Postoperative Bowel Symptoms Improve over Time after Rectosigmoidectomy for Endometriosis.

STUDY OBJECTIVE: To evaluate bowel function (changes in stool caliber, sensation of incomplete evacuation, stooling frequency, and rectal bleeding) and urinary function (dysuria and retention) after segmental resection in patients with bowel endometriosis. DESIGN: Retrospective study. SETTING: Tertiary hospital. PATIENTS: A total of 413 (mean age = 33.6 ± 5.1 years) of reproductive aged women, with bowel endometriosis that underwent segmental bowel resection of the rectosigmoid from 2005 to 2018, without history of prior bowel surgery, without existing or history of malignancy. INTERVENTIONS: Laparoscopic segmental bowel resection performed by the same team and with the same technique. MEASUREMENTS AND MAIN RESULTS: Data collected from the patients' records included length of resected segment, distance of the lesion from the anal verge, and complications. Information on intestinal and urinary function was obtained from a questionnaire applied before the surgery and at 2, 6, and 12 months after the surgery. There was a significant increase in the incidence of stool thinning and rectal bleeding 2 months after surgical procedure; these symptoms decreased significantly over time. The incidence of urinary symptoms decreased significantly over time after surgery. The length of the bowel segment resected was not associated with the postoperative symptoms, but the rectosigmoid lesion was significantly closer to the anal verge in patients with rectal bleeding and urinary symptoms. There was no association between the length of intestinal segment resected and the frequency of stooling. At 6 months, patients who had a decreased frequency of stooling underwent a resection closer to the anal verge (9.7 cm) in comparison with the ones with unchanged or increase frequency of stooling (10.1 cm and 10.7 cm, respectively; p <.05). CONCLUSION: Patient complaints on bowel and urinary alterations after segmental resection were transient with significant improvement over time up to 12 months. Bowel and urinary symptoms were not associated with the size of the bowel segment resected, whereas rectal bleeding at 2 months after surgery was significantly associated with the distance from anal verge. Segmental resection was also associated with a great improvement in constipation at 12 months postoperative.

[THE EFFICIENCY OF SCHOOL OF COMBINED PATHOLOGY IN THE REHABILITATION OF PATIENTS WITH PEPTIC DUODENAL ULCER ASSOCIATED WITH ARTERIAL HYPERTENSON AFTER ACUTE GASTROINTESTINAL BLEEDING].

Objectives of the investigation was to examine the dynamics of emotional and autonomic disorders in patients with peptic duodenal ulcer (DU) associated with arterial hypertension after acute gastrointestinal bleeding during training at School of Combined Pathology (SCP). Main group included 25 patients. The comparison group consisted of 26 patients with the matched pathology, sex and age, but not trained at SCP. Results. Both groups of patients demonstrated improvement in emotional sphere and autonomic regulation. However, in patients who had training at the SCP the indicators of emotional status improved earlier and got a greater extent. Optimization of autonomic regulation was identified in 3 months, not six months, like in untrained patients. Conclusion. Training hypertensive patients with peptic DU at the SCP improves the efficiency of emotional state and autonomic regulation.

[Organization-methodical aspects of health care delivery to the patients with acute gastro-intestinal hemorrhage].

The analysis of organization-methodic work, done with an active participation of academician M. P. Pavlovskiy, for establishment of a Lviv City Center for the treatment of patients, suffering an acute gastro-intestinal hemorrhage, was conducted. During 25 years of the Center activity the organization, diagnostic and treatment and rehabilitation approaches for an acute gastro-intestinal hemorrhage treatment have changed essentially.

[Outpatient care of upper gastrointestinal hemorrhage not related to portal hypertension]. / Seguridad del control ambulatorio de la hemorragia digestiva alta no relacionada con hipertensión portal.

BACKGROUND: The handling of upper gastrointestinal hemorrhage (UGH) usually includes the hospitalization of all patients, regardless of severity and prognosis. The aim of this paper is to assess the security of the outpatient control of some UGH, after their assessment in the hospital emergency room. PATIENTS AND METHODS: Prospective cohort of 533 patients who attended over 1994 and 1995 hospital emergency room for an episode of UGH not linked to portal hypertension. After clinical and endoscopical assessment in the emergency department, 422 cases (79%) were admitted and 111 (21%) discharged for outpatient care. An analysis is presented of the characteristics of both groups, their clinical outcomes and a multivariate analysis to assess the factors associated with the decision to admit the patient. RESULTS: Outpatients were young, with less comorbidity and better haemodynamic status than hospitalized patients. Most of outpatient cases UGH was due to gastroduodenitis, oesophagitis and Mallory-Weiss syndrome, as opposed to the greater importance of peptic ulcer in those admitted. All outpatients presented clean lesions or haematic remains. 25 (5.9%) hospitalized patients presented rebleeding, vs. only 1 (0.9%) outpatient (p < 0.05). When more severity cases were excluded from hospital group, the differences were not significant. All cases with active bleeding, severe haemodynamic repercussion or without endoscopy were admitted. For the remainder, the decision to admit was associated with the presence of bleeding stigmata, haemodynamic repercussion, some causes of hemorrhage, older age, and urea levels. CONCLUSIONS: Although the scarce sample do not permit definitive conclusions, results guide towards that a substantial part of UGH not linked to portal hypertension may be monitored without hospitalizing the patient, thereby minimizing care costs and increasing the productive capacity of the hospital, without increasing risks for the patient.

Hemorragia digestiva alta aguda uso de Ontomicina / Upper digestive acute hemorhage use of Ontomycin

Se presentan dos casos de HDAA, atendidos en urgencias del Hospital Obrero Nro. 1 de la ciudad de La Paz, durante mis estudios de residente en 1981, los cuales por la gravedad de la entidad nosologica presentada requirieron el uso de medidas heroicas para evitar su fallecimiento por sangrado activo a traves de disminuir la presion arterial esplacnica con la infusion de oxitocina Los resultados fueron satisfactorios.