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1.
J Mater Sci Mater Med ; 33(1): 7, 2022 Jan 04.
Artigo em Inglês | MEDLINE | ID: mdl-34982258

RESUMO

In this study, a soft-tissue-anchored, percutaneous port used as a mechanical continence-preserving valve in reservoir ileo- and urostomies was functionally and morphologically evaluated in eight dogs. During follow-up, the skin failed to attach to the implant, but the intestine inside the stoma port appeared to be attached to the mesh. After reaching adequate reservoir volume, the urostomies were rendered continent by attaching a lid to the implant. The experiments were ended at different time intervals due to implant-related adverse events. In only one case did the histological evaluation reveal integration at both the implant-intestine and implant-skin interfaces, with a low degree of inflammation and the absence of bacterial colonisation. In the remaining cases, integration was not obtained and instead mucosal downgrowth and biofilm formation were observed. The skin-implant junction was characterised by the absence of direct contact between the epidermis and the implant. Varying degrees of epidermal downgrowth, granulation tissue formation, inflammatory cell infiltration and bacterial growth and biofilm formation were prominent findings. In contrast, the subcutaneously located anchor part of the titanium port was well integrated and encapsulated by fibrous tissue. These results demonstrate the opportunity to achieve integration between a soft-tissue-anchored titanium port, skin and intestine. However, predictable long-term function could not be achieved in these animal models due to implant- and non-implant-related adverse events. Unless barriers at both the implant-skin and implant-intestine junctions are created, epidermal and mucosal downward migration and biofilm formation will jeopardise implant performance.


Assuntos
Bolsas Cólicas , Estomas Cirúrgicos , Animais , Materiais Biocompatíveis , Bolsas Cólicas/efeitos adversos , Bolsas Cólicas/patologia , Procedimentos Cirúrgicos Dermatológicos/efeitos adversos , Procedimentos Cirúrgicos Dermatológicos/instrumentação , Procedimentos Cirúrgicos Dermatológicos/métodos , Cães , Feminino , Humanos , Ileostomia/efeitos adversos , Ileostomia/instrumentação , Ileostomia/métodos , Teste de Materiais , Microscopia Eletrônica de Varredura , Modelos Anatômicos , Modelos Animais , Próteses e Implantes , Desenho de Prótese , Pele/patologia , Propriedades de Superfície , Estomas Cirúrgicos/efeitos adversos , Estomas Cirúrgicos/patologia , Titânio
2.
Scand J Caring Sci ; 26(1): 20-7, 2012 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-21595729

RESUMO

BACKGROUND: In most families with familial cancers, mutations have not been demonstrated; thus, healthy individuals cannot be tested for mutation status. As a consequence, many persons at risk of familial cancer live with an unknown, but presumably high, risk of developing cancer. AIM: The aim of this study was to describe individuals' perceptions of living with an increased risk of colorectal and gynaecologic cancer where the gene mutation is unknown. METHODS: Interviews were conducted with 30 individuals with familial colorectal cancer. These persons have no known mutation and therefore should be considered presumptive carriers. In connection with the interviews, all participants were offered to take part in a surveillance programme consisting of a colonoscopy and gynaecological examinations. The interview transcriptions were analysed by the use of qualitative content analysis. RESULTS: Two themes emerged from the analyses: first, living under a threat with two subthemes, threat awareness and distancing oneself from the threat. The second theme, living with uncertainty, was divided into four subthemes: influencing one's family, being on the safe side, facing emotions evoked by examinations and trust and disappointment to the medical services. CONCLUSION: These persons live with a lifelong uncertainty with a varying intensity depending on what happens throughout the life trajectory. They have no diagnosis or patient group to relate to; therefore, the entire situation is often perceived as abstract. Thus, providing information and counselling needs to be more deeply elucidated, and we need to address both situational and existential ways of uncertainty. This will, however, require professionals of all disciplines to understand the meaning of uncertainty and help ensure that its adverse effects are decreased with adequate nursing interventions.


Assuntos
Adaptação Psicológica , Neoplasias Colorretais Hereditárias sem Polipose/psicologia , Neoplasias dos Genitais Femininos/psicologia , Síndromes Neoplásicas Hereditárias/psicologia , Incerteza , Adulto , Idoso , Atitude Frente a Saúde , Emoções , Feminino , Neoplasias dos Genitais Femininos/genética , Humanos , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa , Suécia
5.
Int J Oncol ; 45(1): 77-81, 2014 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-24788313

RESUMO

Somatic mutations in the POLE gene encoding the catalytic subunit of DNA polymerase ε have been found in sporadic colorectal cancers (CRCs) and are most likely of importance in tumour development and/or progression. Recently, families with dominantly inherited colorectal adenomas and colorectal cancer were shown to have a causative heterozygous germline mutation in the proofreading exonuclease domain of POLE. The highly penetrant mutation was associated with predisposition to CRC only and no extra-colonic tumours were observed. We have identified a mutation in a large family in which the carriers not only developed CRC, they also demonstrate a highly penetrant predisposition to extra-intestinal tumours such as ovarian, endometrial and brain tumours. The mutation, NM_006231.2:c.1089C>A, p.Asn363Lys, also located in the proofreading exonuclease domain is directly involved in DNA binding. Theoretical prediction of the amino acid substitution suggests a profound effect of the substrate binding capability and a more severe impairment of the catalytic activity compared to the previously reported germline mutation. A possible genotype to phenotype correlation for deleterious mutations in POLE might exist that needs to be considered in the follow-up of mutation carriers.


Assuntos
Neoplasias Colorretais/genética , Neoplasias Colorretais/patologia , DNA Polimerase II/genética , DNA Polimerase II/metabolismo , Síndrome de Lynch II/genética , Adenoma/genética , Adenoma/patologia , Idoso , Substituição de Aminoácidos , Domínio Catalítico , Exodesoxirribonucleases/genética , Feminino , Predisposição Genética para Doença , Humanos , Síndrome de Lynch II/patologia , Masculino , Penetrância , Fenótipo , Mutação Puntual
6.
J Biomed Mater Res B Appl Biomater ; 98(1): 101-9, 2011 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-21563306

RESUMO

Inflammatory bowel diseases, cancer or trauma may require removal of all or part of the intestines, leaving the patient with a need to wear external stoma appliances for collection of bowel contents. By connecting the small bowel to a percutaneous port, equipped with a sealing lid, a fully continent and leak proof stoma can be created without a need for permanently wearing stoma appliance. The prerequisites for a connection between a permanent, transabdominal implant and a visceral organ are largely unexplored. Stoma ports made of titanium were implanted in the abdominal wall of domestic pigs and a branch of distal ileum was inserted through the ports. After being followed for 1-3 weeks, the ports were removed and subjected to histological evaluation to study the influence of their shape, structure, and position on the tissue response. Particular focus was attended to the attachment of the ileal serosal surface to the implants inner structure consisting of a titanium mesh. Macroscopic examination revealed fistulas and formation of abscesses in 4 of 11 the retrieved implants. Histological examination revealed regenerated and well-vascularized collagenous tissue around the mesh structure inside the implant. The integration was complete or partial for 10 of 11 ports. Despite various degrees of inflammation and tissue ingrowth, it was demonstrated for the first time that the serosal surface of ileum was firmly attached to the internal structure of the implant. These experiments provide a basis for optimization of the implant and surgical procedure before long-term functional animal experiments.


Assuntos
Parede Abdominal/patologia , Íleo/patologia , Implantes Experimentais , Estomas Cirúrgicos , Titânio , Parede Abdominal/cirurgia , Animais , Humanos , Íleo/cirurgia , Doenças Inflamatórias Intestinais/patologia , Doenças Inflamatórias Intestinais/terapia , Suínos
7.
Auton Neurosci ; 145(1-2): 89-92, 2009 Jan 28.
Artigo em Inglês | MEDLINE | ID: mdl-19059009

RESUMO

OBJECTIVES: Acupuncture has been used successfully for the treatment of urinary bladder dysfunction. The aim of this study was therefore to investigate if manual acupuncture might also affect fecal incontinence favorably. METHODS: The study comprises 15 female patients, median age 60 years (39 -75). Before treatment and at regular intervals after acupuncture sessions the defects of anal continence were assessed. Ano-rectal function was assessed by means of recto anal manovolumetry. Each patient was submitted to one acupuncture treatment per week for a ten-week period. Subsequently, a control session was repeated once per month up to 7 months for six patients. A final functional assessment was performed at 18 months. RESULT: Patients experienced a significant improvement in anal continence, the overall continence score which changed from 10 (3 -21) estimated before treatment to zero (0 - 7) (p<0.05) at 10 weeks. Patients with irregular bowel habits and/or loose stools reported significant improvement. On the manovolumetric variables a limited increase of resting from 25 (17-35) mmHg to 36 (20-42) mmHg, (p=0.05) and sustained squeeze anal pressure, changing from 41 (32-68) mmHg to 60 (40-100) mmHg (p<0.05) were reported. Rectal sensory function remained unchanged. CONCLUSION: Acupuncture offers good opportunities for improving fecal incontinence. The mechanism of action is obscure but might be an effect of the "neuromodulation" of the recto-anal function similar to that explaining the favorable results achieved by sacral nerve stimulation. The concomitant regulation of disordered bowel habits may also contribute to the satisfactory results.


Assuntos
Terapia por Acupuntura/métodos , Incontinência Fecal/terapia , Adulto , Idoso , Defecação/fisiologia , Incontinência Fecal/fisiopatologia , Feminino , Humanos , Pessoa de Meia-Idade , Projetos Piloto , Fatores de Tempo
8.
Ups J Med Sci ; 112(1): 49-60, 2007.
Artigo em Inglês | MEDLINE | ID: mdl-17578807

RESUMO

Patients with longstanding chronic ulcerative proctocolitis are at risk to develop colorectal cancer Conflicting views as regards surveillance, the indications for surgery and type of preventive procedure exist. For permanent prevention of cancer development complete removal of all potential malignant colorectal mucosa has to be done. Panprocto-colectomy with a conventional ileostomy or continent ileostomy removing all colorectal mucosa should therefore eliminate further risks of colorectal cancer. Colectomy and ileorectal anastomosis is a controversial issue. While many surgeons today are reluctant to use the technique, emphasising the persistent cancer risk, others consider the operation a viable alternative when used on a selective basis. The long-term risk of cancer in the rectal stump is the main strong argument . In restorative proctocolectomy, i.e. proctocolectomy with construction of an ileopouch anal anastomosis residual rectal mucosa is left behind irrespective of technique used and is therefore at risk for cancer development. Quite a few cancers have been reported to occur in these patients but controversy exists as regards the origin of these tumours but the risk for cancer development is very low. Biopsies from ileal pouches demonstrate various histopathological changes from nearly normal mucosa, to inflammation and atrophy, inflammatory cell changes, dysplasia as well as development of carcinoma. Grading of type and atypia is a challenge to reproduce and requires the participation of experienced gastrointestinal histopathologists.


Assuntos
Colite Ulcerativa/cirurgia , Neoplasias Colorretais/prevenção & controle , Colite Ulcerativa/patologia , Colonoscopia , Neoplasias Colorretais/diagnóstico , Procedimentos Cirúrgicos do Sistema Digestório , Humanos
9.
J Adv Nurs ; 49(1): 51-8, 2005 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-15610381

RESUMO

AIM: This paper reports a study whose aim was to assess the quality of care in ostomy patients seen from a patient perspective. BACKGROUND: A stoma operation causes profound changes in a patient's life because of resulting physical damage, disfigurement, loss of bodily function, and change in personal hygiene. Such changes are a cause of major concern for patients and raise important issue for the quality of care. METHODS: The study group comprised patients who had undergone a colostomy for rectal cancer or an ileostomy for ulcerative colitis, all attending a stoma outpatient clinic. Quality of care was assessed using the identity-oriented dimension of the validated questionnaire 'Quality of Care from the Patient's Perspective'. Forty-two ileostomy and 49 colostomy patients completed the questionnaire. RESULT: While the vast majority of patients in both groups thought that most topics in the questionnaire were important, most rated many aspects of their quality of care as unsatisfactory. One-third of the colostomy patients and one-half of the ileostomy patients were dissatisfied with the information they received about the results of medical examinations and laboratory tests, and an even higher proportion was dissatisfied with their opportunities to participate in the decision-making process or to discuss sexual matters. Stoma-related complications, which occurred in 71% of the ileostomy patients and in 43% of the colostomy patients, had no impact on these results. CONCLUSION: Information and counselling for patients having ostomies, both on the part of specialist nurses and colorectal surgeons, appeared to deficient, suggesting that standards for quality of care require continuous evaluation and revision.


Assuntos
Atitude Frente a Saúde , Colite Ulcerativa/cirurgia , Estomia/psicologia , Qualidade da Assistência à Saúde/normas , Neoplasias Retais/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Colite Ulcerativa/complicações , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Relações Enfermeiro-Paciente , Cuidados Pós-Operatórios , Neoplasias Retais/complicações , Inquéritos e Questionários
10.
J Wound Ostomy Continence Nurs ; 32(4): 238-45, 2005.
Artigo em Inglês | MEDLINE | ID: mdl-16030463

RESUMO

PURPOSE: The aim of this study was to evaluate how relatives of patients with an ostomy rated the various aspects of care, how they perceived the quality of the care provided, and how they ranked their involvement in the care. Patients' satisfaction was also sought, particularly their perception of relatives' involvement. DESIGN: Descriptive cross-sectional. SETTINGS AND SUBJECTS: The study comprised a colostomy group (32 pairs) and an ileostomy group (28 pairs). All patients attended a stoma outpatient clinic. METHODS: Quality of care was assessed using the identity-oriented dimension of the validated questionnaire Qualityof Care from the Patient's Perspective. Questionnaires were mailed to patients and their relatives. RESULTS: Relatives and patients in both study groups considered most topics covered by the questionnaire to be important. Half of the patients with an ileostomy and their relatives and approximately 30% of those in the colostomy group were dissatisfied with the information they received, however. Moreover, a greater proportion (41-89%) of the patients were unhappy with the opportunities they were offered to participate in the decision-making process. Patients with an ileostomy and their relatives tended to be more dissatisfied with the quality of care than the colostomy group, but the difference was not statistically significant. CONCLUSION: The topics covered by the questionnaire were considered important to both patients and their relatives. Information and counseling offered by the ET nurses and the colorectal surgeons were judged to be unsatisfactory, indicating the need for frequently assessing and improving general standards of quality of care.


Assuntos
Colostomia/enfermagem , Educação em Saúde , Ileostomia/enfermagem , Relações Profissional-Família , Qualidade da Assistência à Saúde , Adulto , Idoso , Idoso de 80 Anos ou mais , Comportamento do Consumidor , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Suécia
11.
Dis Colon Rectum ; 47(12): 2131-7, 2004 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-15657665

RESUMO

PURPOSE: The principal aim of this study was to assess long-term pouch durability and health-related quality of life in an original series of patients operated on with a continent ileostomy. PATIENTS: Data from 68 of 88 patients who had a continent ileostomy performed at Sahlgrenska University Hospital between 1967 and 1974 were analyzed. Median age at follow-up was 60 (range, 40-89) years and median follow-up was 31 (range, 29-36) years. METHODS: Patients were sent a questionnaire on pouch function along with the Short Form-36 Health Survey 2.0. A random age-matched and gender-matched sample was drawn from the Swedish national Short Form-36 Health Survey norm database to compare with the patient group. RESULTS: The majority of the patients reported good physical condition and satisfactory pouch function. Patients evacuated the pouch a median of four times every 24 hours. Twelve patients (18 percent) had leakages. Forty-four patients (65 percent) had had at least one postoperative revision to restore continence. Generally minor peristomal skin irritation occurred in seven patients (10 percent). Patients with concurrent complaints (mostly age related) reported poorer health-related quality of life. Nevertheless, 78 percent of the patients rated their overall health as good, very good, or excellent. The patients' Short Form-36 Health Survey scores were comparable to reference values. CONCLUSIONS: Although revisional operations may be needed to restore continence, continent ileostomy has a good durability. Pouch function was satisfactory and patients' satisfaction was high. Health-related quality of life levels were similar to those of the general population.


Assuntos
Atitude Frente a Saúde , Ileostomia/psicologia , Qualidade de Vida , Atividades Cotidianas , Adaptação Psicológica , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Comorbidade , Dermatite/etiologia , Drenagem/efeitos adversos , Drenagem/instrumentação , Drenagem/psicologia , Feminino , Seguimentos , Pesquisas sobre Atenção à Saúde , Nível de Saúde , Hospitais Universitários , Humanos , Ileostomia/efeitos adversos , Ileostomia/instrumentação , Masculino , Pessoa de Meia-Idade , Reoperação/estatística & dados numéricos , Inquéritos e Questionários , Suécia , Resultado do Tratamento
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