摘要:

PURPOSE:Perinuclear antineutrophil cytoplasmic autoantibody is known to be a marker for ulcerative colitis, and anti‐Saccharomyces cerevisiaeMannan antibody is a serologic marker associated with Crohn's disease. The aim of this study was to assess the value of detecting perinuclear antineutrophil cytoplasmic autoantibody and/or anti‐Saccharomyces cerevisiaeMannan antibody for the diagnosis of ulcerative colitis, Crohn's disease, Behçet's colitis, and tuberculous colitis.METHODS:Serum samples were obtained from 85 patients with Crohn's disease, 77 with ulcerative colitis, 36 with Behçet's colitis, 14 with tuberculous colitis, 20 healthy controls, and 21 first‐degree relatives of patients with Crohn's disease. Determination of perinuclear antineutrophil cytoplasmic autoantibody and anti‐Saccharomyces cerevisiaeMannan antibody was performed with the standardized indirect immunofluorescence technique and an enzyme‐linked immunosorbent assay, respectively.RESULTS:A relatively high percentage of patients with Crohn's disease (49.4 percent), relatives of Crohn's disease patients (61.9 percent), and patients with Behçet's disease (41.7 percent) tested seropositive for anti‐Saccharomyces cerevisiaeMannan antibody compared with normal controls (10 percent). In cases of ulcerative colitis, 44.2 percent tested seropositive for perinuclear antineutrophil cytoplasmic autoantibody, whereas the controls showed 0 percent positivity. The combination of a positive anti‐Saccharomyces cerevisiaeMannan antibody test and a negative perinuclear antineutrophil cytoplasmic autoantibody yielded a sensitivity and specificity of 48.2 and 87 percent, respectively, for Crohn's disease. The combination of a positive perinuclear antineutrophil cytoplasmic autoantibody test and a negative anti‐Saccharomyces cerevisiaeMannan antibody test yielded a sensitivity and specificity of 36.4 and 97.6 percent, respectively, for ulcerative colitis.CONCLUSION:Anti‐Saccharomyces cerevisiaeMannan antibody may be associated with Crohn's disease and Behçet's disease and perinuclear antineutrophil cytoplasmic autoantibody with ulcerative colitis. A combination of both tests may aid the differential diagnosis of inflammatory bowel disease.

ISSN:0012-3706    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

PURPOSE:This study was designed to compare metabolic and functional results after laparoscopic and open colorectal resection.METHODS:Seventy‐nine patients were randomly assigned to laparoscopic (n = 40) or open (n = 39) colorectal resection. Before and after operation, the following parameters were determined: respiratory function (spirography and blood gas); serum level of cortisol, lactate, and C‐reactive protein; total lymphocyte count; and CD4 and CD8 lymphocyte subsets. Intraoperative core temperature was measured by a bladder probe. Postoperative pain and analgesic consumption were also monitored.RESULTS:Mild operative hypothermia, a trend to postoperative reduction of total lymphocyte count, and significant impairment of respiratory function early after surgery were found in both groups. Laparoscopy showed a higher CD4/CD8 ratio (P= 0.01) on postoperative Day 1 and a faster return of C‐reactive protein to preoperative values (P= 0.01) than in the open colorectal resection group. Morphine consumption in the first 48 hours after surgery was lower in the laparoscopic than in the open group (P= 0.02).CONCLUSIONS:Laparoscopy was associated with a less pronounced immunosuppression and inflammatory response and a lower consumption of analgesic drugs than open surgery. Moreover, our data did not show any additional detrimental effect of laparoscopy on either operative core temperature or early postoperative respiratory function.

ISSN:0012-3706    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

PURPOSE:The only possibility of a surgical cure in patients with locally advanced primary or recurrent rectal cancer would be an extended resection such as pelvic exenteration and sacral resection. The aim of this study was to evaluate the safety, tolerability, and survival benefits of these procedures.METHODS:Between 1988 and 1999, 64 patients with locally advanced primary or recurrent rectal cancer underwent abdominoperineal resection, with sacral resection in 9 patients, anterior pelvic exenteration in 8 patients, total pelvic exenteration in 27 patients, and total pelvic exenteration with sacral resection in 20 patients.RESULTS:Rates of morbidity, reoperation, and mortality were 50, 4.5, and 0 percent in 22 patients with primary cancer, and 60, 2.4, and 2.4 percent in 42 patients with recurrent disease, respectively. Major complications, such as sepsis, intra‐abdominal abscess, and enteric fistula caused one hospital death and reoperation in two patients. In 21 patients who underwent curative resection for primary cancer, the overall five‐year survival rates were 74.1 percent for Dukes B and 47.4 percent for Dukes C, although the difference was not statistically significant. Thirty patients with recurrent cancer who underwent curative resection had significantly improved survival, with a five‐year survival rate of 22.9 percent, compared with 12 patients who underwent palliative resection, resulting in a survival rate of 0 percent (P= 0.0065).CONCLUSIONS:Pelvic exenteration and sacral resection for primary or recurrent rectal cancer are tolerable procedures with a low mortality rate. Although they provide a survival benefit if curative resection is possible, the associated morbidity remains high and should be followed up closely.

ISSN:0012-3706    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

INTRODUCTION:After nonoperative decompression of acute sigmoid volvulus, definitive surgery is necessary because of the high risk of recurrence. However, the optimal surgical technique for this purpose has not been determined.METHODS:We studied 106 consecutive patients (mean age, 60.9 (range, 26‐93) years) who underwent emergency resection for acute sigmoid volvulus between 1992 and 2000. No patient underwent preoperative decompression techniques, had the bowel prepared, or received on‐table lavage.RESULTS:Depending on the patient's condition and the surgeon's preference, either primary anastomosis (57 cases) or Hartmann's procedure (49 cases) was performed. The overall mortality rate was 6.6 percent (7/106). The presence of a gangrenous bowel increased the mortality rate to 11 percent. Wound infections were documented in 8 and 12 cases, intra‐abdominal abscess occurred in 1 and 7 cases, and subsequent surgery was required in 6 and 5 patients who underwent primary anastomosis and Hartmann's procedure, respectively. There were four cases of anastomotic dehiscence (7 percent) and two cases of stoma revisions (4 percent). The median length of stay was eight days for both those who underwent primary anastomosis (range, 3‐27 days) and those who underwent Hartmann's procedure (range, 5‐29 days).CONCLUSION:Emergent primary resection of the acute sigmoid volvulus with or without anastomosis is adequate treatment for this emergent surgical problem.

ISSN:0012-3706    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

PURPOSE:Both topical diltiazem, a calcium channel blocker, and glyceryl trinitrate, a nitric oxide donor, lower anal pressure and heal two‐thirds of chronic anal fissures. This study evaluated the efficacy of diltiazem for fissures that failed to heal with glyceryl trinitrate.METHODS:Consecutive patients with persistent chronic fissures despite treatment with 0.2 percent glyceryl trinitrate ointment underwent anal manometry before and for 1 hour after application of 700 mg of 2 percent diltiazem gel to the distal anal canal. Patients applied diltiazem twice daily for eight weeks or until the fissure had healed. At fortnightly review, fissure healing was assessed, and side effects were noted. Patients scored symptoms of pain, bleeding, and irritation using linear visual analog scales at the initial and follow‐up visits.RESULTS:In 39 patients (13 males; median age, 42 (range, 20‐ 80) years), topical 2 percent diltiazem gel lowered anal resting pressure by 20 percent from a median of 93 to 74 cm H2O (P< 0.0001, Wilcoxon), and fissures healed in 19 (49 percent) within 8 weeks. Before diltiazem, 27 patients (69 percent) had used a complete course of glyceryl trinitrate (0.5 g twice daily for 8 weeks), and 12 (44 percent) of these healed with diltiazem. The remaining 12 patients had discontinued glyceryl trinitrate prematurely or used less because of headaches; 7 (58 percent) of these healed with diltiazem, and 5 (42 percent) did not. Side effects occurred in four patients (10 percent): three reported perianal itching but continued with treatment, and one developed headaches, drowsiness, and mood swings six weeks into treatment and stopped diltiazem at that time.CONCLUSION:Topical 2 percent diltiazem is effective treatment for glyceryl trinitrate‐resistant chronic anal fissures. Side effects, mainly perianal itching, may occur in 10 percent of patients but are generally tolerated.

ISSN:0012-3706    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

PURPOSE:Posthemorrhoidectomy secondary hemorrhage is a rare but serious complication after hemorrhoidectomy. The determination of risk factors for this complication may provide information to improve outcome. A prospective study was conducted to determine the risk factors associated with posthemorrhoidectomy secondary hemorrhage.METHODS:We studied 4,880 patients who underwent an elective closed hemorrhoidectomy by 9 proctologists in a single institution between January 1994 and July 1996. The variables analyzed included age, gender, surgeon, surgeon's seniority, suture material, aseptic preparation, and use of antibiotics. The logistic regression model was used to assess the independent association of variables with posthemorrhoidectomy secondary hemorrhage.RESULTS:Among the 4,880 patients, 45 (0.9 percent) developed posthemorrhoidectomy secondary hemorrhage. The mean interval from operation to the onset of secondary hemorrhage was 8.8 (range, 5‐19) days. Multivariate analysis revealed that patient's gender and individual surgeons were both independently associated with risk of hemorrhage. Male patients were more likely than females to develop posthemorrhoidectomy secondary hemorrhage (relative risk, 2.1; 95 percent confidence interval, 1.1‐4.1;P= 0.021). The posthemorrhoidectomy secondary hemorrhage rates among individual surgeons ranged from 0.2 to 2.4 percent (P= 0.003).CONCLUSION:Our data suggest that male patients are more likely to develop posthemorrhoidectomy secondary hemorrhage than female patients and that intersurgeon variability is highly correlated with this risk.

ISSN:0012-3706    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

PURPOSE:The aim of this study was to compare the lengths of proximally based and distally based gluteus maximus flaps created as for anal sphincter reconstruction in soft human cadavers.METHODS:Twelve soft cadavers were used in this prospective, randomized, controlled study. In each cadaver, a proximally based flap of the gluteus maximus muscle was performed on one side and a distally based flap on the other. All flaps were carefully dissected with neurovascular preservation by one surgeon. After the dissected flap was placed across the anus, the length of the flap that projected beyond the anus was measured. The differences between such lengths of both types of flaps were assessed by pairedt‐test.RESULTS:The average lengths of the parts that projected beyond the anus for proximally based and distally based flaps were 8.08 and 4.50 (standard deviation, 0.51 and 0.79) cm, respectively. The average difference was 3.58 (standard deviation, 0.51) cm, which was statistically significant (P< 0.001).CONCLUSION:Results showed that proximally based flaps were significantly longer than distally based flaps and that transposition and wrapping around the anus with proximally based flaps were always easily performed without tension. These findings support the use of unilateral proximally based gluteus maximus flaps instead of unilateral or bilateral distally based flaps in patients with anal incontinence. The location of the neurovascular pedicle of the gluteus maximus was consistent at 1 cm superior and lateral to ischial tuberosity. Knowledge of this landmark allows quick and safe dissection of the gluteus maximus flap.

ISSN:0012-3706    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

INTRODUCTION:Bladder catheterization is routine during pelvic colorectal surgery, and transurethral catheterization is the norm. However, in gynecologic surgery suprapubic catheters are commonly used and are reported to be superior to urethral catheters.METHODS:A review of published studies comparing urethral and suprapubic catheters in patients undergoing colorectal surgery is presented. Level one evidence from randomized, controlled trials is sparse. Five randomized, controlled trials, most with small numbers, have been published comparing urinary tract infection, urinary retention, duration of catheterization, pain and discomfort, and patient preference.RESULTS:Urinary tract infections were increased in the urethral group in three of the five articles. There were no differences between the two techniques with respect to urinary retention, but all studies commented on the ease with which this complication could be assessed and managed in the suprapubic group. There did not seem to be any difference in duration of catheterization. The suprapubic group experienced less pain and discomfort than the urethral group, and the suprapubic catheter was preferred by those patients who had experienced both.CONCLUSION:The results reported favor suprapubic over urethral catheterization in that urinary tract infections are reduced, particularly in females, and the ability to attempt normal voiding is facilitated, particularly in males.

ISSN:0012-3706    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

&NA;Massive presacral hemorrhage following rectal mobilization for benign or malignant conditions is an uncommon complication but one that is alarming and often difficult to treat. A variety of methods of hemostasis have been described, all with mixed degrees of success. We have used a segment of free rectus abdominis muscle to provide tamponade to the presacral bleeding point in two patients with severe bleeding. The technique was successful and may be considered in cases of problematic hemorrhage when other techniques have failed or inapplicable.

ISSN:0012-3706    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

&NA;A case of adenocarcinoma complicating the outflow tract remnant of a previously excised ileoanal pouch is described. The pouch had failed because of unsuspected Crohn's disease. This is the first reported case of malignancy complicating a pouch that had been constructed in a patient with Crohn's disease. More importantly, it demonstrates that carcinoma may develop in the outflow tract remnant leftin situafter simple pouch excision. This case suggests that patients who require pouch excision may benefit from excision of the outflow tract.

ISSN:0012-3706    

出版商:OVID    

年代:2002

数据来源: OVID