Biomedical subjects
Publications and source records attributed to H C Rees.
A patient with epispadias had a ureterosigmoidostomy. This was converted to an ileal conduit 3.5 years later. 24 years after this, he developed an adenocarcinoma at the site of the ureteric stump. Abnormal mucin staining was found in the resected colon. This stain is not predictive of malignant change, and therefore regular colonoscopy is required for these patients.
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Forty patients with colonic urinary diversions were studied for morphological and histochemical changes in the colon using haematoxylin and eosin, and high iron diamine alcian blue stains. Eighty-nine per cent of ureterosigmoidostomies biopsied at the ureteric orifice and 44% biopsied distal to the orifice showed "transitional" changes thought to represent a pre-malignant state. Thirty-eight per cent of patients who had had ureterosigmoidostomies in the past and 100% of the colon conduits also demonstrated this change. The earliest "transitional" change occurred 1 year after the diversion. This and the low incidence of morphological changes in this group of patients suggest that the finding of "transitional" mucosa is of no value in the follow-up of patients with colonic urinary diversions.
The results of selective visceral angiography and colonoscopy were compared in the diagnosis of angiodysplasia of the large bowel. Fifty six patients were diagnosed as having angiodysplasia on angiography and 34 of these patients also underwent colonoscopy. Twenty three of the colonoscopies were positive giving a diagnostic yield of 68%. Three colonoscopies were negative and eight were incomplete. Colonoscopy was useful in the diagnosis of concomitant disease and also provided the clinician with the therapeutic possibility of electrocoagulation. Colonoscopy at operation proved to be a valuable technique in assessing the extent of angiodysplasia prior to resection.
The records of 37 patients investigated for obscure gastrointestinal haemorrhage originating from the small bowel were reviewed retrospectively. Bleeding was caused by Meckel's diverticula in eight cases, smooth muscle tumours in seven cases, vascular anomalies in 14 cases, and other single lesions in eight cases. The lesions were identified by angiography in 18 patients, operation in 17, and barium follow through examination in two. Only one patient under 50 years of age had a lesion that would not have been found by careful laparotomy. Early laparotomy is advisable in patients aged under 50 with obscure gastrointestinal bleeding; expert selective angiography is recommended before operation in patients aged over 50 and those who have already undergone a laparotomy yielding negative results.