Congenital diaphragmatic hernia (CDH) is a congenital abnormality, rare in adults with a frequency of 0.17-6%. Diaphragmatic rupture is an infrequent consequence of trauma, occurring in about 5% of ...severe closed thoraco-abdominal injuries. Clinical presentation ranges from asymptomatic cases to serious respiratory or gastrointestinal symptoms. Diagnosis depends on anamnesis, clinical signs and radiological investigations.
From May 2013 to June 2016, six cases (four females, two males; mean age 58 years) of diaphragmatic hernia were admitted to our Academic Department of General Surgery with respiratory and abdominal symptoms. Chest X-ray, barium studies and CT scan were performed.
Case 1 presented left diaphragmatic hernia containing transverse and descending colon. Case 2 showed left CDH which allowed passage of stomach, spleen and colon. Case 3 and 6 showed stomach in left hemithorax. Case 4 presented left diaphragmatic hernia which allowed passage of the spleen, left lobe of liver and transverse colon. Case 5 had stomach and spleen herniated into the chest. Emergency surgery was always performed. The hernia contents were reduced and defect was closed with primary repair or mesh. In all cases, post-operative courses were uneventful.
Overlapping abdominal and respiratory symptoms lead to diagnosis of diaphragmatic hernia, in patients with or without an history of trauma. Chest X-ray, CT scan and barium studies should be done to evaluate diaphragmatic defect, size, location and contents. Emergency surgical approach is mandatory reducing morbidity and mortality.
The original article 1 contains a minor typo in reference 47 (reference 2 in this Correction article); the correct reference notation can be shown in the respective reference within this article.
Business Process Management (BPM) is an accepted discipline and its importance in increasing automation inside industrial environment is today recognized by all players. The complexity of modern ...management process will lead to chaos without a well-designed and effective BPM. Several BPM Suites were compared and BPM approach was applied to the case study of process management in a renewable energy power plant. Results both in process reduction and simplification and flow optimization obtained in the real case are discussed to state efficacy and efficiency of the adopted approach.
The transportation sector is marked by high emissions, and new sustainable solutions are required to solve this problem. Biomethane, also known as green gas, has the potential to regenerate certain ...wastes, promoting resource circularity. This study aimed at evaluating the profitability of small- and medium-sized plants using the organic fraction of municipal solid waste (OFMSW) and by-products, considering a new incentive decree within the mature biogas-biomethane market of Italy. Net present value (NPV) was used as a key indicator, and sensitivity, scenario, and risk analyses were proposed. The results showed that a high subsidy for by-products contributed to the profitability of by-products plants across multiple contexts. Conversely, stringent incentive values for the OFMSW led to diminished profitability for plants treating this substrate. Consequently, profitability was verified for 100 m3/h plants with by-products and 300 m3/h plants with the OFMSW. The break-even point analysis showed that the tariff value determining project profitability, contingent on size and substrate, ranged from 0.61 to 0.95 €/m3 for the OFMSW and 0.76–1.01 €/m3 for by-products. The results provide valuable policy and managerial insights, emphasizing the support needed for biomethane – a renewable and circular resource – to achieve the twin goals of energy independence and a low-carbon economy. Consequently, biomethane has the potential to contribute to the achievement of Sustainable Development Goals 7 and 12.
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•OFMSW and by-products are circular resources towards sustainability.•Biomethane supports green transport and the development of the circular economy.•The profitability of biomethane plants is strongly influenced by subsidies.•The probability of having NPV>0 varies between 1 and 59 % with OFMSW.•The probability of having NPV>0 varies between 44 and 100 % with by-products.
Treating chronic low back pain (LBP) can be challenging, and the most effective pharmacological therapy is controversial. The present systematic review investigated the efficacy of various ...pharmacological compounds to achieve pain relief and improve disability in chronic LBP patients. The present study focused on acetaminophen, amoxicillin, flupirtine, baclofen, tryciclic antidepressants (TCAs), duloxetine, topiramate, gabapentinoids, non-steroid anti-inflammatory drugs (NSAIDs) and opioids.
All randomized clinical trials comparing two or more drug treatments for chronic low back pain were accessed. Studies reporting outcomes concerning patients with neurologic or mechanic, specific or aspecific low back pain with or without radiculopathy were included. LBP was considered chronic if pain had lasted more than 6 weeks. Data from 47 articles (9007 patients: mean age: 52.62 ± 7.0 years; mean BMI: 28.26 ± 2.8; mean follow-up: 3.23 ± 3.2 months) were obtained.
According to published level I evidence, only baclofen, duloxetine, NSAIDs, and opiates showed to improve pain and disability levels in patients with LBP. However, the patients' demographics are heterogeneous, and the results must be interpreted with caution and in the light of possible adverse events connected to the use of these drugs.
Femoroacetabular impingement (FAI) is a dynamic pathomechanical process of the femoral head-neck junction. Arthroscopic surgery for FAI has increased exponentially in the last decade, and this trend ...is expected to increase.
Recent published literatures.
FAI promotes quick rehabilitation and low complication rates in the short-term follow-up.
Despite the growing interest on arthroscopic surgery for FAI, current evidence regarding the medium- and long-term role of arthroscopy are unsatisfactory.
Systematically summarize current evidences, analyse the quantitative available data and investigate the medium- and long-term outcomes of arthroscopic surgery for FAI.
Arthroscopic surgery achieves very satisfactory outcomes for patients with FAI at a mean follow-up of 4 years.
Despite an established association with improved patient outcomes, compliance with National Comprehensive Cancer Network (NCCN) guidelines remains suboptimal. We sought to assess the effect of ...patient characteristics (PCs), operative characteristics (OCs), hospital characteristics (HCs), and social determinants of health (SDoH) on noncompliance with NCCN guidelines for colon cancer.
Patients treated for stage I to III colon cancer from 2004 to 2017 were identified from the National Cancer Database. Multilevel multivariate regression analysis was performed to identify factors associated with receipt of NCCN-compliant care and quantify the proportion of variance explained by PCs, OCs, HCs, and SDoH.
Among 468,097 patients with colon cancer treated across 1319 hospitals, 1 in 4 patients did not receive NCCN-compliant care (122,170 26.1%). On regression analysis, older age (odds ratio OR, 0.96; 95% CI, 0.96–0.96), female sex (OR, 0.97; 95% CI, 0.96–0.99), Black race (OR, 0.96; 95% CI, 0.94–0.98), higher Charlson-Deyo score (OR, 0.84; 95% CI, 0.82–0.86), tumor stage ≥II (OR, 0.42; 95% CI, 0.40–0.44), and tumor grade ≥ 3 (OR, 0.33; 95% CI, 0.32–0.34) were associated with lower odds of receiving NCCN-compliant care (all P values <.05). Higher hospital volume (OR, 1.02; 95% CI, 1.02–1.03), minimally invasive or robotic surgical approach (OR, 1.26; 95% CI, 1.23–1.29), adequate (≥12) lymph node assessment (OR, 3.46; 95% CI, 3.38–3.53), private insurance status (OR, 1.33; 95% CI, 1.26–1.40), Medicare insurance status (OR, 1.42; 95% CI, 1.35–1.49), and higher educational status (OR, 1.06; 95% CI, 1.02–1.09) were associated with higher odds of receiving NCCN-compliant care (all P values <.05). Overall, PCs contributed 36.5%, HCs contributed 1.3%, and OCs contributed 12.9% to the variation in guideline-compliant care, while SDoH contributed only 3.6% of the variation in receipt of NCCN-compliant care.
The variation in NCCN-compliant care among patients with colon cancer was largely attributable to patient- and surgeon-level factors, whereas SDoH were associated with a smaller proportion of the variation.
We sought to assess the impact of telemedicine on healthcare utilization and medical expenditures among patients with a diagnosis of gastrointestinal (GI) cancer.
Patients with newly diagnosed GI ...cancer from 2013 to 2020 were identified from the IBM MarketScan database (IBM Watson Health) . Healthcare utilization, total medical outpatient insurance payments within 1 year post-diagnosis, and out-of-pocket (OOP) expenses among telemedicine users and non-users were assessed after propensity score matching (PSM).
Among the 32,677 patients with GI cancer (esophageal, n = 1862, 5.7%; gastric, n = 2009, 6.1%; liver, n = 2929, 9.0%; bile duct, n = 597, 1.8%; pancreas, n = 3083, 9.4%; colorectal, n = 22,197, 67.9%), a total of 3063 (9.7%) utilized telemedicine. After PSM (telemedicine users, n = 3064; non-users, n = 3064), telemedicine users demonstrated a higher frequency of clinic visits (median: 5.0 days, IQR 4.0–7.0 vs non-users: 2.0 days, IQR 2.0–3.0, P < .001) and fewer potential days missed from daily activities (median: 7.5 days, IQR 4.5–12.5 vs non-users: 8.5 days, IQR 5.5–13.5, P < .001). Total medical spending per month and utilization of emergency room (ER) visits for telemedicine users were higher vs non-users (median: $10,658, IQR $5112–$18,528 vs non-users: $10,103, IQR $4628–$16,750; 46.8% vs 42.6%, both P < .01), whereas monthly OOP costs were comparable (median: $273, IQR $137–$449 for telemedicine users vs non-users: $268, IQR $142–$434, P = .625).
Telemedicine utilization was associated with increased outpatient clinic visits yet reduced potential days missed from daily activities among patients with GI cancer. Telemedicine users tended to have more ER visits and total medical spending per month, although monthly OOP costs were comparable with non-users.
Introduction
Benchmarking in surgery has been proposed as a means to compare results across institutions to establish best practices. We sought to define benchmark values for hepatectomy for ...intrahepatic cholangiocarcinoma (ICC) across an international population.
Methods
Patients who underwent liver resection for ICC between 1990 and 2020 were identified from an international database, including 14 Eastern and Western institutions. Patients operated on at high-volume centers who had no preoperative jaundice, ASA class <3, body mass index <35 km/m
2
, without need for bile duct or vascular resection were chosen as the benchmark group.
Results
Among 1193 patients who underwent curative-intent hepatectomy for ICC, 600 (50.3%) were included in the benchmark group. Among benchmark patients, median age was 58.0 years (interquartile range IQR 49.0–67.0), only 28 (4.7%) patients received neoadjuvant therapy, and most patients had a minor resection (
n
= 499, 83.2%). Benchmark values included ≥3 lymph nodes retrieved when lymphadenectomy was performed, blood loss ≤600 mL, perioperative blood transfusion rate ≤42.9%, and operative time ≤339 min. The postoperative benchmark values included TOO achievement ≥59.3%, positive resection margin ≤27.5%, 30-day readmission ≤3.6%, Clavien-Dindo III or more complications ≤14.3%, and 90-day mortality ≤4.8%, as well as hospital stay ≤14 days.
Conclusions
Benchmark cutoffs targeting short-term perioperative outcomes can help to facilitate comparisons across hospitals performing liver resection for ICC, assess inter-institutional variation, and identify the highest-performing centers to improve surgical and oncologic outcomes.
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