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  • Anal manometry  (2)
  • Colorectal liver metastases  (1)
  • Key words: Laparoscopic — Gastroplasty — Conversions — Complications  (1)
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  • 1
    Digitale Medien
    Digitale Medien
    Colorectal metastases to the liver: Present status of management (1990)
    Springer
    Diseases of the colon & rectum 33 (1990), S. 688-694 
    Details
    ISSN: 1530-0358
    Schlagwort(e): Colorectal liver metastases ; Hepatic resection ; Locoregional chemotherapy
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract The management of patients with hepatic metastases from colorectal carcinoma is controversial. While a “no treatment” attitude still persists, other patients undergo systemic chemotherapy with very limited results. Other possible options are hepatic resection and locoregional treatments. One hundred twenty-three patients with hepatic metastases from colorectal cancer were treated at the authors' institution over a period of 15 years. Thirty-nine patients underwent hepatic resection while 84 underwent various forms of locoregional treatment. Several patients in the latter group were registered in one national (RNSI) Phase 2 study and one international (EORTC Phase 3 trial. The authors' experience confirms the opinion that hepatic resection can be performed with the aim of curing in patients with isolated metastases. A five-year survival rate can be achieved in 25 to 30 percent of the resectable patients. Patients with unresectable extrahepatic disease or multiple bilateral metastases are usually excluded from resection. In other cases, hepatic resection should be carried out when technically possible. The value of adjuvant chemotherapy to the remaining liver has to be tested in prospective randomized trials. Patients with diffuse metastases can benefit from locoregional infusion of chemotherapeutic agents. Symptoms improve in most patients; objective responses vary from 53 to 83 percent of the cases, which is a higher rate than that reported for systemic chemotherapy. Survival may be prolonged in respect to untreated patients but this has not been demonstrated yet by prospective randomized studies. Current trends are continuous infusion of chemotherapeutic agents and experimentation of new drugs or drug combinations. Future improvements may be achieved by adding hepatic arterial ischemia, hyperthermia, or radiation therapy. As these kinds of treatments are still experimental, they should be applied to the patients only in the context of prospective clinical trials.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/BF02150746
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  • 2
    Digitale Medien
    Digitale Medien
    Striated anal sphincter electromyography in idiopathic fecal incontinence (1995)
    Springer
    Diseases of the colon & rectum 38 (1995), S. 27-31 
    Details
    ISSN: 1530-0358
    Schlagwort(e): Sphincter electromyography ; Idiopathic fecal incontinence ; Anal manometry ; Anal sphincter
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract PURPOSE: This study was designed to determine the importance of innervation of striated anal sphincters, one of the most important structures in idiopathic fecal incontinence. METHODS: Forty-three idiopathic, fecally incontinent patients (40 women and 3 men; mean age, 57.2±11 (range, 33–77) years) underwent anorectal manometry and sphincteric electromyography. On the basis of electromyographic findings, patients were subdivided into three groups: Group A consisted of 21 patients with normal electromyography; Group B consisted of 14 patients with moderate denervation; Group C consisted of 8 patients with severe denervation. Manometric results from the patients were compared with those from 15 healthy subjects (8 women and 7 men; mean age, 35±12 (range, 15–55) years). RESULTS: Incontinent patients had a shorter anal canal (P =0.005), and anal canal pressure was lower at rest (P 〈0.001), at contraction (P 〈0.001), and at coughing (P 〈0.001); rectal distention and rectal compliance were reduced (maximum tolerated volume,P 〈0.003; compliance at 200 ml,P =0.03; at 250,P 〈0.005; at 300 ml,P =0.03). No statistically significant differences were found between the manometric results of the three different groups of patients. A statistically significant linear correlation was reached by comparing the clinical severity of fecal incontinence with age (P =0.02) and some other manometric parameters: the pressure of the anal canal at rest (P 〈0.001) and at contraction (P 〈0.01); rectal compliance at 50 ml (P =0.03), 100 ml (P =0.004), and 150 ml (P =0.004). CONCLUSION: Clinical severity of fecal incontinence is correlated with some manometric parameters. Severity of denervation of the anal striated sphincters does not appear to influence severity of fecal incontinence.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/BF02053853
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  • 3
    Digitale Medien
    Digitale Medien
    Sarafoff's anoplasty for incontincence following Whitehead's haemorrhoidectomy (1999)
    Springer
    Techniques in coloproctology 3 (1999), S. 63-66 
    Details
    ISSN: 1128-045X
    Schlagwort(e): Key words Sarafoff's anoplasty ; Whitehead's haemorrhoidectomy ; Anal manometry ; Faecal incontinence ; Anal prolapse ; Ectropion
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract: The purpose of our study was to ascertain whether Sarafoff's anoplasty is a valid option for anal ectropion (eversion), in which mucosal prolapse causes continuous mucus discharge and faecal incontinence from loss of sensitivity due to anal skin removal. A retrospective evaluation was made of 12 patients (8 female and 4 male, mean follow-up time 8.3 years, range 2–12 years) who, from 1984 through 1997, underwent Sarafoff's anoplasty for anal ectropion following Whitehead's haemorroidectomy, which in 5 cases had been combined with prolapsectomy. Eight patients complained of incontinence to solid faeces (Miller's score 7–9), and the remaining 4 of incontinence to liquid faeces and gas (Miller's score 1–6). The median score for preoperative incontincence was 7. All patients underwent pre- and postoperative manometric evaluation. Sarafoff's anoplasty consists of a cutaneous and subcutaneous circular incision to a depth equal to that of the sphincteric apparatus (1–4 cm), and at a distance of 1–2 cm from the everted anal or rectal mucosa, with analcoccygeal ligament sectioning. The wound created is made to heal without sutures. Scar retraction, together perhaps with the action of the levator ani muscle, raises the eversion, thus restoring the anoderm of the distal anal canal. On comparing values before and after Sarafoff's anoplasty, a significant improvement was found in: mucus secretion (P 〈 0.01), ectropion (P 〈 0.01), and degree of postoperative continence, with a median score of 2 (P 〈 0.01). No statistical difference was found between mean manometric parameters before and after surgery. Sarafoff's anoplasty in selected patients with ectropion combined with faecal incontinence due to loss of anal sensitivity, is a simple procedure with good long-term results, and without important complications.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/s101510050016
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  • 4
    Digitale Medien
    Digitale Medien
    Conversions and complications in 185 laparoscopic adjustable silicone gastric banding cases (1997)
    Springer
    Surgical endoscopy and other interventional techniques 11 (1997), S. 268 -271 
    Details
    ISSN: 1432-2218
    Schlagwort(e): Key words: Laparoscopic — Gastroplasty — Conversions — Complications
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract Background: Kuzmak's gastric silicone banding technique is the least invasive operation for morbid obesity. The purpose of this study was to analyze the complications of this approach. Methods: Between September 1992 and March 1996, 185 patients underwent laparoscopic gastroplasty by the adjustable silicone band technique. A minimally invasive procedure using five trocars was performed. Results: In 11 patients exposure of the hiatus was impeded because of hypertrophy of the left liver lobe which led to conversion in eight patients and abortion of the procedure in three other patients. Anatomical complications: We observed two gastric perforations and one band slippage at the early stage, one infection and three rotations of the access port. Functional complications: There were eight (4%) cases of irreversible total food intolerance resulting in pouch dilation and eight cases (4%) of esophagitis. One fatality on the 45th day in a patient with a Prader-Willi syndrome. Conclusion: The most disturbing complications of gastric banding technique are gastric perforation and pouch dilation. Their incidence may be reduced by improving the technique and by considering pitfalls of the procedure.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/s004649900341
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