10851
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Abstract
Neuroendocrine tumors (NETs) of the stomach are the most frequent among all neuroendocrine neoplasms in the digestive tract. The diagnosis and classification are complicated by the fact that these tumors have to be categorized not only by common staging and grading but also according to their pathophysiological background (types). The types differ in their biological behaviour (aggressiveness) which influences therapeutic concepts. This article explains and summarizes the etiology and classification of gastric NETs and offers a precise concept for diagnosis and treatment to improve clinical outcome.
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10852
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Baranyai Z, Kulin L, Jósa V, Mayer A. [Surgical infections as patient safety problems]. Magy Seb 2011; 64:107-11. [PMID: 21672680 DOI: 10.1556/maseb.64.2011.3.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Surgical infections are severe complications of surgical interventions and one of the most important patient safety issues. These are associated with increased morbidity, mortality, costs and decreased quality of life. Prevention of infections is essential, while one has to consider pre-, intra- and postoperative factors and procedures in the clinical practice. In this article we summarize the latest recommendations for clinicians based on the relevant published literature.
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Affiliation(s)
- Zsolt Baranyai
- Magyar Betegbiztonsági Társaság 1147 Budapest Kerékgyártó u. 36-38.
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10853
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Murata Y, Mizuno S, Kato H, Kishiwada M, Ohsawa I, Hamada T, Usui M, Sakurai H, Tabata M, Nishimura K, Fukutome K, Isaji S. Nonalcoholic steatohepatitis (NASH) after pancreaticoduodenectomy: association of pancreatic exocrine deficiency and infection. Clin J Gastroenterol 2011; 4:242-248. [PMID: 26189528 DOI: 10.1007/s12328-011-0226-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2011] [Accepted: 04/03/2011] [Indexed: 12/31/2022]
Abstract
Previous clinical study has demonstrated that 30-40% of patients undergoing pancreaticoduodenectomy (PD) developed hepatic steatosis. However, nonalcoholic steatohepatitis (NASH) is a little-known complication after PD. Recently we encountered two patients with PD who later developed NASH diagnosed by liver biopsy. Case 1 was a 79-year-old woman who underwent PD for intraductal papillary mucinous neoplasm (IPMN). She had postoperative severe diarrhea due to pseudomembranous enterocolitis. Severe liver dysfunction was observed on the 31st postoperative day. Abdominal computed tomography (CT) on the 32nd day showed remarkably decreased hepatic CT value of 6 HU. Immediate liver biopsy revealed NASH (Brunt criteria: grade 2, stage 2). Case 2 was a 71-year-old woman who underwent PD for IPMN. Liver biopsy on 70th postoperative day, which was performed for assessment of moderate liver dysfunction and decreased hepatic CT value of 44 HU, demonstrated simple steatosis. In the 21st postoperative month, she developed severe urinary tract infection together with marked liver dysfunction. Immediate liver biopsy revealed NASH (Brunt criteria: grade 1, stage 1). For each patient, treatment of infection and high-dose pancreatic enzyme supplements improved liver dysfunction and liver steatosis. Clinical features of our cases seem to support the current leading hypothesis of the pathogenesis of NASH, i.e., the two-hit theory.
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Affiliation(s)
- Yasuhiro Murata
- Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
| | - Shugo Mizuno
- Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan.
| | - Hiroyuki Kato
- Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
| | - Masashi Kishiwada
- Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
| | - Ichiro Ohsawa
- Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
| | - Takashi Hamada
- Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
| | - Masanobu Usui
- Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
| | - Hiroyuki Sakurai
- Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
| | - Masami Tabata
- Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
| | - Keisuke Nishimura
- Department of Pathology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
| | - Kazuo Fukutome
- Department of Pathology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
| | - Shuji Isaji
- Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
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10854
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Tsoulfas G, Agorastou P. Role of living donor liver transplantation in the treatment of hepatitis C virus infection. HEPATITIS MONTHLY 2011; 11:427-33. [PMID: 22087173 PMCID: PMC3212794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/02/2011] [Revised: 03/17/2011] [Accepted: 04/17/2011] [Indexed: 11/26/2022]
Abstract
Hepatitis C virus (HCV) infection is one of the most common indications for liver transplantation worldwide. Because of the existing organ shortage, adult-to-adult living donor liver transplantation (LDLT) has become an important method of expanding the donor pool to meet the ever-increasing need. However, despite advantages such as the quality of the hepatic graft and the timing of the transplant, the exact role of LDLT in the treatment of HCV is still unclear. In this review, we aim to address some of these issues in an effort to highlight both the advantages and disadvantages, as well as to identify the main challenges, of using LDLT for treating patients with HCV infection.
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Affiliation(s)
- Georgios Tsoulfas
- Department of Surgery, Aristoteleion University of Thessaloniki, Thessaloniki, Greece,Corresponding author at: Georgios Tsoulfas, Department of Surgery, Aristoteleion University of Thessaloniki, 66 Tsimiski Street, 54622, Thessaloniki, Greece. Tel.: +30-6971895190, E-mail:
| | - Polyxeni Agorastou
- Department of Gastroenterology, Aristoteleion University of Thessaloniki, Thessaloniki, Greece
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10855
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Kim JW. The clinical usefulness of the sentinel lymph node in rectal cancer: do we believe it? JOURNAL OF THE KOREAN SOCIETY OF COLOPROCTOLOGY 2011; 27:51-2. [PMID: 21602960 PMCID: PMC3092073 DOI: 10.3393/jksc.2011.27.2.51] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Jong Woo Kim
- Department of Surgery, Cha University School of Medicine, Seongnam, Korea
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10856
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Stoita A, Penman ID, Williams DB. Review of screening for pancreatic cancer in high risk individuals. World J Gastroenterol 2011; 17:2365-71. [PMID: 21633635 PMCID: PMC3103788 DOI: 10.3748/wjg.v17.i19.2365] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2010] [Revised: 12/17/2010] [Accepted: 12/24/2010] [Indexed: 02/06/2023] Open
Abstract
Pancreatic cancer is difficult to diagnose at an early stage and is associated with a very poor survival. Ten percent of pancreatic cancers result from genetic susceptibility and/or familial aggregation. Individuals from families with multiple affected first-degree relatives and those with a known cancer-causing genetic mutation have been shown to be at much higher risk of developing pancreatic cancer. Recent efforts have focused on detecting disease at an earlier stage to improve survival in these high-risk groups. This article reviews high-risk groups, screening methods, and current screening programs and their results.
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10857
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Rieder E, Spaun GO, Khajanchee YS, Martinec DV, Arnold BN, Smith Sehdev AE, Swanstrom LL, Whiteford MH. A natural orifice transrectal approach for oncologic resection of the rectosigmoid: an experimental study and comparison with conventional laparoscopy. Surg Endosc 2011; 25:3357-63. [PMID: 21556994 DOI: 10.1007/s00464-011-1726-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2011] [Accepted: 04/02/2011] [Indexed: 12/21/2022]
Abstract
BACKGROUND A transrectal (TR) approach for natural orifice translumenal endoscopic surgery (NOTES) makes sense for colorectal surgery because the colotomy can be incorporated into subsequent anastomosis. Because cancer is a primary indication for left-sided colon resection, oncologic standards will have to be met by a NOTES procedure. This study aimed to assess whether pure TR rectosigmoidectomy can be performed with strict adherence to oncologic principles compared with a conventional laparoscopically assisted approach (LAP). METHODS Human male cadavers were allocated to either TR (n = 4) or LAP (n = 2). A simulated sigmoid lesion was created at 25 cm. Transrectal retrograde mobilization of the rectosigmoid was performed using conventional transanal endoscopic microsurgery (TEM) instrumentation. After ligation of the superior hemorrhoidal artery and further mobilization, the specimen was delivered transanally and divided extracorporeally. Using a circular stapler, NOTES colorectal anastomosis was performed. Lymph node yield, adequate resection margins, and operative time were compared with LAP. RESULTS Transrectal retrograde rectosigmoid dissection was achieved in all attempts (4/4) and showed numbers of lymph nodes (median, 5; range, 3-6) similar to the LAP group (median, 4.5; range, 2-7). One pure TR approach failed to resect the lesion. Three TR procedures required additional mobilization via an abdominal approach to provide adequate margins. The mean length of TR specimens was 16 ± 4 cm compared with 31 ± 9 cm achieved by LAP (p < 0.01). The TR operative time was significantly longer (247 ± 15 vs 110 ± 14 min). CONCLUSION Lymph node yield during TR rectosigmoidectomy was similar to that achieved by the LAP approach. However, conventional TEM instrumentation alone did not permit adequate colon mobilization. This indicates a need for flexible instrumentation or other technical solutions to perform true NOTES colectomies.
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Affiliation(s)
- Erwin Rieder
- Minimally Invasive Surgery Program, Legacy Health, Portland, OR, USA
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10858
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Abraham NS. Is laparoscopic resection for colorectal cancer the way to the future? Med J Aust 2011; 194:441-2. [PMID: 21534897 DOI: 10.5694/j.1326-5377.2011.tb03055.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2011] [Accepted: 03/16/2011] [Indexed: 11/17/2022]
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10859
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Abstract
Since the identification of self-renewing cells in the hematopoietic system, stem cells have transformed the study of medicine. Cancer biologists have identified stem-like cells in multiple malignancies, including those of solid organs. This has led to the development of a stem cell theory of cancer, which purports that a subpopulation of self-renewing tumor cells is responsible for tumorigenesis. This contrasts with the stochastic model of tumor development, which advances that all tumor cells are capable of tumor formation. Within the field of melanoma, the identity and existence of cancer stem cells has been the subject of recent debate. Much of the controversy may be traced to differences in interpretations and definitions related to the cancer stem cell theory, and the use of dissimilar methodologies to study melanoma cells. Accumulating evidence suggests that cancer stem cells may exist in melanoma, although their frequency may vary and they may be capable of phenotypic plasticity. Importantly, these primitive melanoma cells are not only capable of self-renewal and differentiation plasticity, but also may confer virulence via immune evasion and multidrug resistance, and potentially via vasculogenic mimicry and transition to migratory and metastasizing derivatives. Therapeutic targeting of melanoma stem cells and the pathways that endow them with virulence hold promise for the design of more effective strategies for amelioration and eradication of this most lethal form of skin cancer.
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10860
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Oh TY, Moon SM, Shin US, Lee HR, Park SH. Impact on Prognosis of Lymph Node Micrometastasis and Isolated Tumor Cells in Stage II Colorectal Cancer. JOURNAL OF THE KOREAN SOCIETY OF COLOPROCTOLOGY 2011; 27:71-7. [PMID: 21602965 PMCID: PMC3092078 DOI: 10.3393/jksc.2011.27.2.71] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/24/2010] [Accepted: 03/27/2011] [Indexed: 12/17/2022]
Abstract
Purpose Even though the importance of micrometastases (MMS) and isolated tumor cells (ITC) has been brought up by many physicians, its impact on the prognosis in stage II colorectal cancer is uncertain. In this research, we tried to investigate the clinical features of MMS and ITC and to prove any correlation with prognosis. Methods The research pool was 124 colorectal cancer patients who underwent a curative resection from April 2005 to November 2009. A total of 2,379 lymph nodes (LNs) were examined, and all retrieved LNs were evaluated by immunohistochemical staining with anti-cytokeratin antibody panel. Clinicopathologic parameters and survival rates were compared based on the presence of MMS or ITC and on the micrometastatic lymph node ratio (mmLNR), which is defined as the number of micrometastatic LNs divided by the number of retrieved LNs. Results Out of 124 patients (26.6%) 33 were found to have MMS or ITC. There were no significant differences in clinicopathologic features, such as gender, tumor location and size, depth of invasion, histologic grade, except for age (P = 0.04). The three-year disease-free survival rate for the MMS or ITC positive group was 85.7%, and that for MMS and ITC negative group was 92.8% (P = 0.209). The three-year disease-free survival rate for the mmLNR > 0.25 group was 73.3%, and that for the mmLNR ≤ 0.25 group was 92.9% (P = 0.03). Conclusion The presence of MMS or ITC was not closely correlated to the prognosis. However, mmLNR is thought to be a valuable marker of prognosis in cases of stage II colorectal cancer.
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Affiliation(s)
- Tai Young Oh
- Department of Surgery, Korea Cancer Center Hospital, Seoul, Korea
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10861
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Zhang DH, Zhou JP. Role of focal adhesion kinase in the pathogenesis of colorectal carcinoma. Shijie Huaren Xiaohua Zazhi 2011; 19:1279-1284. [DOI: 10.11569/wcjd.v19.i12.1279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Focal adhesion kinase (FAK) was initially identified as a nonreceptor protein tyrosine kinase localized to the focal contact protein clusters. This enzyme has been shown to facilitate generation of integrin-stimulated signals to downstream targets. It has been reported that activation of FAK leads to a number of processes, including cell attachment, migration, proliferation, and survival. The expression of FAK in colon carcinoma is significantly higher than that in matched cancer-adjacent normal tissue, suggesting that FAK may be an important target for the therapy of colon carcinoma. The inhibition of FAK activation can interrupt many signal pathways involved in colon carcinogenesis and may represent a new therapy strategy for colon carcinoma.
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10862
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Konishi T, Kuroyanagi H, Watanabe T. Combined resection of the iliac vessels for lateral pelvic lymph node dissection can be safely performed through laparoscopic approach. Ann Surg Oncol 2011; 18 Suppl 3:S237; author reply S238. [PMID: 21512865 DOI: 10.1245/s10434-011-1726-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2010] [Indexed: 12/20/2022]
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10863
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Pérez RC, González LRA, Reyes ED, Fernández JCD, Arias LER, Estrada MO. [The transvaginal approach in acute appendicitis]. Cir Esp 2011; 89:517-23. [PMID: 21514578 DOI: 10.1016/j.ciresp.2011.02.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2010] [Revised: 01/17/2011] [Accepted: 02/14/2011] [Indexed: 12/23/2022]
Abstract
INTRODUCTION The purpose of this work is to present 8 minilaparoscopic-assisted transvaginal appendectomies using rigid instruments in patients with acute appendicitis. MATERIAL AND METHODS Eight minilaparoscopic-assisted transvaginal appendectomies were performed from the 10th of August 2009 to the 30th of June 2010. The inclusion criteria were women between 18 and 65 years of age with a diagnosis of acute appendicitis. The exclusion criteria were palpable masses, appendicular abscesses, ASA III and IV; morbid obesity (BMI > 35); gynaecological infections; virgin patients and pregnant women. The surgical intervention was performed with rigid instruments. Surgical time, the need for post-operative analgesics, and post-surgical complications. RESULTS The age range varied between 18 and 42 years, with a mean of 29.6 years. The mean surgical time was 48.3 minutes (37-75). Analgesics were given to 2 patients after surgery (1 parenteral and 1 oral). Five patients were discharged before 24 hours and 3 at 48 hours. There were no post-operative complications. CONCLUSIONS Minilaparoscopic-assisted transvaginal appendectomy with rigid instruments, in selected women is a feasible and safe method, and with better aesthetic results than laparoscopic appendectomy, but future studies will be required that can demonstrate its advantages.
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Affiliation(s)
- Raúl Castro Pérez
- Servicio de Cirugía General, Hospital Provincial Docente Abel Santamaría Cuadrado, Ciudad de Pinar del Río, Provincia de Pinar del Río, Cuba.
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10864
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Monga A, Ramchandani M, Reddy DN. Per-oral cholangioscopy. JOURNAL OF INTERVENTIONAL GASTROENTEROLOGY 2011; 1:70-77. [PMID: 21776429 DOI: 10.4161/jig.1.2.15352] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2011] [Revised: 02/02/2011] [Accepted: 02/05/2011] [Indexed: 02/06/2023]
Abstract
Direct endoscopic views of bile duct have been described in literature since the 1970s. Since then rapid strides have been made with the advent of technologically advanced systems with better image quality and maneuverability. The single operator semi-disposable per-oral cholangioscope and other novel methods such as the cholangioscopy access balloon are likely to revolutionize this field. Even though cholangioscopy is currently used primarily for characterization of indeterminate strictures and management of large bile duct stones, the diagnostic and therapeutic indications are likely to expand in future. The following is an overview of the currently available per-oral cholangioscopy equipments, indications for use and future directions.
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Affiliation(s)
- Amitabh Monga
- Asian Institute of Gastroenterology, Hyderabad, India
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10865
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Affiliation(s)
- Lee L Swanstrom
- Department of Surgery, Oregon Health Sciences University, Portland, Oregon, USA.
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10866
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Targarona EM, Balagué C, Martínez C, Hernández MP, Segade M, Franco L, Garriga J, Trías M. [Medium term results on introducing colorrectal laparoscopic surgery into clinical practice after having an intensive training course]. Cir Esp 2011; 89:282-9. [PMID: 21458783 DOI: 10.1016/j.ciresp.2011.02.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2011] [Accepted: 02/23/2011] [Indexed: 01/12/2023]
Abstract
INTRODUCTION Endoscopic surgery has characteristics that increase the difficulties of learning. Five years ago, an intensive colorectal laparoscopic surgery course was designed to offer training in the technical bases of this type of surgery. The aim of this article is to determine the impact of the colorectal surgery course on clinical practice, and to investigate the factors that limit its applicability and the training preferences of the surgeons. MATERIAL AND METHODS Twenty-two courses of four days duration, with 36 hours of lessons (4 in seminar form and 32 in the surgery), and with 7 trainees, were held between June 2005 and December 2010. A survey was sent out in December 2010 to assess the impact of the course on the colorectal laparoscopic surgery activity of the trainee, to find out the difficulties encountered in its application, and to evaluate the training expectations in endoscopic surgery in this group of surgeons. RESULTS The questionnaire was sent to 148 surgeons, with 74 (50%) responses received. The mean period after the course was 26.5 (2-60) months. A monthly increase of more than 5 cases was observed in 70% of the centres. The course enabled them to consolidate the activity in local hospitals, while in university and general hospitals it served to re-launch an initial experience. Among the obstacles that made it difficult to introduce were care load and the availability of a surgeon, particularly in general and university hospitals (P=.001), and in local hospitals it was the availability of patients. The majority of surgeons (70%) believed that specific training was required, preferring a short period in a hospital with experience. CONCLUSIONS An intensive course on colorectal laparoscopic surgery enabled the activity to be consolidated or increased in this area. Training in colorectal laparoscopic surgery requires additional teaching efforts, which are currently unstructured.
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Affiliation(s)
- Eduard M Targarona
- Servicio de Cirugía, Hospital de Sant Pau, Universidad Autónoma de Barcelona, España.
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10867
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Ishak G, Ribeiro FS, Costa DSD, Bahia LAC, Dias EM, Assumpção PPD. Câncer de vesícula biliar: experiência de 10 anos em um hospital de referência da Amazônia. Rev Col Bras Cir 2011; 38:100-4. [DOI: 10.1590/s0100-69912011000200006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2010] [Accepted: 03/23/2010] [Indexed: 12/29/2022] Open
Abstract
OBJETIVO: Analisar os aspectos epidemiológicos-cirúrgicos dos pacientes com câncer de vesícula biliar (CAVB) atendidos em um Hospital Universitário de Belém/PA, no período de 1999-2009. MÉTODOS: estudo observacional, retrospectivo, descritivo-analítico de fonte secundária dos pacientes com diagnóstico de CAVB, no período de 1999-2009. Foram analisados 75 prontuários, sendo 34 pacientes estudados. As informações coletadas foram utilizadas para o estadiamento tumoral TNM do CAVB e para a caracterização clínico-cirúrgica da população estudada. RESULTADOS: 79% eram do sexo feminino, com média de idade de 66,2±11 anos e tempo de sintomatologia de 10,8±17,2 meses, não obtendo relação estatística com o estadio da doença. Dor no hipocôndrio direito, náuseas e icterícia predominaram como sinais/sintomas. A litíase biliar esteve presente em 91% dos casos, sendo positiva em 100% dos pacientes com estadios I/II. A sensibilidade ultrassonográfica para sugestionar o CAVB no pré-operatório foi 14,28%. A operação mais executada foi a colecistectomia simples, tendo como achado intra-operatório predominante, invasão hepática. O adenocarcinoma foi o tipo histológico preponderante, com destaque para os estadios III e IV. CONCLUSÃO: A série estudada apresentou alta incidência de litíase biliar, o adenocarcinoma com estadio avançado foi o mais prevalente. acarretando um pequeno índice de operações com intenção curativa, 30% dos pacientes operados, e uma taxa de mortalidade de 21%. A valorização dos sintomas e a investigação precoce por exames de imagem poderiam favorecer o tratamento, em fases iniciais do CAVB, proporcionando um melhor prognóstico para os pacientes operados.
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10868
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Heneghan HM, Healy NA, Martin ST, Ryan RS, Nolan N, Traynor O, Waldron R. Modern management of pyogenic hepatic abscess: a case series and review of the literature. BMC Res Notes 2011; 4:80. [PMID: 21435221 PMCID: PMC3073909 DOI: 10.1186/1756-0500-4-80] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2010] [Accepted: 03/24/2011] [Indexed: 11/20/2022] Open
Abstract
Background Pyogenic hepatic abscesses are relatively rare, though untreated are uniformly fatal. A recent paradigm shift in the management of liver abscesses, facilitated by advances in diagnostic and interventional radiology, has decreased mortality rates. The aim of this study was to review our experience in managing pyogenic liver abscess, review the literature in this field, and propose guidelines to aid in the current management of this complex disease. Methods Demographic and clinical details of all patients admitted to a single institution with liver abscess over a 5 year period were reviewed. Clinical presentation, aetiology, diagnostic work-up, treatment, morbidity and mortality data were collated. Results Over a 5 year period 11 patients presented to a single institution with pyogenic hepatic abscess (55% males, mean age 60.3 years). Common clinical features at presentation were non-specific constitutional symptoms and signs. Aetiology was predominantly gallstones (45%) or diverticular disease (27%). In addition to empiric antimicrobial therapy, all patients underwent radiologically guided percutaneous drainage of the liver abscess at diagnosis and only 2 patients required surgical intervention, including one 16-year old female who underwent hemi-hepatectomy for a complex and rare Actinomycotic abscess. There were no mortalities after minimum follow-up of one year. Conclusions Pyogenic liver abscesses are uncommon, and mortality has decreased over the last two decades. Antimicrobial therapy and radiological intervention form the mainstay of modern treatment. Surgical intervention should be considered for patients with large, complex, septated or multiple abscesses, underlying disease or in whom percutaneous drainage has failed.
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Affiliation(s)
- Helen M Heneghan
- Department of Surgery, Mayo General Hospital, Castlebar, Mayo, Ireland.
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10869
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Graf K, Ott E, Vonberg RP, Kuehn C, Schilling T, Haverich A, Chaberny IF. Surgical site infections--economic consequences for the health care system. Langenbecks Arch Surg 2011; 396:453-9. [PMID: 21404004 DOI: 10.1007/s00423-011-0772-0] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2011] [Accepted: 02/24/2011] [Indexed: 11/28/2022]
Abstract
PURPOSES Unfortunately, surgical site infections (SSIs) are a quite common complication and represent one of the major causes of postoperative morbidity and mortality, and may furthermore lead to enormous additional costs for hospitals and health care systems. METHODS In order to determine the estimated costs due to SSIs, a MEDLINE search was performed to identify articles that provide data on economic aspects of SSIs and compared to findings from a matched case-control study on costs of SSIs after coronary bypass grafting (CABG) in a German tertiary care university hospital. RESULTS A total of 14 studies on costs were found. The additional costs of SSI vary between $3,859 (mean) and $40,559 (median). Median costs of a single CABG case in the recently published study were $49,449 (€36,261) vs. $18,218 (€13,356) in controls lacking infection (p < 0.0001). The median reimbursement from health care insurance companies was $36,962 (€27,107) leading to a financial loss of $12,482 (€9,154) each. CONCLUSION Costs of SSIs may almost triple the individual overall health care costs and those additional charges may not be sufficiently covered. Appropriate measures to reduce SSI rates must be taken to improve the patient's safety. This should also diminish costs for health care systems which benefits the entire community.
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Affiliation(s)
- Karolin Graf
- Institute for Medical Microbiology and Hospital Epidemiology, Hannover Medical School, Carl-Neuberg-Str. 1, Hannover, D-30625, Germany.
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10870
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Falidas E, Vlachos K, Mathioulakis S, Archontovasilis F, Villias C. Multiple giant diverticula of the jejunum causing intestinal obstruction: report of a case and review of the literature. World J Emerg Surg 2011; 6:8. [PMID: 21385440 PMCID: PMC3061903 DOI: 10.1186/1749-7922-6-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2010] [Accepted: 03/08/2011] [Indexed: 01/12/2023] Open
Abstract
Multiple diverticulosis of jejunum represents an uncommon pathology of the small bowel. The disease is usually asymptomatic and must be taken into consideration in cases of unexplained malabsorption, anemia, chronic abdominal pain or discomfort. Related complications such as diverticulitis, perforation, bleeding or intestinal obstruction appear in 10-30% of the patients increasing morbidity and mortality rates. We herein report a case of a 55 year-old man presented at the emergency department with acute abdominal pain, vomiting and fever. Preoperative radiological examination followed by laparotomy revealed multiple giant jejunal diverticula causing intestinal obstruction. We also review the literature for this uncommon disease.
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Affiliation(s)
- Evangelos Falidas
- First Department of General Surgery, 417 NIMTS, Veterans Hospital of Athens, 10-12 Monis Petraki, 11521, Athens, Greece
| | - Konstantinos Vlachos
- First Department of General Surgery, 417 NIMTS, Veterans Hospital of Athens, 10-12 Monis Petraki, 11521, Athens, Greece
| | - Stavros Mathioulakis
- First Department of General Surgery, 417 NIMTS, Veterans Hospital of Athens, 10-12 Monis Petraki, 11521, Athens, Greece
| | - Fotis Archontovasilis
- First Department of Therapeutic Endoscopy and Laparoscopic Surgery, Iaso General Hospital, 264 Mesogion Avenue, 15562, Cholargos, Greece
| | - Constantinos Villias
- First Department of General Surgery, 417 NIMTS, Veterans Hospital of Athens, 10-12 Monis Petraki, 11521, Athens, Greece
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10871
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Giri S, Bader A. Improved preclinical safety assessment using micro-BAL devices: the potential impact on human discovery and drug attrition. Drug Discov Today 2011; 16:382-97. [PMID: 21354326 DOI: 10.1016/j.drudis.2011.02.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2010] [Revised: 01/11/2011] [Accepted: 02/21/2011] [Indexed: 02/07/2023]
Abstract
Hepatotoxicity is often unpredictable in the early phase of drug discovery and leads to drug attrition in preclinical and clinical development. Here, we discuss the conventional preclinical liver models that do not mimic in vivo livers. We focus on key components such as new sources of hepatocyte-derived human stem cells, enhanced direct oxygenation, defined biocompatibility nanoscaffolds, organotypical cellular models, dynamic culture, and metabolite status inside and outside the cell for effective configuration for the development of a bioartificial liver (BAL) device to mimic the in vivo liver microenvironment. The potential for development of BAL devices could open up new avenues in: (i) hepatotoxicity assessment for selecting drug candidates during preclinical screening; and (ii) therapeutic approaches for liver cell therapy at the clinical stage.
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Affiliation(s)
- Shibashish Giri
- Centre for Biotechnology and Biomedicine, Department of Cell Techniques and Applied Stem Cell Biology, University of Leipzig, Deutscher Platz 5, D-04103 Leipzig, Germany.
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10872
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Radiofrequency ablation versus resection for liver tumours: an evidence-based approach to retrospective comparative studies. J Gastrointest Surg 2011; 15:378-87. [PMID: 21061179 DOI: 10.1007/s11605-010-1377-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2010] [Accepted: 10/19/2010] [Indexed: 02/08/2023]
Abstract
BACKGROUND Recently randomized controlled trials have been advocated to compare radiofrequency ablation (RFA) and hepatic resection (HR) in resectable tumours and determine whether differences in observed survivals result from the heterogeneity in previous studies between RFA (treating unresectable lesions) and HR (treating lesions deemed resectable). We reviewed the literature that directly compares the treatments and employed an evidence-based approach to examine the data. MATERIALS AND METHODS All studies comparing RFA and HR were included. Primary outcomes were the overall survival (OS) and disease-free survival (DFS) at 3 and 5 years. A subgroup analysis was conducted for solitary or small tumors (<4 cm for colorectal metastases (CRM) or <5 cm for hepatocellular carcinoma (HCC)). RESULTS Most studies were retrospective. For CRM, HR was markedly superior to RFA in respect of 3- and 5-year OS as well as 5-year DFS including tumours smaller than 4 cm and solitary lesions. For HCC, HR was markedly superior to RFA for 3- and 5-year OS as well as 3-year DFS, and produced a better OS at 3 years for solitary lesions and DFS at 3 years for small tumours. CONCLUSIONS Multiple factors determine outcomes following treatment of liver tumours. Small or solitary lesions seem the most appropriate ones to study as this reduces the number of confounding variables, but even in these cases HR confers a better OS and DFS than RFA for both CRM and HCC. If our data are confirmed it will be important to examine other factors influencing the response.
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10873
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Parsi MA. Peroral cholangioscopy in the new millennium. World J Gastroenterol 2011; 17:1-6. [PMID: 21218076 PMCID: PMC3016668 DOI: 10.3748/wjg.v17.i1.1] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2010] [Revised: 08/27/2010] [Accepted: 09/04/2010] [Indexed: 02/06/2023] Open
Abstract
Peroral cholangioscopy was first described in 1970s and has recently gained popularity. Peroral cholangioscopy is appealing to therapeutic endoscopists because a direct intraluminal view of the biliary duct system offers possibilities for diagnosis and interventions beyond that which other imaging or endoscopic modalities can provide. As the image quality of cholangioscopies improves, so too does their diagnostic capability, and as their durability and maneuverability increases, so too does their potential use for therapeutic applications. This editorial is intended to provide a brief review of recent developments in peroral cholangioscopy and current indications for its use.
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10874
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Sileikis A, Beisa V, Rutkauskaite D, Misonis N, Strupas K. Management of Bleeding Pseudoaneurysms in Complicated Pancreatitis. VISZERALMEDIZIN 2011. [DOI: 10.1159/000332931] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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10875
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Abstract
INTRODUCTION Due to a lack of adequate liver donors and post-surgical complications, researchers propose that cell therapy should be an alternative treatment for patients with end-stage liver diseases. DATA SOURCES We performed a literature review on cell-based therapy for liver disorders. AREAS OF AGREEMENT Due to growing numbers of patients on waiting lists for liver transplantation, a substitute treatment strategy is needed for our patients. Cell therapy can save patients who are in life-threatening situations, enabling them to have more time and increase their chances of survival. Pluripotent stem cells can be a good resource for cell-based therapy after the establishment of efficient differentiation protocols in addition to the settlement of ethical and immunological issues. Cell-based therapy will be applicable after the approval of its efficiency via animal model studies. AREAS OF CONTROVERSY Transplanted cells cannot integrate into the recipient liver and lose their functionality after a limited time. The rate of homing and transdifferentiation of transplanted cells into hepatocytes is scant. GROWING POINTS Application of autologous bone marrow mononuclear cells (MNCs), hematopoietic and mesenchymal stem cells (HSCs and MSCs) has improved the general conditions of certain patients. Although this improvement is temporary, new studies have focused on increasing their performance. TIMELY AREAS FOR DEVELOPING RESEARCH: The safety, feasibility and efficacy of applying MNCs, HSCs and MSCs in liver disorders have been proven in clinical trials. Patient-specific cell therapy after the production of induced pluripotent stem cells and new discoveries in somatic cell conversion during transdifferentiation are promising insights.
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Affiliation(s)
- Massoud Vosough
- Department of Stem Cells and Developmental Biology, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran
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10876
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Shrikhande SV, Marda S, Goel M, Shetty G. Laparoscopic surgery for rectal cancer. Lancet Oncol 2010; 11:919-20; author reply 920-1. [PMID: 20932489 DOI: 10.1016/s1470-2045(10)70205-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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10877
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Vollmer CM, Dixon E. Intraductal papillary mucinous neoplasm: Coming of age. World J Gastrointest Surg 2010; 2:299-305. [PMID: 21160834 PMCID: PMC2999208 DOI: 10.4240/wjgs.v2.i10.299] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2010] [Revised: 09/12/2010] [Accepted: 09/19/2010] [Indexed: 02/06/2023] Open
Abstract
Intraductal papillary mucinous neoplasm (IPMN) is a disease in evolution. Since its first description almost 30 years ago, a better understanding of the disease has steadily accrued. Yet, there are numerous challenges still for clinicians who treat this fascinating disease. A group of leading content experts on IPMN was assembled and charged with presenting cutting-edge knowledge on various topics for which they have considerable experience. This manuscript provides an historical perspective of both clinical and biological quandaries that have been resolved to date. Furthermore, it poses new avenues for investigation while highlighting the contributions of the various authors to this collective review.
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Affiliation(s)
- Charles M Vollmer
- Charles M Vollmer Jr, Division of General Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, United States
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10878
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Zia MK, Morris-Stiff G, Luhmann A, Jeffries R, Ehsan O, Hassn A. Safety and application of laparoscopic gastrectomy for benign gastric disease and gastric cancer. Ann R Coll Surg Engl 2010; 93:17-21. [PMID: 20810021 DOI: 10.1308/003588410x12771863936963] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
INTRODUCTION Laparoscopic gastrectomy is rapidly expanding despite reservations by some surgeons regarding its safety and radicality. The aim of this study was to evaluate patients undergoing laparoscopic gastrectomy for both benign and malignant disease with particular emphasis on technical feasibility, safety, effectiveness and complications. PATIENTS AND METHODS Review of prospectively collected data of patients who underwent laparoscopic gastrectomy from May 2005 to September 2009 under the care of one consultant surgeon. RESULTS A total of 61 laparoscopic gastrectomies were performed (35 men and 26 women) with a median age of 68 years (range, 41-90 years). There were 39 distal gastrectomies (19 adenocarcinoma, 6 gastrointestinal stromal tumour [GIST], 4 benign gastric outlet obstruction, 4 high-grade dysplasia in gastric adenomas, 4 non-healing ulcers, 2 gastric antral vascular ectasia [GAVE]); 15 sub-total gastrectomies (13 adenocarcinomas, 2 GIST); and 7 total gastrectomies (5 adenocarcinomas, 1 GIST, 1 carcinoid). Median follow-up was for 48 months (range, 1-72 months). There was one death, two major and six minor complications. All patients with complications made a satisfactory recovery. CONCLUSIONS Laparoscopic gastrectomy is associated with a low mortality (1.75%) and major morbidity (3.50%). Although technically demanding, especially when a D2 lymphadenectomy is performed, our results have shown that tailored laparoscopic resection based on tumour characteristics with either D1 or D2 lymphadenectomy results in good surgical and oncological outcomes.
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Affiliation(s)
- M K Zia
- Department of General Surgery, Princess of Wales Hospital, Bridgend, UK
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10879
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Forgione A. NOTES-Natural orifice transluminal endoscopic surgery: Why not? World J Gastrointest Surg 2010; 2:177-8. [PMID: 21160870 PMCID: PMC2999244 DOI: 10.4240/wjgs.v2.i6.177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2010] [Revised: 06/20/2010] [Accepted: 06/24/2010] [Indexed: 02/06/2023] Open
Abstract
Since natural orifice transluminal endoscopic surgery (NOTES) was first described by Anthony Kalloo, it has attracted tremendous interest from surgeons and gastroenterologist all around the world. This special issue of the World Journal of Gastrointestinal Surgery explores the current possibilities and future potential of the most disruptive revolution in the field of surgery represented by the NOTES approach. In the future, new technologies developed for this approach and deeper insight into several gastrointestinal diseases will lead to the design of completely new interventional procedures and change the way we will operate, bringing us to the previously unimaginable goal of “no scar surgery”.
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Affiliation(s)
- Antonello Forgione
- Antonello Forgione, AIMS Advanced International Mini-invasive Surgery Academy; Department of General and Emergency Surgery, Niguarda Ca' Granda Hospital, Piazza Ospedale 3, Milan 20162, Italy
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10880
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D′souza C, Bhagavan KR, Sunil H, Mohan R. Unusual case of subacute intestinal obstruction due to eosinophilic enteritis with enteroliths. ACTA ACUST UNITED AC 2010. [DOI: 10.4103/1755-6783.77198] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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10881
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Junghanss T, da Silva AM, Horton J, Chiodini PL, Brunetti E. Clinical management of cystic echinococcosis: state of the art, problems, and perspectives. Am J Trop Med Hyg 2008; 68:304-9. [PMID: 18784219 DOI: 10.1016/j.mjafi.2012.04.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Clinical management of cystic echinococcosis (CE) has evolved over decades without adequate evaluation of important features such as efficacy, effectiveness, rate of adverse reactions, relapse rate, and cost. CE occurs in health care environments as different as Europe/North America and resource-poor countries of the South and the East. This creates setting-specific problems in the management of patients. Furthermore, studies carried out in either of the two fundamentally different environments lack external validity, i.e., results obtained in one setting may be different from those in the other and practices that can work in one may not be applicable to the other. In this paper, we review the current management procedures of CE with particular emphasis on the evidence base and setting-specific problems.
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Affiliation(s)
- Thomas Junghanss
- Section of Clinical Tropical Medicine, University Hospital Heidelberg, Heidelberg, Germany.
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10882
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Sarikaya H, Benhidjeb T, Iosivan SI, Kolokotronis T, Förster C, Eckert S, Wilkens L, Nasser A, Rehberg S, Krüger M, Schulte am Esch J. Metal substitutions incarbonic anhydrase: a halide ion probe study. Biochem Biophys Res Commun 1975; 66:1281-1286. [PMID: 32934256 PMCID: PMC7493955 DOI: 10.1038/s41598-020-72025-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Accepted: 08/12/2020] [Indexed: 02/06/2023]
Abstract
The ASA score is known to be an independent predictor of complications and mortality following colorectal surgery. We evaluated early outcome in the initiation phase of a robotic oncological colorectal resection program in dependence of comorbidity and learning curve. 43 consecutive colorectal cancer patients (median age: 74 years) who underwent robotic surgery were firstly analysed defined by physical status (group A = ASA1 + 2; group B = ASA3). Secondly, outcome was evaluated relating to surgery date (group E: early phase; group L: late phase). There were no differences among groups A and B with regard to gender, BMI, skin-to-skin operative times (STS), N- and M-status, hospital-stay as well as overall rate of complications according to Dindo-Clavien and no one-year mortality. GroupA when compared to group B demonstrated significantly lower mean age (65.5 years ± 11.4 years vs 75.8 years ± 8.9 years), T-stage and ICU-stay. When separately analyzed for patients age ICU-stay was comparable (> 75 years vs. < 75 years). Group E and L demonstrated comparable characteristics and early outcome except more frequent lymphatic fistulas in group E. STS was reduced in group L compared to group E. Beyond learning curve aspects in our series, we could demonstrate that patient’s physical condition according to ASA rather than age may have an impact on early outcome in the initial phase of a robotic oncological colorectal program.
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Affiliation(s)
- Hülya Sarikaya
- Department of General and Visceral Surgery, Evangelisches Klinikum Bethel, Schildescher Str. 99, 33611 Bielefeld, Germany
| | - Tahar Benhidjeb
- Department of General and Visceral Surgery, Evangelisches Klinikum Bethel, Schildescher Str. 99, 33611 Bielefeld, Germany
- The New European Surgical Academy, Berlin, Germany
| | - Sergiu I. Iosivan
- Department of General and Visceral Surgery, Evangelisches Klinikum Bethel, Schildescher Str. 99, 33611 Bielefeld, Germany
| | - Theodoros Kolokotronis
- Department of General and Visceral Surgery, Evangelisches Klinikum Bethel, Schildescher Str. 99, 33611 Bielefeld, Germany
| | | | - Stephan Eckert
- Department of Anaesthesiology, Intensive Care-, Emergency- and Pain-Medicine, Evangelisches Klinikum Bethel, Bielefeld, Germany
| | - Ludwig Wilkens
- Institute of Pathology, Clinic Region Hannover, Hannover, Germany
| | - Alaa Nasser
- Department of General and Visceral Surgery, Evangelisches Klinikum Bethel, Schildescher Str. 99, 33611 Bielefeld, Germany
| | - Sebastian Rehberg
- Department of Anaesthesiology, Intensive Care-, Emergency- and Pain-Medicine, Evangelisches Klinikum Bethel, Bielefeld, Germany
| | - Martin Krüger
- Department of Gastroenterology and Internal Medicine, Evangelisches Klinikum Bethel, Bielefeld, Germany
| | - Jan Schulte am Esch
- Department of General and Visceral Surgery, Evangelisches Klinikum Bethel, Schildescher Str. 99, 33611 Bielefeld, Germany
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