Sclerotherapy for the management of rectal prolapse in children

Purpose Rectal prolapse is a commonly occurring and usually self-limited process in children. Surgical management is indicated for failures of conservative management. However, the optimal approach is unknown. The purpose of this study is to determine the efficacy of sclerotherapy for the management of rectal prolapse. Methods This was a retrospective review of children < 18 years with rectal prolapse who underwent sclerotherapy, predominantly with peanut oil (91%), between 1998 and 2015. Patients with imperforate anus or cloaca abnormalities, Hirschprung disease, or prior pull-through procedures were excluded. Results Fifty-seven patients were included with a median age of 4.9 years (interquartile range (IQR) 3.2–9.2) and median follow-up of 52 months (IQR 8–91). Twenty patients (n = 20/57; 35%) recurred at a median of 1.6 months (IQR 0.8–3.6). Only 3 patients experienced recurrence after 4 months. Nine of the patients who recurred (n = 9/20; 45%) were re-treated with sclerotherapy. This was successful in 5 patients (n = 5/9; 56%). Two patients (n = 2/20; 10%) experienced a mucosal recurrence which resolved with conservative management. Forty-four patients were thus cured with sclerotherapy alone (n = 44/57; 77%). No patients undergoing sclerotherapy had an adverse event. Thirteen patients (n = 13/20; 65%) underwent rectopexy after failing at least one treatment of sclerotherapy. Three of these patients (n = 3/13; 23%) recurred following rectopexy and required an additional operation. Conclusions Injection sclerotherapy for children with rectal prolapse resulted in a durable cure of prolapse in most children. Patients who recur following sclerotherapy tend to recur within 4 months. Another attempt at sclerotherapy following recurrence is reasonable and was successful half of the time. Sclerotherapy should be the preferred initial treatment for rectal prolapse in children and for the initial treatment of recurrence

Gender Differences in Academic Surgery, Work-Life Balance, and Satisfaction

Background An increasing number of women are pursuing a career in surgery. Concurrently, the percentage of surgeons in dual-profession partnerships is increasing. We sought to evaluate the gender differences in professional advancement, work-life balance, and satisfaction at a large academic center. Materials and methods All surgical trainees and faculty at a single academic medical center were surveyed. Collected variables included gender, academic rank, marital status, family size, division of household responsibilities, and career satisfaction. Student t-test, Fisher's exact test, and chi-square test were used to compare results. Results There were 127 faculty and 116 trainee respondents (>80% response rate). Respondents were mostly male (77% of faculty, 58% of trainees). Women were more likely than men to be married to a professional (90% versus 37%, for faculty; 82% versus 41% for trainees, P < 0.001 for both) who was working full time (P < 0.001) and were less likely to be on tenure track (P = 0.002). Women faculty were more likely to be primarily responsible for childcare planning (P < 0.001), meal planning (P < 0.001), grocery shopping (P < 0.001), and vacation planning (P = 0.003). Gender-neutral responsibilities included financial planning (P = 0.04) and monthly bill payment (P = 0.03). Gender differences in division of household responsibilities were similar in surgical trainees except for childcare planning, which was a shared responsibility. Conclusions Women surgeons are more likely to be partnered with a full-time working spouse and to be primarily responsible for managing their households. Additional consideration for improvement in recruitment and retention strategies for surgeons might address barriers to equalizing these gender disparities

EAES and SAGES 2018 consensus conference on acute diverticulitis management:evidence-based recommendations for clinical practice

Background Acute diverticulitis (AD) presents a unique diagnostic and therapeutic challenge for general surgeons. This collaborative project between EAES and SAGES aimed to summarize recent evidence and draw statements of recommendation to guide our members on comprehensive AD management. Methods Systematic reviews of the literature were conducted across six AD topics by an international steering group including experts from both societies. Topics encompassed the epidemiology, diagnosis, management of non-complicated and complicated AD as well as emergency and elective operative AD management. Consensus statements and recommendations were generated, and the quality of the evidence and recommendation strength rated with the GRADE system. Modified Delphi methodology was used to reach consensus among experts prior to surveying the EAES and SAGES membership on the recommendations and likelihood to impact their practice. Results were presented at both EAES and SAGES annual meetings with live re-voting carried out for recommendations with < 70% agreement. Results A total of 51 consensus statements and 41 recommendations across all six topics were agreed upon by the experts and submitted for members’ online voting. Based on 1004 complete surveys and over 300 live votes at the SAGES and EAES Diverticulitis Consensus Conference (DCC), consensus was achieved for 97.6% (40/41) of recommendations with 92% (38/41) agreement on the likelihood that these recommendations would change practice if not already applied. Areas of persistent disagreement included the selective use of imaging to guide AD diagnosis, recommendations against antibiotics in non-complicated AD, and routine colonic evaluation after resolution of non-complicated diverticulitis. Conclusion This joint EAES and SAGES consensus conference updates clinicians on the current evidence and provides a set of recommendations that can guide clinical AD management practice

Onset of mortality increase with age and age trajectories of mortality from all diseases in the four Nordic countries

Josef Dolejs,1 Petra Mare&scaron;ov&aacute;2 1Department of Informatics and Quantitative Methods, 2Department of Economics, Faculty of Informatics and Management, University of Hradec Kr&aacute;lov&eacute;, Hradec Kr&aacute;lov&eacute;, Czech Republic Background: The answer to the question &ldquo;At what age does aging begin?&rdquo; is tightly related to the question &ldquo;Where is the onset of mortality increase with age?&rdquo; Age affects mortality rates from all diseases differently than it affects mortality rates from nonbiological causes. Mortality increase with age in adult populations has been modeled by many authors, and little attention has been given to mortality decrease with age after birth.Materials and methods: Nonbiological causes are excluded, and the category &ldquo;all diseases&rdquo; is studied. It is analyzed in Denmark, Finland, Norway, and Sweden during the period 1994&ndash;2011, and all possible models are screened. Age trajectories of mortality are analyzed separately: before the age category where mortality reaches its minimal value and after the age category.Results: Resulting age trajectories from all diseases showed a strong minimum, which was hidden in total mortality. The inverse proportion between mortality and age fitted in 54 of 58 cases before mortality minimum. The Gompertz model with two parameters fitted as mortality increased with age in 17 of 58 cases after mortality minimum, and the Gompertz model with a small positive quadratic term fitted data in the remaining 41 cases. The mean age where mortality reached minimal value was 8 (95% confidence interval 7.05&ndash;8.95) years. The figures depict an age where the human population has a minimal risk of death from biological causes.Conclusion: Inverse proportion and the Gompertz model fitted data on both sides of the mortality minimum, and three parameters determined the shape of the age&ndash;mortality trajectory. Life expectancy should be determined by the two standard Gompertz parameters and also by the single parameter in the model c/x. All-disease mortality represents an alternative tool to study the impact of age. All results are based on published data. Keywords: mortality, age, all diseases, external causes, Nordic countrie

Economic analysis of acupuncture for migraine prophylaxis

Jitka Pokladnikova,1,2 Petra Maresova,3 Josef Dolejs,3 A-La Park,4 Bo Wang,5 Xin Guan,5&nbsp;Frantisek Musil1 1Czech-Chinese Centre for Traditional Chinese Medicine, University Hospital in Hradec Kralove, Hradec Kralove, Czech Republic; 2Faculty of Pharmacy in Hradec Kralove, Charles University, Hradec Kralove, Czech Republic; 3Faculty of Informatics and Management, University of Hradec Kralove, Hradec Kralove, Czech Republic; 4Personal Social Services Research Unit, Department of Health Policy, London School of Economics and Political Science, London, UK; 5Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China Background: Acupuncture has become a viable option for migraine prophylaxis in Europe; however, despite its wide use, more data on the short- and long-term cost-effectiveness are needed when considering the perspectives of a paying third-party, the patient, and of society in general. The aim was to evaluate the cost and effectiveness of adjuvant acupuncture to pharmacologic treatment vs pharmacologic treatment alone in migraine patients after a 3-month acupuncture course and a 6-month follow-up from all perspectives.Methods: The study involved an open-label randomized clinical trial of patients receiving acupuncture (n=42), and a waiting list control group (n=44). The number of migraine days during the last 28 days, as well as direct and indirect costs were considered. The trial was registered under DRKS00009803.Results: The total cost per patient reached &euro;696 vs &euro;285 after 3 months of acupuncture and &euro;66 vs &euro;132 in the acupuncture and control groups after a 6-month follow-up, respectively (P=0.071). The trends observed in effectiveness and costs from all perspectives are discussed.Conclusion: The inclusion of acupuncture in health care results beneficial mainly for its observed trend in reduced losses of productivity and income, with the latter often exceeding the costs of acupuncture treatment. As such, acupuncture may be recommended as an adjuvant treatment in migraine prophylaxis to standard pharmacotherapy. Keywords: acupuncture, cost, effectiveness, migraine, prophylaxis, Traditional Chinese Medicin

Sexual Harassment and Cardiothoracic Surgery: #UsToo?

Background Fifty-eight percent of women in science, engineering, and medicine report being affected by sexual harassment (SH). This study sought to determine the extent of SH in cardiothoracic surgery. Methods The study developed a survey that was based on the Sexual Experience Questionnaire-Workplace, physician wellness, and burnout surveys. The survey was open to responses for 45 days and was disseminated through The Society of Thoracic Surgeons, Women in Thoracic Surgery, and Thoracic Surgery Residents Association listservs. A reminder email was issued at 28 days. Student t tests, Fisher exact tests, and χ2 tests were used to compare results. Results Of 790 respondents, 75% were male and 82% were attending surgeons. A total of 81% of female surgeons vs 46% of male attending surgeons experienced SH (P < .001). SH also was reported by trainees (90% female vs 32% male; P < .001). According to women, the most common offenders were supervising leaders and colleagues; for men, it was ancillary staff and colleagues. Respondents reported SH at all levels of training. A total of 75% of women surgeons vs 51% of men surgeons witnessed a colleague be subjected to SH; 89% of respondents reported the victim as female (male 2%, both 9%; P < .001). A total of 49% of female witnesses (50% of male witnesses) reported no intervention; less than 5% of respondents reported the offender to a governing board. SH was positively associated with burnout. Conclusions SH is present in cardiothoracic surgery among faculty and trainees. Although women surgeons are more commonly affected, male surgeons also are subjected to SH. Despite witnessed events, intervention currently is limited. Policies, safeguards, and bystander training should be instituted to decrease these events

Pancreatic cyst fluid glucose: rapid, inexpensive, and accurate diagnosis of mucinous pancreatic cysts

Background The most widely accepted biochemical test for preoperative differentiation of mucinous from benign, nonmucinous pancreatic cysts is cyst fluid carcinoembryonic antigen. However, the diagnostic accuracy of carcinoembryonic antigen ranges from 70% to 86%. Based on previous work, we hypothesize that pancreatic cyst fluid glucose may be an attractive alternative to carcinoembryonic antigen. Methods Pancreatic cyst fluid was collected during endoscopic or operative intervention. Diagnoses were pathologically confirmed. Glucose and carcinoembryonic antigen were measured using a patient glucometer and automated analyzer/enzyme-linked immunosorbent assay. Sensitivity, specificity, accuracy, and receiver operator characteristic analyses were performed. Results Cyst fluid samples from 153 patients were evaluated (mucinous: 25 mucinous cystic neoplasms, 77 intraductal papillary mucinous neoplasms, 4 ductal adenocarcinomas; nonmucinous: 21 serous cystic neoplasms, 9 cystic neuroendocrine tumors, 14 pseudocysts, 3 solid pseudopapillary neoplasms). Median cyst fluid glucose was lower in mucinous versus nonmucinous cysts (19 vs 96 mg/dL; P 192 ng/mL was 58% sensitive, 96% specific, and 69% accurate. Area under the curve for glucose and CEA were similar at 0.91 and 0.92. Conclusion Cyst fluid glucose has significant advantages over carcinoembryonic antigen and should be considered for use as a routine diagnostic test for pancreatic mucinous cysts