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Biomedical subjects

R W Beart

Publications and source records attributed to R W Beart.

At least 163 records · Page 9Linked to original sources
PubMed1984

Colonoscopic decompression for acute pseudoobstruction of the colon (Ogilvie's syndrome). Report of 22 cases and review of the literature.

This report has described a series of 22 patients who underwent colonoscopic decompression for acute pseudoobstruction of the colon and summarizes those cases previously reported in the literature. Twenty of the 22 patients (91 percent) were successfully treated by decompression initially. Fifteen patients (68 percent) were cured with the initial procedure, and 4 patients (18 percent) experienced recurrence. Overall, in 17 patients (77 percent), the pseudoobstruction resolved completely with colonoscopic decompression. Three patients (14 percent) underwent operation because of cecal dilatation refractory to colonoscopic decompression, and in one patient (4.5 percent), the colonic dilatation resolved spontaneously after a failed colonoscopy. Complications resulted in the death of one patient (4.5 percent). Our data are similar to those in the literature and indicate that colonoscopic decompression is a safe and efficacious first line of treatment for acute pseudoobstruction of the colon.

Acute Disease↗
PubMed1984

Longitudinal and radial variations of pressure in the human anal sphincter.

The pressure profile of the human anal canal integrates the effects of several separate muscles including internal and external and sphincters and the puborectalis. To define the topography of pressure along the anal canal, we developed a new probe that features four perfused side-hole channels spaced at 90 degrees circumferentially. In 18 healthy volunteers (10 women, 8 men), simultaneous four-quadrant pressures were measured at orad, mid-, and distal stations in the anal canal, at rest and during a maximum voluntary "squeeze." Anterior quadrant pressures were reduced significantly (p less than 0.001) at the orad station at rest and during maximum voluntary effort. In the midcanal, radial pressures were equal in all quadrants. Distally, pressures in the posterior quadrant were significantly lower than those in the other three quadrants. Men had longer sphincters than women, but men had higher pressures at the orad station only. Orad pressures were reduced in women who had had vaginal deliveries. We conclude that the human anal canal has marked, but consistent, radial and longitudinal variations of pressure. Based on these results, a structural and physiological explanation for their genesis is suggested. The findings may also be relevant to the development of cystoceles, rectoceles, and chronic anal fissures.

Adult↗
PubMed1983

Straight ileoanal anastomosis v ileal pouch--anal anastomosis after colectomy and mucosal proctectomy.

The postoperative results of 50 patients who underwent straight ileoanal anastomosis after total colectomy and mucosal proctectomy were compared with those of 74 patients who underwent ileal pouch--anal anastomosis. No deaths occurred. Of the straight ileoanal anastomoses, 32% failed because of sepsis or diarrhea and necessitated abdominal ileostomy; only 1.3% failed in the pouch-anal group (P less than .05). Stool frequency among patients followed up for three months or more (straight ileoanal, n = 30; pouch-anal, n = 33) was less in the pouch-anal group (mean +/- SEM, 7 +/- 1 stools per 24 hours) than in the straight ileoanal group (11 +/- 1/24 hr, P less than .01). Major nocturnal incontinence was also less in the pouch-anal group than in the straight ileoanal group (0% v 20%), and patient satisfaction was better, as measured on a scale of 1 (very poor functional result) to 10 (excellent result) (pouch-anal score, 9; straight ileoanal score, 6; P less than .02). We concluded that ileal pouch-anal anastomosis resulted in less diarrhea, better continence, and an improved quality of life when compared with straight ileoanal anastomosis.

Adult↗
PubMed1983

Hickman catheter implantation in the treatment of acute leukemia.

Between July 1980 and May 1981, 32 permanent indwelling Hickman catheters were implanted in 29 patients. Most of the catheters were placed for treatment of acute leukemia (25 patients) or lymphoma (two patients). Catheters were used for a total of 3,461 patient-days (mean, 108 days). Two patients had infections at the exit site, one seven and the other 11 days after implantation. Four patients had sepsis, but none of those infections appeared to be catheter related. Hickman catheters appear to provide ease of treatment in acute leukemia and are associated with patient satisfaction and an acceptable complication rate.

Acute Disease↗
PubMed1983

Trends in right and left-sided colon cancer.

The increasing ratio of proximal to distal colorectal carcinomas was confirmed in this population-based study of 668 new cases diagnosed among Rochester, Minnesota residents between 1940 and 1979. The change was due to a rise in the incidence of proximal lesions (from 15.1 per 100,000 person-years in 1940-59 to 17.3 per 100,000 in 1960-79) and a simultaneous fall in the incidence of distal lesions (from 35.5 to 28.2 per 100,000 person-years). Changes in definitions or referral patterns played no role in these observations, although improved diagnostic capabilities may have had an impact on the incidence of proximal lesions. These discrepant changes in incidence strongly suggest that proximal and distal colonic cancers are different diseases or have a different pathogenesis. The changing incidence rates were not associated with consistent differences in clinical characteristics at the time of initial diagnosis.

Adenocarcinoma↗
PubMed1983

Fate of the rectal mucosa after rectal mucosectomy and ileoanal anastomosis.

The aim of our study was to determine if the rectal mucosa regenerates after rectal mucosectomy and endorectal ileoanal anastomosis for chronic ulcerative colitis. Such regenerated rectal mucosa could be the site of recurrent disease, leading to complications of the operation, and potential malignant degeneration. Pathologic specimens of the ileoanal anastomosis, surrounded by rectal muscular cuff, were obtained from eight patients who required takedown of their ileoanal anastomosis between one and 18 months after construction. Reepithelialization of the rectal cuff was not observed. In two patients, small islets of rectal mucosa and anal glands were identified. In all patients, the rectal muscularis propria was adherent to the serosa of the ileum by fibrous reaction. Three patients were diagnosed, both clinically and pathologically, as having chronic ulcerative colitis at the original ileoanal operation, but features suggestive of Crohn's disease were noted in the subsequently resected neo-rectum. Our observations suggest that, although isolated rectal mucosal cells may remain after mucosectomy, extensive rectal mucosal regeneration does not occur, thus minimizing the risk of recurrent disease and potential malignant change. Failure of an ileoanal anastomosis is therefore most likely related either to technical factors or to the presence of unsuspected Crohn's disease.

Adolescent↗
PubMed1983

The importance of disease-free margins in resections for Crohn's disease.

It has long been a fundamental principle of surgical therapy for Crohn's disease to remove all disease prior to doing an anastomosis. The authors recently noted with concern an article describing a series of patients demonstrating that residual involvement of anastomotic microscopic disease had no significant effect on the recurrence rate at the anastomosis. Examining their own series of 710 patients undergoing surgery for Crohn's disease, the authors found 42 patients with residual anastomotic disease. The criteria for involvement were more specific than that used in the above article and included microscopic mucosal disease. The recurrence rate within the follow-up period of eight years in patients with only microscopic involvement was 89.4 per cent. This was significantly higher than the institutional recurrence rate for Crohn's resections, previously reported, of 55 per cent at ten years. The authors feel that clear margins should be obtained in resections for Crohn's disease, if at all feasible.

Adolescent↗
PubMed1983

A technique for skin grafting around abdominal wall fistulas.

A simple method of grafting around draining abdominal wall fistulas is described. A Silastic sump drain stapled into a doughnut configuration is used. This produces a barrier around the fistula which drains the fluid off as it reaches the perforations of the sump drain.

Abdominal Muscles↗
PubMed1983

A continent ileostomy device.

The feasibility of achieving fecal continence by mechanical occlusion of an end-ileostomy is explored. Accordingly, progressive stomal occlusion with an indwelling occluding device was evaluated in four healthy patients with Brooke ileostomies. Pre-occlusion clinical and physiologic tests were done, including fat balance, intestinal transit time, ileal motility and absorption, ileal compliance, ileal radiography, and ileoscopy. Progressive stomal occlusion was then employed until periods of occlusion of 5 to 8 hours were achieved after 10 to 16 weeks. Pre-occlusion tests were then repeated. Patients mastered use of the occluding device rapidly, and the device achieved reliable stomal continence in each patient. Whereas ileal capacity was small initially, intermittent occlusion resulted in a large, capacious ileal reservoir. Fasting ileal motility was increased slightly by stomal occlusion, although intestinal transit during feeding was not altered. Also, ileal absorption of glucose, electrolytes, vitamin B-12, and fat were not changed, and ileal mucosa at the site of occlusion remained intact endoscopically. The authors concluded that chronic intermittent occlusion of a Brooke ileostomy with an indwelling stomal device achieved enteric continence without impairing intestinal function.

Adult↗
PubMed1983

A clinico-physiological comparison of ileal pouch-anal and straight ileoanal anastomoses.

The ileal pouch-anal anastomosis improves clinical results after colectomy and mucosal proctectomy compared to the straight ileoanal anastomosis. The question was what physiologic changes brought about by the pouch led to the improvement. Among 124 patients who had had ileoanal anastomosis, 25 volunteered for a detailed clinicophysiologic evaluation. Fourteen had had the ileal pouch-anal operation a mean of 8 months previously, and 11 had the straight ileoanal operation a mean of 25 months previously. Both groups of patients had satisfactory anal sphincter resting pressures (mean +/- SEM, pouch = 68 +/- 8 cm H2O, straight = 65 +/- 9 cm H2O, p greater than 0.05) and neorectal capacities (pouch = 278 +/- 26 ml, straight = 233 +/- 36 ml, p less than 0.05), and all could evacuate spontaneously. However, the pouch patients had a more distensible neorectum (delta V/delta P pouch = 9.5 +/- 1.3 ml/cm H2O, straight = 4.9 +/- 0.9 ml/cm H2O, p less than 0.05) and smaller amplitude neorectal contractions (pouch = 36 +/- 5 cm H2O, straight = 90 +/- 13 cm H2O; p less than 0.05). We concluded that the pouch-anal anastomosis increased the distensibility of the neorectum and decreased its propulsive drive, and so improved clinical results.

Adult↗
PubMed1983

Predicting outcome after endorectal ileoanal anastomosis.

The aim of this study was to determine whether anorectal manometry could predict clinical outcome after closure of a diverting ileostomy made at the time of colectomy, mucosal proctectomy and endorectal ileoanal anastomosis for chronic ulcerative colitis. Twenty-two patients were studied, 6 with ileoanal anastomosis and 16 with ileal pouch-anal anastomosis. Resting anal sphincter pressures and pressure-volume curves (compliance) of the neorectum were assessed before the diverting ileostomy was closed and results were correlated with frequency and leakage of stools 1 month after closure. Before stomal closure, the mean (+/- standard error of the mean) resting sphincteric pressure was 44 +/- 5 cm H2O, while neorectal compliance was 2.3 +/- 0.3 ml/cm H2O. One month later daily stool frequency was 12 +/- 1, while severe leakage occurred in four patients during the day and in eight at night. The greater the sphincteric pressure and the compliance, the fewer were the number of stools per day (p less than 0.01). When pressure and compliance were considered together as an index of anorectal function, the correlation of stool frequency and leakage was even stronger (p less than 0.001). The authors conclude that anorectal manometry can predict early clinical outcome after ileoanal anastomosis.

Adolescent↗
PubMed1983

Achieving ileostomy continence with a prestomal ileal pouch and a stomal occlusive device.

To determine whether an artificial, indwelling, stomal occluding device could provide reliable continence for persons with an ileostomy and a prestomal ileal pouch, the device was tested first in four dogs and then in humans. After initial assessment of pouch volume and pressure-volume relationships in the dogs, the animals underwent progressively longer periods of stomal occlusion with the artificial device, such that 4 weeks later, they were tolerating occlusion for periods of 8 hours. The device achieved complete continence for gas and stool without discomfort in every dog. The pouch capacity rapidly increased, so that infusion of 500 ml of water at 4 weeks elicited less than a 10 cm H2O increase in intrapouch pressure. These encouraging canine results prompted use of this approach in a 55-year-old obese man undergoing proctocolectomy for chronic ulcerative colitis. The device achieved continence in the patient for 4- to 6-hour periods by 2 months after operation without discomfort or adverse sequelae. We concluded that the artificial device rapidly increased pouch capacity and effectively maintained leakproof fecal continence in dogs and humans with an ileostomy and a prestomal ileal pouch.

Animals↗
PubMed1982

Staging laparotomy in Hodgkin's disease: Mayo Clinic experience.

Between 1967 and 1979, 316 patients with Hodgkin's disease underwent staging laparotomy. Histologic examination demonstrated lymphocyte predominance in 40 (12.7%) patients, nodular sclerosis in 178 (56.3%), mixed cellularity in 80 (25.3%), and lymphocyte depletion in seven (2.2%); results in 11 (3.5%) patients were considered unclassifiable. There were no deaths. Major complications occurred in 7.9% and required reoperation in 1.9%. Pathologic stage differed from clinical stage in 111 (35.1%) patients. In 90 (28.5%) patients, the stage advanced; in 21 (6.6%) patients, the stage was reduced; and in five (1.6%) patients, the histologic subtype was changed. Stage changes occurred in 40% of those with lymphocyte predominance, in 27.5% with nodular sclerosis, in 46.3% with mixed cellularity, and in 85.7% with lymphocyte depletion. The reliability of staging laparotomy for the determination of appropriate treatment favors its continued use.

Adolescent↗
PubMed1982

Colovesical and rectovesical fistulas.

Colovesical or rectovesical fistulas develop because of a congenital abnormality, a traumatic incident, or an underlying disease, such as inflammation or cancer. Inflammation, either diverticulitis or Crohn's disease, was the cause of fistula in 73 (67%) of 109 patients with colovesical or rectovesical fistulas seen at the Mayo Clinic, Rochester, Minn, between 1965 and 1980. Sixty-six of the 73 patients had colovesical fistulas, and 64% of them underwent resection and anastomosis in one stage. Cancer of the cervix, prostate, bladder, colon, or rectum was responsible for 27 fistulas, equally divided between colovesical and rectovesical types. Only seven (26%) could be treated by one-stage anterior resection. Fifteen patients required fecal diversion with or without resection of bowel. At follow-up, 80 patients were alive; only two (one with prostatic cancer and one with cervical cancer) had recurrence of fistula.

Adolescent↗
PubMed1982

Human colorectal carcinoma: patterns of sensitivity to chemotherapeutic agents in the human tumor stem cell assay.

The human tumor stem cell assay (HTSCA) was applied to 103 primary and metastatic colorectal carcinomas. Thirty-four carcinomas could not be evaluated for colony formation (clonogenicity) because of microbial contamination. Of the remaining 69 carcinomas, 18 (26%) demonstrated clonal growth in vitro. Colony formation did not correlate with the clinicopathologic stage of the tumor, the histological grade of the tumor, the method used to disperse the solid tumors into single cells (mechanical or enzymatic), or cell viability (exclusion of trypan-blue) prior to plating. The in vitro chemotherapy sensitivity data of the 18 tumors which formed colonies indicated that most tumors were generally resistant to chemotherapeutic drugs and that a few tumors were sensitive to multiple agents. Use of the human tumor stem cell assay may facilitate an individualized approach to clinical chemotherapy of colorectal carcinoma for certain patients.

Adenocarcinoma↗