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Biomedical subjects

F D Nemer

Publications and source records attributed to F D Nemer.

7 recordsLinked to original sources
PubMed1991

Fistula-in-ano in Crohn's disease. Results of aggressive surgical treatment.

The outcome of aggressive surgical treatment of 64 symptomatic anal fistulas in 55 patients with Crohn's disease has been studied. Forty-one fistulas, in 33 patients, were treated by conventional fistulotomy (17 subcutaneous, 19 intersphincteric, 5 low transsphincteric fistulas). Thirty wounds (73 percent) healed within 3 months and eight more wounds (93 percent) healed within 6 months. Three wounds did not heal within 12-18 months. Two of these patients subsequently required proctocolectomy. Wound healing was not influenced by the presence of rectal Crohn's disease or granulomatous inflammation in the tract. No change in continence was experienced by 26 of the 33 patients who underwent fistulotomy. Three patients required proctocolectomy and the remaining four patients experienced minor degrees of incontinence postoperatively. Sixteen high transsphincteric, five suprasphincteric, and one extrasphincteric fistula in 22 patients were treated by laying open external tracts and placing a noncutting seton through the sphincter, which was left in place for prolonged periods to maintain drainage. During follow-up (6 months to 10 years, median 2.5 years), three fistulas healed and seven remained quiescent. Nine patients required further treatment by a new seton and three patients required proctocolectomy. Eight of the 22 patients who had a seton inserted had no change in continence, and six patients in this group developed minor changes in continence, mostly related to diarrhea associated with intestinal disease. Anal fistulas in Crohn's disease, which involve minimal sphincter muscle, can be successfully treated by fistulotomy. High fistulas should be treated with seton drainage to limit recurrent suppuration and preserve sphincter function.

Adolescent↗
PubMed1979

Medial deviation of the pelvic ureters after abdominoperineal resection of the rectum.

Pre- and postoperative urograms of 47 patients undergoing abdominoperineal resection were reviewed for ureteral deviation and obstruction. Postoperative medial deviation occurred in 11 patients (23.4%). Both ureters were involved in six of these patients. Ureteral deviation was identified as early as 3 days after surgery. Obstruction of the ureters occurred in four patients and was due to tumor in three of these.

Abdomen↗
PubMedDate not supplied

Smooth-muscle rectal tumors: a therapeutic dilemma.

Five cases of smooth-muscle rectal tumors seen in the Lexington, Kentucky, area over a 25-year period are reported. These unusual tumors cause symptoms similar to those of more common anorectal diseases, namely, painful defecation and rectal bleeding. Often these tumors are initially asymptomatic due to their submucosal origin. Clinical diagnosis depends on awareness of these lesions, digital rectal examination, endoscopic examination, and tissue biopsy. Microscopic diagnosis and differentiation of malignant from benign features require a pathologist with special interest and expertise with these lesions. Smooth-muscle rectal tumors should be considered more dangerous than those in other locations in the gastrointestinal tract, as half are malignant and only a fifth of patients who have sarcomas survive five years. Treatment of malignant rectal myomas should be very aggressive from the outset, with abdominoperineal resection being advocated by most investigators due to almost uniform local recurrence with lesser procedures. When the lesion recurs, it is likely to be more virulent histologically and clinically than the initial lesion. Benign myomas are cured by local excision alone.

Female↗
PubMedDate not supplied

Volvulus of the colon--a continuing surgical problem.

Twenty-six cases of colonic volvulus from the University of Kentucky Medical Center and the Lexington Veterans Administration Hospital, covering a ten-year period, are presented. Overall mortality was 19 per cent (5 of 26 patients). Cecal volvulus carried the greatest mortality, 30 per cent (3 of 10 patients), whereas sigmoidal volvulus had relatively low mortality rate of 7 per cent (1 or 15). A single patient who had volvulus of the transverse colon died. The most significant factor leading to death was not necrotic bowel but the necessity for emergency operation in these generally debilitated patients. A plan of management with the major aim to convert emergency situations into elective or urgent ones is presented with the expectation that the mortality rate can be improved.

Adult↗