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PubMed1986

Perianal fistulas in patients with Crohn's disease.

A series of 55 patients with perianal fistulas and Crohn's disease is reported herein. Thirteen patients (24%) did not need specific treatment of the fistula. Primary proctectomy was necessary in five patients. Defunctioning enterostomy was used in nine patients, followed by healing of the fistula in four patients. Local surgery of the fistula was performed in 28 patients, with an overall success rate of 79%. Healing of the fistula was not influenced by activity of the disease, type of fistula, or condition of the rectum. Local surgery did not cause incontinence in this series.

Crohn Disease↗
PubMed1983

Ten years' experience with a multimodality treatment of advanced stages of rectal cancer.

Patients with inoperable rectal cancer have a remote chance of 5-year survival. In an attempt to improve this poor prognosis a combined radiochemotherapeutic regimen in a split form followed by long term chemotherapy maintenance was used in their management. From January 1971 until December 1980, three categories of patients were so treated. 100 Patients with an inoperable rectal primary (IP) or locally recurrent after anterior resection (LR) with no evidence of distant metastases; 71 patients with pelviperineal recurrences after rectal amputation (PPR); and 28 patients with primary rectal cancer and asymptomatic liver metastases (PALM). Side effects were tolerable and could be medically controlled. The local response rates in the three groups, respectively, were 79%, 85% and 85%. The median duration of this response lasted 25, 16 and 14 months, respectively, after which there was local progression of disease. The median survival rates were 19, 19 and 13 months, respectively. None of the PALM group lived for more than 30 months, while there were 20% 5-year survivors in the IP-LR group and 15% in the PPR group. The incidence of distant metastases in these last two groups were 20% and 50% at 5 years, respectively, while incidence of late complications was about 10%. This regime offers a good palliative measure with a possible 15% to 20% chance of long-term disease-free survival.

Adult↗
PubMed1987

Stage C adenocarcinoma of the prostate. An analysis of 551 patients treated with external beam radiation.

We retrospectively reviewed records of 551 patients with clinical Stage C prostatic adenocarcinoma treated with 60 to 70 Gy external beam radiation. Elective pelvic node irradiation was given to 247 patients (45%). Follow-up for all surviving patients ranged from 16 to 201 months (median, 6.5 years; mean, 7 years). The 5-, 10-, and 15-year uncorrected actuarial survival rates were 72%, 47%, and 27%, respectively. Disease-free survival rates were 59%, 46%, and 40% at the corresponding times. Actuarial local control rates were 88%, 81%, and 75% at 5, 10, and 15 years, respectively. Disease-free survival was adversely affected by high pathologic grade, disease fixed to the pelvic sidewall, invasion of the bladder, prior transurethral resection, hydronephrosis, and elevated serum levels of prostatic acid phosphatase and creatinine. Elective pelvic node irradiation did not improve the outcome. Complications of treatment were acceptable: minor anorectal and/or urinary symptoms, 11%; mild to moderate complications, 19%; serious problems requiring surgery, 3%. It is concluded that localized, high-energy external beam irradiation provides excellent local control of disease, low morbidity, and 5-, 10-, and 15-year survival rates that have not been rivaled by other treatment.

Acid Phosphatase↗
PubMed1990

Primary stomal lymphoma. An unusual complication of ileostomy in a patient with transfusion-related acquired immune deficiency syndrome.

A 73-year-old heterosexual man developed a high-grade non-Hodgkin's lymphoma at the site of an ileostomy only 2 years after proctectomy for undetermined colitis not cured by previous colectomy. In fact, the early occurrence of this usually very late and rare complication of ileostomy was probably favored by the simultaneous presence of acquired immune deficiency syndrome (AIDS) due to repeated blood transfusions for refractory anemia with excess blasts. The intestinal location of the tumor, its high-grade malignancy and B-cell origin are all features of AIDS-related non-Hodgkin's lymphoma. This case report seems to be one of the rarely identified examples of the cooperation between general predisposing factors and local irritating agents at the origin of a malignant tumor.

Acquired Immunodeficiency Syndrome↗
PubMed1982

Inflammatory bowel disease in the older patient.

This paper presents a review of 64 patients in whom the first symptoms of inflammatory bowel disease occurred after the age of 60 years. Inflammatory bowel disease in older patients affects the large bowel much more commonly than the small bowel. The commonest variant is disease localized in the rectum and distal colon, and many of these patients have Crohn's disease (14 out of 28 patients). In 19 patients with localized left-sided colitis it was difficult to distinguish ischaemic colitis, acute diverticulitis and Crohn's disease. Patients with left-sided colitis or total colitis (15 patients) had a high incidence of acute complications, particularly colonic perforation. There should be an awareness of the risks associated with all types of colitis in the older patient.

Age Factors↗
PubMed1989

Prognosis after surgery for colonic Crohn's disease.

The long-term prognosis including operation rates, the incidences of recurrent disease, morbidity and mortality and current status has been analysed in a group of 360 patients with Crohn's colitis grouped according to the primary site of macroscopic disease at diagnosis. The group has been followed from diagnosis for a mean period of 14.9 years. The overall operation rate was 76 per cent. Prolonged spontaneous or drug induced remission occurred at all sites: right-sided disease (11 per cent), extensive colonic disease (21 per cent) and left-sided disease (38 per cent). The cumulative reoperation rates at 5 and 10 years after right hemicolectomy were 26 and 46 per cent, after colectomy and ileorectal anastomosis 46 and 60 per cent, and after panproctocolectomy 10 and 21 per cent, respectively. There was a twofold excess mortality rate from related Crohn's disease deaths during the period of review, but the mortality rate has fallen with time. There have only been 11 related deaths in the last decade, of which eight were probably unavoidable. The current status of most patients is good, although treatment has included a permanent stoma in less than half (41 per cent) the patients still under review. Currently all but 14 patients are well and symptom-free and only 16 are receiving specific medical treatment. Until the aetiology of Crohn's colitis is understood, if medical treatment has failed to resolve symptoms, appropriate surgical treatment in experienced hands is an effective way of restoring patients with chronic persistent symptoms to good health.

Adolescent↗
PubMed1992

Anovaginal and rectovaginal fistula in patients with Crohn's disease.

Between 1971 and 1991, details of 67 women with perianal Crohn's disease were recorded prospectively using the Cardiff classification. Two groups were identified according to the presence (n = 29) or absence (n = 38) of anorectal Crohn's fistula involving the vagina. Patients in both groups were of a similar age and had had Crohn's disease for a similar period before diagnosis of perianal involvement. The incidence of associated perianal lesions, superficial ulcers, cavitating ulcers, other fistulas and strictures was not significantly different between the two groups. A greater proportion of patients with anorectal-vaginal fistulation (n = 15) had distal intestinal Crohn's disease (rectal or contiguous colorectal) compared with women with no vaginal fistulation (n = 14). A range of therapies was used to manage women with perianal Crohn's disease, from local surgery to a defunctioning stoma and/or proctectomy. Only 13 of 38 women with perianal Crohn's disease but no vaginal fistula required a defunctioning stoma or proctectomy, whereas 18 of 29 with anorectal-vaginal fistulation underwent these procedures (P < 0.05). A vaginal fistula has a considerable adverse effect on the outcome of perianal Crohn's disease.

Adult↗
PubMed1995

Experience with ileostomy and colostomy in Crohn's disease.

This study involved 746 patients with Crohn's disease treated surgically within a 13-year interval in whom 227 stomas (159 primary, 68 secondary) were created. The main indication (64 per cent) for primary stoma was severe perianal or genital fistulous disease. Revisional surgery for stomal complications was more common following colostomy than ileostomy (31 versus 5 per cent, P < 0.01). Twenty years after the first symptoms of Crohn's disease the cumulative risks of receiving any stoma or a permanent stoma were 41 and 14 per cent respectively. Four parameters were shown by proportional hazards analysis to be independently associated with the risk for any stoma as well as a permanent one; increased risk coincided with rectal inflammation, perianal fistula or abscess, and absence of small intestinal involvement. In addition, long-standing symptomatic disease before the first surgical intervention reduced the risk of a permanent stoma. The long-term chances of closure following temporary stoma were 75 per cent when used for anastomotic protection or avoidance, 79 per cent after postoperative complications, and 40 per cent for perianal or genital fistulas or for rectal inflammation or stenosis. Rectal disease and perianal fistula were the only independent predictors of a low possibility of stoma closure during follow-up.

Abdominal Abscess↗
PubMed1996

Perineal excision of the rectum.

An intersphincteric and perimuscular approach was employed for perineal excision of the rectum in 33 patients who had previously undergone total colectomy with preservation of the rectum. Laparotomy was avoided in 28 of the 29 patients who had had closure of the rectal stump with ileostomy. Of the four patients (two with ileorectal anastomoses and two with sigmoid mucous fistulas) for whom laparotomy was planned, this was considered to be much less extensive than would otherwise have been required. It is concluded that in patients who have previously undergone total colectomy for inflammatory bowel disease, subsequent perineal excision of the rectal stump without laparotomy is frequently possible.

Adult↗
PubMed1986

Radiotherapy for prostate carcinoma.

The charts of 96 patients who received radiotherapy at The M. S. Hershey Medical Center for their prostatic carcinoma were reviewed. The 4-year NED (no evidence of disease) survival rates for patients receiving between 6,500 and 7,000 rad of external beam radiation (EBR) were 92, 78, 56, and 50% for stages A, B, C, and D1, respectively. The 4-year NED survival rate for stage B patients was 90% for those receiving approximately 6,500 rad of EBR, 75% for those receiving approximately 7,000 rad of EBR, and 71% for those receiving interstitial implants. Bowel or urinary complications occurred in 27% (21% grade I, 3% grade II, and 3% grade III) of those receiving approximately 6,500 rad of EBR, 40% (25% grade I, 10% grade II, and 5% grade III) of those receiving 7,000 rad of EBR, and 0% of those receiving interstitial implants. The effects of stage, grade, and treatment type on NED survival and complications are discussed.

Brachytherapy↗
PubMedDate not supplied

MRI for evaluation of perianal inflammation.

BACKGROUND: We describe the value of using magnetic resonance imaging (MRI) in six distinct clinical settings often encountered in cases of perirectal inflammatory disease. METHODS: MRI was performed on six patients with known perianal inflammatory disease; the number, anatomic extent, location, and signal intensities of various lesions and their associated complications were assessed. RESULTS: MRI is a noninvasive technique that is useful in the diagnosis and management of perirectal inflammatory disease. CONCLUSIONS: In patients with known fistulas, MRI may determine the lesion's anatomic extent, localize unsuspected fistulas, and confirm or exclude the inflammation of the fistulous tract(s). Information obtained by MRI examination may, in turn, be used to determine treatment of patients with perirectal inflammatory lesions and can be a useful adjunct in following results of therapy.

Abscess↗
PubMed1978

Orgotein (superoxide dismutase): a drug for the amelioration of radiation-induced side effects. A double-blind, placebo-controlled study in patients with bladder tumours.

Orgotein, the drug version of Cu-Zn superoxide dismutases is a new and safe anti-inflammatory agent. Animal experiments have shown that it does not interfere with the tumourolytic effects of radiation or chemotherapy. A double-blind, placebo-controlled study has demonstrated that orgotein injected after each daily irradiation session can be used safely and effectively to ameliorate or prevent the side effects due to high-energy radiation therapy (8,400 or 6,400 rads) of bladder tumours. Orgotein significantly reduced the signs and symptoms both in the bladder and the bowel, indicating that it provides a therapeutic regimen for control of these side effects, which to date could only be treated symptomatically.

Clinical Trials as Topic↗
PubMed1975

Colonic epithelial cells and polymorphonuclear leukocytes in ulcerative colitis. An electron-microscopic study.

The following study cinfirms previously reported electron-microscopic findings in ulcerative colitis and agrees with the nonspecific nature of those findings. The study extends these observations in regard to relationship of PMN leukocytes, eosinophil leukocytes, and mast cells to colonic epithelial cells. Strong, though not conclusive, data that PMN and eosinophil leukocytes extensively invade epithelial cells in ulcerative colitis is presented. This finding also is not specific to ulcerative colitis and was found with much less frequency in Crohn's disease of the colon and in salmonella colitis. The presence of intravascular degranulation of PMN leukocytes in ulcerative colitis is confirmed. This study adds additional support to the concept that the major abnormality in ulcerative colitis resides within the colonic epithelial cell.

Animals↗