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At least 1,549 records · Page 86Linked to original sources
PubMed1995

[The role of ultrasonic endoscopy in the examination of post-obstetrical anal incontinence].

Echoendoscopy provides a means of exploring the anorectal and neighbouring areas. The technique has been used for over 10 years in cancerology and more recently in proctology. It can be used to confirm the anatomic integrity of the anal sphincters or to identify and localize damage, making it particularly interesting for the exploration of anal incontinence. Echoendoscopy has been used in several recent series which demonstrated that besides stretch neuropathies, defects in the sphincter play a role in post-obstetrical incontinence. Whether the signs occur early or late after menopause, these ruptures are easily identified with echoendoscopy. Thus, a reliable diagnostic of the anal lesion is possible before any therapeutic decision, not only for anal incontinence but also for prolapsus or urinary incontinence. Further prospective studies should confirm the contribution of echoendoscopy in deciding on surgical repair and help determine, and thus to prevent, the risk of sphincter rupture.

Anal Canal↗
PubMed1995

[The effect of basic therapy on the morphological picture of the rectal mucosa in patients with rheumatoid arthritis].

140 rectal mucosa biopsies were obtained from 86 patients with rheumatoid arthritis (RA), from 54 RA patients prior to or after a year basic therapy with either methotrexate or sulfa drug (sulfasalazine or salazopyridazine). 80% of the examinees exhibited large macrophages, lymphoid follicules, IgM- and IgG-containing cells. The knowledge of the initial morphologic changes in the rectal mucosa from RA patients helps predict efficacy of methotrexate or sulfonic drug treatment. Rectoromanoscopy with biopsy proved important diagnostic tool in RA capable of differentiating the disease variants, prompting valid therapeutic approach with control of the treatment results.

Adult↗
PubMed1996

Managing diarrhoea. Current thinking.

This article reviews the assessment of a patient presenting with diarrhoea. Brief comments are provided about certain specific causes of diarrhoea. Recent changes are highlighted and reference is made to some of the available booklets and pamphlets about the various causes of diarrhoea. This educational material may be useful to both general practitioners and their patients.

Celiac Disease↗
PubMed1996

[Rectal prolapse--choice of procedure and minimal invasive possibilities].

Diagnostic and pathomorphological findings support the notion that external and internal rectal prolapse with and without solitary rectal ulcer are merely different stages of one and the same disease. In view of the fact that, in the last resort, the aetiology of this disease remains largely unknown, the differential approach to therapeutic decision-making makes it necessary to give careful consideration to the individual situation of the patient, age, sex, case history and current findings. Although considerably in excess of 100 different surgical techniques have been reported for the treatment of rectal prolapse, only very few have finally been accepted in practice. In very old and high-risk patients, extra-abdominal corrective procedures (Delorme's procedure, peri-anal rectosigmoidal resection) performed under spinal or peridural anaesthesia, are given preference, despite the fact that the recurrence rate and the rate of persistent incontinence is higher than that seen with transabdominal techniques. In the case of younger patients and older patients unburdened by risk factors, the trans-abdominal procedures offer better functional results and lower recurrence rates. Here, anterior and posterior rectopexy and resection of the sigmoid with rectopexy are the most widely practiced procedures. With the further development of minimal invasive surgery, laparoscopic techniques are now also available, with the aid of which anterior and posterior rectopexy and intracorporeal sigmoid resection can be performed safely and reliably. These techniques will very likely further encourage the trend towards transabdominal procedures for the correction of rectal prolapse. These operative procedures may also be indicated in selected cases, in whom conservative treatment of intussusception and/or solitary rectal ulcer has failed.

Adult↗
PubMed1996

Concentrations of platelet activating factor in rectal mucosa in patients with ulcerative colitis.

OBJECTIVE: To find out if concentrations of platelet activating factor (PAF), which has been proposed as a mediator in the pathogenesis of ulcerative colitis and Crohn's disease, are increased in the rectal mucosa of patients with ulcerative colitis. DESIGN: Open study. SETTING: University hospital, Sweden. SUBJECTS: 45 Patients with ulcerative colitis (19 with active disease and 26 in remission), and 6 control patients and 11 healthy volunteers who acted as controls. INTERVENTIONS: Rectal biopsy. MAIN OUTCOME MEASURE: PAF content of rectal biopsy specimens. RESULTS: There were no differences between the PAF content of rectal mucosa in patients with active disease (median 47 pmol/g wet weight), patients in remission (47 pmol/g), and controls (51 pmol/g). There was no correlation between PAF content and inflammation seen endoscopically or histologically. 13 Patients who had active disease were investigated on a second occasion 9 weeks later (range 7-17), when in remission having received steroids but steroid-free at that time. There was a slight but not significant trend towards lower concentrations of PAF (median 33 pmol/g) compared with their previous results, possibly as a result of treatment. PAF concentrations were significantly lower than those of a group of patients in clinically stable remission of longer duration (p < 0.05). CONCLUSIONS: We did not find high concentrations of PAF in the rectal mucosa of patients with active ulcerative colitis compared with patients in remission or controls. We therefore have no evidence that PAF has an important role as a mediator in the inflammation of ulcerative colitis.

Adult↗
PubMed1996

[Mass screening for colorectal cancer].

Considering the present state of knowledge, only the strategy of screening for intestinal tumours at the asymptomatic stage could reduce such a problem as colorectal cancer. Data from case-control studies provide evidence of the efficacy of screening by rigid proctosigmoidoscopy. But compliance with such a strategy is not known. The effectiveness of screening by sigmoidoscopy has yet to be demonstrated. A European controlled study of flexible sigmoidoscopy in association with the Hemoccult test versus the Hemoccult test alone has been set up. Evaluation by a randomized screening trial with a single flexible sigmoidoscopic examination at age 55 to 60 years has also been suggested. Case-control studies and a randomized study conducted among volunteers demonstrate that it is possible to reduce mortality from colorectal cancer in people who accept screening with faecal occult blood testing, using the Hemocult test. Four population-based studies have been set up in Europe (in England, Denmark, France and Sweden). They are based on a biannual Hemoccult test. Compliance in the test group ranges between 55% and 65% in the first screening campaign and remains high in the following screening campaigns. In France, to achieve this goal, the test must be proposed by GPs and then mailed to those who do not consult GPs. Reliable mortality data will be available within 1 to 3 years. The results of the European trials must be awaited to know if screening biennually is effective in reducing colorectal cancer mortality.

Aged↗
PubMed1996

[Familial adenomatous polyposis (FAP): integration of clinical and genetic parameters in the screening of subjects at risk. A one-family example].

AIM OF THE STUDY: Amongst family members at risk of developing familial adenomatous polyposis (FAP) to distinguish between those who are affected by the disease and those who are not, in order to provide optimal treatment to those requiring it whilst excluding those without the disease from the endoscopic surveillance programme. MATERIAL AND METHODS: A programme of endoscopy, ophthalmologic examination for retinal pigment lesions associated with FAP and genetic analysis was proposed to a patient suffering from FAP and 3 of his children considered to be at risk. RESULTS: One person at risk eventually proved to have the disease. He had diffuse recto-colic polyposis as well as the typical retinal lesions found in his father and was treated by prophylactic proctocolectomy. He had inherited the mutated paternal allele. The other 2 children had neither polyposis nor retinal lesions and had inherited the normal allele from their father. DISCUSSION: Retinal lesions seen at fundoscopy allowed the diagnosis of FAP to be made before endoscopic confirmation in one patient at risk for FAP, but their absence did not exclude the diagnosis in the other 2. In these patients genetic analysis revealed that they had inherited the normal paternal allele and hence would not develop FAP. CONCLUSION: Systematic investigation of a family suffering from FAP allowed the members at risk to be identified. Two subjects at risk were able to be excluded from further follow-up and the remaining patient was able to be treated in an optimal fashion. An algorithm is proposed for the screening of patients at risk.

Adenomatous Polyposis Coli↗
PubMed1977

[Endoscopy and polypectomy for the early detection of carcinoma of the rectum and the colon (methods, significance, and limitations) (author's transl)].

The possibilities for the early detection and prophylaxis of colorectal carcinoma have been considerably increased by the endoscopic examination of the rectum and the colon via rectoscopy, sigmoidoscopy, and coloscopy combined with a coloscopic polypectomy. The routine use of these examinations was, however, impossible for reasons of personnel, patient psychology and cost. The risk groups need to be selected. To do this, the occult blood test (included since January 1, 1977 in the routine cancer detection examination) is used to demonstrate the presence of occult blood in fecal matter. The endoscopic examination of the colon could be included in the checkups for members of those groups selected. The 60% to 70% accuracy in detecting colorectal carcinoma with rectoscopy is only theoretical. The rate of early detection can be increased only if the rectoscopic technique is expanded by incorporating flexible instruments which are now being developed. High coloscopy should be attempted only after a double-contrast enema has been administered. A biopsy should be made of endoscopically diagnosed polypoid lesion; polyps should be excised in toto. Only then is it possible to make any statements regarding the histomorphology of the total structure. For a focal carcinoma, endoscopic polypectomy is not only a diagnostic procedure but also a curative-therapeutic procedure and, at the same time, an effective prophylaxis against carcinoma.

Colonic Neoplasms↗
PubMed1996

[Microsurgery in prospective comparison with conventional transanal excision or anterior rectum resection in adenomas and superficial carcinomas].

In a prospective randomized study, transanal microsurgery (TEM) was compared with anterior resection (AR) for T1-carcinomas (n = 25 vs. 28) and with local submucosal excision for adenomas (n = 90 vs. 98). The TEM procedure was superior to AR in blood loss, operation time, analgetic demand, hospitalisation in carcinoma resection and for local relapse in adenoma resection (6% vs. 22%). The 5-year survival probability between TEM and AR was 96% for both techniques, thus advocating TEM as a considerable procedure for cure of T1-rectal carcinomas.

Adenoma↗
PubMed1997

The hypertonic rectosigmoid junction: description of a new clinicopathologic entity causing constipation.

A physiological sphincter exists at the rectosigmoid junction; this rectosigmoid sphincter (RSS) relaxes on sigmoid colon contraction and contracts on rectal contraction. Eight cases of RSS hypertonia are presented herein. Six women and two men (mean age, 44.2 +/- 10.3 years) complained of chronic constipation of 9.6 +/- 6.2 years' duration. They had had normal bowel habits before that time. Anorectal physiologic studies were performed. Intestinal transit was delayed by the accumulation of pellets in the sigmoid colon. Defecography and electromyography of the external anal sphincter and levator ani muscle were normal. The resting pressure was normal in the sigmoid colon, rectum, and rectal neck (p > 0.05) but elevated in the RSS (p < 0.01). The sigmoidorectal inhibitory and excitatory reflexes were absent. Biopsies from the sigmoid colon and rectum showed normal histologic findings, but those from the RSS were aganglionic. A diagnosis of RSS "achalasia" was made. Five of the eight patients had improvement as a result of RSS dilatation. The remaining three patients underwent sigmoidomyotomy. The eight patients are now 9 to 38 months without recurrence of constipation. Rectosigmoid junction achalasia constitutes a clinicopathologic entity that should be considered in the etiology of constipation.

Adult↗