Outcome after 'curative' surgery for carcinoma of the lower third of the rectum.

Background: Controversy exists about the optimal surgical resection for lower third rectal carcinoma. The aim of this retrospective study was to analyse whether the type of surgery is a significant predictor of outcome after curative surgery alone.

Methods: Eighty-two consecutive patients underwent abdominoperineal rectum excision (APRE, 41 patients) or sphincter-saving operation (SSO, 41 patients) for adenocarcinoma at 3.

Influence of blood components and faeces on the in vitro cancericidal activity of povidone-iodine.

Background: Tumoricidal agents have been used to kill viable exfoliated tumour cells following colorectal cancer surgery. Recent in vivo experiments have thrown some doubt on the tumoricidal activity of povidone-iodine.

Methods: The cytotoxic effect of distilled water and of povidone-iodine at 0.

Stent grafts for iliofemoral occlusive disease.

This report summarizes the technical feasibility and early results of endovascular iliofemoral stented grafts in the treatment of iliofemoral occlusive disease. Twenty-four patients (mean age 71 years) underwent 29 lower-extremity inflow procedures for claudication (n = 7) or limb threatening ischaemia (n = 17). The technical success rate for endovascular grafts was 93% (n = 27).

Ehlers-Danlos syndrome type IV: a heterogeneous disease.

The Ehlers-Danlos syndrome is an inherited disorder of connective tissue, consisting of at least 10 different clinical subtypes. Type IV Ehlers-Danlos syndrome is an autosomal dominant condition characterized by the joint and dermal manifestations as in other forms of the syndrome but also by the proneness to spontaneous rupture of bowel and large arteries. The authors describe their experience with three patients presenting type IV Ehlers-Danlos syndrome: the first presented with several subsequent arterial ruptures, the second with multiple aneurysms, and the third with a dissection of the internal carotid artery.

Diagnostic accuracy of ultrasonography and surgical decision-making in patients referred for suspicion of appendicitis.

Two groups of patients referred for suspicion of acute appendicitis were compared to evaluate the accuracy of preoperative ultrasonography (US) and surgical decision-making. In one retrospective study, US was performed by trainees using a 3.5 MHz probe (219 patients).

Exfoliated tumour cells and locally recurrent colorectal cancer.

The presence of intraluminal viable exfoliated tumour cells has been demonstrated in patients with colorectal cancer. Several non-randomised studies found a significant reduction of the recurrence rate after the intraoperative luminal instillation of cytotoxic agents, as compared with "historical" patient series. Antiseptic solutions, e.

Autogenous reconstruction with the lower extremity deep veins: an alternative treatment of prosthetic infection after reconstructive surgery for aortoiliac disease.

Purpose: This report evaluates the efficiency of use of the lower extremity deep vein as arterial conduits in the autogenous repair of prosthetic infection after reconstructive aortoiliac surgery.

Methods: We reviewed our records for the period 1990 to 1994 of all patients with prosthetic infection after reconstruction for aortoiliac disease, and we selected for this study all those patients who underwent autograft repair with the lower extremity deep veins.

Results: Included were 15 patients: 12 had previously undergone direct aorto(ilio)femoral reconstruction, and three had an extraanatomic prosthetic graft.

Radical versus local surgical treatment for rectum carcinoma. A variety of options?

Local excision has to be classified as either indeterminate or non curative from a surgical oncological point of view. It seems to be an acceptable procedure for well differentiated, exophytic/polypoid pT1 lesions of less than 3 cm in diameter, providing the resection margins are tumour-free. For all other lesions radical surgery is to be preferred, unless the patient is unfit for major surgery or refuses an eventual permanent colostomy.

Manometric evaluation of incontinent patients.

The relationship between symptoms and manometric data was studied in incontinent patients. Conventional anal manometry, the rectal saline infusion test and the balloon-retaining test were performed in 27 control subjects (M:8, F:19; mean age: 47 yr) and in 40 incontinent patients (M:5, F:35; mean age: 49 yr). The correlation coefficient between the clinical degree of continence/incontinence and the maximum anal basal tone, squeeze pressure and the pressure increment during squeeze was -0.

Clinical value of whole-body positron emission tomography with [18F]fluorodeoxyglucose in recurrent colorectal cancer.

To assess the clinical value of whole-body positron emission tomography (PET) with [18F]fluorodeoxyglucose (FDG) in recurrent colorectal cancer, 35 patients were studied: 15 had resectable liver metastases, one a resectable lung metastasis, eight resectable pelvic recurrence, eight a presacral mass with equivocal findings on imaging, and three increasing serum levels of carcinoembryonic antigen (CEA) without clinical or radiological signs of recurrent disease. PET affected management decisions in seven of 16 patients with metastatic disease. In one of eight patients with pelvic recurrence demonstrated by computed tomography (CT), PET detected unknown pulmonary metastases.

Restorative proctocolectomy in elective and emergency cases of ulcerative colitis.

A consecutive series of restorative proctocolectomy for ulcerative colitis was reviewed to determine whether an emergency restorative proctocolectomy procedure leads to a higher morbidity, more especially anastomotic leakage. Severity of illness and nature of surgery were divided in two categories: (1) no acute disease and elective surgery (18 patients), (2) acute disease requiring emergency surgery either immediately or within one week of admission (12 patients). Morbidity after elective surgery was 27% and after emergency surgery 66% (P < 0.

The superficial femoral vein as autogenous conduit in the treatment of prosthetic arterial infection.

Autogenous reconstruction is a well-accepted alternative treatment for prosthetic infection after reconstructive arterial surgery. Because of its technical complexity and the lack of suitable substitutes, the procedure remains limited to a few selected centers. We describe four patients with prosthetic infection after reconstructive surgery for lower limb ischemia.

Left ventricular assist with an axial flow pump (Hemopump): clinical application.

Eighteen patients suffering from acute left heart failure were selected as candidates for Hemopump support. In 6 patients, peripheral atheromatosis prevented insertion of the device. Of the remaining 12 patients, 9 had postcardiotomy shock, 2 had acute rejection after orthotopic heart transplantation, and 1 had acute myocardial infarction complicated by a large postinfarction ventricular septal defect.

Valvular colonic sphincter substitutes. An experimental study in dogs.

Three types of colonic sphincter substitutes were placed at an abdominal colostomy in dogs. Simple valve construction (8) was based on orthograde intussusception of the colon over 3.5 cm.

Biofeedback defaecation training for anismus.

Anismus, paradoxical external sphincter function, spastic pelvic floor syndrome, rectoanal dysnergia, abdomino-levator incoordination for abdominopelvic asychronism, are all due to paradoxical contraction of the striated sphincter apparatus during voiding and is characterised by prolonged and excessive straining at stool. Biofeedback is the treatment of choice and has to be introduced at an early stage. We present the results of an ambulatory approach based on the integration of simulated balloon defaecation with small (50 ml) as well as constant rectal sensation volume, defaecometry and anal manometry.

Long-term patency of the aortofemoral Dacron graft. A graft limb related study over a 25-years period.

Graft limb patency was studied retrospectively in a consecutive series of 912 patients (1605 limbs), who received an aorto(bi)femoral Dacron graft for occlusive disease over a 25 years period (1963-1987). The mean follow-up for the series was 5.35 years (range 1 month to 23 years) and 18.

Intraobserver variation in the radiological measurement of the anorectal angle.

Seven experts drew the rectal axes of 18 representative proctographic images on two occasions, with a 1-year interval, in order to assess intraobserver variation in the determination of the anorectal angle (ARA). Intraobserver variation (6%) and interobserver variation (17%) were smallest when the central rectal axis was used to determine the ARA. A strong relation was found between inter- and intraobserver variation (r = 0.

Observer variation in the radiological measurement of the anorectal angle.

Determination of the anorectal angle (ARA) and the position of the pelvic floor is, theoretically, very important in understanding the mechanisms of anorectal continence and defaecation. The variability in the measurement of the ARA was analyzed. Nine experts drew ther rectal axis either as a line along the posterior wall of the distal rectum or as the central axis of the rectal lumen on the outlines of 18 representative proctographic images.

Recurrences after highly selective vagotomy in refractory and non-refractory duodenal ulcer disease.

The recurrence rate after highly selective vagotomy was evaluated in patients with chronic duodenal ulcer disease presenting non-refractory (64 cases) or refractory ulcers (41 cases) followed for 1 to 8 years postoperatively. Refractoriness was considered when an ulcer remained symptomatic and was not healed at endoscopy after 8 weeks (3 cases) or 12 weeks (30 cases) of appropriate treatment with cimetidine, or when it recurred during maintenance therapy and did not heal after adapted treatment (8 cases). The cumulative 5 year-recurrence rate was 28.

Balloon angioplasty combined with vascular surgery.

Seventy-nine intra-operative balloon angioplasties were performed in 72 patients undergoing a vascular reconstructive procedure over a 7-year-period (1981 through December 1987). The primary purpose of balloon angioplasty was either to increase inflow (26 procedures) or outflow (53 procedures) in association with a planned vascular operation and to avoid more extensive operative procedures in high risk patients. Peroperative balloon angioplasty involved atherosclerotic stenotic lesions in 26 iliac, 37 femoro-popliteal and 10 crural arteries.

A new balloon-retaining test for evaluation of anorectal function in incontinent patients.

The balloon-retaining test consists of progressive filling of a compliant intrarectal balloon in a patient in the sitting position. The pressure inside the balloon is monitored and the patient is asked to retain the balloon as long as possible and to report first, constant, and maximal tolerable sensation levels. A balloon is used to simulate semisolid and solid stool.

Defecometry. A new method for determining the parameters of rectal evacuation.

The parameters of defecation, i.e., maximum rectal pressure increase during straining, duration of effective evacuation, and the work performed to evacuate a simulated stool, can be quantified by defecometry, a new method to evaluate the defecation act.

The composition of anal basal pressure. An in vivo and in vitro study in man.

The maximal anal basal pressure (MABP) was measured with probes of 0.3, 1, 2 and 3 cm diameter in 21 subjects, 60 years old, without anal pathology. The components of MABP were analyzed by inducing a maximal internal sphincter (IS) relaxation, taking pressure measurements in the conscious state and during narcosis with curarization.

Limitation of experimental infarct size by drugs.

Testing drugs on their efficacy in limiting infarct size is difficult in the experimental setting because of the considerable variation in the sizes of infarcts produced in control animals, mainly in dogs. This variation in infarct size in the canine model is theoretically related to variations in the size of the ischemic bed or area at risk, in pre-existing collateral blood flow, and in myocardial metabolic demand. In this study, we identified the determinants of infarct size after different periods of coronary artery occlusion in unconscious dogs and constructed a mathematical model based on these determinants using stepwise logistic regression analysis.