摘要:

PURPOSE:We retrospectively reviewed the records from our past five years of experience with colostomy closure at a large multispecialty hospital to determine postoperative morbidity.RESULTS:From March 1988 to April 1993, 46 patients underwent colostomy closure. Patients ranged in age from 24 to 87 (mean, 41.8) years, and 25 (54 percent) were women. Stomas had been created during emergency operations in 40 patients (87 percent); most operations (54 percent) were for complications of acute diverticulitis. Of the 46 procedures, 40 (87 percent) were end colostomies, and 6 were loop colostomies. Stomas were closed at a range of 11 to 1,357 days after creation (mean, 207 days; median, 116 days). Twenty‐six patients (57 percent) underwent colostomy closure alone, and the remainder underwent additional procedures ranging from appendectomy to hepatic lobectomy. Duration of operations ranged from 1 to 9.5 (mean, 4.2) hours, and estimated blood loss averaged 400 ml. Overall hospital stay for closure was 6 to 62 (mean, 11.5) days. Inpatient complications occurred in 15 percent of patients, including congestive heart failure (2 percent), cerebrovascular accident (4 percent), pneumonia (2 percent), enterocutaneous fistula (2 percent), and pulmonary embolus with death (2 percent). The most common longterm complication was midline wound hernia, which occurred in 10 percent of surviving patients. Overall, complications occurred in 24 percent.CONCLUSIONS:Colostomy closure is a major operation; however, with good surgical judgment and technique, associated morbidity and mortality can be minimized.

ISSN:0012-3706    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

PURPOSE:This study was undertaken to identify the incidence and type of sexual dysfunction experienced by women after undergoing restorative proctocolectomy.METHODS:A questionnaire was sent to 262 females who underwent restorative proctocolectomy by a single surgeon from 1984 to 1993. The response rate was 35 percent (92/262). Additional information was gained from our pelvic pouch data base. Mean follow‐up was 43 (6‐130) months.RESULTS:Following surgery, a significant increase was found in vaginal dryness, dyspareunia, pain interfering with sexual pleasure, and limiting of sexual activity because of concerns of stool leakage. There was no significant change in sexual desire, arousal, sensitivity, frequency of intercourse, or satisfaction with sexual relationship.CONCLUSION:Potential sexual dysfunction following restorative proctocolectomy in women merits discussion in preoperative counseling with the patient.

ISSN:0012-3706    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

PURPOSE:There is a widespread belief that performing hemorrhoidectomy on a patient infected with human immunodeficiency virus (HIV) is an invitation for disaster. Aim of this study was to compare morbidity of hemorrhoidectomy in HIV‐positive (HIV+) with HIV‐negative (HIV−) patients.METHODS:Charts of 27 HIV+ and 30 HIV−male patients less than age 50 years who underwent hemorrhoidectomy were reviewed.RESULTS:Mean age of the 57 study group patients was 38 years. Open hemorrhoidectomy was performed in 26 patients (46 percent), and a closed technique was used in 31 patients (54 percent). HIV+ and HIV−patient groups were well matched to all preoperative and intraoperative variables. Mean T‐cell helper count in the HIV+ patient group was 301 (range, 9‐1,040) cells/μl. There were no deaths, and complications were seen in 15 patients (26 percent). There was no difference in overall complication rates between HIV+ and HIV−patient groups. Urinary retention was seen in ten patients (18 percent), three of whom were HIV+ (11 percent)vs.seven of whom were HIV ‐(23 percent)(P=not significant). Although no patient required reoperation for bleeding, postoperative hemorrhage was seen in three patients (1 HIV+, 2 HIV ‐). None of the patients developed fecal incontinence. Mean time to complete wound healing was 6.8 (range, 4−12) weeks for HIV+ patientsvs.6.6 (range, 4‐14) weeks for HIV−patients(P=not significant).CONCLUSIONS:These data suggest that HIV status of a patient should not alter indications for surgical management of hemorrhoidal disease.

ISSN:0012-3706    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

&NA;Morbidity and treatment ofClostridium difficilecolitis (CDC) continue to be controversial. Some claim minimum morbidity, which may be a function of differences in patient population and/or bacterial virulence.METHODS:To evaluate the effect of CDC in the critically ill, we retrospectively reviewed the records of 59 intensive care unit patients with CDC who were diagnosed by fecal toxin assays or clinical evidence of pseudomembranous colitis from January 1991 to October 1994. Symptoms, signs, antibiotic regimens, diagnostic tests, Acute Physiology and Chronic Health Evaluation II (APACHE II) scores, morbidity, and mortality were analyzed, and results of surgical treatment were compared with the literature.RESULTS:Mean age was 66.4 (17‐95) years, with a male to female ratio of 1.8:1. First treatment was metronidazole by mouth in 15 patients (25.4 percent), vancomycin by mouth in 30 patients (50.8 percent), sequential by mouth vancomycin/metronidazole in 3 patients (5.1 percent), and intravenous metronidazole in 5 patients (8.5 percent). Six patients had no medical therapy before surgery or discharge. Ten patients (17 percent) had recurrence and 12 (20.3 percent) required surgery for progressive toxicity or peritonitis. Of three patients who were initially treated by diverting stomas, one died and two required total colectomy (TAC). Two underwent partial resection (1 that was nearly a total colectomy), and seven others had a TAC. Surgical patients had worse mean APACHE II scores at diagnosis (24.4vs.199;P<0.001). Thirty‐day mortality in surgical patients was 41.7vs.14.7 percent in medical patients(P<0.5).CONLUSION:Twenty percent of critically ill patients with CDC required operation. TAC and diversion appeared to be more effective surgical treatments than diversion alone.

ISSN:0012-3706    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

PURPOSE:The somatostatin analog, octreotide, has previously been found to influence rectal sensation and may also influence anal resting pressure.METHODS:We studied the effect of octreotide on anal resting pressure and rectal compliance in eight healthy patients. Octreotide was administered intravenously as a bolus injection in doses of 100 and 10μgor as infusion of 250μg/hour on separate days and compared with placebo.RESULTS:Within one minute after a bolus injection of 100 μg of octreotide, anal resting pressure increased from 56±12 to 96±16 cm H2O(P<0.005). Octreotide had no effect on rectal sensitivity or compliance measurements. Octreotide counteracted rectoanal reflex by increasing anal pressure almost to the level found with an empty rectum.CONCLUSION:Somatostatin thus seems to contribute to the regulation of rectoanal reflex.

ISSN:0012-3706    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

PURPOSE:This study was designed to determine the cancer prevention and therapeutic effects of selenium on rats treated with 1,2‐dimethylhydrazine (DMH).METHODS:One hundred sixty Spraque‐Dawley male rats were divided into seven groups and received 20 mg/kg/week DMH, subcutaneously for 20 weeks. Two different dosages of selenium (8 and 4 ppm) were administered to the rats through drinking water during DMH treatment (B and C groups) or one month before and during DMH treatment (D and E groups). The rats of Groups A (control group), B, C, D, and E were killed immediately after the last DMH injection. The incidence of intestinal cancer in each group was compared. Eight ppm selenium was also administered to rats after DMH treatment (Group F), and survival times were observed and compared with Group G (treated with DMH only).RESULTS:Rats of Groups B and D received 8 ppm selenium and had a significantly decreased incidence of intestinal cancer (from 65.8 percent (Group A) to 33.3 percent (Group B) and 27.8 percent (Group D);P=0.0225 and 0.0038). Rats receiving 4 ppm selenium had a relatively decreased incidence of intestinal cancer (from 65.8 percent (Group A) to 44.4 percent (Group C) and 47.1 percent (Group E) butP>0.05). Survival time of Groups F and G showed no difference.CONCLUSIONS:Eight ppm selenium providedviadrinking water has a significant intestinal cancer prevention effect in the presence of a high dose of DMH (20 mg/kg×20 weeks), and the cancer therapeutic effect of selenium is doubtful in this animal model.

ISSN:0012-3706    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

PURPOSE:We have used a novel leukocyte adhesiveness/ aggregation test (LAAT) to show that many patients with inflammatory bowel disease (TOD) in clinical remission have a subclinical low grade inflammation.METHODS:Included in the study are 500 controls, 96 patients with IBD in remission, and 106 patients in relapse.RESULTS:The percent of aggregated white blood cells detected in the peripheral blood was 5.9±3.9, 9.1±5.9, and 18.8±9.4, respectively. The difference between each group and any other was significant atP<0.0001. Similar results were obtained when other acute phase reactants like the erythrocyte sedimentation rate, white blood cell count, differential count, and C‐reactive protein level were examined. However, in a linear regression analysis, LAAT was the only significant(P<0.0006) variable that could classify correctly each subject to the appropriate category of control and IBD in remission or relapse.CONCLUSIONS:Identification of patients with IBD in clinical remission who have ongoing inflammation may be of clinical‐therapeutic relevance. The LAAT is a simple, rapid, and convenient test. The present study indicates that it is also very sensitive.

ISSN:0012-3706    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

PURPOSE:Preoperative staging of advanced carcinoma of the rectum by conventional endorectal ultrasonography is often impossible because of the presence of obstruction, which does not allow passage of the endoprobe. In a prospective Study, we investigated the value of three‐dimensional endorectal ultrasonography for staging of obstructing rectal cancer. This technique permits examination of obstructing rectal tumors because scan planes can be chosen deliberately within a scanned volume.METHODS:Overall obstructing tumors not accessible for conventional endoprobes were found in 26 of 94 patients who were subjected to endorectal ultrasonography for staging of rectal cancer. Three‐dimensional volume scanning was performed using a three‐dimensional frontfire transducer or a three‐dimensional bifocal multiplane transducer (7.5/10 MHz). Data of the three‐dimensional scans were stored on a hard disk for subsequent evaluation with a combison 530 processor.RESULTS:Three‐dimensional transrectal endosonography enabled visualization of local tumor spread in all 26 patients. In 18 patients, obstruction was caused by advanced primary rectal carcinoma. Endosonography accurately determined the tumor infiltration depth in three T2 tumors, eight T3 tumors, and three T4 tumors. Overall accuracy for assessment of infiltration depth was 78 percent. Accuracy for assessment of perirectal lymph node involvement was 75 percent. In eight patients, the obstruction was attributable to extramural regrowth of rectal cancer after surgery. Diameter of the lesions ranged between 3 and 6 cm. Although all lesions were clearly depicted by three‐dimensional endosonography, only five lesions (62 percent) were detected by computed tomography.CONCLUSIONS:Three‐dimensional endorectal ultrasonography provides previously unattainable scan planes and enables accurate staging of obstructing rectal tumors. This technique may improve therapy planning in advanced rectal cancer by selecting patients who require preoperative adjuvant therapy.

ISSN:0012-3706    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

PURPOSE:This study was designed to evaluate the clinical characteristics, surgical treatment, and outcome of carcinoid tumors of the rectum and to assess flow cytometry deoxyribonucleic acid (DNA) analysis as a potential prognostic factor for management of these tumors.METHODS:Medical records, tumor registry database, and pathology slides were retrospectively reviewed. Flow cytometry DNA analysis was performed on archived specimens.RESULTS:One hundred nine patients with rectal carcinoid tumors underwent surgery between 1962 and 1987. Follow‐up was available in 86 patients for a mean period of 12 years. Of 100 patients with tumors less than 2 cm, only one with a 1.5 cm ulcerated tumor developed liver metastases. Of nine patients with a tumor more than or equal to 2 cm, three with known liver metastases underwent rectal biopsy only, and three had rectal biopsy and laparotomy with biopsy of liver metastases. Three patients underwent radical resection. Following abdominoperineal resection, one patient died with local recurrence after 5 years, and one developed hepatic recurrence after 5.5 years and died at 9 years. One patient with coloanal anastomosis developed local and hepatic metastases seven years after surgery and died at ten years. No patients developed carcinoid syndrome. DNA ploidy did not correlate with metastases at presentation or recurrence of carcinoid tumor.CONCLUSION:Radical resection of rectal carcinoids with ulceration or size greater than or equal to 2 cm is associated with a poor prognosis; however, survival may be long term, even in the presence of metastatic disease. DNA ploidy does not appear to be a useful prognostic factor for rectal carcinoid tumors.

ISSN:0012-3706    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

INTRODUCTION:Hereditary nonpolyposis colorectal cancer (HNPCC) is an autosomal dominant condition characterized by early age of onset colorectal cancer, right‐sided predominance, excess of synchronous and metachronous colonic neoplasms, and extracolonic cancers. The purpose of this study is to report clinical characteristics of HNPCC families in our registry.METHODS:This is a retrospective review of medical records of patients with a significant history of colorectal cancer and interviews with their families.RESULTS:Three hundred one people with cancer in 40 HNPCC families were identified. In 284 of 301 (94 percent) people, 363 cancers were identified. Colorectal cancer only was identified in 182 people (64 percent) and, in conjunction with extracolonic tumors, in another 31 people (11 percent). Extracolonic cancer alone was noted in 71 people (25 percent). Median age at diagnosis of colorectal cancer was 48 (range, 17‐92) years. In patients with documented pathology, right‐sided tumors predominated (55 percent), synchronous and metachronous tumors were noted in 33 percent, and synchronous or metachronous adenomas were documented in 51 percent of people. Generational anticipation was also noted.CONCLUSION:This study demonstrates and confirms characteristics that have been described in HNPCC. Namely, early age of onset of colorectal cancer, right‐sided predominance, multiple synchronous and metachronous neoplasms, increased extracolonic cancers, and generational anticipation.

ISSN:0012-3706    

出版商:OVID    

年代:1996

数据来源: OVID