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At least 775 records · Page 43Linked to original sources
PubMed1975

Simple chronic constipation: pathophysiology and management.

Chronic constipation is not a simple problem. It is often related to fundamental beliefs and habits. Once it has been established that the cause is not an organic disorder, the physician must take pains to explore with the patient other possible causes. Simple, inorganic constipation can usually be traced to poor diet or poor habits. The physician should provide simple explanations of the mechanisms involved in the act of elimination and detailed instructions on appropriate food and water intake and the development of regular habits. Laxatives should be prescribed only if absolutely necessary and if the patient taking them can be carefully observed.

Antacids↗
PubMed1977

A new look at pediatric endoscopy.

As a result of recent developments in instrumentation, most endoscopic procedures can now be carried out safely in infants and children in less time and with less trauma than previously. In pediatric applications, laparoscopy is possible for the first time, bronchoscopy and esophagoscopy are greatly improved, and urethrocystoscopy can be done with accuracy and dispatch. Small flexible endoscopes have been evaluated for gastroduodenoscopy and colonoscopy.

Bronchoscopy↗
PubMed1979

Adenocarcinoma of unknown origin. A rational approach to a diagnostic puzzle.

Determination of the tissue of origin of disseminated adenocarcinoma is often difficult. Careful clinical evaluation of the patient in light of known characteristics of certain primary tumors, followed by appropriate screening tests, may yield decisive information. If not, a decision for or against more specific tests must be made.

Adenocarcinoma↗
PubMed1981

Lower GI bleeding in the elderly. Diverticulosis and angiodysplasia as dominant causes.

Angiography has greatly improved the precision of diagnosis of massive lower gastrointestinal bleeding in elderly patients. This, in turn, has permitted a more conservative approach, even when operative management becomes necessary. It bears emphasis, however, that hematochezia in elderly patients is usually relatively benign and tends to cease spontaneously. An overly enthusiastic diagnostic or therapeutic course is not warranted, and conservative control of the acute episode, followed by sufficient evaluation to rule out malignancy, is probably all that is necessary. When massive bleeding becomes persistent or recurrent, however, it is clearly life threatening, and a vigorous diagnostic and therapeutic program should be initiated promptly.

Age Factors↗
PubMed1985

Gastrointestinal endoscopy in the dog.

Gastrointestinal endoscopy has proved to be an important tool in the diagnosis of gastrointestinal disease in the dog. An endoscope for the examination of oesophagus, stomach, and colon is described. Examination of the duodenum is also possible with this type of endoscope in the larger breeds of dogs. Indications, advantages, and disadvantages of the endoscopy are pointed out.

Anesthesia, Inhalation↗
PubMed1990

Knowledge of colorectal cancer and use of screening tests among higher-risk persons.

Colorectal cancer is a major cause of cancer mortality in the United States, and certain risk factors have been identified. Random samples (N = 893) of residents between 40 and 74 years old in two areas (ie, Long Island, New York and the state of Connecticut) with relatively high rates of colorectal cancer were surveyed by telephone in 1988. Prevalence of certain risk factors for colorectal cancer was estimated, including family history of colorectal cancer and personal history of "ulcerative colitis" and "polyps." Knowledge of dietary risk factors for cancer (ie, cured meat and low fiber intake), daily use of fiber cereals, and frequency of medical checkups did not differ significantly among those in higher-risk groups v other respondents. In multivariate analyses a family history of colorectal cancer was a significant independent predictor of knowledge of the frequency of colorectal cancer relative to stomach cancer, and of ever having heard of a fecal occult blood test, but not of having had an occult blood test or procto(sigmoido)scopy. Persons reporting a history of "ulcerative colitis" had a lower assessment of the curability of colorectal cancer, and the frequency of recent procto(sigmoido)scopic examination was not increased. Findings are discussed with reference to potential educational programs in the primary and secondary prevention of colorectal cancer.

Adult↗
PubMed2005

Transanal endoscopic repair of rectal perforation with hemoclips.

A 74-year-old male patient had a full-thickness laceration of the mid-rectum during transurethral urologic surgery. The perforation site was 8-cm above the dentate line and 15 x 6 mm in size. Transanal direct access to the injury site was difficult and endoscopic repair with hemoclips was performed without any further intervention. He was discharged from the hospital uneventfully and complete healing was observed 6 weeks after the procedure. We concluded that endoscopic repair with hemoclips may offer a successful and simple closure method for extraperitoneal high lying rectal lacerations.

Aged↗
PubMed1996

Diagnostic utility of endoscopic ultrasonography for preoperative rectal cancer staging estimation.

The preoperative staging accuracy of endoscopic ultrasonography (EUS) was assessed in 38 rectal cancer patients who underwent rectal EUS and curative surgery from July 1992 to September 1994. We used a GF-UM20 instrument with both 12- and 7.5-MHz transducers. Compared with the histological findings, the diagnostic accuracy rate for EUS was 76% (29/38) for the invasion depth and 85% (sensitivity) and 72% (specificity) for level one lymph node metastasis, resulting in an overall preoperative staging accuracy of 74% (28/38). The diagnostic accuracy of invasion depth was poor (only 45%: 5/11) in cases shown histologically to be a1 (tumor invasion through muscularis propria into parietal fat), but ranged from 90 to 100% when the a1 cases were excluded. The diagnostic accuracy for level one lymph node metastasis was proportional to the nodal size. The size of lymph nodes that had been diagnosed as metastatic and non-metastatic (P < 0.05) differed significantly. Eighteen (86%) of the 21 metastatic nodes with histologically massive invasion were detected preoperatively by EUS. Eight of the 11 undetected metastatic nodes were either less than 4 mm in diameter or showed only slight invasion. Most (81%) of the level one metastatic nodes larger than 5 mm were found. The worst preoperative staging diagnostic accuracy was for stage II cases (63%: 5/8), and in four of the 10 misdiagnosed cases, the stage was underestimated due to slight nodal invasion or skip metastasis (2 cases each). Although it was difficult to diagnose nodal metastasis correctly in these cases, preoperative staging using EUS was considered useful for diagnosing almost 80% of our rectal cancer cases.

Humans↗
PubMed1998

Malignant tumors in the rectum simulating solitary rectal ulcer syndrome in endoscopic biopsy specimens.

Patients with solitary rectal ulcer syndrome (SRUS) frequently present with a mass that can be misinterpreted as cancer. In contrast, the occurrence and characteristics of SRUS-like histopathology produced by underlying malignancy have not been reported in detail. We report seven patients whose rectal mass that was induced by infiltrating carcinoma showed only histopathologic changes of SRUS on initial mucosal biopsy specimens. Carcinoma was evident in subsequent specimens after one to five repeat biopsies with delay in diagnosis from 1 week to 18 months in six patients. In one patient, infiltrating carcinoma was suggested on the first biopsy specimen by immunohistochemistry for cytokeratin. Three of the patients had primary rectal adenocarcinoma, two had metastatic carcinoma from stomach or ovary, and two had direct invasion of anal squamous cell carcinoma or prostatic adenocarcinoma. We conclude that the histopathology of SRUS may occasionally represent a characteristic but nonspecific mucosal reactive change to a deeper seated malignancy. The terminology "solitary rectal ulcer syndrome/mucosal prolapse changes" with a cautionary note may be useful for reporting biopsy results to emphasize the possibility of underlying primary or metastatic malignancy in the differential diagnosis.

Adenocarcinoma↗
PubMed1981

Endoscopic polypectomy: inadequate treatment for invasive colorectal carcinoma.

Endoscopic polypectomy has greatly decreased the necessity for transabdominal resection of adenomatous polyps of the colon and rectum. In addition, the routine removal of these presumed precancerous lesions may well decrease the incidence of colon cancer in these patients. However, some authors have proposed that endoscopic resection alone of certain pedunculated polyps containing invasive carcinoma is adequate treatment for these lesions. At Columbia-Presbyterian Medical Center this has not been our standard practice, and 729 patients who have undergone endoscopic removal of pedunculated adenomatous polyps of the colon and rectum during the past decade have been reviewed. Forty-seven (6.4%) of these patients had polyps containing carcinoma in situ for which no further resection was performed. Thirty-nine patients (5.3%) had polyps containing carcinoma which had invaded up to or through the muscularis mucosae and were, therefore, considered invasive carcinomas. In this latter group, 24 patients underwent colon resection and 15 underwent endoscopic polypectomy alone. Within the group undergoing resection, six patients (25%) had from one to two lymph nodes within the resected specimen containing metastatic cancer. In review of these lesions, all 24 were able to be resected with an intervening segment of uninvolved stalk. After analyzing the frequently quoted parameters of size, depth of invasion into the stalk, degree of differentiation and involvement of lymphatics within the polyp, it was not possible to predict which lesions would have lymph node metastases at the time of resection. Consequently, it is concluded that all patients with polyps containing invasive carcinoma should undergo standard colon resection if feasible, despite the technical ability to resect these lesions endoscopically with an "adequate" margin of uninvolved stalk. This will eliminate the possibility of undiagnosed Dukes' Stage C lesions, and potentially improve long-term survival rates within this group of patients with an otherwise poor prognosis.

Adult↗
PubMed1986

Postgraduate surgical flexible endoscopic education.

Postgraduate surgical education of residents in flexible gastrointestinal endoscopy is mandated by the American Board of Surgery. In that context, a retrospective analysis was performed of the general medical and endoscopic records of patients who experienced diagnostic and therapeutic flexible endoscopy during an 18-month period at the University of South Alabama Medical Center by surgical residents under the supervision of attending surgical endoscopists. That analysis revealed these procedures to be safe (diagnostic and therapeutic flexible endoscopy: morbidity incidence 0.4% and 2.2%, mortality incidence 0.2% and 1.1%, respectively), accurate (100%), and therapeutically beneficial (19% of the flexible endoscopic procedures were performed with therapeutic intent). Review of cumulative resident case profiles revealed that during the course of their clinical education (5 years), each resident performed approximately 400-500 endoscopic procedures, functioning successively as first assistant, primary endoscopist, and teaching assistant. The authors contend that: supervision by surgical endoscopists ensures safety and efficacy of the procedures during the education of postgraduate surgical residents; the surgical milieu--integration of endoscopic, surgical anatomic, and histopathologic data--provides the most effective educational format to acquire the skills necessary to achieve a high degree of accuracy associated with these endoscopic procedures; and therapeutic flexible endoscopy obviated the necessity for more invasive surgical procedures in approximately one-fifth of this patient population.

Adolescent↗
PubMed1989

Colostomy and drainage for civilian rectal injuries: is that all?

One hundred consecutive patients with injuries to the extraperitoneal rectum were treated over a ten-year period at an urban trauma center. The mechanisms of injury included firearms in 82 patients, stab wounds in 3 patients, a variety of other penetrating injuries in 10 patients, and in 5 patients the injuries resulted from blunt trauma. Treatment of the rectal injury was determined by the bias of the operating surgeon, the condition of the patient, and the magnitude of the rectal injury. Proximal loop colostomies were performed in 44 patients, diverting colostomies in 51 patients, Hartmann's procedure in 4 patients, and an abdominoperineal resection in 1 patient. Extraperitoneal rectal perforations were closed in 21 patients and the rectum was irrigated free of feces in 46 patients. Transperineal, presacral drainage was used in 93 patients. Infectious complications potentially related to the management of the rectal wound occurred in 11 patients (11%) and included abdominal or pelvic abscesses (4 patients), wound infections (6 patients), rectocutaneous fistulas (3 patients), and missile tract infections (2 patients). Four patients (4%) died as a result of their injuries. Of the therapeutic options available, statistical analysis revealed that only the failure to drain the presacral space increased the likelihood of infectious complications (p = 0.03); however, as it could not be determined with certainty that the use of, or failure to use, any particular therapeutic option had an effect on the risk of death. It is concluded that colostomy and drainage are the foundations of the successful treatment of civilian injuries to the extraperitoneal rectum. The use of adjuncts such as diverting colostomies, repair of the rectal wound, and irrigation of the rectum has little effect on mortality and morbidity.

Adolescent↗
PubMed1992

Endoscopic retrograde hemorrhoidal sclerotherapy.

This article describes an endoscopic retrograde hemorrhoidal sclerotherapy technique that is well tolerated and associated with high patient satisfaction, low complication rates, and satisfactory long-term results. This therapy is best used when colonoscopy is performed, and the need for treatment of hemorrhoidal disease is identified prior to the procedure. Since conventional sclerotherapy equipment is used, the demands on the endoscopy staff and finances are lessened. This article also discusses the implications for nursing care and patient teaching associated with this procedure.

Hemorrhoids↗