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Background/Purpose
The purpose of this study was to review the management of obstructive symptoms and enterocolitis (HAEC) following pull-through for Hirschsprung's disease.Methods
A systematic review and meta-analysis (1992–2017) was performed. Included studies were: randomized controlled trials (RCT), retrospective/prospective case–control (C-C), case-series (C-S). Random-effect model was used to produce risk ratio (RR) [95% CI]. P?<?0.05 was considered significant.Results
Twenty-nine studies were identified. Routine postoperative dilatations (5 C-S, 2 C-C; 405 patients): no effect on stricture incidence (RR 0.3 [0.02–5.7]; p?=?0.4). Routine postoperative rectal irrigations (2 C-C; 172 patients): reduced HAEC incidence (RR 0.2 [0.1–0.5]; p?=?0.001). Posterior myotomy/myectomy (4 C-S; 53 patients): resolved obstructive symptoms in 79% [60.6–93.5] and HAEC in 80% [64.1–92.1]. Botulinum toxin injection (9 C-S; 166 patients): short-term response in 77.3% [68.2–85.2], long-term response in 43.0% [26.9–59.9]. Topical nitric oxide (3 C-S; 13 patients): improvement in 100% of patients. Probiotic prophylaxis (3 RCT; 160 patients): no reduction in HAEC (RR 0.6 [0.2–1.7]; p?=?0.3). Anti-inflammatory drugs (1 C-S, sodium cromoglycate; 8 patients): improvement of HAEC in 75% of patients.Conclusions
Several strategies with variable results are available in patients with obstructive symptoms and HAEC. Routine postoperative dilatations and prophylactic probiotics have no role in reducing the incidence of postoperative obstructive symptoms and HAEC.Type of study
Systematic review and meta-analysis.Level of evidence
Level II. 相似文献4.
Jehan A. Mazroa Sabry A. Elmogy Mohamed M. Elgendy 《The Egyptian Journal of Radiology and Nuclear Medicine》2012
Purpose
To assess the value of the combination of contrast enhanced T1 spoiled gradient (SPGR) MR and maximum intensity projection (MIP) MR imaging in the complete pre-operative evaluation of peri-anal fistula.Patients and methods
This prospective study contained 28 patients with clinical diagnosis of peri-anal fistula, they were performed MRI using the following sequences in both axial and coronal planes: Pre contrast T2FSE, T1FSE and Post contrast SPGR. MIP reformated images were done using the SPGR sequence. Fistulas were classified according to Parks (6) classification, they were evaluated regarding site, type, extensions, complications and diagnostic accuracy of each sequence. Our findings were correlated with operative findings.Results
Fourteen patients had inter-sphincteric fistulas (50%), 8 patients had trans-sphincteric fistulas (28.6%) and 6 patients had supra-sphincteric fistulas (21.4%). Simple non branching tracts were found in 22 patients, branching tracts in 6 patients, abscess cavity in 5 patients, horseshoe extension in 4 patients. Overall diagnostic accuracy of post contrast T1 SPGR was 97.3% and MIP MR imaging was 100%. Post contrast T1 SPGR accurately evaluated all patients but missed one faint horseshoe extension and other fine para anal branches. MIP imaging accurately evaluated all the extensions and ramifications but was poor in depth orientation.Conclusion
MRI is a reliable diagnostic modality in the evaluation of peri-anal fistulas. Post contrast T1 SPGR sequence with its high resolution images and excellent anatomical orientation provides almost all the necessary details for accurate evaluation. Although MIP images lack depth orientation their high sensitivity, rotational 2D and 3D capabilities exquisitely depict all the fine ramifications and extensions. The combination of both provides complete evaluation and highest possible diagnostic accuracy aiding successful surgical interventions, aiming to reduce complications and recurrences. 相似文献5.
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通过回顾分析我院2例确诊为胰岛素自身免疫综合征(IAS)患者的临床资料,并复习相关文献,总结发病机制及治疗方法,探讨IAS患者的临床特点,提高对低血糖症的诊治水平。 相似文献
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Tariq S. Marroush Andrew R. Boshara Bassent Botros Philip Vendittelli Zohaib Ahmed Luay Dawood Howard S. Rosman 《Heart & lung : the journal of critical care》2018,47(2):131-135
Background
The rupture of sinus of Valsalva aneurysm (RSoVA) is a rare disorder that affects the integrity of the cardiovascular system, disrupting its dynamics and resulting in a variety of manifestations. In this report, we discuss two cases of RSoVA that we encountered and review similar cases reported in the literature.Methods
literature review of reported cases of RSoVA in PubMed and Google Scholar.Results
A total of 223 cases were found and the final analysis included 225 cases, of which 69% occurred in males and the mean age was 38.9 years.Dyspnea was the most common presenting symptom and 76% of the cases described continuous murmur on examination. The right sinus was affected in 61% of the cases and the fistula connected to the right chambers of the heart 73% of the time.Conclusion
RSoVA is a rare condition that is difficult to diagnose, it should be considered in the right context, particularly in young patients with symptoms of heart failure and the presence of continuous murmur on cardiac examination. 相似文献9.
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We describe a simple and reliable method for quantitating C3d in human plasma. The method rests on the finding that native C3 and its activation/inactivation product C3c bind to Concanavalin A, whereas C3d does not. Rocket affinoimmunoelectrophoresis with Con-A Sepharose incorporated into an intermediate gel permits quantitation of free C3d in 2-20 microliters aliquots of EDTA-plasma without any manipulation prior to sample application. Using this method, we found that the level of circulating C3d in plasma of 30 healthy donors was usually well below 3% of maximally convertable C3d. 相似文献