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PubMed1980

Triple-lumen perfusion of the canine jejunum.

The triple-lumen gut perfusion technique was validated in five dogs with established jejunal fistulas. Transit time through the 30-cm test segment was 6.2 min when perfused at 4 ml/min with a balanced electrolyte solution (Na 140, K 5, Cl 110 and HCO3 35 mM), and this remained constant during a 3-hr test period. Fasting intestinal content was very small in the dog. After 35 min equilibration, steady-state absorption was achieved during perfusion with electrolyte solution containing polyethylene glycol (5 g/liter) as a nonabsorbable marker (10 studies). The triple-lumen gut perfusion technique is well suited to the study of intestinal transport in vivo in dogs with chronic intestinal fistulas.

Animals↗
PubMed1989

Diarrhea in critically ill patients.

The onset of diarrhea complicates the care of critically ill patients, who often have complex cardiopulmonary, renal or metabolic problems. Diarrhea further upsets fluid and electrolyte balance and creates difficulties in nutritional support. Common causes of acute diarrhea in critically ill patients include medications, enteral feedings, ischemic bowel disease, pseudomembranous colitis, short bowel syndrome, intestinal fistulas, pancreatic insufficiency and opportunistic infections in patients with AIDS.

Critical Care↗
PubMed1997

Prospective study of the features, indications, and surgical treatment in 513 consecutive patients affected by Crohn's disease.

BACKGROUND: The aim of this prospective study was to elucidate the features, indications, and surgical treatment in patients affected by complications of Crohn's disease. METHODS: Between January 1985 and July 1996, 513 consecutive patients (248 male, 265 female; mean age, 38 years) were operated on for 542 occurrences of Crohn's disease. Data were collected prospectively. RESULTS: Indications for abdominal surgery were often multiple but included failure of medical management (n = 220), obstruction (n = 94), intestinal fistula (n = 68), mass (n = 56), abdominal abscess (n = 33), hemorrhage (n = 7), and peritonitis (n = 9). Four hundred sixty-four abdominal procedures were performed, necessitating 425 intestinal resections and 97 stricture plasties. The use of stricture plasty was more common in the second half of the study (16.0% versus 7.3%, second half versus first half; p < 0.01). Perioperative complications occurred in 75 of the 464 abdominal operations (16%). There were no deaths. One hundred thirty patients (25%) required operation for perineal complications of Crohn's disease. The presence of Crohn's disease in the rectal mucosa was associated with a higher risk for permanent stomas in patients requiring operation for treatment of perianal Crohn's disease (67% versus 11%; p < 0.001). CONCLUSIONS: Patterns of surgical treatment in Crohn's disease are changing, with more emphasis on nonresectional options. The presence of rectal involvement significantly increases the need for a permanent stoma in patients with perianal Crohn's disease.

Adolescent↗
PubMed1986

Experiments with continuous hemofiltration and hemofiltrate regeneration in the rat.

Experimental studies were made with continuous hemofiltration treatment for bilaterally nephrectomized rats and initial observations regarding the effects of such treatment on leukocyte and thrombocyte counts are reported. Hemofiltration of unanesthetized rats able to move freely within their cage could be continued for up to 30 h using a pump-driven ECC system. Blood parameters recorded during this treatment indicate that the detoxification was effective. In another series of experiments the water and electrolyte reabsorption capacity of the colon ascendens of healthy rats was tested by continuously supplying NaCl solution into the colon via a fistula. A large proportion, if not all, of the hemofiltrate can be discharged into the colon without diarrhoea. A final series of experiments showed that the three-stage operation (implantation of permanent catheters, connection of a permanent intestinal fistula and bilateral nephrectomy) is possible with the rat.

Animals↗
PubMed1969

Regional enteritis leading to carcinoma of the small bowel.

A case of carcinoma of the small bowel intimately associated with long-standing regional enteritis (Crohn's disease) is described. Sixteen similar cases reported in the literature are briefly reviewed. This neoplasm presents at a younger age than other small bowel carcinomas and there seems little doubt that it is causally related to the inflammatory bowel lesion.

Adenocarcinoma↗
PubMed1985

[Analysis of intestinal motility by enteric sound recording system--clinical evaluation of aclatonium napadisilate and prostaglandine F2 alpha on intestinal movement].

In patients with so-called postoperative enteroplegia after laparotomy, effects of aclatonium napadisilate (abbreviated as TM-723 hereinafter) and prostaglandine F2 alpha (abbreviated as PGF2 alpha) on intestinal motility were determined using an enteric sound recording system (phonointestinography) and simultaneously the time required for breaking wind after operation was examined. TM-723 was administered at a dose of 50 mg from the intestinal fistula after dissolved in 5 ml of physiological saline, while PGF2 alpha was administered as an i.v. drip infusion at a dose of 2 mg dissolved in 500 ml of 5% glucose solution. Intestinal movement was determined at McBurney point using the enteric sound recording system developed at our department. The time required for breaking wind after operation was determined in three groups received TM-723, PGF2 alpha and placebo, respectively. No significant intergroup difference was observed. As to effect on intestinal motility, TM-723 increased intestinal motility when it was reduced in so-called postoperative enteroplegia phase. Its efficacy became higher with a decrease in motility. On the contrary, TM-723 rather tended to depress intestinal motility when it was increased. On the other hand, PGF2 alpha tended to increase intestinal motility regardless of motility in enteroplegia phase.

Acetylcholine↗
PubMed1997

[Intestinal perforation caused by chicken bone mimicking perforated colonic diverticulitis].

Intestinal Perforation can occur in less than 1% of cases of ingestion of foreign bodies. Clinical suspicion is very important to make the diagnosis since many medical conditions can simulate this pathology. We present a case of a 63 years old man who swallowed a chicken bone that perforated the sigmoid colon and produced a clinical picture mimicking a perforated colonic diverticulitis. At surgery, the bone was removed without any evidence of abscess formation. A Hartmann procedure was performed and we reanastomosed it 3 month later. The patient followed an uneventful postoperative course. We demonstrated that early detection and opportune surgical treatment decrease the risk of developing complications such as abscess formation, intestinal fistula or obstruction.

Animals↗
PubMed1983

Changing concepts in diverticular disease.

Conventionally, acquired diverticular disease of the colon has been regarded as a single entity, so far as complications go. Experience at St. Vincent's Hospital, Melbourne, suggests that there are two kinds of diverticular disease, one with the classic muscle abnormality, chiefly confined to the left colon and characterized by inflammatory and perforative complications and the other without muscle abnormality, but with diverticula throughout the colon, in which bleeding is common, perhaps due to a connective-tissue abnormality which, on the one hand, allows development of diverticula in the absence of abnormal intraluminal pressure and, on the other, provides inadequate support for vessels in the diverticular wall or for vascular malformations, which are therefore likely to bleed. Clinical evidence from admissions to St. Vincent's Hospital suggests that both acute and chronic pain may be either inflammatory or associated with muscle spasm and hypertrophy. Finally, there is some evidence to suggest that perforation may be due often, or usually, to abnormal intraluminal pressures rather than to diverticular inflammation.

Abscess↗
PubMed1977

Sleep induced by intestinal stimulation in cats.

The influence of afferent impulses of intestinal origin on the sleep stages was studied in fed and starved cats. Low-frequency electrical stimulation of the mucosal surface in a small intestinal fistula reduced the latency of sleep onset. The number of slow wave sleep episodes decreased, but their mean duration increased during stimulation. Conversely, the number of paradoxical sleep episodes increased, but their mean duration was not significantly modified by the intestinal stimulation. The role of viscerosensory events in the control of sleep is discussed in relationship to these results.

Afferent Pathways↗
PubMed2000

Intestinal failure.

The recognition of intestinal failure (IF) as a distinct clinical entity over the past 20 years has primarily come about through the emergence of increasingly successful treatment based on use of intravenous nutrition delivered both in hospital and at home. Intestinal failure has many and varied causes, and may be complete or partial, acute and short lived, or chronic and permanent. If the latter, lifetime dependence on parenteral nutrition will usually be indicated and where possible patients are trained in the techniques of home parenteral nutrition (HPN). The success of HPN is itself primarily dependent on meticulous catheter care protocols. Sufficient numbers of such patients have now been entered into randomized controlled trials for there to be an evidence base for this aspect of IF treatment. The balanced delivery of nutrients, especially when an enteral component is included, can prevent many of the complications, such as liver and bone disease, recorded as being associated with prolonged total parenteral nutrition. However, nutritional balance is difficult to achieve in the presence of total gut resection, multiple intestinal fistulas or persisting sepsis. Surgical approaches involving bowel lengthening and reversed loops are indicated in selected patients. They have limited success and carry with them the risk of further loss of precious residual bowel. Greatest promise is held out by intestinal transplantation, but the problems associated with the powerful immunosuppression required reduce the value of this treatment. Specialized referral units for patients with severe and persistent IF can produce a high percentage of clinically effective and cost-effective outcomes.

Adaptation, Physiological↗