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  • 1
    ISSN: 1530-0358
    Keywords: Ileal pouch-anal anastomosis ; Coloanal anastomosis ; Anorectal manometry
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract This article examines the effect of ileal pouch-anal (n=134) and coloanal (n=16) anastomoses on resting anal canal pressures in 150 patients. METHODS: Patients underwent anal manometry before ileal pouch-anal anastomosis (IPAA) and coloanal anastomosis (CAA) and again six weeks after ileostomy closure following these procedures. A water-perfused catheter system with four radial ports was used for manometry, pressures being recorded during both station and continuous pull through. RESULTS: Patients with IPAA were younger than those with CAA (34 years vs. 50 years) and had a different ratio of hand-to-stapled anastomosis (1∶2.6 vs. 1.3∶1). All CAA patients had had rectal cancer while IPAA patients suffered mainly from ulcerative colitis (n=114) or familial polyposis (n=10). The mean preoperative resting pressure for all patients was 79 mmHg (75–87, 95 percent confidence limit) and the mean fall in this pressure after surgery was 25 mmHg (−21 to −29, 95 percent confidence limit). There was no difference in preoperative pressure or fall between handsewn and stapled anastomoses, or between IPAA and CAA. CONCLUSION: There was a significant relationship between preoperative pressure and change in pressure that held true for all subgroups (change=−0.7 × preoperative pressure + 31,r=0.69). Analysis of the functional results confirmed that patients with high preoperative pressure are at risk for severe falls after surgery and are not guaranteed a good result. Conversely, patients with low preoperative pressures may actually have an increase with surgery and are not always incontinent. Patients with low preoperative anal resting pressures should not be denied anastomosis to the anus if they are continent.
    Type of Medium: Electronic Resource
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  • 2
    Publication Date: 2021-05-19
    Description: Coral reefs in the Kiunga Marine National Reserve (KMNR) (40o 07’ E, 2o 00’ S) are located in a transition ecotone between the warmer East African coral reef bioregion to the south, and colder waters of the Somali Current to the north. The reefs have been monitored annually from 1998 to the present, documenting a range of ecosystem changes from large and small scale threats. Reefs in the area suffered ˜60% loss of coral cover due to mass bleaching in the 1998 El Niño event, and 25-40% loss of coral species at individual site levels. Recovery of coral community structure has been variable, with some reefs showing strong recovery, while others have declined further. A harmful algal bloom and coral disease in early 2002 further impacted these reefs, causing mass mortalities of fish and coral, and failure of coral recruitment in that year. Fishing impacts to the reserve are high, with a strong south-north decline in fish density due to easier access to the migrant and large fishing communities to the south of the reserve. Responsibility for management of the KMNR falls under multiple institutions, including the Kenya Wildlife Service, Fisheries and Forestry Departments, and the local council. Overlapping mandates, unclear relationships, limited information and understanding, and lack of resources have hampered effective management. The monitoring programme reported here is one aspect of new collaborative appro aches to coral reef and fisheries management, and has focused on improving the information and understanding of the biological and resource systems of the area. The ecosystem trends induced by larger scale threats and the south-north fish resource gradient caused by local use patterns will be analyzed in an attempt to develop sustainable management practices for the reserve.
    Description: Published
    Keywords: Fisheries management ; Overfishing ; Coral reefs ; Ecosystems ; Mass mortality
    Repository Name: AquaDocs
    Type: Book Section , Refereed
    Format: pp.1381-1390
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