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- Andersson, Peter, et al.
(author)
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Continent Ileostomy
- 2008
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In: Seminars in Colon and Rectal Surgery. - Maryland Heights, MO, United States : W.B. Saunders Co.. - 1043-1489. ; 19:3, s. 124-131
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Journal article (other academic/artistic)abstract
- Continent ileostomy reservoir is today still an alternative to a standard (conventional) ileostomy in patients where ileal pouch-anal anastomosis is contraindicated or malfunctioning. It eliminates a protruding stoma, obviates the need for a stoma bag, and permits controlled evacuation of bowel contents. A well-functioning continent ileostomy also is entirely continent for gas and feces in the elderly. The reservoir is emptied three to five times a day. Obvious benefits are improved sexual life and facilitated leisure activities. The main drawbacks are frequent complications requiring reoperations in about 50% of the patients. Slippage of the nipple valve occurs in about one-third but in the majority of patients reoperations are successful in the long run. Other complications are pouchitis, enterocutaneous fistula, and stomal stricture. Modifications of the original Kock pouch have been developed as the Barnett pouch and the T-pouch to reduce complications associated with dysfunction of the nipple valve. Cancer of a continent ileostomy reservoir has been reported only in one patient and there seems to be no risk of high-grade dysplasia even after long-term follow-up. At present there are few indications for creating a continent ileostomy reservoir but it is still recommended in very select patients. © 2008 Elsevier Inc. All rights reserved.
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| 2. |
- Davidson, C., et al.
(author)
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Using the live assessment to discriminate between Autism Spectrum Disorder and Disinhibited Social Engagement Disorder
- 2023
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In: Seminars in Colon and Rectal Surgery. - : Elsevier BV. - 1043-1489. ; 34:2
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Journal article (peer-reviewed)abstract
- Background: Children with Autism Spectrum Disorder (ASD) and children with Disinhibited Social Engagement Disorder (DSED) may present with similar social problems, despite differing aeti-ologies, resulting in diagnostic conundrums. Methods: Thirty children: 10 with ASD, no maltreatment history, 10 with DSED and 10 typically developing children were assessed via 'gold standard' ASD assessments, including the Autism Diagnostic Observational Schedule (ADOS) and a unique unstructured observation known as the Live assessment. Live utilises a triadic interaction (2 assessors and child), playful teasing and social 'stress' scenarios to increase the social challenge. Results: The ADOS supported discrimination of DSED from ASD to a degree. Where additional neurodevelopmental problems created ambiguity, the Live assessment was more supportive than the ADOS for unpicking the underlying nature of the social problems. Conclusion: Live supported differentiation between ASD, DSED and other neurodevelopmental problems. The greater social challenge presented by Live exacerbated core problems of ASD and, in DSED, core social skills stood out.
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| 3. |
- Levin, Anna, et al.
(author)
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The changing landscape of surgery for Crohns disease
- 2020
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In: SEMINARS IN COLON AND RECTAL SURGERY. - : W B SAUNDERS CO-ELSEVIER INC. - 1043-1489. ; 31:2
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Journal article (peer-reviewed)abstract
- The incidence of Crohns disease is increasing world-wide and the disease location and behavior is changing towards more colonic as well as inflammatory behavior. As previous data have spoken towards ileal disease and structuring and penetrating disease to be the indications most in need of surgery, one could expect the surgical load to decrease. As these changes are relative, the absolute numbers of surgical interventions are less affected. There are also data showing an increasing complexity among patients at time of surgery. Finally, a new role for surgery as initial therapy to induce remission instead of biologic therapy in ileal or ileocaecal disease has been suggested. In order to improve the care for patients with Crohns disease in general, and the peri-operative phase in particular, the use of multidisciplinary team discussions is essential. In conclusion, the role of surgery is changing. Fewer patients need surgery, but when they do they have more complex disease. In the future, ileocaecal resection may be used increasingly as initial therapy to induce remission in a true top-down approach. (C) 2020 Elsevier Inc. All rights reserved.
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