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A cohort study of local excision followed by adjuvant therapy incorporating a contact X-ray brachytherapy boost instead of radical resection in 180 patients with rectal cancer. Colorectal Dis 2019; 21:663-670. [PMID: 30742736 DOI: 10.1111/codi.14584] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Accepted: 01/27/2019] [Indexed: 12/21/2022]
Abstract
AIM Recent data have suggested near-equivalent oncological results when treating early rectal cancer by local excision followed by radio- ± chemotherapy rather than salvage radical surgery. The aim of this retrospective study was to assess the use of contact X-ray brachytherapy within this paradigm. METHOD All patients had undergone local excision and were referred to our radiotherapy centre for treatment with contact X-ray brachytherapy. Postoperative (chemo)radiotherapy was also given in their local hospital in most cases. Variables assessed were local excision method, postoperative therapy received, follow-up duration, disease-free survival, salvage surgery and stoma-free survival. RESULTS In total, 180 patients with a median age of 70 (range 36-99) years were assessed. Following local excision, pT stages were pT1 = 131 (72%), pT2 = 44 (26%), pT3 = 5 (2%). All patients received contact X-ray brachytherapy boosting at our centre and, in addition, 110 received chemoradiotherapy and 60 received radiotherapy alone. After a median follow-up of 36 months (range 6-48), 169 patients (94%) remained free of local recurrence. Of the 11 patients with local recurrence (three isolated nodal), five underwent salvage abdominoperineal excision. Eight patients developed distant disease, of whom five underwent metastasis surgery. At last included follow-up 173 (96%) patients were free of all disease and 170 (94%) were stoma free. CONCLUSIONS Contact therapy can be offered in addition to external beam radio (±chemo) therapy instead of radical surgery as follow-on treatment after local excision of early rectal cancer. This combination can provide equivalent outcomes to radical surgery. The added value of contact therapy should be formally assessed in a clinical trial.
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Book Reviews. Br J Hosp Med (Lond) 2018. [DOI: 10.12968/hmed.2018.79.12.716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Book Reviews. Br J Hosp Med (Lond) 2018. [DOI: 10.12968/hmed.2018.79.9.537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Rapidly Progressive Aortic Incompetence and Coronary Artery Disease in a Patient with Takayasu's Disease. J R Soc Med 2018; 82:625-6. [PMID: 2572701 PMCID: PMC1292344 DOI: 10.1177/014107688908201022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Combined Surgical and Endoscopic Clearance of Small-Bowel Polyps in Peutz-Jeghers Syndrome. J R Soc Med 2017; 96:505-6. [PMID: 14519733 PMCID: PMC544636 DOI: 10.1177/014107680309601013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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A training programme for operating theatre personnel in transanal endoscopic operation procedures for local excision of rectal tumours. J Perioper Pract 2015; 25:105-10. [PMID: 26302591 DOI: 10.1177/175045891502500603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The transanal endoscopic operation (TEO) is a minimal access surgical procedure for the removal of benign and early malignant rectal tumours (Nieuwenhuis et al 2009). This surgery involves specialist equipment, set up and positioning by the perioperative team. We report on and evaluate the first ever TEO course designed specifically for theatre practitioners.
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Multimodality treatment with curative intent for early rectal carcinoma—Long term Clatterbridge(UK) experience. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.15018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Salvage Surgery after Inadequate Combined Local Treatment for Early Rectal Cancer. Clin Oncol (R Coll Radiol) 2007; 19:720-3. [PMID: 17826968 DOI: 10.1016/j.clon.2007.07.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2007] [Accepted: 07/27/2007] [Indexed: 11/22/2022]
Abstract
The outcome of salvage surgery after failed local treatment of early rectal cancer is crucial because it determines the overall survival and therefore influences the initial choice of local therapy. The published results of salvage surgery are controversial and unclear. We treated 220 patients with early rectal cancer between 1992 and 2007 and report our experience of salvage surgery. There was an overall salvage rate of 68% (30/44) and a salvage cure rate of 87% (26/30). Immediate surgical salvage was carried out for incompletely eradicated local disease no longer than 6 months after the completion of treatment and had an 87.5% (21/24) salvage rate with a 90% (19/21) cure rate. Delayed salvage was carried out when local recurrence occurred after an apparent cure was sustained for at least 3 months and was undertaken in nine of 11 (82%) patients with local recurrence alone with an 86% (6/7) cure rate for salvage surgery. These data suggest that salvage surgery is effective management after failed local treatment. These high cure rates may reflect the fact that local recurrence is usually intraluminal after multimodality treatment, as initially involved lymph nodes are often sterilised. Follow-up after initial local treatment must be thorough and intensive, particularly during the first 3 years, in order to identify patients who are suitable for salvage and to enable prompt surgery.
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Combined Modality Treatment of Early Rectal Cancer — the UK Experience. Clin Oncol (R Coll Radiol) 2007; 19:674-81. [PMID: 17888639 DOI: 10.1016/j.clon.2007.07.017] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2007] [Revised: 07/15/2007] [Accepted: 07/29/2007] [Indexed: 01/01/2023]
Abstract
With the introduction of colorectal screening in the UK, more patients will probably be diagnosed with early rectal cancer. The UK has an increasingly elderly population and not all patients diagnosed with early rectal cancer will be suitable for radical surgery. Therefore, a national plan is needed to develop the provision of alternative local treatment with equity of access across the country. Here we review the Clatterbridge Centre for Oncology multimodality treatment policy, which has been in clinical practice since 1993 and we discuss its rationale. Clatterbridge is the only centre in the UK offering Papillon-style contact radiotherapy. In total, 220 patients have been treated over 14 years, most of whom were referred from other centres. One hundred and twenty-four patients received Papillon (contact radiotherapy) as part of their multimodality management. The guidelines of the Association of Coloproctology of Great Britain and Ireland recommend local treatment for T1 tumours<3 cm in diameter, but this refers to treatment by surgery alone. There are no published national guidelines for radiotherapy. We plan each treatment in stages and achieve excellent local control (93% at 3 years) with low morbidity. We conclude that radical local treatment for cure can be offered safely to carefully selected elderly patients. Close follow-up is necessary so that effective salvage treatment can be offered. Because of a lack of randomised trial evidence, at present local radiotherapy is not yet accepted as an alternative option to the gold standard surgical treatment. Even with international collaboration, a randomised trial will be difficult to complete as the number of cases requiring local radiotherapy is small due to the highly selective nature of the treatment involved. However, an observational phase II trial is planned. In addition, the Transanal Endoscopic Microsurgery Users Group is also planning a phase II trial using preoperative radiotherapy. These studies will provide evidence to help establish the true role of radiotherapy in early rectal cancer.
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Long term analysis of recurrences in patients treated by multimodality approach for local treatment of early rectal cancer—Liverpool’s Experience. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.18539] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
18539 Background: Local treatment of early rectal cancer with curative intent is highly controversial. Three years ago, we reported our results in 100 patients treated by multimodality approach. We have updated our results and analyse the pattern of recurrences in155 patients treated up to 2005 Methods: From Jan 1992 to Jan 2005, local treatment was offered to 155 patients with low rectal carcinoma. The majority of patients were elderly with the mean age of 76 years( range 33–101). There were 87 males and 68 females. 109 had surgery; TEM (79 patients) and TAR(30 patients). Forty six patients had radical radiotherapy alone.Locally treated patients were followed up regularly with DRE and sigmoidoscopy. CT and MRI scans were done at 0,12 and 24 months. Results: Local recurrence only occured in 13 patients (8.3%). Four patients had local and distant recurrence (2.5%). Overall local recurrence occured in 17 patients (10.8 %). Salvage surgery was carried out in 11 patients(10 APER and 1 local excision). Two had retreatment with Papillon. A total of 13 patients had salvage treatments (76.5%). At median follow-up of 40 months (range 12–168) only 72.7% of patients were still alive. Five patients (3.2%) developed distant metastases only and one had nodal recurrence. Cancer specific survival was 96% and colostomy free survival was 93%. Conclusions: Local treatment of early rectal cancer is a complex issue that needs to be address and discuss. As ageing populationis likely to increased in the next decade demands on local treatment will increase. It is important to balance the benefits of radical surgery in terms of lower local recurrence against increase mortality and morbidity from such procedures especially in elderly patients, versus slightly higher local recurrences and much lower mortality and morbidity from conservative treatments such as TEM and Papillon contact radical radiotherapy. Our study has shown that local treatment is safe and effective treatment for elderly patients with medical co morbidity. In our experience, salvage surgery can be offered for recurrences in the majority of patients but long term close follow-up is necessary. A careful case selection and multimodality treatment is essential for successful out come. No significant financial relationships to disclose.
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Multi-modality approach in curative local treatment of early rectal carcinomas - 12 years Liverpool experience. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.8274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Intra-abdominal adhesions: an underestimated problem. HOSPITAL MEDICINE (LONDON, ENGLAND : 1998) 2004; 65:326. [PMID: 15222204 DOI: 10.12968/hosp.2004.65.6.13726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
Intra-abdominal adhesions are an invariable consequence of abdominal surgery. Most adhesions are asymptomatic, but a significant proportion of patients develop complications including small bowel obstruction, visceral damage, pain and infertility. The symposium in this issue of Hospital Medicine describes the extent of the problem, its aetiology, management and consequences. Professor Harold Ellis, an internationally recognized authority on adhesions, describes the early history. He describes the first recognition of postoperative adhesions in 1883.
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Combined surgical and endoscopic clearance of small-bowel polyps in Peutz-Jeghers syndrome. J R Soc Med 2003. [PMID: 14519733 DOI: 10.1258/jrsm.96.10.505] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Abstract
OBJECTIVE Despite recent advances, surgery remains the mainstay for the management of rectal carcinoma. The conventional surgical treatment for low rectal carcinoma is total mesorectal excision. This results in either abdomino-perineal excision of the rectum (APER) with permanent colostomy or low anterior resection (LAR) usually with a covering stoma. Local resection is an alternative treatment option and this could be offered either using manual trans-anal resection (TAR) or transanal endoscopic microsurgery (TEM) if the tumour is situated higher. PATIENTS Patient selection is an important factor if local resection is used. No further treatment is necessary for T1 tumours with clear surgical resection margins. Conventional radical surgery should be offered for T1 tumours with close resection margins (<1 mm) or T2 tumours with higher risk of lymph node metastases. Patients were treated by postoperative chemo-radiotherapy or radiotherapy, if further radical surgery was not considered appropriate or if the patient refused further surgery. Using this approach, we describe our experience of 100 patients treated from January 1992 to June 2002. RESULTS Only 13 patients had surgery alone and 87 patients had radiotherapy either pre-operative (33 patients), postoperative (25 patients) or radical radiotherapy alone (29 patients). Local recurrence occurred in 10% of patients and salvage surgery was offered in over half (6 patients) of these patients. At median follow up of 33 months (range 3-120 months), the overall survival was 77% reflecting the fact that the majority of these patients were elderly with coexisting medical problems. However, cancer specific survival was 96%. More importantly, only 9 patients had colostomies and colostomy-free survival in our cohort of patients from Liverpool was 91%. CONCLUSION We concluded that in selected patients, who were not medically fit (ASA 111 or above) or those who were unable to accept a permanent colostomy, local treatment could be offered with curative intent using a multimodality approach. In our experience, relapses can be salvaged effectively and we recommend a long-term close follow up policy.
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Colorectal nurse specialists: taking health care forward. HOSPITAL MEDICINE (LONDON, ENGLAND : 1998) 2003; 64:328. [PMID: 12833823 DOI: 10.12968/hosp.2003.64.6.328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Laparoscopically assisted splenectomy for idiopathic thrombocytopenic purpura in a previously conserved spleen. HOSPITAL MEDICINE (LONDON, ENGLAND : 1998) 2001; 62:708-9. [PMID: 11762107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
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The aetiology and epidemiology of faecal incontinence. HOSPITAL MEDICINE (LONDON, ENGLAND : 1998) 2001; 62:529-32. [PMID: 11584609 DOI: 10.12968/hosp.2001.62.9.1641] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Faecal incontinence is experienced by at least 2% of the population and 7% of those over 65 years of age. The true incidence is probably much higher because of the stigmata of the affliction leading to underreporting. The common causes of faecal incontinence are discussed.
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Abstract
The surgical management of faecal incontinence is complex and technically demanding. Surgery should only be offered once the aetiology has been correctly identified and the patient has been counselled regarding outcomes of success. This may only approach 80%, with long-term results declining with time.
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Recent developments in the treatment of faecal incontinence. HOSPITAL MEDICINE (LONDON, ENGLAND : 1998) 2001; 62:546-8. [PMID: 11584613 DOI: 10.12968/hosp.2001.62.9.1645] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Many patients with faecal incontinence can be cured using a simple anal sphincter repair. Some patients are unsuitable for this either because the sphincter is absent, too extensively damaged or anal sphincter repair has failed. In these patients novel treatments have been introduced to augment, replace and stimulate the anal sphincter.
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The management of retroperitoneal soft tissue sarcoma: a single institution experience with a review of the literature. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2001; 27:491-7. [PMID: 11504522 DOI: 10.1053/ejso.2001.1146] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
AIM Ten percent of soft tissue sarcomas (STS) arise in the retroperitoneal tissues. The prognosis for patients with retroperitoneal sarcoma is poor with a 5-year survival rate between 12% and 70%. Stage at presentation, high histological grade, unresectable primary tumour and incomplete resection are associated with a less favourable outcome. METHODS Complete follow-up data were available on 22 patients who underwent surgery for retroperitoneal STS in our institution between 1990 and 2000. Patient, tumour and treatment variables were analysed including use of adjuvant therapy and survival status. RESULTS Eighteen patients underwent surgery for primary disease, four patients were treated for recurrent disease or metastases. Ten patients presented with pain, seven with an abdominal mass, other presentation included weight loss and haematuria. Thirteen patients presented with tumours larger than 10 cm. The tumours were seven liposarcomas, six leiomyosarcomas, three malignant fibrous histiocytomas, two rhabdomyosarcomas, two malignant schwannomas and two undifferentiated sarcomas. Six primary tumours were completely excised, five patients received radiotherapy and five received chemotherapy. Local recurrence rate was 45% and recurrence-free interval for 10 patients with recurrence was 11 months. Five patients received radiotherapy and five received chemotherapy. The median survival for patients with primary tumours was 36 months, and 5-year survival was 44%. Adjuvant therapy was not associated with higher survival rates. CONCLUSION This study re-emphasizes the poor outcome of patients with retroperitoneal STS. Adjuvant radiotherapy and chemotherapy do not appear to be any proven benefit and the single most important prognostic factor is aggressive successful en bloc resection of the primary tumour. Our resection rate and 5-year survival rates are comparable with previous reported UK series although lower than large reports from North American centres. This might partly be explained by difficulty in data collection in a retrospective analysis, but may reflect inadequate subspecialization in UK centres.
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Tropical infections can mimic common western European diseases. HOSPITAL MEDICINE (LONDON, ENGLAND : 1998) 2001; 62:326. [PMID: 11436435 DOI: 10.12968/hosp.2001.62.6.1584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
With increasing international travel and migration, clinicians must have an increased awareness of tropical illnesses. Four case reports in this issue emphasize that these conditions can be difficult to diagnose and can mimic common Western European diseases, including disseminated carcinoma.
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Abstract
Concerted efforts are being made to improve the poor surgical outcomes in rectal carcinomas and this includes the use of total mesorectal excision by specially trained colorectal surgeons, in addition to the use of pre- or postoperative radiotherapy and chemotherapy. The role of each modality should be carefully evaluated, and benefits weighed against toxicity and added costs.
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Abstract
Many of the symptoms of colon cancer do not start until the tumour has spread outside the bowel, and treatment at this stage has reduced chances of cure. Early detection and the optimum combination of surgery and adjuvant treatment can make a significant impact on outcome.
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Abstract
The anatomy of the pelvis makes it difficult to perform local excisions in the rectum when a tumour is some distance from the anal verge. Transanal endoscopic microsurgery, a minimally invasive procedure, has been developed. It provides an alternative to the transsacral or transabdominal approach, with subsequent shorter hospital stay and fewer complications.
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Abstract
A case of a duplication cyst of the rectum is presented. This case highlights the potential role of endoluminal magnetic resonance imaging in the diagnosis of this uncommon condition. Alternative imaging modalities and differential diagnoses are discussed.
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How to do it in surgery: laparoscopic rectopexy. Br J Hosp Med (Lond) 1997; 58:587-8. [PMID: 10193478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
Laparoscopically performed rectopexy is now possible, with all the advantages of a minimally invasive technique. It may involve implantation of mesh (Cuesta et al, 1993), suturing (Graf et al, 1995) of the reduced rectum or resection of redundant colon (Baker et al, 1995). Essentially the laparoscopic operation mimics the open procedure.
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How to do it in surgery: transanal endoscopic microsurgery. Br J Hosp Med (Lond) 1997; 58:498-500. [PMID: 10193452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
Transanal endoscopic microsurgery has been performed in our institution since 1993 (Curran et al, 1994). It involves the use of a specially designed operating sigmoidoscope to excise benign and early invasive tumours from the rectum. It allows for accurate dissection of these lesions ensuring safe and complete excision with histological confirmation of this.
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How to do it in surgery: laparoscopic sacral colpopexy. Br J Hosp Med (Lond) 1997; 57:514-6. [PMID: 9330003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Laparoscopic sacral colpopexy for post-hysterectomy recurrent vaginal vault prolapse. MINIM INVASIV THER 1997. [DOI: 10.3109/13645709709153090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Transanal endoscopic microsurgery--initial experience from three centres in the United Kingdom. Br J Surg 1996; 83:207-10. [PMID: 8689164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Over a 28-month period, 100 transanal endoscopic microsurgical excisions of rectal tumours were carried out in three centres. The histological diagnosis was benign adenoma in 77 and invasive adenocarcinoma in 23. Complete excision of the tumour with histological confirmation was achieved in 70 (91 per cent) of the adenomas and in all but one of the carcinomas. Of the carcinomas, 18 were recognized before operation and the remaining five were diagnosed on postoperative histology. Of the patients with carcinoma, one had immediate further surgery, nine had radiotherapy and 13 had no extra treatment. To date, four patients have had a recurrence of villous adenoma, and two of the patients treated for invasive carcinoma have had local recurrence. These initial results of transanal endoscopic microsurgery in the UK compare well with those of earlier reports, indicating that the technique has a useful place in the management of sessile adenomas of the mid and upper third of the rectum, and of some carefully selected carcinomas.
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Transanal endoscopic microsurgery—initial experience from three centres in the United Kingdom. Br J Surg 1996. [DOI: 10.1002/bjs.1800830216] [Citation(s) in RCA: 64] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Abstract
Pneumatosis coli is a rare condition characterised by multiple gas-filled cysts within the bowel wall. We present 25 cases treated over the past 30 years. The patients' mean age was 59 years: 15 were female. Presenting symptoms included diarrhoea (n = 17), mucus discharge (n = 17), rectal bleeding (n = 15) and constipation (n = 12). Pneumatosis usually affected the left colon (96%), and diagnosis was by sigmoidoscopy and biopsy in 18 cases (72%). Pneumatosis coli was associated with psychiatric disorders (36%), chronic lung disease (20%) and colitis (12%). A redundant sigmoid colon was observed in 80% of cases on contrast radiology. Five patients had mucosal pseudolipomatosis on histological examination. Histological and immunohistochemical review indicated that the cysts were lined by cells of macrophage/monocyte phenotype and that many similar mononuclear cells were present in the adjacent submucosa and overlying mucosa. Treatment with antidiarrhoeals and anti-inflammatory drugs in 14 patients resulted in improvement in 9 cases (64%). Oxygen therapy (n = 9) always alleviated symptoms. There was a high recurrence rate (50-78%), but with further courses of therapy lasting remission was achieved in five patients. Two patients underwent colectomy. The associations of pneumatosis coli with psychiatric disorders and mucosal pseudolipomatosis are new and of possible pathogenetic significance. A novel pathogenetic mechanism is suggested to explain the association of pneumatosis coli and chronic respiratory disorders. A model of pneumatosis coli linking some of the apparently disparate pathogenetic theories is proposed.
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Inspecting the Colon from inside and Out to Solve Pyrexia of Unknown Origin. Med Chir Trans 1995; 88:661P-662P. [PMID: 8544155 PMCID: PMC1295394 DOI: 10.1177/014107689508801115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A man with longstanding intermittent symptoms of abdominal pain, diarrhoea and pyrexia of unknown origin was diagnosed with the novel technique of laparoscopic-assisted colonoscopy. At subsequent laparotomy, a longstanding perforation of sigmoid diverticular disease was resected, with resolution of his symptoms.
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Abstract
Fifty-five patients had resection of locally recurrent rectal cancer. Fourteen patients (25 per cent) had distant metastases, which were resected concurrently in six (11 per cent). Thirty-three patients (60 per cent) had preoperative (one patient) or postoperative (32) external beam radiotherapy (45-60 Gy). The 5-year survival rate was 18 per cent with a median survival of 24 months. The median symptom-free interval was 24 months. At a median follow-up of 28 months 53 per cent of patients had a second local recurrence and 24 per cent metastases only. Treatment complications occurred in 12 patients (22 per cent), three (5 per cent) of whom died 3-10 months after operation. Variables that were significantly related with longer survival and palliation were the radical nature of the operation, the absence of severe symptoms (such as pain, obstruction or sepsis), a recurrent tumour diameter of less than 5 cm measured on the resected specimen and a normal carcinoembryonic antigen level after reoperation. A Cox regression model showed that recurrent tumour diameter was the only independent prognostic variable. Surgery for local recurrence achieved local control in 47 per cent of patients with a low morbidity and mortality rate.
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Abstract
Subclavian artery puncture occurred during attempted subclavian vein catheterisation. Although initially stable, the patient became shocked one day later and died from massive local haemorrhage. This case emphasises the need for continued vigilance following accidental arterial puncture.
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Abstract
BACKGROUND A 46-year-old man presented with recurrent anemia and polyarthralgia. Investigations revealed a mass in the ileal mesentery, which was resected. Results of routine histologic examination suggested a diagnosis of synovial sarcoma, a rare malignancy usually not reported at this site. METHODS Tissue was examined immunohistochemically, ultrastructurally, and by fluorescent in situ hybridization to confirm the diagnosis. RESULTS Immunohistochemical studies revealed widespread labeling for cytokeratins and focal labeling for desmin and vimentin in the epithelial component, with labeling for epithelial membrane antigen in the epithelial and spindle-cell components. Fluorescent in situ hybridization analysis showed the characteristic t(X;18) translocation of synovial sarcoma. CONCLUSIONS This is a unique case of synovial sarcoma in the small intestinal mesentery. Immunohistochemical labeling confirmed the diagnosis, although, to the authors' knowledge, the pattern of desmin labeling has not been described previously. The clinical association with polyarthralgia, which resolved after removal of the neoplasm, also has not been described previously.
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Abstract
The effect of microacinar growth patterns on survival after radical surgery for rectal cancer was assessed in 138 consecutive patients. All had Dukes and Jass staging and a median follow-up of 95 (range 11-180) months. Tumour acini were classified according to size (microacinar, 28; macroacinar, 110). Patients with microacinar tumours had a significantly reduced 5-year survival rate compared with those with macroacinar lesions (43 and 68 per cent respectively, P = 0.004). When examined in the presence of other histological factors, acinar size had independent prognostic value (relative risk 2.37, P = 0.006). This was true even when the Dukes and Jass classifications were included in the model (relative risk 2.08, P = 0.02 and 1.95, P = 0.03 respectively). Histological classification of rectal tumours into microacinar and macroacinar types adds prognostic value to the Dukes and Jass classifications and may be a more objective criterion than conventional histological grading.
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Abstract
A prospective audit of acute pancreatitis involving nine hospitals in the North-West Thames Region recruited 631 patients over 54 months. There were 57 deaths (9 per cent); a diagnosis had been reached in 50 patients (88 per cent) before death and in seven (12 per cent) at autopsy. Eighteen patients (32 per cent) died within the first week, usually as a result of multisystem organ failure (15 patients). Thirty-nine patients (68 per cent) died after the first week from complications related to infection (26 patients) co-morbid conditions (nine) or non-infective complications (four). Twenty-one patients (42 per cent) had been inadequately evaluated by Ranson's criteria, and only 22 (44 per cent) of 50 with a premortem diagnosis of pancreatitis had undergone computed tomography (CT). Fifteen of 26 patients who died from infection-related complications had CT and only nine underwent necrosectomy or surgical drainage. These data suggest that improved diagnosis, investigation and management of patients with acute pancreatitis is possible, and may result in improved clinical outcome.
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47
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48
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A rare cause of upper gastrointestinal bleeding. J R Soc Med 1993; 86:547. [PMID: 8410898 PMCID: PMC1294108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
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49
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Partial malrotation associated with pseudo-obstruction of the small bowel. THE BRITISH JOURNAL OF CLINICAL PRACTICE 1993; 47:274-5. [PMID: 8292481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Intestinal pseudo-obstruction is defined as a syndrome in which there are signs and symptoms of intestinal obstruction without an actual obstructing lesion. In many cases it is associated with other disease entities but may be idiopathic. We report a case associated with partial malrotation of the gut which has not been described in the literature before.
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Asymptomatic Metastatic Small Bowel Carcinoid. Med Chir Trans 1993; 86:479-80. [PMID: 8078050 PMCID: PMC1294057 DOI: 10.1177/014107689308600818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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