摘要:

&NA;This article examines the effect of ileal pouch‐anal (n=134) and coloanal (n=16) anastomoses on resting anal canal pressures in 150 patients.METHODS:Patients underwent anal manometry before ileal pouch‐anal anastomosis (IPAA) and coloanal anastomosis (CAA) and again six weeks after ileostomy closure following these procedures. A water‐perfused catheter system with four radial ports was used for manometry, pressures being recorded during both station and continuous pull through.RESULTS:Patients with IPAA were younger than those with CAA (34 yearsvs.50 years) and had a different ratio of hand‐to‐stapled anastomosis (1:2.6vs.1.3:1). All CAA patients had had rectal cancer while IPAA patients suffered mainly from ulcerative colitis (n=114) or familial polyposis (n=10). The mean preoperative resting pressure for all patients was 79 mmHg (75‐87, 95 percent confidence limit) and the mean fall in this pressure after surgery was 25 mmHg (−21 to −29, 95 percent confidence limit). There was no difference in preoperative pressure or fall between handsewn and stapled anastomoses, or between IPAA and CAA.CONCLUSION:There was a significant relationship between preoperative pressure and change in pressure that held true for all subgroups (change=−0.7 × preoperative pressure + 31,r=0.69). Analysis of the functional results confirmed that patients with high preoperative pressure are at risk for severe falls after surgery and are not guaranteed a good result. Conversely, patients with low preoperative pressures may actually have an increase with surgery and are not always incontinent. Patients with low preoperative anal resting pressures should not be denied anastomosis to the anus if they are continent.

ISSN:0012-3706    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

&NA;Patients with obstructed defecation show no consistent abnormalities when assessed by standard anorectal physiologic methods. With a recently developed technique for dynamic anal manometry, we studied 13 female patients with obstructed defecation and 20 healthy volunteers. Seven parameters of anal function were measured. There were no differences between the median values for the two groups. Seven patients (54 percent; 95 percent confidence limits, 25‐81 percent) had anal compliance below the normal range, either during opening or closing of the sphincter at rest (five patients), during squeeze (one patient), or both (one patient). Opening and closing pressures of the sphincer at rest, maximal closing pressure during squeeze, and anal hysteresis were normal. Standard anal manometry did not show any differences between patients and controls. Rectal compliance was lower in patients with obstructed defecation, median difference 5 ml/cm H2O (95 percent confidence limits, 1‐9 ml/cm H2O). In conclusion, the more detailed method of dynamic anal manometry shows that some patients with obstructed defecation have a less compliant anal sphincter and a less compliant rectum, but in many patients no abnormal findings can be made.

ISSN:0012-3706    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

&NA;Inflammatory bowel disease (IBD) is associated with an increase in colon and rectal carcinoma. Immunosuppression after transplantation increases the incidence of certain types of tumors.PURPOSE:We reviewed the postoperative course of IBD patients who had undergone hepatic transplantation for primary sclerosing cholangitis to see whether there was an increase in the rate of colorectal neoplasms.METHODS:The charts of 44 patients from two institutions who had undergone a hepatic transplant for primary sclerosing cholangitis were reviewed. Of these 44 patients, 33 had IBD (32 chronic ulcerative colitis, 1 Crohn's). Of these 33 patients, 2 had previously undergone total colectomy/proctectomy and 4 died in the perioperative period. The remaining 27 patients had all undergone colonoscopic evaluation just prior to transplant. Postoperatively all patients were given prednisone, cyclosporine, and azathioprine. Minimum follow‐up was 12 months; mean follow‐up was 39 months.RESULTS:Three of the 27 patients (11.1 percent) developed early colorectal neoplasms (2 cancers, 1 large villous adenoma with severe dysplasia) at 9, 12, and 13 months post‐transplant. All three patients were successfully treated with a total colectomy/proctectomy or resection of any remaining colon. These 3 patients had a mean 19‐year history of IBD (range, 9‐27 years), while the 24 patients without tumors had a mean 18‐year history of IBD (range, 6‐39 years).CONCLUSION:There is a subset of transplant patients with primary sclerosing cholangitis and IBD who rapidly develop colorectal neoplasms. Frequent surveillance is recommended for IBD patients in the post‐transplant period.

ISSN:0012-3706    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

PURPOSE:We have previously reported decreased protein kinase C (PKC) enzyme activity in primary human colorectal carcinomas. The purpose of this study was to extend these findings to a larger number of cases and to also examine the levels of expression of mRNAs that encode specific isoforms of PKC in these tumors.METHODS:Colorectal carcinomas and paired grossly normal adjacent mucosal samples were collected from 39 patients. Complete histopathologic analyses were performed on all samples. PKC enzyme activity in both the cytosolic and particulate fractions was quantitated by measuring the amount of32P incorporated into histone Type III‐S. Northern blot nucleic acid hybridization was performed using polyA+RNA extracted from both the tumor and normal tissue samples and32P‐labeled probes for specific isoforms of PKC. The paired samplet‐test was used to determine the statistical significance of tumor to normal ratios of both enzyme activity and mRNA levels.RESULTS:The mean value for cellular PKC enzyme activity in the colon tumors from 39 patients was about 60 percent of that found in the paired adjacent grossly normal mucosa samples(P<0.001). The subcellular distribution of PKC activity was similar in normal and tumor samples (about 70 percent in the particulate fraction). The abundance of PKC&agr; mRNAs varied considerably among 28 tumor/normal pairs, with a mean tumor to normal (T:N) ratio of 1.0±0.6 for the 99‐kb mRNA band and 1.4±0.7 for the 3.5‐kb band. The abundance of PKC&bgr; mRNAs was decreased in 30 of 39 tumors, with a mean T:N ratio of 0.6±0.4 for both the 94‐ and 3.5‐kb bands for all 39 samples(P<0.001). None of the parameters measured correlated with Dukes stage or the grade of the tumor.CONCLUSIONS:These studies extend previous evidence that total PKC enzyme activity is frequently decreased in primary human colon tumors. Our finding that this is often associated with decreased levels of PKC&bgr;mRNA suggest that this is not simply due to posttranslational down‐regulation of this enzyme system. Further studies are required to determine whether these changes in PKC&agr;and PKC&bgr;mRNAs are due to alteredde novotranscription or mRNA stability. It will also be of interest to examine the expression of other isoforms of PKC in colon tumors.

ISSN:0012-3706    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

PPURPOSE:The physiologic changes that occur when the small bowel is used as a reservoir, as in the ileal pouchanal anastomosis, are poorly understood. Alterations in bowel permeability, which may lead to bacterial translocation that could result in illness or dysfunction of the pouch, may be one such consequence of the pouch procedure.METHODS:Whole‐bowel permeability was evaluated in patients with and without the pouch through the use of an orally consumed nonmetabolizable sugar clearance technique. Patients in whom the ileal pouchanal anastomosis was performed for ulcerative colitis (17 patients) and patients with familial polyposis (7 patients) were compared with normal healthy volunteers (10 patients) and patients with ulcerative colitis with and without curative colectomy and ileostomy (6 and 5 patients, respectively).RESULTS:Measured by this technique, no differences were noted in bowel permeability between the volunteers and patients with ulcerative colitis, even after colectomy and ileostomy (1.7±0.4 in normal healthy volunteers, 1.8±0.5 in patients with ulcerative colitis without stoma, and 1.4±0.2 in patients with ulcerative colitis with ileostomy). The group of patients with an ileal reservoir, however, had a significantly increased index of measured bowel permeability (3.5±0.5 in patients with ulcerative colitis and 5.1±0.7 in patients with familial polyposis;P<0.05 by analysis of variance compared with normal healthy volunteers and patients with ulcerative colitis with or without ileostomy).CONCLUSION:The exact site, cause, and consequence of this possible alteration of bowel permeability are unclear but appear to be related to the presence of the pouch and are not caused by the underlying pathologic diagnosis.

ISSN:0012-3706    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

&NA;The treatment and follow‐up strategies of patients with hereditary nonpolyposis colorectal carcinoma (HNPCC) were analyzed in 22 Finnish HNPCC families in systematic follow‐up between 1983 and 1990. During the sevenyear study period metachronous colorectal neoplasia was diagnosed in 41 percent (15/37) of the patients treated by segmentai colonic resection and in 24 percent (4/17) of those treated by subtotal colectomy. Extracolonic carcinoma was diagnosed in 12 (30 percent) of the 40 patients during the long‐term follow‐up. The most common extracolonic malignancy was biliopancreatic carcinoma which accounted for all five cancer‐related deaths in the whole series during the study period. It was concluded that subtotal colectomy is superior to hemicolectomy or segmental resection in HNPCC patients with colorectal carcinoma. A regular annual endoscopic follow‐up of the residual rectum is still necessary, and surveillance for extracolonic cancers must be considered.

ISSN:0012-3706    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

&NA;Forty‐seven patients were submitted to 68 radioimmunoscintigraphic investigations for primary or recurrent colorectal cancer. Immunoscintigraphy with Immu‐4tmcorrectly detected 28 primary colorectal cancers of 29 and 12 of 12 recurrent colorectal cancers. Overall accuracy was 93.75 percent in primary and 91.6 percent in recurrent colorectal cancer. Immunoscintigraphy had a decisive influence on treatment planning in every third primary colorectal cancer patient and was by far superior to CT scan in the detection of early recurrences, especially in patients with a history of abdominoperineal or low anterior resection. Immu‐4tmscintigraphy is a safe and convenient diagnostic approach to colorectal cancer. Because radioactivity is acceptably low and the method is absolutely free of side effects, there are no objections to the repeated use of immunoscintigraphy which provides important information in primary diagnosis as well as in the follow‐up of colorectal cancer patients.

ISSN:0012-3706    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

PURPOSE:The aim of this study was to compare treatment outcomes in the management of pelvic abscess (PA) after rectal surgery.METHODS:Over a 12‐year period all PAs occurring in the patients undergoing colorectal resection were retrospectively reviewed. The APACHE II Score was used to stratify illness.RESULTS:Postoperative PA developed in 56 patients after cancer (32 percent), ulcerative colitis (26 percent), diverticular disease (24 percent), and Crohn's colitis (18 percent)/surgery. Overall, 24 (43 percent) of PAs were after operations for inflammatory bowel disease and 43(77 percent) of PAs were after intrapelvic intestinal anastomoses. PAs were treated by 1) antibiotics alone (11/56), 2) percutaneous computerized tomography‐guided catheter drainage (13/56), 3) transperineal drainage (15/56), or 4) laparotomy (17/56). Recurrent PAs developed in 11/56 (19 percent) after initial treatment, of which 7 required additional surgery. These recurrences were evenly distributed between treatment groups. There were three deaths as a result of PA, two after laparotomy and one after percutaneous drainage. Long‐term sequela in patients with intestinal anastomosis included loss of intestinal continuity (10/43) and anastomotic stenosis (7/43). There was no difference in APACHE II Score among the four treatment groups. The mortality rate was 75 percent among patients whose APACHE II Scores were greater than 15. The development of a PA after colon and rectal surgery was associated with a 5 percent mortality and 41 percent functional morbidity (23 percent permanent stoma and 18 percent symptomatic stricture rate).CONCLUSION:Using clinical judgment, if PA is amenable to computerized tomographyguided percutaneous or transperineal drainage, one of these techniques should be attempted initially in the hemodynamically stable nonseptic patient. Long‐term functional disability is common after PA in rectosigmoid surgery in patients who undergo pelvic/intestinal anastomosis.

ISSN:0012-3706    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

PURPOSE:Endoscopic Doppler sonography is a relatively new technique in the diagnostics of intestinal hemorrhage. It has been used mainly for bleeding gastroduodenal ulcers, but can also be utilized in the lower digestive tract.METHODS:In the study presented 80 patients with symptomatic hemorrhoids of first degree and previous hemorrhage were randomized in two groups. The 40 patients in Group A were examined by transproctoscopic Doppler ultrasound. After measuring the vessels depth, local injection treatment with 5 percent phenol almond oil followed. The patients in Group B had been given conventional sclerotherapy without the aid of Doppler investigation. The success of treatment was checked using Doppler sonographics six weeks later and the results were statistically compared.RESULTS:In the patients in Group A, the hemorrhoids proved to be totally eliminated in 93 percentvs.38 percent of the patients in Group B(P,0.1 percent).CONCLUSIONS:Proctoscopic Doppler ultrasound is useful in the evaluation and sclerotherapy of symptomatic first‐degree hemorrhoids.

ISSN:0012-3706    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

&NA;A new multiple electrode probe (MEP) designed to measure surface electromyographic activity from the subcutaneous and deep portions of the external anal sphincter is described. Using the MEP, electromyographic activity was sampled in an asymptomatic subject and in three incontinent patients. Comparisons of electromyographic data between and within subjects, and across sessions, indicate that the MEP discriminates muscle activity from different sites along the anal canal. The recording method described is capable of identifying patterns of muscle recruitment which have not been reported before using surface electromyography. After a defecation maneuver, the distal and proximal portions of external and sphincter were observed to contract in what would seem to be a closing reflex. Moreover, the absence of this pattern may indicate abnormality. Accordingly, the MEP promises to be useful in the diagnosis, evaluation, and treatment of fecal and urinary incontinence and, particularly, in the biofeedback treatment of these and related disorders.

ISSN:0012-3706    

出版商:OVID    

年代:1993

数据来源: OVID