Prevalence of pelvic floor symptoms in female patients attending the two-week wait clinic with suspected colorectal cancer.

Introduction The aim of this study was to establish the prevalence of pelvic floor symptoms in women referred to a colorectal two-week wait (2WW) clinic with suspected colorectal cancer. Methods A questionnaire assessing faecal incontinence (FI) (Wexner score) and obstructed defecation syndrome (ODS) (Renzi score) was offered to 98 consecutive female patients attending a colorectal 2WW clinic at a single trust. Results Overall, 56 (57%) of the 98 patients had significant ODS and/or FI (scores >9/20), 33 (34%) had ODS and 40 (41%) had FI.

Short-term Outcomes of a Randomized Pilot Trial of 2 Treatment Regimens of Transcutaneous Tibial Nerve Stimulation for Fecal Incontinence.

Background: Fecal incontinence is a socially disabling condition that affects ≤15% of adults. Neuromodulatory treatments for fecal incontinence are now well established. Less invasive, cheaper, and more ambulatory forms of neuromodulation are under exploration.

The association between referral source and outcome in patients with colorectal cancer.

Aim: The colorectal two-week wait fast track (FT) referral system was nationally implemented in the UK in 2000 to ensure patients with colorectal cancer (CRC) received prompt access to specialized services. The aim of this study was to determine the association between the mechanism of referral to colorectal services and the 5-year outcomes for patients with CRC.

Methods: Consecutive patients with newly diagnosed CRC presenting between October 2002 and September 2004 were identified retrospectively.

Randomized clinical trial of metronidazole ointment versus placebo in perianal Crohn's disease.

Background: The potential for metronidazole 10 per cent ointment to exert therapeutic benefit in perianal Crohn's disease, while minimizing the adverse effects found with oral metronidazole, was evaluated in a randomized placebo-controlled study.

Methods: Subjects with perianal Crohn's disease were randomized to metronidazole 10 per cent ointment, 0.7 g applied perianally three times daily, or placebo ointment.

An evaluation of treatment decisions at a colorectal cancer multi-disciplinary team.

Objective: It is mandatory for treatment decisions for patients with colorectal cancer to be made within the context of a multi-disciplinary team (MDT) meeting. It is currently uncertain, however, how to best evaluate the quality of MDT decision-making. This study examined MDT decision-making by studying whether MDT treatment decisions were implemented and investigated the reasons why some decisions changed after the meeting.

The association between referral source and stage of disease in patients with colorectal cancer.

Objective: The colorectal fast track (FT) referral system was set up to ensure patients with suspected cases of colorectal cancer (CRC) received prompt access to specialized services. The aim of this study was to ascertain the association between referral source and the time it took to be seen by a colorectal surgeon to establish whether referral source had any association with the stage of disease at presentation in patients with CRC.

Method: Consecutive patients with newly diagnosed CRC presenting between October 2002 and September 2004 were identified retrospectively.

Single-fiber electromyography correlates more closely with incontinence scores than pudendal nerve terminal motor latency.

Background: The investigation of fecal incontinence is important in deciding the most appropriate treatment. The presence of neuropathy has been shown to affect surgical outcomes adversely. Latency studies are of dubious value in assessing neuropathy; needle electromyography is the gold standard test.

Fast-track barium enema: meeting the two-week wait rule for patients with suspected colorectal cancer.

Objectives: To meet the introduction of the two-week wait (TWW) rule for patients with suspected colorectal cancer, a fast-track barium enema (FTBE) service was set up. This study was conducted to evaluate the success of this approach in preparation for meeting the forthcoming targets on waiting times to treatment from referral and diagnosis.

Methods: All patients were offered a double-contrast barium enema within two-weeks, except those with a palpable rectal mass.

Comparison of ultrasound and manometric sphincter length and incontinence scores.

Purpose: Fecal incontinence can be assessed by a wide variety of means that vary in their clinical relevance. This study assesses the correlation between two methods of recording sphincter length and incontinence scores.

Methods: A retrospective review of results from 1999 to 2001 of 137 patients with fecal incontinence was undertaken on patients who had both ultrasound and manometric assessment.

Abnormal subcellular distribution of mature MUC2 and de novo MUC5AC mucins in adenomas of the rectum: immunohistochemical detection using non-VNTR antibodies to MUC2 and MUC5AC peptide.

Anti-mucin variable number tandem repeat (VNTR) antibodies have been used previously to demonstrate the de novo presence of MUC5AC and MUC6 mucin in colorectal adenomas and increased synthesis of MUC2, the major secreted mucin in normal colorectal mucosa. Here we examined secreted mucins in tubular, tubulovillous and villous adenomas of the rectum using non-VNTR antibodies designed to assess mature mucin. Mucin gene messenger RNAs were detected by in situ hybridization.

Treatment of resistant anal fissure with advancement anoplasty.

Objective: The primary aim of this study was to assess the outcome of advancement anoplasty in the treatment of chronic anal fissure, resistant to conventional therapy. The secondary aim was to evaluate the anal resting pressure in these patients with resistant fissures.

Patients And Methods: Over a five-year period eight patients (2 male, median age 55 years, range 20-74) with resistant anal fissure were referred from 6 centres.

Mucin gene expression in the ileoanal reservoir is altered and may be relevant to the risk of inflammation and dysplasia.

Background: Adaptive colonic phenotypic change of the ileal mucosa is a feature of the ileoanal reservoir (IAR) with time, as described by mucin glycoprotein and histological analysis. Mucin gene expression is altered in colorectal neoplasia and inflammatory bowel disease but little is known of its expression in the IAR.

Aims: To examine the changes in mucin gene expression contributing to mucosal protection of the IAR against a background of known changes occurring in inflammatory disease and colorectal neoplasia.

Mucin expression in the ileoanal reservoir reflects incomplete mucosal adaptation.

Restorative proctocolectomy is regarded as a standard surgical procedure for patients who require a proctocolectomy for ulcerative colitis and familial adenomatous polyposis. The ileal mucosa undergoes colonic phenotypic change with time, but the extent and relevance of these changes to the long-term safety of the ileoanal pouch are unclear. The aim of this study was to study the mucin biology of this adaptive process in order to assess its extent and possible impact on pouch safety.

Differential expression of the chromosome 11 mucin genes in colorectal cancer.

The four secretory mucin genes clustered on chromosome 11, MUC2, MUC5AC, MUC5B and MUC6, were screened in 37 patients with cancers in the left hemi-colon or rectum and 10 normal rectal controls. The mucin genes were detected by in situ hybridization using oligonucleotide probes to the variable number tandem repeat (VNTR) sequences, while the proteins were stained with non-VNTR (MUC2, MUC5AC and MUC5B) or VNTR (MUC6) antibodies. Low levels of MUC2 mRNA were detected in non-mucinous adenocarcinomas (5/27) while a higher proportion of mucinous carcinomas (4/9) was positive.

On-line quantitative analysis of surface electromyography of the pelvic floor in patients with faecal incontinence.

Background: Needle electromyography (EMG) remains the 'gold standard' for the assessment of external anal sphincter innervation. It is, however, an invasive and poorly tolerated technique. In this study a quantitative form of surface electromyography was compared with needle EMG of the external anal sphincter.

Reduction of sialic acid O-acetylation in human colonic mucins in the adenoma-carcinoma sequence.

The oligo-O-acetylation of sialic acids found in normal colonic mucins is greatly reduced in colorectal cancer. Mucins prepared from cancer tissue in adenocarcinoma showed this reduction, while normal O-acetylation was detected in resection margin and control cases and total mucin sialic acid content was significantly decreased in cancer vs. control samples.

Transanal endoscopic treatment of benign canine rectal tumours: preliminary results in six cases (1992 to 1996).

Transanal endoscopic resection and cautery of benign rectal tumours was performed in six dogs with extensive and/or inaccessible rectal neoplasia. The results were encouraging, with three dogs cured and the quality of life of a further two improved for a significant time. The remaining dog died as a result of rectal perforation.

Definitive repair of anovaginal fistula in Crohn's disease.

Anovaginal fistula may be a very distressing complication of Crohn's disease. We review the definitive repair of such fistulas in ten patients. The objectives were to cure the fistula, maintain continence and avoid proctectomy.

Preoperative increase in neuromuscular jitter and outcome following surgery for faecal incontinence.

Background: Long-term results of surgery for faecal incontinence remain disappointing. Previous studies have demonstrated that pudendal neuropathy may progress in incontinent patients managed either conservatively or operatively. This progression of pudendal neuropathy may underlie poor long-term results.

Colonic mucins in ulcerative colitis: evidence for loss of sulfation.

Colonic tissue obtained at surgery from control individuals and patients with ulcerative colitis was used to isolate mucins and to prepare mucin glycopolypeptides by pronase digestion. These were compared with mucins labelled with [35S] sulfate and [3H]-glucosamine after organ culture tissue samples from the same patients. A significant loss of mucin sulfation was detected in the colitis patients by both metabolic labelling and chemical analysis of the glycopolypeptides.

Urge incontinence of faeces is a marker of severe external anal sphincter dysfunction.

A proportion of patients with faecal incontinence experience debilitating urgency of defaecation and urge incontinence. This study prospectively assessed 56 faecally incontinent patients by means of standard interview, physical examination and anorectal physiology. Patients with urge incontinence, when compared with those without urge incontinence, were symptomatically worse, had had more vaginal deliveries and had more bowel actions each day.

Synchronous proctocolectomy and ileoanal pouch formation and the risk of Crohn's disease.

There is controversy on the advisability of one-stage proctocolectomy and the formation of an ileoanal pouch. Accurate preoperative diagnosis is essential to avoid the error of constructing a pouch in a patient with Crohn's disease. Twenty-four consecutive patients undergoing subtotal colectomy for inflammatory bowel disease were reviewed.

What is the relationship between perineal descent and anal mucosal electrosensitivity?

Purpose: Perineal descent is found in many patients with anorectal disorders. There is now substantial evidence against perineal descent causing damage to the motor axons in the pudendal nerves, but the sensory sequelae of perineal descent have been neglected. The purpose of this study was to establish the relationship between perineal descent and anal sensation.