摘要:

PURPOSE:Patients in whom enterolysis is performed are at high risk for recurrence of adhesions and for injury during adhesiolysis. Therefore, the aim of this study was to assess the safety of sodium hyaluronate‐based bioresorbable membrane (Seprafilm®) after myotomy and enterotomy.METHODS:A total of 60 rabbits underwent laparotomy with equal distribution to one of three groups: creation of either three repaired, or three unrepaired myotomies, or three repaired enterotomies. Thus, a total of 180 defects were created in the same anatomic positions. One‐half of the animals in each group had the surface of the myotomies or enterotomies covered by Seprafilm®. Fourteen days later, after complete absorption of Seprafilm®, the presence of intra‐abdominal abscess, adhesions, and the integrity of the suture line were evaluated by a surgeon blinded to the use of Seprafilm®and by a standard radiographic isobaric contrast study. Statistical analysis was done by use of Fisher's exact test; significance was set atP<0.05.RESULTS:The incidence of adhesions in the repaired myotomy group were 2 (6.6 percent) and 9 (30 percent) in the Seprafilm®and control (nonSeprafilm®) groups, respectively (P<0.05); in the unrepaired myotomy group, 2 (6.6 percent) and 10 (33 percent) in the Seprafilm®and control groups, respectively (P<0.05); and in the enterotomy group, 28 (94 percent) and 29 (97 percent) in the Seprafilm®and control groups, respectively (P= not significant). A single phlegmon occurred in the myotomy group at a Seprafilm®site (1.6 (1/60)vs.0 percent,P= not significant). There were no leaks in this group. In the enterotomy group, the incidence of phlegmons was 33 percent (10/30) in the Seprafilm®group, whereas it was 27 percent (8/30) in the nonSeprafilm®group (P= not significant). The incidence of leaks was 6.6 (2/30) and 10 percent (3/30) in the Seprafilm®and nonSeprafilm®group, respectively (P= not significant).CONCLUSION:The use of Seprafilm®at the sites of myotomies significantly reduced the incidence of adhesions. Effectiveness at the enterotomy site may have been attenuated by a greater inflammatory response. Importantly, Seprafilm® did not increase septic mortality in any group.

ISSN:0012-3706    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

PURPOSE:This study was designed to assess the results of the Delorme procedure in the treatment of patients with rectal outlet obstruction.METHODS:A descriptive retrospective study from October 1989 to October 1997 was undertaken. Thirty‐four patients with an abnormal defecography documenting rectal outlet obstruction caused by internal rectal prolapse or a combination of internal rectal prolapse and rectocele were included in the study.RESULTS:Thirty‐four patients (33 females) ages 35 to 82 (mean, 61.4) years were followed up for the duration of the study (mean follow‐up, 43 months). Twenty‐six patients (76.4 percent) reported a good to excellent overall result after the Delorme procedure. Eight patients (23.6 percent) reported fair to poor results. Symptomatic improvement was observed in 89.7 percent for patients who had incomplete evacuation, and in 88.5 percent of patients who had constipation. There was improvement in 78.6 percent of patients with bleedingper rectum, in 92.9 percent of patients with straining, and in 82.4 percent of patients with the need to manually assist in defecation by pushing in the perineum or vagina. Discontinuation of laxative use after the procedure was reported by 66.7 percent of patients. Improvement in the patients with some degree of incontinence was seen in 33.3 percent. Twelve patients (35.3 percent) experienced one or more complications. The procedure was performed in an outpatient setting in 71 percent of the patients.CONCLUSIONS:The Delorme procedure for the treatment of rectal outlet obstruction can be done with minimal morbidity, short hospital stay often in an outpatient setting, with good functional results, and with an overall patient satisfaction above 75 percent.

ISSN:0012-3706    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

PURPOSE:Transrectal ultrasound is the most accurate means of assessing the degree of invasion for rectal neoplasms. A learning curve for performing and interpreting these studies exists, but it is unknown how long or steep it is. We reviewed our initial results with transrectal ultrasound to determine our accuracy and to define the learning curve.METHODS:All patients undergoing transrectal ultrasound during our initial 30 months of experience were included. Each patient was staged with transrectal ultrasound and, after resection, the histopathologic stage was compared with transrectal ultrasound staging. The accuracy of transrectal ultrasound was calculated at intervals as experience was gained.RESULTS:A total of 42 examinations were performed on 41 neoplasms in 41 patients. Comparison between transrectal ultrasound and the pathologic stage could be made in 36 studies. Overall accuracy of degree of wall invasion was 78 percent. Overstaging occurred with eight neoplasms, and one lesion was understaged. Accuracy of transrectal ultrasound staging improved with time: 58 percent of the initial 12 studies were staged correctly compared with 87.5 percent accuracy in the remaining 24 examinations (P=0.048).CONCLUSION:A definite learning curve was apparent. We conclude that transrectal ultrasound is a relatively simple procedure to learn and, once a moderate degree of experience is gained, should be routinely incorporated into the evaluation of rectal neoplasms.

ISSN:0012-3706    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

PURPOSE:Isolated injuries of the internal anal sphincter can cause fecal incontinence. With the advent of ultrasound, which accurately delineates the anatomy of the anal sphincters, internal sphincter injuries can be diagnosed more precisely. The purpose of this study was to evaluate the outcome of direct repair of isolated internal anal sphincter defects.METHODS:Eight patients (6 males; median age, 37 years) with clinically and sonographically proved internal anal sphincter defects were the subject of this study. Patients had different degrees of incontinence that failed to respond to medical treatment. All patients had their sphincters repaired by direct apposition using coated Vicryl® 2‐0 stitches. A strict postoperative regime that avoided stretch of the sphincter for one month was adopted.RESULTS:At a median follow‐up period of 15 months, continence improved in all patients, and two achieved full continence. None of the patients wore pads. Mean continence score improved significantly from 4 to 12 and 11 at 6 and 12 postoperative months, respectively (P<0.0001, pairedt‐test).CONCLUSION:Despite the limited number of patients and the short follow‐up, the preliminary results of repair of isolated internal sphincter defects are satisfactory.

ISSN:0012-3706    

出版商:OVID    

年代:2000

数据来源: OVID

ISSN:0012-3706    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

PURPOSE:Enteroceles are in part difficult to detect but a frequent finding in pelvic floor disorders. The aim of this study was to evaluate magnetic resonance colpocystorectography in the diagnosis of enteroceles.METHODS:In this prospective study 11 volunteers and 55 patients with pelvic floor descent were examined. In addition to magnetic resonance colpocystorectography, a dynamic cystoproctography was performed on 34 patients. Opacification of organs was used. An enterocele was assessed in relationship to the pubococcygeal reference line (magnetic resonance colpocystorectography) or the width of the rectovaginal space (dynamic cystoproctography). A clinical gynecologic examination served as reference.RESULTS:The clinical examination diagnosed an enterocele in 43, magnetic resonance colpocystorectography in 49, and dynamic cystoproctography in 14 cases. Magnetic resonance colpocystorectography further subdivided the enteroceles according to their contents (mesenteric fat or fluid, 12; small bowel, 32, large bowel, 3; and rectosigmoidocele, 2). Magnetic resonance colpocystorectography proved statistically significantly superior to dynamic cystoproctography (15 cases) and the reference. Sensitivity and specificity of magnetic resonance colpocystorectography were 100 percent each. It was able to reveal clinically missed enteroceles as being peritoneoceles associated with a rectocele or a uterovaginal prolapse (10 cases).CONCLUSION:Magnetic resonance colpocystorectography is a promising method for diagnosis of enteroceles, because hernial canal, sac, and contents are reliably identified.

ISSN:0012-3706    

出版商:OVID    

年代:2000

数据来源: OVID

ISSN:0012-3706    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

PURPOSE:Assessment of inflammation within the ileal pouch to establish a diagnosis of “pouchitis” requires both pouch endoscopy and biopsy because there can be a poor correlation between macroscopic and histologic assessments of inflammation. A simplified diagnostic test would be of clinical advantage. Calprotectin is a stable myelomonocytic protein, measurable in feces. It quantitatively relates to inflammation within the gastrointestinal tract. This study was designed to compare single and 24‐hour stool measurements of calprotectin in patients with and without evidence of ileal pouch inflammation with endoscopic, histologic, and immunohistochemical indices.METHODS:Twenty‐four‐hour stool collections were made in ileal pouch patients, 9 with and 15 without (7 with ulcerative colitis and 8 with familial polyposis coli) evidence of pouch inflammation. First‐morning stool concentration and total 24‐hour calprotectin were quantified by use of a single step enzyme‐linked immunosorbent assay. Biopsies from the reservoir were taken for conventional histology and scoring of intraepithelial neutrophil infiltrate. Cells positive for CD3, CD45RO, CD14, and CD15 within the lamina propria were quantified by use of immunohistochemistry.RESULTS:The mean first‐morning stool calprotectin concentration correlated with the 24‐hour level (r=0.91;P=<0.0001). The median single‐stool calprotectin concentrations were 39 mg/l, 4 mg/l, and 8.5 mg/l (normal range, 0.2‐10 mg/l) in patients with inflamed, noninflamed ulcerative colitis, and familial adenomatous polyposis, respectively. All nine patients with endoscopic and histologic evidence of pouch inflammation had raised stool calprotectin. Two of 15 patients without evidence of pouch inflammation had abnormal stool calprotectin. Single‐stool calprotectin concentration correlated with the percentage of mature granulocytes (CD15;r=0.46;P=0.04) and activated macrophages (CD14;r=0.65;P=0.006), but not memory T cells (CD45RO;r=−0.05;P=0.4) within the lamina propria.CONCLUSION:Single first‐morning stool calprotectin levels provide a quantitative measure of pouch inflammation, which may be helpful in the diagnosis and assessment of pouchitis.

ISSN:0012-3706    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

PURPOSE:Because the status of the inherent drug‐resistance of colorectal cancers remains obscure, human colorectal cancers with no neoadjuvant therapy were retrospectively investigated regarding the expression of three drug‐resistant proteins: metallothionein, glutathione S‐transferase‐&pgr;, and P‐glycoprotein.METHODS:Paraffin‐embedded tissues of 130 colorectal cancers (Dukes A, 20; B, 49; C, 41; D, 20) obtained by surgical resections from 1982 to 1989 were used. The three proteins were immunostained by the streptavidin‐biotin complex method. The immunostaining was judged to be positive if more than 5 percent of cells showed positive staining by use of cell analysis system. The data were compared with clinicopathologic features (Dukes A‐D) and patients' prognosis (Dukes A‐C).RESULTS:Metallothionein, glutathione S‐transferase‐&pgr;, and P‐glycoprotein were positively expressed in 91 (70 percent), 30 (23 percent), and 98 (75 percent), respectively. A total of 120 (86 percent) expressed at least one drug‐resistant protein. No intergroup differences were observed between positive and negative expressions of the proteins and their clinicopathologic features except tumor location. Rectal cancers positively expressed P‐glycoprotein and three proteins more frequently. Twenty‐six (20 percent), 65 (50 percent), and 21 (16 percent) cancers positively expressed one, two, and three proteins, respectively. The disease‐free survival rates of patients with Dukes A through C cancer with positive staining for one, two, and three proteins were 100, 94, and 83 percent (at 1 year); 100, 72, and 51 percent (at 3 years); and 94, 66, and 38 percent (at 5 years), respectively (Kaplan‐Meier with log‐rank test;P= 0.016). In the multivariate Cox analysis, age, Dukes stage, tumor size, and glutathione S‐transferase‐&pgr; were independent prognostic factors.CONCLUSIONS:The patients with concurrent expression of drug‐resistant proteins in their cancers had worse prognoses. Examining drug‐resistant proteins in colorectal cancers may be useful in selecting adjuvant chemotherapy and in predicting prognosis more accurately.

ISSN:0012-3706    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

PURPOSE:The aim of this study was to determine how extensive resection affects operative morbidity, mortality, and long‐term survival in elderly patients with colorectal cancer.METHODS:A total of 119 patients 80 years of age or older were given a diagnosis of colorectal carcinoma at our hospital between 1985 and 1997. Eleven patients who did not undergo surgery were excluded. The remaining 108 patients underwent laparotomy and were reviewed. Serum levels of interleukin‐6 were measured perioperatively in 22 patients to assess the degree of operative stress.RESULTS:Potentially curative resection was performed in 64 (88.9 percent) of the 72 patients in the active performance status group and 13 (36.1 percent) of the 36 patients in the sedentary performance status group (P<0.001). The inhospital mortality rate was 8.3 percent in group the active performance status group and 38 percent in the sedentary performance status group (P=0.007). Patients in the sedentary performance status group and those who underwent emergency operations had higher levels of IL‐6 than patients in the active performance status group or those who underwent elective operations.CONCLUSIONS:Preoperative performance status, operative curability, and tumor stage have a significant impact on outcome in patients with colorectal cancer who are 80 years of age or older. Knowledge of early postoperative response of IL‐6 is useful in predicting postoperative mortality and morbidity in this subgroup of patients.

ISSN:0012-3706    

出版商:OVID    

年代:2000

数据来源: OVID