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PubMedDate not supplied

Psychological, sexual and cultural issues for patients with a stoma.

Patients undergoing stoma surgery will more readily adapt to their new body image and way of life if they receive professional and voluntary input from the ostomy agencies such as the British Colostomy Association, from the preoperative stage through to rehabilitation and their return to the community. Nursing has moved away from mechanistic, task-oriented care to holistic care and, apart from the physical changes that a stoma will cause, there are other areas to be considered to improve the patient's quality of life after surgery. Patients undergoing stoma surgery experience a profound threat to their sense of physical integrity and self-concept with the change of body image in relation to bodily functions. Sexuality is an integral part of the whole person and is a highly complex phenomenon. Many patients find it difficult to discuss their sexual feelings, especially after a body image change and the nurse should be able to help patients identify and adapt to alterations in sexual self-concept. Cultural background plays an important part in patients' lives, including their beliefs, whether personal or religious, their perceptions of recovery, behaviour and concepts of and attitude towards the disease process. Nurses must combine sound, general information with open, respectful questions to the patient or family and be committed to responding flexibly and constructively. This article describes some of the potential problems that may be faced by patients after stoma surgery and increased knowledge of these areas will allow nurses to improve patient care and satisfaction.

Adaptation, Psychological↗
PubMed1995

[Aspects of the social reintegration of stoma patients].

The social rehabilitation represents a challenge to ostomy patient and a concern for health professional team. This study intends to verify the difficulties related to returning to the daily domestic, leisure, job and sexual activities showed by 45 ostomizeds after hospital discharge in different periods of late post operative. The data was obtained from patients assisted by two Outpatient Services of São Paulo city, through the interviews. The patients were selected by previous established criteria agreement and then subdivided in three groups as the post operative period. It's possible to verify that the majority of the clients didn't returned totally or returned only partially to the daily activities like before the disease or surgery, specially in the sexual area. They justified these difficulties by physical problems, insecurity and the use of inadequate appliances.

Activities of Daily Living↗
PubMed2001

The WOC nurse: economic, quality of life, and legal benefits.

Patients who require treatment for complications stemming from skin and wound care conditions represent a significant and costly clinical problem in the health care arena. An innovative approach used to manage these patients is utilization and employment of the specialty trained wound, ostomy, and continence (WOC) nurse. A review of the literature supports the role of the WOC nurse in providing quality care, minimizing the expenditure of health care dollars, and overseeing the use of pressure ulcer and wound care guidelines so that litigious events may be avoided.

Fecal Incontinence↗
PubMed2003

OASIS skin and wound integumentary assessment items: applying the WOCN guidance document.

This supplement provides home care nurses, therapists, and clinical managers a tool for understanding of how the Wound, Ostomy, and Continence Nurses (WOCN) Guidance Document on OASIS Skin and Wound Status M0 Items 2001 should be used. The supplement is a pictorial guide that clarifies definitions by linking them to photos using the skin integrity OASIS M0 items as an outline. The additional visual cues enable the clinician to clearly observe subtle characteristics that lead to a more reliable OASIS score and appropriate reimbursement by choosing the correct Home Health Resource Group (HHRG).

Community Health Nursing↗
PubMed1988

Cochleostomy. Long term results.

The original technique of the operation of cochleostomy is described. It should be considered as conservative operation, since it produces an "ostomy" of the cochlear promontory bone, joining the spiral ligament and mucosa of middle ear, without opening of the Cochlea. There is no risk of iatrogenic anacusis. The follow up of 178 cases with more than 10 years after surgery is described. The results are significantly better than endolymphatic sac surgery.

Cochlea↗
PubMed1994

[Locoregional complications of stomas. Therapeutic approach].

Principal local complications of ostomies are examined. Etiologic factors and possibilities of treatment are analyzed. These pathologies are often extremely troublesome and their resolution very difficult, unless appropriate therapy is established and, when possible, causal factors removed. However, because of the particular problems of these patients it would be better for them to be assisted by a specialized staff, in qualified centers.

Adult↗
PubMed1993

Fibromyalgia and quality of life: a comparative analysis.

The quality of life of women with fibromyalgia was explored and compared to the quality of life of women with rheumatoid arthritis, osteoarthritis, permanent ostomies, chronic obstructive pulmonary disease, insulin dependent diabetes, and healthy controls. The women with fibromyalgia consistently scored among the lowest in all domains measured. These results suggest that fibromyalgia may adversely affect quality of life to an extent not previously recognized.

Adult↗
PubMed1997

Stoma site marking: a primer.

The purpose of pre-operative stoma site marking is to select an appropriate location in an area of the abdomen for surgical placement of a stoma. A poorly located stoma may result in pouching problems, increase potential for leakage, and place undue hardship and emotional trauma on the patient. The type of ostomy surgery must be known to select the appropriate abdominal quadrant to be marked. The ideal stoma site is located below the umbilicus, within the rectus muscle, away from scars, creases, bony prominences, umbilicus, and belt line, on the summit of the infraumbilical fat mound, and visible to the patient. It is vital for the clinician to be aware of any extenuating circumstances of the patient that may alter the site selection. Optimal stoma site placement will promote self-care and rehabilitation of the patient.

Anthropometry↗
PubMed1992

Repair of parastomal hernias using polypropylene mesh.

Parastomal hernias are a common complication of ostomy construction. We have developed a method of repair that uses two strips of polypropylene prosthetic mesh through a midline incision. The medical records of 19 patients who underwent parastomal hernia repair were retrospectively reviewed. All nine patients operated on for this condition by the senior author (R.G.P.) (group 1) underwent repairs with this technique. All ten patients operated on by other surgeons in our center (group 2) underwent repairs in which the stoma was moved, the fascia was directly repaired through a parastomal incision, or the fascia was repaired via a midline incision. No patients in group 1 had recurrences while five patients in group 2 had recurrences. Neither group developed strictures or stomal prolapse. Our method of repair is technically easy and has excellent results. It is especially suitable in very large hernias in which incisional hernia is likely in the original stoma site if the stoma is moved.

Abdominal Muscles↗
PubMed1993

Prospective alterations in therapy for penetrating abdominal trauma.

In a double-blind, randomized study, 170 patients with traumatic perforation of the gastrointestinal tract were administered an advanced-generation cephalosporin. Patients were divided into infection risk groups (< or = 40%, low; 40% to 70%, mid; and > 70%, high) at surgical closure using a logistic regression formula based on four proved risk factors--age, blood replacement, ostomy, and the number of organs injured. Patients in the low group received 2 days of antibiotic therapy; those in the mid to high group received 5 days of antibiotic therapy. Those patients in the low to mid group had primary wound closure; those in the high group had their wounds packed open and closed later. Most of the patients (144 [85%]) were in the low group. Their major and minor infection rates (10% and 12%, respectively) were not significantly different from 145 historic control subjects receiving 5 days of antibiotic therapy (9% major; 14% minor). Patients in the mid to high group showed a greater incidence of major infections (46%) but a similar incidence of minor infections (12%). The results indicate that risk factors can be used to identify low-risk patients who require only short-term antibiotic therapy and primary wound closure. The remaining patients are at greater risk for infection despite prolonged antibiotic therapy and delayed wound closure.

Abdominal Injuries↗
PubMed1994

Peristomal pyoderma gangrenosum and inflammatory bowel disease.

Pyoderma gangrenosum (PG) is a debilitating skin disease most often associated with inflammatory bowel disease and is a reportedly rare cause of peristomal ulceration. The lesions of PG rapidly evolve from small, erythematous pustules to deep, painful, pyogenic ulcers within hours to days of onset. Although the behavior and the appearance of the lesions of peristomal PG are diagnostic, a lack of familiarity with PG often leads to misdiagnosis and inappropriate therapy. This study reports four cases of peristomal PG and discusses the 20 previously reported cases in patients with inflammatory bowel disease. Seventy-five percent of patients were female and 67% had Crohn's disease. All patients had colitis, including all of the patients with Crohn's disease, 82% of whom had additional perineal complications. The diagnosis of peristomal PG was based on clinical appearance alone in 83% of cases. The onset of peristomal PG ranged from 2 weeks to 3 years following ostomy. The response to medical therapy was variable. All cases (17 of 17) treated with high-dose corticosteroids and local wound care responded, but five cases required additional therapy. No patient was successfully treated with stoma revision. Risk factors for the development of peristomal PG include Crohn's colitis, female gender, and perineal disease. While most patients respond well to systemic steroids and local wound care, up to one third of patients require long-term medical management.

Adolescent↗
PubMed1995

Gastrointestinal and pancreatic complications associated with severe pancreatitis.

OBJECTIVE: To study the outcomes of gastrointestinal fistulas and pancreatic ductal disruption in severe pancreatitis. SETTING: University tertiary referral center. PATIENTS: One hundred thirty-six patients from 1982 to 1994. INTERVENTION: Diversion followed by resection and ostomy closure for gastrointestinal fistulas, pancreaticojejunostomy for pancreatic fistulas, and excision, external drainage, or internal drainage for pseudocysts. RESULTS: The incidence of infection was 24% (8/33) for peripancreatic fluid collections and 59% (61/103) for patients with necrosis plus fluid collections or necrosis without fluid. Sixty-nine patients developed 25 gastrointestinal fistulas and 51 complications caused by pancreatic ductal disruption. Necrosis and infection but not the open packing technique were associated with increased risk of gastrointestinal fistulas. In patients with pancreatic ductal disruption, pancreatic fistulas developed following necrosectomy and external drainage, while pancreatic pseudocysts evolved from undrained peripancreatic fluid collections. Gastrointestinal fistulas required prompt operative intervention, whereas pancreatic ductal disruption was treated nonoperatively initially. The mortality rate was 13% (3/23) in patients with gastrointestinal fistulas, similar to the overall mortality rate of 10.3% (14/136). There was no mortality in patients with pancreatic fistulas or pseudocysts. Length of hospital stay was prolonged by the presence of necrosis and infection, not by gastrointestinal fistulas or ductal disruption. Thirty-eight of the 69 patients with these complications required readmission for operative management of their complications. To date, only 18 (13.2%) of 136 patients with severe pancreatitis have not required surgical intervention. CONCLUSIONS: Gastrointestinal fistulas and pancreatic ductal disruption are common in severe pancreatitis. Although these complications are not associated with increased mortality or prolonged initial length of stay, readmission for elective surgical correction is necessary in most patients. Severe pancreatitis is a surgical disease, requiring both acute and long-term surgical care.

APACHE↗
PubMed1993

Relevant clinical information and tumor markers.

The preoperative clinical assessment of patients with colorectal cancer provides the surgeon with sufficient information to allow an accurate assessment of operative risks, to plan the extent of resection needed to remove the primary and any associated synchronous lesions, to determine whether perioperative care should be modified to enhance the safety of the proposed surgery (bowel preparation, ureteral catheters, or ostomy placement), to determine operability and probable intent of surgery (curative or palliative), and to determine whether additional, more sophisticated testing is needed to better stage the disease to determine prognosis and ideal treatment. The surgeon, through the process of informed consent, must properly balance these patient and disease factors to select and plan the appropriate treatment that maximizes the potential for cure while minimizing morbidity and mortality.

Biomarkers, Tumor↗
PubMed2005

Preservation of bowel and urinary continence in the management of locally recurrent rectal cancer.

BACKGROUND: The management of locally recurrent rectal cancer should achieve local tumor control and potentially improving disease-free and overall survival. Radical pelvic resection has traditionally been associated with permanent fecal and urinary diversion. However, as advanced techniques have evolved to allow restoration of intestinal and urinary continence, we reviewed the use of these techniques in patients with recurrent rectal cancer. METHODS: Patients with recurrent rectal cancer who underwent a resection at Norris Comprehensive Cancer Center between 1993 and 1999 were retrospectively reviewed. Data collected included demographic data, surgical and oncological history, patterns of recurrence, treatment modalities, and outcome. Follow-up data was obtained from the last clinic visit and/or tumor registry. RESULTS: Sixty-seven patients with locally recurrent rectal cancer (male/female 45/22, age 32-81 years) were included in the analysis. Continence was re-established in 22 (33%) patients, urinary continence was restored in 12 patients, and intestinal continuity in 14 patients (both in 4 patients). A temporary diverting ostomy was necessary in 5 out of 14 (36%) patients. Mortality was zero and morbidity was low and included two urinary leaks and one fecal leak all of which could be managed non-operatively. At a median follow-up of 16 months (range 5-55), 11 (50%) patients were still alive, 7 (31%) without evidence of disease. Comparison of the groups of patients either with or without continence preservation showed no statistically significant difference in disease-free survival and overall survival rates. High quality of life was achieved with restoration of continuity, no patient with restored continuity expressed a desire for a diversion. CONCLUSION: If an oncologically adequate resection of the recurrent rectal cancer can be performed without impairment of the pelvic floor integrity, continence preservation is feasible and results in good functional and oncological outcome.

Adult↗
PubMed1989

Chronic radiation enteritis: a community hospital experience.

A retrospective study was undertaken to evaluate the operative management of patients with chronic radiation enteropathy. Thirty-eight affected patients from 1974 to 1986 were reviewed. Patients with recurrent cancer responsible for symptoms were excluded. Seventy-one percent of patients presented with bowel obstruction. Twenty-one patients were treated with bowel resection, while 17 were treated with a bypass procedure or diverting ostomy alone. Overall morbidity was 45%, and postoperative mortality was 16%. Patients in the bypass group were significantly older than those in the resection group (70.3 vs. 55.5 years, P = .024), suggesting that age may have been a determinant of the procedure performed. In our study there was no difference in outcome based on preexisting vascular disease, tumor site, type of procedure performed, or radiation dose. We conclude that resection is the procedure of choice in cases of chronic radiation enteritis requiring surgery except in cases with dense adhesions when enteroenterostomal bypass is a viable alternative.

Enteritis↗
PubMed1995

Risk and prognostic factors of gut perforation after orthotopic liver transplantation for biliary atresia.

The aim of this study was to assess the risk and prognostic factors of gut perforation after orthotopic liver transplantation in children with biliary, atresia using univariate and stepwise regression analysis. Among 51 pediatric recipients who underwent transplantation because of biliary atresia after failure of portoenterostomy, 10 patients (20%) had 19 episodes of gut perforations after 14 transplantations. The median delay between transplantation and perforation was 13 days. These perforations were treated either by suture (n = 21) or ostomy (n = 11). The study of preoperative and perioperative variables showed that children with gut perforation were in surgery for a significantly longer period of time including a longer period of receiving hepatectomy and undergoing portal venous clamp. These children also needed large amounts of blood transfused during hepatectomy. After transplantation there was no difference regarding total steroid doses and early occurrence of cytomegalovirus disease between the two groups. Stepwise regression analysis identified three factors associated with the occurrence of gut perforation: duration of transplant operation, posttransplant intra-abdominal bleeding requiring reoperation, and early portal vein thrombosis. During the postoperative course, severe fungal infections were significantly more frequent in the gut perforation group. The 3-year patient survival rate was 70% in the group with gut perforation and was not different from the group without perforation (80%). This study shows that children with previous portoenterostomy carry a high risk of developing gut perforation after liver transplantation. This is especially true for those patients with the most difficult hepatectomies, which are responsible for the iatrogenic injury of the bowel. Other risk factors pointed out in this study were splanchnic congestion in case of prolonged portal venous clamp time or early portal vein thrombosis and repeated trauma of the bowel caused by reoperations. On the other hand, other well known risk factors, such as steroid therapy and viral diseases, were not involved in the occurrence of gut perforations in this study. Besides emergent surgical treatment, this type of complication requires aggressive therapy against fungal infections.

Biliary Atresia↗
PubMed1988

Postdischarge distress in surgically treated cancer patients and their spouses.

Temporal patterns of distress among two groups of nonterminally ill, surgically treated cancer patients (n = 40) and their spouses (n = 40) during the immediate pre- and postdischarge period were studied. Data about problems encountered and standardized measures of distress (State Anxiety Index, Brief Symptom Index, and Vulnerability Index) were obtained before hospital discharge and at 10, 30, 60, 90, and 180 days postdischarge. The intensity of distress experienced by patients and spouses was remarkably similar, although the temporal pattern of occurrence was significantly different. Prior to discharge, spouse anxiety was significantly higher than that of the patients and above the norm for hospitalized persons. Spouses were least distressed after 10 days at home, but thereafter experienced a rise in vulnerability culminating in observable clinical depression at 90 and 180 days. Peak distress for the patients occurred 10 days after discharge as a function of physical symptoms that were unexpected or more severe than anticipated. Patients with ostomies (n = 20) were slower to return to pre-illness functional levels and had somewhat more psychological distress than nonostomy patients.

Depression↗
PubMed1989

Quality of life of adults with chronic illness: a psychometric study.

Reliability and validity of the Flanagan Quality of Life Scale (QOLS) were tested in four chronic illness groups. Open-ended questions and four instruments, the QOLS, Duke-UNC Health Profile (DUHP), Life Satisfaction Index (LSI-Z), and either the Arthritis Impact Measurement Scales (AIMS) or the Ostomy Adjustment Scale (OAS) were administered by telephone interview and mailed questionnaires to 227 adults three times over 6 weeks. Subjects generated verbal responses that substantiated the content validity of the QOLS. Stability reliability estimates for all instruments ranged from .53 to .90. Cronbach's alpha coefficients averaged .87 for the QOLS. Appropriate validity coefficients indicated both convergent and discriminant construct validity.

Activities of Daily Living↗