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Rectal Bleeding (rectal + bleeding)

Distribution by Scientific Domains

Medical Sciences	100%

Distribution within Medical Sciences

Surgery & Surgical Specialties	34%
Gastroenterology & Hepatology	28%
Urology	11%

Selected Abstracts

Simplified treatment of massive rectal bleeding following prostate needle biopsy

INTERNATIONAL JOURNAL OF UROLOGY, Issue 7 2004
MURAT GONEN
Abstract Rectal bleeding is frequently seen in patients undergoing transrectal ultrasound-guided prostate biopsy, but it usually stops spontaneously. We report a case of life-threatening rectal bleeding following this procedure. Bleeding was controlled using an ordinary condom, which was successfully inflated in the rectum over the bleeding site. [source]

Treatment of haemorrhagic radiation-induced proctopathy using small volume topical formalin instillation

ALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 11 2006
S. N. CULLEN
Summary Background Between 2 and 5% of patients undergoing pelvic radiotherapy develop chronic radiation proctopathy, occurring as a result of damage to the rectal mucosa during the treatment. Rectal bleeding of varying severity can occur as a consequence. There have been no formal trials of treatment for haemorrhagic radiation proctopathy and a variety of methods are currently used. Aim In a retrospective study of 20 patients treated at a single centre, we assessed the efficacy of small volume topical formalin instillation to control bleeding from radiation proctopathy. Method Patients were treated by a single operator using 20 mL of a 5% solution of formalin instilled into the rectum via a flexible sigmoidoscope for 3 min. Patients were followed up for an average of 22.7 months (range: 2,69). Results A single session of formalin treatment was effective in 13 of 20 (65%) patients and a further four (20%) patients responded to a second treatment. No complications of the treatment was identified. Conclusion Small volume formalin instillation therapy appears to be safe and effective in the context of haemorrhagic radiation proctopathy. The technique is simple, inexpensive, quick and requires no sedation. We suggest that it should be considered as a first line for patients presenting with this distressing condition. [source]

Lower gastrointestinal symptoms are not predictive of colorectal neoplasia in a faecal occult blood screen-positive population,

BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 4 2005
S. Ahmed
Background: The aim of this study was to evaluate the incidence of lower gastrointestinal symptoms in faecal occult blood (FOB) test-positive participants in a colorectal screening programme, and to compare the colonoscopic findings in symptomatic and asymptomatic individuals. Methods: Five hundred and sixty-three consecutive individuals with a positive FOB test in the Scottish arm of the national colorectal cancer screening pilot were studied. All were aged between 50 and 69 years and underwent colonoscopy. Before the procedure the participants were given a standard questionnaire to elicit gastrointestinal symptoms; these were correlated with the colonoscopic findings. Results: Of the 563 participants, 439 (78·0 per cent) had one or more lower gastrointestinal symptoms and 124 (22·0 per cent) were symptom free. Taking adenoma and carcinoma together, 322 (57·2 per cent) of the subjects were found to have colorectal neoplasia, and 128 (22·7 per cent) had a completely normal colon. Rectal bleeding was the most common symptom, followed by change in bowel habit, abdominal pain, tenesmus, unexplained weight loss, rectal pain and unexplained anaemia. No significant associations were found between any of these symptoms and the findings at colonoscopy. Conclusion: In a FOB test-positive screened population, lower gastrointestinal symptoms are common, but are not predictive of colorectal neoplasia. Copyright © 2004 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source]

Reported symptoms, diagnostic delay and stage of colorectal cancer: a population-based study in Denmark

COLORECTAL DISEASE, Issue 8 2006
M. Korsgaard
Abstract Objective, The primary prognostic factor for colorectal cancer (CRC) is stage. Any association between symptoms, diagnostic delay and stage may have implications for the clinical course of the disease. We examined the association between symptoms and diagnostic delay and between symptoms and stage, and assessed whether the associations differed for colon cancer (CC) and rectal cancer (RC). Patients and methods, Population-based prospective observational study based on 733 Danish CRC patients. Diagnostic delay and patients' reported symptoms were determined through questionnaire,interviews. Dukes' stage was obtained from medical records and pathology forms. Diagnostic delay was categorized into three delay groups: , 60, 61,150 and > 150 days. Stage was classified into nonadvanced (Dukes' A and B) or advanced (Dukes' C and D) cancers. We calculated the frequency of the most frequently reported initial symptom or symptom complex for CC and RC patients, and evaluated the frequency of patients with different initial symptoms/symptom complexes in the three delay groups. For the most frequent initial symptoms/symptom complexes, we calculated the frequencies according to stage, and estimated the relative risk of having an advanced stage, with 95% confidence intervals. Results, The most frequent initial symptoms/symptom complexes were very vague symptoms for CC and rectal bleeding for RC. For both CC and RC, rectal bleeding was significantly associated with nonadvanced stage. The relative risk of having an advanced cancer was 0.6 for monosymptomatic rectal bleeding and 0.7 for rectal bleeding combined with other symptoms. Conclusions, Initial symptoms of CC were often very vague, making it difficult to identify a precise start date. The most frequent initial symptom/symptom complex for RC , rectal bleeding , was better defined. Rectal bleeding was significantly associated with nonadvanced CC and RC and a significantly decreased relative risk of having an advanced cancer. [source]

Colorectal cancer in the young: a 12-year review of patients 30 years or less

COLORECTAL DISEASE, Issue 3 2004
M. H. Kam
Abstract Objectives As the incidence of young colorectal cancer is rising, a review of the characteristics of such malignancy in those under 30 years of age is timely at this stage. Patients and methods Thirty-nine patients (21 M, 18 F) were operated upon over a 12-year period in a single centre. The mean age was 25 years and median follow-up was 20 months. Results Rectal bleeding, change in bowel habit and abdominal pain were the commonest symptoms. Six patients had a positive family history, while four others were diagnosed as index cases of familial adenomatous polyposis. Rectal tumours made up 43% of all colorectal cancers diagnosed. Seventy percent of patients presented at an advanced stage, but curative resection was attempted for 29 patients. Eight underwent palliative resections, 1 had an ileostomy while another underwent a bypass procedure. Eleven patients have died, 14 had no evidence of recurrent disease while 3 were still alive with recurrent disease. Conclusion Age does not affect survival, and early endoscopy is recommended for all with persistent symptoms. Early diagnosis, radical resection and adjuvant therapy still form the cornerstone in management of colorectal cancer in this age group. [source]

Suppression of experimental colitis in mice by CD11c+ dendritic cells

INFLAMMATORY BOWEL DISEASES, Issue 2 2009
Joseph E. Qualls PhD
Abstract Background: The innate immune system serves a critical role in homeostasis of the gastrointestinal (GI) tract. Both macrophages (MØs) and dendritic cells (DCs) have been shown to have pathogenic roles in animal models of inflammatory bowel disease. However, studies by several labs have established that resident MØs and DCs within the normal GI tract maintain an immunosuppressive phenotype compared to that seen in other peripheral sites. Recent studies by our lab demonstrated that the depletion of both MØs and DCs before the initiation of dextran sodium sulfate (DSS)-induced colitis resulted in exacerbation of disease, partly caused by increased neutrophil influx. Methods/Results: In this current report, DSS-induced colitis was shown to be significantly more severe when DCs were selectively depleted in mice as indicated by changes in weight loss, stool consistency, rectal bleeding, and histopathology. In contrast to enhanced colitis in MØ/DC-depleted mice, which was associated with increased neutrophil influx, increased colitis in DC-depleted mice was not associated with an increase in neutrophils in the colon, as shown by CXCL1 chemokine levels and myeloperoxidase (MPO) activity. However, increased IL-6 gene and protein expression in colon tissues correlated positively with increased colitis severity in DC-depleted mice compared to colitis in DC-intact mice. Conclusions: This study demonstrates that resident DCs can suppress the severity of acute DSS colitis and that regulation of IL-6 production may contribute to DC-mediated control of intestinal inflammation. (Inflamm Bowel Dis 2008) [source]

Effect of extended MMX mesalamine therapy for acute, mild-to-moderate Ulcerative Colitis

INFLAMMATORY BOWEL DISEASES, Issue 1 2009
Michael A. Kamm MD
Abstract Background: Many patients with ulcerative colitis (UC) respond to mesalamine therapy within 8 weeks. Those not achieving remission after 8 weeks are often treated with steroids or other immunosuppressive therapies. This study aimed to determine the effect of 8 weeks' high-dose MMX mesalamine extension therapy in patients with active, mild-to-moderate UC who had previously failed to achieve complete remission in 2 phase III, double-blind, placebo-controlled studies of MMX mesalamine (SPD476-301 and -302). Methods: Patients with active, mild-to-moderate UC who did not achieve clinical and endoscopic remission after ,8 weeks' treatment with MMX mesalamine (2.4 or 4.8 g/day), ASACOL® (mesalamine) delayed-release tablets 2.4 g/day, or placebo in the phase III studies received MMX mesalamine 4.8 g/day for 8 weeks. The aim was to assess remission at week 8, defined as a total modified UC Disease Activity Index score of ,1, calculated as: scores of 0 for rectal bleeding and stool frequency, a combined Physician's Global Assessment score and sigmoidoscopy score of ,1, no mucosal friability, and a ,1 point reduction from baseline in sigmoidoscopy score. Results: Overall, 304 patients who entered this acute extension study were evaluated; 59.5% achieved remission at week 8. Remission rates were similar irrespective of prior treatment in the initial acute phase III studies. Conclusions: Most patients with mild-to-moderate UC who fail to achieve remission with up to 8 weeks' initial mesalamine therapy can achieve clinical and endoscopic remission following a further 8 weeks' treatment with high-dose MMX mesalamine therapy, thereby avoiding step-up therapy. (Inflamm Bowel Dis 2008) [source]

Efficacy and safety of mesalamine 1 g HS versus 500 mg BID suppositories in mild to moderate ulcerative proctitis: A multicenter randomized study

INFLAMMATORY BOWEL DISEASES, Issue 7 2005
Mark Lamet MD
Abstract Background: Ulcerative proctitis (UP) usually presents as fresh rectal bleeding. Successful treatment using topical mesalamine 5-aminosalicyclic acid (5-ASA) 500 mg BID suppository led to developing a once-a-day formulation that could contribute to better acceptability and ease of use by patients. The objective of this randomized trial, conducted in 18 centers, was to compare efficacy of 2 modes of treatment with 5-ASA suppositories. Methods: Ninety-nine patients with mild or moderate UP limited to 15 cm of the anal margin, evidenced by a disease activity index (DAI) between 4 and 11, were randomized to 5-ASA 500 mg suppository (Canasa; Axcan Pharma) BID or 1 g at bedtime (HS) for 6 weeks. The study used a noninferiority hypothesis based on the mean difference in DAI values after 6 weeks of treatment on an intent-to-treat basis using analysis of covariance. DAI was derived from a composite of the measures of stool frequency, rectal bleeding, mucosal visualization at endoscopy, and general well being. Results: There was no difference between groups at baseline for demographic and clinical parameters. Mean DAIs fell from 6.6 ± 1.5 (SD) to 1.6 ± 2.3 in the 500 mg BID group (n = 48) and from 6.1 ± 1.5 to 1.3 ± 2.2 in the 1 g HS group (n = 39). There was no significant difference (P = 0.74) in mean DAI at week 6 between the 2 groups. Both groups showed a significant reduction (P < 0.0001) in DAI over the course of the 6 weeks. Both formulations showed effectiveness in reducing each individual component of the DAI. There was no significant difference between treatments in adverse events, and both groups had an overall drug compliance of greater than 95%. Conclusion: This study showed that 1 g HS and 500 mg BID mesalamine suppository treatments of UP patients were equivalent in all facets of efficacy, safety, and compliance in a 6-week trial. [source]

Simplified treatment of massive rectal bleeding following prostate needle biopsy

Argon plasma coagulation as first-line treatment for chronic radiation proctopathy

JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 10 2004
SHAJI SEBASTIAN
Abstract Background and Aim:, Chronic radiation proctopathy is a troublesome complication of radiotherapy to the pelvis, for which current treatment modalities are unsatisfactory. The present prospective study was designed to determine the usefulness and safety of argon plasma coagulation in the management of chronic radiation proctopathy. Methods:, Twenty-five consecutive patients (M:F 24:1, mean age: 69 years) with radiation proctopathy were prospectively included. All patients received argon plasma coagulation by a standard protocol. Response to treatment was assessed by symptom response, bleeding severity score, hematological parameters and transfusion requirements over a median 14-month follow up. Results:, Patients received a median of one treatment session with argon plasma coagulation. There was significant improvement in rectal bleeding in all patients, with complete cessation of bleeding in 21 (81%) of the patients. The median bleeding severity score fell from 3 to 0 (P < 0.0005). The mean hemoglobin level rose from 10.05 ± 2.21 g/dL before treatment to 12.44 ± 1.09 g/dL at 6 months following treatment (P < 0.002). There was also improvement in other symptoms such as urgency and diarrhea. Over the period of follow up, there was no recurrence of anemia and no complications were noted. Conclusion:, These results suggest that argon plasma coagulation is a safe and effective modality in the treatment of chronic radiation proctopathy. © 2004 Blackwell Publishing Asia Pty Ltd [source]

Interleukin-18 overproduction exacerbates the development of colitis with markedly infiltrated macrophages in interleukin-18 transgenic mice

JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 8 2003
TAKAHIRO ISHIKURA
Abstract Background and Aim:, The authors have previously shown that production of interleukin (IL)-18 was increased in the inflamed mucosa of patients with Crohn's disease (CD) and blockade of IL-18 ameliorated the murine model of CD. This demonstrated that IL-18 plays a significant role during intestinal inflammation. However, the initial role of IL-18 during intestinal inflammation was unclear; therefore the susceptibility of IL-18 transgenic (Tg) mice to acute dextran sulfate sodium (DSS)-induced colitis was examined. Methods:, Interleukin-18 Tg and wild-type (WT) mice were fed 2.0% of DSS for 8 days. The total clinical scores (bodyweight loss, stool consistency, and rectal bleeding), colon length and histological scores were assessed. The expressions of surface markers and IL-18 on infiltrating lamina propria mononuclear cells were analyzed immunohistochemistrically. Mesenteric lymph node (MLN) cells were isolated and the expressions of CD4+ T-cell activation markers (CD69, CD25 and IL18R) were analyzed by flow cytometry. Results:, The IL-18 Tg mice exhibited an increased susceptibility to DSS-induced colitis, as shown by significantly increased clinical, histological scores, and more severe colonic shortening compared with WT mice. Immunohistochemical analysis revealed a significant increase of IL-18 production and CD11b+ macrophages but not CD4+ T cells in the inflamed mucosa in DSS-fed IL-18 Tg compared with DSS-fed WT mice. Furthermore, MLN cells revealed no evidence of increased CD4+ T-cell activation in DSS-fed IL-18 Tg. Conclusions:, These findings suggest that IL-18 overproduction in the mucosa plays an important role in the marked infiltration of macrophages and exacerbates colitis in IL-18 Tg mice. [source]

Brachyspira aalborgi infection in four Australian children

JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 8 2001
Ralf G Heine
Abstract Aim: The clinical presentation of four children and adolescents (two males and two females with a mean age of 12.4 years; range 9,16 years) with colorectal spirochetosis is discussed. Results: Symptoms included persistent diarrhea (n = 2), rectal bleeding (n = 1) and abdominal pain (n = 2). In all patients, colorectal spirochetosis was an unanticipated finding on colonic histology, and the presence of spirochetes was confirmed by the use of electron microscopy. Spirochetes were identified as Brachyspira aalborgi by using PCR amplification of the bacterial 16S rRNA and nicotinamide adenine dinucleotide oxidase sequences in all four patients. No other enteric pathogens were found. Conclusions: Although all patients appeared to respond to antibiotic treatment, the clinical significance of B. aalborgi as a human pathogen requires further investigation. [source]

Clinical trial: once-daily mesalamine granules for maintenance of remission of ulcerative colitis , a 6-month placebo-controlled trial

ALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 8 2010
G. R. Lichtenstein
Aliment Pharmacol Ther 2010; 32: 990,999 Summary Background, Ulcerative colitis (UC) is a chronic relapsing and remitting idiopathic inflammatory bowel disorder. Aim, To evaluate once-daily mesalamine (mesalazine) granules (MG) for maintenance of remission of UC. Methods, Randomized, double-blind, placebo-controlled trial of patients (n = 209 MG, n = 96 placebo) with UC in remission [revised Sutherland Disease Activity Index (SDAI) rectal bleeding = 0, mucosal appearance <2] who took MG 1.5 g or placebo once-daily for up to 6 months. Primary efficacy endpoint: the percentage of patients who remained relapse-free at month 6/end of treatment. Relapse was defined as SDAI rectal bleeding score ,1 and a mucosal appearance score ,2, a UC flare, or initiation of medication to treat a UC flare. Results, The percentage of relapse-free patients at month 6/end of treatment was higher with MG than placebo (78.9% vs. 58.3%, P < 0.001) in the intent-to-treat analysis. Significant differences (P , 0.025) favouring MG were observed for most secondary endpoints including improvement in rectal bleeding, physician's disease activity rating, stool frequency, the SDAI at month 6/end of treatment, patients classified as a treatment success and relapse-free duration. The incidence of adverse events was similar between groups. Conclusions, Once-daily mesalamine (mesalazine) was effective in maintaining remission of UC for 6 months. [source]

Who needs colonoscopy to identify colorectal cancer?

ALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 2 2010
Bowel symptoms do not add substantially to age, other medical history
Aliment Pharmacol Ther 2010; 32: 270,281 Summary Background, Many bodies advise that people with bowel symptoms undergo colonoscopy to detect colorectal cancer. Aim, To determine which bowel symptoms predict cancer on colonoscopy. Methods, Information was collected on symptoms, demographics and medical history from patients subsequently undergoing colonoscopy. Multiple logistic regression modelling was used to identify predictors of colorectal cancer. An ROC curve was estimated for each model, and the area under the curve (AUC) was computed. Results, Cancer was found in 159 patients and no cancer or adenoma in 7577 patients. Bowel symptoms that predicted cancer were rectal bleeding, change in bowel habit and rectal mucus. Prediction was the strongest in patients who had symptoms at least weekly and commencing within the previous 12 months; abdominal pain was predictive only in such patients. The odds ratios never exceeded 4.27. A model based on age, gender, and medical history was highly predictive (AUC = 0.79). Adding symptoms to this model increased the AUC to 0.85. Conclusions, This model predicts patients in whom colonoscopy will have the highest yield. Conversely, colonoscopy can be avoided in people at low risk: in our study, 95% of cancers could have been detected by doing only 60% of the colonoscopies. [source]

Clinical trial: oral colon-release parnaparin sodium tablets (CB-01-05 MMX®) for active left-sided ulcerative colitis

ALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 3 2010
G. CELASCO
Aliment Pharmacol Ther 31, 375-386 Summary Background, The administration of parnaparin sodium as oral colon-release tablets (CB-01-05 MMX®) has been proposed as a novel approach for the treatment of ulcerative colitis (UC). Aim, To assess the efficacy and the tolerability of 8 weeks' oral daily administration of 210 mg of parnaparin sodium compared with placebo in subjects treated with stable-doses of oral aminosalicylates. Methods, This multicenter, randomized, double-blind proof of concept trial compared the efficacy of CB-01-05 MMX® 210 mg tablets to placebo in 141 subjects with mild to moderately active left-sided UC treated with stable-doses of aminosalicylates. The efficacy was assessed by clinical activity index (CAI), endoscopic index (EI) and histological score (HS). Results, A total of 121 subjects (61 in test group and 60 in control group) formed the per protocol (PP) population. After 8 weeks of treatment, clinical remission was achieved in 83.6% of the CB-01-05 MMX® group, and in 63.3% in the comparator group (P = 0.011). This effect was also significantly evident in the test group at week 4 (P = 0.028). A significant difference was also detected in rectal bleeding, (disappeared respectively in 75.4% and 55.0%; P = 0.018), and in mucosal friability (recovered respectively in 80.3% and in 56.7%; P = 0.005). Conclusions, CB-01-05 MMX® was safe and significantly effective in treating subjects with mild-to-moderate left-sided UC treated with stable-doses of aminosalicylates. [source]

Effect of oral iron supplementation on oxidative stress and colonic inflammation in rats with induced colitis

ALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 12 2001
J. Carrier
Background: Iron supplementation may increase disease activity in ulcerative colitis, possibly through the production of reactive oxygen species from the Fenton reaction. Aim: To assess the effects of two doses of oral iron on intestinal inflammation and oxidative stress in experimental colitis. Methods: Colitis was induced in rats by giving 5% dextran sulphate sodium in drinking water for 7 days. First, using a 2 × 2 factorial design, rats with or without dextran sulphate sodium received the regular diet or a diet containing iron 3%/kg diet. Second, rats with dextran sulphate sodium-induced colitis were supplemented with iron 0.3%/kg diet and compared with rats on dextran sulphate sodium and regular diet. The body weight change, histological scores, colon length, rectal bleeding, plasma and colonic lipid peroxides, colonic glutathione peroxidase and plasma vitamin E and C were measured. Faecal analysis for haem and total, free and ethylenediaminetetra-acetic acid-chelatable iron was also performed. Results: Iron 3% and iron 0.3% increased the activity of dextran sulphate sodium-induced colitis, as demonstrated by higher histological scores, heavier rectal bleeding and further shortening of the colon. This was associated with increased lipid peroxidation and decreased antioxidant vitamins. Faecal iron available to the Fenton reaction was increased in a dose-dependent manner. Conclusions: Iron supplementation taken orally enhanced the activity of dextran sulphate sodium-induced colitis and is associated with an increase in oxidative stress. [source]

Pneumatosis intestinalis in an infant undergoing bone marrow transplantation for Wiskott,Aldrich syndrome

PEDIATRIC TRANSPLANTATION, Issue 5 2001
Duygu Uçkan
Abstract: A 7-month-old patient with Wiskott,Aldrich syndrome (WAS) developed pneumatosis intestinalis (PI) in the immediate post-transplant period after receiving paternal human leucocyte antigen (HLA) phenotypically matched bone marrow (BM). PI has been described in patients with congenital or acquired immunodeficiency states and after bone marrow transplantation (BMT). To our knowledge, the condition has not been described in WAS. The underlying bowel mucosa damage as a result of the history of massive rectal bleeding, the effects of the conditioning regimen, immunosuppression, neutropenia, and infection, may all have contributed to the development of PI. Although the condition resolved by conservative management alone, the patient developed Klebsiella pneumonia sepsis, interstitial pneumonitis, failed to engraft, and died on day +66 following a second infusion of stem cells mobilized from his father's peripheral blood. [source]

Is palliative resection of the primary tumour, in the presence of advanced rectal cancer, a safe and useful technique for symptom control?

ANZ JOURNAL OF SURGERY, Issue 4 2004
Nasser Al-Sanea
Introduction: At some time, every general surgeon will be faced with the task of trying to decide what to do with a patient who presents with rectal cancer and unresectable distant metastases. How safe is resectional surgery? What sort of palliation may be expected following resection of the primary tumour? In an attempt to answer these questions, the management and outcomes of all patients with rectal cancer and distant metastases, who were primarily referred to the colorectal unit at King Faisal Specialist Hospital were examined. Methods: All patients who underwent primary surgery for rectal cancer in the presence of metastatic disease were identified. The charts of these patients were examined and their morbidity, mortality and survival were determined. Results: Over an 8-year period 22 patients (average age 54 years) underwent rectal resectional surgery in the presence of metastatic disease. There were 13 men and nine women. The commonest complaint was rectal bleeding. All patients had chest radiographs. Pulmonary metastases were identified in four patients. Nineteen abdominal and pelvic computed tomography scans were performed and eight showed evidence of metastases. Skeletal radiographs in two patients showed evidence of bone metastasis. At operation, intraperitoneal metastases were found in 18 patients. Nine of these were not identified preoperatively. Six patients underwent abdomino-perineal resection, nine anterior resection and seven a Hartmann's procedure. Eight patients developed a significant postoperative complication and one died 42 days after surgery. The mean length of hospital stay was 18.6 days. Nine patients received preoperative radiotherapy. Four patients had palliative radiotherapy, two for bony, one for liver and one for peritoneal metastases. Patients were followed up for a mean of 1.1 years. During follow up, 11 returned to the emergency room on 24 occasions. Two patients required readmission. No patient had further rectal bleeding. The mean survival was 1.3 years. Conclusion: Patients with rectal cancer and unresectable distant metastases can be successfully palliated by resection of the primary tumour with low morbidity and mortality. The early involvement of a palliative care team facilitates patient management and helps patients enjoy what remains of the rest of their lives at home, in comfort and with good symptom control. [source]

Investigating rectal bleeding: red faced or reliable?

ANZ JOURNAL OF SURGERY, Issue 12 2001
Finlay Macrae
No abstract is available for this article. [source]

Challenge of chronic radiation-induced rectal bleeding

ANZ JOURNAL OF SURGERY, Issue 4 2001
Pierre Chapuis
No abstract is available for this article. [source]

Improving glandular coverage during prostate biopsy using a long-core needle: technical performance of an end-cutting needle

BJU INTERNATIONAL, Issue 1 2002
G.N. Ubhayakar
Objective To compare the technical performance of a 33-mm core-length biopsy needle with that of the standard 18 mm needle, as many prostate cancers are isoechoic and in large prostates the tissue coverage with the 18 mm needle is inadequate. Patients and methods A 33-mm core length BioPinceÔ VSL disposable needle (Amedic, Sweden) and a standard TruCut 18 mm needle (Medical Device Technology Inc., FL, USA) were used to take prostatic biopsies in two groups of 15 patients. The following variables were assessed for each group: mean core length, core quality, capsular coverage (one or both capsules within the specimen), and side-effects in the first week after biopsy (for the BioPince group, surveyed using a self-completed questionnaire). The results were compared with historical data from a group of 30 patients biopsied using the standard needle. Results For the BioPince and standard groups the mean (sd) core length was 19.4 (8.9) and 14.9 (5.1) mm, respectively. Four needles in the BioPince group failed to capture a sample, requiring needle replacement. The samples were fragmented in 15 of 90 (17%) and 41 of 90 (46%) biopsies in the BioPince and standard groups, respectively (P < 0.05). Specimens had both capsules present in five of 90 (6%) and four of 90 (4%), respectively. Within 7 days minor bleeding was the most common side-effect. Pain after biopsy was the only symptom showing a significant difference between the groups, at six of 15 and none (P = 0.001), respectively. The incidence of haematuria, haematospermia and rectal bleeding was similar in the two groups (P > 0.05), but fever more common (three vs none) in the BioPince group (P = 0.06). Conclusion When set at a 33-mm stroke length, the BioPince needle increases the mean core length by 30%, with less fragmentation than a standard 18 mm needle. However, it has a significant failure rate for capture (27% needle replacement rate), slightly greater morbidity (pain and possibly fever) and shows no advantage in capsular coverage. Therefore, there are shortcomings with this end-cutting needle when used at 33 mm core length. [source]

Transanal endoscopic microsurgery is a safe and reliable technique even for complex rectal lesions

BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 7 2008
R. J. Darwood
Background: Transanal endoscopic microsurgery (TEM) is a minimally invasive technique for the excision of rectal lesions, with lower morbidity and mortality rates than open surgery. Following advances in laparoscopic colorectal surgery and endoscopic mucosal resection, this study evaluated the safety and efficacy of TEM in the treatment of complex rectal lesions. Methods: All patients were entered into a prospective database. Complex lesions were identified as high (more than 15 cm from anorectal margin), large (maximum dimension over 8 cm), involving two or more rectal quadrants, or recurrent. Results: Seventy-one lesions (13 carcinomas and 58 tubulovillous adenomas) were identified. The median duration of operation was 60 (interquartile range (i.q.r.) 30,80) min, with an estimated median blood loss of 0 (i.q.r. 0,10) ml. Median hospital stay was 2 (i.q.r. 1,3) days. One patient developed postoperative urinary retention and one returned with rectal bleeding that did not require further surgery. Two patients developed rectal strictures after operation that were dilated successfully. There was no recurrence of benign lesions during a median follow-up of 21 (i.q.r. 6·5,35) months. Conclusion: TEM is a safe technique with low associated morbidity, even when used to excise complex rectal lesions. As such it remains the treatment of choice for rectal lesions not requiring primary radical resection. Copyright © 2008 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source]

Patient-reported acute gastrointestinal symptoms during concurrent chemoradiation treatment for rectal cancer,

CANCER, Issue 8 2010
Ronald C. Chen MD
Abstract BACKGROUND: Although it is known that standard 5-fluorouracil,based chemoradiation therapy for rectal cancer causes significant acute gastrointestinal (GI) toxicity, research on patient-reported outcomes (PROs) is limited. The authors undertook the current study to assess the feasibility of incorporating PRO measurement into routine clinical practice and to describe the trajectory of symptom development during treatment. METHODS: Seventy-seven consecutive patients who were treated between 2006 and 2008 were eligible. Patients completed the 7-item Bowel Problems Scale immediately before weekly physician visits. RESULTS: The questionnaire completion rate was 95%. Individual GI symptoms had different trajectories of development. By Week 5, approximately 40% of all patients developed clinically meaningful pain, bowel urgency, or tenesmus that was not present during Week 1; 30% developed diarrhea, abdominal cramping, and passing mucus. However, overall symptom burden was moderate. Seventy-five percent of patients who presented with rectal bleeding at Week 1 improved by Week 3 of treatment. Within each physician-assessed grade of diarrhea, patient experience varied widely. For example, of the 50 patients who developed grade 2 diarrhea on the Radiation Therapy Oncology Group Acute Morbidity Scale, the numbers of patients reporting only occasional symptoms versus those reporting frequent or very frequent symptoms were similar. CONCLUSIONS: PROs provided information on patient symptoms during chemoradiation treatment for rectal cancer that was not captured otherwise, and it was feasible to incorporate PROs into routine clinical practice. The current results may be used by physicians to counsel their patients before treatment initiation and to provide a benchmark against which trials that use new therapies may be compared. Cancer 2010; 116:1879,86. © 2010 American Cancer Society. [source]

Urinary and rectal complications of contemporary permanent transperineal brachytherapy for prostate carcinoma with or without external beam radiation therapy,

CANCER, Issue 4 2004
Michael F. Sarosdy M.D.
Abstract BACKGROUND Prostate brachytherapy is increasingly used to treat prostate carcinoma, alone or combined (combination therapy) with external beam radiation therapy (EBRT). This report cites the frequency and nature of urinary and rectal complications requiring unplanned interventions after contemporary brachytherapy with or without EBRT. METHODS A total of 177 consecutive patients underwent either brachytherapy (100 patients [56.5%]) or combination therapy (77 patients [43.5%]) for clinical T1-2 prostate carcinoma between July 1998 and July 2000. All the patients were analyzed with regard to disease characteristics, treatment details, and complications requiring unplanned interventions in up to 48 months of follow-up. RESULTS Catheter drainage for urinary retention was required for a median of 55 days (range, 3,330 days) in 36 patients (20%), including 24% after brachytherapy and 16% after combination therapy. Transurethral resection of the prostate (TURP) was performed at a median of 12 months (range, 8,18 months) after implantation in 5% of patients after brachytherapy and 14.5% of patients after combination therapy (P = 0.029). Colonoscopy with or without fulguration for rectal bleeding was performed in 37 of 158 patients (97 in the brachytherapy group and 61 in the combination therapy group) (23.4%) at a median of 17 months (range, 4,45 months), including 15 patients (15.5%) after brachytherapy and 22 patients (36%) after combination therapy (P = 0.002). Combination therapy resulted in fecal diversion in 6.6% of patients (P = 0.021), urinary diversion in 3.2% of patients (P = 0.148), and clean intermittent self-catheterization for recurrent stricture after multiple TURPs in 4.9% of patients (P = 0.055), none of which occurred after brachytherapy. Overall, 20.6% of patients underwent TURP or colonoscopy after brachytherapy, whereas 44.2% underwent those or more extensive unplanned procedures after combination therapy (P = 0.001). CONCLUSIONS Complications requiring unplanned procedures may occur after brachytherapy, and may be increased significantly after brachytherapy combined with EBRT. These data reinforce the concept that quality assurance and technique are important in prostate brachytherapy, but, even when these are in place, complications can occur, especially when EBRT is added to brachytherapy. Cancer 2004. © 2004 American Cancer Society. [source]

Management of isolated rectal bleeding in newborn infants: comparison of two time periods

ACTA PAEDIATRICA, Issue 2 2010
Ayala Maayan-Metzger
Abstract Aim:, To demonstrate the differences in treatment of isolated rectal bleeding (IRB) by comparing two study time period groups and to evaluate whether decreased treatment intensity increased complications during the follow-up period. Methods:, Retrospective recording of medical charts of 307 neonates with IRB during two time periods. Results:, The rate of IRB in both period groups was similar among term and near-term infants, but significantly lower among preterm infants in the later period study group. The rate of breast milk feeding among preterm infants increased significantly in the later compared with the early group. Duration of antibiotic treatments and feeding cessation was significantly shortened in the late period study as compared with the early period. The rates of recurrent episodes of IRB among preterm infants were similar in the early and late period groups. No infant developed necrotizing enterocolitis within the episode of isolated rectal bleeding. Conclusions:, Decreased treatment duration to 1 day of nil per os and 2 days of antibiotics was not associated with increased rates of deterioration to severe clinical conditions, nor to recurrent episodes of isolated rectal bleeding. [source]

Clinical and endoscopic characteristics of acute haemorrhagic rectal ulcer, and endoscopic haemostatic treatment: a retrospective study of 95 patients

COLORECTAL DISEASE, Issue 10Online 2010
Y. Motomura
Abstract Aim, Acute haemorrhagic rectal ulcer (AHRU) is characterized by sudden onset of painless and massive rectal bleeding in elderly bedridden patients who have serious illness. Endoscopic diagnosis and management of AHRU is, however, still controversial. We retrospectively investigated 95 AHRU patients to elucidate the clinical characteristics, endoscopic findings and haemostatic strategies. Method, Between January 1999 and March 2007, 95 patients were diagnosed with AHRU in our hospital. Medical records and colonoscopy files were reviewed. Clinical features, colonoscopic findings, haemostatic treatment and outcome of the patients were evaluated. Results, Eighty per cent of the patients were bedridden at the onset. The most frequent underlying disorder was cerebrovascular disease (36.8%). Hypoalbuminaemia (< 3.5 g/dl) was seen in 92.6% of the patients. Endoscopic findings of AHRU were classified as circumferential ulcer (41.1%), linear or nearly round small ulcer(s) (44.2%), circumferential and small ulcer(s) (7.4%) and Dieulafoy-like ulcer (7.4%). Primary endoscopic haemostatic treatment was performed in 45.3% of cases. Recurrent bleeding occurred in 24.2% of patients. Permanent haemostasis was achieved by secondary endoscopic treatment in 82.6% of re-bleeding patients. Conclusion, Understanding the typical clinical and endoscopic findings and careful endoscopic examination are important for the accurate diagnosis of AHRU, and endoscopic haemostatic therapy may be effective for bleeding patients. [source]

Do patients require outpatient follow-up after rapid referral double contrast barium enema?

COLORECTAL DISEASE, Issue 7 2009
O. Odofin
Abstract Introduction, In our hospital, patients above the age of 40 years referred with a change in bowel habit without rectal bleeding undergo a double contrast barium enema (DCBE) ideally within 2 weeks. Results of benign studies are sent to a consultant colorectal surgeon and a routine clinic visit arranged. The aim of this study was to identify whether, following DCBE, patients (i) presented at a later date with colorectal cancer and (ii) needed assessment in clinic. Method, This is a review looking at all patients who underwent DCBE prior to routine clinic visit between January 2004 and December 2005. Hospital databases were cross-referenced to identify any patients presenting with a new diagnosis of colorectal malignancy between DCBE and April 2007. Clinic letters were reviewed to identify the number of outpatient visits prior to discharge and reasons for continued follow-up. Results, During the study period, 521 patients (age range 31,93 years, 316 female) had DCBE prior to assessment in clinic. Diagnoses: cancer 48 (9.2%), polyps 13 (2.5%), colitis 3 (0.6%), no significant pathology 457 (87.7%). Of this latter cohort, 387 (84.7%) were discharged after one clinic visit; 54 (11.9%) attended twice and 11 (2.4%) were seen more than twice. Reasons for multiple attendances were management of haemorrhoids/anal fissure or investigations of unrelated symptoms. No new cancers were identified in this cohort between January 2004 and April 2007. Conclusion, Double contrast barium enema is a safe screening tool following a ,2-week rule' referral with CIBH. Following a report of no significant pathology, there is no need to arrange routine follow-up. [source]

Diagnostic value of self-reported symptoms in Danish outpatients referred with symptoms consistent with colorectal cancer

COLORECTAL DISEASE, Issue 5 2007
N. C. Bjerregaard
Abstract Objective, To assess the association between self-reported symptoms and a diagnosis of colorectal cancer (CRC) in symptomatic outpatients without CRC risk factors, defined by a Danish expert group. Method, A cross-sectional study of patients aged 40 years and older referred by general practitioners to two Danish surgical outpatient clinics for symptoms consistent with CRC during a 16-month period. CRC was diagnosed at endoscopy and through follow up. Before their first appointment, participants completed a questionnaire about symptoms. Results, The study included 2172 patients. Of these, 122 were diagnosed with CRC (5.6%). Median age was 61 years (range: 40,97) and 44.0% were men. All symptoms had high (93.4,96.8%) negative predictive values for CRC. The highest positive predictive values (PPV) were found for dark rectal bleeding (PPV: 20.6%) and CRC was diagnosed in a first-degree relative over the age of 50 years (PPV: 11.2%). At multiple logistic regression analysis dark rectal blood was the most important predictor of CRC (OR: 7.4). Other predictors were age 60 years or older (OR: 3.0), change in frequency of bowel movements (OR: 2.5), CRC diagnosed in a first-degree relative over the age of 50 years (OR: 2.6), male gender (OR: 2.2) and mono-symptomatic fresh rectal blood (OR: 1.7). Conclusion, No self-reported symptoms presented by outpatients without CRC risk factors can be used accurately to identify patients with CRC with certainty. For clinical purposes self-reported symptoms seems thus not to be a useful accurate tool to distinguish between symptomatic outpatients with and without CRC. [source]