Volumetric threshold of pituitary macroadenoma as a predictor to visual impairment

Purpose: In this study, we aimed at correlating the curve of visual impairment against pituitary macroadenoma size. Method: In this study, we retrospectively analyzed the visual correlation between the volume and dimensions of pituitary adenoma and the degree of visual impairment on patients’ examination. 35 patients with no history of eye or refraction disorder were included in the study. Spearman correlation test was used to validate the correlation. Results: 57 % of pituitary macroadenoma patients suffer from visual impairment, even if not the primary presentation. Macroadenomas greater than 5 cm³ in volume and/or 2 cm height are more likely to cause various degrees of visual impairment, this correlation is not linear beyond these values. Conclusion: Visual impairment due to pituitary adenomas is more frequent than the presentation, the threshold volume is 5 cm³ and height is 2 cm, bigger adenomas behaviour is more multifactorial than the only size.

Arsenic content in the Jie River and its release behaviour from river sediments

Water and sediment samples of Jie River, China were collected and analyzed. The results showed that the average arsenic volume of water sample was 0.42 mg L-1 present in the Jie River. Among the riverway, the arsenic volume and pH kept rising with the flow. Standard leaching experiments showed the leachability of the sediments was lower than the hazardous materials permitted threshold volume but the leaching liquid exceeded the environmental quality standard for surface water which means the sediments might be a source to leach arsenic into aqueous system. In order to figure out the actual situation, simulated leaching experiments were performed. The results revealed that the sediments leaching could aggravate the water quality which was mostly influenced by the agitation and temperature. Solidification procedure was tested and suggested that with clean sand paved on the sediment, the amount of leaching arsenic will decrease 77.89%. Thus, it is of great help to apply cleaned sediments to remediate the contaminated sediments to reduce the leaching of arsenic into the aqueous system.

Extending the terrestrial depositional record of marine geohazards in coastal NW British Columbia

Recurrent storms, floods, landslides, earthquakes and tsunamis challenge the development of resilient infrastructure and communities in coastal northwestern British Columbia. Vulnerability assessment first requires extended and improved understanding of geohazards in the Pacific Basin to constrain modelling of future events. An investigation of soils and bedrock structures in the Douglas Channel provides insight into the distribution of deposits attributed to geohazards in the region. Newly discovered marine inundation deposits corroborate numerical models and suggest that Pacific-sourced storms and earthquake-triggered tsunamis expend much of their energy in the outer coast and rarely reach far up the mainland fjords. Small-volume Folisolic slides and rockfalls do not generate tsunamis of any consequence. In contrast, marine sediments deposited beyond storm berms at the fjord head are a record of local tsunamis generated by large-volume marine slumps. Deep-fractured bedrock mapped upslope from relict submarine features would trigger damaging tsunami waves if rapid failure into the fjord were to occur. The observations above suggest only great earthquakes, large landslides and seasonal storms above a certain threshold volume and impulse energy produce geomorphically significant inundation events. However, even small submarine landslides have tsunamigenic potential in Douglas Channel since they occur in shallow water.

Taeniectomy pouch as neorectum after low rectal resection

Background and purpose The functional outcomes of incontinence and high stool frequency resulting from restorative surgery are often criticised. The aim of this study was to assess the taeniectomy pouch in comparison with other pouches described in the literature. Material and methods This was a prospective cohort study. All patients who were candidate for low rectal resection presenting to the colorectal unit at Cairo University hospitals during the period February 2013 to February 2015 were included in the study (90 patients). Safety and feasibility of the new technique were assessed, including operative time, leakage, postoperative urgency, incontinence, number of daily motions and difficulty in evacuation. These parameters were assessed clinically, by means of defecography and anorectal manometry. Results The mean age of patients was 49.6 years. Percentages of postoperative mortality and leakage were 2.2% and 3.4%, respectively. Mean operative time was 117 minutes. Mean numbers of daily motions were 3.04 and 1.52 at 3 and 12 months, respectively. Mean Wexner score for continence at 3 and 12 months were 3.21 and 1.32, respectively. Mean resting pressure was 51.63 mmHg, squeeze pressure was 130.42 mmHg and mean threshold volume was 118.68 ml. Conclusions Taeniectomy is a novel technique for pouch formation after low rectal resection, which can be used as an alternative to other pouches, especially the widely used transverse coloplasty.

Efficacy and Predictors for Biofeedback Therapeutic Outcome in Patients with Dyssynergic Defecation

Aim. To evaluate the short-term efficacy of biofeedback therapy (BFT) for dyssynergic defecation (DD) and to explore the predictors of the efficacy of BFT. Methods. Clinical symptoms, psychological state, and quality of life of patients before and after BFT were investigated. All patients underwent lifestyle survey and anorectal physiology tests before BFT. Improvement in symptom scores was considered proof of clinical efficacy of BFT. Thirty-eight factors that could influence the efficacy of BFT were studied. Univariate and multivariate analysis was conducted to identify the independent predictors. Results. Clinical symptoms, psychological state, and quality of life of DD patients improved significantly after BFT. Univariate analysis showed that efficacy of BFT was positively correlated to one of the 36-item Short-Form Health Survey terms, the physical role function (r=0.289; P=0.025), and negatively correlated to the stool consistency (r=−0.220; P=0.032), the depression scores (r=−0.333; P=0.010), and the first rectal sensory threshold volume (r=−0.297; P=0.022). Multivariate analysis showed depression score (β = −0.271; P=0.032) and first rectal sensory threshold volume (β = −0.325; P=0.013) to be independent predictors of BFT efficacy. Conclusion. BFT improves the clinical symptoms of DD patients. Depression state and elevated first rectal sensory threshold volume were independent predictors of poor outcome with BFT.

Abstract 96: What Critical Volume of Intraventricular Hemorrhage is Important in Intracerebral Haemorrhage? Interact2 Results

Background and purpose: Intraventricular haemorrhage (IVH) predicts outcome in acute intracerebral haemorrhage (ICH), but there is uncertainty over the strength of association and what clinically relevant threshold volume is relevant to prognosis. We aimed to elucidate risk associations of IVH and outcome in participants of the INTERACT2 study. Methods: INTERACT2 was an international, multicenter, prospective, open, blinded endpoint, randomized controlled trial of 2839 patients with ICH (<6 hr) and elevated systolic BP (SBP) who were randomly assigned to intensive (target SBP <140mmHg) or guideline-based (SBP <180mmHg) BP management in 2008-2012. Associations of 740 (26%) patients with IVH on poor outcome (mRS >3) at 90 days, were determined in logistic regression models. Results: Patients with ICH-IVH were significantly older, had greater clinical severity, and more with prior ischemic stroke and deep and large hematoma volume, after adjustment for other variables. Poor outcome occurred in 67% of ICH-IVH patients compared with 49% of ICH-alone patients (odds ratio [OR] 0.5, 95% confidence interval [CI] 0.42-0.60; p<0.01). There was a strong linear relation between ICH volume and poor outcome. Compared to lowest quartile (Q1) IVH volume (0-2.07mL), OR for poor outcomes increased in Q2 (2.08-5.84 mL) 0.74 (95%CI 0.46-1.18 mL), Q3 (5.97-13-74 ml) 1.27 (95%CI 0.78-2.06), and Q4 (13.82-117.55) 1.56 (95%CI 0.94-2.58), p trend 0.03. Associations were stronger for death, where a baseline IVH volume of 5-10mL emerging as a statistically (and clinically) significant threshold for risk. Conclusion: While a linear relation exists between IVH and outcome in ICH, a 5-10mL volume appears an appropriate cut-point for clinical-decisions over use of interventions with risk.