Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “PROCTOLOGY”

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.

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

At least 757 records · Page 42Linked to original sources
PubMedDate not supplied

Pelvic lymphoscintigraphy: contribution to the preoperative staging of rectal cancer.

PURPOSE: Preservation of the anal sphincter in surgery for cancer of the distal rectum in an attempt to avoid colostomy has been a main concern of colorectal surgeons. Various proposed procedures contradict oncological principles, especially with respect to pelvic lymphadenectomy. Therefore, prior knowledge of pelvic lymph node involvement is an important factor in choosing the operative technique, i.e., radical or conservative resection. Introduction of ultrasound, computerized tomography, and magnetic resonance have made preoperative study of the area possible. Nevertheless, these resources offer information of an anatomical nature only. Lymphoscintigraphy enables the morphological and functional evaluation of the pelvic area and contributes toward complementing the data obtained with the other imaging techniques. The objective of this prospective study is twofold: to standardize the lymphoscintigraphy technique and to use it to differentiate patients with rectal cancer from those with other coloproctologic diseases. CASUISTIC AND METHODS: Sixty patients with various coloproctologic diseases were studied prospectively. Ages ranged from 21 to 96 years (average, 51 and median, 55 years). Twenty-six patients were male and 34 were female. Thirty patients had carcinoma of the distal rectum as diagnosed by proctologic and anatomic-pathologic examinations, 20 patients had hemorrhoids, 5 had chagasic megacolon, 2 had diverticular disease, 2 had neoplasm of the right colon, and 1 had ulcerative colitis as diagnosed by proctologic exam and/or enema. The lymphoscintigraphy method consisted of injecting 0.25 mL of a dextran solution marked with radioactive technetium-99m into the right and left sides of the perianal region and obtaining images with a gamma camera. The results were analyzed statistically with a confidence level of 95% (P <.05) using the following statistical techniques: arithmetic and medium average, Fisher exact test, chi-square test corrected for continuity according to Yates, and distribution tables for the number of patients. RESULTS: In rectal cancer, the tracer progresses unilaterally or is absent; in other patients, the progress of the tracer is bilateral and symmetrical, although its progress may be slow. Statistical tests showed with high significance that the agreement index between the clinical diagnosis and the result of the lymphoscintigraphic exam was 93%. CONCLUSIONS: Lymphoscintigraphy is a standardized, painless, and harmless test that can be performed in all cases; it differentiates patients with rectal cancer from those with other coloproctological diseases.

Adult↗
PubMed2004

Open lateral internal anal sphincterotomy under local anesthesia as the gold standard in the treatment of chronic anal fissures. A prospective clinical and manometric study.

BACKGROUND: Chronic anal fissure is one of the most frequent proctological disorders in Western populations. Open lateral internal sphincterotomy is one of the therapeutic options accepted as the treatment of choice for chronic anal fissure, since it reduces the hypertonia of the internal anal sphincter (the main etiopathogenic mechanism of fissures), decreases anal pain, and allows the fissure to heal. MATERIAL AND METHODS: We carried out a prospective study of 120 patients operated on for chronic anal fissure with open sphincterotomy under local anesthesia at our Proctology Outpatient Unit from 1998 to 2001. No preoperative studies, bowel preparation, or antibiotic prophylaxis were carried out. All patients were followed up after 1 week, 2 months, 6 months, and 1 year, and underwent an anal manometry before and after surgery. RESULTS: Early complications: 3 hematoma-ecchymosis of the wound (2.5%), 3 self-limited hemorrhage events (2.5%). No hemorrhoidal thrombosis, fistulas, or perianal abscesses occurred. Fissures recurred in nine patients (7.5%) within one year. The initial rate of incontinence of 7.5% at two months dropped down to 5% at six months. The mean resting pressure (MRP) in incontinent patients was lower than in continent patients (55 +/- 7 mmHg versus 80.7 +/- 21 mmHg). The difference in mean squeeze pressure (MSP) between incontinent patients and continent patients was not statistically significant. CONCLUSIONS: Open sphincterotomy under local anesthesia has a long-term rate of healing and a morbidity rate similar to other techniques. It may therefore be considered an effective treatment for chronic anal fissure.

Adult↗
PubMed2001

[Precancerous conditions and neoplasms of the anal area].

Classification of this lesions could be done concerning localisation and histological type. Squamous cell carcinoma of the anal canal are the most often to be found, but overall neoplasias in this region are very seldom. The most important role in pathogenesis seems to play infection with HPV viruses. Symptoms are in the beginning unspecific and similar to other common proctological diseases. Proctological diagnostic procedures are to be combined with cytological methods. Therapeutic management depends on malignant potential of the lesions and contains local excision, total operation and combined radiochemotherapy, which is today considered standard therapy of squamous cell carcinoma of the anal canal.

Anal Canal↗
PubMed1992

[What is the value of anorectal manometry today?].

Since it was first introduced into clinical investigations in 1960 by M. Schuster, anorectal electromanometry has become one of the most-important methods to evaluate anorectal continence. Electromanometry now is a wide-spread, safe and simple screening method to analyze chronic constipation and to control the results of proctologic surgery. Its most important parameters are the anorectal pressure profile, the squeezing pressure profile, the adaptation reaction, the internal sphincter relaxation, and the rectal sphincteric reflex to the external anal sphincter. Wherever proctology is performed, electromanometry and electromyography of the external sphincter muscle should be done.

Anal Canal↗
PubMedDate not supplied

[Ambulatory treatment of anal fissure].

Not a long time ago, the standard treatment for anal fissure was surgical, inpatient care; this concept failed in the last years, ambulatory treatment becoming the rule and the inpatient care the exception. We wish to present here our results in 125 ambulatory patients, who were referred to our proctologic office with anal fissure. We used two methods: a conservative one, by applying topical 0.2% nitroglycerine, similar to other proctology practitioners, and one method of our own which is a minimal surgical procedure consisting of sphincterotomy. The average follow-up period was 6 months. Symptom-free and anatomic-free states were obtained in 61.2% for conservative treated patients and in 91.4% for operated patients, respectively. We had no postoperative complications, rebounds or sequelae. We consider the results at least equal in effectiveness to those of standard surgical treatment. This is why we underline that ambulatory treatment for anal fissure reaches the goal to be of a first line option.

Administration, Topical↗
PubMedDate not supplied

[Scientific background and clinical implementation: three new proposals in coloproctology].

OBJECTIVE: The Authors underline three clinical problems in coloproctology: the surgical access to the anal canal, the lacking aspects of the actual classification of hemorrhoids, the difficult choice of the surgical treatment in case of coexisting III degrees and IV degrees degree of hemorrhoids. They propose a new anal retractor which enables the surgeon to better calibrate all the surgical procedures inside the anal canal and to operate alone without the help of another operator. A new computerized software is able to rapidly guarantee a numeric score for hemorrhoids which is repetable before and after treatment of the disease. The Authors present a new surgical technique defined of transfixed stichtes for the resolution of the most advanced stage of hemorrhoids. PATIENTS AND METHODS: The new anal retractor was used in fifthy consecutive patients operated on for proctological problems. A quickly computerized score coming from the new classification PATE 2000 Sorrento was evaluated in one hundred patients, while the surgical technique of transfixed stichtes was utilized in fifthy. RESULTS: All the surgical procedures performed with the new device were concluded without complications. The highest values of the score from PATE 2000 Sorrento always fit with the surgical treatment of the disease, while transfixed stitches gave dysuria in five patients, but a better quality of life was referred by 38 over 50 patients treated. CONCLUSIONS: The Authors underline in this paper the results of the clinical implementation of these three new solutions in colon-proctology.

Adult↗
PubMed2006

The survey on the practice of gastroenterology in Romania.

AIM OF THE STUDY: To get data on the current practice of Gastroenterology in Romania. MATERIAL AND METHOD: We obtained data regarding the number of gastroenterologists in Romania from the Centre of Statistics of the Ministry of Health and Family (CSMHF) and the National Centre of Training for Medical Personnel (NCTMP). We sent a questionnaire to all the Centers of Gastroenterology in Romania inquiring about the number of gastroenterologists and fellows, and about the gastroenterological procedures performed. We compared these data to that of 17 European countries. RESULTS: The total number of gastroenterologists in Romania on January 1, 2005 was 175 (123 specialists and 52 senior consultants), and the total number of fellows in training was 133. Romania has a small number of gastroenterologists - 0.83/100,000 inhabitants, expected to reach approximately 1.4/100,000 inhabitants in 2010. Regarding the abilities in gastroenterological procedures, we obtained data from 98 gastroenterologists. They have good performances in diagnostic gastroscopy (97%), colonoscopy (81.6%), abdominal ultrasound (79.6%), but a poor performance in ERCP (10.2%). Less than half of the gastroenterologists (46.9%) perform proctologic procedures. Data regarding the training program of the Romanian fellows are disappointing: only 69.1% of them perform gastroscopy, 33.8% colonoscopy, 2.9% ERCP, 64.7% abdominal ultrasound and 14.7% proctology. CONCLUSIONS: The number of gastroenterologists in Romania seems low compared with most European countries. They do not acquire a uniform satisfactory mastering of gastroenterological procedures during their training program. This should be improved according to the guidelines of the European Diploma of Gastroenterology.

Digestive System Surgical Procedures↗
PubMed1990

[Outpatient hemorrhoidectomy using the CO2 laser].

In the free standing center of ambulatory surgery of Nice, proctology with carbon dioxide laser is a basic activity. Among 177 cases of proctology operated during 1989, we find 91 hemorroïdectomies realized with CO2 laser in strictly ambulatory surgery (no hospitalisation). This work's interet is demonstrating adaptation to the laser makes many advantages to the classic operation of Milligan and Morgan: simplification of the surgical technique easy post-operative course, no hospitalisation and quicker return to work, leading to a lower cost of this pathology. Complications are rare and excellent results noted.

Female↗
PubMed1986

Non-neoplastic stenoses of the rectum.

Rectal stenoses, often accompanied by a simple, non-specific symptomatology, have multiple and varied causes. The clinical picture is far from specific and can go from absolute latency to the full picture of a distinct colic occlusion. The clinical examination mainly relies on the data from the proctologic examination and, in particular, the rectal touch that enables detection of the lesion. This proctologic examination is completed with a uro-genital clinical check-up. The complementary endoscopic, X-ray and biological examinations are dominated by rectoscopy, barium enema and, if necessary, scanner, ultrasonography and anatomopathology. The etiological forms comprise stenoses by extrinsic compression; inflammatory or non-inflammatory pseudo-tumoral stenoses; inflammatory cryptogenetic (RCH, Crohn) or specific (infectious, parasitic and venereal) stenoses; ischaemic stenoses; traumatic stenoses by internal or external traumatism and medical iatrogenic, post-physiotherapeutic or post-surgical stenoses. The therapeutic problems depend on the type, age and size of the evolution as well as the cause (etiology) of the lesions. Depending on the case, we have to "make do with it", circumvent the problem, force or remove the obstacle.

Constriction, Pathologic↗
PubMed1985

[Anorectal neuralgias].

Ano-rectal neuralgia consists of pain in the ano-rectal region without any underlying organic proctological disease. Classically, three major clinical groups are defined, although associated, successive and intermediary forms may also exist. Proctalgia fugax is the most distinctive condition, consisting of brief episodes of nocturnal pain recurring at very variable intervals. In coccygodynia, the pain is postural and reproduced by pressure and mobilisation of the coccyx. The other forms of ano-rectal pain are grouped under the heading ano-rectal neuralgia or neurosis, which are characterised by the imprecision and the variability of the symptoms described. The pathogenesis of these forms of pain is unknown. Psychiatric elements are generally involved in these conditions, especially in the third clinical group. The treatment suffers from this uncertainty about the pathogenesis. The patient should be reassured by means of the least aggressive proctological procedures.

Anus Diseases↗
PubMed1979

[Anal symptoms of gastro-intestinal diseases].

In most cases the ano-cutaneous clinical symptoms correlated to diseases of the gastro-intestinal tract are not specific (erythema, itching, wounds or scarring). However in the following diseases occasional dermatological lesions may directly contribute to their diagnosis: in Crohn's disease, tuberculosis of bowel, chronic entamoebiasis and bilharziosis, the skin lesions of the anal area have the same histological structure as the gut lesions. Perianal fistulas and ulcers are frequent in Crohn's disease especially if there is a colonic and rectal spreading; they respond badly to steroid therapy and are often correlated with a worse prognosis. Perianal specific lesions occur often in oxyuriasis in children, in candidiasis of the digestive tract, in systemic aphthosis and in some malignancies. In other gastro-intestinal disturbances, the dermatological and features are less specific and can only be suggestive: iatrogenic and microbial diarrheas, side-effects of laxatives, proctological diseases. It has to be emphasized that pruritus ani is only induced by deeper lesions when they spread to the perianal skin. In proctological practice, contact dermatitis by sensitivity to anaesthetics or suppository balsams (Peruvian balsam), itching or burning atrophy by topical steroid abuse, non-diagnosed fungal (candidiasis), bacterial (erythrasma) or psoriatic intertrigos (flexural psoriasis) may sometimes explain the failure of therapy.

Adult↗
PubMed1984

[Clinical manifestations of squamous cell carcinoma of the rectum].

The report deals with an evaluation of the data on 107 cases of squamous cell carcinoma of the rectum. 63 patients (58.8%) had proctological diseases in their case histories. Anal carcinoma is being misdiagnosed at out-patient hospitals as some other proctologic lesion in 34.9%. This fact points to the staff's lack of knowledge of the clinical picture of squamous cell carcinoma of the rectum. Abdominal-perineal extirpation of the rectum was the most frequent procedure used in the treatment of squamous cell carcinoma.

Adenocarcinoma↗
PubMed1982

[Experiences with intraoperative colonoscopy in patient protocols in 2,547 cases].

Technique and indications for intraoperative colonoscopy are reviewed. A total retrograde fiberoptic colonoscopy was performed on the unopened bowel at laparotomy in 1135 patients, and a partial colonoscopy (70 to 90 cm) in 1412 patients. Additional polyps were found in 24% of patients with carcinoma of the rectum and colon (n = 1023), in 26% of patients with diverticulitis (n = 112), and 8.3% of patients with proctological diseases (n = 1412). A second carcinoma was found in 3.1% of cases with colonic carcinoma, in 1.8% of cases with diverticulitis, and 0.35% of cases with proctological diseases.

Colonic Neoplasms↗
PubMed1995

[Methodical aspects of formation of diagnostically related groups for inpatient therapeutic-prophylactic institutions].

The authors discuss problems concerning the methodology of the evolution of standard sets of therapeutic-prophylactic measures and diagnostically related groups (DRG) for in-patient hospitals. The peculiarities of the formation of DRG for colo-proctological patients in a proctological clinic are shown as an example and DRG of the surgical and therapeutic classes are indicated. The results of studying the frequency of combined pathology in diseases of the large intestine are discussed.

Colonic Diseases↗
PubMed1993

[Prospective payment per case and length of stay at coordinated private hospitals].

BACKGROUND: In 1991 the Valencian Health Service (SVS) introduced a system of prospective payment per process to reimburse some surgical interventions to coordinated private hospitals which, until then, had invoiced by retrospective payment per hospital stay. The impact of this change on the mean length of stay in seven groups of surgical interventions is evaluated. METHODS: Retrospective analysis of the mean stay of 2025 admissions in private hospitals coordinated under both systems of payment (payment per process 66%, October 91 to February 92; payment by stay 64%, March 91 to February 92) for seven groups of surgical procedures: cataract surgery, cholecystectomy, hernioraphy, prostate resection, tonsillectomy-adenoidectomy, varicose vein and proctologic procedures was carried out. RESULTS: Mean hospital stay decreased (mean = 5.4 days; p < 0.001) in all the groups reimbursed under PRP (from 72% in proctologic conditions to 43% for adenoidectomy-tonsillectomy) avoiding 8727 stays. The coinciding period under both systems demonstrated a decrease of mean hospital stay similar to the total period. CONCLUSIONS: The coordinated hospitals demonstrated a surprisingly rapid capacity to modify their organizative behaviour or influence the styles of clinical practice or both to adopt the patterns of length of stay which optimize profits according to the system of payment used by the SVS.

Hospitals, Private↗
PubMedDate not supplied

The gay bowel syndrome: clinico-pathologic correlation in 260 cases.

The clinical and pathological findings in a group of 260 homosexual men comprising 10% of a private proctologic practice are reviewed. A clinical pattern of anorectal and colon diseases encountered with unusual frequency in these homosexual patients is termed the gay bowel syndrome. The clinical diagnoses in decreasing order of frequency include condyloma acuminata, hemorrhoids, nonspecific proctitis, anal fistula, perirectal abscess, anal fissure, amebiasis, benign polyps, viral hepatitis, gonorrhea, syphilis, anorectal trauma and foreign bodies, shigellosis, rectal ulcers and lymphogranuloma venereum. 60 anorectal and sigmoid biopsies from 51 patients failed to disclose evidence of specific infection other than condyloma acuminata. Of 21 patients with biopsy diagnosis of nonspecific proctitis, 8 had a specific infection which was detected by other means,--5 cases of shigellosis and one case each of gonorrheal proctitis, amebiasis and lymphogranuloma venereum. In evaluating proctologic problems in the gay male, all of the known sexually transmitted diseases should be considered. Shigellosis, amebiasis and viral hepatitis should be included. Microbiological evaluation is essential. Concurrent infections with 2 or more pathogens should be anticipated. Chlamydia trachomatis, an important cause of nonspecific urethritis in the general population, is high on the list of possible causes of the nonspecific proctitis present in 31 of the 260 patients.

Abscess↗
PubMedDate not supplied

[Villous and tubulovillous adenomas of the colon and rectum. Results in 30 patients].

UNLABELLED: Colorectal adenomas precede carcinomas as much as they become larger and present villous histology. Since colonoscopic polypectomy cannot remove all polyps, surgical options include local resection as well as segmental colectomy. Significant morbidity and high recurrence rates may occur following individual and polyp-related characteristics. This paper focuses the clinical aspects of colorectal tubulo-villous adenomas and the results of the surgical treatment. PATIENTS AND METHODS: Hospital charts from 30 patients who underwent surgical treatment of colorectal tubulovillous adenomas between 1980 and 1997 were retrospectively reviewed. RESULTS: Rectal bleeding, urgency and mucus discharge were the most frequent clinical findings. Proctologic examination (digital and rigid rectosigmoidoscopy) diagnosed the lesion for the majority of cases. Seventy per cent of the polyps were in the distal rectum and 60% were larger than 4 cm. Transanal resection was the surgical option for one half of the patients and segmental colectomy for the other. Fourty-two per cent of the polyps that were considered benign as result of preoperative biopsy showed malignant transformation when the whole polyp was examined. Recurrence rate was 26.7% and 6.7% for patients who underwent local resection and segmental colectomy respectively. Postoperative complication rate was similar for the two surgical groups. CONCLUSIONS: Recurrence may occur frequently after standard local resection. Preoperative biopsy examination has no role for the diagnosis of malignant transformation. Office proctologic examination diagnoses majority of colorectal polyps that may be elected for surgical resection.

Adenoma, Villous↗
PubMed2000

Standardization of anal sphincter electromyography: uniformity of the muscle.

The different parts of the external anal sphincter (EAS) are usually regarded as one muscle with common EMG characteristics. This assumption was addressed by comparing the number of continuously firing motor units (MUs) during relaxation, as well as the parameters of motor unit potentials (MUPs) and interference pattern (IP) in the subcutaneous and the deeper parts of EAS. MUPs and IPs were analyzed in 44 subjects (2008 MUPs and 3014 IPs) without uroneurological or proctological disorders, and the number of continuously active MUs in 34 of these subjects was recorded (221 positions). No significant difference was found in IP and most MUP parameters between the two parts of the EAS muscle, but the number of continuously firing MUs was lower in the deeper part. As far as MUP and IP characteristics are concerned, the whole EAS can be considered as one muscle, but some differences in patterns of activation of MUs may exist in different regions.

Adult↗