Stoma reversal in functional bowel disease: managing patient choice.

Introduction: This study aims to assess the rate of stoma reversal in patients who have undergone stoma formation with permanent intent for functional bowel disorder. We also assessed the incidence of malignancy in defunctioned bowel.

Methods: This is a retrospective study of the outcomes of patients undergoing planned permanent stoma formation for functional bowel disorder over a 10-year period at a single tertiary centre.

A randomized double-blinded sham-controlled cross-over trial of tined-lead sacral nerve stimulation testing for chronic constipation.

Objectives: Sacral nerve stimulation (SNS) may provide long-term symptom relief to patients suffering from chronic constipation. Patients are currently selected for SNS using a 2-week peripheral nerve evaluation (PNE) comprising stimulation by temporary leads. However, only 40% of test responders receive long-term benefit from treatment meaning that healthcare costs per successfully treated patient are too high.

Anal sphincter fibrillation: is this a new finding that identifies resistant chronic anal fissures that respond to botulinum toxin?

Aim: Anal fissures can be resistant to treatment and some patients may undergo several trials of medical therapy before definitive surgery. It would be useful to identify predictors of poor response to medical therapy. This study assesses the role of anorectal physiological criteria to identify patients with anal fissure predicted to fail botulinum toxin (BT) treatment.

Defects in multiple complexes of the respiratory chain are present in ageing human colonic crypts.

Mitochondrial DNA (mtDNA) mutations accumulate in a number of ageing tissues and are proposed to play a role in the ageing process. We have previously shown that colonic crypt stem cells accumulate somatic mtDNA point mutations during ageing. These mtDNA mutations result in the loss of the activity of complex IV (cytochrome c oxidase (COX)) of the respiratory chain in the stem cells and their progeny, producing colonic crypts which are entirely COX deficient.

Use of the internet by colorectal cancer patients.

Objective: To identify the frequency of Internet use by colorectal cancer patients.

Materials And Methods: Fifty patients interviews.

Results: Only four patients (8%) had used the internet to access information about colorectal cancer though 36% would have used it if a site had been recommended.

The quality of patient-orientated internet information on colorectal cancer.

Objective: The Internet provides an enormous amount of patient-orientated information on colorectal cancer. This study examined its accessibility and quality.

Methods: Sites were identified using two search engines (Google and Hotbot) and the search terms 'bowel cancer' and 'colon and rectal cancer'.

Career intentions and prospects of basic surgical trainees in the Northern Region of England.

Objective: To determine the seniority and career intentions of doctors in posts recognised for basic surgical training in the Northern Region of England and to relate it to the number of specialist registrar posts available.

Methods: Postal questionnaire to and telephone interviews with 270 doctors. The main outcome measures were: demographic details, career stage, and intentions regarding subspecialties of choice.

Mitochondrial DNA mutations in human colonic crypt stem cells.

The mitochondrial genome encodes 13 essential subunits of the respiratory chain and has remarkable genetics based on uniparental inheritance. Within human populations, the mitochondrial genome has a high rate of sequence divergence with multiple polymorphic variants and thus has played a major role in examining the evolutionary history of our species. In recent years it has also become apparent that pathogenic mitochondrial DNA (mtDNA) mutations play an important role in neurological and other diseases.

Blind percutaneous insertion of Hickman lines by a specialist team.

Background: Long-term intravenous lines for the delivery of chemotherapy can be inserted by the percutaneous route or under direct vision by surgical exploration. Though the percutaneous route is widely used, many centres still employ a surgical approach. This study evaluates the safety of the blind percutaneous approach.

Rectal retroflexion: an essential part of lower gastrointestinal endoscopic examination.

Purpose: Retroflexion of the endoscope during rectal examination may increase diagnostic yield but is not routinely performed because of concerns about safety and a lack of appreciation of its importance. The purpose of this study was to examine the yield, safety, and tolerance of endoscopic rectal retroflexion.

Methods: Prospective cohorts of subjects undergoing unsedated screening flexible sigmoidoscopy were examined with and without routine retroflexion.

How to alter surgical practice? The use of guidelines to encourage day-case haemorrhoidectomy.

Background: Day case haemorrhoidectomy has been shown to be safe and acceptable to patients. The best way to introduce such evidence into clinical practice remains unclear: The aim is to assess the effectiveness of guidelines on the introduction of day-case haemorrhoidectomy in a general surgical unit.

Methods: Prospective audit of day-case haemorrhoidectomy and retrospective review of in-patient procedures.

Glutaraldehyde as a possible cause of diarrhoea after sigmoidoscopy.

Background: An outbreak of proctitis at the start of a colorectal cancer screening programme utilizing flexible sigmoidoscopy prompted scrutiny of the incidence of this complication and the role of glutaraldehyde in its aetiology.

Methods: Questionnaires completed 1 day and 3 months after sigmoidoscopy were reviewed for 388 patients, and glutaraldehyde levels in the recycled rinse water of the endoscope washing machine were measured. The incidence of symptoms in the subsequent 612 patients after installation of a washer that does not recycle rinse water was examined.

Fine-bore cannulas for peripheral intravenous nutrition: polyurethane or silicone?

The peripheral intravenous route is being used more frequently for the administration of short- to medium-term parenteral nutritional support. Dedicated fine bore cannulas have significantly reduced the incidence of thrombophlebitis. Currently available cannulas are made of polyurethane or silicone.

Rectal hypersensitivity in the irritable bowel syndrome.

Studies of rectal sensory thresholds and compliance in patients with the irritable bowel syndrome have produced conflicting results though there is persistent evidence of rectal hypersensitivity particularly in those with diarrhoea-predominant symptoms. This study examined rectal sensation and compliance in 31 patients with constipation-predominant irritable bowel syndrome (mean age 41 years, 27 female) and 17 healthy volunteers (mean age 45 years, 17 female). A rectal balloon was inflated with fluid at a constant rate and the volume and intrarectal pressure at sensory threshold was recorded.

Neutrophil adhesion molecule expression and response to stimulation with bacterial wall products in humans is unaffected by parenteral nutrition.

1. Total parenteral nutrition is associated with a high incidence of septic complications. This may be partly due to neutrophil dysfunction induced by the parenteral nutrition.

Obstructive jaundice causes reduced expression of polymorphonuclear leucocyte adhesion molecules and a depressed response to bacterial wall products in vitro.

Background: Obstructive jaundice is associated with an increased incidence of infection and endotoxaemia, which may result from impaired host immunity. Neutrophil adhesion to vascular endothelium is a key part of the inflammatory response.

Aims: To investigate neutrophil adhesion molecule expression and activation in obstructive jaundice.

Physiological changes after Delorme's procedure for full-thickness rectal prolapse.

Anal sphincter pressures, rectal compliance and sensation in 19 women of mean age 77 (range 57-94) years were studied before and after Delorme's procedure for full-thickness rectal prolapse. No patient had significant problems with defaecation after operation. There were no significant changes in anal sphincter pressures but the volume of first rectal sensation decreased from a median of 140 ml before surgery to 65 ml after the procedure (P = 0.

Prevention of postoperative renal dysfunction in patients with obstructive jaundice: a comparison of mannitol-induced diuresis and oral sodium taurocholate.

The effect of oral sodium taurocholate was compared with that of intravenous mannitol when used independently to determine their relative effect on protecting postoperative renal function in patients with obstructive jaundice. A total of 20 patients with obstructive jaundice were randomized to receive either mannitol or sodium taurocholate before surgery. Their preoperative and postoperative renal function was monitored using serum creatinine and predicted creatinine clearance over a 4-day period.