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At least 307 records · Page 17Linked to original sources
PubMed1977

Fissure-in-ano: the initial management and prognosis.

The results of treatment of 188 consecutive new patients with a primary diagnosis of fissure-in-ano presenting to the Outpatient Department of St Mark's Hospital are reviewed. One-third underwent operation as the primary treatment and were not studied further. Of the remaining patients who underwent non-operative treatment only, one-half were initially cured. Follow-up at 4 years showed that this cure was maintained in half of these cases, suggesting that there is a place for treatment with a dilator in the correctly selected case. The presence of a sentinel skin tag or a fibrous anal polyp is shown to have a statistically significant association with operative treatment. The use of a paediatric sigmoidoscope to diagnose a fibrous anal polyp is recommended.

Adolescent↗
PubMed1977

Colectomy and ileorectal anastomosis for colitis: report on a personal series, with a critical review.

In a consecutive series of 86 patients who required total colectomy for inflammatory bowel disease, 36 (43 per cent) had an ileorectal anastomosis. On review between 1 and 18 years after the operation, there were 25 patients who retained the anastomosis, all of whom were in good general health. Details of their clinical and sigmoidoscopic assessment and the histological grading of rectal biopsies are given. The results are compared with other published reports in a critical review of the present standing of ileorectal anastomosis.

Adolescent↗
PubMed1980

Volvulus of the sigmoid colon in the Gezira.

Out of 34 consecutive patients presenting with volvulus of the sigmoid colon the Gezira area of The Sudan, 30 were western Sudanese farmers (age range 25-52 years) who habitually ate a single daily meal of high residue food: their colons were long and hypertrophied. In contrast, the 4 northern Sudanese (age range 60-92 years) ate a Western European type of diet and had a thin colon. This factor may have been responsible for the finding that the 5 patients presenting with gangrene of the sigmoid colon included all 4 northern Sudanese patients. Shock was a reliable indicator of gangrene but rebound tenderness was valueless. Deflation of the sigmoid volvulus via the sigmoidoscope succeeded in curing 19 of 25 patients in whom there was no suspicion of gangrene (4 later recurrences). Laparotomy was performed in the other 15 patients with operative untwisting in the absence of gangrene in 10 (2 later recurrences), and resections in the presence of gangrene (3 died).

Adult↗
PubMed1981

The prognosis of ileorectal anastomosis in Crohn's disease.

A total of 105 patients have been treated with colectomy and ileorectal anastomosis from 1958 to 1978 in Birmingham, England (48) and in Leiden, Netherlands (57). At the end of 1978 the mean follow-up was 7.6 years (6 months-20 years). Mild or moderate degrees of proctitis were not considered as contraindications for ileorectal anastomosis. The presence or absence of ileal disease or perianal disease at the time of ileorectal anastomosis did not effect the long term prognosis but patients with sigmoidoscopic proctitis appeared to fare less well (69 per cent still functioning) than those with an apparently normal rectum (87 per cent). However, no statistical significance was obtained. The risk of reoperation for recurrence of Crohn's disease after ileorectal anastomosis calculated by actuarial methods shows a 50 per cent cumulative reoperation rate after 16-20 years. This result suggests that ileorectal anastomosis is a safe and useful procedure for most patients with Crohn's colitis who did not have severe proctitis.

Adolescent↗
PubMed1981

Outpatient flexible fibreoptic sigmoidoscopy, diagnostic yield and the value of glucagon.

One hundred patients had flexible fibreoptic sigmoidoscopy in an outpatient clinic after preparation with a phosphate enema but without sedation. Patients were randomized to receive 1 mg of glucagon intravenously or a matching placebo. The discomfort of the patients and the ease of the procedure were similar in both groups. Nine patients were excluded from the final analysis as they had low rectal or anal lesions. In the remaining 91 patients, abnormalities were found in 27 (29.6 per cent) including 16 adenomatous polyps and 1 carcinoma. Only 3 lesions were below 20 cm and might have been easily visualized using a rigid sigmoidoscope.

Clinical Trials as Topic↗
PubMed1982

Comparison of rigid and flexible fibreoptic sigmoidoscopy with double contrast barium enemas.

One hundred consecutive new patients attending a general surgical and gastrointestinal outpatient clinic had a flexible fibreoptic sigmoidoscopic examination before a double contrast barium enema. Colonic lesions were found in 45 patients and flexible sigmoidoscopy was superior to barium enemas in diagnosing lesions in the sigmoid colon. Two cancers, 1 histologically a Dukes' A lesion and 6 adenomatous polyps greater than 0.5 cm in diameter, in the sigmoid colon, were not detected by barium enemas. In 6 of these patients extensive diverticular disease was present. In patients with rectal bleeding found to have diverticular disease demonstrated radiographically, an endoscopic examination must be performed to exclude polyps or cancer. Flexible fibreoptic sigmoidoscopy may reduce the numbers needing barium enemas.

Adult↗
PubMed1985

Correlation of clinical and manometric abnormalities of rectal function following chronic radiation injury.

Continuous fluid-inflation proctometrograms were performed in men with the symptoms of chronic radiation proctitis and in age and sex-matched control subjects (n = 10). Rectal volumes and compliance were measured. There was a significant reduction in the rectal volumes at sensory threshold, constant sensation and maximal tolerance and in rectal compliance (P less than 0.01). Comparable pressure measurements did not demonstrate significant differences. The maximum tolerable volume, symptomatic and sigmoidoscopic scoring correlated to rectal compliance (r = 0.77, -0.8, -0.73; P less than 0.01, less than 0.01, less than 0.02, respectively). Reduction in volume and compliance is often not obvious radiologically. Histological evidence suggests that smooth muscle hypertrophy and myenteric plexus damage are contributory.

Aged↗
PubMed1987

Synchronous and 'early' metachronous carcinomas of the colon and rectum.

In a review of cases of colorectal cancer presenting to St. Mark's Hospital over the 16-year period 1970-85, 59 patients were found to have a synchronous carcinoma (3.4 per cent). Although 82 per cent of these synchronous tumours were distal to the splenic flexure (and hence within reach of a 60 cm flexible sigmoidoscope) only 42 per cent were detected pre-operatively: the remaining tumours were noted at surgery (24 per cent) or found incidentally on pathological examination of the resected specimen (34 per cent). Histological examination of these synchronous lesions revealed a high proportion with favourable stage (Dukes' A-75 per cent) and grade (well or moderate differentiation-90 per cent). Over the same 16-year period, 10 patients presented with an 'early' metachronous lesion (less than 3 years from initial surgery). Review of these cases noted negative findings on the initial barium studies in four patients and a failure to conduct full examination of the colon at initial presentation in the remaining six. It is concluded that full examination of the colon in all patients presenting with primary colorectal cancer is mandatory and that, in the light of this experience and recent reports in the literature, this should be by pre- or peroperative colonoscopy.

Adult↗
PubMed1988

Rigid sigmoidoscopy: an evaluation of three parameters regarding diagnostic accuracy.

Rigid sigmoidoscopy is the method employed for examining the rectum and sigmoid colon in most general surgical clinics. Commonly, this is performed without any prior preparation of the bowel and with the patient in the left lateral (Sims') position. This study was designed to assess three factors relating to this method: preparation of the bowel; position of the patient; and the experience of the operator. The study shows that diagnostic accuracy without preparation is adequate in only 50 per cent of cases but, by employing a preliminary disposable (Fletcher's) enema, this can be improved to 80 per cent. Employing the knee-elbow position gave only slight advantage over the usual Sims' position and operator experience did not improve diagnostic accuracy once familiarity with the use of the sigmoidoscope had been achieved. The study underlines the importance of preparation as an essential prelude to sigmoidoscopy.

Adult↗
PubMed1990

Intraoperative air testing of colorectal anastomoses: a prospective, randomized trial.

A total of 145 consecutive patients receiving a colorectal anastomosis were randomized to 'test' or 'no test' once the anastomosis had been completed. Anastomotic testing was performed with the pelvis filled with saline and the rectum distended by sigmoidoscopic insufflation of air. Any leaks demonstrated were oversewn. A water-soluble contrast enema was performed on the tenth postoperative day. Seventy-four patients were randomized to 'test' and 71 to 'no test' but one patient was withdrawn from each group leaving a total of 143 for analysis. The two groups were well matched for age, sex, diagnosis and operative details. Eighteen (25 per cent) air leaks were detected and repaired in the 'test' group. After operation there were three (4 per cent) clinical leaks in the 'test' group and ten (14 per cent) in the 'no test' group (Fisher's exact test, P = 0.043). There were eight (11 per cent) radiological leaks in the 'test' group and 20 (29 per cent) in the 'no test' group (P = 0.006). Intraoperative air testing and repair of colorectal anastomoses significantly reduces the risk of postoperative clinical and radiological leaks.

Adult↗
PubMed1994

Endoluminal ultrasonography in the follow-up of patients with rectal cancer.

One principal aim in follow-up after curative surgery for colorectal cancer is to identify recurrent disease at an early and possibly treatable stage. The major problem for patients with rectal carcinoma is local recurrence, which occurs in 3-30 per cent of cases and carries a 5-year survival rate of less than 5 per cent. Since 1989, in addition to digital and sigmoidoscopic examination, endorectal ultrasonography has routinely been used in the follow-up of patients with rectal cancer. Sixty-six patients (40 men) who had undergone attempted radical surgery for mid- and lower-third rectal cancer were included in the study. The mean age was 68 (range 43-87) years. A total of 190 scans were performed, with a mean of 3 (range 1-9) for each patient. Thirteen (20 per cent) of the 66 patients developed local recurrence; in all cases this was suggested by rectal ultrasonography. Digital examination and rigid sigmoidoscopy failed to detect recurrence in three patients. Four detected recurrences were treated radically; the remaining patients received radiotherapy, palliative transanal resection or laser management because of advanced age or refusal to undergo surgery. Six patients were alive a mean of 21 (range 4-50) months after recurrence. Of these six patients, four were free from disease (three had undergone salvage surgery and one radiotherapy). Postoperative rectal ultrasonography can detect some local recurrences at an early treatable stage. The method is more accurate than digital examination and sigmoidoscopy, and should be used as part of a regular follow-up programme.

Adult↗
PubMed1995

The utility of preoperative screening colonoscopy in gynecologic oncology.

The American Cancer Society (ACS) recommends that asymptomatic women, age 50 and over, undergo sigmoidoscopy every 3 to 5 years, after two negative yearly exams. Epidemiologic evidence suggests that women with gynecologic or breast cancers have an increased risk of developing colon cancer. It is unclear whether the ACS guidelines are applicable for women with a new diagnosis of gynecologic malignancy. This retrospective study was undertaken to assess the usefulness of preoperative colonoscopy in our gynecologic oncology patient population. Patients undergoing evaluation for a major operative procedure for known or suspected gynecologic malignancies were referred for colonoscopy at the discretion of their attending surgeon. Five hundred patients' charts were reviewed to identify 212 patients in whom preoperative colonoscopy was performed (the study group). In this group, 17 cases of colonic polyps, 5 cases of synchronous colon cancer, and 2 cases of cancer metastatic to the colon were discovered, representing 11% of the study group. Whereas 23% of the patients screened were less than 50 years of age, only two cases of polyps occurred in this age group, and no cases of cancer. Patients aged 70 or greater made up 28% of the study group, but accounted for 41% of the cases of polyps and 40% of the colon cancers. Twenty-nine percent of the study group had adenocarcinoma of the endometrium, representing 7 of 17 cases of polyps, 1 of 5 colon cancers, and 1 of 2 metastatic cancers. Although this retrospective study involved colonoscopy, the locations of the observed lesions were within the theoretic reach of a flexible sigmoidoscope in 75% of cases. We conclude that in the preoperative workup of gynecologic oncology patients, no colon screening is needed in the asymptomatic patient less than 50 years of age. ACS guidelines are appropriate for patients aged 50-70, but for those 70 or greater we would consider full colonoscopy.

Age Factors↗
PubMed1999

Which technique, circular stapled anastomosis or double stapling anastomosis, provides the optimal size and shape of rectal anastomotic opening?

BACKGROUND: Two types of end-to-end colorectal anastomosis using a circular stapler, circular stapled anastomosis(CSA) and double stapling anastomosis(DSA), have become the standard technique. The possibility of anastomotic openings of the DSA being smaller and somewhat distorted, because of some portion of the stapled rectal stump not being included in the anastomotic opening, was examined. METHODS: Anastomotic openings created by CSA and DSA were photographed through a sigmoidoscope, and the maximal and minimal diameters and the areas of the anastomotic openings were measured and calculated with an image analyzer. They were examined in the swine rectum immediately after surgery and were also examined in the randomized clinical cases 3 or more months after surgery. RESULTS: It was found that larger anastomotic openings could be created as the diameter of the anastomosed intestine and the cartridge size became wider in both methods immediately after surgery. The shape of anastomotic opening created by DSA was observed to be more oval than round immediately after surgery. The anastomotic stenosis occurred in a small number of patients in both methods within 3 months after surgery. The area of the anastomotic opening created by CSA was about 25% larger than that by DSA immediately after surgery and about 30% larger 3 or more months after surgery. CONCLUSION: CSA provides a larger anastomotic opening than DSA. Anastomotic stenosis occurred in a small number of patients in both methods.

Aged↗
PubMed2000

Rectal pacing: pacing parameters required for rectal evacuation of normal and constipated subjects.

BACKGROUND AND PURPOSE: Our previous studies have demonstrated that rectal electric waves start at the rectosigmoid junction (RSJ) and spread caudad along the rectum. A rectosigmoid pacemaker was postulated to exist at the RSJ. We also demonstrated that electric waves in rectal inertia are so scarce that a "silent" electrorectogram is recorded; the myoelectric activity in such cases was stimulated by an artificial pacemaker placed at the RSJ. For this article we investigated the pacing parameters necessary for rectal evacuation in rectal inertia patients. METHODS: The study comprised 24 patients with rectal inertia divided into two groups: study group (10 women, 6 men; mean age, 38.9 +/- 10.6 years) and control group (6 women, 2 men; mean age, 36.3 +/- 9.8 years). The main complaint was infrequent defecation and straining at stools. Eight healthy volunteers (6 women, 2 men; mean age, 37.2 +/- 9.4 years) with normal stool frequency were included in the study. Through a sigmoidoscope, an electrode was hooked to the RSJ (stimulating) and two electrodes were hooked to the rectal mucosa (recording). Rectal electric activity was recorded before (basal activity) and during electric stimulation of the RSJ electrode with an electrical stimulator delivering constant electric current of 5-mA amplitude and 200-ms pulse width. RESULTS: In the healthy volunteers, rectal pacing effected increases in frequency, amplitude, and velocity from a mean of 2.3 +/- 0.9 to 6.2 +/- 1.8 cycles/min (P < 0.01), 1.2 +/- 0.6 to 1.7 +/- 0.8 mV (P < 0.05), and 4.1 +/- 1. 2 to 6.3 +/- 1.7 cm/s (P < 0.05), respectively. No waves were recorded from rectal inertia patients at rest. Rectal pacing of the study group showed pacesetter potentials with a mean frequency of 2. 1 +/- 1.2 cycles/min, amplitude of 0.9 +/- 0.1 mV, and velocity of 3. 3 +/- 1.6 ms. The control group, in whom the pacemaker was not activated, showed no electric activity. CONCLUSIONS: Rectal pacing succeeded in producing myoelectric activity in patients with rectal inertia. It is therefore suggested that this method be applied for rectal evacuation in patients with inertia constipation.

Action Potentials↗
PubMed1990

Topical treatment with 5-aminosalicylic in distal ulcerative colitis by using a new suppository preparation. A double-blind placebo controlled trial.

Sixty-two patients with ulcerative colitis localised to the distal sigmoid colon and rectum (less than 20 cm) entered the trial. Thirty-two were treated with 5-ASA 500 mg suppositories (Asacol) 3 times a day for 1 month while 30 received a placebo given in the same regime. Clinical, sigmoidoscopic and histological assessment was carried out before, after 15 days and after 1 month of treatment. At the end of the study 5-ASA suppositories showed significantly better results in all the parameters recorded than placebo (p less than 0.01). There were no unwanted effects related to the use of suppositories. This treatment should therefore be offered as a first choice for patients with distal rectosigmoiditis.

Adult↗
PubMed1994

The yield of flexible fiberoptic sigmoidoscopy in the detection of asymptomatic colorectal neoplasia.

Recent evidence of a reduction in mortality rates from distal colorectal cancers in populations screened by rigid sigmoidoscopy suggests that further benefits may be achieved by the use of fiberoptic sigmoidoscopy as the screening modality. However, there is limited evidence as to the expected yield of neoplasia using the standard 60-cm instrument. The aim of this study was to determine the yield of neoplasia in an asymptomatic population in the at-risk age group undergoing fiberoptic sigmoidoscopy. Recruitment into the screening program was among State Department personnel. In total, 4,216 asymptomatic subjects (50-65 years) were offered flexible sigmoidoscopic screening performed following a simple enema bowel preparation. Those in whom a neoplastic condition was identified underwent further investigation (colonoscopy or barium enema). Of those offered screening 4,005 (95%) underwent the examination. Eleven carcinomas were detected at flexible sigmoidoscopy and two carcinomas were detected at further investigation in subjects with rectosigmoid polyps. The overall detection rate of carcinomas was 3.2 per 1,000 subjects screened. Histologically proven adenomas were detected in 217 subjects, 5.4% of the population screened. In this cohort of individuals flexible sigmoidoscopy appears to have been an acceptable form of screening. The detection rate of neoplasia, particularly colorectal adenomas, is higher than that reported from studies of fecal occult blood screening.

Adenoma↗
PubMed1977

Electron histochemistry of mucosubstances in normal human rectal epithelium.

The electron microscopic histochemistry of mucosubstances in sigmoidoscopically and microscopically normal rectal biopsies was studied using techniques currently available. The deposition of Alcian Blue and Ruthenium Red and the distribution of Concanavalin A receptors were limited to the epithelial cell borders. Mucosubstances in the fuzzy coat, Golgi apparatus, lysosomes and secretory vesicles were demonstrated by the periodic acid-chromic acid oxidation methods. Glycogen was demonstrated in the epithelium by periodate oxidation methods and the complex cyanide technique. There was little difference in the distribution of mucosubstances in the epithelial cells at any level of the crypts. Phosphotungstic acid staining under controlled conditions gave a similar distribution of mucosubstances to those revealed by the oxidation techniques.

Alcian Blue↗
PubMed1977

Cancer in chronic ulcerative colitis. Diagnostic role of segmental colonic lavage.

Saline colonic lavage in 74 patients with chronic ulcerative colitis was performed utilizing a commercially available dental irrigating unit through a polyethylene catheter in the biopsy channel of a colonoscope or through a sigmoidoscope via a lavage-aspirating double-lumen probe. Six patients were found with colonic carcinoma. Two diagnoses of malignancy were established by cytologic smears and cell block alone. Two patients had positive mucosal biopsies and cell block. One patient with a hepatic flexure carcinoma and a second patient with a malignancy proximal to the left colon stricture were missed by these techniques. Considering the established proclivity for carcinoma in these patients, it is felt that segmental lavage in areas of stricutre, grossly dostorted mucosa, or endoscopically inaccessible areas represents a valuable adjunct in the diagnosis of carcinoma in chronic ulcerative colitis.

Adenocarcinoma↗