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Biomedical subjects

M C Marti

Publications and source records attributed to M C Marti.

At least 37 records · Page 2Linked to original sources
PubMed1994

Results of sphincter repair in postobstetric fecal incontinence.

BACKGROUND: Postobstetric fecal incontinence is a rare and severe complications of vaginal delivery. Most often, it is the result of a tear of the anal sphincter, pudendal neuropathy, or a combination of the two. STUDY DESIGN: Thirty-six patients operated upon at our institution for postobstetric fecal incontinence during a ten year period (1983 to 1992) were questioned (score) and examined to assess the operative results. RESULTS: Preoperatively, all 36 patients (mean age of 37 years, range of 24 to 70 years) had sphincter tears and 32 patients were totally incontinent (score of 16 to 18). Three patients were moderately incontinent (score of 9) and one patient was incontinent of flatus only (score of 3). Eighty percent of the patients were referred with delay. Thirty-six sphincteroplasties with various degrees of rectovaginal and perianal reconstructions were performed. Twenty-eight women (78 percent) are continent (score of zero to 3), seven patients (19 percent) are partially incontinent (score of 4 to 6), and one patient (3 percent) is totally incontinent (score of 18). There was no mortality. Among the six postoperative complications, there were two sphincter breakdowns with persistent incontinence and four minor local complications. CONCLUSIONS: Careful assessment and operative management of sphincter damage at the time of delivery as well as counseling of all women at risk for fecal incontinence are essential. Sphincteroplasty is a simple and safe procedure that offers symptomatic relief in almost all patients with sphincter lesions and cure in 80 percent.

Adult↗
PubMed1993

Chemoradiotherapy versus radiotherapy alone for anal cancer: a retrospective comparison.

PURPOSE: To evaluate the effect of adding one cycle of concomitant chemotherapy to curative radiotherapy on tumor control and toxicity in the treatment of anal cancer. METHODS AND MATERIALS: One hundred twenty-five patients completed curative sphincter-conserving treatment, 57 with radiotherapy alone and 68 with concomitant chemo-radiotherapy. Compared with chemoradiotherapy patients, radiotherapy patients were older (median age 71 vs 63) and had less advanced tumors (T3-4 26% vs 51%). Radiotherapy patients were usually treated with a direct perineal cobalt field (mean dose 31 Gy at 5 cm/10 fractions/3 weeks), complemented in most cases by a sacral are field, followed (mean split 54 days) by Iridium-192 implantation (mean dose 23 Gy, Paris system). The large majority of chemoradiotherapy patients received antero-posterior opposed 10 MV photon fields, including pelvic and inguinal nodes (mean dose 38 Gy/19 fractions/4 weeks), followed (mean split 42 days) by implant boost (mean dose 18 Gy). In addition, chemo-radiotherapy patients received starting on day 1 an IV bolus of Mitomycin-C, 0.4 mg/kg (maximum 20 mg) and a 5-day continuous infusion of 5-fluorouracil 600-800 mg/m2/day. Median follow-up was 65 months for radiotherapy and 48 months for chemo-radiotherapy patients. RESULTS: For all 125 patients at 5 years, overall survival was 65.5%, definitive local control 83% and local control with sphincter preservation 68%. Overall and stage for stage, there was no difference in overall, progression-free or cancer-specific survival, nor in local control, local-regional control, or sphincter preservation rates between patients treated with chemoradiotherapy vs. radiotherapy alone. There was no significant difference between the two groups regarding acute or late toxicity. CONCLUSION: This retrospective analysis does not confirm the efficacy of one course of simultaneous Mitomycin-C and 5-fluorouracil, at least in association with full-dose radiotherapy incorporating Iridium-192 boost.

Adult↗
PubMed1993

[Multiple tumors of colon and rectum].

The possible occurrence of multiple synchronous or metachronous malignant lesions in patients with carcinoma of the colon and rectum is a well known event. In this population-based study in the Geneva area from 1970 to 1986, the frequency of synchronous colorectal carcinomas was 1.1% and that of metachronous carcinomas 1%. The relative risk of metachronous colorectal carcinoma is higher than in the general population (colon after rectum 1.2, colon after colon 1.7 and rectum after rectum 1.4). A high association of adenomatous polyps with multiple colorectal carcinoma was observed. The 5-year actuarial survival in case of curative resection was 87% for metachronous carcinomas, 35% for single carcinomas and 33% for synchronous carcinomas. We conclude that complete preoperative colonoscopy, whenever possible, should be performed to screen patients with synchronous carcinomas. Finally, a lifelong follow-up of the residual colon or rectum should be planned to detect metachronous lesions.

Actuarial Analysis↗
PubMed1993

[The swiss experience of ileo-anal anastomosis with reservoir (AIA). Complications and functional results].

Two hundred and thirteen ileal pouch-anal anastomoses were performed in Switzerland from August 1980 to December 1991, 174 (82%) of them in 7 centres. One hundred and sixty four patients (77%) were operated for ulcerative colitis, 47 (22%) for familial polyposis and 2 others (1%) for another reason. A J pouch was created in 176 cases (83%), an S pouch in 35 cases (16%) and a W pouch in 2 cases (1%). Detailed results were available for 157 (74%) of the 213 operated patients: 81 females (52%) and 76 males (48%) with a mean age of 33.5 years (10-65). One hundred and twenty seven patients (81%) were operated for ulcerative colitis, including 42 as an emergency, and 30 (19%) for familial polyposis. One hundred patients (64%) developed complications which required one or several reoperations (laparotomy and/or perineal operation) in 64 cases (41%). Pouchitis was the most frequent complication (19%). Small bowel obstruction and pelvic abscess secondary to an anastomotic leak were the complications most frequently requiring second laparotomy with an incidence of 13% and 11%, respectively. The mean number of stools per 24 hours was 5.5 (2 to 14). 27% of patients passed one or several nocturnal stools every night, 27% occasionally, and 46% never. Occasional faecal incontinence was reported by 8 patients (6%) and 4 patients (3%) reported uncontrollable urgency. Nine patients retained a permanent ileostomy (failure rate: 6%).

Adenomatous Polyposis Coli↗
PubMed1993

[Loco-regional anesthesia in proctological surgery].

Among the various techniques of anaesthesia, local anaesthesia, posterior perineal block and caudal block allow most of the surgical procedures involving the anal canal to be performed. Practical modalities of the various techniques, choice of drugs and selection of the various indications are reported.

Anesthesia, Caudal↗
PubMed1993

[Multiple tumors of the colon and rectum].

The possible occurrence of multiple synchronous or metachronous malignant lesions in patients with a carcinoma of the colon and rectum is a well known event. In this population-based study in the Geneva area from 1970 to 1986, the frequency of synchronous colorectal carcinomas was of 1.1% and that of metachronous carcinomas of 1%. The relative risk of metachronous colorectal carcinoma is higher than in the general population (colon after rectum 1.2, colon after colon 1.7 and rectum after rectum 1.4). A high association of adenomatous polyps with multiple colorectal carcinomas was observed. The 5-year actuarial survival in case of curative resection was of 87% for metachronous carcinomas, 35% for single carcinomas and 33% for synchronous carcinomas. We conclude that complete preoperative colonoscopy, whenever possible, should be performed to screen patients with synchronous carcinomas. Finally, a lifelong follow-up of the residual colon or rectum should be planned to detect metachronous lesions.

Aged↗
PubMed1992

[Epidermoid cancers of the anal canal].

The frequency of anal epidermoid carcinoma is constantly increasing. Despite the fact that such cancers are easily detectable through rectal examination, anuscopy or biopsy, diagnosis is delayed in 30 to 50% of the cases due to late and unspecific clinical features, often mistaken for benign lesions. Prognosis of anal epidermoid carcinoma has radically improved due to a better knowledge of the tumour's natural history and of its spreading, to new stage classification (UICC-TNM) and to association fo external or interstitial radiotherapy with chemotherapy. Recovery rates of 80% can be achieved nowadays, 75% of which being obtained with complete sphincter preservation. Subsequent actinic lesions are rare. Surgery is now essentially proposed in these cases of therapeutic failure and consists in a rectal excision. Treatment of such tumours requires a multidisciplinary approach and a close collaboration between surgeon, radiotherapist and oncologist.

Adult↗
PubMed1992

[Ambulatory proctologic surgery].

An increasing number of proctological procedures may be performed on outpatients under extensive local anesthesia or by posterior perineal bloc. Precise selection criteria should be observed. Results of 1233 outpatients procedures are reported.

Adolescent↗
PubMed1992

[Mucosal flaps in the treatment of anal fistula].

Results in the treatment of transsphincteric et suprasphincteric fistulae have been greatly improved with the use of mucosal sliding flaps. The aims of this surgical procedure are: division of the fistulous tract from the primary opening within the anal canal, closure of the primary opening to prevent any repermeabilisation of the tract, excision and curettage of fistulous tract without section of the sphincters. Technical details of this procedure and results achieved in the treatment of 30 consecutive cases are reported.

Adult↗
PubMed1992

[Mucosal flap in the treatment of anal fistula].

A technique of sliding flap repair for the treatment of anal fistulae is described. This technique may prevent sphincter damage. Fifty-five consecutive fistulae have been treated: 23 transsphincteric, 26 intersphincteric, 3 suprasphincteric and 3 rectovaginal fistulae. The fistulous tract is excised and cored out. The intersphincteric space is opened: any gland or inflammatory tissue is removed. The internal opening is excised. The gaps in the internal, as well as in the external, sphincter are closed. The endo-anal wound is closed, using a sliding flap of anorectal mucosa. The ischiorectal wound is left open. Healing has been achieved in every case but one within three weeks, without sphincteric functional defect. Only 3 recurrences have been observed in a mean follow-up of 24 months.

Adult↗
PubMed1991

[Ambulatory proctologic surgery].

Outpatient surgical proctology is nowadays more and more frequently performed. Between 1986 and 1989, 65% of 1149 anal surgical procedures were performed in our institution on an outpatient basis. The various criteria used to select patients fit for ambulatory surgery seemed adequate, as no complications were observed and no patient required secondary hospitalization.

Ambulatory Surgical Procedures↗
PubMed1990

[The past and future of proctology].

Since antiquity, surgical treatments of anorectal lesions were performed by barbers and surgeons; proctology became with time a surgical speciality well defined and recognized todays. History of proctology is illustrated by some important figures and events: St. Fiacre, Felix the surgeon who operated on King Louis XIV's fistula and the acutely thrombosed hemorrhoidal prolapse of Napoleon.

Colorectal Surgery↗
PubMed1990

[Incontinence and supra-continence as complications of anorectal surgery].

Incontinence and supra-continence may complicate various ano-rectal surgical procedures. These troubles result from modifications of the ano-rectal angulation, troubles of rectal sensitivity and neurological pathways, direct or functional sphincter damage and modification of the reservoir function of the rectum. These various disorders should be prevented by careful surgery. If they occur, detailed investigations should help to choose the best therapy: medical and bio-feedback treatment or surgical correction.

Anal Canal↗