[Child proctology. Practical aspects].
This review analyses the clinical and therapeutic bases of the various affections of child proctology. The authors emphasizes the need for a careful clinical examination.
Anal Canal↗
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[Surgery of proctologic diseases in the polyclinic].
The incidence of proctological diseases is on a rising trend, and some of them require surgical treatment. Outpatient handling is indicated, following thorough diagnosis, and in common practice worldwide. The surgical specialist, in command of pain-killing methods, is in a position to apply surgical treatment on a outpatient basis. Careful attention has to be given, in this context, to the anal complex and anal sanitation. Perianal thrombosis, incarcerated prolapsed haemorrhoids, acute anal fissure, and, with some reservation, periproctic abscess are situations in which acute action is recommended, while elective interventions seem to be indicated for chronic anal fissure, cryptitis, few anal fistulae, and perianal changes of the skin, but with limitations on the haemorrhoidal problem.
Abscess↗
[Epiduro-sacral anesthesia in proctology].
The experience with 1023 epidural-sacral anesthesias for hemorrhoids, paraproctites, chronic anal fissures, anal papillomas has shown the method to be effective, technically simple, safe and parsimonious. The epidural-sacral anesthesia can be widely used in small proctology.
Aged↗
The Gordon Richards Memorial Lecture 1983: radiotherapy and proctology.
Radiation treatment is playing an increasing role in the management of patients with ano-rectal carcinoma. This role may be categorized as a) adjuvant therapy of rectal cancer, b) definitive irradiation of rectal cancer, and c) radiotherapy of carcinoma of the anal canal. Preoperative irradiation according to a well-planned protocol is able not only to decrease the incidence of local failures but also to convert some tumors, initially suitable for AP resection, into a conservative procedure. Applied to selected cases, intracavitary irradiation can control limited rectal cancer with a rate higher than other conservative methods (series of 231 cases followed more than five years). Carcinoma of the anal canal should not be treated by radical surgery or by external beam irradiation alone. New approaches based on combined procedures such as cobalt-60 and iridium-192 implant, with or without chemotherapy, demonstrated a substantial improvement in five-year survival rates in a series of 100 cases. Proctology represents for the radiation oncologist an experience which is both gratifying and full of promise.
Adenocarcinoma↗
[Notes on cryosurgery in proctology].
The A. in a review of the outpatient proctologic practice suggest the application of the crioprobe to the piles first and second degree, and to polyps small ones. A pathogenetic hypothesis of this narrowing application is supported on the basis of the unpractible mucosa, affected by 3rd degree piles. Furthermore the N2O employment seems to be unusefull in the treatment of the polyps and a further improvement of the probes is required.
Anus Neoplasms↗
[Anesthesiological indications in proctological surgery].
A brief anatomical introduction is followed by the expression of personal views on the anaesthesiological techniques to be employed in proctological surgery in the light of a series of 258 cases.
Anesthesia, Conduction↗
[Surgical policy in emergency proctology].
The article deals with 6-year experience of a department of emergency proctology accommodating 65 patients. Introduction into clinical practice of modern therapeutic tactics, highly effective medicaments, and top-duality anesthesiological service made it possible to cure radically 84.6% of patients with acute paraproctitis and 82.1% of those with acute hemorrhoidal thrombosis. Postponed radical operations are of undeniable advantage in the management of such patients. As a result of them complication incidence reduced from 10.7 to 2.2% in acute paraproctitis and from 39 to 6.1% in acute hemorrhoids. In this connection the achievement of the best end results seems logical--the absence of recurrences in surgical treatment of acute suppuration of an epithelial coccygeal passage and acute thrombosis of the hemorrhoids, and a low incidence of recurrences (1.8%) after operations for acute paraproctitis.
Acute Disease↗
[Surgical therapy of chronic anal fissure--do additional proctologic operations impair continence?].
78 patients with chronic anal fissures have been mainly operated on by lateral internal sphincterotomy (LATS). Continence have been evaluated by questionnaire at least 9 months postoperatively. Patient without any additional proctological operation had minor disturbances of continence in 17%. Patient with additional operations had disturbances of continence in 30%. Especially the subgroup of patients with LATS and haemorrhoidectomy had bad results. In this group only 45% were fully continent.
Adult↗
[Practical proctology (author's transl)].
Hemorrhoidal complaints are the most frequent diseases of the rectal region and form the starting point for practically all other diseases of the rectal area. Acute bleeding often first brings the patient to the doctor, who must establish the source of the hemorrhage with all diagnostic means available. Further stages of the disease are temporary or complete prolapse of the hemorrhoids, under certain circumstances even prolapse of the rectum. Anal cryptitis is the first member of a chain of inflammatory sequelae such as perianal abscess and fistular diseases. It is frequently overlooked, yet in the early stages it could easily be cut short by suitable measures. Proctology has a responsible task to fulfill in the early recognition of diseases of the rectum and malignant tumors of the colon.
Anus Neoplasms↗
[Current proctology--modern functional diagnosis].
The large majority of pathological conditions in proctology can be recognized and distinguished from each other by clinical and endoscopic means of diagnosis. Manometric and neurophysiological investigations are especially useful for understanding pathophysiology; these methods are of great clinical value whenever their results contribute to a specific concept of therapy. Functional tests are able to distinguish among the various causes of sphincteric dysfunction. Defaecography might provide the decisive hint for operative treatment for manometric investigations of the ano-rectum, balloons, perfusion tubes and microtransducers are available. In cases of incontinence, especially in females, endosonography is the investigation of choice, providing most relevant information with regard to possible surgical reconstruction of the sphincter muscle.
Anal Canal↗
[Current anesthesia problems in minor proctological operations].
Surgical interventions, performed routinely or on an emergency basis in the clinic of abdominal surgery are mostly proctologic. All patients operated in the clinic are analyzed with a special reference to the modern methods of analgesia used.
Adult↗
[Problems of postoperative drug analgesia in proctological surgery].
It is the purpose of this study to analyze all practical methods of analgesia in proctologic surgery. A new procedure of intravenous or subcutaneous fentanyl analgesia is proposed.
Analgesia↗
[Neurophysiologic diagnosis in proctology].
Functional diagnostic exploration in proctology is ever-expanding and becoming more differentiating. Neurophysiologic examinations can take over an essential share. They have in part already been introduced into routine diagnostic workup. Both afference and efference, as well as the muscular system can be investigated in functional neurologic disorders of the pelvic floor. The electromyogram using concentric needle electrodes constitutes the most significant tool. It provides us with a better verification of the neurogenic lesion, and enables us to discriminate between acute and chronic and comment on severity and prognosis. The diagnostic program is additionally supplemented by motor and sensory evoked potentials, electroneurography of the pudendal nerve, and measurements of vegetative nerve paths.
Afferent Pathways↗
[Pediatric proctology].
The approach to proctologic disorders has been little studied in the child. The region is, however, easily accessible for direct examination, and the predominant abnormalities are the rectal consequences of passing hard and/or voluminous stools that are often responsible for pain and bleeding. Other lesions are also observed (pseudo-haemorrhoidal vascular swelling, abscess, dermal scar proliferation, prolapsus) but are generally easily diagnosed and treated, although in a paediatric context.
Anus Diseases↗
[Proctological surgery in the one-day surgery regimen: the preliminary results with 232 patients].
Simple anorectal surgery can be routinely employed on a one-day surgery (ODS) bases; however complications such as bleeding, urinary retention, and postoperative pain represent a limitation in this respect. In this paper we report preliminary results of our experience in surgery for haemorrhoids, anal fissures and fistulas, achieved in two years on 232 patients. Our protocol includes admission in the morning of the operation and preoperative evaluation by means of ECG, coagulation profile, assay of beta-HCG for female patients. The patients, prepared with a self-administered enema and perianal applications of prilocaine-lidocaine ointment, is taken in the operative room were a venous line is placed and an anaesthesiologist proceed to monitoring of ECG, blood pressure and oximetry. 211 patients were operated under locoregional anaesthesia performed by the surgeon by means of bilateral pudendal nerves blocking. Whereas the remaining underwent general or spinal anesthesia. With this approach we performed 106 haemorrhoidectomies, 96 sphincterotomies, 19 of which with posterior anoplasty and 30 fistulectomy or fistulotomy. 60 mg of ketorolac have been injected locally at the end of operation in order to improve postoperative pain control. Patients undergoing hemorrhoidectomy, anoplasty, fistulotomy or fistulectomy were discharged after 24 hours whereas those undergoing sphincterotomy went home the same day. We reported 4 early postoperative complications in the haemorrhoids group with an incidence of 1.7% (two bleedings, one urinary retention and one fever) treated conservatively. Postoperative pain resulted adequately controlled by a low dosage of NSAID (a mean of 3.7 doses of 30 mg ketorolac/patient). Our satisfactory results seem to suggest continuing the practice of one-day surgery in proctology.
Adult↗
Hypnosis and its uses in proctology.
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Colorectal Surgery↗
The sixtieth anniversary of the American Proctologic Society.
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Anniversaries and Special Events↗
Proctology and the general practitioner.
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Colorectal Surgery↗