摘要:

&NA;Although stool consistency is considered to be an important component of anorectal continence, its effect on rectal emptying has never been quantitated. In 12 healthy volunteers and 12 patients after ileal pouch‐anal anastomosis (IPAA) (46±5 months after the operation; mean ± SEM), perfused anal manometry was performed; movements of the anorectal angle were quantitated scintigraphically; and rectal capacity and compliance were measured by air insufflation of an intrarectal balloon at three infusion rates. The efficiency of rectal evacuation of three consistencies (5 percent, liquid; 7.5 percent semisolid gel; 11.25 percent solid gel; w/w) of Tc99m labeled artificial stool (aluminum magnesium silicate gel) was quantitated by gamma camera imaging. No abnormalities of pelvic floor function were demonstrated in either controls or patients. The mean neorectal capacity and compliance of patients with IPAA did not differ from control, (capacity; IPAA: 215±22 mlvs. control; 245±29 ml; compliance; IPAA: 5.5±0.7 ml/cm H2Ovs. control; 6.6±0.7 ml/cm H2O;P>0.05). In controls, the percentage of the 7.5 percent consistency evacuated (81±5 percent, mean ± SEM) was significantly more than the percentage evacuation of either the 5 percent consistency (67±7 percent) or the 11.25 percent consistency (77±2 percent) (P<0.05). After IPAA, the mean overall percent evacuation of the three stool consistencies was significantly less than control (52±6 percent after IPAA; 75±5 percent control,P<0.05). However, there was no significant difference in neorectal emptying between the liquid, the semisolid gel and the solid gel (56±6, 55±6, 51±9 percent, respectively,P>0.1). We concluded that in healthy subjects but not in patients after IPAA, stool consistency affected the efficiency of evacuation of enteric content.

ISSN:0012-3706    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

&NA;This study was done to determine the effect of the direct ileal pouch‐anal anastomosis upon pressure and sensory components of the anal canal and ileal pouch. These findings were related to postoperative continence. Thirty‐three patients with ileal pouch‐anal anastomosis (25 continent, eight with episodic minor incontinence) were studied 3±0.3 and 25±5 months after ileostomy takedown. The maximum resting pressure in the anal canal was significantly lower in patients with an imperfect result (35±5 mm Hg) than in continent patients (44±5 mm Hg)(P<0.05). Postoperatively the maximum squeeze anal pressure was slightly greater in continent than in incontinent patients (99±8 mm Hgvs.87±7 mm Hg)(P>0.05). The postoperative recto‐(ileo‐)anal inhibitory reflex was present in 27 percent. The linear correlation between strength of rectal (ileal) distension and depth resp. duration of internal sphincter relaxation as preoperatively observed disappeared postoperatively in every group of patients. Simultaneous measurements of pouch and anal pressure in patients with imperfect results revealed a reduced positive pouch anal pressure gradient compared to the continent group. This low pouch‐anal pressure gradient is thought to be responsible for the increased incidence of soiling in some of our patients.

ISSN:0012-3706    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

&NA;Ileal pouch function in 35 patients operated upon by the same surgeon were compared. Seventeen of the patients had a double loop (J) ileal pouch‐anal anastomosis (IPAA) and 18 a triple loop (S) pouch. The patients were examined a mean of 27.9 months and 5.1 months, respectively, after ileostomy closure. Ten of the S‐pouch patients were evaluated more than 6 months (S>6 months), mean 9.1 after ileostomy closure. There were no differences in the mean maximum resting pressures or maximum squeeze pressures between the groups. The incidence of daytime and nocturnal leakage was lower in the S‐pouch group, 22 and 29 percent, than in the J group 29, and 53 percent. Though the mean maximum tolerated volume (MTV) of the S‐pouch group was greater than the J group, the difference was not statistically significant. The difference in the mean compliance between the J‐ and S‐pouch groups and the J and S>6 months group was statistically significant(P<0.01) and(P<0.008). All the patients could evacuate spontaneously. The difference in the 24‐hour frequency of defecation between the S>6 months and J group was significant(P<0.05), but not between the S and J groups. The median frequency of nocturnal defecation between the S>6 months and J pouch groups was significant(P<0.005), but not between the S and J groups. The triple loop S‐pouches were more compliant than the J‐pouches and had a better functional result as shown by a lower incidence of nocturnal leakage, and a lower frequency of defecation during the day and night.

ISSN:0012-3706    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

&NA;Sixteen female patients (mean age 54.1 years; range 34‐74 years) with a 9.8‐year (range 1‐25 years) history of incontinence to solid stool underwent overlapping sphincteroplasty with internal sphincter imbrication without fecal diversion. All patients were prospectively evaluated with preoperative anorectal manometry, electromyography, and pudendal nerve motor latency assessment, postoperative anorectal manometry, and preoperative and postoperative functional evaluation. Mean and maximal resting pressures increased from 30 mm Hg and 49 mm Hg preoperatively to 40 mm Hg and 57 mm Hg, respectively, postoperatively. Likewise, mean and maximal squeeze pressures increased from 27 mm Hg and 48 mm Hg preoperatively to 39 mm Hg and 73 mm Hg, respectively, postoperatively(P<0.01). Furthermore, anal canal high pressure zone length was increased by sphincteroplasty from a mean of 0.9 cm (range 0‐3 cm) to a mean of 2.1 cm (range 1‐4 cm). These objective physiologic improvements correlated well with subjective functional improvement. Subjectively, functional outcome was rated by patients as excellent in 38 percent, good in 38 percent, fair in 19 percent, and poor in only 5 percent of cases. Overlapping sphincteroplasty with internal sphincter imbrication improves both the anal sphincter physiologic profile and fecal continence.

ISSN:0012-3706    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

&NA;The nuclear DNA pattern of 22 rectal carcinoids was determined by cytophotometry of paraffin embedded tissues. The results were compared with clinical as well as histopathologic features of the tumor. Three of the carcinoids with synchronous or metachronous metastasis had aneuploid DNA pattern, whereas 19 tumors with no metastasis showed diploid DNA pattern. No other single clinical or pathologic feature of the tumor could predict more accurately the malignant potential and the subsequent course of the rectal carcinoid. It is concluded that DNA aneuploidy in rectal carcinoid tumors is not so rare as indicated by earlier studies and that it is a factor of significant prognostic value.

ISSN:0012-3706    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

&NA;A prospective evaluation of the accuracy of real‐time ultrasonography (US), computed tomography (CT), infusion hepatic angiography (IHA), and computed tomography during arterial portography (CT‐AP) was performed on 65 resected liver metastases of colorectal cancers. The total detection rate was 58.5 percent for US, 56.3 percent for CT, 554 percent for IHA, and 86.2 percent for CT‐AP. The sensitivity of 29 lesions with diameters of smaller than 1 cm was 65.5 percent for CT‐AP, CT found only two, and both US and IHA localized no more than three. The smallest lesions detectable by CT‐AP were as small as 0.4 cm in diameter. CT‐AP proved most useful in detecting the liver metastases, and the use of this techique is recommended for preoperative planning of hepatectomy on patients with liver metastases.

ISSN:0012-3706    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

&NA;The symptoms of obstructed defecation have been attributed to rectal intussusception, and thus rectopexy has been advocated in the surgical management. In this study, patients with obstructed defecation underwent manometry and proctography before and after rectopexy. Seventeen patients (16 females and one male, mean age 51.6 years) were studied. Eleven underwent anterior and posterior fixation of the rectum and six had posterior fixation only. Preoperatively five patients demonstrated rectoanal intussusceptions. Fifteen had significant pelvic descent. No significant change in maximum resting pressure, maximum voluntary contraction, pelvic descent, or anorectal angle was seen postoperatively. In the initial follow‐up, many patients had significant amelioration of symptoms. However, on longer follow‐up (mean 30.8 months) only two had long‐term improvement. The remainder had a poor clinical result in spite of complete resolution of rectal intussusception. Many reported a worsening of symptoms as reflected by an increase in tenesmus and stool frequency. In the two cases with a satisfactory result, both could empty the rectum completely and demonstrated rectoanal intussusception on preoperative evacuation proctography. In those with poor results, four had complete emptying and three had rectoanal intussusception. In conclusion rectopexy is an ineffective treatment for obstructive defecation in most patients.

ISSN:0012-3706    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

&NA;The presence of intraepithelial inclusion bodies (Leuchtenberger bodies) was recorded in rectal or colonic specimens from 130 patients. Large to moderate number of intraepithelial bodies were recorded in 81.8 percent of 55 colorectal adenomas from patients with familial adenomatous polyposis (FAP). Conversely, none of the 55 non‐FAP adenomas or of the 20 specimens with ulcerative colitis (10 with dysplasia) had similar amounts of intraepithelial granules. Feulgen studies demonstrated that the granules contain DNA and are probably nuclear fragments of destroyed lymphocytes. Although the pathogenesis of this phenomenom remains obscure, it appears that the presence of large to moderate number of intraepithelial bodies in colorectal adenomas should strongly raise the suspicion of FAP.

ISSN:0012-3706    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

&NA;Dynamic proctography is a radiographic procedure that has become widely used in the evaluation of pelvic floor function. The anorectal angle (ARA) is one parameter which is usually quantified during this examination. To determine the accuracy with which this measurement can be made, three physicians independently measured the resting and squeezing ARAs of 22 women. The coefficient of variation and the kappa statistic were used to describe the degree of agreement among the three examiners. These analyses revealed poor agreement among examiners for all 22 patients taken as individuals, (&kgr;le;0.40; mean coefficient of variation at rest=18 percent; mean coefficient during squeezing=21 percent). These results suggest that measurements of ARAs will vary among examiners for any particular patient, even though individual examiners may demonstrate consistency in recording ARA data. There is wide interobserver variation in the measurement of the ARA from lateral radiographs, making quantification an exercise of only limited clinical value.

ISSN:0012-3706    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

&NA;The purpose of this study was to examine changes in subsite distribution and incidence of colorectal cancer within different age groups. Registration of colorectal cancer by the National Cancer Registry of New Zealand approached 100 percent by 1974. The present study was based on 15,395 individuals aged 25 years and over and registered for colorectal cancer between 1974 and 1983. Subsite distribution (right colon, left colon, rectum) for different age groups (25‐49, 50‐69, 70+ years) was significantly skewed, with an excess of right colonic cancer in individuals aged 25‐49 years and 70+ years. This right colonic excess was accompanied by a relative reduction in left colonic cancer. Age adjusted incidence rates for the periods 1974‐78 and 1979‐83 were compared and stratified by age group and subsite. Incidence rates increased in all subsites in individuals aged 50+ years. This was particularly evident for right sided cancer in the elderly of both sexes. There was a marked reduction in the incidence of left colonic cancer and rectal cancer in individuals under 50 years. In contrast, the incidence of right colonic cancer remained relatively stable in young individuals. Time trend studies indicate that the skewed subsite distribution of large bowel cancer in different age groups may increase with time and is probably due to varying etiological factors acting on different cohorts.

ISSN:0012-3706    

出版商:OVID    

年代:1991

数据来源: OVID