Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0022116 (ischemia)
 91,303 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The hospital and office records of 86 patients who underwent proctectomy for cancer of inflammatory bowel disease with primary closure of the perineal wound were reviewed. Almost one fourth of all patients suffered a significant perineal wound complication, the majority of which were infections. The incidence of postoperative perineal wound complications was comparable in both groups of patients. Urinary retention occurred in 24 percent of patients who underwent abdominoperineal resection or rectal cancer, and half of these patients required transurethral resection which indicates the need for more thorough preoperative assessment of bladder function, especially in older men. The development of leg ischemia that resulted in amputation in two elderly patients who had preoperative evidence of obstructive peripheral vascular disease suggests that a synchronous two-team abdominoperineal resection with the patient in the modified lithotomy position for a prolonged period should be avoided. One third of all patients were discharged less than 10 days after surgery and two thirds within 2 weeks. Prolonged stays were more frequent in cancer patients and appeared to be related to age rather than to the development of postoperative complications. The perineal wound after abdominoperineal resection for cancer healed more rapidly and more completely than did the wound after proctectomy for inflammatory bowel disease. Fourteen percent of the inflammatory bowel disease patients did not have a healed wound 1 year after surgery. The extent of rectal cancer as determined by Duke's classification played no role in healing of the perineal wound, but women with rectal cancer healed at a slower rate than did men. The location of the exit site for wound catheters and the use of cautery and preoperative steroid therapy appeared too have no effect on the healing of the perineal wound.
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PMID:Factors influencing perineal wound healing after proctectomy. 684 90

The role of conventional CT scan and conventional MR imaging in assessing patients with colorectal tumors is now well established. Because both techniques have an unacceptably low accuracy for identifying the early stages of primary colorectal cancers (T1, T2N0 or N1 and early T3N0 or N1, or Dukes stage A, B1 and 2, and C1), their routine use for preoperative staging is not recommended. This low staging accuracy is related to the fact that neither method can assess the depth of tumor infiltration within the bowel wall and both have difficulty in diagnosing malignant adenopathy. These distinctions are necessary in order to determine correctly patient prognosis and tumor resectability. If the various publications on CT scan and MR imaging staging of primary colon tumors are summarized, a mean overall accuracy of approximately 70% can be established. The sensitivity for lymph node detection of malignant lymphadenopathy is only about 45%. The sensitivity for detection of positive lymph nodes is better for rectal tumors because any adenopathy in the perirectal area can be considered malignant because benign adenopathy is not seen in this area. For the early stages of colon cancer or recurrent tumor at the anastomotic site, endoscopic ultrasound or TRUS is the method of choice. Both TRUS and MR imaging with endorectal coils can demonstrate the various layers of the rectal wall, but the ultrasonographic examination can be performed at lower cost and is less time-consuming. Despite these limitations CT scan and MR imaging are useful for assessing patients suspected of having extensive disease, including invasion of fat or neighboring organs or metastatic spread to distant sites including, liver, adrenals, lung, and so forth. CT scan and MR imaging are also helpful in the following ways: in determining whether a patient will benefit from preoperative radiation or whether a patient with rectal cancer can undergo a sphincter-saving procedure; for designing radiation ports; and for detecting complications related to the neoplasm, such as perforation with abscess formation or preobstructive ischemia in patients with complete obstruction by tumor. In these cases, management often is based on CT scan and MR imaging findings and cross-sectional follow-up studies can establish the success of treatment. CT scan and MR imaging have a premier role in the detection of recurrent colorectal cancer. CT scan and MR imaging are superior to colonoscopy for diagnosing extrinsic mass-like tumor recurrences and they are the only methods by which patients with total AP resection can be fully evaluated. The overall accuracy of CT scan and MR imaging for detecting recurrent colorectal tumors ranges from 90% to 95%. Following AP resection, CT scan cannot reliably determine whether a soft tissue density in the surgical bed represents recurrent tumor, and it is important to obtain CT scan baseline studies 4 months after surgery and to repeat this examination at 6-month intervals. Scar tissue, even if initially masslike, shrinks over time and after 1 year should be smaller and its margins more sharply defined. Any apparent increase in size of a mass or any demonstration of adenopathy must be considered an indication for biopsy. Recurrent tumors that do not extend to the pelvis or abdominal sidewalls or invade bone or nerves can be resected. Subtle tumor recurrence or tumor foci in small nodes can be detected by PET scan and immunoscintigraphy, but their future role in the diagnostic imaging of colorectal cancer patients depends on the results of ongoing studies. Helical CT scan has the advantages of fast volume scanning associated with optimal bolus delivery, absence of artifacts related to motion, absence of missed slices, and availability of reformations in multiple planes and three-dimensional reconstruction (virtual reality). The role of this technique in patients with colorectal neoplasms has not been defined. (ABSTRACT TRUNCATED)
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PMID:Colorectal cancer. Radiologic staging. 908 14

The reestablishment of anal function by transposition of the gracilis muscle, combined with the implantation of electrodes and a neuromuscular stimulator (dynamic graciloplasty), has recently been developed. With this method, the transposed muscle maintains contraction by electrical stimulation to maintain neoanal pressure without fatigue. It is necessary to convert the fatigue-prone gracilis muscle to fatigue-resistant muscle by long-term electrical stimulation (conditioning). In most patients receiving dynamic graciloplasty, the conditioning is accomplished after the transposition. However, conditioning before graciloplasty should reduce the risk of ischemia in the transposed muscle after the graciloplasty and improve the outcome. This new sequence of procedures is described, in combination with J-pouch construction, in a patient who required abdominoperineal excision of the rectum for lower rectal cancer. The graciloplasty was performed after conditioning of the gracilis muscle in situ; the conditioning did not cause the patient discomfort and resulted in good anal function.
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PMID:A new approach to dynamic graciloplasty. 949 33

Surgical policy was developed for improvement of functional results and quality of life in patients operated on for low rectal cancer. This policy includes choice of the method of sphincter-saving operation depending on the stage of the tumor, grade of malignancy, distance from a low edge of the tumor to dentate line. Methods of prevention of ischemia and necrosis of brought down colonic transplant and anal incontinence were used. This increased the number of sphincter-saving operations in low location of rectal cancer by 35%, reduced the rate of necrosis of intestinal transplant from 7 to 4.4%, saved continent function and improved significantly quality of life in 89.8% operated patients.
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PMID:[Abdomino-anal resection in the treatment of low-ampullar cancer of the rectum]. 1594 Jan 81

Small bowel perforation due to hematogenous metastatic tumor emboli is a rare event, especially in a patient with rectal cancer. We report a 75-year-old man with relapsed rectal cancer who developed an acute abdomen, which was found to be due to a perforated terminal ileum. Emergency surgery involved segmental resection and ileostomy. The pathology of the resected small bowel showed multifocal and extensive metastatic tumor emboli in the entire wall, leading to transmural infarction followed by perforation, without a discrete tumor mass. The pathology with immunohistochemistry showed a rectal tumor that was positive for CK-20 but negative for CK-7 and TTF-1. This extremely rare complication of rectal cancer resulted from ischemia and infarct caused by disseminated metastatic tumor emboli without direct invasion or mass formation.
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PMID:Infarction and Perforation of the Small Intestine due to Tumor Emboli from Disseminated Rectal Cancer. 2048 23

This review is devoted to current and emerging techniques in gastrointestinal (GI) imaging. It is divided into three sections focusing on areas that are both interesting and challenging: imaging of the small bowel and appendix, imaging of the colon and rectum and finally liver and pancreas in the upper abdomen. The first section covers cross-sectional imaging of the small bowel using the techniques of multidetector computed tomography (MDCT) (including CT enterography) and magnetic resonance imaging (MRI). The evaluation of mesenteric ischemia and GI tract bleeding using MDCT angiography is also reviewed. Current imaging practice in the evaluation of appendix is also reviewed and illustrated. The second section reviews CT and MR colonography and imaging of the rectum. It describes CT virtual colonoscopy (CTVC) with emphasis on the advantages and disadvantages of the technique with discussion of the role of CTVC in screening. The intriguing topic of MR colonography (MRC) is also reviewed. Imaging of the rectum with emphasis on imaging of rectal cancer is described with the roles of CT, MR, endoluminal ultrasound and positron emission tomography scanning discussed. The final section reviews current and emerging techniques in liver imaging with the role of ultrasound including contrast ultrasound, MDCT and MR (including contrast agents) discussed. The new developments and applications of imaging of pancreatic disease are discussed with emphasis on the role of MDCT and MRI with gadolinium. This review highlights the current role and advancement of imaging techniques with new diagnostic and prognostic information pertinent to gastrointestinal disease continuing to emerge.
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PMID:Current and emerging techniques in gastrointestinal imaging. 2062 90

We herein describe a case with an internal hernia that developed after laparoscopic abdominoperineal resection for rectal cancer. The small intestine passed through the space between the sigmoid colon loop of the stoma and the abdominal wall. Internal hernias associated with colostomy are rare; however, the condition is an important complication, because it causes ischemia in both the herniated intestine and the sigmoid colon pulled through the abdominal wall as a stoma.
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PMID:Internal hernia associated with colostomy after laparoscopic abdominoperineal resection. 2360 74

The aim of this review is to characterize the functional results and "anterior resection syndrome" (ARS) after sphincter-saving surgery for rectal cancer. The purpose of sphincter-saving operations is to save the anal sphincters by avoiding the need for rectal abdomino-perineal resection with a permanent stoma. A variety of alternative techniques have been proposed and, today, ultra-low anterior resections of the rectum are commonplace. Inevitably rectal resections modify anorectal physiology. The backdrop of the functional asset for ultralow anterior resections is related to a small neorectal capacity with high endo-neorectal pressures that act together on a weakened sphincteric mechanism. Sometimes a defecation disorder called ARS may be induced and the patient experiences an extremely low quality of life. Impaired bowel function is usually provoked either by colonic dysmotility, neorectal reservoir dysfunction, anal sphincter damage or by a combination of these factors. Surgical technique defects can contribute to these possible causes: anastomotic ischemia, short length of the descending colon and stretching of neorectal mesentery may play a role. Unfortunately, there is no therapeutic algorithm or gold standard treatment that may be used for ARS. Nevertheless, it is rational to use conservative therapy first and then resort to surgery. Drugs, rehabilitative treatment and sacral neuromodulation may be used; after failure of conservative methods, surgical treatment can be considered.
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PMID:A review on functional results of sphincter-saving surgery for rectal cancer: the anterior resection syndrome. 2375 96

Four consecutive cases of a colonic stricture following a da Vinci robot-assisted ultra-low anterior resection (LAR) with coloanal anastomosis and diverting ileostomy for the treatment of rectal cancer are reported. The colonic strictures developed after early proximal colonic ischemia without anastomotic site leakage or disruption. All patients were treated with preoperative chemoradiation therapy. During the postoperative recovery period, patients developed colonic ischemia, presenting with a high, spiking fever, but without any symptoms of peritonitis. Patients were treated with conservative management (antibiotic therapy) and discharged after two weeks when in good condition. Several months after discharge, all four patients developed a long-segment colonic stricture from the anastomosis site to the distal colon. Management of the colon strictures, including the anastomotic site, involved colonic dilation with a Hegar dilator in an outpatient clinic for several months. The ileostomies in three patients could not be closed.
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PMID:Colon Stricture After Ischemia Following a Robot-Assisted Ultra-Low Anterior Resection With Coloanal Anastomosis. 2636 18

A 78 -year-old man with rectal cancer underwent abdominoperineal resection of the rectum. In the postoperative period, the patient experienced wound infection, leading to an abdominal wall hernia. Two years following surgery, a rise in the serum CEA level was seen. A metastatic tumor was detected in the right lung on chest CT. VATS right lung inferior lobe segmental resection was performed. After lobectomy, the serum CEA level continued to increase. Another metastatic tumor was detected in the right lung on chest CT. Chemotherapy with capecitabine, oxaliplatin, and bevacizumab was commenced. The erosive part of the abdominal wall scar hernia extended during the nine weeks of chemotherapy. The chemotherapy was then discontinued. In the follow-up CT scan, a right pleural recurrence, local recurrence in the pelvis, and a liver metastasis were detected. Chemotherapy was re-introduced 3 years after surgery. The erosive part of the abdominal wall hernia again began to spread with chemotherapy recommencement. Four months after restarting chemotherapy, the hernia ruptured, with a loop of the small intestine protruding out of it. The patient covered this with a sheet of vinyl and was taken by the ambulance to our hospital. The erosive part of the abdominal wall hernia had split by 10 cm, and a loop of the small intestine was protruding. As ischemia of the small intestine was not observed, we replaced it into the abdominal cavity, and performed a temporary suture repair of the hernia sac. Following this, bevacizumab was discontinued, and the erosive part reduced. We performed a radical operation for abdominal wall scar hernia repair 11 weeks after the discontinuation of bevacizumab.
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PMID:[A Case of Abdominal Wall Hernia Rupture during Bevacizumab Treatment]. 2680 94


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