Transanal circumferential pouch advancement for treatment of pouch vaginal fistulae.

BACKGROUND: Ileal pouch anal anastomosis (IPAA) circumferential pouch advancement (CPA) involves full-thickness transanal 180-360° dissection of the distal pouch, allowing the advancement of healthy bowel to cover the internal opening of a vaginal fistula. We aimed to describe the long-term outcomes of this rare procedure. METHODS: Patients with IPAA who underwent transanal pouch advancement for any indication between 2009 and 2021 were included. Demographics, operative details, and outcomes were reviewed. An early fistula was defined as occurring within 1 year of IPAA construction. Clinical success was defined as resolution of symptoms necessitating CPA, pouch retention, and no stoma at the time of follow-up. Figures represent the median (interquartile range) or frequency (%). RESULTS: Over a 12-year period, nine patients were identified; the median age at CPA was 41 (36-44) years. Four patients developed early fistula after index IPAA, and five developed late fistulae. The median number of fistula repair procedures prior to CPA was 2 (1-2). All patients were diagnosed with ulcerative colitis at the time of IPAA and all late patients were re-diagnosed with Crohn's disease. Four (44.4%) patients had ileostomies present at the time of surgery, three (33.3%) had one constructed during surgery, and two (22.2%) never had a stoma. The median follow-up time was 11 (6-24) months. Clinical success was achieved in four of the nine (44.4%) patients at the time of the last follow-up. CONCLUSIONS: Transanal circumferential pouch advancement was an effective treatment for refractory pouch vaginal fistulas and may be offered to patients who have had previous attempts at repair.

Japanese cedar pollen-specific interleukin-4 production develops immediately after the first exposure to pollens in infants with atopic dermatitis.

BACKGROUND: Japanese cedar pollens (JCPs) spread over most areas of Japan from February to April and cause pollenosis. While IgE synthesis against JCPs starts after age 1, it remains to be clarified when JCP-specific T helper cells acquire the ability to produce IL-4, a cytokine that induces IgE synthesis. OBJECTIVE: This study aimed to clarify when the sensitization of T cells to JCPs develops. METHODS: Peripheral blood mononuclear cells from 153 children with atopic dermatitis (AD) aged 0-15 years were stimulated with a standardized JCP allergen. As parameters of T cell responsiveness, lymphocyte proliferation and the production of IL-4 and IFN-gamma were measured. RESULTS: T cell responses against JCPs were negative before March in infants with AD who had never been exposed to JCPs or who were exposed for less than a month (nine, seven and nine subjects for lymphocyte proliferation, cytokine production and IgE synthesis, respectively). Lymphocyte proliferation distinctly increased in 67.6% (23/34) of infants with AD examined between March and June. JCP-specific IL-4 production was observed in 56.0% (14/25) of infants with AD examined between March and June. Correspondingly, a slight increase in the level of serum JCP-specific IgE antibody was seen in 17.2% (five of 29) of infants with AD examined between April and June. CONCLUSION: These results demonstrate that the sensitization of T cells to JCPs is effectively completed within a few months after the first exposure to JCPs.

Antibiogram of bacterial isolates from cases of otitis media and lower respiratory tract infections.

A total of one hundred and two cases of otitis media were screened for the isolation of bacterial flora of ears. Out of this, Staphylococcus aureus, Streptococcus pneumoniae and Haemophilus influenzae accounting for 41.2%, 25.5% and 13.3% respectively were isolated. A further two hundred and four sputum samples from cases of lower respiratory tract infections were screened. Moraxella catarrhalis, S. aureus, S. pneumoniae and H. influenzae constituting 20.9%, 37%, 30% and 21% were isolated in that order. Thirty-one point seven percent of the Moraxella catarrhalis isolates were beta-lactamase positive. Beta-lactamase M. catarrhalis were resistant to penicillin and ampicillin while the non-beta-lactamase producers were sensitive to these antimicrobial agents. However, both beta-lactamase producers and non-producers were resistant to trimethoprim but sensitive to erythromycin, tetracycline and amoxycillin. Staphylococcus aureus, S. pneumoniae and H. influenzae was also sensitive to penicillin while S. pneumoniae was also sensitive to erythromycin and H. influenzae to chloramphenicol.

The occurrence of Branhamella catarrhalis and other commensal Neisseriaceae in clinical sputum specimens in Lagos, Nigeria.

Branhamella catarrhalis and other commensal Neisseria species were isolated from 200 out of 500 sputum samples from patients with lower respiratory tract (LRT) infections at the Lagos University Teaching Hospital (LUTH). B. catarrhalis was isolated from 60 (12%). The isolation rates for other Neisseria species were as follows: N. mucosa from 45 (9%), N. sicca from 40 (8%), N. lactamica from 35 (7%), N. cinerea from 12 (2.4%) and N. subflava from 8 (1.6%). B. catarrhalis occurred in pure cultures in 15 (25%) of the 60 samples positive for this organism. Twenty (33%) out of the 60 N. catarrhalis isolates were beta-lactamase positive.