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At least 721 records · Page 40Linked to original sources
PubMed2000

[Budesonide foam as a new therapeutic principle in distal ulcerative colitis in comparison with mesalazine enema. An open, controlled, randomized and prospective multicenter pilot study].

Budesonide is a locally acting steroid with a high first-pass metabolism in the liver and low systemic effects. We performed the first pilot study comparing budesonide foam (1 mg/50 ml b.i.d.) with mesalazine enemas (4 g/60 ml o.d.). 33 patients from 3 centres were enrolled in this open randomized clinical trial. 16 patients got budesonide foam and 17 got mesalazine enemas. The drugs were administered for 4 weeks. Histological index (HI) and endoscopic index (EI) were assessed at day 1 and day 28, clinical activity index (CAI) at day 1, 14 and 28. For patients with left-sided colitis and proctosigmoiditis improvement was defined as decrease in CAI of > or = 2 points. For patients with proctitis improvement was defined as decrease in HI of > or = 1 point. The primary efficacy evaluation was performed with the intention to treat population (n = 32). Improvement was found in 67% of the patients in the budesonide group compared to 71% in the mesalazine group. There was no statistically significant difference between the groups. Adverse events were mild and rare in both groups. Both treatments had no significant influence on plasma cortisol. In this pilot study for distal ulcerative colitis budesonide foam is as safe and effective as mesalazine enema.

Administration, Rectal↗
PubMed2001

Endoscopic snare excision of large pedunculated colorectal polyps: a new, safe, and effective technique.

BACKGROUND AND STUDY AIMS: The endoscopic polypectomy of large pedunculated polyps can have serious complications, such as hemorrhage, which has an incidence of about 2 %. We describe here a new, safe, and effective technique of endoscopic polypectomy for the treatment of large pedunculated colorectal polyps using a standard detachable diathermic snare. PATIENTS AND METHODS: 35 patients (18 men, 12 women; mean age 67.3, range 35 - 82), with 43 pedunculated colorectal polyps, of benign appearance and of size 3 cm or larger (range 3 - 5 cm) on colonoscopy, were included in our study. The polypectomy was performed in two steps: a) we first placed a polypectomy snare round the middle of the stalk, as a prophylactic measure to prevent postpolypectomy bleeding, and we then took out the colonoscope without removing the snare after dismantling it and blocking with a clip; b) endoscopic polypectomy was done using a second polypectomy snare, and transecting the stalk of the polyps at 2 mm above the first snare. The first polypectomy snare was left in place, and the patients were discharged within 3 hours of endoscopic polypectomy. The first polypectomy snare sloughed off spontaneously and slipped down the anus, being evacuated within 4 days following the endoscopic polypectomy. RESULTS: The ensnared polyps were located in the rectosigmoid region (n = 27), and the descending (n = 13) and transverse colon (n = 3). Complete ensnarement of the head of the polyp with a single endoscopic treatment was obtained in all cases. In addition, no procedural or delayed bleeding was noted during a 6-month follow-up. CONCLUSIONS: Our technique allows us to overcome the risk of bleeding, since the use of a standard diathermic snare makes it easier to obtain optimal tightness. Moreover, this technique is cheaper than the use of the standard detachable snare currently available (the cost of the snares being $50.52 compared with $189.47).

Adult↗
PubMed2002

Transanal endoscopic microsurgery (TEM) for minimally invasive resection of rectal adenomas and "Low-risk" carcinomas (uT1, G1 - 2).

Transanal endoscopic microsurgery (TEM) presents a minimally invasive procedure for local removal of large rectal adenomas (>/= 2 cm) and early, so called "low-risk" carcinomas (uT1, G1 - 2) in curative as well as of advanced tumors in palliative intent. Over a 6-year period 92 TEM excisions of rectal tumors were carried out including 91 patients with 56 adenomas, 35 carcinomas (9 pTis, 17 pT1, 5 pT2, 3 pT3, 1 Ca after snare diathermy) and one neurinoma. Two patients of the carcinoma group had to be reoperated by means of anterior resection due to false preoperative rectal ultrasound examination (2 x uT1--> pT2). 4 patients required palliative therapy on account of age or high morbidity. After a mean follow-up time of 23 months (adenomas 23 months, pT1 carcinoma 26 months and advanced tumors 38 months) we encountered a total of 7 complications, of which in 5 cases surgical reintervention was necessary (5,4 %). One 86-year-old patient with a pT2-carcinoma, who was unsuitable for low anterior resection due to a high morbidity risk, died from myocardial infarction after emergency reintervention caused by postoperative bleeding. To date, overall 9 recurrences occurred (9,8 %). In the specific target group of TEM (adenomas and pT1, G1-2 carcinomas) consisting of n = 83 cases, the overall recurrence rate was 7,2 %, of which 5,3 % were due to adenomas and 11,5 % due to carcinomas. After palliative excision 2 recurrences occurred. These results of transanal endoscopic microsurgery (TEM) indicate that this technique has a useful place in curative, as well as in palliative management of rectal tumors.

Adenoma↗
PubMed2002

[Comparison between endorectal MRI (EMRTI) and endorectal sonography (ES) after surgery or therapy for rectal tumors to exclude recurrent or residual tumor].

PURPOSE: This study was designed to evaluate the accuracy and limitations for staging of contrast-enhanced endorectal MR imaging comparing with transrectal US for restaging of rectal lesions after surgery or after therapeutic radiation. Both methods were correlated with histologic findings. METHOD/MATERIALS: The efficacy of these both methods was evaluated in 30 patients with supposed residual or recurrent rectal neoplasms. Contrast enhanced (bolus injection of 0.1 mmol/kg b.w. Gd-DTPA) endorectal MR imaging was performed using a 1.5 Tesla Magnetom. In addition endosonography (7.5 x or 10-MHz transducer) was used. RESULTS: In 8 patients with rectal adenoma after electro-laser resection, 8 patients with rectal carcinoma stage pT1 after transanal resection, 8 patients with rectal carcinoma stage pT2 and 6 patients with rectal carcinoma stage pT3 after regional hyperthermia with radiochemo-therapy, the following results were obtained during the postsurgical or posttherapeutical follow-up with respect to histopathological evaluation: exact staging in 86.6 % with EMRI and 63.3 % in ES, overstaging in 8 % (EMRI) and 23 % (ES), understaging in 0 % (EMRI) and 7 % (ES). The highest diagnostic accuracy was shown in EMRT in patients with rectal adenoma and rectal carcinoma (pT1) and after electro-laser resection or transanal resection during follow-up. CONCLUSIONS: Contrast enhanced endorectal MR imaging appears to be very promising for accurate posttherapeutical staging of rectal cancer and helpful in the diagnosis of recurrence or the differentiation between scar tissue and residual rectal tumor.

Adenoma↗
PubMed2002

Endoscopic laser palliation for rectal cancer-- therapeutic outcome and complications in eighty-three consecutive patients.

OBJECTIVE: The treatment of advanced rectal cancer is still a challenge. We analysed the short-term success, treatment-related complications and the long-term outcome after laser palliation for rectal cancer. METHODS: Over a ten-years period eighty-three consecutive patients (median age 81 (46-94) yrs; 43 female) were treated mainly for obstructive symptoms or tumour bleeding. Laser palliation was performed using a Neodymium:Yttrium-Aluminium-Garnet (Nd:YAG) laser. RESULTS: The immediate overall-success rate was 96.4 % (80 of 83 patients) and only one female received a diverting colostomy because of an inaccessible high-grade rectal stenosis, initially. During follow-up, eight additional patients had to undergo surgery on their rectal cancer because of treatment failures (most of them recurrent obstruction) or complications (long-term success rate: 86.7 % (72 of 83 pts.)). The median survival period was nine months. Patients treated for obstruction had more treatment sessions and had a higher rate of surgical palliation in comparison to those pts. therapied for bleeding. Major complications were seen in three patients (3.6 %). One patient died after rectal perforation following bougienage before laser treatment (overall mortality: 1.2 %). CONCLUSION: Laser therapy is effective for the palliation of advanced rectal cancer with a high short-term and long-term success rate and only few complications. Laser treatment therefore is still a valuable alternative to newer endoscopic techniques and surgery.

Aged↗
PubMedDate not supplied

Angiodysplasia as a cause of gastrointestinal bleeding in childhood.

UNLABELLED: Whereas in adults angiodysplasia is a frequent cause of gastrointestinal bleeding, in children this disorder is extremely rare. A 7 10/12 year old girl is presented suffering over 3-4 months from mild but recurrent rectal bleeding. Blood count and serum ferritin and transferrin levels were normal. The rectosigmoideoscopy revealed a rectal lesion, which was confirmed histologically as angiodysplasia. Pathological investigation of the biopsies included HE staining and immunohistological staining of endothelial cells with anti-CD34 and anti-von Willebrand factor. A follow-up period of three years revealed spontaneous regression of the angiodysplastic lesion at the rectosigmoideal localisation, which could be confirmed by endoscopy. CONCLUSION: The outcome of the few pediatric patients described in the literature was reviewed. Due to the lack of conclusive understanding of the nature of this extremely rare vascular disorder and the variable outcome described, a wait and see attitude should be assumed in cases of less clinical affection.

Angiodysplasia↗
PubMed2004

[Transanal staplermucosectomy for symptomatic rectocele with outlet obstruction].

Between 1.1.2001 and 30.6.2002 n = 52 female patients with symptomatic isolated anterior rectocele underwent transanal staplermucosectomy. All of them were suffering from outlet obstruction. In addition 9 patients complained incontinence grade I and n = 1 incontinence grade III. Complete colonoscopy, defecography and combined anal manometry with needle EMG were carried out preoperativly for exclusion of synchronous pathological findings. Sphinctermanometry showed a significant lower preoperative resting pressure (p < 0.01, t-test ) of 77.0 +/- 21.0 cm H (2)O in comparison to a normal collective. Surgical procedure consisted in a modified staplerresection of the rectocele area with tightening of the anterior rectal wall. No intraoperative complications occurred and outlet obstruction disappeared in all patients. Further investigations have to be performed to show long-term effects of this procedure.

Aged↗
PubMed2004

[Doppler-guided ligation of the hemorrhoidal arteries. Report of experiences with 248 patients].

BACKGROUND AND OBJECTIVE: Since the beginning of 2001, Doppler-giuded ligation of the hemorrhoidal arteries (DG-HAL) has been used at this clinic in almost all patients with various forms of hemorrhoidal disease. Aim of this study was to ascertain whether this intervention can be done without general anaesthesia, the hemorrhoidal knots regress and this procedure provides advantages over the classical methods of treating hemorrhoids. PATIENTS AND METHODS: Early results of DG-HAL in 248 patients are presented. Through a special proctoscope the arteries leading to the hemorrhoidal cushions are located in the pain-free rectum under Doppler guidance and suture ligated. The form of anaesthesia, duration of the operation, numbers and sites of the ligatures, additional interventions and postoperative complications were recorded. RESULTS: 171 patients (69%) needed no anaethesia. 147 patients (Without additional interventions) were re-examined 6 weeks after the operation: 61.2% were free of symptoms. A total of 87.7% were at least improves. The complication rate was low. CONCLUSION: In our experience DG-HAL has been a well tolerated efficacious method with few complications in the ambulatory treatment of hemorrhoids. The ideal indication for this methods is nonprolapsing hemorrhoids.

Adult↗