摘要:

&NA;Thirty patients with epidermoid carcinoma of the anus, ranging in age from 40 to 89 years, were treated with combined chemotherapy (CT) and radiation therapy (RT) in lieu of abdominoperineal resection. Two courses of 5‐FU (1000 mg/m2/day×four days) by continuous infusion and mitomycin‐C (10‐15 mg/m2IV bolus on day 1 of each course) were given 3 to 4 weeks apart simultaneously, with whole pelvis RT to 4140 to 4500 cGy. Twenty‐one of 28 patients had T3‐T4primaries and ten had positive nodes (N1). Two of the 30 patients were treated for local recurrence following surgical excision and one was treated immediately after local excision. Twenty‐six of the 30 patients attained biopsy‐confirmed complete remission. Four of the 30 patients demonstrated residual disease at completion of therapy but all subsequently achieved complete remission with additional nonsurgical treatment. One patient, initially treated for local recurrence following excision failed locally at four years and was salvaged with chemotherapy followed by abdominoperineal resection. No patient has experienced distant failure. Twenty‐seven of 30 patients were alive and disease free after 9 to 76 months of follow‐up and three died, disease‐free, of unrelated causes. Acute toxicities were mild and did not necessitate interruption of treatment. A brisk perineal reaction and diarrhea were noted in all patients. Late complications were unusual. All patients were treated in a community‐based, private practice setting. The authors conclude that combined CT‐RT, as employed herein, represents a first‐line curative treatment for the majority of patients with epidermoid anal carcinoma. For patients who demonstrate residual disease following this therapy, salvage regimens such as 5‐FU infusion and cisplatin, or sequential MTX‐5‐FU‐Leucovorin with additional synchronous RT should be employed before resorting to radical surgery.

ISSN:0012-3706    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

&NA;Abdominal operations induce immunosuppression during the time when tumors are manipulated and tumor cells are released into the circulation. The authors tested the hypothesis that the combined effect of these factors may promote the development of metastatic tumor implants and that perioperative treatment with Human Recombinant Interleukin‐2 (RIL‐2), a known immunostimulant oft, natural killer (NK), and lymphokine activated killer (LAK) cells may reduce the incidence of liver metastases from transplantable rat colon cancers. Hepatic metastases were induced in male Fischer 344 (F344) rats by injecting 107rat colon tumor cells into the portal venous system during laparotomy. Control rats developed tumors by four weeks and were dead by ten weeks. Eleven groups of rats underwent celiotomy with portal vein injection of tumor on day three. Rats received either no RIL‐2, RIL‐2, or excipient buffer at varying doses on days 1 through 5 or 3 through 7 of these experiments. Animals were assessed for the presence of tumor and the incidence of liver metastases at autopsy (sacrifice and autopsy performed at seven weeks). Eighty‐five percent of the rats in the untreated group developed tumor. This compared with only 50 percent of animals receiving 103u/dose (P<.025) and 42 percent of animals receiving 104u/dose (P<.01) of Interleukin‐2 on days 1 through 5. Animals receiving very high doses of RIL‐2 (105or 4×105units per dose) had a greater chance of developing tumors than did control rats, or rats receiving lower doses of RIL‐2 (P<.05). It is concluded that the perioperative period may be critical for the implantation and growth of metastatic disease and that perioperative immunostimulation with RIL‐2 can decrease the incidence of tumors in these animals. This model may have relevance to the treatment of human colon cancer.

ISSN:0012-3706    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

&NA;Metabolic changes between the preoperative period and the defunctionalized stage after ileal pouch‐anal anastomosis were investigated in 21 patients. Aspects studied included weight change, renal function, liver function, lipid metabolism, and two hematologic parameters. Of 21 patients, 19 lost weight. Cholesterol levels decreased from 183±30 IU/I to 122±48 IU/I (P<.0001). Triglyceride levels rose from 95±29 IU/I to 190±86 IU/I (P<.01). Significant elevations were seen in values of four liver function tests: SGOT, SGPT, lactic dehydrogenase, and alkaline phosphatase (P<.05). Blood urea nitrogen levels increased from 11.1±4.7 mg/100 ml to 21.8±24.8 mg/100 ml (P<.05). Serum creatinine levels rose from 0.97±.18 mg/100 ml to 1.5±1.2 mg/100 ml (P<.05). Uric acid levels increased from 5.6±1.8 mg/100 ml to 7.5±2.3 mg/100 ml (P<.001). Hemoglobin values did not change significantly. Platelet counts rose from 304,000±79,000 to 447,800±189,000 (P<.05). Identification of these systematic alterations in metabolic parameters during the defunctionalized stage can aid the physician in management of these patients.

ISSN:0012-3706    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

&NA;The DNA histograms of resected rectal carcinomas from 121 patients were compared, along with a detailed clinicopathologic assessment of the same tumors, with the incidence of postresection tumor recurrence and patient survival over an extended period of 15‐year follow‐up. A poorer prognosis was found for patients with DNA aneuploid and DNA tetraploid rectal cancers as compared with patients with DNA diploid cancers. In addition, local tumor recurrence was twice as common among patients with DNA nondiploid rectal carcinomas. The DNA pattern of a rectal carcinoma was an independent prognostic variable in a Cox's multivariate analysis model. DNA nondiploid rectal carcinomas had a statistically significant increased incidence of vascular invasion, tumor fibrosis, and high Dukes' stage.

ISSN:0012-3706    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

&NA;Forty patients with fecal incontinence underwent sphincter repair between 1975 and 1984. Divided sphincter musculature resulted from obstetrical injury in 23 and previous anorectal surgery in 17. Eighteen had undergone a previous attempt at repair. Fifteen patients experienced seepage of stool and 25 had gross incontinence. In nine patients, reconstruction of the external sphincter was by overlap of the muscle ends. Twenty‐four others underwent accurate approximation of the external sphincter muscle and anterior plication of the levator muscles, and in seven the anal canal was made smaller by narrowing the anal orifice. Follow‐up was an average of 67 months after operation (range, 2.4 to 166 months). Continence was objectively improved in 62 percent (P<.01) when performance criteria were analyzed by Wilcoxon signed‐rank test, although 85 percent of the patients reported subjective improvement. Requirements for protective pads were reduced in 57 percent (P<.01) and fewer social limitations were experienced in 52 percent (P<.01). There was no significant correlation between outcome and type of operation.

ISSN:0012-3706    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

&NA;A randomized trial including 294 patients was performed to evaluate the prophylactic effect of singlevs. multiple doses of antibiotics in elective colorectal surgery. All patients received 1.5 g metronidazole and 3.0 g ampicillin peroperatively and were randomized to: 1) no further prophylactic antibiotic treatment, or 2) ampicillin 1 g×3 and metronidazole 0.5 g×3 given intravenously during the second and third postoperative days. Deep wound infection was seen in 9/149 (6 percent) receiving a single dose and in 8/145 (6 percent) receiving multiple doses. no differences were found in the two groups between frequencies of anastomotic dehiscences, intra‐abdominal abscesses, sepsis, and pulmonary infections. the two groups were similar according to distribution of sex, age, diagnosis, and type of surgery. A single peroperative dose of metronidazole and ampicillin is a simple and satisfactory antibiotic prophylaxis in elective colorectal surgery.

ISSN:0012-3706    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

&NA;The records of 54 patients with documented cirrhosis who underwent colectomy between January 1970 and January 1984 were studied to assess the operative risk and to determine the preoperative predictive risk factors. In‐hospital mortality was 24 percent (13 patients), and postoperative complications occurred in 48 percent (26 patients). The risk of surgical intervention was significantly increased if encephalopathy, ascites, anemia, or hypoalbuminemia was present before operation. A simple operative risk index involving the presence of encephalopathy and ascites and the levels of hemoglobin and albumin is proposed to help distinguish a low‐risk subgroup in whom postoperative mortality was 12.8 percent from a high‐risk subgroup in whom postoperative mortality was 53.3 percent.

ISSN:0012-3706    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

&NA;Twenty‐seven consecutive patients with ultrasonically verified appendiceal abscesses, measuring from 2 to 10 cm in diameter, were studied. Ultrasonically guided percutaneous drainage was performed in 19 by means of one to five punctures, and in eight with one or two catheters. In 16 and 7 patients, respectively, the abscesses resolved without further intervention. Four patients were operated on, two for suspected (but unverified) abscess perforation, one for bowel obstruction, and one because of failed drainage, resulting in a success rate of 85 percent. Hospitalization ranged from 3 to 23 days; however, normal sonograms were not obtained until after nine to 62 days. Follow‐up revealed no diagnostic errors. Two patients (8 percent) had recurrent appendicitis, and late sequelae were observed in four patients, three of these after surgery. Ultrasonically guided percutaneous drainage of appendiceal abscesses with the technique described is indicated whenever feasible, as a safe, gentle, and relatively atraumatic procedure with few complications and late sequelae.

ISSN:0012-3706    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

&NA;In this study the Multi‐Test was applied in 48 patients with inflammatory bowel disease and in 25 normal controls. A significant difference between normal controls and patients with Crohn's disease but not between normal controls and patients with ulcerative colitis was found with regard to anergic status, frequency of positive skin reactions, and size of skin infiltration. The authors conclude that in patients with Crohn's disease a defect exists in the cellular immunity.

ISSN:0012-3706    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

&NA;Twenty‐eight patients who underwent the Bacon pull‐through procedure for carcinoma of the midrectum were reviewed retrospectively. The results were comparable to low anterior resection and abdominoperineal resection. Although the indications are limited, it is a viable option in a highly selected group of patients.

ISSN:0012-3706    

出版商:OVID    

年代:1987

数据来源: OVID