ISSN:0012-3706    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

&NA;The results of total abdominal colectomy (TAC) with ileorectal anastomosis as a treatment for colonic inertia (CI) were prospectively assessed. One hundred sixtythree patients were evaluated for chronic constipation between July 1988 and November 1990. Patients underwent pancolonic transit times, anorectal manometry, cinedefecography (CD), and electromyography (EMG). CI was defined as diffuse marker delay on transit study without evidence of puborectalis contraction on CD or EMG. Sixteen patients (10 percent; 15 females and 1 male) with a mean age of 45 years (range, 24‐75 years) with CI underwent TAC. Preoperative bowel frequency ranged from three per week to one per month; all 16 patients evacuated only with high doses of laxatives, enemas, or both. TAC was performed with no postoperative mortality or major morbidity; three patients were readmitted four times for successful conservative treatment of partial small bowel obstruction. At a mean followup of 15 months (range, 2‐35 months), these 16 patients reported a mean frequency of spontaneous bowel evacuations of 3.5 per day (range, one to six per day). Patient satisfaction with the operation was “excellent” or “good” in 15 cases (94 percent). Thorough preoperative physiologic evaluation permits the selection of a small group of patients with CI who may benefit tremendously from TAC.

ISSN:0012-3706    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

&NA;This study retrospectively evaluated 288 patients who had undergone ileal pouch‐anal anastomosis to determine the incidence of perineal complications and to relate these findings to the pathologic diagnosis, with the goal of specifically clarifying the appropriate surgical management of patients with indeterminate colitis. Of these 288 patients, 235 patients (82 percent) had a diagnosis of chronic ulcerative colitis, 18 patients (6 percent) had indeterminate colitis, 6 patients (2 percent) had Crohn's disease, and 29 patients (10 percent) had familial polyposis. All complications occurred at least 6 months after closure of the stoma and required operative therapy. Of 18 patients with indeterminate colitis, 9 patients experienced complications (50 percent)vs.8 of 235 patients with chronic ulcerative colitis (3 percent), a highly significant difference(P<0.001). Furthermore, the risk of eventual ileostomy because of perineal complications was 0.4 percent in patients with chronic ulcerative colitisvs.28 percent in patients with indeterminate colitis(P<0.001). We conclude that a diagnosis of indeterminate colitis predisposes the patient undergoing ileal pouchanal anastomosis to perineal complications, with a resultant high chance of reservoir loss. Ileal pouch‐anal anastomosis should be considered with caution in the patient with a diagnosis of indeterminate colitis.

ISSN:0012-3706    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

&NA;Diminished production of short‐chain fatty acids (SCFA) by altered flora has been suggested in the pathogenesis of diversion colitis (DC). We evaluated prospectively the effectiveness of SCFA irrigation in 13 patients with excluded colon (eight males, five females; mean age, 48 years). The causes of diversion were inflammatory bowel disease (n=4), colonic cancer (n=2), sigmoid diverticulitis with perforation (n=3), ischiorectal abscess (n=2), and miscellaneous (n=2). Patients were given, twice a day for 14 days in a double‐blind manner, a 60‐ml enema containing either SCFA (acetate: 60 mmol/liter; proprionate: 30 mmol/liter; and N‐butyrate: 40 mmol/ liter) (Group 1; n=7) or isotonic NaCl (Group 2; n=6). Endoscopy with biopsies was performed before starting the trial (D1) and 14 days later (D14). On D1 all patients had endoscopic and histologic findings suggestive of DC. No endoscopic or histologic changes were observed on D14 in either group. We conclude that endoscopic and histologic lesions of DC were not improved by SCFA irrigation during the 14 days.

ISSN:0012-3706    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

&NA;The management of 14 cases of radiation injury to the intestinal tract over a 4‐year period is evaluated. The longest latent interval between radiation treatment and symptoms was 30 years. Eight patients were treated surgically; six were treated conservatively by laser therapy or application of formalin to the affected mucosa. The indications for surgery were rectovaginal fistula (four), rectal stricture (one), radiation proctitis (eight), and small bowel obstruction (one). Seven patients underwent large bowel resection. These consisted of four anastomoses with coloanal J‐reservoirs, two low anterior resections, and one coloanal anastomosis without reservoir. There was no perioperative mortality. Morbidity occurred in one of the eight surgical cases. Radical resection of the radiation‐damaged rectum has been shown to be a safe and reliable treatment for rectovaginal fistulas, rectal strictures, and proctitis unresponsive to medical measures. Coloanal J‐reservoir is the procedure of choice to avoid urgency and frequency symptoms associated with coloanal sleeve anastomosis. Laser therapy for hemorrhagic proctitis can achieve an important place in the management of this problem without recourse to surgery.

ISSN:0012-3706    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

&NA;Thirty‐seven patients underwent construction of a J‐ileal pouch‐anal anastomosis (IPAA) without temporary diverting ileostomy for chronic ulcerative colitis (CUC) (20 patients), familial adenomatous polyposis (FAP) (15 patients), indeterminate colitis (1 patient) and nonhereditary polyposis coli (1 patient) between 1981 and 1990. Seven of 20 CUC patients (35 percent) were on steroids at the time of hospital admission. The postoperative course of these patients was compared with that of a group of patients undergoing IPAA with ileostomy during that same time period and matched for age, sex, diagnosis, date of surgery, and steroid use. Eight patients (22 percent) in the group without ileostomy and four patients (11 percent) with ileostomy experienced one or more postoperative pouch‐related complications. Complications requiring reoperation in patients without ileostomy occurred more frequently in patients either taking steroids or having previous pelvic radiation therapy. Functional results in patients undergoing one‐stage procedures after a mean of 28 postoperative months were comparable to those in patients having staged procedures. Surgeons' criteria for a one‐stage procedure in these patients should include absolute lack of tension on the anastomosis, good blood supply to the terminal ileum, good general health, and absence of recent intake of steroids at the time of surgery. We conclude that J‐pouch construction with IPAA can be safely performed without diverting ileostomy, provided that these selection factors are taken into account.

ISSN:0012-3706    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

&NA;A method for constructing a continent colostomy has been tried in dogs. The pylorus sphincter with blood supply by the left gastroepiploic vessels was transposed around or anastomosed to the terminal abdominal colostomy in five dogs. One dog had a colostomy without pylorus transplantation. Evaluation was by clinical (consistency and weight of fecal material and number of defecations per day), radiologic, and manometry studies. There was no difference in the clinical data. In all the dogs, the radiologic study demonstrated emptying of the contrast medium to the peristomal skin. By manometry one high‐pressure zone was demonstrated, and, in all dogs with a transposed or anastomosed pyloric segment, the average resting pressure was superior to that of the control dog. However, the transposed pylorus sphincter alone was not sufficient to control continence.

ISSN:0012-3706    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

&NA;The purpose of this study is to demonstrate that a transanal excisional approach can be successfully used in most cases of large, benign, rectal villous adenomas with acceptable rates of recurrence and complications in comparison with historic controls. A retrospective review of all cases of benign, large, rectal villous adenomas at this institution from 1975 to 1985 was performed. A total of 122 patients had large, benign, rectal villous adenomas excised. All except five were treated by transanal excision. Thirty‐eight percent of lesions were more proximal than 8 cm from the anal verge. The average follow‐up was 55 months. Twenty‐seven percent of patients were treated for residual disease after a known incomplete initial treatment or an adenoma at the same location within 6 months of the original treatment. Thirty percent of patients were treated for recurrent adenoma 6 months after complete initial treatment. Two patients (1.7 percent) with recurrences were found to have invasive carcinoma. Both patients had excisional therapy, and one had additional radiation therapy for these carcinomas. Ten postoperative hemorrhages and two perforations occurred as symptomatic or serious complications. This renders a 10 percent complication rate for the study group, which is lower than reported by others using the Kraske or transsphincteric approach to the rectum. Because of the expected higher recurrence rate, regular follow‐up is necessary for this type of therapy. In conclusion, this study demonstrated that transanal excision of large, benign, rectal villous adenomas can be a safe and effective method of treatment.

ISSN:0012-3706    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

&NA;A study was established concerning a continent colostomy system consisting of a new one‐piece disposable plug. Twenty patients participated: 13 men and 7 women, who ranged in age from 35 to 87 years. All patients had an end colostomy located on the left lower quadrant. The colostomy age ranged from 2 months to 7 years. Of the 20 participants, 17 found the new procedure to be safer and more comfortable, as well as a considerable improvement for their quality of life. The other three patients found no advantage in its use. In no case was there any perception of local, secondary, or general adverse effects owing to its use. Taking into consideration that the use of this new device does not require any type of special conditioning, we consider that it can contribute to the better quality of life of a colostomy patient, the one best able to evaluate the worthiness of its use.

ISSN:0012-3706    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

&NA;There are no premonitory physical signs or biomarkers which can identify the genotypic status in Lynch syndrome II. Diagnosis is therefore dependent on the pedigree, with attention to cancer of all anatomic sites, inclusive of those cardinal features of its natural history. The tumor spectrum in Lynch syndrome II has continued to expand commensurately with increasing interest in this disorder. We report a family showing the constant cancer features of this syndrome but, in addition, occurrences of carcinoma of the bile duct, urologic system, and extremely early‐onset carcinoma of the pancreas, in patients in the direct genetic lineage who were considered to be candidates for having inherited the deleterious genotype. Diagnosis of Lynch syndrome II is crucial in targeting its surveillance and management.

ISSN:0012-3706    

出版商:OVID    

年代:1991

数据来源: OVID