Modified Gant procedure for treatment of internal rectal prolapse in elderly women

BACKGROUND Although rectal prolapse is not a life-threatening condition,it can cause defecation disorders,anal incontinence,sensory abnormalities,and other problems that can seriously affect quality of life.AIM To study the efficacy of the modified Gant procedure for elderly women with internal rectal prolapse.METHODS Sixty-three elderly female patients with internal rectal prolapse underwent the modified Gant procedure.The preoperative and postoperative anal symptoms,Patient Assessment of Constipation Quality of Life(PAC-QOL),Wexner incontinence score,incontinence quality of life score,and complications(massive hemorrhage,infection,anorectal stenosis,and anorectal fistula)were compared.RESULTS The improvement rates of postoperative symptoms were defecation disorders(84.5%),anal distention(69.6%),defecation sensation(81.4%),frequent defecation(88.7%),and anal incontinence(42.9%)(P<0.05).All dimensions and total scores of the PAC-QOL after the procedure were lower than those before the operation(P<0.05).The postoperative anal incontinence score and Wexner score were significantly lower than those before the procedure(P<0.05).The quality of life and total scores of postoperative anal incontinence were significantly higher than those before the procedure(P<0.05).There were no serious complications and no deaths.CONCLUSION The modified Gant procedure has significant advantages in the treatment of elderly women with internal rectal prolapse.

Pancreatic duct stones in patients with chronic pancreatitis:surgical outcomes

BACKGROUND: Pancreatic duct stone (PDS) is a common complication of chronic pancreatitis. Surgery is a common therapeutic option for PDS. In this study we assessed the surgical procedures for PDS in patients with chronic pancreatitis at our hospital. METHOD: Between January 2004 and September 2009, medical records from 35 patients diagnosed with PDS associated with chronic pancreatitis were retrospectively reviewed and the patients were followed up for up to 67 months. RESULTS: The 35 patients underwent ultrasonography, computed tomography, or both, with an overall accuracy rate of 85.7%. Of these patients, 31 underwent the modified Puestow procedure, 2 underwent the Whipple procedure, 1 underwent simple stone removal by duct incision, and 1 underwent pancreatic abscess drainage. Of the 35 patients, 28 were followed up for 4-67 months. There was no postoperative death before discharge or during follow-up. After the modified Puestow procedure, abdominal pain was reduced in patients with complete or incomplete stone clearance (P>0.05). Steatorrhea and diabetes mellitus developed in several patients during a long-term follow-up. CONCLUSIONS: Surgery, especially the modified Puestow procedure, is effective and safe for patients with PDS associated with chronic pancreatitis. Decompression of intraductal pressure rather than complete clearance of all stones predicts postoperative outcome.

Investigation on Fe,Mn,Zn,Cu,Pb and Cd fractions in the natural surface coating samples and surficial sediments in the Songhua River,China

Natural surface coating samples （NSCSs） from the surface of shingles and surficial sediments （SSs） in the Songhua River, China were employed to investigate the relationship between NSCSs and SSs in fractions of heavy metals （Fe, Mn, Zn, Cu, Pb, and Cd） using the modified sequential extraction procedure （MSEP）. The results show that the differences between NSCSs and SSs in Fe fi＇actions were insignificant and Fe was dominantly present as residual phase （76.22% for NSCSs and 80.88% for SSs） and Fe-oxides phase （20.33% for NSCSs and 16.15% for SSs）. Significant variation of Mn distribution patterns between NSCSs and SSs was observed with Mn in NSCSs mainly present in Mn-oxides phase （48.27%） and that in SSs present as residual phase （45.44%）. Zn, Cu, Pb and Cd were found dominantly in residual fractions （〉48%）, and next in solid oxides/hydroxides for Zn, Pb and Cd and in easily oxidizable solids/compounds form for Cu, respectively. The heavy metal distribution patterns implied that Fe/Mn oxides both in NSCSs and SSs were more important sinks for binding and adsorption of Zn, Pb and Cd than organic matter （OM）, and inversely, higher affinity of Cu to OM than Fe/Mn oxides in NSCSs and SSs was obtained. Meanwhile, it was found that the distributions of heavy metals in NSCSs and SSs were similar to each other and the pseudo-total concentrations of Zn, Cu, Pb and Cd in NSCSs were greater than those in SSs, highlighting the more importance for NSCSs than SSs in controlling behaviours of heavy metals in aquatic environments.

A NEW MODIFICATION OF TRANSANAL SOAVE PULL-THROUGH PROCEDURE FOR HIRSCHSPRUNG’S DISEASE

Background One stage transanal Soave pull-through procedure （TSPP） is a recent popular operation in the treatment of Hirschsprung＇s disease （HD）. With no visible scar and a short hospital stay, it is well accepted by surgeons and mothers. In the conventional Soave procedure, a long rectal muscular cuff left for anocolic anastomosis might increase the incidence of postoperative enterocolitis and constipation. This study presents a modified transanal Soave pull-through procedure （MTSPP） which includes an oblique mucosectomy and an oblique anastomosis with a short split muscular cuff.. Methods A review of two groups of HD patients was made： 112 underwent conventional transanal Soave procedure from 1999 to 2001 （group 1） and 140 underwent modified transanal Soave procedure from 2002 to 2004 （group 2）. A comparison was made between the two groups on operative data and postoperative complications. The data included： age at the operation, operating time, blood loss, time to feeds and hospital stay, occurrence of postoperative enterocolitis or constipation, need for anal dilatation, postoperative bowel function and perianal skin problems. Results There was no significant difference between two groups with respect to age, gender, length of colon resected, operating time, blood loss and hospital stay. However occurrence of postoperative enterocolitis, constipation, anastomotic stricture and time needed for anal dilatation were evidently less in group 2 （MTSPP）. The mean operating time in group 1 was （106 ± 39） minutes with a range of 60 to 170 minutes; in group 2 was （101 ± 36） minutes with a range of 66 to 190 minutes. The average length of the bowel resected in group 1 was （24 ± 7） cm, range 15 to 58 cm; in group 2 was （26 ± 8） cm, range 15 to 70 cm. Two patients, one in each group, required laparoscopic assistance because of long aganglionic colon. Another patient in group 2 required laparotomy because of total colonic aganglionosis. Postoperative complications in group 1 included： temporary perianal excoriation in 34 patients （26 were 〈3 months of age）, enterocolitis in 21, anastomotic stricture in 11, recurrent constipation in 12, cuff abscess in 1, anastomosis leak in 1, soiling in 3 and rectal prolapse in 1. In group 2 post operative complications included： transient perianal excoriation in 37 patients （30 were 〈3 months of age）, enterocolitis in 13, anastomotic stricture in 5, recurrent constipation in 6, anastomotic leak in 1, adhesive bowel obstruction in 1 and soiling in 4. Complete bowel continence was found in 97 children （86.6%） in group 1 and in 129 children （92.1%） in group 2 at one year followup after operation. Conclusions Modified transanal Soave pull-through procedure for HD with oblique mucosectomy and anastomosis and a short split muscular cuff is a safe and feasible operation with low incidence of postoperative complication. It is an encouraging improvement of the conventional transanal Soave pull-through procedure. MTSPP is a preferable choice in the surgery of HD.

Study for obtaining the exact solutions for the propagation of pulses in optical fibers

In this study, the exact solutions for the propagation of pulses in optical fibers are obtained.Special values are given in the model used, and two nonlinear differential equations are obtained.Nonlinear equations are reduced to ordinary differential equations with the help of wave transformations. Then, the obtained differential equations are solved by two different methods,namely the modified simplest equation and the modified Kudryashov procedures. The solutions are given by hyperbolic, trigonometric and rational functions and the results are useful for optics,engineering and other related areas. Finally three-dimensional, contour and two-dimensional shapes are given for some solutions. These figures are important for understanding the motion of the wave. The given methods are applied to the equations for the first time. To the best of the authors' knowledge, these results are new and have not been obtained in the literature. The results are useful for applied mathematics, physics and other related areas.

The Draf Ⅲ procedure: A review of indications and techniques

The DrafⅢprocedure involves the creation of a common frontal sinus cavity.The most common indication for the DrafⅢprocedure is chronic rhinosinusitis of the frontal sinuses despite the failure of more conservative interventions such as bilateral DrafⅡa procedures.Primary DrafⅢmay be indicated in patients with a high risk of failures such as those with severe polyposis and those with a frontal sinus opening less than 4 mm on computed tomography imaging.Other indications for the DrafⅢinclude access for tumor removal and repair of traumatic fractures of the frontal sinus.The"inside-out"DrafⅢprocedure is the standard approach when the frontal recess anterior-posterior diameter is wide enough for instrument access,usually larger than 4-5 mm.The"outside-in"DrafⅢprocedure can be done when the frontal recess is too narrow to safely accommodate instruments.Regular follow-up with debridement should be done to prevent neo-ostium stenosis.

Generalized Cointegrated Time Series: Representation and Estimation

Cointegration analysis is often of special interest in the analysis of nonstationary vector valued time series, especially for the vector with higher order integrated components. In this paper we present the representation theorem for a generalized cointegrated system, and formulate the generalized error correction model(GECM). We also provide the modified EG two step procedure to estimate the parameters in a GECM. The paper extends some important results of cointegration into the analysis of generalized cointegration, and is of great importance in the analysis of nonstationary time series.