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  • 11
    Electronic Resource
    Electronic Resource
    Our approach to the management of congenital presacral tumors in adults (1993)
    Springer
    International journal of colorectal disease 8 (1993), S. 134-138 
    Details
    ISSN: 1432-1262
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract This study reviews the recent overall experience in one colorectal surgery department with congenital presacral tumors in adults. 24 patients greater than 21 years of age, who underwent curative resection between January 1980 and August 1992, were analyzed retrospectively. The growths were divided into two broad categories: developmental cysts and chordomas. The most common presenting symptom was pain (19/24). A preoperative evaluation regimen is outlined in the study and includes use of CT scanning, MRI imaging, and possibly the use of endoluminal ultrasound to document the relationship of presacral tumors to pelvic viscera. There were 20 developmental cysts and 4 chordomas treated in this series. 15 of 19 developmental cysts were excised by a posterior approach alone, 2 were excised by an anterior approach alone, and 3 were treated by a combined approach. Trans-sacral excision was carried out in 4 patients with developmental cysts. One chordoma was resected posteriorly and the other 3 through a combined anterior and posterior approach. Three recurrences were diagnosed after excision of developmental cysts at 8, 18, and 41 months postoperatively. Recurrence occurred in 3 of 4 chordoma patients after 25, 32, and 55 months. Reexcision was carried out in all patients. None of the developmental cyst cases developed a second recurrence but 2 of the 3 chordoma patients have recurred, but have undergone local irradiation, which has controlled their disease. A detailed surgical treatment plan is outlined in this article, emphasizing that total excision be the goal surgery, even if this requires a combined anterior and posterior approach. In cases of recurrence of both development cysts and chordoma, re-excision is a reasonable therapeutic option.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00341185
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  • 12
    Electronic Resource
    Electronic Resource
    The surgical anatomy of the rectum — a review with particular relevance to the hazards of rectal mobilisation (1987)
    Springer
    International journal of colorectal disease 2 (1987), S. 158-166 
    Details
    ISSN: 1432-1262
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The major complications of rectal surgery that are wholly or partially avoidable by the use of an anatomically based dissection are haemorrhage from presacral veins, perforation of the rectum, damage to pelvic autonomic nerves and inadequate clearance of a rectal cancer. Important technical points in minimising the incidence of these complications are: (1) posterior dissection in the presacral space; (2) entry to this space by sharp dissection immediately posterior to the superior rectal artery; (3) deliberate incision of the rectosacral fascia; (4) anterior dissection posterior to Denonvilliers fascia in benign disease; (5) removal of the entire mesorectum for low rectal cancer. Other anatomical points not widely appreciated are: 1. The middle rectal artery does not run in the lateral ligaments of the rectum, but below them, on levator ani. It reaches the rectum by penetrating Denonvilliers' fascia. 2. The lateral ligaments may contain an accessory middle rectal artery in 25% of cases. 3. The pelvic autonomic nerves are buried in endopelvic fascia on the pelvic side wall, but come to lie close to the anterior aspect of the rectum at the level of the prostate or upper vagina.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01648000
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  • 13
    Electronic Resource
    Electronic Resource
    Small bowel explosion: a complication of strictureplasty (1994)
    Springer
    International journal of colorectal disease 9 (1994), S. 5-7 
    Details
    ISSN: 1432-1262
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Résumé Le risque d'explosion accidentelle de l'intestin résultant de l'emploid d'un bistouri électrique est faible. Seul deux cas d'explosion de l'intestin grêle ont été à ce jour décrits. Nous relatons un cas d'explosion de l'intestin grêle survenant au cours d'une stricturoplastie chez un patient porteur d'une sténose chronique sur maladie de Crohn. Afin de prévenir la survenue d'une telle complication dramatique, nous proposons qu'avant toute incision l'on décomprime proximalement l'intestin et que l'on renonce également à l'emploi du bistouri électrique.
    Notes: Abstract Explosion injury to the intestinal tract resulting from electrocautery is a rare occurrence. Only two small bowel explosions have been described previously. Here we describe an explosion of small bowel during strictureplasty in a patient with chronic obstructing Crohn's disease. Recommendations to avoid this disastrous complication include proximal decompression prior to incision and, in some cases, it may be wise to avoid electrocautery altogether.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00304292
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  • 14
    Electronic Resource
    Electronic Resource
    The differential diagnosis and comorbidity of hidradenitis suppurativa and perianal Crohn's disease (1993)
    Springer
    International journal of colorectal disease 8 (1993), S. 117-119 
    Details
    ISSN: 1432-1262
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Résumé Au cours des 8 ans passés, 61 patients avec hidradénite supparative (HS) ont été traités à cette institution. 24 avaient aussi un diagnostic de maladie de Crohn (38%). Cette pathologie double est examinée en détail dans une revue rétrospective. Il y avait 11 hommes et 13 femmes d'un âge moyen de 39 (18–75 ans). La maladie de Crohn était iléale chez 1 patient, iléocolique chez 4 et affectait le colon seulement chez 19. Le diagnostic de malade de Crohn était antérieur à celui de HS en moyenne de 3,5 ans. A l'époque de la revue, 22 patients avaient une stomie, 23 avaient subi une laparotomie et 17 avaient perdu le rectum. L'hidradénite suppurative est survenue dans les zones périnéales ou périanales chez tous les patients mais occupait aussi d'autres lieux dans 20 cas. Une greffe cutanée a été faite chez 9 et des traitements locaux chez 19 patients. Des granulomes ont été trouvés dans la peau excisée chez 6 malades mais ces découvertes n'étaient pas associées avec un mauvais pronostic. Avec un recul moyen de 3,2 ans après la plus récente intervention chirurgicale pour hidroadénite (1 à 11 ans) 11 étaient asymptomatiques pour leur hidroadénite, 11 avaient des symptômes et 2 étaient perdus de vue. Ces faits montrent que HS peut coexister avec la maladie de Crohn rectocolique, compliquant le diagnostic et la traitement des patients ches lesquels elle survient. Un accroissement de l'appréciation de cette possibilité est recommandée.
    Notes: Abstract Over the last 8 years, 61 patients with hidradenitis suppurativa (HS) have been treated at this institution. Twenty-four have also had a diagnosis of Crohn's disease (38%). This dual pathology is examined in detail in this retrospective review. There were 11 males and 13 females with a mean age of 39 years (range 18 to 75 years). The Crohn's disease was ileal in 1 patient, ileocolic in 4, and affected the large bowel only in 19. The diagnosis of Crohn's disease predated that of HS by an average of 3.5 years. At the time of review, 22 patients had a stoma, 23 had undergone laparotomy and 17 had lost their rectum. Hidradenitis suppurativa occurred in the perineal or perianal area in all patients but involved other sites in 20 cases. Skin grafting had been done in 9 and local procedures in 19 patients. Granulomas were found in excised skin in 6 cases but this finding was not associated with a poor outcome. At a mean follow-up of 3.2 years from the most recent surgery for HS (range 1 to 11 years) 11 were asymptomatic for HS, 11 had symptoms and no follow up was available in 2. These data show that HS may coexist with Crohn's proctocolitis, complicating the diagnosis and management of patients in whom it occurs. An increased appreciation of the possibility is recommended.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00341181
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  • 15
    Electronic Resource
    Electronic Resource
    Men tend to be neoplasia prone and women neoplasia resistant (2000)
    Springer
    Surgical endoscopy and other interventional techniques 14 (2000), S. 1162-1166 
    Details
    ISSN: 1432-2218
    Keywords: Key words: Colonoscopy — Colorectal neoplasia — Follow-up
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: Patients with a colorectal neoplasm are at risk for metachronous neoplasia. This risk usually is stratified according to the number, size, and histology of the index lesion(s). This study was performed to search for factors contributing not only to a very high risk of metachronous lesions but also to a very low risk. Methods: An extensive neoplasia follow-up database was used to identify patients who were neoplasia prone and neoplasia resistant. Groups were defined as having consecutive colonoscopies that were either all positive or all negative for adenoma(s). Subgroups with two, three, and four consecutive positive or negative examinations were formed, then analyzed for gender, number of index neoplasms, and family history. Patients with familial adenomatous polyposis or with families fulfilling the Amsterdam criteria for hereditary nonpolyposis colorectal cancer were excluded. Results: The database showed 702 patients who had two follow-up examinations, 103 of which were neoplasia prone and 245 neoplasia resistant. After three consecutive examinations (420 patients), the numbers were 51, and 87, respectively, and after four examinations (231 patients), they were 26 and 34. As the groups became better defined, the proportion of women in the neoplasia-resistant group and the proportion of men in the neoplasia-prone group increased. When gender and number of index lesions were combined, groups were most definitively characterized. Incidence of a positive family history of colorectal cancer was not different between the groups. As the number of follow-up examinations increased, the number of large polyps found decreased. Conclusions: Groups of patients particularly liable to develop colorectal neoplasia or particularly resistant to it can be identified. Female gender and a single-index lesion favor neoplasia resistance, whereas male gender and multiple-index lesions favor a predisposition for neoplasia.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004640000014
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  • 16
    Electronic Resource
    Electronic Resource
    Immune functions in methylmalonicaciduria (1984)
    Springer
    Journal of inherited metabolic disease 7 (1984), S. 12-14 
    Details
    ISSN: 1573-2665
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract A variety of phagocytic cell and lymphocyte assays were employed to evaluate the immune status of four patients with methylmalonicaciduria. One patient had a depressed absolute granulocyte count and two patients had depressed neutrophil and monocyte chemotactic responses. All subjects had normal neutrophil phagocytic and bactericidal activities. One patient had a decreased T-cell number; blastogenic responses to phytohaemagglutinin and pokeweed mitogen were normal in all subjects. B lymphocyte measurements were variably abnormal; two children had decreased B-cell numbers; two had marginally decreased IgG levels; a third had an undetectable rubella titre; and two had elevated serum IgE concentrations.In vitro exposure of normal cells to methylmalonic acid concentrations up to 50mg/100 ml did not affect chemotactic or lymphoproliferative responses. In conclusion, although B-cell function may be affected, no consistent abnormality of lymphocyte or phagocytic cell functions could be attributed to the metabolic disorder.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01805612
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  • 17
    Electronic Resource
    Electronic Resource
    On infinite composition products of probability generating functions (1971)
    Springer
    Probability theory and related fields 19 (1971), S. 243-256 
    Details
    ISSN: 1432-2064
    Source: Springer Online Journal Archives 1860-2000
    Topics: Mathematics
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00534112
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  • 18
    Electronic Resource
    Electronic Resource
    Perioperative tumor localization for laparoscopic colorectal surgery (1997)
    Springer
    Surgical endoscopy and other interventional techniques 11 (1997), S. 1013-1016 
    Details
    ISSN: 1432-2218
    Keywords: Key words: Tumor localization — Laparoscopic surgery — Colon tumors — Rectal tumors
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: Because of the inability to palpate colonic tumors during laparoscopy, their location must be precisely identified before resection is undertaken. Method: A retrospective study was performed of 58 patients in order to be able to describe our methods of tumor localization for laparoscopic colorectal operations and to review their effectiveness. Results: In all patients, the entire colon was examined preoperatively by colonoscopy. In one patient, preoperative colonoscopic localization was inaccurate. In 31 patients, tumors were easily detectable at surgery. In five patients with the tumor in the right colon, even though the lesion was not detectable at surgery, right colectomy was performed without marking because preoperative colonoscopy reliably identified the lesion adjacent to the ileocecal valve. Twenty-two patients required some type of procedure to localize the tumor. The procedures and their problems were as follows: preoperative tattoo (five)—tattoo not visualized (one); intraoperative colonoscopy alone (six), combined with intraoperative tattoo (four) or clip (three)—poor operative exposure due to bowel distension (nine), hard to see the clip (three), dislodged clip (two), inadequate resection margin (one); intraoperative proctoscopy alone (two), combined with laparoscopic stitch (two)—no problems. In no patient was tumor present at a resection line and in no patient was the wrong segment resected. Conclusions: Reliable preoperative identification of the tumor adjacent to the ileocecal valve can permit right colectomy without marking. Lesions in the upper rectum can be approached via intraoperative proctoscopy ± suture placement. If the surgeon anticipates intraoperative localization may be difficult, lesions other than rectal or cecal ones should probably be marked by preoperative tattooing. Further studies regarding the technique of tattooing are warranted.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004649900514
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  • 19
    Electronic Resource
    Electronic Resource
    Colonoscopy — how difficult, how painful? (1994)
    Springer
    Surgical endoscopy and other interventional techniques 8 (1994), S. 784-787 
    Details
    ISSN: 1432-2218
    Keywords: Colonoscopy ; Painful ; Prediction
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Colonoscopy is sometimes painful for the patient and often difficult for the endoscopist, but it is hard to predict how difficult or painful the examination will be. The purpose of this study was to identify factors that influence difficulty and pain during colonoscopy. Some 1,284 consecutive patients undergoing office colonoscopy by three endoscopists were prospectively studied. A standard questionnaire was completed by the nursing staff, who assessed the degree of difficulty and pain associated with each exam on a four-point scale. There were 682 men and 551 women (sex not recorded in 51). There was no pain in 27%, mild pain in 39%, moderate pain in 25%, and severe pain in 9%. There was no difficulty in 25%, mild difficulty in 33%, moderate difficulty in 28%, and severe difficulty in 14%. Colonoscopy was significantly easier (P〈0.001, chi square) and less painful (P〈0.001, chi square) in patients after sigmoidectomy. It was more painful after hysterectomy (P〈0.05, chi square) and more difficult and painful in women than in men (P〈0.01, chi square). There were significant differences between endoscopists in the assessment of pain associated with colonoscopy. Most colonoscopies are associated with little or no pain (66%) and are easy or only mildly difficult to perform (58%). Patients who have had sigmoid resection are especially easy and painless to examine while women, especially after hysterectomy, are at higher risk of having a painful experience. Colonoscopy technique can influence the amount of pain experienced by the patient.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00593441
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  • 20
    Electronic Resource
    Electronic Resource
    Photodegradation of wool keratin: Part I. Vibrational spectroscopic studies (1996)
    New York, NY [u.a.] : Wiley-Blackwell
    Biospectroscopy 2 (1996), S. 249-258 
    Details
    ISSN: 1075-4261
    Keywords: Chemistry ; Analytical Chemistry and Spectroscopy
    Source: Wiley InterScience Backfile Collection 1832-2000
    Topics: Biology , Physics
    Notes: The photodegradation of wool keratin is a very complex process that is not well understood. In this work the techniques of Fourier transform Raman and attenuated total reflectance Fourier transform-infrared spectroscopies have been used to study wool samples irradiated in air using a variety of different sources. The spectra obtained from these samples have been compared with those obtained from wool treated with sodium bisulphite, a reagent well known to produce thiol and S-sulfonate groups. As an aid for spectral interpretation the Raman and infrared spectra of cystine and those of the sodium and potassium cysteine-S-sulfonates have also been obtained. The data suggest that there are two different photolytic reaction pathways involving the cystine residues which are dependent on the wavelength of the applied radiation. © 1996 John Wiley & Sons, Inc.
    Additional Material: 9 Ill.
    Type of Medium: Electronic Resource
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