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Biomedical subjects

N G Kock

Publications and source records attributed to N G Kock.

At least 55 records · Page 3Linked to original sources
PubMed1986

Continent ileostomy. The present technique and long term results.

Continent ileostomies were created in 435 patients in the period 1967-1984. Approximately 50% of the patients were provided with a continent ileostomy in connection with proctocolectomy and in the others a conventional ileostomy was converted to a continent ileostomy. In the majority of patients the indication for proctocolectomy was ulcerative colitis, but 64 patients with Crohn's disease were also included. There was a 1.6% operative mortality overall, but when the material was divided into two groups operated upon during two consecutive time periods, no mortality was recorded in 273 patients operated upon during the latter period. The non-fatal complication rate had also decreased from 23% in the early series to 8% in the group operated upon during the latter period. Revisional surgery because of malfunction of the nipple valve has consecutively decreased from 54% in the original series to less than 10% at the time of writing. Successful outcome of the ileostomy procedure, although revisional surgery was sometimes required, was recorded in 97% of 273 patients operated on during the period 1975-1984.

Colitis, Ulcerative↗
PubMed1985

Hypertrophy of ileal smooth muscle after construction of ileal reservoir in the rat.

An experimental model of the continent ileostomy reservoir used in clinical practise has been adapted for rats in order to evaluate changes in the smooth muscle layers of the ileal wall. The reservoir was constructed in the distal part of ileum, with intestinal continuity in order to avoid emptying problems. The rats were sacrificed 3-7 months after construction of the reservoir. There was a significant dilatation of the reservoir with a 26-fold increase in the mean reservoir volume. Morphometric studies of the smooth muscle in the intestinal wall revealed an increased thickness of the circular and longitudinal layers after construction of the reservoir (p less than 0.001). The number of muscle cell nuclei per section in samples of the ileal reservoir was reduced (p less than 0.01), whereas the mean size of the individual nuclei was greater (p less than 0.001). These results indicate that the enormous dilatation of this ileal reservoir is related to a clear hypertrophy of the smooth muscle layer. Whether there is a concomitant hyperplasia remains to be studied.

Animals↗
PubMed1985

Reflux from the continent ileostomy reservoir. A radiologic evaluation combined with pressure recording.

The reflux from the continent ileostomy reservoir was studied with radiologic and pressure recording techniques in ten patients. The contrast used was poly-iodine-styrene with a density of 0.8 to 1.1 gm/cm3. Reflux into the afferent loop was demonstrated in all patients at a filling volume of approximately 30 percent of the maximal volume capacity of the reservoir. The magnitude of reflux increased with the increasing volume of the reservoir contents and a rise in reservoir pressure. The reflux could temporarily be influenced by antiperistaltic or isoperistaltic motor activity in the afferent loop. Although no adverse effects were seen from the amount of reflux demonstrated in the present investigation, the finding of increasing reflux with increased fullness and intraluminal pressure of the reservoir would indicate that the reservoir should be emptied at regular intervals and before high pressures are built up.

Female↗
PubMed1985

Continent cecostomy. An account of 30 patients.

In this paper, an account is given of our experience with continent colostomy in man. In five patients, the end-sigmoidostomy was provided with an intussusception valve. Evacuation of the bowel by irrigation through a catheter was laborious and time-consuming and this method was abandoned. In another group of 30 patients, the cecum was isolated from the rest of the colon and its distal end was provided with an intussusception valve. Of the 30 patients, eight were later given continent ileostomies, two were converted to conventional sigmoidostomies, and one patient with fecal incontinence preferred to have intestinal continuity reestablished. Thus, 19 patients still have continent cecostomies and are satisfied with their function. When comparing the function of the continent cecostomy with that of the continent ileostomy, however, it is obvious that the ileostomy function is superior. The experience obtained with this group of patients has resulted in a widening of the indications for constructing a continent ileostomy, including selected patients with various anorectal disorders.

Animals↗
PubMed1985

Absorption of an oral contraceptive gestagen in ulcerative colitis before and after proctocolectomy and construction of a continent ileostomy.

Plasma 1-norgestrel (1-Ng) levels after administration of a common oral contraceptive in fertile women (mean age 29 +/- 5 yrs) with mild ulcerative colitis before or after proctocolectomy with a conventional ileostomy or a continent ileostomy reservoir were determined and compared to those of a group of healthy volunteers serving as controls. Before operation, peak and 10-hour levels of 1-Ng were not statistically different from control. Levels in patients with either type of ileostomy were slightly lower than controls, but were only statistically significantly lower in patients with continent ileostomy (p less than 0.05). In a subgroup of patients studied both before and after proctocolectomy with construction of a continent ileostomy, there was a slight reduction in peak and 10-hour levels compared to control. After administration of the pill directly into the reservoir, significant levels of 1-Ng in plasma were found with peak and 10-hour levels approximately one-half of those achieved after oral administration. Although the material is small, it suggests that patients with mild ulcerative colitis and with small ileal resections (8.8 +/- 8 cm) can use combined contraceptive pills containing 1-norgestrel with confidence. Caution should be exercised, however, in prescribing "mini-pills" to patients after proctocolectomy and ileal resection.

Adult↗
PubMed1984

Volume capacity and pressure characteristics of the continent ileostomy reservoir.

The volume capacity and the pressure characteristics of the ileal reservoir were studied at intervals postoperatively in 28 patients with continent ileostomy. The reservoir volume increased during the first 6 months from 100 ml to approximately 700 ml, after which it remained stable. The basal pressure increased during filling to a maximum of roughly 10 cm H2O. Under 'physiological conditions' the basal pressure was around 4 cm H2O before emptying. Two types of pressure waves occurred, small pressure fluctuations with a frequency of 7-8/min and larger phasic waves appearing when approximately 40% of the reservoir volume capacity had been reached. The occurrence of both types of pressure waves decreased with time. The total motor activity, expressed as the area underneath the pressure waves, decreased considerably during the 1st year after operation, indicating an adaptation of the intestinal smooth muscle to distension. The results confirm the original concept proposed by Kock that the ileal reservoir constructed in this manner is a low-pressure reservoir.

Adolescent↗
PubMed1983

Functional and structural studies of ileal reservoirs used for continent urostomy and ileostomy.

The structure and function of the mucosa has been studied in continent ileostomy and urostomy reservoirs, the latter being a receptacle for diverted urine constructed out of ileal tissue. Morphometric evaluation was performed by a microdissection technique and functional studies involved the assessment of L-phenylalanine absorption by the whole pouch in vivo and the uptake of the same amino acid by biopsy samples in vitro. Endoscopic examination revealed fairly homogeneous villous structure in the ileostomy reservoirs. In the urostomies, there was a gradual appearance, as a function of the postoperative time interval, of areas of flat mucosa intermingled with villous regions. When possible, biopsies of the two types of mucosa were studied separately. Even in the villous regions of the urostomies, the size of the villi was smaller in all dimensions than the villi of ileostomy samples. The uptake of phenylalanine in vitro, however, was the same in villous samples from urostomies and in ileostomy biopsies. The absorption of phenylalanine in vivo by the whole pouch was lower in the urostomies. There was a good correlation between amino acid absorption in vivo and in vitro in the ileostomies, but not in the urostomies. This is attributed principally to the variable proportions of avillar and villous mucosa in the latter material, as there is a clear reduction in absorption in vivo in the longest established urostomy pouches.

Adult↗
PubMed1983

Omission of gastric decompression after major intestinal surgery.

This study was performed in order to evaluate whether postoperative nasogastric intubation as a routine measure after major intestinal surgery is advisable or not. Factors related to postoperative nasogastric intubation were compared in two consecutive series of patients operated on with construction of a continent ileostomy. 44 patients were provided with a nasogastric tube and 52 patients had no postoperative nasogastric intubation. There were no postoperative complications which could be ascribed to the presence or absence of the nasogastric tube. Patients without nasogastric tube needed less patenteral fluid support and could resume oral feeding earlier than those with nasogastric intubation. It is concluded that postoperative nasogastric intubation can be omitted as a routine procedure after construction of a continent ileostomy.

Adult↗
PubMed1982

Urinary diversion via a continent ileal reservoir: clinical results in 12 patients.

Urinary diversion via a continent ileal reservoir has been performed in 12 patients. An isolated ileal reservoir was constructed using the technique described for patients with a continent ileostomy. The ureters were implanted into an afferent segment provided with a reflux-preventing nipple valve. There were few operative complications and no operative mortality. Late complications involving malfunction of the nipple valves occurred in 8 patients and were corrected surgically. Postoperative followup presently is between 9 months and 6 1/2 years. Two patients have died: 1 in an accident and 1 of metastatic bladder carcinoma. The remaining 10 patients are continent and without reflux to the upper urinary tract. The reservoir generally is emptied by intermittent self-catheterization between 3 to 6 times daily. The volume capacity of the reservoir is more than 500 ml. Urinary cultures have been constantly negative in 7 patients and the contents of the reservoir more or less permanently contained bacteria in 5. Dilatation of the upper urinary tracts, progressive renal deterioration or metabolic disturbances have not been encountered. All patients are satisfied with this type of urinary diversion, especially those who have undergone other types of diversion previously.

Adult↗
PubMed1981

Quantitative recovery of contaminating bacteria at operation and the relation to postoperative infection in intestinal surgery.

In a prospective study of postoperative septic complications, young patients suffering mainly from inflammatory bowel disease were subjects to elective surgery. The bacterial concentration in the operative field was determined by an irrigation technique. When at least one of two irrigation fluids yielded greater than or equal to 50 CFU/ml of E. coli or S. aureus the risk of postoperative infection was highly increased (p less than 0.0001, Fisher's exact test).

Adolescent↗
PubMed1981

Continent ileostomy. An account of 314 patients.

Continent ileostomies were created in 314 patients between 1967-1979. Approximately 50% of the patients were provided with the continent ileostomy in connection with proctocolectomy and the others were converted from a conventional ileostomy to the continent ileostomy. In the majority of patients the indication for proctocolectomy was ulcerative colitis, but 51 patients with Crohn's disease were also included. There was 2.5% operative mortality overall, but when the material was divided into two groups operated upon during two consecutive time periods, no mortality was recorded in 152 patients operated upon during the latter period. The non-fatal complication rate had also decreased from 24% in the early series to 7% in the group operated upon during the latter period. Revisional surgery because of malfunction of the nipple valve has consecutively decreased with the present technique for construction of the nipple from 54% in the original series to 6%. At the follow up, 94% of the patients were continent and never used ileostomy appliances.

Adolescent↗
PubMed1981

Evolution of ileostomy surgery.

Ileostomy in association with proctocolectomy in one or two stages is the accepted treatment for ulcerative colitis. There are many difficulties in managing the permanent ileostomy in spite of improvements in design and construction, in availability of stomal appliances and in better skin protection and adhesive materials. The collection and storage of excrement in a bag outside the body imposes severe difficulties. To eliminate these problems an alternative ileostomy method, the continent ileostomy, was devised and the clinical results achieved in 314 patients are reported. There was a 2.2% overall operative mortality but no operative deaths in the last consecutive series of 152 patients. The nonfatal complication rate has decreased from 24% to 7% and revision because of a malfunctioning outlet valve has decreased from 54% to 6%. At follow-up 94% of the patients were continent. Except for a slightly increased loss of bile salts and a potential risk of decreased vitamin B12 absorption no harmful effects of the reservoir procedure have been found after observation times up to 12 years.

Colitis, Ulcerative↗