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Biomedical subjects

W O Barnett

Publications and source records attributed to W O Barnett.

At least 19 recordsLinked to original sources
PubMed1989

Current experiences with the continent intestinal reservoir.

From November 1986 through October 1987, 71 patients received a continent intestinal reservoir at the Mississippi Baptist Medical Center. The mean age was 37 years (a range of 13 to 65 years). Coloproctectomy was necessary because of ulcerative colitis in 60, Crohn's colitis in eight and familial polyposis in three. A conventional ileostomy was converted to a continent intestinal reservoir in 54, while 13 received a continent intestinal reservoir at the time of the coloproctectomy. In four, the continent intestinal reservoir was constructed after removal of an ileoanal J pouch. Operative maneuvers of importance during valve construction included an intestinal collar, an isoperistaltic valve, stapling of the valve and electrocautery scarification of the serosa. Two patients experienced valve dessusception. The over-all operative revision rate for valve and pouch problems was 7 per cent. There were no deaths and no reservoirs have been removed. An improved quality of life was reported by almost all of those patients converted from a conventional ileostomy. The continent intestinal reservoir represents an attractive option for certain patients after coloproctectomy.

Adenomatous Polyposis Coli↗
PubMed1987

Continent intestinal reservoir.

In this series, 170 patients have received a continent intestinal reservoir, with follow-up of one to eight years. In 126 a conventional ileostomy was converted to a continent intestinal reservoir, 38 at the time of coloproctectomy. Six had an unsatisfactory ileoanal or ileorectal anastomosis initially, and 26 (15%) required revisional surgery for problems involving the reservoir or valve. The incidence of valve slippage was 3%. Eighty-five percent achieved a normally functioning small bowel reservoir with one operation, and 19 more patients were added with one additional operation, for an ultimate good result of 96% with two operations at most. The average reservoir capacity is 400 ml, and most patients empty the pouch two or three times per day. Under favorable circumstances, the continent intestinal reservoir is preferable for most patients after coloproctectomy.

Adolescent↗
PubMed1984

Modified techniques for improving the continent ileostomy.

Most patients will elect to have a continent ileostomy over the conventional Brooke variety if given a choice. Incontinence from valve slippage has represented a major problem. Our technique for valve construction now includes the use of an isoperistaltic ileal segment, a Marlex mesenteric sling, stapling of the valve, and cauterization of the intussuscepted, serosal bowel surface. Utilizing these maneuvers, 22 consecutive continent ileostomies have been fashioned over a period of 5 years and none has necessitated reoperation for valve slippage. Half of these were done at the time of coloproctectomy, while the remainder were Brooke ileostomy conversions. The continent ileostomy is a viable surgical procedure and represents the anatomical arrangement of choice for many patients after coloproctectomy.

Abdominal Muscles↗
PubMed1983

Continent Ileostomy.

The continent ileostomy, consisting of a valve and a pouch, makes available an alternative system in which intestinal discharge can be stored and controlled after coloproctectomy. Earlier concerns regarding valve slippage with resulting malfunction have been largely eliminated by recent modifications in the technique of valve construction. A continent ileostomy was provided for 19 patients. In the first five, an antiperistaltic (Kock) valve was constructed and two had dessusception which necessitated reoperation. In the 16 cases in which an isoperistaltic valve was fashioned, there has been no slippage. These improvements, along with the significant enhancement of the quality of life, indicate a need to reexamine the advisability of providing a spout-type ileostomy in those cases favorable to the construction of a continent ileostomy.

Adult↗
PubMed1978

Transcorpus impalement: occurrence in an unusual manner.

An unusual case of abdominal impalement is presented. In such patients intra-abdominal injury must be suspected, and the impaling object must not be manipulated until the proper moment in the operating room. An approach involving various subspecialties, such as urology, neuro-, and vascular surgery, is often required.

Abdominal Injuries↗
PubMed1976

A current appraisal of problems with gangrenous bowel.

Gangrenous bowel most often results from hernia, adhesions and mesenteric insufficiency. The overall mortality rate for 151 cases was 37%. This figure was 20% for hernia, 23% for adhesions and 74% for mesenteric insufficiency. In the latter category where bowel resection was feasable the mortality rate was 40%. Other causes of bowel gangrene had a mortality rate of 28%. In many instances the pathophysiologic processes were of such a nature that current medical expertise has not reached a level of development to effectively cope with the situation. There were, however, a significant number of cases where survival may have been achieved had it not been for deficiences on the part of the patient, the primary health care personnel or those in attendence at the referral center. The basic keystone for a successful outcome in the management of patients with the gangrenous bowel problem is early surgical intervention. All will be lost if patient exposure to this source of lethal toxins is allowed to proceed to an irreversible stage. Liberal antibiotic administration probably postpones the arrival of intractable hypotension. Other factors which can be expected to improve the survival rate include minimization of technical errors, repair of incidental hernias, elemination of dependence upon nasogastric tubes for the definitive management of patients with complete bowel obstruction (with one or two exceptions), and a firm commitment to the diligent pursuit and early definitive management of postoperative complications.

Anti-Bacterial Agents↗