Anal sphincter function after restorative proctocolectomy has mainly been investigated by anal manometry. A significant decrease of basal pressure up to 45%, has been recorded postoperatively, possibly due to sphincter stretch during endoanal mucosectomy. Both abdominal mucosectomy and anastomosis at the level of the anorectal ring have been reported to prevent anal sphincter damage and lead to better continence. The striated sphincter is not significantly affected by the surgical procedure. Pouch-anal inhibitory reflex is partly maintained in the presence of a rectal cuff which leaves the ganglionic plexus unaltered; a satisfactory continence is also retained in the absence of the reflex when the rectum is totally excised. Pouch capacity, compliance and motility have been investigated by endoluminal balloon and probes. Pouch emptying has been studied by a "porridge" test, by a semi-solid medium labelled with technetium-99, and by other methods. A more effective storage function is achieved by large capacity reservoirs which lower the bowel frequency. The motor response to pouch distension, to a meal, and to pharmacological stimuli is usually counteracted by sphincter contraction. Ileal hypermotility may lead to fecal leakage mainly in the presence of weak sphincters. Poor pouch emptying may be related to an anal stricture.

Adolescent↗

PubMedDate not supplied

Site, emergency, and duration of symptoms in the prognosis of colorectal cancer.

Four prognostic factors, i.e., site of the tumors, mode of presentation, duration of symptoms, and pathologic staging, were correlated to the results of surgical treatment, i.e., curative resectability, postoperative complications and mortality, and five-year survival, in 161 patients operated upon for colorectal cancer. Only 31 (19 per cent) of the growths were right-sided; 71 patients (44 per cent) had symptoms less than six months. Fifty-four of them had a localized cancer; a radical procedure was performed in 114 (71 per cent), and postoperative complications occurred in 42 cases (26 per cent). The overall crude five-year survival was 38 per cent (53 of the 140 followed-up patients). The length of the clinical history did not correlate with the pathologic staging, which greatly influenced curability and survival. A statistically significant power prognosis was observed in patients with left-sided tumors, with an emergency presentation and with a duration of symptoms shorter than six months. A better prognosis can be achieved by means of a presymptomatic diagnosis.

Adult↗

PubMedDate not supplied

Pain after stapled haemorrhoidectomy.

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Hemorrhoids↗

PubMedDate not supplied

Characterization of the epitope for 4C4.1 mAb on alpha-latrotoxin using phage display-peptide libraries: prevention of toxin-dependent 45Ca(2+) uptake in non-neuronal human embryonic cells transiently expressing latrophilin.

alpha-Latrotoxin, a protein toxin present in the venom of black widow spider, interacts with membrane receptors of neurons and other secretory cells to stimulate exocytosis. Two types of receptors have been identified and cloned. Our attention has been focused on the calcium independent receptor, a G-protein coupled receptor, named latrophilin to see whether alpha-latrotoxin interaction was capable to produce an ionotropic effect, in alternative to the metabotropic hypothesis. Expression of latrophilin receptor is sufficient for the alpha-latrotoxin effect to become manifest. By inducing the transient expression of latrophilin receptor in non-neuronal human embryonic cells, we made them susceptible to toxin action as demonstrated by the increase in 45Ca(2+) accumulation detected after toxin treatment. Since the presence of a monoclonal antibody against alpha-latrotoxin (4C4.1 mAb) was able to obliterate toxin-dependent effects, we further investigated the nature of toxin-antibody interaction by characterization of the binding epitope using phage display-peptide libraries. A conformational epitope was recognized and partially localized on a region of the peptide toxin whereby a tetrameric structure is formed and inserted into the membrane of target cells where it functions as a pore.

Animals↗

PubMedDate not supplied

Manual vs stapled excision of rectal mucosal prolapse: clinical and functional results.

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Adult↗

PubMedDate not supplied

[Stapled hemorrhoidectomy: critical observation on state of art].

The authors review pros and cons of stapled hemorrhoidectomy (SH). Postoperative primary lower than after hemorrhoidectomy, but no data are available on the long term recurrences in large prospective series. Severe postoperative complications have been reported and SH seems less effective in patients with 4th degree files. SH is a useful technique, provided that proper indication are strictly followed and the procedure is carried out by specialists.

Hemorrhoids↗

PubMedDate not supplied

[Prevention of complications of surgery of diverticular disease].

Results are reported for 335 patients hospitalized for diverticular disease of the symptomatic colon: bowel movement disorders, abdominal pains and/or rectorrhagia. Of 81 patients that received operative surgery, 62 presented inflammatory stenosis or perforation. Recurrence is prevented by surgical treatment combining sigmoidectomy and exeresis of the rectosigmoid junction.

Aged↗

PubMedDate not supplied

Management of the perineal wound after rectal excision for carcinoma.

Two methods of treating the perineal wound after proctectomy are compared. One hundred and eleven patients had a Miles operation for rectal cancer: in 81 the perineal wound was left open, in 30, primary suture and suction were performed. A significant (p less than 0.001) decrease in the mean (+/- s.d.) duration of the postoperative period was observed after primary suture: 22 +/- 1.7 days, as compared with 44 +/- 2.2 days after healing by second intention. The occurrence of wound infection was similar in the two groups, whereas in 15 per cent of the patients treated without direct closure, a perineal sinus persisted. According to these data, primary closure seems to be very satisfactory in the management of the perineal wound after excision of the rectum.

Adenocarcinoma↗

PubMedDate not supplied

[The 3rd national workshop on defecography: the functional radiology of (neo) rectal ampullae (ileal reservoir, colo-anal anastomosis, continent perineal colostomy)].

A survey was made in 13 Italian centers with a questionnaire concerning the (a) indications, (b) postoperative complications, (c) functional results and (d) diagnostic imaging modalities related to the making of an ileal or colonic (neo) rectum. Ulcerative colitis (100%), familial polyposis (61.5%) and Crohn's disease (15.3%) were the most common indications for an ileal pouch; rectal cancer (7.96%), chronic inflammatory diseases (15.3%), diverticulosis, rectal prolapse, redundant colon and imperforate anus (7.6% each) were the most common indications for a colonic pouch. Postoperative complications included pelvic abscess (14%), sinus tract/dehiscence (10%) and bowel obstruction (9%). When compared with the S and W variants, the J-shaped ileoanal pouch proved superior because urgency and fecal retention rates were lower (18.4% vs. 44.4% and 23% vs. 28.6%, p < 0.01 and p < 0.05, respectively), despite slightly more frequent staining episodes (15.8% vs. 11.1%; p < 0.05). As for colonic ampullae, fecal retention and provoked evacuation were more frequent in the J pouch and after gracileplasty; urgency and incontinence in the straight colo-anal anastomosis (33.3% vs. 22.2% and 41.6% vs. 33.3%, respectively). The functional outcome was assessed by anal endosonography (available in 4/13 centers), defecography and anorectal manometry. Abnormal findings included: (a) reduced capacity, barium leakage, anal gaping, sphincter damage (urgency and incontinence); (b) barium retention, pouch dilatation, split evacuation, knobs and strictures (fecal retention).

Defecation↗

PubMedDate not supplied

[Closed hemorrhoidectomy].

In the closed hemorrhoidectomy wounds are completely sutured. Ferguson and Whitehead operations, the latter modified in order to avoid mucosal ectropion and stenosis, are the most performed closed hemorrhoidectomies. 15% Ferguson operations, 10% Whitehead-Rand operations, and 75% Milligan and Morgan operation were performed among 400 hemorrhoidectomies. Author discusses indications for closed hemorrhoidectomy; techniques are described, complications and results reported.

Hemorrhoids↗