ISSN:0012-3706    

出版商:OVID    

年代:1999

数据来源: OVID

ISSN:0012-3706    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

PURPOSE:Chronic low‐frequency electrical stimulation can safely transform fatiguing muscle into fatigue‐resistant muscle. This fundamental discovery was used to reconstruct the anal sphincter. Dynamic graciloplasty was found to be effective in the treatment of fecal incontinence. Our study was undertaken to investigate the oncologic, functional, and quality of life results of dynamic graciloplasty anal reconstruction after an abdominoperineal resection for carcinoma.METHODS:Between April 1993 and April 1996, nine patients (4 males) with a median age of 51.2 (range, 29‐69) years underwent an abdominoperineal resection for carcinoma (4 had a rectal adenocarcinoma and 5 had an epidermoidal anal tumor) and an anal sphincter reconstruction with electrically stimulated graciloplasty. Oncologic and functional results were evaluated after a mean follow‐up of 32 (range, 14‐59) months. A quality of life questionnaire was filled out by seven patients.RESULTS:Sphincter reconstruction required the same hospitalization period as abdominoperineal resection. Two patients died from evolutive disease. Three patients were operated on twice, one for immediate colonic necrosis, two for colonic perforation after enema. One of them refused the graciloplasty and had an abdominoperineal resection. Six patients were dysfunctioned. The mean resting pressure was 24±10 mmHg, and the mean pressure during stimulation was 95±25 mmHg. Five patients were continent for solids and liquid; four wore less than three pads per day, and one wore more than three. Four patients used enemas twice a week; one patient had spontaneous evacuation. The quality of life questionnaire showed that the mean scores for social interaction, symptoms, and psychological and physical states were 2.1, 2.2, 2.4, and 2.7, respectively. The mean value was 1.5CONCLUSIONS:Total anorectal reconstruction with dynamic graciloplasty is an oncologically safe procedure. Functional results improve with time, but careful patient selection guarantees a successful functional outcome. Technical progress is necessary to improve the quality of life.

ISSN:0012-3706    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

PURPOSE:The aim of this study was to describe an accelerated‐stay program for repair of the external anal sphincter.METHODS:Twenty consecutive patients undergoing overlapping repair of the external anal sphincter were included in the study. Effect parameters were length of hospitalization and complications within 30 days after the operation. Surgery was performed during the period of March 1993 to May 1997. The accelerated‐stay program included preoperative information, no premedication, a surgical procedure without colostomy, single‐dose prophylactic antibiotics, paracetamol for analgesia, free oral fluid and food immediately after the operation supplemented by laxatives, and enforced mobilization. Follow‐up by questionnaire was performed at a median of 14 (range, 4‐52) months after the operation.RESULTS:Median hospital stay was one day. Fifteen patients were discharged the day after surgery and 5 patients stayed for 48 hours after the operation. There was no 30‐day morbidity, and no patient received a colostomy in conjunction with the sphincter repair. Fourteen of 19 patients available for follow‐up reported a significantly improved functional result compared with preoperative state.CONCLUSION:We have described a safe accelerated‐stay program (24 to 48 hours) for overlapping repair of external anal sphincter.

ISSN:0012-3706    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

&NA;Optional treatment for complete rectal prolapse remains controversial.PURPOSE:We reviewed our experience over a 19‐year period to assess trends in choice of operation, recurrence rates, and functional results.METHODS:We identified 372 patients who underwent surgery for complete rectal prolapse between 1976 and 1994. Charts were reviewed and follow‐up (median, 64; range, 12‐231 months) was obtained by mailed questionnaire (149 patients; 40 percent) and telephone interview (35 patients; 9 percent). Functional results were obtained from 184 responders (49 percent).RESULTS:Median age of patients was 64 (11‐100) years, and females outnumbered males by nine to one. One‐hundred and eighty‐eight patients (51 percent) were lost to follow‐up; 183 patients (49 percent) underwent perineal rectosigmoidectomy, and 161 patients (43 percent) underwent abdominal rectopexy with bowel resection. The percentage of patients who underwent perineal rectosigmoidectomy increased from 22 percent in the first five years of the study to 79 percent in the most recent five years. Patients undergoing perineal rectosigmoidectomy were more likely to have associated medical problems as compared with patients undergoing abdominal rectopexy (61vs. 30 percent,P=0.00001). There was no significant difference in morbidity, with 14 percent for perineal rectosigmoidectomyvs.20 percent for abdominal rectopexy. Abdominal procedures were associated with a longer length of stay as compared with perineal rectosigmoidectomy (8vs.5 days,P=0.001). Perineal procedures, however, had a higher recurrence rate (16vs.5 percent,P=0.002). Functional improvement was not significantly different, and most patients were satisfied with treatment and outcome.CONCLUSIONS:We conclude that abdominal rectopexy with bowel resection is associated with low recurrence rates. Perineal rectosigmoidectomy provides lower morbidity and shorter length of stay, but recurrence rates are much higher. Despite this, perineal rectosigmoidectomy has appeal as a lesser procedure for elderly patients or those patients in the high surgical risk category. For younger patients, the benefits of perineal rectosigmoidectomy being a lesser procedure must be weighed against a higher recurrence rate.

ISSN:0012-3706    

出版商:OVID    

年代:1999

数据来源: OVID

ISSN:0012-3706    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

PURPOSE:A survey was conducted to document current medical treatment of patients with uncomplicated acute diverticulitis.METHODS:A survey was mailed to 667 fellows of The American Society of Colon and Rectal Surgeons certified by the American Board of Colon and Rectal Surgery. Queries were based on a clinical scenario of a patient with uncomplicated diverticulitis.RESULTS:Three hundred seventy‐three surveys (56 percent) were returned completed. The majority (66 percent) chose an abdominal computed tomographic scan as the initial diagnostic test. One‐half used a single intravenous antibiotic with second‐generation cephalosporins (27 percent) and ampicillin/sulbactam (16 percent) being the most common. Oral antibiotics given at discharge were ciprofloxacin (18 percent), amoxicillin/clavulanate (14 percent), metronidazole (7 percent), and doxycycline (6 percent). Combinations chosen were ciprofloxacin/metronidazole (28 percent) and metronidazole/trimethoprim sulfamethoxazole (6 percent), whereas 21 percent chose a variety of other antibiotics. The majority (74 percent) prescribed oral antibiotics for 7 to 10 days. Dietary recommendations at discharge were low residue (68 percent), regular (21 percent), and high residue (10 percent). Half of those surveyed believed avoidance of seeds and nuts were of no value. Follow‐up examinations chosen included sigmoidoscopy and barium enema (29 percent), colonoscopy (25 percent), sigmoidoscopy (17 percent), barium enema (13 percent), and other (16 percent). Sixty‐five percent of colon and rectal surgeons claim to handle more than half of their patients with uncomplicated diverticulitis on an outpatient basis.CONCLUSION:Variations in the management of uncomplicated sigmoid diverticulitis are noted among colon and rectal surgeons, especially in terms of antibiotic choice, discharge instructions, and follow‐up outpatient studies. The survey results are compared with the conclusions reached in The American Society of Colon and Rectal Surgeons practice parameters. Documentation of practice pattern variation may serve as an educational tool for physicians to improve their quality and cost of medical care. Consideration should be given to better publicize already existing American Society of Colon and Rectal Surgeons practice parameters for this common entity.

ISSN:0012-3706    

出版商:OVID    

年代:1999

数据来源: OVID

ISSN:0012-3706    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

PURPOSE:Our laboratory has previously shown that tumors are more easily established and grow larger after laparotomyvs. laparoscopy. The purpose of this study was to better characterize these differences in tumor growth by assessing tumor cell proliferationviathe proliferating cell nuclear antigen assay, which has been shown to be a reliable marker of cellular proliferation.METHODS:Female C3H/He mice (N=40) were inoculated intradermally in the dorsal skin with 106cultured mouse mammary carcinoma cells <1 hour before interventions. Anesthesia control mice underwent no procedure. Laparotomy group mice had a midline incision from xiphoid to pubis that was closed after 20 minutes. Insufflation group mice underwent CO2pneumoperitoneum (4‐6 mmHg) for 20 minutes. On postoperative Day 6, tumors were excised from one‐third of the mice in each group, and from the remaining mice on postoperative Day 12. Sections were made and stained immunohistochemically for proliferating cell nuclear antigen, and the proliferative index of each tumor was determined by taking the average of proliferating cell nuclear antigen‐positive cells in five high‐power fields (×450), counted in a blinded fashion with the aid of an optical grid.RESULTS:On postoperative Day 6, the mean proliferative index for the laparotomy group was significantly higher than those for both the insufflation (P<0.04) and the control (P<0.001) groups. Of note, the proliferative index of the insufflation group was significantly higher than that of the control (P<0.01) group. Similarly, on postoperative Day 12, the mean proliferative index for the laparotomy group was significantly higher than for both the insufflation (P<0.05) and the control (P<0.005)groups. The proliferative index in the insufflation group was also significantly higher than that of the control (P<0.04) group.CONCLUSIONS:We have demonstrated that there is a significantly higher rate of tumor cell proliferation with the mouse mammary carcinoma cell tumor line after laparotomy than after pneumoperitoneum or anesthesia alone at two postoperative times. Additionally, insufflation alone increases postoperative tumor cell proliferation but to a lesser extent than laparotomy. The mechanism underlying these findings is unclear.

ISSN:0012-3706    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

PURPOSE:Electromyography of the external anal sphincter is frequently used when investigating patients with defecation disorders. Investigations are often performed using an invasive technique by perineal insertion of a needle or wire electrode. The aim of the present study was to investigate whether surface electromyography, with electrodes applied to the perineal skin, is a reliable method in the diagnosis of paradoxical anal sphincter reaction.METHODS:Seventy‐one patients with defecation disorders participated in the present study. They were investigated with electromyography of the external anal sphincter using surface and needle electrodes.RESULTS:In 65 of 71 (92 percent) patients the electromyography recording showed the same result during straining using surface electrodes when compared with needle electrodes. Twenty‐two of these 65 patients had paradoxical anal sphincter reaction, and 43 patients had decreased electromyography activity. In 6 of 71 (8 percent) patients the electromyography recording showed a different pattern during straining using surface electrodes when compared with needle electrodes.CONCLUSION:The present study demonstrates a good correlation between surface electrodes applied to the perineal skin and concentric needle electrodes in the diagnosis of paradoxical anal sphincter reaction. Noninvasive electromyography recordings of the external anal sphincter are often preferred in the diagnosis of paradoxical anal sphincter reaction.

ISSN:0012-3706    

出版商:OVID    

年代:1999

数据来源: OVID