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12/31/1969 03:59 PM
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The Continent Intestinal Reservoir
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Continent Ostomy Centers, St. Petersburg, Florida.
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12/31/1969 03:59 PM
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Continent Intestinal Reservoirs in 1993
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Continent Ostomy Center at Palms of Pasadena Hospital, St. Petersburg, Fla.
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12/31/1969 03:59 PM
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Continent Intestinal Reservoir
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colon; 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.
(C) 1987 Southern Medical Association
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12/31/1969 03:59 PM
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Loop IleoStomy: A Reliable Method of Diversion
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colon; Between September 1983 and March 1989, 36 loop ileostomies were performed on 34 patients (16 male and 18 female, mean age 36 years, range 11 to 68). Thirty-two patients had ileoanal pouch procedures (30 for ulcerative colitis and two for familial polyposis). One patient had a low anterior resection and another had a coloanal procedure. By the time of this review, 31 of the loop ileostomies were closed. The average time before closure was 5 months and the average length of follow-up was 37 months. All stomas were brought out through the rectus muscle in the right side of the abdomen, without ileal rotation, mesenteric fixation, or parastomal fascial sutures. A support rod was left in place for 3 to 4 weeks postoperatively. There were no major difficulties with skin irritation or appliance management and no instance of parastomal abscess and stoma retraction. Although no complications related to the ostomy or its closure were encountered in these patients, small bowel obstruction before closure (8 patients) or after takedown (5 patients) of the loop ileostomy required operative correction in one patient in each group.
(C) 1994 Southern Medical Association
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12/31/1969 03:59 PM
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Negative Pressure Wound Therapy: An Important Adjunct to Wound Care
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Negative Pressure Wound Therapy: An Important Adjunct to Wound Care. Mendonca, Derick Amith MBBS, MSC, MRCS gauze in the healing of postoperative diabetic foot wounds. Ostomy Wound Manage 2000;46:28-34
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12/31/1969 03:59 PM
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Clinical Application of Treating Biofilms-Associated Infections in Family Medicine
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Abstract: The management of common infections in family medicine may be complicated by poor treatment response or infection recurrence. In many cases, difficulty in treating these infections can be explained by the important role of biofilms, complex microbial communities with unique survival properties that promote infection resistance, recurrence, and persistence. Biofilms have been demonstrated to play important roles in infections involving the sinuses, ears, and ischemic wounds. Biofilms also commonly grow on medical devices, such as indwelling catheters, where they serve as an important nidus of persistent infection. Understanding the role of biofilms in medical infections suggests preventive and treatment strategies that will directly target the important resistive mechanisms of biofilms.
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12/31/1969 03:59 PM
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How Do You Teach an Old Dog New Tricks? Lessons from Venous Thromboembolism Prophylaxis Guidelines
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How Do You Teach an Old Dog New Tricks? Lessons from Venous Thromboembolism Prophylaxis Guidelines. catheter-related urinary tract infections and pressure ulcers. Ostomy Wound Manage 2007;53:34-42
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12/31/1969 03:59 PM
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Unexpected Economics of Ulcer Care Protocols
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The cost of managing chronic ulcers, both venous leg and decubiti (sacral pressure), was reviewed using 36 randomized, controlled studies with a focus on saline, hydrocolloid, and a human skin construct. When one includes the labor intensiveness of dressing changes three to four times per day, the application of hydrocolloid dressings becomes the most cost-effective.
(C) 2004 Southern Medical Association
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12/31/1969 03:59 PM
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Risk Factors of Cellulitis Treatment Failure with Once-Daily Intravenous Cefazolin Plus Oral Probenecid
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Objectives: Once-daily intravenous cefazolin with probenecid is used commonly to treat cellulitis. The primary objective of this study was to determine the risk factors of treatment failure with this regimen.
Methods: This was a retrospective cohort study of adult outpatients with cellulitis who were initially treated with once-daily intravenous cefazolin plus probenecid. Treatment failure is defined as inadequate improvement that necessitates either hospital admission or a change in antibiotic therapy to a different intravenous regimen. A stepwise logistic regression analysis was performed to determine the risk factors for regimen failure.
Results: From January 2003 to December 2008, 159 patients with cellulitis were initially treated with once daily intravenous cefazolin plus probenecid. Thirty-five (22%) patients had treatment failure. The treatment for 53% (9/17) of the patients with a history of chronic venous disease (CVD) failed, whereas the treatment for 18% (26/142) of patients without CVD failed (P = 0.001). Multivariate analysis identified the presence of CVD as the only risk factor associated with treatment failure (odds ratio 4.4, 95% confidence interval 1.5–13; P = .007).
Conclusions: Patients with cellulitis and CVD who are being treated with once-daily intravenous cefazolin plus probenecid should be monitored closely for treatment failure.
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12/31/1969 03:59 PM
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Spontaneous Cholecystocutaneous Fistula
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Spontaneous cholecystocutaneous fistula is rarely observed today because of the early diagnosis and management made possible by ultrasonography, broad-spectrum antibiotics, and effective surgical management of biliary tract disease. We present a case of spontaneous cholecystocutaneous fistula due to cholecystitis.
(C) 2004 Southern Medical Association
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12/31/1969 03:59 PM
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Skin Toxicity During Breast Irradiation: Pathophysiology and Management
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Radiotherapy is a critical component in the treatment of breast cancer, a disease that is estimated to have affected 203,500 US women in 2002. According to the data from some series, an estimated 90% of patients treated with radiotherapy for breast cancer will develop a degree of radiation-induced dermatitis. This review describes the indications and techniques of radiotherapy for breast cancer. The pathophysiology, clinical presentation, and contributing factors of radiation-related skin injury are discussed. A review of recent clinical research addressing skin toxicity is provided.
(C) 2004 Southern Medical Association
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12/31/1969 03:59 PM
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Adult Postoperative Intussusception: A Rare Cause of Small Bowel Obstruction
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A case is reported of postoperative jejunojejunal intussusception in a 45-year-old Afro-Caribbean male following an emergency truncal vagotomy and pyloroplasty. This is a rare cause of postoperative small bowel obstruction, and the pathogenesis and diagnosis of postoperative intussusception in the adult is discussed. Differences between conventional childhood, postoperative childhood, adult, and postoperative adult intussusception are outlined.
(C) 2007 Southern Medical Association
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12/31/1969 03:59 PM
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Pilot Study on Gastric Electrical Stimulation on Surgery-associated Gastroparesis: Long-term Outcome
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Objectives: Patients with postgastric surgery gastroparesis are often unresponsive to conventional medical therapy. Gastric electrical stimulation (GES) with the use of high-frequency and low-energy neural stimulation is an approved technique for patients with idiopathic and diabetic gastroparesis.
Methods: We hypothesized that GES would improve symptoms, health resource utilization, and gastric emptying in six patients with postsurgical gastroparesis from a variety of surgical procedures. Patients were evaluated by means of the following criteria: symptoms, health-related quality of life, and gastric emptying tests at baseline over time.
Results: All patients noted improvements after device implantation for up to 46 months: the frequency score for weekly vomiting went from a baseline of 3.2 down to 0.4 immediately after treatment before settling at 1.4 by the long-term follow up. Total gastrointestinal symptom score went from 36.5 at baseline down to 12.3 before settling at 20.5 at long-term follow up. Improvements were also seen in health-related quality of life and solid and liquid gastric emptying.
Conclusions: We conclude that GES is associated with clinical improvements in this group of patients with either postsurgical or surgery-associated gastroparesis. This pilot study with long-term outcomes offers evidence for a new therapy for otherwise refractory patients with gastroparesis associated with previous surgery.
(C) 2005 Southern Medical Association
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12/31/1969 03:59 PM
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Stress Urinary Incontinence in Active Elderly Women
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Urinary incontinence in the elderly is a significant health problem fraught with isolation, depression, and an increased risk of institutionalization and medical complications. Stress urinary incontinence (SUI), the complaint of involuntary loss of urine during effort or exertion or during sneezing or coughing, is the most common type of urinary incontinence. SUI can seriously degrade the quality of life for many active seniors, and has become an economic challenge for society. With the rapid increase in the active elderly worldwide, SUI is becoming a significant global problem. However, since only a fraction of women with SUI have consulted a physician, the clinical extent and public health impact of SUI are probably underestimated. The mounting social, medical, and economic problem of SUI in active elderly women as a rapidly growing segment of the population worldwide is reviewed. We evaluate the age-related changes of the lower urinary tract, examine risk factors, and suggest different treatment options shown to be effective in reducing SUI in this population.
(C) 2005 Southern Medical Association
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12/31/1969 03:59 PM
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Platypnea-Orthodeoxia: Bilateral Lower-Lobe Pulmonary Emboli and Review of Associated Pathophysiology and Management
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Platypnea-orthodeoxia is a rare syndrome characterized by dyspnea and arterial deoxygenation, which is exacerbated in an upright position and relieved with recumbency. We report a case of platypnea-orthodeoxia in a 56-year-old male who was found to have bilateral lower-lobe pulmonary emboli. He did not have any evidence of an intracardiac shunt. A comprehensive review of the pathophysiology and management of platypnea-orthodeoxia is provided.
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