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At least 19 recordsLinked to original sources

Overall use of proctoscopy in general practice and possible relation to the stage of rectal cancer.

Data from the Danish National Health Service records on activities of each of 146 general practices in the county of North Jutland, Denmark, were studied to determine whether the use of proctoscopy influenced the stage at which cancer of the rectum was recognized. Information for all patients in the county who received the diagnosis of cancer of the rectum was obtained from the Danish Cancer Registry. Proctoscopy was performed significantly more often in partnership practices (96%) than in single practices (81%). The frequency with which the test was used varied from 1 to 107 proctoscopies per general practitioner per year. In the 95 patients with cancer of the rectum, no relationship was found between the stage (Dukes') at the time of diagnosis and work-load, size and activity of practice, or use of proctoscopy.

Denmark

[Retropneumoperitoneum and pneumomediastinum following proctoscopy (author's transl)].

A 66-year-old patient developed a retropneumoperitoneum and pneumomediastinum after a proctoscopy. Following the examination, which was done as an out patient, he had some pain but was able to reach home without difficulty. Radiography of the abdomen on the next day showed definite gas collection round the right kidney and below the middle of the diaphragm. The mediastinum showed some translucencies consistent with cranial spread of air from the retropneumoperitoneum; it was particularly marked round the aorta. The film also showed supraclavicular emphysema. After being placed supine the patient's symptoms rapidly disappeared. There were no complications and no treatment was necessary. The case is discussed in relation to the relevant literature.

Aged

An evaluation of procedures used in staging carcinoma of the cervix.

A review of 227 cases of invasive carcinoma of the cervix was undertaken to determine the efficacy of procedures using in the staging of this disease. All patients had a pretreatment chest radiography and intravenous pyelogram. 96.5% had pretreatment cystoscopy, 98.6% had pretreatment proctoscopy, and 92% had a pretreatment barium enema. These patients were retrospectively staged on the findings of physical examination only. Each additional procedure was then evaluated by comparison with the initial staging. Cystoscopy and chest film findings each would have changed the clinical stage in fewer than 1% of cases, barium enema in 1.4%, and proctoscopy in 2.2%. No patient had a positive barium enema without a positive proctoscopy, while two patients had positive proctoscopies with negative barium enemas. The overall yield of positive findings by pretreatment intravenous pyelography was 7.3%. Lymphangiography, although inconsistently done, yielded positive findings in all stages. Chest radiographs, intravenous pyelography, proctoscopy, and lymphangiography are recommended as part of the pretreatment workup of patients with carcinoma of the cervix. Routine barium enema is no longer recommended, and cystoscopy is only recommended in patients with clinical stage IIB disease or greater.

Barium Sulfate

A controlled trial of azathioprine in the management of chronic ulcerative colitis.

To determine the efficacy of azathioprine in the treatment of ulcerative colitis, a 6-month double blind trial was carried out. Thirty patients with chronic ulcerative colitis who required the equivalent of at least 10 mg of prednisone per day over the 3 months prior to entering the study were randomized into placebo and azathioprine (1.5 mg per kg) treatment groups. Reduction of steriods was a major objective of the trial. Age and sex distribution, number of bowel movements, sense of well being, steroid dosage, and findings on proctoscopy, rectal biopsy, and colon X-ray initially were similar in the two groups. No side effects were associated with azathioprine. Although steroid dose was lower (p less than 0.05) in the azathioprine group at the termination of the study, no difference between the two groups could be detected in the number of bowel movements, sense of well being, and findings on proctoscopy during the first 3 weeks compared with the last 3 and during the first 3 months compared with the last 3. Although azathioprine does not confer dramatic benefit upon patients with chronic ulcerative colitis who require steroids, it does permit reduction of steroid dosage without apparent worsening of the disease. Its major value in ulcerative colitis may be in facilitating significant decreases or complete discontinuance of steroids.

Adolescent

The spectrum of colitis associated with lincomycin and clindamycin therapy.

Ten cases of protracted diarrheal illness after the oral administration of lincomycin or clindamycin in standard dosages were observed in previously healthy subjects. An abrupt onset of diarrhea, crampy abdominal pain, fever, and leukocytosis was observed one to 12 days after discontinuation of the drug. Proctoscopic examination revealed erythematous friable mucosa covered with small raised, yellowish-white plaques that were sometimes confluent. Barium contrast studies of the colon demonstrated irregular shaggy mucosa, ulcerations, cobblestone appearance, and thumb printing. Rectal bipsy showed acute inflammation with pseudomembranes with focal or superficial ulcerations. All patients had a protracted course but recovered with supportive management. Follow-up barium enemas and proctoscopy were done on all patients and were normal. A history of diarrhea, fever, and mucosal changes seen on proctoscopy in a patient who has recently received one of these antibiotics should raise the possibility of colitis associated with clindamycin and lincomycin therapy.

Adult

Anal dilatation and haemorrhoidectomy. A prospective study.

The results of haemorrhoidectomy alone and anal dilatation alone for the treatment of 20 patients with second or third degree haemorrhoids were assessed prospectively over a 12-month period. After haemorrhoidectomy the symptoms of bleeding, lump, pruritus and discharge disappeared, and anal continence was maintained. Proctoscopy showed the occasional development of secondary piles high in the anal canal. Of those patients having an anal dilation alone, nearly half had symptoms and one had a mucus leak. Anal continence was unalttered in the remainder. Proctoscopy indicated the loss of anal venous engorgement.

Adult

Anal pressures in hemorrhoids and anal fissure.

Maximal anal pressures have been measured after proctoscopy in 145 patients with hemorrhoids, 48 patients with anal fissure, and 78 asymptomatic control subjects. Anal pressures in patients with hemorrhoids (106 +/- 40 cm H2O) and anal fissure (130 +/- 43 cm H2O) were very significantly higher than those of controls (88 +/- 34 cm H2O) (P less than 0.001). Because patients with anal fissure have high anal pressures, these patients should benefit from manual dilatation of the anus or lateral subcutaneous sphincterotomy; however, only young male patients with hemorrhoids have anal pressures that are significantly higher than age- and sex-matched controls. Digital assessment and the two finger test are unreliable indicators of high anal pressure. These results indicate that measurement of anal pressure is useful in assessing the suitability of manual dilatation or sphincterotomy in the treatment of hemorrhoids.

Adolescent

Surgical treatment of colovesical fistula: the value of a one-stage procedure.

The records of all patients (43) with colovesical fistulas at Ochsner Clinic were reviewed retrospectively. The presenting symptoms are more often related to the bladder and not to the colon; fecaluria and pneumaturia are almost pathognomonic. The diagnosis may be difficult to obtain on proctoscopy, cystography, or intravenous pyelograms. Roentgenograms after barium enema and cystoscopy are the best means of diagnosis, though operation is necessary in some instances for definitive diagnosis. Primary resection and anastomosis with closure of the bladder has been successful in our experience with little morbidity and only one postoperative death. The controversy regarding primary colon resection in treatment of colovesical fistulas is perplexing. We do not believe that it is "foolhardy" to save the patient extra time, morbidity, and expense by doing one instead of three procedures. Primary resection of the colon with simple closure of the bladder is our recommended treatment for chronic colovesical fistula. We have had no recurrences.

Adult

Anal dilatation, lateral subcutaneous sphincterotomy and haemorrhoidectomy for the treatment of second and third degree haemorrhoids. A prospective randomized study.

Patients with second or third degree haemorrhoids were randomized for treatment by anal dilatation, lateral subcutaneous sphincterotomy or haemorrhoidectomy. The patients were studied by means of proctoscopy, anal manometry and symptom grading preoperatively, two months and one year after the procedure. After one year, more than half of the patients were symptomless in each treatment group. Both anal dilatation and sphincterotomy gave poor results in 25% of the patients, compared with 9% after haemorrhoidectomy. Young age was related to good results in anal dilatation or sphincterotomy, but not in haemorrhoidectomy. Results of anal dilatation and sphincterotomy in treating haemorrhoids are unpredictable, so they cannot be recommended as routine procedures. Maximal basal pressure was reduced after all three procedures, but neither the preoperative nor postoperative anal pressures were able to predict the result of the different treatment techniques.

Adult

Human rectal mucosa: proctoscopic and morphological changes caused by laxatives.

To determine whether laxatives alter the proctoscopic and morphological appearances of the human rectum, 10 normal subjects were studied prospectively, and the following manipulations were assessed in a randomized, blinded manner: no treatment; oral mannitol to induce diarrhea; isotonic saline enema; Fleet's Phospho-Soda enema; and bisacodyl (Dulcolax), 10 mg, by enema or suppository. The rectal mucosa after mannitol-induced diarrhea, or after saline enema could not be distinguished from untreated rectum by proctoscopy, light microscopy, or scanning electron microscopy. Fleet's enema, and bisacodyl invariably changed proctoscopic appearances, and frequently altered light and scanning microscopic aspects. Both Fleet's enema and bisacodyl caused sloughing of surface epithelium. In addition, bisacodyl decreased the uptake of hematoxylin and eosin by crypt epithelial cells so that the affected cells had a partially erased appearance (16 of 25 biopsies examined by light microscopy). The lamina propria of 3 of these 25 biopsies contained polymorphonuclear cells. Transmission electron microscopy revealed that the abnormal crypt epithelial cells contained fewer cytoplasmic organelles and less nuclear chromatin. All lesions resolved within 7 days. Fleet's enema and bisacodyl by rectum may mislead the proctologist and the pathologist by altering normal rectal mucosa.

Bisacodyl

Evaluation of conventional diagnostic tests for detection of recurrent carcinoma of the cervix.

The use of routine diagnostic tests to evaluate patients periodically after treatment for carcinoma of the cervix has been reviewed. Of 169 patients treated at Brooke Army Medical Center for carcinoma of the cervix, 73 were evaluated after their treatment by a group of six diagnostic tests referred to collectively as an oncologic survey. The survey consisted of an intravenous pyelogram (IVP), chest roentgenogram, barium enema, cystoscopy, proctoscopy, and bone scan. Although 16 patients developed recurrent tumor, the oncologic survey detected only three recurrences that had not already been suspected by physical examination. Only the IVP and chest roentgenogram were of sufficient benefit to suggest their routine use for the detection of recurrent cancer. The other tests included in the oncologic survey were not beneficial when used routinely and should be reserved to evaluate patients otherwise suspected of recurrent cancer.

Barium Sulfate

Clinical spectrum of pseudomembranous colitis.

Five cases of pseudomembranous colitis (PMC) provided the opportunity for observation of clinical, endoscopic, and histologic features, and evaluation of potential modes of therapy. Although PMC may occur postoperatively or concomitantly with staphylococcal infection, if most frequently occurs following the administration of a variety of antibiotics. Patients with this disorder often have chronic, debilitating diseases. The clinical course may vary from a self-limited diarrheal illness to a fatal process. Onset with abdominal pain, diarrhea, and fever is characteristic. Barium enema contrast findings are nonspecific. Proctoscopy usually permits an accurate diagnosis. In the typical case, multiple elevated nodules formed by cream-colored plaques of pseudomembrane are scattered about the inflamed mucosa. Biopsy of these nodular lesions will confirm the diagnosis. Therapy must be individualized.

Adult

Familial colon cancer.

Study was made of a kindred with a strong history of carcinoma of the colon. Twenty-three family members were screened for the tumor with carcinoembryonic antigen (CEA) assay, barium enema, and proctoscopy; one occult colon cancer was diagnosed. Identification and surveillance of families at high colon cancer was diagnosed. Identification and surveillance of families at high risk of cancer can provide unusual opportunities for early tumor detection.

Adenocarcinoma

Histiocytic ulcerative colitis in a Boxer dog.

A 2-year-old male Boxer dog had passed loose faeces mixed with fresh blood and mucus for 8 months. Tenesmus after defaecation was a feature. Colitis was diagnosed from the proctoscopic appearance of the recto-colonic mucosa and confirmed from a biopsy. The disorder proved unresponsive to sulphasalazine therapy, but oral chloramphenicol, betamethasone and prednisolone enemas administered over a 6-week period produced a satisfactory clinical improvement, which persisted for a further 3 weeks without treatment. However, follow-up proctoscopy showed only a marginal improvement in the appearance of the mucosa and appeared to exacerbate further bloody diarrhoea, which persisted. The dog was destroyed and histiocytic ulcerative colitis confirmed at autopsy.

Animals

Chronic immune colitis in rabbits.

A chronic colitis has been induced in rabbits having many of the histological features of human ulcerative colitis. Animals were first immunised with the common enterobacterial antigen of Kunin and haemagglutinating antibodies demonstrated in high titre. An immune complex colitis was then established by the injection of soluble immune complexes following mild irritation of the rectum with dilute formalin as previously described. The rabbits developed an acute colitis within the first week but, in contrast with unsensitised rabbits, the inflammation persisted and was still present at six months as assessed by proctoscopy and rectal biopsy. Kunin-sensitised rabbits receiving intravenous saline, antigen, or antibody alone did not develop a chronic colitis. It is suggested that hypersensitivity to colonic bacterial antigens may be one mechanism whereby an acute colitis becomes chronic.

Animals

Comparison of anal and rectal swabs in the diagnosis of anorectal gonorrhoea in women.

Among 228 women with gonorrhoea (confirmed by culture), swabs taken blindly from the anal canal gave positive results in 26.3% and those taken from the rectum under direct vision in 27.6%. Swabs from both sites gave positive results in 23.2% of patients, from the anal canal alone in 3.1%, and from the rectum alone in 4.4%. Thus, culuture of anal canal swabs seems to give as reliable results as rectal swabs when proctoscopy cannot be carried out.

Anal Canal

Incidental finding of rectal carcinoma during transrectal US for prostatic diseases.

During transrectal ultrasound (TRUS), rectal carcinoma was an incidental finding in seven patients among a series of 5,000 TRUS examinations. TRUS was performed in seven patients with symptoms characteristic of prostatic diseases. All seven patients underwent examination by at least one physician before TRUS and, except for abnormal prostatic findings, no tumors were detected during digital rectal examination (DRE). The tumors were clearly visualized with TRUS and were easily palpated during DREs performed after TRUS. They were large and were located mainly along the posterior and lateral walls of the rectum. All the tumors were diagnosed by means of proctoscopy; the biopsy findings were positive, and the pathologic staging indicated advanced disease: adenocarcinoma of the rectum with a minimum grade of Dukes C. It is recommended that, in addition to evaluation of scans obtained in the transverse plane, the multiplane transducer be used to evaluate the longitudinal plane of the rectum for detection of possible undiscovered tumors.

Adenocarcinoma