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At least 109 records · Page 6Linked to original sources
PubMed2005

[Therapeutic strategy for hemorrhagic radiation proctitis--the optimum condition of argon plasma coagulation (APC)].

AIM: This study was performed to clarify the optimum condition of argon plasma coagulation (APC) to treat hemorrhagic radiation proctitis. SUBJECTS: Among 25 patients with hemorrhagic radiation proctitis treated in the Cancer Institute Hospital between December 2000 and May 2004, 18 were followed-up for more than 6 months. The clinical courses of these 18 patients were analyzed retrospectively. METHODS: Proctoscopic findings of the hemorrhagic lesions were categorized as type-A (localized dilated veins, n = 6) , type-B (diffuse dilated veins, n = 6), and type-C (dilated veins associated with ulcers orerosions, n = 6). APC was applied for 5-10 seconds with the power of 40 W and the argon flow of 1.0 l/min (high power APC), or for 1-2 seconds with the power of 40 W and the argon flow of 0.6 l/min (low power APC). RESULTS: Type-A and B patients were successfully treated with either low or high power APC without any serious complications. But some type-C patients treated with high power APC showed serious complications such as proctovaginal fistula or prolonged ulceration. No recurrence patients were 89% (16/18) during the mean follow up period of 18 +/- 9.9 months. CONCLUSION: APC therapy for hemorrhagic radiation-proctitis was useful, but the pathologic healing process and consequence were different by rectal mucosal weakness. It is necessary for the therapeutic strategy to be put up and down according to proctoscopic findings. As for the optimum condision APC short cauterization by low power setting was more recommended.

Aged↗
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↗
PubMedDate not supplied

Maintenance bran therapy for prevention of symptoms after rubber band ligation of third-degree haemorrhoids.

Proctoscopically diagnosed third-degree haemorrhoids were treated with rubber band ligation (RBL) in 92 patients, who were randomly assigned to management with or without twice-daily intake of unprocessed bran for 18 months. RBL was performed maximally five times at 2-week intervals. Patients who were symptom-free 10 weeks after first banding were considered cured and were enrolled in a follow-up study. The two treatment groups did not differ in regard to clinical or proctoscopic characteristics. The number of RBL required for cure was lower in the bran-treated group (p less than 0.01). The intergroup difference in cure rate 10 weeks after the first treatment was not significant (85% v. 91%). During the follow-up period symptoms recurred in 45% of the RBL group, but in only 15% of the RBL + bran group (p less than 0.01). A high-fiber diet thus increased the long-term cure rate among patients with third-degree haemorrhoids initially cured by RBL.

Adult↗
PubMed1981

Treatment of antibiotic-associated pseudomembranous colitis with metronidazole.

A case of successful treatment of antibiotic-associated pseudomembranous colitis with oral metronidazole is reported. A 67-year-old man developed diarrhea shortly after a 10-day course of oral ampicillin. His diarrhea, consisting of 10 to 12 loose stools a day, had continued for approximately two weeks and was accompanied with abdominal cramping, fever, anorexia, and weight loss. Stool specimen was streaked with blood. Proctoscopic examination revealed a spotty mucous exudate. Rectal biopsy analysis was consistent with pseudomembranous colitis. Metronidazole was initiated at a dose of 500 mg orally three times daily and continued for 10 days. By the third day, the patient was having one bowel movement daily. Proctoscopic examination after 10 days of therapy showed marked improvement with no evidence of pseudomembranous exudate. One month later the patient remained symptom-free.

Aged↗
PubMed1994

Feasibility of transcolonic and transgastric abdominal vascular ultrasound.

Abdominal vascular ultrasound is hampered by tissue attenuation. To improve imaging, the feasibility of real-time color Doppler transcolonic and transgastric abdominal vascular ultrasound was evaluated. A monoplane 5 MHz transesophageal probe was inserted via a proctoscope in five patients with normal colons. At 25 cm (end of proctoscope), the aortic bifurcation and iliac arteries were dynamically imaged with high resolution. In three patients undergoing abdominal surgery, the surgeon grasped the probe and advanced it further through the descending to the transverse colon to examine further vascular structures. High resolution two-dimensional imaging and color Doppler flow were obtained from the abdominal aorta, the origins and proximal portions of the superior mesenteric artery, and the renal and the inferior mesenteric arteries. Additionally, the inferior vena cava, left renal vein, and portal system were imaged. All vascular structures imaged were within 3 cm of the probe. In two additional patients undergoing abdominal surgery and transesophageal echocardiography, the surgeon grasped the probe in the stomach and placed it on various vascular structures. The results were similar and the celiac trunk was also imaged. This technique, when integrated with fiberoptics for guidance, could provide a method for abdominal vascular ultrasound with less tissue-imposed attenuation, providing high resolution imaging and allowing additional structure recognition. This has potential applications for studying patients with disease of the abdominal aorta or its branches.

Abdomen↗
PubMed1997

Treatment of colorectal and ileoanal anastomotic sinuses.

PURPOSE: This study is designed to describe a technique and report results for treating low anastomotic sinuses. METHODS: Restorative proctocolectomy and complicated low anterior resections were protected with diverting loop ileostomy. Contrast enemas identified anastomotic problems before ileostomy closure. Pouch-anal or colorectal anastomotic sinuses that failed to resolve with observation were treated before intestinal continuity was restored. With the patient receiving regional or general anesthesia, a rigid proctoscope or anoscope was used to identify the sinus opening. The common wall between the sinus and the bowel lumen was divided under direct vision with laparoscopic cautery scissors, and the sinus cavity was debrided with a suction cautery wand placed through the scope. RESULTS: Six patients with anastomotic sinuses have received outpatient treatment in the described manner during the past two years. Four patients had restorative proctocolectomies for ulcerative colitis, and two had low anastomosis for rectal cancer. Three patients presented with pelvic sepsis before the contrast study; the remainder were asymptomatic. Division of anastomotic sinus was performed one to eight months after diagnosis of the sinus. Following division, anastomotic cavities resolved in five patients by 1 month and in one patient by 12 months. In these six patients, there was one dilatable anastomotic stricture but no other anastomotic complications at follow-up 5 to 16 (mean, 9.2) months after sinus division. CONCLUSION: When used in conjunction with fecal diversion, sinus unroofing by division of the common wall between the sinus and bowel lumen treats low pelvic sinuses.

Adolescent↗
PubMed1998

Foley catheter-assisted endoscopic treatment of severe anastomotic stenosis following anterior resection of the rectum.

Rectal stenosis following low anterior resection is common. Several methods of treatment have been described. We introduce a simple method for the treatment of anastomotic stenosis using a conventional proctoscope and an electric knife with a Foley catheter as an anvil. Under direct vision, this technique can afford accurate and safe incision of stenosis.

Catheterization↗
PubMed1988

Fine-needle aspiration cytology of rectal tumors.

This report describes the application of fine-needle aspiration cytology to rectal tumors and metastatic deposits in the rectovesical pouch using a short proctoscope and an 8-cm long fine needle.

Biopsy, Needle↗
PubMed2001

Transanal hemorrhoidal dearterialization is an alternative to operative hemorrhoidectomy.

BACKGROUND: Transanal hemorrhoidal dearterialization (THD), a new approach for patients who would otherwise require an operative hemorrhoidectomy, accomplishes hemorrhoidal symptom relief with far less postoperative pain than an operative hemorrhoidectomy. METHODS: THD, an ambulatory procedure, employs a specially designed proctoscope coupled with a Doppler transducer to allow identification and suture ligation of the hemorrhoidal arteries. RESULTS: Sixty patients between ages 22 and 87 were treated. Bleeding was fully corrected in 88%, protrusion in 92%, and pain in 71%. Two patients (3%) failed to improve with THD. Complications included pain resulting in greater than 2 days loss of work in 5 patients, postoperative perirectal thromboses developed in 4 patients, and an anal fissure developed in 1 patient. CONCLUSIONS: THD was an effective alternative to operative hemorrhoidectomy. It may be the only option for patients where an operative hemorrhoidectomy is contraindicated because of incontinence.

Adult↗
PubMed1985

The use of endocavitary irradiation for selected carcinomas of the rectum: ten years experience.

Since July, 1973, endocavitary irradiation has been used to treat 129 patients with rectal carcinoma. The lesion must be a modified Dukes' A, well-differentiated adenocarcinoma and no more than 5 cm in diameter and within 12 cm of the anal verge. Specialized diagnostic techniques assist with the clinical selection. Specially designed proctoscopes are used to visualize the carcinoma which is treated by a Philips RT-50 contact machine. 11000-12000 cGy are delivered in four treatments administered at 2-3 weekly intervals. No systemic side effects have been observed and local morbidity is minimal. This treatment preserves the anal sphincter, and sexual function in male patients. Hospitalization is not required and there is no risk of mortality. Recurrence has been observed in six of 129 patients within 18 months of treatment for known reasons. Two of these six patients have died from disease and a further 25 from other causes. The local control rate is 95.3%. This treatment modality has been offered also to 87 patients for palliation and this has been effectively obtained in 82.7%. This technique is an alternative to surgery in selected cases.

Adenocarcinoma↗
PubMed2004

[Doppler-guided ligation of the hemorrhoidal arteries. Report of experiences with 248 patients].

BACKGROUND AND OBJECTIVE: Since the beginning of 2001, Doppler-giuded ligation of the hemorrhoidal arteries (DG-HAL) has been used at this clinic in almost all patients with various forms of hemorrhoidal disease. Aim of this study was to ascertain whether this intervention can be done without general anaesthesia, the hemorrhoidal knots regress and this procedure provides advantages over the classical methods of treating hemorrhoids. PATIENTS AND METHODS: Early results of DG-HAL in 248 patients are presented. Through a special proctoscope the arteries leading to the hemorrhoidal cushions are located in the pain-free rectum under Doppler guidance and suture ligated. The form of anaesthesia, duration of the operation, numbers and sites of the ligatures, additional interventions and postoperative complications were recorded. RESULTS: 171 patients (69%) needed no anaethesia. 147 patients (Without additional interventions) were re-examined 6 weeks after the operation: 61.2% were free of symptoms. A total of 87.7% were at least improves. The complication rate was low. CONCLUSION: In our experience DG-HAL has been a well tolerated efficacious method with few complications in the ambulatory treatment of hemorrhoids. The ideal indication for this methods is nonprolapsing hemorrhoids.

Adult↗
PubMed2003

Endocavitary radiation therapy for rectal adenocarcinoma: 10-year results.

Local control, survival, and toxicity in patients treated with endocavitary radiation therapy for rectal cancer were evaluated. Thirty-five patients received a total of 20 to 155 Gy in 1 to 5 fractions with 50 kV x-rays through a treatment proctoscope. Twenty-nine of the 35 patients were treated with curative intent. Median follow-up was 102 months. Local control was achieved in 23 of the 29 patients treated curatively and in 3 of the 6 treated palliatively. Local control for patients treated curatively was 76% at 10 years. No local failures occurred after 21 months. For patients treated curatively, survival was 65% at 5 years and 42% at 10 years. Toxicity within 90 days after treatment was observed in 77% of the patients. Toxicity occurring more than 90 days after treatment was observed in 80%, but only 1 patient needed a colostomy, which was for a perforation after the biopsy of a benign ulcer. In conclusion, radiation therapy resulted in a local control rate of 76% at 10 years in curatively treated patients. Although most patients experience toxicity from this treatment, loss of sphincter function is rare.

Adenocarcinoma↗
PubMed1988

Rectal carcinoma: treatment with Papillon technique and fiberoptic-guided methods.

An adaptation of the Papillon technique was developed in which a superficial x-ray machine was used for treatment of small superficially invasive rectal carcinomas. Modification of the proctoscope-treatment cone apparatus, including addition of a fiberoptic scope, allows confirmation of accurate cone placement throughout the entire treatment. There is no personnel exposure to radiation. Measured physics beam characteristics are clinically comparable to those reported for the Papillon treatment beam.

Adenocarcinoma↗
PubMed1975

Drug-induced colitis mimicking an acute surgical condition of the abdomen.

Pseudomembranous colitis secondary to antibiotic therapy has received increasing recognition. During a one-year period, eight of 42 patients with this entity had findings closely resembling an acute surgical condition of the abdomen manifested by fever, leukocytosis, and severe abdominal pain and tenderness. All eight patients received clindamycin and two were also given lincomycin hydrochloride monohydrate. Differentiation from an acute surgical condition of the abdomen was difficult until the characteristic findings of pseudomembranous colitis were noted on proctoscopic examination. Unnecessary celiotomy was averted in all patients. Seven of eight patients responded to discontinuation of the antibiotic and supportive measures; one required a diverting ileostomy. Drug-induced colitis must be an important consideration in any patient recently receiving antibiotics who develops fever, abdominal pain, and diarrhea.

Abdomen, Acute↗
PubMed1975

Pneumatosis cystoides intestinalis. Treatment with oxygen via close-fitting mask.

Four patients with pneumatosis cystoides intestinalis were recently treated with oxygen via a close-fitting mask. They responded initially to this therapy, with cessation of all symptoms and, after seven days of treatment, with return of proctoscopic and barium-contrast roentgenographic findings in the colon to normal. However, the disease recurred in one of the four patients after six months. There is a potential hazard of toxic effects from oxygen, and this may be detected by frequent measurement of pulmonary vital capacity. Our experience corroborates the efficacy of oxygen therapy in the treatment of this disorder but we question its long-term effectiveness in all cases.

Aged↗
PubMed1984

An evaluation of pelvic lymphoscintigraphy in the staging of colorectal carcinoma.

Lymphoscintigraphy was used to delineate the lymphatic drainage of the rectum and distal colon in 18 patients with carcinoma of the rectum or sigmoid colon, in four with inflammatory disease of the large bowel and in 20 controls without colorectal pathology. Abdominal imaging was performed after submucosal injection of either 4 mCi 99mTc-antimony sulphide colloid or 0.5 mCi 99mTc-dextran into the rectum through a proctoscope. In nine patients with colorectal carcinoma, abdominal imaging was performed immediately pre-operatively and the excised specimen of large bowel was also imaged in vitro immediately postoperatively. The presence or absence of nodal uptake of radionuclide on abdominal scanning did not discriminate between normal and diseased large bowel, and the extent of nodal uptake demonstrated either by abdominal scans or by in vitro scans of excised specimens bore no relationship to the presence or absence of nodal metastases demonstrated histologically in the cancer patients. Pelvic lymphoscintigraphy as performed in this study has no demonstrable value in the diagnosis or staging of colorectal cancer.

Aged↗
PubMed1983

Carcinoma of the anal canal.

J.W. is a 68-year-old white female who noted an "anal growth" 1 year prior to admission. She also complained of bleeding from her rectum when she was constipated. She attributed these symptoms to hemorrhoids. She noted increasing pain and more bleeding 1 month prior to admission. Locally applied hemorrhoid remedies gave her no relief. She was then admitted to a hospital where a biopsy of the anal mass was performed, and then referred to Rush-Presbyterian-St. Luke's Medical Center. On physical examination the patient was noted to be obese. There was no inguinal lymphadenopathy. There were no abdominal masses or hepatosplenomegaly. Rectal examination revealed a 3 X 4 cm mass protruding from the anus. Examination and protoscopy done under anesthesia revealed this mass to be approximately 4 X 5 cm and arising from the proximal anal canal. The mass was freely moveable and bled spontaneously when manipulated. Pelvic examination revealed a normal uterus and adnexa with no obvious tumor involvement of the vagina. Proctoscopic examination revealed no tumor proximal to the lesion described. Further evaluation included a liver-spleen scan that was negative for metastatic disease and intravenous pyelogram that showed no lesions. A barium enema revealed only diverticula. A gallium scan showed marked uptake at the area of the anal tumor but no other lesions. The chest x-ray was within normal limits. A CT scan of the abdomen and pelvis revealed no masses or lymphadenopathy. The CEA was 1.3 ng/ml. The patient underwent concomitant radiation therapy and chemotherapy. Over a 4-week period the patient received 5000 rads to the anal region. In addition, during the first week of radiation therapy and the fourth week of radiation therapy, the patient received 5-fluorouracil, 800 mg/m2 by continuous infusion for 5 days. In addition, the patient received mitomycin C, 15 mg/m2 on the first day of the first week of chemotherapy and the first day of the last week of chemotherapy. During the treatment period, the patient had mild diarrhea, perineal desquamation, and mild ulceration at the site of the anal tumor. During the third week of treatment, the patient had a white blood cell count nadir of 2800 and a platelet count of 86,000 per cubic millimeter. Her symptoms were managed with local emolients and antidiarrheal medications.(ABSTRACT TRUNCATED AT 400 WORDS)

Aged↗
PubMed1993

[Clinical and functional results of abdominal rectopexy using different fixation principles].

We report our results with abdominal rectopexy (modified Ripstein procedure, Ripstein/Corman) without resection of the colon in 63 patients using lyophylized dura-strips, Vicryl gauze or Dexon gauze, as the underlying fixation material for the mobilized rectum, presacral fascia and fixation suture material. Forty-five of 64 patients (71.4%) were reevaluated by proctoscopic examination and questioning; the mean follow-up time was 52.5 months (range 3-136 months). Postoperative mortality due to the method was 0%; the mortality was 1.6% (n = 1/63) in general for the first postoperative 30-day period as a result of cardiac complications. There were three complications (4.7%) the durating operation. Postoperative morbidity was 25.4% (16/63); infectious complications occurred in 12.7% (8/63) of cases, with one case of spontaneous closure of a pelvicutaneous fistula after intraoperative injury to the rectal wall. Full-thickness rectal prolapse appeared after rectopexy in 4.4% (2/45) (dura material alone) and mucosal prolapse was seen in 15.5% (7/45) of the follow-up group. Constipation was reduced by 28.6% (18/63) to 22.2% during the follow-up. Seventeen of 28 patients (60.7%) with incontinence showed an improvement; total continence was registered in 35.7% (10/28). The increase in continence as a result of abdominal rectopexy was significant (Wilcoxon, P = 0.05). The special aspects of being in an older age group, having a long history of procidentia, the number of deliveries, the length of the preoperative incontinence period all showed no influence on the postoperative degree of continence (Spearman's rank correlation). In 7/15 cases with persisting incontinence after rectopexy, postanal repair (Parks) was efficient in 7/7 cases leading to total or partial continence.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗