Actinomycosis or Madura disease (popularly known as lumpy jaw), is a disease due to the ray fungus, and occurs in domestic animals - notably cattle, and occasionally human beings who work with cattle and can become infected. Suppurative swellings develop in certain parts of the body, namely the neck and jaw, the intestines - especially the appendix and large bowel - and the lungs. Secondary abscesses are often formed in other adjacent organs. The pulmonary type of disease resembles chronic bronchitis or tuberculosis and is generally fatal, although the disease runs a long course. In the other types the outlook is more hopeful. Research Actinomycosis
Colostomy is the operation of opening into the colon, or lower portion of the intestine. This procedure is one of the most important in abdominal surgery. It is sometimes necessary as a life- saving measure. It may be temporary or permanent as an artificial anus in the radical treatment of rectal cancer. Because of its appearance, its inconvenience and the very thought of an artificial opening in the abdominal wall a great deal of care is necessary to allay the anxieties of patients and their relatives when colostomy is necessary.
In some cases of acute intestinal obstruction the surgeon explores the abdomen and finds perhaps a large mass in the region of the pelvic colon or rectum that cannot be removed. An emergency colostomy is then performed in the transverse colon with the immediate purpose of saving life and with the further objective of providing temporary drainage should the growth be removable at a later date. In some such cases, when at first sight the primary cause of the obstruction seems beyond any possibility of surgical removal, after several weeks of colostomy drainage the infection subsides and the affected portion of bowel may then be removed. Colostomy may be necessary as a preliminary to other operations involving removal of the large bowel. Such an occasion arises if diverticulitis has produced vesico-colic fistula (between the colon and bladder). In some cases of severe incontinence due to abnormality or injury to the anus, a left iliac colostomy enables the patient to be free of the terrible inconvenience of perpetual soiling in the perineum. Injuries or abnormalities of the spinal cord produce paralysis of the anal sphincter mechanism and sometimes colostomy is essential. Congenital absence of the rectum or anus requires an emergency colostomy within a day or so of birth.
There are two main forms of colostomy. First is the loop colostomy which has two limbs. The opening is at the apex of the loop and the bowel has not been divided completely across. A variation of the loop colostomy is the double- barrel form in which the two limbs of the loop are separated by a piece of skinrafter complete division. This is also described as a defunctioning colostomy as it prevents the spill of faeces from the proximal to the distalloop. A second variety is the spur colostomy where a spur is formed by suturing the two ends together for several centimeters inside the abdomen. This is of particular value if the colostomy is temporary as the spur can be destroyed by a crushing clamp without risk of peritonitis or perforation since the limbs have become sealed together. When the spur breaks down, the artificial opening on the surface shrinks and sinks back below the skin level. The aim is that this should close spontaneously without further operation. The third type is the terminal colostomy in which the distal portion of bowel is removed completely or in the case of excision of rectum the lower end is closed to form a blind end. In grave emergencies the simplest form of colostomy is performed in which a loop of colon is brought out through the abdominal wall, where it is held by the insertion of a glassrod passed through a small hole in the mesentery. The ends of the glassrod are connected by a loop of rubber tubing which forms a 'bucket handle' . The abdominal wall is closed around the protrusion of the colostomy. Exteriorisation is another way of performing a colostomy. If a growth is present in a part of the bowel which can be brought readily through the abdominal wall (e.g. transverse or pelvic colon) the affected loop containing the growth is left outside and the peritoneum, muscles and skin are closed around the base of the loop where the two limbs converge. The loop of colon containing the growth is then removed, leaving two open ends of el which can later be joined by crushing the spur between them. This operation avoids the handling of growth or unprepared bowel while the peritoneal cavity is open and so diminishes the risk of peritonitis. A formal operation for closure is required if a spur has not been made.
At the end of the operation a small incision is usually made in the apex of the loop to allow the immediate discharge of gas and faecal material which is collected as cleanly as possible before the patient leaves the theatre. A dressing of petroleum jelly gauze or tullegras is applied on the exposed bowel. The skin incision may be sealed with Whitehead's varnish and a pad of cellulosetissue and wool is bandaged lightly over the opening. For fear of contaminating the abdominal wound before the peritoneal cavity has become sealed, the former practice was to leave the colostomy unopened for 48 hours. The initial opening may be enlarged by the surgeon two or three days after the colostomy has been raised. The bowel is usually divided (without anaesthetic) by an electric cautery which seals the blood vessels and prevents bleeding from the very vascular mucousmembrane and muscle wall of the bowel. A method of draining the colostomy is by the use of Paul's tube. This is an angled wide glass tube which is inserted through a hole in the colostomy loop. It is tied in position in the same way as the caecostomy catheter and connected to a bedside jar with wide, thin, latex tubing. Research Colostomy
Dysentery is of two main types, namely bacillary and amebic, caused by different forms of infection, but in both there is inflammation of the mucousmembrane lining the lower or large bowel. The symptoms are those of enteritis and colitis, diarrhaea with small loose stools containing mucus and blood, abdominal tenderness, griping pain, and tenesmus during evacuation. Bacillary dysentery is a very infectious disease caused by various specific bacterial organisms (Sonne, Shiga and Flexner bacilli) which occur in impure water, contaminated food and excreta, and are often conveyed by flies or by 'carriers'.
The incubation period may be only a few hours, and is seldom more than three days. The disease is prevalent where insanitary conditions occur, and epidemics are common especially in the tropics. The disease develops suddenly with loss of appetite, lassitude, fever, shivering, heat of the skin, and a quickpulse. These are followed by griping pains in the bowels, and a constant desire to evacuate, and prostration. In general the stools are small and slimy, composed of mucus mixed with blood. Defaecation is attended and followed by severe griping and inclination to strain, called tormina and tenesmus; they are sometimes in the early stages attended by nausea and vomiting. The natural faeces are passed in the first few evacuations. Tenesmus continues and perhaps increases for several days, the discharges being mostly blood in some cases, and chiefly mucus in others. Having generally but little odour at first, these discharges become, as the disease advances, exceedingly offensive.
Vomiting is common, and there may be a high or low temperature, with headache. The disease may be severe or moderate in its course. In severe cases there are thirst, muscular pains, blueness of the face, extreme tenderness of the abdomen, hiccough, prostration, incontinence and a high mortality rate. If recovery follows convalescence is slow, with recurrent diarrhaea and various complications such as arthritis, iritis, chronic colitis, peritonitis, piles, boils, etc. In mild cases the symptoms abate after four or
five days. Research Dysentery
An endoscope is a long slender medical instrument originally used for examining the interior of hollow organs including the lung, stomach, bladder and bowel, but with the advent of fibre optics and keyhole surgery endoscopes are increasingly used for general interior investigations (endoscopy) . There are various types of endoscope in use - some rigid, some flexible - with names prefixed by their site of application (for example, bronchoscope and laryngoscope). The value of endoscopy is in permitting diagnosis without the need for exploratory surgery. Biopsies (tissue samples) and photographs may be taken by way of the endoscope as an aid to diagnosis, or to monitor the effects of treatment. Some surgical procedures can be performed using fine instruments introduced through the endoscope. Research Endoscope
Endoscopy is the examination of internal parts of the body using special instruments known as endoscopes. The simplest method of instrumental examination is that employed for the analcanal and rectum. A 'speculum' (proctoscope) which is in fact a simple tube with a handle, is introduced through the analcanal and the surgeon examines the rectal wall through the tube. To facilitate the introduction of the instrument, there is a shaped conical stopper which is known as the 'obturator.' This same principle of a shaped introducer is used on many instruments which have an open tubular end. Sigmoidoscopy is the examination of the upper regions of the rectum and the sigmoid or pelvic colon with a longer tubular speculum. Because the folds of mucousmembrane fall against the end of the instrument and obstruct the view, air inflation is used for the introduction of the sigmoidoscope so that the lumen of the bowel is distended. The surgeon inserts the instrument under direct vision, inspecting the wall of the bowel as far as 25 cm. from the anus.
The oesophagoscope is a similar instrument passed down the oesophagus through the mouth, thus enabling the surgeon to inspect the whole length of the gullet. The inside of the stomach is examined by the gastroscope, using air inflation. Through a very small incision in the abdominal wall the surgeon may introduce another viewing instrument, the peritoneoscope, and with this he may inspect the inside of the peritoneal cavity and obtain infonnation to enable him to reach a decision without open operation. In order to separate the coils of intestine from one another and allow the satisfactory inspection of the viscera, the peritoneal cavity is inflated with air through a separate cannula. Endoscopic instruments, except for the simpler forms of proctoscope, carry their own miniature lamps which draw electric current either from a battery or the mains through a transformer to reduce the voltage. The bladder and urethra are inspected with the cytoscope and urethroscope. The urinary tract is distended with water instead of air for the inspection, but air inflation is sometimes used for the lower part of the urethra. Various forms of speculum are used for the vagina and these are usually illuminated by direct light, although some forms carry a lamp of their own. Operations for the removal of tissue for microscopic examination (biopsy) are performed through some of the tubular instruments, and for this purpose there are special long forceps and diathermy electrodes. Examinations carried out with endoscopic instruments may be made with local or general anaesthesia and in the case of the rectum and colon, without anaesthesia. Research Endoscopy
Neomycin is an antibiotic obtained from the bacterium Streptomyces fradiae. It is administered locally in the treatment of skin and eye infections or orally for bowel infections. Research Neomycin
The Probert Encyclopaedia was designed, edited and programed by
Matt and Leela Probert
Abbreviations
Research Actinomycosis
