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 59,461 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Clinical investigations of infants hospitalized with botulism demonstrate a remarkable uniformity of complaints and physical findings. Constipation precedes a course of progressive weakness and cranial nerve dysfunction. Examination reveals hypotonia, hyporeflexia, and a variable pattern of involvement of the motor cranial nerves. Initial laboratory investigations should include electrodiagnostic tests, because findings of an incremental response to rapid, repetitive nerve stimulation and of brief, small-amplitude motor units on electromyography are virtually pathognomonic of botulism in the infant. Differential diagnosis includes disorders that may produce generalized depression of the central nervous system, such as septicemia, meningitis, metabolic disturbances, and intoxications. Specific involvement of the neuromuscular system includes acute polyneuropathies, diseases of the anterior horn cell, congenital myopathies or muscular dystrophy, and neonatal myasthenia gravis. Recent studies have expanded the clinical spectrum of infant botulism to include some cases of sudden infant death syndrome and otherwise nonspecific constipation.
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PMID:Differential diagnosis of infant botulism. 23 67

Of 84 patients who underwent restorative proctocolectomy with an ileoanal reservoir in 21 Italian departments of surgery, 51 had ulcerative colitis, 32 familial polyposis and 1 intractable constipation. Follow-up information is available for all 58 patients who had their ileostomy closed, the length of follow-up ranging between 2 and 78 months. There were no operative deaths. A failure rate (i.e. excision of the pouch) of 3 per cent was observed. Sepsis was the most common postoperative complication, and was most often related to ileoanal anastomosis dehiscence (15 per cent), followed by small-bowel obstruction requiring laparotomy (10 per cent). Clinical 'pouchitis' occurred in 14 per cent of patients after ileostomy closure. The average frequency of defaecation was four motions per 24 h; evacuation was spontaneous in all patients and only 5 per cent complained of troublesome faecal soiling while 34 per cent had occasional incontinence to flatus and mucus. Patients with a short or absent rectal cuff had a lower rate of incontinence (30 versus 48 per cent, difference not statistically significant) without any increase in the frequency of genito-urinary disorders. None of the two most used reservoirs, the J (n = 40) and S pouch (n = 17) showed significant superiority in terms of bowel frequency and continence. Incontinence was more likely in patients whose ileostomy closure had been delayed for more than one year.
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PMID:Clinical and functional results after restorative proctocolectomy. 283 77

A retrospective review of 108 consecutive patients with perforated typhoid enteritis managed operatively over a 4-year period at Baptist Medical Centre, Ogbomoso, Nigeria is presented. There were 75 males and 33 females with an average age of 19.7 years. Presenting symptoms were fever, abdominal pain, vomiting, and either diarrhea or constipation. One hundred patients (93 percent) underwent debridement of the perforation and two-layer bowel closure. Postoperative morbidity included intraabdominal abscess, wound dehiscence, and subsequent bowel perforation. Most of the 35 deaths (32 percent mortality) were attributed to overwhelming sepsis which progressed despite aggressive operative management and antibiotic administration. The key to improved survival in this deadly disease lies not in a better operation or improved perioperative care but in the prevention of typhoid fever by providing safe drinking water and improved sanitation methods for all of the global community.
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PMID:Perforated typhoid enteritis: operative experience with 108 cases. 292 66

Forty-four patients presenting with painful outlet constipation had internal rectal intussusception documented by cinedefecography. Rectal reservoir reduction by multiple elastic ligation or staple excision of redundant mucosa effectively improved bowel function and outlet symptoms in the majority of patients. Rectal reduction procedures were performed under intravenous sedation with antibiotic coverage, no postoperative sepsis, and a single case of significant postoperative bleeding. Associated abnormalities on defecography were unaffected.
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PMID:Rectal reservoir reduction procedures for internal rectal prolapse. 365 90

This case report presents an unusual case of primary IUD-associated ovarian actinomycosis, which spread to the sigmoid causing intestinal obstruction. A 43-year-old gravida 3, para 2, had her 1st IUD from 1978-80 (Gyne-T) and her 2nd IUD from 1980 to October 1983 (Multiload). Right lower abdominal pain led to hospitalization in May 1983. A tender nodular mass was palpated in the left pelvic area. Laboratory results confirmed the presence of inflammation. Rapid improvement followed a course of laxatives and cephalosporin antibiotics, and the patient was discharged with the diagnosis of acute sigmoid diverticulitis. 2 months later, a double contrast examination of the large intestine was done and showed severe narrowing of the sigmoid colon over a distance of 12 cm and occasional sharp recesses. Colonoscopy showed a spastic stricture of the sigmoid with massive edema of the otherwise intact mucosa at 18 cm. Computer tomography of the abdomen showed a large, focally cystic infiltrative mass in the pelvis with congestion and displacement of both ureters as well as bilateral hydronephrosis, predominantly on the right side. The descending colon was congested. The patient was readmitted to hospital with the tentative diagnosis of ovarian cancer when her general condition deteriorated. She complained again of abdominal pain in the right lower quadrant and alternating diarrhea and constipation. Pyrexia and the hematological findings suggested sepsis. The pelvis contained a predominantly leftsided nodular mass and a brown fetid discharge was coming through the cervix. The IUD was removed and treatment with ampicillin and clindamycin was started with rapid improvement in the patient's condition. Obstruction with extreme distention of the colon required emergency laparotomy. An inflammatory mass was found in the pelvis consisting of a right-sided ovarian tumor, bilateral hydrosalpinges, and a tightly encased sigmoid colon. The dilated caecum had a large necrotic area in its wall which necessitated caecostomy and double-current sigmoidostomy after subtotal hysterectomy and bilateral salpingo-oophorectomy. The patient made a good recovery. As recently as the 1950s, primary pelvic actinomycosis was a rarity. In the last 4 years alone, 20% of all reported cases of actinomycosis involved the female genital tract. The percentage of cases found among IUD users has been continuously increasing and in the last 2 years all published cases were IUD users. The presence of actinomyces in vaginal smears always is indicative of the presence of a foreign body, most commonly and IUD.
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PMID:IUD-associated ovarian actinomycosis causing bowel obstruction. 374 Sep 65

The aim of this prospective study was to evaluate the long-term follow-up result of Swenson's operation in the treatment of Hirschsprung's disease in Vietnamese children. The surgical intervention was performed in three stages. Swenson's operation was performed by the same surgical team. Hirschsprung's disease was confirmed by an operative rectal biopsy. Regular out-patient attendances were made for follow-up. From January 1987 to January 1990, 69 patients including 61 boys and eight girls underwent Swenson's operation at a mean age of two years and five months (range from seven months to 14 years). There were two postoperative deaths during first 48 hours due to sepsis and two other late deaths due to severe enterocolitis (four months and six months after closure of colostomy respectively). Complications such as anastomotic leakage, anastomotic stenosis, perianal abcess, pelvic abcess did not occur. A follow-up result was obtained in 54 of 65 survivors (83%) with follow-up ranging from two to five years (mean: three years and six months). 51 of 54 children (94%) had a normal evacuation. Constipation persisted in three children (6%). Fecal soiling occurred in four children (8%) and stress urinary incontinence in one child (2%). All boys (47 children) had a normal erection. 53 patients (98%) had a normal weight growth, whereas 48 patients (89%) had a normal height growth. In conclusion, the long-term follow-up result of Swenson's operation in the treatment of Hirschsprung's disease was satisfactory.
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PMID:The long-term follow-up result of Swenson's operation in the treatment of Hirschsprung's disease in Vietnamese children. 761 79

A phase II trial was performed to assess the efficacy and toxicity of the combination mitoxantrone (MXN) and vinorelbine (VNR) as first-line chemotherapy for metastatic breast cancer. Forty-one patients with metastatic disease or local relapse recruited between March 1991 and April 1993 received a first-line chemotherapy treatment consisting in 12 mg/m2 intravenous (IV) bolus of MXN on day 1 followed by a 20-minute perfusion of 25 mg/m2 of VNR on days 1 and 8. Cycles were repeated every 21 days until evidence of disease progression or of severe toxicity. Thirty-seven patients were evaluable for response and all 41 for toxicity. An objective response was observed in 19 patients (51%; 95% confidence interval, 45 to 74%). The response was complete in a further 11 (30%). Median time to treatment failure was 9 months. Median survival was 14 months. There were no treatment-related deaths. Limiting toxicity was myelosuppression. Leukopenia occurred in 29 patients (71%) and was grade 3 or 4 in nine of these (15%). Grade 2 or 3 anemia was encountered in six patients (15%), grade 1 thrombocytopenia in one, neurotoxicity (constipation) in two, and grade 2 or 3 alopecia in 12 (29%). Nausea/vomiting requiring antiemetic treatment was experienced by only two patients (5%). There were two cases of septicemia treated by antibiotic therapy in hospital.
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PMID:[Combination of mitoxantrone-vinorelbine as first-line chemotherapy for metastatic breast carcinoma]. 765 48

We treated 65 children with proven Hirschprung's disease between 1970-1992. After definitive surgery, 35 were over 10 years of age and 13 were over 18. The male:female ratio was 4:1. All but 3 were born full-term. 44% were of Bedouin origin, with a higher prevalence in 3 families of 2 tribes. 38 (58%) were diagnosed in the neonatal period: by barium enema and rectal muscle biopsy in 42 (65%), and by barium enema alone in 23 (35%). In the latter the diagnosis was verified by intra-operative biopsy. Severe constipation, intestinal obstruction or enterocolitis were the presenting features. 19 associated anomalies were found in 12 children, but none was life-threatening; 5 (8%) had cardiac anomalies; none had Down's syndrome. The rectosigmoid colon was the most common aganglionic segment involved (only 1 had total colonic aganglionosis). 7 of the 8 with short segment involvement responded well to posterior rectal myectomy. 55 patients had an abdominoperineal pull-through: 48 by Swenson's procedure and 5 by the Soave and 2 by the Duhamel modifications. In 43 a protective colostomy was performed at the end of the procedure. 53 had complete diversion colostomy at the time of initial diagnosis (neonatal and early infancy). There was no intra- or immediate post-operative death. 1 patient died 2 months after operation of complications following enterocolitis and total parenteral nutrition. 2 died a few hours after admission of severe sepsis due to enterocolitis before operation was possible. There were early postoperative complications in 11% of the 151 operations, mostly minor wound infections.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Hirschprung's disease in the Negev]. 799 80

Hyperganglionosis or neuronal intestinal dysplasias (NID) and hypoganglionosis (HO) are intestinal diseases of difficult diagnosis and treatment and diverse evolution, despite identical histologic findings. The aim of this study was to discuss the therapeutic problems derived from the patients differing clinical course. Retrospective review of 14 patients with regard to diagnosis, manometry and histology (hematoxylin-eosin, acetylcholinesterase activity, immunohistochemistry and Smith's silver stain) was done. Six patients presented intestinal occlusion or sub-occlusion from the first months of life with impeded oral feeding. Ileostomy was performed in 5 and total colectomy with anastomosis in 1. All patients required parenteral nutrition; cisapride was added in 2. Three died from sepsis (3 NID). Of the 3 survivors, 2 have ileostomies (2 NID) and the other ileo-rectal anastomosis (NID). Of the remaining patients, two presented aganglionism and the finding of proximal hyperganglionism occurred post-surgery. Surgery was repeated in one patient. The remaining 6 (1 HO, 5 NID) were diagnosed between 3 and 10 years of age because of constipation. Four are under treatment with cisapride and 2 required partial colic resection. No relationship can be established between histologic findings and clinical manifestations. In chronic clinical courses, treatment with cisapride and cleaning enemas should be tried first. Acute clinical pictures (occlusion-sub occlusion) should be treated by decompressive ileostomy. Partial colic resection may lead to new intestinal failure.
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PMID:[Considerations regarding the treatment of non-aganglionic congenital intestinal neuropathies]. 820 35

A total of 168 restorative proctocolectomies have been performed without mortality during the past nine years. Morbidity from pelvic sepsis (12%), ileoanal stricture (15%), and pouch related fistulas (16%) have become less with increasing experience of the operation. Pouch excision, which occurred in 30% of the first 50 patients was undertaken in only 4% in the last 68 patients. Despite this, intestinal obstruction (18%) continues to complicate the operation. We have abandoned restorative proctocolectomy after failed ileorectal anastomosis in patients with slow transit constipation as half have now requested pouch excision because of poor results. Failure to identify Crohn's disease continues to influence the outcome: in 10 patients now known to have Crohn's disease six developed post operative fistulas, three have required pouch excision. Sexual impairment has occurred in three male patients (4%). Ten women had children after operation, eight uncomplicated vaginal deliveries occurred without impaired continence. Seven of nine patients over 60 years of age have had a successful outcome. Our data also indicate that the operation may be justified in distal disease if urgency is socially inconvenient. Frequency of defecation is usually less than three per 24 hours in patients with familial adenomatous polyposis but remains variable in those with ulcerative colitis.
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PMID:An audit of restorative proctocolectomy. 850 71


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