Có 40+ tài liệu thuộc chủ đề "phương pháp và cách cải thiện"
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A CT scan of the abdo- men and pelvis should be considered. “Hemorrhoids” are among the most frequent presenting com- plaints of patients evaluated in the outpatient setting by colon and rectal surgeons. prevalence of symptomatic hemorrhoids in the U.S. Hemorrhoids are cushions of vascular and connective tissue located in the subepithelial space lining the anal canal. Arteriovenous sinu- soids...
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more favorable outcomes, Zmora et al. Crohn’s disease vs. Johnson et al. Champagne et al. Van Koperen et al.. Schwandner et al. One of the largest prospective studies was reported by Ky et al.. Common reasons for recurrent anorectal infection include missed infection at the time of initial drainage in adjacent anatomic planes, presence of an undiagnosed fistula at the...
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20 Surgery and nonoperative therapy of anal fissure Jaime L Bohl and Alan J Herline. A 35-year-old woman presents with a recurrent posterior anal fissure. She had a left lateral anal sphincterotomy 4 years ago for an unresponsive anal fissure. Exam reveals a posterior anal fissure with exposed sphincter muscle and a sen- tinel skin tag. An anal fissure is...
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Given the significant variation in incontinence rates after sphinc- terotomy, several investigators have sought to further characterize incontinence in patients with chronic anal fissure with respect to type, frequency, and permanence. In a study of preoperative and postoperative incontinence in 126 patients with chronic anal fissure, Anmari and colleagues found that 28% of patients had minor preoperative disturbances in continence...
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Slightly more patients in the open group were not satisfied with the outcome of treatment(8%. edges are tacked down to the base of the wound using absorb- able suture. 2%) in the wide local excision group.(26) Simple unroofing without marsupialization has become the preferred initial operation for pilonidal disease and the editors’ institution.. (C) The edges of the wound are...
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Since the decision between medical or sur- gical management (sphincter repair) of FI is largely based on the extent of sphincter injury, imaging of the sphincter makes sense. Note the thickening and retraction of the internal sphincter and the anterior scar (S) replacing the external sphincter.. sphincter clearly because of the contrast between fat and striated muscle and accurately visualizes...
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Rectal prolapse (rectal procidentia) is defined as the full thickness intussusception of the rectum through the anal canal. The annual incidence of rectal prolapse is estimated to be 2.5 per 100,000 pop- ulation.(1) The disorder tends to affect elderly women, psychiat- ric patients, and patients with neurologic disorders. Presenting symptoms are usually referable to the prolapse itself. Additional presenting complaints...
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CT scan of the abdomen and pelvis with oral and rectal contrast demonstrates thicken- ing of the sigmoid colon with mesenteric thickening but no identifiable abscess or perforation.. WBC count is elevated at 17,000 and a CT scan shows a thickened inflamed sigmoid colon with a 3 cm abscess on the medial aspect of the colon.. Patients with an abscess...
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In a confirmatory study here in the US how- ever, Senagore found that all of the POSSUM scoring systems over predicted mortality.(68, 69). the MPI was able to predict 12 of the 14 deaths. They also found that morbidity was related to the MPI score.(71) (Table 24.9). Of the 1,176 patients who had a Hartmann procedure for diverticular disease, only...
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We have particularly emphasized the impact of the quality movement and the role of outcomes on quality measurement and assurance. Jagoditsch M, Lisborg PH, Jatzko GR et al. Mcdermott FT, Hughes ESR, Pihl E et al. Comparative results of surgical management of single carcinomas of the colon and rectum: a series of 1,939 patients managed by one surgeon. Chapuis PH,...
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Refinements in technique continued through the first half of the twentieth century. the operation in one stage, with the abdominal portion done supine and the perineal portion done in the left lateral position.. Preparation for abdominoperineal resection starts with marking the ideal placement of the colostomy by the primary surgeon or enterostomal nurse.(5) Patients are instructed to take a mechani-...
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If there is firm adherence to the posterior aspect of the bladder, seminal ves- icles or prostate, they should be taken en bloc. The remain- der of the dissection is completed, laterally then anteriorly. The remainder of the sacrectomy is performed after turning the patient to the prone position. Reconstruction is completed frequently with the aid of the plastics consultant....
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Resection of liver metastases in colorectal cancer–competitive analysis of treatment results in synchronous versus metachronous metastases. Jovine E, Biolchini F, Talarico F, et al. Major hepatectomy in patients with synchronous colorectal liver metastases:. Adam R, Aloia T, Levi F, et al. Adam R, Miller R, Pitombo M, et al. Adam R, wicherts da, de Haas RJ, et al. Shimizu Y,...
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From inspection of the randomized trials in Table 30.3 it is evident that preoperative radiation treatment reliably produces a clinically and statistically significant reduction in the incidence of local recurrence by about 50 to 60%. This remains true even in the Dutch Colorectal Cancer Group trial which was. designed to minimize the need for pelvic irradiation by mandat- ing surgery...
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Following transection of the ileum flush with the cecum, the surgeon notes that it will be difficult for the pouch to reach the anus.. If the main reason for the pouch not reaching is patient obesity and a thickened mesentery, an initial total abdomi- nal colectomy, ileostomy, and Hartmann closure of the rectum may be performed. A series of technical...
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Karch LA, Bauer JJ, Gorfine SR et al. Boushey RP, Marcello PW, Martel G et al. Hata K, Watanabe T, Kazama S et al. Connell WR, Lennard-Jones JE, Williams CB et al. Befrits R, Ljung T, Jaramillo E et al. Perineal and pelvic mor- bidity following perimuscular excision of the rectum for inflammatory bowel disease. Rivadeneira DE, Schoetz DJ, Marcello...
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The use of antibiotics has been long debated in the prevention of recurrence in the postoperative Crohn’s patient. There are no large controlled trials that show clear effectiveness of the use of antibiotics in postoperative Crohn’s patients beyond 1 year. Diffuse peritonitis due to perforation is a rare but recognized complication of Crohn’s disease. Perianal disease manifestations include perianal pain...
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Operative management of Crohn’s disease of the colon including anorectal disease. Six weeks postoperatively, he presents to the clinic with an obvious parastomal hernia that is easily reduc- ible. In this patient, the optimal management includes reversal of the ostomy after ensuring that the distal anastomosis has healed.. An ostomy reversal ameliorates and addresses all of the symptoms including the...
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This of course implies that the purposes of the stoma placement has been met and the patient is capable and a candidate for another operative procedure. While both approaches are associated with inadver- tent enterotomies, bleeding, wound infections, and anastomotic complications, the biggest advantages of the laparotomy approach is improved exposure and the ability to reexplore the abdomen.. Our approach...
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These results showed a significantly better outcome in patients with pressure biofeedback protocols. The role of other factors on the outcome of biofeedback therapy in patients with pelvic dyssynergy has been studied. One study showed that patients with pelvic floor dys- synergic-type constipation or rectal pain showed a tendency to use somatization as a defense mechanism to manage psychologi- cal...