摘要:

PURPOSE:Patients diagnosed as having anal cancer and human immunodeficiency virus (HIV)‐positive disease were evaluated for response to treatment and its associated toxicity.METHODS:We studied nine HIV‐positive patients with squamous‐cell carcinoma of the anus. Among them, three patients had acquired immunodeficiency syndrome (AIDS). The stage of disease at presentation included: one Stage 0, two Stage I, two Stage II, and four Stage III patients. Seven patients received combined modality treatment,i.e.,radiation therapy and chemotherapy, and two patients received radiation therapy alone. The radiation therapy field included the pelvis and a conedown boost. Chemotherapy consisted of two cycles of 5‐fluorouracil and mitomycin C. Patients have been followed from 2 to 42 (median, 8) months.RE‐SULTS:Seven patients achieved a complete response clinically. All Stage I/II patients and one of four Stage III patients remain alive and have no evidence of disease. Radiation Therapy Oncology Group/European Organization for the Research and Treatment of Cancer Grades 3 and 4 skin toxicity were noted in six patients, and Grades 2 and 3 myelosuppression were noted in eight patients. The response rates achieved are comparable to the experience in non‐HIV patients reported in the literature, but toxicity seems to be increased.CONCLUSION:It would seem reasonable to offer combined modality treatment to early stage, HIV‐positive patients with good performance status and a history of minor opportunistic infections. The value of combined modality in AIDS patients and those who present with advanced stages of the disease is questionable.

ISSN:0012-3706    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

PURPOSE:The aim of this study was to determine the incidence and risk factors that were significant in contributing the intraoperative and early postoperative complications for operations of carcinoma of the rectum.METHODS:Between 1984 and 1986 inclusive, 426 patients underwent surgery for primary adenocarcinoma of the rectum. Cases of local excision were excluded. The relationship between each complication and nominal risk factors were studied. The types of surgery included an abdominoperineal resection, low anterior resection, low anterior resection with coloanal anastomosis, anterior resection, colostomy, and Hartmann's procedure.RESULTS:There were two (0.5 percent) deaths. Intraoperative complications occurred in 34 (8 percent) patients. The most common intraoperative complication was presacral bleeding which occurred in 14 patients. Postoperative complications occurred in 214 (50 percent) patients. The two most common complications were urinary retention and urinary tract infection. Abdominoperineal resection had the highest early postoperative complication rate (59 percent). There were 17 clinical anastomotic leaks (7 percent in 221 patients with unprotected anastomoses). The development of complications reached statistical significance with increasing age(P= 0.003), male sex(P= 0.003), increasing weight(P= 0.006), and types of operative procedure(P= 0.001).CONCLUSIONS:Operations for carcinoma of the rectum can be performed with low mortality. Although the overall early postoperative complications were high, the majority was not life‐threatening and usually resolved with time and proper management.

ISSN:0012-3706    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

&NA;Carcinoembryonic antigen (CEA) estimations are used to facilitate early diagnosis of recurrent disease after treatment for colorectal cancer.PURPOSE:This study was designed to determine the natural history of patients with normal and abnormal levels of CEA.METHODS:Patients undergoing potentially curative resection of colorectal tumors (Dukes Stage A‐C) entered a prospective, randomized trial comparing two follow‐up regimens (to be reported separately) had CEA levels measured every 3 months for two years; then every 6 months for the next three years. In the study protocol, a rise in CEA was not an indication for investigation to determine recurrence unless there was also other evidence of recurrent disease.RESULTS:Three hundred eleven patients were followed for a median of 4.5 (range, 2‐5) years. Recurrent disease developed in 98 (32 percent) patients, 57 of whom had an elevated CEA (sensitivity 58 percent), with a median lead time of six (range, 1‐30) months from first abnormal CEA to diagnosis of recurrent disease by other means. The specificity, positive predictive value, and negative predictive value of CEA as an indicator of subsequent recurrent disease was 93 percent, 79 percent, and 83 percent, respectively. The sensitivity of CEA for predicting hepatic metastases was 80 percent, with a median lead time of eight (range, 1‐30) months, compared with only 46 percent for sites of recurrent disease other than the liver.CONCLUSIONS:CEA was the first indicator of recurrent disease in 58 percent of all patients and in 80 percent of patients with liver metastases. The diagnosis of recurrent disease may be made several months earlier by investigating the first abnormal CEA level, although any benefit in terms of survival remains to be proven.

ISSN:0012-3706    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

PURPOSE:The aim of this study was to evaluate the effect of Nd:YAG laser treatment as palliation for rectosigmoid neoplasms.METHODS:Indications for laser therapy, the degree and duration of symptom relief, complication rate, and survival time were recorded in consecutive patients.RESULTS:Seventy‐four patients entered the study. Poor general health in older patients, and disseminated or complicating disease were the most frequent indications for therapy. Fifty‐five (74 percent) patients experienced good symptomatic effect from the treatment. Six complications occurred: five cases of perforation and one case of moderate bleeding. There was no mortality. The median survival was seven months (range, 14 days‐39 months).CONCLUSION:Laser treatment is a good palliative method in patients with colorectal cancer, especially in patients with local recurrence or symptoms from nonresected tumors.

ISSN:0012-3706    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

PURPOSE:A study of 523 fistulas of cryptoglandular origin operated on between January 1985 and December 1991 at the Lehigh Valley Hospital was undertaken for the purpose of establishing whether the “so‐called” simple fistula‐in‐ano has a favorable outcome. High transsphincteric fistulas with or without high blind track, suprasphincteric, extrasphincteric, and horseshoe fistulas as well as fistulas associated with inflammatory bowel disease were excluded.METHODS:Four‐hundred sixtyone patients with anal fistulas classified as simple fistulasin‐ano (uncomplicated transsphincteric, low and high blind track intersphincteric) were studied retrospectively. There were 310 males and 151 females with an average age of 42 years and mean follow‐up of 34 months.RESULTS:Thirty (6.5 percent) patients developed recurrent fistulas: 16 (53.3 percent) beacuse of missed internal openings at initial surgery, six (20 percent) attributed to missed secondary tracks, five (16.7 percent) because of premature fistulotomy wound closure, and three (10 percent) because of miscellaneous factors.CONCLUSION:All so‐called simple fistulas‐in‐ano may not have readily detectable primary openings and may possess secondary tracks which preclude their behavior as simple fistulas.

ISSN:0012-3706    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

PURPOSE:This study was designed to compare the results of two methods on the rate of postoperative perineum healing.PATIENTS AND METHODS:In this prospective, randomized, multicenter trial of 234 consecutive patients undergoing abdominoperineal rectal excision for carcinoma, 48 had unsatisfactory hemostasis or intraoperative gross septic contamination. Three patients were withdrawn because of protocol violation. Of the 45 remaining patients, 21 were randomized to undergo primary closure of the perineum with drainage while 24 underwent packing. Preoperative factors (sex, age, degree of obesity, weight loss, anemia, or presence of ascites), intraoperative findings (Dukes stage, degree of hemostasis, gross septic contamination), and postoperative oncologic courses (recurrence, mortality rate) were similar in both groups. All patients were followed for at least 12 months or until their demise.RESULTS:There was no significant difference in the number of early (onevs.zero) or late (fivevs.four) deaths between primary closure and packing groups, respectively. Median duration of hospital stay was 25 and 27 days, respectively. Primary closure was associated with a significantly higher rate of healed perineums at one month (30 percentvs.0 percent)(P= 0.01) and a shorter delay to complete cicatrization (median, 47vs.69 days)(P< 0.01). From three months onward, there was no difference in healing between the two groups, but two patients in the packing group had not healed at one year. Conversely, hematoma, perineal abscess, and reoperations were significantly more frequent(P< 0.01) in the primary closure group.CONCLUSION:Primary closure associated with drainage after abdominoperineal resection for carcinoma expedites perineal healing but morbidity is higher.

ISSN:0012-3706    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

PURPOSE:This study analyzes different protocols adopted in 86 electrostimulated graciloplasties performed during the last eight years, comparing functional and manometry results in 63 patients.METHODS:Electrostimulated graciloplasties were performed to construct a neosphincter after surgical removal of the anorectum for cancer in 75 patients and to substitute the anal sphincter in 11 fully incontinent patients. An intermittent stimulation protocol, using external devices, was applied in the first 68 patients, while long‐term stimulation was carried out with implantable stimulators and intramuscular electrodes in the last 18 patients. Sixty‐three patients remaining under study were evaluated by questionnaires, continence scores, and manometry.RESULTS:In patients submitted to intermittent stimulation, continence was achieved in 71 percent of 42 “neosphincters” after rectal resection and in 33 percent of 3 incontinent patients. Adopting chronic stimulation, implantable stimulators and intramuscular electrodes, continence reached 100 percent and 83 percent, respectively. Significant differences were also observed in resting and voluntary pressure values between the intermittently and chronically stimulated patients. Incontinent patients showed after chronic stimulation significant increases in mean resting and maximum voluntary pressures: from 13.3 to 60.5 mmHg and from 32 to 103 mmHg, respectively(P< 0.01).CONCLUSIONS:This study confirms the efficacy of chronic stimulation and the validity of a bilateral, “one‐time” graciloplasty to reconstruct or substitute the anal sphincter.

ISSN:0012-3706    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

PURPOSE:This study was designed to document the operative colorectal experience of members and fellows of The American Society of Colon and Rectal Surgeons.METHODS:A mail survey of 900 members and fellows of The American Society of Colon and Rectal Surgeons was conducted.RESULTS:One hundred eighty questionnaires (20 percent) were returned; however, 25 respondents had retired or lacked accurate operative data. The remaining 155 surgeons averaged 49 (range, 35‐83) years in age and had been in practice an average of 14.7 (range, 2‐51) years. The respondents performed a median of 135 and a mean of 177 anorectal procedures per year (range, 20‐1,471) and a median of 67 and a mean of 79 abdominal colorectal procedures (range, 6‐443). Operative hemorrhoidectomy was the most common anorectal procedure (median, 25; mean, 47/year), while partial colectomy was the most common abdominal procedure (median, 18; mean, 26). The number of anorectal procedures correlated directly with the respondents' time in practice, and the number of abdominal procedures peaked between the tenth and fifteenth years.CONCLUSION:Despite the limitations associated with this type of study, the information is useful in assessing practice patterns and experience level.

ISSN:0012-3706    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

PURPOSE:The long‐term effect of 4,500 cGy of preoperative radiation on anorectal function has not been prospectively evaluated.METHODS:Anal manometry was performed on 20 patients with rectal carcinoma before and four weeks after receiving 4,500 cGy of external radiotherapy. Four patients underwent proctectomies, three died, and three refused follow‐up. Ten patients were available for long‐term follow‐up and underwent anal manometry at 14 to 42 (average, 35.5) months after initial radiotherapy.RESULTS:No significant difference in mean maximum squeeze or resting pressures was found after radiation therapy. The sphincter profile and minimum sensory threshold were unchanged. The rectoanal inhibitory reflex was present in all patients. Nine patients reported normal anal function. One patient who was incontinent before treatment remained incontinent.CONCLUSION:Preoperative radiation therapy has a minimal chronic effect on anorectal function. Incontinence after sphincter‐saving operations for rectal cancer should not be attributed to preoperative radiation therapy.

ISSN:0012-3706    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

PURPOSE:This study was designed to evaluate the longterm complication rate of left iliac fossa end sigmoid colostomies and to determine etiologic factors.METH‐ODS:A retrospective chart review and actuarial analysis were performed.RESULTS:The crude and actuarial risks of paracolostomy complications in 203 patients were 51.2 percent and 58.1 percent at 13 years, respectively. Paracolostomy hernia was the most common complication (36.7 percent at 10 years). Siting the stoma through the belly of the rectus abdominis muscle did not reduce the risk of hernia, but an extraperitoneal course had a significantly lower risk of herniation when compared with a transperitoneal course and intestinal obstruction was marginally less frequent. Paracolostomy hernias were otherwise more likely in the elderly, and in those with other abdominal wall hernias. Mesenteric fixation did not reduce the subsequent chance of prolapse. The reduction in the risk of intestinal obstruction when lateral space closure was employed was not statistically significant (4 percentvs.10 percent,P <0.1), and all three patients with stomal retraction had had lateral space closure.CONCLUSION:The evidence in this study that spans a 22‐year period questions much surgical technical dogma and raises the possibility that parastomal hernias may, like inguinal hernias, represent a failure in the transversalis fascia that might technically be avoidable.

ISSN:0012-3706    

出版商:OVID    

年代:1994

数据来源: OVID