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J Milsom

Publications and source records attributed to J Milsom.

9 recordsLinked to original sources
PubMed1997

The risk of cancer and dysplasia among ulcerative colitis patients with primary sclerosing cholangitis.

BACKGROUND: Ulcerative colitis (UC) patients with primary sclerosing cholangitis (PSC) may have an increased risk for colonic dysplasia or cancer. They also may have higher levels of carcinogenic secondary bile acids and, thus, be more likely to develop cancer in the right side of the colon, where secondary bile acid concentrations are highest. METHODS: Since 1983, 1212 UC patients have undergone total proctocolectomy with ileal pouch-anal anastomosis at the Cleveland Clinic. All 27 patients with PSC were compared with the remaining 1185 patients in a historical cohort study. RESULTS: Dysplasia detected during cancer surveillance was the indication for surgery in 16 (59.5%) PSC patients and 136 (11.5%) controls [adjusted relative risk (RR), 6.9; 95% confidence interval (CI), 3.0-16.0]. Dysplasia or cancer was found in the resected specimen in 18 (66.7%) PSC patients and 145 (12.2%) controls (RR 10.4, CI 4.1-26.1). Right-sided cancers (proximal to the splenic flexure) were found in all four PSC patients with cancer and in 20 of 49 controls with cancer (RR 2.5, CI 1.3-5.4). CONCLUSIONS: UC patients with PSC are at a significantly increased risk for dysplasia or cancer. The high proportion of right-sided cancers supports the contention that secondary bile acids are carcinogenic and increase the likelihood of cancer in the proximal colon.

Adolescent↗
PubMed1996

Quality of life after prophylactic colectomy and ileorectal anastomosis in patients with familial adenomatous polyposis.

BACKGROUND: Prophylactic colectomy or proctocolectomy is standard treatment for colorectal manifestation of familial adenomatous polyposis (FAP), a dominantly inherited disorder for which the risk of developing colorectal cancer in an untreated patient is close to 100 percent. Hereditary nonpolyposis colorectal cancer (HNPCC) is also dominantly inherited but has a lower risk of colorectal cancer than FAP and does not have a clinically obvious phenotype. The role of prophylactic colectomy in patients with HNPCC is controversial. PURPOSE: This study was performed to examine the outcome of colectomy and ileorectal anastomosis (IRA) so its use as a prophylactic procedure can be better evaluated. METHODS: Records of all patients undergoing IRA for FAP between 1985 and 1993 were reviewed. Demographic data and data about the operation were collected. Surgical outcome data included length of hospital stay, complications, bowel function, quality of life, and patient satisfaction. RESULTS: There were 51 patients with a median age of 28 years; 24 were male. All but eight patients were asymptomatic, and all had less than 1,000 polyps in the resected specimen. Mean surgery time was 3.5 hours, mean blood loss was 406 ml, and median length of hospital stay was seven days. There were no deaths, and eight patients (16 percent) had complications. Mean number of stools per day after median follow-up of 4.2 years was 3.6. Only 11 patients had nighttime stooling. Four patients reported seepage, 9 had some incontinence, and 16 had urgency. Quality of life, rated on a scale of 0 to 10, was 7 or above in 44 of 48 assessed patients. Quality of health was rated 7 or higher in all 48 patients, energy level was 7 or higher in 39 patients, and overall happiness with surgery was 7 or higher in 47 patients. CONCLUSIONS: Colectomy and IRA is a relatively safe operation that results in minimum disturbance of bowel function. Patient satisfaction is usually high. Prophylactic colectomy can be offered to HNPCC gene carriers with a greater understanding of the likely outcome of surgery.

Adenomatous Polyposis Coli↗
PubMed1996

Clostridium difficile colitis in the critically ill.

UNLABELLED: Morbidity and treatment of Clostridium difficile colitis (CDC) continue to be controversial. Some claim minimum morbidity, which may be a function of differences in patient population and/or bacterial virulence. METHODS: To evaluate the effect of CDC in the critically ill, we retrospectively reviewed the records of 59 intensive care unit patients with CDC who were diagnosed by fecal toxin assays or clinical evidence of pseudomembranous colitis from January 1991 to October 1994. Symptoms, signs, antibiotic regimens, diagnostic tests, Acute Physiology and Chronic Health Evaluation II (APACHE II) scores, morbidity, and mortality were analyzed, and results of surgical treatment were compared with the literature. RESULTS: Mean age was 66.4 (17-95) years, with a male to female ratio of 1.8:1. First treatment was metronidazole by mouth in 15 patients (25.4 percent), vancomycin by mouth in 30 patients (50.8 percent), sequential by mouth vancomycin/metronidazole in 3 patients (5.1 percent), and intravenous metronidazole in 5 patients (8.5 percent). Six patients had no medical therapy before surgery or discharge. Ten patients (17 percent) had recurrence and 12 (20.3 percent) required surgery for progressive toxicity or peritonitis. Of three patients who were initially treated by diverting stomas, one died and two required total colectomy (TAC). Two underwent partial resection (1 that was nearly a total colectomy), and seven others had a TAC. Surgical patients had worse mean APACHE II scores at diagnosis (24.4 vs. 19.9; P < 0.001). Thirty-day mortality in surgical patients was 41.7 vs. 14.7 percent in medical patients (P < 0.5). CONCLUSION: Twenty percent of critically ill patients with CDC required operation. TAC and diversion appeared to be more effective surgical treatments than diversion alone.

APACHE↗
PubMed1991

Manometric and functional comparison of ileal pouch anal anastomosis with and without anal manipulation.

We report the results of postoperative physiologic and functional evaluation of 153 patients with ileal pouch anal-anastomosis (IPAA). Ninety-nine patients had anal manipulation for either mucosal proctectomy, transanal placement pursestring suture with stapled IPAA, or handsewn IPAA (manipulation). Fifty-four patients had stapled IPAA with anal pursestrings placed transabdominally without mucosectomy (no manipulation). Patients with transabdominal anal pursestring placement and stapled IPAA without mucosectomy had a higher mean maximum anal resting pressure than patients who had endoanal manipulation. This correlates with improved continence and a reduced need to wear a pad. Avoidance of anal manipulation preserves anal canal resting tone and improves the functional result after IPAA.

Adult↗
PubMed1985

Triplication of the esophagus with gastric duplication.

A 2 1/2-year-old girl was seen with an upper abdominal mass. Evaluation by abdominal ultrasonography, esophagography, upper gastrointestinal series, and computerized axial tomography suggested the possibility of duplication of the esophagus, stomach, and duodenum. Surgery revealed a triplication of the esophagus with a gastric duplication, which was resected. The patient recovered and greatly increased her weight-for-age percentile. Of the theories proposed to explain gastrointestinal duplications, the split notochord hypothesis most closely fits this patient's anomalies. It is unusual for a patient with a gastrointestinal duplication to develop symptoms after the first year of life. This is the first report of a triplication of the esophagus with a gastric duplication.

Abnormalities, Multiple↗
PubMedDate not supplied

Endoscopic ultrasound in the pre-operative staging of rectal carcinoma.

Endoscopic ultrasound (EUS) was performed prospectively to stage 45 patients with rectal cancer. Patients were staged utilizing the TNM staging system. All patients subsequently underwent surgical resection with independent histopathologic staging. Depth of invasion was accurately predicted in 40 of 45 patients (89%). Presence or absence of lymph node metastasis was correctly determined in 34 of 45 patients (79%). EUS is an accurate method for local staging of rectal cancer.

Carcinoma↗