Chronic ulcerative stomatitis: A systematic review of the clinical and microscopic features.

BACKGROUND: the purpose of this study was to perform a systematic review regarding clinical and histopathological characteristics, immunopathological findings, and treatment for chronic ulcerative stomatitis (CUS). MATERIAL AND METHODS: articles in English, published from January 1962 up to November 2017, assessing clinical and immunological features, treatment, and follow-up of patientes with CUS, were retrieved from three databases (PubMed, Cochrane Library and SCOPUS). A manual literature search was also conducted. A total of 12 studies met inclusion criteria, therefore, were analyzed in this review. RESULTS: CUS shares similiar clinical and microscopic features to those found in oral lichen planus (OLP) and oral lichenoid lesions (OLL). Hence, direct immunofluorescence (DIF) is indispensable to define a final diagnosis. Due to the poor sample availability in the current literature, it is not possible to accurately confirm the prevalence and features of CUS. CONCLUSION: in order to better evaluate this condition's findings, further studies with a greater amount of similar immune-mediated diseases should be performed.

Impact of systemic lupus erythematosus on oral health-related quality of life.

Oral symptoms in systemic lupus erythematosus (SLE) patients are often unexplored and affect the health-related quality of life. The aims of this study were: (a) to evaluate the oral health condition of SLE patients compared to control subjects without rheumatic diseases; (b) to determine the consequences of oral health condition in the quality of life of these two groups. Individuals with SLE ( n = 75) and without SLE ( n = 78) (control group), paired for gender and age, underwent complete oral examination. Sociodemographic and clinical information was obtained, and interviews were conducted using the Brazilian version of the oral health impact profile. The activity and damage of SLE disease were assessed, respectively, by the systemic lupus erythematosus disease activity index 2000 and the Systemic Lupus International Collaborating Clinics/American College of Rheumatology damage index for systemic lupus erythematosus. When we analysed the oral health condition and hygiene habits of the participants, SLE patients exhibited an increased number of missing teeth despite their higher frequency of tooth brushing. No significant differences were verified in other habits and clinical parameters evaluated such as smoking, flossing, salivary flux, periodontitis, decayed and filled teeth. Patients with SLE presented with worse oral health-related quality of life than controls ( P = 0.011). The significant difference was on individuals' physical disability ( P = 0.002). The determinant of the negative impact on the oral health-related quality of life was prosthesis wearing ( P < 0.05). Overall, the oral health impact profile score was higher in individuals with moderate SLE damage compared to SLE individuals with no damage ( P = 0.043). Patients with SLE had a negative impact of oral condition on their quality of life. The evaluation of the oral health-related quality of life might be useful to monitor the effects of SLE on oral condition.

Outcome in anorectal malformation type rectovesical fistula: a nationwide cohort study in The Netherlands.

PURPOSE: Outcomes of patients with an ARM-type rectovesical fistula are scarcely reported in medical literature. This study evaluates associated congenital anomalies and long-term colorectal and urological outcome in this group of ARM-patients. METHODS: A retrospective Dutch cohort study on patients treated between 1983 and 2014 was performed. Associated congenital anomalies were documented, and colorectal and urological outcome recorded at five and ten years of follow-up. RESULTS: Eighteen patients were included, with a mean follow-up of 10.8years. Associated congenital anomalies were observed in 89% of the patients, 61% considered a VACTERL-association. Total sacral agenesis was present in 17% of our patients. At five and ten years follow-up voluntary bowel movements were described in 80% and 50%, constipation in 80% and 87%, and soiling in 42% and 63% of the patients, respectively. Bowel management was needed in 90% and one patient had a definitive colostomy. PSARP was the surgical reconstructive procedure in 83%. Urological outcome showed 14 patients (81%) to be continent. No kidney transplantations were needed. CONCLUSION: In our national cohort of ARM-patients type rectovesical fistula that included a significant proportion of patients with major sacral anomalies, the vast majority remained reliant on bowel management to be clean after ten years follow-up, despite "modern" PSARP-repair. Continence for urine is achieved in the majority of patients, and end-stage kidney failure is rare.

Hirschsprung's disease in children with Down syndrome: a comparative study.

BACKGROUND AND AIM: There is controversy in the literature regarding the outcome after surgical treatment of Hirschsprung's disease in children with Down syndrome (DS). The aim of this study was to compare the outcome of our series of DS children with Hirschsprung's disease to our series of children without Down syndrome (NDS) with Hirschsprung's disease. The impact of laparoscopy within the DS group was analyzed. MATERIAL AND METHODS: Between March 1987 and August 2008, 149 children were operated on for Hirschsprung's disease. 20 children of this group were additionally diagnosed with Down syndrome. All children underwent either an open or a laparoscopic Duhamel procedure. We evaluated postoperative hospital stay, short-term complications and the incidence of enterocolitis, constipation and incontinence. RESULTS: 20 patients (13.4%) in this series had Down syndrome. There were no significant differences in the extent of aganglionosis between children with or without Down syndrome. There were no intra-operative complications and no conversions. Postoperative leak occurred significantly more often in children with DS (n=5, 25%) compared to NDS children (n=1, 0.7%; p<0.0001). Postoperative leakage-related abscess formation was higher in the DS group (n=3, 15%) compared to the NDS group (0%). Within the DS group there was no significant difference between open or laparoscopic Duhamel procedure with regard to these postoperative complications. Postoperative hospital stay was significantly longer in the DS group compared to the NDS group (p<0.05). In the DS group there was a slightly shorter postoperative stay after laparoscopic Duhamel procedure. Mean long-term follow-up was 5.1 years. One death occurred in the DS group 9 months postoperatively due to sepsis and cardiomyopathy. Severe constipation was present significantly more often in DS children (n=11, 55%) compared to NDS children (n=29, 22.3%; p<0.01). There was no difference in incontinence between DS and NDS children. Enterocolitis occurred more frequently in DS patients after operation (40 [31% NDS] vs. 9 [45% DS]; p=0.038). CONCLUSION: Compared to NDS children, children with DS have a higher rate of postoperative complications and a longer hospital stay. During long-term follow-up most patients with DS are severely constipated and have a higher incidence of enterocolitis.

Minimally invasive pediatric surgery: Increasing implementation in daily practice and resident's training.

BACKGROUND: In 1998, the one-year experience in minimally invasive abdominal surgery in children at a pediatric training center was assessed. Seven years later, we determined the current status of pediatric minimally invasive surgery in daily practice and surgical training. METHODS: A retrospective review was undertaken of all children with intra-abdominal operations performed between 1 January 2005 and 31 December 2005. RESULTS: The type of operations performed ranged from common interventions to demanding laparoscopic procedures. 81% of all abdominal procedures were performed laparoscopically, with a complication rate stable at 6.9%, and conversion rate decreasing from 10% to 7.4%, compared to 1998. There were six new advanced laparoscopic procedures performed in 2005 as compared to 1998. The children in the open operated group were significantly smaller and younger than in the laparoscopic group (p < 0.001 and p = 0.001, respectively). The majority (64.2%) of the laparoscopic procedures were performed by a trainee. There was no difference in the operating times of open versus laparoscopic surgery, or of procedures performed by trainees versus staff surgeons. Laparoscopy by trainees did not have a negative impact on complication or conversion rates. CONCLUSIONS: Laparoscopy is an established approach in abdominal procedures in children, and does not hamper surgical training.

[Invagination in children: not always ileocaecal]. / Invaginaties bij kinderen: niet altijd ileocoecaal.

Three patients, two girls aged 10 and a boy aged 11, suffered from secondary intussusception. Two of the cases were mistakenly managed as an idiopathic or classic intussusception. Hydrostatic reduction with a contrast enema was thought to be successful when retrograde influx in the ileum was seen. As the intussusception recurred, a diagnostic laparoscopy was performed followed by laparotomy and surgical treatment. In both cases an ileo-ileal intussusception was found. In one case the lead point was a malignant lymphoma, in the other case probably an area of vasculitis associated with Henoch Schönlein purpura. The enema had only repositioned the ileocolic part of the intussusception. In the third patient, the ileo-ileal intussusception resolved spontaneously. Due to the location of the intus-susception, a lead point was suspected and a laparoscopy was performed. A Meckel's diverticulum was found and resected. The importance of looking for a lead point is emphasized when dealing with an intussusception in children over the age of 3, or with evidence of underlying disease. In such cases, the relative value of a contrast enema for diagnosis and reposition is emphasised. There should be a low threshold for further investigation, including diagnostic laparoscopy.

Duhamel procedure: a comparative retrospective study between an open and a laparoscopic technique.

BACKGROUND: Few studies are available comparing open with laparoscopic treatment of Hirschsprung's disease. This study compares a laparoscopic series of 30 patients with a historical open series of 25 patients. METHODS: The charts of all patients having had a Duhamel procedure in the period from June 1987 through July 2003 were retrospectively reviewed. Open procedures were performed until March 1994. Patients with extended aganglionosis, pre-Duhamel ostomy, or syndrome were excluded from the study. End points were intraoperative complications, postoperative complications, time to first feeding, hospital stay, and outcome at follow-up such as stenosis, enterocolitis, constipation, fecal incontinence, and enuresis. RESULTS: Twenty-five patients had an open Duhamel (OD) and 30 had a laparoscopic one (LD). There were no differences in patient characteristics and there were no intraoperative complications in either group. Time to first oral feeds was significantly longer in the OD group as was the duration of hospital stay. No significant differences at follow-up were observed but there was a tendency for a higher enterocolitis rate in the LD group. In contrast, the adhesive obstruction and enuresis rates were higher in the OD group. Cosmetic results were superior in the LD group. CONCLUSIONS: Except for a significantly shorter hospital stay and shorter time to first oral feeds in favor of LD, no significant differences could be observed. The cosmetic result was not an end point but there was no doubt that it was better in the LD group. Although not statistically significant different, there were no adhesive bowel obstructions in the LD group compared with 3 of 25 in the OD group. Fecal incontinence was not encountered in either group.

Relationship between psychological stress and semen quality among in-vitro fertilization patients.

The purpose of this study was to determine the relationship between psychological stress and semen quality among men undergoing in-vitro fertilization (IVF). We assessed psychological variables, including self-reported stress, and sperm parameters in a group of 40 men undergoing IVF for the first time at a pre-IVF sampling period (T1) and at the time of egg retrieval (T2). Thirty-one patients completed the study. Results indicated that total and motile sperm concentration, total motile spermatozoa, and lateral head displacement decreased significantly from T1 to T2 in a high percentage of participants. In addition, the perceived importance of producing a semen specimen increased significantly (P = 0.001) from T1 to T2, and this change was significantly correlated (P < 0.05) with diminished semen quality at the time of oocyte retrieval. No decline in the semen quality or increase in perceived stress at egg retrieval was observed at T2 in male factor patients (n = 7). This study provides evidence for a significant decline in semen quality of male IVF patients at egg retrieval and demonstrates an inverse relationship between semen quality and specific aspects of psychological stress.