ISSN:0012-3706    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

&NA;The best treatment of advanced rectal cancer remains uncertain. The aim of this study was to determine the outcome after palliative procedures in patients with advanced rectal cancer. One hundred and three patients treated over a seven‐year period were identified, including 30 with local invasion, 18 with local metastases, and 55 with distant metastases. Patients were grouped into two groups: those who underwent palliative resection (68) and those who were treated without rectal resection (55). The nonresected group included patients who underwent diverting colostomies (28) and those who received multimodality therapy without surgery (7). The average age of all patients was 63.1 years. Patients in the nonresected group had more distant disease (68 percent) than the resected group (46 percent). Significant pelvic pain was a more common problem in the nonresected group (15 percent) than in the resected group (4 percent). Similarly, pelvic sepsis was more common in the nonresected group (14 percent) than in the resected group (9 percent). Postoperative mortality was 4.3 percent after palliative resection and 3.8 percent after diverting colostomy. Survival of the resected group at one year was 65 percent and at two years 20 percent. Survival of the nonresected group at one year was 20 percent and at two years 0 percent. Survival in the resected group was significantly (P<.01) better than the nonresected group but probably can be attributed to the more extensive disease generally present in the patients who did not undergo resection. These results suggest that patients with advanced rectal cancers should undergo palliative resection whenever possible because resection decreases pelvic complications and may improve quality of life.

ISSN:0012-3706    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

&NA;Late diagnosis contributes significantly to the mortality and morbidity of mesenteric ischemia. Although flexible endoscopy permits noninvasive assessment of the colon, ischemic colitis is often difficult to differentiate from nonspecific proctitis/colitis or mucosal changes seen in inflammatory bowel diseases. Intravenously administered fluorescein sodium (FSC) has long been used intraoperatively to assess bowel viability because its uptake is inversely proportional to the degree of intestinal ischemia. The authors wished to determine if FSC could be used to augment conventional endoscopy in an attempt to identify and monitor ischemic areas of the bowel within reach of the endoscope. Segmental mesenteric ligation of canine rectum was performed, and serial transanal biopsies obtained. Endoscopy was performed after intravenous FSC administration, using a rigid proctoscope, with a long‐wave ultraviolet light source inserted into the lumen of the scope. Areas of nonspecific‐appearing proctitis did not take up FSC and were easily differentiated from well‐perfused areas by their failure to fluoresce. Ischemic areas were monitored in this manner over a 28‐day period. Complete resolution of ischemic mucosal changes occurred with late stricture formation. In humans, the sigmoid and left colon are the areas most frequently affected by ischemic colitis. Because long‐wave ultraviolet light is not transmitted through glass fibers, a different light source was needed for potential clinical application. To this end, a single fiber of an argon laser was inserted through the instrument channel of a colonoscope, resulting in greater fluorescence than seen with the ultraviolet light. FSC endoscopy appears to be a sensitive and accurate method of detecting and monitoring ischemic colitis and has many potential clinical applications.

ISSN:0012-3706    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

&NA;In the phenomenon of leukergy, white blood cells agglomerate in peripheral blood slides. This agglomeration has been described in inflammatory infections of various causes. This study assesses this phenomenon in inflammatory bowel disease. A correlation was found between the severity of inflammatory bowel disease activity and the percentage of leukergy. Leukergy was found to parallel the clinical and endoscopic findings of inflammatory bowel disease. Furthermore, leukergy was found to be more accurate than white blood count and erythrocyte sedimentation rate. It is also found to accurately assess the course of the disease when clinical and other laboratory tests were masked by steroid and antibiotic administrations Leukergy is a quick, inexpensive test that can easily be performed at the patient's bedside.

ISSN:0012-3706    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

&NA;The purpose of this study was to determine if a panel of monoclonal antibodies could define phenotypic markers that could be used in risk assessment of a spectrum of colonic polypes and colon cancers. Using the ABC immunoperoxidase technique on formalin‐fixed sections of surgical specimens, the following results were obtained: 1) Mab B72.3 demonstrated increased reactivity in villous lesions and cancers compared with hyperplastic polyps and tubular adenomas; 2) Mab anti‐CAA demonstrated increased reactivity in polyps compared with colon cancers; and 3) using the two antibodies (Mab B72.3 and Mab anti‐CAA), a malignancy ratio was obtained that determined malignancy risk for individual polyps. No hyperplastic polyp gave a positive ratio, but about 30 percent of villous lesions were positive. Over 50 percent of villous lesions greater than 2 cm in size had a positive ratio. The malignancy potential ratio may be a valuable marker in assessing risk of malignancy in an individual case.

ISSN:0012-3706    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

&NA;To investigate the etiology of ileal reservoir inflammation, fecal bacteriology and ileal wall morphology were compared in three groups of 15 patients operated on four ulcerative colitis: 1) conventional ileostomy, 2) Kock ileostomy; and 3) pelvic ileal pouch. Total bacterial counts showed overgrowth of fecal bacteria in each group, but the anaerobic bacterial counts were significantly higher (P<.05) in the two pouch groups than in the conventional ileostomy group. Mucosal morphology did not differ among the three groups showing either normal mucosa or mild chronic inflammatory changes in most patients. In contrast five of the six patients with clinical pouchitis had acute inflammatory changes in histologic specimens., Fecal bacteriologic findings in these patients did not differ quantitatively or qualitatively from others. It is concluded that proctocolectomy for ulcerative colitis predisposes to ileal bacterial overgrowth, and after pouch operations especially, anaerobic overgrowth may be one factor in the development of pouch inflammation. Acute clinical pouchitis with clear histologic changes was, however, not connected with specific changes in fecal bacteriology.

ISSN:0012-3706    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

&NA;An experimental, randomized, prospective study was performed in 64 dogs to evaluate the effect of fecal loading, solely, or in combination with induced peritonitis, on colonic anastomosis. The animals, none of which had bowel preparations, were randomized into four groups. Group I underwent sigmoid resection and standard open end‐to‐end anastomosis; Group II underwent sigmoid resection and an intracolonic bypass procedure; Group III underwent experimentally induced fecal peritonitis, sigmoid resection, and anastomosis; Group IV underwent induction of fecal peritonitis, sigmoid resection and an intracolonic bypass procedure. Using Fisher's exact test, results indicate a more statistically significant increased leak rate in Group III than in Group III (P=.04), and Group III than in Group IV (P=.03), but no statistically significant anastomotic leak rate between the peritonitis (III and IV) and the nonperitonitis (I and II) groups. A very significant statistical increase in leak rate (P=.002) was observed when comparing the 25 percent leak rate of Groups I and III (anastomosis subjected to fecal contact) with the 0 percent leak rate of Groups II and IV (anastomosis excluded from fecal contact) regardless of the peritonitis. This study suggests that the intraluminal contact of fecal loading at the colonic anastomosis is a more significant factor in anastomotic complications due to dehiscences than peritonitisper se. It follows, therefore, that if feces can be excluded from intraluminal contact with an anastomotic site, an anastomosis can be safely performed even in the presence of treated peritonitis

ISSN:0012-3706    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

&NA;Eight patients who receiveden blocexcision of the ureter and internal iliac vessels for locally advanced upper rectal and rectosigmoid cancer were reported. Indications, techniques, functional results of the ileal ureter, and prognosis of these patients are discussed. Although three patients died of recurrent tumor—one of transperitoneal spread and two of liver metastasis—none of them developed local recurrent growth. As a replacement for the resected ureter, ileal substitution was applied in all eight patients—unilateral in six patients and bilateral in two. Serum creatinine and electrolyte patterns were within the normal range in all patients. A voiding cystogram showed no reflux to the anastomosed ureter, and a mild reflux to the ileal segment. The patients had excellent prognoses with regard to local control and also satisfactory functional results with the ileal ureter. The authors recommend that this procedure be applied to patients with locally advanced cancer such as those in this series.

ISSN:0012-3706    

出版商:OVID    

年代:1988

数据来源: OVID

ISSN:0012-3706    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

&NA;Twenty‐seven patients with chronic pilonidal sinus were treated by a new adopted technique. It was found to be simple, time‐saving and to minimize the postoperative morbidity and hospital stay. Results of this new technique were compared with those of other excisional methods in the literature and were found to be superior to them with a shorter hospital stay. The new technique also preserves the internatal cleft, which is valuable in restoring the normal configuration of the breech. Six‐year follow‐up revealed no recurrence.

ISSN:0012-3706    

出版商:OVID    

年代:1988

数据来源: OVID