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At least 451 records · Page 25Linked to original sources
PubMed1977

Hereditary polyposis coli I: the diagnostic value of colonoscopy, barium enema, and fecal occult blood.

In families with one of the Mendelian hereditary polyposes, one can predict the proportion of patients at risk and thus obtain a denominator against which colonoscopy, barium enema, and fecal occult blood can be validated. Colonoscopy is more sensitive than barium enema. There were 42 positive colonoscopies, 12 positive barium enemas, both being positive in 10 of these. There were 141 negative enemas, 133 negative colonscopies, and 118 negative for both. Occult blood was positive in 30% of patients with polyposis, five to seven times more frequently than in those without evident polyposis. Colonoscopy detected polyposis in 30% of the progeny of affected people. The shortfall, compared with the 50% expected under the Mendelian hypothesis, is readily explained by removal of affected cases from the study by surgery or death from cancer.

Barium Sulfate↗
PubMed1980

The earlier detection of colorectal cancers: a preliminary report of the results of the Occult Blood Study.

A long-term clinical study is underway to evaluate the merit of occult stool blood testing in the earlier detection of colorectal cancers; 48,000 participants have been enrolled. Thus far, 873 patients with occult stool blood have been examined, and 77 gastrointestinal cancers have been found in 74 patients. Although data from the control group are not yet available for comparison, most of the cancers found appear to be relatively early in their development. Conventional barium-enema examinations were noted to have "missed" one third of the colon cancers and two-thirds of the colon polyps which were found on colonoscopy. Preliminary results of the study appear encouraging. Definitive analysis will await the availability of additional pertinent data.

Barium Sulfate↗
PubMed1995

Proctographic changes after rectopexy for solitary rectal ulcer syndrome and preoperative predictive factors for a successful outcome.

Rectopexy is advocated as treatment for solitary rectal ulcer syndrome despite variable outcome. Sixteen patients with this condition, who remained symptomatic after surgery, were examined before and after operation by evacuation proctography and compared with a matched group of seven patients whose symptoms had been relieved, to investigate the effect of rectopexy on rectal configuration or emptying, or both, and to identify any preoperative factor associated with a good outcome. Rectal prolapse, demonstrated in 19 of 23 patients before operation (internal in 12, external in seven), was seen in only one patient after surgery. The rectal axis became more vertical at rest (median 44 degrees before operation versus 35 degrees after surgery, P = 0.006) and on evacuation (median 38 degrees versus 31 degrees, P = 0.023). Preoperative evacuation time was increased in patients with poor outcome (median (range) 22 (8-60)s versus 10 (5-15)s, P = 0.008). Rectopexy successfully treats rectal prolapse in patients with solitary rectal ulcer syndrome and alters rectal configuration. These features, however, are unrelated to outcome. Prolonged preoperative evacuation time, suggesting a defaecatory disorder, may predict poor symptomatic outcome.

Adolescent↗
PubMed2003

Laparoscopic intersphincteric resection with coloplasty and coloanal anastomosis for mid and low rectal cancer.

BACKGROUND: The feasibility of laparoscopic rectal resection in patients with mid or low rectal cancer was studied prospectively with regard to quality of mesorectal excision, autonomic pelvic nerve preservation and anal sphincter preservation. METHODS: Laparoscopic rectal excision was performed in 32 patients (21 men) with rectal carcinoma located 5 cm from the anal verge. Most patients had T3 disease and received preoperative radiotherapy. The surgical procedure was performed 6 weeks after radiotherapy and included total mesorectal excision, intersphincteric resection, transanal coloanal anastomosis with coloplasty and loop ileostomy. RESULTS: Three patients needed conversion to a laparotomy. Postoperative morbidity occurred in ten patients, related mainly to coloplasty. Macroscopic evaluation showed an intact mesorectal excision in 29 of 32 excised specimens; microscopically, 30 of the 32 resections were R0. Sphincter preservation was achieved in 31 patients. The hypogastric nerves and pelvic plexuses were identified and preserved in 24 of the 32 patients. Sexual function was preserved in ten of 18 evaluable men. CONCLUSION: A laparoscopic approach can be considered in most patients with mid or low rectal cancer.

Adult↗
PubMed2006

The Kraske procedure: a critical analysis of a surgical approach for mid-rectal lesions.

BACKGROUND AND OBJECTIVES: To analyze the Kraske procedure as an approach to mid-rectal disease. METHODS: Twenty-two patients underwent a Kraske procedure at either Duke University Medical Center, the Durham Veterans Administration Medical Center, or the Durham Regional Hospital between 1992 and 1997. The clinical and pathologic characteristics of these patients were retrospectively analyzed and compared with previous published series. RESULTS: Of the 22 patients, 13 underwent resection of an adenocarcinoma and 9 underwent resection of a villous adenoma. Post-operative complications included four fecal fistulas (two of which required a temporary diverting colostomy), two wound infections, two cases of urinary retention, and one case of transient fecal incontinence. CONCLUSIONS: The Kraske procedure minimizes exposure of mid-rectal lesions without the morbidity of a major laparotomy. However, it does carry a moderate complication rate and thus should be utilized selectively in managing patients with mid-rectal tumors not amenable to other treatment options.

Adenocarcinoma↗
PubMed2007

Balance between endoscopic and genetic information in the choice of ileorectal anastomosis for familial adenomatous polyposis.

BACKGROUND AND OBJECTIVES: The number of rectal polyps and the site of mutations in the APC (Adenomatous polyposis coli) gene have been used to guide the surgical management in patients with familial adenomatous polyposis (FAP). The aim of this study is to assess the utility of the APC mutation screening compared to the degree of the rectal polyposis in surgical decision making. METHODS: The post-surgical courses of 25 patients submitted to subtotal colectomy with ileorectal anastomosis (IRA) were reviewed. Preservation of the rectum was prospectively decided on the basis of well-defined endoscopic criteria. The number of rectal polyps was assessed preoperatively and every 6-12 months. APC gene was screened for mutations by heteroduplex analysis, single strand conformation polymorphism, in vitro synthesized protein (IVSP), and DNA sequencing. Patients negative for APC mutations were tested for MYH mutations. RESULTS: On the basis of preoperative polyp rectal count we categorized patients as follows: Group I, 5 or fewer adenomas; Group II, 6-9 adenomas; Group III, 10 or more adenomas. After a follow-up ranging from 12 to 225 months we have observed a significant difference of recurrent rectal adenomas between Groups I-II versus III. No difference was detected among patients of Group I and II. The mean number of adenomas/year/patient was 0.67, 1.62, and 9.29 for Group I, II, and III, respectively. Carpeting polyposis of the rectal stump developed in three patients with APC mutation at codon 1309 and two of them needed later proctectomy. Diffuse rectal polyposis was observed in one patient with mutation at exon 9 who had 10 small polyps at time of surgery. Mutation at the 5'-end of APC (codons 144-232), mutation of MYH and unknown APC or MYH mutation were correlated with a low number of polyps both at presentation and follow-up. No IRA patients developed rectal cancer. CONCLUSIONS: In our experience fewer than 10 rectal polyps at presentation can predict a favorable outcome after IRA. Identification of specific germ-line APC or MYH mutation can address the choice of surgical treatment.

Adenomatous Polyposis Coli↗
PubMed2001

Colorectal cancer screening in North Carolina: associations with diabetes mellitus and demographic and health characteristics.

BACKGROUND: Diabetes mellitus (DM) may increase the risk of colorectal cancer, a leading cause of cancer death in the United States. This report examines factors associated with colorectal cancer screening, including DM status. METHODS: Data from the 1993/1995/1997 North Carolina (NC) Behavioral Risk Factor Surveillance System were analyzed to assess self-reported screening rates within guidelines for sigmoidoscopy/proctoscopy (sig/proct) and fecal occult blood test (FOBT). RESULTS: Overall, 28.6, 27.2, and 19.7% received a sig/proct, FOBT, or either test within guidelines, respectively. Screening rates varied according to some demographic variables, but not by DM status. However, DM status changed some relationships between screening and some demographic/health characteristics. CONCLUSIONS: Colorectal cancer screening in NC is similar to national rates, but certain subgroups are less likely to get screened. Persons with DM are as likely to get colorectal cancer screening, but some groups with DM (ethnic minorities, persons of low socioeconomic status) may be at high risk for not getting screened. Educational efforts to increase screening should target these groups.

Age Distribution↗
PubMed1995

Transanal endoscopic microsurgery. Results of the initial ten cases.

Transanal endoscopic microsurgery (TEM) permits precise excision of favorable tumors from the mid and proximal rectum, thus avoiding transsacral and low anterior resection in select cases. Ten patients underwent TEM resection of rectal tumors by a single surgeon between April 1992 and August 1993. All patients first underwent endorectal ultrasound. Villous adenomas ranging from 3.2 to 4.5 cm in size (mean, 3.9 cm) in eight patients and T1 adenocarcinomas of 1.5 and 2.5 cm (mean, 2 cm) in two patients were excised. Resection was performed using the mucosectomy method in three and by full-thickness excision in seven patients. Distal extent of tumors ranged from 6 to 11 cm from the anal verge. The operative time in these initial ten cases ranged from 75 to 220 min (mean, 138 min). Estimated blood loss ranged from 0 to 550 cc (mean, 85 cc). Complications occurred in two patients (pseudomembranous colitis; fever of unknown origin). The mean length of hospital stay was 2.7 days. To date, one tumor has recurred, requiring an abdominoperineal resection. In no case was conversion to conventional method of resection necessary at the time of TEM resection. TEM is a safe and effective method for resecting favorable tumors in select cases.

Aged↗
PubMed1991

[Diagnosis and management of lower gastrointestinal hemorrhage. Retrospective analysis of 233 cases].

In a retrospective analysis the diagnostic procedure was evaluated in patients with acute lower gastrointestinal bleeding. Bleeding sources were localized distally to the ligament of Treitz in 233 patients (1979-1988). Patients with hemorrhoidal bleeding were not included. Following exclusion of an upper gastrointestinal bleeding the diagnostic procedure was initiated with a recto-/colonoscopy. Lesions were detected in 77% of the treated patients (n = 136). Angiography localized the bleeding in 68%, in combination with colonoscopy the identification of the bleeding source reached 86.5% in the treated patients. Following scintigraphy the bleeding source was determined in 89.7% of these patients. The sensitivity of colonoscopy (0.93) was superior to the angiography (0.78) and to the scintigraphy (0.75). Apart from neoplasms and adenomas angiodysplasia and Meckel's diverticula were the most common sources of the bleeding in patients who underwent operation. In 61 patients endoscopic therapy was performed, however, 6.5% of these patients had to be operated on later because of persistent bleeding. All together 79 patients underwent operation, 31 for bleeding and 48 for other reasons. 12 patients died, 6 of them were operated on for the bleeding, the other for neoplasms.

Adolescent↗
PubMed1987

Endoscopic lymphoscintigraphy. A new tool for target surgery of rectal cancer.

To define the "in vivo" lymphatic drainage from the rectum and the anal canal, 79 subjects (normal controls and patients with rectal cancer) underwent endoscopic rectal lymphoscintigraphy. This method consists of endoscopically injecting a radiolabelled colloid into the rectal and anal submucosa. The diffusion of the tracer, which is drained preferentially by the lymphatic vessels, was determined by means of a computerized gamma camera. Our results suggest a different pattern of lymphatic drainage from the rectum as compared to traditional anatomical studies. Moreover, analysis of our data yields a new hypothesis about the lymphatic spread of rectal cancer. Therefore, lymphoscintigraphy could be employed in the preoperative assessment of "N" staging of these neoplasms. This should provide better selection of patients for different surgical approaches and for adjuvant therapy. The results of 2 years of experience and possible future applications of this technique are discussed.

Anal Canal↗
PubMed1988

Training program for transanal endoscopic microsurgery.

Televised endoscopy and the concept of the "assisted" endoscopic operation is of great help in teaching surgical endoscopic techniques. The use of training dummies provides a new method of training manual dexterity and surgical skills in special courses or in surgical skill laboratories. We have developed a training system for transanal endoscopic microsurgery. Operations with our technique were performed on 116 patients. Like other microsurgical techniques, our method requires a special introduction and intensive training. This paper presents our multistage, video-supported training course for teaching transanal endoscopic microsurgery. The one-day training session is divided into four steps: (1) becoming acquainted with the technology; (2) training on cloth phantom; (3) training on opened bowel; (4) training on closed bovine bowel distended by gas insufflation. Each step is introduced by a short videotape didactically demonstrating the particular aspects of the method.

Colonoscopy↗