Hospital-acquired infections are nowadays a major health care problem worldwide. The morbidity and mortality associated with them are highest in intensive care units, but their effects are ...identifiable in virtually any medical department. Information about hospital-acquired infections, especially about their preventive measures, are rarely presented nowadays in a correct fashion to patients. This article aims to present, in a structured manner, the theoretical and practical aspects related to disclosure of hospital-acquired infections-related information to patients and its importance in preventing their spread. We will analyze both the conceptual framework for disclosing medical information related to nosocomial infections (autonomy, veracity, social justice, the principle of double effect, the precautionary principle, and nonmaleficence) and the practicalities regarding the disclosure of proper information to patients.
To characterize the pattern of primary small bowel cancers in a tertiary East-European hospital.
A retrospective study of patients with small bowel cancers admitted to a tertiary emergency center, ...over the past 15 years.
There were 57 patients with small bowel cancer, representing 0.039% of admissions and 0.059% of laparotomies. There were 37 (64.9%) men, mean age of 58 years; and 72 years for females. Out of 57 patients, 48 (84.2%) were admitted due to an emergency situation: obstruction in 21 (38.9%), perforation in 17 (31.5%), upper gastrointestinal bleeding in 8 (14.8%), and lower gastrointestinal bleeding in 2 (3.7%). There were 10 (17.5%) duodenal tumors, 21 (36.8%) jejunal tumors and 26 (45.6%) ileal tumors. The most frequent neoplasms were gastrointestinal stromal tumor in 24 patients (42.1%), adenocarcinoma in 19 (33.3%), lymphoma in 8 (14%), and carcinoids in 2 (3.5%). The prevalence of duodenal adenocarcinoma was 14.55 times greater than that of the small bowel, and the prevalence of duodenal stromal tumors was 1.818 time greater than that of the small bowel. Obstruction was the complication in adenocarcinoma in 57.9% of cases, and perforation was the major local complication (47.8%) in stromal tumors.
Primary small bowel cancers are usually diagnosed at advanced stages, and revealed by a local complication of the tumor. Their surgical management in emergency setting is associated to significant morbidity and mortality rates.
Objective:
This Delphi exercise aimed to gather consensus surrounding risk factors, diagnosis, and management of chyle leaks after esophagectomy and to develop recommendations for clinical practice.
...Background:
Chyle leaks following esophagectomy for malignancy are uncommon. Although they are associated with increased morbidity and mortality, diagnosis and management of these patients remain controversial and a challenge globally.
Methods:
This was a modified Delphi exercise was delivered to clinicians across the oesophagogastric anastomosis collaborative. A 5-staged iterative process was used to gather consensus on clinical practice, including a scoping systematic review (stage 1), 2 rounds of anonymous electronic voting (stages 2 and 3), data-based analysis (stage 4), and guideline and consensus development (stage 5). Stratified analyses were performed by surgeon specialty and surgeon volume.
Results:
In stage 1, the steering committee proposed areas of uncertainty across 5 domains: risk factors, intraoperative techniques, and postoperative management (ie, diagnosis, severity, and treatment). In stages 2 and 3, 275 and 250 respondents respectively participated in online voting. Consensus was achieved on intraoperative thoracic duct ligation, postoperative diagnosis by milky chest drain output and biochemical testing with triglycerides and chylomicrons, assessing severity with volume of chest drain over 24 hours and a step-up approach in the management of chyle leaks. Stratified analyses demonstrated consistent results. In stage 4, data from the Oesophagogastric Anastomosis Audit demonstrated that chyle leaks occurred in 5.4% (122/2247). Increasing chyle leak grades were associated with higher rates of pulmonary complications, return to theater, prolonged length of stay, and 90-day mortality. In stage 5, 41 surgeons developed a set of recommendations in the intraoperative techniques, diagnosis, and management of chyle leaks.
Conclusions:
Several areas of consensus were reached surrounding diagnosis and management of chyle leaks following esophagectomy for malignancy. Guidance in clinical practice through adaptation of recommendations from this consensus may help in the prevention of, timely diagnosis, and management of chyle leaks.
In Western countries gastric cancer continues to remain a biologically aggressive tumor, with poorlong-term oncological outcomes. In Romania, the estimated gastric cancer was the fifth cause ...ofoncological death in men and the eighth cause of oncological death in women in 2012.The objectiveof the study is to detail when should the hepatoduodenal ligament (station 12) be cleared surgicallyas a part of D2 dissection during radical gastrectomy.We have performed a review of the Englishlanguage literature using PubMed/Medline library. As keywords we used a combination of thefollowing terms: ‘gastrectomy’, ‘stomach’, ‘cancer’, and ‘lymphadenectomy’. According to theJapanese Gastric Cancer Association, the hepatoduodenal ligament includes the lymph nodesstation 12, which are further divided in 12a – along left side of the proper hepatic artery, 12b –right side of the ligament and posterior to the common bile duct, and 12p – posterior to the portalvein. For middle and lower third gastric tumors, station 12a represents the N2 tier, while for upperthird gastric tumors, it represents the N3 tier. Lymph nodes 12b and 12p represent N3, irrespectiveof the tumor location. For middle and lower third gastric tumors the clearance of the lymph nodessurrounding the proper hepatic artery is a part of the D2 dissection. Dissection of the lymph nodessurrounding the proper hepatic artery is a component of the D2 spleen and pancreas preservinglymphadenectomy, for lesions which extend further than submucosa.
Type 2 Diabetes Mellitus (T2DM) and Acute Pancreatitis (AP) are usually perceived as two different types of pancreatic pathology. Even though, there is a growing evidence that there is a mutual ...influence between these two diseases.Our aim is to assess the risk of patients with T2DM to develop AP according to the three grades of severity of Atlanta 2012 Classification of AP. We consider the hypotheses that patients with T2DM have a greater risk of more severe forms of AP because they have a reduced resistance for acute illnesses. We analyzed all consecutive cases of Acute Pancreatitis admitted to Surgical Clinic during the entire year of 2014.
Lynch syndrome is the most common genetic predisposition for hereditary cancer but remains underdiagnosed. Large prospective observational studies have recently increased understanding of the ...effectiveness of colonoscopic surveillance and the heterogeneity of cancer risk between genotypes. The need for gene- and gender-specific guidelines has been acknowledged.
The European Hereditary Tumour Group (EHTG) and European Society of Coloproctology (ESCP) developed a multidisciplinary working group consisting of surgeons, clinical and molecular geneticists, pathologists, epidemiologists, gastroenterologists, and patient representation to conduct a graded evidence review. The previous Mallorca guideline format was used to revise the clinical guidance. Consensus for the guidance statements was acquired by three Delphi voting rounds.
Recommendations for clinical and molecular identification of Lynch syndrome, surgical and endoscopic management of Lynch syndrome-associated colorectal cancer, and preventive measures for cancer were produced. The emphasis was on surgical and gastroenterological aspects of the cancer spectrum. Manchester consensus guidelines for gynaecological management were endorsed. Executive and layperson summaries were provided.
The recommendations from the EHTG and ESCP for identification of patients with Lynch syndrome, colorectal surveillance, surgical management of colorectal cancer, lifestyle and chemoprevention in Lynch syndrome that reached a consensus (at least 80 per cent) are presented.
The lifetime risk of stroke has been calculated in a limited number of selected populations. We sought to estimate the lifetime risk of stroke at the regional, country, and global level using data ...from a comprehensive study of the prevalence of major diseases.
We used the Global Burden of Disease (GBD) Study 2016 estimates of stroke incidence and the competing risks of death from any cause other than stroke to calculate the cumulative lifetime risks of first stroke, ischemic stroke, or hemorrhagic stroke among adults 25 years of age or older. Estimates of the lifetime risks in the years 1990 and 2016 were compared. Countries were categorized into quintiles of the sociodemographic index (SDI) used in the GBD Study, and the risks were compared across quintiles. Comparisons were made with the use of point estimates and uncertainty intervals representing the 2.5th and 97.5th percentiles around the estimate.
The estimated global lifetime risk of stroke from the age of 25 years onward was 24.9% (95% uncertainty interval, 23.5 to 26.2); the risk among men was 24.7% (95% uncertainty interval, 23.3 to 26.0), and the risk among women was 25.1% (95% uncertainty interval, 23.7 to 26.5). The risk of ischemic stroke was 18.3%, and the risk of hemorrhagic stroke was 8.2%. In high-SDI, high-middle-SDI, and low-SDI countries, the estimated lifetime risk of stroke was 23.5%, 31.1% (highest risk), and 13.2% (lowest risk), respectively; the 95% uncertainty intervals did not overlap between these categories. The highest estimated lifetime risks of stroke according to GBD region were in East Asia (38.8%), Central Europe (31.7%), and Eastern Europe (31.6%), and the lowest risk was in eastern sub-Saharan Africa (11.8%). The mean global lifetime risk of stroke increased from 22.8% in 1990 to 24.9% in 2016, a relative increase of 8.9% (95% uncertainty interval, 6.2 to 11.5); the competing risk of death from any cause other than stroke was considered in this calculation.
In 2016, the global lifetime risk of stroke from the age of 25 years onward was approximately 25% among both men and women. There was geographic variation in the lifetime risk of stroke, with the highest risks in East Asia, Central Europe, and Eastern Europe. (Funded by the Bill and Melinda Gates Foundation.).
The original article 1 contained an error in authorship whereby author, Fausto Catena was mistakenly listed as part of the institutional authorship of the OBA trial supporters instead of in the ...correct position of final author.
Nowadays the laparoscopic approach represents the gold standard for acute cholecystitis, but we are facing little evidence regarding the elderly patients. The purpose of this study is to define the ...benefits in terms of early outcome for laparoscopic cholecystectomy in patients over 70 years old and to compare them with the open cholecystectomy through a retrospective study of patients that underwent a cholecystectomy during 12 months in the Emergency Hospital of Bucharest, Romania. Out of 49 patients, 20 had a laparoscopic cholecystectomy (LC) and 29 an open approach (OC). The mean age was 74,6 ± 4,2 (LC) vs. 77,2 ± 5,4 (OC) (P>0.05). There were 7 (33,3%) (LC) vs. 2 (7,1%) (OC) catarrhal cholecystitis, 13 (62%) (LC) vs. 9 (32,1%) (OC) phlegmonous cholecystitis, and 1 (4,8%) (LC) vs. 17 (60,7%) (OC) gangrenous cholecystitis (P=0.001, Cramer’s V=0,590). The median operative time was 90 (LC) vs. 60 (OC) minutes (P=0.001). There were no differences regarding the ASA risk scale (P=0,253). The median number of days to resume the diet was 3 (LC) vs. 4 (OC) (P=0.009). The median length of hospital stay was 72 hours (LC) vs. 120 hours (OC) (P=0.011). One patient died in the OC group and none in the LC group.To conclude, the laparoscopic approach in acute cholecystitis of elderly patients is safe. It is followed by a lower morbidity rate, a shorter length of hospital stay and by a more rapid return to normal activities.
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