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  • Chemical Engineering  (22)
  • Analytical Chemistry and Spectroscopy  (21)
  • Ileoanal reservoir  (7)
  • 1
    Digitale Medien
    Digitale Medien
    The double-stapled ileal reservoir and ileoanal anastomosis (1991)
    Springer
    Diseases of the colon & rectum 34 (1991), S. 487-494 
    Details
    ISSN: 1530-0358
    Schlagwort(e): Ileoanal reservoir ; Stapling device ; Mucosal ulcerative colitis ; Familial adenomatous polyposis
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract Fifteen consecutive patients (nine males and six females) who underwent construction of a double-stapled ileoanal reservoir (DS-IAR) were prospectively evaluated. Mean and maximal resting pressures preoperatively, before ileostomy closure, and at 12 months, were 53 and 84 mm Hg, 39 and 62 mm Hg, and 62 and 81 mm Hg. Mean and maximal squeeze pressures at those same time periods were 96 and 153 mm Hg, 111 and 173 mm Hg, and 95 and 168 mm Hg. There were no significant decreases in either resting or squeeze pressure between preoperative values and those obtained 12 months after surgery. However, the length of the high pressure zone decreased from 3–8 cm preoperatively to 2.3 cm at 12 months. This reflects the sacrifice of the cephalad 1.5 cm of the internal anal sphincter necessary to effect this anastomosis at a mean of 1.4 cm from the dentate line. However, this maneuver did not result in poor continence. Eleven patients whose ileostomies were closed for a mean of 9 months, ranging from 3 to 15 months, were evaluated regarding functional outcome. Only one patient had any incontinence and this patient had incomplete circularstapled tissue rings, which necessitated transanal suture repair of the anastomotic defect. Similarly, three of the four patients who sometimes or rarely use a pad at night had transanal-suture reinforcement. Ten of the 11 patients never wear a pad during the day. No pelvic or perianal sepsis occurred. Stratified squamous epithelium was found in 6 of the 13 distal stapler “donuts” that were examined. In addition, 10 patients underwent biopsy of the tissue immediately caudad to the circular staple line at the time of ileostomy closure; in five, only stratified squamous epithelium was noted. The DS-IAR is associated with excellent objective physiologic and subjective functional results.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/BF02049935
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  • 2
    Digitale Medien
    Digitale Medien
    Laparoscopic total abdominal colectomy (1992)
    Springer
    Diseases of the colon & rectum 35 (1992), S. 651-655 
    Details
    ISSN: 1530-0358
    Schlagwort(e): Laparoscopic colectomy ; Laparoscopy ; Ileoanal reservoir ; Restorative proctocolectomy ; Colonic inertia ; Ulcerative colitis ; Familial adenomatous polyposis
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract The aim of this study was to prospectively assess the impact of laparoscopy upon the outcome of total abdominal colectomy (TAC). Specifically, patients underwent standard laparotomy with TAC and ileoproctostomy (TAC + IP), TAC and ileoanal reservoir (TAC + IAR), laparoscopically assisted TAC + IP (L-TAC + IP), or laparoscopically assisted TAC + IAR (L-TAC + IAR). Parameters studied included the length of surgery, length of ileus, length of hospitalization, morbidity, and mortality. Five patients underwent standard TAC (Group I), and five underwent L-TAC (Group II). Group I consisted of five patients of a mean age of 32 (range, 24–51) years who had mucosal ulcerative colitis (n=1), familial adenomatous polyposis (n=3), or colonic inertia (n=1). Group II consisted of five patients of a mean age of 33 (range, 17–43) years who had mucosal ulcerative colitis (n=1), familial adenomatous polyposis (n=3), or colonic inertia (n=1). This preliminary prospective study indicates that laparoscopically assisted TAC is feasible. L-TAC resulted in a slightly longer length of ileus and length of hospitalization; these differences were not statistically significant. Moreover, the length of time required for the laparoscopic procedures was 35 percent longer than for the open procedures. Although these results may improve as more cases are performed, dramatic differences in rates of postoperative recovery have not yet been realized. In conclusion, L-TAC, while technically feasible, dose not appear to offer any immediately recognizable benefits to the patient as compared with standard laparotomy.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/BF02053755
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  • 3
    Digitale Medien
    Digitale Medien
    Retained mucosa after double-stapled ileal reservoir and ileoanal anastomosis (1992)
    Springer
    Diseases of the colon & rectum 35 (1992), S. 1051-1056 
    Details
    ISSN: 1530-0358
    Schlagwort(e): Ileoanal reservoir ; Ileal pouch-anal anastomosis ; Mucosal ulcerative colitis ; Ulcerative colitis ; Double-stapled ; Dysplasia ; Restorative proctocolectomy
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract A study was undertaken to assess the incidence of inflammation and dysplasia in retained mucosa after double-stapled ileoanal reservoir (IAR) for mucosal ulcerative colitis (MUC). Between September 1988 and February 1992, 56 patients with MUC underwent an IAR. Forty-five patients had a double-stapled IAR (DS-IAR), seven patients had a transanal pursestring stapled IAR (PS-IAR), and four patients had a PS-IAR with mucosectomy. Distal donuts obtained from the stapled IAR were submitted for pathologic review in 55 patients. Nine patients had only small bowel, connective tissue, and/or muscle noted on review. Mucosa was qualified as squamous epithelium (SE), transitional epithelium (TE), or columnar epithelium (CE). All samples were examined for evidence of inflammation and dysplasia. Four patients had SE only, one patient had TE, and 18 had CE. In addition, three patients had SE and CE, seven patients had SE and TE, two patients had CE and TE, and nine patients had all three types. The distance from the dentate line to the anastomosis ranged from 0 to 2.5 cm (mean, 1 cm). In 19 patients (35 percent), the distal donut revealed MUC. Of these 19 patients, six had persistent MUC (43 percent) at the time of subsequent biopsy. An additional four patients had MUC evident on follow-up biopsy but not on distal donuts; two of these four patients had no mucosa in their distal donuts. Only one of the patients with evidence of MUC on donuts and/or biopsy experienced any symptoms referable to active MUC (1.8 percent). None of the specimens examined had any evidence of dysplasia. In 31 patients, no MUC was present in the initial donuts or follow-up biopsies. Although the double-stapled technique appears safe, periodic monitoring is suggested.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/BF02252995
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  • 4
    Digitale Medien
    Digitale Medien
    Loop ileostomy is a safe option for fecal diversion (1993)
    Springer
    Diseases of the colon & rectum 36 (1993), S. 349-354 
    Details
    ISSN: 1530-0358
    Schlagwort(e): Loop ileostomy ; Ileostomy ; Fecal diversion ; Ileoanal reservoir ; Stoma
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract This study was undertaken to prospectively assess all morbidity and mortality associated with temporary loop ileostomy. Eighty-three consecutive patients of a median age of 45 years required temporary fecal diversion after either ileoanal or low colorectal anastomosis (n=72), for perianal Crohn's disease (n=5), or for other reasons (n=6). All loop ileostomies were supported with a rod, and fecal diversion was maintained for a mean of 10 weeks. To date, 67 patients have had re-establishment of intestinal continuity. Stoma closure was affected through a parastomal incision in 64 patients; in three, a laparotomy was required. The closure was stapled side to side in 49 patients, while a hand-sewn anastomosis was done in the other 18 patients; all skin wounds were left open. The mean length of surgery for ileostomy closure was 56 minutes, and the mean hospital stay was five days. Nine patients (10.8 percent) developed 10 complications, nine of which required hospitalization. Specifically, four patients developed dehydration and electrolyte abnormalities secondary to high stoma output, and two had anastomotic leaks that spontaneously healed following conservative management. One patient developed a superficial wound infection that spontaneously drained itself. One patient developed a partial small bowel obstruction that resolved without surgery after a four-day hospitalization. One stoma retracted after supporting rod removal and prompted premature closure. There was no stomal ischemia, hemorrhage, prolapse, or mortality in this series. Thus, loop ileostomy is a safe way to achieve fecal diversion.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/BF02053937
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  • 5
    Digitale Medien
    Digitale Medien
    Optimization of sphincter function after the ileoanal reservoir procedure (1994)
    Springer
    Diseases of the colon & rectum 37 (1994), S. 419-423 
    Details
    ISSN: 1530-0358
    Schlagwort(e): Kegel exercises ; Pelvic muscle exercises ; Ileoanal reservoir ; J-pouch ; Restorative proctocolectomy
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract PURPOSE: Impairment of sphincter function in patients who undergo ileoanal reservoir is usually most severe immediately after ileostomy closure. Therefore, a prospective, randomized trial was undertaken to assess the potential value of preileostomy closure sphincter-strengthening exercises to improve early functional outcome. METHODS: Patients were randomized either to a control group (Group 1) or to undergo a five-week pelvic floor exercise program (Group 2). An incontinence score from 0 to 20 was used to clinically assess the functional results. Anorectal manometric assessment included: highpressure zone length, mean resting pressure, highest resting pressure, mean squeezing pressure, and highest squeezing pressure. The paired t-test was used to compare the functional results preoperatively and at the time of ileostomy closure. This time corresponded to the conclusion of the exercise program or the equivalent time period for the control group. RESULTS: Twenty-six patients who underwent double-stapled ileoanal reservoir between July 1991 and June 1992 were studied. They included 16 males and 10 females with a mean age of 38 (range, 17–69) years. When both evaluations were compared, the mean incontinence score decreased from 0.2 to 2.8 (Δ=2.6) in Group 1 and from 0.2 to 2.0 (Δ = 1.8) in Group 2 (P=0.07). None of the changes between the preoperative and postoperative clinical and physiologic evaluations were statistically significant (P〉0.05). CONCLUSION: Sphincter-strengthening exercises before ileostomy closure did not minimize the transient impairment of functional results.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/BF02076184
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  • 6
    Digitale Medien
    Digitale Medien
    Recovery of anal sphincter function after the ileoanal reservoir procedure in patients over the age of fifty (1994)
    Springer
    Diseases of the colon & rectum 37 (1994), S. 1002-1005 
    Details
    ISSN: 1530-0358
    Schlagwort(e): Ileoanal reservoir ; Pouch ; Restorative proctocolectomy ; Continence ; Ileoanal anastomosis
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract PURPOSE: This study was undertaken to postoperatively assess the progression of anal sphincter function and clinical outcome in patients ≥50 years old (Group I) compared with those 〈50 years old (Group II). METHODS: Clinical data were assessed after ileostomy closure by a questionnaire. These data were compiled to obtain an incontinence score, which ranged from 0 (perfect continence) to 20 (total incontinence). Anorectal manometry was performed preoperatively (MN1) and postoperatively, before (MN2) and after (MN3) ileostomy closure. Wilcoxon and paired t-test were used to compare the clinical and functional results, respectively. RESULTS: Group I consisted of 22 patients (mean age, 56 years) and Group II, 50 patients (mean age, 32 years). No differences were found relative to either preoperative pressures or clinical outcome. However, both the mean and high resting pressures were significantly lower in Group I at the MN2 examination. CONCLUSION: The effect on anal sphincters of ileoanal reservoir in patients over the age of 50 years is similar to that noted in younger patients. Transient impairment of internal anal sphincter function observed after ileoanal reservoir is more severe in older patients (P=0.01). However, as in younger patients, it does completely recover after ileostomy closure.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/BF02049312
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  • 7
    Digitale Medien
    Digitale Medien
    Ileal pouch-anal anastomosis: Is preoperative anal manometry predictive of postoperative functional outcome? (1994)
    Springer
    Diseases of the colon & rectum 37 (1994), S. 224-228 
    Details
    ISSN: 1530-0358
    Schlagwort(e): Ileal pouch-anal anastomosis ; Ileoanal reservoir ; Anal manometry ; Incontinence ; Anorectal physiology
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract PURPOSE: The aim of this study was to determine the value of preoperative anal manometry in predicting postoperative continence. METHODS: Anal manometry was performed in 73 consecutive patients before ileal pouch-anal anastomosis (IPAA) surgery (m1), before loop ileostomy closure (m2), and at a follow-up of one (m3) and two (m4) years. Mean and maximum resting and squeezing pressures were documented at each occasion. One year after surgery, pressures were correlated (r)with an incontinence score. RESULTS: A significant (P 〈 0.05) decrease in mean resting pressures was observed after IPAA (m1=66 mmHg; m2=42.8 mmHg), followed by a significant (P 〈 0.05) improvement of mean resting pressure after loop ileostomy closure (m3 = 538 mmHg; m4 = 54.7 mmHg). Mean squeezing pressures did not change (P 〉 0.05) at any time during the study (m1 =114 mmHg; m2 = 102.9 mmHg; m3 = 103.4 mmHg; m4 = 95.8 mmHg). There was no correlation between preoperative mean resting pressure and postoperative (mI) incontinence score. CONCLUSION: Anal manometry showed a characteristic trend in internal anal sphincter injury after IPAA followed by recovery after ileostomy closure. However, it failed to prove helpful in the prediction of clinical outcome. Thus, although this study supports the continued use of manometry in a research setting, it challenges the value of routine manometry in a clinical context.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/BF02048159
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  • 8
    Digitale Medien
    Digitale Medien
    Direct measurement of dietary fractional absorption using calcium isotopic tracers (1987)
    Chichester : Wiley-Blackwell
    Biological Mass Spectrometry 14 (1987), S. 603-607 
    Details
    ISSN: 0887-6134
    Schlagwort(e): Chemistry ; Analytical Chemistry and Spectroscopy
    Quelle: Wiley InterScience Backfile Collection 1832-2000
    Thema: Chemie und Pharmazie
    Notizen: Fractional dietary Ca absorption, ‘a’, is measured by determining the ratio of two stable isotopic tracers, one of them orally (44Ca @ 0.2-0.5 mg/kg) and the other intravenously (42Ca @ 0.02-0.1 mg/kg). Thermal ionization mass spectrometry (TIMS) is used to measure the perturbation of natural abundance isotope ratios (delta % excess). Typical sensitivity of the TIMS permits detection of a 2.5 delta % excess change from the natural Ca isotope ratio with relative standard deviations of about 0.5%. At sufficiently long times absorption becomes constant so that ‘a’ is determined by a product of constants and a measured ratio.
    Zusätzliches Material: 5 Ill.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1002/bms.1200141105
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  • 9
    Digitale Medien
    Digitale Medien
    Substituent effects in the mass spectrometry of 4-substituted camphors studied under electron and chemical ionization (1994)
    New York, NY : Wiley-Blackwell
    Rapid Communications in Mass Spectrometry 8 (1994), S. 876-880 
    Details
    ISSN: 0951-4198
    Schlagwort(e): Chemistry ; Analytical Chemistry and Spectroscopy
    Quelle: Wiley InterScience Backfile Collection 1832-2000
    Thema: Physik
    Notizen: The electron ionization mass spectra of fourteen 4-substituted (4-X) camphors have been recorded and analyzed using metastable ion analysis and exact mass measurement. With respect to camphor, alkyl substituents changed the relative importance of different fragmentation pathways, though they did not induce new fragmentations. Substituents X connected to the camphor framework through an atom having a lone pair of electrons were generally lost as HX. Overall the fragmentation behaviour was essentially independent of the inductive substituent constant. Under chemical ionization conditions, only methane of the reagent gases produced extensive fragmentations of these compounds; isobutane, acetone and ammonia were ineffective. The nature of the fragmentations was independent of both the inductive substituent constant of the substituent X and the proton affinity and heat of formation of the corresponding neutral compound HX.
    Zusätzliches Material: 1 Ill.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1002/rcm.1290081104
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  • 10
    Digitale Medien
    Digitale Medien
    Synthesis and use of a novel chiral surfactant based on (R,R)-tartaric acid and its application to chiral separations in micellar electrokinetic capillary chromatography (MECC)Presented at the 17th International Symposium on Capillary Chromatography and Electrophoresis, Wintergreen, Virginia, USA, May 1995 (1995)
    New York, NY [u.a.] : Wiley-Blackwell
    Journal of Microcolumn Separations 7 (1995), S. 513-520 
    Details
    ISSN: 1040-7685
    Schlagwort(e): chiral ; separation ; micellar ; capillary ; electrophoresis ; Chemistry ; Analytical Chemistry and Spectroscopy
    Quelle: Wiley InterScience Backfile Collection 1832-2000
    Thema: Chemie und Pharmazie
    Notizen: This article describes the synthesis of a novel chiral surfactant based on (R,R)-tartaric acid. (R,R)-Tartaric acid is acetylated while simultaneously forming a cyclic anhydride, which is then reacted with n-decylamine forming a chiral, long chain carboxylic acid. This carboxylic acid is then further reacted with the achiral amino acid taurine forming the required surfactant which has a sulfonic acid headgroup. Evidence for its surface activity and an estimate of its critical micelle concentration (cmc) have been obtained using surface tension measurements and conductivity. The surfactant has then been used as the additive in micellar electrokinetic capillary chromatography (MECC) to achieve chiral separations of compounds with multiple aromatic functionality. These separations are compared with those achieved with previously reported tartaric acid based surfactants which show a difference in selectivity. © 1995 John Wiley & Sons, Inc.
    Zusätzliches Material: 8 Ill.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1002/mcs.1220070512
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