Patients'attitudes to rectal drug administration

One hundred adult patients attending for day case surgery were surveyed by anonymous questionnaire in order to determine their attitudes to rectal drug administration. Fifty four patients did not want an analgesic drug (diclofenac sodium) administered rectally whilst under anaesthesia, all preferring to take it orally if available. Ninety eight patients thought that drugs administered per rectum should always be discussed with them beforehand and a few had very strong feelings about this route of administration. We suggest that prescribers of rectal diclofenac should always discuss it with patients pre-operatively. Whilst many are happy to have suppositories, some young patients are sensitive about this and prefer to take such medication by mouth.     

An approach to haemorrhoids

OBJECTIVE: Many patients with haemorrhoids are investigated because of the fear of missing colorectal cancer (CRC). The aim of this study was to determine whether a primarily clinical approach regarding the need for investigation was safe and did not miss patients with CRC. PATIENTS AND METHODS: Data was collected prospectively on 589 consecutive patients with the principle diagnosis of haemorrhoids at first clinic visit. All had clinical assessment including rigid sigmoidoscopy and were treated by phenol injection or banding. They were categorized for (1) no review unless symptoms persisted -'One Stop SOS' (2) outpatient review or (3) investigation. To check for the development of CRC they were contacted by postal questionnaire or telephone interview with a minimum of one year from diagnosis and treatment. All 589 patients were cross-referenced with the Pathology database and the Hospital Information Services System. RESULTS: Four hundred and sixty-nine (80%) answered the questionnaire; 352 patients (60% of the total group) fell in the 'one stop SOS' outpatient category; 95 (16%) patients were followed up to review response to treatment for large haemorrhoids; 105 (18%) were investigated with barium enema (12%), flexible sigmoidoscopy (4%), colonoscopy (1%) and miscellaneous (1%); 37 (6%) patients were either given a haemorrhoidectomy date or referred on with a different diagnosis. No patients selected for 'one-stop' treatment developed CRC. Five (0.8%) patients were diagnosed with CRC after appropriate investigation was instituted for suspicious symptoms. One patient with distal transverse colon cancer had a delayed diagnosis as she was investigated initially by flexible sigmoidoscopy. CONCLUSION: Most patients with the primary diagnosis of symptomatic haemorrhoids do not need investigation.     

直肠脱垂的外科治疗

直肠脱垂的发病机制尚未明确,幼儿直肠脱垂多采用非手术治疗,成人完全性直肠脱垂以手术为主。目前手术方法繁多,疗效不一。本文介绍了直肠脱垂经腹和经肛门两种入路的多种手术方式以及注射疗法、激光手术等常用的外科治疗方法,各有利弊。直肠脱垂的外科治疗提倡个体化治疗,应综合考虑患者的病因、年龄及病情,选择合适的治疗手段。     

直肠癌患者手术前后凝血状态变化的研究

目的：通过研究直肠癌患者凝血与纤溶系统的变化，观察其与手术切除与否、淋巴结转移、细胞分化程度等的关系。方法：选取直肠癌患者58例，于术前及术后两周检测PAGT、PT、APTT、TFPI、D－二聚体、t-PA:a等指标；同期52例非肿瘤病人作为对照组。结果：直肠癌患者较对照组血小板聚集增强（P＜0．05），凝血酶原时间、活化部分凝血活酶时间明显缩短，组织因子途径抑制物降低（P＜0．05），D－二聚体和t-PA:a显著升高（P＜0．01），存在淋巴结转移和低分化腺癌者尤为明显（P＜0．05或P＜0．01），手术切除后有所改善。结论：直肠癌患者处于高凝和纤溶亢进状态，在淋巴结转移和癌细胞分化差的病人中尤为明显；应用抗凝和抗纤溶药物可能对直肠癌的预防有一定作用。     

Seasonal covariation of the circadian phases of rectal temperature and slow wave sleep onset

There is a scarcity of well-controlled studies of the seasonal variation in circadian rhythmicity. In the present study, the circadian phase of rectal temperature and the onset of slow wave sleep were studied in a series of twelve 24-h experiments, one each month of the year, for six healthy subjects under controlled conditions in a climatic chamber. In winter, as compared with summer, the average circadian rhythm of rectal temperature was phase delayed by 45 min, and the average onset of slow wave sleep was phase delayed by 40 min. The temporal relationship between the circadian phase of rectal temperature and the timing of slow wave sleep was maintained throughout the year. Habitual rising and retiring times covaried as well. Furthermore, the circadian rhythm of rectal temperature followed the timing of the photoperiod across the year, but had a much smaller range of seasonal variation. Apparently, the seasonal variation in the photoperiodic zeitgeber is largely compensated for by the stabilizing influence of secondary zeitgebers. However, in healthy subjects some effect of photoperiodic variation can still be observed.     

应用吻合器行中、下段直肠癌切除术后吻合口漏──附10例报告

我科自１９８１年３月至１９９１年１２月应用吻合器行中、下段直肠癌切除术６７例，同期发生吻合口漏１０例（１４９％）。本文分析了吻合口漏发生的因素。病变部位、病灶范围、术中操作技术、术前肠道灌洗以及术后骶前引流是影响吻合口漏的重要因素。本文总结了吻合口漏的治疗方法，提倡保守治疗，或加作暂时性横结肠造口术。     

低位直肠癌根治性切除保肛术式53例临床应用研究

本文介绍一种经腹低位直肠癌根治性切除，保留肛门，乙状结肠拖下固定术式。６年来共施行此手术５３例，占同期低位直肠癌（肿瘤下缘距齿状线２～８ｃｍ）手术部数的９６％（５３／５５）。术后２年和５年肿瘤复发率分别７．７％和１４．３％。术后４周、８周和６个月内完全肛门排便功能者分别占４．９１％、９８％和１００％。肛门功能恢复程度均属均属优良。作者对此术式的特点，并根据手术疗效对保留肛门功能的合理性及其根治性进     

Prevalence of elevated serum prostate-specific antigen in rural Nigeria

BACKGROUND: Recent hospital and cancer registry data show increasing prostate cancer incidence in Nigeria, which was previously regarded as a low incidence region. This study investigates the prevalence of prostate cancer risk in a previously unscreened cohort of rural Nigerians. METHODS: Rural Nigerian men, 40 years and older, were screened by serum prostate-specific antigen (PSA) and digital rectal examination (DRE) and those with PSA >/= 4 ng/mL and/or abnormal DRE were referred for prostate biopsy. RESULTS: Of 200 consecutive men invited, 151 (75.5%) presented for screening, the mean age was 56.45 + 15.1 and 95 (61.6%) were >/= 50 years of age. Of the 140 who consented to a blood test, PSA correlated with age (r = 0.3, P < 0.01), 14 (10.0%) had abnormal PSA >/= 4 ng/mL, increasing from 3 (3.6%) in men < 60 years to 4 (50%) in men >/= 80 years. The rate was 13 (15.7%) for men >/= 50 years and there was no evidence of increased incidence of prostatitis in the community. Mean (median) PSA in ng/mL increased from 1.17 (0.60) in the youngest to 13.75 (4.45) in the oldest cohort. Of those who accepted DRE, 38 (29.0%) had an enlarged prostate, including two who had nodular prostate, one-third with symptoms, increasing from 4 (5.4%) in those < 50 years to 6 (75.0%) in men >/= 80 years. The proportion of men with PSA >/= 4 ng/mL among those with enlarged vs normal prostate is 27.0 to 3.4%, P < 0.001, and the pattern was similar for men >/= 60 years and those < 60 years of age. The 40 (32.0%) men referred for prostate biopsy defaulted mainly because they did not fully understand the need for further investigation because they were symptom free or afraid of the possible side-effects of the procedure or diagnosis of cancer. CONCLUSION: The proportion of men with PSA >/= 4 ng/mL is comparable to that of previously unscreened populations with high incidence of prostate cancer such as African-American men. A larger study is required to confirm these findings and intensify efforts to determine the prostate cancer detection rate by biopsy in this population. A prostate cancer awareness and education campaign will be useful in this community.     

双吻合器技术在直肠癌中的应用

目的探讨双吻合器技术在直肠癌手术中的作用。方法回顾性分析2000年1月~2006年1月间采用双吻合器技术治疗的63例直肠癌患者的临床资料,其中肿瘤下缘距肛缘≤7 cm者33例,7.1~11 cm者21例,>11 cm者9例。结果21例吻合口距肛缘≤3 cm,42例吻合口距肛缘3~7 cm。术后发生吻合口漏3例(4.8%),吻合口狭窄6例(9.5%),伤口感染5例(7.9%),无手术死亡。全组均获随访,平均4.3(3~6)年,5例复发,其中3例行M iles术,随访仍健在,2例放弃手术治疗,分别死于肝转移和腹腔内广泛种植。结论双吻合器技术在直肠癌手术,尤其是在低位及超低位结直肠吻合中可拓展适应证,降低手术风险。     

微波凝固联合黏膜下氟尿嘧啶注射治疗早期低位直肠癌

目的探讨微波凝固联合黏膜下氟尿嘧啶（5-Fu）注射治疗早期低位直肠癌的适应证和疗效。方法1996年1月～2002年12月对9例早期低位直肠癌采用微波凝固联合黏膜下5-Fu注射，微波治疗后用含5．Fu1．0g的生理盐水100～200ml保留灌肠，1次／d，连续3d，随访其疗效。结果3例微波治疗前CEA增高，微波治疗后CEA下降至正常。术中、术后无出血等并发症。随访至2006年1月，9例全部存活。l例生存3年5个月；1例生存3年8个月；1例1年4个月后肿瘤复发，行Miles手术至今又生存2年9个月；6例生存5年以上，其中1例5年1个月，1例6年3个月，l例6年8个月，1例7年6个月，2例9年。结论微波凝固联合黏膜下5-Fu注射治疗早期低位直肠癌适应于早期、距肛缘7cm以下、肿块型、肿瘤直径0．5～3．0cm或肿瘤〈直肠周径的1／3、病理类型为高分化肿瘤、且患者强烈要求保肛的直肠癌。该方法具有创伤小、费用低和疗效满意等特点。