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Biomedical subjects

Neil Hyman

Publications and source records attributed to Neil Hyman.

26 records · Page 2Linked to original sources
PubMed2003

Continence alterations after ileal pouch-anal anastomosis do not diminish quality of life.

PURPOSE: This study was conducted to compare continence after double-stapled ileal pouch-anal anastomosis and laparoscopic cholecystectomy using the Fecal Incontinence Severity Index and to assess the impact on quality of life using the Fecal Incontinence Quality of Life Scale. METHODS: Fifty-five patients randomly selected from a prospective pelvic pouch database were matched with regard to age and gender with patients who had undergone laparoscopic cholecystectomy during the same time interval by the same surgeon. Patients were mailed the two questionnaires, which were reviewed by an independent observer. Demographics, duration since surgery, and functional results were recorded. The Fecal Incontinence Severity Index and Fecal Incontinence Quality of Life scores were compared by the analysis of variance method. RESULTS: Fifty-one pelvic pouch and 50 laparoscopic cholecystectomy patients were able to be contacted and completed both of the measuring tools. For the pouch patients, the median number of bowel movements per day was six (range, 2-15), with two patients reporting more than occasional nighttime incontinence. Mean incontinence scores were higher for the pelvic pouch patients than for the laparoscopic cholecystectomy patients (17.8 vs. 10.7; P = 0.03). However, the quality-of-life scores were very similar: lifestyle (3.8 vs. 3.83; P = 0.88), depression/self-perception (3.81 vs. 3.83; P = 0.94), embarrassment (3.76 vs. 3.8; P = 0.84), and behavior/coping (3.57 vs. 3.71; P = 0.5). CONCLUSION: Although continence is clearly altered after pelvic pouch surgery, quality of life is extremely well preserved.

Adult↗
PubMed2002

The Vermont colorectal cancer project: self-portrait.

HYPOTHESIS: A prospective statewide quality assessment and improvement project requiring active participation and case entry by surgeons is feasible provided that confidentiality and peer review protection are provided. DESIGN: Inception cohort. SETTING: Acute-care hospitals in Vermont. PATIENTS: Consecutive series of 364 patients undergoing elective surgery for colorectal cancer between April 1, 1999, and March 31, 2001, who were prospectively entered into a database created by the Vermont Chapter of the American College of Surgeons under peer review protection from the Vermont Program for Quality Health Care. INTERVENTION: Surgery for invasive colorectal cancer. MAIN OUTCOME MEASURES: Case entry compliance, surgical complications, length of stay, demographics, cancer-specific characteristics, and use of adjuvant therapy. RESULTS: The calculated case entry compliance rate was 78%. There were 7 deaths (2%) and 45 major complications in 39 patients (12.3%). All patients were offered referral for adjuvant therapy when appropriate based on National Institutes of Health Consensus Conference standards. Mean age was 68.7 years, and 52% of cancers occurred in women. The most common site of cancer was the right colon (36.6% of patients), and only 47.9% of malignancies were in the rectum or sigmoid. Eighty-two percent of patients had symptoms on presentation. CONCLUSIONS: Elective colorectal cancer surgery in Vermont is reasonably safe, and adherence to national standards for the use of adjuvant therapy is outstanding. Surgeons will provide outcome data if confidentiality and peer review protection are provided. The predominance of right-sided lesions and the low incidence of asymptomatic detection have significant implications for screening efforts in Vermont.

Adult↗
PubMed2002

Fecal incontinence severity index after fistulotomy: a predictor of quality of life.

PURPOSE: The purpose of this study was to use the Fecal Incontinence Severity Index to assess fecal incontinence after fistulotomy and to correlate the Fecal Incontinence Severity Index score with quality-of-life measures. METHODS: A retrospective chart review was performed on consecutive patients undergoing fistulotomy by a single colon and rectal surgeon at a university hospital from 1991 to 1999. Demographics, fistula anatomy, surgical technique, and length of follow-up were recorded. Mailed questionnaires and telephone interviews were conducted to determine the Fecal Incontinence Severity Index score, pad usage, lifestyle restriction, and psychosocial factors. A linear regression model was used to determine the relationship of clinical factors with Fecal Incontinence Severity Index. One-way ANOVA was used to correlate Fecal Incontinence Severity Index with quality-of-life measures. RESULTS: Of 110 patients who underwent fistulotomy, 96 (88 percent) had complete follow-up. Mean age was 48 (range, 17-84) years, and 68 percent were male. Follow-up was less than two years in 26 percent, two to five years in 39 percent, and more than five years in 35 percent. Of these patients, 41 percent had intersphincteric fistulas, whereas 59 percent had transsphincteric fistulas. Median Fecal Incontinence Severity Index score was 6, with a mean of 13 (maximum Fecal Incontinence Severity Index = 61); 36 percent had a Fecal Incontinence Severity Index score of zero. Linear regression revealed that only the amount of external sphincter divided correlated with Fecal Incontinence Severity Index score (P = 0.05). Quality-of-life measures strongly correlated with Fecal Incontinence Severity Index by analysis of variance (P < 0.01 for pad usage, lifestyle restriction, depression, and embarrassment), with substantial quality-of-life drop-off documented with Fecal Incontinence Severity Index >30. CONCLUSION: The Fecal Incontinence Severity Index is an excellent tool to gauge quality of life after fistulotomy. Fecal Incontinence Severity Index scores >30 predict a detrimental effect on quality of life.

Adolescent↗
PubMed2002

How much colorectal surgery do general surgeons do?

BACKGROUND: Surgical subspecialization has croded the traditional domain of the general surgeon. The purpose of this study was to assess the volume and distribution of colon and rectal cases performed by general surgeons. STUDY DESIGN: The American Board of Surgery database was queried to identify and categorize the number of colorectal cases performed yearly by "generalists" (general surgeons) recertified between 1995-1997. RESULTS: There were 2,434 general surgeons (those with a basic certificate only) recertified. The mean number of large bowel cases was 33 (range 0-243). Thirty-one cases represented the 70th percentile and 60 cases represented the 90th percentile. The mean number of anorectal cases was 12.3 (range 0-185). The 70th percentile was 15 cases, and the 90th percentile was 26 cases. Seventy-five percent of general surgeons perform > or = 17 large intestine cases each year, whereas, only 25% perform > 16 total anorectal cases. CONCLUSION: General surgeons perform a substantial number of colon resections and relatively few anorectal cases. It is unclear whether this is an issue of anorectal training in general surgery programs or referral patterns.

Colorectal Surgery↗
PubMed2002

Rectal cancer as a complication of stapled IPAA.

A case of rectal cancer developing several years after a stapled pelvic pouch procedure is described. The need for concern about leaving residual columnar epithelium in patients with dysplasia or a synchronous cancer is highlighted. In this setting, leaving long segments of native rectum is particularly ill advised.

Adenocarcinoma, Mucinous↗
PubMedDate not supplied

Guidelines for colonoscopy surveillance after polypectomy: a consensus update by the US Multi-Society Task Force on Colorectal Cancer and the American Cancer Society.

Adenomatous polyps are the most common neoplastic findings uncovered in people who undergo colorectal screening or have a diagnostic workup for symptoms. It was common practice in the 1970s for these patients to have annual follow-up surveillance examinations to detect additional new adenomas as well as missed synchronous adenomas. As a result of the National Polyp Study report in 1993, which demonstrated clearly in a randomized design that the first postpolypectomy examination could be deferred for 3 years, guidelines published by a gastrointestinal consortium in 1997 recommended that the first follow-up surveillance be 3 years after polypectomy for most patients. In 2003, these guidelines were updated, colonoscopy was recommended as the only follow-up examination, and stratification at baseline into lower and higher risk for subsequent adenomas was suggested. The 1997 and 2003 guidelines dealt with both screening and surveillance. However, it has become increasingly clear that postpolypectomy surveillance is now a large part of endoscopic practice, draining resources from screening and diagnosis. In addition, surveys have demonstrated that a large proportion of endoscopists are conducting surveillance examinations at shorter intervals than recommended in the guidelines. In the present paper, a careful analytic approach was designed addressing all evidence available in the literature to delineate predictors of advanced pathology, both cancer and advanced adenomas, so that patients can be more definitely stratified at their baseline colonoscopy into those at lower or increased risk for a subsequent advanced neoplasia. People at increased risk have either three or more adenomas, or high-grade dysplasia, or villous features, or an adenoma > or =1 cm in size. It is recommended that they have a 3-year follow-up colonoscopy. People at lower risk who have one or two small (< 1 cm) tubular adenomas with no high-grade dysplasia can have a follow-up in 5 to 10 years, whereas people with hyperplastic polyps only should have a 10-year follow-up as average-risk people. Recent papers have reported a significant number of missed cancers by colonoscopy. However, high-quality baseline colonoscopy with excellent patient preparation and adequate withdrawal time should minimize this and reduce clinicians' concerns. These guidelines were developed jointly by the US Multi-Society Task Force on Colorectal Cancer and the American Cancer Society to provide a broader consensus and thereby increase utilization of the recommendations by endoscopists. Adoption of these guidelines nationally can have a dramatic impact on shifting available resources from intensive surveillance to screening. It has been shown that the first screening colonoscopy and polypectomy produces the greatest effects on reducing the incidence of colorectal cancer in patients with adenomatous polyps.

Adenomatous Polyps↗
PubMedDate not supplied

Guidelines for colonoscopy surveillance after cancer resection: a consensus update by the American Cancer Society and US Multi-Society Task Force on Colorectal Cancer.

Patients with resected colorectal cancer are at risk for recurrent cancer and metachronous neoplasms in the colon. This joint update of guidelines by the American Cancer Society (ACS) and US Multi-Society Task Force on Colorectal Cancer addresses only the use of endoscopy in the surveillance of these patients. Patients with endoscopically resected Stage I colorectal cancer, surgically resected Stage II and III cancers, and Stage IV cancer resected for cure (isolated hepatic or pulmonary metastasis) are candidates for endoscopic surveillance. The colorectum should be carefully cleared of synchronous neoplasia in the perioperative period. In nonobstructed colons, colonoscopy should be performed preoperatively. In obstructed colons, double contrast barium enema or computed tomography colonography should be done preoperatively, and colonoscopy should be performed 3 to 6 months after surgery. These steps complete the process of clearing synchronous disease. After clearing for synchronous disease, another colonoscopy should be performed in 1 year to look for metachronous lesions. This recommendation is based on reports of a high incidence of apparently metachronous second cancers in the first 2 years after resection. If the examination at 1 year is normal, then the interval before the next subsequent examination should be 3 years. If that colonoscopy is normal, then the interval before the next subsequent examination should be 5 years. Shorter intervals may be indicated by associated adenoma findings (see Postpolypectomy Surveillance Guideline). Shorter intervals are also indicated if the patient's age, family history, or tumor testing indicate definite or probable hereditary nonpolyposis colorectal cancer. Patients undergoing low anterior resection of rectal cancer generally have higher rates of local cancer recurrence, compared with those with colon cancer. Although effectiveness is not proven, performance of endoscopic ultrasound or flexible sigmoidoscopy at 3- to 6-month intervals for the first 2 years after resection can be considered for the purpose of detecting a surgically curable recurrence of the original rectal cancer.

American Cancer Society↗