Validation of low-cost models for minimal invasive surgery training of congenital diaphragmatic hernia and esophageal atresia

BackgroundMinimal invasive surgery (MIS) is increasingly used for the correction of congenital diaphragmatic hernia (CDH) and esophageal atresia (EA). It is important to master these complex procedures, preferably preclinically, to avoid complications. The aim of this study was to validate recently developed models to train these MIS procedures preclinically.MethodsTwo low cost, reproducible models (one for CDH and one for EA) were validated during several pediatric surgical conferences and training sessions (January 2017–December 2018), used in either the LaparoscopyBoxx or EoSim simulator. Participants used one or both models and completed a questionnaire regarding their opinion on realism (face validity) and didactic value (content validity), rated on a five-point-Likert scale.ResultsOf all 60 participants enrolled, 44 evaluated the EA model. All items were evaluated as significantly better than neutral, with means ranging from 3.7 to 4.1 (p < 0.001). The CDH model was evaluated by 48 participants. All items scored significantly better than neutral (means 3.5–3.9, p < 0.001), with exception of the haptics of the simulated diaphragm (mean 3.3, p = 0.054). Both models were considered a potent training tool (means 3.9).ConclusionThese readily available and low budget models are considered a valid and potent training tool by both experts and target group participants.Type of studyProspective study.Level of evidenceLevel II.     

Scarf osteotomy for hallux valgus deformity: Radiological outcome,metatarsal length and early complications in 118 feet

BackgroundScarf osteotomy has been widely used to restore axial orientation of the first ray in the treatment of hallux valgus deformity. The aim of the study was to present our radiological outcomes of bunion reconstruction, identify surgical complications in early follow-up, and assess to what extent a shortening of the first metatarsal is present after surgery as a possible cause of postoperative metatarsalgia.MethodsWe enrolled 106 patients (118 feet) and assessed patients’ pre- and postoperative measurements of hallux valgus and intermetatarsal angles on weightbearing X-ray images. Three different methods of measuring metatarsal length were compared and early postoperative complications noted.ResultsHallux valgus angle decreased significantly by an average of 18.7 degrees and the intermetatarsal angle by 7.8 degrees. Using three methods of measuring metatarsal length, all showed significant shortening of the first metatarsal. Mean relative lengthening of the second metatarsal averaged 0.45 mm. The Coughlin method showed the highest interrater reliability (ICC = 0.96).ConclusionsSignificant reduction of the hallux valgus angle and intermetatarsal angle was demonstrated with a low complication rate. There was significant shortening of the first metatarsal. The Coughlin method clearly demonstrated an excellent interrater reliability.Level of evidenceLevel IV.     

Endoscopic therapy of weight regain after bariatric surgery

Weight regain following primary bariatric surgery occurs in a significant proportion of patients and is attributed to epidemiological, anatomical and metabolic factors. Surgical revision of these patients has significant risks and limited benefits. Endoscopic revisions that reduce gastric pouch size and diameter of the gastrojejunal anastomosis may offer an effective, safe, less invasive and even reproducible treatment. We herein discuss the indication, selection and feasibility of different endoscopic techniques that could be used in the management of weight regain following primary bariatric surgery. Future research could optimize a personalized approach not only in the endoscopic management but also in combination with other therapeutic modalities for weight regain after bariatric surgery.     

Reported disease and psychological well-being in Swiss adults

Summary In Switzerland, and in many other countries as well, the distribution of morbidity and perceived health in the general population and their determining factors have not been systematically studied so far. This article reports an exploratory study of prevalence of two complex health indicators, longstanding disease (Disease) and psychological well-being (Well-being) and of their environmental, person-specific and behavioural determinants. Data from a health survey conducted in five cantons and three language regions as part of the Swiss Intercantonal Health Indicators Project were used. Whereas distributions of prevalence of Disease according to gender, age, level of education and place of living confirm results of other studies, unexpected prevalence patterns were found for Well-being, especially with regard to gender differences. Multivariate analyses by general linear models (independent sub-samples of the study population were used to develop and validate models) showed different sets of environmental, person-specific and behavioural factors to explain inter-individual differences of Disease and Well-being, both in the total validation sample and in sub-samples of women and men. The results are discussed with regard to implications for socioepidemiological health research.

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Zusammenfassung Wie in zahlreichen anderen Ländern so sind bisher in der Schweiz die Verteilung und die Determinanten von Morbidität und wahrgenommener Gesundheit in der Gesamtbevölkerung nicht systematisch untersucht worden. Die vorliegende Arbeit berichtet über eine explorative Studie über die Prävalenz zweier komplexer Gesundheitsindikatoren, länger andauernde Krankheit (Disease) und psychisches Wohlbefinden (Well-being), und über deren jeweilige umweltbedingte, personale und verhaltensbezogene Einflußfaktoren. Grundlage dafür waren Daten, die in einer Bevölkerungsbefragung in 5 Kantonen und 3 Sprachregionen im Rahmen des Interkantonalen Gesundheitsindikatorenprojekts (IGIPPROMES) erhoben wurden. Während die Verteilung der Prävalenz von Krankheit nach Geschlecht, Alter, Bildungsstatus und Wohnortgrösse den Ergebnissen anderer Studien entspricht, ergaben sich bei der Prävalenz von Wohlbefinden unerwartete Verteilungsmuster, insbesondere Unterschiede zwischen Frauen und Männern. Eine Analyse interindividueller Unterschiede von Krankheit und Wohlbefinden mit Hilfe eines allgemeinen linearen Modells (Modellentwicklung und Validierung an unabhängigen Teilstichproben) zeigte, dass diese durch jeweils spezifische Konstellationen von Umwelt-, Personen- und Verhaltensfaktoren erklärt werden können, sowohl in der gesamten Validierungsstichprobe als auch in den Teilstichproben für Frauen und Männer. Die Ergebnisse der Studie werden in Hinblick auf die Weiterentwicklung der sozialepidemiologischen Gesundheitsforschung diskutiert.

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Résumé En Suisse, comme dans beaucoup d'autres pays, la morbidité et le bien-être psychologique de la population générale n'ont presque pas été étudiés jusqu'à présent. Dans ce rapport, les résultats d'une étude exploratoire sur deux indicateurs complexes de santé, maladie chronique (Disease) et bien-être psychologique (Well-being) et sur les facteurs de l'environnement, de la personnalité et du comportement qui influencent ces deux indicateurs sont présentés. Cette étude faisait part du projet intercantonal sur les indicateurs de santé (IGIP-PROMES) et se base sur les données tirées d'une enquête auprès des populations de cinq cantons et trois régions linguistique de la Suisse. Tandis que la prévalence de l'indicateur «maladie» par sexe, age, degré de formation et dimension du lieu de résidence était conforme aux résultats d'autres études, des distributions inattendues de la prévalence de «bien-être psychologique», notamment des différences entre hommes et femmes ont été trouvées. Une analyse des différences entre individue de «maladie» et «bien-être» au moyen d'un modèle linéaire généralisi — le développement et l'évaluation duquel ont été faits à l'aide de deux échantillons d'occasion indépendents — a montré que des constellations spécifiques constituées de facteurs de l'environnement, de la personnalité et du comportement, peuvent expliquer ces différences, soit dans l'échantillon d'évaluation totale, soit dans les échantillons partiels de femmes et d'hommes. Ces résultats sont discutés par rapport à l'évolution de la recherche socio-épidémiologique.

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Paper presented at a symposium on The Public Health Perspective of Social and Preventive Medicine, in celebration of the 20th anniversary of the Department of Social and Preventive Medicine, University of Berne, 25 June 1992 in Berne.     

Two outbreaks of typhoid fever related to the war in Bosnia and Herzegovina

Two outbreaks of typhoid fever caused by Salmonella typhi of the same phagotype (A, biotype II) and antibiotic susceptibility are reported. Both occurred during the war in Bosnia and Herzegovina. The first outbreak appeared among the refugees from the town of Jajce. The second outbreak appeared among the inhabitants in the village of Vidosi near Livno. This report describes main clinical, epidemioloigcal and laboratory findings for 22 patients treated in Split University Hospital, Croatia, in the period November 1992–January 1993. Possible epidemiological connections between those two outbreaks are discussed.     

Ten-year outcomes in a population-based cohort of node-negative, lymphatic, and vascular invasion-negative early breast cancers without adjuvant systemic therapies.

PURPOSE: To discuss the absolute benefits from adjuvant systemic therapy knowledge of long-term outcomes and baseline risks of relapse and disease-specific survival are required. We assessed the 10-year outcomes in a population-based cohort of node-negative (N-) lymphovascular negative (LV-) early breast cancers diagnosed from 1989 to 1991 who did not receive adjuvant systemic therapy. METHODS: One thousand one hundred eighty-seven cases of pT(1-2)N(0) LV- breast cancers with a median follow-up of 10.4 years were reviewed. Kaplan-Meier survival curves for relapse free survival (RFS), breast cancer-specific survival (BCSS) and overall survival (OS) were compared with log-rank tests with cohorts stratified for tumor size and grade. RESULTS: The median age of this series was 62 years. Four hundred thirty tumors were < or = 1 cm in diameter (cohort 1), 507 were 1.1-2 cm (cohort 2), and 250 were 2.1 to 5 cm in diameter (cohort 3). The 10-year outcomes for cohorts 1, 2, and 3, respectively, were significantly different: RFS, 82%, 75%, and 66%; BCSS, 92%, 90%, and 77%; and OS, 79%, 78%, and 66%. Tumor grade significantly altered outcome within size cohorts, particularly in pT(1)N(0) breast cancers. CONCLUSION: This study provides detailed information on the continued relapse and breast cancer death rate to 10 years of follow-up. Specifically, without adjuvant systemic therapy, patients with LV-, N - breast cancer had a > or = 25% 10-year risk of relapse and a corresponding 10-year breast cancer death rate of > or = 10% if they had either a grade 3 tumor < or = 1 cm, a grade 2 to 3 tumor from 1.1 to 2 cm, or any grade tumor greater than 2 cm.     

Estrogen receptor status in BRCA1- and BRCA2-related breast cancer: the influence of age, grade, and histological type.

PURPOSE: BRCA1-related breast cancers are more frequently estrogen receptor (ER) negative than are either BRCA2-related or nonhereditary breast cancers. The relationship between ER status and other clinical features of hereditary breast cancers has not been well studied. EXPERIMENTAL DESIGN: ER status, grade, and histological tumor type were evaluated in 1131 women with invasive breast cancer, ascertained at 10 centers in North America. There were 208 BRCA1 mutation carriers, 88 BRCA2 carriers, and 804 women without a known mutation. We stratified the patients by mutation status, grade, age, and histological type and calculated the percentage of ER-positive tumors within each stratum. RESULTS: BRCA1 mutation carriers were more likely to have ER-negative breast cancers than were women in other groups, after adjustment for age, grade, and histological subtype (P < 0.001). Only 3.9% of BRCA1-related breast cancers were ER-positive cancers occurring in women in their postmenopausal years. The direction and magnitude of the change in ER status with increasing age at diagnosis in BRCA1 carriers was significantly different from in BRCA2 carriers (P(intercept) = 0.0002, P(slope) = 0.04). Notably, changes in ER status with age at diagnosis for BRCA1 carriers and noncarriers were almost identical (P(slope) = 0.98). CONCLUSIONS: The strong relationship between the presence of a BRCA1 mutation and the ER-negative status of the breast cancers is neither a consequence of the young age at onset nor the high grade but is an intrinsic property of BRCA1-related cancers. The ER-negative status of these cancers may reflect the cell of origin of BRCA1-related cancers.