The cut-closed-reconnected Roux loop.

Background: Motility disturbances in the Roux loop can negatively influence the outcome of reflux gastritis; the uncut Roux loop does not have these disadvantages, but is less suitable for clinical application because of staple dehiscence. The reported "cut-closed-reconnected" Roux loop has the same physiological starting points as the uncut Roux loop, but a difference is an extra closure at the site of the seromuscular level.

Method: The technique of the cut-closed-reconnected Roux loop is described.

Late results of postanal repair for idiopathic faecal incontinence.

Objective: To assess the long term clinical results of postanal repair for idiopathic faecal incontinence.

Design: Retrospective study.

Setting: University hospital, The Netherlands.

Late results of anterior sphincter plication for traumatic faecal incontinence.

Objective: To assess the long term clinical results of anterior sphincter plication for traumatic rupture of the anal sphincters.

Design: Retrospective study.

Setting: University hospital, The Netherlands.

Secondary surgery after failed postanal or anterior sphincter repair.

Secondary surgery after failed postanal repair or anterior sphincter repair was performed in eight female patients. After failed postanal repair in five patients, anterior sphincter plication and levatorplasty was the secondary procedure. In two patients a defect of the anterior external sphincter was corrected and in two patients an extremely thin external sphincter was augmented.

Cytomegalovirus infection in the pregnant women.

Cytomegaloviruses (CMV) commonly infect man but overt disease only occurs in few patients; in the vast majority the infection is subclinical. We report on a HIV-negative pregnant woman. She suffered from a life-threatening ulcerating colitis due to CMV infection for which laparotomy was indicated.

[A mixed form of mucocele of the colon].

The term mucocele is applied to an accumulation of mucus within a lumen lined with mucus-secreting epithelium as well as to the structure resulting from leakage of mucus into surrounding connective tissue. The case report is presented of a patient with a bizarre, mixed type of mucocele after perforation of a hemicolon retained 26 years previously, a clinical picture which could not be traced in the literature.

Role of Helicobacter pylori in the pathogenesis of complications of Meckel's diverticula.

Objective: To assess the possible role of colonisation of ectopic gastric mucosa in Meckel's diverticula by Helicobacter pylori in causing inflammation, ulceration, perforation and bleeding.

Design: Retrospective study.

Setting: Three hospitals in Amsterdam, The Netherlands.

Pressure and X-ray recording of reflux into the thoracic stomach.

Anastomotic leakage, pulmonary aspiration and reflux-esophagitis might be induced or aggravated by the increased duodenogastric reflux observed in the thoracic stomach. In this study, the effect of respiration on the reflux-promoting pressure gradient in the intrathoracally located stomach was assessed. In nine patients pressure recording was done in the duodenum and the abdominal and thoracic part of the stomach.

Gallstone disease in women younger than 30 years.

The relation between symptomatic cholelithiasis in women under 30 years of age and pregnancy, obesity and oral contraceptive use was retrospectively studied. A total of 885 cholecystectomies were carried out in an English district hospital. In the age group under 30 years the female-male ratio was 9.

Leiomyosarcoma of large and small veins: clinical findings and results of treatment in six patients.

Vascular leiomyosarcomas are rare malignant tumours originating from the media of the vessel wall. Six patients (five women and one man, aged 44-66 years) have been treated for a vascular leiomyosarcoma located in the inferior vena cava (three patients), the suprarenal, the external iliac and an antecubital vein. In four patients, the tumour was large and extended beyond the vessel wall giving rise to a retroperitoneal mass.

What happens to the rectal muscular cuff? An experimental study in dogs.

The anatomy and histology of the rectal muscular cuff was studied in 15 dogs with an ileal pouch-anal anastomosis. Eight channel, three-dimensional anal manometry showed normal maximal squeeze pressure (128 +/- 20 mm Hg) compared to a control group (135 +/- 4 mm Hg). The rectal muscular cuff showed complete absence of the cuff in three cases.

High-vacuum drainage and primary perineal wound closure in abdominoperineal excision of the rectum.

The result of perineal wound healing after rectal excision with primary perineal closure by high-vacuum drainage was studied prospectively. High vacuum drainage was performed via a wide-bore catheter (Ch. 27) placed through a stabwound on the thigh.

Enteroglucagon and peptide Y-Y response after construction of a pelvic reservoir in humans.

The results of an investigation of plasma levels of gastrointestinal hormones in patients after the construction of a pelvic reservoir are reported. Enteroglucagon (EG) and peptide tyrosine-tyrosine (PYY), two hormones believed to play a relevant role in the adaptive response to bowel resection, were investigated using a specific radioimmunoassay in basal conditions and after a standard meal. Pouch patients showed a statistically significant increase in basal levels of both enteroglucagon and PYY compared with control subjects (P less than 0.

[The clinical aspects and treatment of renal angiolipomas in patients with tuberous sclerosis].

The incidence of multiple and bilateral renal angiomyolipomas in tuberous sclerosis patients is 40-80%. These benign abundantly vascularised tumours are almost always asymptomatic. Most of the symptomatic renal angiomyolipomas measure more than 4 cm.

Renal angiomyolipomas: could the histology serve as a marker for tuberous sclerosis?

The histological features of 43 renal angiomyolipomas were studied in an attempt to evaluate whether the isolated forms and those that present as part of the tuberous sclerosis complex can be distinguished. In two patients the mass was classified as an angioleiomyoma, because no adipose tissue was present. All renal angiomyolipomas showed the same basic histological picture.

Immunocytochemical study of endocrine cells in pelvic ileal reservoirs.

The distribution and morphology of intestinal endocrine cells was investigated in the mucosa of pelvic ileal reservoirs using immunocytochemical methods. Endoscopic biopsies were obtained from 15 patients after the construction of a modified J-pouch. The mucosa of the reservoir showed a variable degree of colonic metaplasia in all cases.

Percutaneous transcatheter embolization of symptomatic renal angiomyolipomas: a report of four cases.

Successful percutaneous transcatheter embolization of renal angiomyolipoma is reported in four female patients. The angiomyolipomas measured more than 4 cm in diameter. Three patients had severe haemorrhage and one patient had a growing angiomyolipoma in a solitary kidney.

Endoscopic balloon dilation of the pylorus after esophagogastrostomy without a drainage procedure.

The necessity to perform a drainage procedure after esophagectomy using the stomach for substitution remains controversial. Transection of the pyloric sphincter may cause severe and debilitating gastroesophagitis because of increased duodenogastric reflux. Omitting the drainage procedure may lead to gastric stasis.

[Ileo-anal anastomosis with ileum reservoir].

Ileo-anal anastomosis with an ileal pouch is a reasonable alternative for patients with ulcerative colitis and adenomatous polyposis coli. The type of the reservoir, the length of the rectal cuff and the level of the anastomosis are still topics of discussion. This operation was performed in 41 patients.

Early adenoid cystic carcinoma of the upper oesophagus.

A 70-year-old male patient with an early stage primary adenoid cystic carcinoma of the oesophagus is reported. The 1.5 cm protuberant tumour, located in the upper oesophagus and found during examination for heartburn, was radically resected.

Ileal pouch-anal anastomosis without rectal muscular cuff.

Twenty patients underwent proctocolectomy followed by an ileal pouch-anal anastomosis. The rectum was mobilized in the intersphincteric plane and transected at the level of the dentate line. As a consequence, a rectal cuff, which is considered by some to be important for the maintenance of anal continence, was not left behind.

Traumatic neuroma giving rise to biliary obstruction after reconstructive surgery for iatrogenic lesions of the biliary tract--a report of three cases.

A traumatic neuroma of the biliary tract, most commonly has been described as an amputation neuroma in the cystic duct stump after cholecystectomy. Traumatic neuroma has less frequently been associated with biliary obstruction, and this combination is very rare after reconstructive surgery of the biliary tract. Three patients who had undergone a reconstructive procedure following accidental injury of the biliary tract during cholecystectomy are described.

Intestinal endocrine cells in radiation enteritis.

In this study, the intestinal endocrine cells were investigated in 13 surgical specimens affected by radiation enteritis. Endocrine cells were studied by means of Grimelius' silver staining and immunostaining for chromogranin, a general marker of endocrine cells. Positively stained cells were quantified by counting their number per unit length of muscularis mucosa.

Long-term follow-up after colectomy and ileorectal anastomosis in familial adenomatous polyposis coli. Is there still a place for the procedure?

Forty-four patients with familial adenomatous polyposis coli treated with colectomy and ileorectal anastomosis were studied. Mean age at operation was 27 years. The mean follow-up period was 10 years (median 8 years).