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Dis Colon Rectum. 1999 May;42(5):655-60.
Functional results of operative treatment of rectal prolapse over an 11-year period: emphasis on transabdominal approach.

Aitola PT, Hiltunen KM, Matikainen MJ.

Department of Surgery, Tampere University Hospital, and Medical School, University of Tampere, Finland.

PURPOSE: A variety of surgical procedures have been developed to treat rectal prolapse, but there is still no consensus on the operation of choice. The aim of this study was to evaluate the functional results of operative treatment of rectal prolapse during an 11-year period in our department. METHODS: All patients treated for complete rectal prolapse during an 11-year period, from 1985 to 1995, in a single university hospital were included. Of the 123 patients, 22 were men, and the mean age was 59 (range, 15-88) years. The medical records of all patients were reviewed retrospectively, and a questionnaire on bowel symptoms before and after surgery was sent to all 95 living patients. RESULTS: The majority of the procedures (91 percent) were performed by abdominal approach, and the most frequently used open technique was posterior rectopexy with mesh (78 percent). Of the incontinent patients, 35 (63 percent), all those less than 40 years of age and 64 percent of those 40 years or older, were continent postoperatively (P = 0.0001) after a median follow-up of five (range, 1-72) months. According to the questionnaire, after a median follow-up of 85 (range, 16-144) months, only 38 percent of the incontinent patients in the mesh or suture group, 78 percent of patients less than 40 years of age (n = 18), and 52 percent of those 40 years or older (n = 47) claimed to be continent postoperatively. The proportion of patients with constipation was greater after the operation than preoperatively (P = 0.02) and more patients used medication for constipation after than before the operation (P = 0.0001). The overall complication rate was 15 percent, and the mortality rate was 1 percent (1/123). In the mesh o

Dis Colon Rectum. 1999 Jun;42(6):741-52.
Determination of factors responsible for the declining incidence of colorectal cancer.

Nelson RL, Persky V, Turyk M.

Department of Surgery, College of Medicine, School of Public Health, University of Illinois at Chicago, USA.

INTRODUCTION: After rising for 13 years in the United States, the incidence of colorectal cancer began to fall in 1986 and has continued to drop since then. This report contains an analysis of the pattern of declining colorectal cancer risk by colorectal subsite, race, and gender and a time trend investigation of suspected risk modifiers of colorectal cancer. METHOD: Colorectal cancer incidence data were obtained from the Surveillance, Epidemiology, and End Results Public Use Files from 1973 to 1994. The following exposure variables were assessed, focussing principally on the period 1970 to 1980: dietary fat, fiber, ethanolic beverages, vitamin A, vitamin C, iron, calcium, estrogen, aspirin, energy intake, body mass index, serum cholesterol, body iron stores, cholecystectomy, constipation, cigarette use, physical activity, and colonoscopic polypectomy. Data sources used in these analyses were principally National Health and Nutrition Examination Surveys I, II, and III. RESULTS: After 1985 colorectal cancer incidence declined predominantly in the distal colorectum almost equally in both white males and white females. Some exposures remained unchanged or trended in the wrong direction (dietary fat, calcium, ethanol, energy intake, physical activity, overweight prevalence, and cholecystectomy). Others did not apply equally to both genders (estrogen, aspirin, ethanol, calcium, and cholecystectomy). Others may become significant in the future, such as aspirin, estrogen, or calcium, because their supplementation is now prevalent, but were not in 1970 to 1975. Of all the risk factors or interventions assessed, the one most consistent with the observed pattern of change is increased use of colonoscopic polypectomy. CONCLUSION: The best m

Gut. 1999 Aug;45(2):264-8.
Gall bladder emptying in severe idiopathic constipation.

Penning C, Gielkens HA, Delemarre JB, Lamers CB, Masclee AA.

Department of Gastroenterology-Hepatology, Leiden University Medical Centre, The Netherlands.

BACKGROUND: It has been suggested that slow transit constipation (STC) may be part of a panenteric motor disorder. AIM: To evaluate motility of an upper gastrointestinal organ, the gall bladder, in 16 patients with STC and 20 healthy controls. METHODS: Gall bladder emptying (ultrasonography) was studied in response to neural, cephalic-vagal stimulation with modified sham feeding (MSF) for 90 minutes and in response to hormonal stimulation with cholecystokinin (CCK, 0.5 IDU/kg/h) for 60 minutes. RESULTS: Fasting gall bladder volume in patients with STC (17 (2) cm(3)) was significantly (p<0. 01) reduced compared with that in controls (24 (2) cm(3)). Gall bladder emptying in response to MSF was significantly reduced in patients with STC expressed both as percentage emptying (11 (5)% versus 22 (3)%; p<0.05) and as absolute emptying (2.1 (0.7) cm(3) versus 4.9 (0.7) cm(3); p<0.02). However, percentage gall bladder emptying in response to CCK was not different between patients and controls (73 (4)% versus 67 (4)%) although the absolute reduction in gall bladder volume was significantly (p<0.05) smaller in patients (10.7 (1.1) cm(3) versus 15.3 (1.4) cm(3)). CONCLUSIONS: Patients with slow transit constipation have smaller fasting gall bladder volumes, impaired gall bladder responses to vagal cholinergic stimulation, but normal gall bladder responses to hormonal stimulation with CCK. These results point to abnormalities in gastrointestinal motility proximal from the colon in slow transit constipation and more specifically, impaired neural responsiveness.

Laxative online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10403740&dopt=Abstract constipation laxative colon cleansing

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