EP.TH.421A Systematic Review of Early versus Late Closure of Loop Ileostomy

Aim A Loop ileostomy is one of the most common techniques used in colorectal surgery, in order to protect either a downstream colorectal anastomosis or a coloanal anastomosis. However, it is a procedure that can cause a plethora of complications. Currently, there is no consensus regarding the optimal time for its reversal. Some studies suggested the early reversal of ileostomy procedure as a solution to reduce these complications. This study aims to review the available literature in order to ascertain the benefits behind early closure of loop ileostomy. Methods The literature was searched for all studies that included a comparison between the outcomes of early and late closure of loop ileostomy in terms of morbidity, mortality, or quality of life, where available. Early closure of loop ileostomy is defined as closure less than three months and late as more than three months, in accordance with conventional literature. The resultant articles were filtered using our inclusion and exclusion criteria. Finally, the remaining articles were assessed for quality and their results were compared to one another in order to draw our conclusions. Results The results were slightly inclined toward early closure of loop ileostomy, despite the limitations of the studies reviewed. Conclusion There were limitations of the studies reviewed, including the heterogenicity of studies, selection bias, lack of clear definition of measured outcomes, and small sample size. Taking that into consideration, the results of early closure of loop ileostomies in the selected patients were promising and require further investigation.

Impact of coronavirus disease 2019 in a child who underwent ventricular septal defect device closure: a case report

Background Studies about the incidence and severity of coronavirus disease 2019 (COVID-19) in children are still significantly lower than those in adults. Moreover, data on the effect of COVID-19 in children with congenital heart disease (CHD) are limited. To the best of our knowledge, this study first reported mortality in a child with CHD who acquired COVID-19. Case summary A 16-month-old boy presented to the emergency department due to shortness of breath, fever, cough, and poor oral intake. He tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). He required mechanical ventilation for rapidly progressing respiratory failure. The patient had a large mid-muscular ventricular septal defect (VSD) that was closed percutaneously at the age of 13 months. Moreover, we followed his hospital sequelae from admission to death. Discussion This child had multiple risk factors, including malnutrition and persistent pulmonary hypertension (PH) after late closure of the VSD. The pre-existing PH could have been aggravated by the lung condition associated with COVID-19 and the respiratory failure triggered by SARS-CoV-2 infection. The patient presented with ventricular systolic dysfunction, elevated troponin serum levels and newly developed trifascicular block, which were indicative of myocardial injury. The elevated inflammatory markers and multi-organ dysfunction seem to corroborate multisystem inflammatory syndrome in children, which was described recently among paediatric patients with COVID-19.

The Role of Segmental Information in Syntactic Processing Through the Syntax–Prosody Interface

In two experiments, it was investigated whether potentially contrastive segmental information in the form of an epenthetic glottal stop in Maltese can influence syntactic parsing decisions. The glottal stop in Maltese serves a dual function as a phoneme used for lexical contrast and a non-contrastive phone that may mark a prosodic juncture. In both experiments, participants perceived a larger prosodic boundary before the word u (Engl. “and”) if the u was produced with an epenthetic glottal stop, showing the use of prosodically conditioned segmental information in syntactic parsing. Furthermore, listeners were generally unaware of the existence of the epenthetic glottal stop even though a glottal stop is used as a phoneme represented as a grapheme “q.” They also perceived a larger prosodic juncture when the preceding syllable was lengthened before the word u (“and”). These findings were consistent regardless of whether the glottal stop reinforced a late-closure decision (Experiment 1) or an early-closure decision (Experiment 2). The results indicate that both segmental and suprasegmental information influences syntactic parsing decisions, demonstrating that the syntax–prosody interface is reflected along both the segmental and suprasegmental (duration) dimensions, which are mediated by the phonetics–prosody interface.

A Systematic Review of Early versus Late Closure of Loop Ileostomy

Introduction. A Loop ileostomy is one of the most common techniques used in colorectal surgery to establish a reversible faecal diversion and bypass the large bowels, in order to protect either a downstream colorectal anastomosis or a coloanal anastomosis. However, it is a procedure that can cause a plethora of complications including long term ones such as the psychological effects. Currently, there is no consensus regarding the optimal time to perform closure of a loop ileostomy. Some studies suggested the early reversal of ileostomy procedure as a solution to reduce these complications. This study aims to review the available literature in order to ascertain the benefits behind early closure of loop ileostomy. Methods. The literature was searched for all studies that included a comparison between the outcomes of early and late closure of loop ileostomy in terms of morbidity, mortality, or quality of life, where available. Early closure of loop ileostomy is defined as closure less than three months and late as more than three months, in accordance with conventional literature. The resultant articles were filtered using our inclusion and exclusion criteria. Finally, the remaining articles were assessed for quality and their results were compared to one another in order to draw our conclusions. Results and Discussion. The results were slightly inclined toward early closure of loop ileostomy. However, there were limitations of the studies reviewed, including the heterogenicity of studies, selection bias, lack of clear definition of measured outcomes, and small sample size. Taking that into consideration, the results of early closure of loop ileostomies in the selected patients were promising and require further investigation.

A Filipino Child with Cleidocranial Dysplasia and Acute Leukemia: A Case Report

Cleidocranial dysplasia (CCD) is an autosomal dominant skeletal dysplasia whose most common features include late closure of fontanelles, absent or hypoplastic clavicles, and dental abnormalities. This disorder is primarily due to mutations in RUNX2 (CBFA1) gene. Here we present a Filipino child with clinical and radiologic features of CCD who was also diagnosed with B-cell acute lymphoblastic leukemia (ALL). On history, the patient’s father and paternal grandfather also presented with short stature and similar facial features. Association of leukemia and CCD has been noted in the literature. Hence, this report adds to the potential role of RUNX2 gene in leukemogenesis. With the potential predisposition to developing leukemia, this provides implications in genetic counselling and possible recommendations for surveillance later on.

P694 Late shunt closure: is it the only cause of pulmonary hypertension after surgical repair?

Introduction Atrial septal defects (ASD) may be a cause of pulmonary hypertension (PH) specially when they are only detected in adulthood. Sinus venosus type ASD are rare, with an estimated prevalence of 4-11%, and frequently they are associated with anomalous venous return of the right superior pulmonary vein (RSPV). Surgical closure is safe and effective, and it is associated with normal life expectancy when performed before age 25; the risk of PH is higher in untreated defects or late closure. Clinical case The authors present the case of a 74-years old female patient with previous diagnosis of a sinus venosus type ASD. Closure of the shunt and correction of venous return was performed when the patient was 36. Follow up in the following years was normal, and the patient was discharged from the congenital surgical center. The patient was referred to our PH unit due to symptomatic PH for etiological investigation (PSAP of 70 mmHg in transthoracic echocardiogram). After excluding PH related to left heart disease and lung disease, the most likely cause was pulmonary arterial hypertension due to late closure of left to right shunt, but complete investigation was performed. A transesophageal echocardiogram showed dilatation of right heart chambers and a communication of 36 mm at the high atrial septum between the RSPV and superior vena cava entrance with spontaneous left to right shunt. A severe dilation of coronary sinus (maximal dimension 33.4mm) suggestive of persistent left superior vena cava (PLSVC) was also found. A cardiac magnetic resonance was performed showing dilated right chambers, abnormal drainage of right superior pulmonary vein to right atrium, a dilated coronary sinus with a PLSVC and Qp/Qs 1.7. Right heart catheterization showed a mean pulmonary artery pressure of 25 mmHg with normal pulmonary vascular resistance (2.4 UWood) suggesting that the intracardiac shunt is the responsible for the PH with reversible pulmonary vascular disease. The patient was proposed to surgical repair. Conclusion The authors present a rare clinical case of an undiagnosed persisting sinus venous ASD after surgical repair. Failure of shunt closure led to the development of PH, emphasizing the need to maintain lifelong follow up of these patients in specialized centers. Abstract P694 Figure.

Timing of Syntactic and Rhythmic Effects on Ambiguity Resolution in Turkish: A Phoneme Restoration Study

It has been shown that speakers use prosodic cues to disambiguate the syntactic structure of a sentence and listeners are sensitive to such cues. But the distribution of prosodic boundaries has been reported to depend on the lengths of constituents as well as the syntactic structure of utterances. Hence, it is possible that listeners are sensitive to these alternative reasons (i.e., syntactic or length-related) for why a speaker might introduce a prosodic break (Clifton, Carlson, & Frazier, 2006). The present study of Turkish employs a phoneme restoration paradigm to investigate more closely the time-course of three factors (prosodic cues, syntactic Late Closure, and phrase length effects) in the comprehension of a late/early closure ambiguity. The results confirm a significant role of prosody in restoring missing disambiguating phonemes; listeners tended to maintain an analysis that was syntactically or prosodically favored on-line. Notably, they did not generally revise that decision in face of the rhythmic factor of phrase lengths. This may be because length contrasts become fully apparent only later in a sentence. This is supported by the fact that when tested post-sententially in a previous study of Turkish (Deniz & Fodor, 2017), it was found that phrase lengths as well as prosodic and syntactic effects did influence parsing decisions, indicating that all three sources of guidance were at work. By comparing these two studies, with their different methodologies applied to the same materials, we document here the novel finding that rhythmic phrase length effects are indeed delayed, as previously contemplated by Clifton et al.