RESUMEN
OBJECTIVE: To investigate the neuromuscular activity of the gastrointestinal tract by antroduodenal manometry in women with endometriosis documented by laparoscopy, to assess the effects of diet and drug therapy on symptoms, and to assess the bacterial overgrowth that is commonly associated with these nerve diseases. DESIGN: Prospective, open-label study. SETTING: A clinical center for the care of women's health. PATIENT(S): Fifty women with endometriosis documented by laparoscopy and gastrointestinal tract symptoms characterized by chronic abdominal pain, nausea, vomiting, early satiety, bloating and distention, and altered bowel habits. INTERVENTION(S): Motility of the gastrointestinal tract was recorded and bacterial overgrowth was assessed. Treatment consisted of dietary changes, including reduction of glycemic carbohydrates, balancing with omega 9 oils, elimination of foods with caffeine and tyramine, and addition of omega 3 fatty acids, as well as drug therapy with clonazepam (0.25 mg 3 times per day). RESULT(S): All 50 women showed a characteristic motility change (ampulla of Vater-duodenal wall spasm, a seizure equivalent of the enteric nervous system). Forty of the women showed bacterial overgrowth. There was a significant reduction in the total symptom score after 8 weeks of treatment. CONCLUSION(S): This study suggests that endometriosis and gastrointestinal tract symptoms are a result of the dysfunction of hollow organs. Correction of the biochemical imbalance of the eicosanoid system and the hypersecretion of insulin that results from excessive intake of glycemic carbohydrates and lack of essential fatty acids significantly decreases symptoms in patients with endometriosis and associated neuromuscular disease of the gastrointestinal tract.
Asunto(s)
Endometriosis/fisiopatología , Enfermedades Gastrointestinales/fisiopatología , Motilidad Gastrointestinal/fisiología , Enfermedades Neuromusculares/fisiopatología , Adulto , Clonazepam/uso terapéutico , Dieta , Endometriosis/dietoterapia , Endometriosis/tratamiento farmacológico , Ácidos Grasos Omega-3/metabolismo , Femenino , Agonistas del GABA/uso terapéutico , Enfermedades Gastrointestinales/dietoterapia , Enfermedades Gastrointestinales/tratamiento farmacológico , Motilidad Gastrointestinal/efectos de los fármacos , Humanos , Hidrógeno , Laparoscopía , Manometría , Complejo Mioeléctrico Migratorio/fisiología , Enfermedades Neuromusculares/dietoterapia , Enfermedades Neuromusculares/tratamiento farmacológico , Receptores de GABA-A/efectos de los fármacos , Receptores de GABA-A/fisiologíaRESUMEN
To provide an improved data base for predicting the soft-tissue changes that accompany mandibular advancement surgery, short- and long-term serial cephalograms from the records of eighteen patients were analyzed. Hard- and soft-tissue landmarks were located on serial tracings and later were reduced to rectangular X-Y coordinates for computer-generated measurement data and statistical analyses. The interpretation of mean value, ratio, and regression equation data showed that the lower lip, inferior labial sulcus, and chin tissues moved forward and downward. The mandibular short-term (mean = 3.7 months postsurgery) horizontal change means were greater than the long-term (mean = 18 months postsurgery) horizontal change means. The posteriorly directed long-term means may result from functional adaptations that follow the short-term surgery-related spatial changes. These data also show the need for long-term prediction data to supplement the short-term data base.
Asunto(s)
Cara/anatomía & histología , Mandíbula/cirugía , Cefalometría , Predicción , Humanos , Maloclusión Clase II de Angle/cirugía , Planificación de Atención al Paciente , Estudios Retrospectivos , Factores de TiempoRESUMEN
Although less frequent, arterial prosthetic infections are still a disaster for patient and surgeon since they can lead to multiple complications. The inguinal area is the site of more than three-quarters of the graft infections because of anatomical and technical factors. Of all the proposed forms of treatment none has proven to be totally effective and applicable to all cases. We have employed a technique in which the infected portion of the graft is removed, replaced by a new graft and covered with a distally based sartorius muscle flap. Two illustrative cases are presented in which the procedure proved to be successful for two and for eleven years, and the question is raised as to the benefits of this maneuver in the prevention of infection in those cases that require re-operation.