2,788 research outputs found

    Grand challenges in colorectal and proctological surgery

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    Colorectal surgery (CRS) and proctology represent a branch of general surgery that is becoming increasingly important and relevant. In recent decades, there have been so many innovations that have given coloproctological surgery an identity of its own. In recent years, innovations in major CRS have been revolutionizing healthcare and improving patient outcomes ranging from early diagnosis to the most modern treatment options

    Outcomes after perioperative SARS-CoV-2 infection in patients with proximal femoral fractures: an international cohort study

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    Objectives Studies have demonstrated high rates of mortality in people with proximal femoral fracture and SARS-CoV-2, but there is limited published data on the factors that influence mortality for clinicians to make informed treatment decisions. This study aims to report the 30-day mortality associated with perioperative infection of patients undergoing surgery for proximal femoral fractures and to examine the factors that influence mortality in a multivariate analysis.Setting Prospective, international, multicentre, observational cohort study.Participants Patients undergoing any operation for a proximal femoral fracture from 1 February to 30 April 2020 and with perioperative SARS-CoV-2 infection (either 7 days prior or 30-day postoperative).Primary outcome 30-day mortality. Multivariate modelling was performed to identify factors associated with 30-day mortality.Results This study reports included 1063 patients from 174 hospitals in 19 countries. Overall 30-day mortality was 29.4% (313/1063). In an adjusted model, 30-day mortality was associated with male gender (OR 2.29, 95% CI 1.68 to 3.13, p<0.001), age >80 years (OR 1.60, 95% CI 1.1 to 2.31, p=0.013), preoperative diagnosis of dementia (OR 1.57, 95% CI 1.15 to 2.16, p=0.005), kidney disease (OR 1.73, 95% CI 1.18 to 2.55, p=0.005) and congestive heart failure (OR 1.62, 95% CI 1.06 to 2.48, p=0.025). Mortality at 30 days was lower in patients with a preoperative diagnosis of SARS-CoV-2 (OR 0.6, 95% CI 0.6 (0.42 to 0.85), p=0.004). There was no difference in mortality in patients with an increase to delay in surgery (p=0.220) or type of anaesthetic given (p=0.787).Conclusions Patients undergoing surgery for a proximal femoral fracture with a perioperative infection of SARS-CoV-2 have a high rate of mortality. This study would support the need for providing these patients with individualised medical and anaesthetic care, including medical optimisation before theatre. Careful preoperative counselling is needed for those with a proximal femoral fracture and SARS-CoV-2, especially those in the highest risk groups

    Head and neck cancer surgery during the COVID-19 pandemic: an international, multicenter, observational cohort study

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    Background: The aims of this study were to provide data on the safety of head and neck cancer surgery currently being undertaken during the coronavirus disease 2019 (COVID-19) pandemic. Methods: This international, observational cohort study comprised 1137 consecutive patients with head and neck cancer undergoing primary surgery with curative intent in 26 countries. Factors associated with severe pulmonary complications in COVID-19–positive patients and infections in the surgical team were determined by univariate analysis. Results: Among the 1137 patients, the commonest sites were the oral cavity (38%) and the thyroid (21%). For oropharynx and larynx tumors, nonsurgical therapy was favored in most cases. There was evidence of surgical de-escalation of neck management and reconstruction. Overall 30-day mortality was 1.2%. Twenty-nine patients (3%) tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) within 30 days of surgery; 13 of these patients (44.8%) developed severe respiratory complications, and 3.51 (10.3%) died. There were significant correlations with an advanced tumor stage and admission to critical care. Members of the surgical team tested positive within 30 days of surgery in 40 cases (3%). There were significant associations with operations in which the patients also tested positive for SARS-CoV-2 within 30 days, with a high community incidence of SARS-CoV-2, with screened patients, with oral tumor sites, and with tracheostomy. Conclusions: Head and neck cancer surgery in the COVID-19 era appears safe even when surgery is prolonged and complex. The overlap in COVID-19 between patients and members of the surgical team raises the suspicion of failures in cross-infection measures or the use of personal protective equipment. Lay Summary: Head and neck surgery is safe for patients during the coronavirus disease 2019 pandemic even when it is lengthy and complex. This is significant because concerns over patient safety raised in many guidelines appear not to be reflected by outcomes, even for those who have other serious illnesses or require complex reconstructions. Patients subjected to suboptimal or nonstandard treatments should be carefully followed up to optimize their cancer outcomes. The overlap between patients and surgeons testing positive for severe acute respiratory syndrome coronavirus 2 is notable and emphasizes the need for fastidious cross-infection controls and effective personal protective equipment

    A pilot study on the efficacy and safety of preoperative micronized purified flavonoid fraction treatment and sucralfate-based rectal ointment on patients with grade II to IV hemorrhoidal disease

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    BACKGROUND: Hemorrhoidal disease (HD) is a chronic and extremely common condition that negatively impacts patients’ quality of life. The aim of the present study was to evaluate the changes in symptom severity and the need for further interventions following treatment with the oral micronized purified flavonoid fraction (MPFF) and a topical rectal ointment containing 3% sucralfate and herbal extracts (calendula, witch hazel leaf, chamomile). METHODS: A consecutive series of patients aged 18 to 75 with symptomatic II to IV-degree HD classified according to the Goligher classification were prospectively enrolled between September and December 2023. All patients were proposed a hypothetical surgical strategy at time 0 (T0) based on clinical presentation. At T1 (60 days), 7 days before any subsequent procedure, a different colorectal surgeon from the one who conducted the initial assessment performed a reassessment. All enrolled patients underwent medical therapy with a 500 mg MPFF twice daily and rectal ointment twice daily for a duration of 60 days, in addition to conservative therapy. The primary outcome was the change in symptom severity from T0 to T1, assessed using the Hemorrhoidal Disease Symptom Score (HDSS), Short Health Scale HD (SHS-HD) and Vaizey incontinence score. Secondary outcomes included the rate of downgrading intervention. RESULTS: The present study included 34 patients (15 [44.1%] female) with a median age of 46.5 years (IQR 30-66). Both HDSS and SHS statistically improved from a median value of 11 and 16 at T0 to 2 and 1 at T1, respectively (P<0.00001). In 12 out of 34 (35.3%) of patients, the second colorectal surgeon considered a less invasive treatment due to the downstaging of symptoms. CONCLUSIONS: Combined local and systemic treatment with MPFF and sucralfate-based rectal ointment for HD patients showed clinical advantages both in terms of reducing the severity of the disease and allowing a less invasive treatment in certain cases

    Preliminary functional results after transanal irrigation in patients undergoing SHiP procedure for low rectal cancer

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    The short-stump and high-anastomosis pull-through procedure (SHiP) is a newly introduced technique in the treatment of rectal cancer. This procedure does not involve the creation of a diverting ostomy with great improvement of the patients' quality of life in the post-operative period. However, functional post-operative alterations such as low anterior rectal resection syndrome (LARS) may occur. In this context, trans-anal irrigation (TAI) may represent a viable option in the treatment and management of LARS symptoms. The aim of the present study is to investigate the role of TAI in patients operated on SHiP procedure for low rectal cancer. A prospective database of 17 patients who underwent a SHiP procedure was maintained from April 2019 to December 2021. Anal continence and functional outcomes were assessed through LARS score and Cleveland Clinic Incontinence Score (CCIS), respectively. All patients with a LARS score > 21 underwent TAI in the post-operative period. LARS median value was 36 (IQR = 8) and drastically improved after TAI treatment to 3 (IQR = 3), as the CCIS at a mean follow-up of 9 months (SD +/- 5.02). Good functional result was reached in 12 out of 13 patients (92%). Our study confirms that patients with severe post-operative dysfunction could benefit from the use of TAI

    How Blockchain Technology Can Address Circularity and Trace Emission in the Energy Sector

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    This paper outlines the European perspective on circularity in the energy sector and details how blockchain could support it. Moreover, while the need for raw materials and e-fuels is increasing (due to the economic, industrial, and societal ecological transformation to slow down the pace of climate change), their supply becomes more and more risky. Therefore technologies to support tracing and certification are on the spot. To achieve resilience to new threats, Europe is pointing at circularity in all fields. Circularity requires the need for tracing substances and devices, food, and products, to retrieve and recycle as much as possible. Else than the need to limit the exploitation of the planet’s resources and thus stay within the planetary boundaries, circularity is tightly connected to strategic dependencies from highly unstable or politically distant countries. This issue is further aggravated by the Russia-Ukraine crisis. Digital technologies, like Distributed Ledger Technologies, can well support the implementation of circularity in many fields. The paper identifies challenges and proposes potential solutions related to the implementation of circularity. It also explores the application of circularity principles in the energy sector, with a focus on energy communities. Energy communities involve local stakeholders coming together to generate, consume, and manage renewable energy collectively. Overall, the paper provides insights into the European perspective on ecological transition, highlighting the importance of systemic transformation, resilience, and circularity in addressing climate change and achieving sustainability goals. It explores the role of digital technologies, such as Distributed Ledger Technologies (DLTs), in supporting circular practices and discusses specific applications in the energy sector

    Editorial: Management and Treatment of Pilonidal Disease: 189 Years After Mayo

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    ...Pilonidal Disease (PD) was first scientifically reported 189 years ago by Herbert Mayo, back in 1833, as a sinus containing hair follicles located in the sacrococcygeal region of a female patien

    Editorial: Advances in proctology and colorectal surgery

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    Proctology and colorectal surgery for benign disorders and neoplasia represent a broad field of general surgery. Their relevance is well known, on the one hand because of the still extremely high frequency in Western countries of colon-rectal cancer (currently estimated as the third most frequent cancer in the world), and on the other hand because of the serious impact on the quality of life (QoL) of patients suffering from benign, inflammatory, and functional diseases of the lower gastrointestinal tract. This Research Topic of Frontiers in Surgery, composed by forty-five original articles on colorectal surgery and proctology addresses several topics including non-surgical solutions, diagnostic aspects, translational research, and specific scenarios
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