Fecal incontinence is a serious problem especially for the elderly. The epidemiology of incontinence is not well described in the literature although it is often used as an endpoint for treatment evaluation in clinical trials. Complete continence is often assumed to be the "normal" standard. The goals of this study were to establish detailed prevalence rates for fecal incontinence in a standard population and to identify differences due to age and sex. A questionnaire about fecal incontinence and its consequences with predefined answers was filled out anonymously by 500 volunteers. The study population was selected to meet the respective age and sex distribution of the German adult population. The data indicated that 4.8% of the persons were unable to control solid stools, while 19.6% had problems at least with one type of incontinence (solid, pasty, or lipid stools, winds). Problems with pasty or liquid stools are more frequent in women. The ability to control wind is decreased in elderly persons. The time needed to reach a toilet is shorter for women, and generally decreases in the elderly. Men more often describe soiling the underwear. Persons with signs of incontinence show decreased levels of social activities. A global incontinence rate of 5% fits well with some previously published results. Soiling of the underwear is not well suited for defining incontinence. The increased rate in women may in part be explained by morphological differences. The reduced time to hold stools especially in the elderly in combination with a reduced mobility may result in a higher rate of incontinence, which is correlated with reduced social activities.

Adolescent↗

PubMed1997

The arterial supply of the ankle joint and its importance for the operative fracture treatment.

The operative exposure of a fracture causes disturbances in the blood supply, which may lead to a prolonged healing process or even to bone necrosis, especially when using the complex and complicated methods of osteosynthesis at the ankle. In order to damage the supplying vessels as little as possible, position, direction and penetration of the bone arteries of the talocrural joint were examined by corrosion preparation. The tibial nutrient artery arises from the posterior tibial artery or from the popliteal artery and penetrates constantly from posterior at the level of the proximal third. The fibular nutrient artery, coming from the peroneal artery, penetrates more distally from medial into the middle third of the diaphysis. In one specimen it did not exist at all. Distal tibia and fibula are supplied by the perimalleolar arterial ring, which is connected with the three arteries of the leg. The talus is supplied by numerous very small vessels, which are provided with extraosseous anastomoses and penetrate the whole non-articular surface. Implications for the operation will be explained.

Adult↗

PubMed1997

Arterial supply of forearm bones and its importance for the operative treatment of fractures.

The operative exposure of a fracture in an osteosynthesis causes disturbances in the blood supply, which often leads to a prolonged process of healing or even to healing problems, a fracture non-union, which is frequently located at the forearm. In order to damage the supplying vessels as little as possible, the position, direction and penetration of the arteries of radius and ulna are demonstrated and systematised in this study. Near the elbow arteries, coming from large adjoining vessels, penetrate the area of the capsular insertion. The nutrient arteries enter both bones in the second proximal quarter of diaphysis, at the radius from anterior to medial, at the ulna from anterior to anteroradial. Small vessels, which penetrate closely proximal to the articular surface in order to supply the distal forearm bones, come from an anastomosis between the radial, the interosseous and the ulnar arteries. In this study access vessels, choice and position of implants will be discussed.

Aged↗

PubMed1997

[Violation of patient education responsibility. Implications and outlook].

In both jurisdiction and medical science, given conditions require appropriate intervention, which may in turn result in norms being created. Norms, however, counteract individuality. An essential prerequisite for free decision--making is an absolute awareness of all possibilities available. Therefore the physician/surgeon too, is obliged to impart all relevant information to the patient prior to an operation to enable the patient to reach a decision, either to agree to or refuse the operation. This process of information transfer may sometimes fail on one or both sides. Treatment errors are usually classified according to scientific medical practice. In the case of "breach to duty in information patient" the final decision is the judges. As judicial decisions are not foreseeable, the communication between patient and surgeon thus becomes standardized and doctors tend to become defensive, resulting in the information becoming even more extensive covering all possible situations. There is no guarantee of success in surgery. Selective perception on the part of the patient is unavoidable and confidence in the relationship between patient and surgeon is beneficial to the patient's rehabilitation. Therefore, we should strive to decriminalize the preoperative talk held between surgeon and patient.

Defensive Medicine↗

PubMed1997

[Patient education: what does the patient know, what does he want to know? Thrombosis and wound infection].

UNLABELLED: The manners of which preoperative informations are given to a patient depend on several different points. So not only the patient's education, his knowledge of medical items and his intelligence are important, but also the juridical situation and the doctor's ability to explain the situation in a way the patient is able to understand. The aim of this study was to evaluate the patient's previous knowledge about two major complications in surgery--thrombosis and wound infection. Beside this it was looked for the importance of confidence in the doctor and previous information about the operation. PATIENTS AND METHOD: 117 patients aged 16 to 87 years were tested anonymous by a standardised questionnaire. RESULTS: There is only little knowledge about the time a thrombosis develops, embolism, a wound infection and their consequences. On the other side, more than 50% of the patients were able to explain correctly the symptoms of thrombosis and the time a wound infection occurs. There was a correlation between the statement of knowledge about thrombosis (p < 0.01) and wound infection (p < 0.01) and the ability of correct explanation. Almost 90% of the patients thought that information about the operation is as important as the confidence in their surgeon. More than two third of the patients wanted to be informed about "everything" that possibly could happen. The main sources of information were neighbours, friends, the press, books and at last the doctor. CONCLUSION: There wasn't any influence of former surgeries, the awareness of complications or education on the active knowledge of the patients. Therefore we think that the way of giving explanation to a patient should help reducing fear of an uncomfortable situation and take account to the patients need for information. Thus, the patient will be able to make a real decision.

Adolescent↗

PubMed1997

[Sprain of the cervical spine: early functional vs. immobilization treatment].

Neck sprains are very common injuries often treated with immobilisation of different duration. The treatment with collars was tested against physiotherapy in a prospective randomised trial. Endpoints were defined as state of health, pain and costs. Ninety-seven patients with whiplash injuries were splitted by randomisation into two groups. One group was treated with a certain scheme of physiotherapy. Another group was treated with collar immobilisation for 3 weeks. Concerning symptoms at the time of admittance, age and sex distribution the groups were comparable. Fifty healthy persons with the same age and sex distribution served as a control group. Regarding to physical state of health and pain, which were examined by valid questionnaires, significant advantages of physiotherapy after two weeks were found. After 12 weeks the physical state of health corresponds to that of the control group. No influence on psychical state of health was seen. Physiotherapy for treatment of neck sprain is highly recommended. It has clear advantages over the treatment with collars with regard to state of health and pain, and it seems to be economically favourable.

Adult↗

PubMed1997

[Waiting for the crisis].

AIM OF THE STUDY: Experience in daily routine reveals that most of ICU patients usually go through "crisis" within 14 days of admission. Only few patients need remarkable more time to get to this point and it seems there is hardly anything to be done therapeutically to change the course of it. We therefore examined a large group of ICU patients in order to find reasons for this course or to spot them as an "entity of their own". METHODS: 1,861 ICU patients all being on IPPV for more than three days were included in the study. Every day 18 variables were taken down in a standardised way until the day IPPV was finished. We extracted 170 patients who were artificially ventilated for more than 40 days. For these patients we established mean values for each of the 18 variables during the first and the last 40 days of ventilation. In both groups we compared survivors to non-survivors. RESULTS: Mortality was almost the same in both groups (IPPV < 40 days vs. IPPV > 40 days). Survivors and non-survivors showed remarkable differences regarding extrapulmonary factors-in terms of total fluid amount and transfusion, state of abdomen, brain, liver and kidney function and circulation problems. Pulmonary factors revealed major differences only towards the end of the observation period. CONCLUSIONS: There seems to be an "entity of ist own", a small population of patients who arrive at the crucial turning point later. Pulmonary complications (pneumonia, ARDS) is not the reason but the expression of cause for prolonged ventilation. The key to the extrapulmonary origin of the crisis remains unknown, the only thing we can do is alleviate its manifestations.

Cause of Death↗

PubMed1996

[Possibilities and limits of scores. Theoretical considerations about scores].

Scores are intended to facilitate an accurate appreciation of the overall situation from a few characteristic, reasonably weighted parameters. This definite result in the form of a score means a reduction of reality. For the individual it cannot reasonably be applied in practice. Despite a long list of problems and limitations, a score can describe a collective and thus make it comparable to some extent. Because of the different compositions of the collectives, the value of scores for quality control is limited. The more physiological variables a score contains the more difficult it is to distinguish between the effect of therapy and the clinical course. Therefore, repeated measurement of scores is not useful to verify a therapeutic effect, but it can indicate a trend regarding the endpoint.

Data Interpretation, Statistical↗

PubMed1996

Ileal pouch-anal anastomosis for ulcerative colitis and polyposis coli: is the risk of carcinoma formation conclusively averted?

We took biopsies from the ileal pouch mucosa of 26 patients (13 with ulcerative colitis, 13 with polyposis coli) at least 1 year after the newly formed pouch was finally linked to the faecal flow. Histochemical mucin differentiation was carried out in addition to the ordinary stains. All patients underwent colonization of pouch mucosa with goblet cell multiplication, reduction or loss of villi, and formation of crypts. Only 19 patients could be classified morphologically as bearing large bowel mucosa in the ilea] pouch. Patients with one incidence of ulcerative colitis developed one criterion, those with two incidences two criteria, and those with seven incidences three criteria of the original colitic disease. Patients with two incidences of colitis and those with 10 incidences of polyposis coli developed an excess of sialomucine formation, which is known as an obligate pre-cancerosis. These findings prove, that in ileal pouches, even when affected by systemic diseases with extraintestinal manifestations, a new kind of mucosa develops, which is also prediposed to carcinoma formation. Papers reporting adenocarcinoma arising in ileostomy areas as well as in ileoanal anastomosis, and ileal reservoirs, confirm this presumption. Assuming this conclusion, restorative proctocolectomy cannot hinder malignant transformation of intestinal mucosa, but only delay the onset of cancer, thereby making lifelong follow-ups necessary.

Adolescent↗

PubMed1996

Elastofibroma and pre-elastofibroma--a biopsy and autopsy study.

Two biopsy cases of elastofibroma--one unilateral and one bilateral--are described. A study of 100 autopsies revealed 13 elderly patients with elastofibroma. Males (n = 10; 16.9%) were more affected than females (n = 3; 7.3%). Pre-elastofibroma-like morphological changes (e.g. few or many degenerated elastic fibres) were observed in 81% of the autopsies. Minor pre-elastofibroma-like changes were seen in males and major changes predominantly in females. In addition to physiological ageing as yet unknown factors, rather than abnormal elastogenesis or degeneration, seem to be involved in this pseudotumour.

Adolescent↗

PubMed1996

[Anal fissure. Possibilities for treatment].

Explore the source record for details and available documents.

Aged↗

PubMed1994

Histochemical and metabolic changes in functioning ileal pouches after proctocolectomy for familial adenomatous polyposis and ulcerative colitis.

Ulcerative colitis and familial adenomatous polyposis may be treated by proctocolectomy with ileal pouch reconstruction, anastomosing the pouch to the anus. We studied 24 patients who underwent this procedure, of whom 12 had ulcerative colitis and 12 had familial adenomatous polyposis. Ileal absorption was investigated and pouch histology assessed more than one year after closure of the protective defunctioning loop ileostomy. The results showed a reduction in bile acid reabsorption and vitamin B12 absorption. These observations were associated with a morphologic transformation in the small bowel mucosa to large bowel mucosa. In 10 of the 12 colitis patients one or more of the histological features of the original disease (such as active inflammation, increased regeneration, atypia) were evident. Histological examination of the biopsies taken from the polyposis patients showed areas with an excess of sialomucins.

Absorption↗

PubMed1993

[Deep rectovaginal fistula and incontinence after labor trauma].

The commonest cause of traumata to the organ of continence is the injury during childbirth. Specially after negligent or missing reconstruction apart from incontinence rectovaginal fistulas can arise. This report deals with 24 incontinent women with a perineal laceration. After delivery 17 women had developed a low rectovaginal fistula. In addition to clinical recording of the incontinence, the proctological examination including anal manometry was carried out before and 25 months after surgery on an average. All patients get the same operation: Section of the anterior commissure, cutting out the fistula if necessary, separated suture of the animalic and voluntary sphincter, vaginal plasty. Preoperative resting pressure was 30 cm H2O and the voluntary pressure 46 cm H2O-on an average. Postoperative there was an increase to 61 cm H2O for the resting pressure and to 77 cm H2O for the voluntary pressure. 22 patients reported an improvement. 13 women are completely continent, 7 x soiling, 2 x incontinence for flatus, one incontinence for liquid stool and one stool incontinence were found. One fistula occurred again during follow up. Our surgical procedure compared with others has the advantage to give similar results avoiding protective colostoma. Besides the option for an other surgical procedure is still remained.

Adolescent↗

PubMed1991

[Single-stage exposure of the fistula in surgical treatment of the peri-proctitis abscess].

117 anorectal abscesses has been operated by one operateur. 68x a fistulectomy was done. 2x there has been a high fistula. Of the remaining 47 patients 44 have had a followup for 15 months. In this time 37 showed a fistula-in-ano. Procedure and the position of the fistulous tracks are shown. The assumptions and dangers of the single-stage approach are demonstrated.

Abscess↗