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Biomedical subjects

Y H Ho

Publications and source records attributed to Y H Ho.

At least 73 records · Page 4Linked to original sources
PubMed1997

Randomized controlled trial of primary fistulotomy with drainage alone for perianal abscesses.

PURPOSE: Primary fistulotomy may be advantageous for perianal abscesses because unlike ischiorectal abscesses, fistulas are more commonly found and can be laid open with full preservation of the external anal sphincters. Therefore, a randomized, controlled trial was conducted to compare primary fistulotomy with incision and drainage alone, specifically for perianal abscesses. METHODS: Fifty-two consecutive patients (43 males; mean age, 40 (standard error of mean, 2) years) with perianal abscesses were randomized to treatment by either incision and drainage (controls; N = 28) or fistulotomy (N = 24). Patients were followed up clinically for a mean of 15.5 (standard error of the mean, 0.7) months. Anorectal manometry was also performed before, six weeks, and three months after surgery. RESULTS: Persistent fistulas developing after surgery were significantly more common after incision and drainage (N = 7; 25 percent) than after fistulotomy (N = 0; P = 0.009). One patient in each group was also found to have a residual abscess, which required repeat drainage. All patients remained fully continent. The anal pressures after incision and drainage and fistulotomy were not significantly different. Operative time, hospital stay, and time for the wound to heal completely were the same in both groups. CONCLUSIONS: Primary fistulotomy at the time of drainage for perianal abscesses results in fewer persistent fistulas and no added risk of fecal incontinence.

Abscess↗
PubMed1997

Lymph node involvement and tumor depth in rectal cancers: an analysis of 805 patients.

BACKGROUND: Superficial rectal tumors are said to involve regional lymph nodes rarely. This presumption must be proven beyond any doubt if less radical surgery is to be offered for such patients. PATIENTS AND METHODS: Eight hundred five cases (467 males; median age, 64 (range, 19-97) years) of rectal cancer were reviewed. RESULTS: Lymph node positivity, number of lymph nodes involved, lymphatic vessel, and venous and perineural invasion were significantly increased with increasing depth of invasion of tumor through the bowel wall in univariate analysis. The percentage of lymph node involvement at each tumor depth was as follows: T1, 5.7 percent; T2, 19.6 percent; T3, 65.7 percent; T4, 78.8 percent. Overall lymph node involvement was 59 percent. For patients younger than 45 years of age, the percentage of lymph node involvement was 33.3, 30, 69.3, and 83.3 percent compared with 3.1, 8.4, 64.2, and 78.8 percent for patients aged 45 years or above for T1, T2, T3, and T4, respectively. CONCLUSION: Increased depths of tumor penetration beyond T1 and age less than 45 years have an excessive incidence of lymph node positivity. The finding of lymphatic vessel invasion on biopsy is highly indicative of lymph node metastasis.

Adenocarcinoma↗
PubMed1997

A preliminary comparison of a consecutive series of open versus laparoscopic abdomino-perineal resection for rectal adenocarcinoma.

AIM: To compare a consecutive series of patients who underwent laparoscopic abdomino-perineal resection (LAPR) versus conventional open abdomino-perineal resection (CAPR). MATERIAL AND METHODS: Sixteen patients (8 females) and 11 patients (4 females) underwent LAPR and CAPR respectively. RESULTS: The median operative time was 110 (65-210) mins and 100 (80-185) mins for LAPR and CAPR respectively (P = 0.43). The median amount of blood loss were 200 (100-1000) mls and 100 (60-800) mls for LAPR and CAPR respectively. There was no significant difference in the need for post operative analgesics and time to first stoma function but the LAPR group showed significant improvement in starting fluids, diet, ambulation and discharge from hospital. CONCLUSION: The laparoscopic technique may be an acceptable alternative to conventional abdomino-perineal resection for the patient requiring anal resection for rectal cancer.

Abdomen↗
PubMed1997

Ambulatory anorectal manometric findings in patients before and after haemorrhoidectom.

The physiological abnormalities in piles before and after surgery were studied by an ambulatory prolonged anorectal manometric technique. Eighteen consecutive patients (12 men, 6 women; mean age 43.6 [standard error of mean, 3.3] years) with 3 prolapsed irreducible piles were prospectively recruited. Haemorrhoidectomy was performed with excision of 3 piles. The anal and rectal pressures were monitored before and at a mean 7.8 (1.5) weeks after surgery when the wounds had healed, for a mean period of 361.3 (47.8) min. The maximum anal pressures dropped significantly from a mean 325 (15.5) mmHg before to 213 (24.9) mmHg after surgery (P < 0.05). Ultraslow wave activity was clearly identified in 11 of 18 patients (61%) before surgery, but not found on post operative studies. The maximum rectal pressures were also significantly reduced after surgery (196.8 [23.2] mmHg before, 75.5 [10.6] mmHg after; P < 0.05). These findings help to confirm that haemorrhoidectomy leads to changes in the anorectal physiological findings.

Adult↗
PubMed1997

The Colorectal Cancer Recurrence Support (CARES) System.

Colorectal cancer has risen in incidence to become the second commonest form of cancer in Singapore. The primary treatment is surgery but up to 50% of patients still suffer from recurrence of the cancer after surgery. Early identification of recurrence will increase the effectiveness of therapy and the survival of patients. This paper describes the CARES (Cancer Recurrence Support) System, whose objective is to predict the recurrence of colorectal cancer, using Case-based Reasoning (CBR), and supported by other techniques such as data mining and natural language processing. The CARES System employs CBR to compare and contrast between the new and past colorectal cancer patient cases, and makes inferences based on those comparisons to determine the high risk patient groups. The features and functionality of the system are described.

Artificial Intelligence↗
PubMed1997

Laparoscopic-assisted compared with open total colectomy in treating slow transit constipation.

BACKGROUND: Total colectomy is the procedure of choice when slow transit constipation (STC) can be confidently diagnosed. A laparoscopic-assisted technique (LTC) may be potentially advantageous over traditional open technique (OTC) in the treatment of this benign condition. METHODS: A historical control (non-randomized) study was performed on patients diagnosed to have STC after clinical, anorectal physiologic and transit marker studies. All earlier consecutive patients underwent OTC and the latter consecutive patients underwent LTC. The intra-operative time, blood loss, postoperative ileus recovery, duration of hospitalization and complications were recorded. A bowel function and patient satisfaction questionnaire was administered on follow-up. RESULTS: Twenty-four of 411 patients were found to have STC; 17 (2 men, 15 women; mean age, 40 (standard error of mean [SEM] 5) years) underwent OTC and 7 (2 men, 5 women; mean age, 39.5 (SEM 6) years) underwent LTC. There were significant improvements in the stool frequency, need for assisted evacuation and abdominal distension (P < 0.05) after both procedures; 96% were fully satisfied with the resulting bowel function. However, OTC patients were less satisfied with the cosmetic outcome (P < 0.05). Intra-operative time for LTC was longer by a mean 74 min (P < 0.05). Postoperative blood loss, recovery of ileus and hospitalization time were the same in both groups. There were no deaths. The complication rates were 43% for LTC and 24% for OTC. The predominant complication was bowel obstruction for which two patients (both OTC) required adhesiolysis. CONCLUSIONS: Both OTC and LTC improve bowel function for STC;LTC gives a better cosmetic result, but takes longer to perform.

Adult↗
PubMed1997

Randomized controlled trial of trimebutine (anal sphincter relaxant) for pain after haemorrhoidectomy.

BACKGROUND: Anal sphincter spasm may aggravate pain after haemorrhoidectomy. The aims of this study were to investigate whether a trimebutine suppository (Proctolog) reduced anal resting pressure and, subsequently, to test its efficacy in relieving pain after haemorrhoidectomy. METHODS: Ten patients underwent anal manometry before and 4 h after Proctolog application. A controlled randomized trial was then conducted on 160 consecutive patients. A standard haemorrhoidectomy was performed. Eighty patients were then randomized to receive an application of Proctolog immediately after the procedure (group 1). The remaining 80 did not receive a suppository (controls, group 2). An independent, blinded observer determined the pain scores. RESULTS: Proctolog resulted in a mean 35 per cent reduction in resting anal pressure (P < 0.001). However, there were no differences in the pain score at 4 h after haemorrhoidectomy, maximum pain during the first 24 h, maximum pain during the second postoperative day, ketoprofen requirement or need for intramuscular pethidine injections between groups 1 and 2. CONCLUSION: Although Proctolog reduced mean resting anal pressure at 4 h after application, this did not affect pain after haemorrhoidectomy.

Female↗
PubMed1997

Biofeedback therapy for bowel dysfunction following low anterior resection.

Faecal incontinence and intractable constipation after low anterior resection (LAR) can be refractory to expectancy and appropriate anti-diarrhoeal or laxative medications. The efficacy of anorectal biofeedback therapy (BF) in this clinical situation was prospectively assessed. Eleven patients [5 men and 6 women; mean age 64.8 years; standard error of the mean (SEM) 3.3 years] had either faecal incontinence or intractable constipation which did not settle with medications, for at least 6 months [mean 33.3 (SEM 6.1) months] after LAR. They all underwent 4 sessions of outpatient BF. Assessment was by continence questionnaire and anorectal physiology tests, which were administered before and after BF. In 6 of 6 incontinent patients, weekly incontinent episodes were decreased [14.8 (SEM 2.1] before, 1.8 (SEM 0.8) after; P < 0.05) and anti-diarrhoeal drug requirements were reduced (needed in 6 before, 0 after; P < 0.05) after BF. In the 5 intractible constipation patients, the weekly stool frequency was improved [3 (SEM 0.5) before, 8.9 (SEM 1.6) after; P < 0.05] after BF. There were no significant changes in the anorectal physiology parameters after BF. At a mean follow-up of 12.9 (SEM 1.6) months, there were no regressions or complications. BF is a safe option for refractory bowel dysfunction following LAR.

Anal Canal↗
PubMed1997

Randomized controlled trial of open and closed haemorrhoidectomy.

BACKGROUND: This study was a prospective randomized comparison of healing following open and closed haemorrhoidectomy. METHODS: Sixty-seven consecutive patients (mean(s.e.m.) age 45(1.7) years; 35 men, 32 women) with three prolapsed piles were randomized to open haemorrhoidectomy (n = 34) or closed haemorrhoidectomy (n = 33). RESULTS: Mean(s.e.m.) follow-up was 8.7(0.2) months. There were no differences in the linear analogue pain scores, analgesic requirements and length of hospitalization after open haemorrhoidectomy and closed haemorrhoidectomy. Complete wound healing took significantly longer after closed haemorrhoidectomy (mean(s.e.m.) 6.9(0.7) weeks) compared with open haemorrhoidectomy (4.9(0.4)weeks) (P < 0.05). This was related to wound dehiscence in eight patients. Complication rates, however, were similar except for prolonged serous discharge from unhealed wounds. The anal manometry findings after both procedures were equivalent. CONCLUSION: Open haemorrhoidectomy leads to faster and more reliable wound healing, although this did not result in less pain or fewer complications.

Female↗
PubMed1996

Randomized controlled trial of lateral internal sphincterotomy with haemorrhoidectomy.

A prospective trial was conducted to compare haemorrhoidectomy alone (control, group 1) with haemorrhoidectomy plus lateral internal sphincterotomy (group 2) for prolapsed piles. Some 33 patients (18 men, 15 women) of mean(s.e.m.) age 40(2.3) years were randomized, 16 to group 1 and 17 to group 2. There were no significant differences in postoperative pain scores. Mean resting and maximum anal squeeze pressures, studied 6 weeks and 3 months after operation, were generally lower in group 2, but were not significantly different. Two patients in group 2 were distressed by incontinence to liquid faeces which persisted in one after 1 year. There were no other complications in either group after a mean(s.e.m.) follow-up of 11(0.4) months. The addition of lateral internal sphincterotomy to routine haemorrhoidectomy is unnecessary and carries the added risk of incontinence.

Adult↗
PubMed1996

Prospective randomized controlled study of clinical function and anorectal physiology after low anterior resection: comparison of straight and colonic J pouch anastomoses.

Clinical function and anorectal physiology were studied prospectively in patients with rectal cancer after low anterior resection, randomized to either a straight anastomosis or an 8-cm colonic J pouch anastomosis. Sixteen patients (mean(s.e.m.) age 61.2(3.2) years; ten men, six women) had a straight anastomosis and 17 (mean(s.e.m.) age 61.2(3.8) years; six men, 11 women) a colonic pouch anastomosis. At 1 year after low anterior resection, a bowel function questionnaire was administered and anorectal physiology tests were performed. Patients with a straight anastomosis had significantly more frequent stools (median 6 (range 3-7) daily) compared with those who had a pouch (median 3 (range 2-7) daily; P = 0.02). A frequent sensation of incomplete defaecation was found in three patients with a straight anastomosis compared with ten who had a pouch anastomosis (P = 0.02). The mean resting anal pressures were lower after colonic pouch anastomosis (P = 0.049) but there were no differences in anal squeeze pressure, rectal sensation, volume of first sensation and compliance between the two groups. The decreased stool frequency with an 8-cm colonic pouch was not associated with measured improvements in rectal reservoir function. It is possible that reversed propulsive activity may be important in smaller colonic J pouches.

Adenocarcinoma↗
PubMed1996

Bowel function survey after segmental colorectal resections.

PURPOSE: Long-term bowel function after right hemicolectomy (RHC), extended right hemicolectomy (ERHC), left hemicolectomy (LHC), sigmoid colectomy (SC), and anterior resection (AR) was evaluated. METHOD: Three hundred fifteen patients (52.3 percent) replied to a questionnaire on stool frequency, fecal continence, and defecation problems. All patients had undergone surgery at least one year before questionnaire was sent to them. Patients with anastomotic leaks and recurrences were excluded. RESULTS: Stool frequency was one to two bowel movements per day in 78 percent of patients after RHC, 75 percent after ERHC, 57.6 percent after LHC, 64.3 percent after SC, and only 44.8 percent after AR (P = 0.01). Continence affected lifestyle in 32 percent of patients after AR, but affected only up to 11.5 percent of patients who had had more proximal resections (P = 0.001). Defecation problems occurred in less than 15.4 percent after RHC, ERHC, and LHC but were encountered more frequently after SC (25 percent) and AR (28.4 percent; P = 0.009). CONCLUSIONS: Problems with postoperative bowel function were appreciably more common after SC and AR.

Colectomy↗
PubMed1996

Comparison between segmental left and extended right colectomies for obstructing left-sided colonic carcinomas.

PURPOSE: This study was designed to compare complications and functions following either radical extended right colectomy without colonic decompression or radical segmental left colectomy with intraoperative decompression for obstructed left-sided colonic carcinomas. METHODS: One hundred three patients with obstructed left-sided colonic carcinoma undergoing primary resection and anastomoses were studied. RESULTS: There were 57 males and 46 females with a median age of 65 (range, 24-98) years and who had a median follow-up of 31 (range, 2-59) months. There were no leaks or intra-abdominal sepsis in the extended right colectomy group (44 patients) compared with one anastomosis leak in the segmental left colectomy (59 patients) group. Median hospital stay was 14 days in both groups, with a range of 8 to 36 days in the segmental left colectomy group and 7 to 44 days in those with extended right resection. One month after surgery, the patients who underwent segmental left colectomy had a median bowel movement of 3 (range, 1-6) per 24 hours compared with those with extended right colectomies who had a median of 5 (2-11) bowel movements per 24 hours. Bowel frequency decreased to four or less episodes per 24 hours in all patients in both groups at six months. CONCLUSION: There was no significant difference between bowel function or complications between the two groups.

Adult↗
PubMed1996

Biofeedback therapy for excessive stool frequency and incontinence following anterior resection or total colectomy.

PURPOSE: Excessive stool frequency and incontinence after anterior resection (AR) or total colectomy (TC) can be refractory to expectancy and antidiarrheal agents. We prospectively assessed efficacy of anorectal biofeedback therapy (BF) in this clinical situation. METHODS: Thirteen patients (10 men and 3 women; mean age, 62.1 (standard error of the mean (SEM), 4.6) years) had more than six bowel movements per day and/or episodes of incontinence, which did not abate after antidiarrheal agents were given for at least six (mean, 27.9 (SEM, 6.3)) months after surgery. All underwent four sessions of outpatient BF. Assessment was by continence questionnaire and anorectal physiology tests, which were administered before and after BF. RESULTS: In seven AR patients, daily stool frequency was decreased (8.7 (SEM, 2.1) before and 4.6 (SEM, 1.2) after, P < 0.05), and daily incontinence episodes were reduced (2.7 (SEM, 0.9) before and 0.4 (SEM, 0.2) after, P < 0.05) after BF. Six TC patients also had decreased daily stool frequency (6.2 (SEM, 2.1) before, 3.3 (SEM, 1.6) after; P < 0.05) and incontinence episodes (2.4 (SEM, 0.9) before, 0.5 (SEM, 1) after; P < 0.05) after BF. There were no significant changes in anorectal physiology parameters after BF. At a mean follow-up of 10.6 (SEM, 2.5) months after BF, there were no regressions or complications. CONCLUSIONS: BF is a safe and effective option for refractory excessive stool frequency and/or incontinence following AR or TC.

Biofeedback, Psychology↗
PubMed1996

Clinical and physiologic effects of biofeedback in outlet obstruction constipation.

PURPOSE: We report the results of biofeedback (BF) on patients with outlet obstruction defecation (OOC), including those with and without measurable paradoxical puborectalis contractions (PP). Clinical and anorectal physiologic parameters (ARP) were assessed one week before and after a standardized course of BF. METHODS: Sixty-two consecutive patients (24 men, 38 women; mean age, 48 (standard error of the mean, 2.3) years) were recruited. All had persistent constipation despite six weeks of dietary fiber supplements. Colonic inertia was excluded by transit marker studies. Defecating proctography excluded anatomic abnormalities causing outlet obstruction. Patients underwent four outpatient sessions of biofeedback, each session lasting one hour. RESULTS: After BF, 56 patients (90.3 percent) were subjectively improved. Frequency of spontaneous bowel movements were significantly increased (P = 0.003). Frequency of laxative-induced (P = 0.004) and enema-induced (P = 0.005) stools were reduced. Anal resting (P = 0.04) and squeeze (P = 0.002) pressures were increased. Number of patients with PP was reduced from 40 to 31 (P = 0.004). Presence of PP did not affect response to BF. There were no differences in ARP between the 56 patients who improved and the 6 who did not. There were no side effects or clinical regressions after a mean follow-up of 14.9 (standard error of the means, 0.9) months. CONCLUSIONS: BF effectively treated OOC in 90.3 percent, regardless of PP. Anal pressures were increased, and PP was decreased.

Biofeedback, Psychology↗