ebook img

Colo-Proctology: Proceedings of the Anglo-Swiss Colo-Proctology Meeting, Lausanne, May 19/20, 1983 PDF

188 Pages·1984·4.33 MB·English
Save to my drive
Quick download
Download
Most books are stored in the elastic cloud where traffic is expensive. For this reason, we have a limit on daily download.

Preview Colo-Proctology: Proceedings of the Anglo-Swiss Colo-Proctology Meeting, Lausanne, May 19/20, 1983

Colo-Proctology Edited by 1.-Cl. Givel and F. Saegesser With Contributions by N. V. Addison N. S. Ambrose 1. C. Bonello M. Boumghar D. C. Britton P. Buchmann N. D. Carr R. Cavin S.l. Cawthorn A. Essinger G. Feifel W. Frank I. D. Fraser Ph. Gertsch F. Halter F. Harder F. B. Huber 1.-P. Mach M.-C. Marti R.l. Maxwell M. Merlini G. Mori R. W. Motson c.-A. Muller A. Munro 1. Papillon W. Pugsley A. Rohner P. Shouler T. H. Walsh H. L. Young With 85 Figures and 66 Tables Springer-Verlag Berlin Heidelberg New York Tokyo 1984 Proceedings of the Anglo-Swiss Colo-Proctology Meeting Lausanne, May 19/20, 1983 Dr. med. Jean-Claude Givel Chef de clinique, Service de Chirurgie "A", Centre Hospitalier Universitaire Vaudois CH 1011 Lausanne, Switzerland Prof. Frederic Saegesser Chef du Service de Chirurgie "A" Centre Hospitalier Universitaire Vaudois CH 1011 Lausanne, Switzerland ISBN-13: 978-3-540-12557-0 e-ISBN-13: 978-3-642-95439-9 DOl: 10.1007/978-3-642-95439-9 Library of Congress Cataloging in Publication Data. Anglo-Swiss Colo-Proctology Meeting (1983 : Lausanne, Switzerland) Colo-proctology. "Proceedings of the Anglo-Swiss Colo Proctology Meeting, Lausanne, May 19120, 1983" - T.p. verso. Includes bibliographical ref erences and index. 1. Colon (Anatomy) - Diseases - Congresses. 2. Rectum - Diseases - Congresses. 3. Anus - Diseases - Congresses. 4. Intestines - Cancer - Congresses. I. Givel, J.-C!. (Jean-Claude), 1946- . II. Saegesser, Frederic. III. Addison, N. V. IV. Title. RC 860. A 54 1983 616.3'5 83-20357 This work is subject to copyright. All rights are reserved, whether the whole or part of the material is concerned, specifically those of translation, reprinting, re-use of illustrations, broadcasting, reproduction by photocopying machine or similar means, and storage in data banks. Under § 54 of the German Copyright Law where copies are made for other than pri vate use a fee is payable to 'Verwertungsgesellschaft Wort', Munich. ©Springer-Verlag Berlin Heidelberg 1984 Softcover reprint ofthe hardcover I st edition 1984 The use of registered names, trademarks, etc. in the publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. Product Liability: The publisher can give no guarantee for information about drug dosage and application thereof contained in this book. In every individual case the respective user must check its accuracy by consulting other pharmaceutical literature. Typesetting and binding: G.Appl, Wemding, printing: aprinta, Wemding 2124/3140-543210 Preface The Anglo-Swiss Colo-Proctology Meeting, held at Lausanne in May 1983, enabled numerous specialists to share their experiences of lower gastrointestinal tract pathology. The focus was on ischae mic disease and tumours of the colon, rectum and anus. By featuring ischaemic disease in our programme we hoped to give this too often underestimated process a fair hearing. Ischaemic lesions are far more common than is recognised on clinical grounds alone, particularly in the gastrointestinal tract. Large intestine is chaemia is often confused with other syndromes, especially since the clinical features evoked are, in most cases, atypical. Thus diag nosis is frequently late, with dramatic consequences. The oncology section basically discusses the early diagnosis of gastrointestinal tumours, a prerequisite for improving survival in af fected patients, and also presentation and treatment of certain rare tumours. The third section of this volume covers various diverse subjects including surgical technique, functional disorders of the large intes tine, inflammatory bowel disease, haemorrhoids and investigatory procedures. Several of the articles come from international authorities in their field. Some communications contain unpublished results, and others may lead to new diagnostic and therapeutic methods. We feel that the quality and variety of the texts from the Anglo-Swiss Colo Proctology Meeting merit wide appreciation. We are grateful to Springer-Verlag for accepting these proceed ings for publication. Jean-Claude Givel Frederic Saegesser Contents List of Contributors . . . . . . . . . . . . . . . . . . . . . . . . XI Part I: Vascular Disorders of the Intestine ............ 1 Ischaemic Damage to the Distal Bowel Following Angioplastic Surgery for Infrarenal Aortic Aneurysm or Aorto-Ilio-Femoral Obstruction (Leriche's Syndrome) (M. Boumghar and M. Naef) . . . . . . . . . . . . . . . 3 The Colonic Microcirculation (N. D. Carr and P. F. Schofield) 11 Why is Mortality still so high in Ischaemic Bowel Disease? (F. B. Huber) . . . . . . . . . . . . . . . . . . . . 26 Vasopressin and Blood Flow in the Canine Colon (RJ. Maxwell and T.G. Parks) . . . . . . . . . . 31 Mesenteric Vessel Obstruction and Oral Contraceptives (R. Cavin, G. Chapuis, and F. Saegesser) . . . . . . . 35 Successful Treatment of Acute Mesenteric Ischaemia (Ph. Gertsch, G. Buchheim, and R Mosimann) . . 46 Elective Colonic Resection for Ischaemic Strictures (N. V. Addison) ................... 50 Part II: Tumours of Colon, Rectum and Anus . . . . . . . . . .. 55 Peutz-Jeghers Syndrome. The Experience of Sixteen Patients (I. D. Fraser, J. P. S. Thomson, and H.J. R Bussey). . . . .. 57 Leiomyomata and Leiomyosarcomata of the Rectum and Anal Canal (T. H. Walsh and C. V. Mann) . . . . . . . . . . . .. 59 Desmoid Disease Associated with Adenomatous Polyposis. One Hospital's Experience of Twenty-three Patients (I. D. Fraser, J. P. S. Thomson, H.J. R Bussey, and P. R. Hawley) ...................... 63 Monoclonal Antibodies against Carcinoembryonic Antigen for the Detection of Human Colon Carcinoma by Immunoscintigraphy (J.-P. Mach, F. Buchegger, M. Forni, J. Ritschard, Ch. Haskell, S. Carrel, A Froidevaux, and A. Rohner) . . . . . . . . . . . . . . . . . . . . . . . .. .. 66 Asymptomatic Faecal Occult Blood Screening: A Practical Solution to the Diagnosis and Treatment of Colorectal Cancer? (D. C. Britton, P. A Farrands, and R. L. Griffiths) 73 The Value of Cytology in the Diagnosis of Colonic Cancer (F. Halter, A Dolder, P. Meyrat, U. Scheurer, and P. Gretillat) 74 The Value of CEA as a Determinant of Prognosis in Colorectal Cancer (w. Pugsley and R H. Grace). . . . . . . . . . . .. 78 Causes of Delay in the Early Diagnosis of Colorectal Cancer (C.-A Muller) . . . . . . . . . . . . . . . . . . . . 81 The Ultrasonic Imaging of the Rectum (G. Feifel, U. Hildebrandt, B. Kock, and C. Alzin) ...... 86 Surgical Treatment and Prognosis in Colorectal Cancer. Report on 1357 Cases (M. Merlini, A Besson, and F. Saegesser). 92 Multidisciplinary Approach of Anal Canal Epidermoid Carcinoma (M.-C. Marti, G. Pipard, and R Peytremann) . 98 Liquid Nitrogen in Palliative Treatment of Low Rectal and Anal Carcinoma (w. Frank and G. Kost) ...... . 102 New Prospects in the Management of Squamous Cell Carcinoma of the Anal Canal (J. Papillon). . . . . . . 112 Part III: Miscellaneous ...................... 117 Abnormalities of Anorectal Function in Patients with Chronic Constipation who are Unable to Defaecate. (P. Shouler, M. R B. Keighley, and P. W. Dykes) .............. 119 Defaecography (M.-C. Marti and D. Mirescu) . . . . . . . . . . 122 The Electromyography of the External Sphincter Muscle in Supercontinent and Incontinent Patients (G. Mori, D. Passerini, G. Pezzoli, and A Tajana) ..... . 127 Park's Per-Anal Repair of Recto-Prostatic Fistula (R W. Motson, R. C. Tiptaft, and J. P. Blandy) . . . 136 Restorative Proctocolectomy with Ileal Reservoir (A Rohner and R.de Peyer) ......................... 144 Healing of the Perineal Wound after Intersphincteric Dissection of the Rectum for Inflammatory Bowel Disease (A Munro, P.F.Jones, and RAKeenan) ........... 146 Prevention of Anastomotic Leakage in Colorectal Surgery: Results of a Prospective Randomised Double-Blind Trial of Aprotinin (Trasylol) in Colonic Surgery (H. L. Young and M. H. Wheeler) ...................... . 153 The Parasacral Approach for Rectal Prolapse (F. Harder, M. Durig, and A Huber) . . . . . . . . . . . . . . . . . . 159 A Prospective Randomised Trial to Compare Mezlocillin and Metronidazole with Cefuroxime and Metronidazole as VIII Prophylaxis in Elective Colorectal Operations (N.S.Ambrose, D. W.Burdon, M.R.B.Keighley, and 1. Alexander-Williams) . . . . . . . . . . . . . . . . . . 163 Ten-Year Experience with a Modified Whitehead Haemorrhoidectomy (1. C. Bonello and G. B. Thow) . .. . 165 Why Do Patients with Haemorrhoids Benefit from Lord's Procedure? (P. Buchmann and I. Babotai) . . . . . . . .. . 166 A Simple Combined Clinical and Laboratory Index ofCrohn's Disease (S.l.Cawthorn and C.G.Marks) . . . . . . . .. . 169 Iatrogenic Lesions of the Rectum (A. Essinger and S. Aguet) . . 173 Subject Index ............................ 181 IX List of Contributors N. V.Addison, The Royal Infirmary, GB-Bradford BD9 6RJ, West Yorkshire, England N.S.Ambrose, The General Hospital, GB-Birmingham B4 6NH, England J. C. Bonello, Carle Foundation Hospital, University of Illinois, Urbana, IL 61801, USA M. Boumghar, Service Universitaire de Chirurgie A, CHUV, CH-1011 Lausanne, Switzerland .. D. C. Britton, Royal United Hospital, GB-Bath BA1 3NG, England P. Buchmann, Chirurgische Klinik A, Universitatsspital, CH-8091 Zurich, Switzerland N.D.Carr, Withington Hospital, GB-Manchester M20 8LR R. Cavin, Service Universitaire de Chirurgie A, CHUV, CH-1011 Lausanne, Switzerland S.J.Cawthorn, The Royal Surrey County Hospital, GB-Guildford, Surrey, England A. Essinger, Service Universitaire de Radiologie, CHUV, CH- 1011 Lausanne, Switzerland G. Feifel, Abteilung fUr allgemeine Chirurgie, Universitatsklinik, D-6500 Homburg, Saar, Germany W. Frank, Klinik Nymphenburg, MontenstraI3e 3, D-8000 Munchen 19, Germany I. D. Fraser, St. Mark's Hospital, GB-London EC1V 2 PS, England Ph. Gertsch, Service Universitaire de Chirurgie B, CHUV, CH-1011 Lausanne, Switzerland F. Halter, Abteilung fUr Gastroenterologie, Inselspital, CH-3010 Bern, Switzerland XI F. Harder, Department fUr Chirurgie, Kantonspital, CH-4031 Basel, Switzerland F. B. Huber, Chirurgische Abteilung, Krankenhaus, CH-8810 Horgen, Switzerland J.-P. Mach, Ludwig Institute for Cancer Research, CH-l066 Epalinges, Switzerland M.-C. Marti, Policlinique Universitaire de Chirurgie, Hopital Cantonal, CH-1211 Geneve, Switzerland R.J.Maxwell, Department of Surgery, The Queen's University of Belfast, IHL-Belfast BT12 6BJ, Northern Ireland M. Merlini, Service Universitaire de Chirurgie A, CHUV, CH- 1011 Lausanne, Switzerland G. Mori, 3a clinica Chirurgica della Universita di Milano, Ospedale policlinico, Via F.Sforza, 35 - I-Milano, Italy R. W. Motson, The London Hospital, GB-London El1BB, England C.-A Muller, 11-13 rue de Bourg, CH-l003 Lausanne, Switzerland A Munro, Department of Surgery, Raigmore Hospital, GB-Inverness IV2 3UJ, Scotland J. Papillon, Centre Leon Berard, 28 rue Laennec, F-69008 Lyon, France W.Pugsley, The Royal Hospital, GB-Wolverhampton WV121BT, England A Rohner, Clinique Universitaire de Chirurgie Digestive, Hopital Cantonal, CH-1211 Geneve, Switzerland P. Shouler, The General Hospital, GB-Birmingham B46NH, England T. H. Walsh, St. Mark's Hospital, GB-London EGl V 2PS, England H. L. Young, University Department of Surgery, Welsh National School of Medicine, Heath Park, GB-Cardiff CF4 4XN, Wales XII Part I Vascular Disorders of the Intestine Ischaemic Damage to the Distal Bowel Following Angioplastic Surgery for Infrarenal Aortic Aneurysm or Aorto-Ilio-Femoral Obstruction (Leriche's Syndrome) M. Boumghar and M. Naef Introduction It is well known that following aorto-ilio-femoral revascularisation surgery, clinical evidence ofischaemic syndromes of the brain, heart, kidneys and extremities can be seen. However, ischaemic lesions to the distal bowel are few in number and are of ten undiagnosed or confused with other diseases. The danger of these lesions is un derestimated, particularly in European countries where few papers have been writ ten on this subject [5,8, 10, 11, 13, 14]. Experience acquired from aorto-ilio-femoral angioplastic surgery over the last 20 years shows that anyone operated upon for a terminal aortic aneurysm, or for Leriche's Syndrome, is exposed to a 1 %-2% risk of distal bowel ischaemia in the post-operative period as shown by the study of a large number of cases of aorto-ilio femoral angioplastic surgery. [2, 3, 7] The risks of intestinal ischaemia are low (about 0.03%) in the post-operative period following elective surgery, but are particularly high after resection of a ruptured aneurysm in a patient operated upon during hy povolemic shock (1,4%). These figures are probably lower than the reality, as the majority of publications concern only cases of segmental gangrenous necrosis of the colon discovered at autopsy or during reoperation; one rarely mentions fibrotic colo-rectal stenosis and transient ischaemic colitis, which are the most frequent forms in which large bowel ischaemia presents. Recent prospective studies based on systematic post-operative colonoscopies show that signs of colonic mucosa ischae mia are present in 7.4% of distal aortic aneurysm operations and 4.3% of aorto-ilio femoral operations, whereas the clinical symptoms are discreet and non-specific [1, 4]. Ischaemic damage of the distal bowel is, in general, a consequence of focalised or diffuse, transient or durable, slight or severe insufficiency in the perfusion of the bowel wall, resulting from haemodynamic disturbances and concomitant obstruc tive lesions of the intestinal arteries. The degree of shock, aorto-iliac clamping, liga tion of the inferior mesenteric artery, and obstruction of the hypogastric arteries in sufficiently compensated by collateral supply are the origin of a certain number of ischaemic lesions of the distal bowel which are severe enough to play an apprecia ble role in the operative mortality and morbidity. The parts of the bowel most fre quently involved are the left colon, the area around the splenic flexure, and the sig moid colon, that is to say the areas where the vascularisation is rather precarious. Ischaemic lesions are rarer elsewhere, in the right colon, the caecum, the small intes tine and the rectum [6]. 3

Description:
The Anglo-Swiss Colo-Proctology Meeting, held at Lausanne in May 1983, enabled numerous specialists to share their experiences of lower gastrointestinal tract pathology. The focus was on ischae­ mic disease and tumours of the colon, rectum and anus. By featuring ischaemic disease in our programme w
See more

The list of books you might like

Most books are stored in the elastic cloud where traffic is expensive. For this reason, we have a limit on daily download.