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At least 703 records · Page 39Linked to original sources
PubMed2000

Randomized clinical trial of haemorrhoidectomy under a mixture of local anaesthesia versus general anaesthesia.

BACKGROUND: Application of a topical anaesthetic agent may facilitate infiltration of local anaesthetic at haemorrhoidectomy. METHODS: A randomized clinical trial of 53 consecutive patients requiring elective haemorrhoidectomy was carried out. One group underwent haemorrhoidectomy under general anaesthesia, while the second group had topical anaesthetic cream (containing lignocaine and prilocaine) applied followed by local anaesthetic infiltration for surgical anaesthesia. RESULTS: There were no differences between the two groups in terms of operating time, postoperative pain, nausea or vomiting, pain-free interval after operation, analgesic requirements or patients' satisfaction with the method of anaesthesia. Postoperative oxygen saturation and pulse rate were similar in the two groups. CONCLUSION: Topical anaesthetic and local anaesthesia can be used effectively for haemorrhoidectomy and provide an alternative to general anaesthesia.

Adult↗
PubMed2000

Vertical reduction rectoplasty: a new treatment for idiopathic megarectum.

BACKGROUND: The aetiology of idiopathic megarectum is unknown and the results of surgery are often unsatisfactory. Rectal hyposensation is common and poor perception of rectal filling may contribute to the poor evacuatory function. By reducing the capacity of the rectum, it was hypothesized that sensory thresholds to rectal distension and perception of urge to defaecate would be improved. METHODS: Vertical reduction rectoplasty (VRR) and concomitant sigmoid colectomy was performed on six patients with idiopathic megarectum. Patients were evaluated before and after operation by detailed questionnaire and anorectal physiology. Postoperative rectal compliance was also studied by means of a programmable electronic barostat. Where appropriate, physiological data were compared with those obtained in eight healthy volunteers. RESULTS: Bowel frequency increased from a preoperative median of 2.5 to 16 per month after operation. Four patients reported improved rectal perception of the urge to defaecate. Thresholds for defaecatory urge and maximum tolerated volume were significantly reduced following VRR (P<0.05). Post-VRR rectal compliance was no different from that in healthy volunteers. Colonic transit time decreased significantly after VRR (P<0.05) and evacuation on proctography increased from a median of 30 per cent to 50 per cent. At a median of 57 weeks' follow-up five of the six patients expressed continued satisfaction with the results. CONCLUSION: VRR is a new approach to the treatment of idiopathic megarectum. Clinical and physiological studies confirm that it can improve sensory feedback and defaecation. The procedure needs further evaluation as the number of patients undergoing the procedure increases.

Adolescent↗
PubMed2001

Chronic radiation proctitis.

BACKGROUND: Increasing use of radiation therapy in pelvic malignancy has led to an increase in the incidence of chronic radiation proctitis. The commonest presenting complaint is rectal bleeding. METHODS: A comprehensive MEDLINE search was undertaken for all articles relating to radiation proctitis. RESULTS: The natural history of the disease is poorly documented but improvement is likely in milder forms, with persistence of symptoms in more severe forms. The pathological manifestations of the disease are summarized with particular comparison to acute radiation proctitis. The common clinical presentations and the principles of assessing patients with radiation-induced proctitis will be reviewed. The present article also reviews current treatment options, with particular reference to newer endoscopic therapies and surgical principles of management. CONCLUSIONS: The initial therapy for problematic rectal bleeding related to radiation-induced proctitis shoud be endoscopic therapy with argon plasma coagulation or topical formalin therapy. Surgery is reserved as a last resort for resistant rectal bleeding and for complicated radiation-induced strictures and fistulas.

Acute Disease↗
PubMed2002

Combined endoscopic laser and radiotherapy palliation of advanced rectal cancer.

BACKGROUND: In the palliative treatment of patients with advanced, inoperable rectal cancer, combined endoscopic laser and radiotherapy have been claimed to be more effective than laser therapy alone. The number of laser treatments, laser energy used, relapse rate, treatment of relapse, morbidity and survival in consecutive patients who were treated either by laser therapy alone or laser plus radiotherapy was compared. METHODS: Prospective data were analysed with regard to number of treatments, laser energy used, relapse rate, morbidity and survival for 56 consecutive patients. RESULTS: The crude relapse rate was significantly higher in the laser only group than in the laser plus radiotherapy group (58 and 15%, respectively; P = 0.002). There was no difference between the groups in the median total number of laser treatments or the mean total laser energy used. In patients experiencing a relapse, there was no difference in the median number of relapses, the number of laser treatments post-relapse or the total energy used post-relapse. Survival did not differ between the groups and there were no treatment-related deaths. CONCLUSIONS: These findings demonstrate a clear reduction in relapse after using combined laser and radiotherapy to palliate patients with advanced rectal cancer with no appreciable additional morbidity and have encouraged continuing use of this treatment.

Aged↗
PubMed2003

Local excision of rectal carcinoma not-exceeding the muscularis layer.

AIM: The aim of the study was to compare the results of treatment by local excision of two different clinical stages of the rectal cancer. MATERIAL AND METHODS: Fifty-eight patients with early rectal carcinoma were operated on during the last 26 years using different methods of local excision. The carcinomas were initially assessed as not-exceeding the muscularis layer of the rectal wall. The tumours, localized up to 12 cm from the anal margin, were removed by means of "parachute" excision (47 patients). In 6 patients, carcinoma localized in the central part of rectum, was excised by means of the Localio method. Transanal endoscopic microsurgery was applied in 5 cases of carcinoma localized on the depth of 5-20 cm from the anal margin. RESULTS: After local excision the patients were divided into two groups: I, tumours of low degree of malignancy, not exceeding submucosal layer (26 patients); II, tumours of low or median degree of malignancy with infiltration of muscularis layer (32 patients). There was a significant difference in cancer relapses between groups I and II. One patient in group I and 9 in group II developed local recurrences (P < 0.05) and 5 patients in group II had neoplastic dissemination (15.6%). CONCLUSIONS: Best results were obtained in patients with carcinoma not exceeding submucosal membrane. In cases of rectal muscular layer infiltrations, the risk of carcinoma relapses was markedly higher. The use of transanal endoscopic microsurgery has permitted removal of tumours from the upper rectum.

Adult↗
PubMed2003

Technical and oncological feasibility of laparoscopic total mesorectal excision with pouch coloanal anastomosis for rectal cancer.

AIM: The aim of this study was to evaluate the technical and oncological feasibility of laparoscopic total mesorectal excision (TME) with coloanal anastomosis for mid and low rectal cancer. METHODS: During a 2-year period, 50 patients underwent laparoscopic TME with coloanal anastomosis for rectal carcinoma located at a median of 4.5 (range 2-11) cm from the anal verge. Pre-operative radiotherapy was used in 46 patients. Intersphincteric dissection was combined with the laparoscopic procedure to achieve sphincter preservation. RESULTS: Conversion to a laparotomy was necessary in six patients. Postoperative mortality and morbidity were 2% and 28%, respectively. Morbidity was lower in patients operated on during the second part of the study, who had extraction of the rectal specimen through a small laparotomy incision, than in those operated on during the first part of the study when removal of the specimen was by transanal extraction. Oncological quality of excision was safe in 44 patients with intact or almost intact rectal fascia in 88% and R0 resection in 90%. At a median follow-up of 18 months, there was no local or port-site recurrence. CONCLUSION: This study confirms our preliminary results of oncological feasibility of laparoscopic TME with sphincter preservation for mid and low rectal cancer, and showed that morbidity can be decreased by using a standardized surgical procedure.

Adult↗
PubMed1979

Methylene blue dye spraying method in patients with ulcerative proctitis: a comparative study with morphological findings and functional capacity of the rectal epithelium.

Methylene Blue dye spraying method is currently used in the endoscopic assessment of the colonic mucosa of patients with chronic ulcerative proctocolitis. We have assessed the validity of this method in the evaluation of the functional capacity of the rectal mucosa in 17 patients with ulcerative proctitis and in 5 normal subjects. The ionic transmucosal fluxes of Na+ and K+ and the potential difference were used as parameters of the mucosal function. Our results indicate that methylene blue dye spraying method can be useful in the functional assessment of the rectal epithelium, especially for differentiating normal subjects and patients with mild ulcerative proctitis.

Adolescent↗
PubMed1976

[Excision and removal of multiple polyps of the colon (author's transl)].

Nowadays polyps in the gastrointestinal tract are usually removed under endoscopy, the method being highly effective and of low risk. Endoscopic removal, if necessary in several sessions, can be easily done even if there are multiple polyps of the colon. Altogether 69 polyps were removed from a 33-year-old woman, their microscopic appearance showing various degrees of proliferation. Complete removal of the polyp is of decisive importance, accomplished by enema wash-out. The diagnostic point of polypectomy lies in the histological assessment of the entire material which has been removed.

Adult↗
PubMed1976

[Carcinoid tumours of the rectum (author's transl)].

In three patients aged 21 to 65 rectal polyps diagnosed at rectoscopy were removed by diathermy loop. Histology showed them to be carcinoid tumours, one of tubular type, two of mixed type. Rectal carcinoid rarely presents with typical clinical symptoms. Polyps discovered by digital examination or rectoscopy should be considered to be potentially malignant and removed in toto. The size of the tumour is of decisive prognostic importance. Tumours with a cross section over 2 cm should be treated as malignant. The histological investigation generally gives no indication of clinical prognosis or of the possibility of metastases. Despite invasive growth and despite local or distant metastases carcinoid tumours can be judged more favourably than carcinoma. The plan of treatment should be according to the clinical findings as well, and not only to histological results. Postoperative follow-up is considered imperative.

Adult↗
PubMed1978

[Adenoma of the colon or rectum: relationship between histological structure, polyp size and site and age distribution (author's transl)].

Among 1258 polyps from the lower gastro-intestinal tract removed by rectoscopy or coloscopy and examined histologically there were 744 adenomas, 72% tubular, 27% papillary and 1% villous. 96.5% of all adenomas were extracted from patients aged over 40 years. Four fifths of the tumours were found in the rectum and sigmoid colon. Only 6% of the tubular adenomas were more than 15 mm in diameter, compared with 32% of papillary and 57% of villous adenomas. The special significance of the adenomas lies in their potential malignancy (adenoma-to-cancer sequence).

Adenoma↗