242 research outputs found
Cervical esophagotomy for removal of an ingested clam shell: a very uncommon foreign body ingestion
Get PDFOBJECTIVE:
To report the removal of an ingested clam shell that was firmly impacted in the esophagus.
CLINICAL PRESENTATION AND INTERVENTION:
A 77-year-old man presented at our hospital with acute dysphagia after eating a seafood risotto. An urgent dedicated examination (noncontrast helical multislice computed tomography scan of the neck and flexible esophagoscopy) detected a clam shell lodged in the upper esophagus. After several unsuccessful endoscopic attempts, a lifesaving cervical esophagotomy was performed and the foreign body was retrieved.
CONCLUSION:
This patient who ingested clam shell recovered well following the retrieval of the foreign body by performing a lifesaving cervical esophagotomy
Hollow viscus injuries. Predictors of outcome and role of diagnostic delay
Get PDFINTRODUCTION:
Hollow viscus injuries (HVIs) are uncommon but potentially catastrophic conditions with high mortality and morbidity rates. The aim of this study was to analyze our 16-year experience with patients undergoing surgery for blunt or penetrating bowel trauma to identify prognostic factors with particular attention to the influence of diagnostic delay on outcome.
METHODS:
From our multicenter trauma registry, we selected 169 consecutive patients with an HVI, enrolled from 2000 to 2016. Preoperative, intraoperative, and postoperative data were analyzed to assess determinants of mortality, morbidity, and length of stay by univariate and multivariate analysis models.
RESULTS:
Overall mortality and morbidity rates were 15.9% and 36.1%, respectively. The mean length of hospital stay was 23±7 days. Morbidity was independently related to an increase of white blood cells (P=0.01), and to delay of treatment >6 hours (P=0.033), while Injury Severity Score (ISS) (P=0.01), presence of shock (P=0.01), and a low diastolic arterial pressure registered at emergency room admission (P=0.02) significantly affected postoperative mortality.
CONCLUSION:
There is evidence that patients with clinical signs of shock, low diastolic pressure at admission, and high ISS are at increased risk of postoperative mortality. Leukocytosis and delayed treatment (>6 hours) were independent predictors of postoperative morbidity. More effort should be made to increase the preoperative detection rate of HVI and reduce the delay of treatment
Surgical strategies for duodenal GISTs: benefits and limitations of minimal resections
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Conservative surgery vs. duodeneopancreatectomy in primary duodenal gastrointestinal stromal tumors (GIST): a retrospective review of 114 patients from the French sarcoma group (FSG). [Eur J Surg Oncol. 2014
CRP Predicts Safe Patient Discharge after Colorectal Surgery. Reply
Get PDFReply: We would like to thank Aurelie´n Dupre`, Johan Gagnie´r, Heloı¨se Samba, Michel Rivoire, and Karem Slim for their comments about our article ‘‘Procalcitonin Reveals Early Dehiscence in Colorectal Surgery: The PREDICS Study.’’1 It is very rewarding to realize that this paper is stimulating so many observations, this means thatwe are talking about an interesting topic
Hepatocellular Carcinoma in a non-Cirrhotic Liver of a HCV-Positive Woman with Sustained Viral Response
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L’Arte dell’osservazione, dall’opera artistica alla diagnosi Le prime esperienze in Sapienza Università di Roma, a Medicina e Chirurgia
Get PDFThis study describes how Visual Thinking Strategies (VTS) as a methodological practice can help medical students learn and acquire analytical ability. This ability, capable of improving observational acumen and generally acquired only after years of clinical experience, may be achieved also by recourse to the systematic and reasoned examination of the visual arts, in particular paintings.
Students attending the third year Medicine and Surgery degree-course, within the ambit of the faculty’s integrated medical-scientific and humanities teaching-learning activities, followed an elective course which began with a preparatory-explanatory lecture on the analytical methodologies applied to the study of art, followed by a practical workshop held at Rome’s Galleria Borghese and ended with a third and final lecture where the students themselves provided the teachers who conducted the course with direct feedback regarding the three phases of the course.
The students’ appraisal of the experiences was positive; the experiment is on-going and has been extended to embrace other courses held by the Sapienza University.
Further observations are needed at present to validate the effectiveness to medical training of this kind of course in the long term, even though the limited number of experiments carried out in other countries, whose historical and artistic heritages are undoubtedly not so rich as Italy’s, attest to their undeniable usefulness to students of medicine and surgery at both analytical and, no less important, humanistic-educational level
Laparoscopic versus open rectal resection. a 1:2 propensity score-matched analysis of oncological adequateness, short- and long-term outcomes
Get PDFLaparoscopic resections for rectal cancer are routinely performed in high-volume centres. Despite short-term advantages have been demonstrated, the oncological outcomes are still debated. The aim of this study was to compare the oncological adequateness of the surgical specimen and the long-term outcomes between open (ORR) and laparoscopic (LRR) rectal resections
Leptomeningeal carcinomatosis in early gastric cancer: a case report and literature review
Get PDFLeptomeningeal carcinomatosis (LC) is a rare site of metastasis in solid tumors, and it is associated with poor prognosis due to disabling symptoms and a scarcity of treatment options. This condition is an uncommon entity in gastric cancer (GC). We present a case of primary LC manifestation in a patient with an incidental diagnosis of localized node-negative GC. We additionally perform a literature review and discuss the diagnostic and therapeutic challenges. In conclusion, LC from GC represents a rare condition with a dramatic prognosis. Its diagnosis might be very challenging. A multidisciplinary approach appears to be the best strategy for the management of LC from GC
Procalcitonin Reveals Early Dehiscence in Colorectal Surgery: The PREDICS Study
Get PDFObjectives: We designed a multicentric, observational study to test if Procalcitonin (PCT) might be an early and reliable marker of anastomotic leak (AL) after colorectal surgery (ClinicalTrials.govIdentifier:NCT01817647). Background: Procalcitonin is a biomarker used to monitor bacterial infections and guide antibiotic therapy. Anastomotic leak after colorectal surgery is a severe complication associated with relevant short and long-term sequelae. Methods: Between January 2013 and September 2014, 504 patients underwent colorectal surgery, for malignant colorectal diseases, in elective setting. White blood count (WBC), C-reactive protein (CRP) and PCT levels were measured in 3rd and 5th postoperative day (POD). AL and all postoperative complications were recorded. Results: We registered 28 (5.6%) anastomotic leaks. Specificity and negative predictive value for AL with PCT less than 2.7 and 2.3 ng/mL were, respectively, 91.7% and 96.9% in 3rd POD and 93% and 98.3% in 5th POD. Receiver operating characteristic curve for biomarkers shows that in 3rd POD, PCTand CRP have similar area under the curve (AUC) (0.775 vs 0.772), both better than WBC (0.601); in 5th POD, PCT has a better AUC than CRP and WBC (0.862 vs 0.806 vs 0.611). Measuring together PCT and CRP significantly improves AL diagnosis in 5th POD (AUC: 0.901). Conclusions: PCTand CRP demonstrated to have a good negative predictive value for AL, both in 3rd and in 5th POD. Low levels of PCT, together with low CRP values, seem to be early and reliable markers of AL after colorectal surgery. These biomarkers might be safely added as additional criteria of discharge protocols after colorectal surgery
Oncological Adequacy of Laparoscopic Surgery for Bulky Gastric Cancer. Results of a Western Single-Center Series
Get PDFBackground: Gastric cancer is increasing worldwide and one million new cases were estimated globally in 2020. Use of the laparoscopic approach is increasing especially for subtotal gastrectomy. However, to date, solid data on locally advanced bulky tumors are lacking. The aim of this study is to assess the role of laparoscopic surgery in bulky gastric tumors.
Methods: We performed an observational retrospective single-center analysis. The following data were collected and analyzed for each patient: demographics, tumor-related data, intra-operative data, peri-operative data, and pathological data. Statistical analysis was conducted, including descriptive statistics and chi-squared test, to analyze the differences between categorical variables.
Results: O the 116 patients who underwent gastric surgery, 49 patients were included in the study protocol. All patients had bulky gastric tumors. Eighteen patients underwent laparoscopic gastrectomy and 31 open gastrectomy. The median number of lymph nodes removed was 28.5 (15-46) in the laparoscopic group and 23.05 (6-62) in the open group (p = 0.04). In total, 5.6% of patients of the laparoscopic group had <16 lymph nodes harvested and 35.5% in the open group (p = 0.035). No statistical differences were found between the open and laparoscopic groups in terms of surgical margins (p = 0.69).
Conclusions: Laparoscopic surgery is still a subject of debate in locally advanced bulky gastric cancer. Limited data are available concerning Western patients. This study showed superiority in terms of the quality of lymphadenectomy and non-inferiority in terms of radical resection margins
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