Background: The frequencies and types of anal symptoms were compared with the frequencies and types of benign anal diseases (BAD). Methods: Patients transferred from GPs, physicians or gynaecologists for anal and/or abdominal complaints/signs were enrolled and asked to complete a questionnaire about their symptoms. Proctologic assessment was performed in the knee-chest position. Definitions of BAD were tested in a two year pilot study. Findings were entered into a PC immediately after the assessment of each individual. Results: Eight hundred seven individuals, 539 (66.8%) with and 268 without BAD were analysed. Almost one third (31.2%) of patients with BAD had more than one BAD. Concomitant anal findings such as skin tags were more frequently seen in patients with than without BAD (<0.01). After haemorrhoids (401 patients), pruritus ani (317 patients) was the second most frequently found BAD. The distribution of stages in 317 pruritus ani patients was: mild (91), moderate (178), severe (29), and chronic (19). Anal symptoms in patients with BAD included: bleeding (58.6%), itch (53.7%), pain (33.7%), burning (32.9%), and soreness (26.6%). Anal lesions could be predicted according to patients' answers in the questionnaire: haemorrhoids by anal bleeding (p=0.032), weeping (p=0.017), and non-existence of anal pain (p=0.005); anal fissures by anal pain (p=0.001) and anal bleeding (p=0.006); pruritus ani by anal pain (p=0.001), itching (p=0.001), and soreness (p=0.006). Conclusions:The knee-chest position may allow for the accumulation of more detailed information about BAD than the left lateral Sims' position, thus enabling physicians to make more reliable anal diagnoses and provide better differentiated therapies.
Interest in leading prognostic determinants of proximal gastric adenocarcinoma (PGA) in comparison with distally located adenocarcinoma (DLA) of the stomach led to an analysis of data from 506 patients with PGA and 484 patients with DLA operated on between 1 April 1982 and 31 October 1984 and participating in a multicentre observational study to validate tumour node metastasis (TNM) stage groupings. The proportion of men with PGA was slightly higher than that of men with DLA (69 versus 63 per cent). Men more often had cardia carcinomas than women (14 versus 9 per cent); 74 per cent of these men but only 43 per cent of the women were less than 65 years old. Evaluation of data by a log-linear model indicated a strong partial association (P less than 0.001) between age and site; patients younger than 65 years more often had PGA than older patients. Advanced tumour stage and the intestinal type of carcinoma were more frequently seen in the elderly. More than twice as many patients with PGA in comparison with those with DLA (35 versus 15 per cent) had palliative surgery (moderate association, P less than 0.05). This may have resulted from different stages at different sites; advanced carcinomas (TNM stages IIIb and IV) were more often diagnosed in patients with PGA than in those with DLA (60 versus 38 per cent). Residual tumour left after surgery was associated with deeper infiltration (P less than 0.001). No difference between PGA and DLA groups with respect to histological type of carcinoma was established, but residual tumour was more frequently associated with a diffuse type carcinoma (P less than 0.01). An overall tendency to poorer long-term prognosis in PGA was seen for all TNM stages, with and without residual tumour, except for TNM stage II with residual tumour, even though patients with PGA were younger than those with DLA. These differences in long-term prognosis, however, are based primarily on poorer short-term survival for PGA, particularly for TNM stages Ib and II without residual tumour. A significant risk of surgical management, particularly for early-stage tumours situated in the upper part of the stomach, has therefore been recognized. Surgeons should appreciate the higher surgical mortality rate for patients with PGA when curative treatment requires more risky surgical techniques.
The degree of sedation and amnesia, subjective assessment of awakening and side effects after intravenous injection of 3-4 mg midazolam and 1 mg flumazenil or placebo were studied directly after colonoscopy, and on the first and the eight day. A total of 91 patients were studied; 45 patients were given flumazenil and 46 patients a placebo. Five minutes after injection of the test drugs all 45 patients given flumazenil but only 38 patients given the placebo were alert (p = 0.006). All three response criteria (for sedation, amnesia and subjective assessment of awakening) were fulfilled by 84.4% of the patients given flumazenil and 45.7% of the patients given the placebo (p = 0.0002). Thirty minutes after injection of the test drugs dizziness, nausea, and fatigue were found in 3 patients given flumazenil and in 10 patients given placebo. One day after colonoscopy 9 of 45 patients (20%) given midazolam and flumazenil complained of fatigue and 9 of 46 patients (19.5%) given midazolam and placebo. Eight days (+/- 1 day) later two patients in each group complained of headache, nausea and fatigue. No patient developed phlebitis at the injection site. Flumazenil seems to be a safe and efficient drug for reversing the sedative effect of midazolam, premedication after colonoscopy. However, resedation due to the effects of midazolam may occur. Flumazenil thus permits administration of a higher dose of midazolam without prolongation of the surveillance time. Improved exploitation of time, space and nursing resources is thus possible without jeopardizing patient safety, although caution is necessary since patients may not be fit to resume all normal activities.
This multicenter observational study examined the survival of 1420 patients with histologically proven carcinoma of the stomach. From April 1982 through October 1984, 1360 (95%) patients underwent surgery, 988 (72%) had resections, and 372 (28%) minor surgical procedures. The percentage of patients who have been followed until death or 3 to 5 years was 99.4%. Patients were staged preoperatively and intraoperatively and by pathologists using the old (1978) and new (1987) TNM stage groupings and 5-year survival was analyzed. Subgroups of patients who changed their stage group according to the new stage definitions were analyzed separately. Only age was an important prognostic factor for survival in Stage IA (P less than 0.05) and Stage IB (P less than 0.01). Residual tumor after surgery was most important for survival in Stage II (P less than 0.01) and Stage IIIA (P less than 0.001). This indicates that improvements of stage definitions for individual prognosis can only be achieved by adding data concerning the presence or absence of residual tumor (R classification).
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