A comparison of one and two layer stapled anastomoses in the dog colon.
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Biomedical subjects
Publications and source records attributed to J Buls.
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Ulcerative proctitis is a non-specific inflammatory condition of a diffuse nature involving the mucosa of the rectum. It commences at the dentate line and extends proximally for a variable distance. By definition, the upper extent of the disease must be able to be seen at sigmoidoscopy. This is usually at a distance of 5 to 15 cm from the anal verge. The natural history of the condition is one of spontaneous remission after varying periods. This makes scientific assessment of therapy very difficult if not impossible. In a small proportion of patients (10% or less) the disease will extend to involve the colon. It is difficult to be certain whether this is true progression or inaccurate assessment of extent at the time of presentation. The treatment of the condition is non-specific. Reassurance of the patient with emphasis on the excellent prognosis is essential. Response to drug therapy is unpredictable and in many instances disappointing. Dietary manipulation is usually not required. Operative treatment is never indicated for proctitis. If extension of the disease occurs, operation may be required.
The greater omentum is readily available for the reconstruction of the defect produced after palliative excision of recurrent breast carcinoma. It covers a wide area and readily accepts a skin graft, and it has been observed that there is some local immunity to the reappearance of further recurrence at the site of the graft. The operation can be combined with endocrine ablation.
Three cases of bowel obstruction due to internal hernia caused by entrapment of bowel or omentum through a defect in the peritoneum covering the transplanted kidney are described. All three patients survived due to early surgical intervention and reduction of the hernia and/or resection of necrotic bowel or omentum. In view of the high mortality of peritonitis in transplant patients, early surgical treatment is indicated in all cases of intestinal obstruction to avoid the sequelae of bowel infarction. This "paratransplant" hernia represents the newest type of internal hernia described.
Despite the widespread use of operative cholangiography and choledoschoscopy, stones are still left behind after exploration of the common bile duct. Reoperation is associated with a significant morbidity and mortality. The use of a steerable catheter-basket technique has enabled stones to be removed from the biliary tract in the vast majority of cases without significant complications and has practically eliminated the need for further surgery.
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