Biomedical subjects

David A Rothenberger

Publications and source records attributed to David A Rothenberger.

23 records · Page 2Linked to original sources

PubMed2003

Artificial bowel sphincter: long-term experience at a single institution.

PURPOSE: This study was undertaken to evaluate a single-institution experience with the Acticon artificial bowel sphincter for the treatment of intractable fecal incontinence. METHODS: At the University of Minnesota, 45 consecutive patients underwent artificial bowel sphincter placement (Group I, 1989-1992, n = 10; Group II, 1997-2001, n = 35). Group I was reviewed retrospectively and Group II prospectively. RESULTS: The outcome for Group I patients was initially reported in 1995 (mean age, 32; range, 15-52 years; 7 males). Of these 10 patients, 4 required explantation (2 required stomas), and 6 have a functional artificial bowel sphincter; 2 patients had devices successfully replaced for fluid leaks (at 6 and 10 years). In Group II, artificial bowel sphincter placement was attempted in 37 patients and was successful in 35 (mean age, 47; range, 18-72 years; 11 males). A total of 14 patients required explantation, 12 (34 percent) for infection and 2 (6 percent) for pain. In total, 13 patients have required 21 revisions, including 7 complete device replacements. The infection rate for revisions was 19 percent; four patients required explantation after revisions. Of 18 patients whose artificial bowel sphincter failed, 9 required a stoma. In all, 17 (49 percent) patients have a functional artificial bowel sphincter. In Group II fecal incontinence severity scores decreased from a mean of 103 preimplant to 59 at one year and to 23 at two or more years (P < 0.001) in patients who retained their devices. Quality of life scores improved in all patients at six months and at one year (P < 0.01). CONCLUSION: Artificial bowel sphincter therapy leads to long-term improved continence and quality of life in patients whose implantation is successful. Success rates have not improved in the two patient groups, with infection remaining a major challenge. However, once successfully established, artificial bowel sphincter function remains stable for many years.

Adolescent↗

PubMed2002

Promoting early detection tests for colorectal carcinoma and adenomatous polyps: a framework for action: the strategic plan of the National Colorectal Cancer Roundtable.

BACKGROUND: The purpose of the current study was to provide health professionals, professional organizations, policy makers, and the general public with a practical blueprint for increasing the practice of screening for colorectal carcinoma (CRC) and adenomatous polyps over the next decade. The National Colorectal Cancer Roundtable (NCCRT) was founded in 1997 by the American Cancer Society and the Centers for Disease Control and Prevention to provide strategic leadership, advocacy, long-range planning, and coordination of interventions targeted at reducing the disease burden of CRC through education, early detection, and prevention. The NCCRT and its three workgroups include CRC survivors; recognized experts in primary care, gastroenterology, radiology, colorectal surgery, nursing, public policy, epidemiology, and behavioral science; patient advocates; and representatives of health plans and insurers, government, and other organizations. METHODS: The NCCRT performed a literature review of published and unpublished data related to CRC screening guidelines, compliance, and barriers to adherence, as well as test effectiveness and cost-effectiveness. Members of the three NCCRT workgroups developed summary reports regarding professional education, public education and awareness, and health policy. A drafting committee developed the final strategic plan from workgroup reports, which was reviewed by the entire NCCRT membership, amended, and subsequently approved in final form. RESULTS AND CONCLUSIONS: Although the rationale for population-wide CRC screening is well established, the majority of adults in the U.S. are not currently being screened for CRC. Thus, the nation foregoes an opportunity to reduce CRC-related mortality by an estimated >or= 50%. To increase CRC screening rates, the issues of patient and physician barriers to screening, lack of universal coverage, lack of incentives to motivate adherence, and expanded infrastructure must be addressed.

Adenomatous Polyps↗

PubMed2002

Accuracy of endorectal ultrasonography in preoperative staging of rectal tumors.

PURPOSE: Preoperative staging of rectal tumors is considered essential to tailor treatment for individual patients. The aim of the present study was to evaluate the accuracy of endorectal ultrasonography in preoperative staging of rectal tumors. METHODS: Eleven hundred eighty-four patients with rectal adenocarcinoma or villous adenoma underwent endorectal ultrasonography evaluation at a single institution during a ten-year period. We compared the endorectal ultrasonography staging with the pathology findings based on the surgical specimens in 545 patients who had surgery (307 by transanal excision, 238 by radical proctectomy) without adjuvant preoperative chemoradiation. Comparisons between groups were performed using chi-squared tests and logistic regression analysis. RESULTS: Overall accuracy in assessing the level of rectal wall invasion was 69 percent, with 18 percent of the tumors overstaged and 13 percent understaged. Accuracy depended on the tumor stage and on the ultrasonographer. Overall accuracy in assessing nodal involvement in the 238 patients treated with radical surgery was 64 percent, with 25 percent overstaged and 11 percent understaged. CONCLUSION: The accuracy of endorectal ultrasonography in assessing the depth of tumor invasion, particularly for early cancers, is lower than previously reported. The technique is more precise in distinguishing between benign tumors and invasive cancers and between tumors localized to the rectal wall and tumors with transmural invasion. Differences in image interpretation may in part explain discrepancies in accuracy between studies.

Adenocarcinoma↗

PubMed2002

Salvage radical surgery after failed local excision for early rectal cancer.

OBJECTIVES: Local recurrence after transanal excision of rectal cancer is often amenable to salvage radical proctectomy, but the long-term results remain unknown. This study was designed to determine the outcome of salvage radical surgery after failed local excision in patients with early rectal cancer. METHODS: We retrospectively reviewed the charts of 29 patients who underwent salvage radical surgery for local recurrence after a full-thickness transanal excision for Stage I rectal cancer. End points included local and distant recurrences and disease-free survival after salvage radical surgery. Comparisons between groups were performed by chi-squared test. RESULTS: Recurrence involved the rectal wall in 26 patients (90 percent) and was purely extrarectal in only 3 (10 percent). Mean time between local excision and radical operation was 26 months. The resection was considered curative in 23 patients (79 percent). The stage of the recurrent tumor was more advanced than the primary tumor in 27 patients (93 percent). At a mean follow-up of 39 (range, 2-147) months after radical surgery, 17 patients (59 percent) remained free of disease. The disease-free survival rate was 68 percent for patients with tumors with favorable histology vs. 29 percent for patients with tumors with unfavorable histology. CONCLUSION: Salvage surgery for recurrence after local excision of rectal cancers may not provide results equivalent to those of initial radical treatment. In the present study the poor results of salvage surgery emphasize the importance of appropriate selection of the initial treatment of Stage I rectal cancer.

Adult↗

PubMedDate not supplied

Palliative therapy of rectal cancer. Overview: epidemiology, indications, goals, extent, and nature of work-up.

Each year in the United States, it is estimated that there will be 42,000 new cases of rectal cancer and 8,500 deaths.(1,2) Some patients present with an incurable rectal cancer but more often death follows development of recurrent rectal cancer after failed curative-intent therapy. Knowledge of the natural history of rectal cancer and limitations of treatment options coupled with sound clinical judgment and compassion are essential prerequisites for the clinician providing palliative care.

Humans↗