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At least 163 records · Page 9Linked to original sources
PubMed2006

Prospective randomized clinical trial comparing two different circular staplers for mucosectomy in the treatment of hemorrhoids.

BACKGROUND: The main objections against circular stapled mucosectomy have been anal pain and rectal bleeding during the surgical procedure or in the immediate postoperative follow-up. To avoid these consequences, a new stapler (PPH33-03) has been developed. The aim of this trial was to compare the intraoperative and short-term postoperative morbidity of stapled mucosectomy with PPH33-01 versus PPH33-03 in the treatment of hemorrhoids. METHODS: We conducted a prospective randomized clinical trial comparing hemorrhoidectomy with PPH33-01 (group 1, n=30) versus PPH33-03 (group 2, n=30) for grade III-IV symptomatic hemorrhoids. For the follow-up, the patients underwent examination and proctoscopy at 4 weeks, 3 months, and 6 months. We recorded anal pain (linear analog scale from 0 to 10), intraoperative hemorrhage, postoperative bleeding, and continence (Wexner Continence Grading Scale). RESULTS: Demographic and clinical features showed no differences between the two groups. More patients required suture ligation to stop anastomotic bleeding at surgery when the PPH33-01 stapler was used (15 versus 4, P<0.05). Rectal bleeding during the first postoperative 4 weeks was similar (P>0.05). The postoperative pain scores during the first week were similar (P>0.05). Patients with pain on defecation were fewer in the PPH-03 group (15 versus 2, P<0.05). Six patients from group 1 and none from group 2 (P<0.05) had granulomas along the line of staples at the sites of the reinforcing stitches; the granulomas were associated with postoperative anal discomfort and rectal bleeding. One patient in group 1 complained of persistent pain that resolved within 3 months. Of all the intraoperative or preoperative variables analyzed, only the presence of granuloma was associated with postoperative bleeding and anal discomfort. We have not found any recurrence or incontinence during the 6-month follow-up. CONCLUSIONS: Intraoperative bleeding along the stapled line and tenesmus or discomfort during defecation were less frequent after circular stapled mucosectomy with PPH33-03. Therefore, circular stapled mucosectomy with PPH33-03 decreases the risk of immediate complications and thus allows implantation with more safety as a day surgery procedure.

Female↗
PubMed2000

Anorectal injuries in children.

Anorectal injuries (ARI) are uncommon in children in civil practice. In developed countries the injuries are mainly due to sexual abuse and firearms. This report reviews the experience in tropical Africa. A retrospective study of children aged 12 years or less managed for ARI over 10 years was undertaken. There were seven children, four girls and three boys. Four injuries were due to blunt trauma and three to penetrating trauma. Six patients presented within 6 h of injury and one after 24 h. Five had rectal bleeding, which was associated with vaginal bleeding in one girl. One girl each had vaginal bleeding and vaginal discharge without rectal bleeding. Diagnosis was by rectal examination and proctoscopy. In three patients a laparotomy was necessary to exclude an intraperitoneal rectal injury (IRI); this was positive in one case. One patient with abdominal findings had a laparotomy as the primary procedure. Overall, five patients had rectal injuries (extraperitoneal 3, intraperitoneal 2), which were associated with an anal injury in three while one patient had only an anal injury. An IRI was missed at initial assessment in one girl. Associated injuries were to the vaginal wall (3), urethra (1) and head (1). IRIs were treated by repair and proximal colostomy. Extraperitoneal injuries were treated by colostomy and drainage; in two patients the injuries were accessible and were repaired. Anal and external-sphincter injuries were repaired in two cases. Vaginal lacerations were repaired and other associated injuries treated accordingly. Three patients had wound infections. Faecal continence was maintained in all patients who had anal and external-sphincter injuries. One girl died of peritonitis from a missed IRI. It is concluded that ARI remains uncommon in children. Morbidity and mortality can, however, be high. Meticulous rectal palpation and visualisation is necessary to avoid missing injuries.

Accidental Falls↗
PubMed2005

Complications and recurrence after excision of rectal internal mucosal prolapse for obstructed defaecation.

BACKGROUND: Rectal internal mucosal prolapse (RIMP) may cause obstructed defaecation and encouraging short-term results have been reported after its transanal excision. The objective of this retrospective study was to assess both clinical and functional outcome after this procedure alone for patients presenting with evacuatory difficulty. PATIENTS AND METHODS: Forty patients (30 females, mean age 54 years), all suffering from obstructed defaecation, underwent RIMP excision at our unit during the last 11 years. RIMP was of first degree in three patients, of second degree in 21, and of third degree in 16 with 28/40 cases (70%) having associated anorectal pathology. The operation was carried out by hand suture (submucosal excision, Sarles endorectal excision, or the Delorme mucosectomy) in 26 patients, by circular stapled prolapsectomy in nine patients, or by combined manual and stapled techniques in five cases. Proctoscopy was carried out after 2 months for all patients, with anorectal manometry in 30 patients. Patients were independently assessed by state-trait anxiety scales for attendant anxiety and depression. RESULTS: Eighteen patients (45%) had significant postoperative complications with a surgical reintervention rate of 32.5%. Overall, 21 patients (52%) reported recurrent constipation and of these 14 (65%) had recurrent RIMP; six patients were treated successfully by rubber-band ligation alone. Two patients (5%) experienced new onset faecal incontinence. The recurrence rate of RIMP was unaffected by the type of operation, being 53% after manual techniques and 48% after combined procedures. There was no difference between postoperative manometric values in patients presenting with recurrent RIMP or constipation compared with those without RIMP or constipation on follow-up. Forty-eight percent of the patients with both recurrent constipation plus RIMP had manometric evidence of non-relaxing puborectalis syndrome compared with 26% with RIMP but without constipation (P<0.05). Ten of the 14 patients (71%) with anxiety and/or depression complained of recurrent constipation after surgery compared with nine of the 26 patients (24%) with normal psychological profiles (P<0.01). Patients with a preoperative rectocele were more likely to suffer from recurrent constipation than those without rectocele (eight out of 15, 53.3% vs. seven out of 25, 28%; P<0.05). CONCLUSIONS: Primary excision of RIMP does not seem an effective treatment for obstructed defecation with predictive factors for an adverse outcome in terms of recurrence (RIMP and constipation) including the presence of preoperative non-relaxing puborectalis syndrome and a demonstrated anxiety or depression psychological profile. The technique of prolapsectomy does not seem to affect outcome.

Adult↗
PubMed2007

Ultrasonographic patterns in patients with obstructed defaecation.

BACKGROUND: Anal ultrasound is helpful in assessing organic anorectal lesions, but its role in functional disease is still questionable. The purpose of the present study is to assess anal-vaginal-dynamic perineal ultrasonographic findings in patients with obstructed defecation (OD) and healthy controls. MATERIALS AND METHODS: Ninety-two consecutive patients (77 women; mean age 51 years; range 21-71) with symptoms of OD were retrospectively evaluated. All patients underwent digital exploration, endoanal and endovaginal ultrasound (US) with rotating probe. Forty-one patients underwent dynamic perineal US with linear probe. Anal manometry and defaecography were performed in 73 and 43 patients, respectively. Ultrasonographic findings of 92 patients with symptoms of OD were compared to 22 healthy controls. Anismus was defined on US when the difference in millimetres between the distance of the inner edge of the puborectalis muscle posteriorly and the probe at rest and on straining was less then 5 mm. Sensitivity and specificity were calculated by assuming defaecography as the gold standard for intussusception and rectocele and proctoscopy for rectal internal mucosal prolapse. Since no gold standard for the diagnosis of anismus was available in the literature, the agreement between anal US and all other diagnostic procedures was evaluated. RESULTS: The incidence of anismus resulted significantly higher (P < 0.05) in OD patients than healthy controls on anal (48 vs 22%), vaginal (44 vs 21%), and dynamic perineal US (53 vs 22%). A significantly higher incidence of rectal internal mucosal prolapse was observed in OD patients when compared to healthy controls on both anal (61.9 vs 13.6%, P < 0.0001) and dynamic perineal US (51.2 vs.9% P = 0.001). For the diagnosis of rectal internal mucosal prolapse, anal US had a 100% sensitivity and specificity. For diagnosis of rectal intussusception, anal US had an 83.3% sensitivity and 100% specificity and perineal US had a 66.6% sensitivity and 100% specificity. In the diagnosis of anismus, anal ultrasonography resulted in agreement with perineal and vaginal US, manometry, defaecography, and digital exam (P < 0.05). Other lesions detected by US in patients with OD include solitary rectal ulcer, rectocele and enterocele. Damage of internal and/or external sphincter was diagnosed at anal US in 19/92 (20%) patients, all continent and with normal manometric values. CONCLUSION: Anal, vaginal and dynamic perineal ultrasonography can diagnose or confirm many of the abnormalities seen in patients with OD. The value of the information obtained by this non-invasive test and its role in the diagnostic algorithm of OD is yet to be defined.

Adult↗
PubMed1997

The pattern of recurrent colorectal cancer in a prospective randomised study and the characteristics of diagnostic tests.

In a prospective randomised study, 597 patients subjected to curative surgery for colorectal cancer were allocated to either a group with frequent follow-up or a control group with follow-up every 5 years. The pattern of recurrence is reviewed. An equal number of recurrences was detected in the two groups, but the recurrence was diagnosed 9 months earlier in patients followed frequently, and the diagnostic characteristics of various tests dependent upon how often they were used. It is unlikely that frequent follow-up after curative surgery for colorectal cancer has a large positive influence upon survival, but a small benefit from an intensive follow-up program cannot be ruled out. The present results indicate that clinical examination, digital rectal examination, proctoscopy, colonoscopy and chest x-ray should be included in such a programme, whereas others (blood haemoglobin, faecal occult blood test, double contrast braium enema, serum alanine aminotransferase, and serum bilirubin) should be avoided, having a low sensitivity for detecting recurrent colorectal cancer.

Adult↗
PubMed2001

Assessment and classification of fistula-in-ano in patients with Crohn's disease by hydrogen peroxide enhanced transanal ultrasound.

Crohn's disease is well known for its perianal complications, among which fistulas-in-ano are the most common abnormalities. Fistulas-in-ano in Crohn's disease tend to be complex and have a high recurrence rate. Therefore the role of surgery is generally more conservative. Hydrogen peroxide enhanced transanal ultrasound has proven superior to physical examination, fistulography, computed tomography, and conventional ultrasound in demonstrating the fistula tract. This study examined the fistula tracks in patients with Crohn's disease. Forty-one patients with Crohn's disease and fistula-in-ano were investigated using physical examination, sondage of the fistula, proctoscopy and transanal ultrasound. Hydrogen peroxide was infused via a small catheter into the fistula. The main track and the ramification of the fistula were classified according to the anatomical Parks' classification. Only 9 (22%) patients had a single inter- or transsphincteric fistula. In 5 (12%) patients a single supra- or extrasphincteric fistula (high fistula) was found, in 14 (34%) more than one fistula track (ramified), and in 13 (32%) an anovaginal fistula. Thus 78% of patients had a surgically difficult to treat fistula. In the ramified fistula the main track follows the Parks' classification, but ramifications can have a bizarre pattern which is not in agreement with this classification. Optimal documentation by means of hydrogen peroxide enhanced transanal ultrasound is therefore mandatory before surgery or before other therapies such as anti-tumor necrosis factor treatment.

Adult↗
PubMed2006

Etiologic and causative factors in perianal dermatitis: results of a prospective study in 126 patients.

BACKGROUND: Perianal dermatitis is probably the most common cutaneous disorder of the genitoanal area. Studies on the epidemiology of causative factors are rare. METHODS: Over a 4-year period we prospectively studied 126 patients with a presumptive diagnosis of anal eczema. The diagnostic algorithm comprised medical history, inspection, microbiology, laboratory chemistry, patch tests, proctoscopy, and biopsy if appropriate. RESULTS: The age range was 7-82 years and the majority of patients were male (57.1%). Periods of anal symptomatology ranged from 6 days to 120 months and most of the patients (51.6%) had complaints for more than 12 months. The clinical diagnosis in 68 patients (54%) was: intertrigo/candidiasis (42.9%), atopic dermatitis (6.3%), pruritus ani (5.6%), psoriasis (3.2%), skin atrophy from steroid use (2.4%), lichen sclerosus et atrophicus (n = 2), herpes simplex (n = 1), and condylomata acuminata (n = 1). Contact eczema was suspected in 58 patients (46%), but 25 of these (43.1%) showed no contact sensitization. CONCLUSION: The majority of patients with symptoms of anal eczema suffer from intertrigo/candidiasis, and relevant, causative contact sensitization may be found in only some of them. Patch-testing is a valuable investigative tool only when the patients' own products are included in the test series. Most patients suffer from their perianal complaints for more than 12 months, therefore diligent evaluation is warranted.

Adolescent↗
PubMed1998

Rectal carcinoid tumor associated with the Peutz-Jeghers syndrome.

A 16-year-old man who had been diagnosed with the Peutz-Jeghers syndrome at the age of 8 years presented with crampy abdominal pain. Thorough examinations revealed a large jejunal polyp causing intussusception, as well as multiple polyps in the small and large intestines. Preoperative proctoscopy demonstrated the coexistence of a submucosal tumor in the rectum. Proctoscopic mucosal resection was performed and histological and immunohistochemical examinations led to a diagnosis of carcinoid tumor. Additional transanal resection of the rectal wall showed no residual tumor and the patient has been well for 2 years to date. Although malignant tumors are increasingly reported in association with the Peutz-Jeghers syndrome, to our knowledge, there have been no previous reports of such an association in the English-language and Japanese literature.

Adolescent↗
PubMed2003

The diagnostic value of endoscopic ultrasonography and magnetic resonance imaging for anorectal malignant melanoma: report of a case.

A 74-year-old Japanese woman presented with a 3-month history of anal bleeding. Proctoscopy revealed an unusual polypoid lesion with focal pigmentation at the dentate line, which was histologically diagnosed as a malignant melanoma. Whole-body clinical and radiographic evaluations revealed no alternative primary source. Endoscopic ultrasonography (EUS) showed well-delineated hypoechoic tumors invading the muscularis propria, and magnetic resonance imaging (MRI) revealed regional lymphadenopathy. Following this evaluation, an abdominoperineal resection with regional lymphadenectomy was performed. The excised tumor was histologically confirmed to be malignant melanoma, and its depth and metastatic lymph nodes proved to have been accurately and precisely evaluated by the preoperative examinations. Thus, EUS and MRI are useful preoperative diagnostic tools for the tumor staging of primary anorectal malignant melanomas, as for other rectal tumors.

Aged↗
PubMed2005

New devices for stapled rectal mucosectomy: a multicenter experience.

Stapled mucosectomy is widely performed, but in patients with deep gluteal cleft and small distance between the ischial tuberosities, it is difficult to insert the PPH dilator. We report the results achieved with a new device, the EEA 34-mm circular stapler (Auto-Suture, New Haven, USA). Eighty-five patients (45 men) were submitted to stapled mucosectomy for treatment of third- (n=70) or fourth-degree (n=10) hemorrhoids or mucosal prolapse (n=5) by surgeons at four different centers. The patients' mean age was 53.9 years (range, 45-70 years). ASA Kit (Advanced Surgical Anoscope, Tecplast Company, Fortaleza, Brazil) consists of four devices: a circular anal dilator (CAD) with anterior and posterior wings, an accessory device for insertion of CAD into the anal canal, a circular surgical anoscope (CSA) with proximal and distal openings for placing the rectal mucosal purse-string sutures, and a CSA insertion device. The middle part of the CSA is fully circular in order to avoid that the piles or the prolapsed mucosa fall into the anoscope. The mean excised mucosal band width was 4.7 cm. The mean operative time was 16 min (range, 12-25 min). Bleeding from the stapled suture was observed in 10 patients (11.7%). There were 5 postoperative complications (5.9%): 3 perianal hematomas and 2 stapled suture strictures. Anopexy was considered excellent by the surgeons in 50 patients (58.8%), good in 25 (29.4%) and poor in 10 (11.7%). At a mean follow-up of 12 months, proctoscopy demonstrated residual asymptomatic small internal prolapses in 15 patients (17.6%). Full pile prolapses recurred in 2 (2.3%) and required diathermy excision. ASA Kit made stapled mucosectomy easier to perform, but it's necessary to improve the circular staplers to adequately treat all sizes of mucosal and hemorrhoidal prolapses in order to reduce the recurrence rates.

Aged↗
PubMed2004

The direct closure of the internal fistula opening without advancement flap for transsphincteric fistulas-in-ano.

PURPOSE: The recommended closure techniques for transsphincteric fistulas demonstrate divergent results for postoperative continence and recurrence rates. An incontinence rate of 35 percent and a recurrence rate of up to 54 percent has been reported after transanal advancement techniques. The authors hypothesize that a direct closure of the internal fistula opening without tissue mobilization is easier to facilitate and generally leads to better clinical and functional results. METHODS: A prospective, observational study between 1995 and 1999 was undertaken in 90 patients with transsphincteric fistulas. A direct closure of the internal fistula opening without a flap was performed in all patients. A three-layer, nonstaggered closure of mucosa, submucosa, internal, and external anal sphincters was performed. The follow-up time periods ranged from one-half to six (median, 2.6) years and included assessment of fistula recurrence and continence using patients' histories, physical examinations, proctoscopy, and continence scores. Statistical analysis was performed using Student's t-test or chi-squared test. RESULTS: Data from 90 patients with a total of 106 operations were analyzed (65 males and 41 females; average age 46 (range, 22-78) years). Sixty-six patients had previous anorectal abscess surgery, and 41 had a previous fistula operation. The mean number of previous fistula operations was 1.7. All patients were continent before surgery. Mean elapsed operative time period was 37 +/- 11 minutes, and the mean anal retraction time was 20 +/- 7 minutes. Suture line dehiscence was the main postoperative complication. It was found to occur between the fourth and tenth postoperative days in 15 patients (14 percent). In 12 of 15 patients (80 percent), the fistula persisted and operative treatment was necessary. In three patients (20 percent), spontaneous closure took place. A recurrent fistula after wound healing was observed in seven patients (6.6 percent). The risk of developing a suture line dehiscence leading to a persistent fistula or a recurrent fistula was 22.5 percent. Ninety-four percent of the patients were continent (continence score 0), 6 percent had a minimal disorder of continence (score 4). A continence level for all patients was determined by the international classification of continence disorders. CONCLUSIONS: Direct closure for the treatment of transsphincteric fistulas is a safe and effective approach and achieves a good functional outcome; a small risk of suture line dehiscence, which may lead to a recurrent or persistent fistula, remains.

Adult↗
PubMed2005

Gonyautoxin: new treatment for healing acute and chronic anal fissures.

PURPOSE: The mayor symptoms of chronic anal fissure are permanent pain, intense pain during defecation that lasts for hours, blood in the stools, and sphincter cramps. It is subsequent to formation of fibrosis infiltrate that leads to an increased anal tone with poor healing tendency. This vicious circle leads to fissure recurrence and chronicity. This study was designed to show the efficacy of gonyautoxin infiltration in healing patients with anal fissures. METHODS: Gonyautoxin is a paralyzing phytotoxin produced by dinoflagellates. Fifty recruited patients received clinical examination, including proctoscopy and questionnaire to evaluate the symptoms. Anorectal manometries were performed before and after toxin injection. Doses of 100 units of gonyautoxin in a volume of 1 ml were infiltrated into both sides of the anal fissure in the internal anal sphincter. RESULTS: Total remission of acute and chronic anal fissures were achieved within 15 and 28 days respectively. Ninety-eight percent of the patients healed before 28 days with a mean time healing of 17.6 +/- 9 days. Only one relapsed during 14 months of follow-up. Neither fecal incontinence nor other side effects were observed. All patients showed immediate sphincter relaxation. The maximum anal resting pressures recorded after two minutes decreased to 56.2 +/- 12.5 percent of baseline. CONCLUSIONS: Gonyautoxin breaks the vicious circle of pain and spasm that leads to anal fissure. This study proposes gonyautoxin anal sphincter infiltration as safe and effective alternative therapeutic approach to conservative, surgical, and botulinum toxin therapies for anal fissures.

Acute Disease↗
PubMed1984

Antibody-dependent cell-mediated cytotoxicity in serum samples from patients with ulcerative colitis. Relationship to disease activity and response to total colectomy.

A group of six medically treated patients with ulcerative colitis were followed for up to 30 months along with eight additional patients who underwent proctocolectomy. Patients were examined frequently, and serum samples were collected for antibody-dependent cell-mediated cytotoxicity studies. Clinically active disease was substantiated by history, physical examination, laboratory investigations, proctoscopy and, when feasible, by rectal and/or colonic biopsy specimens. During active clinical disease, serum samples from patients with ulcerative colitis showed antibody-dependent cell-mediated cytotoxicity of 16.5 +/- 1.6 percent (range 8.2 to 25.8 percent). During remission of the disease, serum samples from the same patients demonstrated a mean antibody-dependent cell-mediated cytotoxicity value of 5.9 +/- 1.3 percent (range 0.4 to 11.1 percent) (p less than 0.01). In the eight patients who underwent proctocolectomy, mean preoperative antibody-dependent cell-mediated cytotoxicity value was 19.5 +/- 2.3 percent (range 4.1 to 38.6 percent). One month after proctocolectomy, antibody-dependent cell-mediated cytotoxic activity decreased by 72 +/- 11 percent of the preoperative value (p less than 0.001). These findings reveal a positive correlation between the antibody-dependent cell-mediated cytotoxicity with RPMI-4788 and clinical activity of ulcerative colitis, and support the hypothesis that the antibody being studied has direct relation to the presence of the ulcerative colitis colon in situ.

Adult↗
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↗
PubMed1993

Development of the Perceived Stress Questionnaire: a new tool for psychosomatic research.

A 30-question Perceived Stress Questionnaire (PSQ) was validated, in Italian and English, among 230 subjects. Test-retest reliability was 0.82 for the General (past year or two) PSQ, while monthly Recent (past month) PSQs varied by a mean factor of 1.9 over 6 months; coefficient alpha > 0.9. General and/or Recent PSQ scores were associated with trait anxiety (r = 0.75), Cohen's Perceived Stress Scale (r = 0.73), depression (r = 0.56), self-rated stress (r = 0.56), and stressful life events (p < 0.05). The General PSQ was higher in in-patients than in out-patients (p < 0.05); both forms were correlated with a somatic complaints scale in a non-patient population (r > 0.5), and were higher, among 27 asymptomatic ulcerative colitis patients, in the seven who had rectal inflammation than in those with normal proctoscopy (p = 0.03). Factor analysis yielded seven factors, of which those reflecting interpersonal conflict and tension were significantly associated with health outcomes. The Perceived Stress Questionnaire may be a valuable addition to the armamentarium of psychosomatic researchers.

Adaptation, Psychological↗
PubMed1991

Treatment of severe electrical burns of the genitalia and perineum by early excision and grafting.

A patient with severe electrical burns to his perineum and genitalia is presented. Evaluation of such patients necessarily includes local wound exploration, cystourethroscopy and proctoscopy. The principles of early serial debridement and wound closure were applied to all tissues including testis and penis. Removal of non-viable tissue and wound closure was accomplished by postburn day 10 without sacrifice of viable tissue and without wound sepsis. The benefits of early debridement and wound closure are reduction of infection, earlier onset of physiotherapy, quicker recovery of function, and shortened hospital stay.

Accidents, Occupational↗
PubMed2006

Hispanic acculturation and utilization of colorectal cancer screening in the United States.

BACKGROUND: Despite the evidence on the effectiveness of colorectal cancer (CRC) screening procedures, its use remains low, especially among Hispanics. Social-cultural factors may play a role in the underutilization of cancer screening. This study aimed to examine whether low acculturation was a risk factor for the underutilization of colorectal cancer screening in the Hispanic population. METHODS: The subjects were adults aged 50-80 years who identified themselves as Hispanic and never were diagnosed with colorectal cancer. Colorectal cancer screening utilization was assessed based on the use of at-home Fecal Occult Blood Test (FOBT) and the use of endoscopies (sigmoidoscopy, colonoscopy, or proctoscopy). Respondents who underwent a test for diagnostic purposes were excluded from the study. RESULTS: Our data showed that colorectal screening was underused in Hispanics compared to non-Hispanic Whites. There was a trend that acculturation level was inversely correlated with having an endoscopy in the past 5 years. This trend was also seen with having a FOBT in the past year or an endoscopy in the past 5 years. However, the association disappeared after adjusting for factors pertaining to utilizing other health care services. Additionally, after stratifying by gender, the association between the two variables was diluted. CONCLUSIONS: The findings show that low acculturation was associated with the underutilization of endoscopic colorectal cancer screening. This association may be related to lower utilization of health care services and/or language barriers that may contribute to the lower utilization.

Acculturation↗
PubMed2004

Severe acute colitis associated with CMV: a prevalence study.

BACKGROUND: Cytomegalovirus has been identified as a pathogen that contributes to flares of colitis when detected in colonic specimens of patients with inflammatory bowel disease. AIM: To determine the overall prevalence and the role of cytomegalovirus infection in a consecutive series of patients with acute severe colitis admitted to our department from 2000 to 2003. METHODS: Among 42 patients (38 with ulcerative colitis and 4 with Crohn's disease) admitted to our hospital for acute severe colitis, we performed proctoscopy and biopsy together with blood sample for cytomegalovirus determination at the time of admission, regardless of their steroid resistance. RESULTS: In the 42 patients, we discovered an overall cytomegalovirus infection prevalence of 21.4% (9/42) in our geographical area. In seven patients (16.6%), cytomegalovirus was detected through biopsy. The presence of cytomegalovirus in biopsies was not always predictive of steroid resistance. Three patients with cytomegalovirus in biopsies responded to conventional treatment without needing any antiviral treatment, which suggests that the virus plays only an incidental role. CONCLUSIONS: Cytomegalovirus is frequently associated with colitis but it is not always pathogenic. Studies on the genotyping of the virus might explain the diversity of its biological behaviour.

Adult↗