摘要:

&NA;A new, improved approach to closed, and semiclosed hemorrhoidectomy is described, in which the amount of excision is reduced. The operation has evolved from refinement of the excision and ligation technique, which may be considered too extensive a procedure. Treitz's muscle, lying on, penetrating in, and surrounding the internal anal sphincter, is considered normal functional tissue and is not excised. Its preservation permits easy approximation and suture of the wound edges to their normal, supple underlying tissue, avoiding direct fixation to the more rigid internal anal sphincter. Residual hemorrhoidal tissue beneath the edges, if present, is also sewed to Treitz's fibromuscular tissue. Flat closed and semiclosed wounds with normal supple folding and without narrowing of the anal canal result. In a consecutive series of 100 patients, primary healing was observed in 80 per cent of the patients. Sixty four per cent experienced no pain on defecation. The functional result, with a normally pliant anorectal lining and anchorage to the preserved Treitz's muscle, is excellent. The procedure represents an accurate reconstruction of a normal state with respect to anatomy and function.

ISSN:0012-3706    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

&NA;Left‐sided ischemic colitis was induced in 44 inbred Male Fischer rats of the same age by a standardized devascularization procedure. Fifteen animals had nothing else done (Group I). Twentynine animals had feces evacuated from the left colon and received an enema just before the procedure; 14 had a sterile‐water enema (Group II), and 15 had a 1 per cent hydrocortisone enema (Group III). At sacrifice, 72 hours after the surgical procedure, the mucosal surface grossly involved in ischemic changes was measured. The mean area of ischemic changes in Group I was significantly greater than that of either Group II or Group III (P<.05). The incidence of circumferential changes was highest in Group I and lowest in Group III; the difference between Group I and Group III was marginally significant (P=.06).

ISSN:0012-3706    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

&NA;The problem of peritonitis after perforation or trauma to the colon continues to be an important one for colon and rectal surgeons. Treatments vary, but mortality and morbidity have always been high. For these reasons, the usefulness of continuous peritoneal lavage as adjuvant therapy in the treatment of peritonitis was examined. Twenty patients with gross peritoneal contamination were treated with continuous postoperative peritoneal irrigation for 17 to 72 hours. No patient died of sepsis or developed an intra‐abdominal abscess. Three patients died: two of advanced cancer and one of a pulmonary embolus. Three additional patients developed complications: mild congestive heart failure in two and transient respiratory failure in one.

ISSN:0012-3706    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

&NA;From 1972 to 1976, 11 patients received moderate‐dose pelvic preoperative radiation therapy (4500‐4600 rad ±500 rad boost) for initially unresectable rectal or sigmoid carcinoma. Of six patients subsequently explored, five had radical surgery and are alive without disease at least five years later. Comparison of the present long‐term follow‐up series with prior (short‐term follow‐up) series suggests that moderate‐dose preoperative pelvic radiation therapy can convert many of these lesions to being resectable ones for which long‐term survival‐without‐disease can be achieved. Attention to irradiation dose and field size is stressed, and a suggestion is made that patients whose tumors at final pathology still demonstrate extrarectal extension receive postoperative small‐field boost irradiation.

ISSN:0012-3706    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

&NA;In a seven‐year period, 200 patients with persistent or recurrent anal and perianal condyloma acuminatum were treated by immunotherapy. There were 120 primary and 80 recurrent cases in the study. Autogenous vaccine was prepared for each patient and injected subcutaneously, 0.5 ml weekly, for six weeks. Excellent results were seen in 84 per cent, fair results in 11 per cent and no benefit in 5 per cent of patients. No adverse reactions or complications were encountered. Long‐term follow‐up (average 46 months) was possible for 86 per cent of the patients, all of whom remained disease free. Immunotherapy is the recommended method of treatment for extensive, recurrent, or persistent anal condyloma acuminatum.

ISSN:0012-3706    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

&NA;The physiologic status of the anorectum after low anterior resections or pull‐through operations of the rectum was evaluated clinically and by manometric studies. It was demonstrated that the presence of a normal anal resting pressure and an anorectal reflex were important to achieve postoperative continence after sphincter‐saving operations. In patients with anastomotic leaks and poor function, a marked high‐pressure zone in the anal canal and an anorectal reflex were not found, but as local inflammation resulting from the anastomotic leak disappeared, these parameters returned to normal. A normal anorectal reflex was found in one of three patients after Bacon‐type pull‐through operations, but the remaining two showed an increase of anal canal pressure during colonic distention. These results indicate that an elevation of anal‐canal pressure in response to colonic distention plays a significant role in fecal continence at the time of “a sense of urgency” if internal sphincter function is impaired.

ISSN:0012-3706    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

&NA;In the past two decades, several reports have documented inflammatory changes in acquired diverticula of the terminal ileum and their associated complications, namely, perforation, intestinal obstruction, gastrointestinal hemorrhage, and fistulization. A comprehensive review revealed 28 cases of diverticulitis of the terminal ileum documented in the world medical literature. Only one case of internal fistula (ileovesical) has been reported previously. This report describes another patient with diverticulitis of the terminal ileum with associated perforation and jejunoileal fistula and reviews the world literature.

ISSN:0012-3706    

出版商:OVID    

年代:1982

数据来源: OVID

ISSN:0012-3706    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

&NA;To examine the reliability of clinical features as possible components of a clinical method of prognostic staging for patients with rectal cancer, the results obtained when two pairs of physicians interviewed and examined a consecutive series of 60 patients with unresected rectal cancer were compared. High levels of agreement between physicians were found for most items of the patient's history, on whether the lesion was palpable, on the distance of the tumor from the anus, on the location and circumferential extent of the tumor, and on whether the tumor was fixed or mobile. Although physicians elicited similar physical signs, thier use of terms to describe the rectal lesions varied widely unless agreed‐upon criteria were used. There was 63 per cent agreement on the use of descriptive terms among physicians using criteria and only 13 per cent agreement among physicians not using criteria. These results show that prognostically important clinical features in patients with rectal cancer can be reliably identified and are thus suitable for inclusion in methods of clinical prognostic staging for this disease.

ISSN:0012-3706    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

&NA;Seventy‐eight patients referred to a specialist clinic for investigation of large‐bowel symptoms were examined with the flexible fiberoptic sigmoidoscope. One hundred twenty polyps were treated, including 84 adenomatous and 32 hyperplastic polyps. Sixty‐nine per cent of polyps were situated beyond 18 cm from the anal verge. Endoscopic diagnosis was correct in 82 per cent of cases. The size of the polyp assessed endoscopically strongly influenced the clinical diagnosis but proved unreliable as a means of making an accurate diagnosis. Results indicate that whenever possible all polyps of all sizes should be removed for microscopic examinations.

ISSN:0012-3706    

出版商:OVID    

年代:1982

数据来源: OVID