摘要:

PURPOSE:This study was undertaken to assess results of surgical repair of rectocele and to identify possible determinants of outcome from patient's history and preoperative defecography. Another aim was to evaluate how surgery affects rectal evacuation.METHOD:Thirty‐four women with constipation and rectal emptying difficulties underwent surgery with a transanal technique. A preoperative defecography was performed in each patient. They were followed up after a median of 10 (range, 2‐60) months with a questionnaire (n=34) and a defecography (n=31). Computer‐based image analysis of defecographies was used to evaluate rectal evacuation.RESULTS:In 27 patients (79 percent), the result of surgery was good with subjectively improved emptying. The need for vaginal or perineal digitation preoperatively was related to a good result(P<0.05), whereas a previous hysterectomy(P<0.01) and a large rectal area on defecography(P<0.01) related to a poor result. Preoperative use of enemas, motor stimulants, or several types of laxatives also related to a poor outcome(P<0.05). Surgical treatment resulted in reduction of the rectocele(P<0.001), an elevated position of the anorectal junction(P<0.05), and improved rectal evacuation on defecographies(P<0.001).CONCLUSIONS:Surgical repair reduces the size of the rectocele and improves rectal emptying. These changes are accompanied by a symptomatic improvement in the majority of patients. Preoperative patient data and defecography may help in selecting patients for surgery.

ISSN:0012-3706    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

BACKGROUND:Idiopathic slow‐transit constipation may be a pangastrointestinal motility disorder. We have screened patients referred to surgery for constipation for the presence of biliary dyskinesia.METHOD:Patients had cholecystokinin‐augmented trimethyl‐3‐bromo iminodiacetic acid scans to measure gallbladder ejection fraction.RESULTS:There is a significant difference in gallbladder ejection fraction between patients with idiopathic slow‐transit constipation (median value, 28.5) compared with patients with other causes of constipation (median value, 71; Mann‐Whitney,P=0.0025).CONCLUSION:Idiopathic slow‐transit constipation may be a pangastrointestinal motility disorder.

ISSN:0012-3706    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

&NA;Since its introduction into clinical medicine, flexible fiberoptic colonoscopy has had a great impact on diagnosis and management of diseases of the colon and rectum. There are three mechanisms responsible for colonoscopic perforation: specifically, mechanical perforation directly from the colonoscope or a biopsy forceps, barotrauma from overzealous air insufflation, and, finally, perforations that occur during therapeutic procedures. Perforation of the colon, which requires surgical intervention more frequently than bleeding, occurs in less than 1 percent of patients undergoing diagnostic colonoscopy and may be seen in up to 3 percent of patients undergoing therapeutic procedures such as polyp removal, dilation of strictures, or laser ablative procedures. Management of colonic perforation secondary to colonoscopy remains a controversial issue in that it can be effectively managed by operative and nonoperative measures. If a perforation does occur, signs and symptoms that the patient will experience will be related to both the size and site of the perforation, adequacy of the bowel preparation, amount of peritoneal soilage, underlying colonic pathology (where a thin walled colon from colitis or ischemia, for example, may result in a larger perforation than a healthy colon), and, finally, overall clinical condition of the patient. Radiology often establishes diagnosis. Plain films of the abdomen and an upright chest x‐ray may reveal extravasated air confined to the bowel wall, free intraperitoneal air, retroperitoneal air, subcutaneous emphysema, or even a pneumothorax. A localized perforation may demonstrate lack of pneumoperitoneum. Some surgeons recommend surgery for all colonoscopic perforations; however, there does appear to be a role for conservative management in a select group of patients such as those with silent asymptomatic perforations and those with localized peritonitis without signs of sepsis that continue to improve clinically with conservative management. Finally, conservative management works well in those patients with postpolypectomy coagulation syndrome. Surgery is most definitely indicated in the presence of a large perforation demonstrated either colonoscopically or radiographically and in the setting of generalized peritonitis or ongoing sepsis. The presence of concomitant pathology at time of colonoscopic perforation such as a large sessile polyp likely to be a carcinoma, unremitting colitis, or perforation proximal to a nearly obstructing distal colonic lesion may force immediate surgery. Finally, in the patient who deteriorates with conservative management, one should proceed to surgery.

ISSN:0012-3706    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

&NA;The occurrence of small‐bowel cancer in Crohn's disease (CD) is a rare event. The risk seems to be greatest in patients with long‐standing disease. Strictureplasty has proved to be a valuable alternative in the management of Crohn's strictures of the small‐bowel. Critics and proponents of strictureplasty for selected patients with smallbowel Crohn's disease have voiced their concerns about cancer risk in the strictured or strictureplasty site. To date, there has been no clear or detailed report of such an occurrence. The authors report the first case of small‐bowel adenocarcinoma arising at the site of a previous strictureplasty. In this patient, biopsies of the strictures at the original operation confirmed CD and excluded both cancer and dysplasia. Malignancy occurred seven years later at a strictureplasty site. The main clinical sign associated with the adenocarcinoma was severe, persistent anemia. The authors conclude that the risk of adenocarcinoma developing at the site of a previous strictureplasty for CD, although small, is real.

ISSN:0012-3706    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

PURPOSE:Malignant rhabdoid tumors were first described in the kidney as a rare variant of Wilms' tumor with a “rhabdomyosarcomatoid” pattern and a particularly poor prognosis. Further studies have demonstrated these neoplasms as a distinct clinicopathologic entity. Subsequently, tumors with a similar histologic appearance, demonstrating the “rhabdoid” cells, have been found in a variety of extrarenal sites.METHODS:We report here a case of malignant rhabdoid tumor of the colon studied with selected molecular techniques.RESULTS AND CONCLUSIONS:This tumor demonstrated several unusual findings for malignant rhabdoid tumors of renal or extrarenal sites, including aneuploidy by flow cytometric analysis and a positive nuclear immunohistochemical staining for p53 protein, which suggests presence of p53 gene mutation. DNA analyses, however, failed to demonstrate the presence of point mutation in any of therasfamily genes.

ISSN:0012-3706    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

PURPOSE:The purpose of this manuscript is to present a method of temporary fecal diversion.METHODS:A tube was sutured into the anorectum of eight patients with large infected and/or necrotic perianal lesions that were being soiled and infected by the fecal stream. Five patients were diabetic, two had sacral pressure sores, and one suffered from hidradenitis suppurativa.RESULTS:Tubes remained in place from 10 to 14 days, during which time the infective condition was brought under control. There were no complications.CONCLUSIONS:The difficulties and disadvantages of current medical and surgical methods of controlling the fecal stream under these conditions are discussed, and the method presented is suggested as a viable and simple alternative.

ISSN:0012-3706    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

PURPOSE:Anorectal surgery has been increasingly performed as an ambulatory procedure using general, regional, and local anesthesia. Local anesthesia is classically performed through infiltration of four quadrants around the anal verge, which renders the procedure painful and uncomfortable for most surgeons and patients. We present a new, painless technique of local anesthesia for anorectal surgery.METHODS:Patients with surgical risk Classes I and II (American Society of Anesthesiologists) bearing anorectal pathologies were sedated and placed on the operating table in the prone jackknife position. After local antisepsis, the anal canal was lubricated with 2 percent lidocaine gel, and the mucosa was punctured by a hook‐shaped, curved, 22‐gauge needle just above the pectinate line. A solution of local anesthetics was slowly infused in all four quadrants to the submucosal level. If needed, more anesthetics were infused during the operation.RESULTS:This technique was easily and painlessly applied in more than 60 patients and permitted execution of several ambulatory anorectal procedures with comfort and safety.CONCLUSIONS:The hookneedle puncture for local anesthesia is an effective and safe procedure and may be routinely used for ambulatory anorectal surgery in selected patients.

ISSN:0012-3706    

出版商:OVID    

年代:1996

数据来源: OVID

ISSN:0012-3706    

出版商:OVID    

年代:1996

数据来源: OVID

ISSN:0012-3706    

出版商:OVID    

年代:1996

数据来源: OVID

ISSN:0012-3706    

出版商:OVID    

年代:1996

数据来源: OVID