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Biomedical subjects

C Platell

Publications and source records attributed to C Platell.

At least 37 records · Page 2Linked to original sources
PubMed1999

Distal colonic neoplasms predict proximal neoplasia in average-risk, asymptomatic subjects.

Flexible sigmoidoscopy has been recommended as a screening method to reduce the incidence of colorectal cancer in asymptomatic, average-risk subjects through the early detection and removal of polyps. However, the association between distal and proximal colonic neoplasia and, hence, the requirement for colonoscopic follow up of screen-detected distal neoplasms is unclear. Our aims were: (i) to evaluate the risk of having proximal neoplasms in those with distal colonic neoplasms; and (ii) to determine whether the risk was dependent on the number, size, histology or morphology of the distal lesions. We prospectively evaluated asymptomatic subjects in a flexible sigmoidoscopy based screening programme. Those with rectosigmoid neoplasia underwent colonoscopy. The number, size, histology and morphology of the polyps were recorded. Advanced lesions were defined as adenomas > 1 cm or with a villous component or severe dysplasia, carcinoma in situ or cancer. Adenomatous polyps were found in 17% (135) of screening flexible sigmoidoscopies. At colonoscopy, up to 30% of subjects with distal colonic neoplasms had synchronous proximal lesions at colonoscopy and up to 20% had advanced proximal lesions. The risk of proximal colonic neoplasia was increased in those with distal sessile colonic neoplasms but appeared independent of distal lesion size, number or morphology. In conclusion, distal colonic neoplasia predicts proximal neoplasia in up to 30% of subjects and these were advanced lesions in up to 20%. We recommend that all subjects with biopsy proven distal colonic neoplasia undergo colonoscopy.

Adenoma↗
PubMed1999

Case report: adenocarcinoma arising in a Crohn's stricture of the jejunum.

Patients with Crohn's disease affecting the small intestine appear to have an increased risk of developing adenocarcinoma. However, it remains an uncommon complication of an uncommon disease. The diagnosis is difficult to make both pre- and intra-operatively, and is most commonly made postoperatively on histopathology. Hence, at laparotomy, consideration should be given to performing a frozen section on all small bowel strictures due to Crohn's disease to define the presence of dysplasia or cancer. This will assist the surgeon in deciding whether to perform a stricturoplasty or a resection.

Adenocarcinoma↗
PubMed1998

What is the role of mechanical bowel preparation in patients undergoing colorectal surgery?

BACKGROUND: Most surgeons use mechanical bowel preparation before performing operations on the colon and rectum. The aim of this study is to determine if there is any published literature that supports this practice. METHODS: We undertook a review of the literature on the benefits of mechanical bowel preparation in patients undergoing surgery on the colon and rectum. A meta-analysis was conducted on all available clinical trials addressing this issue. RESULTS: A meta-analysis of three clinical trials revealed a significantly greater incidence of wound infection in patients who received a mechanical bowel preparation (10.8 vs. 7.4 percent; P < 0.002; 95 percent confidence interval of the difference, -1.6-8.4 percent). Patients who received mechanical bowel preparation had an incidence of anastomotic leakage that was twice that of control patients; however, this difference was not significant (8.1 vs. 4 percent; P < 0. 1 14; 95 percent confidence interval of the difference, -0.4-8.4 percent). CONCLUSION: There is limited evidence in the literature to support the use of mechanical bowel preparation in patients undergoing colorectal surgery. Hence, there is a need for clinical trials comparing the more traditional, aggressive forms of bowel preparation (e.g., polyethylene glycol solutions, sodium phosphate) with either no preparation or simpler techniques, such as a single phosphate enema.

Colon↗
PubMed1998

Influence of cardiopulmonary bypass surgery on cancer-specific survival rate of patients with colorectal cancer.

PURPOSE: There is evidence of a relationship between inflammation and cancer growth and spread. Cardiopulmonary bypass surgery is known to induce a systemic inflammatory response. The aim of this study was to determine whether cardiopulmonary bypass surgery influences the cancer-specific survival rate in patients with colorectal cancer. METHODS: The Fremantle Hospital database on patients with colorectal cancer (477 patients) was linked to the Western Australian Hospital Morbidity Database System. Patients who had colorectal cancer after having undergone cardiopulmonary bypass surgery (n = 7) were identified. The cancer-specific survival rate for these patients was compared with that for a group of controls derived from the hospital database. Controls were matched for age, gender, tumor location, tumor stage, operative procedure, and adjuvant therapy (n = 26). RESULTS: The cancer-specific survival rate of the seven patients with colorectal cancer who had undergone cardiopulmonary bypass surgery was significantly lower than that for control patients (5-year survival rate, 34 vs. 71 percent, respectively; P < 0.05; hazard ratio, 2.9; 95 percent confidence interval, 1.5-4.4). Of the two patients in the study group who survived for 18 months, one had liver metastases and the other had local recurrence of a rectal cancer. CONCLUSION: In patients with colorectal cancer, having undergone cardiopulmonary bypass surgery was associated with a reduced cancer-specific survival rate. Additional studies are required to validate this association and explore the possibility of a causal relationship.

Aged↗
PubMed1998

The pathobiology of peritonitis.

The peritoneum is more than a mechanical covering that allows for the easy gliding of opposed peritoneal surfaces. The peritoneal mesothelial cells facilitate the action of powerful innate immune mechanisms. In addition, the peritoneal-associated lymphoid tissues contain unique cells that may play a crucial role in the localization of intraperitoneal infection. A clearer understanding of the molecular and cellular events underlying peritoneal functions in both the unstimulated and stimulated state will aid future treatment of peritonitis.

Humans↗
PubMed1998

Surgery on trial: an account of clinical trials evaluating operations.

BACKGROUND: The objective of this study was to review published clinical trials to determine the level of compliance with issues relevant to operations. METHODS: We evaluated 10 methodologic criteria in 186 trials that were published in 10 prestigious journals between January 1986 and December 1995. RESULTS: One quarter of the trials failed to provide a clear account of the operative technique, 34% of the trials did not adequately detail the adverse events that occurred after operation, and 40% of the trials neglected to declare the nature and success of the follow-up of patients after the operation. Only 35% of the trials indicated that there was an attempt to standardize either the surgical procedure or perioperative care. In addition, less than 20% of the trials declared a method for assessing compliance with the surgical protocol or commented on the use of resources during the perioperative period. CONCLUSIONS: Greater attention needs to be paid to the specific issues that arise when operations are evaluated in clinical trials.

Authorship↗
PubMed1997

A community-based hospital experience with colorectal cancer.

BACKGROUND: Survival figures for patients with colorectal cancer are often based on data from tertiary referral centres for colorectal surgery. The relevance of such data to community-based hospitals is questionable. The aim of the present study was to determine the long-term survival in patients presenting with colorectal cancer to a large community-based teaching hospital. METHODS: A search was conducted on the hospital computerized database to determine those patients who were admitted with a diagnosis of colorectal cancer between 1989 and 1994. These records were linked to the Deaths Registry to determine long-term survival. RESULTS: A total of 477 patients were managed at Fremantle Hospital over the 5-year period. Nearly half of these patients (47.6%) presented via the hospital emergency centre. At diagnosis, 57.8% of patients had advanced cancers with either nodal or distant metastases. Surgery was undertaken on 455 patients, with a postoperative mortality of 4.5%. The corrected 5-year survival rate for patients undergoing curative resections (i.e. complete local excision and no evidence of metastases) was 62.9% for colon cancers and 48.2% for rectal cancers. Local recurrence developed in 21.4% of patients with rectal cancers. CONCLUSIONS: A majority of patients with colorectal cancers are continuing to present with advanced disease. Earlier diagnosis of these cancers through community-based screening programmes could well serve as an achievable solution to this problem.

Adult↗
PubMed1997

The role of wound infection as a clinical indicator after colorectal surgery.

The objective of this study was to evaluate the role of wound infection as a clinical indicator after colorectal surgery. We assessed 553 patients who were entered into clinical trials at Royal Perth Hospital. In the clinical trials, the incidence of wound infection after colorectal surgery was 12%, however, this rose to 20% for patients over 60 years of age and with an American Society of Anaesthesia score of greater than 2. One-third of these infections occurred following discharge from hospital. We found that the incidence of wound infection following colorectal surgery was dependent upon patient characteristics, and many infections occurred after discharge from hospital. Collecting this data accurately is time consuming and expensive. Therefore, for this reason alone, wound infection may not be an appropriate clinical indicator for patients undergoing colorectal surgery.

Age Factors↗
PubMed1996

Anal pathology in patients with Crohn's disease.

BACKGROUND: A distinctive feature of patients suffering from Crohn's disease is a predisposition to develop a variety of anal complications. The aetiology of such conditions is unclear, and the reported incidence of anal involvement in Crohn's disease varies party due to the various criteria used for classification. This study aims to review the management of patients with symptomatic anal pathology associated with Crohn's disease at St Vincent's Hospital, Melbourne. METHODS: A database of 306 patients with Crohn's disease referred to the department between January 1978 and October 1994 was reviewed to identify those patients with symptomatic anal disease. The anal pathology was recorded and classified. Demographic data and the clinical and surgery history of the patient were recorded. RESULTS: Of the 306 patients with Crohn's disease, 129 (42.4%) were identified as having symptomatic anal pathology. Patients were likely to present with anal symptoms after they had been diagnosed as having intestinal Crohn's disease (46.1%). The commonest presentations were perianal abscess (29.5%), anal fissure (27.6%), and low anal fistula (26.7%). A minority of patients presented with high/complex anal fistulae (3.8%), or recto-vaginal fistulae (5.2%). Five per cent of patients had Crohn's disease localized to the anal area. The pattern of intestinal disease in the remaining patients was small bowel 21.1%. small bowel and colon 31.9%, and colon 43.0%. A total of 244 local anal and surgical procedures were performed on these patients; the commonest of these were drainage of an abscess (38.5%), examination under anaesthetic (29.1%), and laying open of a low anal fistula (22.5%). Following surgical treatment, the recurrence rate for perianal abscesses was 13%, and for low anal fistulae 6%. CONCLUSIONS: The majority of patients with Crohn's disease who develop anal pathology have an excellent prognosis. A minority of patients develop complex anal complex anal fistulae and these remain a therapeutic challenge.

Adult↗
PubMed1996

A long-term follow-up of patients undergoing colectomy for chronic idiopathic constipation.

BACKGROUND: Chronic idiopathic constipation is a condition that mainly affects young women and is commonly associated with symptoms of abdominal pain and bloating. It has been proposed that patients with severe symptoms who are unresponsive to conservative measures can be managed by colonic resection. The aim of the present study was to assess the long-term outcome of such surgery on patients with a diagnosis of chronic idiopathic constipation. METHODS: Ninety-six patients (92 females, 4 males) underwent either a total colectomy and ileorectal anastomosis (n = 86) or subtotal colectomy and caecorectal anastomosis (n = 10) between 1986 and 1994. RESULTS: Postoperative mortality was 2.1%, 3.1% suffered from an anastomotic leak and 11.5% developed a pelvic abscess. Follow up was completed in 92.7% of patients at a mean of 5.0 +/- 2.3 years. Following surgery, symptomatic improvement was reported by 81.6% of patients. However, 51.2% still experienced difficulty with straining, 50.6% had some degree of anal incontinence, 55.2% continued to experience abdominal pains and 75.9% continued to be troubled by abdominal bloating. Reoperation was performed on 35.6% of patients (mainly for division of adhesions), and 9.2% of patients required an ileostomy. CONCLUSIONS: Colectomy is associated with relief of constipation in a majority of patients with chronic idiopathic constipation. However, it is associated with a considerable morbidity and is less effective in resolving symptoms of abdominal pain and bloating.

Adolescent↗
PubMed1995

Crohn's disease: a colon and rectal department experience.

This study reviewed a series of patients with Crohn's disease managed by surgeons of the Department of Colon and Rectal Surgery, St Vincent's Hospital, Melbourne, since 1978. There were 306 patients: 171 males and 135 females. The mean age at diagnosis was 33.4 years (ranger 11-93). The distribution of the disease was small bowel 32.3%, small bowel and colon 26.5%, colon 39.9%, and anal disease alone 1.6%. A total of 416 abdominal operations were performed on 204 patients. The commonest indications for surgery were failed medical therapy (21.9%), small bowel obstruction (15.9%), enteric fistula (10.1%), and intra-abdominal abscess (10.1%). The most frequently performed procedures were ileocolic resection with anastomosis (28.8%), small bowel resection (9.4%), and total colectomy and ileostomy (7.0%). Postoperative complications included anastomotic leaks in 4.0%, intra-abdominal abscess formation in 3.6%, and enterocutaneous fistulae developed in 6%. Three patients died during the review period. During follow up (mean 84.4), 30% of patients developed recurrence requiring further surgery at a mean of 72.7 months postoperatively. The most frequent site for a recurrence was the pre-anastomotic terminal ileum (61.7%). In conclusion, the majority of patients with Crohn's disease will require resectional surgery at some stage. This can be performed with a low mortality and morbidity, and a recurrence rate of around 5% per year.

Adolescent↗
PubMed1991

The influence of branched chain amino acids on colonic atrophy and anastomotic strength in the rat.

Conventional solutions of parenteral nutrients fail to reverse the colonic atrophy caused by starvation. This may be due to the absence from these solutions of the amino acid glutamine--a fuel for rapidly dividing cells such as colonocytes and fibroblasts. Although glutamine is unstable in solution, the infusion of branched chain amino acids (BCAA) increases the rate of synthesis and release of glutamine from skeletal muscle. We evaluated the hypothesis that the infusion of BCAA into undernourished rats would reduce the extent of mucosal atrophy and enhance the healing of anastomoses in the colon. Undernourished rats were randomized to receive 6 days of either a normal diet (Chow), conventional parenteral nutrition (CPN), or CPN supplemented with 1.8% BCAA (BCAA). The BCAA group had a higher plasma glutamine concentration than the Chow group (P less than 0.05). Compared with the CPN group, the BCAA group had the greater colonic mucosal weight (P less than 0.05) and colonic mucosal protein content (P less than 0.05), but there were no significant differences between groups in the bursting wall tension of the colon or the hydroxyproline content of the anastomoses. Although the infusion of BCAA has a beneficial effect on colonic atrophy, this did not result in the more secure healing of colonic anastomoses in this experimental model.

Amino Acids↗
PubMed1991

Cholangiocarcinoma in a type III choledochal cyst.

We present the case of an 85 year old woman who was found to have a type III choledochal cyst with cholangiocarcinoma. The case is unusual because of the advanced age of the patient, the presence of both stones and a carcinoma in a type III cyst, and the associated congenital abnormalities.

Adenocarcinoma↗
PubMed1990

Impaired renal function due to raised intraabdominal pressure.

A 19-year-old male developed renal failure after a laparotomy for liver trauma (urinary output of 30 ml/h, plasma creatinine 220 mumol/l). Surgical decompression of the abdomen was performed without any attempt at correcting the underlying pathology. This reduced the intraabdominal pressure (IAP) from 40 to 24 cm H2O and resulted in a massive diuresis (530 ml/h). Twenty-four hours later the plasma creatinine peaked at 280 mumol/l and then returned to within the normal range. This case report confirms that there is a direct relationship between IAP and renal function.

Acute Kidney Injury↗
PubMed1990

Influence of branched chain amino acid infusions on wound healing.

Branched chain amino acids (BCAA) may serve as a major oxidative fuel for skeletal muscle during periods of starvation. This study compared the ability of protein-undernourished rats to heal musculo-aponeurotic wounds of the abdominal wall when they were infused with solutions containing 45% BCAA or 8% BCAA (conventional TPN). Although the provision of 45% BCAA tended to result in better nourished animals and significantly increased plasma glutamine concentrations, this was not associated with improved healing.

Amino Acids, Branched-Chain↗
PubMed1990

Juvenile polyposis: a premalignant condition?

This is the case report of a 20 year old man with juvenile polyposis who developed adenocarcinoma of the duodenum. Patients with juvenile polyposis and their families have an increased risk of developing gastrointestinal malignancies. Such patients require endoscopic monitoring.

Adenocarcinoma↗