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At least 739 records · Page 41Linked to original sources
PubMed1999

Curative external beam radiotherapy for prostate carcinoma: results in 231 patients treated in Lyon.

BACKGROUND: Radical prostatectomy and external beam radiation therapy (EBRT) are the mainstays of treatment of prostate cancer with curative intent. The possible development of radiation proctitis and rectal bleeding are major concerns when using EBRT. Recently, conformal radiotherapy has been introduced in an attempt to improve the results of EBRT. This paper presents an overview of the Lyon experience using standard EBRT with doses of 68 Gy, and reports the preliminary results of a study of conformal radiotherapy with dose escalation. METHODS: From 1981 to 1995, EBRT was used to treat 231 patients with localized adenocarcinomas of the prostate. The dose of EBRT was 68 Gy/34 fractions/7 weeks using a four-field box technique with 18-MeV photons. A feasibility study of conformal radiotherapy was commenced in 1996. To date, 145 patients have been treated with doses escalating from 68 to 80 Gy. RESULTS: In the EBRT group of 231 patients, the 5-year overall survival was 80.3%. Anorectal function was scored as excellent in 90% of patients. Rectal bleeding was seen in 14.3% of patients and required local treatment in only seven. In the group treated with conformal radiotherapy, the preliminary results indicate good early tolerance. CONCLUSION: The curative treatment of patients with prostate cancer using EBRT gives good long-term survival with low rectal toxicity. Conformal radiotherapy appears to be an interesting approach to improve local control and perhaps survival.

Adenocarcinoma↗
PubMed2000

Colonic J pouch reconstruction of the radiation-damaged neorectum.

BACKGROUND: Postoperative radiotherapy after restorative resection for rectal carcinoma can cause fibrosis, stricture and proctitis. There are few accounts in the literature of the surgical approach to the radiation-damaged neorectum. METHODS: Reported are four patients who underwent resection of the radiation-damaged neorectum with colonic J pouch reconstruction between September 1996 and July 1997. The operative and postoperative course is described. Parameters of bowel function were assessed by standardized interview 6 months after ileostomy reversal. Ongoing follow up has occurred to the present time. RESULTS: There was no mortality. Complications were splenic injury requiring splenectomy and a pelvic collection requiring percutaneous drainage. At 6 months after ileostomy reversal all patients had ongoing disturbance of bowel function, and two patients described some degree of incontinence. The mean frequency of bowel actions was four per day. Two patients have subsequently undergone further resection and formation of an end stoma. CONCLUSIONS: Resection of the radiation-damaged neorectum with colonic J pouch reconstruction is technically feasible. Functional results in the present series were disappointing and half the patients went on to formation of a permanent stoma.

Adult↗
PubMed1999

Short-term morbidity and acceptability of 125iodine implantation for localized carcinoma of the prostate.

OBJECTIVE: To report the short-term morbidity and acceptability of the first 50 patients treated with the percutaneous implantation of radioactive iodine seeds for localized carcinoma of the prostate at the Cookridge Hospital. PATIENTS AND METHODS: Fifty patients were treated with transrectal ultrasonography-guided percutaneous implants with radioactive (125I) iodine seeds for localized carcinoma of the prostate. The mean hospital stay was 36 h and most patients were able to return to work or normal activity within one week of implantation. RESULTS: All patients developed urethritis which was most marked within the first 3 months of treatment; 8% of patients developed acute retention which resolved after temporary catheterization. At 3 months, 36% of patients still had moderate frequency and 18% moderate dysuria, but by 12 months these had resolved and only 5% of patients still complained of moderate nocturia. There were no cases of incontinence. The incidence of proctitis was very low, with only 2% still complaining of moderate symptoms at one year. Of those potent before implantation, 72% retained potency at one year. CONCLUSIONS: Although it is too early to comment either on late morbidity or on outcome, the results of this study show a side-effect profile similar to that reported by other centres using the same technique.

Aged↗
PubMed1990

Rectal pseudotumor due to Chlamydia trachomatis in a male homosexual.

Chlamydia trachomatis causes a wide spectrum of human genital infections including lymphogranuloma venereum. We describe an unusual case of Chlamydia trachomatis proctitis in a homosexual man presenting with a large, solid tumor in the distal rectum, which was treated successfully by long-term oral doxycycline therapy.

Adult↗
PubMed1984

[Complications of postoperative radiotherapy in uterine cancer].

A report is given about reversible and irreversible complications following postoperative irradiation in cases of endometrial carcinomas. Intravaginal brachytherapy (Ra226, vaginal cylinder applicator) is given. In advanced cases or in cases with poor prognosis (tumor grading) percutaneous irradiation was added (Co60). Reversible complications (cystitis, proctitis) could be observed in 7%, irreversible complications (fistulas, stenosis) in 1.9% of the cases, respectively. The rate of radiation side effects after primary operation is lower than after primary irradiation of endometrial carcinoma. This is contrary to the results in postoperative irradiation of cervical carcinoma with a markedly higher rate of irradiation side effects. After postoperative intravaginal brachytherapy (Ra226) alone, only in 5.9% of the cases reversible and in 0.8% irreversible complications were observed.

Adult↗
PubMed1980

[The treatment of inoperable endometrial cancer by means of intracavitary radiotherapy (author's transl)].

Epidemiological data are presented to point out the importance of endometrial cancer and the role of primary irradiation. 650 patients with endometrial cancer, who could not be operated because of local tumor spread or contraindication to surgery were treated by primary irradiation at the Department of Radiotherapy of the 1st University-Clinic of Gynecology and Obstetrics in Vienna. 312 patients (48%) were alive after five years. Severe proctitis and/or cystitis was seen in 10,8% fistulas in 2% of the treated patients. These results were obtained with conventional intracavitary radium application.

Adolescent↗
PubMed1983

Strongyloidiasis. When to suspect the wily nematode.

Strongyloidiasis is a tenacious soil-transmitted nematode infestation endemic in the south-eastern United States. Thirty-three cases were diagnosed in a series of 1,290 stool examinations in 971 patients at Veterans Administration Medical Center, Mountain Home, Tennessee. Most patients had a concurrent major illness, such as chronic lung disease, serious bacterial infection, or cancer. A minority presented with gastrointestinal symptoms alone. Skin rash was uncommon. Eosinophilia, IgE elevation, and skin anergy were common. Atypical presentations included severe proctitis, colitis, and exacerbation of inflammatory bowel disease. In a patient with the hyperinfection syndrome, the diagnosis was made only at autopsy. Since strongyloidiasis seems to present like an opportunistic illness, all physicians, not just those in endemic areas, should consider its presence in the appropriate setting.

Adult↗
PubMed1997

Effects of short-chain fatty acids on the inflamed colonic mucosa.

Selected inflammatory conditions of the distal alimentary tract may respond to topical SCFA treatment. The rationale for using SCFA enemas is based on Roediger's (1980) observation that butyrate is the preferred fuel of colonocytes and that SCFA deficiency could lead, in the short term, to mucosal hypoplasia and, in the long term, to colitis. The absence of luminal nutrients is especially evident in the excluded rectum after complete diversion of the faecal stream. Harig et al. (1989) were the first to treat successfully diversion colitis with SCFA irrigation (acetate 60 mM, propionate 30 mM, n-butyrate 40 mM). However, subsequent studies could not reproduce the initial positive data. In distal ulcerative colitis an impaired mucosal oxidation of SCFAs has been described despite their luminal abundance. Pilot studies using either the SCFA mixture or butyrate monotherapy have yielded promising results. However, extended confirmatory studies with a larger sample size have not yet been performed. Preliminary data are also available for the use of SCFA in pouchitis and radiation proctitis. In summary, SCFA topical therapy seems to be a promising option in distinct forms of inflammatory bowel disease; however, the routine use of SCFAs cannot be recommended until their efficacy has been confirmed in larger trials.

Administration, Topical↗
PubMed2006

Association of herpes simplex virus type 2 infection and syphilis with human immunodeficiency virus infection among men who have sex with men in Peru.

BACKGROUND: We evaluated associations between human immunodeficiency virus (HIV) infection, herpes simplex virus type 2 (HSV-2) infection, and syphilis among men who have sex with men (MSM) in Peru. METHODS: A surveillance survey of 3280 MSM was conducted; sexual behavior was assessed with a structured computer-assisted self-interview, and serum antibody testing was performed for HIV, HSV-2, and Treponema pallidum. RESULTS: HIV, HSV-2, and syphilis seroprevalences of 13.9%, 46.3%, and 13.4% were detected, respectively. HSV-2 seroprevalence was twice as high in HIV-infected subjects (80.5%) than it was in HIV-uninfected subjects (40.8%) (P < .01), and HSV-2 seropositivity (adjusted odds ratio [AOR], 5.66) was found to be strongly associated with HIV infection. In addition, homosexual self-definition (AOR, 3.12), exchange of sex for money (AOR, 1.61), unprotected sex (no condom) (AOR, 2.81), history of sex work (AOR, 1.89), oral receptive sex (AOR, 1.43), and cocaine use before/during sex (AOR, 2.53) within the preceding 6 months, as well as such sexually transmitted infections (STIs) and STI syndromes as proctitis (AOR, 2.80), genital ulcer disease (GUD) (AOR, 2.06), prior syphilis (AOR, 2.64), genital warts (AOR, 1.70), and self-reported STIs within the preceding 6 months (AOR, 1.61), were also found to be significant predictors of HIV infection. CONCLUSIONS: We found a strong association between HSV-2 seropositivity and HIV infection. Intervention measures against GUD due to HSV-2 infection and syphilis, such as routine testing, early detection, HSV-2 suppressive treatment, and condom distribution, need to be enhanced as part of STI prevention strategies at a national level to effectively reduce HIV infection among MSM in Peru.

Adolescent↗
PubMedDate not supplied

Jejunoileal bypass: change in the flora of the small intestine and its clinical impact.

Among the complications of jejunoileal bypass for morbid obesity are proctitis, bypass enteritis, liver disease, dermatitis, and arthritis, all of which are thought to be connected with the intestinal microflora. Quantitative cultures from the small bowel of patients before the establishment of the bypass and from patients with reoperations indicate colonization of both the functioning small bowel (bacterial counts, 10(5.0)-10(7.6)/ml) and of the bypassed loop (bacterial counts, 10(6.4)-10(9.7)/ml). Experiments in animals have shown that the presence of a bypassed loop, as compared with that of a resected bowel, is necessary for increased weight loss and for the development of liver disease. Clinical evidence for the impact of the intestinal microflora is based on the beneficial effect of antimicrobial agents, especially metronidazole, and on the demonstration of immunologic phenomena involving antigens of bacterial origin. Complications of jejunoileal bypass may serve to elucidate the pathogenesis of other diseases.

Adult↗
PubMed1989

Lymphogranuloma venereum: 27 cases in Paris.

Twenty-seven men with laboratory-confirmed lymphogranuloma venereum (LGV) were identified among 211 patients tested for LGV or chancroid during a 6-y period. The patients with LGV ranged in age from 17 to 73 y; most were from countries other than France. Twenty-five sought care because of inguinal adenopathy (with spontaneous draining fistulae in two patients) and two because of proctitis. Chlamydia trachomatis was isolated from nine patients; all isolates were the LGV biovar as demonstrated by biologic characterization and monoclonal antibody reactivity. In patients without isolation of C. trachomatis, the diagnosis was based on chlamydial complement fixation antibody titers greater than or equal to 1:32 (mean titer, 1:128). Genital herpes was an associated diagnosis in one patient and syphilis in two patients. Serologic evidence of exposure to human immunodeficiency virus (HIV) type 1 was present in five patients and to HIV-2 in one patient.

Adolescent↗
PubMed1988

Clinical and laboratory indicators of extent of ulcerative colitis. Serum C-reactive protein helps the most.

We estimated the extent of the inflammatory mucosal lesion by colonoscopy and biopsy in 60 patients with their first attack of ulcerative colitis. Proctitis was found in 12, proctosigmoiditis in 19, left-sided colitis in 10, and extensive colitis in 19. Fourteen clinical variables and laboratory measurements (bowel frequency, stool consistency, rectal bleeding, fecal mucus/pus, temperature, pulse rate, white blood cell count, hematocrit, sedimentation rate, serum iron, serum albumin, serum alpha 2-globulin, serum C-reactive protein, and seromucoids) were determined. All the variables except rectal bleeding and hematocrit were correlated (p less than 0.001) with the extent of colitis. On stepwise discriminant analysis, only C-reactive protein distinguished proctosigmoiditis from more improved the discrimination. Cross-validation by the "jack-knife method" showed that 86.7% of patients were correctly classified, the errors consisting in underestimation of disease in 8/29 patients with extensive colitis.

Adolescent↗
PubMedDate not supplied

Cefoxitin vs. penicillin in the treatment of uncomplicated gonorrhea.

Four hundred six men and women with gonorrhea were randomly assigned to receive either 2 g of cefoxitin or 4.8 X 10(6) units of aqueous procaine penicillin G intramuscularly. All patients also received 1 g of probenecid orally. There was no statistically significant difference in the failure rate between patients treated with penicillin (4.3%) and those treated with cefoxitin (5.1%). Twelve (92%) of 13 homosexual men with gonococcal proctitis who received penicillin and 19 (95%) of 20 who received cefoxitin were cured. Adverse reactions were infrequent and mild in the cefoxitin-treated group. Three patients who received penicillin developed reactions consistent with procaine toxicity. It is concluded that cefoxitin is a safe and effective alternative to penicillin for treating uncomplicated anogenital gonorrhea in men and women.

Adult↗
PubMedDate not supplied

Multiple co-existing sexually transmitted diseases in a bisexual man.

The authors report an interesting and instructive case of a bisexual man with four concurrent sexually transmissible infections: secondary syphilis, genital herpes, gonococcal proctitis, and asymptomatic chlamydial urethritis. The case illustrates the necessity for a systematic approach to the diagnosis and management of multiple co-existing sexually transmitted diseases, and it underscores the importance and difficulty of contact-tracing in this patient population.

Adult↗
PubMed1988

Bilateral pelvic lymphadenectomy, iridium 192 template, and external beam therapy for localized prostatic carcinoma: complications and results.

Thirty-five patients with prostatic adenocarcinoma were treated by bilateral pelvic lymphadenectomy and temporary implantation of iridium 192 strands with adjuvant external beam radiotherapy. With the implant the prostate received between 3,200 and 3,500 gray (Gy) followed in two weeks by small-field external beam irradiation for an additional dose of approximately 3,400 Gy. Morbidity included an ileofemoral thrombosis in one patient, and transient radiation proctitis in four patients; one patient required transurethral prostatic resection for obstruction at one year. Local response of the primary tumor was dramatic in every case at three-month follow-up. In 11 of 15 patients (73%), biopsy at one year showed no evidence of disease.

Adenocarcinoma↗
PubMed2006

Food intolerance and chronic constipation: manometry and histology study.

BACKGROUND: Chronic constipation in children can be caused by cows' milk intolerance (CMI), but its pathogenesis is unknown. AIMS: To evaluate the histology and manometry pattern in patients with food intolerance-related constipation. PATIENTS AND METHODS: Thirty-six consecutive children with chronic constipation were enrolled. All underwent an elimination diet and successive double-blind food challenge. All underwent rectal biopsy and anorectal manometry. RESULTS: A total of 14 patients were found to be suffering from CMI and three from multiple food intolerance. They had a normal stool frequency on elimination diet, whereas constipation recurred on food challenge. The patients with food intolerance showed a significantly higher frequency of erosions of the mucosa, and the number of intra-epithelial lymphocytes and eosinophils. The rectal mucous gel layer showed that the food-intolerant patients had a significantly lower thickness of mucus than the other subjects studied. Manometry showed a higher anal sphincter resting pressure and a lower critical volume in food intolerance patients than in the others suffering from constipation unrelated to food intolerance. Both histology and manometry abnormalities disappeared on the elimination diet. CONCLUSIONS: Food intolerance-related constipation is characterized by proctitis. Increased anal resting pressure and a reduced mucous gel layer can be considered to be contributory factors in the pathogenesis of constipation.

Anal Canal↗
PubMed2005

A cluster of acute hepatitis C virus infection among men who have sex with men--results from contact tracing and public health implications.

OBJECTIVE: An acute hepatitis C virus (HCV) infection in an HIV-positive man who had sex with men (MSM) was notified. In the period of his seroconversion he was also diagnosed with a rectal lymphogranuloma venereum (LGV) infection, and was part of a cluster of 15 LGV cases in 2003. Our aim was to investigate HCV transmission and to search for potential spread among sexual contacts and known LGV patients. METHODS: Our case series included the index, two recent contacts, and 14 LGV cases. They were interviewed about parenteral exposure for HCV, history of sexually transmitted diseases(STDs), sexual behaviour and drug use. Laboratory investigations included anti-HCV antibodies, HCV-polymerase chain reaction, and HCV genotyping. RESULTS: Seven out of 17 MSM recently seroconverted for HCV (41%). Three genotypes were found. Parenteral risk factors were excluded. Six out of seven had LGV proctitis coinciding with HCV seroconversion, six (86%) were HIV infected. Unprotected anal contact was practised by both HCV uninfected and infected cases. Unprotected active and passive fisting was reported by all seven HCV infected men, compared with two of nine uninfected men (P = 0.003). Non-intravenous drug use during sexual activities was common among all MSM. Numerous, often anonymous, sexual contacts in various European countries were reported. CONCLUSIONS: A cluster of acute HCV infection is reported among mostly HIV-positive MSM, with multiple partners throughout Europe. Sexual techniques potentially leading to mucosal damage (fisting), concomitant STDs such as LGV and drug use seem facilitating factors for spread. Extensive case finding and partner tracing is advocated as well as targeted prevention messages.

Acute Disease↗
PubMed1983

Radical radiotherapy for carcinoma of the prostate: localized and extended field treatment.

From 1972 to 1981, 50 patients who received radical radiotherapy for clinically localized adenocarcinoma of the prostate have been reviewed. Of these 50 patients, 70% showed some degree of reaction to the radiotherapy in the form of minor, transient urinary or bowel symptoms. Significant complications occurred in 20%, the most common of which was proctitis. There was no apparent relation of complication rate to the extent of the radiation field. The overall corrected 5 year survival was 74%.

Adenocarcinoma↗