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12/31/1969 03:59 PM
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Current Controversies in Pouch Surgery
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Restorative proctocolectomy with ileal pouch anal anastomosis has become the most commonly used procedure for elective treatment of patients with mucosal ulcerative colitis and familial adenomatous polyposis. Since its original description, the procedure has been modified in an attempt to obtain optimal functional results with low morbidity and mortality, and yet provide a cure for the disease. These modifications of the technique are discussed in this review, limited to the current points of controversy. We reviewed the current literature describing restorative proctocolectomy with ileal pouch anal anastomosis. The current "hot topics" for debate are transanal mucosectomy with hand-sewn anastomosis versus the double-stapled technique, the use of diverting ileostomy, indeterminate colitis, the role of laparoscopy, and indications for pouch surgery in the elderly. Longer follow-up of patients and increased knowledge and experience with pouch surgery, coupled with active prospective evaluation of the procedure are required to settle these issues. Patients must be fully informed to understand inherent risks of each choice.
(C) 2003 Southern Medical Association
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12/31/1969 03:59 PM
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Technical Modifications and Improved Results With the Ileal Pouch Anal Anastomosis (Ipaa)
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TECHNICAL MODIFICATIONS AND IMPROVED RESULTS WITH THE ILEAL POUCH ANAL ANASTOMOSIS (IPAA). Schoetz, D. J. Jr. MD Murray, J. J. MD Coller, J. A. MD Colon & Rectal Surgery: PDF Only
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12/31/1969 03:59 PM
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Does Laparoscopic-Assisted Ileal-Pouch Anal Anastomosis Reduce the Length of Hospitalization?
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DOES LAPAROSCOPIC-ASSISTED ILEAL-POUCH ANAL ANASTOMOSIS REDUCE THE LENGTH OF HOSPITALIZATION?. Department of Colorectal Surgery, Cleveland Clinic Colon & Rectal Surgery: PDF Only Nogueras, J. J. MD
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12/31/1969 03:59 PM
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Synchronous Occurrence of Colorectal Adenocarcinoma and Colonic Gastrointestinal Stromal Tumor
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of life, and economic burden of gastrointestinal stromal tumours. J Clin Pharm Ther 2007;32:557-565 with a recently diagnosed GIST located in the colon was admitted to our department in February 2007
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12/31/1969 03:59 PM
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Nonadenomatous Thymic Unencapsulated Parathyroid Tissue as a Cause of Persistent Primary Hyperparathyroidism
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colon; Primary hyperparathyroidism may be caused by ectopic intrathymic parathyroid adenomas or hyperplastic parathyroid glands. The association of the ectopic inferior parathyroid glands and the thymus is due to their common embryologic origin from the third pharyngeal pouch. We report a case of primary hyperparathyroidism due to an unusual pathologic parathyroid gland formation: nonadenomatous thymic unencapsulted parathyroid tissue. Two unsuccessful neck explorations revealed only two normal parathyroid glands within the cervical area. Radiologic imaging studies failed to localize an ectopic parathyroid adenoma. Mediastinal exploration and thymectomy showed one small focus of unencapsulated hypercellular parathyroid tissue expanding peripherally along the septa of thymic adipose tissue. The hyperparathyroidism resolved with the surgical procedure.
(C) 1994 Southern Medical Association
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12/31/1969 03:59 PM
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Ischemic Colitis: A Clinical Review
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Ischemic colitis is the most common form of intestinal ischemia. It manifests as a spectrum of injury from transient self-limited ischemia involving the mucosa and submucosa to acute fulminant ischemia with transmural infarction that may progress to necrosis and death. Although there are a variety of causes, the most common mechanism is an acute, self-limited compromise in intestinal blood flow. Patients typically have mild abdominal pain and tenderness over the involved segment of bowel. There is usually passage of blood mixed with stool, but hemodynamically significant bleeding is unusual. Although computed tomography may have suggestive findings, colonoscopy is the procedure of choice for diagnosis. Supportive care with intravenous fluids, optimization of hemodynamic status, avoidance of vasoconstrictive drugs, bowel rest, and empiric antibiotics will produce clinical improvement within 1 to 2 days in most patients. Twenty percent of patients will have development of peritonitis or may deteriorate despite conservative management and will require surgery.
(C) 2005 Southern Medical Association
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12/31/1969 03:59 PM
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Primary Omental Pregnancy on the Gastrocolic Ligament
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Omental pregnancy is an extremely rare form of abdominal pregnancy. Only 16 cases had been reported in the literature, and most were secondary omental pregnancies. We presented a case of primary omental pregnancy located on "gastrocolic ligament" diagnosed at surgical operation. The aim of this presentation is to remember that pregnancy can exist in unusual localizations, so abdominal observation and examination is very important during operations.
(C) 2007 Southern Medical Association
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12/31/1969 03:59 PM
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A Strange Case of Acute Abdomen
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A 30-year-old male suffered from acute abdomen following duodenal biopsy taken at esophagogastroduodenoscopy (EGD). Exploratory laparotomy showed a large retroperitoneal hematoma arising from the second part of the duodenum that was then treated conservatively. To the authors' knowledge, this is the first case of extensive retroperitoneal hematoma following EGD. The hemorrhage is speculated to have been caused by the tearing of one of the pancreaticoduodenal arteries or one of their branches during the duodenal biopsy.
(C) 2009 Southern Medical Association
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12/31/1969 03:59 PM
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Pediatric Obesity: Impact and Surgical Management
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The incidence of children in the United States who are overweight or obese is increasing at an alarming rate, and many obesity-related complications are now being described in children. There appears to be no current pharmacologic treatment or surgical procedure that is both safe and effective for millions of obese children. Bariatric surgery may be useful, however, in carefully selected obese children with associated serious comorbidities unresponsive to medical or dietary interventions. The complications of pediatric obesity are discussed, as well as current medical and surgical management of this disorder.
(C) 2006 Southern Medical Association
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12/31/1969 03:59 PM
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Metabolic, Renal, and Nutritional Consequences of Bariatric Surgery: Implications for the Clinician
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Management of obesity-associated comorbidities costs about $60 billion/year, about 5% of total US healthcare expenditure. Bariatric surgery is the only proven effective weight loss therapy for severely obese patients with a BMI >=35 kg/m2. Bariatric surgery produces long-term weight loss, improves quality of life, and reduces the number of sick days and medication costs. Surgery has a profound effect on the metabolic milieu and nutritional status from the first few days after surgery, even before significant weight loss has been achieved. Metabolic effects of bariatric surgery reduce obesity-related comorbidities like type 2 diabetes, hypertension, metabolic syndrome, and cardiovascular disease risk. Improvement in renal function is seen, but adverse effects like oxalate nephropathy can lead to chronic kidney disease or end-stage renal disease (CKD/ESRD). Surgery can also lead to micronutrient deficiencies, making dietary supplementation necessary. Reduction in insulin resistance and hypertension after surgery makes medication adjustment imperative. Improvement in comorbidities and nutritional deficiencies after bariatric surgery has important clinical implications.
(C) 2010 Southern Medical Association
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