摘要:

PURPOSE:Previous studies have shown that N‐methyl‐D‐aspartate receptor antagonists provide a preemptive analgesic effect in humans. This study was designed to examine whether premedication with dextromethorphan, an N‐methyl‐D‐aspartate antagonist, also provided a preemptive analgesic effect that improved postoperative pain management.METHODS:Sixty patients who were American Society of Anesthesiologists status I and II scheduled for hemorrhoidectomy (modified Whitehead procedure) were included in the study. Patients were randomly assigned to the control and study groups. For the control group patients received chlorpheniramine maleate (20 mg), a component of the injection form of dextromethorphan, intramuscular injection 30 minutes before skin incision. In the study group dextromethorphan 40 mg containing 20 mg chlorpheniramine maleate (intramuscular) was given as premedication 30 minutes before skin incision. Pethidine (1 mg/kg, intramuscular) was given for pain relief as required postoperatively. The time to first pethidine injection, total pethidine consumption, worst pain score, and pethidine‐related side effects were recorded for 48 hours postoperatively.RESULTS:The times to first pethidine injection (mean ± standard error of the mean) were 5.2±3 and 19.6±6 hours in the control and study groups, respectively. Total pethidine consumption was 140±11.3 and 63.5±11.8 mg in the control and study groups. The worst visual analog scale pain scores were 7.4±0.2 and 5.6±0.3 in the control and study groups during the two‐day observation. The numbers of patients who required pethidine injection were 29 and 20 in the control and study groups, respectively. Two patients suffered pethidine‐related side effects, such as nausea, vomiting, dizziness, and headache, in the control group, and no patient complained of any side effect in the study group.CONCLUSION:We found that dextromethorphan premedication provided a preemptive analgesic effect, thus producing reduced postoperative pain and pethidine requirement and improved recovery from hemorrhoidectomy.

ISSN:0012-3706    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

PURPOSE:Magnetic resonance imaging of fistula‐in‐ano has been shown to predict surgical anatomy accurately and identify complex features. In addition, fistula complexity has been correlated with poor outcome after surgical intervention. We investigated whether preoperative magnetic resonance imaging could predict clinical outcome after surgery for fistulous disease better than clinical examination under anesthetic.METHODS:Seventy patients with clinically suspected fistula‐in‐ano underwent preoperative dynamic contrast‐enhanced magnetic resonance imaging before surgical exploration. Outcome was assessed at a minimum of one year after surgical exploration and correlated in a blinded fashion with the surgical and magnetic resonance grading of the severity of the fistulous disease.RESULTS:Of 70 patients, 12 were not operated on and 6 were lost to follow‐up, making 52 patients eligible for analysis. Assessment by dynamic contrast‐enhanced magnetic resonance imaging more accurately predicted outcome than the findings at initial surgical exploration. Dynamic contrast‐enhanced magnetic resonance imaging had a sensitivity of 81 percent, specificity of 73 percent, and positive predictive value of 75 percent; surgery had a sensitivity of 77 percent, specificity of 46 percent, and positive predictive value of 59 percent. Surgical assessment of apparent disease severity bore no relation to final outcome. Dynamic contrast‐enhanced magnetic resonance imaging could accurately predict whether patients were likely to have a satisfactory or unsatisfactory outcome after surgery.CONCLUSION:Dynamic contrast‐enhanced magnetic resonance imaging better predicts clinical outcome of patients with fistula‐in‐ano than initial surgical exploration.

ISSN:0012-3706    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

PURPOSE:The purpose of this study was to examine the association between coping behavior at the time of surgery and inflammatory bowel disease‐related quality of life after surgery. We also investigated the relationship between perceived social support and both coping style and postsurgical quality of life. Finally, the value of the Medical Outcomes Study Social Support Scale for preoperative screening was assessed.METHODS:Eighty‐six subjects who had surgery during a 12‐month period completed the Inflammatory Bowel Disease Questionnaire, the Ways of Coping, a measure of inflammatory bowel disease symptom severity, and the Medical Outcomes Study Social Support Scale. Analysis of variance was used to test an association between Ways of Coping score and membership in a high quality of life (Inflammatory Bowel Disease Questionnaire > mean) or low quality of life (Inflammatory Bowel Disease Questionnaire < mean) cohort. Comparison of group means between the high quality of life and low quality of life cohorts identified Ways of Coping behavior scales that differed between the high quality of life and low quality of life cohorts. Stepwise linear regression analysis was then used to determine the independent contribution of 1) current inflammatory bowel disease symptoms, 2) current perceived social support, and 3) identified coping behaviors (self‐control, self‐blame, and escape, summed as a single index named “maladaptive coping”) to postsurgical quality of life. The sensitivity, specificity, and negative predictive value of the Medical Outcomes Study Social Support Scale were assessed.RESULTS:The lower quality of life group distinguished itself by more frequent use of maladaptive coping. Regression analysis revealed that current inflammatory bowel disease‐related symptoms, current perceived social support, and maladaptive coping behaviors at the time of surgery each made a highly significant independent contribution to postsurgical quality of life. The sensitivity of the Medical Outcomes Study Social Support Scale in identifying patients with poor postsurgical quality of life was 81 percent, and the specificity was 77 percent. The negative predictive value was 93 percent.CONCLUSIONS:Three coping behaviors which seem to be maladaptive (self‐control, self‐blame, and escape) are associated with lower quality of life after surgery for inflammatory bowel disease. These coping behaviors make a contribution to postsurgical quality of life independent of the negative effect on quality of life of inflammatory bowel disease symptoms. Perceived social support is a third factor that makes an independent contribution to postsurgical quality of life. The Medical Outcomes Study Social Support Scale has properties associated with an effective screening tool and merits further investigation as an instrument to screen presurgically for individuals at higher risk of poor subjective outcome of inflammatory bowel disease surgery.

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 possible deleterious effect of the lateral intersecting margins (so‐called dog ears) on anastomotic disruption after experimentally performed double‐stapled anastomoses.METHODS:Two groups of double‐stapled side‐to‐end anastomoses were performed using pig small intestines. Group A consisted of 35 circular anastomoses and Group B of 32 double‐stapled anastomoses with a bilateral dog ear. In both groups bursting pressures were tested using a water‐filled, pressure‐controlled automatic pumping system (Hamou Endomat®), and special attention was paid to the location(s) in the anastomoses were the disruption(s) occurred.RESULTS:In Group A bursting pressures were significantly higher than in Group B (median pressure, 90vs.60 mmHg;P<0.001, Mann‐WhitneyUtest). Remarkably, in Group B in 13 cases (42 percent) the first disruption occurred at the corner of a dog ear.CONCLUSIONS:We conclude that the lateral intersections of double‐stapled anastomoses are a structural weak spot and that the currently most often applied double‐stapled anastomosis is a less effective type of anastomosis than a complete circular one. Resolving this technical problem might help to reduce the number of anastomotic disruptions after low anterior resections.

ISSN:0012-3706    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

PURPOSE:Patients undergoing urinary diversion by ureterosigmoidostomy after complete cystectomy for malignant bladder tumors show a high incidence of neoplasia at and near the site of anastomosis. We examined a risk factor for tumor occurrence in the area of anastomosis, alterations of mucus glycoproteins in the surrounding colonic mucosa.METHODS:Colonoscopy was performed in 37 patients who had undergone ureterosigmoidostomy. Biopsy specimens were obtained near the ureteral anastomosis and were stained with hematoxylin and eosin, high iron‐diamine alcian blue (pH 2.5), and a fluorescent lectin conjugate (peanut agglutinin).RESULTS:At the anastomotic site colonoscopy showed protruding lesions in 26 of 37 patients (71 percent), all histologically representing inflammatory granulomas. The mucosa around the anastomosis was normal in endoscopic appearance; however, histologically, slight inflammatory cell infiltration, edema, and increased numbers of Paneth cells were observed. Alcian blue staining revealed an increase in mucosal sialomucin postoperatively compared with preoperatively. The proportion of peanut agglutinin‐binding mucin, not observed in normal mucosa but seen in malignant or premalignant tissue, was increased.CONCLUSION:As postoperative interval increases, changes in properties of the “background” mucosa become greater, which suggests an association with colonic carcinogenesis.

ISSN:0012-3706    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

INTRODUCTION:Transcatheter arterial embolization has been used as a therapeutic maneuver for lower gastrointestinal bleeding. The availability of highly selective arteriography has made this procedure safer and warrants re‐evaluation.METHODS:A retrospective chart review was done of all patients undergoing arteriography for presumed lower gastrointestinal bleeding at two acute‐care community hospitals. Causes of bleeding, clinical outcome, and complications caused by transcatheter arterial embolization were recorded.RESULTS:There were 26 arteriographically identified bleeding sites in the colon and small bowel. The most frequent cause of bleeding was diverticulosis (12 patients), with the diagnosis being arteriovenous malformation in two, and one unknown colonic source. Transcatheter arterial embolization was attempted for 17 separate bleeding episodes in 16 patients. Transfusion requirements were an average (± standard deviation) of 7±1.43 units per patient. Transcatheter arterial embolization was successful in stopping bleeding in 14 cases (82 percent). Two patients had surgery after transcatheter arterial embolization: one for colonic necrosis and one for persisting bleeding. There were two more unsuccessful procedures; one had a successful repeated transcatheter arterial embolization, and one stopped spontaneously. One patient rebled during the same hospitalization and was controlled with intra‐arterial vasopressin. There were two deaths, both secondary to sepsis unrelated to the transcatheter arterial embolization or the gastrointestinal tract.CONCLUSIONS:Transcatheter arterial embolization is a relatively safe and successful procedure in patients with massive lower gastrointestinal hemorrhage. It is an excellent choice of therapy for patients that are poor candidates for surgery, but its role in other patients remains to be defined.

ISSN:0012-3706    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

PURPOSE:One of the main problems in coloproctology is chronic idiopathic anal pain. The aim of this study was to investigate the psychosomatic components of proctalgia to identify which, if any, component is associated with this pain and to what extent.METHODS:Twenty patients with proctalgia were observed (mean age, 46 years). Psychologic consultations were required by the surgeons, because of persistent symptoms, to allow a better understanding of the problem and a more integrated therapy. The psychologic investigation consisted of three interviews and administration of the following tests: Institute for Personality and Ability Testing Anxiety Scale Questionnaire (1‐10), Rorschach test (Klopfer and Davidson method), and Draw‐A‐Person test by Karen Machover. This sample was compared with a control group composed of 40 healthy subjects, homogeneous in age, social and working conditions, and investigation procedures.RESULTS:Patients showed depression and anxiety according to standard validated questions (Institute for Personality and Ability Testing Anxiety Scale Questionnaire) and personality disorders; they had a strong tendency to use primitive defense mechanisms and showed a lack of personality formation.CONCLUSIONS:Psychologic investigation allows a progressive clarification of all the components of anal pain. This might be useful not only for research purposes but also for a more effective approach to these patients.

ISSN:0012-3706    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

&NA;The gastrointestinal tract is the most common extranodal site of primary non‐Hodgkin's lymphoma. We present a case of a 50‐year‐old male with primary B cell lymphoma arising in an S‐pouch eight years after a total proctocolectomy for ulcerative colitis. After chemoradiotherapy the patient remained asymptomatic, with an intact S‐pouch. Pouch conservation is feasible in patients with primary lymphoma of the pouch, using chemoradiotherapy and close follow‐up examinations.

ISSN:0012-3706    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

INTRODUCTION:Crohn's disease‐associated colorectal cancer may occur in an area of defunctioning bowel. Some patients with Crohn's colitis undergo subtotal colectomy, ileostomy, and low Hartmann's procedure in an effort to preserve the rectum. This procedure has also been advocated for patients with severe anorectal Crohn's disease, in whom nonhealing of the perineal wound after proctectomy occurs with alarming frequency. The authors present a review of the literature and three cases of cancer developing in the defunctioning rectal stump despite surveillance proctoscopy.METHODS:Twenty‐five patients underwent low Hartmann's procedure for severe anorectal Crohn's disease. Surveillance proctoscopy was performed as follow‐up. Development of cancer in the rectal remnant or anus or recurrence of symptoms was managed by resection and adjuvant therapy.RESULTS:One patient developed squamous‐cell carcinoma of the anal canal, underwent resection and adjuvant therapy, and was disease free at the time of this study. Two patients developed adenocarcinoma of the rectum. Both underwent resection and adjuvant therapy. One patient died and the other developed a recurrence.CONCLUSIONS:The authors recommend interval perineal proctectomy in all patients undergoing low Hartmann's procedure for severe anorectal Crohn's disease in whom rectal preservation is not possible. Regularly scheduled interim surveillance proctoscopy performed every two years, with biopsies of macroscopically normal‐appearing and abnormal‐appearing rectal mucosa and curetting of fistulous tracts, is also recommended to decrease the possibility of missing occult malignancies.

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 describe the technique of radical excision of multifocal anal intraepithelial neoplasia and discuss controversial issues surrounding the management of this condition.METHOD:We describe the case of a 31‐year‐old female with previous vulval warts, vulval squamous carcinoma, and recent immunosuppression who had widespread anal intraepithelial neoplasia excised, and the resulting defect was split‐skin grafted, including the anal canal.RESULTS:Excision and split‐skin grafting was successful in removing the disease and left a satisfactory cosmetic and functional result.CONCLUSION:Diffuse, high‐grade, anal intraepithelial neoplasia is rare. Excision of these lesions remains controversial but may be the best option.

ISSN:0012-3706    

出版商:OVID    

年代:2000

数据来源: OVID