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  • 1
    Electronic Resource
    Electronic Resource
    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
    Keywords: Colorectal liver metastases ; Hepatic resection ; Locoregional chemotherapy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: 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.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02150746
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  • 2
    Electronic Resource
    Electronic Resource
    Sarafoff's anoplasty for incontincence following Whitehead's haemorrhoidectomy (1999)
    Springer
    Techniques in coloproctology 3 (1999), S. 63-66 
    Details
    ISSN: 1128-045X
    Keywords: Key words Sarafoff's anoplasty ; Whitehead's haemorrhoidectomy ; Anal manometry ; Faecal incontinence ; Anal prolapse ; Ectropion
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: 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.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s101510050016
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    Paper (German National Licenses)
    Fulltext
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