BACKGROUND: Stapled hemorrhoidopexy has become increasingly popular over the past five years, mainly because of the assumption that it is associated with less pain. However, persistent tags and recurrence might repres...BACKGROUND: Stapled hemorrhoidopexy has become increasingly popular over the past five years, mainly because of the assumption that it is associated with less pain. However, persistent tags and recurrence might represent a problem, because piles are not excised and severe complications requiring surgery have been occasionally reported. The aim of the present study is to analyze the causes for and the outcome of reintervention following either severely complicated or failed stapled hemorrhoidopexy. METHODS: A total of 232 primary stapled hemorrhoidopexies and 65 reinterventions after stapled hemorrhoidopexy were performed by the authors in five centers devoted to colorectal surgery. Twelve patients of the latter group had the stapled hemorrhoidopexy performed in one of these centers. Thirty-five were males and 30 were females. The mean age was 50 (range, 29-81) years. In all cases the primary indication for stapled hemorrhoidopexy was either third-degree or fourth-degree symptomatic hemorrhoids. In all patients submitted to reoperation the diagnosis of either severely complicated or failed stapled hemorrhoidopexy was made. The clinical history of all of these patients was carefully studied and all underwent inspection, digital exploration, and proctoscopy. After the reintervention, proctoscopy was performed in 61 patients (92 percent) after a median followup of 5.5 (range, 1-36) months. RESULTS: Our reoperation rate after stapled hemorrhoidopexy was 11 percent. The most frequent indications for reintervention were persistent, severe anal pain (visual analog pain score higher than 7) in 29 patients (45 percent), severe postoperative bleeding in 20 (31 percent), anal fissure in 16 (21 percent), pro-lapsing piles in 12 (18 percent), rectal polyp in 11 (16 percent), anorectal sepsis in 11 (16 percent), and fecal incontinence in 7 (11 percent). Thirteen different types of reintervention were needed. Excisional hemorrhoidectomy, removal of staples, and fissurectomy and/or internal sphincterotomy were the most frequent o展开更多
Following a large-scale phylogenetic study of the lichenized genus Cora(Basidiomycota:Agaricales:Hygrophoraceae),we formally describe 70 new species,honouring the seventieth birthday of David Leslie Hawksworth,one of ...Following a large-scale phylogenetic study of the lichenized genus Cora(Basidiomycota:Agaricales:Hygrophoraceae),we formally describe 70 new species,honouring the seventieth birthday of David Leslie Hawksworth,one of the preeminent figures in mycology and lichenology in the past 50 years.Based on an updated phylogeny using the ITS fungal barcoding locus,we now recognize 189 taxa in a genus that until recently was considered to represent a single species;including this contribution,92 of these are formally recognized,including five taxa based on historical names or collections that have not been sequenced.Species of Cora can be recognized by a combination of morphological(size,colour,lobe configuration,surface hairs,hymenophore size and shape),anatomical(thallus thickness,cortex structure,photobiont type,hyphal papillae),and ecogeographical features(substrate,habitat,distribution),and a keytable allowing the identification of all accepted taxa is provided.The new species are:Cora accipiter Moncada,Madrin˜a´n&Lücking spec.nov.,C.applanata Moncada,Soto-Medina&Lücking spec.nov.,C.arachnodavidea Moncada,Dal Forno&Lücking spec.nov.,C.arborescens Dal Forno,Chaves&Lücking spec.nov.,C.arcabucana Moncada,C.Rodrı´guez&Lücking spec.nov.,C.aturucoa Lücking,Moncada&C.Vargas spec.nov.,C.auriculeslia Moncada,Ya´nez-Ayabaca&Lücking spec.nov.,C.barbifera Moncada,Patin˜o&Lücking spec.nov.,C.boleslia Lücking,E.Morales&Dal Forno spec.nov.,C.caliginosa Holgado,Rivas Plata&Perlmutter spec.nov.,C.campestris Dal Forno,Eliasaro&Spielmann spec.nov.,C.canari Nugra,Dal Forno&Lücking spec.nov.,C.caraana Lücking,Martins&Lucheta spec.nov.,C.casasolana Moncada,R.-E.Pe´rez&Lücking spec.nov.,C.caucensis Moncada,M.Gut.&Lücking spec.nov.,C.celestinoa Moncada,CabreraAmaya&Lücking spec.nov.,C.comaltepeca Moncada,R.-E.Pe´rez&Herrera-Camp.spec.nov.,C.corani Lücking,E.Morales&Dal Forno spec.nov.,C.corelleslia Moncada,A.Sua´rez-Corredor&Lücking spec.nov.,C.crispoleslia Moncada,J.Molina&Lücking spec.nov.,C.cuzcoensis Holgado,Rivas展开更多
This study is a re-assessment of basidiolichen diversity in the Galapagos Islands.We present a molecular phylogenetic analysis,based on 92 specimens from Galapagos,using two nuclear ribosomal DNA markers(ITS and nuLSU...This study is a re-assessment of basidiolichen diversity in the Galapagos Islands.We present a molecular phylogenetic analysis,based on 92 specimens from Galapagos,using two nuclear ribosomal DNA markers(ITS and nuLSU).We also re-examined the morphology and anatomy of all sequenced material.The molecular results confirm our previous assessment that all Galapagos basidiolichens belong to the Dictyonema clade,which in Galapagos is represented by four genera:Acantholichen,Cora,Cyphellostereum,and Dictyonema.Most species previously reported from Galapagos in these genera were at the time believed to represent widely distributed taxa.This conclusion,however,has changed with the inclusion of molecular data.Although almost the same number of species is distinguished,the phylogenetic data now suggest that all are restricted to the Galapagos Islands.Among them,six species are proposed here as new to science,namely Cora galapagoensis,Cyphellostereum unoquinoum,Dictyonema barbatum,D.darwinianum,D.ramificans,and D.subobscuratum;and four species have already been described previously,namely Acantholichen galapagoensis,Cora santacruzensis,Dictyonema pectinatum,and D.galapagoense,here recombined as Cyphellostereum galapagoense.Our analysis is set on a very broad phylogenetic framework,which includes a large number of specimens(N=826)mainly from Central and South America,and therefore strongly suggests an unusually high level of endemism previously not recognized.This analysis also shows that the closest relatives of half of the basidiolichens now found in Galapagos are from mainland Ecuador,implying that they reached the islands through the shortest route,with all species arriving on the islands through independent colonization events.展开更多
文摘BACKGROUND: Stapled hemorrhoidopexy has become increasingly popular over the past five years, mainly because of the assumption that it is associated with less pain. However, persistent tags and recurrence might represent a problem, because piles are not excised and severe complications requiring surgery have been occasionally reported. The aim of the present study is to analyze the causes for and the outcome of reintervention following either severely complicated or failed stapled hemorrhoidopexy. METHODS: A total of 232 primary stapled hemorrhoidopexies and 65 reinterventions after stapled hemorrhoidopexy were performed by the authors in five centers devoted to colorectal surgery. Twelve patients of the latter group had the stapled hemorrhoidopexy performed in one of these centers. Thirty-five were males and 30 were females. The mean age was 50 (range, 29-81) years. In all cases the primary indication for stapled hemorrhoidopexy was either third-degree or fourth-degree symptomatic hemorrhoids. In all patients submitted to reoperation the diagnosis of either severely complicated or failed stapled hemorrhoidopexy was made. The clinical history of all of these patients was carefully studied and all underwent inspection, digital exploration, and proctoscopy. After the reintervention, proctoscopy was performed in 61 patients (92 percent) after a median followup of 5.5 (range, 1-36) months. RESULTS: Our reoperation rate after stapled hemorrhoidopexy was 11 percent. The most frequent indications for reintervention were persistent, severe anal pain (visual analog pain score higher than 7) in 29 patients (45 percent), severe postoperative bleeding in 20 (31 percent), anal fissure in 16 (21 percent), pro-lapsing piles in 12 (18 percent), rectal polyp in 11 (16 percent), anorectal sepsis in 11 (16 percent), and fecal incontinence in 7 (11 percent). Thirteen different types of reintervention were needed. Excisional hemorrhoidectomy, removal of staples, and fissurectomy and/or internal sphincterotomy were the most frequent o
基金This study was partially supported by three grants from the National Science Foundation:TICOLICHEN-The Costa Rican Lichen Biodiversity Inventory(DEB 0206125 to The Field MuseumPI Robert Lücking)+8 种基金Neotropical Epiphytic Microlichens-An Innovative Inventory of a Highly Diverse yet Little Known Group of Symbiotic Organisms(DEB 0715660 to The Field MuseumPI R.Lücking)Phylogenetic Diversity of Mycobionts and Photobionts in the Cyanolichen Genus Dictyonema,with Emphasis on the Neotropics and the Galapagos Islands(DEB 0841405 to George Mason UniversityPI J.LawreyCo-PIs:R.Lücking,P.Gillevet).The Verein der Freunde des Botanischen Gartens und Botanischen Museums Berlin-Dahlem e.V.(https://www.bgbm.org/de/BGBM/freunde/index.html)supported molecular sequencing work for specimens collected as part of the Pilotprojekt Kooperation mit dem Botanischen Garten Bogotá(BMBF,see below).The Universidad Distrital Francisco Jose´de Caldas,Bogota´,is thanked for the support to the lichen herbarium and the curatorial work of the UDBC collections.The Jardı´n Bota´nico de Bogota´Jose´Celestino Mutis organized field trips to Sumapaz,Pen˜a Blanca,and Pasquilla(Bogota´),by agreement with the Botanical Garden and Botanical Museum Berlin,partially financed through the German Federal Ministry of Education and Research(BMBFPilotprojekt Kooperation mit dem Botanischen Garten BogotáForderkennzeichen:01DN13030).The Universidad de los Andes,Bogota´,provided logistic support for field work in Chingaza.Fe´lix Fernandez,owner of El Secreto Private Reserve in Garagoa,Colombia,is thanked for providing access to the area.The Galapagos Lichen Inventory acknowledges support by successive science directors of the Charles Darwin Foundation(Alan Tye,Mark Gardener,Rodolfo Martinez,Ulf Hardter,and Noemi d’Ozouville)executive director Arturo Izurieta.Frank Bungartz and collaborators are further indebted to the Directorate of the Galapagos National Park(particular Galo Quezada and Victor Carrio´n,granting specimen export permits)This publi
文摘Following a large-scale phylogenetic study of the lichenized genus Cora(Basidiomycota:Agaricales:Hygrophoraceae),we formally describe 70 new species,honouring the seventieth birthday of David Leslie Hawksworth,one of the preeminent figures in mycology and lichenology in the past 50 years.Based on an updated phylogeny using the ITS fungal barcoding locus,we now recognize 189 taxa in a genus that until recently was considered to represent a single species;including this contribution,92 of these are formally recognized,including five taxa based on historical names or collections that have not been sequenced.Species of Cora can be recognized by a combination of morphological(size,colour,lobe configuration,surface hairs,hymenophore size and shape),anatomical(thallus thickness,cortex structure,photobiont type,hyphal papillae),and ecogeographical features(substrate,habitat,distribution),and a keytable allowing the identification of all accepted taxa is provided.The new species are:Cora accipiter Moncada,Madrin˜a´n&Lücking spec.nov.,C.applanata Moncada,Soto-Medina&Lücking spec.nov.,C.arachnodavidea Moncada,Dal Forno&Lücking spec.nov.,C.arborescens Dal Forno,Chaves&Lücking spec.nov.,C.arcabucana Moncada,C.Rodrı´guez&Lücking spec.nov.,C.aturucoa Lücking,Moncada&C.Vargas spec.nov.,C.auriculeslia Moncada,Ya´nez-Ayabaca&Lücking spec.nov.,C.barbifera Moncada,Patin˜o&Lücking spec.nov.,C.boleslia Lücking,E.Morales&Dal Forno spec.nov.,C.caliginosa Holgado,Rivas Plata&Perlmutter spec.nov.,C.campestris Dal Forno,Eliasaro&Spielmann spec.nov.,C.canari Nugra,Dal Forno&Lücking spec.nov.,C.caraana Lücking,Martins&Lucheta spec.nov.,C.casasolana Moncada,R.-E.Pe´rez&Lücking spec.nov.,C.caucensis Moncada,M.Gut.&Lücking spec.nov.,C.celestinoa Moncada,CabreraAmaya&Lücking spec.nov.,C.comaltepeca Moncada,R.-E.Pe´rez&Herrera-Camp.spec.nov.,C.corani Lücking,E.Morales&Dal Forno spec.nov.,C.corelleslia Moncada,A.Sua´rez-Corredor&Lücking spec.nov.,C.crispoleslia Moncada,J.Molina&Lücking spec.nov.,C.cuzcoensis Holgado,Rivas
基金thank National Science Foundation for financial support through a Division of Environmental Biology grant(DEB 0841405,PI:J.LawreyCoPIs:R.Lücking,P.Gillevet)+1 种基金a Postdoctoral Research Fellowship in Biology(PRFB 1609022,PI:M.Dal Forno)supported by the Mohamed bin Zayed Species Conservation Fund,Project 152510692。
文摘This study is a re-assessment of basidiolichen diversity in the Galapagos Islands.We present a molecular phylogenetic analysis,based on 92 specimens from Galapagos,using two nuclear ribosomal DNA markers(ITS and nuLSU).We also re-examined the morphology and anatomy of all sequenced material.The molecular results confirm our previous assessment that all Galapagos basidiolichens belong to the Dictyonema clade,which in Galapagos is represented by four genera:Acantholichen,Cora,Cyphellostereum,and Dictyonema.Most species previously reported from Galapagos in these genera were at the time believed to represent widely distributed taxa.This conclusion,however,has changed with the inclusion of molecular data.Although almost the same number of species is distinguished,the phylogenetic data now suggest that all are restricted to the Galapagos Islands.Among them,six species are proposed here as new to science,namely Cora galapagoensis,Cyphellostereum unoquinoum,Dictyonema barbatum,D.darwinianum,D.ramificans,and D.subobscuratum;and four species have already been described previously,namely Acantholichen galapagoensis,Cora santacruzensis,Dictyonema pectinatum,and D.galapagoense,here recombined as Cyphellostereum galapagoense.Our analysis is set on a very broad phylogenetic framework,which includes a large number of specimens(N=826)mainly from Central and South America,and therefore strongly suggests an unusually high level of endemism previously not recognized.This analysis also shows that the closest relatives of half of the basidiolichens now found in Galapagos are from mainland Ecuador,implying that they reached the islands through the shortest route,with all species arriving on the islands through independent colonization events.
