摘要:

&NA;A total of 31 patients with diverticulitis were analyzed who had both computed tomography and contrast enema. There was almost equal sensitivity to abnormality of approximately 90 percent. Contrast enema produced a specific diagnosis of diverticulitis in 61 percent, using stringent positive criteria, and an additional 29 percent with suggestive findings. Comparative computed tomography specific diagnoses in those 31 cases was made in 65 percent, and suggestive in 23 percent. Computed tomography was particularly useful diagnostically in cases of retrograde obstruction on contrast enema. The authors conclude that contrast enema should be the primary mode of approach, while computed tomography can be a valuable follow‐up when the diagnosis is still in doubt, or if it is possible that patient management might be altered by additional information.

ISSN:0012-3706    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

&NA;The relationship between gastrointestinal neoplasms and Crohn's disease is poorly defined. The purpose of this study was to characterize the features of gastrointestinal malignancies that developed in Crohn's patients. In this retrospective review the authors identified six patients with Crohn's disease who developed such lesions over a 20‐year period: four patients had colorectal cancers and two had ileal malignant neoplasms. Patients averaged 52.7 years of age (range, 21 to 61 years). Three patients were men and three women. Five of the six patients had endured Crohn's disease for more than 20 years. Only two lesions were diagnosed before surgery. The colorectal lesions were predominantly right‐sided and all occurred in bowel segments with active Crohn's disease. The lesions demonstrated aggressive histologic features: three of six tumors were poorly differentiated, one of the five adenocarcinomas was mucinous, and three of the colorectal cancers were Dukes' B or C lesions. Four of six patients survived five or more years. There was a single malignant carcinoid, which represents the seventh case report of a carcinoid tumor occurring in a patient with Crohn's disease. This study indicates that patients with Crohn's disease develop a wide variety of small bowel and colorectal cancers. Furthermore, it suggests that Crohn's patients with colonic disease should periodically undergo surveillance colonoscopy.

ISSN:0012-3706    

出版商:OVID    

年代:1990

数据来源: OVID

ISSN:0012-3706    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

&NA;A mail survey of 300 members of The American Society of Colon and Rectal Surgeons (ASCRS) was conducted to document the current methods of bowel preparation in use. Two hundred six questionnaires (69 percent) were returned. The majority of respondents (104 or 51 percent) used cathartics and enemas as the primary method of mechanical bowel cleansing. Eighty‐nine (43 percent) used a PEG®lavage, eight (4 percent) used mannitol, and one physician used a saline lavage method. Almost all the responding surgeons believed that their method of preparation was well tolerated by patients, provided good cleansing, and was associated with few complications. Most patients were admitted one day before surgery. All respondents used perioperative antibiotics, with the most common pattern being a combination of oral and parenteral agents. Surgeons using PEG lavage did more colonic resections per month and were fewer years out of their residency. This current pattern of preoperative bowel preparation has changed from previous surveys.

ISSN:0012-3706    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

&NA;Anorectal manometry was performed with a multilumen continuously perfused catheter in nine women with fecal incontinence after vaginal delivery. All patients had a third‐degree or fourth‐degree perineal laceration. The median age was 30 (range, 24 to 38) years. Anal manometry revealed low resting and squeeze pressures with a mean pressure of 28.7±5.3 mm Hg (normal, 60 to 80 mm Hg) and 42.5 ±5.9 mm Hg (normal, 100 to 150 mm Hg), respectively. Seven of nine patients had specific anterior quadrant defects demonstrated by cross‐sectional analysis of the sphincter. In addition, five patients had evidence of global defects of the sphincter or relatively low pressures in other portions of the sphincter. Follow‐up manometric data were obtained in four patients after reconstruction of the sphincter and demonstrated a mean improvement of resting and squeeze pressures of 5.1 mm Hg and 16.0 mm Hg, respectively. Although specific anterior defects may be expected with the history of obstetric trauma, the presence of global defects of the sphincter was unexpected and may support the role of injury to the innervation of the musculature of the pelvic floor as a contributing cause of fecal incontinence after childbirth. Anal manometry provides a quantitative assessment of sphincter function and dysfunction and is an important part of the preoperative assessment of patients with fecal incontinence from obstetric injuries.

ISSN:0012-3706    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

&NA;5‐Aminosalicylic acid and its metabolite, N‐ac‐5‐ASA, were measured in the plasma, urine, and ileostomy effluent of 24 ileostomates who ingested 750 mg Rowasa I®following an overnight fast. Twelve subjects previously had a small‐bowel resection or had part of their small bowel out of circuit (mean 95 cm) (Group I) while 12 had an intact small bowel (Group II). The mean peak plasma concentration of N‐ac‐5‐ASA was 1.11&mgr;g/ml in Group 1 subjects compared with 2.80&mgr;g/ml in Group II subjects(P=N.S.). On average, 53.0 percent of the ingested Rowasa I was detected in the 24‐hr ileostomy effluent of Group I subjects compared with 45.3 percent in the Group II subjects(P=N.S.). The mean recovery of 5‐ASA and N‐ac‐5‐ASA in urine was 8.5 percent in Group I and 35.6 percent in Group II subjects(P<0.001). These studies demonstrate that 5‐ASA is released and present in the small bowel following oral ingestion of Rowasa I in patients who have or have not had small bowel resections.

ISSN:0012-3706    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

&NA;This study was undertaken to determine if the construction of an ileal reservoir induces mucosal changes that can potentiate the effect of a chemical carcinogen (1,2‐dimethylhydrazine) on ileal mucosa. Animals were divided into three groups: 1) sham operation (n=19), 2) total colectomy with ileorectal anastomosis (n=20), 3) total colectomy with an ileal reservoir made of terminal ileum sutured to the rectum (n=20). An adaptation period of 12 weeks was allowed to promote fecal stasis and the histologic changes before exposure to weekly subcutaneous injections of DMH (25 mg/kg) for 16 weeks. Sodium butyrate was added to the diet as a tumor promotor. All animals were sacrificed one month later. Fecal stasis, along with enlargement, occurred in all the reservoirs (mean dimensions, 74×58×43 mm). Their mean volume was 88±14 ml. The histologic changes in the ileal reservoirs were: chronic inflammation (14/20), villous atrophy (14/20), and atrophy of the glands (8/20). In group 3, five carcinomas were seen. There were three in the duodenum and two in the reservoirs. In contrast, 21 carcinomas were detected in the control groups. There were 17 in the colon, 3 in the jejunum, and 1 in the ileum. No significant difference in the number of carcinomas was seen in the ileum with and without reservoir. Although it is possible to induce carcinomas in ileal reservoirs, the incidence remained significantly less than in the colon. In conclusion, the histologic changes induced by the construction of an ileal reservoir do not increase the risk of malignant transformation in the DMH model for intestinal carcinogenesis.

ISSN:0012-3706    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

&NA;One hundred two patients with symptomatic hemorrhoids were randomized to receive treatment with either infrared photocoagulation (IRPC) or a bipolar diathermy probe (BD). There was no significant difference in complications, number of treatments required (IRPC 1.7 [0.9], BD 1.6 [0.8]). Third‐degree hemorrhoids required more treatments than smaller piles. BD has some practical advantages over IRPC but results are similar.

ISSN:0012-3706    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

&NA;Defecography, pelvic floor electromyography, and segmentai colonic transit times were performed in 74 patients with functional constipation. Signs of functional outlet obstruction occurred in 74 percent. Transit times were normal in 33 percent. Measurement of colonic transit time in patients with disordered evacuation studies is useless from a clinical point of view, because abnormal segmental transit time is the result of outlet obstruction in most cases and will return to normal after adequate treatment. Only when evacuation studies are normal, or have become normal after treatment and constipation persists, are segmental transit studies indicated because they may demonstrate primary slow transit constipation. Primary slow transit constipation probably is caused by impaired motility of the whole gastrointestinal tract. As small‐bowel transit time increases, defecation frequency decreases, laxatives are taken again, and abdominal pain persists. Surgery should be performed with restraint.

ISSN:0012-3706    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

&NA;There is increasing interest in the use of coloanal reconstruction following proctectomy for low rectal cancer. The authors review the surgical options for such sphincter‐saving approaches, and report their pilot experience with eight patients receiving high‐dose preoperative radiation with subsequent proctectomy and endoanal anastomosis. There were no anastomotic leaks.

ISSN:0012-3706    

出版商:OVID    

年代:1990

数据来源: OVID