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Acute appendicitis complicating De Garengeot's hernia treated with combined laparoscopic-open technique: a case series and literature review
No full textAn acute appendicitis in the context of a De Garengeot's hernia is a very rare event and represents a hard challenge for surgeons. As only few cases have been reported in literature, there is no consensus about its optimal surgical strategy of treatment. Here we present two consecutive cases of female patients presenting an uncommon acute appendicitis in a femoral hernia treated with a combined laparoscopic/open technique
DOES NEGATIVE PRESSURE WOUND THERAPY (NPWT) FOR TEMPORARY ABDOMINAL CLOSURE REALLY GIVE BETTER RESULTS?
No full textIntroduction: The success of primary fascial closure following TAC is lower in septic patients compared to non-septic patients1. Aim of the study is to analyze whether the outcome of laparostomy could be influenced by the type of TAC adopted Material and methods: We reviewed 271 patients undergone TAC during 2001-2015. Two groups were identified: Group A, 143 patients (52,7%) who had NPWT device and Group B, 128 patients (47,3%) who did not receive NPWT. Both of these groups were divided into
two subgroups based on Septic/Non-septic causes. Main outocomes were mean age, mean length of open abdomen (LOA), definitive closure rate (DCR), and mortality. Results: Overall, between groupAand B, age (p = 0,668),mean LOA (p= 0,080), DCR (p = 0,147) and mortality (p = 0,824) resulted not significant. In GroupA 103 patients (72%) were treated for septic causes and 40 (28%) for non septic conditions; for each subgroup no significant differenceswere found in terms ofmean age (p = 0,319), mean LOA (p = 0,697), DCR (p = 0,227) and mortality (p = 0,357). In Group B, 93 patients (72,6%) had septic diseases and 35 (27,4%) non septic conditions: there was no significant difference about mean age (p = 0,552), mean LOA (p = 0,680), DCR (p = 0,827) and mortality (p = 0,677). Conclusion: This study did not show any impact of NPWT on the outcome of patients undergone open abdomen either for septic and non-septic conditions. However, the length of open abdomen in these patients was relatively short and this may have limited the potential benefits of NPWT.
References: 1. A. Bruhin, F. Ferreira, M. Chariker, J. Smith, N. Runkel. Systematic review and evidence based recommendations for the use of Negative Pressure Wound Therapy in the open abdomen. Int J Surg. 2014 Oct;12(10):1105-14
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Adhesive small bowel obstruction: predictive factors of laparoscopic failure
No full text: The adoption of laparoscopy for the management of adhesive small bowel obstruction (ASBO) patients is debated. The laparoscopic approach has been associated with a considerable conversion-to-open rate. Nonetheless, reliable predictors of conversion are still unclear. The present study aimed to identify factors associated with conversion to open in ASBO patients who underwent laparoscopic surgery. Patients who underwent laparoscopic surgery for ASBO and were admitted to our unit between December 2014 and October 2022 were retrospectively evaluated. The patients were categorized into two groups: patients who underwent complete laparoscopy approach (Group 1) and patients converted to open technique (Group 2). Demographic, clinical, and radiological features, intraoperative findings, and postoperative outcomes were compared. A total of 168 patients were enrolled: 100 patients (59.5%) were included in Group 1, and 68 patients (40.5%) were included in Group 2. The rate of ischemia (p = 0.023), surgical complications (p = 0.001), operative time (p < 0.0001), days of nasogastric tube maintenance (p < 0.0001), time to canalization (p < 0.0001), and length of hospital stay (p < 0.0001) were significantly higher in Group 2 than Group 1. Following univariate analysis, the presence of feces signs (p = 0.044) and high mean radiodensity of intraperitoneal free fluid (p = 0.031) were significantly associated with Group 2 compared with Group 1. Following multivariate analysis, the feces sign was a significant predictive factor of conversion (OR 1.965 [IC 95%]; p = 0.046). Laparoscopic treatment is a safe and effective approach in patients affected by ASBO. The feces sign may be a predictive factor of conversion and could guide the surgeon in selecting the appropriate management of patients affected by ASBO
NEGATIVE PRESSURE WOUND THERAPY NELL’ OPEN ABDOMEN PER CAUSE NON-SETTICHE: UNO STUDIO RETROSPETTIVO SU 75 PAZIENTI
No full textObiettivi: L’open abdomen (OA) rappresenta una valida opzione
chirurgica nel trattamento di un ampio spettro di condizioni settiche
e non settiche. In letteratura, emerge che il tasso di successo della
procedura di Temporary Abdominal Closure (TAC) nei pazienti non
settici, dipende dal tipo di metodica adottata. Lo scopo di questo
studio è valutare se i sistemi di chiusura della ferita a pressione
negativa (NPWT) inuenzano l’outcome dei pazienti trattati con OA
per cause non settiche.
Materiali e metodi: Abbiamo analizzato in maniera retrospettiva
75 pazienti trattati con OA per cause non settiche (Abdominal
Compartment Syndrome, trauma ed ischemia intestinale) tra il
2001 e il 2015. In 40 pazienti (53%) la TAC è stata eseguita con
sistema NPWT (Gruppo A); in 35 (47%) con sistemi non a pressione
negativa (Gruppo B). Abbiamo analizzato e comparato i seguenti
parametri: durata media della TAC, tasso di chiusura de!nitiva
della laparostomia e mortalità. Il t-test di Student e il test corretto
di Fisher sono stati utilizzati per l’analisi statistica. Il valore di p <
0.05 è stato considerato signi!cativo.
Risultati: In totale, la durata media della TAC è di 2,46 giorni, il
tasso di chiusura de!nitivo 75% e la mortalità pari al 44%. Tra il
gruppo A e il Gruppo B, la durata media dell’OA è risultata 2.42 vs
4.82 giorni (p = 0,09), il tasso di chiusura de!nitivo 85% vs 65% (p
= 0.06) e la mortalità 40% vs 48.6% (p=0.49).
Conclusioni: Questo studio, seppur limitato dal confronto tra
differenti “periodi storici”, dimostra la superiorità, anche se non
signi!cativa, della TAC NPWT rispetto a quella non-NPWT in
termini di durata media dell’OA, del tasso di chiusura de!nitivo e
della mortalità nei pazienti sottoposti a OA per cause non settiche.
È verosimile che un ampliamento del campione analizzato possa
fornire una conferma signi!cativa ai dati riportati
THE ROLE OF THE EARLY GASTROGRAFIN TEST IN A DECISION-MAKING ALGORITHM FOR THE MANAGEMENT OF PATIENTS WITH ADHESIVE SMALL BOWEL OBSTRUCTION (ASBO)
No full textIntroduction: The Gastrografin Test (GT) is a very useful tool for the management of ASBO without signs of peritonitis which facilitates the recognition of patients who will benefit from a surgical operation 1,2. The aim of this study is to analyze the results of GT protocol use and to identify failure predictive factors. Material and methods: During 2015-2016, 90 patients with overall 92 ASBO episodes were managed in our Unit using a decision-making algorithm. In 80 cases (87%), a conservative treatment with GT was adopted. We prospectively analyze patients’demographic data and diagnostic CT work-up (wall thickening [ 5 mm, mean small bowel maximum caliber, fluid collection and parietal pneumatosis). Results: 31 ASBO episodes (39%) were successfully managed with a conservative treatment with Gastrographin (group 1, G1). The remaining 49 episodes (61%) required a surgical exploration (group 2, G2). The incidence of intestinal wall thickening [ 5 mm was significantly higher in G1 (49% vs 19,4%, p = 0,015). The same was identified for the mean small bowel maximum caliber (4,35 cm vs 3,7 cm, p = 0,002). The latter parameter (p = 0,011; OR 2,6; IC 95%) and the wall thickening (p = 0,026; OR: 3,88; IC 95%) can be considered as predictive factors of GT failure Conclusion: GT is a safe and effective tool in the management of ASBO not requiring emergency surgery. It may be helpful in establishing whether or not to perform surgery. The mean small bowel maximum caliber and the intestinal wall thickening can be considered as predictive factors for GT failure. References: 1. Di Saverio S et al. Bologna guidelines for diagnosis and management of adhesive small bowel obstruction (ASBO): 2013 update of the evidence-based guidelines from the world society of emergency surgery ASBO working group. World J Emerg Surg. 2013; 8 (1): 42-51. 2. Azagury D et al. Small bowel obstruction: a practical step-by-step evidence-based approach to evaluation, decision making and management J Trauma Acute Care Surg 2015; 79 (4): 661-668.
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Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Conversion After More Than Two Hours Increases the Risk of Major Complication in Patients with Acute Cholecystitis Approached Laparoscopically
No full textAim: The aim of this study was to evaluate whether the length of the laparoscopic time before the decision to convert during laparoscopic cholecystectomy (LC) for acute cholecystitis (AC) has any impact on the patients’ course. Methods: Medical records of 3832 patients undergone LC for AC during the last fifteen years in our unit, were retrospectively analyzed. 71 of these (1.9%) were converted to open. We divided them into two groups: G1 (n=52, 73%) included patients who had conversion within 2 h from the beginning of the operation, and G2 (n=19, 27%) included patients converted after more than 2 h of laparoscopy. We analyzed and compared the following parameters: patients’ general characteristic (age, gender, BMI, ASA score), rate of gangrenous acute cholecystitis, mean operative time, mean length of postoperative stay, morbidity and mortality. Morbidity was graded according to Clavien and Dindo classification. A p value<0.05 was considered significant. Results: 71 LC were converted for severe inflammation (33, 46%), strength visceral adhesions (19, 27%), inability to remove stones from common biliary duct (10, 14%), pneumoperitoneum intolerance (6, 9%), duodenal injuries (2, 3%) and arterial bleeding (1, 1%). Between G1 and G2, F/M ratio (11/33 vs 5/14, p=0.57) and mean BMI (25.3 vs 27.4 kg/m2, p=0.09) were not significantly different. Conversely, there was a significant difference in terms of age (mean, 71 vs 63.4 yrs, p=0.03) and ASA score (mean, 2.44 vs 2, p=0.01). Mean operative time was 174.5 in G1 and 235.2 in G2 patients. The rate of gangrenous cholecystitis was 38% in G1 and 21% in G2 (p=0.25). There were no significant differences regarding overall morbidity (26.9% vs 36.8%, p=0.41), mortality (2% vs 5%, p=0.45), and post-operative stay (mean 8.69 vs 8.27 days, p=0.41). However, major complications (grade III-V according to Clavien and Dindo classification) were 28% in G1 and 86% in G2 (p=0.02). Conclusion: In patients with AC, a laparoscopic time lasting more than 2 h before conversion seems to be linked to the occurrence of major complications, although it does not affect mortality and length of hospital sta
Appropriate Similarity Measures for Author Cocitation Analysis
Full text linkWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
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