31 research outputs found
Protocol of the LATFIA trial (Laser Assisted Treatment of Fistula in Ano): a multicentre, prospective, randomized controlled trial comparing fistula-tract laser closure (FiLaC™) with rectal advancement flap for high trans-sphincteric fistulas
No full textAim: Anal fistula is one of the most common anal diseases, affecting between 1 and 3 per 10 000 people per year. Symptoms have a potentially severe effect on a patient's quality of life. Surgery is the mainstay of treatment, aiming to cure the fistula and preserve anal sphincter function. Rectal advancement flap (RAF) is currently the gold standard treatment but has recurrence rates varying between 20% and 50% and might lead to disturbance of continence. The aim of the trial described in this work is to discover if the minimally invasive fistula tract laser closure (FiLaC (TM)) technique could achieve higher healing rates and a better functional outcome than RAF. Method: We will perform a randomized prospective multicentre noninferiority study of the treatment of high trans-sphincteric perianal fistulas, comparing FiLaC (TM) with RAF in terms of fistula healing, recurrence rate, functional outcome and quality of life. Primary and secondary fistula healing will be evaluated at 26 and 52 weeks' follow-up. Quality of life will be evaluated using the SF-36 questionnaire, the Faecal Incontinence Quality of Life Scale questionnaire and the Vaizey score at 3, 6, 12 and 26 weeks postoperatively. Conclusion: High trans-sphincteric fistulas have a potentially severe effect on a patient's quality of life. Classical treatment with RAF is a time-consuming invasive procedure. The LATFIA trial aims to compare FiLaC (TM) with the gold standard treatment with RAF. In case of noninferiority, FiLaC (TM) treatment could be standardized as a first line treatment for high trans-sphincteric fistulas. Better conservation of the patient's anal sphincter function could possibly be obtained. Likewise, we will report on the postoperative quality of life when applying these two techniques.The LATFIA trial is an investigator-initiated and investigator-ledstudy. The LATFIA trial is funded by Research Foundation Flanders(FWO). The funder has no role in the conceptualization, design,data collection, analysis, decision to publish or preparation of themanuscript
An electronic nose for solid stool detection: eNose - Hardware
No full textThis document reports details the development of a solid stool detection system. On behalf of Momo Medical - a TU Delft-based startup company - a device for detecting defecates by elderly people has been designed. The goal of the detection system is to detect solid stools by elderly patients wearing a diaper and to notify the nurses in a nursing home accordingly. The project has been organized and conducted in two groups: Hardware & Software. Our group has been in charge of the hardware. The other group has been responsible for the software. The main focus in this report will be the hardware design of the system. This report contains: the analysis of the problem, the development of a solution, the design and the evaluation of the device in test. The developed device detects methane by means of multiple gas sensors, since methane is the main gas component released while defecating. Several iterations making a suited printed circuit board and case have been carried out, while taking aspects like safety, reliability and noise performance into account. The report concludes with a summary of main results and an outline of future work.Electrical Engineerin
Contribuição para o estudo da drepanocitemia nos indígenas da Lunda: I- incidência no grupo étnico lunda-quioco
No full textContém quadrosUtilizando a técnica de STIJNS & DELVILLE, o autor estudou a incidência da drepanocitemia no grupo étcnico lunda-quioco.
1-Numa amostra de 1000 indivíduos, observou a transformação falciforme em 213 (21,3%);
2-Os dois sexos não apresentaram diferenças significativas;
3-Os indivíduos com idade aparente inferior a 25 anos mostraram uma taxa de falciformação mais elevada que os restantes;
4-A discriminação por sobados e pela origem étnica dos progenitores (lunda ou quioca) levou à conclusão de que, do ponto de vista da drepanocitemia, o grupo lunda-quioco é homogéneo.L’auteur à étudié l’incidence de la drepanocitémie dans le groupe ethenique lunda-quioco, employant la tecnique de STIJNS & DELVILLE.
1-Dans un échantillon de 1000 individus il a observe la transformation falciforme seulement dans 213 (21,3%);
2-Les deux sexes n’ont pas présenté des différences significatives;
3-Les individus apparemment âgés de moins de 25 ans ont présenté un taux de falciformation plus élevé que lesa utres;
4-La discrimination par contrées des diferentes régules et par l’origine ethnique des parents (lunda ou quioco) a amené l’auteur a conclure que, du point de vue de la drepanocitémie, le groupe lunda-quioco est homogène.Employing the STIJNS & DELVILLE technic the author has studied the drepanocytic anaemie incidence incidence in the lunda-quioco ethnical group.
1-The sickle cell transformation was observed in 213 (21,3%) out of a sample of 1000 individuals;
2-Both sexes do not present significative difference;
3-The individuals under the apparent age of 25 showed a sickle cell index higher than the remaining once;
4-The discrimination of the drepanocytic anaemie by the people of each regulus and by the ethnical origin of their progenitors (lunda or quioco) led to the conclusion that, under the drepanocytic anaemia point of view, the lunda-quioco group is homogeneous.info:eu-repo/semantics/publishedVersio
Ligation of the Intersphincteric Fistula Tract for High Transsphincteric Fistula Yields Moderate Results at Best: Is the Tide Turning?
No full textVentral mesh rectopexy: variations in technique and care process. A multicenter study
No full textAIM: The aim of this improvement collaborative is to explore the variation in care within and between Flemish hospitals in preoperative assessment, surgical indications, perioperative management and surgical technique for ventral mesh rectopexy (VMR). METHOD: This observational, cross-sectional multicentre study was performed in 14 Flemish hospitals. Twenty consecutive patients per hospital undergoing primary VMR in 2022 were included. Quality of care was assessed via predefined perioperative disease-specific quality indicators (QIs) by means of structured questionnaires. Data were collected from electronic patient files. RESULTS: A total of 280 patients were included. All patients were female and their mean age was 62 ± 14 years. Significant intra- and interhospital variation was observed in preoperative work-up, indications, operative technique and postoperative management. Total rectal prolapse was the indication for VMR in only 17.5% of the patients. The surgical approach was minimally invasive in all cases, with 40% via a robotic and 60% a laparoscopic approach. Fifteen per cent of patients had mechanical bowel preparation. All centres used a synthetic polypropylene mesh to perform a VMR, and in 85.6% (n = 238) of all patients a lightweight mesh was used. Diverging practices were noted as to type of mesh fixation to the rectum. In one third of patients a nonresorbable suture was combined with biological glue (n = 89, 31.8%). The overall mean length of stay was 2.1 (± 2.7) days. Only 3% of the procedures were performed as same day discharge, 47% of the patients remained for 1 day and 50% for ≥2 days. Only four patients were readmitted within 30 days after surgery. CONCLUSION: This study shows a significant variation in the perioperative management and surgical technique for VMR between hospitals, ongoing controversies and a lack of standardization. This collaborative can serve as a structured feedback tool to define minimum QIs and minimum outcome reporting parameters. Consensus building and adherence to evidence-based guidelines should reduce variation in care processes and lead to improved patient outcomes.status: Accepte
European Society of Coloproctology:Guidelines for diagnosis and treatment of cryptoglandular anal fistula
No full textAIM: The primary aim of the European Society of Coloproctology (ESCP) Guideline Development Group (GDG) was to produce high-quality, evidence-based guidelines for the management of cryptoglandular anal fistula with input from a multidisciplinary group and using transparent, reproducible methodology. METHODS: Previously published methodology in guideline development by the ESCP has been replicated in this project. The guideline development process followed the requirements of the AGREE-S tool kit. Six phases can be identified in the methodology. Phase one sets the scope of the guideline, which addresses the diagnostic and therapeutic management of perianal abscess and cryptoglandular anal fistula in adult patients presenting to secondary care. The target population for this guideline are healthcare practitioners in secondary care and patients interested in understanding the clinical evidence available for various surgical interventions for anal fistula. Phase two involved formulation of the GDG. The GDG consisted of 21 coloproctologists, three research fellows, a radiologist and a methodologist. Stakeholders were chosen for their clinical and academic involvement in the management of anal fistula as well as being representative of the geographical variation among the ESCP membership. Five patients were recruited from patient groups to review the draft guideline. These patients attended two virtual meetings to discuss the evidence and suggest amendments. In phase three, patient/population, intervention, comparison and outcomes questions were formulated by the GDG. The GDG ratified 250 questions and chose 45 for inclusion in the guideline. In phase four, critical and important outcomes were confirmed for inclusion. Important outcomes were pain and wound healing. Critical outcomes were fistula healing, fistula recurrence and incontinence. These outcomes formed part of the inclusion criteria for the literature search. In phase five, a literature search was performed of MEDLINE (Ovid), PubMed, Embase (Ovid) and the Cochrane Database of Systematic Reviews by eight teams of the GDG. Data were extracted and submitted for review by the GDG in a draft guideline. The most recent systematic reviews were prioritized for inclusion. Studies published since the most recent systematic review were included in our analysis by conducting a new meta-analysis using Review manager. In phase six, recommendations were formulated, using grading of recommendations, assessment, development, and evaluations, in three virtual meetings of the GDG. RESULTS: In seven sections covering the diagnostic and therapeutic management of perianal abscess and cryptoglandular anal fistula, there are 42 recommendations. CONCLUSION: This is an up-to-date international guideline on the management of cryptoglandular anal fistula using methodology prescribed by the AGREE enterprise
Micro-Simulation of Social Security Reforms in Belgium
No full textThe present paper analyzes the budgetary impact of various Social Security reforms in the Belgian institutional setting. Our approach relies on parameters that were derived in Dellis et alii (2002) using a micro-modeling strategy. focusing our attention on a hypothetical age cohort, we illustrate the budgetary impact that the reforms considered might have on the budget of the federal government.
Transanal Minimally Invasive Proctectomy With Two-Stage Turnbull-Cutait Pull-Through Coloanal Anastomosis for Iatrogenic Rectourethral Fistulas
No full textRoutine Preoperative CT Scanning of Patients with Anorectal Sepsis is not Useful. A Retrospective Cohort Study
No full textBackground:
The use of preoperative imaging in anorectal abscesses (AA) is still debated. It is customary to treat AA based solely on clinical findings. Several short- and long-term sequelae of AA have been described such as abscess persistence, recurrence, and anal fistula formation. The current literature does not clarify whether additional preoperative imaging is beneficial.
Objectives:
This study aims to investigate whether performing a preoperative computed tomography (CT) scan influences the outcome after drainage and AA recurrence.
Design:
Retrospective cohort study.
Settings:
Patient files.
Patients (Materials) and Methods:
All consecutive patients undergoing AA drainage between January 2015 and January 2020 were studied retrospectively. The patients who underwent a preoperative computed tomography (preCTI) were compared to those without preoperative imaging (noCTI).
Main Outcome Measures:
Abscess persistence requiring re-intervention and AA recurrence.
Sample size:
Two-hundred and nineteen patients were included in this study.
Results:
Preoperative CT scans were performed in 93 patients. The median length of stay was 1 day. The overall median follow-up duration was 56 days. Male and obese patients were more likely to undergo preoperative CT scans. There was no difference in re-intervention for abscess persistence or recurrence. More drains were placed in the preCTI group (P = .0001), and postoperative antibiotics were administered more often (P = .0008) in this group.
Conclusion:
Routine preoperative CT imaging in acute anorectal sepsis has no benefit in terms of outcomes, namely abscess persistence or recurrence after 30 days. In the preCTI group, an additional drain was placed in a greater number of cases, and postoperative antibiotics were administered more frequently
What Turns a Blessing into a Curse? The Political Economy of Natural Resource Wealth (Invited Lecture)
No full textI review the relationship between natural resource endowment type and economic growth in developing countries. Certain types of natural resources, such as oil and minerals, tend to exhibit concentrated production and revenue patterns, while revenue flows from other resources such as agriculture are more diffuse. Most developing countries that export products from the first group have been prone to growth failure in recent times. The most important channels are political economy mechanisms, where there are negative relationships between natural resource rents and institutional development. An explicit model of growth collapse with micro-foundations in rent-seeking contests that have increasing returns in rent-seeking outlays is presented.Endowment Type, Growth, Institutions
