Fecal incontinence after single-stage Soave’s pull-through: abdominal versus transanal endorectal pull-through

Purpose To compare the postoperative fecal continence and bowel functions between patients who underwent a single stage - Soave’s endorectal pull through operations whether via the classic abdominal endorectal pull through approach (TAPT) or trans-anal endorectal pull through approach (TERPT).Patients and Methods This retrospective study was performed on 50 HD consecutive patients who had undergone surgery during a period of 5 years from January 2002 to January 2007. They were two equal groups; group I (n=25) including patients who underwent TAPT; group II (n=25) including patients who underwent TERPT. Demographic, clinical data, preoperative investigations, operative records, postoperative outcome were studied. Post operative fecal continence score rate (FCSR) was assessed in children over the age of 4 years. Moreover, those with poor FCSR were further investigated by magnetic resonance imaging (MRI). Electromyography (EMG) and anorecatal manometery (AM) were also used in follow-up.Results Twenty six patients (52%) had an excellent FCSR and eighteen patients (36%) showed good FCSR. However, 5 patients (10%) had a fair FCSR and only 1 patient (2%) suffered of a poor FCSR. There was no statistical significant difference between the two groups in neither anal manometry nor EMG. MRI did not show any abnormalities on pelvic floor and anal muscle complex on those patients who had fair or poor FCSR.Conclusion The incidence of fecal incontinence is very low after Soave’s pull-through operations whether TAPT or TERPT approaches with no statistical significant difference.Keywords: fecal continence, Hirschsprung’s disease, Soave’s operation, transanal endorectal pull-throug

N-glycosylation of mouse TRAIL-R and human TRAIL-R1 enhances TRAIL-induced death.

APO2L/TRAIL (TNF-related apoptosis-inducing ligand) induces death of tumor cells through two agonist receptors, TRAIL-R1 and TRAIL-R2. We demonstrate here that N-linked glycosylation (N-glyc) plays also an important regulatory role for TRAIL-R1-mediated and mouse TRAIL receptor (mTRAIL-R)-mediated apoptosis, but not for TRAIL-R2, which is devoid of N-glycans. Cells expressing N-glyc-defective mutants of TRAIL-R1 and mouse TRAIL-R were less sensitive to TRAIL than their wild-type counterparts. Defective apoptotic signaling by N-glyc-deficient TRAIL receptors was associated with lower TRAIL receptor aggregation and reduced DISC formation, but not with reduced TRAIL-binding affinity. Our results also indicate that TRAIL receptor N-glyc impacts immune evasion strategies. The cytomegalovirus (CMV) UL141 protein, which restricts cell-surface expression of human TRAIL death receptors, binds with significant higher affinity TRAIL-R1 lacking N-glyc, suggesting that this sugar modification may have evolved as a counterstrategy to prevent receptor inhibition by UL141. Altogether our findings demonstrate that N-glyc of TRAIL-R1 promotes TRAIL signaling and restricts virus-mediated inhibition

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

Global variation in anastomosis and end colostomy formation following left-sided colorectal resection

Background End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods This study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle- and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low- compared with middle- and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001). Conclusion Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone

Tubularized incised plate technique for recurrent hypospadias: a local experience from Egypt

Objectives To evaluate our local experience of tubularized incised plate (TIP) repair Snodgrass method) in the management of recurrent hypospadias.Summary background data TIP repair has been well described for use in salvage hypospadias repairs, with good results.Patients and methods This prospective, descriptive study was carried out over a period of 5 years from December 2003 to December 2008. The study included 30 patients; all of these patients had previously undergone hypospadias repair, and the indication for surgery was complete failure of the previous repair. Classic TIP repair was performed, although tissues for barrier layers between the neourethra and skin closures were not as readily available.Results Secondary TIP repair was successful in 25/30 patients (83.3%). These patients showed no postoperative complications and had a slit-like meatus and a forwarddirected urinary stream without branching. Their parents were satisfied with the repair results.Conclusion Our local experience coincides with data of the literature that TIP is an excellent option in the treatment of recurrent hypospadias when the results of primary techniques are unsatisfactory.Keywords: recurrent hypospadias, salvage hypospadias, tubularized incised plat

Gynekomastie: Eine Studie zur Wahrnehmung von Studierenden zu diesem Krankheitsbild

Background : Gynecomastia is a benign proliferation of the glandular male breast tissue. Gynecomastia etiology might be physiological or non-physiological such as medications, chronic diseases (e.g. hypogonadism), or steroid supplements. Aim : The purpose of this study was to assess the knowledge and understanding of gynecomastia among medical students and which resources were used to gain their understanding regarding the disease.Methods : Data for this qualitative, questionnaire-based cross-sectional study was collected on the basis of our own study objectives and from available questionnaires with similar objectives. The questionnaire was composed of 26 questions divided into many items that were recorded including sociodemographic data, gynecomastia symptoms, and holistic perception of the problem by the students. Exclusion criteria included those who refused to participate in the study and did not complete the questionnaire. Statistical tests were taken significant at p-value <=0.05. All analyses were performed using SPSS, version 21.Results : A total of 200 medical students participated in this study, among them more males than females (64% vs. 36%). We observed that medical students had significantly more moderate knowledge with teachers as their source of information on gynecomastia (p=0.028) while with books (p=0.005) and internet (p=0.041) as their sources of information they had significantly more a higher level of knowledge. Conclusions : Medical students have overall insufficient knowledge about gynecomastia especially in physical examination and treatment aspects. Therefore, gynecomastia is to be considered more thoroughly in the curriculum.Hintergrund : Gynäkomastie ist eine gutartige Wucherung des Drüsengewebes der männlichen Brust. Gynäkomastie kann physiologische oder nicht-physiologische Ursachen haben, also beispielsweise durch Medikamente, chronische Krankheiten (z.B. Hypogonadismus) oder Steroidpräparate ausgelöst werden.Ziel : Ziel dieser Studie war es, Kenntnisse und Verständnis der Gynäkomastie unter Medizinstudenten zu beurteilen und zu ermitteln, welche Ressourcen zur Erlangung dieser genutzt wurden.Methoden : Die Daten für diese qualitative, Fragebogen-basierte Querschnittsstudie wurden auf der Grundlage unserer Studienziele und verfügbarer Fragebögen mit ähnlichen Zielen erhoben. Der Fragebogen bestand aus 26 Fragen, die in mehrere Items unterteilt waren, die u.a. soziodemographische Daten, Gynäkomastie-Symptome und ganzheitliche Wahrnehmung des Problems der Studenten erfassten. Zu den Ausschlusskriterien gehörten diejenigen, die sich weigerten, an der Studie teilzunehmen und den Fragebogen nicht ausfüllten. Statistische Tests wurden bei einem p-Wert <=0,05 als signifikant angesehen. Alle Analysen wurden mit SPSS, Version 21, durchgeführt.Ergebnisse : Insgesamt nahmen 200 Medizinstudenten an dieser Studie teil, darunter mehr Männer als Frauen (64% vs. 36%). Wir beobachteten, dass Medizinstudenten mit Lehrern als Informationsquelle über Gynäkomastie signifikant eher mäßiges Wissen hatten (p=0,028), während sie mit Büchern (p=0,005) und Internet (p=0,041) als Informationsquellen signifikant einen höheren Wissensstand hatten. Schlussfolgerungen : Medizinstudenten haben insgesamt ein unzureichendes Wissen über die Gynäkomastie, insbesondere in Bezug auf die körperliche Untersuchung und die Behandlung. Deshalb sollte die Gynäkomastie im Curriculum gründlicher berücksichtigt werden

Performance Evaluation of a MW-Size Grid-Connected Solar Photovoltaic Plant Considering the Impact of Tilt Angle

This paper presents a study for the estimation of generation from a large-scale, grid-interfaced solar PV plant using the PVsyst software. This study aims to investigate the effect of tilt angle on the performance of the grid-integrated solar PV plant. Two types of tilt angle test plants, i.e., a fixed tilt angle of 30&deg; (1 MW) and two seasonal tilt angles, in summer 13&deg; and in winter 30&deg; (2.5 MW), have been selected at the same location in Bikaner, India. The performance of the proposed test solar power plants, rated at 1 MW (fixed tilt angle) and 2.5 MW (two seasonal tilt angles), is established by comparing the results obtained using the PVsyst software with the practical data of annual solar insolation. It is established that the radiation incident on PV modules will increase by 2.41% if two seasonal tilt angles are considered. Hence, the annual capacity utilization factor (CUF) has increased by 0.26%. Furthermore, it is established that the proposed method&rsquo;s performance is superior compared to the statistical methods reported in the literature