We report on the observation of time-modulated orbital EC decays of H-like
140Pr
58+,
142Pm
60+, and
122I
52+ (preliminary) ions with only one electron in the K-shell coasting in the ESR storage ring ...of GSI with a velocity
β
=
0.71
and a spread
Δ
v
/
v
∼
5
×
10
−
7
. The decays were observed with time resolved single ion Schottky Mass Spectroscopy by observation of the time of change of the precisely measured revolution frequency of the mother into the daughter ion which is proportional to the mass change or Q-value of the decay. We observed in the EC-branches exponential decay curves time-modulated with periods
T
=
7.06
(
8
)
s
and amplitude
a
=
0.18
(
3
)
for
140Pr decays,
T
=
7.10
(
22
)
s
and
a
=
0.23
(
4
)
for
142Pm decays, and
T
=
6.04
(
6
)
s
and
a
=
0.19
(
3
)
for
122I decays (preliminary) in the laboratory frame. The simultaneously measured
β
+
branch of
142Pm shows no modulation with
a
<
0.03
. An explanation by mixing of massive electron neutrinos has been suggested, according to which the observed modulation frequency yields a value for the quadratic mass difference:
m
2
2
−
m
1
2
=
2.22
(
3
)
×
10
−
4
eV
2
. This value is 2.9 times larger than the value derived by the KamLAND antineutrino oscillation experiment.
Purpose
Ileal pouch prolapse is a rare complication after j-pouch formation with an incidence of about 0.3%. However, if a pouch prolapse occurs, it can be a debilitating complication for the ...patient. Full-thickness pouch prolapse usually warrants surgical repair as reported by Sagar and Pemberton (Br J Surg 99(4):454–468, 2012) and Sherman et al. (Inflamm Bowel Dis 20(9):1678–1685, 2014). This report presents our first experience with laparoscopic ventral pouch pexy with acellular dermal matrix (ADM).
Methods
With the patient in the French position, four trocars were positioned: a camera port at the level of the umbilicus, two 5-mm trocars in the right lower quadrant, and a third 5-mm trocar in the left lower quadrant. The j-pouch was mobilized ventrally and laterally to the level of the sphincter. A 4 × 16-cm piece of ADM (EPIFLEX®, POLYTECH Health & Aesthetics, Dieburg, Germany) was sutured to the levators on both sides and to the ventral pouch directly cranial of the sphincter. In the next step, the ADM was attached to the promontory. Subsequently, further sutures were placed to attach the pouch to the ADM. Finally, the ADM was sewn to the cranial vaginal pole.
Results
Operating time was 249 min. The postoperative course was uneventful except for a higher stool frequency which could be managed conservatively. The patient was discharged on POD 9. At the latest follow-up (12 months after surgery), the patient was still symptom free without any sign of recurrence.
Conclusions
Laparoscopic ventral pouch pexy with ADM performed by a surgeon experienced in laparoscopic pouch surgery is a safe and effective treatment option in patients with pouch prolapse.
Purpose
Gracilis muscle transposition (GMT) is an established surgical technique in the treatment of anorectal fistulas and fistulas to the vagina and the urinary system when previous closure options ...have failed. There is little evidence on the success rate of this procedure in the long term.
Methods
This is a follow-up study on all patients undergoing GMT over a 10-year period at a tertiary referral center for complex fistulas. Postoperative function and quality of life were evaluated by standardized questionnaires (Wexner score, Fecal Incontinence Quality of Life Score (FIQL), SF-12 and a brief questionnaire designed for this study). Sexual function was evaluated by the Female Sexual Function Index (FSFI) and the International Index of Erectile Function.
Results
Forty-seven gracilis muscle transpositions (GMT) in 46 patients were performed. Most treated patients had (neo-)-rectovaginal fistulas (
n
= 29). An overall fistula closure was achieved in 34 of 46 patients (74%): in 25 cases primarily by GMT (53%) and in nine patients with persistent or recurrent fistula by additional surgical procedures. A clinically apparent relapse occurred on average 276 days (median: 180 days) after GMT (mean follow-up 73.4 months).
Conclusion
GMT in our hands has a primary closure rate of 53%, and after further procedures, this rises to 74%. Fecal continence is impaired in patients having undergone GMT. The overall quality of life in patients after GMT is only slightly impaired, and sexual function is severely impaired in female patients.
The K¯N system at threshold is a sensitive testing ground for low energy QCD, especially for the explicit chiral symmetry breaking. Therefore, we have measured the K-series X-rays of kaonic hydrogen ...atoms at the DAΦNE electron–positron collider of Laboratori Nazionali di Frascati, and have determined the most precise values of the strong-interaction energy-level shift and width of the 1s atomic state. As X-ray detectors, we used large-area silicon drift detectors having excellent energy and timing resolution, which were developed especially for the SIDDHARTA experiment. The shift and width were determined to be ϵ1s=−283±36(stat)±6(syst) eV and Γ1s=541±89(stat)±22(syst) eV, respectively. The new values will provide vital constraints on the theoretical description of the low-energy K¯N interaction.
Purpose
This study investigated the association of preoperative hypoalbuminemia and postoperative complications after elective resection for rectal cancer.
Methods
From September 2009 to December ...2014, all patients who underwent elective rectal resection for adenocarcinoma of the rectum were identified using a prospective colorectal cancer database. Hypoalbuminemia was defined as a serum albumin < 35 g/L. Characteristics and outcomes of hypoalbuminemic patients were compared to those of patients with normal albumin levels. Potential risk factors for postoperative major morbidity, defined as Clavien-Dindo ≥ grade 3, were analyzed by both univariate and multivariate analyses.
Results
Three hundred seventy patients met the inclusion criteria. Hypoalbuminemic patients (67/370 (18%)) were significantly older and had more advanced tumor stages and more comorbidities (more ASA III, higher percentage of diabetics). Furthermore, they were more likely to undergo abdominoperineal resection instead of low anterior resection and less likely to be operated laparoscopically. On univariate analysis, a higher BMI, advanced tumor stages, diabetes, open procedures, pre- and postoperative hypoalbuminemia, a higher decrease in albumin (∆ preop-postop), and conversion were significantly associated with postoperative high-grade morbidity. On multivariate analysis, diabetes, advanced tumor stages, a higher decrease in the albumin level, as well as preoperative hypoalbuminemia turned out to be independent risk factors for postoperative high-grade morbidity.
Conclusions
Hypoalbuminemia is an independent risk factor for postoperative high-grade morbidity. As a low-cost and easy accessible test, serum albumin should be used as a prognostic tool to detect patients at risk for adverse outcomes after resection for rectal cancer.
Aim
Older data suggest that colonic resection has a negative impact on continence and quality of life. The aim of this study was to evaluate the functional outcome of colonic resections for colonic ...cancer and diverticulitis and its influence on quality of life.
Methods
Patients who underwent colonic resection between 2005 and 2013 were identified from a prospective database. A survey with two questionnaires Faecal Incontinence Quality of Life (FIQL) scale, Short Form 12 (SF‐12) and additional questions concerning bowel function was sent to all patients.
Results
Colonic resection was performed in 362 patients in the study period; 297 patients returned the questionnaires (response rate 82.0%). Faecal urgency or incontinence more than once a month was present in 15% of patients and 25% of patients reported that bowel symptoms limited their quality of life. The mean total FIQL score for all patients was 3.58. The SF‐12 score was comparable to a reference population without prior colonic resection. Patients after right‐sided resections had liquid stool more often than others (45.3% vs 38.7%, P = 0.011). No differences in bowel function and quality of life were detected between resections for colonic cancer and diverticulitis.
Conclusion
Most patients experience no limitation in bowel function after segmental colectomy. Those with limitations in bowel function still seem to cope well, as the quality of life is not severely affected. Nevertheless, most patients with lower functional scores also had lower quality of life scores. Whether surgery is a relevant factor has to be questioned, as the prevalence of faecal incontinence in a comparable population without prior surgery is almost identical.
Purpose
Despite the increasing use of telemanipulators in colorectal surgery, an additional benefit in terms of improved perioperative results is not proven. The aim of the study was to compare ...clinical, oncological, and functional results of Da Vinci (Xi)–assisted versus conventional laparoscopic (low) anterior resection for rectal cancer.
Methods
Monocenter, prospective, controlled cohort study with a 12-month follow-up of bladder and sexual function using the validated questionnaires International Prostate Symptom Score, International Index of Erectile Function, and Female Sexual Function Index.
Results
Fifty-one patients were included (18, Da Vinci (Xi) assisted; 33, conventional laparoscopy). Conversion to an open approach was more common in the Da Vinci cohort (
p
= 0.012). In addition, surgery and resumption of a normal diet took longer in the robotic group (
p
= 0.005;
p
= 0.042). Surgical morbidity and oncological quality did not differ. There was no difference in most functional domains, except for worsened ability to orgasm (
p
= 0.047) and sexual satisfaction (
p
= 0.034) in women after conventional laparoscopy. Moreover, we found a higher rate of improved bladder function in the conventional laparoscopy group (
p
= 0.023) and less painful sexual intercourse among women in the robot-assisted group (
p
= 0.049).
Conclusion
In contrast to the ROLARR trial, a higher conversion rate was found in the robotic cohort, which may in part be explained by a learning curve effect. Nevertheless, the Da Vinci–assisted approach showed favorable results regarding sexual function.
Aim
Transrectal stoma placement is considered the standard technique for positioning a stoma. A prospective series using a novel method of lateral pararectal stoma placement recently revealed a ...remarkably low stoma herniation rate. A randomized trial was conducted to compare the lateral pararectal with the transrectal stoma position with regard to parastomal herniation, stoma‐related morbidity and quality of life.
Method
Adult patients undergoing elective placement of a temporary loop ileostomy were eligible for inclusion. Patients were intra‐operatively randomized to undergo either a lateral pararectal or a transrectal ileostomy. The primary end‐point was the rate of parastomal herniation. Secondary end‐points included other stoma‐related complications and quality of life. Sample size calculation resulted in 54 patients having to be analysed to detect a difference of parastomal herniation of 30% with an 80% power and a 5% significance level. The trial was registered with the German Clinical Trials Register (registration number DRKS00003534).
Results
Between April 2012 and April 2014, 30 patients were randomized to each group. The incidence of parastomal herniation did not differ between the lateral pararectal (5 of 27) and the transrectal group (4 of 29; P = 0.725). There was also no significant difference regarding other stoma‐related complications and the EORTC quality of life scales C30 and CR29.
Conclusion
The incidence of parastomal herniation and other stoma‐related complications did not differ between the groups. However, due to the limited sample size a small difference in favour of one of the two stoma placement techniques cannot be entirely ruled out.
Purpose. To compare rigid rectoscopy with three different MRI measurement techniques for rectal cancer height determination, all starting at the anal verge, in order to evaluate whether MRI ...measurements starting from the anal verge could be an alternative to rigid rectoscopy. Moreover, potential cut-off values for MRI in categorizing tumor height measurements were evaluated. Methods. In this retrospective study, 106 patients (75 men, 31 female, mean age 64±11.59 years) with primary rectal cancer underwent rigid rectoscopy as well as MR imaging. Three different measurements (MRI1–3) in T2w sagittal scans were used to evaluate the exact distance from the anal verge (AV) to the distal ending of the tumor (MRI1: two unbowed lines, AV to the upper ending of the anal canal and upper ending of the anal canal to the lower border of the tumor; MRI2: one straight line from the AV to the lower boarder of the tumor; MRI3: a curved line beginning at the AV and following the course of the rectum wall ending at the lower border of the tumor). Furthermore, agreement between the gold standard rigid rectoscopy (UICC classification: low part, 0-6 cm; mid part, 6-12 cm; and high part, >12 cm) and each MRI measuring technique was analyzed. Results. Only a fair correlation in terms of individual measures between rectoscopy and all 3 MRI measurement techniques was shown. The proposed new cut-off values utilizing ROC analysis for the three different MRI beginning at the anal verge were low 0-7.7 cm, mid 7.7-13.3 cm, and high>13.3 cm (MRI1); low 0-7.4 cm, mid 7.4-11.2 cm, and high>11.2 cm (MRI2); and low 0-7.1 cm, mid 7.1-13.7 cm, and high>13.7 cm (MRI3). For MRI1 and MRI3, the agreement to the gold standard was substantial (r=0.66, r=0.67, respectively). Conclusion. This study illustrates that MRI1 and MRI3 measures can be interchangeably used as a valid method to determine tumor height compared to the gold standard rigid rectoscopy.
Aim
Surgical site infection (SSI) is a common complication following ileostomy closure with a frequency of up to 40%. This prospective randomized controlled trial was initiated to compare two ...surgical techniques – direct suture (DS) and purse‐string suture (PSS) – used to close the wound following ileostomy closure. The primary end‐point was the SSI rate. Secondary end‐points were cosmetic outcome using two validated scales: the Patient and Observer Scar Assessment Scale (POSAS) and the Body Image Questionnaire (BIQ) and the influence of other factors on the SSI rate.
Method
Of a total of 99 patients screened, 84 were included in this study. Forty‐three patients were randomized into the PSS group and 41 were randomized into the DS group. Follow up was performed within 3 days after surgery, at discharge, and 30 days and 6 months after the operation.
Results
In the PSS group there were no cases of SSI compared with 10 (24%) cases in the DS group (P = 0.0004). There were no statistically significant differences in cosmetic outcome between the two groups. No other statistically significant factors influencing the incidence of SSI could be identified.
Conclusion
The rate of SSI is significantly lower following PSS than following DS, and both techniques have a similar cosmetic outcome. PSS closure should be considered as standard of care for wound closure after ileostomy reversal.
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