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Papers by Paul Boulos

British Journal of Surgery, 1998

Background Anastomotic dehiscence is common after surgery for colonic obstruction. The strength o... more Background Anastomotic dehiscence is common after surgery for colonic obstruction. The strength of an anastomosis is dependent on collagen, which is degraded by matrix metalloproteinases (MMPs). The aim of this study was to determine the distribution of the MMPs and their inhibitor, tissue inhibitor of metalloproteinases (TIMP) 1 in an experimental model of colonic obstruction, with and without resection and anastomosis. Methods The distal colon of rabbits was obstructed with a Silastic ring for 24 h and then either the ring was removed or the obstructed segment was resected and an anastomosis formed. Rabbits were killed immediately or at intervals for up to 7 days after operation. The distribution of the MMPs and TIMP-1 was examined by indirect immunofluorescence. Results MMPs and TIMP-1 were present throughout the descending colon for 24 h in both groups. They persisted to the third day in rabbits with an anastomosis but by day 7 were restricted to the suture line. Their presence ...

Diseases of the Colon & Rectum

Gut, 1978

Gastric secretion and fasting plasma gastrin levels were investigated in 26 patients with bilharz... more Gastric secretion and fasting plasma gastrin levels were investigated in 26 patients with bilharzial hepatic fibrosis and 26 controls. The groups did not differ in their basal secretion. When stimulated by intravenous infusion of histamine the maximal acid output in patients with bilharzial hepatic fibrosis was significantly less than in the control group. This was unlikely to be a result of neutralisation by reflux of alkaline duodenal contents as the volumes of reflux were not different from control subjects, but was compatible with a true reduction in gastric secretion as assessed by two-component hypothesis. Neither the lowered gastric acidity nor the liver damage in patients with bilharzial hepatic fibrosis correlated with circulating gastrin. The fasting levels of plasma gastrin in these patients were not different from controls. As in other liver diseases the cause of diminished gastric secretion remains unclear.

British Journal of Surgery, 1997

Background Nearly 7 per cent of patients who undergo resection for colorectal cancer develop meta... more Background Nearly 7 per cent of patients who undergo resection for colorectal cancer develop metachronous cancers several years later. A molecular marker that could identify patients susceptible to metachronous cancers would be of clinical importance. Methods Twenty-four colorectal cancers from 15 individuals with metachronous colorectal cancer were investigated for microsatellite instability at five loci by single stranded conformational polymorphism analysis. A control group of 14 colorectal cancers from individuals who had only developed one sporadic colorectal cancer each was analysed similarly. Results Microsatellite instability was demonstrated in 17 of 24 cancers from individuals with metachronous cancer compared with one of 14 cancers from individuals with a single colorectal cancer. Conclusion These results suggest that testing for microsatellite instability may be useful in recognizing patients at high risk of developing metachronous colorectal cancers.

Basrah Journal of Surgery, 2003

Six hundred and forty patients (65 of them were children) with acute and chronic anal fissure wer... more Six hundred and forty patients (65 of them were children) with acute and chronic anal fissure were randomized to receive topical 0.2%-0.8% Glyceryl trinitrate (G.T.N.) or Isosorbide dinitrate (ISDN) 1%-3% three times daily digitally applied ointment. Patients were followed for 6-26 months. A course of 2-6 weeks treatment was needed. Resting and maximum anal sphincter pressure (MARP) were measured by manometry for 40 patients and showed a very significant decrease in maximum anal sphincter pressure after application of ointment with progress of days of treatment (p =0.02). After 1-2 weeks of treatment 90.4% of acute fissure patients were free of symptoms and 83.73% of them were later cured. Four to eight weeks of treatment were needed to abolish pain in 85.5% chronic fissure patients, and cure was clear in 80% of them (p = 0.008). Side effects of treatment were negligible. Recurrence rate was 4%, while 24 patients (3.8%) were sent for internal sphincterotomy and 81 patients (12.6%) requested revision of medical treatment. In this study we concluded that surgery can be avoided in most cases of anal fissure, and it kept for recurrent cases. Recurrent cases after surgery can also be treated medically.

Blood, 1994

The analysis of X-chromosome inactivation patterns has been used in a number of clinical situatio... more The analysis of X-chromosome inactivation patterns has been used in a number of clinical situations such as the identification of carrier status in X-linked genetic disorders and the establishment of the monoclonal origin of tumors. Interpretation of the result obtained requires comparison with the constitutive pattern for the individual, and for hematopoietic malignancies, skin biopsies or cultured fibroblasts have often been used as the control tissue because normal cells of the same lineage as the malignancy are not generally available. However, this assumes that patterns in the different tissues are constitutionally the same. We have therefore compared X-chromosome inactivation patterns from peripheral blood (granulocytes, E- cells, and T cells), skin, and muscle from 20 hematologically normal females, and colonic mucosa from 9 individuals. In 11 patients (55%), the results obtained were similar for all tissues of an individual, but in 9 patients, significant differences were ob...

British journal of …, 1993

Immunocytochemistry was used in parallel with conventional cytology to detect circulating maligna... more Immunocytochemistry was used in parallel with conventional cytology to detect circulating malignant epithelial cells in 42 patients undergoing resection for colorectal cancer. Preoperative peripheral and peroperative mesenteric venous blood samples were taken. Tumour cells were ...

European Journal of …, 2001

Abstract. Positron emission tomography (PET) has been successfully used to image colorectal cance... more Abstract. Positron emission tomography (PET) has been successfully used to image colorectal cancer (CRC). This study evaluated the accuracy of 2-[18F]-fluoro-2-deoxy-D-glucose (FDG) PET for the detection and staging of recur-rent CRC and the consequent impact on ...

Int J Colorectal Dis, 1992

In Gut B M J Publishing Group, Apr 1, 2011

ABSTRACT IntroductionBowel dysfunction (BD) affects two thirds of patients with Multiple Sclerosi... more ABSTRACT IntroductionBowel dysfunction (BD) affects two thirds of patients with Multiple Sclerosis (MS), with constipation and incontinence often co-existing. Management is largely empirical; however, Peristeen transanal irrigation (PTAI) has been successfully employed in patients with spinal cord injury and spina bifida. We evaluated the effectiveness of PTAI in MS and examined possible predictors of success.Methods Thirty consecutive consenting patients (26 female, age 48.2 ± 10.8) with MS who failed maximal medical treatment and Biofeedback for BD were entered in the study. They all undertook a one-to-one training session on how to use the device. Primary outcome measures, the Wexner-Constipation and Wexner-Incontinence scores, were prospectively compared pre- and post-treatment. Standard ano-rectal physiology and measurement of rectal compliance with barostat were performed at baseline. Patients post-treatment were classified as Responders or non-Responders on the basis of reduction to below 10 in the relevant Wexner score, and baseline tests and scores were compared between groups to identify predictors of successful treatment.ResultsAt 12 months follow-up Wexner-Constipation (12 ± 5.5 vs 4.8 ± 5.5, p = 0.001) and Wex-Incontinence (11.1 ± 6.3 vs 5.9 ± 9.1) improved. Sixteen patients (54%) were classified as Responders. Age, disease duration and disability status were not different to non-Responders.At baseline, Responders had higher Wexner-Incontinence scores compared to non-Responders (13.3 ± 5.7 vs 8.4 ± 6.1 p = 0.037, respectively). Wexner-Constipation scores were similar in both Responders and non-Responders.Physiology parameters were similar in the 2 groups, except that Responders had a higher Maximum tolerated volume to rectal balloon distension (Resp 272 ± 62 vs non-Resp 205 ± 96 mls, p = 0.0296) and Rectal Compliance (Resp 15.5 ± 3.3 vs non-Resp 10 ± 4.6 ml/mmHg p = 0.003).ConclusionPTAI helps over 50% of MS who have failed to respond to maximal medical treatment for bowel dysfunction. It appears that a more compliant and capacious rectum and higher baseline incontinence scores predict successful treatment.

Journal of Vascular Research, Feb 1, 2008

Background: Innervation of blood vessels shows inter-species variability. There are few studies o... more Background: Innervation of blood vessels shows inter-species variability. There are few studies on the innervation of human vessels; thus, healthy mesenteric vessels were studied to identify the expression of immunomarkers and the morphology of sympathetic innervation as the basis for a study of mesenteric vessels in inflammatory bowel disease. Methods and Results: Electron microscopy studies examined the relationships of nerves to smooth muscle cells. In veins, nerves were distributed throughout the medial smooth muscle coat, often in close apposition (50 nm) to smooth muscle cells. In arteries, nerves were located at the adventitial-medial border, few closer than 2,000 nm to smooth muscle cells, often with interposing connective tissue and Schwann cell processes. There was a significantly greater nerve density in veins than in arteries (227 vs. 41 mm 2 ; p = 0.03). Immunohistochemical studies revealed the presence of sympathetic and sensory-motor nerves in arteries and veins. Conclusions: It is suggested that in humans with an upright stance, the mesenteric venous system plays a particularly important role in controlling mesenteric capacitance, which is reflected by their dense innervation. It is speculated that transmitters released from perivascular nerves supplying the human mesenteric arteries may play a long-term (trophic) role in addition to short-term signalling roles.

In Diseases of the Colon and Rectum, 2001

In British Journal of Surgery, 2002

In Current Challenges in Colorectal Surgery W B Saunders London, 2000

The Journal of Pathology 192 396 403, Nov 1, 2000

Adhesions in the peritoneal cavity have been implicated in the cause of intestinal obstruction an... more Adhesions in the peritoneal cavity have been implicated in the cause of intestinal obstruction and infertility, but their role in the aetiology of chronic pelvic pain is unclear. Nerves have been demonstrated in human pelvic adhesions, but the presence of pain-conducting ®bres has not been established. The purpose of this study was to use an animal model to examine the growth of nerves during adhesion formation at various times following injury and to characterize the types of ®bres present. Adhesions were generated in mice by injuring the surface of the caecum and adjacent abdominal wall, with apposition. At 1±8 weeks post-surgery, adhesions were processed and nerve ®bres characterized histologically, immunohistochemically, and ultrastructurally. Peritoneal adhesions had consistently formed by 1 week after surgery and from 2 weeks onwards, all adhesions contained some nerve ®bres which were synaptophysin, calcitonin gene-related peptide, and substance P-immunoreactive, and were seen to originate from the caecum. By 4 weeks postsurgery, nerve ®bres were found to originate from both the caecum and the abdominal wall, and as demonstrated by acetylcholinesterase histochemistry, many traversed the entire adhesion. Ultrastructural analysis showed both myelinated and non-myelinated nerve ®bres within the adhesion. This study provides the ®rst direct evidence for the growth of sensory nerve ®bres within abdominal visceral adhesions in a murine model and suggests that there may be nerve ®bres involved in the conduction of pain stimuli.

W B Saunders London, 2000

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