1,721,029 research outputs found
Duodeno-Pancreatic and Extrahepatic Biliary Trauma
No full textDuodeno-pancreatic and extra-hepatic biliary trauma are rare traumatic lesions that often occur in the context of major multi-organ lesions and can require multidisciplinary management. Endoscopists, radiologists, and gastronterologists are essential in the early diagnosis and management, in nonoperative management (NOM), and in the treatment of complications. Mortality increase enormously with time in these traumas, and the management should be as early and quick as possible. The American Association for the Surgery of Trauma (AAST) has proposed a grading system for duodenal, pancreatic, and extrahepatic biliary tree injuries indicating degree and description of the lesions. Recently, the World Society of Emergency Surgery (WSES) revised the guidelines and proposed a classification in four classes considering both the AAST classification and the hemodynamic status. Penetrating trauma or hemodynamic instability often require surgical exploration, and in this context control of bleeding is crucial. E-FAST may suggest the presence of a perforation, but, in a hemodynamically stable patient, CT-Scan remains the gold-standard exam to evidence the degree of the lesion. In minor traumas, stable patients, and isolated injuries, NOM may be considered, but, when multiple organs are involved or in severe injuries, surgical management becomes unavoidable
Intestinal duplications: incidentally ileum duplication cyst in young female
Full text linkGastrointestinal tract duplication is a rare congenital malformation in young patients and in adults, that occur anywhere
from the mouth to the anus and their macroscopic structure may be cystic or tubular.
Intestinal duplication does not show specific symptoms, indeed they can present with a variety of symptoms including
abdominal distension and pain, sickness, hemorrhage, chronic respiratory disorders, as well as non-painful abdominal
mass. Nonetheless, intestinal duplication can remain completely asymptomatic and be diagnosed as an incidental
finding. Presentation with acute complications such as intestinal invagination or mechanical occlusion is quite rare.
We present a case of asymptomatic ileum duplication cyst in young female who referred to the emergency department
for trauma and was screened by eco-Focus Assessment Sonography for Trauma (eco-FAST), followed by MR and CT.
The patient underwent ileal resection and prophylactic appendicectomy with ileo-cecal termino-lateral anastomosis. In
this case, the intestinal duplication cyst was an asymptomatic incidental finding
Thoracic complications from retained abdominal gallstones after laparoscopic cholecystectomy: is it always mandatory a thoracic approach?
No full textBACKGROUND: Thoracic complications from retained abdominal
gallstones are quite rare and the incidence rate ranges between
0.08\% and 0.3\%. Diagnosis and treatment of these complications
are challenging due to the uncommon presentations and the
debated role of the thoracic approach. This review of all cases
reported in literature aims to discuss the best practice of this
rare condition. METHODS: A comprehensive literature search was
performed for articles from January 1993 to May 2019 using
PubMed, MEDLINE, Embase, ScienceDirect. The following mesh-words
were used: 'cholelithopthysis', 'thoracic', 'gallstones'
'retained', and 'spilled'. All cases of thoracic complications
from retained gallstones after laparoscopic cholecystectomy were
extrapolated. RESULTS: Twenty-four patients were included in
this study. The most common symptoms were fever, hemoptysis and
lithoptysis. Symptoms after laparoscopic cholecystectomy were
presented after a mean time of 9.814.2 months (range from
one week to 60 months). Delayed diagnosis was found in fourteen
patients (58.4.\%). Only four subjects were treated successfully
with antibiotic therapy alone (16.7\%), whereas 20 patients
needed surgery or interventional radiology (83.3\%). Seven
patients (29.2\%) were successfully managed with an abdominal
approach. Three patients were managed using thoracentesis,
thoracoscopic-thoracotomic drainage (12.5\%). Right lung
decortication and pulmonary wedge resections were necessary for
ten patients (41.6\%). CONCLUSION: Clinicians always must
inquire about the previous cholecystectomy for cholelithiasis
related diseases in all patients suffering from recurrent
right-sided pleural/lung affections, to improve diagnostic
delay. The escalated approach must be performed: empirical
antimicrobial therapy followed by targeted therapy as soon as
microbiological data are available; afterwards, abdominal
surgery is effective in approximately 30\% of patients while the
remaining patients have to be submitted to a thoracic approach
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
Evaluation of surgery risk factor associated to antithrombotic therapy in patients who underwent colorectal surgery
No full textVariations 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
MANAGING A SOFT PANCREATIC STUMP WITH END-TO-SIDE INTERRUPTED DOUBLE LAYER PANCREATOGASTROSTOMY: HOW I DO IT.
No full textPancreatic anastomotic failure is a main cause of significant
morbidity and potential mortality after pancreaticoduodenectomy,
especially in presence of a soft pancreatic
stump. Pancreaticogastrostomy proved to be associated
with a lower risk of pancreatic fistula in a recent metaanalysis.
Since 2010, we have been refining our technique
(illustrated by a videoclip), now routinely implemented
with soft pancreas, without experiencing any clinically
significant pancreatic fistula.
Briefly, after the pancreaticoduodenectomy is completed,
we identify and cannulate the Wirsung with a small Nelaton
catheter. Then we pursue full hemostasis of the pancreatic
stump by 4/0 and 5/0 prolene sutures. The next step consists
in achieving extended mobilization of the left pancreas
(almost 4cm). The double-layer anastomosis starts with a
posterior row of interrupted absorbable 4/0 monofilament
sutures including the gastric serosa and the pancreatic
capsule. It is essential to shape the posterior gastrotomy
shorter than the pancreatic stump to prevent excessive
widening and to ease the anastomosis. The anterior auxiliary
gastrotomy instead needs to be larger to facilitate the
inner anastomosis. Then, we invaginate the pancreas into
the stomach and we proceed with an interrupted row of
sutures between the posterior gastric wall (full-thickness)
and the body of the pancreatic stump, using retractors.
HPB 2016, 18 (S1), e1ee384
Electronic Poster Abstracts e119
Accurate check of the inner sutures is mandatory and
further stitches may be necessary to secure the anastomosis.
The anterior gastrotomy is finally closed with an absorbable
running suture. Finally, a further layer of sutures is applied
over the posterior suture line between the gastric serosa and
the pancreatic capsule
LAPAROSCOPIC VERSUS OPEN LIVER RESECTION FOR HCC: PRELIMINARY CASE-MATCHED ANALYSIS
No full textBackground: Purpose of our study was to evaluate the
safety and effectiveness of laparoscopic liver resection
(LLR) in patients with hepatocellular carcinoma (HCC) and
to compare LLR with open liver resection (ORL) in this
setting.
Methods: Our cohort consisted in patients who underwent
liver resection for HCC between December 2006 and
August 2015 in our institution. A preliminary sample of 50
patients was identified; 26 patients received LLR and 24
had ORL. Intraoperative variables, such as operative time
and estimated blood loss, as well as perioperative outcomes
were assessed for both techniques.
Results: Patients who received LLR had shorter operative
time, less blood loss, and reduced length of stay. Operative
time and blood loss were respectively 177 min versus
225 min and 107 mL versus 312 mL between the two
groups. The LLR cohort had an average length of stay of 7
days, while the ORL patients were hospitalized for an
average of 16 days. Resume of oral intake and full patient
mobilization were quicker after LLR.
Conclusions: Even in our preliminary experience, LLR
confirmed to be a safe, effective and feasible approach in
selected patients, including those with malignancy, being
associated with minor blood loss, reduced overall operative
time, short hospital stay and a prompt return to a regular
diet and physical activity with acceptable oncological
outcomes.
Still, a long-term follow-up is needed to draw definitive
conclusions in terms of long-term survival benefits
The use of energy devices for thyroid surgical procedures:Harmonic Focus versus Biclamp 150
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