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At least 487 records · Page 27Linked to original sources
PubMed2006

[Surgical management of chronic radiation enteritis].

OBJECTIVE: To explore the surgical methods and the clinical results of chronic radiation enteritis. METHODS: Treatments were applied to forty-nine cases of chronic radiation enteritis complicated with intestinal obstruction, enterocutaneous fistula, intestinal stenosis, intestinal bleeding, severe proctocolitis and intestinal perforation, among whom 47 cases received an average of 2.8 +/- 2.1 operations. Twenty-six cases received resection of the injured segment with primary anastomosis, fourteen cases received intestinal resection and proximal enterostomy, among whom 6 ostomies were permanent, and another 8 cases received secondary ostomy closure. The injured intestinal segments were spared in 7 cases. RESULTS: Forty-seven among 49 cases were cured (success rate, 96%) with no anastomotic leakage. Two patients died. CONCLUSIONS: Surgical complications of chronic radiation enteritis should be managed operatively. The operative method should be chosen according to the general condition of the patients and the complexity of the abdomen. Perioperative management and proper selection of intestinal segments for anastomosis are essential for the success.

Adult↗
PubMed1991

[Emergencies in the surgery of colonic neoplasms. A review of the literature and the authors' cases].

The paper reports the personal experience of the 2nd Division of General Surgery of the Martini Hospital in Turin and compares it to the results of the most recently published studies. Of 123 patients who underwent emergency surgery, 101 were suffering from tumors of the colon complicated by intestinal occlusion and 22 by perforation. Only right hemicolectomy was performed in cases of perforation or resection with ileostomy and colic mucous fistula was used for neoplasms located in the right colon; Hartmann's operation or dual ostomy was performed in the event of neoplasms in the left colon. Surgical treatment of occlusive tumors of the left colon is still the subject of continued debate. The elective surgical technique is an amblée resection using colo-colic anastomosis with a protective ostomy. This is followed by Hartmann's operation, whereas decompressive colostomy should only be used in patients who are admitted to hospital in generally precarious conditions.

Aged↗
PubMed1978

[The medical after care of patients with stomas].

The medical care of the increasing number of ostomy patients is necessary in three inseparable areas:--provision of the stoma,--treatment of basis disease,--psychological support. The major medical and technical advances of recent years allow a normal social life. A precisely defined program of examinations at regular intervals is necessary to ensure adequate treatment; especially after Ca-operations. Psychological support must be directed towards the prevention of social isolation. In order to improve the present situation in the German Federal Republic the graduate training of the doctors must be intensified. In order to deal with problematical cases special ostomy out-patient clinics with suitably trained personnel should be set up in certain hospitals.

Aftercare↗
PubMedDate not supplied

Gastrointestinal adenovirus: an important cause of morbidity in patients with necrotizing enterocolitis and gastrointestinal surgery.

Adenoviruses have recently been recognized as etiologic agents of enteric disease in hospitalized infants and young children. Patients who have undergone surgical procedures related to the complications of neonatal necrotizing enterocolitis constitute a population of infants who are often hospitalized for extended periods of time. We studied the incidence of enteric adenovirus infections in infants with necrotizing enterocolitis who had undergone intestinal surgery resulting in colostomies or ileostomies. These studies revealed that 31.7% of the hospital admissions in such patients were complicated by symptomatic infection with enteric adenoviruses. The rate of adenovirus infection in this population was significantly higher than the rate of such infections encountered in infants undergoing ostomy procedures for other conditions and in age-matched hospitalized infants without prior gastrointestinal surgery. The infections with enteric adenovirus were generally accompanied by an increase in intestinal output which was temporally associated with the excretion of adenovirus in the intestinal fluid. In addition infections with enteric adenoviruses in the infants with necrotizing enterocolitis and ostomies were associated with a marked increase in length of hospitalization as compared to uninfected infants with similar underlying gastrointestinal pathology. Epidemiologic analysis revealed that many of the cases of enteric adenovirus infection in the study population occurred during seasons in which enteric adenovirus infections were prevalent in the hospital population. These studies demonstrate that enteric adenovirus infections are major causes of morbidity in hospitalized patients who have of morbidity in hospitalized patients who have undergone ileostomy or colostomy procedures for necrotizing enterocolitis and that the prevention of enteric adenovirus infections might result in a significant improvement in the hospital care of infants with these conditions.

Adenoviridae Infections↗
PubMed1975

Appliances for cutaneous enterostomies.

This report deals with appliances for permanent cutaneous enterostomies such as ileostomy, colostomy and ileal-bladder (called ostomies below). The purpose of the report is to facilitate the choice of appliances for these types of ostomies for prescriber as well as the person operated.

Abdominal Muscles↗
PubMed1983

Role of Roux-en-Y feeding jejunostomy for patients with acute head injury.

The total care of a patient with severe head injury is challenging and may extend for weeks, months, or even years. A major challenge of this care includes nutritional support: swallowing is impaired, aspiration accompanies gastric tube feeding, parenteral nutrition is limited to short term in hospital care, and needle jejunostomy or transabdominal jejunostomy are prone to inadvertent removal. The role of Roux-en-Y feeding jejunostomy was evaluated in 13 patients with acute head injury. Procedure related complications include prolapse of the ostomy (1 patient) and stoma-ischemia requiring revision (1 patient). The effect of ostomy tube feedings on gastric acid secretions was studied in five patients, and no significant change was noted when saline feeding was compared to blenderized diet feeding. Blenderized diet feedings were advanced gradually, and antidiarrheals were added as needed once gastrointestinal function returned. In conclusion, Roux-en-Y feeding jejunostomy provides an attractive, safe method for long-term enteral nutrition in the head injury patient. Easy replacement of the feeding tube facilitates nursing care, and the threat of acid-induced stress gastric bleeding is not enhanced.

Adult↗
PubMedDate not supplied

Principles and techniques in the use of convexity.

Expected outcomes for a correctly fitted ostomy prosthetic device include sustained, predictable wearing time, protection of the stoma from injury, and maintenance of peristomal skin integrity. To accomplish this, the pouching system must be properly sized and maintain continuous contact with the peristomal skin. Continuous contact is achieved when the faceplate provides a mirror image of the topography of the peristomal plane. Varying degrees of support and convexity of the faceplate are used to fit the unique characteristics of the patient's peristomal plane and stoma. Support can be absent, soft or firm. Convexity is some degree of outward curving of the faceplate. Characteristics of the stoma (i.e., flush, retracted, loop), peristomal plane (i.e., creases, hernia, scarring) and abdomen (i.e., flaccid, soft, or firm) may indicate the need for convexity. Potential problems include mucocutaneous separation, ischemia, laceration, erythema, ecchymosis, and pain if convexity is used inappropriately. Alternatives to convexity include the use of an ostomy belt or surgery. Ongoing, intermittent assessment of the prosthetic is essential to evaluate that the convexity and support have achieved the expected outcomes.

Drainage↗
PubMedDate not supplied

Natural killer cells over time in patients with colorectal cancer.

PURPOSE: The purposes of the investigation were: 1) to examine the natural killer (NK) cell levels in a homogeneous group of patients with cancer between the presurgical period and 6 months after surgery; 2) to identify changes in the number of NK cells over time; and 3) to determine whether an association exists among the number of NK cells, demographics, stage of cancer, and treatment variables. DESCRIPTION OF STUDY: A longitudinal descriptive design was used to study biopsychosocial factors in persons newly diagnosed with colorectal cancer over a 6-month period. RESULTS: Patients without ostomies had a significant decrease in NK levels over time, whereas patients with ostomies had a significant increase in NK levels over time. There was a difference in NK level over time for patients who were receiving the additional therapy of radiation alone and a combination of radiation and chemotherapy from those patients who were not receiving additional therapy. Natural killer levels in patients who were receiving radiation alone or a combination of radiation and chemotherapy significantly declined over time, where NK levels in patients receiving no additional treatment significantly increased over time. CLINICAL IMPLICATIONS: Patients with low NK levels should be monitored during the course of their illness and cancer treatment to determine the relationship to immune status of other variables such as nutritional status, infection rates, and functional status.

Adult↗
PubMed1997

[Patients' perception of symptoms in colorectal cancer. A cause of delay in diagnosis and treatment].

A questionnaire was given to a series of 50 patients referred for colorectal cancer to the Department of Surgical Gastroenterology at Hvidovre Hospital, Copenhangen. The patients were asked about the length of the period from debut of symptoms to the first visit to their family doctor (patient's delay), detailed symptoms and their views and attitudes towards the significance of these symptoms. More than half of the patients first saw their own doctor more than three months after the first symptom: 17/33 (52%) with a change in bowel habits, 12/28 (43%) with rectal bleeding, 11/19 (58%) with abdominal pain and 4/6 (67%) with a palpable mass. Only 7/44 (15%) thought that cancer was the cause of their symptoms, and a similar minority was afraid of an operation or an ostomy. We conclude that the main cause of patient's delay is a lack of knowledge among the patients about the significance of bowel symptoms, rather than fear of cancer, operation or an ostomy. On this basis we recommend that an information campaign about cancer-related bowel symptoms (bleeding, change of bowel habits) should be carried out with the aim of reducing patient's delay and thereby possibly also improving the prognosis through an early diagnosis.

Colonic Neoplasms↗
PubMed2006

Skin integrity in hospitalized infants and children: a prevalence survey.

The purpose of this paper was to describe the spectrum of alterations in skin integrity and skin care needs of hospitalized infants and children. A 1-day skin prevalence audit was conducted in the spring of 2005 in a tertiary care university-affiliated children's hospital. Patient skin was assessed for any alterations. The Braden Q Scale was used to assess patient risk for pressure ulcer development. Alterations in skin integrity included diaper dermatitis, pressure ulcers, intravenous infiltrations, device-related injuries, and epidermal injuries. Many patients required additional skin care, including wound/incision care, ostomy care, and care related to invasive devices. Alterations in skin integrity represent a serious problem in the pediatric inpatient setting. The data presented identify skin integrity challenges in the hospitalized patient and can help guide staff education and resource allocation, encourage evidenced-based management protocols, and serve as a benchmark for similar pediatric facilities.

Benchmarking↗
PubMed1996

Postoperative abdominal wall defects with enterocutaneous fistulae.

BACKGROUND: Abdominal wall dehiscence with an associated enterocutaneous fistula is a surgical complication with high morbidity and mortality. Management of the abdominal wall defect is complicated by the continued emergence of liquid bowel contents. PATIENTS AND METHODS: Large abdominal wall wounds of 10 patients with postoperative abdominal wall dehiscence and active enterocutaneous fistulae were managed with early skin grafting directly onto the granulated abdominal viscera. RESULTS: Skin graft take averaged 93 +/- 12%, and there were no perioperative complications related to the skin grafting procedure. Overall mortality was 1 out of 10 patients. Enterocutaneous fistula output did not prove overly injurious to the skin grafts. Wound care was simplified in all but 1 patient with fitting of an ostomy appliance. CONCLUSION: Temporary abdominal wall wound closure with skin grafts improved patient comfort and simplified wound care in a staged reconstructive approach to this surgical complication.

Abdominal Injuries↗
PubMed1990

Improved technique for creation of ileal conduit stoma.

Creation of a circumferentially protruding urinary intestinal stoma is an important aspect to prevent stomal regression, stenosis and parastomal herniation. Furthermore, an improperly fashioned stoma may make fitting of an ostomy appliance difficult, resulting in urinary leakage with secondary dermatitis and incrustation. The major difficulty in fashioning the stoma is everting the mucosa over the intestinal mesentery. We describe our method of stoma formation that creates a circumferentially symmetrical protruding stoma free of tension that has been used successfully even in obese patients. This technique has made the use of a Turnbull stoma unnecessary in our recent experience.

Humans↗
PubMed2000

Thriving and surviving in home care and skilled nursing facilities under the Balanced Budget Act of 1997.

The Balanced Budget Act of 1997 (BBA 97) contains the most dramatic changes to the Medicare program since its genesis nearly 35 years ago. To remain financially viable under the cost-cutting measures mandated in this Act, hospitals, home health agencies, skilled nursing facilities, and their employees must have a working knowledge of its contents. In addition, the patients served by these health care providers must have well documented and positive health outcomes, and they must be satisfied with the care and service they receive. Nevertheless, merely understanding the changes mandated by BBA 97 is not sufficient for success; clinicians also must develop innovative solutions to the hurdles the Act erects and quickly integrate them into daily practice. Issues of payment and reimbursement have everything to do with the delivery of today's patient care, regardless of the setting where it is delivered. BBA 97 offers special opportunities to wound, ostomy, and continence care clinicians.

Community Health Nursing↗
PubMed1996

Mindfulness and people with stomas.

Persons with a stoma must contend not only with the immediate physical changes produced by the operation but also with psychologic adjustments, changes in body image, changes in self-concept, and the chronic stress of stoma care and physical functioning. Mindfulness training can enable these persons to make the necessary adjustments in a more realized and conscious manner. The practice of mindfulness training has been demonstrated to be effective in dealing with clinical and psychologic problems. Mindfulness is defined as being fully awake and is characterized as being nonjudging, having a beginner's mind, being trusting, nonstriving, accepting, and letting go. Mindfulness training is described, and roadblocks to the practice of mindfulness are discussed and exemplified. Resources on the practice of mindfulness and applications to persons with ostomies are provided. Mindfulness training is proposed as an adjunct to patient education or support groups.

Adaptation, Psychological↗
PubMed1999

Adult survivors of childhood sexual abuse as patients: two case studies.

Adult survivors of childhood sexual abuse comprise a high percentage of the patients seen in gastrointestinal and genitourinary clinics and are commonly found among the patient population treated by WOC nurses. The physical and emotional consequences of sexual abuse may permeate the survivor's life, but rise to the forefront only with the additional stress of an ostomy or urinary diversion. Two case studies are described involving women the authors encountered in their practices.

Child↗
PubMed2003

Community health nursing, wound care, and...ethics?

Because of changing demographics and other factors, patients receiving care for wounds, ostomies, or incontinence are being referred in increasing numbers to community health nursing organizations for initial or continued care. As home-based wound care becomes big business, little discussion is being focused on the moral and ethical issues likely to arise in the high-tech home setting. Progressively more complex and expensive home care relies on family members to take on complicated care regimens in the face of decreasing numbers of allowable skilled nursing home visits. A framework and a principle-based theory for reflection on the character and content of moral and ethical conflicts are provided to encourage informed and competent care of patients in the home. Common moral and ethical conflicts for WOC nurses in the United States are presented. These conflicts include issues of wound care supply procurement; use of documentation to maximize care or profit; problems of quality, care consistency, and caregiver consent; and dilemmas of tiered health care options. The advantages of a framework to address ethical conflicts are discussed.

Community Health Nursing↗
PubMed1996

Readability of printed educational materials used to inform potential and actual ostomates.

This paper is primarily concerned with the use of readability formulas to determine the reading ease of printed education materials (PEMs) given to ostomy patients. Whilst the particular clinical focus is stoma care nursing, the content is relevant to all nurses who use printed text to inform their patients. PEMs have significant advantages in conveying information compared with verbal presentations alone. Methods to calculate readability using the Flesch, FOG and SMOG readability formulas are described. Presentation factors that affect readability are briefly reviewed, including use of 'white space', font size and paper colour. The problem of functional illiteracy and the need for indirect assessment of patient literacy are discussed. PEMs in use are often found to be difficult to read. Stress is identified as a potential factor in further reducing a patient's ability to deal with information. Three commercially available PEMs are evaluated for ease of reading and their score on the FOG index indicates that only about 40% of the UK population would understand them. Nurses are advised to evaluate the readability of their PEMs and to assess indirectly the literacy of their patients, so that they can more sensitively match PEMs to patient ability and need.

Educational Status↗
PubMed2005

Living with a stoma: a review of the literature.

AIMS AND OBJECTIVES: This systematic review looks at the psychological and social impact of stoma surgery on peoples' lives. BACKGROUND: The formation of a stoma can have a negative effect on a person's quality of life and affect lifestyle in a number of ways. METHODS: The review examines nursing literature from 1990 to date and focuses on how stoma patients' lives are affected by the presence of a stoma. It informs nursing practice so nurses are better able to help individuals improve, maintain or recover their health following ostomy surgery. RESULTS: The findings of the review indicate that stoma surgery can impact on individuals' lives in many different ways. RELEVANCE TO CLINICAL PRACTICE: Knowledge of the problems stoma patients can experience can help nurses plan care in an individualized way. Recommendations for nursing practice and future research are made.

Activities of Daily Living↗