737 research outputs found
Hypertriglyceridemia-induced acute pancreatitis: a systematic review of the literature
No full textObjective: To summarize the current evidence about the hypertriglyceridemia-induced acute pancreatitis (HAP). Methods: Systematic review of the English language literature was conducted using PubMed/Medline database from its inception until August 2016. As a searching methodology, we have used a combination of `acute pancreatitis' and ` hypertriglyceridemia' as keywords into the title. Results: The diagnosis of HAP should be based on two out of the three criteria recommended by the international guidelines: characteristic clinical picture, serum pancreatic enzymes, and appropriate imagistics. The diagnosis of HAP should be distinguished between mild hypertriglyceridemia (> 150 mg/dL), which accompanies around one-third of all-causes acute pancreatitis, and severe hypertriglyceridemia (> 1 000 mg/dL) which generates acute pancreatitis. There is mixed evidence regarding a worse prognosis for patients with HAP, and a clear conclusion cannot be drawn. Similar to all the other etiologies, in HAP the initial treatment efforts should be nonspecific and addressed to acute pancreatitis, while pharmacologic and mechanical techniques should be added to lower the serum triglycerides as soon as possible. Conclusions: We may conclude that HAP should be managed to respect all the general principles, also adding all the available resources to lower the serum triglycerides value, as early as possible in the acute setting and on long-term to prevent recurrences
Complete mesocolic excision for colon cancer is technically challenging but the most oncological appealing
No full textLaparoscopic Transgastric versus Endoscopic Drainage of a Large Pancreatic Pseudocyst. A Case Report
No full textBackground: Pancreatic pseudocysts are the most common complication of acute and chronic pancreatitis. They account for 75% of the cystic lesions of the pancreas. Case report: A 37 year-old woman was admitted three months after an episode of severe acute pancreatitis with a large tumor mass located in her left abdomen, abdominal tenderness and asthenia. Abdominal Computed Tomography (CT) revealed a giant pancreatic pseudocyst of 23/15/12 centimeters. We performed an anterior laparoscopic transgastric cystogastrostomy. The postoperative clinical course was uneventful, and she was discharged nine days later. After another month she was re-admitted for general malaise and fever. We performed endoscopic evaluation of the cystogastrostomy patency followed by lavage of the pseudocyst cavity. After five days of broad spectrum antibiotic therapy the clinical course started to improve and the patient was discharged after another eight days. One- and two-year follow-ups revealed no remnant cavity. Conclusions: Laparoscopic transgastric cystogastrostomy is a feasible option for selected patients with pancreatic pseudocysts. Careful patients' evaluation in a multidisciplinary team, including imaging specialists, dedicated gastroenterologists with experience in advanced interventional techniques and pancreatic surgeons, balancing between watchful waiting and step-up minimally invasive approach offers the best tailored approach for a specific patient
Application of the AAST EGS Grade for Adhesive Small Bowel Obstruction to a Multi-national Patient Population
No full textBackground: The American Association for the Surgery of Trauma (AAST) anatomic severity grading system for adhesive small bowel obstruction (ASBO) has demonstrated to be a valid tool in North American patient populations. Using a multi-national patient cohort, we retrospectively assessed the validity the AAST ASBO grading system and estimated disease severity in a global population in order to correlate with several key clinical outcomes. Methods: Multicenter retrospective review during 2012–2016 from four centers, Minnesota USA, Bologna Italy, Pietermaritzburg South Africa, and Bucharest Romania, was performed. Adult patients (age ≥ 18) with ASBO were identified. Baseline demographics, physiologic parameters, laboratory results, operative and imaging details, outcomes were collected. AAST ASBO grades were assigned by independent reviewers. Univariate and multivariable analyses with odds ratio (OR) and 95% confidence intervals (CIs) were performed. Results: There were 789 patients with a median [IQR] age of 58 [40–75] years; 47% were female. The AAST ASBO grades were I (n = 180, 23%), II (n = 443, 56%), III (n = 87, 11%), and IV (n = 79, 10%). Successful non-operative management was 58%. Conversion rate from laparoscopy to laparotomy was 33%. Overall mortality and complication and temporary abdominal closure rates were 2, 46, and 4.7%, respectively. On regression, independent predictors for mortality included grade III (OR 4.4 95%CI 1.1–7.3), grade IV (OR 7.4 95%CI 1.7–9.4), pneumonia (OR 5.6 95%CI 1.4–11.3), and failing non-operative management (OR 2.4 95%CI 1.3–6.7). Conclusion: The AAST EGS grade can be assigned with ease at any surgical facility using operative or imaging findings. The AAST ASBO severity grading system has predictive validity for important clinical outcomes and allows for standardization across institutions, providers, and future research. Disease severity and outcomes varied between countries. Level of evidence III: Study type Retrospective multi-institutional cohort study
Laparoscopic <i>vs</i> open complete mesocolic excision with central vascular ligation for colon cancer: A systematic review and meta-analysis
No full textBatch versus flow stereoselective hydrogenation of α-acetamido-cinnamic acid catalyzed by an Au(I) complex
No full textInternational audienceA chiral gold (I) (2S,4S)-1-tert-butoxycarbonyl-4-diphenylphosphino-2-(diphenylphosphino- methyl) pyrrolidine (BPPM) complex has been prepared using [Au(SMe2)Cl] as precursor. The heterogenization of the Au-BPPM catalyst onto the CNT support followed two routes, ie (i) the non-covalent immobilization of the gold(I)complex by dry-impregnation, and (b) covalent immobilization of the gold(I)complex on a pre-functionalized CNT. These catalysts afford the stereoselective hydrogenation of α-acetamidocinnamic acid to the (R)-N-acetyl-phenylalanine enantiomer. The nature of the solvent affected both the enantioselectivity and TOFs. Among MeOH, EtOH, and TFE, methanol appeared to be the most efficient one (at 80 °C a TOF of 0.37 h−1 for a total enantioselectivity to the R-isomer). Transferring the reaction in the flow reactor, under similar conditions (methanol, room temperature) led to a 10 time increase of the TOF with no change in the stereoselectivity. The decrease of the TOF in time for both the reference Rh and the Au catalysts was assigned to their partial modification under the reaction conditions. The heterogenization of the Au-BPPM catalyst onto the CNT support, for the same content of Au-complex, led to a very important increase of the conversion with no change in the selectivity. However, the covalent bonding was more efficient affording a very high increase of the conversion even at room temperature (95% after 24 h), thus demonstrating that the anchoring a support increases the dispersion, and in consequence the efficiency. These CNT-Au-BPPM catalysts preserved the catalytic performances during recycling as also confirmed by the characterization results
Trauma pattern in a level I east-European trauma center
No full textObjective: To analyze trauma epidemiology, pattern of lesions or death profile in a level I east-European trauma center.
Methods: Prospective observational study of patients admitted to a level I east-European trauma center and enrolled in our trauma registry, between January 2012 to January 2013, was conducted, with the inclusion criteria: (1) trauma lesions, (2) new injury severity score (NISS) higher than 15.
Results: There were 141 patients admitted during the study interval, including 102 (72.3%) males, with a mean age of (43.52 ± 19.00) years, and a mean NISS of 27.58 ± 11.32. The trauma etiology was traffic-related injuries 101 (71.6%), falls 28 (19.9%) and crushing injuries 7 (5.0%). Only one case of gunshot wound was encountered in our study. Out of traffic-related injuries, the automobiles were involved in 56 (55.4%) and motorcycles in 9 (8.9%) patients. The bicyclists accounted for 2 (2.0%) of patients and pedestrians hit by vehicles were in 33 (32.7%) cases. High-velocity falls were found in 7 (25.0%) patients, whereas low-velocity falls accounted for 21 (75.0%) of cases. The overall mortality was 30.00%, and these patients presented the mean NISS of 37.63.
Conclusions: Our trauma pattern profile is similar to the one found in west-European countries, with a predominance of traffic-related injuries and falls. The severity and anatomical puzzle for trauma lesions were more complex secondary to motorcycle or bicycle-to-auto vehicles collisions. A trauma registry, with prospective enrollment of patients, is a very effective tool for constant improvements in trauma care
Batch versus flow stereoselective hydrogenation of α-acetamido-cinnamic acid catalyzed by an Au(I) complex
No full textInternational audienceA chiral gold (I) (2S,4S)-1-tert-butoxycarbonyl-4-diphenylphosphino-2-(diphenylphosphino- methyl) pyrrolidine (BPPM) complex has been prepared using [Au(SMe2)Cl] as precursor. The heterogenization of the Au-BPPM catalyst onto the CNT support followed two routes, ie (i) the non-covalent immobilization of the gold(I)complex by dry-impregnation, and (b) covalent immobilization of the gold(I)complex on a pre-functionalized CNT. These catalysts afford the stereoselective hydrogenation of α-acetamidocinnamic acid to the (R)-N-acetyl-phenylalanine enantiomer. The nature of the solvent affected both the enantioselectivity and TOFs. Among MeOH, EtOH, and TFE, methanol appeared to be the most efficient one (at 80 °C a TOF of 0.37 h−1 for a total enantioselectivity to the R-isomer). Transferring the reaction in the flow reactor, under similar conditions (methanol, room temperature) led to a 10 time increase of the TOF with no change in the stereoselectivity. The decrease of the TOF in time for both the reference Rh and the Au catalysts was assigned to their partial modification under the reaction conditions. The heterogenization of the Au-BPPM catalyst onto the CNT support, for the same content of Au-complex, led to a very important increase of the conversion with no change in the selectivity. However, the covalent bonding was more efficient affording a very high increase of the conversion even at room temperature (95% after 24 h), thus demonstrating that the anchoring a support increases the dispersion, and in consequence the efficiency. These CNT-Au-BPPM catalysts preserved the catalytic performances during recycling as also confirmed by the characterization results
Application of biocompatible magnetite nanoparticles for the removal of arsenic and copper from water
No full text- …
