摘要:

PURPOSE:The aim of this study was to investigate the number of new colorectal neoplasms during the first seven years after the end of rescreening in a prospective randomized screening study.METHODS:27,700 inhabitants of Göteborg born between 1918 and 1922 (60‐64 years old) who were randomly allocated to a control or a test group in 1982 were followed up. All people in the latter group were offered six fecal occult blood tests and rescreening 16 to 22 months later.RESULTS:One hundred one carcinomas were diagnosed in the screened group and 128 in the control group during the seven years of follow‐up. The number of carcinomas in the test group was half that in the control group during the first two years of follow‐up, but equal during the rest of the follow‐up period. The distribution of carcinomas according to Dukes classification was significantly better among the participants compared with the refusers (P<0.02) but there was no difference in the Dukes distribution when the test and control groups as a whole were compared. The number of adenomas in the two groups during seven years of follow‐up was the same.CONCLUSION:The results indicate that screening and rescreening of a population has little influence upon the stage of the carcinomas in the test group compared with a control group during the first seven years of follow‐up. The number of carcinomas was higher in the control than in the test group during the follow‐up, probably because of a lead time effect during the screening.

ISSN:0012-3706    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

PURPOSE:The aim of this study was to determine what factors may be responsible for the development of a stricture at the pouch‐anal anastomosis after restorative proctocolectomy.METHODS:A consecutive series of 115 patients was studied retrospectively a median of 34 months (range, 4‐100 months) after operation or ileostomy closure. The procedure failed in 11 patients (9.6 percent) who subsequently had to have a permanent ileostomy. Another two patients were excluded from the analysis, one of whom was awaiting ileostomy closure, whereas the other had a stricture due to a desmoid tumor. Of the remaining 102 patients, 39 (38 percent) developed an ileoanal anastomotic stricture, which was severe and persistent in 16 percent.RESULTS:The results were analyzed with the aid of multivariate logistic regression analysis. Factors which predisposed significantly to the development of an ileoanal anastomotic stricture were 1) use of the 25‐mm (small) diameter stapling gun (P<0.05), 2) use of a quadruplicated reservoir (P=0.05), 3) use of a defunctioning ileostomy (P=0.03), and 4) anastomotic dehiscence and pelvic sepsis (P=0.03). The single patient whose operation failed because of a stricture had also developed pelvic sepsis associated with an anastomotic dehiscence.CONCLUSIONS:The eventual clinical, functional outcome after dilation of a stricture in the 39 patients who developed a stricture was as good as the outcome in the 63 patients who did not a develop stricture.

ISSN:0012-3706    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

PURPOSE:The aim of our study was to determine the five‐year survival of patients with colorectal carcinoma whose Dukes classification had changed following fat clearance of the mesocolon or mesorectum.METHODS:One hundred three patients with colorectal carcinoma were followed up at a special clinic for at least five years after surgery. The tumors from these patients had previously been given a Dukes classification before and after fat clearance.RESULTS:Four of the five patients whose Dukes status changed from B to C as a result of fat clearance died of malignant disease during the five‐year follow‐up period. After fat clearance it was apparent that Dukes B patients survived, on average, 11 months longer than Dukes C patients. A significantly increased mean number of positive nodes was found after fat clearance in Dukes C cases, both in those who were alive at five years and those who died of their malignant disease.CONCLUSIONS:The fat clearance technique is a useful aid to improving the accuracy of the Dukes classification and has prognostic significance. It should be used in specimens of colorectal carcinoma, which on initial examination appear to be Dukes B cases.

ISSN:0012-3706    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

PURPOSE:The role of immunoscintigraphy with111Insatumomab pendetide in the medical and/or surgical management of colorectal cancer patients was evaluated in a multicenter trial.METHODS:This 103 patient study population included 46 individuals with rising serum carcinoembryonic antigen levels and otherwise negative diagnostic evaluation, 29 patients with known recurrence, presumed to be isolated and resectable, and 28 patients for whom standard diagnostic tests provided equivocal information.RESULTS:No adverse reactions were noted following intravenous administration of 1 mg of satumomab pendetide radiolabeled with approximately 5 mCi of111In. Thirty percent of patients developed human anti‐mouse antibodies postinfusion. In the 84 patients for whom correlation with histopathologic, diagnostic, and/or clinical findings was available, antibody imaging demonstrated a sensitivity of 73 percent in patients with confirmed tumor (36/49) and negative results for all 35 patients with no evidence of malignancy. Occult disease was detected in 18 patients.CONCLUSION:111 In‐satumomab pendetide immunoscintigraphy was helpful in the medical and/or surgical management of 45 (44 percent) patients and provided information unavailable from other diagnostic modalities.

ISSN:0012-3706    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

PURPOSE:The aim of our study was to investigate internal anal sphincter electromyographic signals.METHODS:Electromyography of the internal anal sphincter was performed with platinum wire electrodes in six healthy volunteers (three males and three females), inserted under endosonographic guidance. Platinum wire electrodes were also inserted into the external anal sphincter. Activity of both the internal and external anal sphincter in a 40‐second period was measured.RESULTS:Internal anal sphincter median activity was 22.1 (range, 5.5‐67.6) &mgr;V. Slow‐wave activity was 47 cycles/minute (range, 34‐55 cycles/minute). After inflation of a rectal balloon with air until a constant relaxation of the anal canal was obtained, a decrease in internal anal sphincter activity to 15.9 (1.2‐31.3) &mgr;V as well as a decrease in slow‐wave activity to 34 cycles/minute (range, 27‐40 cycles/minute) was found. The original internal anal sphincter EMG was resumed after deflation of the rectal balloon. External anal sphincter median activity was 31 (range, 0.77‐18.6)&mgr;V. During inflation of the rectal balloon, a reflex increase in external sphincter EMG activity was found. With the rectal balloon fully inflated a part of this increase was still present, 11.0 (1.9‐24.6)&mgr;V. In some of the subjects, this increased activity was superimposed on the internal anal sphincter recordings as well. During a voluntary squeeze it was not possible to identify internal anal sphincter activity due to activity of the external anal sphincter totally overriding the internal anal sphincter signal.CONCLUSION:Precise EMG recordings from the internal anal sphincter is possible with endosonographic guidance of the electrodes, except during voluntary squeezing of the external anal sphincter.

ISSN:0012-3706    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

&NA;Recent advances have been made with the publication of the results of GITSG and NCCTG trials, which demonstrated the significant improvement of survival by combined postoperative radiochemotherapy protocols for Stage II and III rectal cancer. These data show that systemic chemotherapy has a decisive role to play in this policy. Some of the advantages of preoperative irradiation compared with postoperative radiation therapy consist of the improvement of resectability of T4 tumors and the anal preservation for low‐lying cancers. These data suggest that preoperative chemoradiotherapy should be applied not only to T4 tumors but also to all T3 tumors even when the transrectal extension is limited. The most usual protocol combines 5‐fluorouracil (300‐350 mg/m2/day) and leucovorin (20 mg/m2/day) for 5 days, followed by radiation therapy (30‐35 Gy in 10 fractions within 12‐15 days), with surgery taking place 4 to 8 weeks later, after the tumor has been restaged. Systemic therapy is continued for four more months. T2 cancers should not be excluded from the benefit of preoperative irradiation.

ISSN:0012-3706    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

PURPOSE:The aim of the study was to review our experience with colostomy closure after Hartmann's procedure and the possible impact of laparoscopic colostomy closure.METHODS:A retrospective review of hospital stay after colostomy closure by laparotomy in the last four years was conducted. A chart review of patients undergoing laparoscopic colostomy closure after Hartmann's procedure since the introduction of operative laparoscopy at our institution was also done.RESULTS:One hundred twenty patients had colostomy closure carried out by the trauma service at the University of Miami/Jackson Memorial Hospital. In thirty‐seven patients, colostomy closure was associated with other surgical procedures such as ventral herniorrhaphy, delayed closure of the open abdomen, ureteroneocystostomy, and so forth, or they underwent loop colostomy closure. These patients were excluded from further review. Sixty‐five patients underwent reversal of Hartmann's procedure by laparotomy. They had an average hospital stay of 9.5 days (range, 6 to 34 days). This group of patients had colostomy closure prior to the introduction of operative laparoscopy in our institution. With increased laparoscopy experience, laparoscopically assisted Hartmann's reversal has been attempted in 18 patients and completed in 14 patients. The average hospital stay in the laparoscopically completed group was 6.3 days (range, 4 to 10 days). This group had a 0 percent mortality and a 14.3 percent morbidity. This compares favorably to recently reported series of colostomy closure by laparotomy.CONCLUSION:Laparoscopically assisted Hartmann's reversal results in comparable morbidity, but may be associated with shorter hospital stay when compared with laparotomy.

ISSN:0012-3706    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

PURPOSE:Positron emission tomography (PET) is an imaging technique based onin vivocellular metabolism. Increased glucose metabolism in neoplastic cells is detected by using fluorine‐18 deoxyglucose. In an ongoing pilot study to determine the usefulness of this technique, PET is compared with computerized tomography (CT) for the preoperative staging of colorectal carcinoma.METHODS:Sixteen patients were evaluated with both PET and CT of the abdomen and pelvis. Results were compared with operative and histopathologic findings. Fifteen malignant lesions were found in 16 patients by histology. PET had a positive predictive value of 93 percent and a negative predictive value of 50 percent. By comparison CT had a positive predictive value of 100 percent and a negative predictive value of 27 percent.CONCLUSIONS:These preliminary results indicate that PET has increased sensitivity for staging colorectal carcinoma, whereas CT has higher specificity. The predictive value of a positive PET compares favorably with CT. Furthermore, the predictive accuracy for detection of colorectal carcinoma is 83 percent for PET and 56 percent for CT.

ISSN:0012-3706    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

PURPOSE:Rectal cancer frequently occurs in patients with familial adenomatous polyposis (FAP) and, in some cases, proctocolectomy and ileal pouch‐anal anastomosis (IPAA) can be proposed as an alternative to end ileostomy. This study aimed to assess the results of IPAA for familial adenomatous polyposis complicated by rectal carcinoma.PATIENTS AND METHODS:Postoperative morbidity and bowel function following IPAA were assessed in six patients who had a mesorectal excision for rectal cancer. The functional results were compared with those obtained after IPAA in 134 FAP patients without bowel cancer.RESULTS:Carcinomas were located at a mean of 11 cm from the dentate line. There were no postoperative complications. One patient with synchronous hepatic metastases died 6 months after operation and the 5 others were alive without recurrence after a mean follow‐up of 29 months. Mean frequency of defecation was 6.5/day (vs.4.2/day in patients without carcinoma), 86 percent of patients had nocturnal defecation (vs.50 percent), day and night continence were normal in 66 percent and 33 percent of patients, respectively, compared with 90 percent and 85 percent for IPAA without cancer. Pouch excision was required in one patient for unsatisfactory functional result.CONCLUSION:IPAA can be safely performed for cancer of the upper rectum complicating FAP, but a poor functional outcome related to mesorectal excision has to be expected.

ISSN:0012-3706    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

PURPOSE:A new method of treating fecal impaction is described, selecting patients that would otherwise have required operative disimpaction.METHOD:Using the pulsed irrigation enhanced evacuation device, individuals were selected for treatment based on evidence of massive fecal impaction on physical examination or abdominal x‐ray.RESULTS:Fourteen individuals were treated for fecal impaction. The patients ranged in age from 13 to 86 years. Only one patient required intravenous sedation, an elderly patient with Alzheimer's disease. The treatment was successful in each case, although repeated treatment was often necessary. No morbidity arose from the treatment. By the midpoint in our study, because of the success of this treatment, no patient required hospitalization for impaction.CONCLUSION:Pulsed irrigation enhanced evacuation has been in our experience a simple, quick, and effective treatment for severe fecal impaction.

ISSN:0012-3706    

出版商:OVID    

年代:1994

数据来源: OVID