Urological leaks after pelvic exenterations comparing formation of colonic and ileal conduits.

Item does not contain fulltextBACKGROUND: The aim of this study was to assess possible risk factors for urinary leakage of a newly formed urinary conduit after a partial or total pelvic exenteration. METHODS: An analysis was conducted from prospectively collected data of patients who underwent a pelvic exenteration with conduit formation for advanced and recurrent pelvic cancer. RESULTS: Of 232 patients undergoing a pelvic exenteration, 74 (32%) had a conduit formed. Of these, 47 (64%) had an ileal conduit compared with 27 (36%) a colonic conduit. Twelve (16%) patients developed a leak, of which nine occurred within the first month. Factors associated with a conduit leak included involvement of R2 surgical margins (43%), the magnitude of the exenteration and a current cardiovascular medical history (27%). Leaks were not found to be associated with either radiotherapy or chemotherapy. The 30-day leak rate for ileal conduits was 17% (8/47) and 4% (1/27) for colonic conduits with enterocutaneous fistula only occurring in the ileal conduit group (2/47). Fistula, drained collections and sepsis occurred in 40% of ileal and 19% of colonic conduits (p < 0.01). Patients with a conduit leak had a longer length of stay (59 versus 23 days, p < 0.001). CONCLUSIONS: Urine leaks after conduit formation in association with exenterations are relatively common with a prolonged length of hospital stay. Positive surgical margins and exenterations involving all four quadrants of the pelvis were associated with higher leak rates. There was no evidence of a difference between ileal and colonic conduits and number of leaks. However colonic conduits had less total complications including sepsis, leak and pelvic collections with comparatively no complications of a small bowel fistula.1 april 201

Modelling the effects of human activity on the vegetation of a northeast Mediterranean island

Question: Which factors affect the spatial variation of maquis and phryganic vegetation and how can the role of human activities be estimated through degradation models. Location: Island of Sifnos, Cyclades, Greece. Methods: Data on woody vegetation, environmental conditions and intensity of human activity were collected by field survey. The vegetation data were analysed using TWINSPAN. Models based on the combination of Canonical Variate Analysis and logistic regressions were used in order to examine and describe the different pathways of maquis degradation. Results: The spatial variation of maquis and phryganic vegetation was related to both environmental and disturbance factors. The replacement of maquis by phryganic vegetation can follow two different pathways which reflect differences on the environmental conditions. However, the pathways themselves are determined by the combinations and levels of disturbance only. Conclusion: Degradation models can provide essential information on the effects of human activities on the vegetation. Maquis vegetation is relatively tolerant of disturbance, however. if disturbance exceeds certain critical thresholds, maquis is replaced by phryganic vegetation. The presence of phryganic vegetation is not always the result of maquis degradation

To graze or not to graze? Sheep, voles, forestry and nature conservation in the British uplands

The British uplands are internationally important for their unique plant and bird communities. They have considerable economic, nature conservation, landscape, aesthetic and tourism-related value and as a result are under a variety of different pressures, most notably from sheep farming, shooting interests, commercial forestry and conservation interests. In order to optimize biodiversity in the uplands, the challenge is to find how to balance the different land-use pressures. One key upland species that is potentially affected by livestock grazing, and is of considerable interest to both foresters and nature conservationists, is the field vole Microtus agrestis. Relaxation of livestock grazing can result in an increase in vole numbers. This in turn could have both positive and negative implications for biodiversity as (i) field voles are a major source of prey for other species and (ii) they are a cause of damage to newly planted trees and potentially damaging in areas of native woodland regeneration. A replicated, randomized block experiment, consisting of six replicates of four livestock grazing treatments, was established in 2003 (with baseline data collected in 2002). This enabled us to examine the effects of livestock grazing on field vole abundance. We have demonstrated experimentally for the first time that livestock grazing pressure affects the abundance of field voles (as measured by a vole sign index) in the uplands. In the first year of the experiment, immediate treatment effects were detectable, with a lower abundance of voles in the conventionally grazed treatment compared with those in the ungrazed treatment, and with intermediate vole abundances in the lightly grazed treatments. The significant treatment effects became more apparent in 2004, with a higher abundance of voles in the extensively grazed mixed treatment (i.e. sheep and cattle) than in the extensively grazed treatment that contained only sheep. Synthesis and applications. In order to maximize biodiversity in the uplands, our results suggest that low intensity livestock grazing, used in a novel ways, could be a useful management tool to reduce vole abundance (and hence subsequent tree damage) compared with excluding livestock from young plantations completely. Furthermore, vole abundance would be higher at low grazing intensity compared with conventional stocking rates, thus still providing food for raptors and other vole-eating vertebrates. Indeed, low-intensity sheep and mixed livestock grazing might improve prey availability as a direct consequence of increased heterogeneity in vegetation structure. Our results suggest that it may be possible to maintain the open character of moorland habitats, and benefit key upland species generally, by reducing sheep grazing pressure and introducing low-intensity mixed livestock grazing throughout the uplands