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At least 271 records · Page 15Linked to original sources

Penetrating wounds of the buttock.

Results of a study of 15 patients with penetrating wounds of the buttock managed during a recent five year period suggest that penetrating trauma to the buttock is a distinct injury syndrome accompanied by serious intestinal, bladder or vascular damage. Following a complete history, physical examination and appropriate roentgenograms, most injuries can be anticipated, but proctoscopy and cystography should be performed upon all patients at risk. Intravenous pyelography, a poor test of bladder integrity, may be misleading and should by supplemented by additional techniques. If a retroperitoneal or intraperitoneal injury is suspected, preoperative antibiotic therapy, followed promptly by aggressive intraoperative management of all injuries, is recommended.

Adolescent↗

Comparison of conventional and immunofluorescent techniques for the detection of Entamoeba histolytica in rectal biopsies.

Two comparative studies of six staining techniques in detection of Entamoeba histolytica in rectal biopsies were performed. The techniques evaluated were direct and indirect fluorescent antibody technique, and four conventional stains: PAS, H & E, Trichrome, and PTAH). On ethanol-fixed tissue, the direct fluorescent antibody technique was the most sensitive, detecting amoebas in 84% of rectal biopsies from 19 aspirate-positive dysentery patients. PAS staining was specific, almost as sensitive, and amoebas could be rapidly detected. The other three conventional methods, however, detected amoebas in only 53--58% of the aspirate-positive patients and required considerable efforts to find the amoebas. The indirect fluorescent antibody technique performed on ethanol-fixed tissues was comparable to the direct technique. The same technique used on formalin-fixed tissues had high background staining, but amoebas could still be detected more efficiently than with conventional staining. Following 20 hr or more treatment with metronidazole, no patient had amoebas detectable in their rectal biopsies by any technique used. Patients with amoebic dysentery and necrotic ulcers on protoscopy had amoebas detected more frequently in rectal biopsy than did patients with mild disease as determined by proctoscopy. Entamoeba histolytica in rectal biopsies can be detected most easily in ethanol-fixed tissue stained with either a fluorescent antibody or with PAS. If amoebas are not detected in the rectal biopsy, amoebic colitis cannot be excluded.

Adult↗

Endoscopic evaluation of the effect of indomethacin capsules and suppositories on the gastric mucosa in rheumatic patients.

Twelve patients with rheumatic diseases took part in a 6-week double-blind crossover trial comparing 14 days of oral with 14 days of rectal indomethacin treatment, 50 mg 3 X /day, with a 14-day placebo period. The patients had a gastroscopic and a proctoscopic examination after each of the 3 periods. The gastric acid production, serum concentrations and the 24-h urine excretion of indomethacin was measured. Both indomethacin capsules and suppositories caused an equal amount of gastric damage, indicating that the irritative effect of indomethacin on the gastric mucosa is not a local effect, but due to a systemic effect of indomethacin. Although the suppositories caused some mucus discharge no mucosal damage was found by proctoscopy.

Adult↗

Outpatient treatment of fissure-in-ano.

A review of 86 cases of fissure-in-ano as seen in Ife is presented. The method of management is described and compared with other conservative methods of treatment. The results show a complete healing of the condition within two weeks as compared with four to six weeks recorded in other series. Healing was confirmed by a complete resolution of symptoms together with re-epithelisation of the fissure on inspection at proctoscopy. It is suggested that the described surgical management is simple, fast, cost reducing and time saving in the treatment of fissure-in-ano. It is further envisaged that this procedure may also serve as a means of relief to our already congested hospitals.

Adolescent↗

Iron stores in adults with sickle cell anemia.

Iron status was investigated in 60 adults with sickle cell anemia as determined by stainable iron in bone marrow aspirates, serum ferritin, serum iron, and the total iron-binding capacity. Seventeen patients (28%) were found to have absent bone marrow iron. There was an excellent inverse correlation between serum ferritin and the serum transferrin (p less than 0.001), and a significant positive correlation between serum ferritin and transferrin saturation (p less than 0.005), bone marrow iron (p less than (p less than 0.001), and history of prior blood transfusion (p = 0.005). Results of complete radiologic examination of the gastrointestinal tract and proctoscopy were negative in the 17 patients in the iron-deficient group. The high incidence of iron deficiency may be related to excessive urinary losses of iron. Our data indicate that serum ferritin values of less than 30 ng/ml are diagnostic of iron deficiency in patients with sickle cell anemia, with a high degree of specificity (98.7%). However the sensitivity of the test at a serum ferritin level of 30 ng/ml is only 32%. The diagnostic evaluation and the management of sickle cell anemia in iron-deficient patients needs to be better defined.

Adolescent↗

Diffuse ischemic colitis associated with systemic lupus erythematosus--response to subtotal colectomy.

A 26-year-old woman with systemic lupus erythematosus developed massive rectal bleeding that failed to respond to medical treatment. X-rays and proctoscopy indicated that she had universal colitis. She underwent emergency subtotal colectomy because of a rapidly declining clinical course. The small intestine appeared normal. Pathological examination demonstrated a gangrenous large intestine, ischemic ulcerations, and extensive fibrinoid vasculitis that was typical of systemic lupus. The patient has had no further gastrointestinal complaints for 2 years since surgery.

Adult↗

The operative management of Crohn Disease.

The natural history of Crohn disease* is varied and unpredictable, and its cause is not known. No modality of treatment has definitely been shown to alter its course. Surgical treatment was carried out in a consistent fashion in 141 consecutive patients with Crohn disease. The indications for surgical operation were the complications of the disease only; these included fistula, abscess, obstruction and hemorrhage. Preoperative evaluation included upper gastrointestinal examination, barium enema, intravenous pyelogram, proctoscopy, and nutritional and volume support. In 76 of these patients previous operations had been carried out for Crohn disease. The surgical treatment was based upon the specific complication present, with adherence to the principle of resection of diseased tissue only. Ureterolysis also was necessary in 20 percent of these patients. The operative mortality was 1.4 percent, postoperative complications occurred in 54 patients and the surgical recurrence rate was 26 percent. A favorable result was accomplished in 85 percent of the patients.

Adolescent↗

Urologic injuries associated with penetrating wounds to the buttock.

The clinical syndrome of penetrating injuries to the buttocks at the Medical College of Virginia has been reviewed. This syndrome may present with a spectrum of injuries, from minor soft tissue damage to serious bowel, genitourinary, or vascular damage. Careful history and physical examination along with preliminary plan X rays and appropriate contrast radiographs should be performed. Additional diagnostic studies such as proctoscopy and cystoscopy are helpful when additional preoperative information is required. When retroperitoneal and intraperitoneal injury is suspected, prompt exploration with aggressive intraoperative management is recommended.

Adolescent↗

[Scintigraphy of bleeding. The diagnostic value based on a 10-year period].

The purpose was to examine the diagnostic value of 99mTc-labelled red blood cell scintigraphy for detection of gastrointestinal haemorrhage. In a retrospective investigation 85 patient files over a 10 year period (1.1.1984-31.12.1993) were evaluated. Data regarding the patients' clinical condition, number of blood transfusions, findings with angiography, gastroscopy, colonoscopy, proctoscopy, operation, x-ray of colon and autopsy were registered. A bleeding site was localized in 52% of the scintigraphies. Among these patients the scintigraphic localization was confirmed or made "very possible" in 65% by operation, autopsy or one of the other mentioned diagnostic modalities. Among the 25 operated patients the localization of the bleeding site was confirmed in 19 patients. In 40 patients with a "negative" scintigraphy a bleeding site was found in 10 patients 1-18 days after the scintigraphy by operation or one of the listed diagnostic modalities. It is concluded that 99mTc-labelled red blood cell scintigraphy is a valuable diagnostic tool for identification of acute gastrointestinal haemorrhage. Operation after scintigraphic guidance is well indicated. A "negative" scintigraphy can only exclude ongoing bleeding from the gastrointestinal tract.

Adolescent↗

Patient expectation: what is comprehensive health care?

A patient expectation survey was developed and implemented in order to define the spectrum of health care activities expected from the University of Nebraska Family Health Centers. The hypothesis underlying the survey is that patient expectations or opinions vary considerably among the members of any given population. High expectation is present for office visits, emergency services, yearly physical examination, and performance of chest x-ray, blood test, proctoscopy, and eye examination. Psychiatric services, marital counseling, youth counseling, nursing home care, and health education are indicated as not necessary by a plurality of the respondents. Examination of the responses by age, sex, and payment status through canonical correlation reveals a number of strong correlations of specific subgroups and expectations. Factor analysis revealed three independent factors or clusters representating health care issues as perceived by the patient. This study and further similar studies will be helpful in aiding the family physician's understanding of what patients expect. Through a better understanding of patient expectation, patient satisfaction and compliance may be improved.

Adolescent↗

A case of radiation-induced rectal cancer developing after a long-term follow-up.

A case of radiation-induced rectal cancer is presented. In November, 1971, a 58-year-old woman had a stage II squamous cell carcinoma in the uterine cervix. She underwent a hysterectomy and postoperative radiotherapy. External pelvic irradiation of 10 MV x-ray was carried out in 15 fractions of 2 Gy daily, with a total dose of 30 Gy, and intracavitary radium insertion with a total dose of 960 mg hours (20 mg x 48 hours). She had been followed-up in our department since 1972, when rectal bleeding occurred. Proctoscopy and periodical biopsies were performed when the patient visited our hospital. There was no evidence of malignant tumor cells nor of recurrent cervical cancer from 1973 to 1989. In August, 1990, a biopsy specimen taken from a rectal ulcer revealed a malignant mucinous adenocarcinoma. The time interval between the radiotherapy and the development of the rectal cancer was 19 years. Microscopically, the main lesion was situated in the granulation tissue covered with the regenerating mucosal epithelium, and histologically was found to be a mucinous adenocarcinoma. Other radiation damage was additionally found including colitis, endarteritis and intestinal wall fibrosis. The evidence strongly suggested the present case to be one of radiation-induced rectal cancer.

Adenocarcinoma, Mucinous↗

[Rheological parameters in hemorrhoid pathology].

The authors studied erythrocyte aggregation in 62 patients suffering from hemorrhoidal disease, distributed on the basis of proctoscopy findings between three groups (recent uncomplicated congestive attack, recent thrombosed hemorrhoid, stage IIb or III chronic prolapse). This hemorheological parameter is a sensitive marker of circulatory stasis. Values measured were compared with those obtained in 21 healthy subjects. Erythrocyte aggregation index was significantly higher in patients than in controls (31.6 +/- 6.8 versus 27.7 +/- 4.4) (p < 0.05). This difference was due essentially to increased values in patients with acute hemorrhoid problems. A parallel increase in blood fibrinogen was found in these same patients. Hemorheological changes could predispose to worsening of venous stasis in the hemorrhoidal circulation and participate in the onset or spread of thrombotic processes.

Acute Disease↗

[Solitary ulcer of the rectum].

In line with the literature, the authors consider that solitary ulcer of the rectum, either isolated, multiple or histological, like suspended proctitis, inverted hamartomatous polyp, deep cystic colitis, is a complication of rectal prolapse, which usually shares the same clinical symptoms. Solitary ulcer of the rectum is generally discovered on proctoscopy and is due to the strain exerted on the rectal mucosa by 2 opposing forces:violent effort of defecation against an anal and/or perineal obstruction. The reduction of these pressure and counterpressure forces with age and progressive alteration of the pelvic floor accounts for the progression of acute lesions towards chronic or attenuated lesions or even complete resolution. The therapeutic strategy should therefore decrease trauma by facilitating defecation by a combination of hygiene and dietary advice and biofeedback retraining, and surgical reduction of the anal obstruction and prolapse and correction of any perineal insufficiency.

Barium Sulfate↗

[Ulcertive colitis: clinical picture and treatment with total parenteral nutrition in a newborn].

The purpose of the paper is to demonstrate the usefulness of total parenteral hyperalimentation in a lactant, 4 months old patient with ulcerative colitis. At admission the lactant had diarrhea, dehydratation, anemia, malnutrition, and edema in the ankles. Proctoscopy and barium enema, and rectal biopsy were typical of ulcerative colities. Treatment included steroids and azulfidine. Evolution was poor and signs of perforation appeared. Total intravenous hyperalimentation was used and after one month the diarrhea disappeared and the patient gained weight. Ulcerative colitis is rare in lactants and usually appeares a chronic diarrhea. The diagnosis should be based on radiology, endoscopy, and biopsy. Parenteral hyperalimentation is the only treatment that permits to keep the colon at total rest while simultaneously maintaining nutrition.

Colitis, Ulcerative↗

Prevalence of shigellosis and other enteric pathogens in a zoologic collection of primates.

An epidemiologic study of shigellosis was the preliminary step in the formulation of a plan for the control of devastating infectious diseases in nonhuman primates at the National Zoological Park. Data were collected from primate groups with enzootic shigellosis and included the following species: white-cheeked and siamong gibbons (Hylobates concolor and H syndactylies); lion-tailed, celebes, and Barbary macaques (Macaca silenus, M nigera, and M sylvanus); black and white colobus monkeys (Colobus guerzea); grey-cheeked mangabeys (Cerecocebus albigena); spider monkeys (Ateles susciceps robusuts); ruffed lemurs (Lemur varrigatus); lowland gorillas (Gorilla gorilla); and orangutans (pongo pygmaeus). Data included results of physical examination, proctoscopy with biopsy, fecal parasitologic and cytologic examinations, and bacteriologic culturing of swabbed specimens of rectum and gingiva. Repetitive fecal examinations were subsequently performed and included bacteriologic culturing of fecal specimens for enteropathogenic bacteria and parasites and cytologic examination of feces. Data were collected for a 1-year period from 82 primates, and 14 gibbons were studied intensively. White-cheeked and siamang gibbons shed Shigella flexneri sporadically, but persistently. All gibbons were affected with a mean point prevalence of 30.7% (range 0 to 71%). Shigella flexneri also was isolated from feces of lion-tailed macaques. Shigella sonnei was isolated from feces of grey-cheeked mangabeys, celebes macaques, and spider monkeys.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

Cancer prevention practices and continuing education needs of primary care physicians.

We surveyed 1,500 primary care physicians in Massachusetts regarding their current attitudes and practices, as well as their interests and preferences in regard to a continuing education course, in cancer prevention and screening. Thirty-three percent (n = 488) of physicians returned questionnaires, with equal distribution among internists, family practitioners, and gynecologists. Our findings are based on physicians' self-report: 80%-92% of physicians routinely perform or order breast, cervical, skin, prostate, and colon examinations (with the exception of proctoscopy) for asymptomatic patients 50 years of age and older. Perceived barriers reported were as follows: for mammography, patient age older than 75; for sigmoidoscopy, cost; for counseling, lack of educational materials. Ninety-one percent of physicians rated a comprehensive course on cancer detection and prevention emphasizing practical matters and offering opportunity to upgrade clinical skills in physical exam and in counseling as somewhat to very useful. Specific topic preferences varied by specialty, but first preference for all three primary care groups was a course in improving their office management of cancer prevention and screening activities. Most appealing to practitioners was a one-day course leading to accreditation in screening and prevention and to reduction in malpractice premiums.

Aged↗

Foreign bodies in the rectum.

Although infrequent, rectal foreign bodies present a challenge in management. The authors report on their experience with 29 patients who had rectal foreign bodies. Emergency-department procedures included rectal examination, proctoscopy and abdominal radiography. Soft or low-lying objects having an edge could be grasped and removed safely in the emergency department, but grasping hard objects was potentially traumatic and occasionally resulted in upward migration toward the sigmoid. Operating-room procedures included anal dilatation under general anesthesia, transrectal manipulation, bimanual palpation if necessary and withdrawal of the foreign body. In two cases, rectal mucosa was trapped--in an open deodorant bottle in one patient and in a curtain rod in the second patient; operative release of the mucosa enabled safe removal. Two patients presented with peritonitis; both had "broomstick" injuries and required proximal colostomy. Five patients had perianal sepsis due to inadvertently ingested pieces of wood (three) and chicken bones (two). The mean hospital stay was 3 days (range from 6 hours to 6 days). There were no deaths. Because of the potential complications, rectal foreign bodies should be regarded seriously and treated expeditiously.

Adolescent↗

Metachronous colon cancer in persons who have had a large adenomatous polyp.

OBJECTIVE: To determine, among persons who have had a large colon polyp, the risk of subsequent colon cancer at a site distant from that polyp. METHODS: Follow-up was done for 226 persons at the Mayo Clinic who had had a > or = 1-cm polyp demonstrated on barium enema between 1965 and 1970 and for whom yearly colon surveillance examination was recommended. Information was collected from Mayo Clinic records and from contact with patients, physicians, and other hospitals regarding the results of surveillance examinations and the development of colon cancer. Colon surveillance was routinely done at the Mayo Clinic using the technique of single contrast barium enema with vigorous manual fluoroscopic examination and proctoscopy. The expected rate of colorectal cancer (CRC) was calculated based on previously published rates for this community. RESULTS: Patients received, on average, four colon examinations in addition to the examination that discovered the index polyp. During 2126 person-years of follow-up, 16 persons developed a colon cancer at a location other than the site of the index polyp, in comparison with 4.0 expected cases, for a standardized incidence ratio of 4.0 (95% CI,2.3, 6.4). The cancers were large (mean 4.5cm) at presentation, and eight of the 16 cancers had been preceded within 3 yr by at least one negative barium enema. CONCLUSIONS: The rate to develop colon cancer in persons who have had a large colon polyp es about 4 times the expected rate, suggesting that such persons should be considered for aggressive colonoscopic surveillance. The failure to detect early cancer or its precursors by surveillance barium enema is probably explained by inherent insensitivity of single contrast barium enema.

Adenomatous Polyps↗