摘要:

&NA;Rates of sodium absorption in the presence of bacterial fatty acids and bile salts are unknown along the length of the colon. Such information may guide resection of colon with a view to leaving colon most optimal for ion absorption. Absorption of sodium and permeability of the colonic mucosa to51Cr EDTA was measured in the proximal (PC) and distal colon (DC) instilled with NaCl (120 mM), n‐butyrate (40 mM) and chenodeoxycholic acid (1 or 2 mM) in varying combinations. Sodium absorption in the PC was 123.6±19 (nmoles/min/cm2) (n=7) with saline alone and was doubled (P<.001) when 40 mM n‐butyrate replaced chloride anions. Sodium absorption in the DC with saline alone was 106.9±18 without significant alteration by addition of n‐butyrate. CDC (1 mM) diminished sodium absorption in the PC and DC. Diminished sodium absorption induced by bile salts was significantly reversed by n‐butyrate in the PC but not DC. Permeability of51Cr EDTA was greatest with 2 mM CDC in the distal colon. Mucosal function—sodium absorption with SCFAs, permeability changes, and protection by bacterial fatty acids from sodium losses due to bile salts—was superior in the PC compared with DC. Our results suggest that it may be preferable to preserve the proximal rather than distal colon in operations of the colon to secure optimal absorption of sodium.

ISSN:0012-3706    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

&NA;The management of malignant colonic polyps removed colonoscopically has been a controversial subject. A continuing series is reported of 36 patients with 37 malignant polyps removed by colonoscopic polypectomy (CP) between 1976 and 1982. Fourteen polyps contained carcinomain situ(CIS); 13 were treated by CP alone; one was treated by CP and colectomy. Nineteen polyps contained invasive carcinoma; 13 were treated by CP alone; six were treated by CP and colectomy. Four patients had sessile polyps resected piecemeal, in which accurate staging was impossible. Two were treated with CP alone, and two had CP plus colectomy. All patients were followed with yearly colonoscopy and/or barium enema. Follow‐up has been six to 84 months (mean 36 months). Twenty‐seven patients whose polyps were treated by CP alone have had no evidence of recurrent tumor at the polypectomy site. Of the nine patients undergoing colectomy, six had residual tumor at the polypectomy resection site. No patients had involved lymph nodes. Our current approach to this problem is based on the degree of invasion and the status of the resection margins. Polyps containing CIS can safely be treated with CP alone. Polyps with invasive carcinoma and clear resection margins should be treated with CP and either colectomy or frequent repeat colonoscopy. This decision is a clinical one and must involve input from both the clinician and the pathologist. Those polyps whose resection margins are involved or where piecemeal excision precludes accurate pathologic assessment should undergo colectomy.

ISSN:0012-3706    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

&NA;Two hundred thirty‐two cases of colorectal malignancy were studied between January 1975 and March 1981. The material was analyzed with respect to various epidemiologic features such as age, sex, residence, religion, socioeconomic status, diet, bowel habits, site of bowel involved, acute obstructive symptoms, and histopathology. The disease afflicted predominantly old people but at an age earlier than is reported in most western studies. Rectal cancer was more common in males, while colonic cancer involved the two sexes equally. Acute large‐bowel obstruction was found in 19.4 per cent of patients. The rectum was the most common site (41.8 per cent). Of all the colonic malignancies, 63.4 per cent were in the right colon. Simultaneously, normal gut transit studies using radiopaque markers were conducted in 30 healthy volunteers. The colonic transit rate was 3.09 cm/hour. The markers had a faster gut transit but, interestingly, exhibited pronounced stasis in the right colon, which correlates well with the significantly higher incidence of right‐sided malignancy.

ISSN:0012-3706    

出版商:OVID    

年代:1984

数据来源: OVID

ISSN:0012-3706    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

&NA;Immunoperoxidase method can be used to detect cellular or tissue CEA. Forty formalin‐fixed paraffin‐embedded specimens of colorectal carcinoma, 19 from patients who survived for five years after resection, and 21 from patients who died within five years were studied. Cellular CEA was present in 100 per cent of the specimens. Accurate quantitative evaluation of cellular CEA is currently not feasible. Therefore, the mere presence of cellular CEA has no prognostic value.

ISSN:0012-3706    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

&NA;The technique of single‐layer continuous polypropylene colorectal anastomosis is described. The authors' experience with their initial 100 cases is analyzed in detail. No clinical leaks or anastomotic strictures were noted in a two‐year follow‐up period. The technique is safe, easily learned, rapidly performed, and it does not add significantly to the cost of medical care. The authors' total experience with this anastomosis now exceeds 350 cases.

ISSN:0012-3706    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

&NA;Over a 17‐year period, all patients presenting with acute obstruction of the left colon due to carcinoma were treated by emergency tube cecostomy. There were 57 patients aged between 35 and 93 years. After the decompressive procedure, eight died, 34 had complications, and eight were left with permanent cecostomies. Forty‐one underwent secondary procedures of which 35 had resections. Seven patients died postoperatively and 15 had complications. Of the 34 survivors, in 23 the cecostomy closed spontaneously, and 11 had operative cecostomy closure. Of the latter, four died postoperatively, and nine had complications. Thus, 30 survived the entire treatment program. Reasons for the high morbidity and mortality are discussed. Comparison is made with other forms of treatment in the literature. A treatment program is suggested, using tube cecostomy for poor‐risk patients and primary resection without anastomosis for patients in better condition.

ISSN:0012-3706    

出版商:OVID    

年代:1984

数据来源: OVID

ISSN:0012-3706    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

&NA;Another method for repair of anal ectropion is reported. Two triangular island flaps, deeply based, are advanced medially to cover the excised area, thus resurfacing the anal canal with normal skin. The technique is recommended because of its simplicity, reliability, and satisfactory results.

ISSN:0012-3706    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

&NA;Colonic resections, particularly those that require mobilization of the splenic flexure, occasionally will lead to injury of the spleen. Under these circumstances, the abdominal surgeon has traditionally considered incidental splenectomy to be the only safe alternative. Currently, a better understanding of splenic physiology and its role in sepsis prevention has reversed this trend. These efforts to preserve splenic function have resulted in various options available to the surgeon, herein reviewed. The results obtained in 36 general surgical patients with splenic injuries suggest that the salvage of the spleen is a safe alternative. In situations where salvage is impossible, the surgeon can resort to omental autotransplantation of the removed spleen, a recently described technique of appealing simplicity. The results obtained with this procedure in 23 other patients are presented.

ISSN:0012-3706    

出版商:OVID    

年代:1984

数据来源: OVID