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Biomedical subjects

A R Dixon

Publications and source records attributed to A R Dixon.

At least 19 recordsLinked to original sources
PubMed2006

Short course preoperative radiotherapy is the single most important risk factor for perineal wound complications after abdominoperineal excision of the rectum.

AIM: To determine factors associated with perineal wound complications following abdominoperineal excision of the rectum (APER) for rectal adenocarcinoma and their effects on time to healing. PATIENTS AND METHODS: We studied all cases of APER performed in our unit by four consultants over 7 years. Seven out of nine factors considered important in wound healing were analysed using logistic regression and a multivariate model was built to examine interactions. Wound persistence was calculated using the Kaplan-Meier method. RESULTS: Data were available for 94 of 96 patients [male:female, 3:2, median age 72.5 (IQR: 64-78)]. Thirty-nine (41%) patients had 25 Gray, 3-portal, fractionated 5-day short course preoperative radiotherapy (SCPRT). Dukes stages were A (34%), B (26%), C (40%). Perineal wound complications occurred in 44 (47%), 16% of these requiring return to theatre. Local recurrences occurred in 13 (15%). There was no evidence to suggest that either patient gender, age, smoking status, preoperative albumin or haemoglobin level, or T stage were associated with the development of wound complications. The odds of wound complications for a patient who had SCPRT was over 10 times that for a patient who did not have preoperative radiotherapy (odds ratio 10.15, 95% CI: 3.80-27.05, n = 94). Seventy-four per cent of SCPRT and 96% of non-SCPRT wounds had healed by 1 year. Estimated failed wound healing rates at 30 and 90 days were 64% (95% CI: 46-78) and 48% (95% CI: 30-64) in SCPRT patients compared with 23% (95% CI: 12-35) and 9% (95% CI: 3-20) in non-SCPRT patients (log rank test P < 0.0001). CONCLUSION: Patients who have an APER are over 10 times more likely to have a perineal wound complication if they have SCPRT than not. Two-thirds of these will not have healed by 1 month, half by 3 months and over a quarter will still remain unhealed at 1 year. This has important implications for patient management decisions. Large prospective studies are needed to evaluate the effects of a selective policy for radiotherapy administered to patients requiring APER.

Adenocarcinoma↗
PubMed2006

A colorectal cancer patient focus group develops an information package.

INTRODUCTION: In order to deliver high quality care and empower cancer patients in decision-making, good quality information and communication are essential. We describe the development of an information booklet. PATIENTS AND METHODS: A total of 22 colorectal cancer patients (12 male; median age, 72 years, range, 40-86 years) met on 3 occasions. Patients were asked to define their information needs and score them (1-4) according to importance. The information document was written. The second meeting involved feedback on the booklet. The modified booklet was reviewed/approved by the group before submission for local ethics committee approval prior to its distribution to other patients. RESULTS: All participants felt the project a good idea. Essential information included the surgeon's individual morbidity, mortality, survival, recurrence data and details of adjuvant therapies (score = 4). Also important were type of surgery, complications and postoperative recovery (score = 3). Simple anatomical drawings were also considered important. CONCLUSIONS: The booklet is now used to personalise information for all our patients and serves, in part, as a record of the key issues discussed during the consultation. The booklet has been evaluated in a randomised trial.

Adult↗
PubMed2005

Laparoscopic anterior resection and uterine manipulation: why make things difficult?

The uterus continues to be a source of difficulty in mobilization of the rectum. These difficulties are compounded in laparoscopic operations, particularly anterior resection, proctectomy and vaginal sacrocolpopexy. Techniques to overcome this have in general proved unsatisfactory. We have adopted a technique of using an extended Vesellum forceps from gynaecological practice and recommend its use by all. The technique is described.

Colon↗
PubMed2004

Management of recurrent anastomotic stricture and iatrogenic stenosis by circular stapler.

Anastomotic stricture is an increasingly common clinical finding. It is thought to arise because of ischemia, disruption, or leakage at an anastomosis site. Its management can be difficult and strictures often are resistant to standard dilation therapy. Major corrective surgery is possible; however, it is technically challenging and not without risk. We have used a circular stapler to excise colorectal strictures, introducing the anvil of the stapler via a proximal stoma or colotomy, drawing the anvil through the stricture with a snare via a colonoscope and affixing it to the body of a circular staple gun and excising the stricture. We have with found this to be an effective treatment in appropriately selected patients.

Aged↗
PubMed2004

Laparoscopic proctocolectomy with restorative ileal-anal pouch.

OBJECTIVE: The aim of the study was to analyse the outcome of restorative proctocolectomy carried out by laparoscopic surgery. METHODS: A prospectively collected electronic database of all colorectal laparoscopic procedures performed between April 2001 and July 2003 has been used to identify surgical outcomes in 14 consecutive patients who have undergone laparoscopic RPC. RESULTS: Fourteen patients (5 male), median BMI 24 kg/m(2) have undergone restorative laparoscopic proctocolectomy over a two year period: 13 (ulcerative colitis, one with cancer) and 1 (FAP). The median operation time was 260 min; time has not decreased with experience. There were no intra-operative surgical complications or deaths. Patient controlled analgesia continued for a median of 36 h. The median time to diet was 48 h and median hospital stay 7 days; three patients required nasogastric aspiration for delayed gastric emptying. Eighteen regional lymph nodes were retrieved local to the carcinoma. There was one anastomotic leak. All covering stomas were closed by 6 months (12 by eight weeks). All 14 patients are fully continent, able to suppress urgency and have a median pouch frequency of 4/24 h. None admit to having problems with potency, orgasm sensation, ejaculation, micturition. One lady reports dysparunia. All are highly satisfied with functional outcome and cosmesis. CONCLUSION: We are encouraged to continue to offer our patients the option of a laparoscopic resection.

Adult↗
PubMed2003

An unusual cause for a colonic stricture: a case of Mycobacterium xenopi mimicking malignancy.

Colonic strictures are very common and are a frequent finding on double contrast barium examination; they very often reflect the presence of malignancy, diverticular disease, ischaemia, inflammatory bowel disease, and rarely mycobacterial disease. A case of mycobacterial disease mimicking malignancy is presented; this was due to a rare mycobacterial subtype and there was complete resolution of symptoms with antimycobacterial therapy.

Colonic Diseases↗
PubMed2002

The impact of bowel cancer awareness week.

OBJECTIVES: To assess knowledge of Bowel Cancer Awareness Week (BCAW) amongst patients attending their general practice surgery and to identify whether BCAW could increase knowledge of colorectal cancer symptoms. METHOD: Questionnaire study with ethics committee approval. Patients attending non-emergency clinics in a single general practice during the week following BCAW were given a questionnaire. Respondents were asked for knowledge of colorectal cancer symptoms, sources of this information and awareness of BCAW compared to similar knowledge of breast cancer. RESULTS: Seventy-seven patients responded (96% response rate, median age 42, 40% male). Eighty-five percent could name a breast cancer symptom compared to only 44% who could name a colorectal cancer symptom (McNemar's chi2, P < 0.0001). Respondents identified more sources of information for breast than colorectal cancer. Only 21% had heard of BCAW and none could name any symbol for bowel cancer awareness whereas 69% were aware of Breast Cancer Awareness Month and 28% could name its symbol (McNemar's chi2, P < 0.0001). Multivariate analysis demonstrated that patients who were aware of BCAW were 4.6 times more likely to have knowledge of colorectal cancer symptoms (95% CI 1.25-17.1). CONCLUSIONS: Despite their similar incidence, knowledge of colorectal cancer is much less than breast cancer. In part this may be due to the greater publicity given to breast cancer. BCAW can increase knowledge of colorectal cancer symptoms but currently, too few people are aware of it.

Journal Article↗
PubMed2002

Knowledge of cancer symptoms among patients attending one-stop breast and rectal bleeding clinics.

AIM AND METHOD: The aim of this questionnaire study was to identify knowledge of breast and colorectal cancer symptoms among 100 patients attending one-stop breast clinics and rectal bleeding clinics and to determine the source of the information. RESULTS: Seventy-five breast clinic (mean age 46 years, all female) and 78 colorectal clinic patients (mean age 59 years, 51% male) responded. Knowledge of breast was significantly greater than bowel cancer in both groups (P<0.0001, McNemar's chi(2)). There was no difference in knowledge of symptoms of breast cancer or bowel cancer between patients attending either clinic. There was a positive association between cancer knowledge, family history and female gender but no association with age. Knowledge of Bowel Cancer Awareness Week was positively associated with colorectal cancer knowledge. CONCLUSION: Knowledge of colorectal cancer is much less than breast cancer in clinic attenders. Seventy-five per cent of women attending breast clinic could name a breast cancer symptom whereas only 37% of patients attending colorectal clinic could name a bowel cancer symptom. These findings have implications when considering patients' anxiety, expectations of a cancer diagnosis and breaking bad news.

Ambulatory Care Facilities↗
PubMed2002

Early diagnosis of colonic carcinoma: a haemorrhagic complication after the use of tissue plasminogen activator.

Haemorrhagic complications of thrombolytic therapy for myocardial infarction are common. A 68 year old man presented with a myocardial infarction and was started on tissue plasminogen activator. Soon after he experienced rectal bleeding and a barium enema showed a small carcinoma in the colon, which was treated surgically. It is important that gastrointestinal bleeding secondary to thrombolysis is always investigated for an underlying cause.

Aged↗
PubMed2002

Laparoscopic inguinal hernia repair: a NICE operation.

Published evidence comparing laparoscopic and open herniorraphy is controversial. NICE recommends that open techniques are used for first time repairs and that TEP be considered for bilateral/recurrent repairs undertaken in specialist units. We report a consecutive series of 224 patients undergoing 268 TEP repairs between 1996 and 2001. Operating time, complications, return to normal activity/full time employment and recurrence were examined. The median operating time was 30 minutes. There was one conversion. Ninety four percent of patients drove on the third post-operative day. The median time to normal activity was 4 days (1-10 days). The median time to return to professional employment in 82 patients was 3 days (range 2-9 days). Four patients (1.7%) had self-limiting minor groin pain. There were 3 recurrences (1.4%) and none since altering the surgical technique to use a larger anchored mesh. We have demonstrated TEP to be an easily learnt, safe, effective technique with low morbidity, and with sufficient experience, takes no longer than an open repair. It can be performed at little increased cost and restores selected patients to an early return to full-time employment. We believe that the choice between open and laparoscopic repair is a subjective decision for patient and surgeon

Adult↗
PubMed2001

Is routine histological reporting of doughnuts justified after anterior resection for colorectal cancer?

OBJECTIVE: 'Doughnuts' of colonic tissue which remain on a circular stapler after firing are routinely examined histologically. However, Royal College of Pathologists' guidelines state that this is not necessary. The aim of this study was to examine current practice among pathologists in one region in the UK and to determine the incidence of clinically significant pathology within colonic doughnuts. METHODS: Current practice in all pathology Departments within the South-west Region was examined and 100 doughnuts from anterior resection specimens were reviewed for the presence of abnormal pathology. RESULTS: Practice varied between hospitals with only 15% following guidelines for examination of doughnuts and 38% following guidelines for reporting of resection margins. Review of pathology specimens demonstrated no incidence of colonic adenocarcinoma in a doughnut. Benign pathology was present in 9% and dysplasia in 3% but in no case was patient management altered as a result of the pathology report. CONCLUSION: Application of recommended guidelines is inconsistent. We have demonstrated a low incidence of clinically significant pathology in doughnuts and more economical guidelines could therefore be safely applied without detriment to patient care.

Journal Article↗
PubMed2000

The extracellular hyaluronidase gene (hylA) of Streptococcus pyogenes.

Group A streptococci produce an extracellular hyaluronidase (hyaluronate lyase) which may be associated with the spread of the organism during infection. The gene for this hyaluronidase (hylA) encodes an 868 amino acid protein with a molecular size of 99636 Da. Cleavage of the proposed signal peptide results in an extracellular protein of 95941 Da. Comparison with other bacterial hyaluronidases indicates strong similarities to the genes from Streptococcus pneumoniae, Streptococcus agalactiae and Staphylococcus aureus. A region internal to the hylA gene was amplified from all 175 strains of Streptococcus pyogenes tested suggesting a widespread distribution of the gene.

DNA, Bacterial↗
PubMed2000

Laparoscopic appendicectomy: safe and useful for training.

Debate exists about the benefits of laparoscopic appendicectomy when compared to a conventional open procedure. The majority of appendices are removed by the open route in the UK. We report a series of 132 cases of suspected appendicitis managed laparoscopically: 112 (85%) of the patients had acute appendicitis, the remaining 20 (15%) had non-appendiceal pathology. The median operative time was 30 min and there were no conversions to an open operative procedure. The median postoperative stay was two days. Complications were seen in two patients. The published evidence comparing laparoscopic and open appendicectomy is contradictory. Our series shows that laparoscopic appendicectomy is a safe procedure with low morbidity; it is also an excellent training tool in laparoscopic technique and, with sufficient experience, takes no longer than an open procedure. Negative appendicocecotomies are most common in women of fertile age and can be associated with significant morbidity; therefore, laparoscopy should be used to make the diagnosis and, if appendicitis is the cause, the appendix could safely be removed laparoscopically. However, the choice between open and laparoscopic procedure is a subjective decision for the patient and their surgeon. Laparoscopic appendicectomy cannot be regarded as the gold standard.

Acute Disease↗
PubMed1995

Phyllodes tumours of the breast: a clinicopathological review of thirty-two cases.

We have reviewed the histological features and clinical outcome in 32 women with phyllodes tumours of the breast diagnosed in Nottingham between 1975 and 1990. We assessed 23 tumours as histologically benign, four as borderline and five as malignant. After clinical follow up for periods ranging from 36 months to 221 months (median 135 months), six of 23 benign tumours have recurred locally; in all these cases the original tumours had been incompletely excised. There were no recurrences amongst 10 benign tumours in which excision had been complete. Benign tumours which recurred showed a tendency to greater stromal cellularity and more pronounced stromal overgrowth than incompletely excised lesions which did not recur, but these differences were not statistically significant. The recurrent tumours resembled the respective original lesions histologically, except in one case in which two local recurrences were histologically malignant. The recurrent tumours were controlled by further excision or mastectomy in all cases and none have metastasized. All four borderline tumours were completely excised at initial surgery and none have recurred or metastasized. One of the five malignant tumours recurred within two months of incomplete excision, with widespread infiltration of the chest wall, although the patient died of unrelated causes. The other four malignant tumours have not recurred. We conclude that presence of tumour at the margins of the excised specimen is the major determinant of local recurrence in phyllodes tumours and that the histological features are of secondary importance. These findings are discussed in relation to other published series in the literature.

Adult↗
PubMed1993

Relationship between EGF-R, c-erbB-2 protein expression and Ki67 immunostaining in breast cancer and hormone sensitivity.

The expression of the epidermal growth factor receptor (EGF-R), c-erbB-2 protein product and Ki67 have been evaluated in 105 breast cancers of known responsiveness to endocrine therapy using immunohistochemistry. EGF-R staining was observed in 62 of the tumours and was significantly associated with elevated rates of cell proliferation (%Ki67 positive cells) and loss of hormone sensitivity. In contrast, c-erbB-2 expression was not correlated with cell proliferation rates and was less strongly related to hormone insensitivity. Subdivision of the EGF-R data according to c-erbB-2 measurements revealed an association between c-erbB-2 immunostaining and worsened patient outlook and hormone insensitivity in moderately EGF-R-positive tumours. c-erbB-2 immunostaining in highly EGF-R-positive tumours did not further contribute to the already poor prognosis of these patients. These data confirm the prognostic importance of EGF-R measurements in breast cancer and may infer a functional interaction between this protein and the c-erbB-2 protein product in the aberrant growth of a subset of breast tumours.

Breast Neoplasms↗