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PubMed1950

Considerations of postoperative electrolyte and fluid replacement.

The most important postoperative fluid considerations are maintenance of adequate urinary output, of blood volume, and of extracellular and interstitial cell water and electrolytes. Normal urinary output is between 1,000 and 1,500 cc. daily. A fluid intake of 2,000 cc. of 5 per cent dextrose in distilled water, plus 500 cc. of normal saline solution, will insure this amount of urinary output. The use of 5 per cent dextrose solutions in distilled water provides fluid, retards the protein catabolism of the body, and spares electrolytes. Irradiated plasma is the only intravenous solution which will adequately supply protein in amounts to maintain nitrogen equilibrium. Protein hydrolysates in the absence of adequate caloric intake do not provide enough protein for nitrogen balance. The role of the potassium ion is ordinarily not a consideration in postoperative fluid management. It becomes a consideration in the presence of a large amount of drainage from wounds or abscess cavities, nasogastric suction, or intestinal fistulae. It also must be given attention in cases in which parenteral administration of fluids is necessary for a prolonged period.

Blood Volume↗
PubMed1992

[De-diversions. Indications, techniques, and complications].

Today it is possible to restore the continuity of the urinary tract and to correct the underlying condition that had prompted the diversion procedure. Patients with a Bricker cutaneous ureteroileostomy will essentially benefit from this possibility. However, they must be carefully evaluated and meet the following criteria: patients with upper urinary tract disorders and/or symptoms arising from a malfunctioning urinary diversion, those who refuse a stoma for social or personal reasons, those requiring renal transplantation and those who had undergone urinary diversion for pathologies that can be resolved otherwise today. Undiversion, however, is not free from complications, which may present early (wound infection, suprapubic or intestinal fistula, irritation syndromes, mucus secretion) or late (diminished renal function, incontinence or urinary obstruction, electrolyte imbalance or problems arising from the artificial sphincter. In carefully selected patients, therefore, undiversion permits amending a surgical indication which, in the light of current knowledge and possibilities, can be resolved otherwise.

Adult↗
PubMed1992

[Surgical staplers. Urologic surgery with intestines].

Since the late 1980s, different reservoirs and bladder substitution techniques have been added to the urological surgical armamentarium. The necessary use of an intestinal segment--generally detubularized--make these surgical procedures complicated and time-consuming. Furthermore, problems are encountered postoperatively due to the important morbidity arising from these procedures. The present article describes our experience with mechanical sutures and resorbable material. Although the results have not been analyzed, our initial experience at the Miguel Servet Hospital has shown that these devices significantly facilitate the operative procedure, thereby reducing the incidence of urinary and intestinal fistulas. Although there is an evident risk of calculi formation, complicated solutions are not required and the biological tolerance to the metal sutures is excellent.

Humans↗
PubMed1992

[The classification of ileostomies].

From experience in the treatment of 527 patients the authors suggested an original classification of ileostomy. The systematization was based on the following criteria: the object of ileostomy, the shape and method for formation of the opening, the peculiarities of its construction, localization, functions, as well as the nature of complications linked with ileostomy. The suggested classification takes into account the modern concept on artificially formed intestinal fistulas, and gives a complete idea of patients with ileostomy. The use of the principles of the suggested classification in practice allows a rational variant of ileostomy to be chosen according to the existing conditions and effective measures for rehabilitation of patients with ileostomy to be marked out later.

Humans↗