Surgery for Hirschsprung's disease: comparison between the Duhamel method and the transanal endorectal pull-through based on 59 patients and a review of the literature

Background:¦Hirschsprung's disease (HSCR) is a congenital malformation of the enteric nervous system due to the¦arrest of migration of neural crest cells to form the myenteric and submucosal plexuses. It leads to an anganglionic intestinal segment, which is permanently contracted causing intestinal obstruction. Its incidence is approximately 1/5000 birth, and males are more frequently affected with a male/female ratio of 4/1. The diagnosis is in most cases made within the first year of life. The rectal biopsy of the mucosa and sub-mucosa is the diagnostic gold standard.¦Purpose:¦The aim of this study was to compare two surgical approaches for HSCR, the Duhamel technique and the transanal endorectal pull-through (TEPT) in term of indications, duration of surgery, duration of hospital stay, postoperative treatment, complications, frequency of enterocolitis and functional outcomes.¦Methods:¦Fifty-nine patients were treated for HSCR by one of the two methods in our department of pediatric¦surgery between 1994 and 2010. These patients were separated into two groups (I: Duhamel, II: TEPT), which were compared on the basis of medical records. Statistics were made to compare the two groups (ANOVA test). The first group includes 43 patients and the second 16 patients. It is noteworthy that twenty-four patients (about 41% of all¦patients) were referred from abroad (Western Africa). Continence was evaluated with the Krickenbeck's score.¦Results:¦Statistically, this study showed that operation duration, hospital stay, postoperative fasting and duration of postoperative antibiotics were significantly shorter (p value < 0.05) in group II (TEPT). But age at operation and length of aganglionic segment showed no significant difference between the two groups. The continence follow-up showed generally good results (Krickenbeck's scores 1; 2.1; 3.1) in both groups with a slight tendency to constipation in group I and soiling in group II.¦Conclusion:¦We found two indications for the Duhamel method that are being referred from a country without¦careful postoperative surveillance and/or having a previous colostomy. Even if the Duhamel technique tends to be replaced by the TEPT, it remains the best operative approach for some selected patients. TEPT has also proved some advantages but must be followed carefully because, among other points, of the postoperative dilatations. Our postoperative standards, like digital rectal examination and anal dilatations seem to reduce the occurrence of complications like rectal spur and anal/anastomosis stenosis, respectively in the Duhamel method and the TEPT technique.

Novel (60%) and recurrent (40%) androgen receptor gene mutations in a series of 59 patients with a 46,XY disorder of sex development.

BACKGROUND Androgen receptor (AR) gene mutations are the most frequent cause of 46,XY disorders of sex development (DSD) and are associated with a variety of phenotypes, ranging from phenotypic women [complete androgen insensitivity syndrome (CAIS)] to milder degrees of undervirilization (partial form or PAIS) or men with only infertility (mild form or MAIS). OBJECTIVE The aim of the study was to characterize the contribution of the AR gene to the molecular cause of 46,XY DSD in a series of Spanish patients. SETTING We studied a series of 133 index patients with 46,XY DSD in whom gonads were differentiated as testes, with phenotypes including varying degrees of undervirilization, and in whom the AR gene was the first candidate for a molecular analysis. METHODS The AR gene was sequenced (exons 1 to 8 with intronic flanking regions) in all patients and in family members of 61% of AR-mutated gene patients. RESULTS AR gene mutations were found in 59 individuals (44.4% of index patients), of whom 46 (78%) were CAIS and 13 (22%) PAIS. Fifty-seven different mutations were found: 21.0% located in exon 1, 15.8% in exons 2 and 3, 57.9% in exons 4-8, and 5.3% intronic. Twenty-three mutations (40.4%) had been previously described and 34 (59.6%) were novel. CONCLUSIONS AR gene mutation is the most frequent cause of 46,XY DSD, with a clearly higher frequency in the complete phenotype. Mutations spread along the whole coding sequence, including exon 1. This series shows that 60% of mutations detected during the period 2002-2009 were novel.

Archives parlementaires de 1787 à 1860 ; 52-61, 63-82. Convention nationale. Série 1 / Tome 59 / impr. par ordre du Sénat et de la Chambre des députés ; fondé par MM. Mavidal et E. Laurent ; continué́ par M. L. Lataste,... M. Louis Claveau,... M. Constant Pionnier,... [et al.]

Collection : Les archives de la Révolution française ; 3.1

Friday Facts, June 11, 2010, Vol. 59

Bureau of Nutrition and Health Promotion part of the Iowa Department of Public Health produces of weekly newsletter about the Iowa WIC Program for the State of Iowa citizen.

Road Safety Audit for the Intersection of US 59 and IA 9 in Osceola County, Iowa Final Report, March 2012

The Iowa Department of Transportation (DOT) requested a road safety audit (RSA) of the US 59/IA 9 intersection in northwestern Iowa, just south of the Minnesota border, to assess intersection environmental issues and crash history and recommend appropriate mitigation to address the identified safety issues at the intersection. Although the number of crashes at the location has not been significantly higher than the statewide average for similar intersections, the severity of these crashes has been of concern. This RSA was unique in that it included intersection video observation and recorded traffic conflict data analysis, along with the daylight and nighttime field reviews. This report outlines the findings and recommendations of the RSA team for addressing the safety concerns at this intersection.

Crack and Seat PCC Pavement Prior to Resurfacing US 59 - Shelby County, HR-527, 1993

Asphalt concrete resurfacing is the most commonly utilized rehabilitation practice used by the Iowa Department of Transportation. The major problem with asphalt concrete resurfacing is the reflective cracking from underlying cracks and joints in the portland cement concrete (PCC) pavement. Cracking and seating the PCC prior to an asphalt overlay was the construction method evaluated in this project. There was cracking and seating on portions of the project and portions were overlaid without this process. There were also different overlay thicknesses used. Comparisons of crack and seating to the normal overlay method and the different depths are compared in this report. Cracking and seating results in some structural loss, but does reduce the problem of reflection cracking.

Water Summary Update, December 10, 2015, No. 59

A snapshot of water resource trends prepared by the Iowa DNR in collaboration with the Iowa Department of Agriculture and Land Stewardship, the U.S. Geological Survey, and The Iowa Homeland Security and Emergency Management Department.