ISSN:0012-3706    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

INTRODUCTION:Anal incontinence is eight times more frequent in females than in males because of injuries sustained at childbirth. The aim of the present study was to determine the long‐term costs associated with anal incontinence related to obstetric injuries.METHODS:Sixty‐three patients with anal incontinence caused by obstetric sphincter injuries answered questionnaires regarding previous treatments, symptoms, and use of protective products. Of the patients, 31 were treated surgically, 11 with biofeedback, 6 with a combination of surgery and biofeedback, and 15 conservatively. Treatments and their respective costs were obtained from patient records, patient questionnaires, billing database, and Health Care Financing Administration's 1996 inpatient database. Costs were expressed in 1996 dollars.RESULTS:The mean incontinence score changed from 26 at evaluation to 16 at follow‐up (P<0.001). The average cost per patient was $17,166. Evaluation and follow‐up charges totaled $65,412, and physiologic assessment accounted for 64 percent of these costs. Treatment charges totaled $559,341, and physician charges accounted for 18 percent of these charges.CONCLUSIONS:Fecal incontinence after childbirth results in substantial economic costs, and treatment is not always successful. New treatment modalities, such as artificial bowel sphincter or dynamic graciloplasty, should be assessed to determine their cost‐effectiveness.

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 porcine model has been developed to allow the real‐time imaging of radiolabeled tumor cell movement throughout the peritoneal cavity, both at rest and during carbon dioxide insufflation.METHODS:Fifteen 30‐kg domestic white female pigs were used. Under anesthesia, 15 to 20 million radiolabeled human colorectal tumor cells (LIM1215) were introduced into the peritoneal cavity under laparoscopic vision into the pelvis. Radiolabeled tumor cell movement was examined by using a 25‐cm‐diameter, low‐energy mobile gamma camera with high resolution collimator. Tumor cell movement and distribution during two hours without insufflation was examined in four pigs. Then tumor cell movement and distribution during two hours with CO2insufflation was examined in four pigs. In a further four pigs, tumor cells were then mixed with blood and injected into the peritoneal cavity and the effect of no insufflationvs. insufflation was noted. A further three pigs were examined with manipulation of the intra‐abdominal contents after injection of LIM1215 cells into the peritoneal cavity. Venting insufflating CO2was filtered for tumor cells.RESULTS:Widespread intraperitoneal distribution of tumor cells from the pelvis was identified both with CO2insufflation of the peritoneal cavity and without insufflation. Tumor cells dispersed throughout the peritoneal cavity at a slower rate without carbon dioxide insufflation. There was a differential rate of tumor cell movement to the left upper quadrant and right upper quadrant with insufflation and without insufflation. Blood within the peritoneal cavity and an extended contact of the laparoscopic trocars with the peritoneal cavity in this setting increased contamination of the trocars and trocar sites with tumor cells. Tumor cells were identified on laparoscopic instruments in all experiments. No evidence of aerosolization of tumor cells was found.CONCLUSION:Tumor cells move throughout the peritoneal cavity both at rest and during CO2insufflation. The pattern of tumor cell dispersion differs with CO2insufflation. The presence of blood and extended contact of trocars with peritoneal contents are a major factor in trocar and trocar site tumor cell contamination.

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:Colonoscopy is the preferred method for colorectal cancer surveillance of high‐risk patients. Despite its high sensitivity, polyps or cancers may be undetected by colonoscopy and later attributed to an accelerated adenoma‐carcinoma sequence. This study assesses how the characteristics of colorectal cancers found at intervals between surveillance relate to the adenoma‐carcinoma sequence and its prevention.METHODS:The records of 557 patients with colorectal cancer that were diagnosed from January 1, 1990, to December 31, 1996, were reviewed to identify those patients who had prior colonoscopic surveillance within 60 months of their diagnosis.RESULTS:There were 29 (5.2 percent) patients who had one or more colonoscopies before diagnosis of their colorectal cancer. Mean interval between diagnosis and prior colonoscopy was 23 (range, 4‐59) months. The distribution of cancers included nine cecum, two ascending, three hepatic flexure, five transverse, one splenic flexure, three descending, two sigmoid, three rectum, and one anal canal. The mean tumor size was 4.4 cm for the cecum and 2.4 cm for all other locations. There were 7 Tis, 6 T1, 4 T2, and 12 T3 lesions. Six patients with T3 lesions had prior colonoscopies within 24 months of the diagnosis. Three of four patients with lymphatic metastases had tumors in the cecum. Twenty tumors (69 percent) were well or moderately differentiated. Mean follow‐up was 41 (range, 7‐95) months with two local recurrences and two unrelated deaths.CONCLUSIONS:Size, differentiation, and stage of colorectal cancer in addition to the interval to diagnosis suggest that the majority of cancers found during surveillance colonoscopy followed prior false‐negative examinations. Because cecal landmarks are most constant, prior photographic documentation may help to prove or disprove fast growth of cancers found in the cecum during surveillance colonoscopy.

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:Although local excision can be curative in patients with early‐stage rectal cancer, approximately 20 percent of patients will develop local recurrence, many as a result of unrecognized and unresected regional lymph node metastases. Our objective was to determine if standard pathologic factors can predict lymph node metastases in small intramural rectal cancers and provide a basis for patient selection for nonradical surgery.METHODS:Between June 1986 and September 1996, 318 patients with T1 or T2 rectal cancers underwent radical resection at our institution. Of these, 159 patients (48 T1 and 111 T2) were potentially eligible for curative local excision (≤4 cm in size, ≤10 cm from the anal verge, no synchronous metastases), and the prevalence of lymph node metastases based on T stage and other pathologic factors was analyzed in this group.RESULTS:The overall frequency of lymph node metastasis was 15 percent (24/159 patients). T stage (T1, 10 percent; T2, 17 percent), differentiation (well‐differentiated or moderately differentiated, 14 percent and poorly differentiated, 30 percent), and lymphatic vessel invasion (lymphatic vessel invasion‐negative, 14 percent and lymphatic vessel invasion‐positive, 33 percent) influenced the risk of lymph node metastasis. However, only blood vessel invasion (blood vessel invasion‐negative, 13 percent and blood vessel invasion‐positive, 33 percent) reached statistical significance as a single predictive factor (P=0.04). Tumors with no adverse pathologic features (low‐risk group) had a lower overall frequency of lymph node metastasis (11 percent) compared with the remaining tumors (high‐risk group, 31 percent;P=0.008). However, even in the most favorable group (T1 cancers with no adverse pathologic features) lymph node metastases were present in 7 percent of patients.CONCLUSION:In rectal cancer patients potentially eligible for local excision, the overall risk of undetected and untreated lymph node metastases is considerable (15 percent). The use of pathologic factors alone after local excision does not reliably assure the absence of lymph node metastases.

ISSN:0012-3706    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

PURPOSE:This study retrospectively evaluated the effects of intraoperative electron beam irradiation on patients with locally recurrent (pelvic) rectal cancer.METHODS:From November 1, 1975, to December 31, 1997, 51 patients underwent surgery for locally recurrent rectal or rectosigmoid cancer, and 27 patients received intraoperative electron beam irradiation. The intraoperative electron beam irradiation dose was 15 to 30 Gy. Kaplan‐Meier survival estimates at three and five years were analyzed for the 47 patients who recovered postoperatively.RESULTS:Statistically significant factors related to survival included intraoperative electron beam irradiationvs.no intraoperative electron beam irradiation (P=0.0007), amount of residual tumor (slightvs.gross;P=0.0022), and symptom status (P=0.0024). Factors not associated with survival included distant metastases at reoperation, type of surgery for the recurrent tumor, external beam irradiation, pathologic grade, age, and gender. Surgical resection without intraoperative electron beam irradiation resulted in three‐year and five‐year survival rates of 5 and 0 percent, respectively. For patients who received intraoperative electron beam irradiation, the three‐year survival rate was 43 percent and five‐year survival rate was 21 percent. Intraoperative electron beam irradiation was a statistically significant factor related to survival in patients with and without distant metastasis (P=0.04 andP=0.0035, respectively), with slight residual tumor (P=0.0003), or with palliative surgery (P=0.0276).CONCLUSION:The trends seen in resection with intraoperative electron beam irradiation are encouraging with regard to improvements in survival as compared with studies not using intraoperative electron beam irradiation treatment.

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