B N Pararas | PubMed Health

PubMed1984

The influence of corticosteroids on ileostomy discharge of patients operated for ulcerative colitis.

The ileostomy output and electrolyte loss was studied in 23 patients undergoing operation for ulcerative colitis, to determine corticosteroid influence. Ten patients did not use corticosteroids and 13 patients received postoperatively 400 mg hydrocortisone intravenously for 4 to 5 days followed by 90 mg prednisone per os thereafter. Ileostomy volume and electrolyte concentration and total loss were measured on the 4th and 8th postoperative days. Patients on corticosteroids presented with a reduction of volume lost from the ileostomy (P less than 0.001), lower sodium concentration and total loss (P less than 0.00001), higher potassium concentration (P less than 0.00001) with similar total loss (P is not significant) and higher calcium concentration (P less than 0.00001) but lower total loss (P less than 0.05). It is concluded that corticosteroid administration influences significantly both volume and electrolyte loss due to the ileostomy discharge in patients operated for ulcerative colitis, suggesting a need for careful maintenance of fluid and electrolyte balance in the early postoperative period.

Adrenal Cortex Hormones↗

PubMedDate not supplied

The use of TWH catheters in CAPD patients: fourteen-year experience in technique, survival, and complication rates.

OBJECTIVE: To evaluate the technique of insertion, complication rates, and survival rates of Toronto-Western Hospital (TWH) peritoneal catheters in continuous ambulatory peritoneal dialysis (CAPD) patients. PATIENTS AND METHODS: A total of 222 TWH catheters were inserted into 203 CAPD patients (113 males and 90 females) with end-stage chronic renal failure during a period of 14 years (1 January 1982 to 31 August 1995). The mean age of the patients was 58.5 years (range 18-86 years). For the first 6 years, the peritoneal cavity approach was performed via a lower midline incision (45 insertions), various other approaches (17 insertions), and, finally, for the last 160 insertions (for approximately 8 years) the transverse paraumbilical incision was exclusively employed. The duration of CAPD ranged between 1 to 151 months (mean time 33.2 months). RESULTS: Regarding early and late complications (namely leakages, obstructions, eviscerations, tunnel infections, herniation, and others), as well as catheter survival, the transverse paraumbilical insertion, compared to other approaches, had the smallest number of complications. Thus, early leakage occurred in 5/222 (2.25%) versus 10/222 (4.5%), obstruction nil versus 2/222 (0.9%), and evisceration nil versus 1/222 (0.45%). In addition, as far as the late complications are concerned: tunnel infections 5/222 (2.22%) versus 13/222 (5.85%), herniations 1/222 (0.45%) versus 16/222 (7.3%), and cuff protrusion nil versus 7/222 (3.1%). Finally, overall peritonitis occurred with a rate of one episode every 21.2 months. Actuarial survival for 1 and 3 years was 75% and 37%, respectively. CONCLUSIONS: The transverse paraumbilical incision seems to be the most advantageous approach in inserting (by "surgical method") theTWH catheters. We found it to be a safe, simple, versatile procedure, giving good results in all parameters concerned.

Actuarial Analysis↗

PubMedDate not supplied

Perforated small bowel diverticulosis. Case report.

Three patients who presented with perforated small bowel diverticulosis were healed by resection of the perforated segment and primary anastomosis. Clinical awareness of this disease may reduce the relatively high mortality reported by most authors.

Adult↗