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Biomedical subjects

D C Nyam

Publications and source records attributed to D C Nyam.

26 records · Page 2Linked to original sources
PubMed1996

Comparison between segmental left and extended right colectomies for obstructing left-sided colonic carcinomas.

PURPOSE: This study was designed to compare complications and functions following either radical extended right colectomy without colonic decompression or radical segmental left colectomy with intraoperative decompression for obstructed left-sided colonic carcinomas. METHODS: One hundred three patients with obstructed left-sided colonic carcinoma undergoing primary resection and anastomoses were studied. RESULTS: There were 57 males and 46 females with a median age of 65 (range, 24-98) years and who had a median follow-up of 31 (range, 2-59) months. There were no leaks or intra-abdominal sepsis in the extended right colectomy group (44 patients) compared with one anastomosis leak in the segmental left colectomy (59 patients) group. Median hospital stay was 14 days in both groups, with a range of 8 to 36 days in the segmental left colectomy group and 7 to 44 days in those with extended right resection. One month after surgery, the patients who underwent segmental left colectomy had a median bowel movement of 3 (range, 1-6) per 24 hours compared with those with extended right colectomies who had a median of 5 (2-11) bowel movements per 24 hours. Bowel frequency decreased to four or less episodes per 24 hours in all patients in both groups at six months. CONCLUSION: There was no significant difference between bowel function or complications between the two groups.

Adult↗
PubMed1996

Surgery for inflammatory bowel disease in Singapore.

Inflammatory bowel disease is uncommon in Asians and reports of surgery in these populations are rare. Eighty-two patients with inflammatory bowel disease were seen in the Department of Colorectal Surgery over a five-year period (1989-1994). Twenty-three patients underwent surgery for their disease. There were 12 males and 11 females with 16 Chinese, 4 Indians and 3 Malays. Twelve had Crohn's disease and 11, ulcerative colitis. The majority of patients with Crohn's disease had emergency surgery for bleeding, perforation, abdominal masses and intestinal fistulae. Fifty percent of these had the diagnosis made intraoperatively or post-operatively. Surgery for ulcerative colitis was indicated because of multiple relapses, non-response to medical treatment, side effects of therapy or malignant change. The median age at surgery of patients with Crohn's disease and ulcerative colitis was 39 years (range 24-84) and 40 (range 18-60) respectively. The median follow-up was 22.4 months (range 9-50). The results of surgical therapy in these patients show that surgery when indicated can be done with minimum morbidity and mortality.

Adult↗
PubMed1995

Island advancement flaps in the management of anal fissures.

The classic high-pressure fissure responds well to lateral internal sphincterotomy. The management of recurrent fissures and those that occur in patients with weak sphincters is open to debate. An island advancement flap technique used in 21 patients is described with the above criteria. Preoperative median resting anal pressure was 66 (range 43-90) cmH2O and median maximal squeeze pressure was 132 (range 76-193) cmH2O, values that were significantly lower than in controls and those with classic fissure. Endoanal ultrasonography in 15 of these patients showed defects in the anal sphincters. All flaps healed primarily with preservation of sensation. Perfect continence was maintained in all patients. Follow-up was for a median of 18 (range 2-28) months. There were no serious complications. All fissures healed with minimal postoperative discomfort. This procedure provides a useful alternative for symptomatic anal fissures, in which a sphincter-weakening procedure might jeopardize continence.

Adult↗
PubMed1995

Submucosal adrenaline injection for posthemorrhoidectomy hemorrhage.

PURPOSE: A technique found effective in stopping active posthemorrhoidectomy bleeding, outside the operating room, is described. METHOD: After resuscitation and sedation, a proctoscope was inserted to identify the bleeding point. 1 to 2 ml of 1/10,000 adrenaline was injected submucosally. RESULTS: This technique was totally successful in 12 of 12 treated patients. CONCLUSION: Submucosal adrenaline injection is a simple and readily accessible technique for managing posthemorrhoidectomy bleeding.

Epinephrine↗
PubMed1995

Bladder involvement in patients with colorectal carcinoma.

Twenty-seven patients underwent concomitant partial cystectomies out of a total of 542 patients with colorectal carcinoma operated on between October 1989 to December 1991. There were 19 males and 8 females with a median age of 63.7 years (range 44-80). The patients were followed up for a median of 40.2 months (range 27-75 months). Histological invasion into the bladder was found in only 26% of the tumours. Eighty-five percent of the patients with carcinomatous invasion had preoperative urological symptoms whilst only 20% of those with inflammatory adhesions had urological symptoms. Four percent of the patient were Dukes' A, 50% Dukes' B, 42% Dukes' C and 4% Dukes' D. Twenty (74%) patients are alive without evidence of local or distant metastasis. One has local recurrence and another, distant metastasis. Five patients have died. The prognosis of patients with colorectal cancer and bladder involvement appears to be similar to those without bladder involvement provided clear margins are obtained.

Adult↗
PubMedDate not supplied

Does the presence of a pre-ileostomy closure asymptomatic pouch-anastomotic sinus tract affect the success of ileal pouch-anal anastomosis?

Ileal pouch-anal anastomosis (IPAA) is the procedure of choice for patients with ulcerative colitis and familial adenomatous polyposis. This two-stage procedure with a temporary diverting ileostomy avoids the catastrophic consequences of anastomotic leakage. We set out to determine the incidence and effect of asymptomatic pouch sinuses detected prior to ileostomy closure on the outcome of IPAA. A total 1600 IPAAs performed at the Mayo Clinic were reviewed. Forty-one (2.6%) asymptomatic sinuses were treated expectantly. There were 22 males and 19 females who had a median age of 32 years (range 14 to 58 years). The median time to ileostomy closure was 5.9 months (range 4 to 11 months). Five patients required further surgery following closure of ileostomy. The pouch function in these five patients was similar to that in the remainder of the group. Patients with a persistent sinus at the time of ileostomy closure had the same function as the main cohort. This group had a median of five (range 2 to 12) stools during the day and two (range 0 to 4) at night. The total number of stools per 24 hours was seven (range 2 to 14). Frequent incontinence occurred in 9.7% and 7.3% during the day and at night, respectively. Only 2.4% (1/41) were disappointed with the results of the operation and 80.4% (33/41) found their quality of life improved. Functional outcomes were comparable to those achieved with uncomplicated IPAA. Radiologically detected asymptomatic sinuses can be treated expectantly with a low rate of pouch loss and subsequent surgery. This is not considered a serious setback inasmuch as long-term function and quality of life are comparable to that achieved with IPAA without sinus tracts.

Adenomatous Polyposis Coli↗