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Biomedical subjects

P Belliveau

Publications and source records attributed to P Belliveau.

28 records · Page 2Linked to original sources
PubMed1983

Restorative proctocolectomy with ileal reservoir and ileoanal anastomosis.

An initial experience with a technique of restorative proctocolectomy utilizing a rectal mucosectomy, total colectomy, and ileal reservoir (Parks S-pouch) with ileoanal anastomosis for patients with ulcerative colitis and familial polyposis is presented. Although there were no deaths, significant morbidity did occur and was attributed to the use of a temporary loop ileostomy which may not be necessary. Early functional results are promising and to date, patient satisfaction is very high.

Adolescent↗
PubMed1983

The cecal diaphragm.

A detailed radiologic, colonoscopic, and histologic analysis is described in the case of a cecal web presenting as a "cecal mass." The demonstration of a transverse band-like lucency proximal to the ileocecal valve should prompt careful double-contrast barium studies, to which endoscopy may be added, enabling a correct diagnosis to be made.

Aged↗
PubMed1982

Idiopathic acquired megacolon: the value of subtotal colectomy.

Forty-eight patients treated for chronic incapacitating constipation by surgical resection were reviewed. Thirty-seven had subtotal colectomy, eight had left colectomy, two had right hemicolectomy, and one had ileostomy, colectomy, and a Hartmann pouch. There were significant complications (21 per cent) and one mortality (2 per cent). A long-term successful outcome was found in 81 per cent of the patients on follow-up. Physiologic studies are recommended to improve the selection of patients.

Adult↗
PubMed1981

Prognosis after surgical treatment for granulomatous enteritis and colitis.

To assess the rate of recurrence of Crohn's enterocolitis, 118 patients with Crohn's disease of the small intestine, the small and large intestine, or only the large intestine who had surgery were assessed. Of 53 patients with disease confined to the small intestine, 25 had recurrence, while 19 of 37 patients with disease of the small and large intestine had recurrence. Of 16 patients with Crohn's disease of the colon who had limited reaction, 11 had recurrence. None of the 28 patients with Crohn's disease of the colon or rectum, followed up for 5 years, had recurrence in the small intestine. This study demonstrates that (1) limited resection for Crohn's disease of the colon leads to a significant recurrence rate, and (2) in patients with Crohn's disease localized to the colon, follow-up for at least 5 years revealed no recurrence in the small intestine.

Adult↗
PubMed1981

Restorative proctocolectomy with ileal reservoir: a pathophysiological assessment.

A metabolic and physiological assessment was carried out in 14 patients who had undergone restorative proctocolectomy with ileal reservoir more than six months previously. The haemoglobin was normal in all but one and plasma electrolytes and serum albumin, calcium, phosphorus, and red cell folate estimations were normal in all. Five patients had low serum iron levels of whom one had an iron deficiency anaemia. The 24 hour faecal fat output was normal in all patients and there was no case of vitamin B12 malabsorption as judged by the Schilling test, although four patients had marginally low values. These were not associated with increased bacterial counts in the faeces within the reservoir and there was no evidence to support a diagnosis of stagnant loop syndrome. Inflammation of the reservoir mucosa was, however, associated with higher counts of aerobic bacteria than in cases where inflammation was absent. Subtotal villous atrophy or inflammation was seen in biopsies of the reservoir in six patients. The mean faecal output per 24 hours was 659 +/- 259 g and the mean reservoir volume was 330 +/- 78 ml. Mean resting anal canal pressure was significantly lower in patients with a mucous leakage per anum than in those without, while manometry of the reservoir showed no alteration of pressure over a period of one hour before and after a meal. A positive rectosphincteric reflex was observed in nine patients.

Adult↗
PubMed1980

Proctocolectomy with ileal reservoir and anal anastomosis.

A technique of proctocolectomy avoiding an ileostomy has been developed for patients with ulcerative colitis or polyposis coli. After excision of all diseased tissue a reservoir of terminal ileum is constructed which is brought through the rectal stump denuded of mucosa; an ileo-anal anastomosis is then carried out. Twenty-one patients (17 ulcerative colitis, 4 polyposis) have been treated and 20 followed for from 2 to 34 months (mean 13.5 months). There was no mortality but early complications occurred in 9 patients. All are currently well, with no disturbance of urinary or sexual function. Continence of faeces is complete in all during the day, but 1 patient evacuates unconsciously at night. The average frequency of evacuation is 3.8 times in 24 h. Ten patients void spontaneously. All patients tolerate a full diet and only 2 use medicaments to reduce frequency. This operation appears to be a satisfactory alternative to proctocolectomy with a permanent ileostomy.

Adolescent↗
PubMedDate not supplied

Institution-specific patterns of infection and Gram's stain as guides for empiric treatment of patients hospitalized with typical community-acquired pneumonia.

STUDY OBJECTIVE: To determine the appropriateness of cefazolin as empiric treatment of typical, as opposed to atypical, bacterial community-acquired pneumonia at our institution. DESIGN: Combination of retrospective chart review and prospective determination of microbial susceptibilities and cefazolin-associated cost savings. SETTING: General acute-care referral hospital. PATIENTS: We evaluated the charts of patients discharged with a diagnosis of community-acquired pneumonia over a 10-year period. Gram's stains and culture results of sputum samples processed over 2 months were analyzed to determine the ability of the stains to predict positive Haemophilus influenzae cultures. The susceptibility and beta-lactamase status of clinical isolates of H. influenzae were determined. Cost savings of cefazolin as empiric treatment for community-acquired pneumonia were evaluated. MEASUREMENTS AND MAIN RESULTS: The frequency of H. influenzae pneumonia at our institution was 15% of the three major bacterial community-acquired pneumonias. Gram's stain was highly accurate in predicting the presence or absence of Haemophilus sp in sputum. Five patients had positive outcomes with cefazolin treatment despite being diagnosed with H. influenzae pneumonia. The organism isolates demonstrated intermediate sensitivity to cefazolin and 85% were beta-lactamase negative. Our program that encourages empiric use of cefazolin over cefuroxime for typical bacterial community-acquired pneumonia has allowed a modest projected annual cost savings of $24,000. CONCLUSIONS: We concluded that when Gram's stain of sputum does not show Haemophilus sp in patients with typical bacterial community-acquired pneumonia, empiric treatment with cefazolin is appropriate and results in cost savings.

Adult↗