[Permanent colostomy].
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Adaptation, Psychological↗
Biomedical subjects
A Husa
Publications and source records attributed to A Husa.
Dysplasia and carcinoma in longstanding ulcerative colitis: an endoscopic and histological surveillance programme.
From 1976 to 1989 a total of 66 patients with longstanding ulcerative colitis were entered in a colonoscopic surveillance programme in order to detect dysplasia. Thirty patients had extensive or total ulcerative colitis and 36 left sided colitis. The median duration of the disease at the end of the follow up was 15.0 years. Altogether 182 colonoscopies (2.8 per patient), each involving approximately 20 biopsies from different sites of the colon, were performed. In the total or extensive colitis group, five patients had low grade and one patient had high grade dysplasia. In the left sided colitis group, three patients had low grade dysplasia. In three patients low grade dysplasia was detected in a macroscopic lesion or mass of colonic mucosa. Sixty per cent of the dysplasia specimens were from the right colon. The incidence of dysplasia was higher in patients with extensive colitis and increased with the duration of the disease. None of the patients have so far developed colorectal carcinoma. Our results indicate that a colonoscopic surveillance programme is a safe alternative to prophylactic colectomy in longstanding ulcerative colitis.
Adolescent↗
Double-contrast barium examination and endoscopy in the detection of small polyps of the large intestine.
The purpose of this study was to compare double-contrast barium examination (DCBE) and endoscopy in detection of small colonic polyps. In 57 patients DCBE revealed 106 polyps in the large intestine. On total colonoscopy, 62 polyps could be verified. The size of the polyps excised ranged from 2 to 15 mm. Compared with DCBE, colonoscopy verified 48 true positive, 44 false positive and 14 false negative polyps. In revealing a polyp less than 5 mm, DCBE had a sensitivity of 72%, whereas in detection of larger polyps the sensitivity was 81%. Histological verification was available in 52 of the 62 removed polyps. A tubular adenoma was found in 12 of the 29 diminutive polyps verified with histology. DCBE and colonoscopy could not differentiate between adenomas and hyperplastic polyps. Since a polyp less than 5 mm may represent an adenoma, a precancerous lesion, its removal is indicated during colonoscopy after DCBE has detected it.
Adenoma↗
The incidence of Crohn's disease in the Helsinki metropolitan area during 1975-1985.
The hospital incidence of Crohn's disease in the Helsinki metropolitan area during 1975-1985 was studied retrospectively. The resident population in this urban, well-defined district was 790,000 in the year 1985. During this period 193 new patients suffering from Crohn's disease were diagnosed. The annual incidence increased three times from 1/100,000 to 3/100,000, while the annual mean incidence was 2,3/100,000. The age-specific incidence was highest in the age-groups 15-24 with no sex difference. After the initial rapid increase the incidence of Crohn's disease in the Helsinki metropolitan area has stabilized on the level 3/100,000. These figures are similar to those reported from other Scandinavian and Western countries.
Adolescent↗
Abdominal rectopexy and sigmoid resection (Frykman-Goldberg operation) for rectal prolapse.
Transabdominal posterior rectopexy with resection of the redundant left colon (Frykman-Goldberg operation) was performed on 48 selected patients with complete rectal prolapse. Uterine suspension was also performed on most of the women. The 30-day mortality rate was 2.1%. Prolapse recurred in 4 (9%) of the 45 patients followed up for 1-10 (mean 4.3) years. There were no complications attributable to bowel resection or anastomosis. Adequate data on both preoperative and postoperative anal function and bowel habit were available in 41 cases. All but two of the 32 patients with associated incontinence experienced improved anal control after the operation (9 regained normal continence). Bowel habit improved in 23 patients (56%), especially in those with chronic constipation. No patient reported increased problems of bowel management. The operation does not involve the risks associated with implantation of foreign material and can be especially beneficial for constipated patients with rectal prolapse who are fit for major abdominal surgery.
Adult↗
Colorectal adenomas: morphologic features and the risk of developing metachronous adenomas and carcinomas in the colorectum.
The morphologic features of 307 colorectal adenomas among 159 patients are reviewed. Most adenomas (66.4%) were located in the sigmoid colon and the rectum, and the percentage decreased proximally to the right colon. The 307 adenomas comprised 244 (79.5%) tubular, 41 (13.3%) tubulovillous, and 22 (7.2%) villous adenomas. The epithelial dysplasia was graded as mild in 260 (84.7%) adenomas, moderate in 33 (10.7%), and severe in 14 (4.6%). The percentage of severe dysplasia was greater in villous adenomas than in tubular adenomas (p less than 0.05) and correlated with the increasing size (greater than 5 mm) of the adenomas (p less than 0.01). The risk of metachronous adenomas could be evaluated among 56 patients, 34 men and 22 women with a history of removed adenoma(s). Fourteen of 56 patients (25%) with 6:1 male to female ratio developed 18 new adenomas, after an average of 34.3 months (range, from 12 to 88 months). Eleven of the 14 patients had multiple adenomas at the initial examination. In addition, a carcinoma of the rectum was found in one male patient. Of the 48 patients, 17 men and 31 women, operated on for colorectal cancer 16 patients (34%) with 1.3:1 male to female ratio had 40 new adenomas after an average of 51.8 months (range, 12 to 252 months) after the surgical excision of their carcinomas. One patient had a recurrent carcinoma at the site of the anastomosis 22 months after anterior resection of his carcinoma. Our data suggest that a history of colorectal carcinoma, multiple adenomas, and male sex predict a higher risk of having future colorectal tumours.
Adenoma↗
[Management of anal fistulas].
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Anus Diseases↗
Long-term results of sigmoidostomy in patients with anorectal malignancy.
The long-term results with permanent end-sigmoidostomy were studied in 54 patients after abdominoperineal excision of the rectum for anorectal malignancy. The patients were re-examined 1-8 years postoperatively, when the function and late complications of the end-sigmoidostomy and the need for reconstructive procedures were assessed. An attempt was also made to evaluate the patients' quality of life. Only one patient reported severe impairment of social life due to the enterostomy. The main surgical problem was paracolostomy hernia (48% of the series), but revisonal surgery because of hernia was necessary in only two cases. Stomal stenosis (5.6%) in no case required reoperation. Peristomal eczema (5%) was always manageable with local treatment. The results indicated that the quality of life with end-sigmoidostomy is reasonably good, and this should be kept in mind when deciding on type of operation for low rectal malignancy.
Adult↗
Fistula-in-ano. Clinical features and long-term results of surgery in 199 adults.
The clinical features and the long-term results of surgery for anal fistula were studied. Fistula distribution was subcutaneous (13%), intermuscular (14%), low anal (55%) or high anal (18%). There were no pelvirectal fistulas. The location was mostly posteriorly in the anus, except for the low anal fistulas, which were most frequent anteriorly. Follow-up examination was carried out on 199 patients, on average 9 years after fistula operation. The recurrence rate was 11% after laying open of fistula, with the highest rate (26%) in high anal fistula. The most common causes of recurrence were undetected internal opening and incomplete laying open of the fistulous tract proper. Most (91%) of the recurrences appeared within 18 months after surgery. Minor defects in anal control were found in 34% of the patients, and in 9% of controls matched for age and sex but with no anal surgery. Multiple operations for anal fistula, and also a gutter-shaped and a firm or hard scar in the anal canal adversely affected anal control. The amount of divided sphincter musculature did not influence the incidence of postoperative anal incontinence.
Adult↗
A prospective manometric study of the effect of anal fistula surgery on anorectal function.
In 31 adults consecutively undergoing surgery for anal fistula (opening of fistulous tract), anorectal manometry was performed before and 7 months after the operation. The resting pressure was significantly reduced in the distal 3 cm of the anal canal postoperatively. Voluntary sphincter contraction was less markedly affected. Maximal squeeze pressure and maximal contractile power were significantly reduced, however, especially in women and after division of the external sphincter muscle. The pressures were significantly lower in women than in men, particularly after operation, and defective anal control was associated with reduced squeeze pressure. It is therefore suggested that in selected cases, primarily women, anal pressure should be measured preoperatively and division of the external sphincter muscle avoided if the pressure is low. Constant rectoanal inhibitory reflex was elicited by a significantly smaller distending volume and lower rectal pressure postoperatively than preoperatively which, like the reduced resting pressure, indicated impaired function of the internal sphincter muscle.
Adult↗
Colitis cystica profunda. Report of a case.
Colitis cystica profunda is a non-neoplastic condition characterized by intramural mucus-containing cysts of the colon and rectum. The cysts are in most cases located as polypoid masses 5 to 12 cm from the anal margin. The diameter of the cysts varies from less than 0.1 cm to 3 cm. Since this rarely recognized condition undoubtedly is a benign lesion, it is important to identify it from other colorectal tumours and ulcerative colitis. Extensive colorectal surgery should be avoided.
Adult↗