摘要:

&NA;Anastomotic stenosis is a poorly understood and underexamined complication of gastrointestinal surgery, reportedly most frequent in the coloproctostomy. In order to better define this problem, a questionnaire was sent to members of the American Society of Colon and Rectal Surgeons regarding patients with gastrointestinal anastomotic stenosis. A total of 123 patients with intestinal anastomotic stenosis were analyzed. Eighty‐two anastomoses were stapled and 41 were handsewn. Nearly all stenoses occurred in the distal bowel (70 rectal, 23 sigmoid colon). Preoperative risk factors identified were obesity (28 patients) and abscess (12 patients). Incomplete “doughnuts” were noted in 12 patients. Postoperative anastomotic leaks (15 patients), pelvic infection (13 patients), and postoperative radiation (7 patients) were believed to be contributing factors. Dilatation, using a variety of techniques, was the sole treatment for 65 patients, however, intra‐abdominal surgery was necessary in 34 patients. Large intestinal anastomotic stenosis probably occurs most commonly following coloproctostomy (both with handsewn and stapled anastomoses). Dilatation alone resulted in adequate treatment in most patients in the study. Major surgery was required to correct this problem in a significant number of patients (28 percent) in this series. The true incidence of anastomotic stenosis in colorectal surgery is unknown and warrants further study.

ISSN:0012-3706    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;The effects of aging on the pelvic floor musculature and its innervation are described in 102 women and 19 men without colorectal or pelvic floor disease. In the women, a reduction in anorectal “squeeze” pressure was found in the fifth decade, but the resting anal pressure remained unchanged. This reduction in squeeze anal pressure was accompanied by an increase in the mean pudendal nerve terminal motor latency, indicating damage to this nerve, and increased perineal descent in the resting and straining positions. The fiber density, recorded by single fiber electromyography in the external anal sphincter muscle, a muscle innervated by the pudendal nerves, was increased in the sixth decade, indicating the later development of compensatory reinnervation in this muscle. The interrelation of aging, menopausal effects, and parity in these changes is difficult to define from currently available data, but the authors suggest, from other evidence, that menopausal effects may be relevant.

ISSN:0012-3706    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;The effect of perioperative blood transfusions on survival after curative resection for colorectal carcinoma was studied retrospectively on 270 patients with special emphasis on whole blood transfusion. Eightysix (32 percent) patients did not receive blood transfusions, whereas the remaining 110 (41 percent) received packed cells and 74 (27 percent) received at least 2 units of whole blood. The recurrence‐free and overall 5‐year survival rates for the transfused group were 58 and 57 percent, respectively, and for the non‐transfused group, 78 and 72 percent, respectively. These differences were highly significant (log rank test,P<0.001). The recurrence‐free and overall 5‐year survival rates for patients who received only whole blood or a combination of whole blood and packed cells was 51 percent, and of those who received only packed cells was 63 percent. The difference was not statistically significant (log rank test,P=0.08,P=0.35). Administration of more than 6 units of blood is attended with a significantly worse 5‐year disease‐free survival rate than administration of a smaller volume. The survival was not decreased if 6 or more units of whole blood were given. The authors conclude that perioperative blood transfusions have a significant detrimental effect on survival after curative resection for colorectal carcinoma. This effect is not enhanced by whole blood transfusions.

ISSN:0012-3706    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;In order to determine whether perioperative blood transfusion affects the recurrence of Crohn's disease, the authors reviewed the records of 79 patients with Crohn's disease who underwent their initial intestinal resection at their institution. Recurrence of Crohn's disease was documented by radiographic studies, endoscopy, or laparotomy. During the hospital admission for resection, 45 patients received multiple red blood cell transfusions. Recurrence developed in 22 percent of these patients by 36 months, and the median time to recurrence was 35 months. In the 34 patients who did not receive multiple transfusions, recurrence was found in 44 percent by 36 months, and the median time to recurrence was 20 months. These differences are significant, using the Kaplan‐Meier analysis (P<0.04). Recurrence in patients with disease limited to the small bowel or to the colon was not significantly affected by the transfusion status. However, recurrence developed in only 10 percent of multiply transfused patients with ileocolic disease by 36 months, whereas recurrence developed in 45 percent of the patients who were not multiply transfused. (Significance,P=0.057). The authors believe that the observed decreased rate of recurrence of Crohn's disease in patients receiving multiple perioperative transfusions may represent another example of clinically significant immunosuppression from blood transfusion.

ISSN:0012-3706    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;A voluntary community colorectal cancer screening project to detect occult blood in the stool of asymptomatic individuals was undertaken; 49,353 Hemoccult®II kits were distributed. A total of 23,674 completed kits were returned to a central repository and processed (compliance rate, 48 percent); 851 participants had positive results (3.6 percent). Of the 640 who underwent further medical evaluation, 299 participants (46.7 percent) who had adequate follow‐up had no evidence of disease. Diverse disease entities were detected in 341 participants, which was 1.4 percent of those enrolled. Forty‐one patients (0.17 percent) showed significant findings that included 29 cancers (0.12 percent) and 12 (0.05 percent) noninvasive malignant polyps. Of the cancers, there were 27 colorectal, one nonHodgkin's lymphoma, and one carcinoma of the vocal cord. In addition, 107 patients (0.45 percent) had benign polyps and 193 patients (0.82 percent) had various diseases of the gastrointestinal tract and other medical conditions. The cost of the program was modest and the results conformed to those found in previous screening surveys. The heightened public awareness of testing for colorectal disease and the detection of early lesions justifies the guaiac test screening program for mass survey.

ISSN:0012-3706    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;Perforation of the rectum or sigmoid colon complicated 5 of 2200 barium‐enema examinations performed during a 4‐year period. Three patients with rectal perforations manifested by air extravasation were successfully treated with intravenous antibiotics and complete bowel rest. Two patients with barium extravasation were treated with immediate operation and colostomy. All five patients recovered. Perforation was found to be associated with a rectal stricture due to ulcerative colitis, a rectal cancer, an incarcerated inguinal hernia, fulminant ulcerative colitis, and a normal colon in an elderly patient. To determine the pressure in the rectum that could potentially be generated during a barium‐enema examination, the pressures created by a standard barium delivery set were measured, using 1‐meter columns of water, 25 percent diatrizoate sodium (Hypaque®), 20 percent barium, and 80 percent barium. The columns generated pressures of 70, 85, 95, and 120 mm Hg respectively. Squeezing the delivery bag increased the pressure 21 to 79 percent or a maximum of 55 mm Hg. Colorectal perforation during barium‐enema examination that was not accompanied by barium extravasation could be successfully treated nonoperatively. The associated pathology and our studies of pressures generated during a barium‐enema examination allow us to suggest that the incidence of colorectal perforation during barium‐enema radiography can be reduced by 1) performing proctoscopy prior to barium enema, 2) avoiding the use of the rectal balloon in patients with known rectal lesions, 3) avoiding barium studies in patients with active colitis, 4) avoiding generation of pressure greater than that created by a column of barium suspension of one meter, and 5) using a lower concentration of barium when possible.

ISSN:0012-3706    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;To obtain clear evidence of the rectoanal reflex, cold water was injected into the rectum. All patients with a normal reflex had a rectoanal reflex when the water was either 4°C or 17°C. The same reflex was seen when a balloon was used for distention. No reflex was evident when the water was 37°C. At 27°C or 45°C, the reflex was evident occasionally. In patients with Hirschsprung's disease, the rectoanal reflex was absent with balloon distention, and when water at any temperature was injected. As cold water will induced the rectoanal reflex safely and without rectal distention, measurement of the reflex using cold water is useful when the presence or absence of the reflex is doubtful. The authors' results suggest that the receptor related to the reflex is neuronal in origin and not muscular, and that the receptor locates near the mucosa.

ISSN:0012-3706    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;Transanal extirpation was performed in 38 patients with adenocarcinoma of the rectum. In 17 patients (group I) the tumor extended into the submucosa only, and in 14 patients (group II) tumors extended into, but not through, the muscularis propria. There was a significant difference in local recurrence between groups I and II. None of the patients in group I and six of the patients (42.6 percent) in group II developed local recurrences (P=0.02). The 5‐year actuarial survival probability was 100 and 82.6 percent, respectively. Transanal extirpation is an alternative to transsphincteric and abdominoperineal resection in the treatment of early well or moderately well‐differentiated cancer of the rectum. The surgical procedure is simple and has few complications; however, only tumors extending no deeper than the submucosa are suitable for this treatment. The operation should be followed by frequent sigmoidoscopies and rectal palpation. The procedure should be defined as an excisional biopsy until results from the histologic examination are presented.

ISSN:0012-3706    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;Thirty consecutive patients with epidermoid carcinomas of the anal canal larger than 2 cm were treated with the concomitant application of radiation and two cycles of chemotherapy (5FU and mitomycin‐C) between January 1982 and January 1988. Twenty‐eight patients were treated with curative intention and two for palliation only. All patients were reexamined after a period of one to 2 months, under light general anesthesia, and any residual tumor or scar tissue was biopsied. Control biopsy was positive in eight patients. Three of six patients who had abdominoperineal excision died from locoregional recurrence; the remaining are alive and cancer free after 1 to 4 years. Two patients had local excision; one is alive and the other died of other cancer metastasis four years later. Seventeen patients who had negative biopsies are alive and free of disease after 1 to 5 years; two died of unrelated causes, two died with distant metastasis (present prior to treatment), and one died with locoregional recurrence. Locoregional failures occurred in four patients (13.3 percent) in the entire series. Individualization of each patient, adjustment of doses, and carefully executed radiation and chemotherapy are the most important points for the success of treatment.

ISSN:0012-3706    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;Familial adenomatous polyposis was always believed to be a colonic disease of genetic determination with a high risk of development of cancer of the large bowel. Over the years the list of extracolonic manifestations of this disease, both benign and malignant, has amplified. Brain tumors and, in particular, medulloblastoma have not become recognized as major malignant extracolonic manifestations of familial adenomatous polyposis. They are of particular significance because, unlike most of the other manifestations, they occur prior to or early in the development of the colonic manifestations of this disease. This report documents the investigation of 168 kindreds in The Cleveland Clinic Familial Adenomatous Polyposis Registry in a search for those at‐risk individuals who developed brain tumors.

ISSN:0012-3706    

出版商:OVID    

年代:1989

数据来源: OVID