ISSN:0012-3706    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

BACKGROUND:The prevalence of benign anorectal diseases (BAD) in the general population has been difficult to establish, either because the individual diseases themselves were difficult to characterize in surveys or because of bias in the selection of the survey population. Reported herein is a prevalence survey of BAD symptoms and treatment history of a sample of the general population, selected by random digit dialing.METHOD:A survey instrument that inquired into symptoms of BAD, BAD treatment history, and health‐seeking behaviors was administered by telephone interview with 102 individuals, between the ages of 21 and 65 of both genders and all races, chosen by random digit dialing in the Joliet, Illinois area. For selected variables (gender, education level, obesity, previous BAD treatment, fiber supplementation, time for defecation and reading during defecation all related to BAD symptoms) odds ratios and 95 percent confidence intervals were calculated.RESULTS:Of the 102 individuals, 9 had been previously treated for hemorrhoids, 4 by surgery, and 5 medically. Twenty individuals currently have BAD symptoms, six of these have multiple symptoms frequently, implying established BAD, and four of these have been previously treated for hemorrhoids. Seven of eight individuals with rectal bleeding in the past year have not sought medical evaluation. Of the associations tested, statistical significance was found only between female gender and BAD symptoms (odds ratio=4.6; 95 percent confidence interval=1.3 ‐ 20.4).CONCLUSIONS:History of hemorrhoidal treatment and current BAD symptomatology are highly prevalent in a randomly selected population, and 80 percent of the subjects with symptoms of BAD have not consulted a physician regarding BAD. Some previously held correlates of hemorrhoidal symptoms, such as obesity and extended time for defecation, showed no apparent association with hemorrhoid treatment history or current BAD symptoms. The best predictors of current BAD symptoms were female gender (odds ratio=4.6; 95 percent confidence interval=1.3‐20.4) and previous hemorrhoid treatment (odds ratio=3.9; 95 percent confidence interval=0.7‐20).

ISSN:0012-3706    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

PURPOSE:Subtotal colectomy with ileostomy is the operation of choice for patients with fulminant colitis. Restorative proctocolectomy (RPC) with ileal pouch‐anal anastomosis (IPAA) is preferred for patients who undergo elective surgery for ulcerative colitis. We retrospectively evaluated the safety of RPC with IPAA in patients with a moderate form of fulminant colitis.METHODS:A chart review of 737 patients who underwent RPC with IPAA for ulcerative and indeterminate colitis from 1983 through 1992 was performed. Moderate fulminant colitis was defined as acute disease requiring hospitalization and parenteral steroid therapy, but without hypotension (systolic blood pressure, <100 mmHg), tachycardia (>120 beats/min), or megacolon.RESULTS:Twelve patients with moderate fulminant colitis underwent urgent surgery (1.6 percent). They had been treated preoperatively for 5.1±2.3 days with intravenous high‐dose steroids, total parenteral nutrition, and antibiotics. These patients had a shorter length of disease (P=0.01), lower hemoglobin, hematocrit, and albumin(P=0.001), and higher temperature(P=0.002) and leukocyte count(P=0.007) than patients undergoing elective surgery. No early septic complications occurred, although perianal abscess occurred in one patient and pouch‐anal fistula in another patient, 13 and 14 months after surgery, respectively.CONCLUSION:In carefully selected, hemodynamically stable patients with fulminant colitis and without megacolon, RPC with IPAA can be safely performed.

ISSN:0012-3706    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

PURPOSE:Reports of fatality related toClostridium difficilecolitis and a sharp increase in prevalence of this infection prompted a study of patients who develop a more aggressive form of this disease.METHODS:Over 38 months, 710 patients at our institution developedC. difficilecolitis. Twenty‐one (3 percent) of these patients either required intensive care unit admission or died as a result of their infection. A retrospective, case‐controlled study was undertaken to compare these patients, who were considered to have severeC. difficilecolitis, with the remaining patients with milder disease.RESULTS:Factors that predisposed to the development of severeC. difficilecolitis included intercurrent malignancy, chronic obstructive pulmonary disease, immunosuppressive and antiperistaltic medications, renal failure, and administration of clindamycin(P<0.05 for all). Patients with severeC. difficilecolitis were more likely to have abdominal pain, tenderness and distention, peritonitis, hemoconcentration (>5 points), hypoalbuminemia (<3 mg/dl), and elevated or suppressed white blood cell count (>25,000; <1,500;P<0.05 for all). These factors were used to create a scoring system that could distinguish between patients with severeC. difficilecolitis and those with mild disease. Thirteen patients in the late stages of terminal illness with metastatic malignancy or age >90 were considered poor or inappropriate surgical candidates. Only the remaining eight patients could have potentially recovered from operation with hope for long‐term survival. Of these, seven were treated without colonic resection, and six of the seven survived, whereas one patient underwent colectomy and did not survive.CONCLUSIONS:Patients with severeC. difficilecolitis can be readily identified. Often they have coexisting illness that precludes operation. In this series, only 1 of 21 patients with severeC. difficilemight have benefited from an aggressive surgical approach.

ISSN:0012-3706    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

PURPOSE:This study was designed to compare diagnostic accuracies of measuring liver enzymes, preoperative ultrasonography, surgical examination, and intraoperative ultrasonography for detection of liver metastases from colorectal cancer.METHODS:Blind, prospective comparisons of diagnostic examinations mentioned above were performed in 295 consecutive patients with colorectal cancer. An experienced ultrasonologist performed the preoperative examinations, nd results were unknown to the other experienced ultrasonologist who performed the intraoperative examinations. The latter, also was unaware of the findings by the surgeon. The presence of metastases was further assessed by ultrasonography three months postoperatively, as well as additional surgery and liver biopsy in some of the patients.RESULTS:The sensitivity of intraoperative ultrasonography (62/64) was significantly superior to that of surgical exploration (54/64) and that of preoperative ultrasonography (45/64). The lowest sensitivity was presented by liver enzymes. Bilobar metastases were detected in 42 of 46 patients by intraoperative ultrasonography but in only 33 patients by the surgeon. Intraoperative ultrasonography demonstrated the highest specificity of all examinations.CONCLUSIONS:Intraoperative ultrasonography reduces the number of patients with liver metastases from being subjected to superfluous or even harmful liver surgery, and it may increase the number in whom liver surgery will prolong life.

ISSN:0012-3706    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

PURPOSE:The bowel and sexual function of colorectal cancer patients undergoing either sphincter‐saving or sphincter‐sacrificing surgical procedures may be impaired. A legitimate question is how these different surgical techniques affect the patients' quality of life.METHODS:Seventeen studies were identified that compared at least one of four aspects of patient functioning(i.e.,physical, psychologic, social, and sexual) between stoma patients and non‐stoma patients.RESULTS:Although the literature does not yield entirely consistent findings, some long‐term effects of surgery can be identified: 1) both patient groups are troubled by frequent or irregular bowel movements and diarrhea; 2) stoma patients report higher levels of psychologic distress than do nonstoma patients; 3) although both stoma patients and nonstoma patients report restrictions in their level of social functioning, such problems are more prevalent among patients with a colostomy; 4) sexual functioning of male and female stoma patients is consistently more impaired than that of male and female patients with intact sphincters. Results of the current review were compared with those of other, related areas.CONCLUSIONS:Although nonstoma patients generally fare better than do stoma patients, they also suffer from physical impairments induced by sphincter‐saving procedures(e.g.,impaired bowel and sexual function). These impairments may become more prevalent as ultralow anastomosis is more frequently applied, resulting in bowel and sexual dysfunction and related psychologic distress. Well‐designed studies are needed that examine whether quality‐of‐life benefits are to be gained by use of ultralow anastomosis compared with colostomy.

ISSN:0012-3706    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

PURPOSE:The significance of manometric anal waves is uncertain, and their fate and diagnostic importance are unknown. It is conceivable that in neurogenic fecal incontinence (NFI) the frequency and amplitude of these waves may be altered into specific, recognizable patterns. Evaluation of this unexplored relationship between fecal incontinence and anal manometric waves has potential diagnostic use.METHODS:Anal motility was studied in 20 patients, each with NFI and traumatic fecal incontinence (TFI), and results were compared with findings in 20 control subjects to determine changes in frequency and amplitude of anal waves in fecal incontinence.RESULTS:Frequency of slow waves when present (NFI=9.5/minute; TFI=9.5/minute; control subjects=9.1/minute) was identical in the three groups(P>0.05). Amplitude of slow waves (NFI=mean, 4.3 mmHg; TFI=mean, 3.9 mmHg; control subjects =mean, 6.6 mmHg) was reduced in patients who were incontinent compared with control subjects but failed to reach statistical significance(P>0.05). Frequency of ultraslow waves when present (NFI=mean, 0.75/minute; TFI =mean, 0.6/minute; control subjects=mean, 1.2/minute) was not statistically different between the three groups(P>0.05). Amplitude of ultraslow waves (NFI=mean, 10.5 mmHg; TFI=mean, 23.4 mmHg; control subjects=mean, 29.6 mmHg) was significantly reduced in NFIvs.control subjects(P<0.01) and between TFIvs.control subjects(P<0.05).CONCLUSIONS:Manometric slow and ultraslow waves, when present, retain their frequency characteristics, irrespective of underlying disease. Amplitude of slow waves was not statistically different from control subjects, but the amplitude of ultraslow waves was significantly decreased in patients who were incontinent.

ISSN:0012-3706    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

PURPOSE:Different studies have shown that low colorectal and coloanal anastomosis often yield poor functional results. The aim of the present study was to investigate whether a colonic reservoir is able to improve functional results.METHODS:Thirty‐eight consecutive patients subjected to low anterior resection were randomized following rectal excision in two groups. One (n=19) had a stapled straight coloanal anastomosis, and the other (n=19) had a 10‐cm stapled colonic pouch low rectal anastomosis. Median anastomotic distance above the anal verge was 3.38±0.56 cm and 2.14±0.36 cm in both groups, respectively. Continence alterations, urgency, tenesmus, defecatory frequency, anal resting and maximum voluntary squeezing pressures, and maximum tolerable volume were evaluated one year later.RESULTS:One patient died of pulmonary embolism, and seven presented with a recurrence and were excluded from the study. Stool frequency was greater than three movements per day in 33.3 percent of cases with a reservoir and in 73.3 percent of those with a straight coloanal anastomosis(P<0.05). Maximum tolerable volume was significantly greater in patients with a reservoir (335 ± 195) than in those without (148 ± 38)(P<0.05). There were no significant differences in other variables studied.CONCLUSIONS:This study shows that some aspects of defecatory function after rectal excision could improve with a colonic reservoir.

ISSN:0012-3706    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

PURPOSE:This study was designed to review a 20‐year experience of the treatment of patients with anal fissure to identify possible etiologic factors and to explore effective preventative measures and the ideal treatment for this disease.METHODS:From January 1972 to December 1991, 1,391 patients (700 males, 691 females; average age, 39 years) with chronic symptomatic anal fissures underwent surgical treatment using either open or closed techniques. The following procedures were performed: 1) internal sphincterotomy for 1,313 idiopathic fissures; 2) C‐anoplasty for 36 cases of anal stricture; 3) debridement and sphincterotomy for 25 patients with postsurgical nonhealing wounds; 4) bilateral excision of the protruding internal sphincter for 17 patients with “subluxation.” Acute superficial anal fissures were treated conservatively, with emphasis on anal hygiene.RESULTS:Acute superficial anal fissures responded well to conservative management. Over 95 percent of patients with chronic anal fissures treated by surgery had satisfactory relief of symptoms. Early complications included urinary retention (1.4 percent), bleeding (1.1 percent), and abscess and fistula formation (0.7 percent). Late complications manifested as flatus and liquid incontinence (1.5 percent), delayed wound healing (1.4 percent), recurrence of fissures (1.3 percent), and symptomatic itching and burning (1.1 percent). The complication rate was higher in the group that underwent closed sphincterotomy than in the group treated by open techniques.CONCLUSIONS:Proper anal hygiene is important in both prevention and initial conservative management of symptomatic anal fissures. For chronic intractable cases, open lateral internal sphincterotomy is strongly recommended. C‐anoplasty should be done when strictures are present. Excision of the protruding internal sphincter is recommended in patients who present with an excessively elongated, tight anal canal with a partially protruding internal sphincter.

ISSN:0012-3706    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

PURPOSE:The aim of the present study was to visualize supposed defects of the internal anal sphincter after ileal pouch‐anal anastomosis (IPAA) by anal endosonography and to relate these findings with anal manometry and fecal continence.METHODS:We investigated 23 patients, visualized the sphincter complex by anal endosonography, and quantified the anatomic changes of the sphincter. Anal resting and squeezing pressures as well as length of the anal canal were determined by anal manometry. Continence was objectively scored by an observer not involved in treatment of patients and subjectively by patients themselves.RESULTS:At anal endosonography, the mean thickness of the internal anal sphincter was 1.16 mm (95 percent confidence interval, 0.98‐1.33), which is significantly less than in normal volunteers. Tapering of the internal anal sphincter only occurred in six patients (of whom two had a gap in the internal sphincter). In 17 patients endosonography showed a thin internal anal sphincter without essential variation in thickness over the complete circumference. Approximately eight weeks after ileostomy closure following IPAA, maximum resting pressure (MRP) and length of the anal canal appeared to be significantly decreased compared with values before IPAA(P=0.001 and 0.002, respectively). These differences were less striking(P=0.05 and 0.04, respectively) when measured six or more months after ileostomy closure,. The extent of reduction of the MRP and thickness of the internal anal sphincter were not correlated with grade of continence or with subjectively scored continence.CONCLUSIONS:IPAA leads to a reduction of thickness of the internal anal sphincter and reduction of the MRP. Tapering or gaps in the internal anal sphincter are probably caused by direct trauma to this sphincter because of mucosectomy, whereas in cases of circular reduction of thickness of the internal anal sphincter without tapering or gaps, direct trauma is an unlikely explanation; this reduction is probably caused by denervation. IPAA compromises continence to a variable degree in 18 of 23 patients. No correlations were found between the extent of reduction of the MRP and the extent of reduction in internal anal sphincter thickness or between these two parameters and objectively or subjectively scored continence. Difficulties in obtaining reliable information on continence may be a causal factor. A striking discrepancy was noticed among objective, scored disturbances in continence, and overall satisfaction concerning level of continence by patients themselves.

ISSN:0012-3706    

出版商:OVID    

年代:1995

数据来源: OVID