I J Adam

Publications (8)58.35 Total impact

• Article: Six of the Best, Colorectal 19

  M. Katory, P. Goodfellow, D. Fletcher, I.J. Adam, A.J. Shorthouse
  [show abstract] [hide abstract]
  ABSTRACT: Aims: The ACGBI have identified four index procedures for training and suggests the minimum numbers to achieve competency. For fistula-in-ano (FIA) surgery this number is 30. No recommendation of what proportion should be ‘complex’ FIA has been made. The central unit in our region has a regional referral practice for complex FIA. This provides an ideal opportunity to assess exposure of HSTs to complex FIA.Method: We reviewed the notes of all patients referred for FIA surgery over an 18-month period using the unit's prospective audit databse. Fistulas were analysed using Parks' classification.1Subcutaneous (simple)2Intersphincteric (simple)3Intersphincteric + abscess or secondary track above the dentate line (complex)4Transsphincteric at the dentate line or above (complex)5Transsphincteric + abscess or secondary track (complex)6Supra-sphincteric (complex)7Extra-sphincteric (complex)Results: Eighty-five operations for FIA were performed. Twenty-nine of 58 patients with simple FIA (50%) and 13/27 patients with complex FIA (48%) were operated on by higher surgical trainees. An average of 57 FIA operations per year were performed; 39 simple and 18 complex. Trainees performed 19 and 9 of these respectively.Conclusion: Over a period of 1 year this colorectal unit provided 93% of the minimum number of FIAs for trainees to achieve competency levels as defined by the ACPGBI. However, most were simple with complex fistulas requiring significant consultant input. The competency of colorectal HSTs required to manage ‘complex’ FIA as independent practitioners remains uncertain without the availability of more detailed guidelines on what constitutes a complex FIA and the degree of exposure to these procedures during training.
  British Journal of Surgery 01/2009; 89(S1):58 - 58. · 4.61 Impact Factor
• Article: A randomised controlled trial of transverse skin crease vs. vertical midline incision for right hemicolectomy.

  S R Brown, P J Goodfellow, I J Adam, A J Shorthouse
  [show abstract] [hide abstract]
  ABSTRACT: A transverse skin crease incision for right hemicolectomy may result in more rapid recovery than traditional vertical midline incision. This hypothesis was tested with a prospective randomised trial. Patients from 2 centres undergoing right hemicolectomy were randomised to received a midline or transverse incision. Incision lengths were sufficient to enable unrestricted resection of the right colon. Patients and carers were blinded to the incisions using strategically placed dressings. Analgesia and oral intake were controlled by the patient. Operative details and recovery parameters were compared. A total of 28 patients were randomised. Demographic data and tumour characteristics of the two treatment groups were similar. The transverse incision group had a slightly shorter median wound (10 cm vs. 11 cm, p<0.05). Operative time, analgesia requirements, recovery parameters (time to discharge, 6.5 vs. 6.5 days) and frequency of complications were otherwise comparable. A transverse skin crease incision for right hemicolectomy results in a slightly smaller wound but no other advantages were demonstrated compared with a traditional vertical midline incision.
  Techniques in Coloproctology 03/2004; 8(1):15-8. · 1.29 Impact Factor
• Article: A randomised controlled trial of transverse skin crease vs. vertical midline incision for right hemicolectomy

  S.R. Brown, P.J. Goodfellow, I.J. Adam, A.J. Shorthouse
  [show abstract] [hide abstract]
  ABSTRACT: Background:A transverse skin crease incision for right hemicolectomy Background:A transverse skin crease incision for right hemicolectomy may result in more rapid recovery than traditional verticalmay result in more rapid recovery than traditional vertical midline incision. This hypothesis was tested with a prospectivemidline incision. This hypothesis was tested with a prospective randomised trial.Methods:Patients from 2 centres undergoing right hemicolectomyrandomised trial.Methods:Patients from 2 centres undergoing right hemicolectomy were randomised to received a midline or transverse incision.were randomised to received a midline or transverse incision. Incision lengths were sufficient to enable unrestrictedIncision lengths were sufficient to enable unrestricted resection of the right colon. Patients and carers were blindedresection of the right colon. Patients and carers were blinded to the incisions using strategically placed dressings. Analgesiato the incisions using strategically placed dressings. Analgesia and oral intake were controlled by the patient. Operativeand oral intake were controlled by the patient. Operative details and recovery parameters were compared.Results:A total of 28 patients were randomised. Demographic datadetails and recovery parameters were compared.Results:A total of 28 patients were randomised. Demographic data and tumour characteristics of the two treatment groups wereand tumour characteristics of the two treatment groups were similar. The transverse incision group had a slightly shortersimilar. The transverse incision group had a slightly shorter median wound (10 cm vs. 11 cm, p<0.05). Operative time, analgesiamedian wound (10 cm vs. 11 cm, p<0.05). Operative time, analgesia requirements, recovery parameters (time to discharge, 6.5 vs.requirements, recovery parameters (time to discharge, 6.5 vs. 6.5 days) and frequency of complications were otherwise6.5 days) and frequency of complications were otherwise comparable.Conclusions:A transverse skin crease incision for right hemicolectomycomparable.Conclusions:A transverse skin crease incision for right hemicolectomy results in a slightly smaller wound but no other advantages wereresults in a slightly smaller wound but no other advantages were demonstrated compared with a traditional vertical midlinedemonstrated compared with a traditional vertical midline incision.
  Techniques in Coloproctology 02/2004; 8(1):15-18. · 1.29 Impact Factor
• Article: The management of persistent and recurrent chronic anal fissures.

  S. R Brown, A Taylor, I. J Adam, A. J Shorthouse
  [show abstract] [hide abstract]
  ABSTRACT: There are numerous definitive reviews concerning aetiology and management of acute and chronic anal fissures. The problem of persistence and recurrence after surgical and nonsurgical therapy has not been specifically addressed and there is little evidence-based guidance for the management of this difficult group of patients. A review of the literature with particular reference to persistence and recurrence of chronic anal fissures is presented and an algorithm of management incorporating evidence-based data is suggested.
  Colorectal Disease 08/2002; 4(4):226-232. · 2.93 Impact Factor
• Article: Inadequacy of colonoscopy revealed by three-dimensional electromagnetic imaging.

  I J Adam, Z Ali, A J Shorthouse
  [show abstract] [hide abstract]
  ABSTRACT: It is generally accepted that clinicians performing colonoscopy should reach the cecum in at least 90 percent of examinations. However, little attention has been paid to whether the endoscopist correctly estimates the amount of colon actually seen. During colonoscopy, endoscopists were asked to state how far they had reached. This was compared with the amount of colon actually seen, as assessed by a novel electromagnetic imaging device that recorded a three-dimensional position of the scope within a magnetic field pervading the patient's abdomen. If electromagnetic imaging showed that the cecum had not been reached, the endoscopist was asked to use the electromagnetic imaging system to determine whether it helped advance the colonoscope further. In 119 patients undergoing colonoscopy, clinical assessment of position reached was correct in only 92 (77.3 percent). When the endoscopists stated that cecal landmarks had been seen (n = 85), the scope was distal to the cecum in seven cases (8.2 percent). When cecal landmarks had not been seen (n = 34), the endoscopist's assessment of the position of the scope was accurate in only 14 (41.2 percent). The use of electromagnetic imaging in this latter group assisted passage to the cecum in 26 cases (76.5 percent). Despite assumed visualization of the cecum, inadequate colonoscopy highlights the potential for missing significant pathology in the right colon.
  Diseases of the Colon & Rectum 08/2001; 44(7):978-83. · 3.13 Impact Factor
• Article: Outcome following transanal endoscopic microsurgery.

  I J Adam, A J Shorthouse
  Diseases of the Colon & Rectum 05/1998; 41(4):526-7. · 3.13 Impact Factor
• Article: The immunomodulatory effect of levamisole is influenced by postoperative changes and type of lymphocyte stimulant.

  E E Abdalla, I J Adam, G E Blair, A Boylston, H M Sue-Ling, P Finan, D Johnston
  [show abstract] [hide abstract]
  ABSTRACT: The results of both laboratory and clinical research into the immunomodulatory activity of levamisole have shown a considerable degree of inconsistency and sometimes contradiction. This is probably a reflection of the lack of understanding of the mechanism(s) of action of levamisole and it is therefore necessary to base conclusions about its immunomodulatory efficacy in the treatment of disease on experimental assays that take into consideration the in vivo conditions. This investigation was designed to compare the immunomodulatory activity of levamisole under clinically achievable and non-achievable conditions as judged by changes in the perioperative proliferative response of lymphocytes from 30 patients with colorectal cancer. The results obtained showed that proliferation in antigen (purified protein derivative, PPD)-stimulated, but not phytohaemagglutinin(PHA)- or staphylococcal-enterotoxin-B(SEB)-stimulated, lymphocyte cultures was consistently and significantly augmented by levamisole in concentrations of 25 ng-25 micrograms/ml. High concentrations of levamisole (25 micrograms/ml and 100 micrograms/ml) were inhibitory to PHA- and SEB-stimulated, but not PPD-stimulated, lymphocyte cultures, especially in the postoperative period. Of particular interest was the observation that, although levamisole temporarily lost its stimulatory activity in the postoperative period (third postoperative day), it did enhance antigen-stimulated lymphocytes at the time of the nadir of the postoperative suppression of lymphocyte proliferation (first postoperative day). Clinically achievable concentrations of levamisole are therefore effective both before and after operation in enhancing the response of lymphocytes to antigens.
  Cancer Immunology and Immunotherapy 10/1995; 41(3):193-8. · 3.70 Impact Factor
• Article: Role of circumferential margin involvement in the local recurrence of rectal cancer.

  I J Adam, M O Mohamdee, I G Martin, N Scott, P J Finan, D Johnston, M F Dixon, P Quirke
  [show abstract] [hide abstract]
  ABSTRACT: Local recurrence after resection for rectal cancer remains common despite growing acceptance that inadequate local excision may be implicated. In a prospective study of 190 patients with rectal cancer, we examined the circumferential margin of excision of resected specimens for tumour presence, to examine its frequency and its relation to subsequent local recurrence. Tumour involvement of the circumferential margin was seen in 25% (35/141) of specimens for which the surgeon thought the resection was potentially curative, and in 36% (69/190) of all cases. After a median 5 years' follow-up (range 3.0-7.7 years), the frequency of local recurrence after potentially curative resection was 25% (95% CI 18-33%). The frequency of local recurrence was significantly higher for patients who had had tumour involvement of the circumferential margin than for those without such involvement (78 [95% CI 62-94] vs 10 [4-16]%). By Cox's regression analysis tumour involvement of the circumferential margin independently influenced both local recurrence (hazard ratio = 12.2 [4.4-34.6]) and survival (3.2 [1.6-6.53]). These results show the importance of wide local excision during resection for rectal cancer, and the need for routine assessment of the circumferential margin to assess prognosis.
  The Lancet 10/1994; 344(8924):707-11. · 38.28 Impact Factor