Risk factors for severe morbidity and definitive stoma after elective surgery for sigmoid diverticulitis: a multicenter national cohort study.

BACKGROUND: In the decision to perform elective surgery, it is of great interest to have data about the outcomes of surgery to individualize patients who could safely undergo sigmoid resection. The aim of this study was to provide information on the outcomes of elective sigmoid resection for sigmoid diverticular disease (SDD) at a national level. METHODS: All consecutive patients who had elective surgery for SDD (2010-2021) were included in this retrospective, multicenter, cohort study. Patients were identified from institutional review board-approved databases in French member centers of the French Surgical Association. The endpoints of the study were the early and the long-term postoperative outcomes and an evaluation of the risk factors for 90-day severe postoperative morbidity and a definitive stoma after an elective sigmoidectomy for SDD. RESULTS: In total, 4617 patients were included. The median [IQR] age was 61 [18.0;100] years, the mean ± SD body mass index (BMI) was 26.8 ± 4 kg/m2, and 2310 (50%) were men. The indications for surgery were complicated diverticulitis in 50% and smoldering diverticulitis in 47.4%. The procedures were performed laparoscopically for 88% and with an anastomosis for 83.8%. The severe complication rate on postoperative day 90 was 11.7%, with a risk of anastomotic leakage of 4.7%. The independent risk factors in multivariate analysis were an American Society of Anesthesiologists (ASA) score ≥ 3, an open approach, and perioperative blood transfusion. Age, perioperative blood transfusion, and Hartmann's procedure were the three independent risk factors for a permanent stoma. CONCLUSIONS: This series provides a real-life picture of elective sigmoidectomy for SDD at a national level. TRIAL REGISTRATION: Comité National Information et Liberté (CNIL) (n°920361).

CLINICAL AND IMMUNOLOGICAL PROFILE OF NEWLY DIAGNOSED DIABETIC PATIENTS IN A COHORT OF YOUNG ADULTS OF NATIONAL HEPATITIS C VIRUS SURVEY IN EGYPT.

T2DM (Type 2 diabetes mellitus) is considered a disease that affects old age group. Recently, it has become common in children, adolescents and adults. Aim of the work - to highlight the challenges in differentiating T1DM (type1 diabetes mellitus) from T2DM (type2 diabetes mellitus) in early onset diabetes in youth depending on clinical and laboratory characteristics. Our cross-sectional study was performed on 200 newly diagnosed diabetic patients aged (18-30) years. All patients were subjected to detailed medical history and full clinical examination. Laboratory investigations included FBS, 2hPP, HbA1C, fasting C peptide and GADA. About 59% (118) of our patients were T2DM while (82) 41% were T1DM. T1DM was more dominant than T2DM in age group less than 25 years (T1DM 79% versus T2DM 21%, P<0.001), while T2DM was more than T1DM in age group more than 25 years (T2DM 93% versus T1DM 17%, P<0.001). GADA was detected in 73.2% of T1DM patient and it was high titer while GADA was detected in only 8% of T2DM with low titer, in addition GADA positive patients were significantly younger than negative patients, age (20.9±2.5 years vs. 26.4±3.5 years respectively) (P <0.001). About 8% of phenotypically type 2 diabetic youth had GADA positive antibodies which did not confer impact on c peptide level or glycemic control yet type 1 diabetics who were GADA negative had a better glycemic control.

Are oncological long-term outcomes equal after laproscopic completed and converted laparoscopic converted rectal resection for cancer?

BACKGROUND: The aim of this study was to compare long-term survival after laproscopic completed and laparoscopic converted rectal resection for cancer. METHODS: All consecutive patients who underwent curative laparoscopic rectal surgery for cancer at our institution between January 2001 and December 2016 were included in a single-center retrospective study. Patients were divided into two groups: the converted (CONV) group and the totally laparoscopic (LAP) group. The primary outcomes were long-term oncologic outcomes including overall survival (OS) and disease-free survival (DFS), as well as local and distant recurrence (LR, DR). The secondary outcomes included postoperative mortality and morbidity as defined as death or any complication occurring within 90 days postoperatively. RESULTS: Of 214 consecutive patients included, 57 were converted to open surgery (CONV group), leading to a 26.6% conversion rate. Mean length of follow-up was 68 ± 42 months in the LAP group and 70 ± 41 months in the CONV group. Five-year OS was significantly shorter in the CONV group compared to the LAP group (p = 0.0016). On multivariate analysis, rectal tumor location (middle and low) and conversion to open surgery were predictors of both OS and DFS. CONCLUSIONS: This study suggests that conversion to open surgery after laparoscopic rectal resection appears to significantly reduce OS without having a significant impact on DFS and recurrence rates.

Does conversion during laparoscopic rectal oncological surgery increases postoperative complications and anastomotic leakage rates? A meta-analysis.

OBJECTIVE: To evaluate, regarding previous published studies, postoperative outcomes between patients undergoing rectal cancer resection performed by totally laparoscopic approach (LAP) compared to those who underwent peroperative conversion (CONV). METHODS: Studies comparing LAP versus CONV for rectal cancer published until December 2017 were selected and submitted to a systematic review and meta-analysis. Articles were searched in Medline and Cochrane Trials Register Database. Meta-analysis was performed with Review Manager 5.0. RESULTS: Twelve prospective and retrospective studies with a total of 4503 patients who underwent fully laparoscopic approach for rectal cancer and a total of 612 patients who underwent conversion were included. Meta-analysis did not show any significant difference on overall mortality between both approaches (OR=0.47, 95%CI=0.18-1.22, P=0.12). However, Meta-analysis showed that anastomotic leakage rate, wound abscess rate and postoperative morbidity rate were significantly decreased with totally laparoscopic approach (OR=0.37, 95%CI =0.24-0.58, P<0.0001; OR=0.29, 95%CI=0.19-0.45, P<0.00001; OR=0.56, 95%CI=0.46-0.67, P<0.00001 respectively). CONCLUSION: This meta-analysis suggests that conversion increases anastomotic leakage, overall morbidity and wound abscess rates without increasing mortality rate for patients who underwent rectal resection for cancer.

Has adherence to treatment guidelines for mid/low rectal cancer affected the management of patients? A monocentric study of 604 consecutive patients.

INTRODUCTION: In 2006 under the supervision of the French health authorities (HAS), recommendations for clinical practice (RCP) in the management of rectal cancers were first published. The primary objective of this study was to assess the impact of these guidelines on multidisciplinary management in terms of therapeutic strategies based on disease staging and quality indicators for surgical excision. Secondarily, we assessed the impact of the RCPs on postoperative and oncological outcomes. METHODS: All consecutive patients having undergone curative surgical excision for middle and low (subperitoneal) rectal cancer from 1995 to 2017 in the university hospital of Caen were included in accordance with the relevant French guidelines. They were divided into two groups: before (Gr1) and after (Gr2) 2006. For each group, a chart review was conducted on demographic variables, preoperative rectal tumor features, disease severity variables and quality of surgery variables. Postoperative and oncological outcomes were likewise assessed and compared between the two groups. RESULTS: Six hundred and four patients were included (Gr1, n=266; Gr2, n=338). Compliance with French guidelines significantly improved (i) use of magnetic resonance imaging (P<0.0001) and CT-scan (P<0.0001)]; (ii) organization of multidisciplinary tumor boards (P<0.0001) leading to suitable neo-adjuvant treatment plan classification (P<0.0001). Consequently, compliance improved widespread total mesorectal excision (P<0.0001), sphincter-sparing surgery (P=0,0005), and completeness of curative resection in the specimen (P<0.0001). Although postoperative 90-day mortality was similar, overall postoperative morbidity significantly increased in Gr2 (P<0.0001). Overall (P=0.0005) and disease-free survival (P=0.0016) of patients in Gr2 were significantly prolonged and correlated with a significant reduction in local and distant recurrences. CONCLUSION: Compliance with the relevant French guidelines improved the quality of multidisciplinary management of patients undergoing curative surgery for subperitoneal rectal cancer. However, further progress is still needed to render accession to the recommendations more comprehensive.

Influence of social deprivation and remoteness on the likelihood of sphincter amputation for rectal cancer: a high-resolution population-based study.

BACKGROUND: Medical care in rectal cancer is subject to social inequality. According to the last French guidelines, a 1-cm distal margin below the lower pole of the rectal tumor is now considered sufficient. This extends the limits of the current sphincter preservation gold standard. Like for other innovative technics, the dissemination of such technics is often subject to social and geographical inequalities. The objective was to analyze whether sphincter preservation in rectal cancer is subject to social or geographical inequality. METHODS: The odds of sphincter preservation was modeled by logistic regression among the 1453 patients in the Calvados digestive cancer registry between 1 January 1997 and 31 December 2015 by examining some of the variables that could influence it: social inequalities and geographical remoteness, sex, age, and stage. RESULTS: A total of 69.4% of the population received sphincter preservation. Patients in the more deprived quintiles had a significantly higher probability of having sphincter amputation (odds ratio (OR) = 1.469 (1.046-2.064)). This result was no longer significant after adjustment on stage and travel time. There was a dose-effect pattern of geographical remoteness on likelihood of sphincter preservation with a progressive increase in OR between patients living the nearest and the furthest from the reference center (p-trend = 0.0178). CONCLUSION: This study shows that the probability of receiving sphincter preservation is influenced by the social environment and strongly influenced by remoteness. Although management guidelines have had a huge impact on the rates of sphincter preservation, they have not reduced the influence of the social and geographical environment on sphincter preservation.

Does previous transanal excision for early rectal cancer impair surgical outcomes and pathologic findings of completion total mesorectal excision? Results of a systematic review of the literature.

BACKGROUND: Transanal excision (TAE) is increasingly used in the treatment of early rectal cancer because of lower rate of both postoperative complications and postsurgical functional disorders as compared with total mesorectal excision (TME) OBJECTIVE: To compare in a meta-analysis surgical outcomes and pathologic findings between patients who underwent TAE followed by completion proctectomy with TME (TAE group) for early rectal cancer with unfavorable histology or incomplete resection, and those who underwent primary TME (TME group). METHODS: The Medline and Cochrane Trials Register databases were searched for studies comparing short-term outcomes between patients who underwent TAE followed by completion TME versus primary TME. Studies published until December 2016 were included. The meta-analysis was performed using Review Manager 5.0 (Cochrane Collaboration, Oxford, UK). RESULTS: Meta-analysis showed that completion TME after TAE was significantly associated with increased reintervention rate (OR=4.28; 95% CI, 1.10-16.76; P≤0.04) and incomplete mesorectal excision rate (OR=5.74; 95% CI, 2.24-14.75; P≤0.0003), as compared with primary TME. However there both abdominoperineal amputation and circumferential margin invasion rates were comparable between TAE and TME groups. CONCLUSIONS: This meta-analysis suggests that previous TAE impaired significantly surgical outcomes and pathologic findings of completion TME as compared with primary TME. First transanal approach during completion TME might be evaluated in order to decrease technical difficulties.

Effects of catecholamines on ovary morphology, blood concentrations of estradiol-17beta, progesterone, zinc, triglycerides and rate of ovulation in domestic hens.

The present study is an attempt to shed more light on the role of epinephrine (EP) and norepinephrine (NE) in regulating ovarian follicular development, folliculogenesis and ovulation in laying hens. Sixty Egyptian local cross females (Mandarah), 50 weeks old, were individually housed and equally divided into three treatments: control (saline, 0.9% NaCl), EP (0.15 mg epinephrine/hen/day) and NE (0.75 mg norepinephrine/hen/day) (n=20). Animals were injected intramuscularly once a day for 15 successive days. At the end of the experimental period, 10 females from each treatment were randomly chosen, weighed and killed by decapitation. Ovaries and oviducts and ovarian follicles were examined. Plasma concentrations of estradiol-17beta, progesterone, zinc and triglyceride were determined. Results indicated that the ovaries of NE- and EP-treated hens were more developed than those of control hens being heavier and containing more yellow yolk-filled follicles. EP or NE significantly increased the ovulation rate and plasma concentrations of estradiol-17beta, progesterone, zinc and triglyceride compared with control treatment. It could be concluded that catecholamines may have a part in promoting ovarian follicular development and in stimulating ovulation in laying hens at the end of their reproductive lives.

Ovarian follicular development, lipid peroxidation, antioxidative status and immune response in laying hens fed fish oil-supplemented diets to produce n-3-enriched eggs.

The objective of the present study was to research the effect of feeding laying hens fish oil-supplemented diets to produce n-3-enriched eggs on their ovarian follicular development, serum lipid peroxidation, antioxidative status and immune response. A total of 105 white Bovens hens at 24 weeks of age were housed in cages in an open-sided building under a 16 h light : 8 h dark lighting schedule. Birds were randomly divided into five treatments and were fed, ad libitum, diets containing 0% (control), 1.25%, 2.5%, 3.5% or 5.0% fish oil from 24 to 36 weeks of age. Egg production and weight were recorded. By weeks 35 and 36 of age 15 eggs were taken at random from each treatment to determine the yolk lipid profile and cholesterol content. At the end of the experimental period, 10 females from each treatment were randomly chosen, anaesthetised and killed by decapitation. Ovary and oviduct samples were immediately weighted and ovarian follicles were classified. Serum thiobarbituric acid-reactive substance (TBARS), hepatic TBARS and hepatic glutathione peroxidase (GSH-Px) activity were measured. No clear trend was observed concerning egg production and egg yolk cholesterol. As dietary fish oil levels increased, n-3-polyunsaturated fatty acids (n-3 PUFA) increased, whereas n-6 PUFA tended to decrease in yolk lipids. No negative effects were detected in ovary and oviduct weights, expressed in both absolute terms and relative to body weight. The numbers and total weights of large yellow follicles (LYF) in the ovary were not significantly affected by fish oil supplementation. Low levels (1.25% to 2.5%) of fish oil reduced both plasma and hepatic TBARS and enhanced GSH-Px activity. It is also interesting to note that inclusion of 2.5% fish oil in laying hen diets enhanced the antibody titre in laying hens. Therefore, it could be concluded that inclusion of fish oil in laying hen diets at moderate levels increased the n-3 fatty acids content in eggs, improved antioxidative status, enhanced the antibody response and did not have a negative influence on the different reproductive morphology parameters in laying hens.

Vitamin E supplementation reduces dexamethasone-induced oxidative stress in chicken semen.

1. We examined the effects of supplemental dietary vitamin E (Vit E) on semen quality and antioxidative status in male domestic fowls exposed to oxidative stress induced by synthetic glucocorticoid, dexamethasone (DEX) injection. 2. Thirty-six Egyptian local cross males, 42 weeks old, were housed individually in cages in an open-sided building under 16 h light:8 h dark and were provided with commercial feed and water ad libitum. Birds were divided into 4 groups: DEX (4 mg/bird/d), Vit E (200 mg/kg diet), DEX + Vit E (4 mg/bird/d + 200 mg/kg diet, respectively) and control, n = 9. All treatments lasted for 7 continuous days. 3. Oxidative stress induced by injection of DEX (4 mg/bird/d) resulted in decreased sperm count and motility correlated with an increased percentage of dead sperms. Vit E (200 mg/kg diet) enhanced sperm count and viability when supplemented to stress-induced birds, compared to DEX treatment alone. 4. In seminal plasma, low calcium concentration, high lipid peroxidation and reduced activity of glutathione peroxidase were associated with the oxidative stress. Vit E reduced lipid peroxidation in the seminal plasma. 5. In conclusion, excessive supplemental dietary Vit E improved semen quality when cockerels were subjected to stress conditions. It increased both sperm count and motility, reduced the percentage of dead sperm and enhanced the antioxidative status of seminal plasma.

Tea polyphenols reduce glucocorticoid-induced growth inhibition and oxidative stress in broiler chickens.

1. The effects of dietary polyphenols (PP) on growth and oxidative stress in the corticosterone (CTC) treated broiler chickens model were studied. 2. Chicks (Cobb strain) were divided into 3 (CTC) x 3 (PP) blocks and given diets containing CTC at concentrations of 0, 10 and 20 mg/kg. 3. The body weight gain was lower when the birds were treated with CTC. However, the high dose of PP tended to reduce the effect of CTC. 4. The abdominal fat content, plasma triglyceride concentration and liver weight were increased by CTC and reduced by PP. 5. Muscle and liver thiobarbituric acid reactive substance (TBARS) were elevated by CTC and these effects were reduced by PP. Plasma CTC concentration was increased by dietary CTC treatment and decreased by PP. 6. In conclusion, our results indicate that PP can minimise growth inhibition, hyperlipidemia and oxidative stress induced by CTC treatment in broiler chickens.

Ipsilateral fracture of the femoral neck and shaft, treatment by reconstruction interlocking nail.

This study involved nine patients with ipsilateral fractures of the neck and shaft of the femur. They were all male with an average age of 28.5 years. All of the fractures resulted from high-energy trauma. The neck fracture was initially missed in one case. All fractures were fixed by a Russell-Taylor reconstruction femoral nail. Surgery was delayed for an average of 6.6 days (range 2-21 days). The patients were followed up for an average of 2.1 years. All fractures healed; the average time of union for the neck fracture was 4.2 months (range 3-6 months) and for the shaft fracture, 6.9 months (range 4-18 months). A delay in surgery did not affect the union rate. There were no cases of avascular necrosis or non-union of the femoral neck fracture. One hip healed into mild varus, one shaft fracture had a delayed union, and one developed a late infection of the femoral shaft. The use of the reconstruction nail offers superior stabilization over other currently used methods and is associated with fewer complications.