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F A Frizelle

Publications and source records attributed to F A Frizelle.

At least 19 recordsLinked to original sources
PubMed2003

The utility of laparoscopy in the diagnosis of acute appendicitis in women of reproductive age.

AIM: To see whether laparoscopy improves the accuracy of a clinical diagnosis of acute appendicitis in women of reproductive age, and to determine what the long-term sequelae are of not removing an appendix deemed at laparoscopy to be normal. METHOD: The initial part of the study was undertaken during 1991-1992. Female patients between 16 and 45 years were eligible for inclusion once a clinical decision had been made to perform an appendicectomy for suspected acute appendicitis. Following consent, patients were randomized into two groups. One group had open appendicectomy, as planned. The other group had laparoscopy, followed by open appendicectomy only if the appendix was seen to be inflamed or was not visualized. The end points for the study were the clinical outcomes of all patients, and the results of histology, where appropriate. An attempt was made to contact all patients at 10 years to determine whether they had had a subsequent appendicectomy, or had been diagnosed with another abdominal condition that might be relevant to the initial presentation in 1991-1992. RESULTS: Laparoscopic assessment was correct in all cases in which the appendix was visualized. Diagnostic accuracy was improved from 75% to 97%. Laparoscopy was associated with no added complications, no increase in hospital stay in patients who went on to appendicectomy, and a reduction in hospital stay for those who underwent laparoscopy alone. No patients developed a problem over the 10-year follow-up period from having a normal-looking appendix not removed at laparoscopy. CONCLUSION: Laparoscopic assessment of the appendix is reliable, and to leave a normal-looking appendix at laparoscopy does not appear to cause any long-term problems.

Abdominal Pain↗
PubMed2003

Parastomal hernia.

BACKGROUND: Parastomal hernia following formation of an ileostomy or colostomy is common. This article reviews the incidence of hernia, the technical factors related to the construction of the stoma that may influence the incidence, and the success of the different methods of repair. METHODS: A literature search using the Medline database was performed to locate English language articles on parastomal hernia. Further articles were obtained from the references cited in the literature initially reviewed. RESULTS: Parastomal hernia affects 1.8-28.3 per cent of end ileostomies, and 0-6.2 per cent of loop ileostomies. Following colostomy formation, the rates are 4.0-48.1 and 0-30.8 per cent respectively. Site of stoma formation (through or lateral to rectus abdominis), trephine size, fascial fixation and closure of lateral space are not proven to affect the incidence of hernia. The role of extraperitoneal stoma construction is uncertain. Mesh repair gives a lower rate of recurrence (0-33.3 per cent) than direct tissue repair (46-100 per cent) or stoma relocation (0-76.2 per cent). CONCLUSION: The incidence of parastomal hernia is between 0 and 48.1 per cent, depending on the type of stoma and length of follow-up. No technical factors related to the construction of the stoma have been shown to prevent herniation. If repair is required, a prosthetic mesh technique should be considered. Further randomized clinical trials (particularly of extraperitoneal stoma construction) are needed.

Colostomy↗
PubMed2003

Management of late complications of pelvic radiation in the rectum and anus: a review.

PURPOSE: Radiotherapy has become one of the most important treatment modalities for human malignancy. Tumors affecting the organs of the pelvis are increasingly being irradiated for local treatment benefit, with the subsequent complication of anorectal injury of varying extent. The aim of this review is to determine how to manage the consequences of long-term effects of radiotherapy on the rectum and anus. METHODS: A comprehensive search of the literature with manual cross-referencing was performed using the MEDLINE, PubMed, and Cochrane Databases. RESULTS: Long-term manifestations of injury caused by pelvic radiotherapy include abscess and fistula formation, stricture, mucus discharge, urgency, tenesmus, diarrhea, increased risk of cancer, and most commonly, bleeding. Most patients present with several symptoms; however, usually one symptom dominates. CONCLUSIONS: Many of these symptoms are self-limiting, and mucosal complications may often be treated by nonsurgical methods such as topical formalin application, endoscopic argon plasma coagulation, and hyperbaric oxygen therapy. Conservative measures have not been shown to be of benefit if symptoms persist. Structural abnormalities and septic complications are likely to require surgery. Modern techniques in the delivery of radiotherapy help minimize the likelihood of rectal complications.

Anal Canal↗
PubMed2003

A retrospective audit of long-term lower limb complications following leg vein harvesting for coronary artery bypass grafting.

OBJECTIVE: To evaluate the prevalence of leg complications following leg-vein harvest for coronary artery bypass grafting. METHOD: A questionnaire was sent to patients who had coronary artery bypass surgery between January 1993 and December 1998. Questions addressed pain, numbness, infection, swelling and general healing. The relationship between the risk factors of diabetes, peripheral vascular disease, previous fractures/injuries to legs, previous deep vein clots and arthritis affecting the legs with post operative symptoms of pain, numbness, swelling and general healing was explored with multivariate analysis. RESULTS: Of 700 questionnaires sent out 497 were returned, of which 422 (60%) were suitable for analysis. Numbness or tingling related to the wound was reported by 256 (61%), of whom 94 (37%) improved within 3 months. However, 105 (41%) had persistent numbness beyond 2 years. Pain in the wound was reported by 193 (46%), of whom 149 (77%) reported that this had improved by 3 months and only 19 (10%) had pain persisting beyond 2 years. A leg wound infection was reported by 126 (32%) patients, with 82 (65%) of these receiving antibiotics. A total of 336 (87% of 387 responses) described their wound as completely healed at 3 months. Unilateral leg swelling was reported by 175 (41%) with 98 of these (56% of those with swelling) improving by 3 months and 41 (23%) with swelling persisting beyond 2 years. There was no relation of wound problems to examined risk factors diabetes (P-values for numbness 0.31, wound healing 0.15, swelling 0.21, pain 0.22) and peripheral vascular disease (P-values for numbness 0.8, wound healing 0.21, swelling 0.18, pain 0.09). There was insufficient data to comment on the influence of fractures/injuries to legs, previous deep vein clots and arthritis affecting the legs. CONCLUSIONS: Wound complications are common following leg vein harvest. Prevalence of infection was higher than has previously been reported. Few people suffer long-term pain from saphenous nerve damage although paraesthesia and swelling were common long-term complications. We did not identify either diabetes or peripheral vascular disease as a risk factor for pain, numbness, swelling or problems with general healing. There is a need for a large multicentre prospective study.

Adult↗
PubMed2002

A multicentre retrospective audit of outcome of patients undergoing curative resection for rectal cancer.

AIM: This study describes the outcome of patients with rectal cancer treated in four New Zealand public hospitals before the advent of specialised colorectal units in order to provide a baseline against which any changes in management can be measured. METHODS: A retrospective review of case notes of patients who underwent resection of rectal cancer with curative intent over a period of 7-10 years up to 1995 in Christchurch, Wellington, Nelson, and Masterton Public Hospital's, was undertaken. Patients were identified from hospital records using a combination of methods (pathology data bases, clinical case mix data, operating logs and audit data). Metastatic disease was considered to be present if confirmed on histology or the clinical course of the patient was consistent with metastatic disease. Patients were excluded if there was perioperative evidence of metastatic disease or if they had transanal excision. Previously published results from Auckland and Dunedin Hospitals are compared. RESULTS: 524 patients with rectal cancer were identified who had undergone surgery with curative intent in the four hospitals. The overall permanent stoma rate was 37%. The overall 30-day mortality was 2.9%, five-year survival was 63% and local recurrence at five years was 26%. CONCLUSION: While low perioperative mortality and good long-term survival were achieved, there were high rates of local recurrence. These data are a baseline against which the impact of new approaches to curative resection for rectal cancer can be measured.

Colorectal Neoplasms↗
PubMed2002

Postoperative epidural analgesia following elective major abdominal surgery in high risk patients: a retrospective cohort study.

AIM: To describe the effect of post-operative epidural analgesia on morbidity and mortality rates in a group of high-risk patients undergoing elective major abdominal surgery. METHODS: Retrospective chart review of patients in American Society of Anaesthetists Physical Status (ASA) category III or IV, who underwent elective major I or II general surgical procedures between 01/01/1996 and 01/09/1998. Patients were identified from a prospective audit database. Patients who had epidural analgesia or conventional parenteral opioids were compared for outcome measures. RESULTS: There were 167 patients identified (72 epidural, 95 non-epidural group). There was no significant difference in demographic data, inpatient stay, intensive care unit stay, or mortality rates (11% epidural v 17% non-epidural, p>0.05). There was no significant difference in morbidity rates, however there was a non-significant trend towards a lower morbidity in the epidural group. CONCLUSIONS: This study does not show any benefit from post-operative epidural analgesia on morbidity and mortality rates in high risk patients undergoing major abdominal surgery. It does illustrate that ASA 3 and 4 patients undergoing major abdominal surgery have a high morbidity and mortality.

Abdomen↗
PubMed2002

Nutritional and immune status following spinal cord injury: a case controlled study.

STUDY DESIGN: Case controlled study. OBJECTIVE: To compare nutritional status and immune response in a group of spinal cord injured (SCI) patients with age and gender matched non SCI control subjects. METHOD: Thirty past patients of the Burwood Hospital Spinal Injuries Unit living locally were enrolled in the study. Age and gender matched non SCI control subjects were selected volunteers from hospital staff. Nutritional status was assessed by generating a Nutritional Risk Score (NRS, Appendix 1) and drawing blood for full blood count, iron studies, red blood cell folate, vitamin B12, ferritin, magnesium, and zinc. Immune status was assessed by vaccination response index (VRI) to Pneumovax 23 vaccine. RESULTS: Full blood count, iron studies, and testing for red blood cell folate, albumin, prealbumin, vitamin B12, ferritin, magnesium and zinc were normal range for both groups. The SCI group had significantly different median values than controls (P < 0.01) for haemoglobin concentration, white blood cell count, albumin, prealbumin, serum iron and % saturation. Body Mass Index (weight kg/(height cm(2)) was 22.2 (range 15-30) for the SCI group, significantly less than the paired control group index of 26 (range 20-32, P = 0.0004). Median NRS for SCI patients was 2 (range 0-6), compared to 0 (range 2-4) for paired controls (P < 0.0001). Scores ranged from 0 to 2 for each of the five NRS components for the SCI patients and 0 to 3 for the control group. There was no significant difference in the pre- and post-vaccination ratio for IgG, IgA, and IgM response to Pneumovax 23 vaccine. CONCLUSION: We have not identified any nutritional or immune status abnormality in SCI patients, however the SCI patients have a lower value for certain nutritional parameters and BMI. SCI patients however are at only slight risk of nutritional problems given their NRS and their lower normal values for certain nutritional factors.

Adult↗
PubMed2002

Does human papilloma virus have a role in squamous cell carcinoma of the colon and upper rectum?

AIM: To determine if Human Papilloma Virus (HPV) has a role in the aetiology of adenosquamous and squamous cell carcinoma of the colon and upper rectum, and to describe the clinical features seen in our patients with this condition. METHODS: Patients were identified with squamous cell carcinoma (SCC), adenosquamous carcinoma (Ad-SCC), or adenocarcinoma with squamous metaplasia (AA) of the colon and upper rectum over the 10 years from 1/1/1990 to 31/12/1999. Patients were identified from a prospective pathology database. All tumours were at least 5cm above the dentate line. Pathology blocks were stained using the Peroxidase labelled Streptavidin technique using mouse monoclonal antibody NCL-HPV-4C4, which identifies HPV 6, 11, 16 and 18. Age, gender and site matched controls (colorectal adenocarcinomas) were also stained. The clinical presentation and management was reviewed from the case notes. RESULTS: Twenty patients were identified from a pathological database of 2351 colorectal cancers (0.85% of colorectal cancers). 0/20 of the study patients (SCC, Ad-SCC, AA) or adenocarcinoma controls stained positively for HPV 6, 11, 16, 18. The clinical presentation was similar to patients presenting with adenocarcinomas. CONCLUSIONS: The peroxidase labelled streptavidin technique is an immunohistochemical technique with high specificity but lower sensitivity. There was no apparent association between HPV 6, 11, 16, 18 and squamous cell and adenosquamous carcinoma of the colon and rectum using this technique. Clinical features are similar in squamous and adenosquamous colorectal carcinomas to colorectal adenocarcinomas.

Aged↗
PubMed2001

The prevalence of faecal incontinence and constipation in a general New Zealand population; a postal survey.

AIMS: To determine the prevalence of constipation and faecal incontinence in the community. METHODS: A 20-question multi-field postal questionnaire was sent to 1500 adults (over 18 years) randomly selected from the electoral roll in the Canterbury region. Questions detailed frequency of bowel function, time spent at the toilet, incidence and severity of faecal incontinence, constipation, and the effect of disordered bowel function. RESULTS: Of 1500 questionnaires, 717 (48%) were returned (male: female 388:329). The median age was 46 years (range 18-70). 24 (4%) had self-reported gastrointestinal disease. There was a median frequency of seven bowel motions per week (BM/wk) (range 1 to 70) with 89% having between two motions a day and one every two days. Faecal incontinence affected lifestyle in 58 (8.1%). Incontinence of solid stool at least once a month occurred in 70 (9.8%), of liquid stool in 91 (12.7%), of gas in 459 (64%), while 12 (2%) regularly wore a pad. Those with self-reported gastrointestinal disease had a significantly higher (p<0.05) bowel motion frequency (17 vs 7 BM/wk) and median faecal incontinence score (2.5 vs 0). Laxatives were used by 4.9% of the population, while 26.2% increased fibre to avoid constipation. CONCLUSIONS: The normal frequency of bowel motions (+/- 2SD) was 2-17 per week. Faecal incontinence affecting life style affected 8.1%, while constipation requiring regular laxative use affected 4.9% of people. There is acceptance in the community that a moderate degree of bowel dysfunction is normal. Stool frequency and faecal incontinence scores can be used to predict those most likely to have organic gastrointestinal disease.

Adolescent↗
PubMed2001

Follow-up after attempted curative surgery for colorectal cancer; postal survey of New Zealand surgeons' practice.

AIMS: The role of follow-up after attempted curative resection of colorectal cancer (CRC) is not clearly defined. We wished to establish the frequency, duration and type of follow-up practised by New Zealand surgeons. METHODS: A postal survey was performed of surgeons on the General Medical Register, asking about the follow-up of asymptomatic patients after potential curative surgery. RESULTS: The response rate was 66%(107/163). There was wide variability in the frequency, duration and type of the indicated follow-up practice. 97% of surgeons followed their patients on average four monthly for the first year. At five years, 79% of surgeons followed their patients. Routine blood tests were performed 54%, while serum carcinoembryonic antigen (CEA) levels were measured by 56% of surgeons for the first two years. 41% performed abdominal imaging in the first two years. 97% of surgeons screened the remaining colon (88% by colonoscopy). 90% performed colonic screening three to five yearly. CONCLUSIONS: Follow-up after potential curative surgery for CRC appears to be widely practised in New Zealand. There is, however, considerable variation between surgeons in the frequency, duration and type of follow-up. This may reflect the conflicting evidence in the literature on the value of follow-up. The outcome of current large prospective randomised trials may confirm whether or not such follow-up is worthwhile and what form it should take.

Carcinoembryonic Antigen↗
PubMed2001

Adenosquamous and squamous carcinoma of the colon and upper rectum: a clinical and histopathologic study.

PURPOSE: Squamous and adenosquamous carcinoma of the colon and proximal rectum are rare neoplasms in which the clinicopathologic behavior and the most appropriate management are unknown. The purpose of this study was to review the histology and clinical course of the largest series of cases ever reported from a single center on this rare condition. METHOD: The Mayo Clinic tissue registry was searched for all primary cases of squamous and adenosquamous carcinoma of the colon or rectum proximal to 8 cm from the dentate and presenting before December 31, 1992. Of the 52 identified cases there was adequate histologic material for review in 44 cases. These cases were divided into pure squamous-cell carcinoma (n = 11), mixed adenosquamous carcinoma (n = 31), and adenocarcinoma with benign-appearing squamous metaplasia (adenoacanthoma; n = 2). Squamous-cell carcinomas were examined for evidence of human papilloma virus by in situ hybridization. A retrospective review of medical records was undertaken in all 52 cases with respect to predisposing factors, clinicopathologic behavior, prognostic features, and treatment with adjuvant therapy. RESULTS: The charts of 52 patients (20 females), with a mean age of 58.6 (range, 19-90) years, were reviewed. Right-sided lesions were the most common (43 percent). Metastatic disease was evident at presentation in 49 percent of patients, the most common sites in order being liver, peritoneal, and lung. The five-year overall survival rate was 34 percent, Stage I to III disease had a 65 percent five-year survival rate, and Stage IV mean survival time was 8.5 months. For node-positive and node-negative disease, 23 and 85 percent, respectively, survived five years. There was no evidence of human papilloma virus in the six squamous-cell carcinomas examined. CONCLUSION: Squamous and adenosquamous carcinomas of the colon and rectum are rare neoplasms. Although a poor prognosis can be expected for node-positive disease, patients with negative nodes do generally the same as patients with adenocarcinoma histology. Based on advances made with multimodality therapy of squamous-cell cancer of the anus and adenocarcinoma of the rectum, further studies should define the role of postoperative therapies for these lesions.

Adenocarcinoma↗
PubMed2001

Bowel dysfunction following spinal cord injury.

STUDY DESIGN: Review. OBJECTIVES: To outline the present knowledge of bowel dysfunction following spinal injury, and look at future directions of management and research. SETTING: Spinal Unit and Colorectal Unit, Christchurch, New Zealand. METHODOLOGY: Review. RESULTS: The underlying physiology of colorectal motility and defecation is reviewed, and consequences of spinal cord injury on defecation are reported. A discussion of present management techniques is undertaken and new directions in management and research are suggested. CONCLUSION: There is need for more intervention in regard to bowel function that could improve quality of life, but there is also a need for more research in this area.

Anal Canal↗
PubMed2001

Does a colostomy alter quality of life in patients with spinal cord injury? A controlled study.

STUDY DESIGN: Prospective controlled comparative analysis. OBJECTIVE: To determine whether a colostomy changes quality of life in patients with a spinal cord injury. METHOD: A previously validated questionnaire designed to assess quality of life in spinal injured patients (Burwood Questionnaire) was sent to 26 spinal cord injured patients with colostomies and 26 spinal cord injured patients without colostomy. The two groups were matched for level of injury, completeness of injury, length of time since injury, age (+/- 5 years) and gender. RESULTS: There was 100% completion of the questionnaire. There was no significant difference (P > 0.05) in the two groups of patients in regard to their general well being, emotional, social, or work functioning. CONCLUSIONS: Patients with colostomy following spinal injury are no worse off in regard to quality of life, than those without. The inference is that perhaps a colostomy should be considered earlier in patients with major bowel dysfunction following spinal cord injury. SPONSORSHIP: Financial support for Dr AC Lynch was provided by Royal Australian College of Surgeons with a Foundation Scholarship and Grant in aid by the Burwood International Spinal Trust. Mr N Randell was supported by the Canterbury Medical Research Foundation with a summer studentship.

Adult↗
PubMed2001

Does anorectal manometry predict clinical outcome after laparoscopic ACE procedures in children with spina bifida?

PURPOSE: The laparoscopic antegrade continence enema (LACE) procedure is used for the treatment of faecal incontinence in children with spina bifida. The purpose of this study was to relate the outcome of the LACE procedure to anorectal function, as determined by anorectal manometry. METHOD: Eleven children with spina bifida who had the LACE procedure underwent anorectal manometry (ARM) to document their anorectal function, and its relationship to the level of continence obtained following surgery. RESULTS: There was a consistently high level of functional continence achieved following surgery despite wide variability in the parameters of anorectal manometry. There was no demonstrable correlation between the outcome of the LACE procedure and anorectal function as assessed by manometry. CONCLUSION: Anorectal function as determined by manometry failed to predict outcome after the laparoscopic ACE procedure in children with spina bifida.

Journal Article↗
PubMed2000

Extracorporeal shock wave lithotripsy for difficult common bile duct stones: initial New Zealand experience.

AIM: Common bile duct (CBD) stones can usually be managed by open surgery, endoscopic retrograde cholangiopancreatography (ERCP) or radiological intervention. At times, however, these methods are either unsuccessful or inappropriate. We report our initial experience of extracorporeal shock wave lithotripsy (ESWL) for CBD stones that had either been unsuccessfully managed by conventional techniques, or in cases where these techniques were associated with a high level of risk. METHODS: A retrospective review of medical records of cases receiving ESWL for CBD was undertaken. The aspects reviewed were: indications, outcome and completions from the procedure. RESULTS: ESWL was used in the management of eight patients (three male, five female, age range 24-83, mean 54 years). The indications in five cases were failure of open surgery, ERCP or radiological techniques to clear the duct. In the other three cases, ERCP was unsuccessful and there was significant coincidental medical illness (morbid obesity with diabetes, and severe ischaemic heart disease). CBD clearance was achieved in seven cases. In one unsuccessful case, the duct was cleared after two open procedures. CONCLUSIONS: ESWL can be used to clear CBD stones. It should only be used, however, where prior CBD drainage has been achieved, preferably by endoscopic sphincterotomy. Morbid obesity is a relative contraindication to the use of ESWL. If ESWL fails, a period of time should be allowed to elapse before open surgery because of distortion of soft tissue planes. ESWL can be a useful technique in dealing with some difficult CBD stones.

Adult↗