RESUMEN
AIM: Ileal pouch-anal anastomosis is a procedure offered to patients with ulcerative colitis who opt for restoration of bowel continuity. The aim of this study was to determine the risk of pouch failure and ascertain the risk factors associated with failure. METHOD: The study included 1991 patients with ulcerative colitis who underwent ileal pouch-anal anastomosis in Denmark in the period 1980-2013. Pouch failure was defined as excision of the pouch or presence of an unreversed stoma within 1 year after its creation. We used Cox proportional hazards regression to explore the association between pouch failure and age, gender, synchronous colectomy, primary faecal diversion, annual hospital volume (very low, 1-5 cases per year; low, 6-10; intermediate 11-20; high > 20), calendar year, laparoscopy and primary sclerosing cholangitis. RESULTS: Over a median 11.4 years, 295 failures occurred, corresponding to 5-, 10- and 20-year cumulative risks of 9.1%, 12.1% and 18.2%, respectively. The risk of failure was higher for women [adjusted hazard ratio (aHR) 1.39, 95% CI 1.10-1.75]. Primary non-diversion (aHR 1.63, 95% CI 1.11-2.41) and a low hospital volume (aHR, very low volume vs high volume 2.30, 95% CI 1.26-4.20) were also associated with a higher risk of failure. The risk of failure was not associated with calendar year, primary sclerosing cholangitis, synchronous colectomy or laparoscopy. CONCLUSION: In a cohort of patients from Denmark (where pouch surgery is centralized) with ulcerative colitis and ileal pouch-anal anastomosis, women had a higher risk of pouch failure. Of modifiable factors, low hospital volume and non-diversion were associated with a higher risk of pouch failure.
Asunto(s)
Colitis Ulcerosa/cirugía , Reservorios Cólicos/efectos adversos , Complicaciones Posoperatorias/etiología , Proctocolectomía Restauradora/efectos adversos , Adulto , Estudios de Cohortes , Dinamarca , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/epidemiología , Modelos de Riesgos Proporcionales , Sistema de Registros , Factores de Riesgo , Adulto JovenRESUMEN
AIM: A double-blind randomized controlled study was conducted to compare the effect of magnesium oxide (1 g 12-h) with placebo given within an evidence-based multimodal rehabilitation programme on gastrointestinal recovery, pain, mobilization and hospital stay after open colonic resection. METHOD: Of 62 potentially eligible patients, 13 were excluded, leaving 22 in the magnesium oxide group and 27 in the placebo group. The main outcome measure was time to normalization of bowel function. Secondary outcome measures included postoperative nausea, vomiting, pain, fatigue, mobilization and length of postoperative hospital stay. RESULTS: The median times to first flatus and defaecation in the laxative and placebo groups were 18.0 vs 14.0 h and 42 vs 50 h (P > 0.15). Early intake of liquids, protein drinks and solid food, nausea and vomiting, pain, fatigue and mobilization were similar in the groups (P > 0.3). The median postoperative hospital stay was 3 days in both groups (P > 0.65). CONCLUSION: Magnesium oxide does not enhance the recovery of gastrointestinal function within the context of an evidence-based multimodal rehabilitation programme after open colonic surgery.
Asunto(s)
Colon/cirugía , Defecación/efectos de los fármacos , Motilidad Gastrointestinal/efectos de los fármacos , Laxativos/administración & dosificación , Óxido de Magnesio/administración & dosificación , Recuperación de la Función , Adulto , Anciano , Anciano de 80 o más Años , Método Doble Ciego , Femenino , Humanos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Periodo Posoperatorio , Estadísticas no Paramétricas , Factores de TiempoRESUMEN
Deep venous thrombosis is an uncommon but feared complication in pregnancy. The treatment of choice in most centers is heparin and compression stockings, which effectively prevents pulmonary embolism, but the incidence of chronic venous insufficiency with skin change and ulcers after such treatment is reported to be up to 65%. In the period 1985-93, thirty-nine pregnant women were treated for femoroiliacal venous thrombosis (FIVT) with operative thrombectomy, arteriovenous fistula and anticoagulant therapy. The aim of this study was to examine those of the women who subsequently had been pregnant again. The pregnancy and delivery were closely monitored and the frequency of clinically detected as well as objectively measured venous insufficiency was recorded. Nineteen of the women subsequently became pregnant again, resulting in 25 deliveries. They were investigated at the Coagulation Laboratory and treated with phenendione or low molecularweight heparin. All pregnancies proceeded successfully. None showed clinical signs of rethrombosis during the subsequent pregnancy. At follow up 11 patients had dilated or varicose veins, nine had a closed iliaca at ultrasound examination, none had skin changes or ulcers. We conclude that women treated for FIVT in pregnancy with thrombectomy followed by anticoagulant therapy may undergo a new pregnancy with low risk of obstetrical complications and with a low risk of developing rethrombosis or chronic venous insufficiency.