摘要:

&NA;A retrospective review of patients with Crohn's disease treated at our institution from 1973 to 1986 revealed 12 patients operated on for rectovaginal fistula. Disease involved the large intestine in 10 patients. Primary fistula repair was performed in four patients and four others had staged repair with preliminary fecal diversion. Four patients with severe colonic and anorectal disease had proctocolectomy performed as the first procedure. Of eight patients who underwent fistula repair, complete healing occurred in six. One patient has a persistent fistula, which is minimally symptomatic, and the other required proctocolectomy after three unsuccessful repairs. Success of operation correlated with quiescent intestinal disease and absence of rectal involvement. In selected patients with symptomatic fistulas, surgical repair is indicated and healing can be anticipated.

ISSN:0012-3706    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;In a retrospective study, the procedure and follow‐up of 266 patients with 345 stomas on the small and large bowel were reviewed to reveal possible etiologic factors for stomal complications. The overall complication rate for creating a stoma was 36 percent. No differences in overall complication rate were encountered when comparing acute and elective management; however, high output stomas and necrosis were encountered more often in the acutely managed group. Preoperative contamination was followed more often by stomal retraction. Septic events, however, occurred less frequently than in the noncontaminated procedures. Adequate supply with antibiotics might account for the lack of difference in these complications between the two groups. Antibiotics might not have prevented low‐grade infections giving rise to retractive reaction. The influence of body weight was evaluated by the Quetelait index. It was demonstrated that moderate obesity had no significant influence on the outcome of the procedure. Adipose patients had a statistically significant larger number of necroses. This may be due to the relatively short and fatty mesenterium causing a compromised circulation. The outcome of stoma surgery was greatly influenced by bowel quality. Crohn's disease and bowel ischemia were encountered in 50 percent of stoma complications. In ischemic disease, significantly more necrosis was found. Retration of the stoma occurred more often in Crohn's disease. Chronic ulcerative colitis did not have a higher complication rate.

ISSN:0012-3706    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;Animal studies have demonstrated the value of the proteolytic enzyme inhibitor, aprotinin, in reducing collagen breakdown and improving the healing of experimental colonic anastomoses. A double‐blind, multicenter, prospective trial has evaluated the use of aprotinin in the prevention of anastomic leakage in patients. Two hundred sixteen patients undergoing colonic resection and anastomosis were studied. Patients were randomized to receive either aprotinin or placebo intravenously, peroperatively, and for the first three postoperative days. Anastomotic integrity was assessed clinically and by Hypaque®enema on the tenth postoperative day. Although the use of aprotinin was not associated with a significant overall decrease in anastomotic leakage rates, in 95 patients undergoing anterior resection, leakage rates in those receiving aprotinin (clinical 10.8 percent; radiologic 32.4 percent) were lower than in those receiving placebo (17.2 percent and 43.1 percent, respectively). An apparent adverse association was noted, however, in patients undergoing left hemicolectomy or sigmoid colectomy who received aprotinin.

ISSN:0012-3706    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;Eighty‐five patients treated surgically for rectal cancer have been followed up by conventional clinical examination, sigmoidoscopy, and endosonography. Local recurrence was diagnosed in 22 patients. Nineteen of these had either sigmoidoscopic or digital evidence of recurrence and three were diagnosed solely by endosonography. In all cases endosonography gave additional information on which to base management decisions. Routine use of endosonography should allow the detection of early recurrence in a larger number of patients

ISSN:0012-3706    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;A case of African histoplasmosis primarily affecting the large bowel—a very unusual manifestation—is reported. In the absence of classical clinical features, pathognomonic of large bowel histoplasmosis, the macroscopic appearance at surgery was confused with large‐bowel cancer. The diagnosis was, therefore, retrospective and based on demonstration of large yeast cells ofHistoplasma capsulatumvar.duboisiiin tissue sections of the lesions.

ISSN:0012-3706    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;A case of nonHodgkin's lymphoma of the perianal region in a patient with AIDS is reported. The unusual features of AIDS‐related lymphoma and the possible role of immunodeficiency increasing susceptibility to oncogenic viruses are discussed.

ISSN:0012-3706    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;A 14‐year‐old girl who had colonic bleeding caused by colonic varices is described. Upper gastrointestinal endoscopy, radiography of the small and large bowel, and vascular studies of the superior and inferior mesenteric arteries and the portal vein were all reported to be normal. Submucosal varices, however, were identified colonoscopically in relation to the hepatic flexure and the sigmoid colon. Dilatation of subserosal right colonic vascular channels was identified at operation. Right hemicolectomy was performed and there has been no further bleeding. No obvious mesenteric arteriovenous communications were identified histologically.

ISSN:0012-3706    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;Three patients with complete colonic obstruction treated by primary resection and anastomosis with intraoperative colon tube decompression and bowel lumen sterilization without a protective colostomy are presented. An improved colonic decompressor was used. It is postulated that this procedure is an alternative safe technique in patients with colonic obstruction in whom an end‐colostomy, mucous fistula, or Hartmann pouch would be necessary.

ISSN:0012-3706    

出版商:OVID    

年代:1989

数据来源: OVID

ISSN:0012-3706    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;A simple device, applied to a conventional stomal appliance, prevents loop colostomy prolapse.

ISSN:0012-3706    

出版商:OVID    

年代:1989

数据来源: OVID