Proximal Stoma Research Articles

Increased canine jejunal absorption of water, glucose, and sodium with intestinal pacing.

Our aim was to determine if pacing a segment of jejunum backwards with electrical stimuli could increase absorption from it. In four dogs, 75-cm loops of jejunum were isolated from the intestinal stream. After recovery, fluid was infused into the proximal stoma of the loop and effluent collected from the distal stoma for three consecutive 30-min periods. In the second period electrical stimuli were applied to the distal end of the loop to drive the pacesetter potentials of the loop, hence its contractions, backwards. The output of water, glucose, and sodium from the loop was decreased, and the transit of content through the loop was slowed during backward pacing. We conclude that pacing a segment of jejunum backwards with electrical stimuli enhances absorption of water, glucose, and sodium from that segment.

Turner-Warwick urethroplasty and urethral stricture Results in 60 patients

Sixty patients with urethral strictures at the bulbous and membranous levels were treated with Turner-Warwick urethroplasty. Initially, there were significant difficulties with restenosis of either the proximal or distal stoma following the first-stage urethroplasty. Use of nitrofurazonehydrocortisone (Furacin-Hc) urethral suppositories practically eliminated recurrent stomal stenosis after the first stage. Several additional modifications were made in the original technique; these included placement of urethral sutures prior to scrotal mobilization and abandonment of the suprapubic cystotomy for drainage at the second stage of the procedure. These modifications increased the chances of achieving a successful result while facilitating the actual surgery and improving the patients' comfort. The over-all success rate was approximately 90 per cent. Patients with urethral stricture surgery subsequent to prostatectomy had problems with urinary control, but not so if prostatectomy was done after the first stage of urethroplasty. It appears that the Turner-Warwick urethroplasty is a good one, and predictably good results can be expected on selected patients with urethral strictures.

Defunctionalizing a Colostomy

To the Editor.—Increasing use of stapling devices has prompted us to devise a simplified method for performing a defunctionalizing colostomy. Often the loop colostomy is employed by the surgeon as a compromise for complete fecal diversion in sick patients because of its simplicity, efficiency, and lack of complications. The technique we use converts this to a completely diverting colostomy by bringing out a loop of bowel through the abdominal wall; placement of a glass rod below the loop of bowel through an avascular segment of mesentery and onto the abdominal wall; ligation of the distal part of the bowel with the 30- or 55-mm automatic stapler (Figure, A); and formation of the A, Ligation of distal part of bowel with 30- or 55-mm automatic stapler. B, Formation of proximal limb stoma by opening bowel wall with cautery 24 to 48 hours postoperatively. proximal limb stoma by opening the bowel

Ammonia Absorption from the Human Colon

Ammonia absorption from the human colon was studied by direct perfusion in 4 patients in whom surgical colon bypass procedures had been performed previously for chronic hepatic encephalopathy. Eight solutions at pH 5 (acetate buffer) and 8 solutions at pH 9 (trihydroxyaminomethane buffer) with varying NH3-N concentrations between 10 and 150 μg per ml were infused at 15 ml per min into a proximal colonic stoma for 20-min periods. In 2 patients, 12 infusions were also given at varying pH with both phosphate (pH 5.0, 6.6, 8.2) and trihydroxyaminomethane buffers (pH 7.0, 8.0, 9.0). Ammonia absorption was linearly or slightly curvilinearly related to infusate concentration in all patients at both pH 5 and pH 9. A pronounced pH effect was noted in all studies; absorption was always greater at pH 9 than at pH 5 at given ammonia levels. That the pH effect did not result solely from the different buffer anions employed was shown in 2 patients in whom absorption increased with increasing pH for each buffer system at given ammonia concentration. These studies clearly indicate that nonionic diffusion is operative in ammonia absorption from the human colon.

Complications from resection of the colon: An evaluation of complementary cecostomy

1. 1. The complications arising from 226 cases of resection of the colon for various types of lesions have been reviewed. Only non-obstructive cases of primary anastomosis distal to the ascending colon are considered. 2. 2. The incidence and severity of complications attributable to leakage from the suture line or perforation of the large bowel were lower in the group of sixty-seven patients treated with complementary cecostomy. In contrast to the group in which no proximal stoma was established, conditions of anastomosis were such in most of the cases in which complementary cecostomy was performed that complications were to be expected. The difference between the two groups, therefore, appears to be significant. 3. 3. Complementary cecostomy is still a useful procedure and should be considered when ideal conditions for bowel anastomosis are not present.