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Biomedical subjects

T Oresland

Publications and source records attributed to T Oresland.

At least 37 records · Page 2Linked to original sources
PubMed1997

Does simple hysterectomy alter bowel function?

BACKGROUND AND AIMS: Hysterectomy is believed to be associated with disturbed defecation, mainly constipation. This study longitudinally describes bowel function in women submitted for hysterectomy. MATERIAL AND METHODS: Rectoanal manovolumetry, whole gut transit time and detailed interviews on bowel function and dyspareunia were performed preoperatively and at 3 and 11-18 months after hysterectomy in 42 women. Twenty healthy women matched for age and parity served as manovolumetry controls. RESULTS: No significant changes in anal sphincter pressures could be demonstrated, neither early nor late after hysterectomy. Transit time was unaffected. All but one of the patients claimed that they had been suffering from one or more of the following symptoms; abdominal pain, distension, constipation and dysparenuia. While postoperative interviews revealed a significant improvement with respect to abdominal pain and dyspareunia (P < 0.01) after 3 and 11-18 months, improvement of abdominal distension and constipation proved to be transient only. CONCLUSION: Simple abdominal hysterectomy appears not to interfere adversely with bowel function. On the contrary many patients were relieved from abdominal pain present before operation.

Adult↗
PubMed1996

Postoperative pain. Does subcutaneous lidocaine spray relieve it? Can pain be predicted?

Postoperative pain is often a big problem after gastrointestinal surgery. The aim of the present investigation was two-fold; To see whether supplying of lidocaine spray in the surgical wound influences postoperative pain and to evaluate the role of patients and caring factors on the perception of postoperative pain. Sixty consecutive patients undergoing major abdominal surgery were randomized into a control or a treatment group. Pain relief, apart from lidocaine, was given according to routine. The methods included interviews, pain registration, on a visual analogue scale and registration of administered analgesics. No effect could be attributed to lidocaine. Nurses' ability to predict pain was unreliable, patients predicted pain better. Younger patients suffered greater pain than elderly. Preoperative anxiety correlated to postoperative pain, whereas malignant diagnoses did not. Most of the studied patients had considerable postoperative pain. Routines for postoperative pain relief should be improved.

Administration, Topical↗
PubMed1996

Perinuclear antineutrophil cytoplasmic antibody in pouchitis after proctocolectomy with ileal pouch-anal anastomosis for ulcerative colitis.

BACKGROUND: It has been shown that perinuclear antineutrophil cytoplasmic antibody (P-ANCA) may be associated with pouchitis after proctocolectomy with ileal pouch-anal anastomosis (IPAA) for ulcerative colitis (UC). METHODS: P-ANCA was studied with the indirect immunofluorescence technique in 76 UC patients after IPAA. Twenty-eight patients had had pouchitis, whereas 48 patients did not. RESULTS: P-ANCA was found in 49 of 76 (64.5%) UC patients after IPAA. In patients who had had pouchitis attacks within 1 year of serum sampling (group 1) 12 of 12 (100%) patients had positive P-ANCA. In patients who had had pouchitis attacks 1 or several years before the serum sampling (group 2) 9 of 16 (56.3%) patients had positive P-ANCA. In patients who had not yet had a pouchitis attack (group 3) 28 of 48 (58.3%) were positive. The occurrence of P-ANCA in group 1 was significantly higher than in group 2 (p = 0.01) or group 3 (p = 0.005). No statistically significant difference was found between the occurrence of P-ANCA in group 2 and group 3. Furthermore, we found that the titres of P-ANCA in the pouchitis patients were associated with the observation time since the first pouchitis attack to the time of serum sampling (r = -0.43, p = 0.02) and a pouchitis relapse index (average pouchitis attacks per year, r = 0.47, p = 0.03). CONCLUSIONS: P-ANCA was found in UC patients after proctocolectomy with IPAA. Patients with recent (< or = 12 months) or ongoing pouchitis are all P-ANCA-positive. Pouchitis patients with higher P-ANCA titres are more prone to have frequent relapses.

Adult↗
PubMed1995

Intestinal intraluminal continuity is a prerequisite for the distal bowel motility response to feeding.

BACKGROUND: We wanted to elucidate further the regulation of the intestinal motility response to feeding. METHODS: After intraduodenal administration of an oleate solution, mimicking a meal, the distal bowel motility and the plasma levels of bile acids, cholecystokinin (CCK), and neurotensin were monitored in patients operated on with restorative proctocolectomy (n = 4) or low anterior resection of the rectum (n = 4). Investigations were performed both with and without a diverting loop ileostomy. RESULTS: Intraduodenal sodium oleate elicited a prompt and significant increase in distal bowel motility. The motility response failed to appear when the luminal flow was diverted by a loop ileostomy. An increase in plasma CCK preceded the motility increase, but CCK was increased also in patients with a loop ileostomy. Whereas plasma bile acid levels were significantly increased after 30-45 min (p < 0.05), both with and without a loop ileostomy, neurotensin levels were not affected. CONCLUSION: Intestinal continuity is a prerequisite for the distal bowel motility response, indicating that apart from other possible mechanisms, luminal factors are involved in the regulation of intestinal motility.

Adult↗
PubMed1994

Gynaecological and sexual function related to anatomical changes in the female pelvis after restorative proctocolectomy.

Restorative proctocolectomy with an ileal pouch-anal anastomosis preserves anal sphincters, the normal route of defaecation and the normal body image and it has been suggested that the procedure might be associated with less gynaecological and sexual problems than conventional proctocolectomy. To shed further light on this subject 60 female patients were invited to participate in a study comprising a detailed interview, examination by a gynaecologist and investigation with hysterosalpingography and vaginography. Twenty-one women with a mean follow-up of 38 months after surgery agreed to participate. Their gynaecological state was considered normal although one woman complained of vaginal discharge. Five women experienced occasional dyspareunia and 2 patients had to take special precautions to avoid bowel leaks at intercourse. While the position of the vagina and uterus in the pelvis appeared normal, hysterosalpingography disclosed bilateral occlusion of the fallopian tubes in 2 and unilateral occlusion in another 9 patients with tubes adhering to the bottom of the lesser pelvis in 10 of the patients. Only one out of 14 patients succeeded in trying to conceive during the follow-up period. Among the remaining 39 women not specially studied 5 out of 14 had conceived after the operation.

Adult↗
PubMed1994

Abdominal rectopexy for rectal prolapse. Influence of surgical technique on functional outcome.

PURPOSE: The aim of this study was to investigate the influence of surgical technique on functional and manovolumetric results in patients treated with Marlex mesh abdominal rectopexy. METHODS: The lateral ligaments were completely divided (the Wells procedure) in 16 patients and preserved (the Ripstein procedure) in 16 patients. Clinical and physiologic assessment were performed before and at 3, 6, and 12 months after operation. RESULTS: Improvement of continence was similar. Bowel regulation problems which were unchanged after the Ripstein procedure increased significantly after the Wells procedure (P < 0.01). Rectal volume became reduced in the group who received the Wells procedure (225 ml vs. 115 ml, P < 0.05 at one year), but remained unchanged after receiving the Ripstein procedure. The pressure thresholds required to elicit sensation of rectal filling and defecation urge were increased after the Wells procedure (15 cm of H2O vs. 25 cm of H2O, P < 0.05 and 25 cm of H2O vs. 45 cm of H2O, P < 0.05, respectively). In the Ripstein group there was only a slight increase of the threshold for urge (P < 0.05). CONCLUSION: The Wells procedure was followed by severe rectal dysfunction accompanied by increased constipation and evacuation problems. The Ripstein procedure, preserving the lateral ligaments, appears not to affect such symptoms adversely. On the other hand, improvement is not likely to occur.

Defecation↗
PubMed1994

Does the level of stapled ileoanal anastomosis influence physiologic and functional outcome?

PURPOSE: The aim of this investigation was to ascertain how the length of anal canal preserved above the dentate line in stapled end-to-end ileoanal anastomosis influenced late outcome. METHODS: Two groups, high cuff group and low cuff group of nine subjects with stapled anastomosis, matched for sex, age, pouch configuration, and mean follow-up, representing the highest (median, 2.5 cm) and lowest (median, 0.7 cm) anal cuff lengths in our series, were selected. Physiologic and functional parameters were appraised preoperatively, at the time of ileostomy closure, and at 1, 3, 6, and 12 months after reestablishment of intestinal continuity. RESULTS: At one year, the drop in mean anal canal resting pressure was 13 percent in the high cuff group (not significant) and 31 percent in the low cuff group (P < 0.05); mean maximum squeezing pressure did not differ significantly from preoperative values in both groups. The mean volume of the ileal pouch was higher in the low cuff group at all insufflation pressures. The rectoanal inhibition reflex reappeared in four high cuff group patients and in none of the low cuff group patients. Mean distention pressure (cm H2O) and volume (ml) eliciting urge sensation were 80 and 360 in the low cuff group compared with 40 and 240 in the high cuff group (P < or = 0.05). Daytime bowel movements and night incontinence were significantly better in the low cuff group. No statistical differences were observed for night stool frequency, daytime incontinence, pad use (day and night), discrimination between gas and feces, ability to defer evacuation, and difficulty in emptying the pouch. CONCLUSION: Patients with stapled anastomoses and a low rectal cuff length, despite presenting lower anal resting pressure and absence of rectoanal inhibition reflex, had a better functional outcome in terms of continence than those with a high cuff length.

Adult↗
PubMed1994

Loperamide improves anal sphincter function and continence after restorative proctocolectomy.

The physiological and clinical effects of loperamide treatment versus placebo were investigated in a randomized, double-blind, crossover study in patients operated with restorative proctocolectomy. Sixteen patients operated with endoanal mucosectomy and a handsewn ileal pouch-anal anastomosis and 14 patients operated with abdominal proctocolectomy and stapling of the pouch to the top of the anal canal were studied. While loperamide treatment increased resting anal pressure in both groups of patients by approximately 20% (P < 0.05), squeeze pressure was not affected. Loperamide did not affect pouch volume or contractility. Sensory thresholds and the recto/pouch-anal inhibitory reflex were not influenced by loperamide treatment. Clinical function was improved, with a reduced bowel frequency and an improved nighttime continence, with less soiling (P < 0.05) as well as need to wear a protective pad.

Adult↗
PubMed1994

Ileostomy output and bile acid excretion after intraduodenal administration of oleic acid.

BACKGROUND: Ileostomy output and small-intestinal transport are regulated by complex mechanisms, which the present study aimed to further elucidate. METHODS: The time-related ileostomy output and bile acid excretion after intraduodenal administration of a fat solution (oleic acid, 3.5 g) was studied in 29 ileostomy patients. Eighteen patients had the entire small bowel preserved (group I), whereas 11 had various lengths of the ileum resected or bypassed (group II). RESULTS: Intraduodenal fat administration resulted in a prompt and significant increase in ileostomy output in both groups. The accumulated 2-h output after fat administration amounted to 60% of the normal 24-h output in group I and 30% in group II. A marked increase in bile acid excretion preceded the flow response. The fat-induced response was abolished by administration of cholestyramine. CONCLUSIONS: Bile acids seem to have important regulatory effects with regard to secretion/absorption and transport of small-bowel contents, affecting ileostomy output, with clinical implications in many patients.

Bile Acids and Salts↗
PubMed1994

The leaking colorectal anastomosis; why does it happen and how do we prevent it?

The ingredients predisposing for an anastomotic leak can be attributed both to the patient and to the surgeon. Some causative elements can be remedied; others cannot be changed very much. In cancer surgery the quest for cure involves ligation of the inferior mesenteric artery in the treatment of left-sided tumours. This obviously creates a conflict with the goal of constructing a well circulated anastomosis. In the treatment of rectal cancers total mesorectal excision has in recent years been put forward as the crucial step in avoiding local recurrences. The use of drains is a matter of controversy. The rationale for using them is to avoid pelvic collections with subsequent infection. The anastomosis is the point of least resistance so this is where a pelvic abscess is liable to break through, thus creating a leak. The choice of anastomosis, single layer or double layer, has been extensively dealt with and is beyond the scope of this presentation. My opinion is that you should stick to the type of anastomosis you are familiar with and try to refine your technique as much as possible. Continuous surgical audit and improved surgical training are likely the most important measures to lower the complication rates in colorectal surgery.

Anastomosis, Surgical↗
PubMed1993

Possible role of the autonomic nervous system in sphincter impairment after restorative proctocolectomy.

Peroperative manometry was performed in 12 patients operated on with endoanal proctectomy and a hand-sewn pouch-anal anastomosis and in 12 in whom proctectomy was performed entirely from above, with the ileal pouch stapled to the top of the anal canal. Results from both groups showed that division of the superior rectal artery reduced the median (95 per cent confidence interval (c.i.)) resting anal pressure from 77.5 (69.9-83.3) mmHg to 64.5 (55.2-70.0) mmHg (P < 0.01). Complete rectal mobilization to the pelvic floor decreased resting pressure by an additional 22 per cent, to a median of 50.0 (95 per cent c.i. 40.1-53.5) mmHg (P < 0.01). After completion of anastomosis, irrespective of the operative technique used, a further decline in median pressure to 35.0 (95 per cent c.i. 26.0-47.7) mmHg could be demonstrated (P < 0.05). This study indicates that anal sphincter pressure is reduced to a similar extent after hand-sewn and stapled anastomoses. Injury to the autonomic nervous supply to the anal sphincter mechanism might be the major cause for this reduction.

Adult↗
PubMed1993

Incidence and characteristics of pouchitis in the Kock continent ileostomy and the pelvic pouch.

The incidence, the median time to first appearance, and the clinical pattern of pouchitis were prospectively studied in 180 patients operated on for ulcerative proctocolitis with a continent ileostomy (CI; 84 patients) and a pelvic pouch (PP; 96 patients). Median follow-up for CI patients was 8.5 years (range, 2-15 years) and for PP patients, 5 years (range, 1-8 years). Pouchitis, with symptoms severe enough to require treatment, developed in 33% (28 of 84) of CI and 47% (45 of 96) of PP patients. The cumulative risk of developing one or more episodes of pouchitis over a 5-year follow-up was 34% in CI patients and 51% in PP patients. The median time to first appearance of pouchitis was 5 and 12 months, respectively. Eighty-six per cent of CI patients with pouchitis (24 of 28) and 71% of PP patients (32 of 45) experienced their initial episode within the first 2 years. Sixty-four per cent (18 of 28) of the CI patients and 76% (34 of 45) of PP patients had one single or a few short-lasting episodes of pouchitis with various symptom-free intervals, whereas 18% of patients in each group (5 of 28 CI patients, 8 of 45 PP patients) had frequent relapses. Most of these patients responded promptly to metronidazole treatment. Eighteen per cent (5 of 28) of CI patients and 6% (3 of 45) of PP patients had long-lasting episodes with a poor response to treatment. In this long-term study the pouch inflammation proved eventually to be Crohn's disease in four patients (2.2%).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
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

The effects of atropine or benzilonium on pelvic pouch and anal sphincter functions.

Anticholinergic drugs are used on an empirical basis for treatment of functional disturbances after restorative proctocolectomy, but their mode of action on ileal pouch performance is mainly unknown. We studied the acute effects of atropine or benzilonium on pouch characteristics and anal sphincter function in 20 patients with a pelvic pouch. Pouch volume was increased by 27% by atropine at distension with 20 cm H2O (p less than 0.01). Benzilonium tended to have a similar effect, but the changes did not reach statistical significance (p = 0.06). Pouch contractility, as reflected by volume fluctuations and pressure changes during distension, was almost abolished by both drugs. Sensory thresholds for sense of filling and, particularly, urge were raised. Resting anal pressure was slightly lowered, whereas no significant effect was found on maximal squeeze pressure. In conclusion, anticholinergics appear to have specific properties of action on small-intestinal reservoirs, constituting possible explanations for the empirically observed beneficial effects of anticholinergic treatment of functional disturbances after restorative proctocolectomy.

Adult↗
PubMed1990

Pouch size: the important functional determinant after restorative proctocolectomy.

Sixty-seven patients with a J-shaped ileonanal pouch were studied over a 2-year period with regular recording of sphincter and pouch characteristics and analysis of their role in functional outcome. Although there was a 27 per cent permanent reduction in resting anal pressure (RAP) (P less than 0.001), two-thirds of the patients still had a RAP within the normal range. The mean(s.d.) pouch volume increased during the first year from 132(46) ml to 282(85) ml. RAP was not related to functional outcome and preoperative RAP was not predictive of subsequent function. Large pouch volume and compliance correlated with low defaecation frequency (range of r = 0.27-0.36; P less than 0.05) and good overall function (r = 0.37-0.56; P less than 0.01). The initial pouch volume was predictive of subsequent overall function. The ileal length used for pouch construction predicted subsequent pouch volume (r = 0.48; P less than 0.001) and to some extent functional outcome (r = 0.28-0.37; P less than 0.05). However, the studied variables accounted for only 21 per cent of the total variance of functional outcome.

Adolescent↗
PubMed1990

Manovolumetric and sensory characteristics of the ileoanal J pouch compared with healthy rectum.

Pouch volume, motility, sensory function and integrated pouch-anal mechanisms during graded isobaric distension of the pouch were prospectively studied in 67 patients with a J pouch-anal anastomosis. The findings were related to functional outcome. Thirty-six normal controls were studied for comparison. In contrast with normal rectum, the ileal pouch exhibited pronounced motility, and pouch contractions were frequent even at a high distension pressure. The presence of high pressure motility was associated with a poor functional outcome. The threshold pressure and threshold volume for eliciting first sensation of filling and urge to defaecate were significantly higher in the ileal pouch. The pressure threshold levels were not related to the functional outcome. Sphincter inhibition on pouch distension reappeared in 25 per cent of the patients. The distension pressure required to elicit the inhibition was considerably higher than in the control subjects. The functional result was similar irrespective of whether sphincter inhibition was present or not. The motor and sensory function of this artificial setting appear to be controlled by nervous mechanisms that are different from those in the healthy anorectum.

Adenomatous Polyposis Coli↗