Objectives: Ileal pouch anal anastomosis (IPAA), the removal of the colon and formation of a reservoir from ileum, is the surgery of choice for ulcerative colitis and familial adenomatous polyposis. Yet, 10 to 35% of patients develop pouchitis, an inflammation of the pouch mucosa. Microbial imbalances are observed in pouchitis and inulin has been suggested as a prebiotic treatment. Our objectives were to determine the effect of inulin supplementation on quality of life (QOL), and its practicality and safety as a treatment in IPAA patients.<p> Methods: Adults with IPAA (n= 8) consented to a blinded, placebo-controlled trial of inulin supplementation. Baseline symptoms were measured for 1 month prior to supplementation, followed by a blinded low-dose (5 g of inulin) or placebo (maltodextrin) for 2 weeks and a higher-dose (10 g) for 5.5 months. Participants recorded any symptoms that they experienced in a diary and QOL was assessed using the Short Inflammatory Bowel Disease Questionnaire (SIBDQ) at the beginning and end of the study.<p> Results: Two participants in the same group developed significant side effects on the 10 g supplementation; abdominal discomfort, severe gas, and small amounts of blood with defecation were reported. Unblinding determined that these participants were taking the active treatment (inulin); therefore, the study was stopped early. No differences were observed in SIBDQ scores.<p> Implications & Conclusions: In this pilot study, inulin appeared to be ineffective in improving QOL and may have contributed to unpleasant side effects. Future research should explore synbiotic therapy in IPAA, by combining prebiotics and probiotics for optimal results.

published_or_final_version / Surgery / Master / Master of Surgery

Diss. (sammanfattning) Stockholm : Karol. inst., 2003. / Härtill 4 uppsatser.

Orientadores: Claudio Saddy Rodrigues Coy, João Jose Fagundes / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-09T01:10:44Z (GMT). No. of bitstreams: 1 Pereira_YaraEmantneAmaral_M.pdf: 1682869 bytes, checksum: 9d5801f67ab43156ce97cd3a10778b4d (MD5) Previous issue date: 2007 / Resumo: Introdução: As complicações das anastomoses intestinais podem ser graves com altos índices de morbi/mortalidade. Vários fatores relacionados à qualidade das mesmas têm sido objetos de estudos, como técnica operatória, fios de sutura ou variáveis bioquímicas, enquanto que outros, não associados diretamente à técnica cirúrgica, são menos avaliados, como por exemplo, a influência de choque hemorrágico. Objetivo: Avaliar o efeito do choque hemorrágico em anastomoses de cólon em ratos, com teste de ruptura à distensão por líquido. Material e Método: Foram utilizados ratos da linhagem Wistar, com idade aproximada de 90 dias e peso variando de 310 gramas a 380 gramas. Os animais foram divididos em dois grupos, sendo o grupo G1, composto por 10 animais submetidos à anastomose de cólon em condições de normovolemia e o grupo G2, composto por 10 animais submetidos à anastomose de cólon em condições de hipovolemia. O choque foi instalado através da retirada de meio mililitro de sangue a cada dois minutos, até que se atingissem valores de pressão arterial média (PAM) de 50mmHg ou volume total de retirada correspondente a 30% da volemia. Foram realizadas dosagens séricas de lactato (mmol/l) no início do procedimento e ao término do mesmo. Os valores séricos médios de lactato ao término da cirurgia foram de 1,91 mMol/l no grupo G1 e de 3,69 mMol/l no grupo G2 (p<0,05) No quinto dia de pós-operatório, os animais foram submetidos à eutanásia e tiveram suas anastomoses testadas por teste de resistência à pressão de ruptura à distensão por líquido. Resultados: No grupo G1, o valor médio da pressão de ruptura do cólon à distensão por líquido foi de 160,7 mmHg enquanto que no grupo G2 foi de 152,1mmHg (p>0,05). Conclusão: A presença de choque hemorrágico, nas condições estabelecidas neste estudo, não exerceu influência em anastomoses de cólon em ratos, avaliadas com teste de ruptura à distensão por líquido / Abstract: Introduction: Intestinal anastomoses complications can be very serious, with high morbidity and mortality rates. Several factors related to their quality have been object of studies, such as technical aspects, suture threads or biochemical variables. Others, not directly associated with the surgery technique, are less evaluated, such as the influence of hemorrhagic shock. Objective: Evaluate the effect of hemorrhagic shock in colonic anastomoses in rats, with resistance test to rupture by liquid distension. Methods and Material: Wistar lineage rats, averaging 90 days old and weight varying from 310 to 380 grams were divided into two groups. In the G1 group, 10 animals were submitted to colonic anastomoses in normovolemic terms and the G2 group 10 animals were submitted to colonic anastomoses in hipovolemic conditions. The shock was caused by half milliliter blood withdrawal, done every two minutes, until reached the value of average arterial pressure of 50mmHg or total volume of corresponding withdrawal to 30% of volemia. Serum lactate dosages were carried out at the beginning and at the end of the procedure. The average serum values lactate at the end of the surgery were 1,91 mMol/l in the G1 group and 3,69 mMol/l in the G2 group (p<0,05). On the fifth postoperative day, the animals were submitted to euthanasia. The anastomoses were evaluated with resistance test to rupture by liquid distension. Results: In the G1 group, the average value of colonic rupture was 160,7mmHg whereas in the G2 group was 152,1mmHg (p>0,05). Conclusion: Hemorrhagic shock, in the established conditions of this study, had no influence in colonic anastomosis in rats evaluated with resistance test to rupture by liquid distention / Mestrado / Cirurgia / Mestre em Cirurgia

Diss. (sammanfattning) Linköping : Univ., 2006. / Härtill 5 uppsatser.

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Licentiatavhandling (sammanfattning) Linköping : Linköpings universitet, 2007. / Härtill 3 uppsatser.

Diss. (sammanfattning) Stockholm : Karol. inst., 2002. / Härtill 5 uppsatser.