摘要:

&NA;The finding that splenic atrophy is associated with a high complication rate in colitis has led to a long‐term, prospective study of spleen size in inflammatory bowel disease. The spleen has been measured in 116 patients undergoing laparotomy for inflammatory bowel disease —2‐80 Crohn's disease and 36 ulcerative colitis—from 1975 to 1985. Small spleen size, of lesser degree than that of classic splenic atrophy, is associated with presurgery disease complications as well as infective problems after surgery. Spleen size was not related to site or extent of disease, or to recurrence, but the wide range of spleen size seen in inflammatory bowel disease, comparable to that seen in malignancy suggests that more sophisticated tests of splenic function might show a closer correlation with disease patterns

ISSN:0012-3706    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

&NA;In 14 human autopsy specimens, obtained within two hours of death, the contribution of external ligamentous attachments to competence against reflux at the ileocecal junction (ICJ) was evaluated. The ascending colon was filled with saline by retrograde flow, and pressures at which coloileal reflux occurred were recorded. Twelve of 14 ICJ's were competent to pressures of up to 80 mm Hg; two incompetent ICJ's refluxed fluid into the ileum at intracecal pressures of approximately 40 mm Hg. Competent specimens were then restudied. Removal of mucosa at the ileocecal junction (N=6), or a strip of circular muscle (N=6), did not impair competence to pressures above 40 mm Hg. However, division of fibrous tissues which helped maintain an angulation between the ileum and cecum (superior and inferior ileocecal ligaments) rendered the junction incompetent in all specimens. In four samples tested, surgical reconstruction of the ileocecal angle restored competence. Comparable observations were made in three anesthetized dogsin vivo. These findings suggest that mechanical factors, maintained by the external anatomy, contribute to competence at the ICJ.

ISSN:0012-3706    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

&NA;A total of 1578 patients were treated with potentially curative surgical resection for colon and rectal cancer by one surgeon from 1950 to 1982. Follow‐up revealed that 117 (11,5 percent) of 1013 patients with rectal carcinoma eventually presented with clinical evidence of pulmonary recurrence, with or without evidence of spread elsewhere; the corresponding figures for the colon were 20 (3.5 percent) of 565 (P<0.001). An analysis of the times to recurrence revealed that half of the lung recurrence, were clinically obvious within 32 months for rectal tumors and 34 months for colonic, compared to 22 and 21 months, respectively, for liver recurrences, excluding those with other distant metastases. The slower recurrence rate and the longer survival in patients with recurrences in the lung compared to the liver were statistically significant only for rectal primaties (P<0.02 andP=0.001, respectively). Sixteen patients underwent surgeery with curative intention for lung recurrences; four of these remain alive at two, six, 11, and 15 years, and one patient was free of recurrence when he died from other causes 15 months after surgery. The conditional probability survival rate for the 16 patients was 38±13 percent at five years after recurrence operation.

ISSN:0012-3706    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

&NA;The results of a rospective randomized trial in 111 patients were recorded to compare manual dilatation of the anus with lateral subcutaneous sphincterotomy performed under general anesthesia. There was no significant difference in the clinical results nor in the incidence of complications. Persistent or recurrent fissure occurred in three of 59 patients after manual dilatation of the anus and two of 39 patients after lateral subcutaneous sphincterotomy, and incidence of 5.1 percent in each group. Only one patient developed serious impairment of continence, and this occurred following lateral subcutaneous sphincterotomy (5.1 percent).

ISSN:0012-3706    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

&NA;The outcome of mucosal proctectomy with ileoanal anastomosis in patients with polyposis coli has not been well studied. A series of 25 patients with polyposis treated at the Mount Sinai Hospital over a period of ten years is reported. The mean age of the patients was 23 years. Early postoperative complications were present in seven patients and consisted of thrombophlebitis (three), pelvic sepsis (three), and retraction of the anastomosis (one). Intestinal obstruction requiring laparotomy occurred in another five patients. Twenty‐three patients were followed for a mean of 47 months after closure of the ileostomy. Ninety‐one percent are satisfied with the operative results. The mean number of bowel movements per 24 hours is 6.0. All patients are continent, but eight have occasional episodes of rectal seepage at night. Nearly 50 percent require some antidiarrheal medication. New adenomatous polyps have developed just above the dentate line in four patients. Patients with polyposis coli seem to have fewer serious complications requiring excision of the ileoanal anastomosis than patients with ulcerative colitis. They also should have lifelong surveillance of the entiregastrointestinal tract even after total colectomy with ileoanal anastomosis.

ISSN:0012-3706    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

&NA;Following 630 potentially curative resections, three patients had reoperations for metachronous tumors and 36 for local recurrences. Twenty‐four of the latter were identified at follow‐up clinic, but 12 presented as emergencies with obstruction. At reoperation only five patients had obvious hepatic metastases. Further colon resections were performed in ten patients. Nine of the 36 survived more than 12 months and three are alive and well over five years after reoperation.

ISSN:0012-3706    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

&NA;Is the observed recurrence rate after curative surgery for rectal cancer always a good measure of therapeutic improvements? In an attempt to answer this question, the rates of local and distant recurrences were studied in two complete series of patients operated on for cure for rectal carcinoma. One hundred one consecutive patients were followed for five years in one series and 231 were followed for at least 18 years in the other series. The recurrence rate in the first series was 39 percent and in the second, with the longer observation time, 54 percent. The local recurrence rates were 24 and 38 percent, respectively. Both local and total recurrence rates increased with the length of the follow‐up period. This was especially true for patients with combined local and distant disease. Autopsy sometimes demonstrated recurrences, clinically undiscovered. It is concluded that completeness, long follow‐up, and intensive search for recurrence, including a high autopsy rate, are factors that raise both total and local recurrence rates. All these factors are important to consider when comparing results of different treatment modalities.

ISSN:0012-3706    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

&NA;Routine preoperative colonoscopy has been recommended for those patients with the diagnosis of colorectal cancer to identify synchronous polyps and/or cancers which might otherwise be undetected on barium enema or at the time of operation. It has been suggested that this approach may alter surgical therapy or follow‐up. The charts of 98 patients who underwent preoperative colonoscopy solely for the purpose of detecting additional polyps or cancers prior to open surgical resection for colorectal cancer were retrospectively reviewed. All patients had biopsy or barium‐enema evidence of colorectal cancer. Patients with familial polyposis or chronic ulcerative colitis were excluded. Synchronous cancers were detected in 7.1 percent of patients, and synchronous neoplastic polyps in 29 percent. Forty‐three percent of synchronous cancers and 73 percent of synchronous neoplastic polyps would not have been included in the standard surgical resection for the index cancer if the additional information provided by colonoscopy had not been available. Surgical treatment and/or follow‐up were altered in 33 percent of patients as a consequence of the colonoscopic evaluation. Colonoscopy prior to surgery for colorectal carcinoma is highly desirable and may potentially improve long‐term survival.

ISSN:0012-3706    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

&NA;The epithelial expression of carbohydrate antigen, stage‐specific embryonic antigen 1 (SSEA‐1) was examined immunohistochemically in noncancerous specimens from patients with familial polyposis coli, and compared with the colorectal epithelia from patients with sporadic colorectal cancer. In mucosa remote from carcinoma of sporadic cases, SSEA‐1 was expressed only faintly in the lower crypts. In mucosa adjacent to carcinoma of sporadic cases, SSEA‐1 was expressed not only in the lower crypts but also in the upper crypts. These results corresponded to those observed in the authors' previous study. In the flat mucosa of familial polyposis coli cases, SSEA‐1 was detected not only in the lower crypts, but also in both upper crypts and the surface epithelium in contrast with the flat mucosa of sporadic cases. The staining pattern in the upper crypts of the flat mucosa of familial polyposis coli cases was very similar to that of the mucosa adjacent to carcinoma of sporadic cases, but was stronger and more diffuse in the surface epithelium. In microscopic adenomas, SSEA‐1 was expressed diffusely. These results demonstrate that the flat mucosa of patients with familial polyposis coli shows preneoplastic changes similar to those in the mucosa adjacent to carcinoma of sporadic cases, and that SSEA‐1 is related to adenoma formation in the early stage of carcinogenesis in the colorectum. In addition, the results suggest that immunohistochemical studies of flat mucosa may be useful for the early detection of high‐risk individuals in a familial polyposis coli family.

ISSN:0012-3706    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

&NA;Specimens from 47 cases of anal squamous‐cell carcinoma were examined in Stockholm county (1978 to 1981) with respect to clinical stage (43 cases), histologic grade (41 cases), and DNA content of the tumor cells (31 cases). Follow‐up ranged from four to seven years (median, 5.5 years). The increased mortality in advanced stage and high‐grade lesions was significant. Analysis of DNA content showed that most tumors were aneuploid. No statistically significant effect of DNA content on survival could be demonstrated. Thus, histologic grade and clinical stage seem to be the best predictors of patient outcome in squamous‐cell carcinoma of the anus.

ISSN:0012-3706    

出版商:OVID    

年代:1987

数据来源: OVID