Diseases of the colon and rectum
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Epidural anesthesia is believed to benefit colorectal anastomotic blood flow because of the sympathetic blockade it produces. Our purpose is to measure with tonometry the effect of epidural anesthesia on colorectal anastomotic oxygenation. ⋯ Epidural anesthesia with bupivacaine causes a significant decrease in the oxygenation-perfusion state of colorectal anastomosis in comparison with the increase in other areas of the digestive tract. Further studies need to be done to see if other epidural anesthetic-analgesic protocols also worsen colorectal anastomotic blood flow.
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Comparative Study
Use of epidural anesthesia and spontaneous ventilation during transabdominal colon and rectal procedures in selected high-risk patient groups.
Patients with cardiopulmonary compromise who require transabdominal colon and rectal procedures are at increased risk for postoperative cardiac and pulmonary complications and prolonged hospital stays. Because epidural anesthesia has been shown to minimize reductions in functional residual capacity and consequently improve pulmonary function, we sought to determine its impact on patients undergoing colon and rectal procedures who were at high risk for postoperative cardiopulmonary morbidity. ⋯ Use of epidural anesthesia with spontaneous ventilation in elective transabdominal colon and rectal procedures may decrease the incidence of pulmonary complications and length of postoperative hospital stay in a select group of high-risk patients.
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Gunshot wounds to the buttocks may cause significant intra-abdominal injuries. Policies of aggressive abdominal exploration or extensive diagnostic testing have been suggested to avoid delays in treatment and consequent morbidity. Our group has recently suggested that clinical examination is a safe and reliable tool for triaging patients with anterior and posterior abdominal gunshot wounds. ⋯ Clinical examination is a safe method for selecting patients with gunshot wounds to the buttocks for nonoperative treatment.
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Randomized Controlled Trial Clinical Trial
Guided imagery: a significant advance in the care of patients undergoing elective colorectal surgery.
Guided imagery uses the power of thought to influence psychologic and physiologic states. Some studies have shown that guided imagery can decrease anxiety, analgesic requirements, and length of stay for surgical patients. This study was designed to determine whether guided imagery in the perioperative period could improve the outcome of colorectal surgery patients. ⋯ Guided imagery significantly reduces postoperative anxiety, pain, and narcotic requirements of colorectal surgery and increases patient satisfaction. Guided imagery is a simple and low-cost adjunct in the care of patients undergoing elective colorectal surgery.
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1) Disease control and survival will be evaluated for treatment regimens containing intraoperative electron irradiation (IOERT) for locally recurrent, previously unirradiated colorectal cancers. 2) Various prognostic factors will be evaluated to determine whether they have an impact on disease control or survival. ⋯ Encouraging trends for improved local control with or without survival exist in separate locally recurrent colorectal IOERT analyses from our institution and other institutions. Therefore, continued evaluation of IOERT approaches seems warranted. Disease control within the IOERT and external fields is decreased when the surgeon is unable to accomplish a gross total resection. Therefore, it is reasonable to consistently add 5-fluorouracil or other dose modifiers during EBRT and to evaluate the use of dose modifiers in conjunction with IOERT (sensitizers and hyperthermia). In view of high systemic failure rates of > 50 percent in patients with locally recurrent disease, more routine use of systemic therapy is indicated as a component of IOERT-containing treatment regimens (use existent chemotherapy and/or develop effective immunotherapy and gene transfer therapy). Even with locally recurrent lesions, the aggressive multimodality approaches including IOERT have resulted in improved local control and long-term survival rates of 20 percent vs. an expected 5 percent with conventional techniques.