摘要:

&NA;The severity of Crohn's disease has not been objectively estimated for patients treated at community hospitals. During an 11‐year period, 105 patients underwent initial intestinal resection for Crohn's disease at a large community hospital. Follow‐up data were actuarially analyzed. The overall resectional reoperation rate was 4.0 per cent per year the first seven years after initial resection and 1.9 per cent per year for the next ten years. Patients with small‐bowel disease had a better prognosis than did patients with ileocolic disease. Patients who were less than 30 years of age at initial resection needed a second resection more often than did older patients. The 81 patients with initial resection after 1970 have had the lowest resectional reoperation rate yet reported: 2.8 per cent per year for ten years. The resectional reoperation rate for patients with Crohn's disease treated at this community hospital compares favorably with reoperation rates reported for patients at referral centers.

ISSN:0012-3706    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

&NA;In an effort to determine whether or not the addition of parenteral antibiotics to orally administrated erythromycin and neomycin would diminish postoperative septic complications in elective colorectal operations, a randomized, double‐blind, controlled trial was conducted comparing three groups. All patients received vigorous preoperative mechanica bowel preparation, 3 g erythromycin and 3 g neomycin orally, the day prior to operation. Patients in Group O received three doses of saline intravenously as placebo, patients in Group C received cefazolin, 1 g, immediately preoperatively and 1 g every 6 hours postoperatively, intravenously, for two doses, and patients in Group T received a single immediate preoperative dose of 6 g of ticarcillin intravenously and two saline placebo doses intravenously, postoperatively. The patients' progress has followed in the hospital and for one month postoperatively. Septic complications occurred in 35 per cent of patients in Group 0, 7 per cent of patients in Group C, and 5 per cent of patients in Group T. Wound infections comprised most of these complications, occurring in 29 per cent of Group O, 4.7 per cent of Group C, and 2.3 per cent of Group T patients. Thus, the addition of either parenteral cefazolin or ticarcillin in this study significantly reduced wound infections in elective colorectal surgery

ISSN:0012-3706    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

&NA;Based on reported success and safety, 1121 sigmoidoscopies were performed in 964 patients seen privately by one surgeon, as a routine office screening procedure, using the flexible 60‐cm sigmoidoscope instead of the rigid 25‐cm instrument. The doubling of the distance that was examined doubled the diagnostic yield for neoplasia and inflammatory bowel disease, specific or nonspecific. As compared with bariumenema examinations, the yield was even greater 5:1 for neoplasia, 7:1 for inflammation, 3:1 for polyps >1 cm, and 5:1 for false‐negative, false‐positive, or equivocal x‐ray findings. No serious complications were encountered in any of the examinations including 72 polypectomies performed in the office. The study supports flexible fiberoptic sigmoidoscopy as a major screening tool for individuals in private practive in truly evaluating the interior of the lower 60‐cm of the colorectum for neoplasia and for the diagnosis and monitoring of bowel disease or neoplasia confined to that area.

ISSN:0012-3706    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

&NA;To evaluate a semi‐standardized protocol for colostomy closure, the cases of 166 consecutive patients from 1974 through 1981 were analyzed retrospectively. There were 17 complications (17/166); overall morbidity rate was 2.4 per cent. A significantly increased incidence of major morbidity and septic complications was associated with colostomies closed at an interval of less than 8.5 weeks from formation (P≤0.001). Simple transverse closure of colostomy versus resection and end‐to‐end anastomosis did not result in increased morbidity (P≤0.1). The wound infection rate was 1.2 per cent (2/166) with 135/166 wounds closed primarily, or primarily over a subcutaneous drain, thus rendering primary wound closure safe and desirable

ISSN:0012-3706    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

&NA;In western cultures, spontaneous free perforation of the small intestine in adults is rare. The vast majority of published reports are of isolated cases. A review of 19 patients treated at the Lahey Clinic over the past 23 years is presented. All patients presented with an acute onset of peritoneal signs, and free perforation subsequently was documented at operation or at autopsy.Causes of the perforations were malignancy, six; inflammatory small bowel disease, four; combinations of radiotherapy, chemotherapy, or steroids, four; mechanical, three; and iatrogenic, two. Of the 19 patients, 15 had a history of previous abdominal surgery or recent steroid use, chemotherapy, or radiation therapy. Although the underlying disease may be of prime importance in causing perforation, these treatment modalities may be important factors in enhancing predisposition to perforation.Of the 16 patients operated on, ten had intestinal resection with primary anastomosis, and six had primary closure of the perforation. Four major complications included two deaths, and five minor complications occurred. In general, earlier operative intervention decreased mortality. A population of patients who may be at risk for small bowel perforations is identified. A review of the pertinent literature is presented.

ISSN:0012-3706    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

&NA;Progress in regional arterial infusion therapy for metastatic cancer confined to the liver from colorectal primary and in systemic chemotherapy for widespread disease has been limited. Despite considerable search for effective antitumor agents, only few drugs have been shown to have efficacy to warrant additional evaluation alone or in multidrug regimens. Despite high response rates reported with regional therapy and some of the systemic chemotherapy regimens, significant prolongation of the overall survival on these treatment programs remains to be documented. Although chemotherapy for advanced large bowel cancer is only moderately effective at present, patients do obtain substantial benefit occasionally. Thus, chemotherapy should be attempted and there should be trials of new treatment regimens to find effective treatments for these patients.

ISSN:0012-3706    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

&NA;Rectal cysts are uincommon, with a search of the medical literature revealing only 12 reported cases. This is in contrast with postanal and sacrococcygeal dermoids which, although still uncommon, appear to occur more frequently. This paper describes a case involving a dermoid cyst arising in the lateral wall of the rectum and review the recorded cases of rectal cysts.

ISSN:0012-3706    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

&NA;Malignant fibrous histiocytoma occurs most commonly in the extremities and trunk, but rarely in visceral organs. This report documents a case of malignant fibrous histiocytoma arising in the terminal ileum. Following surgical resection, there is no evidence of recurrence or metastasis in this patient after one‐year followup studies

ISSN:0012-3706    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

&NA;We report the second case of a malignant fibrous histiocytoma of the large bowel. The neoplasm constituted an incidental finding during the diagnostic work‐up for diverticulitis of the sigmoid colon. There was a massive abdominal recurrence of the tumor four months after colectomy, and the patient died nine months after the initial operation. The literature on fibroblastic sarcomas of the colon is also reviewed.

ISSN:0012-3706    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

&NA;The development of identically sited carcinoma of the colon in identical twins is described. A simultaneous presentation occurred. The case is discussed in the context of the cancer family syndrome

ISSN:0012-3706    

出版商:OVID    

年代:1983

数据来源: OVID