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Query: UMLS:C0699790 (colon cancer)
 28,837 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Most operations on elderly patients are of an urgent nature. If time permits, measures to improve cardiac, respiratory and renal functions in the appropriate ways should be undertaken. During recovery from anesthesia careful but adequate sedation will reduce the risk of myocardial ischemia. Throughout the postoperative period constant encouragement of the older patient is particularly helpful.Transverse abdominal incisions and the frequent use of temporary gastrostomy are advocated.External hernia, hiatus hernia, peptic ulcer, carcinoma of the stomach, biliary disease, appendicits, intestinal obstruction, and carcinoma of the large intestine are discussed specifically, with special reference to the practical details of management in the elderly patient.
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PMID:Some aspects of abdominal surgery in the elderly patient. 582 19

The effects of subtotal colectomy on the survival of rats with established colon cancer induced by 1,2-dimethylhydrazine (DMH) have been investigated in an attempt to assess whether it might provide a suitable model of surgical treatment of this disease. 40 female Wistar rats received a regimen of DMH injections (40 mg/kg body weight s.c. every 14 days for 10 weeks) known to produce colon cancer. An additional 10 rats received no DMH, serving as controls (group 1). After presenting with signs of colonic disease at 25 weeks, all DMH-treated rats had diagnostic colonoscopy under general anaesthesia, only those with visible neoplasms (n = 34) being included in the study. These were randomised into two groups: group 2 (n = 13) animals were unoperated controls while group 3 (n = 21) animals had a therapeutic subtotal colectomy with histological confirmation of cancer in the resected colon. The animals were observed until death, the postoperative survival and cause of death at necropsy being compared between groups. The results showed that overall survival (p less than 0.013) and survival from death due to colon cancer (p less than 0.001) were significantly increased in the colectomised group 3 animals compared to unoperated controls (group 2). While 91% of the unoperated controls died of colon cancer, only 8% of the colectomised group died of this cause (p less than 0.001), the remainder dying from unrelated causes, predominantly DMH-induced primary extracolonic cancers. Subtotal colectomy in rats with DMH-induced colon cancer reduces mortality from this disease, providing a suitable model of surgical treatment. However, the high incidence of DMH-induced extracolonic cancers may make the model unsuitable for studies of adjuvant therapy.
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PMID:Subtotal colectomy in the dimethylhydrazine-treated rat. A surgical model of colorectal cancer. 717 84

In a prospective study, plasma levels of soluble fibrin (SF) were assessed in 97 patients with colorectal cancer immediately before and 1, 2, 7, and 90 days after surgery, 18 patients undergoing surgery for benign colorectal disease serving as controls. Age distribution, routine blood analysis, duration of surgery, perioperative blood loss and anaesthesia was similar in the two groups. SF was quantitated using a commercial enzyme-linked immunosorbent assay. The preoperative plasma level of SF was normal in cancer patients as a whole. However, patients with disseminated colorectal cancer had higher levels of SF preoperatively compared to patients with localized colorectal cancer (p < 0.01) and controls (p < 0.005). On days 1, 2, and 7 days postoperatively, a rather pronounced increase in plasma SF was observed in cancer patients as well as in the controls. Three months after surgery, plasma SF had normalized in controls and in patients undergoing curative cancer treatment. Postoperative deep venous thrombosis (DVT) was detected in 23% of the cancer patients by means of phlebography. The preoperative values of SF in these patients were higher compared to patients not developing DVT (p < 0.05). Patients with colon cancer displayed higher SF in plasma than patients with rectal cancer (p < 0.05).
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PMID:Soluble fibrin in plasma before and after surgery for benign and malignant colorectal disease. 750 73

Indications for microwave tumor coagulation (MTC) and percutaneous approach in liver tumor were investigated. The study population comprised 26 patients with unresectable liver tumor (4 with hepatocellular carcinoma, 22 with metastatic liver tumor) who underwent MTC at our department after April 1990. Concomitant therapies were alcohol injection in 2 patients, hepatectomy in 12 and selective arterial chemotherapy in 20. Percutaneous MTC was performed on 2 patients with a single lesion under general anesthesia. Following tip coagulation electrode penetration under echo guidance, the lesion was thermally coagulated at 60W. To establish indications for MTC by the effect of thermal coagulation, survival periods were compared by underlying disease, number of masses coagulated, and maximum tumor size, in 23 patients who had undergone MTC at least 1 year previously. Thirteen of these 23 survived for 1 year or longer, including all 3 with hepatocellular carcinoma, 3 with breast cancer, 2 with leiomyosarcoma (gastric, small intestine), 4 of the 10 with colon cancer and 1 of the 2 with pancreatic cancer. According to evaluation of the degree of coagulation, complete coagulation was obtained in 11 of 23, all of whom had at most 6 tumor masses (of up to 3 cm in diameter) coagulated, and 9 of whom survived for 1 year or longer. Percutaneous MTC, of low invasiveness, proved useful as a tool of regional cancer therapy.
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PMID:[Microwave tumor coagulation (MTC) in liver tumor: indication and percutaneous approach]. 794 20

A patient was a 67-year-old female, 153 cm tall and weighing 47 kg. In 1988, she noticed sudden hypotonicity of her extremities, which led her to visit our hospital. Diagnosis of polymyositis (PM) was made. Treatment started with prednisolone 60 mg.day-1, followed by 2.5-5mg.day-1 as a maintenance dose. Her clinical symptoms were alleviated. However, in October, 1994, colon cancer was found and she underwent sigmoidectomy. For anesthesia, thoracic epidural block (Th 11/12) was performed. No problems occurred during and after the surgery. The following points must be considered for anesthesia of a patient with PM: (1) enhanced or delayed effect of muscle relaxant, (2) pulmonary complications--aspiration pneumonia and lung fibrosis, (3) cardiomyopathy--arrhythmia and cardiac failure, (4) steroid supplementation. In our case, because cardio-pulmonary functions were almost normal, epidural anesthesia without using muscle relaxant was a successful method.
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PMID:[Anesthetic management for colon resection in a patient with polymyositis]. 872 Nov 34

A 66-year-old male with colon cancer was scheduled for left hemicolectomy. He had a past history of respiratory failure due to chronic obstructive pulmonary disease (COPD). Anesthesia method chosen was general anesthesia with sevo-flurane combined with epidural anesthesia. Respiration was managed with assisted ventilation using laryngeal mask airway and muscle relaxation was obtained with suxamethonium chloride given intermittently. After the operation, he did not seem to have COPD because of the relation between arterial PCO2 and bicarbonate in the perioperative period. Therefore, after obtaining informed consent from this patient, we determined the relation between arterial and spinal fluid acid-base balance under acetazolamide administration. He was more sensitive to central respiratory response because his respiration increased following the decrease of spinal fluid bicarbonate. We further examined and diagnosed him as Eaton-Lambert syndrome by evoked electromyography and by Ca2+ channel antibody.
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PMID:[Anesthetic management of a patient with Eaton-Lambert syndrome with chronic respiratory failure]. 1021 10

We report a case of ACTH deficiency. A 75-year-old man complained of anoxia, nausea and vomiting. Three years ago, he had an attack of loss of consciousness. On admission, his serum sodium level was down to 119.6 mEq.l-1. Plasma osmolality was low and urinary osmolality was high without edema, and he was diagnosed as having SIADH. After CRH test, rapid ACTH test and continuous ACTH test, he was diagnosed as having ACTH deficiency, and he was treated with steroids. One year later, he received urethrotomy due to urethrostenosis under spinal anesthesia with no trouble. In the next year, he was scheduled for sigmoidectomy due to sigmoid colon cancer under general anesthesia combined with epidural anesthesia. In the morning of his operation, he took hydrocortisone 10 mg per os. During operation, hydrocortisone 300 mg was given intravenously divided for three times. Plasma ACTH and aldosterone levels were below normal ranges, but serum cortisol was above the normal range. His operation was finished without troubles. Regarding this case, we discussed steroid therapy during anesthesia and operation.
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PMID:[A case of adrenocorticotropic hormone (ACTH) deficiency]. 1213 56

A 65-year-old male in malnutrition due to advanced colon cancer underwent resection of transverse colon tumor and the invaded abdominal muscles with necrosis and abscess. After epidural catheter insertion between Th 10-11 for 9 cm cephalad, anesthesia was induced with thiopental 200 mg and fentanyl 50 micrograms. Tracheal intubation was done with vecuronium 5 mg, and anesthesia was maintained with sevoflurane with nitrous oxide in oxygen and epidural block. During surgery, systolic blood pressure often went up to 130 to 140 mmHg and down to 50 to 60 mmHg. Dopamine 3-5 micrograms.kg-1.min-1 was administered but occasional ephedrine bolus injection was still necessary. The intestine, including the intact part, was edematous. After the surgery, when systolic blood pressure was stable at about 130 mmHg and his consciousness was clear with regular spontaneous respiration, the tracheal tube was removed. However, soon after the extubation, expiratory stridor and cyanosis of the bilateral hands and feet were observed. Hydrocortisone 200 mg and nicardipine 0.5 mg were administered and room temperature was raised. About 30 minutes later, stridor and cyanosis subsided. In the ward after surgery, only hoarseness was observed. The stridor might have been due to the laryngeal edema, which could be attributed to stimulation by tracheal tube in the patient with malnutrition. The hemodynamic instability during surgery and cyanosis after extubation might have come from changes of the vascular resistance by sepsis.
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PMID:[A case report of the laryngeal edema and peripheral cyanosis after extubation of the tracheal tube]. 1367 88

Tumor masses in the area between the esophagus and the tracheobronchial tree can lead to complications involving both systems, mainly strictures and compressions. Malignant esophageal strictures are nowadays often treated by insertion of a metal stent which, however, can cause airway compression especially in the proximal area. We present here a new method of creating a Y-stent out of two self-expandable tracheal nitinol stents, utilizing fiber bronchoscopy, in a 55-year-old woman with advanced colon cancer metastastic to the mediastinum. The endo-Y-stent technique can be performed with the patient under sedation and having topical anesthesia. The opening through which the second tracheal stent must be placed for the Y construction is created by laser. In this case, the patient suffered from airway compression which was efficiently relieved by this method. Within a short time the endo-Y-stent provides effective restoration and maintenance of airway patency in patients with tumor compression in the region of the esophagus and airway, and in those with airway compression following esophageal stenting. Expertise in both stent implantation and laser application is, however, mandatory.
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PMID:Y-nitinol airway stent for management of central airway compression due to metastatic colon cancer. 1455 66

We experienced a case of fulminant malignant hyperthermia during laparoscopic surgery, which is the first reported case of this kind. A 69-year-old man, weighing 69 kg, underwent laparoscopic colectomy for cecal colon cancer. He had a remarkable familial history of malignant hyperthermia (MH). His uncle had MH from enflurane. In addition, 6 male relatives died at operation, exercise or drinking. However, he hid it intentionally because of social concern about inheriting abnormal genes and of inadequate explanation from medical personnel. Anesthesia was induced with fentanyl 100 microg, propofol 60 mg and vecuronium 9 mg intravenousely and maintained with nitrous oxide, oxygen and sevoflurane. About 120 min after the induction of anesthesia (50 min after pneumoperitoneum), PETCO2 increased to 54 mmHg. Thirty min later, body temperature (BT), heart rate (HR), PETCO2 and airway pressure (Paw) increased rapidly to 37.5 degrees C, 92 beats x min(-1), 62 mmHg and 3/33 cmH2O, respectively. The diagnosis of MH was made. The inspiratory gas was changed to 100% O2, and a bolus of 100 mg dantrolene was given. He had BT of 39.7 degrees C, HR of 152 beats x min(-1), PETCO2 of 123 mmHg, Paw of 3/40 cmH2O at the worst point. Rise in Paw and arrhythmia turned up frequently as complications of laparoscopic surgery, but they are very similar to the first symptoms of malignant hyperthermia. The decrease in BT with CO2 pneumoperitoneum can mask symptoms of MH. Awareness of this fact is important not to delay the diagnosis.
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PMID:[First report of malignant hyperthermia which occurred during laparoscopic surgery in Japan in a patient with typical family history]. 1644 Jul 11


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