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At least 325 records · Page 18Linked to original sources
PubMed1990

[Examination of the rectosphincteric reflex by means of endoscopic electrical stimulation. A new device].

An endoscopic electrical stimulation method (the new method) for the examination of the rectosphincteric reflex was devised to overcome difficulties attributable to the manometric method using balloon stimulation. Safety of the electrical stimulation under the conditions used routinely, was confirmed symptomatically and histologically. It was found that the optimal parameters of electrical stimulation to obtain the recto-sphincteric reflex were: 1 ms, 20 Hz, 5 to 7mA, and for 3 sec. The degree of the reflex relaxation became less and the time lag of the response to the stimulation became longer, as the distance of the stimulation site from the anal verge was increased. These relationships were significant. In the cases which received anterior resection of the rectum, the rectosphincteric reflex was examined using the new method. In 12 of 39 cases the recto-sphincteric reflex was induced by stimulation at the oral side of the anastomosis. In all of them the reflex was observed at 9 or more months postoperatively. Incidence of postoperative reflex appearance tended to be higher after end-to-end anastomosis than after side-to-end anastomosis. In two cases which received Duhamel-Okamoto's operation and in one which received Soave-Denda's operation, it was possible to analyze the relationship between the stimulating site and presence or absence of the reflex-like phenomenon.

Adult↗
PubMed1989

[Microscopic endoscopic tumor surgery. What is possible?].

The technique of transanal endoscopic microsurgery was used to remove sessile polyps which involved the whole circumference and were up to 8 cm long. This defect is always closed endoscopically by transverse continuous suture; in case of segmental resection end-to-end anastomosis is performed. The complication and recurrence rate is lower than that of conventional procedures. Moreover the postoperative course is shorter and the patient is free of pain. A second example of minimal invasive surgery is the endoscopic-microsurgical dissection of the esophagus. Here the whole esophagus is exposed endoscopically using the newly developed operating mediastinoscope. The definite superiority of this new technique to conventional procedures was proven by a controlled randomized experimental animal study.

Endoscopes, Gastrointestinal↗
PubMed1989

[New endosonographic examination technic for improving the assessment of small rectal tumors].

Conventional endosonographic techniques of examination in early carcinoma and sessile rectal adenoma have shown unsatisfactory results. We therefore fill the rectal cavity directly with water. Using this technique the anatomy of the rectal polyp is preserved, and the separate layers are easier to differentiate, especially when the 10-MHz scanner is used. The clinical results in 56 patients show an improvement concerning the preoperative staging especially in those tumors which are not palpable.

Carcinoma↗
PubMed1989

[Endosonography in preoperative assessment of rectal tumors].

Together with digital examination and rectoscopy, the endorectal ultrasound is of great value in the preoperative diagnostics of rectal carcinoma. In 90% of these patients it is possible to determine the depth of infiltration preoperatively. At the same time assessment of lymph node involvement can be made with a sensitivity and specificity of 78%. Thus, endorectal ultrasound gives decisive criteria for the therapeutic plan. Furthermore, endorectal ultrasound represents a fitting instrument for the postoperative follow-up of patients with anterior resection of the rectum. Intramural as well as extrarectal sited recurrences of the tumor can be detected. Whether endosonography will have an influence on the prognosis of rectal carcinoma, remains to be seen.

Adult↗
PubMed1985

[Is rigid rectoscopy obsolete?].

Flexible fiberoptic sigmoidoscopy more and more replaces sigmoidoscopy with a rigid tube. In a retrospective series of 152 rigid sigmoidoscopies we analysed depth of endoscopy and findings. In 36% of patients without anaesthesia endoscopy had to be stopped at 15 cm and in further 31% at 20 cm leading to a highly significant difference to the anesthetized patients (p less than 0.0005). A good history of the present illness allows separating of bleeding carcinoma and polyps proximal to the sigmoid colon which have to be examined by colonoscopy. In routine screening for blood loss per anum it is desirable to achieve in all patients a maximal security not to overlook a finding, because of the medical costs. We have enlarged the list of indications for the rigid sigmoidoscopy by Marks et al. as a practical compromise: delineation of rectal lesions, side localization and critical rectal measurements, surveillance of disease states or anastomoses within its reach, for performing rectal biopsy and rectal polypectomy, in patients with possible contamination of the instrument, endoscopy in the anesthetized patient before a proctological operation if case history excludes a higher sited lesion. In all other cases there is an indication for colonoscopy or barium contrast enema. It is stressed that in patients with blood loss per anum the search for the source always is done by flexible fiberoptic sigmoidoscopy.

Adult↗
PubMed1985

[Transanal endoscopic microsurgery].

A new endoscopic surgical method was developed for removal of large sessile adenomas of the rectum and lower sigmoid. Stereoscopic sight and magnifying glasses do allow precise surgery of these tumors. If adenomas are present they can be removed using the technique of mucosa excision; if on the other hand rectum carcinomas have to be removed the complete wall of the rectum in an appropriate extension can be excised. Hemorrhages which occur during preparation always can be stopped by diathermy. The surgical intervention is terminated by a transverse continuous suture of the defect. 33 patients were operated upon in this way from July 1983 to April 1985. Areas with an diameter of up to 10 cm could be removed, even located up to 18 cm in the colon. Suturing of the defect could always be performed without problem. In 1 patient a relapse occurred.

Humans↗