rest was instituted and the temperature resolved in 24 hours, while all signs symptoms disappeared five days.Subsequent investigations showed no evidence of streptococcal infection (a throat swab grew pathogens antistreptolysin titre < 125 units/ml both one day after admission six weeks later).The antibody for psittacosis LGV > 1/1000 on later still raised at 1/128.Inquiry that before his illness he had visited regularly a neighbouring house which healthy, psittacine bird kept. DiscussionIn...

Objective To measure the prevalence and severity of postpartum faecal incontinence, especially new to identify obstetric risk factors. Design A cohort study with information on symptoms collected in home‐based interviews data from hospital casenotes. Setting Deliveries a maternity Birmingham. Participants Nine hundred six women interviewed mean 10 months after delivery. Main outcome measures New incontinence starting birth, including frank soiling urgency. Results Thirty‐six (4%) developed...

PURPOSE: This study examined risk factors for intra-abdominal sepsis after surgery in Crohn's disease. METHODS: We reviewed 343 patients who underwent 1,008 intestinal anastomoses during 566 operations primary or recurrent disease between 1980 and 1997. Possible were analyzed by both univariate (chi-squared test) multivariate (multiple regression) analyses. RESULTS: Intra-abdominal septic complications, defined as anastomotic leak, abscess, enterocutaneous fistula, developed 76 (13 percent)....

The efficacy of vancomycin in pseudomembranous colitis was assessed a prospective randomised controlled trial. Forty-four patients with postoperative diarrhoea were allocated to five days9 treatment either 125 mg six-hourly or placebo. Sixteen had high titres the neutralised faecal toxin characteristic colitis; nine received and seven At end toxins present one patient given compared controls. Vancomycin caused disappearance Clostridum difficile from stool all except patient, whereas...

Objective This study was performed to (1) correlate anal sphincter defects, identified by endoanal ultrasound with operative findings, and (2) define the appearance of such defects as seen at operation. Summary Background Data Endoanal ultrasonography is a minimally invasive method imaging complex enables identification defects. Little known about accuracy limitations in identifying Furthermore, there are no data appearances these endosonic Methods Forty-four patients (40 women; age range,...

One hundred and six consecutive patients were seen between January 1973 1982 with a circumferential full thickness rectal prolapse. treated by abdominal rectopexy using rectangular sling of monofilament knitted polypropylene (Marlex) mesh sutured to the sacrum lateral ligaments mobilized rectum. There only 9 men in series 23 per cent over age 80 years. Sixty-seven gave history faecal incontinence. Previous unsuccessful treatment for prolapse included Thiersch wire or Silastic perianal 19,...

Abstract A study of 120 patients undergoing elective colorectal operations has investigated the effect adding oral neomycin and metronidazole to bowel preparation in a double-blind randomized controlled trial. Comparisons have also been made between standard mechanical use an elemental diet. The addition significantly reduced rate wound sepsis (P&amp;lt;0.01), septicaemia (P&amp;lt;0.02) anastomotic dehiscence (P&amp;lt;0.02); anaerobic infections were abolished there was significant...

Levels of plasma cytokines and circulating endotoxin were assessed in 41 patients with severe intra-abdominal sepsis. Comparison was made the Acute Physiology And Chronic Health Evaluation (APACHE) II scoring system. Blood samples taken within 24 h onset sepsis syndrome at serial times thereafter. Increased levels interleukin (IL) 6 (range 50-25,500 pg/ml) detectable all Eighteen 19 deaths attributable to higher IL-6 correlated a poor outcome. The sensitivity concentration predicting...

PURPOSE: Preanastomotic recurrence and stricturing after surgery for ileocolic Crohn's disease is a frequent, unexplained phenomena that may lead to prompt reoperation. The aim of this study was determine whether wide-lumen stapled anastomosis (side-to-side, functional end-to-end) provides better outcome than conventional sutured end-to-end METHOD: A case-control comparative analysis patients with from two inflammatory bowel centers treated matched (age gender) group performed. RESULTS:...

Forty six patients (median age 61 years; 42 women) with faecal incontinence and 16 sex matched controls undergoing a restorative proctocolectomy were assessed by clinical examination, anorectal physiology, anal endosonography. (87%) had sphincter defect demonstrated on endosonography (31 external 21 internal defects). The commonest cause of was obstetric trauma. This occurred in 35 women, 30 whom exhibited morphological the complex. In 22 these history perineal tear or episiotomy, (95%)...

Abstract A randomized controlled trial was performed to assess the role of loop ileostomy in totally stapled restorative proctocolectomy. Entry criteria included all patients who were not on corticosteroids whom on-table testing revealed a watertight pouch with intact ileoanal anastomosis. Of 59 undergoing proctocolectomy over 36 months, 45 eligible and (n = 23) or no 22). The age diagnosis groups similar. There deaths; two anastomotic leaks occurred, one each group. Ileoanal stenosis...

Abstract A randomized trial was performed to compare abdominal resection rectopexy and pelvic floor repair (n = 10) with perineal rectosigmoidectomy in elderly female patients full-thickness rectal prolapse faecal incontinence. There were no recurrences of following but one after rectosigmoidectomy. Continence liquid solid stool achieved nine patients, soiling reported only two, eight, six, The median (range) frequency defaecation 1 (1–3) per day compared 3 (1–6) an increase the mean(s.d.)...

Eighteen patients with a clinical impression of complex fistula in ano, had anal endosonography to delineate the anatomy track and identify associated areas sepsis. The was refuted by subsequent surgical exploration two cases. Horseshoe tracks were identified nine (50%) fluid collections, not evident on examination eight (45%) patients. Accurate identification internal opening 7 MHz transducer possible (11%) External sphincter damage four (22%) Surgical findings matched endosonographic...

The natural history of complicated diverticular disease based on details 300 patients entered into a national audit between 1985 and 1988 is reported. Questionnaires were sent to the general practitioners 176 with this condition 5 years after hospital admission; 120 responded. Of these patients, ten died from recurrent disease, 29 other disorders 81 remain alive. Forty 110 (excluding those who recurrence) are still symptomatic or so at time unrelated death. Thirty-nine developed severe...

Ninety-five patients have been referred for the assessment and treatment of faecal incontinence. Incontinence was associated with previous anal trauma in 49 cases: 13 occurred after vaginal delivery, 32 were operations 4 severe perineal road accidents. Other causes were: idiopathic incontinence 18, persistent despite successful rectopexy prolapse 10, diabetic neuropathy 5 cause not identified. Conservative by control diarrhoea, physiotherapy or electrical therapy often minor Fifty-six...

A cluster analysis of 17 preoperative and 10 operative variables has been undertaken from a prospective study 181 patients undergoing operations on the biliary tract in order to identify those with organisms bile who would therefore benefit prophylactic antibiotic cover. The defined populations high risk (45 patients) low (136 which incidence infected was 67 19 per cent respectively (P less than 0-001). Eight were more common group These "high factors" were: jaundice at operation, recent...

Abstract Two treatment policies for rectal prolapse were prospectively assessed between April 1986 and January 1989. Sixteen patients had a Marlex® mesh posterior rectopexy alone 13 underwent sigmoidectomy combined with sutured rectopexy. Preoperative post-operative assessment included manometry, saline infusion test video-proctography. Hospital stay, control of complications comparable in both groups. Restoration continence occurred nine the 12 incontinent after Marlex rectopexy, compared...

Abstract A technique of totally stapled abdominal restorative proctocolectomy is reported in 20 consecutive patients using a × cm J pouch and ileoanal anastomosis. The anastomosis had to be abandoned three because attempted mucosectomy one megarectum two. One patient receiving steroids covering ileostomy. remaining 16 procedure without Three developed serious postoperative morbidity but they were the only at time operation. Of 13 none complications, median hospital stay was 14 days operating...

We have reviewed 66 cases of antibiotic-associated colitis since March 1975, which been associated with a 27 per cent mortality. believe antibiotics may predispose patients to this condition is caused by toxin produced Clostridium difficile. Although the disease rare, it more common than previously reported. The presentation, methods diagnosis and treatment are discussed.