Closure of defunctioning loop ileostomy is associated with considerable morbidity.

AIM: An elective defunctioning ileostomy is commonly employed to attenuate the morbidity that may arise from distal anastomotic leakage. The magnitude of risk associated with subsequent ileostomy closure is difficult to estimate as many of the data arise from small series. This study looked at the rate of complications and predictive factors in a large series of patients. METHODS: The National Surgical Quality Improvement Program database was queried for patients who had an elective closure of ileostomy between 2005 and 2010. Patient demographics, preoperative risk factors and operative variables were recorded. The primary outcome was occurrence of major (mortality, sepsis, return to the operating room, renal failure, major cardiac, neurological or respiratory episode) or minor (wound infection, urinary tract infection) complications within 30 days. Univariate and multivariate regression was used to evaluate the effect of these clinical factors on the complication rate. RESULTS: In total, 5401 patients underwent closure of ileostomy, of whom 502 (9.3%) patients had major complications. The incidence of minor complications was 8.4% (452 patients). There were 32 (0.6%) deaths. American Society of Anesthesiologists grade, functional status, prolonged operative time, history of chronic obstructive pulmonary disease, dialysis and disseminated cancer were independent predictors of major complications. There was no significant increase in complication rates in patients over the age of 80. Major complications were associated with a significant increase in postoperative stay (13.9 vs 4.7 days, P < 0.0001). CONCLUSION: Closure of ileostomy is associated with a significant complication rate. It may use as many resources as the primary surgery and is not a minor follow-up operation.

Neurobehavioural testing in workers occupationally exposed to lead: systematic review and meta-analysis of publications.

Although the toxic effects of lead on the central nervous system have been well described, the blood concentration at which lead begins to exert adverse effects remains the focus of debate. A meta-analysis of occupational studies was conducted evaluating the association between neurobehavioural testing results and moderate blood lead concentrations.

Variability, predictive value, and uses of the beryllium blood lymphocyte proliferation test (BLPT): preliminary analysis of the ongoing workforce survey.

The beryllium blood lymphocyte proliferation test (BLPT) is used as a medical surveillance tool for assessment of persons at risk for developing clinical and subclinical chronic beryllium disease (CBD). Three laboratories, coded "A," "B," and "C," were used to perform the BLPTs, which involved two simultaneous tests on a split specimen. The intra-laboratory agreement analysis compared the first and the second test performed by the same laboratory. The interlaboratory agreement analysis compared test results performed by different laboratories on the same sample. The level of agreement was expressed as a kappa statistic. The positive predictive value (PPV) analysis compared BLPT results against the results of a bronchoscopy used to detect CBD. The data included 5483 records representing 3081 samples from 1510 persons. Intra-laboratory agreement was fair to moderate, with kappa values between 0.3 and 0.6. Inter-laboratory agreement was moderate (kappa = 0.5) for Labs A and B, moderate (kappa = 0.6) for Labs B and C, and poor (kappa = 0.2) for Labs A and C. A single unconfirmed abnormal test had a PPV for CBD of 39 percent, a confirmed (based on subsequent testing) abnormal test had a PPV for CBD of 45 percent, and a first-time double abnormal test had a PPV for CBD of 49 percent. Substantial inter- and intralaboratory disagreement exists between and within major laboratories that conduct this test.