摘要:

&NA;In cases of severe colon bleeding, it is more important to know the site than the cause, in case surgery is required. Technetium‐labeled red‐cell scan (TLRCS) is known to identify the site of bleeding at the rate of 0.1 ml per minute or more. The aim of this retrospective study was to see whether TLRCS was a reliable indicator of the site of severe colon bleeding. A retrospective study was made of patients investigated in this way for acute, severe colon bleeding at St. Vincent's Hospital, Melbourne, from 1984 to 1988 (five years). TLRCS identified the site of bleeding in less than half of the cases but correctly identified the site in all nine patients in whom bleeding was so severe as to require emergency surgery, avoiding total colectomy in eight cases.

ISSN:0012-3706    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

&NA;A prospective, randomized trial of inpatientvs.outpatient bowel preparation for elective colorectal surgery was performed in 100 consecutive patients. Bowel preparation was standardized for both groups and consisted of 4 liters of Colyte®(Reed & Carnrick, Piscataway, NJ) and oral neomycin and Flagyl®(G. D. Searle & Co., Skokie, IL) the day before surgery. Patients were randomized into four subcategories: ileocolostomy, colocolostomy, abdominal perineal resection, and other. Tap water enemas were administered on the morning of surgery to ensure an adequate mechanical preparation. Ninety‐six percent of the inpatient group and 97 percent of the outpatient group were able to drink three‐fourths or more of the oral lavage preparation (P=0.789, Fisher's exact text). A mean of 2.26 tap water enemas was required to achieve clear returns for the inpatient group, compared with 2.28 tap water enemas for the outpatient group (P=0.221, Fisher's exact test). The adequacy of the bowel preparation as graded by the primary surgeon was good (84 percent), fair (12 percent), and poor (4 percent) in the outpatient group (P=0.673, Fisher's exact test). Wound infection developed in 4 percent of the inpatient group and 4 percent of the outpatient group (P=1.0, Fisher's exact test). Anastomotic leak or intra‐abdominal abscess was seen in one patient in each group (P=1.0, Fisher's exact test). We conclude that outpatient bowel preparation is as effective as inpatient bowel preparation for elective colorectal surgery and offers the advantage of cost savings and shorter hospitalization.

ISSN:0012-3706    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

&NA;A retrospective study of 80 patients with biopsy‐proven solitary rectal ulcer (SRU) was conducted to review its clinical spectrum. The median follow‐up was 25 months. The female‐to‐male ratio was 1.4:1.0, and the mean age was 48.7 years (range, 14‐76 years). Principal symptoms were bowel disturbances (74 percent) and rectal bleeding (56 percent). Twenty‐one patients (26 percent) were asymptomatic and required no treatment. A previous “wrong” diagnosis was made in 25 percent. Rectal prolapse was identified in 28 percent (full‐thickness, 15 percent; mucosal, 13 percent). The macroscopic appearance of the lesion seen in SRU varied widely and included polypoid lesions in 44 percent (the predominant finding in the asymptomatic group), ulcerated lesions in 29 percent (always symptomatic), and edematous, nonulcerated, hyperemic mucosa in 27 percent. Anorectal manometry provided little helpful information in the patients in whom it was performed. Management by bulk laxatives and bowel retraining led to symptomatic improvement in 19 percent of cases. In 29 percent of cases, symptoms persisted despite endoscopic healing of the lesion. Intractability of symptoms led to surgery in only 27 (34 percent) patients. Depending on the presence or absence of rectal prolapse, rectopexy or a conservative local procedure (such as local excision), respectively, appeared to be the optimal surgical treatment. The polypoid variety tended to respond to therapy more favorably than non‐polypoid varieties. Thus, the macroscopic appearance of SRU has a significant bearing on the clinical course, and most cases do not require surgery.

ISSN:0012-3706    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

&NA;The results of colectomy for constipation based only on evidence of delayed colonic markers have been disappointing. The operation may fail because these patients are unable to evacuate the rectum owing to outlet obstruction. In the present study, we have used a combination of videoproctography and transit marker studies in an attempt to predict patients who will have a favorable outcome after colectomy by excluding patients with outlet obstruction. Videoproctography was performed in 228 patients referred for consideration of surgery for constipation. Only 111 (38 percent) had a normal proctogram with complete evacuation of liquid barium. Of these 111 patients, 21 (19 percent) had delayed colonic marker studies. Colectomy and ileorectal anastomosis were performed in 18 of these 21 patients; two years later, 16 were symptom free, with a median daily bowel frequency of four (range, two to six). The remaining two patients failed to respond to surgery. These data suggest that true idiopathic, slow‐transit constipation is uncommon, but, when identified on the basis of delayed markers and the ability to expel liquid on proctography, an excellent result can be anticipated from colectomy and ileorectal anastomosis.

ISSN:0012-3706    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

&NA;Anastomotic recurrence after resection of colorectal carcinoma has been attributed to insufficient clearance, migration of tumor cells into lymphatics, or implantation of exfoliated malignant cells during anastomosis. We studied 10 patients submitting to low anterior resection for cancer 6 to 16 cm (mean, 12.6 cm) from the anal verge. The anastomosis was performed with a circular stapler introduced transanally into the rectum using the established technique. No lavage of the rectal stump with a cytotoxic agent was conducted before the anastomosis was performed. Having completed the anastomosis, the stapler and the doughnuts were washed with saline, which was collected for cytologic examination. The doughnuts were then examined histologically; all were tumor free. In 9 of the 10 cases, malignant cells were identified in the centrifuged saline. It may be that malignant cells collected by the stapler are implanted during anastomosis and cause subsequent anastomotic recurrence.

ISSN:0012-3706    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

&NA;Childhood constipation with encopresis is a common malady. Previous reports suggest that essentially all patients either respond to standard treatments or have spontaneous recovery before 16 years of age. In this paper, we describe the results of anorectal function studies and treatment outcome in four patients in whom constipation and encopresis persisted beyond 15 years of age. Abnormalities in the ability to defecate water‐filled balloons, in external sphincter relaxation with straining, in rectal sensation and development of the urge to defecate, and in maximum anal resting pressure were seen in some or all of these patients. In addition, two patients had impaired voluntary squeeze strength. Two patients responded to standard therapy; a colostomy was needed in one; and one failed therapy and has become a recluse.

ISSN:0012-3706    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

&NA;Jejunoileal bypass (JIB) has been a widespread operation for treatment of morbid obesity. Bile acids are regarded as cofactors in the carcinogenesis of the colon, and, since intestinal bypass involves increased exposure of bile acids to the large intestinal mucosa, JIB has been postulated to increase the risk for colorectal carcinoma. In experimental studies on animals, the results have indicated an increased frequency of induced carcinomas, but in clinical series only one patient with colon carcinoma has been reported. Thirty women, operated on with JIB 11 to 17 years earlier, were examined by colonoscopy with multiple biopsies, systematically taken for histologic evaluation and flow cytometric DNA analysis. In only one patient, low‐grade dysplasia was detected in an initial adenomatous lesion but was not visible macroscopically. No DNA aneuploidy was found. In a control group of 11 patients examined for non‐neoplastic disease, neither dysplasia nor aneuploidy was diagnosed. Within 17 years postoperatively, we have, by these methods, not been able to verify any colorectal malignant transformation in patients operated on with JIB. However, since carcinogenesis is a long process, further surveillance will be demanded before an increased risk for colorectal carcinoma can be excluded.

ISSN:0012-3706    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

&NA;Many surgeons are reluctant to construct a bowel anastomosis with irradiated intestine. Previous studies have demonstrated diminished tensile strength of rat small bowel anastomoses that have been irradiated intraoperatively. To determine whether fibrin glue, a known tissue adhesive, improves the healing of these anastomoses, 69 male Sprague‐Dawley rats were randomized into three anastomotic groups: Group 1, sutured ileal anastomosis without radiation or fibrin glue; Group 2, irradiated sutured ileal anastomosis without fibrin glue; and Group 3, irradiated ileal anastomosis with fibrin glue added to the suture line. Groups 2 and 3 received a single dose of 2,000 R intraoperatively. At seven days, the rats were sacrificed and the anastomotic segment was tested for breaking (tensile) strength. Anastomotic collagen content was evaluated using a hydroxyproline assay. Tensile strength results demonstrated that Group 2 was significantly weaker than Groups 1 and 3(P=0.001) and that the hydroxyproline content of Group 3 was significantly greater than that of Group 2(P=0.015). These results show that the addition of fibrin glue to an intraoperatively irradiated small bowel anastomosis improves healing, as demonstrated by both tensile strength and hydroxyproline content studies.

ISSN:0012-3706    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

&NA;Surveillance after colorectal carcinoma and adenoma includes colonoscopy, which is a demanding procedure for the patient, doctor, and society. Therefore, it was investigated whether a simple fecal occult blood test could replace colonoscopy. Hemoccult‐IITM(H‐II) was performed before 1,244 colonoscopies in patients with previous cancer and before 328 colonoscopies in an adenoma surveillance program. The H‐II test was positive in 3 of 9 patients with local recurrence, in 2 of 13 with metachronous cancer, and in 31 of 186 with adenomas. The test was positive more often in patients with large and multiple adenomas, sigmoid adenomas, and adenomas with villous elements and moderate‐to‐severe dysplasia, but the sensitivity did not reach more than 25 to 40 percent. It was concluded that markers more sensitive than H‐II are needed to detect metachronous cancers and new adenomas. In the meantime, colonoscopy has to be used with intervals of several years, but not for detection of local recurrent cancer, which in most cases may be found by simpler means.

ISSN:0012-3706    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

&NA;A case of adenocarcinoma developing in the pouch following restorative proctocolectomy is presented. This seems to be the third reported in the literature. The carcinoma developed from the remnants of precancerous rectal mucosa left in the muscular rectal cuff. The patient had been suffering from ulcerative colitis for 17 years prior to the development of the malignancy. He presented with features of subacute intestinal obstruction. Diagnosis was by sigmoidoscopic examination of the pouch and biopsy. He was treated with abdominoperineal resection of the pouch and rectum, followed by chemotherapy.

ISSN:0012-3706    

出版商:OVID    

年代:1992

数据来源: OVID