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At least 1,513 records · Page 84Linked to original sources
PubMed1994

Experience with TEM in Germany.

Transanal endoscopic microsurgery (TEM) presents a minimally invasive procedure for local removal of large adenomas as well as early carcinomas of the rectum. 57 surgical departments/clinics, which practice this method in Germany were asked about their experience. 44 questionnaires were evaluated. Indications for the 1,900 recorded operations were 1,411 adenomas, 433 carcinomas (curative intention: 286; palliative intention: 147), and 56 other procedures. The conversion rate to laparotomy was dependent on the experience with this surgical method (1.2%-11.6%). A radical rectal resection as a second step was performed in 5.7% of patients in the case of advanced carcinoma in the histologic examination of the specimen. Complications appeared in 120 patients (6.3%), 77 patients (4.0%) recovered with conservative treatment, and 43 (2.3%) had to undergo surgery. The mortality rate was 0.2% (3/1,900 pts).

Anal Canal↗
PubMed1994

Transanal endoscopic microsurgery in Italy.

The Italian experience with Transanal Endoscopic Microsurgery (TEM) started in 1991. Until April, 1994, 122 patients were operated on by such a technique in six centres. The surgical protocol in the 66 patients with benign lesions was similar to that described by Buess. In contrast to the German experience, the indications of TEM for cancer have been extended to more advanced tumours and in 22 out of 56 patients with rectal carcinoma adjuvant radiation- or radiation-chemotherapy have been applied according to various protocols. In 88% of TEM for rectal tumours the operation has been carried out according to a full-thickness technique, with or without perirectal fat excision. Postoperative morbidity of TEM for adenoma was 15.8% and that of TEM for carcinoma 29.6%. There was no postoperative mortality. Local recurrence rate after TEM for adenoma was 10.5%, while that after TEM for cancer was 9.25%. No local recurrence has been reported among patients treated with a combination of TEM and adjuvant radiation treatments. The median follow-up in the 6 centres ranged between 7 and 16 months. A randomised prospective clinical trial has been planned in order to evaluate the role of transanal endoscopic microsurgery in the treatment of locally advanced rectal cancer.

Adenocarcinoma↗
PubMed1994

Transanal endoscopic anorectal mucosectomy with ileal pouch anal anastomosis for familial adenomatous polyposis. A case report.

In patients with familial adenomatous polyposis (FAP) who are undergoing ileal pouch-anal anastomosis (IPAA), transanal mucosectomy can be performed without excessive anal dilatation and manipulation using the operative proctoscope introduced by Buess. In this way, mucosectomy under a direct three-dimensional six-fold magnified view is accurate and bloodless.

Adenomatous Polyposis Coli↗
PubMed1994

A preliminary report on endoscopic transanal resection of the rectum.

Since 1986 we have performed 62 endoscopic transanal resections (TAR) on 43 patients with malignant or benign tumours. Initially a transurethral resectoscope was used, and later the recently developed rectal resectoscope was introduced, enabling diathermy resection of a rectal lesion growing into the lumen of the rectum and making it possible to take the resection level up to or below the level of the muscularis propria. The wound is left to epithelialise spontaneously. 32 patients with malignant lesions of the rectum underwent TAR. The aim was to palliate symptoms and avoid colostomy. 11 patients with benign tumours (8 adenomas, 2 polyps, 1 stricture) also underwent TAR. No patient died within 25 days of operation. TAR is a minimally invasive procedure. It is quick, safe and effective if performed caudal to the peritoneal reflection fold.

Aged↗
PubMed1995

[Diagnostic and therapeutic problems of acute lower gastrointestinal hemorrhage].

In a four year period (1990-93) 75 patients were treated in our hospital for acute lower gastrointestinal bleeding. In the course of diagnostic procedures an upper gastrointestinal bleeding was excluded routinely and further 126 endoscopic measures were performed. All patients underwent rectoscopy and additional partial or total coloscopy. In addition to that, 16 scintigrams and 7 angiograms were taken. The validity of the endoscopic measures was 0.73, scintigraphy and angiography were less valid with 0.53 and 0.34. Therefore endoscopic diagnostic procedures are of more value. 32 of these 75 patients underwent operative treatment. Recurrent bleeding after operative treatment was seen in 6.25%. Overall mortality was 5.33%. Because prognosis of a recurrent bleeding after operative treatment is poor, primary subtotal colectomy is indicated when the source of bleeding can not be localized.

Aged↗
PubMed1995

[Leiomyosarcoma of the rectum].

The distinction between leiomyoma and high differentiated leiomyosarcoma can be difficult. The most important distinguishing feature is the number of mitoses. Additionally the tightness of the cells, the number of necroses and cell atypias and the size of the tumor are significant. The most common therapy for large and low differentiated leiomyosarcomas of the rectum are the abdomino-perineal resection or the low anterior resection. In high graded tumors of less than 2.5 cm the radicality of the surgical treatment is questioned. Some authors recommend a wide local excision, but in this case a high local recurrence rate has to be expected. This is the reason for a more radical treatment of all leiomyosarcomas of the rectum. Chemotherapy and radiotherapy are generally not effective. The prognosis is poor.

Adult↗
PubMed1976

Antibiotic-associated pseudomembranous colitis.

This review defines the entity pseudomembranous colitis and briefly outlines the supposed etiologic causes of pseudomembranous colitis including antibiotics. The incidence, mortality rate, and natural history of antibiotic-related pseudomembranous colitis is contrasted with other forms and causes of pseudomembranous colitis. The clinical spectrum of antibiotic-related pseudomembranous colitis, ranging from a nonbloody, watery diarrheal state to a life-threatening condition mimicking an acute surgical abdomen, is reviewed. The classic proctoscopic and pathologic findings, as well as common problems encountered in interpretation, are discussed. A complete review of the spectrum of radiographic findings is presented from the nonspecific to the quite characteristic radiographic findings, including both plain film and contrast studies of the colon. These findings are contrasted with the X-ray features of other inflammatory and ischemic colitides and a differential diagnosis is discussed. A section dealing with the treatment of antibiotic-associated pseudomembranous colitis will be included. This section will review the various modes of therapy that have been employed. Finally, a brief section will speculate on the possible etiologic role that antibiotics play in pseudomembranous colitis, including the alteration of the bacterial flora and possible effect on bile salt metabolism.

Administration, Oral↗
PubMed1994

Solitary plasmacytoma of the rectum: report of a case treated by endoscopic polypectomy and radiotherapy.

Solitary extramedullary plasmacytoma (EMP) of the rectum is an exceedingly rare entity. We report the fourth case of solitary EMP of the rectum and the first one treated by endoscopic polypectomy and radiotherapy. The patient showed no signs of local recurrence or dissemination of the disease after a 12-month follow-up. This case report is presented along with a review of the literature dealing with solitary plasmacytomas of the rectum.

Aged↗
PubMed1994

[Transanal endoscopic microsurgery (TEM): indications and limitations].

Sessile polyps of the proximal and middle part of the rectum are difficult and sometimes impossible to remove by snaring techniques. The conventional transanal approach to this level results in inappropriate survey and security. Parasacral techniques and low anterior resection require disproportionate measures to treat these adenomas. Transanal endoscopic microsurgery (TEM) is a relatively new operative technique to remove sessile polyps of the entire rectum, developed by Buess et al. [1] in Germany. The system uses a special endorectal scope connected to a stereoscopic angulated optical system for visualization. A continuous pressure-controlled insufflation of carbon dioxide keeps the rectum open for exposure. The excision is done by electrocautery in the submucosal plane or as full thickness excision in the submuscular plane. The defect is closed with an intrarectal running suture. Our report demonstrates the indications and limits of this technique and compares it to conventional techniques mentioned above. 12 patients with different kinds of tumor have been selected and serve as basis for our discussion. TEM offers excellent survey in the entire rectum and permits removal of villous adenomas and incidental low risk and early rectal cancers. High risk patients tolerate this procedure well. Unsuitable are circular and long-distance adenomas and transmural growing benign tumors of the proximal rectum.

Adenoma, Villous↗
PubMed1994

[Rectoscopy and Hemoccult-II as initial diagnosis. A procedure in patients with symptoms of irritable colon].

The diagnostic accuracy for colorectal cancer (CRC) of rigid sigmoidoscopy and faecal occult blood test (Hemoccult-II) (H-II) was investigated in patients with irritable bowel syndrome in general practice in a three year period and the results were compared with those of the previous three years, where rigid sigmoidoscopy and double contrast barium enema (DCBE) were the initial preferred examinations. Colonoscopy was recommended in patients with positive H-II, but also in patients with repeated negative H-II within three months, provided that the symptoms persisted. CRC was detected in 141 of 630 patients with positive H-II and in 52 of 8697 with negative H-II. The number of CRC's in the two study periods was similar, in spite of a pronounced reduction in DCBE's from 12,196 to 5656 and a small increase in colonoscopies from 3053 to 4127. It was concluded that the new strategy was no worse than the previous one and the major savings in DCBE's could be used to exchange the rigid sigmoidoscopy with a 60 cm flexible sigmoidoscopy, increasing diagnostic accuracy, shortening delay of diagnosis and removing more adenomas, which eventually may reduce the future incidence of CRC and thereby the mortality from CRC.

Adenoma↗
PubMed1994

Management of large malignant rectal polyps with transanal endoscopic microsurgery. Is there anything better for the patient?

The authors report their experience with transanal endoscopic microsurgery (TEM), a technique that allows all the standard surgical manoeuvres such as tissue excision, suction, control of bleeding and suturing in the entire length of the rectal cavity. Main indications for TEM are the removal of large sessile polyps and early rectal cancers' (T1, G1-G2). Out of 50 patients submitted to TEM the authors consider in this study 24 cases with a preoperative diagnosis of benign large sessile polyps. The procedures included: 14 (58.3%) total wall excision, four (16.6%) total wall excision with perirectal fat, three (12.5%) mucosectomy, one mucosectomy + total wall excision, one partial wall excision + total wall excision, and the remaining case was converted to laparotomy due to a large intraperitoneal perforation. There was no operative mortality and an 8.3% rate of major complications. With a median follow up of 19 months there was no evidence of local or distant recurrence. The authors compare their results with those of alternative endoscopic and surgical techniques and highlight the advantages of TEM in the management of large and giant rectal polyps.

Adenocarcinoma↗
PubMedDate not supplied

Resectoscopic cervical trauma minimized by inserting Laminaria digitata preoperatively.

OBJECTIVE: To examine the safety and efficacy of Laminaria digitata to dilate the cervix before resectoscopic surgery. DESIGN: Randomized, prospective. METHODS: A group of 30 patients who were dilated preoperatively with Laminaria tents were compared to a group of 30 patients in whom cervical dilatation was performed in the operating room without previously inserted Laminaria tents. Statistical analysis was done with Student's t test and the chi-square test. RESULTS: Statistically significant differences were documented between the two groups for three variables: bleeding, inability to reach desired cervical dilatation, and length of time required for cervical dilatation up to a #23 Pratt's dilator. CONCLUSIONS: This study strongly suggests the advantages of using Laminaria tents preoperatively in the nonpregnant patient population when more than 8-mm cervical dilatation is necessary. The very low cost of L. digitata tents makes this technique cost effective.

Cervix Uteri↗
PubMed1994

Feasibility of transcolonic and transgastric abdominal vascular ultrasound.

Abdominal vascular ultrasound is hampered by tissue attenuation. To improve imaging, the feasibility of real-time color Doppler transcolonic and transgastric abdominal vascular ultrasound was evaluated. A monoplane 5 MHz transesophageal probe was inserted via a proctoscope in five patients with normal colons. At 25 cm (end of proctoscope), the aortic bifurcation and iliac arteries were dynamically imaged with high resolution. In three patients undergoing abdominal surgery, the surgeon grasped the probe and advanced it further through the descending to the transverse colon to examine further vascular structures. High resolution two-dimensional imaging and color Doppler flow were obtained from the abdominal aorta, the origins and proximal portions of the superior mesenteric artery, and the renal and the inferior mesenteric arteries. Additionally, the inferior vena cava, left renal vein, and portal system were imaged. All vascular structures imaged were within 3 cm of the probe. In two additional patients undergoing abdominal surgery and transesophageal echocardiography, the surgeon grasped the probe in the stomach and placed it on various vascular structures. The results were similar and the celiac trunk was also imaged. This technique, when integrated with fiberoptics for guidance, could provide a method for abdominal vascular ultrasound with less tissue-imposed attenuation, providing high resolution imaging and allowing additional structure recognition. This has potential applications for studying patients with disease of the abdominal aorta or its branches.

Abdomen↗
PubMed1994

Psychological stress and disease activity in ulcerative colitis: a multidimensional cross-sectional study.

OBJECTIVES: It is not known whether any link exists between life stress and disease activity in ulcerative colitis; attempts to demonstrate one have been complicated by recall bias, distressing psychological consequences of disease, psychogenic symptom exaggeration, and an irritable bowel component of inflammatory bowel disease symptoms. We therefore studied the relationship between psychological measures and two different aspects of ulcerative colitis activity. METHODS: The relation of perceived stress, depression, state anxiety, trait anxiety, and life events with endoscopic appearance of the rectal mucosa was studied "blind" in 46 asymptomatic outpatients with known ulcerative colitis. The same measures were then examined in relation to subjective activity, comparing the group in clinical remission with 32 ulcerative colitis outpatients who reported symptoms. RESULTS: Among asymptomatic patients, the level of stress over the past 2 yr on the General Perceived Stress Questionnaire was higher in the 11 with mucosal abnormalities than in the 35 with a normal rectal mucosa (p = 0.004). Among the entire population, symptomatic patients were more likely to recall major life events in the previous 6 months than the asymptomatic group (p = .02). Adjustment for smoking and for duration of remission did not substantially alter these findings. CONCLUSIONS: Life stress is associated with both objective and subjective aspects of activity in ulcerative colitis. Although the association of life events with reported symptoms may be subject to recall bias, the association of perceived stress with rectal mucosal abnormalities in asymptomatic patients is strongly suggestive of a true link between psychological factors and ulcerative colitis activity.

Adult↗
PubMed1994

[Assessment for development of superficial colorectal neoplasm--endoscopic and clinicopathologic analysis of 149 submucosal invasive carcinomas].

We performed the endoscopic and clinicopathologic analysis for the development of superficial colorectal carcinoma, using 149 submucosal (sm) invasive colorectal carcinomas. It was observed that superficial colorectal carcinomas had a tendency to rise by their sm massive invasion. In this study, we judged that the sm colorectal carcinomas originated from superficial colorectal carcinoma were 37 (25%) of 149 lesions, and their distribution in the colon and rectum was similar to that of advanced colorectal carcinomas, although the lesions originated from non-superficial (polypoid) colorectal carcinoma did not show so tendency. On the other hand, sm colorectal carcinomas originated from superficial colorectal carcinoma contained the evident adenomatous components in 7 (19%) of 37 lesions and had significantly higher incidence of lymph node metastasis than those originated from non-superficial (polypoid) carcinoma. These results suspected the facts as follows; 1) Superficial early colorectal carcinoma may be compatible as the origin to advanced colorectal carcinoma and has higher malignant potential than non-superficial early carcinoma. 2) Superficial colorectal carcinoma might also have the route of the development of "adenoma-carcinoma sequence", as well as "de novo" histogenesis.

Adenoma↗
PubMed1993

[Transrectal polypectomy using a TEM (transanal endoscopic microsurgery) technique].

The paper describes the removal of a broad-based tubulo-villous adenoma from the middle rectum using a transanal endoscopic microsurgical technique. This procedure, which was introduced by Buess, Thess and Hutterer in 1983, represents an alternative to the classic transanal technique, compared to which it is more accurate, and to the trans-sacral and transperitoneal methods compared to which it is less invasive.

Aged↗