摘要:

&NA;A prospective, manometric study has been performed on 23 female patients with rectal prolapse and varying degrees of incontinence. Seven of the 14 incontinent patients regained continence after surgery, and a further two patients improved. Improvement in internal and external sphincter function follows correction of rectal prolapse. Preoperative resting anal pressure was significantly higher in continent patients than in incontinent patients(P< 0.05), as was the maximum voluntary contraction pressure(P< 0.027). Postoperatively there was a significant increase in the resting anal pressure(P< 0.0001) and maximum voluntary contraction pressure(P< 0.003)in the whole group. The preoperative resting anorectal angle was significantly more acute(P< 0.028) in continent patients than in incontinent patients. There was no significant change in the resting anorectal angle following prolapse repair. Patients who remained incontinent had a significantly lower preoperative resting anal pressure(P< 0.01) than patients who improved or regained continence. Similarly, maximum voluntary contraction pressure was lower preoperatively in these patients(P< 0.02). Preoperative resting anal pressure below 10 mm Hg and maximum voluntary contraction pressure below 50 mm Hg are associated with persisting incontinence after surgery.

ISSN:0012-3706    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

&NA;Radioimmunoguided surgery (RIGS) using an anti‐CEA (A5B7) monoclonal antibody has been assessed in 52 patients (43 primary excisions and nine second look procedures) undergoing surgery for colorectal carcinoma. The antibody localized in 97.8 percent of primary tumours and in 88.8 percent of the principal tumor in second look procedures. Additional information concerning the extent of primary tumor was obtained in 11 of 43 patients (25.5 percent) undergoing excision of primary carcinoma and five of nine patients (55 percent) in the second look series. Incorrect information was obtained about the extent of the primary tumour in six patients (11.3 percent), whereas no incorrect information was obtained during second look procedures. RIGS correctly predicted the subsequent Dukes' staging in 77 percent of first look cases (sensitivity 65 percent, specificity 90 percent), although accurate identification of individual nodes was impossible. The technique influenced the surgical procedure performed in 2 of 43 cases (4.6 percent) in primary surgery and in three of nine patients undergoing second look laparotomy (33 percent). RIGS in primary colorectal carcinoma may provide additional information concerning extent of locally advanced tumors in particular and the principle that the subsequent surgery may be influenced has been established. The technique appears to have a greater role in second look procedures where it may help determine the extent of recurrent tumour. Larger follow‐up series are required to define how the additional information provided by this technique may best be exploited.

ISSN:0012-3706    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

&NA;A 2‐year randomized prospective clinical trial was undertaken to determine whether postoperative irrigation of the pelvis would result in a decreased incidence of local septic complications. Two hundred consecutive patients undergoing low pelvic procedures with rectal resection and entry of the presacral space by a single surgeon, were randomized. In the irrigation group, two of four presacral sump drains were placed to low intermittent suction and the remaining sumps infused continuously with saline until the effluent was clear. In the drainage alone group, all four presacral sump drains were placed to suction. Drains were removed when drainage was less than 50 ml/ 24 hours. Perioperative antibiotics and bowel preparation were identical. Postoperative complications included pelvic abscess (n=7), anastomotic leak/cuff sinus (n= 11), abdominal wound infection (n=19), and perineal wound infection (n=5). Postoperative irrigation of the pelvis did not result in a reduction in the overall rate of local pelvic septic complications. Positive intraoperative presacral cultures, the presence of anaerobes in the presacral space, and duration of pelvic drainage had no effect on the development of pelvic sepsis.

ISSN:0012-3706    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

&NA;Multiorgan system failure due to hypotension and sepsis is an important cause of death in patients with bowel obstruction. We have investigated the pathophysiology of this entity in an animal model. After 5 days of bowel obstruction, blood flow in the superior mesenteric artery was measured with and without Pitressin and norepinephrine given in separate experiments. In controls, Pitressin in moderate dosages caused a substantial fall in gut blood flow, which was not seen in obstructed animals (blood flow reduction 52 percentvs.11 percent in sham and obstructed animals respectively,P<0.01). Similarly, norepinephrine infusion had less of an effect on gut blood flow in obstructed animals (blood flow reduction 79 percentvs.58 percent shamvs.obstructed animals(P< 0.05). Thus, both agents had dose‐related effects on gut blood flow, which was maintained at a higher level throughout the drug infusion periods in the bowel of obstructed animals, demonstrating that splanchnic flow is less responsive to vasoactive drug infusion under these experimental conditions. Because splanchnic vasoconstriction is an important feature of normal hemodynamic homeostasis, we suggest that these results may help explain some aspects of the pathophysiology of multiorgan failure caused or worsened by systemic hypotension seen in bowel obstruction.

ISSN:0012-3706    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

&NA;Limiting degradation of collagen during the initial phase of wound healing is expected to improve postoperative intestinal strength and thereby decrease chances for anastomotic dehiscence. We studied the influence of four nonsteroid anti‐inflammatory drugs on the healing of intestinal anastomoses in rats, with special regard to changes of collagen levels around the anastomoses. Four experimental groups of 20 rats each received daily oral doses of piroxicam, ibuprofen, aspirin, or indomethacin and were compared with a control group. Animals were sacrificed 3 or 7 days after operation. Both morbidity and mortality rate in the experimental groups were high. Collagen, measured as hydroxyproline, levels in anastomotic and adjoining 1‐cm intestinal segments were compared with concentrations in control segments resected during operation. After an initial decrease on day 3, hydroxyproline concentrations increased on day 7. In the colon the lowering of hydroxyproline concentrations, which was more pronounced than in the ileum, was significantly reduced by administration of piroxicam and ibuprofen, both in the anastomosis and its proximal segment. On day 7, the increase of hydroxyproline concentrations in the ileum was inhibited by administration of anti‐inflammatory drugs. It is concluded that nonsteroidal anti‐inflammatory drugs may limit postoperative degradation of collagen in colonic anastomoses, but at the same time may increase the rat's susceptibility to surgical infections.

ISSN:0012-3706    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

&NA;Clostridium difficleinfection manifests as a self‐limiting diarrhea, protracted colitis, or toxic pseudomembranous colitis. The incidence ofC. difficilein a 514‐bed community hospital was studied retrospectively; 155 patients of a total 18,262 admitted during 1988 were identified withC. difficileas an admitting or subsequent diagnosis. The method of diagnosis, mode of therapy, and related costs were analyzed. We have determined that education, with an emphasis on pathogenesis and prevention, is necessary to reduce the incidence in the hospital and the cost to the patient.

ISSN:0012-3706    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

&NA;In search for a more reliable prognostic discriminant, a retrospective analysis of 100 cases of colorectal carcinoma having undergone curative resection and followed for at least 5 years were assessed by nuclear morphometry. Each case was staged according to the Dukes' classification as well as graded histologically. For all patients in this series, the perimeter, area, and nuclear shape factor of 50 interphase nuclei were determined for each carcinoma. The information was obtained through the use of an image analysis system by tracing the nuclear profiles (magnification 1000×) as digitized on a video screen. The nuclear shape factor was defined as the degree of circularity of the nucleus, a perfect circle recorded as 1.0. A nuclear shape factor greater than 0.84 was associated with poor outcome. Multiple regression models showed that the single nuclear parameter of the shape factor was the most highly significant predictor of survival(P<0.0001). This variable remained highly significant even when corrected for sex, age, histologic grade, and Dukes' classification. These findings indicate that a nuclear shape factor ≥0.84 as determined by nuclear morphometry is an independent morphometric nuclear variable of great importance in the prognosis of large bowel carcinoma.

ISSN:0012-3706    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

&NA;Acute hemorrhoidal crisis can occur in the pregnant female. When medical therapy fails to relieve pain, operative intervention may be necessary. The surgeon, however, may be reluctant to operate due to potential complications to the mother and fetus. From July 1983 to July 1989, hemorrhoidectomy was performed in 25 of 12,455 pregnant women (0.2 percent) who delivered in our institution. Twenty‐two women were in their third trimester, 80 percent were multiparous, and each had a remote history of hemorrhoidal symptoms, including intermittent pain, bleeding, and protrusion. Closed hemorrhoidectomy was performed under local anesthesia. The surgery was directed at removing only symptomatic disease, which included three quadrants in 14 patients, two quadrants in seven patients, and one quadrant in four patients. All patients experienced relief of intractable pain the day after surgery, except one patient who required a hemostatic packing during the immediate postoperative period. There were no other maternal or fetal complications. Subsequent follow‐up for anorectal disease ranged from 6 months to 6 years. Six (24 percent) patients required additional hemorrhoid treatment. Hemorrhoidectomy in selected pregnant patients is safe in our experience.

ISSN:0012-3706    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

&NA;The anal canal muscles development is studied in 18 human embryos. The external anal sphincter results to origin common with the urogenital sphincter from the cloacal sphincter. The muscle, after its appearance, is subdivided into two portions from a thin mesenchimal layer. Moreover, our embryologic study clearly confirms that the puborectalis muscle is a portion of the levator ani, its primordium being common with the ileo and the pubococcygeus muscles. The anal smooth musculature appears later than the striated one.

ISSN:0012-3706    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

&NA;Construction of a loop ileostomy is usually advised in patients having an ileal pouch‐anal anastomosis to minimize the complication of chronic pelvic sepsis. Formation and closure of a loop ileostomy was associated with a 41 percent and 30 percent complication rate, respectively, in a prospective series of 34 patients. This morbidity must now be assessed in relation to the benefits of avoiding temporary fecal diversion in restorative proctocolectomy.

ISSN:0012-3706    

出版商:OVID    

年代:1991

数据来源: OVID