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Biomedical subjects

S Fasth

Publications and source records attributed to S Fasth.

At least 19 recordsLinked to original sources
PubMed1992

Anal fistulas in Crohn's disease: incidence and outcome of surgical treatment.

The incidence and prognosis of anal fistulas were investigated in a prospective study comprising 136 patients operated on for Crohn's disease. The incidence of anal fistulas was 27 of 136 (20%), in patients with classical disease 12 of 68 (18%), and in those with Crohn's colitis 15 of 68 (22%). A fistula preceded the intestinal manifestation of the disease in 6 patients. At the time of diagnosis of Crohn's disease anal fistulas were observed in 19 cases, including 3 of the 6 with early onset which had resisted treatment and remained active. Five patients developed anal lesions during the course of the disease, all but 2 in temporal relationship to an intestinal recurrence. Of the 27 patients with anal fistulas, 11 were of the low-anal type, whereas 14 were anorectal. Conventional laying open of the fistula was undertaken in all patients with classical Crohn's disease in close conjunction with resection of the intestinal disease. On local surgical treatment 10 of 12 (89%) healed with preservation of continence. Four recurrent fistulas occurring in conjunction with intestinal recurrence also healed uneventfully. Laying open was undertaken in 11 of the 15 patients with colitis. Healing was obtained in only 4 of these patients. In the remaining 4 severe colitis indicated immediate proctocolectomy. Occurrence of fistulas involved a significant delay in perineal healing after proctectomy. It is concluded that traditional laying open of an anal fistula in patients with classical Crohn's disease is followed by high rate of uneventful healing. In contrast, local surgical treatment of anal fistulas complicating Crohn's colitis is usually unsuccessful.(ABSTRACT TRUNCATED AT 250 WORDS)

Crohn Disease↗
PubMed1992

The failing pelvic pouch conversion to continent ileostomy.

Excision of a failing pelvic pouch is often a great disappointment for the patient. It is also an unfortunate decision considering that a significant length of terminal ileum is sacrificed. Transformation of the pouch to a continent ileostomy is an alternative. Five patients with a malfunctioning pelvic pouch have had their pouch converted to a continent ileostomy. The operative technique is described.

Adult↗
PubMed1991

Sodium and potassium excretion in patients with ileostomies.

The output of sodium and potassium from urine and ileostomy was investigated in 35 healthy patients with ileostomies; 17 had undergone proctocolectomy for ulcerative colitis and 18 for Crohn's colitis. Fifteen of the patients with Crohn's disease had also had small bowel resections, varying from 15 to 46% of the original bowel length. The patients were investigated at home because most studies of sodium and water balance in patients with ileostomies have been done in hospital wards, which may not reflect actual conditions. Mean (SD) ileostomy output was 565 (152) ml in patients with ulcerative colitis and 1,267 (540) ml in patients with Crohn's disease. The intrapatient variation was limited, whereas the interpatient variation was significant and correlated with the length of small bowel resected. The sodium concentration in the ileostomy discharge was 110 (9.2) mmol/l and did not change consistently with ileostomy volume. The potassium concentration was 10 (2.1) mmol/l. There was a significant inverse correlation between daily ileostomy sodium output and urinary sodium concentration (r = -0.44, p less than 0.01), and a significant correlation between the daily output of sodium in ileostomy contents and the sodium:potassium ratio in urine. We conclude that patients with ileostomies are at risk of sodium and water depletion, particularly those who have had small bowel resections. Increased sodium output from the ileostomy is associated with a reduction in the sodium:potassium ratio in the urine. To screen patients at risk, an estimate of the sodium balance can be made by measuring sodium and potassium concentrations in a single specimen of urine.

Adult↗
PubMed1979

Faecal excretion of intravenously injected 14C-cholic acid in patients with conventional ileostomy and in patients with continent ileostomy reservoir.

Bile salt absorption, as determined by the faecal excretion in i.v. injected 14C-cholic acid (FBS) was studied in 13 ileostomy patients before and after conversion to Kock's continent ileostomy reservoir. The result was compared with that obtained in 8 ileostomy patients in whom about 50 cm of the terminal ileum has also been removed. As compared with 16 healthy controls, FBS was moderately increased in the conventional ileostomy patients, but still within normal limits. After conversion to ileostomy reservoir all patients had pathological FBS, although less severe than in the ileostomy patients with ileal resection. Bacterial contamination probably contributes more than the structural mucosal changes to the bile malabsorption in the pouch, whereas reduced mucosal surface and short small-intestinal transit time are the main causes of malabsorption in ileostomy patients in whom an appreciable amount of the terminal ileum has been resected.

Adult↗
PubMed1978

Mobilization of colonic kallikrein following pelvic nerve stimulation in the atropinized cat.

1. Pelvic nerve stimulation (p.n.s.) in cats induces atropine-resistant colonic vasodilatation and colonic contraction. The effects of this on cat colon are mimicked by synthetic bradykinin infusions. The present study examines the effect of p.n.s. on the activation of kallikrein, the kinin-forming enzyme present in colonic tissue and its effects on the plasma kinin system in the atropinized cat.2. Mean level (+/- S.D.) of mucosal kallikrein was found to be about 37 times higher in unstimulated colonic mucosa (300 +/- 100 ng bradykinin equivalents min(-1)g(-1)) than in the underlying muscle (8.2 +/- 6.3 ng bradykinin equiv min(-1)g(-1)).3. After a p.n.s. of 5 min, mean kallikrein level in colonic muscle was 7.3 +/- 3.5 ng bradykinin equiv min(-1)g(-1), which was not significantly different from the control muscle kallikrein. However, there was an 86% fall in mucosal kallikrein to 41.3 +/- 34.7 ng bradykinin equiv min(-1)g(-1) after 5 min p.n.s., indicating a rapid activation and secretion of mucosal kallikrein.4. Secretion of mucosal kallikrein was paralleled by specific depletion of plasma kininogen, the precursor of active kinin in blood draining the colon. The mean plasma kininogen level fell to 79 and 68% of the prestimulated value (3.1 +/- 1.1 S.D. mug bradykinin equiv per ml. plasma) after 5 and 10 min p.n.s. respectively. Total plasma protein and haematocrit remained unaltered excluding non-specific changes due to protein extravasation or haemodilution and indicating utilization of the plasma kinin precursor.5. Following 2 hr p.n.s., raised levels of kallikrein were detected in both colonic muscle (28 +/- 2.0 bradykinin equiv min(-1)g(-1)) and mucosa 434 +/- 118 ng bradykinin equiv min(-1)g(-1)). Preliminary studies using a kallikrein inhibitor indicated that the increased kallikrein levels originated from plasma.6. Direct stimulation of the parasympathetic pelvic nerve in the atropinized cat thus produced activation of the plasma kinin system in the colon and formation of free kinins may be responsible for the mucosal vasodilatation and strong motor contraction which is not blocked by large doses of atropine. The observation that prolonged stimulation causes extravasation of plasma kallikrein, a potential inflammatory mediator, into the tissues may be of clinical significance.

Animals↗
PubMed1978

Intramural oesophageal cyst with massive mediastinal bleeding. A case report.

Intramural oesophageal cysts lined by ciliated columnar epithelium are considered to be lesions which are not prone to serious complications except infection. In contrast to this view, a case of intramural oesophageal cyst recently operated upon by us, in which severe mediastinal bleeding developed, is described.

Adult↗
PubMed1978

Sexual dysfunction following proctocolectomy.

122 patients, 66 men and 56 women, operated upon by proctocolectomy were interviewed by means of a detailed questionaire regarding any significant change in sexual function. In the majority of the patients (70% of the men and 87% of the women) the sexual relationships were considered to be unchanged or even enhanced. Impaired function was reported by 19 men (29%) and seven women (12%). Male sexual dysfunction consisted of impotence and abolition of ejaculation. True impotence occurred in five men, all above 40 years of age, corresponding to an incidence of 25%. Loss of ejaculation occurred even in young people (about 7%) but was more common in elderly patients (15%). Female dysfunction consisted of dyspareunia and/or inability to achieve orgasm. On the basis of the present results it appears unlikely that impotence is caused by the operative trauma per se. On the other hand loss of ejaculation is probably due to injury of the presacral nerves. Postoperative impotence might probably be improved by medical information and encouragement. Particular precautions during operation might reduce ejaculatory disorders. Careful handling and proper treatment of the perineal wound might prevent scarring and stricture of the posterior aspect of the vulva, a condition that appears to be a common cause of dyspareunia.

Adult↗
PubMed1978

Blood pressure changes in the marginal artery of the colon following occlusion of the inferior mesenteric artery.

The perfusion pressure in the marginal artery of the descending colon was measured continuously at laparotomy in eight patients and the effect of sudden occlusion of the inferior mesenteric artery recorded. Three patients with ulcerative colitis, all in their early 30s, and five elderly patients with colonic or rectal carcinoma were studied. In all patients occlusion caused an initial and marked pressure drop, which remained reduced at a critically low level in two of the elderly patients. Such a reduction in perfusion pressure is probably still insufficient to interfere with the nourishment of the terminal part of the colon provided that the systemic pressure is kept at a normal level. However, since in many patients there is a sharp drop in systemic blood pressure during the recovery phase after surgery, it appears likely that the perfusion pressure in the marginal artery may in those cases be insufficient to maintain an adequate blood flow to the colon despite the inherent tendency of "auto-regulation" in this vascular bed. The results of the present study indicate that, contrary to previous belief, ligation of the inferior mesenteric artery may increase the risk of ischaemia in the terminal part of the descending colon, leading to anastomotic dehiscence after anterior resection, or sloughing after a "pull-through" operation. This complication could probably be prevented by a more generous resection of the sigmoid and descending colon, thus reducing the length of the anastomosis formed by the arc of Riolan and by careful maintenance of an adequate blood pressure during the recovery phase.

Adult↗
PubMed1977

[Fistula in ano].

Explore the source record for details and available documents.

Anal Canal↗
PubMed1977

Vascular responses to mechanical stimulation of the mucosa of the cat colon.

Mechanical stimulation of the mucosa of the proximal colon evoked a hyperemia which also could be elicited when severing the autonomic fibres to the colon. Mechanical stimulation of the distal colon produced a hyperemia which, on the other hand, was abolished by cutting the pelvic nerves. Afferent pelvic nerve stimulation evoked a response similar to that seen when stimulating the distal colon. Adrenergic and cholinergic receptor blockers did not affect the studied colonic vasodilations. Dihydroergotamine, given in doses abolishing the vascular effects of i.a. injected 5-hydroxytrptamine, abolished the hyperemia to mechanical stimulation of the proximal colon but not that of the pelvic stimulation. It is concluded that a local nervous vasodilator reflex exists in the proximal colon similar to that earlier demonstrated in the small bowel (Biber et al. 1971) and that the reflex vasodilatation evoked by mechanical stimulation in the distal colon is mediated via the pelvic nerves. Hence, the vascular control differs in the proximal and in the distal parts of the colon.

Animals↗
PubMed1977

Regional intestinal blood flow in ulcerative colitis and Crohn's disease.

By means of a recently developed isotope washout technique, regional intestinal blood flow and its intramural distribution were determined during surgery and correlated to the morphological inflammatory and vascular features of ulcerative colitis (UC) and Crohn's disease (CD) at different stages and location. In severe colitis total blood flow was significantly increased (64 +/- 9 ml per min X 100 g; mean +/- SE; n = 13) both in UC and CD, the mucosal-submucosal blood flow amounting to 121 +/- 25 ml per min X 100 g (n = 7). The muscularis blood flow was within normal range (18 +/- 10; n = 7), however. In chronic long-standing quiescent or inactive UC, in "healed colitis," and in chronic segmental colitis (CD), colonic blood flow was normal or even reduced (13 +/- 2; n = 8), the decrease in flow comprising both the mucosa-submucosa (21 +/- 3; n = 3) and the muscularis (7 +/- 3; n = 3). In early exudative stage of CD in the ileum total blood flow was normal (26 +/- 5; n = 7) with a normal mucosal-submucosal blood flow (35 +/- 5; n = 3). In late fibrosing stage total blood flow was reduced (11 +/- 1; n = 6) as was the mucosal-submucosal flow (10 +/- 4; n = 3). The muscularis blood flow was reduced in both these stages of ileal CD (7 +/- 1; n = 6). There was a satisfactory agreement between the obtained blood flow figures and the morphologically observed vascular pattern.

Chronic Disease↗
PubMed1977

Ommission of pelvic peritoneal closure after abdominoperineal rectal excision.

Peritonealization of the raw areas and closure of the pelvic floor is sometimes impossible to perform in patients subjected to abdominoperineal rectal excision when combined with extensive lymph node clearance. The postoperative course in 34 patients, treated in that way, necessitating sacrifice of the peritoneum on the dorsal aspect of the abdominal wall and in the pelvis was studied with the possible relevances in mind. Complications requiring laparotomy in the early postoperative period, occurred in three patients, but in only one of the patients was the complication considered to be related to the omission of closing the pelvic floor. Admittedly, small intestinal obstruction complicated the postoperative course later on in another three patients, but it can hardly be excluded that this complication, caused by pelvic recurrence, should not have occurred if pelvic closure had been performed. It is concluded that the importance of peritonealization, covering all raw peritoneal surfaces and pelvic reconstruction, has been overstressed in the past. Moreover, it is also suggested that it is in fact better to leave the pelvic cavity widely open than to perform a reconstruction under tension, even in patients treated by conventional abdominoperineal resection for rectal carcinoma.

Humans↗
PubMed1976

Ureteric obstruction complicating Crohn's disease in the terminal ileum.

Ureteric obstruction complicating Crohn's disease of the terminal ileum is reported in three patients. This complication is treacherous, since symptoms of urinary tract disease are mostly absent, as is laboratory evidence of urinary tract infection. It is concluded that inflammatory ureteral engagement should always be suspected in patients with Crohn's disease, particularly when located in the terminal ileum. A preoperative intravenous pyelography should be included as a routine procedure in these patients. The detection of ureteral obstruction is a strong indication for early operative treatment of the disease. Ureterolysis combined with intestinal resection is recommended. The ureteral involvement, which is most likely a late phenomenon of the disease, could provably be avoided if surgical treatment is instituted at an earlier stage of the disease.

Adult↗