Biomedical subjects

Nicholas Rieger

Publications and source records attributed to Nicholas Rieger.

10 recordsLinked to original sources

PubMed2006

Identification of early-stage colorectal cancer patients at risk of relapse post-resection by immunobead reverse transcription-PCR analysis of peritoneal lavage fluid for malignant cells.

PURPOSE: Colorectal cancer patients diagnosed with stage I or II disease are not routinely offered adjuvant chemotherapy following resection of the primary tumor. However, up to 10% of stage I and 30% of stage II patients relapse within 5 years of surgery from recurrent or metastatic disease. The aim of this study was to determine if tumor-associated markers could detect disseminated malignant cells and so identify a subgroup of patients with early-stage colorectal cancer that were at risk of relapse. EXPERIMENTAL DESIGN: We recruited consecutive patients undergoing curative resection for early-stage colorectal cancer. Immunobead reverse transcription-PCR of five tumor-associated markers (carcinoembryonic antigen, laminin gamma2, ephrin B4, matrilysin, and cytokeratin 20) was used to detect the presence of colon tumor cells in peripheral blood and within the peritoneal cavity of colon cancer patients perioperatively. Clinicopathologic variables were tested for their effect on survival outcomes in univariate analyses using the Kaplan-Meier method. A multivariate Cox proportional hazards regression analysis was done to determine whether detection of tumor cells was an independent prognostic marker for disease relapse. RESULTS: Overall, 41 of 125 (32.8%) early-stage patients were positive for disseminated tumor cells. Patients who were marker positive for disseminated cells in post-resection lavage samples showed a significantly poorer prognosis (hazard ratio, 6.2; 95% confidence interval, 1.9-19.6; P = 0.002), and this was independent of other risk factors. CONCLUSION: The markers used in this study identified a subgroup of early-stage patients at increased risk of relapse post-resection for primary colorectal cancer. This method may be considered as a new diagnostic tool to improve the staging and management of colorectal cancer.

Adult↗

PubMed2005

Randomized prospective controlled trial of lateral internal sphincterotomy versus injection of botulinum toxin for the treatment of idiopathic fissure in ano.

BACKGROUND: Chronic anal fissure is a significant cause of morbidity. Internal sphincterotomy has long been the operative treatment of choice. Concerns remain, however, on its effects on continence. Botulinum toxin has been used as an agent for chemical sphincterotomy, causing temporary alleviation of sphincter spasm and allowing the fissure to heal. The aim of the present study was to compare the results of sphincterotomy to botulinum toxin. METHODS: The study was designed as a randomized controlled trial. All adult patients over the age of 18 with chronic idiopathic fissure in ano who had failed conservative treatment were included in the trial. Patients were randomized to receive either Botox or sphincterotomy. Pain, healing of fissure and continence scores were the outcomes assessed. RESULTS: A total of 38 patients were studied. Seventeen patients were randomized to receive Botox and 21, sphincterotomy. Patients in the Botox group were found to have significantly higher 2-week pain scores and reoperation rates, and poor healing. Continence scores were not significantly different in the two groups. CONCLUSION: Sphincterotomy gives better results than Botox in the treatment of fissure. Botox, however, is safe with no complications and no detriment to continence and could be used in certain situations.

Adult↗

PubMed2004

Perianal abscess: a pilot study comparing packing with nonpacking of the abscess cavity.

PURPOSE: Perianal sepsis is traditionally treated by incision and drainage, with packing of the residual cavity until healing. This study was designed to show that perianal abscess may be safely treated by incision and drainage alone. METHODS: Healing times, analgesic requirements, pain scores, abscess recurrence, and fistula rates were compared between two randomized groups treated with and without packing of perianal abscess cavities. RESULTS: Fifty patients were recruited (7 lost to follow-up): 20 in the packing and 23 in the nonpacking arm. The groups were comparable in terms of age and gender distribution, type and size of abscess, and the presence of a fistula at operation. Mean healing times were similar ( P = 0.214). The rate of abscess recurrence was similar ( P = 0.61). Postoperative fistula rates were similar ( P = 0.38). Pain scores at the first dressing change were similar ( P = 0.296). Although pain scores appeared much reduced in the nonpacking arm, this did not attain statistical significance. CONCLUSIONS: Our pilot study indicates that perianal abscesses can be managed safely without continued packing of the cavity without any obvious complications.

Abscess↗

PubMed2004

Detection of occult metastasis in lymph nodes from colorectal cancer patients: a multiple-marker reverse transcriptase-polymerase chain reaction study.

INTRODUCTION: Lymph node status is a key factor for disease staging and is the main determinant for adjuvant therapy of colorectal cancer. The current staging procedure is unable to identify occult metastasis in lymph nodes, which is likely to be an important cause of treatment failure in some early-stage patients. The detection of occult metastasis could identify a patient subgroup at risk for disease relapse that would benefit from adjuvant therapy. The purpose of this study was to establish and test a multimarker reverse transcriptase-polymerase chain reaction assay for the molecular detection of occult metastases in lymph nodes. METHODS: Forty-four patients with colorectal cancer and 14 patients with benign bowel diseases undergoing colonic resection were enrolled in the study. Reverse transcriptase-polymerase chain reaction was used to detect expression of three epithelial markers, carcinoembryonic antigen, cytokeratin 20, and guanylyl cyclase C, in fresh colorectal lymph node tissue. RESULTS: Forty-six of 47 (97.9 percent) histologically positive lymph nodes were also positive by reverse transcriptase-polymerase chain reaction. Of 221 histologically negative nodes, 97 (43.9 percent) were positive for at least one of the three markers by reverse transcriptase-polymerase chain reaction: 24.9 percent for carcinoembryonic antigen, 16.7 percent for cytokeratin 20, and 24.9 percent for guanylyl cyclase C. Among these were 13 of 20 stage I and II cases, implying a staging shift to stage III by molecular diagnosis of occult metastasis. Fifty-nine additional nodes were found to be positive for occult metastases in 22 of 24 stage III and IV patients. CONCLUSIONS: These results indicate that occult metastases are detectable by reverse transcriptase-polymerase chain reaction in histologically negative lymph nodes from colorectal cancer. The use of a panel of three markers improves the specificity of the method.

Adenocarcinoma↗

PubMed2004

Anal sphincter function and integrity after primary repair of third-degree tear: uncontrolled prospective analysis.

BACKGROUND: The purpose of the present paper was to determine the anatomical integrity and functional effect of a tear to the anal sphincter in women after vaginal delivery. METHODS: A prospective review of third- and fourth-degree vaginal tears over a 3 year period at Lyell McEwin and Queen Elizabeth Hospitals, Adelaide. Obstetric details were obtained from the records. All were counselled by a continence advisor and offered consultation with a colorectal surgeon. The integrity of the anal sphincter was assessed by endoanal ultrasound. RESULTS: During the study period there were 6875 vaginal deliveries. There were 89 women (1.3%) who had a third- or fourth-degree tear. Fifty-one (57%) agreed to participate. Primiparity (67%), episiotomy (49%), forceps delivery (29%) and instrumental delivery were common in women sustaining a tear. Symptoms of anal incontinence (mild) or faecal urgency were described in 23 women (45%). Except for three women with an anovaginal fistula none required surgery for the management of faecal incontinence. A sphincter defect was seen in 27 women (53%) on endoanal ultrasound. The presence or absence of a sphincter defect was not significantly associated with symptoms but a trend was suggested (chi2=3.21; P=0.07). CONCLUSIONS: Third-degree tear after vaginal delivery was a significant intrapartum event, yet associated only with minimal symptoms (excluding patients with anovaginal fistula) even in the presence of a sphincter defect on anal ultrasound.

Adolescent↗

PubMed2004

Endoanal and endorectal ultrasound: applications in colorectal surgery.

Endoanal and endorectal ultrasound have an important role in colorectal surgery. They can be applied in the management of faecal incontinence, rectal tumours and inflammatory perianal conditions. In faecal incontinence, anal ultrasound will confirm the presence or absence of sphincter defects. This will direct any operative intervention such as direct sphincter repair. Ultrasound in rectal cancer allows staging of the tumour by assessing the depth of invasion through the bowel wall and involvement of mesenteric nodes. Such staging might influence the choice of operation and determine which patients might benefit from preoperative chemotherapy and radiotherapy. Ultrasound has a particular role in recurrent and complex anal fistula and perianal sepsis. Preoperative and perioperative planning with accurate delineation of fistula tracts, extensions and sphincter involvement might help prevent recurrence and impaired continence from sphincter damage after surgery. Correct interpretation of ultrasound images requires training and experience so that the results can be properly correlated with the clinical situation.

Endosonography↗

PubMed2003

Retrorectal endometrial cyst.

CASE REPORT: An unusual case of retrorectal endometriosis is presented. This presented as an asymptomatic pelvic mass at the level of the pelvic floor not contiguous with the pelvis or peritoneal cavity. RESULT: It was successfully excised via an abdominal approach.

Adult↗

PubMed2003

Audit and the birth of the abdomino-perineal excision for carcinoma of the rectum.

Sir Ernest Miles first performed his radical abdomino-perineal excision for carcinoma of the rectum in 1907. This event was the culmination of almost a decade of audit in which he carefully studied the outcomes of patients with rectal carcinoma. Miles's interpretation of his audit led, in a stepwise manner, to gradual changes in his operative technique and the eventual development of the radical abdomino-perineal operation; the operation that bears his name. The Miles operation and the principles upon which it is based, would lead to an improved outcome for patients with rectal carcinoma.

Carcinoma↗

PubMed2002

Sentinel lymph node biopsy for squamous cell carcinoma of the anal canal.

BACKGROUND: The current Trans-Tasman Radiation Oncology Group (TROG) protocol for T1 and T2 anal cancers is combination chemotherapy and radiotherapy excluding the inguinal region from the field. Several centres worldwide irradiate both inguinal regions as there is a small incidence of involvement with early stage tumours. The presence of inguinal lymph node metastases is not accurately detected using clinical and most radiological assessment modalities. We have developed a method of sampling the sentinel node in the groin using established node mapping techniques. METHODS: A combination of radio-labelled Antimony Sulphide and Patent Blue dye injected around the anal cancer enable identification of the sentinel node in the groin, using a gamma probe and direct visualization of the blue node. RESULTS: This technique has been used in four patients. A groin sentinel node was identified and removed in three of these, with pathological assessment excluding metastatic disease in the inguinal region. The fourth patient had a sentinel node mapped to a meso-rectal node. This was not sampled. CONCLUSIONS: The application of this effective technique will allow accurate staging of anal cancers to better plan future treatment regimes.

Aged↗

PubMed2002

Surgical intervention for faecal incontinence in women: an update.

PURPOSE OF REVIEW: In this review we intend to overview the operations available for faecal incontinence with particular reference to recently published articles. RECENT FINDINGS: Operations benefiting faecal incontinence in women are direct sphincter repair, dynamic graciloplasty, artificial anal sphincter and sacral nerve stimulation. Considerable benefit was demonstrated with these operations but not without complications. Studies with longer follow-up are required for better assessment of these operations. SUMMARY: Surgery for faecal incontinence is indicated after failure of non-operative measures. Good results may be achieved.

Fecal Incontinence↗