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Biomedical subjects

A Allan

Publications and source records attributed to A Allan.

At least 55 records · Page 3Linked to original sources
PubMed1992

Clinical index to quantitate symptoms of perianal Crohn's disease.

We describe an anal disease activity index suitable for use in prospective studies of treatment and recording the natural history of anal disease. We studied 40 patients with perianal Crohn's disease (PACD), 14 patients with anal disease not related to Crohn's disease, and 10 normal individuals. Seven symptoms related to anal disease were measured using a linear analog scoring system, which proved easy for the patients to complete. Only three of the seven clinical parameters studied before and after treatment had a high discriminant value. On the basis of these findings, we conclude that a good index of response to therapy in patients with anal disease can be obtained from a linear analog scoring of three symptoms: spontaneous anal pain, pain following defecation, and inhibition of locomotion by pain. The index should be of value in comparing management options in PACD.

Adolescent↗
PubMed1991

Assessment of the defunctioning efficiency of the loop ileostomy.

The defunctioning efficiency of the loop ileostomy has been assessed using a radioisotope and dye technique. The median defunctioning capacity in patients without episodes of fecal discharge per rectum (n = 18) was 99.99 percent and was not affected by body position or the formation of a dependent stoma. In patients (n = 4) who passed fecal material per rectum but who had no stomal retraction, the median defunctioning efficiency was 99.99 percent, and continued fecal discharge was considered to be due to mucopurulent secretion from active distal disease. In patients who passed fecal material per rectum and also had a retracted stoma (n = 4), the defunctioning efficiency was significantly reduced (median = 84.70 [31.2-99.10 percent; P less than 0.01]), owing to the overspill into the distal limb. Two patients underwent stomal revision, with an improvement in defunctioning efficiency to 99.99 percent.

Adolescent↗
PubMed1991

Topical tretinoin for treatment of photodamaged skin. A multicenter study.

The clinical and histologic effects of a new emollient cream formulation of topical tretinoin at concentrations of 0.05% and 0.01% were examined in 251 subjects with mild to moderate photodamaged facial skin in a randomized, double-blind, vehicle-controlled, multicenter study. Seventy-nine percent of the subjects who received 0.05% tretinoin for 24 weeks showed overall improvement in photodamaged skin compared with improvement in 48% of the vehicle-treated control subjects. Significant reductions were found in fine wrinkling, mottled hyperpigmentation, roughness, and laxity after 0.05% tretinoin therapy when compared with controls. In addition, histologic changes of increased epidermal thickness, decreased melanin content, and stratum corneum compaction provide independent evidence supporting clinical improvement. Side effects of erythema, peeling, and stinging were usually mild and well tolerated.

Administration, Cutaneous↗
PubMed1989

Recurrence after strictureplasty or resection for Crohn's disease.

This study attempts to define whether there is an increased need for reoperation in patients with small bowel Crohn's disease treated by strictureplasty compared with those treated by small bowel resection. Previous studies of the rate of reoperation for small bowel Crohn's disease do not distinguish between reoperation performed because of a lesion at the original operation site and that undertaken because of a lesion at a distant site. This study analyses the need for reoperation only at the original site of operation and measures operation-free intervals. The site specific operation-free intervals in 41 patients with small bowel Crohn's disease treated by strictureplasty were not significantly different from the similar intervals in 41 patients treated by a small bowel resection.

Adult↗
PubMed1989

The fecal microflora in pruritus ani.

Pruritus ani is a common condition in which there is a tendency for liquids to leak from the anal canal, resulting in perianal soiling. In order to ascertain if an abnormal fecal flora contributes to the irritant effects of fecal material, qualitative and quantitative measurement of the fecal microflora was performed in 20 patients with pruritus ani and 20 matched controls. No differences were found between the two groups. This study has failed to provide evidence for a microbiologic basis for pruritus ani.

Adult↗
PubMed1989

Beware of hemolytic uremic syndrome presenting as colorectal disease in adults. Report of two cases.

Hemolytic uremic syndrome is seen occasionally by the surgeon in adult patients with colorectal manifestations. Two cases of hemolytic uremic syndrome are presented here, one misdiagnosed clinically as acute appendicitis and the other as acute ulcerative colitis. In each case the diagnosis was only established postoperatively and both patients died of this disease. These cases serve to remind colorectal surgeons that this potentially lethal disease may occur with symptoms and signs suggestive of more common colorectal pathology.

Adult↗
PubMed1989

Plasma fibronectin in Crohn's disease.

The hypothesis that abnormal fibronectin metabolism in Crohn's disease could be an important mechanism leading to stricture formation or postoperative infection was tested in three related studies. (1) Lower concentrations of plasma fibronectin (p less than 0.05) were found in 20 patients with small and large bowel Crohn's disease (mean 0.24 g/l) compared with 13 patients with more limited disease confined to only small or only large bowel (mean 0.27 g/l) or 20 healthy controls (mean 0.29 g/l). (2) In 25 patients followed for 10 days after operation for Crohn's disease, there was a significant fall in fibronectin concentrations of 43% (p less than 0.01, Wilcoxon's rank-sum test). This fall was maximal on the second postoperative day and was more marked in patients undergoing more major operative procedures. (3) The predictive value of plasma fibronectin for subsequent stricture formation or progression was studied for one year; during which 10 patients developed strictures requiring operative treatment. Higher plasma fibronectin concentrations were related to stricture formation, although there was not a complete, predictive relationship. In this study we found that plasma fibronectin concentrations were low in patients with extensive or severe Crohn's disease, fall after operation and may be related to the risk of stricture formation. This relationship is unlikely to be of clinical value, although it shows the potential significance of fibronectin in the pathogenesis of strictures.

Adult↗
PubMed1988

Anorectal sepsis as a presentation of occult rectal and systemic disease.

Between 1980 and 1982, 233 patients were treated for anorectal sepsis in three hospitals. The incidence of underlying disease associated with perianal sepsis and the results of surgical treatment were assessed retrospectively. Of the 233 patients who had perianal sepsis, 136 (58.4 percent) had perianal abscesses, while a further 12 (5.1 percent) had associated fistulas. Ischiorectal abscesses were found in 79 (33.9 percent) and a further two (0.9 percent) had fistulas. Four (1.8 percent) patients were found to have intersphincteric abscesses. One hundred and nine (46.8 percent) had examinations under anesthesia or definitive procedures, while the remaining 124 (53.2 percent) had incision and drainage alone. A second procedure was required by 55 (23.6 percent) patients, 40 (32 percent) in the group who had incision and drainage only and 15 (14 percent) of those having initial examinations under anesthesia (P less than .001). Twenty-seven (11.6 percent) patients had occult disease. Twelve patients (5.1 percent) had systemic disease (six diabetic, three nongastrointestinal neoplasia, two inflammatory, and 1 hematologic), while of the 109 patients who had examinations under anesthesia, 15 (6.4 percent) had associated colorectal pathology (four neoplasia, 11 inflammatory). It is important that patients with anorectal sepsis have complete medical and surgical assessments at the time of their first admission.

Abscess↗
PubMed1988

Quantitative 99mTc-DISIDA scanning and endoscopic biliary manometry in sphincter of Oddi dysfunction.

Sphincter of Oddi (SO) dysfunction is a recognised cause of postcholecystectomy pain, but a difficult condition to diagnose, requiring endoscopic biliary manometry (EBM) to confirm sphincter motor abnormalities. We have assessed quantitative cholescintigraphy in 10 postcholecystectomy (PC) patients with clinical and manometric evidence of SO dysfunction, 10 PC patients with non-biliary type abdominal pain and 10 asymptomatic PC volunteers acting as controls to determine its value as a non-invasive screening test. Quantitative 99mTc-DISIDA scans lasted 60 minutes, activity/time curves being created by computer analysis using the entire hepatobiliary system as region-of-interest (ROI). Scintigraphic analysis demonstrated that the time in minutes to maximum counts (Tmax) was significantly increased in the SO dysfunction group compared with the non-biliary pain group and the asymptomatic volunteers (p less than 0.001). The per cent of biliary tracer emptied was also significantly less in the SO dysfunction group than either of the other groups at both 45 minutes (p less than 0.01) and 60 minutes (p less than 0.02). We conclude that quantitative cholescintigraphy may be a valuable non-invasive screening test in clinically suspected SO dysfunction.

Adult↗
PubMed1987

Physiological study of pruritus ani.

Physiological abnormalities in the anorectum of 34 patients with pruritus ani, and 20 age and sex matched controls were assessed. A saline infusion (1500 ml) test showed that leakage started after infusion of 600 ml in patients with pruritus ani compared with 1300 ml in controls (median values: P less than 0.001). There was an inverse relationship between the severity of the symptoms of pruritus ani and the volume of first leakage on the saline infusion test P less than 0.02. Studies to assess anal sphincter function, rectal sensation to balloon distension, rectal compliance, and perineal descent did not show any significant differences between pruritic patients and controls. However, pruritic patients without co-existing anal pathology had a significantly greater fall of anal pressure when a rectal balloon was inflated (57 per cent) when compared with controls (40 per cent) P less than 0.05.

Adult↗
PubMed1986

The therapeutic dilatation of enteric strictures due to Crohn's disease.

The use of dilatation as a treatment of strictures due to Crohn's disease has hitherto received little attention. We report dilatation of small and large bowel strictures in twelve patients with Crohn's disease. The technique appears to be safe when carried out either endoscopically or as part of a laparotomy. Short term follow-up suggests that the technique may have a part to play in the treatment of suitable strictures that can be reached endoscopically but early restenosis limits its value at laparotomy when strictureplasty may provide a more lasting relief of the stenosis.

Adolescent↗
PubMed1985

Early gastric cancer: the case for long term surveillance.

Thirty five patients with early gastric cancer have been treated at the Bristol Royal Infirmary since 1965. The number of cases diagnosed has doubled in the last 10 years. Epigastric pain (74%), loss of weight (63%), and gastrointestinal bleeding (43%) were the most common presenting symptoms, with a median length of history of 12 months (range five days to 72 months). Life table survival curves showed a crude five year survival of 71% (age adjusted 92%) and a crude 10 year survival of 63% (age adjusted 85%). Sixteen patients have been followed up clinically, endoscopically, and by scintigraphy with technetium-99m p-butyl iminodiacetic acid to assess the risk of recurrent disease. Of seven patients with pronounced bile reflux, two had moderate dysplasia of the gastric remnant, and one patient was found to have developed a metachronous tumour nine years after surgery. Partial resection seems to be the best choice of treatment for early gastric cancer, giving good functional results. Consideration should, however, be given to Roux en Y diversion, and long term surveillance of the gastric remnant is recommended.

Adult↗