摘要:

&NA;Twelve patients who underwent total colectomy and J‐pouch‐anal anastomosis were followed up to 3 years after surgery to evaluate the functional and morphologic changes of the small‐bowel reservoir. Intestinal absorption was impaired for lactose in 18 percent, for D‐xylose in 27 percent, and for75SeHCAT in 83 percent. Morphologic changes in ileal‐pouch specimens consisted of a marked flattening of the villi and augmentation in crypt number and length. The number of Paneth's cells was increased compared with normal ileum. Parameters, indicating neorectal function such as stool frequency, pouch volume, and intestinal transit, improved in time during the postoperative course. Because of impaired small‐bowel function, which is not restricted to the pouch reservoir, the ileum acquires progressive colonic capacities in accordance with its morphologic transformation to a colonic type mucosa. None of our patients developed clinical malabsorption requiring regular therapeutic substitution beyond a well‐balanced diet due to these morphologic and functional changes and postoperative acceptance was good or excellent in all but one case.

ISSN:0012-3706    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;The prognostic usefulness of four variables and four staging systems were evaluated by the Akaike Information Criterion (AIC) and conventional statistical tests for survival time analysis (log rank test, generalized Kruskal‐Wallis test, and linear trend test), based on the data of 394 colorectal cancer patients who had been followed for more than 5 years after surgery. The four variables were the histopathologic findings of cancer penetration through the bowel wall (w), lymphnode metastasis (n), intraoperative observations of liver metastasis (H), and peritoneal dissemination (P). They were graded according to the general rules proposed by the Japanese Society for Cancer of the Colon and Rectum (JRSCCR). The stagin systems were Turnbull's modification of Duke's classification, UICC's TNM system, the Japanese classification proposed by JRSCCR, and the authors' modification of the latter. AIC was calculated by changing the cutoff points of survival time, as well as by reclassifying predictor variables into two categories by different levels. The results of the standard tests differed from those of AIC in the evaluation of the four variables. The former statistics showed that the intraoperative observations were of more prognostic importance than the histopathologic findings, whereas AIC revealed that the histopathologic variables have more prognostic information except for prediction of early outcome. Further analysis of the w‐factor showed that survival is more drastically changed by serosal involvement or extensive extramuscular invasion than by penetration of the muscularis propria. Analysis of the n‐factor indicated that a major change in survival time occurs twice,i.e., when lymphonode metastasis occurs and when it extends beyound the paracolic level. Compared with single variables, the staging system using multiple factors gives more information on both early and long‐term outcomes. The authors conclude that AIC analysis provides prognostic information that cannot be obtained with conventional tests.

ISSN:0012-3706    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;The economic crisis in which Venezuela is living, caused by the fall in oil prices, has forced the government to reorganize its medical services. A central administrative organ, the National Health Service, has been created. It seeks to develop a social medicine directed at the less favored classes of the population. Notwithstanding the continuously rising costs of private medicine, which, until now, the government has permitted without restrictions, the shadow of government intervention looms ominously over private practice, where subemploymed of doctors already exists, along with the growing tendencies of insurance companies to impose economic conditions. The Venezuelan Medical Federation, which, by law, groups all Venezuelan doctors, has began a battle on two main fronts: against the State intervention and against the insurance companies who hope to benefit at the expense of the already underpaid doctors.

ISSN:0012-3706    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;A patient with familial adenomatous polyposis was treated with colectomy, mucosal proctectomy, and a straight ileoanal anastomosis in 1962. Thirteen to 21 years later recurrent adenomas developed at the ileoanal anastomosis, and 25 years after the operation multiple adenomas were found in the terminal ileum up to 12 cm from the ileoanal anastomosis. It is concluded that colectomy and mucosal procectomy, with or without an ileoanal reservoir, does not eliminate the future risk of adenoma formation. Thus, this method should be used only in selected polyposis patients

ISSN:0012-3706    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;Spontaneous umbilical fistula in Crohn's disease is extremely rare, with very few reports found on a 15‐year review of the medical literature. Among those reports, no patient had prior abdominal surgery. Attention was recently focused on this unique entity when spontaneous umbilical fistula was diagnosed in a 64‐year‐old anemic male mechanic with known ileocolic Crohn's disease. This fistula locus occurred despite a right lower quadrant appendectomy incision done 15 years earlier. Spontaneous umbilical fistula pathophysiology and pathways are reviewed.

ISSN:0012-3706    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;In a review of 5424 colonoscopies performed in the last ten years at Bronx‐Lebanon Hospital Center, 14 perforations related to the procedure were found. Seven perforations occurred during therapeutic colonoscopies (polypectomies) and seven during diagnostic colonoscopies. Eight patients were treated surgically and six nonsurgically. The decision about whether or not to perform surgery for a colonoscopically induced perforation depends on the clinical condition of the patient. Nonsurgical management is indicated if the patient's general condition remains stable, if the perforation has been diagnosed late, if the pneumoperitoneum that led to the diagnosis does not increase in size, if there are no signs of peritonitis, if the patient does not have a distal obstruction, and if the patient's condition improves in response to conservative treatment.

ISSN:0012-3706    

出版商:OVID    

年代:1989

数据来源: OVID

ISSN:0012-3706    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;The increasing use of pelvic radiotherapy has necessitated the study of ways to avoid radiation enteropathy. The authors have been using a pelvic sling to keep the small intestine out of the pelvis and because of the difficulties encountered, believe the method that has evolved is worthy of description.

ISSN:0012-3706    

出版商:OVID    

年代:1989

数据来源: OVID

ISSN:0012-3706    

出版商:OVID    

年代:1989

数据来源: OVID

ISSN:0012-3706    

出版商:OVID    

年代:1989

数据来源: OVID