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Biomedical subjects

I Khubchandani

Publications and source records attributed to I Khubchandani.

6 recordsLinked to original sources
PubMed1999

Colorectal cancer after surveillance colonoscopy: false-negative examination or fast growth?

PURPOSE: Colonoscopy is the preferred method for colorectal cancer surveillance of high-risk patients. Despite its high sensitivity, polyps or cancers may be undetected by colonoscopy and later attributed to an accelerated adenoma-carcinoma sequence. This study assesses how the characteristics of colorectal cancers found at intervals between surveillance relate to the adenoma-carcinoma sequence and its prevention. METHODS: The records of 557 patients with colorectal cancer that were diagnosed from January 1, 1990, to December 31, 1996, were reviewed to identify those patients who had prior colonoscopic surveillance within 60 months of their diagnosis. RESULTS: There were 29 (5.2 percent) patients who had one or more colonoscopies before diagnosis of their colorectal cancer. Mean interval between diagnosis and prior colonoscopy was 23 (range, 4-59) months. The distribution of cancers included nine cecum, two ascending, three hepatic flexure, five transverse, one splenic flexure, three descending, two sigmoid, three rectum, and one anal canal. The mean tumor size was 4.4 cm for the cecum and 2.4 cm for all other locations. There were 7 Tis, 6 T1, 4 T2, and 12 T3 lesions. Six patients with T3 lesions had prior colonoscopies within 24 months of the diagnosis. Three of four patients with lymphatic metastases had tumors in the cecum. Twenty tumors (69 percent) were well or moderately differentiated. Mean follow-up was 41 (range, 7-95) months with two local recurrences and two unrelated deaths. CONCLUSIONS: Size, differentiation, and stage of colorectal cancer in addition to the interval to diagnosis suggest that the majority of cancers found during surveillance colonoscopy followed prior false-negative examinations. Because cecal landmarks are most constant, prior photographic documentation may help to prove or disprove fast growth of cancers found in the cecum during surveillance colonoscopy.

Aged↗
PubMed1986

Nephrocolic fistula.

A patient with nephrocolic fistula secondary to perinephric abscess was treated successfully with nephrectomy, colonic resection, and colocolostomy.

Abscess↗
PubMed1986

Management of anorectal horseshoe abscess and fistula.

Over a 10-year period 69 patients were treated consecutively for posterior and anterior horseshoe abscesses and fistulas. Fifty-nine patients had posterior and ten had anterior abscesses or fistulas. There were 52 patients with acute abscess. Treatment consisted of incision and drainage, incision and drainage with primary fistulotomy, incision and drainage with primary fistulotomy and counter-drainage, and incision and drainage with insertion of seton. Seventeen patients with chronic fistulas were treated by primary fistulotomy with curettage, or incision and drainage with insertion of seton. Patients were followed from three months to ten years with a mean follow-up of three years. No incidences of incontinence were reported in this series. The overall rate of recurrence was 18 percent, and included only patients with posterior abscesses and fistulas. Recurrence was related to the failure to maintain prolonged drainage in the midline after primary fistulotomy. The use of seton for delayed fistulotomy appears to promote wound drainage and precludes premature wound closure. More liberal use of the seton in the treatment of horseshoe abscesses and fistulas is advocated.

Abscess↗
PubMed1986

Rationale for medical or surgical therapy in anal incontinence.

Seventy patients with anal incontinence referred to a colorectal service over a two-year period were evaluated and treated. In each case, a comprehensive history and physical examination as well as anal manometry were performed. Anorectal angle measurement was done when indicated. Patients were separated into groups of the four major causes of incontinence: 1) external/internal sphincter dysfunction, 2) puborectalis and anorectal angle, 3) alterations in rectal compliance, and 4) sensory deficits. Treatment was dictated by categorization of the patients. All patients were followed for a minimum of one year and, with the exception of patients with profound sensory loss, each believed that their symptoms had decreased substantially, enabling them to return to normal occupational and social activities.

Anal Canal↗