ABSTRACT
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.
Subject(s)
Colonic Diseases/surgery , Colonic Neoplasms/complications , Intestinal Perforation/surgery , Rectal Diseases/surgery , Sigmoid Diseases/surgery , Aged , Colonic Neoplasms/mortality , Colonic Neoplasms/surgery , Female , Humans , Intestinal Perforation/etiology , Intestinal Perforation/mortality , Male , Middle Aged , Postoperative Complications , Retrospective StudiesSubject(s)
Anthropometry , Nutritional Physiological Phenomena , Obesity/diagnosis , Adult , Female , Humans , Male , Reference Values , Sex Factors , Skinfold Thickness , SpainSubject(s)
Anthropometry , Adolescent , Adult , Aged , Arm/anatomy & histology , Body Height , Body Weight , Female , Humans , Male , Middle Aged , Pregnancy , Reference Values , Skinfold Thickness , SpainABSTRACT
A series of 75 patients with 87 postoperative enterocutaneous fistulas (PEF) is reported. All received parenteral nutrition after the diagnosis of PEF was made. There were 16 deaths (21.3 per cent) and 62 fistulas (71.2 per cent) closed spontaneously. A classification of PEF is proposed according to the results obtained. The therapeutic approach cannot be uniform in all types of PEF. We feel that parenteral nutrition has substantially improved the prognosis of fistulous patients by increasing the rate of spontaneous closure and improving the nutritional status of patients needing repeated operations. Comparison between series of patients to establish the usefulness of parenteral nutrition is bound to yield inconclusive data due to marked differences in patient populations. We suggest that proper information be obtained by studying series of homogeneous patients, namely those who develop oesophageal, gastric or intestinal fistulas after surgery.
Subject(s)
Intestinal Fistula/surgery , Parenteral Nutrition, Total , Parenteral Nutrition , Drainage , Humans , Intestinal Fistula/mortality , Intestinal Fistula/therapy , Postoperative ComplicationsABSTRACT
A case of atrial perforation by a subclavian vein catheter, which was inserted for total parenteral nutrition (TPN) is reported. Acute thoracic symptoms developed 3 days after the infusion was started. The diagnosis was correctly made by demonstrating contrast medium within the pericardial sac. The catheter was withdrawn and the patient recovered satisfactorily. The clinical picture and the differential diagnosis of this complication are discussed.
Subject(s)
Cardiac Tamponade/etiology , Catheterization/adverse effects , Heart Injuries/etiology , Parenteral Nutrition, Total , Parenteral Nutrition , Adult , Cardiac Tamponade/diagnosis , Diagnosis, Differential , Heart Atria/injuries , Heart Injuries/diagnosis , Heart Injuries/therapy , Humans , Male , Pancreatic Diseases/therapy , Subclavian VeinABSTRACT
Staphylococcus epidermidis is a pathogenic organism with increasing importance in total parenteral nutrition therapy. Strict asepsis during catheter insertion prolongs the interval free from Staphylococcus epidermidis infection. Staphylococcus epidermidis colonizes the catheter after migrating from the skin. For protection, we advise a long subcutaneous tunnel for all catheters that are to be indwelling for longer than three weeks. Prompt recatheterization of a patient with Staphylococcus epidermidis sepsis can result in hematogenous seeding of the new catheter and persistence of the infection. Catheter related Staphylococcus epidermidis sepsis has subsided after catheter withdrawal, and there is no need for antibiotic therapy provided that other prosthetic materials are not placed in the vascular tree. Immunologic status of the patients is not related to the frequency or severity of Staphylococcus epidermidis infections, or both.
