Manometric findings in relation to functional outcomes in different types of anorectal malformations

Aims: To compare anorectal manometry (AM) in patients with different types of anorectal malformations (ARMs) in relation to functional outcomes. Methods: A single-institution, cross-sectional study. After ethical approval, all patients >= 7 years old treated for anterior anus (AA), perineal fistula (PF), vestibular fistula (VF), or rectourethral fistula (RUF) from 1983 onwards were invited to answer the Rintala bowel function score (BFS) questionnaire and to attend anorectal manometry (AM). Patients with mild ARMs (AA females and PF males) had been treated with minimally invasive perineal procedures. Females with VF/PF and males with RUF had undergone internal-sphincter saving sagittal repairs. Results: 55 of 132 respondents (42%; median age 12 (7-29) years; 42% male) underwent AM. Patients with mild ARMs displayed good anorectal function after minimally invasive treatments. The median anal resting and squeeze pressures among patients with mild ARMs(60 cm H2O and 116 cm H2O respectively) were significantly higher than among patients with more severe ARMs (50 cm H2O, and 80 cm H2O respectively; p Conclusions: Our findings support the appropriateness of our minimally invasive approaches to the management of mild ARMs, and IAS-saving anatomical repairs for patients with more severe malformations. (C) 2017 Elsevier Inc. All rights reserved.Peer reviewe

Muscular Fitness Improves during the First Year of Academy Studies among Fighter Pilot Cadets

: Background: An adequate level of muscular fitness is related to occupational performance in military personnel, including pilots flying high performance aircraft. The aim of this study was to describe the baseline level and the change in muscular fitness between the first and the second years of the Air Force Academy among fighter pilot cadets. Methods: The muscular strength and endurance test results of 182 male fighter pilot cadets were analyzed during their first year in the Air Force Academy and one year after. Maximal isometric strength tests included trunk flexion, trunk extension and bilateral leg extension tests, whereas muscle endurance was measured with modified a sit-up test and seated alternative dumbbell press. Results: The maximal isometric bilateral strength of the leg extensor muscles increased from 220 ± 42 to 232 ± 42 kg. The maximal isometric trunk extension strength increased from 117 ± 21 to 120 ± 19 kg and trunk flexion from 82 ± 16 to 86 ± 17 kg. Muscle endurance increased from 68 ± 13 to 75 ± 15 repetitions/min in seated dumbbell press and from 47 ± 12 to 51 ± 13 repetitions/min in sit-up test. Conclusions: Both maximal strength and muscular endurance improved among fighter pilot cadets, which indicates that occupational performance is well maintained or improved from the perspective of physical fitness during the early phase of academy studies. Education in the Air Force Academy, including physical education, seems beneficial in improving muscular fitness among military pilots

Combined management of perianal rhabdomyosarcoma with chemotherapy, radical surgery, and irradiation : A series of three consecutive children

Background and aim: We describe a series of three successive patients with perianal rhabdomyosarcoma (PRMS) from 2014 to 2017 managed with combined chemotherapy, radical surgery, and radiotherapy. Methods: Ethical consent was obtained. Data including tumor presentation, treatment, and survival was collected from hospital reports. Results: Two girls aged 15 and 16 years (patient #1 and #2) and one boy aged five years (patient #3) were referred because of a suspected perianal abscess. MRI showed large perianal tumors from 7 to 12 cm in diameter that surrounded or infiltrated the anal sphincters and were inconsistent with abscess. Tumor biopsies showed RMS of alveolar (#1 and #2) and embryonal (#3) types. Patient #1 had lymph node and bone metastases, patient #2 lymph node metastases, and patient # 3 no metastases. Pretreatment staging, IRS Clinical Group, and Risk Groups were: Stage 4, II, high; Stage 3, GII, intermediate; and Stage 3, I, low, respectively. All underwent colostomy before neoadjuvant chemotherapy (CWS-RMS 2009 program). Neoadjuvant chemotherapy failed to clear the tumors from anal sphincters preventing anus-saving surgery, and all patients underwent abdominoperineal excision. All removed specimens had freemargins with negative lymph nodes. After adjuvant chemotherapy and local radiation, the patients were tumor free after 48, 13, and 18 months. Conclusion: In PRMS local surgical control required abdominoperineal excision. Confusion between PRMS and abscess may cause unnecessary delay in management. (C) 2018 Elsevier Inc. All rights reserved.Peer reviewe

Outcomes of fundoplication in oesophageal atresia associated gastrooesophageal reflux disease

Aim of the study: Conservative management of gastrooesophageal reflux (GORD) in oesophageal atresia (OA) is sometimes inefficient, and fundoplication is required. We assessed the outcomes of fundoplication among OA patients from 1980 to 2016. Methods: After ethical consent, hospital records of 290 patients, including 22 referred patients, were reviewed. Included were 262 patients with end-to-end repair. Excluded were patients who underwent oesophageal reconstruction (n = 23) or no repair (n = 5). Primary outcome measures included survival, retaining the native oesophagus, resolution of GGORD symptoms, failure of fundoplication, and long-term endoscopic results. Main results: Gross types of OA in 262 patients were A (n = 12), B (n = 2), C (n = 217), D (n = 10), E (n = 19), and F (n = 2). Eighty-six (33%) patients, type A (n = 12, 100%), B (n = 2, 100%), C (n = 69, 31%), D (n = 3, 30%), and F (n = 1, 50%), underwent fundoplication at the median age of 5.4 (IQR 3.1-16) months. Main indications included recalcitrant anastomotic stenosis (RAS) in 41 (48%), respiratory symptoms in 16 (19%), and acute life threatening events (ALTE) in 15 (17%) of patients. Associated tracheomalacia in 25 (29%) patients were treated with aortopexy. Median follow-up was 7.5 (IQR 1.8-15) years. RAS resolved in 30 (73%) patients, whereas 11 (27%) with unresolved RAS underwent oesophageal resection (n = 8) or replacement (n = 3). Six (7%) patients died of heart failure (n = 4), bolus impaction (n = 1), and ALTE (n = 1). Fundoplication failed in 27 (31%) patients, and 13 (15%) underwent redo fundoplication. Fundoplication failure was predicted by long-gap OA RR = 3.8 (95% CI = 1.1-13), P = 0.04. In total GORD associated symptoms persisted in 7 (8%) patients, including one with permanent feeding jejunostomy. Latest endoscopy showed moderate or severe oesophagitis in 7% of fundoplicated and in 3% nonfundoplicated patients and intestinal metaplasia in 3% and 1% (p = 0.20-0.29). Conclusion: Fundoplication provided a safe and relatively effective control of OA associated symptomatic GORD and oesophagitis. The failure rate of fundoplication was high in those with long-gap OA. Type of study: Treatment study. Level of evidence: IV (C) 2017 Elsevier Inc. All rights reserved.Peer reviewe

Sexual Function, Fertility and Quality of Life after Modern Treatment of Anorectal Malformations

Purpose: Sexual dysfunction and impaired quality of life due to fecal incontinence are common after classic operations for anorectal malformations. We hypothesized that modern repairs may result in improved outcomes. Materials and Methods: Following ethical approval for this single institution cross-sectional study, all patients 16 years or older treated for rectourethral, vestibular or perineal fistula from 1983 onward were sent detailed postal questionnaires on sexual function and quality of life. Each respondent was age and gender matched to 3 controls randomly selected from the general population. Penoscrotal/gynecologic abnormalities were obtained from the records. Results: A total of 41 patients (62%) with a median age of 22 years participated in the study. Of the patients 20 were males with rectourethral fistula (prostatic in 60%), 10 were females with vestibular/perineal fistula and 11 were males with low malformations. Although experience of sexual relationships and orgasmic function were reported in comparable proportions to controls, age at coital debut was significantly delayed in all groups of patients (p Conclusions: While erectile and orgasmic function appear preserved after sagittal repair, further evaluation of fertility issues in males with rectourethral fistula is indicated. Larger multicenter studies are needed to confirm our findings.Peer reviewe

Lower urinary tract symptoms and sexual functions after endorectal pull-through for Hirschsprung disease : controlled long-term outcomes

Background/purpose: To define the prevalence of lower urinary tract symptoms (LUTS) and outcomes for sexual function after endorectal pull-through (EPT) for Hirschsprung disease (HD) compared to controls. To date, similar controlled studies are lacking. Methods: Patients aged = 4 years (n= 123) operated on forHDat our center between 1987 and 2011were invited to answer questionnaires on LUTS and sexual function (aged = 16 years). Patients with an intellectual disability and patients with a definitive endostomy were excluded. Patients were matched to three controls and also invited to a clinical follow-up for urological investigations including urine flow measurement, renal tract ultrasound, and urinalysis. Results: Altogether, 59 responses concerning LUTS and 24 responses concerning sexual functions were analyzed. No significant differences were demonstrated in the overall prevalence of LUTS between patients (67%) and controls (80%), nor in the prevalence of frequent LUTS (14% vs. 16%; P = NS for both). One patient (2%) had a urethral stricture after laparotomy-assisted EPT. Male patients reported sexual satisfaction and erectile function similar to controls (P N 0.10). Female patients were currently less in stable relationships compared to controls (25% vs. 83%, P= 0.005). Conclusions: Our results support the safety of EPT in patientswith HDwith regard to preservation of the integrity and functioning of the genitourinary tract. (C) 2017 Elsevier Inc. All rights reserved.Peer reviewe

Prognostic utility of human complement factor H related protein test (the BTA stat® Test)

The purpose of the study was to determine, in addition to well-known prognostic factors, histological grade, stage, tumour size and multiplicity, the correlation of BTA stat Test on disease free interval (DFI) on primary superficial bladder cancer. A total of 116 patients with newly diagnosed bladder cancer were evaluated in a prospective multicentre study. A voided urine sample was obtained prior to TURB and split for culture, cytology and BTA stat testing. Follow-up data for the patients were collected until the first recurrence or the last visit and the DFI was analysed by Kaplan–Meier method and Cox analysis. Ninety-seven of the 116 (83.6%) patients were eligible for analysis. The BTA stat Test was positive in 73 (75.3%) patients, whereas cytology detected 20 (20.6%) cases. The DFI was found to be shorter among patients with a positive BTA stat Test, and also among those with intermediate or high-grade tumours. The BTA stat Test result divided patients with grade 2 tumours into two prognostic groups, in that those testing positive had 68.6% risk of recurrence during the first year compared to 42.9% risk of those with a negative test result (P = 0.041). Although the effect of tumour size on DFI was notable, the difference did not reach statistical significance (P = 0.064). Number of tumours was not related to DFI, nor was the difference between different stage of tumour of significance. BTA stat Test is not only sensitive in detection of primary bladder cancer, but also might have some independent prognostic significance. © 2001 Cancer Research Campaign http://www.bjcancer.co

On the phenology and seeding potential of sea-ice microalgal species

Sea ice is an important habitat for a wide variety of microalgal species. Depending on the species composition, sea ice can be a seeding source for pelagic phytoplankton blooms after ice melt in spring. Sea-ice algal communities were studied over 2 full winter seasons in 2014 and 2016 at Rothera Research Station, situated at the Western Antarctic Peninsula (WAP). Algal pigment patterns and microscopic observations were combined with photophysiological studies based on fluorescence analyses to monitor and explain the phenology of ice-algal species. Clear patterns in species succession were identified. Young sea ice contained a mixture of algal species including dinoflagellates, cryptophytes and diatoms like Chaetoceros spp. and Fragillariopsis spp. In winter, severe environmental conditions resulted in a decline in species diversity and selection towards heterotrophy. Pennate diatoms like Amphiprora kufferathii and Berkeleya adeliensis were the first to dominate the nutrient-enriched bottom-ice layers in early spring. The bottom communities exhibited a remarkably stable value for the photoadaptation parameter, E-k, of circa 25 mu mol photons m(-2) s(-1), Whereas pennate diatoms were most abundant in spring ice, the initial seeding event linked to ice melt was associated with flagellate species. Haptophyte species like Phaeocystis antarctica and prymnesiophytes like Pyramimonas spp. best sustained the transition from sea ice to seawater. Comparison with previous studies shows that the seeding patterns observed in Ryder Bay were characteristic over the wider sea-ice domain, Arctic and Antarctic. Over the course of this century, the WAP is predicted to experience continuing thinning and decline in sea-ice cover. For the near future, we expect that especially microalgal communities of haptophytes and chlorophytes will benefit from the changes, with yet unknown implications for carbon fluxes and higher trophic levels.Peer reviewe

Aktinomykeettien ja homeiden esiintyminen verkostovedessä

Valtaosa Suomen talousvesistä täyttää kaikki asetetut normit ja kuluttajat pitävät talousveden laatua hyvänä, mutta myös suomalaisissa talousvesissä esiintyy mikrobiologisia ongelmia. Yksi tällainen ilmiö on verkostovesien haju- ja makuongelmat, jotka aiheutuvat verkostoissa tapahtuvasta mikrobikasvusta. Tässä oleelliset tekijät ovat putkistojen pinnoilla biofilmeillä kasvavat aktinomykeetit ja mikrosienet (homeet ja hiivat). Aiempaa tutkimustietoa asiasta ei juuri ole, joten Kansanterveyslaitos aloitti vuonna 2004 Vesihuoltolaitosten kehittämisrahaston tukemana tutkimuksen, jossa selvitettiin homeiden ja aktinomykeettien esiintymisestä Suomen talousvesiverkostoissa. Tutkimus käynnistettiin valtakunnallisella kyselyllä, johon vastasi 405: vedenottamoa. Näistä n. 10%:lla oli homeisiin/aktinomykeetteihinmahdollisesti liittyviä haju- tai makuongelmia verkostovesissä

International survey on the management of esophageal atresia

IntroductionBecause many aspects of the management of esophageal atresia (EA) are still controversial, we evaluated the practice patterns of this condition across Europe. MethodsA survey was completed by 178 delegates (from 45 [27 European] countries; 88% senior respondents) at the EUPSA-BAPS 2012. ResultsApproximately 66% of respondents work in centers where more than five EA repairs are performed per year. Preoperatively, 81% of respondents request an echocardiogram, and only 43% of respondents routinely perform preoperative bronchoscopy. Approximately 94% of respondents prefer an open approach, which is extrapleural in 71% of respondents. There were no differences in use of thoracoscopy between Europeans (10%) and non-Europeans (11%, p=nonsignificant). Approximately 60% of respondents measure the gap intraoperatively. A transanastomotic tube (90%) and chest drain (69%) are left in situ. Elective paralysis is adopted by 56% of respondents mainly for anastomosis tension (65%). About 72% of respondents routinely request a contrast study on postoperative day 7 (2-14). Approximately 54% of respondents use parenteral nutrition, 40% of respondents start transanastomotic feeds on postoperative day 1, and 89% of respondents start oral feeds after postoperative day 5. Pure EA: 46% of respondents work in centers that repair two or more than two pure EA a year. About 60% of respondents opt for delayed primary anastomosis at 3 months (1-12 months) with gastrostomy formation without esophagostomy. Anastomosis is achieved with open approach by 85% of respondents. About 47% of respondents attempt elongation of esophageal ends via Foker technique (43%) or with serial dilations with bougies (41%). Approximately 67% of respondents always attempt an anastomosis. Gastric interposition is the commonest esophageal substitution. ConclusionMany aspects of EA management are lacking consensus. Minimally invasive repair is still sporadic. We recommend establishment of an EA registry