Undifferentiated embryonal sarcoma of the liver is a malignancy with poor prognosis observed more frequently in children between 6 and 10 years old and very rarely found in adults. We present a case ...of embryonal sarcoma of the liver in a 60-year-old woman without significant medical history who presented to our attention with constitutional symptoms. Preoperative assessments did not show alterations in blood chemistry or tumor markers. Imaging studies showed a huge mass lying in the right abdominal quadrants, strictly adherent to the liver. The tumor was partially cystic with a thickened wall, sporadic contrast enhancement, and solid component. The patient underwent excision of the mass with associated liver bisegmentectomy S5-S6. Postoperative course was uneventful. The definitive histological diagnosis revealed the presence of embryonal sarcoma of the liver. We describe the clinical, histopathological, and therapeutic options adopted in the multimodal treatment of this disease.
Solitary fibrous tumor is a mesenchymal tumor of intermediate malignant potential characterized by a recurrent NAB2::STAT6 fusion and STAT6 nuclear expression. Primary thyroid solitary fibrous tumor ...is relatively uncommon, with 45 cases described in the English literature to date. Although its histologic features are characteristic, its diagnosis in the thyroid can be problematic, especially in small biopsies or cytology specimens. We herein present three new cases of thyroid solitary fibrous tumor, one of which is malignant, with new insights on the morphological spectrum and malignant potential of this tumor. We additionally provide a review of the literature with a focus on the clues and challenges of a preoperative cytological diagnosis of this tumor, which can nowadays be supported by STAT6 nuclear expression, when appropriately suspected.
Post-operative hypocalcemia and postoperative persistent hypoparathyroidism remain the most common complications after thyroidectomy. Many approaches have been developed to prevent them, but ...actually, a common protocol is not yet individuated.
We retrospectively analyzed the results of a prospectively collected database. We dosed PTH preoperatively and 4 h after surgery (PTH_4); calcium was evaluated preoperatively, on the first (I_POD) and on the second postoperative day (II_POD). Hypocalcemia was defined when calcium <8 mg/dl. PTH_4 and I_POD calcium serum levels are identified to predict postoperative hypocalcemia.
Three hundred and forty-eight patients were enrolled, 37 patients resulted as hypocalcemic on I_POD and 41 on the II_POD. PTH_4 is related to I_POD (
< 0.001,
= 0.45) and II_POD (
< 0.001,
= 0.44) calcemia. PTH_4-cut-off predicting I_POD hypocalcemia was 10.50 pg/ml (sensitivity: 78.7%, specificity: 72.7%). A PTH_4 value of 11.5 pg/ml is able to predict hypocalcemia during II_POD (sensitivity: 76.5%, specificity: 69.2%). We set up a combined test to predict II_POD hypocalcemia, using PTH_4 and I_POD calcium (sensitivity: 77.8%, specificity: 89.9%).
This research shows the association between PTH_4 and postoperative hypocalcemia. The PTH_4 cut-off to predict I_POD-hypocalcemia was 10.5 pg/ml. We analyzed the calcemia trend during the postoperative period and we realized a combined test using PTH_4 and I_POD-calcemia. This test improves the accuracy of the previous test. Further studies, in particular multicentric, with a larger sample are necessary to validate the combined model.
There is still no consensus about timing of laparoscopic cholecystectomy after endoscopic retrograde cholangiopancreatography in the treatment of cholecystocholedocholithiasis. The aim of our ...retrospective study is to analyze the optimal timing of surgical treatment in patients presenting concurrent choledocholithiasis, choosing to perform a sequential endoscopic plus surgical approach, introducing a same-day two-stage alternative. All cases of cholecystocholedocholithiasis occurred between January 2007 and December 2014 in “Gradenigo” Hospital (Turin—Italy) were reviewed. Patients were divided into three groups, based on the timing of cholecystectomy after endoscopic retrograde cholangiopancreatography, and compared. Out of 2233 cholecystectomies performed in the mentioned time interval, have been identified 93 patients that fulfill the selection criteria. 36 patients were treated with a same-day approach, while 29 within first 72 h and 28 with delayed surgery. The overall length of stay was significantly lower in patients that were treated with a same-day approach (4.7 days), compared with other groups (
p
= 0.001), while no significant differences were found in terms of length of surgical intervention, intraoperative complications and conversions to open procedure, postoperative stay, morbidity and mortality. Patients treated with delayed surgery had a 18 % recurrency rate of biliary events, with an odds ratio of 14.13 (
p
= 0.018). Same-day two-stage approach should be performed in suitable patients at the index admission, reducing overall risks, improving the patients’ quality-of-life, preventing recurrency, leading to a significant cost abatement; furthermore, this approach allows same outcomes of laparoendoscopic rendezvous, avoiding technical and organizational troubles.
Laparoscopic access in low anterior rectal resection is widely adopted, performing an ‘up-to-down’ dissection. The aim of this study is to present and analyze the outcomes of a novel surgical ...‘down-to-up’ total mesorectal excision technique that could obviate to the well-known issues of the standard treatment. 18 suitable patients underwent double endolaparoscopic pelvic access (DEPA) ‘down-to-up’ technique. DEPA TME was completed in all patients, with intact mesorectum. Mean operative time was 365 min (range 280–510 min). The morbidity rate was 22 %, including three radiologically detected leakage (grade A) and one pelvic abscess, requiring only a conservative management. Mortality rate at 30 and 90 days was 0 %. Resection margins were negative in all patients. A median of 11 nodes (range 5–19) was retrieved per specimen. Mean length of hospital stay was 9 days (range 7–19 days). Patients were followed for an average of 14 months (range 0–42 months), with no recurrence. Despite exiguous patient’s sample in this pilot study, transanal endoscopic TME with laparoscopic assistance seems to be feasible and safe, and is a promising alternative to open and laparoscopic TME. However, a conspicuous functional and oncologic long-term evaluation is required, before the widespread adoption could be recommended.
Acute gallstone-related pancreatitis is a potentially life-threatening condition, and its adequate therapy is represented by cholecystectomy. The aim of this study was to analyze the best surgical ...strategy, and the optimal timing.
All cases of acute pancreatitis of biliary origin occurred between January 2007 and December 2013 in Gradenigo Hospital (Turin, Italy) undergone to a surgical procedure, were reviewed. Patients were divided in two groups, based on the timing of cholecystectomy, and compared.
Out of 2233 cholecystectomies performed in the mentioned time interval, we have identified 79 patients that fulfill the selection criteria. 24 patients were treated with an index-stay procedure, while 55 with a delayed approach. Length of stay was significantly lower in patients that underwent to an early laparoscopic cholecystectomy (9 vs. 13 days, P=0.003), while no differences were found in terms of length of intervention, intraoperative complications, postoperative stay and mortality. Patients treated with delayed surgery had a 28.6% recurrence rate of acute pancreatitis, with an odds ratio of 10.28 (P=0.02).
Early laparoscopic cholecystectomy should be performed in suitable patients in the index admission, reducing overall risks, avoiding or at least minimizing recurrencies, and rationalizing the scarce economic resources.
Studies employing noninvasive pressure support ventilation in cardiogenic pulmonary edema have been performed in the intensive care unit when overt respiratory failure is already present and in small ...groups of patients. In this multicenter study, performed in emergency departments, 130 patients with acute respiratory failure were randomized to receive medical therapy plus O2 (65 patients) or noninvasive pressure support ventilation (65 patients). The primary end point was the need for intubation; secondary end points were in-hospital mortality and changes in some physiological variables. Noninvasive pressure support ventilation improved PaO2/FIO2, respiratory rate, and dyspnea significantly faster. Intubation rate, hospital mortality, and duration of hospital stay were similar in the two groups. In the subgroup of hypercapnic patients noninvasive pressure support ventilation improved PaCO2 significantly faster and reduced the intubation rate compared with medical therapy (2 of 33 versus 9 of 31; p=0.015). Adverse events, including myocardial infarction, were evenly distributed in the two groups. We conclude that during acute respiratory failure due to cardiogenic pulmonary edema the early use of noninvasive pressure support ventilation accelerates the improvement in PaO2/FIO2, PaCO2, dyspnea, and respiratory rate, but does not affect the overall clinical outcome. Noninvasive pressure support ventilation does, however, reduce the intubation rate in the subgroup of hypercapnic patients.
How to Prepare Leaders for a Crisis Cutt, Andrea Hyatt; Miller, Dave; Borasi, Raffaella ...
The learning professional,
11/2021, Letnik:
42, Številka:
5
Journal Article
The COVID-19 pandemic found many K-12 school leaders unprepared to deal with the magnitude and duration of this emergency. Dealing with sustained crises is not sufficiently addressed in most K-12 ...leadership programs, nor in the National Educational Leadership Preparation (NELP) standards (NPBEA, 2018). What can be done to better prepare leaders for similar situations in the future? The authors interviewed over 50 school leaders in the 2020-21 school year to better understand their experiences during the pandemic. Their stories enabled the authors to identify distinct challenges they experienced -- and felt ill-equipped to address -- at three different stages of the COVID-19 pandemic: (1) The immediate emergency as schools closed in spring 2020, which necessitated quick decision-making; (2) The continuing crisis of the 2020-21 school year, which called for sustained solutions; and (3) The long-term response to the crisis as schools reopened in fall 2021 and planned for the future. In this article, the authors present school leaders' insights during COVID-19 by suggesting ways to strengthen leadership preparation and support.
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