Biomedical subjects

Mark H Whiteford

Publications and source records attributed to Mark H Whiteford.

5 recordsLinked to original sources

PubMed2005

Practice parameters for the treatment of perianal abscess and fistula-in-ano (revised).

The American Society of Colon and Rectal Surgeons is dedicated to assuring high-quality patient care by advancing the science, prevention, and management of disorders and diseases of the colon, rectum, and anus. The Standards Committee is composed of Society members who are chosen because they have demonstrated expertise in the specialty of colon and rectal surgery. This Committee was created to lead international efforts in defining quality care for conditions related to the colon, rectum, and anus. This is accompanied by developing Clinical Practice Guidelines based on the best available evidence. These guidelines are inclusive, and not prescriptive. Their purpose is to provide information on which decisions can be made, rather than dictate a specific form of treatment. These guidelines are intended for the use of all practitioners, health care workers, and patients who desire information about the management of the conditions addressed by the topics covered in these guidelines. It should be recognized that these guidelines should not be deemed inclusive of all proper methods of care or exclusive of methods of care reasonably directed to obtaining the same results. The ultimate judgment regarding the propriety of any specific procedure must be made by the physician in light of all of the circumstances presented by the individual patient.

Abscess↗

PubMed2005

Practice parameters for the surgical treatment of ulcerative colitis.

The American Society of Colon and Rectal Surgeons is dedicated to assuring high-quality patient care by advancing the science, prevention, and management of disorders and diseases of the colon, rectum, and anus. The Standards Committee is composed of Society members who are chosen because they have demonstrated expertise in the specialty of colon and rectal surgery. This committee was created to lead international efforts in defining quality care for conditions related to the colon, rectum, and anus. This is accompanied by developing Clinical Practice Guidelines based on the best available evidence. These guidelines are inclusive, and not prescriptive. Their purpose is to provide information on which decisions can be made, rather than dictate a specific form of treatment. These guidelines are intended for the use of all practitioners, health care workers, and patients who desire information about the management of the conditions addressed by the topics covered in these guidelines. It should be recognized that these guidelines should not be deemed inclusive of all proper methods of care or exclusive of methods of care reasonably directed to obtaining the same results. The ultimate judgment regarding the propriety of any specific procedure must be made by the physician in light of all of the circumstances presented by the individual patient.

Colectomy↗

PubMed2004

Effects of estrogen on messenger ribonucleic acid expression patterns of extracellular matrix proteases in the primate colon.

PURPOSE: Recent studies suggest that hormone replacement therapy in postmenopausal women can decrease colon cancer risk. To better understand the molecular effects of estrogen on the colon, we examined the effects of estrogen replacement on gene expression of proteases associated with extracellular matrix degradation in rhesus monkey colon tissue. METHODS: Rhesus monkeys were oophorectomized and one-half were implanted with estradiol capsules. After five months, colon tissue was harvested, and messenger ribonucleic acid was extracted and converted to cDNA. The cDNA was hybridized with a DNA array spotted with cDNA corresponding to genes involved in extracellular matrix remodeling. Selected genes exhibiting significant differential expression were validated using reverse transcriptase-polymerase chain reaction and real-time polymerase chain reaction analysis. RESULTS: Of 96 genes assessed, nearly 18 percent showed a twofold or greater change in expression; however, signals from approximately 65 percent of genes assayed were below detection levels. A distinct pattern of decreased gene expression was observed in colon tissue of animals with estrogen implants compared with females without estrogen replacement. Reverse transcriptase-polymerase chain reaction confirmed decreased expression in estrogen-replaced vs. hormone-deprived tissues of proteases cathepsin-D and caspase-8. Real-time polymerase chain reaction data confirmed the suppression of proteases A disintegrin and mettaloproteinase with thrombospondin motifs, type 1 and matrix metalloproteinase-2 with estrogen replacement in colon tissue. CONCLUSIONS: This is the first investigation of the specific effects of estrogen in normal primate colon. Estrogen replacement suppressed expression of several proteases linked to tumor growth and metastasis. This study provides the groundwork for targeted future studies to further characterize the role of estrogen in colon tissue.

Animals↗

PubMed2004

Full-thickness intraperitoneal excision by transanal endoscopic microsurgery does not increase short-term complications.

PURPOSE: Transanal endoscopic microsurgery (TEM) is a minimally invasive technique for full-thickness excision of benign and malignant rectal neoplasms located 4 to 24 cm above the anal verge. Entrance into the peritoneal cavity during TEM has been regarded as a complication that mandates conversion to open laparotomy for adequate repair of the defect. This study compares the rate of complications arising from TEM with and without intraperitoneal entry. METHODS: Patients undergoing peritoneal entry were compared to those who did not. RESULTS: No perioperative deaths occurred. There was no significant difference in the incidence of postoperative complications. No major complications occurred with peritoneal entry, and all peritoneal entries were closed transanally via endoscope. CONCLUSIONS: Entry into the peritoneum during TEM is not associated with an increased incidence of complication. Entry into the peritoneum during TEM excision does not mandate conversion to open laparotomy but may be safely repaired endoscopically. Lesions likely to be above the peritoneal reflection and within reach of the endoscope (4 to 24 cm) should be considered for TEM excision.

Aged↗

PubMed2002

The rational use of computed tomography scans in the diagnosis of appendicitis.

BACKGROUND: Recently, limited abdominal computed tomography (CT) scans have been reported (Rao, New England Journal of Medicine, 1998) to have accuracy as high as 98%. We compare our hospital's CT accuracy ordered by emergency room (ER) physicians with that of experienced surgeons provided only with the ER history and physical examination in the evaluation of appendicitis. METHODS: All charts of patients 16 years or older with limited CT scans ordered by ER from January 1, 1996, through February 28, 1998, were reviewed. CT scans ordered when appendicitis was not in the differential were excluded from analysis. Pathology and clinical follow-up were criterion standards. Four surgeons reviewed ER history and physical and placed them into one of three categories: appendectomy, observe to rule out appendicitis, or discharge with follow-up (included admitting to another service or treating for another disorder). RESULTS: A total of 526 charts were reviewed; 129 met the criteria for the study. The accuracy of CT scans as used by our ER was not as high as reported in the literature. In addition, surgeon accuracy approached that of the CT scan even without the ability to evaluate the patients in person. Noncontrast CTs were ordered before surgical evaluation in contrast to the Rao protocol, likely reducing their accuracy. CONCLUSIONS: Ordering CT scans to evaluate for appendicitis prior to surgical evaluation is of limited value.

Abdominal Pain↗