摘要:

&NA;In the present study, the epidemiology of constipation in the United States and an assessment of its impact on national health are presented. This analysis was based on four different surveys,i.e., the National Health Interview Survey, the National Hospital Discharge Survey, the National Ambulatory Medical Care Survey, and the Vital Statistics of the United States. These surveys have estimated that over 4 million people in the United States have frequent constipation, corresponding to a prevalence of about 2 percent. Constipation was the most common digestive complaint in the United States, outnumbering all other chronic digestive conditions. Cathartics and laxatives were prescribed to 2 to 3 million patients yearly by general and family practitioners or internists. In 92,000 annual hospitalizations, constipation was listed among the discharge diagnoses. About 900 persons die annually from diseases associated with or related to constipation. Constipation was three times more common in women than men. It showed a marked increase after the age of 65 years. It appeared to affect nonwhites 1.3 times more frequently than whites. In addition, constipation was more frequent in people living in the South than elsewhere in the United States, and in people from families with low income or brief education of the head of family than in people from families with high income or a high educational level of their family head. These data suggest that there are other factors involved in the cause of constipation in addition to dietary fiber content and psychogenic infljences. The frequent occurrence of constipation and its impact on public health stress the need for further studies devoted to the epidemiology and basic pathophysiology of this condition.

ISSN:0012-3706    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;To evaluate the effects of povidone‐iodine (PI) enema on the bacterial flora of colorectal mucosa, the authors studied 113 patients who were candidates for colorectal surgery. The study of the rectum included 72 patients. Total bacterial concentrations after a PI enema (N=44) were significantly lower than after a simple water enema (N=12,P<0.001), or than after a water enema associated with intravenous metronidazole (N=16,P<0.01). The study of the colon included 41 patients. Total bacterial concentrations did not differ after a PI enema (N=24) than after a water enema (N=11); both groups were associated with intravenous metronidazole. In contrast, both preparations significantly reduced bacterial concentrations when compared with oral administration of polyethyleneglycol (N=6,P<0.01). Similar results were observed in rectal and colonic studies, when analysis was restricted to the anaerobic flora. PI is an antiseptic that, when administered alone in an enema or in association with metronidazole, significantly reduces bacterial concentrations in the mucosa of the colon and rectum. It may be proposed as a simple preoperative preparation for colorectal surgery.

ISSN:0012-3706    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;The site distribution of large‐bowel adenocarcinomas was studied in a retrospective study compromising 600 patients. These patients were divided into two groups according to the year of their operation; group A included patients operated upon between 1978 and 1982, and group B patients were operated upon between 1983 and 1987. Comparing these two five‐year periods, a statistically significant increase in the incidence of right colon tumors was noted (P<0.05). There was no difference in the distribution pattern of the carcinomas according to sex or age between the two groups (P<0.1). The shift to the right of large‐bowel neoplasms may indicate the need for an alteration of the diagnostic procedures concerning this disease, with more emphasis given to total colonoscopy and or double‐contrast barium enema.

ISSN:0012-3706    

出版商:OVID    

年代:1989

数据来源: OVID

ISSN:0012-3706    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;A prospective, double‐blind, randomized study was undertaken to compare perioperative parenteral metronidazole and erythromycin. One neomycin, and cefazolinhundred fifty‐five patients were randomized into two groups by the pharmacy department. The resulting difference between the overall septic complication rate in patients receiving erythromycin, neomycin, and cefazolin (10.9 percent) and the rate in patients receiving metronidazole alone (31.9 percent) was significant. This indicates that an antibiotic to cover aerobic bacteria should be added to the regimen when metronidazole is used.

ISSN:0012-3706    

出版商:OVID    

年代:1989

数据来源: OVID

ISSN:0012-3706    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;It has been said that the most important cause of morbidity and mortality in surgery of the colon, rectum, and esophagus is dehiscence. The new method of anastomosis tested here immediately after its completion is a sleeved continuous monolayer anastomosis with full‐thickness proximal bowel joined to the mucosa and submucosa of distal bowel. The 3 to 5‐mm sleeve of distal seromuscularis fashioned by prior excision of a ring of distal mucosa is folded over the monolayer anastomosis and tacked on to proximal seromuscularis by a second continuous suture. In this bench study, sleeved seromuscularis monolayer anastomoses were compared for immediate ability to withstand air distention with conventional all‐layer continuous and interrupted monolayer anastomoses. The results, even in fresh nonliving bowel, suggest that there may be benefits from sleeving monolayer anastomosesin vivo. It is noted that in the newly fashioned anastomosis, through‐the‐suture leaks were common on progressive distention, but were observed at higher pressures in sleeved and in extramucosal suture lines than in full‐thickness monolayers.

ISSN:0012-3706    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;The effect of acute and chronic stress on the colonic mucosa of the rat was investigated at various time intervals, ranging from one day to eight weeks. The amount of DNA synthesized by the mucosa was used as a marker of time‐related events. A total of 75 Sprague‐Dawley rats were investigated. Acute stress was considered for rats briefly plunged (psychic stimulus) or swimming for two hours (physical stimulus). Chronic stress was determined when rats were briefly plunged or swam for two hours for periods ranging from one to eight weeks. “Sham‐transported” rats were used as controls. DNA in the descending colon decreased significantly in rats swimming for two weeks, but increased (even for plunged rats) at four and eight weeks. In the ascending colon, a substantial increase in DNA content was found in rats plunged or swimming for eight weeks. The descending colon appears to be quantitatively more affected by various stressors than the ascending colon. It is apparent that, in control rats, the mucosa of the descending colon differs from the ascending colon. Fluctuations in the colonic DNA synthesis throughout the experiment suggest that this phenomenon may be connected to compensatory mechanisms toward cell adaptation to stress conditions. The model may prove of value in studies of the therapeutic abrogation of the fluctuations of the DNA replication of the colonic mucosa during the acute and chronic phases of a given stress.

ISSN:0012-3706    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;A retrospective study of 83 patients undergoing surgery for diverticular disease over two years at a colorectal specialty hospital was undertaken to assess the safety of resection. No patient had free perforation. Eightynine percent of 46 patients with neither abscess nor fistula underwent resection and primary anastomosis, the remainder undergoing other resectional therapy; there was no mortality in this group. Of the 37 patients with abscesses, fistulas, or both, all had resections with or without primary anastomoses and one of these 37 patients died (2.7 percent mortality). In the entire series of 83 patients, the operative mortality was 1.2 percent, although 69 percent had morbidity. Resection can be performed safely for diverticulitis, and primary anastomosis can be safely added in uncomplicated and selected complicated cases.

ISSN:0012-3706    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;Between 1978 and 1981, 73 patients with colonic or rectal cancer were randomized to have their anastomoses made by either a single interrupted layer of braided polyester sutures, or by a circular stapling instrument. Of these operations, 20 were considered to have been palliative, the remaining 53 being potentially curative. The incidence of local recurrence in the latter group was analyzed in relation to initial septic and anastomotic complications. The 53 patients were followed for a median of 36 months (range, 1 to 87); 24 were alive and well and 22 had died of disseminated cancer or unrelated causes. Seven patients died with local recurrent disease proved at laparotomy or autopsy after a median of 33 months (range, 3 to 72). Thirty anastomoses were stapled and 23 sutured; of the seven patients who died with local recurrent disease, six had stapled anastomoses (Fisher's exact probability F2=0.12; log rank chi‐square=3.53, 0.05<P<0.10). Two patients who died with locally recurrent disease had had clinically apparent anastomotic leads and one other patient had had a radiologically demonstrated leak. This compares with a total of seven leaks (clinical or radiologic) in the remaining group of 46 patients with no recurrence (Fisher's exact probability F2=0.11). These results tend to support the hypothesis that anastomotic leaks may lead to locally recurrent disease, particularly after stapled anastomoses

ISSN:0012-3706    

出版商:OVID    

年代:1989

数据来源: OVID