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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: Global change is defined here for this review as changes caused by increasing greenhouse gas emissions resulting in a high CO2 world and the direct and indirect changes that ensue. Increasing green house gas emissions are causing three major impacts on the ocean: warming sea surface temperature (SST), ocean acidification and deoxygenation (Turley et al 2011). The latter two are poorly understood at present, particularly in Eastern Africa. Secondary impacts include sea level rise due to melting polar ice caps. Coral bleaching and death caused by SST rise has been extensively studied and measured (HoeghGuldberg 1999; Hughes et al. 2003), including in the WIO (Obura 2005, McClanahan 2009), with likely ecosystem phase shifts as coral reefs become dominated by macroalgae (brown algae such as Turbinaria, Sargassum spp.) (Bellwood et al. 2004; Hughes et al. 2005). Ocean acidification is likely to have enormous impacts on marine resources and hence fisheries (Turley et al. 2011), as ocean chemistry is changed and thus any marine organisms that rely on Ph sensitive chemical reactions will be affected. This field is still relatively new and early reports predict trophic level shifts as organisms with calcium carbonate skeletons, e.g molluscs, corals, are compromised. Deoxygenation is caused by ocean warming (oxygen becomes less soluble) which will result in less growth of most marine organisms and a shift to low oxygen tolerant organisms, often microorganisms. Coastal environments and people are also undergoing changes that are directly related to human pressures caused by development and other activities. These include increasing population, mechanisation (eg in fisheries), industrialisation (eg ports and coastal cities), pollution, and extraction of oil and gas.
    Description: Published
    Keywords: Global warming ; Sea level changes ; Greenhouse effect ; Mangroves ; Surface temperature
    Repository Name: AquaDocs
    Type: Report , Not Known
    Format: 50pp.
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