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Biomedical subjects

I G Finlay

Publications and source records attributed to I G Finlay.

At least 55 records · Page 3Linked to original sources
PubMed1999

Colonic motility is abnormal before surgery for rectal prolapse.

BACKGROUND: Abdominal rectopexy remains the operation of choice for patients with rectal prolapse. Recurrence rates are low but the functional results are poor. Hindgut motility was measured before abdominal rectopexy to determine whether an underlying neuropathy might explain these poor results. METHODS: Seven women of mean(s.d.) age 56(10) years had a multilumen catheter inserted in the colon before abdominal rectopexy. Colonic intraluminal pressure was recorded for a mean(s.d.) of 19(3) h; the number of peaks over 5 and 50 mmHg, motility and high-amplitude propagated contractions (HAPCs) were measured before and after a meal and compared with the findings in five controls. RESULTS: Patients had high numbers of contractions greater than 5 mmHg and high motility before meals. Controls responded to meals by increasing motility, unlike patients. HAPCs were seen in one patient but in all controls. CONCLUSION: These data show that patients with rectal prolapse have a hindgut motility abnormality before abdominal rectopexy, similar to that observed in spinal cord injury. This may explain the poor functional results after surgery, offering a rationale for colonic resection.

Adult↗
PubMed1999

Identification of patients likely to benefit from biofeedback for outlet obstruction constipation.

BACKGROUND: Biofeedback for outlet obstruction constipation has a varying success rate. The aim of this study was to identify which patients are likely to respond to biofeedback. METHODS: Thirty patients with severe outlet obstruction constipation were treated by a specialist nurse using three or four sessions of visual and auditory feedback of anal sphincter pressures. All patients were assessed by evacuating proctography, whole-gut transit studies and anorectal physiology before treatment. RESULTS: Two patients did not complete the course of biofeedback. Nine patients improved. Before treatment these patients had predominantly normal anorectal physiology and were all able to open the anorectal angle at evacuating proctography. Nineteen patients did not improve, of whom only three had no measured abnormality other than inability to empty the rectum. Ten of these patients had abnormal anorectal physiology which may have been due to previous vaginal delivery. CONCLUSION: Biofeedback for outlet obstruction constipation is more likely to be successful in patients without evidence of severe pelvic floor damage.

Adolescent↗
PubMed1999

Uneven pressure application by the artificial urinary sphincter: an explanation for tissue ischaemia?

OBJECTIVE: To determine, in an in vitro study, the pressure inside the AMS 800 (American Medical Systems, USA) sphincter placed around porcine intestine and to correlate this with the pressure retention for liquids, in an attempt to explain the increased sensitivity of bowel to ischaemic injury when the artificial urinary sphincter is used around bowel neo-urethral segments. MATERIALS AND METHODS: Segments of porcine intestine were placed in a specially designed mechanical jig and an AMS 800 sphincter placed around the segment. The device was inflated by injecting water and the cuff pressure measured. Water was infused into the bowel and the pressure at which leakage occurred through the sphincter recorded. At each inflation pressure, a catheter-tipped microtransducer was used to measure the pressure inside the cuff-fold. It was then placed in the centre of the cuff lumen, rotated by 360 degrees and the pressure continuously recorded. RESULTS: The cuff occluded the lumen by creating a 'triple-cushion' effect. The fluid retention pressure was 49% of the cuff pressure. There were directional differences in the pressure measured inside the bowel lumen. The pressure was also disproportionately higher inside the cuff folds than in the centre of the sphincter, and increased rapidly with inflation of the cuff. CONCLUSION: The thin wall of the bowel may 'crenate' inside the high-pressure areas in the cuff folds and this may explain the increased sensitivity of bowel to ischaemic injury in such cases.

Animals↗
PubMed1999

The applicability of quality-of-life assessment in palliative care: comparing two quality-of-life measures.

Two self-administered quality-of-life measures, the McGill Quality of Life Questionnaire (MQOL) and the Patient Evaluated Problem Scores (PEPS) were compared in patients receiving palliative care. The MQOL is a multidimensional questionnaire consisting of 16 items in five quality-of-life (QOL) domains: physical symptoms, physical well-being, psychological, existential and support domains. The PEPS is an individualized questionnaire asking patients to identify and rate major problems affecting their QOL. Both questionnaires were completed by 36 patients during outpatient clinic visits in three palliative care settings in Wales. Of those patients who stated their questionnaire preference 60% favoured MQOL due to its comprehensiveness, while others (28%) preferred PEPS due to its simplicity. The MQOL showed excellent internal consistency (alpha = 0.90). The intrapatient analysis of answers from both questionnaires showed that MQOL was better than PEPS in reporting physical symptoms and support domain, while PEPS detected more psychosocial issues. The MQOL overall QOL score correlated highly with its existential domain (rs = 0.57, P < 0.0005) and the PEPS overall quality of life (rs = 0.77, P < 0.0005). Similarly, the PEPS overall QOL correlated well with MQOL total score (rs = 0.76, P < 0.0005) and existential domain of the MQOL (rs = 0.63, P < 0.0005). The findings support the importance of an existential domain in assessing the QOL of this population. Both MQOL and PEPS were found to be relevant and acceptable in advanced cancer patients receiving palliative care. However, with its favourable psychometric properties MQOL may be more suitable for QOL assessment in this population.

Adolescent↗
PubMed1998

Non-invasive measurement of colonic blood flow distribution using laser Doppler imaging.

BACKGROUND: This study tested a prototype laser Doppler scanner for the measurement of human colonic blood flow. METHODS: Blood flow distribution was assessed in human colon during operation in six controls and in six patients with inflammatory bowel disease undergoing colectomy. Image processing software analysed several hundred reading points, expressing average flow in perfusion units. RESULTS: Blood flow in the colon was not significantly lower in the control group than in patients with inflammatory bowel disease (mean(s.e.m.) 297.8(24.5) versus 347.2(59.0) perfusion units, P = 0.12). Intestinal colonic mural blood supply was demonstrated up to a distance of 6 cm and ischaemia demarcation lines were identified before the onset of visible changes. CONCLUSIONS: This prototype laser Doppler flowscanner overcomes the previous limitations of laser Doppler flowmeters and may have many clinical and research applications.

Adult↗
PubMed1998

Effect of a novel prosthetic anal neosphincter on human colonic blood flow.

BACKGROUND: An artificial anal sphincter has been developed which aimed to simulate the normal physiology of the anorectum. As a prelude to human implantation the present study reports the effect of inflation of this device on colonic perfusion in patients undergoing colectomy, which was assessed by using a laser Doppler scanner. METHODS: Eleven patients (median age 49.8 (range 24.3-78.7) years) were studied. Five patients had inflammatory bowel disease (IBD). The neosphincter was placed around the bowel and progressively inflated. The model was designed so that blood flow changes to the colon under the neosphincter would be reflected in the distal segment of the bowel, which could be scanned by the laser Doppler scanner. RESULTS: The blood flow in the colon distal to the device was significantly higher in patients with IBD (mean(s.e.m.) 288.6(71.9) versus 211.1(57.6) perfusion units; P < 0.001). The mean(s.e.m.) 'biological zero' value was 46(14) perfusion units. Blood flow distal to the neosphincter decreased progressively with increased sphincteric compression by 0.66 per cent per mmHg applied pressure in controls and 0.35 per cent per mmHg in patients with IBD (P < 0.05). CONCLUSION: These results suggest that at the planned operating occlusion pressure (less than 45 mmHg) this neosphincter should not put the vascularity of the human colon at risk.

Adult↗
PubMed1998

A randomized controlled study of portfolio learning in undergraduate cancer education.

Portfolio learning has not previously been reported for clinical undergraduate teaching. This open randomized study aimed to assess the effect of portfolio learning in the teaching of oncology to medical students. The project aimed to provide the student with a holistic understanding of the impact of the disease and its treatment on the patient and family, and the natural history of malignant disease, through long-term personal experience of a cancer patient. All undergraduate medical students entering Clinical Studies in October 1992 at the University of Wales College of Medicine were randomized to a study or control group. Both groups continued with the standard curriculum. Each study-group student followed a patient with cancer for 9 months, supported by bi-monthly small-group tutorials. Tutors were either general practitioners or hospital consultants, not necessarily oncologists; each was supplied with a tutor's resource pack of key oncology review papers. Students recorded triggers to learning and key items in a personal learning portfolio. Students' performances in clinical examinations and the contents of their portfolio was assessed. Final assessment was by hidden questions in the objective structured clinical examination (OSCE) in the final degree examination, when students in the study group showed higher marks in factual knowledge of oncology, particularly amongst the weaker students (P = 0.01). Those submitting portfolios for formative assessment had higher overall marks than those in the study group who did not (P = 0.04), representing the more motivated students. The whole study group showed a beneficial trend in their knowledge of oncology.

Education, Medical, Undergraduate↗
PubMed1998

Managing terminally ill prisoners: reflection and action.

In 1997 a young remand prisoner was 'shackled' to his bed until shortly before his death. An outcry ensued. This paper discusses issues concerning care of terminally ill prisoners. In Cardiff, the Prison Service, local National Health Service trusts and the hospice have produced joint guidance on the escorting of ill prisoners and managing a bedwatch; these are outlined.

Delivery of Health Care↗
PubMed1997

Assessment of a novel implantable artificial anal sphincter.

PURPOSE: The aim of the study was to test a new implantable artificial anal sphincter in the porcine model. METHOD: The artificial sphincter, which includes an inflatable expander that compresses and flattens the bowel against a pillow, was implanted in 16 animals and studied for periods of up to 20 weeks. The anal sphincters were destroyed, and the efficacy of the device in rendering the animals continent was studied. RESULTS: Of the 11 animals in which the artificial sphincter was regularly closed, 8 completed the study and were continent during 85 percent of activation times. There was no evidence of ischemic injury. Major complications were related only to failure of the control pumps of the device. CONCLUSION: This study suggests that this neosphincter produces fecal continence without intestinal ischemia. At present reliability is limited only by the performance of the pump.

Anal Canal↗
PubMed1997

Totally stapled restorative proctocolectomy.

BACKGROUND: Totally stapled restorative proctocolectomy (TSRP) has simplified ileoanal pouch surgery but few reports exist concerning experience with the technique. A retrospective study of operative and functional data in a consecutive series of patients undergoing TSRP was undertaken. METHODS: TSRP with J pouch formation was attempted in 103 patients between 1988 and 1995 (for ulcerative colitis (87 patients), familial adenomatous polyposis coli (nine), slow transit constipation (six) and hereditary non-polyposis colorectal cancer (one). Three technical failures resulted in 100 patients available for assessment. Case notes were reviewed together with functional assessment by clinical interview and/or postal questionnaire. RESULTS: Median operating time was 200 min, intraoperative blood loss 360 ml and hospital stay 12 days. There were no operative deaths. All but five patients (95 per cent) had loop ileostomy formation with subsequent reversal. There were 29 complications, six of which required further surgical intervention. Six pouches were excised and two patients had a temporary defunctioning ileostomy. Five patients were rediagnosed as having Crohn's disease, of whom four underwent subsequent pouch excision. Pouchitis (in the absence of Crohn's disease) occurred in eight patients (8 per cent). In 60 patients with at least 12 months of established function, median day and night stool frequencies were 5 and 1 respectively. Functional evaluation in 49 patients (82 per cent) revealed regular use of antidiarrhoeal medication in 21, urgency in 17, and total continence by day and night in 37 and 35 respectively. Fifty-three patients (88 per cent) were satisfied with the overall long-term outcome. CONCLUSION: TSRP is safe, has simplified a technically difficult operation and gives good long-term functional results.

Adenomatous Polyposis Coli↗
PubMed1997

Gastric emptying in patients with constipation following childbirth and due to idiopathic slow transit.

BACKGROUND: Idiopathic slow transit constipation (ISTC) is considered to be a heterogeneous condition in which patients have varying sites and degrees of delayed gastrointestinal transit. The majority of patients have pancolonic disease, and colectomy with ileocolorectal anastomosis has been the mainstay of surgical treatment. Severe constipation following traumatic childbirth is now being recognized and this subgroup of patients may have delayed transit confined to the rectosigmoid colon. In theory, proximal transit in these patients should be normal. METHODS: Gastric emptying was studied in patients with constipation following childbirth or ISTC and in controls. After an overnight fast, both patients and controls received breakfast, which consisted of cornflakes, sugar and milk. The liquid marker 111In-labelled di-ethylene tri-amine penta-acetic acid (DTPA) was added to the milk. A solid marker, 99mTc-labelled colloid, was impregnated on to paper and sealed with cellulose. The t1/2 for gastric emptying was calculated. RESULTS: Liquid phase emptying was normal in both constipation following childbirth and ISTC. Solid phase emptying was delayed significantly in ISTC compared with that in patients with constipation following childbirth and controls. In addition, half the patients with ISTC had delayed transit through the small bowel and proximal colon. Small bowel and colonic transit were normal in patients with constipation following childbirth. CONCLUSION: Patients with constipation following childbirth represent a distinct subgroup with normal proximal gastrointestinal function. Gastric emptying studies may be helpful in selecting patients for surgical management of severe constipation.

Adult↗
PubMed1996

Anorectal angle enhances faecal continence.

This study was performed with an in vitro model to assess the relative importance of sphincter pressure and anorectal angulation in maintaining faecal continence. Water and semisolid material were infused separately into porcine intestine compressed by an inflatable cuff until leakage was observed. Angulation of the bowel with respect to the cuff was 180 degrees and then 90 degrees. With water, holdback pressure was independent of angulation. In contrast, when semisolid material was used, angling the bowel to 90 degrees increased holdback pressure by at least 100 per cent. Measurements taken in solid tubes demonstrated that both a restriction in the tube and an unconstricted 90 degrees bend produced a resistance to flow of the semisolid material which was dependent on flow rate. These data suggest that liquid is retained in the rectum by occlusion pressure alone, whereas the retention of semisolid material is enhanced by angulation.

Anal Canal↗
PubMed1996

Cutting seton without preliminary internal sphincterotomy in management of complex high fistula-in-ano.

PURPOSE: The traditional treatment of a complex high fistula-in-ano by internal sphincterotomy and insertion of a cutting seton carries a risk of fecal incontinence. We have assessed the functional impact of treating patients with a complex fistula-in-ano by a cutting seton fistulotomy technique that preserves the internal sphincter. METHODS: The operative steps consisted of initial eradication of sepsis, identification of the internal and external openings of the fistula tract, excision of the fistula tract with anal canal mucosa, and insertion of a cutting silk seton around both the internal and external sphincters. In this way open drainage of the intersphincteric space was avoided, and integrity of the internal sphincter was maintained. Functional outcome following treatment with this technique, with regard to fistula eradication and effect on fecal continence was assessed in 27 patients (15 males) who were treated during a six-year period. Twenty-three patients (85 percent) had a history of previous fistula surgery. RESULTS: The fistula was cured in 26 patients (96 percent) with no reports of altered continence at the time of discharge from outpatient review. Recurrence developed in one patient (4 percent) in whom hidradenitis suppurativa was subsequently diagnosed. All four patients with Crohn's disease had their fistulas eradicated; three (75 percent) have subsequently undergone proctectomy for severe perianal and rectal Crohn's involvement. Long-term follow-up revealed three patients (19 percent, all rectovaginal fistulas) who experienced a deterioration in continence after discharge. CONCLUSIONS: Although this procedure may not be appropriate for rectovaginal fistulas, the data suggest that cutting setons are effective in treating complex fistula-in-ano, including those that have failed to respond to other forms of surgery. Avoidance of preliminary internal sphincterotomy may prevent deterioration in continence.

Adult↗