1,721,002 research outputs found
Development and validation of a practical score to predict pain after excisional hemorrhoidectomy.
No full textPURPOSE: Excisional hemorrhoidectomy (EH) can be complicated by high early (EP)
and prolonged pain (PP). This study aimed to determine predictors of high
postoperative pain and to develop a risk score suitable to identify patient
candidates to a more active analgesic treatment.
METHODS: We collected data of patients undergoing EH between January 2005 and
September 2012 (development group). Patient-, disease-, surgery-, and
surgeon-related characteristics were gathered. Anxiety was evaluated by means of
STAI-Y. EP was assessed at 1-day, while PP at 15-day follow-up by means of a
10-cm VAS (cutoff, EP ≥ 5; PP ≥ 3 cm). On the basis of the odds ratio from a
logistic regression, independent risk factors were assigned a weighted integer.
The sum comprised the risk score, which was validated on a prospective cohort of
patients undergoing EH between September 2012 and January 2014.
RESULTS: Five hundred fourteen patients were included in development group.
Incidence of EP was 18.3 %, with 40.4 % developing PP. Younger age, male gender,
advanced education, constipation, external component, anxious state and trait,
and high anal resting tone were independent predictors of EP. Previous pain
exerted a protective effect. Incomplete postoperative evacuation, advanced
education level, high anal resting tone, and anxious trait were predictors of PP.
In the development group, the risk of EP ranged between 1 % (low risk) and 21 %
(high risk). Receiver operating curve (ROC) analysis of validation group
(n = 130) confirmed the discriminatory power of this model (area under the
ROC = 0.69).
CONCLUSION: The score can stratify the risk of EP following EH, identifying
high-risk patient candidates to active analgesic administration or alternative
surgical procedures
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
Rectosigmoid stump washout as an alternative to permanent mucous fistula in patients undergoing subtotal colectomy for ulcerative colitis in emergency settings
No full textAbstract Background Restorative proctocolectomy with ileopouch-anal anastomosis (IPAA) is the treatment of choice for intractable or complicated ulcerative colitis(UC). Elderly patients often present with acute colitis requiring emergent subtotal colectomy(SC). Frail patients are at risk of developing septic complications related to the closed rectosigmoidal stump, often requiring formation of a second stoma to be reversed at the time of completion proctectomy. This carries nuisance to such exhausted patients. We propose a simple and inexpensive trick to avoid the need for creating a mucous fistula. Methods IPAA was performed as a 3-stage procedure in emergency settings. The rectosigmoidal stump was closed and placed subcutaneously; skin was closed over it. After SC, if patients showed signs of stump-related pelvic sepsis, a lavage of the rectal stump with povidone iodine solution and with saline was carried out as a rescue treatment aiming to avoid the need of opening the rectal stump to drain sepsis. Results Thirty-five patients underwent SC for UC between 1987 and 2012. The skin was closed over the closed stump in the 20. Seven patients out of these 20 experienced early stump-related septic complication. In five cases, we were able to avoid opening of the rectal stump, and a second stoma was unnecessary. After opening the closed stump in the remaining ones, a prompt improving of symptoms was observed. Conclusions Rectal washout was well tolerated and avoided a second stoma in five out of seven patients, with better quality of life and body perception after IPAA surgery. This is relevant when dealing with geriatric patients, needing to completely recover before undergoing completion proctectomy.</p
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
Trattamento chirurgico dell’iperparatiroidismo secondario.Esperienza clinica in 47 pazienti
No full textAbstract
To date surgical treatment of secondary hyperparathyroidism (HPTs) is still controversial. Subtotal parathyroidectomy with sparing of a part of not-nodular gland and total parathyroidectomy with autotransplantation (subcutaneous or muscular) represent the most common procedures with the aim to warrant a condition of euparathyroidism. Total parathyroidectomy (or so presumed) represent an unusual therapeutic option as the risks arising from aparathyroidism and from the need of a substitutive therapy are largely known. The authors evaluate the surgical results collected from 47 consecutive patients affected by HPTs and Chronic Renal Failure (CRF) and operated on between January 1999 and January 2006. Probably, a proper indication to the type of surgical procedure could be based on the severity of the disease, on the age of the patient and on the expectation of transplant. The significant incidence of recurrence and persistent disease is due to autoimplantation or residual gland hypertrophy after subtotal parathyroidectomy, to the presence of supernumerary or ectopic glands, to cervico-mediastinic hypertrophy of cellular foci. The identification and removal of supernumerary glands, which may cause persisting hyperparathyroidism, is mandatory
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