摘要:

&NA;Between August 1988 and September 1989, 100 consecutive patients who underwent elective abdominal colorectal surgical procedures were prospectively randomized to receive or not to receive metoclopramide. Metoclopramide was intravenously administered every 8 hours from the completion of surgery until a solid food diet was able to be tolerated. Seven patients were not included in the final tabulations because of one death, one small bowel obstruction requiring laparotomy, one anastomotic leak requiring laparotomy, and four protocol violations. Ninety‐three patients, 37 men and 56 women (mean age, 59.5; range, 14‐89 years) underwent 40 segmental colectomies, 13 total abdominal colectomies, 8 abdominoperineal resections, 8 ileoanal pouch procedures, 7 small bowel resections, and 17 other colorectal procedures. The 40 patients who received postoperative metoclopramide were in Group 1, and the 53 who did not were in Group 2. The mean length of time between laparotomy and commencement of oral fluid and oral solid intake in Groups 1 and 2 were 3.5 and 4.8 days, and 3.5 and 5.0 days, respectively. These differences were not statistically significant(P>0.05). Prolonged ileus was seen in seven patients in Group 1 and in eight patients in Group 2. These differences were also not statistically significant(P>0.05). Prolonged ileus was defined as the need for nasogastric tube reinsertion or discontinuation of oral intake. We conclude that metoclopramide does not significantly alter the course of postoperative ileus.

ISSN:0012-3706    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

&NA;Bowel anastomoses are conventionally performed using a handsewn technique or a stapling device. Each has potential benefits and disadvantages. The most clinically significant complications of the bowel anastomosis are anastomotic leakage and stricture formation. The indices of healing and tissue cohesion were compared dynamically over time in 24 dogs randomized to undergo either a standard two‐layer handsewn anastomosis or a stapled anastomosis with the PremiumCEEATM(United States Surgical Corporation, Norwalk, CT). Animals were sacrificed at 1, 4, 7, and 28 days postoperatively. Each anastomosis was evaluated for anastomotic index, burst pressure, collagen content, and histologic appearance. The anastomotic index was similar on postoperative day (POD) 1, 4, and 7; but on day 28 all handsewn anastomoses had larger diameters than the widestCEEATManastomosis. Burst pressure was higher in handsewn anastomoses at all intervals. Collagen content tended to be higher on POD 7 in theCEEATManastomoses. Histological evaluation showed more complete epithelialization and less inflammation in handsewn anastomoses on POD 28. The higher level of collagen in theCEEATManastomoses on POD 7 may be implicated in the tendency toward stricture formation found with this type of anastomosis. This study demonstrates that the greater speed and ease of the stapled anastomosis is offset by the greater strength, reduced tendency to stricture, and more complete healing of the handsewn anastomosis.

ISSN:0012-3706    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

&NA;Several investigators have used morphometric measurements to determine differences in the nuclear size and shape of normal and neoplastic colorectal tissue. Changes in nuclear morphometric parameters have also been shown to correlate with prognosis in a variety of noncolorectal cancers. The association of nuclear morphometry with prognostic indicators in rectal cancer has not been well studied. Measurements of the nuclear area, perimeter, longest cord, and circularity factor from 39 primary rectal adenocarcinomas were compared with DNA content, degree of tumor differentiation, Dukes' class, and patient survival. Nuclear circularity was found to correlate with DNA ploidy. Nondiploid tumors with a DNA index greater than 1.3 had significantly more circular nuclei than tumors with diploid or near‐diploid DNA content. There was no correlation between nuclear morphometry and Dukes' class or patient survival. Significant increases in DNA content of rectal cancers appear to be reflected by measurable changes in nuclear shape. Nuclear morphometric measurements may provide useful information in the study of the progression of neoplastic changes in colorectal cancer.

ISSN:0012-3706    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

&NA;The conservative treatment of solitary rectal ulcer is generally unsatisfactory. Six patients, aged 27‐54 years, with recurrent solitary rectal ulcer were treated with topical administration of sucralfate in a daily dose of 2 g twice a day for 6 weeks. Four patients experienced complete relief of symptoms and the remaining two patients had marked improvement. Although macroscopic healing of the ulcer was apparent in all, histologic improvement was not appreciable. Five of the six patients remain in remission during a follow‐up period of 4‐14 months (mean, 8±1.5 months). Recurrence was observed in one patient at 5 months, which satisfactorily resolved with sucralfate enemas. From these preliminary observations we infer that solitary rectal ulcer can be effectively treated with topical application of sucralfate.

ISSN:0012-3706    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

&NA;We have developed an animal model for colon cancer metastasis and produced a metastasizing tumor after using a microinjection technique to inject SW480 cells into the cecal wall of athymic nude mice during “minilaparotomy.” After the metastatic foci formed in murine lung, anin vitroprimary culture was performed and a new metastatic cancer cell line, which was designated as CC‐ML3, was established. The studies included: 1) the comparison between SW 480 and CC‐ML3 in morphology, growth kinetics, seeding and plating efficiency, and karyotype; and 2) carcino‐embryonic antigen determination, origination, and metastatic ability of CC‐ML3. The results showed that CC‐ML3 was significantly different from SW480in vitroand possesed a high metastatic potentialin vivo.This newly developed animal model may thus be useful for studying the biology and pathogenesis of metastasis of human colonic cancer.

ISSN:0012-3706    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

&NA;Survey forms were sent to all members of the Coloproctology Section of the Royal Society of Medicine and the American Society of Colon and Rectal Surgeons to obtain their opinions of the availability, actual use, and perceived helpfulness of different methods for the evaluation of the physiology of the colon and rectum. Responses revealed a similarity in age and practice patterns in both groups. Of the 19 methods surveyed, greater than 90 percent of respondents in both groups rely on three traditional methods of patient evaluation: patient history, digital examination, and sigmoidoscopy. Four other methods have gained acceptance by the majority of respondents in both groups: colon transit studies, defecography, perfused‐catheter manometry, and rectal compliance. The three methods ranked lowest in availability, actual use, and helpfulness by both groups were single‐fiber electromyography, use of a perineometer, and evoked potential studies. Our study provides a baseline for future surveys on the investigative efforts of physicians studying the physiology of the colon, rectum, and anus.

ISSN:0012-3706    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

&NA;Although squamous‐cell epithelium is the most frequent target site of human papillomavirus (HPV) infection, a similar infection is demonstrated in columnar epithelial cells in this paper. The papillomavirus expression in three cell lines was detected in colorectal adenocarcinoma of Chinese patients. The HPV‐16 and HPV‐18 DNA sequences were found in colorectal cancer cell lines, which might suggest the correlation of HPV to the etiology of colorectal cancers. In addition, c‐myconcogene was identified by amplification in all three colorectal cancer cell lines, but only normal germ‐line fragments were found in control tissue. The correlation between HPV and c‐myc,and the implications of these findings in colorectal cancers are also discussed

ISSN:0012-3706    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

&NA;The pelvic‐pouch procedure has become a standard operation for selected patients with ulcerative colitis, but is contraindicated in patients with Crohn's disease at our institution. However, the distinction between ulcerative colitis and Crohn's colitis can sometimes be difficult, if not impossible. Between January 1982, and March 1989, 272 patients with ulcerative colitis underwent pelvic‐pouch procedures at our institution. Nine (35 percent) of these patients eventually were found to have Crohn's disease. The records of these patients were examined to assess their clinical outcome and complication rate. There were five females and four males with a mean age of 28.8 years. In five patients (Group I) the diagnosis of Crohn's disease was made postoperatively on histologic examination of the rectum. The ileostomy was closed in all patients. Two developed complications necessitating excision of the pouch. Three patients are well. In the other four cases (Group II) the mean time to diagnosis was 2.5 years after the pouch procedure. Three patients developed pouch‐vaginal fistula, and one multiple anal fissures and stenosis. Two required excision of the pouch whereas two have a functioning pouch but with a persistent pouch‐vaginal fistula (n=1) or anal fissures (n=1). Overall, four patients have had their pouches removed, and five patients have functioning pouches: three with no complications and two with persistent perianal disease. Thus, we would conclude that the pelvic‐pouch procedure should not knowingly be performed in patients with Crohn's disease because of the high associated complication rate.

ISSN:0012-3706    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

&NA;Seven patients (five men and two women) ranging in age from 26 to 65 years (&OV0335;=44) underwent bilateral gluteus maximus transposition for complete anal incontinence. The indications for operation were sphincter destruction secondary to multiple fistulotomies (n=4), bilateral pudendal nerve damage (n=2), and high imperforate anus (n=1). The procedure is performed without the use of a diverting colostomy. The inferior portion of the origin of each gluteus maximus is detached from the sacrum and coccyx, bifurcated, and tunneled subcutaneously to encircle the anus. The ends are then sutured together to form two opposing slings of voluntary muscle. Postoperatively, six patients regained continence to solid stool, two to liquid stool as well, and only one patient in this group was able to control flatus. Although resting pressures remained unchanged, voluntary squeeze pressures were restored by this operation. In addition, rectal sensation was markedly improved, which helps make this a worthwhile procedure for properly selected patients.

ISSN:0012-3706    

出版商:OVID    

年代:1991

数据来源: OVID

ISSN:0012-3706    

出版商:OVID    

年代:1991

数据来源: OVID