摘要:

PURPOSE:The aim of this study was to determine if recall of informed consent is affected by the timing of obtaining informed consent before endoscopic procedures.METHODS:Sixty patients scheduled for colonoscopy or esophagogastroduodenoscopy were enrolled in this prospective, randomized study. Each patient received informed consent 24 to 72 hours or immediately before the procedure, and follow‐up occurred one to three days postprocedure.RESULTS:There was no statistically significant difference in recall of informed consent or the individual elements of informed consent (indication, risks, benefits, alternatives) between the two groups.CONCLUSION:Recall of informed consent is similar whether consent is obtained immediately or several days before endoscopie procedures.

ISSN:0012-3706    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

PURPOSE:Operative repair of low rectovaginal fistulas should be tailored to the specific anatomic defect. Endoanal flap repair frequently provides successful fistula closure; however, if substantial injury to the perineal body, anal sphincter, or rectovaginal septum exists, a more extensive repair is required. We present our experience with 95 consecutive patients, operated for rectovaginal fistulasviaseptal repair after conversion to a fourth degree perineal laceration, endoanal flap, or anoperineorrhaphy.METHODS:A retrospective chart review was performed. Data collected included etiology, location, size, repair type, and degree of anal continence. All patients received standard mechanical and antibiotic bowel preparation and parenteral antibiotics. No covering stomas were used.RESULTS:Fistula etiology included obstetric injury (N=77), perianal cryptoglandular infection (N=15), and other (N=3). Thirty‐one patients had previous unsuccessful repairs. Types of repairs were fourth degree perineal laceration (38), endoanal flap (19), and anoperineorrhaphy (38). Excellent or good functional results occurred in 92 patients (97 percent). Similar success occurred in patients with previous failed repairs (90 percent excellent or good). The recurrence rate was 3 percent. There were no outcome differences between techniques.CONCLUSION:We believe that all three types of repair for rectovaginal fistulas result in a high cure rate, thereby allowing operative technique to be tailored to the anatomic defects present. This approach should allow for optimal functional outcome.

ISSN:0012-3706    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

PURPOSE:This study was designed to evaluate the results of rectocele repair and parameters that might be useful in selecting patients for this operation.METHODS:Twentyfive patients with symptom‐giving rectoceles were prospectively evaluated with a standardized questionnaire, physical examination, defecography, colon transit studies, anorectal manometry, and electrophysiology. Patients underwent posterior colporrhaphy and perineorrhaphy. They were followed postoperatively (mean, 1.0 year) with the same questionnaire, physical examination, defecography, anorectal manometry, and electrophysiology.RESULTS:Constipation had improved postoperatively in 21 of 24 constipated patients (88 percent). At postoperative follow‐up 13 patients (52 percent) had no constipation symptoms, 8 (32 percent) had occasional symptoms, and 4 (16 percent) had symptoms more than once per week. Four patients with rectocele at preoperative defecography, but not at physical examination, had favorable outcomes following surgery. The majority of patients not using vaginal digitalization preoperatively had improved with respect to constipation. All patients with pathologic transit studies had various degrees of constipation postoperatively. Constipation was not improved in two of five patients with preoperative paradoxic sphincter reaction.CONCLUSIONS:Rectocele is one cause of constipation that can be treated with good results. Preoperative use of vaginal digitalization is not mandatory for a good postoperative result. Defecography is an important complement to physical examination. Patients with pathologic transit study might have a less favorable outcome of rectocele repair with respect to constipation. More studies about the significance of paradoxic sphincter reaction in these patients are indicated.

ISSN:0012-3706    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

PURPOSE:This study was designed to examine the role of adjuvant internal anal sphincter plication in women with neuropathic fecal incontinence undergoing pelvic floor repair.METHODS:We completed a randomized trial with symptomatic and physiologic assessment before and after surgery.RESULTS:There was no symptomatic advantage of adding internal sphincter plication; the mean improvement of functional score was 3.61±1.82 (standard deviation;P<0.01) following pelvic floor repair alone compared with 2.80±1.66 (standard deviation;P<0.01) when adjuvant internal anal sphincter plication was added. The addition of internal sphincter plication was associated with a significant fall in maximum anal resting and squeezing pressures(P<0.01).CONCLUSIONS:Addition of internal sphincter plication is not advised in women with neuropathic fecal incontinence treated by pelvic floor repair.

ISSN:0012-3706    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

PURPOSE:The aim of this study was to determine the long‐term outcome after curative resection of colorectal cancers that extend only into the submucosa (“minimally invasive”) and to evaluate potential histologic predictors of lymph node metastases.METHODS:Seventy‐nine patients who underwent curative resection of minimally invasive colorectal cancer and were followed for at least five years were studied retrospectively.RESULTS:The series was comprised of 53 men and 26 women, with a mean age of 61 years. The lesion was in the colon in 47 patients and the rectosigmoid or rectum in 32 patients. Open surgery followed attempted endoscopic tumor removal in 25 patients. Lymph node metastasis, found in 11/79 patients (13.9 percent), was associated with worse outcome: 36.4 percent of node(+) patients developed recurrence,vs.only 5.9 percent of node(−) patients(P<0.005). The cumulative survival rate was also worse in node(+)vs.node(−) patients: 72.7 percentvs.91.1 percent at five years(P<0.05) and 45.5 percentvs.65.3 percent at ten years(P<0.05). Five histopathologic characteristics were identified as risk factors for lymph node metastasis: 1) small clusters of undifferentiated cancer cells ahead of the invasive front of the lesion (“tumor budding”); 2) a poorly demarcated invasive front; 3) moderately or poorly differentiated cancer cells in the invasive front; 4) extension of the tumor to the middle or deep submucosal layer; 5) cancer cells in lymphatics. Whereas patients with three or fewer risk factors had no nodal spread, the rate of lymph node involvement with four or more risk factors was 33.3 percent and 66.7 percent, respectively.CONCLUSIONS:Metastasis is not infrequent in “minimally invasive” colorectal cancer. Appropriate bowel resection with lymph node dissection is indicated if such a lesion exhibits more than three histologie risk factors for metastasis.

ISSN:0012-3706    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

PURPOSE:This study was designed to determine the importance of innervation of striated anal sphincters, one of the most important structures in idiopathic fecal incontinence.METHODS:Forty‐three idiopathic, fecally incontinent patients (40 women and 3 men; mean age, 57.2±11 (range, 33‐77) years) underwent anorectal manometry and sphincteric electromyography. On the basis of electromyographic findings, patients were subdivided into three groups: Group A consisted of 21 patients with normal electromyography; Group B consisted of 14 patients with moderate denervation; Group C consisted of 8 patients with severe denervation. Manometric results from the patients were compared with those from 15 healthy subjects (8 women and 7 men; mean age, 35±12 (range, 15‐55) years).RESULTS:Incontinent patients had a shorter anal canal(P=0.005), and anal canal pressure was lower at rest(P<0.001), at contraction(P<0.001), and at coughing(P<0.001); rectal distention and rectal compliance were reduced (maximum tolerated volume,P<0.003; compliance at 200 ml,P=0.03; at 250,P<0.005; at 300 ml,P=0.03). No statistically significant differences were found between the manometric results of the three different groups of patients. A statistically significant linear correlation was reached by comparing the clinical severity of fecal incontinence with age(P=0.02) and some other manometric parameters: the pressure of the anal canal at rest(P<0.001) and at contraction(P<0.01); rectal compliance at 50 ml(P=0.03), 100 ml(P=0.004), and 150 ml(P=0.004).CONCLUSION:Clinical severity of fecal incontinence is correlated with some manometric parameters. Severity of denervation of the anal striated sphincters does not appear to influence severity of fecal incontinence.

ISSN:0012-3706    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

PURPOSE:The aim of this study was to develop a method for determination of rectal compliance that allows direct measurement of corresponding changes in the rectal crosssectional area or perimeter and rectal pressure.METHODS:We developed an anal probe for transrectal endosonography. The probe was testedin vitro,and rectal compliance of six healthy patients was determined.RESULTS:In vitromeasurements proved the method to be well reproducible. The method allowed calculation of an endosonographic rectal compliance, which correlated well with rectal compliance measured by the standard method.CONCLUSION:Endosonographic determination of rectal compliance is possible, and the endosonographic method may give a more precise and reproducible estimation of rectal compliance.

ISSN:0012-3706    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

PURPOSE:Most patients with primary sclerosing cholangitis also have ulcerative colitis. It has been suggested that in the presence of primary sclerosing cholangitis the risk of colorectal dysplasia and carcinoma is greater than in patients with ulcerative colitis alone.METHODS:In a retrospective study, we evaluated the possibility of colorectal cancer or dysplasia in 35 consecutive patients with primary sclerosing cholangitis and ulcerative colitis seen at The Johns Hopkins Hospital between 1979 and 1991.RESULTS:Thirteen of the 35 patients (37 percent) with ulcerative colitis and primary sclerosing cholangitis had colorectal neoplasia (5 with adenocarcinoma and 8 with dysplasia). In the 27 patients undergoing colonoscopic biopsy surveillance, the cumulative incidence at 28 years of colorectal cancer was 18.5 percent and for colorectal dysplasia it was 29.6 percent. The high incidence of colorectal cancer was less than the rate of colorectal cancer in patients with extensive colitis of childhood onset without primary sclerosing cholangitis (35 percent), but the rate of colorectal cancer and dysplasia (48.1 percent) is similar to the highest rates of cancer noted in the comparison group. Because patients had subtle, quiescent colitis, a short time from diagnosis of ulcerative colitis to diagnosis of colorectal neoplasia was noted (mean, 12.2±9 years; less than 8 years in 5/13 (38.5 percent) patients).CONCLUSION:Ulcerative colitis patients with primary sclerosing cholangitis appear to have a high frequency of colorectal cancer but a rate lower than expected in patients with extensive quiescent ulcerative colitis of childhood onset alone. However, exact conclusions are complicated by the high incidence of colorectal dysplasia found, which portends malignant transformation. Because of the subtle nature of colitis, the diagnosis of ulcerative colitis is often delayed, and surveillance programs should start as soon as ulcerative colitis is diagnosed.

ISSN:0012-3706    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

PURPOSE:Black patients with colon cancer are more likely to have poorer survival from colon cancer than are white patients. To determine whether anatomic site differences might contribute to survival differences, we compared anatomic site distributions of black and white patients.METHODS:As part of the Black/White Cancer Survival Study, we collected medical record data for 1,045 patients from Atlanta, New Orleans, and San Francisco/Oakland, newly diagnosed in 1985 or 1986 and interviewed 745 of them.RESULTS:In polychotomous logistic regression analysis, site was related to stage, grade, and histologic type and among women with age, parity, and possibly smoking. However, it was not related to race, except perhaps among men age 65 and older, among whom blacks were somewhat likely to have more transverse and distal, not proximal, cancer. These relations were consistent across subgroups and were independent of other factors examined.CONCLUSION:Results suggest that site differences are unlikely to contribute to poorer survival commonly observed among black colon cancer patients in the United States.

ISSN:0012-3706    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

&NA;Uncertainty persists concerning the long‐term results of ileal pouch‐anal anastomosis performed for indeterminate colitis.PURPOSE:This study was designed to compare functional outcomes of ileal pouch‐anal anastomosis in patients with typical chronic ulcerative colitis and indeterminate colitis.METHOD:Seventy‐one ileoanal pouch patients were identified with a diagnosis of indeterminate colitis. Mean follow‐up was 56 months. Outcomes were compared with 1,232 chronic ulcerative colitis patients after ileal pouchanal anastomosis. Mean follow‐up was 60 months.RESULTS:(mean±SD) There was no difference in the frequency of daily bowel movements (indeterminate colitis, 7±3,vs.chronic ulcerative colitis, 7±2). Daytime and nighttime incontinence rates were likewise similar. Prevalence of pouchitis was identical (33 percent). However, failure rate was higher in the indeterminate colitis group (indeterminate colitis, 19 percent,vs.chronic ulcerative colitis, 8 percent; (P=0.03)).CONCLUSIONS:At a mean of nearly five years after surgery, failure appears to occur more frequently in patients with indeterminate colitis than in patients with chronic ulcerative colitis. However, the great majority of indeterminate colitis patients (>80 percent) have long‐term functional results identical to those of patients with chronic ulcerative colitis.

ISSN:0012-3706    

出版商:OVID    

年代:1995

数据来源: OVID