1,721,000 research outputs found
VAC (Vacuum Assisted Closure) treatment in Fournier's gangrene: personal experience and literature review.
No full textFournier's gangrene (FG) is a rapidly developing necrotizing fasciitis that originates in genital and perineal region. The mortality rate is high and requires prompt diagnosis, antibiotic treatment and extensive necrosectomy with derivative colostomy. Vacuum Assisted Closure (VAC) is a wound care system of paramount importance in the treatment of complex wounds, including the perineum. We evaluated 6 cases of FG (males, mean age: 54.6 yrs) of the last 3 years (February 2008-August 2010). All patients were diabetics. We used intravenous antibiotic treatment and early surgical debridement with colostomy, followed by immediate positioning of a VAC device (NP 125-200 mmHg). The dressing changes were done every 3-4 days. Hyperbaric oxygen therapy (HBOT) was given only to one patient. Microbiological etiology was assessed by multiple cultures to tailor the antimicrobial treatment. The VAC therapy reduces the number of dressings and the hospital length of stay (LOS), in agreement with the literature; in one of the cases a secondary reconstructive surgical intervention was possible. The colostomy was reversed in all patients within 3 months. Negative pressure is a time saving device, reducing days of hospitalization, patient's discomfort and number of medications. The possibility of a early reconstructive surgery improves significantly quality of life
Outpatient treatment for liposarcoma of the spermatic cord
No full textOutpatient treatment for liposarcoma of the spermatic cord Liposarcoma of the spermatic cord is a very rare neoplastic disease. In effect little more than two hundred cases are described in literature. Natural history of this tumour is characterized by high local recurrence rate although hematogenic and lymphatic spread is usually a late event and involves high-grade tumours. The clinical diagnosis of spermatic cord liposarcoma can be difficult particularly for non expert surgeons, and is often mistaken for different diagnoses. Radical orchiectomy with high cord ligation is the treatment of choice to prevent local recurrence. Otherwise than commonly advised, the treatment is suitable to be performed under local anaesthesia and the patient easily and safely discharged few hours after surgery
Increasing diagnostic accuracy for thyroid nodules by an integrated multivariate approach: a methodological study.
No full textObjectives: Current guidelines for diagnostic management of thyroid nodules are based on a linear approach, using categorial classifications to cluster diagnostic findings and they still lead to unnecessary surgery. A diagnostic scoring system, based on clinical, cytological and ultrasound findings is described. Materials and Methods: Two groups of patients (168 and 55 pts) were used to compute a multivariate model and the discriminating threshold by ROC curves. The performance of the derived scoring system was assessed by a simulation on a third group of 60 patients, who had undergone surgery according to current guidelines. Results: The scoring system displayed a sensitivity of 100%, specificity 53.3%, positive and negative predictive values of 68.1% and 100%. According to the scoring system, 16 out of 60 operations would have been saved. Conclusions: A scoring system can take into account in a more accurate way the full informative content of the fine-grained description of diagnostic and clinical features
First case of bronchiolar-pleural fistula repair with platelet-leukocyte rich gel
No full textBronchiolar-pleural fistulas are a
frequent complication of thoracic surgery. Current
treatment strategies and their invasiveness
are quiet different, but often surgeons decide for
a new surgical intervention and definitive closure
of the breach. We report the case of a bronchiolar-
pleural fistula in a 75 years old man with
important co-morbidities that we treated with instillation
of platelet-leukocyte rich gel (PLR-G).
We disuss actual indications for PLR-G as well
as its possible role in thoracic surgery
Un modello multivariato integrato di previsione del rischio neoplastico dei noduli della tiroide
No full textRiassunto
Obiettivo: la diagnosi di natura di un nodulo della tiroide è ancora oggi un problema non
completamente risolto e spesso vengono eseguiti interventi a solo scopo di conferma istologica.
Lo studio si propone di definire un modello integrato predittivo del rischio neoplastico per un
nodulo tiroideo: Tale modello può essere complementare all’attuale approccio sequenziale di
attività diagnostiche, governato da criteri mono-dimensionali.
Materiali: sono stati raccolti i dati clinici, ecografici e citologici preoperatori di 168 pazienti
consecutivi (per un totale di 197 noduli studiati), operati successivamente di tiroidectomia totale. I
dati sono stati analizzati con statistica monovariata e quindi integrati in un modello statistico
multivariato. Sono stati esclusi pazienti con referto citologico inadeguato (classe Th 1 secondo la
British Thyroid Ass.) o con diagnosi citologica certa di neoplasia (classe Th 5).
Risultati: sono risultate variabili predittive indipendenti di maggior valore la anisonucleosi, la
presenza di atipie e di proliferazione follicolare nell’esame citologico; la presenza di calcificazioni
interne al nodulo e l’unicità del nodulo stesso come caratteri ecografici.
Conclusioni: è stato possibile integrare in un unico modello predittivo di rischio a cinque elementi i
caratteri derivanti dall’ecografia e dalla citologia su FNA. Tale modello può essere la base per
ottenere un sistema di punteggio da affiancare alla strategia di semplice algoritmo sequenziale
raccomandata dalle linee guida attuali.
Summary
Objective: the diagnosis of nature of a thyroid nodule is still an unresolved problem and often
patients undergo surgery just to confirm an histological diagnosis. This study is aimed to define an
integrated model to predict the risk of malignancy for a thyroid nodule. This model should
complement the presently preferred approach, based on a sequential diagnostic workup ruled by
mono-dimensional criteria.
Materials: data from clinical exam, ultrasound and cytology were collected in the preoperative
period from 168 consecutive patients (for a total number of 197 considered nodules), who then
underwent total thyroidectomy. Data were analysed by monovariate statistics and then integrated in
a multivariate statistical model. Patients with an inadequate cytology (Th 1class, according to la
British Thyroid Ass.) or with a definite cytological diagnosis of malignancy (Th 5class) were
excluded.
Results: anisonucleosis, the presence of atipia and follicular proliferation resulted as independent
significant criteria for cytology; the presence of calcifications inside a nodule and the condition of
unique nodule were the ultrasonographic most significant characters.
Conclusions: it has been possible to integrate in a unique predictive model of risk with five
elements the information deriving from ultrasound and cytology. This model can be the starting
point to obtain a scoring system to improve the strategy of simple sequential algorithm
recommended by the present guidelines.
Introduzione
La diagnosi di natura di un nodulo della tiroide è ancora oggi un problema non completamente
risolto e poiché, nonostante l’alta prevalenza dei noduli della tiroide, solo in una piccola percentuale
di casi essi sono maligni, spesso vengono eseguiti interventi a solo scopo di conferma istologica.
Le più recenti linee guida (1, 2, 3) raccomandano un flusso sequenziale di attività diagnostiche,
governato da criteri mono-dimensionali (anamnesi-esame obiettivo ecografia FNA) e non
sembrano esistere in letteratura tentativi di costruire sistemi di punteggio di rischio, specie per
quella tipologia di noduli tiroidei con caratteristiche ecografie sospette o con citologia di tipo
“lesione follicolare”. Lo scopo dello studio è quello di confermare il valore diagnostico di alcune
delle caratteristiche della citologia e dell’ecografia citate in letteratura come predittive di malignità
(4, 5, 6) e integrarle in un unico modello statistico multivariato predittivo del rischio di neoplastico
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
Appropriate Similarity Measures for Author Cocitation Analysis
Full text linkWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
Early Procalcitonin Assessment in the Emergency Department in Patients with Intra-Abdominal Infection: An Excess or a Need?
No full textBackground: Intra-abdominal infection (IAI) is a wide range of intra-abdominal disease. Management involves empirical therapy and source control. Procalcitonin (PCT) has been suggested to assist in defining individual infection status and delivering individualized therapy. The aim of this study was to investigate the effects on patient outcomes of an early procalcitonin (PCT) assessment (in the emergency department [ED]) in patients with IAI.Methods: This was a retrospective, mono-centric study evaluating consecutive patients admitted to the ED from 2015 to 2019 with diagnosis of IAI. According to whether there had been PCT determination in the ED, patients were divided into no ePCT determination (no-ePCT) and early PCT determination in the ED (ePCT). The primary endpoint was the intra-hospital mortality rate. Secondary endpoints were occurrence of major complications and length of hospital stay (LOS). The propensity score match (PSM) was generated using a logistic regression model on the baseline covariates considered to be potentially influencing the decision to determine PCT in the ED and confounding factors identified as significant at a preliminary statistical analysis with respect to in-hospital death.Results: A series of 3,429 patients were included. The ePCT group consisted to 768 (22.4%), whereas the no-ePCT group contained 2,661 patients (77.6%). When the PSM was matched to the two groups, no significant difference was observed. Considering patients with uncomplicated infections, the PCT determination was associated with a higher mortality rate. We found no significant differences regarding outcomes with the exception of LOS, which was slightly longer in the ePCT group. However, we observed a tendency toward a minor difference in the number of complications in the ePCT group, in particular a reduced rate of progression to sepsis.Conclusion: Early PCT determination could be irrelevant in IAIs. The PCT value may be cost-effective and possibly improve the prognosis in cIAIs. Further research is needed to understand the optimal use of PCT, including in combination with other emerging diagnostic tests
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