Search PubMed⌕ Search

Biomedical subjects

J B Fozard

Publications and source records attributed to J B Fozard.

13 recordsLinked to original sources
PubMed2004

Per-anal excision of large, rectal, villous adenomas.

PURPOSE: Considering the malignant potential of villous adenoma of the rectum, complete resection at the first intervention is desirable and yet many series suggest that a high recurrence rate must be expected. The experience of one colorectal surgeon in the management of this condition is described. METHODS: Between 1993 and 2000, 50 patients underwent per-anal resection of villous adenoma. The procedure was conducted in the prone jackknife position unless contraindicated, with dissection performed using a diathermy blade, with particular attention to circumferential and deep margins of excision. RESULTS: The mean distance of the proximal margin of the tumor from the dentate line was 5.6 (range, 0.5-11) cm. The mean length of the tumor was 5.2 (range, 0.5-9) cm. Mean anesthetic time was 27 (range, 10-110) minutes, and median hospital stay was two (range, 1-14) days. There was no significant perioperative morbidity and no mortality. On histology of ten patients, there were foci of adenocarcinoma. Excision was complete histologically in 49 patients. The median follow-up was 30 (range, 6-91) months. The patient with incomplete excision developed a probable recurrence after six months, which was ablated with diathermy (residual tumor rate, 2.1 percent). Two patients have subsequently developed villous adenoma at different sites within the rectum (metachronous tumor rate, 4.3 percent). CONCLUSIONS: Many series of this procedure report recurrence in up to 36 percent and significant complication in up to 19 percent of patients. Transanal endoscopic microsurgery has achieved recurrence rates of 2.8 percent and low complication rates but for economic reasons has failed to find a widespread role. This article demonstrates that large, villous tumors of the low and mid rectum can be simply and effectively treated by per-anal resection with recurrence rates equivalent to transanal endoscopic microsurgery.

Adenoma, Villous↗
PubMed1990

The application of isotope limb blood flow measurement to diagnostic problems in vascular surgery.

A new method of limb blood flow measurement has been developed; normal flow is 10-22 ml/100 ml of tissue/min and flow to limbs with claudication is 1.8-2.3. Does this technique help to deal with diagnostic problems in vascular surgery? Twenty-five patients presented with exercise-induced leg pain. Twelve had a convincing history of claudication but seven of these had palpable pedal pulses, the other five had normal Doppler ratios. Of 13 with a poor history six had absent pulses; of the other seven with palpable pulses, two had abnormal and five had normal Doppler ratios. All 25 patients have had blood flow to both legs measured. For the five with a poor history, palpable pulses and normal Doppler ratios: (Table: see text). Twelve had reduced flows consistent with claudication (less than 8 ml/100 ml of tissue/min); 10 of these have undergone arteriography which demonstrated significant vascular disease, one had surgery to rheumatoid toes deferred and one refused further investigation. Of 13 with normal flows nine have been found to have significant orthopaedic problems affecting spine, hips or knees, the other four have all had normal arteriograms. In every case the history, signs or Doppler ratios were potentially misleading, but all cases of significant arterial disease were detected. It is cheap, readily available and effectively selected cases for referral or arteriography.

Gamma Cameras↗
PubMed1989

Epithelial dysplasia in Caroli's disease.

We report a young patient with a solitary intrahepatic cyst without demonstrable connection with the biliary tree. The operative appearances suggested hydatid disease but histological examination of the resected cyst showed that it was the result of Caroli's disease already complicated by severe dysplasia. This case provides further evidence for the premalignant nature of Caroli's disease.

Adult↗
PubMed1988

DNA aneuploidy and cell proliferation in familial adenomatous polyposis.

Two hundred and thirteen samples from 20 patients with familial adenomatous polyposis (FAP) were investigated by flow cytometry and the results compared with 100 sporadic adenomas. Eleven of the 20 (55%) yielded one or more DNA aneuploid samples with an overall incidence within FAP adenomas of 12%. Despite a similar level of DNA aneuploidy in sporadic adenomas, it was commonly detected at a smaller polyp size. The degree of cell proliferation was found to be similar in the two groups (median %S+G2 15.8% v 16.4%) but larger FAP adenomas demonstrated a higher level of cell proliferation than smaller adenomas. DNA aneuploidy had no value as a predictor of a synchronous carcinoma and appeared to be an early change in the development of carcinoma in these patients.

Adenomatous Polyposis Coli↗
PubMed1987

Lectin and mucin histochemistry as an aid to cancer surveillance in ulcerative colitis.

In a preliminary study, we assessed 10 lectins for the identification of dysplasia in colectomy specimens from patients with ulcerative colitis. Peanut agglutinin (PNA) binding was found in all cases of dysplasia. In the main study the relationship between PNA staining, high iron-diamine/alcian blue (HID-AB) histochemistry, and dysplasia was investigated in 115 pre-operative colonoscopic biopsies and the subsequent resection specimens from patients with ulcerative colitis complicated by carcinoma (n = 6) and patients undergoing proctocolectomy for failure of medical management (n = 8). Peanut lectin was of no value in the assessment of pre-malignant changes or cancer risk. However, the HID-AB stain appears to clarify the interpretation of less severe pre-malignant changes and may be usefully applied to the interpretation of colonoscopic biopsies for cancer surveillance in ulcerative colitis.

Alcian Blue↗
PubMed1986

DNA aneuploidy in colorectal adenomas.

The frequency of DNA aneuploidy was investigated by flow cytometry in 156 colorectal adenomas including 56 associated with 36 synchronous adenocarcinomas. Nine of 156 adenomas (6%) were DNA aneuploid. DNA aneuploidy correlated with increasing size (P less than 0.005) and histopathological type P less than 0.05) but not with dysplasia. Adenomas in associated with a synchronous adenocarcinoma did not have an increased incidence of DNA aneuploidy. Adenocarcinomas found in association with adenomas tend to have a lower incidence of DNA aneuploidy then the generality of colorectal cancers.

Adenocarcinoma↗
PubMed1986

DNA aneuploidy in ulcerative colitis.

The prevalence of deoxyribonucleic acid (DNA) aneuploidy in 297 samples from 38 patients with ulcerative colitis of varying duration was investigated by flow cytometry. In 12 patients colitis was complicated by the development of colorectal carcinoma: one had three synchronous carcinomas. Only four of 14 carcinomas were DNA aneuploid. Deoxyribonucleic acid aneuploidy occurred focally in the colorectal mucosa in the presence and absence of carcinoma: rates of aneuploidy (67% in cancer patients and 42% in non-cancer patients), were not significantly different (chi 2 = 1.0962, p = 0.295). A higher rate of DNA aneuploidy was found in dysplastic tissues (21%) compared with non-dysplastic tissues (15%), but again these differences did not reach statistical significance (chi 2 = 1.0747, p = 0.299). Deoxyribonucleic acid aneuploidy and dysplastic change occurred more often with increasing duration of ulcerative colitis (p less than 0.001, p less than 0.005 respectively). We conclude that flow cytometric analysis of cellular DNA content should not replace present morphological methods of assessment of premalignancy in ulcerative colitis, but may be a useful adjunct in the identification of abnormal mucosa.

Adult↗
PubMed1983

Asepsis and out-patient cystoscopy.

Cystoscopy was performed on a control group of 74 patients under full sterile precautions and on a study group of 83 patients under aseptic conditions, which required fewer materials. The incidence of urinary infections in the two groups was 4 and 6% respectively; this difference is not statistically significant. Rigors were rare in both groups (1%). The financial savings achieved by using an aseptic technique for out-patient cystoscopy are discussed.

Antisepsis↗