摘要:

&NA;Carcinoma of the anal canal develops in the area of the dentate line and is referred to as cloacogenic, transitional, basaloid, epidermoid, and squamous cell cancer. For years, the accepted treatment for these lesions has been abdominoperineal resection. The use of preoperative radiation and chemotherapy was begun by our group in 1972. By 1975, it became apparent that radiation and chemotherapy alone appeared effective enough so that radical operation was not done routinely. An evaluation of the results in 104 patients, 44 of whom were treated by us (the rest of the data was collected by questionnaire), suggests that radiation and chemotherapy alone are at least as effective as radical surgery in most patients with this disease.

ISSN:0012-3706    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

&NA;In spite of modern suture materials and different techniques in colonic anastomoses after resection, leakage is still the most feared complication in colonic surgery. In female pigs of Swedish land breed, standardized 5‐cm long colonic resection was performed 10 cm above the peritoneal deflection, usign either a single layer of Gambee‐stitches (n=6, Vicryl®4‐0), two‐layer interrupted stitches (n=6, Vicryl®4‐0) or the intraluminal stapling device (n=6, ILS Ethicon®). After one week, the animals were sacrificed and an anastomotic index was calculated usingin vitrox‐ray. Also, anastomotic circulation (calculated by the microsphere technique), breaking strength, and histologic evaluation were performed. All animals survived and no leakage was observed. The time to perform, the anastomosis was significantly shorter (P<0.05) for the stapling device compared with the manual techniques used. The anastomotic index was lower (P<0.05) for two rows (0.24) compared with Gambee‐stitches (0.38) or stapler anastomoses (0.37). There were no differences in blood flow among the three groups and no differences in breaking strength. Macroscopic investigation revealed mucosal defects in two of the stapled anastomoses and histologic investigation showed small areas of necrosis. The stapling device did not induce any inflammatory reaction. On the other hand, a severe inflammatory reaction was seen when using conventional suture materials. In conclusion, this study shows that a single row of Gambee‐stitches is equal to the ILS stapling device when performing colonic anastomoses and these two methods seem to be superior to the two‐layer technique.

ISSN:0012-3706    

出版商:OVID    

年代:1984

数据来源: OVID

ISSN:0012-3706    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

&NA;The reason for the higher leakage frequency after low anterior resection compared with high resection is unexplained. With the development of stapling devices, we have a unique opportunity to investigate anastomotic healing during standardized conditions. In female pigs, six in each group, a high anterior resection was performed by resection of a 5‐cm colon segment, 10 cm above the peritoneal fold, and low anterior resection was performed after resection of a 5‐cm segment at the peritoneal fold and downward. Differences in healing parameters,i.e., blood flow, breaking strength, and radiologic and histologic appearance between low and high anterior resection, were evaluated. Two leakages occurred after low and none after high anterior resection. The anastomotic index was 0.37 (high) and 0.26 (low) (P<0.05). The breaking strength was higher in low resections; this might be due to the thicker wall. There were no differences in blood circulation between high and low anastomoses, but the blood flow was significantly higher in the anastomotic area in both groups. This is probably due to the inflammatory reaction taking place in the healing anastomoses. This study, performed in a standardized fashion with a stapler adjusted to wall thickness and size of the intestine, cannot, on the basis of microcirculation, explain why leakage is more common in lower anastomoses.

ISSN:0012-3706    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

&NA;This paper is a retrospective study of 100 sequentially selected cases of colorectal carcinoma treated at The Roosevelt Hospital between 1978 and 1983. In 44 of these patients, the admitting physical digital rectal examination was hemoccult‐negative (HN). This group of patients showed no significant difference in tumor location, stage, size, or in presenting symptoms when compared with the 56 patients who were found to be hemoccult‐positive (HP). It is concluded that a negative stool hemoccult examination should not alter the course of the patient's work‐up if any suspicion of colorectal carcinoma exists. Furthermore, hemoccult sensitivity does not appear to be affected by the size, location or Dukes' classification of a colorectal neoplasm.

ISSN:0012-3706    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

&NA;Forty consecutive patients were questioned after proctectomy to ascertain the presence and characteristics of phantom sensations. Twentysix (65 per cent) reported the presence of these sensation. Once established, the sensations were permanent in 20 patients; in six, they disappeared after a variable lapse of time. The most frequent sensation was an urge to defecate, which may be very disturbing to the patient. Explanation of the phenomenon usually is sufficient to alleviate anxiety.

ISSN:0012-3706    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

&NA;Paraileostomy ulcers (PSU) are uncommon after construction of an ileostomy and are difficult to manage. Seventeen patients with Crohn's disease developed 28 parastomal ulcers at least 1.5 cm in diameter from two weeks to seven years after ileostomy construction (mean 45.6 weeks, median 8 weeks). Some patients had multiple episodes of parastomal ulceration. The etiology and clinical features of PSU are discussed. Conservative management included debridement, curettage, unroofing of the ulcer complex, pouching of the stoma with Telfa strips placed in the ulcer base and a conventional appliance or a Perry Model #51 device. Most of the ulcers healed between two and 32 weeks (mean 12.7 weeks, median 8 weeks). In the six patients in whom the ulcers did not heal, Crohn's disease or another ileostomy complication necessitated ileostomy relocation. This conservative management allowed most patients to be treated on an outpatient basis, carrying out their daily tasks and delaying orobviating the need for ileostomy relocations. When required, relocations were done electively.

ISSN:0012-3706    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

&NA;Twenty‐five colonic cancer tissues were studied for the presence of estrogen and progesterone receptors (ER, PR) and the distribution of immunoreactive carcinoembryonic antigen (IR‐CEA). ER and PR were determined in 6 (24 per cent) and 3 (12 per cent), respectively, of 25 patients with colonic cancer. Of the six patients with ER, five were females, four of whom were postmenopausal. Steroid receptors, however, had no correlation with age, tumor localization, stage of disease or IR‐CEA. In cancer tissue, IR‐CEA in the cytosol fraction was higher than that found in the membrane fraction. In normal colon, however, the concentrations of the two fractions were reversed. Immunohistochemical findings have shown a different distribution of IR‐CEA in cancerous and normal colon, and our results demonstrated similar findings by using radioimmunoassay (RIA).

ISSN:0012-3706    

出版商:OVID    

年代:1984

数据来源: OVID

ISSN:0012-3706    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

&NA;Inadvertent perforation of the bowel during curative resection for colorectal cancer has serious consequences. In 174 curative resections with spillage, five‐year survival was 29 per cent. In 67 patients where the cancer itself was disrupted during dissection, five‐year surival fell to 14 per cent in the colon and to 9.3 per cent in the rectum. Local recurrence developed in 65 per cent of spillage cases. In Dukes' C tumors that were perforated during surgery, local recurrence occurred in 87 per cent. As surgeons, our efforts must be directed toward preventing injury to the bowel during definitive resection of colorectal cancers. The instillation of tumoricidal solutions within the bowel lumen and the application of bowel ligatures prior to dissection may help toward preventing recurrence, should inadvertent perforation and spillage occur.

ISSN:0012-3706    

出版商:OVID    

年代:1984

数据来源: OVID