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PubMed1994

Indomethacin as adjunct analgesia following open cholecystectomy.

Fifty patients scheduled for elective cholecystectomy were randomised to receive either indomethacin suppositories 200 mg p.r. at the end of anaesthesia, followed by 100 mg bd for three days, or placebo suppositories according to the same regimen. All patients were given intravenous pethidine via patient-controlled analgesia (PCA) postoperatively. The mean dose of pethidine required by the patients in the indomethacin group was significantly less than that used by the placebo group, the cumulative dose after three days being 530.7 mg (SD 664.0) and 1151.0 mg (682.0) for the indomethacin and placebo groups respectively. At the same time the patients in the indomethacin group had lower pain scores both at rest and with movement, though this was only statistically significant on the first day on movement. There was no statistical difference between the groups with respect to the incidence of nausea, indigestion, proctitis, volume of drainage from the wound drain, or width of bruising around the wounds. Serum creatinine levels were compared pre- and postoperatively where possible and showed no change in either group.

Analgesia↗

PubMedDate not supplied

Factors associated with the detection of Entamoeba histolytica in homosexual men.

In a study of bowel parasites in 128 Australian homosexual men attending a sexually transmitted diseases (STD) clinic, Entamoeba histolytica was detected in 37%, Giardia intestinalis in 3% and at least one protozoan in 81% of the group. There was no evidence of pathogenicity of E. histolytica, nor was there any association between the detection of E. histolytica and sexual practices, gastrointestinal symptoms, proctitis, human immunodeficiency virus antibody result or T-cell subset values. However it was noted that those subjects with an elevated IgM greater than 4 g/l were more likely to harbour E. histolytica trophozoites than those with a level below 4 g/l (OR 6.54, 95% CI 1.3-32.8). Travel to South-East Asia, India, China, Africa, South America or the Pacific islands in the previous 3 years emerged also as an independent factor (OR 2.70, 95% CI 1.12-6.53) associated with detection of E. histolytica.

Adult↗

PubMedDate not supplied

Anogenital non-gonococcal neisseriae: prevalence and clinical significance.

Over a 13-year period non-gonococcal neisseriae (NGN) were isolated from 114 of 88,670 patients (0.13%) screened for anogenital gonorrhoea at a Genitourinary Medicine Unit. During the same period there were approximately 9000 anogenital gonococcal infections (10%). The prevalence of NGN was 0.09% (27/31,500) in women, 0.04% (20/52,800) in heterosexual men and 1.5% (67/4370) in homosexual men: the differences in prevalence between women and heterosexual men (P < 0.01) and between heterosexual patients and homosexual men (P < 0.001) are highly significant. Neisseria meningitidis was isolated most frequently and accounted for 85% (99/114) of the NGN. Whenever possible, N. meningitidis was serogrouped and its occurrence correlated with patient symptoms. Eleven of 18 heterosexual men who had meningococci isolated from their urethras had urethritis but co-existing chlamydial infection was excluded in only 5. None of 9 women with cervical colonization had clinical evidence of pelvic inflammation. Only one of 49 men with rectal colonization had proctitis. The management of anogenital NGN infection is discussed in relation to our findings and those of previously published studies. Within each patient group the prevalence and incidence of anogenital NGN were similar at the beginning and end of the study period indicating that levels have not been influenced by the advent of AIDS.

Anus Diseases↗

PubMed1991

Mesalamine in ulcerative colitis.

Sulfasalazine has been used for many years in the management of ulcerative colitis. As many as 20 percent of patients treated with it experience intolerable adverse effects usually attributed to its sulfapyridine component. The other active component is 5-aminosalicylic acid (5-ASA); the only 5-ASA enema preparation currently available in the U.S. is mesalamine (Rowasa, Reid-Rowell) containing 5-ASA 4 g in 60 mL. In clinical trials, mesalamine has proved efficacious in treating refractory cases of distal ulcerative colitis, proctitis, and proctosigmoiditis. Because of its high cost compared with more conventional treatment modalities, it should be reserved for cases that are either refractory or intolerant to conventional treatment.

Administration, Rectal↗

PubMed2005

Fate of the rectum after colectomy with ileorectal anastomosis in ulcerative colitis.

OBJECTIVE: Aim of the study was to evaluate the cumulative success of colectomy and ileorectal anastomosis in 20 patients with ulcerative colitis. PATIENTS AND METHODS: Data were collected from patient histories and cumulative success was calculated by the Kaplan-Meier method. RESULTS: Seven of 20 (35%) ileorectal anastomoses were lost. Cumulative success rate was 84% at 5 years, 69% at 10 years and 56% at 20 years. Most common indication for proctectomy was disabling proctitis. Other reasons for failure were postoperative ileal necrosis and persisting presacral infection. Patients with advanced colonic cancer managed relatively well with ileorectal anastomosis until death. No cases of rectal cancer were detected during postoperative follow-up but one moderate dysplasia was treated locally. CONCLUSION: Ileorectal anastomosis can be chosen for patients who are not suitable for ileoanal operation. Rectal endoscopies are mandatory postoperatively.

Adult↗

PubMed2000

Effect of intrarectal prostaglandin E2 analogue (enprostil) on trinitrobenzenesulphonic acid-induced colitis in rats.

Prostaglandins exert a protective effect on colonic mucosa in experimentally induced colitis. This study investigated the effect of enprostil, a prostaglandin E2 (PGE2) analogue, on trinitrobenzenesulphonic acid (TNBS)-induced colitis in rats. Each rat received a rectal enema containing TNBS (30 mg), followed 24 h later by intrarectal once-daily enprostil (200 microg). Enprostil-treated and control rats were killed on day 3 (enprostil group, n = 5; control, n = 6) or day 10 (enprostil group, n = 5; control, n = 5) after TNBS treatment. The area of damaged mucosa of the colon was measured relative to the total colonic area. We also determined the macroscopic score of mucosal damage, and measured PGE2, 6-keto-prostaglandin F1alpha (6-keto-PGF1alpha) and thromboxane B2 (TXB2) concentration in portal vein blood samples. Enprostil significantly reduced both the area of damaged mucosa (including the ulcer area) and the macroscopic score after 3 days' treatment compared with control. Similarly, enprostil significantly reduced plasma concentration of PGE2, 6-keto-PGF1alpha and TXB2 during the acute phase at day 3 of treatment compared with control, but not at day 10. These results suggest that PGE2 enema may have therapeutic potential for treating patients with proctitis or left-sided colitis.

Animals↗

PubMedDate not supplied

Autoimmunity to heat shock protein 40 in ulcerative colitis.

Autoantibodies against heat shock protein 40 (HSP40) and their clinical significance in ulcerative colitis (UC) have not been evaluated before. Twenty-six tissue specimens of inflamed areas from patients with UC, 16 from patients with Crohn's disease (CD) and 16 endoscopically normal tissues were analysed for HSP40 expression. Sera from 47 patients with UC and 44 healthy volunteers were examined for the presence of autoantibodies against HSP40 by enzyme-linked immunosorbent assay test. Immunohistochemistry showed that 17 out of 26 specimens from UC patients, one specimen from a CD patient and one normal tissue specimen were positive for HSP40. Most HSP40-positive cells expressed CD68. Higher titres of anti-HSP40 autoantibodies were detected in sera from UC patients compared with healthy volunteers. In patients with inactive disease, those with proctitis or left-sided colitis had higher titres of anti-HSP40 autoantibodies than those with total colitis. Our study suggests that autoimmunity against HSP40 may have a beneficial effect in UC patients by limiting the extent of the disease.

Adolescent↗

PubMed2006

Capecitabine chemoradiation for rectal cancer after curative surgery.

This study reports the tolerability and feasibility of capecitabine, an oral fluoropyrimidine, chemoradiation as postoperative treatment. Stage II-III rectal cancer patients received 2 cycles of bolus 5-FU (425 mg/m2) and leucovorin (LV) (20 mg/m2) on days 1-5 q3w followed by oral capecitabine (800 mg/m2 bid) continuously during pelvic radiotherapy (total 50.4 Gy). Two additional cycles of 5-FU/LV were finally administered. Forty-one radically resected patients (median age: 61 years) were enrolled. All patients were evaluable for safety. Grade 3 adverse events included: proctitis (n = 3, 7%), diarrhea (n = 5, 12%), and leukopenia (n = 1, 2%). The overall rate of grade 3 diarrhea and leukopenia was 15% (95% confidence interval, 5-29%). Capecitabine chemoradiation in the adjuvant setting is well tolerated and is convenient to administer. These results support the use and further study of capecitabine chemoradiation in radically resected rectal cancer patients.

Adenocarcinoma↗

PubMed1996

Primary chemoradiation therapy with fluorouracil and cisplatin for cancer of the anus: results in 35 consecutive patients.

PURPOSE: This prospective phase II study was designed to test the activity and toxicity of a regimen of fluorouracil (5-FU) and cisplatin (CDDP) in combination with radiation therapy in the treatment of epidermoid cancer of the anal canal. PATIENTS AND METHODS: Thirty-five consecutive patients with untreated epidermoid cancer of the anal canal were candidates for chemoradiation therapy (CRT). Staging of cancer was as follows: T1, 26%; T2, 60%; T3, 14%; and N1, 2,3, 26%. No patient had distant metastases. The treatment protocol consisted of two to three cycles of chemotherapy starting on days 1 and 21 and concurrent radiotherapy at a daily dose of 1.8 Gy up to a total dose of 36 to 38 Gy in 4 weeks, delivered to the anal region, perineum, middle and lower pelvis, and inguinal and external iliac nodes. Radiotherapy was then delivered to the anoperineal region and metastatic inguinal nodes to a total dose of 18 to 24 Gy in 10 fractions. Chemotherapy consisted of 24-hour intravenous (IV) infusion of 5-FU 750 mg/m2 on days 1 to 4 and CDDP 100 mg/m2 by 60-minute IV infusion on day 1. RESULTS: All patients received two cycles of chemotherapy; the second was delayed in three patients because of leukopenia that was evident in 11 (31%). In eight patients, a third cycle was added. They all experienced nausea or vomiting; one patient showed signs of cardiotoxicity and one developed proctitis, dermatitis, and diarrhea (grade 3). Complete regression (CR) was assessed in 33 patients (94%); nine patients with metastatic lymph nodes also had CR. Two patients had a partial response (PR); both underwent abdominoperineal resection, which was not curative in one. Two patients (6%) had a local recurrence; in one, this was associated with hepatic metastases. One of these patients underwent surgery and is alive after about 4 years, while the other is undergoing chemotherapy. After a median follow-up duration of 37 months, 94% of patients are alive without evidence of disease and 86% are colostomy-free. CONCLUSION: This regimen is well tolerated; its toxicity does not exceed that observed with the combination of 5-FU and mitomycin (MMC). Compared with our previous experience based on the classic CRT (5-FU, MMC, and radiation), the objective response rate observed with this new combination was similar. However, the local recurrence rate, observed in patients treated with the new regimen, was lower (6% v 24%). According to more recent data from the literature, primary CRT is the elective indication in epidermoid cancer of the anus and replacement of MMC with CDDP seems an effective and logical evolution.

Adult↗

PubMed2002

Sphincter-sparing local excision and adjuvant radiation for anal-rectal melanoma.

PURPOSE: To evaluate the outcome and toxicity of a sphincter-sparing treatment strategy in the management of patients with anal-rectal melanoma. PATIENTS AND METHODS: Between 1989 and 2000, 23 patients with invasive anal-rectal melanoma were managed with sphincter-sparing surgical resection and adjuvant radiation. Surgery consisted of primary local excision, as well as dissection for patients with documented regional nodal disease. Adjuvant radiation was delivered using a hypofractionated regimen of 30 Gy in five fractions over 2.5 weeks. Adjuvant systemic therapy was delivered to nine patients: cytotoxic chemotherapy in seven and immunotherapy in two. RESULTS: After a median follow-up of 32 months, 15 patients had relapsed and 15 patients had died. The actuarial 5-year overall, disease-specific, disease-free, and distant metastasis-free survival rates were 31%, 36%, 37%, and 35%, respectively. The actuarial 5-year local and regional nodal control rates were 74% and 84%, respectively. No patient had locoregional failure as the sole site of failure and no patient required salvage abdominoperineal resection (APR). By univariate analysis, patients with nodal disease at presentation had a decreased actuarial 5-year disease-specific (0% v 45%, P =.004), disease-free (0% v 45%, P <.001), and distant metastasis-free survival (0% v 42%, P <.001). The actuarial complication-free survival rate was 71%. Two patients developed mild scrotal edema (grade 1), and four patients developed moderate proctitis requiring prolonged medical management (grade 2). CONCLUSION: Sphincter-sparing local excision and adjuvant radiation is well tolerated and can effectively control local-regional disease while avoiding the functional morbidity of APR.

Adult↗

PubMed1977

Lysozyme in plasma and neutrophilic granulocytes in ulcerative colitis and Crohn's disease.

The concentration of lysozyme in plasma (P) and in neutrophil leucocytes (N) was determined by a turbidimetric method in 32 patients with ulcerative colitis (U.C.), 11 patients with Crohn's disease (C.D.), 9 patients with haemorrhagic proctitis, and 39 healthy volunteers. In active U.C., P was significantly elevated (p less than 0.05), whereas C.D. showed normal values. Corresponding N was significantly reduced in active U.C. (p less than 0.05) but normal in C.D. In calculating the ratio N/P, highly significant lower values were found in active U.C. (p less than 0.001) compared to normal levels in C.D. The high P in active U.C. is presumed to reflect an accelerated destruction of neutrophil leucocytes as well as an intensified turnover rate. The reduced N is probably attributable to an inhibited synthesis. The findings suggest that lysozyme determinations are valuable in be differential diagnosis of active U.C. and C.D.

Adolescent↗

PubMed2006

Rectal gonorrhoea in men -- is microscopy still a useful tool?

Rectal gonorrhoea (GC) in men may cause anal discharge or proctitis, but these symptoms have been shown to correlate poorly with rectal infection. Culture of Neisseria gonorrhoeae from an exposed site offers a readily available, sensitive and cheap diagnostic test, and is currently the gold standard for diagnosis; however, these results can take a few days and therefore do not offer an instant diagnosis. Gram staining of rectal smears for N. gonorrhoeae has a low sensitivity but a high specificity when performed by experienced personnel. We audited whether rectal microscopy increased the number of patients diagnosed and treated for rectal GC at initial presentation at one inner London genitourinary clinic over a 12-month period. One hundred and thirty-six episodes of rectal GC were identified in 132 men. In all, 134/136 had rectal microscopy of whom, 47/134 (35%) were smear-positive for GC. Of the 136 cases, 90 received antibiotics for GC at their first presentation. Twenty-four of 90 (27%) would not have been treated until culture results were available, if rectal microscopy had not been performed. These results suggest that rectal microscopy remains an important tool and increases the proportion of men treated for GC at their first attendance.

Adult↗

PubMed1981

Effect of X irradiation on the rectum of the rat.

It is demonstrated how a definite part of the rectum of the female Wistar rat can be selectively irradiated without surgery. The effect of X irradiation on the rectum is in the acute phase (second week after irradiation) a haemorrhagic radiation proctitis and in the chronic phase a rectal obstruction. The dose-effect relationship using rectal obstruction as the end point is a sigmoid curve with a ED10 of 17.50 Gy, ED50 of 21.5 Gy and ED90 of 27.5 Gy. Latency time decreases exponentially with increasing dose and is 150 days at the ED50. Histological findings show mucosal glands and cysts within the submucosa and a severe submucosal radiation within the submucosa and a severe submucosal radiation fibrosis which results in the rectum becoming a rigid and non-elastic tube which leads to a functional block in transport of faeces.

Animals↗

PubMed1994

Case report: rectal infarction after abdominal aortic surgery.

Full thickness ischaemic colitis complicates approximately 1-2% of abdominal aortic procedures. Ligation of the inferior mesenteric artery and hypotension are recognized as causative factors. It is not, however, widely appreciated that ischaemic proctitis may also rarely complicate aortic surgery, especially after complex procedures or if there has been additional interruption to the internal iliac circulation. We report a case of rectal necrosis following repair of a thrombosed aortic aneurysm in which plain X-ray appearances aided the diagnosis.

Aged↗

PubMed2006

Disposition of imatinib and its metabolite CGP74588 in a patient with chronic myelogenous leukemia and short-bowel syndrome.

Imatinib mesylate, licensed to treat chronic myelogenous leukemia and gastrointestinal stromal tumors, is metabolized by means of cytochrome P450 3A and excreted primarily in the bile. Although the bioavailability of imatinib mesylate is more than 97%, the exact gastrointestinal site of its absorption is unknown. Liquid chromatography-mass spectrometry was used to quantitate imatinib and its metabolite CGP74588 in the plasma and jejunostomy output of a patient with newly diagnosed chronic myelogenous leukemia. She had previously lost most of her small bowel and all of her colon as a result of mesenteric artery thrombosis and radiation-induced colitis and/or proctitis. Imatinib pharmacokinetics in plasma indicated that approximately 20% of the patient's 400-mg dose was absorbed. The jejunostomy output contained 338 mg of imatinib, which was consistent with 320 mg of a nonabsorbed dose plus approximately 23% of the absorbed dose being excreted unchanged in the bile. These data indicate the importance of considering gastrointestinal anatomic abnormalities or disease states when oral imatinib is dosed.

Antineoplastic Agents↗

PubMed1976

Analysis of 6,293 routine proctosigmoidoscopies.

7,679 proctosigmoidoscopies were performed on 6,293 patients during a period from 1962 to 1974 at the Third Department of Internal Medicine, Tohoku University Hospital. Results were summarized as follows: Polyps were observed in 470 patients (7.5%) and cancer was found in 178 patients (2.8%). 129 patients (2.0%) were observed to have ulcerative colitis. There were 57 patients with melanosis coli, 12 radiation proctitis, 7 amebic colitis, 5 granulomatous colitis, 2 endometriosis coli, 2 carcinoid and 2 intestinal tuberculosis. Thus, 879 out of 6,293 patients examined had some forms of disease, an over-all incidence being 14.0%. Biopsies were performed under the proctosigmoidoscopic observation in 82.4% out of 273 patients with polyps during the 6-year period from 1969 to 1974 and 105 patients (46.7%) were observed to have adenomatous polyps. The age-specific distribution pattern and incidences of these patients with adenomatous polyps were mostly consistent with those of 178 patients with cancer of the large bowel, which were observed by proctosigmoidoscopy during the 13-year period from 1962 to 1974. Thus, it is suggested that etiological correlation exists between polyps of adenomatous type and cancer of the large bowel.

Aging↗

PubMed1981

Isolation of N. meningitidis from patients in a gonorrhea screen program: a four-year survey in New York City.

In the course of the screening program for gonorrhea in New York City, a total of 964 N. meningitidis strains were recovered from the genitourinary tract and/or anal canal over a four-year period (April 1975-April 1979), the rate of such recoveries having tripled during that time. The majority of strains were isolated from anal canal cultures of male patients most of whom were seen in a clinic treating homosexuals. N. meningitidis and N. gonorrhoeae were cultured together from 41 patients: in 24 cases from different sites and in 17 instances from the same specimen. Evidence of clinically significant N. meningitidis involvement of genitourinary sites was obtained in a number of cases of urethritis and proctitis as well as in three instances of epidemiologically linked cases. The rising frequency of N. meningitidis isolations from these sites, with its potential clinical implications, should alert microbiologists, clinicians, and epidemiologists to the need for careful distinction of meningococcal from gonorrheal infection, particularly among homosexual men.

Female↗

PubMed2003

Quality of life and economic considerations in the management of prostate cancer.

The purpose of this article was to provide an overview of the morbidity and mortality of prostate cancer, QOL issues and the economic impact of the disease. We searched Medline (from 1990 onwards) for all studies dealing with prostate cancer epidemiology, treatment, screening and staging, and critically reviewed the most relevant articles, focusing on pharmacoeconomic issues. Prostate cancer is the most common cancer in men. In the US, new estimated cases of prostate cancer represented 14.8% of all new cancer cases for 2000, with estimated deaths from prostate cancer comprising 5.8% of all deaths from cancer. Current options for prostate cancer management include radical prostatectomy, cryosurgery, radiotherapy, hormone therapy and watchful waiting. Many of the long-term effects of treatment, such as urinary incontinence, impotence and radiation-induced proctitis, have a large impact on patients' quality of life and, in some patients, may offset the clinical benefits. Regulatory bodies and managed care organisations are assigning increasing importance to the evaluation of QOL benefits as an independent clinical endpoint and a measure of patient satisfaction. Several screening programmes for early detection of prostate cancer, mostly based on prostate-specific antigen (PSA) measurement or digital rectal examination, have been proposed, but their routine implementation in all asymptomatic elderly men has been questioned. There is still no definite proof that patient outcomes are improved by extensive PSA screening. Furthermore, the total cost of a screening programme is difficult to define since it extends well beyond the initial test. Several instruments are used for QOL assessment in prostate cancer, some of which have been specifically developed for, or adapted to, patients with this disease, such as the Functional Assessment Cancer Therapy (FACT) tool, Prostate Cancer Treatment Outcome Questionnaire (PCTO-Q) and Prostate Cancer Specific Quality of Life Instrument (PROSQOLI). More than 50% of treatment costs for prostate cancer are accrued during the patient's last year of life, and total initial care costs decrease with increasing age. In the US, initial average inpatient costs were estimated at $US 2253, in 1995, for men aged > or =80 years, compared with $US 4540 for men aged 35-64 years. In recent years, treatments based on combined modalities (i.e. radiotherapy/prostatectomy plus hormonal therapies) have emerged. Although cost-effectiveness analyses of various treatment options have been attempted, the strength of their conclusions appears to be limited by the lack of homogeneous literature data on the effects of such interventions on survival and morbidity.

Androgen Antagonists↗