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PubMedDate not supplied

Is intraluminal clip application an appropriate treatment for iatrogenic gastric perforation?

BACKGROUND: The standard treatment of iatrogenic perforation has been an urgent operation. Recently, endoscopic clip application was recommended particularly for iatrogenic perforations. This study was designed to investigate the usage of surgical clips for gastric perforations. METHOD: Forty male rats were allocated to four groups. Following a midline laparotomy, a 5-mm gastrotomy was made at the fundic part of the stomach and through this ostomy a pre-pyloric perforation was created in all groups. In group I, the perforation site was closed with polypropylene sutures. In group II, the perforation site was closed extraluminally by vascular surgical clips. In group III, the perforation site was closed intraluminally by the same number of clips. In group IV, control group, the perforation site was left open. The animals were sacrificed on the 4th postoperative day. The healing of the perforation site was evaluated by the bursting pressure and the hydroxyproline content of the suture line. RESULTS: Measurements revealed no differences in bursting pressure and hydroxyproline levels between the intraluminal clip application group (group III) and the group in which the perforation site was left open (group IV) (p > 0.05). Higher bursting pressures and hydroxyproline levels were observed in groups I and II compared to control group (p < 0.05). CONCLUSIONS: These results suggest that gastric perforations are not strengthened by intraluminal clip application. Further detailed clinical studies are necessary in order to conclude that intraluminal clip application is an appropriate treatment for iatrogenic perforation.

Animals↗
PubMedDate not supplied

Posterior flank approach to the peritoneum for ventriculoperitoneal shunting.

We report a technique for insertion of a distal shunt catheter into the peritoneal cavity through a posterior incision. This has been helpful in patients with impaired access anteriorly. It may also be useful in elective situations. We have performed this procedure on 3 infants where the traditional anterior approaches would have been difficult due to subcutaneous scar tissue, ostomy sites and anterior intra-abdominal adhesions. This technique was safe and provided easy access to the peritoneal cavity. Complications would be similar to those for the standard ventriculoperitoneal shunts including bowel perforation, damage to the kidney or liver, infection and occasionally posterior cervical webbing that may cause pain locally or pull the head into an extended position.

Cerebrospinal Fluid Shunts↗
PubMed1989

Treatment of an enteric fistula with somatostatin in a premature.

The authors present the case of an extremely premature baby affected by severe Necrotizing Enterocolitis (NEC) needing intestinal resection and ileostomy. An enteric fistula developed 3 days after ostomy closure. The baby was started on Total Parenteral Nutrition (TPN), and 7 days later the fistula output remained constant. Somatostatin (SM) was then given intravenously (3.0 micrograms/Kg/hr) and the fistula closed on the 3rd day of treatment. Since SM was introduced in 1986 as an adjunct treatment to TPN in enteric fistulas, the authors believe that theirs is the first report of a successful SM treatment in a premature.

Enterocolitis, Pseudomembranous↗
PubMed2002

Short bowel syndrome in the elderly.

BACKGROUND: The need for massive intestinal resection in the elderly presents an ethical dilemma. The mortality rate for elderly patients who undergo this procedure is high, and quality of life with the short bowel syndrome (SBS) in this group is often questioned. This study evaluated the clinical outcome of patients >70 years of age who underwent intestinal resection leading to SBS. METHODS: This was a retrospective study of 23 patients ranging in age from 70 to 92 years, who were evaluated over a 20-year period. RESULTS: There were 11 (48%) early postoperative deaths. Parenteral nutrition (PN) was required for 8 of 12 discharged patients. Five (63%) of the 8 remained on PN permanently, and 3 were transitioned to enteral nutrition (EN). Three patients (PN = 2, EN = 1) died within a year of resection. Four (67%) of 6 patients surviving 5 years received EN only. Five of 10 patients with remnant length <120 cm were discharged, all on PN. PN was later discontinued in 2 patients. Seven (54%) of 13 patients with remnants > 120 cm were discharged; 3 of the 7 remained on PN. Resection was performed for mesenteric vascular disease (n = 13), radiation or cancer (n = 6), and other benign conditions (n = 4). Underlying diagnosis did not influence mortality rate or need for PN. Intestinal continuity was restored in 3 of the 8 patients discharged with an ostomy. Stricturoplasty was performed in 2 patients to improve intestinal function. CONCLUSIONS: Massive resection in the elderly has a high early mortality rate. Long-term survival is achieved in 50% of discharged patients, especially if they can transition to full EN. Nutritional prognosis is influenced by remnant length more than by underlying disease. Despite their advanced age, these patients are often candidates for further surgical procedures to improve intestinal function.

Journal Article↗
PubMedDate not supplied

Use of clonidine to decrease intestinal fluid losses in patients with high-output short-bowel syndrome.

BACKGROUND: Some patients who have short bowel syndrome (SBS) have high intestinal outputs, which increases the risk of dehydration and fluid-electrolyte abnormalities and impairs quality of life. METHODS: We evaluated the use of clonidine, an alpha2-adrenergic receptor agonist, in 2 patients with SBS and high intestinal outputs, who were refractory to conventional therapy with antidiarrheal and antisecretory agents (loperamide, belladonna, opiates, somatostatin, histamine2 receptor antagonists and proton pump inhibitors). The first patient (case 1) was a 29-year-old woman who had 175 cm of small bowel anastamosed to 8 cm of descending colon, ending in a colostomy. The second patient (case 2) was a 22-year-old man who had 30 cm of jejunum anastomosed to 30 cm of sigmoid colon and rectum. RESULTS: The addition of clonidine, 0.1 mg per os (PO) 2 times per day, to the treatment regimen of case 1 decreased her ostomy output from approximately 4 L/day to approximately 1 L/day, eliminating the need for parenteral nutrition and fluids and decreasing the need for opiate therapy. The addition of clonidine, 0.2 mg PO 2 times per day in case 2 resulted in decreased rectal outputs from approximately 4 L/day to approximately 1.5 L/day. CONCLUSIONS: These results demonstrate that clonidine can effectively reduce intestinal fluid and electrolyte losses and should be considered as an additional treatment option in patients with SBS and high intestinal outputs.

Adrenergic alpha-Agonists↗
PubMedDate not supplied

Care and long-term maintenance of percutaneous endoscopic gastrostomy tubes.

Placement of a percutaneous endoscopic gastrostomy (PEG) tube creates a controlled perforation of a hollow viscous organ and an acute surgical wound. Physicians who place PEG tubes endoscopically or fluoroscopically often do not have the opportunity to provide these patients with long-term follow-up care. Thus, nutrition support specialists who do treat these patients may be the one member of the health care team who is in the most advantageous position for ongoing inspection and maintenance of the access device. Carefully monitored surveillance and adherence to routine principles of wound care assure the health of the skin, the underlying tissue, and the tract into the abdominal cavity through which the PEG passes. Having knowledge of the types of tubes placed, performing a regular physical examination of the PEG site, and maintaining good communication with the endoscopist results in early identification of problems, promotes rapid simple strategies to correct deficiencies, and the opportunity to minimize long-term complications. Dietitians, wound-care ostomy nurses, and other nutrition support specialists are encouraged to be more proactive with their participation in the care and management of the PEG site.

Communication↗
PubMed1996

The impact of federal regulations on urethral catheterization in Virginia nursing homes.

The 1990 Omnibus Budget and Reconciliation Act (OBRA) nursing home regulations limit the use of indwelling urinary catheterization to certain appropriate cases. This study examines the impact of OBRA on catheterization among 3149 pre-OBRA and 5073 post-OBRA Virginia residents. The two cohorts were similar in activities of daily living function and medical status, but the post-OBRA cohort was more incontinent. A higher percentage of residents were catheterized pre-OBRA than post-OBRA. Post-OBRA, catheterized residents were more likely to meet OBRA conditions for appropriate catheterization than noncatheterized residents, and less than 1% of long-term catheterized residents were catheterized inappropriately. Long-term catheterized residents had more urinary tract infections than short-term catheterized residents, however. Also, some nursing homes may substitute ostomies for catheters. Catheter use may no longer be a reliable indicator of quality of care at the nursing home level, if homes are minimizing catheterization in response to OBRA.

Activities of Daily Living↗
PubMed1996

Cholestyramine ointment to treat buttocks rash and anal excoriation in an infant.

OBJECTIVE: To describe a novel treatment for perianal excoriation in an infant receiving a promotility agent. CASE SUMMARY: A 2-month-old boy with reflux, and regurgitation was treated with cisapride. Shortly after cisapride therapy he developed a rash on his buttocks and anal irritation that progressed in severity despite the use of numerous topical products and extended diaper-free periods. A topical cholestyramine ointment compound was prepared and administered, resulting in complete resolution within 3 days. DISCUSSION: Cisapride can decrease the gastrointestinal transit time, which can lead to less time for bile acid reabsorption in the distal ileum. If high concentrations of bile acids are contained in the stool, they can irritate the anus and buttocks in a manner similar to the skin irritation experienced by patients with ostomies. Cholestyramine, a bile acid sequestrant, can irreversibly bind the bile when applied topically and bring relief to the patient. CONCLUSIONS: Topical cholestyramine ointment may be a safe and efficacious treatment option for perianal irritation due to bile acids.

Antipruritics↗
PubMed1978

The effects on normal skin of adhesives from stoma appliances.

The irritancy of 7 adhesive plasters from different ostomy appliances was compared in 30 normal subjects. The adhesives were replaced both daily and weekly over a 21-day period. Using a clinical rating scale, the results slowed that "Stomahesive" had a significantly less irritating effect on the skin than the other plasters, both when removed daily and when removed weekly. The difference between daily and weekly removal reached statistical significance at the end of Weeks 2 and 3, and the results suggest that the nature of the adhesive is more important than the frequency of removal.

Adolescent↗
PubMed2005

Complications and mortality following stoma formation.

INTRODUCTION: As stoma formation is thought to be declining, we performed a study to evaluate the rate of stoma formation and the impact on stoma complication rates, together with risk factors for complications. PATIENTS AND METHODS: Stoma incidence, individual complications and mortality rates were retrieved from a stoma nurse database of 345 stomas created over an 8-year period. RESULTS: Stoma formation increased over the study period, although the incidence of complications declined. Stoma complications were more frequently seen in emergency surgery. A significant association between stoma complications and mortality was identified. CONCLUSIONS: Age of patient, urgency of surgery and diagnosis were associated with high levels of morbidity and mortality. Stomas are often formed in frail patients unsuitable for anastomosis formation, which may explain the high mortality in ostomy patients.

Adolescent↗
PubMedDate not supplied

[Ostomized person's experience with cancer: an analysis based on the chronic disease model according to Morse and Johnson].

The study aimed at understanding the meaning of the disease experience for the ostomized people with cancer and the changes on their identity. With a qualitative approach based on the methodological referential of the oral history of life, we have accompanied the subjects during one year, from the moment of hospitalization. During that period, a series of five interviews were performed with each subject. The description and analysis of the evolution were based on the Model of Constellation of the Disease proposed by Morse and Johnson. The analysis showed that, after the deep impact caused by the disease and the permanent ostomy, the subjects begin a new process of realizing their identities, which includes a rediscovery of their place in life.

Aged↗
PubMed2005

[Home care: the experience of a private hospital in the state of São Paulo].

Home care is defined as a group of hospital procedures that can be developed at home, encompassing health actions developed by a multiprofessional team. This study aims at disseminating the experience of a home care service offered by São Francisco Hospital, located in the city of Ribeirão Preto, presenting the results of a 12-month period (from September 2001 to August 2002). During the analyzed period, the service provided care mainly to women (57%), with age between 70 and 80 years (30%), with diagnosis of neurological diseases (27%) and tumors (17%). The sector is coordinated by nurses, who are also responsible for bringing in clients. The work is performed by an interprofessional team that performs procedures of collecting material for lab examinations, dressing, deliver care with catheters and ostomies, as well as home hospitalization.

Brazil↗
PubMed2005

Autosomal dominant polycystic kidney disease showing rupture of a lateral ventral hernia following paralytic ileus.

We report an 83-year-old Japanese male with autosomal dominant polycystic kidney disease (ADPKD), which was marked by unusually enlarged kidneys, and in whom ileus occurred after administration of procainamide. The bowels became swollen and ruptured the skin and appeared on the outside of the skin. Even after the ileus state was resolved, the projected intestinal tract was not restored due to a large defect of the skin, and ostomy was performed. Abdominal hernia including lateral ventral hernia due to enlarged kidneys may result in perforation of the abdominal wall as well as intestinal wall.

Aged↗
PubMed1982

Psychiatric disorders associated with Crohn's disease.

This article is a report of the authors' experience with a series of forty-six patients with Crohn's disease seen in psychiatric consultation over a nine year period. We treated twenty-two of these patients in either long term or short term psychotherapy in addition to the initial psychiatric evaluation. A brief literature review of previous studies on the psychiatric aspects of Crohn's disease is also presented. The most common reason that psychiatric consultation was requested was depression, followed by pain and narcotic-related problems. Factors which appeared to contribute to psychiatric morbidity were the following: duration of Crohn's disease, frequent hospitalizations and surgical procedures, presence of an ostomy, history of proctocolectomy, current psychosocial stress unrelated to Crohn's disease and a history of traumatic childhood experiences. Four suggestions regarding psychiatric management of this group of patients are presented and discussed.

Adult↗
PubMed1986

Intussusception in adults.

A review of 25 adult patients with intussusception is reported. Intussusception in adults constituted 16.6% of 150 intussusception cases observed during 1956-1985. The underlying pathologic processes were identified in 23 patients (92%). Etiologically, adult intussusception could be categorized into four groups: (1) tumor-related (13 cases, 52%); (2) postoperative (nine cases, 36%); (3) miscellaneous--Meckel diverticulum (one case, 4%); and (4) idiopathic (two cases, 8%). The tumor-related intussusceptions were caused by benign tumors in five and malignant tumors in eight patients. Postoperative intussusceptions were related to various factors including suture lines, ostomy closure sites, adhesions, long intestinal tubes, bypassed intestinal segments, submucosal edema, abnormal bowel motility, electrolyte imbalance, and chronic dilatation of the bowel. The sites of involvement of intussusception were jejunogastric (one), jejunojejunal (seven), ileoileal (four), ileocolic (10), and colocolic (three patients). Four patients had synchronous multiple (ileoileal and jejunojejunal), four had compound (ileoilealcolic), and two had recurrent intussusceptions. When an intussusception is encountered in adults, an underlying pathologic process usually can and should be determined for proper management.

Adolescent↗
PubMed1981

Organizing pain control and rehabilitation service in a cancer centre.

A unique programme of rehabilitation and pain control has been created within the Istituto Nazionale per lo Studio e la Cura dei Tumori in Milan. Rehabilitation of mastectomy, amputee and ostomy patients has been very active and, particularly in this last group, a good rehabilitative outcome may be observed. Pain evaluation was one of the main problems. The treatment modalities have been refined in order to obtain the maximum pain relief with the minimum trauma possible. These treatments are based on a closely monitored analgesic drug administration and on percutaneous thermocontrolled lesions. The growing needs of the Cancer Institution have brought to about 30 000 the number of treatments performed by the Service during the last year. Nevertheless, enormous efforts are necessary to break the barrier of indifference to this problem that still persists in the oncologic field.

Amputees↗
PubMed1991

[The relationship between and hardiness and psychosocial adjustment of persons with colostomies].

The problem addressed by this study were to explore the effect of hardiness on psychosocial adjustment of persons with a colostomy and to identify factors which influence that psychosocial adjustment. The purpose was to suggest a theoretical base for the planning of supportive nursing interventions to increase the level of adjustment. Among members of the Korea Ostomy Association, 34 subjects who had undergone colostomy from March, 1990 to March, 1991 were selected as the sample. Data were collected from April 8 to May 8, 1991 using a mailed questionnaire. The instruments used for this study were the Health-Related Hardiness Scale (Pollock, 1984) and the Psychosocial Adjustment to Illness Scale (Derogatis, 1975). ANOVA, Pearson correlation coefficient and Stepswise Multiple Regression were used for data analysis. The results of the study are summarized as follows. 1. Hardiness was significantly related to psychosocial adjustment (p = 0.009). That is, the higher the hardiness, the higher the level of psychosocial adjustment. 2. Among the demographic variables, only economic level was significantly related to the level of psychosocial adjustment. (p = 0.005). 3. The important factors influencing the level of psychosocial adjustment of persons with a colostomy were economic level, commitment, challenge (subconcepts of hardiness). Therefore, in order to increase the level of the psychosocial adjustment, it might be helpful to provide them with hardiness training to strengthen their commitment and their challenge.

Adaptation, Psychological↗
PubMed2000

Fournier gangrene associated with Crohn disease.

A 17-year-old boy presented with Fournier gangrene associated with previously undiagnosed Crohn ileocolitis. Fournier gangrene was managed by débridement, broad-spectrum antibiotics, and hyperbaric oxygen. A diverting ileostomy was performed before skin grafting and scrotal reconstruction. Microscopy of a full-layer surgical sample from the terminal ileum revealed granulomas with multinucleated histiocytes, consistent with Crohn disease. Crohn disease was treated with mesalamine, metronidazole, 6-mercaptopurine, and infliximab. The patient was discharged on hospital day 32. At 6-month follow-up, reconstruction of his scrotum had completely healed. Ostomy output was normal.

Adolescent↗