Highlights Hirschprung’s disease (HD) is a rare congenital colonic disorder. Volvulus is a rare complication of HD, described in children and adults and occasionally in infants. Diagnosis of Hirschprung’s disease was accepted. The sigmoid volvulus was HD complication appeared at the term of pregnancy. Duhamel’s procedure revealed as a safe technique to use in HD adult.

Introduction: Transurethral microwave thermotherapy is an anesthesia-free, outpatient method of treating lower urinary tract symptoms due to benign prostatic hyperplasia (BPH). Our results with the use of this technique in 25 patients are reported. Materials and Methods: Twenty-five patients with BPH, 8 of whom with complete urinary retention, were treated with high-energy transurethral microwave thermotherapy (HE-TUMT) (Prostatron system). Preoperative investigations included digital rectal examination, urinary free flow rate, PSA, urinalysis, urine culture, transrectal ultrasonography, urodynamic evaluation, International Prostatic Symptom Score (IPSS) and quality of life (QoL). Main selection criteria included: large prostate, high surgical risk, reluctance to undergo surgery. All patients were obstructed according to the Abrams-Griffith’s nomogram. For the statistical analysis a repeated-measures, one-way ANOVA was performed on previously non-catheterized patients. Results: Six of the 8 patients with catheter before treatment were able to urinate spontaneously with no significant post-voiding residual urine. In the 17 remaining patients, IPSS decreased from a mean of 18.5 at baseline to 7.30 and QoL from a mean of 3.9 to 1.2. Mean maximum flow rates during uroflowmetry increased from 8.5 to 16.9 ml/s. P_det Q_max decreased from a mean of 83.0 cm H₂O at baseline to 50.7 cm H₂O and Q_max increased from a mean of 6.8 ml/s at baseline to 15.1 ml/s during the pressure-flow study. After TUMT, 13 patients were unobstructed and 4 equivocal according to the Abrams-Griffith’s nomogram. Conclusion: Our study performed in a selected population of patients with BPH documents the efficiency and safety of HE-TUMT. This technique appears to be a valid therapeutic option, particularly in patients with high surgical risk.

both questionnaires and verbal interviews. Incident cases were identified by linkage with routinely collected hospital inpatient and cancer registry data for England, Scotland and Wales. Primary clinical outcomes were GORD without oesophagitis, GORD with oesophagitis (reflux oesophagitis), Barrett's oesophagus and oesophageal adenocarcinoma. The effects of heavy manual activity on disease risk were estimated using Cox proportional hazard regression adjusted for multiple risk factors and stratified by socioeconomic status.Results: Between 2006 and 2010, 502 men and 524 women were enrolled. Main analyses were limited to the working population with a full set of variables of interest (n¼266, 453). Compared to jobs with low levels of heavy manual activity, high-level jobs had increased hazard ratios (HRs) for GORD (1.20, 95% CI 1.11-1.30), reflux oesophagitis (1.17, 95% CI 1.04-1.31) and Barrett's oesophagus (1.13, 95% CI 0.98-1.32), but not oesophageal adenocarcinoma (0.91 95% CI 0.54-1.56). Conclusion:High levels of occupational heavy manual activity could be used as a new risk factor for GORD and reflux oesophagitis, the precursor diseases of oeosphageal adenocarcinoma.Legal entity responsible for the study: The authors.

Background. More than 50% of operable GEA relapse after curative-intent resection. We aimed at externally validating a nomogram to enable a more accurate estimate of individualized risk in resected GEA. Methods. Medical records of a training cohort (TC) and a validation cohort (VC) of patients undergoing radical surgery for c/uT2-T4 and/or node-positive GEA were retrieved, and potentially interesting variables were collected. Cox proportional hazards in univariate and multivariate regressions were used to assess the effects of the prognostic factors on OS. A graphical nomogram was constructed using R software’s package Regression Modeling Strategies (ver. 5.0-1). The performance of the prognostic model was evaluated and validated. Results. The TC and VC consisted of 185 and 151 patients. ECOG:PS > 0 (p < 0.001), angioinvasion (p < 0.001), log (Neutrophil/Lymphocyte ratio) (p < 0.001), and nodal status (p = 0.016) were independent prognostic values in the TC. They were used for the construction of a nomogram estimating 3- and 5-year OS. The discriminatory ability of the model was evaluated with the c-Harrell index. A 3-tier scoring system was developed through a linear predictor grouped by 25 and 75 percentiles, strengthening the model’s good discrimination (p < 0.001). A calibration plot demonstrated a concordance between the predicted and actual survival in the TC and VC. A decision curve analysis was plotted that depicted the nomogram’s clinical utility. Conclusions. We externally validated a prognostic nomogram to predict OS in a joint independent cohort of resectable GEA; the NOMOGAST could represent a valuable tool in assisting decision-making. This tool incorporates readily available and inexpensive patient and disease characteristics as well as immune-inflammatory determinants. It is accurate, generalizable, and clinically effectivex.