SEARCH · Search PubMed

Results for “Sigmoidoscopes”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

SourceResearch connectionFrom yearThrough year

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 649 records · Page 36Linked to original sources

PubMedDate not supplied

[Colonofibroscopy, diagnostic style and therapeutic application].

Endoscopic examination of the entire colon is now possible without complication with the fiberoptic colonoscope. Early cancers and polyps not detected by X-ray have been disclosed. Biopsy is posible under direct vision at any level of insertion. Patients with suspicious lesions by barium enema are spared surgery by definitive endoscopic diagnosis. Polyps, pedunculated or sessile, beyond the reach of the conventional rigid sigmoidoscope can be removed without complication. The instruments used in this study were the colonofiberoscopes model ACMI F0 9000 P [105 cm] and ACMI two channel 7 Fr, and 12 Fr [160 cm] in length, respectively.

Adolescent↗

PubMed1993

[Colorectal cancer. A study of 133 surgical cases].

The author studied the medical records of 133 patients who underwent surgery for adenocarcinoma of the colon or rectum in the Metropolitan Hospital Complex Arnulfo Arias Madrid from June 1972 to July 1992. In 9 (6.7%) the tumor was staged as Dukes A, in 49 (36.8%) as Dukes B; in 60 (43.1%) as Dukes C and in 10 (16.7%) as Dukes D. The anatomical location of the tumor was the cecum in 9 (6.7%), the ascending colon in 3 (2.3%), the sigmoid colon in 44 (33%) and the rectum in 41 (31.6%). Of the rectal carcinomas 24 (58.5%) were in the inferior one third, 10 (24.3) were in the middle and 7 (17%) in the superior third. It is evident that nearly two thirds of the tumors were within reach of the digital rectal examination of the sigmoidoscopic examination. The parents ranged from 21 to 89 years of age and their median age was 63 years. 73 patients were women and 60 were men. 60.5% of the women and 39.5% of the men had carcinoma of the colon. The sexual prevalence of carcinoma of the rectum was different: 5% were in men and 43% were in women. 2.2% of the tumors were synchronous and 4% were metachronous. The author discusses the number, type and indications for the surgical procedures used. There were no perioperative deaths. The 5 year survival for adenocarcinomas of the colon was 100% for those patients with tumors staged as Dukes A, 78.5% for the Dukes B, 61.1% for the Dukes C and 0% for those staged as Dukes D. For the rectal adenocarcinomas the 5 year survival was 100% for those patients with tumors in Stage Dukes A, 57.1%, for those in Dukes B, 33.3 for those in Dukes C and 0% in those in Dukes D. These results indicate that these patients are seen in an advanced stage and point to the urgent need to make the diagnosis in early, curable stages. The low incidence of tumors in stage Dukes A indicates an indifference of the patients and/or the doctors to the symptoms and signs of this disease. The most frequent symptoms, in descending order were: bleeding on defecation (all types), change in bowel habits (diarrhea or constipation), abdominal pains, tenesmus and anemia (with its different clinical manifestations). Other symptoms were a palapable abdominal mass, feces with bloody mucus and rectal prolapse on defecation.(ABSTRACT TRUNCATED AT 400 WORDS)

Adenocarcinoma↗

PubMed1993

Evolving colonoscopy skills in a rural family practice: the first 293 cases.

During the 1980s, many family physicians acquired flexible sigmoidoscopy skills for the early detection and secondary prevention of colorectal cancer. As these skills have matured, some family physicians have advanced from flexible sigmoidoscopy to the performance of colonoscopy. This is a descriptive report of this phenomenon from the private practice of one family physician. The first five years of total colonoscopy experience (293 procedures) were analyzed. No complications were encountered. A learning effect (measured in terms of scope depth and anatomical depth) was present during the first 50 procedures; an improvement in examination depth between the 25th and 50th procedure was present. Previous abdominal surgery had an effect on limiting scope-insertion depths. There were no complications, and among sedated patients, 137/253 (54%) of procedures reached the cecum. Important findings included cancer, polyps, and colitis. Twenty-seven percent (9/34) of important pathological findings were located beyond the reach of the 60 cm sigmoidoscope. This study of full colonoscopy in private family practice suggests it is safe, and the diagnostic yield is substantial. Additional studies by family physicians are needed regarding technique, quality assurance, and patient satisfaction.

Adolescent↗

PubMed1993

Clostridium difficile infection is a treatable cause of diarrhea in patients with advanced human immunodeficiency virus infection: a study of seven consecutive patients admitted from 1986 to 1992 to a university teaching hospital.

Of 427 human immunodeficiency virus-seropositive patients admitted to the Robert Wood Johnson University Hospital from January 1986 through August 1992, seven had Clostridium difficile enteric infection documented by the presence of cytotoxin B in the stool, without other enteric infection. All seven patients had AIDS, and all had recently received antibiotics. These patients had a severe clinical presentation of C. difficile infection. All patients had profound watery diarrhea, with a mean of 20 +/- 14 (SD) bowel movements per day. Four had fever > 38.5 degrees C, and another had hypothermia. Three patients had borderline hypotension, and another was orthostatic. The mean pulse was 119 +/- 26 (SD) beats/min. Five patients had abdominal pain and tenderness. Two had occult blood in the stool. Four had metabolic derangements such as hyponatremia, hypokalemia, or prerenal azotemia. Three of four patients undergoing abdominal roentgenography had radiographic findings consistent with severe colitis of colonic dilation, mural thumbprinting, or mural thickening. Sigmoidoscopic findings ranged from diffuse erythema to prominent pseudomembranes. During a mean interval of 14.3 +/- 6.2 (SD) days before institution of specific antibiotic therapy, the diarrhea spontaneously resolved in only one of the seven patients. In the others, the diarrhea resolved on average 7.3 +/- 4.0 (SD) days after instituting antibiotic therapy. During a mean follow-up of 4.4 +/- 6.3 (SD) months, only two patients redeveloped diarrhea. Both patients had recurrent C. difficile colitis; the symptoms again rapidly resolved after repeat antibiotic therapy. We conclude that in patients with AIDS C. difficile may present as a severe enteric infection with profound diarrhea due to immunosuppression, that the diarrhea may be prolonged and not remit spontaneously, and that the diarrhea usually rapidly resolves with specific antibiotic therapy.

AIDS-Related Opportunistic Infections↗

PubMed1995

Sigmoid volvulus among Africans in Durban.

The pattern of presentation and management of 90 patients treated for sigmoid volvulus over a 7-year period was studied. There was a 9:1 male preponderance and 64% were under 50 years of age. Intestinal obstruction was the presenting feature in 84%, while the rest presented with acute abdomen or pain. Unlike other African series, this constituted only 8% of intestinal obstruction. Sixty-one per cent were managed by sigmoidoscopic decompression and semi-elective sigmoidectomy, and 30% had an emergency operation. A primary anastomosis was undertaken in 71% while others, mainly emergency cases, had a temporary colostomy. There was a 20% morbidity and 12% mortality, 80% of which was in the emergency operation group. It is concluded that the pattern of sigmoid volvulus among Durban Africans differs from that reported in other African countries where young males predominate, and from that in Western societies with elderly female preponderance. When volvulus necessitates emergency surgery, it carries a substantial mortality even in relatively young patients and therefore we advocate resection in all patients during the same hospital admission even in those whose torsion is easily reduced at sigmoidoscopy lest a recurrence fails to reduce.

Adolescent↗

PubMed1995

The value of an elimination diet in the management of patients with ulcerative colitis.

Debate exists about the role of diet in both the aetiology and the management of ulcerative colitis. To examine the latter, a group of patients with documented ulcerative colitis was studied at the Groote Schuur Hospital Gastro-intestinal Clinic. A total of 18 subjects, 9 female and 9 male, were randomised into active or control groups and followed up weekly for 6 weeks. Subjects in the control group were asked to document but not alter their intake of food and drink. Those in the experimental group had their diets systematically manipulated to exclude foods that appeared to provoke symptoms. The symptoms, sigmoidoscopy and biopsy findings of all subjects were compared before and after. 'Remission' was defined as the passage of normal stools with absence of rectal bleeding. 'Improvement' was defined as a decrease in the number of diarrhoeal stools and/or a diminution of rectal bleeding. At the end of the trial the diet group displayed significantly fewer symptoms than did the controls (P = 0.009; Fisher's exact test). Sigmoidoscopic findings improved in 8 subjects in the diet group compared with 2 of the controls. Histological findings improved in 3 of the diet group as well as in 3 of the controls. There were no foods that provoked symptoms in all patients, though spiced and curried foods and fruits, especially grapes, melon and the citruses, commonly caused diarrhoea. In only 2 patients were symptoms reproduced consistently on reintroduction of a particular food, pork in 1 case and yellow cheese in another.

Adult↗

PubMed1996

Chloroquine for mild to moderately active ulcerative colitis: comparison with sulfasalazine.

Chloroquine and hydroxychloroquine have been used successfully in a number of immunological diseases because of their immunomodulatory effect. Preliminary studies have shown them to be effective in the treatment of idiopathic ulcerative colitis. We assessed the efficacy or oral chloroquine in the treatment of idiopathic ulcerative colitis of mild to moderate severity in a randomized, controlled, blinded trial. Forty patients were assigned to receive chloroquine phosphate (500 mg/day) or sulfasalazine (3 g/day). The outcome of therapy was monitored at the end of 2 wk and 4 wk by symptom assessment and sigmoidoscopic examination. An objective scoring system was used for the evaluation, and patients were categorized into those showing complete remission, partially responding, and nonresponders. There was a sequential improvement in the individual scores as well as total activity score in both groups at 2 wk and 4 wk. With chloroquine, 12 patients (60%) showed complete remission at 4 wk, whereas six (30%) had a partial response. With sulfasalazine, 11 patients (55%) had complete remission at 4 wk, and eight (40%) showed partial response. There was no significant difference in the response to the two drugs (p > 0.05). Five (25%) patients in the chloroquine group had side effects, compared with eight (40%) in the sulfasalazine group (p > 0.05). All side effects were minor and transient, not requiring withdrawal of the drug. We conclude that short-duration chloroquine therapy is a safe and effective alternative to sulfasalazine in the treatment of mild to moderately active ulcerative colitis.

Adjuvants, Immunologic↗

PubMed1996

A comparison of mesalamine suspension enema and oral sulfasalazine for treatment of active distal ulcerative colitis in adults.

OBJECTIVES: To compare the efficacy and safety of mesalamine (5-ASA) suspension enema versus oral sulfasalazine (SAS) in patients with active mild to moderate distal ulcerative colitis. METHODS: Thirty-seven patients were randomly assigned to treatment with either rectal mesalamine, 4 g at night, (n = 19) or oral sulfasalazine, 1 g four times a day, (n = 18) in a 6-wk, double-blind, double-dummy, parallel-group, multicenter study. Patients known to be refractory to SAS or 5-ASA preparations were excluded. Efficacy was assessed by a physician-rated Disease Activity Index (DAI), which included symptom evaluations and sigmoidoscopic findings, by physician-rated Clinical Global Improvement (CGI) scores, and by Patient Global Improvement (PGI) scores. Safety was assessed by adverse event reports, clinical laboratory tests, and physical examination. Results. Mean DAI scores indicated significant improvement from baseline in both treatment groups. CGI scores indicated that 94% of the 5-ASA patients were either "Very Much Improved" or "Much Improved" at wk 6 versus 77% of the SAS patients. PGI ratings showed more improvement in the 5-ASA treatment group than in the SAS group at wk 2 (p = 0.02) and at wk 4 (p = 0.04). Adverse events, primarily headache and nausea, occurred significantly more frequently (p = 0.02) in the SAS than in the 5-ASA group (83 vs 42%). Three patients were withdrawn from SAS treatment because of adverse events. CONCLUSIONS: Rectally administered 5-ASA is as effective as oral SAS in treatment of active distal ulcerative colitis but is associated with fewer and milder adverse events. Patients treated with 5-ASA reported improvement earlier than those treated with SAS.

Administration, Oral↗

PubMed1996

'Above and below' dilatation of anastomotic colorectal strictures.

A new technique is described for dilating anastomotic colorectal strictures lying distal to a protecting stoma where attempts at instrumentation from below have failed. The new manoeuvre consists of approaching the stricture simultaneously from above, using a fibrescope inserted through the stoma, and from below using a rigid sigmoidoscope. A guidewire is passed from above through the stricture and retrieved by the lower operator. Dilators can then be railroaded through it. Six successful cases are reported.

Aged↗

PubMed1996

[Mass screening for colorectal cancer].

Considering the present state of knowledge, only the strategy of screening for intestinal tumours at the asymptomatic stage could reduce such a problem as colorectal cancer. Data from case-control studies provide evidence of the efficacy of screening by rigid proctosigmoidoscopy. But compliance with such a strategy is not known. The effectiveness of screening by sigmoidoscopy has yet to be demonstrated. A European controlled study of flexible sigmoidoscopy in association with the Hemoccult test versus the Hemoccult test alone has been set up. Evaluation by a randomized screening trial with a single flexible sigmoidoscopic examination at age 55 to 60 years has also been suggested. Case-control studies and a randomized study conducted among volunteers demonstrate that it is possible to reduce mortality from colorectal cancer in people who accept screening with faecal occult blood testing, using the Hemocult test. Four population-based studies have been set up in Europe (in England, Denmark, France and Sweden). They are based on a biannual Hemoccult test. Compliance in the test group ranges between 55% and 65% in the first screening campaign and remains high in the following screening campaigns. In France, to achieve this goal, the test must be proposed by GPs and then mailed to those who do not consult GPs. Reliable mortality data will be available within 1 to 3 years. The results of the European trials must be awaited to know if screening biennually is effective in reducing colorectal cancer mortality.

Aged↗

PubMed1977

Thoracoscopy.

Poor results in the treatment of lung cancer have led to the development of several techniques designed to obtain tissue for diagnosis and to determine the feasibility of resection. Although mediastinoscopy has obtained great popularity, we have been dissatisfied with it because of the low yield of positive results and the attendant increases in length of operations and hospitalizations. We have modified the old technique of thoracoscopy, using a sterilized sigmoidoscope inserted through an intercostal space with the patient positioned and prepared for thoracotomy. Although most frequently used in patients with lung cancer, this procedure also has been helpful in patients with coin lesions, mediastinal tumors, and penetrating wounds of the chest. Although we agree that mediastinoscopy is useful in selected patients, we believe that thoracoscopy offers a greater number of patients a reliable means of obtaining the proper diagnosis more efficiently.

Humans↗

PubMed1996

Screening for colonic neoplastic lesions using flexible sigmoidoscopy in employees of a nuclear research center and members of collective settlements.

It has been shown that screening of average risk individuals reduces the incidence of colorectal cancer. The most effective method for screening has yet to be determined in terms of cost-effectiveness, but approximately two-thirds of colorectal neoplastic lesions are within the reach of the flexible sigmoidoscope. It has been estimated that a single such examination at the end of the sixth decade may reduce the colorectal cancer incidence by 60%. As part of a screening program for colon cancer, short colonoscopy was performed on 399 employees of a nuclear research center and 228 members of a collective settlement (kibbutz). The examinations were carried out on individuals aged > or = 40 years by two experienced endoscopists. The splenic flexure or transverse colon was reached in 95% of the procedures. Neoplastic lesions were found in 24 (6.0%) and 8 (3.5%) screenees (not significant) in the Nuclear Research Center and kibbutz populations respectively. Polyps <1 cm in diameter were significantly more common in the Nuclear Research Center population but larger polyps and cancers were not. In 47 Nuclear Research Center screenees with a family history positive in a first-degree relative, findings increased to 14.9% (P = 0.016). A family history of malignancy was found in 33.8% of kibbutz members but in only 11.8% of Nuclear Research Center employees. There was no evidence to suggest that working at the Nuclear Research Center increased the risk of colonic neoplasms. We conclude that flexible sigmoidoscopy is a valuable screening tool, especially for individuals with a first-degree relative with cancer. The yield of neoplastic lesions in the Israeli Nuclear Research Center and kibbutz populations is similar to that of the general population in the western world. Compliance rates are high in well-defined populations.

Adult↗

PubMed1997

Colonoscopy performed by a family physician. A case series of 751 procedures.

BACKGROUND: Colonoscopy, including biopsy and polypectomy, is a procedure not commonly performed by primary care physicians. The purpose of this research was to present a large case series of colonoscopic procedures performed by a family physician in a rural practice. METHODS: A chart review of every colonoscopy procedure performed by a family physician over a 7-year period determined the demographic characteristics, indications, findings, and complications for each procedure. RESULTS: A total of 751 colonoscopies were performed on 555 patients (347 women and 208 men), with a mean age of 53.8 years. In 91.5% of procedures, the cecum was intubated. The most common indications for colonoscopy were bleeding (49.9%), polyp follow-up (20.9%) abdominal pain (11.7%), diarrhea (11.6%), and abnormal findings on flexible sigmoidoscopy (8.4%). Three hundred sixteen benign polyps were discovered and removed by either biopsy or polypectomy. There were 184 adenomatous colorectal polyps found in 134 (17.8%) colonoscopies. Of these 184 adenomatous polyps, 106 (58%) were potentially within reach of the flexible sigmoidoscope. Only three adenocarcinomas were discovered during the entire study period. There was only one major procedural complication: a patient experienced blood oozing from a polypectomy stump; cautery stopped the bleeding, and the patient was hospitalized overnight, with no further intervention or transfusion required. There were five other self-limited complications, including adverse reactions to sedation and infiltration at the intravenous site. CONCLUSIONS: Colonoscopy with polypectomy that was safely and competently performed in a solo rural practice adds to the evidence that experienced family physicians can provide this important service to their community.

Adenocarcinoma↗

PubMed1997

Methodological findings and considerations in measuring colorectal epithelial cell proliferation in humans.

The methodological issues for measuring colorectal epithelial cell proliferation, an intermediate end point for studies of colon neoplasia, in epidemiological studies are deceptively numerous and complex, with few methodological data available. Accordingly, during our experience with measuring colorectal epithelial cell proliferation from nearly 500 participants attending over 1300 study visits over a 6-year period, we recorded data on a variety of measurement variations. Methods investigated included rectal biopsy technique, general histological and labeling procedures [including the tritiated thymidine, 5-bromodeoxyuridine (BrdUrd), and the proliferating cell nuclear antigen (PCNA) immunohistochemical techniques used to label S-phase cells in colonic crypts in rectal biopsy specimens], biopsy scoring procedures, and summary scoring methods. Findings include that the PCNA technique was the simplest, most economical, and least time-consuming. The BrdUrd labeling failure rate was 15% versus < 1% for PCNA. The percentage of labeled cells (labeling index) was highest using PCNA in biopsies processed without prior incubation, intermediate using PCNA in biopsies processed with prior incubation as for BrdUrd, and lowest using BrdUrd. The percentage of labeled cells that were in the upper 40% of the crypt (phi h) was higher using BrdUrd than PCNA; visit-to-visit correlations were higher using PCNA (r = 0.51 versus 0.35), and visit-to-visit variability was lower and between-person variability was higher using PCNA. Intra- and inter-rater reliabilities for the techniques were comparable (PCNA intra-rater r = 0.93, inter-rater r = 0.92). The PCNA technique, compared to the BrdUrd technique, is more feasible and reliable, provides a more accurate estimate of the labeling index, and cell proliferation measures determined with PCNA have statistical properties that are generally more favorable for detecting differences in clinical trials. Thus, the PCNA technique may be preferable to techniques requiring incubation of biopsies. Other methodological findings lead us to recommend that, for larger studies measuring colorectal epithelial cell proliferation on outpatient rectal biopsies, biopsies should be taken 10 cm above the anus using a flexible, preferably jumbo cup, endoscopic forceps through a rigid sigmoidoscope, and histological sections should be 3 microns thick taken 50 microns apart.

Analysis of Variance↗

PubMed1976

Colonoscopic polypectomy.

The colonoscopic management of 86 patients with polypoid lesions of bleeding from the colon of intermittent nature is discussed. There were 145 polyps found in 85 of these patients. Adenomatous polyps occurring in the sigmoid colon above the reach of the standard sigmoidoscope was the most common finding and pathological diagnosis. Adenocarcinoma of the colon occurred in two patients and invasive carcinoma of a polyp was found in three other patients. Five other patients had polyps that demonstrated a carcinoma in situ. The definitive treatment of these complicated polyps is outlined. The importance of barium enema examination on follow-up of polyp and carcinoma patients and on patients with polyps found at standard sigmoidoscopy is stressed. The possibility of colonoscopic follow-up in lieu of colectomy and ileoproctostomy is suggested for patients with multiple polyps of the colon who do not belong to the familial polyposis group.

Adenocarcinoma↗

PubMed1997

A community hospital experience with colonoscopic polypectomies.

This study analyzed 432 consecutive polypectomies performed in 279 patients in the gastroenterology unit of a community hospital. The patients were separated into 2 groups; group I--symptomatic patients considered suitable for colonoscopic examination, and group II--asymptomatic high-risk patients. The mean number of detected polyps was similar in both groups, the vast majority of the polyps in both groups were small (< 5 mm), and were mainly of tubular histology. Polyps in the rectosigmoid area were more common (56.6%) in the symptomatic patients than in the asymptomatic patients (44.1%). Fourteen percent of patients in group I and 33% in group II had no polyps within 60 cm from the anal verge. Carcinoma in situ was found in large polyps mainly in group I. Flat adenomas were not found in the studied population. The incidence of hyperplastic polyps was similar in both groups and did not predict the concomitant existence of adenomatous polyps. The male:female ratio was the same in both groups. The percent of detected polyps increased with age. A strong right shift in the location of the polyps was evident with increasing age. Multiple polyps were a common event in this Israeli population of symptomatic and high-risk asymptomatic patients. More than 30% of the polyps were found outside the reach of the sigmoidoscope, with this proportion increasing with age. These data provide further support to the claim that colonoscopy should therefore serve as the choice diagnostic tool in these high-risk populations.

Age Distribution↗

PubMed1976

Early detection and prevention of colon cancer. The role of colonscopy.

The incidence of and mortality associated with colon cancer has not decreased during the past 25 years despite several innovations in therapy. Earlier detection and prevention by polypectomy though the sigmoidoscope and colonoscope have been suggested as one alternative offering improvement. The polyp-cancer sequence is controversial, but recent evidence indicates that polyps with a papillary component have a substantial potential for becoming malignant. Forty-four polyps were resected from 26 patients. Nineteen polyps from 14 patients had papillary features of "in-situ" carcinoma. Thus, colonoscopic polypectomy may play an important role not only in early detection but also in the prevention of colon cancer.

Adenoma↗

PubMed1998

Endoscopic sigmoidopexy: a safer way to treat sigmoid volvulus?

Sigmoid volvulus may be treated by sigmoidoscopic reduction and elective sigmoidopexy or resection at a later stage, provided there is no evidence of peritonitis, perforation or rectal bleeding. However, operative treatment, whether urgent or elective, is associated with a relatively high morbidity and mortality. An endoscopic technique of sigmoidopexy is reported which is relatively quick and straightforward to perform, and is likely to have a lower rate of morbidity and mortality than conventional techniques for the treatment of sigmoid volvulus.

Aged↗