The Effect of Bladder Filling Rate on the Voiding Behavior of Patients with Overactive Bladder.

Purpose: Many self-help guides advise patients that spreading fluid intake throughout the day can reduce overactive bladder symptoms. However, although animal studies suggest a link between a faster filling rate and increased afferent nerve firing, to our knowledge the relationship between the filling rate and bladder sensation has not been examined in humans. The aim of this study was to investigate the effect of bladder volume and the bladder filling rate on the bladder sensation and voiding patterns of patients with overactive bladder.

APRIL is a novel clinical chemo-resistance biomarker in colorectal adenocarcinoma identified by gene expression profiling.

Background: 5-Fluorouracil(5FU) and oral analogues, such as capecitabine, remain one of the most useful agents for the treatment of colorectal adenocarcinoma. Low toxicity and convenience of administration facilitate use, however clinical resistance is a major limitation. Investigation has failed to fully explain the molecular mechanisms of resistance and no clinically useful predictive biomarkers for 5FU resistance have been identified.

Endoscopic trans-anal resection of rectal tumours: critical appraisal of an interdisciplinary approach.

Objective: Endoscopic trans-anal resection (ETAR) is an accepted technique for treating benign rectal adenomas that relies on technical expertise with the urological resectoscope. We present our experience with ETAR in an interdisciplinary setting combining the decision-making of the colorectal surgeon with the technical skill of the urologist.

Method: Assessment of all patients with adenomas and their subsequent care was organized by the colorectal team.

Non-restorative surgery for rectal cancer: indications in 2003.

Background: Although the majority of patients with low rectal tumours can now be offered restorative surgery, a subset of patients with very distal, locally extensive tumours, or excessive comorbidity, continue to require abdominoperineal resection or a Hartmann's procedure. The Clinical Standards Board for Scotland (CSBS) recommends that the permanent stoma rate for patients with rectal cancer should be no more than 40%. The aim of this study was to determine the proportion of patients not suitable for restorative surgery and to explore the remaining indications for non-restorative surgery.

Nicorandil associated anal ulceration.

Objective: Nicorandil is a vasodilator used to control angina. It has been associated with oral and anal ulceration that resolves upon withdrawal of the drug.

Patients And Methods: We report a series of 13 patients with nonspecific anal ulceration all of whom were receiving nicorandil for control of symptoms of ischaemic heart disease.

Colonic pouchography is not routinely required prior to stoma closure.

Background: Colonic pouch formation with pouch-anal anastomosis is now regarded as the procedure of choice for restoration of intestinal continuity following anterior resection for low rectal cancers. The aim of this study was to review the necessity for routine colonic pouchography prior to closure of a diverting loop stoma.

Methods: This was a prospective study of 52 consecutive patients who underwent colonic pouch formation between 1 June 1999 and 31 May 2002, four of whom have subsequently died.

Nicorandil associated anal ulceration.

Nicorandil is a vasodilator used to control angina. It has been associated with oral ulceration and stomatitis that resolves upon withdrawal of the drug. We report a series of five patients with non-specific anal ulceration, all of whom received nicorandil for symptomatic control of ischaemic heart disease.

Right hemicolectomy: mechanical bowel preparation is not required.

Background: Mechanical bowel preparation before colonic surgery is widely advocated but remains controversial. Recent guidelines published by the Clinical Standards Board for Scotland recommend mechanical bowel preparation prior to surgery for all colorectal cancers but this may be inappropriate. This study examines the outcome of a policy of no mechanical preparation before elective right hemicolectomy.

Analysis of uracil DNA glycosylase in human colorectal cancer.

Uracil DNA glycosylase (UDG) is responsible for the removal of uracil present in DNA after cytosine deamination or misincorporation during replication. Colorectal cancer is widely treated with 5-FU, which leads to thymidylate synthase inhibition; this accounts for increased dUTP intracellular pools and subsequent uracil incorporation into DNA. Uracil misincorporation has also been implicated in the link between folate deficiency and colorectal cancer risk.

Eniluracil treatment completely inactivates dihydropyrimidine dehydrogenase in colorectal tumors.

Purpose: To determine the effect of eniluracil on colorectal tumor dihydropyrimidine dehydrogenase (DPD) activity.

Patients And Methods: Patients who were to undergo primary colorectal tumor resection received oral eniluracil 10 mg/m(2) twice daily for 3 days before surgery. Mononuclear cells were obtained before the start of eniluracil and on the morning of surgery, to measure DPD activity, protein, and mRNA.

Optimum method for urinary drainage in major abdominal surgery: a prospective randomized trial of suprapubic versus urethral catheterization.

The outcome of suprapubic and urethral catheterization in abdominal surgery was compared in a prospective randomized trial. Twenty-eight patients received a suprapubic and 29 a urethral catheter. The groups were similar in terms of age, sex, operation performed and postoperative analgesia.

Pouch-vaginal fistula after restorative proctocolectomy: aetiology and management.

Pouch-vaginal fistula is a rare complication following restorative proctocolectomy. Seven patients who developed such a fistula are presented. Six pouch-vaginal fistulas occurred at the level of the pouch-anal anastomosis and one 3 cm above the anastomosis, level with the posterior vaginal fornix.

Distribution of nitric oxide synthase containing neurons in the rectal myenteric plexus and anal canal. Morphologic evidence that nitric oxide mediates the rectoanal inhibitory reflex.

Purpose: Following the demonstration that a novel neurotransmitter, nitric oxide (NO), is released during neurogenic relaxation of the internal anal sphincter in vitro, it has been suggested that NO could mediate the rectoanal inhibitory reflex in vivo. The aim of this study was to establish whether the distribution of NO-producing nerves in the anorectum is consistent with this proposed role.

Methods: NO is synthesized in neurons which contain the enzyme nitric oxide synthase and their presence in the anorectum was determined in tissue obtained from nine abdominoperineal and three anterior resection specimens in patients undergoing surgery for rectal carcinoma.

Abnormalities of nitric-oxide-producing neurons in Hirschsprung's disease: morphology and implications.

Nitric oxide (NO) is a recently discovered neurotransmitter that is thought to mediate relaxation of gut smooth muscle during peristalsis. To assess its role in the pathophysiology of Hirschsprung's disease, the authors examined the distribution of neurons that produce NO in specimens from seven infants with this condition. Immunohistochemical analysis of cryostat sections for nitric oxide synthase (NOS) immunoreactivity (NOS catalyzes the production of NO) showed that NOS is localized in a substantial subpopulation of enteric neurons in both the myenteric and submucosal plexuses in the ganglionated gut, but it was completely absent in aganglionic bowel.

In vitro response of the human anal canal longitudinal muscle layer to cholinergic and adrenergic stimulation: evidence of sphincter specialization.

A study was performed to determine the in vitro response of the longitudinal smooth muscle layer (conjoined longitudinal coat) of the human and canal to cholinergic and adrenergic stimulation, and to compare this with similar features of the internal anal sphincter (IAS) and rectal smooth muscle. Tissue was obtained from abdominoperineal and anterior resection specimens, and strips of muscle mounted for isometric tension recording in superfusion organ baths. Both conjoined longitudinal coat and IAS strips generated and maintained spontaneous myogenic tension (mean(s.

Nerve mediated relaxation of the human internal anal sphincter: the role of nitric oxide.

The aim of this study was to determine if nitric oxide (NO) is the non-adrenergic, non-cholinergic neurotransmitter, released by enteric inhibitory nerves, which mediates relaxation of the human internal anal sphincter. Isolated muscle strips were mounted for isometric tension recording in superfusion organ baths. Sodium nitroprusside, an exogenous donor of NO, relaxed the strips in a concentration dependent manner.

Flexible cystoscopy compared with ultrasound in the detection of recurrent bladder tumours.

A combination of transrectal and transabdominal ultrasound was compared with flexible cystoscopy as a means of detecting recurrent bladder tumours. The study group comprised 50 patients who had previously had rigid cystoscopy. They underwent combination ultrasound in the out-patient department 1 week before flexible cystoscopy.

Trauma centres and the efficient use of financial resources.

The economic aspects of trauma centres were examined using published results and local financial data to discover if such institutions are an efficient use of resources. The cost of trauma centre care depends upon the number of centres built. An 'ideal' system in the UK of eight centres will cost 31.

Which deaths in vascular surgery are avoidable? A review of 150 consecutive deaths occurring on the Oxford regional vascular service.

One hundred and fifty consecutive deaths occurring on the Oxford regional vascular service were reviewed using data collected prospectively by weekly audit to determine which deaths were avoidable. During the period of study there were 2449 admissions to the vascular service and 1796 operations were performed. Of those who died 71 (47%) had aneurysmal disease and 76 (51%) occlusive disease.

General practice-based population screening for abdominal aortic aneurysms: a pilot study.

All 1195 male patients aged between 65 and 74 years on the Family Practitioner Committee register for the four group practices in Stroud, UK were invited for a health screening check. The examinations included abdominal ultrasonography to measure maximum aortic diameter, measurement of blood pressure and recording of smoking habits. An attendance rate of 76 per cent was achieved (906 patients).

The feasibility of screening for abdominal aortic aneurysms in a district general hospital.

The feasibility of a screening programme for abdominal aortic aneurysms within a district general hospital population is explored, based on our current accepted knowledge of the natural history of this disease process. It is shown that ultrasound screening of males aged between 65 and 74 years, with elective repair of the aneurysms discovered, could save up to 20 lives per year in this district at a reasonable and justifiable cost. Moreover, such a programme would not place an unacceptable burden on existing radiological and surgical facilities.