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At least 271 records · Page 15Linked to original sources
PubMed1997

A randomized prospective study of endoscopic bipolar electrocoagulation and heater probe treatment of chronic rectal bleeding from radiation telangiectasia.

BACKGROUND: Our purposes were to (1) evaluate efficacy and safety of bipolar or heater probe endoscopic coagulation compared to prior medical therapy for bleeding radiation telangiectasia, and (2) consider the impact of treatments on patients' impression of their overall health and activity. METHODS: Twelve months of medical management had failed in 18 men and 3 women with chronic, recurrent hematochezia and anemia after radiation treatment of pelvic malignancies. Patients had multiple rectal telangiectasias coagulated with bipolar or heater probes in a randomized, prospective study. RESULTS: Rectal bleeding stopped within four treatment sessions. During 12 months of endoscopic versus medical therapy, severe bleeding episodes diminished significantly for bipolar probe versus 12 months of prior medical therapy (75% vs 33%) and heater probe (67% vs 11%); mean hematocrits rose significantly for patients undergoing bipolar (38.2 vs 31.9) and heater probe (37.6 vs 28.4) treatments, and their impression of overall health improved. During long-term follow-up, new telangiectasias or rectal bleeding were easily controlled. No major complications resulted. CONCLUSIONS: (1) Bipolar or heater probes were safe and effective relative to medical therapy for palliation of patients with lower gastrointestinal bleeding from radiation telangiectasias, and (2) all patients improved in ability to travel and exercise and in their overall impression of their health.

Aged↗
PubMed1999

Management of functional bladder neck obstruction in women: use of alpha-blockers and pediatric resectoscope for bladder neck incision.

PURPOSE: Functional bladder neck obstruction has been definitively diagnosed in the last few years due to detailed synchronous pressure flow, electromyography and video urodynamics. Clean intermittent self-catheterization and bladder neck incision are the modalities of treatment. To our knowledge the role of alpha-blockers is not yet defined in women. A new technique was developed to perform bladder neck incision using a pediatric resectoscope. MATERIALS AND METHODS: A total of 24 women with obstructive voiding symptoms or retention were evaluated with video pressure flow electromyography, and diagnosed with functional bladder neck obstruction due to high pressure and low flow on silent electromyography and bladder neck appearance on fluoroscopy. Patients were initially treated with clean intermittent self-catheterization and alpha-blockers. Catheterization was stopped when post-void residual was less than 50 ml. and only alpha-blocker therapy was continued. Bladder neck incision was performed in patients who had a poor response to or side effects of alpha-blocker therapy, or when therapy was discontinued due to economic reasons. Clean intermittent self-catheterization was continued in patients who had a poor response to alpha-blockers or refused to undergo bladder neck incision. Bladder neck incision was performed in the initial 2 cases with an adult resectoscope using a Collin's knife and subsequently a pediatric resectoscope (13F). Uroflow and post-void residual measurements were performed in all cases. RESULTS: Of the 24 patients 12 (50%) showed improvement in symptoms, peak flow and post-void residual (p <0.01) with alpha-blocker therapy only. Of the 12 patients who had a poor response to alpha-blockers 6 underwent bladder neck incision subsequently and 6 remained on clean intermittent self-catheterization. All 8 patients treated with bladder neck incision, including 2 who had a good response but discontinued alpha-blocker therapy, had sustained improvement in post-void residual and peak flow (p <0.01) after a mean followup of 3.8 +/- 2.4 years. Grade 1 stress incontinence in 2 adult resectoscope cases responded to conservative treatment. None of the pediatric resectoscope cases had stress incontinence. CONCLUSIONS: Clean intermittent self-catheterization and alpha-blockers are the initial treatment options for functional bladder neck obstruction. The alpha-blockers were successful in 50% of our patients. Bladder neck incision should be offered judiciously with minimal risk of curable stress incontinence. The pediatric resectoscope is useful to make a well controlled incision safely in the female urethra.

Adrenergic alpha-Antagonists↗
PubMed1981

Endoscopic management of urethral strictures in children.

The management of urethral strictures in children prior to urethroplasty has involved dilation and internal urethrotomy. Low success rates with these modalities led to the evaluation of visual urethrotomy and intralesional steroid injection. Of 12 patients so managed 10 achieved an excellent result, with 2 classified as having good results initially. These 2 cases were ultimately converted into the excellent category following repeat procedures. Non-invasive urinary flow rates proved invaluable in the management and assessment of these patients, and the success of their treatment.

Adolescent↗
PubMed1995

Endoscopic ultrasound and endorectal magnetic resonance imaging: a prospective, comparative study for preoperative staging and follow-up of rectal cancer.

BACKGROUND AND STUDY AIMS: Endoscopic ultrasound has become the best available method for local staging of primary rectal cancer and diagnosing recurrent local disease. The aim of this study is to compare the value of endoscopic ultrasound (EUS) to magnetic resonance imaging with an endorectal coil (EMRI). PATIENTS AND METHODS: Twenty-one patients (11 women, 10 men, mean age 63 years, range 31-79) with primary rectal cancer (n = 6) or follow-up examinations for recurrent local disease (n = 15) were investigated by EUS using an echo colonoscope (CF-UM 20, Olympus Optical) and by endorectal coil MRI on a 1.5 tesla MR system (General Electric). T2-weighted and contrast-enhanced T1-weighted images were obtained. The results of preoperative examinations were compared to histopathological findings regarding the T staging, with special focus on the transmural tumor infiltration. RESULTS: EUS identified all tumors, whereas one tumor was missed by EMRI. EUS was superior to EMRI in T staging (accuracy 83%/40%), due to the better differentiation between T1 and T2 tumors, as the endorectal coil could not differentiate between stage T1 and stage T2. The accuracy of EMRI in assessing perirectal infiltration was 80%, compared to EUS with 100%. Local tumor recurrence was found in six of 15 patients, without endoscopic signs of recurrent disease in four of them. All were detected by EUS. Only one recurrence was missed by EMRI. Accuracy and positive and negative predictive values in follow-up examinations for recurrent disease for EUS were 93%, 86%, and 100%, and for both the T2-weighted and T1-weighted contrast-enhanced sequences of endorectal coil MRI, they were 93%, 100%, and 90%, respectively. CONCLUSIONS: Endoscopic ultrasound and endorectal coil MRI are comparable methods in the preoperative staging and early diagnosis of recurrent rectal cancer. The advantages of EUS are the small diameter of the instrument, availability, and lower costs. In contrast, EMRI is operator-independent, and may become important for combined local and distant staging and follow-up examination in rectal cancer, if contrast-enhanced imaging can improve the sensitivity for liver metastases.

Adult↗
PubMed1994

Preoperative staging of rectal and colonic cancer.

In rectal cancer, endosonography assesses the tumor penetration depth, EUS T1 to EUS T3, with a sensitivity of 96% and a specificity of 89%. The evaluation of lymph nodes is less accurate, at 79%. The surgical strategy is different in the three parts of the rectum, and depends on the endosonographic tumor stage: upper third of the rectum--anterior resection for all tumor stages; middle third of the rectum--EUS T1 N0: transanal endoscopic microsurgery for "low-risk" carcinomas; EUS T1-2: anterior resection; EUS T3: anterior resection with complete excision of the mesorectum, reconstruction with coloanal pouch; lower third of the rectum--EUS T1 N0: transanal endoscopic microsurgery for "low-risk" carcinomas; EUS T1-2: anterior or intersphincteric resection with complete excision of the mesorectum, reconstruction with colon pouch; EUS T3: abdominoperineal excision. With the impact of endosonography, the proportion of abdominoperineal excisions has dropped from 46% to 15% during the last five years. Laparoscopic technology is likely to have an increasing impact on surgical procedures that have previously required an open approach. The following treatment policy derived from the endosonographic staging of colon tumors is proposed: EUS T1, laparoscopic segmental resection; EUS T2, laparoscopic oncological resection; EUS T3, conventional open surgery.

Colonic Neoplasms↗
PubMed1994

Endoscopic ultrasonography of perianorectal fistulas and abscesses.

In this article we describe the history, instrument, indications, and results of endoscopic ultrasonography (EUS) in the evaluation of perianorectal fistulas and abscesses. EUS has been reported to be helpful in the management of patients with Crohn's disease or colitis associated with fistulas and abscesses, due to its clear imaging of the leasion and valuable topographic anatomical information. Recent studies point out the relationship between EUS and electromyography. We believe EUS will become a standard procedure in the management of these complex disease processes.

Abscess↗
PubMed1987

Endoscopic microsurgery of rectal tumors.

Seventy-five patients with sessile adenomas or early carcinomas of the rectum or rectosigmoid were operated on with the new technique "transanal endoscopic microsurgery" Employing a newly developed complex endoscopic operating system, complete removal of sessile adenomas can be accomplished up to a distance of 25 cm from the anal verge, accurately and non-invasively. Complications occurred in three cases, with no resulting mortality. In the follow-up period we discovered only one adenomatous recurrence that required operative treatment. The superior accuracy of preparation, a short average stay in hospital, and low recurrence and complication rates are the advantages of this transanal endoscopic operative technique.

Humans↗
PubMed1985

Endoscopic surgery in the rectum.

A new transanal endoscopic operative technique permits microsurgery in the rectal cavity and the placing of surgical sutures. Compared with other procedures this one is non-aggressive, and there were not postoperative complications in twelve cases. A stereoscopic optical system, a new operating rectoscope and special surgical instruments, as well as a modification to an insufflation device are necessary for the endoscopic operation.

Adenocarcinoma↗
PubMed1990

[Endosonographic staging of rectal tumors].

Pre-operative staging was performed in 81 patients with rectal tumours by means of endorectal sonography. In 87% of cases (70 out of 81), the endosonographic findings corresponded with the histopathological appearance; the recognition of T0 and 1 tumours, which is important in deciding surgical procedures, was possible in 94% (51 out of 54). Differentiation between T0 and T1 tumours (i.e. between adenomas and carcinomas infiltrating the submucosa) was not possible. Five out of ten of T2 and 14 out of 16 T3 tumours were staged correctly. One T4 tumour was placed in too low a stage. A comparison of the echo structure of adenomas and carcinomas in 76 patients showed that 28 out of 43 adenomas (65%) have homogeneous echoes, while 24 out of 33 carcinomas (73%) showed inhomogeneous low intensity echoes.

Adult↗
PubMed1985

[Rectoscopy: rigid or flexible? A comparative study].

The customary rigid rectoscope was compared prospectively, with a new, flexible one (prototypes of Olympus Opt. and Fuji) in each of 114 patients selected at random. Maximal depth of introduction was reached on average after 1 min with the rigid instruments, after 1 min 40 sec with the flexible one. Mean depth of introduction was 16 cm for the rigid and 33 cm for the flexible one. In 21 patients (18.4%) additional information was obtained with the flexible rectoscope. 80% of patients reported that the flexible instrument caused them no or only slight discomfort. Skill in using the flexible instrument can be quickly acquired.

Fiber Optic Technology↗
PubMed1991

Determination of X-ray-induced damage to the murine colon using tissue compliance measurements.

A proctometroscope has been developed to measure the mechanical functioning of the colon in a murine model. A balloon-tipped probe is inserted into the colorectal region of anaesthetized mice and inflated hydraulically, at a constant rate, by a motor-driven syringe. Balloon pressure and volume are monitored, processed and plotted on a X-Y/t recorder. The balloon is inserted within the irradiated area, such that the centre of the balloon is 1 cm proximal to the anus, and inflated up to either a maximum volume of 100 microliters or a maximum pressure of 100 cmH2O, depending on which occurs first. Compliance (delta V/delta P) of the colon was measured at various intervals following X-irradiation, a dose-dependent decrease being observed at 24 weeks. This decrease was progressive with time out to 72 weeks postirradiation. The compliance measured, in both control and irradiated groups, was not dependent on the inflation rate used to make the determination, and no iatrogenic effects have been detected after repeated probing during a long-term study. The use of different anaesthetic agents was also investigated, no significant difference between the compliance of mice anaesthetized with the different agents being detected. Use of this technique provides fully quantitative data on the function of the colon following radiation injury, and provides an alternative to other physiological assays. The technique is non-destructive, rapid, easy to use and non-invasive to the tissue, thus the onset and progression of damage can be followed in each mouse over long postirradiation periods.

Animals↗
PubMed2003

Multiple hemorrhoidal ligation: a prospective, randomized trial evaluating a new technique.

PURPOSE: A modified anoscope was developed, with lateral apertures at the left lateral, right anterior, and right posterior quadrants, to enable synchronous exposure and ligation of all three internal hemorrhoids. Results were compared with those for conventional multiple ligation. METHODS: Postligation pain, complications, and outcomes were compared between synchronous ligation with the new anoscope (synchronous group) and three-quadrant ligation with a conventional anoscope with similar overall dimensions (conventional group). RESULTS: Twenty-five patients were prospectively randomized to each group. Postligation pain and analgesic requirements were recorded up to 28 days, and postligation complications and outcomes were evaluated for a minimum of 6 months. Narcotic requirements were lower in the synchronous group, but this difference did not achieve statistical significance (P > 0.05, Student's t-test). Secondary hemorrhage occurred in 1 patient (4 percent) in the conventional group but resolved spontaneously. The synchronous group experienced significantly less pain during the ligation procedure and for 2 days afterward (P < 0.01, Wilcoxon's test). External hemorrhoidal thrombosis developed in 4 percent of the synchronous group and 12 percent of conventionally treated patients, all of whom responded to conservative treatment. Repeat ligation was required less often in the synchronous group (16 percent) than with conventional ligation (28 percent). Surgery (completion hemorrhoidectomy for external thrombosis) was necessary in one patient (4 percent) in each group. Anal stenosis developed in one patient in the synchronous group. CONCLUSION: The new anoscope provides improved exposure of all three internal hemorrhoids and permits optimal placement of the rubber bands; this may account for the decreased postligation pain and lower repeat ligation rates. Synchronous hemorrhoidal ligation is a less painful method of multiple hemorrhoidal ligation and may improve outcomes compared with conventional multiple ligation.

Analgesics↗
PubMed1992

The transanal resectoscope: an under-used instrument?

The use of the urological resectoscope in the treatment of rectal tumours has been described in detail. We report the use of the purpose built transanal resectoscope in the treatment of 34 patients. Fourteen patients had villous adenomas and all but one were relieved of symptoms. Of 20 patients with rectal carcinoma, three presented with acute intestinal obstruction and three had rectal stump recurrences. Palliation was excellent in patients with general symptoms, but the results were disappointing for rectal stump recurrences. Transanal resection (TAR) is a novel form of treatment for patients with rectal obstruction. Two patients in this study had their obstruction successfully relieved by transanal resection alone. This allowed formal bowel preparation and full pre-operative assessment. We feel that this technique is under-used and that the results of treatment justify more widespread acceptance of the procedure.

Adenoma↗