[Surgical procedure in Crohn disease].
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Anastomosis, Surgical↗
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Clinical experience of the Kock continent ileal urinary reservoir in 20 cases focusing on complications.
From August 1986 through July 1990, 20 patients underwent construction of the Kock continent ileal reservoir and were observed for more than three months. The early complications within the first 3 months were wound infection in four patients (20%), leakage at uretero-intestinal anastomosis in three patients (15%), prolapse of efferent limb and ileus in two patients (10%) and reflux, ureteral stenosis, intestinal fistula and postoperative pancreatitis in one patient (5%). The three late complications included stone formation in two patients and stenosis at an afferent limb in one patient. The stenosis occurred at the position of Dacron collar. The patients were divided into two groups and we compared the recent 10 patients with the initial 10 patients on complications and end results. In the initial group, 8 patients (80%) had 14 complications. In the recent group, 4 patients had 4 complications. The early complications have been reduced with the increase of Kock pouch operation. The result of the recent group was better than that of the initial group. Frequency of postoperative hydronephrosis in patients with Kock pouch was investigated. In nine patients (45%) the minimal hydronephrosis occurred within the first two months and in 5 patients (25%) three months after the operation. It had a normalizing tendency. The maximum pouch pressure at the pouch volume of 400 to 500 ml was not significantly high (37.9 +/- 12.2 cmH2O, mean +/- S.D.).
Adult↗
[Intraperitoneal placement of composite implants--polyester mesh coated with polyurethane in experimental study].
INTRODUCTION: Polyester and polypropylene are currently the most frequently materials for repair of abdominal wall hernias. Most of the mesh materials used intraperitoneally in repair of hernias lead to considerable adhesion formation, as well as the resultant bowel obstruction and intestinal fistula formation. Some newer composite products can reduce risk of adhesion formation. The aim of this experimental study is testing properties of patch, composite structure, characterised by the association of a non-woven textile structure made from polyester multifilaments, and a fine coat of polyurethane on one side, placed intraperitoneally in rat. MATERIALS AND METHODS: The experiment was carried out with 21 laboratory rats. Laboratory animals were divided into 3 groups - 7 animals in a group. In the first group the check-up laparotomy was realized the 7th day, in the second group the 14th day and in the third group the 28th day after the intraperitoneal implantation of a composite mesh. All animals were sacrificed and adhesion scoring and histological evaluation of tissue specimens with implanted mesh were done. RESULTS: A macroporous polyester mesh component supported an early and huge fibrous proliferation with a good adhesion onto the abdomen wall. On the other hand, a microporous polyurethane layer led to the creation of a fibrous pocket. During the check-up laparotomy, the larger adhesion of omentum to the fibrous layer, covering the polyurethane side of implanted mesh, were located in most laboratory rats - in all the groups. CONCLUSION: We can presume that the protective polyurethane layer does not eliminate risk of adhesion formation in rat.
Animals↗
[Diagnostic timing in complicated and uncomplicated diverticular disease].
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Angiography↗
[Controlled therapeutic "evisceration" in so-called "terminal" peritonitis (author's transl)].
Absence of closure of the abdominal wound following reoperation for severe peritonitis is an additional therapeutic technique in dealing with peritoneal infection. However, this technique poses the problem of covering the loops of the small intestine in order to avoid fistulisation in the exposed viscera. The loops are initially protected by a "wound protector" or covered with a plate of polyurethane foam. Secondarily, when the peritoneal cavity is clean, the open wound is converted to an incisional hernia by a thin dermo-epidermal graft in strips, applied to the granulation tissue. This technique is effective and would seem to be simpler than detachments, plasties and relieving incisions.
Abdominal Muscles↗
[Surgical treatment of complicated forms of abdominal tuberculosis].
The results of surgical treatment were analyzed in 31 patients with complicated abdominal tuberculosis in 2001 to 2003. Before 2003, a surgical intervention was mainly palliative and reduced to the suturing of perforative tuberculous ulcers limited to the resections of the small intestine and to the separation of adhesions (Group 1, n=17). Then radical surgical interventions were undertaken in the volume of extended right-sided hemicolectomies, by removing caseously changed mesenteric lymph nodes (Group 2, n=14). Postoperative peritoneal lavage was performed, by using antituberculous agents. Twelve and 5 patients died in Groups 1 and 2, respectively. The authors suggest that radical surgical interventions for complicated abdominal tuberculosis can improve the outcomes of treatment of this disease.
Antitubercular Agents↗
Cytoreductive surgery followed by intra peritoneal hyperthermic perfusion in the treatment of peritoneal surface malignancies: morbidity and mortality with closed abdomen technique.
AIMS: The purpose of this phase II study was to analyze the morbidity and mortality of cytoreductive surgery (CRS) + intraperitoneal hyperthermic perfusion (IPHP) in the treatment of peritoneal surface malignancies. PATIENTS AND METHODS: One hundred and sixty four patients (36 ovarian cancer, 32 abdominal sarcomatosis, 34 peritoneal mesothelioma, 36 pseudomyxoma peritonei, 12 gastric cancer, 8 colon adenocarcinoma and 8 from other origins) underwent 166 procedures. Two patients underwent the intervention twice due to disease relapse. The mean follow-up was 20.6 months (range: 0.4 - 91.3). The mean age was 52 years (range: 24-76). CRS was performed with peritonectomy procedures. IPHP through Closed abdominal technique was conducted with preheated (42.5 degrees) perfusate containing cisplatin+mitomycin C or cisplatin+doxorubicin for 60/90 minutes. RESULTS: grade 3/4 morbidity rate was 12.0%. Some frequent post-operatory complications were intestinal fistulas (17), respiratory (5) and abdominal bleeding (4). Multivariate analysis with logistic regression model with the backward elimination method identified carcinomatosis extension (OR: 5.3, CI95%: 1.2-24.5) as the best predictor of morbidity grade 3/4. Four patients presented grade 3/4 toxicity. Operative mortality rate was 0.6%. CONCLUSIONS: CRS+ IPHP presented acceptable morbidity 3/4 toxicity and mortality rates what support the need to be tested in prospective phase III clinical trial.
Adult↗
[A case of advanced gastric cancer successfully treated by TS-1 and CDDP after jejunostomy].
A 65-year-old female with unresectable advanced gastric cancer accompanied by multiple lung metastases underwent jejunostomy and was treated with TS-1 and CDDP. One course consisted of TS-1 (80 mg/day) via an intestinal fistula tube from days 1 to 14 followed by 14 days rest and CDDP (80 mg/day) was administered by 24-hour continuous intravenous infusion on day 8. After 3 courses, the primary tumor and lymph node metastases decreased in size (PR), and CT scan showed the multiple lung metastases had disappeared. Total gastrectomy (D 2) and splenectomy were performed after chemotherapy. The final diagnosis was Stage IIIA and the pathological response to chemotherapy was Grade 2. The patient has survived for over 14 months after surgery and has presented no signs of recurrence.
Aged↗
[Clinical analysis for iatrogenic injuries in the distal part of common bile duct].
OBJECTIVE: To investigate the early diagnosis on iatrogenic injuries in distal part of common bile duct and the prevention of severe retroperitoneal infection. METHODS: From 1990 to 2004, 17 patients with bile duct injures in the distal part of common biliary tract were admitted. And the clinical data of the 17 cases were retrospectively analyzed. RESULTS: Of the 17 cases, the injuries of 15 cases were caused by the operation, and the injuries of the other 2 cases were caused in the process of removing the stone by endoscopic retrograde cholangiopancreatography (ERCP). The injuries of 14 cases were found during the operation, but the other one was not found in time. Before the operation, 16 cases were examined by B-type ultrasonography, 2 by MRCP and 6 by intraoperative choledocho-endoscope after the biliary tract exploration. Ten cases underwent perforating suture repair and T-tube drainage; 2 with Odd's sphincter incision and shaping; 2 with choledochojejunostomy; 1 with duodenum wall and bile duct repair and drainage. When the bile duct injured, the major findings during operation were bile duct explorer located out of the duodenum wall and bile duct, two or more than cleft in the distal part of common biliary tract found by choledocho-endoscopic examination, retroperitoneal edema and liquid accumulation found by irrigating water through T-tube, and/or retroperitoneal tissues stained blue by irrigating methylthioninium chloride through T-tube. The clinical manifestations after injuries were abdominal distention, abdominal pain, pain in the waist and back, fever and shock, et al. Thirteen cases were cured. And the syndromes included 1 case with intestinal fistula, 1 with incisional infection, 4 dead (3 died from infectious shock; 1 from bleeding in gastrectomy). CONCLUSIONS: The postoperative clinical manifestations for iatrogenic injuries in the distal part of common biliary tract lack specificity, CT examinations are necessary to doubtful patients. Early diagnosis and timely management can obtain better results, and can effectively lower severe retroperitoneal infection. The perfect preoperative imaging examinations and intraoperative choledocho-endoscopic examinations before the biliary tract exploration maybe reduce iatrogenic injuries in the distal part of common biliary tract.
Adult↗
[Overview of clinical occurrence of primary immunodeficiency disorders in children].
OBJECTIVE: More than one hundred primary immunodeficiency disorders have been discovered so far. But the incidence of these disorders in our country is still not clear, so we analyzed the clinical data of 93 children with primary immunodeficiency disorders seen in our hospital in recent 30 years to understand the occurrence of primary immunodeficiency disorders in children, to promote the clinicians to become familiar with these disorders, to improve the nationwide registry system and to establish the basis for the treatment and prevention in future. METHODS: To analyze the constituent ratio of the 93 children with primary immunodeficiency disorders seen in our hospital from 1974 to 2003, diagnostic and classification criteria were set by taking the proposal by International Union of Immunological Societies (IUIS) PID classification committee in 2003 into account. All the data were analyzed retrospectively. RESULTS: In the 93 children with primary immunodeficiency disorders, antibody deficiencies were the most frequent (39.8%) finding, followed by combined immunodeficiency, combined T- and B-cell disorders (22.6%), and T lymphocytic deficiencies alone (14.0%). Immunodeficiency with other major defects accounted for 12.9%, phagocytic disorders 9.7%, and complement deficiencies 1.1%. Thus, there seemed to be a tendency that the incidence increased with time. The incidence of these disorders has increased significantly as shown by 50 diagnosed cases in children with these disorders since 1996. Sixteen children died, with the highest mortality occurred with combined immunodeficiency. Seven children developed bronchiectasis. Two children suffered from persistent diarrhea while one of the two was complicated with persistent intestinal fistula. One child developed juvenile rheumatoid arthritis, another one with granulocytopenia and iridocyclitis, and the other with allergic purpura. The boys: girls ratio for all disorders was 3:1. The age of onset ranged from 10 days to 37 years of age. CONCLUSIONS: There are vast variety of primary immunodeficiency disorders in our area and antibody deficiency is the most common abnormality. Combined immunodeficiency has early onset age and high mortality rate. With the great improvement of the diagnostic techniques, these disorders have become a group of important disorders and all the clinicians should pay great attention to these disorders.
Adolescent↗
Use of somatostatin for complications occurring after liver transplantation.
Somatostatin can be helpful after liver transplantation in some well-defined indications. In uncontrolled digestive haemorrhage, a short course of somatostatin therapy can be of great help in controlling the acute bleeding and to avoid emergency laparotomy. Somatostatin could also be helpful in bilio-pancreato-intestinal fistula, but in this case its advantage over elective surgical treatment remains to be confirmed.
Acyclovir↗
[Continuous blood purification in the treatment of pediatric septic shock].
OBJECTIVE: To investigate the efficacy of continuous blood purification (CBP) and to explore its mechanism in the treatment of pediatric septic shock. METHODS: Nine children weighted 3.1 kg - 14.0 kg with septic shock were treated with continuous veno-venous hemofiltration (CVVH) which is also referred to as CBP with blood access of double-lumen hemodialysis catheter of 6.5 to 8Fr inserted via central vein, hemofilters of Minifilter plus (for children with body weight < 5 kg) or AV400s (for children with body weight > or = 5 kg), child's type extracorporeal circuit vessel and heparin anticoagulation. The replacement solution was delivered pre-dilution after 3 to 4 hours' post-dilution. The blood gas, clinical biochemical items, medium molecule substance (MMS) concentration in blood as well as capillary refill time (CRT), BP, urine output, vasopressors dosage were examined at a set of time points from the beginning to the end of the CVVH. RESULTS: Of the 9 children, 6 had acute renal failure (ARF), 3 had acute respiratory distress syndrome (ARDS), 5 were blood culture positive and all the 9 needed vasopressors to keep BP before CVVH. The blood pH was 7.14 +/- 0.23, base excess (BE) was -11.3 +/- 4.25 mmol/L, MMS was 3532 +/- 519 U/L, PO2/FiO2 was 188 +/- 33, CRT > 5 s, urine output was 0.85 +/- 0.52 ml/(kg.hr) and the adrenalin dosage 1.36 +/- 0.48 microg/(kg.min), and dopamine 16.35 +/- 3.27 microg/(kg.min) before CVVH. The patients' condition was improved much as demonstrated by pH 7.38 +/- 0.16, BE -0.28 +/- 1.37 mmol/L, MMS 2576 +/- 375 U/L, PO2/FiO2 285 +/- 63, CRT < 2 s, and the adrenalin dosage 0.08 +/- 0.04 microg/(kg.min) and dopamine 8.53 +/- 6.72 microg/(kg.min), urine output 2.9 +/- 1.6 ml/(kg.hr) after 24 hour treatment with CVVH. Of the 9 children, 2 died of MODS (1 intussusception complicated with intestine necrosis, 1 severe scald) and 1 was given up because of severe intestinal fistula, the other 6 children recovered at the end. CONCLUSION: CBP was effective in treatment of pediatric septic shock by improving the oxygenation, correcting metabolic acidosis, stabilizing BP, increasing the tissue perfusion and eliminating the medium molecule substances.
Acid-Base Equilibrium↗
[Myasthenia gravis and intestinal resection: is dehiscence likely to occur?].
Experimental and clinical data have proved that anticholinesterase drugs are responsible for vigorous peristaltic contractions and for an increase of the intraluminal pressure, because they determine muscarinic effects on the smooth muscle of the intestine both in small and large intestine. Therefore, a greater incidence of intestinal anastomotic disruption has been supposed when anticholinesterases are used both in the early postoperative period, to reverse curarization, and in myasthenic patients. The authors report a case of a patient with myasthenia gravis who received maximal doses of pyridostigmine and underwent left hemicolectomy and small intestine resection and afterwards total colectomy in order to treat a sigmoid perforated diverticulitis. In the postoperative course an anastomotic leak developed after both surgical operations. The authors believe that pyridostigmine could have had an important role in the pathogenesis of the leak and assert that, when an intestinal resection has to be performed in a myasthenic patient, it could be useful to reduce in the preoperative period the administration of anticholinesterase drugs and always perform a protective ileostomy.
Aged↗
[Reconstructive surgery after subtotal resection of the small intestine and placing the intestinal anastomosis].
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Adult↗
[Evaluation of metabolic disorders in surgical patients].
The paper treats the problems of metabolism derangement in surgical patients. Special emphasis is laid on the correction of metabolic abnormalities in the pre- and postoperative periods and on the use of parenteral feeding in surgical complications: incompetence of anastomosis sutures, peritonitis, intestinal fistulas, and so forth. The authors define the role of the drugs of directed action in such a severe pathology as hepatorenal insufficiency.
Amino Acids↗
[Surgical treatment of necrotizing hemorrhagic pancreatitis with a prolonged course].
The authors describe the course of acute haemorrhagic necrotizing pancreatitis complicated by prolonged septicaemia, the formation of abscesses, acute haemorrhage and a intestinal fistula--"Critically ill patient". Early surgical elimination of necrotic septic foci is the prerequisite of effective treatment and cure. In the diagnosis CT and magnetic resonance prove most useful. With the latter so far little experience as been assembled. Ultrasonographic visualization technique is insufficient for the diagnosis of focal changes in the area of the pancreas.
Acute Disease↗
[Surgical therapy of Crohn disease--definition of Crohn-specific surgery].
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Abscess↗
A case of zinc deficiency during long-term total parenteral nutrition.
A 54-year-old housewife received total parenteral nutrition (TPN) because of an intestinal fistula and total wound breakdown after an emergency operation for perforation of the ileum and diffuse peritonitis. The TPN regimen reversed the catabolism and resolved the abdominal wound and enterocutaneous fistula. Zinc and copper were not supplemented because there was no licensed parenteral trace element solution available. At week 17 of TPN, eczematoid dermatitis appeared on the face, nasolabial folds and chin, and the perineal area. These changes, coinciding with a serum zinc level of 20 micrograms/dl, were consistent with zinc deficiency. Zinc supplementation was commenced giving 6 mg of elemental zinc intravenously daily. The response to zinc therapy was very dramatic. Not only did the serum zinc level increase, but the skin changes returned to normal within 7 days. The patient gradually resumed her usual diet and TPN was discontinued after an approximate duration of 21 weeks. She was later discharged in good health.
Copper↗