PTN neuromodulation without surgically implanted electrode could represent a safe and low-cost alternative to permanent sacral neuromodulation for idiopathic anal incontinence.
Prognostic factors of unresected liver metastases in patients with colorectal cancer are not well established. A total of 544 patients with unresected liver metastases from colorectal cancer were registered in a national survey over a 1-year period and followed until death. Twenty factors were studied in a univariate analysis (log rank test) and 16 influenced survival (P < 0.01). These 16 factors were entered in a multivariate analysis (Cox model) and eight, ranging from the most significant (relative risk of death 1.9) to the less significant (relative risk of death 1.2), independently influenced survival: performance status, alkaline phosphatase level, number of involved liver segments, administration of chemotherapy, presence of extrahepatic metastases, site of the primary tumour, prothrombin time and resection of the primary lesion. Two simple classifications are proposed, taking into account the performance status and the alkaline phosphatase level, or the performance status and the number of involved liver segments.
After abdominoperineal resection, Malone antegrade continence enema associated to perineal colostomy provided an acceptable continence. It preserved patients' body image and resulted in a satisfying quality of life. It could become an alternative to iliac colostomy in selected patients.
Ninety patients were included in this prospective randomized trial. Each required electric colorectal surgery and was prepared for operation with oral preoperative antibiotic therapy, systemic peroperative therapy, or by a combination of both. The number of each type of septic postoperative complication and their total did not differ between the group treated by oral antibiotics prior to operation and the group treated peroperatively with systemic antibiotic therapy. The total number of septic complications (wall abscesses, fistulas, subdiaphragmatic abscesses, septicemia, peritonitis), however, was significantly less (P less than 0.05) in the group treated by both preoperative oral antibiotics and peroperative systemic antibiotic therapy (3.3 per cent) than in either groups treated only orally preoperatively (30 per cent) or by systemic antibiotic therapy during the operation (23 per cent). The combination of oral antibiotic therapy prior to operation and of systemic peroperative antibiotic therapy, therefore, presents the most effective prophylactic effectiveness.
Stenoses and leakages occurred more frequently after appendicostomy and caecal flap than after ileal neoappendicostomy. This latter technique appears to reduce morbidity for adult patients.
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