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Biomedical subjects

S Fasth

Publications and source records attributed to S Fasth.

At least 55 records · Page 3Linked to original sources
PubMed1987

Long-term ileostomy complications in patients with ulcerative colitis and Crohn's disease.

Ileostomy complications in 203 patients operated on with proctocolectomy and ileostomy for ulcerative colitis and Crohn's disease were investigated prospectively. The patients were examined at regular intervals by interview and thorough examination of the stoma. Stomal dysfunction was carefully assessed and patients presenting with surgical complications were admitted for reconstruction. The crude rate of ileostomy complications necessitating reconstruction was 34% and significantly higher in patients with Crohn's disease compared with patients with ulcerative colitis. The cumulative rate of surgical revision after 8 years was 75% in the former group and 44% in the latter. Ileostomy stenosis and sliding recession were the two most common indications for reconstruction. Eighty-three per cent of the revisions were performed as local procedures, making a formal laparotomy unnecessary. Causative factors such as surgical technique, length of concomittant ileal resection and postoperative weight gain were analysed for possible influence on the rate of reconstruction, but no significant association was identified.

Adolescent↗
PubMed1987

Cholelithiasis and urolithiasis in Crohn's disease.

In a consecutive series of 107 patients operated on for Crohn's disease involving the distal ileum, the overall incidence of gallstones was 17% and of renal stones 12%. Whereas the frequency of gallstone disease was 9% in patients with minor resections, patients with more than 100 cm diseased or resected small bowel had a frequency of 35%. The probability of gallstone development in both sexes was calculated to be approximately 50% after 20 years of distal ileopathy. The frequency of renal stone disease in patients with minor resection was comparable to that of a population in Sweden but was significantly commoner in patients with resection of more than 100 cm (28%), provided they were not colectomized. The high frequency of stone disease after resection of distal ileum is attributed to metabolic disturbances due to steatorrhea and bile salt malabsorption.

Cholelithiasis↗
PubMed1986

Restoration of intestinal continuity (pelvic pouch) after previous proctocolectomy with distal mucosal proctectomy.

Colectomy with full thickness proximal proctectomy and endoanal distal mucosal proctectomy may be a rational alternative to the conventional single stage proctocolectomy for ulcerative colitis. One of the great attractions of the method is that the preserved anal canal and anal sphincters may subsequently be used for restoration of intestinal continuity. Two patients are described who were both successfully treated by construction of a pelvic pouch at a second stage. This approach should be considered an alternative for patients with severe ulcerative colitis particularly those in whom preservation of the rectum is judged to be hazardous.

Adult↗
PubMed1986

Effect of alpha, beta-methylene ATP on distal colonic and rectal motility--a possible involvement of P2-purinoceptors in pelvic nerve mediated non-adrenergic, non-cholinergic contraction.

The possible involvement of purinoceptors in the parasympathetic nervous control of large intestinal motility was investigated in cats anaesthetized with chloralose and treated with adrenolytics. Distal colonic and rectal motor responses to efferent pelvic nerve stimulation (PNS) and drugs injected close i.a., were recorded by a volumetric method. Single dose i.a. injections of alpha, beta-methylene ATP (mATP) induced colonic and rectal contractions which were resistant to atropine, hexamethonium and indomethacin, as well as to the nerve blocking agent tetrodotoxin. Repeated injections of mATP were followed by attenuated motor responses and eventually complete tachyphylaxis to the compound developed. In the presence of atropine, or a combination of hexamethonium and atropine, contractions elicited by PNS were inhibited during mATP tachyphylaxis. In contrast, prior to such anticholinergic drugs, or in the presence of hexamethonium alone, pelvic nerve mediated contractions persisted despite mATP tachyphylaxis, which did not affect the colonic and rectal contractions evoked by acetylcholine or histamine. The results suggest that P2-purinoceptors are involved in non-adrenergic, non-cholinergic large intestinal excitatory motor responses to PNS.

Adenosine Triphosphate↗
PubMed1985

Mucosal proctectomy and ileostomy as an alternative to conventional proctectomy.

Endoanal mucosal proctectomy with preservation of the anal sphincters has been employed as an alternative to the traditional method of rectal excision in 23 patients with ulcerative colitis or Crohn's disease. Ten patients in whom the anal canal was left open and drained had uneventful postoperative courses. Of the remaining 13 patients in whom the top of the anal remnant was oversewn, four had local pelvic sepsis that resolved in a few weeks' time and one patient had a pelvic hematoma requiring relaparotomy and sphincter muscle excision. Postoperative disturbances in bladder or sexual function did not occur in any of the patients. At the latest follow-up (mean 21 months), all patients were fully satisfied with the result of the operation. On proctoscopic examination, an anal remnant, measuring approximately 3 cm from the anal verge, could be demonstrated. Its upper end had healed with a fibrous scar in 50 percent of the patients, whereas a small area of friable granulation tissue, sometimes with a short sinus tract was still observed in the others. The persistence of such lesions was associated with minor mucous discharge occasionally escaping from the anal canal. Biopsies disclosed regeneration of cylindric and transitional types of epithelium. The fate of these epithelial remnants remains to be seen. Endoanal mucosal proctectomy appears to be an attractive alternative to the conventional technique. It prevents a great deal of morbidity and enhances postoperative rehabilitation.

Adult↗
PubMed1985

Studies on the integrated extrinsic nervous control of rectal motility in the cat.

The effect of sympathetic nervous activity on rectal motility induced by pelvic nerve stimulation (PNS) was studied in anaesthetized cats. Division of the sympathetic lumbar colonic and hypogastric nerves or alpha-adrenoreceptor blockade, both of which reduced rectal tone, also reversed a predominantly relaxatory pelvic nerve response into a pure contraction. Contractions to pelvic nerve stimulation were reduced by simultaneous lumbar colonic nerve stimulation. This lumbar colonic nerve-induced inhibition was augmented by alpha-adrenoceptor blockade and abolished by beta-blockade. Close intra-arterial injection of a beta-adrenergic agonist reduced contractions to PNS, while an alpha-adrenergic agonist had no effect. Stimulation of the hypogastric nerves enhanced rectal contractions to simultaneous PNS. The apparent similarity with the arrangement of extrinsic nervous control of the internal anal sphincter suggests that the rectum is functionally involved in continence mechanisms.

Adrenergic alpha-Agonists↗
PubMed1985

On the transmission of sacral parasympathetic nervous influence on distal colonic and rectal motility in the cat.

Experiments were performed on cats anaesthetized with chloralose and treated with adrenoceptor blocking agents. Distal colonic and rectal motility were selectively recorded by a volumetric method. The effects of muscarinic and ganglionic nicotine receptor blockade on motor responses induced by graded efferent electrical pelvic nerve stimulation (PNS) were studied. Stimulation at low current strength evoked contractions in both the colon and the rectum, which were sensitive to atropine and to hexamethonium. High intensity stimulation elicited distal colonic contractions resistant to both atropine and hexamethonium. Similar excitatory responses to high strength PNS were also observed in the rectum, though not in all experiments. Stimulation at intermediate intensities evoked distal colonic and rectal relaxations which were resistant to atropine but blocked by hexamethonium. The results indicate that PNS influences colonic and rectal motility by activation of at least three discrete non-adrenergic nervous pathways: (1) low-threshold excitatory fibres involving nicotinic and muscarinic transmission, (2) high-threshold excitatory fibres with a non-muscarinic, non-nicotinic transmission mechanism, (3) inhibitory fibres with an intermediate stimulus intensity threshold, exerting their effect by a non-muscarinic mechanism involving a nicotinic step.

Animals↗
PubMed1984

Efferent sympathetic nervous control of rectal motility in the cat.

The sympathetic nervous control of rectal motility was studied in anesthetized cats. Division of the sympathetic nerves, i.e. the hypogastric nerves and the lumbar colonic nerves and alpha-adrenergic blockade reduced rectal tone indicating that these nerves are tonically active. Efferent electrical stimulation of the nerves at high intensities caused an immediate and sustained contraction which was inhibited after phentolamine but unaffected by hexamethonium suggesting a direct alpha-adrenergic effect on the rectal smooth muscle. However when prevailing rectal tone was high beta-adrenergic inhibitory responses unaffected by hexamethonium were observed. In addition the hypogastric nerves seem to convey cholinergic excitatory fibres to the rectum. The results imply that the sympathetic nerves are integrated in the nervous regulation of rectal motility in a fashion similar to the nervous control of the internal anal sphincter.

Animals↗
PubMed1984

Osteopenia with normal vitamin D metabolites after small-bowel resection for Crohn's disease.

Thirty-six unselected patients were investigated 3-24 years (mean, 7.8 years) after small-bowel resection for Crohn's disease (mean small intestinal resection, 105 cm). Iliac crest bone biopsies after in vivo tetracycline double-labelling showed a markedly reduced trabecular bone mass (controls, 0.25 +/- 0.06; patients, 0.15 +/- 0.05; p less than 0.01). The average bone remodeling and osteoid mineralization was normal, and only two patients demonstrated signs of frank but slight osteomalacia. The mean serum levels of the three vitamin D metabolites 25-hydroxyvitamin D, 24,25-dihydroxyvitamin D, and 1,25-dihydroxyvitamin D were normal. The observed reduction in trabecular bone mass may theoretically be followed by an increased risk of spontaneous fractures.

24,25-Dihydroxyvitamin D 3↗
PubMed1984

Factors regulating sodium balance in proctocolectomized patients with various ileal resections.

Patients subjected to proctocolectomy together with an ileal resection will lose increased amounts of sodium with the ileostomy excreta and may develop sodium and water depletion. Studies of sodium balance and measurements of renin activity, aldosterone, and arginine vasopressin in plasma were made in 23 such patients, 8 of them under metabolic-ward conditions while receiving various salt loads. Salt loss never resulted in subnormal sodium levels in serum. The earliest sign of salt depletion was a nearly total inhibition of renal sodium excretion, which could precede activation of the renin-aldosterone axis in these patients. Secretion of vasopressin remained unaffected by sodium-water depletion and by activation of the renin system. The routine monitoring of these patients should include measurements of renal sodium excretion. Measurement of renin and aldosterone levels should be used for evaluation of the severity of a sodium deficiency.

Adolescent↗
PubMed1983

The effects of 5-hydroxytryptamine on large intestinal motility and blood flow in the cat.

The effects of 5-HT on proximal colonic and rectal motility and total colonic blood flow were studied in anaesthetized cats and compared with those evoked by pelvic nerve stimulation. Vasodilator responses, consistently elicited by low doses (5-10 micrograms/min close i.a.) and intermediate doses (10-50 micrograms/min) of 5-HT were invariably abolished by hexamethonium indicating a nerve mediated response. Simultaneously to the vasodilator response both cholinergic and non-cholinergic hexamethonium sensitive non-adrenergic motility responses were evoked in the proximal colon. Furthermore non-cholinergic, non-adrenergic inhibitory neurons were excited. In the rectum excitation of such inhibitory neurons was the most consistent finding. The mechanisms behind the nerve mediated vascular and motility responses seem to differ as only the vascular effects were blocked by dihydroergotamine. The nerve mediated responses were in many respects similar to those evoked by pelvic nerve stimulation indicating that 5-HT exerts its effects on the same instrinsic neurons as the pelvic nerves. At intermediate and high doses (50-100 micrograms/min) the effects exerted on the instrinsic reflex arcs were modulated by direct effects on the smooth muscle.

Animals↗
PubMed1983

Magnesium deficiency after ileal resections for Crohn's disease.

The magnesium status of the body was studied in 87 patients with various lengths of small-bowel resections for Crohn's disease. The urinary magnesium excretion decreased with increasing resection length, and so did the concentration of magnesium in muscle. Muscular fatigue, an early symptom of magnesium deficiency, was positively correlated to a pathologically low concentration of muscle magnesium. It was concluded that clinically important magnesium deficiency, which was not detected by determination of serum magnesium, occurred in patients with ileal resections exceeding 75 cm.

Adult↗
PubMed1983

Functional results after subtotal colectomy and caecorectal anastomosis.

Subtotal colectomy, preserving the ileocaecal valve and caecum, and caecoproctostomy has been recommended by some authors in the past and hypothetically it is a good a priori argument on the grounds of function for its use. The procedure has been employed in nine patients on different indications and the functional results assessed. When employed for treatment of chronic constipation or diverticular disease of the colon the functional results were poor. If the operation should be used at all it should probably be restricted to patients with an otherwise normal colorectal function. Even when employed on these indications, bowel habits differ little from those experienced by patients with a conventional ileorectal anastomosis.

Adult↗