摘要:

&NA;The Whitehead technique of hemorrhoidectomy has developed a reputation as an undesirable procedure since its description in 1882. The chief criticisms have been considerable blood loss, disturbance of continence, formation of an ectropion, and poor healing of the mucocutaneous junction followed by stricture formation. Five hundred fifty‐six patients underwent a modified Whitehead hemorrhoidectomy, performed by one author (C.E.C.), between 1963 and 1983. Seventy‐two of these patients had unclaimed follow‐up letters, leaving 484 patients available for review. Four hundred forty of these patients were followed for over three years. Postoperative complications included fistula or abscess in 1.1 percent, flap loss in 6.9 percent, and a nonhealing wound in one patient. There were no recurrences and there was no ectropion formation, or “Whitehead deformity”. Mortality was zero and total morbidity, including 7.2 percent flap detachment, was 12.2%. A modified Whitehead technique has become the authors' procedure of choice for circumferential prolapsing and bleeding hemorrhoids and mucosa.

ISSN:0012-3706    

出版商:OVID    

年代:1988

数据来源: OVID

ISSN:0012-3706    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

&NA;Internal fistulas in diverticular disease are uncommon and have a reputation of being difficult to treat. Eighty four patients treated from 1960 to April 1986, representing 20.4 percent (84 of 412) of the surgically treated diverticular disease patients, were reviewed. Eight patients had multiple fistulas. Sixty‐five percent (60 of 92) of fistulas were colovesical, 25 percent (23 of 92) colovaginal, 6.5 percent (6 of 92) coloenteric, and 3 percent (3 of 92) colouterine fistulas. There were 66 percent (35 of 53) males and 34 percent (18 of 53) females with colovesical fistulas only. Hysterectomies had been performed in 50 percent (12 of 24) and 83 percent (19 of 23) of females with colovesical and colovaginal fistulas, respectively. Operative management included: resection anastomosis, resection with anastomosis and diversion, Hartmann procedure, and three‐stage procedure. In the latter half of the series there was a significant decrease in stating procedures with no significant statistical difference in complications. There were three deaths (3.5 percent) in the series. Other complications included: wound infection, 21 percent (18 of 84), enterocutaneous fistula, 1 percent (4 of 84), and anastomotic dehiscence, 5 percent (4 of 84). Primary anastomosis can be performed with acceptable morbidity and mortality and today is the procedure of choice, leaving staging procedures to selected patients.

ISSN:0012-3706    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

&NA;Between 1980 and 1982, 233 patients were treated for anorectal sepsis in three hospitals. The incidence of underlying disease associated with perianal sepsis and the results of surgical treatment were assessed retrospectively. Of the 233 patients who had perianal sepsis, 136 (58.4 percent) had perianal abscesses, while a further 12 (5.1 percent) had associated fistulas. Ischiorectal abscesses, while a further 12 (5.1 percent) had and a further two (0.9 percent) had fistulas. Four (1.8 percent) patients were found to have intersphincteric abscesses. One hundred and nine (46.8 percent) had examination under anesthesia or definitive procedures, while the remaining 124 (53.2 percent) had incision and drainage alone. A second procedure was required by 55 (23.6 percent) patients, 40 (32 percent) in the group who had incision and drainage patients, 40 (32 percent) in the group who had incision and drainage only and 15 (14 percent) of those having initial examination under anesthesia (P<.001). Twenty‐seven (11.6 percent) patients had occult disease. Twelve patients (5.1 percent) had systemic disease (six diabetic, three nongastrointestinal neoplasia, two inflammatory, and 1 hematologic), while of the 109 patients who had examinations under anesthesia, 15 (6.4 percent) had associated colorectal pathology (four neoplasia, 11 inflammatory). It is important that patients with anorectal sepsis have complete medical and surgical assessments at the time of their first admission.

ISSN:0012-3706    

出版商:OVID    

年代:1988

数据来源: OVID

ISSN:0012-3706    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

&NA;The only technique available for creating an intestinal anastomosis without tissue strangulation is gluing. Theoretically, this could lead to a higher hydroxyproline content and greater mechanical strength than in a sutured anastomosis. To test the hypothesis, 83 rats underwent left colon resection and inverted primary anastomosis with either one layer of sutures (NG group) or fibrin glue (FG group). Seven‐day FG anastomoses showed less adhesions (P=.02) but one subclinical leakage and a further radiologic one, compared with a greater amount of adhesions but no leakages in the NG group. The mean bursting pressures (mmHg) in the FG and NG groups, respectively, were 25±20 (SD) and 63±23 (N.S.) 30 minutes after surgery, 107±33 and 115±30 after one day, 81±31 and 133±26 (P<.001) after four days, and 161±36 and 175±24 after seven days. The somewhat earlier rise in hydroxyproline content in the glued anastomoses did not lead to significant intergroup differences. The glued anastomoses were thus weak during the critical lag period of healing. Also, by preventing adhesion formation, the glue may reduce the extra blood supply from perianastomic vessels. The outcomes might have differed more under demanding experimental or clinical situations.

ISSN:0012-3706    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

&NA;Adenocarcinoid of the appendix is a tumor that shares the histologic features of both carcinoids and adenocarcinomas. The metastatic ability of the tumor is uncertain. Twenty consecutive cases of adenocarcinoids were compared with 88 cases of conventional appendiceal carcinoids. Metastatic tumor spread was found in six of 20 cases of adenocarcinoids, but in none of the conventional carcinoids. Metastasizing tumors were characterized by a moderate to severe nuclear atypia and a high mitotic count. These features were present in only two of the nonmetastasizing tumors, one of which was treated by hemicolectomy. Adenocarcinoids showing moderate or severe nuclear atypia, a mitotic count of two or more mitoses/10 high power fields, or spread beyond the appendix should be treated by hemicolectomy. If these features are not present, simple appendectomy is adequate.

ISSN:0012-3706    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

&NA;Participants in the meeting were aware of not only inconsistencies in their respective data bases, but also emergence of other registries wishing to collaborate in collecting information. To this end, efforts should be made to achieve standardized collection of information, while preserving patient and institutional privacy. There is a need for central leadership and coordination that will stimulate more active collaboration.

ISSN:0012-3706    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

&NA;To accurately assess the depth of cancer invasion, endorectal ultrasound was performed using a radial scanner (Aloka, 7.5 MHz) in 145 patients with rectal cancer. High‐resolution ultrasound clearly depicted five‐ or seven‐layer echographic structures in the normal rectal wall, and demonstrated cancer as a hypoechoic lesion. These layer structures provided an important feature in determining the depth of cancer invasion. Rectal cancers of 122 patients were examined thoroughly by endorectal ultrasound. In 95 of these patients (77.9 percent), ultrasonic assessment of the depth of cancer invasion as classified in four groups was correct, corresponding accurately to the microscopic findings. Ultrasonography overestimated the depth of cancer invasion in 21 patients, however, and underestimated it in six patients. This study indicated that a cause of the overestimation was inflammatory cell infiltration around cancer, and that one possible cause of underestimation was microscopically minimal invasion of cancer. Although there are certain limitations of endorectal ultrasound, this ultrasound technique will provide valuable information to determine the preoperative staging of rectal cancer.

ISSN:0012-3706    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

&NA;A case report and review of the literature support a new theory that giant colonic diverticula are three distinct pathologic entities. The three types can be separated by histologic type.

ISSN:0012-3706    

出版商:OVID    

年代:1988

数据来源: OVID