45 research outputs found

    Ambulatory Seton Placement Followed by Fistulotomy: Efficacy and Safety for Perianal Fistula Treatment

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    Purpose: To evaluate the efficacy and safety of ambulatory seton placement followed by superficial fistulotomy as treatment of perianal fistula. Methods: Retrospective observational analysis of patients with cryptogenic perianal fistula aged 18-90 years, followed in a central hospital proctology consultation between 2006 and 2017. Data were obtained through clinical record's analysis. Fistula was characterized, using Parks Classification. A probe was passed through the fistula tract, followed by a seton, which remained in situ until superficial fistulotomy was possible. Results: Ninety-six patients were included (66.67% males, mean age 56 ± 15 years old). Nineteen patients (19.89%) had previous history of perianal fistula and 14 (14.58%) previous anorectal surgery. Seventy-four patients (78.72%) were submitted to fistulotomy, three (3.19%) had seton fistulotomy and one had no seton progression. Intention-to-treat and per-protocol efficacy analyses were 80.2 and 98.7%, respectively. Among the 74 patients who completed the procedure, type of fistula and time with seton were distributed as followed: 47 (63.51%) intersphincteric fistula (15 ± 31 weeks), 26 (35.14%) transsphincteric fistula (32 ± 47 weeks), one (1.35%) suprasphincteric fistula (11 weeks). Previous fistula was associated with a longer time with seton (P = 0.018). Incontinence was reported in two (2.7%) patients, who had previous perianal fistula or anorectal surgery. Two patients (2.7%) had recurrence after fistulotomy. Conclusion: Placement of seton followed by superficial fistulotomy in an ambulatory setting is a safe and effective method for simple low perianal fistula treatment. Incontinence rate may be higher in patients with previous perianal fistula or anorectal surgery.info:eu-repo/semantics/publishedVersio

    Prehabilitation in elective abdominal cancer surgery in older patients: systematic review and meta‐analysis

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    Background Prehabilitation has emerged as a strategy to prepare patients for elective abdominal cancer surgery with documented improvements in postoperative outcomes. The aim of this study was to assess the evidence for prehabilitation interventions of relevance to the older adult. Methods Systematic searches were conducted using MEDLINE, Web of Science, Scopus, CINAHL and PsychINFO. Studies of preoperative intervention (prehabilitation) in patients undergoing abdominal cancer surgery reporting postoperative outcomes were included. Age limits were not set as preliminary searches revealed this would be too restrictive. Articles were screened and selected based on PRISMA guidelines, and assessment of bias was performed. Qualitative, quantitative and meta‐analyses of data were conducted as appropriate. Results Thirty‐three studies (3962 patients) were included. Interventions included exercise, nutrition, psychological input, comprehensive geriatric assessment and optimization, smoking cessation and multimodal (two or more interventions). Nine studies purposely selected high‐risk, frail or older patients. Thirty studies were at moderate or high risk of bias. Ten studies individually reported benefits in complication rates, with meta‐analyses for overall complications demonstrating significant benefit: multimodal (risk difference −0·1 (95 per cent c.i. −0·18 to −0·02); P = 0·01, I2 = 18 per cent) and nutrition (risk difference −0·18 (−0·26 to −0·10); P < 0·001, I2 = 0 per cent). Seven studies reported reductions in length of hospital stay, with no differences on meta‐analysis. Conclusion The conclusions of this review are limited by the quality of the included studies, and the heterogeneity of interventions and outcome measures reported. Exercise, nutritional and multimodal prehabilitation may reduce morbidity after abdominal surgery, but data specific to older patients are sparse

    РЕАКТОРНЫЕ И ПОСЛЕРЕАКТОРНЫЕ ИСПЫТАНИЯ И ИССЛЕДОВАНИЯ НА БЫСТРЫХ КРИТИЧЕСКИХ СБОРКАХ ВЫСОКОПЛОТНОГО НИЗКООБОГАЩЕННОГО УРАН-ЦИРКОНИЕВОГО КАРБОНИТРИДНОГО ТОПЛИВА

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    UZrCN fuel is a high-density, high-temperature fuel that has potential for application in different type reactors. In the past, reactor tests using UZrCN HEU (96% U-235) fuel have been performed to low burnup. However, reactor-testing data are still needed at high burnup to confirm the optimal performance of this-type fuel. The SM-3 research reactor, which is a high-flux reactor located at the State Scientific Center – Research Institute of Atomic Reactors, Dimitrovgrad, Russia, will be used to test a UZrCN LEU (19.73% U-235) fuel to ~40% of burnup. The fuel will then be examined to determine its performance during irradiation.On the “Giacint” and “Kristal” critical facilities located at the Joint Institute for Power and Nuclear Research – SOSNY of the National Academy of Sciences of Belarus, Minsk, Belarus, criticality experiments on multiplying systems modeling physical features of cores with UZrCN LEU (19.75% U-235) fuel have been prepared for use in works on fast reactors with gaseous and liquid-metal coolants. Critical assemblies represent uniform hexagonal lattices of fuel assemblies, each of which consists of 7 fuel rods and has no clad. The active fuel length is 500 mm. Clad material is stainless steel or Nb. Three types of fuel assemblies with different matrix material (air, aluminum and lead) are investigated. These are side radial, top and bottom reflectors – beryllium (internal layer) and stainless steel (external layer).This article desribes the design of the experiment that will be performed in the SM-3 reactor and discusses the results of different calculations that have been performed to show that the experiment design will meet all objectives. The description of construction and composition of critical assemblies with UZrCN fuel and the calculation results are also presented. Топливо UZrCN представляет собой высокоплотное высокотемпературное топливо, которое может применяться в реакторах различных типов. В прошлом реакторные испытания ВОУ (96% U-235) UzrCN-топлива были выполнены только с низким выгоранием. Вместе с тем данные реакторных испытаний необходимы при высоком выгорании для подтверждения оптимальных характеристик этого типа топлива. Высокопоточный исследовательский реактор СМ-3, расположенный в Государственном научном центре – Научно-исследовательский институт атомных реакторов (г. Димитровград, Россия), будет использоваться для испытания НОУ (19,73% U-235) UzrCN-топлива до ~40 % выгорания. Затем топливо будет исследоваться для определения его характеристик после облучения.На критических стендах «Гиацинт» и «Кристал» в Объединенном институте энергетических и ядерных исследований – Сосны Национальной академии наук Беларуси (г. Минск, Беларусь) осуществляется подготовка к экспериментам по критичности на размножающих системах, моделирующих физические особенности активных зон с НОУ (19,75% U-235) UzrCN-топливом для использования в работах по новому поколению быстрых реакторов с газообразными и жидкометаллическими теплоносителями. Критические сборки представляют собой однородные гексагональные решетки топливных сборок, каждая из которых состоит из семи топливных стержней и не имеет оболочки. Длина активной части топливного стержня составляет 500 мм. Материал оболочки – нержавеющая сталь или ниобий. Будут исследованы три типа топливных сборок с различным материалом матрицы в них (воздух, алюминий и свинец). Боковой радиальный, верхние и нижние отражатели – бериллий (внутренний слой) и нержавеющая сталь (внешний слой).В настоящей статье описываются проектные данные эксперимента, который будет осуществлен на реакторе СМ-3, и обсуждаются результаты расчетов, призванные показать, что эксперимент будет отвечать всем поставленным целям. Также представлены описания конструкции и состава критических сборок с топливом UZrCN и результаты их расчетов.

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