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PubMedDate not supplied

Ligation and cryosurgery of all hemorrhoids. An office procedure.

Over 21,000 patients with symptomatic hemorrhoids were treated either at the Rudd Clinic in Toronto, or at Proctology International in the Cayman Islands, with the ligation or the ligation and cryosurgical technique. The procedures as described are simple, very effective and should be done in the office and not in the hospital. It is better for both patient and doctor and the cost saving is in the tens of millions of dollars in our series alone. Other problems such as anusitis and para-anal lesions should be differentiated from hemorrhoids and treated as described to improve your success rate. All surgeons are encouraged to adopt new techniques which will improve the treatment of their patients and their own reputation. It is a changing world--especially in medicine and we must keep up and be willing to adapt. I recommend the ligation and cryosurgical technique to all surgeons for the treatment of all symptomatic patients with hemorrhoids.

Ambulatory Surgical Procedures↗
PubMed1989

[The conservative therapy of chronic colostasis].

In 1972-1988 487 (5.35%) of patients were hospitalized in a Ukrainian SSR Proctological Center for chronic colostasis; 243 (49.8%) were operated on due to developing decompensation of the large intestine and failed multicomponent conservative treatment and invalidism. 244 patients admitted to the clinic were conservatively treated. A scheme of conservative treatment used in the clinic is described.

Chronic Disease↗
PubMed1989

[The role of the laser in gastrointestinal surgery].

In a series of 2500 operations with laser in the gastrointestinal region the authors used laser CO2 with up to 90 W strength and Nd--Yag with up to 80 W strength, both alone and in combination. Principal application of this technique is in oncologic surgery: resection of liver, volatilization of hepatic and other metastases, destruction of inoperable carcinoma in the middle and distal portion of the rectum and in other fields of proctologic surgery. In this aspect, laser technique is a powerful palliative means in the general arsenal of surgery.

Digestive System Surgical Procedures↗
PubMed1989

[Anorectal melanoma].

Anorectal melanoma is a malignant lesion constituted by melanoma-producing cells which has a very poor prognosis. It is a rare proctologic pathology, representing 0.5-1% of anorectal tumors. It is predominant in females and in the sixth and seventh decades of life. The evolution is more benign in elderly patients due to hormonal factors. The diagnosis is histological and the treatment is surgery, with radical resection being suggested for shallow lesions, and local excision if lesions are deep and the disease is disseminated. We present a case of anorectal melanoma in a 76-year-old woman which had an unusual location on the right anterolateral face of the rectal ampulla. The histological study demonstrated the presence of intracytoplasmatic melanin deposits (Fontana-Mason stain). Abdominoperineal resection of the anus and rectum was performed, confirming the absence of lymph node or hepatic involvement.

Aged↗
PubMed1989

[Experiences with sacral anesthesia in combination with morphine analgesia].

Sacral anaesthesia is an anaesthetic method which is easy to learn, has a low complication rate and can be used also in elderly patients. The application of long-lasting local anaesthetics like bupivacaine in combination with morphine provides good conditions for postoperative pain relief following proctological operations. The extradural injection of 5 mg morphine considerably eases the postoperative period for the patient. The mean value of postoperative pain relief amounts to 53 +/- 23.4 hours in patients given sacral anaesthesia with 2 mg/kg bupivacaine with adrenaline 0.005% and 5 mg morphine. Our results are based on 513 patients of whom 105 were given sacral anaesthesia without morphine and 308 with morphine.

Aged↗
PubMed1985

[Current trends in the diagnosis and therapy of anal pruritus. Review of 238 cases].

Perianal pruritus may be caused by a variety of factors. Of these, the most frequently occurring are proctological, infections, dermatological, dietary, and systemic. The results of a study carried out on 238 patients from 1980 to 1984 are reported. The survey was carried out with the aim of defining the frequency of pruritus in relation to the triggering cause, to sex and to age. It is emphasised that diagnosis is often difficult and requires the measurement of the following parameters: blood glucose levels, blood, nitrogen levels, ESR, haemochrome, hepatic functions, in addition to a gynaecological examination, analysis of faeces, proctocolonoscopy, skin biopsy and other tests. These are carried out to determine whether anal pruritus is a symptom of a systemic disease, or whether it is brought about by local causes. Treatment measures adopted are reported. Treatment is mainly symptomatic and aetiological for cases caused by local disturbances.

Administration, Topical↗
PubMed1988

[Development of cryosurgery treatment methods in inoperable anus and rectum cancer and their introduction to general practice].

The domain of cryosurgery in proctology is in the field of inoperable anal and rectal carcinoma therapy with the aim of improving living quality. By intravital microscopy the role of microcirculation as the causative factor for counterheating could be proved. There by the cryodestruction is restricted. By temperature measurements we know that the limit for absolute tissue destruction is given at 3-8 mm tissue depth. A new device for cryosurgical treatment of inoperable anal and rectal carcinoma was developed (2nd generation of the device) and introduced into praxis. A total of 247 cases were our own patients at the average age of 75 years and a lethality of 0.25%. Generally, an improvement of living quality was achieved by the cryotherapy in those patients with stenosing colorectal carcinoma. 50% of all patients lived longer than 2 years. In 242 patients of the total of 247 cryosurgically treated patients the establishing of an anus praeter could be spared.

Aged↗
PubMed1987

Simple help for spina bifida children with anal incontinence.

The search for an effective means of helping children with anal incontinence has been facilitated by tissue-compatible material which has already been in use for a long time in proctology. Polyvinyl alcohol foam is characterized by its elasticity, malleability under the influence of liquids and its good tissue compatibility. We have had anal plugs manufactured in the shape of hourglasses. These are available in various sizes and can be adapted individually. We consider their application to be indicated in about one third of myelomeningocele children who either have partial or complete fecal incontinence. We have also tested the plugs in healthy children and experience is available in the meantime in eight children after operation on a high anal atresia and 15 children with spina bifida. The period of application is in childhood. Our experience so far is encouraging. The handling is described in detail.

Child↗
PubMed1988

[Iatrogenesis in urology].

The proportion of misdiagnosis and errors in the treatment of urological diseases holds high, this being particularly true for iatrogenic pathology of the ureter and urinary bladder. The disturbances used to arise in response to traumatic gynecological and proctological surgical interventions and often remained undetected. The traumas are mainly induced by inaccurate use of the instruments and defects in surgical techniques. One of the serious iatrogenic complications is microcystic involvement of the urinary bladder as a result of radiotherapy for cancer. The method proposed by the authors for medical and social rehabilitation of such patients implies the replacement of the affected urinary bladder with isolated intestinal segment providing the recovery of natural uresis. Systemic endotoxinemia, another variant of urologic iatrogenesis, is associated with massive-dose antibiotics and extensive intracavitary operations. Early diagnosis and management of the conditions are supposed an effective protection against endotoxin shock.

Diagnostic Errors↗
PubMed1988

[Reconstructive-restorative operations in patients with various types of colostomy].

The intraabdominal anastomoses are thought to be expedient in performing restorative operations when the excluded rectum is longer than 10 cm. When the rectum stump is shorter than 10 cm the extra-abdominal colorectal and coloanal anastomoses are expedient with the descending of the colon on the lateral pelvic wall without a mobilization of the rectum stump. The reconstructive-restorative operations should be performed at proctological and surgical departments.

Adolescent↗
PubMed1978

[Hemorrhoids: recognition and current therapeutic possibilities].

Up to 5% of the patients of a general practitioner have terminal bowel disease, most frequently hemorrhoids. Any patient who presents with ano-rectal discomfort or anal blood losses should undergo thorough proctologic examination including rectoscopy. Digital palpation is insufficient as only 10% of rectal carcinomas can be reached. The treatment of hemorrhoids should be started by instructing the patient on anal hygiene, to be followed only then by symptomatic application of creams or suppositories. If these symptomatic measures fail, treatment by injections is indicated. This method may be complicated by localized or extensive necrosis of the rectal mucosa, the cause of which is assumed to be an immunologic event resembling the Arthus phenomenon in which bacterial or possibly pharmacologic substances may act as antigens. Therefore, a method of provoking coagulation without using foreign substances was sought. Thermocoagulation by the infrared coagulator appears to be a suitable method: first experience tends show equal efficacy with coagulation by injection treatment. Prolapsing hemorrhoids are still treated by barron ligation. The precise management of each therapeutic approach is described.

Electrocoagulation↗
PubMed1987

Ambulatory procedures in anorectal surgery.

In view of the broad spectrum of conventional and unconventional STDs in the homosexual man, the following diagnostic workup is recommended: History. Physical examination, including proctosigmoidoscopy with biopsy. Urethral, pharyngeal, and rectal cultures. Darkfield examination of any genital ulceration. Stool cultures for bacteria and parasites. Serologic analysis, including VDRL and, where indicated, for Chlamydia trachomatis and amebiasis. It is an essential part of proctologic practice for the surgeon to be able to recognize, diagnose, and treat sexually transmitted diseases.

Ambulatory Surgical Procedures↗
PubMed1986

[Rubber-band ligation of hemorrhoids].

In the last few years there has been a considerable reduction in surgical treatment of piles; on the other hand a series of therapeutic outpatient treatments has developed aiming at a conservative management of piles. This new approach is mainly due to high costs in surgical treatment. In accordance also with the experience of the most important proctologic centres, nowadays only 26% of our patients suffering from piles undergo operation, since we regard rubber band ligation as a more rational and economical method for the treatment of hemorrhoids. The instruments and the technique related to band ligation have been described together with some modifications suggested by our personal experience. Indications and contraindications for rubber band ligation have been analyzed pointing out that, in our opinion, such an approach is advised also in the management of stage 3 and 4 hemorrhoids; on the other hand the surgical treatment has its role when band ligation is contraindicated. We have then reported about the good results obtained with 162 patients suffering from stage 2, 3 and 4 hemorrhoids, by using band ligation. Our experience, in accordance with international literature, enables us to emphasize the almost complete absence of complications and the satisfactory results of band ligation, even if compared to other methods.

Hemorrhoids↗
PubMed1986

Surgical treatment of anal incontinence--a preliminary report.

Six patients with anal incontinence were treated operatively at two Finnish proctological centres: 3 patients with post-anal repair, 2 with direct sphincter repair and 1 with a gracilis sling operation. In short term, improvement of continence was demonstrated in all cases both clinically and by manometric measurements; 5 out of the 6 patients are acceptably continent after surgery. The present techniques of surgical treatment of incontinence can offer gratifying results. Anal manometry is a valuable means in the evaluation of these patients before and after the operation.

Adult↗
PubMed1985

Colonoscopic findings in patients with hemorrhoids, rectal bleeding and normal rectoscopy.

Within a period of 18 months, 387 patients were referred to the Proctologic Service at the Chaim Sheba Medical Center because of recurrent rectal bleeding. Hemorrhoids were found in 194 of these patients and further investigation showed that 45 of the 194 patients (23.2%) had other coexisting colonic pathology (12 cancers, 28 polyps, 4 inflammatory bowel diseases and 1 angiodysplasia). Sixteen of 40 patients with diverticulosis and 13 of 30 patients with hemoglobin less than 11 g/dl had additional colonic pathology. Single-contrast barium enema, which was used in this survey for screening of the colon, proved to be inaccurate. In view of the issue of cost-effectiveness, this study suggests that patients with recurrent rectal bleeding and hemorrhoids (Grades II and III) who had normal rectoscopy should be further investigated by double-contrast barium enema if they are greater than 40 years of age. All patients with anemia, diverticulosis or abnormal findings in barium enema should undergo total colonoscopy.

Adult↗
PubMed1985

[Diagnosis and therapy of anal eczema].

Eczema of the anus is symptomatic of different diseases, and pure symptomatic treatment should therefore not be carried out. After dermatological and proctological examinations have been performed, the correct diagnosis can be made and the therapy determined, which will then be successful.

Anus Diseases↗
PubMed1985

[Is rigid rectoscopy obsolete?].

Flexible fiberoptic sigmoidoscopy more and more replaces sigmoidoscopy with a rigid tube. In a retrospective series of 152 rigid sigmoidoscopies we analysed depth of endoscopy and findings. In 36% of patients without anaesthesia endoscopy had to be stopped at 15 cm and in further 31% at 20 cm leading to a highly significant difference to the anesthetized patients (p less than 0.0005). A good history of the present illness allows separating of bleeding carcinoma and polyps proximal to the sigmoid colon which have to be examined by colonoscopy. In routine screening for blood loss per anum it is desirable to achieve in all patients a maximal security not to overlook a finding, because of the medical costs. We have enlarged the list of indications for the rigid sigmoidoscopy by Marks et al. as a practical compromise: delineation of rectal lesions, side localization and critical rectal measurements, surveillance of disease states or anastomoses within its reach, for performing rectal biopsy and rectal polypectomy, in patients with possible contamination of the instrument, endoscopy in the anesthetized patient before a proctological operation if case history excludes a higher sited lesion. In all other cases there is an indication for colonoscopy or barium contrast enema. It is stressed that in patients with blood loss per anum the search for the source always is done by flexible fiberoptic sigmoidoscopy.

Adult↗
PubMed1985

[Adaptation of graduate gastroenterology education in Switzerland].

To evaluate the quality of Swiss postgraduate gastroenterological training, a questionnaire was circulated to 100 practising gastroenterologists. The results show that knowledge of psychosomatic problems, proctology and nutrition should be improved. The majority of practising Swiss gastroenterologists favoured formal education in ultrasound techniques. Radiological and laparoscopic techniques are no longer needed. The question whether postgraduate training standards should be raised, and a board examination introduced, is discussed.

Education, Medical, Graduate↗