摘要:

&NA;The comparative role of free ometal, peritoneal, Dacron®velour, and Marlex®mesh grafts in reinforcement of an extremely vulnerable experimental model of large‐bowel anastomosis was studied in dogs. While both the omentum and peritoneum proved not to be effective in preventing anastomotic leakage, Dacron velour did considerably lower this incidence to within reasonable limits but led to formation of low‐grade lymphoma at the reinforcement site in two animals. Only Marlex mesh was found to be highly effective in sealing the suture line, and it is anticipated that, with the usual teachnique of anastomosis, this sealing effect will be foolproof, thereby nullifying any risk of suture‐line breakdown

ISSN:0012-3706    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

&NA;The procedure of choice in the emergency surgical management of ulcerative colitis and Crohn's colitis is often subtotal colectomy and ileostomy. Further surgery of the retained rectum may be delayed, sometimes for many years. The risk of malignant change in ulcerative colitis is well documented; the cancer risk seems to be much less in Crohn's disease. Five cases are reported where carcinoma developed in the out‐of‐circuit rectal stump after subtotal colectomy, three cases of ulcerative colitis, and two of Crohn's disease. The importance of regular surveillance or removal of an excluded rectum is emphasized

ISSN:0012-3706    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

&NA;Changes in anal sphincteric manometric pressures in response to rectal distention were measured in eight patients with chronic anal fissures and were compared with the of ten controls. No statistically different resting pressures were noted between the two groups. Overshoot phenomenon was more commonly seen in patients with fissure. There were no differences in the anal sphincteric pressures after lateral internal sphincterotomy (LIS) or fissurectomy midline sphincterotomy (FMS). All fissures healed postoperatively, irrespective of the surgical technique (LIS or FMS) or the pressure readings. It can be concluded that the therapeutic effect of sphincterotomies might at least in part be due to anatomic widening of the anal canal rather than to decreased resting pressures of the internal sphincter.

ISSN:0012-3706    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

&NA;The author's limited experience with the use of Marlex mesh to repair large paracolostomy hernias on five patients supports the experiences of others who have used this method of repair. The use of synthetic material in the repair of these often troublesome hernias is by no means conclusive since it was used only in a small number of patients. However, it is encouraging enough to warrant further use.

ISSN:0012-3706    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

&NA;In order to determine the feasibility, yield, and impact of routine total colonoscopy on the management of large‐bowel cancer 157 cancer patients underwent 175 colonoscopic procedures; 13.6 per cent of the cancers had been missed on double‐contrast barium enema examination.Among 92 patients undergoing perioperative colonoscopy, the lesion was reached in 89 per cent and the cecum in 60 per cent; 7.6 per cent demonstrated synchronous cancers, all curable, and all missed on barium‐enema examination.Seventy‐eight patients underwent colonoscopy at an average of 3.7 years after treatment of the index cancer; 7.7 per cent demonstrated metachronous cancers, all curable, two‐thirds of which were missed on barium‐enema examination.Benign polyps were noted in 62 per cent of the patients studied; 77 per cent of those polyps, 1 cm or greater in size, were missed on barium‐enema examination. Polyps were found proximal to the cancer in 60 per cent of the patients with polyps. Approximately 85 per cent of those with multiple cancers demonstrated benign polyps. Preoperative total colonoscopy with periodic postoperative colonoscopy at an interval of three to five years are essential in the reliable detection of synchronous cancers and for the detection of metachronous cancers at an earlier, more favorable stage.

ISSN:0012-3706    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

&NA;Twenty‐nine of 31 patients bearing resectable colorectal cancers had elevated levels of serum Tennessee antigen in comparison with only eight of 31 patients for carcinoembryonic antigen. This high detection rate is, however, of limited value since the level of serum. Tennessee antigen is not specific for the presence of malignancy. There appeared to be no relationship between the level of preoperative serum Tennessee antigen and subsequent prognosis. Furthermore, in only nine of 31 patients did the serum Tennessee antigen level fall after removal of all macroscopic cancer. There also appeared to be no relationship between the level of serum TennaGen at three months after resection and subsequent prognosis. These findings are in contrast, to estimations of serum carcinoembryonic antigen.

ISSN:0012-3706    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

&NA;Serial estimations of serum Tennessee antigen have been performed at regular three‐month intervals on 35 patients with colorectal cancer who had undergone resection of all macroscopically obvious tumor but who were considered to be at high risk of developing subsequent metastases. The results were interpreted by a panel of surgeons in order to assess the clinical relevance of using serum Tennessee antigen for monitoring of patients. The serial estimation of serum Tennessee antigen was found to be very variable, difficult to interpret, and clinically unreliable as an accurate marker for the development of recurrent cancer in this group of patients. There are unacceptably high false‐positive and false‐negative diagnostic rates for serum Tennessee antigen estimations in comparison with serial estimations of carcinoembryonic antigen.

ISSN:0012-3706    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

&NA;This review was undertaken in an attempt to accumulate and critically evaluate all evidence that suggests that special techniques may alter survival rates of patients undergoing surgery for large‐bowel cancer. Data suggesting reduced survival with a distal margin of resection less than 5 cm in patients undergoing anterior resection were found to be inconsistent.En blocremoval of the primary tumor and an adhesed adjacent structure seemed important, for 30 to 60 per cent survival has been reported using this approach, and adhesions were found to contain malignant cells at the interface of the primary tumor and adjacent structure in 40 to 100 per cent of patients. No statistically significant differences in survival rates were found in studies comparing conservative segmental bowel resection with radical hemicolectomy. This was true for colonic as well as rectal resections; while patient morbidity was not markedly increased for radical colectomy, it was found to be much greater with radical rectal resections. No data to support the use of “no‐touch techniques” could be uncovered. Data to support the use of techniques for control of intraluminal tumor cells were sparse; however, because these maneuvers cost the patient little in terms of added morbidity, they should be used. Important aspects of the techniques for large‐bowel surgery need to be investigated by prospective controlled clinical trials.

ISSN:0012-3706    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

&NA;In recent years, several accounts have reported a proximal migration of colorectal cancer. To determine the experience at the Jewish General Hospital in Montreal, 1044 cases of large‐bowel cancer that presented between the years 1955 and 1978 were analyzed. The colon was arbitrarily divided into five anatomic regions, and the distribution of cancer in each region for each of eight three‐year periods was calculated. An increase in right‐sided lesions ocurred from 15.6 per cent in the first three‐year period to 37.6 per cent in the final three‐year period (P<0.01). No significant change occurred in transverse and left‐colon lesions. An increase in sigmoid carcinomas occurred from 14 per cent to 35 per cent (P<0.01). A dramatic decrease in rectal carcinoma from 53 per cent to 2.1 per cent occurred (P<0.001). These findings imply that methods for the early detection and screening of large‐bowel carcinoma should be directed at the entire colon rather than the distal 25 cm.

ISSN:0012-3706    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

&NA;A group of 230 patients undergoing elective colorectal surgery was analyzed for the presence of deep venous thrombosis (DVT). Prophylaxis against DVT was practiced with low‐dose heparin (either 5000 IU every eight hours, or 5000 IU every 12 hours for seven days) in 199 patients. Prevention of infection was attempted with preopetive administration of Enterobiotic®in 155 patients and of Vibramycin®in patiens. DVT was diagnosed in 46 patients. The frequency of DVT did not differ significantly between patients who underwent resections of the colon and those who underwent rectal surgery. DVT was diagnosed in 27 of the 73 infected patients, which was significantly higher than the incidence of 19 with DVT among the 157 uninfected patients. The frequency of DVT among patients in the two heparin regimens was 15 and 17 per cent respectively, which was significantly lower with untreated patients. No lethal pulmonary embolism was found and no patient showed clinical signs of embolism. It is assumed that measures aimed at reducing postoperative infection, combined with low‐dose heparin, will reduce the incidence of postoperative DVT after colorectal surgery.

ISSN:0012-3706    

出版商:OVID    

年代:1982

数据来源: OVID