摘要:

&NA;Thirty‐three patients with perianal Bowen's disease were treated at the Cleveland Clinic Foundation from 1954 to 1986. Twenty‐one patients were women and 12 were men, ranging in age from 30 to 69 years (mean, 48 years). Twenty patients (61 percent) presented with symptomatic perianal disease, while 13 patients (39 percent) were noted as having perianal Bowen's disease upon pathologic examination of routine hemorrhoidectomy specimens. Ten of the patients (30 percent) had prior histories of unrelated cancer. Twenty‐seven patients were managed by wide local excision, three patients by simple excision, three patients by fulguration, and one patient by an abdominoperineal resection. During a follow‐up period averaging 3.7 years (range, 0.3 to 10 years), one patient developed a new invasive skin cancer while a second patient experienced a recurrence of perianal Bowen's disease. The characteristic gross appearance of this lesion and its failure to respond to conventional therapy should prompt the performance of a hiopsy, which readily establishes the diagnosis. This experience confirms that wide local excision is adequate therapy for perianal Bowen's disease and that close clinical follow‐up is necessary to identify disease recurrence or the development of a malignancy.

ISSN:0012-3706    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

&NA;Flow cytometric DNA analysis was performed on the colonic adenomas of 24 patients who had resection of an invasive colorectal carcinoma subsequent to polypectomy. The incidence of DNA aneuploidy among these adenomas was only 13 percent. Thus, simple recognition of colonic adenomas as being DNA diploid or DNA aneuploid is unlikely to be helpful for identifying patients with adenoma who are at high risk for developing a future colorectal carcinoma.

ISSN:0012-3706    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

&NA;The impact on wound infection of the addition of perioperative cefamandole to a mechanical bowel preparation with oral antibiotics was studied in a prospective randomized series of patients undergoing elective colectomy for biopsy‐proven carcinoma or adenomatous polyps. Seventy patients were randomized, all underwent mechanical bowel preparation and received oral neomycin and erythromycin base. Thirty‐four patients also received a preoperative and four postoperative doses of cefamandole, while 36 patients were randomized to receive no parenteral antibiotics. The two groups were well stratified for age, sex, and risk factors. The Dukes stage was similar and the surgical procedures were equally distributed in the two groups. There were no wound infections in the 34 patients receiving cefamandole and only one wound infection (2.8 percent) in the 36 control patients. Therefore, the addition of perioperative intravenous cefamandole to a good mechanical bowel preparation with oral antibiotics was of no benefit in reducing wound infections following resection of colorectal malignancies in this select group of patients.

ISSN:0012-3706    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

&NA;Chemoprevention of various epithelial cancers with vitamins or minerals has been the subject of multiple intervention trials to assess the impact of supplementation. These include several trials in patients with adenomatous polyps of the colon, a precursor lesion for colon cancer. The authors interviewed 255 women who underwent colonoscopy at Columbia Presbyterian Medical Center between 1983 and 1985 with a telephone‐administered structured questionnaire. Eleven interviews were excluded for various reasons. Overall, 57.7 percent of the 244 interviewees used vitamin pills on a regular basis (at least once a week for a year); 6.6 percent of the interviewees used vitamin A, 20.7 percent used vitamin C, and 16.2 percent used vitamin E. There were no statistically significant differences in vitamin usage among women with adenomatous polyps of the colon (105 cases), women with colon cancer (56 cases), and women without colonic neoplasia (83 cases). Despite widespread use of supplementary vitamins, this study failed to demonstrate major benefits in preventing colon polyps or cancer.

ISSN:0012-3706    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

&NA;Thermal sensation is thought to be important in sensory discrimination between different substances. The aim of this study was to determine the thermal sensitivity in the anal canal in continent patients with hemorrhoids (N=20), a group that has been reported to have a sensory deficit, and to compare the results with control subjects (N=40) and patients with idiopathic fecal incontinence (IFI) (N=22). Anal manometry was performed and sensation to mucosal electrostimulation and temperature change in the lower, middle, and upper zones of the anal canal assessed. Thermal sensation was impaired in the hemorrhoid group as compared with controls, but not to the same degree as in IFI (e.g., median thermal sensitivity in mid anal canal, control 0.9°C, hemorrhoid 1.2°C, IFI 2.0°C,P<.05 and <.001, respectively). The correlation between the two tests of sensation was 0.54 (P<.001) and the reproducibility of thermal sensory thresholds was 0.82 (P<.001). In conclusion, patients with hemorrhoids have a mild anal sensory deficit, but continence in this group is likely to be augmented by other factors.

ISSN:0012-3706    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

&NA;Approximately 5 to 6 percent of the total colorectal cancer burden is accounted for by hereditary nonpolyposis colorectal cancer (HNPCC). Because clinical premonitory signs such as those seen in familial polyposis coli (FPC) are lacking, the clinician must recognize clinical findings and family history typical of HNPCC. The authors have described colorectal cancer expression from a survey of ten HNPCC kindreds. Kindred members with colorectal cancer differed significantly (P<.05) from patients with sporadic colorectal cancer: 1) mean age of initial colon cancer diagnosis was 44.6 years; 2) 72.3 percent of first colon cancers were located in the right colon, and only 25 percent were in the sigmoid colon and rectum; 3) 18.1 percent had synchronous colon cancers; and 4) 24.2 percent developed metachronous colon cancer, with a risk for metachronous lesions in ten years of 40 percent. Affecteds and their first‐degree relatives should undergo early intensive education and surveillance. In families with an early age of onset, colonoscopy should begin at age 25, and biannually thereafter, with fecal occult blood testing of the stool semiannually. Third‐party carriers must become more responsive to the costly surveillance measures required for these otherwise healthy patients.

ISSN:0012-3706    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

&NA;The management of cecal volvulus is controversial. From 1971 to 1986, 26 patients with cecal volvulus were treated at Malmö General Hospital. Treatment and patient follow‐up are presented, together with a review of 350 patients reported in the literature during the past 15 years. Anatomic background and types of volvulus are described. Simple detorsion is an alternative in high‐risk patients without gangrene, but resection is the method of choice also when there is no gangrene present.

ISSN:0012-3706    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

&NA;The immunohistochemical expression of blood‐group substances and carcinoma‐associated antigens were cmpared in rectal carcinoids and adenocarcinomas. Rectal carcinoid tumors, in contrast to rectal carcinomas, were consistently negative for CEA, gastrointestinal cancer antigen GICA (or CA 19‐9), and carcinoma‐associated antigen CA‐50 (except in one case where <10 percent of the cells expressed CA‐50). The carcinoids and rectal carcinomas extensively expressed blood‐group substance A, B, and H, Lewis B antigen, and difucosylated carbohydrate antigens (DFCA). Thus, rectal carcinoids and adenocarcinomas possess both similar and different tumor antigen profiles. The occurrence of discrepant antigen determinants may be used in the differential diagnosis of these two types of tumors. The coexpression of blood‐group substance A, B, and H, Lewis B antigen, and DFCA is consistent with the opinion that both rectal carcinomas and carcinoids have a common entoderm origin, but carcinoids are considered to rise from the endocrine‐differentiated and the adenocarcinomas from the nonendocrine‐differentiated enterocytes.

ISSN:0012-3706    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

&NA;The United Kingdom and Ireland Register of Home Parenteral Nutrition (HPN) contains details on 237 cases treated between 1977 and 1987. One hundred courses of HPN were given to 89 patients for complications of Crohn's disease. Six registering centers provided 87 percent of the courses of treatment. The short‐bowel syndrome was a factor in 60 patients, fistulas in 29 patients, and exacerbation of the disease in 41 patients. Thirty patients had more than one complication. The age distribution of patients with Crohn's disease was the same as for all HPN patients. Nine patients have died and eight have ceased HPN because of complications from the treatment. Fifty two percent of the patients had no complications. Patients with Crohn's disease on HPN had a significantly better lifestyle than the group as a whole (P<.05) and had lower sepsis and complication rates (P<.01 and 0.001, respectively). The 60 Crohn's patients with short‐bowel syndrome spent a significantly longer time on HPN than Crohn's patients overall (P<.05). Only 15 of these have been able to cease treatment and resume enteral feeding, compared with 23 of the other 40 patients who were able to resume enteral nutrition after a median of three months. Analysis of the authors' group of 35 patients included in the 100 showed that the only nutritional parameters of use in monitoring the patients' well‐being were weight and serum albumin. Eighty percent of the patients with Crohn's disease who were treated by HPN have either successfully resumed enteral feeding or are successfully managing their own HPN. HPN is a safe and effective treatment for patients with acute or chronic intestinal failure from Crohn's disease.

ISSN:0012-3706    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

&NA;Aggressive desmoid tumors present difficult problems among patients with Gardner's syndrome. Recently, attention has been directed toward metabolic or hormonal manipulation of these tumors. A 21‐year‐old woman with Gardner's syndrome was admitted because of recurrent abdominal wall tumors. She was treated with nonsteroidal anti‐inflammatory drugs, tamoxifen, and ascorbate for seven months. During this therapy, CT scan showed a gradual increase in size of the tumors. Subsequent resection of the abdominal tumors and the colon was performed. Although these three types of drugs were administered to prevent postoperative recurrence, an abdominal wall desmoid tumor that invaded the mesentery developed within nine months. The known treatments, that is, chemotherapy, irradiation, and surgical resection are discussed in view of this experience.

ISSN:0012-3706    

出版商:OVID    

年代:1988

数据来源: OVID