The influence of closure technique in total laryngectomy on the development of a pseudo-diverticulum and dysphagia.

OBJECTIVE: In total laryngectomy, the neopharynx can be closed in several ways. It is suggested that a pseudo-diverticulum is seen more frequently in patients closed with vertical closure than with "T"-shaped closure, causing postoperative dysphagia. We report the results of patients treated with vertical closure and "T"-shaped closure with regard to the formation of a pseudo-diverticulum and postoperative dysphagia. METHODS: In our retrospective cohort study, we identified 117 consecutive laryngectomized patients treated in the VU University Medical Center of Amsterdam between March 2009 and December 2013. Evaluations with statistical analysis of postoperative outcome measures (the formation of a pseudo-diverticulum and dysphagia), qualitative and quantitative variables were conducted. RESULTS: Patient demographics were similar between the vertical-shaped closure and the "T"-shaped closure groups. In 84.6% of patients with vertical closure, a pseudo-diverticulum was seen compared to 18.5% with "T"-shaped closure (p < 0.001). Dysphagia was increasingly seen in patients with a pseudo-diverticulum (60.5%) compared to patients without a pseudo-diverticulum (39.5%) (p = 0.090). CONCLUSION: Formation of a pseudo-diverticulum is more frequently seen in laryngectomy patients closed with vertical closure than in patients closed with "T"-shaped closure of the neopharynx. It is favorable to implement "T"-shaped closure in laryngectomy.

Management of anorectal malformation without ligation of fistula: an approach preventing posterior urethral diverticula.

OBJECTIVE: The posterior urethral diverticulum is a common urologic complication requiring reoperations in anorectal malformation cases (ARM). We present a series of 24 cases of male ARM managed without ligation of fistula. MATERIAL AND METHODS: A prospective study was conducted between July 2010 and June 2012 including male neonates with ARM, where rectobladder neck and rectoprostatic fistula were approached by the abdominal route. The fistulous tract was dissected to the distal-most possible length and was excised flush with the urethra without its ligation. A per-urethral catheter was placed in situ. A record was made of any features of urinary leak and a micturating cystourethrogram was performed at the 1-year of follow-up. RESULTS: Twenty-four cases of ARM, 16 with rectobladder neck fistula and eight cases with rectoprostatic fistula were included. Of these, 12 had single-stage primary abdominoperineal pull-through and 10 were managed by primary posterior sagittal anorectoplasty. Two cases with colostomy during the neonatal period were managed by laparoscopic assisted anorectoplasty at 6 months. None of the cases had a urinary leak during the postoperative period. All had a normal micturating cystourethrogram at 1 year. CONCLUSIONS: The approach of dividing fistula without ligation may prevent posterior urethral diverticula, but larger long-term follow-up studies are needed.

Source of dietary fibre and diverticular disease incidence: a prospective study of UK women.

BACKGROUND: Previous prospective studies have found the incidence of intestinal diverticular disease decreased with increasing intakes of dietary fibre, but associations by the fibre source are less well characterised. We assessed these associations in a large UK prospective study of middle-aged women. METHODS AND FINDINGS: During 6 (SD 1) years follow-up of 690 075 women without known diverticular disease who had not changed their diet in the last 5 years, 17 325 were admitted to hospital or died with diverticular disease. Dietary fibre intake was assessed using a validated 40-item food questionnaire and remeasured 1 year later in 4265 randomly-selected women. Mean total dietary fibre intake at baseline was 13.8 (SD 5.0) g/day, of which 42% came from cereals, 22% from fruits, 19% from vegetables (not potatoes) and 15% from potatoes. The relative risk (95% CI) for diverticular disease per 5 g/day fibre intake was 0.86 (0.84 to 0.88). There was significant heterogeneity by the four main sources of fibre (p<0.0001), with relative risks, adjusted for each of the other sources of dietary fibre of 0.84 (0.81 to 0.88) per 5 g/day for cereal, 0.81 (0.77 to 0.86) per 5 g/day for fruit, 1.03 (0.93 to 1.14) per 5 g/day for vegetable and 1.04 (1.02 to 1.07) per 1 g/day for potato fibre. CONCLUSIONS: A higher intake of dietary fibre is associated with a reduced risk of diverticular disease. The associations with diverticular disease appear to vary by fibre source, and the reasons for this variation are unclear.

A systematic review of high-fibre dietary therapy in diverticular disease.

PURPOSE: The exact pathogenesis of diverticular disease of the sigmoid colon is not well established. However, the hypothesis that a low-fibre diet may result in diverticulosis and a high-fibre diet will prevent symptoms or complications of diverticular disease is widely accepted. The aim of this review is to assess whether a high-fibre diet can improve symptoms and/or prevent complications of diverticular disease of the sigmoid colon and/or prevent recurrent diverticulitis after a primary episode. METHODS: Clinical studies were eligible for inclusion if they assessed the treatment of diverticular disease or the prevention of recurrent diverticulitis with a high-fibre diet. The following exclusion criteria were used for study selection: studies without comparison of the patient group with a control group. RESULTS: No studies concerning prevention of recurrent diverticulitis with a high-fibre diet met our inclusion criteria. Three randomised controlled trials (RCT) and one case-control study were included in this systematic review. One RCT of moderate quality showed no difference in the primary endpoints. A second RCT of moderate quality and the case-control study found a significant difference in favour of a high-fibre diet in the treatment of symptomatic diverticular disease. The third RCT of moderate quality found a significant difference in favour of methylcellulose (fibre supplement). This study also showed a placebo effect. CONCLUSION: High-quality evidence for a high-fibre diet in the treatment of diverticular disease is lacking, and most recommendations are based on inconsistent level 2 and mostly level 3 evidence. Nevertheless, high-fibre diet is still recommended in several guidelines.

Low-residue diet in diverticular disease: putting an end to a myth.

Residue refers to any indigestible food substance that remains in the intestinal tract and contributes to stool bulk. Historically, low-residue diets have been recommended for diverticulosis because of a concern that indigestible nuts, seeds, corn, and popcorn could enter, block, or irritate a diverticulum and result in diverticulitis and possibly increase the risk of perforation. To date, there is no evidence supporting such a practice. In contrast, dietary fiber supplementation has been advocated to prevent diverticula formation and recurrence of symptomatic diverticulosis, although this is based mostly on low-quality observational studies. This report focuses on the evidence that fiber intake may be beneficial in the prevention and recurrence of symptomatic and complicated diverticular disease and provides recommendations regarding fiber supplementation in individuals with diverticulosis.

Posterior urethral diverticulum after laparoscopic-assisted repair of high-type anorectal malformation in a male patient: surgical treatment and prevention.

Currently, laparoscopic-assisted colon pull-through (LACPT) is the treatment of choice for male patients with high-type imperforate anus and rectourethral fistula. Since laparoscopy was introduced for treating this condition, reports concerning post-LACPT complications are rare. Here we discuss the case of a boy, now 3.5 years old, born at 37 weeks' gestation weighing 2,300 g, who was diagnosed with rectobulbar urethral fistula (RUF) at birth. LACPT was performed when the boy was 11 months old and weighed 7.2 kg. No intraoperative complications occurred, and the initial post-LACPT course was uneventful. When he was 2 years old, he developed dysuria requiring urethral catheterization. Diagnostic radiology confirmed a large cystic mass behind the bladder, suggestive of a posterior urethral diverticulum (PUD). Histopathology of the excised mucosa of the cyst showed colonic mucosa, confirming that the cyst was indeed an enlarged residual RUF. We discuss our treatment and our approach to prevention.

Overview of the health benefits of fruit and vegetable consumption for the dietetics professional: selected literature.

Epidemiologic evidence of a protective role for fruits and vegetables in cancer prevention is substantial. The strength of this scientific base guides US national policymaking in diet and health issues and facilitates community and local programs that address national dietary goals to increase fruit and vegetable consumption. Current scientific evidence also suggests a protective role for fruits and vegetables in prevention of coronary heart disease, and evidence is accumulating for a protective role in stroke. In addition, a new scientific base is emerging to support a protective role for fruits and vegetables in prevention of cataract formation, chronic obstructive pulmonary disease, diverticulosis, and possibly, hypertension. This article provides an overview of the health benefits associated with fruit and vegetable consumption for each of these conditions, including brief discussions of underlying protective mechanisms, identifies key scientific findings regarding the health benefits of fruit and vegetable consumption, and outlines applications of these findings for dietetics professionals. The evidence reviewed provides additional support for increased consumption of a wide variety of vegetables, in particular, dark-green leafy, cruciferous, and deep-yellow-orange ones, and a wide variety of fruits, in particular, citrus and deep-yellow-orange ones. Continued attention to increasing fruit and vegetable consumption is a practical and important way to optimize nutrition to reduce disease risk and maximize good health.

A prospective study of dietary fiber types and symptomatic diverticular disease in men.

To examine prospectively dietary fiber calculated from food composition values based on analytic techniques and specific dietary fiber types in relation to risk of diverticular disease, we analyzed data from a prospective cohort of 43,881 U.S. male health professionals 40-75 y of age at base line; subjects were free of diagnosed diverticular disease, colon or rectal polyps, ulcerative colitis and cancer. The insoluble component of fiber was inversely associated with risk of diverticular disease relative risk (RR) = 0. 63, 95% confidence interval (CI), 0.44-0.91, P for trend = 0.02, and this association was particularly strong for cellulose (RR = 0.52, 95% CI, 0.36-0.75, P for trend = 0.002). The association between diverticular disease and total dietary fiber intake calculated from the AOACstandards method was not appreciably different from results using the Southgate or Englyst method [for AOAC method, RR = 0.60, 95% CI, 0.41-0.87; for Southgate method, RR = 0.61, 95% CI, 0.42-0. 88; for Englyst method, RR = 0.60, 95% CI, 0.42-0.87, for the highest quintiles]. Our findings provide evidence for the hypothesis that a diet high in dietary fiber decreases the risk of diverticular disease, and this result was not sensitive to the use of different analytic techniques to define dietary fiber. Our findings suggest that the insoluble component of fiber was significantly associated with a decreased risk of diverticular disease, and this inverse association was particularly strong for cellulose.

Modified ASOPA procedure (Hodgson XX) achieves the goals of hypospadias repair.

Several vascularized island flap procedures have been described for the repair of severe hypospadias with chordee. The modified ASOPA (Hodgson XX) procedure, a variant of transverse island flap, employs an inner preputial skin tube for the neourethra while providing simultaneous skin coverage. Since 1988, more than 240 hypospadias repairs have been performed at the authors' institution, including 15 modified ASOPA procedures. All of the patients had proximal hypospadias with chordee. The follow-up of 12 of these patients showed a straight penis, free of chordee, with the meatus at the tip in 11 (92%). One patient had glanular separation and retraction of the meatus to a coronal position. No patient had a urethrocutaneous fistula or urethral diverticulum. Proximal anastomotic strictures were identified in three (25%) patients, which resolved with dilation in two and with internal urethrotomy in the other. The final cosmetic appearance was excellent for 11 patients. Based on these results, the authors conclude that the modified ASOPA procedure reliably achieves the goals of hypospadias repair: release of chordee, urethroplasty, scrotoplasty, and redistribution of skin coverage in one operation, with minimal morbidity.

A prospective study of diet and the risk of symptomatic diverticular disease in men.

To examine the association between dietary fiber, sources of fiber, other nutrients, and the diagnosis of symptomatic diverticular disease, we analyzed data from a prospective cohort of 47,888 US men. During 4 y of follow-up we documented 385 new cases of symptomatic diverticular disease. Total dietary fiber intake was inversely associated with the risk of diverticular disease after adjustment for age, energy-adjusted total fat intake, and physical activity [relative risk (RR) 0.58; 95% CI 0.41, 0.83; P for trend = 0.01 for men in the highest as compared with the lowest quintile of dietary fiber]. This inverse association was primarily due to fruit and vegetable fiber. For men on a high-total-fat, low-fiber diet, the RR was 2.35 (95% CI 1.38, 3.98) compared with those on a low-total-fat, high-fiber diet, and for men on a high-red-meat, low-fiber diet the RR was 3.32 (95% CI 1.46, 7.53) compared with those on a low-red-meat, high-fiber diet. These prospective data support the hypothesis that a diet low in total dietary fiber increases the incidence of symptomatic diverticular disease. They also provide evidence that the combination of high intake of total fat or red meat and a diet low in total dietary fiber particularly augments the risk.

[Bulk vegetable material in human nutrition (author's transl)]. / Die Bedeutung von Ballaststoffen in der Ernährung des Menschen.

Intake of bulk vegetable material has diminished in the western countries considerably since the beginning of industrialisation. Lack of bulk substances is being held responsible lately for the increase of diseases of the gastrointestinal tract. It has been shown, that bulk materials increased stool weight and decreased gastrointestinal passage time; it is assumed, that they do have beneficial effects in the treatment of diverticulosis of the colon. It is still controversial, how bulk materials influence mineral metabolism, especially intestinal resorption of iron, calcium and other bivalent cations. Hypocholesterinemic effects of lignin and pectin, which form part of vegetable bulk food, are as yet not well defined. The question is still open, if bulk foods do have prophylactic effects in regard to carcinoma of the colon.

Go ..., eat thy bread with joy.

Bread--man's oldest "convenience food" --is often overlooked in this era of "take-away" and snack foods. Bread is a nutritious food which contributes protein, vitamins of the B group, some calcium and iron as well as starch, the preferred form of carbohydrate, to the diet. Being low in fat it is not as high in calories as is often thought.