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PubMed1995

[Differential diagnosis of non-epithelial rectal neoplasms].

Experience in the treatment of 118 patients with nonepithelial new growths of the rectum has been accumulated at the Scientific Research Institute of Proctology in the period from 1970 to 1991. They accounted for 1.5% of all benign and malignant tumors of this organ. Leiomyoma was diagnosed in 44, leiomyosarcoma in 18, lipoma in 30, fibroma in 17, neurinoma in 7 and rhabdomyoma in 2 of these patients. A differential diagnosis was made between benign and malignant tumors, as well as with other nonepithelial new growth of the rectum. On the basis of the clinical picture and the results of digital and instrumental (radiological, endoscopic, and ultrasonic) examination of the rectum the correct preoperative diagnosis may be established with certain probability. This influences directly the choice of the volume of the operative intervention in various types of nonepithelial rectal tumors. Morphological verification of the tumor is the principal method of examination in establishing the differential diagnosis in the preoperative and postoperative periods.

Adult↗
PubMedDate not supplied

[The effect of propofol anesthesia with and without the use of opioid analgesia on cardiorespiratory stability in patients].

The possibility of use of propofol as an anesthetic induction agent was studied in 147 patients who were scheduled for trauma, abdominal, plastic and proctologic surgery. The patients were divided into 4 groups. Group I consisted of 39 patients who had anesthesia induced with propofol alone for outpatient operations. There was neither the decrease in blood pressure nor respiratory depression. Group II comprised 71 patients. These patients had anesthesia induced with a combination of propofol and alfentanil. They were breathing spontaneously. In this group, the decrease in blood pressure was seen in 20 patients (28%), and respiratory depression in 61 patients (85.9%). The Group III was composed of 30 patients who were assigned to the propofol and fentanyl for total intravenous induction combined with nitrous oxide-oxygen and pancuronium bromide for a maintenance of anesthesia. The patients were mechanically ventilated. The decrease in blood pressure occurred in 9 of these patients (30%). In Group IV in which a combination of propofol and talamonal were used because of a prolonged ventilation of patients by means of a respirator, 2 of 7 (28.6%) patients had the decrease in blood pressure. The study demonstrates that propofol as an anesthetic induction agent my be used for a great number of diagnoses and that it is very important to take into account the duration of surgical procedure and the stress of surgery, because if propofol is combined with narcotic analgetics the respiratory depression will appear in a high percentage.

Adult↗
PubMed1994

[The value of defecography for diagnosis of rectocele and rectal prolapse].

The role of defecography with respect to rectoceles and to any grade of rectal prolapses has not been defined so far. Therefore, we studied 42 out of 45 patients that were submitted to a defecography between 1988 and 1992 for defecation disorders of unknown origin. In particular, we compared the diagnosis obtained by anamnestic data and the physical examination with the defecographic results and the definitive diagnosis with regard to the chosen therapies and the results. Rectocele and rectal prolapse were very frequent pathologies with 69% and 33% respectively. Of 23 patients with a clinically palpable rectocele, defecography was false negative in 4 and moreover, it did not provide any information about the functional relevance of the rectocele. Yet, it disproved the clinically diagnosed prolapses in 6 of 15 subjects, but revealed one in 5 of 27 patients that were presumed normal. On the other hand, a previously not diagnosed rectocele was detected in 6 out of 19 patients by means of defecography, but none of them proved to be of any clinical relevance. Of all rectoceles, only 48% were regarded responsible for the patients' symptoms and were therefore operated. Hereby, the indication for a surgical approach based more on anamnestic data and the proctological examination than on radiographic findings. Contrarily, the indication for a rectopexy--even if given only in 4 of those 14 patients with any grade of invagination--mainly based on the dynamics during defecation as documented by defecography.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

[Ambulatory surgery--a sensible future perspective].

Increasing costs in health system, reduction of bed capacities and lack of nurses force to search for solution. To prove that day surgery may be a kind of solution, a pilot project was analysed during 8 months. This project was fully integrated in normal clinical management. Operated patients (n = 100; hernias, varicosis, proctological and other indications), preoperatively selected by specific criterias, and the family doctors were questioned retrospectively of their experiences. The results were very encouraging. Moreover we stated that day surgery is cost-covering. So day surgery is to consider as an important factor to cost-reduction.

Adolescent↗
PubMed1994

[Consensus hemorrhoids (Dutch Society for Surgery)].

On the initiative of the Dutch Surgical Society a consensus meeting was held on December 3rd, 1993 in Utrecht, the Netherlands by the National Organisation for Quality Assurance in Hospitals (CBO), on the diagnosis and treatment of haemorrhoids. The following statements were formulated. Haemorrhoids are vascular cushions, covered by mucosa, originating from the plexus rectalis superior, and are part of the normal anatomy of man. Complaints from haemorrhoids occur if they prolapse. The usual 4-grade classification of haemorrhoids has no direct impact on their treatment. Portal hypertension is not a cause of haemorrhoids. Blood loss, a sensation of prolapse, pruritus and soiling are non-specific symptoms of haemorrhoids. Anaemia may only be attributed to haemorrhoids after other pathology has been excluded. Acute massive anorectal blood loss is frequently caused by traumatic damage to the rectum. Anticoagulant therapy is a risk factor. The presence of unexplained perianal skin lesions neccessitates further proctologic investigation. Haemorrhoids are not palpable on rectal digital examination. In patients under 50 with anorectal blood loss and a history of haemorrhoids, a proctoscopic examination is sufficient. Anorectal blood loss in patients over 50 requires exclusion of higher pathology. The regulation of defaecation and eating habits can have a preventive effect on the development of haemorrhoids. Conservative measures form the basis of treatment for haemorrhoidal complaints. Local antihaemorrhoidal treatment can only be expected to give short-term relief and is not a causal therapy. Barron elastic band ligation and sclerosing, in addition to infrared coagulation are treatment modalities in the outpatient setting that are very effective, inexpensive and optimally patient-friendly.(ABSTRACT TRUNCATED AT 250 WORDS)

Hemorrhoids↗
PubMed1994

[Malignant epidermoid tumors of the anus. Etiopathogenesis and clinical aspects].

Malignant squamous tumors of the anus (MSTA) are most often carcinomas of the anus (80 to 85%) but remain rare. They occur above all in women between the age of 45 and 70. Three groups are considered to be high-risk: passive homosexuals, individuals with anal condylomas (in particular HIV+) and women with genital dysplasias or carcinomas. The presentation of MSTA is variable and often quite non-specific: bleeding, pain, pruritus, discharge. Proctological examination reveals an ulcerated lesion, proliferative or infiltrating. The diagnosis is confirmed by biopsy. Clinical (often under general anesthesia) and paraclinical (endoscopy, CT scan and endo-anal ultrasonography) evaluation is necessary. This involves three levels: local (enabling determination of spread in terms of height and circumference and/or infiltration of deep layers), regional (detection of inguinal and/or pelvirectal lymphadenopathy) and general (detection of bone, liver or lung metastases). This evaluation enables classification of the tumor, forming the basis of management choices and defining its prognosis.

Aged↗
PubMed1994

[Update of anal-perineal and rectal lesions observed in AIDS].

Anorectal lesions in patients carrying the HIV virus are uncommon (13%, in our personal life, 1 women/15 men). The following raise the possibility of AIDS: Kaposi sarcoma, non Hodgkin's lymphoma and also with the young patients, intraepithelial dysplasia, in situ carcinoma or squamous carcinoma of the anus. Other anorectal lesions encountered in proctology, should lead to suspicion of HIV infection: anal involvement in STD, florid papillomatosis, the most frequent lesion in his serious form which recur on a interminable bases, extensive and chronic herpes, lesions refractory to standard treatment, megalovirus and ulcers. Date by history indicating sexual habits, toxicomania as well as the existence of chronic diarrhea and full physical examination scoking enlarged lymph nodes are all factors to be taken into consideration in support of the diagnosis. Apart from painful emergencies justifying immediate surgery, indications for surgery should be weighed in terms of the patient's general condition, the stage of advancement of the disease and expected benefit in terms of patient comfort.

Acquired Immunodeficiency Syndrome↗
PubMed1994

[Perineo-scrotal gangrene. Analysis of 49 cases].

Perineo-scrotal gangrene is a necrotizing infection of the tissues of the perineum and scrotum. It accounts for 0.6% of our hospitalizations. The commonest etiology is urologic (86% of our cases). A proctologic origin was found in 6%, while the condition appeared to be primary in 8%. Concomitant diseases were found in 37% with diabetes the commonest. The diagnosis is clinically evident. The majority of patients are seen late (5 to 10 days) and the necrotizing process spreads rapidly. This is a multidisciplinary emergency, requiring intensive care, antibiotics, surgical excision of all necrotic tissues and possible urinary and/or fecal diversion. Extensive skin loss requires surgical cutaneous reconstruction procedures. The prognosis is severe, with a 12% mortality rate in our series.

Adult↗
PubMed1994

[Effectiveness of preserving large intestinal segments in surgical treatment of proliferative diffuse polyposis].

Among 390 patients who were operated on in the Research Institute of Proctology for the proliferative form of diffuse polyposis, 242 underwent various types of operations in which polyp-free segments of the large intestine were not resected. In the first 5 postoperative years all 242 patients were examined, in follow-up periods of 6 to 10 years 144 patients (59.5%), in periods of 11 to 15 years 88 patients (36.4%), in periods of 16 to 20 years 28 patients (11.6%), and after 21 years 8 patients (3.3%) were examined. Development of carcinoma in the preserved segments was encountered in 26 patients (10.7%), and intensive growth of polyps for which the preserved segment had to be removed was found in 5 patients (2.1%). There was no significant increase of the risk of carcinoma development in the preserved intestinal segments in patients who previously had a malignant tumor in the resected part of the large intestine. The development of carcinoma and intensive growth of polyps were encountered most frequently in patients in whom the distal parts of the large intestine were not removed during the operation. The obtained data are evidence of the validity of the choice of the volume of the operation based on the endeavor to preserve the polyp-free parts of the large intestine for rehabilitation of the patients.

Adolescent↗
PubMed1993

[Congenital angiodysplasias of the large intestine].

Angiodysplasia is a rare disease of the intestinal vessels. One of its types is the congenital form (so-called hemangioma or vascular hamartoma) which is mostly encountered at young age. Forty-eight patients with congenital forms of angiodysplasia of the large intestine were treated at the Scientific Research Institute of Proctology, RF Ministry of Health, beginning from 1962. According to morphological structure, there were 26 cases of the cavernous type, 11 of the capillary type, 11 of the mixed forms. In 46 of 48 patients the rectum and sigmoid were involved in the pathological process. Intestinal bleeding of various degree and intensity, occurring in 40 patients from early childhood, was the principal symptom in the clinical picture of the disease. The endoscopic picture of congenital angiodysplasia of the large intestine has characteristic macroscopic signs. Irrigoscopy and angiography are also very valuable and informative methods in the diagnosis of this form. Surgical interventions were performed on 28 patients, which accounted for 58.3% of the total number of patients with congenital angiodysplasia. Profuse bleeding leading to stable anemization of the patient is an indication for surgery. The volume of the operation was determined by the localization and spread of the pathological process. In concurrent localization of dysplasias, particularly in the pelvic cavity, and bearing in mind the seriousness of the operation itself, the degree of intraoperative blood loss, and the technical peculiarities of the intervention we prefer many-stage treatment. We encountered 18 complications, which mainly developed on the part of the perineum.

Adolescent↗
PubMed1993

[Bowel preparation for surgery of the anus, rectum and colon].

Successful bowel preparation for proctologic surgery is not schematic possible for all patients. Quality of cleansing after whole gut irrigation in women for example with chronic constipation is not always as efficient as in other patients. Two techniques for preparation of the colon were compared in a controlled trial. Fifty given the strong laxative Prepacol and fifty with whole gut irrigation. Significantly more patients suffered from vomiting and postoperative infections (translocation?) following irrigation. Prepacol preparation was well tolerated, showed a similar quality of cleansing and only a small discomfort.

Anus Diseases↗
PubMed1993

[Deep rectovaginal fistula and incontinence after labor trauma].

The commonest cause of traumata to the organ of continence is the injury during childbirth. Specially after negligent or missing reconstruction apart from incontinence rectovaginal fistulas can arise. This report deals with 24 incontinent women with a perineal laceration. After delivery 17 women had developed a low rectovaginal fistula. In addition to clinical recording of the incontinence, the proctological examination including anal manometry was carried out before and 25 months after surgery on an average. All patients get the same operation: Section of the anterior commissure, cutting out the fistula if necessary, separated suture of the animalic and voluntary sphincter, vaginal plasty. Preoperative resting pressure was 30 cm H2O and the voluntary pressure 46 cm H2O-on an average. Postoperative there was an increase to 61 cm H2O for the resting pressure and to 77 cm H2O for the voluntary pressure. 22 patients reported an improvement. 13 women are completely continent, 7 x soiling, 2 x incontinence for flatus, one incontinence for liquid stool and one stool incontinence were found. One fistula occurred again during follow up. Our surgical procedure compared with others has the advantage to give similar results avoiding protective colostoma. Besides the option for an other surgical procedure is still remained.

Adolescent↗
PubMed1995

[Extrapelvic endometriosis involving the perineum].

The ectopic endometriosis in the perineum is very rare (0.2% of ectopic endometriosis). We studied 16 cases of vaginoperineal endometriosis. Fifteen of them were localized in the site of an episiotomy scar and in one there was another focus of a severe endometriosis of multiple localizations. All the patients were submitted to anamnesis, physical, gynecologic and proctologic examination, surgical excition, histopathologic study of the lesion and control. All the patients are asymptomatic after treatment. To cure definitively the disease it is necessary to make a complete ablation of the endometrial lesion. Eventually, hormonal treatments could be use in case there were other endometrial localizations besides the vaginoperineal one.

Adult↗
PubMed1995

[The role of ultrasonic endoscopy in the examination of post-obstetrical anal incontinence].

Echoendoscopy provides a means of exploring the anorectal and neighbouring areas. The technique has been used for over 10 years in cancerology and more recently in proctology. It can be used to confirm the anatomic integrity of the anal sphincters or to identify and localize damage, making it particularly interesting for the exploration of anal incontinence. Echoendoscopy has been used in several recent series which demonstrated that besides stretch neuropathies, defects in the sphincter play a role in post-obstetrical incontinence. Whether the signs occur early or late after menopause, these ruptures are easily identified with echoendoscopy. Thus, a reliable diagnostic of the anal lesion is possible before any therapeutic decision, not only for anal incontinence but also for prolapsus or urinary incontinence. Further prospective studies should confirm the contribution of echoendoscopy in deciding on surgical repair and help determine, and thus to prevent, the risk of sphincter rupture.

Anal Canal↗
PubMed1996

[Diagnosis and surgical treatment of recurrences of rectal cancer].

The authors present the analysis of the results of surgical treatment of 145 patients with recurrent rectal carcinoma in 1960-1990 at the State Scientific Centre of Proctology. A group of 304 patients who underwent radical operation for carcinoma of the rectum was also studied to determine the frequency of recurrences after radical surgery. It was found to be 30.9% (in 94 out of 304 patients). More than half of carcinoma recurrences (63.8%) were revealed in the first postoperative year and 85.1% in the first two years. The average term of their appearance was 13.4 months. A radical operation may be performed for a second time in only 22.3% of cases of recurrences. The study of factors considerably influencing the frequency of the recurrence made it possible to determine three groups of patients with various risks of the development and create a scheme of their regular medical examination. Repeated radical operations on the cavities were carried out in 90 patients with recurrences, in 55 patients local resection of recurrrent tumor was performed. The indications for repeated operations were elaborated. More than half repeated operations on the cavity (53.3%) were combined, extensive, and concomitant. The incidence of intraoperative (52.2%) and postoperative (62.2%) complications was significantly higher than in primary operations. The use of a complex of therapeutic and preventive measures usulted in relatively low postoperative lethality (6.7%). Five-year survival after repeated operations on the cavity was 29 +/- 5.5%, the frequency of repeated recurrences was 34.5 +/- 5.2%; the respective figures after local excision were 14.6 +/- 5.5 and 40.8 +/- 7%.

Combined Modality Therapy↗
PubMedDate not supplied

[Complications of the surgical treatment of hemorrhoids and its therapy].

Hemorrhoidal disease is a common problem in a proctological ambulatory. Surgery is the best therapy for fourth degree hemorrhoids and the complication rate is 10-20%: postoperative urinary retention etiology is unknown but it may be caused by dysfunction of bladder muscles in response to pain and by an excessive perioperative somministration of fluids; delayed hemorrhage (i.e., 7-10 days postoperative) needs an inpatient care and the treatment ranges from bedside and packing to hemorrhoid pedicle suture ligation in the operating room. Anal stenosis is most commonly a result of a prior improper hemorrhoidectomy: it may be mild, moderate or severe; V-Y and C-anoplasty are the best therapy, also for ectropion. Rubber band Ligation and Sclerotherapy are the most common treatment of internal hemorrhoids: external hemorrhoid trombosis and delayed hemorrage are frequent complications.

Anal Canal↗
PubMed1996

[Endo-anal sonography in diagnosis of fecal incontinence].

Endoanal ultrasound is a new imaging technique in the diagnostic work-up of patients suffering from anal incontinence. A standardised examination as well as hardware specific reference values for the sphincter muscles are of paramount importance to allow correct interpretation of the continence organ. At the University Hospital of Würzburg from 1.2.1993 to 31.7.1994 90 patients (50 male, 40 female; age: 16-81 y.) with normal continence underwent endosonographic assessment of their sphincter complex. We measured the internal anal sphincter (IAS), puborectalis muscle as well as the three separate parts of the external anal muscle (EAS). Apart from establishing reference values we found a significant increase in thickness of both EAS and IAS with increasing age. However, no correlation was seen between muscle thickness, sex, height or weight. We also examined 29 patients with a history of incontinence. 13 (45%) had a morphological sphincter defect, most of which were due to obstetric trauma or previous proctological operations. 10 (35%) patients suffered from so called idiopathic incontinence. Anal ultrasound in these patients revealed muscle hypotrophy of the structurally intact sphincters.

Adolescent↗
PubMed1996

[Anorectal pull-through and vector volume manometry].

Anorectal manometry has been developed from an object of clinic oriented scientific interest to an established tool within the spectrum of proctologic diagnostics. At present it represents the only objective diagnostic method with regards to continence disorders; it is routinely applied in the evaluation of constipation, of incontinence, of pre- and postoperative conditions in diseases of the anorectum as well as in the indication and therapeutic control investigations during biofeedback training of the anal sphincter. The new technique of determination of the anal sphincter pressure vector volume allows for the most sensitive functional separation of patients with different degrees of continence; this method delivers a 3-dimensional graphic imaging of the sphincter pressure profile, thus allowing for an objective visualisation of the present mechanic defect and an aid in planning a surgical correction.

Anal Canal↗