Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0036690 (sepsis)
 59,461 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The aim of this study was to determine the long-term outcome among 390 patients with ulcerative colitis who underwent ileal J pouch-anal anastomosis and whether patient or operative factors influenced results. The combined operative morbidity rate for the pouch-anal anastomosis and the subsequent closure of the temporary ileostomy was 29% (bowel obstruction, 22%; pelvic sepsis, 5%), with one death due to pulmonary embolus. The probability of a successful outcome at 5 years was 94%. Of the 24 patients who failed (6% of total), 18 did so within 1 year (4%), three during year 2 (1%), three during year 3 (1%), and none thereafter. Stool frequency (7 stools/24 h), the occurrence of pouchitis (14%), and satisfactory daytime continence (94% of patients) remained stable over 4 years after operation, whereas nocturnal fecal spotting decreased (51% of patients to 20%). Women had more spotting than men, whereas patients over 50 years old had more stools per day than those 50 years or younger. In conclusion, ileal pouch-anal anastomosis achieved a reasonable stool frequency and satisfactory continence in patients with ulcerative colitis over the long-term. These results support the ileal pouch-anal anastomosis as a safe, satisfactory alternative to permanent ileostomy.
 ...
PMID:Ileal pouch-anal anastomosis for chronic ulcerative colitis. Long-term results. 366 60

The operation consisting of abdominal colectomy, proximal proctectomy, distal mucosal proctectomy, and ileal pouch-anal anastomosis eliminates colorectal mucosal disease, restores transanal defecation, and avoids the need for a permanent abdominal stoma and the wearing of an external appliance. During the 4-year period from January 1981 through December 1984, 369 such operations were done at the Mayo Clinic for either ulcerative colitis (in 336 patients) or polyposis coli (in 33 patients). None of the patients died in the immediate postoperative period. Follow-up data for the initial 188 patients showed the following complications: anastomotic stricture in 12%, pelvic sepsis in 11%, obstruction of the small intestine in 9%, and reservoir ileitis in 7%. A permanent stoma had to be established in 5% of patients. All patients could defecate spontaneously, and 95% had satisfactory continence for stools and gas. This operation seems safe and effective and provides a quality of life superior to that seen after the conventional Brooke ileostomy.
 ...
PMID:Restorative proctocolectomy and ileal reservoir. 395 Dec 58

Endoanal mucosal proctectomy with preservation of the anal sphincters has been employed as an alternative to the traditional method of rectal excision in 23 patients with ulcerative colitis or Crohn's disease. Ten patients in whom the anal canal was left open and drained had uneventful postoperative courses. Of the remaining 13 patients in whom the top of the anal remnant was oversewn, four had local pelvic sepsis that resolved in a few weeks' time and one patient had a pelvic hematoma requiring relaparotomy and sphincter muscle excision. Postoperative disturbances in bladder or sexual function did not occur in any of the patients. At the latest follow-up (mean 21 months), all patients were fully satisfied with the result of the operation. On proctoscopic examination, an anal remnant, measuring approximately 3 cm from the anal verge, could be demonstrated. Its upper end had healed with a fibrous scar in 50 percent of the patients, whereas a small area of friable granulation tissue, sometimes with a short sinus tract was still observed in the others. The persistence of such lesions was associated with minor mucous discharge occasionally escaping from the anal canal. Biopsies disclosed regeneration of cylindric and transitional types of epithelium. The fate of these epithelial remnants remains to be seen. Endoanal mucosal proctectomy appears to be an attractive alternative to the conventional technique. It prevents a great deal of morbidity and enhances postoperative rehabilitation.
 ...
PMID:Mucosal proctectomy and ileostomy as an alternative to conventional proctectomy. 397 97

One hundred and four patients were treated by restorative proctocolectomy with ileal reservoir for ulcerative colitis and familial polyposis. Three different designs of reservoir were used (triple loop 68, double loop 13, quadruple loop 23). There were no postoperative deaths but six (5.8 per cent) had the reservoir removed. Rates for pelvic sepsis were 25, 15 and 13 per cent, and for intestinal obstruction requiring laparotomy 14.7,0 and 8.6 per cent. Function was assessed in 88 patients (58, 12 and 18) after mean intervals from closure of the ileostomy of 23.7, 12.7 and 4.5 months. Frequency of defaecation per 24 h was 3.7 +/- 1.6, 5.5 +/- 1.6 and 4.1 +/- 1.3, being significantly greater for double loop reservoirs; night evacuation was more prevalent in the same group (26, 58 and 22 per cent). Significantly fewer patients with triple than with double loop reservoirs required antidiarrhoeal medication (19 and 58 per cent). Normal continence occurred in 67, 75 and 89 per cent of patients in the three groups. All patients with double or quadruple loop reservoirs defaecated spontaneously while only 41 per cent with triple loop reservoirs did so. Mean intra-operative reservoir volumes were 177 +/- 64, 172 +/- 58 and 325 +/- 37 ml and volumes after closure of the ileostomy were 416 +/- 176, 197 +/- 69 and 322 +/- 33 ml respectively. Double loop reservoirs were significantly smaller than the other two designs after ileostomy closure. There was an inverse relationship between reservoir volumes and frequency. A quadruple loop reservoir directly connected to the anal sphincter preserved spontaneous evacuation and resulted in function similar to that obtained with the triple loop reservoir.
 ...
PMID:Restorative proctocolectomy with ileal reservoir for ulcerative colitis and familial adenomatous polyposis: a comparison of three reservoir designs. 401 16

One hundred eighty-eight patients undergoing abdominal colectomy with distal mucosal proctectomy and endorectal ileal pouch-anal anastomosis were reviewed to assess long-term functional results and to identify factors that might influence them. There was no postoperative mortality, but 10 patients (5.3%) required permanent ileostomy because of postoperative complications or the development of unsuspected Crohn's disease. Immediate postoperative complications, including pelvic sepsis, small bowel obstruction requiring surgery, anastomotic stricture, and ileostomy dysfunction, were observed in 11%, 9%, 14% and 9% of patients, respectively. No males were impotent but nine (9%) developed retrograde ejaculation. Pouchitis occurred in 8% of patients. Among 157 patients assessed at least 60 days after ileostomy closure (mean +/- SD, 375 +/- 216 days), all evacuated their neorectum spontaneously, and stool frequency was 6.0 +/- 2.6 daily and 1.2 +/- 1.3 nightly. While continence was generally good, 2.5% of patients during waking hours and 4.5% during sleep had occasional frank soilage. Moreover, seepage was noted in 25 and 47% of patients during daytime and nighttime, respectively. Both stool frequency and degree of continence improved with time. Patients less than 50 years of age and those with polyposis coli had fewer stools and better continence than those older than 50 or those with ulcerative colitis. It is concluded that ileal "J" pouch-anal anastomosis can be performed safely and will provide acceptable anorectal function without late deterioration.
 ...
PMID:Ileal "J" pouch-anal anastomosis. Clinical outcome. 407 86

In an effort to avoid the failures of perineal wound healing that are common after proctectomy, 57 patients who had abdominoperineal resection of the rectum or total proctocolectomy for ulcerative colitis (35 patients), Crohn's colitis (12), or carcinoma (10) had primary closure of the levator muscles and perineal tissues. No attempt was made to approximate the pelvic peritoneum. The small bowel was allowed to fill the pelvic space, which was also drained by suction catheters brought out through the lower abdominal wall. The skin and subcutaneous tissues were allowed to heal by secondary intention in seven patients who had excessive preoperative perineal sepsis from fistulas, deep fissures, and abscesses. All seven wounds healed within 2 months. Of the other 50 patients, whose wounds were closed to the skin, 48 were discharged with completely healed perineal wounds. Two patients had sterile pelvic hematomas that drained through the perineum and delayed wound healing 1 month and 2 months. There were no postoperative perineal, pelvic, or intraabdominal abscesses. Immediate postoperative ambulation was allowed. There was no increased short-term or long-term incidence of small bowel obstruction related to this procedure, nor did perineal hernia occur after long-term observation (mean: 5.3 years). This method of accomplishing perineal wound healing is simpler, safer, more comfortable, and remarkably effective in eliminating the prolonged morbidity of an unhealed perineal wound. It is superior to any other reported method of managing the perineal wound in patients with inflammatory bowel disease and may be applicable to the treatment of cancer without compromising the chances for cure.
 ...
PMID:Improved management of the perineal wound after proctectomy. 407 88

The popular view of ileorectal anastomosis for ulcerative colitis as an operation of above average mortality and morbidity is supported by the results of this series. Great care must be taken to differentiate ulcerative colitis from Crohn's disease of the colon, as it is clear from consideration of their clinical course that they are different disease entities with a different prognosis. It is suggested that the more general adoption of Aylett's operative technique would reduce the number of failures due to sepsis. There appears to be a group of patients, 15% in this series, who will be failures because of intractable diarrhoea despite a technically adequate and successful operation, but it might be possible to reduce these with modern medical therapy given postoperatively.Patients with a preoperative history of more than 10 years' disease appear to do better than the others. An actively diseased rectum does not appear adversely to affect the result, and the fulminating disease is not a counter indication to a staged ileorectal anastomosis. The use of steroids preoperatively does not appear to affect the healing of the anastomosis or the longterm result of the operation. No case of carcinoma of the rectum has occurred in this series but there has been histological evidence of premalignant change in two patients. The need for a strict follow-up programme, including regular sigmoidoscopy and rectal biopsy, is emphasized.
 ...
PMID:The results of ileorectal anastomosis at St Mark's Hospital from 1953 to 1968. 542 3

More than 100 patient-years' experience has been acquired in the treatment of 133 patients with ambulatory home total parenteral nutrition (TPN) between May 1974 and December 1983. Indications for chronic or permanent home TPN include short bowel syndrome, malabsorption, scleroderma, and vasoactive intestinal polypeptide syndrome. Indications for acute or temporary home TPN include Crohn's disease, malignancies, gastrointestinal fistulas, ulcerative colitis, anorexia nervosa, and numerous other disorders. Eighty-two patients in the acute group were treated primarily with percutaneously placed standard subclavian catheters and 51 patients in the chronic group have been treated thus far with implanted silicone rubber, Dacron-cuffed catheters for a cumulative total of 38,939 patient days. Of the 125 implanted catheters, 115 were placed in the superior vena cava and ten in the inferior vena cava for an average duration of 250 catheter-days, the longest single catheter remaining in situ for more than 8 1/2 years. Catheter-related sepsis occurred 33 times with the implanted catheters, or once every 2.6 catheter-years. One hundred and fourteen temporary catheters were placed percutaneously in the superior vena cava via a subclavian vein for an average duration of 68 days, the longest single catheter remaining in situ for 213 days. Catheter-related sepsis occurred seven times, equivalent to one episode per 3 catheter-years. Total catheter-related complications were quite infrequent and were directly related to duration of catheterization. They included venous thrombosis (12), clotted catheter (11), catheter failure or rupture (8), catheter compression (5) and inadvertent catheter removal (4). Twenty-six catheters were repaired or spliced in situ when the external segment was accidentally damaged or deteriorated secondary to long-term material fatigue. One remarkable patient has been maintained exclusively by TPN originally as an inpatient and subsequently as an outpatient for the entire 13 years of his life.
 ...
PMID:100 patient-years of ambulatory home total parenteral nutrition. 642 31

Lipid A, the toxic part of the bacterial endotoxin, is a common antigen for many gram-negative bacteria. Antibodies to lipid A occur naturally in humans; they have been found in 10%-34%, and even up to 73%, of individuals tested, as detected by indirect hemolysis and enzyme-linked immunosorbent assay (ELISA), respectively. Inflammatory bowel diseases (Crohn's disease or ulcerative colitis) cause changes in the level of antibodies to lipid A, as compared with that found in healthy control subjects. Increased levels of antibodies to lipid A are seen in both children and adults with infections due to gram-negative bacteria, such as urinary tract infections (UTI). The highest titers of IgG in serum, as detected by ELISA, have been recorded in patients with development or progression of renal scarring associated with UTI. Since lipid A may play a role in the pathogenesis of renal impairment, the determination of the level of antibodies to lipid A may help in the diagnosis of certain forms of UTI. Possible beneficial roles of antibodies to lipid A during septicemia caused by gram-negative bacteria in humans are still unclear.
 ...
PMID:Antibodies to lipid A: occurrence in humans. 647 15

While there have been several overseas studies on the quality of life after proctocolectomy, data concerning patients who have undergone ileostomy and proctocolectomy in Australia are limited. For this reason, a questionnaire was sent to all members of the New South Wales Ileostomy Association. Of the 354 who replied, the indication for ileostomy had been ulcerative colitis in 82%, Crohn's disease in 10%, familial polyposis in 4%; and 4% had undergone proctocolectomy and ileostomy for some other reason. Ages ranged from 15 to 93 years. Most subjects, of whom 51% were female, had had their ileostomy for a median of 9.4 years. Immediate postoperative complications related to the ileostomy occurred in 23% of patients, the most common causes being obstruction and sepsis. The rate of readmission to hospital for complications of ileostomy was a high 48%; 25% had further surgery. In view of these results, the need for continued efforts to develop alternative methods is emphasized.
 ...
PMID:Surgical morbidity after ileostomy in New South Wales. 648 94


<< Previous 1 2 3 4 5 6 7 8 9 10 Next >>