Revisiting stapled and handsewn loop ileostomy closures: a large retrospective series

OBJECTIVE: To compare the surgical outcomes of stapled and handsewn closures in loop ileostomies. METHODS: The data of 225 patients requiring loop ileostomies from 2002 to 2007 were retrospectively evaluated. The patients underwent partial small-bowel resections and either handsewn or stapled anastomoses for the ileostomy closures. They were followed up postoperatively with routine surgical examinations. RESULTS: The study group consisted of 124 men and 101 women with a mean age of 49.12 years. The ileostomy closure was performed with handsewn in 129 patients and with stapled in 96 patients. The mean time to the first postoperative flatus was 2.426 days in the handsewn group and 2.052 days in the stapled group (p <0.05). The mean time to the first postoperative defecation was 3.202 days in the handsewn group and 2.667 days in the stapled group (p <0.05). The mean duration of patient hospital stay was 8.581 days for the handsewn group and 6.063 days for the stapled group (p <0.05). CONCLUSIONS: Patients who underwent ileostomy closure with stapled recovered faster in the postoperative period and required shorter hospital stays than those whose closures were performed with handsewn. In our opinion, stapled should be considered the gold standard for loop ileostomy closure

Clinical Study Parameters That May Be Used for Predicting Failure during Endoscopic Retrograde Cholangiopancreatography

Aim. Endoscopic retrograde cholangiopancreatography (ERCP) is frequently used for the diagnosis and treatment of hepatic, biliary tract, and pancreatic disorders. However, failure during cannulation necessitates other interventions. The aim of this study was to establish parameters that can be used to predict failure during ERCP. Methods. A total of 5884 ERCP procedures performed on 5079 patients, between 1991 and 2006, were retrospectively evaluated. Results. Cannulation was possible in 4482 (88.2%) patients. For each one-year increase in age, the cannulation failure rate increased by 1.01-fold ( = 0.002). A history of previous hepatic biliary tract surgery caused the cannulation failure rate to decrease by 0.487-fold ( &lt; 0.001). A tumor infiltrating the ampulla, the presence of pathology obstructing the gastrointestinal passage, and peptic ulcer increased the failure rate by 78-, 28-, and 3.47-fold, respectively ( &lt; 0.001). Conclusions.Patient gender and duodenal diverticula do not influence the success of cannulation during ERCP. Billroth II and Roux-en-Y gastrojejunostomy surgeries, a benign or malignant obstruction of the gastrointestinal system, and duodenal ulcers decrease the cannulation success rate, whereas a history of previous hepatic biliary tract surgery increases it. Although all endoscopists had equal levels of experience, statistically significant differences were detected among them

Renal complications of lipodystrophy: A closer look at the natural history of kidney disease

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/144612/1/cen13732_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/144612/2/cen13732.pd

Analysis of the common genetic component of large-vessel vasculitides through a meta- Immunochip strategy

Giant cell arteritis (GCA) and Takayasu's arteritis (TAK) are major forms of large-vessel vasculitis (LVV) that share clinical features. To evaluate their genetic similarities, we analysed Immunochip genotyping data from 1,434 LVV patients and 3,814 unaffected controls. Genetic pleiotropy was also estimated. The HLA region harboured the main disease-specific associations. GCA was mostly associated with class II genes (HLA-DRB1/HLA-DQA1) whereas TAK was mostly associated with class I genes (HLA-B/MICA). Both the statistical significance and effect size of the HLA signals were considerably reduced in the cross-disease meta-analysis in comparison with the analysis of GCA and TAK separately. Consequently, no significant genetic correlation between these two diseases was observed when HLA variants were tested. Outside the HLA region, only one polymorphism located nearby the IL12B gene surpassed the study-wide significance threshold in the meta-analysis of the discovery datasets (rs755374, P?=?7.54E-07; ORGCA?=?1.19, ORTAK?=?1.50). This marker was confirmed as novel GCA risk factor using four additional cohorts (PGCA?=?5.52E-04, ORGCA?=?1.16). Taken together, our results provide evidence of strong genetic differences between GCA and TAK in the HLA. Outside this region, common susceptibility factors were suggested, especially within the IL12B locus

Psychodynamic formulation in borderline personality disorder: A case study

Psychodynamic case formulation examines how symptoms of the patient appeared and constitutes a useful guideline for clinicians because it examines the level of object relations, ego strength, mental capacity, and core conflict, plans the treatment, and predicts prognosis. Borderline personality disorder (BPD) cases display symptoms characterized by dramatic life history, impulsivity, relationship problems, and unstable moods and behaviors. These unstable and multiple symptoms affect the clinical appearance and treatment response of the disorder. People with BPD build up intense transference and countertransference responses and are often perceived as “difficult patients” by healthcare professionals and nurses who spend the most time with these patients in inpatient services. Therefore, psychodynamic formulation is particularly necessary and useful in BPD cases to understand the patient better and manage the treatment processes. The case presented here reported complaints including mood swings, feelings of emptiness, inability to go to school, bursts of rage, self-injurious behaviors, and suicidal thoughts and attempts. Her expectations from treatment were to control her anger, express herself, be strong in bilateral relationships, and be a normal person. A psychodynamic formulation was done in company with the supervision and the case was diagnosed with BPD. Formulating BPD cases in terms of a psychodynamic perspective may provide more information on thoughts, emotions, and behaviors of the patients. In this study, through the information obtained using psychodynamic interview techniques, impulse, affectivity, mood characteristics, defense mechanisms, selfdom, object relations, and superego of the BPD diagnosed case are discussed. © 2019, Kare Publishing. All rights reserved

Surgical treatment of abdominal aortic aneurysms associated with horseshoe kidney

Abdominal aortic aneurysm surgery associated with a horseshoe kidney (HSK) is a serious technical challenge for the surgeon. We reviewed our experience with 127 patients electively operated on between 1990 and 2004 for abdominal aortic aneurysm. Pre- and perioperative medical, surgical, and radiologic data were retrospectively reviewed. Preoperative diagnosis was achieved with computed tomography with or without angiography or with additional conventional aortography

Prevalence of BRAF Mutation in Papillary Thyroid Cancer

Objectives: Papillary thyroid cancer (PTC) is the most common endocrine malignancy and the most common genetic anomaly with PTC is the BRAF V600E mutation. This mutation is linked to many clinical and pathological features and may have a diagnostic and therapeutic role especially in the era of targeted therapy. The aim of this study is to review the prevalence of BRAF V600E mutation in PTC, its distribution according to the histological subtype and geographic area and its association with the age of patients, gender, subtype and recurrence of tumors. Methods: The Pubmed database was searched to look for articles about BRAF mutation in PTC. Outcomes of interest included prevalence, age, gender, country, subtype and recurrence. Results: The prevalence of BRAF V600E mutation in PTC was 47%, with noticeably higher prevalence in the eastern countries. The prevalence of BRAF V600E was also higher in the tall and classic subtypes and could be associated with worse prognosis and higher risk of recurrence. Conclusions: The BRAF mutation, which is more prevalent in the eastern countries, is determined to be an important molecular marker for PTC

Surgical Approach to Extensive Hidradenitis Suppurativa in the Perineal/Perianal and Gluteal Regions

Verneuil's disease, or hidradenitis suppurativa, is a chronic suppurative disease with a tendency to sinus formation, fibrosis, and sclerosis. It is a disease of the apocrine sweat glands and may arise from each of the localizations where apocrine glands are prominent: axilla, nipples, umbilicus, perineum, groin, and buttocks. Extensive hidradenitis suppurativa of the perineal/perianal and the gluteal regions constitute a serious social problem. In this study, we present our experience with stage III extensive hidradenitis suppurativa cases, including our treatment methods and patient outcomes

Revisiting stapled and handsewn loop ileostomy closures: a large retrospective series

OBJECTIVE: To compare the surgical outcomes of stapled and handsewn closures in loop ileostomies