Outcomes and indications for Emergency Thoracotomy after adoption of a more liberal policy in a western European level 1 Trauma Center: 8-years experience.

Background: The role of Emergency Thoracotomy (ET) in blunt trauma is still a matter of debate and in Europe only small studies have been published. We report our experience about ET both in penetrating and blunt trauma, discussing indications, outcomes and proposing an algorithm for patient selection. Materials and methods: We retrospectively analysed patients who underwent ET at Maggiore Hospital Trauma Center over two periods: from January 1st, 2010 to December 31st, 2012, and from January 1st, 2013 to May 31st, 2017. Demographic and clinical data, mechanism of injury, Injury Severity Score, site of injury, time of witnessed cardiac arrest, presence/absence of signs of life, length of stay, were considered, as well as survival rate and neurological outcome. Results: 27 ETs were performed; 21 after blunt trauma and six after penetrating trauma. Motor vehicle accident was the main mechanism of injury, followed by fall from height. The mean age was 40,5 years and the median Injury Severity Score was of 40. The most frequent injury was cardiac tamponade. The overall survival rate was 10% during the first period and 23.5% during the second period, after the adoption of a more liberal policy. No long term neurological sequelae were reported. Conclusions: The outcomes of ET in trauma patient, either after penetrating or blunt trauma, are poor but not negligible. To date, only small series of ET from European trauma centers have been published, although larger series are available from USA and South Africa. However, in selected patients, all efforts must be made for the patient's survival; the possibility of organ donation should be taken into consideration as well

PENGARUH DOSIS PUPUK KOMPOS DAN NPK TERHADAP PERTUMBUHAN DAN HASIL BAWANG MERAH (ALLIUM ASCOLANICUM L.) VARIETAS BREBES

Penelitian ini bertujuan untuk mengetahui pengaruh kompos dan NPK pupuk terhadap pertumbuhan dan produksi tanaman bawang Brebes dan interaksi antara kedua faktor. Percobaan ini menggunakan Faktorial Rancangan Acak Pola. Faktor-faktor yang mempengaruhi dosis diuji kompos terdiri dari 4 tingkatan, yaitu: kontrol, 10, 20 dan 30 faktor ton / ha dan NPK dosis pupuk yang terdiri dari 4 tingkatan, yaitu: kontrol, 100, 200 dan 300 kg / ha, sehingga bahwa ada 16kombinasi perlakuan dengan 3 ulangan dan 48 unit percobaan, setiap unit terdiri dari 5 tanaman sampel percobaan.Hasil penelitian menunjukkan bahwa dosis kompos cenderung lebih baik pada dosis pengobatan 30 ton / ha untuk pertumbuhan dan hasil bawang. Sementara itu, NPK dosis pupuk untuk pertumbuhan dan hasil tanaman bawang merah cenderung lebih baik pada dosis pengobatan 200 kg NPK / ha. Tidak ada interaksi yang nyata antara perlakuan dosis pupuk NPK untuk kompos dengan semua variabel yang diamati pada pertumbuhan dan hasil bawang.Kata kunci: bawang, kompos, NPKBanda Ace

Rottura traumatica del diaframma: analisi retrospettiva di 30 casi trattati chirurgicamente.

7nonenoneBAIOCCHI G L; TIBERIO G A M; CONIGLIO A; VETTORETTO N; DESTER S; CEREA K; GIULINI S MBaiocchi, Gian Luca; Tiberio, Guido Alberto Massimo; Coniglio, Arianna; Vettoretto, N; Dester, S; Cerea, K; Giulini, Stefano Mari

Follow-up after surgery for gastric cancer: how to do it

There is no consensus on follow-up after gastric surgery for cancer, nor evidence that it improves outcomes. We investigated the impact of intensity of follow-up, comparing the regimens adopted by two centres, in Italy and in the UK. Patients who underwent surgery for gastric and junctional type-3 adenocarcinoma, between September 2009 and April 2013, at the Surgical Clinic, University of Brescia (Italy), and at the Department of Upper Gastrointestinal Surgery, University College London Hospital (UK), were identified. Patients' demographics, stage, recurrence rates, modality of detection and treatment were recorded. Overall survival and costs were compared between the two protocols. A total of 128 patients were included. Recurrence rates were similar (p = 0.349), with more than 70% diagnosed during regular follow-up appointments in both centres. At univariate and multivariate analysis, stage I and treatment of recurrence were associated with a better survival. Patients treated for recurrence at the Italian centre showed an almost significant better survival (p = 0.052). The intensive Italian surveillance protocol was associated with significant higher costs per year. Follow-up and early detection of recurrence did not affect survival in the analysed series, focused on periods in which chemotherapy was ineffective towards recurrence. However, intensive follow-up allowed a greater number of patients to receive a treatment for recurrence; this might prove useful in the next few years, when more effective chemotherapy combinations are expected to become available. The costs could be reduced by adopting a less intensive surveillance programme

How could we identify the ‘old’ patient in gastric cancer surgery? A single centre cohort study

To analyze the population submitted to gastric cancer surgery in our Institution in order to find those characteristics which could help in the identification of the elderly high-risk patient. In a cohort of 263 patients (>65 y) we selectively investigated the risk factors for medical and surgical complications and postoperative mortality, focusing on the variable “age”. All the significant variables were used to find predictors of complications with Clavien-Dindo>2. Age>75 (AUC 0.61; 95% 0.55–0.67, p = 0.003) and ASA score >2 (AUC 0.60; 95% CI 0.54–0.67, p = 0.01) were significantly associated with an increased risk of medical complications. Operative time >330 min (OR 1.00; 95% CI 1.00–1.01; p = 0.0001- AUC 0.62, 95% CI 0.56–0.68, p = 0.01) was the only significant predictor of surgical complications. In-hospital mortality (6/263 patients) was significantly associated with preoperative albumin ≤2.95 g/dl (OR 0.15; 95% CI 0.04–0.93, p = 0.041 – AUC 0.74 95% CI 0.68–0.80; p = 0.003) and additional procedures (OR 7.05; 1.23–40.32, p = 0.03). Stepwise multivariate analysis showed that albumin ≤2.95 g/dl (OR 3.43; 95% CI 1.06–11.13 p = 0.033), ASA>2 (OR 9.51; 95% CI 1.23–72.97; p = 0.042) and additional resections (OR 3.39; 95% CI 1.36–8.45; p = 0.045) were independent risk factors for complications Clavien Dindo >2. Our work demonstrated that, in our institution, 75 years of age could identify the elderly in gastric surgery as those patients were at higher risk of medical complications. ASA >2, preoperative serum albumin ≤2.95 g/dl and the need of additional procedures could increase the risk of severe postoperative adverse events