摘要:

PURPOSE:There is still considerable debate whether internal intussusception represents a functional disorder. We have reviewed our results in an effort to define its symptomatology and to assess defecography.METHODS:Rectopexy has been performed for internal intussusception in 37 patients. Eighteen had solitary rectal ulcer syndrome (SRUS), and 31 had anterior rectal wall prolapse. Defecography demonstrated anterior wall prolapse in 13, circular prolapse in 21, and no disorders in 3 patients. Pelvic floor function was normal. Follow‐up varied from one to nine years.RESULTS:Twenty‐six patients became asymptomatic. Anterior wall prolapses could not be palpated anymore. All SRUS lesions healed. Patients with SRUS (P<0.001) or circular prolapse (P<0.001) became significantly more asymptomatic. Results in patients with anterior rectal wall prolapse were significantly worse (P<0.001).CONCLUSIONS:Internal intussusception is a distinct functional rectal disorder. Its symptomatology and findings during physical examination are aspecific. Characteristic defecographic features and presence of SRUS are indications for surgery, provided pelvic floor function during straining is normal.

ISSN:0012-3706    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

PURPOSE:Surgical treatment of ileosigmoid fistulas in Crohn's disease remains controversial and can be radical (resection of both segments) or conservative (ileal resection with suture or wedge resection of the sigmoid). At our institution, the sigmoid defect is sutured if the sigmoid is not affected by primary Crohn's disease or by important stricture; otherwise, the sigmoid is resected. We reviewed our experience to evaluate our results with this procedure.METHODS:Thirty patients with ileosigmoid fistulas underwent operation. Among them, 15 had a preoperative colonoscopy, whereas others had no Endoscopic work‐up. In nine patients, the sigmoid was thought to be affected by Crohn's disease (n = 7) or stricture (n = 2) and was resected. In 21 patients, the sigmoid was thought to be affected by proximity, and a simple suture (n = 15) or wedge resection (n = 6) was performed. Eleven patients had a temporary stoma (37 percent). One had coloproctectomy.RESULTS:One patient died postoperatively. One patient had postoperative sigmoidocutaneous fistula after conservative treatment. Histology of the sigmoid specimen showed Crohn's disease in 8 patients (27 percent), including 5 of 9 resected specimens, and 3 of 21 conservative procedures. All patients with Crohn's misdiagnosis did not have preoperative colonoscopy. Nine of 11 stomas were closed in a median delay of four months. With a median delay of nine years, four patients have again undergone surgery for recurrent colonic Crohn's disease, all of whom underwent surgery initially without preoperative colonoscopy.CONCLUSION:Preoperative Endoscopic assessment of the colon is a reliable guide to use when choosing between sigmoid resection or a conservative approach and can result in reduced morbidity and improved long‐term results.

ISSN:0012-3706    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

PURPOSE:This analysis was undertaken to assess whole abdomen radiation therapy and concurrent 5‐fluorouracil for toxicity and patterns of failure in high‐risk colon cancer patients after curative surgical resection.METHODS:Eighteen patients were treated adjuvantly after curative resection. Four patients (22 percent) had Stage B and 14 (78 percent) had Stage C disease. Histology was poorly differentiated in 4 (22 percent) and moderately differentiated in 14 (78 percent) patients. Four patients received whole abdominal radiation only, 30 Gy at 1 Gy/day. Fourteen patients had an additional locoregional boost of 9.6 to 16 Gy at 1.6 Gy/day. The liver received 19.8 Gy at 0.67 Gy/day. 5‐Fluorouracil was given as a continuous infusion during therapy.RESULTS:With a median follow‐up of three years, 6 of 18 (33 percent) patients have relapsed. Failure occurred locally in 3 of 18 (17 percent) and distantly in 4 of 18 patients (22 percent). Four of six (67 percent) failures occurred in the liver. The five‐year actuarial survival and disease‐free survival were 78 percent and 66 percent, respectively. Median elapsed time on radiotherapy was 73 days, with 5 of 18 patients (28 percent) requiring two or more weeks of unplanned treatment breaks. Acute Grade 3 to 4 toxicity (diarrhea, leukopenia) occurred in 3 of 18 patients (17 percent), with late complications (bowel obstruction) occurring in 2 of 18 patients (11 percent).CONCLUSIONS:Whole abdominal radiotherapy with concomitant 5‐fluorouracil appears to improve local control but not to prevent liver metastases. Significant toxicity resulted in frequent interruption of therapy and protracted its course. Whether this adjuvant regimen impacts on survival or offers an advantage over locoregional irradiation remains to be studied.

ISSN:0012-3706    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

PURPOSE:The ability of endorectal ultrasonography (EU) to detect the presence of a malignant focus within rectal villous adenomas was studied.METHODS:Clinical charts were reviewed of 62 consecutive patients undergoing EU of rectal villous adenomas, in whom Histologic confirmation was available.RESULTS:Twelve lesions were found to contain cancer, of which only two demonstrated clinical signs of induration. Positive predictive value of EU for detecting a malignant focus was 66.7 percent, negative predictive value was 88.7 percent, sensitivity was 50 percent, and specificity was 94 percent. There was moderate overall agreement between pathologic and ultrasound staging (kappa statistic, 0.48). When an optimal image was obtained, all cancers that penetrated the submucosa were detected. Sensitivity of the technique was compromised in some large exophytic lesions and those at the level of the anal sphincter because of artefacts produced in the ultrasonographic image.CONCLUSION:A clear EU image can detect a malignant focus within a villous adenoma and direct the surgeon to the appropriate plane of surgical resection. In lesions with an ambiguous image, a malignancy cannot be excluded.

ISSN:0012-3706    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

PURPOSE:This study was designed to investigate the effect of intestinal subepithelial collagenous thickening on diabetic diarrhea because one of the seven patients diagnosed with collagenous colitis was diabetic.METHODS:Rectosigmoidoscopic rectal biopsies were taken from 50 diabetic patients (8 with and 42 without diarrhea), 20 nondiabetic patients with diarrhea, and 10 healthy patients. Histopathologic examinations and measurements of subepithelial collagen layers were performed on these biopsies.RESULTS:In diabetic patients who had diarrhea, the subepithelial collagen layer (SCL) was thicker than it was in diabetics without diarrhea (P<0.05). In diabetic groups, the SCL was thicker than it was in both nondiabetics with diarrhea and those without diarrhea (P<0.05). There was no statistical difference between nondiabetics with diarrhea and those without (P>0.05). There was no correlation between collagen thickness, age, and diabetes duration (P>0.05).CONCLUSION:It was concluded that there was a thickening of the colonic SCL in diabetic patients.

ISSN:0012-3706    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

PURPOSE:This study was undertaken to review the literature regarding the current therapy for recurrent and extensive anal warts.METHODS:The available treatments for condyloma acuminatum are reviewed with particular regard to their efficacy for recurrent or extensive anal lesions. Topical agents, surgical methods, and the use of interferon are discussed. Treatment of anal warts in the immunocompromised patient is also addressed.CONCLUSIONS:Although small lesions may be responsive to repeated applications of topical agents, more extensive lesions require surgical or combination treatment. Intralesional interferon may be a useful adjunct to surgical methods to decrease recurrence.

ISSN:0012-3706    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

PURPOSE:A surgical technique is described for a new intracolonic bypass procedure in patients who underwent colonic surgery with an unpreParcd colon.METHODS:Resection and primary anastomosis was performed. The intraluminal bypass tube used was a latex condom.RESULTS:No clinical anastomotic leakage was noted.CONCLUSIONS:This is a safe, low cost, and uncomplicated procedure that decreases the risk of dehiscence and permits the performance of a high number of primary anastomosis.

ISSN:0012-3706    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

PURPOSE:Use of laparoscopic techniques for resection of colon and rectal cancer has raised considerable controversy. There is increasing concern that wound recurrence and peritoneal dissemination may represent a potentially fatal complication of this technique.METHODS:The surgical literature was reviewed, and clinical course of two patients is presented.RESULTS:Our two patients had tumor recurrence in the laparoscopy port sites within one year after laparoscopic‐assisted colectomy for Dukes B adenocarcinoma of the colon. At laparotomy, diffuse peritoneal carcinomatosis without lymph node or liver metastases were found in both patients. They were treated by surgical resection of recurrent disease combined with heated intraoperative intraperitoneal mitomycin C chemotherapy and five days of early postoperative intraperitoneal 5‐fluorouracil. These patients are clinically free of disease at 1.5 years after treatment of peritoneal implants.CONCLUSIONS:Cancer recurrence in abdominal wall incisions after laparoscopic colectomy has been reported in an increasing number of patients. It is possible that this technique should be abandoned. Cytoreductive surgery combined with intraperitoneal chemotherapy may represent the most adequate treatment of recurrent cancer that occurs following laparoscopic colectomy.

ISSN:0012-3706    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

PURPOSE:Three recent cases of femoral neuropathy at our institution following colorectal surgery have been ascribed to the use of the self‐retaining BookwalterTMretractor. The pathophysiology of neural injury includes compression, stretch, transection, ligation, iliopsoas hematoma, ischemia, and cement encapsulation. The Alm of this study is to provide a comprehensive review of femoral nerve anatomy and mechanism of retractor injury.METHODS:The relationship of the femoral nerve to the lateral blade of the BookwaiterTMretractor was evaluated during colorectal surgery and in cadaveric dissections.RESULTS:The lateral blade of the self‐retaining retractor was observed to either compress or impinge the intrapelvic portion of the femoral nerve.CONCLUSION:The incidence of postoperative femoral neuropathy is likely underestimated because a majority of cases are self‐limited. This debilitating iatrogenic injury can be prevented with a thorough understanding of femoral nerve anatomy and careful placement of self‐retaining retractor blades.

ISSN:0012-3706    

出版商:OVID    

年代:1995

数据来源: OVID

ISSN:0012-3706    

出版商:OVID    

年代:1995

数据来源: OVID