Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Proctoscopy”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 199 records · Page 11Linked to original sources
PubMed2003

Profiles and time course of acute radiation toxicity symptoms during conformal radiotherapy for cancer of the prostate.

Symptoms of gastrointestinal toxicity are dose-limiting for pelvic radiotherapy (RT). Existing toxicity registrations (RTOG/EORTC) are helpful in defining maximal tolerated doses, but tend to underestimate the total toxicity burden by excluding several minor complaints. We have applied a more detailed and quantitative recording of symptoms and related these scores to RT-induced endoscopic and histopathologic changes. Prevalence and severity of specific toxicity symptoms were recorded before, during (weeks 2 and 6) and 2 and 8 weeks after RT in 96 patients undergoing external beam RT for localized prostate cancer. RTOG/EORTC acute toxicity and ad hoc total toxicity scores (TTS) were recorded. TTS scores were calculated by adding scores based on visual analog scale (VAS) grading of individual symptoms Fifty of the patients also underwent sequential proctoscopy with mucosal biopsy. Individual symptoms increased, but differed in prevalence and intensity during and after RT TTS increased during the entire treatment course in spite of normalizing histopathologic and endoscopic changes from week 2 onwards. Twenty-seven patients had no RTOG/EORTC toxicity, four had grade 3 and none had grade 4 toxicity. All patients with grade 0 had increased TTS. Thus, TTS appeared more sensitive than RTOG/EORTC scoring. The study demonstrates that multiple toxicity symptoms contribute to total toxicity in response to pelvic RT. TTS is a feasible and sensitive method for detecting and quantifying acute toxicity and unveils morbidity which remains hidden with the RTOG/EORTC score system. The development and timing of symptoms may give clues to pathogenesis, treatment, and prophylaxis.

Aged↗
PubMed1990

The presidential effect: the public health response to media coverage about Ronald Reagan's colon cancer episode.

Little previous research has been done on the public health impact of mass media coverage of cancer episodes of public figures. This paper uses a variety of data sources to examine the impact of President Reagan's colon cancer episode of July, 1985. Records of phone calls to the Cancer Information Service of the National Cancer Institute are examined as a measure of public interest and concern about colorectal cancer; data on the use of two colorectal early detection tests--proctoscopy and fecal occult blood tests--are looked at as a measure of behavioral change; and data on the incidence of early and advanced colorectal cancer are used to estimate the potential public health impact of this behavioral change. We find that there was a sharp, albeit somewhat transitory, increase in public interest in colorectal cancer in the wake of President Reagan's colon cancer episode, with a corresponding increase in the use of early detection tests. The incidence data on early and advanced disease is indicative of a beneficial public health impact, but this can be confirmed only after additional data on mortality becomes available.

Attitude to Health↗
PubMed1998

Disease stage prognostic indices in the early clinical screening of colorectal cancer patients.

It is a truism to state that in cancer the extent to which the disease has spread (stage) is probably the most important factor determining patient prognosis and must be given prime consideration in evaluating and comparing different therapeutic regimes. Because of this, clinical screening tests (such as a rectal exam proctoscopy and colonoscopy), if tissue that is not normal is found, should include analyses contributing to the patient disease stage classification. However, the difficulty involved in this, principally due to the absence of reliable early prognostic indices of the disease stage, makes the cancer patients' treatment full of problems and risks. By a retrospective statistical study on pre-surgery peripheral blood immunological parameters of our groups of colorectal cancer patients and healthy subjects, we evaluated our previously suggested possibility of defining stage prognostic indices by parameter blood range values, evaluating their ability in the stage classification compared to the pTNM method. We have investigated the serum levels of various cytokines and cytokine receptors, leukocyte surface markers, peripheral blood mononuclear cell (PBMC) cytokine production and PBMC proliferative response. Statistically significant correlations between a variety of these immunological parameters and the disease stage were found, but as a clinical patient screening of all parameters is quite expensive, to identify the greatest stage weighting parameter and the respective blood range values, we performed a multivariate statistical analysis. We found that the blood ranges of IL-4 serum level and the PBMC proliferative response to anti-CD3 monoclonal antibody (mCD3) stimulus may be reliable prognostic indices which may contribute to an early disease stage classification in colorectal cancer patients, since they seem to be valid as the pTNM method. Moreover, as the immunological prognostic indices could be a useful tool to evaluate the patient immune response, they may also improve the definition of the patient's stage classification for the selection of treatment and restaging procedures for the evaluation of the treatment benefit and recurrent disease.

Adult↗
PubMed2001

Fistula between a total hip arthroplasty and the rectum: a case report.

An 81-year-old man was referred to the authors for examination of the gastrointestinal tract. A proctoscopy revealed a draining sinus tract in the terminal rectum. Plain radiographs revealed a failed total hip arthroplasty that had migrated into the pelvis. Hip aspiration revealed an infection with bacteria commonly found in the gastrointestinal tract. A fistulogram confirmed a connection between the rectum and the hip replacement. The development of a fistula between the colon and the hip is extremely uncommon. A fistula between the hip and the rectum is a previously unreported complication of total hip arthroplasty.

Arthroplasty, Replacement, Hip↗
PubMed1988

A new concept of the anatomy of the anal sphincter mechanism and the physiology of defecation. XXXI. "Strainodynia": an etiopathologic study.

"Strainodynia" is the name I give to the excessive and exhaustive straining that may accompany defecation. Eighty-six patients with strainodynia were studied; the investigations comprised study of the stool character, proctoscopy, colonoscopy, barium enema, intestinal transit rate, EMG, manometry, and rectal biopsy. These patients were classified into 3 groups: band, diet, and levator strainodynia. The first, band strainodynia, more common in men, presented with a normal stool character. However, the rectal neck pressure was elevated, and a fibrous band could be demonstrated by a rectal neck biopsy. Bandotomy relieved the strainodynia. Diet strainodynia, more common in women, presented with stool frequency and weight less than normal. Rectal neck pressure was normal or elevated, and the rectosphincteric reflex was diminished. There was internal sphincter fibrosis. Improvement occurred after dietary management or internal sphincterotomy. Levator strainodynia was due to levator dysfunction syndrome. Stools were repeatedly obstructed at defecation despite normal stool character. Rectal neck pressure was elevated only on straining. There was reduced levator myoelectric activity. Levatorplasty cured the condition.

Adolescent↗
PubMed1989

Management of transpelvic gunshot wounds.

The records of 98 patients with transpelvic gunshot wounds from 1983 to 1988 were reviewed: 22 patients were admitted in shock and required aggressive resuscitation and immediate exploration, and 76 patients were normotensive and were evaluated with diagnostic peritoneal lavage, angiography, cystography, proctoscopy, CT scan, and contrast-enhanced CT enema in various combinations as indicated. Using this approach, 40 stable patients were observed without operation and discharged without complications. Fifty-eight patients were explored: 20 had both arterial and hollow viscus injuries. Thirty-nine major vascular injuries were evaluated: 27 were ligated and 12 repaired. Other injuries were colon, 27; including seven rectal perforations, multiple small bowel perforations, five bladder, one ovarian, four ureteral, three caval, three renal, and two distal aortic injuries. Colon injuries associated with vascular injuries were treated with colostomy and ligation of the vessel with extra-anatomic bypass when revascularization was required. Overall 12 patients died as a result of their injuries, a mortality of 12.2%. However, 50% of the patients who were admitted in shock died. Two external iliac artery injuries and two ureteral injuries were missed at initial operation. Penetrating trauma to the pelvis presents a serious challenge because of the complex anatomy of the region. Patients in shock have a high incidence of vascular injury and subsequent exsanguination, and associated visceral injuries may complicate their management. However, stable patients may be managed without operation, when appropriate diagnostic techniques fail to demonstrate an injury. Arterial ligation and extra-anatomic bypass should be considered for vascular injury with gross fecal contamination.

Adolescent↗
PubMed1994

Limited role of barium enema examination preceding colostomy closure in trauma patients.

Whether trauma patients should undergo barium enema (BE) examination of the colon prior to colostomy closure has recently been questioned. To ascertain the utility of BE and its impact on postoperative course in this patient population, we reviewed 86 trauma patients who underwent colostomy closure during a 12-year period at our institution. There were 82 males and four females with an average age of 28 years. Ninety-five percent of the injuries were the result of penetrating trauma. Sixteen patients had rectal injuries. Fifteen of these had BE greater than 6 weeks post-trauma and all showed healing of the injury. Of the 70 patients with colonic injuries, 43 (group 1) had BE prior to colostomy closure. Ninety-eight percent (n = 42) of these studies were negative. The only positive finding did not affect the planned surgical procedure. Group 2 (n = 27) did not have a BE prior to colostomy closure. Overall complication rates were not significantly different between group 1 (18.6%) and group 2 (29.6%). We conclude that BE prior to colostomy closure for colonic injuries yields little useful information and does not affect the morbidity rate prior to colostomy closure. Its routine usage should be abandoned. The role of barium enema in assessing rectal injury status is less clear because of the small number in our series, but probably offers no advantage over proctoscopy.

Adolescent↗
PubMed1998

The role of presacral drainage in the management of penetrating rectal injuries.

PURPOSE: To compare in a randomized, prospective manner infectious complication rates associated with presacral drainage versus no drainage in the presence of penetrating rectal injury. METHODS: During a 45-month period, 48 patients with penetrating rectal injuries were entered into a randomized, prospective study at an urban Level I trauma center. The patients were randomized to a presacral drainage group or a nondrainage group. Randomization was performed after detection of the rectal injury. Forty-four injuries were identified by proctoscopy (92%), with the rest detected intraoperatively or by physical examination. All patients with rectal injuries were included regardless of age, associated injuries, time from injury to operation, blood loss, severity of rectal injury, other abdominal organs injured, or hemodynamic stability. Rectal injuries were defined as those injuries to the large bowel distal to the peritoneal reflection. All rectal injuries underwent fecal diversion, and all drainage was accomplished using closed Jackson-Pratt drainage. RESULTS: Forty-eight patients were studied, of whom 25 were randomized to no drainage and 23 were randomized to presacral drainage. The average age for the nondrainage group was 21.9 years, and the average age for the presacral drainage group 26.0 years. The average Penetrating Abdominal Trauma Index score was 34.3 for the nondrainage group and 32.4 for the presacral drainage group. There were two (8%) septic complications (one perirectal and one perivesical abscess) associated with the rectal injuries in the presacral drainage group. The abscesses in the drainage group resolved after computed tomography-guided drainage. There was one (4%) septic complication (rectocutaneous fistula) in the nondrainage group, which was associated with a retained missile fragment. The fistula resolved after bedside percutaneous removal of the missile fragment. CONCLUSION: We conclude that presacral drainage for penetrating rectal injuries has no effect on infectious complications associated with the rectal injuries.

Adolescent↗
PubMed1987

Prolonged rectal bleeding associated with hemorrhoids: the diagnostic contribution of colonoscopy.

We studied 387 patients with prolonged rectal bleeding and hemorrhoids (grades 2 and 3) routinely examined by anoscopy, proctoscopy, single contrast barium enema, and hemoglobin measurements. Normal results were obtained in 86 patients above the age of 40. Total colonoscopy in these patients revealed one patient (1.2%) with cancer, 19 (22.1%) with colorectal polyps, and one (1.2%) with angiodysplasia. These findings indicate that in patients above age 40, a full investigation of the large bowel should be done in every case of prolonged rectal bleeding despite the presence of substantial hemorrhoids. Double contrast barium enema or colonoscopy must be used, rather than single contrast barium enema, which proved to be an inaccurate method of investigating prolonged rectal bleeding.

Barium Sulfate↗
PubMed1990

Sigmoid volvulus in childhood.

Although it is common in the adult population, sigmoid volvulus is unusual in childhood. We report the cases of four children treated for sigmoid volvulus, and we review an additional 44 cases. The mean age of occurrence was 8 years. Predisposing factors were present in 33%. Abdominal pain (66%), vomiting (31%), and obstipation (10%) were the most common symptoms. Abdominal findings included distention (69%), tenderness (41%), and a mass (10%). The classic roentgenographic omega sign of volvulus was present on plain films in only 29% of the cases. Barium enema examination was diagnostic in 61% of the cases in which it was used. Nonoperative treatment by barium enema or proctoscopy was successful in all 17 cases in which it was attempted. The recurrence rate after nonoperative treatment was 31%. Thirty children had operation. The mortality in the group of patients having "derotation" alone was 29%. Immediate resection was associated with a 25% mortality; none of the patients who had elective resection died. Sigmoid resection is the definitive treatment for children as well as adults, but nonoperative decompression to allow for elective resection should be attempted in patients who have no evidence of peritonitis.

Adult↗
PubMed1995

Sunflower seed bezoar leading to fecal impaction.

We report the cases of two children, ages 8 and 10 years, with painful defecation and constipation due to impaction of sunflower seed shells that did not respond to laxative and enema therapy. Physical examination revealed a prickly mass in the rectal vault. Proctoscopy revealed bezoars of sunflower seed shells, which were removed by endoscopic biopsy forceps followed by a combination of rectal irrigation and manual disimpaction. The rectal pain resolved, and bowel habits returned to normal with laxatives. Patients with rectal bezoars who fail to respond to enemas or colonic lavage may require endoscopic management for resolution of their symptoms.

Bezoars↗
PubMed1999

Sources of health insurance in the U.S.: analysis of state-level data and implications for public health programs.

Lack of health insurance coverage is associated with lack of accessibility to preventive health care services such as mammography screening, clinical breast examination, Papanicolaou smear test, digital rectal examination, proctoscopy examination, and cholesterol screening. State and federal public health agencies must have an understanding of insurance coverage of the population to plan intervention programs aimed at early detection of medical conditions. Using data from the March Supplement of the Current Population Survey for the years 1994, 1995, and 1996, this study examines the sources of health insurance coverage in the U.S. The implications of the findings for public health programs are discussed.

Adult↗
PubMed1995

Fissure in ano.

The present study documents a 15 year experience with anal dilatation in patients with fissure in ano. Patients who were unable to tolerate rectal examination were admitted urgently for anal dilatation. Patients in whom rectal examination and proctoscopy was possible were offered an anal dilator and were reviewed after 4 weeks. Patients who preferred not to use an anal dilator or who had not become asymptomatic were admitted for elective anal dilatation. Four finger anal dilatation was performed under general anaesthesia. Between 1975 and 1990 104 patients underwent 111 procedures. The male to female ratio was 1.3:1. Five patients were re-operated because of failure of resolution of symptoms. Three patients with anal fissures and Crohn's disease were successfully managed by anal dilatation. Nine patients had excision of a 'sentinel pile' in addition to anal dilatation. Ten patients were admitted acutely. One patient developed a perineal haematoma. Seventy-four procedures were performed as day cases. There was no mortality associated with the procedure. At the time of discharge from the clinic no patient complained of problems with continence. These results support our policy of gentle anal dilatation as first management choice in the treatment of anal fissure.

Adult↗
PubMed2006

The rectal pocket syndrome after stapled mucosectomy.

OBJECTIVE: Stapled rectal mucosectomy (SM) is less painful than manual haemorrhoidectomy but may be followed by unusual complications which may require reinterventions. The aim of the present study was to report on a particular postoperative complication, the rectal pocket syndrome (RPS). METHODS: Six patients, four females and two males, five with severe proctalgia and signs of intermittent sepsis and one with faecal soiling following SM, underwent clinical examination, proctoscopy (n = 5) anal manometry and ultrasound (n = 4) revealing a painful rectal intramucosal pocket with an endoluminal orifice at the level of the suture line. Four of them underwent a reintervention. RESULTS: At surgery, a faecolyth was found to be entrapped in the rectal pocket with an underlying chronic abscess in four patients. The cavity was laid open and curetted in all cases. One of the females needed a fistulotomy of a low intersphincteric track after one year. In none of the others did endorectal pocketing and abscess or prostatitis recur after a mean follow up of 25 months (range 2-60 months). The male patient still had moderate postevacuation pain and prostatitis possibly via a bacterial translocation after two months. Overall, the incidence of the post mucosectomy RPS at our Units was 2.5%. CONCLUSIONS: The RPS can occur after SM, is likely to be due to a failure of either the purse-string or of the staples causing a suture defect leading to an intramural sinus, and may be successfully treated by a transanal lay-open in most cases.

Abscess↗
PubMed2006

A prospective evaluation of occult disorders in obstructed defecation using the 'iceberg diagram'.

OBJECTIVE: Surgical treatment of constipation and obstructed defecation (OD) carries frequent recurrences, as OD is an 'iceberg syndrome' characterized by 'underwater rocks' or occult diseases which may affect the outcome of surgery. The aim of this study was to evaluate occult disorders in order to alert the clinician of these and minimize failures. METHOD: One hundred consecutive constipated patients with OD symptoms, 81 female patients, median age 52 years, underwent perineal examination, proctoscopy, anorectal manometry, and anal/vaginal ultrasound. Anorectal physiology and imaging tests were also carried out when indicated, as well as psychological and urogynaecological consultation. Symptoms were graded using a modified 1-20 constipation score. Both evident (e.g. rectocele) and occult (e.g. anismus) diseases were prospectively evaluated using a novel 'iceberg diagram'. The type of treatment, whether conservative or surgical, was also recorded. RESULTS: Fifty-four (54%) patients had both mucosal prolapse and rectocele. All patients had at least two occult OD-related diseases, 66 patients had at least three: anxiety-depression, anismus and rectal hyposensation were the most frequent (66%, 44% and 33% respectively). The median constipation score was 11 (range 2-20), the median number of 'occult disorders' was 5 (range 2-8). Conservative treatment was carried out in most patients. Surgery was carried out in 14 (14%) patients. CONCLUSION: The novel 'iceberg diagram' allowed the adequate evaluation of OD-related occult diseases and better selection of patients for treatment. Most were managed conservatively, and only a minority were treated by surgery.

Adult↗
PubMed2001

Prevalence of cytomegalovirus infection in severe refractory ulcerative and Crohn's colitis.

OBJECTIVES: Cytomegalovirus infection has been reported as a cause of refractory inflammatory bowel disease, but no data are available on its prevalence in severe colitis. The aim of this study was to evaluate the prevalence and outcome of cytomegalovirus infection in a consecutive series of patients with severe steroid refractory colitis admitted to our department from 1997 to 1999. METHODS: Among 62 patients with severe colitis, 55 with ulcerative colitis and seven with Crohn's disease, 19 (30%) were resistant to intravenous steroids and bowel rest. In all of them, rectal biopsies were examined for cytomegalovirus (the flexible proctoscopy being performed without air insufflation and limited to the first 10 cm). Buffy coat preparation on leukocytes was also performed to detect systemic infection. If cytomegalovirus was not detected, cyclosporine was started. RESULTS: In seven (five with ulcerative colitis and two with Crohn's disease) out of 19 (36%) patients with refractory disease, cytomegalovirus was diagnosed in the rectal specimens as well as by buffy coat preparation. Five patients went into remission after antiviral treatment (three with ganciclovir and two with foscarnet). One patient did not respond and was operated on. In one patient, cytomegalovirus was found in the surgical specimen. CONCLUSIONS: Cytomegalovirus infection is a frequent cause of severe refractory colitis. Rectal biopsy should always be performed in severe steroid-resistant colitis.

Adult↗
PubMed2002

A population-based, community estimate of total colon examination: the impact on compliance with screening for colorectal cancer.

OBJECTIVE: Colorectal cancer screening is underutilized. Total colon examination (TCE), such as with colonoscopy, can have a significant effect on the measured compliance with screening, as colonoscopy may be able to be performed as infrequently as once every 10 yr. In a population-based survey we determined the prevalence and validated the self-reporting of TCE and assessed its impact on compliance with screening. METHODS: We interviewed an age- and sex-stratified random sample of 50- to 79-yr-old residents in two communities in southwestern Pennsylvania. Subjects reported ever having had and duration since last use of fecal occult blood testing (FOBT), flexible sigmoidoscopy (FS), rigid proctoscopy, barium enema, and colonoscopy. Self-reports of colorectal testing were validated via retrieval of procedure reports. RESULTS: Out of 1223 individuals sampled, 496 completed a telephone interview (40.6% overall and 58.3% of eligible contacts). In those without personal or family histories of colorectal cancer or personal histories of polyps (n = 377), 50%, 19.6%, 39.8%, and 17.5% reported ever having had FOBT, FS, barium enema, and colonoscopy, respectively. Thirty-one percent reported having FOBT within the previous year or FS within the previous 5 yr. Including TCE within the previous 5 yr increased the measured compliance to 39.7%. Compliance was significantly greater among subjects with family histories of colorectal cancer (62.9% vs 39.7%, odds ratio = 2.6, 95% CI = 1.3-5.2). Self-reports of recent colonoscopy were verified in 29 of 35 instances (83%). CONCLUSION: The prevalence of TCE in this population was significant, and including TCE substantially increased measured compliance with colorectal cancer screening. Self-reported use of colonoscopy was validated as accurate.

Age Distribution↗
PubMed2005

Perianal abscesses due to ingested foreign bodies.

Four cases of perianal abscesses due to foreign bodies (FBs) impacted in the anal canal are reported. The clinical presentation mimics common causes of acute anal pain. Digital rectal examination under local or general anaesthesia and/or proctoscopy can establish the diagnosis, but may miss the presence of an FB. Incision and drainage of the abscess along with removal of the FB results in immediate pain relief and long-term cure. Impacted FBs must not be overlooked as an unusual cause of perianal abscess.

Abscess↗