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Biomedical subjects

M Lamah

Publications and source records attributed to M Lamah.

17 recordsLinked to original sources
PubMed2001

Inflammatory bowel disease and pregnancy.

The peak age ranges for pregnancy and inflammatory bowel disease (IBD) coincide, and many women develop IBD during their reproductive years. This contribution reviews the major studies on the subject, and is sub-divided into two broad considerations: the effects of the disease on fertility, pregnancy and other factors related to the puerperium, and, conversely, the effects of pregnancy and childbirth on the disease: its natural history and recent surgical treatment options, namely pouch anatomy and function. A systematic review of the literature from 1950 to the present was undertaken using Medline and the keywords inflammatory bowel disease and pregnancy.

Adrenal Cortex Hormones↗
PubMed2001

Anatomical variations of the extrahepatic biliary tree: review of the world literature.

The anatomy facing a surgeon during cholecystectomy involves complex relationships between the hepatic artery, extrahepatic biliary tree, and gallbladder. A sound knowledge of the normal anatomy of the extrahepatic biliary tract is thus essential in the prevention of operative injury to it. Equally important, however, is an understanding of congenital variation of biliary and vascular anatomy, as the literature abounds with reports of specific anatomical variations, and their operative implications. This article reviews the world literature on congenital variation of extrahepatic biliary anatomy.

Bile Ducts↗
PubMed2001

The ascending testis: is late orchidopexy due to failure of screening or late ascent?

It is widely recommended that infant boys with undescended testes (UDT) should be referred for surgical opinion before the age of 18 months. To attempt to identify the reasons why the mean age at orchidopexy in our institution was as high as 5.5 years, a retrospective review of the screening history, examinations, and management of boys over the age of 3 years at the time of orchidopexy was undertaken by reference to community, general practitioner, and hospital records. In 36 children where hospital and community records giving information prior to referral were available, the UDT had previously been documented on at least one occasion as descended in 24 children or retractile in 10. In 1 child there was delayed referral, and in another, there was operative delay. It is concluded that there is either frequent failure of the Child Health Surveillance screening programme, or that late ascent of a testis previously sited in the scrotum is a common occurrence. We recommend further prospective studies to clarify this latter phenomenon.

Adolescent↗
PubMed2001

Effect of faecal occult blood testing on colorectal cancer mortality in the surveillance of subjects at moderate risk of colorectal neoplasia: a case-control study.

Colonoscopy is the established method of surveillance of subjects at high risk of developing colorectal neoplasia. Its role in the surveillance of a population at moderate risk is less clear, however, as the procedure is expensive, time consuming and occasionally hazardous. The aim of this study was to estimate by case-control methods the effect of faecal occult blood (FOB) screening on colorectal cancer (CRC) mortality in a population at moderate risk of developing CRC. Screening by FOB testing prior to diagnosis in patients over the age of 45 years who died of CRC diagnosed in 1989-1998 was compared with screening in controls matched with the case for age and sex. Information about episodes of FOB testing and potential confounders was obtained from the data collection system of the screening programme. Cases were less likely than controls to have ever been screened, with an odds ratio of 0.64 (95% confidence interval 0.34-1.15) for exposure to at least one FOB testing. There was no significant difference between the sub-groups according to gender, age at diagnosis or location of the cancer. The inverse association between screening for faecal occult blood and fatal colorectal cancer suggests that screening in a population at moderate risk of CRC can reduce mortality from CRC in this group.

Aged↗
PubMed2001

Results of anterior levatorplasty for rectocele.

OBJECTIVE: Transanal and transvaginal repair of rectocele have been advocated in the treatment of rectocele, with mixed results. The aim of this study was to assess our experience using anterior levatorplasty in the surgical management of rectocele. PATIENTS AND METHODS: Sixty of 90 women who had undergone anterior levatorplasty for rectocele over a seven year period were traced, and 44 (33 with rectocele only and 11 with rectocele and faecal incontinence) responded to a standardized questionnaire 6 months to 7 years (mean 3.5 years) after anterior levatorplasty. Results were expressed in general and specific improvement of symptoms and were classified as excellent, good, fair, or poor. The effects on social activities, sexual function, and employment were also assessed. RESULTS: General satisfaction with the operation was rated as good or excellent in 27 of 33 (82%) and 18 of 24 (75%) patients with rectocele only at 2 and 3.2 years follow-up, respectively, and in 7 of 11 (64%) and 5 of 11 (45%) patients with rectocele and faecal incontinence at 2 and 4 years follow-up, respectively. 31 (70%) and 34 (77%) of all patients reported an improvement in sensation and the ability to defaecate, respectively. An improvement in social activities, sexual satisfaction and employment was noted in 10 of 21 (48%), 10 of 23 (43%), and 7 of 12 (58%) patients, respectively. CONCLUSION: Anterior levatorplasty provides good short and long-term symptomatic improvement in patients with rectocele and avoids complications associated with rectal or vaginal approaches.

Journal Article↗
PubMed2000

Three-year evaluation of a rapid-access coloproctology clinic.

BACKGROUND/AIMS: Evolving surgical practice has placed increasing pressures on surgical outpatient clinics. This article provides a prospective evaluation of a rapid-access coloproctology clinic over a 3-year period. METHODS: Primary care physicians (PCP) were circulated details of the clinic, and invited to refer any patient presenting with colorectal or anorectal symptoms, or with a family history of bowel cancer wishing advice about screening. Data were collected prospectively and patients and the referring PCPs were invited to complete a self-administered structured questionnaire. RESULTS: In all, 3,119 patients were referred, the main indications being rectal bleeding (67%), abdominal pain (16%) and change in bowel habit (15%). The average time interval between PCP visit and specialist consultation was 2 days and neoplastic disease was detected in 7.1% of patients. 70% of patients with haemorrhoids and 39% of those with other minor diseases were discharged back to their PCPs after definitive treatment at the time of their visit to the clinic. The majority of PCPs and patients expressed satisfaction with the service as evidenced by the returned questionnaires. CONCLUSION: These data show that a more universal implementation of such clinics may result in improved care of colorectal disease and considerable savings of outpatient time and resources.

Adolescent↗
PubMed1999

Congenital anatomical abnormalities of the extrahepatic biliary duct: a personal audit.

Awareness of variations in the anatomy of extrahepatic bile ducts may be important in preventing iatrogenic injury to the duct system during cholecystectomy. Their delineation, before or during surgery is therefore considered mandatory in this surgical unit, and a policy of always performing a per-operative cholangiogram has allowed us to evaluate the duct system in a retrospective review of 2080 cases. Twelve surgically significant anatomical variations were found, consisting of absent cystic duct (three cases), abnormal termination of cystic duct (two into the right hepatic duct, and one into the left hepatic duct), one case of double cystic duct, and five cases of significant accessory bile ducts.

Bile Ducts, Extrahepatic↗
PubMed1999

Value of routine computed tomography in the preoperative assessment of abdominal aneurysm replacement.

This study compares the findings of conventional computed tomography (CT) and ultrasound (US) imaging in the preoperative evaluation of patients with abdominal aortic aneurysm (AAA). It also assesses the impact of preoperative CT-derived information on operative strategy. A prospective study was conducted of 96 patients who were considered for aortic aneurysm surgery, and the operative notes and US and CT reports were analyzed to assess correlation of findings and influence of CT on operative tactics. Agreement between CT and US in sizing the aneurysm was generally good. CT was more accurate than US for defining the upper and lower extent of the aneurysm (75% and 83%, respectively, with CT, compared to 47% and 41% with US), although it had a high false positive rate (48%) for juxtarenal disease. Its advantage over US in regard to showing other intraabdominal pathology was only marginal, and it predicted an inflammatory reaction in only two of the five cases. Its influence on operative strategy was minimal: Of the 25 cases where a juxtarenal aneurysm was predicted by CT, only 2 patients did not have surgery as a result. CT is a relatively expensive and time-consuming procedure, and its ionizing radiation, however small, and potential side effects from contrast material hypersensitivity cannot be ignored. In light of the above findings, we suggest that CT scanning need not be routinely employed in the preoperative workup of elective aortic aneurysm repair but should be used only in selected cases.

Aged↗
PubMed1999

Fecal incontinence.

Explore the source record for details and available documents.

Fecal Incontinence↗
PubMed1999

Quantitative study of capillary density in the skin of the foot in peripheral vascular disease.

BACKGROUND: The aim of this study was to investigate possible differences in capillary density of the skin of the foot between normal subjects and patients with peripheral vascular disease. METHODS: Using in vivo video microscopy, a method was developed to measure the average capillary density (ACD) of the skin of the foot and toes. In a cross-sectional observational study, 21 patients with intermittent claudication and 23 patients with rest pain or ischaemic ulceration were compared with 19 age- and sex-matched controls. RESULTS: Mean(s.e.m). values of ACD of the foot were 33.7(1.9) and 34.4(1.7) per mm2 in the right and left sides respectively for controls, 31.2(1.8) per mm2 (P not significant) and 31.9(2.6) per mm2 (P not significant) in the symptomatic and contralateral sides respectively for patients with claudication, and 22.0(1.8) per mm2 (P < 0.001) and 24.3(1.7) per mm2 (P < 0.001) in the symptomatic and contralateral sides respectively for patients with rest pain or ulceration. CONCLUSION: Capillary density of the skin of the foot is significantly reduced in patients with arterial ulceration compared with that in patients with claudication and healthy subjects.

Adult↗
PubMed1999

In vivo microscopic study of microcirculatory perfusion of the skin of the foot in peripheral vascular disease.

OBJECTIVES: the aim of this study was to determine the proportion of perfused capillaries in the skin of the foot in patients with peripheral vascular disease, and compare it with that in normal subjects. DESIGN: experimental study comparing capillary perfusion in nine patients with severe peripheral vascular disease (group 2) with seven age- and sex-matched control subjects (group 1). MATERIALS AND METHODS: using in vivo video microscopy, a method was developed to measure the ratio of perfused to total capillaries, by comparing the numbers of corresponding capillaries before and after intravenous injection of sodium fluorescein. RESULTS: the mean percentage ratio of perfused to total capillaries was 54.7% (range 41-87%, standard deviation 16.5) in group 1, and 86.0% (range 62-100%, standard deviation 13.2) in group 2 (p<0.001, t-test). CONCLUSION: a significantly higher proportion of capillaries is perfused in the skin of the foot of patients with severe peripheral vascular disease than in that of normal subjects. This is of important pathophysiological significance and may have clinical implications with regard to the role of pharmacological intervention in severe limb ischaemia.

Adult↗
PubMed1998

The use of rectosigmoid stents in the management of acute large bowel obstruction.

The management of the acutely obstructed colon is controversial. Initial decompression of the bowel is still favoured by many surgeons, but the resulting colostomy has significant morbidity and mortality. Instead, stenting of the obstruction would permit defunctioning of the bowel, without the need for surgery and stoma formation. In this study we present our experience of the use of stents in the initial management of six patients with acute and sub-acute large bowel obstruction.

Acute Disease↗
PubMed1995

Extended lymph node dissection (D2 resection) should now be performed routinely in the curative surgical treatment of gastric carcinoma.

Gastric cancer has a dismal prognosis in the Western world. In contrast, in Japan where extended lymphadenectomy is the rule in curative gastric cancer surgery, the prognosis is much better. The arguments for and against the adoption of this procedure in the West are presented. This procedure is safe in the hands of experienced surgeons and by improving locoregional control, may improve survival. However, in the absence of controlled data supporting a survival advantage, the excess morbidity and mortality of this extended procedure in the West may not be justified.

Humans↗
PubMedDate not supplied

Study of temporal and perfusion physiology of skin capillaries in the dorsum of the foot.

The aim of this study was twofold: firstly, to study the nature of any temporal variation in capillary numbers, and secondly to determine the proportion of perfused to total nutritional capillaries in normal skin. Using in vivo microscopy, the temporal behaviour of the number of visible capillaries in the skin of the dorsum of foot was observed over periods of time varying from 5 min to 55 days in 15 healthy subjects. Capillary perfusion was then studied by comparing capillary numbers before and after intravenous injection of sodium fluorescein. The mean percent difference in the number of visible capillaries over a mean period of 25.3 days was 5.5%. The percentage ratio of perfused to total capillaries was 54.2%. This study shows that there is little quantitative change in capillary numbers over periods of up to 50 days, and that under physiological conditions, about half of the nutritional capillaries of skin are not perfused.

Adult↗
PubMedDate not supplied

Repeatability of intravital capillaroscopic measurement of capillary density.

The reliability of intravital capillaroscopy for determining capillary density (CD) of skin has been questioned because it depends upon the variability of the measuring process and subjective interpretation of data as well as the intrinsic heterogeneity of capillary spacing. The aim of this study was to assess the repeatability of a standardised method for measuring CD of the skin of the dorsum of foot. In each of 30 subjects (10 controls and 20 patients with peripheral vascular disease), the foot was systematically mapped by examining 20 sites on the dorsum of foot and 2 sites on each toe, using white light (native) videomicroscopy at 40 x magnification. Off-line analysis of videoprints was then undertaken to determine CD at each site, by counting capillaries within areas of acceptable photographic quality only, having first defined the criteria for counting capillaries. The mean values were then calculated and taken to represent the CD of the foot or toes. Repeatability of the measuring equipment was first assessed by noting the presence or absence of each corresponding capillary in 2 prints, taken at intervals of hours or days (in 10 subjects) or months (in 2 patients), of an identical area of skin which was marked by a microtattoo on the first occasion. On average, 95% of corresponding capillaries were identified in both prints (from controls and patients), thus implying little intrinsic temporal variation of capillary anatomy as well as excellent repeatability of the measuring equipment. Repeatability of data analysis was assessed by the same observer reading the same 20 prints in a blinded manner on three separate occasions (intraobserver repeatability), and 2 observers reading the same 24 prints (interobserver repeatability). The mean coefficient of intraobserver variation of CD estimate was 5.6% and the interobserver correlation coefficient was 0.94. Finally, overall repeatability of the method was assessed by repeating the procedure on a subsequent occasion (mean time interval of 5 days) in 10 subjects. The rate of agreement in mean CD between the two procedures [defined as 100- (difference between the two measurements/mean of the two measurements) x 100]% ranged from 86.4 to 97.1% (mean 93.5%). Thus using the above methodological technique, native capillaroscopy can be reliably used to determine CD of the dorsum of foot in comparing patient subgroups, as well as in longitudinal studies.

Aged↗
PubMedDate not supplied

Heterogeneity of capillary density of skin over the dorsum of the foot and toes of healthy subjects.

The spatial pattern of capillaries is one of many factors important for the optimisation of oxygen and nutrient delivery in a specified region of tissue. One area of particular interest to the vascular specialist is the skin of the dorsum of the foot and toes, as these are especially prone to ulceration in patients with arterial disease. The aim of this study was therefore to establish the extent of capillary density (CD) heterogeneity in the normal skin of the dorsum of the foot and toes, since any great non-uniformity might produce regions of low perfusion, which may become vulnerable to ulceration. Using white-light (native) videomicroscopy at a magnification of x 40 in 15 healthy subjects (mean age 72 years), the dorsum of the foot and toes was systematically mapped by determining the CD at each of 25 sites on the dorsum of the foot, and at 2 sites on the distal phalanx of each toe. Off-line analysis of videoprints was then undertaken to determine CD at each site, according to a fixed protocol of measurement and data analysis. The mean value and spatial coefficient of variation of CD was then calculated for each foot. There was striking spatial heterogeneity of CD in the dorsum of the foot, some areas having low numbers of capillaries and other areas in the same foot having higher capillary numbers. This spatial heterogeneity of CD was observed in all the feet studied, and the mean coefficient of variability was 22.3%. The toes had a significantly higher mean CD (47.7/mm2) than the dorsum of the foot (33.5/mm2, p < 0.001). The finding of a significant spatial heterogeneity of CD in the foot of normal subjects has important implications in relation to function, methodology of CD measurement and the possibility that regional 'rarefaction' of CD may contribute to the pathogenesis of skin ulceration in arterial disease.

Adult↗