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Biomedical subjects

F Seow-Choen

Publications and source records attributed to F Seow-Choen.

At least 145 records · Page 8Linked to original sources
PubMed1994

Comparison of emergency and elective haemorrhoidectomy.

A total of 704 patients with symptomatic prolapsed haemorrhoids were operated on over a 24-month period. Overall, 500 underwent elective haemorrhoidectomy for symptomatic prolapsed haemorrhoids and 204 emergency haemorrhoidectomy for acutely prolapsed, thrombosed or gangrenous haemorrhoids. The mean age was 43 (range 16-80) years in patients undergoing elective surgery and 42 (range 20-86) years in those receiving emergency procedures. After elective surgery 27 patients (5.4 per cent) had an episode of secondary haemorrhage; ten (2.0 per cent) required blood transfusion and six (1.2 per cent) needed surgical haemostasis. After emergency surgery, ten patients (4.9 per cent) developed secondary haemorrhage; four (2.0 per cent) required blood transfusion and two (1.0 per cent) surgical haemostasis. Twelve patients (5.9 per cent) developed anal stenosis after an emergency procedure compared with 15 (3.0 per cent) after elective operation. None of the patients in either group developed portal pyaemia. After elective surgery 26 patients (5.2 per cent) developed a degree of incontinence (eight to flatus, 15 to liquids, three to solids) as did nine patients (4.4 per cent) after emergency procedures (three to flatus, five to liquids, one to solids). Recurrent haemorrhoids were found in 38 patients (7.6 per cent) after elective surgery and in 14 (6.9 per cent) after an emergency procedure.

Adult↗
PubMed1994

Performing internal sphincterotomy with other anorectal procedures.

PURPOSE: A study was conducted to compare the outcome of combined anorectal procedures involving lateral internal sphincterotomy with lateral internal sphincterotomy alone to determine if the former results in increased complications. METHODS: Complications and anal function of 57 patients who underwent lateral internal sphincterotomy for chronic anal fissure in conjunction with another anorectal procedure (combined group) between April 1989 and June 1992 were compared with 57 other age- and sex-matched patients who underwent lateral internal sphincterotomy alone (control group). RESULTS: There was no statistical difference in the incidence of incontinence in the combined group (8.7 percent) and the control group (7 percent). None of the cases in either group had permanent incontinence. There were also no statistical differences in the incidence of postoperative bleeding, pruritus ani, mucus discharge, abscess formation, fistulation, and rates of fissure recurrence. CONCLUSIONS: Additional anorectal procedures performed at the same time as internal sphincterotomy do not increase the incidence of postoperative complications.

Adolescent↗
PubMed1994

Histoanatomy of anal glands.

PURPOSE: This study was designed to investigate the histology of adult anal glands using conventional as well as immunochemical methods. METHODS: Fifteen fresh human ani were prepared and stained with conventional and immunohistologic stains. RESULTS: The median number of anal glands in each anus was six (range, 3-10). Sixty-eight (80 percent) of 85 anal glands found were submucosal in extent, seven (8 percent) extended to the circular internal sphincter, seven (8 percent) to the longitudinal internal sphincter, two (2 percent) to the intersphincteric space, and only one (1 percent) penetrated the external anal sphincter. Ampulla-like dilations were noted in anal glands from ten patients only, occurring at the submucosal level in seven ani and at the circular internal sphincter in three ani. Lymphocytic infiltrations were noted around the glands in all ani studied. Mucus-secreting cells were found in all ani, and many glands showed the presence of intraluminal secretions. Immunostaining for smooth muscle actin showed the presence of one to two cell layers of myoepithelial cells surrounding all anal glands. CONCLUSIONS: Anal glands are definite preformed structures with secretory activity.

Adult↗
PubMed1994

The ileo-anal reservoir: results from an evolving use of stapling devices.

Thirteen patients had a hand-sewn pouch-anal anastomosis (group A) during restorative proctocolectomy for familial adenomatous polyposis. Median length of follow-up since ileostomy closure was 41.5 months (range 30-56 months). Median stool frequency per 24 h was 4.5 (range 2-5). Six patients were fully continent, three were incontinent to flatus and three patients were occasionally incontinent to liquid stool. Three patients suffered nocturnal seepage but all patients could defer the urge to defaecate by at least 15 min. Fourteen patients (familial adenomatous polyposis: seven; ulcerative colitis: six; intractable constipation: one), had a totally stapled ileal J pouch and pouch-anal anastomosis (group B). Five patients did not have a defunctioning ileostomy while nine patients did. Median follow-up after ileostomy closure or one-stage restorative proctocolectomy was 17.5 months (range 1-30 months). Median frequency of bowel movement per 24 h was 4 (range 2-6). Eleven patients had full continence and three patients suffer occasional incontinence to liquid stools. Two patients have nocturnal seepage but all can defer the urge to defaecate by more then 15 min. There was no significant difference in physiological parameters between the two groups.

Adolescent↗
PubMed1994

Unusual rectal perforation--an individualised approach to management.

The management of rectal perforations is controversial. Surgical repair or resection and anastomosis is usually undertaken with faecal diversion in the management of traumatic perforations. Primary repair without colostomy is less commonly employed. Five cases of rectal perforation seen in the Department of Colorectal Surgery, three from penetrating foreign objects and two from barium enema examination, are presented. The principles of management of patients with rectal perforations include faecal diversion, primary repair of rectal perforation and sphincter muscles, presacral drainage, parenteral antibiotics and distal bowel irrigation. This approach was used in the management of these five cases and the results were very satisfying.

Adolescent↗
PubMed1993

Synchronous colorectal cancer in an Oriental population.

Thirty-four (4.1%) out of 820 patients operated for colorectal cancer between April 1989 and October 1992 were found to have synchronous cancers. Twenty (59%) were male and 14 (41%) were female. The mean age was 69.3 years (range = 25 to 89 yr). Synchronous tumours were located in the same or adjacent segments of the large intestine in 24 (71%) of the patients. A curative resection was performed in 27 (79%) patients, a palliative resection in 8 (18%) and one (3%) patient had a palliative colostomy only. Dukes' staging based on the worse of the 2 cancers showed 1 (3%) Dukes' A, 11 (32%) Dukes' B, 14 (38%) Dukes' C and 9 (27%) with disseminated disease. Age, sex and Dukes' staging did not differ significantly from those of patients with solitary cancers and prognosis was also not adversely affected.

Aged↗
PubMed1993

Ischaemic colitis and colorectal cancer: some problems and pitfalls.

Four cases out of 204 new cases of colorectal carcinoma seen in a 24 month period were proven to have concomitant proximal ischaemic colitis. Ischaemic colitis associated with obstructing carcinoma of the colorectum may present dramatically with gangrene or colonic perforation if the acute vascular insufficiency is severe. Less severe degrees of ischaemic insult must be recognised intra-operatively as the incorporation of ischaemic colon in a colonic anastomosis may result in an anastomotic leak. Two other patients with ischaemic colitis were wrongly diagnosed as colorectal carcinoma on colonoscopy. Endoscopic features of ischaemic colitis may mimic colonic carcinoma and endoscopic biopsy is essential where any doubt exist as to the possibility of ischaemic colitis so that unnecessary surgery may be avoided.

Aged↗
PubMed1993

A simple and effective treatment for hemorrhagic radiation proctitis using formalin.

Radiation proctitis is a common complication of radiotherapy for pelvic malignancy. In the more severe form, it leads to intractable or massive hemorrhage, which may require repeated hospital admissions and blood transfusions. Medical therapy in patients with radiation proctitis is usually ineffective, whereas surgery is associated with a high morbidity and mortality. Eight patients (seven females and one male) with hemorrhagic radiation proctitis were treated over a six-month period with endoluminal formalin. The technique used ensured minimal contact with formalin. The median age of the patients was 68 years (range, 42-73 years). Seven patients had had cancer of the uterine cervix, and one patient had had cancer of the prostate treated with radiotherapy at a median time of 30 months (range, 9-46 months) previously. The median duration of time of symptomatic rectal hemorrhage before formalin therapy was eight months (range, 1-12 months). The median number of units of blood transfused previously per patient was four (range, 2-32). The time taken for formalin therapy was 20 minutes (range, 10-70 minutes). One patient required repeat formalin application at two weeks. Bleeding ceased immediately in seven patients after formalin treatment. No further bleeding was noted, nor was any blood transfusion needed, at follow-up at four months (range, 1-6 months). Formalin therapy is a simple, inexpensive, and effective treatment for hemorrhagic radiation proctitis.

Adult↗
PubMed1993

Results of a policy of selective immediate fistulotomy for primary anal abscess.

A prospective study of a policy of selective immediate fistulotomy in the management of acute primary anal abscesses was performed. Eighty-nine patients (74%) underwent simple drainage only, as no internal openings were found during drainage of pus (group A). Thirty-one patients (26%) had drainage of pus and immediate fistulotomy (group B). Follow up for groups A and B occurred at a median of 122 weeks (104-136 weeks) and 121 weeks (104-136 weeks), respectively. No patient in group A had residual problems with anal continence whilst two patients (6.5%) from group B had minor anal incontinence following the initial procedure (p = 0.07). Ten patients from group A (11%) and four patients from group B (13%) developed recurrent anal sepsis. The overall rate of recurrent sepsis was 11.7%. In those patients who had incision and drainage alone, 90% of those who developed a recurrence and 71% of those who did not develop a recurrence grew gut-associated organisms from pus obtained during the initial drainage of the acute abscess, giving a positive predictive value for recurrence of 13.8% for a culture of gut-associated organisms. The positive predictive value for recurrent sepsis for both groups taken together for a culture of gut-associated organisms was 28.2%. Patients with acute primary anal abscess should be treated with simple drainage.

Abscess↗
PubMed1993

Colorectal cancer and intestinal tuberculosis.

Intestinal tuberculosis occurring together with colorectal cancer is an uncommon event and presents an interesting patho-aetiological relationship. Four cases of abdominal tuberculosis occurring together with colorectal cancer are presented. There were three males and a female. The median age was 71 years with a range from 68 to 75 years. All cancers were moderately differentiated adenocarcinomas. Two of the carcinomas were Dukes B, one had a metastatic liver nodule whilst one was locally advanced. One of the tumours occurred in the sigmoid colon, two were in the rectum and one was in the right colon. Acid-fast bacilli were identified in tissues from all patients. Of the four patients, tuberculosis was only found within the regional lymph nodes in one patient; in one patient tuberculosis was found immediately adjacent to the tumour plaque; in one patient tuberculosis was disseminated within the abdominal cavity; whilst in one patient the two diseases coexisted with the same tumour mass. All the patients had had a complete course of anti-tubercular chemotherapy but no patient had had radiotherapy or chemotherapy for cancer. All the patients are well and no patient has detectable recurrence of tuberculosis or cancer at a median follow-up of 34 months (range: 21-36). The exact relationship of abdominal tuberculosis with colonic cancer is speculative but the possibility of a cause and effect relationship exists.

Adenocarcinoma↗
PubMed1993

Colonic pouch after low anterior resection of the distal third of the rectum.

Very low anterior resection with construction of colo-anal anastomosis for carcinoma of the distal third of the rectum may result in an increased bowel frequency and urgency. These latter problems have been correlated directly with the decreased capacity and compliance of the neo-rectum. Clinical trials have shown a significant advantage of the colonic pouch-anal anastomosis over conventional colo-anal anastomosis in decreasing post-operative bowel frequency and urgency as the former increases neo-rectal capacity. Recent innovations in pouch design and construction with the ingenious use of mechanical stapling devices will enable the widespread use of the colonic pouch to benefit more patients who require very low anterior resection for carcinoma of the distal third of the rectum.

Colectomy↗
PubMed1992

Bacteriology of anal fistulae.

Anal fistulae are said to arise from cryptoglandular infection of the anal glands, which lie within the intersphincteric space. The type and virulence of the micro-organism responsible may determine whether an anal fistula develops. The microbiology of chronic anal fistulae has not been reported previously. Twenty-five consecutive anal fistulae were studied prospectively (eight intersphincteric fistulae, 12 trans-sphincteric fistulae, two suprasphincteric fistulae, one extrasphincteric fistula, one superficial fistula, one anovaginal fistula). There were 18 men and seven women, with a median age of 42 (range 22-71) years. Patients with Crohn's disease or acute anorectal suppuration were excluded. In 18 patients, 0.1 ml granulation tissue from the track of the fistula was obtained and processed within 4 h using standard microbiological techniques. Sixty-nine isolates representing at least 17 species were obtained. The predominant organisms were Escherichia coli (22 per cent), Enterococcus spp. (16 per cent) and Bacteroides fragilis (20 per cent). The majority of the growths were obtained only from enrichment. Bacteria from only one patient grew at a dilution of 10(3). Granulation tissue from 25 patients was processed for mycobacterial culture, and Mycobacterium tuberculosis was grown from one patient. No other mycobacterium was isolated. The chronic inflammation in anal fistulae does not seem to be maintained by either excessive numbers of organisms or organisms of an unusual type.

Adult↗