Letter: Biopsy in syphilitic proctitis.
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We treated 160 patients (96 males, 64 females) with a mean age of 66 +/- 12 years. 63 patients presented adenomas (AD) and 97 adenocarcinomas (ADC). In the ADC group 32 patients received preoperative chemoradiation (RT + CT), and 15 postoperative RT. In 7 patients with RT + CT the tumor disappeared. No hospital mortality was recorded. Morbidity was observed in 13% of AD group and 18% of ADC group. Hospital stay was less than 7 days for 72% of patients. Stages were: 10 pTis, 40 pT1, 29 pT2, 18 pT3. Recurrence was observed in 7 (11%) of AD and 23/97 ADC (24%). 0 pTis, 12% pT1, 24% pT2, 61% pT3. No patient with RT + CT and negative margins had recurrence with a minimum follow-up of 2 years (11 patients). Five-year cumulative survival was 100% for pTis, 92% for pT1, 75% for pT2 and 69% for pT3.
OBJECTIVE: To investigate lymphatic drainage of rectal and lymphatic spread of rectal cancer. METHODS: Rectal endoscopic lymphoscintigraphy was performed in 37 volunteers and 16 patients. One millilitre dextran marked with (99m)Tc was injected bilaterally into submucosa of the rectum through rectal endoscopy. 1, 2, 3 hours after the injection, rectal lymphoscintigraphy was registered with a computerized gamma camera (TOSHIBA GCA901A). RESULTS: Lymphoscintigraphy in control subjects showed upward epirectal and pararectal nodes. The average number of the nodes was 12 three hours after the injection. Compared with histological node examination in all patients operated upon for rectal cancer, rectal endoscopic lymphoscintigraphy showed a sensitivity of 97.1%, a specificity of 75.0%, an overall accuracy of 87.5%, a false positivity of 25.0%, and false negativity of 8.3%. CONCLUSION: The method is better for evaluating lymphatic spread of rectal cancer before operation.
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In the presented material a review of the current data and comprehensions of the anatomy and physiology of the hemorrhoids is made, as like of the ethiology and pathogenesis of the disease. The new conceptions of the surgical treatment of the disease are pointed out. An attempt was made to differentiate the operative methods in patogenetical principal. The operative results of the General Surgery Clinic by the University Hospital "St. Ann", Sofia for the period 1991-2000 of 157 treated patients with hemorrhoidal disease are presented. Based on these results the authors come to a conclusion, that the Whitehead's operation remains "the golden standard" as a choice of an operative method for the treatment of the hemorrhoidal disease in advanced stages (III-d or IV-th).
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Several methods have been used to cleanse the large bowel prior to roentgen examination and rectoscopy for more than ten years. A method with administration of a salt solution (SALAX) in combination with different oral laxatives (Cascara sagrada, Dantron, Bisacodyl) without cleansing enemas is described. Hospitalized patients should have an individual preparation while ambulatory patients are almost completely cleansed if they carefully follow the given instructions.
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AIM: To determine the usefulness of endoscopic dilatation in dealing with benign stenosis of the anus, rectum and colon. PATIENTS AND METHODS USED: Thirty six (36) patients with stenosis, anus (8), rectum (22) and colon (6) were given endoscopic treatment using hydroneumatic balloons, electro incision (radiated cuts) or a combination of both. Rigid equipment (metal) was used for distal stenosis. Age ranged between 30 and 82 years. Twelve (12) patients were male and 24 female. The diameter of the stenosis was less than 13 mm in 18 of the patients and 11 patients carried colostomy. RESULTS: All 36 patients were subjected to a total of 113 dilatation sessions. The average number of sessions per patient for patients with anal stenosis was 2.5 and for patients with colorectal stenosis, 3.32. One patient with rectal stenosis required 21 sessions to achieve final objective. The result achieved was good in 31 patients, less than satisfactory in 3 patients and bad in one patient, who presented a stenosis which was over 5 cm long. We lost track of a patient in the follow up stage. Success in closing the colostomy was achieved in 9 patients, while one presented a complication due to the procedure (cervical emphysema) which remitted with medical attention. CONCLUSIONS: Endoscopic dilatation offers, through its different techniques, a safe and efficient method for the treatment of benign stenosis of the anus, rectum and colon and must be considered as a first class tool for the treatment of this kind of pathologies.