A 15-year audit of home parenteral nutrition provision at the John Radcliffe Hospital, Oxford.

Background: Home parenteral nutrition (HPN) is an established option for patients suffering from intestinal failure, often pending definitive surgery, but sometimes for life or pending intestinal transplant. Care for patients with HPN is provided at centres other than designated intestinal failure units in the UK, but there are few data on outcomes.

Aim: To audit the standard of care at one such centre using objective measures to compare with results published from other centres and intestinal failure units.

The management and outcome of anastomotic leaks in colorectal surgery.

Purpose: Anastomotic leaks in colorectal surgery are associated with significant morbidity and mortality and may result in poor functional and oncological outcomes. Diagnostic difficulties may delay identification and appropriate management of leaks. The aim of this study was to look at the diagnosis, clinical management and outcomes of anastamotic leaks in our department.

Quantification of histologic regression of rectal cancer after irradiation: a proposal for a modified staging system.

Purpose: Long-course preoperative radiotherapy has been recommended for rectal carcinoma when there is concern about the ability to perform a curative resection, for example, in larger tethered tumors or those sited anteriorly or near the anal sphincter. "Downstaging" of the tumor may occur, and this is of importance when estimating the prognosis and selecting postoperative therapy for patients. We studied the effects of preoperative chemoradiotherapy on the pathology of rectal cancer, and we propose a simplified measurement of tumor regression, the Rectal Cancer Regression Grade.

Randomized, double-blind, placebo-controlled trial of sildenafil (Viagra) for erectile dysfunction after rectal excision for cancer and inflammatory bowel disease.

Purpose: Controlled trials have demonstrated the efficacy of sildenafil for "mixed etiology" erectile dysfunction, but this may not be the case if there is underlying pelvic parasympathetic nerve damage. We aimed to determine the efficacy of sildenafil after rectal excision for rectal cancer and inflammatory bowel disease.

Methods: Patients with erectile dysfunction after rectal excision were randomly assigned in a double-blind manner to sildenafil or placebo groups.

Recurrence after abdominal surgery for Crohn's disease: relationship to disease site and surgical procedure.

Purpose: We investigated the hypothesis that there is an "aggressive" subtype of Crohn's disease characterized by early recurrence and that disease location and surgical procedure are associated with differing patterns of recurrence.

Methods: We analyzed 280 patient records totaling 482 major abdominal operations from a prospectively compiled Crohn's disease database. Patterns of recurrence, as defined by reoperation, were analyzed by Kaplan-Meier plots and log-rank tests for the group as a whole, as well as according to disease location and operation performed using log-rank and Cox regression analysis.