Nacido en el seno de una familia acomodada del Trentino austríaco, Damiano Chiesa se inició desde muy joven a la defensa de la italianità de este territorio. Sus años formativos se caracterizaron por ...su intensa actividad anti-austriaca, obligándole en más de una ocasión a hacer frente a las amenazas que provenían de la autoridad civil, particularmente atenta a sofocar cualquier ensayo patriótico-irredentista local. Elevado al grado de ‘mártir por la causa italiana’ al finalizar la Gran Guerra, compartió este reconocimiento con el socialista Cesare Battisti y el patriota Fabio Filzi, completando así la célebre tríada del irredentismo trentino.
Peptic ulcer disease is common with a lifetime prevalence in the general population of 5-10% and an incidence of 0.1-0.3% per year. Despite a sharp reduction in incidence and rates of hospital ...admission and mortality over the past 30 years, complications are still encountered in 10-20% of these patients. Peptic ulcer disease remains a significant healthcare problem, which can consume considerable financial resources. Management may involve various subspecialties including surgeons, gastroenterologists, and radiologists. Successful management of patients with complicated peptic ulcer (CPU) involves prompt recognition, resuscitation when required, appropriate antibiotic therapy, and timely surgical/radiological treatment.
The present guidelines have been developed according to the GRADE methodology. To create these guidelines, a panel of experts was designed and charged by the board of the WSES to perform a systematic review of the available literature and to provide evidence-based statements with immediate practical application. All the statements were presented and discussed during the 5th WSES Congress, and for each statement, a consensus among the WSES panel of experts was reached.
The population considered in these guidelines is adult patients with suspected complicated peptic ulcer disease. These guidelines present evidence-based international consensus statements on the management of complicated peptic ulcer from a collaboration of a panel of experts and are intended to improve the knowledge and the awareness of physicians around the world on this specific topic. We divided our work into the two main topics, bleeding and perforated peptic ulcer, and structured it into six main topics that cover the entire management process of patients with complicated peptic ulcer, from diagnosis at ED arrival to post-discharge antimicrobial therapy, to provide an up-to-date, easy-to-use tool that can help physicians and surgeons during the decision-making process.
En aquest article es pretén analitzar alguns dels esdeveniments finals de la Primera Guerra Mundial i els efectes que aquests van provocar en un país neutral com Espanya al llarg de la segona meitat ...de 1918. Aquest estudi es farà a través de l'enfocament periodístic d'una revista aliadòfila, Los Aliados, que al seu moment es va crear no solament com a resposta als ambients germanòfils –en la seva majoria reunits entorn de la revista Renovación Española–, sinó també com a nucli intel·lectual compromès amb una pau democràtica de clars matisos wilsonians. El que ens demostrarà que, malgrat la seva neutralitat, Espanya va romandre molt atenta al desenvolupament del conflicte i compromesa amb un debat que amb el temps va proporcionar les condicions de la seva futura adhesió a la Societat de Nacions. Quant a això, observarem que la propaganda va jugar un paper fonamental en aquest avanç polític, a causa de la publicació –precisament a Los Aliados– d'una ingent quantitat de material propagandístic provinent en la seva majoria des de l'exterior, originant al seu torn la base i el filtre informatiu més proper a les postures aliadòfiles.
Periodista, opinionista y voz influyente del panorama político internacional, Louise Weiss (1893-1983) es considerada una de las mujeres más representativas del siglo XX. Sus inicios se remontan a la ...colaboración con la prestigiosa revista “L’Europe nouvelle”, coincidiendo con las últimas fases del primer conflicto mundial. Desde 1920 trabajó asiduamente con la idea de impulsar la integración europea, favoreciendo el intercambio de ideas y el entendimiento entre las naciones. Firme defensora de la participación femenina en los asuntos políticos y diplomáticos, luchó para dar una mayor visibilidad a las mujeres, introduciendo su discurso feminista en las rubricas de la revista, así como en los actos públicos. A partir de 1934 fundó “La Femme nouvelle”, dando así continuidad a su idea de una Europa plural, igualitaria y feminista.
The epidemiology and the outcomes of acute appendicitis in elderly patients are very different from the younger population. Elderly patients with acute appendicitis showed higher mortality, higher ...perforation rate, lower diagnostic accuracy, longer delay from symptoms onset and admission, higher postoperative complication rate and higher risk of colonic and appendiceal cancer. The aim of the present work was to investigate age-related factors that could influence a different approach, compared to the 2016 WSES Jerusalem guidelines on general population, in terms of diagnosis and management of elderly patient with acute appendicitis. During the XXIX National Congress of the Italian Society of Surgical Pathophysiology (SIFIPAC) held in Cesena (Italy) in May 2019, in collaboration with the Italian Society of Geriatric Surgery (SICG), the World Society of Emergency Surgery (WSES) and the Italian Society of Emergency Medicine (SIMEU), a panel of experts participated to a Consensus Conference where eight panelists presented a number of statements, which were developed for each of the four topics about diagnosis and management of acute appendicitis in elderly patients, formulated according to the GRADE system. The statements were then voted, eventually modified and finally approved by the participants to the Consensus Conference. The current paper is reporting the definitive guidelines statements on each of the following topics: diagnosis, non-operative management, operative management and antibiotic therapy.
The development of a new cholangioscope, the SpyGlass™ Discover (Boston Scientific), has allowed the laparoscopic transcystic common bile duct exploration and stone clearance. The possibility of ...simultaneous treatment of choledocholithiasis during early laparoscopic cholecystectomy offers the opportunity to enormously reduce the time between acute cholecystitis diagnosis and the execution of cholecystectomy with better outcomes for patients. Furthermore, an altered anatomy of the gastrointestinal tract is not an obstacle to this technique. The aim of the study was to determine whether this new procedure is feasible, safe, and effective.
The investigation employs a retrospective case series study including all consecutive patients with a diagnosis of common bile duct stones undergoing cholecystectomy and intraoperative laparoscopic common bile duct clearance using SpyGlass™ Discover at IRCCS Policlinico San Matteo in Pavia (Italy). Eighteen patients were included from May 2022 to May 2023.
A complete clearance of the common bile duct was obtained in 88.9% of patients. The mean postoperative length of stay was 3 days. No major complications occurred. After a median follow-up of 8 months, no recurrence of biliary events or readmissions occurred.
This procedure has proven to be feasible, safe, and effective.
Background
In recent years, many studies showed that the Trauma Mortality Probability Model (TMPM-ICD-9) had better calibration compared to other ICD-9-based models and to the ones based to the ...Abbreviated Injury Scale (AIS). The study aims to assess the validity of TMPM-ICD-9 in predicting injury severity in an Italian region and, through this model, to assess the performances of the Trauma Systems SIAT Romagna.
Methods
Administrative data of trauma patients admitted in the Trauma System of SIAT Romagna, in Northern Italy, from 2014 to 2018 were obtained. The XISS, an indirect indicator of Injury Severity Score (ISS) and the TMPM-POD (Probability of Death) were calculated from ICD-9-CM codes. Only patients with XISS > 15 were included. Student t-test, Mann–Whitney test and Chi-square test were used for univariate analyses, while logistic regression for multivariate analyses.
Results
3907 trauma patients with XISS > 15 were included. The Hub hospital (HUB) received 47.1% of these patients. Patients treated in HUB had higher TMPM-POD than in SPOKE + PST (mean TMPM-POD ± SD: HUB 0.093 ± 0.091, SPOKE + PST 0.082 ± 0.90,
p
< 0.027), but only age and sex were significant risk factors for centralization at multivariate analyses. Higher age (73.1 ± 21.2 vs 66.9 ± 21.2,
p
< 0.001), higher XISS (16(9) vs 16(4),
p
< 0.001) and higher TMPM-POD (0.15 ± 0.14 vs 0.08 ± 0.08,
p
< 0.001) resulted significant risk factors for mortality at multivariate analysis. Lower age, higher XISS and lower Trauma Centers (TC) level were significant risk factors for splenectomy at multivariate analysis. The splenectomy rate was 1.3% in HUB and of 2.2% in SPOKE + PST (Risk Ratio = 0.4,
p
= 0.002).
Conclusions
Present analysis proved the validity of TMPM-ICD-9 in predicting mortality of trauma patients in an Italian region. Furthermore, the usefulness of data extracted from an administrative database to assess the performance of a TS and the importance of an adequate centralization process have emerged. Even with a higher TMPM-POD and with the same mortality rate, HUB showed a higher spleen salvage rate compared to SPOKE + PST. However, thanks to this model, an improvable centralization process in SIAT Romagna was found in the study period. Probably, an enhanced centralization would have improved the spleen salvage rate, which is an important quality indicator in the evaluation of the performance of the TS
.
Acute appendicitis has been considered by surgeons a progressive disease leading to perforation for more than 100 years. In the last decades the theories about this concept gained attention, ...especially in adults. However, appendectomy for acute appendicitis remains the most common urgent/emergent surgical procedure. At present, accumulating evidences are showing the changing in clinical practice towards the non-operative management of several cases of acute appendicitis either non-complicated or complicated. The present review aims to show the literature results regarding the non-operative management of acute appendicitis in non-complicated and in complicated cases.
Gastric outlet obstruction can result from several benign and malignant diseases, in particular gastric, duodenal or pancreatic tumors. Surgical gastroenterostomy and enteral endoscopic stenting have ...represented effective therapeutic options, although recently endoscopic ultrasound-guided gastroenterostomy using lumen-apposing metal stent (LAMS) is spreading improving the outcome of this condition. However, this procedure, although mini-invasive, is burdened with not negligible complications, including misdeployment.
We report the case of a 60-year-old male with gastric outlet obstruction who underwent ultrasound-guided gastroenterostomy using LAMS. The procedure was complicated by LAMS misdeployment being managed by laparoscopy-assisted placement of a second LAMS. We performed a systematic review in order to identify all reported cases of misdeployment in EUS-GE and their management. The literature shows that misdeployment occurs in up to 10% of all EUS-GE procedures with a wide spectrum of possible strategies of treatment.
The here reported hybrid technique may offer an innovative strategy to manage LAMS misdeployment when this occurs. Moreover, a hybrid approach may be valuable to overcome this complication, especially in early phases of training of EUS-guided gastroenterostomy.
Abstract
Background
Endoscopic ultrasound-guided drainage is suggested as the first approach in the management of symptomatic and complex walled-off pancreatic necrosis. Dual approach with ...percutaneous drainage could be the best choice when the necrosis is deep extended till the pelvic paracolic gutter; however, the available catheter could not be large enough to drain solid necrosis neither to perform necrosectomy, entailing a higher need for surgery. Therefore, percutaneous endoscopic necrosectomy through a large bore percutaneous self-expandable metal stent has been proposed.
Case presentation
In this study, we present the case of a 61-year-old man admitted to our hospital with a history of sepsis and persistent multiorgan failure secondary to walled-off pancreatic necrosis due to acute necrotizing pancreatitis. Firstly, the patient underwent transgastric endoscopic ultrasound-guided drainage using a lumen-apposing metal stent and three sessions of direct endoscopic necrosectomy. Because of recurrence of multiorgan failure and the presence of the necrosis deeper to the pelvic paracolic gutter at computed tomography scan, we decided to perform percutaneous endoscopic necrosectomy using an esophageal self-expandable metal stent. After four sessions of necrosectomy, the collection was resolved without complications. Therefore, we perform a revision of the literature, in order to provide the state-of-art on this technique. The available data are, to date, derived by case reports and case series, which showed high rates both of technical and clinical success. However, a not negligible rate of adverse events has been reported, mainly represented by fistulas and abdominal pain.
Conclusion
Dual approach, using lumen apposing metal stent and percutaneous self-expandable metal stent, is a compelling option of treatment for patients affected by symptomatic, complex walled-off pancreatic necrosis, allowing to directly remove large amounts of necrosis avoiding surgery. Percutaneous endoscopic necrosectomy seems a promising technique that could be part of the step-up-approach, before emergency surgery. However, to date, it should be reserved in referral centers, where a multidisciplinary team is disposable.
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