摘要:

&NA;Posterior sagittal anorectoplasty was used for the first time in 1980 to treat anorectal malformations. This approach includes a wide exposure, through a midline posterior incision, to determine the limits of the sphincteric mechanism and to place the rectum within its limits. This approach has been used to treat children with anorectal malformations, who underwent conventional procedures that failed. The management of anorectal malformations with this approach rendered significantly better results in terms of bowel control. However, there is still a large number of patients suffering from fecal incontinence and for them a bowel management program was designed to improve their quality of life. The posterior sagittal approach was also used for the treatment of acquired conditions including tumors, post‐trauma and postradiation fistulas, and other postoperative complications. A historic review of the posterior approach disclosed that Cripps, a British surgeon, published his experience with a posterior transsphincteric approach to the rectum nine years before Kraske, a German surgeon, whose name has been traditionally associated with the leadership in this approach. Kraske actually approached the rectum through a paramedian incision and never performed a real transsphincteric incision. An experimental study done in dogs by the author demonstrated that it is not harmful to divide the sphincteric mechanism. The posterior sagittal approach represents a useful alternative to treat many pelvic conditions and, therefore, it must be a part of the armamentarium of colorectal surgeons. Finally, a series of clinical experiences convinced the author that coordinated rectosigmoid motility is the most important single factor in fecal continence and, therefore, our efforts to help patients suffering from fecal incontinence must be aimed at the manipulation of bowel motility.

ISSN:0012-3706    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

PURPOSE:This study was designed to determine the effect of corticosteroids on healing colonic anastomoses.METHODS:Bursting pressure measurements were performed on 108 male albino rats receiving corticosteroid treatment. Twelve animals were sacrificed at time zero to determine the bursting pressure of nonoperated, nonsteroid‐treated colon. The remaining 96 animals underwent division and reanastomosis of their midtransverse colon. They were then separated into four groups of 24 each. Twelve animals in each group received steroid treatment while the remaining 12 acted as controls. The groups were sacrificed at 4, 6, 8, and 20 days. The bursting pressures of the anastomoses were then noted.RESULTS:There was no significant difference in bursting strength between treated animals and controls at four days(P=0.27). A significant difference occurred at 6, 8, and 20 days(P=0.01, 0.003, 0.009, respectively). The colonic bursting pressure of operated controls returned to that of a normal, nonoperated colon by 20 days.CONCLUSION:This study demonstrates that steroids do have an adverse effect on colonic anastomotic healing.

ISSN:0012-3706    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

PURPOSE:The postoperative course of intestinal Behçet's disease was studied in nine patients who had undergone a total of 15 operations due to intestinal ulcers.METHODS:These patients were followed up for an average of 6.0 years (range, 1 year, 3 months to 13 years, 10 months) after each operation and they were repeatedly examined by double‐contrast radiography and/or colonofiberscopy.RESULTS:Recurrence of intestinal ulcers was observed in 12 (80 percent) of the 15 surgical cases. The incidence (50 percent) of postoperative recurrence in six cases in which intraoperative endoscopy revealed no abnormality in the retained intestine was lower than that (100 percent) in nine cases without this examination. Recurrent intestinal lesions in most cases were demonstrated as multiple aphthoid ulcers in the ileum near the ileocolectomy, or as one or two deep ulcers at the ileocolectomy site. The recurrent ulcers were successfully treated by various medical therapies, but the effectiveness of these therapies was only temporary.CONCLUSION:In the case of this disease, intraoperative endoscopy may be useful for preventing postoperative recurrence and periodic follow‐up examination with radiography and endoscopy should be performed, even after surgery.

ISSN:0012-3706    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

PURPOSE:An evaluation of the importance of gastrin in the colorectal carcinogenesis in patients with familial adenomatous polyposis was conducted.METHODS:Blood samples from 168 family members of 26 families were investigated for circulating gastrin. Blood was drawn from 65 affected patients, 66 clinically unaffected first‐degree relatives, and 37 spouses.RESULTS:We did not find any difference in distribution of serum gastrin among these groups.CONCLUSION:Our results seem to exclude gastrin from being relevant in early carcinogenesis in patients with familial adenomatous polyposis.

ISSN:0012-3706    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

PURPOSE:This study was undertaken to assess the electron microscopic and microbiologic findings in tissue biopsy samples from patients with pouchitis and to compare them with findings in patients with normal pouches, conventional ileostomies, and normal ileum.METHODS:Tissue samples were obtained from 78 patients: 23 patients with normal pouches endoscopically and histologically (Group 1), 12 patients with endoscopic and histologic evidence of inflammation (pouchitis) (Group 2), 14 patients who had either endoscopic or histologic evidence of inflammation but not both (Group 3), 20 patients with conventional ileostomies (Group 4), and 9 patients without ileostomies from whom biopsy samples of normal ileum were obtained (Group 5).RESULTS:The mean total aerobic facultative counts in the biopsy samples from the pouchitis patients were significantly higher when compared with biopsy samples from Groups 4 and 5 (P<0.05). There were no significant differences in the mean anaerobic counts among the five groups. Positive cultures were obtained in 90 percent of patients with pouches compared with 69 percent of patients with conventional ileostomies or normal ileum (P<0.05). Intramural bacteria were observed on electron microscopy in biopsy specimens of 47 percent patients with pouches compared with 14 percent of patients with conventional ileostomies or normal ileum (P<0.05). However, the proportion of patients with positive cultures or intramural bacteria was not increased in the pouchitis group compared with the normal pouch group.CONCLUSION:These data suggest that intramural aerobic facultative bacterial counts are elevated in patients with pouchitis and may play a role in the pathogenesis of pouchitis.

ISSN:0012-3706    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

PURPOSE:The aim of this study was to further investigate continuous ambulatory anal manometry which has recently been introduced as a method for studying anorectal activity in ambulant patients, thereby avoiding many of the potential drawbacks of static techniques.METHOD:In this study continuous ambulatory manometry was used to assess the activity of the internal anal sphincter in patients who had undergone restorative proctocolectomy, and, in particular, to compare patients who had undergone conventional mucosal proctectomy with sutured endoanal, ileoanal anastomosis with patients who had undergone restorative proctocolectomy with preservation of the entire anal canal by means of stapled, end‐to‐end, ileoanal anastomosis without mucosectomy.RESULTS:Evidence of basal internal sphincter activity was found in only 38 percent of patients after mucosal proctectomy with sutured endoanal anastomosis, whereas all patients after restorative proctocolectomy with stapled end‐to‐end anastomosis and all control individuals showed such activity of the internal sphincter. Similarly, the number of sampling episodes seen in patients after mucosal proctectomy with endoanal anastomosis was significantly less (median, 0.0/hours (0‐30/hours)) than the number of sampling episodes observed in patients after end‐to‐end anastomosis (median, 4.5/hours (1‐48/hours)) or in control individuals (median, 5.6/hours (0‐31/hours)) (P<0.001).CONCLUSIONS:These results suggest that the internal anal sphincter is damaged in the course of mucosal proctectomy and endoanal anastomosis. In contrast, after restorative proctocolectomy with stapled, end‐to‐end anastomosis normal function of the internal sphincter is preserved.

ISSN:0012-3706    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

PURPOSE:The aim of our study was to evaluate the risks of multiple hemorrhoidal bandings in a single session.METHODS:We retrospectively examined all of the patients who had hemorrhoidal bandings from July 1989 to August 1992.RESULTS:Patients with multiple hemorrhoidal banding in a single session when compared with patients with single banding had greater discomfort and pain (29 percentvs.4.5 percent), but this discomfort was usually manageable with oral analgesia of limited duration. There were also more vasovagal symptoms (5.2 percentvs.0 percent), local swelling and edema (2.6 percentvs.0 percent), and urinary hesitancy and frequency (12.3 percentvs.0 percent) in the multiple‐banded patients. No major complication such as massive delayed bleeding and perineal or pelvic sepsis was noted.CONCLUSION:Most patients tolerated multiple hemorrhoidal banding in a single session with acceptably low complications. Multiple banding in a single session is a safe and cost‐effective alternative.

ISSN:0012-3706    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

PURPOSE:The aim of the study was to evaluate the use of anal endosonography in idiopathic incontinence.METHODS:In 29 patients and 26 normal controls, the relationship between sonography images and physiologic parameters was studied.RESULTS:External anal sphincter function, measured as fiber density by single‐fiber electromyography(P=0.0001) and pudendal nerve terminal motor latency(P=0.04), was significantly impaired in patients with idiopathic incontinence compared with controls. Both the external and internal anal sphincter could be identified by anal endosonography, and the thickness directly measured. The thickness of the external anal sphincter was significantly negatively correlated to muscle fiber density(r=−0.65,P=0.0002) and to pudendal nerve distal conduction velocity(r=−0.74,P=0.008). The thickness of the internal anal sphincter was significantly correlated to resting pressure(r=−0.67,P=0.0001).CONCLUSION:The ratio between the thickness of the external and internal sphincter muscles measured on the sonography screen was significantly reduced in patients with neurogenic incontinence compared with controls(P<0.01).

ISSN:0012-3706    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

&NA;Serum C‐reactive protein was measured in 56 patients hospitalized with a suspected diagnosis of acute appendicitis. Based on these determinations, four groups of patients were defined: Group A=26 patients with acute appendicitis who had a C‐reactive protein level higher than 2.5 mg/dl. Group B=4 patients with a C‐reactive protein level lower than 2.5 mg/dl who, after surgery based on a presumed diagnosis of acute appendicitis, were found to have a normal appendix. Group C=22 patients with nonspecific abdominal pain, 18 (72 percent) of whom had an elevated C‐reactive protein level, although in only 4 (7.1 percent) were these levels higher than 2.5 percent mg/dl. Group D=4 patients who had diseases other than acute appendicitis. It is concluded that an increase in C‐reactive protein levels to more than 2.5 mg/dl is not a definite indicator of acute appendicitis. However, if the C‐reactive protein level in blood drawn 12 hours after the onset of symptoms is less than 2.5 mg/ dl, acute appendicitis can be excluded.

ISSN:0012-3706    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

&NA;For properly selected rectal cancers, local excision is a sphincter‐saving alternative to abdominoperineal resection. If histologic assessment of a locally excised tumor reveals ominous features, further treatment with radical resection or irradiation may be necessary to treat potential lymph node metastases.PURPOSE:We wished to determine which features, if any, were predictors of nodal metastases.METHODS:Nine histologic and morphologic features of 62 radically excised rectal cancers were reviewed to determine which factors, if any, were associated with nodal disease.RESULTS:Using a chi‐squared analysis, we found worsening differentiation(P=0.0001), increasing depth of penetration(P=0.026), a microtubular configuration of 20 percent or more(P=0.023), and the presence of venous(P=0.001) or perineural invasion(P=0.002) to significantly influence nodal disease. Lymphatic invasion was witnessed too infrequently to determine significance but, when present, was associated with nodal metastases in every case. Exophytic tumor morphology, mitotic count, and tumor size were not significant predictors. An analysis of variables determined that, of all factors or combination of factors examined, Broder's classification was the strongest predictor of nodal disease.CONCLUSIONS:If a rectal cancer is accessible and of small size to facilitate local excision, an in‐depth histologic assessment is needed to determine if nodal metastases are likely on a statistical basis.

ISSN:0012-3706    

出版商:OVID    

年代:1994

数据来源: OVID