scholarly journals Role of Routine Dilatations after Anorectal Reconstruction—Comparison of Two Tertiary Centers

2018 ◽  
Vol 29 (03) ◽  
pp. 243-246 ◽  
Author(s):  
Dhanya Mullassery ◽  
Sumita Chhabra ◽  
Ashik Babu ◽  
Roberta Iacona ◽  
Simon Blackburn ◽  
...  
Keyword(s):  
General Anesthesia ◽  
Surgical Outcomes ◽  
Anorectal Malformations ◽  
Postoperative Management ◽  
Posterior Sagittal Anorectoplasty ◽  
Anorectal Reconstruction ◽  
Definitive Surgery ◽  
The Uk

Aim Regular anal dilatations are commonly recommended in the postoperative management following posterior sagittal anorectoplasty (PSARP) in anorectal malformations (ARM). We hypothesized that routine postoperative dilatations may not affect surgical outcomes following PSARP. We compare surgical outcomes of routine postoperative dilatations versus no routine postoperative dilatations from two United Kingdom tertiary pediatric surgical centers. Materials and Methods This is retrospective records review of patients undergoing definitive surgery for ARM in two tertiary surgical centers in the UK over 5 years. Center A used a protocol of routine postoperative dilatations, and center B used a protocol, which used dilatations only for clinical indications of stricture. Data collected included ARM type, operative procedures, and postoperative interventions. All post-operative interventions under general anesthesia (GA) were compared between groups. Results From 2011 to 2015, 49 procedures (46 PSARPs) were performed in center A and 54 (52 PSARPs) in center B. Median follow up period was 31 months (interquartile range [IQR] 18–48). The first postoperative anal calibration under GA was documented for 43 (86%) patients in center A and for 42 (78%) patients in center B. Following this, center A followed routine postoperative dilatation (RPD) at home, and center B reserved further dilatations for specific indications. RPD was performed for 100% of patients in center A versus 8% in center B. Further anal dilatations under GA were performed in 19 (38%) children in center A and in 17 (34%) children in center B (p = 0.68). In center A, 10 patients (22%) needed further surgery versus 14 (28%) in center B (p = 0.48). Conclusion The use of routine postoperative dilatations does not significantly improve surgical outcomes following PSARP in ARM.

scholarly journals Anorectal malformation with long perineal fistula: one of a special type

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Sen Li ◽  
Jun Wang
Keyword(s):  
Anorectal Malformation ◽  
Bowel Function ◽  
Anorectal Malformations ◽  
Contrast Enema ◽  
Posterior Sagittal Anorectoplasty ◽  
Function Score ◽  
Perineal Fistula ◽  
Definitive Surgery ◽  
Inhibitory Reflex

AbstractThe anorectal malformation with long perineal fistula is a rare anomaly in the spectrum of anorectal malformations. Aim of the study is to describe the series of patients with anorectal malformation with long perineal fistula and compare the outcome with patient with standard perineal fistula. From March 2012 to January 2019, 7 patients who suffered from anorectal malformation with long perineal fistula were retrospectively reviewed. Three were operated on primarily by our department, and 4 cases were re-operated after a perineal anoplasty repair performed elsewhere. Four were operated by laparoscopy assisted anorectoplasty, and 3 cases were repaired by posterior sagittal anorectoplasty. The follow-up outcomes were compared with 71 cases of normal perineal fistula (NPF) in the same period. 7 cases have been followed up for 0.5–4 years (M = 2.57 ± 1.26) after definitive surgery. Their bowel function score was lower than normal perineal fistula (SPF = 12, range: 5–18; NPF = 18.5, range: 18–20). Four cases underwent anorectomanometry. The incidence of rectoanal inhibitory reflex was lower in the special type group. (p = 0.14). Three cases of contrast enema using barium: 2 cases of colorectal dilatation and thickening changes, 1 case showed no obvious abnormalities. Anorectal perineal fistula should be examined by distal colostogram at preoperation. This should be altered in: When suspecting a case of anorectal malformation type long perineal fistula a preoperative contrast enema could give insight of the anatomy befor performing a anoplasty.

scholarly journals Perineal Fistula With High Dilated Colon: One of a Special Type of Anorectal Malformations

2020 ◽  
Author(s):  
Sen Li ◽  
Jun Wang
Keyword(s):  
Bowel Function ◽  
Anorectal Malformations ◽  
Posterior Sagittal Anorectoplasty ◽  
Function Score ◽  
Perineal Fistula ◽  
Defecation Function ◽  
Definitive Surgery ◽  
Inhibitory Reflex

Abstract Background The perineal fistula with high dilated colon is a rare anomalous in the spectrum of anorectal malformations. The aim of this study is to explore the diagnosis and treatment of this special type of perineal fistula (SPF), and to avoid the severe consequence due to misdiagnosis.Methods From March 2012 to January 2019, 7 patients who suffered from perineal fistula with high dilated colon were retrospectively reviewed. Three were operated on primarily by our department, and 4 cases were re-operated after a perineal anoplasty repair performed elsewhere. Four were operated by laparoscopic anorectoplasty (LARP), and 3 cases were repaired by posterior sagittal anorectoplasty (PSARP). The follow-up outcomes were compared with 71 cases of normal perineal fistula (NPF) in the same period.Results 7 cases have been followed up for 0.5-4 years (M=2.57±1.26) after definitive surgery. Their bowel function score (BFS) was lower than normal perineal fistula (SPF=12, rang:5-18; NPF=18.5, rang:18-20). Four cases underwent anorectomanometry. The incidence of rectoanal inhibitory reflex (RAIR) was lower in the special type group. (p=0.14). Three cases of barium enema angiography: 2 cases of colorectal dilatation and thickening changes, 1 case showed no obvious abnormalities.Conclusions Anorectal perineal fistula should be examined by distal colostogram at preoperation. Select appropriate surgical approach is essential for children’s defecation function, and blind surgery can seriously affect long-term defecation function.

Displaced Fractures of the Os Calcis Involving the Subtalar Joint: The Key Role of the Superomedial Fragment

Foot & Ankle ◽  
1983 ◽  
Vol 4 (2) ◽  
pp. 91-101 ◽  
Author(s):  
John R. Stephenson
Keyword(s):  
Internal Fixation ◽  
Open Reduction ◽  
Subtalar Joint ◽  
Postoperative Management ◽  
Lateral Approach ◽  
Normal Anatomy ◽  
Os Calcis ◽  
Articular Fractures

Fourteen displaced intra-articular fractures of the os calcis are reviewed following open reduction and internal fixation using a lateral approach with an average follow-up of 22 months (range, 12 to 44 months). Postoperative management consisted of early subtalar motion with delayed weightbearing. Twelve of 14 fractures were considered good results on the basis of no pain, 50% normal subtalar motion, and near-normal anatomy. Pain correlated with incomplete reduction of the superomedial fragment and, thus, incongruent reduction of the posterior facet in two cases. The importance of effecting a reduction of the superomedial border of the os calcis is emphasized.

scholarly journals Investigating the role of behaviour in the genetic risk for schizophrenia

2019 ◽  
Author(s):  
Jessye Maxwell ◽  
Adam Socrates ◽  
Kylie P. Glanville ◽  
Marta Di Forti ◽  
Robin M. Murray ◽  
...  
Keyword(s):  
Risk Taking ◽  
Disease Onset ◽  
Risk Scores ◽  
Numerical Reasoning ◽  
Causal Path ◽  
Tea Drinking ◽  
The Uk ◽  
Trait Associations

AbstractThe notion that behaviour may be on a causal path from genetics to psychiatric disorders, such as schizophrenia, highlights a potential for practical interventions. Motivated by this, we test the association between schizophrenia (SCZ) polygenic risk scores (PRS) and 420 behavioural traits (personality, psychological, lifestyle, nutritional) in a psychiatrically healthy sub-cohort of the UK Biobank. Higher schizophrenia PRS was associated with a range of traits, including lower verbal-numerical reasoning (P= 6×10−61), higher nervous feelings (P= 2×10−51) and higher self-reported risk-taking (P= 2×10−41). We follow-up the risk-taking association, hypothesising that the association may be due to a genetic propensity for risk-taking leading to greater migration, urbanicity or drug-taking – reported environmental risk factors for schizophrenia, and all positively associated with risk-taking in these data. However, schizophrenia PRS was also associated with traits, such as tea drinking (P= 2×10−34), that are highly unlikely to be on a causal path to schizophrenia. We depict four causal relationships that may in theory underlie such PRS-trait associations and illustrate ways of testing for each. For example, we contrast PRS-trait trends in the healthy sub-cohort to the corresponding trait values of medicated and non-medicated individuals diagnosed with schizophrenia, allowing some differentiation of mediation-by-behaviour, disease-onset effects and treatment effects. However, dedicated follow-up studies and new methods are required to fully disentangle these relationships. Thus, while we urge caution in interpretation of simple PRS cross-trait associations, we propose that well-designed PRS analyses can contribute to identifying behaviours on the causal path from genetics to disease.

SPLATT Combined with Tendo Achilles Lengthening for Spastic Equinovarus in Adults: Results and Predictors of Surgical Outcome

Foot & Ankle ◽  
1993 ◽  
Vol 14 (6) ◽  
pp. 335-338 ◽  
Author(s):  
Peter Edwards ◽  
John Hsu
Keyword(s):  
Surgical Outcomes ◽  
Postoperative Management ◽  
Ambulatory Status ◽  
Brain Injured ◽  
Anterior Tibial ◽  
Ambulatory Patients ◽  
And Function ◽  
Injured Patients ◽  
Spastic Quadriparesis

During a 4-year period, split anterior tibial tendon transfer (SPLATT) was performed on 42 adults with cerebrospastic equinovarus deformity. Twenty-one patients (24 feet) had a minimum 1-year follow-up, which included detailed documentation of foot appearance position and function as well as ambulatory status. Thirteen patients were male and 8 were female. Average age of the patients was 41 years. Seventeen patients were independent ambulators with orthoses, one was a maximally assisted ambulator. Three patients with spastic quadriparesis were nonambulatory. All patients had uniform surgical technique and postoperative management. This paper presents the results of SPLATT and identifies risk factors for poor surgical outcomes. After an average follow-up of 39 months, 83% of the feet were rated as having good or excellent results. All ambulatory patients had improved gait and 35% of them were able to discontinue their orthoses. Poor surgical outcomes were associated with nonambulatory status in brain injured patients ( P = .018). Salvage of failed SPLATT is discussed.

scholarly journals Examining the Use of Radiation Therapy for Cholangiocarcinoma: Benefits through Modern Techniques

2021 ◽  
pp. 1-6
Author(s):  
Michael Oertel ◽  
Felix Gattermann ◽  
Hartmut Schmidt ◽  
Hans Theodor Eich
Keyword(s):  
Radiation Therapy ◽  
Local Control ◽  
Progression Free Survival ◽  
Free Survival ◽  
Treatment Situation ◽  
Significant Difference ◽  
Bile Duct Epithelium ◽  
Definitive Surgery

<b><i>Background:</i></b> Cholangiocarcinoma (CCA) is a rare malignant tumor of the bile duct epithelium. At first diagnosis, only a minority of patients are eligible for surgery, which is regarded as the only curative treatment. This study examines the role of radiation therapy (RT) and chemoradiotherapy (CRT) in the definitive and adjuvant treatment situation. <b><i>Methods:</i></b> The monocentric, retrospective analysis included 39 patients with CCA undergoing 53 RT courses. Data were collected from January 2005 to September 2018. There were 11 cases of CRT, 6 of which were definitive. Surgery was either palliative (<i>n</i> = 6) or radical (<i>n</i> = 15). <b><i>Results:</i></b> After RT, the median overall survival (OS) was 10.4 months (m), median progression-free survival was 5.6 m, and median duration of local control (DOLC) was 8.9 m. There was a significant difference in survival between patients with and without locoregional lymph node metastasis (OS: 4.3 vs. 15.4 m, <i>p</i> = 0.031). After treatment of a primary tumor, DOLC was about twice as long as in the recurrent situation (10.4 vs. 5.4 m, <i>p</i> = 0.032). Conservative therapy significantly elevated the risk of local recurrence compared to radical surgery in univariate and multivariate analyses. Side effects were mostly classified as mild to moderate. Termination of RT and increased alanine aminotransferase were significantly less frequent after stereotactic body radiation therapy and hypofractionation. <b><i>Conclusion:</i></b> RT can achieve local control in patients with CCA. Toxicities of RT are manageable but require close clinical and laboratory follow-up.

The Role of Patenting in Academic—Industry Links in the UK

1995 ◽  
Vol 9 (5) ◽  
pp. 293-302
Author(s):  
Kathryn Packer
Keyword(s):  
Government Policy ◽  
Policy Instruments ◽  
Research Staff ◽  
Speed Up ◽  
The Government ◽  
Future Policy ◽  
The Uk ◽  
Industry Relations

In this follow-up article to her paper in the December 1994 issue of Industry and Higher Education, Kathryn Packer summarizes and assesses the views of industrial liaison (IL) staff and university researchers on the activities in UK universities that are designed to promote academic-industry relations in general and increased revenue through patenting in particular. She also looks at the government policy instruments intended to facilitate and speed up these changes. The paper explores the perceptions IL staff have of the changes that have taken place in their own institutions with regard to patenting, what forms of contact they currently have with research staff and what the role of the Department of Trade and Industry sponsored technology audits has been in promoting these links. The author then discusses IL staff's recommendations for future policy activities and changes in the law relating to intellectual property rights.

scholarly journals Primary Posterior Sagittal Anorectoplasty in male neonates with Anorectal Malformations: A tertiary care hospital experience

2021 ◽  
Vol 10 ◽  
pp. 29
Author(s):  
Charu Tiwari ◽  
Neha S Shenoy ◽  
Suraj Gandhi ◽  
Apoorva Makan ◽  
Syamantak Basu ◽  
...  
Keyword(s):  
Tertiary Care ◽  
Anorectal Malformations ◽  
Care Hospital ◽  
Posterior Sagittal Anorectoplasty ◽  
Diversion Stoma ◽  
Definitive Repair ◽  
Pull Through ◽  
Male Neonate ◽  
Primary Psarp

Background: The conventional surgical management for a male neonate with intermediate Anorectal Malformation (ARM) involves three stages – the creation of a diversion stoma in the neonatal period, a definitive pull-through procedure/ Posterior Sagittal Anorectoplasty (PSARP) followed by stoma closure. With this background, we present our experience with Single-stage primary definitive repair in selected male neonates with ARM. Methods: Medical records of male ARM cases managed from 2016 to 2018 were reviewed. Male neonates who underwent primary PSARP were analysed retrospectively. Results: A total of 35 records were found, out of which 12 male neonates underwent primary PSARP. The      median gestational age and birth weight were 36.7 weeks and 2.75 kg respectively. Fistula with urinary tract was documented in all. The mean operative time was      65 minutes +/- 15 minutes. Two neonates had minor superficial surgical site infection at neo-anus. Anal dilatations were started after 2 weeks. At follow-up period of 3 years, 11 patients were continent; one patient had constipation with pseudo-incontinence which was successfully being managed by bowel management programme. Conclusions: A primary definitive procedure is feasible when performed on carefully selected male neonates with ARM and also avoids the morbidity of stoma and multiple surgeries and follow-up visits to hospitals.

Postoperative Epileptic Seizures in Children: Is the Brain Incision a Risk Factor?

Neurosurgery ◽  
2017 ◽  
Vol 82 (4) ◽  
pp. 465-472 ◽  
Author(s):  
Luca Massimi ◽  
Domenica Battaglia ◽  
Federico Bianchi ◽  
Simone Peraio ◽  
Elisabetta Peppucci ◽  
...  
Keyword(s):  
Risk Factor ◽  
Surgical Planning ◽  
Epileptic Seizures ◽  
Postoperative Management ◽  
The Other ◽  
Group A ◽  
Group B ◽  
The Brain

Abstract BACKGROUND Postoperative seizures (PSs) after neurosurgical operations are common but little is known about the role of surgical brain incision on their genesis. This topic has not been addressed so far. OBJECTIVE To verify if the corticotomy affects the risk of PSs and postoperative epilepsy (PE) in children. METHODS One hundred forty-three consecutive pediatric cases operated on for supratentorial lesions at the same institution in the last 15 yr have been retrospectively reviewed by dividing them into group A, 68 children who required brain corticotomy mainly for hemispheric tumors, and group B, 75 children treated through extracortical approaches mainly for suprasellar and optic tumors. Patients with possible “epileptic” biases, like preoperative seizures, were excluded. RESULTS No significant differences have been found between group A and B as far as incidence of PSs (11.7% vs 14.5%) and PE (4.5% vs 6.5%), timing, and type of seizures are concerned after a mean 6.8 yr follow-up. The size of corticotomy in group A (&lt;3 cm2 vs &gt;3 cm2) had no impact on epileptogenesis as well as the other variables considered in both groups (age, sex, extent of lesion resection). CONCLUSION This study shows that the surgical cortical “trauma” would not represent a risk factor for PSs and PE. According to the present analysis and the literature, other causes seem to be involved (namely, electrolytic imbalance and brain gliosis). This information is important for preoperative surgical planning and postoperative management. A validation by both adult series and prospective studies is needed.

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