Biomedical subjects

A M Metcalf

Publications and source records attributed to A M Metcalf.

25 records · Page 2Linked to original sources

PubMed1987

High-resolution sonography of acute appendicitis.

During a 7-month period high-resolution sonography was used in the evaluation of 68 patients with an equivocal clinical diagnosis of acute appendicitis. The sonographic findings were correlated with surgical-pathologic outcome in 32 cases and with clinical follow-up in the remainder. This technique was found to be accurate in the diagnosis of acute appendicitis with a specificity of 95%, a sensitivity of 80%, and an accuracy of 90%. The predictive value of a positive test was 91%; that of a negative test was 89%. The results show that high-resolution sonography is indicated to establish the diagnosis of acute appendicitis in patients with equivocal clinical findings.

Acute Disease↗

PubMed1986

Temporary ileostomy for ileal pouch-anal anastomosis. Function and complications.

The function and complications associated with temporary ileostomies were reviewed in patients undergoing ileal pouch-anal anastomosis. A series of 180 patients had temporary ileostomies established (157 loop, 23 Brooke). Patients with incomplete fecal diversion had a significantly higher incidence of pouch-anal anastomotic complications (44 percent) than did those with complete diversion (14 percent). Patients with loop ileostomies were more likely than patients with Brooke ileostomies to develop technique-related complications (18 percent vs. 13 percent) and peristomal irritation (54 percent vs. 26 percent). The most frequent complications after take-down of the ileostomy were transient bowel obstruction (13 percent) and peritonitis (7 percent). These complications could not be related to the type of stoma used or the interval to closure. Temporary diversion of a pouch-anal anastomosis decreased the incidence of anastomotic complications. These ileostomies, however, are associated with a significant risk of complications, which can be minimized by meticulous surgical technique.

Anal Canal↗

PubMed1986

Ileal pouch-anal anastomosis without temporary, diverting ileostomy.

Of two hundred patients undergoing proctocolectomy with ileal pouch-anal anastomosis, all but nine have had temporary diverting ileostomies. Of these nine patients, eight had successful results. One patient developed abdominal sepsis due to jejunal volvulus and perforation after she had returned home, and at surgery the pouch was excised. Ileal pouch-anal anastomosis without a temporary diverting ileostomy can be performed safely by surgeons experienced with this procedure in carefully selected patients.

Anal Canal↗

PubMed1986

Sexual function in women after proctocolectomy.

One hundred women who had undergone proctocolectomy with a continence-preserving procedure (50 Kock pouches, 50 ileoanal anastomoses) for ulcerative colitis or polyposis coli were interviewed regarding their preoperative and postoperative sexual function. Frequency of intercourse increased and the incidence of dyspareunia decreased after operation in both groups. Patients who had a Kock pouch had a greater incidence of persistent postoperative dyspareunia than patients who underwent an ileoanal procedure (38% vs. 18%, p less than 0.02). Only one patient in each group reported a postoperative disturbance in ability to achieve orgasm. Most women reported no change in their menstrual cycle, but patients with a Kock pouch had more episodic vaginal discharge than patients with an ileoanal anastomosis (18% vs. 0%, p less than 0.001). Postoperative fertility was minimally impaired. Overall, the majority of women in this study who underwent proctocolectomy for benign diseases experienced enhanced sexual function after operation, which they attributed mainly to improved health.

Adenomatous Polyposis Coli↗

PubMed1986

Ileostomy diarrhoea.

Proctocolectomy renders patients more prone to significant fluid and electrolyte disturbance due not only to the loss of the normal absorptive capacity of the colon, but also due to unique complications of the postoperative state. Other than causes of diarrhoea unrelated to ileostomy, ileal resection, partial small bowel obstruction, and regional enteritis represent the most common causes of ileostomy diarrhoea following conventional ileostomy. In addition, patients with intra-abdominal reservoirs are prone to develop a bacterial overgrowth syndrome. With reservoirs placed in a pelvic location, as part of an ileoanal procedure, defecatory frequency (with or without high faecal outputs) can also result from ineffective pouch evacuation, decreased pouch capacity or poor sphincteric function.

Bibliographies as Topic↗

PubMed1985

Ileal "J" pouch-anal anastomosis. Clinical outcome.

One hundred eighty-eight patients undergoing abdominal colectomy with distal mucosal proctectomy and endorectal ileal pouch-anal anastomosis were reviewed to assess long-term functional results and to identify factors that might influence them. There was no postoperative mortality, but 10 patients (5.3%) required permanent ileostomy because of postoperative complications or the development of unsuspected Crohn's disease. Immediate postoperative complications, including pelvic sepsis, small bowel obstruction requiring surgery, anastomotic stricture, and ileostomy dysfunction, were observed in 11%, 9%, 14% and 9% of patients, respectively. No males were impotent but nine (9%) developed retrograde ejaculation. Pouchitis occurred in 8% of patients. Among 157 patients assessed at least 60 days after ileostomy closure (mean +/- SD, 375 +/- 216 days), all evacuated their neorectum spontaneously, and stool frequency was 6.0 +/- 2.6 daily and 1.2 +/- 1.3 nightly. While continence was generally good, 2.5% of patients during waking hours and 4.5% during sleep had occasional frank soilage. Moreover, seepage was noted in 25 and 47% of patients during daytime and nighttime, respectively. Both stool frequency and degree of continence improved with time. Patients less than 50 years of age and those with polyposis coli had fewer stools and better continence than those older than 50 or those with ulcerative colitis. It is concluded that ileal "J" pouch-anal anastomosis can be performed safely and will provide acceptable anorectal function without late deterioration.

Adolescent↗

PubMedDate not supplied

Fabricating a gold occlusal platform on a removable partial denture to help prevent extrusion of mandibular incisors.

A clinical procedure is presented in which a maxillary removable partial denture replacing anterior teeth was fabricated with a cast gold anterior occlusal platform. This treatment is indicated to correct abrasion caused by extruded mandibular anterior teeth on the maxillary removable partial denture. The advantages compared to prosthetic teeth supported by an acrylic resin base or metal-backed facings are discussed. This technique allows for development of optimal esthetics, strength, and durability while preventing further extrusion and excessive wear of the teeth occluding against prosthesis.

Denture Design↗