Continent ileostomies: what the radiologist needs to know

Continent ileostomies are performed in patients who are not candidates for or do not want a traditional J-pouch after total colectomy. In these cases, patients may opt for a type of continent ileostomy instead of an end ileostomy. The most common types of continent ileostomies include the Kock (K) pouch, S-pouch and Barnett Continent Intestinal Reservoir. The normal fluoroscopic and CT appearance of these types of continent ileostomies are reviewed. CT provides better evaluation of the proximal small bowel and pouch for inflammatory bowel disease, while fluoroscopy is superior in evaluating the nipple valve. Common complications of these types of continent ileostomies are discussed including slipped nipple valve, pouch inflammation, fistulas, and polyps. Radiologist should be familiar with the different types of continent ileostomies that exist and their common complications.

Socioeconomic Relation with Plastic Consumption on 61 Countries Classified by Continent, Income Status and Coastal Regions

In this study, World Bank socioeconomic data of 61 countries during 2009-2015 combine with a semi-systematic literature review was applied to analyze the relationship between plastic consumptions and socioeconomic levels statistically. Based on a total data volume of 5551, we found that all countries can be divided into different groups like the continent, income status, and coastal countries. It is showed that most plastics were consumed by North America, Europe, high-income countries, and coastal countries in the Pacific and the Atlantic Ocean. A potential relation occurred in plastic consumptions with different socioeconomic parameters like Gross National Income (GNI) per capita, Gross Domestic Product (GDP) per capita, life expectancy, agriculture land use, etc. The results indicated the need should continue to support initiatives to cover identified gaps, either geographic or thematic, to address plastic consumptions.

A right colon pouch with a novel efferent channel concept: long-term results of the Turin pouch

PURPOSE

To report stoma stenosis rates and efferent channel (EC) complications at long term follow-up for Turin pouch (TP).

METHODS

This is a retrospective analysis of the prospectively maintained database of patients who underwent TP between March 2006 and May 2018. The TP is a U-shaped right colon pouch. The EC was conceived by the tubularization of 5 cm of the colon wall with the use of a stapler and sutured to the skin (EC-cutaneostomy). The ureters are sutured separately to the last 10 cm of ileum before the ileocecal valve. In literature, catheterization problems have been described on average in 20.3% of patients and stoma stenosis in 19.5% of the patients with flap valve systems.

RESULTS

Thirty-eight consecutive patients underwent a TP procedure. The median age was 55 years (IQR: 52-60). Median operative time was 201 min (IQR: 170-210), median reconstructive time was 61 min (IQR: 55-65) and the blood loss was 244 ml (IQR: 150-300) and 4 patients (10.5%) needed blood transfusions. The median follow-up was 52 months (IQR: 37-92). Complete 24h continence was achieved in 34 (89%) patients. Seven (18.4%) patients reported difficulties in EC catheterization and 4 (10.5%) patients had stoma stenosis. This study is limited by the relatively small number of patients.

CONCLUSION

In relation to similar systems, the TP seems to offer comparatively good functional results but EC and stoma complications were lower than other pouch variants in literature.

Ozone impact on wheat in Europe, Asia and North America - A comparison

Data from experiments where field-grown wheat was exposed to ozone were collated in order to compare the effects in Europe, Asia and North America using dose-response regression. In addition to grain yield, average grain mass and harvest index were included to reflect the influence of ozone on the crop growth pattern. In order to include as many experiments as possible, daytime average ozone concentration was used as the ozone exposure index, but AOT40, estimated from average ozone concentrations, was also used to compare the performance of the two exposure metrics. The response to ozone differed significantly between the continents only for grain yield when using AOT40 as the exposure index. North American wheat was less sensitive than European and Asian that responded similarly. The variation in responses across all three continents was smallest for harvest index, followed by grain mass and grain yield. The highly consistent effect on harvest index shows that not only effects on biomass accumulation, but also on the partitioning of biomass, are important for the ozone-induced grain yield loss in wheat. The average duration of daily ozone exposure was longer in European experiments compared to North American and Asian. It cannot be excluded that this contributed to the indicated higher ozone sensitivity in European wheat in relation to North American. The main conclusions from this study are that on the average the response of wheat to ozone was lower for the older North American experiments and that the ozone response of the growth pattern reflected by grain mass and harvest index did not differ between continents.

Global road fatality trends' estimations based on country-wise micro level data

The global road crash deaths during the past 35 years are estimated and analysed considering micro-level data for 215 countries. The data were gathered from Governmental records, international databases, and personal contacts. The data are adjusted for underreporting, death definition differences and missing data. The study models both reported and adjusted death to forecast future crash trends for each continent. The developed models employed curve fitting regression technique. It took over five years to build-up the database. The global sum of crash deaths showed firm increasing trends between 1980 and 2008. Subsequently, the global deaths tend to slow down. The adjusted death during 2014 ranged between 792,000 and 905,000. The high range showed 40% lesser death than World Health Organization (WHO) estimate. The developed models presented a plateauing transition stage of global road deaths before descending. This is contradicting WHO and The World Bank (TWB) forecasts. The global adjusted death for 2020 and 2030, differed substantially from WHO and TWB forecasts. The results showed inconsistencies in road deaths between various WHO sectors. The trend of crash fatalities in Asia followed closely with that for global trend, and that in Africa it showed fluctuated trend with steep increasing tendency after 1999. In South America, it showed continuous ascending trends, and that in Europe and Oceanic countries showed clear descending patterns. The trend in North and Central America did not change much during the period between 1980 and 2007. While the developed models indicated drops of 33% in North and Central America, 18% in Oceania and 13% in Asia by 2025 compared with 2014, they increase by over 44% in Africa and 32% in South America. The poor safety records in several continents, require careful reading, proper interpretation of the results and extensive research.

Follow up of children undergoing antegrade continent enema: experience of over two hundred cases

PURPOSE

Antegrade continent enema (ACE) procedures have been used as a treatment of constipation and soiling. Little is known about the long-term results of these procedures, particularly as patients progress into adulthood. This study presents the long-term outcomes of ACE in children, with follow up into adulthood, over a fifteen-year period.

METHODS

A prospective database of all consecutive procedures performed from 1998 to 2013 by a single surgeon in a regional centre was analysed. Operative details and follow up by both paediatric and adult clinicians and stoma nurses were included.

RESULTS

During the study period 203 ACE procedures were performed in children with a median age of 9years 7months (3-17). Indications included chronic idiopathic constipation (CIC) resistant to medical treatment in 62% of cases, anorectal malformation in 18%, spinal cord abnormalities in 9% and Hirschprung's in 7%. After an average follow-up of 5.5years (0.5-15) 132 patients were still using their ACE. 113 (93%) regularly had a good result from the procedure, 8 a variable result and 1 poor. Soiling was prevented in 79 patients (75%), partially improved in 15 and persistent in 15. Over the study period 53 patients (26%) no longer used their ACE due to resolution of symptoms. In 32 of these patients the ACE was reversed at a median interval of 5years from formation (1-12). In 17 cases (8%) the procedure failed with significant symptoms persisting. Four of these patients were reversed and a further 11 went on to have other procedures including 5 restorative pouches and 4 stomas. Of the patients that no longer required their ACE the majority (81%) had a pre-operative diagnosis of CIC. Only 7% of ACE procedures performed for CIC failed compared to 26% for spinal cord abnormalities.

CONCLUSION

Many patients continue to use their ACE to good effect in long-term follow up. In this study over a quarter had resolution of their symptoms permitting reversal. This was more likely if they suffered idiopathic constipation.