bluuebunny/crossref_metadata_2025_split huggingface dataset:
Persistence ofSalmonellaEnteritidis Phage Type 4 in the environment and arthropod vectors on an empty free‐range chicken farm
Authors: Davies Robert H. , Breslin Mark 
Published: March 2003

SummaryThe persistence ofS.Enteritidis PT4 was studied on a free‐range breeding chicken farm which had been depopulated following identification of the organism in breeding birds. The site was sampled periodically for 26 months after depopulation and the organism was found to persist in litter, dried faeces and feed, but not in dust within empty poultry houses, for the whole of that period.SalmonellaEnteritidis PT4 was also found in soil samples after 8 months but not 13 months and in faeces from wild mice, foxes and cats but not wild birds or badgers. The organism was also found in adult and larval forms of ground beetles and centipedes. Addition of pullets to a contaminated pen or inclusion of contaminated litter, feed or beetles/larvae to feed did not result in acquisition of infection by birds.
Delays experienced by patients with symptomatic colorectal cancer
Authors: Wheeler  , Wakefield  , Mortensen N. J. McC. , Kettlewell  
Published: March 2003

ObjectiveTo measure delays in diagnosis and treatment of colorectal cancer (CRC), assessing changes since a similar study in 1979. To ascertain whether modern diagnostic techniques have improved Dukes' staging at treatment.Patients and methodsProspective data collection. All patients diagnosed with CRC at the Oxford Radcliffe Hospital between January 1994 and January 1995 were questioned about their symptoms. Delays between symptom onset and definitive treatment were measured.ResultsOn average, patients with colonic carcinoma consulted their general practitioner (GP) 9.6 weeks after symptom onset, whereas those with rectal carcinoma waited 20.8 weeks. GP referral accounted for an average 6.7 and 5.0 week delay for colonic and rectal cancers, respectively. Waiting for out‐patient appointments accounted for an average delay of 4.6 weeks for both. Those with non‐specific referrals waited an average of 9.0 weeks against 2.0 weeks when GPs mentioned CRC. There was an average 7·7 week delay for treatment of colonic cancer, and 6·3 weeks for rectal cancer. Pre‐hospital delays compared favourably with 1979, but post‐referral delays were longer. Total delay was unchanged in 15 years, and there was no improvement in Dukes' staging.ConclusionDespite prompt GP consultation and out‐patient referral, delays in the treatment of CRC now occur after referral to hospital. Patients referred without mention of CRC wait longest. Colonoscopy and double contrast barium enema have not improved tumour staging at treatment.
A comparison of function and patient satisfaction after restorative proctocolectomy for ulcerative colitis (UC) and familial adenomatous polyposis (FAP)
Authors: Körsgen  , Keighley  
Published: March 2003

ObectiveFunction after restorative proctocolectomy for UC and FAP varies. We assessed function, satisfaction and social activity in patients with ileal pouch‐anal anastomosis and explored possible factors associated with poor function.Patients and methodsWe reviewed all case notes and sent postal questionnaires to 145 patients (121 UC, 24 FAP).ResultsOne hundred and twenty questionnaires were returned (98 UC and 22 FAP). The complication rate, particularly pouch failure, was higher in the UC group (UC 18·8%, FAP 8%). Functional outcome was similar: 74% of UC patients and 68% of FAP patients had an acceptable result. Although social activity was similar in the UC and FAP groups, satisfaction with the outcome was much less in the FAP group.ConclusionPatients, particularly with FAP, who are asymptomatic need to be told about the functional outcome they can expect, particularly bowel frequency and soiling. Restorative proctocolectomy may not be the best option for all FAP patients.
A multivariate analysis of the factors associated with wound infection after colorectal surgery
Authors: Platell  , Hall  , Hall  
Published: March 2003

ObjectivesWound infection has been proposed as a key indicator of clinical outcome after colorectal surgery. The aim of this study was to identify risk factors that were associated with wound infections in patients undergoing either emergency or elective colonic resections.Patients and methodsWe prospectively evaluated 251 patients admitted to Royal Perth Hospital over a 12‐month period. All patients received prophylactic peri‐operative antibiotics and were reviewed for 6 weeks post‐operatively. Wound infection was defined as either the presence of pus or a serous discharge containing pathogenic bacteria. We evaluated the relationship between 40 independent variables and the incidence of wound infection.ResultsThere were 124 males and 127 females, of median age 68 years (range 14–90 years). The overall incidence of wound infection was 12%. Multiple logistic regression identified the presence of shock (odds ratio (OR) 14.6, P=0.05), atelectasis (OR 3.9, P=0.02), and number of days on antibiotics before surgery (OR 1.2, P=0.02) as significant independent variables.ConclusionThese results suggest that the factors which were most often associated with wound infection were those that are indicative of either extensive disease or poor general health. The presence of a stoma and colonic perforation were not strong independent associations with wound infection.
Complacency or ignorance about rectal bleeding?
Authors: Kocher  , Saunders  
Published: March 2003

ObjectiveThe aim is to assess the importance that patients attach to their symptoms of rectal bleeding and their perception of its possible causes.Patients and methodsPatients referred by their general practitioner (GP) to the Surgical Out‐patients Clinic with a history of rectal bleeding were asked to fill in a questionnaire about the symptoms and their perceptions of the complaint. Data on 104 (61 female, 43 male) consecutive patients between the ages of 17 and 88 years are presented.ResultsFifty‐eight (55.8%) patients had experienced rectal bleeding on at least one previous and unrelated occasion, many (n=32) patients experienced it multiple times. However, only two‐thirds (n=36) of patients immediately sought advice. Embarrassment, non‐importance or ‘that the bleeding stopped too quickly’ were the most cited reasons for delay. Increasing personal concern (66.3%), the development of accompanying symptoms (16.3%), persistent bleeding (9.6%), or the bleeding becoming a nuisance (3.8%), prompted medical advice. Seventy‐five percent of patients were immediately referred on by their GP. Only 46 (44.2%) patients associated rectal bleeding with cancer of the large bowel. Haemorrhoids (piles) was most frequently acknowledged (92 patients or 88.5%). Anal fissure, polyps, colitis, and diverticulosis were also recognized causes.ConclusionImproved health information relating to colorectal cancer, perhaps in a more direct symptom format reflecting the importance of rectal bleeding, is necessary to reduce patient complacency.
Thrombospondin in colorectal disease
Authors: Behzad  , Abdalla  , Gardy  , Battrick  , Kumar  , Haboubi  
Published: March 2003

ObjectiveTo assess the presence of thrombospondin (TSP) in normal and colonic disease and correlate its presence to survival in colorectal cancers.Materials and methodsA specific antibody was used to stain paraffin‐embedded sections of human colorectal disease (103 carcinomas, 10 inflammatory bowel disease (IBD), 10 diverticulosis and 10 normal). The stained sections were viewed by light microscopy and the degree of staining was quantified using computer‐assisted image analysis system.ResultsSeventy‐three percent of carcinomas, 30% of IBD and 80% of the diverticulosis specimens stained for TSP. None of the ‘normal’ specimens examined showed any staining. No significant correlation could be detected between TSP expression and survival in colorectal cancer patients.ConclusionThe presence of TSP in the colon is not specific and merely indicates the presence of a disease process.
Should air contrast computed tomography become the first investigation of the colon of frail or elderly patients?
Authors: Murray D. , Hellawell G. , Oakley R. , Rosenfeld K. , Al‐Mufti R. A. M. , Lewis A. A. M. , Berger L. A. 
Published: March 2003

ObjectiveAir contrast computed tomography (ACCT) is an alternative test to barium enema or colonoscopy. We review our experience of this test as the first investigation of frail, elderly patients with lower gastrointestinal symptoms, and record the subsequent clinical course of these patients to evaluate the efficacy of the technique.Patients and methodsWe performed 109 ACCT studies on frail patients aged 70 years or over with lower gastrointestinal symptoms. The findings were correlated with subsequent investigations and surgical findings. Patients with normal scans were followed up in out‐patients or by their GP. Average follow up was 17 months.ResultsA good quality complete examination of the colon was achieved in 97% of patients. Of 109 examinations 34 (31%) were reported as normal, 65 (60%) as diverticular disease, nine (8%) as demonstrating a colonic malignancy and one (1%) showed a benign polyp. One sigmoid tumour was missed initially but diagnosed on a repeat ACCT study.ConclusionACCT is a reliable, well‐tolerated technique in elderly frail patients.
Identifying rectal carcinoma with distal submucosal spread
Authors: Kraemer  , Seow‐Choen  , Ho  , Eu  , Ho  
Published: March 2003

ObjectiveThis study was designed to find features that would preoperatively identify a high risk of distal submucosal spread in patients with rectal carcinoma.Patients and methodsThe resected specimens of 124 patients with rectal carcinoma were prospectively examined for submucosal spread. The results were correlated with patho‐anatomical, histological, and operative findings.ResultsThere were 64 male and 60 female patients with a mean age of 62 years. Distal submucosal spread was detected in four (3%) patients, all with Dukes’ C or disseminated carcinoma and macroscopic and microscopic signs of advanced and aggressive tumour growth. In particular, all cases had advanced lymph node involvement (N3, P=0.0005) and all tumours were classified as poorly differentiated (P=0.0002). The presence of both features gave a 31% chance of distal submucosal spread in our series.ConclusionDistal submucosal tumour spread is associated with poorly or undifferentiated tumours and advanced lymph node involvement. Preoperative identification of patients at risk of distal submucosal spread requiring more extensive distal clearance is possible.
Comparison of micronutrients in patients having had panproctocolectomy and either ileal pouch anal anastomosis or Brooke ileostomy for chronic ulcerative colitis (UC)
Authors: Whineray E. , Inder W. J. , Roche D. , Dobbs B. R. , Frizelle F. A. 
Published: March 2003

ObjectivePatients having panproctocolectomy undergo major metabolic changes. A recent study suggested that patients who have had a panproctocolectomy and ileal pouch‐anal anastomosis (IPAA) may be trace element‐deficient, while other recent evidence has suggested a gradual decrease in vitamin B12. This study was undertaken to compare patients who had a panproctocolectomy for UC in combination with either an IPAA or a Brooke ileostomy (BI), and to determine whether the type of surgery post‐proctocolectomy influences the absorption of trace elements, as well as comparing the levels after both operations with the normal population values.Patients and methodsOne hundred randomly selected patients who had had a panproctocolectomy for UC (50 IPAA, 50 BI) were invited to take part in the study by letter. The patients who consented had blood taken for haemoglobin, serum iron, ferritin, serum folate, red cell folate, vitamin B12, insulin‐like growth factor‐1 (IGF‐1), albumin, and the trace elements copper, magnesium, manganese, selenium, and zinc.ResultsOf the 100 patients, 46 consented to participate in the study (23 IPAA, 23 BI). The age of the BI group was significantly higher than those of the IPAA group (mean age IPAA 44 years, BI 52 years, P < 0.05). There was no significant difference between the two groups with respect to time since operation, mean levels of haemoglobin, iron indices, albumin, serum and red cell folate, vitamin B12, or any of the trace elements examined. Plasma IGF‐1 was higher in the IPAA group, but this was no longer significant when adjusted for age.ConclusionNo difference was found in trace element status in patients who had had a panproctocolectomy for UC with either an IPAA or BI. Furthermore, no difference existed between these two groups.
Patient quality of life after successful restorative proctocolectomy is normal
Authors: Richards D. M. , Hughes S. A. , Irving M. H. , Scott N. A. 
Published: March 2003

ObjectiveTo measure quality of life (QoL), using validated health status instruments, of patients with functioning IPAA for CUC.Patients and methodsBetween 1986 and 1997, a total of 77 patients had an IPAA. Thirteen patients were excluded [6 excised, 3 awaiting ileostomy closure, 2 lost to follow up, 2 serious unrelated illnesses]. Postal survey using SF36 and EuroQol questionnaires. Age, sex, year of pouch construction and stool frequency were documented.ResultsFifty‐six patients (87.5%) replied. Male:female ratio; 3:2. Median age; 34 years (range 13–64). Median time since pouch construction; 4 years (range 1–10 years). Median SF36 scores (range); physical function 86.6 (0–100), physical role 81.6 (0–100), body pain 78.4 (22–100), general health 61.6 (5–100), vitality 57.6 (5–100), social function 75.4 (25–100), emotional role 83.5 (0–100), mental health 70.7 (16–100). All the SF36 scores were within the normal range, as were the EuroQol scores. Median EuroQol score (range); 0.85 (−0.07–1.0). Median EuroQol thermometer score (range); 83.3 (20–100). There was no correlation between objective QoL score and age, gender, stool frequency and year of pouch construction.ConclusionThe QoL for patients with a functioning IPAA for CUC measured using validated health status instruments is normal. Age, gender, stool frequency and year of construction do not affect QoL outcome after the IPAA for ulcerative colitis.
Is routine histological reporting of doughnuts justified after anterior resection for colorectal cancer?
Authors: Pullyblank A. M. , Kirwan C. , Rigby H. S. , Dixon A. R. 
Published: March 2003

Objective‘Doughnuts’ of colonic tissue which remain on a circular stapler after firing are routinely examined histologically. However, Royal College of Pathologists’ guidelines state that this is not necessary. The aim of this study was to examine current practice among pathologists in one region in the UK and to determine the incidence of clinically significant pathology within colonic doughnuts.MethodsCurrent practice in all pathology Departments within the South‐west Region was examined and 100 doughnuts from anterior resection specimens were reviewed for the presence of abnormal pathology.ResultsPractice varied between hospitals with only 15% following guidelines for examination of doughnuts and 38% following guidelines for reporting of resection margins. Review of pathology specimens demonstrated no incidence of colonic adenocarcinoma in a doughnut. Benign pathology was present in 9% and dysplasia in 3% but in no case was patient management altered as a result of the pathology report.ConclusionApplication of recommended guidelines is inconsistent. We have demonstrated a low incidence of clinically significant pathology in doughnuts and more economical guidelines could therefore be safely applied without detriment to patient care.
Colorectal subspecialization in a DGH. The way forward!
Authors: Shankar P. J. , Achuthan R. , Haray P. N. 
Published: March 2003

AimsTo audit all aspects of the diagnosis and management of colorectal cancers by a specialist unit within a District General Hospital (DGH). To compare the clinical effectiveness of the specialist service with the service prior to specialization and attempt to assess the feasibility of setting up such a service within the constraints imposed by a DGH.Materials and methodsData for this study was collected prospectively over a 3‐year period from July 1997 to June 2000 since the establishment of a specialist colorectal service. The results so obtained have been compared with the Trent and Wales audit of 1993 as well as with the guidelines issued by the Royal College of Surgeons of England and the Association of Colo‐proctologists of Great Britain and Ireland. We have attempted to evaluate whether specialization has altered the outcome for patients with colorectal cancer.ResultsA total of 2181 patients were seen at the specialist colorectal clinic and 42% underwent immediate flexible sigmoidoscopy. A total of 241 colorectal cancers were diagnosed during this period by the specialist unit, of which the rapid access clinic had picked up 191 (a pick‐up rate of 8.75%). The mean age of patients with colorectal cancer was 69.23 years and the median waiting time from referral to clinic and from referral to treatment was 9 days and 24 days, respectively. These compare favourably with the waiting times prior to specialization. 117 rectal cancers were diagnosed of whom 32 (32%) underwent APER. A selective approach to short course preoperative radiotherapy resulted in 24% of rectal cancer patients receiving this treatment. The CRM was positive in 14% of resected rectal cancers, all of whom had received preoperative radiotherapy. The percentage of patients with Dukes’ stage A disease has risen from 11% in 1993 to 23% and the percentage of patients undergoing emergency surgery have fallen from 29% in 1993 to 8.2%. The rate of permanent stoma formation has also decreased from 52% to 32%. This audit has also confirmed that the guidelines for the management of colorectal cancers were all being met or exceeded.ConclusionThe study demonstrates that, even within the constraints of a DGH, a specialist service can result in earlier diagnosis, shorter waiting periods and judicious use of adjuvant treatment leading to improved clinical effectiveness. It is possible to deliver a high quality service, which meets, and in some areas, surpasses the minimum guidelines, provided there is an integrated multidisciplinary approach.
The role of anal ultrasound in the management of anal fistulas
Authors: Lindsey I. , Humphreys M. M. , George B. D. , Mortensen N. J. M. C. 
Published: March 2003

ObjectiveTo assess the accuracy of anal ultrasound (AUS) for anal fistulas, and the impact of routine pre‐operative AUS on their surgical management.MethodsPre‐operative AUS was performed in 38 consecutive patients with an anal fistula using a 10‐MHz Brüel & Kjaer probe. All patients underwent subsequent examination under anaesthetic (EUA) with documentation of the anatomy of the fistula before the surgeon was shown the AUS results. Agreement between AUS and EUA findings and any modification to the surgical treatment was recorded.ResultsThere was 84% agreement between AUS and EUA findings regarding presence and site of fistulas. One fistula not seen at AUS was found at EUA, and 5 fistulas seen on AUS were not demonstrated at EUA. AUS influenced the surgery undertaken in 9/24 (38%) patients; demonstrating occult sphincter defects (2 patients), reclassifying fistulas from low to higher fistulas (3 patients), deciding a surgical treatment open to doubt (2 patients) and helping identify an obscure fistula not initially found at EUA (2 patients).ConclusionsAccuracy of AUS in the assessment of anal fistulas is confirmed. Operative management is influenced in 38% of cases, usually towards more conservative treatment. We recommend the use of pre‐operative AUS in the assessment of anal fistulas.
Screening sigmoidoscopy in persons aged 60 years
Authors: Santavirta J. 
Published: March 2003

ObjectiveTo reduce mortality associated with colorectal cancer, an increased interest has focused in recent years on screening of colorectal cancer. No studies of colorectal cancer screening in Finland has been reported. A pilot study of screening sigmoidoscopy was started in 1994 and the results are presented in this paper.Subjects and methodsBetween March 1994 and May 2000 all 1224 persons aged 60 years from four communities (population 15 400) were invited to screening sigmoidoscopy; 896 (73%) took part in this study. The screening procedure was flexible sigmoidoscopy to 60 centimetres. All the patients who had adenomas or cancers, were invited to have a double contrast barium enema (DCBE) or colonoscopy to investigate the proximal colon. To study the experience of persons undergoing screening sigmoidoscopy, a questionnaire was sent to 81 consecutive persons after the examination. Sixty persons (74%) returned the filled‐in questionnaire.ResultsHyperplastic polyps were found in 136 people (15.2% of the whole material). Hyperplastic polyps were more common in males than females (19.3% and 11.4%, respectively, P=0.0015). People with hyperplastic polyps had the same rate of neoplasia as people without. Neoplastic lesions were found in 65 people. Adenomas were found in 62 patients (6.9%). Twenty‐five people (2.8%) had at least one advanced adenoma (>10 mm or villous component). The rate of advanced adenomas in males was 4.9% and in females 0.9% (P=0.0006). Three patients (0.3%) were found to have colorectal cancer. Of 43 diabetic patients, 7 (16.3%) had adenomas whereas 6.5% of the non‐diabetic persons had adenomas (P=0.03). The proximal colon was investigated in 34 patients by DCBE and/or colonoscopy and the rate of proximal adenomas in patients with neoplastic findings in screening sigmoidoscopy was 5/34 (14.7%). Concerning the experience of screening sigmoidoscopy, 56 persons (93%) found bowel preparation easy and 4 unpleasant, 55 (92%) experienced either no or mild discomfort during the endoscopy whereas 5 found the examination painful; 59 people (98%) said that they would participate again in screening sigmoidoscopy.ConclusionsIn this study of screening sigmoidosopy, the first published in Finland, adenoma rate was 6.9%, advanced adenoma rate was 2.8% and cancer rate was 0.3%. Males had more hyperplastic polyps and advanced adenomas than females. Diabetic people had more adenomas than non‐diabetics. Experiences of the people screened were positive and nearly all said that they would participate again in screening sigmoidoscopy.
Outcome of argon beam and LASER ablation of large rectal adenomas
Authors: Adedeji O. A. , Allison S. I. , Varma J. S. 
Published: March 2003

ObjectiveEndoscopic ablation of large rectal adenomas is being increasingly used as primary treatment. Despite the avoidance of general anaesthesia and the prevention of more major procedures, patients undergoing endoscopic ablation have the disadvantage of multiple treatment sessions and the lack of adequate tissue sample for complete histological study. The aim of this study was to analyse the outcome of all patients with large rectal polyps treated with endoscopic ablation.Patients and methodsBetween 1993 and 1998, 29 patients who underwent endoscopic ablation of large rectal adenoma were identified. All their case notes were analysed and information was collected on recurrence, treatment episodes, complications, the incidence of carcinoma and the necessity for further procedures.ResultsAt a median 40 (range 4–67) months follow‐up, 41% of patients had recurrence of their adenoma and 14% had been diagnosed with adenocarcinoma. Only 24% of patients had been discharged while 21% were clear but were still under surveillance. Seven (24%) patients had complications, 6 stenosis and one severe bleeding. All stenosis occurred in patients who had more than 10 treatment sessions. In all, 31% of patients needed further endoanal or abdominal surgery and the median time to making this decision was 28 (range 4–66) months. There were no deaths.ConclusionLaser and argon ablation of large rectal adenomas has proved very disappointing. It should be reserved for patients who are unfit to undergo general anaesthesia.