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Biomedical subjects

J Hobbiss

Publications and source records attributed to J Hobbiss.

5 recordsLinked to original sources
PubMed2005

Is it possible to predict or prevent third degree tears?

OBJECTIVES: This paper reviews the causes anal sphincter injury during vaginal delivery. It emphasises that they are not usually the result of poor obstetric care. The role of the colorectal surgeon in their management is discussed. METHODS: Medline was searched using the key words third degree tears, pregnancy, risk factors, prevention and recurrence risk. A hand search of journals and located articles was made. Two hundred and twenty three papers were identified, 84 are referenced. RESULTS: The reported incidence of anal sphincter tears is usually between 0.5% and 2.5% of vaginal deliveries. Maternal factors such as parity and age and obstetric factors such as mode of presentation, the use of forceps and the size of the baby all influence the incidence of sphincter tears. Predicting tears in individual women is inaccurate and midwifery practices can do little to prevent them. Reducing pelvic floor morbidity by increasing the caesarean section rate would require that a large number of caesarean sections be done to prevent a small number of tears. The recognition of perineal trauma is improved by training. Accurate apposition of the sphincters with antibiotic cover and post-operative laxatives are the important technical aspects of the repair. Colorectal follow up helps to identify those women with symptoms and allows advice about the advisability of subsequent vaginal deliveries. A previous third degree tears increases the risk of a subsequent one, although the overall risk remains low. A second vaginal delivery after a third degree tear that has resulted in a functional deficit predisposes to worsening function. When there is no residual anatomical defect and no functional loss, there is no evidence of increased risk of incontinence following another vaginal delivery. CONCLUSION: Vaginal delivery will continue to be the main method of delivery and will continue to generate a low incidence of pelvic floor morbidity. The management of injury to the anal sphincter is facilitated by close co-operation between obstetricians and colorectal surgeons.

Delivery, Obstetric↗
PubMed1993

Pelvic ileo-anal reservoirs: a lectin histochemical study.

Pelvic ileo-anal reservoir (ileal pouch) formation is now a common surgical approach to the management of long-standing inflammatory bowel disease. The ileal mucosa in this new environment responds with changes in morphology and histochemical reactivity, as shown by conventional techniques. In this study, pre-pouch ileum and pouch ileal mucosa from 20 patients have been examined with a large panel of lectins using an avidin-biotin-peroxidase technique, with appropriate negative controls and sugar-inhibition studies. Changes were noted between pre-pouch ileum and the pouch mucosa which were complex, and no single alteration was seen in every case. Most variations related to saccharide sequences near the non-reducing termini of O- and N-linked glycans. Many of these were seen with lectins having requirements for terminal fucosyl residues, and to a lesser extent for galactosyl sequences, and were most obvious in the epithelium. Some of the changes occurred with such frequency as to suggest a direct response to surgery, but many of the variations were likely to be adaptive responses, possibly related to inflammation or infection. The changes in glycans were largely additive and could not be explained as a consequence of the actions of bacterial glycosidases. These alterations suggest that reservoir mucosa undergoes an adaptive response to the new intraluminal environment, without frank colonic metaplasia, and some changes occur to a greater degree in patients with pouchitis.

Adult↗
PubMed1984

Pneumatosis coli: a case report with ultrastructural study.

A case of pneumatosis intestinalis studied by light and electron microscopy is presented. The cysts are dilated lymphatic vessels. Abundant fine fatty globules are found in the cysts and in the histiocytes and multinucleated giant cells which line the lymphatics and which are present in the interstitium. The giant cell formation and florid histiocytic reaction are most probably due to leakage of fatty material from the dilated lymphatics.

Aged↗
PubMed1983

Limitations of immune complex measurements in colorectal disease.

Three techniques (Clq, Raji and L1210 binding assays) alleged to measure circulating immune complexes (ICs) were applied to the sera of 101 patients with colorectal disease (54 carcinoma; 23 inflammatory; 13 benign tumour and 11 miscellaneous) at the time of diagnostic or definitive surgery, and 58 healthy adult controls. Elevated levels in the pathological sera were observed by all 3 methods in order of sensitivity: Raji greater than Clq greater than L1210. However, none of them differentiated between benign, inflammatory and neoplastic conditions nor, in the case of colorectal carcinoma, was there any correlation with stage of disease. With the exception of Raji v. L1210 (r = 0.43, P less than 0.001), correlations between the various assays were poor and levels of serum carcinoembryonic antigen (CEA) did not correlate with ICs measured by any of the techniques. Indeed, the IC assays were even less discriminatory than CEA, which was elevated mainly in the serum of carcinoma patients and which was positively correlated with serum gamma-glutamyl transpeptidase (gamma GT) (r = 0.42, P less than 0.005). The data suggest that the lack of concordance between the IC assays is a reflection of heterogeneity among ICs, interfering factors present in pathological sera, or both. Thus the IC assays deployed here have neither diagnostic nor prognostic utility in colorectal disease at this time, and immunochemical characterization of the serum reactive material detected by the different assays is required.

Adult↗