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At least 253 records · Page 14Linked to original sources
PubMedDate not supplied

One stop rectal bleeding clinic: the coventry experience.

Among most patients attending a rectal clinic, rectal bleeding is a common presenting feature. In most patients, the cause is attributed to a benign lesion. In a small percentage, the cause is neoplastic, and for this reason, rectal bleeding merits further study. Left-sided tumors account for the majority of these tumors and are within the reach of a flexible sigmoidoscopy. This study aimed at examining the diagnostic performance of the one stop rectal clinic in Coventry. Between November 2001 and May 2002, 250 consecutive patients were seen in the one stop rectal bleeding clinic of a tertiary referral hospital. Patients were asked of the nature of rectal bleed and altered bowel habits and were examined by digital rectal examination, with a proctoscopy and rigid sigmoidoscopy before either a full colonoscopic examination or flexible sigmoidoscopy with a completion Barium enema. During the study period, colorectal cancer was detected in 4 patients (1.6%), adenomatous polyps in 36 patients (14.4%), and ulcerative colitis in 8 patients (3.2%). In 98 patients (39.2%), no abnormality was present, and in the remaining patients, diverticulosis (n = 60; 24%) and hemorrhoids were present (n = 44; 17.6%).

Adult↗
PubMed1991

Six years of occult blood screening in an urban public hospital: concepts, methods, and reflections on approaches to reducing avoidable mortality among black Americans.

While early cancer detection is frequently overused in high socioeconomic status communities, opportunities for early detection often are overlooked by practitioners serving lower income and minority populations. Review of our patient records in 1980 revealed that only 13% of patients had a record of a rectal examination, and less than 1% had either proctoscopy or fecal occult blood testing. Our program has made a dramatic impact on colorectal cancer detection, performing 8192 fecal occult blood tests in the first 5 1/2 years of our program. As with other programs, stage of cancer is greatly influenced by fecal occult blood testing, with 0 modified Dukes' stage D compared to 33% for the hospital registry, and 35% stage A compared to 0 for the registry. Compliance with diagnostic evaluation has been excellent (89.6%). The program has allowed for increased communication between patients and staff. Education about diet and other prevention has been institutionalized. Patients see our nurses as their advocates and openly express their fears and concerns about their health and health care. We began our fecal occult blood testing program at a time when it was considered the "standard of care" although randomized clinical trial proof was, and is, incomplete. This program provides evidence that "standard of care" is feasible in the public sector.

Black or African American↗
PubMed1991

[The mucosal sliding flap in the treatment of supra and high trans-sphincteric anal fistula].

Since 1989 we have operated upon 28 patients for trans- or suprasphincteric fistula, using the mucosal sliding flap: After injection of a vasoconstrictory agent into the submucosal tissue we sparingly excise the inner opening of the fistula just beyond the dentate line. A mucosal flap is then meticulously dissected and used to cover the lesion in the rectum. The flap prevents fecal bacteria from invading the intrasphincteric portion of the fistula. This portion remains intact, and so does the sphincter apparatus. Then we excise the fistulous tract, proceeding from its external opening towards the sphincter muscle. After a mean follow-up of 8.1 months all 28 patients are free of symptoms. Proctoscopy did not reveal persistent or recurrent fistula in any of them.

Adult↗
PubMed1991

[Internal intussusception of the rectum. An analysis of 62 cases].

In 62 cases of internal intussusception of the rectum, 21 were treated surgically. Their clinical features included serious dyschesia demanding longer time and strength, tenesmus, and slender stool. Digital examination of the rectum, proctoscopy, and colonoscopy usually showed no abnormalities, while defecography could show the presence and severity of internal intussusception. Parenchymal diseases of the rectum such as carcinomas should be ruled out before surgical correction. Operative measures included rectal suspension raising of the pelvic floor, resection of the redundant sigmoid colon, and the pathogenesis of the disease.

Adult↗
PubMed1991

[Colonoscopy after radical surgery for colorectal cancer. A 10-year prospective study of 309 patients].

Experience from ten year colonoscopic follow-up in patients after radical surgery for colorectal cancer is presented. In all, 309 patients below 76 years were included from 1978 to 1983. All had preoperative proctoscopy and barium enema. Colonoscopy was performed perioperatively, every six months the first three years, four and five years, seven to eight years and ten years after surgery. A minority had double-contrast barium enemas. Synchronous adenomas were removed during surgery and at perioperative colonoscopy and these patients had the same risk of metachronous cancer as those without synchronous adenomas. Five patients with six metachronous cancers, all had new curative surgery. Patients with synchronous adenomas had a higher risk of metachronous adenomas, but had a better prognosis than those without synchronous adenomas. Colonoscopically demonstrated intraluminal local recurrence in the colon could not be treated with new radical surgery in contrast to four out of eight intraluminal recurrences in the rectum. Most local recurrences were extraluminal and were diagnosed by other means.

Adenoma↗
PubMed1990

Health promotion and disease prevention in the elderly. Comparison of house staff and attending physician attitudes and practices.

The purpose of this study was to evaluate and compare attending physician and house staff attitudes and practices regarding health promotion and disease prevention in the elderly. Seventy-four physicians (38 house staff and 36 attending physicians) were surveyed from four sites in Pittsburgh, Pa, regarding their agreement with recommendations of the American Cancer Society and the Canadian Task Force. Two hundred fifty patients were interviewed and their charts were reviewed for performance of the recommendations. In all patients, physicians agreed highly with the American Cancer Society and the Canadian Task Force recommendations (agreement, 80% to 100%), with the exception of proctoscopy and thyroid examinations. Physicians performed screening procedures much less frequently. House staff and attending physicians differed regarding their attitudes about prevention. House staff felt the need for more formal instruction and were more positive regarding a healthy life-style and commitment to health promotion. The significant predictors of tests (defined as either examination or test ordered by a physician) were presence of a checklist, site of practice, and physician status. A logistic regression analysis was performed; however, this model could not entirely explain the variations found. Although physicians agreed with recommendations for screening, the attending physicians and house staff (particularly attending physicians) were less likely to perform the screening, especially in the elderly.

Aged↗
PubMed1990

[Treatment of radiogenic colitis with a rectal foam containing cortisol. Clinical and pharmacologic data].

20 patients with highly dosed irradiation of the small pelvis had been treated with Colifoam (hydrocortisone) in order to prove the therapeutic effect of radiation-induced proctitis. Over a period of three to six weeks starting in the third week of irradiation all patients received one applicator filling of rectal foam after bowel movement daily. The findings were verified by proctoscopy, histology and subjective personal well being. In ten patients we determined the daily cortisol profiles. Six months post irradiation ten patients underwent barium enema of the colon. During therapy no major complaints were recorded. The proctoscopic findings showed little changes concerning the submucous vascular walls. In none of the patients any kind of late lesion could be observed. The daily cortisol profile did not show any aberration of the physiological patterns. In conclusion the local therapy of Colifoam can be considered an additional treatment of radiation-induced colitis (proctitis).

Abdominal Neoplasms↗
PubMed1989

Computed tomography and endosonography in the preoperative staging of rectal carcinoma.

In 30 patients with rectal carcinoma the accuracy of computed tomography (CT) and endosonography (ES) was compared with the surgical specimen. Three cases were overstaged by ES and 4 cases were understaged by CT. The accuracy of ES was 84% and of CT only 76%. Both methods had advantages and limitations. An accurate staging of lymph node metastases was possible neither by ES nor by CT. - We advocate endosonography as the first imaging examination after proctoscopy. CT is recommended in endosonographic doubtful findings and in tight stenoses.

Adenocarcinoma↗
PubMed1989

[Cystic sacrococcygeal lesions].

Eleven out of twelve cases of sacrococcygeal cystic lesions, 10 females and 2 males, with ages ranging from 12 to 64 underwent surgical excision with the pathological diagnosis of teratoma in 1, dermoid in 4 and epidermal cyst in 6. Most lesions were multicystic and located in the perirecto-coccygeal region, some are extending into the pelvic cavity. Occult lesions may bulge toward the rectal lumen and thus could be early detected by digital examination or proctoscopy. Early surgery is advocated for fear of malignant change and secondary infection and coccygectomy advised to ensure satisfactory exposure.

Adolescent↗
PubMed1989

Diagnosis of rectal and colon disease by the primary care physician.

Digital anorectal examination, combined with long proctoscopy, done without bowel preparation, constitutes a diagnostic tool remarkable for its comprehensive facility and for the basic role it plays in the systematic diagnosis of anorectal-colon disease. This venerable combination is a paragon of physical diagnosis with which flexible sigmoidoscopy cannot and need not compete. It is uniquely suited for use by the primary care physician in all his physical examinations and can greatly enhance early diagnosis of anorectal-colon cancer. It also has promising potential for mass screening. Clinical effectiveness of the procedure is evaluated in a survey of 1,200 patients in whom it was used.

Colonic Diseases↗
PubMed1985

Pruritus ani: could it be malignant?

The management of extramammary perianal Paget's disease should include a careful search for an associated carcinoma in the pelvic viscera by means of proctoscopy and x-ray. Such local malignancies as Bowen's disease, which may be pigmented and multifocal in this region, and invasive squamous cell carcinoma may first manifest themselves as pruritus ani.

Anus Neoplasms↗
PubMedDate not supplied

[Portal hypertension and hemorrhoids. Cause effect relationship?].

The aim of this study was to compare the prevalence and the size of hemorrhoids with the degree of portal hypertension; 101 patients with intrahepatic portal hypertension documented by measuring wedged and free hepatic venous pressures before performing transjugular liver biopsy and 67 patients free of liver disease were investigated by proctoscopy. Portal hypertension was associated with a higher prevalence of hemorrhoids (93 p. 100 vs 76 p. 100); there was no relation between portal pressure and the size of haemorrhoids; no relation was found between the size of hemorrhoids and the grade of esophageal varices.

Cross-Sectional Studies↗
PubMed1987

Nonvenereal perianal conditions.

A variety of conditions can affect the perianal tissues. Evaluation must include a thorough history, which should emphasize hygienic habits, use of topical and oral medications, and a review of systems with particular attention to gastrointestinal symptoms. Examination of other areas of the skin may provide clues to the correct diagnosis. Examination of scrapings for yeast, more rarely dermatophytes, and Tzanck preparations from the base of blisters or erosive lesions are useful office diagnostic techniques. In some conditions biopsy of the involved area can be diagnostic (e.g., Paget's disease); in others it may indicate the need for additional studies. Direct immunofluorescent evaluation and special stains may also be indicated. Culture is important to define deep fungal and mycobacterial infections as well as more common bacterial infections. Proctoscopy and roentgenographic studies may be an important part of evaluation, especially in patients who present with perianal suppuration, masses, or anal fissures. Serologic tests for syphilis cannot be overlooked when lesions are ulcerative, moist, or papillomatous. It must be remembered that the symptoms related to perianal eruptions are nonspecific. It is only with a high index of suspicion and careful evaluation that the correct diagnosis can be established.

Anal Canal↗
PubMed1987

Colorectal adenocarcinoma in dogs: 78 cases (1973-1984).

Colorectal adenocarcinoma was diagnosed in 78 dogs. Clinical signs in all 78 dogs included tenesmus, hematochezia, and dyschezia; most of the dogs had clinical signs less than or equal to 12 weeks before examination. Ultimately, most dogs were euthanatized because of the severity of clinical signs. Proctoscopy and colonoscopy were essential for complete assessment of extent of disease. Tumors were classified by gross appearance and included single, pedunculated masses, 2 or more nodular masses, and annular or intraluminal masses. In dogs in which survival time was compared with location and gross appearance of the tumor, dogs with annular masses had the shortest mean survival time (1.6 months), and dogs with single, pedunculated, polypoid tumors had the longest mean survival time (32 months). The rectum was a more common site than the colon, with 48.2% of the tumors developing in the middle portion of the rectum. Six different modes of surgical treatment were used, depending on the location and type of mass. Dogs that did not have surgical treatment had a mean survival time of 15 months. Mean survival time in the surgically treated dogs varied slightly according to mode of treatment; they survived 7 to 9 months longer than the untreated dogs. Dogs that underwent cryosurgery and local excision had the longest survival times (24 and 22 months, respectively). Statistical analysis disclosed a significantly longer survival time for dogs treated by excision or cryosurgery, as opposed to dogs undergoing biopsy only (P = 0.001). Statistical difference in survival times was not found between dogs that had mass excision and those that had cryosurgery.

Adenocarcinoma↗
PubMed1986

[A case of rectal cancer with malacoplakia].

A 59-year-old man was hospitalized for rectal bleeding. Barium enema and proctoscopy revealed an elevated tumor, completely stenosing the rectum. The microscopic features of the specimens obtained by proctoscopic biopsy of the tumor comprised aggregations of histiocytes with intracytoplasmic inclusions (von Hansemann cells and Michaelis-Gutmann bodies). Rectal malacoplakia was diagnosed. In the course of laparotomy, the tumor was found to be strongly infiltrated to the pelvis. Thus, radical surgery was not performed, and an artificial anus was made. Excisional biopsy from the tumor tissue revealed the features of well-differentiated adenocarcinoma and malacoplakia. Forty-three cases of malacoplakia of the gastrointestinal tract from a review of the literature including ours were collected and discussed.

Adenocarcinoma↗
PubMed1985

Evaluation of the Proximate-ILS circular stapler. A prospective study.

In a prospective open study of the Proximate ILS circular stapler, the results of 125 intestinal anastomoses in 119 patients were reviewed. Intraoperative leakage was observed in five instances, after intraluminal povidone instillation, necessitating suture-line reinforcement. In three instances, incomplete tissue rings (donuts) were found. Temporary fecal diversion was used in seven of 84 patients with anastomoses made to the rectum or anal canal. Roentgenographic assessment of 79 of these anastomoses using Gastrografin demonstrated a leak in three (3.8%). There was one clinical leak (0.9%) in the series. Three patients died (2.5%), none from anastomotic complications. Transient anastomotic strictures were found in three of 82 operative survivors where the anastomosis was within range of the proctoscope. There were no instances of significant hemorrhage from the anastomosis. No patient required anastomotic revision, and of the 51 survivors of cancer surgery where proctoscopy could evaluate the anastomosis, there was no evidence of local recurrence in the period of follow up (mean 16.3 months). The authors conclude: that the Proximate ILS is a safe, reliable and effective instrument for construction of intestinal anastomoses.

Aged↗
PubMed1979

[Beginnings of endoscopy].

At the beginning of the 19. century emphasis was put on the research for possibilities to get a look into the interior of the abdominal cavity. The "body-cavity" which seemed to be most easily to access was the bladder and thus the development of the endoscopy is practically identical with the elaboration of the cytoscopy. This survey shows the starting phases as well as the further developement of the endoscopy as oesophagus-, gastro- and proctoscopy, the application on the gynaecological sector and the beginning of the laryngoscopy by Czermak and Türck in 1885, although already before their experiments in London in 1829 an instrument being similar to the laryngoscope was described by Babington.

Endoscopes↗