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Biomedical subjects

M C Winslet

Publications and source records attributed to M C Winslet.

62 records · Page 4Linked to original sources
PubMed1989

Vaginal fistulas in Crohn's disease.

Twenty-eight patients with vaginal fistulas complicating Crohn's disease, seen between 1970 and 1987, are described. Twelve required early operation; five of them had rectal excision. Conservative management was used in 16 patients but in none of these did the fistula close spontaneously. Subsequent proctocolectomy was required in seven patients though two patients with high vaginal fistulas were managed by total colectomy, end ileostomy, and oversewing of the rectal stump. Only two high fistulas resulting from ileal Crohn's disease resolved with resection and anastomosis of the diseased segment alone. Local repair was unsuccessful despite repeated operations in two of five patients. Two patients died of malignancy arising within a chronic vaginal fistula. Although some vaginal fistulas complicating Crohn's disease cause little disability and can be managed symptomatically, they do not heal by conservative therapy or by a proximal defunctioning stoma alone. In time, severe bowel symptoms develop in the majority of patients and necessitate proctectomy.

Adult↗
PubMed1989

Multivariate analysis of factors influencing the results of restorative proctocolectomy.

Univariate and multivariate analysis has been used to assess the influence of 14 variables on the results of 65 consecutive ileoanal pouch procedures over 5 years. There were 9 failures requiring intubation, ileosomy or pouch excision. There was a significant association between failure and pelvic sepsis (p less than 0.05; n = 8), endoanal mucosectomy (p less than 0.05; n = 7), preservation of a long rectal cuff (p less than 0.05; n = 5) and lack of experience with the operation (p less than 0.05; n = 8). Of 49 patients with preoperative evidence of ulcerative colitis, 3 are now known to have Crohn's disease. The only factor having a significant adverse influence on complications was endoanal mucosectomy (p less than 0.01). Functional outcome was significantly impaired in patients who developed pelvic sepsis (p less than 0.001), a post-operative fistula (p less than 0.05) and who had an endoanal mucosectomy (p less than 0.05). Success with ileo-anal pouch reconstruction increases with experience. Avoidance of sepsis is associated with a lower failure rate, improved functional results and reduced hospital stay. Preliminary colectomy is also advised to exclude Crohn's disease if the diagnosis is in question.

Adult↗
PubMed1987

Discrimination is not impaired by excision of the anal transition zone after restorative proctocolectomy.

Anal sensation has been assessed using a constant current stimulator in 21 patients after restorative proctocolectomy (15 J pouch, 6 W pouch). The anal transition zone (ATZ) has been excised in 15 patients but preserved in 6. Results were compared with 14 age- and sex-matched patients with ulcerative colitis (UC) and 14 controls. Median threshold values in the lower, mid and upper zones of the anal canal in pouch patients were: 6.8 mA, greater than 15.0 mA and greater than 15.0 mA respectively compared with 3.9 mA (P less than 0.01), 5.7 mA (P less than 0.01) and 11.4 mA (P less than 0.01) in UC and 3.5 mA (P less than 0.01), 4.2 mA (P less than 0.01) and 11.4 mA (P less than 0.01) in controls. The mid and upper zone threshold anal sensation was significantly lower when the ATZ had not been removed and except in the lower zone did not differ from UC or controls (median threshold sensations when ATZ was preserved were: lower zone, 5.8 mA; mid zone, 5.5 mA; upper zone, 7.5 mA). Paired studies in eight patients showed that excision of the ATZ was associated with a significant impairment in anal sensation (mid zone: 5.7 versus greater than 15.0 mA, P less than 0.05; upper zone: 7.5 versus greater than 15.0 mA, P less than 0.05) whereas no change in anal sensation was recorded when the ATZ was preserved. Despite these physiological changes, no clinical benefit could be identified in patients in whom the ATZ was preserved. Discrimination was normal in all except one patient. The incidence of soiling, nocturnal incontinence and failure to defer defaecation for more than 1 h was recorded in 3/15 patients (20 per cent) whose ATZ had been removed, compared with 1/6 patients (17 per cent) in whom the ATZ had been preserved. We conclude that excision of the ATZ does not eliminate the ability to discriminate and does not increase the risk of impaired continence after ileo-pouch anal anastomosis.

Adolescent↗
PubMed1987

The pouch as an alternative to permanent ileostomy.

Restorative proctocolectomy has become a realistic alternative to construction of a permanent stoma for patients with ulcerative colitis and familial polyposis coli. The operation restores intestinal continuity but continent patients have to open their bowels 4-5 times during the day, and over half have to rise at night to defaecate. The potential complications are considerable, but their frequency decreases with experience with the operation. This article reviews the place and results of ileoanal pouch anastomosis.

Adult↗
PubMed1986

Breakdancer's thumb--partial rupture of the ulnar collateral ligament with a fracture of the proximal phalanx of the thumb.

Breakdancing is an acrobatic dance that involves spinning on various parts of the body including the head, dorsal spine and hand. Three cases are reported of partial rupture of the ulnar collateral ligament (UCL) of the thumb, associated with a fracture of the base of the proximal phalanx which occurred as a result of torsional forces applied to the abducted and hyperextended thumb. It appears to be a distinct clinical entity. In all cases, open reduction was required and led to excellent functional recovery.

Adolescent↗
PubMedDate not supplied

Proliferation and p53 expression in anal cancer precursor lesions.

BACKGROUND: Anal squamous cell carcinoma (SCC) develops from dysplastic anal warts. This study quantifies the expression of p53 and Ki67 in pre-invasive and invasive anal lesions. MATERIALS AND METHODS: Samples of 70 patients with anal warts (n = 20), low grade anal intraepithelial neoplasia (LG AIN) (n = 12), high grade anal intraepithelial neoplasia (HG AIN) (n = 27) and anal SCC (n = 11) were stained using immunohistochemical techniques. Eight patients with normal anal skin were used as controls. RESULTS: Both the expression of p53 and Ki67 increased significantly (p < 0.001) and gradually as the lesions became dysplastic and invasive. The main increase in p53 expression was as the lesions progressed from anal warts (7.38 +/- 11.93-mean +/- SD) to low grade AIN (20.778 +/- 13.14). CONCLUSION: p53 is involved in the progression of anal cancer and its expression increases from early in the development of pre-invasive anal lesions. p53 and Ki67 may be useful markers of early dysplasia and should be considered in the screening of high risk patients.

Anus Neoplasms↗