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At least 1,063 records · Page 59Linked to original sources
PubMed1998

Appropriate nutritional support in acute and complicated Crohn's disease.

Crohn's disease is frequently complicated by protein-calorie malnutrition. Four common clinical presentations of Crohn's disease include acute exacerbations or flares of disease, intestinal obstruction, fistulizing disease, and perianal disease. In this review, we examine the role of nutritional support in these clinical scenarios. Nutritional support is important for maintaining functional status and preventing loss of lean tissue. Determinants of lean-tissue loss include severity of underlying injury, baseline nutritional status, and duration of inadequate nutrition. One of the clinically useful measures of nutritional status is the nutritional risk index (NRI) defined on the basis of the serum albumin and weight loss. Nutritional support is important in severely malnourished patients (NRI < 83). Enteral nutrition is the route of choice, provided there are no contraindications to using the gastrointestinal tract. In acute exacerbations of Crohn's disease, enteral nutrition also has a role in the primary management of disease although it is not as effective as corticosteroids in inducing remission. The mechanisms are poorly understood and the most effective enteral formulation needs to be determined. Total parenteral nutrition is justified in severely malnourished Crohn's disease patients who are unable to tolerate enteral feeding or in whom enteral feeding is contraindicated. More clinical studies are needed on the assessment of malnutrition in Crohn's disease, the effects of nutritional management on functional status, and the timing of nutritional intervention.

Acute Disease↗
PubMed1996

Complication of Laparoscopic Coagulation of an Endometrioma Surface

A 32-year-old infertile woman with a 9-cm right ovarian endometrioma with severe adhesions to nearby organs was treated with coagulation of the surface of the endometrioma during laparoscopy. Ultrasonography 6 months later showed a normal pregnancy with an 8-cm ovarian cyst. After a normal delivery at term, while cutting the adhesions on the right side, 200 ml of pus was released, the origin of which was not known. Another endometrioma was present on the left ovary. A drain was inserted into the peritoneal cavity and the operation was completed. Five months later the woman returned with a painful point of redness on the skin of her abdomen. Ultrasonography revealed an 8-week pregnancy. We drained the pus and the patient was discharged. The result of the culture was Escherichia coli. We believe this is a case of intestinal fistula caused by coagulation of the surface of the endometrioma in the first operation.

Journal Article↗
PubMed2001

Intestinointestinal inhibitory reflexes: effect of distension on intestinal slow waves.

The motor response induced by intraluminal distension of the small intestine has been well investigated. However, little is known of the myoelectrical response to intraluminal distension. The aim of this study was to investigate the effects of oral- and anal-side distension on jejunal slow waves in dogs. The study was performed in 10 healthy female hound dogs implanted with three pairs of electrodes on the jejunum and an intestinal fistula. The first study session was designed to investigate the effects of anal-side distension on jejunal myoelectrical activity in fasting state. The protocol consisted of a 30-min baseline recording, a 30-min recording during anal-side balloon distension located 5 cm distal to the most distal pair of electrodes, and another 30-min recording after distension. The second session was designed to investigate the effect of oral-side distension with the balloon 5 cm proximal to the most proximal pair of electrodes. Jejunal slow waves were severely impaired by both anal- and oral-side distension. The dominant power was significantly reduced from -2.96 +/- 0.90 dB at baseline to -6.00 +/- 0.64 dB during anal-side distension (P < 0.0005) and from -3.90 +/- 0.85 dB at baseline to -7.17 +/- 0.90 dB during oral-side distension (P < 0.001). The percentage of normal 17 to 22-cpm slow waves was significantly decreased from 97.39 +/- 0.88% to 83.48 +/- 3.12% during anal-side distension (P < 0.0005) and from 92.49 +/- 2.42% to 68.80 +/- 7.24% during oral-side distension (P < 0.002). The percentage of slow wave coupling was decreased from 95.08 +/- 2.27% to 52.48 +/- 7.73% during anal-side distension (P < 0.0005) and from 84.82 +/- 6.75% to 49.21 +/- 8.91% during oral-side distension (P < 0.001). The instability coefficient of the dominant frequency was significantly increased during anal-side distension. In conclusion, intraluminal distension of the jejunum severely impairs jejunal slow waves. The slow waves on both sides of distension become less coupled, less regular, and are of lower amplitude.

Animals↗
PubMed2003

[Crohn disease--surgical standards].

Surgery for Crohn's disease is restricted to the treatment of complications. Even then, nearly all patients with Crohn's disease must be operated on at least once in lifetime. Surgical concepts base on the right timing for the operation, interventional drainage of abscesses, accurate pre-operative work-up to determine the extent of inflammation, and bowel conserving operation techniques. Respecting these principles, surgery for Crohn's disease can be performed with low complication rates restoring in most cases patients' quality of life.

Anastomosis, Surgical↗
PubMed1999

Neoadjuvant therapy and bladder substitute for invasive bladder cancer: 20 years experience at Tohoku University.

BACKGROUND: Neobladder, using the intestine, was performed after neoadjuvant therapy and total cystectomy as a treatment for invasive bladder cancer. METHODS: Between January 1977 and April 1997, an ileocecal neobladder was used for 23 patients and a sigmoid neobladder was chosen for use in 32 patients. For the diagnosis of invasive bladder cancer and the evaluation of neoadjuvant therapy, we used whole-layer core biopsy (WLCB) of the bladder tumor and fine needle aspiration biopsy (FNAB) of pelvic lymph nodes after bipedal lymphography. For neoadjuvant therapy, two to four courses of internal iliac arterial infusion chemotherapy (IIA) were undertaken in 32 patients. Five patients were treated with IIA combined with 40 Gy irradiation to the pelvic space. RESULTS: Pretreatment WLCB revealed a tumor of stage T2b or greater in 10 patients. After neoadjuvant therapy, three patients were down-staged to pT0. In five patients, pretreatment FNAB revealed pelvic lymph node metastases that were not detected by computed tomography or magnetic resonance imaging. Fine needle aspiration biopsy post-neoadjuvant therapy revealed tumor stage N0 in all patients and lymph node dissection revealed pN0 in four patients. Of the five patients who received 40 Gy irradiation, none had any postoperative complications, such as intestinal fistula or urinary leakage. Four male patients (10%) had urethral recurrence, but all were successfully treated by transurethral resection. Two patients treated prior to 1985 experienced local recurrence. Neither was treated by neoadjuvant therapy. Eight patients who died after 1985 had metastatic cancer, but none had local recurrence. None of the patients who received a sigmoid neobladder required clean intermittent catheterization or had bilateral vesico-ureteral reflux. CONCLUSIONS: Neoadjuvant therapy seems to reduce local recurrence in invasive bladder cancer. The sigmoid colon may be suitable for neobladder.

Adult↗
PubMed2001

Gastrointestinal problems in patients with advanced gynaecological malignancy.

Gastrointestinal problems are among the most common problems encountered in the management of women with far advanced gynaecological malignancy. They frequently have a multifactorial aetiology and may require a number of different strategies for effective management. Recognition of the central role of alimentary function in human life is essential to effective treatment. Elucidation of the probable cause of each problem is essential. A thorough knowledge of the natural history of the disease and the patient's current status and future prospects is needed to ensure the highest standard of care for the individual suffering from the problem.

Anorexia↗
PubMed1979

[Crohn's disease of the colon (author's transl)].

Despite the availability of endoscopy, radiological examination remains an essential method in the investigation of Crohn's disease. Various authors agree that it has an accuracy of 75% (1, 8, 14, 20). In our experience accuracy is somewhere between 70 and 85%. These figures depend on the fact that in about 16% histology is also unable to make a definite diagnosis. Crohn's disease of the large bowel is of significance since it is often misinterpreted as ulcerative colitis, because in 10% of cases there is no involvement of the terminal ileum. The final diagnosis depends on the summation of the individual features whose individual significance must be considered. Malignant involvement of the peritoneum, which has not been extensively described in the radiological literature, may result in changes in the wall of the colon and lead to an appearance resembling Crohn's disease, with consequent errors in diagnosis.

Abscess↗
PubMed1982

New methods of endoscopic diagnosis of digestive tract diseases in the Soviet Union.

The development of new methods and apparatus for laparoscopy and investigations of the small and large intestine makes it possible considerably to extend the boundaries of examinations. The method of fistuloscopy makes it possible to obtain more precise information about the branching and presence of cavities which cannot be seen during routine fistulography. The described methods and instruments are a stage on the road towards further improvement of the potentialities of endoscopy.

Colonic Diseases↗
PubMed1982

A radiologic study of chronic radiation-induced injuries of the small intestine and colon.

On the basis of 144 radiation-induced intestinal and colorectal lesions seen in 109 patients, the authors review the radiologic aspects associated with such affections. Two points are emphasized: (1) the chronic and still active nature of radiation-induced injury which can explain the appearance of lesions more than 10 years after irradiation, and (2) the locoregional nature of the affection which warrants systematic exploration of the urinary tract by intravenous pyelography in addition to radiologic and endoscopic investigation of the digestive tract. The authors also advise an echography and/or CT scan to detect any neoplastic recurrence.

Barium Sulfate↗
PubMed1986

[Atypical initial manifestation of abdominal aortic aneurysm. The causes of diagnostic and therapeutic errors].

Initial manifestations of an abdominal aortic aneurysm may, depending on its site, morphology and direction of expansion, imitate numerous other intraabdominal diseases, but also lesions of peripheral vessels, vertebral column and spine. In this way they may give rise to errors of diagnosis and treatment. An abdominal aortic aneurysm should be considered especially in case of unclear gastrointestinal bleeding or abnormal intestinal passage (ischaemic colitis; mechanical displacement or compression of the duodenal-jejunal flexure and of the small-intestinal mesentery). In case of massive or recurrent gastrointestinal bleeding, especially in combination with a septicaemia, an aorto-intestinal fistula should be considered in the differential diagnosis. Radicular compression syndrome may be caused by an aortic aneurysm which is usually contained and predominantly suprarenal (to be considered especially once a herniated disk has been excluded by computed tomography). The same is true for unclear bone defects of the lumbar vertebrae (erosion by a penetrating aneurysm). Noninvasive methods, such as upper abdominal sonography, computed tomography and relatively minor invasive transvenous digital subtraction angiography now predominate in the definitive diagnosis of abdominal aortic aneurysm.

Aged↗