Diseases of the colon and rectum
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This study examines surgical salvage of locally recurrent rectal cancer following transanal excision of early tumors. ⋯ Pelvic recurrence following transanal excision of early rectal cancer is often locally advanced, requiring an extended pelvic dissection with en bloc resection of adjacent pelvic organs to achieve salvage. The long-term outcome in patients undergoing resection is less than expected, considering the early stage of their initial disease. When contemplating local excision for early rectal cancer, the risk of local recurrence, the extent and morbidity of surgery required for salvage, and the modest cure rate following salvage should be considered.
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Colonoscopy can be painful for patients and difficult for colonoscopists; however, it is hard to predict how painful or difficult the examination will be. This study was designed to identify factors that predict pain and difficulty during sedation-free colonoscopy. ⋯ By use of intubation time and patient pain, several patient characteristics were identified that may predict technical difficulty and pain associated with the procedure. These findings have implications for the practice and teaching of colonoscopy.
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Randomized Controlled Trial Multicenter Study Clinical Trial
Phase III trial of alvimopan, a novel, peripherally acting, mu opioid antagonist, for postoperative ileus after major abdominal surgery.
Postoperative ileus presents significant clinical challenges that potentially prolong hospital stay, contribute to readmission, and increase morbidity. There is no approved treatment for postoperative ileus. Alvimopan is a novel, peripherally acting, mu opioid receptor antagonist currently in development for the management of postoperative ileus. ⋯ In patients undergoing major abdominal surgery, alvimopan accelerated gastrointestinal recovery and time to the hospital discharge order written compared with placebo and was well tolerated.