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  • 1
    Electronic Resource
    Electronic Resource
    Anorectal melanoma—An incurable disease? (1997)
    Springer
    Diseases of the colon & rectum 40 (1997), S. 661-668 
    Details
    ISSN: 1530-0358
    Keywords: Anorectal melanoma ; Melanoma ; Surgical treatment ; Abdominoperineal resection ; Wide local excision ; Recurrence ; Anus ; Rectum ; Treatment
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract PURPOSE: This study was designed to describe recurrence and survival rates after operative treatment for anorectal melanoma and to identify predictive factors for recurrence. METHODS: Records of 50 patients with anorectal melanoma from 1939 to 1993 were reviewed. RESULTS: Overall five-year survival and disease-free survival were 22 and 16 percent, respectively. At the time of diagnosis, 26 percent of patients had metastatic disease, and all died within 12 (mean, 6.3) months. Five-year survival and recurrence rates were identical after either abdominoperineal resection (APR) or wide local excision, both with curative intent. Gender, size of tumor, presence of melanin, positive perirectal lymph nodes, or treatment were not predictive of recurrence. Anorectal melanoma was found incidentally after hemorrhoidectomy or polypectomy in five patients. Three other patients underwent an excisional biopsy of a lesion measuring less than 2 cm. Of these eight patients, five underwent APR and three underwent wide local excision with no microscopic residual tumor at pathology. All developed regional or systemic recurrence at a mean of 21 (range, 4–88) months, and all died of their disease at a mean of 29 (range, 5–98) months. CONCLUSION: Prognosis for anorectal melanoma is poor, irrespective of surgical treatment performed. No predictive factors for recurrence were identified in this series. Wide local excision with a negative margin of a least 1 cm is suggested as the treatment of choice. APR should be reserved for tumor not amenable to local excision or for palliative treatment of large obstructive lesion until effective adjuvant therapies are available.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02140894
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  • 2
    Electronic Resource
    Electronic Resource
    Safety and advantages of laparoscopicvs. open colectomy in the elderly (2000)
    Springer
    Diseases of the colon & rectum 43 (2000), S. 326-332 
    Details
    ISSN: 1530-0358
    Keywords: Laparoscopic surgery ; Aged ; Colorectal surgery ; Morbidity ; Quality of life
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract PURPOSE: The aim of this study was to determine rates of complications and extent of benefits for laparoscopic-assisted colectomy compared with open colectomy in patients older than age 75. METHODS: Forty-two patients undergoing laparoscopic-assisted colectomy (1992–1998) were matched to 42 open colectomy patients for gender, age, year of surgery, operating surgeon, and procedure. Health status (American Society of Anesthesiology score), previous abdominal surgery, conversion rate, surgical outcome, and need for assistance at admission and dismissal (independencevs. home with assistancevs. nursing facilities) were reviewed. RESULTS: Mean ages were 81.2 and 80.5 years for laparoscopic-assisted colectomy and open colectomy, respectively (P=not significant). Twenty-one laparoscopic-assisted colectomy and 23 open colectomy patients were females. American Society of Anesthesiology scores were comparable, as were rates of previous abdominal surgery (57 percent for laparoscopic-assisted colectomyvs. 62 percent for open colectomy;P=not significant). Mean operative times were longer for laparoscopic-assisted colectomy (190 minutes for laparoscopic-assisted colectomyvs. 142 minutes for open colectomy;P〈0.001); operating room times progressively decreased from 221 minutes in 1992 to 1995 to 147 in 1998 for laparoscopic right hemicolectomy (P〈0.001). The conversion rate for laparoscopic-assisted colectomy was 14.3 percent. There were no deaths in either group, and laparoscopic-assisted colectomy was associated with fewer morbidities (14.3 percent for laparoscopic-assisted colectomyvs. 33.3 percent for open colectomy;P=0.04), narcotic usage (2.7vs. 4.8 days;P〈0.001), time to return to bowel movements (3.9vs. 5.9 days;P〈0.001), and length of hospital stay (6.5vs. 10.2 days;P〈0.001). Independent status at admission in 37 laparoscopic-assisted colectomy and 38 open colectomy patients was maintained at discharge by 35 laparoscopic-assisted colectomyvs. 29 open colectomy patients (P=0.025). CONCLUSIONS: Laparoscopic-assisted colectomy is safe and beneficial, including preservation of postoperative independence, to the elderly when compared with open colectomy.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02258297
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  • 3
    Electronic Resource
    Electronic Resource
    Long-term results of surgery for chronic constipation (1997)
    Springer
    Diseases of the colon & rectum 40 (1997), S. 529-529 
    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/BF02055372
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  • 4
    Electronic Resource
    Electronic Resource
    Leiomyosarcoma of the rectum and anus (1989)
    Springer
    International journal of colorectal disease 4 (1989), S. 91-96 
    Details
    ISSN: 1432-1262
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Twenty-two patients with leiomyosarcoma of the rectum (n=19) or the anus (n=3) were treated surgically at the Mayo Clinic from 1950 through 1985. The majority of tumors occurred in men (1.4∶1.0) during the sixth and seventh decades of life. Fifty-nine percent of the patients had symptoms including, most commonly, change in bowel habit, bleeding, and pain. Wide local excision was performed in 10 patients, whereas a more radical surgical procedure, including abdominoperineal resection (n=8), pelvic exenteration (n=2), and low anterior resection (n=1), were performed in 11 patients. One tumor was unresectable. The overall survival until death from disease was 90% at 1 year, 74% at 5 years, and 51% at 10 years postoperatively. The percentage of patients free of disease at 1, 5, and 10 years postoperatively was 85, 62, and 40, respectively. Wide local resection was not superior to a more radical surgical approach in preventing tumor recurrence or improving survival. Lesions less than 2.5 cm and confined to the bowel wall can be treated by wide local excision, whereas larger or more extensive tumors should be treated by a more radical surgical approach.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01646866
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  • 5
    Electronic Resource
    Electronic Resource
    Postoperative intra-abdominal and pelvic sepsis complicating ileal pouch-anal anastomosis (1988)
    Springer
    International journal of colorectal disease 3 (1988), S. 149-152 
    Details
    ISSN: 1432-1262
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract In a series of 500 patients who underwent ileal pouch-anal anastomosis for ulcerative colitis or polyposis coli, significant intra-abdominal or pelvic sepsis developed in 30 (6%). Among the patients who did not require laparotomy because they responded to treatment with antibiotics or local drainage (surgical or radiologically guided) or both, no pouches were excised and the ileostomy closure rate (92%) was similar to that for the patients who did not have sepsis. The 17 patients whose sepsis did require laparotomy had a high rate of pouch excision (41%) (p〈0.0001) and a low rate of ileostomy closure (29%) (p〈0.0001). Factors identified as possibly associated with severe sepsis included female gender and ulcerative colitis complicated by toxicity or malignancy.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01648357
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  • 6
    Electronic Resource
    Electronic Resource
    Lack of a direct effect of the autonomic nervous system on glucose-stimulated gastric inhibitory polypeptide (GIP) secretion in man (1986)
    Springer
    Digestive diseases and sciences 31 (1986), S. 929-935 
    Details
    ISSN: 1573-2568
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract To determine whether the autonomic nervous system has a direct effect on GIP secretion, six normal subjects received a 4-hr intraduodenal perfusion of glucose (225 mg/min) and polyethylene glycol on four successive days. During the latter 2 hr, either normal saline, propranolol, phentolamine, or atropine were infused intravenously. Glucose absorption was calculated by measuring glucose and polyethylene glycol following luminal aspiration distal to the perfusion site. Basal and peak or nadir values in the saline study of plasma glucose, insulin, glucagon, and GIP were similar to the other three studies prior to autonomic blockade. During the latter 2 hr of the glucose perfusion, the plasma glucose and glucagon responses to saline did not differ from responses to the three blocking agents. Phentolamine but not atropine or propranolol resulted in a greater insulin response compared to saline (3247±762 vs 1348±388 μU/ml/120 min,P〈0.01). GIP was not significantly affected by phentolamine (18,146±4574), propranolol (7585±5854), or atropine (15,797±6297) compared to saline (11,717±5204 pg/ml/120 min). Glucose absorption was unaffected by infusions of saline, phentolamine, and propranolol, but was increased following atropine infusion (5841±1120 vs 1044±808 mg/120 min,P〈0.02). There appears to be no direct effect of the autonomic nervous system on glucose-induced secretion of GIP.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01303213
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