Fistula Recurrence: A Clinical Reality after Successful Endoscopic Closure of Laparoscopic Sleeve Gastrectomy Fistulas

Background and Aims: Laparoscopic sleeve gastrectomy (LSG)-related fistulas are important and potentially fatal complications. We aimed at determining the incidence, predictive factors, and management of recurrence of post-LSG fistulas. Methods: This is a retrospective cohort study of 12 consecutive patients with LSG fistulas managed endoscopically between 2008 and 2013. We analyzed factors associated with recurrence of post-LSG fistulas and the efficacy of a primarily endoscopic approach to manage fistula recurrence. Results: The average age at fistula detection after LSG was 43.3 ± 10.9 years, and 10 (83%) patients were female. The median interval between surgery and initial fistula detection was 14 (4–145) days. Fistulas were located at the gastric cardia in 9/12 patients. A median of 4 (1–10) endoscopies were performed per patient until all fistulas were successfully closed. The median follow-up was 30.5 (15–72) months. Fistula recurrence was detected in 3 (25%) female patients with an average age of 31.7 ± 7.9 years after a median of 119 (50–205) days of the initial fistula closure. Fistulas in all 3 patients recurred at the gastric cardia and were successfully managed endoscopically. There was a second recurrence in 1 patient after 6 months, and she was re-operated with anastomosis of a jejunal loop at the site of the fistula orifice at the gastric cardia. We did not find any factors at initial fistula detection that were significantly associated with fistula recurrence. There were no deaths related to initial fistula after LSG and fistula recurrence. Conclusions: A primarily endoscopic approach is an effective and safe method for the management of fistulas after LSG. Fistula recurrence occurred in 25% of patients and was managed endoscopically. Key Messages: Although we could not define predictive factors of post-LSG fistula recurrence, it is a clinical reality and can be managed endoscopically

O retraimento social e as competências sociais em crianças do pré-escolar

Dissertação de Mestrado em Psicologia Clínica apresentada ao ISPA - Instituto UniversitárioO presente trabalho teve como objectivo, estudar a relação entre o retraimento social e as competências sociais nas crianças do pré-escolar. Alguns estudos indicam que o retraimento social pode influenciar de forma negativa o desenvolvimento das competências sociais. Os participantes são 98 crianças (56 do sexo feminino e 42 do sexo masculino), com idades compreendidas entre os 3 e os 6 anos (M=4.84, DP=0.78), as respectivas educadoras e mães. Os dados sobre o retraimento social foram recolhidos pelas educadoras através da Escala de Comportamentos de Brincadeira Observados no Pré-escolar – ECBOP/PPBS (Coplan & Rubin, 1998, adaptado por Monteiro e Santos, 2012). Os dados da competência social foram recolhidos junto das mães através da Escala de Competência Social e Avaliação do Comportamento (LaFreniere & Dumas, 1996). Os resultados indicam, que a manifestação de comportamentos de retraimento está relacionado com uma baixa competência social por parte das crianças. Assim como, se evidenciou que os comportamentos de retraimento e as competências sociais não são afectados pelo sexo da criança.ABSTRACT: This paper aims study the relation between social withdrawal and the social competencies in children of preschool. Some studies indicate that social withdrawal can affect in the negative way the social competencies development. The participants are 98 children (56 females and 42 males), with ages between 3 and 6 years old (M=4.84, DP=0.78), and their kindergarten teachers and mothers. The data about the social withdrawal were collected by the kindergarten teachers through The Preschool Play Behavior Scale– ECBOP/PPBS (Coplan & Rubin, 1998, adapted by Monteiro & Santos, 2012). The data about social competencies were collected from mothers through the SCBE-30 (LaFreniere Dumas, 1996). The results indicate that manifestation of withdrawal behaviors is related to low social competencies of the children. As well as, this study also showed that the withdrawal behavior and the social competencies are not affected by the gender of the child

Biofertilizers and Silicon Fertilization as a Sustainable Option for Maize Production

Due to the rapid growth of human population and increasing living standards, there is a continuous increase in the gap between food productivity and demand. At the same time there is a global reduction in freshwater availability for agriculture. Several options have been proposed along the way to increase water use efficiency in the field. One promising possibility is the adoption of fertilization with silicon (Si) combined with biofertilizers (microorganisms). Si is estimated to impact on the root volume and distribution, while microorganisms added to the soil in the rhizosphere also impact directly on root growth. In this work we have tested the influence of Si fertilization (magnesium silicate + diatomaceous earth) combined with biofertilizers and 20% reduction in NPK fertilization in the growth of maize and the soil water balance on a field trial located in Companhia das Lezírias (Portugal). Data on soil water content was collected regularly and root analysis was performed at harvest. The water balance was calculated through the model HYDRUS, using root growth model calibrated for maize in the present conditions. Results showed that using an alternative source of fertilization (Si+microbes) while reducing NPK fertilization impacted on root growth development, with roots growing more horizontally, while conventional NPK fertilization resulted in deeper roots. As a consequence,, root water uptake increased and evaporation losses were lower in the treatment supplemented compared to the conventional, without compromising the yield obtained. Using biofertilizers combined with Si sources resulted in higher water use efficiency (2.64 kg m −3 ) than the NPK fertilization, normally applied for maize growth (2.56 kg m−3 ). The results imply that the supplementation+biofertilization allows a potential saving of 206 m 3 ha −1 water and 157 kg NPK ha −1 fertilization in a growing season assuring the same yield as obtained with the conventional NPK fertilization (18.64 ton ha −1 ). Implications are important for Portuguese agriculture, where maize is one of the most important cereals cultivated, especially in Centre and Southern part of the country where water is a scarce resource.info:eu-repo/semantics/acceptedVersio