PubMed · 768877
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M Kun, F Lányi, K Labancz, F Földes. 1976-02-22. [Transcecal ileostomy].. https://pubmed.ncbi.nlm.nih.gov/768877/
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Patients with Crohn's disease are operated on with a morbidity of 15% and a mortality of 0% if the indication for surgery is decided in good time. After ileocecal resection the probability of having a second resection in 15-20 years is about 50%. When elective surgery is done at an early disease stage, ileocecal resections and reoperations for anastomotic stenosis can be performed by assisted laparoscopy assisted. Laparoscopic colonic resections are done more rarely. Acute and life-threatening conditions such as obstruction, perforation and sepsis are excluded from the laparoscopic approach. In a combined series of 222 laparoscopic resections for Crohn's disease, the following types of surgery were included: ileocecal resections (75), anastomotic resections (26), small intestinal resections (4), loop ileostomies (17), gastrojejunostomies (3), partial colonic resections (15), colectomies (16), loop colostomies (2) and one adhesiolysis. Two patients who sustained intraoperative bleeding underwent conversion of laparotomy. The conversion rate ranged from 0 to 22%. Reasons for 32 conversions were: large inflammatory mass (14), severe inflammation (5), fistula (3), abscess (1), perforation (1), small intestine dilation (1) and mesenteric thickening (1). Mean operative time for ileocecal resections ranged from 105 to 200 min. The postoperative hospital stay was 5 to 8 days. As more experience is gained and technical improvement is achieved, additional procedures such as resolution of severe adhesions, fistula closure and resections of colonic segments will be offered to the majority of patients who require elective surgery for localized Crohn's disease.
The appendix stoma for Mainz-pouch continent cutaneous urinary diversion is reliable and easy to perform. Two new continence mechanisms were developed for patients in whom the appendix is not available or usable. A seromuscular tube was used in 27 patients (12 women, 15 men, mean age 63 years) and a bowel-wall tube was used in 24 patients (13 women, 11 men, mean age 57 years) as the continence mechanism for continent cutaneous urinary diversion. At a mean follow-up of 32 months (range 2-68 months), 93% of patients with a seromuscular tube and 92% of those with a bowel-wall tube are continent day and night. Four early and nine late stoma-specific complications have occurred, requiring seven open surgical revisions. Thus far, both techniques have fulfilled all requirements as continence mechanisms for continent cutaneous urinary diversion. However, the reliability, advantages, and disadvantages of these techniques have to be confirmed in further long-term studies.
This paper presents a brief technical evaluation and first review of clinical experiences with an experimental direct digital X-ray image detector designed to support both dynamic and snap-shot imaging. Derivatives of this type of image detector can potentially fulfil the majority of the fluoroscopic and radiographic imaging requirements of clinical radiology departments, and initial results suggest that imaging systems using the new technology will provide a high quality dose-efficient solution to the search for a universal digital X-ray image detector.