ISSN:0012-3706    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

PURPOSE:The goal of genetic testing is to define individual risk, which in turn may guide clinical management.METHODS:Thirty‐two international familial adenomatous polyposis registries were surveyed regarding their approach to a specific clinical management question. There were 30 respondents. Respondents declared their clinical policy for an at‐risk, first‐degree relative who undergoes direct mutation analysis and does not have anAPCgene mutation known to be present in his or her family.RESULTS:Nineteen of 30 (63.3 percent) registries would discharge this negativeAPCmutation case from clinical screening. Eleven of 30 (37 percent) registries would maintain clinical screening. Reasons offered for maintaining surveillance included the need for additional confirmation of theAPCmutation in two affected relatives, the possibility of sampling error or two different mutations in an affected family, limited prospective data, and patient anxiety.CONCLUSIONS:The discrepancy in response to the survey suggests that some clinicians are as yet reluctant to accept fully that predictive genetic analysis is a definitive guide to clinical management in familial adenomatous polyposis. Nevertheless, we believe that use of a predictive gene test for familial adenomatous polyposis should alter management, decrease cost, and reduce psychological trauma for the tested individual. Although the benefit ofAPCanalysis is accepted for the positive gene carrier, the challenge remains to reclassify the negative gene carriers who are no longer at risk for familial adenomatous polyposis.

ISSN:0012-3706    

出版商:OVID    

年代:1999

数据来源: OVID

ISSN:0012-3706    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

PURPOSE:Controversy exists in regard to the prognostic value of clinical data and physiological tests in patients undergoing sphincter repair for fecal incontinence. The aim of this study was to identify prognostic factors.METHODS:Between 1986 and 1996, 405 consecutive patients had a sphincter repair for fecal incontinence. Preoperative and postoperative manometric data were available on 51 of these patients, and these patients' charts were reviewed retrospectively. Preoperative and postoperative continence was scored using the four‐level scale of Browning and Parks. Mean follow‐up was 16.2 (median, 6; range, 1‐96) months. Mean age was 41 (median, 36; range, 21‐80) years, and 46 (90 percent) patients were female.RESULTS:Twenty‐three (45 percent) patients had perfect continence postoperatively, whereas 41 (80 percent) patients demonstrated improvement in continence score after sphincter repair. Using univariate analysis, various clinical and anal physiologic data were analyzed for an association with postoperative continence score. Postoperative mean resting pressure and postoperative anal canal length were both significantly related to postoperative continence (rsBfor Spearman correlation coefficient to differentiate from r for the Pearson coefficient. =0.442;P=0.0012; andrs=0.440;P=0.0012, respectively), whereas postoperative mean squeeze pressure was not (rs=0.273;P=0.0529). Postoperative mean resting pressure and anal canal length were entered into a logistic regression model. Postoperative mean resting pressure was not significant (P=0.6643), and when it was dropped from the model, postoperative anal canal length was highly significant (estimated odds ratio, 3.2; 95 percent confidence interval, 1.1‐9.3;P=0.0047) in predicting postoperative continence.CONCLUSIONS:No preoperative data predicted functional outcome, and in contrast to other studies, postoperative anal canal length provides the best prediction of postoperative continence.

ISSN:0012-3706    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

PURPOSE:The development of port‐wound tumor recurrences has raised questions regarding the safety of laparoscopic methods for the resection of malignancies. The cause and the incidence of abdominal‐wall tumor recurrences remain unknown. It is also not clear how to avoid or lower the incidence of port‐tumor recurrences. The purpose of the current study was to determine the impact of abdominal irrigation with povidone‐iodine on the port‐wound tumor incidence in a murine model.METHODS:A splenic tumor model was used for this study. To establish splenic tumors, female BALB/c mice (N=48) were given subcapsular splenic injections of a 0.1 ml suspension containing 105C‐26 colon adenocarcinoma cellsviaa left‐flank incision at the initial procedure. Seven days later, the animals with isolated splenic tumors (100 percent) were randomly assigned to one of three groups: 1) control, 2) saline irrigation (saline), or 3) povidone‐iodine irrigation. All animals underwent laparoscopic mobilization of the spleen using a three‐port technique, intra‐abdominal crushing of the tumor, followed by an extracorporeal splenectomyviaa subcostal incision. No irrigation was performed for control group animals. In the saline irrigation group, the subcostal incision was closed and pneumoperitoneum was reestablished. The abdominal cavity was irrigated with 5 ml of normal saline for 60 seconds before instrument removal. In the povidone‐iodine irrigation group, similar abdominal irrigation was performed, using 0.25 percent povidone‐iodine. Attempts were made to recover completely the irrigation for both irrigation groups. Seven days after the splenectomy, animals were killed and inspected for abdominal‐wall tumor implants.RESULTS:There were significantly more animals with at least one port‐tumor recurrence in the control group than in the povidone‐iodine group (P=0.007). Although not statistically significant, the number of animals with port‐wound tumors was higher in the saline group than in the povidone‐iodine group (P<0.08). There was no significant difference between the saline group and the control group. When each port site was considered independently, the incidence of port‐wound tumors (number of ports with tumors per total number of ports) was significantly lower in the povidone‐iodine group than in both the control (P=0.00001) and saline groups (P=0.03). The incidence of port‐wound tumors was also significantly lower in the saline group compared with the control group incidence (P=0.03).CONCLUSIONS:Abdominal irrigation with dilute povidone‐iodine solution significantly reduced the number of animals with port‐tumor recurrences. Abdominal irrigation with saline was also effective in reducing the incidence of port‐wound tumor formation when each port was considered separately. However, povidone‐iodine irrigation was much more effective than saline irrigation in preventing port‐wound tumor formation.

ISSN:0012-3706    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

INTRODUCTION:The place of laparoscopic‐assisted colectomy for colorectal carcinoma is controversial. This study reviewed a consecutive series of patients who underwent laparoscopic‐assisted resection of colorectal carcinoma in the past five years.METHODS:Two hundred seventeen laparoscopic‐assisted resections of colorectal carcinoma were attempted starting in April 1992. Initially, we only selected patients with metastatic disease or patients who were older than 65 years. Subsequently, both palliative and curative resections were attempted in patients with a suitable tumor, with no age limitation. Thus, all suitable patients were randomly assigned to received either laparoscopic‐assisted or conventional open surgery.RESULTS:Data collection was completed in 201 patients. In 22 patients open surgery was performed after a diagnostic laparoscopy. In the remaining 179 patients (90 males) in whom laparoscopic dissection was actually performed, the mean follow‐up was 19.8 months, and the mean age was 66.3 years. The procedures performed included right hemicolectomy or extended right hemicolectomy (30 patients), transverse colectomy (2 patients), left hemicolectomy (3 patients), sigmoidectomy (48 patients), anterior resection (59 patients), and abdominoperineal resection (37 patients). Thirty‐two (17.7 percent) procedures were converted to open surgery. The mean operation time was 203 minutes. The median blood loss was negligible, and the median requirement of transfusion was zero. The median number of postoperative parenteral analgesic injections was three. The median time to resume diet and hospital discharge were four and six days, respectively. The operative mortality was 1.7 percent. The survival rates at four years were 100, 88.3, and 64.5 percent for patients with Dukes A, B, and C disease, respectively. There was only one (0.65 percent) port‐site recurrence.CONCLUSION:Laparoscopic‐assisted resection of colorectal carcinoma was technically feasible and safe. It allowed early postoperative recovery with satisfactory long‐term survival. This is at the expense of a long operation. Its benefits over the conventional open technique await the results of the randomized trials.

ISSN:0012-3706    

出版商:OVID    

年代:1999

数据来源: OVID

ISSN:0012-3706    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

PURPOSE:Appendectomy and cigarette smoking have been suggested to reduce the chance of developing ulcerative colitis. A case‐control study was undertaken to determine the relative incidence of appendectomy in patients with ulcerative colitis.METHODS:This case‐control study examined the incidence of appendectomy in patients with ulcerative colitis and patients attending an orthopedic outpatient clinic.RESULTS:Of 100 patients with ulcerative colitis, 75 pairs were matched for age, gender, and cigarette smoking. The ulcerative colitis group had an appendectomy rate of 8 percent (6/75), compared with 21 percent in the control group (P=0.018). The odds ratio was 3.5 (95 percent confidence interval, 1.15‐10.6).CONCLUSIONS:No previous study has examined the effect of appendectomy, controlling for cigarette smoking. This study confirms that appendectomy protects against or reduces the chance of development of ulcerative colitis. A possible immunological explanation for this effect is advanced.

ISSN:0012-3706    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

PURPOSE:The aim of this study was to examine the relationships between smoking and alcohol use and risk of colorectal adenoma.METHODS:Information about smoking, alcohol use, and other lifestyle variables were obtained prospectively from 14,427 male and 17,125 female residents in a city of Gifu Prefecture, Japan, by a self‐administered questionnaire in September, 1992. Colorectal adenomas were newly diagnosed in 181 men and 78 women in this cohort between January, 1993 and December, 1995 by colonoscopic examination at two major hospitals of the city. Gender‐specific and site‐specific relative risks and 95 percent confidence intervals adjusted for age and for age plus other potential confounding factors were calculated by using logistic regression models.RESULTS:Thirty or more years of smoking was significantly associated with risk of adenoma in general compared with never having smoked in both men and women (relative risk, 1.60; 95 percent confidence interval, 1.02‐2.62 and relative risk, 4.54; 95 percent confidence interval, 2.04‐9.08, respectively). Effect of smoking was stronger in the proximal colon. After adjusting for age and carbohydrate intake, total alcohol intake was not associated with risk of adenoma in any site in the colon in men. Sake drinkers were at significantly increased risk of adenoma in general, but the dose‐response relationship was not statistically significant. Risk of adenoma in the rectum was not significantly increased for those who consumed >30.3 g/day of ethanol (relative risk, 5.7).CONCLUSION:These data suggest that smoking is a risk factor of adenoma in Japanese men and women. The role of alcohol, however, is less clear.

ISSN:0012-3706    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

PURPOSE:Because of the increased risk of colorectal cancer in patients with inflammatory bowel disease, surveillance colonoscopy with mucosal biopsies for dysplasia has been advocated to prevent malignancy or permit its early diagnosis. However, despite adoption of colonoscopic surveillance programs by many clinicians, we have noted a pattern of continued referrals for inflammatory bowel disease‐associated malignancy. This study was undertaken in an effort to characterize this cohort of patients.METHODS:We reviewed the operative records of a large metropolitan colorectal practice from 1983 to 1995. During this period 40 large‐bowel resections were performed for patients with documented inflammatory bowel disease and concomitant carcinoma. A retrospective analysis was conducted with emphasis on clinical presentation, pathologic description, and most recent follow‐up.RESULTS:Mean age at the time of diagnosis of cancer was 48 years with an average inflammatory bowel disease duration of 19 years. Seven patients had documented inflammatory bowel disease for less than eight years before their cancer diagnosis. Carcinomas were identified preoperatively by colonoscopy in 92 percent of patients. One‐half of these patients had the colonoscopy to investigate a recent change in inflammatory bowel disease symptoms or signs, whereas the other half underwent endoscopy as routine surveillance. For the remaining 8 percent of patients, operated on for worsening symptoms, the carcinoma was detected in the pathological specimen only. The majority of patients (68 percent) did not have a preoperative diagnosis of dysplasia. Twenty‐five percent of tumors were mucinous, 20 percent were multicentric, and 70 percent were located distal to the splenic flexure. Among the seven patients who died, four had pancolitis, six had a recent worsening of symptoms, and all had cancer involving the rectum.CONCLUSION:Cancer occurs at a younger age in patients with long‐standing inflammatory bowel disease. The tumors are often mucinous, multiple, and located in the left colon. Despite increasing acceptance of surveillance colonoscopy as a recommended strategy in cancer prevention, almost one‐half of the patients in this study had their cancer diagnosed because increased colitis symptoms led to colonoscopic examination. Eighteen percent of patients developed cancer with less than an eight‐year history of inflammatory bowel disease. These data call into question the effectiveness of dysplasia surveillance as a population‐based strategy to decrease the colorectal cancer mortality in inflammatory bowel disease patients.

ISSN:0012-3706    

出版商:OVID    

年代:1999

数据来源: OVID