摘要:

&NA;During its second meeting at Amsterdam in 1990, the International Collaborative Group on Hereditary Non‐Polyposis Colorectal Cancer (ICG‐HNPCC) decided to carry out a pilot study on colorectal cancer surveillance in HNPCC. The objectives of the study were to ascertain in each of the participating centers the number of HNPCC families, the recommended screening procedures, the age at diagnosis of colorectal cancer (CRC), and the occurrence of interval cancers. Nine centers in seven countries including Denmark, Finland, Italy, Japan, The Netherlands, Switzerland, and the United States participated. Data were derived from a total of 165 families. With respect to screening, half of the centers advise colonoscopy as the only procedure. The interval between the consecutive examinations varies from one to three years. In the majority of the centers, screening begins at 20 to 25 years. Lifelong screening is recommended by three centers, while the rest advise discontinuation at age 60 to 75 years. The family material included 840 patients with colorectal cancer. The mean age at diagnosis was 45 years, and about 15 percent were diagnosed at age 60 or later. A total of 682 high‐risk relatives are being followed. After the follow‐up of 1 to 10 years in these families, only six cases of interval cancers were encountered.

ISSN:0012-3706    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

&NA;There is no specific association established between colorectal cancer and blood group type. In this study, the distribution of ABO and Rh blood groups was studied in 838 patients with colorectal cancer. There was no difference in distribution of ABO blood groups between patients who were Rh+ and Rh‐. There was no difference in ABO blood group or Rh factor and tumor location. The highest A/O ratio was found in rectal cancer. Although there was no difference in stage distribution for each ABO blood group, there was a significant difference between the Rh+ and Rh‐groups(P<0.037).It is not clear, however, whether the prognosis is different between the two groups since there were more early tumors as well as incurable tumors in the Rh‐group. All patients with synchronous cancer were Rh+. Further studies on blood group antigens are needed to elucidate the relationship between these antigens and colorectal cancer.

ISSN:0012-3706    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

&NA;A retrospective review of 637 consecutive colonoscopies with polypectomy in 526 patients was performed to determine the association of small polyps of the rectum and sigmoid colon with more proximal colonic neoplasms. All colonic polyps were proximal to the sigmoid colon in 117 procedures. Proximal neoplasms were found in 32 percent of patients with a single polyp in the rectum or sigmoid colon. The incidence increased to 83 percent for those with three or more polyps. The occurrence of proximal colonic neoplasms was not affected by the size or histologic type of the rectosigmoid polyps. These findings would suggest that total colonic evaluation be considered in all patients with a polyp in the rectum or sigmoid colon regardless of the size or histologic type of the polyp.

ISSN:0012-3706    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

&NA;A study of the anatomy of the anal striated musculature is performed on 34 adult specimens to reconsider some debated morphologic aspects. The original “eight‐shaped” arrangement of the fibers of the pubococcygeus is pointed out, suggesting a definite role of the muscle as a superior part of the continence muscular complex; the intermediate part seems to be formed by the puborectalis loop and the deep external anal sphincter, not always separable. Finally, the inferior portion is represented by the superficial sphincter, which shows an anatomic behavior similar to that of the pubococcygeus.

ISSN:0012-3706    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

&NA;The aim of this study was to develop a natural tissue valve that could be anastomosed into any area of the gastrointestinal (GI) tract to act as a fecal “brake” and so establish enteric continence at that site. A 4‐cm‐long valve created from an intussuscepted small bowel pedicle was anastomosed into the cecum and brought out through the abdominal wall as a stoma in 11 rabbits. The animals were re‐explored five weeks later for assessment of valve viability and continence and microscopic appearance. In all cases, the valve was fully continentin vivo.All valves were viable, and there was no anastomotic leakage. Pressure testing of the valve at reoperation revealed that 7 of 10 valves tested withstood pressures of 30 mmHg before and after catheterization and 6 of 10 were fully continent to cecal “blanching” pressure (50 mmHg). Valve failure was due to deintussusception in three cases. In four cases, valves were continent over 50 mmHg and showed no tendency to incontinence to bursting pressure of the cecum. We conclude that a continent pedicle valve unit (PVU) for placement in a variety of locations in the GI tract is feasible. The PVU has implications in the management of short‐gut syndrome, incontinent ileostomy, continent cecostomy, and as a continent valve placed in the perineum for restoration of perineal defecation following proctectomy.

ISSN:0012-3706    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

&NA;A prospective study was undertaken to evaluate pudendal neuropathy in fecal incontinence. Fifty‐two patients (38 women and 14 men) with fecal incontinence underwent manometric and electromyographic evaluation (measurement of pudendal nerve terminal motor latency [PNTML] and sphincter muscle mapping). The average age of all patients was 54±17 years. Fifty‐two percent (27/52) were found to have a pudendal neuropathy (PNTML > 2.1 milliseconds). Seventeen of these 27 patients (63 percent) had a bilateral pudendal neuropathy. Patients with a pudendal neuropathy were older than those without a neuropathy (63.7 yearsvs.51.9 years;P=0.01). Women were significantly more likely than men to have a pudendal neuropathy(P=0.03). Nine patients had an anatomic sphincter defect identified, and six of these (67 percent) had a neuropathy; 4/6 (67 percent) had a bilateral pudendal neuropathy. In the 43 patients who did not have an anatomic sphincter defect, there was no difference in resting pressure (69 mmHgvs60 mmHg;P= 0.4) or maximum voluntary contraction (95 mmHgvs.86 mmHg;P=0.5) when patients without a neuropathy were compared with those with a neuropathy. Patients with a pudendal neuropathy had a shorter sphincter length than those without a neuropathy (3.0 cmvs.3.9 cm;P=0.01). Bilateral pudendal neuropathy tended to occur more frequently in women(P=0.08) and was not associated with poorer resting pressure, maximum voluntary contraction, or shorter sphincter length. We conclude that pudendal neuropathy is a common cause of fecal incontinence, particularly in older women, and frequently occurs in association with a sphincter defect. Manometric evaluation alone is not helpful in identifying the neuropathic patient. PNTMLs should be routinely measured in the evaluation of fecal incontinence.

ISSN:0012-3706    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

&NA;A multicenter retrospective study was undertaken to assess the efficacy and safety of laparoscopy in colon and rectal surgery. To minimize potential bias in interpretation of the results, all data were registered with an independent observer, who did not participate in any of the surgical procedures. Sixty‐six patients underwent a laparoscopic procedure. Operations performed included sigmoid colectomy (19), right hemicolectomy (15), low anterior resection (6), colectomy with ileal pouch‐anal anastomosis (IPAA) (5), and abdominoperineal resection (APR) (3). The conversion rate from laparoscopic colectomy to celiotomy was 41 percent. Major morbidity and mortality were 24 percent and 0 percent, respectively. Length of stay, hospital costs, and lymph node harvest were compared between the sigmoid resection and right hemicolectomy subgroups. Data from traditional sigmoid colectomies and right hemicolectomies were obtained from the same institutions for comparison. Mean postoperative stay for laparoscopically completed sigmoid and right colectomies was significantly less than that for either the converted or the traditional groups(P<0.02). Total hospital cost for traditional right hemicolectomy was significantly less than that for the converted group(P< 0.05) but not the laparoscopic group. Laparoscopic sigmoid resection showed no significant total hospital cost difference among traditional, converted, and laparoscopic groups. Lymph node harvest in resections for carcinoma was comparable in all groups. These preliminary data suggest that laparoscopic colon and rectal surgery can be accomplished with acceptable morbidity and mortality when performed by trained surgeons. Length of stay is shorter, but there is no proven total hospital cost benefit. Appropriate registries will be necessary to adequately assess long‐term outcome.

ISSN:0012-3706    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

&NA;Fecoflowmetry is a new technique by which the fecal flow rate is studied through recorded curves representing the changes that occur in the flow against time. Fecal flow rate is the product of rectal detrusor action against outlet resistance. The technique was performed on 36 normal volunteers and 88 chronically constipated patients. Simultaneous recording of the fecal flow rate and intra‐abdominal and rectal neck pressures were performed. A water or paste enema was given to the individual. Upon feeling the desire to defecate, he or she was placed on a fecoflowmeter commode and was asked to defecate. Evaluation of the obtained defecation flow curve comprises the reporting on the defecated volume, flow time, mean and maximum flow rates, time to maximum flow, and shape of the curve. In the 88 constipated patients, two fecoflowmetric patterns were recognized: nonobstructive (inertia) and obstructive. They differ from each other in parameters and curve configuration. The defecated volume as well as mean and maximum flow rates were lower in outlet obstruction than in the inertia type, whereas flow time and time to maximum flow were longer. The ascending limb in the obstructive‐type curve rose less steeply than in inertia; the curve had a long plateau, and the descending limb sloped more gradually. To conclude, fecoflowmetric studies could differentiate between defecation of normal and constipated subjects, and in the latter between the obstructive and inertia types of constipation. The technique was developed to simulate natural defecation. It provides quantitative and qualitative data concerning the defecation act. The technique is simple, easy, noninvasive, and nonradiologic. It can be used as a screening tool in defecation disorders.

ISSN:0012-3706    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

&NA;A critical appraisal of all clinical studies published in 1980 and 1990 in three surgical journals—Diseases of the Colon and Rectum(DCR),Surgery(SURG), and theBritish Journal of Surgery(BJS)—was made to ascertain the frequency with which various research designs appeared, the standard of individual clinical studies, and a comparison of changes in the past decade. Clinical studies were classified into case studies or comparative studies. Comparative studies included randomized controlled trials (RCT), nonrandomized controlled trials, retrospective cohorts, and case‐control studies. A 10‐point index score (range, 0‐10) was used to assess the comparative studies. A sample of articles was analyzed for interobserver and intraobserver variation, with strong agreement between reviewers for classification of trials (unweighted kappa, 0.87) and index scores (0.67). Of 1,481 articles reviewed, 1,060 were classified as clinical studies. Sixteen percent of all clinical studies were comparative studies in 1980, compared with 17 percent in 1990. Of these, 7 percent were RCT in both years. In 1980, 6 percent of clinical studies in DCR were comparative studies, 19 percent in BJS, and 18 percent in SURG. In 1990, 11 percent, 18 percent, and 18 percent, respectively, were comparative studies. In 1980, the proportion of RCT in DCR was 0 percent, in BJS 12 percent, and in SURG 4 percent, compared with 3 percent, 8 percent, and 8 percent, respectively, in 1990. Overall, 52 of 76 (68 percent) RCT were published in BJS. The standard of comparative studies increased overall from 5.49 to 6.04(P=NS), and that of RCT increased from 7.06 to 7.70(P=NS). The standard of comparative studies in DCR in 1980 was lower than those in BJS(P<0.001) and SURG(P<0.001). The standard of comparative studies in DCR improved from 1.67 in 1980 to 5.47 in 1990(P<0.001). There was no significant difference in the standard of comparative studies among the three journals in 1990. In conclusion, there has been no overall increase in the proportion of stronger clinical trial designs in the journals reviewed. A small increase seen in the overall standard of comparative studies was not statistically significant.

ISSN:0012-3706    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

&NA;The significance of mucinous carcinoma has been controversial since first described by Parham in 1923. Previous reports have suggested that mucinous tumors affect young patients, involve the more proximal colon, are more advanced at diagnosis, and have a poorer prognosis than nonmucinous colon carcinoma. More recent reports have refuted these results. In an effort to clarify the significance of mucinous histology, a retrospective review of cases of invasive colon cancer treated at the Ochsner Clinic between 1982 and 1985 was undertaken. Mucinous adenocarcinoma, as defined by ≥50 percent mucin, was found in 52 patients. During the same period, 343 nonmucinous adenocarcinomas were resected. The mean age, distribution within the colon, stage at diagnosis, and survival of mucinous carcinoma patients were compared with those with nonmucinous tumors. Mucinous tumors presented at a statistically significant more advanced stage (38 percent vs. 22 percent Dukes C lesions;P<0.01). No significant differences were seen in age at presentation, distribution within the colon, or stage‐for‐stage survival when the entire group was analyzed. Mucinous carcinomas of the rectum occurred at an advanced stage more frequently(P<0.05) than nonmucinous rectal carcinomas and had a markedly worse five‐year survival (11 percent vs. 57 percent;P<0.002).

ISSN:0012-3706    

出版商:OVID    

年代:1993

数据来源: OVID