[Iatrogenic intraperitoneal laceration of urinary bladder wall during trans-urinary adenomectomy for benign hyperplasia of the prostate gland].
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Follow-Up Studies↗
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Local excision of rectal cancer with transanal endoscopic microsurgery (TEM).
BACKGROUND: Local excision for T1 rectal cancers with Transanal Endoscopic Microsurgery (TEM) is an accepted standard of care. However for T2/T3 rectal cancers, the high local failure indicates that this is not a valid option. MATERIALS AND METHODS: Between 1990 and 2000, 83 patients with rectal adenocarcinoma underwent complete full thickness local excision. The mean diameter of the tumor was 3.4+/-1.7 cm, 60% were located more than 5 cm from the anal verge; 43% of patients received radiation therapy (26 pre- and 10 postoperatively). RESULTS: Postoperative complications occurred in 15 patients (18%); there were no postoperative deaths. Mean follow-up was 37 months (range 18-118). The pathological stage was: Tis 9, T1 39, T2 23, T3 12. The overall local recurrence rate was 0% for Tis, 13% for T1, 17% for T2 and 50% for T3. Recurrence was managed surgically in 65% and nonsurgically in 35% because of advanced disease or poor general condition. Overall 5-year survival rates were 100%, 92%, 75% and 69% for Tis, T1, T2 and T3, respectively. CONCLUSION: Local excision with TEM is effective for early (Tis, T1) rectal cancers. Patients with T2 tumors can be treated with preoperative chemoradiation and subsequently local resection. Patients with T3 should not be treated with local excision unless they are unable to tolerate more extensive surgery.
Adult↗
Treatment of early rectal tumours by transanal endoscopic microsurgery in Hong Kong: prospective study.
OBJECTIVE: To summarise the results of transanal endoscopic microsurgery for the treatment of rectal villous adenoma and early rectal tumours. DESIGN: Prospective study. SETTING: Regional hospital, Hong Kong. PATIENTS: Consecutive patients between November 1995 and January 2003. INTERVENTION: Transanal endoscopic microsurgery. MAIN OUTCOME MEASURES: Intra-operative morbidity and mortality, complication rate, operating time, postoperative morbidity and mortality, recurrence rate and correlation between preoperative ultrasonography staging and postoperative pathological staging. RESULTS: Thirty-two patients with rectal villous adenoma and early rectal carcinoma were registered, 31 of whom (14 men and 17 women) were included in the study. The median tumour size was 2.5 (range, 1-8) cm and the median operating time was 95 (45-220) minutes. The median follow-up period was 23 (2-92) months, and there was no local recurrence. There was no operation-related mortality and the resection margins were all clear. Complications included temporary flatus incontinence (n=2), acute retention of urine (n=1), exacerbation of chronic obstructive airway disease (n=1), and secondary haemorrhage in a patient on aspirin. CONCLUSIONS: Transanal endoscopic microsurgery is a safe procedure and can achieve good local tumour control. It is ideal in the management of rectal villous adenomas at stages pT0 and pTis. Its application is now extended to the treatment of early rectal carcinoma at stage pT1 with curative intent. For tumours at stage pT2 or later, it can also serve as a good option for local palliation.
Adenoma, Villous↗
Liver metastases of a minute rectal carcinoid less than 5mm in diameter: a case report.
We report a case of liver metastases of a minute rectal carcinoid less than 5mm in diameter, which was found during the postoperative follow-up course of a stomach cancer patient. For the early stomach cancer, laparoscope-assisted distal gastrectomy with lymph node dissection was performed on August 26, 1998. Later, abdominal CT revealed space-occupying lesions in the liver (S2). Metastatic tumors of the stomach cancer were suspected, but further examination revealed that the lesions were metastatic tumors due to a rectal carcinoid tumor. Ten months later, metastatic carcinoid tumors were found in the liver (S1, S5, S6, S7, S8). Subsegmentectomy of the liver (S7) and microwave coagulation therapy (S1, S5, S6, S8) were performed. Carcinoid tumors metastatic to the lymph nodes, liver, and other areas have been reported, but all were larger than 20mm in diameter. In this case, the primary tumor was less than 5mm in diameter, which is extremely rare. This patient was successfully treated with lateral segmentectomy, subsegmentectomy (S7), microwave coagulation therapy of the liver, and transanal extirpation. She is presently in a good condition and has had no recurrence of the carcinoid tumor from ten months after the last hepatectomy.
Adult↗
[Proposals for the explanation of diagnostic procedures in gastroenterology].
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Biopsy↗
Proctoscopic diagnosis of rectal schistosomiasis.
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Proctoscopy↗
[PATE 2000 Sorrento: a modern, effective instrument for defining haemorrhoids. A multicentre observational study conducted in 930 symptomatic patients].
In 2000, the Italian Society of Coloproctology and the UCP (Coloproctology Units) devised a new haemorrhoid classification system, named PATE 2000 Sorrento, which is capable of defining all the main characteristics of the disease. Any new system should be able to predict the real extent of hemorrhoids by means of a specific index in order to help physicians in choosing the best therapeutic option. The authors present the results of a national multicentre study of 930 patients with symptomatic haemorrhoids. Nineteen patients (2%) could not be classified with the old haemorrhoid classification, while PATE 2000 Sorrento proved successful in classifying all patients. The difference was statistically significant. The new classification enables us to establish a specific score for the disease. In order to better evaluate the clinical impact of the scores obtained with PATE 2000 Sorrento, the authors analyzed the correlation between the score itself and the therapy chosen by each individual centre. The highest scores always corresponded to the choice of surgical hemorrhoidectomy, while in the case of lower values each centre seemed to be in doubt between medical therapy and other less invasive procedure such as sclerotherapy or rubber band ligation. These data were statistically significant (P < 0.0001). On the basis of our findings, PATE 2000 Sorrento seems to confirm its scientific and clinical relevance and could be a useful tool for the choice of the best treatment for each individual patient.
Adolescent↗
[Appliance of "LigaSure" generator in hemorrhoidectomy].
Results of hemorrhoidectomy in 185 patients were analyzed. In 82 patients of the study group surgery was performed with "LigaSure" generator. Control group consisted of 103 patients who underwent surgery by Milligan-Morgan method. Appliance of "LigaSure" generator to reduced time of surgery by 3.5 times (from 48+/-10.3 min to 13+/-3.7 min), pain syndrome -- 2.2 times, and dysuric disorders -- 2.4 times.
Adult↗
A mobile system for postmortem genital examinations with colposcopy: SART-TO-GO.
The interpretation of genital findings in the deceased is a vital and timely issue. A paucity of information exists on the nature and appearance of the anogenital tissues in the postmortem interval. The traditional postmortem genital examination consists of gross visualization, which may preclude detection of the subtler trauma that usually constitutes injury in sexual assault. The mobile system grew out of a need to bring the examiner to the patient, e.g., in jurisdictions that lack a centralized morgue. The theoretical framework of the methodology lies in the sexual activity that culminates in the death of the sexual homicide victim. This sequential methodology was based on the Sexual Assault Response Team (SART) model, with adaptation to the autopsy milieu. Colposcopy is well-established for the medical-legal investigation of living sexual assault victims. During the author's initial rape-homicide examinations, only gross visualization was available. It soon became apparent that a system that facilitated detailed scrutiny of the anogenital tissues at various postmortem intervals was needed. Colposcopy was selected as the examination method because of its magnification, photodocumentation, and peer review potential. The sequential protocol was developed and refined during an ongoing accumulation of baseline cases. The role of the forensic nurse examiner is described within a defined scope of expertise and as a collaborative member of the homicide investigative team.
Body Fluids↗
Safety and effectiveness of large-volume enema solutions.
The effectiveness and side effects of three types of enema solutions were compared in healthy subjects. Using a repeated-measures, double-blind design, the three different enemas (soapsuds, tap water, and polyethylene glycol-electrolyte solution) were given at 1-week intervals to 24 healthy volunteers. Soapsuds and tap water enemas produced significantly greater returns than polyethylene glycol electrolyte solution (PEG-ES) and were also more uncomfortable. Rectal biopsies showed surface epithelium loss after soapsuds and tap water but not after PEG-ES enemas. Before recommending changes in nursing practice, further research is needed to determine the mechanism for the surface epithelium damage and to determine if this damage produces a stronger defecation stimulus and discomfort.
Abdominal Pain↗
Accuracy and reliability of the endoscopic classification of chronic radiation-induced proctopathy using a novel grading method.
GOALS: To assess a novel grading method of radiation proctitis for intraobserver and interobserver agreement among endoscopists. BACKGROUND: There are no established criteria for the endoscopic classification of chronic radiation-induced proctopathy. We introduce a classification system based on telangiectasia density and vascular coalescence. Accuracy and reproducibility of this system were examined. STUDY: A total of 131 endoscopic images of the rectum in 74 consecutive patients undergoing lower endoscopy who had received pelvic radiation therapy were analyzed. Each image was duplicated, reversed, and rotated 90 degrees for a total of 262 images. These were shown in random order to 13 endoscopist evaluators (6 attending physicians, 7 gastroenterology fellows) using an online computer testing program. Each image was scored from grade 0 to 3 using criteria from the rectal telangiectasia density (RTD) classification we developed. Kappa (kappa) statistics and percent agreement were used to quantify the reproducibility and level of agreement. RESULTS: Intraobserver agreement: The mean (SD) for kappa among the 13 raters was 0.58 (0.09); 95% confidence interval [CI] = 0.527-0.636. Interobserver agreement: The estimated kappa across all 13 raters was 0.518 (95% CI = 0.506-0.530). For the 7 trainees, kappa was 0.547 (95% CI = 0.523-0.571). For the 6 attending physicians, the kappa was 0.481 (95% CI = 0.453-0.509). As another indicator of agreement, all 13 evaluators agreed on 30 (22.9%) of images, differed by no more than 1 grade on 60 (45.8%) images, no more than 2 grades on 33 (25.2%) of images, and no more than 3 grades on 8 of the images (6.1%); 73% of patients referred for bleeding control were RTD grade 2 or 3. CONCLUSIONS: The RTD grading scale for radiation proctopathy is reproducible among endoscopists. Hematochezia is associated with high RTD grade.
Chronic Disease↗
[Open hemorrhoidectomy with using the apparatus controlled bipolar electrocoagulation].
Hemorrhoids are known to be a widely spread disease. The aim of this study was to compare two methods of hemorrhoidectomy. The hemorrhoidectomy was performed on 262 patients with combined III-IV degree hemorrhoids, 130 patients being operated by the conventional method--Milligan-Morgan hemorrhoidectomy, 132 patients undergoing hemorrhoidectomy using a bipolar vessel sealing system. It was noted that the operation time was significantly shorter, postoperative pain and postoperative complications less frequent due to the bipolar device-controlled electrocoagulation.
Adult↗
Spectrum of human papillomavirus-related dysplasia and carcinoma of the anus in HIV-infected patients.
The incidence of human papillomavirus (HPV)-related anal squamous cell carcinoma is increasing. It is likely that long-standing HIV-related immunosuppression plays a significant role in the pathogenesis of anal carcinoma; however, a direct HIV-HPV interaction has also been implicated. Using cervical cancer prevention as a paradigm, anal Pap smear screening as part of routine HIV preventive care has been proposed to detect and treat precancerous anal lesions in the hope of decreasing anal cancer rates. All HIV-positive patients with invasive cancer of the anal canal, particularly those with CD4+ cell counts greater than 200/microL and those receiving HAART, should be managed in the same manner as their HIV-negative counterparts.
Anus Neoplasms↗
Catheterisation in a large inguinoscrotal hernia.
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Catheterization↗
[Iatrogenic diagnostic delay in rectal cancer].
From a case material of 151 rectal carcinoma patients it has been established that the duration of anamnesis from the first consultation of the doctor to the onset of treatment was in 40 percent of the cases longer than 3 months, and in 17 percent of the cases, longer than 6 months. Only 36 percent of the patients with clinically manifest disease underwent diagnosis within a month following the first consultation of the doctor; in 37 and 15 percent of the cases, diagnosis was made only after 3 and 6 months, respectively. The causes of iatrogenic delay of diagnosis are analyzed and demonstrated by typical examples.
Diagnosis, Differential↗
[Surgical treatment of distally located rectal carcinomas using the rendez-vous method--a laparoscopic resection in combination with T.E.M].
The aim of this work is to introduce a surgical procedure, which would make operations of distally located rectal carcinomas indicated for abdominoperineal extirpation of the rectum possible while maintaining intestinal continence and full functioning of the sphincter system. At the same time, we have aimed at the maximum use of all pros of contemporary miniinvasive surgical techniques. We have labelled our proposed surgical technique the "rendez-vous technique". The trial group includes the original group of 10 patients, who have been operated in our clinic since April 2004, using the rendez-vous technique. We are aware of the fact, that the trial group is small, however we believe that this trial group is the starting group, which will continue to enlarge and that it will bring results to the patients themselves, as well as for a valid prospective study in order to confirm or challenge the proposed method's effectiveness.
Female↗
[Endosonographic diagnosis of metastatic tumors in the recto-uterine or recto-vesical space by transrectal scan].
A 6-year experience of transrectal ultrasonography (TRUS) in 75 patients with advanced gastrointestinal cancers was reviewed regarding the diagnostic yield of metastatic extrarectal tumors. A diagnostic capability of TRUS (a sensitivity of 82.9%, a specificity of 97.5% and an accuracy of 90.7%) was statistically superior to that of digital rectal examination (a sensitivity of 62.9%, a specificity of 75% and an accuracy of 69.3%). However, TRUS could hardly correctly diagnose a miliary type of extrarectal tumors in contrast to nodular and thickened types. TRUS also had an advantage over conventional ultrasonography in detecting a small amount of ascites with a sensitivity of 75%, a specificity of 93% and an accuracy of 86.6%. Patients with positive signs of extrarectal tumors or ascites on TRUS survived significantly shorter than those with negative signs. TRUS renders a convenient means in the objective diagnosis of peritoneal carcinomatosis, and predicts patient's prognosis.
Adult↗
[Ambulatory treatment of anal fissure].
Not a long time ago, the standard treatment for anal fissure was surgical, inpatient care; this concept failed in the last years, ambulatory treatment becoming the rule and the inpatient care the exception. We wish to present here our results in 125 ambulatory patients, who were referred to our proctologic office with anal fissure. We used two methods: a conservative one, by applying topical 0.2% nitroglycerine, similar to other proctology practitioners, and one method of our own which is a minimal surgical procedure consisting of sphincterotomy. The average follow-up period was 6 months. Symptom-free and anatomic-free states were obtained in 61.2% for conservative treated patients and in 91.4% for operated patients, respectively. We had no postoperative complications, rebounds or sequelae. We consider the results at least equal in effectiveness to those of standard surgical treatment. This is why we underline that ambulatory treatment for anal fissure reaches the goal to be of a first line option.
Administration, Topical↗