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Why do we have so much trouble treating anal fistula?

World Journal of Gastroenterology 2011年第28期17卷 3292-3296页

作者： Haig Dudukgian herand abcarian Department of Colorectal Surgery John Stroger Hospital of Cook County Department of Surgery University of Illinois Chicago

Anal fistula is among the most common illnesses affecting *** literature dating back to 400 BC has discussed this *** causative factors have been proposed throughout the centuries,but it appears that the majority of fistulas unrelated to specific causes (***,Crohn’s disease) result from infection (abscess) in anal glands extending from the intersphincteric plane to various anorectal *** tubular structure of an anal fistula easily yields itself to division or unroofing (fistulotomy) or excision (fistulectomy) in most *** problem with this single,yet effective,treatment plan is that depending on the thickness of sphincter muscle the fistula transgresses,the patient will have varying degrees of fecal incontinence from minor to *** an attempt to preserve continence,various procedures have been proposed to deal with the *** include: (1) simple drainage (Seton);(2) closure of fistula tract using fibrin sealant or anal fistula plug;(3) closure of primary opening using endorectal or dermal flaps,and more recently;and (4) ligation of intersphincteric fistula tract (LIFT).In most complex cases (***’s disease),a proximal fecal diversion offers a measure of symptom-atic *** fact remains that an "ideal" procedure for anal fistula remains *** failure of each sphincter-preserving procedure (30%-50% recurrence) often results in multiple *** essence,the price of preservation of continence at all cost is multiple and often different operations,prolonged disability and disappointment for the patient and the ***,the surgeon treating anal fistulas on an occasional basis should never hesitate in referring the patient to a ***,an expert colorectal surgeon must be familiar with many different operations in order to selectively tailor an operation to the individual patient.

关键词： Fistula Abscess Fibrin sealant Anal fistula plug Dermal advancement flap Endorectal flap Ligation of intersphincteric fistula tract procedure

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Does Chemo-Radiation Therapy Influence Outcomes in Unresectable Locally Advanced State IV Rectal Cancer?

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Surgical Science 2012年第10期3卷 469-472页

作者： Joaquin J. Estrada Vivek Chaudhry Jose R. Cintron Leela M. Prasad herand abcarian Division of Colon and Rectal Surgery John H. Stroger Jr. Hospital of Cook County Chicago USA

Introduction: The median survival for patients with stage IV rectal cancer is approximately 20 months. Therapy should focus not only on improving survival but also on quality of life. The aim of our study was to determine if chemoradiation (C-RT) would improve palliation for metastatic unresectable locally advanced disease compared to patients receiving palliative chemotherapy alone (C) for stage IV cancer. Methods: Retrospective review of a prospectively maintained database at a single institution was carried out under IRB approval. From January 2004 to December 2008, 43 patients presenting with unresectable stage IV rectal cancer were identified with a median follow-up of 12 months. Patients with evidence of locally advanced disease or bulky disease received infusional 5-FU ± bevacizumab and 3D conformed mega voltage photon therapy (5400 cGy). Patients without evidence of bulky disease received either FOLFOX or FOLFIRI ± bevacizumab. Data on demographics, investigations, treatment, complications, metastasis, number of blood transfusions, days of hospitalization, and surgical intervention were analyzed using SPSS statistical software. p < 0.05 was considered statistically significant. Results: There were 25 and 18 patients in the C and C-RT groups respectively. There was no difference in mean age, sex or overall survival. Three patient (12%) in the C group developed hydronephrosis compared to 8 patients (44%) in the C-RT group (p < 0.05). Six patients (24%) developed bowel obstructions requiring an ostomy in the C group compared to 9 patient (50%) in the C-RT group (p = 0.07). In the C arm, 80% of patients required multiple hospitalizations for symptoms consistent with progression of disease compared to 61% of patients in the C-RT arm (p < 0.01). Conclusion: Chemoradiation in patients with locally advanced unresectable stage IV cancer has not been extensively investigated. At our institution, patients treated with C-RT for bulky stage IV rectal cancer required fewe

关键词： Chemo-Radiation Cancer

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Management of low colorectal anastomotic leak:Preserving the anastomosis

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World Journal of Gastrointestinal Surgery 2015年第12期7卷 378-383页

作者： Jennifer Blumetti herand abcarian Division of Colon and Rectal Surgery John H.Stroger Hospital of Cook County

Anastomotic leak continues to be a dreaded complication after colorectal surgery, especially in the low colorectal or coloanal anastomosis. However, there has been no consensus on the management of the low colorectal anastomotic leak. Currently operative procedures are reserved for patients with frank purulent or feculent peritonitis and unstable vital signs, and vary from simple fecal diversion with drainage to resection of the anastomosis and closure of the rectal stump with end colostomy(Hartmann's procedure). However, if the patient is stable, and the leak is identified days or even weeks postoperatively, less aggressive therapeutic measures may result in healing of the leak and salvage of the anastomosis. Advances in diagnosis and treatment of pelvic collections with percutaneous treatments, and newer methods of endoscopic therapies for the acutely leaking anastomosis, such as use of the endosponge, stents or clips, have greatly reduced the need for surgical intervention in selected cases. Diverting ileostomy, if not already in place, may be considered to reduce fecal contamination. For subclinical leaks or those that persist after the initial surgery, endoluminal approaches such as injection of fibrin sealant, use of endoscopic clips, or transanal closure of the very low anastomosis may be utilized. These newer techniques have variable success rates and must be individualized to the patient, with the goal of treatment being restoration of gastrointestinal continuity and healing of the anastomosis. A review of the treatment of low colorectal anastomotic leaks is presented.

关键词： Anastomotic leak Colon and rectal surgery Colorectal anastomosis Management anastomotic leak Endoscopic treatment Surgical complications

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活体亲属阶段性肠移植：由实验阶段过渡到标准的手术

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医学信息（手术学分册） 2007年第8期20卷 753-753页

作者： Benedetti , Enrico Holterman, Mark Asolati, Massimo Di Domenico, Stefano Oberholzer, Jose Sankary, Howard abcarian, herand Testa,Giuliano

活体肠移植不久前问世，是尸体肠移植的重要替代手术。本文总结了单中心经验。材料和方法：自1998年4月至2004年10月，对11例患者（7例男性，4例女性；平均年龄26岁）进行了12次活体肠移植。其中4例为年龄不足5岁的儿童。儿童受者和成... 详细信息

活体肠移植不久前问世，是尸体肠移植的重要替代手术。本文总结了单中心经验。材料和方法：自1998年4月至2004年10月，对11例患者（7例男性，4例女性；平均年龄26岁）进行了12次活体肠移植。其中4例为年龄不足5岁的儿童。儿童受者和成人受者均接受了远段回肠移植，长度分别为150—180cm和200cm。免疫抑制方案包括胸腺球蛋白诱导和他克莫司加（或不加）霉酚酸酯和类固醇激素维持治疗。结果：所有的供者均恢复良好，末发生任何早期或晚期并发症。患者1年和3年总体生存率为82％，移植物生存率为75％。于2000年1月以后接受移植的后8例患者，患者和移植物1年生存率分别为100％和88％。中位住院时间为36天（范围13～290天）。移植后第一年中，只有接受完全不匹配移植物的患者发生了一次急性排斥反应（8％）。所有存活的患者目前均接受肠道营养而无需额外输液。结论：活体肠移植是治疗不可逆性肠衰竭中的一项重要策略。由于医疗团队经验的积累，数年中移植结果有所改善。

关键词：回肠移植活体亲属替代手术实验阶段标准免疫抑制方案急性排斥反应平均年龄

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Discharge Coefficient Measurements Using Heron's Fountain

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Journal of Civil Engineering and Architecture 2019年第3期13卷 195-203页

作者： Gevo abcarian Zainab Algharib Omran Hussain Ana Martin Abraham Villa Francisco Villalobos Tadeh Zirakian David Boyajian Department of Civil Engineering and Construction Management California State UniversityNorthridgeCA 91330USA

Civil Engineering design students at CSUN (California State University, Northridge), aimed to demonstrate the pneumatic action of liquid water as it flows through an airtight one-way vessel system which is known as Heron’s Fountain. This project explores hydraulic and pneumatics principles commonly found in environment control systems, such as the non-isothermal heating facilities located on the CSUN campus. Since this was a simply constructed version of an ancient Greek fountain, its development required the collaboration of the team to execute its simple function. The parameters involved were diameter, length, height, and density. This analysis utilizes Pascal and Bernoulli’s equations to reinforce the principles of fluid mechanics. The fountain action is described based on flow rate and head loss is described by Darcy’s equation. Friction loss with an angled fitting attached to the fountain head is described by Reynold’s equation. The experiment observed the performances of two types of reentrant tube fittings for head loss: straight and angled. The experiment enhanced the educational experience of the research team by bringing together creative ideas from different educational and cultural backgrounds. The results of the experiment concluded with a 0.58% error for the straight fitting and 5.3% error for an angled fitting.

关键词： Heron's Fountain hydraulic principles air pressure pneumatics friction factor engineering education

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