Acute appendicitis associated with tumours of the appendix.
Explore the source record for details and available documents.
Adenocarcinoma↗
Biomedical subjects
K D Vellacott
Publications and source records attributed to K D Vellacott.
An evaluation of a direct access flexible fibreoptic sigmoidoscopy service.
During a 3 year period 146 general practitioners referred 630 patients to a direct access flexible sigmoidoscopy clinic. The yield was 53.3% with significant colonic or rectal pathology in 30%. Twenty six cancers, 4 Dukes' A, and 38 patients with symptomatic adenomatous polyps were detected. Five further cancers were detected by subsequent barium enemas. The service reduced delay in diagnosing colorectal pathology but did not reduce the number of barium enemas requested by general practitioners. It is suggested that where facilities are already available, such a service to investigate rectal bleeding in patients over 40 years is of benefit both to patients and general practitioners.
Adolescent↗
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↗
Early endoscopy for acute lower gastrointestinal haemorrhage.
A personal prospective study of the value of early lower gastrointestinal endoscopy on patients admitted as emergencies with acute colorectal haemorrhage is presented. Thirty two patients were studied of whom 13 had severe continued colonic haemorrhage. A correct diagnosis was made in 20 (62.5%) and an incorrect diagnosis in 3 (9%). In only 3 was the examination terminated due to excessive blood. There was one serious complication of septicaemia in a patient with an arterio-enteric fistula. It is concluded that early colonoscopy for lower gastrointestinal bleeding is worthwhile.
Acute Disease↗
Septicaemia after colonoscopy due to an iliac artery aneurysm.
Transient bacteraemia following colonoscopy is very rare after colonoscopy though endotoxaemia without clinical consequences may occur in about 9% of patients (1, 2). An unusual case of septicaemia after colonoscopy associated with an iliac artery aneurysm is reported.
Aged↗
Cause of death and accuracy of certification of colorectal cancer.
Of 160 patients who died of colorectal cancer in the Exeter district in 1979 and 1980, 15 had not been correctly certified as such and of these 10 had died postoperatively. A further 2 had not died of colorectal cancer and in 9 the diagnosis was unsubstantiated. When those not proven to have cancer are considered, colorectal cancer as a cause of death was underestimated by about 5%, which is much more accurate than for other diseases. A total of 35 patients (21.8%) had no operative treatment due to advanced disease, old age or rapid death. The mean inpatient stay was 32.3 days, and 184 operations were performed on 125 patients. Only 20 patients were admitted to the district hospital for terminal care.
Adult↗
Feasibility of direct access flexible fibreoptic sigmoidoscopy for general practitioners.
Explore the source record for details and available documents.
Adult↗
Lahaut's operation for rectal prolapse.
Thirty-four patients with complete rectal prolapse were treated by Lahaut's operation in which the mobilised rectosigmoid was implanted in the posterior rectus sheath. There were no prolapse recurrences, but one patient died postoperatively. Of the 12 patients with incontinence, 11 were improved by the procedure. Lahaut's operation is a simple and effective procedure which avoids the potential problems associated with a surgical implant of Ivalon or Teflon.
Adult↗
Flexible fiberoptic sigmoidoscopy and double-contrast barium-enema examination in the identification of adenomas and carcinoma of the colon.
To assess the accuracy of the flexible fiberoptic sigmoidoscope, 227 consecutive patients (mean age 61.8 +/- 13 years) requiring investigation of colonic symptoms were evaluated using rigid and flexible sigmoidoscopy (PAF and KDV) and double-contrast barium enema (SSA). Patients with equivocal findings or adenomatous polyps underwent colonoscopy (TWB). Thirty-four patients had carcinoma and 50 patients had one or more adenomatous polyps (greater than 5mm). The neoplastic yield from rigid sigmoidoscopy was 12 per cent, flexible fiberoptic sigmoidoscopy 90 per cent, and double-contrast barium enema only 76 per cent. Barium enema failed to identify eight carcinomas and 13 adenomatous polyps; seven of the eight carcinomas were polypoid Dukes' Stage A lesions, and associated diverticular disease was present in 62.5 per cent of cases. Flexible fiberoptic sigmoidoscopy failed to identify seven carcinomas and one adenomatous polyp. Five of the carcinomas were beyond range of the instrument; in one patient, a stricture was seen that was caused by the carcinoma; and in the seventh patient, the examination was terminated because of angulation spasm. Double-contrast barium enema is inaccurate in detecting lesions in the sigmoid colon, with flexible sigmoidoscopy being superior.
Adenoma↗
Outcome of endoscopy and barium radiography for acute upper gastrointestinal bleeding: controlled trial in 1037 patients.
A study was conducted to find whether the higher diagnostic yield of endoscopy compared with barium radiography improves management or survival in patients with acute upper gastrointestinal bleeding. A total of 1037 patients were entered into a randomised study comparing the outcomes after each investigation. The diagnostic yield in patients who underwent endoscopy was 73% (382 of 526 cases) and in those examined by radiography 55% (280 of 511 cases). A fifth of the patients in the radiology group and a tenth of those in the endoscopy group subsequently underwent the alternative investigation; in most cases, however, no additional diagnostic information was obtained. Operation rates were similar in two groups, though patients in the endoscopy group were generally operated on sooner. Mortality rates were also similar in the two groups, though postoperative mortality was higher in the endoscopy group. Endoscopy may be a more accurate means of diagnosis than radiography, but it offers no short-term benefits in management.
Clinical Trials as Topic↗
Comparison of surgical and medical management of bleeding peptic ulcers.
During 1975-80, 908 patients admitted to Nottingham hospitals with gastrointestinal bleeding and found to have gastric or duodenal ulcers were analysed retrospectively for short-term outcome of treatment. Overall one-quarter of all patients underwent operation, but when the years 1975-7 were compared with 1978-80 the operation rate fell from one in three to just over one in five. Death rates were much lower in patients treated medically than in those who underwent operation, and the risks of operation were greater for patients with gastric ulcer. Less conventional operations were attended by greater mortality. Almost all patients who died during medical treatment and three-quarters of those who died after operation were over 65. No differences in age or clear variations in haemoglobin concentrations or transfusion requirements were found between the earlier and later periods. Reduction in operation rates had no appreciable effect on mortality, despite the accepted view that early operation is advisable.
Adult↗
Comparison of rigid and flexible fibreoptic sigmoidoscopy with double contrast barium enemas.
One hundred consecutive new patients attending a general surgical and gastrointestinal outpatient clinic had a flexible fibreoptic sigmoidoscopic examination before a double contrast barium enema. Colonic lesions were found in 45 patients and flexible sigmoidoscopy was superior to barium enemas in diagnosing lesions in the sigmoid colon. Two cancers, 1 histologically a Dukes' A lesion and 6 adenomatous polyps greater than 0.5 cm in diameter, in the sigmoid colon, were not detected by barium enemas. In 6 of these patients extensive diverticular disease was present. In patients with rectal bleeding found to have diverticular disease demonstrated radiographically, an endoscopic examination must be performed to exclude polyps or cancer. Flexible fibreoptic sigmoidoscopy may reduce the numbers needing barium enemas.
Adult↗
Colorectal cancer. Early diagnosis and detection.
Explore the source record for details and available documents.
Adenoma↗
Tumour associated products in colonic lavage fluid.
Explore the source record for details and available documents.
Adenoma↗
An evaluation of flexible fibreoptic sigmoidoscopy.
Results of 350 flexible fibreoptic sigmoidoscopy examinations showed a diagnostic yield of 30% compared with 6.5% by rigid sigmoidoscopy of the same patients. The mean time for the examinations was eight minutes, a distance of over 50 cm being visualised in 65% of the patients. Preparation of the bowel with a single phosphate enema was adequate in 95% of the patients. As an outpatient investigation for clinicians fibreoptic sigmoidoscopy is a safe, quick, and useful addition to rigid sigmoidoscopy and should result in a decrease in the number of barium enema examinations required.
Adenoma↗
An immunofluorescent test for faecal occult blood.
An immunological test for faecal occult blood is described, which is suitable for screening purposes. Fluorescein-labelled rabbit anti-human-haemoglobin serum is mixed with an aqueous faecal suspension, and free antibody is bound to a membrane sampler coated with human haemoglobin. The fluorescence on the membrane sampler is measured in a fluorometer, and the level of haemoglobin in the suspension is estimated. Advantages over chemical tests include absence of cross-reaction with animal haemoglobins, minimal observer error, and an adjustable sensitivity.
Colonic Neoplasms↗
Circulating immune complexes in patients with benign and malignant colorectal tumours.
Circulating immune complexes were measured using a modified Clq binding assay in 100 preoperative patients with colorectal cancer and in 52 patients with benign polyps. Sixty-one per cent of the patients with cancer and 49 per cent of the patients with benign polyps had elevated levels, as did 92 per cent of those with malignant polyps. There was no relation to a, the stage of the disease, with 10 out of 13 Dukes' A tumours (77 per cent) having increased levels; b, the degree of differentiation of the cancers; c, the tumour mass. However, cancers on the right side of the colon had significantly higher levels than rectal cancers.
Adult↗
Outpatient flexible fibreoptic sigmoidoscopy, diagnostic yield and the value of glucagon.
One hundred patients had flexible fibreoptic sigmoidoscopy in an outpatient clinic after preparation with a phosphate enema but without sedation. Patients were randomized to receive 1 mg of glucagon intravenously or a matching placebo. The discomfort of the patients and the ease of the procedure were similar in both groups. Nine patients were excluded from the final analysis as they had low rectal or anal lesions. In the remaining 91 patients, abnormalities were found in 27 (29.6 per cent) including 16 adenomatous polyps and 1 carcinoma. Only 3 lesions were below 20 cm and might have been easily visualized using a rigid sigmoidoscope.
Clinical Trials as Topic↗