摘要:

INTRODUCTION:We have reported previously on anin vitromodel to examine tumor cell adherence to metal and plastic laparoscopic ports and to port sites through which they had been passed. This demonstrated that increased numbers of tumor cells were found both on metal ports compared with plastic ports and on the port sites through which metal ports had passed. In this study, thein vivoadherence of such cells to ports and port sites was investigated.METHODS:LIM 1215 tumor cells were injected under direct vision into the pelvises of 16 30‐kg female pigs (range, 15‐70 × 106 cells). A total of 12 ports were inserted through each anterior abdominal wall (6 metal and 6 plastic), and these were either leftin situfor 30 minutes (nondisplaced) or were removed twice and replaced through the original wound (displaced).RESULTS:Increasing the tumor cell inoculum resulted in increased deposition of tumor cells on both ports (P= 0.002) and on the port sites (P= 0.017). Significantly more tumor cells adhered to metal ports than to plastic ports (P= 0.04), although this failed to reach significance for the sites through which metal ports had been passed (P= 0.066). Although displacement of ports did not increase the number of tumor cells that adhered to ports (P= 0.45), this did result in more tumor cells being deposited on the port sites (P= 0.01).CONCLUSIONS:These data suggest that minimizing the number of tumor cells within the abdominal cavity, using plastic ports, and securing ports to prevent inadvertent displacement would be expected to reduce the number of tumor cells deposited in port sites during operative laparoscopy. This may be beneficial in reducing the incidence of port‐site metastases after laparoscopic surgery for gastrointestinal malignancies.

ISSN:0012-3706    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

PURPOSE:Thromboembolism is a significant cause of morbidity and mortality in inflammatory bowel disease. Several prothrombotic conditions have been investigated in inflammatory bowel disease. The aim of this study was to evaluate the incidence of symptomatic postoperative superior mesenteric vein thrombosis in inflammatory bowel disease patients undergoing colonic resections and to identify and characterize their clinical presentation.METHODS:Between January 1999 and December 2001, 83 consecutive patients undergoing total colectomy for inflammatory bowel disease were studied retrospectively. Patients who developed new‐onset postoperative acute abdominal pain were evaluated by CT scan of the abdomen. A complete coagulation profile, including thrombin time, platelet count, protein C, protein S, antithrombin III, homocysteine level, factor V Leiden mutation, plasminogen, and prothrombin G20210A mutation, was obtained in patients diagnosed with superior mesenteric vein thrombosis.RESULTS:Four patients (4.8 percent; 3 females; 3 patients with ulcerative colitis and 1 with Crohn's colitis) developed symptomatic postoperative superior mesenteric vein thrombosis. Two of these patients had extension of the clot into the portal vein. Their presenting symptom was abdominal pain, with a median interval of ten days from the index surgery. The hematologic workup was negative in three patients, with one heterozygous for prothrombin G20210A mutation. All patients were treated with systemic anticoagulation for at least six months. One ulcerative colitis patient was diagnosed after abdominal colectomy and underwent an uneventful ileal pouch‐anal anastomosis after systemic anticoagulation.CONCLUSION:Postoperative superior mesenteric vein thrombosis is a more frequent occurrence than previously reported in patients with inflammatory bowel disease. Direct surgical trauma to the middle colic veins, with resulting thrombosis, is likely to be the precipitating factor in a borderline intrinsically hypercoagulable environment. All patients became asymptomatic after systemic anticoagulation and recovered uneventfully.

ISSN:0012-3706    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

INTRODUCTION:Despite antibiotics and aggressive debridement, the mortality rate of Fournier's gangrene remains high. Attempts have been made to study factors that may affect prognosis; however, reliable criteria are still lacking.METHODS:The medical records of 45 patients with Fournier's gangrene who presented at the Ege University Medical Faculty Hospital from January 1990 to May 2001 were reviewed retrospectively to analyze the outcome and identify the risk factors and prognostic indicators of mortality. Univariate analysis was performed using the chi‐squared test and Fisher's exact probability test, then multivariate analysis of statistically significant variables was performed using logistic regression.RESULTS:The most prominent associated disease was diabetes, affecting 55.6 percent of the patients. The overall mortality rate was 20 percent. However, the mortality rate among diabetics was 36 percent (P= 0.002). The other statistically significant predictors of outcome were the interval from the onset of symptoms to the initial surgical intervention (P= 0.001) and the need of fecal diversion (P= 0.009). Multivariate regression analysis disclosed that the interval from the onset of symptoms to the initial surgical intervention and diabetes were independent predictors of mortality (P= 0.001 andP= 0.003, respectively).CONCLUSION:The interval from the onset of clinical symptoms to the initial surgical intervention seems to be the most important prognostic factor with a significant impact on outcome. Given the significantly high mortality rate among diabetics, diabetes is also an independent prognostic factor. Despite the decreased number of idiopathic cases and extensive therapeutic efforts, Fournier's gangrene remains a surgical emergency, and early recognition with prompt radical debridement is the mainstays of management.

ISSN:0012-3706    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

PURPOSE:To identify the risk factors for anastomotic leakage after left‐sided colorectal resections with rectal anastomosis.METHODS:Forty‐four patients with anastomotic leakage identified from a computer‐generated database were compared with 44 control patients standardized for gender, age, and operative indication.RESULTS:The mean hospital stay was significantly prolonged in the leakage group, which resulted in a higher total cost of hospital treatment. The preoperative variables significantly associated with anastomotic leakage included malnutrition, weight loss, hypoalbuminemia, cardiovascular disease, two or more underlying diseases, and use of alcohol. The surgery‐related factors that turned out to be significant were The American Society of Anesthesiologists physical status, operation time greater than two hours, multiple blood transfusions, intraoperative contamination of the operative field, and a short distance of the anastomosis to the anal verge. Obesity, body mass index, diabetes, smoking, serum hemoglobin, serum creatinine, serum bilirubin, bowel preparation, mode of antibiotic prophylaxis, type of anastomosis, technique of stapling, size of stapler used, and use of drain were nonsignificant variables. Malnutrition, weight loss, use of alcohol, intraoperative contamination, long operation time, and multiple blood transfusions remained significant in logistic regression model. Eighty‐six percent of the patients with three or more risk factors of anastomotic leakage belonged to the leakage group.CONCLUSIONS:Patients with multiple risk factors have higher risk for anastomotic leakage. When patients have three or more risk factors, the creation of a protective stoma should be considered in cases with a low rectal anastomosis, and all these patients should be carefully monitored postoperatively for signs of possible leak.

ISSN:0012-3706    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

PURPOSE:Colon gas analysis using abdominal radiography has been reported as a reliable method for assessing functional bowel disorders. The aim of this study was to clarify the relevance of colon gas distribution in postoperative disorders such as constipation and feelings of incomplete evacuation following rectal cancer operation.METHODS:Colon gas volume score was calculated using plain abdominal radiographs and evaluated in 50 patients who had received low anterior resections. Twenty‐one constipated patients who required laxatives and 29 patients who did not were compared in terms of colon gas distribution. In addition, 32 patients with postoperative feelings of incomplete evacuation and 18 patients without such feelings were assessed in similar fashion.RESULTS:Left colon gas scores in patients who required laxatives were significantly higher (2.82 ± 3.23 percent) than in nonusers (1.21 ± 0.96 percent;P< 0.01). Patients with feelings of incomplete evacuation displayed significantly higher left side colon gas scores (2.51 ± 2.66 percent) than those without such feelings (0.77 ± 0.81 percent;P< 0.0001).CONCLUSION:Patients with postoperative functional bowel disorders such as constipation or feelings of incomplete evacuation may experience relatively high volumes of gas in the left colon.

ISSN:0012-3706    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

PURPOSE:The purpose of this article is to review the different aspects of the colonic J‐pouch reconstruction with special focus on functional results and complicationsMETHODS:A MEDLINE search from 1965 to the present with manual search for older articles was used as the basis of this review.RESULTS:Rectal reconstruction using a colonic J‐pouch‐anal anastomosis after excision of extraperitoneal cancers can be performed with acceptable morbidity and good functional results.CONCLUSIONS:Among the different methods of rectal reconstruction now available after total rectal resection for cancer, the colonic J‐pouch may be the optimal choice.

ISSN:0012-3706    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

&NA;Merkel cell tumors are rare neuroendocrine tumors typically found on sun‐exposed areas such as extremities. We describe the case of a 42‐year‐old female with a Merkel cell tumor arising in the anal canal. The tumor was initially thought to represent a hemorrhoid arising during pregnancy and was excised locally after confirmation of extensive metastatic disease. The patient died 13 months after diagnosis with extensive metastatic disease involving the liver. In our search of the world literature there are several reports of neuroendocrine tumors in the rectum; however, no cases of documented Merkel cell tumors arising in the anal canal have been reported. These tumors seem to behave in a very aggressive manner when found in other atypical areas. The presentation symptoms were perianal discomfort and bleeding. Local excision may be the only surgical treatment necessary to control symptoms, given the propensity to early metastases and short life expectancy.

ISSN:0012-3706    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

&NA;Squamous‐cell carcinoma of the anus is an uncommon but treatable gastrointestinal malignancy. Radiation, in addition to chemotherapy, is widely accepted as the standard of care for treatment in most patients. However, significant anal complications, such as stricture, fistula, and ulceration, may result from radiation therapy. Some medical therapies have been used for radiation proctopathy, but treatments for radiation‐induced anal injury other than surgical diversion are unknown. Vitamin A has been shown in laboratory studies to facilitate wound healing and prevent radiation‐induced gastrointestinal damage. However, it has not been used clinically in patients with radiation enteritis, proctopathy, or anal ulceration. We report a case of a patient with human immunodeficiency virus infection who developed a symptomatic anal ulcer after receiving high‐dose radiotherapy for anal squamous‐cell carcinoma. We prescribed 8,000 IU of oral vitamin A twice daily and within seven weeks his anorectal symptoms and anal ulcer completely resolved. Vitamin A seems to be very effective in the treatment of radiation‐induced anorectal damage, with little toxicity and expense.

ISSN:0012-3706    

出版商:OVID    

年代:2003

数据来源: OVID

ISSN:0012-3706    

出版商:OVID    

年代:2003

数据来源: OVID

ISSN:0012-3706    

出版商:OVID    

年代:2003

数据来源: OVID