Perineal colostomy: an alternative to avoid permanent abdominal colostomy: operative technique,results and reflection

Background

The most common injury to indicate definitive stoma is rectal cancer. Despite advances in surgical treatment, the abdominoperineal resection is still the most effective operation in radical treatment of malignancies of the distal rectum invading the sphincter and anal canal. Even with all the effort that surgeons have to preserve anal sphincters, abdominoperineal amputation is still indicated, and a definitive abdominal colostomy is necessary. This surgery requires patients to live with a definitive abdominal colostomy, which is a condition that modify body image, is not without morbidity and has great impact on the quality of life.

Aim

To evaluate the technique of abdominoperineal amputation with perineal colostomy with irrigation as an alternative to permanent abdominal colostomy.

Method

Retrospective analysis of medical records of 55 patients underwent abdominoperineal resection of the rectum with perineal colostomy in the period 1989-2010.

Results

The mean age was 58 years, 40 % men and 60 % women. In 94.5% of patients the indication for surgery was for cancer of the rectum. In some patients were made three valves, other two valves and in the remaining no valve at all. Complications were: mucosal prolapse, necrosis of the lowered segment and stenosis.

Conclusion

The abdominoperineal amputation with perineal colostomy is a good therapeutic option in the armamentarium of the surgical treatment of rectal cancer.     

Cool Mist Irrigation Improves Heat Dissipation during Surgical Bone Drilling

Objective High-speed drilling generates heat in small cavities and may pose a risk for neurovascular tissues. We hypothesize that a continuous pressurized cold mist could be an alternative approach for better cooling during drilling of bone to access cranial lesions. This study aims to examine this idea experimentally. Design Ex-vivo drilling tests with controlled speed, feed, and depth were performed on cortical bone samples. Thermocouples were embedded underneath the drilling path to compare the temperature rises under mist cooling (at 3°C, < 300 mL/h) and flood irrigation (at 22°C, > 800 mL/h). Results A significant difference exists between these two systems (p value < 0.05). The measured temperature was ∼ 4°C lower for mist cooling than for flood irrigation, even with less than a third of the flow rate. Conclusion Experimental data indicate the capability of mist cooling to reduce heat generation while simultaneously enabling flow reduction and targeted cooling. An improved field of view in an extremely narrow access corridor may be achieved with this technology.     

The Influence of Irrigation during the Finishing and Polishing of Composite Resin Restorations—A Systematic Review of In Vitro Studies

The surface smoothness of composite restorations affects not only their esthetic appearance but also other properties. Thus, rough surfaces can lead to staining, plaque accumulation, gingival irritation, recurrent caries, abrasiveness, wear kinetics, and tactile perception by the patient. The aim of this study was to evaluate the influence of irrigation during the finishing and polishing of composite resin restorations. A systematic search of the PubMed, Cochrane Library, EMBASE, Web of Science, and Clinical Trials databases was conducted. Papers published up to 11 February 2021 were considered. The quality of each study was assessed using the modified Consolidated Standards of Reporting Trials checklist for reporting in vitro studies on dental materials. No clinical studies were identified. Six in vitro studies were included, reporting changes in physical and esthetic properties. After performing a methodological quality assessment of the studies, some limitations were identified, the main limitation being the heterogeneous methodology across studies. The evidence resulting from this systematic review did not favor either wet or dry finishing/polishing procedures. There is a clear need for well-designed studies focusing on the comparison of dry/wet finishing/polishing with standard protocols to evaluate the differences among different materials and methods.     

Human modification of global water vapor flows from the land surface

It is well documented that human modification of the hydrological cycle has profoundly affected the flow of liquid water across the Earth's land surface. Alteration of water vapor flows through land-use changes has received comparatively less attention, despite compelling evidence that such alteration can influence the functioning of the Earth System. We show that deforestation is as large a driving force as irrigation in terms of changes in the hydrological cycle. Deforestation has decreased global vapor flows from land by 4% (3,000 km(3)/yr), a decrease that is quantitatively as large as the increased vapor flow caused by irrigation (2,600 km(3)/yr). Although the net change in global vapor flows is close to zero, the spatial distributions of deforestation and irrigation are different, leading to major regional transformations of vapor-flow patterns. We analyze these changes in the light of future land-use-change projections that suggest widespread deforestation in sub-Saharan Africa and intensification of agricultural production in the Asian monsoon region. Furthermore, significant modification of vapor flows in the lands around the Indian Ocean basin will increase the risk for changes in the behavior of the Asian monsoon system. This analysis suggests that the need to increase food production in one region may affect the capability to increase food production in another. At the scale of the Earth as a whole, our results emphasize the need for climate models to take land-use change, in both land cover and irrigation, into account.     

The place of intraoperative antegrade colonic irrigation in emergency left-sided colonic surgery

The healing of colinic or colorectal anastomoses depends, at least partially, on the volume of fecal residue. Intraoperative antegrade colonic irrigation enables the surgeon to prepara the colon adequately at the time of surgery and to perform safely an immediate resection and primary anastomosis in obstructive lesions of the left colon. Its indications have been extended to other left-sided colonic emergencies, especially perforation and hemorrhage. The technique is described in this study and its value is assessed in the light of available experimental and clinical evidence     

涵闸渠系钉螺截留系统(OSSS)模型实验研究初报

本实验根据流体力学和钉螺生态学理论,在配有循环水的玻璃水槽中,设计制作出由进水控制段、分离扩散段、沉降集中杀灭段、出流还原段组成的涵闸渠系钉螺截留系统(Oncomelania Stem-Stay System简称OSSS)模型。研究了改变流量、平均流速对钉螺截留的影响,分离扩散段对附叶钉螺的脱离率和截留率的影响。“采用模拟钉螺”对OSSS及其改良模型,在相同的水流条件下进行比较研究。结果表明:不加OSSS,钉螺和“模拟钉螺”全部冲向下游。而加OSSS,截留率均在98％以上,脱离率为97％。证明OSSS有良好的截留钉螺和使钉螺脱离载体的能力,而其中OSSS-1-3型较好,当相当原型流量0.93m~3/s,平均流速为15.4cm/S时,截留率可达99％。结果还表明OSSS具有不壅高水位,无需处理漂浮物,工程量小的优点。     

Can source reduction of mosquito larval habitat reduce malaria transmission in Tigray,Ethiopia?

The development of irrigation schemes by dam construction has led to an increased risk of malaria in Tigray, Ethiopia. We carried out a pilot study near a microdam to assess whether environmental management could reduce malaria transmission by Anopheles arabiensis, the main vector in Ethiopia. The study took place in Deba village, close to a dam; Maisheru village, situated 3-4 km away from the dam, acted as a control. Baseline entomological and clinical data were collected in both villages during the first 12 months. Source reduction, involving filling, draining and shading of potential mosquito-breeding habitats was carried out by the community of Deba in the second year and routine surveillance continued in both villages during the second year. Anopheles arabiensis was highly anthropophilic (Human Blood Index=0.73), biting early in the night before people went to bed. The major breeding habitats associated with the dam were areas of seepage at the dam base (28%), leaking irrigation canals (16%), pools that formed along the bed of streams from the dam (13%), and man-made pools (12%). In the pre-intervention year, 5.9-7.2 times more adult vectors were found in the dam village compared with the control village. There was a 3.1% higher prevalence of an enlarged spleen in children under 10 years in the dam village than in the control village during the pre-intervention period, but no statistically significant difference was found in the incidence of falciparum malaria between the two villages during the same period. Source reduction was associated with a 49% (95% CI=46.6-50.0) relative reduction in An. arabiensis adults in the dam village compared with the pre-intervention period. There were very few cases of malaria during the intervention period in both villages making it impossible to judge whether malaria incidence had been reduced. These preliminary findings suggest that in areas of low intensity transmission community-led larval control may be a cheap and effective method of controlling malaria. Further, large-scale studies are needed to confirm these findings.     

持续灌流模式下的耳内镜外科手术

鉴于传统耳内镜手术方式的一些缺陷,一种新型的持续灌流模式下的耳内镜外科手术模式得以形成和发展。镜头需要反复擦拭、单手操作限制、术中磨骨困难等一系列问题得到了有效解决。本文详细地介绍了持续灌流模式下的耳内镜外科手术模式的应用原理、使用方法、技术优点、临床应用场景和技术不足,有助于学习和开展该手术方式。