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J Am Coll Surg. 1998 Dec;187(6):577-83.
Longterm outcomes and quality of life after Z-shaped anastomosis for Hirschsprung's disease.

Suita S, Taguchi T, Yanai K, Kamimura T, Nakao M, Ikeda K.

Department of Pediatric Surgery, Kyushu University, Fukuoka, Japan.

BACKGROUND: Z-shaped anastomosis is one of the modifications of Duhamel's procedure that was designed to eliminate the blind rectal pouch and to achieve complete resection of the colorectal septum. It has been the most widely performed operation in Japan for many years. The longterm postoperative function of evacuation and quality of life of the patients are considered important to evaluate this procedure. METHODS: At Kyushu University Hospital, from 1963 to 1997, 127 patients with Hirschsprung's disease underwent Z-shaped anastomosis. As a result, 122 out of 127 patients (96%) survived. The present status and symptoms, and anorectal functions, including a manometric study and barium enema, were evaluated during the clinical followup. RESULTS: A total of 99 of the 122 surviving patients (81%) were available for this study, and the mean postoperative period was 16 years. Evacuation scores in all patients were as follows; excellent, 62.2%; good, 28.6%; fair, 8.2%; and poor, 1.0%. The percentage of the patients who showed severe symptoms was 4.1% for diarrhea, 3.1% for constipation, 5.1% for incontinence, and 7.1% for soiling. The evacuation score improved chronologically and tended to reach a plateau at 10 to 15 years after operation, at which time 73% of the patients showed excellent outcomes and 95% were satisfactory (good or excellent). The appearance of a sense of defecation and an increase in the pressure difference between the anal canal and the rectum substantially contributed to the improvement in the defecation score. The appearance of the rectosphincteric reflex, including the atypical one, was seen in 40.5% of patients, but the appearance of a reflex did not seem to be related to the clinical status of defecation. Twenty-two o



Gastroenterol Clin Biol. 1998 Oct;22(10):785-91.
[Descriptive study of digestive functional symptoms in the French general population]

[Article in French]

Frexinos J, Denis P, Allemand H, Allouche S, Los F, Bonnelye G.

Service de Gastroenterologie et Nutrition, CHU de Rangueil, Toulouse.

To study the prevalence of "reported" functional digestive symptoms (FDS) in terms easily understood by the general population without resorting to predefined concepts of functional syndromes, and to assess FDS impact on public health, a sample survey has been carried out between September and December 1995. METHODS: Four thousand eight hundred and seventeen subjects representative of the French general population aged 15 years or more filled in a questionnaire describing their digestive disorders. RESULTS: Seventy percent of the subjects had digestive complaints, 9% being related to a presumably organic disease, and 61% attributed to FDS. Twenty-seven % of the subjects claimed to be inconvenienced by their FDS, whereas 34% seemed not to feel any inconvenience. Among FDS, gas emission was the most frequent symptom (59%), followed by stomach ache and/or digestive pain (48%), flatulence (47%), bad digestion sensations (40%), constipation (35%), aerophagia (29%), bad breath (22%), incomplete evacuation of stools (19%). FDS had lasted from 6 months to 5 years in 38%, and over 5 years in 52%. In the subgroup of subjects inconvenienced by FDS (27%), 9% consulted and 18% did not, whereas in the subgroup not inconvenienced, 3% consulted and 31% did not. Altogether, 26% of the subjects followed a prescription or self medication treatment; 35% were not treated. Some explanatory variables appeared to be associated with the onset of inconvenience: the associations pain and bad digestion, flatulence and aerophagia, incomplete evacuation and nervous or presumably organic origin of FDS, age, stress, FDS frequency. Duration of symptoms, age above 65 years, digestive pain, presumably organic origin, and FDS frequenc



Dis Colon Rectum. 1998 Dec;41(12):1534-41; discussion 1541-2.
Associations between hemorrhoids and other diagnoses.

Delco F, Sonnenberg A.

Department of Veterans Affairs Medical Center and The University of New Mexico, Albuquerque 87108, USA.

PURPOSE: The risk factors and mechanisms that contribute to the occurrence of hemorrhoids are not well understood. The study of the comorbid occurrences of hemorrhoids with other diagnoses in identical patients may point to a common underlying pathophysiology. The present study was undertaken to determine which diagnoses are associated with the occurrence of hemorrhoids. METHODS: A case-control study compared the occurrence of comorbid diseases in case subjects with hemorrhoids with that of control subjects without hemorrhoids. The case population comprised all patients with hemorrhoids (International Classification of Diseases codes 455.0-455.9), who were discharged from hospitals of the U.S. Department of Veterans Affairs between 1986 and 1996. In a multiple logistic regression analysis, the occurrence of hemorrhoids served as outcome variable, and age, gender, ethnicity, and the comorbid occurrence of other diagnoses served as predictor variables. RESULTS: A total of 96,314 individual patients with hemorrhoids and the same number of control subjects were identified. In a chart review of a random sample of 100 cases, the diagnosis of hemorrhoids could be confirmed in 97 percent of all instances checked. The variety of diagnoses associated with hemorrhoids could be broken down into five large categories: 1) diseases associated with diarrhea (odds ratio, 1.30; 95 percent confidence interval, 1.27-1.33); 2) spinal cord injuries (odds ratio, 1.17; 95 percent confidence interval, 1.09-1.26); 3) constipation and related diseases (odds ratio, 1.48; 95 percent confidence interval, 1.43-1.54); 4) various types of anorectal diseases (odds ratio, 4.71; 95 percent confidence interval, 4.44-5.0); and 5) conditions that could be considered manifestations or sequelae of the hemorrhoidal



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