Temporary Ileostomy Versus Temporary Colostomy: A Meta-analysis of Complications

ObjectiveTo compare the complications of temporary diverting ileostomy with those of temporary colostomy for patients with colorectal diseases.MethodsTwo independent researchers conducted a systematic search for randomized controlled trials (RCTs) comparing temporary ileostomy with temporary colostomy in MEDLINE, the Cochrane database, evidence-based medicine reviews and the American College of Physicians journal club, as well as relevant reference lists in journal articles. Five RCTs were found and included in this meta-analysis. All complications were abstracted and compared between groups. All complications were also assessed using tests of statistical heterogeneity, pooling of risk ratios using Mantel-Haenszel fixed effects and DerSimonian and Laird random effects. Clinical heterogeneity was investigated by examining the methodology and selection of patients described in each trial.ResultsTemporary colostomy was significantly more likely to cause stoma complications in colorectal cancer patients undergoing elective resections, and also more likely to cause infectious and wound complications. Temporary ileostomy tended to cause more post-closure surgical complications.ConclusionsThere is not yet a strong case for the superiority of one temporary diverting stoma over another for all colorectal patients. In this regard, a large, well-conducted RCT is still needed

Fibroadenoma versus phyllodes tumor: distinguishing factors in patients diagnosed with fibroepithelial lesions after a core needle biopsy

PURPOSEWe aimed to identify factors that might help differentiate phyllodes tumors from fibroadenomas among cases in which a fibroepithelial breast lesion was diagnosed from core needle biopsy (CNB) under imaging guidance. MATERIALS AND METHODSA retrospective review was performed on 213 lesions in 200 patients who had undergone both CNB and excisional biopsy during a four-year period between 2008 and 2011. The final pathology revealed 173 fibroadenomas and 40 phyllodes tumors. The data, including patient characteristics, clinical presentation, and mammography, ultrasonography (US), and pathology findings were analyzed. RESULTSUpon univariable analysis, the factors that significantly helped to identify phyllodes tumors consisted of the presenting symptoms (palpable mass or breast pain), increased size on clinical examination, hyperdense mass on mammogram, and the following three US features: heterogeneous echo, presence of round cysts within the mass, and presence of clefts within the mass. The pathologist’s suggestion of a phyllodes tumor was also helpful. The factors that remained statistically significant upon multivariable analysis consisted of symptoms of breast pain, the presence of clefts on US, the presence of round cysts on US and the pathologist’s favoring of phyllodes tumors from a CNB specimen. CONCLUSIONA multidisciplinary approach was needed to distinguish phyllodes tumors from fibroadenomas in patients who had undergone CNB. US findings (clefts and round cysts), suggestive pathological diagnoses, and clinical symptoms were all useful for the decision to surgically remove the fibroepithelial lesions diagnosed from CNB

Upgrading rate of papillary breast lesions diagnosed by core-needle biopsy

PURPOSEWe aimed to estimate the upgrading rate of core-needle biopsy (CNB)-diagnosed papillary breast lesions to atypical or malignant papillary lesions on subsequent surgery.MATERIALS AND METHODSWe performed a retrospective review of medical records and imaging findings of patients diagnosed by CNB as having papillary lesions from January 1, 2005 to May 31, 2011. Outcomes were determined by pathology findings from surgical excision or by imaging findings at 12 months follow-up.RESULTSOf 130 papillary lesions in 127 patients, the upgrading rates were 0% for benign papillary lesion to malignancy, 19% for benign papillary lesion to atypical papillary lesion, and 31% for atypical lesion to malignancy. Most of the malignancies were ductal carcinoma in situ. The presence of malignant lesions was related to specific symptoms (palpable mass or nipple discharge; P = 0.020) and to a higher Breast Imaging Reporting and Data System (BIRADS) category (P = 0.017).CONCLUSIONCNB is accurate in the diagnosis of benign papillary lesions. If no atypical cells are present, no malignancy is found. The presence of atypia on CNB strongly indicates a need for surgical excision

Follow-up of Long-term Treatment with Clean Intermittent Catheterization for Neurogenic Bladder in Children

To assess the results of long-term clean intermittent catheterization (CIC) treatment for neurogenic bladder in children born with myelomeningocele, and to compare the long-term results between the early treatment group ( 3 years old). Methods: Thirty-six paediatric patients with myelomeningocele who were treated in the first year of life (Group 1) and 31 cases who were treated after the age of 3 years (Group 2) were followed regularly for at least 11 years. All medical records were reviewed and long-term results of treatment, including increases in blood urea nitrogen (BUN) and serum creatinine, development of hydronephrosis, recurrent upper urinary tract infection, and the number of augmentation cystoplasties needed, were noted. Kaplan-Meier methods were used to analyse time-to-event data. Results: Mean age at start of treatment was 6.88 months (range, 3-11 months) in Group 1 and 44.97 months (range, 37-60 months) in Group 2. Increases in BUN and serum creatinine were found in 12 cases (33.3%) in Group 1 and 19 cases (61.3%) in Group 2. Patients in Group 2 showed earlier renal deterioration and worse renal function at the last follow-up. Hydronephrosis was found in 10 cases (27.8%) in Group 1 and 18 cases (58.1%) in Group 2. Patients in Group 2 also had earlier and more severe hydronephrosis. Augmentation cystoplasty was needed in five cases (13.9%) in Group 1 and 10 cases (32.3%) in Group 2. The results of surgery were better in Group 1 than in Group 2, and surgery was needed earlier in Group 2 compared with Group 1. There was no significant difference regarding upper urinary tract infection between the two groups. Conclusions: For most patients and with close long-term follow-up, early treatment of neurogenic bladder using CIC in children born with myelomeningocele yields better results than late treatment. In our experience, treatment is recommended as soon as possible, especially during the first year of life

Tangidesk: a Tangible Interface Prototype for Urban Design and Planning

This paper describes the design and implementation of TangiDESK, a tangible interface prototype to assist in the design and planning of urban design projects. The prototype derives from the need for an intuitive user interface similar to a designeris or architectis CAD system but also simple enough for non-designers like city planners and developers who are not accustomed to CAD interfaces to use and understand easily. Users can manipulate the objects or modify its relationship with other elements in the site while making preliminary design decisions together in a single environment. With TangiDESK, designers and planners can collaborate and make informative decisions more effectively and accurately in early stages of an urban design project

Bladder substitution by ileal neobladder for women with interstitial cystitis

OBJECTIVE: To report our experience with cystectomy and ileal neobladder for women with interstitial cystitis (IC). MATERIALS AND METHODS: Thirty-five female patients treated during 2000-2005 with the mean age of 45.9 ± 4.4 years were included in this study. All of them had experience suprapubic pain with irritative voiding symptoms and were diagnosed as having IC based on NIDDK criteria for at least 2 years. Conservative treatments had failed to relieve their symptoms; and therefore all of them agreed to undergo a bladder removal. For cystectomy, the urethra was cut 0.5 cm below the bladder neck, proximal to the pubourethral ligament, leaving the endopelvic fascia intact. An ileal segment of 65 cm was used to create the neobladder with the Studer's technique. RESULTS: All patients presented good treatment outcome with regard to both diurnal and nocturnal urinary control without any pain. Quality of life using the SF-36 questionnaire showed significant improvement of both physical health and mental health. Spontaneous voiding with minimal residual urine was found in 33 cases (94.3%), and the remaining 2 cases (5.7%) had spontaneous voiding with residual urine and were placed on clean intermittent catheterization (CIC). Twelve out of 30 cases with sexually active ability had a mild degree of dyspareunia but without disturbance to sexual life. CONCLUSION: Bladder substitution by ileal neobladder for women who suffer from IC can be a satisfactory option after failure of conservative treatment. Resection of the urethra distal to the bladder neck can preserve continence and allow spontaneous voiding in almost all patients

3D Syllabus: Interactive Visualization of Indexes to Multimedia Training Content

Abstract. Indexes such as bookmarks and recommendations are helpful for accessing multimedia documents. This paper describes the 3D Syllabus system, which is designed to visualize indexes to multimedia training content along with the information structures. A double-sided landscape with balloons and cubes represents the personal and group indexes, respectively. The 2D ground plane organizes the indexes as a table and the third dimension of height indicates their importance scores. Additional visual properties of the balloons and cubes provide other information about the indexes and their content. Paths are represented by pipes connecting the balloons. A preliminary evaluation of the 3D Syllabus prototype suggests that it is more efficient than a typical training CD-ROM and is more enjoyable to use.