摘要:

&NA;Rectovaginal fistulas in the setting of Crohn's disease present a difficult management dilemma. Some patients with this problem require proctocolectomy, yet other patients with minimal symptoms never require an operation for treatment of the rectovaginal fistula. For a small percentage of patients, local surgical repair of the fistula may be warranted. Since 1980, this study has attempted local repair in seven patients with symptomatic rectovaginal fistulas from Crohn's disease. Five patients underwent staged repair of the fistula. Closure of the colostomy was eventually possible in three of these patients. Two of the three patients have had no evidence of recurrence at followup in excess of two years. The third patient required an ileostomy for intestinal disease and had no recurrence of the fistula. Two patients underwent primary repair of the rectovaginal fistula without fecal diversion; in one of these patients, the fistula recurred ten days after operation, necessitating a diverting ileostomy. The other patient remains cured 26 months after repair. The results of this review indicate that in the setting of quiescent rectal disease, an attempt to repair the fistula can be expected to have a reasonable chance of success. The presence of a rectovaginal fistula in a patient with Crohn's disease does not mandate removal of the rectum.

ISSN:0012-3706    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;The management of patients with invasive carcinoma removed by colonoscopic polypectomy remains controversial. In order to assess the criteria for subsequent surgery after polypectomy, the histologic findings and outcome of 25 patients with invasive carcinomas treated by polypectomy were analyzed. Subsequent surgery was indicated when removed invasive carcinoma showed at least one of the following findings: 1) carcinoma near the surgical margin, 2) vessel invasion, 3) massive invasion, and 4) poorly differentiated adenocarcinoma. The authors considered those findings to be a risk factor for local residual carcinoma or lymph‐node metastases, or both. Of 25 patients, 18 showed risk factors, with 16 receiving surgery. Only one had residual carcinoma in the lymphatic vessel of the surgical specimen. The remaining 15 had no carcinoma in the surgical specimens, however, one died of recurrent disease 55 months later. Two patients with risk factors received no surgery for various reasons. Local recurrent carcinoma developed in one 39 months later and the other had no recurrent carcinoma at autopsy. Seven patients without risk factors were adequately treated by polypectomy without recurrent disease 34 to 96 months later (average, 69 months). Consequently, of 18 patients with risk factors, 3 showed either residual carcinoma in the surgical specimens or recurrent carcinoma was found later. None of 7 patients without risk factors developed recurrent disease. We recommend that patients with risk factors be followed by surgery; however, patients without risk factors can be adequately treated by polypectomy alone.

ISSN:0012-3706    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;One hundred sixty‐five cases of abdominal rectopexy using polypropylene (Marlex®) mesh for rectal prolapse were reviwed. Six patients were men and 159 were women. Thirty patients have not been evaluated after surgery, 22 having died of interrecurrent disease and 8 have had their surgery during the last two months. Incontinence was observed in 95 patients (58 per cent) before surgery, whereas it persisted in only 21 of 135 patients (16 percent) after surgery. Forty patients (24 percent) claimed constipation before surgery, whereas 60 of 135 patients (44 percent) had constipation after rectopexy. Recurrence of full‐thickness rectal prolapse was found in only 2 patients (1.5 percent). Mucosal prolapse occurred in 9 patients (7 percent) after surgery. These results indicate that abdominal posterior rectopexy using Marlex mesh is an effective operation for rectal prolapse, but persistent incontinence occurs in one third of patients and almost half become constipated after the procedure

ISSN:0012-3706    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;Manometric study with the use of continuous water perfusion system was performed on 50 patients with Grade III or IV hemorrhoids and for 29 patients with chronic anal fissure. Another 36 patients who had no anorectal symptoms or pathology were chosen as the control group. The maximal basal pressures for the controls, hemorrhoids, and chronic anal fissures 71.2±24.9, 85.3±27.7, and 87.4±38.8 mmHg, respectively; the maximal contraction pressures for the controls, hemorrhoids, and fissures were 132.9±44.9, 158.8±58.0, and 162.1±64.5 mmHg, respectively; the lengths of the functional sphincter of the three groups were 3.7±0.5, 3.8±0.8, and 3.9±0.6 cm, respectively. The maximal basal pressures and maximal contraction pressures of the hemorrhoid and fissure patients were significantly greater than those of the control group (ttestPvalue <0.05); whereas the functional sphincter lengths ofthe three groups showed no significant difference.

ISSN:0012-3706    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;To assess prognostic factors in patients who develop colorectal cancer before the age of 40 years, a 30‐year experience from 1956 through 1985 was reviewed. There were 50 patients ranging in age from 7 to 39 years. Five cases were associated with either ulcerative colitis (2) or familial polyposis (3). The most common presenting symptoms were abdominal pain (66 percent), hermatochezia (60 percent), change in bowel habit (41 percent) and weight loss (30 percent). On pathologic staging (N=44), only 14 of 44 (31 percent) had a Dukes' stage A on B lesion, 20 (45 percent) had Dukes' stage C, and the remaining 10 (23 percent) had distant metastases at the time of surgery. Fiveyear survival rate was 28 percent with a disease‐free survival rate of 18 percent. Median survival was only 28 months. Negative prognostic tactors were Dukes' stage C/D (P<0.01), symptom duration of longer than 3 months (P=01), noncaucasian ancestry (P=0.1), and poorly differentiated histology (P=06). In contrast to older patients with colorectal cancer, only 1 of 30 (3 percent) patients with stage C/D disease was disease‐free at 5 years. In view of the poor survival rate associated with both delay in diagnosis and the presence of advanced disease, it was concluded that young patients presenting with the symptoms listed above need early, aggressive evabuation for possible colorectal cancer

ISSN:0012-3706    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;The experience of the senior author has been reviewed in dealing with perianal fistulas in patients with Crohn's disease. Early surgical therapy was advocated, the theory being, that perianal fistulas start as intersphincteric fistulas. This fistula is easily controlled surgically by fistulotomy with partial internal anal sphincterotomy. Delay in surgical treatment, especially in Crohn's patients, results in more complicated fistulas that may require colostomy or proctectomy. The presence of Crohn's disease did not affect the healing of fistulotomy. In our series fistulotomy was the treatment of choice in patients with 26 fistulas; 18 of 19 went on to full healing. We conclude that early fistulotomy, before an intersphincteric fistula has time to blossom fistulotomy, before an intersphincteric fistula has time to blossom into a more difficult management problem, is the treatment of choice in patients with Crohn's disease who have perianal fistulas

ISSN:0012-3706    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;Ninety‐three patients who underwent surgery were studied retrospectively over a five‐year period for complications of diverticular disease, including free perforation in 32 patients (with fecal peritonitis in S), inflammation or peritonitis in 22 patients, an abscess in 11 patients, and intestinal obstruction in 14 patients. Sixty‐eight patients (73 percent) had systemic symptoms and signs consistent with serious sepsis. There has been a growing popularity of the Hartmann procedure throughout the study period. The overall 30‐day mortality rate was 10.8 percent. Because of a high proportion of poor‐risk patients, the Hartmann group fared particularly badly compared with‐those who had other operations, with a 28 percent mortality rate, 69 percent incidence of major complications, and one third of the survivors having a permanent colostomy. Other operative procedures are discussed, but until prospective data become available, it is unlikely that the widespread popularity of the Hartmann procedure will decline. Therefore, the importance of meticulous attention to technical detail is stressed if results are to improve.

ISSN:0012-3706    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;The diagnostic value of C‐reactive protein (CRP), total white blood cell (WBC) count, total neutrophil count, and neutrophil differential count were evaluated in a prospective blinded study of 204 patients submitted with the tentative diagnosis of acute appendicitis. The laboratory tests were performed on blood samples obtained at the time of admission, and the results were stored until the patients were discharged. One hundred patients were operated on: 59 had appendicitis, 3 had other surgically correctable diseases, and 38 had a superfluous exploration. All 104 nonoperated patients recovered spontaneously. The sensitivity, specificity, and predictive values of single tests and test combinations were calculated at different cutoff levels. Using standard reference intervals, WBC count demonstrated the best sensitivity (83 percent) and predictive value of a negative result (88 percent). Combining the tests by an “or” rule enhanced the sensitivity to 100 percent, employing WBC count or CRP or neutrophil percentage above the reference range (triple test), but at the expense of the predictive value of a positive test (37 percent). It was concluded that both single tests and combined tests are of limited value in predicting acute appendicitis. However, the same triple test combination proved a predictive value of a negative result at 100 percent (95 percent confidence limits 92 to 100 percent), indicating that acute appendicitis is unlikely when these tests are simultaneously negative. The triple test combination was valid in 32 percent of the patients who were free from appendicitis. In the study group, 10 of the patients (25 percent) who had a superfluous exploration had a negative triple test, and they might have avoided surgery if it had been used. Therefore, the triple test is recommended as a help in reducing the significant rate of negative laparotomies in patients suspected of having acute appendicitis.

ISSN:0012-3706    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;The effect of bile on the development of 1,2‐dimethylhydrazine (DMH)‐induced colon cancer was studied in male Wistar rats. Experimental operative models were created, in which in Group 1, the half intestinal tract, the ileum, and the right side of colon were released from bile. In Group 2, both sides of the colon contained bile. The sham operated animals formed Group 3. These techniques changed the concentration of bile acid in different parts of the colon, and the daily total fecal bile acid excretion as well. After DMH treatment, the relationship between these changes of bile acid level and the development of colon cancer was studied. Significantly more tumors than in the control group were found if the daily total bile acid level and the bile acid concentration in the left side of the colon were increased. Our findings show an unambiguous connection between the fecal bile acid level and the incidence of DMH‐induced colon cancer.

ISSN:0012-3706    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;Since 1982, intraoperative colonoscopy has been performed on 66 patients. Preoperative intent was to perform a colonoscopic polypectomy during an intra‐abdominal procedure in 44 patients, localize lesions that might subsequently lead to either colon resection or colotomy and polyp excision in 13, localize bleeding sites in 4, determine the extent of inflammatory bowel disease in 2, survey the colon in 2 who did not have preoperative colon radiography, and assess bowel viability in 1. Surgery proceeded as planned in 54 patients; however, colonoscopic findings extended the resection to include additional segments of bowel in 4. In four patients, polypectomy or bowel resection was avoided as a result of the colonoscopic findings. Intraoperative colonoscopy was not possible in four patients. No complications were related directly to this procedure. Intraoperative colonoscopy is a useful adjunct for localizing lesions or “clearing” the colon. In some patients colonoscopic findings may change the extent of resection performed.

ISSN:0012-3706    

出版商:OVID    

年代:1989

数据来源: OVID