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At least 865 records · Page 48Linked to original sources
PubMed1975

Acute pancreatitis.

A general survey of acute pancreatitis has been given, with the emphasis on diagnosis and management. Attention is drawn to the difficulties that sometimes arise in the accurate diagnosis of the acute upper abdominal illness and in the assessment of complications arising during the treatment of acute pancreatitis. The importance of the routine use of 'Trasylol' (aprotinin) during the acute attack is emphasized. The indications for operation are discussed in relation to achieving accurate early diagnosis, the management of certain complications and the prevention of further attacks. The mortality rate of acute pancreatitis has dropped considerably with improvement in the diagnostic rate and the routine use of intensive conservative treatment, but the prognosis of septic complications is still grave and will be improved only by the universal recognition that pancreatic suppuration is no ordinary septic process and that the timing of surgical drainage is critical.

Acute Disease↗
PubMed1991

Spectrum of intestinal failure in a specialised unit.

300 consecutive admissions over 7 years to a purpose-built intestinal failure unit are reviewed. The commonest underlying condition was Crohn's disease (42%), and the commonest complication precipitating admission was intestinal fistula (42%). Total parenteral nutrition was used in 85% and surgery in 50%. A multidisciplinary approach to management gave a high success rate--90% of patients were discharged from hospital, although nearly 25% needed home parental nutrition. These results suggest that chronic intestinal failure should be managed in specialised units in the same manner as other types of organ failure.

Adolescent↗
PubMed1991

[Treatment of perforated appendicular peritonitis].

The article analyses the results of treatment of 104 patients with generalized appendicular peritonitis. Sixty-four patients were admitted for acute disease and 40 patients for chronic disease. Twenty-three patients had been previously subjected to appendectomy for destructive appendicitis at other clinics. Among 100 patients who were operated on 60 were treated by appendectomy: cecostomy was established in 5 and ileostomy in 3 patients with incompetence of the stump of the vermiform process; in nonviability of the wall of the small intestine (11 patients) the wall was resected and an anastomosis formed in 7 and enterostomy was performed in 4 cases. The method of "closed evisceration" was employed in 24 patients with neglected forms of peritonitis. Thirty-three hemosorption sessions were conducted in 30 patients in the terminal stage of peritonitis. Four patients died in the preoperative period and 12 died after the operation. Seventeen complications were encountered after the operation: intestinal fistulas 4, abscess of Douglas' space 2, suppuration of wounds 5, and pneumonia 6.

Adult↗
PubMed2003

Surgical management of intestinal failure.

Surgery plays a key role in the management of both acute and, less frequently, chronic intestinal failure. Acute intestinal failure frequently requires surgical treatment when it arises as a consequence of intestinal fistulation or obstruction. In specialised clinical practice approximately 50% of acute intestinal failure is associated with intestinal fistulas and in approximately 50% of patients, this condition arises as part of the natural history or complicating treatment for Crohn's disease. A considerable proportion of such patients have abdominal infection and present complex nutritional and metabolic problems. The most important aspect of the surgical management of patients with acute intestinal failure associated with intra-abdominal infection is management of sepsis, since recovery is unlikely in the presence of active infection. Moreover, effective nutritional support and restoration of body composition is not possible if sepsis remains unresolved. Surgical strategies to deal with intra-abdominal infection may involve percutaneous drainage, laparotomy and resection of fistulating segments of intestine and, when infection is persistent and contamination extensive, laparostomy (a technique in which the abdomen is left open and allowed to heal by secondary intention). Surgical treatment should not only be timely and effective, but also aimed at preventing secondary damage to the small intestine, in order to minimise the risk of short bowel syndrome. In some cases a proximal defunctioning stoma may be required, with prolonged nutritional support, using either home total parenteral nutrition or feeding via the defunctioned distal gut (fistuloclysis), pending restoration of intestinal continuity. The role of surgical treatment for patients with short bowel syndrome is less clear. While surgery is frequently required for the management of complications of short bowel syndrome (including gallstones and possibly peptic ulcer disease), the role of intestinal lengthening and tapering procedures (to increase functional intestinal length), and artificial valves, reversed segments and colonic interposition (to reduce intestinal transit) remains controversial. For some patients with short bowel syndrome and, in particular, those with combined intestinal and hepatic failure, intestinal transplantation may become the treatment of choice as long-term results continue to improve.

Acute Disease↗
PubMed2006

Omentum prevents intestinal adhesions to mesh graft in abdominal infections and serosal defects.

BACKGROUND: Many studies have evaluated the use of grafts in the reconstruction of abdominal wall defects. In this study, the effects resulting from the presence or absence of the omentum were evaluated in the setting of infection or serosal defects in the formation of adhesions in abdominal closures using mesh grafts. METHODS: For this study, 60 Wistar albino rats were divided into six groups. A circular 3.79-cm(2) fascioperitoneal defect was created. After group-specific procedures, defects were reconstructed using polypropylene mesh grafts. In group C (control group), only a mesh graft recontruction was performed, whereas group O (O for omentectomy) underwent an omentectomy plus mesh closure. In group SD (serosal defect group), the cecum was abrased with a brush before mesh closure. Group SDO underwent cecal abrasion plus an omentectomy. In group I (infection group), the intraabdominal space was filled with 1 ml of solution containing 100,000 colony-forming units (CFUs) of Escherichia coli per milliliter. Group IO received the same same amount of E. coli solution plus an omentectomy before mesh closure. After 28 days, the groups were evaluated by intraabdominal and blood cultures, grading of intraabdominal adhesions, graft-organ adhesions, proportion of adhesions to graft size, and histopathologic studies. The results were statistically evaluated using one-way variant analysis and Scheffe's and Fisher's definite chi-square tests. RESULTS: For the groups in which the greater omentum was preserved, intestinal adhesions to the graft surface were less frequently observed, especially in cases with intraabdominal infections and serosal defects (p < 0.05). CONCLUSIONS: Preservation of the greater omentum reduces the formation of intestinal adhesions, especially in cases with underlying infections and serosal defects in abdominal closures using mesh grafts. This could be beneficial in related clinical situations in lowering the rate of intestinal fistulas, erosions, and obstructions that can be attributed to the formation of adhesions.

Abdomen↗
PubMed1981

Immune response in the bovine mammary gland after intestinal, local, and systemic immunization.

The immune response in mammary glands of cattle was measured after intestinal, local, and systemic immunization with T4 bacteriophage. Nonlactating pregnant cows were immunized by infusions into the intestine or mammary gland and by subcutaneous injections in the region of the prescapular or external inguinal lymph nodes. Titers of antibodies of different isotypes were measured in serum and in lacteal secretions by enzyme-linked immunosorbent assay, and numbers of cells producing antibodies of each isotype were determined in lacteal secretions by the Jerne plaque assay. Substantial increases in immunoglobulin G subclass 1 (IgG1) and IgG2 antibody titers were detected in serum and lacteal secretions of animals immunized through an intestinal fistula. IgM and IgA antibody responses were low or undetectable. Low numbers of IgA and IgG1 plaque-forming cells were occasionally detected. It is proposed on the basis of these data that migration of antigen-stimulated IgG lymphoblasts, and perhaps of antigen, to spleen and peripheral lymph nodes may be dominant events after intestinal immunization of ruminants. This is consistent with the predominance of serum-derived IgG antibodies in colostrum and milk. Intramammary infusion of antigen gave rise to increases in antibody titers in all classes which were greater not only in lacteal secretions but also in blood serum than with either systemic route used. There was clear evidence from relative antibody titers for local synthesis of antibodies, principally IgA and IgG1, in the immunized glands. Comparison of IgA titers in secretions from the immunized glands with those in serum also suggested that locally synthesized IgA antibodies may have contributed in some measure to serum titers. Local synthesis in both immunized and nonimmunized glands was also reflected by the presence of increased numbers of IgA and IgG1 plaque-forming cells. It is hypothesized that antibody-forming cells responsible for local synthesis originated in lymphoid tissue within the mammary gland or from peripheral lymph nodes, depending upon the route of immunization.

Animals↗
PubMed1989

[The role of Treitz' ligament in regulating the evacuation of solid food from the duodenum].

In the chronic experiments on dogs by means of modified method of multiple drainage of the intestinal fistulas, the effect of the Treitz ligament transection on dynamics of solid carbohydrate food evacuation from the duodenum was studied. It was established that in the norm, evacuation from the duodenum was submitted to exponential law and depended on absolute quantity of food evacuated from the stomach. After the Treitz ligament transection, the evacuation through intestine had a non-exponential character. The operation led to disturbance in co-ordination between evacuatory function of the stomach and that of duodenum, and also had the depressive effect on intestinal emptying. The conclusion is made of the functional role of the Treitz ligament as active regulator of solid food evacuation from the duodenum.

Animals↗
PubMed1983

Complications of diverticular disease: a review of the barium enema findings.

Complications of diverticular disease are among the most common causes of all acute hospital admissions. The barium enema is the most important investigation in these patients, both for establishing the diagnosis and planning their management. However, few comprehensive reviews have described the radiological appearances of the complications of diverticular disease. We describe the radiological features and emphasize the diagnostic difficulties that may occur.

Abscess↗