ISSN:0012-3706    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;Epidemiologic and clinical evidence has suggested a possible association between anal cancer and human papillomavirus (HPV) types that are known to be associated with cervical and other genital cancers. Using Southern blot and dot blot analysis, the authors examined 45 primary anal malignancies for HPV DNA types 6,11,16, and 18. HPV 16, DNA was detected in 23 of 41 (56 percent) anal squamous‐cell carcinomas (SCC) and in the lymph‐node metastases of two of these tumors. In addition, HPV 18 DNA was detected in 2/41 (5 percent) anal SCCs. Anal SCC contained no detectable HPV 6 or 11 DNA. The remaining four primary anal malignancies were not squamous carcinomas and did not contain any detectable HPV DNA. Nonmalignant anal epithelium and malignant rectal mucosa obtained from surgical patients undergoing hemorrhoidectomy and abdominoperineal excision of the rectum did not contain any detectable HPV DNA. HPV 16 DNA in anal cancer was predominantly integrated into the host cell DNA.In situhybridization was used to demonstrate that HPV 16 DNA in anal SCC tissues is confined to the nuclei of carcinoma cells. The results of this investigation closely parallel similar studies of cervical cancer and lend support to the concept of the involvement of HPV 16 and 18 in the development of anal and genital squamous‐cell carcinoma.

ISSN:0012-3706    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;In an effort to determine the reliability of colonoscopy the authors retrospectively reviewed preoperative colonoscopic findings and compared them with the postoperative pathologic specimen reports. Only lesions greater than 0.5 cm were included in the comparison. Over a 13‐year period, 429 patients with colorectal cancer underwent preoperative colonoscopy. Four hundred thirteen (97 percent) of the colonoscopic examinations correlated with the pathologic specimen, but, in 16 cases (3 percent), lesions were missed. In total, 17 adenomatous polyps and 3 cancers were found in the surgical specimens that were not documented at colonoscopy. Eighteen patients had total preopecative colonoscopy and total abdominal colectomy, which makes for a reliable model to judge the accuracy of colonoscopy. In these 18 patients, 17 of the pathologic specimens correlated with the endoscopic findings, which yields an accuracy rate of 94 percent. Blind areas in the colon, plus misjudgment that the scope had reached the cecum, are responsible for the majority of colonoscopic errors

ISSN:0012-3706    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;Although the prevalence of fecal incontinence is greater in women compared with men and in elderly subjects compared with younger subjects, data regarding the influence of age and sex on anorectal performance in continent and incontinent patients are conflicting. The authors, therefore, investigated age‐and gender‐related changes in anal resting and squeeze pressure as well as in sphincter relaxation after rectal balloon distention in 75 patients with fecal incontinence of different pathogenesis and in 99 continent patients by multichannel anorectal manometry. As a group, incontinent patients usually exhibit lower pressure profiles than do continent patients regardless of age and gender; however, both the resting pressure of the internal anal sphincter and the voluntary contractile pressure of the external anal sphincter are decreased with age, and both are lowered in women compared with men. Sphincter relaxation and perception of gastrointestinal events are not altered in incontinent patients, and they are not different between men and women or between elderly and younger patients.

ISSN:0012-3706    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;Colonoscopy is a common procedure, usually performed in a hospital setting. Hospital backup is desirable for high‐risk patients, but the cost to benefit ratio may be unnecessarily high for low‐risk patients. The demand for colonoscopic examinations is escalating, and cost containment has become an important issue. One way to reduce the cost is to climinate the hospital component by performing the examination in the office. Over the past two and a half years, colonoscopy was performed on selected patients in the authors' office. Five hundred fifty‐four office colonoscopies were performed to date, including biopsy or polypectomy in 348. Basic principles of safe intravenous sedation and colonoscopy were followed strictly. The cecum was reached in 92 percent of cases, and no signficant complications were encountered. Office colonoscopy is a safe alternative to hospital colonoscopy. It confers significant cost savings to the patient and allows more efficient use of the physician's time.

ISSN:0012-3706    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;Endoscopy and biopsy of the terminal ileum were performed in 18 patients with familial adenomatosis coli/Gardner's syndrome. All had undergone total colectomy with ileoproctostomy 7 to 249 months (average, 79.7 months) before the study. In all of these patients, endoscopic studies revealed multiple or innumerable small (less than 4 mm in diameter) polypoid lesions, all recognizable, as whitish, sessile elevations. Histologic findings of the biopsy specimens from the polypoid lesions showed tubular adenoma, with or without lymphoid hyperplasia, in nine (50 percent), but only lymphoid hyperplasia in the other nine patients. Colonic metaplasia was present in the adjacent ileal mucosa in 3 patients with ileal adenomas. The incidence (83 percent) of ileal adenomas detected 113 to 249 months after colectomy was higher than that (33 percent) found 7 to 90 months after surgery. In view of these results, endoscopy and biopsy of the terminal ileum, as well as the retained rectum, should be done periodically for postcolectomy patients with this disease

ISSN:0012-3706    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;The incidence of anorectal complications following vaginal delivery was studied in 20,500 women. One thousand forty (5 percent) of all normal vaginal deliveries resulted in episiotomy with third‐ and fourth‐degree extension or a fourth‐degree perineal tear. Of these fourth‐degree lacerations, 101 patients (10 percent) experienced wound disruption after primary repair. Sixty‐seven patients (66 percent) experienced wound disruption that required surgical correction. Anorectal complications were anal ulcer, anorectal abscess, sphincteric disruption, and rectovaginal fistula. Surgical correction of these complications resulted in satisfactory outcome.

ISSN:0012-3706    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;A homosexual man in stage IV of HIV infection, who suffers from HPV 16‐positive bowenoid papulosis of the anal region, is described. In one area the patient developed an HPV 16‐positive squamous‐cell carcinoma of the anus. Bowenoid papulosis represents a squamous‐cell carcinomain situ, and usually follows a benign clinical course. The possibility exists that immunocompromised individuals are at higher risk to develop cancer on the basis of bowenoid papulosis.

ISSN:0012-3706    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;The charts of 81 consecutive patients with penetrating colonic trauma were reviewed. Sixty‐five patients were considered for evaluation. Penetrating abdominal trauma index, associated injuries, length of operative procedure, wounding agent, length of hospital stay, method of treatment, and septic complications were evaluated. Twenty‐eight patients were treated with colostomy at the site of injury: five with diverting colostomy proximal to repair, 30 with primary repair (either single or multiple injuries), and two with exteriorization and early drop back. Overall septic morbidity was 15 of 65 (23 percent) patients. No statistically significant difference was found in morbidity between colostomy, 9 of 33 (27 percent), and primary repair, 6 of 30 (20 percent). The two patients with exteriorized repairs had no morbidity. No deaths were reported among the 65 patients studied. Thirty‐two of the 33 (97 percent) colostomies were later closed with morbidity in 7 of 32 (22 percent). The mean length of stay for primary repair patients was 10.3±2.8 days and for colostomy patients 25.7±3.8 days, counting days for both initial and colostomy closure admissions (P<.05). Colostomy was not mandated by anatomic location or number of colonic injuries, circumference of colonic wall involved, presence of fecal contamination, or involvement of mesenteric blood supply. This study indicates that primary repair does not carry an increased risk of septic complications and saves the patient the significant risk and increased hospital stay of colostomy closure. Prospective studies addressing this area are indicated.

ISSN:0012-3706    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;For patients needing proctocolectomy, there are several alternatives available today for the previously dominating conventional ileostomy. Currently, the ilead pouch‐anal anastomosis attracts major interest. Various reservoir procedures have been proposed, but the ideal reservoir design is still debated. The double‐folded ileal reservoir (Kock pouch) has a large capacity, low pressure, and is expandable. It is successfully used for the construction of continent ileostomies, continent urostomies, and for replacing the urinary bladder by connecting the reservoir to the urethra. In view of these facts, it was decided to interpose the Kock pouch between the ileum and the anus after colectomy and mucosal proctectomy in a small number of patients, and to study and evaluate its merits in this position. Six consecutive patients formed the study group. Three months after ileostomy closure the stool frequency was 4 every 24‐hours, range 3 to 5, and remained so during the follow‐up period. All patients could sleep through the night without bowel movements or soiling. None of the patients used pads. The capacity of the reservoir increased from a mean of 100 ml preoperatively to 550 ml one year after ileostomy closure. The large reservior capacity and the low pressure can explain the good functional results.

ISSN:0012-3706    

出版商:OVID    

年代:1989

数据来源: OVID