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At least 811 records · Page 45Linked to original sources
PubMed1986

Loop ileostomy for anorectal Crohn's disease.

The treatment of symptomatic Crohn's disease of the anorectum can be challenging. Medical therapy may fail and local surgery may be complicated by delayed healing or incontinence. The authors report the clinical course of 12 patients with this condition treated by fecal diversion with a loop ileostomy. Seven patients had a rectovaginal fistula. At the time of review, one of them had restored intestinal continuity following successful fistula repair, three had minimal or no symptoms, one had an active perianal fistula after closure of the ileostomy and two had undergone a proctocolectomy for recurrent symptoms. Five patients with Crohn's proctitis or anorectal sepsis were treated by loop ileostomy. One was asymptomatic, one had recurrent symptoms and three underwent a proctocolectomy. From their experience the authors conclude that construction of a loop ileostomy will temporarily improve the symptoms of anorectal Crohn's disease. Fecal diversion does not appear to alter the long-term course of the disease, and successful restoration of intestinal continuity is uncommon.

Adult↗
PubMed1985

Villous adenomas of the rectum. Results of endoscopic treatment with argon and Nd:YAG lasers.

Endoscopic treatment of rectal villous adenomas with argon and neodymium:yttrium aluminum garnet lasers is reported in 56 patients. Patients treated include 25 who had polyp recurrence after non-laser polyp treatment, 8 who had small sessile polyps that would otherwise require major surgery, and 23 who had contraindications to surgery. Complete tumor ablation was documented over a 3-24-mo follow-up period in 42 of the 56 treated patients. Of the remaining 14 patients, 5 were referred for other therapy because invasive carcinoma developed during treatment, 5 could not be assessed with confidence because of radiation proctitis, and 4 were lost to follow-up. In all patients with symptoms, improvement was noted when 75% of the tumor was destroyed. Treatment was well tolerated with no major complications. The results compare favorably with conventional treatment. Because laser tissue destruction precludes complete histologic evaluation of polyp tissue, laser ablation of polyps should presently be limited to (a) patients with recurrent tumors after previous non-laser treatment who refuse surgery, (b) patients with serious contraindications to surgery, and (c) small benign tumors that would require major surgery.

Adenoma↗
PubMed1977

[Anal and perianal complications of Crohn's disease (author's transl)].

Anal and perianal lesions in Crohn's disease such as fistulae, fissures, abscesses and proliferative ulcerous proctitis are often misinterpreted and consequently unsatisfactorily treated. They always indicate a florid intestinal attack or a relapse after previous intestinal resection. Out of 153 patients with Crohn's disease in the last 11 years we have had 59 cases (= 38.6%) with a history of anal changes or such changes were demonstrable on admission to hospital. Only after subtle diagnosis in which the nature and extent of these complications and the location of the intestinal disease focus are determined, the most promising therapy, after all possibilities of conservative treatment have been exhausted, is intestinal resection. Local surgical measures which would often endanger continence, are reserved for the individual case.

Crohn Disease↗
PubMed1979

[Blood flow disorders of the colon and rectum and their therapy].

Ischemic colitis or proctitis shows three evolutionary stages. a. complete recovery, b. fibrous stenosis, and c. acute ischemia leading to gangrene. The two first stages result more frequently from hemodynamic disorders than from vascular occlusions because, in the presence of the latter, collateral circulation develops. In addition, the colonic ischemia occurs in a septic medium in the presence of an abundant microbial flora which may be highly pathogenic.

Aged↗
PubMed1984

[Anaerobic paraproctitis].

An analysis of 25 cases of anaerobic paraproctitis has shown that in most cases they were people over 60 having severe concomitant diseases. Primary necrotic proctitis should be distinguished as a special morphological form. Sepsis was found to develop mostly in necrotic forms and ascending anaerobic lymphadenitis. An urgent wide opening of paraproctitis with a radical dissection of the tissues suspected of a damage is thought to be a necessary condition for the favourable outcome of the disease.

Adult↗
PubMed1981

Treating gonorrhea.

The records of 1,381 patients with gonorrhea were examined by the Massachusetts Department of Public Health to determine the efficacy of their treatment schedules. Urethritis, cervicitis and pharyngitis were treated with 4.8 million u. of aqueous procaine penicillin G intramuscularly, without probenecid. Cure rates were 98 percent in urethritis, 97 percent in pharyngitis and 98 percent in cervicitis. Patients allergic to penicillin were treated with tetracycline orally or spectinomycin intramuscularly. In patients with proctitis, a 98 percent cure rate was achieved with one intramuscular injection of procaine penicillin G, followed by ampicillin orally for four days.

Adult↗
PubMed1981

Syndrome of pelvic cellulitis following rectal sexual trauma.

Three cases of a syndrome of pelvic cellulitis following fist fornication are described. These cases are characterized by the history of fist fornication three or more days previously, fever, pararectal induration, acute proctitis and signs of pelvic peritoneal irritation. It is important to recognize this entity as it is usually adequately treated by means of broad spectrum antibiotics. Operative intervention can usually be avoided.

Adult↗
PubMed1980

Beneficial effect of cholestyramine in sclerosing cholangitis.

Cholestyramine exerted a beneficial effect on the course of a patient with sclerosing cholangitis associated with ulcerative proctitis. Over a 6.5-yr period, discontinuation of cholestyramine resulted in episodes of RUQ pain and/or appearance of abnormalities in liver tests. Readministration of the resin was followed by disappearance of symptoms and normalization of test resuls. The mechanism of the beneficial effect of cholestyramine was not elucidated.

Adolescent↗
PubMed1980

[Prevention and therapy of radiation injuries].

Every effective tumor therapy is, to a certain extent, accompanied by side effects and this applies also to radiotherapy. A large number of side effects occuring during radiotherapeutic treatment is reversible. The chronic radiation injuries remain, in general, asymptomatic. They can be considerably reduced by the use of megavolt machines, a sophisticated computer-assisted treatment technique and with the help of concomitant medication therapy. While earlier, an incipient reaction to radiation appeared on the skin, during the era of high-voltage therapy, the important radioreactions developed deeper in the human body. Besides the reaction of the oral and pharyngeal mucosae, radiation pneumonitis or radiation pneumosclerosis, radiation enteritis and radiation proctitis are important. These are the reactions which the family physician is most frequently confronted with. Possible prophylactic measures and therapy are discussed. The responsibiliy for radiotherapeutic side effects and risks must be assumed jointly by the physicians involved, the patient must be informed about them and efforts made to gain his cooperation.

Colostomy↗
PubMed1994

[Solitary ulcer of the rectum].

In line with the literature, the authors consider that solitary ulcer of the rectum, either isolated, multiple or histological, like suspended proctitis, inverted hamartomatous polyp, deep cystic colitis, is a complication of rectal prolapse, which usually shares the same clinical symptoms. Solitary ulcer of the rectum is generally discovered on proctoscopy and is due to the strain exerted on the rectal mucosa by 2 opposing forces:violent effort of defecation against an anal and/or perineal obstruction. The reduction of these pressure and counterpressure forces with age and progressive alteration of the pelvic floor accounts for the progression of acute lesions towards chronic or attenuated lesions or even complete resolution. The therapeutic strategy should therefore decrease trauma by facilitating defecation by a combination of hygiene and dietary advice and biofeedback retraining, and surgical reduction of the anal obstruction and prolapse and correction of any perineal insufficiency.

Barium Sulfate↗
PubMed1995

Endoscopic ultrasonography in inflammatory bowel diseases.

Endoscopic ultrasound (EUS) was designed for the evaluation of malignancies; however, its utility has been extended to the assessment of benign disorders, which include inflammatory bowel diseases. Topics discussed in this article include instruments and methods, EUS images in various inflammatory diseases, clinical severity and EUS typing, endoscopic grading of inflammation and EUS typing, extent of disease involvement and EUS typing, response to therapy and EUS typing, changes in EUS findings by treatment, Crohn's disease, radiation proctitis, ischemic colitis, tuberculosis, and mucosal prolapse syndrome.

Colitis, Ischemic↗
PubMed1996

Colonoscopic findings in patients with lower gastrointestinal bleeding send to a hospital for their study. Value of clinical data in predicting normal or pathological findings.

BACKGROUND: Lower gastrointestinal bleeding is a highly frequent clinical problem that may reflect serious pathology in the colon. Colonoscopy is generally accepted as the diagnostic procedure of choice. Decisions as to whether to carry out colonoscopy or not, are not well defined. METHODS: 536 colonoscopies, made to discover the cause of lower gastrointestinal bleeding were analyzed and a final 457 included in the study. All of these patients came to the hospital because they had presented at least in one occasion, one episode of rectal bleeding, and were send by the specialist of the zone, in order to achieve a correct diagnosis of its process. In all cases the following associated symptoms were analyzed: the presence of diarrhea, constipation, abdominal pain and rectal mass on examination. The characteristics of lower gastrointestinal bleeding were analyzed in a subset of 150 consecutive patients. RESULTS: Mean age was 59 +/- 16.9 years. 54.5% were male and 45.5% female. The exploration was normal until the cecum in 146 patients (32%). In the remaining 311, the findings were: polyps (25.1%), diverticular disease (24%), neoplasia (12.6%), inflammatory bowel disease (9.4%), unspecific proctitis (2.4%), ischemic colitis (2.4%), angiodysplasia (1.9%), infectious colitis (1.1%), and miscellaneous (0.7%). An age of less than 40 years and the existence of anal pathology were significantly more frequent among patients with a normal examination (p < 0.001), but with a sensitivity of only 66%. No differences were found among patients with disordered bowel frequency or abdominal pain in relation to the colonoscopic findings. Previous presence of a rectal mass when the examination proved abnormal (p=0.06). Intermittent bleeding and the presence of blood in the stools were more frequent in patients with normal examination (p= 0.07 and p< 0.05, respectively). No significant differences in relation to colour, duration of bleeding, or to whether toilet paper was stained with blood were found. CONCLUSIONS: 1) The more frequent endoscopic findings were polyps and diverticular disease. 2) Clinical data are of little value in predicting a normal examination. 3) Total colonoscopy appears to be the first procedure of choice in all patients with lower gastrointestinal bleeding, irrespective of the clinical data and the presence of anal pathology.

Adolescent↗
PubMed1996

[Acute gastrointestinal side effects of radiotherapy. What is certain in the treatment?].

PURPOSE: Radiotherapy, especially in the abdominal region, is frequently associated with gastrointestinal side effects. METHODS: The article reviews the current knowledge about pathophysiological background, clinical symptoms and the treatment strategies of the major gastrointestinal side effects. RESULTS: Several basics are investigated and depending on this knowledge some special treatment strategies have been developed (5-HT3-receptor-antagonists in the treatment of nausea, Figure 1, Table 2). The treatment of stomatitis, esophagitis, enteritis and proctitis still remains symptomatic and is not yet standardized (Tables 3 to 6). There are some promising results with smectit (enteritis) and sucralfat. Special dental attendance should be performed before initiating radiotherapy of the head and neck region. Technical improvement in radiotherapy will also help to reduce side effects. CONCLUSION: In order to minimize gastrointestinal side effects, it is necessary to further investigate the pathophysiology of acute and late toxicity.

Abdominal Neoplasms↗
PubMedDate not supplied

External radiation therapy of prostatic carcinoma and its relationship to hormonal therapy.

From 1980 to 1990, a total of 54 patients with prostatic carcinoma were treated with external radiation therapy at the Kumamoto National Hospital. Ten patients were classified as Stage B, 22 as Stage C, and another 22 as Stage D according to the American Urological Association Clinical Staging System. The 5-year survival for all 54 patients was 30%. The 5-year disease-specific survival was 67% for Stage B, 47% for Stage C, and 26% for Stage D. The 5-year survival was 43% for patients in whom radiation therapy was initiated immediately after the first diagnosis or with less than one year of hormonal therapy, while it was 0% for patients in whom radiation therapy was initiated after more than one year of hormonal therapy (p = 0.01). The cause of intercurrent death was acute myocardial infarction in four patients and acute cardiac failure in one. Four of these patients received hormonal therapy for more than one year. The incidence of radiation-induced proctitis was not severe. This study suggests that long-term hormonal therapy prior to radiation therapy worsens the prognosis of patients with prostatic carcinoma.

Aged↗
PubMed1998

Rectal stricture in an ostrich (Struthio camelus).

Exploratory celiotomy of an 18-mo-old female ostrich (Struthio camelus) with anorexia, lethargy, and constipation of 5 days' duration showed mesenteric volvulus and a focal narrowing of the rectum approximately 28 cm cranial to the cloaca. The prognosis was poor and the animal was euthanized. Necropsy revealed a fibrinonecrotic proctitis and a 3-cm-long circumferential stricture of the rectum. Histologically, the rectal wall at the stricture was deeply effaced by fibrovascular connective tissue with vascular thrombosis and necrotizing vasculitis, and it resembled the lesions in feeder pigs with fibrinonecrotic colitis.

Animals↗
PubMed1998

[Therapy planning and surgical indications for Crohn-associated anal fistulas].

A prospective study conducted from April 1988 to April 1998 in 83 patients with anal fistulas associated Crohn's diseases registers and evaluates data regarding the type of fistula, the planned therapy, the operative procedure, and the therapy itself. The choice of the operation time with special regard to the type of fistula and the presence of proctitis as well as the interdisciplinary management in cooperation with the gastroenterologist and the strict observance of the operative procedure for the different types of fistulas enable individually defined surgical treatment of anal fistulas associated with Crohn's disease. It is important that the primary intervention be performed by a surgeon who is experienced in classifying the different types of fistulas because of the recurrence rate of 23% and the required interval between the first and final surgical intervention and so that patients are well informed.

Crohn Disease↗
PubMed2003

Recurrent rectal carcinoma treated with high dose rate intraluminal brachytherapy.

A 65 years old man with recurrent rectal cancer was treated with remote afterloading High Dose Rate Intraluminal Brachytherapy (HDRILB). After eight weeks of HDRILB there was complete regression of the tumor. Bleeding per rectum and pain in the perineum were greatly improved. He died of myocardial infarction after 41 months of treatment with HDRILB. The treated lesions were incomplete remission at the time of death. The procedure was well tolerated. The only treatment-associated toxicity was grade 2 proctitis, which was treated conservatively. HDRILB can be used as one of the treatment options in patients with recurrent rectal cancers who have undergone previous abdominal surgery and external beam irradiation, as exhibited in our limited experience.

Adenocarcinoma↗