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Query: UMLS:C0036690 (sepsis)
 59,461 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Pressure, moisture, shear forces and friction lead to skin ulcer formation. Nursing home and home-bound patients with restricted mobility, poor nutrition, incontinence and chronic conditions such as anemia, diabetes and dementia are at risk for ulcer formation. Bedridden patients should be turned from side to side at 30-degree angles at least every two hours. Mattress and chair cushions, splints and cradle boots may reduce pressure. Good hygiene and barrier ointments, condom catheters, absorptive products and scheduled toileting for incontinence may control moisture. Calorie and protein supplements, feeding assistance and serial weight measurements are essential in the management of malnourished patients. Treatment should be based on the stage of the ulcer and the presence of conditions such as necrotic debris, infection and drainage. Saline wet-to-dry dressings and enzymatic and surgical debridement are necessary to remove necrotic tissue. Saline-soaked gauze, hydrogel preparations and occlusive dressings provide the physiologic environment for fibroblasts to grow and form granulation tissue. Patients with sepsis may require hospital admission for both further evaluation and systemic antibiotic therapy.
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PMID:Pressure ulcers in nursing home patients. 846 16

Major rectal bleeding may occur in children and adults who have extensive hemangiomatous involvement of the pelvis and rectosigmoid colon, as in the Kleppel-Trenaunay syndrome (KTS). Conventional surgical techniques such as bowel resection and colostomy have often been associated with large blood loss and/or incontinence. We have used a new approach to this problem utilizing rectal mucosectomy to eliminate the bleeding rectal mucosa and to preserve anal function. Four patients born with KTS eventually developed major rectal bleeding and were successfully corrected by this surgical approach. Two were females and two males. Ages ranged from 4 to 25 years at the time of surgery. The patients developed rectal bleeding leading to chronic anemia during the first decade of life. Rectal bleeding gradually increased requiring multiple transfusions (2 to 20 units) prior to surgery. Patient 1 underwent resection of the rectosigmoid colon, with rectal mucosectomy and endorectal coloanal anastomosis. The Nd:YAG laser was used on 3 occasions on the distal remaining rectal mucosa. Patients 2, 3, and 4 underwent sigmoid resection, transanal rectal mucosectomy, and a coloanal anastomosis, with minor YAG laser therapy in one patient. Blood loss during surgery was minimal. Follow-up ranged from 1.5 to 4 years. All have excellent sphincter control with no incontinence. No strictures or sepsis occurred following surgery. Rectal bleeding was eliminated in all 4 patients. This sphincter-saving approach should be considered in patients with extensive hemangiomas of the rectosigmoid colon because of its remarkable effectiveness and safety.
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PMID:Rectal mucosectomy: a definitive approach to extensive hemangiomas of the rectum. 817 22

Between 1971 and 1991, 41 patients underwent anterior resection for the treatment of complete rectal prolapse. Anterior resection was performed after full rectal mobilization to the levator ani muscles with reanastomosis (39 hand-sewn and two stapled) carried out to peritonealized distal rectum. The 41 patients comprised 35 women and six men with an average age of 56 years (range, 7-88 years). Postoperative follow-up averaged 6 years (range, 6 months to 18 years). Three patients (7%) suffered recurrent prolapse in 2, 2.5, and 5.5 years, respectively. Mortality was 0 per cent; morbidity was 15 per cent including three incisional herniae, two small bowel obstructions, and one stroke. No pelvic sepsis, abscess, or anastomotic dehiscence occurred. Anal incontinence was a preoperative finding in 21 patients (51%) with rectal prolapse. Nineteen of these patients (90%) noted either improvement or no change in postoperative continence. Anterior resection is a familiar, frequently performed operation that does not require a foreign body or rectal suspension. We believe this to be the procedure of choice for patients with complete rectal prolapse. Anterior resection withstands long-term scrutiny both in terms of recurrence rate and associated complications.
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PMID:Anterior resection for the treatment of rectal prolapse: a 20-year experience. 848 90

A prospective study of a policy of selective immediate fistulotomy in the management of acute primary anal abscesses was performed. Eighty-nine patients (74%) underwent simple drainage only, as no internal openings were found during drainage of pus (group A). Thirty-one patients (26%) had drainage of pus and immediate fistulotomy (group B). Follow up for groups A and B occurred at a median of 122 weeks (104-136 weeks) and 121 weeks (104-136 weeks), respectively. No patient in group A had residual problems with anal continence whilst two patients (6.5%) from group B had minor anal incontinence following the initial procedure (p = 0.07). Ten patients from group A (11%) and four patients from group B (13%) developed recurrent anal sepsis. The overall rate of recurrent sepsis was 11.7%. In those patients who had incision and drainage alone, 90% of those who developed a recurrence and 71% of those who did not develop a recurrence grew gut-associated organisms from pus obtained during the initial drainage of the acute abscess, giving a positive predictive value for recurrence of 13.8% for a culture of gut-associated organisms. The positive predictive value for recurrent sepsis for both groups taken together for a culture of gut-associated organisms was 28.2%. Patients with acute primary anal abscess should be treated with simple drainage.
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PMID:Results of a policy of selective immediate fistulotomy for primary anal abscess. 849 20

Fourteen patients with recurrent high anal fistula were treated by total excision of the fistulous tract with primary sphincter reconstruction. Nine patients with sepsis had seton drainage for one to three months before the operation. The surgical approach was the transsphincteric technique described by Mason. No covering stoma was used routinely, but three patients referred with a colostomy had the stoma closed 3 to 5 months later. After a follow-up from 1 to 4 years two patients had recurrence, which in one necessitated a diverting ileostomy. Three patients, one with recurrence and two without, suffered from minor anal incontinence. It is concluded that total excision with primary sphincter reconstruction is a treatment modality which should be considered for recurrent high anal fistula, especially in patients where closure by an advancement flap is not possible.
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PMID:Treatment of recurrent high anal fistula by total excision and primary sphincter reconstruction. 856 5

The aim of this retrospective study was to determine the outcome of patients with a dysfunctional pelvic ileal reservoir in whom disconnection of an ileal pouch-anal anastomosis (IPAA), pouch revision and reanastomosis had been carried out. There were 23 patients (15 women). At the revision operation functional problems were found to be due to a long efferent spout (nine patients), sepsis and/or fistula (four), a redundant blind limb (three), a twisted pouch (three), anastomotic problems (three) or no reservoir (one). The pouch was salvaged in 16 patients and a new pouch was constructed in seven. The pouch-anal anastomosis was resutured in 22 patients and stapled in one. Postoperative complications (all minor) occurred in six patients. Two patients underwent two revision of IPAA. At a median follow-up of 5 (range 1-10) years, 11 patients reported good to excellent function, five reported fair function and one reported recurrent pouchitis. Revision surgery was unsuccessful in six of 23 patients (three had gross incontinence, two excessive bowel movements and one Crohn's disease), and they subsequently underwent pouch excision. It is concluded that revision of an ileal reservoir and IPAA can be undertaken safely with good results in carefully selected patients.
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PMID:Disconnection, pouch revision and reconnection of the ileal pouch-anal anastomosis. 894 42

Eversion of the rectum during restorative proctocolectomy with stapled ileal pouch-anal anastomosis (IPAA) remains a controversial surgical manoeuvre because of concern that it may impair anal sphincter function and adversely affect outcome. We have reviewed the long-term results in 41 patients whose operation included formation of a 20 cm J-pouch with stapled IPAA by the technique of rectal eversion. At median follow-up of 4 years (range 1-6 years), 4 pouches (10%) had been removed (2 for pelvic sepsis, 1 for rectovaginal fistula and 1 for Crohn's disease). In 34 patients with functioning pouches in situ, median stool frequency was 5 per 24 h (range 2-10). 11 patients (33%) regularly had to evacuate their pouch at night and 4 (12%) used antidiarrhoeal medication. No patients reported major incontinence; 2 (6%) had minor leakage, and in another 2 minor leakage had now ceased. 4 patients had had episodes of pouchitis. These favourable results offer no support for the contention that rectal eversion substantially worsens the long-term results of restorative proctocolectomy.
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PMID:Effect of anorectal eversion on long-term clinical outcome of restorative proctocolectomy. 929 Apr 18

Stapled ileal pouch-anal anastomosis after proctocolectomy enables a continence preserving reconstruction. We assessed complications and functional outcome after ileoanal pouch-anastomosis in 86 consecutive patients with ulcerative colitis. There was no postoperative mortality. 2 patients required permanent ileostomy and pouch excision for manifestation of unsuspected Crohn's disease. Major postoperative complications consisted of pelvic sepsis (n = 2), anastomotic leakage (n = 4), bleeding (n = 1), pancreatitis (n = 3) and peritonitis (n = 1). Both frequencies of bowel movements and degree of continence improved with time. Two years after take down of the deviation ileostomy frequency of bowel movements was 5,6 [2]/die. At this time no patient complained of major incontinence. Minor incontinence was reported with 9% and 14% during day-time and night-time respectively. It is concluded that direct stapled ileal pouch-anal anastomosis is a safe procedure with excellent functional results for patients with ulcerative colitis.
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PMID:[Direct ileum pouch-anal anastomosis in ulcerative colitis: function and complications after stapler technique]. 962 98

The overall rate of complications after ileal pouch-anal anastomosis is 60%. This rate, however, includes complications such as bowel-obstruction and hernias. Pouch-related complications occur after ileal pouch-anal anastomosis with a frequency of 15-25%. In an analysis of the recent literature the main risk factors are: tension of the ileal pouch-anal anastomosis, anastomotic leakage, lack of protective ileostomy, preoperatively undiagnosed Crohn's disease and the experience of the surgeon. We classified pouch related-complications into (1) surgical complications (leakage, bleeding, pelvic sepsis, fistulas); (2) technical problems (long S-pouch spout, rectal cuff stenosis, etc.); (3) functional problems (anal sphincter insufficiency, night incontinence, hypermotility, evacuation disorders); (4) pouchitis; (5) pouch neoplasias. Pathogenesis, diagnostic features, and medical and surgical therapy are discussed in detail. In our own series of 11 pouch-redo operations we had 6 pouch fistulas (3 related to Crohn's disease, 3 postoperative fistulas), 3 wrongly constructed pouches, 1 chronic pouchitis and 1 long S-pouch spout. In 3 cases the pouch had to be excised completely. Two patients remained with a permanent ileostomy. In 6 patients the pouch could be preserved on long term. Due to the technical complexity, the need to understand pathophysiology and the need for a differentiated diagnostic procedure, this operation should be performed only in specialised centers.
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PMID:[Typical complications and their control after restorative proctocolectomy]. 983 82

Clinical and manometric results of Delorme's operation and sphincteroplasty were assessed retrospectively in patients undergoing this procedure for fecal incontinence and rectal prolapse. A series of 33 patients (11 males, 22 females; aged 18-83 years, mean 59) with external rectal prolapse were treated by Delorme's operation between 1989 and 1996. Mean follow-up was 39 months (range 7-84). Sphincteroplasty was associated in 12 cases with severe fecal incontinence due to striated muscle defects. Good results were achieved in 27 patients (79%); prolapse recurrence was observed in 6 (21%), the mean recurrence time being 9 months (range 1-24 months). There were no postoperative deaths. Minor complications occurred in 15 patients. Changes in preoperative and postoperative manometric patterns were as follows (mean +/- SEM): voluntary contraction from 59 +/- 6.9 to 66 +/- 7.1 mmHg (P = 0.05), resting tone from 33 +/- 5 to 32 +/- 4.3 mmHg, rectal sensation from 59 +/- 5 to 61 +/- 5.2 ml of air (n.s.). A solitary rectal ulcer syndrome was detected in five patients. The histological pattern demonstrated pathological changes in 40% of cases. Fecal incontinence was resolved in 6 of 20 cases (30%) and chronic constipation in 4 of 9 (44%). Failure (n = 3) was related primarily to postoperative sepsis. The incontinence score showed a mean improvement of 35% decreasing, from 4.5 +/- 0.39 to 2.9 +/- 0.44 after surgery (P < 0.01). In conclusion, Delorme's procedure did not lead to constipation and improved anal continence when associated with sphincteroplasty.
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PMID:Delorme's operation and sphincteroplasty for rectal prolapse and fecal incontinence. 987 Jan 65


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