摘要:

&NA;A safe, simple technique of curative local excision is used for early invasive carcinoma of the rectum. Strict criteria were applied in selecting patients for curative local excision: (1) the tumor was less than 3cm in diameter; (2) there were no clinically involved pelvic lymph nodes; (3) the tumor had a pedicle or pseudopedicle, and (4) subsequent histopathologic examination showed that the tumor was confined to the mucosa and submucosa of the bowel wall and completely excised. Curative local excision in 16 patients had no operative mortality or morbidity. The five‐year cancer specific survival was 100 per cent, which compares favorably with the 88 per cent cancer specific survival rate in 268 patients managed by conventional curative resection for Dukes' stage A tumors. When the 7.1 per cent operative mortality of resection was additionally considered, the five‐year survival fell to 81 per cent. The probability of lymph‐node metastases in primary rectal tumors confined to the mucosa and submucosa was found to be 6.2 per cent irrespective of their diameter,i.e., slightly less than the mortality of resection.

ISSN:0012-3706    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

&NA;The traditional work‐up of patients with lower left quadrant peritonitis often includes the eventual use of barium‐enema radiography. Diagnosis is usually delayed until adequate patient stabilization allows diagnostic contrast enemas. Delay of accurate diagnosis may, at times, have serious clinical sequelae. The use of barium enema in acute lower left quadrant peritonitis has both theoretic and actual disadvantages. These include extravasation of barium, with resultant barium cellulitis and peritonitis, precipitation of acute obstruction, and delay in evaluation by endoscopy, sonography, computerized tomography, and angiography. Forty recent cases of lower left quadrant peritonitis were evaluated on admission by water‐soluble contrast enema. Watersoluble contrast enemas appear to be safe and accurate and avoid the aforementioned disadvantages of barium.

ISSN:0012-3706    

出版商:OVID    

年代:1984

数据来源: OVID

ISSN:0012-3706    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

&NA;Injury to the small bowel is one of the tragic complications of radiotherapy. We performed a retrospective analysis of patients operated upon for stenosis, perforation, fistulization, and chronic blood loss of the small bowel after radiotherapy for multiple malignant diseases. In the period 1970 to 1982 in the Department of General Surgery of the St. Radboud University Hospital, Nijmegen, and the Department of Surgical Oncology of the State University, Groningen, 27 patients were treated surgically. Twenty patients presented with obstruction. In 17 patients a side‐to‐side ileotransversostomy was performed; in three the injured bowel was resected. Of the five patients with fistulization, three underwent a bypass procedure; in two cases the affected bowel was resected. In one patient with perforation, a resection was performed, as in a patient with chronic blood loss. Two of the 20 patients (10 per cent) in whom the diseased bowel was bypassed died postoperatively. Of the seven patients whose affected bowel was resected four (57 per cent) died of intra‐abdominal sepsis. Management of the patient with chronic radiation enteritis is discussed. We conclude, on the basis of our experience, that in patients with obstruction and fistulization, a bypass procedure of the affected bowel is a safe method of treatment. In case of resection, the anastomosis should be performed during a second operation.

ISSN:0012-3706    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

&NA;A series of 121 patients with chronic fissure‐in‐ano who underwent fissurectomy with superficial midline sphincterotomy was studied. The mean follow‐up was 8.1 years. Minor problems with anal competence occurred after the operation in 30 patients (25 per cent). Within two months, this problem had resolved in all patients. One patient (0.8 per cent) had a true recurrence. Five patients (4.1 per cent) had recurrent acute anal abrasions as the result of passage of a hard stool. These healed spontaneously. Twelve patients (9.9 per cent) had fragile scars, but this was a significant problem in only five (4.1 per cent). No patient had significant stricture formation, keyhole deformities, or major persistent problems with anal competence. The patients graded their operations with regard to satisfaction: 118 (97.5 per cent) reported satisfactory results and three (2.5 per cent) reported unsatisfactory results. This study shows that fissurectomy with superficial midline sphincterotomy is a viable approach to the surgical management of chronic fissure‐in‐ano.

ISSN:0012-3706    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

&NA;A retrospective study evaluating 40 patients who underwent the Wells procedure for complete rectal prolapse has been carried out. The procedure is described in detail. Results show a 10 per cent (four patients) recurrence rate. Two have been successfully reoperated on. There was no mortality or morbidity related to the procedure. This relatively simple procedure can be tolerated by most patients presenting with the problem.

ISSN:0012-3706    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

&NA;The healing of ileal and colonic anastomoses is compared in rabbits. The intestinal segment that contains the anastomosis shows a temporary loss of strength, which is reflected in a decreased bursting pressure. This loss of strength is accompanied by a massive loss of collagen, measured as hydroxyproline, both in ileum and in colon. In ileum, hydroxyproline concentrations, expressed on a dry weight basis, are lowered by 30 per cent, one day after operation. Thereafter, they rise again, after seven days reaching a level that is 40 per cent enhanced as compared with unwounded tissue. Maximal decrease in colon, measured two days after operation, is 40 per cent. After seven days hydroxyproline levels are back at preoperative values. In colon, significant loss of hydroxyproline is also apparent in the intestinal segment proximal to the anastomosis. This phenomenon does not occur in ileum. These results clearly demonstrate that after ileal anastomosis a loss of collagen occurs similar to that in colonic anastomoses. The fact that the loss of collagen is less extensive and more rapidly restored may be important in explaining the lesser incidence of leakage encountered after surgery of the small intestine.

ISSN:0012-3706    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

&NA;Orthopantomograms of the mandible were performed on 46 patients with familial polyposis coli having no clinical signs of Gardner's syndrome and on 46 control patients matched according to age and sex. Thirty‐five patients (76.1 per cent) and two (4.3 per cent) controls had osteomas (P<0.0005). It is concluded that orthopantomography of the mandible is a valuable diagnostic supplement to prophylactic proctosigmoidoscopic examination of first‐degree relatives of polyposis patients. Due to the frequent occurrence of mandibular osteomas in polyposis patients without clinically detectable extracolonic manifestations, it is suggested that “Gardner's syndrome” is no longer considered a clinical entity.

ISSN:0012-3706    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

&NA;Ten extrasphincteric fistulas have been treated by the two‐stage seton procedure. The seton was leftin situfor three months; follow‐up varied from six months to 2 1/2 years. There were no recurrences. Six patients experienced slight soiling and one patient became incontinent. Provided that only muscle tissue is enclosed by the seton, the procedure gives good results; a diverting colostomy is not necessary.

ISSN:0012-3706    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

&NA;A 50‐year‐old woman presented with a long history of nausea, abdominal pain, weight loss, and intermittent watery diarrhea. All investigations were negative except for the finding, on five separate colonoscopic biopsies, of a layer of band‐like collagen beneath the surface epithelium, diagnostic of collagenous colitis.

ISSN:0012-3706    

出版商:OVID    

年代:1984

数据来源: OVID