Parastomal hernia: an overview.

Parastomal hernia (PH) is one of the most frequent ostomy complications, and the reported incidence in the literature is highly variable. As highlighted by the Association of Stoma Care Nurses UK, this complication develops mainly in children and older men over 70, but many predisposing factors are related to the individual patient and surgery. There is no standardised system for assessing PH. The main assessment techniques include objective examination, ultrasound scan and computed tomography. Prevention is based on various interventions by surgeons and stoma care nurses (SCNs). The SCN's primary interventions include accurate patient evaluation, pre-operative ostomy siting, education about body weight management and advice on appropriate exercises. The treatment of PH can be conservative or surgical, and the choice is based on the patient's clinical condition. Ostomy can significantly impact on a patient's quality of life (QoL), and the presence of PH can further aggravate the situation. This overview of PH considers the incidence, aetiology, prevention, treatment and impact on QoL.

Peristomal Skin Complications: Detailed Analysis of a Web-Based Survey and Predictive Risk Factors.

Patients with a stoma are at risk of developing peristomal skin complications (PSCs) that can negatively impact their quality of life. This study aims to identify potential risk factors for dermatitis, pruritis/xerosis, infections, and ulcerations among patients with a stoma and evaluate preventive measures. This cross-sectional study involved data regarding 232 Italian patients with a stoma. A questionnaire was used to collect patient characteristics, comorbidities, and stoma management data. The most frequent PSCs observed were dermatitis and pruritis/xerosis in approximately 60% of patients. Psoriasis was strongly correlated with dermatitis, while being overweight or obese increased the risk of pruritis/xerosis. Class 2 obesity and atopic dermatitis were associated with an increased risk of infections. Being underweight, completely nonautonomous, and having inflammatory bowel disease were associated with a higher risk of ulcerations, while radiotherapy was a strong risk factor for ulceration. Preventive measures such as using hydrocolloid barriers, TNT gauze cleansing, and low pH detergent were effective in preventing dermatitis. Appropriate stoma care and maintenance, including the use of protective film and careful monitoring of weight and comorbidities, are crucial in minimizing the risk of complications associated with a stoma.

The frequency of early stomal, peristomal and skin complications.

BACKGROUND: The incidence of early complications after stoma formation (within 30 days of surgery) is difficult to determine and has been reported to be in a range of 3%-82%. AIM: The aim of this study was to analyse the onset of stomal, peristomal and skin complications one month (30 days) after ostomy creation. METHOD: This review analysed enteral stoma therapy nurse reports on patients who had an ostomy created between January 2016 and December 2020. FINDINGS: Complications were analysed according to ostomy type: colostomy, ileostomy and urostomy. There were 1292 incidences of complications: skin complications were the most common (26%), and abscess the least common (0%). CONCLUSION: A majority (63%) of patients experienced at least one or more complications within 30 days of surgery. Haemorrhage was reported as a complication (2%) but the authors found no data on its incidence in the literature. In addition to early complications, late complications were detected.

SACS Evolution: a peristomal health tool for the prevention of peristomal skin disorders.

BACKGROUND: The ostomy patient's quality of life also depends on their peristomal health and thus first and foremost on keeping healthy peristomal skin. This is by no means an easy task, given that the incidence of peristomal skin disorders can be a factor in up to 80% of cases. Over the past 15 years, several tools have been developed to classify peristomal skin lesions to facilitate the management of the problem. These tools, however, meet the needs of healthcare professionals and those of patients. Hence the decision to work on an advanced version of the SACS©, currently the most widely used tool, with the setting up of the SACS Evolution Consensus Group. METHODS: By applying the simplified Delphi method, the SACS Evolution Consensus Group critically re-read what had been garnered from the literature in the light of their personal clinical experience, identified the key issues to be addressed, and processed and refined the relevant statements. This made it possible to achieve the challenging objective of creating a peristomal health tool to help prevent peristomal skin lesions. RESULTS: SACS Evolution is, indeed, a promising tool for preventing peristomal lesions. It is structured on two different levels, one for the patient and one for the healthcare professional, each characterized by specific language and based on an innovative concept of healthy peristomal skin, which is essential for those who work on peristomal health. CONCLUSIONS: The SACS Evolution Consensus Group thus aims to validate this peristomal health tool and has already started a validation process so that the tool can be used in clinical practice.

Two-group Poisson-Dirichlet mixtures for multiple testing.

The simultaneous testing of multiple hypotheses is common to the analysis of high-dimensional data sets. The two-group model, first proposed by Efron, identifies significant comparisons by allocating observations to a mixture of an empirical null and an alternative distribution. In the Bayesian nonparametrics literature, many approaches have suggested using mixtures of Dirichlet Processes in the two-group model framework. Here, we investigate employing mixtures of two-parameter Poisson-Dirichlet Processes instead, and show how they provide a more flexible and effective tool for large-scale hypothesis testing. Our model further employs nonlocal prior densities to allow separation between the two mixture components. We obtain a closed-form expression for the exchangeable partition probability function of the two-group model, which leads to a straightforward Markov Chain Monte Carlo implementation. We compare the performance of our method for large-scale inference in a simulation study and illustrate its use on both a prostate cancer data set and a case-control microbiome study of the gastrointestinal tracts in children from underdeveloped countries who have been recently diagnosed with moderate-to-severe diarrhea.

Computed Tomographic Trochlear Depth Measurement in Normal Dogs.

OBJECTIVES: The main purpose of this study was to describe the relationship between patellar maximal craniocaudal thickness and femoral trochlear groove depth in normal dogs and to valuate the intra-observer or inter-observer variability of maximal trochlear depth and maximal patellar craniocaudal thickness using computed tomography. METHODS: Trochlear groove depth and patellar maximal craniocaudal thickness of 40 limbs (20 dogs) were measured by three independent veterinarians using three-dimensional multiplanar reconstruction computed tomography images. The patellar maximal craniocaudal thickness/trochlear depth ratio was determined. RESULTS: The mean ratio of these stifles was 0.46 (range 0.24-0.70), meaning that the mean maximal depth of the trochlea was 46% of the mean maximal-patellar thickness. CLINICAL SIGNIFICANCE: A wide range of maximal-patellar-craniocaudal-thickness/maximal trochlear-depth ratio was found suggesting that breed studies should be performed to determine a breed-specific patellar-thickness/trochlear-depth ratio. To make decisions on when and where to perform a sulcoplasty during patellar luxation surgery, patella/trochlea thickness relationship should be measured for each breed with patellar tracking from stifle hyperflexion to stifle hyperextension.