Publications
315 results found
Zhen XA, Luke BT, Izmirlian G, et al., 2004, Serum proteomic profiles suggest celecoxib-modulated targets and response predictors, CANCER RESEARCH, Vol: 64, Pages: 2904-2909, ISSN: 0008-5472
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- Citations: 25
Tekkis PP, Boella ML, Rasheed S, et al., 2004, Evaluation of lymph node positivity in rectal cancer the St Mark's Lymph Node Positivity model, Annual Meeting of the American-Society-of-Colon-and-Rectal-Surgeons, Publisher: LIPPINCOTT WILLIAMS & WILKINS, Pages: 566-567, ISSN: 0012-3706
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- Citations: 1
Gallagher MC, North ME, Islam S, et al., 2004, Dendritic cells from patients with familial adenomatous polyposis and colorectal cancer display an immature phenotype - A mechanism of immune dysregulation permissive to cancer development, Annual Meeting of the British-Society-of-Gastroenterology, Publisher: B M J PUBLISHING GROUP, Pages: A120-A120, ISSN: 0017-5749
Lee J, Hargest R, Wasan H, et al., 2004, <i>In vitro</i> model for liposome-mediated adenomatous polyposis coli gene transfer in a duodenal model, DISEASES OF THE COLON & RECTUM, Vol: 47, Pages: 219-226, ISSN: 0012-3706
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- Citations: 4
Beveridge IG, Swain DJW, Groves CJ, et al., 2004, Large villous adenomas arising in ileal pouches in familial adenomatous polyposis: report of two cases., Dis Colon Rectum, Vol: 47, Pages: 123-126, ISSN: 0012-3706
A restorative proctocolectomy or ileal pouch procedure is one of the main surgical options for patients with familial adenomatous polyposis. The main premise underlying the recommendation of a pouch procedure rather than an ileorectal anastomosis is that it minimizes the risk of rectal cancer. Several studies have evaluated the risk of developing pouch adenomas. There also have been reports of pouch cancers, although the long-term risk of malignancy cannot yet be quantified. Most pouch polyps reported have been small tubular adenomas with mild dysplasia. A 19-year-old female with familial adenomatous polyposis had a colectomy and ileorectal anastomosis. Progressive rectal polyposis led to a restorative proctocolectomy at aged 38 years. Four years later, a large, 3-cm x 2-cm, villous adenoma was identified in the mid pouch, which was resected endoscopically. A 32-year-old male with familial adenomatous polyposis had a restorative proctocolectomy. Ten years after surgery, pouch endoscopy revealed several large, villous adenomas arising from the pouch mucosa. These advanced polyps may present a significant risk for cancer development and require close endoscopic surveillance. These findings strengthen the recommendation for careful regular endoscopic surveillance of familial adenomatous polyposis pouches and the evaluation of management and treatment strategies for pouch adenomas.
Lim W, Olschwang S, Keller JJ, et al., 2004, Relative frequency and morphology of cancers in STK11 mutation carriers., Gastroenterology, Vol: 126, Pages: 1788-1794
Buchanan GN, Bartram CI, Phillips RKS, et al., 2003, Efficacy of Fibrin Sealant in the Management of Complex Anal Fistula, Diseases of the Colon & Rectum, Vol: 46, Pages: 1167-1174, ISSN: 0012-3706
Buchanan GN, Bartram CI, Phillips RKS, et al., 2003, Efficacy of fibrin sealant in the management of complex anal fistula: a prospective trial., Dis Colon Rectum, Vol: 46, Pages: 1167-1174, ISSN: 0012-3706
PURPOSE: A prospective trial was conducted to establish long-term healing of complex idiopathic anorectal fistula, without extension, after fibrin glue treatment, with clinical assessment and magnetic resonance imaging to determine tract healing. METHODS: Twenty-two patients undergoing glue instillation after fistula curettage and irrigation were followed up for a median of 14 months. Clinical assessment, short tau inversion recovery sequence magnetic resonance imaging, and combined short tau inversion recovery and dynamic contrast-enhanced magnetic resonance imaging were performed at a median of three months postoperatively, and their ability to predict outcome in the presence of early skin healing was determined. RESULTS: Of 22 patients, 19 (86.5 percent) had transsphincteric fistulas, 1 (4.5 percent) had a suprasphincteric fistula, 1 (4.5 percent) had an extrasphincteric fistula, and 1 (4.5 percent) had a rectovaginal fistula. None had clinical or radiologic evidence of secondary extension. Despite skin healing in 17 (77 percent) of 22 patients at a median of 14 days after treatment, only 3 (14 percent) remained healed at 16 months. Magnetic resonance imaging with short tau inversion recovery sequences in combination with dynamic contrast-enhanced magnetic resonance imaging predicted outcome in all 10 assessments (100 percent), compared with short tau inversion recovery sequence alone in 16 (94 percent) of 17 assessments or clinical examination in 12 (71 percent) of 17 (P = 0.02). CONCLUSIONS: The success rate of fibrin glue application for complex anorectal fistulas without extension is 14 percent. Magnetic resonance imaging predicts outcome at an earlier stage than clinical examination.
Lim W, Hearle N, Shah B, et al., 2003, Further observations on <i>LKB1/STK11</i> status and cancer risk in Peutz-Jeghers syndrome, BRITISH JOURNAL OF CANCER, Vol: 89, Pages: 308-313, ISSN: 0007-0920
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- Citations: 106
Crabtree M, Sieber OM, Lipton L, et al., 2003, Refining the relation between 'first hits' and 'second hits' at the <i>APC</i> locus:: the 'loose fit' model and evidence for differences in somatic mutation spectra among patients, ONCOGENE, Vol: 22, Pages: 4257-4265, ISSN: 0950-9232
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- Citations: 81
Buchanan GN, Halligan S, Williams AB, et al., 2003, Magnetic resonance imaging for primary fistula in ano., Br J Surg, Vol: 90, Pages: 877-881, ISSN: 0007-1323
BACKGROUND: This was a prospective study designed to determine the therapeutic impact of magnetic resonance imaging (MRI) in primary fistula in ano, and to assess its effect on outcome. METHODS: Thirty patients with suspected primary fistula in ano underwent preoperative MRI, and the findings were revealed during surgery following examination under anaesthesia (EUA). Any effect on operative approach was noted. Outcome was assessed at a median of 12 months. RESULTS: Two patients had sinuses, one had no sepsis and 27 had fistulas: five superficial, seven intersphincteric, 14 trans-sphincteric and one suprasphincteric. MRI and EUA agreed in 15 patients and MRI findings altered the surgical approach in a further three (10 per cent); two of the latter patients were believed to have a sinus at EUA, which MRI correctly identified as a fistula, allowing definitive treatment. The therapeutic impact of MRI was therefore 10 per cent. Persisting disagreement between MRI and EUA in 12 patients mostly related to minor discrepancies in classification. Only one patient required further unplanned surgery, which was for skin-bridging rather than any new sepsis. CONCLUSION: In experienced hands, MRI has a therapeutic impact of 10 per cent for primary fistula in ano, precipitating surgery that is likely to reduce recurrence in a small, but important, proportion of patients.
Cheetham MJ, Cohen CRG, Kamm MA, et al., 2003, A randomized, controlled trial of diathermy hemorrhoidectomy vs. stapled hemorrhoidectomy in an intended day-care setting with longer-term follow-up., Dis Colon Rectum, Vol: 46, Pages: 491-497, ISSN: 0012-3706
PURPOSE: Hemorrhoidectomy is the most effective long-term treatment for hemorrhoids. Although it is possible to perform hemorrhoidectomy as a day case with a high degree of patient satisfaction, patients take an average of 14 days off work after surgery. Stapled hemorrhoidectomy is believed to be less painful than conventional hemorrhoidectomy and should allow an earlier return to work. The aim of this study was to compare both the immediate and the long-term results of stapled hemorrhoidectomy with diathermy hemorrhoidectomy in patients with prolapsing internal hemorrhoids in an intended day-care setting. METHODS: Thirty-one patients were randomly assigned to undergo diathermy hemorrhoidectomy (n = 16) or stapled hemorrhoidectomy performed with a purpose-designed endoluminal stapling device, PPH01T (n = 15). All operations were planned as day or short-stay cases. All patients received lactulose, commenced preoperatively, together with postoperative topical glyceryl trinitrate and oral metronidazole. Patients were assessed by structured interview to assess their symptoms before and after surgery, with an intended follow-up of six months. All patients completed a 10-cm visual analog pain scale daily for the first ten days after surgery. RESULTS: The total pain score (sum of all pain scores) was significantly higher in the diathermy group (50 (range, 9.8-79.9) vs. 19.6 (range, 1.3-89.5), P = 0.03). Patients took a median of 14 (range, 3-21) days off work after diathermy hemorrhoidectomy compared with 10 (range, 3-38) days for the patients undergoing stapled hemorrhoidectomy (P = 0.15). At long-term follow-up, three patients (all in the stapled group) developed new symptoms of fecal urgency and anal pain, and three patients required further surgery to remove symptomatic external hemorrhoids after stapled hemorrhoidectomy. CONCLUSIONS: Although stapled hemorrhoidectomy is less painful in the short term, this does not lead to a significantly earlier return to work, and s
Lipton L, Sieber OM, Crabtree M, et al., 2003, Multiple colorectal adenomas, familial adenomatous polyposis and germline mutations in MYH, Digestive Disease Week 2003 Meeting/104th Annual Meeting of the American-Gastroenterological-Association, Publisher: W B SAUNDERS CO, Pages: A45-A45, ISSN: 0016-5085
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- Citations: 1
Middleton SB, Clark SK, Matravers P, et al., 2003, Stepwise progression of familial adenomatous polyposis-associated desmoid precursor lesions demonstrated by a novel CT scoring system, DISEASES OF THE COLON & RECTUM, Vol: 46, Pages: 481-485, ISSN: 0012-3706
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- Citations: 19
Maxwell-Armstrong CA, Phillips RKS, 2003, Extrasphincteric rectal fistulas treated successfully by Soave's procedure despite marked local sepsis., Br J Surg, Vol: 90, Pages: 237-238, ISSN: 0007-1323
Edwards DP, Khosraviani K, Stafferton R, et al., 2003, Long-term results of polyp clearance by intraoperative enteroscopy in the Peutz-Jeghers syndrome., Dis Colon Rectum, Vol: 46, Pages: 48-50, ISSN: 0012-3706
PURPOSE: Enteroscopy during laparotomy for Peutz-Jeghers syndrome was introduced in our unit in 1987. Its aim is to achieve more complete polyp clearance and thereby reduce the number of subsequent laparotomies for small intestinal polyps. METHODS: All patients with Peutz-Jeghers syndrome who had undergone intraoperative enteroscopy since its introduction into our unit in 1987 were identified. The numbers of polyps identified by palpation and transillumination and by enteroscopy were recorded. The timing of, indications for, and findings of all subsequent laparotomies were analyzed and compared with data from our unit before the introduction of intraoperative enteroscopy. RESULTS: Twenty-five patients (14 females) were studied. Enteroscopy identified 350 (median 12, range 0-35) polyps not detected by palpation and transillumination. All impalpable polyps were removed endoscopically by snare or biopsy. The median follow-up was 53 (interquartile range, 13-133) months. Six patients have had an additional laparotomy (1 urgent relaparotomy for small-bowel perforation after endoscopic polypectomy, 4 polypectomies, and 1 adhesion obstruction). No patient has required operative polypectomy within 4 years of polyp clearance by intraoperative enteroscopy, compared with registry data of 4 (17 percent) of 23 patients who had more than 1 laparotomy within 1 year. CONCLUSION: Intraoperative enteroscopy for Peutz-Jeghers syndrome improves polyp clearance without the need for additional enterotomies and may help to reduce the frequency of laparotomies.
Sieber OM, Lipton L, Crabtree M, et al., 2003, Multiple colorectal adenomas, classic adenomatous polyposis, and germ-line mutations in MYH., New England Journal of Medicine, Vol: 348, Pages: 791-799
Healy JC, Halligan S, Bartram CI, et al., 2002, Dynamic magnetic resonance imaging evaluation of the structural and functional results of postanal repair for neuropathic fecal incontinence, DISEASES OF THE COLON & RECTUM, Vol: 45, Pages: 1629-1634, ISSN: 0012-3706
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- Citations: 3
Buchanan G, Halligan S, Williams A, et al., 2002, Effect of MRI on clinical outcome of recurrent fistula-in-ano., Lancet, Vol: 360, Pages: 1661-1662, ISSN: 0140-6736
Recurrent fistula-in-ano is usually due to sepsis missed at surgery, which can be identified by MRI. We aimed to establish the therapeutic effect of MRI in patients with fistula-in-ano. We did MRI in 71 patients with recurrent fistula, with further surgery done at the discretion of the surgeon. Surgery and MRI agreed in 40 patients, five (13%) of whom had further recurrence, compared with 16 (52%) of 31 in whom surgery and MRI disagreed (p=0.0005). Further recurrence in all 16 was at the site predicted by MRI. For surgeons who always acted on MRI, further recurrences arose in four of 25 (16%) operations versus eight of 14 (57%) operations for those who ignored imaging (p=0.008). Surgery guided by MRI reduces further recurrence of fistula-in-ano by 75% and should be done in all patients with recurrent fistula.
Crabtree MD, Tomlinson IPM, Hodgson SV, et al., 2002, Explaining variation in familial adenomatous polyposis: relationship between genotype and phenotype and evidence for modifier genes, GUT, Vol: 51, Pages: 420-423, ISSN: 0017-5749
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- Citations: 63
Phillips RKS, Wallace MH, Lynch PM, et al., 2002, A randomised, double blind, placebo controlled study of celecoxib, a selective cyclooxygenase 2 inhibitor, on duodenal polyposis in familial adenomatous polyposis, GUT, Vol: 50, Pages: 857-860, ISSN: 0017-5749
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- Citations: 310
Groves CJ, Saunders BP, Spigelman AD, et al., 2002, Duodenal cancer in patients with familial adenomatous polyposis (FAP): results of a 10 year prospective study., Gut, Vol: 50, Pages: 636-641, ISSN: 0017-5749
BACKGROUND: Duodenal cancer is one of the leading causes of death in familial adenomatous polyposis (FAP) patients. An endoscopic surveillance programme was therefore initiated in 1988, the outcome of which is described in this paper. METHODS: We report the 10 year follow up of 114 patients with FAP who were prospectively screened for the presence and severity of duodenal adenomas. RESULTS: Six of 114 patients (median age 67 years) developed duodenal adenocarcinoma. Four of these were from 11 patients who originally had Spigelman stage IV disease (advanced duodenal polyposis), which gives a 36% risk within this group of developing cancer. One case of duodenal cancer arose from 41 patients who originally had stage III disease (2%) and one cancer arose from 44 patients with original stage II disease (2%). All six patients have died: five were inoperable and one had recurrence three years after a pancreaticoduodenectomy. There was no association between duodenal cancer and site of germline mutation of the APC gene. CONCLUSIONS: Surveillance for duodenal adenocarcinoma and subsequent early referral for curative surgery has not been effective. Selection of patients with advanced but benign (Spigelman stage IV) duodenal polyposis for prophylactic pancreaticoduodenectomy should therefore be considered and can now be justified on the basis of these results. More comprehensive endoscopic surveillance of high risk (stage III and IV) patients is needed in an attempt to avoid underestimating the severity of duodenal polyposis, and to evaluate the role of endoscopic therapy in preventing advanced disease.
Sieber OM, Lamlum H, Crabtree MD, et al., 2002, Whole-gene <i>APC</i> deletions cause classical familial adenomatous polyposis, but not attenuated polyposis or "multiple" colorectal adenomas, PROCEEDINGS OF THE NATIONAL ACADEMY OF SCIENCES OF THE UNITED STATES OF AMERICA, Vol: 99, Pages: 2954-2958, ISSN: 0027-8424
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- Citations: 97
Catena F, Wilkinson K, Phillips RKS, 2002, Untreatable faecal incontinence: colostomy or colostomy and proctectomy?, Colorectal Dis, Vol: 4, Pages: 48-50
PURPOSE: To determine the frequency of rectal symptoms and secondary proctectomy in patients undergoing elective permanent end sigmoid colostomy for faecal incontinence and determine risk factors. METHODS: A retrospective chart review of patients undergoing elective end sigmoid colostomy for faecal incontinence at St Mark's Hospital between January 1991 and December 1998. Patients were divided into three groups: A, symptoms leading to subsequent proctectomy; B, symptomatic but avoiding proctectomy; C, asymptomatic. RESULTS: There were 44 patients (80% women, average age 57 years): Group A 12 (27%); Group B 13 (30%); Group C 19 (43%). Group A were on average younger than Group C (45 years vs 64 years, P < 0.05). No other risk factor for symptoms or proctectomy was evident, and in particular a prior history of obstructed defaecation/anal digitation was not related. Only half the patients undergoing proctectomy had histological evidence of defunctioned proctitis in the resected rectum. CONCLUSIONS: Data are insufficient presently to recommend primary proctectomy in this group of patients (even if it were to be performed laparoscopically).
Wallace MH, Forbes A, Beveridge IG, et al., 2001, Randomized, placebo-controlled trial of gastric acid-lowering therapy on duodenal polyposis and relative adduct labeling in familial adenomatous polyposis., Dis Colon Rectum, Vol: 44, Pages: 1585-1589, ISSN: 0012-3706
PURPOSE: Bile has been implicated in the pathogenesis of duodenal polyps in patients with familial adenomatous polyposis. In vitro experiments have shown that familial adenomatous polyposis bile is capable of producing DNA adducts. This effect can be ameliorated by increasing the pH of the incubate. The aim of this double-blind randomized placebo-controlled trial was to examine the effect of oral ranitidine on duodenal polyposis in a group of patients with familial adenomatous polyposis. METHODS: Twenty-six patients with familial adenomatous polyposis were randomly assigned to ranitidine 300 mg daily or placebo for six months after baseline endoscopy. Polyp counts were performed and biopsy specimens taken to detect DNA adducts by 32P-postlabeling. RESULTS: No difference was seen in polyp numbers (P = 0.9) or relative adduct labeling (P = 0.7) after treatment with ranitidine or placebo. DISCUSSION: Acid suppression therapy does not seem to improve duodenal polyposis despite in vitro findings. On the other hand, ranitidine does not exacerbate actual (or markers of) neoplasia in this highly tumor-prone condition.
Crabtree MD, Tomlinson IPM, Talbot IC, et al., 2001, Variability in the severity of colonic disease in familial adenomatous polyposis results from differences in tumour initiation rather than progression and depends relatively little on patient age, GUT, Vol: 49, Pages: 540-543, ISSN: 0017-5749
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- Citations: 21
Zhou XP, Woodford-Richens K, Lehtonen R, et al., 2001, Germline mutations in <i>BMPR1A/ALK3</i> cause a subset of cases of juvenile polyposis syndrome and of Cowden and Bannayan-Riley-Ruvalcaba syndromes, AMERICAN JOURNAL OF HUMAN GENETICS, Vol: 69, Pages: 704-711, ISSN: 0002-9297
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- Citations: 183
Crabtree M, Hodgson SV, Tomlinson IPM, et al., 2001, Evidence for genetic modifiers in FAP, JOURNAL OF MEDICAL GENETICS, Vol: 38, Pages: S39-S39, ISSN: 0022-2593
O'Bichere A, Bossom C, Gangoli S, et al., 2001, Chemical colostomy irrigation with glyceryl trinitrate solution., Dis Colon Rectum, Vol: 44, Pages: 1324-1327, ISSN: 0012-3706
PURPOSE: Colostomy irrigation may improve patient quality of life, but is time consuming. This study tests the hypothesis that irrigation with glyceryl trinitrate solution, by inducing gastrointestinal smooth muscle relaxation, may accelerate expulsion of stool by passive emptying, thereby reducing irrigation time. METHODS: Fifteen colostomy irrigators(with more than 3 years' experience) performed washout with tap water compared with water containing 0.025 mg/kg glyceryl trinitrate. Fluid inflow time, total washout time, and hemodynamic changes occurring during glyceryl trinitrate irrigation were documented by an independent observer. Subjects recorded episodes of fecal leakage and overall satisfaction on a visual analog scale. Cramps, headaches, and whether or not a stoma bag was used were expressed as a percentage of number of irrigations. Comparison of fluid inflow time, total washout time, leakage, and satisfaction was by Wilcoxon's signed-rank test and headaches, cramps, and stoma bag use was by McNemar's test. Pulse rate (paired t-test), systolic and diastolic blood pressures (Wilcoxon's test) at 20 and 240 minutes after washout with glyceryl trinitrate solution were compared with baseline. RESULTS: Fifteen patients (9 female), with a mean age of 53 (31-73) years, provided 30 sessions (15 with water and 15 with glyceryl trinitrate). Medians (interquartile ranges) for water vs. glyceryl trinitrate were fluid inflow time 7 (4-10) vs. 4, (3-5; P = 0.001); total washout time 40 (30-55) vs. 21, (15-24; P < 0.001); leakage 0 (0-1) vs. 0, (0-0; P = 0.02), satisfaction 10 (8-10) vs. 10 (9-10; P = 0.31). The number (percentage) of stoma bags, cramps, and headaches with water vs. glyceryl trinitrate were 7 (47 percent) vs. 7 (47 percent), P = 1; 1 (7 percent) vs. 14 (93 percent), P < 0.001; and 0(0 percent) vs. 14 (93 percent), P < 0.001, respectively. Changes in pulse (increase) and systolic and diastolic blood pressures (decrease) from baseline were maximal a
Clark CL, Wilkinson KH, Rihani HR, et al., 2001, Peri-operative management of patients having external anal sphincter repairs: temporary prevention of defaecation does not improve outcomes., Colorectal Dis, Vol: 3, Pages: 238-244, ISSN: 1462-8910
OBJECTIVE: To determine whether there was any detectable difference in outcomes of external anal sphincter repair depending on whether patients were managed routinely with a covering stoma, a constipating dietary regimen or a laxative dietary regimen in the early postoperative period. PATIENTS AND METHODS: A consecutive retrospective series of 299 anal sphincter repairs undertaken on 286 patients within a single institution was studied. Patients were divided into three groups depending on the peri-operative regimen followed: routine use of a covering stoma (group 1), routine use of a postoperative constipating dietary regimen (group 2) and routine use of a laxative dietary regimen (group 3). Choice of peri-operative regimen depended on surgeon preference alone. Short-term outcomes (length of stay, complications) and long-term outcomes (functional reported degree of continence, anal ultrasound and physiology test results) were assessed in relation to peri-operative group as well as aetiology of sphincter damage. RESULTS: Short-term results (complications of surgery) were obtainable in all patients; long-term results were available for 89% of patients. Length of stay was similar for all 3 groups (excluding re-admission for stoma closure). Complication rates were not significantly different between the three groups. Functional improvement in continence was reported by 68% of group 1, 69% of group 2 and 79% of group 3 (differences not statistically significant). An anatomical sphincter defect was detected postoperatively in 8% of patients in group 1, 9% in group 2 and 7% of group 3. Poorer outcomes were achieved in older patients and in patients with previous ileo-anal pouch formation. Early faecal impaction and repair breakdown were independently associated with poor long-term outcomes. CONCLUSIONS: Neither routine use of a covering stoma nor a postoperative constipating regimen produced better results following external anal sphincter repair than did the use of a post
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