摘要:

&NA;One hundred forty‐three patients irradiated for locoregional recurrences after curative surgery for cancer of the rectum and sigmoid were studied retrospectively. An analysis was made of the symptomatic response and survival in the total series and in three subgroups treated with different dose levels (40 Gy or lower, between 40 and 50 Gy, 50 Gy or higher). The symptom‐free period was calculated as percent of the overall survival. Symptomatic control was obtained in 80.4 percent of the cases, and the crude patient survival rate was 17.5 percent at two years. No significant difference was found in the three subgroups treated with different dose levels. The cumulative time/patient asymptomatic periods in the total series and in the three subgroups were 31.5, 30.2, 31.8, and 31.9 percent respectively, of the survival period.

ISSN:0012-3706    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

&NA;Using a microtip pressure transducer, anorectal manometry was performed in 119 patients with symptomatic hemorrhoids. In 96 patients (80.7 percent), a high anal pressure (>125 cm/H2O) was found. These patients were treated by lateral internal sphincterotomy, carried out under local anesthesia. In 23 patients 919.3 percent), a normal or low anal pressure (<125 cm/H2O) was found. These patients were treated by band ligation or hemorrhoidectomy. The clinical results after lateral internal sphincterotomy (success rate, 75.3 percent) suggest that this procedure is a good alternative in selected patients.

ISSN:0012-3706    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

&NA;Urine polyamine content is increased in patients with colorectal malignancy and may be a useful tumor marker in the management of these patients. Urinary excretion of putrescine and spermidine was measured preoperatively and in the first week postoperatively in nine patients with inflammatory bowel disease, eight with other benign colorectal disease, and 13 with colorectal cancer. Preoperative urine putrescine levels were elevated similarly in patients with inflammatory bowel disease and malignancy. Polyamine levels were increased in all three groups in the early postoperative period. Urinary polyamine excretion did not correlate with serum CEA levels, tumor volume, or stage of disease in patients with cancer. Because elevated levels of urinary polyamines are not specific for malignancy and do not correlate with other prognostic indicators, such measurements are unlikely to be useful in tumor detection and determining prognosis. Polyamine levels, however, may prove useful in monitoring response to therapy and detecting recurrences in individual patients.

ISSN:0012-3706    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

&NA;Eighteen trainees with no prior fiberoptic endoscopic experience performed a total of 305 fiberoptic sigmoidoscopies using a colonoscope. Basic training, consisting of reading materials, lecture instructions, practice on a colon model, and observation of procedures, was completed prior to beginning patient examinations. Additional instruction was given between examinations. The performance of these examinations was an individual effort on the part of the trainee without verbal or mechanical assistance from the instructor after the initial ten examinations. All were performed with an instructor viewing through a teaching attachment. Total insertion distance was ≥30,≥40,≥50, ≥60 cm in 65, 60, 46, and 20 percent of examinations, respectively. Overall performance was better in those with prior rigid sigmoidoscopic experience (20 examinations). The mean examination time was 11.8 minutes. These data help to define the appropriate length of fiberoptic sigmoidoscope recommended for use by inexperienced endoscopists.

ISSN:0012-3706    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

&NA;Although the colonofiberscope has undergone various modifications and improvements, the insertion principle remains unchanged; that is pushing and rotation and the elasticity of the scope itself are inevitable. It often is difficult to maintain proper balance among these dynamic factors; imbalance prevents deep insertion. Over‐elongation of the scope leads to insertion failure, particularly if there are adhesions of the sigmoid colon, overextension of the colon, or transverse colon ptosis. Our “leading cord” method is an excellent aid to colonofiberscopy. It can be inserted from the clamp hole of a conventional fiberscope and hardened to straighten the scope, thereby permitting deep insertion. With this technique the region from the rectum to the descending colon, as well as a ptosed transverse colon, can be straightened. Our clinical experience indicates that the rate of successful insertions in colonofiberscopy will be increased considerably with this complementary device.

ISSN:0012-3706    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

&NA;The double stapling technique (TA‐55®and EEA®staplers) was used to perform low anterior resections for rectal carcinomas in 79 patients (49 men, 30 women). The mean age was 66 years (range, 38 to 85 years). Curative resections were performed in 68 patients, and palliative resections in 11 patients. The mean level of the cancer from the dentate line was 9 cm (range, 5 to 16 cm). The mean follow‐up has been 29 months (range, four to 58 months). Perioperative mortality was 2.5 percent (two patients). Technical problems related to the stapling technique occurred in 6 percent (five patients). The clinical anastomotic leak rate was 8 percent (six patients). There were 11 local recurrences among 68 curative resections (16 percent). Local recurrence according to individual surgeon showed marked variability (range, 0‐43 percent,P>0.05). There were no differences in location, differentiation, or stage in those that recurred. The mean distal resection margin for the recurrent cancer group was 3.0 cm and for the nonrecurrent group, 2.9 cm. Disturbances of continence were seen commonly (56 percent) in the first three months after surgery, but 85 percent of patients became fully continent with an acceptable bowel habit at later follow‐up. The double stapling technique is useful for the restorative resection of suitable mid and low rectal cancers. The anastomotic leak rate, local recurrence rate, and functional results are acceptable.

ISSN:0012-3706    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

&NA;Forty‐six patients were diagnosed as having schistosomal, tuberculous, or amebic colitis over a two‐year period using colonoscopy and biopsy. Both schistosomal and tuberculous colitis could be diagnosed by characteristic endoscopic and histologic features in the majority of cases. Colonoscopy provided the added advantage of endoscopic polypectomy at the diagnostic session itsell. The yield of granulomas in tuberculous lesions was 100 percent, although acid‐fast bacilli could not be recovered from any. The endoscopic picture of amebic colitis often resembles that of inflammatory bowel disease; hence endoscopic biopsies are of paramount importance in establishing a correct diagnosis, especially in developing countries where both diseases exist with considerable frequency.

ISSN:0012-3706    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

&NA;Histologic criteria for malignancy in colonic adenomas have been well established, but little has been written regarding the gross or macroscopic appearance of malignant adenomas. The following nine criteria, listed in order of most to least importance, were used to endoscopically evaluate polypoid lesions of the colon: friability, ulceration, firmness, the dunce cap sign, lobulation, asymmetry, size, macroscopic growth pattern, and color. Three cases of the dunce cap adenoma are reported in detail. In evaluating 121 consecutive colonic lesions, 87 percent were resected endoscopically. Eleven carcinomas, three villous adenomas, and two lipomas were not removed via the endoscope.

ISSN:0012-3706    

出版商:OVID    

年代:1986

数据来源: OVID

ISSN:0012-3706    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

&NA;Traumatic, clostridial myonecrosis is a rare and serious complication of wounds. Nontraumatic, metastatic, clostridial myonecrosis may be caused by carcinoma of the large intestine. Nontraumatic myonecrosis becomes evident with localized pain, generalized toxicity, local signs of inflammation, and crepitation. Serum creatine kinase determinations may be of help in diagnosing patients suspected of having acute myonecrosis. Immediate heroic surgical intervention, usually with demonstration ofClostridium septicum, is mandatory to control the myonecrosis. Appropriate antibiotic therapy is a valuable adjunct to surgical intervention, and penicillin in massive doses appears to be the agent of choice for the clostridia. Hyperbaric oxygen therapy may help in the optimal control. General supportive measures, including frequent blood transfusions, are most important. To save the life of the patient with nontraumatic, metastatic, clostridial myonecrosis, it is necessary, as soon as the patient's general condition permits, to diagnose and eliminate the cause of the myonecrosis. In addition to the case reported, 16 cases have been reported in the literature, making a total of 17. Five patients have survived (survival rate, 29 percent).

ISSN:0012-3706    

出版商:OVID    

年代:1986

数据来源: OVID