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[Functional study of the anorectal region in hemorrhagic rectocolitis].

Because the rectum is always severely affected by haemorrhagic procto-colitis, the functional investigation of the ano-rectal region is an essential element in the pathophysiological approach and the objective evaluation of functional disorders (urgency of stools, number of stools per 24 hours, incontinence) described by patients. In fact, the rectum is a compliant organ which behaves like a reservoir between the propulsive colinic element and the resistant anal element and it plays an essential role in the continence of faeces. The work of Farthing et al. and Denis et al. in cases of non-operated haemorrhagic procto-colitis have demonstrated: an abnormal sensitivity of the rectum to disension, a significant reduction in the rectal capacity and a decrease in the distensibility of the rectal wall. The abnormalities appear to be related to inflammation of the rectal mucosa. The studies reported by Denis et al. and by Zielinski et al. suggest that there is a functional adaptation of the rectal wall after ileo-rectal anastomosis for heamorrhagic procto-colitis, even in endoscopically severe forms.

Adaptation, Physiological↗

[Rectal hemorrhage in adults].

Two hundred thirty two patients, aged over 50, were examined, that were consulted with a view to rectal hemorrhage. After the analysis of the results obtained the author established that the causes of the rectal hemorrhage were: Tumours of colon--in 40,5 per cent, 64 per cent of them with cancer of colon. Diseases of sphincter region--in 44,9 per cent (anal fissure in 12,5 per cent; erosive and ulcerous sphincteritis--in 16,9 per cent; internal and external hemorrhoids--in 15,5 per cent). Ulcerous and erosive colitis--in 10,6 per cent, etc. The group of the sixth decade was underlined to be most affected--in 48,5 per cent. The localization of the tumours from the anorectal line up to 30 cm--is in 84 per cent and over 30 cm--in 16%. It is stressed that the presence of blood in feces, demands, without delay, the elucidation of the etiology of the hemorrhage.

Aged↗

[Transanal endoscopic surgery of the rectum - testing a new method in animal experiments].

Surgery of the lower third of the rectum can be done without difficulty through the anus using an endoscopical approach. Polyps or tumors located in the upper two thirds of the rectum can be removed using the Mason or Kraske procedure, or by the transabdominal approach. A new endoscopic technique has been developed with the aim, to allow surgery in the whole rectum through the anus. The rectum is being dilated by mechanical means and air insufflation. An oblique angle stereoscopic endoscope as well as modified surgical instruments are used. In animals 47 excisions of mucosa were done, and the incisions were closed by continuous suture. Application of this technique in a clinical setting is planned.

Anal Canal↗

[Transitory bacteremia following rectoscopy?].

Our rectoscopies were made in patients for various indications. Venous blood samples before rectoscopy as well as 1, 5, 10, 20 and 30 minutes after its beginning and blood cultures were taken. No transient bacteriaemia could be identified. Only in patients suffering from carditis an internist should be consulted before performing the rectoscopy.

Adult↗

[Colonic cancer screening with KRYPTO-HAEM SSW. The results in 3015 persons].

In a factory 3015 individuals have been tested for occult blood in stool using the KRYPTO-HAEM SSW. Test results were positive in 100 individuals (3.3%). Subsequent investigations have revealed 6 carcinomas of the colon, one carcinoid in the cecum and adenomas in 9 cases. Eleven out of the 16 tumors detected were beyond the range of the rectoscope. The test was valued as false-positive in 42 individuals (1.4%). A cecum carcinoma and 5 adenomas were revealed by false-negative findings. The importance of case history and exact diagnostic clarification of a positive test is pointed out. The inclusion of the KRYPTO-HAEM test into basic medical care proved to be an adequate measure for early detection of colorectal tumors.

Aged↗

[Pediatric digestive endoscopy: personal experience].

Fiberendoscopy has become a diagnostic and therapeutic procedure of the outmost importance also in pediatric gastroenterology. 100 gastrointestinal fiberoscopies have been carried out on 81 patients ranging in age from 1 month to 14 years during a three-year period (November 79 - October 82), using general anesthesia for 9 patients. The 70 upper GI endoscopies, almost always performed with the Olympus GIF P2 instrument, showed acute or chronic, limited or diffuse inflammatory changes in most cases; post-bulbar areas were successfully visualized in 46 patients. The 30 colonoscopies were carried out with the standard adult equipment in most part of cases; in 50% of cases the inspection was extended to the caecum. Inflammatory diseases have been frequently revealed, but more frequently no remarkable changes were found. Indications for "operative" endoscopy were dilatation of an esophageal achalasia and removal of four gastrointestinal bleeding polyps. All procedures gave satisfactory results, and no morbidity occurred to patients.

Adolescent↗

[Influence of rectal preparation by enema on cell proliferation in the normal rectal mucosa in man].

In order to study the potential influence of rectal enemas on epithelial cell proliferation, two groups of 13 patients without any disease of the digestive tract were compared, one group having received two warm enemas (Normacol) prior to proctoscopic examination. Cell proliferation was studied by in vitro incorporation of tritiated thymidine in mucosal biopsies and radioautographic analysis of the number and position of labeled nuclei in the glands. The mean number of labeled cells per gland and the mean labeling index were significantly higher in group i (with enemas) than in group II (without enema). In group I there was an extension of the proliferative compartment towards the surface with less than 50 p. 100 of labeled cells located in the lower third of glands. Intraindividual variations of labeling index from gland to gland were more important in group I than in group II. In group I, eight out of 13 patients had rectal glands with elevated labeling indices (15 p. 100) in contrast to one patient in group II. Our results suggest that proliferation abnormalities observed in group I are related to enema administration and indicate that this type of rectal preparation should preferably be excluded whenever cell kinetic parameters are studied in the rectal mucosa.

Adult↗

[Rectoscopy: a useful tool to diagnose pseudomembranous colitis (author's transl)].

The authors have performed nine rectoscopies in 14 cases of pseudomembranous colitis. A rectoscopic appearance enables eight times out of nine to diagnose the disease, which asserts itself in all cases by biopsies. Out of the nine cases, two had previously undergone an unnecessary laparotomy, and for three cases the diagnosis of rectal tumour established on rectal digital examination is twice set right by rectoscopic appearance and three times by biopsies. In the remaining five cases with mild intestinal symptoms and severe associated disease the diagnosis was only made with autopsies. A systematic rectoscopy with biopsies is indicated in all patients treated with antibiotics who present an unexplained diarrhea, collapsus or acute abdominal syndrom.

Adult↗