Intoxication à la Méthadone chez l'enfant

info:eu-repo/semantics/publishe

Amyand’s hernia, a rare clinical presentation. Diagnostic and therapeutic update on the role of cœlioscopy

Introduction: Appendicite aiguë et hernie etranglée sont des urgences chirurgicales courantes dont le diagnostic et le traitement sont aisés. L’ existence d'un appendice inflammatoire ou non dans une hernie étranglée est rare. Ce syndrome est appelé hernie d'Amyand ou syndrome d’Amyand.Nous décrivons deux de ces rares présentations et proposons mise au point et traitement.Dans le premier cas, le diagnostic de syndrome Claude-Amyand a été posé avant l’intervention au moyen d’un CT-scanner abdominal. Une appendicectomie fut tout d’abord réalisée suivie de la cure de hernie dans un deuxième temps. Dans le deuxième cas, seul le diagnostic de hernie fut posé par échographie en préopératoire. La persistance d’un syndrome inflammatoire 4 jours après l’opération et d’un syndrome abdominal douloureux justifiait alors un Ct scanner qui démontrait la présence d’un plastron appendiculaire laissé en place lors de la première interventionDiscussion: Il est rare que l’appendice enflammé se glisse dans une hernie ou une éventration et favorise son étranglement. Le chirurgien doit être conscient que le sac herniaire peut contenir autre chose que l’intestin ou de l’épiploon non enflammé. En présence d’une pathologie herniaire associée à un syndrome inflammatoire, un CT pré-opératoire doit être réalisé. Nous proposons qu’une coelioscopie soit réalisée si l’examen du sac herniaire ne confirme pas l’impression radiologique Conclusion: La connaissance chirurgicale des complications potentielles liées à la prise en charge des hernies étranglées est primordiale pour la détermination de la stratégie opératoireinfo:eu-repo/semantics/publishe

Penetrating atherosclerotic ulcer of the descending thoracic aorta: Treatment by endovascular stent-graft

SCOPUS: ar.jinfo:eu-repo/semantics/publishe

An international assessment of the adoption of enhanced recovery after surgery (ERAS®) principles across colorectal units in 2019–2020

AimThe Enhanced Recovery After Surgery (ERAS®) Society guidelines aim to standardize perioperative care in colorectal surgery via 25 principles. We aimed to assess the variation in uptake of these principles across an international network of colorectal units.MethodAn online survey was circulated amongst European Society of Coloproctology members in 2019–2020. For each ERAS principle, respondents were asked to score how frequently the principle was implemented in their hospital, from 1 (‘rarely’) to 4 (‘always’). Respondents were also asked to recall whether practice had changed since 2017. Subgroup analyses based on hospital characteristics were conducted.ResultsOf hospitals approached, 58% responded to the survey (195/335), with 296 individual responses (multiple responses were received from some hospitals). The majority were European (163/195, 83.6%). Overall, respondents indicated they ‘most often’ or ‘always’ adhered to most individual ERAS principles (18/25, 72%). Variability in the uptake of principles was reported, with universal uptake of some principles (e.g., prophylactic antibiotics; early mobilization) and inconsistency from ‘rarely’ to ‘always’ in others (e.g., no nasogastric intubation; no preoperative fasting and carbohydrate drinks). In alignment with 2018 ERAS guideline updates, adherence to principles for prehabilitation, managing anaemia and postoperative nutrition appears to have increased since 2017.ConclusionsUptake of ERAS principles varied across hospitals, and not all 25 principles were equally adhered to. Whilst some principles exhibited a high level of acceptance, others had a wide variability in uptake indicative of controversy or barriers to uptake. Further research into specific principles is required to improve ERAS implementation.AimThe Enhanced Recovery After Surgery (ERAS®) Society guidelines aim to standardize perioperative care in colorectal surgery via 25 principles. We aimed to assess the variation in uptake of these principles across an international network of colorectal units.MethodAn online survey was circulated amongst European Society of Coloproctology members in 2019–2020. For each ERAS principle, respondents were asked to score how frequently the principle was implemented in their hospital, from 1 (‘rarely’) to 4 (‘always’). Respondents were also asked to recall whether practice had changed since 2017. Subgroup analyses based on hospital characteristics were conducted.ResultsOf hospitals approached, 58% responded to the survey (195/335), with 296 individual responses (multiple responses were received from some hospitals). The majority were European (163/195, 83.6%). Overall, respondents indicated they ‘most often’ or ‘always’ adhered to most individual ERAS principles (18/25, 72%). Variability in the uptake of principles was reported, with universal uptake of some principles (e.g., prophylactic antibiotics; early mobilization) and inconsistency from ‘rarely’ to ‘always’ in others (e.g., no nasogastric intubation; no preoperative fasting and carbohydrate drinks). In alignment with 2018 ERAS guideline updates, adherence to principles for prehabilitation, managing anaemia and postoperative nutrition appears to have increased since 2017.ConclusionsUptake of ERAS principles varied across hospitals, and not all 25 principles were equally adhered to. Whilst some principles exhibited a high level of acceptance, others had a wide variability in uptake indicative of controversy or barriers to uptake. Further research into specific principles is required to improve ERAS implementation.A