Ostomy

The impact of sinus surgery on the pulmonary status of cystic fibrosis patients is unknown. This retrospective study reviewed the charts of the cystic fibrosis patients presenting to our institution's cystic fibrosis center with nasal obstruction, recurrent sinusitis, and nasal polyposis. This group subsequently underwent endoscopic ethmoidectomy and antrostomy. Fourteen of the 15 patients, ages 5-24 years, received preoperative and postoperative pulmonary function testing obtained by spirometry. The data were compiled and analyzed statistically. Our results suggested no significant improvement in the pulmonary function of cystic fibrosis patients after sinus surgery.

We have studied stoma care nurses' experience with Asian patients having a stoma. The general public's attitudes to abdominal surgery in general were assessed in a survey of employees in Leicester. M a n y stoma care nurses are aware of the needs of Asian patients, especially with regards to ethnic dress, but only half o f the ostomists who wanted to see a stoma care nurse or fellow ostomist were able to do so (Z= = 4.5, p < 0.03). All ostomists considered counselling on education, employment and marriage inadequate. There is a high level o f anxiety about stomas and these anxieties are surprisingly similar for all ethnic groups. R~sum& Nous avons 6tudi6 l'expdrience des infirmi6res stomathdrapistes avec les patients asiatiques ayant une stomie abdominale. L'attitude du public en g6n6ral envers la chirurgie abdominale a 6t6 6tudi6e sur des em-ploy6s de Leicester. Beaucoup de stomath6rapistes sont conscientes du besoin des patients asiatiques, particuli6rement en raison de leurs v6tements traditionnels, mais seulement la moitib des stomis6s qui voulaient voir une stomath6rapiste ou un malade stomis6 6tait capable de le faire (Z 2 = 8.5, p < 0.005), et significativement moins d'infirmi6res que de malades savaient que les asiatiques avaient un besoin de stomath&apistes (x 2 = 4.5, p < 0.03). Tousles stomisds consid6raient que les conseils en 6ducation, en emplois, ou en mariage 6taient inad6quats. I1 y avait un taux important d'anxi6t6 envers les stomies et cette anxi6t6 6tait de faqon surprenante similaire pour tous les groupes ethniques.

Stenosis of stomas sited at the umbilicus presents a surgical challenge. A paucity of literature exists on the surgical management of this problem, despite its relatively frequent occurrence. A simple technique is described, using scar incision and advancement of an umbilical skin flap, to accomplish stomal revision. UROLOGY 69: 771-772, 2007.

Aim. This paper is a report of an evaluation of the effectiveness of a multimedia education program in relation to stoma knowledge, self-care attitudes and behaviour with patients with a stoma in the postoperative period. Background. Multimedia education programmes not only give patients with useful information in the absence of health professionals, but can also augment information given in traditional clinical practice. However, the literature on the effectiveness of different approaches to stoma education is limited. Method. A randomized experimental study design was used. Participants were recruited from a surgical unit in a large hospital in Taiwan. A total of 102 patients with a stoma were randomly assigned to either the multimedia education programme (n = 46) or a conventional stoma education programme (n = 56) with a follow-up of 1 week. Outcome variables measured were levels of self-care knowledge, attitudes towards self-care and self-care behaviour. Findings. Patients who received the multimedia education programme improved their overall self-care knowledge, attitudes and behaviour statistically significantly when compared with those who received the conventional stoma education programme. Conclusion. Although further, longer-term follow-up will be useful, this study demonstrates that multimedia packages can enhance patient involvement in their stoma care and can augment stoma education -particularly in resource challenged healthcare environments.

■ ABSTRACT PURPOSE: The purpose of this study was to adapt the Ostomy Adjustment Scale to a Norwegian version and to assess its construct validity and 2 components of its reliability (internal consistency and test-retest reliability). SUBJECTS AND SETTING: One hundred fi fty-eight of 217 patients (73%) with a colostomy, ileostomy, or urostomy participated in the study. Slightly more than half (56%) were men. Their mean age was 64 years (range, 26-91 years). All respondents had undergone ostomy surgery at least 3 months before participation in the study. METHODS: The Ostomy Adjustment Scale was translated into Norwegian according to standard procedures for forward and backward translation. The questionnaire was sent to the participants via regular post. The Cronbach alpha and test-retest were computed to assess reliability. Construct validity was evaluated via correlations between each item and score sums; correlations were used to analyze relationships between the Ostomy Adjustment Scale and the 36-item Short Form Health Survey, the Quality of Life Scale, the Hospital Anxiety & Depression Scale, and the General Self-Effi cacy Scale. RESULTS: The Cronbach alpha was 0.93, and test-retest reliability r was 0.69. The average correlation quotient item to sum score was 0.49 (range, 0.31-0.73). Results showed moderate negative correlations between the Ostomy Adjustment Scale and the Hospital Anxiety and Depression Scale ( − 0.37 and − 0.40), and moderate positive correlations between the Ostomy Adjustment Scale and the 36-item Short Form Health Survey, the Quality of Life Scale, and the General Self-Effi cacy Scale (0.30-0.45) with the exception of the pain domain in the Short Form 36 (0.28). Regression analysis showed linear associations between the Ostomy Adjustment Scale and sociodemographic and clinical variables with the exception of education. CONCLUSIONS: The Norwegian language version of the Ostomy Adjustment Scale was found to possess construct validity, along with internal consistency and test-retest reliability. The instrument is sensitive for sociodemo-graphic and clinical variables pertinent to persons with urostomies, colostomies, and ileostomies. KEY WORDS: adjustment , body image , colostomy , healthrelated quality of life , ileostomy , ostomy , quality of life , self-effi cacy , urostomy .

Infrahepatic vena cavocavostomy has been reported to be a rescue therapy when venous outflow from a liver allograft is obstructed due to stenosis of a piggyback anastomosis. The authors have described herein two consecutive adult liver transplantations using this technique as the primary venous anastomosis. Using a caval clamp positioned above the retrohepatic portion, partial hemodynamic obstruction of caval flow was well tolerated, avoiding use of a venovenous bypass. Although additional studies regarding this technique are needed, we believe that an infrahepatic vena cavocavostomy should be considered to be an alternative technique in carefully selected cases.

Ostomy patients are subject to signifi cant negative psychological impact, affecting their quality of life in all respects (physical, psychological, social, economic, and spiritual), especially if they are not properly constructed or if there are complications during the recovery phase. In the light of published research and studies, the main problems are as follows: a) alteration of body image; loss of sphincter control; b) odor, leakage, and complications related to the stoma; c) impairment of sexuality; d) alteration of nutrition and sleep; e) anxiety, depression, and loneliness; embarrassment and shame; f) loss of control of the situation; drop in self-esteem; g) rejection; h) stigmatization; i) disinvestment in social activities; l) abandonment of work and sports activities; isolation; m) diffi culties in couple relationships and social contacts. The psychological problems caused by ostomy can be avoided, or at least contained, by comprehensive care of the patient, both before and after the operation. In addition to purely technical care, teaching, accompaniment and constant support are the main components of care that can make a difference to how the patient will accept his or her ostomy. Setting the care only on the management of the physical dimension will hardly allow the person to integrate the ostomy into his life. The present work proposes a specifi c protocol of psychological intervention (Perrotta-Guerrieri Psychological Care for Ostomy Patients, PCOP), for all the clinical phases (pre-operative, operative, postoperative, follow-up) and a specifi c questionnaire (Perrotta-Guerrieri Psychological Care for Ostomy Patients Questionnaire-fi rst version, PCOP-Q1) to be submitted to the patient which investigates the 9 subjective functions (physical, psychological, sexual, emotional, sentimental, work, family and social), in 45 items with a response on L1-5 scale, for the study of quality of life in the ostomised patient.

Aim: The aim of this literature review is to qualitatively and quantitatively evaluate research and publications on patients with stoma in Turkey and to contribute and improve the quality of care for patients with stoma by shedding light on new studies. Method: Dokuz Eylül University electronic data base (n=71), ULAKBİM (Turkish Academic Network and Information Center), Pubmed, Council of Higher Education Thesis Center, Google Scholar, congress websites, accessible conference/symposium books and reference lists of articles were searched online. Results: Two hundred and seventy-eight studies (between January 1981 and January 2016) were reached. These studies were 54% (n=100) research articles, 14% (n=27) thesis, 15% (n=28) review articles, 14% (n=27) case reports and 3% (n=6) qualitative research; Rate of studies being published in international journals was 7% (n=20). More than half, 65% (n=182) of the studies were in the form of full/summary text. Descriptive (retrospective, prospective, cross-sectional) research articles made up 80% (n=80), ampirical articles made up 8% (n=8) and methodological research made up 6% (n=6) of research articles; 58% (n=19) of the thesis was of master's, 11% (n=3) was of expertise in medicine, 18% (n=5) was PhD thesis; 15% (n=6) of thesis was published in a journal. It was found that out of 107 studies that were presented at the congress 71% (n=76) was original research, 18% (n=19) was case report and 9% (n=11) was review. Studies were on stoma complications (17%), life quality (12%), stoma surgery techniques and comparison of effectiveness (10%), patient follow-up results (6%), sexuality (6%), patient experience (4%), adaptation to ostomy (4%), body image (4%), self-esteem (3%), nurse/patient knowledge level about ostomy care (3%). Conclusion: It was seen that most of the studies were descriptive and on stoma complications and quality of life. Morever, the ratio of publications published in international journals were low. More interventional studies should be conducted on adaptation to life with stoma for the patients in Turkey; these studies should be presented in congress and published in national/international journals.

Background. Completely occlusive esophageal strictures may develop after head and neck radiotherapy or esophagectomy with gastric or colonic interposition. Major surgical intervention may be required to restore alimentary tract patency when endoscopic lumen reconstitution is not feasible by routine antegrade endoscopy.

Background: Previous research suggests an ostomy worsens health-related quality of life (HR-QOL), but comorbidities also can affect HR-QOL. Methods: Eligible patients had abdominal operation with ostomy (cases) or similar procedure without ostomy (controls). Patients were recruited for this case-control study from 3 Veterans Affairs hospital medical and pharmacy records. Comorbidities were assessed with Charlson-Deyo Comorbidity Index. Multinomial logistic regression evaluated the impact of comorbidities and having an ostomy on HR-QOL, measured using the Medical Outcomes Study Short Form 36 for Veterans. Results: A total of 237 ostomates (cases) and 268 controls were studied. Average age was 69 years; 64% of cases had colostomy, 36% ileostomy. Twenty-nine percent of patients had a high level of comorbidities. Cases and controls were similar except for reasons for undergoing surgery. High comorbidity was a significant predictor of low HR-QOL in 6 domains of the Short Form 36 for Veterans; having an ostomy was a significant predictor in 4. Conclusions: High comorbidity significantly influences low HR-QOL and impacted more domains than having an ostomy.

To study possible initial mechanisms of alterations in aqueous outflow that may result from the injection of viscoelastic into Schlemm's canal (SC) during viscocanalostomy. Design: Experimental animal (Macaca nemestrina) and human autopsy study. Methods: Eyes were dissected into a limbal ring and hemisected or quartered. Uncannulated segments served as controls. In treated segments, SC was cannulated and viscoelastic injected. Segments were fixed and sectioned into continuous 500 to 1000 m pieces, examined at the dissecting microscope, and photomicrographs were taken. Representative tissue was further prepared for scanning electron microscopy or sectioned at 1 m. Main Outcome Measures: Tissue sections were examined to determine the extent of dilation and disruption of SC and related structures. SC dimensions were measured in segments from controls, cannulated regions, and regions of viscoelastic injection beyond the cannula insertion. In the hemisected segments, the circumferential extent of SC dilation was determined, and structures within the canal were described and counted. Results: SC was dilated with increased anteroposterior length and height in cannulated and viscoelasticinjected segments in both primate and human eyes relative to untreated controls. The walls of SC were disrupted in both regions of cannulation and of viscoelastic injection, and the collector channels were widely dilated by viscoelastic. With decreasing effectiveness, the injected viscoelastic circumferentially dilated SC as far as 14 mm and 16 mm in primate and human hemisections, respectively. Structures that bridged between the walls of SC were often disrupted. Conclusions: Cannulation of SC and injection of viscoelastic beyond the cannula resulted in marked dilation of SC and associated collector channels. Lateral walls, inner wall endothelium, and bridging structures of SC were frequently disrupted by cannulation and sometimes by injected viscoelastic. These findings suggest that viscocanalostomy may acutely cause a direct communication between SC and the juxtacanalicular space, and so may initially enhance conventional aqueous outflow. Controlled clinical trials will be necessary to determine the long-term outcomes of this procedure.

Support surfaces are an integral component of pressure ulcer prevention and treatment, but there is insufficient evidence to guide clinical decision making in this area. In an effort to provide clinical guidance for selecting support surfaces based on individual patient needs, the Wound, Ostomy and Continence Nurses Society (WOCN®) set out to develop an evidence- and consensus-based algorithm. A Task Force of clinical experts was identified who: 1) reviewed the literature and identified evidence for support surface use in the prevention and treatment of pressure ulcers; 2) developed supporting statements for essential components for the algorithm, 3) developed a draft algorithm for support surface selection; and 4) determined its face validity. A consensus panel of 20 key opinion leaders was then convened that: 1.) reviewed the draft algorithm and supporting statements, 2.) reached consensus on statements lacking robust supporting evidence, 3.) modified the draft algorithm and evalu...

This article aims to review the regulatory framework governing the Belgian ostomy appliance market in the light of the experience of Denmark, France, the Netherlands and Ontario (Canada) with regulation of ostomy appliances. Information about the regulatory framework was derived from the international literature, analysis of legal texts and a survey completed by national experts. The comparative analysis revealed that these countries have adopted varying approaches towards regulating their domestic ostomy appliance market. Strategies to keep down prices include public procurement in Denmark, maximum prices in France and exclusion of expensive appliances from reimbursement in the Netherlands. To contain public expenditure on ostomy appliances, consumption patterns are monitored in the Netherlands, the quantity of reimbursed appliances is limited in Belgium and public reimbursement is restricted in Ontario. Ostomy appliances are generally distributed by community pharmacies and medical equipment shops. In countries that emphasise home care delivery such as Denmark, domiciliary distributors dominate the market to the detriment of community pharmacies which do not seem to be able to offer this service at a competitive price. An avenue for reforming the Belgian ostomy appliance market is proposed which valorizes the role of ostomy care nurses in guiding the choice of ostomy appliances. Furthermore, it is recommended that a competitive tendering process determines the price of ostomy appliances, that reimbursement for service provision by distributors is separated from reimbursement of appliances, and that patients receive a fixed grant from the third-party payer to buy ostomy appliances.

Background: Several studies have shown a relationship between surgeon volume and outcomes in colorectal cancer surgery. The aim of this study was to determine the impact of surgeon volume and specialization on primary tumour resection rate, restoration of bowel continuity following rectal cancer resection, anastomotic leakage and perioperative mortality. i. 1·06 to 1·90); P = 0·018) were more likely to perform elective sphincter-saving rectal surgery. In elective surgery, the risk of perioperative death was lower for high-volume surgeons (OR 0·58 (95 per cent c.i. 0·44 to 0·76); P < 0·001), but this was not the case in emergency surgery.

A 34-year-old primiparous woman underwent an elective primary cesarean delivery. Five days later a hysterectomy had to be performed to save the patient's lifo because of generalized peritonitis. Although risks have decreased dramatically with modern obstetric care, awareness of the potential for severe complications is mandatory even in cases of elective cesarean delivery.

I n 2008, nearly 148,810 people were diagnosed with colorectal cancer, with approximately 49,960 patients dying of the disease (American Cancer Society, 2008). For most of these patients, surgery is the first line of treatment , followed by other adjuvant modalities, such as chemotherapy, targeted therapy, or radiation. In select cases, based on staging, adjuvant therapies might precede surgery. Either way, the selection of therapy options is complex and vexing to most individuals faced with making decisions about care. Given the complexity of treatment options before and after surgery, there is a significant need for specific educational and counseling support. Hence, patient teaching along the continuum of care becomes vitally important to patient understanding, skill mastery, and optimal recovery. This is especially true for the patient with a new ostomy (Jackson, Pokorny, & Vincent, 1993). A number of factors in today's health care environment affect the provision of seamless colorectal cancer patient education and support (Anthony & Hudson

to assess self-esteem (SE) and health-related quality of life (HRQoL) in ostomized patients due to colorectal cancer. cross sectional research with a quantitative approach. Three instruments were used for data collection: one instrument containing sociodemographic and clinical data, Rosenberg&#39;s Self-Esteem Scale, and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire. SE and HRQoL were considered satisfactory. Significant statistical difference was found in the social function domain and marital status, ostomy duration, location, and time; global health scale and ostomy type; cognitive function and pain in the ostomy site. There was a correlation between self-esteem and all the functional scales and the global health scale. knowing SE and HRQoL levels, in addition to the variables that influence them, supports ostomized patients&#39; care planning, rehabilitation, and social autonomy.

Background: Portal hypertension develops in 15-20% of patients with benign bile duct stricture. Hepaticojejunostomy in such patients is associated with considerable morbidity and mortality. Preliminary portosystemic shunting has been suggested to reduce intra-operative bleeding. We present our experience without preliminary shunting in such patients.

Background Peristomal skin problems are common, most often the result is disruption of the skin barrier and this may account for more than one in three visits to ostomy nurses. Therefore a specific assessment of individual risk factors relating to the skin barrier function would be of great interest. Methods Skin barrier integrity in ostomy patients with peristomal skin problems (PSP) was compared with that of ostomy patients with normal skin (controls) using transepidermal water loss (TEWL). Mechanical barrier disruption was determined by a tape stripping test and chemical barrier disruption [sodium lauryl sulphate (SLS) 0AE25%]. Results Patients and controls had a highly significant increase in TEWL value in the peristomal area compared with nonperistomal contralateral abdominal skin (P < 0AE0001 for both groups). The skin barrier of normal-looking contralateral skin of ostomates was found to be borderline impaired in patients with PSP compared with those without. A linear association was seen between the number of tape strips removed and TEWL for both cases and controls. Tape stripping suggested that patients with PSP had less resilient skin (P = 0AE002). A significant difference in TEWL value between cases and controls was also seen for the SLS patch test on the dorsal skin (P = 0AE02). Conclusion Successive tape stripping, a situation analogous to the normal use of a pouching system, caused a higher degree of barrier damage more rapidly in patients with PSP, indicating an impaired mechanical quality of the barrier. The SLS exposure test suggested a generally increased susceptibility to irritant dermatitis as assessed by TEWL. Our findings suggest tape stripping and SLS testing may have a role as predictive tests to identify patients at risk of PSP.

A one group repeated measures design was used to describe changes in body image in 45 patients treated with ostomy for bowel or bladder cancer. Body image was measured preoperatively and at two postoperative points: 1 month and in 6 months or postclosure. The Body Cathexis Scale, Draw-a-Person, and subjective responses to open-ended questions were used. There was a significant difference in Body Cathexis scores between the immediate 1 month postoperative period and 6 months later (F(2, 88) = 3.13, p = .049). Body image scores did not change significantly between the preostomy and first postostomy measures. Qualitative data suggested that cancer diagnosis and its associated concerns were paramount on subjects' minds preoperatively and thus negatively influenced body image before the creation of the ostomy. Although altered body image is an appropriate nursing diagnosis for patients with ostomy in both the preoperative and postoperative periods, other issues may be dominant especially in the preoperative period.

Little published information is available about access failure in children undergoing chronic peritoneal dialysis. Our objectives were to evaluate frequency, risk factors, interventions, and outcome of peritoneal dialysis access revision. Data were derived from 824 incident and 1629 prevalent patients from 105 pediatric nephrology centers enrolled in the International Pediatric Peritoneal Dialysis Network Registry between 2007 and 2015. In total, 452 access revisions were recorded in 321 (13%) of 2453 patients over 3134 patient-years of follow-up, resulting in an overall access revision rate of 0.14 per treatment year. Among 824 incident patients, 186 (22.6%) underwent 188 access revisions over 1066 patient-years, yielding an access revision rate of 0.17 per treatment year; 83% of access revisions in incident patients were reported within the first year of peritoneal dialysis treatment. Catheter survival rates in incident patients were 84%, 80%, 77%, and 73% at 12, 24, 36, and 48 mo...

Little published information is available about access failure in children undergoing chronic peritoneal dialysis. Our objectives were to evaluate frequency, risk factors, interventions, and outcome of peritoneal dialysis access revision. Data were derived from 824 incident and 1629 prevalent patients from 105 pediatric nephrology centers enrolled in the International Pediatric Peritoneal Dialysis Network Registry between 2007 and 2015. In total, 452 access revisions were recorded in 321 (13%) of 2453 patients over 3134 patient-years of follow-up, resulting in an overall access revision rate of 0.14 per treatment year. Among 824 incident patients, 186 (22.6%) underwent 188 access revisions over 1066 patient-years, yielding an access revision rate of 0.17 per treatment year; 83% of access revisions in incident patients were reported within the first year of peritoneal dialysis treatment. Catheter survival rates in incident patients were 84%, 80%, 77%, and 73% at 12, 24, 36, and 48 mo...

Background The Bernese periacetabular osteotomy (PAO) continues to be a commonly performed nonarthroplasty option to treat symptomatic developmental hip dysplasia, but there are few long-term followup studies evaluating results after PAO. Questions/purposes (1) What is the long-term survivorship of the hip after PAO? (2) What were the validated outcomes scores among patients who had PAO more than 14 years ago? (3) What factors are associated with longterm failure? Methods One hundred fifty-eight dysplastic hips (133 patients) underwent PAO between May 1991 and September 1998 by a single surgeon. Of those, 37 hips (34 patients [26%]) were lost to followup; an additional seven patients (5% [eight hips]) had not been seen in the last 5 years. The 121 hips (in 99 patients) were retrospectively evaluated at a mean of 18 years (range, 14-22 years). Survivorship was assessed using Kaplan-Meier analysis with total hip arthroplasty (THA) as the endpoint. Hips were evaluated for activity, pain, and general health using the UCLA Activity Score, modified Harris hip score, WOMAC, and Hip disability and Osteoarthritis Outcome Score (HOOS). Failure was defined as a WOMAC pain subscale score C 10 or having undergone THA. Hips were divided into three groups: asymptomatic (did not meet any failure criteria at any point in time), symptomatic (met WOMAC pain failure criteria at previous or most recent followup), and replaced (having undergone THA). A multinomial logistic regression model using a general estimating equations approach was used to assess factors associated with failure. Results Kaplan-Meier analysis with THA as the endpoint revealed a survival rate (95% confidence interval [CI]) of 74% (66%-83%) at 18 years. Twenty-six hips (21%) underwent THA at an average of 9 ± 5 years from the surgery. Sixty-four hips (53%) remained asymptomatic and did not meet any failure criteria at most recent followup. Thirty-one hips (26%) were symptomatic and considered failed based on a WOMAC pain score of C 10 with a mean ± SD of 11 ± 4 out of 20 at most recent followup. Although some failed initially by pain, their most recent WOMAC score may have been \ 10. Of the 16 symptomatic hips that failed early by pain (reported a WOMAC pain subscale score C 10 in the prior study), two were lost to followup, two underwent THA at 16 and 17 years, four still failed because of pain at most recent followup, and the remaining eight had WOMAC pain scores \ 10 at most recent followup. Asymptomatic hips reported better UCLA Activity Scores (asymptomatic: mean ± SD, 7 ± 2; symptomatic: 6 ± 2, p = 0.001), modified Harris hip scores (pain, function, and activity sections; asymptomatic: 80 ± 11; symptomatic: 50 ± 15, p \ 0.001), WOMAC Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research1 editors and board members are on file with the publication and can be viewed on request. Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

Background-Antegrade continence enema (ACE) has become an important therapeutic modality in the treatment of intractable constipation and fecal incontinence. There are little data available on the long-term performance of the ACE procedure in children. Methods-A retrospective review of patients who underwent the ACE procedure was conducted. Irrigation characteristics and complications were noted. Outcome was assessed for individual encounters based on frequency of bowel movements, incontinence, pain, and predictability. Results-One hundred seventeen patients underwent an ACE. One hundred five patients had at least 6 months of follow-up, and were included in the analysis. Diagnoses included myelodysplasia (39%), functional intractable constipation (26%), anorectal malformations (21%), nonrelaxing internal anal sphincter (7%), cerebral palsy (3%), and other diagnoses (4%). The average follow-up was 68 months (range 7-178 months). At the last follow-up, 69% of patients had successful bowel management. Of the 31% of patients who did not have successful bowel management, 20% were using the ACE despite suboptimal results, 10% required surgical removal, and 2% were not using the ACE because of behavioral opposition to it. Patients were started on normal saline, but were switched to GoLYTELY (PEG-3350 and electrolyte solution) if there was an inadequate response (61% at final encounter). Additives were needed in 34% of patients. The average irrigation dose was 23 ± 0.7mL/kg. The average toilet sitting time was 51.7 ± 3.5minutes, with infusions running for 12.1 ± 1.2minutes. Stomal complications occurred in 63% (infection, leakage, and stenosis) of patients, 33% required surgical revision and 6% eventually required diverting ostomies. Conclusions-Long-term use of the ACE gives successful results in 69% of patients, whereas 63% had a stoma-related complication and 33% required surgical revision of the stoma.

Objectives The purpose of this study was to investigate the role of perceived stress, social support, and body image in predicting the severity of depressive symptoms in ostomy patients. Methods In this descriptive/correlational study with a cross-sectional design, 120 ostomy patients referred to the Iranian Ostomy Society were selected using a convenience sampling technique, and responded to The Depression, Anxiety and Stress Scale, Perceived Stress Scale, Body Image Questionnaire, and Social Support Scale. For data analysis, Pearson correlation and stepwise regression analysis were used. Results The three variables of perceived stress, body image and social support were able to predict the severity of depressive symptoms by %21, %10 and %11, respectively. In Overall, they accounted for 42% of changes in the severity of depressive symptoms. Conclusion Given the role of perceived stress, body image and social support in the severity of depression symptoms, the depression treatment and prevention programs should be facilitated for the patients with ostomy by considering these factors.

Background: Portal hypertension develops in 15-20% of patients with benign bile duct stricture. Hepaticojejunostomy in such patients is associated with considerable morbidity and mortality. Preliminary portosystemic shunting has been suggested to reduce intra-operative bleeding. We present our experience without preliminary shunting in such patients.

Introduction. PU is an option to manage complex and/or recurrent urethral strictures and is necessary after urethrectomy and/or penectomy. PU is generally assumed to be the last option before abandoning the urethral outlet. Methods. Between 2001 and 2013, 51 patients underwent PU. Mean age (± standard deviation) was 60 ± 15 years. Only 13 patients (25.5%) did not undergo previous urethral interventions. PU was performed according to the Johanson ( = 35) or Blandy ( = 16) technique and these 2 groups were compared for surgical failure, maximum urinary flow (Q max ), urinary symptoms, and quality of life (according to the International Prostate Symptom Score). Results. Both groups were similar for patient's and stricture characteristics. Only follow-up duration was significantly longer after Johanson PU (47.9 months versus 11.1 months; = 0.003). For the entire cohort, 11 patients (21.6%) were considered a failure (9 or 25.7% for Johanson group and 2 or 12.5% for Blandy group; = 0.248). There was a significant improvement of Q max in both groups. Quality of life after PU was comparable in both groups. Conclusions. PU is associated with a 21.6% recurrence rate and the patient should be informed about this risk.

... The role of repeat endoscopic third ventriculostomy after failure of the initial procedure Pasquale Gallo, Francesco Sala Pediatric ... 6. 7. Gallo P, Szathmari A, De Biasi S, Mottolese C. Endoscopic third ventriculostomy in obstructive infantile hydrocephalus: remarks about the so ...

Many ostomy patients experience peristomal skin lesions. A descriptive study was conducted to assess the validity, usability, and reliability of the Peristomal Skin Lesions Assessment instrument (SACS instrument) adapted to Turkish from English. The SACS Instrument consists of 2 main assessments: lesion type (utilizing definitions and photographs) and lesion area by location around the ostomy. The study was performed in 2 stages: 1) the SACS language was changed and its content validity established; and 2) the instrument\&#39;92s content validity and inter-observer agreement (consistency) were determined among pairs of nurses who used the tool to assess peristomal skin lesions. Patients (included if they were &gt;18 years old and receiving treatment/observation at 1 of the 4 participating stomatherapy units) and 8 stomatherapy nurses also completed appropriate sociodemographic questionnaires. Of the 393 patients screened during the 7-month study, 100 (average age 56.74 \&#39;b1 14.0...

Amaç: Ülkemizde stomalı bireylerle yapılan araştırmaların ve bu alandaki yayınların niceliksel ve niteliksel olarak incelemek ve yapılacak yeni çalışmalara ışık tutarak stomalı bireylere yönelik bakımın kalitesini arttırmaya katkı sağlanmasıdır. Yöntem: Dokuz Eylül Üniversitesi abone elektronik veri tabanları (n=71), ULAKBİM (Ulusal Akademik Ağ ve Bilgi Merkezi) Ulusal Veri Tabanı, Pubmed, Ulusal Tez Merkezi, Google Akademik, kongre web siteleri, ulaşılabilen kongre/sempozyum kitapları ve makalelerin referans listeleri online tarandı. Bulgular: Ocak 1981-Temmuz 2016 yılları arasında yapılmış 278 çalışmaya ulaşıldı. Çalışmaların %54'ünün (n=100) araştırma makalesi, %14'ünün (n=27) tez çalışması, %15'inin (n=28) derleme makale, %14'ünün (n=27) olgu sunumu ve %3'ünün (n=6) niteliksel araştırma olduğu; yurt dışı dergilerde yayınlananların oranının %7 (n=20) olduğu belirlendi. Çalışmaların %65'inin (n=182) tam/özet metnine ulaşıldı. Araştırma makalelerinin %80'inin (n=80) tanımlayıcı (retrospektif, prospektif, kesitsel), %8'inin (n=8) deneysel, %6'sının (n=6) metadolojik araştırmalar olduğu; tezlerin %70'inin (n=19) yüksek lisans, %11'inin (n=3) uzmanlık tezi, %18'inin (n=5) doktora tezi olduğu; %15'inin (n=6) bir dergide yayınlandığı; kongrelerde sunulan 107 çalışmanın %71'inin (n=76) orijinal araştırma, %18'inin (n=19) olgu sunumu, %9'unun (n=11) derleme olduğu belirlendi. Çalışmalar stoma komplikasyonları (%17), yaşam kalitesi (%12), stoma cerrahi teknik uygulamaları ve etkinliğinin karşılaştırılması (%10), izlem sonuçları (%6), cinsellik (%6), hasta deneyimleri (%4), ostomiye uyum (%4), beden algısı (%4), benlik saygısı (%3), hemşire/hastaların ostomi bakımı hakkındaki bilgi seviyesi (%3) konularında yapılmıştı. Sonuç: Çalışmaların daha çok stoma komplikasyonları ve yaşam kalitesine yönelik tanımlayıcı çalışmalar olduğu; yurtdışı dergilerde yayınlanma oranının da düşük olduğu belirlendi. Ülkemizde stomalı bireylerin stomayla yaşama uyumlarını kolaylaştıracak daha fazla girişimsel çalışmaların yapılması; çalışmaların kongrelerde sunulmasının yanı sıra yurt içi/yurt dışı dergilerde yayınlanması önerilmektedir.

Background: Portal hypertension develops in 15-20% of patients with benign bile duct stricture. Hepaticojejunostomy in such patients is associated with considerable morbidity and mortality. Preliminary portosystemic shunting has been suggested to reduce intra-operative bleeding. We present our experience without preliminary shunting in such patients. Patients and Methods: Fourteen consecutive cases of biliary stricture with portal hypertension over a 13-year period (1989-2001) were retrospectively analysed. Results: Thirteen patients were operated upon. One patient had a preliminary portosystemic shunt. In another patient, shunt was attempted. One stage hepaticojejunostomy was possible in 11 patients. There were no intra-operative deaths. Nine of the 13 survived and were available for follow-up. One patient had cholangitis. Another had jaundice related both to chronic liver disease and a strictured hepaticojejunostomy. The remaining 7 patients are asymptomatic and anicteric although alkaline phosphatase levels remain elevated in 5 of them. Conclusions: Hepaticojejunostomy without preliminary portosystemic shunting is possible in patients with portal hypertension and benign biliary stricture with acceptable morbidity and mortality rates.

Little published information is available about access failure in children undergoing chronic peritoneal dialysis. Our objectives were to evaluate frequency, risk factors, interventions, and outcome of peritoneal dialysis access revision. Data were derived from 824 incident and 1629 prevalent patients from 105 pediatric nephrology centers enrolled in the International Pediatric Peritoneal Dialysis Network Registry between 2007 and 2015. In total, 452 access revisions were recorded in 321 (13%) of 2453 patients over 3134 patient-years of follow-up, resulting in an overall access revision rate of 0.14 per treatment year. Among 824 incident patients, 186 (22.6%) underwent 188 access revisions over 1066 patient-years, yielding an access revision rate of 0.17 per treatment year; 83% of access revisions in incident patients were reported within the first year of peritoneal dialysis treatment. Catheter survival rates in incident patients were 84%, 80%, 77%, and 73% at 12, 24, 36, and 48 mo...