ISSN:0012-3706    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

&NA;It should be recognized that these guidelines should not be deemed inclusive of all proper methods of care or exclusive of methods of care reasonably directed to obtaining the same results. The ultimate judgment regarding the propriety of any specific procedure must be made by the physician in light of all of the circumstances presented by the individual patient.

ISSN:0012-3706    

出版商:OVID    

年代:2001

数据来源: OVID

ISSN:0012-3706    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

PURPOSE:Although the randomized, controlled trial has gained preeminence as the criterion standard for evaluating pharmaceutical treatments, randomized controlled trials in surgery have been perceived as difficult to surmount. Furthermore, attitudes of surgeons toward randomized, controlled trials are not well understood. We determined the views of Australian surgeons about feasibility of and barriers to surgical randomized trials.METHODS:All members of the Section of Colon and Rectal Surgery of the Royal Australasian College of Surgeons (n=147) and all Australian colorectal subspecialist surgeons (n=72) were mailed a questionnaire that included questions about surgical randomized, controlled trials.RESULTS:A total of 195 surgeons responded (89 percent). Two‐thirds (66.7 percent; 95 percent confidence interval 59.5‐73.1) of respondents agreed that “Randomized controlled trials should be the study design of choice” to evaluate new surgical procedures. Only 19 percent (95 percent confidence interval 13.9‐25.3) endorsed the statement that “too much emphasis is placed on results of randomized controlled trials.” Barriers to conducting surgical randomized, controlled trials identified by the majority included insufficient funding (74.4 percent; 95 percent confidence interval 67.5‐80.2), a lack of support from the wider surgical community (55.9 percent; 95 percent confidence interval 48.6‐62.9), and difficulties in convincing patients to accept random allocation to treatment (62.6 percent; 95 percent confidence interval 55.3‐69.3).CONCLUSION:These results reveal positive attitudes among Australian surgeons toward randomized, controlled trials, although concerns about the feasibility of randomized, controlled trials have been reinforced.

ISSN:0012-3706    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

PURPOSE:This is the first reported prospective study comparing outcome and cost in patients undergoing sphincteroplasty for anal incontinencevs.sphincteroplasty performed in combination with one or more procedures for urinary incontinence and/or pelvic organ prolapse.METHODS:We analyzed 44 patients with fecal incontinence who underwent anal sphincter repair alone (20 patients) or in combination with procedures for urinary incontinence or pelvic organ prolapse (24 patients). Information regarding risk factors for fecal incontinence, the degree of incontinence, and the extent that incontinence limited social, physical, and sexual activity was prospectively obtained from questionnaires. Clinic chart reviews and follow‐up telephone interviews provided additional data. A cohort of case‐matched patients who underwent only urogynecologic procedures was compared retrospectively for operative time, hospital cost, length of stay, and postoperative complications.RESULTS:There were no major complications in any group. The functional outcomes, physical, social, and sexual activity were similar in all three groups. Twenty‐two of 24 patients who underwent the combined procedures were glad that they had both procedures concomitantly.CONCLUSION:Combination pelvic floor surgery provides good outcomes and is cost effective. This approach should be offered to women with concurrent problems of fecal and urinary incontinence and/or pelvic organ prolapse.

ISSN:0012-3706    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

PURPOSE:Dynamic graciloplasty can improve continence in patients with severe refractory fecal incontinence, but associated morbidity is high. The purpose of this study was to identify complications associated with dynamic graciloplasty and to characterize their treatment and impact on patient outcome.METHODS:In 121 patients enrolled in a prospective trial of 20 centers and eligible for safety analysis, all complications of dynamic graciloplasty were recorded at the time of their occurrence and followed up until resolution. Severe treatment‐related complications were defined as those requiring hospitalization or surgical intervention.RESULTS:In 93 patients, 211 complications occurred. Of these, 89 (42 percent) in 61 patients were classified as severe treatment‐related complications and resulted from the following: major infection, 19; minor infection, 10; thromboembolic events, 3; device performance and use, 13; pain, 16; noninfectious gracilis problems, 8; noninfectious wound‐healing problems, 3; other surgery‐related complications, 3. In addition, severe treatment‐related complications resulted from constipation in ten and stoma creation or closure in ten. The recovery rate (full or partial) was 87 percent overall, and for severe treatment‐related complications, was 92 percent. Of the types of complications, only major infections had an adverse effect on outcome.CONCLUSION:Severe complications occur frequently after dynamic graciloplasty, but are usually treatable. They often require one or more reoperations and can lead to significant delays in completion of therapy. In most cases therapy can be salvaged.

ISSN:0012-3706    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

PURPOSE:Cyclosporin is used in severe ulcerative colitis that is refractory to intravenous steroids. Cyclosporin is a potent immunosuppressant and can cause side effects such as opportunistic infections. This study aimed to investigate the incidence of perioperative complications in patients treated with intravenous cyclosporin and steroids compared with patients treated with intravenous steroids alone.METHODS:We retrospectively reviewed the case notes of 44 patients with severe ulcerative colitis who underwent total abdominal colectomy and ileostomy. Twenty‐five patients were treated with intravenous steroids and 19 patients were treated with intravenous cyclosporin and steroids. Details were recorded with respect to age, length of illness, extent of disease, Truelove and Witt's criteria, hemoglobin and albumin at surgery, surgical procedure, and perioperative morbidity.RESULTS:Twenty‐four percent of patients treated with intravenous steroids alone and 15.8 percent of patients treated with intravenous cyclosporin and steroids had major surgical complications. Sixteen percent of patients treated with intravenous steroids alone and 5.2 percent of patients treated with intravenous cyclosporin and steroids had minor surgical complications. Eight percent of patients treated with intravenous steroids alone and 10.5 percent of patients treated with intravenous cyclosporin and steroids had major medical complications. There was no mortality in either group.CONCLUSIONS:There is no increased incidence of perioperative complications associated with the use of intravenous cyclosporin in addition to steroids in acute severe ulcerative colitis provided cyclosporin treatment is for a defined period and surgery is not delayed.

ISSN:0012-3706    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

INTRODUCTION:There are no previous comparative studies of total abdominal colectomy by laparoscopic methods in ulcerative colitis and Crohn's disease patients requiring urgent colectomy. This study aimed to determine the safety and efficacy of laparoscopic colectomy in these patients compared with those undergoing conventional urgent colectomy.METHODS:Patients undergoing laparoscopic total colectomy for acute colitis were identified in a prospective registry. All patients underwent a total colectomy with creation of an end ileostomy and buried mucous fistula. No patient had fulminant disease (tachycardia, fever, marked leukocytosis, peritonitis), but all were failing to respond to medical treatment. Patients undergoing conventional total colectomy were matched for age, gender, body mass index, diagnosis, disease severity, and operative period. Median values (range) are listed.RESULTS:From 1997 to 1999, there were 19 laparoscopic and 29 matched conventional patients. There were no inadvertent colotomies or conversions in the laparoscopic group. Although there was no difference in operative blood loss in the laparoscopic group (100 (range, 50‐700) ml) when compared with the conventional group (150 (range, 50‐500) ml), the operative times were significantly longer in the laparoscopic group (210 (range, 150‐270)vs.120 (range, 60‐180) minutes,P<0.001). Bowel function returned more quickly in the laparoscopic group (1 (range, 1‐3)vs.2 (range, 1‐4) days;P=0.003) and the length of stay was shorter (4 (range, 3‐13)vs.6 (range, 4‐24) days;P=0.04). Complications occurred in three (16 percent) laparoscopic patients (2 wound infection and 1 ileus) and in seven (24 percent) conventional patients (3 wound infection, 3 deep venous thrombosis, 1 upper gastrointestinal bleed).CONCLUSIONS:Laparoscopic total colectomy is feasible and safe in patients with acute nonfulminant colitis and may lead to a faster recovery than conventional resection.

ISSN:0012-3706    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

PURPOSE:To examine the prevalence of DNA aneuploidy as a function of the extent of ulcerative colitis and to study the correlation of aneuploidy with clinical characteristics. Furthermore, the occurrence of aneuploidy and dysplasia during colonoscopic surveillance was studied in a subset of these patients.METHODS:By analyzing 5404 biopsy samples of 368 patients with ulcerative colitis, we have evaluated the importance of DNA ploidy measured by flow cytometry. We have also investigated the influence of extent (219 patients with extensive or total colitisvs.149 patients with localized colitis) and duration of colitis on the development of dysplasia (patients with biopsy specimens that showed inflammation alone were compared with those with biopsy specimens that were equivocal or positive for dysplasia) and aneuploidy. Included was a subgroup of patients with ulcerative colitis and primary sclerosing cholangitis (n=16).RESULTS:Aneuploidy was found in 8.7 percent (32/368) of all patients. The prevalence of aneuploidy increased by the extent of ulcerative colitis (2 percent localized, 6.8 percent extensive colitis, 14.9 percent total colitis). The frequency of aneuploidy was higher in patients with disease duration longer than 10 years (P=0.007). Patients with ulcerative colitis and primary sclerosing cholangitis were more likely to develop aneuploidy (9/16, 56.3 percentvs.14/120, 11.7 percent;P<0.001) and dysplasia (4/16, 25 percentvs.10/120, 8.3 percent;P=0.06) than patients without primary sclerosing cholangitis.CONCLUSION:Because DNA aneuploidy represents an early alteration during neoplastic transformation in ulcerative colitis, flow cytometry is a valuable tool in the surveillance of those patients. Primary sclerosing cholangitis represents an additional risk factor for the development of DNA aneuploidy and dysplasia.

ISSN:0012-3706    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

PURPOSE:The value of specialization has frequently been challenged by many health care institutions and providers. This review was conducted to determine whether there were any outcome differences in the management of fistulas complicating diverticulitis.METHODS:We conducted an historical cohort study using hospital charts of all cases of fistulas complicating diverticulitis that were operated on in four university‐affiliated hospitals between 1975 and 1995. There were 122 patients, with 37 under the care of fully trained colorectal surgeons and 85 under the care of general surgeons.RESULTS:There were no significant differences in patient demographics, preoperative comorbidities, or the number of preoperative diagnostic investigations between the two groups. The colorectal surgeons performed more intraoperative ureteral stenting (Colorectal Surgery 55.5 percentvs.General Surgery 24.4 percent,P=0.001). The general surgeons performed more initial diverting Hartmann's and colostomy procedures (Colorectal Surgery 5.4 percentvs.General Surgery 27 percent,P=0.013). The patients in the General Surgery group had longer preoperative lengths of stay (median Colorectal Surgery 3 (range, 1‐28) daysvs.General Surgery 8 (range, 0‐29) days;P<0.001), longer postoperative lengths of stay (median Colorectal Surgery 11 (range, 5‐40) daysvs.General Surgery 14 (range, 2‐80) days;P=0.001), and longer total lengths of stay (median Colorectal Surgery 14 (range, 6‐62) daysvs.General Surgery 24 (range, 6‐100) days;P<0.001). The patients in the General Surgery group experienced a higher rate of wound infections (Colorectal Surgery 5.4 percentvs.General Surgery 12.9 percent), and a larger proportion of them experienced complications (Colorectal Surgery 27 percentvs.General Surgery 41.2 percent).CONCLUSIONS:We conclude that specialization in colon and rectal surgery contributed to an improved outcome, with a lower rate of diverting procedures, a shorter hospital stay, and a lower rate of complications.

ISSN:0012-3706    

出版商:OVID    

年代:2001

数据来源: OVID