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Biomedical subjects

J Virjee

Publications and source records attributed to J Virjee.

36 records · Page 2Linked to original sources
PubMed1988

An analysis of rectal morphology in obstructed defaecation.

Obstructed defaecation in the descending perineum syndrome has been attributed to anterior mucosal prolapse. Manometric and radiological measurements together with evacuation proctograms in 49 patients with obstructed defaecation and normal whole gut transit times were carried out and compared in a total of 25 controls. Proctography delineated four groups: (I) puborectalis accentuation, n = 11; (II) rectal intussusception, n = 25; (III) anterior rectal wall prolapse, n = 11; (IV) rectocele, n = 2. The anorectal angle at rest, maximum basal sphincter pressures and the rectoanal inhibitory reflex did not differ between the groups and controls. Group III achieved a greater increase in anorectal angle on straining than controls. Groups II and III exhibited significant perineal descent below the pubococcygeal line whereas group I did not. In perineal descent intussusception was the commonest morphological abnormality associated with obstructed defaecation. Isolated anterior mucosal prolapse was not observed, making local treatment aimed at reducing its bulk questionable.

Adult↗
PubMed1988

Barium enemas are a headache.

The frequency of headache after Picolax (sodium picosulphate, Nordic Ltd) preparation for barium enema was investigated and its association with dehydration, as assessed by haemoconcentration, was determined. Eleven out of 41 patients (26.8%) complained specifically of headaches. Although patients with and without headaches developed significant increases in haemoglobin concentration after Picolax preparation, the rise in haemoglobin in those with headaches was significantly greater than in those without (P less than 0.05). In both groups the haemoglobin concentration returned to normal after a bowel washout. These results suggest an association between dehydration and headache developing after a Picolax regimen. It may be possible to prevent this symptom by advising on the intake of specific volumes of fluid during preparation for barium enema.

Adult↗
PubMed1987

Preoperative staging of local invasion in rectal cancer using endoluminal ultrasound.

Digital examination is the most commonly used method of assessing local invasion in rectal cancer, but it is highly subjective and accuracy is related to surgical experience. The use of transrectal ultrasound in the preoperative staging of rectal cancer has been assessed in 51 patients with histologically proven rectal cancers. Results showed a high degree of correlation when compared with postoperative histopathology (r = 0.91, P less than 0.001). Invasion beyond the muscularis propria was predicted with a sensitivity of 97%, specificity of 92% and predictive value of 97%.

Carcinoma↗
PubMed1986

Flap-valve theory of anorectal continence.

The most important component of continence is considered to be the puborectalis muscle which is reputed to function by creating a flap-valve mechanism in which the anterior rectal wall occludes the upper and canal. To elucidate this, anal and rectal pressures were measured simultaneously together with external anal sphincter and puborectalis electromyogram and synchronously superimposed on an image intensifier displaying the rectum outlined by barium. We studied 13 subjects at rest, and during a Valsalva manoeuvre. There was a significant rise in rectal and sphincter pressures (P less than 0.005) and external sphincter and puborectalis EMG (P less than 0.005). In a further 13 patients Valsalva manoeuvres were performed during proctography alone. In all subjects the anterior rectal wall was always clearly separated from the upper sphincter despite a maximal effort and a rectum filled with sufficient liquid to produce a desire to defaecate. These findings question the flap-valve theory of continence and suggest the puborectalis functions by sphincteric occlusion of the anal canal.

Adult↗
PubMed1986

Pre-operative assessment of local invasion in rectal cancer: digital examination, endoluminal sonography or computed tomography?

Forty-four patients with primary rectal cancers and six patients with benign rectal lesions were examined pre-operatively digitally, with endorectal sonography (ELU) and also computed tomography (CT). Digital examination of the rectal cancers had an overall accuracy of 68 per cent and predicted invasion beyond the muscularis propria with a sensitivity of 68 per cent, specificity of 83 per cent, positive predictive value of 100 per cent and negative predictive value of 46 per cent. In comparison CT had an accuracy of 82 per cent, sensitivity of 86 per cent, specificity of 62 per cent, positive predictive value of 91 per cent and negative predictive value of 50 per cent. ELU was the most reliable indicator of local invasion in rectal cancer when compared with postoperative histopathology with an accuracy of 91 per cent, sensitivity of 94 per cent, specificity of 87 per cent, positive predictive value of 97 per cent and negative predictive value of 78 per cent.

Aged↗
PubMed1986

Endorectal sonography: laboratory and clinical experience in Bristol.

The normal echographic pattern produced by the colon and rectum has been investigated in vitro. Five basic ultrasonic layers or interfaces have clearly been identified; a first echogenic layer produced by the mucosa, then an echopoor layer representing the mucosa and muscularis mucosae, an echogenic layer which was submucosa, echopoor layer which was muscularis propria and an echogenic layer which was either pararectal fat or serosa. The effectiveness of endoluminal ultrasound (ELU) in the pre-operative staging of rectal cancer has been assessed in a group of 67 patients who were also, where possible, graded by digital examination and in some cases computer aided tomography (CT) (33 patients). Digital examination had an overall accuracy of 50% and could predict invasion beyond or confinement to the rectal with an accuracy of 64%. ELU is a highly accurate method for staging local invasion and when compared to post-operative histopathology had an overall correlation coefficient of 0.88 (p less than 0.001) (Rank Spearman). Our overall accuracy was 91% and it could predict invasion beyond the muscularis propria with a sensitivity of 96%, specificity of 94% and positive predictive value of 98%. In the cohort studied by both radiological techniques ELU was more accurate than CT where overall accuracy was 79%, sensitivity was 84%, specificity was 63% and the positive predictive value was 88%.

Humans↗
PubMed1986

The endosonic appearances of normal colon and rectum.

With the increasing use of transrectal sonography, accurate preoperative staging of rectal cancer requires correct identification of the normal ultrasonographic appearances of the colon and rectum. Fifteen rectal and colonic specimens have been studied in vitro to define the normal anatomy. Five distinct ultrasonic layers have been identified; a first echogenic layer that corresponds to the mucosa, a second echopoor layer made up of mucosa and muscularis mucosae, a third echogenic layer that is submucosa, a fourth echopoor layer that is muscularis propria, and a fifth echogenic layer made up of serosa and perirectal fat.

Colon↗
PubMed1986

Audit on the use of the barium enema.

All 1358 referrals for barium enemas at Bristol Royal Infirmary in 1981 were studied. The overall diagnostic yield for colonic or distal ileal pathology was 33% with 75 (5.5%) cancers detected. General practitioner requested enemas constituted 25.8% of the total undertaken and their diagnostic yield was equal to hospital outpatient requested enemas. Medical and surgical diagnostic yields were similar for both inpatient and outpatients though the indications varied. Women predominated by 3:2 in all age groups. In the under 40's the yield was low (19.8%) except for inflammatory bowel disease. When related to symptoms the lowest yield was obtained for the investigation of abdominal pain (25%), particularly in women, except in those admitted as inpatients. The clinicians were wrong in diagnosing abdominal or pelvic masses as being of colonic origin in over 50% of cases. It is suggested that yield could be improved by being more selective in patients under 40, more use being made of suitable faecal occult blood testing, and ultrasonic scanning of abdominal masses before barium enema.

Adult↗
PubMed1985

Evacuation proctography in obstructed defaecation and rectal intussusception.

The symptoms of obstructed defaecation may present as a number of different syndromes including descending perineum, solitary rectal ulcer, irritable bowel and mucosal or complete rectal prolapse. In order to clarify the pathophysiology of obstructed defaecation we carried out dynamic and static radiological investigations together with manometric and electrophysiological measurements in ten patients with severe, intractable obstructed defaecation. Results were compared with a total of 35 control subjects. There were no significant differences in sphincter pressures or the recto-anal inhibitory reflex between patients and controls. Mean motor unit potential duration was prolonged in patients compared with controls (P less than 0.02) in the puborectalis and external sphincter indicative of neuropathic changes. X-ray measurements of the anorectal angle and perineal descent at rest showed no differences. However, obstructed defaecation patients had a greater increase in anorectal angle on straining (P less than 0.02) and significantly more descent on straining (P less than 0.002). Fast film sequence evacuation proctography showed that the anal canal was occluded by anterior rectal wall in four patients and five patients had variants of recto-rectal intussusception without overt rectal prolapse, which explained the obstructive symptoms. This information should allow the surgeon to follow a rational treatment programme based on the anatomical abnormality.

Adult↗
PubMed1984

A comparison of two high-density barium sulphate preparations for double-contrast barium meals.

The mucosal coating properties, liability to bubble formation and palatability of a new barium sulphate suspension (Micropaque HD) were compared with those of the barium suspension shown by previous trials to produce the best results (E-Z-HD). The results show that E-Z-HD gave significantly better mucosal coating and was less liable to bubble formation. There was no significant difference in the palatability of the two preparations.

Barium Sulfate↗
PubMed1983

The role of decubitus films in double-contrast barium enemas.

Five hundred barium enemas were reviewed to find the influence of the decubitus films on the radiologist's report. In two cases they demonstrated abnormalities that had not been seen on any other film. In 21 out of 43 cases they resolved a diagnostic problem that had arisen when viewing the other films. They were of greatest value in differentiating possible polyps from faecal residue in patients with imperfect bowel preparation.

Barium Sulfate↗
PubMed1983

The effect of hyoscine butylbromide on the swallowing of capsules.

Hyoscine butylbromide (20 mg) given intravenously to 48 patients with normal oesophageal motility significantly reduced oesophageal transit of hard gelatin capsules when swallowed in the erect and supine positions with 15 ml and 60 ml water when compared to an age/sex matched group. Delayed capsule transit and possible failed or slowed drug absorption occurring as a consequence of anti-cholinergic drugs on the oesophagus, constitutes a new drug interaction.

Adult↗
PubMed1979

Changing patterns of neonatal necrotizing enterocolitis.

In a 4 year and 4 month period 80 patients with necrotizing enterocolitis were treated. Review of the mode of clinical presentation, radiological features, management, mortality, and complications showed that there have been considerable changes over this period. The disease is now frequently diagnosed clinically prior to the development of paralytic ileus. Scalloping of the bowel wall and separation of the bowel loops are probably the earliest radiological signs. The management has become a more aggressive medical approach with more limited and well-defined surgical indications. These changes have been associated with a marked decrease in mortality and a concomitant increase in the number of late complications.

Enterocolitis, Pseudomembranous↗