Biomedical subjects

J M Langevin

Publications and source records attributed to J M Langevin.

10 recordsLinked to original sources

PubMed1997

"Sandwich" preoperative and postoperative combined chemotherapy and radiation in tethered and fixed rectal cancer: impact of treatment intensity on local control and survival.

PURPOSE: The present "sandwich" preoperative and postoperative chemotherapy and radiation study was undertaken to evaluate the impact of treatment intensity on the local control and survival in tethered or fixed rectal adenocarcinoma (T3, 4 NX M0). METHODS AND MATERIALS: Between 1990 and 1992, 27 patients were treated with this sandwich protocol. Preoperative therapy consisted of 4 weeks of concurrent radiation (40 Gy) and chemotherapy (mitomycin C on day 1, 5-fluorouracil infusion and leucovorin on days 1-4 and days 15-18, respectively), and one cycle of bolus 5-fluorouracil and leucovorin chemotherapy. After surgery, they received 2 additional weeks of radiation (18 Gy) and 4 days of similar chemotherapy. The outcome was compared to another 54 patients who were treated with our previous preoperative chemoradiation protocol (mitomycin C, 5-fluorouracil infusion and 40 Gy of pelvic RT). RESULTS: The complete resectability rate was improved from 91% in the preoperative protocol to 100% in the sandwich protocol, and the pathologic complete response rate (T0 N0 M0) was increased from 4 to 15%. There was no local recurrence in the sandwich protocol. The 4-year local failure rate was 23 vs. 0% (p = 0.005). The 4-year distant failure rate was 47 vs. 28% (p = 0.079). The 2-year and 4-year survival were 63 and 41% for the preoperative protocol, vs. 92 and 72% for the sandwich protocol, respectively (p = 0.014). There were more treatment-related Grade 2 diarrhea, but not Grade 3/4 diarrhea in the sandwich protocol. Two patients (7%) in the sandwich protocol developed late gastrointestinal complications. CONCLUSIONS: More intensive radiation and chemotherapy appeared to improve the resectability, local control, and survival in tethered and fixed rectal cancers. There was a moderate but acceptable increase in the bowel morbidity.

Adenocarcinoma↗

PubMed1997

Causes and management of intestinal obstruction in a Saudi Arabian hospital.

A retrospective review of 84 cases of intestinal obstruction admitted to the National Guard Hospital over a period of 10 years was carried out. The main causes of obstruction were: post-operative adhesions, 38 patients (45%); hernia, 17 (20%); pseudo-obstruction, eight (9.5%); intussusception, six (7%); malignant obstruction, four (4.8%); inflammatory obstruction, three (3.6%); volvulus, three (3.6%); and others, five (6%). Large bowel obstruction occurred in only 16 patients (19%). Surgical intervention was necessary in 61 patients (73%) while 23 patients (27%) responded to conservative treatment. Post-operative complications occurred in 14 patients (17%). The main complications were: wound infection, chest infection, prolonged ileus and intestinal fistulae. The mortality rate was 3.5%. The pattern of small bowel obstruction in Saudi Arabia is similar to that in the West, while large bowel obstruction is rather uncommon.

Adult↗

PubMed1994

Loop ileostomy for temporary fecal diversion.

The aim of this study was to prospectively assess the morbidity of creating and closing loop ileostomies in a consecutive series of patients having an ileoanal pouch procedure. Between 1983 and 1991, 203 patients had loop ileostomies created for temporary fecal diversion after an ileoanal pouch procedure. There was one death as a result of liver failure. One patient developed a persistent pouch-vaginal fistula that resulted in pouch excision. The remaining 201 patients had their ileostomies closed at a mean time of 10 weeks after the primary procedure. Only 7% needed surgery to correct ileostomy-related problems. After ileostomy closure, complications were noted in only 2% of patients. Loop ileostomy is easy to create and provides highly effective fecal diversion, which decreases the incidence of and mitigates the serious sequelae of pouch sepsis. Closure is simple, does not require a laparotomy, and is associated with few complications. Our experience with loop ileostomy for temporary fecal diversion after an ileoanal pouch procedure has been favorable. The loop ileostomy may be the stoma of choice for most clinical situations in which temporary fecal diversion is indicated.

Adenomatous Polyposis Coli↗

PubMed1992

Chronic fissure-in-ano: a randomized study comparing open and subcutaneous lateral internal sphincterotomy.

A prospective study comparing open and subcutaneous lateral internal sphincterotomy for chronic anal fissure was conducted. One hundred twelve patients were randomized to open (n = 54) or subcutaneous (n = 58) sphincterotomy. There was no significant difference in acute complications between the subcutaneous (8.6 percent) and open (7.4 percent) groups. Postoperative length of stay was significantly shorter for the subcutaneous group (1.7 +/- 0.2 days) than for the open group (2.3 +/- 0.1 days; P less than 0.001). Although the response rate to a pain questionnaire was less than 50 percent, the data suggest a lower level of postoperative pain in the subcutaneous group. Fissure healing was similar between the subcutaneous (96.6 percent) and open (94.4 percent) groups. We conclude that subcutaneous lateral internal sphincterotomy for chronic fissure-in-ano is effective and may result in significantly less postoperative discomfort, shorter postoperative lengths of stay, and a comparable rate of complications compared with the open technique.

Adult↗

PubMed1992

A prospective randomized trial of routine postoperative nasogastric decompression in patients with bowel anastomosis.

Until relatively recently, the nasogastric (NG) tube has been used routinely for decompression in the patient with small- or large-bowel anastomosis. To determine if routine postoperative NG decompression benefited such patients, 102 patients were randomized prospectively to either NG decompression or no-NG tube. Excluded were patients with chronic bowel obstruction, peritonitis, gross fecal contamination or spillage, and previous abdominal or pelvic irradiation. There were 52 patients in the no-NG group and 50 in the NG group. Patients in the no-NG group had earlier bowel sounds, return of flatus, oral intake and first bowel movement. Four patients (8%) in the no-NG group, compared with one patient (2%) in the NG group, required subsequent decompression. Length of hospital stay was significantly (p < 0.001) shorter in the no-NG group. There were no significant differences in the presence of atelectasis, postoperative fever, wound infections and anastomotic leaks between the two groups. The authors conclude that routine nasogastric decompression is not warranted after elective surgery involving small- or large-bowel anastomosis.

Adolescent↗

PubMed1986

Giant and symptomatic inflammatory polyps of the colon in idiopathic inflammatory bowel disease.

Four cases of giant inflammatory polyps were found in a series of 86 consecutive colectomies for inflammatory bowel disease. Two presented a distinctive clinical syndrome of abdominal pain and chronic iron-deficiency anemia due to blood loss. Secondary ulceration of the heads of the polyps accounted for the bleeding and anemia, and the size of the polyps accounted for the abdominal pain. In both cases unusually long portions of colon were involved by the giant polyps. The third and fourth cases had rare complications--reactivation of an enterocutaneous fistula and perforation of an acquired diverticulum. These cases demonstrate that giant inflammatory polyps may produce symptoms independently of the underlying inflammatory bowel disease. In reported cases of giant inflammatory polyps, approximately two-thirds had Crohn's disease and one-third had ulcerative colitis. The transverse colon was the commonest location, pain was the commonest symptom, and the polyps were localized to a short segment of colon in the majority of cases. More than 50% of cases mimicked neoplasm on barium enema. Giant inflammatory polyps may produce a variety of distinctive signs and symptoms and deserve independent recognition.

Adult↗

PubMed1985

Recurrence following stapled coloproctostomy for carcinomas of the mid portion of the rectum.

A retrospective analysis of 90 patients who underwent a curative surgical resection for a carcinoma of the middle third of the rectum was carried out to determine the preliminary recurrence rates associated with stapled coloproctostomy. Acknowledging the obvious limitations of this preliminary report, the liberal use of restorative resections for these lesions does not appear to be resulting in an obvious increase in tumor recurrence, and the use of the circular intraliminal staplers has significantly decreased the number of abdominoperineal resections required to treat these lesions. We will continue to use stapled coloproctostomy for the majority of these lesions; however, definitive statements regarding the over-all effect of this approach upon survival time await further studies incorporating larger numbers and longer follow-up studies.

Adult↗

PubMed1985

What is appropriate follow-up for the patient with colorectal cancer?

Overall recurrence rates after curative resection for colorectal cancer average 30%. The value of intensive follow-up protocols is assessed from a review of the literature, which reveals that recurrent colorectal cancer can be detected at an earlier stage (average 3 months) and that repeat resection rates for cure can be increased (twofold or more) by intensive follow-up. Despite this, no improvement in survival has been documented. As nonsurgical modalities of therapy for recurrence become further refined, earlier detection of recurrent tumour will become increasingly important. An intensive follow-up regimen is therefore proposed, based on a knowledge of the patterns and timing of recurrence, the relative merits of the investigational modalities available and the assumption that at some point earliest detection and subsequent therapy will improve survival.

Colonic Neoplasms↗

PubMed1984

The true incidence of synchronous cancer of the large bowel. A prospective study.

The reported incidence of synchronous primary cancers and polyps associated with single cancers of the large bowel is varied. In a prospective study over a 5 year period, 166 patients with primary colorectal cancer had either total colonoscopy preoperatively or total colonoscopy within 6 months of surgical resection. One hundred seventy-eight cancers were detected. Synchronous cancers were found in eight patients (5 percent), and benign neoplastic polyps were demonstrated in 46 patients with single cancers (28 percent) and in 112 patients with synchronous primary cancers (38 percent). Of significance is that seven of eight (88 percent) synchronous cancers would not have been included in the standard resection for the index primary cancer. Similarly 31 of 46 neoplastic polyps (67 percent) were not in the same surgical segment as the primary cancer. Total large bowel evaluation, preferably using colonoscopy, is essential in all patients with cancer of the large bowel.

Adult↗

PubMed1984

Accidental splenic injury during surgical treatment of the colon and rectum.

Although operative injury to the spleen continues to account for a large number of splenectomies, the incidence of injury during operations upon the colon and rectum has not previously been reported. Of 993 consecutive colonic and rectal excisions, the spleen was injured in eight and splenectomy resulted in three. Two hundred and sixty patients had the splenic flexure of the colon mobilized. All splenic injuries occurred in this group (3.1 per cent) for an incidence of splenectomy during splenic flexure mobilization of 1.15 per cent. In all patients, splenic injury consisted of a capsular tear and was a result of traction on spleno-omental peritoneal bands in 50 per cent. The spleen was salvaged using topical hemostatic agents in 63 per cent of the injuries. A method of splenic flexure mobilization which improves visualization of splenic attachments and avoids traction injuries is discussed. The morbidity and mortality from traumatic splenectomy are also reviewed.

Colon↗