Laparoscopic Hartmann's reversal has better clinical outcomes compared to open surgery: An international multicenter cohort study involving 502 patients.

Background: Hartmann's procedure (HP) is used in surgical emergencies such as colonic perforation and colonic obstruction. "Temporary" colostomy performed during HP is not always reversed in part due to potential morbidity and mortality associated with reversal. There are several contributing factors for patients requiring a permanent colostomy following HP. Therefore, there is still some discussion about which technique to use. The aim of this study was to evaluate perioperative variables of patients undergoing Hartmann's reversal using a laparoscopic and open approach. Methods: The multicenter retrospective cohort study was done between January 2009 and December 2019 at 14 institutions globally. Patients who underwent Hartmann's reversal laparoscopic (LS) and open (OS) approaches were evaluated and compared. Sociodemographic, preoperative, intraoperative variables, and surgical outcomes were analyzed. The main outcomes evaluated were 30-day mortality, length of stay, complications, and postoperative outcomes. Results: Five hundred and two patients (264 in the LS and 238 in the OS group) were included. The most prevalent sex was male in 53.7%, the most common indication was complicated diverticular disease in 69.9%, and 85% were American Society of Anesthesiologist (ASA) II-III. Intraoperative complications were noted in 5.3% and 3.4% in the LS and OS groups, respectively. Small bowel injuries were the most common intraoperative injury in 8.3%, with a higher incidence in the OS group compared with the LS group (12.2% vs. 4.9%, p < 0.5). Inadvertent injuries were more common in the small bowel (3%) in the LS group. A total of 17.2% in the OS versus 13.3% in the LS group required intensive care unit (ICU) admission (p = 0.2). The most frequent postoperative complication was ileus (12.6% in OS vs. 9.8% in LS group, p = 0.4)). Reintervention was required mainly in the OS group (15.5% vs. 5.3% in LS group, p < 0.5); mortality rate was 1%. Conclusions: Laparoscopic Hartmann's reversal is safe and feasible, associated with superior clinical outcomes compared with open surgery.

Clinician preferences for neurotechnologies in pediatric drug-resistant epilepsy: A discrete choice experiment.

OBJECTIVE: Novel and minimally invasive neurotechnologies offer the potential to reduce the burden of epilepsy while avoiding the risks of conventional resective surgery. Few neurotechnologies have been tested in randomized controlled trials with pediatric populations, leaving clinicians to face decisions about whether to recommend these treatments with insufficient evidence about the relevant risks and benefits. This study specifically explores the preferences of clinicians for treating pediatric drug-resistant epilepsy (DRE) with novel neurotechnologies. METHODS: A discrete-choice experiment (DCE) was designed to elicit the preferences of clinicians with experience in treating children with DRE using novel neurotechnological interventions. The preferences for six key attributes used when making treatment decisions (chances of clinically significant improvement in seizures, major and minor risks from intervention, availability of evidence, financial burden for the family, and access to the intervention) were estimated using a conditional logit model. The estimates from this model were then used to predict the adoption of existing novel neurotechnological interventions. RESULTS: Sixty-eight clinicians completed the survey: 33 neurosurgeons, 28 neurologists, and 7 other clinicians. Most clinicians were working in the United States (74%), and the remainder (26%) in Canada. All attributes, apart from the nearest location with access to the intervention, influenced preferences significantly. The chance of clinically significant improvement in seizures was the most positive influence on clinician preferences, but low-quality evidence and a higher risk of major complications could offset these preferences. Of the existing neurotechnological interventions, vagus nerve stimulation was predicted to have the highest likelihood of adoption; deep brain stimulation had the lowest likelihood of adoption. SIGNIFICANCE: The preferences of clinicians are drive primarily by the likelihood of achieving seizure freedom for their patients, but preferences for an intervention are largely eradicated if only low quality of evidence supporting the intervention is available. Until better evidence supporting the use of potentially effective, novel neurotechnologies becomes available, clinicians are likely to prefer more established treatments.

Endoscopy mitigation strategy with telemedicine and low-cost device use for COVID-19 prevention: A fourth-level Colombian center experience.

BACKGROUND AND STUDY AIMS: The COVID-19 outbreak has reorganized surgical team conditions regarding endoscopy. The number of interventions has been reduced, the number of healthcare professionals must be limited, and both the patients and physicians are more protected than ever. PATIENTS AND METHODS: In the highest peak of contagion in Colombia, endoscopy, colonoscopy, and esophagogastroduodenoscopy were performed using a low-cost disposable device. A total of 1388 procedures were performed. Every patient was assessed for symptoms via a telephone call, at the health center, and after the procedure, following specific attention routes. RESULTS: After procedure follow-up, no positive cases of COVID-19 were noted. CONCLUSION: The methodology reduced the risk of infection during the COVID-19 pandemic.

Laparoscopic management of gastric liposarcoma: A case report and review of the literature.

INTRODUCTION: Liposarcoma is one of the most common mesenchymal neoplasms in adults. Predominant locations are the retroperitoneum and limbs, it rarely occurs in the gastrointestinal tract. Gastric liposarcoma is extremely rare, with fewer than 30 cases reported around the world. PRESENTATION OF CASE: Here we present the case of a 70-year-old female patient who was diagnosed with gastric liposarcoma and managed with laparoscopic surgical resection. The patient is currently being followed up and is alive without recurrence 12 months after the operation. DISCUSSION: Gastric liposarcoma approach requires proper diagnosis with computed tomography and endoscopy, in order to develop an adequate surgical plan. Laparoscopic en-bloc resection and gastrointestinal reconstruction is the ideal management in this type of patient. CONCLUSION: Gastric liposarcoma is an extremely rare entity, his management consists of wide en-bloc resection with a gastrointestinal reconstruction.

Adjuvant radiotherapy for low-risk early breast cancer in elderly women: evidence from randomized trials.

Breast cancer is the most common cancer pathology in women in the Western world. The median age at diagnosis is 60 years and in the coming decades it is estimated that the number of elderly women affected reaches an important percentage. This aging of the cancer population, associated with its inherent comorbidities and aggravated by the lack of consensus about the most appropriate treatment, make it difficult to administer an effective postoperative treatment in elderly women with a low-risk profile. An exhaustive geriatric evaluation is a sine qua non condition to opt for a specific type of treatment. To date, several options are available such as endocrine therapy (ET) alone, moderate/high hypofractionation and various accelerated partial breast irradiation (APBI) techniques. In this article, we provide information about each of them.

Clinical Perspectives on Psychiatric Neurosurgery.

INTRODUCTION: Surgical interventions such as stereotactic radiosurgery and magnetic resonance-guided focused ultrasound, and neuromodulatory interventions such as deep brain stimulation (DBS) and vagal nerve stimulation, are under investigation to remediate psychiatric conditions resistant to conventional therapies involving drugs and psychological supports. OBJECTIVE: Given the complicated history of psychiatric neurosurgery and its renaissance today, we sought to examine current perceptions and predictions about the field among practicing functional neurosurgeons. METHODS: We designed a 51-question online survey comprising Likert-type, multiple-choice, and rank-order questions and distributed it to members of the American Society for Stereotactic and Functional Neurosurgery (ASSFN). Descriptive and inferential statistical analyses were performed on the data. RESULTS: We received 38 completed surveys. Half (n = 19) of responders reported devoting at least a portion of their clinical practice to psychiatric neurosurgery, utilizing DBS and treating obsessive compulsive disorder (OCD) most frequently overall. Respondents indicated that psychiatric neurosurgery is more medically effective (OR 0, p = 0.03242, two-sided Fisher's exact test) and has clearer clinical indications for the treatment of OCD than for the treatment of depression (OR 0.09775, p = 0.005137, two-sided Fisher's exact test). Seventy-one percent of all respondents (n = 27) supported the clinical utility of ablative surgery in modern neuropsychiatric practice, 87% (n = 33) agreed that ablative procedures constitute a valid treatment alternative to DBS for some patients, and 61% (n = 23) agreed that ablative surgery may be an acceptable treatment option for patients who are unlikely to comply with postoperative care. CONCLUSIONS: This up-to-date account of practices, perceptions, and predictions about psychiatric neurosurgery contributes to the knowledge about evolving attitudes over time and informs priorities for education and further surgical innovation on the psychiatric neurosurgery landscape.

The re-emergence of psychiatric neurosurgery: insights from a cross-national study of newspaper and magazine coverage.

BACKGROUND: Surgical approaches to treat psychiatric disorders have made a comeback. News media plays an essential role in exposing the public to trends in health care such as the re-emergence of therapeutic interventions in psychiatric neurosurgery that were set aside for decades, and in shaping attitudes and acceptance to them. METHOD: We conducted an analysis of media articles covering all types of psychiatric neurosurgery published in Canada, USA, Germany, and Spain between the years 1960 and 2015. We applied both quantitative and qualitative methods to elucidate patterns of reporting for conditions, themes and tone, across geographic regions, time, and for type of intervention. RESULTS: Coverage of psychiatric neurosurgery has surged since 2001 and is largely consistent across the countries examined. It focuses on depression and deep brain stimulation, and is explicit about historical context. The tone of coverage becomes more positive for Canada, USA and Spain over time; the tone of coverage from Germany remains cautious. Identity and privacy are among the few ethical and philosophical issues raised, notably in the German press. CONCLUSIONS: The focused and optimistic attention to contemporary psychiatric neurosurgery in the media, but inattention to ethical issues, places an extra burden on functional neurosurgeons, psychiatrists, and other frontline health professionals to attend to queries from patients and policy makers about the full range of relevant emergent and emerging interventions and the mental health issues to which they may beneficially apply.

Pesticides.

There is growing evidence about the influence of chemical exposures on specific molecular systems and mechanisms involved in cognitive and mental function. Evidence is also emerging about the negative impact of these chemical exposures on mental health, including depression, suicide, and other risks. Despite the growing appreciation of these factors, however, little attention has been paid to the ethical and social implications of their interactions. Drawing on recent work that argues for an environmental neuroethics approach that explicitly brings together ethics, environment, and conditions of the central nervous system, this article focuses on these critical issues for pesticides specifically.

Ozone Therapy in the Management of Persistent Radiation-Induced Rectal Bleeding in Prostate Cancer Patients.

Introduction. Persistent radiation-induced proctitis and rectal bleeding are debilitating complications with limited therapeutic options. We present our experience with ozone therapy in the management of such refractory rectal bleeding. Methods. Patients (n = 12) previously irradiated for prostate cancer with persistent or severe rectal bleeding without response to conventional treatment were enrolled to receive ozone therapy via rectal insufflations and/or topical application of ozonized-oil. Ten (83%) patients had Grade 3 or Grade 4 toxicity. Median follow-up after ozone therapy was 104 months (range: 52-119). Results. Following ozone therapy, the median grade of toxicity improved from 3 to 1 (p < 0.001) and the number of endoscopy treatments from 37 to 4 (p = 0.032). Hemoglobin levels changed from 11.1 (7-14) g/dL to 13 (10-15) g/dL, before and after ozone therapy, respectively (p = 0.008). Ozone therapy was well tolerated and no adverse effects were noted, except soft and temporary flatulence for some hours after each session. Conclusions. Ozone therapy was effective in radiation-induced rectal bleeding in prostate cancer patients without serious adverse events. It proved useful in the management of rectal bleeding and merits further evaluation.

Proceso de pruebas y suite de herramientas de soluciones informáticas para la salud / Process of tests and suite of tools of informatics solve for the health

Con la estrategia trazada por el Ministerio de Salud Pública para alcanzar la informatización del sector de la salud, se han creado un conjunto de sistemas informáticos capaces de automatizar lo que anteriormente se hacía de forma manual, siendo el Grupo de Integración de Soluciones (GIS) perteneciente a la empresa SOFTEL del Ministerio de Informática y Comunicaciones, el encargado de realizar un conjunto de pruebas con una serie de herramientas para reducir los recursos dedicados a esta actividad e incrementar mayor calidad, fiabilidad y con el menor número de errores posibles. Este trabajo detalla cada proceso de pruebas con las herramientas a utilizar, donde el objetivo es proporcionar los procesos que permiten utilizar disímiles herramientas automatizadas de pruebas, como una suite donde validar las aplicaciones informáticas desarrolladas para el Sistema Nacional de Salud. Esto minimizaría la ocurrencia de errores, cuyo resultado es la automatización de las pruebas unitarias, funcionales y de regresión de todos los sistemas en desarrollo; así como las pruebas a los servicios web, permitiendo la disminución ostensible del tiempo de demora de las pruebas a los sistemas y la cantidad de defectos detectados por los usuarios de las aplicaciones(AU)

With the strategy outlined by the Ministry of Public Health to achieve the informatization have been created a group of computer systems able to automate that previously you toward in a manual way. as the Group Management Integration Solutions (GIS), belonging to the company SOFTEL, Ministry of Information and Communications, in charge of carrying out a group of tests with a series of tools to reduce the resources dedicated to this activity and to increase bigger quality and reliability and with the smallest number of possible errors. This work details each process of tests with the tools to use for each process process where the objective is to provide processes that allow dissimilar to use automated testing tools as a suite which validate software applications developed for the National Health System. This minimize the occurrence of errors, the results are automating unit, functional and regression of all developing test systems; as well as testing web services allowing considerable reduction of delay time test systems and the number of errors detected by application users(AU)

Sagittal and vertical aspects of Class II division 1 subjects according to the respiratory pattern

INTRODUCTION: The teeth position, specially maxillary and mandibular incisors, in relation to basal bone and surrounding soft tissues must be considered in the elaboration of diagnosis, treatment planning and execution to obtain alignment, leveling, intercuspation, facial balance and harmony with stability of results. OBJECTIVES: To evaluate the modifications in the positioning of incisors in individuals with Angle Class II, division 1 malocclusion in two distinct moments of dentocraniofacial development, with mean interval of 2 years and 5 months. METHODS: The measures were obtained by means of lateral cephalograms of 40 individuals, being 23 nasal breathers (NB) and 17 mouth breathers (MB). The analyzed measures were overjet, overbite, UCI-NA, LCI-NB, UCI.NA, LCI.NB, UCI.SN, LCI.GoGn, UCI.LCI, ANB, GoGn.SN, and OccPl.SN. Statistical analysis (2-way repeated-measures ANOVA) was applied to verify intergroups differences. RESULTS: Overjet, UCI-NA, LCI-NB, ANB, GoGn.SN, and OccPl.SN demonstrated statistically significant difference (p < 0.05) when observed the moment or the respiratory method. CONCLUSION: There is alteration in the positioning of incisors during growth with interference of the respiratory pattern.

INTRODUÇÃO: a posição dos dentes, principalmente incisivos superiores e inferiores, em relação às bases ósseas e tecidos moles circundantes deve ser considerada na elaboração do diagnóstico, planejamento e execução do tratamento, para se obter alinhamento, nivelamento, intercuspidação, equilíbrio e harmonia facial com estabilidade dos resultados. OBJETIVOS: avaliar as modificações no posicionamento dos incisivos em indivíduos com má oclusão de Classe II, divisão 1, de Angle, em dois momentos distintos do desenvolvimento dentocraniofacial, num intervalo médio de 2 anos e 5 meses. MÉTODOS: as medidas foram obtidas por meio de telerradiografias em norma lateral de 40 indivíduos, sendo 23 respiradores predominantes nasais (RN) e 17 predominantemente bucais (RB). As medidas avaliadas foram sobressaliência, sobremordida, ICS-NA, ICI-NB, ICS.NA, ICI.NB, ICS.SN, ICI.GoGn, ICS.ICI, ANB, GoGn.SN, Plo.SN. Para verificar a diferença intergrupos, utilizou-se a ANOVA a dois critérios com medidas repetidas. RESULTADOS: sobressaliência, ICS-NA, ICI-NB, ANB, GoGn.SN, Plo.SN apresentaram diferença estatisticamente significativa (p < 0,05) quando observado o momento ou o modo respiratório. CONCLUSÃO: existe alteração no posicionamento dos incisivos no decorrer do crescimento, com interferência do modo respiratório.

Cephalometric effects of the use of 10-hour Force Theory for Class II treatment

OBJECTIVE: This study aimed to evaluate the cephalometric effects promoted by the orthodontic treatment of Class II malocclusion patients with the use of the 10-Hour Force Theory, that consists in the use of fixed appliances with 8 hours a day using a cervical headgear appliance and 16 hours a day using Class II elastics, 8 hours on the first mandibular molar and 8 hours in the second mandibular molar. METHODS: Sample comprised 31 patients with mean initial age of 14.90 years, final mean age of 17.25 years and mean treatment time of 2.35 years. The lateral cephalograms in pre-treatment and post-treatment stages were evaluated. Evaluation of cephalometric changes between initial and final treatment phases was performed by paired t test. RESULTS: The cases treated with the 10-Hour Force Theory presented a slight restriction of anterior displacement of the maxilla, increase in the effective length of the mandible, significant improvement of the maxillomandibular relationship, significant increase in anterior lower face height, distal tipping of the maxillary premolar crowns, extrusion and distal tipping of the roots of maxillary molars, significant proclination and protrusion of mandibular incisors, significant extrusion and mesialization of mandibular molars, besides a significant correction of the molar relationship, overjet and overbite. CONCLUSION: The use of the 10-Hour Force Theory in treatment of Class II malocclusion provided satisfactory results.

OBJETIVO: esse estudo objetivou avaliar os efeitos cefalométricos promovidos pelo tratamento ortodôntico de pacientes com má oclusão de Classe II com o uso da Teoria de Força das 10 Horas, que consiste no uso de aparelho ortodôntico fixo, 8 horas diárias de uso de aparelho extrabucal cervical e 16 horas de uso de elásticos de Classe II, sendo 8 horas com apoio no primeiro molar inferior e 8 horas com apoio no segundo molar inferior. MÉTODOS: a amostra consistiu de 31 pacientes, com idade média inicial de 14,90 anos, idade média final de 17,25 anos e tempo médio de tratamento de 2,35 anos. Foram avaliadas as telerradiografias em norma lateral nas fases pré e pós-tratamento ortodôntico. Para avaliação das alterações cefalométricas entre as fases inicial e final de tratamento, foi utilizado o teste t dependente. RESULTADOS: os casos tratados com a Teoria de Força das 10 Horas apresentaram uma suave restrição do deslocamento anterior da maxila, aumento do comprimento efetivo da mandíbula, melhora significativa da relação maxilomandibular, aumento significativa da altura facial anteroinferior, inclinação para distal da coroa dos pré-molares superiores, extrusão e inclinação para distal da raiz dos molares superiores, inclinação para vestibular e protrusão significativa dos incisivos inferiores, extrusão e mesialização significativos dos molares inferiores, além de correção significativa da relação molar e dos trespasses horizontal e vertical. CONCLUSÃO: o uso da Teoria de Força das 10 Horas no tratamento da má oclusão de Classe II proporcionou resultados satisfatórios.