1
|
Steele RJC, Carey FA, Stanners G, Lang J, Brand J, Brownlee LA, Crichton EM, Winter JW, Phull PS, Mowat C, Strachan JA, Digan AM, Fraser CG. Randomized controlled trial: Flexible sigmoidoscopy as an adjunct to faecal occult blood testing in population screening. J Med Screen 2019; 27:59-67. [DOI: 10.1177/0969141319879955] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Objectives Flexible sigmoidoscopy screening at around age 60 can reduce colorectal cancer incidence. Insufficient evidence exists on flexible sigmoidoscopy at age 60 in a population being offered biennial faecal occult blood test screening from age 50. This randomized controlled trial assessed if flexible sigmoidoscopy would be an effective adjunct to faecal occult blood test. Methods In the Scottish Bowel Screening Programme between June 2014 and December 2015, 51,769 individuals were randomized to be offered flexible sigmoidoscopy instead of faecal occult blood test at age 60 or to continue faecal occult blood test. Those not accepting flexible sigmoidoscopy and those with normal flexible sigmoidoscopy were offered faecal occult blood test. All with flexible sigmoidoscopy-detected neoplasia or a positive faecal occult blood test result were offered colonoscopy. Results Overall flexible sigmoidoscopy uptake was 17.8%, higher in men than women, and decreased with increasing deprivation (25.7% in the least to 9.2% in the most deprived quintile). In those who underwent flexible sigmoidoscopy, detection rate for colorectal cancer was 0.13%, for adenoma 7.27%, and for total neoplasia 7.40%. In those who underwent colonoscopy after a positive flexible sigmoidoscopy, detection rate for colorectal cancer was 0.28%, adenoma 8.66%, and total neoplasia 8.83%. On an intention to screen basis, there was no difference in colorectal cancer detection rate between the study and control groups. Adenoma and total neoplasia detection rate were significantly higher in the study group, with odds ratios of 5.95 (95%CI: 4.69–7.56) and 5.10 (95%CI: 4.09–6.35), respectively. Conclusions In a single screening round at age 60, there was low uptake and neoplasia detection rate. Flexible sigmoidoscopy detected significantly more neoplasia than faecal occult blood test alone.
Collapse
Affiliation(s)
- Robert JC Steele
- Centre for Research into Cancer Prevention and Screening, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
- Scottish Bowel Screening Centre, NHS Tayside, Kings Cross Hospital, Dundee, UK
| | - Francis A Carey
- Department of Pathology, Ninewells Hospital and Medical School, Dundee, UK
| | - Greig Stanners
- Quality Indicators, NHS National Services Scotland, Glasgow, UK
| | - Jaroslaw Lang
- Quality Indicators, NHS National Services Scotland, Glasgow, UK
| | - Jess Brand
- National Specialist and Screening Services Directorate, Edinburgh, UK
| | - Linda A Brownlee
- Scottish Bowel Screening Centre, NHS Tayside, Kings Cross Hospital, Dundee, UK
| | - Emilia M Crichton
- Public Health Directorate, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Jack W Winter
- Department of Gastroenterology, Glasgow Royal Infirmary, Glasgow, UK
| | - Perminder S Phull
- Department of Digestive Disorders, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Craig Mowat
- Department of Gastroenterology, NHS Tayside, Ninewells Hospital and Medical School, Dundee, UK
| | - Judith A Strachan
- Department of Blood Sciences and Scottish Bowel Screening Laboratory, NHS Tayside, Ninewells Hospital and Medical School, Dundee, UK
| | - Ann-Marie Digan
- Scottish Bowel Screening Centre, NHS Tayside, Kings Cross Hospital, Dundee, UK
| | - Callum G Fraser
- Centre for Research into Cancer Prevention and Screening, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
| |
Collapse
|
2
|
Naismith GD, Smith LA, Barry SJE, Munro JI, Laird S, Rankin K, Morris AJ, Winter JW, Gaya DR. A prospective evaluation of the predictive value of faecal calprotectin in quiescent Crohn's disease. J Crohns Colitis 2014; 8:1022-9. [PMID: 24566170 DOI: 10.1016/j.crohns.2014.01.029] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2013] [Revised: 01/30/2014] [Accepted: 01/31/2014] [Indexed: 02/08/2023]
Abstract
BACKGROUND Faecal calprotectin (FC) is a non-invasive marker of gastrointestinal inflammation. AIM To determine whether higher FC levels in individuals with quiescent Crohn's disease are associated with clinical relapse over the ensuing 12 months. METHODS A single centre prospective study was undertaken in Crohn's disease patients in clinical remission. The receiver operating characteristic (ROC) curve for the primary endpoint of clinical relapse by 12 months, based on FC at baseline, was calculated. Kaplan-Meier curves of time to relapse were based on the resulting optimal FC cutoff for predicting relapse. RESULTS Of 97 patients recruited, 92 were either followed up for 12 months without relapsing, or reached the primary endpoint within that period. Of these, 10 (11%) relapsed by 12 months. Median FC was lower for non-relapsers, 96 μg/g (IQR 39-237), than for relapsers, 414 μg/g (IQR 259-590), (p=0.005). The area under the ROC curve to predict relapse using FC was 77.4%. An optimal cutoff FC value of 240 μg/g to predict relapse had sensitivity of 80.0% and specificity of 74.4%. Negative predictive value was 96.8% and positive predictive value was 27.6%, FC ≥240 μg/g was associated with likelihood of relapse by 12-months 12.18 (95% CI 2.55-58.2) times higher than lower values (p=0.002). CONCLUSIONS In this prospective dataset, FC is a useful tool to help identify quiescent Crohn's disease patients at a low risk of relapse over the ensuing 12 months. FC of 240 μg/g was the optimal cutoff in this cohort.
Collapse
Affiliation(s)
- Graham D Naismith
- Department of Gastroenterology, Glasgow Royal Infirmary, Glasgow, United Kingdom.
| | - Lyn A Smith
- Department of Gastroenterology, Glasgow Royal Infirmary, Glasgow, United Kingdom.
| | - Sarah J E Barry
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom.
| | - Joanna I Munro
- Department of Gastroenterology, Glasgow Royal Infirmary, Glasgow, United Kingdom.
| | - Susan Laird
- Department of Gastroenterology, Glasgow Royal Infirmary, Glasgow, United Kingdom.
| | - Karen Rankin
- Department of Clinical Biochemistry, Glasgow Royal Infirmary, Glasgow, United Kingdom.
| | - Allan J Morris
- Department of Gastroenterology, Glasgow Royal Infirmary, Glasgow, United Kingdom.
| | - Jack W Winter
- Department of Gastroenterology, Glasgow Royal Infirmary, Glasgow, United Kingdom.
| | - Daniel R Gaya
- Department of Gastroenterology, Glasgow Royal Infirmary, Glasgow, United Kingdom.
| |
Collapse
|
3
|
Naismith GD, Smith LA, Barry SJE, Munro JI, Laird S, Rankin K, Morris AJ, Winter JW, Gaya DR. A prospective single-centre evaluation of the intra-individual variability of faecal calprotectin in quiescent Crohn's disease. Aliment Pharmacol Ther 2013; 37:613-21. [PMID: 23347334 DOI: 10.1111/apt.12221] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2012] [Revised: 11/16/2012] [Accepted: 01/03/2013] [Indexed: 12/13/2022]
Abstract
BACKGROUND As a non-invasive marker of gastrointestinal inflammation, faecal calprotectin (FC) is being increasingly used to guide the management of Crohn's disease. It is therefore a concern that studies have shown variability in day to day levels. AIM To determine the degree of this intrapersonal variability in the context of quiescent Crohn's disease. METHODS A single-centre prospective study was undertaken in 143 Crohn's disease patients in clinical remission. Three faecal calprotectin levels were analysed from stool samples on consecutive days. Consistency of faecal calprotectin levels was determined by measuring the intraclass correlation (ICC). Due to higher variability at higher faecal calprotectin levels, the ICC was calculated for the log-transformed values. The reliability of detecting a 'case' of active inflammation as defined for specific concentrations of faecal calprotectin was measured by the kappa statistic. RESULTS Ninety-eight complete sets of results were obtained. The ICC was 0.84 (95% CI: 0.79-0.89), which represents low variability across samples. The kappa statistic for the reliability of detecting a case as defined by an FC level of >50 μg/g was substantial at 0.648 (0.511-0.769). CONCLUSIONS Day to day variability of faecal calprotectin is low in our cohort of quiescent Crohn's disease patients and the reliability of defining a 'case' is moderately good. These data provide reassurance to clinicians using a single calprotectin sample to inform therapeutic strategies in this cohort.
Collapse
Affiliation(s)
- G D Naismith
- Department of Gastroenterology, Glasgow Royal Infirmary, Glasgow, UK
| | | | | | | | | | | | | | | | | |
Collapse
|
4
|
Winter JW, Gaffney D, Shapiro D, Spooner RJ, Marinaki AM, Sanderson JD, Mills PR. Assessment of thiopurine methyltransferase enzyme activity is superior to genotype in predicting myelosuppression following azathioprine therapy in patients with inflammatory bowel disease. Aliment Pharmacol Ther 2007; 25:1069-77. [PMID: 17439508 DOI: 10.1111/j.1365-2036.2007.03301.x] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Myelosuppression occurs in 2-7% of inflammatory bowel disease (IBD) patients treated with azathioprine, and can be associated with reduced activity of thiopurine methyltransferase (TPMT) in some patients. It has been proposed that pretreatment assessment of TPMT status reduces the incidence of toxicity and is cost-effective. AIMS To determine if screening for TPMT status predicts side-effects to azathioprine in patients with IBD and to ascertain whether screening by TPMT enzyme activity or genotype is superior. METHODS Sequential IBD patients were identified and azathioprine tolerance recorded. Blood was collected for measurement of TPMT activity and TPMT*3C, TPMT*3A and TPMT*2 genotypes. RESULTS Of 130 patients, 25% stopped azathioprine because of toxicity. Four patients experienced severe myelosuppression (WCC < 2). Eleven of 17 patients with reduced TPMT activity were heterozygotes, including one patient with marked TPMT deficiency who experienced severe myelosuppression. There was no association between intermediate TPMT deficiency and any side-effect. CONCLUSIONS Moderate reduction of TPMT activity in heterozygotes was not associated with toxicity, but very low TPMT activity caused severe myelosuppression in one patient. This would have been predicted by measuring TPMT activity but not by genotyping. Measurement of TPMT activity may therefore be superior to genotype in predicting severe myelosuppression.
Collapse
Affiliation(s)
- J W Winter
- Gastroenterology Unit, Gartnavel General Hospital, Glasgow, UK.
| | | | | | | | | | | | | |
Collapse
|
5
|
Kanowski J, Irvine AK, Winter JW. The relationship between the floristic composition of rain forests and the abundance of folivorous marsupials in north-east Queensland. J Anim Ecol 2003; 72:627-632. [PMID: 30893968 DOI: 10.1046/j.1365-2656.2003.00733.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Three species of folivorous ringtail possums (Marsupialia: Pseudocheiridae) inhabit higher elevation rain forests on the Atherton Tablelands, north-east Queensland, Australia. Each possum is thought to specialize on a restricted suite of host plants. It has been hypothesized that the absence of the possums from lowland forests may reflect the absence or 'inappropriate combination' of their host plants in lowland forests. We test this 'floristics hypothesis' using data from published dietary studies, herbarium records and field surveys. Studies of the possums' diets show that each possum eats a wide variety of plant species. However, the majority of each possum's diet comes from a few genera or families of plants and there is considerable dietary partitioning between the possums. These data are consistent with the hypothesis that the possums are specialists on a restricted suite of plant taxa. The altitudinal ranges of plants known to be important in the diets of the ringtail possums were compiled from herbarium records. Several plant species eaten by the possums are absent from lowland forests, but all genera and families of plants important in the possums' diets occur in lowland forests. The relationship between the floristic composition of forests and the abundance of the ringtail possums was examined at 16 sites on the Atherton Tablelands. The floristic composition of forests varied primarily with geology and secondarily with altitude. This was true whether the entire plant assemblage was considered, or just those families known to be important in each possum's diet. Possum abundance varied primarily with altitude and secondarily, for two species, with geology. There was no correlation between the abundance of ringtail possums and the floristic composition of forests, whether the entire plant assemblage was considered, or just those families known to be important in each possum's diet. Altitudinal variation in the abundance of ringtail possums in north Queensland does not appear to be a response to variation in the floristic composition of those forests.
Collapse
Affiliation(s)
- J Kanowski
- Rainforest Cooperative Research Centre, Environmental Sciences, Griffith University, Nathan 4111, Australia
| | - A K Irvine
- PO Box 388, Atherton 4883, Australia; and
| | | |
Collapse
|
6
|
Abstract
We retrospectively reviewed 360 consecutive cholecystectomies done by the four surgeons in our private group practice. No patient had dehiscence of the wound or evisceration. One patient had a seroma, which was opened in the office, but the fluid contained no white blood cells or bacteria on smear, and the culture was negative. No deaths occurred during the hospitalization or within 30 days after the operation. Routine perioperative antibiotics were used, and most wounds were drained with closed suction drainage. Routine intraoperative cholangiography was also done. On the basis of the favorable morbidity and mortality in this large group of patients and a review of the literature, we recommend the routine use of antibiotics and cholecystectomy for most patients with gallstones.
Collapse
Affiliation(s)
- D Vanderpool
- Department of Surgery, Baylor University Medical Center, Dallas, Tex
| | | | | | | |
Collapse
|
7
|
Vanderpool D, Lane BW, Winter JW, Ettinger J. Choledochal cysts. Surg Gynecol Obstet 1988; 167:447-51. [PMID: 3051462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- D Vanderpool
- Department of Surgery, Baylor University Medical Center, Dallas, Texas
| | | | | | | |
Collapse
|
8
|
Novick DM, Enlow RW, Gelb AM, Stenger RJ, Fotino M, Winter JW, Yancovitz SR, Schoenberg MD, Kreek MJ. Hepatic cirrhosis in young adults: association with adolescent onset of alcohol and parenteral heroin abuse. Gut 1985; 26:8-13. [PMID: 3855296 PMCID: PMC1432410 DOI: 10.1136/gut.26.1.8] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Hepatic cirrhosis is infrequently diagnosed in young adults. In a hospital for addictive diseases in New York City, we found cirrhosis in 53 patients under age 35 within just 40 months. The cirrhosis was biopsy-proven in 37 patients (group I) and diagnosed clinically in 16 patients with severe liver disease (group II). Alcohol abuse was found in 51 patients (96%), and parenteral heroin abuse was seen in 52 (98%). The duration of alcohol abuse was seven or fewer years in 24 patients (45%) and 10 or fewer in 39 (74%). In 44 (83%), the substance abuse began in adolescence. Comparison of group I cirrhotic patients with 65 non-cirrhotic biopsied patients showed that cirrhosis was significantly associated with abuse of both alcohol and parenteral heroin (p less than 0.001). The distribution of 66 HLA antigens from A, B, C, and DR loci showed no differences when 42 patients were compared with 42 ethnically-matched control substance abusers. The early development of cirrhosis in these young patients may be related to multiple hepatic injuries induced by alcohol and parenteral heroin abuse and to the onset of addictive diseases during adolescence or early adult life.
Collapse
|
9
|
Anolik JR, Mildvan D, Winter JW, Puttlitz D, Rubenstein S, Lozman H. Mycotic aortic aneurysm. A complication of Campylobacter fetus septicemia. Arch Intern Med 1983; 143:609-10. [PMID: 6687525 DOI: 10.1001/archinte.143.3.609] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
The first surviving case, to our knowledge, of a Campylobacter fetus mycotic aortic aneurysm is reported. Bacteremia and an ileofemoral thrombophlebitis preceded the development of the infected aneurysm, reconfirming the vascular tropism of this organism. The clinical similarity with infections caused by Salmonella choleraesuis is illustrated by this case. The full recovery of our patient attests to the efficacy of extralanatomic bypass combined with long-term antibiotic therapy in the treatment of aortic mycotic aneurysm. Because of frequent changes in nomenclature and insufficient emphasis on speciation of the various campylobacters, pathogenesis and optimal antimicrobial therapy for systemic C fetus infections have not yet been adequately defined.
Collapse
|
10
|
|
11
|
Abstract
Tooth wear of M1 was used as a method of assessing age during a field study of the social organization of the brush-tailed possum.
Collapse
|
12
|
Ochsner JL, Winter JW, Martin S. Noninvasive vascular laboratory--its place in the study of vascular diseases. J La State Med Soc 1979; 131:295-303. [PMID: 528813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
|
13
|
|
14
|
Mann PH, Bjotvedt G, Winter JW. Survey of poultry, dogs, cats, and monkeys for the presence of Salmonella and Cryptococcus neoformans. Cornell Vet 1966; 56:195-9. [PMID: 4959965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
|
15
|
Winter JW. Improved Plates. Dent Regist 1858; 11:348. [PMID: 33695073 PMCID: PMC6876463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
|