摘要:

&NA;Regeneration of rectal mucosa after rectal mucosectomy and ileoanal anastomosis (IAA) could jeopardize the long‐term safety of the procedure. The aim of this study was to determine if rectal mucosal regeneration occurred after IAA. Pathologic specimens of the IAA and surrounding rectal muscular cuff were obtained from 29 patients who had required IAA excision 17±2 months (mean±SEM, range, 2 to 48 months) following construction. Multiple (≥6) coronal and sagittal sections of each specimen were made and examined histologically. The rectal muscle cuff was bound to ileal serosa by dense fibrous tissue. Small islets of residual rectal mucosa were identified between the denuded rectal cuff and the ileal pull‐through in four patients (14 percent) and at the ileoanal anastomosis in two patients (7 percent). Active rectal muscosal disease, dysplasia, or reeplithelialization of the denuded rectal muscle were not seen. It is concluded that small islets of rectal mucosa may remain after IAA. Up to four years after IAA, however, no evidence of rectal mucosal regeneration could be documented.

ISSN:0012-3706    

出版商:OVID    

年代:1987

数据来源: OVID

ISSN:0012-3706    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

&NA;To investigate the distribution of granulomas in Crohn's disease, a step sectioning study of the surgically resected intestines was carried out. This study proved that granulomas in Crohn's disease are found in the seemingly uninvolved intestinal mucosa as well as in the affected mucosa. Granulomas in the apparently involved mucosa were close to the mucosal surface (less than 500 &mgr;m) and small (80 to 160 &mgr;m across), while in the affected mucosa they were farther away from the mucosal surface (more than 500 &mgr;m) and larger (more than 160 &mgr;m across). We emphasize that these small granulomas, namely microgranulomas, in the apparently uninvolved intestinal mucosa, are of great value in diagnosing Crohn's disease.

ISSN:0012-3706    

出版商:OVID    

年代:1987

数据来源: OVID

ISSN:0012-3706    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

&NA;Local tumor recurrence rates after curative rectal cancer surgery with the end‐to‐end anastomosis stapler (EEA®) are reportedly high. Therefore, a retrospective review in ten Yale‐affiliated hospitals was undertaken to establish the outcome of surgical resection for rectal cancer in this patient population.Of those 373 patients who had had curative resections, 192 (52 percent) were abdominoperineal resections (APR); 105 patients (28 percent) had restorative resections with sutured anastomoses, and the EEA stapler was used in 76 patients (20 percent). There was an equal distribution of tumors in the various Dukes' stages in all three procedures. Local tumor recurrence was: APR 19 percent, SUT 17 percent, and EEA 24 percent, but local tumor recurrence was more frequent after EEA than APR for tumors 7 to 10 cm from the anal verge (32 vs. 13 percent, respectively,P<0.05), and the time to recurrence was least in EEA patients.It is concluded that local tumor recurrence is higher than expected for all three procedures and that the EEA stapler was associated with a greater risk of local tumor recurrence. These findings are attributed to surgeon‐related technical operative factors rather than to the nature of the tumors themselves.

ISSN:0012-3706    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

&NA;To evaluate the reliability of screening only the distal colon in patients at high risk for colonic cancer, the endoscopic findings of 49 completely asymptomatic patients who underwent colonoscopy based solely on a positive family history of colonic cancer (average age, 54.5 years) were reviewed. Polypoid lesions were present in 31 (63.3 percent). Thirty‐three polyps in 13 patients were large than 1 cm, including two invasive cancers.Eleven patients (22.4 percent) had polyps proximal to 40 cm only and would not have been identified on examination of the distal bowel alone. The predictive accuracy of rectosigmoid screening in this population is 78 percent. Initial screening of patients at high risk for colonic cancer should include full colonoscopy. The extent of follow‐up examinations is then based on endoscopic findings.

ISSN:0012-3706    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

&NA;Eight patients (seven male and one female) with symptomatic postoperative perineal hernias treated at the Cleveland Clinic Foundation from 1975 to 1986 are reviewed. The patients ranged in age from 43 to 68 years (mean, 61 years). Seven had previous abdominoperineal resections of the rectum and one had a pelvic exenteration. The first two patients underwent repair via a perineal approach and both had recurrences of their hernias. These recurrences, as well as the presenting hernias in the six later patients, were repaired with mesh placed through an abdominal approach. Of these, there was one recurrence, which was repaired via an abdominal approach. There was no operative mortality. Based on experience, the authors believe that the best method of repair for this uncommon problem, involves placement of Marlex®mesh across the pelvic inlet through an abdominal approach. This allows attachment to the mesh to the lateral musculature and posterior sacral periosteum under direct vision. The anterior borders of the mesh can be secured to the apex of the vaginal or prostatic tissue. The placement of metallic clips to the edges of the mesh allows for confirmation of the mesh position by radiographic examination during follow‐up.

ISSN:0012-3706    

出版商:OVID    

年代:1987

数据来源: OVID

ISSN:0012-3706    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

&NA;To assess whether the presence of backwash ileitis predisposed to the subsequent development of ileal pouchitis after ileal pouch‐anal anastomosis, 131 patients who had the operation were studied. Fifteen patients had nonspecific inflammation in the terminal ileum noted at the time of the operation, while 20 patients subsequently developed pouchitis. No correlation between the two conditions was found. Pouchitis developed in two of 15 patients (13 percent) with backwash ileitis and in 18 of 116 patients (16 percent) without the ileitis (P>0.05). Among the 20 patients (16 percent) without the ileitis (P>0.05). Among the 20 patients with pouchitis only two (10 percent) had had previous backwash ileitis. It is concluded that the presence of backwash ileitis does not predispose to later development of pouchitis, and so does not contraindicate use of the inflammed terminal ileum for construction of the ileal pouch and anastomosis.

ISSN:0012-3706    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

&NA;A conscutive series of 28 patients with acutely obstructing carcinomas of the left colon and rectum were encountered during the last three years. Two patients treated by loop colostomy only were excluded from the study. Fifteen patients received a one‐stage operation of immediate resection and primary anastomosis without proximal colostomy. The remaining 11 patients were treated by a conventional staged operation. The operative mortality and complications were similar in both groups. The duration of hospital stay in the former was half of that in the latter. Of nine patients treated by subtotal or total colectomy with primary anastomosis, the average number of bowel movements three months after surgery was 1.8 per day. Intraoperative colonic irrigation was performed in five patients of the one‐stage group and permitted a safe primary anastomosis. The immediate results of the one‐stage operation were surpisingly good. The authors propose it as the treatment of choice for the majority of patients with obstructing carcinomas of the left colon and rectum.

ISSN:0012-3706    

出版商:OVID    

年代:1987

数据来源: OVID