ISSN:0012-3706    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

PURPOSE:By considering the pathophysiologic basis of inflammatory bowel diseases, a role for excessive lipid peroxidation caused by oxygen free radical compounds has been proposed repeatedly. However, to date only a few studies are available on this topic in human beings. This study was designed to assess breath alkanes in a group of patients with active inflammatory bowel disease by a technique that clearly distinguishes pentane from isoprene, to prevent overestimation of values as in previous studies.PATIENTS:Twenty patients with a diagnosis of active inflammatory bowel disease (10 with Crohn's disease and 10 with ulcerative colitis) were studied. Extension of the disease was similar between patient groups, and all were treated with equivalent doses of steroids and salicylates.METHODS:Breath alkanes determination was performed by a standard procedure involving a gas cromatography column able to separate pentane from isoprene.RESULTS:Overall, significant differences between patients with inflammatory bowel diseases and controls were found for ethane, propane, and pentane, but not for butane and isoprene. Isoprene was clearly distinguished from pentane, demonstrating that the significant elevation of pentane levels in patients with inflammatory bowel diseases is a real phenomenon and not an artifact caused by coelution with isoprene.CONCLUSIONS:An excess of lipid peroxidation is probably an important pathogenetic factor in inflammatory bowel diseases, and this may be assessed through a nonivasive method. Because this method previously also has been shown to be able to evaluate disease activity, it could be a useful tool for studying patients with inflammatory bowel diseases.

ISSN:0012-3706    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

PURPOSE:The aim of this study is to demonstrate whether anorectal function after anterior resection with side‐to‐side anastomosis results in better clinical outcomes than endo‐to‐end anastomosis in patients with carcinoma of the upper half of the rectum.METHODS:Anorectal function was studied in two groups of patients who had anterior resection, those with end‐to‐end anastomosis (Group E; n=11) and those with side‐to‐side anastomosis (Group S; n=11). Eight control subjects who had sigmoid colectomy for carcinoma were also studied. Each patient underwent manometric study and was questioned about clinical bowel symptoms before the operation and 3, 6, and 12 months postoperatively.RESULTS:The median length of residual rectum in both Group S and Group E was 7 cm. No significant difference was observed in maximum anal resting pressure and maximum squeeze pressure between the groups before and after operation. Maximum tolerable volume in Group S was significantly higher than that in Group E and was close to that in the control group at each postoperative interval. Median volumes in Group S were 200 ml (3 months), 220 ml (6 months), and 220 ml (12 months). Median volumes in Group E were 140 ml (3 months), 150 ml (6 months), and 175 ml (12 months). Bowel frequency per 24 hours at three and six months postoperatively was significantly greater in Group E than in Group S or the control group. Median frequency in Group E was four times (3 months) and three times (6 months) per 24 hours. Median frequency in both Group S and the control group was two times (3 months) and two times (6 months) per 24 hours. Postoperative urgency of defecation was not found in Group S, significantly less frequent than in Group E at three months.CONCLUSION:Side‐to‐side anastomosis may lead to a better clinical outcome than end‐to‐end anastomosis for carcinoma of the upper half of the rectum in the adaptation phase.

ISSN:0012-3706    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

PURPOSE:We noted the combination of obstructed defecation or constipation and fecal incontinence, the poor results of abdominal rectopexy for constipation, and the well‐known risk of postoperative induction of constipation after rectopexy. We developed a new operation to treat patients with constipation or fecal incontinence (with a concomitant rectocele, internal rectal intussusception, enterocele at dynamic defecography, or all three) or both. This new rectopexy technique avoided dorsolateral mobilization of the rectum and did not endanger the hypogastric nerves and pelvic autonomic nerves. A better effect on constipation compared with rectopexies with dorsolateral mobilization was expected.METHODS:The results of this new operation, which was called rectovaginopexy, were studied prospectively in a series of 27 patients. Four‐year results were obtained. Preoperative and postoperative questionnaires, dynamic defecograms, and anorectal physiology studies were analyzed.RESULTS:Before the operation 17 patients were constipated, compared with 4 patients one year after rectovaginopexy (76 percent improvement;P=0.0015) and 5 patients four years after rectovaginopexy (71 percent improvement;P=0.005), respectively. At one year, fecal incontinence decreased significantly: 15 of 17 patients improved and 9 patients became fully continent (P=0.0007). Four years after rectovaginopexy the effect on fecal incontinence was no longer significant (P=0.09). Rectovaginopexy restored anatomy: all (9) enteroceles, all but 1 (17) internal rectal intussusception, and 12 of 20 rectoceles dissolved, and the majority were reduced in size. Rectal sensation for distention was unchanged, and rectal electrosensitivity improved (P=0.04).CONCLUSIONS:Rectovaginopexy provides significant one‐year improvement of both constipation and fecal incontinence. The positive effect on constipation did not deteriorate with time, in contrast to the effect on fecal incontinence.

ISSN:0012-3706    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

PURPOSE:The significance of anal sphincter injury from transanal inserted staplers was studied. A randomized, controlled comparison was made of anorectal manometry and clinical function after sigmoid colectomy (avoiding nerve injury from rectal mobilization), anastomosed by either transanal inserted stapler or biofragmentable anastomotic ring (avoiding anal manipulation).METHOD:Fifty‐eight consecutive patients with sigmoid adenocarcinoma were randomly assigned to transanal inserted stapler or biofragmentable anastomotic ring groups. Anorectal manometry and clinical bowel function assessment were performed by an independent blinded observer before surgery and six weeks and six months after surgery.RESULTS:At six weeks after surgery, there was significant impairment of mean anal resting pressures (mean impairment, 23 percent;P<0.001) and physiologic anal length (mean impairment, 31 percent;P<0.01) in the transanal inserted stapler group (27 completed the trial), but not in the biofragmentable anastomotic ring group (18 completed the trial). Pressures remained impaired at six months. When changes in the anal pressures were compared between groups, the mean anal resting pressure (P<0.001) and maximum squeeze pressure (P<0.01) at six weeks and mean anal resting pressure at six months (P<0.01) were significantly more impaired in the transanal inserted stapler group. Postoperative bowel function was not different between the two groups. Postoperative complications were similar. In the transanal inserted stapler group one patient died of anastomotic leak sepsis and one had wound infection; in the biofragmentable anastomotic ring group one patient died of myocardial infarct and one had wound infection.CONCLUSION:Direct injuries to the internal anal sphincter occurred after transanal inserted stapler but not biofragmentable anastomotic ring anastomoses. Clinical function was not correspondingly affected, probably because of the adequate residual rectal reservoir after sigmoid colectomy.

ISSN:0012-3706    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

PURPOSE:Persistent perineal sinus is a source of morbidity after proctocolectomy for Crohn's disease. This study examined the factors responsible for persistent sinus after proctocolectomy for Crohn's disease. We also assessed the outcome of surgical treatment for persistent perineal sinus.METHODS:The records of 145 patients who underwent proctocolectomy for Crohn's disease between 1970 and 1997 were reviewed.RESULTS:Persistent sinus occurred in 33 (23 percent) patients after proctocolectomy. Factors associated with a significantly greater risk of perineal sinus were younger age (P=0.006), rectal involvement (P=0.02), perianal sepsis (P=0.0005), high fistulas (P=0.04), extrasphincteric excision (P=0.0004), and fecal contamination at operation (P=0.0003). Multivariate analyses showed that age (P=0.0001), rectal involvement (P=0.007), and fecal contamination (P=0.009) were significant independent predictive factors for perineal sinus. Fifty‐six operations, including 24 radical excisions, two rectus abdominis flaps, four gracilis transpositions, and two omentoplasties were performed in 24 patients with persistent sinus, but only 9 achieved healing. Long sinuses (>10 cm) and sinuses presenting late (>12 weeks after proctocolectomy) were seldom cured by surgical treatment.CONCLUSION:Persistent perineal sinus is more likely to occur if an extrasphincteric dissection is needed because of extensive anorectal disease or if fecal contamination occurs at operation. Attempted surgical eradication of perineal sinus is often ineffective.

ISSN:0012-3706    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

PURPOSE:The majority of colorectal neoplasms diagnosed are adenocarcinomas. Other histologies such as squamous, adenosquamous, carcinoid tumors, or lymphoid tumors are occasionally identified. Given the rarity of squamous‐cell tumors, it is very difficult to study their natural course and response to therapy. An attempt is made to describe the frequency, anatomic location, and response to therapy with a review of the literature.METHODS:From the Cancer Registry at the University of Missouri‐Columbia Ellis Fischel Cancer Center, tumors of the colon identified above the dentate line were selected for chart review. Data were extracted from cases between the years 1940 and 1996. The key terms used to identify cases were epidermoid, squamous cell, and cancer of the rectum or colon. Using this approach, forty patients were identified and each record was reviewed.RESULTS:The majority of these cases were anal cancers with proximal extension into the rectum and were excluded. Of 4,561 cases of epithelial colon and rectal cancers identified, only one additional case of squamouscell cancer could be verified. In this report we describe a patient with a primary squamous‐cell carcinoma of the sigmoid colon with metastatic disease to the liver at diagnosis who responded to systemic chemotherapy. We believe this to be the first reported case of this rare tumor type in which the patient's tumor responded to systemic chemotherapy. Two cases with a thorough review of literature are presented.CONCLUSIONS:Primary squamous‐cell carcinoma of the colon is a rare malignancy of unknown cause and pathogenesis. Metastatic tumors to the colon should be ruled out in all cases before therapy. Early detection and surgery remain the main therapeutic options, but as presented in our case, response to chemotherapy in advanced disease is encouraging.

ISSN:0012-3706    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

PURPOSE:A case of anal tuberculosis in an otherwise asymptomatic patient with bleeding anal ulcers is presented. The clinical features of this entity and the problems in differential diagnosis between anal infectiousvs. inflammatory diseases are discussed.METHODS:The management and outcome of the case of an adult patient who presented with perianal ulcers is described.RESULTS:On a three‐drug antituberculous regimen, symptoms abated, radiographic infiltrates improved, and perianal ulcers healed.CONCLUSION:Anal tuberculosis is an extremely rare disease. A tuberculous origin must be considered when the cause of perianal ulcers is unclear to avoid undesirable delays in the diagnosis and treatment of this disease.

ISSN:0012-3706    

出版商:OVID    

年代:1999

数据来源: OVID

ISSN:0012-3706    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

PURPOSE:Pseudomyxoma peritonei is a rare disease characterized by mucinous ascites and associated with ruptured mucocele, cystadenoma, and low‐grade carcinoma arising from the appendix, ovaries, or colon. Metastases and extraperitoneal involvement are extremely rare events.METHOD:This is a case report of a patient with pseudomyxoma peritonei with pleural involvement.RESULTS:A 38‐year‐old male patient with a pseudomyxoma peritonei from appendiceal origin underwent an extensive cytoreduction procedure. During the operation pleural involvement was noted. This was later confirmed by thoracoscopy. An expectant policy was followed until the patient became symptomatic with progressive disease in the abdomen and both pleural cavities. With systemic chemotherapy (5‐fluorouracil and leucovorin), a good clinical response was obtained, and the patient was alive with stable disease 2.5 years after the first diagnosis.CONCLUSIONS:Involvement of the pleural cavity by pseudomyxoma peritonei is rare and carries an unfavorable prognosis. Whenever possible, the same guidelines as for intra‐abdominal disease should be followed: extensive cytoreductive procedures with local and/or systemic chemotherapy. In our patient we hope to achieve a prolonged palliation with systemic chemotherapy.

ISSN:0012-3706    

出版商:OVID    

年代:1999

数据来源: OVID