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  1. Article: Laparoscopic surgery for rectal cancer.

    Indar, Adrian / Efron, Jonathan

    The Permanente journal

    2007  Volume 13, Issue 1, Page(s) 47–52

    Abstract: Laparoscopic surgery for rectal cancer is much more challenging than that for colon cancer because of the confined space within the pelvis. Further, because of the tumor's location in the pelvis, maintenance of resection margins is of greater concern. ... ...

    Abstract Laparoscopic surgery for rectal cancer is much more challenging than that for colon cancer because of the confined space within the pelvis. Further, because of the tumor's location in the pelvis, maintenance of resection margins is of greater concern. Nonrandomized studies by groups experienced in laparoscopic surgery have shown both that it produces short-term outcomes equivalent to those for open surgery and that it can be performed safely from an oncologic perspective. Nonsurgical complications appear to be fewer, but conversion to open surgery may become a real issue. This review summarizes these findings by addressing technical considerations, early outcomes, late outcomes, costs, and complications.
    Language English
    Publishing date 2007-08-21
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2062823-7
    ISSN 1552-5775 ; 1552-5767
    ISSN (online) 1552-5775
    ISSN 1552-5767
    DOI 10.7812/TPP/08-058
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article: Image of the month. Internal herniation of the transverse colon.

    Indar, Adrian A / Indar, Rupert A / Indar, Rupert

    Archives of surgery (Chicago, Ill. : 1960)

    1999  Volume 138, Issue 2, Page(s) 225–226

    MeSH term(s) Adult ; Colonic Diseases/diagnostic imaging ; Female ; Hernia/diagnostic imaging ; Humans ; Radiography
    Language English
    Publishing date 1999-08-11
    Publishing country United States
    Document type Case Reports ; Journal Article
    ZDB-ID 80055-7
    ISSN 1538-3644 ; 0004-0010 ; 0096-6908 ; 0272-5533
    ISSN (online) 1538-3644
    ISSN 0004-0010 ; 0096-6908 ; 0272-5533
    DOI 10.1001/archsurg.138.2.225
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  3. Article: A dual benefit of sacral neuromodulation.

    Indar, Adrian / Young-Fadok, Tonia / Cornella, Jeffrey

    Surgical innovation

    2008  Volume 15, Issue 3, Page(s) 219–222

    Abstract: Sacral neuromodulation is a therapeutic option for women with detrusor overactivity and more recently has been used in patients with fecal incontinence and slow-transit constipation. A 47-year-old woman presented with chronic constipation since childhood. ...

    Abstract Sacral neuromodulation is a therapeutic option for women with detrusor overactivity and more recently has been used in patients with fecal incontinence and slow-transit constipation. A 47-year-old woman presented with chronic constipation since childhood. She used multiple laxatives, fiber supplements, and enemas, all without success, and defecated only once per week. Extensive investigations, including barium enema, colonoscopy, defecating proctography, pelvic magnetic resonance imaging, and anorectal manometry all were normal. A transit study showed delayed small-bowel emptying. Colonic transit could not be accurately interpreted because of the marked delayed in proximal transit. An ileostomy was being considered to defunction the colon after the patient become desperate for a better quality of life. She also complained of severe urinary frequency and incomplete emptying. A cystoscopy was normal, and a temporary sacral neuromodulation device was inserted as a staged procedure to improve her urinary symptoms. From the day of device placement and thereafter, the patient defecated without difficulty and has also been free of bladder symptoms. Repeat colonic transit has shown normalization of the stomach, small bowel, and colon.
    MeSH term(s) Comorbidity ; Constipation/diagnostic imaging ; Constipation/epidemiology ; Constipation/physiopathology ; Constipation/therapy ; Electric Stimulation Therapy/instrumentation ; Female ; Gastrointestinal Transit ; Humans ; Intestine, Large ; Intestines/diagnostic imaging ; Middle Aged ; Prostheses and Implants ; Radionuclide Imaging ; Urinary Incontinence/epidemiology
    Language English
    Publishing date 2008-09
    Publishing country United States
    Document type Case Reports ; Journal Article
    ZDB-ID 2182571-3
    ISSN 1553-3514 ; 1553-3506
    ISSN (online) 1553-3514
    ISSN 1553-3506
    DOI 10.1177/1553350608321318
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    Zs.A 4269: Show issues Location:
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  4. Article ; Online: Acute cholecystitis.

    Indar, Adrian A / Beckingham, Ian J

    BMJ (Clinical research ed.)

    2001  Volume 325, Issue 7365, Page(s) 639–643

    MeSH term(s) Acute Disease ; Cholecystectomy/methods ; Cholecystitis/diagnosis ; Cholecystitis/etiology ; Cholecystitis/therapy ; Digestive System Fistula/etiology ; Female ; Gangrene/etiology ; Humans ; Pregnancy ; Pregnancy Complications/etiology ; Rupture, Spontaneous/etiology
    Language English
    Publishing date 2001-02-06
    Publishing country England
    Document type Journal Article ; Review
    ZDB-ID 1362901-3
    ISSN 1756-1833 ; 0959-8154 ; 0959-8146 ; 0959-8138 ; 0959-535X ; 1759-2151
    ISSN (online) 1756-1833
    ISSN 0959-8154 ; 0959-8146 ; 0959-8138 ; 0959-535X ; 1759-2151
    DOI 10.1136/bmj.325.7365.639
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  5. Article ; Online: Laparoscopic ileal pouch-anal anastomosis reduces abdominal and pelvic adhesions.

    Indar, Adrian A / Efron, Jonathan E / Young-Fadok, Tonia M

    Surgical endoscopy

    2009  Volume 23, Issue 1, Page(s) 174–177

    Abstract: Background: Postoperative adhesions are an expected outcome for the majority of open abdominal operations, occurring in more than 90% of cases. Adhesions are responsible for more than 75% of small bowel obstruction cases. This study aimed to evaluate ... ...

    Abstract Background: Postoperative adhesions are an expected outcome for the majority of open abdominal operations, occurring in more than 90% of cases. Adhesions are responsible for more than 75% of small bowel obstruction cases. This study aimed to evaluate adhesions to the anterior abdominal wall and adnexal organs after laparoscopic ileal-pouch anal anastomosis (IPAA).
    Methods: Patients who underwent laparoscopic IPAA for ulcerative colitis had laparoscopic evaluation of adhesions at loop ileostomy closure for assessment of adhesions to the anterior abdominal wall and for adhesions to the adnexae in the case of women. Adhesions to the adnexae were quantified using the American Fertility Society adhesion score. Data were maintained prospectively.
    Results: In this study, 34 patients (21 women) ranging in age from 19 to 78 years (median, 36 years) underwent laparoscopic IPAA. With regard to anterior abdominal wall adhesions, 23 patients (68%) had no adhesions to the anterior abdominal wall, and the remaining 11 patients had few adhesions (filmy, avascular). No patients had dense adhesions to the abdominal wall. Of the 21 women, 15 (71%) had no adnexal adhesions, 5 had filmy adhesions enclosing less than one-third one adnexa, and 1 had filmy adhesions enclosing one-third to two-thirds of one adnexa. No patient had adhesions affecting both adnexae.
    Conclusions: Laparoscopic IPAA results in few adhesions to the anterior abdominal wall or to gynecologic organs. These adhesions were significantly fewer than previously reported for open operations with or without the use of a glycerol hyaluronate/carboxymethylcellulose bioresorbable (GHA/CMC) adhesion barrier.
    MeSH term(s) Adnexal Diseases/epidemiology ; Adnexal Diseases/pathology ; Adult ; Aged ; Cohort Studies ; Colitis, Ulcerative/surgery ; Colonic Pouches ; Female ; Humans ; Laparoscopy ; Male ; Middle Aged ; Peritoneal Diseases/epidemiology ; Peritoneal Diseases/pathology ; Proctocolectomy, Restorative ; Retrospective Studies ; Tissue Adhesions/epidemiology ; Tissue Adhesions/pathology ; Young Adult
    Language English
    Publishing date 2009-01
    Publishing country Germany
    Document type Journal Article
    ZDB-ID 639039-0
    ISSN 1432-2218 ; 0930-2794
    ISSN (online) 1432-2218
    ISSN 0930-2794
    DOI 10.1007/s00464-008-0139-y
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    Zs.A 2214: Show issues Location:
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  6. Article: Active specific immunotherapy for colorectal cancer.

    Indar, Adrian A / Maxwell-Armstrong, Charles A

    Expert review of anticancer therapy

    2003  Volume 3, Issue 5, Page(s) 685–694

    Abstract: With advances in molecular biology and the identification of tumor-associated antigens, a number of new strategies have been developed in an attempt to overcome the limits of chemotherapy and to aid in the fight to cure patients of metastatic and ... ...

    Abstract With advances in molecular biology and the identification of tumor-associated antigens, a number of new strategies have been developed in an attempt to overcome the limits of chemotherapy and to aid in the fight to cure patients of metastatic and micrometastatic colorectal carcinomas. Biological therapy has now moved into the era of immunotherapy. Nonspecific immunotherapy has been surpassed by modalities that produce a specific and potent immune response against identifiable tumor-associated antigens, so called active specific immunotherapy. Approaches that come under this heading include tumor cell vaccines, anti-idiotypic antibody therapy and dendritic cell vaccines. Cells can be further boosted by the use of immunostimulatory cytokines. This review aims to evaluate current strategies of immunotherapy for colorectal cancer with particular emphasis on the clinical aspects.
    MeSH term(s) Cancer Vaccines/genetics ; Cancer Vaccines/therapeutic use ; Colorectal Neoplasms/immunology ; Colorectal Neoplasms/therapy ; Genetic Therapy ; Humans ; Immunotherapy ; Tumor Escape
    Chemical Substances Cancer Vaccines
    Language English
    Publishing date 2003-10
    Publishing country England
    Document type Journal Article ; Review
    ZDB-ID 2112544-2
    ISSN 1744-8328 ; 1473-7140
    ISSN (online) 1744-8328
    ISSN 1473-7140
    DOI 10.1586/14737140.3.5.685
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    Zs.A 5907: Show issues Location:
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  7. Article: Effect of perioperative immunosuppressive medication on early outcome in Crohn's disease patients.

    Indar, Adrian A / Young-Fadok, Tonia M / Heppell, Jacques / Efron, Jonathan E

    World journal of surgery

    2009  Volume 33, Issue 5, Page(s) 1049–1052

    Abstract: Background: The aim of the present study was to examine the early outcome in patients undergoing intestinal resection for Crohn's disease (CD) while they are receiving perioperative immunosuppressive medication.: Methods: We reviewed patients with CD ...

    Abstract Background: The aim of the present study was to examine the early outcome in patients undergoing intestinal resection for Crohn's disease (CD) while they are receiving perioperative immunosuppressive medication.
    Methods: We reviewed patients with CD undergoing intestinal surgery from 1999 to 2007. Demographics and relevant perioperative information, including medication, were extracted from patient charts. Statistical analysis was performed using Fisher's exact test.
    Results: During the course of the study period 112 with Crohn's disease underwent intestinal resection, and 69 of them were receiving perioperative medication (47, corticosteroids; 39, immunomodulators; and 17, anti-tumor necrosis factor-alpha antibodies). There were no deaths. Median blood loss was 137 ml. Twenty-two of the patients using perioperative medication (32%) experienced complications, 10 of which were major. The major complications occurred in 3 of the 43 patients (7%) who were not receiving perioperative medications, in 5 of 38 patients (13%) who were receiving one drug, 4 of 28 patients (14%) receiving two drugs, and 1 of 3 patients (33%) receiving three drugs. Thus the occurrence of major complications was not significantly greater in patients receiving perioperative medication. Risk factors for a major complication were intraoperative blood loss >400 ml (P < 0.003) and emergency surgery (P < 0.005).
    Conclusions: The occurrence of complications in Crohn's disease patients undergoing intestinal resection was not associated with the use of immunosuppressive medication. However, emergency surgery and blood loss were risk factors, and reflect the difficulty of surgery in this group of patients.
    MeSH term(s) Adrenal Cortex Hormones/therapeutic use ; Adult ; Aged ; Aged, 80 and over ; Antibodies, Monoclonal/therapeutic use ; Combined Modality Therapy ; Crohn Disease/drug therapy ; Crohn Disease/surgery ; Digestive System Surgical Procedures/adverse effects ; Drug Therapy, Combination ; Female ; Humans ; Immunologic Factors/therapeutic use ; Immunosuppressive Agents/therapeutic use ; Male ; Middle Aged ; Perioperative Care/methods ; Postoperative Complications ; Retrospective Studies ; Risk Factors ; Treatment Outcome ; Tumor Necrosis Factor-alpha/antagonists & inhibitors ; Young Adult
    Chemical Substances Adrenal Cortex Hormones ; Antibodies, Monoclonal ; Immunologic Factors ; Immunosuppressive Agents ; Tumor Necrosis Factor-alpha
    Language English
    Publishing date 2009-03-11
    Publishing country United States
    Document type Journal Article
    ZDB-ID 224043-9
    ISSN 1432-2323 ; 0364-2313
    ISSN (online) 1432-2323
    ISSN 0364-2313
    DOI 10.1007/s00268-009-9957-x
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    Zs.A 1336: Show issues Location:
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  8. Article: A neoadjuvant/adjuvant randomized trial of colorectal cancer patients vaccinated with an anti-idiotypic antibody, 105AD7, mimicking CD55.

    Ullenhag, Gustav J / Spendlove, Ian / Watson, Nicholas F S / Indar, Adrian A / Dube, Mukul / Robins, Richard A / Maxwell-Armstrong, Charles / Scholefield, John H / Durrant, Lindy G

    Clinical cancer research : an official journal of the American Association for Cancer Research

    2006  Volume 12, Issue 24, Page(s) 7389–7396

    Abstract: Purpose: To assess the tolerability and effectiveness of 105AD7 vaccination in colorectal cancer patients. 105AD7 is a human anti-idiotypic antibody mimicking CD55, a glycoprotein, which is more than expressed on colorectal cancer cells and protects ... ...

    Abstract Purpose: To assess the tolerability and effectiveness of 105AD7 vaccination in colorectal cancer patients. 105AD7 is a human anti-idiotypic antibody mimicking CD55, a glycoprotein, which is more than expressed on colorectal cancer cells and protects them from attack by complement.
    Experimental design: Colorectal cancer patients (n = 67) eligible for primary surgery were randomized to receive the anti-idiotypic antibody 105AD7+/-Bacillus Calmette-Guerin/alum or to no treatment (control group). The immunizations were given i.d./i.m. before surgery and continued for a period of 2 years. The patients were monitored in enzyme-linked immunospot (ELISPOT; gamma-IFN), proliferation assay, and Luminex cytokine assays.
    Results: No serious adverse events were recorded. Of the 32 investigated immunized patients, 14 (44%) were considered to be responders in the ELISPOT assay. Induced proliferative responses were noted in 17 of 40 (43%) monitored patients. There was no correlation between the ELISPOT and proliferation assays. Luminex analyses revealed tumor necrosis factor-alpha and granulocyte macrophage colony-stimulating factor responses not only to the vaccine but also toward the native antigen CD55 in 9 of 13 (69%) patients.
    Conclusions: Immune responses to vaccination were induced in a majority of monitored patients measured by ELISPOT and proliferation assay. The lack of correlation between the ELISPOT and proliferation assays may reflect the fact that the two methods measure different T-cell responses and highlights the importance of multiple readouts in evaluating a potential cancer vaccine. Responses to both the anti-idiotype and the CD55 antigen were measurable, adding support to the use of CD55 as a target in cancer treatment.
    MeSH term(s) Adjuvants, Immunologic/therapeutic use ; Adult ; Aged ; Aged, 80 and over ; Antibodies, Anti-Idiotypic/therapeutic use ; CD55 Antigens/immunology ; Cancer Vaccines/therapeutic use ; Carcinoma/immunology ; Carcinoma/therapy ; Cell Proliferation ; Colorectal Neoplasms/immunology ; Colorectal Neoplasms/therapy ; Cytokines/blood ; Female ; Humans ; Immunization, Passive/methods ; Interferon-gamma/blood ; Lymphocyte Activation/immunology ; Male ; Middle Aged ; Molecular Mimicry/immunology ; Neoadjuvant Therapy ; T-Lymphocytes/immunology ; Treatment Outcome
    Chemical Substances 105AD7 antibody ; Adjuvants, Immunologic ; Antibodies, Anti-Idiotypic ; CD55 Antigens ; Cancer Vaccines ; Cytokines ; Interferon-gamma (82115-62-6)
    Language English
    Publishing date 2006-12-15
    Publishing country United States
    Document type Journal Article ; Randomized Controlled Trial ; Research Support, Non-U.S. Gov't
    ZDB-ID 1225457-5
    ISSN 1557-3265 ; 1078-0432
    ISSN (online) 1557-3265
    ISSN 1078-0432
    DOI 10.1158/1078-0432.CCR-06-1003
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    Zs.A 4223: Show issues Location:
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  9. Article: Percutaneous biliary metal wall stenting in malignant obstructive jaundice.

    Indar, Adrian A / Lobo, Dileep N / Gilliam, Andrew D / Gregson, Roger / Davidson, Ian / Whittaker, Simon / Doran, John / Rowlands, Brian J / Beckingham, Ian J

    European journal of gastroenterology & hepatology

    2003  Volume 15, Issue 8, Page(s) 915–919

    Abstract: Background: Most patients with advanced stage malignant obstructive jaundice will be suitable for palliation only. Metallic stents are safe, effective and minimally invasive.: Design: A review of case notes of patients who had Wallstents inserted ... ...

    Abstract Background: Most patients with advanced stage malignant obstructive jaundice will be suitable for palliation only. Metallic stents are safe, effective and minimally invasive.
    Design: A review of case notes of patients who had Wallstents inserted percutaneously from January 1996 to December 2000.
    Results: Eighty-nine patients with a median age of 72 years underwent percutaneous insertion of biliary metal stents. The diagnoses were cholangiocarcinoma (41.5%), pancreatic carcinoma (40.5%), nodal metastases at the porta hepatis (14.6%) and gall bladder cancer (3.4%). Ninety-six per cent of patients improved their hyperbilirubinaemia to normal levels by 1 month. The median post-procedure hospital stay was 16 days. Early overall complications (within 30 days of stenting) occurred in 30% of patients (70% of these were disease related). The 30 day mortality rate was 20% (n = 18). Fifty (70%) patients were readmitted to hospital, most commonly because of carcinomatosis (16) or stent obstruction (12). The symptom-free period ranged from 2 weeks to 13 months. Median survival for all patients was 3.5 months. Survival correlated inversely with serum bilirubin at presentation (r = -0.34, P = 0.001), but not with other liver function tests.
    Discussion: Metal wall stenting for malignant obstructive jaundice provides good palliation with low, procedure-related morbidity and mortality, but poor overall survival from disease-related morbidity. Survival significantly correlates with pre-stenting serum bilirubin levels. There is a need to identify the subgroup of patients in whom stenting has no beneficial effect.
    MeSH term(s) Aged ; Aged, 80 and over ; Bile Duct Neoplasms/therapy ; Bile Ducts, Intrahepatic ; Cholangiocarcinoma/therapy ; Cholangiopancreatography, Endoscopic Retrograde ; Cholestasis/etiology ; Cholestasis/therapy ; Digestive System Neoplasms/complications ; Digestive System Neoplasms/therapy ; Female ; Gallbladder Neoplasms/complications ; Gallbladder Neoplasms/therapy ; Humans ; Length of Stay ; Liver Neoplasms/secondary ; Male ; Middle Aged ; Pancreatic Neoplasms/complications ; Pancreatic Neoplasms/therapy ; Patient Readmission ; Postoperative Complications/etiology ; Stents ; Treatment Outcome
    Language English
    Publishing date 2003-06-10
    Publishing country England
    Document type Journal Article
    ZDB-ID 1034239-4
    ISSN 1473-5687 ; 0954-691X
    ISSN (online) 1473-5687
    ISSN 0954-691X
    DOI 10.1097/00042737-200308000-00013
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