ABSTRACT
BACKGROUND: Ureteric injury (UI) is an infrequent but serious complication of colorectal surgery. Prophylactic ureteric stenting is employed to avoid UI, yet its efficacy remains debated. Intraoperative indocyanine green fluorescence imaging (ICG-FI) has been used to facilitate ureter detection. This study aimed to investigate the role of ICG-FI in identification of ureters during colorectal surgery and its impact on the incidence of UI. METHODS: A retrospective cohort study involving 556 consecutive patients who underwent colorectal surgery between 2018 and 2023 assessed the utility of routine prophylactic ureteric stenting with adjunctive ICG-FI. Patients with ICG-FI were compared to those without ICG-FI. Demographic data, operative details, and postoperative morbidity were analyzed. Statistical analysis included univariable regression. RESULTS: Ureteric ICG-FI was used in 312 (56.1%) patients, whereas 43.9% were controls. Both groups were comparable in terms of demographics except for a higher prevalence of prior abdominal surgeries in the ICG-FI group. Although intraoperative visualization was significantly higher in the ICG-FI group (95.3% vs 89.1%; p = 0.011), the incidence of UI was similar between groups (0.3% vs 0.8%; p = 0.585). Postoperative complications were similar between the two groups. Median stent insertion time was longer in the ICG-FI group (32 vs 25 min; p = 0.001). CONCLUSION: Ureteric ICG-FI improved intraoperative visualization of the ureters but was not associated with a reduced UI rate. Median stent insertion time increased with use of ureteric ICG-FI, but total operative time did not. Despite its limitations, this study is the largest of its kind suggesting that ureteric ICG-FI may be a valuable adjunct to facilitate ureteric visualization during colorectal surgery.
Subject(s)
Indocyanine Green , Optical Imaging , Stents , Ureter , Humans , Retrospective Studies , Female , Male , Ureter/injuries , Ureter/surgery , Middle Aged , Aged , Optical Imaging/methods , Colorectal Surgery/adverse effects , Colorectal Surgery/methods , Postoperative Complications/etiology , Postoperative Complications/prevention & control , Postoperative Complications/epidemiology , Coloring Agents , Intraoperative Complications/prevention & control , Intraoperative Complications/etiology , Intraoperative Complications/epidemiology , Incidence , AdultABSTRACT
BACKGROUND: First described by Parks and Nicholls in 1978, the ileal pouch-anal anastomosis (IPAA) has revolutionized the treatment of mucosal ulcerative colitis (MUC) and familial adenomatous polyposis (FAP). IPAA is fraught with complications, one of which is pouch-vaginal fistulas (PVF), a rare but challenging complication noted in 3.9-15% of female patients. Surgical treatment success approximates 50%. Gracilis muscle interposition (GMI) is a promising technique that has shown good results with other types of perineal fistulas. We present the results from our institution and a comprehensive literature review. METHODS: A retrospective observational study including all patients with a PVF treated with GMI at our institution from December 2018-January 2000. Primary outcome was complete healing after ileostomy closure. RESULTS: Nine patients were included. Eight of nine IPAAs (88.9%) were performed for MUC, and one for FAP. A subsequent diagnosis of Crohn's disease was made in five patients. Initial success occurred in two patients (22.2%), one patient was lost to follow-up and seven patients, after further procedures, ultimately achieved healing (77.8%). Four of five patients with Crohn's achieved complete healing (80%). CONCLUSION: Surgical healing rates quoted in the literature for PVFs are approximately 50%. The initial healing rate was 22.2% and increased to 77.8% after subsequent surgeries, while it was 80% in patients with Crohn's disease. Given this, gracilis muscle interposition may have a role in the treatment of pouch-vaginal fistulas.
Subject(s)
Adenomatous Polyposis Coli , Colitis, Ulcerative , Colonic Pouches , Crohn Disease , Gracilis Muscle , Proctocolectomy, Restorative , Vaginal Fistula , Humans , Female , Cohort Studies , Crohn Disease/complications , Colonic Pouches/adverse effects , Neoplasm Recurrence, Local/surgery , Proctocolectomy, Restorative/adverse effects , Colitis, Ulcerative/surgery , Colitis, Ulcerative/complications , Vaginal Fistula/etiology , Vaginal Fistula/surgery , Treatment Outcome , Retrospective Studies , Adenomatous Polyposis Coli/surgery , Observational Studies as TopicABSTRACT
Samples of water and barnacles Amphibalanus amphitrite were collected from Recife, Brazil, to assess if it accumulates total (TC) and thermotolerant coliforms (TTC) related with sewage pollution. The Most Probable Number (MPN) values and the standard procedures for examination of shellfish were used. Comparatively with the water samples, the highest coliform values came from the barnacles, with TC values ranging from < 3.0 x 10(3) to > 2.4 x 10(6) MPN.g-1, and TTC ranging from > 2.4 x 10(3) to 2.9 x 10(5) MPN.g-1. Barnacles accumulate the TC Ewingella americana, and the TTC Escherichia coli, Enterobacter gergoviae, Enterobacter aerogenes, and Enterobacter sakazakii. The results provided an indication of the level of organic contamination at the sampling locations and that this species could be a good organic pollution bioindicator.
Subject(s)
Enterobacteriaceae/isolation & purification , Environmental Monitoring/methods , Thoracica/microbiology , Water Pollution/analysis , Animals , BrazilABSTRACT
Samples of water and barnacles Amphibalanus amphitrite were collected from Recife, Brazil, to assess if it accumulates total (TC) and thermotolerant coliforms (TTC) related with sewage pollution. The Most Probable Number (MPN) values and the standard procedures for examination of shellfish were used. Comparatively with the water samples, the highest coliform values came from the barnacles, with TC values ranging from < 3.0 × 10³ to > 2.4 × 10(6) MPN.g-1, and TTC ranging from > 2.4 × 10³ to 2.9 × 10(5) MPN.g-1. Barnacles accumulate the TC Ewingella americana, and the TTC Escherichia coli, Enterobacter gergoviae, Enterobacter aerogenes, and Enterobacter sakazakii. The results provided an indication of the level of organic contamination at the sampling locations and that this species could be a good organic pollution bioindicator.
Amostras de água e cirrípedes Amphibalanus amphitrite foram coletados em Recife, Brasil, para avaliar se estes acumulam coliformes totais (CT) e termo-tolerantes (TTC) relacionados à poluição por esgoto doméstico. Foram utilizados os valores de Números Mais Prováveis (NMP) e os procedimentos padrões para exame de bivalves. Comparativamente às amostras de água, os valores mais altos de coliformes foram dos cirrípedes, com valores de TC variando de < 3,0 × 10³ a > 2,4 × 10(6) NMP.g-1, e TTC variando de > 2,4 × 10³ a 2,9 × 10(5) NMP.g-1. Os cirrípedes acumularam TC Ewingella americana e TTC Escherichia coli, Enterobacter gergoviae, Enterobacter aerogenes e Enterobacter sakazakii. Os resultados proveram uma indicação de que há contaminação orgânica nas localidades de amostras e que esta espécie pode ser um bioindicador bom de poluição orgânica.
Subject(s)
Animals , Enterobacteriaceae/isolation & purification , Environmental Monitoring/methods , Thoracica/microbiology , Water Pollution/analysis , BrazilABSTRACT
A Doença de Chagas (DC) é uma infecção sistêmica generalizada, normalmente crônica, cujo agente etiológico é o Tripanossoma cruzi, que parasita as células miocárdicas, lesa o sistema de condução e perturba o controle autonômico, levando a uma cardiomiopatia dilatada e arritmias cardíacas. A análise da variabilidade da frequência cardíaca com o domínio de tempo e de freqüência é uma forma simples e prática de avaliar a função autonômica. O objetivo do estudo foi a avaliação de pacientes com DC usando as variáveis de domínio de tempo e de frequência. Foram comparados um grupo de 81 pacientes com DC (47 na fase indeterminada, 8 do sexo masculino, idade média de 55,07 Ý 10,75 anos, e 34 na crônica, 8 do sexo masculino, idade média de 57,46 Ý 11,59 anos) e um grupo controle de 24 pacientes (7 do sexo masculino, idade média de 48,50 Ý 13,93 anos). Obtidas as variáveis de todos os indivíduos através do Holter 24 horas (SDNN, índice de SDNN e de SDANN, rMSSD, pNN50, LF e HF), utilizou-se a análise de variância (a=5por cento) como teste estatístico. Para o SDNN, o índice de SDANN e o HF não houve diferença estatística entre os grupos (p=0,01). Uma diferença estatística foi encontrada entre o grupo controle e os grupo de pacientes chagásicos (indeterminado e crônico) com relação ao SDANN e o LF (p=0,01). Em relação ao grupo controle, os chagásicos apresentaram as variáveis rMSSD e pNN50 com valores estatisticamente maiores. Usando a análise espectral, foi observada uma redução na capacidade da resposta simpática, bem como uma diminuição global da função autonômica observada pela redução do SDANN em ambos os grupos de pacientes chagásicos
Subject(s)
Humans , Male , Adult , Middle Aged , Chagas Disease/physiopathology , Heart Rate/physiology , Spectrum Analysis/statistics & numerical data , Data Interpretation, StatisticalABSTRACT
OBJECTIVE: To assess late complications following percutaneous tracheostomy using the Griggs technique. DESIGN: Observational cohort study SETTING: General ICU of a 700-bed district general hospital in the United Kingdom. PATIENTS: Twenty-five patients who underwent Griggs tracheostomy in the ICU and survived for at least 6 months after decannulation. INTERVENTION: Patients were invited to attend for assessment by questionnaire and for spiral CT of the trachea. RESULTS: Eight patients had moderate tracheal dilatation, two patients were permanently hoarse, nine patients had minor voice changes, no patient had tracheal stenosis, and no patient had a disfiguring scar. CONCLUSION: Following Griggs percutaneous tracheostomy, 8 of 25 patients developed moderate tracheal dilatation, and none developed a tracheal stenosis. The cosmetic result after Griggs tracheostomy is good, but the number of patients with minor voice changes is high. A further investigation of long-term outcome following Griggs tracheostomy is necessary.
Subject(s)
Critical Care , Image Processing, Computer-Assisted , Postoperative Complications/diagnostic imaging , Tomography, X-Ray Computed , Tracheostomy , Aged , Aged, 80 and over , Cohort Studies , Dilatation , Female , Follow-Up Studies , Humans , Male , Middle Aged , Trachea/diagnostic imagingABSTRACT
The speciation of As(III), As(V), MMA and DMA in marine sediments from La Coruña estuary is described. The arsenic species have been separated by ion-exchange chromatography and detected by hydride generation atomic absorption spectrometry (HGAAS). The redox potential has been determined in order to relate the concentration of arsenic species to this parameter.
