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Biomedical subjects

W H Isbister

Publications and source records attributed to W H Isbister.

At least 19 recordsLinked to original sources
PubMed1992

Inpatient management of piles: a surgical audit.

A retrospective study was performed on 160 patients admitted to the University Surgical Unit between July 1975 and November 1989 with haemorrhoidal disease. Patients' records were analysed with respect to predisposing factors, inpatient management, postoperative analgesia, hospital stay and post-management complications. One hundred and nineteen patients had haemorrhoidectomy (low ligation combined with an anal stretch). Of these, 1.6% developed urinary retention and 4.2% bled postoperatively but did not require surgical intervention. Ten patients were found to have tight anal canals post surgery and required outpatient anal dilatation. In no case was dilatation necessary for more than 3 months. Three patients required a therapeutic course of antibiotics. Of the 119 patients, 60 required narcotic analgesia for less than 24 hours. Hospital stay was 1-4 nights.

Adult↗
PubMed1992

Sex and subsite frequency of large bowel cancer in the Kingdom of Saudi Arabia: a comparison with New Zealand.

New Zealand (NZ) has a high risk population for the development of large bowel cancer (LBC). The Kingdom of Saudi Arabia (KSA) has a low risk population and is estimated to have incidence and mortality rates which are ten times lower than NZ. It has already been shown that in NZ, females have a higher incidence of right-sided colonic cancer and males a higher incidence of rectal cancer. To determine whether the same situation exists in a low risk population the NZ data were compared with similar data from the cancer registry at the King Faisal Specialist Hospital and Research Center (KFSHRC). Between 1975 and 1989, 433 Saudi and Yemeni patients with LBC were registered at KPSH. The subsite distribution of tumours in this group were compared with the subsite distribution in 4678 patients registered in NZ between 1972 and 1975. The male to female (M:F) ratio for right-sided tumours in KSA was 1:0.90 compared with 1:1.56 in NZ whereas the ratios for rectal tumours were 1:0.61 and 1:0.83 respectively. This study confirms the presence of a lower frequency of right-sided tumours in females in a low risk country and further confirms the importance of gender in LBC. It may be that early and multiple child bearing, physical activity and relatively poor diets have been protective for Saudi females.

Colorectal Neoplasms↗
PubMed1992

Colorectal cancer below age 40 in the Kingdom of Saudi Arabia.

This study compares colorectal cancer from the King Faisal Specialist Hospital and Research Center (KFSHRC) Tumour Registry in patients under and over 40 years and contrasts the data with registry data from New Zealand (NZ). Between 1975 and 1989 622 patients were registered at KFSHRC and 528 were Saudi. Three hundred and twenty-one were male and 207 were female. The average ages were 55.3 and 49.6. One hundred and nineteen were less than 40 years. More patients with proximal lesions were less than 40 years. Of the young patients 8.3% had small tumours (less than 4 cm) compared with 24.9% of patients over 40. Mucinous and signet ring carcinomata were more common in the young. Tumours were less well differentiated in younger patients. There were more young patients with 'localized' disease and nodal involvement. Older patients had more distant metastases. Of patients registered in NZ 5.5% were young compared with 23% of Saudi patients. In both countries localized disease was more common in the young. Nodal involvement was more frequently seen in the young in the Kingdom of Saudi Arabia (KSA) whereas the opposite was true in NZ. Distant metastases were more common in the old in the KSA but there were more young patients with metastases in NZ. In both countries young females with rectal tumours were more common but this ratio was reversed in the old. This study suggests that colorectal cancer may be more aggressive in the young in KSA but there was no evidence that the disease was more aggressive in young New Zealanders. Differences in the epidemiology of the disease in the young and old were found in both countries.

Adult↗
PubMed1991

Lymphoid follicular hyperplasia--a distinctive feature of diversion colitis.

Diversion colitis refers to the inflammatory changes that occur in the defunctioned segment of the large intestine following diversion of the faecal stream. We report the histological features in the defunctioned rectums from seven patients: one each with severe constipation and Behçet's disease, two with Crohn's disease with rectal sparing and three with ulcerative colitis. The appearances of diversion colitis in a previously normal rectum are compared with diversion colitis with superimposed inflammatory bowel disease. Lymphoid follicular hyperplasia was found in all cases. This was marked in patients with inflammatory bowel disease, with or without initial rectal involvement. Other changes comprised surface epithelial degeneration and ulceration, mucosal inflammation including crypt abscesses, and crypt branching. Inflammatory and crypt changes were mild, except in ulcerative colitis where changes were marked and resembled those of the proximal colon. Lymphoid hyperplasia is a distinctive feature in diversion colitis. The term follicular proctitis, previously used to indicate chronic ulcerative colitis exclusively, should be re-examined.

Adult↗
PubMed1991

Presentation, duration of symptoms and staging of colorectal carcinoma.

A prospectively recorded, consecutive series of 155 colorectal carcinoma specimens clinically and pathologically staged according to the Australian Clinico-pathological System (ACPS) between April 1987 and May 1989 at Wellington and Kenepuru Hospitals is reviewed. Clinical records were available for retrospective review for 146 of the 155 patients. Change in bowel habit, rectal bleeding and abdominal pain were the most common presenting symptoms. Thirty-five patients presented as emergencies, twenty-six with obstruction and nine with perforation. Abdominal pain resulted in the earliest surgical intervention. The median duration of symptoms prior to diagnosis was 3 months. No correlation existed between tumour stage and duration of symptoms. Earlier diagnosis during the symptomatic phase of colorectal carcinoma is unlikely to contribute significantly to improved overall survival.

Adult↗
PubMed1991

Bechet's colitis: a differential diagnosis in inflammations of the large intestine.

A previously well 39 year old woman presented with severe localized and painful anorectal ulceration. There were no other associated symptoms apart from arthritis of the hips and fingers. In the absence of definitive tissue diagnosis, a presumptive diagnosis of Crohn's disease was made. After a period of progression, the inflammation and ulceration subsided with conservative therapy. Following a relatively symptom-free period of 7 years, painful ulceration recurred in the same segment of bowel, which was refractory to steroid therapy but responded to defunctioning of the rectum. Upon excision of the defunctioned rectum, multiple discrete ulcers developed in the remaining colon, with a fistula from the distal sigmoid colon to the midline wound. The patient simultaneously developed painful apthous ulceration of the mouth and throat, and pustules appeared on the perianal skin and trunk for the first time. A colectomy was performed, with good results. The pathology of the colonic lesions is described. The characteristic appearance of these lesions, together with associated 'major' and 'minor' clinical criteria, enabled a diagnosis of Bechet's disease to be made. Although there is some overlap, particularly in the distribution of this condition with Crohn's colitis, the pathologic appearances in Bechet's colitis are relatively distinct. A diagnosis of Bechet's colitis should not be excluded in a patient presenting with atypical inflammatory bowel disease, even if associated clinical criteria are not simultaneously present.

Adult↗
PubMed1990

Single dose prophylaxis in colorectal surgery.

Moxalactam disodium (Latamoxef), was evaluated as a single dose prophylactic antibiotic against wound infection in open colorectal surgery. One hundred and five consecutive patients admitted to the university department of surgery, Wellington Hospital, were studied. Twelve patients were excluded because either the antibiotic was not given or antibiotics were given for other reasons. Eleven patients developed early wound infections and one further patient developed a late infection, an overall wound infection rate of 13% (95% CI 7-19). Whilst this infection rate is higher than that previously reported from this unit using more prolonged (3 dose) antibiotic prophylaxis (9.8%, 95% CI 9.6-10) the difference is not likely to be significant because the patient groups were not matched, and the comparisons were sequential. On the basis of the present study it is concluded that 1 g of moxalactam disodium administered at the induction of anaesthesia in open colorectal surgery is inexpensive, is associated with a low incidence of side effects and its further use in colorectal surgery would seem to be justified.

Aged↗
PubMed1990

Large-bowel cancer in the young: a national survival study.

Large-bowel cancer in young patients is reported to be a more aggressive and advanced disease at presentation and is believed to be associated with a relatively poor prognosis. Of 2420 patients registered in New Zealand (1968 to 1970), 131 were under 40 years of age and 2289 were over 40 years of age. The annual average incidence of treatable colorectal cancer in patients under 40 years of age was 2.36 per 100,000 and 82.93 in patients over 40 years of age. There were predominantly more females in both age groups with colonic tumors, 50:44 (female:male), and 759:652 (female:male). The rectal tumor male-to-female ratio of 1:0.68 in those over 40 years of age was reversed in those under 40 years of age (1:2.08). There was no significant difference in the subsite distribution of colorectal cancer between the two groups. There was a higher proportion of Stage 1 tumors in those under 40 years of age and a correspondingly higher proportion of Stage 2 tumors in those over 40 years of age. The overall crude and relative five-year survival rates for patients under 40 years of age were both 60 percent, whereas the crude rate for older patients was 42 percent, with a corresponding relative rate of 53 percent. Ten-year survival rates were generally higher in younger patients. From this study, there was no evidence to suggest that younger patients (less than 40 years old) with colorectal cancer had worse prognoses and did not survive as long as older patients (40 years and over).

Adult↗
PubMed1990

Non-operative management of malignant intestinal obstruction.

Intestinal obstruction is a relatively common clinical problem in patients with advanced cancer, particularly those with colorectal and ovarian tumours. A proportion of patients have a non-malignant cause for their obstruction, but in the remaining patients obstruction will be caused by advanced malignancy itself. In the past, most patients were either managed surgically or by nasogastric intestinal decompression and intravenous hydration. Surgery in patients with advanced cancer is associated with high mortality and morbidity. Effective surgical decompression is difficult. We have managed 24 patients with advanced abdominal malignancy and previous operative or radiological evidence of intestinal obstruction without operation. The technique is only appropriate for patients in whom a solitary or correctable obstructing lesion can be excluded. The patient is encouraged to take free fluid and a diet low in fibre. Intestinal colic is managed with morphine, the dose required being titrated for each individual patient against background pain and colic. Vomiting is controlled by the parenteral administration of antiemetic drugs. To simplify drug administration, morphine and metoclopramide are mixed in the same syringe and infused subcutaneously simultaneously. In our 24 patients the mean survival rate after the onset of complete obstruction was 29.2 days. The mean dose of morphine infused was 9.2 mg/h, and the mean dose of metoclopramide was 6.9 mg/h. The case of an 82-year-old male patient is presented. We commend the technique to surgeons contemplating surgery in these very difficult patients. It is simple, relatively non-invasive and saves the patients the pain, discomfort and complications of unproductive surgery.

Adult↗
PubMed1990

Management of anorectal abscesses: comparison between traditional incision and packing and de Pezzer catheter drainage.

This study compares the results of de Pezzer catheter drainage of anorectal abscess with the more traditional technique of incision and packing. A prospective study from this department in 1987 detailed the outcome of patients with anorectal abscess managed routinely by de Pezzer catheter drainage. Ninety-one patients were treated, 18 required general anaesthesia, the mean hospital stay was 1.4 days, and 24% subsequently required fistula surgery. A retrospective study has now been undertaken of all patients admitted to Wellington Hospital with anorectal abscess during the same period who were treated by incision and packing. Of 54 patients treated, all had general anaesthesia, the mean hospital stay was 4.5 days, 63% needed district nursing care after discharge and 25% required fistula surgery. Simple de Pezzer drainage is not only safe, convenient and well tolerated by patients, but it compares very favourably with the more traditional method of treating anorectal abscesses and, as a consequence of the minimal hospital care necessary, it must necessarily be a much cheaper method of treatment.

Abscess↗
PubMed1989

Colonoscopy, mucosal biopsy and brush cytology in the assessment of patients with colorectal inflammatory bowel disease.

Patients with total long-standing mucosal ulcerative colitis are at an increased risk of developing carcinoma of the colon or rectum. Recently it has been suggested that cytological examination of the colon may play an important role in the examination of these patients. The present study was undertaken in order to determine the malignancy/severe dysplasia rate in our patients and to examine the role of cytology in comparison with mucosal biopsy in the detection of mucosal abnormality. Three patients had severe dysplasia in the absence of active inflammation (7.1%). Fifty-four patients were examined concurrently by histology and cytological brushing and at least seven specimens were obtained from each patient. Cytological examination detected active mucosal inflammation more often than histological examination at all sites in the colon. There was good agreement between the cytologists' evaluation, routine histopathological examination and endoscopic evaluation of the colorectal mucosa, although the latter tended to underestimate the degree of active inflammation. It was concluded that, since there was no real improvement in sampling by brush cytology, there may be little advantage in supplementing routine biopsy with brush cytology in patients with long-standing inflammatory bowel disease.

Adult↗
PubMed1989

Colonic varices. Report of a case.

A 14-year-old girl who had colonic bleeding caused by colonic varices is described. Upper gastrointestinal endoscopy, radiography of the small and large bowel, and vascular studies of the superior and inferior mesenteric arteries and the portal vein were all reported to be normal. Submucosal varices, however, were identified colonoscopically in relation to the hepatic flexure and the sigmoid colon. Dilatation of subserosal right colonic vascular channels was identified at operation. Right hemicolectomy was performed and there has been no further bleeding. No obvious mesenteric arteriovenous communications were identified histologically.

Adolescent↗
PubMed1989

Colostomy closure.

One hundred and forty-seven colostomies were closed in 146 patients at Wellington Hospital between 1 January 1978 and 1 January 1987. The majority of stomata were formed in patients with colorectal cancer. At least one additional significant procedure was undertaken at the time of stoma closure in 10 patients. The overall complication rate was highest in those patients undergoing closure of a sigmoid end-colostomy (50%). Three complications resulted in death (2%). Twenty-four patients (16.3%) developed wound infections. Five patients developed 'leaks' (3.4%). The use of prophylactic antibiotics appeared to reduce the rate of infection significantly. The highest rates of wound infection and leakage occurred in patients in whom drains were used. Wound infections increased hospital stay. Thirty-one non-bowel or wound-related complications occurred in 25 patients.

Colostomy↗
PubMed1989

Dysplastic and malignant areas in hyperplastic polyps of the large intestine.

The clinical and pathological findings in a patient with 3 adenocarcinomas of the colon, 16 pure hyperplastic polyps, 1 hyperplastic polyp with adenomatous elements and 1 hyperplastic polyp with malignant transformation to adenocarcinoma within an area of adenomatous dysplasia are described. The possibility of neoplastic transformation of hyperplastic polyps is discussed.

Adenocarcinoma↗