12685 research outputs found
Sort by
Evaluation of short-term complications in laparoscopic peritoneal dialysis catheter placement - a single tertiary center experience
Get PDFBackground. Peritoneal dialysis is a form of kidney function replacement that is not as widespread as hemodialysis. However, it has recognized advantages, such as preservation of residual renal function, lack of vascular access, and the ability to be performed at home. On the other hand, it requires the correct insertion of a peritoneal dialysis (PD) catheter and maintaining its patency. Methods. We conducted a retrospective study of 126 patients with end-stage renal disease who underwent laparoscopic Tenckhoff catheter placement for peritoneal dialysis between January 2016 and December 2022. The study analyzed the frequency and type of complications registered within three months, in order to validate laparoscopy as a safe method of catheter insertion (with reduced periprocedural complications), as well as the importance of the multidisciplinary team in the care of patients with peritoneal dialysis. Results. In about 14% of patients, we encountered a total of 23 complications: 61% in the first month, 34.7% in the second month, and 4.3% in the third month. The most frequent complication was infection (peritonitis 35%, catheter exit site infection 30.4%), followed by peri-catheter leak (21.7% of total complications). Catheter migration, hernia, and significant bleeding were rare events (4.3% of total complications each). All complications were managed by medical treatment, except two cases which required replacement of the catheter. Conclusions. Laparoscopic catheter insertion is a safe procedure with low post-procedural complications in patients who are dependent on peritoneal dialysis
Approaches and indications in laparoscopic choledoscopy
Get PDFObjectives. Up to 20% of patients with biliary lithiasis have bile duct stones, which are asymptomatic in 50% of cases. The aim of the study was to evaluate the role of choledoscopy in extracting stones from the main bile ducts. Materials and Methods. This is a retrospective study (January 2014 - December 2024) on 2309 patients who underwent a laparoscopic cholecystectomy. Laparoscopic choledoscopy was performed in 32 cases. Of the 32 patients with complete clearance, none had residual common bile duct stones (CBDS) at 1 year postoperatively. Results. The ideal approach in our study was the transcystic approach, with the shortest hospital stays (mean 3 days) transcholedochal approach; it was only feasible in 7 patients. All patients had transcystic drainage that was removed after 10 days (mean operative time 105 min). The transcholedochal approach was demanding from a technical point of view. Primary ductal closure was performed in 5 patients. Ductal closure with transcystic drain was in 9 patients. A total of 14 patients had a T-tube and a longer operative time (on average 170 min). Conversion to open surgery was performed in 4 cases, due to difficult dissection at the level of the hepatic porta. Conclusions. LCBDE for previously documented or discovered CBDS during LC is a safe and feasible procedure. The technique is technically demanding, and requires advanced laparoscopic skills. Patient selection is very important, but the transcystic approach for LCBDE when possible is optimal
Endoscopic and immunohistochemical aspects in an inverted papilloma with unilateral total obstruction of the nasal fossa
Get PDFAn inverted papilloma is a medical condition in which epithelial cells placed on the surface grow in depth into the underlying supporting tissue. The case of a 68-year-old man with a 6-month history of right-sided complete nasal obstruction, who was referred to the ENT Department of our hospital, is presented. The associated symptoms were represented by repeated epistaxis, rhinorrhea and anosmia. From a clinical point of view, a polypous reddish-gray irregular mass, with cauliflower-like appearance, has been described. The formation was friable, richly vascularized, and with minor bleeding on light touch. The patient was diagnosed with inverted papilloma which was treated by endoscopic surgery. By analyzing the clinical, histochemical and immunohistochemical aspects of this case, the cause of tumor growth and its potential for malignant transformation were established. Many particularities are presented in this article: increased regional aggressiveness, its ethmoidal sinus origin, specific symptomatology, paraclinical examinations, all of which were useful in choosing a customized therapy and follow-up program
Pathophysiological mechanisms of type 2 diabetes mellitus involved in acute mesenteric ischemia
Get PDFType 2 diabetes mellitus is a complex condition with high prevalence in the global population, implying multiple complications for the entire organism. It is essential to understand its implications in the development and evolution of other pathologies in order to manage efficiently their complications thus decreasing overall mortality. A surgical pathology potentially associated with type 2 diabetes is acute mesenteric ischemia. Although it has a decreased prevalence in the global population, mesenteric infarction is related to an extremely high mortality rate due to its elusive clinical presentation and rapid progression. The difficult diagnosis emphasizes the need to make associations between acute mesenteric ischemia and other pathologies involved in its evolution, such as type 2 diabetes mellitus. This metabolic disease raises the risk of macro and microvascular complications, therefore disturbing the vascularization of the bowel. The purpose of this review is to describe how diabetes is particularly involved in all four types of mesenteric infarction by modulating different physiopathological mechanisms based on the process of atherosclerosis and other endothelial molecular processes
Survival prognostic factors and molecular aspects in extremity soft tissue sarcoma
Get PDFSoft tissue sarcomas are defined as relatively rare, wide-ranging mesenchymal tumors that present several forms of aggressive behavior. In order to improve the therapeutic result and thus the patient\u27s prognosis, reliable diagnostic and evaluation tools are needed, capable of establishing the evolutive pattern of each patient. Materials and Methods. An analytical observational study was conducted in the period 2016-2023 in the Orthopedics Department of the Bucharest University Emergency Hospital, on patients diagnosed with soft tissue sarcoma. Data such as sex, age, site, size, depth, histotype, grade and margin status, vessel or bone involvement, adenopathies, adjuvant therapy, clinical findings, etc., were analyzed. Diagnosis included immunohistochemistry after macroscopic pathological findings were carefully reviewed by a dedicated pathologist. A molecular study was performed to increase the accuracy of diagnosis, prognosis and clinical management of selected sarcomas. Results. In adult soft tissue sarcomas, histotype has been reported to be a significant predictor of overall survival. In terms of survival rate, vascular invasion appears to be a significant pathological factor for progression in extremity STS. Even though the local control of the disease has improved, the development of systemic metastases seems to be largely influenced by the biological characteristics of the tumor. Conclusions. Significant prognostic factors for the likelihood of a lower survival and death rate are tumor size, tumor depth, histology type, and vascular invasion. The results of the study support and complement the literature data, thus improving the understanding of the prognosis of soft tissue sarcomas
Relationship between serum estradiol level, ultrasound follicle count, number of oocytes retrieved and their influence on IVF/ICSI treatment outcomes: a retrospective cross-sectional study
Get PDFThis retrospective cross-sectional study investigates determinants on follicular development, oocyte retrieval and pregnancy outcome. It assessed the clinical practicability of monitoring parameters in relation to predict a successful treatment. Analysis of serum-estradiol (E2), sonographic follicle count, number of oocytes and optimizable parameters have therefore been carried out based on patient files from the IVF outpatient clinic at the Department of Gynecology, Obstetrics and Reproductive Medicine, Homburg/Saar, Germany. Equidirectional connection occurred between serum-E2, sonographic follicle count and number of oocytes (p \u3c 0.001). There was no significant difference between sonographic and punctured follicle count (p = 0.428), but between sonographic/punctured follicle count and number of oocytes obtained (p \u3c 0.01). Increasing endometrial thickness was associated with increasing serum-E2 (p = 0.003) and number of oocytes (p \u3c 0.001), but not with the follicle count (p \u3e 0.05). Additionally, age was inversely associated with sonographic follicle count and number of oocytes (p \u3c 0.001) but not with E2 (p \u3e 0.05). BMI, nicotine and stimulation protocol had no association with the observed parameters (p \u3e 0.05). Mean differences in follicle numbers can be used for predicting expectable numbers of oocytes. Due to comparable numbers of follicles visualized on the day of ovulation induction and the number of follicles punctured, more emphasis should be placed in optimizing oocyte retrieval procedures
KitKats and Boiling Kettles: Understanding Reciprocal Relationships in the Workplace
Get PDFOften referred to as a law, principle, norm or rule, reciprocity can be defined as a state or condition of free interchange or mutual responsiveness. This paper considers the importance of reciprocity in organisational settings, whilst identifying three reciprocal exchange behaviours of which leaders should be aware. A Socratic dialogue using the Nelson/Heckmann approach is adopted as a research method, with the primary methodological concern being that of the axiological field of philosophy. Axiology deals with the nature of value and asks what is intrinsically worthwhile. This can lead to multiple questions about what we value in an organisational context. The central value being explored in this research activity is reciprocal exchange and its importance to organisational success. The dialogue involves three middle management leaders reflecting on why they work reciprocally. Adopting an inductive content analysis approach, three key themes emerge from the dialogue transcript: the importance of ‘small gestures’, ‘safety and threat’ and ‘not keeping count’. One of the conclusions of this paper is that from an organisational leadership perspective, ‘generalised’ reciprocal exchange behaviours can create the \u27durable ties’ needed in balanced and thriving organisations
The Association of Leadership Styles with Psychosocial Safety Climate: The Case of Authentic Leadership
Get PDFPsychosocial safety climate (PSC) is an organisation-level construct that measures an organisation’s commitment to the prevention of psychological harm in the workplace and has been identified as a lead indicator for psychological hazards. A key factor in PSC is senior leaders’ involvement through the establishment of policies, procedures, and practices for the prevention of psychological harm in the workplace. While leadership has been identified as an antecedent for a favourable PSC, the impact of different leadership styles on PSC has not been extensively studied.
This article reports a multivariate study of five contemporary leadership styles and their impact on PSC. The study collected data through an anonymous online survey which included questions from the psychosocial safety climate questionnaire (PSC-12), multifactor leadership questionnaire (MFQ) 3rd edition, ethical leadership questionnaire (ELQ), and authentic leadership questionnaire (ALQ). Regression analysis was conducted to determine the leadership styles that significantly impact PSC. Passive avoidant leadership was negatively associated with PSC (r = -.280, p = .036), while authentic leadership had a statistically significant positive relationship with PSC (r = .41, p \u3c .001).
There is limited research on leadership and its impact on PSC. This study is the first to conduct a multivariate analysis to determine the leadership style that is more likely to bring about psychosocially safer workplaces, thus making an important contribution to the literature. The study also demonstrates that leadership styles found to impact other safety climate constructs, like safety climate and patient safety climate, cannot simply be transposed to PSC