SEARCH · Search PubMed
Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
We report a case of skin affection on the abdomen in a 75 year-old woman with an ileostomy. The lesion developed during a period of two years on a site distant from the patient's present ostomy. However, it was located on the site of a former ileostomy removed 25 years ago. The lesion was due to proliferation of remaining gut mucosa.
Using a simplified questionnaire from the NADYA group, data referring to age, sex, diagnosis, access route, duration, form of administration, complications, and quality of life have been gathered from 1,400 patients (57% male, 43% female) who receive home enteral nutrition, and from 38 patients (20% male and 18% female) who receive home parenteral nutrition. All of these patients come from the 1996 national registry. The most common indication for home enteral nutrition are neoplasias (39%) followed by neurological alterations (33%). The most common access route is oral (48%), followed by a nasogastric tube in 34%, PEG in 10% and surgical ostomies in 7%. The average treatment duration is 6 months. There is an index of 0.74 complications/patient-year (gastrointestinal 0.28 and mechanical alterations 0.19). At the end of the year 58% of the patients continued to use at home enteral nutrition, with a death rate of 17%. The majority of the treated patients presented a severe social disability (28%) or was bed-ridden (22%). The most common indications for home parenteral nutrition are: neoplasia (42%), Crohn_s disease (10%), and mesenteric ischemia (10%). AIDS (8%), radical enteritis (5%), and motility disorders (5%) are less common. In 42% of the cases tunneled catheters are used, and port-a-cath are used in 53%. The average treatment duration is 6.9 months. 1.06 hospitalizations/patient-year have been registered in relation to the nutritional treatment (mainly catheter sepsis). A mortality of 29% is registered, and there is recovery of the oral route in 7.9% of the cases. 50% of the patients present a severe social disability.
BACKGROUND: The acceptance of a colostomy by a patient requires a great amount of psychological resources and social support. AIM: To identify factors that influence the postoperative adaptation to a colostomy. PATIENTS AND METHODS: Sixty patients subjected to a colostomy in 5 hospitals in Santiago were interviewed. The adaptation to the procedure was assessed using the Olsbrisch Ostomy Adjustment Scale. Three regression equations were elaborated to determine the main predictors associated to adaptation. Control variables such as sex, age and the lapse between the interview and the surgical procedure, were included in the model. RESULTS: The model used identified the simultaneous and combined effects of socioeconomic variables such as education and income on the adaptation to colostomy. A generalized detriment of the self image was detected. Patients valued the social support given by the family and friends. Multiple regression analysis determined that the main predictor of the patient's adaptation to colostomy was the level of self care developed. CONCLUSIONS: The better adaptation to a colostomy could be achieved by training the patient for an adequate self care and providing him with psychological and social support.
The simple and safe technical supply of ostomy is the patients indicator for life quality after an operation with performing colostomy. Therefore the correct choice of place, form and size is important as the guarantee of a sufficient perfusion of colostomy wall.
Cancer treatments often cause sexual dysfunctions that remain severe long after therapy is over. Nevertheless, sexual counseling is not routinely provided in most oncology treatment settings. Most patients and their partners can benefit from brief counseling that includes education on the impact of cancer treatment on sexual functioning; suggestions on resuming sex comfortably and improving sexual communication; advice on how to mitigate the effects of physical handicaps, such as having an ostomy, on sexuality; and self-help strategies to overcome specific sexual problems, such as pain with intercourse or loss of sexual desire. Brief counseling can be provided by one of the allied health professionals on the oncology treatment team. A minority of patients will need specialized, intensive medical or psychological treatment for a sexual dysfunction. In a large cancer center, such treatment could be provided as part of a reproductive health clinic serving the special needs of cancer patients. In smaller settings, the oncologist should build a referral network of specialists. Not all managed care organizations reimburse for these services, however.
Wound, ostomy, and continence specialists have a unique opportunity for developing programs in the long-term care environment. Their expertise and perspective can assist in providing care within the PPS payment rate, improving the fiscal stature of the facility, improving patient outcomes, and increasing the facility's referral base. The HCFA has posted a tool on its website that allows the user to follow RUG III grouper logic manually. It walks through each step of the process and is designed to be a helpful learning tool: http:@www.hcfa.gov/medicare/hsqb/mds20/>.
People with ostomies in Singapore were initially resistant to colostomy irrigation. This study, a prospective crossover study of 26 patients who underwent abdominoperineal resection, compared colostomy irrigation with the natural evacuation method. During the colostomy-irrigation phase of the study, all 26 patients reported an improvement in continence and fewer problems with sleep, sex, and skin complications compared to the natural-evacuation phase. The study also found a reduction in monthly expenses with colostomy irrigation compared to natural evacuation. Patient satisfaction scores were also superior during the colostomy-irrigation phase. This difference in satisfaction scores was less marked in those who were more than 1-year postsurgery than in those who were less than 1-year postsurgery. The difference in satisfaction between colostomy irrigation and natural evacuation scores was statistically significant in the group that was less than 1-year postsurgery, but not in the group that was more than 1-year postsurgery. The study concluded that colostomy irrigation after abdominoperineal resection is superior to natural evacuation in terms of cost and patient satisfaction and should be introduced soon after surgery.
The surgical management of Crohn's disease has always been a challenging issue for physicians because of concerns of the historical need for repeated surgeries over time, the physiological limitations of a shortened small bowel, and the transmural, fistulizing, and/or skip-lesion nature of the disease. Patients are fearful of the potentially disfiguring results, especially the need for a permanent ostomy. The challenge has been to develop surgical approaches that are bowel sparing and/or minimally invasive. Stricutureplasty has been used with relatively good results as a bowel-sparing procedure for patients with small-bowel Crohn's disease, potentially sparing patients of a short-bowel syndrome. Laparoscopic approaches to Crohn's disease have thus far been mostly limited to ileocecal resections in selected patients, but as more expertise is developed, will hopefully be extended to other surgical procedures in patients with Crohn's disease in the future. Patient criteria, success rates, complications, and economic implications are discussed for each procedure.
Skin recently has attained a status of importance among vital organs. Consumers, insurance companies, legislators, and regulatory agencies expect that skin health will be maintained, improved, or restored. As health care providers cut costs in response to new payment systems, interventions for skin and wound care must be evidence-based and cost-effective. A comprehensive healthy skin program, guided by the Center for Advanced Nursing Practice's Evidence-Based Practice Model, was designed and implemented by a skin wound ostomy continence nurse coordinator with successful outcomes, including expansion of the program into diverse settings throughout the community.
BACKGROUND: Only a part of patients suffering from Crohn's disease has enteric fistulae and a different behaviour of Crohn's disease with fistulae is reported in the literature. Aim of this paper is to evaluate if enteric fistulae are a factor conditioning mortality, morbidity and overall postoperative course, in patients with Crohn's disease. METHODS: Data on the postoperative course of 126 laparotomies for Crohn's disease, performed between November 1993 and July 1998, have been prospectively examined. Moreover, the presence of enteric fistula has been evaluated during surgery. RESULTS: Out of 126 interventions, in 58 (46%) enteric fistulae were present. Mortality (5.2% vs 0), morbidity (14.5% vs 7.3%), necessity for a temporary ostomy (20.4% vs 3.5%) were greater in those patients with fistula, as compared as those without fistula. CONCLUSIONS: In conclusion, it is suggested that Crohn's disease with fistulae is a different type of disease, with higher mortality and morbidity rates.
We report a 52 year old man with a pancreatic pseudocyst, that was admitted with severe abdominal pain, severe vomiting, fever and malaise. The clinical picture was considered secondary to a pseudocyst infection and the patient was operated, draining the infected cyst performing a necrosis surgery and pancreatojejunostomy. Forty eight hours after the operation, an ostomy bleeding was detected. A upper mesenteric artery angiography showed two pseudoaneurysms in the gastroduodenal artery, that were embolized. Bleeding stopped initially, but seven days later, it reappeared. The patient was subjected to an emergency pancreatoduodenectomy. Postoperative evolution was uneventful and the patient was discharged two weeks later. Spontaneous bleeding of pseudoaneurysms secondary to chronic pancreatitis is a complication with a 15 to 40% mortality that must be bore in mind.
Despite improvements in the supportive care of immunosuppressed patients controversy still surrounds the surgical management and outcome of anorectal sepsis in these patients. We reviewed 83 immunocompromised patients with diagnosis of perianal sepsis from 1995 to 1997. Sixty-six patients (80%) were followed for a mean of 15 months. Mean age was 44 years and 76 per cent were males. Twenty-eight per cent were HIV+, 34 per cent had inflammatory bowel disease on steroids, 20 per cent had malignancies, and 18 per cent had diabetes. Twenty-eight per cent had anal fistula, 2 per cent had perianal abscess, and 40 per cent had both. Primary sites of fistula were: transsphincteric (38%), intersphincteric (33%), superficial (20%), and suprasphincteric (3%), and multiple tracks (6%). Horseshoeing was present in 14 per cent of cases. The most commonly practiced surgical procedures were primary fistulotomy (n = 23) and fistulotomy plus drainage (n = 28). Seven patients underwent fistulotomy and ostomy and eight patients were treated with fistulectomy plus drainage. Most wounds (91%) healed within 8 weeks. Incontinence (6%) and recurrence (7%) were the most commonly observed complications. These results are similar to those seen in the general population. Perianal sepsis can be safely managed in immunocompromised patients, with high rates of healing and low complication rates. An aggressive sphincter-preserving approach in the management of these patients may be undertaken.
Prosthetic mesh reinforcement of abdominal wall hernias has gained acceptance as a result of its ease of placement and a favorably low incidence of hernia recurrence. However, its use in contaminated wounds secondary to open bowel exposure is felt to be contraindicated because of potential septic complications and lack of incorporation. The impact of permanent mesh placement in contaminated fields on wound morbidity, hernia recurrence, and mortality was examined. Records of 24 consecutive patients having permanent mesh placement in contaminated wounds for repair of abdominal wall hernias between 1994 and 2001 were reviewed. Factors examined included age, hernia type, body mass index, comorbidity, degree of contamination, concurrent gastrointestinal procedures, wound morbidity, and mortality. The mean age and body mass index were 63 years and 26.1 kg/m2 respectively. Twelve patients had risk factors for wound complications or were immunocompromised. There were 11 incisional, eight parastomal, two femoral, and two inguinal repairs and one obturator hernia repair. Twenty-three were repaired with polypropylene and one with Gore-Tex mesh. Prosthetic herniorrhaphy was performed in nine patients with ostomies already in place and in 15 patients with concomitant bowel resections. Of those with bowel resections five had enterocutaneous fistulae, three had bowel resection because of injury during mobilization, six had resections for necrotic bowel, and one had enterostomy closure. Fourteen cases were clean contaminated and ten contaminated. Eight cases were performed under emergency conditions. Wound-related morbidity occurred in five patients (21%) and in all but one was limited to cellulitis and minor wound infections. Three patients died, but in all cases death was unrelated to the surgical procedure. No patient required mesh removal. One patient had a recurrent hernia after parastomal repair. Placement of permanent mesh prostheses in clean-contaminated and contaminated operative fields can be performed with minimal wound-related morbidity and patient mortality. Utilization of permanent mesh in these wounds is associated with a low incidence of hernia recurrence and eliminates the need for further surgery.
Parastomal pyoderma gangrenosum (PPG) is an exceedingly rare disease process most often observed in inflammatory bowel disease patients with an ileostomy. Fewer than 50 cases have been reported in the medical literature. The incidence is 0.6 per cent of patients with ileostomy and inflammatory bowel disease. The rarity of the disease leads to misdiagnosis and mistreatment of the lesion. The intense pain and disruption of ostomy function greatly impair affected individuals beyond the limit of their underlying disease. Current best care practices observed in small study series indicate long-term intensive medical therapy aimed at systemic disease suppression to optimize PPG wound healing. Our patient had no signs of active Crohn disease at the time of PPG presentation. She was initially treated with minimal wound debridement and intralesional triamcinolone. Finally under the care of an enterostomal/wound care therapist the patient achieved excellent PPG resolution in 6 months.
INTRODUCTION: Total pelvic exenteration (TPE) is the standard of care for locally advanced colorectal cancer. This is a morbid procedure often leaving the patient with two ostomy sites and an extended recovery. Bladder preservation with complete tumor resection is often possible in these cases and we set out to determine if limited resection of the GU tract was as effective in tumor control as TPE. MATERIALS AND METHODS: This is a retrospective review of all patients over a 7-year period with colorectal tumors invading the urinary system. These patients were divided into two groups based upon the surgical procedure they received: TPE or GU tract sparing surgery. Tumor stage, adjuvant cancer therapy, and complications were reviewed. Recurrence and survival rates were calculated. RESULTS: There were 19 patients with colorectal tumors invading the GU tract. Eight patients were treated with TPE and 11 patients received GU tract sparing procedures. Tumor stage and extent of disease were similar for both groups as were adjuvant/neoadjuvant therapy received. The average follow up from surgery for TPE and GU tract sparing procedures was 40 months (range 9 - 96) and 53 months (range 21.5 - 94), respectively. The limited resection and TPE groups experienced similar complication rates: 7/11 (63.6%) and 6/8 (75%) respectively. The 5-year survival rate was 37.5% and 61.4% for TPE and limited GU resections, respectively (p=0.07). CONCLUSION: The cancer recurrence and complication rates were similar in both groups offering no clear advantage to TPE. GU sparing surgery in the face of locally invasive colorectal tumors is a viable option allowing for treatment of the disease and reducing the morbidity of total pelvic exenteration.
OBJECTIVE: To analyze the quality of life of children with stomas according to the children and mothers' point of view; to compare the results related to quality of life in both groups, and to verify the statistical associations between those aspects and children's demographic and clinical data. METHODS: After fulfilling ethical requirements, the specific data were obtained using the Autoquestionnaire Qualité de Vie Enfant Imagé, adapted and validated for Brazilian culture and also for this study by Assumpção Jr. et al. It is composed by 26 questions, 18 of them are distributed among four factors: Functions, Family, Autonomy and Leisure. RESULTS: Twenty children, aged 4 to 12 years, from a Specialized Outpatient Ostomy Care Center for Children and their respective mothers answered the questionnaire. Ten boys and 10 girls participated, their mean age was 8.7 (SD = 2.64) years, with the predominance of Caucasians (55.0%), and elementary education level (65.0%). Clinical profile shows a predominance of urinary stomas (55.0%) caused by congenital diseases (60.0%). Related to quality of life, the total mean scores were 51.95 (SD = 7.90) and 49.60 (SD = 5.60), respectively for children and mothers, without statistically significant difference. Regarding each factor, the patients' scores were 8.14, 8.29, 10.27 and 11.41, respectively for autonomy, leisure, functions and family. Some statistically significant associations were verified between education level and mothers' quality of life (r = -0.56) and children's quality of life (r = -0.63), and also between mothers' quality of life and family (r = 0.86), autonomy (r = 0.60) and functions (r = 0.59). CONCLUSION: This study improves the comprehension about quality of life of children with stoma as well as some of these aspects on their mother's point of view.
A Systematic Nursing care to ostomized patients at Oswaldo Cruz German Hospital (São Paulo Brazil) has been used in order to care for these patients through a nursing process approach since December 1988. Until June 1991 the group gave orientation to 115 patients. This systematic nursing care has three steps: pre-operative period, pos-operative period and discharge. These steps improved self care without complications and guided the patients to work with ostomy associations which helped them im their whole reintegration.
The management of chronic, nonhealing, draining wounds is challenging for the wound, ostomy, and continence nurse and other health care providers involved in skin integrity care. Vacuum-assisted closure (VAC) therapy has proven cost efficient, safe, and effective as a treatment modality in wound care. The background, description, mechanisms of action, indications for use, and nursing implications of VAC therapy are presented.