Innovation in colostomy management: Symphony.
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The expedience of using a portion of the large intestine as a colontransplant which has a two-trunk disloading stoma is substantiated. The operative method was successfully used in 6 cases.
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Total parenteral nutrition or elemental diet has frequently replaced the use of a proximal stoma. Since 1969, data on patients receiving these non-residue nutritional methods have been collated daily; there were 63 patients where the surgeon believed that a proximal stoma would otherwise have been indicated. In 35 patients, these methods were used prophylactically perioperatively and in 28 patients, they were instituted postoperatively after complications occurred; in both groups, there was a very high rate of successful outcome. Modern nutritional support avoided fecal bulk while maintaining nutrition, and appeared to accomplish the equivalent of a diverting proximal stoma with considerable success in other than Crohn's disease.
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Tegafur (FT-207) suppositories were administered at a rate of 750 mg via the artificial anus (ST Group) following surgery of rectal cancer. Comparative studies were conducted of changes in blood concentrations of 5-FU and tegafur at the time of initial administration and following one week of continuous use for the low-anterior resection cases (LA Group) and the rectal administration cases (RE Group). FT-207 concentration at initial administration was low in the ST group compared to those for both LA and RE groups which received anal administration of the drug, but only little changes were noted. Blood concentration one hour after administration was 11.1 micrograms/ml, elevated to 14.3 micrograms/ml at two hours, and remained at 10 micrograms/ml and above for six hours following administration. The ST group 5-FU concentrations at two, four and six hours after administration were significantly lower than those in the RE group but the changes were little. Blood concentrations were 0.015 microgram/ml at one hour after administration, 0.017 micrograms/ml at two hours and maintained virtually the same level thereafter. An effective concentration of 0.012 microgram/ml was maintained even at ten hours following administration. After one week of administration of the suppositories, the ST group showed the lowest concentration among three groups, but it was approximately double compared to the initial concentration; FT-207 showed nearly the same concentration in the LA group and 5-FU blood concentration was 0.025 microgram/ml at one hour after administration, reached to a maximum of 0.030 microgram/ml at two hours and maintained 0.020 microgram/ml and higher at ten hours. 5-FU concentration in the LA and RE groups after one week of continuous administration showed a dual-peaked pattern. No patient with an abnormal artificial anus was involved in this study. The artificial anus is thought to be an adequate and effective administration route of FT-207 suppositories.