Long-term outcomes of Hartmann's procedure versus primary anastomosis for generalized peritonitis due to perforated diverticulitis: follow-up of a prospective multicenter randomized trial (DIVERTI).

BACKGROUND: Surgical management of Hinchey III and IV diverticulitis involves Hartmann's procedure (HP) or primary resection anastomosis (PRA) with or without fecal diversion. These procedures were evaluated in four randomized controlled trials. Early results from these trials demonstrated similar rates of complications but higher rates of colonic restoration after PRA than HP. Long-term follow-up has not been reported to date. The aim of this study was to analyze long-term outcomes and quality of life (QoL) in patients previously enrolled in a prospective randomized trial comparing HP and PRA for generalized peritonitis due to perforated diverticulitis (DIVERTI trial). STUDY DESIGN: Follow-up data were available for 78 of 102 patients. Demographic data, incisional hernia rate, need for additional surgery related to the primary procedure, and QoL were recorded. RESULTS: The overall survival rate was 76% and did not differ between the two groups. Incisional hernia was reported in 21 (52%) patients in the HP arm and in 11 (29%) patients in the PRA arm (p = 0.035). The HP arm demonstrated significantly lower SF-36 physical and mental component scores. The mean general QoL (EQ-VAS) and mean EQ-5D index scores were better after PRA than after HP, but this difference was not statistically significant. The results of GIQLI, which measures intestine-specific QOL, did not differ between the two groups. CONCLUSIONS: This follow-up study with a median follow-up time of > 9 years among living patients indicates that PRA for perforated diverticulitis is associated with fewer long-term complications and better QoL than HP. PRA significantly reduced the incisional hernia rate and the need for reoperation. Long-term survival was not jeopardized by the PRA approach. Future studies are needed to address the utility of protective stoma.

Parity-broken chiral spin dynamics in Ba3NbFe3Si2O14.

The spin-wave excitations emerging from the chiral helically modulated 120° magnetic order in a langasite Ba3NbFe3Si2O14 enantiopure crystal were investigated by unpolarized and polarized inelastic neutron scattering. A dynamical fingerprint of the chiral ground state is obtained, singularized by (i) spectral weight asymmetries answerable to the structural chirality and (ii) a full chirality of the spin correlations observed over the whole energy spectrum. The intrinsic chiral nature of the spin waves' elementary excitations is shown in the absence of macroscopic time-reversal symmetry breaking.

[Measurement of respiratory effort (esophageal pressure) and estimation of resistance of the upper airway in polysomnography: indications, limitations and results]. / Mesure de l'effort respiratoire (pression oesophagienne) et estimation des résistances des voies aériennes supérieures au cours de l'enregistrement de sommeil: indications, limites, résultats.

During polysomnography, measurement of airflow and respiratory effort are essential for classifying the type of respiratory event and for evaluating the efficacy of treatment. There are various ways to measure respiratory effort, the reference technique being oesophageal manometry. This measures fluctuations in intrathoracic pressure which correspond to variations in upper airway resistance and therefore allows differentiation between central and obstructive respiratory events. Thus the simple snorer can be distinguished from an individual with the upper airway resistance syndrome (UARS). In the UARS abnormally high resistance develops in the upper airway in the absence of identifiable apnoeas and hypopnoeas. The characteristic cresendo-decresendo pattern of the oesophageal pressure signal, when associated with the micro-arousals which are responsible for the hypersomnolence, is pathognomonic of this condition. The clinical application of oesophageal manometry is limited by its poor tolerance in certain individuals and by the potential deleterious effect the catheter itself has on sleep quality and on the dynamics of the upper airway. Other less invasive techniques, such as nasal pressure and pulse transit time, are currently under evaluation.