Abdominal resection rectopexy versus Delorme's procedure for rectal prolapse: comparison of clinical and physiological outcomes.
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Adult↗
Biomedical subjects
Y H Ho
Publications and source records attributed to Y H Ho.
Protection of mouse bone marrow by Si-WU-Tang against whole body irradiation.
The ability of Si-Wu-Tang to eliminate bone marrow damage after radiation was assessed using both a clonogenic assay (survival of colony forming units spleen--CFUs) of stem cell survival and a hematopoietic functional assay including the changes of hemograms and hematocrit. Cell survival curves and dose-response curves for radiation alone and Si-Wu-Tang administration with radiation were constructed over the dose range of 1 to 9 Gy. Si-Wu-Tang was given 7 days before irradiation at a consecutive fractionated dose of 20 mg/20 g body weight. The radioresistance of stem cells treated by Si-Wu-Tang was higher than that of those treated by irradiation alone. However, the anti-radiation effect of leukocytes was not as significant as that of erythrocytes, thrombocytes and hematocrit. These data suggest that the anti-radiation effect by Si-Wu-Tang is dependent on dose and will be less after 4 Gy irradiation. Hemograms with a short turnover period, such as leukocytes, may be less affected after Si-Wu-Tang administration.
Animals↗
Recovery of the hematopoietic system by Si-Jun-Zi-Tang in whole body irradiated mice.
The herbal formulation Si-Jun-Zi-Tang reduced the decrease of leukocytes, erythrocytes, thrombocytes and hematocrit in irradiated mice. In general, its protection was more effective in leukocytes and thrombocytes than other hematocytes. Protection of bone marrow stem cells by Si-Jun-Zi-Tang was markedly enhanced by increased radiotolerance under the dose ranging from 0 to 5 Gy. This increased radiotolerance led to a prolonged shoulder in the survival curve but did not influence the D0 value. Si-Jun-Zi-Tang exerted a beneficial effect on clinical syndromes such as anemia. From the results in this study, we concluded preliminarily that the most effective concentration with least toxicity was about 20 mg/20 g body weight. At this dose, levels of leukocytes as well as thrombocytes were enhanced significantly after chi-irradiation. Elevation of erythrocytes and hematocrits could also be found but was not significant.
Animals↗
Genitoperineal gangrene: experience in Singapore.
BACKGROUND: The experience with genitoperineal gangrene at the Department of Colorectal Surgery, Singapore General Hospital is documented. METHODS: The results of 12 patients treated during the 5 year period between 1 January 1990 and 31 January 1995 were studied. There were 10 men and two women. The mean age of the patients was 55.2 (range 37-83) years. RESULTS: Perianal pain and swelling were the commonest presentation. However, three patients were admitted in a toxic state with mental confusion. The gangrene progressed from anorectal sepsis in six patients. Five of these patients had diabetes mellitus. Escherichia coli was the commonest organism cultured. Early diagnosis, immediate resuscitation, antibiotics and early aggressive surgery was our management policy. Applying these principles, all except two patients survived (mortality 17%). One had advanced malignancy and the other had extensive burn injuries. CONCLUSIONS: A high index of suspicion should be maintained in patients with diabetes and with anorectal sepsis. Should genitoperineal gangrene develop, aggressive surgery is often successful.
Adult↗
Patterns of distant metastases in nasopharyngeal carcinoma.
The distant metastasis in nasopharyngeal carcinoma has remained the major cause of mortality and treatment failure despite better locoregional control of the disease in the past decades. Between 1987 and 1992, 125 out of 629 cases of nasopharyngeal carcinoma were found to have distant metastasis. The location of metastatic site, the timing and median survival were analyzed. The diagnosis of distant metastasis in the retrospective study was based on radiography, computed tomography, skeletal scintigraphy, abdominal sonography and pathology reports. The results showed that the frequencies of metastases were as follows: bone (75% of total metastatic patients), lung (46%), liver (38%), retroperitoneal lymph nodes (10%). Multiple organ involvement was high (57%). Most of the distant metastases (95%) occurred within 3 years after completion of radiotherapy, the first year (52%), the second year (23%) and the third year (20%). The median survival time from the discovery of distant metastasis was 11.2 months for bone metastasis, 16.3 months for pulmonary metastasis, and 3.2 months for hepatic metastasis. The results revealed that the skeletal system was the most common site of distant metastasis, followed by lung and liver. The incidence of retroperitoneal lymphadenopathy is higher than previous reports.
Adult↗
The investigation of chronic constipation for surgical management.
AIMS: This study was conducted to ascertain the incidence of patients requiring surgery for intractible constipation. We also aimed to determine the anorectal physiology findings which influenced the surgery, and the outcome of surgical intervention. METHODS: A prospective study was done on 217 patients (34 men, 183 women; mean age 59 years [SD 17.7]) managed in a tertiary referral centre. Physiological tests consisting of transit marker studies, anal manometry, electromyography (EMG) and synchronised mano-myo-cinedefaecography (SMC), were then performed where appropriate. Surgical management was based on the results of these investigations. The mean follow-up was 19.6 months (SD 9.3). RESULTS: Eighteen patients (8.3 percent) underwent surgery: 2 for Hirschsprung's disease, 8 for colonic inertia (CI) and 8 for obstructed defaecation (OD). CI patients were younger than the OD patients (p = 0.03). Transit marker studies were abnormal but manometry was not different from the OD patients. The latter were identified on SMC to have rectoceles, sigmoidocele or rectal intussusception. The stool frequency significantly improved after surgery (before = 1.9 bowel motions a week [SD 0.9], after = 8.8 bowel motions a week [SD 1.2]; p = 0.003). There were no complications. CONCLUSIONS: A small but significant proportion of constipation patients require surgery. Good results are obtainable when surgery is directed by the findings of anorectal physiology investigations.
Adult↗
Surgery for inflammatory bowel disease in Singapore.
Inflammatory bowel disease is uncommon in Asians and reports of surgery in these populations are rare. Eighty-two patients with inflammatory bowel disease were seen in the Department of Colorectal Surgery over a five-year period (1989-1994). Twenty-three patients underwent surgery for their disease. There were 12 males and 11 females with 16 Chinese, 4 Indians and 3 Malays. Twelve had Crohn's disease and 11, ulcerative colitis. The majority of patients with Crohn's disease had emergency surgery for bleeding, perforation, abdominal masses and intestinal fistulae. Fifty percent of these had the diagnosis made intraoperatively or post-operatively. Surgery for ulcerative colitis was indicated because of multiple relapses, non-response to medical treatment, side effects of therapy or malignant change. The median age at surgery of patients with Crohn's disease and ulcerative colitis was 39 years (range 24-84) and 40 (range 18-60) respectively. The median follow-up was 22.4 months (range 9-50). The results of surgical therapy in these patients show that surgery when indicated can be done with minimum morbidity and mortality.
Adult↗
Haemorrhoidectomy and disordered rectal and anal physiology in patients with prolapsed haemorrhoids.
The effect of haemorrhoidectomy on rectal and anal physiological abnormalities was studied in 24 consecutive patients (12 men and 12 women of mean (s.e.m.) age 39.1 (2.4) years) and compared with results in 13 sex- and age-matched controls. Before operation those with haemorrhoids had significantly higher resting anal pressures (P < 0.005), lower rectal compliance (P < 0.05) and more perineal descent (P < 0.05). Following haemorrhoidectomy there were significant decreases in the maximum resting (P < 0.05) and maximum squeeze anal (P < 0.001) pressures to within normal values 3 months after operation. Rectal compliance also increased significantly (P < 0.05), to that of normal controls. The abnormalities found in patients with prolapsed piles reverted to the normal range within 3 months of haemorrhoidectomy. These physiological changes are therefore more likely to be an effect, rather than the cause, of enlarged anal cushions.
Adult↗
Prospective randomized controlled trial of a micronized flavonidic fraction to reduce bleeding after haemorrhoidectomy.
A prospective randomized controlled trial was carried out on the effects of Daflon 500 mg (a micronized flavonidic fraction containing diosmin 450 mg and hesperidin 50 mg) on bleeding after haemorrhoidectomy. In all, 228 consecutive patients with prolapsed irreducible piles were recruited. Elective haemorrhoidectomy was performed with a standardized diathermy excision method. Some 114 patients were randomized to receive Daflon 500 mg for 1 week after operation (group 1), and there were 114 controls (group 2). Postoperative analgesia and laxative prescription as well as hospital stay were otherwise the same. One patient (0.9 per cent) from group 1 and seven (6.1 per cent) from group 2 had postoperative bleeding (P = 0.03). All bleeding occurred from 6 to 15 days after haemorrhoidectomy. There were no side-effects from the use of Daflon 500 mg. The risk of secondary bleeding from haemorrhoidectomy is reduced with postoperative Daflon.
Adult↗
Non surgical management of colonoscopic bowel perforation.
Five patients (four males, and one female, median age of 60 years) with colonoscopy-related bowel perforations were managed between January 1993 and June 1994. One patient had a difficult colonoscopy whereas four patients had polypectomies or biopsies. Abdominal pain was the main presenting symptom at a median of 3 h (range 2 to 12 h) following colonoscopy. Four patients demonstrated free pneumoperitoneum whilst one showed a pelvic abscess. Following non-surgical management, abdominal signs diminished after 24 to 48 h and disappeared by the fifth day in all patients. All patients were discharged well at day seven (range 5 to 9 days) and have remained well at 12 months of follow-up (range 3 to 18 months).
Acute Disease↗
The neurophysiological significance of perineal descent.
The establishment of a linear relationship between perineal descent (PD) and pudendal nerve motor terminal latency (PNMTL) is important in understanding the pathophysiology of pudendal neuropathy. The amount of stretching of the pudendal nerve resulting from the extent of PD, should correlate with the amount of injury sustained (PNMTL). The two key previous studies which used different techniques to measure PD, have differed on this vital issue. A prospective study was undertaken in 141 consecutive patients with PD (M:F = 57:84; mean age 46.3 SEM 1.6 years) to clarify this discrepancy. The patients had chronic constipation (81), neurogenic faecal incontinence (31), rectal mucosal prolapse (17) or female urinary stress incontinence (9). All underwent measurements of PD (by perineometry), anal sphincter pressures, single fibre anal sphincter electromyography and PNMTL. These variables, as well as age were analyzed for a linear relationship with PD by multiple regression analysis. Age was the only independent variable predicting PD at rest (T = -3.2; p < 0.005). PNMTL was the only independent variable predicting PD on straining (T = -3.0; p < 0.005). In conclusion, a linear relationship between PD on straining and PNMTL was confirmed, supporting the previous study which also measured PD by perineometry. The other study which refuted such a relationship measured PD radiologically, and it is likely that the difference was in the measurement technique.
Adult↗
Submucosal adrenaline injection for posthemorrhoidectomy hemorrhage.
PURPOSE: A technique found effective in stopping active posthemorrhoidectomy bleeding, outside the operating room, is described. METHOD: After resuscitation and sedation, a proctoscope was inserted to identify the bleeding point. 1 to 2 ml of 1/10,000 adrenaline was injected submucosally. RESULTS: This technique was totally successful in 12 of 12 treated patients. CONCLUSION: Submucosal adrenaline injection is a simple and readily accessible technique for managing posthemorrhoidectomy bleeding.
Epinephrine↗
Unilateral anal electrosensation. Modified technique to improve quantification of anal sensory loss.
PURPOSE: Anal electrosensation is usually tested by an annular configured electrode that stimulates the circumference of the anus. In certain pelvic conditions, the right and left pudendal nerve function may be damaged separately and to different degrees. This may only be detected by a unilateral electrode testing each side independently. METHODS: Our study compares accuracy and sensitivity of annular and unilateral electrodes in assessing patients with hemorrhoids, perineal descent, incontinence, after low anterior resection, and constipation (107 subjects). RESULTS: In normal controls (n = 19), annular thresholds ranged from 0.5 to 2.7 mA and unilateral thresholds from 0.6 to 2.6 mA. In prolapsed hemorrhoids, unilateral was more sensitive than annular electrode in detecting deficits at the upper (P < 0.0001), mid (P < 0.005), and lower (P < 0.0005) anus. Patients with perineal descent had a sensory deficit in the upper anal canal, detected more consistently by unilateral electrode (P > 0.05). No significant abnormalities were found in neuropathic incontinence, after anterior resection and chronic constipation. Results of the unilateral electrosensory technique were found to be consistent with repeated measurements (r = 0.8878; P < 0.001). CONCLUSIONS: By being more sensitive than the annular technique, the unilateral electrode method may become, with refinement, a useful test for quantifying anal sensation.
Adult↗
Solitary rectal ulcer syndrome: the clinical entity and anorectal physiological findings in Singapore.
The clinical pattern and physiological abnormalities in solitary rectal ulcer syndrome (SRUS) occurring in Singapore, were investigated. Since April 1989, 25 patients have presented with histologically proven SRUS. There were 13 males and 12 females (20 Chinese, 4 Malay and 1 Indian) with a mean age of 47.5 (+/- 3.1) years. Ninety-six per cent presented with rectal bleeding, 92% strained at stools, 40% had mucus discharge, 40% felt incomplete defecation and 32% digitated to defecate. Four had previous haemorrhoidectomies that did not cure their symptoms. The lesions were at a mean 6.8 (+/- 0.5) cm above the anal verge, usually anteriorly (64%) but one was circumferential. Anorectal physiology performed on 14 patients was compared with 13 age and gender matched normal controls. The measured mean resting perineum level in SRUS (1.4 +/- 0.3 cm) was significantly lower than in normals (P < 0.01). The mean anal electrosensory threshold (2.5 +/- 0.52 mV) was also significantly higher than in the controls (P < 0.05). Fifteen patients were successfully treated with a high fibre diet and avoidance of straining. Three patients required surgery and the most recent seven patients have responded well to biofeedback treatment. Awareness of this uncommon anorectal condition is necessary for early diagnosis and appropriate management. The physiological findings support a pelvic straining pathophysiology resulting in perineal descent, with less sensitive rectal mucosa prolapsing into, and raising, the anal canal electrosensory threshold. Treatment strategies aimed at correcting the straining have usually been successful.
Anal Canal↗
The anesthetic management of a patient with streptococcal toxic shock-like syndrome--a case report.
Streptococcal toxic shock-like syndrome (TSLS), a severe multisystem disorder with rapid progression and fulminant course, is caused by group A beta-hemolytic streptococcal (GAS) infection. The mortality rate is around 30%. It has been reported in the United States and Europe since the 1980s. The recent recognition of this syndrome is thought to stem from the appearance of more virulent strains of streptococci with a greater tendency to produce potent exotoxins than prior ones. Early diagnosis, treatment with penicillin, radical operative debridement and adjuvant therapy with immunoglobulin and plasma exchange may bear a favourable outcome. A case of TSLS who received surgical management in operating room is presented in this paper.
Aged↗
Anorectal physiological parameters in chronic constipation of unknown aetiology (primary) and of cerebrovascular accidents--a preliminary report.
Chronic constipation may be secondary to dietary, metabolic or neurological causes such as cerebrovascular accidents (CVA). In certain patients, the cause is unknown (primary idiopathic constipation [PIC]). This study compared the anorectal physiological parameters of 15 PIC patients (all females; median age 40, range 32-48 years) with 7 CVA patients (M:F = 6:1; median age 58, range 51-67 years), to observe the influence of cerebral factors on the anorectal physiology of constipation. Twenty-five normal subjects (M:F = 13:12; median age 47, range 43-50 years) acted as controls. Transit marker studies showed decreased passage in both groups, but 9 of the PIC patients had a diffuse pattern (slow transit constipation [STC]) and 6 had a pelvic outlet obstruction pattern (PO). The CVA patients had a diffuse pattern of delayed transit. Rectal sensation was significantly impaired in STC (P < 0.05) but not in PO or CVA. Electromyographic evidence of paradoxical puborectalis contractions was significantly more common in PO only (P < 0.05). Therefore, CVA patients had a different anorectal physiological pattern of constipation from PIC patients.
Adult↗
The ileo-anal reservoir: results from an evolving use of stapling devices.
Thirteen patients had a hand-sewn pouch-anal anastomosis (group A) during restorative proctocolectomy for familial adenomatous polyposis. Median length of follow-up since ileostomy closure was 41.5 months (range 30-56 months). Median stool frequency per 24 h was 4.5 (range 2-5). Six patients were fully continent, three were incontinent to flatus and three patients were occasionally incontinent to liquid stool. Three patients suffered nocturnal seepage but all patients could defer the urge to defaecate by at least 15 min. Fourteen patients (familial adenomatous polyposis: seven; ulcerative colitis: six; intractable constipation: one), had a totally stapled ileal J pouch and pouch-anal anastomosis (group B). Five patients did not have a defunctioning ileostomy while nine patients did. Median follow-up after ileostomy closure or one-stage restorative proctocolectomy was 17.5 months (range 1-30 months). Median frequency of bowel movement per 24 h was 4 (range 2-6). Eleven patients had full continence and three patients suffer occasional incontinence to liquid stools. Two patients have nocturnal seepage but all can defer the urge to defaecate by more then 15 min. There was no significant difference in physiological parameters between the two groups.
Adolescent↗
Small bowel causes of per rectum haemorrhage.
The majority of cases of per rectal haemorrhage (PRH) are due to colorectal causes within the diagnostic reach of the colonoscope. However a few cases are from the small bowel which may pose difficulty and delay in diagnosis. We reviewed 1489 patients with PRH from 1989 to 1993 and identified 10 cases of bleeding originating from the small bowel (0.7%). These were diagnosed when both the colonoscopy and upper gastrointestinal endoscopy were negative or by observing blood coming through the ileo-caecal valve. The causes were Meckel's diverticulum (4), leiomyoma (1), intussusception (1), lymphoma (1), carcinoma (1), Crohn's disease (1) and vasculitis (1). Six cases presented with active bleeding and haemodynamic instability; 4 had chronic bleeding associated with anaemia. Bleeding from Meckel's diverticulum could be differentiated by age, mid-20s or younger compared with mid-40s or older of non-Meckel's cases. Small bowel causes need to be considered in PR bleeding unexplained on colonoscopy and oesophagogastroduodenoscopy findings. A 99mtechnetium isotope scan is most likely to be of help in the young adult but from mid-life onwards, however, other techniques such as small bowel barium studies are required.
Adolescent↗