PubMed Health⌕ Search

Biomedical subjects

S Nordgren

Publications and source records attributed to S Nordgren.

At least 19 recordsLinked to original sources
PubMed1992

Anal fistulas in Crohn's disease: incidence and outcome of surgical treatment.

The incidence and prognosis of anal fistulas were investigated in a prospective study comprising 136 patients operated on for Crohn's disease. The incidence of anal fistulas was 27 of 136 (20%), in patients with classical disease 12 of 68 (18%), and in those with Crohn's colitis 15 of 68 (22%). A fistula preceded the intestinal manifestation of the disease in 6 patients. At the time of diagnosis of Crohn's disease anal fistulas were observed in 19 cases, including 3 of the 6 with early onset which had resisted treatment and remained active. Five patients developed anal lesions during the course of the disease, all but 2 in temporal relationship to an intestinal recurrence. Of the 27 patients with anal fistulas, 11 were of the low-anal type, whereas 14 were anorectal. Conventional laying open of the fistula was undertaken in all patients with classical Crohn's disease in close conjunction with resection of the intestinal disease. On local surgical treatment 10 of 12 (89%) healed with preservation of continence. Four recurrent fistulas occurring in conjunction with intestinal recurrence also healed uneventfully. Laying open was undertaken in 11 of the 15 patients with colitis. Healing was obtained in only 4 of these patients. In the remaining 4 severe colitis indicated immediate proctocolectomy. Occurrence of fistulas involved a significant delay in perineal healing after proctectomy. It is concluded that traditional laying open of an anal fistula in patients with classical Crohn's disease is followed by high rate of uneventful healing. In contrast, local surgical treatment of anal fistulas complicating Crohn's colitis is usually unsuccessful.(ABSTRACT TRUNCATED AT 250 WORDS)

Crohn Disease↗
PubMed1991

The effects of atropine or benzilonium on pelvic pouch and anal sphincter functions.

Anticholinergic drugs are used on an empirical basis for treatment of functional disturbances after restorative proctocolectomy, but their mode of action on ileal pouch performance is mainly unknown. We studied the acute effects of atropine or benzilonium on pouch characteristics and anal sphincter function in 20 patients with a pelvic pouch. Pouch volume was increased by 27% by atropine at distension with 20 cm H2O (p less than 0.01). Benzilonium tended to have a similar effect, but the changes did not reach statistical significance (p = 0.06). Pouch contractility, as reflected by volume fluctuations and pressure changes during distension, was almost abolished by both drugs. Sensory thresholds for sense of filling and, particularly, urge were raised. Resting anal pressure was slightly lowered, whereas no significant effect was found on maximal squeeze pressure. In conclusion, anticholinergics appear to have specific properties of action on small-intestinal reservoirs, constituting possible explanations for the empirically observed beneficial effects of anticholinergic treatment of functional disturbances after restorative proctocolectomy.

Adult↗
PubMed1991

Sodium and potassium excretion in patients with ileostomies.

The output of sodium and potassium from urine and ileostomy was investigated in 35 healthy patients with ileostomies; 17 had undergone proctocolectomy for ulcerative colitis and 18 for Crohn's colitis. Fifteen of the patients with Crohn's disease had also had small bowel resections, varying from 15 to 46% of the original bowel length. The patients were investigated at home because most studies of sodium and water balance in patients with ileostomies have been done in hospital wards, which may not reflect actual conditions. Mean (SD) ileostomy output was 565 (152) ml in patients with ulcerative colitis and 1,267 (540) ml in patients with Crohn's disease. The intrapatient variation was limited, whereas the interpatient variation was significant and correlated with the length of small bowel resected. The sodium concentration in the ileostomy discharge was 110 (9.2) mmol/l and did not change consistently with ileostomy volume. The potassium concentration was 10 (2.1) mmol/l. There was a significant inverse correlation between daily ileostomy sodium output and urinary sodium concentration (r = -0.44, p less than 0.01), and a significant correlation between the daily output of sodium in ileostomy contents and the sodium:potassium ratio in urine. We conclude that patients with ileostomies are at risk of sodium and water depletion, particularly those who have had small bowel resections. Increased sodium output from the ileostomy is associated with a reduction in the sodium:potassium ratio in the urine. To screen patients at risk, an estimate of the sodium balance can be made by measuring sodium and potassium concentrations in a single specimen of urine.

Adult↗
PubMed1990

Pouch size: the important functional determinant after restorative proctocolectomy.

Sixty-seven patients with a J-shaped ileonanal pouch were studied over a 2-year period with regular recording of sphincter and pouch characteristics and analysis of their role in functional outcome. Although there was a 27 per cent permanent reduction in resting anal pressure (RAP) (P less than 0.001), two-thirds of the patients still had a RAP within the normal range. The mean(s.d.) pouch volume increased during the first year from 132(46) ml to 282(85) ml. RAP was not related to functional outcome and preoperative RAP was not predictive of subsequent function. Large pouch volume and compliance correlated with low defaecation frequency (range of r = 0.27-0.36; P less than 0.05) and good overall function (r = 0.37-0.56; P less than 0.01). The initial pouch volume was predictive of subsequent overall function. The ileal length used for pouch construction predicted subsequent pouch volume (r = 0.48; P less than 0.001) and to some extent functional outcome (r = 0.28-0.37; P less than 0.05). However, the studied variables accounted for only 21 per cent of the total variance of functional outcome.

Adolescent↗
PubMed1990

Manovolumetric and sensory characteristics of the ileoanal J pouch compared with healthy rectum.

Pouch volume, motility, sensory function and integrated pouch-anal mechanisms during graded isobaric distension of the pouch were prospectively studied in 67 patients with a J pouch-anal anastomosis. The findings were related to functional outcome. Thirty-six normal controls were studied for comparison. In contrast with normal rectum, the ileal pouch exhibited pronounced motility, and pouch contractions were frequent even at a high distension pressure. The presence of high pressure motility was associated with a poor functional outcome. The threshold pressure and threshold volume for eliciting first sensation of filling and urge to defaecate were significantly higher in the ileal pouch. The pressure threshold levels were not related to the functional outcome. Sphincter inhibition on pouch distension reappeared in 25 per cent of the patients. The distension pressure required to elicit the inhibition was considerably higher than in the control subjects. The functional result was similar irrespective of whether sphincter inhibition was present or not. The motor and sensory function of this artificial setting appear to be controlled by nervous mechanisms that are different from those in the healthy anorectum.

Adenomatous Polyposis Coli↗
PubMed1990

A prospective randomized comparison of two different pelvic pouch designs.

The clinical manovolumetric, and functional results of restorative proctocolectomy were studied in patients randomly allocated to construction of either a J-shaped pouch (n = 29) or a pouch fashioned by the folding technique used for the Kock continent ileostomy (K-pouch) (n = 26). A complete endoanal mucosectomy was performed, and the pouches were all constructed from 30-cm lengths of ileum. There were no deaths and no significant difference in postoperative morbidity. Anal pressures were equal in the two groups. The K-pouch expanded more favourably postoperatively, and its volume at 1 year was significantly greater than that of the J-pouch (355 +/- 71 ml (SD); range, 225-495, versus 264 +/- 81 ml; range, 75-440; p less than 0.001). The pouches had similar motility patterns and sensory pressure thresholds. Initially after closure of the loop ileostomy there was a tendency for better functional outcome in K-pouch patients. At 1 year the overall distribution of functional defects did not differ, and the defaecation frequency was about equal in the groups.

Adolescent↗
PubMed1990

The stapled ileal pouch--anal anastomosis. A randomized study comparing two different pouch designs.

Thirty patients were operated on with restorative proctocolectomy with an end-to-end ileal pouch-anal anastomosis constructed by double stapling (STP). Pouches were randomized to either J type or K type (folded by the principles used for the Kock continent ileostomy). Manovolumetric and functional results were compared. Patients were followed up for at least 6 months. K pouches acquired a significantly larger volume than the J-configurated pouches, and at 6 months the mean +/- SD volumes amounted to 361 +/- 59.8 ml versus 283 +/- 43.0 ml (p less than 0.01) with a concomitant reduction in 24-h frequency (4.4 +/- 1.5 versus 5.8 +/- 1.9; p less than 0.05). The initial postoperative mean reduction of resting anal pressure amounted to 33%. which was similar to that observed in a group of matched historical controls operated on with endoanal mucosectomy and hand-sutured pouch-anal anastomosis. Compared with these controls STP patients showed a superior overall functional result, most marked in the early postoperative period.

Adolescent↗
PubMed1990

The effects of age, gender, and parity on rectoanal functions in adults.

The effects of age, gender, and parity on rectoanal function were examined in a cross-sectional population study, including 68 normal subjects (32 men and 36 women) aged 23 to 91 years. Rectal volumetry was evaluated with graded isobaric rectal distension with 5-60 cm H2O in combination with anal manometry. Data were analysed by use of the multiple regression technique. Increasing age correlated with a decrease in rectal volume (r = -0.285, p less than 0.05), resting anal pressure (r = -0.625, p less than 0.001), and maximal squeezing pressure (r = -0.557, p less than 0.001). The decrease in maximal squeeze pressure with age was similar in men and women (approximately = 1% x year-1), although the median of maximal squeeze pressure in women was 58.3-75.7% of that in men (p less than 0.001). Nor was there a difference in resting anal pressure between men and women. An age-dependent increase was observed for the pressure threshold to produce an initial sensation of rectal filling and the rectoanal inhibition reflex (r = 0.446, p less than 0.001). The sensory threshold increased with age, but this was more pronounced in women. No effect of parity on rectoanal function could be demonstrated. However, this would best be investigated in a longitudinal population study. We believe that identification of causes for interindividual variation and regression analysis procedures will increase the discriminative accuracy of analysis of rectoanal function. The present study shows that several of the demonstrated age-related changes have a tendency to expose elderly subjects, particularly women, to the problems of incontinence.

Adult↗
PubMed1990

Fecal excretion of radiolabeled (51CrCl3) proteins in patients with Crohn's disease.

Intestinal leakage of plasma proteins was studied in 69 patients with Crohn's disease. In vivo labeling of plasma proteins was performed by intravenous injection of trace amounts of 51CrCl3. Complete fecal collection was done for 5 days, carefully avoiding contamination with urine. The daily fecal radioactivity was measured in a whole-body counter and expressed as a percentage of given dose. In patients with a classic localization of the disease the mean fecal excretion of radiolabeled proteins was 2.8% (range, 0.8-5.5%). The excretion was significantly higher in patients with extensive ileojejunal involvement (8.8%; 4.3-14.0%) and in patients with a total colitis (5.5%; 2.0-8.2%) but not different from that in patients with prestomal recurrent ileal disease (3.5%; 1.6-5.3%). A close correlation was found between fecal excretion of 51Cr and extent of the small-intestinal disease as measured at laparotomy (r = 0.86, p less than 0.001). A highly significant inverse relationship was also demonstrated between fecal protein excretion and serum albumin concentration in patients without septic complications of the disease (r = -0.57, p less than 0.001). A pre-existing septic complication made the patients hypoalbuminemic despite limited intestinal loss of protein. It is concluded that estimation of intestinal protein loss is a sensitive and simple test for assessment of the extent of the small-intestinal involvement in patients with Crohn's disease. The test may be of value in patients with unclear radiologic findings and in patients with hypoalbuminemia of unknown cause.

Adolescent↗
PubMed1990

Clinical course and management of suprasphincteric and extrasphincteric fistula-in-ano.

Over an 8-year period five patients with suprasphincteric fistula and two with extraspincteric fistula a primary transsphincteric track were treated with fistulotomy, using delayed seton technique. In all but one case the fistulas had caused considerable morbidity, involving multiple episodes of abscess drainage and attempts to lay open the track before the correct diagnosis was established. No patient had recurrence of fistula and, despite complete division of the anorectal ring, and sphincter pressures were well maintained and anal continence was unchanged. The results suggest that the delayed seton technique is useful in the treatment of these very rare and complicated fistulas.

Adult↗
PubMed1989

The clinical and functional outcome after restorative proctocolectomy. A prospective study in 100 patients.

One hundred consecutive patients treated by restorative proctocolectomy with construction of an ileo-anal anastomosis and a J-shaped (n = 90) or an S-shaped ileal reservoir were studied prospectively to evaluate postoperative complications and functional outcome and to search for factors that might influence results. There were no deaths. Postoperative complications requiring surgery were pelvic sepsis (3 patients), pouch-related fistula (2), peritonitis following ileostomy closure (3) and small bowel obstruction (6), with an overall relaparotomy rate of 14%. The cumulative risk of pouchitis was 30% at 2 years. The average stool frequency decreased gradually, stabilizing at about five evacuations/24 h after 1 year. At that time 9% of patients still had greater than or equal to 7 day-time evacuations and 40% had night evacuations (greater than 1/week). These parameters did not improve further with time. Mucous soiling, a frequent problem initially, also diminished with time, occurring in 30% of patients at 1 year. At 2 years, however, this mucous leak occurred in only 20%, suggesting that improvement of continence can be expected to occur even beyond one year. Despite defects in function patient satisfaction was generally excellent. So far only three patients have preferred conversion to an ileostomy. To establish which factors might influence the functional results a specially designed scoring system, combining all functional variables, was used. It was shown that results deteriorated with increasing age and that elderly women tended to have a poorer result than elderly men. Sex, previous parity or postoperative complications appeared not to affect the functional outcome. Male sexual disturbances occurred in 8%.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

Epidural anaesthesia and postoperative colorectal motility--a possible hazard to a colorectal anastomosis.

The effects of epidural anaesthesia (EDA, mepivacaine) and EDA in combination with atropine and neostigmine on postoperative intestinal motility were studied in 17 patients undergoing operation for cancer of the rectum or sigmoid colon. Motility was recorded by a volumetric technique. Epidural anaesthesia (EDA) increased motor activity in the small bowel as well as in the left colon and rectum. Phasic motility dominated in the small intestine whereas tonic and segmental contractions were recorded from the large bowel. EDA induced a powerful tonic contraction with a concomitant shortening of the rectum. This effect was inhibited by atropine. The influence of atropine/neostigmine on left colonic motor activity was studied in six patients before and during EDA in a cross-over fashion. When administered alone, atropine/neostigmine did not cause any motility increase. Atropine/neostigmine administered during EDA, however, elicited a significant increase of motility. The increase of intestinal motor activity induced by EDA may expose a newly constructed colorectal anastomosis to undue strain in the immediate postoperative period. When EDA is used in combination with general anaesthesia, particular attention should be directed towards the use of neostigmine for reversing the effect of nondepolarizing muscle relaxants. Atropine appears under such circumstances not to protect from the excitatory effects of this drug on colorectal motility.

Aged↗
PubMed1989

Manovolumetric characteristics and functional results in three different pelvic pouch designs.

Different pouch designs and techniques for the perineal approach have been on trial in an attempt to improve results after restorative proctocolectomy. The 1-year results of two currently advocated procedures, the J-pouch and the S-pouch, were compared with the results obtained in patients with a pelvic pouch fashioned according to the folding technique used for the Kock continent ileostomy, all pouches having been constructed from equal 30 cm lengths of ileum. The maximal volume of the S- and Kock pouches at one year was 420 ml (250-570) (median and (range] and 410 ml (244-490) respectively, while it was significantly less, 305 ml (200-445) in the J-pouch (p less than 0.05). The compliance of the J-pouches was also significantly lower at all distension pressures. The median day-time defaecation frequency was four and was equal in the three groups. Although there was a tendency towards a more favourable overall functional result with less soiling, and less need for night evacuations among patients with a Kock-folded pouch compared to the other pouch types these differences failed to reach statistical significance. The favourable properties of the Kock pouch, well-known also from the conteinent ileostomy and urostomy, suggest that its design should be considered an interesting alternative even for restorative proctocolectomy. These encouraging results have yet to be confirmed in a comparative randomized trial.

Adolescent↗
PubMed1989

The influence of the pelvic nerves on anorectal motility in the cat.

The influence of the parasympathetic pelvic nerves on anorectal motility was studied in anaesthetized cats. Anal pressure and rectal motility were recorded by a manometric and a volumetric method, respectively. Severing of the pelvic nerves did not cause any pressure change in the anus, indicating that these nerves are not significantly tonically active. Efferent low intensity (0.05-0.5 ms, 8 V at 5 Hz) electrical stimulation of the pelvic nerves (PNS) elicited a contraction of the internal anal sphincter (IAS), while high intensity stimulation (greater than 1 ms, 8 V at 5 Hz) caused a sphincter relaxation. A rectal contraction was noted on both low and high intensity stimulation. After sectioning of the sympathetic nerves, PNS elicited a contraction in both the anus and the rectum irrespective of stimulation intensity. PNS inhibited the anal contraction elicited by simultaneous stimulation of the sympathetic nerves or noradrenaline infusion. The inhibitory anal responses to PNS were unaffected or augmented by atropine, unaffected by propranolol and abolished by hexamethonium. The excitatory anal effects of PNS were reduced or abolished by atropine and abolished by phentolamine. The rectal contraction induced by low intensity PNS was abolished by atropine or converted to a relaxation. In half of the experiments an atropine resistant rectal contraction was observed in response to high intensity PNS. The results are consistent with a pelvic nerve influence on IAS pressure through several mechanisms, including modulation of the activity in the sympathetic nerves and activation of inhibitory non-adrenergic, non-cholinergic neurons. The pelvic nerves convey both cholinergic and non-cholinergic excitatory, as well as non-adrenergic, non-cholinergic inhibitory fibres to the rectum.

Adrenergic alpha-Antagonists↗
PubMed1989

Rectal reservoir and sensory function studied by graded isobaric distension in normal man.

The rectal expansion and concomitant sensory function on graded, isobaric, rectal distension within the interval 5-60 cm H2O was investigated in 36 healthy young volunteers. Anal pressure and electromyography (EMG) from the external anal sphincter were simultaneously recorded. Rectal distension caused an initial rapid expansion followed by transient, often repeated, reflex rectal contractions and a slow gradual increase of rectal volume. The maximal volume displaced by the first reflex rectal contraction was 18 (13) ml, which was less than 10% of the volume at 60 s. The pressure threshold for appreciation of rectal filling was 12 cm H2O (95% CL 5-15 cm H2O) and coincided with the threshold for rectoanal inhibition. Urge to defecate was experienced at 28 cm H2O (15-50 cm H2O) distension pressure, which was close to the threshold for maximal rectal contraction, also coinciding with the appearance of the external anal sphincter reflex. The interindividual variation of rectal volume on distension with defined pressures varied widely, indicating a considerable variation of rectal compliance in normal man. No correlation was found between rectal volume and sex or anthropometric variables. The relative variations in pressure thresholds for eliciting rectal sensation and rectoanal reflexes were less than the corresponding threshold volumes. It was concluded that the dynamic rectal response to distension reflects a well graded reflex adjustment ideal for a reservoir.

Adult↗
PubMed1988

Sympathetic nervous influence on the internal anal sphincter and rectum in man.

The effect of sympathetic nerve block and efferent stimulation of the sympathetic nerves on anorectal motility was studied in 21 patients undergoing operation for rectal carcinoma. Anal pressure and rectal volume were simultaneously recorded before and after epidural anaesthesia and during nerve stimulation. Efferent electrical stimulation of the presacral hypogastric nerves (HGN) elicited a contraction of the internal anal sphincter (IAS) in 13 out of 15 patients. The contraction was preceded by a relaxation in seven patients. In the rectum stimulation of the HGN caused variable responses. A weak contraction was the most frequent response. Efferent stimulation of the periarterial lumbar colonic nerves (LCN) elicited a clear-cut contraction of the IAS, while rectal motor responses were only occasionally observed. Epidural anaesthesia encompassing the thoraco-lumbar region (EDA), when used to block the sympathetic discharge to the IAS and the rectum, caused a reduction of anal pressure (28 +/- 11%) and an increased rectal tone. The results imply that the human IAS receives a sympathetic excitatory innervation via both the HGN and the LCN. Furthermore, it appears that the HGN convey inhibitory fibres to the IAS. The rectal responses to EDA and sympathetic nerve stimulation also indicate the presence of both excitatory and inhibitory neurones in the sympathetic nerve supply to the rectum in man.

Aged↗
PubMed1988

The functional results after colectomy and ileorectal anastomosis for severe constipation (Arbuthnot Lane's disease) as related to rectal sensory function.

Rectoanal manovolumetry during graded isobaric rectal distension was carried out in 12 women with severe constipation classified as slow transit constipation (Arbuthnot Lane's disease). The resting anal sphincter pressure, the rectoanal inhibitory reflex and the rectal capacity were all normal. While the distension volumes required to elicit sensation of rectal filling and an urge to defaecate were within normal limits in all patients the distension pressures required to elicit such sensations fell outside the 95% limits of variation of control subjects in 4 patients. All patients were subsequently subjected to colectomy and ileorectal anastomosis. Patients with normal rectal sensory function had a satisfactory functional result after colectomy, whereas the four patients with blunted sensation did not improve. These findings suggest that rectoanal manovolumetry with determination of the distension pressures required to elicit rectal sensation is an important preoperative measure to be used in patients with severe constipation for selection of patients suitable for colectomy and ileorectal anastomosis.

Adult↗