After Elective Sigmoid Colectomy for Diverticulitis, Does Recurrence-Free Mean Symptom-Free?

After elective sigmoidectomy for diverticulitis, patients may experience persistent abdominal symptoms. This study aimed to determine the incidence and characteristics of persistent symptoms (PSs) and their risk factors in patients who had no reported recurrence after elective sigmoidectomy. Patients who underwent elective sigmoidectomy for diverticulitis from 2002 to 2016 at a tertiary academic colorectal surgery practice were included. After retrospective review of medical records, patients were contacted with a questionnaire to inquire about recurrence of diverticulitis and persistent abdominal symptoms since resection. Outcomes examined were prevalence of and risk factors for PSs after elective sigmoidectomy. Of 662 included patients, 346 completed the questionnaire and had no recurrent diverticulitis. PSs were reported by 43.9 per cent of the patients. The mean follow-up was 87 months. Female gender and preoperative diagnosis of irritable bowel syndrome were independent risk factors for PSs (Relative Risk 1.65, P < 0.001 and Relative Risk 1.41, P = 0.014). Previous IV antibiotics treatment was associated with PSs (P = 0.034) but not with a significant risk factor. As the follow-up interval increased, prevalence of PSs decreased (P = 0.006). More than 40 per cent of patients experienced persistent abdominal symptoms after sigmoidectomy for diverticulitis. Female patients and those with irritable bowel syndrome were at significantly increased risk.

Open reduction and internal fixation of rib fractures in polytrauma patients with flail chest.

BACKGROUND: Open reduction and internal fixation (ORIF) of fractured ribs for flail chest is safe and effective but who is most likely to benefit is unknown. Our purpose is to compare ORIF with nonoperative management (NOM) in polytrauma patients. METHODS: Albany Medical Center Hospital Trauma Registry was queried for adult patients with flail chest admitted over 7 years. RESULTS: Eighty-six patients with radiographic flail chest were identified who met inclusion criteria. The 41 ORIF and 45 NOM patients had similar demographics and injury severity. Hospital length of stay and intensive care unit length of stay were significantly longer in the ORIF group than that of the NOM group. There was a trend toward longer time on the ventilator in the ORIF group. CONCLUSIONS: In this retrospective study, patients treated by ORIF had longer hospitalization and ventilator duration. Future studies should be designed to optimally identify patients who are most likely to benefit from ORIF.

The influence of cathodic polarization and simulated inflammation on titanium electrochemistry.

This study evaluated the influence of simulated inflammation and cathodic polarization on the electrochemical properties of commercially pure titanium (CpTi) and titanium-6%aluminum-4%vanadium (Ti6Al4V). Normal conditions immersed the metals in phosphate buffered saline at open circuit potential (OCP). Inflammatory conditions immersed the metals in a 150 mM hydrogen peroxide titrated to pH = 5.0 at OCP. Cathodic inflammatory conditions immersed the metals in the inflammatory electrolyte at -1 V versus Ag/AgCl. Cathodic polarization scans revealed a more electropositive corrosion potential (Ecorr ) and an increased corrosion current density (Icorr ) for both metals after incubation at inflammatory conditions (CpTi: Ecorr = 171 mV, Icorr = 147 nA/cm(2) and Ti6Al4V: Ecorr = 241 mV and Icorr = 413 nA/cm(2) ) as compared to normal conditions (CpTi: Ecorr = -249 mV, Icorr = 19 nA/cm(2) and Ti6Al4V: Ecorr = -263 mV and Icorr = 11 nA/cm(2) ). Electrochemical impedance spectroscopy showed the polarization resistance (Rp ) decreases and constant phase element (CPE) magnitude increases for both metals when comparing normal (CpTi: Rp = 3.5 MΩ cm(2) , CPE = 35 µS s(α) /cm(2) and Ti6Al4V: Rp = 6.5 MΩ cm(2) and CPE = 30 µS s(α) /cm(2) ) to inflammatory (CpTi: Rp = 79 kΩ cm(2) , CPE = 55 µS s(α) /cm(2) and Ti6Al4V: Rp = 230 kΩ cm(2) and CPE = 56 µS s(α) /cm(2) ) to cathodic inflammatory (CpTi: Rp =24 kΩ cm(2) , CPE = 290 µS s(α) /cm(2) and Ti6Al4V: Rp = 12 kΩ cm(2) and CPE = 250 µS s(α) /cm(2) ) conditions. These observed changes are consistent with the formation of a thin and defective oxide film. Inductively coupled plasma mass spectroscopy revealed that inflammatory conditions increased dissolution of both metals and that the addition of cathodic potential significantly increased the dissolution of the beta phase elements of Ti6Al4V.