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PubMed1976

Radical pelvic surgery versus radiation therapy for stage I carcinoma of the cervix (exclusive of microinvasion).

During the period from January 1, 1945, through December 31, 1975, 446 patients with Stage I infiltrative carcinoma of the cervix (exclusive of microinvasion) were evaluated at the University of Michigan Medical Center. Four different study groups with treatment comparisons between radical hysterectomy with pelvic lymph node dissection and full-course radiation therapy are analyzed. The over-all uncorrected five-year survival rate when each form of therapy is evaluated approximates 85 per cent; the corrected five-year survival rate is approximately 90 per cent. When the regional lymph nodes were negative, the five-year survival rate was 96 per cent; when they were positive, the five-year survival rate was 55 per cent. Pathologic variations are evaluated, and basic vital statistics are reported. Thirteen per cent of the patients developed a recurrence within five years, 70 per cent occurring within the first three years. The therapeutic morbidity experienced in both groups of patients is essentially comparable, and the advantages of each form of therapy are presented.

Adult↗
PubMed1979

Operative management of radiation injuries of the intestinal tract.

A review of forty cases of radiation-induced gastrointestinal injuries is presented. Based on this experience and reports in the literature, preoperative management and operative technics are discussed. The increased risk of radiation bowel injury is recognized in patients who have had previous operations. Preradiation contrast studies are advised to identify trapped loops of intestine in the pelvis. Small bowel resection is recommended with localized segments of disease. Bypass operations are preferable to avoid any extensive dissections. Bypass operations have anastomotic dehiscence rates similar to those of resections. Proctocolitis is usually managed by diverting colostomy, with resection in a few favorable cases or with treatment failures. Most rectovaginal fistulas are managed by permanent colostomy. Small bowel fistulas are best treated by bypass with partial or total exclusion rather than by primary resection. Vigorous preoperative and postoperative nutritional support and evaluation are vital because of the poor healing qualities of irradiated bowel. Multiple operative procedures should be anticipated because the natural history of radiation bowel injury is slowly progressive.

Aged↗
PubMed1980

Natural history of perianal Crohn's disease. Ten year follow-up: a plea for conservatism.

A 10 year follow-up of 109 patients with histologic Crohn's disease and anal lesions is reported. Fourteen patients (13 percent) have died, 7 from unrelated disorders. Ten required excision of the rectum, but only 5 for perianal disease (4.5 percent). Of the remaining 85 patients, 61 have been followed up to proctoscopy and rectal biopsy. Anal skin tags were still evident in 25 of 37 patients (68 percent), but new tags have appeared in only 2 patients. Ten of 53 fissures (19 percent) were still present at 10 years, and there were no new fissures. Seven of 21 patients (33 percent) still had fistulas but were asymptomatic; the remainder of the fistulas had healed spontaneously (8) or after operation (6). New fistulas have appeared in five patients. None of the patients have been in continent. These results indicate that perianal manifestations of Crohn's disease pursue a relatively benign course and are rarely an indication for proctectomy.

Adult↗
PubMed1986

Urinary excretion of polyethylene glycol 3350 and sulfate after gut lavage with a polyethylene glycol electrolyte lavage solution.

Ingestion of an electrolyte lavage solution containing polyethylene glycol 3350 and sulfate is an effective method of cleansing the colon for diagnostic studies. Polyethylene glycol and sulfate are considered poorly absorbed from the gastrointestinal tract. Because of the quantities administered, concern exists about potential toxicity of absorption of even a small percentage, particularly for polyethylene glycol. We measured the urinary excretion of both polyethylene glycol and sulfate in normal subjects and inflammatory bowel patients. Absorption of polyethylene glycol can be assessed by measuring recovery in urine, as 85%-96% of an intravenous load is excreted in urine. Similarly, appreciable sulfate absorption would exceed renal tubular reabsorption and result in increased urinary excretion. Mean percent polyethylene glycol load recovered in urine was minimal and similar for normal (0.06%) and inflammatory bowel (0.09%) subjects. Urinary sulfate excretion after lavage was also similar for both groups and was not different from baseline. These results do not suggest the likelihood of toxicity due to polyethylene glycol 3350 or sulfate absorption during gut lavage with this solution.

Colitis, Ulcerative↗
PubMed1982

Psychological adjustment and patient information in inflammatory bowel disease: development of two assessment instruments.

Research on the psychological adjustments that patients must make in living with inflammatory bowel disease, symptomatic and life-disrupting chronic illnesses, has been difficult to interpret because no standard measurement instruments of known reliability and validity have been available. Two studies are presented on the construction, validation and cross-validation of the two instruments measuring patient information and psychological adjustment in inflammatory bowel disease. Both scales were shown to be reliable on the basis of internal consistency. Convergent validity of the psychological adjustment scale with measures of self-esteem and social competence and with a measure of public self-consciousness was demonstrated, as was discriminant validity along the dimension of social desirability. Assumptions underlying the scales are discussed, and research and clinical applications are suggested.

Adolescent↗
PubMed1992

Intraanal ultrasound: a new aid in the diagnosis of pelvic processes and their relation to the sphincter complex.

Intraanal ultrasound provides a very accurate structural analysis of the continence organ. In addition it proved to give excellent pictures of solid or fluid intrapelvic, particularly retrorectal, structures. It is superior to computed tomography and magnetic resonance imaging (requiring anesthesia), because the scanner is very close to the structures in question. This allows high scanner frequencies with resolutions of 0.9 mm and better. It is a quick method, avoiding radiation, and can be safely repeated as often as necessary.

Abscess↗
PubMed1994

Interpretation of large intestinal mucosal biopsy specimens.

The development of flexible endoscopes has led to a great increase in the examination and mucosal biopsy evaluation of all portions of the large intestine and rectum. Examinations are now performed not only for the determination of diagnosis but also for the monitoring of the course of a wide variety of conditions and for the early detection of complications. This review concentrates on the uses and interpretations of such biopsies in a large number of inflammatory conditions, with special emphasis on the correlations with clinical and functional features. Illustrated are examples of infections, idiopathic inflammatory bowel disease (IBD), vascular disorders, motor and mechanical conditions, toxic and physical reactions, and other inflammatory conditions. Mucosal biopsy specimens also are obtained to identify dysplasia and to evaluate mass lesions, and these subjects are well covered in other articles within this symposium. In patients with chronic disorders multiple examinations are now expected to follow the course of the disease and to detect and correct any complications at an early stage. The exact reasons for the endoscopy and relevant clinical data are essential for the optimal analysis of these mucosal biopsy specimens.

Biopsy↗
PubMed1983

Pelvic complications after definitive treatment of prostate cancer by interstitial or external beam radiation.

Radiation complications, after definitive treatment of localized prostatic carcinoma by either external beam or interstitial implantation with Iodine-125 seeds, are reviewed. Late serious complications to immediately adjacent structures of the anterior rectal wall, prostatic urethra, bladder neck, and external sphincter occurred with similar frequency in both treatment groups. However, late serious complications of the remotely adjacent structures of the bladder, urethra, distal ureters, and circumferential rectal wall occurred more frequently in the external beam treatment series, a reflection of the fact that larger tissue volumes were irradiated. Rectal ulceration, while occurring in both treatment groups, was amenable to surgical correction or underwent spontaneous healing only in the 125I group. At this point in our experience, morbidity from late radiation complications has been less among those patients having interstitial implantation for definitive treatment of localized prostatic carcinoma.

Adenocarcinoma↗
PubMed1990

Late results of combined iodine-125 and external beam radiotherapy in carcinoma of prostate.

A total of 96 patients were treated for localized carcinoma of the prostate using combined Iodine-125 (125I) implantation and external beam radiotherapy. The implant was tailored to deliver 10,000 rad to the periphery of the prostate. A significant incidence of serious late rectal complications was observed. Positive pelvic nodes were found in 28 percent of the patients. Disease-free survival at seven years was 76 percent for those with negative nodes and 46 percent for patients with positive nodes.

Fistula↗
PubMed1990

Benefit of external irradiation in pathologic stage I endometrial carcinoma: a prospective clinical trial of 605 patients who received postoperative vaginal irradiation and additional pelvic irradiation in the presence of unfavorable prognostic factors.

Six hundred and five cases of endometrial carcinoma, pathologic stage I, without definable extrauterine disease were initially treated with total abdominal hysterectomy and bilateral salpingo-oophorectomy, followed by high-dose-rate iridium-192 irradiation of the vagina. External irradiation of the pelvis was performed only for patients with poor prognostic factors. Five-year survival was calculated by the product-limit method of Kaplan and Meier. Three hundred and forty-eight patients with tumor invasion of the inner third, of any tumor grade, received postoperative vaginal irradiation only. Twenty-eight patients with grade 1 tumor invasion of the middle third received vaginal irradiation only. One hundred and six patients with grade 2 or 3 tumor and infiltration of the middle third received vaginal and external irradiation of the pelvis. One hundred and twenty-three patients with deep muscle invasion of the external third of the myometrium received vaginal and pelvic irradiation. Differences in survival figures were not significant. Survival of the treatment group with good prognosis who received vaginal irradiation alone (91%) was similar to that of the group with poor prognosis who received additional pelvic irradiation (87.7%). Despite the unfavorable situation of patients with poor prognostic factors, treatment results after additional external irradiation were relatively equal to the results for patients with good prognostic factors who had not received external irradiation. Therefore, the benefit of external irradiation in patients with stage I endometrial carcinoma with unfavorable prognostic factors seems evident.

Aged↗