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Query: UMLS:C0036690 (sepsis)
 59,461 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Sixty-five patients with low rectal cancer 4-9 cm from the anal margin were treated by rectal resection and direct colo-anal anastomosis. The procedure simultaneously combined abdominal dissection with the patient in the lateral position with a trans-sphincteric approach. In 57 cases a temporary defunctioning colostomy was performed. There were no postoperative deaths. Six patients (9 per cent) developed pelvic sepsis or anastomotic leakage. Faecal continence was normal in 46 of 51 patients (91 per cent) who were operated on at least 1 year previously. The remaining 5 complained of occasional minor soiling. No patients require a permanent colostomy for incontinence. Of 29 patients treated for potential cure greater than 3 years previously, 24 (82 per cent) were alive without recurrence. Local recurrence occurred in four patients (6 per cent). Direct colo-anal anastomosis using a combined abdominotrans-sphincteric approach has produced good functional results without impairing the patient's life expectancy.
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PMID:Synchronous abdominotrans-sphincteric resection of low rectal cancer: new technique for direct colo-anal anastomosis. 373 Jul 92

This is an analysis of 23 patients with clinically and/or surgically unresectable adenocarcinoma of the rectum on initial evaluation who were treated with preoperative irradiation and surgery between March 1970 and April 1981. All patients have had follow-up for at least 5 years. Five patients (22%) had exploratory laparotomy and diverting colostomy before irradiation. All patients were irradiated with megavoltage equipment to the pelvis at 180 rad/fraction, continuous-course technique. Total doses ranged from 3500 to 6000 rad with a mean of 4800 rad and a median of 5000 rad. All patients had surgery 2-11 weeks (mean: 4.9 weeks; median: 4 weeks) after radiation therapy. Twelve patients (52%) had lesions that were incompletely resected because of positive margins (7 patients), distant metastasis (1 patient), or both (4 patients). All of these patients died of cancer within 5 years of treatment. Eleven patients had an apparent complete excision of their rectal cancer; six patients (55%) subsequently had a local recurrence. The 5-year absolute survival rate for patients who had complete resection was 18% (2 of 11 patients). The 5-year absolute and determinate survival rates for the entire study were 9% (2 of 23 patients) and 9% (2 of 22 patients), respectively. One patient (in the incomplete resection group) died after operation secondary to sepsis and diffuse intravascular coagulation.
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PMID:Initially unresectable rectal adenocarcinoma treated with preoperative irradiation and surgery. 380 Apr 61

The popular view of ileorectal anastomosis for ulcerative colitis as an operation of above average mortality and morbidity is supported by the results of this series. Great care must be taken to differentiate ulcerative colitis from Crohn's disease of the colon, as it is clear from consideration of their clinical course that they are different disease entities with a different prognosis. It is suggested that the more general adoption of Aylett's operative technique would reduce the number of failures due to sepsis. There appears to be a group of patients, 15% in this series, who will be failures because of intractable diarrhoea despite a technically adequate and successful operation, but it might be possible to reduce these with modern medical therapy given postoperatively.Patients with a preoperative history of more than 10 years' disease appear to do better than the others. An actively diseased rectum does not appear adversely to affect the result, and the fulminating disease is not a counter indication to a staged ileorectal anastomosis. The use of steroids preoperatively does not appear to affect the healing of the anastomosis or the longterm result of the operation. No case of carcinoma of the rectum has occurred in this series but there has been histological evidence of premalignant change in two patients. The need for a strict follow-up programme, including regular sigmoidoscopy and rectal biopsy, is emphasized.
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PMID:The results of ileorectal anastomosis at St Mark's Hospital from 1953 to 1968. 542 3

Two hundred and seventeen patients, undergoing abdominal colonic and rectal surgery, received after randomization, the following regimen: group A (74 patients): cefotaxime 1 g intravenous at the induction of anaesthesia, the beginning of the resection, 4 and 8 h later; group B (72 patients): cefotaxime in the same regimen associated with ornidazole or metronidazole 0.5 g intravenous at the induction of anaesthesia and 0.5 g intravenous with the last injection of cefotaxime; group C (71 patients):cefotaxime following the same regimen as groups A and B and metronidazole orally 0.5 tds 3 days before surgery. All wounds were assessed daily, until discharge from hospital. Severe sepsis included: septicaemia, peritonitis, intra-abdominal abscess and extra-abdominal infections with death. Non-severe sepsis included all others. All the patients having a history of allergy to beta-lactam antibiotics and those with pre-operative infection were excluded. Mean age of the population was: 64.5 years. Seventy-seven patients had rectal cancer and 82 patients cancer of the colon; Twenty-five patients had inflammatory bowel disease, and in 33 others disease such as polyposis was present. Risk factors of post-operative infection were present in 115 cases (A, 36 patients; B, 37 patients; C, 42 patients). All three groups were very well matched for age, sex, type of intervention and diagnosis. Non-infectious complications appeared in 56 patients. Sepsis developed in 76 patients (A, 27 patients; B, 27 patients; C, 22 patients, no significant difference). Severe sepsis occurred in 14 patients (A, 6 patients; B, 4 patients; C, 4 patients, no significant difference) and in 62 patients non severe sepsis (A, 21 patients; B, 23 patients; C, 18 patients, no significant difference). Post-operative peritonitis was not seen. This study suggests that cefotaxime alone 4 g peri-operatively is useful in prophylaxis during rectal and colonic surgery.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Prophylactic use of cefotaxime in colonic and rectal surgery. 609 48

The incidence of small-intestinal obstruction requiring surgical relief following resection for a single carcinoma of the rectum in 1061 patients is reviewed. Forty-eight patients (4.7%) required surgical relief. There were no postoperative deaths. In 18 patients small-intestinal obstruction occurred within the first six weeks of resection. Each obstruction was related to postoperative complications, especially intraabdominal sepsis. In 30 patients the obstruction developed after this period and was due to bands and/or adhesions. The majority occurred within the first two years. The incidence of intestinal obstruction was similar after both curative and palliative resection. Extensive pelvic dissection did not influence the incidence. The paracolostomy lateral space was not closed in patients treated by abdominoperineal excision. There was no incidence of paracolostomy obstruction.
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PMID:Small-intestinal obstruction following resection for carcinoma of the rectum. 616 60

Over a three-year period, 1980-82, 79 per cent of our patients with rectal cancer were treated with the intention of cure, and sphincter-saving procedures were performed in 62 per cent of these cases. This report concerns 21 patients with mid-rectum cancer operated on with low anterior resection and extraperitoneal EEA-stapled anastomosis. Nine patients had Dukes' stage A tumors, seven had stage B, and five had stage C tumors. An 86-year-old woman died in the sixth postoperative week, and a 74-year-old man died after 20 months with a probable recurrence. Nineteen patients are currently alive 4 to 40 months post-operatively, with no overt signs of recurrence. We cannot confirm recent alarming reports on a significant incidence of early local recurrence. Routine Gastrografin enemas were performed and offered very little in terms of clinical guidance. Significant anastomotic leakage occurred in four patients, although without clinical symptoms or the need for fecal diversion. Despite initially intact anastomoses in 13 patients, pelvic sepsis with late dehiscence developed in three, all of whom required fecal diversion. The clinical leak rate was thus 3 of 21, 14 per cent, and the total incidence of leakage 7 of 21, 33 per cent. We performed routine colostomy on the first three patients but, in retrospect, believe this was unneccessary. Only one of the 19 survivors still has a colostomy, due to a benign anastomotic stricture. We consider anterior resection of mid-rectum carcinoma with EEA-stapled anastomosis a highly feasible procedure, the curative potential of which, however, can be established only by long-term follow-up studies.
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PMID:EEA stapler for mid-rectum carcinoma. Review of recent literature and own initial experience. 664 59

Management of the perineal wound following rectal excision was assessed in 57 patients at the Toronto General Hospital; 40 had ulcerative colitis, 4 had Crohn's disease, 10 had carcinoma of the rectum, 2 had carcinoma of the anus and 1 had anal incontinence. The preferred technique was careful anatomical dissection with meticulous hemostasis, and primary skin closure with a laterally placed closed Hemovac suction system. Alternatively, wounds were packed and allowed to heal secondarily. Overall, the perineal wound healed primarily in 41 patients (72%). Primary closure was possible in 50 patients (88%); in 41 (82%) the wound healed without complication but in 9 (18%) the wound had to be opened because of hematoma and abscess (8 patients) or bleeding (1 patient). In 41 (91%) of the 44 patients with inflammatory bowel disease the perineal wound was closed primarily; 34 wounds (83%) healed without complication. In seven patients the perineal wound was packed at surgery because of bleeding (four), fecal spillage (two) or sepsis (one). Healing time averaged 6 months. These results indicate that primary closure is the optimal management of perineal wounds. Primary healing is achieved in a high proportion of patients and postoperative morbidity is decreased. Results are excellent in patients with inflammatory bowel disease as well as in those with carcinoma.
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PMID:Primary perineal wound closure following excision of the rectum. 682 98

Resection with preservation of the anal sphincters is new widely accepted as providing satisfactory treatment for carcinoma of the upper rectum. However, restorative resection is less widely performed for tumours of the lower rectum because anastomosis can be technically difficult when performed low in the pelvis. Between 1973 and 1980, 76 patients with rectal carcinoma underwent rectal resection and restoration of bowel continuity by means of a sutured anastomosis between colon and anal canal. The pathological characteristics of these tumours were similar to those of all cases of carcinoma of the rectum treated at St. Mark's Hospital between 1948 and 1972. Two patients developed pelvic sepsis following colonic necrosis and anastomotic breakdown. Eight developed pelvic sepsis without major anastomotic breakdown. No patient died as a result of pelvic sepsis. Sixty-nine of the 70 patients who were able to be assessed were either completely normal functionally or had only minor deficiencies of bowel function. Six patients have been observed to develop recurrent pelvic tumour, localized to the pelvis in 4 patients and concurrent with the development of widespread metastases in 2. Twenty-one of 32 patients are alive 3 years and 12 of 19 patients are alive 5 years after a curative operation for rectal carcinoma. These results are comparable with those seen following total excision of the rectum and pelvic floor for similarly sited tumours.
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PMID:Resection and sutured colo-anal anastomosis for rectal carcinoma. 708 51

The technique of the Turnbull-Cutait pullthrough procedure as performed at the Cleveland Clinic for carcinoma of the rectum and other conditions is described. The results in 127 patients are reported. Eighty-four patients were operated upon for cancer of the rectum and 47 for miscellaneous benign conditions. The average distance of tumors from the anal margin was 7.6 cm. The average margin of resection was 4.1 cm. The overall operative mortality was 1.2% in the cancer group. Ischemic necrosis occurred in 1.2% of the cancer patients, and minor pelvic sepsis occurred in 7.1%. The five-year survival in Dukes' A, B and C carcinoma of the rectum was 100%, 57% and 53%, respectively. The incidence of pelvic recurrence of the tumor at 6% was within acceptable limits. The quality of bowel function following the pullthrough procedure is discussed. It is concluded that this pullthrough procedure has a significant role in the management of carcinoma of the rectum and other conditions.
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PMID:The Turnbull-Cutait pullthrough procedure for certain cancers of the rectum and Hirschsprung disease. 725 Nov 72

Between May 1989 and April 1993 we treated 108 patients, aged 44-82 years, for rectal cancer. Of them, 7 men and 2 women underwent anterior resection with colo-anal anastomosis. In this group the average distance of the tumor from the anal verge was 6 cm. Follow-up ranged from 12-48 months. There was no operative mortality. Perioperative morbidity included wound infection in 1 patient and pelvic sepsis in another; temporary disturbances in micturition occurred in 4; 1 developed an anastomotic stricture and another intestinal obstruction; 1 died of systemic spread; another was reoperated and salvaged, but had a local recurrence 3 years after the first operation. Continence was achieved in 6, while 3 had minor impairment of control. Frank incontinence did not occur. We believe that anterior resection with colo-anal anastomosis in low rectal cancer avoids a permanent colostomy, while meeting oncological and functional criteria. We advocate this procedure in selected patients with low rectal cancer.
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PMID:[Anterior resection with colo-anal anastomosis for low rectal cancer]. 803 62


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