Surgical outcome and long-term follow-up after segmental colorectal resection in women with a complete obstruction of the rectosigmoid due to endometriosis.

INTRODUCTION: Intestinal involvement is reported in up to 12% of women with endometriosis. Complete large bowel obstruction is a rare complication of intestinal endometriosis. It is estimated to occur in less than 1% of the cases. OBJECTIVE: The aim of this study is to evaluate the surgical outcome and long-term follow-up after segmental colorectal resection in women with a complete obstruction of the rectosigmoid due to endometriosis. In addition, the diagnostic work-up is described and discussed in view of the current literature. PATIENTS AND METHODS: We present a case series of 5 patients with a complete obstruction of the rectosigmoid due to endometriosis who were finally treated in our hospital within a multidisciplinary endometriosis team. We retrospectively analyzed all patients with this condition who were referred in the period January 2000 to December 2006. RESULTS: All patients (mean age 31.8 years, range 25-43 years) underwent emergency surgery resulting in a diverting colostomy before referral to our hospital. The principal diagnostic tool used was magnetic resonance imaging which demonstrated in all patients multiorgan endometriosis with complete obstruction of the rectosigmoid. Thereafter, all patients underwent a segmental colorectal resection by re-laparotomy. The diagnosis intestinal endometriosis was histologically confirmed in all cases. After surgery no major complications occurred. During a follow-up of 18-36 months, residual symptoms such as chronic constipation, deep dyspareunia and chronic pelvic pain were reported in 2 patients. No recurrences of intestinal endometriosis occurred. CONCLUSION: In our case series, segmental colorectal resection showed a favorable surgical outcome with no major complications. In the long-term follow-up, a limited number of residual symptoms were reported and no recurrences occurred. Intestinal endometriosis as a cause of bowel obstruction is often a diagnostic challenge mimicking a broad spectrum of diseases. It should be included in the differential diagnosis in women of reproductive age presenting with any symptoms of bowel obstruction. Magnetic resonance imaging is recommended as the primary imaging technique in such cases. In our opinion, these patients should be treated in a multidisciplinary setting.

Tenecteplase: a promising new fibrinolytic agent.

Acute coronary syndrome can mean anything from unstable angina to acute myocardial infarction (MI) with ST-segment elevation. Tenecteplase, a new fibrinolytic agent used to treat ST-segment elevation acute MI, has some advantages over other fibrinolytic agents. This article describes tenecteplase's actions, indications, contraindications, and use.

Predictors of atrial dysrhythmias for patients undergoing coronary artery bypass grafting.

BACKGROUND: Coronary artery bypass grafting is a commonly used and effective procedure for treating coronary artery disease. Atrial dysrhythmias are common after this surgery, but definitive characteristics that predict the development of such dysrhythmias postoperatively have not been determined. OBJECTIVES: To determine demographic, preoperative, intraoperative, and postoperative factors that are predictive of atrial dysrhythmias that occur after coronary artery bypass grafting. METHODS: A descriptive design was used to study a convenience sample (N = 162) of adult patients undergoing coronary artery bypass grafting. Data were collected via prospective chart review. Patients were grouped according to whether or not atrial dysrhythmias developed after coronary artery bypass grafting. Univariate analyses followed by multivariate analyses were conducted by using forward stepwise logistic regression to determine variables that are predictive of atrial dysrhythmias after coronary artery bypass grafting. RESULTS: Postoperative atrial dysrhythmias developed in 52 patients (32.1%). Univariate predictors of postoperative atrial dysrhythmias included older age (P < .001) and presence of right coronary artery disease (P = .004). Multivariate predictors of postoperative atrial dysrhythmias included age (odds ratio by decade = 1.93, 95% CI = 1.86-2.00, P < .001) and right coronary artery disease (odds ratio = 2.67, 95% CI = 1.14-6.23, P = .02). Hospital stay was significantly longer (P = .003) in patients who had postoperative atrial dysrhythmias than in patients who did have these dysrhythmias. CONCLUSIONS: Age and right coronary artery disease can be used to predict which patients will be at increased risk for atrial dysrhythmias after coronary artery bypass grafting.

Family perceptions of support interventions in the intensive care unit.

Family needs of critically ill patients have been well documented in nursing literature. However, few researchers have examined support interventions intended to meet these needs. This study examines which interventions provide the greatest benefit to critically ill patients' families and recommends nursing actions to meet families' support needs.

New adjunctive therapy for ischemic syndromes.

Because anticoagulant and GP IIb/IIIa inhibitors reduce mortality, myocardial ischemia, AMI, and reintervention, these agents are now becoming the standard of care for patients with USA and NQWMI. Unanswered questions remain about the best treatment regimen, appropriate dosing, long-term benefit, and cost-effectiveness of these agents, however, and many additional trials are ongoing or planned. As nurses administer these drugs, assess the patients' responses to therapy, and educate patients and families about these agents, they contribute to recent advances in preventing ischemic heart disease.

Control of vascular complications after cardiac catheterization: a research-based protocol.

Cardiac catheterization has become a common diagnostic procedure. However, many institutions arbitrarily decide the postprocedure method used to achieve hemostasis, the approach to femoral site care, the patient's position while on bedrest, and the length of bedrest. The authors review past research studies and present a research-based protocol for postcatheterization nursing care.