Is Radical Bowel Cancer Resection Under Local Anaesthesia and Sedation Feasible?

Some patients with bowel cancer have significant comorbidities, making them unfit for major surgery under general anaesthesia. However, treatment without surgery offers no possibility of cure, and furthermore, symptom control may be poor. We investigated the possibility of performing these resections under local anaesthesia in patients with a slim body habitus in a cohort of patients rejected for general anaesthesia. Eight patients (4 M, 4 F) aged 77-89 were included in this study. All had significant comorbidities and were deemed unfit for general anaesthesia by the consultant anaesthetist in charge of pre assessing high-risk patients. All patients had undergone a thorough assessment, which included P-POSSUM scoring. The recruited patients underwent a careful and fully informed consenting process, leading to standard cancer resections. These resections occurred between 2005 and 2012, under combined local anaesthesia and sedation. The operations undertaken were four right hemicolectomies (for caecal cancer), two Hartmann's procedures (for sigmoid cancer), one Hartmann's procedure with en bloc small bowel resection (for sigmoid cancer invading small bowel) and one transverse colectomy (for mid transverse colon cancer). Seven patients survived radical surgery without complications, although one died from an unrelated cause 8 months after surgery. One of these surviving patients subsequently underwent CABG and further bowel surgery under GA 2 years later for a metachronous sigmoid cancer. There was one postoperative death due to cardiogenic shock on the third postoperative day. Radical cancer resections under local anaesthesia are feasible in suitably selected high-risk patients with acceptable mortality and comparable medium- to long-term results.

Knowledge of periconceptional folic acid use among pregnant women at Ain Shams University Hospital, Cairo, Egypt.

Egypt has a high incidence of neural tube defects. Folic acid supplementation in the periconceptional period is known to lower the risk of such defects. This cross-sectional study aimed to measure the level of knowledge about periconceptional folic acid use among pregnant women attending for antenatal care at Ain Shams University Hospital, Cairo, Egypt in 2012. Questionnaires were filled through personal interviews with 660 pregnant women. Of the respondents, 62.4% had heard of folic acid and 39.2% knew about the role of folic acid supplementation in prevention of congenital anomalies. Knowledge about using folic acid before and in the first trimester of pregnancy was highest among university-educated women and those working in professional occupations. Only 18.8% of women reported taking folic acid, and 8.8% had used it before conception. Awareness campaigns are suggested to improve knowledge about folic acid among women in the childbearing period in Egypt.

Knowledge of periconceptional folic acid use among pregnant women at Ain Shams University Hospital, Cairo, Egypt

Egypt has a high incidence of neural tube defects. Folic acid supplementation in the periconceptional period is known to lower the risk of such defects. This cross-sectional study aimed to measure the level of knowledge about periconceptional folic acid use among pregnant women attending for antenatal care at Ain Shams University Hospital, Cairo, Egypt in 2012. Questionnaires were filled through personal interviews with 660 pregnant women. Of the respondents, 62.4% had heard of folic acid and 39.2% knew about the role of folic acid supplementation in prevention of congenital anomalies. Knowledge about using folic acid before and in the first trimester of pregnancy was highest among university-educated women and those working in professional occupations. Only 18.8% of women reported taking folic acid, and 8.8% had used it before conception. Awareness campaigns are suggested to improve knowledge about folic acid among women in the childbearing period in Egypt

En Egypte, l'incidence des malformations du tube neural est élevée. La supplémentation en acide folique durant la période périconceptionnelle est connue pour réduire le risque de telles malformations. La présente étude transversale visait à mesurer le niveau de connaissances sur l'utilisation périconceptionnelle de l'acide folique chez des femmes enceintes consultant à l'hôpital universitaire Ain Shams au Caire [Egypte] pour des soins prénatals en 2012. Des questionnaires ont été remplis pendant des entretiens individuels avec 660 femmes enceintes. Parmi les répondantes, 62,4% avaient entendu parler de l'acide folique et 39,2% connaissaient le rôle de la supplémentation en acide folique dans la prévention des anomalies congénitales. Les femmes ayant fait des études universitaires et celles exerçant une activité professionnelle possédaient les connaissances les plus élevées sur l'utilisation de l'acide folique avant et pendant le premier trimestre de grossesse. Seules 18,8% des femmes ont déclaré prendre de l'acide folique, et 8,8% y avaient eu recours avant la conception. Des campagnes de sensibilisation sont suggérées pour améliorer les connaissances sur l'acide folique chez les femmes en âge de procréer en Egypte

لوحظ في مر وقوع مرتفع لعيوب الأنبوب العصبي. ومن المعروف أن المعالجة التكميلية بحمض الفوليك في الفرة المحيطةبالحمل تقلل من مخاطر مثل هذه العيوب. وقد هدفت هذه الدراسة المستعرضة إلى قياس مستوى المعرفة حول استخدام حمضالفوليك في الفرة المحيطة بالحمل لدى النساء الحوامل اللائي يرددن عى الرعاية السابقة للولادة في مستشفى جامعة عن شمسبالقاهرة في مر في عام 2012 . فتم ملء استبيانات من خال مقابات شخصية مع 660 امرأة حامل. فتبنَّ أن 62.4 % من المستطلَعاتقد سمعنَ بحمض الفوليك، و 39.2 % منهن عى علم بدور المعالجة التكميلية بحمض الفوليك في الوقاية من الشذوذات الخلقية.وكانت المعرفة عن استخدام حمض الفوليك قبل الحمل وفي الأشهر الثلاثة الأولى منه أعى بن النساء اللواتي تلقن تعلياً جامعياًوالنساء اللواتي يعملن في مهن حِرَفيّة. وقد أفادت 18.8 % فقط من النساء بتناول حمض الفوليك، و 8.8 % منهن كنَّ قد استخدمنهقبل الحمل. وتم اقراح القيام بحمات توعية لتحسن المعرفة عن حمض الفوليك لدى النساء اللواتي هنّ في فرة الإنجاب في مر

Mucin lakes or perforation?

We are reporting two cases with similar appearances on post chemo radiotherapy MRI scan of the mucinous adenocarcinoma. There was high signal on T2-weighted sequences of the mucin pools within and beyond the rectal wall. Does this imply that wall tissues become less resistant to cancer pools intrusion after chemo radiation? Does the high intramural pressure have an impact on the protrusion of the cancer pools beyond the muscularis propria? Final histology reports differ from predicted MRI staging. It highlights the difficulty of the final MRI staging and outcome for mucinous adenocarcinomas. The presence of acellular mesothelial reaction, acellular mucin pools and inflammation extending to the serosal surface causes considerable confusion and may result in over staging or under staging of mucinous adenocarcinoma. Pathogenesis and prediction of the mucin lakes behaviour prior and post chemoradiotherapy is unclear and requires future study but may impact surgical management.

Metabolic and cardiovascular risk profiles and hepatitis C virus infection in rural Egypt.

BACKGROUND AND AIMS: To investigate the relationship between lipid profiles and diabetes with past and chronic hepatitis C virus (HCV) infection among village residents of Egypt. PATIENTS AND METHODS: Fasting lipids and glucose profiles were compared among adults never infected with HCV (negative HCV antibodies), infected in the past (positive HCV antibodies and negative HCV RNA) and chronically infected (positive HCV antibodies and HCV RNA). RESULTS: Of the 765 participants, 456 (59.6%) were female, and median age was 40 (range 25-88) years. Chronic HCV infection was present in 113 (14.8%) and past infection in 67 (8.8%). After adjustment for age and sex, participants with chronic HCV infection had lower plasma low density lipoproteins (LDL) cholesterol and triglyceride levels compared with those never infected (age and sex adjusted differences (95% CI) were -19.0 (-26.3 to -11.7) mg/dl and -26.2 (-39.0 to -13.3) mg/dl, respectively). In contrast, participants with cleared HCV infection had higher triglyceride levels compared with those never infected (age and sex adjusted difference (95% CI) was +16.0 (0.03 to 31.9) mg/dl). In multivariate analysis, participants with chronic HCV infection were more likely to have diabetes (OR 3.05, 95% CI 1.19 to 7.81) compared with those never infected, independent of LDL cholesterol levels. CONCLUSION: In conclusion, this community based study has shown that in a single population, chronic HCV infection is associated with glucose intolerance and, despite that, a favourable lipid pattern. An intriguing finding was the high triglyceride levels observed among participants with past infection, suggesting that elevated triglycerides at the time of acute infection may facilitate viral clearance.

A review of contemporary surgical alternatives to permanent colostomy.

OBJECTIVES: To review the options available to patients with faecal incontinence with failed conservative treatment and/or failed anal sphincter repair and assessing the current indications and results of these options. METHODS: A literature search of MEDLINE, EMBASE and Cochrane databases was performed using the relevant search terms. RESULTS: Continent options for patients with severe or end stage faecal incontinence include the creation of a form of an anal neosphincter and more recently sacral nerve stimulation. Over half the patients, who are candidates, may benefit from these procedures, although long term results of sacral nerve stimulation are unknown. Dynamic graciloplasty improves the continence in 44-79% of the patients. The complications include frequent reoperations, high incidence of infection and obstructive defaecation. The success rates of artificial bowel sphincter vary between 24% and 79%. Once functional, the artificial bowel sphincter seems to improve the continence in the majority of the patients. Device removal due to infection, obstructive defaecation and pain is a frequent problem. Sacral nerve stimulation is claimed to result in improvement in continence in 35-100% of patients. The main risks in this procedure are infection, electrode displacement and pain. CONCLUSIONS: All these procedures have high complication rates and have moderate success rates only. A major proportion of patients will need reoperations and hence high motivation is necessary for patients who undergo these procedures. A uniform standard for measurement of success is also necessary so that these procedures can be compared with each other.

[Value of the "Dentascanner"al in dento-maxillary diseases (infectious and cystic)]. / Apport du "dentascanner" en pathologie dento-maxillaire (infectieuse et kystique).

MATERIAL AND METHODS: From July 1993 to April 1994, forty dentascans were performed at Bicetre Hospital, on an Elscint Elite Plus scanner for: chronic sinusitis (18 cases); cystic pathologies (8 cases); pre-operative assessment for dental implantation (14 cases). RESULTS: Dentascan images permitted a precise analysis of dentomaxillary anomalies. In all cases they demonstrated the anatomical relationships of the lesions, permitting a determination of potential complications. In chronic sinusitis dental pathology was demonstrated including peri-apical granulomas or cysts breaks or elevations of the floor of the maxillary sinus, malplaced dental filling material in the maxillary antrum and fistula tracks. Among the 14 pre-operative assessments, four cases of infectious lesions were demonstrated, thereby counter-indicating dental implantation. CONCLUSION: The dentascan appears to be very useful for dentomaxillary pathology by facilitating diagnosis and the formulation of treatment and operative strategies.

Age-related changes in balance performance.

The postural stability of 1280 healthy subjects (640 males and 640 females) between the ages of 6 and 85 years was measured using a modified single limb stance timed test. Balance performance for both sexes increased with chronological age but peaked at different ages. The males' performance with eyes opened and eyes closed peaked at the third decade of life, after which a progressive decline was found. The females' performance with eyes opened and eyes closed peaked at the fourth decade of life and thereafter progressively declined. Except for the first decade of life, males performed better (p < 0.001) than females at all ages. The results of the stepwise regression analyses revealed that stature and body weight were the two viable anthropometric determinants of balance performance; the contribution of body surface area and body adiposity to the prediction of balance performance was negligible.

High voltage electrical stimulation in the augmentation of muscle strength: effects of pulse frequency.

This study was designed to determine the effects of pulse frequency (20pps, 45pps, 80pps) on subjects' voltage tolerance, delayed muscle soreness, and muscle strength gained following 6 weeks of electrical stimulation. Thirty healthy men (mean age = 22 years) were randomly assigned to three groups. Subjects in group 1 (n = 10), group 2 (n = 10), and group 3 (n = 10) had their right quadriceps femoris muscles electrically stimulated with a high-voltage pulsed galvanic stimulator present at pulse frequencies of 20pps, 45pps, and 80pps, respectively. The left limb of each subject served as the control. For all the groups, the duty cycle of the stimulator was set at 10 seconds on and 50 seconds off during the stimulation. At each training session, the maximal tolerable voltage for each subject was monitored. Ten maximum contractions was allowed at each training session. Muscle soreness perception was evaluated 48 hours after stimulation using a 10-point visual analog scale. Electrical stimulation was administered three times a week for 6 weeks. For each subject, the average voltage output and muscle soreness rating were computed at the end of each week. With a cable tensiometer, the knee extension isometric force of both limbs was evaluated before training and at the end of the second, fourth, and sixth weeks of the study and 3 weeks after training. Repeated measure's analysis of variance was used to determine significant differences in the dependent variables. The results showed that the maximum voltage tolerance, muscle soreness ratings, and muscle strength gained by the three groups are not significantly (p > .05) different.(ABSTRACT TRUNCATED AT 250 WORDS)

Implementing the Americans With Disabilities Act of 1990 in higher education.

The purpose of this paper is to provide educators and administrators in higher education with a greater understanding of how the Americans With Disabilities Act of 1990 (ADA) (Public Law 101-336) may affect institutions of higher education and to suggest ways that occupational therapists can assist institutions of higher education to comply with the ADA. When educators attempt to comply with the ADA in systems of higher education, the complexity of universities calls for a model reflective of that complexity. The systems approach to higher education, a model based on the general systems theory, is suggested as such a model. The three essential components of the model--input (i.e., applicants to a university), throughput (i.e., enrolled university student), and output (i.e., the student being graduated)--are acted on by many subsystems of the university. Some of those likely to be affected are application procedures, transportation, housing, dining facilities, and curricula. In planning ways to comply with the ADA, educators in higher education may find that many of these subsystems are required to adapt and make reasonable accommodations for the student with a disability. The model can be used to help identify those subsystems that will be affected by the law and to facilitate planning to comply with the law. Although occupational therapists most often work with persons to help them adapt to change in their lives, they can also work in systems of higher education and help the systems to plan and implement programs related to the ADA. The most effective programs are usually those that are well planned and designed from a holistic perspective, rather than those that are developed as a reaction to a specific situation or incident, that is, programs that are proactive rather than reactive. By using the systems approach to higher education, occupational therapists can focus on those components and subsystems within a university that may be affected by the ADA and meet the individual needs of a university.

Function after ileal pouch and stapled pouch-anal anastomosis for ulcerative colitis.

Fourteen patients with ulcerative colitis underwent formation of an S ileal pouch and construction of a stapled pouch-anal anastomosis by a modified technique, which eliminated the use of purse-string sutures. Eleven have had their covering ileostomies closed. Anal manometry performed before and a median of 9 months after ileostomy closure showed significant impairment of internal anal sphincter function. Night evacuation was significantly reduced in the stapled group compared with a similar group of patients who had undergone S ileal pouch formation, mucosal proctectomy and manual transanal anastomosis, but this was the only parameter of function to show a difference. A stapled pouch-anal anastomosis may be superior to the conventional procedure but it still may lead to internal anal sphincter damage which cannot be due to mucosectomy or prolonged anal retraction.

Comparison of digital and manometric assessment of anal sphincter function.

Anal sphincter function was assessed by digital examination and anal canal manometry in 66 patients and controls. Digital scores were allotted by using visual analogue scales for basal and squeeze sphincter function and were compared with the corresponding pressures. There were good correlations between digital basal score and maximum basal pressure (Spearman rank correlation coefficient rs = 0.56, P less than 0.001), and digital squeeze score and maximum squeeze pressure (rs = 0.72, P less than 0.001). There were wide ranges of sphincter function on digital and manometric assessment with considerable overlap between patient groups. Digital scores detected differences in sphincter function between patient groups as accurately as manometry. The sensitivities and specificities of digital scores and anal canal manometry in segregating continent and incontinent patients were similar. It was concluded that digital estimation was equally as good as assessment of anal sphincter function as anal canal manometry.