摘要:

&NA;A retrospective review was conducted of 326 patients undergoing intersphincteric rectal excision for ulcerative colitis. Seventy‐five patients (Group A) had rectal excision with closure of the pelvic peritoneum and packing of the pelvic space via an open perineal wound. One hundred sixty‐nine patients (Group B) had excision without pelvic peritoneal closure, but with the levators and subcutaneous tissue closed and with transabdominal sump suction drainage of the pelvic space. Complete healing for Groups A and B occurred by three months in 42 and 79 percent, respectively, and by six months in 56 and 89 percent. Thirty‐one percent of Group A and 9 percent of Group B were unhealed at one year, and/or required further surgery. When all 326 patients were considered, healing was achieved at three, six, and 12 months, for packed and for closed wounds, in 42 percent and 79 percent, 55 percent and 89 percent, 66 percent and 91 percent, respectively. All these differences are highly significant (P<0.0001). The incidence of small‐bowel obstruction requiring surgery during follow‐up was similar whether the pelvic peritoneum was closed (15.5 percent) or left open (15.7 percent). Other factors which adversely affected perineal wound healing were younger age, a short history of disease, a two‐stage proctocolectomy especially for persistent severe rectal disease, and the presence of perianal disease.

ISSN:0012-3706    

出版商:OVID    

年代:1985

数据来源: OVID

ISSN:0012-3706    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

&NA;To make objective and accurate assessment of depth of invasion in rectal carcinoma, transrectal ultrasonography, was performed on 49 patients with rectal carcinoma. Two types of scanners were available for use;i.e., 5.0 MHz linear array scanner and 3.5 MHz radial scanner. An experimental study using fresh specimen revealed that the middle low echoic layer of the rectal wall corresponded to the muscularis propria. Depth of cancer invasion was assessed as to whether or not invasion had reached the muscularis propria, or whether invasion had gone through the muscularis propria. The result of 5.0 MHz linear array scan was superior to 3.5 MHz radial scan, and was fairly satisfactory. Future studies, using a sonographic probe with higher frequency and better resolution, are expected to produce valuable benefits in deciding indications for local excision of rectal carcinomas.

ISSN:0012-3706    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

&NA;Serum levels of gastrointestinal cancer antigen (GICA) and carcinoembryonic antigen (CEA) were determined in 167 patients with colorectal carcinoma. Eighty‐eight patients were studied preoperatively, and 79 postoperatively, before, at the time of, and after the diagnosis of relapse. The authors aimed to assess how often the GICA test failed,i.e., was false‐negative in patients in whom the CEA test was true‐positive and, more importantly, whether it could give diagnostic information in patients in whom the CEA test failed. Before surgery, serum GICA gave similar information to serum CEA in 56 percent of the patients: true‐positive in 18 percent and false‐negative in 38 percent; less information in 42 percent; and more information in only 2 percent. During the postoperative follow‐up, serum GICA gave similar information to serum CEA in 55 percent of the patients: true‐positive (i.e., rising persistently from a postoperative nadir) in 27 percent and falsenegative in 28 percent; less information in 44 percent; and more information in only 1 percent. Therefore, this test in its present version, where both the catcher and the tracer antibody are the same, NS 19‐9, is redundant.

ISSN:0012-3706    

出版商:OVID    

年代:1985

数据来源: OVID

ISSN:0012-3706    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

&NA;Good clinical practice is based on a continuous reevaluation of one's own work as compared with published standards. That which limits particularly the private practitioner from examining and publishing his data, is not the lack of desire, but the scarcity of opportunities and resources to do so. Computers as tools for data retrieval and analysis for research purposes and patient management have been available for some time. They have been of limited utility for most surgeons because of an inhibiting size and/or training period, and illogical design. The authors discuss the limitations of much of the available computer “tools,” and present a system, METABASE, specifically designed for colon and rectal surgeons to use in their private practices for data retrieval and analysis.

ISSN:0012-3706    

出版商:OVID    

年代:1985

数据来源: OVID

ISSN:0012-3706    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

&NA;The intracolonic bypass is a procedure preventing the gastrointestinal secretions and fecal contents from coming into contact with an anastomotic closure site without interrupting the intraluminal continuity of fecal flow from proximal to distal colon. Experimental and clinical data have indicated that the intracolonic bypass can protect such an anastomosis, in the presence of maximal colonic loadings, dehiscences, and fecal peritonitis. This single stage procedure obviates the necessity for construction and subsequent closure of a temporary colostomy in situations where it is currently indicated; the morbidity, mortality, psychologic problems, and economic costs associated with these multiple procedures are avoided. Sufficient experience now has been gained to recommend the intracolonic bypass as a viable alternate to temporary colostomy.

ISSN:0012-3706    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

&NA;The purpose of this study was to determine whether small intestinal transplantation could be considered as an alternative in the treatment of patients suffering from the short‐bowel syndrome. The site of absorption of oral cyclosporine A was determined as were the changes that follow small intestinal transplantation. The interactions between the lipophilic cyclosporine A molecule and fat emulsion solutions used for total parenteral nutrition were investigated. Finally, a technique for harvesting the entire small bowel in man was developed. The absorption of oral cyclosporine A in normal dogs, and in bowel‐resected, autotransplanted, and allotransplanted dogs was determined. Cyclosporine A levels were monitored in all animals. This demonstrated that cyclosporine A is absorbed through the small bowel and carried through the lymphatics; that absorption is decreased to 40 percent of normal after autotransplantation or allotransplantation without rejection. Rejection further hampers cyclosporine A absorption. Administration of olive oil alone enhances absorption of cyclosporine A. We also administered cyclosporine A IV to five dogs, with and without a concomitant infusion of fat emulsion solution (Intralipid®). No changes in plasma cyclosporine A levels, in the clearance of cyclosporine A, or in thein vivodistribution of cyclosporine A were noted. Finally, dissections in six cadavers and in four brain‐dead organ donors were performed, and a reproducible technique for harvesting the small bowel in man was established. In selected patients with the short‐bowel syndrome, small intestinal transplant may be considered as an alternative therapy to home total parenteral nutrition.

ISSN:0012-3706    

出版商:OVID    

年代:1985

数据来源: OVID

ISSN:0012-3706    

出版商:OVID    

年代:1985

数据来源: OVID