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At least 127 records · Page 7Linked to original sources
PubMed1990

[Proctoscopic versus histologic diagnosis of rectal polyps].

On the basis of the endoscopic appearance, 71 rectal polyps were assessed as adenomata or non-neoplastic polyps, after which the endoscopic diagnosis was compared with the results of histological examination. The diagnosis based on macroscopic examination of the polyps proved correct in only 62% of the cases. It is concluded that the diagnosis of adenoma cannot be established solely on the proctoscopic appearance of a polyp and, as adenomata are premalignant, removal of all polyps found at proctoscopy is recommended.

Adenoma↗
PubMed1990

Postoperative surveillance of patients with carcinoma of the colon and rectum.

The early detection and management of recurrence following curative resection for colorectal carcinoma can prolong survival. However, at the present time there is no consensus on the appropriate follow-up protocol for such patients. This investigation was undertaken to determine which tests and procedures are most useful in detecting recurrence and the frequency with which they should be employed. Another purpose of this study was to identify those patients at high risk for recurrence. Sixty-five patients who underwent curative resection of adenocarcinoma of the colon and rectum were followed for at least two years or until recurrence. Thirty were classified as Duke's A carcinoma of the colon, 18 were Duke's B, and 17 were Duke's C. Mean follow-up was 44.9 months. The follow-up regimen consisted of clinical exam, liver function tests, carcinoembryonic antigen (CEA) level, and chest x-ray every three months for the first two years postoperatively and every six months thereafter, and colonoscopy or barium enema and proctoscopy every six months for the first two years postoperatively and every year thereafter. Seventeen patients (26%) had a recurrence; 24% per cent of these developed within one year, 65 per cent developed within two years, 82 per cent developed within three years, and 94 per cent developed within four years of resection. Recurrence was detected by CEA in eight patients, chest x-ray in five, endoscopy in three, and laparotomy for small-bowel obstruction in one patient.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenocarcinoma↗
PubMed1990

Office proctology and sigmoidoscopy.

Proctoscopy and sigmoidoscopy are readily acquired skills and should be routine office procedures for general practitioners. Correct positioning of the patient is of utmost importance to a successful examination.

Family Practice↗
PubMed1985

Clinical staging of rectal cancer. Results of a prospective continuing study.

78 patients with rectal adenocarcinoma were studied with a diagnostic protocol in order to obtain a TNM clinical stage in the preoperative period. Each patient underwent digital rectal examination, proctoscopy, double contrast barium enema, pelvic CT scan, liver ultrasound and chest x-ray. The degree of infiltration of the rectal wall by the tumor and the presence or absence of node and liver metastases were evaluated. After resection all specimens were studied by a pathologist who defined the pathologic stage. Data obtained by each diagnostic procedure were compared with the pathologic data. For each method, accuracy, specificity and sensitivity were evaluated. Each method showed an equivalent accuracy (100%) to detect infiltration of the muscularis of the rectum. Data were less accurate in identifying extraparietal tumor invasion. Accuracy was 79% for rectal examination, 74% for double contrast barium enema and 72% for pelvic CT scan. In the evaluation of lymph-node involvement, accuracy was 77%, specificity 74% and sensitivity 80%. Liver metastases were detected with 94% accuracy, 97% specificity and 50% sensitivity.

Barium Sulfate↗
PubMed1980

Screening for colorectal tumors - results of two years experience.

The experience after two years of systematic colorectal tumors screening of 603 subjects, aged between 40 and 70, is reported. All subjects were submitted to proctoscopy (P) and air filled barium enema (AFBE). Total frequency of screened tumors: 15.25%. More than 85% of the tumors were found in the recto-sigmoid. Two subgroups were identified in this population. In subgroup A, 125 subjects were submitted to P, AFBE and flexible pansigmoidoscopy (FP). Percentage of screened tumors is 19.2%. Sensitivity rate of radiology for exploration of the recto-sigmoid area, as compared to FP is rather low: 0.41. In subgroup B, 165 subjects were submitted to hemoccult, P, AFBE and colonoscopy when an abnormal or dubious image was shown by AFBE. The comparative study of these different means of investigation shows a very low rate of sensitivity of hemoccult: 0.16. In addition, the percentage of screened colorectal tumors is significantly higher (p less than 0.01) in subjects with personal or family history of polyp or carcinoma: 22%, compared to the incidence in the remaining population of 13%. Flexible pansigmoidoscopy is recommended for systematic screening of colorectal tumors in subjects older than 40.

Adult↗
PubMedDate not supplied

[Anorectal tumor pathology and its diagnosis].

Anal cancer is very rare, but its diagnosis is often too late. Treatment is usually non surgical and can be very effective. Prognosis can be improved by earlier diagnosis. Proctoscopy is mandatory for all symptomatic patients. Could an high risk population be determined, the incidence of anal cancer could fall. By contrast, rectal cancer is one of the most frequent and its prognosis has not been improved. Hope can be found in screening and prevention; these will be more effective when the transformation sequence of adenoma to cancer will be entirely explained.

Aged↗
PubMed1993

[Screening for colorectal cancer--does it help?].

During the last decade, evidence from retrospective as well as prospective case-control studies suggest that screening for colorectal cancer in average-risk persons above 50 years of age may be worthwhile. Screening with proctoscopy may reduce the mortality from rectal cancer and screening with fecal occult blood tests (Hemoccult-II) may reduce the mortality from colorectal cancer. Final results from ongoing population studies will appear within a few years and there are reasons to believe that mortality for colorectal cancer may be reduced with at least 30 per cent by a combination of Hemoccult-II and flexible 60 cm sigmoidoscopy.

Aged↗
PubMed1977

Human rectal mucosa: proctoscopic and morphological changes caused by laxatives.

To determine whether laxatives alter the proctoscopic and morphological appearances of the human rectum, 10 normal subjects were studied prospectively, and the following manipulations were assessed in a randomized, blinded manner: no treatment; oral mannitol to induce diarrhea; isotonic saline enema; Fleet's Phospho-Soda enema; and bisacodyl (Dulcolax), 10 mg, by enema or suppository. The rectal mucosa after mannitol-induced diarrhea, or after saline enema could not be distinguished from untreated rectum by proctoscopy, light microscopy, or scanning electron microscopy. Fleet's enema, and bisacodyl invariably changed proctoscopic appearances, and frequently altered light and scanning microscopic aspects. Both Fleet's enema and bisacodyl caused sloughing of surface epithelium. In addition, bisacodyl decreased the uptake of hematoxylin and eosin by crypt epithelial cells so that the affected cells had a partially erased appearance (16 of 25 biopsies examined by light microscopy). The lamina propria of 3 of these 25 biopsies contained polymorphonuclear cells. Transmission electron microscopy revealed that the abnormal crypt epithelial cells contained fewer cytoplasmic organelles and less nuclear chromatin. All lesions resolved within 7 days. Fleet's enema and bisacodyl by rectum may mislead the proctologist and the pathologist by altering normal rectal mucosa.

Bisacodyl↗
PubMed1977

Evaluation of conventional diagnostic tests for detection of recurrent carcinoma of the cervix.

The use of routine diagnostic tests to evaluate patients periodically after treatment for carcinoma of the cervix has been reviewed. Of 169 patients treated at Brooke Army Medical Center for carcinoma of the cervix, 73 were evaluated after their treatment by a group of six diagnostic tests referred to collectively as an oncologic survey. The survey consisted of an intravenous pyelogram (IVP), chest roentgenogram, barium enema, cystoscopy, proctoscopy, and bone scan. Although 16 patients developed recurrent tumor, the oncologic survey detected only three recurrences that had not already been suspected by physical examination. Only the IVP and chest roentgenogram were of sufficient benefit to suggest their routine use for the detection of recurrent cancer. The other tests included in the oncologic survey were not beneficial when used routinely and should be reserved to evaluate patients otherwise suspected of recurrent cancer.

Barium Sulfate↗
PubMed1997

[Anal fissure].

The anal fissure is a very common disease of the anal canal. Diagnosis is easy and most patients have a typical history of pains and anal bleeding. Proctoscopy will certify the anal fissure. The treatment is based on reducing the spastic of the internal anal sphincter, either by dilating the anal canal or sphincterotomy. Excision of the anal fissure should only be done in case of fissures with intersphincteric fistula or abscess. High fibre diet and increasing the volume of daily drinks is a useful and very efficient help in treating anal fissures.

Anal Canal↗
PubMed1976

Clinical spectrum of pseudomembranous colitis.

Five cases of pseudomembranous colitis (PMC) provided the opportunity for observation of clinical, endoscopic, and histologic features, and evaluation of potential modes of therapy. Although PMC may occur postoperatively or concomitantly with staphylococcal infection, if most frequently occurs following the administration of a variety of antibiotics. Patients with this disorder often have chronic, debilitating diseases. The clinical course may vary from a self-limited diarrheal illness to a fatal process. Onset with abdominal pain, diarrhea, and fever is characteristic. Barium enema contrast findings are nonspecific. Proctoscopy usually permits an accurate diagnosis. In the typical case, multiple elevated nodules formed by cream-colored plaques of pseudomembrane are scattered about the inflamed mucosa. Biopsy of these nodular lesions will confirm the diagnosis. Therapy must be individualized.

Adult↗
PubMed1998

[Heidelberg polyposis register. Experiences with ileoanal pouch in familial adenomatous polyposis coli (FAP): the ileoanal anastomosis problem zone].

Restorative proctocolectomy and ileal pouch-anal anastomosis (IPAA) is the therapy of choice for the prophylactic treatment of FAP. Despite maximal radicality, we frequently observed remaining rectal mucosa and in some cases even adenomas at the pouch-anal anastomosis. Therefore, we changed our postoperative care by adding a yearly proctoscopy to regular pouchoscopies.

Adenomatous Polyposis Coli↗
PubMed1976

Familial colon cancer.

Study was made of a kindred with a strong history of carcinoma of the colon. Twenty-three family members were screened for the tumor with carcinoembryonic antigen (CEA) assay, barium enema, and proctoscopy; one occult colon cancer was diagnosed. Identification and surveillance of families at high colon cancer was diagnosed. Identification and surveillance of families at high risk of cancer can provide unusual opportunities for early tumor detection.

Adenocarcinoma↗
PubMed1980

A mass screening program for colorectal cancer using chemical testing for occult blood in the stool.

Following five promotional and educational programs on CBS-TV news in Chicago, 54,101 Hemoccult kits were requested by the public and distributed by seven cancer detection facilities. Only 14,074 individuals completed the test. Six hundred and seventeen or 4.38% were positive. Two hundred and fifteen test positive persons failed to respond to repeated notification. In 123 positives, diagnostic tests by the private physician were considered incomplete. In 33 positives, the private physician did no further testing at all. In 152 positives, no abnormality could be found, but work-up was variable. One hundred and eighty-seven had abnormalities other than cancer, including 40 with polyps. Twenty-seven asymptomatic and two symptomatic cancers were found. Nearly two-thirds had Dukes A or B lesions, while one-third had Dukes C tumors. Public compliance in both completing kits and following through with positive results was low. Physician evaluation of positives was often incomplete. Chemical testing for occult fecal blood, when properly combined with other tests such as proctoscopy, has the potential for lowering mortality from colorectal cancer. Continued public and professional education is needed.

Colonic Neoplasms↗
PubMed1992

Mesosigmoplasty as a definitive operation for sigmoid volvulus.

In a prospective study, 126 patients with sigmoid volvulus were treated by mesosigmoplasty during a 12-year period. Patients with sigmoid volvulus with no clinical evidence of gangrene were selected for study, and all were given a trial of non-operative reduction by proctoscopy and passage of a rectal tube. Reduction was achieved in 48 patients (38 per cent), who were subsequently treated by mesosigmoplasty as an elective procedure 1-2 weeks later. For the remaining 78 patients (62 per cent) who were not relieved by the non-operative method, emergency mesosigmoplasty was performed. There was one death in the emergency group, and two patients had a recurrence after 2 and 6 months respectively in the elective group, in whom resection was carried out. In the other 123 patients during a maximum follow-up of 12 (mean 8.2) years no recurrence was detected. Mesosigmoplasty has the advantage of low rates of mortality, morbidity and recurrence; it can be carried out as either an emergency or an elective procedure.

Adult↗
PubMed1996

Diagnostic assessments in patients with invasive cancer of the cervix: a national patterns of care study of the American College of Surgeons.

Using a standard collection form designed by a multidisciplinary committee of specialists, cancer registrars at 703 hospitals submitted anonymous data on 11,721 patients with cervical cancer diagnosed during 2 study years, 1984 and 1990. Information concerning the initial use of diagnostic assessments was analyzed with respect to the potential influences of clinical stage, patient age, race/ethnicity, insurance status, and modalities of therapy employed. Estimates of the yield of diagnostic information for each test were correlated with clinical stage and patient age. Judged by the number of procedures performed, the intensity of pretreatment assessment declined between 1984 and 1990. Substantially increased use of the newer body imaging modalities (computerized axial tomography and magnetic resonance imaging) with high probabilities of revealing abnormalities attributed to cancer, balanced major declines in utilization of procedures historically important in staging and assessment (cystoscopy, proctoscopy, barium enema, excretory urography (intravenous pyelogram), bone scintography, and lymphangiography). Race/ethnicity and insurance status had no discernible independent impact on the intensity of diagnostic evaluation. Patients with more advanced clinical stages underwent more extensive testing, as did patients treated initially with radiation compared to surgery. Periodic review of assessment strategies would seem prudent to avoid widening discrepancies between sanctioned staging formalisms with endorsed and authorized appraisals and actual clinical practice.

Adult↗
PubMed1999

Malignant transformation of an ovarian mature cystic teratoma presenting as a rectal mass.

BACKGROUND: Squamous cell carcinoma arising from malignant degeneration of a mature cystic teratoma is rare with a reported incidence of approximately 1-3%. The most common presenting symptoms are lower abdominal pain and increasing abdominal girth of several months' duration. Approximately 50% of the patients present with FIGO stage I while 35-38% present with stage III diseases. CASE: The case described herein represents an unusual presentation and initial diagnostic dilemma of locally aggressive squamous cell carcinoma arising in an ovarian dermoid cyst, with invasion into the distal rectum and anal canal causing rectal bleeding similar to the presentation of anal squamous cell carcinoma. Despite aggressive surgical management with posterior exenteration and optimal tumor debulking followed by 5040-cGy pelvic radiation utilizing 25-MV photons, the patient developed pelvic recurrence at the vaginal cuff 6 weeks after completion of her adjuvant radiotherapy. She subsequently failed cis-platinum single-agent chemotherapy and died 9 months after her initial surgery and diagnosis. CONCLUSION: Squamous cell carcinoma in the anal canal, diagnosed by colonoscopy or proctoscopy, could be an unusual presentation of that arising from malignant degeneration of an ovarian dermoid cyst. This tumor may behave in a locally aggressive manner and be resistant to pelvic radiation or single-agent chemotherapy of cis-platinum. The current experience of adjuvant treatment after comprehensive staging and cytoreductive surgery reported in the world literature is limited, and the optimal management of the malignancy remains unclear.

Adult↗
PubMed1995

Management of rectourethral fistulas in Crohn's disease.

We report the thirteenth case of a recto-urethral fistula in Crohn's disease. The patient, a 37-year-old white male, had a 20-year history of intestinal Crohn's disease and had undergone numerous bowel resections. His symptoms were fecaluria, urorrhea and passing of urine from an orifice just outside the base of the scrotum. He had urinary infection and severe ileocolitis. He underwent a diagnostic evaluation (cystourethroscopy, proctoscopy, retrograde pyelography, intravenous urography, voiding cystourethrography) that revealed a fistula comprising the membranous urethra, the rectum, the perineum and the scrotum. He was treated with Metronidazole (20 mg/kg/day/12 mo). At 1 year no signs of intestinal disease and urinary sepsis were noted. The external orifice and the perineal fistulous network were closed, and the drainage from the rectum and the urethra had improved. No side effects limited use of the drug. No relapse was observed in the 3 months, after the therapy was discontinued. We present a review of the literature on the management of rectourethral fistulas in Crohn's disease. Surgeons have used successfully several approaches in the repair of this lesion, but no single procedure has proved optimal or even universally applicable. We emphasize, as the literature suggests, that the management must be individualized. Medical therapy with metronidazole has an important role in a patient with rectourethral fistula and concomitant proctitis, ileocolitis, urinary sepsis and multiple previous surgical procedures.

Adult↗