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Biomedical subjects

K B Hosie

Publications and source records attributed to K B Hosie.

11 recordsLinked to original sources
PubMed1992

Temporary loop ileostomy following restorative proctocolectomy.

A retrospective study compared the outcome of restorative proctocolectomy in patients who had a covering ileostomy (n = 53) with those who had no proximal stoma (n = 32). Those who had a loop ileostomy had a higher incidence of anastomotic leakage (21 per cent), pelvic abscess (32 per cent) and postoperative fistula (28 per cent) than those with no covering ileostomy (6, 12 and 12 per cent respectively). Intestinal obstruction occurred in 23 per cent of those with an ileostomy, compared with 6 per cent in those who had no stoma. The functional outcome was identical.

Abscess↗
PubMed1992

Randomized trial of loop ileostomy in restorative proctocolectomy.

A randomized controlled trial was performed to assess the role of loop ileostomy in totally stapled restorative proctocolectomy. Entry criteria included all patients who were not on corticosteroids in whom on-table testing revealed a watertight pouch with intact ileoanal anastomosis. Of 59 patients undergoing restorative proctocolectomy over 36 months, 45 were eligible and were randomized to loop ileostomy (n = 23) or no ileostomy (n = 22). The age and diagnosis of the groups were similar. There were no deaths; two ileoanal anastomotic leaks occurred, one in each group. Ileoanal stenosis occurred in five patients with and one without an ileostomy. The incidences of wound and pelvic sepsis, bowel obstruction and pouchitis were similar. Twelve patients (52 per cent) developed ileostomy-related complications. The median total hospital stay was 23 (range 13-75) days with ileostomy and 13 (range 7-119) days without (P < 0.001). This study indicates that there is a low risk of pelvic sepsis which is not increased by avoiding a protective ileostomy. Loop ileostomy was associated with a high incidence of complications.

Adolescent↗
PubMed1992

Ileal mucosal absorption of bile acid in man: validation of a miniature flux chamber technique.

A method that allows the quantitative assessment of ileal mucosal cell uptake and transport of bile acids in mucosal biopsy specimens has been validated. Viability of the tissue was confirmed by maintenance of normal cell morphology, wet weight, extracellular space, porosity to polyethylene glycol-900, lactate dehydrogenase release, and transmucosal potential difference. Using 14C-taurocholic acid, absorption was shown to be directional, capable of working against a concentration gradient, reduced by metabolic inhibitors, and sodium dependent. The system showed saturation kinetics with an estimated Km of 10 mumol/l. At a standard substrate concentration of 10 mumol/l ileal mucosal bile acid absorption was compared in patients with colorectal cancer (n = 6), ulcerative colitis (n = 10), and slow transit constipation (n = 8). There was no significant difference in tissue uptake or transport between the three groups.

Bile Acids and Salts↗
PubMed1990

Constipation: another indication for restorative proctocolectomy.

We have extended our experience of restorative proctocolectomy and ileoanal anastomosis to include 13 patients with functional bowel disorders. Eight had recurrent constipation after colectomy for slow transit constipation and five had constipation and overflow incontinence associated with megarectum and megacolon. In all cases the only alternative was a permanent stoma. Despite a high complication rate, 11 patients (85 per cent) felt that the operation had been worthwhile with improvement of their symptoms and quality of life. The operation led to a mean frequency of defaecation of 4.8 times (range 2-8) during the day, and 1.2 times (range 0-4) during the night. There was no frank incontinence and, while only one patient experienced soiling during the day, six patients suffered from night-time soiling. Two patients have had the pouch converted to an ileostomy due to persistent complications and a poor functional result.

Adolescent↗
PubMed1990

A retrospective review of the outcome of patients over 70 years of age considered for vascular reconstruction in a district general hospital.

In the management of peripheral vascular disease advanced age has often been considered a relative contraindication to attempts at limb salvage procedures. However, failure to intervene may result in a high morbidity and mortality associated with loss of independence and quality of life. We present a review of patients over 70 years of age presenting with ischaemia of the lower limb who were considered for vascular reconstruction. A total of 214 patients had arteriograms between December 1979 and December 1985 in Derby. Following this, 99 (46%) had a vascular reconstruction as the primary procedure, 49 (23%) had an amputation as the primary procedure, and 66 (31%) did not have a major operation. Mortality was high (31% at 6 months), but there was no significant difference between those having amputation and those having vascular reconstruction. However, the outcome of vascular reconstruction in surviving patients was better in terms of independent mobility (63/70 vs. 16/38), long term care (9/70 vs. 22/38), use of hospital beds (27.2 vs. 69.9 days) and was more acceptable to the patient.

Age Factors↗
PubMedDate not supplied

Laser Doppler assessment of human colonic blood flow.

We have used laser Doppler flowmetry to assess human colonic blood flow in patients with healthy mucosa and in those with active proctitis. We report a significant correlation between colonic serosal laser Doppler flux readings and serosal tissue oxygen tension (n = 45: r = 0.671: p = 0.001). Mucosal blood flow was measured using the PF309 probe of a Perimed Pf2b set on 12 kHz frequency shift. There was no significant difference throughout the colon in healthy patients. The flow in rectal mucosa was significantly higher in patients with proctocolitis than in normal mucosa.

Colon↗