The Annual Report 2004 St Mark’s Hospital The Hospital for Intestinal and Colorectal Disorders

The Annual Report for the year ending 31st December 2004

North West London Hospitals NHS Trust Watford Road Harrow Middlesex HA1 3UJ, UK

Tel: +44 (0) 20 8235 4002 Fax: +44 (0) 20 8235 4001 www.stmarkshospital.org.uk Preface

A hospital is more than its component parts. This report is of necessity divided into sections but is actually about a single vibrant entity - St Mark’s Hospital, dedicated to helping patients with difficult and often embarrassing colorectal and anal problems since its foundation in 1837.

This is the 170th edition of our Annual Report, continuing a tradition begun in 1837. The Report encapsulates the multi-disciplinary nature of St Mark’s, the many contributions from the various departments summarising the multitude of clinical and academic activities of the Hospital, the St Mark’s Academic Institute and our major collaborators. These range from major research studies whose results will influence medicine around the world, to more modest local and personal achievements. All are part of the varied and valued life of St Mark’s.

The editors are grateful to all who have contributed to this report. Thanks are also given to the St Mark’s Association and the St Mark’s Hospital Foundation whose support enables us to produce and distribute this report. Modern technology permits a larger format this year, with more flexibility for illustrations and we hope that the new style will be favourably received.

Editor Ian Talbot

Assisted by Judith Landgrebe Janice Ferrari Alan Warnes

23 Table of Contents

4 Patrons, Senior Staff and Trustees 6 Clinical Director’s Report 8 St Mark’s Tide Service 9 Service Manager’s Report 10 Frederick Salmon Ward 11 Outpatients Department 12 The Robert & Lisa Sainsbury Wing 14 Medical Social Work 15 St Mark’s Association 16 St Mark’s Hospital Foundation

Support Groups 20 Friends of St Mark’s 21 Inside-out Stoma Support Group

Academic Institute 24 Dean’s Report 26 Administrator’s Report Visitors to St Mark’s Academic Institute Grand Rounds Regular Hospital Schedule 39 Research Executive

Departmental Reports 44 Colorectal Cancer Unit Director’s Report Population Screening Research Colorectal Cancer Genetics Group Family Cancer Group The Polyposis Registry 54 Intestinal Imaging Centre 55 Endoscopy Wolfson Unit for Endoscopy Incorporating the Kennedy Leigh Academic Endoscopy Centre Diagnostic Nursing 58 Medicine General Gastroenterology Physiology Unit 66 Nursing Burdett Institute of Gastrointestinal Nursing Stoma Care Department 68 Intestinal Failure 70 Academic Department of Pathology 72 Research Records Department 73 Surgery 78 Bibliography St Mark’s Annual Report 2004 St Mark’s Hospital Patrons, Senior Staff and Trustees

Consultant Physicians The Board of Patrons CB Williams MA BM Mchir FRCP FRCS Professor MA Kamm MD FRCP FRACP Lady Bingley MBE MR Jacyna MD FRCP Sir Walter Bodmer FRS A Forbes BSc MD FRCP ILTM Mrs Eileen Carey HJW Thomas MA PhD FRCP Sir John Chalstrey BP Saunders MD MRCP Mr Derek Coe M Pitcher MD FRCP Lord Foster of Thamesbank OM S Gabe MD FRCP Lord McColl of Dulwich A Emmanuel MD MRCP Lady McGregor of Durris Lord McNally of Blackpool Consultant Histopathologists Dr Joy Newman Professor IC Talbot MS FRCPath Lady Riches Professor AB Price MA BM MCh PRCPath Lady Sainsbury T Guenther MD PhD Priv.-Doz, Dr. med.habil Mr Evan Stone QC Professor A von Herbay MD Mr Keith C Wetherell Lord Wolfson of Marylebone Consultant Radiologists Professor CI Bartram MB BS FRCP FRCS FRCR S Halligan MD MRCP FRCR Emeritus Staff M Marshall MB FRCR S Taylor MD FRCR MRCP Consultants Professor EW Walls MD BSc FRCS FRCSEd FRSEd Consultant Psychiatrist Sir Ian Todd KBE MS MD FRCS FCS (SA) FRACS FACS FRCPSGlas J Stern BA MB ChB MRCPsych BC Morson CBE VRD MA DM FRCP FRCS FRCPath Hon FRACS CV Mann MA MCh FRCS Consultant Psychologists IR Verner MB Bchir FRCA P McHugh MSc CPsych Professor JE Lennard-Jones MD FRCP FRCS E Serrano-Ikkos CPsych PhD SK Alexander MB BS A Brook MD FRCPsych Consultant Dermatologist BM Thomas MB BS FRCP FRCR S Goolamali MD FRCP PR Hawley MS FRCS JPS Thomson DM MS FRCS Consultant Nurses Professor RW Beard MD FRCOG Professor C Norton PhD MA RN M Vance RGN DIP MSc A Davidson MSc Dip HE RN Senior Staff

Honorary Consultants Consultant Surgeons S Arnott MB Bchir FRCSEd FRCR Radiotherapy Professor RJ Nicholls MA Mchir FRCS FRCPSGlas Professor KE Britton MSc MD FRCR FRCP Nuclear Medicine Professor JMA Northover MS FRCS SJD Chadwick MS FRCS Surgery Professor RKS Phillips MS FRCS M Granowska MD MSc FRCR Nuclear Medicine PJ McDonald MS FRCS M Slevin MB ChB FRCP MRCP Medical Oncology ACJ Windsor MD FRCS CRG Cohen MD FRCS Sir Francis Avery Jones Visiting Professor SJD Chadwick MS FRCS Professor D Rex-USA CJ Vaizey MD FRCS

Sir Alan Parks Visiting Professor Professor R Parc-France

4 5 Visiting Consultants Pharmacists Professor MJG Farthing BSc MD FRCP Gastroenterology Claire Chadwick BPharm MRPharmS Professor A Darzi MD FRCS Surgery Jackie Eastwood BPharm Dr A Shaw G. U. Medicine Social Worker Consultant Staff from other Directorates Solveig Wilson CSS M Brunner MB MS FRCA Anaesthetics J Elkabir MB BS FRCS (Eng) FRCS (Urol) FEBU Urology Managers D Fermont MB BS FRCR FRCS Oncology Professor CI Bartram Clinical Director R Glynne-Jones MB BS FRCR MRCP Oncology Dr A Forbes Dean M Hasan MB ChB FRCA Anaesthetics Mr PJ McDonald Sub-Dean J Harris MB BS FRCA Anaesthetics Mrs Veda Enser Assistant Director Operations, Elective Services A Hewlett MB ChB FRCA Anaesthetics Ms Ann Curry The Robert & Lisa Sainsbury Wing C Higgens MD FRCP Rheumatology Mrs Nesta Dutton Patient Services Manager W Hyer MRCP MRCPCH Paediatrics Miss Judith Landgrebe Academic Administrator M Kapembwa BSc MB FRCP FRCPEd G. U. Medicine Ms Karen McGuire Services Manager A Keat MD FRCP Rheumatology Mrs Val Pryor Diagnostic Services Manager K Konieczko MB BS FRCA Anaesthetics Mrs Jo McCarthy Head of Specialist Nursing P Kulkarni MB BS FRCA Anaesthetics D Newton MB BS FRCA Anaesthetics V Ramachandra MB BS FRCA Anaesthetics North West London Hospitals NHS Trust N Robinson MB ChB FRCA Anaesthetics Chairman Nurse Specialists Dr Alastair McDonald Jennie Burch Stoma Care Mariann Baulf Endoscopy Non-Executive Directors Clare Bossom Stoma Care Ms Moira Black Debbie Buchan Nutrition & IF Ms Marvelle Brown Angelina Chai Endoscopy Dr John Green Natalie Crawley Stoma Care Ms Sally Kirkwood Annmarie Daniels Nutrition & IF Dr Yashwant Patel Julie Duncan Biofeedback Angie Davidson Nutrition & IF Executive Directors Allison Durrant Pouch Care Mr John Pope CBE Chief Executive Officer Nicky Horton Biofeedback Mr Mark Devlin Deputy Chief Executive Officer Ripple Man Endoscopy Dr John Riordan OBE Medical Director Christine Norton Continence Mr Don Richards Finance Marian Smith Nutrition & IF Sir Graham Morgan Nursing Jayne Somerset Pain Management Ms Rhaj Bhamber Human Resources Director David Swain Endoscopy Mr Phillip Sutcliffe Corporate & Support Services Jo Sweeney Pouch Care Claire Taylor Macmillan Sarah Varma Stoma Care Julia Williams Lecturer in Nursing Maggie Vance Endoscopy Anjela Vujnovich Stoma Care Jacquie Wright Biofeedback/Polyposis Lisa Younge Inflammatory Bowel Disease

5 St Mark’s Annual Report 2004 St Mark’s Hospital Clinical Directors Report 2004

This is my last Funding remains a key issue for the discussion, this offer had to be rejected. report as Clinical hospital. When we moved to Northwick No sooner had we done so than we Director as I Park, extra-contractual referrals provided received a second offer from University retired from appropriate finance for complex case College Hospital. This was to move both the NHS in management. This devolved into service the hospital and our academic base December. I have level agreements with individual PCTs. to the University College Campus and always felt that Payment from next year is about to had many attractions: an integrated unit St Mark’s needed change, and will be based on a uniform within the new hospital with adjoining to be larger and weighted cost for different HRGs (health space for our units, the presence of expansion was the keynote to the start related groups). This may work for many specialist units and a large ITU to of my Directorship at our Academic away routine cases, but as yet does not take support complex case management, a day some 3 years ago. The plans for a into account the higher costs involved in Foundation Hospital encompassing the Nutrition Centre would have increased managing complex cases and presents largest number of tertiary hospitals of our bed capacity to about 70, an a major problem for funding specialist any Trust, with research and academic appropriate size for a dynamic tertiary units. The Department of Health has units all together in a very compact hospital, and had received support from appreciated the problem and I attended campus. This was a unique opportunity the Trust and Imperial. Funding for the a series of meetings looking at how to move St Mark’s into a specialist NHS component was proving difficult complex cases may be differentiated, as environment with academia on site. The as NSCAG does not support capital the current coding system is inadequate downside was that the hospital would programmes. The Strategic Health in this respect, and how these may be lose its local secondary referral base Authority is overwhelmed by demands funded. Financial information is hard to and return to a highly specialist referral and also felt, with justification, that it obtain to cost complex cases properly, role that marked the last decade in should not bear the entire capital burden and there was interest from the DoH City Road. Only the Barts and London for a national resource. Unfortunately in using St Mark’s as a reference site site would have given us both a large no mechanism for funding via the NHS for costing complex coloproctology. local secondary base and an integrated seemed to be forthcoming and we Progress in this and the whole issue of academic campus. The medical staff were starting to look for donors when specialist funding will have to await next visited the new site and had a number there was a rather sudden decision for year’s report. of meetings to discuss this offer and the a new hospital PFI at Northwick Park. pros and cons of any move. After initial Even if we obtained the money for the Our negotiations with Imperial support these preliminary discussions Nutrition Unit, the NHS component unfortunately became unduly protracted had reached a point when we had to would have meant a dramatic increase during the year, and this was not without decide as to whether to move into the in the capital budget for the trust to repercussions. In the middle of the year, next stage of detailed planning and pay for its rebuilding within the PFI. we received an offer from the Warden of negotiations with the relevant Trusts, Given the serious Trust overspend this Queen Mary’s School of Medicine and Medical Colleges, Cancer Research UK was obviously impossible, and the Dentistry, Professor Nicholas Wright, to and undoubtedly the DoH. At a special project had to be shelved. Fortunately join QMC. This was on very attractive meeting the proposal to take this next these constrictions did not apply to the terms, and an outline agreement was step was rejected by a majority vote, project to build 3 portacabins between negotiated within just a few weeks. It thus terminating formal negotiations by the end of X block and the Himsworth, was a generous offer, but the problems St Mark’s with UCH, though this may not so that this project could proceed and of the geographical separation had be the end of individual staff considering was completed just before the end of always been a major concern, and a future with UCH. the year. It has provided 216 sq m of in the final analysis were considered office space for Academic Nursing, too great and would have prevented I held a meeting with all the staff of an inflammatory bowel diseases unit significant integration with the relevant the hospital to explain what had been and psychological medicine. The academic units at Queen Mary’s. Any happening during these initial discussions accommodation is of a high standard question of moving the hospital was with UCH and also, with colleagues, met and integrates well with the hospital complicated by the PFI’s at both Barts with John Pope, the CEO of the Trust, to provide much needed expansion in and the London already being fixed, for a frank discussion as to why this had these disciplines. so that after much consideration and come about and the current feeling of

6 the medical staff in St Mark’s. We were responsibility for all the NHS clergy hindsight have been a turning point pleased to receive written support for and it was fitting that a senior member for the hospital. I shall watch from the our concerns regarding the governance of the Church should attend the 150th sidelines, but as ever with enthusiasm of St Mark’s within the Trust, notably the anniversary of the official opening of and support for the continuation of establishment of specialist commission the first St Mark’s Hospital in City Rd, Salmon’s great enterprise. in the Trust, investment in St Mark’s, which was on St Mark’s Day, the 25th membership of the project board for the April 1854. The Bishop visited Radiology Clive Bartram PFI, our representation on the critical to see CT colonography, meet Chris Clinical Director care steering group for HDU and support Norton, then went to see some patients St Mark’s-tide Service for an Intestinal Failure ward. This has in Frederick Salmon Ward and the private obviously been a difficult period for wing, before having tea in the Medawar St Mark’s, but one from which I feel Centre. After the service John Northover the hospital will emerge the stronger gave a short lecture on the history of for being fully united in its purpose for the hospital, which was received with staying on the Northwick Park campus. great interest, as many now working at the hospital have no understanding of There was a major management its history. That evening a dinner was re-structure in May with Veda Enser held at the House of Lords, hosted by becoming Associated Director of Baroness Northover. Thomas Guenther Women’s and Elective Services, and and Axel Von Herbay were welcomed Caroline Francis Associated Director as new staff following the retirement of of Clinical Diagnostics. My PA, Louise Ashley Price and Ian Talbot. Later in the Dunne, left in June to be replaced by year the latter held a most successful Rehana Shah, who was academic Festschrift. Christopher Williams also secretary to Professor Talbot. I am gave his retirement speech, this time grateful to her for all the work she did several months after his Festschrift. in the last few months of my tenure as National training for colonoscopy Clinical Director. commenced at the beginning of the year, and partly as a result of this, Brian The details of developments in nursing Saunders transferred to an NHS contract will be highlighted elsewhere, but it was in November, and Chris Fraser was a pleasure to welcome Jo McCarthy appointed to support the expanding as Head of Specialist Nursing, and to work of the unit, not only in teaching but congratulate Angie Davidson on her in capsule endoscopy and interventional appointment as Nurse Consultant in endoscopic procedures. Intestinal Failure and Nutrition. Chris Norton was appointed Chair of the I leave feeling that I have only achieved Burdett Institute of Gastrointestinal a fraction of what I hoped for, but take Nursing, which marks a most important comfort that some progress has been development of Nursing at St Mark’s. made and there have been significant Her chair is at King’s College and developments within the hospital. we all wish her well in this exciting St Mark’s has always suffered by being development. The offices for the on the outside of organisations. I believe Institute will be the top floor of the we now have a clearer relationship with Portacabin unit. the NHS Trust and the development of the St Mark’s Institute within Imperial We were fortunate that the Bishop of is to become a reality. Through the St Albans agreed to take this year’s PFI there is the opportunity to create a St Mark’s Day Tide service. The Right purpose built St Mark’s, and in spite of Reverend Christopher Herbert has the difficulties of the year, it may with

7 St Mark’s Annual Report 2004 St Mark’s Hospital St Mark’s Tide Service

The service this year marked the 150th Before the Service the Bishop visited Anniversary of the official opening of the Radiology Dept. to see the colour St. Mark’s Hospital in City Road. In imaging machines and met Professor honour of the occasion one of the Senior Christine Norton, the first Professor of Bishops in the Church of England was Colo-Rectal Nursing and after visiting invited to take part in the Service and to Sainsbury and Salmon Wards had tea give the address. Rt. Rev. Christopher with the ensemble of Bishops. Herbert is Bishop of St. Albans, lead Bishop in the House of Lords and the After the Service and reception the General Synod of the Church of England celebrations continued with an excellent on the NHS and is Chair of the Hospital Dinner at the House of Lords after which Chaplaincies Council. the Bishop presented service badges to staff on the balcony. In his address the Bishop said that in an increasingly fragmented society, Spiritual Dave Byrne Health care was even more important Chaplain than ever before. Joining him at the Service was a retired Archbishop, Most Rev. Donald Arden, 2 local Bishops, Rt. Rev. George Stack (R/C) and Rt. Rev. Pete Broadbent, The Archdeacon of this area, Venerable Christopher Chessun, and the 2 Roman Catholic Deans, Fr. Peter Harris and Fr. David Williamson.

8 St Mark’s Annual Report 2004 St Mark’s Hospital Service Manager’s Report

What an interesting and challenging This year Professor Robin Phillips, Congratulations to Angie Davidson year this has been for St Mark’s. We became our new Clinical Director. We who was appointed as our new Nurse have worked under significant pressure also welcomed some new and old faces Consultant in Nutrition and Intestinal to achieve this year’s inpatient and back to St Mark’s, Jo McCarthy, joined Failure and to Dr Chris Fraser who was outpatient targets. Well done everyone, us in June as our Head of Specialist appointed as a Consultant in Endoscopy. we could not have achieved this without Nursing. Jane Campbell returned to your continued support! St Mark’s to take up her new post as On the service development side we Clinical Nurse Manager for Outpatients, were successful in our bid for additional The second Annual Conference in and was subsequently appointed to resources to assist the work of the Intestinal and Colorectal Disease was the role of modern Matron for Frederick gastroenterologists Trust-wide and we an enormous success and next year’s is Salmon Ward and Outpatients. Denise appointed three new staff-grade doctors currently being planned. Robinson, was appointed to the Clinical to support our busy outpatient and Nurse Manager’s role in Outpatients inpatient workload. There have been a number of staff following Jane’s promotion. Susheela This year saw the Xmas show take on changes over the year. Sadly, we said Robinson and Steve Wright took up a completely different theme. It was in goodbye to some of our old friends, their new posts in July as peri-operative the form of a play, Kammelot. I would Professor Bartram retired from the NHS, colorectal nurse practitioners and have like to thank everyone who entered into as did Jenny Jones and Pam Nye much been working alongside Jane and all the spirit of things by dressing up in to my disgust! They will be sorely missed the nurses on the ward to improve medieval costumes. There were certainly and I am sure you will all join me in the standard of care provided to our some outstanding costumes. Well done thanking them for all their hard work and patients. Bharti Patel who joined us the to everyone who worked so tirelessly commitment to St Mark’s over the years. previous year as an apprentice, has now in ensuring it was a huge success, become a fully fledged member of staff although I’m not too sure about being and is well on her way to becoming an cast in the role of a witch! excellent medical secretary. Tracy Morris will join us in January 2005, as the new Finally, I thank the friends of St Mark’s for Outpatient Service Manager, and we look all their hard work over the year. forward to welcoming her to St Mark’s. Karen McGuire Service Manager Frederick Salmon Ward

9 St Mark’s Annual Report 2004 St Mark’s Hospital Frederick Salmon Ward

Modern Matron It gives me great pleasure to contribute We are a pilot site for the trial of an Jane Campbell to my first annual report. What a year! early warning MEWS chart. We have Senior Sister I returned to St Mark’s in February 2004 also continued the Friday staff teaching Vanitha Kanagaratnam Louise Williams to manage the Outpatient Department sessions. We had a sisters’ away day

Sisters but this was soon to change and I and developed a nursing strategy for Maureen Pillay am now Modern Matron for Frederick Frederick Salmon ward. This document Jas Dhiman Maura Prenter Salmon Ward and Outpatients. provides us with objectives with time Ann Callaghan scales and gives us some direction and Alison Manley Congratulations to Susheela Robinson focus for the coming year. Staff Nurses who has now taken up her new post Pauline Anderson Jitka Aido as Peri-operative Colorectal Nurse We continue to have student nurses on Sam Kay Janet Superio Practitioner. I would like to take this the ward who are at various stages of Mercy Amoah opportunity to thank Susheela for her their training. The evaluations from the Mohamed Dahir Chandy Gungadin support and on behalf of the staff thank students have been very positive and Ceclia Obi her for her 5 years of management we have recruited from the final year Les Bunencamino Vanessa Lopez and leadership. Steve Wright has also students. This reflects well on the ward Nirmalie Madurawala returned to St Mark’s as Peri-operative as we must be providing an effective Eleanor Ntiamoah Azam Shamsi Colorectal Nurse Practitioner. These learning environment. As the demand Joy Odita posts have had a very beneficial effect for assessors increases, we continue to Suzan Mahon Niamh Garry on the service provided to patients on send some staff to undertake Slice I and II Sushma Bhattarai Frederick Salmon ward. which is a teaching and assessors course. Miralie Legaspi Juanita Lavina Plaza Elizabeth Kamara One of the first tasks I set myself was to We would like to congratulate a number of Donna Smith Ma Roseele Soriano review the skill mix on the ward. I would staff on the birth of their babies, namely:- Barbara Rugge like to thank Vanitha Kanagaratnam who Mercy Amoah – a baby boy, Marilyn Sackey Lolita Plegaria took up her ‘G’ grade post in February Alison Manley – a baby boy, Anna Shetty 2004 for her support. The new ward Amirtha Prabhaharan – a baby girl, Health Care Assistants structure is in its final stages of agreement. Sushma Bhattarai – a baby boy, Maureen Jarrett Rosy Vijayamanoharan Recruitment and the retention of staff on Nirmalie Madurawala – a baby boy, Vivian White Frederick Salmon ward has been very Aaron Cabangon – a baby boy. Manjeet Sikand Sheila Waterworth successful in the last year. As usual there I would like to thank the Committee of Jennifer Piper have been a few changes this year :- the Friends of St Mark’s for the purchase Elizabeth Njogu Aaron Cabangon Leavers of patients’ Christmas presents, Johann Doohan, Grainne Dwyer, resources for the laundry room and their Administrative Staff Nancy Swasbrook Claire Walsh, Alison McCulloch, continued support. Margaret McCarthy Moussa Diop, Paula Hui Zahira Mohamed New Starters I would like to thank the ward clerks Vanitha Kanagaratnam, Amirtha Margaret McCarthy and Zahira Mohamed Prabhaharan, Dev Vath Ramgoolam, for their efforts in keeping the department Lolita Plegaria, Monica Shrestha, running smoothly. I would also like to Romaine Joseph, Marilyn Sackey, thank our domestic staff Valentina and Sam Kay and Anna Shetty. Bennie for all their hard work in keeping Promotions the department clean. I would also like Maura Prenter to ‘F’ grade. to thank Nancy Swasbrook who has kept We have had one member of staff, me on the straight and narrow over the Camile Simone, retire. We wish Camile a past year. long and happy retirement. Jane Campbell Modern Matron Frederick Salmon Ward & OPD

10 St Mark’s Annual Report 2004 St Mark’s Hospital Outpatients Department

Acting Clinical Nurse Manager Firstly I must thank Denise Robinson Even with the changes in the nursing Denise Robinson for running the department prior to me team the service provided has been to Staff Nurses & starting in February 2004 and also for a high standard. We welcome Bharti Health Care Assistants Jocelyn Hyndman her hard work since she became Clinical Punjani, Dopoda Mehta, Katie De Matos, Dopoda Mehta Nurse Manager firstly on secondment and Sophie Smith to the team. Bharti Punjani Katie De Matos and then permanently. Sophie Smith Myself and Denise are reviewing the The Outpatient’s department runs a roles and responsibilities of the nursing number of varied and busy clinics. team and some new initiatives will be The staff have to work closely with many commencing soon. We realise that members of the multidisciplinary team. we need to develop the staff in the Many research projects recruit patients outpatient’s department and are working from clinic and therefore the nursing closely together. We know that the staff liaise with the research staff on coming year will be a challenging one a regular basis. but we will continue to provide the highest quality of care to our patients. Due to members of the nursing team leaving for pastures new Thola Luthuli Jane Campbell and Valentina Baffour-Gyawu were Modern Matron relocated from Frederick Salmon ward Frederick Salmon Ward & OPD to the outpatient’s department to ensure continuity of service. During the year Valentina was promoted to an ‘E’ grade. During the year some members of staff relocated within the Trust – Maria Rakova transferred to Biofeedback, Patricia Lawrence transferred to Surgical Outpatients – NWP, Evette Cooper transferred to Physiology. We wish them all well in their new posts.

11 St Mark’s Annual Report 2004 St Mark’s Hospital The Robert and Lisa Sainsbury Wing

Chair Sainsbury Wing has had an interesting transferred to ITU at Northwick Park, Mr Ian Fyfe year in 2004, a year of change in some Julie Storrie, a long-standing nurse of Vice Chair areas and new challenges that were St Mark’s, moved to a community role Professor Robin Phillips succeeded by Mr Richard Cohen faced by the staff. Our continued aim closer to home and Caroline Kennedy was to monitor the services provided left to broaden her experience within Private Patient Manager Pam McGowan to the private patients and to our colorectal nursing. We were fortunate consultant users and to focus on to be able to recruit two newly qualified Clinical Nurse Manager Ann Curry providing clinical excellence. nurses from TVU. Both Afua Brew

Team Leaders/Sisters and Karen Parfitt had been student Sally Crowther I have been supported in leading the nurses on Sainsbury Wing and show Rebecca Slater nursing team by an excellent cohort of excellent potential. There was also the Kathrine Fredericks Annalyn Manalastas team leaders. They have consistently opportunity for three of the junior staff

Staff Nurses demonstrated vision and commitment nurses to progress into E grade roles. Afua Brew to their role, ensuring that the provision Aileen Castro of patient care is planned and delivered All of the nursing staff have worked Caroline Kennedy Deena Iosefu to a high standard and also helping extremely hard throughout the year and Sandra McGrath to develop junior staff. Becky Slater have enjoyed the challenge of caring for Sandra Maxwell Ramil Pangilinan returned from maternity leave in June; patients within gastrointestinal disease. Karen Parfitt baby Olivia was born in February. It was a difficult year in some respects, Mercy Sigauke Gladys Singson Kath Frederick chose to broaden her which in part was due to a higher than Julie Storrie clinical skills by transferring to Kingsley usual number of patients with terminal Emilia Tazarurwa Richard Wagland Wing In August, yet she continues to disease being admitted in the final stage Victoria Zideman provide senior support to Sainsbury of their illness. However the experience

Healthcare Assistant Wing when required for unit cover. and commitment of our staff enabled us Leticia Alvarado Annalyn Manalastas had a four-month to master the challenge and to provide

Ward Receptionists period working on Kingsley Wing in expert care to our patients. At this stage Sheila Alzano the middle of the year – the two wards the ward team worked closely with the Gill Bell have been working together to develop Macmillan nurse specialists. The staff organisational systems and also to were also supported through this by an provide clinical and managerial support independent psychologist. for each other. Sally Crowther returned to Sainsbury Wing in August following Education and training has remained an almost a year on secondment to the important feature of staff development, Nutrition and Intestinal Failure team. It and staff attended a variety of both in- was wonderful to have Sally back as part house and external courses, covering a of the team, even though it is anticipated wide range of clinical topics. This was that she will not stay with us for long. in addition to the ever-growing number Amongst the staff nurses we had a few of mandatory training sessions that must leavers and new starters but on the be completed annually. Our healthcare whole the nursing team has remained assistant Leticia Alvardo has continued relatively stable. We were sorry to see to put in tremendous effort to her NVQ the departure of some experienced E level 3 and will be aiming to complete grades to pastures new: Deena Iosefu this programme next year.

12 Sainsbury Wing has continued to Reviewing the business activity on provide learning placements to Sainsbury Wing, there was an operating undergraduate students from both surplus of £90k on a £2.3m turnover. Thames Valley University and City This was an increase of 6% compared University. We have also facilitated to last year. Sainsbury Wing operated clinical support to nurses from overseas on an average private patient occupancy during their six-month Supervised of 58%, a 3% increase on the previous Practice programme. Feedback from year. In addition, where possible, all students has been positive and has St Mark’s NHS patients have been given reflected the commitment from the staff beds when there have been shortages to ensure that the students maximise on Frederick Salmon Ward. St Mark’s their learning opportunities. consultants accounted for 69% of all admissions and 83% of the bed days Early in the year in order to develop used on Sainsbury. The average length the support services for the unit a Hotel of stay was 6.5 days ranging from 1 day Services Manager post was established to 5+ months. and this has allowed an increased focus on the room and catering facilities for The key challenges for 2005 will be our patients. meeting the Trust’s tough financial targets, implementing Agenda for In September Pam McGowan left her Change and further improving quality position as Private Patients Manager across a range of services provided on to take up a new position at The Royal Sainsbury Wing. So whilst we look out Marsden. I would like to thank Pam for onto the changing skyline of London her tremendous support that she has and the new look Wembley Stadium, we given to Sainsbury Wing as well as to anticipate and look forward to an exciting me personally. We wish her well in her and promising year ahead. new role. Until the appointment of a new manager Trustplus was temporarily Ann Curry supported by Benniess Tilbury. Clinical Nurse Manager The ward has been given invaluable admin and clerical support by our two receptionists. Gill Bell retired at the end of October after 25 years with the Trust and we wish her a well-deserved happy retirement.

13 St Mark’s Annual Report 2004 St Mark’s Hospital Medical Social Work

In June 2004, the Friends of St Mark’s As patients and relatives come to My role as social worker and counsellor at asked if I would give a talk at their AGM. St Mark’s from quite a distance, I am St Mark’s has quite a wide remit. Many I was filled with trepidation, as I am indebted to the Friends of St Mark’s patients don’t need “a social worker” more used to talking one to one than for their generous funding for overnight nor a “counsellor” but may welcome an to a roomful of people. I could have accommodation at the Residence opportunity to air their personal issues. talked about the everyday problems [managed by Network Housing One of these issues is the implications for and pleasures encountered on Frederick Association] or at local hostelries when younger patients who have permanent Salmon Ward or indeed with outpatients the Residence is unavailable. Many stomas. Bringing a small group together and the work involved in dealing with patients just need help in finding for a few sessions gave the patients an statutory benefits or planning discharges accommodation in an unfamiliar area, opportunity to share their experiences and or just being around to lend an ear, but rather than financial help. take on board some of the experiences I realised how therapeutic my daily walk of others. The notion of holistic treatment is and how energised I feel by the time The Friends of St Mark’s have come to comes to mind, where body and soul I reach St Mark’s, hence the title “The the rescue on more than one occasion is one whole to be treated. Having the Walking Social Worker” and I described for a homeless patient. They have helped recourse to offer this is part of what my walk every day over Harrow on the with securing rented accommodation makes St Mark’s special. Hill to the hospital. where a deposit was required in excess of what was available. This kind of help is Solveig Wilson In last year’s report I said there were rarely available elsewhere. Social Worker & Counsellor many new patients with “old” problems familiar to many “old” St Mark’s patients. Rustington Convalescent Home in West The main issues continue to be centred Sussex continues to be an excellent round various benefits, i.e. Disabled stepping stone between hospital and Living Allowance, Incapacity Benefit and home for many a patient. Gentle Housing Benefits. As local authorities are exercise, good food and sea air seem more rigorous in reviewing entitlement to have the desired beneficial effect on to Housing Benefit, several long-stay the patients who go there for a couple patients found that their benefits had of weeks. Again, this would not be been stopped because review forms had possible without the generous support not been completed and returned. The and funding from charities like the Victoria good news is that most local authorities Convalescent Trust and the Florence are very helpful when the facts are put Nightingale Aid in Sickness Trust. before them along with covering letters explaining the situation.

14 St Mark’s Annual Report 2004 St Mark’s Hospital St Mark’s Association

Executive This year was the first in post for the The President Elect Mr Michael

President new Secretariat. Our heartfelt thanks go Thompson was welcomed and the Professor Clive Bartram to Dr Halligan and Dr Saunders for their presidency duly transferred with the St Mark’s Hospital hard work over the last 5 years. Judith handover of the President’s Lion. Next President Elect Landgrebe has been a cornerstone year’s President Elect, Professor Ian Mr Mike Thompson Portsmouth Hospitals NHS Trust of the successful transition and has Talbot, was approved by the Association been working with only the occasional and has already been planning his Secretary whimper of distress to get the new Presidential year with enthusiasm. Dr Michele Marshall St Mark’s Hospital secretariat into shape - her continued sense of humour and optimism are as Mike Thompson informed us of his Treasurer Dr Anton Emmanuel ever, much appreciated. plan for the coming year, with an St Mark’s Hospital eye to infusing a new spirit of social External Representatives The St Mark’s Association Day was engagement for next year. He challenged Miss Jane Mccue held on 18th October 2004, chaired us all to reunite our former peers and East and North Hertfordshire NHS Trust Ms Asha Senapati by the President, Professor Bartram. gather them next year for an opportunity Portsmouth Hospitals NHS Trust Attendance this year was a little lower to renew old friendships and inform the Administrator than in previous years, though this did Association of the developments and Miss Judith Landgrebe not hamper the success of the day. An projects they are taking forward across St Mark’s Hospital interesting and interactive programme the country. was presented; the President’s lecture “A New Radiological Subspeciality” was The membership was reviewed and 21 a welcome refresher in the rapid advance new members elected, 11 from the UK of technology in the last 10 years in and 10 from overseas. Gastrointestinal Radiology. As well as an excellent overview of the developments Michele Marshall with respect to GI radiology in particular, Hon. Secretary he gave us an enticing look into the future, destined to be dominated by high powered computer analysis and the promise of Virtual Reality. Luckily, a rapid relocation to Harrow School for refreshments and a convivial Annual Dinner took the strain off the faces of the non-technologically minded!

15 St Mark’s Annual Report 2004 St Mark’s Hospital St Mark’s Hospital Foundation

Chairman of Trustees 2004 was a year in which great did not stop the Trustees pressing ahead Charlotte Barney challenges arose for St Mark’s, and we with making a significant investment Treasurer have begun to look ahead in order to in new modular buildings to provide William Phillips agree what part the Foundation might extra office space for inflammatory Trustees play in the future of the Hospital in years bowel disease research, psychological Prof Sir Leszek Borysiewicz PhD FRCP FRCPath FMedSci to come. medicine and the new Burdett Institute Mr Richard Cohen MD FRCS of Gastrointestinal Nursing. The Trustees Edward Charlton Prof Michael Edwards JP BSc Perhaps the most significant challenge contributed half towards the cost of (Econ) PhD was the announcement by North West these buildings, the remainder coming Prof Colin Green PhD DSc (Med) FRVS FRCPath FRCS (Hon) AcadUKrAcadSci London Hospitals NHS Trust of a Private from the Special Trustees. Prof Michael Kamm MBBS MD Finance Initiative (PFI) worth £305m FRCP FRACP aimed at rebuilding Northwick Park The buildings were completed by Michael Liebreich Prof John Nicholls BA MChir FRCS and St Mark’s Hospitals. This initiative December and the new offices have Prof Robin Phillips MS FRCS is scheduled for completion in 2011 been welcomed by those to whom it has Dr Christopher Williams BM FRCP FRCS and will provide state of the art clinical provided vital extra space at a time when facilities incorporating a new St Mark’s space is at a premium. Director Sean Bonnington Hospital within the main building.

Office Manager 2004 saw the continuation of investment Gill Royal It however seems very unlikely at the by the Foundation in research into

Fundraising Assistant time of writing that this new build will bowel disease. Catherine Mulcahy include dedicated space for the research

Secretary and postgraduate teaching activities The Foundation agreed to extend Mr Richard Cohen MD FRCS currently carried out at St Mark’s, and its support for the work of Dr Shanu thus leaves a major opportunity for the Rasheed for a third and final year so that Foundation to support the creation of Dr Rasheed could complete his PhD into new facilities for research and teaching. prognostic indicators of rectal cancer.

At the moment it is not clear what Dr Eric Cheung continued his research support might be necessary, but it into bowel function following spinal injury seems likely that a capital appeal for as the Andrew Skinner Memorial Fellow, the substantial funds necessary for and Dr David Lloyd took up his post such new facilities will be planned and as the Robertshaw Fellow, looking to launched in the next year or so. The establish the correct nutritional regime for Trustees look forward to working with patients with enterocutaneous fistulae. the Dean and Clinical Director, as well as the Trust Board, to make progress In education, the Foundation once more on these plans. underwrote the cost of the St Mark’s International Congress, at the Hilton The announcement of the PFI did affect London Metropole in December. The two projects which the Foundation was Trustees were pleased to see that the hoping to support via fundraising. Both Congress made a small profit from the proposed Nutrition Centre and the this year’s event, and look forward to proposed extension to the Kennedy extending their support for a third year. Leigh Academic Centre for Endoscopy The Trustees were sorry to see two were stopped by the announcement of of their number leave the Foundation the PFI and the subsequent freeze on in 2004. new development on the Northwick Park site. It is hoped that an extension to the Professor Sir Leszek Borysiewicz Kennedy Leigh Academic Centre will still (Boris) was promoted to Deputy be possible, albeit on a smaller scale. Rector of Imperial College and his new The limitation imposed by the PFI plans commitments meant that his time

16 available for his duties as a Trustee were severely restricted. The Trustees are grateful for the time he gave at a crucial time for the relationship between St Mark’s and Imperial College.

Professor Michael Kamm also stepped down in late 2004, and the Trustees would like to thank him for his vigorous and robust contributions to the Trustees’ meetings and for his passion for the work of St Mark’s.

On the staff side of the Foundation, in October the Trustees welcomed Catherine Mulcahy as the new Fundraising Assistant. Catherine joins the Foundation straight from Erection of new offices for university, and is looking to build her inflammatory bowel research, career in fundraising. psychological medicine and the Burdett Institute partly As always, the Trustees would like to express their most sincere thanks to all funded by the St Mark’s the many supporters of the Foundation Hospital Foundation who made donations both large and small. The work of the Foundation continues to develop, and that is only possible through the generosity of those supporters.

I am stepping down as Secretary to the Foundation in 2005 following my move to UCH, and will be handing over to Dr Simon Gabe, who has already proved his enthusiasm as a fundraiser by participating in two triathlons to raise sponsorship for St Mark’s. I wish Simon well in his new role as Secretary, and would like to offer my thanks to the staff and Trustees of the Foundation for all their hard work and support during the last year.

Finally, I would like to offer my very best wishes for the future to St Mark’s, and hope that the Foundation goes from strength to strength.

Richard Cohen, Secretary

17 Support Groups St Mark’s Annual Report 2004 Support Groups Friends of St Mark’s

President Reporting on what we have achieved in I must pay tribute to the ladies (and one Lady Juliet Bingley one year can be very difficult as so many gent) who turn up week after week to

Vice Presidents of the projects can start in one year and keep our tea bar going. All the profits Mrs Verma Lennard-jones not be completed until the following are used by the Friends on grants such Mr John White year. A case in point is Dr Simon Gabe’s as the above. So please keep on buying Chairman bio-feedback video. Work was started Vernon’s excellent sandwiches. Dorothy Gill in 2003 but it was not launched until Early in the year we put out an appeal for Vice Chairman 2004. There is also the new flooring for new committee members. The response Janina Phillips the third floor reception corridor; colour was poor but Anni Saunders offered her Secretary design and costs all agreed in 2004 but services and was quickly co-opted onto Helen Shorter work will not commence until 2005. the Committee. We can survive another

Treasurer year but more volunteers are needed. Alan Oldham So what did we actually do in 2004? Basically we spent a lot of money on Late in the year we were informed that Committee Members Michele Bartram equipment for various departments in we would be receiving quite a large (at Anne Driscoll St Mark’s. The Endoscopy Department least by our standards) legacy. It was Tonia Kaufman Stella Nicholls received a £20,000 state of the art agreed that rather than keeping it in Sue Talbot video capsule endoscope. The Intestinal general funds it should be used in a way Gillian Whitmee Annie Saunders (Co-opted) Imaging Department received a £13,000 that would benefit St Mark’s as a whole. computer-linked 3D anal probe. The Clinical Director was informed Frederick Salmon ward was provided and already several ideas have been with yet another tumble drier and we suggested. Therefore, the future of the funded patient information leaflets for friends is very important to carry these the Stoma Care team. We have taken new projects forward. on board the complete funding of the artwork display around St Mark’s and I assure you that we will survive, one way continue to maintain the garden. or another.

More importantly, working with Solveig Dorothy Gill Wilson, we have been able to offer Chairman some form of financial support to needy patients. This mostly helps long-term patients or those who have travelled a long way to attend St Mark’s, by paying travel and/or accommodation costs so that relatives can visit; a great morale-booster.

It is mainly due to the generosity of friends, patients and staff that we are able to do all this, so next time a member of the committee approaches you clutching a book of raffle tickets, dig deep; you now know where the money goes.

20 21 St Mark’s Annual Report 2004 Support Groups Inside-out Stoma Support Group

Since November 1999, when Inside Out first started, we have lost two of our founder members. One is Celia Myers, who retired just over a year ago and is enjoying every minute of it. The second one is Clare Bossom, who has just recently left us, after having her second child, to work in a hospital that is much nearer her home. Our thanks go out to both of them for having the foresight to see that a support group that caters for all types of stomas is not only practical but also fundamental in helping to bring stoma patients together. This is so that they may learn from one another how to deal with some of the traumas that they may incur, how to deal with body image, diet and sexual problems, etc, just to name but a few. Throughout our nearly six years of existence, we have helped many stoma patients and their families come to terms with their stoma. Some have, after the initial surgery, not needed us again and others have regularly come along to our coffee mornings, which are This was taken at our last event on the of Gastrointestinal Nursing). It brought a held every two weeks in out patients, to 29th April ’05, in the Himsworth Hall, conclusion to the month of April’s Bowel share their experiences with others and as a joint adventure of all the support Cancer Awareness in conjunction with talk about how they have started to get groups in St Marks Hospital, (Red Lions, Colon Cancer Concern. back into the swing of life by doing some Bottoms Up, In Contact, Macmillan of the things they used to do before Nursing Team and The Burdett Institute Bob Azevedo-Gilbert, having their stoma. Chairman

21 Academic Institute St Mark’s Annual Report 2004 Academic Institute Dean’s Report

Chairman During 2004 we held our Second The 2005 Lecture Course will be a little Professor MM Edwards JP BSc PhD International Lecture Course in a shorter than has become usual because Dean purpose-built conference facility at we are collaborating with the European Dr A Forbes BSc MD FRCP ILTM an off-site venue, again at the Hilton School of Oncology such that their Sub-Dean Mr P McDonald MS FRCS Metropole in central London. As in 2003 biennial meeting on colorectal cancer the meeting was a tremendous success, will take place immediately after our own Administrator Miss JC Landgrebe BS MSc this time with over 300 delegates and meeting. Our meeting will run through again an excellent programme. It has the 1st and 2nd of December with theirs Assistant Administrator Mrs JD Ferrari come to be axiomatic that we get on the 2nd and 3rd and also held in the superb value from our visiting professors, Hilton Metropole venue that is becoming Administrative Assistants Mrs Rasmita Bhudia and 2004 proved no exception. Prof our central London base! Clearly our Rolland Parc from Paris and Prof Doug own programme will this year eschew Rex from the USA excelled themselves cancer topics but a varied and topical both in their own presentations and in academic feast can nonetheless be their contributions to the meeting as a assured. After only 2 years the meeting whole. The Course Dinner took place has become the second largest of its at the Banqueting Hall in Whitehall (site kind in the UK and deserves to become of the execution of King Charles the a firm diary fixture for those in the field. First) and Mr John Kane lately of the Royal Shakespeare Company gave an The affiliation of St Mark’s with Imperial after-dinner entertainment of the first College was further delayed by the order (despite a rather difficult acoustic). internal reorganisation of the divisional However the clear tour de force of the structure in the medical school, but this meeting was the live link by satellite is now complete and we anticipate a from the theatres and endoscopy rooms key role in the new division of Surgery, of the hospital, which ran through two Oncology, Reproductive medicine and days of the meeting. The collaboration Anaesthetics (SORA). There is already with our broadcast colleagues at GME talk of a chair and senior lecturer in is clearly poised for great things, and pathology and an additional senior we are actively exploring imminent use lecturer position in inflammatory bowel of the technology (now fully installed at disease. These can only be good things the hospital) for broadcasts to Hungary, for the academic future of the institution. Greece, Egypt, and China. St Mark’s now has the same facilities for live Elsewhere in this Report will broadcasting as Sky Television (and be highlighted the tremendous uses the same satellites). Again the achievements of the first (not yet meeting had generous sponsorship full) year of the Burdett Institute of from our friends in the pharmaceutical Gastrointestinal Nursing at St Mark’s. and biomedical industries, and I am This represents an extraordinary series of pleased and not a little relieved to report advances in which St Mark’s as a whole a balanced financial account (actually a can be very proud to share. We have profit of £11!). Considering our losses not – this year - been able to secure last year and the overall budget for the funding for new major competitive grants meeting of over £250,000 I am content from the Hospital Foundation, but this and equally confident that we can do still has been partly because of an alternative better in 2005. use of capital funds to support the

24 franchise agreements intended for the catering facilities. Vernon Dickinson has provided immense support for many of our meetings throughout the time we have been in Harrow and we will be sorry if he is unable to return to the new unit.

As always my report ends with my

Professor Nicholls and guests at the Course appreciation of those without whom Dinner, Banqueting Hall, Whitehall the Academic Institute would be nothing. Firstly I will thank my consultant creation of the new modular building, colleagues for their continued efforts which was erected in almost no time, in teaching with such enthusiasm and now houses the Department of and panache and especially for their Psychological Medicine, the Inflammatory collective role in the December Meeting. Bowel Disease Research Groups, and, Our Clinical Tutors have as ever in pride of place on the top floor, the performed a sterling service, especially Burdett Institute. This is an excellent in their care and nurture of our many development and the Academic Institute visitors, but again pride of place goes is very grateful to our erstwhile Clinical to Judith Landgrebe, Janice Ferrari and Director, Prof Clive Bartram, for his Rasmita Bhudia who actually run the insight and enthusiasm for the project Institute. Thank you all! as well as to Mrs Charlotte Barney and Sean Bonnington from the Hospital Alastair Forbes Foundation for their active support. Dean

As usual we have had our three post- graduate terms, multiple surgical workshops and a whole range of specialist meetings. At the turn of the year we are experiencing some difficulties with teaching space because of the refurbishment of the Medawar Centre to accommodate more Imperial medical students, but when the work is finished we will have an additional series of seminar rooms and a more flexible (if significantly smaller) Himsworth Hall. It is encouraging that the North West London Trust is taking its teaching responsibilities seriously and so obviously in this way. Sadly it does appear that one casualty of this enlargement and modernisation will be the services of Ace Caterers who are unlikely to be able to afford the new

25 St Mark’s Annual Report 2004 Academic Institute Administrator’s Report

The 2nd Annual International Congress European School of Oncology will follow St Mark’s will be able to televise its “St Mark’s 2004 – Frontiers in Intestinal straight on after our meeting allowing educational programmes to a number and Colorectal Disease” took place individuals to attend both events on the of centres throughout the world. at The Hilton London Metropole in same site. December. We were pleased to welcome Congratulations to Janice Ferrari, Professor Rolland Parc from Hopital It was with a great deal of sadness that Assistant Administrator, who passed her Saint-Antoine Paris as The Sir Alan we said goodbye to Professor Ian Talbot Management Course with flying colours. Parks Visiting Professor and Professor and Professor Ashley Price who had both I would to thank both her and Rasmita Douglas Rex from Indiana University contributed so much to postgraduate Bhudia for all their hard work throughout School of Medicine, USA as The Sir teaching at St Mark’s over the years. the year. Francis Avery Jones Visiting Professor. The occasion was marked by the The programme included sessions on “Gastro-intestinal Pathology Day” in May. Judith Landgrebe Anal Surgery, Nutrition/Intestinal Failure, Administrator Imaging, Colonoscopy, Cox in the Gut The Intestinal Failure team go from and Functional Disorders. The highlights strength to strength and held a meeting, were the live endoscopy and operating together with The Hope Hospital at sessions which both ran very smoothly. The Royal College of Surgeons on The Consultants Corners proved most Enterocutaneous Fistula. It is planned interesting and controversial. that these meetings will be repeated on a regular basis, alternating between The Congress audience of 400 Manchester and London. comprised Gastroenterologists, Nurses and Surgeons from all over the world. Mr Richard Cohen ran the Management The Gala Dinner, sponsored by Proctor of Complex Anal Fistula to which Dr Rudi and Gamble, was held at the magnificent Schoutens from The Netherlands came Banqueting House in Whitehall. and assisted. This is always a popular course and it is likely another will be Sponsorship plays a key part in the run soon. Mr Peter McDonald, the Sub organisation of such an event. I am Dean, continues to run The Advanced particularly grateful to Procter and Colorectal Workshops and I am grateful Gamble Pharmaceuticals UK Ltd to Ethicon Endo Surgery who continue to and KeyMed who steadfastly gave support this meeting. Members of staff, their support throughout the year. too numerous to mention, teach during Others that must be thanked include the Postgraduate terms. Individuals Ethicon Endo-Surgery, Pfizer Ltd, from all over the world continue to come B-K Medical (UK), Elan Corporation, to these courses and I am pleased to Novartis Pharmaceuticals UK Ltd, see many of them return as Honorary Tyco Healthcare UK Ltd, Dansac and Clinical Assistants. Bolton Surgical. The St Mark’s Association Day was held Plans are already well underway for the in October with Professor Clive Bartram Third Annual International Congress as the President. It is hoped that an which will be held at The Hilton London Alumni dinner might be held at the Metropole from 1st – 2nd December. Tripartite meeting next year when The Sir Alan Parks Visiting Professor will Mr Mike Thompson will be President. be Professor David Rothenberger from Minneapolis and The Sir Francis Avery Possibly the most exciting event of Jones Visiting Professor will be Professor the year has been our launch into Gassull from Barcelona. I am delighted satellite broadcasting. In collaboration to say that in 2005 the meeting of The with Global Medical Education (GME),

26 St Mark’s Annual Report 2004 Academic Institute Visitors and Delegates

Second International Congress Greece Libya Frontiers in Intestinal and Colorectal Dr Antonio Panagiotis Mr Abdalla Fantazi Disease held at The Hilton Metropole Dr Dimitrios Polymeros 1st to 3rd December 2004 Dr Spyridon Skaltsas Netherlands The Dr Spyros Triantafyllidis Dr Irene Donse Albania Dr Steven Olde Damink Dr Lindita Mano Guernsey Dr Marion vander Kolk Dr Malcolm Chamberlain Dr Wim van Gemert Australia Mr Matt Lawrence Hungary New Zealand Professor Ivan Bartha Mr John Woodfield Bosnia & Herzegovina Dr Sefik Beslik India Norway Professor S R Banerjee Jesudason Dr Jan Cyril Wexels Brazil Professor Mohandas Mallath Dr Rogerio Palma Poland Iraq Professor Anna Cysewska Cyprus Mr Abdullah Al-Damluji Prof Noorali Ismaili Portugal Italy Dr Carlos A Gomes Denmark Dr Maria Livia Boella Dr João Martins Dr Jens Christian Andersen Dr Antonio Canero Dr Vagn Berg Dr Alfonso Carriero Republic of Macedonia Dr Steffen Bulow Dr Helbert Maria dal Corso Professor Vlado Janevski Mr Peter Hesselfeldt Dr Francesco Di Rosa Dr Dzvonko Nikolovski Mr Ole Thorlacius-Ussi Dr Guiseppe Garofalo Dr Emma Marchigiano Serbia & Montenegro Eire Professor Giovanni Milito Dr Aleksandar Martinovic Mr Aamir Farooq-Majeed Dr Gabriele Naldini Dr Srdjan Nikolic Mr Balachandra Rao Chundru Dr Cinzia Papadia Professor Fergus Gleeson Dr Antonino Pulvirent Singapore Dr Geraldine McCormack Dr Angelo Stuto Miss Aileen Seah Ai Lin Dr Pasquale Talento Finland Dr Simona Truvolo Slovenia Dr Anna Lepisto Dr Tomaz Benedik Dr Laura Rnekonen- Japan Dr Palvi Vento Dr Ichiro Nakada South Korea Dr Jin Myeong Huh France Jordan Dr Jae Bum Lee Dr Frederic Borie Jamal Suleiman Haddad Professor Suk-Hwan Lee Dr Hanan Rihani Dr Jin-Young Park Germany Mr Gabriele Alpers Korea Spain Mrs Maria Theresia Alpers Professor Duk Ju Sung Dr Pablo Collera Dr Rudolf Alpers Dr Herminio Sanchez Dr Else-Li Bock Kingdom of Saudi Arabia Prof Dietmar Lorenz Dr Samar Al-Homoud Sweden Dr Sebastian Roka Mr Abdalla Omeyer Dr Ingrid Nilsson

26 27 St Mark’s Annual Report 2004 Academic Institute Visitors and Delegates cont.

Switzerland Mr Parthasarathi Das Mrs Sue Horan Dr Gaudenz Curti Mr Vivek Datta Mr Mohammad Hosny Mr Roger Dawson Dr Chris Hovell Taiwan Mr Thayil Ram Dilraj Gopal Mr Andrew Huang Dr Cheng Hsiu-Hsieh Ms Karen Dixon Mr Simon Huddy Miss Helen Dorrance Dr M Ibrahim United Kingdom Dr Andrew Douds Mr Douglas Irving Mr Edward Maurice Absoud Mr Samir Doughan Mr Moazzam Sajjad Jafri Mr Austin Acheson Mr Tom Dudding Mr Mark Janssens Dr Ahmed Adil Miss Julie Duncan Mr Muhammed Jamed Mr Samir Afify Dr Arthur Dunk Miss Laura Johnston Mr Muzaffar Ahmad Sister Ann Edwards Sister Gill Jones Mr Charles Akle Mr Tawfik El-Sayed Ms Sue Jones Mr Ala Al-Ajeel Mr Moftah Elbuzidi Dr Chris Jordan Mr Malcolm Aldridge Mr Sudhaker Eleti Sister Louisa Josiah Mr David Alexander Mr Huzaifa Elkhalifa Mr Vickram Joypaul Ms Catherine Amey Mr Faisal Elmedani Mr Sharad Karandikar Mr Graham Angell Mr Anthony Emezie Mr Wansanatha Katugampola Dr Naila Arebi Miss Rachel Evans Mr Rajab Kerwat Mr Fawwaz Arikat Mrs Trish Evans Dr Hamid Khan Dr Ian Arnott Dr Riyaz Faizallah Mr George Khoury Mr Mohammad Asif Mr Olu Fajobi Mr Martin Klein Dr Roger Aubrey Dr Abdul Fallouji Dr Anastasios Koulaouzidis Mr Myat Soe Aung Mr Martin Farmer Mr Kandaswamy Krishna Mr Chris Avotri Mrs Margaret Feeney Mr F F Krouma Mr Abuhakim Azmi Mr Reinhard Fenchel Dr Clement Lai Dr Zain Bafadhel Mr John Ferguson Dr Andrew Latchford Mr Mirza Khurrum Baig Mr Nigel Fieldman Mr Michael Lavelle Mr Dinesh Balasubramania Mr Timothy Freemantle Mr Roger Le Fur Dr James Barbour Mr Ian Fretwell Dr Anthony Leahy Mr Pradeep Basnyat Mr Paddy Gallagher Dr Wendy Lim Mr Maged Bassuini Mr Kurudammanil George Kutty Dr Melanie Lockett Mrs Julie Bell Miss Angela Gibbs Miss Ann Lyons Mr Alan Berry Mrs Anne Gibson Dr Yasuko Maeda Mr Jin Bong Mrs Anna Giles Mr Christopher Mahon Sister Jayne Butcher Dr Anthony Griffiths Mr Kishore Makam Mr Khalid Canna Mr Jan Gryf- Lowczowski Mr Ala Malik Dr Martyn Carter Mr Keith Gunning Dr Raza Malik Mr Kandiah Chandrakumara Mr Amyn Haji Miss Ripple Man Mr Madihalli Chandramouli Mr Richard Halpin Mr Helmy Mashaly Mr Mark Chapman Dr Mohammad Hanif Mr Clittus John Mathews Mr Dave Chatoor Dr Anika Hansmann Miss Sue McIntosh Dr Guy Chung-Faye Dr Anis Ul Haq Dr Peter McIntyre Ms Jackie Clemit Mr Manzar Haque Dr Simon McLaughlin Mrs Sheree Coles Mr Jonathan Heath Mrs Laura McMahon Dr Opeter Coode Mr Richard Heath Mr Adrian McQueen Mr Paul Cullen Mr Mohamed Heshaishi Mr Hamish Michie Mrs Ann Curry Dr David Hick Dr Stephen Middleton Sister Kirsi Cutler Miss Rebecca Himpson Mr Antonino Morabito Mrs Julie D’Silva Mr Hon Noe Dr Gordan Moran

28 Mr Hesham Morsey Mr Kumarakrishnan Samraj Denmark Mr Sivakumar Motha Dr Ian Sargeant Dr Io Christofferson Miss Mina Mottahedeh Mr Michael Saunders Mr Sarbajit Mukherjee Dr A Sawyerr Hong Kong Dr Siew Ng Miss Gill Schofield Dr Kin Yan Lee Mrs Lesley Nickell Dr Rakesh Shah Dr Wen Chieng Tsang Mr Oomar Nur Mr Javed Shami Miss Olutayo Oke Mr Peter Sharma Italy Mr Olufemi Olagbaiye Miss Tinni Sharma Dr Silvia Cornaglia Mr Mammen Oommen Dr Masoud Shebani Dr Edelweiss Licitra Mr Chris Oppong Mr Saleem Sheikh Mr Eoghan RTC Owen Mr David Skidmore Korea Miss Bridget Owles Mr Frank Smedley Dr Dyung Jong Kim Miss Nicky Palmer Mr W James B Smellie Mr James Palmer Dr Ash Soliman Norway Mr Dineshkumar Patel Mr Christopher Speakman Dr Torstein Dirgranes Mr Surendra Paul Dr Andrew Steel Dr AJG Pearson Mr Stevan Stojkovic Portugal Dr Ranjith Peiris Mr Paul Strauss Dr Marta Castro Guimares Dr Rosemary Phillips Mr Annamalai Subramanian Dr Gloria Santos Mr Ian Pickford Mr Ian Sugarman Ms Usha Pillai Ms Helen Tate Republic of Ireland Dr Adele Polecina Mr Michael Thompson Mr Anjum Akhtar Sister Jo Pragnell Mr Vijay Kumar Thumbe Dr Khalid Hussain Maghal Dr Alison Prior Dr Jay Vadani Dr Mujahid Pervaz Mr Graham Pritchard Mr Christopher Vickery Mrs Val Pryor Mr Rohan Vidanage Spain Sister Denise Pugh Dr Alex Von Roon Dr Jimenez de los Galanes Marchan Miss Liz Purcell Dr David Watmough Santos Mr Ashraf Raja Miss Clare Westwood Mr Ramesh Rajagopal Mr Kevin Wheatley Switzerland Ms Maria Rakova Dr Nick Wight Dr Markus G Appelt Mr Kosala Ranatunga Sister Heather Wilson Sister Arlene Rashwan Mr Athula Withanage Taiwan Mr Srinivasan Ravi Mr Srini Yellapu Dr Jung-Hung Hsieh Mr Thomas Ryamond Sister Carole Younger Dr Tien-Li Lin Dr Andrew Renehan Dr Philip Roberts Trinidad & Tobago Ms Hillary Robinson Advanced Colorectal Workshops Dr Feisal Daniel Sister Sue Robinson Miss Tanya Robinson Australia United Kingdom Mr Alan Roe Dr Vincent Ferrero Mr Sibdas Chaudary Dr Shishir Kumar Roy Mr Jagath Roshan De Costa Dr Amang Sabir-Ali Bahrain Dassenaieke Mr Mohammad Saeed Mr Ali Saeed Mr Samarasekera Dharmabandhu Mr Mrinal Saharay Dr Nasir Mumtaz Mr Tarek Salem Bangladesh Ms Gisella Salerno Dr AKM Daud United States of America Mr Saad Salman Dr Manohar Nalluthambi Mr Dharmabandhu Samarasekera Croatia Dr Tutek Zvonimir

28 29 St Mark’s Annual Report 2004 Academic Institute Visitors and Delegates cont.

Anorectal Endosonography United Kingdom M D Sarah Ducharme Study Days Dr Rakesh Bharedwaj Lieut Colonel David Edwards Dr Praveen Bilagi Dr Herminio Sánchez Farpón Australia Dr Neeraj Chaudhary Colonel Keith Galbraith Dr Matt Lawrence Dr Sharad Desai Mr Richard Guy Dr Paul Elton Dr Capt Stuart Harrison Austria Dr Mayoni Gooneratne Colonel Noorali Isamili Dr Luisangel Rondon Mr Tony Hammond Dr Neal Jacobs Mr Iraklis Katsoulis Surgeon Vice Admiral Ian L Jenkins Bahrain Mr Michael Lim Mr Jon athan Kaplan Mr Ali Saeed Mr Hesham Morsey Dr Litivan Khamphommala Mr BV Praveen Dr Mansoor Khan France Dr Suzanne Ryan Dr Tom Konig Dr Litavan Eric Khamphommala Dr Ian Stanton Surg Cdr A W Lambert Dr Sukumar Sathi Mr Ian Lindsey Greece Dr Janet Tomlin Cptain Niall Martin Dr Chryssostomos Kalantzis Dr Gill Turner Dr João Miguel Martins Dr Lin Sen Wong Mr Pawan Mathur Hong Kong Colonel Simon Mellor Dr Tim-Lok Kwan Mr Stuart Mercer Dr Kin Yan Lee Celia Myers Advanced Stoma Dr Henrik Moeller Care Course Dr Kunihiko Obara Iran Miss Harriet Owen Dr Mahmood Norozifar Ms Christine Brown Major Thanesan Ramalingam Dr Derakhshani Saeed Ms M Caulfield Dr Venkat S Rao Kommmoju Ms Anette Chrisitiansen Sir John Rawlins Israel Ms Natalia Fumis Dr Claus Ronholt Dr Jose Bendahan Ms Betty Graham M D Stacy Shackelford Ms Linda Hazel Mr F D Skidmore Italy Ms Elizabeth Jeffries Surgeon Commander MCG Terry Dr Roubik Behboo Ms Dawn Moffatt Captain Neil Walker Dr Renzo Clara Ms Glynis Morris Group Captain Mark Watkins Dr Silvia Cornaglia Ms Mireille Oliver Dr Dajana Cuicchi Ms Bridget Owles Dr Francesco Paolo Di Rosa Ms Gillian Powell Enterocutaneous & Intestinal Failure Dr Marco Ferronato Ms Freda Ratican Study Day Dr Edelweiss Licitra Ms Eleanor Russell Dr Paolo Parise Ms Kim Walker Miss Kharti Balakrishnan Dr Simona Truvola Ms Alison Woolgar Ms Jill Bosworth Dr Anna Brown Portugal Miss Debbie Buchan Dr João Martins Defence Medical Study Day Mrs Astrid Burrows-Grolle Ms Clare Chadwick Republic of Ireland Major Chuk Abraham-Igwe Dr Rama Chandra Mr Abdalla Fantazzi Dr Ahmed Alkoraishi Miss Jane Chapman Mr David Carey Mr Dave Chatoor Republic of Korea Dr Julio Castillo Dr Sheldon Cooper Dr Kyung Jong Kim Mr Stephen Chadwick Dr Silvia Cornaglia Major Mansel Leigh Davies Mrs Sally Ann Crowther Surg Lt Cdr Catherine Doran Ms Ruth Davies

30 Ms Alys de Jabrun Mr Emad Helmy Sherkawi Dr Yoon Chia Ms Heather Dennis Ms Jane Sillars Dr Jo-anne Chin Aleong Dr Saeed Derakhshani Dr Trevor Smith Dr Peter Coode Dr Francesco Paolo Di Paolo Ms Rosie Smyth Dr Edwin Cooper Mr John Ducker Dr Mike Stroud Dr Andrew Coup Mr Anthony Emezie Mrs Ammi Tanda Dr David Day Ms Elizabeth Anne Evans Mrs Bernadette Tavner-Allsopp Dr Shaila Desai Mr Abdalla Fantazzi Dr Kathy Teahon Dr Nayneeta Deshmukh Mr Keith Gardiner Mr Christopher Thorn Professor Paola Domizio Mr Serban Gheorghiu Dr Simon Travis Dr Ursula Earl Mr Chui-Hoong Goo Miss Julie Turner Dr roger Feakins Dr Janet Gregory Dr Wilson Tsang Wen Dr Shyam Fernandez Miss Sura Hamoudi Miss Siet Tye Dr Charlotte Fisher Miss Claire Hanika Miss Tina Vaghjani Dr Ian Martin Frayling Ms Sue Harding Miss Marielle Valette Dr Izabella Georgiades Mrs Fiona Henderson Miss Cherry Vickery Dr John Geraghty Miss Lisa Hodge Mrs Nicola Ward Mr Jonathan Gilbert Prof Noorali Ismaili Ms Alison White Dr Rashida Goderya Dr Barry Jones Mr Martin Willner Dr Robert Goldin Dr Kim Kyung Jong Mrs Mandy Wong Dr Bryan Green Dr Litavin Khamphommala Mrs Susan Wood Dr Mihir Gudi Mrs Alexandra Leckie Ms Susan Woodcock Dr Thomas Guenther Mr Jack Lee Dr Jeremy Woodward Dr T Guha Dr Kin Yan Lee Mr Chu Yiu Dr Mustafa Haddaqi Dr Edelweiss Licitra Dr Natalia Zarate Dr John Harvey Dr Robert Lord Dr Ian Hawley Dr João Miguel Martins Dr Sarah Hill Miss Susan McCabe Histopathology Symposium to mark Dr Georgina Howarth Mr Brendan McIlroy the retirement of Professors Ashley Dr Andrew Jackson Mr Mark Midwinter Price and Ian Talbot Dr Peter David James Dr Caje Moniz Dr Michael Jarmulowicz Ms Elizabeth Moore Dr AM Abbassi Dr Mihir Khan Ms Catherine Morgan Dr Tanya Alan Dr Edward leen Ms Rachel Mortlock Dr Bernice Martha Almeida Dr Jo Lloyd Mr HS Narula Dr Nayef Aqel Dr Meg Lott Dr Penny Neild Dr Mark Arends Dr Paul Manley Ms Jean O’Reilly Dr Parvin Ashrafzadeh Dr Lisa Mears Mrs Marion O’Connor Dr Maria Bahhadi Dr Gopi Menon Miss Tayo Oke Dr Manimekalai Balakishnan Dr Steven Milkins Ms Carol Parker Professor CI Bartram Dr Cian Muldon Mrs Sharmalie Parkinson Dr Adrian Bateman Dr Salli Muller Mrs Gopi Patel Dr Leigh Biddlestone Dr Joseph Newman Miss Depal Patel Dr Hilary Birch Dr Exra Nigar Dr Shri Pathmakanthan Dr Stuart Blackie Dr Marco Novelli Mrs Mandy Rimmer-Gray Dr Anthony Blackshaw Dr PS Ong Dr Luisangel Rondon Dr Margaret Burke Mr Eoghan Owen Ms Sarah Ryan Dr David Michael Butterworth Dr Hosep Pambakian Dr Pradeep Sanghi Dr Norman Carr Dr Miklos Perenyei Mrs Joanne Scantlebury Dr Ian Chandler Dr Essam Raweily Dr Clare Shaw Dr Preeti Chaudhri Dr Cathy Richards

30 31 St Mark’s Annual Report 2004 Academic Institute Visitors and Delegates cont.

Dr David Rimmer Yasuko Maedo Japan Dr Dejan Ivanov Dr Philip Roberts Emma Marchigiano Italy Ms Natalie James Dr Suzanne Rogers João Miguel Martins Portugal Ms Hannah Christina Jones Dr Ibtisam Saeed Charlie Murray UK Mrs Karen Judson Dr Virginia Sams Heena Surendra Patel UK Ms Caroline Kennedy Dr Vicki Save Sebastian Roka Austria Dr Nassar Khan Dr Loraine Sheehan Francesco Paolo di Rosa Italy Mr Goldie Khera Dr Jonathan Sheffield Ian Stanton UK Ms Linda Killeen Dr Salma Soomro Christina Thirlwell UK Ms Bonita Kirchner Dr Joanna Stafford Simona Truvolo Italy Ms Natalie Kowadlo Dr Paul J Tadrous Katharina Wallis Germany Dr Andrew Latchford Dr Jin-Yeow Tan Evi Zampeli Greece Mrs Helen Lawrence Dr W Taylor Natalia Zarate Spain Ms Avril Leach Dr Monica Terlizzo Mrs Nikki Levitas Dr Michael Thomas Mr Nathan Alun Lewlis Dr Karine Treurnicht Intestinal Failure Study Day Mrs Sally Lindsay Dr Peter Trott Ms Angeles Liston Dr S E Trotter Dr Atta Abbasi Ms Catherine Lyne Dr Jane Weston Miss Rachel Ablett Ms Winnie Magambo Dr Margaret Wilkins Ms Hazel Adams Ms Tamsin Mann Dr Christopher Williams Mrs Wendy Annan Dr João Miguel Martins Dr Judith Wilson Dr Markus G Appelt Mr Dya Marzouk Dr AM Zaitoun Ms Waseema Azam Ms Fiona Masters Mr Andrew Ball Dr Michelle McCarthy Ms Jose Bennell Miss Amy McDonald Honorary Clinical Assistants Mr Anthony Blower Ms Sandra McGrath and Research Fellows Dr Fréderick Borie Miss Lee McNaughton Mrs Sharon Broadbere Ms Aisling McHugh Domenico Aiello Italy Mrs Sue Caffarey Ms Sandra McLellan Anthony Antoniou UK Dr Yuan Kun Cai Mr Adam Mead Naila Arebi UK Ms Joanna Campbell Dr Shyam Menon Malika Bennis UK Mrs Debbie Corin Mr Kenneth Michie Frédéric Borie France Dr Andrew Coulton Mr Kevin Stuart Micklin Aidan Cahill UK Ms Joanna Cullen Ms Gloria Morgan Sonya Chelvanayagam UK Dr Robert Cunliffe Mrs Helen Murphy Alex Chung UK Ms Rachel De Boer Ms Mimosa Nadkarni Sean Cochrane UK Mr David DeFriend Ms Susan Nally Silvia Cornaglia Italy Dr Francesco Paolo Di Rosa Mrs Alison Nicholls Kay Crotty UK Miss Teresa Edgeway Ms Liz O’Connor Dajana Cuicchi Italy Ms Shawna Emmett Mrs Colette O’Hara Parthasarathi Das UK Mrs Helyn Evans Mrs Nicola Ockwell Tom Dudding UK Ms Emma Fletcher Ms Tase Oputu Marco Ferronato Italy Ms Isabelle Fry Dr Ataf Palejwala Patricia Hanson UK Mr Khera Goldie Mrs Yhogita Pandya Alexander Hardy UK Ms Jackie Hall Ms Ramil Pangilinan Matthew Johnson UK Ms Sarah Harris Mrs Claire Partington Litavan Eric Khamphommala France Ms Anne-Marie Holdsworth Ms Rakhee Patel Hussila Keshaw New Zealand Ms Lindsey Hollister Ms Jane Power Andrew Richard Latchford UK Ms Sue Hyam Ms Kathryn Quinn Edelweiss Licitra Italy Mr Uchenna Ihedioha Dr Stephan Raffeiner

32 Dr Paolo Jorge Ramos de Passos Portugal Norway Ms Lisa Rawstorne Dr Paulo Ramos de Passos Dr Kari Loevvik Dr Sufian Rifai Miss Hillary Robinson Republic of Korea Republic of Ireland Dr Sebastien Roka Dr Kyung Jong Kim Mr Nzewi Emeka Mrs Lynn Russell Mrs Rebecca Sharp Serbia & Montenegro Spain Ms Nicola Shepstone Dr Dejan Ivanov Mr Jesus Aragon Mrs Nancy Smith Dr Marta Pascual Ms Jenny Steedman Switzerland Dr Herminio Sánchez Farpón Ms Sarah Tobin Dr Markus G Appelt Ms Joanne Tomuny United Kingdom Dr Timothy Trebble Management of Complex Anal Fistula Mr Abraham Ayantunde Mrs Sophie Turigel Mr Pradeep Basnyat Ms Jeanne van der Merwe Austria Mr Anthony Blower Mrs Clare Vesey Dr Sebastian Roka Miss Christine Bronder Miss sheena Visram Mr Gordon Buchanan Mrs Jennie Walker Belgium Mr Palanichamy Chandran Mr Ciaran Walsh Dr Anne-Catherine Dandrifosse Professor William Corbett Miss Liesl Wandrag Dr Damien Dresse Mr Massimo Cristaldi Mr Garrick Wheatley Mr William Cunliffe Ms Gwar Williams Cyprus Mr Ahmed Eldin Ms Helen Williams Colonel Ismaili Noorali Mr Martin Farmer Colonel Keith Galbraith Denmark Mr Bruce George Postgraduates Teaching Terms Dr Jens Chr. Riis Joergensen Mr Ufuk Gur Dr Lilli Lundby Mr Paul Hainsworth Austria Dr Henrik Moeller Mr Ian Hastie Dr Luisangel Rondon Dr Claus Ronholt Mr Jonathan Heath Dr Peer Wille-Jorgensen Mr Khalil Khalil China Mr Muhammad Khan Dr Tim-Lok Kwan Germany Mr Kandaswamy Krishna Dr Assis Yuan Kun Cai Dr Ignaz Schneider Mr Marc Lamah Professor Karl-Heinz Vestweber Mr Danny Lawes Hong Kong Mr Chris Mahon Dr Wen Chieng Tsang Greece Mr Feliz Mazarelo Dr Kin Yan Lee Dr Spyros Triantafyllidis Mr Mark Mercer - Jones Mr Peter Milewski Iran India Mr Matthew Miller Dr Mahmoud Noroozifar Dr Venkat Shambashiv Rao Kommoju Mr Lalude Olutunde Mr Rajan Patel Israel Italy Mr Henry Pearson Dr Jose Bendahan Dr Emma Marchigiano Mr Ian Pickford Mr Mark Potter Italy Japan Mr Graham Pritchard Dr Roubik Behboo Dr Yahunobu Tsujinaka Mr Ramesh Rajagopal Dr Renzo Clara Mr Nagesh Rao Dr Silvia Cornaglia Netherlands The Mr Thomas Raymond Dr Paolo Parise Dr WR Schouten Mr Ramesh Rajagopal Dr Stephen Raffeiner Mr Mark Rogers

32 33 St Mark’s Annual Report 2004 Academic Institute Visitors and Delegates cont.

Mr Mrinal Saharay Hungary Spain Mr Chelliah Selvasekar Professor Ivan Bartha Dr Javier Die-Trill Mr Mohamed Shahabdeen Dr Herminio Sanchez-Farpon Mr Alil Shakir India Dr Io Christofferson Dr Emad Helmy Sherkawi Dr Venkat Shambashiv Rao Kommoju Mr Amit Sinha United Kingdom Mr John Stebbing Iran Dr Ahmed Syed Mr A Subramanian Dr Mahmoud Noroozifar Miss Anna Sverrisdottir Mr George Tsavellas Iraq Mr Manickam Vairavan Dr Abdullah Al-Damluji Mr Ciaran Walsh Italy U S A Mr Stefano Angeletti Dr Ahmed Alkoraishi Mr Daniele Caraceni Ms Bernetti Evangelista Chiara Professor Marco Frascio Observers Mr Luca Ghitarrini Mr Yves Kana Ngafack Albania Mr Emanuele Luchetti Dr Lindita Mano Dr Mauro Manno Mr Gianluca Marini Bangladesh Ms Chiara Massaccesi Dr AKM Daud Ms Monia Nardi Ms Martina Nisi China Mr Lorenzo Organetti Dr Jun Wang Ms Francesca Orici Dr Alessandro Paoloni Czech Republic Mr Lorenzo Pimpini Dr Petr Hanek Mr Mirco Qyondamatteo Mr Emanuele Ricciardi Denmark Dr Henrik Moeller Japan Dr Claus Ronholt Dr Shingo Tsujinaka

Egypt Jordan Dr Ahmed A Abou-Zeid Dr Sufian Mohammed Rifaei

France Korea Dr Remi Chamberod Dr Dongwan Kang Dr Kin Yan Lee Germany Dr Seong-Young Choi Dr Manfred Giensch Dr Flrian Giensch Nigeria Dr Ernst Horling Mr Alexander Ngwube Mr Ogunna Ignatios Okechukwu Ghana Miss Nanaama Barnes Pakistan Dr Nusrat Anis Subhan Miss Shabeeha Jan Memon

34 St Mark’s Annual Report 2004 Academic Institute St. Mark’s In House Rounds

Clore Lecture Theatre

7.30 am to 9.30 am These meetings include an X-Ray presentation at 8.30 am followed by a Pathology presentation at 9.00 am

16 January Intra-operative blood salvage in penetrating abdominal injuries Mr Doug Bowley Chair: Prof. Robin Phillips

23 January Manipulation of solid tumour vascularity Mr Pav Mathur Chair: Prof. John Northover

30 January Crohn’s disease in adolescence and children - Dr Warren Hyer same disease different treatment Chair: Prof. John Northover

6 February Are your patients ‘fit for surgery’? Mr Al Windsor Chair: Prof. Robin Phillips

13 February Audit

20 February Changing concepts and the surgical management Professor Stanley Goldberg of perforated sigmoid diverticular disease University of Minnesota Chair: Prof. Robin Phillips

27 February Right and left-sided colorectal cancer - the same or different? Professor Jeremy Jass Chair: Prof. Robin Phillip

5 March Heparin and inflammation: a new use for an old GAG Dr Ajeya Shetty Chair: Prof. Robin Phillips

12 March Short-chain fatty acids and the development of a new Professor Henry Binder oral rehydration solution Yale University School of Medicine Chair: Prof. Robin Phillips

19 March The Wolfson Unit National Endoscopy Training Centre & Dr Brian Saunders and Capsule Enteroscopy: St Mark’s experience so far Dr Gregor Brown Chair: Prof. Robin Phillips

26 March Bowel management after spinal cord injury Maureen Coggrave and Prof. Christine Norton Chair: Prof. John Northover

2 April Gene therapy in IBD Dr James Lindsay Chair: Prof. John Northover

16 April Stomal hernias - prevention and treatment Dr Anders Fischer Consultant Surgeon, Copenhagen Mr Peter McDonald Chair: Prof. Robin Phillips

34 35 St Mark’s Annual Report 2004 Academic Institute St. Mark’s In House Rounds cont.

23 April One stage ileo-anal pouch Dr Harvey Sugarman Chair: Prof. Robin Phillips

30 April Importance of CMV in ulcerative colitis” Dr Roser Vega Chair: Prof. Robin Phillips

7 May “Blood glorious blood” Mr Guy Nash Chair: Dr Alastair Forbes

14 May 1. New developments in laparoscopic hernia repair (30 mins) Mr Stephen Chadwick 2. Video: Management of Crohn’s Disease (20 mins) Chair: Prof. Robin Phillips

21 May Colostomy as an option for faecal incontinence? Professor Christine Norton Chair: Prof. Robin Phillips

28 May Magnification/chemoendoscopy and histopathology Dr Norico Suzuki interpretation, east vs west Chair: Prof. Robin Phillips

4 June Molecular pathology of digestive system and Dr Salto-Mallez translation of research Chair: Prof John Northover

11 June 1. Masterclass video Mr Stephen Chadwick 2. Hartmann’s is dead Chair: Prof Robin Phillips

18 June Difficult nursing cases Professor Christine Norton et al Chair: Dr Alastair Forbes

25 June Maternal birth trauma: a view beyond London Dr Louis Wall (USA) Chair: Prof Robin Phillips

2 July Update on drugs in IBD and gut flora manipulation Professor Michael Kamm Chair: Prof Robin Phillips

23 July Can we objectively predict continence following fistulotomy? Dr Hattie Owen

30 July A tale of two cities Mr Christopher Chan Chair: Prof Robin Phillips

3 September Endoscopic competency assessments: carrots or sticks? Dr. Siwan Thomas-Gibson Chair: Prof Robin Phillips

17 September Complex nursing cases Professor Christine Norton Chair: Prof Robin Phillips

24 September Evaluating risks in inflammatory bowel disease Mr Paris Tekkis

1 October Peutz Jeghers syndrome and pancreatic screening Dr Andy Latchford Chair: Prof Robin Phillips

36 8 October Code name Whipple Dr Axel von Herbay Chair: Prof Robin Phillips

15 October Preventing most adult diseases - it’s all in the infants nutrition Dr Warren Hyer Chair: Prof Robin Phillips

29 October Endoscopic anti-reflux procedures Dr Chris Fraser Chair: Prof Robin Phillips

5 November Peutz Jeghers Syndrome and pancreatic screening Dr Andy Latchford Chair: Prof Robin Phillips

12 November Rectal cancer and lymph nodes Professor Ian Talbot Chair: Prof Robin Phillips

19 November The two week rule for upper GI cancer - Dr S Ng and Dr Max Pitcher on target but missing the point Chair: Prof Robin Phillips

26 November Anal cancer in renal transplant patients Miss Heena Patel Chair: Prof Robin Phillips

10 December A bacterial pathogenesis for pouchitis - Dr Mathew Johnson is there a role for probiotics? Chair: Prof Robin Phillips

17 December Cot death, murder or mayhem Dr Paul Sibbons Chair: Prof Robin Phillips

36 37 St Mark’s Annual Report 2004 Academic Institute Regular Hospital Schedule

Morning

Monday Tuesday Wednesday Thursday Friday

Dr S Gabe Dr S Gabe Dr A Forbes Dr A Forbes Dr A Forbes Dr S Gabe Prof. JMA Northover Mr PJ McDonald Ward Rounds

Prof. RKS Phillips Dr A Forbes Prof. JMA Northover Mr CRG Cohen Mr P McDonald Mr PJ McDonald Dr A Forbes Dr M Pitcher Outpatients Dr BP Saunders Dr S Gabe Dr J Stern

Mr PJ McDonald Mr AJ Windsor Prof. RJ Nicholls Prof. JMA Northover Mr CRG Cohen Prof. RJ Nicholls Ms C Vaizey Theatres /Ms C Vaizey Prof. RKS Phillips

Dr A Forbes Dr M Jacyna Prof. MA Kamm Dr B Saunders Prof. RKS Phillips Dr M Pitcher Dr H Thomas Mr AJ Windsor Dr B Saunders

Endoscopy

Afternoon

Monday Tuesday Wednesday Thursday Friday

Prof. RJ Nicholls Prof. JMA Northover Dr MA Kamm Mr A Windsor Prof. RKS Phillips Prof. MA Kamm Ward Rounds Mr AJ Windsor

Prof. RJ Nicholls Prof. MA Kamm Dr A Emmanuel Mr S Chadwick Mr A Windsor Dr J Stern Dr A Forbes Dr S Gabe Outpatients Dr A Emmanuel Dr S Goolamali (2nd Thursday of month)

Mr PJ McDonald Mr AJ Windsor Prof. RJ Nicholls Prof. JMA Northover Mr CRG Cohen Ms C Vaizey Theatres Prof. RKS Phillips

Dr BP Saunders Prof. RKS Phillips Dr M Jacyna/ Dr BP Saunders Dr M Pitcher Endoscopy Dr BP Saunders

38 St Mark’s Annual Report 2004 Academic Institute Research Executive, chairman’s report

The Research Executive was set up Research Inventory in October 2002, in parallel with the Early work focused on identifying support new Educational Executive, to bring for researchers, which is now complete St. Mark’s research groups together in and is available both as a poster and order to develop a cohesive and visible in an electronic format. Following strategy. This move came about as completion of Principal Investigators part of preparations for a formal link questionnaires, analysis by the Research with the Faculty of Medicine of Imperial Co-ordinator using Common Scientific College. The Executive is chaired by the Outline, Disease Site Codes and Director-elect of the St. Mark’s Institute Disease Associated Projects definitions of Intestinal and Colorectal Disorders, the to describe broadly the research work body to encompass St. Mark’s research of the Hospital and to record its peer- activities in Imperial College and is reviewed publication output, indicate supported by the Research Co-ordinator. the range and complexity of research at St. Mark’s which fulfils the second aim. Initial Aims Finally a strategy has been developed • To identify expertise capable of which shows the association with supporting research fellows embarking recently published Imperial College on the research process strategy (Figure 1). The strategy of • To define the existing St. Mark’s the Faculty of Medicine, has five ‘core research portfolio strategic themes’ (in which Imperial sees • To develop a five year rolling St. Mark’s itself as an international leader), with research plan three ‘areas for strategic development’ (including cancer). Fig 2 shows the Membership areas of research interest that fit into the • Institute Director (Chair of RE) core and development themes in the and Deputy Director (Chair of the Imperial strategy. Educational Executive) • Core members from each clinical There were ~100 peer reviewed research area (surgery, medicine, publications 2004, slightly down on imaging, pathology, endoscopy, cancer 2003, but still 25% ahead of the output and nursing). These individuals carry in 1998 (Fig 3). From next year the responsibility for representing their output will be monitored by impact discipline-colleagues and co-ordinating factor rather than simple numbers. The their contribution to fulfilling the range of research activity categorised Executives aims by disease type is shown in Fig 4. • Those holding substantive Imperial The very high level of multidisciplinary College positions (presently four Senior collaboration is seen in Fig 5; for each Lecturers) are de facto members primary specialty, collaborations with • Representative for the St. Mark’s other specialties are depicted in stacked Hospital Foundation (fundraising); histogram format. Trust R&D Manager and a St. Mark’s management representative John Northover Chairman

38 39 St Mark’s Annual Report 2004

Research Executive, chairman’s report cont.

Research Strategy Matrix

Clinical Research mmunity cience Cross-cutters metabolism and I ung Imaging nternational Genetics and Cell and and I and L

Molecular INTER-FACULTY COLLABORATION cer euroscience eart AN eproductive S ublic nflammation H P endocrine I infection c R N

Core strategic themes Areas for strategic development

Figure 1. Imperial College, Faculty of Medicine Research Strategy

Cancer, Public Genetics Cell Imaging Inflammation Endocrine & Reproductive & BioMedical & International and Molecular Cross-cutter & Immunity Metabolism Neuroscience Engineering Health Cross-cutter

Obstetric Genetics & Inflammatory Nutrition and Tissue Cancer Imaging Trauma Genomics Bowel Disease Intestinal Failure Engineering Neoplasia

In concordance with IC Strategy Imperial strategic theme St Mark’s Strategic areas

Figure 2. St Mark’s Strategic Areas

40 Peer Reviewed Publications up to 2004 Disease Orientated Project Numbers

40 120

30 80 20

40 10

0 0

1998 1999 2000 2001 2002 2003 2004 FAP Crohns Polyposis Incontinence Cancer - Colon Ulcerative colitis Cancer - Rectum

Figure 3. Peer Reviewed Publications up to 2004 Figure 4. Research Activity shown by Disease Orientation - project numbers

25 Nursing 100

Nutrition 50 20 Physiology 60

Pathology 100 15 Medicine 20

Radiology 25 10 Endoscopy 80

CRUK 75 5 Surgery 40

0

CRUK Surgery Nursing Medicine Radiology Pathology Education Endoscopy Physiology Psychology

Nutrition - intestinal Figure 5. Multidisciplinary collaborations, listed by primary speciality

40 41 Departmental Reports St Mark’s Annual Report 2004 Colorectal Cancer Unit Director’s Report

Director The work of the Colorectal Cancer Unit A study to investigate anal neoplasia in Professor John M A Northover MS FRCS has continued with great vigour this year immunocompromised renal transplant with 3 new PhD and 2 MD students patients has made a solid start in Deputy Director being registered in the autumn term. collaboration with the CRUK group at Professor Wendy Atkin MPH PhD The plans for a large new laboratory, the Royal London and Barts, and with Consultants principally to facilitate the Cancer pathology colleagues at St Mark’s. Professor Robin K S Phillips MS FRCS Professor Ian C Talbot MD FRCPath Genetics Group, were also completed. Dr Huw J W Thomas MA PhD MRCP This has been financed by The Bobby There was near completion of studies on Moore Fund, for which we owe great the significance of vascular endothelial Unit Manager Mr Kenneth J Miller thanks to Stephanie Moore and her growth factors (VEGFs) in colorectal team for all their efforts. cancer, on the use of an iron oxide Unit Administrator Ms Elizabeth Goodband medium in the preoperative detection of The genetics work currently being nodal metastasis, and on pathological Scientific Staff undertaken in the Unit is headed by variables in prognosis. Professor Ian Tomlinson BM BCh MA PhD MRCPath Ian Tomlinson and Andy Silver, who Dr Andrew Silver BSc PhD are driving research in the investigation J M A Northover Dr Nirosha Suraweera PhD analysis of specific genes responsible Director Clinical Research Fellows for individuals developing colorectal Dr Andrew Latchford BSc MB BS MRCP cancer, in collaboration with all the Dr Kevin Monahan MSc MB BCh BAO MRCP other Unit groups. Miss Heena Patel BSc MBBS MRCS Mr Shahnawaz Rasheed B Clin Sci MRCS The Flexible Sigmoidoscopy Trial came substantially closer to producing Phd Students Ms Eiram Elahi BSc MSc definitive outcome data. With further Mr James Robinson BSc MSc funding secured from the DoH, the drive to establish the role of flexible Scientific Officers Ms Victoria Johnson BSc sigmoidoscopy as a national screening Mr Kevin Pack BSc tool will soon bear fruit. Mr Emmanouil Volikos BSc Msc

Laboratory Aide The Polyposis Registry has established Ms Jasu Godhania the world’s first paediatric polyposis Research Nurses clinic. With Andy and Ian they have Ms Kay Neale SRN MSc also identified 16 MYH homozygotes Ms Sandra Burke RN BSN Ms Carole Cummings RGN SCM expressing the classical FAP phenotype Ms Maggie Gorman RGN and have increased the number of Ms Jacquie Wright RN DN BSc primary cell cultures established from Statistician human FAP-associated desmoid tumours. Ms Pauline Rogers MSc CStat

Data managers The Family Cancer Group have Ms Pamela Adjei BSc completed the ascertainment on the Ms Reshma Mashru BSc Ms Urvi Shah BSc MSc NHS Central Register of cancers and deaths in the 2271 individuals Pa/secretaries on the Family Cancer Group Bobby Ms Marie Gun Ms Julie Jeffries Moore Database who are undergoing Ms Belynda Muir colonoscopic surveillance. The study of Ms Samia Riaz Ms Margaret Stevens anticipated reactions to genetic testing for hereditary nonpolyposis colorectal cancer has also been completed.

44 45 St Mark’s Annual Report 2004 Colorectal Cancer Unit Population Screening Research

Our aims continue to be finding cost- to have adenoma detection potential risks of these procedures. effective and acceptable methods of rates comparable with the best of Funding was secured last year from the preventing colorectal cancer. Our main the medical endoscopists in the UK DOH Health Technology Assessment focus is the evaluation and delivery of FS Screening Trial. for a clinical trial to examine the role of colorectal cancer screening and the computed tomographic colonography management of patients found to have In collaboration with Professor Jane (CTC) in the efficient diagnosis of colorectal polyps. We are also examining Wardle of CR-UK’s Health Behaviour colorectal cancer. The trial is comparing risk factors for the development of Unit, funding has been secured for CTC with colonoscopy and barium sporadic (non-familial) colorectal cancer. a larger pilot project to complete the enema in two 2-way randomisations essential development work required by (CTC versus colonoscopy, CTC versus The UK Flexible Sigmoidoscopy (FS) the DOH to undertake the Demonstration barium enema) in symptomatic patients. Screening Trial is a UK-wide randomised of FS screening. The pilot project is Over the next 2 years it is intended to trial examining the efficacy of a single expected to start in Jan 2006. recruit and randomise 4,320 patients to flexible sigmoidoscopy screening in the complete the trial. prevention of colorectal cancer morbidity Wendy Atkin has been an active and mortality. A trial, using the UK participant in the DOH programme Wendy Atkin is UK principal investigator protocol, is also in progress in Northern to phase in a national bowel cancer and a member of the Steering Italy. Both trials completed accrual and screening programme. She is a member Committee for the PRESAP (Prevention screening in 1999 and are now in follow- of the overall advisory group and three of Sporadic Adenomas) trial, which up. They are on target to analyse results of the working groups (screening, is examining the effect of celecoxib, in 2007, depending on the decision of the endoscopy and early diagnosis of a COX2 specific non-steroidal anti- data monitoring committees for each trial. cancer) and has provided data from inflammatory, in preventing recurrent both CR-UK trials and other international adenomas in people with an advanced In anticipation of a positive outcome trials to populate an options appraisal, adenoma detected at baseline of the Screening Trial, the Department commissioned by the DOH, to inform a colonoscopy. This highly successful trial of Health Cancer Policy Team has decision on which screening modality randomised the required sample size agreed that a Demonstration Project (FS, faecal occult blood testing or a (1562 patients) within one year, and the of FS screening is required to examine combination) should be implemented in first patients are now nearing the end population uptake rates and the role a programme. The options appraisal is of the first phase, having completed of nurse endoscopists in a potential now complete and an implementation three years on study drug. The rate of NHS Screening Programme. In strategy has been drawn up by the DOH. withdrawals is less than 20%, which is preparation we have undertaken and With respect to the diagnosis of extremely low for a prevention trial in completed a feasibility study, with colorectal cancer, data provided by asymptomatic individuals. funding from KeyMed Ltd., to develop Professor Mike Thompson, Portsmouth, As part of the UK Flexible invitation materials and obtain a has been analysed on risk of cancer Sigmoidoscopy Screening Trial, data preliminary measure of uptake rates in 17,000 patients presenting with were collected (prior to screening) on with nurse-led FS screening when the symptoms of bowel cancer. We have diet, smoking, alcohol consumption public are invited as an NHS service. shown that, in the absence of anaemia and use of drugs such as aspirin and The feasibility study was undertaken or an abdominal mass, the risk of having hormone replacement therapy. In between September 2003 and July. a cancer beyond the reach of the flexible addition, two 5 ml samples of blood This study has been highly successful, sigmoidoscope in patients with bowel were collected from 1000 individuals with an uptake rate of 67%, and has symptoms is no higher than in the who were found to have adenomas at facilitated the development of an asymptomatic general population. Thus screening, 1000 individuals found to invitation strategy, patient information this group may not require complete have non-adenomatous polyps and materials and a patient management colonic imaging by colonoscopy 1000 individuals who were polyp-free. system that could be used in the larger or barium enema. If adopted, this DNA has been extracted from the first demonstration project. The nurse recommendation has the potential to samples and used to analyse the effects endoscopy practitioner, Maggie Vance, save valuable NHS resources and to of inherited mutations in genes that who performed the screening, was found protect very low risk patients from the metabolise carcinogens in diet.

45 St Mark’s Annual Report 2004

Population Screening Research cont.

A long-term aim is to investigate genetic and environmental risk factors for the development of colorectal cancer and its precursor, the adenoma. This year Kevin Pack, a scientific officer in our laboratory analysed the frequency of mutations in various exons of the base excision repair gene, MYH, which has been implicated in predisposition to multiple adenomas. The study was undertaken in individuals with adenomas and controls who were polyp-free. Both groups included individuals with and without a family history of colorectal cancer. This study will provide an estimate of the MYH variance in the general population and will be the largest of its kind to date.

The colorectal polyps collected during FS screening have been a valuable resource for examining the genetic aetiology of colorectal cancer. Activating ß-catenin mutations in exon 3 have been implicated in colorectal tumorigenesis. It has been suggested that ß-catenin mutations may occur more frequently in microsatellite- unstable (MSI+) colorectal cancers, including hereditary non-polyposis colorectal cancer (HNPCC), as a consequence of defective DNA mismatch repair. 337 colorectal carcinomas and adenomas, from sporadic cases (mainly from our trial series) and HNPCC families, were used to provide an accurate assessment of ß-catenin mutation frequency in each tumour type. Mutations were found to be rare in both sporadic and HNPCC adenomas, and no oncogenic ß-catenin mutations were identified in 34 MSI+ and 78 MSI- sporadic colorectal cancers. However an increased mutation frequency (8/44, 18.2%) was found in HNPCC cancers; this frequency was significantly higher than that in HNPCC adenomas (p=0.035), and both MSI- (p<0.0001) and MSI+ (p=0.008) sporadic cancers.

Professor Wendy Atkin Deputy Director

46 St Mark’s Annual Report 2004 Colorectal Cancer Unit Colorectal Cancer Genetics Group

The Colorectal Cancer Genetics Group and facilitate the mapping of modifier The main function of APC within the Wnt aims to identify the genes involved in and susceptibility genes following pathway is to destabilize cytosolic ß- colorectal cancer (CRC) predisposition exclusion of APC, MYH or mismatch catenin, and loss of APC function causes and severity using a combined approach repair mutation. Constitutive DNAs from stabilized ß-catenin to translocate to the involving genetic analysis of human patients recruited under CORGI have nucleus where it results in transcriptional familial colorectal cancer, genetic been used to investigate a potential up-regulation of c-Myc and cyclin-D1. profiling using the extensive archive link between two common germ-line Mutations have been reported in other of human CRC tissue samples at mutations of the haemochromatosis Wnt pathway genes, such as ß-catenin St Mark’s, and modifier mapping using (HFE) gene, C282Y and H63D, and and Axin2, which render ß-catenin the multiple intestinal neoplasia (Min) predisposition to CRC. A recent study resistant to destruction. Whilst alterations mouse model. An individual’s lifetime has reported an increased risk of CRC in the pathway are among the most risk of developing CRC is governed by associated with any HFE mutation. common pathogenic events associated a combination of life style, exposure However, other investigators have with colorectal carcinogenesis, with APC to environmental carcinogens, and the concluded that there is no increased accounting for the majority of pathogenic balance between inherited resistance risk, or that any increase is dependent mutations in microsatellite stable (MSI-) and susceptibility genes. The challenge on polymorphisms in HFE-interacting tumours, no systematic attempt has is to identify all the relevant genes and to genes such as the transferrin receptor yet been made to establish mutation specify their contribution to CRC in the (TFR). To resolve these issues, we frequencies in other Wnt signalling human population. In terms of identifying have established the frequency of HFE pathway genes. Consequently, we genetic modifiers of tumourigenesis, the mutations in CRC CORGI patients with are now analysing a number of genes polygenic nature of cancer inheritance a family history of the disease, and (GSK-3beta, DKK1, LRP6, SOX17, and in human populations and the relatively randomly selected controls; this design PP2C2B), known to be involved directly low penetrance of most contributing increases greatly the power of the or indirectly in the regulation of APC polymorphic genes, presents a number study. Genotyping for the TRF S142G or ß-catenin, for potentially pathogenic of problems which can be modulated polymorphism was also conducted on mutations in a series of microsatellite to some extent through the use of a large proportion of the study group. unstable (MSI+) and MSI- sporadic rodent models. These offer significant We have shown that the presence of any colorectal cancers and cell lines. experimental opportunities to overcome HFE mutation (Y282 or D63) was not Following single strand confirmation problems of variability in life style associated with colorectal cancer risk; polymorphism (SSCP) we have found a and carcinogen exposure, as well as but that individuals who are compound number of potential mutations in GSK- providing a means of controlling, or heterozygous for both the HFE mutations 3beta, SOX17, LRP6 and DKK1. We are specifying, the genetic component may have about three times the odds presently confirming these mutations through the use of induced/engineered of developing CRC compared to those by direct sequencing, and conducting mutations and selective breeding. The with a single mutation. We concluded immunohistochemistry experiments. To Group’s investigations and achievements that individuals with a single HFE date, our results indicate that mutations are detailed below. mutation, C282Y or H63D, are unlikely in Wnt pathway genes, other than Apc to be predisposed to develop CRC. In and ß-catenin, do occur in sporadic Human Colorectal Cancer Studies contrast, risk of CRC might be increased colorectal cancer The ColORectal tumour Gene by compound heterozygosity for the HFE Identification study (CORGI) directed by mutations. TFR gene polymorphism was MYH associated polyposis is a Prof Ian Tomlinson seeks to identify novel not an independent risk factor and did recessively inherited condition and CRC modifier and predisposition genes. not modify the disease risk associated the majority of inherited mutations in The rationale for this study is based with HFE mutation. European populations are Y165C and on genetic epidemiological evidence G382D in exons 7 and 13 respectively. that genes of moderate penetrance Activation of the Wnt pathway through In a small sample population, individuals might be responsible for up to a third mutation of the tumour suppressor gene of an Indian origin with multiple polyposis of all bowel cancers. The collection of a adenomatous polyposis coli (APC) gene appear to have a predominance of large number of families with colorectal is linked to the familial adenomatous a mutation in exon 14, suggesting a neoplasia through the CORGI study will polyposis coli (FAP) syndrome and is founder effect. We are now comparing help overcome problems of sample size frequently observed in sporadic cancer. the levels of MYH variants, heritable

47 St Mark’s Annual Report 2004 Colorectal Cancer Unit Colorectal Cancer Genetics Group cont.

mutations and published polymorphisms, In summary, host genetic background is in a very large number of individuals a major determinant of susceptibility to with and without a strong family history. cancer and tumour progression, and to This is the largest study on the MYH non-malignant disease that predisposes gene in the general UK population to to cancer. Before we can assess the risk date and will allow a better assessment of cancer in an individual, the controlling of the importance of MYH variations to genetic factors and their interactions colorectal cancer predisposition. need to be understood fully. A complete knowledge of the genetics of CRC will Mouse Models of Colorectal Cancer lead to improved strategies for early ApcMin/+ (Min) mice are heterozygous assessment of individual patients, for a truncating Apc mutation and along with enhanced prevention and provide a good model of human FAP. treatment regimes. The model has been used to provide an unambiguous example of a locus Andy Silver (Modifier of Min1; Mom1) modifying Research Scientist adenoma numbers in inbred strains. Linkage analysis located Mom1 and further investigation identified the secreted phospholipase A2 (sPla2) as the gene. Unfortunately, studies in humans did not confirm sPLA2 as a major modifier of cancer risk, because functional variation in humans did not exist. By exploiting an observation that our Min mouse stock was not on a pure genetic background, recombinant lines that presented with limited intra-line variation in adenoma numbers have been established through selective breeding. One line showed a particularly severe phenotype compared to the other lines that recorded significantly lower means. Using various mapping strategies we have shown that either a modifier gene close to Apc or structural variation on chromosome 18 modifies polyp numbers in our mice by altering the frequency of loss of the wild type copy of Apc. We are now investigating the genetic nature of this modifier of disease severity.

48 St Mark’s Annual Report 2004 Colorectal Cancer Unit Family Cancer Group

Director The aim of our group is to define the In 15000 patient-years of follow-up, Huw Thomas MA PhD FRCP inherited predispositions to colorectal high-risk adenomas and cancer were Nurse Specialist cancer and to refine our management most frequent in HNPCC (5.7% and Carole Cummings RGN, SCM of familial risk so as to prevent familial 0.9% on initial colonoscopy). In non- Clinical Research Fellow colorectal cancer. HNPCC they were particularly infrequent Kevin Monahan MRCP under the age of 45 (1.1% and 0.1%) Corgi Research Nurse This year we have completed the and on follow-up colonoscopy if Maggie Gorman RGN flagging of our colonoscopy surveillance advanced neoplasia was absent initially Bfcr Research Co-ordinator patients on the NHS Central Register (1.7% and 0.1%). There was a highly Patricia Gray MSc and submitted a paper on the outcome significant reduction in colorectal cancer Secretary of colonoscopic surveillance for familial incidence (80% in moderate risk, and Maggie Stevens colorectal cancer. We have completed 43% in HNPCC) and mortality (81% Database administrator and published our study on anticipated for moderate risk, and 72% in HNPCC) Julie Stokes reactions to genetic testing for compared to expected rates taking into susceptibility to colorectal cancer. We account family history. have also completed a pilot study of the interaction of genetic and environmental This study confirms that HNPCC family factors in familial colorectal cancer. members require surveillance with short intervals. Those with a lesser family Clinical Resource history may not require surveillance The Family Cancer Group Bobby Moore under the age of 45, and if advanced Oracle Database has the clinical details neoplasia is absent on initial colonoscopy of 6001 individuals affected by or at risk surveillance intervals may be lengthened. of familial colorectal cancer. 2314 have Colonoscopic surveillance reduces the undergone a surveillance colonoscopy risk of colorectal cancer in those with and 1563 have had multiple examinations. a strong family history (Dove-Edwin et The results of histopathology, genetic al, submitted). analysis of tumours and of blood samples are recorded. This year the Anticipated reactions to genetic testing Office for National Statistics has flagged for hereditary non polyposis colon cancer all the individuals who have undergone (HNPCC) susceptibility colonoscopy on the NHS Central In collaboration with Steven Sutton Register and we now have complete (formally CR-UK Health Behaviour Unit, ascertainment of individuals who have now University of Cambridge). We have developed cancers or have died. investigated how people anticipated they would react emotionally and Prevention of colorectal cancer by behaviourally to learning of their genetic colonoscopic surveillance in individuals susceptibility to colon cancer. We used with a family history of colorectal cancer a cross-sectional questionnaire in 437 In collaboration with Peter Sasieni (CR- asymptomatic individuals. UK Dept of Epidemiology, Mathematics and Statistics) we have analysed We found more women than men the outcome of 3823 colonoscopies anticipated feeling worried, regretful undertaken for familial risk of colorectal and angry if they carried a susceptibility cancer in 1678 individuals. The families mutation. People with a lower estimated were classified as hereditary non- risk anticipated more surprise and polyposis colorectal cancer (as judged disbelief than those at higher risk. by the Amsterdam criteria) or moderate People anticipated that they would risk with one, two or three affected first- feel regret and less relief if they were degree relatives. not tested than if they were. High risk

49 St Mark’s Annual Report 2004 Colorectal Cancer Unit Family Cancer Group cont.

We are combining our results from St Mark’s with those of Hans Vasen from The Netherlands Foundation for the Detection of Hereditary Tumours and analysing the results in collaboration with Peter Sasieni (CR-UK Dept of Epidemiology, Mathematics and Statistics).

Hereditary mixed polyposis syndrome (HMPS) We have previously described the phenotype of HMPS in St Mark’s Family 96 (Whitelaw et al 1997) and with Ian Tomlinson we published evidence of genetic linkage to chromosome 15q21- q22 based on a genome-wide linkage study (Jeghers et al 2003). The team from the Family Cancer Unit Dr Emma Jeghers has undertaken fine mapping of the region and excluded the known genes and ESTs. She is now results were anticipated to lead to for selecting families/cases for evaluation undertaking genetic sequencing of more depression. Most people wanted of HNPCC using molecular tests (Lipton the region. screening if at low risk but anticipated et al 2004). leading healthier lifestyles whichever test MYH-associated polyposis result they received. People anticipated Colorectal Adenoma/carcinoma and We have described the clinical making more plans for the future if they Prevention Programme 2 (CAPP2) features of individuals who carry were at high risk (Henning et al 2004). We are recruiting patients to this be-allelic MYH mutations (Sieber et We will perform a follow-up study when randomised study of dietary and al, 2003). In collaboration with Ian sufficient individuals have undertaken pharmacological intervention in HNPCC Tomlinson and Robin Phillips (CR- genetic testing. gene-carriers to assess the effect on the UK St Mark’s Polyposis Registry) we development of colorectal adenomas are now undertaking a more detailed Refining the Amsterdam criteria and in individuals who are undergoing analysis of the phenotype associated Bethesda guidelines- testing algorithms colonoscopic surveillance (organised by with heterozygote and bi-allelic MYH for the prediction of mismatch repair John Burn, University of Newcastle). mutations. mutations status in the familial cancer clinic Familial colorectal cancer: results of Families with multiple colorectal In collaboration with Ian Tomlinson (CR- colonoscopy in families with and without adenomas UK Molecular and Population Genetics microsatellite instability of their tumours We have successfully applied for Laboratory) we have looked at the We have sought to establish a Bobby Moore Clinical Research selection of families for genetic testing for prospectively whether individuals with Fellowship to undertake genetic linkage HNPCC. We have developed two new a strong family history of colorectal analysis in two Irish families with multiple models (Amsterdam-plus and Alternative) cancer but without evidence of DNA colorectal adenomas. This will be in and verified them on two different data mismatch repair gene deficiency are collaboration with studies undertaken on sets. The Alternative model avoids the also at increased risk of colorectal CORGI families with multiple adenomas needs to evaluate the Amsterdam criteria cancer by examining the incidence (see opposite). and performs nearly as well as the of advanced neoplasia during Wijnen and Amsterdam-plus model. We colonoscopic surveillance. suggest it should be used as first choice

50 Colorectal cancer gene identification The completion rate of diet diaries in study (CORGI) the pilot indicates that a study of all This is a multi-centre genetic linkage the St Mark’s patients undergoing study to identify genes predisposing colonoscopic surveillance for a family to colorectal cancer organised by Ian history of colorectal cancer would Tomlinson. We have a full-time research not have adequate statistical power. nurse at St Mark’s who has already Adequate numbers of patients may collected clinical information and blood be available from British Family samples from 580 individuals registered Cancer Record. with the St Mark’s Family Cancer Clinic. We have submitted a grant application Risk model for familial colorectal cancer to undertake a genome-wide association In collaboration with Peter Sasieni and study search of non-synonymous, Jonathan Tyrer we are developing a coding and splice-site SNPs to identify colorectal cancer prediction model low-penetrance alleles predisposing to incorporating familial and personal colorectal cancer. risk factors.

A pilot study of the interaction of genetic Cluster analysis of familial colorectal and environmental factors in familial cancer not due to DNA mismatch colorectal cancer repair defects The role of diet in the development of In collaboration with the CR-UK familial colorectal cancer is unknown and Computational Genome Analysis the genes responsible for a moderate Laboratory and Ian Tomlinson we increase in risk of colorectal cancer have are undertaking a cluster analysis of yet to be defined. This project had two the clinical and molecular features of major aims: firstly, to investigate the role individuals with familial risk colorectal of diet in the development of neoplasia in cancer not due to DNA mismatch familial colorectal cancer and secondly, repair defects to identify genes predisposing to familial colorectal cancer. St Mark’s Family Huw Thomas Cancer Clinic patients undergoing Director colonoscopic surveillance for a familial risk of colorectal cancer were invited to complete a 7-day EPIC food diary prior to their colonoscopy and at the time of colonoscopy to give a venous blood sample which is separated with two cell pellets aliquots and 10 aliquots of serum and stored at –70˚C. This was undertaken in collaboration with Tim Key (CR-UK Cancer Epidemiology Unit).

307 patients were invited to take part in this pilot. 268 patients consented and 282 underwent colonoscopy of whom 247 donated a blood sample and 107 returned the 7-day diet diary.

51 St Mark’s Annual Report 2004 Colorectal Cancer Unit The Polyposis Registry

Director Following the discovery of the MYH gene The Registry and the Trust Robin K.S. Phillips MS, FRCS in the previous year, 2004 presented an There have been 126 new patient Honorary Research Consultant opportunity to solve some of the puzzles referrals, either with or at risk of a Basil C. Morson CBE, VRD, MA, of the past. In families suspected of polyposis syndrome, to St Mark’s in FRCPath, Hon FRACS having familial adenomatous polyposis 2004. Of these, 81 came directly as a Consultant Pathologist (FAP) but where the causative mutation result of Registry involvement with the Ian C. Talbot MD, FRCPath. had proved elusive, or where a family, the remaining 45 being referred Honorary Consultant Paediatrician diagnosis had been in doubt because directly to a Consultant. Warren Hyer FRCP of the relatively low number of polyps,

Registrar pedigrees were re-examined and DNA New patient referrals in 2004 Kay F. Neale MSc, SRN samples re-tested. Due to the recessive At risk of inheriting FAP 35 nature of inheritance of the MYH gene, Nurse Practitioner At risk of inheriting MYH 31 Jacqueline Wright BSc, RN, DN in many cases partners as well as Affected MYH 2 children had to be contacted and Research Nurse Difficult cases referred on to St Mark’s 5 Sandra Burke BSN, RN offered counselling and testing. Other routine referrals 46 Assistant Registrar/genetic Peutz Jeghers syndrome 4 Counsellor Since the Registry computer system Juvenile Polyposis 2 Caroline Philp MSc,BSc. was last upgraded the number of patients monitored has increased Cowden’s Syndrome 1 substantially and the server was found Total 126 Registry And Research Project to be dangerously short of memory. Administrative Assistant Professor Phillips gave the go-ahead for A total of 859 patients who attend Kalpna Vekaria BA a complete overhaul, which, although St Mark’s are on the Polyposis Register. Honorary Research Fellow expensive, created an opportunity to In 2004 particular effort was extended to Allan D. Spigelman FRACS update the way in which the data are decrease the number of patients failing Research Fellow collected and managed. to attend their appointments. Patients Andrew Latchford MRCP were contacted by telephone if they

Research Fellow Staff did not turn up. If they failed to attend Julian Sturt FRCS Jacqueline Wright successfully a second time a letter would be sent completed the Physical Assessment to them explaining the importance of module, part of a Masters degree in screening or surveillance. After failing to Nursing, at City University. attend a third time a letter would be sent to both the patient and their GP. By the In September Caroline Philp successfully end of the year the numbers failing to applied to join the Regional Genetics attend had been halved. team at Addenbrooke’s in Cambridge and we wish her well in her new post. Patients with, or at risk of inheriting Sandra Burke, successfully applied for the polyposis are required to attend at least post as Assistant Registrar providing a once a year and often twice. For some seamless and very effective change much of these patients the examinations are appreciated by both patients and staff. required to confirm that they remain free of disease and, for those already At the end of the year Kalpna Vekaria affected, surveillance is required to went on maternity leave and had a baby monitor the disease. Most of these girl. Belynda Muir, who has worked patients feel well and do not need to see as a medical receptionist and medical a doctor. In this respect the clinics run secretary in her native Australia, replaced by the Nurse Practitioner have proved to Kalpna and rapidly proved herself to be a be a great success and in 2004 a total of most valuable asset. 307 patients were seen in the Nurse-led Clinic, thus releasing the medical staff for more urgent cases.

52 The Paediatric clinics, dedicated to of microsatellite and chromosomal how colorectal cancers develop. During children in polyposis families, continued instability in these tumours. Comparative this research they also hope to identify to be in demand. They take place every genomic hybridisation and microarray new targets against which novel anti- six weeks with a total of 39 children seen analysis are also being undertaken. cancer therapies can be designed. during 2004. Andrew has also undertaken a clinical Dr Andrew Silver International Society for Gastrointestinal audit of the surgical management of Most patients with familial adenomatous Hereditary Tumours (InSiGHT) duodenal disease in total and of desmoid polyposis (FAP) carry germline mutations Membership of this new Society formally tumours from 1996. On-going projects, in the adenomatous polyposis coli (APC) started in January 2004 and a new in collaboration with Simona Truvolo, gene. A small number of individuals with database for monitoring the membership include the assessment of cellularity polyposis have biallelic mutations in the list and payment of subscriptions was in desmoids and the assessment base-excision repair gene, MYH. It is, developed within the Registry. The of angiogenesis factors and factors however, possible that there are a limited website, which is being developed by modifying the extracellular matrix to number of patients where FAP cannot be Dr Hans Vasen in Leiden, went online in try to explain differences in the way in explained by known germline mutations July. The address is: www.insight-group. which these tumours behave. of APC. Dr Silver and his team are org. The first biennial scientific meeting, considering two likely explanations; the hosted by Professor John Burn, will Professor Ian Tomlinson and existence of rare APC mutations difficult be held in Newcastle upon Tyne in Dr Christine Thirlwell to detect by standard mutation analysis, June 2005. Two main mechanisms are thought to and the possibility that some cases of cause cancer. One is when a cell divides adenomatous polyposis are caused by too quickly and/or fails to die when it mutations in genes other than APC and Research Projects should do so. The other mechanism MYH. They have been examining DNA is when cells acquire genetic changes from 55 patients with classical FAP, Andrew Latchford (mutations) more quickly than normal. screened by the NW Thames Regional Andrew is responsible for the co- There exist two inherited bowel cancer Genetics Service at the Kennedy ordination of a clinical trial, funded by syndromes which seem almost identical Galton Centre using standard mutation the National Cancer Institute in the USA, to the clinician, but which occur through screening methods where no mutation and being undertaken in collaboration each of the above mechanisms. These was identified. In eleven of these they with the MD Anderson Cancer Centre are, as previously mentioned, FAP and have been successful in identifying a in Texas. The study is designed to MYH. It is already known how MYH pathogenic mutation. They have also investigate the effect of Celecoxib associated polyposis (MAP) is inherited verified a previously unreported mutation with difluoromethylornithine (DFMO) and that it involves a specific type of involving duplication of exon 4 of APC. compared to Celecoxib alone, in mutation being acquired more quickly The cohort of patients, without germ-line the prevention and regression of than normal, but many other features mutation of APC or MYH, is now the duodenal and colorectal adenomas. of the disease, especially its similarity to subject of further genetic analysis. It is anticipated that within the next FAP, are poorly understood. Professor year we will have reached the target Tomlinson and Dr Thirlwell aim to find out Donations for recruitment and that all of these more about how MAP occurs. They will We should like to thank all those patients will have completed the trial. do this by studying blood and tumours individuals who have donated funds from patients with MAP, by analysing to support our work. In addition, we In addition Andrew is working with a large set of patients with colorectal gratefully acknowledge the financial Professor Phillips in collaboration with cancer, by using “test-tube” analyses to assistance given by the following Professor Ian Tomlinson and Dr Andy work out how the mutations in patients organisations: - Silver to continue work on the genetic with MAP act, and by setting up animal The St Mark’s Hospital Foundation aspects of desmoid disease. He has models of MAP to allow a study of the Cancer Research UK completed beta-catenin gene analysis development of a bowel tumour from The National Cancer Institute, USA and second hit APC gene analysis on its earliest stages all the way through to a large group of desmoid tumours. cancer. Benefits to health will include Kay Neale In addition he has completed a study a better understanding about why and Registrar

53 St Mark’s Annual Report 2004

Intestinal Imaging Centre

Consultants We were pleased to welcome Andrew His replacement Dr Taylor has settled in Prof Clive Bartram Slater to our department in March 2004. and become a central part of the team, S. Halligan Mrcp Frcr M Marshall Bsc Mrcp Frcr Andrew hails from Oxfordshire and did his which means the day-to-day activities Stuart Taylor Mrcp Frcr Specialist Registrar training on the Oxford were interrupted to the minimum by

Research Fellows Scheme, based largely at the John Clive’s departure. Stuart has been busy David Burlling Mrcp Frcr Radcliffe Hospital. He is a lively individual this year again in the world of CTC, with Vicky Goh Mrcp Frcr with a determination and attention to David, Steve and Stuart between them Andrew Slater Mrcp Frcr detail which will come in very handy as he representing St Mark’s in all the major Superintendent Radiographers helped Steve manage the first of his two events nationally and internationally, Anna Giles multi-centre trials into CT colonography. where this technique is being challenged Adrian Mcqueen and developed. As you can see from the Senior Radiographer As you may recall, Steve was awarded publications lists, the travelling has not Hon Hoe a £1 million grant from the NHS Health stopped them in the quest for publication! Nursing Technology Assessment programme to Diane Gollagly carry out a multi-centre trial (SIGGAR Michele continues to provide a steady TRIAL), which started here at St Mark’s continuity to the day to day radiology Office Staff Josephine Convey in April 2004. Steve’s multi-centre trial service. Whilst maintaining involvement Bhartiya Shah (ESGAR) was completed in December in the department’s research, her links 2004. It looked at the effect of directed with Northwick Park are underpinning training on reader performance across a an expansion of the profile of good number of large European Centres and quality gastro-intestinal radiology, with confirmed the need for dedicated training the local Specialist Registrars fast and accreditation in CTC. Andrew has becoming budding enthusiasts. As well been working with Steve to look at as providing teaching at all levels, she the merits of CTC when compared to this year took on the joint role of Head of barium enema in terms of the diagnostic Training to the Northwick Park Radiology confidence achieved with each test. Training Scheme.

Sadly, we said goodbye to Professor Once again our thanks go to all our staff, Clive Bartram as he retired in November for their continued good humour and 2004 and to David Burling who left in support. Josie and the front desk staff December 2004. David completed his continue to smile through the challenges work for his MD thesis and returned to each day brings and the radiographers Swindon to finish his registrar training. seem to work harder each year – as the I am delighted to inform you that we doctors draw in more challenging cases will continue to see Clive as he is keen from all over the country, we expect and to remain involved in our research - to receive an unerring sense of calm and lose both his keen and wise eye for the practicality from those who support us to intricacies of gastro-intestinal imaging ensure a seamless and effective journey and his profound understanding and for each patient through our Department. inspiration in terms of his research work That is what makes it one of the best would be too much to bear all at once! places one could wish to work in.

Michele Marshall Consultant Radiologist

54 St Mark’s Annual Report 2004 St Mark’s Annual Report 2004 Endoscopy Intestinal Imaging Centre Wolfson Unit for Endoscopy Incorporating the Kennedy Leigh Academic Endoscopy Centre

Consultant Endoscopists 2004 built on the transitions and Dr Saunders continues to be in Dr. Brian Saunders Md Frcp Dr. Chris Fraser Md Mrcp changes of 2003. The highlight of demand to lecture both nationally Sr. Maggie Vance Msc Dip Rgn the year has undoubtedly been the and internationally on the advances

Honorary Consultant and Clinical appointment of Dr Chris Fraser as in endoscopic practice. This included Specialist in Gastrointestinal Consultant Gastroenterologist to replace delivering lectures for at the American Endoscopy & Endoscopy Training Dr Christopher Williams, who retired College of Gastroenterology, Orlando (the Dr. Noriko Suzuki Md in 2003. Chris, previously our clinical J Edward Berk lecture), the Association Consultant Anaesthetist fellow and locum consultant was of Surgeons Birmingham, BSG Glasgow, Dr. Douglas Newton Mbbs Frca officially appointed in October 2004. live demonstration of colonoscopy and Endoscopy Fellows His expertise in luminal endoscopy, invited lectures in Belfast, ASGE New Dr. Naila Arebi Md Phd Mrcp Dr. Gregor Brown Phd Fracp both upper and lower, has enhanced Orleans, Genoa and London, both the clinical service and research Clinical Specialist Dr. Arabinda Pal Md Mrcp within the Kennedy Leigh and the Dr Fraser, after his appointment as Wolfson unit for endoscopy as well as Consultant Gastroenterologist in October Research Fellows Dr. Siwan Thomas-gibson Mrcp providing invaluable clinical support to 2004, has developed several new

Nurse Endoscopists Dr Saunders and the Wolfson unit team. areas of clinical expertise, research and Marianne Baulf Srn teaching within the Unit including: capsule Ripple Mann Rn Bsc After the Unit was designated a National endoscopy, double-balloon enteroscopy, Research/training Nurses Centre for Endoscopy training in 2003 endoscopic anti reflux therapies, Barrett’s David Swain Rgn Catherine Thapar Rgn Bsc Dr Saunders, Dr Fraser and Sr Vance oesophagus, and a new national Gillian Schofield Rn Bsc continue to lead on both doctor and therapeutic endoscopy course for Nicky Palmer nurse endoscopist training and also trainees. He has also been appointed as Unit Administrator training trainers to teach others in their the SHA Lead for the North West London Jean Mannings own hospitals. The first year has been sector to promote service improvement Unit Secretary extremely busy. We have performed within endoscopy units ‘‘in the patch’’. Lisa Mackay 10,500 cases and all courses have been Academic Co-ordinator fully attended with the Unit reaching Research in 2004 remained a central for National Endoscopy Training Centre all its targets. Over 300 doctors and focus of the unit. Dr Siwan Thomas- Dorothy Saunders nurses have attended training courses Gibson completed her research on Audio-visual Production Team at the Unit this year. The training performance assessment at endoscopy Steve Preston Bsc methodology developed at the Wolfson and evaluation of training methodology. Unit has been embraced at a National This research has been of national level. The success of the courses has importance in the development and been greatly assisted by our nursing validation of current and new education team. Catherine Thapar, research nurse and training strategies for endoscopy. co-ordinator, developed the format Siwan presented widely both nationally for the implementation of the courses at the BSG and internationally at the and with research being a main focus ASGE on this field and has been has set up a database to monitor our instrumental in the development of training outcomes. After the success of training methodologies and assessment the first year we were able to appoint tools utilised in our training programmes. an academic co-ordinator, Dorothy After completing her MD research Saunders, to run our training portfolio. Siwan has returned to a medical role to The continuing success in this first year complete her training prior to taking a has been greatly assisted by the efforts Consultant gastroenterologist post. Matt of Dorothy and our research nurse Rutter completed his MD thesis and has educators: David Swain, Catherine had several groundbreaking publications Thapar and Gillian Schofield, to whom in major journals. His work on dysplasia we are indebted. surveillance in chronic ulcerative colitis will undoubtedly change practice for many years to come.

55 St Mark’s Annual Report 2004 Endoscopy Wolfson Unit for Endoscopy cont.

Dr Noriko Suzuki continues to be whilst providing an excellent clinical We have continued to build on the invaluable as an expert in endoscopy service for our patients. Naila has several success of our capsule endoscopy for both the delivery of our training ongoing research projects, including the service which is co-ordinated by Gillian programmes, the performance of effects of position change on adenoma Schofield, with the assistance of her complex endoscopy and in the field of detection rates, an evaluation of the nursing colleagues, David Swain, endoscopic research. Noriko has had capsule endoscopy service and an Catherine Thapar and Ripple Man. Gill several major publications and has audit of our endoscopic mucosal has performed in excess of 100 capsules presented both nationally at the BSG resection procedures. in 2004 and is to be commended for the and internationally at the ASGE on development, success and expansion of the incidence of flat adenomas in the Our academic nursing continues to go this service. Gill has completed a nurse western population and new techniques from strength to strength, led by Maggie doctor comparative study examining for endoscopic therapy. Vance, Nurse Consultant. Maggie nurse versus doctor’s accuracy at completed the feasibility study examining reviewing capsule images, which she Unfortunately in 2004 we had to say nursing performance of screening flexible presented at the UEGW in Prague 2004. goodbye to 2 members of our unit. sigmoidoscopy with Professor Wendy Gregor Brown, our clinical fellow from Atkin of CRUK as part of her PhD. Dr Brian Saunders Melbourne, Australia, left us in October From the success of this study a major Consultant Endoscopist 2004 to take up a position as consultant research grant has been awarded for a gastroenterologist in Melbourne. During national demonstration project to assess his year with us Gregor developed the potential of a nurse led flexible expertise in endo-luminal therapy and sigmoidoscopy screening programme. completed several research projects Maggie has presented both nationally focussing on capsule endoscopy (see and internationally this year at the BSG, publications) Gregor will be much missed UEGW and St Mark’s International by all the team, we wish him every Congress on Nurse Colonoscopy and success in his new consultant role. colorectal cancer screening.

We were also very sad to say goodbye David Swain, our senior research nurse to Dr Arabinda Pal, clinical specialist educator, has with Steve Preston, in gastroenterology in October developed a state of the art web and 2004. Arabinda, a very experienced DVD education and training package for Gastroenterologist has contributed nurses working within endoscopy. This significantly to both the Wolfson Unit has received very positive evaluation for Endoscopy and NWLH Trust, from the national endoscopy nursing providing expert endoscopic practice community and we hope this will be and contributing to all unit training implemented in every endoscopy unit programmes. Arabinda has left to in 2005. David is responsible for the set complete his clinical training and work up and maintenance of the Wolfson unit towards a consultant post in the UK and website, which continues to receive 5000 is currently based at Central Middlesex hits a month as well as assisting in the hospital, the Wolfson unit’s loss is the implementation of our new endoscopy NWLH NHS Trust’s gain. reporting system. David also continues to co-ordinate the propofol service We were however very fortunate in as well as having a crucial role in the having Dr Naila Arebi join us as a clinical development and co-ordination of the endoscopy fellow in October 2004. Naila basic therapeutic endoscopy course and has a specialist interest in endoscopic being heavily involved on all our teaching therapy and research and has been activities and continued to be a key figure developing her expertise in this area in the success of the unit in 2004.

56 St Mark’s Annual Report 2004 St Mark’s Annual Report 2004 Endoscopy Endoscopy Wolfson Unit for Endoscopy cont. Diagnostic Nursing

In Chair In October 2004 Janet Hammersley In 2004 we saw the dawn of a new age Mr Ian Fyfe G grade sister of many years with both in endoscopy training in the UK with the Vice Chair Northwick Park and St Mark’s retired Wolfson Unit National Training Centre, Professor Robin Phillips after 22 years service with the trust. firmly at the helm of the ship. It has succeeded by Mr Richard Cohen She is now enjoying a busy retirement. been a productive year, which has seen Private Patient Manager Both Jayne Butcher and Sarah us greatly expand our clinical horizons. Pam McGowan Tomlinson F grade sisters have acted In so doing we have run out of office and Clinical Nurse Manager up in the G grade post and both sisters clinical space but not enthusiasm for the Ann Curry have enjoyed the experience. multiple challenges ahead. The need for

Team Leaders/Sisters expansion must be addressed to allow Sally Crowther Our endoscopy nurse practitioners the Unit to reach its maximum potential Rebecca Slater Kathrine Fredericks continue to provide a major resource and refocus on the endoscopic research Annalyn Manalastas in terms of service development and which has been the bedrock for the research in the unit. Ripple Man, excellence we have achieved in training Staff Nurses Afua Brew currently the only endoscopy nurse and clinical practice. Aileen Castro practitioner in Polyposis in the UK, Caroline Kennedy Deena Iosefu leads the FAP endoscopy surveillance Val Pryor Sandra McGrath programme single handed in Endoscopy Diagnostic Services Manager Sandra Maxwell Ramil Pangilinan and is to be commended for its success. Karen Parfitt Mariann Baulf our upper GI endoscopy Mercy Sigauke nurse practitioner has forged the Gladys Singson Julie Storrie way ahead in developing a Barrett’s Emilia Tazarurwa surveillance programme for the Trust and Richard Wagland Victoria Zideman a nursing PEG service, as well as having a large clinical commitment to both out Healthcare Assistant Leticia Alvarado patients, endoscopy and major research projects. Mariann is also the educational Ward Receptionists secretary of the BSG Endoscopy Sheila Alzano Gill Bell associates group and has been responsible for developing the nursing programme for the BSG conference in 2004, which was a great success.

Nicky Palmer our research assistant has been instrumental in the ongoing success of the PRESAP trial and has also been responsible for co-ordinating the nurse led flexible sigmoidoscopy screening feasibility study.

Our administrative and secretarial team, Jean Mannings, Lisa Mackay and Dorothy Saunders continue to assist us with all our endeavours, whether organising our clinical commitments or assisting with our educational programmes and continue to be dedicated and valued members of our team.

57 St Mark’s Annual Report 2004 Medicine General Gastroenterology

Consultants Research Fellows The Department of Medicine comprises St Mark’s & Northwick Park St Mark’s and Northwick general medical gastroenterology, Michael Kamm (Chairman) Park Hospitals Anton Emmanuel Gregor Brown endoscopy, inflammatory bowel disease, Alastair Forbes Ailsa Hart nutrition, physiology, psychological Christopher Fraser Ian Gooding medicine, and the medical contribution Simon Gabe Matt Johnson Meron Jacyna Andrew Latchford to cancer care. It continues to function Max Pitcher David Lloyd as a vibrant department for excellent Brian Saunders Charlie Murray Julian Stern Fiona Nicholson clinical care, research and teaching. Huw Thomas Clive Onnie This report encapsulates some of the Cinzia Papadia developments that occurred during Central Middlesex Hospital Rakesh Sharma Sharon O’brien Ajeya Shetty 2004; further information is also to be Siwan Thomas Gibson David Sherman found in the reports of individual Units David Silk Roser Vega elsewhere in this Annual Report. Staff Grade Specialists Scientists Amar Nagree Mb Bs Md Angela Jones Evi Zampelli Md Hafid Omar Rachel Rigby Activity During 2004 Senior Clinical Fellows Naila Arebi Post Doctoral Scientists Jennifer Barro Md Richard Day General Gastroenterology Andrew Stagg During 2004 the Department of

Research Nurses Gastroenterology at Central Middlesex Associate Specialists Angela Gibbs Hospital moved from the St Mark’s Central Middlesex Hospital Mary Molloy Roser Vega Directorate to become part of the Medicine Directorate at the Central Middlesex Hospital. Clinical Assistants Northwick Park Hospital Riadh Dawood Professor David Silk retired from the Anwar Hanid Central Middlesex Hospital during the year. Specialist Registrars St Mark’s & Northwick Park St Mark’s Hospital Naila Arebi A large number of postgraduate Jonathan Hoare Tunde Idowu researchers are active within the Sarah Langlands Department, making St Mark’s James Lindsay Melanie Lockett one of the major UK centres for Aravinth Murugunathan postgraduate research. Aymer Postgate

Laboratory work took place in Senior House Officers collaboration with other Departments St Mark’s Hospital at Northwick Park Hospital and the Adam Bennion Aneka Haussmann Northwick Park Institute of Medical Tehfik Ismail Research. Professor Kamm takes Andrew Coulton part in joint research with the Antigen Tommy Kalantzis Presentation Group led by Professor Stella Knight. Dr Forbes and Dr Richard Day undertake laboratory activity within St Mark’s. Dr Emmanuel continued joint laboratory work focussing on gut neuromuscular function with GlaxoSmithKline.

58 St Mark’s Annual Report 2004 Medicine General Gastroenterology

Inflammatory Bowel Disease process. Dendritic cells can control the study demonstrated that in a significant The department has maintained its tissue-specific homing of lymphocytes proportion of patients infliximab produces involvement in clinical trials of a variety that they activate. This control of homing a clinical response or complete healing of novel agents for inflammatory bowel is a novel immunoregulatory function of of fistulas at one year. In 2003 we had disease. This included a large multicentre dendritic cells that has implications for previously published results regarding study examining the role of infliximab the therapy of intestinal inflammation as the long term outcome and clinical in the treatment of chronic active well as the design of mucosal vaccines. course of anal fistulas in the era before ulcerative colitis, the use of probiotics infliximab. In 87 patients followed for a in inflammatory bowel disease, and Ailsa also published work in Gut, median of 6 years, 68 percent of patients studies examining the role of new 5- focussing on the immunological showed healing of all fistulas. Perianal aminosalicylic acid formulations. characteristics of individual probiotic and rectovaginal fistulas took a median bacteria, both in isolation and in of 2.6 years to heal. Half of all complex Great progress was made in furthering combination. She demonstrated that fistulas required a stoma, resection or the plan to form a coherent Inflammatory bifidobacteria in particular exhibit the proctectomy. Given the poor prognosis Bowel Disease Unit. A new Unit was desirable anti-inflammatory property of complex fistulas in this condition, built to bring together and house the of causing dendritic cells to produce treatment with potent agents such as major groups with a clinical and research interleukin-10 (IL-10) and diminish infliximab represents a real therapeutic interest in inflammatory bowel disease, production of the pro-inflammatory IL-12. advance for a proportion of patients. including medical clinicians, nurse specialists, scientists, research fellows, Ailsa Hart completed work as a A separate published study from our a database manager, and secretaries. Wellcome Trust Research Training group had demonstrated that the This was funded by the hospital’s special Fellow, studying gut dendritic cells and response of fistulating Crohn’s disease charitable funds, through the assistance their interaction with commensal and to infliximab can be monitored and of the St Mark’s Hospital Foundation. probiotic bacteria. treatment adjusted, using magnetic This Unit will serve as a focus and co- resonance imaging. ordinating centre for the hospital’s activity Rachael Rigby, a PhD student, completed in this area. work on the interactions between colonic Michael Kamm and Stella Knight dendritic cells and bacterial antigens. continued clinical and laboratory work on Approval was also gained for a second She reported on animal studies which the potential therapeutic role of antibiotics nurse specialist in inflammatory bowel demonstrated that although such and probiotics in treating inflammatory disease, to complement the activity dendritic cells co-exist with very large bowel disease with Professor Massimo of our successful first nurse specialist numbers of commensal bacteria in Campieri and Associate Professor Lisa Younge. vivo, they retain the ability to respond Paolo Gionchetti, from the University of to bacterial antigens and are capable of Bologna. During 2004 laboratory work The active collaboration between Prof. producing both pro-inflammatory and conducted by Karen Lammers and Ailsa Michael Kamm at St Mark’s and Prof anti-inflammatory cytokines depending Hart demonstrated that probiotic bacterial Stella Knight and Dr Andrew Stagg on the nature of the stimulus. DNA has regulatory immunological effects at the Antigen Presentation Research separate from those of live bacteria, and Group of Imperial College continued. The Michael Kamm published results in that these effects are mediated, at least aim of this mucosal immunology group is Gut of part of a large international in part, by toll-like receptor 9 (TLR-9). to determine the role played by antigen- study, demonstrating that the probiotic Toshiki Mimura published a controlled presenting dendritic cells in both the bacteria E coli Nissle is as effective as study, conducted between Bologna and regulation of normal intestinal immunity 5-aminosalicylic acid in maintaining St Mark’s, demonstrating that once-daily and in inflammatory bowel disease. remission in ulcerative colitis. high dose probiotic therapy can maintain remission in patients with recurrent or Ailsa Hart, supervised by Andy Stagg, Michael Kamm published work in the chronic active pouchitis. Stella Knight and Michael Kamm, New England Journal of Medicine as part published work related to intestinal of an international study assessing the Chris Rayner, working together with homing memory T cells in both ulcerative medium term outcome of the treatment Michael Kamm, published a study colitis and Crohn’s disease. These cells of fistulas in Crohn’s disease using the reporting on the upward dose titration play a critical role in the inflammatory monoclonal antibody infliximab. This of azathioprine in patients with

59 St Mark’s Annual Report 2004 Medicine General Gastroenterology cont.

inflammatory bowel disease who have assessment and treatment service to the For the 2004 second International not responded to standard doses. A hospital. It will also facilitate enhanced St Mark’s Lecture Course the fourth quarter of such patients will respond teaching and research. Sir Avery Jones Visiting Professorship to an increased dose. was Dr Douglas Rex from the USA. Staffing consists of Dr Julian Stern, Matt Rutter, working primarily in the Consultant Psychiatrist in Psychotherapy The Department has four Specialist Endoscopy Unit, published extensively (full time), Dr Esther Serrano-Ikkos registrar posts in gastroenterology, on clinical aspects of cancer surveillance and Ms Patricia McHugh ( both part shared between St. Mark’s and in patients with inflammatory bowel time Consultant Psychologists), Mrs Northwick Park Hospitals. Trainees rotate disease. He demonstrated that Solveig Wilson (full time hospital Social through six months in each of general dysplastic areas of colonic mucosa are Worker and counsellor), and Mrs Breda gastroenterology, specialist lumenal often endoscopically recognisable, and Orrell (Secretary). gastroenterology, and specialised that a completely normal endoscopy training in nutrition, endoscopy and signifies a lesser cancer risk. Clinical work continued to expand. New gastrointestinal physiology. The campus projects in 2004 included the provision remains one of the most popular sites in Physiology Unit of group psychotherapy for patients with the region for training in gastroenterology, The Physiology Unit remains active with spinal injury and the development of a and also attracts trainees from around a busy clinical, research and teaching hypnotherapy service. the country. programme. Oesophageal, gastric, intestinal and pelvic floor studies and Support for SMH staff is an important Teaching days were again arranged for treatments are undertaken in part of the Unit’s role and regular the Region’s specialist registrars, and a coordinated and pre-booked supervision for biofeedback nurses, the medical undergraduate programme “one-stop” way. nutrition nurses, dieticians and the continues to grow. hospital social worker is provided. Research is multidisciplinary, ranging The Department runs an active teaching through epidemiology, psychology, Teaching remains an important programme for specialist registrars and pharmacology, surgery and basic part of the Unit’s activities. Future research fellows. This includes a regular science. Research programmes in meetings planned include a one day journal club, an inflammatory bowel faecal incontinence, constipation, national conference in June 2005 on disease research meeting, the Friday anal pharmacology, oesophageal Psychotherapy for patients with physical morning academic activities, and an reflux disease, and bowel dysfunction ailments, entitled “Body in Mind”. ongoing program of teaching activities in patients with neurological disease, within the sub-specialities. continued during 2004. A clinical study reporting on patients with an eating disorder who present Clinical Assistants from other hospitals The Unit is led by Professor Michael to gastroenterologists was published around London continue to seek an Kamm, with a focus on multidisciplinary jointly by St Mark’s physicians and attachment to the Department of care and research. Christine Norton, Dr Stern during 2004. Such patients Medicine for clinical experience in Nurse Consultant and Anton Emmanuel, are often poorly recognised as having lumenal gastroenterology. Senior Lecturer, continue to strengthen an eating disorder, due to the presence the Unit’s clinical and research activity. of associated gastrointestinal symptoms. Conclusions This controlled study demonstrated Gastroenterology at St Mark’s Psychological Medicine that such patients often have a worse and Northwick Park is thriving. The The new offices and clinical area for the prognosis than patients who present to building of new dedicated Units in Unit opened in December 2004, providing an eating disorder unit. Inflammatory Bowel Disease and office accommodation and consulting Psychological Medicine in 2004 will rooms (both individual and group). This Teaching And Training greatly enhance these areas of clinical new resource, generously funded by All the physicians maintained an active and research activity. St Mark’s Hospital special charitable academic role, presenting at international funds, has enhanced the Unit’s ability to meetings on all continents, and publishing Michael A Kamm provide a comprehensive psychological in major peer review academic journals. Chairman

60 St Mark’s Annual Report 2004 Medicine Physiology Unit

Director B Med Science Students During 2004 clinical activity and Michael A Kamm Md Frcp Fracp Parminder Dhanjal research continued to expand in Deanna Khoo Senior Lecturer / Consultant Physician the Physiology Unit. Anton V Emmanuel Bsc Md Frcp Secretaries Jenny Bowen Regular BSc modules with City Nurse Consultant & Hon Professor Smita Patel of Nursing Paulette Sharkey University on Bowel Continence Christine Norton Ma Phd Rgn Dms Nursing, and an MSc in continence Appointments Consultant Physician Bernadette Olivar care, continued during the year. Sharon O’brien Md Mrcpi Margaret Phillipson Nisha Dholakia Senior Fellow The work undertaken jointly between Carolynne J Vaizey Fcs(Sa), Frcs St Mark’s and GlaxoSmithKline continued to investigate enteric neuromuscular Senior Scientist Christopher Jordan Phd physiology. This work is located at the GSK site in Harlow. Studies focus Clinical Scientists Salma Gurmany Bsc, Msc on establishing new techniques for Tanya Nicholls Phd quantifying sensory function in the gut, Deepa Solanki Bsc, Msc Elisa Wrightham Phd and potentially thereafter modifying this pharmacologically. Charlie Murray Biofeedback Nurse Specialists continued his work last year, as the first Lesley Butcher Rgn Julie Duncan Rgn research fellow in this program. His work Jenny Lewis Rgn focussed on in vitro evaluation of the Maria Rakova Rgn effects of ghrelin on the gut. Biofeedback Physiotherapist Patricia Evans The Physiology Unit continues to pursue Research Nurses a policy of structuring its research into Angela Gibbs main streams, much of it undertaken Mary Molloy Eric Tripoli by research fellows registered for higher degrees such as MS, MSc, MD and PhD. Health Care Assistants Jo Battersby Shanthi Manickam The chronic pain service Evette Cooper During 2004 the chronic pain clinic

Medical Officer continued to provide a service in pain Michael Jarrett Frcs management of ward and out patients. Tom Dudding Frcs In addition to providing a clinical service Research Fellows for patients with chronic functional and David Chattoor Mb Bs organic pain, the clinic is undertaking Sonya Chelvanayagam Rgn Eric Chung Frcs research into measurements of outcome, Maureen Coggrave Rgn pharmacological treatment, and the Alexander Hardy Frcs Ailsa Hart Mrcp value of group treatment in patients Yasuko Maeda Md with chronic pain. Charles Murray Mrcp Harriett Owen Frcs Natalia Zarate Md During 2004 Marianne Smith led on the St Mark’s daily “Pain Round”. When appropriate she is supported by input from Dr Jonathan Harris with regard to acute pain management, and Anton Emmanuel for patients with chronic problems. Marianne also contributes to the Pain Services on the Northwick Park site.

61 St Mark’s Annual Report 2004 Medicine Physiology Unit cont.

On the out-patient side of the service, The clinical service Anton Emmanuel continued his work Marianne has contributed actively to The Physiology Unit investigates and as an honorary consultant at the Royal the Wednesday afternoon pain clinic. treats patients with functional disorders National Orthopaedic Hospital, working A pain management programme has affecting any part of the gut, ranging primarily in the Spinal Injury Unit. He been devised and implemented. Careful from the oesophagus to pelvic floor. provides a clinical service for patients selection of patients to enter this Diagnostic studies include stationary with acute and chronic spinal injury, who programme, and close monitoring of oesophageal manometry, ambulatory are known to suffer with a large burden efficacy by questionnaires and interview oesophageal pH and manometry of bowel dysfunction. This clinical service has suggested that such a program is studies, studies of gastric and intestinal forms the basis of a formal research effective. Improvement is seen in self- transit, breath hydrogen studies, practice between the Physiology Unit at reported pain, use of analgesia, visits and studies of pelvic floor function. St Mark’s and the Spinal Injury Unit at to specialists and quality of life. Behavioural and psychologically the Royal National Orthopaedic Hospital. based treatments include behavioural Two years or greater follow up data therapies (including “biofeedback”) for Faecal Incontinence are now available in over 100 patients. incontinence, constipation, and related Behavioural therapy (biofeedback) Approximately 40% of patients are therapies, cognitive behavioural therapy, During the year the joint Pelvic Floor improved and maintain improvement. counselling, and limited psychotherapy. Clinic continued to see patients with In addition to pain management, Other therapies include newer surgical urinary and bowel symptoms. This other interventions include opiate treatments, pharmacological therapies multidisciplinary clinic involves specialist and benzodiazepine weaning, (including new topical pharmacological urogynaecologists from Northwick Park relaxation therapy, rationalisation of therapies), and injection of biomaterials. and St Mary’s Hospitals, as well as pharmacological therapy and access to Choosing between behavioural, different disciplines from within St Mark’s. psychological services. The Pain Clinic is pharmacological, psychological, and indebted to the Psychological Medicine surgical treatments depends on the A study of anal electrical stimulation Unit, with whom a number of patients nature of the symptoms and the for faecal incontinence was completed are jointly cared for, and to Pam Nye underlying condition. in 2004. and Smita Patel for administrative and secretarial support. During the year more than 1500 Sarah Collings, a psychosexual diagnostic and 3500 treatment episodes counsellor, started exploratory work Outcome data from the clinic have took place. There are often up to eight on womens’ reactions to faecal been presented at the British Society or nine diagnostic and treatment clinics incontinence. of Gastroenterology annual meeting, running concurrently in the Unit. and at The Royal London and Middlesex The Unit is very focussed on a Sonya Chelvanayagam has been Hospitals. The clinic has had visitors comprehensive package of care that collaborating with the Menopause clinic from Birmingham, the Royal Free, encompasses patients having all their to explore the relationship between St Bart’s and Whipps Cross Hospitals. investigations and the beginning of menopause and new bowel symptoms. treatment pre-booked to occur on the Nursing clinical care and research same day. Tests are not considered an Sacral nerve stimulation Nurses within the Physiology Unit end in themselves; all patients referred The development of sacral nerve continue to provide much of the from outside the hospital have a careful stimulation as a novel therapy for faecal specialist care. history taken, tests performed, and incontinence continued. a plan of management formulated. Christine Norton represents nursing Booking and reporting systems are now During 2004 an international multi-centre on the St Mark’s and Campus streamlined and computer-based. The study involving the Unit was published Academic Boards, and the Health Unit is multidisciplinary in personnel and in the Lancet. This demonstrated the Services Research Committee. She in the range of treatments offered, and value of sacral nerve stimulation for the also chairs the campus Nursing is continually expanding its staff to meet treatment of faecal incontinence in the Research steering group. the growing diagnostic and clinical need. presence of a structurally intact but weak sphincter.

62 St Mark’s Annual Report 2004 Medicine Physiology Unit cont.

Michael Jarrett completed work on We are grateful to Medtronic for their There remains a group of patients in extending the range of indications for support of work involving sacral nerve whom laxatives are ineffective and this therapy, including patients with stimulation. behavioural treatment fails. One of the incontinence persisting after rectal means of improving bowel function may prolapse repair, incontinence following Sphincter Surgery be through the use of pharmacological partial spinal injury, and incontinence Work from this Unit had previously therapy that improves peristalsis. The after rectal resection for cancer. This demonstrated a variable long term serotonin type 4 (5-HT4) agonists work was accepted for publication. outcome of primary sphincter repair have this effect. In 2004 Michael in patients with faecal incontinence Kamm published a study, as principal In a further study, completed during following obstetric sphincter damage. investigator, in the American Journal 2004, the role of sacral nerve stimulation In contrast Carolynne Vaizey published of Gastroenterology examining the in patients with a disrupted sphincter work demonstrating that repeat sphincter effectiveness of tegaserod in patients due to obstetric sphincter damage repair has a good outcome in many with intractable constipation. The study was investigated. Eight patients patients with such damage who had included more than 1200 patients across were permanently implanted, with failed a previous repair. This difference in Europe. The drug was significantly more most experiencing markedly improved results may reflect differences in residual effective than placebo in increasing continence during the short to striated muscle bulk and function bowel frequency and decreasing medium term. between the two groups of patients. associated symptoms such as bloating and discomfort. The total UK experience of sacral nerve Haemorrhoids stimulation for faecal incontinence Alex Hardy commenced work on the When patients fail behavioural and drug was compiled by Michael Jarrett and structure, pathophysiological basis and therapy, a small number may require published during 2004. More than symptom treatment of haemorrhoids. more intense treatment. The traditional 80 percent of patients permanently He is supervised by Richard Cohen. surgical therapy has been colectomy, but implanted in 3 centres experienced a this is associated with an unpredictable marked improvement in continence, Diverticular Disease and variable outcome. As part of the indicating the broad applicability of this During 2004 Toshiki Mimura published sacral nerve stimulation program the treatment outside teaching centres. work evaluating the role of matrix value of this treatment in patients with metalloproteinases in causing tissue intractable constipation has been During 2004 Michael Jarrett and Michael changes in patients with diverticular assessed. During 2004 Michael Jarrett Kamm reviewed the world literature disease. This work was undertaken in and Tom Dudding commenced work as regarding the use of sacral nerve collaboration with Professor Thomas part of an international multicentre study stimulation for the treatment of faecal MacDonald at Southampton University. examining the efficacy of sacral nerve incontinence and constipation. This work stimulation for this indication. was published in the British Journal of Constipation Surgery, and also formed the basis of a Biofeedback (behavioural retraining) is Chronic idiopathic intestinal review of this treatment by the National the first line therapy for patients with pseudo-obstruction Institute for Clinical Excellence (NICE). intractable idiopathic constipation in the Patients with visceral myopathy or Unit. Treatment consists of a package neuropathy pose a major management Sacral nerve stimulation involves an of care including biofeedback to correct problem, due to intractable pain, operation associated with relatively low pelvic floor sphincter dyssynergia, vomiting, or altered bowel function. Work morbidity; there is much less trauma correct use of other muscle groups published from the Unit demonstrated for the patient than is experienced with such as abdominal muscles, redefining that the motilin analogue, erythromycin, pelvic floor surgery. The precise range toileting behaviour, supervision in coming can be therapeutically valuable in of indications for this procedure, and its off laxatives, and counselling. patients with upper gut dysfunction. medium to long term results, are now being defined.

63 St Mark’s Annual Report 2004 Medicine Physiology Unit cont.

Gut dysfunction associated with Charlie completed electrophysiological Parminder Dhanjal obtained a BSc spinal injury studies demonstrating the role of ghrelin in Gastroenterology and Hepatology. Maureen Coggrave, a nurse specialist, in augmenting sensory input from the gut Supervised by Anton Emmanuel she continued work on bowel management to the central nervous system in response demonstrated that patients with irritable in spinally injured patients, in to physiological intestinal stimuli. These bowel syndrome have a tendency collaboration with Stoke Mandeville laboratory studies were performed in to somatisation (reporting emotional Hospital. Maureen should complete collaboration with colleagues at Glaxo symptoms in terms of bodily complaints) her PhD, funded by Action Medical SmithKline in Harlow. which was associated with heightened Research, in 2005. rectal sensitivity. This original work Charlie completed a study demonstrating highlights a mechanism through Alex Chung, a British surgical trainee, the beneficial effect of ghrelin in diabetic which emotional factors can influence continued research towards his patients with gastroparesis, a disabling gut sensitivity. doctorate. Working at both St Mark’s condition characterised by recurrent and the Royal National Orthopaedic bouts of vomiting. This work has Gut blood flow Hospital, under the supervision of involved collaboration with the Diabetes Previous work in the department has Anton Emmanuel and Professor Department at Northwick Park Hospital. focussed on the development of laser Michael Craggs, he studied the effect Charlie also completed a study Doppler techniques to measure mucosal of stimulation of sensory nerves in investigating the possible mechanisms blood flow. The extrinsic autonomic order to modify rectal compliance by which the cultural food, khat, nerves innervate the submucosal (stretch) in spinally injured patients. induces anorexia. He showed that this arterioles, which are one of the main He has shown that it is possible to anorexic effect is independent of the gut determinants of mucosal blood flow. The modify rectal compliance and rectal hormones ghrelin and PYY. measurement of mucosal blood flow was reflexes, a process which may influence therefore validated in the department the identification of optimal parameters Catherine Gouveia obtained a BSc in as a marker for the level of activity of for electrical stimulation. Alex completed Gastroenterology and Hepatology. She extrinsic autonomic nerves. a study of bowel function in spinal was jointly supervised by Dr Simon cord injury patients who have an Gabe and Anton Emmanuel. She studied The recent development of 5-HT3 electrical stimulator placed in their spine patients with short gut syndrome, antagonists for the treatment of patients to treat bladder dysfunction. He used demonstrating that certain types of with irritable bowel syndrome has been a specific questionnaire developed intravenous feed induce a reduction in associated with the possible occurrence within St Mark’s and Stoke Mandeville ghrelin secretion, which may correlate of ischaemic colitis. Whether this may Hospitals, and found that electrical with altered symptoms of hunger. relate to slowing of bowel motor function stimulation for the bladder is effective in alone, or a separate direct effect on improving bowel management in the vast Gut response to stress – in health and blood flow, is unknown. A study was majority of patients. irritable bowel syndrome completed in the department to examine A study conducted by two medical the effect of drugs on mucosal blood Enteric hormones and visceral afferent students from Imperial College, Jo Flynn flow, as measured by mucosal doppler nerve function and Laura Ratcliffe, as part of their BSc, techniques, and enteric blood flow of Charlie Murray, a British gastroenterology was published in Gastroenterology. the main mesenteric blood vessels, as trainee, completed his third year of study They showed that acute physical and measured using abdominal doppler towards a PhD with Imperial College. He psychological stress heightens gut techniques. This work was undertaken completed organ bath laboratory studies sensitivity in patients with IBS to a by Fiona Nicholson, Charlie Murray, Chris illustrating the effect of ghrelin, a gut- greater degree than controls. Jordan, Angela Gibbs, Anton Emmanuel derived hormone intimately associated and Michael Kamm, together with the with the sensation of hunger, on mouse help of Stuart Taylor and Michele Marshall stomach and colon muscle. The in Radiology. We are grateful to GSK for hormone augments contraction of gut their support in undertaking this study. muscle, especially in the upper gut.

64 Gastro-oesophageal reflux and other Members of the Unit lectured on a Finally, the link with industry is oesophageal functional disorders range of courses within the hospital, expanding. The Unit is well placed During 2004, a Spanish for doctors, nurses, pelvic floor to play a leading role in the evaluation Gastroenterologist Natalia Zarate physiotherapists, and other special of emerging drugs which influence undertook work on the development interest groups. They also lectured gut function. of pharmacological therapies to modify outside the hospital at other national oesophageal function. courses, societies such as the Royal Michael A Kamm Society of Medicine, and internationally. Director Deanna Khoo obtained a BSc in Work from the Unit was published in a Gastroenterology and Hepatology with wide range of peer review journals, from Imperial College. Supervised by Anton general journals such as the Lancet to Emmanuel she planned and completed a number of speciality journals in the a study of the effect of acid infusion in fields of surgery, medicine, obstetrics, patients with gastro-oesophageal reflux. psychology, and nursing. She showed that patients with non- erosive reflux had greatest sensitivity to The Future acid, compared to patients with erosive The Unit consists of a number of reflux, who in turn had greater sensitivity specialised “groups”, each developing than healthy controls. their own expertise in clinical practice, research and teaching. Education The unit ran a number of courses last Research fellows continue to “drive” some year. Christine Norton continued to run of the individual streams of research, into a bowel continence course for specialist areas including novel technologies for the continence nurses. This validated control of bowel and sphincter function, course was run in conjunction with City anal sphincter pharmacology, and University. A new Masters in Continence inflammatory bowel disease. Care module continued in 2004. Nurse specialists are taking on an The Unit aims to provide a national increasingly independent and high profile focus for information about functional role in the hospital, and this is particularly colorectal and pelvic floor disorders, and so in the Physiology Unit. Nurse as part of this maintains links with other specialists in the Unit provide expertise organisations such as The Continence in the fields of continence, defaecation Foundation, and the National Association disorders, and clinical trial research. for Colitis and Crohn’s Disease (NACC). Nurse-led research in these areas is It also makes representations to the becoming an increasingly important area Department of Health or government of the Unit’s activity. when policy issues involve continence. Telephone information and advice Clinical scientists are continuously is also provided to a wide variety of refining measurement techniques, professionals, the public, the media by a process of technological change and official bodies. Public information and clinical trials. They are taking on was promoted via the website a national role to lead in their areas www.bowelcontrol.org.uk. of clinical practice and research. Although the Unit has always had a strong clinical and research activity in oesophageal and upper gut motility problems, this is being expanded.

65 St Mark’s Annual Report 2004 Nursing Burdett Institute of Gastrointestinal Nursing

Director And Professor of Gastrointestinal Nursing Christine Norton RN MA PhD

Administrator Janet Paul

Lecturer-practitioner Annmarie Nunwa BSc RN

Lecturers Richard Day BSc PhD Kathy Whayman MSc RN Julia Williams Med RN

Research Fellows Husila Kershaw Maureen Coggrave MSc RN Sonya Chelvanayagam MSc RN Sarah Collings MA Sue Woodward MSc BSc RN

Reception lunch at the House of Lords celebrating the launch of the Burdett Institute

The Burdett Institute of Gastrointestinal Acknowledgements Nursing is a partnership between Kings We would like to thank the Burdett Trust College London, the Burdett Trust for for Nursing for funding this project from Nursing and St Mark’s Hospital. 2004-2009. Additional support has been The aim of the Burdett Institute is to given by Dansac Ltd, St Mark’s Hospital improve the health and wellbeing of Foundation, the Sir Halle Stewart Trust people with gastrointestinal disorders by and Kings College London. promoting excellence in gastrointestinal nursing education, research and Christine Norton practice. This new Institute is located at Director St Mark’s in accommodation provided by the St Mark’s Hospital Foundation.

Our objectives include ensuring that people with GI disorders will have easy access to evidence-based information in a variety of formats. We plan an extensive programme of nurse education and will commence both a BSc and MSc in GI nursing programme in the 2005-6 academic year. We also plan to expand the research capacity and output of quality evidence underpinning GI nursing practice and to provide leadership and a role model for GI nursing nationally and internationally. Further information can be obtained from our website: www.burdettinstitute.org.uk .

66 St Mark’s Annual Report 2004 Nursing Stoma Care Department

Lead Nurse Stoma Care At the beginning of 2004 the department clinics are run once a week and are Angela Vujnovich Rcn, Cert. In Stomal Therapy revamped the data collection system designed for general support, post that was in place to one that would operative review and those patients Stoma Care Nurse Specialist more accurately reflect the work that who are experiencing any problems. Jennie Burch Rn Adult, Dipn was being produced by the Stoma All patients are requested to attend the Pouch Support Nurse Care Department. In 2004 the stoma clinic 3 months after discharge for a Jo Wagland Ba (Hons), Rgn care nurses had over 5000 face-to-face check up on their progress, as previous Stoma Care Nurse Specialist contacts with patients. These were research has suggested that this is the Clare Bossom En, Rgn, Diphe Comm, conducted as either inpatients, outpatient best time to assess how patients are Enb216 appointments in clinics or home visits. actually managing and coming to terms Stoma Care Nurse Specialist There were approximately 430 new with their stoma. Clare and Sarah are Sarah Varma Rgn, Dipn referrals, the number of these requiring a now planning to audit the effectiveness Stoma Care Nurse Specialist stoma being just over 200. It is pleasing of this clinic. Clare and Sarah were Zarah Perry-woodford Rgn Adult to see that 65% of these patients now also involved in the Inside Out patient

Stoma Care Administrator have temporary stomas rather then information open day. This day was a Karen Pinder permanent. Comparing these figures great success judging from all the positive to previous years we can see that while feedback we received from patients. our new referrals remain the same the number of patients requiring a stoma has Clare Bossom went on maternity leave for increased slightly. With over 5000 patient the birth of her daughter Fay, with Sarah contacts the Department continues to Varma seconded into Clare’s position. provide a greatly utilised clinical service to Jennie Burch was invited to speak on both inpatients and outpatients. the Foundations in Stoma Care course at Hillingdon Hospital. She also successfully The Department ran a number of study completed her Introductory Certificate in days for internal and external delegates First Line Management. Joanna Wagland during the year, including a new starter started her MSc in nursing and has and intestinal failure study day, advanced successfully passed all modules to date. stoma care study day, health care Joanna and the Red Lion Committee assistant study day and the community organised the Red Lion Open Day for nurse study day. All these days were ileo anal pouch patients that was well designed to improve the care that stoma attended and received positive feedback. patients receive both in hospital and in the Zarah Perry-Woodford and Sarah Varma community setting. both successfully completed modules at City University in stoma care and An important development for academic colorectal cancer respectively. Karen nursing last year was the development of Pinder continued in her role as stoma the Burdett Institute in conjunction with care administrator in the Department. St Mark’s and Kings College London. Karen has been invaluable in her This institute will run both MSc and BSc organisation of all the study days that the programmes in Gastrointestinal Nursing. Department has run throughout the year. Angela Vujnovich has been involved in the In December Karen flew to Australia for planning and development of the stoma her wedding. care modules for these programmes. These modules will be designed to ensure 2004 is now over and we must look that all future stoma care nurses have forward to 2005. The Department education to a high standard. The first of already has a number of plans under these modules will start late 2005. way which I’m sure that I will be able to tell you about next year. 2004 saw Clare Bossom and Sarah Varma launch their nurse-led follow-up Angela Vujnovich clinics for local stoma patients. These Lead Nurse Stoma Care

67 St Mark’s Annual Report 2004

Intestinal Failure

Consultants and Senior Lecturers Another year passes and the nutrition We wish her well and are confident that Dr Alastair Forbes Dr Simon Gabe and intestinal failure service at St Mark’s she will have a successful career ahead Mr Alastair Windsor grows. One important promotion is of her. She will be succeeded by Jackie Ms Angie Davidson for Angie Davidson, who has been Eastwood in 2005, who joins us from Specialist Registrars, Clinical made Nurse Consultant in Nutrition Leeds and we look forward to her joining Fellows & SHOs and Intestinal Failure. Congratulations the team. We also say farewell to Ammi Dr Melanie Lockett Dr Aymer Postgate to Angie! As our clinical workload Tanda our intestinal failure coordinator, Dr James Lindsay increases for intestinal failure, we have she moved upstairs to the Macmillan Dr Jonathan Hoare Dr Clive Onnie been promised an Intestinal Failure Unit Services in December and I know that Dr Cinzia Papadia by the Trust, which will be separate we will miss her greatly. She managed Dr Anika Hansmann to our current ward base on Frederick to do a difficult job very well and even Dr Charlie Murray Dr Adam Bennion Salmon Ward. Our referral base is managed to run the London Marathon Dr Andrew Coulton strong for both medical and surgical as well! She is replaced by Carmen

Nursing causes of intestinal failure and we receive UgarteCano and we look forward to Debbie Buchan referrals from throughout the UK but working with her. Anne Marie Daniels Sally Crowther most come from the South West, South East, Eastern and London regions. One Educational Meetings Dietetics continued frustration continues to be In 2004 we have held a number of very Alison Culkin Morag Pearson that patients are waiting too long to be successful meetings. In May we held Diane Brundrett transferred and this is something that the first Joint Intestinal Failure Units Christina Wong we hope to be able to address once we meeting which focused on the Frontiers Pharmacy have a dedicated IF Unit. in Intestinal Failure. This joint meeting Claire Chadwick with the Hope Hospital in Manchester Shola Olusanya Angela Moore With respect to home parenteral demonstrates our commitment to a close nutrition, we care for around 135 working and academic relationship that Intestinal Failure Coordinator Ammi Tanda patients from around the country, has developed between the two units Carmen Ugartecano making us the country’s largest HPN over the past few years. The meeting centre. We continue to hold specialist attracted over a hundred delegates with Research Fellows Dr David Lloyd multidisciplinary nutrition clinics for Professor Deitch from New Jersey giving Dr Katharina Wallis patients with intestinal failure on a seminal talk on bacterial translocation.

Scientists parenteral nutrition and have had a In October, we held our 6th Intestinal Professor Colin Green number of professionals attending to Failure Study Day which attracted over Dr Richard Day Dr Aldo Boccaccini observe these uniquely designed clinics. a hundred delegates and was very well Dr Tahera Ansari Our specialist dietitians (Morag Pearson, received. Thirdly, a session on intestinal Diane Snoxell, Christina Wong and Alison failure was held at the St Mark’s lecture Students Charlene Foley Culkin) continue to support the IF service course in December at the Hilton hotel. Catherine Gouvea as do pharmacy (Shola Olusanya and Other study days have been held which

Administration, Contracts Clare Chadwick). Pharmacy support is includes and enteral feeding study day and IT undergoing change as Clare Chadwick organised by Alison Culkin as well as a Mr John Arnold Caroline Francis returned part-time but went on maternity number of parenteral nutrition study days Karen Mcguire leave in December. Shola Olusnaya has held by the nutrition nurses which aim to Julie Vasquez developed over the years that she has train staff in the provision of parenteral been with us and left in December to nutrition. go to UCH, with a significant promotion.

68 Intestinal transplantation will also be collaborating closely with Finally, 2004 has been the year of We continue to have six monthly Dr Julian Walters at the Hammersmith procreation as Angie Davidson, Christina transplant meetings together with Hospital for this project, which has Wong and Claire Chadwick have all had Addenbrooke’s Hospital, Cambridge. the potential to get selected patients babies – we welcome Oscar, Dylan and More patients are being discussed off parenteral nutrition altogether. Sophie. Congratulations! as the survival rate improves for On a separate note, Alison Culkin has patients undergoing this procedure completed her randomised controlled We recognise and are grateful for the and one of our patients is not listed trial of glutamine supplementation in financial support that we have received for transplantation. long-term intravenous nutrition and from the Medical Research Council, this is awaiting publication. She will JM Robertshaw Fellowship, Katie Jacobs Research next be addressing parenteral taurine Appeal, the TR Golden Charitable Trust David Lloyd started as research fellow in patients with IVN related cholestasis. and to Calea and Fresenius Kabi Ltd. in the department. He will be running Richard Day was awarded an MRC the appropriately named ACE fistula grant in 2003/4 allowing him to cross Simon Gabe trial (acute & chronic enterocutaneous specialise and this has allowed him to Senior Lecturer and Honorary Consultant fistula trial), which aims to be a perform further work with Dr Boccaccini large multicentred trial of enteral or along the avenue of material sciences. parenteral feeding in patients with Finally, two Imperial College medical enterocutaneous fistulae. The outcome students (Charlene Foley and Catherine of this study should influence the surgical Gouvea) performed BSc research management of these patients and projects supervised by Simon Gabe may help to re-write the management (Catherine guided also by Dr Charlie protocols in the textbooks. David will Murray and Dr Anton Emmanuel). also be undertaking an MSc in Clinical Their research projects were on the Nutrition and will also be involved in hormonal control of appetite, hunger tissue engineering research with Simon and satiety in parenterally fed intestinal Gabe. The tissue engineering project failure patients and a comparison of has flourished as we have been able malnutrition screening tools in acute to engineer small intestinal mucosa on hospital admissions (helped also by artificial construct. This has required Christina Wong). The results of both a close collaboration with Dr Aldo projects were presented at national and Boccaccini from the Department of international meetings and publications Materials at Imperial College, Professor are expected. Well done! Colin Green and Dr Tahera Ansari within Northwick Park Institute of Medical The National Picture Research, as well as the University of At a national level St Mark’s is having Liege where the scaffolds are made. a significant influence. Alastair Forbes Our group is included within the Imperial continues as chair of the British College Tissue Engineering Research Association of Parenteral and Enteral Group, headed by Professor Dame Nutrition (BAPEN), Angie Davidson is Julia Polak. Another key research editor of the National Nurses Nutrition project recently started by Dr Katharina Group Newsletter and a member of Wallis involves the first human use of a the British Artificial Nutrition Survey. GLP2 analogue in patients with short Simon Gabe is chair of the regional bowel syndrome on parenteral nutrition, representatives for BAPEN and sits supervised by Alastair Forbes. Katharina on BAPEN council.

69 St Mark’s Annual Report 2004

Academic Department of Pathology

Consultant Histopathologists Professor Ashley B Price had already MDT meetings at both sites of the North Ian C Talbot Md Frcpath Thomas Guenther Md Phd Priv-Doz Dr retired at the end of 2003. The second West London Hospitals Trust has almost med habil of the Gastrointestinal Histopathology doubled, and this makes an additional Axel von Herbay Md Prof Dr med habil ‘living legends’ at St Mark’s, Professor impact to the workload of the service. Secretary Ian C Talbot, retired in April 2004. Rehana Shah To mark their retirement and in their Mrs Rehana Shah, who was PA to

Visiting Research Fellows honour a Gastrointestinal Pathology Ian Talbot for many years, left the Dr Najat Mourra Md, Saint Antoine symposium was held at St Mark’s on Department in May 2004. She had not University Hospital, Paris, France 14 May 2004. Friends and former co- only managed all the routine clerical Dr Doerthe Kuester, Otto-von-Guericke University, Magdeburg, Germany workers, registrars and colleagues from support but also contributed to the Dr Salwa Mekki, Khartoum University, all over the country and abroad took the organisation of the academic work of GI Sudan opportunity to come and say farewell to histopathology. Rehana’s departure is a Specialist Registrars Ian and Ashley. The symposium was a great loss for the Department and her Khuram Chaudhry Mb Bs Phd Shyamala Helen Fernandez Mb Bs great success and provided the chance position has, sadly, not yet been filled. Mihir Gudi Md Mb Bs to listen to state-of-art lectures on a wide Farah Sandhu Mb Bs range of topics related to Gastrointestinal The lack of personal assistance was Pathology. We will remember Ashley’s augmented by deficiencies of the and Ian’s farewell speeches and the technical equipment. During the year, wonderful anecdotes they told. both new GI pathologists were without cameras to take photomicrographs. After Ian’s retirement in March there were Equipment for gross photography is also considerable problems in maintaining deficient. Microscope and computers the service in late spring. By then were outdated, and internet access the gastrointestinal histopathology is restricted. service was left for two months with Thomas Guenther as the only expert Given the circumstances the two new GI pathologist, though he was most GI histopathology consultants focussed grateful for support from colleagues initially on improving the service of in the Northwick Park Histopathology the Department in order to meet the Department. expectations and demands of our clinical partners. By the end of 2004 the In June 2004, however, we were most turnaround time had been significantly happy to welcome Professor Axel von reduced and is now almost meeting Herbay to fill the second consultant international standards. post in GI histopathology. With Axel von Herbay, who was already a well- Despite facing the difficulties at the known figure in academic gastrointestinal service front we managed to continue pathology in Germany, a second with academic duties. We provided academic histopathologist was in place. seminars for undergraduates of Imperial The gastrointestinal histopathology College London on gastrointestinal service is facing a substantially increasing histopathology and colorectal workload. Now we are reporting morphology. Thomas Guenther, Ian about 8,500 biopsies and resection Talbot and Axel von Herbay lectured specimens from St Mark’s & Northwick on the three St Mark’s postgraduate Park Hospitals, as well as from Central courses during the year. Middlesex Hospital. The number of

70 Both of the new pathology consultants contributed to St Mark’s weekly Grand Rounds, introducing a new format of case presentations to the clinico-pathological conferences. On 7th October 2004 Professor von Herbay presented his first Grand Round lecture, on Whipple’s Disease, an intestinal disorder which is until now rarely seen at St Mark’s.

In March, Professor Ian Talbot presented lectures at the international meeting on Coloproctology at St Vincent in Italy, on indeterminate colitis and indications for genetic testing for colorectal cancer risk.

In September, Professor von Herbay assisted at a consensus conference, held by the European Crohn’s and Three generations of pathologists. Colitis Organization ( ECCO ) in Prague, Left to right, Mrs Sue Talbot, Mrs Sylvia Morson, Professor Ian Talbot, Lady Northover, Dr Basil to establish new evidence-based Morson, Mrs Judith Price, Dr Thomas Guenther, Professor Ashley Price. ECCO guidelines for the diagnosis and treatment of Crohn’s Disease.

Axel von Herbay lectured (in September) at the Royal Society of Medicine’s Gastrointestinal Study Day for postgraduate trainees in Histopathology.

Both Privatdozent Dr Thomas Guenther and Professor Dr Axel von Herbay maintained their academic commitments in teaching and research in Germany, at the Otto-von-Guericke University Magdeburg, Germany, and at the University of Heidelberg, respectively.

Thomas Guenther Axel von Hebay Ian Talbot

71 St Mark’s Annual Report 2004

Research Records Department

Director The Research Records Department has post related to specialist coding as Mr Alastair Windsor MD FRCS FRCS(Ed) collected and provided clinical data at soon as possible. The final blow to Research Fellow St Mark’s for a wide variety of purposes development was dealt when the trustees Dr Kay Wilkinson BA BM BCh PG Dip for many years. This has been of the Hospital Foundation turned down Comp continuous since the days of Dr. Jean an application for monies to fund the Research Assistant Ritchie in the 1960’s who continued development of a proposal suggested Mr Steve Rumbles RGN Dip Comp BSc and extended the detailed data already by Michael Leibreich to raise funding Research and Administrative collected before the computer age and from external sources. Further attempts Assistant governments started dictating data for money proved futile leaving the Miss Neha Vaid BSc MSc collection to hospitals. Department with no option but to Clerical Assistant wind down and close in an orderly, Mrs Preeti Shah Sadly, the main event for the Research controlled manner. Records Department of 2004 was the forced wind-down of the Department, The sadness of the Department’s demise closing in early 2005, due to withdrawal was outweighed by the many happy of funding. A big achievement of the events and personal achievements for the year was the scanning and classification Department staff. Kay Wilkinson became of over 30,000 record cards into a pregnant, giving birth to Guy in January database, some over 80 years old. This 2005, although this did delay Kay’s writing was initially intended to be part of the up of her thesis! Department’s development but despite the closure, hopefully, will have preserved Neha Vaid was awarded a distinction the data and information for the future. for an MSc in Human Resource Management and Organisation Analysis The Department produced its first report from King’s College, London. Neha in 2001 about the future of information was then successful in her first job and data at St Mark’s. The report application being appointed as a concluded that change and development Human Resources Advisor within was necessary to once again be at the Northwick Park and St Mark’s which forefront of data collection and information she started in January 2005. Preeti Shah for research. Further brief reports were who worked in Research Records as a produced by the Department in 2003 “temp” since 2003 has been a superb and 2004 to supplement the initial report. asset to the Department, keeping the The committee representing the many rest of the team in order. Preeti found facets of the hospital formed under some work with the Nutrition department the chairmanship of John Northover just after the Department closed. Steve in 2003 continued to meet to develop Rumbles was also successful in his the Department for the future. In 2004 first job application and left the NHS to the trustees of the St Mark’s Hospital join the new London Oncology Clinic in Foundation stated their intention to Harley Street as the IT Manager. stop further funding of the Department from April 2005 as only projects, not Early 2005 brought mixed emotions “infrastructure”, would be supported from for the Department. New exciting their funds. In 2004 one of the trustees beginnings for staff, new baby for Kay, of the St Mark’s Hospital Foundation, Neha and Steve off to new jobs and Michael Leibreich, joined the committee Preeti finding other work within the trust. to attempt to raise money for the However, there was also a tinge Department. However, in May another of sadness at the end of an era within funding setback occurred when Veda St Mark’s Hospital. Enser announced the NHS’s intention to withdraw funding of Steve Rumbles’s Steve Rumbles post in order to fund a management Research Assistant

72 St Mark’s Annual Report 2004

Surgery

Consultants John Nicholls terminated his Presidency UK Training and Career Development JMA Northover Rj Nicholls of the European Association of Board and chaired the Appointments Rks Phillips Coloproctology during a successful group for Clinical Research and Senior Acj Windsor - Chairman year for the organisation ending with Research Fellowships. He continued Crg Cohen Pj Mcdonald the Annual Meeting in Geneva in to chair the Treatment Sub-Committee Sjd Chadwick September. This was well attended of the NHS Bowel Cancer Advisory Cj Vaizey by large numbers of delegates from Group, and as a member of the Steering Specialist Registrars West, Central and East Europe. There Committees for the national MDT- Pav Mathur Christopher Chan was a strong transcontinental faculty TME Training Programme (led by Bill Gordan Buchanan which made an excellent contribution. Heald), and the HTA-funded FACS Trial Paris Tekkis He retained his place on Council of (investigating post-operative follow-up Doug Bowley Matt Lawrence the EACP and also on the European strategies in bowel cancer). He served Guy Nash Merger Committee. The amalgamation his second year as a member of the Jack Lee Ann Lyons of EACP and the European Council of Awards Committee of the Digestive Austin Acheson Coloproctology (ECCP) is now almost Disease Foundation. Andrew Huang Vivek Datta certain. He also remained on Council of the Division of Coloproctology of the Lecture commitments included giving Perioperative Nurse Practitioners Union des Medecins Specialistes (UEMS) the Bernstein Lecture at the University Susheela Robinson Steve Wright with a particular interest in certification of Minneapolis, the Moshal Lecture to in Coloproctology in discussion with the South African Gastroenterology Surgical House Fellows Alex Hardy the Association of Coloproctology of Society (SAGES) in Cape Town, the Suresh Pushpananthar Great Britain and Ireland. He remained Forrest Lumpkin Lecture at the University Oliver Smith Alex Von Roon Civil Consultant Adviser in surgery to of Texas, Dallas, the Edward Wilson David Roberts the Royal Air Force. He was therefore Lecture to the Sydney Surgical Society, Henry De’ath joint host to the Defence Medical and the Gerald Townsley Lecture at the Liz O’donovan Rebecca Himpson Services during a meeting held at Medway Maritime Hospital, Dartford. Jay Panchmatia St Mark’s Hospital in September. He He also lectured in Milan, Kuwait and Rachel Maynard Janice Murphy continued as Chairman of the Distinction Basingstoke. He designed and chaired Simona Truvolo Awards Committee of the Association the European School of Oncology

Honorary Clinical Assistants and of Coloproctology of Great Britain and Colorectal Cancer Masterclass in Research Fellows Ireland. He lectured in the UK and Cyprus, and was elected to membership Domenico Aiello Italy abroad and was received as an Honorary of the international Association of Malika Bennis U K Frédéric Borie France Member of the Spanish Society of Pelvic Surgeons. Alex Chung U K Surgery and of the Italian Society of Silvia Cornaglia Italy Dajana Cuicchi Italy Colon and Rectal Surgery. He continued In November 2004 Professor Robin Parthasarathi Das U K as editor of Colorectal Disease which Phillips took up the post of Clinical Tom Dudding U K Marco Ferronato Italy maintained satisfactory progress. He Director in succession to Professor Clive Patricia Hanson U K remained in research collaboration with Bartram. During the year he continued Alexander Hardy U K Matthew Johnson U K Professors Kamm and Ciclitira with Mike as Director of the St Mark’s Polyposis Litavan Eric Khamphommala France Jarrett, Paris Tekkis and Matt Johnson Registry, Joint Administrative Director Edelweiss Licitra Italy as research fellows. of INSIGHT (The International Society Emma Marchigiano Italy João Miguel Martins Portugal for the Investigation of Gastrointestinal Heena Surendra Patel U K John Northover continued in several Hereditary Tumours), President of the Sebastian Roka Austria Francesco Paolo Di Rosa Italy national roles, including Chair of the Data British Colostomy Association, Civilian Simona Truvolo Italy and Ethics Committee for all Medical Consultant in Colorectal Surgery to the Research Council colorectal cancer Royal Navy, and on the Editorial Board trials, and Civilian Consultant Adviser for Familial Cancer and Diseases of the in Colorectal Surgery to the Army. As Colon and Rectum. He was invited to Director of the CR-UK Colorectal Cancer become joint Co-Editor for Techniques in Unit, he continued membership of CR- Coloproctology. Julian Stuart completed

73 St Mark’s Annual Report 2004

Surgery cont.

his period of research in gene therapy over from Mr Richard Cohen as the intestinal failure unit. Ideally situated for FAP and Sandra Martinico continued Lead Clinician for Colorectal Cancer between theatre, ITU and the endoscopy her PhD in the same field, both jointly and also lead on Clinical Governance unit, this ward would have had 20 supervised with Dr Georges Vassaux, within St Mark’s. intestinal failure beds. Unfortunately, this while Dr Andrew Latchford continued development has been frustrated by the recruitment to the DFMO/Celecoxib trial Peter MacDonald continues to hold a Trust’s planned PFI scheme. in FAP patients and further scientific joint post working both in St Mark’s and work on FAP desmoid tumours along at Northwick Park Hospital. Mr Stuart Carolynne Vaizey with Dr Andrew Silver and Professor Gould joined the staff at St Mark’s and at Senior Lecturer and Honorary Ian Tomlinson in CRUK at St Mark’s. Northwick Park Hospitals, coming from a Consultant Surgeon Simona Truvola finished her year as an Senior Lecturer post at St Mary’s. Honorary Clinical Assistant working with Robin and left to become one of the Stephen Chadwick continues to enjoy St Mark’s Fellows in Colorectal Surgery. a busy practice. Despite professing an She was replaced by Dr João Martins, a interest in laparoscopic surgery much surgeon from Portugal. Robin lectured open surgery is performed. Visits to in: Aarhus, Denmark; Nordveig, Holland; other units and major surgical meetings Madrid, Spain; Montreal, Canada; have been made. Surgical presentations Chepstow, Wales; Birmingham, England; have been given at national and Belgrade, Serbia; Milan, Italy; he was the international meetings, including the College Lecturer in Melbourne, Australia; Society of Laproendoscopic Surgeons he ran a practical workshop on ‘Plastic meeting in New York. At the St Mark’s surgical techniques around the anus’ Association a paper detailing the use of in Perth, Western Australia; he gave Hartman’s procedure was presented. the Daher Cutait Oration at Campos de Videos on a synchronous combined Jordao, Brazil; and he lectured at the resection of the rectum with Professor Glasgow Surgical Forum when he was John Nicholls and management of elected Fellow of the Royal College of Crohn’s disease were completed and Physicians and Surgeons of Glasgow. presented. Outside surgery the highlight of the year was winning the Girling silver Carolynne Vaizey settled into her new salver in the Windsor Park Carriage role at St Mark’s forming an excellent driving championships. working relationship with Professor Northover as his Senior Lecturer. She Lead by Mr Chadwick and Mr Gould lectured in the UK and abroad and laparoscopic surgery is now being continued in research collaboration performed at St Mark’s. This area has with Professor Kamm and Professor been identified as our next area for Nicholls. She also maintained her surgical expansion. It is hoped that we research links with her former colleagues will be able to form a leading minimally at The Middlesex Hospital. Research invasive unit in combination with fellows Mike Jarrett, Tom Dudding radiology and the endoscopy unit within and Yasuko Maeda continued the the next year. work on new treatments for faecal incontinence. With the approval of sacral The Intestinal Failure Unit continues nerve stimulation by NICE, this has to grow. All of the St Mark’s surgeons now become one of the most common have been involved in the treatment treatments for incontinence at St Mark’s. of enterocutaneous fistula patients as Neurostimulation is now a major the number of these surgical patients research focus for the treatment of other has continued to increase. A ward was colorectal conditions. Carolynne took identified for conversion to a dedicated

74 St Mark’s Annual Report 2004

Surgery cont. Bibliography St Mark’s Annual Report 2004 Publications for 2004

Books, Book Chapters and Editorials

Beveridge I, Forbes A. Mardeno Patient Atlas: Gastroenterology 2nd edn. Mardeno (UK) Ltd, Knebworth, 2004.

Carter MJ, Lobo AJ, Travis SPL, Breslin N, Driscoll R, Forbes A, Goodfellow P, Halligan S, Hawkey CJ, Hawthorne AB, O’Morain C, Probert CSJ, Rampton DS, Sercombe J, Shaffer J, Shorthouse AJ, Warren BF, Wood S.

Guidelines for the management of inflammatrory bowel disease in adults. Gut 2004;53:Suppl V;V1-V16

Dove-Edwin and H.J.W.Thomas. Colorectal cancer screening and surveillance. Stuart Bloom ed. Practical Gastroenterology, Martin Dunitz, London 2002.

Forbes A. Parenteral nutrition: new advances and observations. Curr Opin Gastroenterol. 2004;20:114-8

Forbes A. New biologicals – is ulcerative colitis being neglected? IBD Update 2004. Helen Lawn Ltd, London.

Forbes A. Existing IBD treatments and new options. Inflammatory News 2004;1:1.

Forbes A, Misiewitcz JJ, Compton CC, Levine MS, Quraishy MS, Rubesin SE, Thulavath PJ. Atlas of Clinical Gastroenterology, 3rd edn. Elsevier Mosby, Edinburgh, 2004.

Kamm MA. The therapy of Crohn’s disease should be guided clinically. In Trends and Controversies in IBD – evidence-based approach or individual management? Eds Dignass A, Lochs H, Stange EF. Kluwer academic publishers. 2004 pp109-16.

Kamm MA. Chronic active disease and maintaining remission in Crohn’s disease. Aliment. Pharmacol. Ther. 2004;20(Suppl 4):102-5

Kamm MA. Debate. Antagonist. Early surgical intervention in ulcerative colitis. Gut 2004;53:308-309.

Kemp Z, Thirlwell C, Sieber O, Silver A, and Tomlinson I. (2004). An update on the genetics of colorectal cancer. Hum Mol. Genet. 13:R177-185.

Langlands S, Forbes A. Provision and management of home parenteral nutrition. Prescriber 2004;15:30-44.

Norton, C. & Chelvanayagam, S. Bowel Continence Nursing Beaconsfield Publishers, Beaconsfield, 2004.

Phillips RKS. Invited Commentary: Stapled rectal resection for outlet obstruction. Dis Colon Rectum 2004; 47: 1296.

Saunders BP. New Developments in colonoscopy In Medical Radiology : diagnostic imaging. Ed Chapman Springer Verlag 2004 Saunders BP, Fraser C. Colon tumours and colonoscopy. Endoscopy. 2003 Nov;35(11):902-12. Review.

78 St Mark’s Annual Report 2004 Publications for 2004

Saunders BP & Shah SG. ‘Magnetic endoscope imaging.’ In. Colonoscopy Ed: Waye, Rex & Williams. Blackwell Science 2004.

Shah R, Day R, Forbes A. Proteomics and its potential applications to gastroenterology. CMEJ Gastroenterol. Hepatol. Nutr. 2004;6:3-7.

Suzuki N, Saunders BP, Brown G. Flat colorectal neoplasms: endoscopic detection, clinical relevance and management. Tech Coloproctol. 2004;8 Suppl 2:S261-6.

Williams CB, Price AB, Talbot IC, Forbes A. Cancer surveillance in longstanding ulcerative colitis: endoscopic appearances help predict cancer risk. Gut 2004;53:1813-6

Original Peer-reviewed Articles

Arebi N, Forbes A. High-output fistulae. Clin Colon Rect Surg 2004;17:189-98.

Arebi N, Patel B, Aquel N.M, Pitcher M.C.L. IgA multiple myeloma presenting as non-obstructive jaundice Postgraduate Med J 2004 Aug;80(946):489-90.

Atkin W.S, Rogers P, Cardwell C, Cook C, Cuzick J, Wardle J, Edwards R. Wide variation in adenoma detection rates at screening flexible sigmoidoscopy.. Gastroenterology 2004;126:1247-56.

Bardhan K.D, Forbes A, Marsden C.L, Mason T, Short G. The effects of withdrawing tegaserod treatment in comparison with continuous treatment in irritable bowel syndrome patients with abdominal pain/discomfort, bloating and constipation: a clinical study. Aliment Pharmacol Ther 2004; 20: 213-22.

Bell A.J, Nicholls R.J, Forbes A, Ellis H.J, Ciclitira P.J. Human lymphocyte stimulation with pouchitis flora is greater than with flora from a healthy pouch but is suppressed by metronidazole. Gut 2004; 53: 1801-1805.

Beveridge I.G, Swain D.J, Groves C.J, Saunders B.P, Windsor A.C, Talbot I.C, Nicholls R.J, Phillips R.K. Large villous adenomas arising in ileal pouches in familial adenomatous polyposis: report of two cases. Dis Colon Rectum. 2004 Jan;47(1):123-6.

Bliss D.Z, Norton C, Miller J.M, & Krissovich M. Directions for future nursing research on fecal incontinence. Nursing Research, 2004;53(6S):S15-S21.

Bloom S, Kiilerich S, Lassen M.R, Forbes A, Leiper K, Langholz E, Irvine J, O’Morain C, Lowson D, Orm S. Low molecular weight heparin (tinzaparin) vs. placebo in the treatment of mild to moderately active ulcerative colitis. Aliment Pharmacol Ther 2004; 19: 871-8.

Bray F, Atkin W. International cancer patterns in men: geographical and temporal variations in cancer risk and the role of gender. J Men’s Health & Gender. 2004; 1:38-46.

Buchanan G.N, Cohen C.R, Nicholls R.J. Randomized clinical trial of the costs of open and laparoscopic surgery for colonic cancer. Br J Surg 2004; 91: 409-417). Br J Surg. 2004 Sep;91(9):1202.

Buchanan G.N, Halligan S, Bartram C.I, Williams C.B, Tarroni D, Cohen C.R. Clinical examination, endosonography, and MR imaging in preoperative assessment of fistula in ano: comparison with outcome-based reference standard. Radiology. 2004 Dec;233(3):674-81. Epub 2004 Oct 21.

Long-term outcome following loose-seton technique for external sphincter preservation in complex anal fistula. Br J Surg. 2004 Apr;91(4):476-80.

79 St Mark’s Annual Report 2004 Publications for 2004

Burch J. Priorities in nursing management of fistulas in a community setting. British J Community Nursing 2004, Suppl: S6-14

Burch J. The management and care of people with stoma complications. British J-Nurs 2004 Mar 25-Apr 7;13(6):307-8, 310, 312, 314-8

Burch J. Urostomy products: an update of recent developments. British J-Community 2004 Nov;9(11):482-6.

Burling D. Taylor S, Halligan S. Computerized tomography colonography. Expert Rev Anticancer Ther. 2004 Aug;4(4):615-25.

Butcher L. Clinical skills: nursing considerations in patients with faecal incontinence British J Nurs 2004;13:760-7

Chai A.L.Y. Informed consent for endoscopy – the legal implications in practice Gastrointestinal Nursing 2004.

Chambers A, Halligan S, Goh V, Dhillon S, Hassan A. Therapeutic impact of abdominiopelvic computed tomography in patients with acute abdominal symptoms Acta-Radiol 2004;45(3):248-53.

Chambers W.M, Khan U, Gagliano A, Smith R.D, Sheffield J, Nicholls R. Tumor morphology as a predictor of outcome after local excision of rectal cancer. Br J Surg. 2004 Apr;91(4):457-9.

Coggrave, M. Effective bowel management for patients after spinal cord injury Nursing (Times) 2004 May 18;100(20):48-51.

Collings S, Norton C. Women’s experiences of faecal incontinence: a study. Br J Community Nurs. 2004;9:520-3.

Crabtree M.D, Fletcher C, Churchman M, Hodgson S.V, Neale K, Phillips R.K.S, Tomlinson I.P. Analysis of candidate modifier loci for the severity of colonic familial adenomatous polyposis, with evidence for the importance of the N-acetyl transferases.Gut. 2004; 53:271-6.

Cuthbert A.P, Fisher S.A, Lewis C.M, Mathew C.G, Sanderson J, Forbes A. Genetic association between EPHX1 and Crohn’s disease: population stratification, genotyping error, or random chance. Gut. 2004;53:1386.

Dalla Valle R, Zinicola R, Sianesi M, de’Angelis G.L, Michiara M, Rasheed S, Phillips R.K.S. Distal duodenal surveillance in familial adenomatous polyposis. Dig Liver Dis. 2004;36:559-60.

Davidson A. The pharmacological effects of novel nutrients on the immune system Nursing Times 2004 May 4-10;100(18):62-3.

Day R.M, Boccaccini A.R, Maquet V, Shurey S, Forbes A, Gabe S.M, Jerome R. In vivo characterisation of a novel bioresorbable poly(lactide-co-glycolide) tubular foam scaffold for tissue engineering applications. J Mater Sci Mater Med 2004; 15: 729-34.

Day R.M, Boccaccini A.R, Shurey S, Roether J.A, Forbes A, Hench L.L, Gabe S.M. Assessment of polyglycolic acid mesh and bioactive glass for soft-tissue engineering scaffolds. Biomaterials 2004; 25: 5857-66.

Douglas E.J, Fiegler H, Rowan A, Halford S, Bicknell D.C, Bodmer W, Tomlinson I.P, Carter N.P. Array comparative genomic hybridization analysis of colorectal cancer cell lines and primary carcinomas. Cancer Res. 2004 Jul 15;64(14):4817-25.

Duncan J. Pregnancy in chronic inflammatory bowel disease. Gastrointestinal Nursing 2004.

El-Bahrawy M, Poulsom R, Rowan A.J, Tomlinson I.T, Alison M.R. Characterization of the E-cadherin/catenin complex in colorectal carcinoma cell lines.

Int J Exp Pathol. 2004 Apr;85(2):65-74. Erratum in: Int J Exp Pathol. 2004 Jun;85(3):175.

Emmanuel A, Shand A, Kamm M.A. Erythromycin for the treatment of chronic intestinal pseudo-obstruction description of six cases with a positive response. Aliment Pharmacol Ther 2004;19:687-694.

Emmanuel A.V, Stern J, Treasure J, Forbes A, Kamm M.A. Anorexia nervosa in gastrointestinal practice. Eur J Gastroenterol Hepatol 2004; 16: 1135-42.

80 St Mark’s Annual Report 2004 Publications for 2004

Ferraris R, Senore C, Fracchia M, Sciallero S, Bonelli L, Atkin W.S, Segnan N. Predictive value of rectal bleeding for distal colonic neoplastic lesions in a screening population. Eur J Cancer. 2004; 40:245-52.

Fearnhead N.S, Wilding J.L, Winney B, Tonks S, Bartlett S, Bicknell D.C, Tomlinson I.P, Mortensen N.J, Bodmer W.F. Multiple rare variants in different genes account for multifactorial inherited susceptibility to colorectal adenomas.. Proc Natl Acad Sci U S A. 2004 Nov 9;101(45):15992-7.

Fraser C, Saunders B. Preventing postpolypectomy bleeding: obligatory and optional steps. Endoscopy. 2004 Oct; 36(10): 898-900.

Gallagher M.C, Shankar A, Groves C.J, Russell R.C.G, Phillips R.K.S. Pylorus-preserving pancreaticoduodenectomy for advanced duodenal disease in familial adenomatous polyposis. Br J Surgery 2004; 91: 1157-1164.

Goldhill D.R, McNarry A.F, Hadjianastassiou V.G, Tekkis P.P. The longer patients are in hospital before Intensive Care admission the higher their mortality. Intensive Care Med. 2004 Oct;30(10):1908-13. Epub 2004 Jul 23.

Hadjianastassiou V.G, Tekkis P.P, Poloniecki J.D, Gavalas M.C, Goldhill D.R. Surgical mortality score: risk management tool for auditing surgical performance. World J Surg. 2004 Feb;28(2):193-200. Epub 2004 Jan 8.

Halligan S, Taylor S, Burling D. Virtual colonoscopy. JAMA. 2004 Jul 28;292(4):432.

Harari D, Norton C, Lockwood L, Swift C. Treatment of constipation and faecal incontinence in stroke patients: randomised controlled trial. Stroke, 2004;35:2549-2555.

Hart A.L, Kamm M.A, Knight S.C, Stagg A.J. Quantitative and functional characteristics of intestinal-homing memory T cells: analysis of Crohn’s disease patients and healthy controls. Clin Exp Immunol 2004;135:137-145.

Hart A.L, Kamm M.A, Knight S.C, Stagg A.J. Prospective evaluation of intestinal homing memory T cells in ulcerative colitis. Inflamm Bowel Dis 2004;10:496-503.

Hart A.L, Lammers K, Brigidi P, Vitali B, Rizzello F, Gionchetti P, Campieri M, Kamm M.A, Knight S.C, Stagg A.J. Modulation of human dendritic cell phenotype and function by probiotic bacteria. Gut 2004;53:1602-9.

Henning Brodersen N, Sutton S, Goff S, Hodgson S.V, Thomas H.J.W. Anticipated reactions to genetic testing for hereditary non polyposis colon cancer (HNPCC) susceptibility. Clin Genet. 2004;66:437-44.

Hollington P, Mawdsley J, Lim W, Gabe S.M, Forbes A, Windsor A.J. An 11-year experience of enterocutaneous fistula. Br J Surg 2004; 91: 1646-1651.

Howarth K.M, Thirlwell C, Rowan A, Mandir N, Goodlad R.A, Gilkar A, Spencer-Dene B, Stamp G, Johnson V, Silver A, Yang H, Miller J.H, Ilyas M, Tomlinson I.P. Myh deficiency enhances intestinal tumorigenesis in multiple intestinal neoplasia (ApcMin/+) mice. Cancer Res. 2004 Dec 15;64(24):8876-81.

Jarrett M.E.D, Emmanuel A.V, Vaizey C.J, Kamm M.A. Behavioural therapy (biofeedback) for solitary rectal ulcer syndrome improves symptoms and mucosal blood flow. Gut 2004;53:368-370.

Jarrett M.E.D, Varma J.S, Duthie G.S, Kamm M.A. Sacral nerve stimulation for faecal incontinence in the United Kingdom. Brit J Surg 2004;91:755-761.

Jarrett M.E, Mowatt G, Glazener C.M.A, Fraser C, Nicholls R.J, Grant A.M, Kamm M. A Systematic review of sacral nerve stimulation for faecal incontinence and constipation Br J Surg. 2004 Dec;91:1559-69.

Karoui M, Cohen R, Nicholls J. Results of surgical removal of the pouch after failed restorative proctocolectomy. Dis Colon Rectum. 2004;47:869-75. Epub 2004 Apr 19.

Kemp Z, Thirlwell C, Sieber O, Silver A, Tomlinson I. An update on the genetics of colorectal cancer. Hum Mol Genet. 2004 Oct 1;13 Spec No 2:R177-85.

81 St Mark’s Annual Report 2004 Publications for 2004

Kruis W, Fric P, Pokrotnieks J, Lukas M, Fixa B, Kascak M, Kamm MA, Weismuller J, Beglinger C, Stolte M, Wolff C, Schulze J. Maintaining remission of ulcerative colitis with the probiotic E coli Nissle 1917 is as effective as with standard mesalamine. Gut 2004; 53:1617-23.

Latchford A, Silver A, Phillips R. (2004). Familial adenomatous polyposis associated desmoid disease. CME J Gastroenterology, Hepatology & Nutrition 6:22-27.

Lee J, Hargest R, Wasan H, Phillips R.K.S. In vitro model for liposome-mediated adenomatous polyposis coli gene transfer in a duodenal model. Dis Colon Rectum 2004; 47: 219-226.

Lee J, Hargest R, Wasan H and Phillips R.K.S. Liposome-mediated adenomatous polyposis coli gene therapy: A novel anti- adenoma strategy in multiple intestinal neoplasia mouse model. Dis Colon Rectum. 2004;47:2105-13.

Leff, D.R, Willis A, Menzies D. Dentures in a small-bowel stricture J R Soc Med. 2004;97:206-7.

Lieberman D.A, Atkin W.S. Balancing the ideal versus the practical considerations of colorectal cancer prevention and screening. Alimentary Pharmacology and Therapeutics. 2004;19, suppl1:71-6.

Lim W, Olschwang S, Keller J.J, Westerman A.M, Menko F.H, Boardman L.A, Scott R.J, Trimbath J, Giardiello F.M, Gruber S.B, Gille J.J, Offerhaus G.J, de Rooij F.W, Wilson J.H, Spigelman A.D, Phillips R.K, Houlston R.S. Relative frequency and morphology of cancers in STK11 mutation carriers. Gastroenterology. 2004;126:1788-94.

Lipton L.R, Johnson V, Cummings C, Fisher S, Risby P, Eftekhar Sadat A.T, Cranston T, Izatt L, Sasieni P, Hodgson S.V, Thomas H.J, Tomlinson I.P. Refining the Amsterdam Criteria and Bethesda Guidelines: testing algorithms for the prediction of mismatch repair mutation status in the familial cancer clinic. J Clin Oncol. 2004;22:4934-43.

McDonald P.J, Bona R ,Cohen C.R. Rectovaginal fistula after stapled haemorrhoidopexy. Colorectal Dis. 2004;6:64-5.

Man R. Nurse-led endoscopy for familial adenomatous polyposis. Gastrointestinal -4 (Nursing).

Matzel K.E, Kamm M.A, Stosser M, Baeten C.G.M.I, Chjristiansen J, Madoff R, Mellgren A, Rius J, Rosen H. Sacral spinal nerve stimulation for faecal incontinence: multicentre study. Lancet 2004; 363:1270-1276.

Mawdsley J.E, Gibson P, Forbes A, Gabe S.M. Per-oral image-guided insertion of a jejunostomy feeding tube. Clin Radiol 2004; 59: 951-3.

Mawdsley J, Kamm M.A. A case of Crohn’s disease with immune thrombocytopaenic purpura. Gastroenterology Today 2004;14:18-9.

Mimura T, Bateman A.C, Lee R.L, Johnson P.A, McDonald P.J, Talbot I.C, Kamm M.A, McDonald T.T, Pender S.L.F. Upregulation of collagen and tissue inhibitors of matrix metalloproteinase in colonic diverticular disease. Dis Col Rectum 2004;47:371-378.

Mimura T, Kaminishi M, Kamm M.A. Diagnostic evaluation of patients with faecal incontinence at a specialist institution. Digestive Surgery 2004;21:235-241.

Mimura T, Rizzello F, Helwig U, Poggioli G, Schreiber S, Talbot I.C, Nicholls R.J, Gionchetti P, Campieri M, Kamm M.A. Once daily, high dose probiotic therapy (VSL#3) for maintaining remission in recurrent or refractory pouchitis. Gut 2004;53:108-114.

Murray C.D, Emmanuel A.V. Ghrelin and Helicobacter pylori. Gut. 2004 Feb;53(2):315 (letter)

Murray C.D, Flynn J, Ratcliffe L, Jacyna M.R, Kamm M.A,Emmanuel A.V. Effect of acute physical and psychological stress on gut autonomic innervation in irritable bowel syndrome. Gastroenterology. 2004 Dec;127(6):1695-703

Nicholls R.J. Salvage surgery after restorative proctocolectomy. Acta Chir-lugosl. 2004;51(2):23-6.

Nicholls R.J. Sphincter repair: its present place. Acta Chir-lugosl. 2004;51(2):27-9.

82 St Mark’s Annual Report 2004 Publications for 2004

Nicholls T. Anorectal physiology testing techniques. Gastrointestinal Nursing 2004.

Norton C. 2004, “Bowel management in multiple sclerosis”. Gastrointestinal Nursing 2, 6: 31-35.

Norton C. Nurses, Bowel Continence, Stigma and Taboos. Journal of Wound Ostomy and Continence Nursing, 2004;31:85-94.

Norton C. Behavioral management of fecal incontinence in adults 2004. Gastroenterology; 126:S64-S70.

Norton C. Chevanayagam S, Wilson B.J, Ringel Y. A new perspective on biofeedback treatment in patients with fecal incontinence. Evidence based -63

O’Bichere A, Green C, Phillips R.S. Randomized cross-over trial of polyethylene glycol electrolyte solution and water for colostomy irrigation. Dis Colon Rectum. 2004;47:1506-9. Epub 2004 Jul 8.

Phillips R. Modern surgery for rectal cancer. Acta Chir-lugosi. 2004;51:9.

Rayner C.K, Hart A.L, Hayward C.M, Emmanuel A.V, Kamm M.A. Azathioprine dose escalation in inflammatory bowel disease. Aliment Pharmacol Ther 2004;20:65-71.

Renehan A, Atkin W, O’Dwyer S.T, Shalet S.M. The effect of cigarette smoking use and cessation on serum insulin-like growth factors. Br J Cancer. 2004;91:1525-31.

Rutter M, Forbes A. Colorectal cancer in inflammatory bowel disease in inflammatory bowel disease. Inflamm Bowel Dis Monitor 2004;6:2-7.

Rutter M.D, Saunders B.P, Schofield G, Forbes A, Price B.P, Talbot I.C. Pancolonic indigo carmine dye spraying for the detection of dysplasia in ulcerative colitis. Gut 2004; 53:256-60.

Rutter M.D, Saunders B.P, Wilkinson K.H, Kamm M.A, Williams C.B, Forbes A. Most dysplasia in ulcerative colitis is visible at colonoscopy. Gastrointest Endoscopy 2004; 60: 334-9.

Rutter M.D, Saunders B.P, Wilkinson K.H, Rumbles S, Schofield G, Kamm M.A, Williams C.B, Price A.B, Talbot I.C, Forbes A. Cancer surveillance in longstanding ulcerative colitis: endoscopic appearances help predict cancer risk. Gut 2004; 53: 1813-6.

Rutter M, Saunders B, Wilkinson K, Rumbles S, Schofield G, Kamm M, Williams C, Price A, Talbot I, Forbes A. Severity of inflammation is a risk factor for colorectal neoplasia in ulcerative colitis. Gastroenterology 2004; 126: 451-9.

Sands B.E, Anderson F.H, Bernstein C.N, Chey W, Feagan B.G, Fedorak R.N, Kamm M.A, Korzenik J.R, Lashner B.A, Onken J, Rachmilewitz D, Rutgeerts P, Wild G, Wolf D.C, Marsters P, Travers S, Blank M, van Deventer S.J. Randomised controlled trial of infliximab maintenance therapy for fistulizing Crohn’s disease (Accent II). NEJM 2004;350:876-85.

Saunders B.P, Brown G.J, Lemann M, Rutgeerts P. Balloon Dilation of Ileocolonic Strictures in Crohn’s Disease. Endoscopy. 2004;36:1001-1007.

Schofield G, Thapar, C and Vance, M. Capsule endoscopy and the development of a nurse-led service. Gastrointestinal Nursing 2004; 2: 25-29.

Senagore A.J, Warmuth A.J, Delaney C.P, Tekkis P.P, Fazio V.W. POSSUM, p-POSSUM, and Cr-POSSUM: implementation issues in a United States health care system for prediction of outcome for colon cancer resection. Dis Colon Rectum. 2004;47:1435-41. Epub 2004 Jul 15.OM,

Sieber O.M, Howarth K.M, Thirlwell C, Rowan A, Mandir N, Goodlad R.A, Gilkar A, Spencer-Dene B, Stamp G, Johnson V, Silver A, Miller J.H, Ilyas M, Tomlinson I.P.M. Myh deficiency enhances intestinal tumourigenesis in multiple intestinal neoplasia (Apc Min/+) mice. Cancer Res 2004; 64:8876-8881

Stagg AJ, Hart AL, Knight SC, Kamm, MA. Interactions between dendritic cells and bacteria in the regulation of intestinal immunity. Best Pract Res Clin Gastroenterol. 2004;18:255-70.

83 St Mark’s Annual Report 2004 Publications for 2004

Sturt N.J, Gallagher M.C, Bassett P, Philp C.R, Neale K.F, Tomlinson I.P.M, Silver A.R.J, Phillips R.K.S. Evidence for genetic predisposition to desmoid tumours in familial adenomatous polyposis (FAP) independent of the APC germline mutation. Gut 2004;53:1832-6.

Sturt N.J, Phillips R.K.S, Clark S. High-dose tamoxifen and sulindac as first-line treatment for desmoid tumors. Cancer. 2004;101:652

Suraweera N, Zampeli E, Rogers P, Atkin W, Forbes A, Harbord M, and Silver A. NCF1 (p47phox) and NCF1 pseudogenes are not associated with inflammatory bowel disease. Inflammatory Bowel Diseases 2004; 10:758-762.

Suzuki N, Saunders B.P, Brown G. Flat colorectal neoplasms: endoscopic detection, clinical relevance and management. Tech Coloproctol. 2004: 8 Suppl 2:S261-6

Suzuki N, Saunders B.P, Thomas-Gibson S, Akle C, Marshall M, Halligan S. Colorectal stenting for malignant and benign disease: outcomes in colorectal stenting. Dis Colon Rectum. 2004;47:1201-7.

Suzuki N, Talbot I.C, Saunders B.P. The prevalence of small, flat colorectal cancers in a western population. Colorectal Dis. 2004;6:15-20.

Suzuki N, Talbot I.C, Saunders B.P. The “frost sign”: an inadvertent minor complication of endoscopic mucosal resection. Endoscopy. 2004;36:835.

Taffinder N.J, Tan E, Webb G, McDonald P.J. Retrograde commercial colonic hydrotherapy. Colorectal Dis. 2004;6:258-60.

Taylor S.A, Halligan S, Burling D, Morley S, Bassett P, Atkin W, Bartram C. CT colonography: Effect of experience and training on reader performance. European Radiol. 2004;14:1025-33. Epub 2004 Feb 10.

Taylor S.A, Halligan S, Moore L, Saunders B.P, Gallagher M, Phillips R.K, Bartram C.I. Multidetector-row CT duodenography in familial adenomatous polyposis: a pilot study. Clin Radiol. 2004;59:939-45.

Tekkis P.P, Kinsman R, Thompson M.R, Stamatakis J.D. The Association of Coloproctology of Great Britain and Ireland study of large bowel obstruction caused by colorectal cancer. Ann Surg. 2004;240:76-81.

Tekkis P.P, Boella M.L, Rasheed S, Talbot I, McDonald P, Phillips R, Northover J.M. Evaluation of lymph node positivity in rectal cancer the St Mark’s Lymph Node Positivity model. Dis Colon Rectum 2004; 47:566-567

Tekkis P.P, McCulloch P, Poloniecki J.D, Prytherch D.R, Kessaris N, Steger A.C. Risk-adjusted prediction of operative mortality in oesophagogastric surgery with O-POSSUM. Br J Surg. 2004;91:288-95.

Tekkis P.P, Prytherch D.R, Kocher H.M, Senapati A, Polonieki J.D, Stamatakis J.D, Windsor A.C. Development of a dedicated risk-adjustment scoring system for colorectal surgery (colorectal POSSUM). Br J Surg. 2004;91:1174-82.

Thomas-Gibson S, Jawhari A, Atlan P, LeBrun A, Farthing M, Forbes A. Safe and efficacious prolonged use of an olive oil- based lipid emulsion (ClinOleic©) in chronic intestinal failure. Clin Nutrit 2004; 23: 697-703.

Ueno H, Jones A.M, Wilkinson K.H, Jass J.R, Talbot I.C. Histological categorisation of fibrotic cancer stroma in advanced rectal cancer. Gut 2004;53:581-6.

Ueno H, Price A.B, Wilkinson K.H, Jass J.R, Mochizuki H, Talbot I.C. A new prognostic staging system for rectal cancer. Ann Surg 2004;240:832-9.

Vaizey C.J, Norton C, Thornton M, Nicholls R.J, & Kamm M.A. Long-term results of repeat anterior anal sphincter repair. Dis Colon Rectum, 2004;47:858-863. Epub 2004 May 04.

Wardle J, McCaffery K, Atkin W, Nadel M. Socioeconomic differences in cancer screening participation: comparing cognitive and psychosocial explanations. Soc Sci Med 2004; 59:249-61.

84 St Mark’s Annual Report 2004 Publications for 2004

Windsor A, Braga M, Martindale R, Buenos R, Tepaske R, Kraehenbuehl L, Weimann A. Fit for surgery: an expert panel review on optmising patients prior to surgery, with a particular focus on nutrition. Surgeon. 2004;2:315-9.

Yehuda R, Golier J.A, Halligan S.L, Meaney M, Bierer L.M. Multidetector-row CT duodenography in familial adenomatous polyposis: a pilot study. Clin Radiol. 2004;59:939-45.

Zinicola R, Rutter M.D, Falasco G, Brooker J.C, Cennamo V, Contini S, Saunders B.P. Haemorrhagic radiation proctitis: endoscopic severity may be useful to guide therapy. Int J Colorectal Dis. 2004;19:294.

Abstracts

Fraser C, Swain D, Suzuki N, Saunders B.P. Endoscopic mucosal resection of large colorectal neoplasms. Gut 2004;53 A54

Fraser C, Swain D, Suzuki N, Saunders B.P. Endoscopic mucosal resection of large colorectal neoplasms. Gastrointest Endosc 2004;59. AB151

Suzuki N, Swain D, Schofield G, Thapar C, Saunders B.P. Injection solutions for EMR.. GUT 2004; 53, A53.

Suzuki N, Palmer N, Saunders B.P. Prevalence and characteristics of flat and depressed colorectal neoplasms in a western population: A prospective study by a Japanese trained endoscopist Gut. 2004; 53, A120

Suzuki N, Palmer N, Saunders B.P. Prevalence and characteristics of flat and depressed colorectal neoplasms in a western population: A prospective study by a Japanese trained endoscopist Gastrointest Endosc 2004, 59, AB9

Thomas-Gibson S, Swain D, Schofield G, Saunders B.P, Atkin W. Quality of performance at screening flexible sigmoidoscopy correlates with adenoma detection rates. Gut 2004, 53, A8.

Schofield G, Fraser C, Brown G, Thapar C, Saunders B. Do Nurse-Practitioners and physicians examine and report video-capsule endoscopy differently? Gut 2004, 53, A75

Brown G.J.E, Fraser C, Schofield G, Thapar C, Saunders B.P. Initial experience of video capsule endoscopy at a large UK referral centre. MON-E-12.Gut 2004, 53, A75

Brown G.J.E, Fraser C, Schofield G, Thapar C, Saunders B.P. Video capsule endoscopy in hereditary small intestinal Polyposis: The initial St Mark’s experience. Gut 2004, 53, A75

Smith J.J, Tekkis P.P, Heriot A.G, Tarroni D, Talbot I.C, Northover J.M. Retrorectal tumours: Tertiary unit experience & management. Dis Colon Rect 2004, 47:648

Thomas-Gibson S, Shah S.G, Swain D, Thapar C.J, Schofield G, Saunders B.P. Performance in Colonoscopy can be reliably scored in the first 8 minutes of insertion; Further evidence for a video assessment tool. Gut 2004, 53, A79

Fraser C, Thapar C, Schofield G, Palmer N, Swain D, Newton D, Saunders B. Propofol Anaesthesia in Polyposis syndromes: A useful adjunct for both therapeutic endoscopist and patient. Gut 2004, 53, A83.

Thomas-Gibson S, Swain D, Schofield G, Saunders B.P, Atkin W. Quality of performance at screening flexible sigmoidoscopy correlates with adenoma detection rates. Gut 2004, 53, A190.

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