PubMed Health⌕ Search

Biomedical subjects

N G Kock

Publications and source records attributed to N G Kock.

At least 19 recordsLinked to original sources
PubMed1992

Ileostomy output of gas and feces before and after conversion from conventional to reservoir ileostomy.

In 28 patients who had previously had a proctocolectomy for ulcerative colitis, the ileostomy output of feces was determined before and after conversion to continent reservoir ileostomy, as was the output of gas in 20 of the patients. The median output of feces/24 hours collected in the hospital was 576 g before and 692 g after conversion (P less than 0.05); when collected at home the corresponding figures were 734 g and 740 g, respectively. In the majority of patients, the change in fecal ileostomy output after the conversion was not considerable, while in a few patients there was a marked increase. The fecal output was 24 percent (P less than 0.01) and 11 percent (P less than 0.01) larger at home than in hospital before and after conversion, respectively. The proportion dry weight of ileostomy discharge decreased after conversion (P less than 0.01). The median gas volume in the ileostomy output/24 hours was 1,664 ml before and 1,450 ml after conversion. The gas constituted 58 percent of the output and is significant with respect to the required reservoir capacity. Recording the emptying volumes and frequency in patients with reservoir ileostomy showed that, in general, patients with large output expand their reservoir capacity instead of increasing their emptying frequency.

Adult↗
PubMed1992

Further experience with the urethral Kock pouch.

In 185 men a urethral Kock pouch was constructed as a bladder substitute after radical cystectomy for cancer. A total of 117 patients was followed for a minimum of 1 year and is fully evaluable. Of the patients 108 (92%) are completely continent during the day, while 85 (73%) are dry at night. Also, 8 patients had an excellent response to imipramine hydrochloride. Stability or improvement in the configuration of the upper tract was noted in 210 renal units (90%). A total of 24 renal units showed evidence of deterioration due to reflux (16) and an anastomotic stricture (8). Stability of the antireflux nipple valve was ensured by creation of a window in the mesentery of the corresponding bowel segment and by anchoring the valve to the wall of the pouch by an additional row of staples. On the basis of this favorable outcome the procedure is recommended for male patients for whom cystectomy is indicated and in whom the urethra can be preserved.

Cystectomy↗
PubMed1992

Further experience with the modified rectal bladder (the augmented and valved rectum) for urine diversion.

Continent diversion with the modified rectal bladder was done in 83 patients and 65 are currently evaluable with followup ranging from 6 to 36 months. There was no postoperative mortality and the morbidity rate was acceptable. Renal function and configuration were maintained in most patients (91%). Dessusception of the colorectal valve was observed in 7.6% of the patients. Evidence was provided that this valve is effective in prevention of regurgitation of the rectal contents to the proximal colon. All patients were continent during the day. Enuresis was noted in 6 patients and all of them responded to imipramine hydrochloride therapy. The results support earlier observations that the procedure offers distinct advantages over ureterosigmoidostomy and the simple rectal bladder.

Adult↗
PubMed1992

Significance of the antireflux valve for upper urinary tract pressure. An experimental study in patients with urinary diversion via a continent ileal reservoir.

When bladder substitution is required, a low pressure receptacle and an antireflux valve with low resistance to flow is essential for preservation of the upper urinary tract. The aim of this study was to evaluate whether these criteria are attained in the continent ileal reservoir used for urinary diversion. The investigations were performed in six patients more than one year after supravesical urinary diversion via a continent ileal reservoir. The pressure was recorded simultaneously both in the afferent loop and in the reservoir during filling of the reservoir. There was a slow parallel increase in the basal pressure in the reservoir and the afferent loop. Pressure waves appeared sometimes simultaneously and sometimes in only one compartment at a time. Only during short periods of time did the pressure exceed 25 cm of water. The frequency of pressure waves increased with increased filling of the reservoir. The "total pressure" was larger in the reservoir than in the afferent loop. It is the antireflux valve which prevents pressure rises in the reservoir from being conveyed to the upper urinary tract. The resistance to urinary flow was moderate.

Humans↗
PubMed1992

[Evolution of urinary bladder substitution].

The historical background to the currently used methods for continent bladder substitution is shortly outlined. The significance for the patient's quality of life of various methods for bladder reconstruction or urinary diversion is briefly discussed. The importance of reservoir configuration for achieving a high compliant urinary receptacle is pointed out. Factors affecting reabsorption of urinary constituents are stressed and the significance of an antireflux mechanism is discussed. Currently the majority of patients undergoing cystectomy for cancer or for other reasons can be offered bladder substitutes providing continence and easy emptying; that is, complete control over voiding. This can be achieved by orthotopic bladder reconstruction or by diverting the urine to the augmented and valved rectum or to the skin via a continent intestinal reservoir.

Cystectomy↗
PubMed1991

Decreased absorption of 22Na and 36Cl in ileal reservoirs after exposure to urine. An experimental study in patients with continent ileal reservoirs for urinary or fecal diversion.

After urinary diversion to intestinal segments, reabsorption of chloride, ammonium, and hydrogen ions occurs, sometimes leading to hyperchloremic acidosis. The mucosa of ileal reservoirs exposed to urine show substantial atrophy, indicating a loss of absorptive capacity. In ten patients with urinary diversion via a continent ileal reservoir, the absorption of [22Na] and [36Cl] was studied after instillation for 15 min into the reservoir of a test solution containing 50 kBq [22Na] and 50 kBq [36Cl]. The activity of the radionuclides was determined in serum samples after 60 and 180 min and the fractions absorbed were calculated. Absorption of the two radionuclides was also calculated by comparison of the activities in samples of the test solution taken before and 15 min after instillation into the reservoir. The same investigations were performed in seven patients with continent ileostomy reservoirs. The study demonstrated a decreased capacity to absorb [22Na] and [36Cl] across the mucosa of the reservoirs exposed to urine compared to the mucosa of those exposed to feces. Due to the transformation of the ileal mucosa after exposure to urine, the risk for development of metabolic disturbances should be minimal after urinary diversion to a continent ileal reservoir.

Chlorine↗
PubMed1991

Bladder substitutes controlled by the anal sphincter: a comparison of the different absorption potentials.

A comparative study of the absorption potentials of the simple rectal bladder (10 patients), modified rectal bladder (20) and ureterosigmoidostomy (10) was done with intrarectal instillation of 22sodium. Results indicate that absorption is significantly greater among patients with ureterosigmoidostomy. The emptying patterns of ureterosigmoidostomy and the modified rectal bladder were also studied by ascending scintigraphy with 99mtechnetium. Evidence was provided that in cases with ureterosigmoidostomy the isotope is distributed throughout the entire colon. These studies proved the role of the colorectal valve in preventing reflux of urine from the rectum to the proximal colon. Consequently, the surface area of colonic mucosa exposed to urine is decreased and the rate of reabsorption is limited.

Absorption↗
PubMed1991

Pregnancy and delivery in patients with urinary diversion through the continent ileal reservoir.

The social and psychologic sequelae after external urinary diversion are known to be fewer in patients with urinary diversion through the continent ileal reservoir (Kock pouch) compared with those with diversion through the incontinent ileal conduit. Therefore, in young female patients treated surgically with urinary diversion through the continent ileal reservoir, a number of pregnancies can be expected. We report herein the results of four pregnancies in three women with this type of reservoir. All deliveries were vaginal. One patient showed urinary obstruction at the end of the pregnancy and delivery was induced. This particular infant was treated with phototherapy because of hyperbilirubinemia; the other three infants were mature. No damage to renal function was noted and revisional surgical treatment of the reservoir was not necessary in any. Consequently, pregnancy is not contraindicated after urinary diversion through the continent ileal reservoir (Koch pouch).

Adult↗
PubMed1990

Long-term follow-up of patients with continent ileostomies.

Thirty-six patients were evaluated after having continent ileostomies for 16 to 20 years. Follow-up included clinical examination, response to a questionnaire, blood tests, and radiologic studies of the gallbladder. In addition, reservoir biopsies from 15 patients were examined. The patients were in excellent general health, all but one having gained weight postoperatively. There was no increased risk for gallstone formation or for urinary tract stone development. Although 11 of the 36 patients had reservoirs that were not provided with a valve, 92 percent of all patients were continent. Working capacity was normal in most patients and no harmful effects of the reservoir were revealed by morphologic or biochemical studies. In conclusion, no deleterious long-term effects were found as a result of the continent ileostomy.

Activities of Daily Living↗
PubMed1989

Ileoanal anastomosis with interposition of the ileal 'Kock pouch'. Preliminary results.

For patients needing proctocolectomy, there are several alternatives available today for the previously dominating conventional ileostomy. Currently, the ileal pouch-anal anastomosis attracts major interest. Various reservoir procedures have been proposed, but the ideal reservoir design is still debated. The double-folded ileal reservoir (Kock pouch) has a large capacity, low pressure, and is expandable. It is successfully used for the construction of continent ileostomies, continent urostomies, and for replacing the urinary bladder by connecting the reservoir to the urethra. In view of these facts, it was decided to interpose the Kock pouch between the ileum and the anus after colectomy and mucosal proctectomy in a small number of patients, and to study and evaluate its merits in this position. Six consecutive patients formed the study group. Three months after ileostomy closure the stool frequency was 4 every 24-hours, range 3 to 5, and remained so during the follow-up period. All patients could sleep through the night without bowel movements or soiling. None of the patients used pads. The capacity of the reservoir increased from a mean of 100 ml preoperatively to 550 ml one year after ileostomy closure. The large reservoir capacity and the low pressure can explain the good functional results.

Adolescent↗
PubMed1979

Absorption studies in patients six to 10 years after construction of ileostomy reservoirs.

The absorption of fat, bile salts, and vitamin B12 was studied in 14 proctocolectomised patients six to 10 years after construction of a continent ileostomy. All patients were in excellent health and displayed no signs of malnutrition. Schilling test disclosed subnormal absorption of vitamin B12 in one patient and borderline values in five. Faecal loss of bile acid was increased in 12 patients and fat malabsorption occurred in two. Except for slightly pathological liver tests in two patients, routine laboratory tests, including plasma concentration of vitamin B12 and folic acid, were normal. There were no signs of sodium or potassium depletion.

Adult↗
PubMed1979

Faecal excretion of intravenously injected 14C-cholic acid in patients with conventional ileostomy and in patients with continent ileostomy reservoir.

Bile salt absorption, as determined by the faecal excretion in i.v. injected 14C-cholic acid (FBS) was studied in 13 ileostomy patients before and after conversion to Kock's continent ileostomy reservoir. The result was compared with that obtained in 8 ileostomy patients in whom about 50 cm of the terminal ileum has also been removed. As compared with 16 healthy controls, FBS was moderately increased in the conventional ileostomy patients, but still within normal limits. After conversion to ileostomy reservoir all patients had pathological FBS, although less severe than in the ileostomy patients with ileal resection. Bacterial contamination probably contributes more than the structural mucosal changes to the bile malabsorption in the pouch, whereas reduced mucosal surface and short small-intestinal transit time are the main causes of malabsorption in ileostomy patients in whom an appreciable amount of the terminal ileum has been resected.

Adult↗
PubMed1978

Gastric emptying of a liquid meal in health and duodenal ulcer disease.

In the present investigation an extension of the method of George was used, which allows the rate of emptying of the gastric content (GC) to be assessed. The aim of the study was to find out whether ther is any difference in gastric emptying rate of a liquid meal of 750 ml 10% glucose (glucose monohydrate, mol. wt. 198) between healthy subjects and duodenal ulcer patients (DU). The straight numerical volume of GC, the logarithm and the square root of GC were related to time, and these functions were compared. The correlation coefficient for the regression line for these functions showed that data both for healthy subjects and DU gave a better fit to the GC/time and GC/relationship than to a semi-logarithmic function, when the starting point at time zero was excluded. Regardless of the type of transformation of the basic data, there was no difference between healthy controls and DU as regards the regression coefficient, indicating that from 20 min after the installation of the test volume the GC is decreasing at the same rate in the two groups. When the straight numerical volume of GC was used, there was a significant difference in the extrapolated Y-intercept for the regression lines between healthy subjects and the DU, indicating an increased initial emptying in the DU patients. This was further confirmed when the volume emptied during consecutive 20-min periods was estimated. Furthermore, there was a shorter emptying time in patients with duodenal ulcer than in healthy controls.

Adult↗
PubMed1977

Ileostomy.

Explore the source record for details and available documents.

Animals↗
PubMed1977

Gastric emptying after different surgical procedures for duodenal ulcer.

Gastric emptying has been studied in patients operated upon for duodenal ulcer by either 1) parietal cell vagotomy without or 2) with pyloroplasty, 3) truncal vagotomy combined with pyloroplasty or 4) antral resection, 5) gastric resection a.m. Billroth I or 6) Billroth II. Isotonic saline and 10% glucose solution have been used as test meals. Volumes of meal remaining 10 and 30 minutes after the instillations of the saline and the glucose meal respectively have been estimated. After parietal cell vagotomy without pylorplasty (PCV) the gastric emptying rate of 10% glucose solution was significantly faster than in unoperated duodenal ulcer patients. After all the other surgical procedures the gastric emptying rate of saline as well as of glucose solution was in turns significantly faster than after PCV. These results indicate the importance of the antrum-pyloric region for the control of gastric emptying rate of isotonic saline and hyperosmolar glucose solution.

Duodenal Ulcer↗
PubMed1976

[Artificial anus. Advantages and disadvantages of ileo- and colostomy].

The majority of patients with ileostomy adapt to their new situation and are able to live a nearly normal professional and social life. This does not mean that there is not a need for improvement in the ileostomy construction. It merely proves the great adaptive mechanism in man. In spite of the improvement in surgical techniques in the construction of the ileostomy and the development of modern ileostomy appliances, a proportion of the patients still experiences serious problems. In order to improve the situation for patients with ileostomy a new type of ileostomy has been developed. From the terminal ileum an intraabdominal, intestinal reservoir is constructed and the outlet from the reservoir is provided with a "nipple valve" preventing leakage of gas and faeces through the outlet. The continent ileostomy has now been under clinical trial for more than seven years. The success-rate has increased along with improvements in technique and introduction of methodological modifications. More than 90% of 164 patients provided with this type of ileostomy had at follow-up satisfactory functional results of their ileostomy. That means that they had no need for carrying external ileostomy appliances. A method for constructing a continent colostomy has been tested in dogs. The sigmoid colon was divided and the distal end closed. At the proximal end a "nipple valve" was constructed by intussuscepting a part of the intestine into its lumen. All dogs were continent from the time of operation until they were sacrificed one to eight weeks later. The method is now under elaboration for clinical trial.

Animals↗