1,721,126 research outputs found
Unusual presentation of small bowel GIST. Diffuse omental & mesenteric sarcomatosis
Full text linkGastrointestinal stromal tumors (GISTs) represent ~1% of gastrointestinal (GI) tract neoplasms. Unusual presentation of a small bowel GIST with diffuse omental and mesenteric implants in a symptomatic patient is reported. CT scan in a 68-years-old woman showed multiple processes with solid density and colliquation areas in the abdominal cavity. At surgery, an uncommon finding of multiple omental and mesenteric secondary implants was evident. The index mass with 40 cm of adjacent small bowel, omentum and all peritoneal lesions were completely removed. Definitive pathology report showed a small bowel GIST with focal areas of necrosis and high mitotic activity (35 mitosis/50 High Power Fields), with multiple metastases on mesentery and omentum. Patient was therefore submitted to adjuvant treatment with Imatinib and a close follow-up program. Small bowel GIST with high mitotic activity may present with diffuse omental and mesenteric peritoneal seedings. Complete surgical clearance remains the mainstay of treatment
Telemedicine in surgery during COVID-19 pandemic: are we doing enough?
Full text linkIntroduction: The aim of this systematic review was to report and to analyze if there is and what is the impact of telemedicine in the surgical practice during COVID-19 pandemic. Many authors have posited that the pandemic urged a high implementation of the telemedicine service even in surgical specialties, however, the impact of this change of the clinical practice has been variably reported and its utilization in general surgery is uncertain. Evidence acquisition: All articles from any country written in English, Italian, Spanish, or French, about the use of telemedicine for indication to surgical treatment or for 30-day postoperative follow-up in general surgery during the COVID 19 outbreak, from the March 1, 2020, to December 1, 2020, were included. Evidence synthesis: Two hundred nine articles were fully analyzed, and 207 further articles were excluded. Finally, 2 articles, both published in October 2020, were included in the present systematic review. Conclusions: In conclusion, the rapid spread of SARS-CoV-2 pandemic has forced to review the traditional methods to deliver surgical assistance and urged surgeons to find alternative methods to continue their practice. The literature about this topic is yet scarce and many questions regarding its efficacy in improving patients' health, cost-effectiveness and user satisfaction remain unsolved
Retroprosthetic seroma after laparoscopic ventral hernia repair is related to mesh used?
No full textPurpose: Retroprosthetic seroma (RS) is defined as a fluid collection located between the abdominal viscera and the intraperitoneal mesh implanted during surgery. Aim of this study is to report the incidence and clinical impact of RS based on the type of mesh implanted during laparoscopic ventral hernia repair (LVHR). Materials and Methods: Patients who underwent LVHR were allocated in group A if expanded polytetrafluoroethylene (ePTFE) mesh was used during surgery and in group B if other types of mesh were used. Patients were evaluated on postoperative day (POD) 1 and 7 with physical examination and 1 month after surgery by physical examination and with an abdominal computed tomography scan, respectively. Results: Sixty patients were included. Of these 41 patients (68.3%) were included in group A and 19 patients (31.7%) in group B. Signs of RS were not observed in any patient on POD 7. One month after surgery, RS was observed in 13 patients (21.6%). One patient (7.7%) with RS experienced great discomfort and mesh detachment, and underwent a second surgical treatment. All RSs were observed in group A, and the difference with group B was statistically significant (P = .005). Conclusions: The use of ePTFE mesh is related to the development of RS. The treatment of choice without clinical symptoms should be conservative. Randomized control trial and prospective studies with a larger sample size and control group are required to confirm these data, although this study shows a high evidence of the relation of RS and the type of mesh
Minimally invasive repair of ventral hernia with one third of tackers and fibrin glue: less pain and same recurrence rate
No full textBackground: Aim of this study was to assess whether the reduction in the number of tackers maintains a similar recurrence rate and to subsequently evaluate whether this reduction associated with fibrin adhesive (FA) influences postsurgical pain after laparoscopic ventral hernia repair (LVHR) at 5 years follow-up.
Methods: Fifty patients with ventral hernia (intervention group) underwent to LVHR with the double crown (DC) technique with a decrease in the number of tackers, each tacker being separated by about 3 cm associated with FA to seal the spaces between them. Data obtained from intervention group were compared to data obtained from a historical series of 50 patients (control group) undergoing LVHR using DC technique with tackers at 1 cm each other.
Results: No statistically significant differences were found between groups about patients' characteristics. Mean hospital stay was 2 days. Statistically significant differences were observed about hospital stay between both groups U-Mann-Whitney ([UMW] =345, P=0) being higher in the control group. Statistically significant difference was observed in the postoperative pain evaluated by the visual analogical scale (VAS) score, having 95% of patients in the control group with VAS less than or equal to 7 compared to 4.55 in the intervention group. Recurrence rate was 4.1% for the control group versus 4.2% in the intervention group.
Conclusions: The reduction of metallic tackers associated with FA does not present statistically significant differences in the recurrence rate in comparison to conventional DC technique. In the intervention group a reduction in postoperative pain and hospital stay were observed
Minilaparoscopic cholecystectomy versus conventional laparoscopic cholecystectomy. An endless debate
Full text linkBackground: Our systematic review and meta-analysis examine the impact of minilaparoscopic cholecystectomy (MLC) versus conventional laparoscopic cholecystectomy (CLC). Some authors previously compared these surgical approaches without reaching any clear conclusion, since then, further trials have been performed, but an update was needed. Materials and Methods: PubMed, EMBASE, and the CENTRAL were systematically searched for randomized controlled trials comparing MLC versus CLC up to August 2019. The outcome measures used for comparison were operative time (OT), overall morbidity, intra- and postoperative complications, conversion and reintervention rate, length of hospital stay (LOS), postoperative pain (POP), and cosmetic results. A meta-analysis of relevant studies was performed using RevMan 5.3. Results: Fifteen studies, including 863 patients, were considered eligible to collect data and entered the meta-analysis. A total of 415 patients in the MLC group versus 448 in the CLC group were compared. No statistical difference as for overall morbidity, intra- and postoperative complications, conversion and reintervention rate, LOS, and cosmetic results were retrieved among the groups. CLC results faster and MLC shows to be the least painful. Conclusions: According to the available high-level evidence, both surgical approaches resulted substantially equivalent to perform LC, with some advantages of CLC as for OT and of MLC concerning POP. As a consequence, we can conclude that either procedure is superior or inferior to the other one; actually, we are not able to suggest the adoption of any of the two on a routine basis
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
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