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PubMedDate not supplied

[Colitis due to radiation: endoscopic management with heat probe].

Rectal bleeding is a frequent symptom in radiation colitis, and is due to vascular lesions usually confined to the rectum. We present our preliminary experience with the use of the heater probe, in eight patients with radiation proctitis, whose main symptom was rectal bleeding. Six patients had radiation for carcinoma of the cervix and 2 had endometrial cancer. One to four sessions of coagulation were performed with an intensity of 200 to 400 Joules per session. In all patients a good response was obtained, bleeding diminished or stopped completely, with improvement of blood counts and the need for transfusions. We think that heater probe is a good therapeutic alternative, for the management of these difficult complication.

Cautery↗
PubMedDate not supplied

Local control of prostate cancer with transurethral intracavitary radiation therapy.

As of January 1986, 13 patients with adenocarcinoma of the prostate had been treated in our clinic by remote after-loading transurethral high dose rate radiotherapy using a 60Co source. Of these patients, four were at stage B2, three at stage C, three at stage D1, and three at stage D2. The mean total dose of transurethral radiotherapy was 35.2 Gy to the most distant prostatic capsule from the source. Three patients with stage D1 disease and one patient with stage C disease received additional external radiation with a total dose of 20 Gy to the prostate and 40 Gy to the pelvis. Local tumor response proved rapid and satisfactory as verified by rectal examination, ultrasonography, and needle biopsy. Serious complications such as proctitis, cystitis, incontinence, and urethral stricture were not evident during the average follow-up term of 34.9 months.

Adenocarcinoma↗
PubMed1993

[Articular and extraarticular involvement in inflammatory bowel diseases].

Idiopathic inflammatory bowel disease include basically two disorders: ulcerative colitis and Crohn's disease. Both diseases are chronic and of unknown etiology and extraintestinal manifestations are seen in a high number of these patients. We studied 18 patients (7 female, 11 male) with previous diagnosis of inflammatory bowel disease (14 ulcerative colitis, 2 Crohn's disease, 1 pancolitis, 1 ulcerative proctitis) in order to search for extraintestinal manifestations with emphasis on osteoarticular and ocular involvement. The mean age at the time of diagnosis of the inflammatory bowel disease was 44 years (range 20 to 71 years). Mean time duration of the inflammatory bowel disease was 7 years (range 1 to 24 years) and of the articular manifestations 3.2 years (range 1 to 8 years). The osteoarticular manifestations developed after the diagnosis of the bowel disease in all but one patient (simultaneously) 17/18 patients had artralgias, 7/18 lumbalgia, 3/18 talalgia, 1/18 knee arthritis. (table I) Only six of the 17 patients with orteoarticular involvement has simultaneous activity of the underlying bowel disease. All the 18 patients were taking 2 g/day of sulfasalazine. Radiographic screening in all patients revealed sacroiliitis in 10. (table II) Of the 10 radiographic sacroiliitis 4 were grade I (confirmed by technetium phosphate scans, 2 were grade II and 4 grade III-IV. Three of the ten patients with radiographic sacroiliitis were asymptomatic (table II). Axial computed tomography was performed done in two patients: a) in one case to exclude osteitis condensens ilii, and b) in the other case to exclude septic arthritis. The severity of the sacroiliac damage was related with a longer duration of the inflammatory bowel disease.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

[Is ileorectal anastomosis still a valid therapeutic alternative in the surgical treatment of hemorrhagic rectocolitis? Analysis of the functional, endoscopic and histologic result of 74 cases].

The objectives of this study were to determine the functional results of ileorectal anastomosis (IRA) and the endoscopical and histological outcome of the rectal stump in 74 patients operated on for ulcerative colitis. Median follow-up was 7.5 years (range 1 to 35). Functional results, as defined by the usual accepted criteria, were good in 80% of patients. The mean daily number of bowel movements was 4.2 +/- 1.6 (SD). Long term endoscopical and histological features improved in most of cases and only 13.3% of rectal biopsies showed the persistence of acute inflammatory changes; 28.4% of the patients had one or more episodes of acute proctitis during the follow-up period, but none of the patients required proctectomy. One case of severe dysplasia was disclosed, leading to proctectomy. A second case of proctectomy was performed in a patient with microrectum. Biopsies performed preoperatively in this case showed the only case of moderate dysplasia found in our population. Provided that the usual contraindications to this surgical procedure are observed, IRA is still a valid option in the surgical treatment of ulcerative colitis.

Adolescent↗
PubMed1993

[Radiation therapy for carcinoma of vagina].

Thirty-four patients with carcinoma of the vagina were treated by radiotherapy at the Hyogo Medical Center for Adults between April 1965 and May 1990. All patients were treated with a combination of external and intracavitary or intestinal irradiation. Twenty-three patients had squamous cell carcinoma, five had adenocarcinoma and two had malignant melanoma. The five-year survival of patients with squamous cell carcinoma was 70% in Stage I (10 patients), 40% in Stage II (seven patients), 50% in Stage III (three patients) and 0% in Stage IV (three patients). Local control was achieved in 72.7% of the patients with squamous cell carcinoma and 60% of those with adenocarcinoma. However, neither of the malignant melanomas was controlled. Five patients had severe complications that required surgical treatment: severe proctitis and small-bowel perforation, ileus, rectal stenosis, vesicovaginal fistula and small-bowel perforation. Local and pelvic failure was noted in three patients. Patients with previous hysterectomy were more likely to develop serious treatment-related complications.

Adenocarcinoma↗
PubMed1993

Twenty years follow-up of patients with inoperable cancer of the prostate (stage C) treated by radiotherapy: report of a national cooperative study.

PURPOSE: To evaluate the longevity and curability of patients with inoperable, Stage C, carcinomas of the prostate by means of external pelvic irradiation. METHODS AND MATERIALS: 372 patients, averaging 61 years of age, with histologically proven adenocarcinoma of the prostate, Stage C, received radiotherapy as part of a National Research Study, from 1967 to 1973. Treatments were administered in accordance with a strict protocol. Portals of entry were optional but it was required that the total dose received at the center of the prostate should be no less than 7000 cGy in no less than 47 days or 7500 cGy in 54 days. RESULTS: 245 of the 372 patients survived 5 years without evidence of recurrence of metastases; 142 were living after 10 years, 64 after 15 years, and 24 after 20 years. A total of 167 patients (44%) survived for years and died from intercurrent diseases without evidence of prostatic cancer. A total of 177 patients (47%) died of prostatic cancer in decreasing proportions in the years after treatment. Mild episodes of hematuria and of rectal bleeding were recorded in a number of patients; urethral and rectal strictured occurred following cystitis and proctitis but no life-threatening complications occurred. CONCLUSIONS: Adequately fractionated external pelvic irradiation can eradicate inoperable intrapelvic prostatic cancer. A simple statement of survival would disregard the fact that these elderly patients may be cured of cancer and yet may die of intercurrent diseases proper of their age. Also, it may be expected that a number of patients with Stage C may have unsuspected subclinical bone metastases when first seen and that death from metastases is not necessarily a reflection on the effectiveness of the regional treatment.

Adenocarcinoma↗
PubMedDate not supplied

Incidence of inflammatory bowel disease in the province of Liège (Belgium). La Société de Gastroentérologie Liègeoise.

UNLABELLED: Up to now, as there is no national registry of patients with inflammatory bowel disease (IBD) in Belgium, the study of IBD epidemiology in our country is only possible through institutional or regional series. Therefore we conducted a prospective epidemiologic study of IBD in the Province of Liège (1 million inhabitants). METHODS: 29 (out of 47) private and public gastroenterologists completed a standard questionnaire for each patient consulting for the first time with clinical symptoms compatible with IBD between 1/06/1993 and 31/05/1994. RESULTS: During that period 104 cases of IBD were recorded: 56 (54%) Crohn's disease (CD), 36 (35%) ulcerative colitis (UC) including 7 proctitis (19% of UC) and 12 (11%) unclassified colitis. The annual incidence was 5.5 per 100.000 for CD and 3.5 for UC. The sex ratio F/M was 1.7 for CD and 0.7 for UC. The median age at the time of diagnosis was 33.5 yrs for CD and 40 yrs for UC. The highest age specific incidence rate for CD and UC was between 20 and 29 yrs : 13.6 and 6.1, respectively. CONCLUSIONS: This first Belgian prospective study has shown an incidence rate for CD comparable with that seen in north European studies but lower than that seen for UC. These results were similar to those observed in the northern part of France. Belgium appears to be a privileged country to undertake a national register and to study epidemiological aspects of IBD.

Adult↗
PubMed1996

Neoplasms in long-term Hartmann's pouches.

A Hartmann's pouch is a blind segment of the rectum created in conjunction with a colon resection in which primary bowel reanastomosis is judged unsafe. Often forgotten, this defunctionalized rectal pouch has a high potential of pathologic lesions, including disuse proctitis, ulcers, bleeding and occasionally neoplasm formation. What are the consequences of Hartmann's pouches left unattended? In this paper, we discuss three patients with neoplasms in a long-term Hartmann's pouch and the pathophysiology of the long-term defunctionalized rectum. We also question the possibility of increased incidences of neoplasms in long-term Hartmann's pouches. To monitor this we recommend close observation of the rectal pouch with proctoscopy and contrast studies.

Adenocarcinoma↗
PubMed1996

Outcome of laparoscopic colorectal surgery in older patients.

The object of this study was to assess the outcome of laparoscopic colorectal surgery in patients >60 years of age and compare it to a younger group of patients who underwent similar procedures. All consecutive patients who underwent a laparoscopic or laparoscopic-assisted procedure were evaluated. The parameters analyzed included gender, indication for surgery, procedure, complications, conversions, length of ileus, length of hospitalization, and comorbidity. The results of patients 60 years of age or older were compared to a procedure-matched group of younger patients. Between August 1991 and August 1995, 165 patients underwent a laparoscopic or laparoscopic-assisted colorectal procedure. Thirty-six patients were 60 years of age or older [mean age, 73 (60-88) years; 17 males and 19 females] and were compared with 36 younger patients [mean age, 44 (20-58) years; 13 males and 23 females]. The indications for surgery included Crohn's disease in 14 patients, polyps in 23, diverticular disease in 15, carcinoma in 11, fecal incontinence in 4, rectal prolapse in 2, radiation proctitis in 2, and sigmoidocele in 1. Identical procedures were performed in each group including right colectomy or ileocolic resection in 17 patients, sigmoidectomy in 14, loop ileostomy in 3, loop colostomy in 1, and abdominoperineal resection in 1 patient. Fourteen patients (38%) in the elderly group had comorbid conditions including ischemic heart disease (3), chronic obstructive pulmonary disease (3), hypertension (2), chronic renal failure (2), atherosclerotic vascular disease (2), congestive heart failure (1), and diabetes (1). All patients were cleared for surgery by their respective specialists. There were no statistically significant differences between the younger and older groups relative to the incidence of complications (11 vs 14%, respectively) and conversion (8 vs 11%, respectively) or the length of ileus (2.8 vs 4.2 days, respectively) or hospitalization (5.2 vs 6.5 days, respectively) (P = NS for all). There was no mortality in either group. The outcome of laparoscopic colorectal surgery in older patients is similar to that noted in younger patients. Advanced age should not be a contraindication to laparoscopic colorectal surgery.

Adult↗
PubMedDate not supplied

[The prevention of hemorrhoids in sailors].

Seafaring personnel are exposed in their everyday life and work to factors of ship environment contributing to the development of hypomotor intestinal dyskinesias, colitis, proctitis, proctosigmoiditis, hemorrhoids. Rations for seafaring personnel are deficient in food fibre: 11 g per twenty-four hours, with the norm being 40-70 g per twenty-four hours. A positive result was achieved in the study of the action of a concentrate of food fibre prepared from wheat bran by special methods in patients with hemorrhoids. The above concentrate can be recommended for prevention and dietotherapy of hemorrhoidal disorders of the intestine and hemorrhoids.

Chronic Disease↗
PubMed1997

[Outcome of simultaneous radiochemotherapy of anal carcinoma].

The combined radiochemotherapy with mitomycin C and 5-fluorouracil is an effective and well tolerable treatment modality. Its superiority in comparison with radiotherapy alone could not be reliably demonstrated. The goal of this paper was to analyse the results of routinely used combined modality in patients with anal carcinoma. From 1989 to 1994 simultaneous radiochemotherapy was performed in 20 patients with carcinoma of the anal canal. The 3- and 5- year survival rate was 79%, the 3- and 5-year local tumor control rate was 88% and 77%, respectively. In 2 patients a recurrence-related colostomy was performed. The acute side effects were tolerable, 2 patients (10%) suffer from moderate late effects (partial incontinence, proctitis). Our results, being of high validity due to accurate follow-up are similar to the data reported in international trials and support the hypothesis of superiority of combined radiochemotherapy compared to radiotherapy alone. In our opinion, the combined modality treatment should also be applied preferentially in practice, beyond the clinical trials.

Aged↗
PubMed1997

Combined therapy with 5-aminosalicylic acid tablets and enemas for maintaining remission in ulcerative colitis: a randomized double-blind study.

OBJECTIVES: To assess the efficacy of a combination of oral and topical 5-aminosalicylic acid (5-ASA) for the maintenance treatment of ulcerative colitis, we undertook a double-blind randomized clinical trial. METHODS: Patients aged 18 to 65 yr (with disease extent greater than proctitis only) were eligible for inclusion in the study if they met the following criteria: (a) history of two or more relapses in the last year; (b) achievement of remission in the last 3 months (with maintenance of remission for at least 1 month). Patients enrolled in the study were randomly assigned to one of the two following 1-yr treatments: (1) combined therapy with 5-ASA tablets 1.6 g/day and 5-ASA enemas 4 g/100 ml twice weekly; (2) oral therapy with 5-ASA tablets 1.6 g/day and placebo enemas/twice weekly. The main end point of the study was the maintenance of remission at 12 months. RESULTS: Upon completion of the study, relapse occurred in 13 of 33 patients in the combined treatment group versus 23 of 36 patients in the oral treatment group (39 vs 69%; p = 0.036). No significant side effects related to treatment were observed in either group. A simplified pharmacoeconomic analysis shows that this form of combined treatment can have a favorable cost-effectiveness ratio. CONCLUSIONS: Our results indicate that 5-ASA given daily by oral route and intermittently by topical route can be more effective than oral therapy alone. This form of combination treatment can be appropriate for patients at high risk of relapse.

Administration, Oral↗
PubMed1997

[Brachytherapy with pulsed dosage. General considerations. Radiobiological considerations. First clinical experience in Mestre (Venice)].

The pulsed dose rate (PDR) brachytherapy technique is analyzed and compared with the low and high dose rate (LDR and HDR, respectively) techniques relative to therapy and management, considering the advantages and pitfalls of each technique. From a radiobiological viewpoint, PDR optimization is aimed at obtaining the same therapeutic results as with LDR and HDR relative to both tumor cell killing and possible late damage. PDR permits to administer the same nominal dose rates as with LDR and HDR, but with very different pulse intervals and length. March, 1995, through March, 1996, forty-two patients were treated with microSelectron PDR at the radiotherapy Department of Umberto I Hospital in Mestre (Venice). Twenty-two patients were irradiated on the vaginal vault, 14 on the anal canal, 4 on the breast, one on the endometrium and one on the urethra (the latter patient was a man). Dose rates were 250-300 cGy/h in the vaginal vault and 90 cGy/h in the other sites. Source-dwell interval in the applicators was 2.5 mm, dwelling time for each position ranged 6.8-122 s, 3-73 pulses were applied lasting 167-1958 s. The unit was reliable and the only problem was the need to recalibrate it every 5-6 applications because of computer memory saturation. Because of the short minimum follow-up (3 months), only the early reactions to treatment have been assessed: no toxicity was found in the vaginal vault, endometrium and breast. Low-grade proctitis was observed in 11 of 14 treated anal canals and another patient complained of more severe symptoms for two weeks; the disease progressed in two anal canal patients, as in the urethra patient. In conclusion, PDR brachytherapy appears a reliable technique whose early clinical results are encouraging.

Brachytherapy↗
PubMed1996

Assessment of chlorpromazine as radiation sensitizer and protector.

In vitro studies of chlorpromazine (CPZ) a popular anti-psychotic drug has shown radiation sensitizing effects at higher celluar concentration and protective effect at a lower concentration. The present study was designed to evaluate both sensitizing and protective effects in the treatment of advanced cancer of the cervix treated with hypofractionated external radiation and intratumoural injection of chlopromazine. Twenty patients were treated with intratumoural CPZ and radiation, while, 23 patients received radiation alone. A 52.94% complete response was noted in CPZ arm while 39.1% complete response in the control. A trend towards improved response is seen in CPZ group. Similarly patients who received CPZ showed significantly low proctitis rates.

Carcinoma, Squamous Cell↗
PubMed1997

Genital herpes masquerading as anal fissures.

Sexually transmitted genital infections in women may affect the vulva, vagina, cervix and urethra, or more rarely the rectum. Proctitis, a common finding in surgical clinics, can be caused by sexually transmitted infections including gonococcal and chlamydial. This possibility should be considered by coloproctologists and general surgeons when sexually active young women present to them with relevant anorectal symptoms, particularly if the symptoms are of a relapsing nature. Unless specifically questioned, the patient may fail to see the relevance of a history of an anogenital infection. The case reported provides an example.

Adult↗
PubMed1997

[Incidence of inflammatory bowel diseases in Bretagne (1994-1995). ABERMAD. Association Bertonne d'Etude et de Recherche des Maladies de l'Appareil Digesif].

OBJECTIVES: The aim of the study was to determine the incidence and the main clinical data of inflammatory bowel disease in Brittany. METHODS: According to EPIMAD registry's methodology, private and public gastroenterologists (n = 139) of Brittany (2836418 inhabitants) referred all patients consulting for the first time, in 1994 and 1995 with clinical symptoms compatible with inflammatory bowel disease. An interviewer practitioner completed at the gastroenterologist's consulting room a standard questionnaire for each patient. Each case was reviewed separately by four experts to assign a diagnosis of definite, probable, possible Crohn's disease, ulcerative colitis, unclassifiable chronic colitis, or acute colitis (onset of symptoms < 6 weeks). RESULTS: 657 cases were recorded: 205 Crohn's disease (31%), 165 ulcerative colitis (25%) including 75 ulcerative proctitis (46%), 42 unclassifiable chronic colitis (7%), 245 acute colitis (37%). The crude mean annual incidence (per 10(5) inhabitants) based on definite and probable cases only was 2.8 for Crohn's disease and 2.9 for ulcerative colitis. The female/male ratio was 0.9 for Crohn's disease and 0.5 for ulcerative colitis. The median age at time of diagnosis was 27 for Crohn's disease and 36 for ulcerative colitis. The median time between onset of symptoms and diagnosis was equal to 3 months for Crohn's disease and ulcerative colitis. CONCLUSION: In Brittany the observed incidence of ulcerative colitis is similar to that of Crohn's disease and close to that observed in northern France. The incidence of Crohn's disease is lower. However, the real incidence of inflammatory bowel disease is currently underestimated due to the large number of acute colitis requiring a follow up and the cases of Crohn's disease classified as possible not taken into account.

Acute Disease↗
PubMed1997

[Incidence of inflammatory bowel diseases in the department of Puy-de-Dôme in 1993 and 1994. EPIMICI. Epidémiologie des Maladies Inflammatoires Cryptogenetiques de l'Intestin group].

UNLABELLED: The aim of this prospective epidemiological study was to investigate the incidence of Inflammatory Bowel Disease in the Puy-de-Dôme county using the same methodology as EPIMAD's registry. METHODS: From 01/01/93 to 31/12/94, each gastroenterologist (n = 22) collected patients consulting for the first time with clinical symptoms compatible with inflammatory bowel disease. Data were reported on a questionnaire by an interviewer practitioner. The final diagnosis of Crohn's disease and ulcerative colitis was made in a blind manner by two expert gastroenterologists and recorded according to the Calkin's criteria as definite, probable, or possible diagnosis, or unclassifiable chronic colitis or acute colitis. RESULTS: 167 new cases were identified: 112 (67.1%) inflammatory bowel disease for the combined group of definite and probable cases with 79 Crohn's disease (70.5%), 29 ulcerative colitis (25.9%) of which 11 ulcerative proctitis (37.9%), 4 unclassifiable chronic colitis (3.6%) and 55 acute colitis (32.9%). The crude and age-adjusted incidence (per 10(5)/year) was respectively 6.6 and 5.7 for Crohn's disease and 2.4 and 1.9 for ulcerative colitis. The highest age-specific incidence rate for Crohn's disease was between 40-49 years (14.1) and for ulcerative colitis between 80-89 years (6.8). The female/male ratio was 0.8 for Crohn's disease and 1.1 for ulcerative colitis. The median age at the time of diagnosis was 42.6 years for Crohn's disease and 35.3 years for ulcerative colitis. CONCLUSIONS: These preliminary findings revealed a high incidence of Crohn's disease and low of ulcerative colitis in this county. However, these results must be managed carefully because these data were recorded only on two years and the inflammatory bowel disease classified possible and acute colitis require a follow-up.

Acute Disease↗
PubMed1997

Syphilitic rectal ulcer associated with perforation of the hard palate: case report.

We report a case of a patient that presented with a perforated hard palate as a late complication due to an unsuspected syphilis. This disease first presented as a rectal ulcer which was misdiagnosed as an amebic proctitis. The patient received antiamebic treatment with a satisfactory outcome. He did not return for late control of the latter treatment and returned seeking medical advice six years later with the former complication. He tested positive for syphilis and appropriate treatment was performed. In addition, the ORL department recommended a palate prosthesis.

Humans↗