11 research outputs found
Loop ileostomy reversal: 5 year experience in an English rural district general hospital
No full textPotential applications of fish oils rich in <i>n</i>-3 fatty acids in the palliative treatment of advanced pancreatic cancer
No full textThe palliative treatment of patients with advanced pancreatic cancer (APC) has undergone little advancement in the last 15 years. Novel therapies that have been investigated to extend survival have shown little benefit over existing chemotherapy regimens. Patients with APC often experience significant weight loss, which is one of the primary factors involved in declining quality of life. Recently, the ability of n-3 fatty acid rich oral preparations to attenuate or reverse tumour-related weight loss has been investigated in this patient group with encouraging results. Laboratory investigation has also yielded promising results suggesting a potential direct tumouricidal effect of n-3 fatty acids as well as the putative potentiation of existing chemotherapy regimes. The present review aims to examine the potential applications of fish oils rich in n-3 fatty acids in patients with APC, present a selection of the studies carried out to date and outline avenues of possible further clinical investigation.</jats:p
Margin Accentuation Irreversible Electroporation in Stage III Pancreatic Cancer: A Systematic Review
No full textThe present systematic review aimed to summarise the available evidence on indications and oncological outcomes after MA IRE for stage III pancreatic cancer (PC). A literature search was performed in the Pubmed, MEDLINE, EMBASE, SCOPUS databases using the PRISMA framework to identify all MA IRE studies. Nine studies with 235 locally advanced (LA) (82%, 192/235) or Borderline resectable (BR) PC (18%, 43/235) patients undergoing MA IRE pancreatic resection were included. Patients were mostly male (56%) with a weighted-mean age of 61 years (95% CI: 58–64). Pancreatoduodenectomy was performed in 51% (120/235) and distal pancreatectomy in 49% (115/235). R0 resection rate was 73% (77/105). Clavien Dindo grade 3–5 postoperative complications occurred in 19% (36/187). Follow-up intervals ranged from 3 to 29 months. Local and systematic recurrences were noted in 8 and 43 patients, respectively. The weighted-mean progression free survival was 11 months (95% CI: 7–15). The weighted-mean overall survival was 22 months (95% CI 20–23 months) and 8 months (95% CI 1–32 months) for MA IRE and IRE alone, respectively. Early non-randomised data suggest MA IRE during pancreatic surgery for stage III pancreatic cancer may result in increased R0 resection rates and improved OS with acceptable postoperative morbidity. Further, larger studies are warranted to corroborate this evidence
Varicose Veins
No full text Varicose veins are a common problem in the developed world estimated to affect up to a third of adults in the UK aged 18–64 years. They are tortuous or dilated veins in the subcutaneous tissues that rarely present as an acute emergency but bear a significant impact upon quality of life, which can be improved by surgery or in most cases effective reassurance. The key role of the GP remains to appropriately reassure patients with varicose veins and identify those that require referral for further assessment and therapy. </jats:p
Pooled Survival and Response Data From Phase III Randomized Controlled Trials for Gemcitabine-based Regimes in the Treatment of Advanced Pancreatic Cancer
No full textHepatic Haemangioma Masquerading as the Gallbladder in a Case of Gallbladder Agenesis: A Case Report and Literature Review
No full textGallbladder agenesis is uncommon. In contrast, liver haemangiomas are the most common type of benign liver lesions. We describe the first documented case of gallbladder agenesis where the clinical presentation was consistent with biliary colic, and radiological investigation suggested the presence of gallstones. Subsequent operative findings revealed a solitary haemangioma of the liver sited in the normal position of the gallbladder fossa but with absence of the gallbladder. It is important that clinicians should keep gallbladder agenesis in mind when the gallbladder appears abnormal on preoperative imaging studies and cannot be found at laparoscopy. As symptoms will improve in 98% of cases, it is very important to avoid unnecessary intervention in patients who have a negative laparoscopy. The clinical presentation, investigations, and operative findings are discussed with a review of other relevant reported cases in the literature.</jats:p
The safety and efficacy of epidural anaesthesia in acute pancreatitis: a systematic review and meta-analysis
No full textBACKGROUND: Acute pancreatitis (AP) has variable clinical courses. This systematic review and meta-analysis aimed to determine the safety, efficacy, and impact of epidural anaesthesia (EA) use in AP.METHODS: The PubMed, EMBASE, SCOPUS and Cochrane library databases were systematically searched between 1980 and 2022 using the PRISMA guidelines, to identify observational and comparative studies reporting on EA in AP. The meta-analysis was performed in R Foundation for Statistical Computing using the meta R Package for Meta-Analysis.RESULTS: A total of 9 studies with 2006 patients of which 726 (36%) patients had EA were included. All studies demonstrated high safety and feasibility of EA in AP with no reported major local or neurological complications. One randomised controlled trial demonstrated an improvement in pain severity using a 0-10 visual analogue scale (VAS) at the outset (1.6 in EA vs 3.5 in non-EA, P = 0.02) and on day 10 (0.2 in EA vs 2.33 in non-EA, P = 0.034). There was also improvement in pancreatic perfusion with EA measured with computerised tomography 13 (43%) in EA vs 2 (7%) in non-EA, P = 0.003. The need for ventilatory support and overall mortality was lower in EA patients 40 (19%) vs 285 (24%) P = 0.025 (OR: 0.49, 95% CI: 0.28-0.84) and 16 (7%) vs 214 (20%), P = 0.050 (OR: 0.39, 95% CI: 0.15-1.00), respectively.CONCLUSION: EA is infrequently used for pain management in AP and yet the available evidence suggests that it is safe and effective in reducing pain severity, improving pancreatic perfusion, and decreasing mortality.</p
The Development of a Multiorgan Ex Vivo Perfused Model: Results With the Porcine Liver‐Kidney Circuit Over 24 Hours
No full textEvaluating image quality in surgical photography: a multivariable analysis of cameras and shooting conditions
No full text\ua9 2025 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group. Introduction: Use of mobile devices with high-quality cameras has expanded medical photography. We investigate the impact of different devices and conditions on photograph quality in a surgical setting. Methods: Fourteen surgeons across six centres scored photograph quality of kidneys donated for transplantation. Images were captured using an iPhone, iPad, or DSLR camera on automatic modes under varying lighting conditions. In blinded A/B testing, surgeons selected the image perceived more clinically useful for remote organ quality assessment and rated each on a 5-point Likert scale. Quality was objectively analysed using two computer vision referenceless quality assessment tools (BRISQUE & NIMA). Results: Of 369 photographs, mobile device images were rated higher quality by surgeons (78.4%) compared to DSLR (9.4%, p < 0.001). Multilevel regression using BRISQUE showed higher quality for iPhones (β = −5.86, p < 0.001) and iPads (β = −3.90, p < 0.001) versus DSLR. Room lighting improved quality over direct overhead illumination with theatre lights (β = 17.87, p < 0.001). Inter-rater (Gwet AC = 0.78) and intra-rater (Cohen’s κ = 0.86) agreements were high. Discussion: Smartphones can produce high quality photographs. These findings should reassure clinicians that smartphone devices do not compromise photograph quality and support their use in clinical practice and image analysis research
ОСТАЛОСЬ ЛИ МЕСТО ОМЕГА-3 ЖИРНЫМ КИСЛОТАМ В КАРДИОХИРУРГИИ?
No full textGoal of the review: to study theoretical and applied aspects of using omega-3 fatty acids in the high risk patients undergoing cardiac surgery in order to reduce the intensity of system inflammatory response, caused by cardiopulmonary bypass and forming the basis of organ dysfunctions in the post-operative period. Цель обзора: рассмотреть теоретические и прикладные аспекты применения омега-3 жирных кислот у кардиохирургических пациентов высокого риска с целью снижения выраженности системной воспалительной реакции, обусловленной применением искусственного кровообращения и лежащей в основе органных дисфункций в послеоперационном периоде.
