摘要:

&NA;It should be recognized that these guidelines should not be deemed inclusive of all proper methods of care or exclusive of methods of care reasonably directed to obtaining the same results. The ultimate judgment regarding the propriety of any specific procedure must be made by the physician in light of all of the circumstances presented by the individual patient.

ISSN:0012-3706    

出版商:OVID    

年代:1993

数据来源: OVID

ISSN:0012-3706    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

&NA;It should be recognized that these quidelines should not be deemed inclusive of all proper methods of care or exclusive of methods of care reasonably directed to obtaining the same results. The ultimate judgment regarding the propriety of any specific procedure must be made by the physician in light of all of the circumstances presented by the individual patient.

ISSN:0012-3706    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

PURPOSE:The aim of our study was to evaluate the safety and functional outcome of restorative proctocolectomy (RP) without diversion.METHODS:Fifty patients underwent RP without diversion for ulcerative colitis (82 percent), familial adenomatous polyposis (12 percent), and indeterminate colitis (6 percent). The perioperative course and functional outcome of these patients were compared with another group of 50 patients undergoing RP with diverting ileostomy during the same time period (1989‐1991) and closely matched for age, gender, surgeon, diagnosis, extent and duration (median, 10 years) of colitis, prior colectomy (˜22 percent), steroid use (40 percent), type of pouch, distance of ileal pouch‐anal anastomosis from the dentate line (median, 1.5 cm), and the duration of follow‐up (median, 12 months). All patients had a stapled ileal pouch‐anal anastomosis without mucosectomy and a smooth conduct of the operation.RESULTS:There was no operative mortality. Anastomotic leaks and pelvic abscess were more common in patients without ileostomy (7/50 or 14 percentvs.2/50 or 4 percent); 8 of these 9 patients were taking ≥20 mg of prednisone/day. Septic complications requiring relaparotomy (6 percentvs.0 percent), prolonged ileus, and fever of unknown origin (10 percentvs.4 percent) were also more common in patients without ileostomy. Despite similar functional results at 6 weeks and at 12 months after initial pouch function, patients without ileostomy had a poorer quality of life index (5vs.8; 10 being best) in the early period (0‐6 weeks) of pouch function.CONCLUSION:In equally favorable cases, RP without diversion is not as safe as RP with diversion, especially in patients taking ≥20 mg of prednisone/day.

ISSN:0012-3706    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

PURPOSE:To assess, in one single procedure, a complete study of the female pelvis, including the Douglas pouch.METHODS:Colpocystodefecography (CCD) combines vaginal opacification, voiding cystography, and defecography. Three hundred examinations are reviewed.RESULTS:Thanks to the simultaneous visualization of the pelvic structures, CCD proved to be more useful than clinical evaluation to diagnose prolapses and particularly Douglas pouch hernias (enteroceles), the clinical diagnosis of which was missed in 93 of 111 cases. Moreover, in addition to morphologic and functional information, CCD brings about a new insight in the study of pelvic organs reciprocal influences, should they be positive (supporting function) or negative (external compression). Finally, significative pelvic surgery and particularly hysterectomy enhances greatly the risk of enteroceles.CONCLUSION:CCD is helpful in the preoperative staging, especially in the selection of the surgical procedure that will least likely predispose to possible late postoperative complications such as vaginal prolapses or enteroceles.

ISSN:0012-3706    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

&NA;Most patients experience a high stool frequency immediately following the closure of the temporary ileostomy after total colectomy and ileoanal pouch reconstruction. Adaptation occurs within the ensuing weeks to reach a plateau in about three months. Increasing volumes of liquid nutrients were injected, twice daily for two months, into the pelvic pouch through a mucous ileal fistula proximal to the pouch before closing the temporary ileostomy. With this method the number of evacuations per 24 hours was significantly reduced during the first few weeks following the reestablishment of intestinal continuity, compared with a control group (average, 8.5vs.18.2, respectively). Patients also had better continence and less urgency to defecate. We suggest this technique in patients undergoing pelvic ileal reconstruction with temporary ileostomy.

ISSN:0012-3706    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

PURPOSE:The wild‐type P53 protein, a product of theP53gene, is a normal growth controlling protein. Mutation of theP53gene generates a mutant P53 protein which promotes tumor formation through loss of growth suppression. Some of the agents responsible forP53gene mutation are known, one of which may be tumorigenic human papillomavirus (HPV) infection. Anal cancers are demonstrating a changing trend in the affected population, from older females in the older reported series to younger males more recently. This may be a reflection of infection with tumorigenic HPV types 16 and 18. The E6 oncoprotein of these viruses inactivates the growth‐controlling wild‐type P53 protein. In this study, our purpose was to determine the incidence of mutant P53 and HPV‐16 and 18‐related E6 protein and their coexpression in anal cancers.METHODS:We examined 29 anal cancers immunohistochemically for mutant P53 protein, HPV 16 and 18 E6 protein, and coexpression of the two.RESULTS:Mutant P53 protein was present in 58.6 percent of anal cancers overall and in 85.7 percent of anal adenocarcinomas. E6 oncoprotein was present in five cases (17.2 percent), all of which were squamous‐cell carcinomas. Coexpression of both mutant P53 and E6 proteins was seen in only three cases (10.3 percent).CONCLUSION:Although tumorigenic HPV may be an important cause forP53gene mutation in anal cancers, perhaps other mutagenic factors play a predominant role.

ISSN:0012-3706    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

&NA;Herniation of the anterior rectal wall into the lumen of the vagina (so called rectocele) may be encountered in patients who complain of constipation and emptying difficulties but it is difficult to ascertain whether this anatomic abnormality is an etiologic factor or a consequence of the dyschezia.PURPOSE:The aim of our study was to assess symptomatic, anatomic, and physiologic features encountered in womenwith a clearly defined rectocelein order to determine the predisposing factors, symptoms, functional associations, and effects on quantified rectal emptying.METHODS:Clinical, physiologic (manometry), and anatomic (evacuation proctography) assessments were carried out in 26 consecutive women (mean age, 47.6±12 years) with dyschezia and a large rectocele as evidenced by radiography and compared with a group of 26 consecutive women complaining of dyschezia without a significant rectocele (mean age, 42.6±14 years). Both groups were similar with respect to mean age, parity, laxative abuse, manual anal evacuation, fecal incontinence, urgency, and weekly stool frequency.RESULTS:Patients having a rectocele differed significantly from those without a rectocele in having frequent endovaginal digitation during defecation (7vs.1,P< 0.05), more frequent symptoms of urinary incontinence (14vs.3,P<0.001), and a surgical history of hysterectomy (9vs.2,P< 0.05). The rectocele group differed in having a delayed rectal emptying (55.5±38vs.30.3±23 seconds,P<0.005), a more frequent incomplete rectal emptying (23vs.11,P<0.0005), and was more often associated with a manometric anismus (16vs.6,P<0.01). During the straining effort, there was a correlation between the depth of the rectocele and the duration of rectal emptying (rs=0.3,P<0.05). In the group without manometric anismus, women with a rectocele (n=10) had a more incomplete rectal emptying than those without rectocele (8/10vs.8/19,P=0.05).CONCLUSION:Some of our results indicate that the rectocele itself could be a contributory factor in difficult evacuation. These results also exhibit the importance of other disorders, such as anismus, in the occurrence of dyschezia. Physiologic examination therefore should be made before considering surgical repair in any patient with rectocele and dyschezia.

ISSN:0012-3706    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

PURPOSE:A direct comparison of anal sphincter physiology (muscle performance and anatomy‐muscle thickness) has not yet been undertaken but may be of importance in patients with defecation disorders.METHODS:We evaluated 15 healthy volunteers by means of anorectal manometry to determine pressure functions of the internal and external anal sphincter. Transcutaneous electromyography was recorded to assess the electrical activity of the external anal sphincter. Thickness of the anal sphincter muscles was measured sonographically from within the anal canal with dorsal projection using a 7.5‐MHz 360° rectal panorama scanner.RESULTS:It was shown that neither is the muscle thickness of the external anal sphincter during rest (6.26±1.02 mm) or during squeezing (7.40±1.39 mm) correlated to its squeeze pressure (138.8±15.2 mmHg), nor is the diameter of the internal anal sphincter (2.09±0.58 mm) correlated to its resting pressure (61.1±15.2 mmHg). Finally, the thicker the internal anal sphincter muscle, the lower the electrical activity of the external anal sphincter during squeezing (r=0.74,P<0.001).CONCLUSION:It is concluded that both manometry to assess sphincter function and sonography to determine sphincter morphology are important measures in the evaluation of continence function.

ISSN:0012-3706    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

PURPOSE:Recently, laser technology has been advocated for the treatment of hemorrhoids. However, there has been little scientific evaluation of the use of the Nd:YAG laser for excisional treatment of hemorrhoidal disease. The purpose of this study was to perform a prospective randomized study of the Nd:YAG laservs.scalpel excision, when performing a standard Ferguson‐closed hemorrhoidectomy.METHODS:Patients presenting for internal‐external hemorrhoidectomy were eligible for study. Hemorrhoidectomies were performed under epidural or caudal blocks. The standard Ferguson closed hemorrhoidectomy technique was used. Data evaluated included: age, sex, estimated blood loss, operative time, postoperative pain scores, postoperative analgesic use, wound healing, and time for return to work. Eighty‐six patients were eligible for study (laser, N=51; scalpel, N=35).RESULTS:There were no significant differences between the groups, except for a greater degree of wound inflammation and dehiscence at the 10 day postoperative visit for the laser group (laser, 1.7±.2; scalpel, 0.8±.2;P<0.05,t‐test). The use of the Nd:YAG laser added $480 per case; as a result, the treatment cost for the laser group was $15,360 higher than that of the conventional group.CONCLUSION:The results indicate that there are no patient care advantages associated with the use of the Nd:YAG laser for excisional hemorrhoidectomy compared with scalpel excision. As new technology becomes available, surgeons must rigorously assess therapeutic efficacy and cost‐benefit ratio before deciding to employ this technology for patient care.

ISSN:0012-3706    

出版商:OVID    

年代:1993

数据来源: OVID