Showing papers by "Jeffrey W. Milsom published in 1990"
TL;DR: Intrarectal ultrasonography appears to be the most accurate imaging technique for staging rectal cancers and demonstrates promise in the evaluation of perirectal-pelvic disease.
Abstract: Accurate preoperative staging of a rectal cancer patient may impact heavily on subsequent management. This study attempts to evaluate the accuracy of intrarectal ultrasonography (IRUS) in staging rectal cancers compared to clinical and pathologic examination. In addition the accuracy of IRUS was assessed in a group of patients with uncertain pelvic-perirectal disease after a negative physical examination. In a prospective manner, 52 cancer patients were staged with digital exam and IRUS. Accuracy rates were 48% and 83%, respectively, compared to pathologic evaluation in assessing wall penetration, and IRUS identified positive lymph nodes in 12 of 17 cases. In patients with pelvic disease, IRUS corresponded with pathologic diagnosis in 15 of 17 cases and revealed new information in 6 patients. Intrarectal ultrasonography appears to be the most accurate imaging technique for staging rectal cancers and demonstrates promise in the evaluation of perirectal-pelvic disease.
91 citations
TL;DR: Results indicate that, although laser Doppler velocimetry and intramural pH measurements provide safe, easy techniques for assessing the effects of ischemia on the colorectal anastomosis, measurement of intramur pH provides an optimal quantitative method for predicting subsequent anastsomotic outcome and tissue viability.
Abstract: Leakage and stenosis are serious complications of gastrointestinal anastomotic surgery that may, in part, be related to local ischemia. The ability to accurately quantitate the degree of gastrointestinal anastomotic ischemia remains a challenging clinical problem. The purpose of this study was to: 1) develop a model of colorectal anastomotic stenosis following local ischemia; 2) compare the accuracy of laser Doppler velocimetry and intramural colonic pH in quantitating critical levels of intestinal anastomotic ischemia; and 3) compare the anastomotic healing process using either a standard two-layer Czerny-Lembert handsewn or EEA™ stapled anastomotic technique under ischemic conditions. The studies reported here were performed in two phases. Phase I was the pilot study in which the authors developed a model of colorectal anastomotic ischemia and defined critical levels of ischemia using laser Doppler velocimetry and intramural pH (≤200 mV; ≤7.0, respectively). These parameters were then tested prospectively in Phase II, assessing the effects of anastomotic ischemia on animals kept alive for 5, 11, 21, and 60 days after surgery. Overall there was a 70 percent incidence of anastomotic healing complications in the Phase II trial with laser Doppler velocimetry correctly predicting anastomotic outcome in 70 percent of cases and tissue pH in 93 percent of cases. The results indicate that, although laser Doppler velocimetry and intramural pH measurements provide safe, easy techniques for assessing the effects of ischemia on the colorectal anastomosis, measurement of intramural pH provides an optimal quantitative method for predicting subsequent anastomotic outcome and tissue viability.
51 citations
TL;DR: Patients with preservation of the transitional zone of the anal canal have less leakage and less need to wear pads than patients who have had mucosectomy and other factors affecting continence and stool frequency, such as diet, antidiarrheal medications, stool consistency and compliance, were found to be unrelated factors.
Abstract: Patients with preservation of the transitional zone of the anal
canal have less leakage and less need to wear pads than patients who have had
mucosectomy. There is a significant difference in mean maximum resting pressure
between patients that have had anal transitional zone preservation and
mucosectomy. With preservation of the anal transitional zone, a mean maximum
resting pressure of 57.6±3.8 mmHg was obtained compared with 47.3±4 mmHg
in the mucosectomy group. Preservation of the resting pressure is dependent on
preservation of internal anal sphincter integrity. The integrity of the sphincter
is injured during mucosectomy due to anal dilation. Other factors affecting
continence and stool frequency, such as diet, antidiarrheal medications, stool
consistency and compliance, when examined were found to be unrelated factors.
17 citations
TL;DR: This symposium brings together surgeons from hospitals with large HIV-positive populations to discuss some of the more frequent problems which arise in management of anorectal disease in HIV- positive patients.
Abstract: Moderator: Mr. Allen-Mersh: Anorectal disease is the most frequent reason for surgical referral of HIV-positive patients in our hospital [1]. In the UK the incidence of anorectal disease is about 14-fold more common in HIV-positive male homosexuals than in the age and sex-matched general population. This is due to the combination of immune deficiency with the sexually transmitted diseases associated with anoreceptive intercourse. Surgeons within inner city hospitals have gradually learned how to manage these conditions from experience over the past decade of the HIV epidemic. This symposium brings together surgeons from hospitals with large HIV-positive populations to discuss some of the more frequent problems which arise in management of anorectal disease in HIV-positive patients. We start by discussing staff safety when treating HIV-positive patients, and go on to consider management of the more common anorectal conditions associated with these patients.
14 citations