ISSN:0012-3706    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;Time trends in surgical treatment of ulcerative colitis in Stockholm County over the 30‐year period 1955 to 1984 were investigated. Four hundred eighty‐six patients (263 men and 223 women) were submitted to colectomy with or without proctectomy. In elective cases, proctocolectomy was the procedure of choice until the 1980s, when subtotal colectomy became more common. In acute cases subtotal colectomy was the procedure of choice during the entire period. Major complications developed in 162 patients (33 percent) and 103 (21 percent) underwent another operation. The frequency of major complications increased, with the urgency of intervention being 25 percent in elective cases and 46 percent in acute cases (P<.001). The postoperative mortality was 1.7 percent in 301 elective cases and 9.2 percent in 185 acute cases (P<.001). The overall postoperative mortality was 4.5 percent and fell from 13 percent during 1960 to 1964 to 2.0 percent during 1980 to 1984 (P<.01). In acute cases, the mortality during the same two periods fell from 36 to 3.0 percent (P<.001). The postoperative mortality for proctocolectomy (2.7 percent) was significnatly lower (P<.01) than for subtotal colectomy (9.0 percent). Seventy‐four percent of the patients treated by subtotal colectomy were acute cases, however, with a mortality of 11 percent and only 30 percent of the proctocolectomy cases were acute cases, with a mortality of 6.5 percent.

ISSN:0012-3706    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;Radioimmunoguided surgery (RIGS system) was performed in ten patients with rectal or low sigmoid colon carcinoma with the use of a hand‐held gamma detector (NeoprobeTM1000) intraoperatively and externally after injection of radiolabeled (125I) monoclonal antibody to detect pelvic and metastatic tumor. Fifteen procedures, including six exploratory laparotomies, four transperineal explorations, two transsacral explorations, one transvaginal biopsy, one brachytherapy, and one transanal polypectomy, were performed. Two patients had previous low anterior resection, seven abdominoperineal resection, and one a rectal polypectomy. Five patients had previous pelvic radiation therapy. Reoperation was indicated by elevated CEA levels in seven patients (70 percent), persistent pelvic pain in six (60 percent), and a suspicious radiologic study in seven (70 percent). RIGS system localized tumors verified by histopatholoy in all ten patients (100 percent); one patient with a positive CT scan and probe findings lacked histopathologic confirmation on frozen section, but had a tumor confirmed on permanent histology. Five major abdominal operations were avoided; in five patients major modifications were made in the surgical procedure based on probe findings. Six received chemotherapy or radiation therapy based on findings of the RIGS system. In six patients with negative or equivocal CT scans, the RIGS system localized histopathologically confirmed tumor. Major abdominal procedures can be avoided, the surgical approach modified, and other modes of therapy instituted earlier with the use of the RIGS system.

ISSN:0012-3706    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;The patterns of presentation and associated treatments of 65 patients with acute perforated diverticulitis of the left colon have been reviewed. Four types of operations were identified: primary resection with anastomosis (group I, N=29), primary resection with anastomosis and protective colostomy (group II, N=5), primary resection with Hartmann procedure (group III, N=26), and delayed resection three‐staged procedure (group IV, N=5). The severity of disease was also classified (stages I to IV). Postoperative mortality rates in the first two groups were lower than that of the Hartmann group (3.4 vs. 15.3 percent). The mean length of initial hospitalization was 16±1.2 days for group I, 18.2±4.4 days for group II, 19.4±2 days for group III, 26.4±4.4 days for group IV (P<.05,t‐test group IVvs.groups I, II, and III). Complications in the Hartmann group were high with a 23 percent wound infection rate and mortality after closure of colostomy and bowel reconstruction was 3.8 percent. These data demonstrate that primary resection with anastomosis is a satisfactory operation for the majority of patients with perforated diverticulitis (stages I to III), and there appears to be no clinical indication to use the three‐staged operation.

ISSN:0012-3706    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;A prospective, randomized, single‐blind, controlled clinical trial was undertaken to compare two different prophylactic antibiotic single‐dose regimens in patients undergoing elective colorectal surgery. Timentin, a combination of ticarcillin and clavulanic acid, was administered intravenously (3.1 g) to 87 patients. Mezlocillin, a semisynthetic penicillin was given intravenously (2.0 g) to 98 patients. The wound infection rate was 10.6 percent in patients receiving Timentin and 9.7 percent in those receiving mezlocillin (P>.05). Multivariate analysis of factors possibly affecting the wound infection rate showed that the presence of a colostomy preoperatively, fecal contamination at surgery, and the surgical group were the only factors that independently achieved a statistically significant association with the development of a postoperative wound infection in this trial (P<.0001).

ISSN:0012-3706    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;A comparison of the prognostic values of the Dukes and Jass systems were performed with 722 patients with rectal cancer enrolled in the National Surgical Adjuvant Breast and Bowel Projects, protocol R‐01. The Jass system revealed four prognostic groups when all patients or only Dukes' B and C cases were examined; however, the magnitude of differences between groups I and II and III and IV were small. Dukes' classification, as defined in this study, revealed five prognostic groups. A statistically strong association between the Jass and Dukes systems was observed. Although histologic grade permitted further prognostic discrimination of all Dukes stages except A, only the Jass system allowed for the subdivision of C cases with up to four nodes positive for metastases. Those in that group had survival rates comparable to B cases (no nodal involvement) when scores of I and II were found. The distributions of the patients in the extremes of the Jass and Dukes systems (C2 as defined) were almost similar. The findings indicate that the Jass system is a valid prognostic method for patients with rectal carcinoma. In this material, however, it basically allowed for only two major prognostic groups whereas five were noted by the Dukes method. These results, as well as the more objective nature of Dukes' classification, warrant its continued use for prognosis and therapeutic decisions for patients with rectal cancer.

ISSN:0012-3706    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;A comparison, based on results from anal manometry and continence, was made between eight patients after circular stapled ileal J‐pouch‐anal anastomosis without mucosectomy (Js) and seven patients after endoanal mucosal proctectomy and hand‐sewn ileal pouch‐anal anastomosis (Jm). The mean and range from ileostomy closure were 3.5 months (1.5 to 12) and 21.7 months (13 to 32), respectively. The mean maximum resting pressure (MRP) (±SEM and range) was 81.3 mm Hg (±6.0 and 61 to 112.5) and 50.0 mm Hg (±6.2 and 17 to 62.5), respectively, for the Js and Jm groups (P<.003). None of the Js patients experienced leakage or wore a pad, while in the Jm group 14 percent experienced minor leakage during the day and 28 percent at night. Seventy‐one percent of the Jm group wore a pad at some point. Anal sphincter resting pressures and continence were better in the Js group. The improvement in MRP resulted from avoidance of injury to the internal anal sphincter during dilatation and mucosectomy and the maintenance of a normal anal canal that allowed for proper closure.

ISSN:0012-3706    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;The immunohistochemical staining for carcinoembryonic antigen (CEA) and secretory component (SC) was evaluated in 166 endoscopically obtained colorectal adenomas of 124 patients. Expression of CEA, both in the cytoplasm and on the surface of the epithelial cells, was found to be moderately correlated with the severity of dysplasia in all adenomas. This relation was not observed with the SC expression in the adenomas. Both CEA and SC expressions were found to be increased with the size of the adenomas, but only in the villous adenomas and not in the tubular adenomas. These findings indicate that evaluation of CEA and SC expression does not add much additional information to the known parameters of malignant potential of colonic adenomas, such as dysplasia, size, and pattern of mucosal growth.

ISSN:0012-3706    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;The effect of postanal repair on internal and external sphincter function has been assessed by comparing preoperative and postoperative manometric results in 39 patients with neurogenic fecal incontinence. Postanal repair was effective in 70 percent. The urge to defecate was restored in 70 percent, the ability to retain feces in 45 percent. The procedure caused an increase in squeeze pressure (P=.001), but clinical results were not related absolutely to improvement of external sphincter function, which remained within limits of fecal incontinence in most cases. The procedure restores anatomy rather than function. The influence of the procedure on resting pressure was not statistically significant (P=.4).

ISSN:0012-3706    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;The subjective response to rectal balloon sensation was assessed with anorectal manometry and pudendal nerve terminal motor latency measurement (PNTML) in three groups of patients. There were 37 healthy subjects, 54 patients with idiopathic fecal incontinence (IFI), and 36 with complete rectal prolapse and incontinence (CRP). There was no significant difference for any parameter of rectal balloon sensation between patients with IFI and normals. Patients with CRP differed only in onset (P=.001). The results show that the appreciation of rectal distention is maintained in IFI.

ISSN:0012-3706    

出版商:OVID    

年代:1989

数据来源: OVID