Efficacy of porcine dermal collagen (PermacolTM) injection for passive faecal incontinence in a dedicated Colorectal Unit at the Wits Donald Gordon Medical Centre.

BACKGROUND: Passive faecal incontinence (FI) due to a defect of the internal anal sphincter is a distressing condition and can be difficult to manage medically and surgically. The use of a trans-anally injected bulking agent to improve continence has been published internationally with contradictory results. METHOD: Patients with passive FI due to confirmed internal anal sphincter deficits that had been treated with PermacolTM injections were followed up. They were asked to complete the Wexner faecal incontinence scores and Rockwood QoL scores for both their pre- and post-treatment continence state. RESULTS: Of the 14 patients who completed the questionnaires, most were women with a mean (SD) age of 56.4 (13.4) years. The majority of the patients had a history of a predisposing event. They reported a significant improvement in both the Wexner scores (p < 0.0005) and the Rockwood QoL (p=0.004), including all subsections. The Wexner scores and the Rockwood scores were significantly correlated post-procedure (r= -0.6186; p=0.0183). There were no significant correlations between change in scores and time after procedure. CONCLUSION: Trans-anal submucosal PermacolTM injections produced a significant improvement in both faecal continence and quality of life scores in patients with passive faecal incontinence for up to two years.

Concepts in malignant transformation.

The precise biochemical nature of malignant transformation remains elusive. This article reviews some of the current theories of oncogenesis and aims to synthesize these concepts into a possible schema for the origins of malignant transformation, using a cell-programmed origin for neoplastic progression. It is proposed that cell transformation in malignancy is initiated by injury but finds ultimate promulgation through cellular, self-determined, epigenetic events. Explanations for this arrangement are sought in evolutionary models and our knowledge of cell biology. The proposed mechanisms have not been experimentally validated, but will hopefully stimulate further research.

Evolving concepts in the management of colonic injury.

PURPOSE: The management of colonic injury has changed in recent years. This study sought to evaluate current surgical management of injuries to the colon in a busy urban trauma centre, in the light of our increasing confidence in primary repair and evolving understanding of the concepts and practice of damage control surgery. METHODS: A retrospective analysis was made of consecutive patients presenting with colonic injury from January 1 to December 31 1998. Patients without full-thickness lesions of the colon were excluded, as were patients who died within 24 h of admission. Demographic data, wounding patterns and clinical course were studied. RESULTS: One hundred twenty-seven patients were analyzed. Management without colostomy was achieved in 84% of cases. Patients who underwent diversion of the faecal stream had increased morbidity and hospital stay compared to equivalent patients who were repaired primarily. The important subgroup of patients who underwent damage control or abbreviated laparotomy is discussed. CONCLUSION: This study further strengthens the validity of direct repair or resection and primary anastomosis for colonic injury. Strategies to deal with the subgroup of patients at very high risk of postoperative complications are suggested.