In spite of remarkable improvement of surgical skills and anesthesia, local failure still occurred in 36-45% of locally advanced colorectal cancer after curative resection with or without pre-or post-operative irradiation. Intraoperative radiation therapy (IORT) is the ideal modality which respectable lesions are removed surgically and the remaining cancer nests are sterilized by irradiation during a surgical procedure. Therefore, the excellent local control without the damage of the adjacent normal tissues can be achieved. In IORT, judicious set up of the treatment cone on the treatment surface of the patient is required for accurate and homogenous dose distribution within treatment field, especially on the slopping surface of sacrum and pelvic sidewall which are the common sites of the local recurrence in rectal cancer. For this purpose, adequate coordination of gantry rotation and table tilting are essential. Adjusting gantry rotation is not difficult but tilting of the table is impossible inconventional treatment couch. Department of Therapeutic Radiology in Yeungnam University Medical Center developed the IORT table for colorectal cancer which is easy to set up and detach on head-down is about 30 degree which is efficient and easy-to-use, not only for IORT but also for colorectal surgery. So far, authors performed IORT with newly developed treatment table in 2 patients with rectal cancer and we found that this newly developed table could contribute in improving the dose distribution of IORT and surgical procedure for colorectal cancer.
Academic Medical Centers ; Anesthesia, Local ; Colorectal Neoplasms* ; Colorectal Surgery ; Humans ; Radiation Oncology ; Rectal Neoplasms ; Recurrence ; Sacrum

OBJECTIVETo observe analgesic effect of acupuncture anesthesia.

METHODSSixty-nine cases undergoing rectal cancer surgery were randomly divided into 3 groups, group I, II and III, 23 cases in each group. Both Zusanli (ST 36) and Sanyinjiao (SP 6) were selected for acupuncture anesthesia. Group I received general anesthesia after acupuncture induction, group II received acupuncture after general anesthesia, and group II received only general anesthesia. Minimum alveolar concentration (MAC) before and after operation was recorded.

RESULTSMAC was (1.35 +/- 0.19) vol% in the group I, (1.49 +/- 0.22) vol% in the group II and (1.64 +/- 0.27) vol% in the group III. Acupuncture before and after general anesthesia could decrease respectively by about 0.29% and 0.15% of MAC in rectal cancer surgery undergoing general anesthesia, with a very significant difference (P < 0.01) or a significant difference (P < 0.05) among the 3 groups.

CONCLUSIONAcupuncture anesthesia has a certain adjuvant action for anesthesia and analgesia, and acupuncture before general anesthesia has a better action.

Acupuncture Analgesia ; Acupuncture Therapy ; Anesthesia, General ; Humans ; Pain Management ; Rectal Neoplasms

PURPOSE: The analgesic efficacy of the periprostatic nerve blockade during transrectal ultrasound guided prostatic biopsies was evaluated. MATERIALS AND METHODS: A transrectal ultrasound guided prostate biopsy was performed in 90 men due to abnormal digital rectal examinations or elevated prostate specific antigens. During the biopsy, two groups of 45 patients were randomly assigned to receive either an injection of 1% lidocaine or no prior analgesia. Immediately after the biopsy the pain score was independently recorded by the patients using a 10-point linear scale. RESULTS: The mean intraoperative pain scores were 2.7+/-1.7 and 4.9+/-2.6 in the lidocaine and control groups, respectively, and were significantly different (p<0.001). The mean immediate postoperative pain scores were 0.7+/-0.7 and 1.5+/-1.3 in the lidocaine and control groups, respectively, and were not significantly different (p=0.057). There were no differences in the complication rates between the two groups. CONCLUSIONS: Our results show a significant benefit of periprostatic anesthesia over that in the controls (no anesthesia applied) in our randomized trial. This safe, simple and rapid technique should be applied before a transrectal ultrasound guided prostatic biopsy to reduce undue patient discomfort.
Analgesia ; Anesthesia ; Biopsy* ; Digital Rectal Examination ; Humans ; Lidocaine ; Male ; Nerve Block* ; Pain, Postoperative ; Prostate* ; Prostate-Specific Antigen ; Ultrasonography*

PURPOSE: The incidence of stage T1c prostate cancer has been reported to have increased more than any other prostate cancer. To evaluate whether a sextant biopsy is useful for the detection of stage T1c prostate cancer, the detection rates were compared between the sextant and 12-sample needle biopsies, in relation to the prostate volume (PV) and serum prostate specific antigen (PSA) level. MATERIALS AND METHODS: Between January, 1986 and December, 2002, 123 patients who were found to be normal upon digital rectal examination, with negative findings on a transrectal ultra sonography (TRUS) examination and elevated serum PSA (>4ng/ml), underwent either a sextant or 12-sample needle biopsy, under local anesthesia, to detect the presence of prostate cancer. RESULTS: There was no statistically significant difference in the cancer detection rate between the sextant (11/41) and 12-sample (24/82) needle biopsies of the prostate. According to the total PSA level, the detection rates of prostate cancer for the 6 and 12 core groups were 31.6 (6/19) and 22.8% (8/35), respectively, (PSA: 4.1-9.9ng/ml), 23.1 (3/13) and 32.0% (8/25) (PSA: 10.0-19.9ng/ml), and 22.2 (2/9) and 36.4% (8/22) (PSA >or=20.0ng/ml). According to the prostate volume, the detection rates of prostate cancer for the 6 and 12 core groups were 28.6 (2/7) and 31.0% (9/29), respectively (PVor=60ml). Our study did not have the statistical power required to rule out small differences. CONCLUSIONS: These findings imply that a sextant biopsy constitutes a useful method for the detection of prostate cancer.
Anesthesia, Local ; Biopsy* ; Biopsy, Needle* ; Digital Rectal Examination ; Humans ; Incidence ; Needles* ; Prostate* ; Prostate-Specific Antigen ; Prostatic Neoplasms*

PURPOSE: Many centers rely on radiologists to detect prostate cancer by transrectal ultrasound guided prostate biopsy. In this study we evaluated transrectal ultrasound guided prostate biopsy by radiologist or urologist, and compared prostate cancer detection rate, pathologic results and pain scrore. MATERIAL AND METHODS: In all, 259 consecutive patients had transrectal ultrasound guided prostate biopsy by one radiologist (group 1) and one urologist (group 2). The indication for prostate biopsies were a raised or rising prostate specific antigen (PSA) level or abnormal digital rectal examination (DRE). All data were collected prospectively. RESULTS: Both group showed comparable demographic data in age, PSA, prostate volume. But pain score showed higher in urologist group (p<0.05). Prostate cancer was detected in 73 patients (28.1%). Radiologist detected prostate cancer in 38 patients (29.2%) and urologist detected prostate cancer in 35 patients (27.1%) (p=0.70). Both groups showed comparable cancer detection rates in PSA of <4, 4-10 and >10 ng/ml. Both groups had similar Gleason score (6.8+/-0.7 vs 6.7+/-0.8) and number of cancer cores (3.0+/-1.7 vs 3.9+/-2.3). Group 1 showed significantly low visual analogue pain scale compared with Group 2 (2.9+/-1.9 vs 4.0+/-2.1)(p<0.05). CONCLUSION: Transrectal ultrasound guided prostate biopsy showed equally reliable datas whether performed by radiologist or urologist. The urologist can effectively perform transrectal ultrasound guided prostate biopsy like radiologist in detecting prostate cancer. Also we recommend to perform anesthesia to relieve pain before prostate biopsy and furthermore future studies with more patients with more datas are needed.
Anesthesia ; Biopsy ; Digital Rectal Examination ; Humans ; Neoplasm Grading ; Pain Measurement ; Prospective Studies ; Prostate ; Prostate-Specific Antigen ; Prostatic Neoplasms ; Urology

OBJECTIVETo investigate the more reliable and effective operations for high anal fistula.

METHODSFrom Jan. 2002 to Oct. 2004, 117 cases suffering from high anal fistula were divided into two groups, and received tying therapy on main fistula with external anal fistulae excision (62 cases) or tying therapy on main fistula with external anal fistulae laid aside (55 cases). The curing time and recurrence were compared between the two groups.

RESULTSThere were no significant differences in basic clinical data between the two groups. There were 37 cases of high simple fistula, and 25 cases of complicated fistulae in resection group, while 39 cases of simple fistula and 16 cases of complicated fistulae in laying aside group. The curing time was 15-20 (17+/-2) days and no recurrence occurred after follow-up for half a year in resection group. The curing time was 25-55 (35+/-8) days and recurrence occurred in 6 cases (10.9%) in laying aside group including one case of high simple anal fistula and five cases of high complicated anal fistulae. There was statistical significance in treatment efficacy for high complicated anal fistulae (chi2=6.23, P=0.013), and the overall efficacy (chi2=5.06, P=0.024) between the two groups.

CONCLUSIONTying therapy on main fistula with external anal fistulae excision is a more effective treatment for high complicated anal fistulae.

Adolescent ; Adult ; Aged ; Anesthesia ; methods ; Digestive System Surgical Procedures ; methods ; Female ; Humans ; Male ; Middle Aged ; Rectal Fistula ; surgery ; Young Adult

As an important basis for lesion determination and diagnosis, medical image segmentation has become one of the most important and hot research fields in the biomedical field, among which medical image segmentation algorithms based on full convolutional neural network and U-Net neural network have attracted more and more attention by researchers. At present, there are few reports on the application of medical image segmentation algorithms in the diagnosis of rectal cancer, and the accuracy of the segmentation results of rectal cancer is not high. In this paper, a convolutional network model of encoding and decoding combined with image clipping and pre-processing is proposed. On the basis of U-Net, this model replaced the traditional convolution block with the residual block, which effectively avoided the problem of gradient disappearance. In addition, the image enlargement method is also used to improve the generalization ability of the model. The test results on the data set provided by the "Teddy Cup" Data Mining Challenge showed that the residual block-based improved U-Net model proposed in this paper, combined with image clipping and preprocessing, could greatly improve the segmentation accuracy of rectal cancer, and the Dice coefficient obtained reached 0.97 on the verification set.
Algorithms ; Delayed Emergence from Anesthesia ; Humans ; Image Processing, Computer-Assisted ; Rectal Neoplasms/diagnostic imaging* ; Tomography, X-Ray Computed

A male, 67 years old, visited the emergency room because of a foreign body impacted in his rectum. While he was being treated for grade-II hemorrhoids conservatively, he heard that massage of the peri-anal area could be helpful for preventing hemorrhoids. Thus, while using an electronic massager after placing the head of the machine into a short round bar, the head became separated from the machine, and this was inserted into the anus and impacted. The patient had anal discomfort without abdominal pain. His vital signs were stable, and no abnormal physical findings were found for the abdomen. On digital rectal examination, the rim of the foreign body was palpated about 8 cm from the anal verge. Anal bleeding, abnormal discharge, or foul odor was not found. On a simple abdominal X-ray, a radio-opaque foreign body was observed in the pelvic cavity, and mild leukocytosis was noted on the laboratory test. To avoid injury to the anal sphincter, we tried to remove the foreign body under the spinal anesthesia. After anesthesia had been administered, the foreign body was palpated more distally at 5-6 cm from the anal verge by digital examination, and the foreign body was found to have a hole in its center. This was held using a Kelly clamp, and with digital guiding, was removed through the anus. After removal, an anoscopic examination was performed to determine if mucosal injury had occurred in the rectum or anal canal. The patient was discharged without complication after 24 hours of close observation.
Abdomen ; Abdominal Pain ; Anal Canal ; Anesthesia ; Anesthesia, Spinal ; Digital Rectal Examination ; Electronics ; Electrons ; Emergencies ; Foreign Bodies ; Head ; Hemorrhage ; Hemorrhoids ; Humans ; Leukocytosis ; Male ; Massage ; Odors ; Rectum ; Vital Signs

PURPOSE: This retrospective study was designed to review and analyze the results of Delorme's procedure for rectal prolapse. METHODS: Between 1990 and 1999, twenty-nine patients with rectal prolapse underwent Delorme's procedure. These patients had had no previous operation for rectal prolapse. This study was proceeded retrospectively through the out-patient clinic and by telephone questionnare. RESULTS: Twelve cases (41%) were males and 17 cases (59%) were females. Mean age was 55.5 years (range, 23~86 years). The duration of the symptoms was ranged from 3 months to 60 years, with the mean period of 12.2 years. The follow-up period after the operation was from 3 months to 10 years (mean follow-up, 45 months). The internal rectal prolapses were 11 cases (38%), and the complete rectal prolapses were 18 cases (62%). The common preoperative bowel habits were incontinence with 6 cases (21%) and constipation with 10 cases (34%). After the operation, incontinence and constipation were improved in 4 cases (67%) and 6 cases (60%) respectively. Additional 2 cases of constipation occurred among 19 cases who hadn't had it preoperatively but the use of laxative helped in improving the symptom. The mean operation time was 71 minutes and in 24 cases (83%), the operation was proceeded with spinal anesthesia. In 27 cases (93%), the amount of bleeding during the operation was less than 100 cc, and in 1 case (3.4%), blood transfusion was needed because the amount was more than 400 cc. The three patients (10%) had postoperative complications(one perianal abscess due to anastomotic dehiscence and two urinary retention). There was one case of recurrence (3.4%) after the operation and no postoperative mortality. CONCLUSIONS: Delorme's procedure has the short operation time, causes less bleeding and is possible with regional anesthesia. Delorme's procedure has low complication rate, results in good bowel function and has a low recurrence rate. Therefore, Delorme's procedure can be performed with satisfactory outcome in elderly patients and the poor general conditioned patients as well as younger patients. As recurrence rates is low and continence is improved, this procedure may be the preferred initial treatment of all patients with rectal prolapse.
Abscess ; Aged ; Anesthesia, Conduction ; Anesthesia, Spinal ; Blood Transfusion ; Constipation ; Female ; Follow-Up Studies ; Hemorrhage ; Humans ; Male ; Mortality ; Outpatients ; Rectal Prolapse* ; Recurrence ; Retrospective Studies ; Telephone

BACKGROUND: This study was undertaken to evaluate the treatment of circumferential hemorrhoids using the CO2 laser. METHOD: Five hundred seventy-two consecutive patients with circumferential hemorrhoids(411 males, 161 females) had hemorrhoidectomy performed with CO2 laser under caudal or epidural anesthesia during the 2 year-period between July 1994 and June 1996. The follow-up period was a minimum of 3 months after hemorrhoidectomy. The standard Milligan-Morgan open technique was used for most full three-quadrant hemorrhoidectomies. For the excision of necessary piles, "core-ablation" technique was employed. RESULTS: The postoperative pain lasted for an average of 2.10 days. Comlications of hemorrhoidectomy included Postoperative skin tags, bleeding, wound infection, delayed wound healing, urinary retention and anal fistula in only a few of the cases, none of which caused any long-term problems. CONCLUSIONS: These results indicate that CO2 laser hemorrhoidectomy is feasible and safe provided it is used with care, and that it seems to cause no significant alteration in anorectal physiology.
Anesthesia, Epidural ; Follow-Up Studies ; Hemorrhage ; Hemorrhoidectomy ; Hemorrhoids* ; Humans ; Laser Therapy* ; Lasers, Gas ; Male ; Pain, Postoperative ; Physiology ; Rectal Fistula ; Skin ; Urinary Retention ; Wound Healing ; Wound Infection