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At least 937 records · Page 52Linked to original sources
PubMed2000

The frequency of large bowel cancer as seen in Addis Ababa University, Pathology Department.

Colorectal carcinoma (CRC) once thought rare in Africans is being seen more frequently. Diet and life style modify the risk of CRC. Its frequency, age, sex and site distribution has not been studied systematically in our country. The presentation of CRC was studied and compared in two 5-year periods with a 10 year time gap. The biopsies of 255 patients with a diagnosis of CRC during two periods were reviewed. CRC constituted 0.8% of the total of biopsies and 34% of colorectal biopsies. The mean age at presentation was 47 years while 61.4% occurred below the age of 50 years, 36% below 40 and 16% occurred below the age of 30 years. Of all CRC 66.7% were located in the rectum and 33.3% in the colon. The male to female ratio for both rectal and colonic cancers was 2:1. These findings did not show any major change during the two study periods. CRC occur at a much younger age in Ethiopia than in the developed world. More than half of the cases were in the rectum. Therefore, the shift of CRC to the right colon reported of elsewhere was not observed. The clinician should expect CRC also in young patients, and most of these carcinomas are still detectable by proctosigmoidoscopy.

Adenocarcinoma↗
PubMed2000

Transanal endoscopic microsurgery for excision of rectal lesions: technique and initial results.

The aim of this study was to review experience with transanal endoscopic microsurgery (TEM) and to assess its applicability to an existing practice of colorectal surgeons. Patients undergoing TEM excision of rectal lesions from March 1997 through May 1999 were selected for this study. Medical records were reviewed retrospectively to obtain pertinent data, including indications for TEM, tumor size, distance from anal verge, duration of operation, completeness of tumor resection, postoperative complications, duration of stay and follow-up, and recurrence. Thirty-one patients underwent TEM during the 2-year period. Indications for TEM included benign disease in eight patients and cancer in 23 patients. Mean distance of the tumor from the anal verge was 8.3 cm. Mean size of the lesion was 2.8 cm, and mean specimen size was 4.5 cm. Larger specimen sizes allowed for tumors to be removed with negative margins (97%) in all cases but one. Mean duration of operation was 140 minutes (including set-up time), and mean duration of hospital stay was 1.2 days. Major postoperative complications occurred in one patient. Mean duration of follow-up was 15 months, and recurrence developed in two patients during this period. Transanal endoscopic microsurgery excision of rectal lesions with negative margins was possible in 97% of cases with minimal morbidity and a short-duration hospital stay. Follow-up was too brief to evaluate recurrence, but the thoroughness of resection of tumor in a high proportion of cases is promising.

Aged↗
PubMed2000

Anal duct carcinoma: case report and review of the literature.

This report details the clinical course of two patients with true anal duct carcinoma. The incidence of this malignancy is low. The tissues of origination are the glands of the anal duct. The features that differentiate this tumor from the usual rectal carcinoma are prominent ductal structures, abundant mucin production with organized mucinous pools, and infiltration into the perirectal soft tissue. The clinical management of anal duct carcinoma remains a surgical challenge. The extent of surgical resection must be radical because of the infiltrative nature of the tumor. This report describes treatment of two patients with anal duct carcinoma. The first patient was a black woman with no previous history of rectal disease. Her operative procedure was an abdominoperineal resection with posterior vaginectomy. Nine months after initial surgery a local recurrence was resected. The second patient was a white man with a previous history of hemorrhoidectomy and anal fissure. He underwent an abdominoperineal resection but had positive dermal skin margins on permanent sections despite wide perirectal soft tissue resection. A secondary resection with confirmed clear margins of the skin was performed 2 weeks postoperatively. One management aspect of anal duct carcinoma that needs emphasis is the need for wide local excision of the perirectal soft tissues.

Adenocarcinoma, Mucinous↗
PubMed1975

Rectal biopsy in clindamycin-associated colitis. An analysis of 23 cases.

The findings on rectal biopsy and proctoscopic examination in 23 cases of clindamycin-associated pseudomembranous colitis are summarized. On proctoscopic examination, discrete 2- to 5-mm raised plaques are seen adherent ot an edematous, friable mucosa. Rectal biopsy shows pseudomembrane formation and inflammation of the underlying rectal mucosa. Necrosis of the surface epithelium is a frequent finding; however, true ulcers were not observed. Vasculitis or thrombosis is not a feature of any of the cases. Frequently, the pseudomembrane is observed to be dislodged from the mucosal surface. In five of 23 cases, characteristic pseudomembranes are not present in the biopsy specimen in spite of the fact that they are evident proctoscopically.

Adolescent↗
PubMedDate not supplied

Colorectal adenocarcinoma in children and adolescents: a report of 8 patients from Zaria, Nigeria.

Colorectal adenocarcinoma is predominantly a disease of the old and less than 1% of patients are below 20 years in most reports. Though increasingly younger patients are seen in Africa, most reports indicate that the disease is extremely rare in children and adolescents. This is a report of 8 patients below 20 years managed for colorectal adenocarcinoma in a 10-year period in Zaria, Nigeria. They represented 16.3% of all cases of colorectal adenocarcinoma seen at the institution, an incidence higher than that in other parts of Africa and developed countries. All the tumours were in the rectosigmoid region and are accessible to digital rectal examination and proctosigmoidoscopy. The histology was mucinous adenocarcinomas in 6 patients, 5 of who had a Duke's stage C or D disease and well-differentiated in 2 (Duke's stage B and C respectively). Haemorrhoids was found in association in 2 patients and schistosoma mansoni in one and were responsible for delay in referral and diagnosis. Only palliative treatment could be offered in most patients due to advanced disease. Three patients died within 7 months and one after 2 years from their disease. One patient died from sepsis following surgery. The outcome in 3 patients could not be ascertained. It is emphasized that children and adolescents with rectal bleeding must have digital rectal examination and proctosigmoiscopy as this is the only hope of making an early diagnosis.

Adenocarcinoma↗
PubMed2001

[Fecal incontinence: various causes and treatments].

Three patients, two women aged 73 and 54 years and one man aged 46 years, had faecal incontinence for several years. All three patients had sphincter defects; two were managed conservatively and one was treated surgically with acceptable results. Of the many possible causes of faecal incontinence, a disturbed defecation pattern and obstetric trauma are most frequently encountered. After medical history and physical examination, anal endosonography is important in demonstrating or excluding an anal sphincter defect. Conservative treatment by means of a fibre-enriched diet, laxatives, pelvic floor exercises or daily enemas may provide a socially acceptable balance for the patient. When conservative management fails and a sphincter defect is present, sphincteroplasty is indicated.

Aged↗
PubMed2001

Hand-assisted laparoscopic colorectal surgery.

Hand-assisted laparoscopic surgery is a newly developed technique. It involves the intra-abdominal placement of a hand or forearm through a mini laparotomy incision while pneumoperitoneum is maintained. This way, the hand can be used as in an open procedure to palpate organs or tumours, reflect organs atraumatically, retract structures, identify vessels, dissect bluntly along a tissue plain, and provide finger pressure to bleeding points while proximal control is achieved. Additionally this approach is more economical than a totally laparoscopic approach, reducing both the number of laparoscopic ports and number of instruments required. Some advocates of the technique claim that it is also easier to learn and perform than totally laparoscopic approaches, and that there may be increased patient safety.

Colectomy↗
PubMed2001

[Transanal endoscopic microsurgery: a forgotten minimally invasive technique].

OBJECTIVES: The aim of this study was to evaluate transanal endoscopic microsurgery in patients with benign and malignant rectal tumours with special reference to feasibility, morbidity, and recurrence rate. METHODS: Forty-three patients underwent transanal endoscopic microsurgical excision of rectal tumours between 1996 and 2000. The histological diagnosis was benign adenoma in 30 and invasive carcinoma in 13. The mean height of the tumour above the anal verge was 11.2 +/- 3 cm and the mean diameter of the lesion was 3.4 +/- 1.5 cm. RESULTS: The mean operative time was 85 +/- 26 min and in one case (2%), it was necessary to convert to an anterior resection. The morbidity rate was 18%. Mean hospital stay was 3.9 +/- 2.4 days. Complete excision of the tumour with histological confirmation was achieved in 42 cases (98%). With a mean follow-up of 26 months, benign tumour recurrence was observed in one patient (3%). Of the 13 patients with carcinoma, two had immediate further radical resection. For the remaining 11 patients, with a mean follow-up of 19 months, the recurrence rate was 75% for T2 tumours and nil for T1 tumours. CONCLUSIONS: Transanal endoscopic microsurgery is safe and feasible technique which should have a useful place in the management of sessile adenomas of the mid and upper rectum. Its role in the management of rectal cancer is limited, although it may be appropriate for carefully selected cases.

Adenoma↗
PubMed2001

[Laparoscopic colorectal surgery: 499 interventions].

Laparoscopic colorectal surgery hasn't been generally accepted yet. We present here our experience of 449 operations performed with this method. More than a quarter of the indications were for malignancy. Conversion rate was 9.3% for the benign diseases and 14.1% for the malignant ones. Operating time was longer compare to open surgery. Postoperative complications were 9.9% for benign and 23.6% for malignant diseases. Of those complications 7.1% concerned anastomotic leakages. Four patients presented with port-site metastases and this in the beginning of our experience. Mortality rate was zero for the benign group while it was 1.6% for the malignant one. According to our experience we believe that laparoscopic colorectal surgery offers a satisfactory minimal invasive alternative. Technological advances such as the harmonic scalpel or new visual techniques give more possibilities for better application of the method. Randomised studies, running actually, should allow us to say in the following years, if this method could be a widespread standard.

Abscess↗
PubMed2001

[Port site metastases, current state of knowledge].

Laparoscopic procedures performed for diagnostic or staging purposes or even for a treatment, incorporate a certain risk for port-sites metastases. That possibility seems more potential with this method than with the open procedures. According to the works of Hugues, Welch and after that of Reilly, we do know that the percentage of wound metastatization in median laparotomies should be below 1%. In colorectal surgery this complication has been described with an incidence of 21%. Diverse factors influencing this phenomenon are reviewed. Nowadays the overall incidence of this complication seems to be significantly lower and two recent papers on laparoscopic colorectal surgery show an incidence varying between 0.2 and 1.1%. The oncological significance of such a secondary tumoral manifestation is not yet known. Is it a laproscopy-related complication or just a sign of immunosupressed host? More studies are certainly useful to precise the answer.

Colonoscopy↗
PubMed2001

[Preoperative evaluation of rectal cancer].

For a patient with a rectal tumor, the preoperative staging should answer four questions: Is the rectal tumor unique? Is the patient operable? Are there distal metastases? What is the loco-regional extension? The loco-regional extension is well evaluated by the echo-endoscopy while the involvement of the surrounding organs is better assessed by CT-scan or resonance magnetic imaging.

Barium Sulfate↗
PubMed2001

Transanal endoscopic microsurgery.

Transanal endoscopic microsurgery, although technically challenging, offers a viable and perhaps superior outcome to radical abdominal or traditional transanal excision of rectal neoplasia. Appropriate training and case selection, as with any new technology, are mandatory to help ensure optimal results.

Equipment Design↗