Antegrade continence enema (ACE): predictors of outcome in 111 patients.

PURPOSE: The antegrade continence enema (ACE) is used as a means of managing faecal incontinence and constipation with varying outcomes. We aim to evaluate our outcomes of ACEs and identify predictors of outcome. METHODS: A retrospective case-note review of patients ≤16 years of age undergoing an ACE (March 2000-September 2013) was carried out. Data collected included: patient demographics, functional outcomes and complications. Data are quoted as median (range) and compared using Mann-Whitney and Fisher's exact test. Univariate analysis was performed to identify predictors of successful outcomes. P < 0.05 is significant. Successful outcome = total continence/occasional leakage and failed outcome = regular soiling and/or constipation. RESULTS: 111 patients with complete data sets underwent an ACE [59% male, median age = 9.5 years (3.4-16 years)] and median follow-up = 48 months (4 months-11 years 4 months). Underlying diagnoses were idiopathic constipation (n = 68), anorectal malformation (n = 27), neuropathic bowel (n = 7), Hirschsprung disease (n = 5) and gastrointestinal dysmotility (n = 4). Social continence was achieved in 87/111 (78%). Fifteen percent of patients underwent reversal of ACE due to resolution of symptoms. There was no difference in outcomes related to diagnosis, gender, age or follow-up duration. Complication rate was 20.7% (23/111). CONCLUSIONS: The ACE is safe and effective in the management of intractable constipation and soiling. No predictors of outcome were identified.

Botulinum toxin use in paediatric colorectal surgery.

PURPOSE: To evaluate outcomes of intrasphincteric botulinum toxin injection (ISBTI) in children with intractable constipation. METHODS: Retrospective case-note review of patients ≤ 16 years of age undergoing ISBTI between January 2010 and February 2014. Data collected included patient demographics, diagnosis, complications, follow-up duration and functional outcomes. Successful outcome was defined as resolution/improvement in symptoms and failed when there was no change in symptoms. Statistical analyses were performed using PRISM (GraphPad, CA, USA). p values <0.05 were considered as significant. RESULTS: 43 patients [male 29, median age 5 years 9 months (range 13 months-13 years 5 months)] underwent 86 ISBTIs. Underlying diagnoses were idiopathic constipation (67 %), Hirschsprung disease (26 %), anorectal malformation (5 %), gastrointestinal dysmotility (2 %). 72 % (31/43) reported improvement in symptoms after the first ISBTI. 39 % of patients had recurrence of symptoms at 12-month median follow-up. 10 patients non-responsive to ISBTI required an antegrade continence enema or stoma. There was no correlation between age (p = 0.3), gender (p = 0.7), diagnosis (p = 0.84), or number of ISBTIs (p = 0.17) with successful outcome. CONCLUSION: Successful outcomes occurred in 72 % patients after the first ISBTI. 25 % required further surgical management of their symptoms. Further work is required to help predict which patients will benefit from ISBTI.

Age of diagnosis of congenital hearing loss at Universitas Hospital, Bloemfontein.

BACKGROUND: Congenital hearing loss affects 3 - 6/1 000 children worldwide. The benefits of early identification of hearing loss and early intervention have been clearly established. There are no previous studies reporting on the age of diagnosis of congenital hearing loss in the Free State province. OBJECTIVES: To determine the age of diagnosis of congenital hearing loss in the Otorhinolaryngology Clinic at Universitas Hospital. Secondary aims included determining age at first visit, as well as the time delay between first visit and diagnosis, and documenting any interventions which took place. METHODS: A retrospective, descriptive study was undertaken, analysing data from 2001 to 2010. RESULTS: A total of 260 cases of congenital hearing loss were analysed. The median age of diagnosis of hearing loss was 44.5 months. The median age of first visit was 40.9 months, and the median delay between first visit and diagnosis was 49 days. CONCLUSIONS: The median age of diagnosis far exceeds national and international benchmarks. This has a profoundly negative impact on the development and outcomes of children with hearing loss. These results have been used to motivate for the expansion of hearing screening and diagnostic services in the province.

Late complications after aortic surgery.

The incidence of false aneurysms, anastomotic stenoses, and ureteric obstruction is reported to be low in patients who have undergone aortic surgery. The use of intravenous peripheral digital subtraction angiography (IVDSA) with completion excretory urography (CEU) may provide a more sensitive means of long-term detection of these complications. The aim of this study was to (1) establish the incidence of anastomotic aneurysms, anastomotic stenoses, and ureteric obstruction after aortic surgery; (2) identify local and systemic factors that predispose to these complications; and (3) evaluate IVDSA as a single radiologic investigation to diagnose these complications. Forty-four patients who had undergone aortic surgery 1 to 12.3 years previously agreed to undergo IVDSA and CEU. False aneurysms were found at 10 distal anastomoses (none at the aorta), for an anastomotic incidence of 11.2% and a patient incidence of 15.9%. Endarterectomy and the femoral artery as a site of distal anastomosis were important factors in the development of anastomotic aneurysms, as were detected radiologically at eight aortic anastomosis (18%). There were no distal anastomotic stenoses. Hypercholesterolemia was more common in this group (62.5%) than in the overall group (21.2%). Three asymptomatic ureteric obstructions were diagnosed in two patients, both of whom had emergency surgery for ruptured aortic aneurysms. The higher incidence of anastomotic aneurysms, anastomotic stenoses, and asymptomatic ureteric obstruction sound merits careful follow-up. IVDSA with CEU may be a simple and effective method of detection.

Relationship of Tridimensional Personality Questionnaire scores and smoking variables in female and male smokers.

The Tridimensional Personality Questionnaire (TPQ) was developed by Cloninger (1986) to measure heritable variation in three patterns of response to environmental stimuli: novelty seeking, harm avoidance, and reward dependence. Cloninger (1987) used the TPQ to identify two types of alcoholism: Type 1 (low novelty seeking, high harm avoidance and reward dependence; both male and female) and Type 2 (high novelty seeking, low harm avoidance and reward dependence; predominantly male). To determine whether characteristic patterns exist in smokers, we administered the TPQ to 119 female and 121 male smokers, along with the Fagerstrom Tolerance Questionnaire (FTQ, a measure of nicotine dependence), the Russell Motives for Smoking Questionnaire (RMSQ), and the Spielberger State-Trait Anxiety Inventory (STAI/trait). Compared with a normative sample, our sample exhibited elevated scores on the Novelty-Seeking scale; female smokers were somewhat overrepresented in the highest quartile of the Harm-Avoidance scale; both genders tended to be clustered in the lower quartiles of the Sentimentality-Attachment-Dependence subscale of the Reward-Dependence scale and in the highest quartile of the Persistence subscale. Female smokers showed a significant positive association between Harm Avoidance and FTQ scores, and Harm Avoidance was positively correlated with several RMSQ factors (including Additive smoking) in both genders. These findings suggest that the likelihood of becoming a smoker may be a function of novelty seeking and reward dependence, whereas degree of dependence or addiction once the habit is entrained may be linked to harm avoidance. Our observations establish the potential utility of the TPQ as a tool for examining environmental and heritable variation in smoking behavior and may contribute to improved strategies for prevention and treatment of smoking.

Effect of Host Plant Age on Population Development and Pathogenicity of Ditylenchus destructor on Peanut.

The effect of inoculating peanut, Arachis hypogaea cv. Sellie, with Ditylenchus destructor at timed intervals after planting and with different initial nematode population densities (Pi) was tested in greenhouse experiments. Final nematode population densities (Pf) in hulls and seeds were greater (Pf < 0.001) in plants inoculated at or before 9 weeks after planting. Pod disease symptoms correlated positively with the Pf in the pods. The seedgrade of peanuts inoculated at or before 9 weeks after planting was reduced, whereas grade of peanuts from plants inoculated at 15 weeks or later was not reduced. Peanut plants inoculated 12 weeks after planting with a Pi of 10-100 had a lower Pf (P < 0.05) than plants with a Pi of 250 to 8,000. Seed of plants with a Pi of 250 or less could be marketed as choice edible seed, whereas those with a Pi of 500 or more were of reduced seedgrade. These results suggest that as few as 500 nematodes per plant at 12 weeks after planting can build up to injurious levels before harvest. A nematicide should therefore be active for longer than 12 weeks after planting to sufficiently suppress the population.

Population Dynamics of Ditylenchus destructor on Peanut.

The population development of Ditylenchus destructor in the roots, pegs, hulls, and seeds of eight peanut (Arachis hypogaea) genotypes was studied in the greenhouse. Although all genotypes tested were good hosts for D. destructor, differences in host suitability were observed. Invasion of the plant parts by Ditylenchus destructor proceeded more slowly in genotypes with long growth periods. During the second half of the growth period of these genotypes, D. destructor populations emigrated from the hulls and seeds into the soil but reinfected the pods after a few weeks. The genotypes with the longest growth periods supported the highest number of nematodes when each genotype was harvested at its usual harvest time. The long-season genotypes supported low numbers of nematodes when harvested before crop maturity.

Host Status of Seven Weed Species and Their Effects on Ditylenchus destructor Infestation of Peanut.

The host suitability to Ditylenchus destructor of seven common weed species in peanut (Arachis hypogaea) fields in South Africa was determined. Based on the number of nematodes per root unit, white goosefoot (Chenopodium album), feathertop chloris (Chloris virgata), purple nutsedge (Cyperus rotundus), jimson weed (Datura stramonium), goose grass (Eleusine indica), khaki weed (Tagetes minuta), and cocklebur (Xanthium strumarium) were poor hosts. Ditylenchus destructor survived on all weed species; population densities increased in peanut hulls and caused severe damage to seeds of peanut grown after weeds. Roots of purple nutsedge left in the soil suppressed populations of D. destructor and root and pod development in peanut grown after the weed. However, nematode populations in peanut hulls and seeds were not suppressed. Some weed species, especially purple nutsedge which is common in peanut fields, can be used to indicate the presence of D. destructor in the absence of peanut.

In Vitro Embryo Explant Cultures of Peanut to Evaluate Resistance to Ditylenchus destructor.

Population densities of D. destructor on embryo explants of 22 peanut genotypes grown in vitro were compared with those in roots and seeds of the same genotypes grown in the greenhouse. During the first 8 weeks after inoculation, the optimum incubation period was 6 weeks for maximum reproduction of Ditylenchus destructor on embryo explants of peanut (Arachis hypogaea L. cv. Sellie) inoculated with 250 nematodes at 25 C. Nematode numbers increased 17-fold. Deletion of MnSO HO and a higher KHPO concentration in the medium resulted in higher nematode reproduction. Resistance or susceptibility to D. destructor was observed in seeds of several genotypes but was not matched by differences in host suitability in roots. The results indicate that the factor for resistance or susceptibility to D. destructor is synthesized in the seeds of peanut but is not translocated to the roots. Use of embryo explant cultures of peanut as a rapid method to evaluate resistance to D. destructor did not work under the conditions described.

Primary torsion of the omentum.

Primary torsion of the omentum is an uncommon cause of acute abdominal emergency. Five cases are reported and the English-language literature reviewed.