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

Six cases of gracilis muscle transplant for fecal incontinence are reported. The causes of fecal incontinence included previous anal operation, idiopathic incontinence, and rectal prolapse. All patients had had a previous operation for fecal incontinence. Postoperative sepsis developed at the operative site in five patients despite a defunctioning colostomy in two. Functional results of the operation were poor in all patients and a colostomy has now been raised in all cases. The operation was not associated with any objective improvement in resting or voluntary component pressure.
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PMID:Clinical and manometric assessment of gracilis muscle transplant for fecal incontinence. 316 62

The case records of thirty patients (21 male and 9 female) aged 8 to 62 years treated for complete rectal prolapse by operation over 5 years were studied. The results of treatment were compared with those in seven consecutive patients treated more recently by posterior rectopexy. Thiersch operation has been attended by an unacceptable high rate of reoccurrence, recurrent sepsis and faecal impaction. We recommend that is use should be abandoned. Anterior resection, usually more successful, is also associated with significant morbidity. We consider it too formidable an operation for a benign condition. We have found posterior rectopexy to be simple, safe and effective and we recommend it for the surgical treatment of complete rectal prolapse.
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PMID:Complete rectal prolapse in Enugu, Nigeria. 350 34

A 15-year review of children's hospital patients with cystic fibrosis (CF) who underwent surgery yielded 578 cases in 210 patients (mean 2.7 per patient). The median age was 16 years (range newborn to 43 years). Four hundred procedures were done under general anesthesia and 176 under local. There was one anesthetic complication, respiratory depression in a patient whose MediPort (Cormed, Inc, Medina, NY) was inserted using local anesthesia and sedation. The most frequent procedure was nasal polypectomy, with 165 procedures in 50 patients. The second most common procedures were vascular access procedures: 75 central lines and 29 MediPorts were implanted in 57 patients, complicated by two pneumothoraces. Thoracic procedures included 32 bronchoscopies, 8 lobectomies, 2 pneumonectomies, and 30 pleural strippings. There were three reoperations for bleeding in the pulmonary resection patients. Thirteen newborns underwent a total of 26 procedures for meconium ileus and its complications, with two deaths secondary to respiratory failure and sepsis. These, and one death postlobectomy were the only operative deaths in the entire series of 578 cases (0.5% mortality rate). There were four slings for rectal prolapse; two required removal secondary to infection. Eight patients underwent central splenorenal shunts for portal hypertension, 15 underwent cholecystectomy, 5 underwent Nissen fundoplication, 16 underwent inguinal herniorrhaphy, 2 underwent umbilical herniorrhaphy, 3 underwent orchidopexies, and 4 underwent miscellaneous pediatric surgical procedures. Eleven patients underwent appendectomy for appendicitis; four were ruptured at the time of diagnosis.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Surgery in patients with cystic fibrosis. 361 55

Sixty-four cases of complete rectal prolapse have been treated by the Teflon sling operation since 1969. One case has recurred. No sepsis has occurred. Approximately 80% of patients followed are totally continent. This relatively simple operation seems to be the procedure of choice in this disease.
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PMID:The teflon sling operation for repair of complete rectal prolapse. 693 Feb 26

Twenty-two female patients (mean age 75 years) with complete rectal prolapse have been treated by operative fixation of the rectum to the sacrum using a perineal approach. There has been no operative mortality, sepsis or serious morbidity. Recurrence of complete prolapse has been seen once only within a month of operation and was due to inadequate operative fixation. The other 21 patients have been followed for up to 4 years. This type of operation may be the treatment of choice in the elderly patient considered unfit for major abdominal surgery but further experience is required before it can be advocated in other groups of patients.
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PMID:Perineal rectopexy for rectal prolapse. 702 58

The existence of combined rectal and vaginal prolapse is more common than the literature would suggest. This paper outlines a further development in the operative management which has been applied to 24 patients with this problem. All had had a hysterectomy and most had had in addition one or more vaginal repairs. The common mode of presentation was one of pelvic pain (19 patients), sometimes severe, crippling and intractable and some form of protrusion (14 patients), difficult or unsatisfied defaecation and rectal incontinence (9 patients). The vaginal prolapse which always involved the vault and usually involved the lower vagina was usually found to be incomplete and the rectal prolapse complete (but occult). The operative procedure essentially consists of a Wells type rectopexy which has a new modification in which the sling is extended to anchor the vaginal vault after correction of the enterocele by the abdominal approach. A vaginal repair is subsequently performed at the same operation where anterior or posterior vaginal prolapse persists. Important points in the procedure are the avoidance of sepsis (the vaginal vault is not opened during the procedure) and protection of the ureters by careful assessment of the lateral margins of the vaginal vault which is illuminated by transvaginal vault endoscopy. At this early stage operative morbidity has been minimal, relief of the pelvic symptoms has been most encouraging, but the length of follow-up is short (range 6-30 months, average 15.6) and long-term evaluation will be necessary as with all surgery for prolapse.
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PMID:Posthysterectomy rectal and vaginal prolapse, a commonly overlooked problem. 830 99

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

We report 81 of 107 cases of hemolytic uremic syndrome (HUS), admitted between July 1994 and February 1996, following an outbreak of Shigella dysenteriae type 1 dysentery in Kwazulu/Natal. All patients, excluding 1, were black with a mean age of 38 months (range 1-121); 50 (61.7%) were males. The mean duration of dysentery was 11.3 days (range 1-41) and HUS 15 days (range 1-91). Most patients had acute oliguric renal failure (90.1%), 42 (51.6%) required peritoneal dialysis. Complications included encephalopathy 30 (37.0%), convulsions 12 (14.8%) and hemiplegia 2 (2.3%), gastrointestinal perforation 8 (9.9%), protein losing enteropathy 26 (32.1%), toxic megacolon 4 (4.9%), rectal prolapse 5 (6.2%), hepatitis 11 (13.6%), myocarditis 5 (6.2%), congestive cardiac failure 3 (3.7%), cardiomyopathy 3 (3.7%), infective endocarditis 1 (1.2%), septicemia 15 (18.5%), disseminated intravascular coagulation 17 (21%). Leukemoid reactions were found in 74 (91.3%) patients, hyponatremia in 56 (69.1%), and hypoalbuminemia in 67 (82.7%). Stool culture for Shigella dysenteriae type I was positive in only 7 (8.6%) patients; Shiga toxin assays were not performed. Outcome was as follows: recovery 32 (39.5%), impaired renal function 8 (9.9%), chronic renal failure 26 (32.1%), end-stage renal disease 1 (1.2%), and death 14 (17.3%) patients.
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PMID:Post-dysenteric hemolytic uremic syndrome in children during an epidemic of Shigella dysentery in Kwazulu/Natal. 932 80

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

Most symptomatic internal hemorrhoids, grade 1 through 3, can be treated successfully with office-based procedures. Anorectal suppurative diseases must be treated surgically. Control of sepsis with subsequent fistula surgery as necessary is the goal. New nonoperative methods of anal fissure therapy are directed at reducing anal sphincter pressures. These methods have shown significant reduction in the need for sphincterotomy--a proven surgical technique with some risk of impaired continence. Surgery, using an advancement flap and partial internal sphincterotomy, remains the primary treatment for anal stenosis. Solitary rectal ulcer remains a difficult problem to manage medically and surgically. Multiple surgical techniques can effectively treat rectal prolapse. A minimal technique using Silastic wrap (Wright Medical Technologies; Arlington, TX), perineal resection (Altemeier procedure), and sigmoidectomy-rectopexy, or Ripstein suspension, has been the most favored method in selected patients.
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PMID:Anorectal Disease. 1109 40


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