| 1. |
- Hallböök, Olof, 1954-, et al.
(författare)
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Safety of the temporary loop ileostomy
- 2002
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Ingår i: Colorectal Disease. - : Wiley. - 1462-8910 .- 1463-1318. ; 4:5, s. 361-364
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Tidskriftsartikel (refereegranskat)abstract
- Objective. To evaluate the complications of the temporary loop ileostomy. Method. A retrospective study of 222 consecutive patients with low anterior resection, ileal pouch-anal anastomosis or continent ileostomy and a diverting loop ileostomy routinely fashioned during the primary operation. The loop ileostomy was closed in 213 patients (96%) during the minimum follow-up period of 15 months. Results. Four patients (2%) required preterm closure of the ostomy due to stomal retraction (n = 3) or bowel obstruction (n = 1). Four patients were readmitted due to transient bowel obstruction that resolved without surgery. After closure of the loop ileostomy a total of 27 patients (13%) had complications. In 7 patients emergency re-operation was done due to small bowel obstruction (n = 5) or intra-abdominal abscess (n = 2). Elective re-operation was done in 5 patients for hernia at the site of the previous stoma. Despite the use of a loop ileostomy there was 1 postoperative death after the initial operation in consequence of anastomotic leakage. There was 1 death in consequence of closure of the loop ileostomy after 3 weeks due to intra-abdominal sepsis and heart failure. Conclusion. In this series closure of the ostomy was associated with one death (0.5%) and overall ostomy-related morbidity included the need to re-operate in 6%.
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| 2. |
- Leinsköld, Ted, et al.
(författare)
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Effect of postoperative insulin-like growth factor I supplementation on protein metabolism in humans
- 1995
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Ingår i: British Journal of Surgery. - : Oxford University Press (OUP). - 0007-1323 .- 1365-2168. ; 82:7, s. 921-925
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Tidskriftsartikel (refereegranskat)abstract
- Insulin-like growth factor I (IGF-I) has been shown experimentally to exert a nitrogen-sparing effect in both animals and humans. Its effects on protein metabolism during the first 5 days after radical large bowel resection were investigated. Nineteen patients were randomly allocated to receive either human recombinant IGF-I (2 × 80 μ/kg body weight subcutaneously, n = 10) or placebo (n = 9) starting on the morning of the first day after operation. All patients received parenteral nutrition (glucose 3 g and nitrogen 0.1 g/kg/day). The mean(s.e.m.) urinary nitrogen: creatinine ratio was significantly reduced in patients who received IGF-I compared with those given placebo (275.0(17.1) compared with 386.3(23.6), P<0.01). The mean urinary 3-methylhistidine: creatinine ratio and nitrogen balance were lower in the IGF-I group, but not significantly so. Plasma IGF-I concentrations were four times higher in the treated group compared with those in the placebo group. Insulin-like growth factor binding protein 3 (IGFBP-3) increased significantly after the start of IGF-I treatment, compared with mean postoperative levels. The mean blood glucose concentration was significantly lower in the IGF-I group than the placebo group (P < 0.05) but no patient had a hypoglycaemic attack. The authors conclude that IGF-I does not significantly influence the nitrogen balance, but that results indicate a possible nitrogen-sparing effect in patients after major abdominal operations. IGF-I therapy is safe, and may be of value in catabolic patients after serious injury and major operations.
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| 3. |
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| 4. |
- Leinsköld, Ted, et al.
(författare)
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Gastrointestinal growth factors and pancreatic islet hormones during postoperative IGF-I supplementation in man
- 2000
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Ingår i: Journal of Endocrinology. - : Bioscientifica. - 0022-0795 .- 1479-6805. ; 167:2, s. 331-338
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Tidskriftsartikel (refereegranskat)abstract
- Insulin-like growth factor-I (IGF-I) has been demonstrated to exert a nitrogen sparing effect, both experimentally and in patients after abdominal surgery. IGF-I is a major mediator for the anabolic effects of growth hormone (GH). Whether elevated circulating IGF-I levels are the sole mediator of the anabolic effects following GH has not been clarified. IGF-I influences glucose metabolism, both through its own specific receptor and by activating the insulin receptor, and has also been proposed to influence pancreatic islet secretion directly. In the present study, the postoperative effects of IGF-I on plasma levels of other gastrointestinal and pancreatic islet hormones and growth factors were measured in patients after abdominal surgery. Fifteen patients who were candidates for large bowel resection were randomly divided into two groups: IGF-I-treated (n=8) and placebo-treated (n=7). The IGF-I group received daily two s.c. injections of human recombinant IGF-I (80 microg/kg body weight) for five days, beginning on the morning of the first postoperative day. The other group received placebo injections. Fasting plasma levels of gastrointestinal growth factors (epidermal growth factor, transforming growth factor-alpha, IGF-II), gastrointestinal hormones (gastrin, enteroglucagon, peptide YY), and islet hormones (insulin, islet amyloid polypeptide (IAPP) and pancreatic glucagon) were determined by RIA preoperatively and after five days of treatment. No significant effects of IGF-I on other growth factors or gastrointestinal hormones were seen. A marked increase in plasma insulin postoperatively compared with the preoperative levels (42+/-3 vs 61+/-5 pM, P<0.05) was seen in the placebo group, whereas the postoperative levels in the IGF-I-treated patients remained unchanged (44+/-3 vs 45+/-4 pM). A similar pattern was observed for IAPP and cortisol concentrations. No differences in glucagon concentrations were seen. In conclusion, these results suggest that IGF-I does not influence production of other gastrointestinal hormones thought to be involved in alimentary growth or pancreatic glucagon. In contrast, IGF-I caused a marked reduction of insulin and IAPP secretion. The inhibition of beta-cell secretion could be direct or, alternatively, could involve an improvement in postoperative insulin resistance, perhaps by reducing serum cortisol.
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