摘要:

&NA;Perianal hidradenitis suppurativa, a chronic recurrent inflammatory disease of apocrine glands, adjacent anal canal skin, and soft tissues, is characteristically ignored and misdiagnosed. A retrospective analysis of 43 patients with perianal hidradenitis suppurativa was performed; 40 patients (93 percent) were male and 3 (7 percent) were female, with a median age at presentation of 29 years. Symptoms, including pain, swelling, purulent discharge, and pruritus, had been present for a median of six years. Diagnoses at the time of presentation included pilonidal disease (28 percent), anal fistula (37 percent), and perirectal abscess (16 percent). Associated medical conditions included diabetes (12 percent) and obesity (12 percent), and 70 percent of the patients were smokers. Once the correct diagnosis was established, 72 percent of patients had wide local excision with healing by secondary intention, and 28 percent of patients had incision and drainage or limited local excision. Although 67 percent of the patients had recurrence of disease after initial treatment, wide excision was more successful in preventing recurrence. Skin grafting failed uniformly, and colostomy was rarely necessary. Despite its relatively common occurrence, perianal hidradenitis suppurativa is infrequently diagnosed correctly and recurs in many patients despite appropriate surgical treatment, making the disease a source of frustration for surgeon and patient alike.

ISSN:0012-3706    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

&NA;Faced with the responsibility of treating patients with invasive distal rectal cancer who were medically unacceptable for the indicated radical surgery, a prospective study was initiated in which high dose preoperative radiation and full‐thickness local excision were used. High dose preoperative radiation permitted full‐thickness local excision of select cancers, which, by conventional standards, otherwise would have required radical surgery and permanent colostomy. Feasibility was measured on the basis of safety of the technique, control of the cancer, and the quality of anal sphincter function expected. Patients were selected initially because of their predicted inability to tolerate radical surgery, but indications were broadened to include those whose tumors had completely disappeared after irradiation. From 1984 to 1988, 20 patients underwent 21 operative procedures for cancers located between 0 and 7 cm from the anorectal ring. This report is concerned with the 14 patients of this group who were observed for a minimum of 24 months. High‐dose preoperative radiation was administered for a total dose of 4500 cGy. Excision and repair were performed 4 to 6 weeks after completion of radiation therapy. Full‐thickness disc or hemicircumferential excision was accomplished by transanal, transsphincteric, and transsacral techniques, which included, in several instances, excision of the sphincter mechanism and perineal body, and/or the vaginal wall. Full‐thickness local excision after high‐dose radiation therapy for rectal cancers has never been reported. Follow‐up observation ranged from 24 to 48 months with a median of 31 months. Rectal reservoir function and sphincter control were good in 13 patients. Local recurrence developed in three patients (21 percent), two of whom had postradiation therapy B2 mucinous cancers. Three‐year actuarial rate of local recurrence is 23 percent. One (7 percent) patient died of recurrent disease. Actuarial Kaplan‐Meier survival at 3 years is 61 percent. Based on the results of this small, select patient group, high‐dose radiation therapy followed by full‐thickness local excision appears to be a reasonable option for patients who cannot tolerate radical surgery. This bimodal approach also may serve as an option for those who aregoodmedical risks, but for whom sphincter preservation is at stake, and to whom radical surgery offers limited benefits.

ISSN:0012-3706    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

&NA;A gene associated with the inherited syndrome, familial adenomatous polyposis (FAP), has been localized to the long arm of chromosome 5 near the 5q21‐22 region, and markers that identify genetic polymorphisms near this locus are now available. The authors evaluated several of these markers for linkage to the FAP trait in 11 families entered in the Cleveland Clinic Polyposis Registry. The original probe that established linkage to the FAP locus (C11p11) has limited utility for family studies because of low heterozygosity and distance from the FAP gene. Other probes, however, should be useful for assessing FAP inheritance by restriction fragment length polymorphism analysis, for presymptomatic diagnosis of the disease.

ISSN:0012-3706    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

&NA;The predictive value of the route of venous drainage on prognosis was investigated in a consecutive series of 44 patients who underwent curative resection of pulmonary metastases from colorectal carcinoma. The primary tumor was located in the colon in 14 patients and in the upper third of the rectum in 11 patients, thus indicating blood drainage directed toward the portal vein (Group I). In 10 and 9 cases, respectively, the initial growth was in the middle and lower thirds of the rectum with the venous outflow at least partially directed into the vena cava (Group II). There was no obvious difference between the two groups regarding the initial site of cancer relapse. The liver was involved in 4 of 15 patients failing in Group I as opposed to 4 of 13 patients with hematogenous relapse in Group II. Median survival and tumor‐free survival times were significantly longer in patients in Group I (58.4 and 50.2 months) than in patients in Group II (30.9 and 16.8 months), and, even more pronounced, in colon cancer patients (75.4 and 60.2 months) when compared with rectal cancer patients (31.0 and 17.9 months). In contrast, survival curves did not differ significantly if either the two groups with different routes of drainage (5‐year survival 53 percentvs.38 percent, 5‐year tumor‐free survival 43 percentvs.37 percent), or tumors of the colon and rectum (5‐year survival 67 percentvs.38 percent, 5‐year tumor‐free survival 60 percentvs.32 percent) were compared using the log‐rank test. Similar trends were obtained for the subgroup of 34 patients without previous or simultaneous extrapulmonary recurrent disease at the time of lung resection. The primary tumor site does therefore not become a major criterion in selecting patients for surgical resection.

ISSN:0012-3706    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

&NA;The bowel sounds of 21 patients with mechanical obstruction of the intestine were studied. A computer analysis of bowel sounds was performed using a signal processor. Bowel sounds of patients were classified into 3 types (Types I, II, and III) based on the histograms, although these were not distinguishable on auscultation. The lower, peak, and upper frequencies were 173 ± 25 Hz, 273 ± 64 Hz, and 667 ± 58 Hz, respectively, in Type I; 309 ±121 Hz, 632 ± 94 Hz, and 878 ± 116 Hz, respectively, in Type II; and 330 ± 120 Hz, 612 ± 86 Hz, and 766 ± 82 Hz, respectively, in Type III. High frequency sounds above 900 Hz were recorded in Types I and II but not in Type III. The ratio of the operated patients was 0, 23, and 100 percent in Types I, II, and III, respectively. The intervals between the times of admission and operation were 4.3 days and 1.2 days in Types II and III, respectively. Thus, it appears that the methods described by the authors could provide a very objective assessment of the severity and help determine the treatment (conservative or operative) of each patient.

ISSN:0012-3706    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

&NA;During a four‐year period, 150 consecutive patients were treated for chronic pilonidal disease by one of three different operative techniques. Patients with acute pilonidal abscesses or with complex or multiple recurrent pilonidal disease were excluded from this study. The average healing time was four weeks and the average length of hospital stay was one day. The overall recurrence rate was 8 percent (12 of 150 patients). The method of management most commonly used was fistulotomy with marsupialization of the sinus tract or cyst wall (125 of 150 patients). This simple and effective technique gave excellent results with a 6 percent recurrence rate (7 of 125 patients). On the basis of their experience, the authors propose that chronic pilonidal disease usually can be treated successfully on a same day surgery basis with fistulotomy, minimal excision, and marsupialization.

ISSN:0012-3706    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

&NA;Retained menstrual blood, colpitis, chronic discharge from the vagina, and dyspareunia are not uncommon symptoms after proctectomy. In patients suffering from this syndrome, the vaginal drainage is impaired because of a pouch caused by adhesions formed between the coccyx and the vagina, and an angulation of the upper part of the vagina. Surgical treatment consists of extirpation of the coccyx, separation of the posterior fornix from the lower part of the sacrum, and interposition of muscle flaps from the right and left gluteus maximus muscle, which shifts the vagina to a more vertical position. The authors report the results of this procedure in nine women observed for more than two years. Wound infection occurred in two patients, and one underwent a second operation because of relapsing symptoms. Eight patients were relieved of impaired drainage of the vagina; one patient empties her menstrual blood by straining. Dyspareunia disappeared in all patients. The operation can be recommended in patients with “the horizontal vagina syndrome.”

ISSN:0012-3706    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

&NA;A review of 561 cases of cecal volvulus that were published between 1959 and 1989 along with 7 new cases, was performed to characterize the clinical and laboratory profile and to evaluate the various surgical options in treating this life‐threatening condition. The age and sex distribution of these patients have changed over the years and shifted toward older patients (mean, 53 years) and female predominance (female:male ratio, 1.4:1). The clinical presentation was usually of distal closed‐loop small bowel obstruction. Forty‐six percent of the plain abdominal radiographs were suspected for cecal volvulus, but only 17 percent were diagnostic. Barium enema had a high rate of accuracy (88 percent) and was associated with minimal complications. True volvulus was 6 times more common than bascule, and gangrenous cecum was found in 20 percent of cases. Detorsion alone and cecopexy had almost similar complications, mortality, and recurrence rates (15, 10, and 13 percent, respectively), whereas, resection, which was performed primarily for gangrenous cecum, had higher rates. However, the highest rates of complications (52 percent), mortality (22 percent), and recurrence (14 percent) were noticed after cecostomy. These data suggest that resection should be reserved for patients with necrotic cecum and that detorsion is sufficient for patients with viable cecum. Cecostomy should be abandoned.

ISSN:0012-3706    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

&NA;The majority of patients with idiopathic pruritus ani respond favorably to conservative treatment. Moreover, response to specific medical therapy is almost always favorable in certain dermatologic diseases such as psoriasis, mycotic dermatitis, and contact dermatitis. When surgery is performed for anorectal disorders such as hemorrhoids and fistulas, or potentially malignant entities such as extramammary Paget's disease, the accompanying pruritus ani invariably improves as well. Only patients with chronic intractable pruritus ani are included in the current study. Methylene blue (methylthionine chloride) 0.5 percent is injected intracutaneously on the anodermal and perianal skin. With one treatment, long‐term cure has been observed.

ISSN:0012-3706    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

&NA;Five cases of giant inflammatory polyps associated with idiopathic inflammatory bowel disease are reported. Polyps produced intestinal obstruction in three cases; consequently, surgery was performed. In a further two cases, intestinal bleeding was improved by endoscopic polypectomy. Electron microscopy showed fibroblasts, myofibroblasts, mast cells, lymphocytes, collagen fibers, capillaries, and venules. Remnants of the original mucosal epithelial cells, smooth muscle cells, and hypertrophic autonomous nerve plexuses were noted. Nerve fibers were interwoven with the matrix of the polyps. Mast cells were closely linked with vessels, nerves, and collagen fibers. They may have an important role in the excessive granulation, angiogenesis, and fibrotic process in giant inflammatory polyps.

ISSN:0012-3706    

出版商:OVID    

年代:1990

数据来源: OVID