Emergency laparotomy is a common intra-abdominal procedure. Outcomes are generally recognized to be poor, but there is a paucity of hard UK data, and reports have mainly been confined to ...single-centre studies.
Clinicians were invited to join an ‘Emergency Laparotomy Network’ and to collect prospective non-risk-adjusted outcome data from a large number of NHS Trusts providing emergency surgical care. Data concerning what were considered to be key aspects of perioperative care, including thirty-day mortality, were collected over a 3 month period.
Data from 1853 patients were collected from 35 NHS hospitals. The unadjusted 30 day mortality was 14.9% for all patients and 24.4% in patients aged 80 or over. There was a wide variation between units in terms of the proportion of cases subject to key interventions that may affect outcomes. The presence of a consultant surgeon in theatre varied between 40.6% and 100% of cases, while a consultant anaesthetist was present in theatre for 25–100% of cases. Goal-directed fluid management was used in 0–63% of cases. Between 0% and 68.9% of the patients returned to the ward (level one) after surgery, and between 9.7% and 87.5% were admitted to intensive care (level three). Mortality rates varied from 3.6% to 41.7%.
This study confirms that emergency laparotomy in the UK carries a high mortality. The variation in clinical management and outcomes indicates the need for a national quality improvement programme.
Cardiopulmonary exercise testing (CPET) is increasingly used in the preoperative assessment of patients undergoing major surgery. The objective of this study was to investigate whether CPET can ...identify patients at risk of reduced survival after abdominal aortic aneurysm (AAA) repair.
Prospectively collected data from consecutive patients who underwent CPET before elective open or endovascular AAA repair (EVAR) at two tertiary vascular centres between January 2007 and October 2012 were analysed. A symptom-limited maximal CPET was performed on each patient. Multivariable Cox proportional hazards regression modelling was used to identify risk factors associated with reduced survival.
The study included 506 patients with a mean age of 73.4 (range 44–90). The majority (82.6%) were men and most (64.6%) underwent EVAR. The in-hospital mortality was 2.6%. The median follow-up was 26 months. The 3-year survival for patients with zero or one sub-threshold CPET value ( V˙O2 at AT<10.2 ml kg−1 min−1, peak V˙O2<15 ml kg−1 min−1 or V˙E/V˙CO2 at AT>42) was 86.4% compared with 59.9% for patients with three sub-threshold CPET values. Risk factors independently associated with survival were female sex hazard ratio (HR)=0.44, 95% confidence interval (CI) 0.22–0.85, P=0.015, diabetes (HR=1.95, 95% CI 1.04–3.69, P=0.039), preoperative statins (HR=0.58, 95% CI 0.38–0.90, P=0.016), haemoglobin g dl−1 (HR=0.84, 95% CI 0.74–0.95, P=0.006), peak V˙O2<15 ml kg−1 min−1 (HR=1.63, 95% CI 1.01–2.63, P=0.046), and V˙E/V˙CO2 at AT>42 (HR=1.68, 95% CI 1.00–2.80, P=0.049).
CPET variables are independent predictors of reduced survival after elective AAA repair and can identify a cohort of patients with reduced survival at 3 years post-procedure. CPET is a potentially useful adjunct for clinical decision-making in patients with AAA.
Context. PKS 1424+240 is a BL-Lac blazar with unknown redshift that was detected at high-energy gamma rays by Fermi-LAT with a hard spectrum. At very high energy (VHE), it was first detected by ...VERITAS and later confirmed by MAGIC. Its spectral energy distribution is highly attenuated at VHE gamma rays, which is coherent with distant sources. Several estimations enabled the redshift to be constrained to the range 0.6 <z< 1.3. These results place PKS 1424+240 in the very interesting condition of being probably the most distant blazar that has been detected at VHE. The ambiguity in the redshift is still large enough to prevent precise studies of the extragalatic background light and the intrinsic blazar spectrum. Aims. Given the difficulty of measuring spectroscopic redshifts for BL-Lac objects directly, we aim to establish a reliable redshift value for this blazar by finding its host group of galaxies. Methods. Elliptical galaxies are associated with groups, and BL-Lac objects are typically hosted by them, so we decided to search for the host group of the blazar. For this, we performed optical spectroscopic observations of thirty objects in the field of view of PKS 1424+240 using the Gemini Multi-Object Spectrograph. After analysing the data for groups, we evaluated the probability of finding groups of galaxies by chance around the position of PKS 1424+240, using a deep catalogue of groups. We also used photometric data from the SDSS catalogue to analyse the red sequence of the proposed blazar host group Results. We found a new group of galaxies with eight members at z = 0.6010 ± 0.003, a virial radius of Rvir = 1.53 Mpc, and a velocity dispersion of σv = 813 ± 187 km s-1. The photometric study indicates that more members are probably populating this previously uncatalogued group of galaxies. The probability of PKS 1424+240 being a member of this group was found to be ≳98%. Conclusions. The new group of galaxies found at z = 0.6010 ± 0.003 is very likely hosting PKS 1424+240.
This guideline aims to ensure that patients admitted to hospital for elective surgery are known to have blood pressures below 160 mmHg systolic and 100 mmHg diastolic in primary care. The objective ...for primary care is to fulfil this criterion before referral to secondary care for elective surgery. The objective for secondary care is to avoid spurious hypertensive measurements. Secondary care should not attempt to diagnose hypertension in patients who are normotensive in primary care. Patients who present to pre-operative assessment clinics without documented primary care blood pressures should proceed to elective surgery if clinic blood pressures are below 180 mmHg systolic and 110 mmHg diastolic.
Context. The BL-Lac blazar PKS 0447-439 is one of the brightest HE gamma-ray sources that were first detected by Fermi-LAT. It was also detected by H.E.S.S. at VHE gamma-rays, which allowed ...constraining the redshift of PKS 0447-439 by considering the attenuation caused by gamma-ray interactions with ambient photons in the extragalactic background light (EBL). This constraint agreed with color-magnitude and spectroscopic redshift constraints (0.179 <z< 0.56). Recently, however, a much higher redshift was proposed for this blazar (z> 1.2). This value was debated because if true, it would imply either that the relevant absorption processes of gamma-rays are not well understood or that the EBL is dramatically different from what is believed today. This high redshift was not confirmed by three independent new spectroscopic observations at high signal-to-noise ratios. The scenario is clear evidence of the difficulties in estimating the redshift of BL-Lac objects, whose optical spectra are typically featureless. Neither of the estimated redshifts for PKS 0447-439 are confirmed as yet. Aims. Given that BL-Lac are typically hosted by elliptical galaxies, which in turn are associated with groups, we aim to find the host group of galaxies of PKS 0447-439. The ultimate goal is to estimate a redshift for this blazar. Methods. Spectra of twenty-one objects in the field of view of PKS 0447-439 were obtained with the Gemini Multi-Object Spectrograph. Based on the redshifts and coordinates of these galaxies, we searched for groups of galaxies. Using a deep catalog of groups, we studied the probability of finding by chance a group of galaxies in the line of sight of PKS 0447-439. Results. We identified a group of galaxies that was not previously cataloged at z = 0.343 with seven members, a virial radius of 0.42 Mpc, and a velocity dispersion of 622 km s-1. We found that the probability of the host galaxy of PKS 0447-439 to be a member of the new group is ≳97%. Therefore, we propose to adopt z = 0.343 ± 0.002 as the most likely redshift for PKS 0447-439.
Current UK practice in emergency laparotomy Barrow, E; Anderson, ID; Varley, S ...
Annals of the Royal College of Surgeons of England,
11/2013, Letnik:
95, Številka:
8
Journal Article
Recenzirano
Odprti dostop
Introduction
Emergency laparotomy is a common procedure, with 30,000–50,000 performed annually in the UK. This large scale study reports the current spectrum of emergency laparotomies, and the ...influence of the surgical procedure, underlying pathology and subspecialty of the operating surgeon on mortality.
Methods
Anonymised data on consecutive patients undergoing an emergency laparotomy were submitted for a three-month period. The primary outcome measure was unadjusted 30-day mortality. Appendicectomy and cholecystectomy were among the procedures excluded.
Results
Data from 1,708 patients from 35 National Health Service hospitals were analysed. The overall 30-day mortality rate was 14.8%. ‘True’ emergency laparotomies (ie those classified by the National Confidential Enquiry into Patient Outcome and Death as immediate or urgent) comprised 86.5% of cases. The mortality rate rose from 8.0% among expedited cases to 14.3% among urgent cases and to 25.7% among laparotomies termed immediate. Among the most common index procedures, small bowel resection exhibited the highest 30-day mortality rate of 21.1%. The presence of abdominal sepsis was associated with raised 30-day mortality (17.5% in the presence of sepsis vs 12.6%, p=0.027). Colorectal procedures comprised 44.3% and within this group, data suggest that mortality from laparotomy may be influenced by surgical subspecialisation.
Conclusions
This report of a large number of patients undergoing emergency laparotomy in the UK confirms a remarkably high mortality by modern standards across the range. Very few pathologies or procedures can be considered anything other than high risk. The need for routine consultant involvement and critical care is evident, and the case distribution helps define the surgical skill set needed for a modern emergency laparotomy service. Preliminary data relating outcomes from emergency colonic surgery to surgical subspecialty require urgent further study.
Extragalactic very-high-energy (VHE; E > 100 GeV) sources are unique objects to study the most powerful particle accelerators in nature, as active galactic nuclei are likely sources of ...ultra-high-energy cosmic rays. BL Lacertae blazars are the most frequent extragalactic objects found in the VHE gamma-ray catalogs. It is very difficult to estimate their redshifts, considering they have no strong enough optical spectral features, hence ∼20% of them have unknown or poorly constrained redshifts. KUV 00311-1938 is a VHE BL Lacertae blazar, with an uncertain redshift in the range of 0.5 < z < 0.98. We have obtained deep spectroscopy using Gemini and the GTC telescopes of KUV 00311-1938 and its surroundings with high signal-to-noise ratio in 2016-2017. The lack of features did not allow us to determine the spectroscopic redshift of KUV 00311-1938; nevertheless, we obtain a lower limit of z 0.475. We determined the redshifts of 41 galaxies observed in the field-of-view of the blazar and through a population study, identified three pairs and four groups consisting of 3 or 4 members with redshifts in the range z = 0.1468-0.4756. Due to the absence of a large group of galaxies, we could not associate KUV 00311-1938 with any of the groups detected.
Reply from the authors Saunders, D. I; Murray, D; Peden, C. J ...
British journal of anaesthesia : BJA,
01/2013, Letnik:
110, Številka:
1
Journal Article
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