17 research outputs found
HER-2/neu - Molecular Structure and Status. Antibody - Targeted Therapy with Pertuzumab, Trastuzumab and Docetaxel and the Impact on Overall Survival (OS) and Progression-Free Survival (PFS) in Patients with Metastatic Breast Cancer
No full textIntroduction: HER-2 positive breast cancer is one of the most aggressive and rapidly growing neoplasms, due to the amplification and overexpression of the HER-2/neu gene. The exceeding presence of the receptor on the cell`s membrane makes it a valuable treatment target.Materials and Methods: HER-2 receptors are among the main factors controlling the cellular growth, division and self-repair. In approximately 25% of breast cancers, the HER-2 gene mutates, producing too many copies of itself. Several methods are possible for discovering the HER-2 status: immunohistochemistry (IHC) and in situ hybridization (ISH, FISH, CISH, Dual-ISH tests). Positive results on these tests qualify patients for specific antibody-targeted therapy with trastuzumab and pertuzumab. The therapy includes docetaxel combined with trastuzumab or with both trastuzumab and pertuzumab. Scientific studies analyze key aspects such as OS and PFS by conducting double-blind studies comparing pertuzumab+trastuzumab+docetaxel with placebo+trastuzumab+docetaxel. Poll among oncologists was also used to review the efficacy of both treatments.Results: The result of the study, used as reference, showed that the PFS was prolonged by 6.1 months - from 12.4 in the control group to 18.5 in the group, using pertuzumab, instead of placebo. The OS rates improved from 40.8 to 56.6 months - a 15.8 months increase. Distinct side effect of the treatment - left ventricular dysfunction also drops by 3.9% in the pertuzumab group (from 8.3% to 4.4%). Data, gathered from the study, is further validated by the oncologists polled. The results can be explained by delving into the action mechanism of pertuzumab, which blocks heterodimerization of the HER-2 receptor with other members of the ErbB family, thus complementing the effects of trastuzumab.Conclusion: The pertuzumab+trastuzumab+docetaxel treatment shows significantly better results in OS and PFS, as opposed to placebo+trastuzumab+docetaxel, when used as first line of therapy, simultaneously lowering cardiovascular side effects
Aerobic Microbiological Spectrum and Antibiotic Resistance in Children Operated for Anorectal Abscesses
No full text(1) Background: Anorectal abscesses are a relatively rare pathology in childhood. Most often, male children under 1 year of age are affected. The importance of microbiological examination for the diagnosis and treatment of such patients remains debatable among surgeons, resulting in scarce data being available in the literature. We aimed to identify the aerobic microbiological spectrum and antibiotic resistance of isolates in children undergoing operation to treat anorectal abscesses. (2) Methods: We performed a case series of 102 children diagnosed and operated for anorectal abscesses over a period of 10 years (2010–2019). Purulent wound exudate was used for microbiological evaluation, which was subsequently cultured on 5% sheep-blood agar and eosin–methylene blue agar. For microbiological identification, conventional biochemical tests and semi-automated (API 20, bioMerieux, Marcy-l’Étoile, France) tests were used, as well as automated systems (Vitek-2 Compact, bioMerieux, France). Antimicrobial susceptibility testing was performed by the disk diffusion method of Bauer–Kirby and by determining the minimal inhibitory concentrations for glycopeptides. The results were interpreted according to the EUCAST standard for the corresponding year. (3) Results: Microbiological testing in children operated for anorectal abscesses mainly identified the gut commensals that normally reside in the rectal mucosa. Monocultures were found in just over half of the cases. Escherichia coli, Klebsiella pneumoniae complex, and Proteus mirabilis were the most frequently isolated. In addition, Staphylococcus aureus was found in 7% of patients. In Gram-negative bacteria, antibiotic resistance was most often observed in penicillins, cephalosporins, sulfonamides, and fluoroquinolones. (4) Conclusions: The increasing rates of antimicrobial resistance impose the need for the local monitoring of circulating commensal bacteria associated with anorectal abscesses in children to guide antibiotic therapy when indicated
Instruments for Analysis of the External Environment through the Prism of Self-Managed Work Teams
No full textThe article studies the specific characteristics of the external environment
because they create actual possibilities for the introduction of self-management in the
functioning of work teams in the Bulgarian organizational practice. An emphasis is put
on the organizational context within which self-managed work teams (SMWT) function.
The study also identifies the key instruments integrated in the model of analyzing the
external environment in the process of transforming traditional work structures into selfmanaged
ones. The article outlines the effects of the direct and indirect environment
factors on the various dimensions of SMWT, namely structural characteristics, work and
interpersonal processes, etc. The author supports the idea that the sustainable
development of the SMWT-concept and the creation of added value for organizations
require adequate monitoring of the competitive environment factors (specific microenvironment)
and the common environment. This is one of the paradigms of modern
management. Changes in the external environment affect the internal integration of the
system and vice versa – the damaged internal processes limit the organization’s
potential for adapting to the environment
Experience on the treatment of anorectal abscesses with primary or ligation fistulotomy
No full textINTRODUCTION: Anorectal abscess (ARA) is frequently treated inappropriately with a simple incision and drainage. In 30-50% of the patients this leads to recurrent ARA, chronic rectal fistula and several hospital admissions.PATIENTS AND METHODS: For a ten years period, from 2007 till 2016, 547 patients with ARA were operated. Males were 419 and females 128, with a ratio of 3.3:1. Depending on localization, we divide four types of ARA: perianal - 281 patients (51.4%), ischiorectal - 176 patients (32.2%), intersphincteric - 56 patients (10.2%), supralevator - 34 patients (6.2%).RESULTS: Radical operative treatment of ARA depends of type and location of abscess, its relationship to the sphincter and the extent of the inflammatory process. In 204 patients (37.3%) was performed incision, revision and drainage. In perianal, lower types of intersphincteric ARA incision, revision, excision of the fistula and the crypt is performed. This kind of operation we carried out on 181 patients (33.1%). In all ischiorectal, high intersphincteric and supralevator ARA we made wide incision, digital revision, necrectomy, drainage and seton ligation for gradual and continuous section of the sphincter, performed on 162 patients (29.6%).CONCLUSIONS: Surgical tactics based on individual and differentiated approach of ARA treatment in specialized coloproctologic clinics assures effective and radical management, avoiding secondary abscess or chronic fistulization. Although still on debate, the primary or ligation fistulotomy should become a method of choice for the radical treatment of ARA, eliminating the possibility of recurrent inflammation or fistula-in-ano. Scr Sci Med 2017; 49(3): 45-4
Clinical presentation and diagnosis of colonic perforative peritonitis
No full textINTRODUCTION: Colonic perforative peritonitis (CPP) is a life-threatening surgical emergency where timely diagnosis is of ultimate impact on outcome.MATERIALS AND METHODS: For a five-year period (2014 – 2018), 62 patients with CPP were treated in First Clinic of Surgery in St. George University Hospital - Plovdiv. Males were 48 (77.42%) and females 14 (22.58%), with a ratio of 3.4:1.Patients’ age ranged from 14 to 92 years, with an average age of 71 years ± 2.4.Colonic perforative peritonitis was more common in patients over 80 years of age (n=21; 33.87%). The main causes of CPP were: perforated colon diverticulitis (n=19), perforated colon cancer (n=18), perforation in incarceration (n=9), sigmoid volvulus (n=6), mesenteric ischemia (n=5) and miscellaneous (n=5). There were 12 patients with local peritonitis (19.36%), with diffuse peritonitis - 21 patients (33.87%), and with total peritonitis - 29 patients (46.77%). The following surgical procedures were performed: Hartmann’s procedure – 21, right hemicolectomy - 13, left hemicolectomy - 9, right hemicolectomy with ileostomy - 8, diverticulectomy - 7, colon excision and suture - 4.RESULTS: Twenty-four patients (38.71%) were вith subacute perforation type (38.71%), while 38 (61.29%) were with acute type. Atypical clinical presentation with vague symptoms was found in 7 patients (11.29%). Early clinical symptoms in subacute and atypical forms of CPP were nonspecific. According to the elapsed time from the beginning of the perforation to the operation, the patients were divided as follows: up to the 6th hour - 24 (38.71%), from the 6th to the 12th hour - 19 (30.65%), from the 12th to the 24th hour - 12 (19.35%), and over 24 hours - 7 (11.29%). Of the total 62 operated patients with CPP, 49 patients (79.03%) survived. Postoperative mortality was 20.97% (n=13) with an average age of 78.9 years.CONCLUSION:Early diagnosis of colonic perforation can be difficult, due to omissions and inaccuracies on admittion and follow-up. The correct and timely diagnosis of CPP is crucial for prompt surgery, lower morbidity and mortality and better outcome
Correction: Surgeons’ perspectives on artificial intelligence to support clinical decision-making in trauma and emergency contexts: results from an international survey
No full textFollowing publication of the original article [1], in Pub-Med the author name Daniele Bissacco under Team Dynamics Study Group has not been tagged and now it has been rectified
Supralevator abscess – clinic, diagnosis and treatment
No full textINTRODUCTION: The supralevator abscess, though uncommon, is a significant issue in the emergent colorectal surgery, due to its atypical symptoms, surgical tactics and frequent postoperative failure.AIM: The aim of this article is to analyze the frequency, the diagnostic difficulties and the clinical features by improving the results of their treatment through the timely diagnosis and rational surgical tactics.MATERIALS AND METHODS: For a period of 15 years, from 2004 to 2018, a retrospective analysis of 845 urgently admitted patients, with an acute anorectal abscess (ARA) was done. Depending on the localization, we established four types of ARA: perianal – 392 patients (46.39%), ischiorectal – 287 patients (33.96%), intersphincteric – 93 patients (11.01%), and supralevator – 73 patients (8.64%). Superficial localization was determined in 450 patients (53,25%) and deep - in 395 (46.75%). Males were 53 (72.60%) and females were 20 (27.40%), with a ratio of 2.65:1. The age of the patients varied between 17 to 85 years old, with an average age of 51.27 ± 8.43 years. The following operations were performed: single surgery in 39 patients (53.42%) - two incisions, revision, necrectomy, lavage and drainage №2, and in 34 reoperated patients (46.58%) – reincisions, revision, necrectomy and redrainage. RESULTS: In all of the cases the early signs of a supralevator abscess were atypical, therefore timely diagnosis was exceptionally rare. After the formation of the purulent collection, an inflammatory intoxication syndrome with manifestations of sepsis was determined. The main diagnostic methods in patients with supralevator abscess were digital rectal examination, rectoscopy, anoscopy, transrectal ultrasound, CT and MRI of the pelvis. During the operation in 25 patients (34.25%) with supralevator abscess, a rubber seton ligature was placed through the internal opening for gradual tightening of the sphincter. There were no patients with a lethal outcome. CONCLUSION: The variety and atypical presentation of the supralevator abscess makes the diagnosis difficult, which may lead to delays of hospital admission and operative treatment. The timely and adequate removal of the purulent necrotic structures requires total necrectomy until full mechanical eradication, followed by daily control and proper follow-up of the postoperative period
Colorectal neoplastic emergencies in immunocompromised patients: preliminary result from the Web-based International Register of Emergency Surgery and Trauma (WIRES-T trial)
No full textAssociation of advanced age, neoplastic disease and immunocompromission (IC) may lead to surgical emergencies. Few data exist about this topic. Present study reports the preliminary data from the WIRES-T trial about patients managed for colorectal neoplastic emergencies in immunocompromised patients. The required data were taken from a prospective observational international register. The study was approved by the Ethical Committee with approval n. 17575; ClinicalTrials.gov Identifier: NCT03643718. 839 patients were collected; 753 (80.7%) with mild-moderate IC and 86 (10.3%) with severe. Median age was 71.9 years and 73 years, respectively, in the two groups. The causes of mild-moderate IC were reported such malignancy (753-100%), diabetes (103-13.7%), malnutrition (26-3.5%) and uremia (1-0.1%), while severe IC causes were steroids treatment (14-16.3%); neutropenia (7-8.1%), malignancy on chemotherapy (71-82.6%). Preoperative risk classification were reported as follow: mild-moderate: ASA 1-14 (1.9%); ASA 2-202 (26.8%); ASA 3-341 (45.3%); ASA 4-84 (11.2%); ASA 5-7 (0.9%); severe group: ASA 1-1 patient (1.2%); ASA 2-16 patients (18.6%); ASA 3-41 patients (47.7%); ASA 4-19 patients (22.1%); ASA 5-3 patients (3.5%); lastly, ASA score was unavailable for 105 cases (13.9%) in mild-moderate group and in 6 cases (6.9%) in severe group. All the patients enrolled underwent urgent/emergency surgery Damage control approach with open abdomen was adopted in 18 patients. Mortality was 5.1% and 12.8%, respectively, in mild-moderate and severe groups. Long-term survival data: in mild-moderate disease-free survival (median, IQR) is 28 (10-91) and in severe IC, it is 21 (10-94). Overall survival (median, IQR) is 44 (18-99) and 26 (20-90) in mild-moderate and severe, respectively; the same is for post-progression survival (median, IQR) 29 (16-81) and 28, respectively. Univariate and multivariate analyses showed as the only factor influencing mortality in mild-moderate and severe IC is the ASA score. Colorectal neoplastic emergencies in immunocompromised patients are more frequent in elderly. Sigmoid and right colon are the most involved. Emergency surgery is at higher risk of complication and mortality; however, management in dedicated emergency surgery units is necessary to reduce disease burden and to optimize results by combining oncological and acute care principles. This approach may improve outcomes to obtain clinical advantages for patients like those observed in elective scenario. Lastly, damage control approach seems feasible and safe in selected patients
Surgical Tactics and Treatment of Anorectal Abscesses in Adult Patients
No full textINTRODUCTION: Patients with anorectal abscesses (ARAs) represent the most common proctological emergency in the anorectal area. Their wide distribution leads to clinical variety in the type and expression of inflammatory changes in the anorectal area.AIM: The aim of this article is to carry out a study of different surgical methods in order to improve the effectiveness of operative treatment in patients with ARA.MATERIALS AND METHODS: A total of 254 operated adult patients with ARA were studied, of whom 194 (76.4%) were males and 60 (23.6%) were females. The following operative methods were used: incision, revision, and drainage in 137 patients (53.9%), incision, revision, primary fistulotomy with cryptectomy and drainage in 48 patients (18.9%), and incision, revision, with ligation fistulotomy and drainage in 69 patients (27.2%). The average age of the operated patients was 49.57±16.12 years.RESULTS: The ARA types were subcutaneous in 63 patients (24.8%), intersphincteric in 62 patients (24.4%), ischiorectal in 88 patients (34.7%), and supralevator in 41 patients (16.1%). Superficial ARA was found in 107 patients (42.1%), and deep ARA was diagnosed in 147 patients (57.9%). CONCLUSION: The definitive operative treatment was applied in patients with incision, revision, and one-time liquidation of the internal opening by primary or ligation fistulotomy, leading to timely healing without disease chronicity. The principles of necrosectomy and sphincter-preserving manipulations near the external anal sphincter in the treatment of different ARA types should always be a must
Analysis Of Data From The Aerobic Microbiological Landscape In Adult Patients Operated For Anorectal Abscesses
No full textINTRODUCTION: Systematic analyses and studies on the microbiological spectrum of anorectal abscesses (ARAs) are currently lacking in modern proctology. Microorganisms from the colonic flora lead to retrograde infection of the anorectal glands with the subsequent appearance of ARA. AIM: The aim of this article is to analyze the frequency, type, and structure of the aerobic microbiological landscape in adult patients operated for ARA.MATERIALS AND METHODS: A detailed analysis of the microbiological agents was performed in 254 operated adult patients, with a total of 274 isolates, which were divided as follows: 188 monocultures, 20 pairs of aerobic microbial associations, and 46 found sterile. Microbiological studies were performed by bacteriological examination of the purulent exudate taken during the operation.RESULTS: A total of 17 types of microbial cultures were identified. The most common were as follows: E. coli (n=160, 58.4%), Proteus spp. (n=15, 5.5%), Klebsiella spp. (n=11, 4%), Staphylococcus spp. (n=12, 4.4%), Enterococcus faecalis (n=8, 2.9%), Enterobacter cloacae complex (n=6, 2.2%). Monocultures were found in 188 patients (74.0%) and mixed infection with microbial associations in 20 patients (7.9%). Of the isolates, Gram (-) predominated, accounting for 201 (73.3%) strains, and Gram (+) constituted 26 (9.5%).CONCLUSION: So far, there have been only isolated reports on this issue in our country, without systematic studies. This determines the relevance and importance of our study on the aerobic microbiological landscape in operated adult patients with ARA. Routine microbiological screening should be an integral part of the diagnosis of ARA and of great help in the treatment
