摘要:

&NA;In a randomized, prospective study of 438 patients, the safety and efficacy of the Valtrac biofragmentable anastomotic ring (BAR) was compared with stapling and with conventional suture techniques. There was no significant difference in the morbidity, mortality, and clinical course of the patients. The BAR can effect reestablishment of intestinal continuity somewhat more rapidly, but its major advantage is its uniform applicability to all areas of the intestinal tract, except the low rectum.

ISSN:0012-3706    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;Surgical treatment of colon and rectal trauma continues to challenge physicians. Injuries to a colon or rectum filled with feces results in subsequent peritoneal contamination which will lead to severe septic complications unless dealt with promptly and correctly. The authors have reviewed the records of 242 patients with colon and rectal trauma operated on at the Cook County Trauma Unit from July 1, 1973 to December 31, 1983, to evaluate treatment results. The mechanism of trauma was penetrating in 233 of 242 patients. Most, if not all, colonic lesions were treated with either exteriorization, resection and no anastomosis, or closure and proximal colostomy. Mortality related to colonic injury was 2.5 percent. Morbidity related to colonic injury included wound infection, 6.3 percent; abscess, 2.5 percent; other, 3.3 percent. Despite the severity of the trauma, adherence to conservative principles of “no anastomosis” in the overwhelming majority of cases has resulted in low morbidity and mortality.

ISSN:0012-3706    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;It has been shown previously that it is difficult for a general practitioner to predict analvs.colorectal sources of bleeding in patients presenting with rectal bleeding. The aim of the present study was to determine whether there are any aspects of such a patient's history or clinical features that strongly indicate bleeding from a colorectal cancer or polyp. One hundred forty‐five consecutive patients, aged 40 years and older, who had complained of rectal bleeding to a general practitioner, were referred to a specialist for full colonic investigation. Among 15 symptoms and clinical features examined, few had any statistically significant association with the source of bleeding. There was an elevated probability of colorectal cancer (21 percent) in patients who had seen blood mixed with feces. Most bowel symptoms and clinical features are not helpful in deciding whether to proceed with full colorectal assessment in patients aged 40 and older who have rectal bleeding of recent onset.

ISSN:0012-3706    

出版商:OVID    

年代:1989

数据来源: OVID

ISSN:0012-3706    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;The parameters of defecation,i.e., maximum rectal pressure increase during straining, duration of effective evacuation, and the work performed to evacuate a simulated stool, can be quantified by defecometry, a new method to evaluate the defecation act. Simultaneous anal pressure records demonstrate the nature of the sphincter activity during simulated defecation. The test was performed on 19 patients with constipation and on 14 controls. Five patients could not evacuate the simulated stool, while five others could, but more laboriously than the remaining nine patients whose defecation was comparable with the controls. Laborious defecation is characterized by longer duration and more performed work during evacuation. Every patient with difficult or ineffective evacuation had sphincter contraction during defecation, whereas this phenomenon was not observed in patients with normal defecation. Defecometry permits more adequate identification and characterization of the outlet‐obstruction‐type constipated patients than the simple balloon expulsion test and the analysis of sphincter activity during straining with empty rectum in lateral decubitus. Early diagnosis and treatment of patients with outlet obstruction is important to avoid late neuromuscular damage to the pelvic floor.

ISSN:0012-3706    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;The balloon‐retaining test consists of progressive filling of a compliant intrarectal balloon in a patient in the sitting position. The pressure inside the balloon is monitored and the patient is asked to retain the balloon as long as possible and to report first, constant, and maximal tolerable sensation levels. A balloon is used to simulate semisolid and solid stool. This test is a more realistic approach to the evaluation of fecal continence than the rectal saline infusion test and anal manometry. The test evaluates the rectal reservoir function, sensation, and sphincter competence simultaneously; however, the real rectal distensibility and compliance must be determined by compliance measurement until the maximal tolerable level for patients in a reclining position is reached. This test also permits objective evaluation of the effect of different treatments in incontinent patients.

ISSN:0012-3706    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;Neutropenic typhlitis is a frequently fatal disease most commonly reported in leukemics. The authors have treated eight such patients over the last 18 months. All patients had abdominal pain and sepsis during chemotherapy‐induced neutropenia. CT scanning was diagnostic in six patients thought to have typhlitis. Two patients were not diagnosed before exploratory laparotomy. The authors have found nonoperative treatment highly effective in patients who do not manifest signs of peritonitis, perforation, gastrointestinal hemorrhage, or clinical deterioration. Recurrent typhlitis was frequent after conservative therapy (recurrence rate, 67 percent), however. One patient underwent an elective right hemicolectomy after a second episode, and typhlitis did not recur despite neutropenia associated with a subsequent course of chemotherapy. It is concluded that successful treatment of this disease hinges on: 1) early diagnosis provided by a high index of suspicion and the use of CT scanning, 2) nonoperative treatment for uncomplicated cases, and 3) elective right hemicolectomy to prevent recurrence.

ISSN:0012-3706    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;Antitumor immune response to colorectal cancer extracts was tested by leukocyte adherence inhibition (LAI) assay. Of 38 colorectal cancer patients, 26 (68.4 percent) were LAI positive. The sensitivity of LAI assay was found to be inversely related to the stage of the disease. In contrast, 2 of 50 (4 percent) healthy individuals, 2 of 37 (5.4 percent) patients with nonmalignant gastrointestinal diseases, and 2 of 32 (6.3 percent) patients with malignancies other than colorectal cancer were LAI positive. Serum carcinoembryonic antigen (CEA) and serum sialic acid (SA) also were determined in 38 colorectal cancer patients. Using LAI assay in combination with CEA determination could improve the detection rate of colorectal cancer.

ISSN:0012-3706    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;In 375 patients who had curative resection for cancer of the rectum below the peritoneal reflection, prognosis was evaluated according to four currently used staging systems,i.e., Dukes' system, the modified TNM system described by the American Joint Committee for Cancer Staging, The Australian Clinicopathological Staging System, and The Astler‐Coller Staging System. Dukes' Staging System, which originally was described for use in rectal cancer, gives as good a prognostic separation as any of the other staging systems, some of which include serosal involvement as a staging criteria, which cannot be used for cancer of the extraperitoneal part of the rectum. It is furthermore demonstrated that an important prognostic separation can be obtained by dividing the B group of Dukes' Staging System into tumors that reach the surface of the muscularis propria and those with demonstrable invasion of extrarectal structures, the latter having as bad a prognosis as Dukes' C tumors.

ISSN:0012-3706    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;In the ten‐year period between 1975 and 1986, 367 patients underwent colonic resection with subsequent anastomosis using intraoperative colonic irrigation with 10 percent povidone iodine. One hundred thirty three patients underwent resection of the right or transverse colon, whereas 233 patients had left hemicolectomy with low anterior anastomosis or reanastomosis. Twenty individuals underwent emergency resection for perforation and temporary end colostomy. Nineteen of these patients returned for definitive reanastomosis as part of a two‐stage procedure. The rate of wound infection, and/or intra‐abdominal abscess formation was retrospectively reviewed and found to be completely nonexistent in these patients. This study examines the various techniques used to reduce the rate of wound infection after colonic surgery and addresses the concept of intraoperative povidone iodine irrigation.

ISSN:0012-3706    

出版商:OVID    

年代:1989

数据来源: OVID