The British journal of surgery
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Two cases are reported of gallstone ileus complicating terminal ileal Crohn's disease. Both patients had a prolonged history of Crohn's disease without the need for surgical intervention. They were admitted with small bowel obstruction which failed to resolve on conservative management as is usually the case. The features of these two cases that may lead to the development of this complication and the pointers in diagnosis are discussed.
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Randomized Controlled Trial Comparative Study Clinical Trial
Total parenteral nutrition versus gastrostomy in the preoperative preparation of patients with carcinoma of the oesophagus.
Gastrostomy feeding has been a well established form of nutritional support for patients presenting with total dysphagia for carcinoma of the oesophagus. More recently, total parenteral nutrition has proved to be efficient and safe, offering an alternative to gastrostomy feeding. ⋯ However, gastrostomy feeding is still preferred as it is cheap, simple and safe, and allows patients to be active, mobile and self dependent. Total parenteral nutrition is reserved for those patients in whom an earlier operation is advisable.
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A total of 105 patients have been treated with colectomy and ileorectal anastomosis from 1958 to 1978 in Birmingham, England (48) and in Leiden, Netherlands (57). At the end of 1978 the mean follow-up was 7.6 years (6 months-20 years). Mild or moderate degrees of proctitis were not considered as contraindications for ileorectal anastomosis. ⋯ However, no statistical significance was obtained. The risk of reoperation for recurrence of Crohn's disease after ileorectal anastomosis calculated by actuarial methods shows a 50 per cent cumulative reoperation rate after 16-20 years. This result suggests that ileorectal anastomosis is a safe and useful procedure for most patients with Crohn's colitis who did not have severe proctitis.
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Over the past few years many centres have shown that blood transfusions given to potential renal transplant patients are beneficial to subsequent graft survival. Results from this centre have shown that an elevated ability of plasma to suppress lymphocyte reaction to antigen is associated with blood transfusions in chronic renal failure patients. ⋯ Furthermore, most of the suppressive activity was related to the naturally occurring plasma protein. alpha 2-macroglobulin. This prospective study reports a significant association between low plasma suppressive activity and early kidney graft loss through rejection, and suggests an explanation for the beneficial effects of blood transfusion on graft survival.