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Biomedical subjects

I Lindsey

Publications and source records attributed to I Lindsey.

18 recordsLinked to original sources
PubMed2006

Randomized clinical trial of botulinum toxin plus glyceryl trinitrate vs. botulinum toxin alone for medically resistant chronic anal fissure: overall poor healing rates.

PURPOSE: This study was designed to assess whether addition of glyceryl trinitrate to botulinum toxin improves the healing rate of glyceryl trinitrate-resistant fissures over that achieved with botulinum toxin alone. METHODS: Patients were randomized between botulinum toxin plus glyceryl trinitrate (Group A) and botulinum toxin plus placebo paste (Group B). Patients were seen at baseline, four and eight weeks, and six months. The primary end point was fissure healing at eight weeks. Secondary end points were symptomatic relief, need for surgery, side effects, and reduction in maximum resting and squeeze pressures. RESULTS: Thirty patients were randomized. Two-thirds of patients had maximum anal resting pressures below or within the normal range at entry to the study. Healing rates in both treatment groups were disappointing. There was a nonsignificant trend to better outcomes in Group A compared with Group B in terms of fissure healing (47 vs. 27 percent), symptomatic improvement (87 vs. 67 percent), and resort to surgery (27 vs. 47 percent). CONCLUSIONS: There is some evidence to suggest that combining glyceryl trinitrate with botulinum toxin is superior to the use of botulinum toxin alone for glyceryl trinitrate-resistant anal fissure. The poor healing rate may reflect the fact that many of the patients did not have significant anal spasm at trial entry.

Adult↗
PubMed2004

Chronic anal fissure.

BACKGROUND: The treatment of chronic anal fissure has shifted in recent years from surgical to medical. METHODS: A Medline search of studies relevant to modern management of chronic anal fissure was undertaken. RESULTS: Traditional surgery that permanently weakens the internal sphincter is associated with a risk of incontinence. Medical therapies temporarily relax the internal sphincter and pose no such danger, but their limited efficacy has led to displacement rather than replacement of traditional surgery. Emerging medical therapies promise continued improvement and new sphincter-sparing surgery may render traditional surgery redundant. CONCLUSION: First-line use of medical therapy cures most chronic anal fissures cheaply and conveniently. The few non-responders can be targeted for sphincter assessment before traditional surgery. If the initial good results of new sphincter-sparing surgery are confirmed, it may be possible to avoid any risk of incontinence, while achieving high rates of fissure healing.

Anal Canal↗
PubMed2002

The role of anal ultrasound in the management of anal fistulas.

OBJECTIVE: To assess the accuracy of anal ultrasound (AUS) for anal fistulas, and the impact of routine pre-operative AUS on their surgical management. METHODS: Pre-operative AUS was performed in 38 consecutive patients with an anal fistula using a 10-MHz Brüel & Kjaer probe. All patients underwent subsequent examination under anaesthetic (EUA) with documentation of the anatomy of the fistula before the surgeon was shown the AUS results. Agreement between AUS and EUA findings and any modification to the surgical treatment was recorded. RESULTS: There was 84% agreement between AUS and EUA findings regarding presence and site of fistulas. One fistula not seen at AUS was found at EUA, and 5 fistulas seen on AUS were not demonstrated at EUA. AUS influenced the surgery undertaken in 9/24 (38%) patients; demonstrating occult sphincter defects (2 patients), reclassifying fistulas from low to higher fistulas (3 patients), deciding a surgical treatment open to doubt (2 patients) and helping identify an obscure fistula not initially found at EUA (2 patients). CONCLUSIONS: Accuracy of AUS in the assessment of anal fistulas is confirmed. Operative management is influenced in 38% of cases, usually towards more conservative treatment. We recommend the use of pre-operative AUS in the assessment of anal fistulas.

Journal Article↗
PubMed2002

Histopathology of stapled haemorrhoidectomy specimens: a cautionary note.

OBJECTIVE: Stapled haemorrhoidectomy is a new technique with encouraging early results. The aim of this study was to examine the tissue removed during stapled haemorrhoidectomy, in particular to check on the presence or absence of transitional or squamous anal canal mucosa and internal anal sphincter muscle. METHODS: Twenty-six consecutive patients undergoing stapled haemorrhoidectomy were studied. Resected tissue was examined histologically according to a standardized histological protocol. RESULTS: All 26 specimens contained columnar mucosa. Twelve specimens also contained anal transitional and stratified squamous epithelium. Two specimens contained columnar and transitional mucosa. Twenty-two of 26 specimens contained smooth muscle as well as mucosa (median maximum diameter 7.5 mm, range 2-20 mm). In 11 specimens this was circular muscle only; in 11 circular and longitudinal smooth muscle were present. In 10 specimens smooth muscle was seen to be lying beneath stratified squamous or transitional epithelium, suggesting that it was from the internal anal sphincter. CONCLUSIONS: Stapled haemorrhoidectomy results in resection of stratified squamous mucosa or part of the internal anal sphincter in a significant proportion of patients. Surgeons should be aware that this technique may result in damage to the internal anal sphincter.

Journal Article↗
PubMed2001

Impotence after mesorectal and close rectal dissection for inflammatory bowel disease.

PURPOSE: Close rectal dissection is a surgical technique used by some surgeons in inflammatory bowel disease. It is performed within the mesorectum, close to the rectal muscle wall, with the aim of minimizing damage to the pelvic sexual nerves. Other surgeons dissect in the more anatomical mesorectal plane. Our aim was to determine whether close rectal dissection is more protective of the pelvic sexual nerves than mesorectal dissection. METHOD: Patients undergoing surgery for inflammatory bowel disease were entered prospectively into a database. Male patients were mailed a standardized, validated, urologic impotence questionnaire: the International Index of Erectile Function. RESULTS: There was an 81 percent response rate. Six of 156 assessable patients were totally impotent (3.8 percent). They were all in the 50-year-old to 70-year-old age group, with no impotence in patients younger than 50 years old. Twenty-one patients complained of minor diminution of erectile function (13.5 percent), where sexual activity was still possible. There was no statistical difference in the rate of complete (2.2 percent vs. 4.5 percent, P = 0.67) or partial (13.5 percent vs. 13.3 percent, P = 0.99) impotence between close rectal and mesorectal dissection (Fisher's exact test). There were no ejaculatory difficulties. The time elapsed since surgery ranged from 2.7 months to 192.7 months, with a median of 74.5 months. CONCLUSION: Rectal excision for inflammatory bowel disease can be conducted with low rates of impotence. Minor degrees of erectile dysfunction may be more common than currently recognized. We could not demonstrate that close rectal dissection significantly protects the patient from impotence compared with operating in the anatomical mesorectal plane. Age appears to be the most important risk factor for postoperative impotence.

Adolescent↗
PubMed2001

Lessons from laparoscopic surgery-a fresh look at post-operative management after major colorectal procedures.

OBJECTIVE: Laparoscopy holds promise of exciting advances in colorectal surgery, yet the data we require to draw appropriate evidence-based conclusions on its apparent advantages are sadly lacking. In the meantime, our focus on improved recovery after major colorectal resections has changed the way we manage patients after open surgery. METHODS: A literature review was undertaken to collect published data on laparoscopic colorectal surgery. In addition, data on newer developments in open colorectal surgery were collected. RESULTS: Although there are many published data in laparoscopic colorectal surgery, very few are randomized and controlled. It is clear that, at least in the short to medium term, oncological outcomes are comparable to open surgery. There are data suggesting advantages, including less immune suppression, faster recovery with earlier feeding, less ileus, shorter length of stay and earlier return to normal activity. CONCLUSION: Unfortunately, due to study design the data are largely not comparable with open surgery data, and open surgery itself has changed to some extent recently. We must encourage recruitment of patients into current ongoing randomized controlled trials of laparoscopic and open surgery and await the results.

Journal Article↗
PubMed2000

Anatomy of Denonvilliers' fascia and pelvic nerves, impotence, and implications for the colorectal surgeon.

BACKGROUND: The development and anatomy of Denonvilliers' fascia have been controversial for many years and confusion exists about its operative appearance. Better appreciation of this poorly understood anatomy, and its significance for impotence after rectal dissection, may lead to further functional improvements in pelvic surgery. METHOD: A literature review of the embryology and anatomy of Denonvilliers' fascia and impotence after pelvic rectal surgery was undertaken. RESULTS: Denonvilliers' fascia has no macroscopically discernible layers. The so-called posterior layer refers to the fascia propria of the rectum. The incidence of erectile and ejaculatory dysfunction after rectal excision is high in older patients, and when performed for rectal cancer. There is no consensus about the relationship of Denonvilliers' fascia to the plane of anterior dissection for rectal cancer. CONCLUSION: Colorectal surgeons should focus on the important anatomy between the rectum and the prostate to improve functional outcomes after rectal excision. A classification of the available anterior dissection planes is proposed. Surgeons should be encouraged to document the plane used as well as outcome in terms of sexual function.

Autonomic Nervous System↗
PubMed1997

Preoperative screening for common bile duct stones with infusion cholangiography: review of 1000 patients.

OBJECTIVE: The authors aimed to study the safety and accuracy of infusion cholangiography in patients undergoing laparoscopic cholecystectomy. SUMMARY BACKGROUND DATA: Intravenous cholangiography is a theoretically attractive method of screening the common bile duct for stones. However, there still remain serious reservations regarding its safety and accuracy, despite some reports in the literature to the contrary. METHODS: A personal series of 1000 patients undergoing routine preoperative infusion cholangiography was reviewed. RESULTS: The cholangiograms detected bile duct stones with a sensitivity of 93.3% and a specificity of 99.3%. There were no serious contrast reactions, and the minor contrast reaction rate was 0.7%. CONCLUSIONS: The authors conclude that infusion cholangiography is indeed safe and accurate and should play a substantial role in preoperative screening for incidental common bile duct stones.

Cholangiography↗
PubMed1997

Cosmesis following complete local excision of breast cancer.

BACKGROUND: With the establishment of the safety of breast conservation in early breast cancer, cosmesis has become an increasingly important end-point of treatment. The aim of the present study was to establish a model to assess breast cosmesis after complete local excision and to assess cosmesis achieved in patients who had surgery using the seroma technique. METHODS: A total of 42 patients were retrospectively reviewed and assessed by independent clinical assessment by a surgeon, structured questionnaire and clinical photography. RESULTS: A total of 86% of patients were rated by surgeon and patient as having a good or excellent cosmetic outcome. There was a high degree of concordance between independent clinical assessment and clinical photographic analysis. CONCLUSIONS: A model has been established for the assessment of breast cosmesis; the technique of seroma formation without reconstruction of the defect results in good or excellent cosmesis in the majority of patients.

Activities of Daily Living↗
PubMed1997

Laparoscopic management of blunt diaphragmatic injury.

BACKGROUND: Diaphragmatic injury is difficult to diagnose using current radiological modalities, and missed diagnosis has been associated with a mortality of 20-36%. Laparotomy is the most sensitive of the standard diagnostic tools, but its unnecessary use can be up to 25% and carries a morbidity of 20%. METHODS: The use of the laparoscope in three cases of blunt diaphragmatic injury is reported here. Two cases were non-acute. The diagnosis of diaphragmatic injury could not be confirmed pre-operatively in any of the cases. RESULTS: One, a left-sided injury, was easily diagnosed and repaired laparoscopically. The second, right-sided, was confirmed laparoscopically but had to be repaired by open due to difficulty with liver retraction. The third case, an acute injury, was not diagnosed at laparoscopy. Findings of free blood and distended small bowel warranted laparotomy and prevented the establishment of a safe, satisfactory pneumoperitoneum. Repair was performed open. None of the cases was complicated by pneumothorax. CONCLUSIONS: Laparoscopy is a useful tool for diagnosis of non-acute blunt diaphragmatic injury but has limitations in the acute setting. Left-sided injuries can be repaired laparoscopically but right-sided injuries proved difficult and may be better dealt with thoracoscopically.

Accidents, Traffic↗
PubMed1997

Laparoscopic management of small bowel obstruction caused by a retrocaecal hernia.

Laparoscopy is not commonly used in the management of small bowel obstruction (SBO). We report the first documented case of laparoscopic diagnosis and treatment of a retrocaecal hernia, a type of internal abdominal hernia. An 86-year-old woman with a chest infection was referred with features of a well-established SBO. At laparoscopy, the hernia was quickly diagnosed and easily reduced, the bowel assessed for viability, and the sac treated by widely laying open its neck, thereby marsupializing the defect. A laparotomy was avoided, and she recovered promptly and without complication. We conclude that laparoscopy can play a useful role in the management of SBO and that its use should be considered in patients with no obvious external hernia and a virgin abdomen in whom an unusual cause is suspected.

Aged↗
PubMed1986

Diagnostic and prognostic significance of the IgM antibody to the hepatitis delta virus.

The IgM class antibody to the hepatitis delta virus (HDV) was determined in different clinical categories of hepatitis B surface antigen carriers infected by the HDV (positive in the test for total antibody to HDV). The IgM antibody was found at high titers in each of 70 patients with inflammatory liver disease and at a low titer in one of six patients with inactive cirrhosis; it was not found in eight carriers with normal liver histology. The IgM antibody persisted in high titer over many years in patients with unremitting or progressive liver disease, but declined or disappeared before the homologous IgG antibody in the patients whose disease improved or resolved. Testing for IgM antibody to HDV distinguishes hepatitis B surface antigen carriers who have underlying inflammatory HDV liver disease from those with past HDV infection and provides prognostic information on the course of chronic HDV hepatitis.

Antibodies, Viral↗