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 investigate the role of omentoplasty, by means of intact omentum, in preventing anastomotic leakages after rectal resection.METHODS:Between 1992 and 1997 a total of 112 patients (64 males) with a mean age of 64.7 (range, 39‐83) years were randomly assigned to undergo omentoplasty (Group A) or not (Group B) to reinforce the colorectal anastomosis after anterior resection for rectal cancer. The primary end point was anastomotic leakage; the secondary end point included morbility and mortality related to omentoplasty.RESULTS:The two groups were comparable in terms of preoperative and intraoperative characteristics. Staple‐ring disruption at plain abdominal radiographs was detected in seven instances in Group A and in ten in Group B patients (P= not significant). Two leakages were evident clinically in Group A and seven in Group B (P<0.05). Three leaks were documented radiologically in Group A and eight in Group B (P= not significant). No complications related to omentoplasty were observed in Group A. There were two repeat operations for anastomotic leakage in Group B. At follow‐up, one stricture developed in Group A and three in Group B (P= not significant)CONCLUSIONS:Despite a similar incidence of staple‐ring defects, a strikingly lower rate of clinically and radiologically detected leaks developed in patients submitted to omentoplasty. Although not affecting the incidence of anastomotic disruption, omentoplasty seems to contain the severity of anastomotic leakage.

ISSN:0012-3706    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

PURPOSE:Functional neosphincters after pudendal nerve anastomosis proved possible in animal models and may be applicable in humans, but access is a recognized problem. We report the occurrence of pudendal nerve anomalies, its implications for reconstruction, and describe a new approach for maximal exposure.METHODS:Adult human cadavers were positioned prone and dissectedviaa gluteal approach. Pudendal nerve variations and physical measurements were analyzed statistically.RESULTS:A new, simple, four‐step approach (surface landmarks and exposure of gluteus maximus muscle, sacrotuberous ligament, and pudendal neurovascular bundle) permitted optimal pudendal nerve exposure in all 14 human cadavers (28 limbs). Six were males and had a mean age of 82 (range, 58‐102) years. Two anomalies, Type 1 (2‐trunked) and Type 2 (3‐trunked), of the pudendal nerve were recognized in 30 percent of cadavers, with a left‐to‐right ratio of 2.5:1. Mean pudendal nerve length over the ischial spine was 23.9 (range, 19‐28) mm right, 24.2 (range, 19‐28) mm left (P=0.54), but its diameter measured 5.2 mm (right) and 4.9 mm (left;P=0.04). Mean length of pudendal nerve trunk exposed after reflection of the sacrotuberous ligament was 55 (range, 44‐75) mm on either side before division into terminal branches. The number and percent frequency of inferior rectal nerve on both sides were 1 (13 percent), 2 (76 percent), and 3 (11 percent), respectively, with a mean length of 27.1 (range, 21‐34) mm right and 27.9 (range, 20‐33) mm left (P=0.31).CONCLUSION:A simple four‐step approach to the pudendal nerve contributes to improved access in all cases. It facilitates reconstruction because it allows accurate nerve selection and recognition of potential anomalies that might influence functional outcome.

ISSN:0012-3706    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

PURPOSE:Fecal diversion for sphincter repair is controversial. This randomized trial assessed whether fecal diversion would improve primary wound healing and functional outcome after sphincter repair.METHODS:Thirty‐three patients with fecal incontinence requiring sphincter repair were recruited, but only 27 agreed to be randomly assigned to a defunctioning stoma (n=13) or no stoma (n=14). Patients were assessed by the Cleveland Clinic Incontinence Score (0‐20) and anal physiology; the mean follow‐up was 34 (range, 16‐47) months.RESULTS:Incontinence score improved significantly in both groups (stoma, 13.5‐7.8;P= 0.0072; no stoma, 14‐9.6;P=0.0470): No difference was found between the two groups. Maximum resting pressure and maximum squeeze pressure increased significantly only in the no‐stoma group (maximum resting pressure, 52.4‐71.3 cm H2O; maximum squeeze pressure, 87.3‐100.7 cm H2O;P<0.0001). There was no significant difference in functional outcome (stoma, 7.8; no stoma, 9.6;P=0.4567) or the number with complications of sphincter repair (stoma, 5; no stoma, 3;P=0.4197). However, stoma‐related complications occurred in 7 of 13 patients having a stoma (parastomal hernia, 2; prolapsed stoma, 1; incisional hernia at the stoma site requiring repair, 5; and wound infection at the closure site, 1).CONCLUSION:Fecal diversion in sphincter repair is unnecessary, because it gives no benefit in terms of wound healing or functional outcome, and it is a source of morbidity.

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:The anal sphincter system of the skeletal musculature consists of various parts but functions as a single unit. The motor latencies measured at the puborectalis, deep external anal sphincter, superficial external anal sphincter, and subcutaneous external anal sphincter have yet to be clearly elucidated. This study was designed to measure the motor latencies of these sphincters separately and to investigate the electrophysiologic heterogeneity of the anal sphincter system.METHODS:In 20 preoperative patients with colon cancer without either neurologic or anorectal diseases, motor evoked potentials were taken separately bilaterally at levels measuring approximately 5, 3.8, 2.6, and 1.5 cm from the perineal skin using a concentric needle electrode after magnetic stimulation on the sacral region. These latencies were considered to be separately measured at the puborectalis, deep, superficial, and subcutaneous external anal sphincter.RESULTS:The motor latencies (median (95 percent confidence interval)) were 4.33 (4.1‐4.93; right) and 4.24 (3.97‐5.22; left) ms at the 5 cm level; 5.96 (5.45‐7.32; right) and 6.44 (5.49‐8.20; left) ms at the 3.8 cm level; 9.28 (7.99‐11.21; right) and 8.88 (7.68‐10.93; left) ms at the 2.6 cm level; and 11.06 (9.69‐14.13; right) and 9.18 (8.09‐10.31; left) ms at the 1.5 cm level. Significant differences were seen in the latencies between the 5 cm level and the other levels and between the 3.8 cm level and the other levels.CONCLUSIONS:The motor latencies in the anal sphincter system significantly varied depending on the distance from the skin. The latency may be shortest in the puborectalis and increasingly longer in the deep, superficial, and subcutaneous EAS, in that order.

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 test the prognostic influence of p53 nuclear overexpression in colorectal carcinoma.METHODS:We performed an analysis of the prognostic influence of the nuclear overexpression of p53 with immunohistochemistry in 126 cases of colorectal carcinoma operated on in our hospital between 1987 and 1992, with a minimum follow‐up time of 60 months (5 years).RESULTS:Our results show a statistically significant prognostic influence of p53 overexpression on disease‐free survival time, but not on the overall survival time, in univariate analysis, but this influence is lost in multivariate analysis.CONCLUSIONS:Our results confirm recent reports by other authors that failed to show the independent prognostic value of p53 in colorectal carcinoma.

ISSN:0012-3706    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

PURPOSE:Colonoscopic surveillance is recommended for patients with adenomatous polyps. Significant cost savings would result from identification of subgroups of patients in whom less costly surveillance would suffice. This study was performed to determine the natural history of patients undergoing removal of isolated rectosigmoid adenomas and to establish whether flexible sigmoidoscopy might be adequate for follow‐up.METHODS:A retrospective review of a database of 7,677 colonoscopies, from 1990 to 1996, identified patients who had a minimal follow‐up of two years after removal of adenomatous polyps isolated to the rectosigmoid. Polyps detected on surveillance colonoscopy were categorized as distal (≤60 cm from anal verge), proximal (>60 cm from anal verge), and diffuse (proximal plus distal). The risk of polyp formation was determined by actuarial analysis using the Kaplan‐Meier method.RESULTS:Sixty‐two patients undergoing surveillance for adenomas met inclusion criteria. At the index colonoscopy, 124 isolated rectosigmoid polyps were identified. The median polyp size was 1 cm and median frequency was one polyp. The median follow‐up time for the entire cohort (N = 62) was 53 months. At follow‐up surveillance colonoscopy, 105 additional adenomas were discovered and removed in 40 patients. No malignant polyps were detected. The pattern of polyps detected were proximal (n=19), rectosigmoid (n=16), and diffuse (n=5).CONCLUSIONS:The majority (65 percent) of patients with isolated rectosigmoid polyps have additional polyps on long‐term surveillance, and 60 percent of patients will have these polyps located proximal to the reach of a sigmoidoscope. Therefore, flexible sigmoidoscopy is not a safe alternative for surveillance of patients with isolated rectosigmoid polyps.

ISSN:0012-3706    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

PURPOSE:Tumor‐induced angiogenesis requires migration and remodeling of endothelial cells derived from pre‐existing blood vessels. Vascular endothelial growth factor is the growth factor most closely implicated in the development of neovessels in colon cancer. However, vascular endothelial growth factor‐specific receptors flt‐1 and KDR mRNA expression are absent in normal sinusoid vessels surrounding vascular endothelial growth factor‐producing secondary hepatic tumors. Thus, the potential role of sinusoidal endothelial cells in the mechanism of neovessel formation within liver metastatic carcinomas remains unclear. The purpose of this study was to determine whether sinusoidal endothelial cells are involved in tumor angiogenesis in a syngeneic model of liver metastases from colorectal cancer.METHODS:Sinusoidal endothelial cells were identified by fluorescence microscopy after uptake of acetylated low density lipoprotein labeled with a fluorescent probe (dioctadecylindocarbocyanine). One hundred microliters of dioctadecylindocarbocyanine acetylated low density lipoprotein were injected intraportally at the start of experiment in BD IX rats. Two days later, intraportal injection of 107DHD K12, a chemically induced colon carcinoma cell line, was performed in syngeneic BD IX rats. Animals were killed one week later and the livers were processed for routine histologic examination and immunohistochemistry using the rat endothelial cell antigen‐1 monoclonal antibody.RESULTS:In normal parenchyma fluorescence was associated with sinusoidal cells but not with endothelium of large blood vessels. Thus, specific acetylated low density lipoprotein uptake allowed histological differentiation of sinusoidal endothelial cells from other large‐vessel endothelial cells present in the hepatic parenchyma. In tumor‐bearing liver a spatial gradient of fluorescence was generated. Labeled cells accumulated at the periphery of the metastases. When tumors grow beyond 200 &mgr;m, neovessel formation was observed; there was an invasion of fluorescent‐labeled cells from the periphery, which were arranged in a tubular formation within neoplasia.CONCLUSION:In liver metastases tumor vessels are lined with sinusoidal endothelial cells. Identification of a specific cell type involved in the formation of the stromal compartment of tumors has important implications. Sinusoidal endothelial cells express well‐characterized surface receptors and differ morphologically and metabolically from large‐vessel endothelia. They should be considered as attractive targets for future and existing antiangiogenic strategies directed against the stromal compartment of liver metastases.

ISSN:0012-3706    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

PURPOSE:This study was designed to investigate the protective effect of a pedunculated seromuscular flap on intestinal anastomosis after corticosteroid treatment.METHODS:Forty male Sprague‐Dawley rats were divided into four groups, and all animals underwent intestinal anastomosis. Two groups, with or without seromuscular flap wrapping, received 5 mg cortisone acetate, and two groups received placebo (saline) preoperatively for 16 days. Anastomotic strength was defined as bursting pressure (in millimeters of mercury). The pedunculated seromuscular flap was prepared from a segment of intestine next to the anastomosis. Intestinal bursting strength at the anastomotic site was measured at Postoperative Day 8.RESULTS:The anastomotic bursting strength was significantly lower in the steroid groups at Postoperative Day 8 (P<0.01). The pedunculated seromuscular flap increased the strength of the anastomosis both in the steroid and control groups (P<0.05).CONCLUSION:The adverse effect of corticosteroids on intestinal anastomoses may be prevented by a pedunculated seromuscular flap.

ISSN:0012-3706    

出版商:OVID    

年代:2000

数据来源: OVID