Clinical and manometric postoperative evaluation of posterior sagital anorectoplasty (PSARP) in patients with upper and intermediate anorectal malformations

PSARP is currently the most widely-used surgical technique for surgical correction of high and intermediary anorectal malformations, but there is much controversy in the literature about the postoperative evaluation of these cases. We studied 27 cases of anorectal malformations operated with PSARP from clinical and manometric aspects in order to analyze: 1) fecal continence; 2) the relationship between fecal continence and the associated sacral anomalies and; 3) the relationship between the postoperative manometric evaluation and fecal continence. From the analysis of 27 cases of high and intermediary anorectal malformations, we concluded that: 1) fecal continence was achieved in 48.14 percent of the cases; partial fecal continence in 25.92 percent; and fecal incontinence in 25.92 percent of the cases; 2) the presence of fecal incontinence was directly related to the association of sacral anomalies and; 3) anorectal manometry is a useful test to evaluate the patients operated by PSARP, due to the existence of a relationship between the manometric results and the degree of fecal continence.A anorretoplastia sagital posterior (ARPSP) é o procedimento cirúrgico mais utilizado atualmente para a correção das anomalias anorretais altas e intermediárias. Existe muita controvérsia na literatura a respeito da avaliação pós-operatória desses pacientes. Baseado nesse fato, estudamos 27 casos de anomalias anorretais operados com a ARPSP do ponto de vista clínico e manométrico, com a finalidade de avaliar: 1. Continência fecal; 2. Relação entre a continência fecal e anomalias sacrais associadas; 3. Relação entre a avaliação manométrica pós-operatória e a continência fecal. Da análise dos 27 casos de anomalias anorretais altas e intermediárias, concluímos que: 1. A continência fecal foi conseguida plenamente em 48,14% dos casos, parcialmente em 25,92% dos casos, e a incontinência fecal foi observada em 25,92%; 2. A presença de incontinência fecal foi diretamente relacionada com a associação de anomalias sacrais; 3. A manometria anorretal foi extremamente útil para avaliar os pacientes operados por anomalias anorretais devido à existência de uma relação entre os resultados manométricos e o grau de continência fecal.Federal University of São Paulo PSMUNIFESP, PSMSciEL

Use of biofeedback (BFB) in the treatment of fecal incontinence after surgical correction of anorectal malformations by posterior sagital anorectoplasty (PSARP)

OBJECTIVE: To evaluate biofeedback(BFB)responses to rehabilitation techniques and physical exercises in incontinent or partially continent anorectal malformations patients after posterior sagital anorectoplasty (PSARP). DESIGN: Prospective study. SETTING: Pediatric Surgery - Department of Surgery - UNIFESP-EPM. PATIENTS:The authors report on 14 patients with anorectal malformations (4 with partial fecal incontinence after primary PSARP; 6 with fecal incontinence after primary PSARP; 3 with partial fecal incontinence after secondary PSARP; and 1 with fecal incontinence after secondary PSARP). All patients were rehabilitated via a BFB program of exercises in order to improve the function of the anal sphincteric muscular complex for a period of 1 -3 years. MAIN OUTCOME MEASURE: Clinical and manometric control. RESULTS: After BFB, of 4 partially continent patients after primary PSARP, 3 became continent; of 6 incontinent patients after primary PSARP, 4 became continent; of 3 partially continent patients after secondary PSARP, 1 became continent,1 showed no improvement and 1 became incontinent (infection + abscess + fibrosis + important anorectal stenosis). The incontinent patient after secondary PSARP showed no improvement. CONCLUSION: The authors concluded that BFB, used at the appropriate time with patient collaboration, is an important complement to the anatomical reconstruction of anorectal malformations in order to achieve good development and contractile functioning of the sphincteric muscular complex.A anorretoplastia sagital posterior (ARPSP) representa hoje, a técnica mais usada para tratamento das anomalias anorretais em todo o mundo. Entretanto, alguns casos associados com anomalias sacrais, evoluem com continência fecal parcial ou com incontinência fecal. Podemos tratar esses casos com nova cirurgia ou com técnicas de rehabilitação tipo biofeedback, por meio de exercícios físicos, com a finalidade de melhorar a função do complexo muscular esfincteriano. São relatados 14 casos de pacientes portadores de anomalias anorretais (4 com continência fecal parcial após ARPSP primária; 6 com incontinência fecal pós ARPSP primária; 3 com continência fecal parcial após ARPSP secundária; e, 1 com incontinência fecal pós ARPSP secundária). Todos os pacientes foram submetidos a exercícios de rehabilitação com a finalidade de melhorar a função do complexo muscular esfincteriano tipo BFB, durante um período de tempo que variou de 1 a 3 anos, com acompanhamento clínico e manométrico. Após o BFB, dos 4 pacientes com continência fecal parcial após ARPSP primária, 3 ficaram continentes; dos 6 incontinentes após ARPSP primária, 4 ficaram continentes; dos 3 pacientes com continência parcial após ARPSP secundária, 1 tornou-se continente e 1 incontinente, piorando seu resultado por infecção, abscesso, fibrose e importante estenose anal. Os autores referem que o BFB usado no momento adequado, com a colaboração do paciente, é um importante complemento para a reconstrução anatômica das anomalias anorretais, para conseguir um bom desenvolvimento e uma boa função contráctil do complexo muscular esfincteriano.Federal University of São Paulo EPM Department of SurgeryUNIFESP, EPM, Department of SurgerySciEL

Crossed testicular ectopia

Crossed testicular ectopia (CTE) is a rare anomaly, characterized by migration of one testis towards the opposite inguinal canal. Presented here is a case of crossed ectopia of the right testis, treated by extraperitoneal transposition of the gonad and right orchiopexy. Embriology and surgical findings suggest that CTE is a common consequence of many unclear ethiologic factors, specially mechanical ones, and can be associated with Muller duct persistence. Review of literature suggests a classification of CTE into 3 types: I - associated with inguinal hernia alone; II - associated with persistent mullerian remnants; III - associated with other anomalies without mullerian remnants. Treatment includes transeptal orchiopexy or extraperitoneal transposition of the testis, research for mullerian remnants and other anomalies, and long term postoperative follow-up, due to the risk of becoming malignant.INTRODUÇÃO: A ectopia testicular cruzada (ETC) é uma anomalia rara, caracterizada pela descida de um testítulo no canal inguinal do lado oposto. Apresentamos um caso de ectopia cruzada do testículo direito, tratado por transposição extraperitoneal da gônada e orquipexia direita. CONCLUSÃO: Os conhecimentos embriológicos e os achados cirúrgicos sugerem que a ETC seja uma conseqüência comum de vários fatores etiológicos, sobretudo fatores mecânicos, e pode causar persistência do ducto de Müller. Após extensa revisão da literatura,sugerimos uma classificação da ETC em 3 tipos: 1 - associada somente à hérnia inguinal; II associada a remanescentes mullerianos; III - associada a outras anomalias, sem remanescentes mullerianos. O tratamento inclui orquipexia trans-septal ou transposição trans-abdominal do testículo, pesquisa de remanescentes mullerianos e outras anomalias, e seguimento pós-operatório a longo prazo, devido a risco de malignização.Escola Paulista de Medicina Department of Surgery Pediatric Surgery DivisionUNIFESP, EPM, Department of Surgery Pediatric Surgery DivisionSciEL

Meningkatkan Hasil Belajar Siswa Pada Mata Pelajaran Sains Melalui Metode Eksperimen Siswa Kelas IV SDN Kayumpia Kecamatan Kinovaro

The main problem of this research is the result of the student grade IV SDN Kayumpia to learn science program is to low. The peroblem statement of this research is an experiment method apllycan be increase the result of student to learning science. The goal of the research is to description of experiment method can be increase the abilty of the student grade IV SDN Kayumpia. Kind of this research is an action class research which did in two siclus. Designed by Kemmis and Mc.Taggart. The research did through view they are planning, action, observation, and reflectionn. The subject of this research are fiveteen student of student of SDN Kayumpia. The result of teacher observation for the first siclus got 55% and second siclus got 90%. The result of teacher observation for the first siclus got the grade 46,7% it mean failed and the second siclus got the grade 91,1%. Student result for the resultfor the first siclus is 60% and for the second siclus got 93,3%. It mean teaching method of second siclus got good indicator of the research wich found 85%, it can be conclude that eksperiment method apply can be increase the result of student grade IV to learning science subject at SDN Kayumpia. Keywords: Result of Studying, Science, Eksperimen

Overpressure Role in Isothermal Kinetics of H2 Desorption-Absorption: the 2LiBH4-Mg2FeH6 System

International audienceThe rates of the irreversibile LiBH4 +Mg2FeH6 → LiH + 2MgH2 + FeB + 5/2H2 and reversible (with significant sorption/desorption hysteresis) LiBH4 + 1/2Mg ↔ LiH + 1/2MgB2 + 3/2H2 reactions were measured by isothermal–isobaric experiments in a Sievert-type apparatus. Measurements were done at several temperature T and overpressure Δp/p values, deriving the rate constants k(T, Δp/p) by Avrami’s fitting of reaction advancement vs time. The results could be rationalized on the basis of the k = A exp(−Ea/RT) = A0 exp[−Ea0/RT + a(Δp/p)] kinetic formula, which couples the standard Arrhenius approach for thermal effects with an exponential dependence of the rate constant on overpressure. The empirical a coefficient varies with temperature in a way that requires the activation energy and entropy to depend linearly on Δp/p. For the first of the above reactions, Ea = −151(Δp/p) + 118 kJ mol–1 and ln(A/min–1) = −34(Δp/p) + 16; similar values are obtained for the second one. Relations of this kinetic model with the thermodynamic driving force ΔG and with equations of electrochemical kinetics, where overpressure is replaced by overvoltage, are discussed

Kepuasan Anggota Kelompok Tani Terhadap Bantuan Pupuk Subsidi Pemerintah Di Kecamatan Tingkir Kota Salatiga

Penelitian ini bertujuan: 1) Menganalisis atribut bantuan pupuk subsidi pemerintah yang dianggap penting oleh petani. 2) Menganalisis kepuasan petani terhadap bantuan pupuk subsidi pemerintah dan posisi atribut pupuk subsidi pemerintah. Jenis penelitian ini deskriptif kuantitatif menggunakan analisis importance performance analysis (IPA). Penelitian ini dilakukan pada bulan Mei 2023, di kecamatan Tingkir kota Salatiga. Pengambilan sampel dilakukan dengan pendekatan non-probability sampling menggunakan purposive sampling dengan jumlah responden sebanyak 30 responden, dari petani penerima pupuk subsidi anggota kelompok tani. Kesimpulan penelitian ini adalah: 1) Atribut bantuan pupuk subsidi pemerintah yang dinilai penting adalah: jenis pupuk (X1), jumlah pupuk (X3), kualitas pupuk (X2), waktu penyaluran pupuk subsudi (X4), dan harga pupuk subsidi (X5). 2) Hasil matrik analisis IPA didapatkan hasil sebaran atribut dari bantuan pupuk subsidi pemerintah, pada kuadran I (prioritas utama) adalah: jenis pupuk (X1), dan jumlah pupuk (X3); kuadran II (pertahankan kinerja) adalah: kualitas pupuk (X2), waktu penyaluran pupuk subsidi (X4), dan harga pupuk (X5); kuadran III (prioritas rendah) adalah: persiapan penyaluran pupuk subsidi bagi petani (X6); dan kuadran IV (cenderung berlebihan) adalah: pendampingan dari petugas dalam penyaluran pupuk (X8), proses penyaluran pupuk (X7), dan penggunaan kartu tani (X9).This research aims to: 1) Analyze the attributes of government subsidized fertilizer aid that farmers consider important. 2) Analyze farmers satisfaction toward government subsidized fertilizer aid and the position of government subsidized fertilizer attributes. This type of research is quantitative descriptive using importance performance analysis (IPA). This research was conducted in May 2023, in Tingkir sub-district, Salatiga city. Sampling was carried out using a non- probability sampling approach using purposive sampling with a total sample of 30 respondents, from farmers who received subsidized fertilizer, members of farmer groups. The conclusions of this research are: 1) The attributes of government subsidized fertilizer aid that are considered important are: type of fertilizer (X1), quantity of fertilizer (X3), quality of fertilizer (X2), timing of distribution of subsidized fertilizer (X4), and price of subsidized fertilizer (X5). 2) The results of the IPA analysis matrix show the distribution of attributes from government subsidized fertilizer aid, in quadrant I (main priority) are: type of fertilizer (X1), and amount of fertilizer (X3); quadrant II (maintain performance) are: fertilizer quality (X2), distribution time of subsidized fertilizer (X4), and fertilizer price (X5); Quadrant III (low priority) is: preparation for distribution of subsidized fertilizer to farmers (X6); and quadrant IV (tends to be excessive) are: assistance from officers in fertilizer distribution (X8), fertilizer distribution process (X7), and use of farmer cards (X9)

Los módulos interactivos en un museo de ciencias como herramientas de aprendizaje científico

Tesis doctoral inédita leída en la Universidad Autónoma de Madrid, Facultad de Psicología, Departamento de Psicología Básica. Fecha de lectura: noviembre de 200