Treatment Options for Perforated Colonic Diverticular Disease

Diverticular disease is one of the most common diseases of the gastrointestinal (GI) tract requiring in-hospital treatment in Western countries. Despite its high incidence, controversies remain about the optimal treatment of the different stages of this disease. Most people with diverticular disease remain asymptomatic; however, approximately 15% develop symptoms, and of these, 15% will develop significant complications such as perforation [1]. Although the absolute prevalence of perforated diverticulitis (PD) complicated by generalized peritonitis is low, its importance lies in the significant postoperative mortality rate, ranging from 4–26% [2–4]. Owing to the low prevalence of generalized peritonitis due to PD (GPPD), strategies for the treatment of this stage of diverticulitis are even less thoroughly investigated. There are two major reasons for this...

Preoperative staging of perforated diverticulitis by computed tomography scanning

Background: Treatment of perforated diverticulitis depends on disease severity classified according to Hinchey's preoperative classification. This study assessed the accuracy of preoperative staging of perforated diverticulitis by computerized tomography (CT) scanning. Methods: All patients who presented with perforated diverticulitis between 1999 and 2009 in two teaching hospitals of Rotterdam, the Netherlands, and in addition had a preoperative CT scan with

Effects of new anti-adhesion polyvinyl alcohol gel on healing of colon anastomoses in rats

Background: Adhesions follow abdominal surgery with an incidence as high as 95%, resulting in invalidating complications such as bowel obstruction, female infertility, and chronic pain. Searches have been performed for a safe and effective adhesion barrier; however, such barriers have impaired anastomotic site healing. The primary aim of this study was to investigate the effect of a new adhesion barrier, polyvinyl alcohol gel, on healing of colonic anastomoses using a rat model. Methods: Thirty-two Wistar rats were divided in two groups. In all animals, an anastomosis was constructed in the ascending colon. The first group received no adhesion barrier, whereas in the second group, 2mL of polyvinyl alcohol gel (A-Part Gel®; Aesculap AG, Tuttlingen, Germany) was applied circularly around the anastomosis. All animals were sacrificed on the seventh post-operative day, and the abdomen was inspected for signs of anastomotic leakage. The anastomotic bursting pressure, the adhesions around the anastomosis, and the collagen content of the excised anastomosis were measured. Results: No significant differences were observed between the two groups in the incidence of anastomotic leakage, the anastomotic bursting pressure (p=0.08), or the collagen concentration (p=0.91). No significant reduction in amount of adhesions was observed in the rats receiving polyvinyl alcohol gel. Conclusions: This experimental study showed no significant differences in anastomotic leakage, anastomotic bursting pressure, or collagen content of the anastomosis when using the adhesion barrier polyvinyl alcohol around colonic anastomoses. The barrier did not prevent adhesion formation

New Approaches to the Surgical Treatment of Intra-abdominal Infection

Buikpijn is een veel voorkomende reden van presentatie op de spoedeisende hulp. In ongeveer de helft van de gevallen betreft het buikpijn ten gevolge van een infectie. Een dergelijke infectie kan aanleiding geven tot peritonitis; inflammatoire reactie van het lichaam binnen het abdomen. Dit proefschrift richt zich op de behandeling van intra-abdominale infecties en complicaties volgend op intra-abdominale infecties. Een van de meest voorkomende oorzaken van abdominale infecties is diverticulitis. Divertikel ziekte leidt in Nederland tot 18.000 ziekenhuisopnames per jaar. De ziekte komt voor in verschillende verschijningen: van asymptomische diverticulose tot geperforeerde diverticulitis met systemische sepsis. Om een goede inschatting van de ernst van de ziekte te kunnen maken wordt in de meeste patiënten verdacht voor diverticulitis aanvullend onderzoek verricht. De eerste keus is hierbij echografisch onderzoek. Indien deze niet conclusief is of verdacht voor gecompliceerde diverticulitis wordt een CT-scan geadviseerd. Classificatie van de ernst van de ziekte op basis van de Hinchey classificatie blijkt een diagnostische accuraatheid tussen de 71 en 92% te hebben. Daarom adviseren wij een nieuw gradatie systeem om richting te geven aan de behandeling van diverticulitis. De chirurgische behandeling van diverticulitis bestaat van oudsher uit een sigmoidresectie met eindstandig colostoma of met directe anastomose. Een minder invasieve behandeling middels laparoscopische lavage (spoelen van de buikholte) is onderzocht in de gerandomiseerde Ladies trial. In de LOLA arm werd de laparoscopische lavage vergeleken met een sigmoidresectie. Deze studie toonde dat er geen voordeel is van lavage op het primaire eindpunt van ernstige morbiditeit en mortaliteit. In geval van geperforeerde diverticulitis is er een verhoogde kans op ontwikkelen van hernia cicatricalis. In enkele dierexperimenten werden synthetische en biologische meshes onderzocht op infectieuze complicaties, adhesie vorming en ingroei na implantatie in schone en gecontamineerde omgeving. Er werden significant meer mesh infecties gevonden na implantatie van gecrosslinkte biomeshes en de synthetische meshes C-Qur en Dualmesh. Ingroei van biologische meshes in de buikwand varieerde tussen de 0 en 39%. Opvallend was de complete verdwijning van Surgisis meshes. De slechte ingroei, hoge percentage meshinfecties en complete verdwijning maakt lange termijn biomechanische kracht van hernia herstel met behulp van biologische meshes twijfelachtig

Low agreement between cardiologists diagnosing left ventricular hypertrophy in children with end-stage renal disease

Background: Monitoring of the appearance of left ventricular hypertrophy (LVH) by echocardiography is currently recommended for in the management of children with End-stage renal disease (ESRD). In order to investigate the validity of this method in ESRD children, we assessed the intra- and inter-observer reproducibility of the diagnosis LVH. Methods. Echocardiographic measurements in 92 children (0-18 years) with ESRD, made by original analysists, were reassessed offline, twice, by 3 independent observers. Smallest detectable changes (SDC) were calculated for continuous measurements of diastolic interventricular septum (IVSd), Left ventricle posterior wall thickness (LVPWd), Left ventricle end-diastolic diameter (LVEDd), and Left ventricle mass index (LVMI). Cohen's kappa was calculated to assess the reproducibility of LVH defined in two different ways. LVHWT was defined as Z-value of IVSd and/or LVPWd>2 and LVHMI was defined as LVMI> 103 g/m 2 for boys and >84 g/m2 for girls. Results: The intra-observer SDCs ranged from 1.6 to 1.7 mm, 2.0 to 2.6 mm and 17.7 to 30.5 g/m2 for IVSd, LVPWd and LVMI, respectively. The inter-observer SDCs were 2.6 mm, 2.9 mm and 24.6 g/m2 for IVSd, LVPWd and LVMI, respectively. Depending on the observer, the prevalence of LVHWT and LVHMI ranged from 2 to 30% and from 8 to 25%, respectively. Kappas ranged from 0.4 to 1.0 and from 0.1 to 0.5, for intra-and inter- observer reproducibility, respectively. Conclusions: Changes in diastolic wall thickness of less than 1.6 mm or LVMI less than 17.7 g/m2 cannot be distinguished from measurement error in individual children, even when measured by the same observer. This limits the use of echocardiography to detect changes in wall thickness in children with ESRD in routine practice

The 'reach' of Digital Language Archives: towards criteria for evaluation

Over the last decade, and with the help of digital media and technologies, archives (with the focus here on archives for endangered and minority languages) have extended their focus from preservation to also becoming facilities for dissemination. Their innovations have largely been on ‘discovery’: firstly by encouraging digitisation and inclusion of analogue and obscure materials, and by partnership with funding institutions to support the creation of new, ‘born digital’ language resources; and secondly through online provision of language resources via web catalogues driven by standardised metadata and in some cases providing enhanced discovery through web portals aggregating the holdings of multiple archives. These advances have increased the visibility, relevance and authority of archives for language-related disciplines and for language-speaker communities. This paper considers a broader set of parameters describing the ‘reach’ of archives, where ‘reach’ includes (a) archives’ understanding of their key audiences in order to provide appropriate services for them, e.g. identifying a range of relevant audiences, their languages of access, their varied technological and information literacies, interface design and usability; (b) discovery, drawing on the understandings of audiences in order to help them browse, navigate, search, identify and select their items of interest; (c) delivery, i.e. making available selected resources according to users’ preferences whether by download, view-in-browser, through apps or other means; (d) access management such that resource delivery follows depositors’ and communities’ preferences, and where users have ways of applying for and negotiating for access; (e) information accessibility, where the actual desired content is accessible to users, whether in terms of contextualisation or appropriate complexity, language, or modality; and finally (f) feedback channels, where users can utilise the archive to provide feedback to depositors or to enhance deposits with user-generated content. Through considering how a number of archives are providing such services, we can see their transition from repositories of memory to facilities for fostering participation and understanding

Narrative Exposure Therapy for Posttraumatic Stress Disorder associated with repeated interpersonal trauma in patients with Severe Mental Illness: a mixed methods design

Background: In the Netherlands, most patients with severe mental illness (SMI) receive flexible assertive community treatment (FACT) provided by multidisciplinary community mental health teams. SMI patients with comorbid posttraumatic stress disorder (PTSD) are sometimes offered evidence-based trauma-focused treatment like eye movement desensitization reprocessing or prolonged exposure. There is a large amount of evidence for the effectiveness of narrative exposure therapy (NET) within various vulnerable patient groups with repeated interpersonal trauma. Some FACT-teams provide NET for patients with comorbid PTSD, which is promising, but has not been specifically studied in SMI patients. Objectives: The primary aim is to evaluate NET in SMI patients with comorbid PTSD associated with repeated interpersonal trauma to get insight into whether (1) PTSD and dissociative symptoms changes and (2) changes occur in the present SMI symptoms, care needs, quality of life, global functioning, and care consumption. The second aim is to gain insight into patients’ experiences with NET and to identify influencing factors on treatment results. Methods: This study will have a mixed methods convergent design consisting of quantitative repeated measures and qualitative semi-structured in-depth interviews based on Grounded Theory. The study population will include adult SMI outpatients (n=25) with comorbid PTSD and receiving NET. The quantitative study parameters will be existence and severity of PTSD, dissociative, and SMI symptoms; care needs; quality of life; global functioning; and care consumption. In a longitudinal analysis, outcomes will be analyzed using mixed models to estimate the difference in means between baseline and repeated measurements. The qualitative study parameters will be experiences with NET and perceived factors for success or failure. Integration of quantitative and qualitative results will be focused on interpreting how qualitative results enhance the understanding of quantitative outcomes. Discussion: The results of this study will provide more insight into influencing factors for clinical changes in this population

Meta-analysis of genome-wide association studies of anxiety disorders.

Anxiety disorders (ADs), namely generalized AD, panic disorder and phobias, are common, etiologically complex conditions with a partially genetic basis. Despite differing on diagnostic definitions based on clinical presentation, ADs likely represent various expressions of an underlying common diathesis of abnormal regulation of basic threat-response systems. We conducted genome-wide association analyses in nine samples of European ancestry from seven large, independent studies. To identify genetic variants contributing to genetic susceptibility shared across interview-generated DSM-based ADs, we applied two phenotypic approaches: (1) comparisons between categorical AD cases and supernormal controls, and (2) quantitative phenotypic factor scores (FS) derived from a multivariate analysis combining information across the clinical phenotypes. We used logistic and linear regression, respectively, to analyze the association between these phenotypes and genome-wide single nucleotide polymorphisms. Meta-analysis for each phenotype combined results across the nine samples for over 18 000 unrelated individuals. Each meta-analysis identified a different genome-wide significant region, with the following markers showing the strongest association: for case-control contrasts, rs1709393 located in an uncharacterized non-coding RNA locus on chromosomal band 3q12.3 (P=1.65 × 10(-8)); for FS, rs1067327 within CAMKMT encoding the calmodulin-lysine N-methyltransferase on chromosomal band 2p21 (P=2.86 × 10(-9)). Independent replication and further exploration of these findings are needed to more fully understand the role of these variants in risk and expression of ADs.Molecular Psychiatry advance online publication, 12 January 2016; doi:10.1038/mp.2015.197

Prognostic value of multiple repeated biomarkers in pulmonary arterial hypertension associated with congenital heart disease

Contains fulltext : 202687.pdf (publisher's version ) (Open Access

Genetic determinants of thyroid function in children

OBJECTIVE:Genome-wide association studies in adults have identified 42 loci associated with thyroid stimulating hormone (TSH) and 21 loci associated with free thyroxine (FT4) concentrations. While biologically plausible, age-dependent effects have not been assessed. We aimed to study the association of previously identified genetic determinants of TSH and FT4 with TSH and FT4 concentrations in newborns and (pre)school children. METHODS: We selected participants from three population-based prospective cohorts with data on genetic variants and thyroid function: Generation R (N = 2169 children, mean age 6 years; N = 2388 neonates, the Netherlands), the Avon Longitudinal Study of Parents and Children (ALSPAC; N = 3382, age 7.5 years, United Kingdom), and the Brisbane Longitudinal Twin Study (BLTS; N = 1680, age 12.1 years, Australia). The association of single nucleotide polymorphisms (SNPs) with TSH and FT4 concentrations was studied with multivariable linear regression models. Weighted polygenic risk scores (PRSs) were defined to combine SNP effects.RESULTS:In childhood, 30/60 SNPs were associated with TSH and 11/31 SNPs with FT4 after multiple testing correction. The effect sizes for AADAT, GLIS3, TM4SF4, and VEGFA were notably larger than in adults. The TSH PRS explained 5.3%-8.4% of the variability in TSH concentrations; the FT4 PRS explained 1.5%-4.2% of the variability in FT4 concentrations. Five TSH SNPs and no FT4 SNPs were associated with thyroid function in neonates. CONCLUSIONS: The effects of many known thyroid function SNPs are already apparent in childhood and some might be notably larger in children as compared to adults. These findings provide new knowledge about genetic regulation of thyroid function in early life.</p