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At least 1,063 records · Page 59Linked to original sources
PubMed1991

[Results of endoscopic interventions in large and giant epithelial neoplasms of the large intestine].

The paper presents the analysis of the results obtained for 319 patients at endoscopic interventions for large and giant tumors of the colon. Altogether 415 neoplasms were removed: 207 nodular, 126 creeping and 82 flat. The latter two were removed using specially developed technique of endoscopic electroresection of the intestinal mucosa along with the tumor. Malignancy was established in 16.1% of the cases. During the endoscopic procedure 2 patients were diagnosed to have colon perforations, 24 intensive hemorrhage which was stopped endoscopically in 22 cases. One patient developed subsequently necrosis of the intestinal wall. Surgical treatment was performed in 5 patients: for hemorrhage, colon wall perforation, malignancy in 2, 2 and 1 patient, respectively. One-eight-year follow-up of 316 patients reports cure in 217 (68.6%), relapses in 79 patients (71 of them were endoscopically successfully retreated), cancer in 15 and corrosive strictures in 5 patients.

Adolescent↗
PubMed1991

[Training program for minimally invasive surgery].

Currently 'Minimally Invasive Surgery' (MIS) is rapidly finding a widening range of applications and increasing numbers of surgical departments start with new MIS techniques. Surgical work under endoscopic control requires an intensive readjustment to operation technique bringing about new problems in training. We believe that intensive training of MIS procedures on suitable training phantoms should be a prerequisite for clinical application of MIS and therefore have established a training center for MIS in Tübingen, FRG, offering weekly hands on training courses for different procedures.

Curriculum↗
PubMedDate not supplied

Proctologic diseases in geriatric persons.

The aim of present study was the estimation of the frequency and kind of disease of the lower part of the digestive tract in aged patients, based on rectoscopic examination. There were undertaken rectoscopy and examination per rectum of 193 patients over 65 years (mean age 70.4 years from whom only 13 patients had not suffered from any sensations on the part of digestive tract and among 239 patients ranging up to 65 (mean age value 39.6 years from whom majority suffered from various sensations on part of digestive tract and were treated in Clinic of Gastrology and Angiology or Clinic Endoscopy Department. It was stated that the most frequent disease in the elder group of patients were: proctitis (or sigmoiditis) with accompanying spastic conditions of large bowel 14 per cent and hemorrhoids 46.4 per cent. Rectal polyps and sigmoidic polyps occurred in 8.1 per cent of the whole examined group, in the elder group they ranged to 10.4 per cent and in the younger one they ranged to 6.6 per cent. Cancers in rectum and sigmoid were present in 4.1 per cent of the whole examined group, in the elder group in 5.6 per cent and 2 per cent in the younger one.

Adult↗
PubMed1991

Endoscopic transanal resection of rectal lesions: facilitation by adaptation of Lord's dilator.

A wide variety of techniques are available to remove lesions within the anal canal and rectum. Endoscopic transanal resection is a well tolerated procedure which achieves good palliation. Leakage of glycine from the rectum during the procedure can be problematic. To overcome this problem a Lord's dilator has been specially adapted to enable the passage of a urological resectoscope so preventing leakage of glycine during the procedure and improving operator acceptability. This technique of transanal resection with the adapted Lord's dilator provides a cheap and effective way of treating some rectal lesions largely utilizing existing equipment.

Anal Canal↗
PubMed1991

Differences in rates of cancer screening by usual source of medical care. Data from the 1987 National Health Interview Survey.

Data from the Cancer Control Supplement of the 1987 Health Interview Survey (NHIS), a nationally representative sample of the United States population, was used to examine rates of six screening tests for cancer. The rates of screening were compared for people who receive their usual source of medical care in an HMO or prepaid group practice versus those who receive it in the fee-for-service sector. The purpose of this article is to determine whether HMOs remain more likely to offer cancer screening examinations than the fee-for-service sector. Results indicate that for five of six screening tests examined (Pap smear, mammography, breast physical examination, digital rectal examination, and blood stool test), members of HMOs are significantly more likely to have received the test within the last 3-year period. These results hold in a multivariate analysis when many factors correlated with selection into HMOs, health status, and use of medical services are controlled for, although results are only generalizable to whites. Future research should focus on why the rates for five of the six cancer screening tests examined are higher in HMO settings, and how we can use the HMO experience to improve consensus as to the usefulness of the tests in the non-HMO physician pool, and ultimately increase rates of screening tests in the non-HMO population.

Adolescent↗
PubMed1991

Anastomotic recurrence of carcinoma of the colon and rectum. The value of endoscopy and serum CEA levels.

The early diagnosis of anastomotic recurrence after surgery for carcinoma of the colon and rectum is difficult. Whether repeat colonoscopy and serial serum CEA measurements were useful in diagnosing early anastomotic recurrence was examined. A total of 112 patients with carcinoma of the colon and rectum who had undergone resection and anastomosis were followed with frequent colonoscopy and serum CEA measurements. Seventeen patients developed anastomotic recurrence. Fourteen patients had elevated serum CEA levels, and 15 patients had endoscopic evidence suggesting recurrence at the anastomotic site. CT scans of the abdomen and pelvis demonstrated metastatic disease in seven patients, localized anastomotic disease in six patients, and no evidence of disease in four patients. Laparotomy was then carried out in 10 patients. In eight of 10 patients, it was possible to resect localized disease. In a 3-year follow-up study, eight patients were alive, four without any evidence of recurrent disease. Repeat colonoscopy and serum CEA measurements are recommended as postoperative surveillance for carcinoma of the colon and rectum. In select cases laparotomy and resection may prolong survival.

Abdominal Neoplasms↗
PubMed1991

[Value of endorectal sonography in the follow-up of patients treated surgically for rectum carcinoma].

This prospective study included 80 patients in routine follow-up examinations after rectal cancer treatment. We performed anamnesis, clinical examination, total colonoscopy and endorectal sonography and tested the level of tumour markers CEA and CA 19-9. In 10 cases we detected local cancer recurrence of the rectal tumour. In 8 cases tumour markers were pathologically raised. Endoscopy detected the local recurrence in 4 patients only. Endorectal US was able to detect all of the recurrence cases. A histological confirmation was possible by EUS-guided needle biopsy in all cases. We were able to perform R 0-re-resection with the hope of curing in 4 patients out of 10 recurrence cases. Only endorectal US was able to detect two of those 4 recurrent tumours. In the follow-up of rectal cancer endorectal US seems to be a highly sensitive examination that may raise the number of re-resection with the hope of curing after rectal cancer treatment.

Antigens, Tumor-Associated, Carbohydrate↗
PubMed1990

[The potentials of intrarectal echography for the preoperative staging and postoperative follow-up of rectal cancer].

The method is reported of intrarectal echography and the ultrasound changes of the rectal wall in cancer. The report is based on experience with 38 patients. The basic criteria for preoperative grading of rectal cancer by the TNM system are determined and the diagnostic exactness of the method is discussed (89.5 per cent). The value of intrarectal echography in determining the extent of the surgical intervention and the postoperative control of the patients is debated.

Adult↗
PubMedDate not supplied

[The endoscopic diagnosis of rectorrhagias].

The diagnosis of bleeding of gastrointestinal low tract is still a very controversial subject. At the Service of Digestive Endoscopy of Popoli (PE) Hospital, in a period of 4 years, 2074 colonoscopies have been effected. In 640 cases, that is 30.8%, the indication for the exam was suggested by rectal bleeding. In the 566 patients examined for minor rectal bleeding, the most frequent lesions were: haemorrhoids (35.3%), polyps (15.2%), malignant neoplastic disease (9.3%). In all active rectal haemorrhages (14 massive, 41 medium) an urgent colonoscopy has been carried out with a percentage of success of 90%; in the 20 cases of unexplained melena, colonoscopy has not led to a diagnosis; in the 14 patients with unexplained anemia, colonoscopy has shown 2 carcinomas, whereas in the 5 cases with occult blood in stools it has been diagnostic in the percentage of 60%. We have ascertained that, when barium enema was effected before colonoscopy, the diagnostic agreement between the two examinations was only of 21.4 (9/42); on the contrary there was an agreement of 95% when colonoscopy was effected before barium enema. In accordance with Siewert and Blum (25), Ottenjann (24) and Farrands (42), we believe that colonoscopy should be considered the main examination after either major or minor rectal bleeding, because it is a quick and safe investigation with high diagnostic specificity and sensitivity. We refuse William's position (41), because, even in presence of haemorrhoids or anal fissures, the colon must be studied as a whole, especially in a period when neoplastic disease of this tract of intestine is considerably increasing.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1990

[Differential-diagnostic symptoms of endometriosis and cancer of the rectum].

93 patients aged from 21 to 52 years were examined and operated upon. Endometriosis was diagnosed in 31 patients, carcinoma of the rectum--in 62 patients. Endometriosis had two forms: superficial (noninvasive) and deep (invasive) forms. The necessary components of diagnostics should be rectal and rectovaginal examinations, endoscopy, histological verification. Differential symptoms of endometriosis and rectal carcinoma are described.

Abdominal Pain↗
PubMed1990

[Irritable colon and colonic disease due to laxatives].

Diarrhea of colonic origin is fairly common in irritable colon and after long term abuse of laxatives. This form of diarrhea causes difficulties not only in diagnosis but also in treatment. Irritable colon is a functional disorder sometimes involving other segments of the bowel. The term "irritable bowel disease" is thus more appropriate. Extraintestinal symptoms are in addition quite common. Although the diagnosis can be established with great reliability using an index we consider some laboratory tests, recto-sigmoidoscopy and abdominal sonography essential to rule out organic lesions. Therapy comprises (small) psychotherapy, dietary measures and eventually transient medication. Symptoms usually persist but tolerance of the disorder should be improved. Laxative-induced colonic dysfunction results usually from false assumptions about normal defecation. Loss of water and potassium deteriorates the symptomatology leading to a vicious circle. Alterations of neurons in the enteric nervous system of the colon can be the cause but eventually the consequence of chronic intake of laxatives. Hidden abuse of laxatives can cause great diagnostic difficulties. The therapy of choice is weaning which usually is only possible gradually. Cisapride can be a useful adjuvant.

Cathartics↗
PubMed1990

[Rectoscopy and Hemoccult II in irritable colon. A prospective study].

It was investigated whether Hemoccult-II test (H-II) could reduce the number of colonic examinations in patients with the irritable bowel syndrome, with normal rigid proctoscopic findings. A negative H-II was obtained in 299 patients from general practice and a positive test in nine. Colonoscopy was done in 157 and double contrast barium enema in 142 after random allocation. The nine patients with positive H-II all had colonoscopy. Among the 299 with negative H-II, colonic adenomas were detected in ten and an early cancer in an adenoma in the sigmoid colon; overlooked rectal adenomas were found in three, rectal cancer in one, rectal carcinoid in another and a coecal cancer, which could be palpated, in a third patient. Two patients with colonic cancer and one with adenoma were detected among those with positive H-II. All patients were followed by clinical examination after one year. In conclusion, colonic examination should carry a low priority in patients with symptoms of irritable bowel, negative Hemoccult-II and normal rigid proctoscopic findings performed by an experienced examiner. The investigation confirmed the recommendation of total colonoscopy in patients with a positive H-II and added support for increasing number of endoscopy services in contrast to those of diagnostic radiology, which should be reduced.

Adenoma↗
PubMed1990

Endoscopic ultrasonography in staging rectal cancer.

Endoscopic ultrasonography (EUS) was used to stage rectal cancer by assessing depth of invasion through bowel wall layers and/or involvement of lymph nodes. EUS findings were correlated with histopathologic findings to discern the usefulness of this modality in predicting which patients could be candidates for sphinctersaving procedures and the avoidance of abdominoperineal resection. The Olympus EU-M3 endoscopic ultrasound system was used to assess depth of penetration through rectal wall layers and to identify lymph nodes. Comparison of EUS findings to histopathologic findings was possible in 13 patients. EUS agreed with histopathology in 9 of 13 cases (69.3%) ( p = 0.07, kappa statistic). EUS agreed with histopathology as the presence or absence of lymph nodes in 9 of 13 cases (69.3%) (p = 0.07). However, the presence of lymph nodes could not necessarily predict metastatic involvement of these nodes. In one patient, invasion of vaginal cuff was correctly predicted. In nine cases, computed tomographic analysis (CT) was available for comparison to EUS in detection of penetration beyond the bowel wall. CT agreed with histopathology in 3 of 9 (33%), whereas EUS agreed with histopathology in 7 of 9 (78%).

Adenocarcinoma↗