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Complications associated with ileal pouch-anal anastomosis. 总被引:8,自引:0,他引:8
K McMullen T C Hicks J E Ray J B Gathright A E Timmcke 《World journal of surgery》1991,15(6):763-6; discussion 766-7
Seventy-three patients underwent total colectomy, rectal mucosectomy, creation of J or S ileal reservoir, and ileal pouch-anal anastomosis from 1982 to 1989. Mean follow-up was 38 months, with a minimum of 3 months in 15 patients being followed long-term at another institution. Forty-eight (66%) patients had histologically proven ulcerative colitis and 25 (34%) patients had familial polyposis. Thirty-eight J reservoirs and 35 S reservoirs were constructed. There were no perioperative deaths. The failure rate (loss of pouch) was 3%. Thirty-six complications in 34 (47%) patients were reported, 14 (19%) patients required surgery. Bowel obstruction was the most common postoperative complication (16%), followed by pouchitis (15%), and cuff infection (5%). Seventy-eight percent of the complications were associated with the J pouch. Average stool frequency at 1 year was 4 per 24-hour period. Other complications included postoperative pneumonia (1), peroneal nerve palsy (1), and temporary sexual dysfunction (1). Seven of 15 complications requiring surgical intervention occurred in the first 2 years of the study period, illustrating the learning curve associated with the procedure. Blood loss, transfusion requirements, and length of operation were not associated with higher complication rates. Use of the J pouch and experience of the individual surgeon affected morbidity. 相似文献
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Isolated segments of rat jejunum were perfused in situ with glucosesaline containing varying amounts of CdC12. At low Cd concentrations the endogenous Cd-binding capacity sufficed to trap almost all Cd taken up in the mucosa. At higher Cd levels, induction of metallothionein synthesis by Zn increased fractional trapping of Cd. Pretreatment with Zn did not induce protein synthesis in any fraction other than the low molecular weight heatstable cytosol fraction. Acutely Zn did not affect Cd extrusion from the mucosa. Finally, Cd-metallothionein itself crosses the mucosa only very slowly. An earlier conclusion that metallothionein does not contribute to Cd trapping was based on low Cd concentrations in the perfusate; at higher concentrations metallothionein appears to be a major determinant of mucosal Cd retention. 相似文献
76.
Martin C Mahoney Joseph E Bauer Laurene Tumiel Sarah McMullen Jeff Schieder Denise Pikuzinski 《BMC family practice》2002,3(1):3-9
Background
Information on the effectiveness of elementary school level, tobacco-use prevention programs is generally limited. This study assessed the impact of a structured, one-time intervention that was designed to modify attitudes and knowledge about tobacco. Participants were fifth-grade students from schools in western New York State. 相似文献77.
K McMullen D Hayes J L Hussey J P Boudreaux 《Archives of surgery (Chicago, Ill. : 1960)》1991,126(10):1303-1305
Infection combined with additional complications of arteriovenous fistulas is a serious threat to access in patients with upper-extremity polytef (polytetrafluoroethylene) grafts. We present three cases of infected access grafts that were treated with systemic antibiotics, excision of the grafts, and primary anastomosis of the arterialized vein to artery for access salvage. The new arteriovenous fistulas were used immediately, preventing interruptions in hemodialysis regimens. This technique of immediate reconstruction allows the surgeon to utilize the arterialized outflow vein and save other sites of access for future use. 相似文献
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THE EVOLUTION OF THE OPHTHALMOSCOPE 总被引:1,自引:1,他引:0
McMullen WH 《The British journal of ophthalmology》1917,1(10):593-599
80.
BACKGROUND: Inaccuracies in symptom perception may contribute to morbidity and mortality in childhood asthma. OBJECTIVE: To systematically examine the accuracy of symptom perception on the part of children with asthma and their parents, as well as their interpretation and evaluation of the symptoms. METHOD: Twenty-eight patient/parent pairs from suburban and underserved urban pediatric populations participated in a 5-week protocol tracking subjective assessments of asthma severity (visual analog scales) and peak expiratory flow rates. Relationships between perceptual accuracy and demographic and disease factors were investigated. RESULTS: Adolescents were more accurate than school-aged children, more accurate children had better morbidity outcomes, and African American parents were more accurate than Caucasian parents. Socioeconomic status did not affect accuracy. Both children and parents missed early symptoms and waited too long prior to intervening in an exacerbation. CONCLUSIONS: There are multiple opportunities for error in symptom perception and evaluation. Identification of the source of error is critical to the effective utilization of education on self-management. 相似文献