PURPOSE:Data supporting an increased risk of colorectal cancer in patients with Crohn’s colitis are inconsistent.Despite this,clinical recommendations regarding colonoscopic screening and surveillance for patients wi...PURPOSE:Data supporting an increased risk of colorectal cancer in patients with Crohn’s colitis are inconsistent.Despite this,clinical recommendations regarding colonoscopic screening and surveillance for patients with Crohn’s colitis are extrapolated from chronic ulcerative colitis protocols.The primary aim of our study was to determine the incidence of dysplasia and carcinoma in pathology specimens of patients undergoing segmental or total colectomy for Crohn’s disease of the large bowel.In addition,we sought to identify risk factors associated with the development of dysplasia and carcinoma.METHODS:We performed a retrospective review of all patients operated on at our institution for Crohn’ s colitis between January 1992 and May 2004.Data were retrieved from patient charts,operative notes,and pathology reports.Logistic regression was used to model the probability of having dysplasia or adenocarcinoma.RESULTS:Two hundred twenty-two patients(138 females) who underwent surgical resection for the treatment of Crohn’s colitis were included in the study.Mean age at surgery was 41(range,15-82) years and the mean duration of disease was 10(range,0-53) years.There were five cases of dysplasia(2.3 percent) and six cases of adenocarcinoma(2.7 percent) .Three patients with dysplasia and one with adenocarcinoma were diagnosed on preoperative colonoscopy;while the other cases were discovered incidentally on pathologic examination of resected specimens.Factors associated with the presence of dysplasia or adenocarcinoma included older age at diagnosis(38.2 vs.30.3 years,P = 0.02) ,longer disease duration(16.0 vs.10.1 years,P = 0.05) ,and disease extent(90 percent extensive vs.59 percent limited,P = 0.05) .CONCLUSIONS:Patients with severe Crohn’s colitis requiring surgery are at significant risk for developing dysplasia and adenocarcinoma,particularly when diagnosed at an older age,after longer disease duration,and with more extensive colon involvement.展开更多
PURPOSE: Pudendal nerve terminal motor latency testing has been used to test for pudendal neuropathy, but its value remains controversial. We sought to clarify the relationship of pudendal nerve terminal motor latency...PURPOSE: Pudendal nerve terminal motor latency testing has been used to test for pudendal neuropathy, but its value remains controversial. We sought to clarify the relationship of pudendal nerve terminal motor latency to sphincter pressure and level of continence in a cohort of patients with intact anal sphincters and normal pelvic floor anatomy. METHODS: We reviewed 1,404 consecutive patients who were evaluated at our pelvic floor laboratory for fecal incontinence. From this group, 83 patients had intact anal sphincters on ultrasound and did not have internal or external rectal prolapse during defecography. These patients were evaluated by pudendal nerve terminal motor latency testing, a standardized questionnaire, and anorectal manometry, which measured resting and squeeze anal pressures. Incontinence scores were calculated by using the American Medical Systems Fecal Incontinence Score. Values were compared by using the Fisher’s exact test and Wilcoxon’s rank-sum test; and significance was assigned at the P < 0.05 level. RESULTS: 1) Using a 2.2-ms threshold, 28 percent of patients had prolonged pudendal nerve terminal motor latency unilaterally and 12 percent bilaterally. 2) At a 2.4-ms threshold, 18 percent of patients had prolonged pudendal nerve terminal motor latency unilaterally and 8 percent bilaterally. 3) Bilaterally prolonged pudendal nerve terminal motor latency was significantly associated with decreased maximum mean resting pressure and increased Fecal Incontinence Score, but not decreased maximum mean squeeze pressure, at both 2.2-ms and 2.4-ms thresholds. 4) Unilaterally prolonged pudendal nerve terminal motor latency was not associated with maximum mean resting pressure, maximum mean squeeze pressure, or fecal incontinence score at either threshold. CONCLUSIONS: The majority of incontinent patients with intact sphincters have normal pudendal nerve terminal motor latency. Bilaterally but not unilaterally prolonged pudendal nerve terminal motor latency is associated with poorer function and physiology in the incontinent patient with an intact sphincter.展开更多
文摘PURPOSE:Data supporting an increased risk of colorectal cancer in patients with Crohn’s colitis are inconsistent.Despite this,clinical recommendations regarding colonoscopic screening and surveillance for patients with Crohn’s colitis are extrapolated from chronic ulcerative colitis protocols.The primary aim of our study was to determine the incidence of dysplasia and carcinoma in pathology specimens of patients undergoing segmental or total colectomy for Crohn’s disease of the large bowel.In addition,we sought to identify risk factors associated with the development of dysplasia and carcinoma.METHODS:We performed a retrospective review of all patients operated on at our institution for Crohn’ s colitis between January 1992 and May 2004.Data were retrieved from patient charts,operative notes,and pathology reports.Logistic regression was used to model the probability of having dysplasia or adenocarcinoma.RESULTS:Two hundred twenty-two patients(138 females) who underwent surgical resection for the treatment of Crohn’s colitis were included in the study.Mean age at surgery was 41(range,15-82) years and the mean duration of disease was 10(range,0-53) years.There were five cases of dysplasia(2.3 percent) and six cases of adenocarcinoma(2.7 percent) .Three patients with dysplasia and one with adenocarcinoma were diagnosed on preoperative colonoscopy;while the other cases were discovered incidentally on pathologic examination of resected specimens.Factors associated with the presence of dysplasia or adenocarcinoma included older age at diagnosis(38.2 vs.30.3 years,P = 0.02) ,longer disease duration(16.0 vs.10.1 years,P = 0.05) ,and disease extent(90 percent extensive vs.59 percent limited,P = 0.05) .CONCLUSIONS:Patients with severe Crohn’s colitis requiring surgery are at significant risk for developing dysplasia and adenocarcinoma,particularly when diagnosed at an older age,after longer disease duration,and with more extensive colon involvement.
文摘PURPOSE: Pudendal nerve terminal motor latency testing has been used to test for pudendal neuropathy, but its value remains controversial. We sought to clarify the relationship of pudendal nerve terminal motor latency to sphincter pressure and level of continence in a cohort of patients with intact anal sphincters and normal pelvic floor anatomy. METHODS: We reviewed 1,404 consecutive patients who were evaluated at our pelvic floor laboratory for fecal incontinence. From this group, 83 patients had intact anal sphincters on ultrasound and did not have internal or external rectal prolapse during defecography. These patients were evaluated by pudendal nerve terminal motor latency testing, a standardized questionnaire, and anorectal manometry, which measured resting and squeeze anal pressures. Incontinence scores were calculated by using the American Medical Systems Fecal Incontinence Score. Values were compared by using the Fisher’s exact test and Wilcoxon’s rank-sum test; and significance was assigned at the P < 0.05 level. RESULTS: 1) Using a 2.2-ms threshold, 28 percent of patients had prolonged pudendal nerve terminal motor latency unilaterally and 12 percent bilaterally. 2) At a 2.4-ms threshold, 18 percent of patients had prolonged pudendal nerve terminal motor latency unilaterally and 8 percent bilaterally. 3) Bilaterally prolonged pudendal nerve terminal motor latency was significantly associated with decreased maximum mean resting pressure and increased Fecal Incontinence Score, but not decreased maximum mean squeeze pressure, at both 2.2-ms and 2.4-ms thresholds. 4) Unilaterally prolonged pudendal nerve terminal motor latency was not associated with maximum mean resting pressure, maximum mean squeeze pressure, or fecal incontinence score at either threshold. CONCLUSIONS: The majority of incontinent patients with intact sphincters have normal pudendal nerve terminal motor latency. Bilaterally but not unilaterally prolonged pudendal nerve terminal motor latency is associated with poorer function and physiology in the incontinent patient with an intact sphincter.
