摘要:

&NA;On hundred thirty‐eight consecutive patients undergoing elective colonic resections were treated prospectively and randomly with either a long intestinal (Cantor) tube preoperatively, a nasogastric tube placed intraoperatively, or no gastrointestinal tube at all. Patients were evaluated for length of hospital stay, duration of postoperative ileus, adequacy of intraoperative intestinal decompression, gastric dilatation, and operative complications. No significant difference could be seen in the tubed or no‐tube group.

ISSN:0012-3706    

出版商:OVID    

年代:1986

数据来源: OVID

ISSN:0012-3706    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

&NA;The function and complications associated with temporary ileostomies were reviewed in patients undergoing ileal pouch‐anal anastomosis. A series of 180 patients had temporary ileostomies established (157 loop, 23 Brooke). Patients with incomplete fecal diversion had a significantly higher incidence of pouch‐anal anastomotic complications (44 percent) than did those with complete diversion (14 percent). Patients with loop ileostomies were more likely than patients with Brooke ileostomies to develop technique‐related complications (18 percent vs. 13 percent) and peristomal irritation (54 percent vs. 26 percent). The most frequent complications after take‐down of the ileostomy were transient bowel obstruction (13 percent) and peritonitis (7 percent). These complications could not be related to the type of stoma used or the interval to closure. Temporary diversion of a pouch‐anal anastomosis decreased the incidence of anastomotic complications. These ileostomies, however, are associated with a significant risk of complications, which can be minimized by meticulous surgical technique.

ISSN:0012-3706    

出版商:OVID    

年代:1986

数据来源: OVID

ISSN:0012-3706    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

&NA;One hundred patients underwent anal dilatation for acute or chronic anal fissure during the period 1983‐1984; white blood count, serum, muscle enzymes, and blood cultures were done. Positive blood cultures were found following the procedure in eight patients. A correlation based on serum enzymes, bacteremia, and trauma can be made. Prophylactic broad‐spectrum antibiotics are recommended for patients at risk.

ISSN:0012-3706    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

&NA;A retrospective review of 176 patients with adenocarcinoma of the colon who underwent total colonoscopy preoperatively demonstrated synchronous carcinomas in 3.4 percent and synchronous polyps in 55.1 percent. Full‐column barium enemas (68 patients) failed to identify cancer in 22 percent of patients and synchronous polyps in 58 percent of patients, a statistically significant (P<0.001) number of falsenegative examinations. Double‐contrast barium enemas (30 patients) failed to identify cancer in 27 percent of patients and synchronous polyps in 42 percent of patients, also a statistically significant (P<0.007) number of false‐negative examinations. Full column and air contrast barium enemas identified all index cancers with distant metastases. Air‐contrast barium enemas failed to identify 40 percent of “early” index cancers (confined to the bowel wall, negative nodes), and full‐column barium enemas failed to identify 32 percent. The incidence of synchronous carcinoma and polyps underscores the need for total colon evaluation when a primary carcinoma is detected. Because of the poor accuracy of barium studies, total colonoscopy is the method of choice for this evaluation.

ISSN:0012-3706    

出版商:OVID    

年代:1986

数据来源: OVID

ISSN:0012-3706    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

&NA;Seven patients with widespread, active, stricturing, small intestinal Crohn's disease and two with localized disease were treated by a total of 45 strictureplasties. They have been followed up for a mean of 20 months (range, 6 to 30). Two patients had early postoperative complications with enterocutaneous fistulas, one of which may have been related to a strictureplasty. The two patients with localized disease remain well after 16 and 30 months. Of the seven patients with extensive small bowel disease, two are well six and 28 months after surgery. Recurrent symptoms developed in six patients two to six months postoperatively; four of those patients required further surgery. Previous reports of strictureplasty in inactive Crohn's strictures suggest it is a safe operation with good long‐term results. Strictureplasty in active Crohn's disease has a much higher recurrence rate of symptoms. Because it is a conservative operation, however, we believe it has a place in the surgical treatment of Crohn's disease.

ISSN:0012-3706    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

&NA;Fifteen black patients with Crohn's disease were seen during a ten‐year period (1975‐1985). They represented 11 percent of our experience with Crohn's disease during that time. These patients had an earlier age of onset of Crohn's symptoms than our white patients, and correct diagnosis was delayed for an average of four years. All 15 patients required abdominal surgery, and seven (47 percent) suffered recurrences necessitating additional abdominal operations. The five‐year actuarial estimate of probability of reoperation was 77 percent. Extraintestinal manifestations were present in all patients, and six (40 percent) had multiple manifestations. These disease manifestations are more severe than those noted in series that studied predominantly caucasian Crohn's populations, and suggest that Crohn's disease in the black patient is a distinctly aggressive form.

ISSN:0012-3706    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

&NA;In a review of 1037 patients with colorectal cancers, there were 32 patients below the age of 40 years (3 percent). Rectal bleeding and abdominal pain were the most common presenting symptoms. The average delay between the onset of symptoms and treatment was 6.5 months. An analysis of tumors according to Dukes' staging revealed no significant difference between young and elderly patients. The younger patients had a greater frequency of mucinous and poorly differentiated carcinoma. When compared by clinical staging, however, the young patient did as well or better than his older counterpart. Clinical staging was the most important prognostic factor, irrespective of age. No inherent difference was found in the virulence of the cancer in the young, and five‐year survival rates were not significantly different in young and old patients (59 percent vs. 49 percent).

ISSN:0012-3706    

出版商:OVID    

年代:1986

数据来源: OVID