摘要:

&NA;Early dysfunction of intestinal anastomoses is sometimes blamed on anastomotic edema. This study compares stapled and hand‐sewn anastomoses for the development of early anastomotic edema. After segmental colon resections, one group of dogs was reconstructed with two‐layered handsewn anastomoses, and the other group had stapled anastomoses. Controls were untouched small bowel in each operated animal and untouched colon in a separate group of dogs. At 24 hours postoperatively, all animals were given125I albumin and at 28 hours the animals were killed, venous blood was obtained, and the anastomoses were harvested. Tissue levels of125I albumin were measured at 1‐mm and 1‐cm distances from each anastomosis and compared with controls. This quantitative measure of edema was compared with the histologic appearance of the tissue specimens. The results show significant edema formation in both stapled and handsewn anastomoses compared with control tissues (P<.05 for each animal). Although quantitative and histologic results demonstrate less edema in the stapled group, the difference is not significant by the Wilcoxin rank test. These and similar studies may allow improvement in surgical technique.

ISSN:0012-3706    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

&NA;Life‐long bowel habits of 685 colorectal cancer cases and 723 age/sex frequency matched community controls were investigated as one part of a large, comprehensive, population‐based study of colorectal cancer incidence, etiology, and survival, The Melbourne Colorectal Cancer Study. Self‐reported chronic constipation was statistically significantly more common in cases than in controls (P=.05). Three or more bowel actions per day were reported by more cases than controls but the total number of respondents in this subset consisted of only ten cases and two controls. Otherwise, the frequency and consistency of bowel motions was similarly distributed among cases and controls. Constipation disappeared as a significant risk when simultaneously adjusted for previously determined dietary risk factors, indicating that it is the diet and not the constipation that is associated with the risk of large‐bowel cancer. Additionally, a highly statistically significant association (P=.02) was found with the risk of colorectal cancer in those who reported constipation and also had a high fat intake, a finding consistent with current hypotheses of colorectal carcinogenesis. It is concluded that chronic constipation, diarrhea, and the frequency and consistency of bowel motions, as well as laxative use, are unlikely to be etiologic factors in the development of colorectal cancer. Self‐reported chronic constipation is a marginally significant indicator of excess risk of large‐bowel cancer and may be used as one of the indices in the screening of individuals for this cancer.

ISSN:0012-3706    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

&NA;From the time of Hippocrates until the late 19th century, physicians and surgeons were convinced that surgical attempts at treating colorectal cancers were doomed to failure. This opinion stemmed from prevailing views on carcinogenesis. The three dominant theories, the humoral, mineral, and lymph theories, held that all cancers developed in tissue that had a diseased disposition. Thus, excision of the gross tumor mass alone seemed unlikely to cure the patient. Consequently, surgical treatment of all cancers, and in particular colorectal cancer, was vehemently condemned. The 19th century represented a transition period. Advances in surgical technique made excision of rectal cancers feasible. Unfortunately, classical views that resection of cancer was futile delayed the development of surgical treatment for colorectal cancer. Indeed, it was not until the late 19th century that a few individuals ignored these tenets of classical medicine and attempted local resections of rectal cancers. By the second quarter of the 20th century, a radical change occurred in the prevailing theories of carcinogenesis. Wide acceptance of the unicellular origin of cancer and the mucosal origin of colorectal cancers washed away admonitions against surgical treatment of colorectal cancers. It became axiomatic that all cancers, including colorectal cancers, could be cured surgically if treated while still local diseases.

ISSN:0012-3706    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

&NA;Three hundred forty‐five colorectal cancers were identified in 320 patients over a nine‐year period. Twenty‐one patients (7 percent) had synchronous cancers. Metachronous cancers were identified in five patients (2 percent). Thirteen of the synchronous cancers were foci of invasive adenocarcinoma in polyps with elements of benign neoplastic tissue. There was a trend for younger patients to have multiple colon cancers. Fifteen percent of the synchronous colon cancer patients were less than 50 years of age. The mean age of patients who presented with metachronous cancer was 54, and 11 years was the average time interval between the diagnosis of the initial and the metachronous tumor. Colonoscopy proved to be more reliable than barium‐enema examinations in identifying synchronous cancers. It is concluded from this review that before elective resections, colonoscopy should be used to effectively screen patients for synchronous cancers, and following curative resection, the residual colon should be periodically examined for the remainder of the patient's life.

ISSN:0012-3706    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

&NA;Intestinal adaptation and its regional difference after total colectomy were investigated in dogs by measuring mucosal Na−K ATPase, cyclic AMP, and transmural electric potential difference (PD). Twenty‐four weeks after the total proctocolectomy, Na−K ATPase activity and PD increased significantly in all intestinal sites, whereas cyclic AMP showed no significant changes. The regional difference in the remaining intestine was examined in the jejunum, ileum, and interposed jejunum (neorectum). Na−K ATPase activity showed no significant regional difference, but the largest increase was found to occur in the ileum. PD also increased markedly in the ileum and there was significant difference between the ileum and other intestinal sites. These facts suggest that the increased active ion transport mediated by mucosal Na−K ATPase and transmural PD in the ileum is closely related to the intestinal adaptation occurring after total colectomy and indicates a greater potential of the ileum for adaptive compensation than either jejunum or neorectum.

ISSN:0012-3706    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

&NA;Plasma diamine oxidase (DAO) activity may reflect intestinal involvement in Crohn's disease. The purpose of this study was to develop a simple heparin stimulation test for assessing postheparin plasma diamine oxidase activity in Crohn's disease. Ten volunteers and five patients with Crohn's disease received 1000 units and 3000 units of heparin intravenously and plasma samples were obtained at timed intervals. Plasma DAO activity increased significantly, compared with basal values, 30 minutes after 3000 units of heparin in both volunteers (26.2±5.0vs.4.5±0.5 units/ml) and patients with Crohn's disease (14.6±2.0vs.4.0±1.1 units/ml,P<.05) and was significantly greater in the volunteers. There was no significant increase in DAO activity after 1000 units of heparin. Plasma DAO activity increased significantly within 15 minutes after 3000 units of heparin and remained at this high level at 60 minutes. Postheparin DAO activity correlated with the integrated area under the DAO activity curve. Plasma DAO activity correlated with the Crohn's Disease Activity Index in the patients with Crohn's disease. Plasma DAO activity, 30 minutes after the intravenous administration of 3000 units of heparin, should reflect intestinal involvement in Crohn's disease.

ISSN:0012-3706    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

&NA;Seventy‐six operative procedures for anal incontinence performed at the Lahey Clinic Medical Center between 1964 and 1985 were reviewed. Etiologic factors, findings on preoperative physical examination, and functional results are reported for 61 procedures in the four categories of simple anterior reefing, anterior reefing with perineal body reconstruction and anoplasty skin closure, posterior proctopexy, and Dacron Silastic®sling insertion. In women with anterior sphincter defects, combining anoplasty skin closure and deep external sphincter plication gives superior functional results over superficial reefing, especially when there is attenuation of the rectovaginal septum and perineal body. The posterior proctopexy is most useful in patients with intact external sphincters and incontinence without recognizable cause or after abdominal repair of rectal prolapse.

ISSN:0012-3706    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

&NA;The effect of a new prostacyclin analogue OP‐41483 on ischemic colonic anastomosis was investigated in dogs. Colonic ischemia was produced by devascularization of the marginal vessels in the left colon and graded into three degrees by measuring colonic blood flow with a hydrogen gas clearance method. The agent was administered intravenously after devascularization using a continuous infusion pump. The parameters studied were colonic blood flow in the submucosal layer, rate of anastomotic leakage, &bgr;‐glucuronidase activity and protein content of the colonic mucosa, and histologic changes. After administration of the agent, blood flow increased significantly and &bgr;‐glucuronidase activity at the anastomotic site was well preserved at a relatively high level in spite of ischemic change. The anastomotic leakage rate was significantly decreased. The present study proved that administration of this new prostacyclin analogue minimizes ischemic damage, and may be of considerable importance in ischemic colonic anastomoses.

ISSN:0012-3706    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

&NA;A patient with colohepatic fistula due to hydatid disease is reported. Only two similar cases have been described in the medical literature. This case illustrates that medical treatment with mebendazole is ineffective.

ISSN:0012-3706    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

&NA;The case of a 14‐year‐old boy who had oral ulcers with histologic proof of granulomatous disease nine months before the diagnosis of intestinal Crohn's disease is presented. Additional extraintestinal manifestations of this case were cheilitis, anal fissures, and “metastatic” disease to the umbilicus. The diagnosis was established after the onset of abdominal symptoms. All manifestations responded rapidly to systemic prednisone, sulfasalazine, and metronidazole.

ISSN:0012-3706    

出版商:OVID    

年代:1988

数据来源: OVID