International journal of colorectal disease
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Int J Colorectal Dis · Sep 1993
Effect of perioperative blood transfusions on survival of patients after radical surgery for colorectal cancer.
The effect of perioperative blood transfusion on the survival of patients with colorectal cancer was evaluated in 128 patients undergoing curative surgery between 1980 and 1988. The following clinical and histopathological variables were also studied: age, sex, duration of symptoms, presence of intestinal obstruction, tumour site, extent of spread through the bowel wall, lymph node involvement, Dukes' stage, grade of differentiation, venous invasion and type of surgical procedure performed. The need for perioperative blood transfusion was unrelated to the stage of disease. ⋯ Similar differences were found in the comparison of the groups with (n = 68) and without (n = 60) transfusions on the day of operation. The deleterious effect of transfusion was evident in patients who received only one unit of blood (n = 19)--these had a 5-year survival rate of 45% compared those who had more than one unit of blood (n = 54) (5-year survival rate 35%) (P = 0.0062). With a multivariate analysis, using a Cox proportional hazard model, taking into account all the variables studied, a significant and independent effect on survival was found for lymph node involvement (beta coefficient = 3.97), blood transfusion (beta coefficient = 2.16) and extent of bowel wall spread (beta coefficient = 1.75).(ABSTRACT TRUNCATED AT 250 WORDS)
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Int J Colorectal Dis · Jul 1993
Comparative StudyHow reliable is digital examination for the evaluation of anal sphincter tone?
This study investigates whether digital examination of the anal canal can differentiate reliably between competent and incompetent sphincters. Digital examinations were performed by an experienced proctologist who was blinded with regard to the patient's history as well as manometric and endoscopic findings. ⋯ The sensitivity of digital examination for diagnosing incompetent sphincters ranged from 63% to 84%, whereas specificity was calculated as only 57%. It is concluded that even the experienced examiner needs to use more sophisticated methods than digital examination for the evaluation of anal sphincter competence.
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Int J Colorectal Dis · Feb 1990
A retrospective study of colostomies, leaks and strictures after colorectal anastomosis.
A review was undertaken of 360 patients undergoing elective left-sided colonic or rectal resections with primary anastomosis, under the care of one surgeon, over a nineteen year period. The incidence, aetiology and management of anastomotic leaks and strictures was studied and the role of proximal diverting colostomy considered. Perioperative mortality was 2.7%. ⋯ It was not possible to determine whether the presence of a colostomy affected the incidence of leaks but the local effects of such leaks were mitigated in patients with colostomies. Where a minor leak had occurred it was not necessary to wait for complete anastomotic healing before closing the colostomy. After major leaks, colostomy closure before complete healing was associated with further anastomotic problems in 16.0% of cases.