Pelvic reservoir with S-pouch: can surgeons evaluate the results of their own operations?

PURPOSE: This study was designed to evaluate whether operating surgeons could follow up the functional outcome of their own operations, without bias, by using standardized methods at follow-up. METHODS: Fifty-five patients who received a pelvic reservoir with an S-pouch were evaluated regarding functional outcome after at least one year postoperative follow-up. The functional surgical outcome was evaluated by an internist especially trained in gastroenterology and the operating surgeon by using a standardized scale comprising eight functional variables. RESULTS: None of the variables analyzed reached statistically significant difference between the two observers, and a high degree of agreement could be shown by using kappa and weighted kappa analysis. CONCLUSIONS: Our results indicate that it is possible for an operating surgeon to assess the postoperative surgical outcome using standardized methods at follow-up.

Functional alterations of the microflora in patients with ulcerative colitis.

The aim of the study was to examine microflora-associated characteristics in patients with inactive ulcerative colitis, receiving sulphasalazine, in relation to the spread of the disease. The conversion of cholesterol to coprostanol, the production of urobilinogen, and the degradation of tryptic activity (FTA) and beta-aspartylglycine were measured in faecal samples from patients with proctitis or left-sided or total ulcerative colitis and in age- and sex-matched controls. No significant differences in the results were observed in patients with various degrees of extension of inflammatory bowel disease. However, the coprostanol ratio and the urobilinogen level were lower and the FTA was higher in patients with colitis than in the controls (p < 0.05). Beta-aspartylglycine was not found in any faecal sample. The results indicate that patients with ulcerative colitis taking sulphasalazine have a microflora with abnormal metabolic characteristics.

Prevalence of inflammatory bowel disease among relatives of patients with Crohn's disease.

The prevalence of familial inflammatory bowel disease was 13.4% in a population-based study of 1048 patients with Crohn's disease (CD). Seventy-two of the index cases had 82 first-degree relatives. Forty-nine were more distantly related (19 first cousins from the same generation as the index patient). The prevalence of CD among first-degree relatives was 21 times higher than among non-relatives. Four of six monozygotic twins were concordant. The age at onset was 25 years in the patients with familial CD, compared with 33 years in the entire group. An additional 53 relatives were found to have ulcerative colitis (UC). The prevalence of UC among first-degree relatives of patients with CD was six times higher than among non-relatives.

Extracolonic diagnoses in ulcerative colitis: an epidemiological study.

In a population-based study of 1274 patients with ulcerative colitis (UC), the overall prevalence of extracolonic diagnoses was 21%. Seventy percent of patients with extracolonic diagnoses had extensive colitis. Patients without extracolonic diagnoses had only 28% extensive colitis (p less than 0.001), compared with 37% in the entire test population. The prevalence was higher in familial UC (p less than 0.05). The extracolonic diagnoses could be classified into two major groups, activity related and autoimmune, with regard to the extent and activity of UC and to the effects of medical and surgical treatment. Three hundred sixty-four diagnoses were distributed in 271 UC patients. It is concluded that extracolonic diagnoses are less frequent in an unselected patient group. However, extracolonic diagnoses are associated with the extent of UC at the time of diagnosis and with familial UC, and they can be classified as either activity related or autoimmune, with characteristic combinations of several extracolonic diagnoses occurring in 25% of the 271 patients.

The function of the intestinal microflora in patients with ulcerative colitis before and after colectomy.

The function of the intestinal microflora was studied in patients with ulcerative colitis before and after colectomy. The following six microflora-associated characteristics (MACs) were investigated: formation of coprostanol and urobilinogen; degradation of mucin, water-soluble protein, and beta-aspartylglycine; and presence of faecal tryptic activity. In 12 unoperated patients without sulphasalazine as maintenance therapy the six MACs were similar to those in normal subjects. In 12 unoperated patients receiving sulphasalazine the formation of coprostanol and urobilinogen was significantly lower (p less than 0.01 and p less than 0.001, respectively) and the level of faecal tryptic activity was significantly higher (p less than 0.01) than in normal subjects. The functional capacity of the microflora in operated patients treated by colectomy combined with one of four surgical procedures (ileorectal anastomosis, ileoanal anastomosis with pelvic pouch, Kock's continent ileostomy, or conventional ileostomy) was disturbed with regard to all six MACs. The disturbance was most pronounced in patients with conventional ileostomy.

Inflammatory bowel disease. An epidemiological and genetic study.

The epidemiology of ulcerative colitis (UC) in Stockholm County over a 25-year period, 1955-1979, was investigated. There were 1,274 cases--681 males and 593 females. The proportion of patients with proctitis, left-sided, and total extent of disease remained constant over the study period, as did the time interval between onset of symptoms and definite diagnosis. The incidence increased over the first 20 years followed by a plateau and was 4.3 per 10(5) inhabitants at the end of the study period. The peak incidence in relation to age increased, but remained in the 3rd and 4th decade throughout the study period. In a population-based study of UC the overall prevalence of extracolonic diagnoses was 21%. Seventy percent of patients with extracolonic diagnoses had extensive colitis whereas among the patients without extracolonic diagnoses only 28% had extensive colitis (p less than 0.001). The extracolonic diagnoses were classified into two major groups, activity-related and autoimmune, the former is related to the extent and activity of UC and responds to both medical and surgical treatment, whereas the latter is unaffected by medical and surgical treatment for UC. A total of 364 diagnoses were distributed among 271 UC patients. The prevalence of extracolonic diagnoses was higher in familial UC (p less than 0.05), but was distributed as UC in general mostly with activity-related diagnoses. The familial occurrence of inflammatory bowel disease (IBD) was investigated among 963 patients with UC. There was a general prevalence of 7.9% for familial IBD. In 80% one relative was affected, in most cases this was a first degree relative with UC. Sibship was the most common relationship. No concordance for UC was found among three pairs of monozygotic twins. The prevalence of UC in first degree relatives of index patients was 15 times higher than in non-relatives. The age at onset was significantly lower among patients with a family history for UC; they also had a higher prevalence of total colitis. The prevalence of Crohn's disease (CD) in first degree relatives of index patients with UC was almost 3.5 times higher than in non-relatives. Complex segregation analysis of 124 families with UC where two or more individuals were affected points to a rare additive major gene with a low penetrance as the cause of the disease with. About 20% of the affected were heterozygotes for the gene. There was no evidence for multifactorial inheritance. The prevalence of IBD was found to be 13.4% in a population-based study on patients with CD.(ABSTRACT TRUNCATED AT 400 WORDS)

Evidence for a major additive gene in ulcerative colitis.

Complex segregation analysis of 124 families with ulcerative colitis with two or more affected individuals suggests a rare additive major gene causing the disease with about 20% affected among the heterozygotes for the gene. There was no evidence for multifactorial inheritance.

Surgical treatment of ulcerative colitis in Stockholm County, 1955 to 1984.

Time trends in surgical treatment of ulcerative colitis in Stockholm County over the 30-year period 1955 to 1984 were investigated. Four hundred eighty-six patients (263 men and 223 women) were submitted to colectomy with or without proctectomy. In elective cases, proctocolectomy was the procedure of choice until the 1980s, when subtotal colectomy became more common. In acute cases subtotal colectomy was the procedure of choice during the entire period. Major complications developed in 162 patients (33 percent) and 103 (21 percent) underwent another operation. The frequency of major complications increased, with the urgency of intervention being 25 percent in elective cases and 46 percent in acute cases (P less than .001). The postoperative mortality was 1.7 percent in 301 elective cases and 9.2 percent in 185 acute cases (P less than .001). The overall postoperative mortality was 4.5 percent and fell from 13 percent during 1960 to 1964 to 2.0 percent during 1980 to 1984 (P less than .01). In acute cases, the mortality during the same two periods fell from 36 to 3.0 percent (P less than .001). The postoperative mortality for proctocolectomy (2.7 percent) was significantly lower (P less than .01) than for subtotal colectomy (9.0 percent). Seventy-four percent of the patients treated by subtotal colectomy were acute cases, however, with a mortality of 11 percent and only 30 percent of the proctocolectomy cases were acute cases, with a mortality of 6.5 percent.

Prognosis and mortality of ulcerative colitis in Stockholm County, 1955-1979.

All 1274 patients in Stockholm County who were diagnosed as having ulcerative colitis during the 25-year period 1955-79 were followed up and studied with regard to prognosis and mortality. There were 109 deaths recorded--41 caused by ulcerative colitis and 68 from other causes. The cumulative survival probability (computed by life-table methods) was worse than expected. For males it was approximately 80% at 20 years, to be compared with the approximately 97% expected in the background population. For females the corresponding figures were approximately 85% and 98%, respectively. The excess death risk increased with increasing age and was more commonly due to unrelated causes than to ulcerative colitis as such. In patients with total colitis at onset the death risk was greater than for other patients during the first years of disease. Thereafter the prognosis was, if anything, better than in other cases. There was no major change in postoperative mortality or general mortality pattern during the 25 years of observation.

Prevalence of inflammatory bowel disease among relatives of patients with ulcerative colitis.

The familial occurrence of inflammatory bowel disease (IBD) was investigated among 963 patients with ulcerative colitis (UC) diagnosed in 1955-1979 in Stockholm County. For 76 patients who had a relative with IBD a pedigree was drawn. The diagnoses of the diseased relatives were verified. There was a general prevalence of 7.9% for IBD among relatives. In 80% one relative was affected, in most cases a first-degree relative with UC. Sibship was the commonest relationship. No concordance for UC was found among three pairs of monozygotic twins. The prevalence of UC in first-degree relatives was 15 times higher than in non-relatives. The age of onset was significantly lower among patients with a family history for UC; they also had a higher incidence of total colitis. The prevalence of Crohn's disease in first-degree relatives of patients with UC was almost 3.5 times higher than in non-relatives.

Incidence of ulcerative colitis in Stockholm County 1955-1979.

The epidemiology of ulcerative colitis in Stockholm County over a 25-year period, 1955-79, was investigated. Only definite cases in accordance with specified acceptance criteria were included. There were 1274 cases--681 males and 593 females. The proportion of patients with proctitis, left-sided, and total extent of disease of diagnosis remained constant over the study period, as did the time interval between onset of symptoms and definite diagnosis. The peak incidence in relation to age increased slightly but remained in the 3rd and 4th decade through the study period. The incidence in men over 40 years old increased markedly towards the end of the study.

Effect of an H2-receptor blocking agent on diarrhoeas after extensive small bowel resection in Crohn's disease.

The effect of an H2-receptor blocking agent, cimetidine, on faecal losses of fluid, electrolytes and fat was examined in 10 patients with Crohn's disease, who had diarrhoeas after extensive small bowel resection. A randomized, double-blind and cross-over design was applied, and patients were hospitalized and on a defined diet during the study. Cimetidine, 4 x 400 mg, significantly reduced diarrhoeal volumes by an average of 22% (p less than 0.05) and faecal sodium by 27% (p less than 0.05). Patients with severe diarrhoeas responded better to treatment. No side-effects were recorded. The reported data suggest that cimetidine may be useful in symptomatic treatment of patients with severe diarrhoeas after extensive ileal resection. Due to deficient drug absorption, higher doses may be needed for optimal effect.