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At least 1,549 records · Page 86Linked to original sources
PubMed1996

Surgery for inflammatory bowel disease in Singapore.

Inflammatory bowel disease is uncommon in Asians and reports of surgery in these populations are rare. Eighty-two patients with inflammatory bowel disease were seen in the Department of Colorectal Surgery over a five-year period (1989-1994). Twenty-three patients underwent surgery for their disease. There were 12 males and 11 females with 16 Chinese, 4 Indians and 3 Malays. Twelve had Crohn's disease and 11, ulcerative colitis. The majority of patients with Crohn's disease had emergency surgery for bleeding, perforation, abdominal masses and intestinal fistulae. Fifty percent of these had the diagnosis made intraoperatively or post-operatively. Surgery for ulcerative colitis was indicated because of multiple relapses, non-response to medical treatment, side effects of therapy or malignant change. The median age at surgery of patients with Crohn's disease and ulcerative colitis was 39 years (range 24-84) and 40 (range 18-60) respectively. The median follow-up was 22.4 months (range 9-50). The results of surgical therapy in these patients show that surgery when indicated can be done with minimum morbidity and mortality.

Adult↗
PubMed1977

Ruptured tuboovarian abscess. Is hysterectomy necessary?

The use of conservative pelvic surgery combined with intra- and postoperative antibiotic peritoneal lavage has been evaluated in 113 women with generalized peritonitis due to ruptured tuboovarian abscess. Mortality was 7.1% and hysterectomy was only required in 3% of cases. Hormonal and menstrual functions were retained in 73.5% and the potential for future pregnancy in 42.5%. Further surgery was required in 17.5% of the patients. These results are contrasted with recent series of comparable size in which the mortality and morbidity were similar but the frequency of hysterectomy ranged from 70--100%. It is concluded that hysterectomy is not necessary in the management of ruptured tuboovarian abscess if the major source of sepsis is removed and adequate peritoneal drainage is provided by the use of lavage.

Abscess↗
PubMed1997

Five-year audit of the acute complications of diverticular disease.

BACKGROUND: The objective of this study was to audit the presentation and outcome for patients admitted with an acute complication of diverticular disease. METHODS: This study was a retrospective review of 418 admissions with an acute complication of diverticular disease over a 5-year interval. RESULTS: Of the 418 admissions, 15 patients were eventually found to have an alternative diagnosis. Some 403 patients were studied further. The overall mortality rate in this group was 5.7 per cent. A total of 113 patients (28.0 per cent) required an operation and in this group the mortality rate was 17.7 per cent. All deaths occurred in patients who had surgery for septic complications or bowel obstruction. Of the patients who had surgery, 90.2 per cent had a resection of the involved colon. One-third of these had a primary anastomosis; the remainder underwent Hartmann's procedure. Some 83 patients had a stoma fashioned and of these 72 went on to have the stoma closed. The median age of those who died after operation was 80 years. An American Society of Anesthesiologists (ASA) score of 3 or more, concurrent medical disease and shock on admission were all associated with a high mortality rate (P < 0.001). Some 30 per cent of patients were readmitted during this study with a further complication of diverticular disease. CONCLUSION: The mortality rate after surgery for acute diverticular disease remains excessive and a high-risk group can be identified before operation. A policy of resection and anastomosis appears justified for selected patients. Adopting a practice of interval elective sigmoid colectomy after admission with acute diverticulitis might prevent readmission with further complications.

Abscess↗
PubMedDate not supplied

Surgical management of patients with radiation enteritis.

To improve the surgical outcome in patients with radiation enteritis, 18 female cases were analyzed. Out of the 18 cases, 3 (16.7%) were treated conservatively while 15 (83.3%) underwent surgical procedures. Thirteen out of 14 patients (92.8%) with ileus underwent an operation. The overall mortality was 22.2% (4 out of 18 cases). However, no significant difference in the mortality between the operated and non-operated cases was observed. Although an analysis of the 15 operated cases did not reveal any significant factors that might have affected the prognosis, all four patients who underwent a bypass operation showed a good postoperative course, with only one excepting being a patient suffering from malnutrition. Although only a small number of patients were included in this study, these results suggest that 1) surgeons should not hesitate to operate on patients with radiation enteritis demonstrating ileus, and 2) a bypass operation may be one surgical alternative in the presence of massive adhesion or for patients at high risk for a standard operation.

Adult↗
PubMed1997

Experience with the use of polytetrafluoroethylene pericardial membrane (preclude pericardial membrane) for retroperitoneal closure after abdominal aortic surgery.

OBJECTIVE: The purpose of the present publication is to assess the outcome after closure of the retroperitoneum with a patch of polytetrafluorethylene surgical membrane (Preclude Pericardial Membrane. PPM) after abdominal aortic surgery. EXPERIMENTAL DESIGN: Retrospective review of 7 operated patients with a patch of PPM covering their abdominal aortic synthetic graft. Twenty-five months of follow up. SETTING: Institutional and University Hospital. PATIENTS AND PARTICIPANTS: Between June 1993 and February 1995, in 7 consecutive male patients (mean age 62 years) a patch of PPM was applied to their retroperitoneum after undergoing surgery in their infrarenal abdominal aorta. One patient had total obliteration of the distal abdominal aorta (Leriche syndrome) and the remaining 6 had a small infrarenal abdominal aortic aneurysm measuring in transverse diameter between 4 and 5 centimetres. INTERVENTIONS: The patient with Leriche Syndrome had an end to end aorto bifemoral bypass graft and the 6 cases with abdominal aortic aneurysm underwent resection of the aneurysm plus interposition of a straight vascular graft (3 cases), straight vascular graft and extension with other graft to the femoral artery (1 case) and bifurcated aorto-bifemoral graft (2 cases). MEASURES: Clinical outcome and evolution of the patients, absence of complications derived from the PPM. RESULTS: There was no hospital mortality. All patients are alive after a mean follow-up of 25 months. Two patients were reoperated in the early postoperative period, one of them required a limited resection of the jejunum. There have been no complications related to the PPM. CONCLUSIONS: In order to avoid secondary aorto-intestinal fistulas, in cases where complete coverage and isolation of an artificial vascular graft in the abdominal aorta can not be achieved, the use of a sheet of PPM separating the arterial graft from the gastrointestinal system may be an useful alternative.

Adult↗
PubMed1997

[Major complications of percutaneous nephrolithotripsy (PCNL). Analysis of our cases].

The major complications occurred in 140 cases of percutaneous nephrolithotomy, from March 1988 to December 1996 are studied. They were: 1 important hemorrhage with secondary nephrectomy, 1 intestinal fistula resolved with parenteral therapy, 1 hyponatriemic syndrome which required an intraperitoneal drainage and 1 global kidney functional exclusion after 3 months. Etiopathogenesis and suggestions for prevention are discussed as well as the necessity of adequate training.

Aged↗
PubMed1995

[Entero-vesical fistula in primary lymphoma of the small intestine].

The introduction of self-expandable urethral endoprotheses for the management of relapsing urethral stenosis has required the development of a minimally invasive therapeutical approach of widespread acceptance by the urological community. The reason for its success is the simplicity of implantation and the low rate of complications up to date. This paper reports on a patient carrying a ¿Urolume¿ urethral endoprothesis for a relapsing bulbar urethral stenosis, which two years after implantation presents re-stenosis secondary to endoluminal inflammatory tissue growth. After two failure endoscopic resections, endoscopic removal of the prosthesis was required. Currently the patient carries a ¿Urocoil¿ spiral endoprosthesis to avoid tissular reaction. The therapeutical aspects found in the literature are reviewed, emphasizing the need of follow-up to detect complications, to improve indications and to select those patients that may be candidates for this treatment.

Humans↗