Diseases of the colon and rectum
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Randomized Controlled Trial
Pudendal block with bupivacaine for postoperative pain relief.
Postoperative pain after hemorrhoidectomy is very intense, and the pain at the first postoperative defecation is very intense. Based on our pilot initial results that reflected reduced postoperative pain, we conducted a prospective, randomized, double-blind study to investigate whether the analgesia produced by bilateral pudendal nerve block using a nerve-stimulator could provide better postoperative pain relief compared with the routine technique in use in the Department of Anesthesia. ⋯ In this controlled study, bilateral pudendal nerve block oriented by nerve stimulator provided excellent analgesia with low need for opioids, without local or systemic complications, and without urinary retention.
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The introduction of reimbursement for screening colonoscopy in Germany more than one year ago raised concerns that the consequent workload might lead to underuse of diagnostic colonoscopy for symptomatic patients. Available appropriateness criteria for diagnostic colonoscopy have been rarely tested in a realistic outpatient setting. This study was designed to test current appropriateness criteria for diagnostic colonoscopy to better select patients and potentially provide more capacity for screening cases. Secondary goals were yield and quality control in both the diagnostic and screening cases. ⋯ Currently used appropriateness criteria for diagnostic colonoscopy increase the yield of relevant findings but lead to a miss rate for relevant findings in the range of 10 to 15 percent. Simple selection criteria based on age and symptoms could be more suitable and should be tested in a larger group of patients.
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Controlled Clinical Trial
Accuracy of four fecal assays in the diagnosis of colitis.
This study was designed to evaluate the accuracy of four different fecal markers in discriminating between irritable bowel syndrome, inflammatory bowel disease, and other forms of colitis and to examine the feasibility of collecting fecal samples in outpatients. ⋯ IBD-SCAN and PhiCal-Test have the best overall accuracy for detection of colitis, followed by LEUKO-TEST, Hexagon OBTI, C-reactive protein, and blood leukocytes. Accuracy of fecal markers is high even in patients with Crohn's disease in remission. Fecal sampling feasibility was high in outpatients. Because fecal markers are unspecific, endoscopic workup remains crucial to determine the underlying cause of colitis.
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The risk factors for postoperative urinary retention after colorectal carcinoma surgery can be clearly defined. This study was designed to determine risk factors for postoperative urinary retention after colorectal cancer surgery. ⋯ Older patients, lung disease, rectal cancer, longer operation duration, and additional pelvic procedure were at greater risk. There is a time-dependent change in postoperative urinary dysfunction. Male gender, American Society of Anesthesiologists' score of 2 or 3, rectal tumor, surgical drain, and pelvic infection can identify patients at risk for prolonged urinary dysfunction.
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The levator ani has been divided into many functional portions based on necropic observation. Our objective was to use a combination of CT and magnetic resonance images to show a complete levator ani. ⋯ The transverse portion of the levator ani has five kinds of shapes in the different-coronal sections of the pelvis, which changes from basin to dome in a lying position. The puborectalis is outside the vertical portion and not part of the levator ani.