Primary Versus Staged Reconstruction and Risk of Surgical Failure in Patients With Ulcerative Colitis: a Nation-wide Cohort Study

Background Restorative surgery after colectomy due to ulcerative colitis (UC) may be performed simultaneously with colectomy (primary) or as a staged procedure. Risk factors for failure after restorative surgery are not fully explored. This study aimed to compare the risk of failure after primary and staged reconstruction. Methods This is a national register-based cohort study of all patients 15 to 69 years old in Sweden treated with colectomy due to UC and who received an ileorectal anastomosis (IRA) or ileal pouch-anal anastomosis (IPAA) between 1997 and 2017. Failure was defined as a reoperation with new ileostomy after restorative surgery or a remaining defunctioning ileostomy after 2 years. Risk of failure was calculated using the Kaplan-Meier method and Cox regression adjusted for sex, age, calendar period, primary sclerosing cholangitis, and duration of UC. Results Of 2172 included patients, 843 (38.8%) underwent primary reconstruction, and 1329 (61.2%) staged reconstruction. Staged reconstruction was associated with a decreased risk of failure compared with primary reconstruction (hazard ratio, 0.73; 95% CI, 0.58–0.91). The 10-year cumulative risk of failure was 15% vs 20% after staged and primary reconstruction, respectively. In all, 1141 patients (52.5%) received an IPAA and 1031 (47.5%) an IRA. In stratified multivariable models, staged reconstruction was more successful than primary reconstruction in both IRA (hazard ratio, 0.75; 95% CI, 0.54–1.04) and IPAA (hazard ratio, 0.73; 95% CI, 0.52–1.01), although risk estimates failed to attain statistical significance. Conclusions In UC patients undergoing colectomy, postponing restorative surgery may decrease the risk of failure.

In Vivo Assessment of Water Content, Trans-Epidermial Water Loss and Thickness in Human Facial Skin

Mapping facial skin in terms of its biophysical properties plays a fundamental role in many practical applications, including, among others, forensics, medical and beauty treatments, and cosmetic and restorative surgery. In this paper we present an in vivo evaluation of the water content, trans-epidermial water loss and skin thickness in six areas of the human face: cheeks, chin, forehead, lips, neck and nose. The experiments were performed on a population of healthy subjects through innovative sensing devices which enable fast yet accurate evaluations of the above parameters. A statistical analysis was carried out to determine significant differences between the facial areas investigated and clusters of statistically-indistinguishable areas. We found that water content was higher in the cheeks and neck and lower in the lips, whereas trans-epidermal water loss had higher values for the lips and lower ones for the neck. In terms of thickness the dermis exhibited three clusters, which, from thickest to thinnest were: chin and nose, cheek and forehead and lips and neck. The epidermis showed the same three clusters too, but with a different ordering in term of thickness. Finally, the stratum corneum presented two clusters: the thickest, formed by lips and neck, and the thinnest, formed by all the remaining areas. The results of this investigation can provide valuable guidelines for the evaluation of skin moisturisers and other cosmetic products, and can help guide choices in re-constructive/cosmetic surgery.

Incidence and Risk Factors of Pressure Ulcers in a Tunisian University Hospital

Background: Pressure ulcers are a major problem both in our context than in studies conducted around the world. In Tunisia, few studies have focused on estimating their extent. Aim: To estimate the incidence of pressure ulcers in some at-risk departments of the Hospital of Sahloul and to identify the associated risk factors. Methods: We carried out a longitudinal study in the departments of Anesthesia-Resuscitation, Internal Medicine, and Aesthetic and Restorative Surgery at the Hospital of Sahloul during 3 months from October the 1st until December 31st, 2015. Results: Overall, 150 patients were eligible. Their mean age was 46.1 ± 20.2 years. The sex ratio was 1.94. In our study, 29 patients had pressure ulcers, which represented a patient incidence of 19.3% (95% CI: [13-25.3]). In addition, 56 episodes of pressure ulcers were observed in these patients, resulting in a pressure ulcer incidence of 37% (95% CI: [29.3-44.7]) and incidence density of 2.3 episodes per 1000 days of hospitalization. The most frequent locations were the heels followed by the buttocks. In multivariate analysis, polytrauma (p=0.048) and disorders of higher functions (p<10-3) were found as independent risk factors for pressure ulcer occurrence. Regarding the evaluation of different pressure screening scores, Braden had the best sensitivity-specificity pair. Conclusion: Our results highlight the extent of the problem of pressure ulcers in our hospital. The fight against the occurrence of this complication requires a good management of traumatized and patients with a disorder of the higher functions based on the recommendations concerning the rehabilitation and the nutrition.

Supplementary prescribing by dietitians: a case study

In February 2016, registered dietitians in the UK gained supplementary prescribing rights. The aim of this case study is to describe the prescribing process by a registered dietitian supplementary prescriber. A 46-year-old male was transferred to a tertiary referral centre for a surgical review due to intra-abdominal tuberculosis resulting in bowel obstruction. The registered dietitian performed a nutritional assessment, estimated nutritional requirements and formulated a bag of parenteral nutrition to meet his needs. The patient remained an inpatient to complete a 6-month course of treatment for tuberculosis and then underwent surgery to resolve the obstruction. He was prescribed parenteral nutrition, which improved his nutritional status ready for restorative surgery. Post-operatively, he was weaned from parenteral nutrition onto an oral diet and was discharged.