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  • 1
    Electronic Resource
    Electronic Resource
    Clinical conundrum of solitary rectal ulcer (1992)
    Springer
    Diseases of the colon & rectum 35 (1992), S. 227-234 
    Details
    ISSN: 1530-0358
    Keywords: Rectal ulcer ; Solitary ; Prolapse ; Rectum ; Rectopexy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract A retrospective study of 80 patients with biopsy-proven solitary rectal ulcer (SRU) was conducted to review its clinical spectrum. The median follow-up was 25 months. The female-to-male ratio was 1.4∶1.0, and the mean age was 48.7 years (range, 14–76 years). Principal symptoms were bowel disturbances (74 percent) and rectal bleeding (56 percent). Twenty-one patients (26 percent) were asymptomatic and required no treatment. A previous “wrong” diagnosis was made in 25 percent. Rectal prolapse was identified in 28 percent (full-thickness, 15 percent; mucosal, 13 percent). The macroscopic appearance of the lesion seen in SRU varied widely and included polypoid lesions in 44 percent (the predominant finding in the asymptomatic group), ulcerated lesions in 29 percent (always symptomatic), and edematous, nonulcerated, hyperemic mucosa in 27 percent. Anorectal manometry provided little helpful information in the patients in whom it was performed. Management by bulk laxatives and bowel retraining led to symptomatic improvement in 19 percent of cases. In 29 percent of cases, symptoms persisted despite endoscopic healing of the lesion. Intractability of symptoms led to surgery in only 27 (34 percent) patients. Depending on the presence or absence of rectal prolapse, rectopexy or a conservative local procedure (such as local excision), respectively, appeared to be the optimal surgical treatment. The polypoid variety tended to respond to therapy more favorably than non-polypoid varieties. Thus, the macroscopic appearance of SRU has a significant bearing on the clinical course, and most cases do not require surgery.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02051012
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  • 2
    Electronic Resource
    Electronic Resource
    Endoluminal ultrasound defines anatomy of the anal canal and pelvic floor (1992)
    Springer
    Diseases of the colon & rectum 35 (1992), S. 465-470 
    Details
    ISSN: 1530-0358
    Keywords: Ultrasound ; Imaging ; Anus ; Anal sphincters
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The aims of this study were to determine whether endoluminal ultrasound (ELUS) could identify various layers of the normal anal canal and to evaluate whether a 10-MHz probe provided better image resolution than a 7-MHz probe. Sonographic anatomy of the anal canal on ELUS was directly correlated with anatomic dissection of various layers (mucosa-submucosa, internal anal sphincter, and external anal sphincter) in cadavers. Sonographic appearance of the anal sphincters was further evaluated in patients by “tagging” various layers using sonodense needles. A higher frequency 10-MHz ultrasound probe (focal length, 1–4 cm) provides improved sonographic images of the anal canal, compared with the 7-MHz probe (focal length, 2–5 cm). ELUS can also successfully identify various structures of the pelvic floor including the puborectalis, urethral sphincter, vagina, and outlines of the pelvis and ischiorectal fossae. Its role in the evaluation of anorectal disorders appears promising.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02049404
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  • 3
    Electronic Resource
    Electronic Resource
    Clinical and pathologic factors associated with delayed diagnosis in solitary rectal ulcer syndrome (1993)
    Springer
    Diseases of the colon & rectum 36 (1993), S. 146-153 
    Details
    ISSN: 1530-0358
    Keywords: Solitary rectal ulcer ; Rectal prolapse ; Clinicopathologic study ; Rectal polyp
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Solitary rectal ulcer syndrome (SRUS) often goes unrecognized or is misdiagnosed. Of 98 patients with a final clinicopathologic diagnosis of SRUS, an initially incorrect diagnosis had been made in 25 patients (26 percent). In these 25 patients with a misdiagnosis, the median age was 43 years and the female-to-male ratio was 3.2∶1. The median duration of incorrect diagnosis was five years (range, three months to 30 years), and seven patients received prednisone (〉30 mg/day) for a mistaken diagnosis of inflammatory bowel disease. The main clinical symptoms were rectal bleeding (84 percent) and a disturbance of bowel function (56 percent). Rectal prolapse was present in 13 patients. Original rectal biopsy specimens from 23 patients were reviewed; inadequate specimens and failure to recognize diagnostic features of SRUS contributed to delayed diagnosis in 13 and 10 patients, respectively. The most common clinicopathologic mis-diagnoses in SRUS patients with rectal ulcers or mucosal hyperemia were Crohn's disease and mucosal ulcerative colitis. In patients with “polypoid” SRUS, diagnostic confusion was usually with a neoplastic polyp. Persistent bowel symptoms and rectal lesions led to review of the presentations and repeat biopsy directed toward the edge of the rectal ulcers or from within the polypoid or hyperemic rectal lesions, finally establishing the diagnosis of SRUS. Intractable symptoms led to surgery in 15 patients (60 percent), with symptomatic improvement in over two-thirds.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02051170
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  • 4
    Electronic Resource
    Electronic Resource
    Endoluminal ultrasound is preferable to electromyography in mapping anal sphincteric defects (1993)
    Springer
    Diseases of the colon & rectum 36 (1993), S. 689-692 
    Details
    ISSN: 1530-0358
    Keywords: Ultrasound ; Imaging ; Electromyography ; Anus ; Anal sphincters
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Assessment of complex sphincteric defects in patients with fecal incontinence by digital rectal examination and intraoperative dissection can be difficult in the presence of excessive scarring. Adjunctive investigation such as endoluminal ultrasound (ELUS) and needle electromyography (EMG) may provide objective evidence of the nature and extent of the sphincteric defects. In a series of 11 patients, ELUS of the anal canal with a 10-MHz transducer (focal zone of 1–4 cm) accurately detected defects in the external anal sphincter (EAS) in seven of seven patients, defects in the internal anal sphincter (IAS) in eight of eight patients, and integrity of both sphincters in two patients. These findings were confirmed by needle EMG of the EAS alone in five patients, by operative findings at a perineal sphincteroplasty operation in six patients, and by both in two patients. ELUS was associated with less pain than was needle EMG (pain score 4vs. 10, 10 being most painful) and provided high-resolution radial images of both the EAS and the IAS. Thus, ELUS seems preferable to EMG in mapping anal sphincteric defects and can be a useful anatomic adjunct to physiologic studies of anorectal function in patients with fecal incontinence.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02238597
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  • 5
    Electronic Resource
    Electronic Resource
    Parastomal pyoderma gangrenosum in inflammatory bowel disease (1994)
    Springer
    Diseases of the colon & rectum 37 (1994), S. 938-942 
    Details
    ISSN: 1530-0358
    Keywords: Pyoderma gangrenosum ; Crohn's disease ; Ulcerative colitis ; Extraintestinal manifestations
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract PURPOSE: Parastomal pyoderma gangrenosum is uncommon and its association with inflammatory bowel disease is unclear. This is a review of five patients with parastomal pyoderma gangrenosum. METHODS: A retrospective review of five patients with ulcerative colitis (two patients) or Crohn's disease (three patients) who have been seen in one surgical unit was conducted. RESULTS: All patients were females and each presented within nine months of abdominal surgery and stoma construction. All had active proctitis (n=3) or perianal Crohn's disease (n=2). Both patients with perianal Crohn's disease had a mild clinical course with healing of parastomal pyoderma gangrenosum when treated with steroids with and without low-dose cyclosporin A. They both had curettage of the perineal wound as well. In the remaining three patients with active proctitis, the parastomal lesions failed to resolve despite high-dose systemic steroids. By contrast, the parastomal pyoderma gangrenosum healed promptly in two of these patients following proctectomy for active proctitis. CONCLUSION: The variable clinical outcome of parastomal pyoderma gangrenosum may be related to the activity of the underlying inflammatory bowel disease or possibly to low-grade perineal sepsis.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02052602
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  • 6
    Electronic Resource
    Electronic Resource
    Cecal intubation model in the rat that facilitates selectivein vivo study of colonic epithelial biology (1998)
    Springer
    Diseases of the colon & rectum 41 (1998), S. 1500-1505 
    Details
    ISSN: 1530-0358
    Keywords: Animal model ; Colonic intubation ; Animal surgery ; Colonic epithelial proliferation ; Sodiumn-butyrate
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract PURPOSE: A free-living animal model with ready and repetitive access to selected regions of the large bowel and with minimally altered bowel anatomy and physiology would facilitate thein vivo study of luminal factors on the colonic mucosa in a steady-state environment. This study describes a novel model of large-bowel intubation in the rat. METHOD: Four Sprague-Dawley rats (240–260 g) had laparotomy and intubation of the distal colon and the cecumvia a cecotomy with the use of two small tubes with restraints and transmural anchors. The tubes were tunneled and anchored to the back for infusion of fluid directly into the colon. Tube positions were studied when the animals were killed. Animals were fed on either a 10 percent fiber diet or a fiber-free diet. Stathmokinetic assessment of the distal colon was performed after one week of infusion with phosphate-buffered saline and sodiumn-butyrate. RESULTS: The technique produced an easy access without affecting the weight gain of the animals after recovery. Tube positions were accurate after three weeks at the time the animals were killed. Infusions of phosphate-buffered saline andn-butyrate were well tolerated.n-Butyrate infusions twice daily for a week reversed the atrophy in the colonic mucosa induced by dietary fiber deprivation. CONCLUSION: Anin vivo large-bowel intubation model permitting selective delivery of luminal factors provides an effective option for the study of colonic mucosal biology.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02237296
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  • 7
    Electronic Resource
    Electronic Resource
    Morbidities of adjuvant chemotherapy and radiotherapy for resectable rectal cancer (1999)
    Springer
    Diseases of the colon & rectum 42 (1999), S. 403-418 
    Details
    ISSN: 1530-0358
    Keywords: Rectal cancer ; Adjuvant therapy ; Radiotherapy ; Chemotherapy ; Pelvic floor function ; Quality of life
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract PURPOSE: Although adjuvant chemoradiotherapy may improve outcomes after surgery for high-risk rectal cancer, its toxicities are not well documented. This is a review of complications associated with adjuvant therapy in randomized, controlled trials. METHODS: A MEDLINE and literature search was performed for randomized, controlled trials of adjuvant therapy for rectal cancer. Modalities of adjuvant therapy evaluated included preoperative radiotherapy, preoperative chemoradiotherapy, postoperative radiotherapy, and postoperative chemoradiotherapy. All documented complications were analyzed, including any effect on pelvic floor function and quality of life. RESULTS: Short-term (acute) complications of preoperative radiotherapy include lethargy, nausea, diarrhea, and skin erythema or desquamation. These acute effects develop to some degree in most patients during treatment but are usually self-limiting. With preoperative radiotherapy the incidence of perineal wound infection increases from 10 to 20 percent. The acute toxicities after postoperative radiotherapy for rectal cancer occur in 4 to 48 percent of cases, and serious toxicities, requiring hospitalization or surgical intervention, occur in 3 to 10 percent of cases. Postoperative radiotherapy is associated with more complications than preoperative radiotherapy. The main problems with postoperative radiotherapy are small-bowel obstruction (5–10 percent), delay in starting radiotherapy caused by delayed wound healing (6 percent) and postoperative fatigue (14 percent), and toxicities precluding completion of adjuvant therapy (49–97 percent). The morbidity and mortality of both preoperative and postoperative radiotherapy are higher in elderly patients and when two-portal rather than three-portal or four-portal radiation technique is used. Meticulous radiation technique is important, and multiple fields of irradiation are mandatory. After combined adjuvant chemotherapy and radiotherapy acute hematologic and gastrointestinal toxic effects are frequent (5–50 percent). Delayed radiation toxicities include radiation enteritis (4 percent), small-bowel obstruction (5 percent), and rectal stricture (5 percent). Pelvic floor function and quality of life have not been well evaluated in randomized, controlled trials. CONCLUSION: Adjuvant therapy for rectal cancer has considerable adverse effects. Adverse effects on bowel and sphincter function and quality of life have not been defined.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02236362
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  • 8
    Electronic Resource
    Electronic Resource
    Long-term follow-up of strictureplasty in Crohn's disease (1993)
    Springer
    Diseases of the colon & rectum 36 (1993), S. 355-361 
    Details
    ISSN: 1530-0358
    Keywords: Strictureplasty ; Resection ; Crohn's disease ; Strictures ; Ileitis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Because Crohn's disease of the small bowel is often diffuse, strictureplasty has been advocated as an alternative or adjunct to resection(s) of strictured segments. We reviewed 116 patients with obstructive Crohn's disease undergoing 452 primary strictureplasties (Heineke-Mikulicz, 405; Finney, 47). The median age was 34 years (range, 13–72 years); the male-to-female ratio 1.4∶1; and the median follow-up was three years (range, six months to seven years). Seventy-six patients (66 percent) had at least one previous small bowel resection. Perforative disease was present in 18 patients (15 percent), and synchronous resections were performed in 71 patients (61 percent). The median number of strictureplasties was three (range, 1–15). There was no mortality. Septic complications (intra-abdominal abscess/fistula) occurred in seven patients (6 percent), and reoperation for sepsis was needed in two patients. Relief of obstructive symptoms was achieved in 99 percent of the patients. After surgery, the median weight gain was 4 kg, and two-thirds of the patients were weaned off steroids. Symptomatic recurrence occurred in 28 patients (24 percent), and 17 patients (15 percent) needed reoperation. Rates of restricture and new stricture/perforative disease were 2.8 percent and 24 percent, respectively.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02053938
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  • 9
    Electronic Resource
    Electronic Resource
    Fecal seepage in males with paradoxically high resting anal tone may be associated with anismus (1999)
    Springer
    Diseases of the colon & rectum 42 (1999), S. 824-825 
    Details
    ISSN: 1530-0358
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02236946
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  • 10
    Electronic Resource
    Electronic Resource
    Anorectal physiologic testing for bowel dysfunction in patients with spinal cord lesions (2000)
    Springer
    Diseases of the colon & rectum 43 (2000), S. 927-931 
    Details
    ISSN: 1530-0358
    Keywords: Anorectal physiologic testing ; Spinal cord lesions ; Bowel dysfunction ; Fecal incontinence ; Constipation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract PURPOSE: Bowel dysfunction is common in patients with spinal cord lesions. This study aims to determine whether there are any discriminatory findings at anorectal physiologic testing in patients with spinal cord lesions. METHODS: Twelve consecutive patients (6 females) with significant spinal cord lesions who had mixed symptoms of constipation, fecal impaction, and fecal incontinence were evaluated by perfusion manometry and pudendal nerve terminal motor latency. None of the patients had a sphincter defect as evaluated by endoanal ultrasonography. RESULTS: The median age was 54 (range, 40–87) years. Eight (67 percent) of them had had traumatic spinal cord injuries. Other spinal cord lesions included spina bifida, syringomyelia, arachnoid cyst, and spinal cord ischemia after abdominal aortic aneurysm repair. In patients with spinal cord lesions, the mean (range) resting anal canal pressure and maximum squeeze anal canal pressure were 46 (10–100) mmHg and 76 (30–120) mmHg respectively compared with 62 (50–70) mmHg, and 138 (100–180) mmHg, respectively, in healthy controls. Eleven (92 percent) patients had prolonged pudendal nerve terminal motor latency (9 bilateral and 2 unilateral) whereas rectoanal inhibitory reflex was abolished in all 9 patients tested. CONCLUSIONS: Spinal patients with severe bowel symptoms tended to have lower anal canal pressures than healthy controls. Pudendal neuropathy and impaired rectoanal inhibitory reflex are common and may be important in the pathogenesis of bowel dysfunction in patients with spinal cord lesions.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02237352
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