1,721,109 research outputs found
Health related quality of life after surgeryfor colonic diverticular disease
No full textDiverticular disease (DD) of the colon is very common in developed countries and
is ranked the fifth most important gastrointestinal disease worldwide. The
management of acute diverticulitis without perforation and peritonitis is still
debated. Health related quality of life (HRQL), subjectively perceived by
patients, is becoming a major issue in the evaluation of any therapeutic
intervention, mainly in patients with chronic disease. To date only a few
published studies can be found on Medline examining HRQL in patients with DD. The
aim of this study was to review the impact of surgery for DD on HRQL. All Medline
articles regarding HRQL after surgery for colonic DD, particularly those
comparing different surgical approaches, were reviewed. DD has a negative impact
on HRQL with lower scores in bowel function and systemic symptoms. Both
surgery-related complications and disease activity have a significant impact on
patients' HRQL. While no significant differences in HRQL between different
operations for DD in non-randomized studies were revealed, the only prospective
double-blind randomized study that compared laparoscopic and open colectomy found
that patients undergoing laparoscopic colectomy had significantly reduced major
postoperative complication rates and subsequently had better HRQL scores. Formal
assessment of HRQL could be a good instrument in the selection of appropriate
patients for elective surgery as well as in the assessment of surgical outcome
A systematic review on advancement flaps for rectovaginal fistula in Crohn's disease: transrectal vs transvaginal approach
No full textAbstract: Aim Despite advances in the treatment of Crohn's disease (CD), the treatment of rectovaginal (RV) fistula remains challenging. Transrectal (RAF) and transvaginal advancement flaps (VAF) represent two possible alternative surgical approaches to this problem. The study aims to review and compare the results of these approaches for RV fistula in CD.
Method Medical databases from January 1983 to August 2008 were consulted for potentially relevant publications. All studies dealing with the RV fistula repair in CD with RAF or VAF were included. Two researchers worked independently on the study selection, quality assessment, data extraction and analysis phases of the study. Analyses were performed with Review Manager 2.0 software.
Results Eleven observational studies were included with a total of 219 flap procedures for RV fistula. The primary fistula closure pooled rate was 54.2% (range 33.3-100%) after RAF and 69.4% (range 0-92.9%) after VAF (P = 0.13). Four studies were eligible for direct comparison between the two procedures. No clearly significant difference between RAF compared with VAF in terms of primary fistula closure rate, nor in terms of overall fistula closure rate, was apparent. The risk of recurrence after RAF compared with VAF seemed similar; in this case, only two studies were taken into consideration.
Conclusions Although limited by a small number of studies of low clinical evidence level, this systematic review suggests that there is no significant difference in terms of outcome between RAF and VAF for RV fistula in CD
Diffuse Small Bowel Crohn's Disease Treated with Side-to-Side Isoperistaltic Strictureplasty: Report of Two Cases and Description of a Variation of the Original Technique
No full textDiffuse small bowel Crohn's disease is unusual and it is characterized by
multiple diseased segments involving the jejunum and ileum. The most frequent
indication for surgery is an intestinal obstruction, often complicated by a high
grade of malnutrition. The natural history of this clinical form is not well
defined and the optimal surgical approach remains controversial. We herein
present our surgical policy in two cases of diffuse small bowel Crohn's disease,
who were particularly at risk of developing short bowel syndrome. We focused our
attention on the use of side-to-side isoperistaltic strictureplasty as described
by Michelassi for the treatment of stenoses longer than 20 cm. We also propose
the application of this technique for the treatment of shorter stenosis cases
Results of iterative surgery for persistent and recurrent parathyroid carcinoma.
No full textParathyroid carcinoma (PC) is a rare cause of primary hyperparathyroidism. Surgery is the only effective treatment; re-operations are often required, because recurrences occur in most of the cases. The aim of this retrospective study was to analyse the rate of biochemical cure, clinical relief, sensitivity of localizing studies and morbidity after re-operations. PATIENTS AND METHODS:
From January 1980 to December 2000, 19 patients underwent surgery for PC. PC persisted or recurred in all cases. Fourteen re-operations were performed in six patients. RESULTS: Twelve re-operations at loco-regional site and two pulmonary metastasectomies were performed. Iterative surgery achieved a symptomatic relief in 86% of cases and a transient biochemical remission only in one patient, but significantly reduced parathormone and calcemia. The sensitivity of scintigraphy, CT and ultrasonography was 86, 79 and 100%, respectively. CONCLUSION: When recurrences occur, complete cure of PC is unlikely, despite re-operations. Iterative surgery is associated with some morbidity and never achieves a definitive cure, but provides significant clinical and biochemical palliation. Localizing studies are mandatory but do not detect all recurrences
Inflammatory fibroid polyp causingintestinal obstruction following restorative proctocolectomy for ulcerativecolitis.
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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
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