摘要:

&NA;The authors identified 132 patients who died with a documented diagnosis of familial adenomatous polyposis (FAP). A review of the medical records, autopsy reports, and in‐depth discussion with local physicians and well‐informed family members was performed. It was impossible, even after the review, to ascertain the exact cause of death in 22 patients. In the remaining patients, the cause of death was as follows: metastatic colorectal carcinoma, 64 patients (58.2 percent), (colon, 49 [44.5 percent], rectal, 15 [13.6 percent]); desmoid tumors, 12 (10.9 percent); periampullary carcinoma, 9 (8.2 percent); brain tumors, 8 (7.3 percent); perioperative mortalities, 5 (4.5 percent); adrenal carcinoma, 1 (0.9 percent); and abdominal carcinomatosis, 1 (0.9 percent). Ten patients died of causes not related to FAP. The major causes of death in 36 patients who underwent prophylactic colectomy were desmoid tumor and periampullary malignancy. This finding underscores the importance of lifelong surveillance and periodic endoscopic evaluation in patients with FAP.

ISSN:0012-3706    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

&NA;The medical records of 54 patients treated for sigmoid volvulus from 1983 to 1987 were reviewed. Patient demographics were very similar to previously published results. Four patients (7.4 percent) underwent emergency resection for gangrene with a mortality of 75 percent. Of the 50 patients who presented without ischemia, 23 (46 percent) were managed by nonoperative detorsion while 3 (6 percent) detorsed spontaneously. Fourteen of these 26 patients received no further treatment. Nonoperative mortality was 0 percent. Celiotomy was performed on 36 patients. The type of operative procedure performed had no significant bearing on outcome. Fifteen patients underwent resection and anastomosis; two of these patients died (13 percent). Fifteen patients underwent resection and colostomy with two deaths (13 percent), and six had open detorsion alone with one death (17 percent). The two factors associated with adverse outcome after surgical intervention were patient age and history of previous volvulus. All five deaths occurred in patients older than 70 years presenting with a first episode of volvulus (N=15, mortality=33 percent). No deaths occurred among patients younger than 70 years regardless of volvulus history or among those older than 70 years who were being treated for a recurrence (P≤0.01). Patients older than 70 years with a first episode of volvulus represent a high risk if subjected to surgical intervention. Nonoperative detorsion alone should be considered for this subgroup of patients.

ISSN:0012-3706    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

&NA;Worldwide regional variations exist in the incidence of sigmoid volvulus. This article describes the experience with sigmoid volvulus at the Ahmadu Bello University Teaching Hospital in Kaduna, Nigeria. Sixty of 121 patients who had large‐bowel obstruction over a 15‐year period had sigmoid volvulus. Fifty‐seven (95 percent) had gangrenous bowel. The mortality rate was 16.7 percent. The clinical presentation and the treatment modalities offered are discussed.

ISSN:0012-3706    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

&NA;Rectal compliance (dV/dP) was studied in 31 patients with fecal incontinence, 8 patients with constipation, and 16 control subjects. Patients with fecal incontinence experienced a constant defecation urge at a lower rectal volume and also had a lower maximal tolerable volume and a lower rectal compliance than control subjects (median 126vs.155 ml, 170vs.220 ml, and 9vs.15 ml/mm Hg, respectively;tP<0.05). Constipated patients had a higher constant defecation urge volume and maximal tolerable volume than controls (median, 266 ml and 300 ml;P<0.05). There was no differences in the parameters between patients with idiopathic fecal incontinence and patients with incontinence of traumatic origin, indicating that a poorly compliant rectum in patients with fecal incontinence may be secondary to anal incontinence due to the lack of normal reservoir function.

ISSN:0012-3706    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

&NA;The preoperative staging of rectal cancer has important implications for treatment as local therapies become increasingly utilized. Seventy‐seven patients underwent preoperative staging using endorectal ultrasonography. All patients had complete pathologic staging and none had preoperative radiotherapy. Depth of invasion of the tumor was accurately predicted in 75 percent of cases in the entire group, with 22 percent overstaged and 3 percent understaged. Accuracy improved greatly over the study period, and in the past six months, 95 percent have been accurately staged for depth of invasion with 5 percent overstaged. Lymph nodes have been properly classified into positive and negative groups in 88 percent of cases in the past year, with a specificity of 90 percent and a sensitivity of 88 percent. Endorectal ultrasound is an accurate preoperative staging modality. Accuracy is improved greatly with increased experience and it has been found that the 5‐layer anatomical model facilitates accurate staging. Introduction of the ultrasound probe through a previously placed proctoscope ensures complete scanning of the entire lesion and should be used for the majority of examinations.

ISSN:0012-3706    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

&NA;Surgery was performed in 35 patients with familial adenomatous polyposis (FAP) from 22 family trees. To clarify retinal pigmentation as an important subclinical marker in patients with FAP, precise retinal examinations were performed in 41 cases (82 eyes), including 23 patients and 18 family members including 12 second‐generation and third‐generation possible carriers. In 27 patients, precise studies were done on accompanying lesions, and the number of polyps was counted at the time of surgery in each patient in every family tree. The overall incidence of retinal pigmentation in patients was 82.6 percent. The incidence of retinal pigmentation in possible carriers was found to be 50 percent, which is comparable with the calculated expressibility of the polyps. The shape and distribution of pigmentations were classified into two categories—large and small. A total of 1984 control retinal examinations were performed, which revealed only six retinal pigmentations (0.3 percent). In the control group, all pigmentation was solitary and unilateral. No large pigmentations in bilateral eyes were found in the control group. In large pigmentation, the sensitivity and specificity were calculated as 0.652 and 0.999, respectively, and in small pigmentation, the sensitivity and specificity were calculated as 0.783 and 0.997, respectively. Small pigmentation appears to increase in number around the age of the appearance of the polyp. Earliest recognition of the pigmentation in this series was one year of age.

ISSN:0012-3706    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

&NA;The striated pelvic floor musculature and the striated muscle of the external anal sphincter contribute to anal continence by effecting, respectively, the rectoanal angulation of the bowel and an anal high pressure zone. The muscular anatomy of the pelvic floor is generally understood, but the neuroanatomy remains controversial. The authors dissected three male cadavers and traced the sacral nerves from their entrance into the pelvis through the sacral foramina throughout their branching to their final destinations. Deriving from a common source, the sacral nerves S2to S4, the neural supply of the levator ani was distinct from that of the external anal sphincter: the levator is supplied by direct branches splitting from the sacral nerves proximal to the sacral plexus and running on the inner surface; the external anal sphincter is supplied by nerve fibers travelling with the pudendal nerve on the levator's undersurface. To document the functional relevance of these anatomic findings, stimulation of the pudendal and sacral nerves was performed at different levels in five patients with lower urinary tract dysfunction. Stimulation of the pudendal nerve increased the anal pressure, whereas stimulation of S3increased it only slightly but caused an impressive decrease of the rectoanal angle; when S3was stimulated after bilateral pudendal block, anal pressure did not change but the decrease in the rectoanal angulation persisted. The changes in anal pressure could be obtained without fatigue at stimulation frequencies of 10 to 20 Hz.

ISSN:0012-3706    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

&NA;Anorectal function was prospectively evaluated in 43 consecutive patients with fecal incontinence and in 19 healthy volunteers using manometry and electrical stimulation of the anoderm. Both anorectal motor and sensory function was impaired in incontinent patients as compared with healthy controls. Further statistical analysis identified four subgroups of patients showing different pathomechanisms of fecal incontinence: severe combined anorectal motor and sensory dysfunction, isolated anal sphincter dysfunction, isolated anorectal sensory dysfunction, and combined dysfunction of the internal anal sphincter and impaired anorectal sensitivity. These data support the hypothesis that sensory function of both the rectum and the anal canal is an important and independent factor in the preservation of continence.

ISSN:0012-3706    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

&NA;The authors have investigated the metabolic sequelae Picolax bowel preparation in a group receiving their preparation either 24 hours (n=17) or 48 hours (n=18) before elective colonic resection. No significant changes in any metabolic parameter were found in the 24‐hour group. In the 48‐hour group, there was a significant decrease in serum sodium (P<0.005), serum chloride (P<0.005), pH (P<0.005), HCO3(P<0.005), and base excess (P<0.005). Only 16 of 35 cases (46 percent) had an acceptable bowel preparation: 11 of 17 (65 percent) in the 24‐hour group and 5 of 18 (28 percent) in the 48‐hour group. Marker studies did not correlate with the quality of bowel preparation. The risk of potentially explosive intraluminal gas was increased if the bowel preparation was poor: 12 of 19 patients (63 percent) with a poor bowel preparation compared with 3 of 16 patients (19 percent) of those with an acceptable preparation (P<0.005). Picolax is a poor mechanical bowel preparation and is associated with unacceptable physiologic disturbance if given two days before surgery.

ISSN:0012-3706    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

&NA;A retrospective review of 64 rectocele repairs done over a four‐year period was performed. The most common indication for repair was constipation. Thirty‐five patients were repaired transanally, and 29 were repaired transvaginally. The overall morbidity was 34 percent, and the overall mortality was 0 percent. The most common complication was urinary retention in 12.5 percent. There was no difference in complications between techniques. Of 46 patients contacted for follow‐up, 25 (54 percent) still complained of constipation, 17 (34 percent) had partial incontinence, 8 (17 percent) noted persistent rectal pain, 15 (32 percent) mentioned occasional rectal bleeding, and 10 (22 percent) complained of vaginal tightness or sexual dysfunction. Thirty‐seven (80 percent) patients stated that they had improved after surgery. Except for persistent rectal pain, there was no difference in results between transanal and transvaginal repairs. Those undergoing transvaginal repair had a much greater problem with pain. Our relatively poor results may be due to an unselective approach to rectocele repair. The presence of both constipation and a rectocele does not imply an association, and a complete anorectal physiologic examination should precede repair. There is no functional difference between transvaginal and transanal rectocele repair.

ISSN:0012-3706    

出版商:OVID    

年代:1990

数据来源: OVID