196,052 research outputs found
Modifications in the International Study Group for Pancreatic Surgery (ISGPS) definition of postoperative pancreatic fistula
No full textPostoperative pancreatic fistula (POPF) remains the major postoperative cause of morbidity and mortality following pancreatic surgery. Since 2005, the International Study Group of Pancreatic Fistula (ISGPF) definition and classification has been adopted worldwide allowing the comparison among different surgical approaches and mitigation strategies. Over the last 11 years, several limitations have emerged from clinical practice and in 2016 the International Study Group for Pancreatic Surgery (ISGPS) updated the POPF definition and grading system. Objectives of this review article were to summarize modifications in the updated ISGPS definition and to illustrate their clinical impact
Pancreatic surgery in Italy. Criteria to identify the hospital units and the tertiary referral centers entitled to perform it
No full textIndicators of effectiveness and quality of care are urgently needed to improve the surgical outcomes. This is particularly felt in the field of complex surgical fields, such as the HPB one. International and national studies have documented an association between the large number of pancreatic surgical procedures and the outcome quality. The aim of this paper is to suggest reliable structural requirements and surgical volume to support pancreatic surgical accreditation, preserving patient's safety. Moreover, an accreditation program is outlined
La cardiomiopatia aritmogena del ventricolo destro nel Bulldog Inglese: Una patologia emergente
No full textArrhythmogenic right ventricular cardiomyopathy is a familial heart disease characterized by a progressive replacement of myocardium with fibro-fatty tissue. These structural changes are accompanied by functional changes with the onset of ventricular arrhythmias and myocardial dysfunction. In veterinary medicine, this disease has been reported sporadically in several canine and feline breeds, while in the Boxer breed the ultra-structural alterations, genetic transmission, and clinical and instrumental findings of the disease have been extensively described. Recently arrhythmogenic right ventricular cardiomyopathy has also been recognized in the English Bulldog, with distinctive features such as the presence of monomorphic ventricular tachycardia with left bundle branch block morphology and an incessant behaviour and the presence, in two thirds of affected dogs, of a segmental form with aneurysms of the right ventricular outflow tract. The purpose of the present manuscript is to describe clinical and instrumental findings of this disease in English Bulldog comparing them with those reported in Boxer breed dogs
Robotic pancreatectomies
No full textPancreatic surgery represents one of the most challenging fields in general surgery. Its complexity is related to the severity of the disease and the technical skills required for surgical approach. Given this, most pancreatic resections are performed through classic open surgery. Minimally invasive approaches are gradually gaining widespread popularity also in this specific setting, as for distal resections and enucleations. The robotic platform, due to its 3-dimensional vision and articulated movements, represents the natural progress of laparoscopic surgery overcoming the technical defaults and opening up the possibility to perform major pancreatic resections as pancreaticoduodenectomies. This review focuses on the impact of robotic platform in pancreatic surgery in terms of surgical and oncological outcome
Minimally invasive vessel-preservation spleen preserving distal pancreatectomy-how I do it, tips and tricks and clinical results
No full textBackground: Minimally invasive spleen-preserving distal pancreatectomy (SPDP) has emerged as a parenchyma-preserving approach and has become the standard treatment for pancreatic benign and low-grade malignant lesions. Nevertheless, minimally invasive SPDP is still technically challenging, especially when vessel preservation is intended. This study aims to describe the technique and outcomes of laparoscopic (LSPDP) and robot-assisted spleen-preserving distal pancreatectomy (RSPDP) with intended vessel preservation, highlighting the important tips and tricks to overcome technical obstacles and optimize surgical outcomes. Methods: A retrospective observational study of consecutive patients undergoing LSPDP and RSPDP with intended vessel preservation by a single surgeon in two different centers. A video demonstrating both surgical techniques is attached. Results: A total of 50 patients who underwent minimally invasive SPDP were included of which 88% underwent LSPDP and 12% RSPDP. Splenic vessels were preserved in 37 patients (74%) while a salvage vessel-resecting technique was performed in 13 patients (26%). The average surgery time was 178 ± 74 min for the vessel-preserving and 188 ± 57 for the vessel-resecting technique (p = 0.706) with an estimated blood loss of 100 mL in both groups (p = 0.663). The overall complication rate was 46% (n = 23) with major complications (Clavien Dindo ≥ III) observed in 14% (n = 7) of the patients. No conversions occurred. The median length of hospital stay was 4 days. Conclusion: This study presented the results after minimally invasive SPDP with intended vessel preservation by a highly experienced pancreatic surgeon. It provided tips and tricks to successfully accomplish a minimally invasive SPDP, which can contribute to quick patient rehabilitation and optimal postoperative results. Graphical Abstract: [Figure not available: see fulltext.]
Implementation of a strategic preoperative surgical meeting to improve the level of care at a high-volume pancreatic center: a before-after analysis of 1000 consecutive cases
No full textThe indication, planning, and risk analysis of a pancreatic surgical procedure have recently become increasingly complex. In December 2015, the "Pancreas Round" (PR) meeting was established at our institution to preoperatively review all scheduled cases with a specific focus on surgical indications and technical issues. The present study aims to determine the impact of the PR on the clinical practice in terms of avoiding unrequested laparotomies and anticipating intraoperative pitfalls. A "before-after" study was conducted by retrospectively comparing a pre-intervention period (9/2014-11/2015) to a prospectively assessed post-intervention one (12/2015-3/2017). Outcomes considered were explorative laparotomy (EL) occurrence and a "mismatch" between what was preoperatively expected by the PR and what was intraoperatively found. Of the 1057 patients included in the present study, 531 underwent surgery in the pre- and 526 in the post-intervention period, respectively. The EL rate was comparable between the two periods (15.4% vs. 12.2%, p = 0.123), despite the significant increase of surgical explorations after neoadjuvant chemotherapy during the post-intervention period (27% vs. 18%, p < 0.001). The "mismatch" rate between preoperative planning and intraoperative findings was significantly reduced in the post-intervention period (12.2% vs. 8.4%, p = 0.038) compared to the pre-PR period. In the setting of a high-volume center, a preoperative surgical meeting designed to review all cases scheduled for surgical exploration can enhance the level of care by addressing intraoperative pitfalls
Dr. Duane M. Jackson, Morehouse College, July 2011
No full textThis video is a conversation with Dr. Duane M. Jackson. Dr. Jackson talks about his paper, "Recall and the Serial Position Effect: The Role of Primacy and Recency on Accounting Students' Performance." Jackie Daniel, AUC Woodruff Library, is the interviewer
Minimally invasive surgery for pancreatic cancer
No full textIntroduction: Minimally invasive surgery (MIS) for pancreatic cancer has become very popular in modern pancreatic surgery. Evidence of the benefits of an MI approach are increasing thanks to prospective studies and randomized controlled studies. Areas covered: Agreement is lacking regarding the oncological feasibility of MIS for pancreatic cancer. Therefore, we performed a systematic review focusing on MIS for cancer of the head, body or tail of the pancreas. A total of 5237 studies were identified. After paper screening, 44 studies (22 on MI-pancreaticoduodenectomy and 22 on MI-distal pancreatectomy) met the eligibility criteria for the present review. The mean morbidity and mortality rates after MIPD were 31% and 4.9%, while overall complication and mortality rates were 32,5% and 1%. Median overall survival after MIPD and MIDP was 21.9 and 29.8 months, respectively. Both surgical and oncological outcomes were comparable to the open approach. Expert opinion: MIS offers advantages to the surgeon thanks to the high definition of the surgical field and the freedom of fine movement of the robot but should be considered only in selected patients and in high volume centers. Further studies are needed to prove the intraoperative and postoperative advantages of MIS compared to open surgery
"Reflections on the subject of Emigration from Europe with a view to Settlement in the United States" By M. Carey.
No full text"Reflections on the subject of Emigration from Europe with a view to Settlement in the United States: containing bried sketches of the moral and political character of those states.
By M. Carey, member of the American philosophical, and of the American Antiquarian Society, and author of The Olive Branch, Cindiciae Hibernicae, essays on banking, on political economy, and on internal improvement.
To which are now added the English editor's comments on the subject; together with Important Advice to Emigrants, and Cautions Against Impositions Practiced in the Outports
Dispelling the Myths Behind First-author Citation Counts
No full textWe conducted a full-scale evaluative citation analysis study of scholars in the XML research field to explore just how different from each other author rankings resulting from different citation counting methods actually are, and to demonstrate the capability of emerging data and tools on the Web in supporting more realistic citation counting methods. Our results contest some common arguments for the continued
use of first-author citation counts in the evaluation of scholars, such as high correlations between author rankings by first-author citation counts and other citation
counting methods, and high costs of using more realistic citation counting methods that are not well-supported by the ISI databases. It is argued that increasingly available digital full text research papers make it possible for citation analysis studies to go beyond what the ISI databases have directly supported and to employ more
sophisticated methods
- …
