Anal sensitivity test: what does it measure and do we need it? Cause or derivative of anorectal complaints.

Purpose: This study was undertaken to determine the anal sensitivity in controls and in different patient groups and to establish factors that determine anal sensitivity.

Methods: Anorectal function tests were performed in 387 patients with different anorectal diseases. Anal sensitivity was measured in 36 controls.

Elective laparoscopic-assisted sigmoid resection for diverticular disease.

Background: Although the laparoscopic-assisted approach to colorectal cancer remains controversial, its use for benign diseases can have important advantages. The purpose of this study is to determine the feasibility of this approach for the treatment of elective diverticular disease and to identify preoperative and perioperative factors which can help to select the best procedure for each patient: either assisted laparoscopic resection (ALR) or dissection-facilitated laparoscopic resection (DLR).

Methods: From November 1991 to the present, we conducted a prospective study of 41 patients approached electively for diverticular disease.

[Etiology of schizophrenia: review of genes-ambient interaction].

Schizophrenia is a disorder of extraordinary importance and complexity. Heterogeneity in the clinical presentation of schizophrenia is certain, which probably reflects heterogeneity in pathophysiology and etiology. Examination of various risk factors can give clues to the causes.

Third degree obstetric perineal tears: risk factors and the preventive role of mediolateral episiotomy.

Objective: To determine risk factors for third degree obstetric perineal tears and to give recommendations for prevention.

Design: Retrospective case control study.

Setting: A teaching hospital in The Netherlands.

Massive pleural effusion as isolated manifestation of metastatic spread of salivary adenoid cystic carcinoma.

Adenoid cystic carcinoma is a low-grade malignant neoplasm that arises preferentially in the major and/or minor salivary glands. While it has a tendency to spread locally, distant metastases have been described occasionally. This case report describes a patient with a massive pleural effusion as primary manifestation of metastatic adenoid cystic carcinoma.

Perioperative anti-endotoxin strategies.

Lipopolysaccharides from the outer membrane of Gram-negative bacteria are potent stimuli for the production of numerous cytokines by the immune cells. The systemic inflammatory response to these gut-derived endotoxins is therefore dependent on the responsiveness of the immune system. This paper presents results on anti-endotoxin strategies and the responsiveness to endotoxin in animal models of liver failure.

The influence of fixation delay on mitotic activity and flow cytometric cell cycle variables.

Proliferation variables such as mitotic activity and the percentage of S-phase cells have been shown to be of prognostic value in many tumors, especially in breast cancer. However, some studies reported a decrease in mitotic activity caused by delay in fixation of the tissue. In contrast, other studies showed that the identifiability of mitotic figures decreases after fixation delay, but the total number of mitotic figures and also the percentage of S-phase cells remain unchanged.

The Kahlbaum syndrome: a study of its clinical validity, nosological status, and relationship with schizophrenia and mood disorder.

Kahlbaum described catatonia as a disorder in which mood syndromes were the primary features and characteristic symptoms were the motor ones. However, after Kahlbaum this concept has not been taken into account and catatonia has been identified with motor features alone. In the present study, we assessed the clinical validity of Kahlbaum's concept of catatonia, its nosological position in relation to DSM-III-R, DSM-IV, and Leonhard's diagnostic criteria, and its relationships with schizophrenia and mood disorder.

Prognostic value of negative intraoperative ultrasonography in primary colorectal cancer.

The risk of developing recurrent tumour was assessed in a group of 85 patients with primary colorectal cancer who had a negative intraoperative ultrasonographic examination at the time of primary tumour resection. At a median follow-up of 40 months liver metastases had developed in 14 patients (16 per cent). Dukes classification of the primary tumours was stage A, B and C in one, three and ten patients respectively.

Aesthetic and functional reconstruction with the trapezius osseomyocutaneous flap and dental implants in oral cavity cancer patients.

The trapezius osseomyocutaneous flap is the only pedicled flap that is able to transfer vascularized bone for mandibular reconstruction as well as skin for intra-extra oral reconstruction. The trapezius muscle also helps to fill the defect created by the neck dissection and covers the vessels of the neck. This flap has been used in our maxillofacial surgery service during the past 14 years.

Immunological response in laparoscopic surgery.

Immunological response to surgical trauma may be protected during laparoscopic surgery. A less surgical trauma, in comparison with conventional surgery, may explained these important advantages. Plasma and macrophages studies have demonstrated that laparoscopic cholecystectomy causes less depression of cell mediated immunity than open cholecystectomy.

Laparoscopic rectopexy for complete rectal prolapse. Clinical outcome and anorectal function tests.

Background: The purpose of this study was to evaluate the clinical outcome of laparoscopic rectopexy and its effect on anorectal function investigations.

Methods: Twelve patients with complete rectal prolapse without constipation underwent laparoscopic rectopexy. Pre- and postoperative evaluation included scoring of incontinence, anorectal manometry, and anal endosonography.

Symptoms of the schizophrenic negative syndrome.

Background: The aim was an investigation of the symptom composition of the negative syndrome of schizophrenia.

Method: A hundred schizophrenic patients were assessed with various rating scales for positive and negative symptoms and typological criteria. A subgroup with a negative syndrome was defined, and a discriminant analysis performed using symptoms from the Scale for the Assessment of Negative Symptoms (SANS) as discriminant variables.

Anal sphincter repair improves anorectal function and endosonographic image. A prospective clinical study.

Purpose: This study investigated the effect of anal sphincter repair on fecal continence in relation to anal endosonography and anal manometry.

Methods: Eighteen patients (7 male, 11 female) with anal sphincter defects and complaints of fecal incontinence (5), soiling ( = liquid discharge; 3), or both (10) were studied before and after sphincter repair with endosonography and anal manometry. Complaints were the result of obstetric trauma (7), surgical trauma (7), both (3), and other trauma (1).

Detection of occult liver metastases by measurement of biliary carcinoembryonic antigen concentrations.

Objective: To assess whether biliary CEA concentrations can be used as early markers of occult liver metastases in patients with colorectal cancer.

Design: Consecutive open study.

Setting: University hospital, The Netherlands.

Neurological frontal signs and neuropsychological deficits in schizophrenic patients.

A higher prevalence of neurological signs (NS) has been described in schizophrenic patients when compared with controls or patients with other mental illnesses. This study, which includes a sample of 66 DSM-IIIR schizophrenics, was designed to assess the relationship between 7 frontal neurologic signs described by Luria and cognitive disturbances measured by an exhaustive neuropsychological battery. There was a statistically significant relationships between the frontal signs and the cognitive deficits (mean shared variance was 22%) which persisted after correcting for the influence of age, education, and duration of illness.

Increased soluble interleukin-1 type II receptor concentrations in postoperative patients and in patients with sepsis syndrome.

Plasma interleukin-1 (IL-1) activity is modulated in part through the simultaneous appearance of several inhibitors of IL-1 action, including interleukin-1 receptor antagonist (IL-1ra) and the soluble IL-1 type II receptor (IL-1RII). However, little is known concerning the plasma appearance of these inhibitors in patients following operative trauma or those with sepsis syndrome. In the present report, plasma IL-1beta, IL-1ra, and soluble IL-1RI and IL-1RII concentrations were evaluated in 118 patients with sepsis syndrome or after elective operative trauma.

Rectosigmoid neocolpopoiesis for male-to-female transsexuals: Amsterdam experience.

Penile skin inversion is the method of choice for vaginoplasty in male-to-female transsexuals. Rectosigmoid neocolpopoiesis should be considered only when penile skin inversion has become impossible or has not led to functional results. In this paper we describe our technique and the results of colocolpopoiesis in 7 male-to-female transsexuals.

Computed tomography and granulocyte scintigraphy in active inflammatory bowel disease. Comparison with endoscopy and operative findings.

The accuracy of computed tomography (CT) and [99mTc]HMPAO granulocyte scintigraphy (GS) for detection of bowel localization, inflammatory activity, and complications in acute inflammatory bowel disease (IBD) was prospectively studied in 32 patients. Of each bowel segment, findings on CT and GS were scored by one blinded observer. Findings on operation or endoscopy served as the gold standard.

Video-assisted thoracoscopic surgery in patients with clinically resectable lung tumors.

To investigate the feasibility of thoracoscopic resection, a pilot study was performed in patients with clinically resectable lung tumors. In 40 patients, Video-assisted thoracic surgery (VATS) was performed because of suspicion of malignancy. There were 29 men and 11 women with a median age of 54.

Antegrade colonic enema (ACE): a new therapeutic approach to chronic constipation.

Continent appendio-cecostomy is a recently developed operation for the therapy of chronic constipation, refractory for other treatment modalities. Two patients are described in whom the operation led to a dramatic improvement of their quality of life. Technical details of the operation are offered as well as some data on the possible mechanism of colonic motility in this pathological disorder.