734 research outputs found
Chirurgia elettiva nella recidiva da cancro del colon con diffusione peritoneale: quando intervenire?
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Keyhole versus Sugarbaker techniques in parastomal hernia repair following ileal conduit urinary diversion:a retrospective nationwide cohort study
No full textAbstract
Background: Previous research on parastomal hernia repair following ileal conduit urinary diversion is limited. This nationwide cohort study aims to present the results of keyhole and Sugarbaker techniques in parastomal hernia repair in the setting of ileal conduit urinary diversion.
Method: All patients in this cohort underwent primary elective parastomal hernia repair following ileal conduit urinary diversion in four university hospitals and one central hospital in Finland in 2007–2017. Retrospective clinical data were collected from patient registries to compare keyhole and Sugarbaker parastomal hernia repair techniques. The primary outcome was parastomal hernia recurrence during the follow-up from primary surgery to the last confirmed follow-up date of the patient. The secondary outcomes were reoperations during the follow-up and complication rate at 30 days’ follow-up.
Results: The results of 28 hernioplasties were evaluated. The overall parastomal hernia recurrence rate was 18%, the re-operation rate was 14%, and the complication rate was 14% during the median follow-up time of 30 (21–64) months. Recurrence rates were 22% (4/18) after keyhole repair and 10% (1/10) after Sugarbaker repair. Re-operation rates referred to keyhole repair were 22% and Sugarbaker repair 0% during follow-up. The majority of reoperations were indicated by recurrence. Complication rates were 17% after keyhole and 10% after Sugarbaker repair during the 30 days’ follow-up.
Conclusion: The results of parastomal hernia repair in the setting of ileal conduits are below optimal in this nationwide cohort comparing keyhole to Sugarbaker repair in elective parastomal hernia repair. Nonetheless, the Sugarbaker technique should be further studied to confirm the encouraging results of this cohort in terms of recurrence
Reparación de sugarbaker en eventraciones paraestomales mediante mallas compuestas
No full textLa innovación tecnológica en el diseño de las mallas quirúrgicas, ha generado una amplia gama de mallas para uso intraabdominal, dando soporte y solución a grandes defectos de pared hasta entonces dependientes de autoplastias. Las mallas compuestas son fruto de este avance tecnológico y su aplicación en la hernia incisional está asociado a menores tasas de recurrencias, debido sobre todo a su capacidad de integración dentro de la pared abdominal, sin embargo, existe un silencio científico en relación a su uso en hernias paraestomales. Es lógico pensar que la característica dual marcada por una cara de polipropileno o poliéster propicia una mayor integración, y por tanto una menor recidiva a largo plazo, además su flexibilidad, translucidez y grosor, permiten una buena fijación con helicosuturas precisando menos suturas transfasciales, también proporcionan una visión directa de la inserción de éstas en la pared abdominal, evitando perforaciones intestinales inadvertidas. Si aunamos la técnica de Sugarbaker que presenta las menores tasas de recidivas, con el empleo de estas mallas, debemos obtener mejores resultados que los publicados con esta técnica usando las mallas de PTFE-e. Pretendemos con este estudio demostrar que el uso de mallas compuestas en las eventraciones paraestomales se asocian a una menor recurrencia, con una morbilidad similar a las mallas usadas hasta ahora en este campo (PTFE-e), representando su uso un procedimiento seguro y fiable. Analizamos 25 pacientes con hernias paraestomales tipo III y tipo IV según la clasificación de la Sociedad Europea de la Hernia, intervenidos con la técnica de Sugarbaker mediante abordaje convencional o laparoscópico. Utilizamos para la reparación una malla compuesta de poliéster y colágeno, en todos los pacientes. Las variables de estudio son la recurrencia en un periodo mínimo de dieciocho meses, valorada mediante las revisiones al mes, los seis, doce y dieciocho meses. Evaluamos la morbilidad asociada a la técnica mediante la valoración de la infección de herida, seroma y/o hematoma del saco herniario, y la morbilidad asociada directamente a la malla como son la infección y el explante de la misma. Por último observamos la diferencia de estancia hospitalaria en función de los abordajes
CORREZIONE DI ERNIA PARASTOMALE CON TECNICA DI SUGARBAKER
No full textSi procede ad esplorazione della cavità addominale. I margini del difetto vengono liberati dal tessuto preperitoneale e l’ansa colica mobilizzata per permettere l’adattabilità della rete. Per facilitare la procedura l’ansa viene caricata su fettuccia. Si delimita l’area del difetto con 4 aghi e si procede alla sua misurazione per via endoaddominale. La rete composita è preparata con adeguato overlap ed inserita attraverso il trocar. Un adeguamento del fissaggio su difetti non mediani e particolarmente ampi è spesso richiesto. In questo caso si è scelto di ricorrere ad un sistema di fissaggio ibrido, preferendo sul versante sinistro una sutura in continua in vicryl 0 e nelle restanti aree il sistema protack
Probe station for testing of ALICE silicon drift detectors
No full textLarge area, 7.25 cm multiplied by 8.76 cm silicon drift detectors have been developed and are in production for the ALICE experiment at LHC. An active area of the detector of more than 50 cm**2 imposes high demands on the quality of processing and raw material. Automated testing procedures have been developed to test detectors before mounting them on the ladders. Probe stations for ALICE SDD testing were designed and built at INFN, Trieste and Ohio State University (OSU). Testing procedures, detector selection criteria and some details of the OSU probe station design are discussed
Evaluación y soporte nutricional en pacientes con carcinomatosis peritoneal sometidas a cirugía sugarbaker
No full text[spa] La técnica de Sugarbaker se realiza para el tratamiento multidisciplinar de la
carcinomatosis peritoneal (CP) donde el paciente es sometido a una cirugía
altamente agresiva que conlleva a complicaciones derivadas de la resección
intestinal. En la valoración del paciente previamente a la intervención quirúrgica
se debe descartar desnutrición moderada o severa, ya que se ha observado
que está directamente relacionado con un incremento de complicaciones. Por
ello, junto con los cuidados médicos se planifica una valoración nutricional
previa (VNP) con el objetivo de alcanzar el mejor estado nutricional posible en
el momento de la cirugía. Los objetivos principales de este estudio son:
-Evaluar que método de valoración nutricional es el más adecuado para este
tipo de pacientes.
-Realizar una evaluación nutricional completa previa a las pacientes
intervenidas, mejorar el estado nutricional de las pacientes, establecer
características comunes entre ellas.
-Diseñar una fórmula de nutrición parenteral adecuada a sus necesidades.
-Comparar los resultados obtenidos de dichas pacientes con una cohorte
histórica de pacientes a las que no se realizo valoración y intervención
nutricional previa.
Se diseña un estudio prospectivo que incluye a las pacientes con CP de origen
ovárico que van a someterse al procedimiento Sugarbaker a las que se les
realiza una VNP. Se realizan recomendaciones tratamiento nutricional en caso
necesario y se realiza seguimiento en el postoperatorio inmediato, con soporte
nutricional parenteral e individualización de la fórmula de nutrición. Se espera
obtener información preoperatoria y postoperatoria de parámetros
antropométricos y analíticos implicados en el estado nutricional de las
pacientes con el fin de establecer una relación entre el estado nutricional previo
y su evolución clínica en el postoperatorio (complicaciones y la duración de su
estancia hospitalaria). La principal limitación del estudio es la variabilidad
interindividual ya que existen multitud de factores implicados en la morbilidad
Laparoscopic parastomal hernia repair: keyhole, Sugarbaker, sandwich, or hybrid technique with 3D mesh? An updated systematic review and meta-analysis
No full textPurpose: Parastomal hernia is the most common complication after stoma formation with an incidence that approaches 50% at 2 years postoperatively. In the last decade, different approaches of minimally invasive procedures have been proposed for the treatment of parastomal hernia. Nevertheless, the superiority of one technique over the others remains still unclear. Our objective was to update and systematically analyze current state of research concerning the postoperative outcomes of the four most prevalent minimally invasive techniques. Methods: A systematic literature search of three databases (Medline, Scopus, Google Scholar) was undertaken for articles published from January 2015 to November 2022. Fifteen studies from a previous meta-analysis on the topic were included. Results: Thirty-three studies incorporating 1289 total patients were deemed eligible for inclusion in the final analysis. The keyhole technique was associated with the highest incidence of postoperative complications and recurrences (31.3% and 24.1%, respectively), followed by the Sugarbaker technique (27.6% and 9%, respectively). Operative time was among the lowest in patients operated with the 3D mesh technique, while patients undergoing the keyhole technique experienced the shortest cumulative length of hospital stay (6 days). Conclusion: Each technique demonstrates a unique profile of effectiveness offset by the propensity towards developing postoperative complications. While no conclusive evidence on the optimal technique exist to date, newer minimally invasive techniques show promising results, albeit based on limited data. The future of parastomal hernia repair seems to rely on a highly individualized approach, tailored to the distinctive characteristics of both the hernia and the patient. © 2023, The Author(s)
Molecular analysis of appendiceal mucinous cystadenoma and rectal adenocarcinoma in a patient with urothelial carcinoma: a case report
No full textIntroduction: In this report, we present the case of a patient affected by appendiceal cystadenoma, a colorectal adenocarcinoma, and a concomitant bladder carcinoma, as well as the results of the molecular study of the most relevant mutational pathways involved in these tumors.
Case presentation: A 68-year-old Italian man was admitted to our unit complaining of macrohematuria, rectorrhagia, and rectal tenesmus for about 2 months. A colonoscopy showed the presence of a rectal lesion at 11cm from the anal margin; multiple biopsies were performed and a diagnosis of moderately differentiated adenocarcinoma was made. Abdominal ultrasonography and total body computed tomography performed subsequently to stage the rectal cancer showed the presence of two round nodules, interpreted as swollen lymph nodes of neoplastic origin, at the anterior aspect of the iliopsoas muscle and a budding lesion affecting the bladder. The patient underwent transurethral biopsy of the lesion in the right retrotrigonal region; the diagnosis was grade II urothelial carcinoma. The patient underwent an open anterior rectal resection with loco-regional lymphadenectomy. An enlarged appendix and a voluminous whitish soft-tissue lesion requiring an appendicectomy were detected perioperatively. Transurethral resection of the bladder lesion was also performed. The histological examination revealed that the nodular lesions in the appendix were due to a cystadenoma. For mutation analysis, genomic deoxyribonucleic acid was isolated from tumor tissue samples; for PIK3CA mutations, screening revealed that all three samples analyzed carried mutations in exon 9.
Conclusions: Appendiceal mucoceles are rare but require adequate surgical treatment, given their malignant potential and the possibility of causing peritoneal pseudomyxoma. It is essential to make a correct preoperative evaluation based on a colonoscopy rather than ultrasound and computed tomography to exclude synchronous neoplasias often associated with mucoceles and to plan the optimum surgical strategy. The association between appendiceal mucoceles and other neoplasias is relatively frequent, especially with colorectal cancer. Oncogenic activation in the PIK3CA-depending pathway may contribute substantially to the pathogenesis of the different solid tumors in the same patient
Meeting the science needs of the nation in the wake of Hurricane Sandy—A U.S. Geological Survey science plan for support of restoration and recovery
No full textThis science plan was developed immediately following Hurricane Sandy to coordinate continuing USGS activities with other agencies and to guide continued data collection and analysis to ensure support for recovery and restoration efforts. The data, information, and tools that are produced by implementing this plan will: (1) further characterize impacts and changes, (2) guide mitigation and restoration of impacted communities and ecosystems, (3) inform a redevelopment strategy aimed at developing resilient coastal communities and ecosystems, (4) improve preparedness and responsiveness to the next hurricane or similar coastal disaster, and (5) enable improved hazard assessment, response, and recovery for future storms along the hurricane prone shoreline of the United States.The activities outlined in this plan are organized in five themes based on impact types and information needs. These USGS science themes are: Theme 1: Coastal topography and bathymetry. Theme 2: Impacts to coastal beaches and barriers. Theme 3: Impacts of storm surge and estuarine and bay hydrology. Theme 4: Impacts on environmental quality and persisting contaminant exposures. Theme 5: Impacts to coastal ecosystems, habitats, and fish and wildlife.Circular 1390Suggested citation: Buxton, H.T., Andersen, M.E., Focazio, M.J., Haines, J.W., Hainly, R.A., Hippe, D.J., and Sugarbaker, L.J., 2013,Meeting the science needs of the Nation in the wake of Hurricane Sandy—A U.S. Geological Survey science plan for support of restoration and recovery: U.S. Geological Survey Circular 1390, 26 p., http://pubs.usgs.gov/circ/1390
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