[Effect of transcutaneous electric muscle stimulation on postoperative muscle mass and protein synthesis]. / Effekten at transkutan elektrisk muskelstimulation på postoperativ muskelmasse og proteinsyntese.

In an experimental study, 13 patients undergoing major elective abdominal surgery were given postoperative transcutaneous electrical muscle stimulation (TEMS) to the quadriceps femoris muscle on one leg, where the opposite leg served as a control. Changes in cross sectional area (CSA) and muscle protein synthesis were assessed by CT-scan and percutaneous muscle biopsies for ribosome analysis before surgery and on the sixth postoperative day. The percentage of polyribosomes in the ribosome suspension decreased significantly (p < 0.03) after operation in control legs, but not in stimulated legs (p > 0.16). The total concentration of ribosomes decreased significantly in TEMS legs (p < 0.03), but not in control legs (p > 0.16) CSA decreased significantly in both legs. The decrease in polyribosomes and CSA after operation was significantly less in TEMS legs than in controls (p < 0.05). TEMS may be a simple and effective method to improve muscle protein synthesis and muscle mass after abdominal surgery and should be evaluated in other catabolic states with muscle wasting.

[Surgery for ulcerative colitis. Treatment with proctocolectomy, stapled ileum-J-pouch, stapled pouch-anal anastomosis and temporary ileostomy]. / Operation for colitis ulcerosa. Behandling med proktokolektomi, staplet ileum-J-pouch, staplet pouch-anal anastomose og midlertidig ileostomi.

Thirty-two patients with ulcerative colitis, median age 29 (range 14-49), were submitted to restorative proctocolectomy. Twenty-five patients had a three-stage procedure and seven had a two-stage procedure. A stapled J-pouch was formed, and a pouch-anal anastomosis was created by the double stapling technique. A temporary end ileostomy was closed through peristomal incision after three months. There were no pouch failures and no cases of pouch-anal anastomosis leakage. In one patient secondary mucosectomy and neo-anastomosis became necessary due to severe inflammation of remnant rectal mucosa. Five patients were operated for small bowel obstruction, and two had to have a dilatation of a slight stricture of the pouch-anal anastomosis. In two patients the final diagnosis was verified or probable Crohns disease, of whom one developed recurrence of a previous rectovaginal fistula. Twenty-seven patients have had the ileostomy closed for more than one month, 25 of these (93%) were fully continent three months after ileostomy closure and later on. After one year the patients had median five (range 3-9) bowel movements per day. It is concluded that restorative proctocolectomy with a stapled J-pouch-anal anastomosis and a temporary end ileostomy for ulcerative colitis carries few complications and provides a good functional result.

[Percutaneous endoscopic gastrostomy. A retrospective study of the course and complications]. / Perkutan endoskopisk gastrostomi. En retrospektiv opgørelse af forløb og komplikationer.

To assess mortality, morbidity and outcome of percutaneous endoscopic gastrostomy (PEG) we retrospectively studied 67 patients. PEG was successful in 65 patients (success rate, 97%). PEG was used as the procedure of choice when enteral feeding was needed. PEG was performed employing an introducer-technique and a Danish developed gastrostomy tube. The most common indication for PEG were neurological diseases (45 patients (69%)), trauma and malignant disorders (17 patients (26%)). Oral intake recovered in 18 patients (28%) who then had the tube removed, 25 patients (38%) were discharged with the gastrostomy, 13 patients (20%) died from their primary disease and five patients with PEG remained in hospital, PEG was removed in three patients due to intolerance to enteral feeding (two patients) or stomal leak (one patient). The total complication rate was 8% with three major complications (one procedure-related death). We recommend PEG for both short and long-term feeding.

[Gastrostomy. Simplified technique and extended field of indications]. / Gastrostomi. Forenklet teknik og udvidet indikationsområde.

The technique by which percutaneous access to the stomach for enteral nutrition is obtained is generally accepted in cases in which swallowing is defective and for aspiration in cases of gastro-intestinal retention. Experience with a gastrostomy tube developed in Denmark has provided inspiration to establish access by means of outpatient intervention. Since 1986, 15 patients with defective swallowing were treated as outpatients with percutaneous introduction of a gastrostomy tube without complications of the intervention or to subsequent management in nursing homes or their own homes. Replacement of the catheter was undertaken by the general practitioner or by renewed outpatient visits. In many of the patients, replacement of the catheter was performed by the caring staff. A narrow-bore tube was chosen primarily in order to reduce the risk of complications. Despite the narrow-bore tube, the effect of the decompression tube has proved satisfactory in five patients since 1986. The method is simple, the trauma minimal and it is well accepted by the patients.