S Fasth's research while affiliated with Sahlgrenska University Hospital and other places
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Publications (95)
The specific aim of the investigation was to assess the long-term results of subtotal colectomy with ileorectal anastomosis in patients with severe idiopathic constipation.
40 patients with severe idiopathic constipation were operated on between 1981 and 1993. Patients were accepted for a colectomy and an ileo-rectal anatomosis after a thorough gas...
Tissue specimens from the large bowel of 18 patients with long-standing slow transit constipation were investigated to determine the distribution and density of several neuropeptides and amines in the enteric nerve system, and also of endocrine cells in comparison to normal individuals. CGRP (calcitonin gene-related peptide), galanin, glucagon, GRP...
We wanted to elucidate further the regulation of the intestinal motility response to feeding.
After intraduodenal administration of an oleate solution, mimicking a meal, the distal bowel motility and the plasma levels of bile acids, cholecystokinin (CCK), and neurotensin were monitored in patients operated on with restorative proctocolectomy (n = 4...
The physiological and clinical effects of loperamide treatment versus placebo were investigated in a randomized, double-blind, crossover study in patients operated with restorative proctocolectomy. Sixteen patients operated with endoanal mucosectomy and a handsewn ileal pouch-anal anastomosis and 14 patients operated with abdominal proctocolectomy...
The aim of this study was to investigate the influence of surgical technique on functional and manovolumetric results in patients treated with Marlex mesh abdominal rectopexy.
The lateral ligaments were completely divided (the Wells procedure) in 16 patients and preserved (the Ripstein procedure) in 16 patients. Clinical and physiologic assessment...
PURPOSE: The aim of this study was to investigate the influence of surgical technique on functional and manovolumetric results in patients treated with Marlex mesh abdominal rectopexy. METHODS: The lateral ligaments were completely divided (the Wells procedure) in 16 patients and preserved (the Ripstein procedure) in 16 patients. Clinical and physi...
Peroperative manometry was performed in 12 patients operated on with endoanal proctectomy and a hand-sewn pouch-anal anastomosis and in 12 in whom proctectomy was performed entirely from above, with the ileal pouch stapled to the top of the anal canal. Results from both groups showed that division of the superior rectal artery reduced the median (9...
The incidence and prognosis of anal fistulas were investigated in a prospective study comprising 136 patients operated on for Crohn's disease. The incidence of anal fistulas was 27 of 136 (20%), in patients with classical disease 12 of 68 (18%), and in those with Crohn's colitis 15 of 68 (22%). A fistula preceded the intestinal manifestation of the...
Excision of a failing pelvic pouch is often a great disappointment for the patient. It is also an unfortunate decision considering that a significant length of terminal ileum is sacrificed. Transformation of the pouch to a continent ileostomy is an alternative. Five patients with a malfunctioning pelvic pouch have had their pouch converted to a con...
The output of sodium and potassium from urine and ileostomy was investigated in 35 healthy patients with ileostomies; 17 had undergone proctocolectomy for ulcerative colitis and 18 for Crohn's colitis. Fifteen of the patients with Crohn's disease had also had small bowel resections, varying from 15 to 46% of the original bowel length. The patients...
Anticholinergic drugs are used on an empirical basis for treatment of functional disturbances after restorative proctocolectomy, but their mode of action on ileal pouch performance is mainly unknown. We studied the acute effects of atropine or benzilonium on pouch characteristics and anal sphincter function in 20 patients with a pelvic pouch. Pouch...
Surgical research in Sweden has a long tradition of excellence enhanced by the positive attitude of governmental authorities toward medical and surgical research during the past 40 years. Significant investments made during the 1950s created a solid foundation for rapid and extensive expansion in research during the 1960s, in parallel with industri...
The effects of age, gender, and parity on rectoanal function were examined in a cross-sectional population study, including 68 normal subjects (32 men and 36 women) aged 23 to 91 years. Rectal volumetry was evaluated with graded isobaric rectal distension with 5-60 cm H2O in combination with anal manometry. Data were analysed by use of the multiple...
Thirty patients were operated on with restorative proctocolectomy with an end-to-end ileal pouch-anal anastomosis constructed by double stapling (STP). Pouches were randomized to either J type or K type (folded by the principles used for the Kock continent ileostomy). Manovolumetric and functional results were compared. Patients were followed up fo...
The clinical manovolumetric, and functional results of restorative proctocolectomy were studied in patients randomly allocated to construction of either a J-shaped pouch (n = 29) or a pouch fashioned by the folding technique used for the Kock continent ileostomy (K-pouch) (n = 26). A complete endoanal mucosectomy was performed, and the pouches were...
Pouch volume, motility, sensory function and integrated pouch-anal mechanisms during graded isobaric distension of the pouch were prospectively studied in 67 patients with a J pouch-anal anastomosis. The findings were related to functional outcome. Thirty-six normal controls were studied for comparison. In contrast with normal rectum, the ileal pou...
Intestinal leakage of plasma proteins was studied in 69 patients with Crohn's disease. In vivo labeling of plasma proteins was performed by intravenous injection of trace amounts of 51CrCl3. Complete fecal collection was done for 5 days, carefully avoiding contamination with urine. The daily fecal radioactivity was measured in a whole-body counter...
Intestinal leakage of plasma proteins was studied in 69 patients with Crohn's disease. In vivo labeling of plasma proteins was performed by intravenous injection of trace amounts of 5lCrCl3. Complete fecal collection was done for 5 days, carefully avoiding contamination with urine. The daily fecal radioactivity was measured in a whole-body counter...
Sixty-seven patients with a J-shaped ileonanal pouch were studied over a 2-year period with regular recording of sphincter and pouch characteristics and analysis of their role in functional outcome. Although there was a 27 per cent permanent reduction in resting anal pressure (RAP) (P less than 0.001), two-thirds of the patients still had a RAP wit...
The effects of epidural anaesthesia (EDA, mepivacaine) and EDA in combination with atropine and neostigmine on postoperative intestinal motility were studied in 17 patients undergoing operation for cancer of the rectum or sigmoid colon. Motility was recorded by a volumetric technique. Epidural anaesthesia (EDA) increased motor activity in the small...
The rectal expansion and concomitant sensory function on graded, isobaric, rectal distension within the interval 5-60 cm H2O was investigated in 36 healthy young volunteers. Anal pressure and electromyography (EMG) from the external anal sphincter were simultaneously recorded. Rectal distension caused an initial rapid expansion followed by transien...
One hundred consecutive patients treated by restorative proctocolectomy with construction of an ileo-anal anastomosis and a J-shaped (n=90) or an S-shaped ileal reservoir were studied prospectively to evaluate postoperative complications and functional outcome and to search for factors that might influence results. There were no deaths. Postoperati...
One hundred consecutive patients treated by restorative proctocolectomy with construction of an ileo-anal anastomosis and a J-shaped (n = 90) or an S-shaped ileal reservoir were studied prospectively to evaluate postoperative complications and functional outcome and to search for factors that might influence results. There were no deaths. Postopera...
The influence of the parasympathetic pelvic nerves on anorectal motility was studied in anaesthetized cats. Anal pressure and rectal motility were recorded by a manometric and a volumetric method, respectively. Severing of the pelvic nerves did not cause any pressure change in the anus, indicating that these nerves are not significantly tonically a...
Different pouch designs and techniques for the perineal approach have been on trial in an attempt to improve results after restorative proctocolectomy. The 1-year results of two currently advocated procedures, the J-pouch and the S-pouch, were compared with the results obtained in patients with a pelvic pouch fashioned according to the folding tech...
A method to study electrically induced distal colonic motility in the rat in vivo is reported. The animals were anaesthetized with methohexital and chloralose and were artificially ventilated. Motility of a segment (2 cm) of the distal colon was monitored as volume changes of an intraluminal balloon, introduced via the anus. Local electrical stimul...
Although patients' satisfaction may be high after restorative proctocolectomy the functional results are still far from perfect. Increased bowel frequency and imperfection in continence are common. Pouch volume and anal sphincter status are important determinants for the outcome. The aim of the present study was to evaluate if balloon dilatation of...
The distribution of the sympathetic innervation to the internal anal sphincter (IAS) and rectum and the occurrence of different types of adrenergic receptors in the two organs were investigated in anaesthetized cats. Anal pressure and rectal motility were recorded by a manometric and a volumetric method respectively. Division of both the hypogastri...
Rectoanal manovolumetry during graded isobaric rectal distension was carried out in 12 women with severe constipation classified as slow transit constipation (Arbuthnot Lane's disease). The resting anal sphincter pressure, the rectoanal inhibitory reflex and the rectal capacity were all normal. While the distension volumes required to elicit sensat...
The effect of sympathetic nerve block and efferent stimulation of the sympathetic nerves on anorectal motility was studied in 21 patients undergoing operation for rectal carcinoma. Anal pressure and rectal volume were simultaneously recorded before and after epidural anaesthesia and during nerve stimulation. Efferent electrical stimulation of the p...
This study reports a patient previously operated upon with proctocolectomy and construction of a continent ileostomy (Kock pouch). The sphincter muscles, which were preserved by using the mucosal proctectomy technique, were used for conversion to a pelvic pouch five years later. The functional result was satisfactory and superior to that commonly s...
A new technique for manovolumetric investigation of rectoanal function allowing for simultaneous recording of rectal volume, anal pressure and external sphincter EMG in response to graded rectal distension was developed. Distension pressure was generated by a water column between two reservoirs. Volume was recorded as shifts of water between the re...
The short and long-term effects of postoperative total parenteral nutrition (TPN) on body composition were studied in a randomised series of patients undergoing major colorectal surgery. Ninety-two patients (colorectal cancer: 50, ulcerative colitis or Crohn's disease: 42) were grouped according to diagnosis and clinical inflammatory activity. TPN...
The impact of the pre-operative nutritional and clinical state on post-operative morbidity and mortality is not fully known and the effect of total parenteral nutrition (TPN) on the postoperative complication rate has not been established. We have investigated the effects of postoperative TPN on the complication rate in 92 patients after major colo...
Early and late morbidity was studied in 45 consecutive patients submitted to the Kock continent ileostomy reservoir procedure protected by a temporary loop ileostomy. In 24 patients the nipple valve was made by simple intussusception of the ileal segment after stripping of its mesenteric peritoneum and fat, whereas in 21 patients the nipple valve w...
In a consecutive series of 107 patients operated on for Crohn's disease involving the distal ileum, the overall incidence of gallstones was 17% and of renal stones 12%. Whereas the frequency of gallstone disease was 9% in patients with minor resections, patients with more than 100 cm diseased or resected small bowel had a frequency of 35%. The prob...
Ileostomy complications in 203 patients operated on with proctocolectomy and ileostomy for ulcerative colitis and Crohn's disease were investigated prospectively. The patients were examined at regular intervals by interview and thorough examination of the stoma. Stomal dysfunction was carefully assessed and patients presenting with surgical complic...
Carcinoma of the upper third of the rectum (12–15 cm from the anal verge) is almost invariably treated with resection and end-to-end anastomosis. The operation is followed by an excellent functional result; except for a slight increase of bowel movements and urgency during the first post-operative months in some patients there are no differences as...
Colectomy with full thickness proximal proctectomy and endoanal distal mucosal proctectomy may be a rational alternative to the conventional single stage proctocolectomy for ulcerative colitis. One of the great attractions of the method is that the preserved anal canal and anal sphincters may subsequently be used for restoration of intestinal conti...
The possible involvement of purinoceptors in the parasympathetic nervous control of large intestinal motility was investigated in cats anaesthetized with chloralose and treated with adrenolytics. Distal colonic and rectal motor responses to efferent pelvic nerve stimulation (PNS) and drugs injected close i.a., were recorded by a volumetric method....
Surgical research in Sweden has a long tradition of excellence which has been enhanced by the positive attitude of governmental authorities towards medical and surgical research during the last 40 years. Significant investments made during the 1950’s created a solid foundation for the rapid and extensive expansion in research that took place during...
Experiments were performed on cats anaesthetized with chloralose and treated with adrenoceptor blocking agents. Distal colonic and rectal motility were selectively recorded by a volumetric method. The effects of muscarinic and ganglionic nicotine receptor blockade on motor responses induced by graded efferent electrical pelvic nerve stimulation (PN...
The effect of sympathetic nervous activity on rectal motility induced by pelvic nerve stimulation (PNS) was studied in anaesthetized cats. Division of the sympathetic lumbar colonic and hypogastric nerves or alpha-adrenoreceptor blockade, both of which reduced rectal tone, also reversed a predominantly relaxatory pelvic nerve response into a pure c...
Endoanal mucosal proctectomy with preservation of the anal sphincters has been employed as an alternative to the traditional method of rectal excision in 23 patients with ulcerative colitis or Crohn's disease. Ten patients in whom the anal canal was left open and drained had uneventful postoperative courses. Of the remaining 13 patients in whom the...
The sympathetic nervous control of rectal motility was studied in anesthetized cats. Division of the sympathetic nerves, i.e. the hypogastric nerves and the lumbar colonic nerves and alpha-adrenergic blockade reduced rectal tone indicating that these nerves are tonically active. Efferent electrical stimulation of the nerves at high intensities caus...
Thirty-six unselected patients were investigated 3-24 years (mean, 7.8 years) after small-bowel resection for Crohn's disease (mean small intestinal resection, 105 cm). Iliac crest bone biopsies after in vivo tetracycline double-labelling showed a markedly reduced trabecular bone mass (controls, 0.25 +/- 0.06; patients, 0.15 +/- 0.05; p less than 0...
In a consecutive series of 99 patients, we have evaluated the safety of the loop ileostomy employed for diversion and/or decompression. We have recorded the complications after construction and subsequent closure and any associated difficulties with stoma care have been evaluated. The results indicate that a loop ileostomy, when properly constructe...
Patients subjected to proctocolectomy together with an ileal resection will lose increased amounts of sodium with the ileostomy excreta and may develop sodium and water depletion. Studies of sodium balance and measurements of renin activity, aldosterone, and arginine vasopressin in plasma were made in 23 such patients, 8 of them under metabolic-war...
The serum concentration and the 24-h urinary excretion of zinc was studied in 87 consecutive out-patients with distal small-bowel resections (mean 104 cm) because of Crohn's disease. Muscle zinc concentration was determined in 55 of the patients. The 24-h urinary excretion decreased with increasing resection length. It was abnormally low in 13 per...
The effects of 5-HT on proximal colonic and rectal motility and total colonic blood flow were studied in anaesthetized cats and compared with those evoked by pelvic nerve stimulation. Vasodilator responses, consistently elicited by low doses (5-10 micrograms/min close i.a.) and intermediate doses (10-50 micrograms/min) of 5-HT were invariably aboli...
The magnesium status of the body was studied in 87 patients with various lengths of small-bowel resections for Crohn's disease. The urinary magnesium excretion decreased with increasing resection length, and so did the concentration of magnesium in muscle. Muscular fatigue, an early symptom of magnesium deficiency, was positively correlated to a pa...
Subtotal colectomy, preserving the ileocaecal valve and caecum, and caecoproctostomy has been recommended by some authors in the past and hypothetically it is a good a priori argument on the grounds of function for its use. The procedure has been employed in nine patients on different indications and the functional results assessed. When employed f...
The safety of low colorectal anastomosis constructed with autosuture technique (U.S. EEA-stapling device, USSC) and the functional results were assessed in consecutive series of patients operated upon for rectal carcinoma. The operative procedure was greatly facilitated and certainly, many of the patients would otherwise have been subjected to abdo...
1. Pelvic nerve stimulation in atropinized cats elicits a sustained contraction of the proximal colon and a relaxation of the rectum. Concomitantly there is an immediate but transient vasodilatation which is followed by recurrent increases and a slight post-stimulatory hyperaemia. Direct stimulation of the pelvic nerve produces secretion of colonic...
119 patients with Crohn's disease, primarily treated with excisional surgery during a ten-year period (1968-77), were studied prospectively. The extent of ileal disease, the number and magnitude of resections and the site of recurrence were assessed. In patients with classical Crohn's disease the recurrent lesion was invariably located in the termi...
To study adverse reactions associated with intravenous administration of fusidic acid 6 patients were treated with fusidic acid intravenously in association with a major large bowl operation, and 9 patients were treated in the same way because of staphylococcal infections. The main adverse reaction was thrombophlebitis, which occurred in as many as...
The effects induced by infusion of vasopressin into the superior mesenteric artery on the small intestinal series-coupled vascular sections were studied in cats and compared to those evoked by stimulation of the regional sympathetic nerves. The doses used were similar to those recommended for clinical purposes. Vasopressin induced an increase in in...
The vascular responses of the small intestine and liver to regional infusion of vasopressin were measured continuously and synchronously in anaesthetized cats. When infused into the superior mesenteric artery there was a marked initial blood flow reduction (peak response) followed by a sustained but moderately reduced flow (steady state). Correspon...
Sixteen patients submitted to reservoir ileostomy were at the same time given a proximal loop ileostomy to defunction the reservoir for 2-3 months. All made smooth recoveries in the immediate postoperative period both before and after the closure of the loop ileostomy. During follow-up of at least 12 months the function of the reservoir ileostomy h...
The mutual changes in hepatic and small intestinal blood flow on selective nervous stimulation of the periarterial vasoconstriction fibres, were studied in anaesthetized cats. Occlusion of the hepatic artery did not change portal blood flow, whereas occlusion of superior mesenteric blood flow caused a significant increase in hepatic arterial flow....
1. The effects of efferent electric pelvic nerve stimulation on colorectal motility and blood flow with emphasis on the motor responses in consecutive colonic and rectal segments were studied in anaesthetized cats. It was considered of particular interest to explore whether selective pharmacological blockade and graded nerve stimulations might reve...
Right-sided transverse colostomy and loop ileostomy when temporary used for protecting a new-constructed colorectal anastomosis were compared in two matched series of patients. The relative safety of the methods as expressed in complication rate on construction and subsequent closure and any difficulties associated with stoma care were assessed. Th...
Early postoperative mortality and morbidity and factors that might be of importance in this respect were studied in a series of consecutive patients resected for classical Crohn's disease (IPI) or mainly colonic disease (CPC). The operative mortality was comparatively low after surgery for both primary and recurrent disease (1.5 and 2.0% respective...
Bile salt absorption, as determined by the faecal excretion in i.v. injected 14C-cholic acid (FBS) was studied in 13 ileostomy patients before and after conversion to Kock's continent ileostomy reservoir. The result was compared with that obtained in 8 ileostomy patients in whom about 50 cm of the terminal ileum had also been removed. As compared w...
1. Pelvic nerve stimulation (p.n.s.) in cats induces atropine-resistant colonic vasodilatation and colonic contraction. The effects of this on cat colon are mimicked by synthetic bradykinin infusions. The present study examines the effect of p.n.s. on the activation of kallikrein, the kinin-forming enzyme present in colonic tissue and its effects o...
The perfusion pressure in the marginal artery of the descending colon was measured continuously at laparotomy in eight patients and the effect of sudden occlusion of the inferior mesenteric artery recorded. Three patients with ulcerative colitis, all in their early 30s, and five elderly patients with colonic or rectal carcinoma were studied. In all...
122 patients, 66 men and 56 women, operated upon by proctocolectomy were interviewed by means of a detailed questionaire regarding any significant change in sexual function. In the majority of the patients (70% of the men and 87% of the women) the sexual relationships were considered to be unchanged or even enhanced. Impaired function was reported...
Mechanical stimulation of the mucosa of the proximal colon evoked a hyperemia which also could be elicited when severing the autonomic fibres to the colon. Mechanical stimulation of the distal colon produced a hyperemia which, on the other hand, was abolished by cutting the pelvic nerves. Afferent pelvic nerve stimulation evoked a response similar...
By means of a recently developed isotope washout technique, regional intestinal blood flow and its intramural distribution were determined during surgery and correlated to the morphological inflammatory and vascular features of ulcerative colitis (UC) and Crohn's disease (CD) at different stages and location. In severe colitis total blood flow was...
Peritonealization of the raw areas and closure of the pelvic floor is sometimes impossible to perform in patients subjected to abdominoperineal rectal excision when combined with extensive lymph node clearance. The postoperative course in 34 patients, treated in that way, necessitating sacrifice of the peritoneum on the dorsal aspect of the abdomin...
Ureteric obstruction complicating Crohn's disease of the terminal ileum is reported in three patients. This complication is treacherous, since symptoms of urinary tract disease are mostly absent, as is laboratory evidence of urinary tract infection. It is concluded that inflammatory ureteral engagement should always be suspected in patients with Cr...
Jahnberg, T., Martinson, J., Hultén, L. & Fasth, S. Dynamic gastric response to expansion before and after vagotomy. Scand. J. Gastroent. 1975, 10, 593-598.
The dynamic gastric pressure response to expansion by direct intragastric air insufflation, 30-50 ml/s, was studied in healthy volunteers, non-operated ulcer disease patients, and in patients o...
The effect of bradykinin on gastric and colonic motility was studied in anaesthetized cats with volume recording devices and compared with the effects of vagal nerve stimulation. When administered intrarterially bradykinin caused a profound and prolonged gastric relaxation. Stimultaneously there was a marked and likewise prolonged colonic contracti...
Fasth, S. and J. Martinson. On the possible role of bradykinin in functional hyperemia of cat's stomach. Acta physiol. scand. 1973. 89. 334–341.The reactions of the consecutive vascular sections of the stomach were studied with a plethysmography technique at “rest”, during graded and maximal vasodilatation induced by isoprenaline and during infusio...
Zusammenfassung Nachweis, dass Pentagastrin und CCK, in physiologischen Dosen bei der Katze infundiert, nur geringfügige Durchblutungseffekte im Dünndarmgebiet zeigen, während Sekretin über einen offenbar verschiedenen Mechanismus die Durchblutung erhöht.
Zusammenfassung Indiz, dass Plasma-Kinin sow in den Regulationsmechanismus der Kolon-Motilität auch der Blutströmung eingreift.
A plethysmographic technique was utilized to investigate quantitatively the reactions within the consecutive vascular sections of the small and large intestine of the cat during graded intraarterial infusion of bradykinin (Bk). Bk infusion in doses that reduced vascular resistance evoked a characteristic increase in intestinal volume, occurring in...
The effect of bradykinin (Bk) on motility and blood flow in the small intestine and the colon was studied in anesthetized cats. When administered intravenously, Bk caused a profound intestinal inhibition and a concomitant increase in blood pressure. Adrenalectomy abolished these responses, indicating that they were caused by a secondary release of...
The mechanism by which glucagon inhibits intestinal and vascular smooth muscle tone was studied in anesthetized cats. The intestinal motility was recorded by a volume recording device and the intestinal blood flow by connecting the left carotid artery via a drop recording unit with the superior mesenteric artery by a wide bore polyethylene tube. A...
Citations
... If the patient has PLE, the radioactivity from enterically lost 51 CrCl 3 can be measured in the feces. 31,32 Although this method is still considered the gold standard for PLE testing, it is impractical for clinical practice because the use of radioactive material is limited to certified institutions and the administration of 51 CrCl 3 requires confinement of the dog in certified premises for several days after conducting the test. The fecal test to quantify Fα 1 -PI concentration is not invasive and avoids the need for handling and storage of radioactive waste. ...
Reference: Gastroenteropathy in Norwegian Lundehund
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... ATP can produce vasoconstriction via P2-purinoceptors on vascular smooth muscle. The desensitizing action of a,fi methylene ATP which has been described previously (Kasakov & Burnstock, 1983; Hedlund et al., 1983; This response was mediated via P,-purinoceptors on vascular smooth muscle as it was antagonized by 3-methylxanthine, but unaffected after removal of the endothelium. The weak effect of adenosine prior to elevation of vascular tone was probably due to this agent acting on blood vessels which were already vasodilated in the absence of tonic sympathetic constrictor discharge. ...
... The transition of the 'usual' ileum to terminal ileum is not structurally demarcated. However, studies investigating absorption of vitamin Bl2 and bile metabolism have suggested that the last 50-60 cm of the distal ileum constitute the terminal ileum and resection of 50 cm or more of the distal small bowel will invariably lead to malabsorption of vitamin Bl2 and bile salts(Heaton 1968, Lenz 1975, Andersson et al 1979. Vitamin B12 is an essential micronutrient which is required for the formation of haemoglobin, function of the nervous system and other metabolic processes. ...
... The Ripstein procedure (anterior rectopexy) was first described in 1952, the essence of which is the complete mobilization of the rectum, the anterior part of the presacral fascia or a strip of a synthetic prosthesis is placed in front of the rectum and several sutures are applied to the promontorium (Scaglia et al., 1994). In this case, the posterior curve and the anorectal angle, i.e. normal anatomical position of the rectum, are restored, thereby minimizing intra-abdominal pressure increased before surgery and improving defecation. ...
... This presumably represents solute production by microbes colonizing the pouches (43,44). These pouches have a volume on the order of 250-500 ml and the end ileal fluid resides in them at body temperature for some time, allowing microbial growth and metabolism (45,46). Microbial colonization of the end-ileum has also been demonstrated in colectomy patients without ileal pouches, which may account for urinary excretion of small quantities of colon-derived solutes in these patients (25,44). ...
... It includes 11 parameters, evaluating the 24-h stool frequency, nighttime defecation, the urgency of defecation, dyschezia, soiling and the use of pads, perianal skin irritation, dietary restrictions, regular medication for diarrhea and social handicap. 35 The value obtained in the Oresland score allows us to classify the pouch its functional outcome into three groups: good (0-4), moderate (5-7) and poor (8)(9)(10)(11)(12)(13)(14)(15) (Table 3). Another score was presented by Brandsborg et al evaluating the function of the pouch and subsequently the quality of life of the patient. ...
... Maintaining the integrity of the autonomous nerve plexus is a prerequisite for the integrity of the sexual function [34,35]. This paper could not determine the frequency of postoperative sexual dysfunctions and retrograde ejaculation or impotence, although most studies cite ranges between 33 and 95% [36,37], depending on the surgical technique used, the thoroughness of nerve dissection and the association with radiotherapy. However, recent data are more optimistic. ...
... 1,3 This problem may be prevented by conservation of the IMA, at least of its left colic branch in risky patients, 15,16 or by a more generous resection of the descending colon. 17 In Case 4, we think that if a more extended resection (as a left hemicolectomy) had been performed, the complication could have been omitted. ...
... The various components of the kinin/kallikrein system are known to exist in the gastrointestinal tract (46)(47)(48). The presence of kininogen and kallikrein in the colon has been studied in particular. ...