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PubMed2002

[Sacral nerve stimulation in fecal incontinence].

INTRODUCTION: Sacral nerve stimulation for the treatment of faecal incontinence has gained increasing use in Europe over the last two years. Experience with the first patients treated in Denmark is described here. MATERIAL AND METHODS: Fourteen patients with severe faecal incontinence were given sacral nerve stimulation. The first treatment was temporary, and if this was successful they had a device for permanent stimulation implanted. RESULTS: The result of the test stimulation was good in ten of the 14 patients and a permanent system was implanted. After a median of 4.5 months' stimulation, nine of the ten patients continued to respond to respond well. DISCUSSION: Sacral nerve stimulation in the treatment of faecal incontinence shows promising results. Compared to other more advanced forms of treatment, this method is minimally invasive.

Adult↗
PubMedDate not supplied

[Principles of surgery of the deep femoral artery in arteritis of the lower extremities].

The role of the deep femoral artery has too often been ignored in the assessment of arteritis of the lower limb. This anatomical distribution, which seems to be restricted to the thig, has left pride of place to the superficial artery as being responsible for intermittent claudication. In fact the deep femoral artery represents an exceptional and privileged route for anastomosis that is capable of replacing almost perfectly an obstructed superficial femoral artery and also in a more limited way femoro-popliteal arteries with extensive obstructions. The authors estimate that the deep femoral artery represents a true physiological bypass for a thrombosed superficial femoral artery on which a lumbar sympathectomy has a particularly remarkable action. It is important, in order to obtain as good a result as possible, that the flow in the deep femoral artery should be good, which presupposes complete freedom of the iliac axis and good permeability of the trunk of the artery, begining at its ostium. Surgery of the deep femoral artery is short or lon angioplastic surgery depending on the type of lesion, usually involving a venous patch. The surgical approach is straightforward. Whe it is used for isolated lesions or as the last stage of aorto-iliac surgery, delicate angioplasty of the deep femoral artery is a perfectly feasible operation which the authors believe should take its place, in association with lumbar sympathectomy, in the restoration of the superficial femoral artery.

Arteritis↗
PubMedDate not supplied

[Lumbar sympathectomy].

The authors undertook a study of the present indications for lumbar sympathectomy in cases of obliterating arteriopathy of the lower limbs. The principal physiological effects are described in addition to its action on the circulation. Apart from the opening of arteriovenous shunts, the lifting of the precapillary block should be emphasized since this increases the flow and consequently leads to the development of the collateral circulation. A recent experiment over a period of three years involving 457 hospitalized patients is then analysed: out of 371 conservative operations performed, 169 involved restorative arterial surgery and 202 involved only lumbar sympathectomy. Lumbar sympathectomy was combined with the arterial surgery in 150 of the 169 cases quoted above. Lumbar sympathectomy alone is required in stages III and IV when arterial is not possible. At stage II, there is a choice, sympathectomy being preferred to direct surgery. The results are analysed and the best were obtained with patients at stage II.

Arterial Occlusive Diseases↗
PubMedDate not supplied

[Chances of avoiding amputation in an arteritis patient with gangrene].

During the period 1970-1974, restorative surgery was carried out 324 times in patients with gangrene or severe ischaemia caused by arteritis of the lower limbs. In 67 percent of the cases major excision surgery, such as amputation at the thigh or of the whole leg, was avoided and the support was retained. In 61 cases (19 percent) amputation was necessary either immediately or within a few weeks or months. Death occurred in 47 patients (14 percent) either in the operative period or in the 3 following years.

Amputation, Surgical↗