摘要:

&NA;Fecal stasis in an ileal reservoir may lead to overgrowth of bacteria and changes in mucosal morphology that are of future concern. Moreover, improper evacuation may lead to increased stool frequency and reduced continence. The aims of this study were: 1) to compare the functional results of two types of ileal reservoirs constructed with an ileoanal anastomosis, 2) to compare their emptying to a normal rectum as assessed by a radionuclide enema, and 3) to correlate functional results with emptying. The reservoirs were made of two (J) or three (S) limbs of terminal ileum. Thirty‐three patients (16 with J‐pouch and 17 with S‐pouch) and ten healthy controls were included in the study. There was no difference in the mean age of patients or interval following diverting ileostomy closure. Functional results were obtained by written questionnaire assessing stool frequency, anal soiling, use of medication, need for intubation, and episodes of pouchitis. Emptying was measured with instillation per anus of a semisolid medium labeled with 1.0 mCi of Tc‐99. Ileal pouch counts were measured using a scintillation camera and computer before and after spontaneous evacuation. The emptying was defined as the difference in counts divided by preevacuation counts. The functional results were similar in the two groups. Nocturnal soiling occurred more frequently in the S‐pouch group. Pouchitis occurred in seven patients. Emptying of the two types of reservoir was similar (J: 72±4%, S: 67±5%), but it was less efficient than a normal rectum (90±3%,P<0.004). No correlation was established between age, sex, number of stools, pouchitis, and the efficacy of emptying.The clinical outcome of two patients who emptied less than 30%, however, was greatly improved by intermittent intubation. In conclusion, a semisolid radionuclide enema can be useful to identify patients who would benefit from intubation. No persistent defect in emptying was detected in patients with pouchitis.

ISSN:0012-3706    

出版商:OVID    

年代:1987

数据来源: OVID

ISSN:0012-3706    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

&NA;Twenty‐one patients were reviewed five to 12 years after silicone rubber perianal suture for rectal prolapse. Sixteen patients (76 percent) were continent with control of prolapse and two patients (9 percent) suffered only from occasional prolapse or incontinence. Rebanding for silicone cutout or fracture was required in four patients and a second rebanding operation was needed in two. Silicone rubber perianal suture for rectal proplapse stands the test of time and might be recommended for more widespread use in younger patients.

ISSN:0012-3706    

出版商:OVID    

年代:1987

数据来源: OVID

ISSN:0012-3706    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

&NA;The records of 93 patients with colocutaneous fistulas associated with diverticulitis treated at the Cleveland Clinic between 1965 and 1983 were reviewed. There were 56 males and 37 females with an age range of 19 to 80 years (median, 57 years). Eighty‐eight fistulas followed surgery for diverticulitis while five developed spontaneously. The presence of a diverting stoma in 34 patients did not prevent fistula formation but did decrease morbidity (x2=12.75,P<0.001). Initial investigations showed a high incidence of recent weight loss (in 40 percent) and hypoalbuminemia (47 percent), although these factors did not influence outcome. Patients with high output (>200 cc/day) fistulas) (n=9) fared significantly worse than those with low outputs. There were 28 patients with fistulas to other organs, 20 involving small bowel. Factors leading to persistence of the fistulas included sepsis (42 cases) and sigmoid colon distal to an intended colorectal anastomosis (38 cases).Ninety‐two patients underwent surgery, 80 percent having a one‐or two‐stage resection and anastomosis. There was one postoperative death and complications occurred in 44 patients (48 percent). Surgery was successful in producing patients without stoma or fistula in 71 cases (77 percent). There were five recurrent fistulas, 14 new fistulas, and 13 patients retained their stomas. A diagnosis of Crohn's disease was made in ten patients who had a high rate of complicated fistulas, recurrent fistulas, and retained stomas. Patients with carcinomas (n=5) also did poorly, but those on systemic steroids (n=7) fared no worse than patients not receiving them.This study emphasizes the role of diversion of the fecal stream in reducing the morbidity of colonic fistulas. It is clearly important to carry out a truecolorectalanastomosis after resection for diverticulitis, and in patients with unusually complicated clinical courses, the diagnosis of Crohn's disease should be entertained.

ISSN:0012-3706    

出版商:OVID    

年代:1987

数据来源: OVID

ISSN:0012-3706    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

&NA;Fecal incontinence and/or constipation are frequent complaints in multiple sclerosis associated with urinary bladder dysfunction, incontinence, and/or retention. Total and segmental colonic transit were studied by determination of radiopaque markers, and anorectal function by anorectal manometry, in 16 multiple sclerosis patients clinically defined (with urinary bladder dysfunction shown by urodynamic examination). Fifteen multiple sclerosis patients had constipation and 14 had increased colonic transit time; ten multiple sclerosis patients had fecal incontinence and five had spontaneous rectal contractions. It is suggested that increased colonic transit and anorectal dysfunction were secondary to neurologic disorders just as urinary bladder dysfunction is due to neurologic disorders in multiple sclerosis.

ISSN:0012-3706    

出版商:OVID    

年代:1987

数据来源: OVID

ISSN:0012-3706    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

&NA;A specific macrophage migration inhibition assay, using patient lymphocytes incubated with a human colonic cancer extract, was studied in 92 patients with proven colorectal cancer and in 134 other individuals (20 normal controls, 80 patients with various nonmalignant gastrointestinal diseases, and 34 patients with extracolonic malignancies).A positive response was obtained in 78 of 92 colorectal cancer patients, but in none of the 20 normal controls. A positive response occurred in four of 34 patients with extracolonic malignancies and in approximately half of patients with colonic adenomas and in one third of patients with ulcerative colitis. The significance of positive results in these patients (with diseases considered premalignant) is unclear, and is being studied further. In patients with previous resection of colorectal cancers, positive responses were frequent during the first year following resection, and rare thereafter.The results suggest that this method may be useful as a clinical marker for colorectal cancer, and warrants further technical refinement and study of specific patient populations.

ISSN:0012-3706    

出版商:OVID    

年代:1987

数据来源: OVID

ISSN:0012-3706    

出版商:OVID    

年代:1987

数据来源: OVID