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PubMed2006

[Physiological and clinical outcome of open and closed hemorrhoidectomy compared with stapling method according to long].

AIM OF STUDY: The aim of the study was to evaluate and inaugurate a new method for the treatment of hemorrhoidal disease with the usage of a stapling device (Long's method). PATIENTS: The study spanning two years (September 1999 to June 2001), included 97 hospitalized patients aged 19-75 years, 42 (43.3%) female and 55 (56.7%) male, exhibiting symptoms and signs of stage III hemorrhoidal disease. The patients were divided into three groups: (a) 35 patients treated with open hemorrhoidectomy for stage II hemorrhoidal disease; (b) 30 patients treated with closed hemorrhoidectomy for stage III hemorrhoidal disease; and (c) 32 patients treated for stage III hemorrhoidal disease by a stapling device, i. e. Long's method. RESULTS: Study results showed no statistically significant differences between either open or closed hemorrhoidectomy and Long's method in the following parameters: urinary retention, early bleedings during the first 48 hours, late bleedings, incontinence, anal stenosis, and relapses. Statistically significant differences between the groups of patients treated with either open or closed hemorrhoidectomy and those treated with Long's method were recorded in the following parameters: healing time, subjective feeling of pain, pain pro rata to quantity, and use of analgesics. CONCLUSION: Hemorrhoidectomy by Long's method is an ideal surgical procedure because it allows to realize to goals set on implementing new therapeutic methods: to achieve healing without relapse, to reduce postoperative pain, anal stenosis and incontinence after hemorrhoidectomy, to preserve the physiology of the anal canal, and to familiarize less skilled proctology surgeons with the simplicity of the method.

Adult↗
PubMedDate not supplied

[Comparative study between propofol and thiopental for anesthesia induction in surgery of short duration].

To compare anesthetic characteristics of thiopental and propofol in short duration surgical interventions, we have studied 40 patients undergoing gynecologic and proctologic surgery. Patients were randomly assigned to two groups receiving 2.5 mg/kg of propofol or 5 mg/kg of thiopental. In both groups, arterial hypotension of comparable intensity occurred. Heart rate was significantly higher in thiopental anesthesia. Postanesthesia recovery was significantly more rapid with propofol. Some of these results can be influenced by the different immediate premedication (atropine and diazepam in thiopental group) and duration of anesthesia.

Adult↗
PubMed1991

[Local surgical treatment of anal-perineal lesions in Crohn's disease. Retrospective study of 68 cases].

Sixty eight cases of ano-perineal lesions (APL) were studied. Lesions were classified into primary (19) and secondary (49) after Hughes. The course of primary APL was favourable (15 cases, 78 p. cent) when proximal CD was controlled, with 4 proctectomies being required when the latter was not the case. Suppurative secondary APL (48) were treated surgically either for an acute abscess (22) or for a chronic fistula (low: 14; high: 12). The treatment of fistulas involved: opening in 10 cases (4 recurrences, 5 failures) or slow fistulotomy with elastic in 17 cases (9 recurrences, 4 failures). Genital fistulas (9 cases) were studied separately: 3 recto-vaginal fistulas resulted in a permanent bypass and 6 ano-vulval fistulas healed or were tolerated. When proximal CD was controlled medically, proctological treatment alone resulted in the healing or quiescence of APL in 17/24 cases. In the group of patients undergoing intestinal resection with restoration of continuity, 10/25 recurred, with the appearance of worsening of an APL in 9 of them. Fifteen had no recurrence, with the appearance or worsening of an APL in 3 of them. In total, 13 patients (19 p. cent) underwent proctectomy, including 6 from the outset. Five had a stroma which was left open and 46 (72 p. cent) a functional anus. Local surgical treatment improved the comfort of patients without any increased risk regarding sphincter function, but the long term benefits of the active treatment of chronic fistulas remain to be proven.

Adolescent↗
PubMed1991

[Causes for surgical interventions in HIV seropositive patients. 226 interventions].

Between January 1, 1983 and October 1, 1990, we performed 266 surgical operations in 255 patients with human immunodeficiency virus (HIV) infection. We report the reasons for these operations and compare them with those recorded in all patients operated upon in our department between January 1, 1988 and December 31, 1989 (4,960 operations in 4,498 patients). During the 1988-89 period, 2.4 percent of these patients had HIV infection, which suggests that the proportion of patients operated upon is the same in an HIV-infected population as in the general population. The proportion of HIV-infected patients who underwent surgery for diagnostic purposes or as adjuvant treatment was 42.7 percent as compared with 37.3 percent in the general population. Among laparotomies, 37.3 percent were exploratory in the HIV group versus 7.3 percent in the control group. The emergency surgery rate was the same in both groups. In gastrointestinal surgery, proctological operations were performed in 33.5 percent of the HIV group versus 7.4 percent of the control group. Among other types of surgery, only splenectomies were more frequent in HIV-infected patients than in the general population (6.3 versus 1.7 percent).

HIV Seropositivity↗
PubMed1991

[Small polyps of the rectosigmoid].

The increasing interest in colorectal polyps is due to the fact that they may not only be diagnosed, but removed by endoscopic route. The aim of the study were small polyps of the rectosigmoid removed on rectoromanoscopy and their clinical significance. Included in the study were 193 small polyps, 0.5 cm in diameter, diagnosed on rectoromanoscopy and removed by mechanical way from 182 patients at the Proctologic Unit of the Department of Gastroenterology. Medical Academy in Sofia. Small polyps have a definite place and importance in colpoproctology. They should not be overlooked, since in the author's study 66.9 per cent were neoplastic, 55.7 per cent showed varying degree of dysplasia, 4.6 per cent appeared to be surface carcinoma in situ and 2 per cent were adenocarcinomas. Endoscopic polypectomy is considered obligatory for small polyps, both for diagnosis and for therapy.

Adenocarcinoma↗
PubMed1991

[Practical indications for anorectal manometry].

Anorectal manometry has taken on an important role in the investigation of functional anorectal disorders. This investigation studies the two factors, the resistive system and the capacitive system, involved in anorectal function, continence and defecation. Practical indications can be grouped into three categories concerning different aspects of physiopathological, diagnostic and therapeutic interest. Manometry is essential in the investigation of disorders of pelvic static function, is useful in colorectal surgery and of interest in a wide range of proctological diseases.

Anus Diseases↗
PubMed1991

[Hemorrhoidal disease and the concomitant changes in the rectosigmoid].

Hemorrhoids is the most common disease in coloproctology, and rectoromanoscopy is a valuable tool of diagnosis. Of a total of 1614 patients examined at the proctologic consulting room of the Department of Gastroenterology at the Medical Academy in Sofia, hemorrhoids had 609 (37.8 per cent). External were 2 per cent of the hemorrhoids, internal 81.1 per cent and external + internal 15.9 per cent. Characteristic finding in internal hemorrhoids were the swelling in the anal canal, localized along 3, 7 and 11 hours of the clock dial in knee-elbow position of the patient. Endoscopic symptoms of hemorrhoid malignization were ulceration, thickening and infiltration of the mucosa at the bottom of the erosion. Hemorrhoids were frequently associated with accompanying diseases (52.6 per cent) which aggravated the patients complaints. They may occasionally be the cause of symptomatic hemorrhoids.

Adolescent↗
PubMed1991

Detection, localization, and quantitation of HIV-associated antigens in intestinal biopsies from patients with HIV.

This study determined the prevalence, cellular localization, and content of human immunodeficiency virus (HIV)-associated antigens in intestinal mucosa from HIV-infected subjects. Studies were performed in 168 subjects with gastrointestinal, nutritional, or proctologic complaints, and HIV-seronegative controls. The polymerase chain-reaction technique, which detects viral DNA, was used in 20 subjects and was positive in 70%. In situ hybridization studies, using RNA probes, were employed in 48 cases and were positive in 31%. Immunohistologic studies using monoclonal antibodies to HIV p24 antigen were employed in 73 cases and were positive in 67%. Quantitative ELISA assays for tissue p24 content were performed in 168 cases and was positive in 68%. Evidence of HIV was found throughout the intestine and in different disease stages. The quantitative ELISA studies correlated significantly with in situ hybridization, implying a possible association between the presence of viral RNA and protein expression. The authors conclude that HIV is present in intestinal mucosa from most, if not all HIV-infected subjects. The relationship to intestinal disease currently is unclear.

Antibodies, Monoclonal↗
PubMed1991

[Restoration of natural intestinal passage after Hartmann's operation].

From 1972 to 1988 restorative operations were carried out at the Institute of Proctology on 252 patients after resection of the colon by Hartmann's technique. Analysis showed that restoration of natural intestinal passage after Hartmann's operation for resection of the colon is a complex and dangerous surgical intervention. When undertaking such intervention, the surgeon should take into account not only the patient's wish to be relieved from the colostomy, but also correct appraisal of the possibility of accomplishing the restorative operation from the standpoint of the patients' somatic condition, the technical conditions for restoration of intestinal continuity, and his own professional possibilities. In cases of a short rectal stump, various modifications of Duhamel's operation are the most safe and technically executable method for restoration of the natural intestinal passage. Such restorative-reconstructive operations should be carried out in specialized coloproctological clinics.

Adolescent↗
PubMedDate not supplied

[Analgesia and intensive therapy in single-step, combined and complex operations].

300 single-step, combined and complex operations have been performed to patients aged 16 to 82 years in the Institute of Proctology, USSR Ministry of Public Health, over the last 10-year period. Surgery was performed under various types of endotracheal combined analgesia: NLA, NLA in combination with halothane or calypsol. Arterial hypotension (short-term BP decrease by more than 40% baseline) was found in 29 patients (9.6%), no intraoperative lethal outcomes have been observed. The volume of the infusion-transfusion therapy depended on intraoperative blood loss, duration of surgery and the extension of surgical interventions (8.4-12.4 ml/kg.h). An overall mortality rate was 3.6%, which does not exceed the mortality rate observed during conventional operations on the colon.

Adolescent↗
PubMed1990

[Bleeding and pain following anal surgery].

Bleeding and pain are frequent complications, following proctological procedures. Their intensity however, can be influenced by the therapist. Through careful hemostasis and wound closure the risk of bleeding is greatly reduced so that most procedures can be done on an outpatient basis. The intensity of pain experienced by the patient is very much personality dependent and is in general unpredictable. Pain can be reduced by using an improved technique (high position of rubber-band ligation, manual anal dilation). This paper deals mainly with bleeding and pain following treatment of external hemorrhoids, inner piles, fissure-in-ano, abscesses and fistulae.

Abscess↗
PubMed1990

[Treatment of fissure in ano by the method of laser coagulation].

The article analyses the results of treatment of acute and chronic anal fissures with the use of the method of laser photocoagulation in 181 patients, in 87 of them the fissures were combined with other proctological diseases. The essence of the operation is three-fold laser treatment (CO2 laser) of the edges and floor of the fissures. The pathologically changed tissues are evaporated and coagulated in this case with the formation of a coagulation film on the wound surface. Histological examination of bioptic material collected from the zone exposed to the effect of the laser shows complete disappearance of the pathological tissue. The operation is simple and sparing in the treatment of anal tissues, ensures improvement of the immediate results, as well as a decrease of the frequency of a recurrence to 1.4%. The method may be introduced successfully into outpatient surgical practice.

Adult↗
PubMed1990

[Screening using Krypto-Haem-SSWR for the early detection of colorectal carcinomas and adenomas].

In the last 30 years, colorectal carcinomas have been stated to occur markedly in all industrial countries. From colonic and rectal malignant tumors, the amounts of 4225 in 1961 and 7220 in 1984 were newly registered in GDR. Thus the number of patients with colorectal carcinomas showed the decrease for up to 70.9% starting from 1961. The biochemical Krypto-Haem-SSWR screening test has been implemented during the last few years by members of proctologic section. Colorectal carcinoma was stated in 48 asymptomatic subjects aged more than 45 years, and colonic adenoma in 83, respectively. At present, the yearly screening of occult bleeding into faeces is the unique measure contributing to early recognition of colorectal carcinomas and precancerous lesions.

Adenoma↗
PubMed1990

[Epidural sacral anesthesia with 3% mepivacaine in rectal surgery].

The authors think that the sacral epidural anaesthesia effected with Mepivacaine 3%, 6 ml (180 mg) and Fentanyl 2 ml (100 mcg) is perfectly indicated for the proctologic surgery as it is of simple execution and presents a short latency (12 min.), good deepness and perfect haemodynamic stability. Besides, it does not endanger the lower limbs innervation. No urinary retention.

Adult↗
PubMed1990

[Simultaneous radical surgery in patients with cancer of the rectum with metastases to the liver].

From 1972 to 1987, a total of 3.033 operations were carried out for carcinoma of the rectum at the Research Institute of Proctology. Various types of resection of the liver were conducted in one stage in 51 cases. The postoperative mortality in the group of patients who underwent operation in association with resection of the liver was 5.9%, which was only slightly higher than that in the general group of patients with rectal carcinoma (4.9%) operated on in the same period of time. Among 35 patients dismissed from the clinic after removal of verified metastases of the liver 15 had been operated on more than 5 years ago. Four of them have a survival period of more than 5 years and 2 have a survival period of over 10 years. On basis of their experience, the authors claim that the performance of one-stage radical operations for rectal carcinoma with removal of solitary metastases from the liver is admissible and, most probably, expedient.

Adult↗
PubMed1989

[Diagnosis of prostatitis in the light of current knowledge].

Authors review the up-to-date questions of the prostatitis diagnostics on the basis of data of nearly 2,000 patients. In case of symptoms indicative of chr. prostatitis it is essential to localise the inflammation to the prostate with laboratory methods and in case of negative finding to identify the organic and functional diseases hidden behind the nonspecific clinical picture. A modified variation of the bacterial localisation culture (4 glasses test) has been applied by the authors in addition to previous methods. Among the potential etiological factors the hypertrophy of prostate stands first above 45 years of age. In the majority of cases etiological factor cannot be proved under 45 years. Among the subjective symptoms the cystitis syndrome, the low back and scrotal pain predominate, whereas among the objective symptoms above 45 years the microscopic pyuria, under 45 years of age the concomittant urethritis. Among Drach's prostatitis prevails (61%) whereas in the older patients prostetodynia, chr. nonbacterial and bacterial prostatitis have similar prevalence. In acute and subacute prostatitis the cystitis and the epididymitis, in chr. prostatis the pathozoospermia (44%) and the neurosis are the most frequent complications. Prostatitis presents a common differential diagnostic problem not only for the urology, but also for the abdominal diagnostics, rheumatology, proctology etc.

Bacterial Infections↗
PubMed1989

[Surgical treatment of middle aged and aged patients with complicated and locally invasive forms of cancer of the colon].

The article analyses treatment of 207 patients subjected to surgical intervention at the onco-proctological department of the Moscow City Oncological Dispensary in the period between 1982 and 1986. Most patients in the age group suffered from complicated and locally proliferated forms of cancer. Data are cited in favour of avoiding operations with formation of primary colonic anastomosis when the tumor in this group of patients is found in the left half of the colon.

Age Factors↗
PubMed1985

[15 years' experiences with cryosurgical treatment of rectal cancer].

The field of cryosurgery in proctology can be seen in therapy of inoperable anal and rectal carcinomas. It is aimed at improving life quality. The role of microcirculation as a factor causing a contrary heating effect can be proved by intravital microscopy. Cryodestruction is limited by this factor. By means Of measurements of temperature we know the boundaries of complete tissue destruction which is reached in a distance of 4-8 mm. Our own number of cases consists of 122 patients with a mean age of 72 years.

Aged↗