摘要:

&NA;Since November 1980, 180 patients underwent abdominal colectomy, rectal mucosectomy, ileoanal reservoir construction, and ileoanal anastomosis at the authors' institutions. One hundred twenty‐nine patients had restoration of intestinal continuity before the end of 1986. One hundred fourteen of these patients (88 percent) were available for follow‐up at a mean length of time of 5.0 years from ileostomy closure (range, 16 to 88 months). The mean number of pouch evacuations was 5.4±2.5 during the day (range, 1 to 12) and 1.5±1.0 at night (range, 0 to 6). Ninety‐one percent of patients reported perfect or almost perfect daytime continence, and 74 percent found this true at night. Sixty‐three percent of patients believed their pouch function continued to improve over many years. Ninety‐five percent of patients questioned would choose an ileoanal reservoir again instead of a permanent ileostomy. This long‐term assessment of the function of the ileoanal reservoir confirms that it is a viable, although not perfect, option in the management of ulcerative colitis and familial adenomatous polyposis.

ISSN:0012-3706    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;Pathologic (Dukes) and clinicopathologic staging systems (Australian and TNM) are all used for the staging of colorectal cancer. Many modifications of the systems, with different standards of evidence, are currently used for a variety of purposes. It is not yet possible to readily exchange data from one staging system to another because of the lack of uniform anatomic and pathologic subdivisions. It would also be an advantage if staging systems more confidently predicted potential for cure. It is proposed that the TNM based system be modified to satisfy these requirements. Modifications identify common ground between the various systems, use prognostic variables shown to be significant by multivariate analyses, and introduce an abbreviated form of tumor grading. Grading improves prediction of cure and allows standardization of the composition of stages and substages because distant metastatic potential is shown to be related to the presence of high grade. The modifications are considered necessary and appropriate for epidemiologic and clinical studies.

ISSN:0012-3706    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;To determine the perioperative mortality and morbidity and the long‐term prognosis of patients undergoing extended pelvic resections for localized advanced primary adenocarcinoma of the rectum, the authors reviewed their experience with 65 patients operated on between 1956 and 1984. Local invasion without distant metastasis was present in all patients at operation anden blocresection of all involved organs was performed with intent of cure. Average age at operation was 61 years; 15 (23 percent) were men and 50 (77 percent) were women. Operations included abdominoperineal resection in 37 patients (57 percent), low anterior resection in 20 patients (31 percent), and Hartmann procedure in 8 patients (12 percent). Additionally, 34 of 42 women (81 percent) with intact uteri underwenten blochysterectomy, 37 of 48 women (77 percent) with intact ovaries had oophorectomy, and 25 of 50 women (50 percent) had partial vaginal resection. Seventeen of the 65 patients (26 percent) had a cystectomy, and 2 patients had a portion of small intestine resected in continuity with their tumor. Pathologic examination revealed lymph node involvement in 29 patients (45 percent) and histologic confirmation of adjacent organ extension in 37 patients (57 percent). There were no perioperative deaths, the average survival was 5.7 years, and 25 patients (38 percent) were alive after a mean follow‐up period of 9.3 years. Overall five‐year survival was 52 percent. Forty patients died during the follow‐up period, with 26 (65 percent) of the deaths attributable to either recurrent carcinoma (25 patients) or a new primary lesion (1 patient). The cumulative probability of tumor recurrence at five years was 39 percent.

ISSN:0012-3706    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;To evaluate the possible effect of gastrointestinal neuropeptides on anal function, the effect of somatostatin, enkephalin, VIP, and substance P on anal canal pressure and electromyographic response of the external anal sphincter was studied in healthy subjects. Enkephalin and somatostatin elicited a significant decrease in anal canal pressure after a bolus injection of 1 &mgr;g/kg body weight whereas VIP and substance P had no effect. Future studies must show whether these effects are of pharmacologic importance and if these peptides participate in the physiologic regulation of anorectal function.

ISSN:0012-3706    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;Endoscopic electrocoagulation or photocoagulation is now the method of choice for treating colonic angiodysplasia. Follow‐up of such patients has not been extensive. The authors report 26 patients with typical and symptomatic lesions who have been treated endoscopically. Follow‐up (mean duration, 29.3 months) revealed that 21 patients remained symptom‐free after a single procedure. Two patients needed a second procedure before being considered cured. In two others, the need for transfusions was lessened considerably after treatment. The last patient died of terminal cardiac failure. No complications occurred during treatment. Endoscopic treatment is a safe and efficient method for treating bleeding colonic angiodysplasia.

ISSN:0012-3706    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;One hundred twenty‐six patients underwent 130 end colostomies, 44 for benign and 86 for malignant disease, and were followed for an average of 35 months. The left or sigmoid colon was used in 99 and the transverse colon in 31. Stomas were made electively in 98 patients and urgently in 32. Seventy‐six stomas were brought out through the incision and 54 from separate sites. There were 69 complications in 55 patients (44 percent) including 11 strictures, 9 wound infections, 14 hernias, 9 small‐bowel obstructions, 4 prolapses, 2 abscesses, 1 peristomal fistula, 17 skin erosions, and 2 poor stoma locations. Fifteen complications required reoperation. Five of these procedures included stoma revision. Total numbers of complications were not related to the stoma site, the disease process, the urgency of the procedure, or the segment of colon used. Wound infections, however, were increased in urgently made stomas. The incidence of hernia was equivalent in stomas brought out through the incision or at a separate site. Forty‐one patients (30 percent) had 43 colostomies closed an average of 3.5 months after creation. Thirteen patients had 14 complications‐5 wound infections, 6 hernias, 2 small‐bowel obstructions, and 1 rectovaginal fistula. One patient died. Four patients required reoperation. There were no anastomotic leaks. Complications were equivalent in Hartmann closures and transverse colostomy closures. Complications were similar in stomas created for cancer and those created for diverticular disease.

ISSN:0012-3706    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;It has been suggested that radiology of the skull and jaw in familial polyposis coli may be a useful marker in up to 90 percent of cases. These x‐rays were reviewed independently by a dental surgeon and a neuroradiologist in 51 patients. Only seven patients (14 percent) had significant lesion seen in the context of screening. Each of these patients also had other extracolonic manifestations of familial polyposis coli. The Cleveland Clinic Foundation experience with radiology of the jaw and skull is that it is not a useful screening tool.

ISSN:0012-3706    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;Two hundred thirty two patients with rectal cancer at or below the peritoneal reflection, who underwent extended systematic lymphadenectomy, especially lateral node dissection, were reviewed with respect to survival rate, degree of surgical technique, and mode of recurrence. On the basis of the extent of lateral node spread, two types of lateral node dissection were performed, consisting of preservation of internal iliac vessels (conventional) anden blocexcision of these vessels (extended). The overall disease‐free five‐year survival rate was 69.4 percent in all patients—75.8 percent for those who underwent extended resection and 67.4 percent for those who underwent conventional resection an excellent survival rate of 49 percent of patients with lateral node metastasis was obtained. The analysis was carried out with regard to prognostic factors such as number of node metastases, obesity index, mode of recurrence, etc. We would recommend that systemic lymphadenectomy with lateral node dissection be performed for advanced rectal cancer at or below the peritoneal reflection.

ISSN:0012-3706    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;Preoperative hyperthermochemoradiotherapy (HCR therapy), consists of a combination of hyperthermia at 42 to 45°C for 40 minutes (2 times per week for two weeks), 5‐fluorouracil (5‐FU) intravenously (total, 1000 to 1750 mg), and a total of 30 Gy irradiation. The therapy was prescribed preoperatively most recently for 11 patients with rectal cancer. The authors used a radiofrequency system involving an endotract electrode with thermosensors for the hyperthermia. The effectiveness of preoperative HCR therapy was evaluated by irrigography, fiberscopy, and histopathologic findings in the resected specimens. Reduction in tumor size and amount was evident in all patients, with all modes of assessment. Histologically, no or only a few viable cancer cells were seen in the resected specimens in six patients, a small number of viable cancer cells in three, and a fair number of viable cancer cells in two patients; there were no complications. This method of treatment is expected to play an important role in the interdisciplinary treatment for rectal cancer.

ISSN:0012-3706    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;Restorative proctocolectomy and ileal reservoir, performed as a two‐stage procedure, has the advantages of a shorter hospital stay, one less anesthetic, and a shorter time with a stoma when compared with the three‐stage procedure. In a prospective, nonrandomized study of 152 consecutive patients undergoing restorative proctocolectomy (57 two‐stage and 95 three‐stage), the complication rates for the ileal reservoir phase and the functional results of the two‐ and three‐stage operations were compared. The results suggest that there is no advantage to the three‐stage procedure except in the following circumstances: when urgent surgery is required for the complications of ulcerative colitis, when malignancy or Crohn's disease cannot be ruled out, and when a patient with active colitis has a combination of a low hemoglobin value (male<13.5 g/dl, female<11.5 g/dl), a low serum albumin level (<40 g/l), and is taking oral steroids.

ISSN:0012-3706    

出版商:OVID    

年代:1989

数据来源: OVID