PubMed Health⌕ Search

Biomedical subjects

P F Anseline

Publications and source records attributed to P F Anseline.

9 recordsLinked to original sources

Presence of granulomas is associated with recurrence after surgery for Crohn's disease: experience of a surgical unit.

BACKGROUND: The determinants for recurrence of Crohn's disease remain controversial. Eight factors that might predict recurrence were studied in 130 patients operated on for Crohn's disease over a 24-year period. METHODS: Separate survival curves were estimated for each variable. A multivariate analysis was then carried out in which several selected explanatory variables were included simultaneously in a proportional hazards regression model. RESULTS: Operation for recurrent disease was necessary in 36 patients. Univariate analysis revealed a highly significant relationship between the presence of granulomas and subsequent recurrence (P = 0.003). There was a trend towards increased recurrence in patients with ileocolonic disease and segmental colectomy (P = 0.11 and P = 0.1 respectively). Age, sex, length of history, indication for operation and affected lines of transection were not associated with recurrence. After multivariate analysis, the association of granulomas with recurrence remained significant (P = 0.03). This association persisted when death was regarded as a treatment failure (P = 0.02). CONCLUSION: The presence of granulomas in patients with Crohn's disease is significantly associated with recurrence.

Adolescent↗

Crohn's disease in the Hunter Valley region of Australia.

Between 1967 and 1991, 130 patients underwent surgery for Crohn's disease at The Royal Newcastle Hospital, New South Wales. There were more patients in recent years, which suggested an increased incidence of the condition (2.1/100 000/per year). The clinical profile and recurrence rate were similar to other studies. However, a greater proportion of patients required surgery for chronic small bowel obstruction and fulminant colitis compared with patients in other countries.

Adolescent↗

Turcot's syndrome.

A non-familial case of cerebellar medulloblastoma associated with adenomatous polyposis coli is described and the literature is reviewed. This is the second reported case of Turcot's syndrome in Australia. A greater understanding of the genetic implications of this rare condition might be achieved through reporting of cases and long-term documentation with polyposis registries.

Adenomatous Polyposis Coli↗

Quality of life after restorative proctocolectomy.

An audit of 18 patients whom the author managed by abdominal colectomy, rectal mucosectomy and ileo-anal reservoir anastomosis was undertaken to assess the resulting quality of life. Sixteen patients had ulcerative colitis and two had familial adenomatous polyposis. In each case, a temporary loop ileostomy was performed at the time of reservoir construction. The minimum time since stoma closure was 12 months. The mean number of daily evacuations after stoma closure was eight (range: 4-15). Six patients usually had daytime soiling and eight overnight soiling. Nine patients always wore a perineal pad. Six patients had significant urgency of defecation and 15 patients took medication to reduce bowel frequency. Anorectal problems were noted by all but one of the 18 patients. However, of 14 patients who had lost time from work prior to operation, 12 have returned to uninterrupted employment. Of 11 patients who were unable to travel because of colitis symptoms, eight have no restrictions postoperatively. Twelve patients noted that their diets were more varied since surgery. Of fourteen patients who had restricted sex lives because of colitis symptoms, 11 were subsequently not restricted. On the other hand, during the 3 months the ileostomy was required, sexual activity was restricted in all but one patient. Other aspects of life also restricted by the stoma were sporting activity (14) and social life (15). Improvement followed stoma closure. Overall, the patients graded the success of the reservoir surgery as excellent (7), very good (3), good (2), satisfactory (4), poor (0), or prefer ileostomy (2). Thirteen patients believed their total lifestyle had improved.(ABSTRACT TRUNCATED AT 250 WORDS)

Activities of Daily Living↗

Efficacy of double versus single gloving in protecting the operating team.

Double-glove perforation rates and perforation rates in standard single-gloved operating teams were compared, in order to determine whether double gloving provides additional protection for the operating team. Patients were randomized to undergo surgery with a double-gloved or single-gloved operating team. All gloves worn during the operation were tested for perforations by water-filling and individual digital distension; 115 single-gloved operations and 103 double-gloved operations were performed. There were 841 individual operating team members 'at risk'. In the single-glove group, 20.8% of individuals had perforations, but only 2.5% had perforations in both inner and outer gloves (dual perforation) in the double-glove group (P less than 0.0001). The surgeon was most at risk of glove perforation (34.7% of cases in the single-glove group, 3.8% dual perforation in the double-glove group). Longer operations were associated with increased risk of glove perforation. Double-gloving significantly reduces the risk of skin contamination by blood and body fluids and is recommended for all high risk cases.

General Surgery↗

Radiation injury of the rectum: evaluation of surgical treatment.

One hundred four patients, 80 women and 24 men, with radiation injury of the rectum following treatment for gynecologic and urologic malignancy were studied. In 50 patients, the rectal injury was treated surgically; 54 patients were treated conservatively. The age and sex distributions were the same in each group. In 63 patients, symptoms developed one month to one year after radiotherapy. The longest latent interval was 17 years. Of the 50 surgical patients, 23 had associated small bowel injury. The indications for surgery for the rectal injury were 1) proctitis unresponsive to conservative measures in 14 patients, 2) rectal stricture or fistula or both in 32, and 3) rectosigmoid perforation in four. Forty-one patients had external diversions. Eleven had intestinal continuity restored; six of the 11 had required the stoma for proctitis unresponsive to medical measures. Nineteen patients did not undergo colostomy closure, although symptoms wer greatly improved. Diversion alone was insufficient treatment in the remaining 11 patients. Twenty-six patients died. The 12 deaths in the surgical group comprised four due to residual malignancy, four from postoperative complications, and four from unrelated causes. Of the 14 deaths in the nonsurgical group, 11 died of the primary malignancy and three of unrelated causes. Diversion is considered the safest form of treatment for rectovaginal fistulae, rectal strictures, and proctitis unresponsive to medical measures. Intestinal resection resulted in sharp rise in the morbidity and mortality rates.

Adult↗

Is the ascending colon dispensable in resection for Crohn's disease?

Resection for chronic ileocaecal Crohn's disease may be conservative with ileo-ascending-colon anastomosis, or be extended to standard right hemicolectomy. The two operations have been compared to determine whether preservation of the ascending colon is advantageous. Stool frequency, consistency and weight were similar after the two operations. A slower stool transit time was the only clinical difference associated with preservation of the ascending colon. An adaptable and patient-acceptable technique for domicillary collection of stools is described.

Cecum↗