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Biomedical subjects

B M Stephenson

Publications and source records attributed to B M Stephenson.

At least 55 records · Page 3Linked to original sources
PubMed1994

Coordinated activity of the new "rectum" and anal sphincter after sphincter-saving resection of the rectum for colitis or carcinoma.

PURPOSE: The aim of this study was to determine whether coordinated activity exists across a stapled enteroanal anastomosis. METHODS: Twenty-nine patients were studied for a median of one year after complete excision of the rectum and stapled enteroanal anastomosis; 12 patients underwent low anterior resection with coloanal anastomosis for carcinoma, and 17 patients underwent restorative proctocolectomy with ileoanal anastomosis. RESULTS: Maximum anal resting pressures were slightly lower after coloanal anastomosis than after ileoanal anastomosis [median range, 56 (11-60) cm H2O, cf 69 (40-107) cm H2O, P = NS]. During distention of the neorectum, anal sphincter pressures at 2.5, 1.5, and 0.5 cm from the anal verge were significantly lower after coloanal anastomosis compared with after ileoanal anastomosis (P < 0.01 at each station). The volume of neorectal distention required to produce maximal inhibition of the anal sphincter was significantly less after coloanal anastomosis at 50 (range, 20-60) ml of air than after ileoanal anastomosis at 240 (range, 100-420) ml of air (P < 0.01). Minor fecal leakage and urgency of bowel action were significantly more common after coloanal anastomosis (P < 0.01). CONCLUSION: Alterations in the dynamic response of the anal sphincter to distention of the neorectum may explain why the clinical results were better after ileal pouch-anal anastomosis than after coloanal anastomosis.

Adult↗
PubMed1994

The role of CA-242 and CEA in surveillance following curative resection for colorectal cancer.

This study was undertaken to evaluate the role of a new tumour marker, CA-242, alone or in combination with CEA in the practical management of colorectal cancer patients after potentially curative resection. A cohort of 149 patients who had undergone 'curative' surgery was followed up according to an intensive protocol in order to detect recurrent disease. Over a median tumour marker follow-up period of 24 months there were 25 recurrences in 24 patients. Both CEA and CA-242 alone detected half the local recurrences. The sensitivity of CEA was 84% for distant or mixed recurrence compared with 64% for CA-242. An abnormality of either CEA or CA-242 enabled detection of five out of six local recurrences and 17 out of 19 distant or mixed recurrences with a median lead time of 5 months for each marker. Both markers were elevated concurrently in only one local and 11 distant recurrences. While CA-242 alone is not superior to CEA, their combined use (either abnormal) has a high sensitivity (88%), specificity (78%) and negative predictive value (97%); this may be useful in reducing unnecessary investigations in follow-up programmes and as a guide to the initiation of further treatment for recurrent disease.

Adult↗
PubMed1994

The role of total thyroidectomy in the management of differentiated thyroid cancer.

The extent of surgical resection required in the optimal management of differentiated (papillary and follicular) thyroid carcinoma remains controversial. Arguments in favor of total thyroidectomy include the adequate treatment of tumor multifocality, reduction in local recurrence rates and anaplastic transformation, and creating a suitable environment for radioactive iodine scanning and treatment of metastases. The benefits of this procedure have to be weighed against the potential but minimal morbidity.

Adenocarcinoma, Follicular↗
PubMed1993

Feasibility of family based screening for colorectal neoplasia: experience in one general surgical practice.

Relatives of patients with colorectal cancer have on average a two to threefold increased risk for developing bowel neoplasia although in some families the risk is much higher. This study examined the compliance for endoscopic screening and faecal occult blood testing among first degree relatives of patients with colorectal cancer to determine the feasibility of offering a screening service in a surgical practice. The endoscopic method (flexible sigmoidoscopy or colonoscopy) offered depended upon the extent of family history. Spouses of patients were offered flexible sigmoidoscopy as a group for comparison. Compliance in first degree relatives was significantly higher than in spouses (69% v 47%, p < 0.01) and among those relatives of patients who had died recently from colorectal cancer but time since diagnosis in the index case had no effect. Adenomas were found in 14 of 92 (15%) relatives and three of 30 (10%) spouses. It is estimated that, under our screening guidelines, every 100 patients with colorectal cancer would generate a list of 35-40 relatives who would be screened once by flexible sigmoidoscopy and perhaps 75, who because of their young age, might be screened twice in their lifetime. Also, from this same 100 patients, about 12-15 relatives would merit entry in a colonoscopic screening programme because of their more extensive family history. These results indicate that endoscopic screening of relatives of patients with colorectal cancer is feasible within a practice.

Adult↗
PubMed1993

Acute intestinal ischaemia: options in surgical management.

Seven patients (mean age 67 years, range 52-82 years) presented with acute intestinal ischaemia over a 4-year period. Massive bowel resection was performed in all patients. Exteriorisation and secondary restoration of intestinal continuity was employed in four patients. In two patients a primary anastomosis was performed at the time of resection and one patient underwent a 'second-look' procedure. Massive bowel resection and exteriorisation allows direct observation of stoma viability, avoids the risk of anastomotic breakdown and should be considered in all but moribund patients with acute intestinal ischaemia. In elderly patients resection and primary anastomosis may be an alternative option.

Aged↗
PubMed1993

Feasibility of 'day case' laparoscopic cholecystectomy.

Laparoscopic cholecystectomy was offered as a day case to 15 patients (mean age 42; range 33-72 years). Three patients required overnight admission for non-operative reasons. The mean in-hospital stay for those patients successfully treated as day cases was 8.5 h and overall 12 h (range 6-28 h). In selected cases day case laparoscopic cholecystectomy is a feasible alternative to conventional inpatient management.

Adult↗
PubMed1993

'Diabetic tibial disease': the case for revascularisation.

Diabetic patients with critical ischaemia of the lower limb are frequently considered to have unreconstructable vascular disease. In the presence of a palpable popliteal pulse they are often labelled as having 'small vessel disease'. In nine patients (mean age 69 years) with 'diabetic tibial disease' and critical ischaemia we have avoided major amputation using short vein bypasses. All revascularisations remained patent at a mean follow-up of 32 months (range 12-60 months). Diabetic patients with critical ischaemia should at the very least undergo arteriography to ensure that the possibility of successful distal revascularisation is not feasible before amputation is performed. However, if arteriography fails to demonstrate patent distal vessels and limb salvage is considered practical, Doppler insonation of the tibial and pedal vessels should be performed.

Aged↗
PubMed1992

Role of the rectum in the physiological and clinical results of coloanal and colorectal anastomosis after anterior resection for rectal carcinoma.

This study investigated the relationships between length of residual anorectum, anorectal physiological function and clinical outcome after anterior resection for rectal carcinoma. Thirty-four patients were studied a median of 13 (range 4-100) months after anterior resection. They were compared with a control group of ten patients who had undergone sigmoid colectomy for carcinoma without rectal excision. Resting anal pressure was found to be lower after coloanal than after colorectal anastomosis, and the capacity of the (neo)rectum was less after coloanal than after colorectal anastomosis. The (neo)rectoanal inhibitory reflex was found to be present in each patient, but maximum anal pressure during this 'sampling' reflex was significantly lower (P < 0.01) after coloanal than after colorectal anastomosis, and the volume required for maximal inhibition of the sphincter was also less (P < 0.01). At 1 year after operation, median bowel frequency was greater after coloanal (4 per day) than after colorectal (2 per day) anastomosis and the degree of urgency of defaecation was also greater (P < 0.01). Quality of life in terms of anorectal function after anterior resection is thus significantly influenced by the length of rectum that is left. This, in turn, influences the functional capacity of the neorectum and the degree of inhibition of the anal sphincter during the neorectoanal inhibitory reflex.

Adult↗
PubMed1992

Endoscopic transanal resection of large villous tumours of the rectum.

Endoscopic transanal resection (ETAR) is an innovative approach in the management of low lying tumours of the rectum. We report our experience of this technique in six elderly patients (mean age 74 years) with large villous adenomas, situated between 2 and 12 cm from the anal verge. There were no complications. One patient with a circumferential tumour has been spared the more conventional operation of abdominoperineal excision. Follow-up ranged from 6 to 30 months (mean 16 months) during which two recurrences were detected. These were adequately treated by further ETARs. It is concluded that ETAR is a simple and well-tolerated procedure and is a useful addition to the surgeon's armamentarium.

Adenoma↗