摘要:

&NA;Over a period of seven years, 474 patients with acquired immune deficiency syndrome (AIDS) or AIDS‐related complex were admitted on 782 occasions to the St. Francis Medical Center, Trenton, New Jersey. Abdominal surgery was performed on 16 (3.4 percent) patients, 14 (88 percent) of whom were heterosexual intravenous drug users. Anorectal surgery was performed on 20 (4.2 percent), 14 (70 percent) of whom were intravenous drug users. Intravenous drug users undergoing abdominal surgery had the same types of surgical abdominal conditions that occur in the general population. None required surgery for complications secondary to cytomegalovirus, visceral lymphoma, or visceral Kaposi's sarcoma. The postoperative morbidity rate was 72 percent. The postoperative mortality rate (30 day) was 0 percent. No intravenous drug users who underwent anorectal surgery had associated anorectal malignancies or infectious diseases. Five of six homosexual patients had either an anorectal malignancy or an associated anorectal infectious disease. Anorectal wounds did not heal within one month in one third of the intravenous drug users. The rate of wound healing was inversely related to the white blood cell count. One third of the intravenous drug users undergoing anorectal surgery were dead within six months.

ISSN:0012-3706    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

&NA;A review of the surgical treatment of enterovesical fistula in Crohn's disease was undertaken to evaluate its effectiveness and long‐term results. Sixty‐three patients, 39 men and 24 women, with a mean age of 34.4 years were identified with enterovesical fistula. They had documented Crohn's disease for a mean period of 7.0 years. Distribution of anatomic pattern was 34.9 percent ileal, 7.9 percent colonic, and 57.2 percent ileocolic. Nineteen (30.1 percent) had previous abdominal surgery for Crohn's disease. Presenting symptoms included frequency and dysuria in 93.6 percent, pneumaturia in 79.3 percent, and fecaluria in 63.4 percent; 60.3 percent of patients had all three features. Enterovesical fistula was confirmed preoperatively in 43 patients, suspected clinically in 15 patients, and diagnosed intraoperatively in 5 patients. Sixty‐one of 63 patients underwent surgery with resection of the phlegmon or abscess with the diseased bowel and curettage or resection of the fistula. After curettage of the bladder defect, pelvic and bladder drainage was instituted. Coexistent fistulas, most commonly ileosigmoid, occurred in 31 patients. Intra‐abdominal abscesses were found in 21 patients, of whom 15 required two‐stage procedures. One patient died (mortality 1.6 percent), urine leak occurred in 3.2 percent, and wound infection occurred in 1.6 percent. Follow‐up (mean, 106 months) has identified one recurrence of enterovesical fistula due to Crohn's disease, and a further recurrence from concomitant sigmoid diverticulitis. Enterocutaneous fistulas developed in 6.4 percent and 11 patients (17.4 percent) have required further resections for Crohn's disease. Surgical treatment of enterovesical fistula in Crohn's disease is a safe and effective treatment.

ISSN:0012-3706    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

&NA;To evaluate the results and clinical impact of defecography in patients with anorectal disorders, 100 results of defecographic examinations from 92 patients were reviewed. The defecographic results were screened for the anorectal angle, defined both at rest and during straining, perineal descent, and abnormalities of the rectal configuration during straining. Anal manometry, saline infusion test, rectal capacity measurement, and anal electromyography (EMG) were also performed. There was a significant difference(P<0.001) both at rest (22°) and during straining (12°) between the two anorectal angle measurements. Incontinent patients had a larger anorectal angle, both at rest and during straining, than continent patients(P<0.04), but with a large overlap. The anorectal angle was not influenced by gender or age. An abnormal rectal configuration was found in 62 defecographic examinations. From the 8 patients with rectopexy performed for a large rectocele or intussusception, incontinent patients with an intussusception had the best results. In four patients, anal EMG showed an increased activity of the external sphincter during straining. Two of these four patients had abnormal defecograhic results. No correlations were found between anorectal angle and the other function tests. In conclusion, the anorectal angle lacks clinical relevance. In patients with defecation problems, defecography may be indicated whenever other investigations (physical examination, anal manometry, anal EMG) have excluded local pathology or a spastic pelvic floor syndrome. In these situations, defecography could detect an intussusception, which could easily be treated with rectopexy.

ISSN:0012-3706    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

&NA;From June 1983 to January 1986, 91 patients with biopsy‐proven adenocarcinoma of the rectum had computed tomographic scans of the pelvis performed before treatment as part of a “sandwich” radiotherapy‐surgery regimen. Two experienced diagnostic radiologists performed locoregional staging of all scans according to the University of California at San Francisco criteria; one of these radiologists repeated this staging at a later time to test the reproducibility of a single observer. Staging was performed without the use of any other radiographic studies or of any clinical information except the patients' age, sex, and the diagnosis of rectal carcinoma, to test the value of computed tomographic scans alone for staging. Agreement between the two stagings performed by the first observer was 51 percent, and interobserver agreement was only 37 percent. Agreement with Dukes' staging was only 33 percent. Therefore, preoperative pelvic computed tomographic scanning of primary rectal adenocarcinoma should not be relied upon for staging or for the selection of patients for treatment options.

ISSN:0012-3706    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

&NA;The anastomotic compression button is a new mechanical device that uses three interlocking polypropylene buttons to produce a sutureless bowel anastomosis. The device is unique in that it allows application of the buttons via a device similar to the popular intraluminal stapler, but it leaves no staples or foreign body of any kind in the bowel wall. The authors compared the 25‐mm anastomotic compression button with the 25‐mm intraluminal stapler in the colon of dogs. After 28 days, the mucosal blood flow, burst pressure, and anastomotic indices were found to be identical between the anastomotic compression button and the stapler. The anastomotic compression button was easier to use, and microscopic examination showed less ulceration, fibrosis, and inflammation, and better re‐epithelialization at the anastomotic compression button site. The anastomotic compression button appears to have the potential to be a superior method compared with stapled anastomoses in the colon.

ISSN:0012-3706    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

&NA;A prospective cohort study was conducted to examine whether an association exists between gastric surgery and the subsequent development of colorectal carcinoma. One thousand nine hundred twenty‐seven patients (1316 men and 611 women) who had undergone curative gastrectomy for gastroduodenal diseases in the First Department of Surgery, Tottori University Hospital, during the 18‐year period from 1964 to 1981, were followed to determine the incidence of the development of large‐bowel carcinoma after gastric surgery. The age‐, sex‐, and calendar‐specific population at risk was calculated by the person‐years method. The observed number of colorectal cancers after gastrectomy was 19 (15 men, 4 women) compared with 9.69 expected carcinomas. The difference between the observed and expected numbers was statistically significant. The authors believe that patients with previous gastrectomy are at high risk for colorectal carcinoma.

ISSN:0012-3706    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

&NA;The authors evaluated the peroperative immunologie state of patients with colorectal tumors and controlled the postoperative incidence of infections. Twenty‐one patients were studied, and delayed type hypersensitivity reactivity determined by the CMI multitest (Merieux) eight days before and eight days after surgery. A lymphocytogram was performed using monoclonal antibodies. A significant percentage of patients were anergic preoperatively. Immunologic analysis revealed lymphocytosis in the first postoperative period. The largest absolute quantitative increase was shown by NK CD16+cells. It is possible that the results, obtained by dynamic monitoring of the main parameters of cellular immunity, will offer a new way for prognostic evaluation of surgical risk.

ISSN:0012-3706    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

&NA;A previously unreported case of colonie obstruction secondary to incarcerated spigelian hernia is presented. The diagnosis was suspected preoperatively, based on the results of a barium‐enema examination. Available diagnostic techniques are reviewed.

ISSN:0012-3706    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

&NA;Variceal bleeding from ileostomy, colostomy, or ileal conduit stomas is unusual. There is no consensus on which of the various treatment options is best. A case of bleeding ileostomy varices is presented. The English‐language medical literature since 1962 is reviewed and an additional 71 cases of stomal variceal bleeding are identified. Treatment options evaluated include stomal manipulation, variceal ligation, sclerotherapy, beta blockade, and surgical shunting. The incidence of rebleeding, requirement for additional procedures, and survival with the various options are compared. Although stomal manipulation was the most commonly performed procedure, portosystemic shunting had the lowest incidence of both rebleeding and need for additional procedures (4 percent each) and provided the longest mean postoperative survival (50 months). The authors conclude that portosystemic shunting is the treatment of choice in patients with bleeding from stomal varices who are good surgical candidates.

ISSN:0012-3706    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

&NA;A 56‐year‐old male patient underwent excision of a rectal villous adenoma by a transsphincteric approach. Six years after surgery, an extrarectal mucinous mass was noted, which, on biopsy, had histologie features of implantation of benign villous adenoma within the operative scar. For medical reasons, surgery was avoided and the lesion enlarged until symptoms necessitated rectal excision five years later. Histologic examination of the resected mucinous tumor supported an origin from implanted adenomatous epithelium. This is apparently the first description of implantation of an adenoma in the surgical track. Care should be taken during transsphincteric and transsacral excision of rectal adenomas to prevent implantation at the time of surgery.

ISSN:0012-3706    

出版商:OVID    

年代:1990

数据来源: OVID