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At least 973 records · Page 54Linked to original sources
PubMed1996

[Diagnostic and therapeutic procedures in fecal incontinence in general practice of the surgically educated proctologist].

Age related, about 10% of the general population suffer from faecal incontinence. In a surgical, proctological office diagnosis is possible with carefully taken history, physical examination, digital examination of the anorectum, rigid rectosigmoidoscopy, and anoscopy. Together with special examinations (endoanal ultrasound, electromyography, pudendal nerve terminal motor latency [PNTML], anorectal manometry, defaecography, transit time of the colon) the plan for medical and surgical treatment can be made. The basic medical conservative therapy consists of regulating the form of stool (high fibre diet and/or loperamid), training of the sphincter and pelvic muscles electrical stimulation or biofeedback training. Outpatient surgery is possible for small prolapsing tumors of the lower rectum or anal canal, hemorrhoids grade 2 or segmental anal prolapse. Inpatient surgery is needed for any form of reconstruction of the sphincter or the sensitive area of the anal canal, post- and preanal repair, anal and rectal prolapse, (dynamic) gracilis sphincteroplasty, or for a terminal stoma in those patients, whose uncontrolled incontinence cannot be managed otherwise. After surgery it is needed to continue the medical therapy (regulating the bowel movements, biofeedback training, electrical stimulation of the sphincter).

Adult↗
PubMed1997

[Anal epidermoid carcinoma: a rare incidence or a rare diagnosis?].

Epidermoid cancer of the anus is a rare entity which represents 1-2% of all gastrointestinal tract cancers. Possible predisposing causes include smoking and sexual behaviour, particularly homosexual anal intercourse, chronic inflammation (Crohn, anal fistula, fissure, sepsis, hydradenitis suppurativa), and transmissible agents (human papillomavirus type 16 y 18, condylomata acuminata). Another factor is the genetic, which may be related to changes in chromosome 11 and the sort arm of chromosome 3. The aetiology of anal carcinoma is a multifactorial interaction between environmental factors. HPV infection, immune status and suppressor genes. We report on three cases of squamous cell carcinoma of the anus seen in our Unit of Proctology. One patient with widespread perianal hydradenitis suppurativa. Another one in a patient VIH+ with anal human papillomavirus infection, in situ cervix cancer and condylomata acuminata of the vulva and anus. A third case, a man with haemorrhoids. Is addition, constant irritation, chronic inflammatory changes, and repeated epithelial regeneration that accompany noninfectious conditions may be related to risk of anal epidermoid cancer. It is important that this cancer is kept in mind. It is unforgivable that a cancerous lesion that can be suspected in a simple inspection or rectal digital examination be attributed, to a benign anal condition.

Adult↗
PubMed1997

[Defecation problems: incontinence, constipation and impeded defecation; why and what can be done?].

Defaecation disorders may be subsumed in three categories: Inability to control motions = incontinence. Difficulty of evacuation = constipation [inertia coli, outlet obstruction]. Impeded defaecation: Rectocele, enterocele, intussusception. Etiology, examination and therapy are described in detail. Characteristic complaints of patients are listed and matched with probable diagnoses. Beside routine proctologic examination endosonography, estimation of transit time, endoscopy and defecography are discussed. The role of nutrition is stressed and emphasis layed on fibre and fluid intake. The advice, "take more fluid and fibres" does not help a lot, because no individual help is given. A time consuming nutrition and defaecation history has to be taken to establish nutritional support. This attention gives confidence to the patient and helps a great deal in the treatment. A checklist of the therapy of constipation and summarizing tables on different types of fibres are included. Additional conservative treatments are pelvic exercises and biofeedback training. Operative therapy is directed towards etiology of the disorder. Therefore many different methods exist and their diagnose related indication are discussed.

Anal Canal↗
PubMed1997

The chronic anal fissure treatment by internal partial lateral sphincterotomy and following anal manometry.

Anal fissure remains one of the most common proctologic problems. A number of reports have advocated the use of partial internal sphincterotomy as a treatment of chronic anal fissure. Our study shows the results of a retrospective analysis of our patients who underwent lateral internal sphincterotomy for the treatment of chronic anal fissure. To determine long time results we examined random sample of 75 operated patients. Apart from taking careful history and patient's assessment of the operation effect, the patients were investigated "per rectum", and even possibly rectoscopically. To asscertain suitability and also security of properly done internal sphincterotomy, we performed anorectal manometric examinations in 53 patients controlled. To conclude our results, we can state that in 9 (12%) patients controlled some subjective complaints or certain pathologic findings connected with anal fissure or sphincterotomy were found. None of the people from the set of ours suffered from any complaints, which can be taken as stool incontinency. In no patients any change in pressure measured by anorectal manometry indicating incontinency was proved.

Anal Canal↗
PubMed1997

Learning relevant procedural skills. Are supervisors providing opportunities?

OBJECTIVE: The aim of this study is to assess general practice registrars' (GPRs) learning needs in relation to their procedural skills development and compare these with the learning opportunities offered by their general practice supervisors (GPSs). METHOD: A 43 item questionnaire was designed to assess the procedural skills development needs of GPRs. The questionnaire was administered to GPSs and GPRs. RESULTS: GPRs can expect to consolidate their skills in the areas of joint injections. ENT procedures and some small surgical procedures. They are unlikely to gain experience in the areas of proctology, the use of the microscope as a diagnostic tool, cardiac stress testing, hearing assessment and some less frequently needed procedures. Respondents identified spinal mobilisation manipulation, flexible sigmoidoscopy, colposcopy and fine needle aspiration biopsy as procedures they would like to see performed in general practice. CONCLUSION: GPRs are keen to enhance their procedural skills in a wide range of areas. They cannot necessarily expect that their general practice attachment will provide the opportunities to develop all skills desired. The Royal Australian College of General Practitioners (RACGP) Training Program needs to provide registrars with a list of core skills that are expected of every general practitioner (GP). To ensure this objective is achieved, innovative learning opportunities for GPSs and GPRs in the domain of psychomotor competencies need to be developed.

Adult↗
PubMed1997

[Perineal injuries in wartime].

Perineal war wounds involve the anterior perineum or urogenital perineum and posterior perineum or ano-sphincteric perineum. They are rare in civilian practice and in war practice, as only a small and hidden surface of this anatomical region is exposed to damaging agents. An isolated wound of the perineum is rarely life-threatening, but always threatens the functional prognosis of these patients, who have a mean age less than 30 years. In war practice, these wounds are often associated with lesions of adjacent of sacral, buttock or abdomino-pelvic regions. This article is confined to perineal war wounds in men. Lesions of the urethra and anus and rectum, as well as lesions of the genital appendages and pelvic nerves, leave micturating, gastrointestinal and sexual sequelae, which are sometimes permanent. These sequelae must not be exacerbated during investigation and surgical repair, despite the unfavourable emergency context, associated lesions and the time required to repair them. The basic principles of surgical treatment remain urinary diversion by a large cystostomy tube for urogenital lesions, faecal diversion by terminal colostomy for ano-sphincteric lesions, conservative debridement of the margins of the anal or urethral wound, debridement and drainage of contaminated soft tissues and connective tissue spaces. First-line immediate suture of the urethra or edges of the anal wound must be considered according to the defect, and the septic and haemorrhagic context. When ideal repair cannot be performed, alignment over an urethral catheter, urethrostomy, fixation-identification of the urethral or anal extremities constitute intermediate procedures allowing secondary urological and proctological specialized procedures in these patients.

Abdominal Injuries↗
PubMed1997

[Restoration of bowel tube continuity in patients with colostomies].

The experience of restorative operations conducted within 1980-1995 in 186 patients with one-tube and separated two-tube colostomy gainred in proctologic clinic is reviewed. 179 patients suffered from cancer of the colon. The causes of performing colostomy are outlined. The main stages of restorative operation in two-tube colostomy are described. Peculiarities of colonic anastomosis formation after resection of bowel segment bearing fistula are considered, the resection being performed with the help of laser scalpel. Possibilities of the use of suturing apparatus AKA, peculiarities and advantage of its application in carrying out restorative surgical intervention in 69 patients after Hartmann's operation are demonstrated. The data of reconstructive-restorative operations in conditions of short rectal stump (modification of Duhamel operation), information about complications in restorative operations and their causes are analyzed. The mortality rate made up 2.2%. Possibility and expediency of restorative operations in patients with colostomy accompanied by metastases are discussed.

Adolescent↗
PubMed1997

[Functional disorders of the rectum and pelvic floor--surgical diagnosis].

Pelvic-floor disorders present themselves as isolated entities or, often, in combination with other ano-rectal diseases. In each case, the basis for individual therapy has to be a precise diagnosis. For differentiation of pelvic-floor disorders, we use a step by step diagnostic cascade: the first step is a basic proctological evaluation, including history, scoring, inspection, palpation, proctorectoscopy and anorectal manometry. Secondary special diagnostics, such as endosonography, neurological examination, transit-time studies and defecography are also used. In special individual problems, CT scan, MRI, urological or gynecological examination complete the diagnostic route, resulting in the definite coloproctological therapy.

Colonic Diseases, Functional↗
PubMedDate not supplied

[Nitazole--an antimicrobial substance].

The antibacterial activity of protistocide drug nitazole has been revealed for the first time in the 80's at the Laboratory of Clinical Microbiology of the Mechnikov Research Institute of Microbiology and Immunology. Unlike other imidazoles, such as metronidazole and tinidazole, nitazole acts as the inhibitor of growth of gram-positive facultative and obligate anaerobic microorganisms as well as gram-negatives except for Pseudomonas aeruginosa and Proteus. Nitazole, as a main antimicrobial agent of many multicomponent drugs which are created on the hydrophilic basis (matrices), is particularly useful for topical treatment of wounds and burns in the first and second phases of these processes. Drugs which include nitazole possess not only antibacterial and protistocide activity but also act as anti-inflammatory, wound-healing ones and have osmotic property. These drugs are approved by the Ukrainian Ministry of Public Health for wide use in surgical, gynecological, proctological and dermatological clinics as well as in combustology.

Anti-Bacterial Agents↗
PubMed1998

[Is there a correlation between dietary habits and hemorrhoidal disease?].

OBJECTIVES: It is empirically accepted that certain foods play a role in the pathogenesis of hemorrhoids or their acute exacerbation. The aim of this work was to determine whether there is a relationship between hemorrhoids and certain food-related or common toxin-related factors. PATIENTS AND METHODS: Two groups of 50 subjects were compared. Group I was composed of 50 patients with hemorrhoid symptoms. Fifty volunteers with no proctologic abnormality were included in group II. We used a diet survey to compare total calorie, protein, carbohydrate, fat, food fiber, water, alcohol, salt, pepper, pimento, tea, and coffee intake was well as smoking habits. Episodes of constipation were also noted. RESULTS: Overall calorie intake, as well as protein, carbohydrate and fiber intake were similar in the two groups as were use of salt, coffee and tea. Dietary intake in group I was higher for fat (p = 0.02), alcohol (p = 0.01), pepper (p = 0.04, and pimento (p = 0.001). Subjects in group I drank less water (p = 0.008), smoked more (p = 0.01) and were more often constipated (p < 0.001) than those in group II. CONCLUSION: Our findings provide further arguments suggesting that dietary imbalance or smoking could be involved in the development of hemorrhoids. These factors should be evaluated in appropriate dietary inquiries. Epidemiological surveys would be required to confirm their possible causal effect.

Alcohol Drinking↗
PubMed1976

[Consultation hours for special surgery in a surgical department of a district infirmary ("kreiskrankenhaus") (author's transl)].

At the Surgical Department of the Kreiskrankenhaus of Burg five consultation hours for special surgery have been established and have been working for 2 to 3 years: 1. consultation hours for surgical angiology, especially varicosis and proctology, 2. consultation hours for goitre, 3. consultation hours for traumatology, especially follow up control of patients after operative fracture treatment, 4. consultation hours for pediatric surgery, 5. consultation hours for surgical gastroenterology, especially follow up control of patients after partial and total gastrectomy, vagotomy, and complications after biliary surgery. The experiences gained from these consultation hours are discussed. With regard to the personal and organizational problems in district infirmaries many difficulties have to be overcome in establishing consultation hours for special surgery. However, these consultation hours offer the possibility to improve the surgical care in the rural population and to hold international standards in general surgery practice even in smaller surgical departments.

Adult↗
PubMed1998

[Hemorrhoidal disease].

Prevalence of hemorrhoidal diseases in proctologic practice has decreased over the past years. Inflammatory and functional diseases predominant as a consequence of improved differential diagnosis and diagnostic management. In less than 20% of patients of a specialized practice stage-adapted therapy is indicated. Favorable long term results, however, are barely obtainable without elimination of pathogenic factors. If inflammatory and/or functional disorders of the anal region are not eliminated relapses are preprogrammed.

Hemorrhoids↗
PubMed1998

[Control of function before and after sphincter-preserving rectal resection].

Prior to sphincter-saving rectal surgery an in-depth evaluation of the patient's anorectal physiology is of paramount importance to avoid poor functional outcome. A detailed history comprising all previous operations and childbirths as well as a precise proctological examination are the most important steps in the diagnostic work-up. A standardized continence score is easy to obtain and can be used as a guideline preoperatively as well as during follow-up. Furthermore, endosonography, manometric studies and quality of life assessment can add valuable information before and after surgery. Electrophysiologic studies are generally not necessary and can therefore not be regarded as routine investigations.

Fecal Incontinence↗