Anterior resection with total mesorectal excision.
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Anastomosis, Surgical↗
Biomedical subjects
R J Steele
Publications and source records attributed to R J Steele.
Measurement of quality of life in surgery.
Quality of life has become an important outcome measure in surgery. Its use as an end-point in clinical trials is well recognised. However, quality of life measurement in surgery is currently done mainly for research purposes, and still has to find a place in routine clinical practice. This paper presents an overview of the methodology and uses of quality of life assessments in surgical practice.
Health Status↗
Socioeconomic status and stage at presentation of colorectal cancer.
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Colorectal Neoplasms↗
Gelatinase (MMP-2 and -9) expression in gastrointestinal malignancy.
The aim of the study was to investigate expression of the active and inactive gelatinases (MMP-2 and -9) in colorectal neoplasia and gastric cancer compared with normal mucosa. A total of 53 colorectal cancers and corresponding normal mucosa were studied using gelatin zymography as well as 15 colorectal adenomas and 13 gastric cancers with corresponding normal mucosa. Overexpression of all the gelatinases occurs in both colorectal and gastric cancer, with activation of MMP-2 appearing to be a feature of the malignant phenotype. Overexpression of MMP-9 occurs in colorectal adenomas. The gelatinases are overexpressed in gastrointestinal neoplasia, suggesting that these enzymes may have an important role in tumour invasion and metastasis.
Adenoma↗
Patterns of food and acid reflux in patients with low-grade oesophagitis--the role of an anti-reflux agent.
BACKGROUND: Food and acid have been shown to be refluxed independently of each other in healthy volunteers, and anti-reflux agents decrease the reflux of both parameters. Until now this phenomenon had not been studied in patients with low-grade oesophagitis, who are the group most likely to use anti-reflux medication. AIM: To assess patterns of gastro-oesophageal reflux of acid and food in 12 ambulant patients with endoscopically proven oesophagitis of between grades I and II, but who were otherwise healthy. Also to assess the effectiveness of a single dose of an alginate-containing anti-reflux agent in controlling food and acid reflux in this patient group. METHODS: Oesophageal pH monitoring and external ambulatory gamma detection were used to study food and acid reflux. A pH electrode was positioned 5 cm above the cardia and the gamma detector was positioned externally over the pH electrode. The patients then received a technetium-99m labelled meal designed to provoke reflux. Thirty minutes later the patients were given a 20 ml dose of alginate (Liquid Gaviscon), or 20 ml of tap water. Incidence of reflux was monitored for approximately 4 h from the end of the meal. Allocation to treatment group was randomized, with patients receiving the alternative treatment on the second study day after approximately a 7-day washout period. RESULTS: The mean percentage time oesophageal pH remained below 4 was 16.3 min for the control group and 5.4 min for the treatment group (P = 0.03). Food reflux was detected 23.7% of the time in the control group compared to 12% of the time in the treatment group (P = 0.02). The anti-reflux agent was also successful in decreasing the number of events, but the duration of the reflux events was not significantly different. CONCLUSIONS: Patients with grades I and II oesophagitis reflux food and acid independently, and are predominantly either food refluxers or acid refluxers, but not both. Liquid alginate decreases the number of both food and acid reflux events, but does not change their duration.
Adult↗
Quality of life after treatment for rectal cancer.
BACKGROUND: The studies on patient-reported symptoms and quality of life following the treatment of rectal cancer were evaluated; guidelines for future quality of life studies in this field are proposed. METHODS: Relevant papers in the English language were identified via Medline from January 1970 to November 1997, supplemented by a manual search for similar articles. RESULTS: Patients suffer various short- and long-term complications after treatment of rectal cancer, although the reported prevalence of such problems varies from study to study. Recent prospective studies have shown that, despite these problems, global quality of life scores as measured by generic questionnaires improve after surgery. CONCLUSION: The methodological shortcomings of previous work must be rectified if quality of life studies are to have relevance in patient management.
Antineoplastic Agents↗
The p53 tumour suppressor gene.
BACKGROUND: Abnormalities of the p53 tumour suppressor gene are thought to be central to the development of a high proportion of human tumours. This article reviews current understanding of its function and potential clinical significance. METHODS: Material was identified from previous review articles, references cited in original papers, a Medline search of the literature over the 12 months to January 1998, and by scanning the latest issues of relevant journals. RESULTS AND CONCLUSION: p53 is considered to be a stress response gene, its product (the p53 protein) acting to induce cell cycle arrest or apoptosis in response to DNA damage, thereby maintaining genetic stability in the organism. These functions are executed by a complex and incompletely understood series of steps known as the 'p53 pathway', part of which involves induction of the expression of a number of other genes. As p53 is the most commonly mutated gene in human cancer, it has attracted a great deal of interest as a prognostic factor, diagnostic tool and therapeutic target. However, despite many promising studies, its potential in practical cancer management has still to be realized.
Apoptosis↗
Phase I/II trial of batimastat, a matrix metalloproteinase inhibitor, in patients with malignant ascites.
Matrix metalloproteinases have been shown to be important in tumour invasion and metastasis, and the use of matrix metalloproteinase inhibitors in animal models has suggested that these agents may be useful in the control of malignant disease. This article reports the results of an early clinical trial of batimastat, one of the first generation of metalloproteinase inhibitors, in patients with malignant ascites. The drug was well absorbed via the intraperitoneal route and associated with few side-effects. Furthermore, a response to treatment was seen in about half the evaluable patients with advanced malignant disease. The results suggest that further research on the use of matrix metalloproteinase inhibitors in patients with malignant disease is worthwhile.
Aged↗
An investigation of lower oesophageal redox potentials in gastro-oesophageal reflux patients and healthy volunteers.
Oesophageal electrical properties are thought to be important in the development of gastro-esophageal reflux. This study simultaneously monitored the intraoesophageal pH and redox potentials in 18 patients with gastro-oesophageal reflux symptoms and 15 asymptomatic controls, for a 24 h period. The pH and redox electrodes were positioned 5 cm proximal to the lower oesophageal sphincter, the position of which had been determined by manometry. Since significantly different behaviour was observed during the day and night, the data were divided into periods of waking and sleeping. Data were analysed for acid reflux (pH < 4) and transients in the redox potential-time curve. Both patients and normal subjects showed negative redox transients which were more frequent and pronounced at night than during the day, and which were uncorrelated with acid reflux. The only parameter which was significantly different between normal and refluxing groups was the amount of nocturnal redox activity, which was lower in refluxing subjects than in normals. Some possible hypotheses for these observations, and the origin of the redox species, are discussed.
Adult↗
Colorectal cancer pathology reporting: a regional audit.
AIMS: To audit the information content of pathology reports of colorectal cancer specimens in one National Health Service region. METHODS: All reports of colorectal cancer resection specimens from the 17 NHS histopathology laboratories in Wales during 1993 were evaluated against: (a) standards previously agreed as desirable by pathologists in Wales; and (b) standards considered to be the minimum required for informed patient management. RESULTS: 1242 reports were audited. There was notable variation in the performance of different laboratories and in the completeness of reporting of individual items of information. While many items were generally well reported, only 51.5% (640/ 1242) of rectal cancer reports contained a statement on the completeness of excision at the circumferential resection margin and only 30% (373/1242) of all reports stated the number of involved lymph nodes. All of the previously agreed items were contained in only 11.3% (140/1242) of reports on colonic tumours and 4.0% (40/1242) of reports on rectal tumours. Seventy eight per cent (969/1242) of colonic carcinoma reports and 46.6% (579/ 1242) of rectal carcinoma reports met the minimum standards. CONCLUSIONS: The informational content of many routine pathology reports on colorectal cancer resection specimens is inadequate for quality patient management, for ensuring a clinically effective cancer service through audit, and for cancer registration. Template proforma reporting using nationally agreed standards is recommended as a remedy for this, along with improved education, review of laboratory practices in the light of current knowledge, and further motivation of pathologists through their involvement in multidisciplinary cancer management teams.
Colonic Neoplasms↗
Matrix metalloproteinases.
BACKGROUND: The matrix metalloproteinases (MMPs) have a role in gastrointestinal malignancy. This role is reviewed, with particular reference to the gelatinase subgroup of enzymes. METHODS: All relevant papers derived from the Medline and Enbase databases between 1984 and early 1996 were reviewed. RESULT AND CONCLUSION: There is now strong evidence that MMPs play a major role in tumour invasion and metastasis. The development of MMP inhibitors may lead to important new treatment for the control of malignant disease.
Clinical Trials as Topic↗
Long-term results of the Angelchik prosthesis for gastro-oesophageal reflux.
INTRODUCTION: Between 1982 and 1989, 46 patients had insertion of an Angelchik prosthesis for gastro-oesophageal reflux. Eleven patients (24 per cent) subsequently had the prosthesis removed, all but one for intractable dysphagia. METHODS: Thirty-six of the original patients were followed by questionnaire, and 32 of these had a barium marshmallow swallow investigation. RESULTS: A high proportion of patients (20 of 26) with a prosthesis in situ had symptoms of dysphagia. On objective evaluation by marshmallow swallow, the transit time was significantly slower than that of an age-matched control group (P < 0.01), but showed no significant deterioration with time compared with previous postinsertion studies. CONCLUSION: The Angelchik prosthesis causes long-term dysphagia in a high proportion of patients, severe enough in one-quarter to necessitate its removal. Its continued use cannot, therefore, be recommended.
Adult↗
Surgeons' follow-up practice after resection of colorectal cancer.
Consultant surgeons in two United Kingdom Health Regions were invited to complete a questionnaire on details of their personal management of patients with colon and rectal cancer, with particular emphasis on follow-up. Replies from 140 (94%) were analysed by the surgeon's subspecialty of colorectal and gastrointestinal surgery (group 1) and all others (group 2). There was a wide variation in the duration of followup, but no difference between the two groups. More group 1 surgeons carried out investigations as a routine after colonic (P < 0.01) and rectal (P < 0.01) resection. Colonoscopy was used more frequently by group 1 (P < 0.0001) and barium enema by group 2 surgeons (P < 0.05). Investigations to detect asymptomatic metastases were used as a routine by 33.3% of surgeons, in whom there was no concordance over the choice or combination of tests and no difference between the two groups of surgeons. There is no consensus among surgeons as to the ideal duration, intensity and method of follow-up after resection for colorectal cancer and little difference between the practice of colorectal and gastrointestinal surgeons and that of other specialists, except in the use of colonoscopy and barium enema. These results reflect the continuing lack of evidence on which to base the follow-up of patients after surgery for colorectal cancer.
Colonic Neoplasms↗
The preprocedural care of the patient with gastrointestinal bleeding.
This article considers the management of the gastrointestinal bleeding patient up to the time of endoscopy and/or surgery. It deals with initial assessment, resuscitation, history taking, examination, and preparation for both endoscopy and surgery. Clinical detail is emphasized, and stress is placed on the adequate organization of a gastrointestinal bleeding unit.
Endoscopy, Gastrointestinal↗
Population-based audit of colorectal cancer management in two UK health regions. Colorectal Cancer Working Group, Royal College of Surgeons of England Clinical Epidemiology and Audit Unit.
BACKGROUND: To obtain information on the contemporary management of colorectal cancer in the UK to assist in the development of management guidelines, an independent, 1-year population audit was carried out in Trent Region and Wales. METHODS: Data were collected on all patients admitted to hospital with a new diagnosis of colorectal cancer in a 1-year period. RESULTS: Of 3520 patients, 3221 (91.5 per cent) had surgery. Emergency/urgent operations were carried out as the first procedure in 552 (17.1 per cent). Resection of the primary disease was achieved in 2859 (81.2 per cent) and this was deemed curative in 2070 (58.8 per cent). Twenty-one per cent of all patients had metastatic disease at presentation. Overall, 30-day operative mortality was 7.6 per cent (21.7 per cent for emergency/urgent and 5.5 per cent for scheduled/elective procedures). Anastomotic dehiscence occurred in 105 patients (4.9 per cent); this was 3.9 per cent after colonic resections and 7.9 per cent after anterior rectal resections. Elective rectal excision resulted in a permanent stoma in 486 of 1054 patients (46 per cent). CONCLUSION: This initial report from a comprehensive, independent audit of colorectal cancer management shows improvement in some aspects of treatment as evidenced by improved anastomotic dehiscence and stoma rates when compared with previous studies. However, there has been little improvement in the proportion of patients presenting with advanced disease, and curative resection rates remain low.
Colonic Neoplasms↗
Malignant ascites.
Investigation and treatment of malignant ascites are often in the hands of the general surgeon and can be difficult. This article considers the aetiology and pathophysiology of malignant ascites and explores the best form of management. Established treatment modalities and new therapeutic options are reviewed and a new management regimen based on a knowledge of the tumour of origin is proposed, which aims to balance potential benefit against morbidity.
Abdominal Neoplasms↗
Value of a weekly surgical x-ray meeting.
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Decision Making↗
D-cycloserine causes transient enhancement of memory for a weak aversive stimulus in day-old chicks (Gallus domesticus).
The N-methyl-D-aspartate (NMDA) receptor plays an important role in acquisition of memory after one-trial passive avoidance training in day-old chicks. Here, we examined the effect of D-cycloserine, a partial agonist of the glycine site on the NMDA receptor, on memory retention after training on weak aversive stimuli (10% methyl anthranilate). Bilateral, or unilateral, intracranial injections of 5 microliters of 600 mumol.l-1 D-cycloserine (DCS) were made into the intermediate and medial hyperstriatum ventrale 5 min posttraining and chicks were tested either 30 min or 1, 6, or 24 h later. Enhanced memory retention (number of chicks avoiding) occurred after bilateral, or left hemisphere, injections of DCS (compared to saline-injected controls), when chicks were tested at 1 and 6 h, but not at 30 min or 24 h posttraining. These data suggest that activation of the glycine site on the NMDA receptor in the immediate posttraining period can transiently extend the retention period of memory for a weak aversive stimulus.
Animals↗