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  • 1
    ISSN: 1530-0358
    Keywords: Anastomotic healing ; Colonic anastomoses ; Steroids ; Prostaglandin E 1 ; Bursting pressures ; Hydroxyproline
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract PURPOSE: The effect of prostaglandin E1 (PGE1) and corticosteroids alone and in combination were studied in the healing rat colon to determine whether PGE1 could not only improve healing but reverse the negative effect of steroids on colonic wound healing. METHODS: Colonic anastomoses were performed in 144 male Sprague-Dawley rats divided into four groups. The control group (I) received no further treatment. The steroid group (II) received cortisone acetate (5 mg/kg/day) beginning six days preoperatively and continuing until sacrifice. The PGE1 group (III) received 2 μg of PGE1 intra-aortically at surgery and for three days postoperatively. The combination PGE1/steroid group (IV) received both drugs in the same doses as those in Groups II and III. Animals were sacrificed on postoperative days 6, 10, and 14. Wound healing was evaluated by hydroxyproline content, bursting pressures, and histology. RESULTS: The hydroxyproline assay at day 10 revealed that steroid-treated rats have significantly lower levels than any other group. The PGE1 group (III) had the highest level of significance in comparison to the steroid group (II) (P=0.001). The addition of PGE1 to steroid (Group IV) appeared to abolish the negative effect of the steroid as measured by hydroxyproline content on day 10 (P=0.038). When measuring bursting pressures, the PGE1 group (III) had significantly higher pressures than any other group at day 10. However, no amelioration of the steroid effect on bursting pressures was seen. Histologic evaluation of the anastomosis did not reveal any significant differences among the four groups. CONCLUSIONS: PGE1 reverses the negative effect of the steroid on hydroxyproline levels at day 10. Furthermore, using bursting pressure as a parameter of wound healing, administration of PGE1 results in significantly improved anastomotic healing at day 10.
    Type of Medium: Electronic Resource
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  • 2
    ISSN: 1530-0358
    Keywords: Colon ; Steroids ; Anastomoses ; Wound healing
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract PURPOSE: This study was designed to determine the effect of corticosteroids on healing colonic anastomoses. METHODS: Bursting pressure measurements were performed on 108 male albino rats receiving corticosteroid treatment. Twelve animals were sacrificed at time zero to determine the bursting pressure of nonoperated, nonsteroid-treated colon. The remaining 96 animals underwent division and reanastomosis of their midtransverse colon. They were then separated into four groups of 24 each. Twelve animals in each group received steroid treatment while the remaining 12 acted as controls. The groups were sacrificed at 4, 6, 8, and 20 days. The bursting pressures of the anastomoses were then noted. RESULTS: There was no significant difference in bursting strength between treated animals and controls at four days (P =0.27). A significant difference occurred at 6, 8, and 20 days (P =0.01, 0.003, 0.009, respectively). The colonic bursting pressure of operated controls returned to that of a normal, nonoperated colon by 20 days. CONCLUSION: This study demonstrates that steroids do have an adverse effect on colonic anastomotic healing.
    Type of Medium: Electronic Resource
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  • 3
    Electronic Resource
    Electronic Resource
    Springer
    Diseases of the colon & rectum 38 (1995), S. 281-285 
    ISSN: 1530-0358
    Keywords: Fecal incontinence ; Manometry ; Anal electromyography ; Pudendal nerve terminal motor latency
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract PURPOSE: This study sought to identify clinical and manometric characteristics of male fecal incontinence. METHOD: Clinical charts of 25 men with a chief complaint of fecal incontinence were retrospectively reviewed. Their anorectal physiology test results were compared with those from a group of 20 healthy men. RESULTS: Fourteen men (56 percent) were “leakers,” who complained of loss of liquid or solid stool smears that stained their underclothes. Eleven men (44 percent) had true incontinence, with loss of control over gas, liquid, and/or solid stool. Leakers had lower anal sphincter pressures than normal men (P 〈0.05) but higher pressures than incontinent men (P 〈0.05). In leakers the anal sphincter length at rest was longer than in incontinent (P 〈0.01) and normal men (P 〈0.05). All incontinent men had decreased manometric pressures, abnormal anorectal sensation or prolonged pudendal nerve terminal motor latencies, whereas only one-half of the leakers had physiologic abnormalities. Treatment using dietary manipulation, constipating agents or cleansing enemas was successful in nearly 90 percent of incontinent men but only 55 percent of the leakers. CONCLUSIONS: Whereas true incontinence in men is caused by a short, low pressure sphincter with altered sensation or innervation, leakage is associated with a long, intermediate pressure sphincter that frequently has normal sensation and innervation. This long, intermediate pressure sphincter may predispose these men to leakage. Treatment of leakers is less successful than treatment of incontinent men. Leakers and incontinent men have unique clinical and physiologic profiles that should be identified to help guide treatment and determine prognosis.
    Type of Medium: Electronic Resource
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  • 4
    ISSN: 1530-0358
    Keywords: Proctography ; Defecography ; Peritoneography ; Herniography ; Enterocele ; Pelvic floor hernia
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract PURPOSE: We sought to evaluate a new diagnostic technique for the identification of rectal and pelvic floor pathology in patients with obstructed defecation, pelvic fullness/ prolapse, and/or chronic intermittent pelvic floor pain. METHODS: Thirteen symptomatic women with either a nondiagnostic physical examination or nondiagnostic dynamic proctography (DPG) were studied. After placement of intraperitoneal and intrarectal contrast material, resting and straining pelvic x-rays were obtained in all patients, and defecation was videotaped using fluoroscopy. RESULTS: Simultaneous DPG and peritoneography identified clinically suspected and unsuspected enteroceles in 10 of the 13 patients studied. An enterocele or other pelvic floor hernia was ruled out by the technique in three of the women studied. Rectoceles and rectal prolapse that were identified during physical examination were confirmed by DPG with peritoneography. Simultaneous DPG and peritoneography also gave a qualitative assessment of the severity and clinical significance of the identified pelvic floor disorders. Results of simultaneous DPG and peritoneography affected operative treatment planning in 85 percent of patients studied. CONCLUSION: Simultaneous DPG and peritoneography identifies both rectal and pelvic floor pathology and provides a qualitative assessment of pelvic floor pathology severity, which allows for better treatment planning in selected patients with obstructed defecation and pelvic prolapse.
    Type of Medium: Electronic Resource
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  • 5
    ISSN: 1530-0358
    Keywords: Anastomotic healing ; Arginine ; Bursting pressure
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract INTRODUCTION: This study sought to determine whether dietary arginine influences colonic anastomotic healing in the rat model. METHODS: Three groups of 42 Sprague-Dawley rats were fed 0, 1, and 3 percent arginine diets for three preoperative and three postoperative days. Animals underwent transection of the transverse colon with handsewn anastomosis. Subgroups of 14 animals in each dietary group were killed on postoperative Days 6, 10, or 14, and bursting pressures, histologic inflammation, and collagen content were compared. RESULTS: Mean anastomotic bursting pressures on postoperative Day 6 were lower for the 0 percent arginine group than the 1 and 3 percent arginine groups (mean ± standard error of the mean =134±6 mmHg, 164±7 mmHg, and 166±7 mmHg, respectively;P〈0.0005). On Days 10 and 14, no significant differences in bursting pressures were noted between arginine diets. Mean bursting pressures on postoperative Day 6 (155±4 mmHg) were significantly lower than on Days 10 (204±5 mmHg) and 14 (217±6 mmHg;P〈0.001) for all arginine diets. Microscopic evaluation of the anastomoses did not show significant differences in flammation or collagen content between arginine diets. Collagen content in all dietary groups peaked at Day 10. CONCLUSIONS: Perioperative arginine deficiency in the rat model is associated with impaired anastomotic healing during the first week, as reflected by lower bursting pressures. Arginine supplementation to 3 percent does not improve bursting pressures above those found in the usual 1 percent arginine diet at 6, 10, or 14 days. Bursting pressures plateau by Day 10 regardless of perioperative dietary arginine, whereas collagen content peaks at Day 10 after six-day perioperative arginine diet manipulation.
    Type of Medium: Electronic Resource
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  • 6
    ISSN: 1530-0358
    Keywords: Breast neoplasms, genetics ; Breast neoplasms, mortality ; Genes, BRCA1, genetics ; Colorectal neoplasms, genetics
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract PURPOSE: This study compared characteristics of colorectal cancer between families with dominant breast cancer inheritance and the general population. The cumulative incidence of colorectal cancer was also studied in genetically determined breast cancer syndrome subjects with BRCA1 and BRCA2 mutations and compared with the general population. METHODS: Subjects included 42 patients with colorectal cancer from 32 clinically determined hereditary breast cancer kindreds based on the autosomal dominant inheritance of breast cancers and early age of onset. The general population colorectal cancer cohort was composed of 755 patients from a tumor registry. Lifetime risk of colorectal cancer was determined in 164 BRCA1 and 88 BRCA2 gene mutation carriers and compared with the general population. Mean age of colorectal cancer onset, anatomic site distribution, histologic stage at presentation, and five year stage-stratified survival rates were compared between clinically determined hereditary breast cancer family members and the general population. RESULTS: The lifetime risk of colorectal cancer in male BRCA1 and BRCA2 mutation carriers was 5.6 percent, which was not different from 6 percent in males from the general population. Likewise, the lifetime colorectal cancer risk in female BRCA1 and BRCA2 mutation carriers was 3.2 percent, which was not different from 5.9 percent in females from the general population. Mean age of onset ± standard error for patients with colorectal cancer was 60±2 years for hereditary breast cancer kindreds compared with 67±0.4 years for the general population (P=0.0004). Colorectal cancer site distribution did not vary between hereditary breast cancer and the general population. Overall colorectal cancer stage distribution was significantly different, with more Stage I and fewer Stage IV cancers in subjects with hereditary breast cancer compared with the general population (P=0.01). Overall five year stage-stratified colorectal cancer survival rate ± standard error was 66±8 percent for hereditary breast cancer kindreds and 46±2 percent for the general population (P=0.023). CONCLUSION: Lifetime cumulative colorectal cancer incidence in subjects with BRCA1 and BRCA2 gene mutations was not different from the general population. However, significant differences in colorectal cancer were noted between hereditary breast cancer family members and the general population. Hereditary breast cancer-associated colorectal cancer had an earlier age of onset, lower tumor stage, and better survival rate than the general population. Except for age of onset, colorectal cancer in hereditary breast cancer kindreds exhibited more favorable characteristics than colorectal cancer in the general population.
    Type of Medium: Electronic Resource
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  • 7
    ISSN: 1530-0358
    Keywords: Fecal incontinence ; Quality of life ; Health surveys ; Reproducibility of results ; Outcome assessment (health care)
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract PURPOSE: This goal of this research was to develop and evaluate the psychometrics of a health-related quality of life scale developed to address issues related specifically to fecal incontinence, the Fecal Incontinence Quality of Life Scale. METHODS: The Fecal Incontinence Quality of Life Scale is composed of a total of 29 items; these items form four scales: Lifestyle (10 items), Coping/Behavior (9 items), Depression/Self-Perception (7 items), and Embarrassment (3 items). RESULTS: Psychometric evaluation of these scales demonstrates that they are both reliable and valid. Each of the scales demonstrate stability over time (test/retest reliability) and have acceptable internal reliability (Cronbach alpha 〉0.70). Validity was assessed using discriminate and convergent techniques. Each of the four scales of the Fecal Incontinence Quality of Life Scale was capable of discriminating between patients with fecal incontinence and patients with other gastrointestinal problems. To evaluate convergent validity, the correlation of the scales in the Fecal Incontinence Quality of Life Scale with selected subscales in the SF-36 was analyzed. The scales in the Fecal Incontinence Quality of Life Scale demonstrated significant correlations with the subscales in the SF-36. CONCLUSIONS: The psychometric evaluation of the Fecal Incontinence Quality of Life Scale showed that this fecal incontinence-specific quality of life measure produces both reliable and valid measurement.
    Type of Medium: Electronic Resource
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  • 8
    Electronic Resource
    Electronic Resource
    Springer
    Diseases of the colon & rectum 33 (1990), S. 1069-1074 
    ISSN: 1530-0358
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
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  • 9
    Electronic Resource
    Electronic Resource
    Springer
    Diseases of the colon & rectum 33 (1990), S. 444-449 
    ISSN: 1530-0358
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
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  • 10
    Electronic Resource
    Electronic Resource
    Springer
    Diseases of the colon & rectum 35 (1992), S. 201-203 
    ISSN: 1530-0358
    Keywords: Anal stricture ; Anal stenosis ; Sliding skin flap ; “House” advancement pedicle flap ; Anoplasty ; Surgical technique
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Long strictures of the anal canal, extending from the dentate line to the perianal skin, have challenged surgeons for many years. Numerous techniques have been devised to treat anal strictures. A technique to relieve an anal stenosis that involves the entire circumference and the length of the anal canal from the dentate line onto the perianal skin is described. It has two principal advantages: 1) it provides a broad skin flap for the entire length of the involved anal canal; and 2) it provides primary closure of the donor site. In addition, it avoids extensive mobilization of tissue, the flap maintains good blood supply with minimal tension, and there is no small tip prone to necrosis.
    Type of Medium: Electronic Resource
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