摘要:

PURPOSE AND METHODS:Certain factors in a patient's history, such as prior abdominal surgery or complicated diverticular disease, have been reported to hinder cecal intubation during colonoscopy. Over a 16‐month period, 1,047 consecutive colonoscopies were prospectively evaluated to determine whether these factors were indeed clinically relevant.RESULTS:Of the 90 patients (9 percent) who had incomplete intubation of the colon, there were significantly more women (66 percent) than men (34 percent)(P<0.001). Women with a history of abdominal hysterectomy had a significantly lower cecal intubation rate(P< 0.01). A history of diverticulitis did not alter the cecal intubation rate. In patients with incomplete colonic intubation, the most proximal extent of intubation was the sigmoid colon in women (31 percent) and the right colon in men (68 percent). Sixty‐seven percent of patients with incomplete intubation of the colon had a prior colonoscopy completed to the cecum (67 percent women, 67 percent men), whereas 50 percent had a follow‐up colonoscopy completed to the cecum (56 percent women, 40 percent men).CONCLUSIONS:Women, especially those with a history of abdominal hysterectomy, had a significantly lower cecal intubation rate usually because of an impassable sigmoid colon. Prior inability to complete colonoscopy to the cecum does not necessarily forecast future failure.

ISSN:0012-3706    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

&NA;A number of physiologic and radiologic investigations are used in investigating defecation disorders. Defecography is one important part of these investigations. However, a correct diagnosis of an enterocele is sometimes difficult despite use of contrast media in the rectum, vagina, and small bowel.PURPOSE:This study was undertaken to ascertain if it was technically possible to perform simultaneous defecography and peritoneography in an effort to improve the diagnostic possibilities in patients with defecation disorders.METHODS:Twelve patients with defecation disorders and an unexplained widening of the rectovaginal space at defecography were investigated. Contrast medium was introduced intraperitoneally, after which conventional defecography was performed.RESULTS:All investigations were carried out without complications and demonstrated the peritoneal outline in all patients. Simultaneous defecography and peritoneography differentiated between an enterocele and a pathologically deep pouch of Douglas—a peritoneocele. Three types of peritoneocele were visualized: vaginal peritoneocele, septal peritoneocele, and rectal peritoneocele with or without enterocele. Combinations of the three types were also found. Eight of the 12 patients had rectal intussusception or rectal prolapse. All of these eight patients had a rectal peritoneocele.CONCLUSIONS:Simultaneous defecography and peritoneography can be performed without technical difficulties or complications. Peritoneal outlines and pouches can, therefore, be studied directly during the act of defecation. An unexplained widening of the rectovaginal space at defecography can be clarified as a peritoneocele, with or without an enterocele. Peritoneocele can be of three different types: rectal, septal, or vaginal.

ISSN:0012-3706    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

PURPOSE:To verify whether short chain fatty acids (SCFA) alter the proliferative and endoscopic pattern of the mucosa in ileal pouches of ulcerative colitis (UC) or familial adenomatous polyposis (FAP) patients.METHODS:We studied patients after proctocolectomy carrying a pelvic ileal pouch for FAP or UC (noncanalized pouches in 10 UC and 4 FAP patients and canalized pouches in 6 UC and 5 FAP patients). Patients with noncanalized pouches were treated twice daily for one week with 30 ml of a SCFA solution (60 mM sodium acetate, 30 mM sodium propionate, 40 mM sodium butyrate, and 22 mM sodium chloride, pH 7); patients with canalized pouches were treated with the same solution twice daily for two weeks. Pouch mucosal biopsies were collected before and after SCFA. Mucosal proliferation was assessed by incorporation of[3H]thymidinein vitroand autoradiography.RESULTS:In UC patients proliferation did not vary in noncanalized pouches but was significantly reduced in canalized pouches after SCFA. In FAP patients SCFA did not alter proliferation. No significant effects of SCFA were observed on daily defecation frequency, endoscopic appearance, or histopathology of the pouches.CONCLUSIONS:SCFA do not control inflammation and clinical functions but reduce cell proliferation in UC patients. On the contrary, FAP patients are refractory to SCFA.

ISSN:0012-3706    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

BACKGROUND:The characteristics of patients who develop clinically significant angiodysplasia of the lower gastrointestinal (GI) tract are unknown, and methods of treatment are evolving.PURPOSE:This study was undertaken to identify patient characteristics, methods of diagnosis, and current management of patients who require operation and outcome.METHODS:Patients with the diagnosis of angiodysplasia of the lower GI tract at St. Louis University affiliated hospitals over the past five years were reviewed.RESULTS:Thirty‐two consecutive patients were identified. The mean age was 69‐8 (range, 29‐86) years; 62.5 percent were males. Patient characteristics included: age greater than 65 years, 22 of 32 patients (69 percent); documented coagulopathy, 9 of 32 patients (28 percent); and cardiac valvular disease, 8 of 32 patients (25 percent). Diagnosis was established by colonoscopy in 27 of 32 patients (84 percent), enteroscopy in 3 of 32 patients (9 percent), and angiography in 2 of 32 patients (6 percent). Seventy‐eight percent of the angiodysplasias were located in the right colon. Patients were treated by endoscopic coagulation in 16 of 32 patients (50 percent), surgical resection in 9 of 32 patients (28 percent), transfusion alone in 4 of 32 patients (12.5 percent), or observation in 3 of 32 patients (9 percent). Four of 32 patients (12.5 percent) developed recurrent bleeding. Four of 32 patients (12.5 percent) died of various causes.FOLLOW‐UP:Follow‐up was possible in 25 of 28 surviving patients, and the follow‐up period ranged from 3 to 42 months, during which rebleeding occurred in 5 patients who had been previously treated by endoscopic coagulation and in 1 patient who had been treated by transfusion alone. Two patients died of unrelated causes and one from a recurrent lower GI bleed.CONCLUSION:Angiodysplasia is primarily a disease of elderly patients. These patients are frequently anticoagulated and often have co‐existing cardiac valvular disease. Endoscopy usually establishes the diagnosis, and endoscopic coagulation is an effective and safe method of treatment. Most patients can be managed without operation.

ISSN:0012-3706    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

PURPOSE:Immunolocalization of the tumor‐associated glycoprotein 72 antigen with the monoclonal antibody B72.3 has been used as a “cancer marker” in radioimmunoscintigraphy and radioimmunoguided surgery (RIGS). Radioimmunoscintigraphy and RIGS have been used to detect occult metastatic deposits from colorectal adenocarcinoma. It has been suggested that RIGS is superior to histologic examination in detecting lymph node metastases from colorectal cancer. To determine the specificity of immunodetection of the tumor‐associated glycoprotein ‐72 antigen as a marker for metastatic adenocarcinoma, we studied benign intraabdominal lymph nodes with B72.3 and an immunohistochemical technique.METHODS:Formaldehyde‐fixed, paraffin‐embedded sections of 276 benign abdominal lymph nodes, resected with 35 cases of colonic adenocarcinoma and 33 cases of benign gastrointestinal disorders, were evaluated for B72.3 immunoreactivity using an avidin‐biotin complex immunohistochemical technique. Lymph nodes from cases of colonic carcinoma were also studied with cytokeratin immunostaining to help eliminate occult micrometastases.RESULTS:B72.3 immunoreactivity was seen in the germinal centers of benign lymph nodes associated with 49 percent of the cases of colonic adenocarcinoma and 12 percent of the cases of benign gastrointestinal disease.CONCLUSIONS:B72.3 immunoreactivity can be seen in benign abdominal lymph nodes associated with gastrointestinal disease. We advise caution in the use of diagnostic techniques that equate B72.3 immunoreactivity with the presence of adenocarcinoma.

ISSN:0012-3706    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

PURPOSE:This study was undertaken to determine the effect of rectal dilation in a patient with urge‐type fecal incontinence and frequent bowel movements associated with low rectal compliance and capacity.METHOD:Daily rectal balloon dilation was performed for a period of four weeks.RESULTS:The patient regained complete fecal continence with one to two daily bowel movements. Rectal compliance, capacity, and cross‐sectional area increased by 37 to 136 percent. Nine months later the patient was still without symptoms.CONCLUSION:Rectal balloon dilation may be a therapeutic alternative in selected patients.

ISSN:0012-3706    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

PURPOSE:This study was conducted to report a rare cause of colonic bleeding.METHODS:Case report.CONCLUSION:Surgical resection of congenital colonic varices is associated with a low incidence of morbidity and mortality, and a favorable long‐term prognosis can be expected when there is no evidence of hepatocellular disease (portal hypertension).

ISSN:0012-3706    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

PURPOSE:We examined the theoretic possibility that therapeutic ultrasound can disrupt a stapled gastrointestinal anastomosis.METHOD:A case is reported in which leakage of a stapled ileocolic anastomosis occurred following therapeutic ultrasound. Calculations are performed on the power of the ultrasound beam and its adsorption and dispersion in the tissue between the probe and anastomosis to establish its intensity at the anastomosis.RESULTS:Ultrasound intensity at the anastomosis in this patient was calculated at 10 to 46 mW/cm2.CONCLUSION:Although the calculated ultrasound intensities at the anastomosis do not appear to be very high, other factors such as “pressure doubling” and “stress concentration” at the stapled surface suggest that therapeutic ultrasound may cause staple disruption.

ISSN:0012-3706    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

PURPOSE:Increasing experience with ileal pouch‐anal anastomosis (IPAA) associated with increasing knowledge about anorectal physiology has lead to a large number of publications. The purpose of this review is to evaluate the current understanding of fecal continence as revealed by the evolution of the ileoanal procedure.METHODS:Review of the literature covering the most important physiologic parameters involved in fecal continence was undertaken.RESULTS:Rectoanal inhibitory reflex is probably absent after IPAA but is preserved when distal anorectal mucosa is spared. Anal resting pressure decreases but is less affected when the internal anal sphincter is less traumatized. Squeeze pressure is not importantly affected, and the importance of reservoir function as a determinant of stool frequency is emphasized. IPAA does not affect the coordination between pouch and anal canal motility in the majority of cases. Normal continence is preserved, even during the night, by preserving a gradient of pressure between the pouch and anal canal.CONCLUSIONS:Physiologic concepts are well established, but controversies about the continence mechanism related to IPAA remain. The IPAA procedure has allowed discrimination of details about the function of multiple structures involved in fecal continence.

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