摘要:

&NA;Patients undergoing proctocolectomy with an ileal pouch‐anal anastomosis (IPAA) are reported to have an improvement in lifestyle and are able to return to their previous occupation. We questioned whether this was also true of active duty military personnel who require this operation. The rigors of military service are unlike that of most civilian occupations. Soldiers must maintain a physical fitness regimen and remain eligible to deploy overseas. We reviewed our experience with IPAA to determine whether our active duty patients could return to full duty.METHODS:The charts of all patients undergoing IPAA since October 1990 were reviewed, and each patient was interviewed by telephone to elicit late complications not noted in their medical records and to inquire about their present bowel function. Patients were classified as active duty or nonactive duty. Active duty patients were queried as to whether they have remained on active duty, have required a permanent profile, have been promoted, or have been deployed overseas. If a military medical evaluation board had determined whether they were fit for duty, the findings of the board were reviewed.RESULTS:Thirty‐four patients underwent an IPAA; 15 were active duty. Mean follow‐up was 24 months. Indication for IPAA was ulcerative colitis in 76 percent of patients and familial adenomatous polyposis in 24 percent. J‐Pouch was created in 88 percent of patients. Mean bowel movement frequency was seven per day, and 84 percent could defer a bowel movement for more than one hour. Leakage requiring a pad was reported by three patients (9 percent). Seven of 15 active duty patients (47 percent) remained on active duty, and 3 have been promoted. Of the eight patients who were evaluated by a medical evaluation board and were retired, only four were found unfit because of poor bowel function. Therefore, if it were not for other physical limitations, 11 of 15 (73 percent) active duty patients could have continued to serve.CONCLUSIONS:Barring other disqualifying illnesses, active duty soldiers can anticipate continuation of their military career following IPAA. Active duty soldiers, if motivated, can excel and maintain their status in the military.

ISSN:0012-3706    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

PURPOSE:Intracolonic infusions of short chain fatty acids promote healing of colonic anastomoses. Because the intravenous route may have wider clinical application, we studied the effect of intravenous n‐butyrate on the mechanical strength of colonic anastomoses in the rat.METHODS:After placement of an indwelling intravenous catheter, the descending colon was transected and an anastomosis was performed. Rats were then randomized to receive total parenteral nutrition (TPN group; n=15) or total parenteral nutrition plus 130 mM/1 of n‐butyrate (TPN+BUT group; n=13). On the fifth postoperative day, bursting pressure and bowel wall tension of the anastomoses were measuredin situ.Anastomotic tissues were analyzed for hydroxyproline.RESULTS:The TPN+BUT group had a significantly higher bursting pressure (107.5±30.3vs.83±41.0 mmHg;P=0.04) and bowel wall tension (20.7±7.6vs.14.1±99 Newton;P=0.03). Tissue hydroxyproline was not different between the two groups (TPN, 45.8±9.2, and TPN+BUT, 47.9±2.9 &mgr;g/mg tissue nitrogen).CONCLUSIONS:We conclude that intravenous butyrate improves mechanical strength of a colonic anastomosis without a detectable change in total collagen content.

ISSN:0012-3706    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

&NA;Total proctocolectomy and ileostomy for Crohn's colitis offers a low recurrence rate but commits patients to a permanent ileostomy. In contrast, segmental resection may predispose patients to recurrence and further surgery but may delay or avoid a stoma in select individuals.AIM:This study was undertaken to determine the risk of recurrence and the need for permanent stoma in patients treated with segmental or abdominal colectomy for Crohn's colitis.METHODS:Between 1976 and 1985, 699 patients underwent surgery for Crohn's colitis at the Mayo Clinic. Patients who had a total proctocolectomy and end ileostomy or primary ileal or anorectal disease were excluded from further study. Fifty‐three patients had a colon resection without a permanent stoma, and 49 were alive and available for follow‐up. During a mean follow‐up of 14 years, completed questionnaires provided current details on subsequent medical and surgical therapies and/or stomas that were required. In these 49 patients, Crohn's of the colon involved the right, left, and both sides of the colon in 12, 31, and 6 patients, respectively, and involved less than one‐third, one to two‐thirds, and greater than two‐thirds of the colon in 23, 25, and 1 patients, respectively.RESULTS:Twenty‐two of fortynine patients (45 percent) required no further therapy. In 27 patients (55 percent), further treatment was required, including 11 (22 percent) patients who were managed medically (only 4>1 year) and 16 (33 percent) patients who were managed surgically. Three recurrences developed in the small bowel; the remaining 24 developed in the colon. For the 16 patients with recurrence requiring surgery, mean time to recurrence was 51±14 months; in all cases, recurrent disease involved the colon, with four anastomotic recurrences. At first recurrence, ten patients underwent another limited colon resection, and six patients underwent completion proctectomy with permanent ileostomy. Five patients required a third procedure, only one of which resulted in a permanent ileostomy. Therefore, 42 patients (86 percent) remained stoma‐free, and 7 (14 percent) ultimately required permanent ileostomy, with a mean stoma‐free interval of 23±4 months.CONCLUSION:Colon resection without proctectomy in select patients with limited colonic Crohn's disease can delay or avoid the necessity of a permanent stoma.

ISSN:0012-3706    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

PURPOSE:The aims of this study were first to establish whether any difference among pudendal nerve terminal motor latency (PNTML) values exists relative to diagnosis, second to determine whether left and right latencies are similar, and third to assess any correlation between age and neuropathy. Latency was elicited three times on each side, and an average latency was recorded as a result.MATERIALS AND METHODS:Between June 1989 and April 1995, 1,026 patients (775 females and 251 males) underwent PNTML study. These patients were divided into four groups according to diagnosis: Group I, fecal incontinence; Group II, chronic constipation; Group III, idiopathic rectal pain; Group IV, rectal prolapse. Overall mean age was 61.5 (range, 6‐95) years. Student'st‐test was used to calculate statistical differences. Patients were then analyzed according to age and gender. Correlation was calculated with the nonparametric Mann‐WhitneyUtest.RESULTS:Unilateral or bilateral prolongation of PNTML was noted in 90 patients (21.2 percent) in Group I, 80 (20.4 percent) in Group II, 22 (18.1 percent) in Group III, and 38 (42.6 percent) in Group IV. Average PNTML on the left side was 1.88 ms in Group I, 1.94 ms in Group II, 1.98 ms in Group III, and 2.12 ms in Group IV. Average PNTML on the right side was 1.85 ms in Group I, 1.94 ms in Group II, 1.99 ms in Group III, and 2.07 ms in Group IV. The only statistically significant differences in PNTML were between Groups I and IV (left,P<0.005; right, <0.05) and between females and males (P<0.0001).CONCLUSION:There is no statistically significant difference between latencies of left and right pudendal nerves. Similarly, there are no statistically significant differences among patients with fecal incontinence, chronic constipation, or chronic idiopathic rectal pain. Normal latency can be expected in patients with constipation or fecal incontinence. However, patients with rectal prolapse have a more prolonged PNTML. Age is correlated with a higher incidence of pudendal neuropathy. This study reveals significant overlap among PNTML values and diagnosis.

ISSN:0012-3706    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

PURPOSE:Patients with an ileal pouch‐anal anastomosis may develop impaired evacuation of the pouch. A new surgical approach and the role of dynamic defecography in such patients are highlighted.METHODS:Five patients with ileal pouch‐anal anastomosis were assessed clinically and with dynamic defecography before and after reoperation.RESULTS:In one patient an extensive approach with complete pouch mobilization, stenoplasty of a pouch outlet stenosis, shortening of the rectal remnant, and renewed pouch‐anal anastomosis were needed; in three patients, a long and angulated efferent limb was shortened by transabdominal techniques (stenoplasty or a newly developed technique with a linear stapler), and in one patient a pouch inlet stenosis was corrected. In all patients, impaired emptying was cured; in all patients, obstructive abdominal pain improved considerably.CONCLUSIONS:Dynamic defecography is indispensable for tailoring surgical treatment. Effective transabdominal shortening of the efferent limb can be performed with the aid of a linear stapler.

ISSN:0012-3706    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

PURPOSE:The aim of this study is to assess the ability of progressive anal dilations to improve frequency of spontaneous bowel movements in patients with puborectalis syndrome (PRS).METHOD:Thirteen patients (9 females and 4 males; mean age, 37 years) with severe, chronic constipation caused by PRS were treated with daily, progressive anal dilation for a three‐month period. Three dilators of 20, 23, and 27 mm in diameter were used. Dilators were inserted every day for 30 minutes (10 minutes each dilator). Patients were evaluated with anorectal manometry and defecography halfway through treatment, at the end of treatment, and six months after the end of treatment. At six months, patients also underwent physical examination.RESULTS:There was a significant improvement of weekly mean spontaneous bowel movements from zero to six(P<0.0001), and the need for laxatives decreased from 12 patients with a weekly mean of 4.6 to 2 patients once per week(P< 0.001). Enemas used before treatment by eight patients who had a weekly mean of 2.3 were, after treatment, needed only by three patients once per week(P<0.01). During straining, tone measured with anorectal manometry decreased from 93 to 62 mmHg after six months of the end of therapy(F=6.97; P<0.01), and anorectal angle measured with defecography during the strain increased from 95° to 110°(P=not significant).CONCLUSIONS:Daily progressive anal dilation should be considered as the first and most simple therapeutic approach in patients with PRS.

ISSN:0012-3706    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

PURPOSE:This study was designed to investigate colonic spike bursts regarding 1) their migration behavior, 2) their pressure correlates, and 3) comparing colonic short spike bursts with spike bursts from migrating myoelectric complex from the small bowel.METHODS:Rectosigmoid electromyography and manometry were recorded simultaneously in seven normal volunteers and electromyography alone in five others during two hours of fasting and for two hours after one 2,100‐kJ meal. One patient with an ileostomy was also studied by the same method to record the migrating myoelectric complex from the terminal ileum during fasting.RESULTS:Three kinds of spike bursts were observed in the pelvic colon: rhythmic short spike bursts, migrating long spike bursts, and nonmigrating long spike bursts. The meal significantly increased the number of migrating and nonmigrating long spike bursts (from 25 to 38.7 percent of the recording time;P<0.01). These bursts of potentials showed a peak 15 minutes after the meal, which may be caused by the gastrocolic reflex. Migrating long spike bursts started anywhere along the rectosigmoid and migrated from there aborad 82 percent of the time and orad or in both directions in 10 or 7 percent of the time, respectively. They originated pressure waves 99 percent of the time. Short spike bursts were more frequent before the meal (15.1 percent before and 9.6 percent after the meal), but the difference was not significant; they neither propagated nor initiated pressure waves detected by the miniballoon.CONCLUSIONS:Migrating long spike bursts were the only potentials that migrated, sometimes for short distances. Short spike bursts are a different phenomenon from the small‐bowel migrating myoelectric complex because they do not migrate; they can occur during the postprandial period and never originated intraluminal pressure waves.

ISSN:0012-3706    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

PURPOSE:This study was undertaken to determine whether different regimens using sodium phosphate (NaPh) solutions resulted in better bowel cleansing than polyethylene glycol‐salt (PEG) solutions and, if so, why. Side‐effects and patient acceptability of the different regimens were also investigated.METHODS:A total of 486 patients requiring colonoscopy were randomly assigned to one of three preparations in a single‐blind prospective study. The preparations were as follows: Group A, 3 liters of PEG solution taken at 2 p.m. the day before examination; Group B, 45 ml of NaPh solutions taken at 7 a.m. and 7 p.m. the day before examination; or Group C, 45 ml of NaPh taken at 6 p.m. the day before and at 6 a.m. on the morning of, examination. Cleanliness of the bowel was assessed blindly, and patients were questioned about side‐effects and preferences for NaPhvs.PEG.RESULTS:Numbers, ages, and gender distribution of patients in the three groups did not differ significantly from each other. Cleanliness scores for the three groups were 3.34±0.97, 3.22±0.85, and 4.11±0.67 (Group Cvs.Groups A and B,P<0.0005; Group Avs.Group B,P>0.30). Predominance of material in the right side of the colon was found in 13.7, 29.8, and 4.2 percent of Groups A, B, and C, respectively. In the three groups, nausea alone occurred in 3.8, 13.7, and 16.3 percent of patients; vomiting occurred in 0.6, 7.4, and 5.4 percent of patients; and dryness/thirst occurred in 1.9, 17.4, and 20.4 percent of patients, respectively. A total of 80.6 and 82.6 percent of those in Groups B and C who had previously had PEG expressed a preference for taking NaPhP<0.001).CONCLUSIONS:The regimen of Group C is significantly better than the regimens of Groups A or B in bowel cleansing. Regimens of Groups A and B did not differ in efficacy of cleansing. It is the timing of taking NaPh in the regimen of Group C rather than its composition that is responsible for its superior cleansing ability compared with PEG. Overnight deposition of small intestinal material in the right colon is partly responsible for the inferior cleansing ability of regimens that involve taking the solution on the day before colonoscopy. Despite a higher incidence of minor side‐effects from NaPh than from PEG, a significantly higher proportion of patients preferred NaPh.

ISSN:0012-3706    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

BACKGROUND:Synchronous neoplasms of the rectum are an uncommon condition. The situation becomes more rare when tumors are of different origin. To the authors' knowledge, synchronous anorectal melanoma and adenocarcinoma of the rectum have not been reported in the literature before.METHODS AND RESULTS:A 67‐year‐old female patient with synchronous anorectal malignant melanoma and adenocarcinoma of the rectum is described. She had preoperative colonoscopic diagnosis. The different neoplasms' origin was histologically proven. Surgical management consisted of abdominoperineal resection of the rectum. Postoperatively, the patient received adjuvant chemotherapy of six cycles duration. At present, the patient has completed 32 months of follow‐up. There is no evidence of recurrent disease or distant metastases.CONCLUSION:Review of the literature confirms the rarity of anorectal malignant melanoma. On the other hand, the rectum represents the most common site for development of colonic adenocarcinoma. We were unable to trace synchronous presentation of these two tumors. Prognosis should be defined by the most malignant neoplasm; therefore, management should be focused on treating the melanoma.

ISSN:0012-3706    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

PURPOSE:This report presents a patient who developed signs and symptoms of acute appendicitis because of sarcoid involvement of the appendix.METHODS:This is a retrospective case review with review of the English language literature.RESULTS:The patient underwent appendectomy for suspected acute appendicitis. Histologically the appendix had no signs of acute inflammation but did have noncaseating granulomas. The patient's abdominal pain resolved following appendectomy, and she has had no further similar pain in the two years since the operation.CONCLUSION:Patients with sarcoidosis may develop signs and symptoms of acute appendicitis without inflammation. Operative exploration should not be delayed in equivocal cases of right lower quadrant abdominal pain in patients with sarcoidosis.

ISSN:0012-3706    

出版商:OVID    

年代:1997

数据来源: OVID