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At least 1,099 records · Page 61Linked to original sources
PubMed2006

Argon plasma coagulation in the management of symptomatic gastrointestinal vascular lesions: experience in 100 consecutive patients with long-term follow-up.

BACKGROUND: The long-term efficacy of argon plasma coagulation (APC) in the management of gastrointestinal vascular lesions has not been evaluated in a large and well-defined series. The impact of APC on transfusion requirements and hemoglobin, and technical parameters including complications and number of treatment sessions, is assessed in this series. METHODS: Patients who underwent APC for bleeding gastrointestinal vascular lesions were identified via interrogation of an established endoscopic database, excluding patients with radiation proctitis, tumors, residual polypectomy tissue and acute ulcer bleeding. Follow-up data were collected via interview with patients and referring doctors, review of medical records, and follow-up blood tests. RESULTS: One hundred patients were enrolled, males = 46, median age = 74 yr (range: 19-99 yr). Median follow-up time was 16 months (range: 4-47 months). Lesions treated were arteriovenous malformations (n = 74) and gastric antral vascular ectasia (n = 26). Fifty-three patients required transfusion. In this group, median hemoglobin improved from 66 g/L (range: 35-114) to 111 g/L (range: 55-155, p < 0.001). Median transfusion velocity fell from 2 units/month (range: 0.1-6) to 0 units/month (range: 0-4, p < 0.001). Transfusion requirement was abolished in 77%. In non-transfusion-requiring patients, median hemoglobin improved from 105 g/L (range: 58-143) to 123 g/L (range: 79-158, p < 0.001). No complications occurred. CONCLUSIONS: APC is effective and safe in the management of gastrointestinal vascular lesions.

Adult↗
PubMed1995

Disease conditions of canine anal sacs.

The literature about the anal sacs of healthy dogs and the pathogenesis, diagnosis and therapy of anal sac impaction and sacculitis are reviewed. Knowledge about the physiological role of the anal sacs is still confusing. The colour and consistency of the anal sac contents are variable in healthy dogs and there are no pathognomonic signs of anal sac impaction or sacculitis. The wide variation in macroscopic detail of anal sac secretions may give rise to misinterpretation and thus overdiagnosis of sacculitis. Other diseases such as vaginitis, flea allergy, atopy, proctitis, parasites and perianal fistulae can lead to similar signs and must be eliminated from the differential diagnosis before the anal sacs are incited as the cause of the signs. Further research is necessary on the morphological, physical and biochemical aspects of the anal sacs and their secretions to define more precise criteria for the diagnosis of impaction and sacculitis. It is imperative that controlled therapeutic trials should be performed, and such studies are indispensable for the rational therapy of anal sac disease.

Anal Sacs↗
PubMed1988

Nervous disease associated with coccidiosis in young cattle.

Four cases are described of nervous disease associated with coccidiosis in young cattle. Prodromal nystagmus, ventromedial strabismus, sternal or lateral recumbency with contortions of the head and neck, near normal interictal periods and palpable proctitis were common findings. Differentiation from other nervous disorders in young cattle and the pathogenesis of the nervous signs associated with coccidiosis are discussed. It is suggested that the clinical picture is sufficiently distinctive to allow a diagnosis to be made on clinical grounds alone.

Animals↗
PubMed2004

Comparison between manual and automatic segment generation in step-and-shoot IMRT of prostate cancer.

PURPOSE: To compare two methods to generate treatment plans for intensity-modulated radiotherapy (IMRT) of prostate cancer, delivered in a step-and-shoot mode. The first method uses fluence optimization (inverse planning) followed by conversion of the fluence weight map into a limited number of segments. In the second method, segments are manually assigned using a class solution (forward planning), followed by computer optimization of the segment weights. METHODS: Treatment plans for IMRT, utilizing a simultaneous integrated boost, were created. Plans comprise a five-field technique to deliver 78 Gy to the prostate plus seminal vesicles. Five patients were evaluated. Optimization objectives of both planning approaches concerned dose coverage of the target volumes and the dose distribution in the rectal wall. The two methods were evaluated by comparing dose distributions, the complexity of the resulting plan and the time expenditure to generate and to deliver the plan. RESULTS: For both planning approaches 99% of the target volumes received 95% of the prescribed dose, which complies with our planning objectives. Inverse planning resulted in more conformal dose distributions than forward planning (conformity index: 1.37 versus 1.51). Inverse planning reduced the dose to the rectal wall compared to a manually designed plan, albeit to a small extent. The theoretical probability of severe rectal proctitis and/or stenosis was reduced on average by 1.9% with inverse planning. Maximal sparing of the rectal wall was achieved with inverse planning for a patient whose target volume was partly wrapped around the rectum. The number of segments generated with inverse planning ranged between 33 and 52, and between 9 and 13 segments for manually created segments. CONCLUSION: Dose coverage of the planning target volumes is adequate for both approaches of planning. Inverse planning results in slightly better dose distributions with respect to the rectal wall compared to manual planning, at the cost of an increase of the number of segments by a factor of 3.

Humans↗
PubMed1976

Metaphyseal chondrodysplasia, neutropenia, and pancreatic insufficiency presenting with respiratory distress in the neonatal period.

Two pairs of brothers suffered respiratory distress in the newborn period because their ribs were abnormally short. The diagnostic radiological features of metaphyseal chondrodysplasia appeared only in the second year. Pancreatic insufficiency and neutropenia were present. One died of overwhelming infection and his brother survived a life-threatening episode of gangrenous proctitis.

Agranulocytosis↗
PubMed1995

Hydrosonography in the evaluation of colorectal polyps.

Prewarmed saline enemas and transabdominal ultrasound (hydrosonography) were used to evaluate 17 consecutive children with rectal bleeding before colonoscopy. Twelve patients with polyps were identified (10 by ultrasound, 10 by endoscopy): these included multiple hyperplastic polyps (1), multiple polyps (1), solitary polyps (9), and pseudopolyps (1). Ultrasound identified 11 polyps in 10 patients, missing two patients with small polyps less than 0.5 cm in diameter. The polyps were hyperechoic ovoid masses fixed to the colonic wall, with a stalk (7), submucosal infolding (5), and intraluminal floating (5). There was one false positive. Colonoscopy was refused by one patient and failed to reach beyond the distal sigmoid in another following previous surgery for malrotation. Colonoscopy was superior in identifying finer mucosal detail (colitis, ulcers, proctitis, anal fissure) and in detecting smaller polyps (sessile polyps, hyperplastic polyps). Hydrosonography of the colon is a simple, relatively non-invasive procedure that provides an alternative, radiation-free examination of the whole colon before colonoscopy. It is complementary to colonoscopy in the management of rectal bleeding in children.

Child↗
PubMed2003

Presenting features of inflammatory bowel disease in Great Britain and Ireland.

BACKGROUND: Reports from individual referral centres suggest that a significant proportion of children with inflammatory bowel disease (IBD) present after prolonged delays and with impaired growth. AIMS: To prospectively document the presenting features, delay in presentation, disease localisation, and growth in newly diagnosed cases of IBD. METHODS: For 13 months, between June 1998 and June 1999, 3247 paediatricians, adult gastroenterologists, and surgeons across the UK and Ireland were prospectively surveyed each month and asked to report every newly diagnosed case of childhood IBD. RESULTS: A total of 739 new IBD cases aged less than 16 years were identified. Only one quarter of Crohn's disease (CD) cases presented with the "classic triad" of diarrhoea, weight loss, and abdominal pain; nearly half did not report diarrhoea. The median delay from onset of symptoms to diagnosis was 5 months (mean 11 months), with one fifth having symptoms of more than one year. Delays were most common in CD and in younger children. Short stature was noted only in those with CD and not with ulcerative colitis. One fifth of CD cases had disease activity in the jejunum and this group had significantly reduced stature. Ileo-colonic involvement was documented in most CD cases, with only a small minority having isolated ileal or isolated colonic disease. Pan-colitis was reported in most UC cases, with very few having only an isolated proctitis. CONCLUSIONS: Many children are diagnosed after prolonged delays and have growth failure. Improved knowledge of the presenting features of IBD, and earlier investigation of suspected cases, may help reduce the delays noted.

Abdominal Pain↗
PubMed1979

Campylobacter colitis.

Eleven consecutive patients with diarrhoea from whose stools campylobacter were isolated were investigated by sigmoidoscopy and rectal biopsy. Eight had definite proctitis, and in seven biopsy specimens were abnormal with histological changes ranging from non-specific colitis to gross colitis with goblet-cell depletion and crypt-abscess formation. Nine of the patients passed blood in their stools, and in all but one abdominal pain was a feature of the illness. Severe campylobacter colitis may be clinically, sigmoidoscopically, and histologically difficult to differentiate from ulcerative colitis and is a differential diagnosis in acute colitis.

Adolescent↗
PubMed1983

Schistosomiasis mekongi diagnosed by rectal biopsy.

Schistosoma mekongi, a parasite of the dog which is endemic in small foci along the Mikong river, is rarely seen in Europe. A case of schistosomiasis caused by S mekongi was recently seen in France, in a native of Laos who had been living in Thailand. He was admitted for treatment of previous diagnosed tuberculoid leprosy but was found to have hepatosplenomegaly, with a high eosinophil count and high bilirubin concentrations. Serological examination suggested schistosomiasis, but there were no parasites in the urine and the rectal mucosa looked normal on endoscopy. Nevertheless, rectal biopsy showed schistosomal proctitis and many ova of S mekongi. Two courses of praziquantel cleared the ova from his rectal mucosa. Although serological examination using S mansoni antigen suggested schistosomiasis, only biopsy of normal looking rectal mucosa allowed the diagnosis to established.

Adult↗
PubMed2000

Open access follow up for inflammatory bowel disease: pragmatic randomised trial and cost effectiveness study.

OBJECTIVE: To evaluate whether follow up of patients with inflammatory bowel disease is better through open access than by routine booked appointments. DESIGN: Pragmatic randomised controlled trial. SETTING: Two district general hospitals in Swansea and Neath, Wales. PARTICIPANTS: 180 adults (78 with Crohn's disease, 77 ulcerative or indeterminate colitis, 25 ulcerative or idiopathic proctitis) recruited from outpatient clinics during October 1995 to November 1996. INTERVENTION: Open access follow up according to patient need. MAIN OUTCOME MEASURES: Generic (SF-36) and disease specific (UK inflammatory bowel disease questionnaire UKIBDQ) quality of life, number of primary and secondary care contacts, total resource use, and views of patients and general practitioners. RESULTS: There were no differences in generic or disease specific quality of life. Open access patients had fewer day visits (0.21 v 0. 42, P<0.05) and fewer outpatient visits ( 4.12 v 4.64, P<0.01), but some patients had difficulty obtaining an urgent appointment. There were no significant differences in specific investigations undertaken, inpatient days, general practitioner surgery or home visits, drugs prescribed, or total patient borne costs. Mean total cost in secondary care was lower for open access patients (P<0.05), but when primary care and patient borne costs were added there were no significant differences in total costs to the NHS or to society. General practitioners and patients preferred open access. CONCLUSIONS: Open access follow up delivers the same quality of care as routine outpatient care and is preferred by patients and general practitioners. It uses fewer resources in secondary care but total resource use is similar. Better methods of ensuring urgent access to outpatient clinics are needed.

Adult↗
PubMed1982

Mucin secretion in inflammatory bowel disease: correlation with disease activity and dysplasia.

When rectal biopsies from 65 patients with ulcerative colitis and 20 patients with Crohn's disease was stained for mucins, an abnormal pattern (excess of sialomucins) was seen in about half of them. This is in contrast with 65 cases of non-specific proctitis where the mucin pattern of rectal biopsies was normal in all except one case. The abnormal mucin secretion in patients with ulcerative colitis was apparently related to the activity, duration, and extent of the disease. All biopsies with dysplasia showed predominant sialomucin staining except one. All biopsies showing sialomucins during remission also had dysplasia, while during active disease a number of biopsies had increased sialomucins without the evidence of dysplasia. It is not known if such cases will subsequently develop morphological atypia.

Colitis, Ulcerative↗
PubMed1986

Function of the anal sphincters after chronic radiation injury.

Anorectal manometry was done in 10 men with chronic radiation proctitis and symptoms of urgency, frequency, and occasional incontinence of faeces. They were compared with 10 asymptomatic age and sex-matched controls. The maximum resting anal canal pressure and the physiological sphincter length were significantly lower (p less than 0.01) in the irradiated group. The rectosphincteric reflex was absent in one patient and showed abnormalities of recovery in four others, who had received radiotherapy. The squeeze pressure of the external sphincter was not significantly different. These results indicate that dysfunction of the internal anal sphincter may contribute to patients' anorectal symptoms after pelvic radiotherapy. Histological evidence suggests that damage to the myenteric plexus is mainly responsible. The manometric function of the external sphincter remains relatively unaffected.

Aged↗
PubMed1987

Prognosis of chronic ulcerative colitis in a community.

Utilising the population based data resources of the Rochester Epidemiology Project, we estimated survival and risk of subsequent colon cancer in the 182 residents of Rochester, Minnesota, initially diagnosed with chronic ulcerative colitis (CUC) between 1985 and 1979. Twenty five (13.7%) had a proctocolectomy during the course of follow up. Three patients developed colorectal adenocarcinoma after the initial diagnosis of CUC (relative risk = 1.9, 95% CI 0.4-5.4). Excluding proctitis cases, the relative risk of cancer was 2.4 (95% CI 0.3-8.7). At last follow up, 37 (20.3%) were dead; only 10 patients had chronic ulcerative colitis mentioned on the death certificate. Overall survival was similar to that expected for the general population of like age and sex. Our results suggest that chronic ulcerative colitis in the community is typically a milder disease than would appear from hospital or referral centre series.

Adenocarcinoma↗
PubMed1987

Chronic ulcerative colitis: incidence and prevalence in a community.

Utilising the population based data resources of the Rochester Epidemiology Project, we determined the incidence and prevalence of chronic ulcerative colitis among Rochester, Minnesota, residents over the 20 year period, 1960-79. One hundred and thirty eight cases met diagnostic and residency criteria, for an overall age, and sex adjusted chronic ulcerative colitis incidence rate of 15.0 per 100,000 person years. The male:female ratio of age adjusted rates was 1.5:1. Age specific incidence was roughly bimodal in appearance but was not consistent in different patient subgroups. On 1-1-80, there were 120 Rochester residents with a history of chronic ulcerative colitis, corresponding to a prevalence rate of 225.2 per 100,000 population. Fifty three per cent of chronic ulcerative colitis incidence cases were 'definite' and 47% were 'probable', the former requiring consistent observations for at least six months. The definite group had proportionately more men and disease of greater extent and severity. Pancolitis comprised about one-third of all cases (4.6 per 100,000 person years). Proctitis and distal disease (7.1 and 2.0 per 100,000 person years) made up most of the rest. One-fourth of all patients had 'severe' or 'moderate' disease (3.8 per 100,000 person years), while the remainder had either 'mild' or 'transient' chronic ulcerative colitis (11.2 per 100,000 person years). In residents of Rochester, Minnesota, chronic ulcerative colitis is most often a mild disease. The over-representation of severe or complicated examples that results from selected referral to major centres probably distorts the natural clinical spectrum of the disease.

Adolescent↗
PubMed1988

Colorectal cancer in ulcerative colitis: a cohort study of primary referrals from three centres.

A retrospective cohort of 823 patients with ulcerative colitis who resided at the time of diagnosis in one of three defined geographical areas (West Midlands region, Oxford region, England and Stockholm County, Sweden) was assembled. The patients were first seen at named hospitals in these areas and the diagnosis of ulcerative colitis established within five years of onset of symptoms between 1945-1965. All patients were 15 years of age or more at onset of disease and were followed for a minimum of 17 years and a maximum of 38 years. Ninety seven per cent completeness of follow up was achieved. Examining the colorectal cancer risk in the series relative to the risk in the general population by standardised morbidity ratios, there was an eight fold increased risk of cancer in the series as a whole. Dividing the series by extent of colitis, extensive colitis patients showed a 19 fold increase in risk. A four fold increased risk was shown in the remainder of the series (left sided colitis, proctitis and extent unknown). Life table analyses in extensive colitis gave cumulative risks of 7.2% (CI 3.6-10.8) at 20 years from onset of disease and 16.5% (CI 9.0-24.0) at 30 years from onset. No significant effect of age at onset, sex or referral centre could be detected. Examination of the data by interval from onset to cancer and by actual age at development of cancer suggests that patients who develop colorectal cancer will do so in a distribution around 50 years of age independent of duration of disease in adult onset ulcerative colitis (greater than 15 years at onset of disease). An inverse relationship was shown between age at onset of disease and interval from onset of disease to cancer. Further age specific rates for cancer increased up to 50 years and decreased thereafter. These results suggest that extensive colitis patients have a genetic predisposition to colorectal cancer and that longstanding inflammation is not of primary importance in the initiation/promotion of cancer in this disease.

Actuarial Analysis↗
PubMed1989

Epidemiological study of asymptomatic inflammatory bowel disease: the identification of cases during a screening programme for colorectal cancer.

An asymptomatic population of 37,000 people in the Nottingham area were offered faecal occult blood tests in a screening study for colorectal cancer. Seventeen thousand nine hundred and thirty people completed the tests and 481 individuals with positive tests underwent full investigation of the colon. Eight people with previously undiagnosed inflammatory bowel disease were identified. In five cases there was total ulcerative colitis; in one a proctitis and in two Crohn's disease. Two further patients with ulcerative colitis were identified; they had been lost to follow up for 25 and 45 years respectively. The combined prevalence of inflammatory bowel disease was 56/10(5) and it is likely that current studies of the epidemiology of these conditions may underestimate the true prevalence by between 27% and 38%.

Aged↗
PubMed1990

Factors affecting colectomy rate in ulcerative colitis: an epidemiologic study.

Factors affecting colectomy rate were studied in a retrospective population based series of 1586 patients with ulcerative colitis, in Stockholm County during 1955-84. Five hundred and sixty eight patients (36%) had total colitis at diagnosis, 603 patients (38%) left sided colitis, and 397 patients (25%) proctitis. During a median period of observation of 13 years 514 patients were treated by colectomy. The five, 10, and 25 year cumulative colectomy rate were 20% (CI 18-22%), 28% (CI 26-30%), and 45% (CI 41-49%) respectively. The main factor affecting the colectomy rate was the extent of disease at diagnosis. Patients with total colitis showed a five, 10, and 25 year cumulative colectomy rate of 32% (CI 28-36%), 42% (CI 38-46%), and 65% (CI 58-72%) respectively. Ten per cent of the 1586 patients had a colectomy during the first year after diagnosis, 4% during the second year and 1% during subsequent years. The age at diagnosis and sex did not affect the cumulative colectomy rate. Elective colectomy was performed in 322 cases (63%) and acute colectomy in 192. The duration of disease before colectomy fell during the study period due to a more standardised criteria for colectomy in severe attacks. One hundred and twenty nine (66%) of the acute colectomies were performed within two years from diagnosis.

Adult↗
PubMed1991

Acute colorectal ischaemia after anaphylactoid shock.

A 29 year old woman is reported with bloody diarrhoea three hours after developing anaphylactoid shock. Sigmoidoscopy, barium enema, and histology showed rectal and colonic ischaemia to the splenic flexure. Recovery was complete. There was no history of vascular disease but the patient was taking an oral contraceptive. Thirty one other cases of spontaneous ischaemic proctitis are reviewed.

Acute Disease↗