PubMed Health⌕ Search

Biomedical subjects

J Heppell

Publications and source records attributed to J Heppell.

At least 37 records · Page 2Linked to original sources
PubMed1992

Antigenic and genomic differences of two Jasper strains of infectious pancreatic necrosis virus.

Strains of infectious pancreatic necrosis virus (IPNV-Jasper) obtained from two different laboratories were compared serologically with polyclonal and monoclonal antibodies. Nucleotide sequence and restriction endonuclease patterns of 359-bp fragment of genome segment A cDNA were also compared. Substantial differences were found in both analyses that will support the fact that the two Jasper strains are not identical.

Animals↗
PubMed1992

[Quality of life of patients after restorative surgery for cancer of the rectum].

During the last decades surgeons have put a tremendous effort to perform low anterior resection (LAR) as a curative procedure for rectal cancer treated classically by abdomino-perineal resection (APR) and permanent colostomy. A psychological evaluation testing the multi-dimensional concept of quality of life was done in 32 patients (M = 21; F = 11) treated by APR and compared to 28 patients (M = 16; F = 12) treated by LAR. Patients were assessed for quality of life on the following dimensions: physical well-being, psychological well-being, dietary habits, surgical response, social concerns, body image, stress and marital adjustment. Using as covariables social support and time elapsed since surgery, a covariate analysis was used to determine the presence of group ans sex interaction. Patients with LAR had a better body image (p.001), dietary habits (p.003) and tolerance to stress (p.004). Better global quality of life (p.001), physical well being (p.001) and less surgical sequela (p.001) were found with LAR in women only. No significant difference was found on psychological well being, social concerns and marital adjustment in both surgical groups.

Adult↗
PubMed1990

An assessment of the risk of neoplasia in long-term ileal reservoirs using the DMH rodent model.

This study was undertaken to determine if the construction of an ileal reservoir induces mucosal changes that can potentiate the effect of a chemical carcinogen (1,2-dimethylhydrazine) on ileal mucosa. Animals were divided into three groups: 1) sham operation (n = 19), 2) total colectomy with ileorectal anastomosis (n = 20), 3) total colectomy with an ileal reservoir made of terminal ileum sutured to the rectum (n = 20). An adaptation period of 12 weeks was allowed to promote fecal stasis and the histologic changes before exposure to weekly subcutaneous injections of DMH (25 mg/kg) for 16 weeks. Sodium butyrate was added to the diet as a tumor promotor. All animals were sacrificed one month later. Fecal stasis, along with enlargement, occurred in all the reservoirs (mean dimensions, 74 X 58 X 43 mm). Their mean volume was 88 +/- 14 ml. The histologic changes in the ileal reservoirs were: chronic inflammation (14/20), villous atrophy (14/20), and atrophy of the glands (8/20). In group 3, five carcinomas were seen. There were three in the duodenum and two in the reservoirs. In contrast, 21 carcinomas were detected in the control groups. There were 17 in the colon, 3 in the jejunum, and 1 in the ileum. No significant difference in the number of carcinomas was seen in the ileum with and without reservoir. Although it is possible to induce carcinomas in ileal reservoirs, the incidence remained significantly less than in the colon. In conclusion, the histologic changes induced by the construction of an ileal reservoir do not increase the risk of malignant transformation in the DMH model for intestinal carcinogenesis.

1,2-Dimethylhydrazine↗
PubMed1990

Dietary habits after ileal pouch-anal anastomosis.

Dietary habits of patients who had undergone ileal pouch-anal anastomosis were assessed and correlated with bowel function. Twenty-four well-adapted patients (11 women, 13 men; mean age 32 years) voluntarily entered the study 30 +/- 4 months after closure of the diverting ileostomy. A standardized questionnaire on 108 food items and a 3-day food journal were used in the assessment. Twenty-one patients had no difficulty in selecting an appropriate diet. Caloric intake was adequate. Specific symptoms associated with several foods were as follows: increased stool frequency (beer, spirits, chinese food), decreased stool consistency (beer, wine, fried fish), perianal irritation (spicy foods), undigested particles (grapefruit, lettuce), odours (eggs). Pasta and bananas were associated with increased stool consistency. The authors believe that these observations may help in dietary counselling after ileal pouch-anal anastomosis.

Adult↗
PubMed1988

A new bowel preparation for elective colon and rectal surgery. A prospective, randomized clinical trial.

A two-day cathartic/enema preparation with oral administration of erythromycin and neomycin was compared with an orthograde lavage preparation with oral administration of metronidazole and neomycin in a prospective randomized trial in 300 and 293 eligible patients, respectively, who were undergoing elective colon and rectal surgery. Patients were assessed for infections at six weeks after discharge from the hospital. The major infection rate was less than 1% and the minor infection rate was less than 4%. The overall infection rate was 4.2%. The type of bowel preparation used, the type of operation, and the addition of systemic antibiotic therapy did not affect infection rates significantly. We conclude that this one-day lavage technique, as described, is a safe, effective, economical, and preferred method of colonic preparation for elective colon and rectal surgery.

Adolescent↗
PubMed1987

Quantitative assessment of pelvic ileal reservoir emptying with a semisolid radionuclide enema. A correlation with clinical outcome.

Fecal stasis in an ileal reservoir may lead to overgrowth of bacteria and changes in mucosal morphology that are of future concern. Moreover, improper evacuation may lead to increased stool frequency and reduced continence. The aims of this study were: to compare the functional results of two types of ileal reservoirs constructed with an ileoanal anastomosis, to compare their emptying to a normal rectum as assessed by a radionuclide enema, and to correlate functional results with emptying. The reservoirs were made of two (J) or three (S) limbs of terminal ileum. Thirty-three patients (16 with J-pouch and 17 with S-pouch) and ten healthy controls were included in the study. There was no difference in the mean age of patients or interval following diverting ileostomy closure. Functional results were obtained by written questionnaire assessing stool frequency, and soiling, use of medication, need for intubation, and episodes of pouchitis. Emptying was measured with instillation per anus of a semisolid medium labeled with 1.0 mCi of Tc-99. Ileal pouch counts were measured using a scintillation camera and computer before and after spontaneous evacuation. The emptying was defined as the difference in counts divided by preevacuation counts. The functional results were similar in the two groups. Nocturnal soiling occurred more frequently in the S-pouch group. Pouchitis occurred in seven patients. Emptying of the two types of reservoir was similar (J: 72 +/- 4%, S: 67 +/- 5%), but it was less efficient than a normal rectum (90 +/- 3%, P less than 0.004). No correlation was established between age, sex, number of stools, pouchitis, and the efficacy of emptying. The clinical outcome of two patients who emptied less than 30%, however, was greatly improved by intermittent intubation. In conclusion, a semisolid radionuclide enema can be useful to identify patients who would benefit from intubation. No persistent defect in emptying was detected in patients with pouchitis.

Adult↗
PubMed1987

[Peristomal pyoderma gangrenosum in a patient with ulcero-hemorrhagic rectocolitis].

Cutaneous manifestations of chronic ulcerative colitis are numerous and present in 20 p. 100 of the patients. The case of a 49-year old man with peristomal pyoderma gangrenosum (PG) is presented. In November, 1983, one year after the onset of chronic ulcerative colitis, the patient underwent total colectomy. The formation of an ileal reservoir resulted in a pelvic abscess which necessitated right lower ileostomy. Because of severe ulcerations around the stoma, the ileostomy was transferred to the left lower abdomen. Similar inflammatory ulcerations developed, and the diagnosis of pyoderma gangrenosum was made. The patient responded very well to dapsone combined with prednisone for only 6 months. The possibility of PG being an autoimmune condition is discussed, as well as the differential diagnosis. The several therapeutic approaches are summarized. The peristomal localization of PG in this patient suffering from chronic ulcerative colitis seems to be rather unique. No other case has been reported so far, to our knowledge.

Administration, Topical↗
PubMed1987

Physiopathologic aspects of ileal reservoirs.

The author reviews some aspects of fecal continence after ileoanal anastomosis with an ileal reservoir. Also, the consequences of fecal stasis on small-bowel absorption and morphologic and bacteriologic features are discussed. Some recommendations for the follow-up of these patients are outlined.

Anal Canal↗
PubMed1986

Toxic megacolon. An analysis of 70 cases.

The clinical features and outcome of 70 patients treated for toxic megacolon between 1970 and 1984 in five university-affiliated hospitals were determined. There were 35 women and 35 men with a mean age of 39 +/- 0.2 years. Toxic megacolon occurred at the initial episode of colitis in 43 patients (61 percent). Only five patients had a specific colitis: salmonellosis, two; ischemic, two; and pseudomembranous, one. Of the 65 remaining patients with nonspecific colitis, six had to be operated on without delay because of peritonitis. In the remaining 59 patients, toxic megacolon was cured with intensive medical management in nine (15 percent), improved temporarily in 14 (24 percent), and remained unchanged in 36 (61 percent). The postoperative mortality rate was 11 percent for all patients (6/56), 4 percent for patients without perforation (2/50) compared with 27 percent for patients with perforation (4/15). None of the patients who underwent surgery within five days of medical treatment died. When toxic megacolon was complicated by hemorrhage (nine patients) or peritonitis (eight patients), the mortality rate increased to 33 percent and 27 percent, respectively. A one-stage proctocolectomy was performed in 19 patients (32 percent). Of 32 patients in whom the rectum was retained, successful restoration of continuity was possible in only seven (22 percent) within 12 months after surgery. In well-selected patients, a plea is made for rectal preservation to offer an alternative to permanent ileostomy.

Adolescent↗
PubMed1986

Vascular complications of inflammatory bowel disease.

During an 11-year period from January 1970 to December 1980, 7,199 patients at our institution had chronic ulcerative colitis or Crohn's disease. Thromboembolic complications developed in 92 (1.3%) of these patients. An additional 4 patients had cutaneous vasculitis, and 17 had an arteritis-associated diagnosis. Of the thromboembolic complications, 61 were deep vein thromboses or pulmonary emboli. The mortality among patients with thromboembolic complications was high (25%). Sixty percent of the patients had a thrombocytosis unaffected by sulfasalazine or corticosteroid therapy. In 73% of the patients, the erythrocyte sedimentation rate was increased, and when measured, fibrinogen and factor VIII were commonly elevated. Peripheral arterial thrombosis, coronary thrombosis, and mesenteric and portal vein thrombosis were predominantly postsurgical complications, but 77% of peripheral venous thromboses occurred spontaneously. The role of anticoagulation and surgical intervention in the management of hypercoagulation in patients with inflammatory bowel disease is discussed.

Adolescent↗
PubMed1985

Small-cell carcinoma of the rectum.

Small-cell carcinoma of the rectum is a rare tumor. We treated a patient with small-cell carcinoma of the rectum with radiation and multidrug regimen being used for small-cell carcinoma of the lung. Within two months of chemotherapy, the primary lesion, as evaluated by rectoscopy, biopsy, and CT scan, had resolved completely. The patient was in complete remission for 12 months after initiation of chemotherapy and died of widespread metastases. At autopsy, no residual tumor was found in the rectum. This case stresses the importance of ultrastructural study in the differential diagnosis of small-cell cancer of the rectum and the fact that this tumor can be treated in the same fashion as for small-cell carcinoma of the lung with multidrug chemotherapy and radiation therapy to achieve local control.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1984

Gastric influences on canine small intestinal myoelectric activity.

The aim was to determine whether the canine stomach modulates interdigestive and digestive small intestinal myoelectric activity. In four conscious dogs with electrodes implanted chronically on the duodenum and jejunum, enteric myoelectric activity was recorded during fasting and after feeding a 200-g liver meal. The dogs then underwent total gastrectomy and esophagoduodenostomy, after which they were restudied. Gastrectomy did not alter the pattern of the enteric interdigestive myoelectric complexes; the occurrence, period, duration of phase III, and consistency of distal propagation of enteric IMCs remained unchanged. Gastrectomy also preserved both the postcibal inhibition of the enteric IMCs and the postcibal induction of the fed myoelectric pattern in the small bowel. However, the onset of the fed pattern occurred more promptly after gastrectomy than before gastrectomy. We concluded that the pattern of canine duodenal and jejunal interdigestive myoelectric activity was largely independent of the stomach. The more rapid onset of the fed pattern with feeding postgastrectomy may relate to more rapid entry of chyme into the small intestine.

Animals↗
PubMed1984

Tetanus after anorectal abscess.

As illustrated by this case report, tetanus can occur as a complication of anorectal surgical procedures or abscesses just as it can in other wounds. A synergistic infection of the perineum occurred in a 62-year-old man 8 days after drainage of an anorectal abscess. He was treated with vigorous debridement and antibiotics and was given tetanus prophylaxis. The next day, tetanus developed, presumably from the original abscess. The patient recovered after aggressive therapy, including muscle relaxants and ventilatory support.

Abscess↗
PubMed1983

Fate of the rectal mucosa after rectal mucosectomy and ileoanal anastomosis.

The aim of our study was to determine if the rectal mucosa regenerates after rectal mucosectomy and endorectal ileoanal anastomosis for chronic ulcerative colitis. Such regenerated rectal mucosa could be the site of recurrent disease, leading to complications of the operation, and potential malignant degeneration. Pathologic specimens of the ileoanal anastomosis, surrounded by rectal muscular cuff, were obtained from eight patients who required takedown of their ileoanal anastomosis between one and 18 months after construction. Reepithelialization of the rectal cuff was not observed. In two patients, small islets of rectal mucosa and anal glands were identified. In all patients, the rectal muscularis propria was adherent to the serosa of the ileum by fibrous reaction. Three patients were diagnosed, both clinically and pathologically, as having chronic ulcerative colitis at the original ileoanal operation, but features suggestive of Crohn's disease were noted in the subsequently resected neo-rectum. Our observations suggest that, although isolated rectal mucosal cells may remain after mucosectomy, extensive rectal mucosal regeneration does not occur, thus minimizing the risk of recurrent disease and potential malignant change. Failure of an ileoanal anastomosis is therefore most likely related either to technical factors or to the presence of unsuspected Crohn's disease.

Adolescent↗
PubMed1983

Surgical treatment of recurrent peptic ulcer disease.

One hundred twenty patients in whom recurrent peptic ulcer developed after various surgical procedures for primary duodenal ulcer were operated on at the Mayo Clinic between 1970 and 1975. The postoperative mortality rate was 3.3% for all cases, 0.9% for elective cases, and 23% for the 13 patients who required emergency surgical care. The mean hospital stay was 13 days, and postoperative complications developed in 25 patients (20%). Approximately 70% of the patients had excellent or good results, whereas the rest had significant postoperative sequelae, including 8.4% (9 patients) in whom rerecurrent ulceration developed. When remedial surgery for recurrent ulcer consisted of vagotomy and distal subtotal gastrectomy (35 patients) after previous vagotomy and drainage procedure (21 patients), subtotal gastrectomy (three patients), vagotomy and hemigastrectomy (eight patients), or gastroenterostomy alone (three patients), there were no operative deaths, 74% of 27 patients available for at least a 5-year follow-up had excellent or good results, and rerecurrent ulceration developed in only one patient. These results indicate that vagotomy and resection is a satisfactory operation for recurrent peptic ulcer and that the long-term results after this operation compare favorably with those reported for cimetidine therapy.

Adult↗
PubMed1983

Neural control of canine small intestinal interdigestive myoelectric complexes.

Our aim was to determine the role of the extrinsic and intrinsic nerves in the regulation of the small intestinal interdigestive myoelectric complex (IMC). In five dogs, the extrinsic nerves of the jejunoileum were divided, but the bowel was left in situ with its wall intact. After recovery, IMCs were detected in the duodenum (mean IMC period +/- SE = 188 +/- 19 min), from where most migrated distally into and through the jejunum (84%). In addition, extra IMCs appeared in the jejunum. Thus, the mean period of the IMCs in the jejunum (134 +/- 10 min) was shorter than in the duodenum (P less than 0.05). In contrast, after enteric transection and reanastomosis at the ligament of Treitz and at a site 75 cm distal to the ligament, fewer duodenal IMCs migrated into the jejunum (only 61%). However, extra IMCs still arose in the jejunum, so that the mean period of IMCs in the jejunum (111 +/- 5 min) was now similar to that in the duodenum (128 +/- 4 min, P greater than 0.05). Our data were consistent with the hypothesis that extrinsic nerves regulate the frequency of the small intestinal IMCs, while an intact enteric wall aids in their distal propagation.

Action Potentials↗
PubMed1983

Postprandial inhibition of canine enteric interdigestive myoelectric complex.

Our aim was to determine whether the passage of postprandial duodenal chyme into the jejunum activates jejunal feedback mechanisms that inhibit the interdigestive myoelectric complex (IMC) of the canine small bowel. In five conscious dogs with 75-cm Vella loops of proximal jejunum and recording electrodes on the duodenum and the loop, intestinal myoelectric activity was recorded for approximately 4 h during fasting. The dogs were then given either a 200-g liver meal orally or they underwent perfusion of the jejunal loop with postprandial duodenal chyme collected from a donor dog given an identical liver meal. Before feeding, IMCs occurred at mean intervals of 126 +/- 16 (SE) min in the duodenum and 88 +/- 10 min in the loop. Feeding by mouth completely inhibited the IMCs in the duodenum but failed to inhibit the IMCs in the loop. However, perfusion of the jejunal loop with duodenal chyme suppressed the IMCs in both the loop and the duodenum. We concluded that postprandial inhibition of duodenal IMCs is mediated in part by neural and/or hormonal factors activated by chyme in the jejunum, whereas local factors inhibit jejunal IMCs. An enteric phase of postprandial IMC inhibition is postulated.

Animals↗