RESUMEN
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Asunto(s)
Humanos , Servicios Médicos de Urgencia/estadística & datos numéricos , Calidad de la Atención de Salud/estadística & datos numéricos , Tratamiento de Urgencia/estadística & datos numéricos , Indicadores de Calidad de la Atención de Salud/estadística & datos numéricosRESUMEN
Somatostatin and octreotide both enhance closure of gastrointestinal fistulas. The present trial was undertaken to test whether early combined treatment with parenteral nutrition and octreotide 100 micrograms every 8 h by subcutaneous injection had a beneficial effect compared with parenteral nutrition plus placebo. Thirty-one patients with post-operative gastrointestinal or pancreatic fistula were randomly assigned to receive parenteral nutrition plus octreotide (14 patients) or placebo (17) within 8 days of fistula onset. The percentage reduction in output and rate of spontaneous closure within 20 days were analysed. Mean(s.d.) reduction in output was similar after octreotide and placebo at 24 h (66(43) versus 68(47) per cent, P = 0.9), 48 h (60(46) versus 57(43) per cent, P = 0.8) and 72 h (62(50) versus 66(49) per cent, P = 0.9) after starting the combined treatment. Closure within 20 days was observed in eight of 14 fistulas in patients given octreotide and in six of 17 in those receiving placebo (P = 0.4). Administration of octreotide, within 8 days of fistula onset, associated with parenteral nutrition does not significantly increase the spontaneous fistula closure rate compared with parenteral nutrition plus placebo.
Asunto(s)
Fístula Cutánea/tratamiento farmacológico , Fístula Intestinal/tratamiento farmacológico , Octreótido/administración & dosificación , Fístula Pancreática/tratamiento farmacológico , Anciano , Método Doble Ciego , Femenino , Humanos , Inyecciones Subcutáneas , Masculino , Persona de Mediana Edad , Nutrición Parenteral , Cuidados Posoperatorios , Resultado del TratamientoRESUMEN
A series is presented of 83 patients surgically explored for massive bowel infarction. Old men with previous heart disease and symptoms of peripheral atherosclerosis were primarily affected. Clinical presenting features were abdominal pain (100 per cent), peritonitis (57 per cent), shock (34 per cent) and hypothermia (26 per cent). A third-space syndrome with metabolic acidosis and uraemia was the most common physiological derangement. Age was the only factor that appeared to have influenced the surgeon's decision to perform massive bowel resection (71 years in non-resected versus 64 years in resected patients, P less than 0.006). The overall mortality rate was 71 per cent. Forty-four patients underwent massive bowel resection (mean length of remaining small bowel 60 +/- 40 cm) and twenty-four (54 per cent) survived the procedure. Axillary temperature was higher in survivors (36.7 degrees C versus 36.1 degrees C, P less than 0.03). Early postoperative total plasma protein and albumin concentrations were also higher in survivors (57 versus 46 g/l, P less than 0.005; 27 versus 22 g/l, P less than 0.02). Patients with previous symptoms of atherosclerotic disease and high pre-operative blood urea levels also had a bad prognosis. Survivors had a mean hospital stay of 57 days and parenteral nutrition had to be maintained for a mean of 34 days. The survival rate achieved with massive resection justifies this surgical approach in selected patients with massive bowel infarction.
Asunto(s)
Infarto/cirugía , Intestino Delgado/cirugía , Oclusión Vascular Mesentérica/cirugía , Anciano , Femenino , Humanos , Masculino , Arterias Mesentéricas , Persona de Mediana Edad , Pronóstico , Factores de RiesgoRESUMEN
Colonic perforation is the second most common complication of colonic neoplasms and is associated with an elevated morbidity and mortality. We undertook a two-centre retrospective analysis of 378 colonic neoplasms seen from 1978 to 1985. Thirty-six patients (9.5%) presented with a perforated colonic carcinoma. Two-thirds had a past history suggesting colonic disease while in the remaining one-third, the perforation was the first manifestation of the disease. Resection was carried out initially in 33 cases (21 Hartmann's procedure, 9 primary anastomosis, 2 mucous fistula and 1 abdominoperineal excision). Two patients had a proximal colostomy only and 1 an exploratory laparotomy only because of disseminated disease. Postoperative mortality was 14% (five cases). Actuarial survival rate was 52% at 1 year and 40% at 2 years. Eleven patients are still alive after a mean follow-up of 43 months.