393 research outputs found
With adequate precautions colorectal cancer surgery can be safely continued during COVID-19 pandemic
No full textAllylic functionalization of 2,5- and 2,4-cyclohexadiene-1,3-dicarboxylates
No full textA series of 2,4- and 2,5-cyclohexadiene-1,3-dicarboxylates were functionalized at the allylic position via oxidotion, (SeO2, PDC/t-BuOOH) and halogenation (NBS). The regiochemical outcome for different substrates and reactions was studied and the importance of factors such as reaction mechanism,steric hindrance and reaction intermediates stability was discussed
Laparoscopic right colectomy after previous colonic resection - the importance of three-dimensional CT angiography reconstruction and indocyanine green fluorescence - a video vignette
No full textImproving Outcomes in Laparoscopic Anterior Rectal Resection: The Benefits of REAL Score in Preoperative Risk Assessment for Anastomotic Leak
No full textBACKGROUND
The aim of the study is to evaluate the effectiveness of REctal Anastomotic Leak (REAL) score for predicting the risk of anastomotic leakage in patients undergoing laparoscopic anterior rectal resection with total mesorectal excision (lapARR-TME) for rectal cancer.
METHODS
This prospective study collected data on patients' medical history, surgery, hospital stay, and short-term outcome. We calculated the REAL score for each patient and statistically compared those who experienced an anastomotic leak to those who did not. Additionally, we conducted a univariate and multivariate analysis on other factors that may have influenced outcomes.
RESULTS
The study included 57 patients with a mean age of 70 years and a Charlson Comorbidity Index of 6.1±1.9. 57.9% of patients had a loop ileostomy fashioned and Indocyanine green (ICG) angiography was used during surgery in 53.3% of cases. There were 6 cases of anastomotic leakage, with 4 treated surgically and 2 conservatively. Patients with anastomotic leak had a significantly higher REAL score than those without (71.3±20.5 vs. 33.7±21.3). The 30-day readmission and mortality rates were 5.3% and 0%, respectively. Low preoperative serum albumin levels, preoperative blood transfusions, and the absence of ICG angiography during surgery were factors significantly associated with an increased risk of anastomotic leakage according to both univariate and multivariate analyses.
CONCLUSIONS
The REAL score may be a helpful tool for evaluating the risk of anastomotic leak in patients undergoing lapARR-TME. Further investigation is needed to evaluate the incorporation of additional modifiable factors such as hypoalbuminemia, preoperative transfusion rate, and the use of ICG angiography during surgery
Mens, anima, corpo in una polemica tra medici e filosofi in Olanda: Descartes versus Regius
No full textPolimirfismo del gene dell'ACE ed eritrocitosi nel trapianto di rene
No full textIntroduzione. L’eritrocitosi post-trapianto (PTE) può essere responsabile d’importanti complicanze.
Gli ACE inibitori (ACE-i) sono stati proposti nella terapia della PTE perché in grado di ridurre l’ischemia renale (dipendente
dall’angiotensina II), ritenuta un fattore patogenetico importante. Tuttavia l’efficacia degli ACEi nel trattamento della
PTE è variabile. In questo studio è stato valutato se il polimorfismo del gene dell’ACE può influenzare la prevalenza di PTE
e la risposta terapeutica agli ACEi.
Metodi. Pazienti sottoposti a trapianto renale erano retrospettivamente valutati. La PTE era diagnosticata sulla base dello
stabile aumento di ematocrito (Ht; >50%). Cause secondarie d’aumento di Ht erano escluse mediante esame clinico, ecografia
renale, esami ematologici. Erano rilevati: comparsa di PTE, dose di ACEi somministrata, pressione arteriosa, e clearance
della creatinina. I pazienti erano divisi in due gruppi; gruppo A, pazienti trattati con ACEi; gruppo B, pazienti trattati
con salassi periodici. Sulla base del valore di Ht dopo terapia con ACEi, i pazienti del gruppo A erano ulteriormente suddivisi
in “responder” (Ht <50%) e “non-responder”. Il polimorfismo del gene dell’ACE era determinato mediante PCR in
tutti i pazienti con PTE ed era confrontato con quello di un gruppo controllo; un ulteriore confronto era effettuato tra quello
dei “responder” e quello dei “non-responder”.
Conclusioni. La PTE era riscontrata in 55 (53 M, 2 F) pazienti dei 470 esaminati. Tra i pazienti trattati con ACEi (n. 38;
69%), Ht era completamente normalizzato in 29 (76%, “responder”) mentre rimane elevato in 9 (24%, “non-responder”). I
restanti 17 pazienti erano trattati con flebotomie intermittenti. Il polimorfismo del gene dell’ACE riscontrato nei pazienti
con PTE non era differente da quello del gruppo controllo né era differente tra i pazienti “responder” e “non-responder”.
Risultati. I risultati del presente studio indicano che il polimorfismo del gene dell’ACE non influenza l’incidenza della
PTE né l’efficacia della terapia con ACEi
A surgical instrument cover for the prevention of thermal injuries during laparoscopic operations
No full textAccidental thermal injuries are infrequent, nonetheless, dangerous complications in laparoscopic surgery. Burns are produced because of direct contact, lack of instrument insulation and capacitive coupling. Biological fluids on the surface of laparoscopic instruments behave as electric conductors on the sheath and may be responsible for accidental thermal injuries. Our hypothesis is that using an insulator device may prevent those injuries. Materials and Methods: After evaluating different materials for dielectric properties, costs, and temperature increase tolerance, we selected polytetrafluoroethylene (PTFE) to develop a sleeve that works as an electrical insulator when applied on the sheath of laparoscopic instruments. Efficacy of this PTFE cover in reducing conduction of electricity was tested on both reusable and disposable laparoscopic instruments. Results: Electric conduction of the laparoscopic instrument sheaths was tested using an ex vivo model that reproduces the abdominal environment in basal conditions and in presence of blood. Electric conduction of laparoscopic instruments was measured before and after the placement of the PTFE cover. We measured a significant difference in electric resistance on the sheath's surface without and with blood, revealing a weak electrical conduction: infinity versus a median value of 251.11 Mohm, respectively. Conclusions: This ex vivo study demonstrated that a PTFE sleeve may reduce electricity conduction of laparoscopic instruments. A pilot in vivo study is planned to test its safety and efficacy
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