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Biomedical subjects

R Farouk

Publications and source records attributed to R Farouk.

At least 37 records · Page 2Linked to original sources
PubMed1997

Staged delivery of Nd:YAG laser therapy for palliation of advanced rectal carcinoma.

PURPOSE: This study was designed to assess the degree of symptom relief, complication rate, and survival time of patients who undergo palliation with the neodymiumyttrium aluminum garnet (Nd:YAG) laser for advanced rectal cancer. METHODS: Charts of 41 consecutive patients with advanced rectal cancer treated by this method were reviewed. RESULTS: Thirty-three patients received laser treatment for a primary tumor, and eight received laser palliation for local recurrence following previous surgery. Mean number of treatments delivered was 2 (range, 1-6) for patients with a primary lesion and 2 (range, 1-4) for those patients with local recurrence. In patients in whom more than one delivery was required, subsequent procedures were deferred for more than six weeks. Morbidity rate was 2 percent, with no procedure-related mortality. Median survival time was 19 (range, 1-60) months for patients with a primary tumor and 7 (range, 3-38) months for patients with local recurrence. Four patients subsequently elected to undergo palliative surgery, and five other patients had a loop colostomy formed because of large-bowel obstruction after a mean of 24 (range, 18-41) months. Nd:YAG laser treatment offered adequate laser palliation for 78 percent of patients in this series. However, patients who survive for more than 24 months after their first laser treatment are more likely to require palliative surgery. CONCLUSIONS: The majority of patients undergoing laser ablation for palliation do not require large numbers of treatment sessions. By delaying the interval between treatments, morbidity and mortality rates are negligible. Most patients avoid a stoma or defer the date of requiring one before their death with this therapy.

Aged↗
PubMed1997

Feasibility study for use of brush cytology as a complementary method for diagnosis of rectal cancer.

UNLABELLED: Brush cytology has previously been described as a feasible method for accurately diagnosing colorectal cancer. PURPOSE: This study was designed: 1) to determine the sensitivity and specificity of brush cytology for the diagnosis of rectal cancer; 2) to prospectively assess the extent of interobserver variability with this technique; 3) to prospectively examine the cost impact of the addition of brush cytology as a routine method of confirming the diagnosis of rectal cancer. PATIENTS AND METHODS: Three hundred fifty-seven patients who attended a rectal clinica and who were found to have a lesion between January 1990 and March 1996 were assessed. Each patient underwent rigid proctoscopy, followed by brush cytology and tissue biopsy. Results were compared with the final histologic diagnosis in each patient. The brushings from the last 92 consecutive patients in this series were independently examined by four cytologists and a pathologist to determine the rate of interobserver variability. RESULTS: Rectal adenocarcinoma was confirmed from surgically resected specimens in 303 patients. Brush cytology accurately diagnosed 278 of them. Of the remaining 25 patients, two had brushings that were insufficient for diagnosis. There was one false-positive case. Forceps biopsy correctly identified cancer in 260 patients, with no false-positive interpretations. Brush cytology accurately identified 53 of 54 adenomas as being benign, and forceps biopsy correctly identified all as benign. Sensitivity of brush cytology in this series was 92 percent, with a specificity of 92 percent. Interobserver agreement was 84 percent. Actual costs incurred with this method was an additional $17.00 per patient. CONCLUSIONS: Brush cytology can accurately diagnose rectal cancer in a high proportion of patients. Interobserver variation is low and compares favorably with other forms of cytologic interpretation. The additional cost remains a concern but can be kept within acceptable proportion.

Adenoma↗
PubMed1997

Surgical options in ulcerative colitis.

The length of ileum used rather than pouch configuration per se is related to eventual functional outcome: A pouch constructed from 15- to 20-cm limbs is ideal. One-stage procedures appear feasible in those patients who are not malnourished or taking steroids and in whom a tension-free anastomosis may be achieved. Because most of our patients do not satisfy these criteria, single-stage IPAA is rarely used at the Mayo Clinic. The decision to excise the ATZ should relate to the risk of developing subsequent neoplasia. All patients with FAP should have a mucosectomy performed. Patients with CUC who do not have a mucosectomy should have life-long surveillance. Indeed, an argument can be made that all patients should undergo surveillance after IPAA. The decision to staple the anastomosis impacts little on eventual functional outcome but does preserve the ATZ with the attendant risk of recurrent disease, polyps, and neoplasia. When cancer is a presenting feature, the decision to perform IPAA should be based on the stage of the tumor and the subsequent need for radiation therapy. Patients with early-stage tumors not requiring adjuvant radiation therapy attain long-term function comparable to that of patients who have had an IPAA for benign disease.

Anastomosis, Surgical↗
PubMed1997

The optimum bowel preparation for flexible sigmoidoscopy.

With the proposed introduction of a flexible sigmoidoscopic screening programme for colorectal cancer, patient compliance is of paramount importance. Therefore, the bowel preparation providing optimum cleansing of the bowel with the least associated discomfort and inconvenience for the patient must be found. Patients were randomized to receive either Picolax the evening before the examination or self-administered Fleet enemas prior to the investigation. The endoscopist and nurse practitioner who collected data on a standard questionnaire were blinded to the preparation used. Bowel preparation was graded by the endoscopist as: excellent, good, adequate or poor. One hundred and two consecutive patients were randomized: 56 to the Fleet enema group and 46 to the Picolax group. Self-administered Fleet enemas provided a significantly superior bowel preparation with 52 (93%) being judged adequate or better, as opposed to 34 (74%) in the Picolax group. In addition, Fleet enemas were associated with significantly fewer adverse associated symptoms: 11 (20%) vs 24 (52%). Patients reported to be willing to receive Fleet enemas again in 53 (95%) vs 37 (80%) for the Picolax group. The self-administered Fleet enema is superior to Picolax in terms of bowel preparation for flexible sigmoidoscopy and the incidence of associated adverse symptoms.

Administration, Oral↗
PubMed1997

Preoperative staging of rectal carcinoma by magnetic resonance imaging with a pelvic phased-array coil.

BACKGROUND: The use of surface coils for magnetic resonance imaging (MRI) allows enhanced image definition and so potentially more accurate staging of colorectal cancer. Endorectal coil imaging is invasive, operator dependent and impossible in a high proportion of patients due to rectal stricture. The phased-array pelvic coil, however, is non-invasive and applicable to all rectal tumours. METHODS: A pelvic phased-array coil was used for preoperative MRI staging of 38 primary rectal carcinomas. Results were expressed according to the Dukes and tumour nodes metastasis (TNM) classifications. After resection of the tumour, the stage predicted on MRI was compared with the pathological classification. RESULTS: The overall accuracy of preoperative staging with the pelvic phased-array coil was 55 per cent for both Dukes class and T stage. Assessment of nodal involvement gave an overall accuracy for MRI of 76 per cent with a sensitivity of 57 per cent and specificity of 88 per cent. CONCLUSION: Use of a pelvic phased-array coil did not improve the staging accuracy of MRI to a clinically useful level.

Adult↗
PubMed1997

Aggressive multimodality treatment for locally advanced irresectable rectal cancer.

BACKGROUND: Local failure rates are high for locally irresectable primary or recurrent colorectal cancer, even when chemoradiation therapy is employed. AIM: This review evaluates evidence supporting aggressive preoperative chemoradiation followed by maximal surgical resection and intraoperative radiation therapy to achieve disease control and cure for patients with locally advanced irresectable primary or recurrent rectal cancer. RESULTS: A 5-year survival rate of 42 per cent with a central failure rate of 2 per cent may be achieved in patients with locally irresectable primary rectal cancer. In patients with locally recurrent disease, these values at 5 years are 18 and 28 per cent respectively. The 5-year incidence of distant metastasis remains high, affecting 64 per cent of patients with primary cancer and 75 per cent of those with recurrent cancer. CONCLUSION: A disease-free surgical resection margin remains paramount to achieve cure. Encouraging trends exist, however, for further evaluation of multimodality therapy as a means of reducing local recurrence of disease.

Brachytherapy↗
PubMed1997

The evaluation and treatment of patients with rectal prolapse.

Many of the reported series have tended to concentrate on recurrence rates rather than functional outcome, and virtually all have short follow-up of clinical outcome. There have been very few randomised trials making interpretation of results more difficult. Our own practice has evolved to perform a suture rectopexy performed laparoscopically in those patients without preoperative evacuation difficulties for the previously outlined reasons. Where there is evidence of slow transit constipation, a sub-total colectomy performed as an open procedure is offered. Mesh rectopexy is a suitable, safe alternative, particularly in the absence of preoperative evacuation difficulties (3, 24). The primary problem with this approach is the subjective nature of the preoperative assessment in relation to the patient's (and doctor's) definitions of evacuation difficulty or constipation. While debate continues as to whether the lateral ligaments should be divided, a more practical approach would be to preserve these ligaments if a sutured or mesh rectopexy is to be used, with division of the lateral ligaments when a resection is performed. These manoeuvres would reduce the risk of troublesome postoperative constipation, although recurrent mucosal or full-thickness prolapses have been described. The final decision for the choice of procedure should take account of basic preoperative abnormalities being present, i.e. motility disorders, the presence of neurogenic injury to the pelvic floor etc., combined with the age, gender and medical condition of the patient (43).

Fecal Incontinence↗
PubMed1996

Brush cytology for the diagnosis of rectal carcinoma.

The use of brush cytology as an aid in the preoperative diagnosis of rectal cancer was prospectively assessed at 328 examinations in 289 consecutive patients with rectal lesions suspicious of carcinoma. Forty-five patients were reported as having benign polyps. There was 97 per cent agreement between conventional biopsy and cytology brushings for this group. Some 249 patients underwent a subsequent resection allowing comparison with formal histology. Forceps biopsy produced a true-positive diagnosis of cancer in 218 patients (89.7 per cent) and cytology in 222 (91 per cent). The sensitivity for forceps biopsy and cytology was 81 and 83 per cent respectively, with a combined sensitivity of 98 per cent. It is concluded that the addition of cytology to forceps biopsy increases the diagnostic yield in a single examination, and may be a complementary method of establishing the diagnosis of rectal lesions.

Biopsy↗
PubMed1996

Suprapubic versus transurethral catheterisation of males undergoing pelvic colorectal surgery.

A prospective, randomised double-blind trial of suprapubic (SPC) versus transurethral (TUC) catheterisation was undertaken in fifty consecutive male patients of median age 66 (range 32-81) years undergoing pelvic colorectal surgery. Twenty-four patients were randomised to SPC. Catheter removal times were comparable between the two groups: SPC = mean 7.2 (3-14) days; TUC = man 7.5 (2-13) days; P > 0.5. Acute urinary retention was recorded in 5 patients with SPC and 6 in the TUC group. Chronic retention with overflow was recorded in one TUC patient. Frequent voiding after catheter removal occurred in two SPC, and in eleven TUC patients (P < 0.05). Re-catheterization was required in two SPC, and seven TUC patients. One culture positive urinary tract infection occurred in the SPC, and three in the TUC groups. It is concluded that suprapubic catheterisation allows comparable controlled return of normal voiding with fewer bladder and urethral symptoms when compared with transurethral catheterisation.

Adult↗
PubMed1995

Island advancement flaps in the management of anal fissures.

The classic high-pressure fissure responds well to lateral internal sphincterotomy. The management of recurrent fissures and those that occur in patients with weak sphincters is open to debate. An island advancement flap technique used in 21 patients is described with the above criteria. Preoperative median resting anal pressure was 66 (range 43-90) cmH2O and median maximal squeeze pressure was 132 (range 76-193) cmH2O, values that were significantly lower than in controls and those with classic fissure. Endoanal ultrasonography in 15 of these patients showed defects in the anal sphincters. All flaps healed primarily with preservation of sensation. Perfect continence was maintained in all patients. Follow-up was for a median of 18 (range 2-28) months. There were no serious complications. All fissures healed with minimal postoperative discomfort. This procedure provides a useful alternative for symptomatic anal fissures, in which a sphincter-weakening procedure might jeopardize continence.

Adult↗
PubMed1995

Heightened visceral sensation in functional gastrointestinal disease is not site-specific. Evidence for a generalized disorder of gut sensitivity.

Alteration in visceral sensation locally at the site of presumed symptom origin in the gastrointestinal tract has been proposed as an important etiopathological mechanism in the so-called functional bowel disorders. Patients presenting with one functional gastrointestinal syndrome, however, frequently have additional symptoms referable to other parts of the gut, suggesting that enhanced visceral nociception may be a panintestinal phenomenon. We measured the sensory thresholds for initial perception (IP), desire to defecate (DD), and urgency (U) in response to rectal balloon distension, and the thresholds for initial perception and for discomfort in response to esophageal balloon distension in 12 patients with irritable bowel syndrome (IBS) and 10 patients with functional dyspepsia (FD), in comparison with healthy controls. As expected, IBS patients exhibited lower rectal sensory thresholds than controls (P < 0.0001), but in addition had significantly lower sensory thresholds for both perception and discomfort evoked by balloon distension of the esophagus (mean +/- SEM: 8.8 +/- 1.3 ml vs 12.1 +/- 1.5 ml (P < 0.05) and 12.2 +/- 1.4 ml vs 16.4 +/- 1.4 ml (P < 0.02) respectively. Patients with FD showed similarly enhanced esophageal sensitivity, with thresholds for perception and discomfort of 8.1 +/- 0.9 ml (P < 0.02), and 10.1 +/- 1.0 ml (p < 0.001), respectively, but were also found to have sensory thresholds for rectal distension similar to those observed in the IBS group, significantly lower than in controls: IP 45.0 +/- 17.6 vs 59.3 +/- 1.5 ml (P < 0.001), DD 98.0 +/- 17.9 vs 298.7 +/- 9.0 ml (P < 0.0001), U 177.2 +/- 25.4 vs 415.1 +/- 12.6 ml (p < 0.0001).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

Abnormal transient internal sphincter relaxation in idiopathic pruritus ani: physiological evidence from ambulatory monitoring.

Patients with idiopathic pruritus ani have an abnormal rectoanal inhibitory reflex and a lower threshold for internal sphincter relaxation during the saline continence test. This led to the hypothesis that these patients may exhibit abnormalities of the transient internal anal sphincter relaxation reflex. To study this, 23 men of median age 41 (range 27-64) years with idiopathic pruritus ani and 16 male controls of median age 39 (range 26-68) years were assessed using computerized ambulatory anorectal electromyography and manometry. Resting anal pressure, maximum anal squeeze pressure, internal sphincter electromyogram frequency, the number of internal sphincter relaxations and pudendal nerve terminal motor latency were similar for the two groups. The rise in rectal pressure during internal sphincter relaxation was higher in patients with pruritus than in controls (median (range) 29 (18-60) versus 18 (11-37) cmH2O, P < 0.01). Furthermore, the fall in anal pressure was greater in patients with pruritus than in controls (median (range) 39 (15-52) versus 29 (21-43) cmH2O, P < 0.01). The duration of internal sphincter relaxation was prolonged in patients compared with controls (median (range) 29 (18-55) versus 8 (5-12) s, P < 0.001). Fourteen patients reported staining of underclothes and 17 complained of perianal itch within 1 h of these episodes of abnormal internal sphincter relaxation. Pruritus ani may result from occult faecal leakage as a result of abnormal transient internal sphincter relaxation.

Adult↗
PubMed1994

Rectoanal inhibition and incontinence in patients with rectal prolapse.

Thirty-five patients with complete rectal prolapse, 32 with neurogenic faecal incontinence and 33 controls underwent ambulatory recording using a computerized anal electromyographic and anorectal manometry system. Median resting anal pressures were 34 cmH2O in patients with prolapse, 51 cmH2O in those with neurogenic faecal incontinence and 94 cmH2O in controls. Median basal rectal pressures were 18, 21 and 21 cmH2O respectively. High-pressure rectal waves of median amplitude 71 cmH2O lasting 30-150 s and associated with inhibition of the electromyographic activity of the internal and sphincter and a fall in anal pressures were seen in all patients with prolapse but not in controls or those with neurogenic incontinence. These waves were abolished following successful resection rectopexy. Recovery of continence occurs by abolition of high-pressure rectal waves, which produce maximal inhibition of sphincter activity before operation.

Adult↗