scholarly journals Colonic Stoma Creation as the First Stage of Surgical Correction of Total Colonic Aganglionosis in Children

2020 ◽  
Vol 26 (2) ◽  
Author(s):  
Oleh Kurtash
Keyword(s):  
Surgical Treatment ◽  
Small Bowel ◽  
Functional Outcomes ◽  
Radical Surgery ◽  
Surgical Correction ◽  
Total Colonic Aganglionosis ◽  
Stoma Creation ◽  
The Third ◽  
Third Stage ◽  
The Creation

Abstract. The use of a staged approach in surgical treatment of total colonic aganglionosis is controversial. The creation of a protective colonic stoma as the first stage of surgical correction of total colonic aganglionosis rather than one-stage correction has become an alternative in treatment of such patients. This approach contributes to better survival, reduces the incidence of ileoanal anastomotic failure and improves functional outcomes. The objective of the research was to study and evaluate the need for colonic stoma creation as the first stage of surgical correction of total colonic aganglionosis in children. Materials and Methods. The analysis of surgical treatment of 41 children with total colonic aganglionosis over the period 1980-2020 was conducted. Protective colonic stoma was created in all the patients, namely 36 children with isolated colonic aganglionosis and 5 children with the involvement of the entire colon and a segment of the small bowel. Results. Twenty-four (58.54%) patients were diagnosed and underwent the first stage of treatment in National Specialized Children’s Hospital “Okhmatdyt”. There were 17 (41.46%) patients who were transferred from other clinics after being diagnosed with a pathology and undergoing colonic stoma creation. During staged treatment of children with total colonic aganglionosis, a single-barrel ileostomy (n=10, 24.40%), a double-barrel ileostomy (n=5, 12.19%), or a loop colonic ileostomy (n=26, 63.41%) were created. The periods between creating the protective colonic stoma and performing radical surgery ranged from 4 to 14 months. The colonic stomas were closed 2-4 months after radical surgery. The third stage of surgical correction of total colonic aganglionosis in children was carried out after the state of the neorectum formed and ileoanal anastomosis were assessed for readiness of inclusion in the passage. There were no complications after protective stoma closure. Within the first 3 months, the frequency of bowel movement ranged from 10 to 15 times a day, and, in a year, it was 2-4 times a day. All the children survived. Functional outcomes of treatment were found to be good. Bowel function was satisfactory. The X-ray images demonstrated the rectal reservoir of sufficient size with pronounced colonization. Conclusions. Surgical correction of total colonic aganglionosis in children involves the three-stage approach consisting in the creation of the protective small bowel stoma (the first stage), radical surgery, namely colectomy with reconstructive plastic formation of functionally advantageous reservoir version of the neorectum (the second stage) and ileostomy closure after adaptation of the small bowel reservoir (the third stage). The creation of the protective small bowel stoma as the first stage of surgical correction of total colonic aganglionosis in children is emergency surgery. The creation of the loop small bowel stoma at 12 cm above aganglionosis level is the most rational type of the first stage of correcting total colonic aganglionosis in children.

scholarly journals Images of Stars and their Significance in Japanese Esoteric Art of the Heian Period

2006 ◽  
Vol 10 (1 and 2) ◽  
pp. 145-193
Author(s):  
Tsuda Tetsuei
Keyword(s):  
Heian Period ◽  
Historical Significance ◽  
The Third ◽  
Esoteric Buddhism ◽  
Third Stage ◽  
Three Stages ◽  
The Creation

This essay considers the significance of images of stars within the framework of Esoteric Buddhism in the Heian Period. Firstly, it outlines the development of Heian Esoteric Art in three stages, and points at the appearance of star icons in the third stage. Secondly, it examines some representative examples of this iconography as developed by competing schools of Esoteric Buddhism: the rectangular star mandala created by the Shingon Ninna-ji school; the Sonjōō mandala created by the Tendai Jimon school; and the circular star mandala created by the Tendai Sanmon school. I discuss the similarities that occur in these representations, for example the position of stars, and reconsider the historical significance of the creation of such icons in the area of the capital from the late tenth to the early eleventh centuries. In addition, I introduce one example of unique star imagery created at the same time in the provinces.

scholarly journals Tradisi Upacara Pasola dalam Kebudayaan Masyarakat Sumba sebagai Ide Penciptaan Boardgame

2021 ◽  
Vol 1 (2) ◽  
pp. 58-67
Author(s):  
Iis Hannani
Keyword(s):  
Board Game ◽  
Fourth Stage ◽  
Cultural Wealth ◽  
Exploration Process ◽  
Second Stage ◽  
The Third ◽  
Eastern Indonesia ◽  
Third Stage ◽  
Last Stage ◽  
The Creation

The purpose of writing this article is to describe the process of creating a board game that makes the Pasola Ceremony a source of ideas. The Pasola ceremony is one of the cultures originating from eastern Indonesia, namely Sumba, East Nusa Tenggara. This ceremony is part of a series of cultural rituals carried out by the Sumba people who still adhere to the Merapu belief. Therefore, Pasola is a cultural wealth of Indonesia that must be preserved and preserved as a wealth of ancestral heritage. This is a source of inspiration in realizing ideas and ideas, so that they are translated into board game works. The process of creating this board game is adapting from the method of designing the work created by the author. The first stage is to explore the data to be the source of the creation idea. The second stage, deepening the source of ideas and determining the form of the work. The third stage, the form exploration process to enrich the design. The fourth stage enters the creation stage and the last stage is finishing. The visualized work is in the form of an integral part of the Pasola Boardgame.

The Coherence of Mary Barton: Romance, Realism, and Utopia

2015 ◽  
Vol 5 (3) ◽  
pp. 185-200
Author(s):  
Robert Z. Birdwell
Keyword(s):  
Thomas Carlyle ◽  
The Novel ◽  
Second Stage ◽  
The Third ◽  
Third Stage ◽  
Three Stages ◽  
Mode Of Production

Critics have argued that Elizabeth Gaskell's first novel, Mary Barton (1848), is split by a conflict between the modes of realism and romance. But the conflict does not render the novel incoherent, because Gaskell surpasses both modes through a utopian narrative that breaks with the conflict of form and gives coherence to the whole novel. Gaskell not only depicts what Thomas Carlyle called the ‘Condition of England’ in her work but also develops, through three stages, the utopia that will redeem this condition. The first stage is romantic nostalgia, a backward glance at Eden from the countryside surrounding Manchester. The second stage occurs in Manchester, as Gaskell mixes romance with a realistic mode, tracing a utopian drive toward death. The third stage is the utopian break with romantic and realistic accounts of the Condition of England and with the inadequate preceding conceptions of utopia. This third stage transforms narrative modes and figures a new mode of production.

Native Americans and the Third World Strike at UC Berkeley

2019 ◽  
Vol 42 (2) ◽  
pp. 32-39
Author(s):  
LaNada War Jack
Keyword(s):  
Native American ◽  
Native Americans ◽  
Personal Experience ◽  
Third World ◽  
Leadership Roles ◽  
The Third ◽  
The Creation ◽  
The 1960S ◽  
The Third World ◽  
The University

The author reflects on her personal experience as a Native American at UC Berkeley in the 1960s as well as on her activism and important leadership roles in the 1969 Third World Liberation Front student strike, which had as its goal the creation of an interdisciplinary Third World College at the university.

Bankruptcy Model Construction and its Limitation in Input Data Quality

2019 ◽  
Vol 10 (2) ◽  
pp. 117-125
Author(s):  
Dana Kubíčková ◽  
◽  
Vladimír Nulíček ◽  
Keyword(s):  
Data Quality ◽  
Normal Distribution ◽  
Input Data ◽  
Model Construction ◽  
The Third ◽  
Third Stage ◽  
Discriminant Analyses ◽  
One Year ◽  
The University ◽  
Multivariate Discriminant

The aim of the research project solved at the University of Finance and administration is to construct a new bankruptcy model. The intention is to use data of the firms that have to cease their activities due to bankruptcy. The most common method for bankruptcy model construction is multivariate discriminant analyses (MDA). It allows to derive the indicators most sensitive to the future companies’ failure as a parts of the bankruptcy model. One of the assumptions for using the MDA method and reassuring the reliable results is the normal distribution and independence of the input data. The results of verification of this assumption as the third stage of the project are presented in this article. We have revealed that this assumption is met only in a few selected indicators. Better results were achieved in the indicators in the set of prosperous companies and one year prior the failure. The selected indicators intended for the bankruptcy model construction thus cannot be considered as suitable for using the MDA method.

Histological examination of rat small intestine after surgical removal of obturation small bowel obstruction and peptide stimulation of lymph flow

2018 ◽  
pp. 157-162
Author(s):  
А.А. Коваленко ◽  
Г.П. Титова ◽  
В.К. Хугаева
Keyword(s):  
Small Intestine ◽  
Surgical Treatment ◽  
Survival Rate ◽  
Small Bowel ◽  
Goblet Cells ◽  
Intestinal Wall ◽  
Structure And Function ◽  
Lymph Flow ◽  
Intestinal Lumen ◽  
And Function

Оперативное лечение различных заболеваний кишечника сопровождается осложнениями в виде нарушений микроциркуляции в области анастомоза кишки. Ранее нами показана способность лимфостимуляторов пептидной природы восстанавливать нарушенную микроциркуляцию, что послужило основой для настоящего исследования. Цель работы - оценка влияния стимуляции лимфотока в стенке кишки на процессы восстановления микроциркуляции, структуры и функции тонкой кишки в области оперативного вмешательства. Методика. В экспериментах на наркотизированных крысах (хлоралгидрат в дозе 0,6 г/кг в 0,9% растворе NaCl) моделировали различные поражения тонкой кишки (наложение лигатуры, перевязка 1-3 брыжеечных артерий, перекрут петли кишки вокруг оси брыжейки, сочетание нескольких видов повреждений). Резекция поврежденного участка через 1 сут. с последующим созданием тонкокишечного анастомоза завершалась орошением операционного поля раствором пептида-стимулятора лимфотока (40 мкг/кг массы животного в 1 мл 0,9% раствора NaCl). На 7-е сут. после операции проводили гистологическое исследование фрагмента кишки в области анастомоза. Результаты. На 7-е сут. после резекции у выживших животных (летальность вследствие кишечной непроходимости составляла 30%) имеют место морфологические признаки острых сосудистых нарушений стенки кишки, изменений кровеносных и лимфатических микрососудов, интерстициальный отек всех слоев стенки кишки, дилатация просвета кишки, повреждение всасывающего эпителия ворсин с истончением щеточной каемки клеток, морфологические признаки гиперфункции бокаловидных клеток. Использование лимфостимулятора пептидной природы после операции увеличивало выживаемость животных на 24%. У части животных отмечалось уменьшение расширения просвета кишки, у других практически полная его нормализация. Восстанавливалась форма кишечных ворсин и распределение бокаловидных клеток. Отсутствовали признаки внутриклеточного и межмышечного отека. Отмечено умеренное полнокровие венул. Заключение. Использование лимфостимулятора при хирургическом лечении кишечной непроходимости увеличивает выживаемость животных на 24% по сравнению с контролем, способствует более раннему восстановлению структуры и функции тонкой кишки. Полученные результаты свидетельствуют о перспективности использования стимуляции лимфотока при операциях на кишечнике. Surgical treatment of bowel diseases is associated with complications that cause microcirculatory disturbances in the anastomosis area and may lead to a fatal outcome. This study was based on our previous finding that peptide-type lymphatic stimulators are able to restore impaired microcirculation. The aim of this work was stimulating the lymph flow in the intestinal wall to facilitate recovery of microcirculation, structure and function of the small intestine in the area of surgical intervention. Methods. In experiments on anesthetized rats (0.6 g/kg chloral hydrate in 0.9% NaCl), various small bowel lesions were modeled (bowel ligation, ligation of 1-3 mesenteric arteries, gut torsion, combination of several lesion types). In 24 h, the damaged area was resected, and a small intestine anastomosis was creased. The surgery was completed with irrigation of the operative field with a solution of lymph flow stimulating peptide (40 мg/kg body weight in 1 ml of 0.9% NaCl). A gut fragment from the anastomosis area was examined histologically on day 7 after the surgery. Results. On the 7th day after removing the intestinal obstruction, the surviving animals (lethality 30%) had morphological signs of acute vascular disorders in the intestinal wall; changes in blood and lymphatic microvessels; interstitial edema of all intestinal wall layers; dilatation of the intestinal lumen; damage to the absorptive epithelium of villi with thinning of the brush border, and hyperfunction of mucous (goblet) cells. The use of the peptide after surgery increased the survival rate of animals by 24% and provided a smaller dilatation of the intestinal lumen in some animals. In other animals, the lumen recovered. The shape of intestinal villi and distribution of goblet cells were restored. Signs of intracellular and intermuscular edema were absent. Moderate venular congestion was noticed. Conclusion. Using the lymphatic stimulator in surgical treatment of intestinal obstruction increases the survival rate of animals by 24% compared to the control, facilitates earlier restoration of the small intestine structure and function. The obtained results indicated the effectiveness of lymphatic stimulation in intestinal surgery.

How well do voice-hearing assessment measures capture the positive experiences of individuals?

2019 ◽  
Author(s):  
Lucy Armstrong ◽  
Lorna Hogg ◽  
Pamela Charlotte Jacobsen
Keyword(s):  
Systematic Review ◽  
Lived Experience ◽  
Second Stage ◽  
The Third ◽  
Third Stage ◽  
Hearing Assessment ◽  
Positive Experiences ◽  
Assessment Measures ◽  
Stage 1 ◽  
The Voice

The first stage of this project aims to identify assessment measures which include items on voice-hearing by way of a systematic review. The second stage is the development of a brief framework of categories of positive experiences of voice hearing, using a triangulated approach, drawing on views from both professionals and people with lived experience. The third stage will involve using the framework to identify any positve aspects of voice-hearing included in the voice hearing assessments identified in stage 1.

Pèlerinages barrésiens

2013 ◽  
pp. 116-123
Author(s):  
Claire Bompaire-Evesque
Keyword(s):  
Large Scale ◽  
The Self ◽  
Joan Of Arc ◽  
The Third ◽  
National Importance ◽  
The Earth ◽  
Third Stage ◽  
The Dead

This article is a inquiry about how Barrès (1862-1923) handles the religious rite of pilgrimage. Barrès stages in his writings three successive forms of pilgrimage, revealing what is sacred to him at different times. The pilgrimage to a museum or to the birthplace of an artist is typical for the egotism and the humanism of the young Barrès, expressed in the Cult of the Self (1888-1891). After his conversion to nationalism, Barrès tries to unite the sons of France and to instill in them a solemn reverence for “the earth and the dead” ; for that purpose he encourages in French Amities (1903) pilgrimages to historical places of national importance (battlefields; birthplace of Joan of Arc), building what Nora later called the Realms of Memory. The third stage of Barrès’ intellectual evolution is exemplified by The Sacred Hill (1913). In this book the writer celebrates the places where “the Spirit blows”, and proves open to a large scale of spiritual forces, reaching back to paganism and forward to integrative syncretism, which aims at unifying “the entire realm of the sacred”.

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