Treatment Options for Perforated Colonic Diverticular Disease

Diverticular disease is one of the most common diseases of the gastrointestinal (GI) tract requiring in-hospital treatment in Western countries. Despite its high incidence, controversies remain about the optimal treatment of the different stages of this disease. Most people with diverticular disease remain asymptomatic; however, approximately 15% develop symptoms, and of these, 15% will develop significant complications such as perforation [1]. Although the absolute prevalence of perforated diverticulitis (PD) complicated by generalized peritonitis is low, its importance lies in the significant postoperative mortality rate, ranging from 4–26% [2–4]. Owing to the low prevalence of generalized peritonitis due to PD (GPPD), strategies for the treatment of this stage of diverticulitis are even less thoroughly investigated. There are two major reasons for this...

New Approaches to the Surgical Treatment of Intra-abdominal Infection

Buikpijn is een veel voorkomende reden van presentatie op de spoedeisende hulp. In ongeveer de helft van de gevallen betreft het buikpijn ten gevolge van een infectie. Een dergelijke infectie kan aanleiding geven tot peritonitis; inflammatoire reactie van het lichaam binnen het abdomen. Dit proefschrift richt zich op de behandeling van intra-abdominale infecties en complicaties volgend op intra-abdominale infecties. Een van de meest voorkomende oorzaken van abdominale infecties is diverticulitis. Divertikel ziekte leidt in Nederland tot 18.000 ziekenhuisopnames per jaar. De ziekte komt voor in verschillende verschijningen: van asymptomische diverticulose tot geperforeerde diverticulitis met systemische sepsis. Om een goede inschatting van de ernst van de ziekte te kunnen maken wordt in de meeste patiënten verdacht voor diverticulitis aanvullend onderzoek verricht. De eerste keus is hierbij echografisch onderzoek. Indien deze niet conclusief is of verdacht voor gecompliceerde diverticulitis wordt een CT-scan geadviseerd. Classificatie van de ernst van de ziekte op basis van de Hinchey classificatie blijkt een diagnostische accuraatheid tussen de 71 en 92% te hebben. Daarom adviseren wij een nieuw gradatie systeem om richting te geven aan de behandeling van diverticulitis. De chirurgische behandeling van diverticulitis bestaat van oudsher uit een sigmoidresectie met eindstandig colostoma of met directe anastomose. Een minder invasieve behandeling middels laparoscopische lavage (spoelen van de buikholte) is onderzocht in de gerandomiseerde Ladies trial. In de LOLA arm werd de laparoscopische lavage vergeleken met een sigmoidresectie. Deze studie toonde dat er geen voordeel is van lavage op het primaire eindpunt van ernstige morbiditeit en mortaliteit. In geval van geperforeerde diverticulitis is er een verhoogde kans op ontwikkelen van hernia cicatricalis. In enkele dierexperimenten werden synthetische en biologische meshes onderzocht op infectieuze complicaties, adhesie vorming en ingroei na implantatie in schone en gecontamineerde omgeving. Er werden significant meer mesh infecties gevonden na implantatie van gecrosslinkte biomeshes en de synthetische meshes C-Qur en Dualmesh. Ingroei van biologische meshes in de buikwand varieerde tussen de 0 en 39%. Opvallend was de complete verdwijning van Surgisis meshes. De slechte ingroei, hoge percentage meshinfecties en complete verdwijning maakt lange termijn biomechanische kracht van hernia herstel met behulp van biologische meshes twijfelachtig

Temporal Interpolation of Dynamic Digital Humans using Convolutional Neural Networks

In recent years, there has been an increased interest in point cloud representation for visualizing digital humans in cross reality. However, due to their voluminous size, point clouds require high bandwidth to be transmitted. In this paper, we propose a temporal interpolation architecture capable of increasing the temporal resolution of dynamic digital humans, represented using point clouds. With this technique, bandwidth savings can be achieved by transmitting dynamic point clouds in a lower temporal resolution, and recreating a higher temporal resolution on the receiving side. Our interpolation architecture works by first downsampling the point clouds to a lower spatial resolution, then estimating scene flow using a newly designed neural network architecture, and finally upsampling the result back to the original spatial resolution. To improve the smoothness of the results, we additionally apply a novel technique called neighbour snapping. To be able to train and test our newly designed network, we created a synthetic point cloud data set of animated human bodies. Results from the evaluation of our architecture through a small-scale user study show the benefits of our method with respect to the state of the art in scene flow estimation for point clouds. Moreover, correlation between our user study and existing objective quality metrics confirm the need for new metrics to accurately predict the visual quality of point cloud contents

Preoperative staging of perforated diverticulitis by computed tomography scanning

Background: Treatment of perforated diverticulitis depends on disease severity classified according to Hinchey's preoperative classification. This study assessed the accuracy of preoperative staging of perforated diverticulitis by computerized tomography (CT) scanning. Methods: All patients who presented with perforated diverticulitis between 1999 and 2009 in two teaching hospitals of Rotterdam, the Netherlands, and in addition had a preoperative CT scan with

Low agreement between cardiologists diagnosing left ventricular hypertrophy in children with end-stage renal disease

Background: Monitoring of the appearance of left ventricular hypertrophy (LVH) by echocardiography is currently recommended for in the management of children with End-stage renal disease (ESRD). In order to investigate the validity of this method in ESRD children, we assessed the intra- and inter-observer reproducibility of the diagnosis LVH. Methods. Echocardiographic measurements in 92 children (0-18 years) with ESRD, made by original analysists, were reassessed offline, twice, by 3 independent observers. Smallest detectable changes (SDC) were calculated for continuous measurements of diastolic interventricular septum (IVSd), Left ventricle posterior wall thickness (LVPWd), Left ventricle end-diastolic diameter (LVEDd), and Left ventricle mass index (LVMI). Cohen's kappa was calculated to assess the reproducibility of LVH defined in two different ways. LVHWT was defined as Z-value of IVSd and/or LVPWd>2 and LVHMI was defined as LVMI> 103 g/m 2 for boys and >84 g/m2 for girls. Results: The intra-observer SDCs ranged from 1.6 to 1.7 mm, 2.0 to 2.6 mm and 17.7 to 30.5 g/m2 for IVSd, LVPWd and LVMI, respectively. The inter-observer SDCs were 2.6 mm, 2.9 mm and 24.6 g/m2 for IVSd, LVPWd and LVMI, respectively. Depending on the observer, the prevalence of LVHWT and LVHMI ranged from 2 to 30% and from 8 to 25%, respectively. Kappas ranged from 0.4 to 1.0 and from 0.1 to 0.5, for intra-and inter- observer reproducibility, respectively. Conclusions: Changes in diastolic wall thickness of less than 1.6 mm or LVMI less than 17.7 g/m2 cannot be distinguished from measurement error in individual children, even when measured by the same observer. This limits the use of echocardiography to detect changes in wall thickness in children with ESRD in routine practice

Effects of new anti-adhesion polyvinyl alcohol gel on healing of colon anastomoses in rats

Background: Adhesions follow abdominal surgery with an incidence as high as 95%, resulting in invalidating complications such as bowel obstruction, female infertility, and chronic pain. Searches have been performed for a safe and effective adhesion barrier; however, such barriers have impaired anastomotic site healing. The primary aim of this study was to investigate the effect of a new adhesion barrier, polyvinyl alcohol gel, on healing of colonic anastomoses using a rat model. Methods: Thirty-two Wistar rats were divided in two groups. In all animals, an anastomosis was constructed in the ascending colon. The first group received no adhesion barrier, whereas in the second group, 2mL of polyvinyl alcohol gel (A-Part Gel®; Aesculap AG, Tuttlingen, Germany) was applied circularly around the anastomosis. All animals were sacrificed on the seventh post-operative day, and the abdomen was inspected for signs of anastomotic leakage. The anastomotic bursting pressure, the adhesions around the anastomosis, and the collagen content of the excised anastomosis were measured. Results: No significant differences were observed between the two groups in the incidence of anastomotic leakage, the anastomotic bursting pressure (p=0.08), or the collagen concentration (p=0.91). No significant reduction in amount of adhesions was observed in the rats receiving polyvinyl alcohol gel. Conclusions: This experimental study showed no significant differences in anastomotic leakage, anastomotic bursting pressure, or collagen content of the anastomosis when using the adhesion barrier polyvinyl alcohol around colonic anastomoses. The barrier did not prevent adhesion formation

The Amsterdam studies of acute psychiatry I (ASAP-I); A prospective cohort study of determinants and outcome of coercive versus voluntary treatment interventions in a metropolitan area

Background: The overall number of involuntary admissions is increasing in many European countries. Patients with severe mental illnesses more often progress to stages in which acute, coercive treatment is warranted. The number of studies that have examined this development and possible consequences in terms of optimizing health care delivery in emergency psychiatry is small and have a number of methodological shortcomings. The current study seeks to examine factors associated with compulsory admissions in the Amsterdam region, taking into account a comprehensive model with four groups of predictors: patient vulnerability, social support, responsiveness of the health care system and treatment adherence. Methods/Design: This paper describes the design of the Amsterdam Study of Acute Psychiatry-I (ASAP-I). The study is a prospective cohort study, with one and two-year follow-up, comparing patients with and without forced admission by means of a selected nested case-control design. An estimated total number of 4,600 patients, aged 18 years and over, consecutively coming into contact with the Psychiatric Emergency Service Amsterdam (PESA) are included in the study. From this cohort, a randomly selected group of 125 involuntary admitted subjects and 125 subjects receiving non-coercive treatment are selected for further evaluation and comparison. First, socio-demographic, psychopathological and network characteristics, and prior use of health services will be described for all patients who come into contact with PESA. Second, the in-depth study of compulsory versus voluntary patients will examine which patient characteristics are associated with acute compulsory admission, also taking into account social network and healthcare variables. The third focus of the study is on the associations between patient vulnerability, social support, healthcare characteristics and treatment adherence in a two-year follow-up for patients with or without involuntarily admittance at the index consultation. Discussion: The current study seeks to establish a picture of the determinants of acute compulsory admissions in the Netherlands and tries to gain a better understanding of the association with the course of illness and patient's perception of services and treatment adherence. The final aim is to find specific patient and health care factors that can be influenced by adjusting treatment programs in order to reduce the number of involuntary admissions