The role of negative pressure wound therapy in the treatment of pilonidal disease

Pilonidal disease is a particularly difficult disorderto treat. Guidelines and recommendations for the treatment ofpilonidal disease neglect the use of negative pressure woundtherapy (NPWT), but studies strongly support the role of NPWTin preventing surgical site infection in high-risk patients.During a webinar on the pilonidal disease, we asked 51participants to complete a questionnaire about the treatmentof pilonidal disease. They answered questions about treatmentpractices for patients with a pilonidal disease, and the use ofNPWT.The study showed that a relatively large number of surgeonsuse NPWT to treat patients with the pilonidal disease. Themajority of them are satisfied with maintaining the tightnessand effectiveness of a vacuum dressing and would use thesingle-use NPWT systems if they were more easily available andaffordable. It seems that the NPWT in the pilonidal disease isincreasingly used and this method is gaining popularity amongpractitioners

Novel therapeutic strategies for patients with NSCLC that do not respond to treatment with EGFR inhibitors

Introduction: Treatment with epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) yields tumour responses in non-small cell lung cancer (NSCLC) patients harbouring activating EGFR mutations. However, even in long-lasting responses, resistance to EGFR TKIs invariably occurs. Areas covered: This review examines resistance mechanisms to EGFR TKI treatment, which mainly arise from secondary EGFR mutations. Other resistance-inducing processes include mesenchymal\u2013epithelial transition factor (MET) amplification, epithelial\u2013mesenchymal transformation, phenotypic change from NSCLC to small-cell lung carcinoma, and modifications in parallel signalling pathways. Current therapeutic strategies to overcome these EGFR TKI resistance mechanisms focus on the inhibition or blocking of multiple members of the ErbB family. Several molecules which target multiple ErbB receptors are being investigated in NSCLC and other indications including afatinib, an ErbB Family Blocker, as well as dacomitinib and lapatinib. Novel, non-quinazoline, EGFR inhibitors, that also target EGFR activating and resistance (T790M) mutations, are currently under clinical development. Other therapeutic strategies include inhibition of parallel and downstream pathways, using agents which target heat shock protein (HSP)90 orpoly (ADP-ribose) polymerase in addition to mammalian target of rapamycin (mTOR), monoclonal antibodies against the insulin-like growth factor-1 receptor, and fulvestrant-mediated oestrogen receptor regulation. Conclusion: Improved understanding of mechanisms underlying resistance to EGFR TKIs emphasises the importance of a genotype-guided approach to therapy. Elucidation of resistance mechanisms is indeed crucial to target innovative therapeutic approaches and to improve the efficacy of anticancer regimes in NSCLC

Hermann Kantorowicz i Theodor Viehweg przeciwko pozytywizmowi prawniczemu

Article’s aim is to describe the essence of Hermann Kantorowicz’s and Theodor Viehweg’s theoretical stand against legal positivism. Two basic works analysed in the article are H. Kantorowicz‘s Der Kampf um die Rechtswissenschaft [The Struggle for the Science of Law] (1906) and Th. Viehweg’s Topik und Jurisprudenz [Topic and Jurispudence] (1974). Article aims to compare these two scholars’ theoretical stand against legal positivism to the negation of scientific paradigm as described by Thomas S. Kuhn. The article contains methodological reflection. The author briefly defines legal positivism.. According to the author, H. Kanotorowicz negated legal positivism from the perspective similar to Protestantism. He claimed that the person ascertaining the law should somehow “evolve” and become “self-conscious”. Th. Viehweg’s theory emphasizes that it is impossible to treat the law as a complete, logical system. He claimed that law should be treated as a sum of topoi, rather resolving concrete problems than aiming to form the system.Celem artykułu jest opisanie istoty Hermanna Kantorowicza i Theodora Viehwega teoretycznego odniesienia wobec pozytywizmu prawniczego. Dwie kluczowe prace opisane w artykule to H. Kantorowicza Walka o naukę prawa (1906) i Th. Viehwega Topika i jurysprudencja (1974). Artykuł porównuje teoretyczne nastawienie dwóch wspomnianych badaczy wobec pozytywizmu prawniczego do negacji paradygmatu naukowego opisanego przez Thomasa S. Kuhna. Artykuł zawiera refleksje metodologiczne. Autor krótko ustala, co to jest pozytywizm prawniczy. Według autora H. Kantorowicz negował pozytywizm prawniczy z perspektywy podobnej do protestantyzmu. Uznawał, że osoba określająca prawo musi niejako „ewoluować” i stać się „samo-świadoma”. Teoria Th. Viehwega podkreśla, że niemożliwym jest traktować prawo jako skończony, logiczny system. Uważał on, że prawo powinno być traktowane jako suma topoi, czyli jako raczej rozwiązujące konkretne problemy niż zmierzające do uformowania wspomnianego systemu

Pancreaticopleural Fistula as a Rare Cause of Both-Sided Pleural Effusion

A pancreaticopleural fistula is a rare cause of pleural effusion. It is a complication of chronic or acute pancreatitis. It is rarely formed to the right or both pleural cavities. Diagnosis and proper treatment often turn out to be difficult and require the cooperation of a multidisciplinary team. The authors present the case of a 59-year-old patient treated for recurrent pleural effusion of unknown origin, first to the left and then to the right pleural cavity. After many months of treatment, the diagnosis of a pancreaticopleural fistula was made. The patient underwent surgery, which finally led to a successful complete recovery. Pancreaticopleural fistula should always be considered in patients with pleural effusion of unknown origin

The role of negative pressure wound therapy in the treatment of pilonidal disease

Pilonidal disease is a particularly difficult disorderto treat. Guidelines and recommendations for the treatment ofpilonidal disease neglect the use of negative pressure woundtherapy (NPWT), but studies strongly support the role of NPWTin preventing surgical site infection in high-risk patients.During a webinar on the pilonidal disease, we asked 51participants to complete a questionnaire about the treatmentof pilonidal disease. They answered questions about treatmentpractices for patients with a pilonidal disease, and the use ofNPWT.The study showed that a relatively large number of surgeonsuse NPWT to treat patients with the pilonidal disease. Themajority of them are satisfied with maintaining the tightnessand effectiveness of a vacuum dressing and would use thesingle-use NPWT systems if they were more easily available andaffordable. It seems that the NPWT in the pilonidal disease isincreasingly used and this method is gaining popularity amongpractitioners

Improving Outcomes of Bariatric Surgery in Patients With Cirrhosis in the United States: A Nationwide Assessment

Introduction: With increasing burden of obesity and liver disease in the United States, a better understanding of bariatric surgery in context of cirrhosis is needed. We described trends of hospital-based outcomes of bariatric surgery among cirrhotics and determined effect of volume status and type of surgery on these outcomes. Methods: In this population-based study, admissions for bariatric surgery were extracted from the National Inpatient Sample using International Classification of Diseases, 9th and 10th Revision, Clinical Modification codes from 2004 to 2016 and grouped by cirrhosis status, type of bariatric surgery, and center volume. In-hospital mortality, complications, and their trends were compared between these groups using weighted counts, odds ratios [ORs], and logistic regression. Results: Among 1,679,828 admissions for bariatric surgery, 9,802 (0.58%) had cirrhosis. Cirrhosis admissions were more likely to be in white men, had higher Elixhauser Index, and higher in-hospital complications rates including death (1.81% vs 0.17%), acute kidney injury (4.5% vs 1.2%), bleeding (2.9% vs 1.1%), and operative complications (2% vs 0.6%) (P < 0.001 for all) compared to those without cirrhosis. Overtime, restrictive surgeries have grown in number (12%-71%) and complications rates have trended down in both groups. Cirrhotics undergoing bariatric surgery at low-volume centers (<50 procedures per year) and nonrestrictive surgery had a higher inpatient mortality rate (adjusted OR 4.50, 95% confidence interval 3.14-6.45, adjusted OR 4.00, 95% confidence interval 2.68-5.97, respectively). Discussion: Contemporary data indicate that among admissions for bariatric surgery, there is a shift to restrictive-type surgeries with an improvement in-hospital complications and mortality. However, patients with cirrhosis especially those at low-volume centers have significantly higher risk of worse outcomes (see Visual abstract, Supplementary Digital Content, http://links.lww.com/AJG/B648)