36 research outputs found
Generalised Pustular Psoriasis (von Zumbusch type) following renal Transplantation. Report of a case and review of the literature
Generalized pustular psoriasis appears as an uncommon variant form of psoriasis consisting of widespread pustules on an erythematous background (von Zumbusch). A 39-year old male patient with a history of plaque psoriasis since the age of 9 who had an acute onset of generalized pustular psoriasis 12 days after he underwent renal transplantation is presented. Despite administered immunosuppression for transplantation the addition of cyclosporine A and methotrexate did not reverse the ongoing process of disease and the patient died on the 57th post-transplant day due to multiorgan failure following severe bone marrow suppression
“High or low Inferior Mesenteric Artery ligation in Laparoscopic low Anterior Resection: study protocol for a randomized controlled trial” (HIGHLOW trial)
COVID-19 and the Global Impact on Colorectal Practice and Surgery
Background: The novel severe acute respiratory syndrome coronavirus 2 virus that emerged in December 2019 causing coronavirus disease 2019 (COVID-19) has led to the sudden national reorganization of health care systems and changes in the delivery of health care globally. The purpose of our study was to use a survey to assess the global effects of COVID-19 on colorectal practice and surgery. Materials and Methods: A panel of International Society of University Colon and Rectal Surgeons (ISUCRS) selected 22 questions, which were included in the questionnaire. The questionnaire was distributed electronically to ISUCRS fellows and other surgeons included in the ISUCRS database and was advertised on social media sites. The questionnaire remained open from April 16 to 28, 2020. Results: A total of 287 surgeons completed the survey. Of the 287 respondents, 90% were colorectal specialists or general surgeons with an interest in colorectal disease. COVID-19 had affected the practice of 96% of the surgeons, and 52% were now using telemedicine. Also, 66% reported that elective colorectal cancer surgery could proceed but with perioperative precautions. Of the 287 respondents, 19.5% reported that the use of personal protective equipment was the most important perioperative precaution. However, personal protective equipment was only provided by 9.1% of hospitals. In addition, 64% of surgeons were offering minimally invasive surgery. However, 44% reported that enough information was not available regarding the safety of the loss of intra-abdominal carbon dioxide gas during the COVID-19 pandemic. Finally, 61% of the surgeons were prepared to defer elective colorectal cancer surgery, with 29% willing to defer for ≤ 8 weeks. Conclusion: The results from our survey have demonstrated that, globally, COVID-19 has affected the ability of colorectal surgeons to offer care to their patients. We have also discussed suggestions for various practical adaptation strategies for use during the recovery period. We have presented the results of a survey used to assess the global impact of coronavirus disease 2019 (COVID-19) on the delivery of colorectal surgery. Despite accessible guidance information, our results have demonstrated that COVID-19 has significantly affected the ability of colorectal surgeons to offer care to patients. We have also discussed practical adaptation strategies for use during the recovery phase
Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries.
BACKGROUND: As global initiatives increase patient access to surgical treatments, there remains a need to understand the adverse effects of surgery and define appropriate levels of perioperative care. METHODS: We designed a prospective international 7-day cohort study of outcomes following elective adult inpatient surgery in 27 countries. The primary outcome was in-hospital complications. Secondary outcomes were death following a complication (failure to rescue) and death in hospital. Process measures were admission to critical care immediately after surgery or to treat a complication and duration of hospital stay. A single definition of critical care was used for all countries. RESULTS: A total of 474 hospitals in 19 high-, 7 middle- and 1 low-income country were included in the primary analysis. Data included 44 814 patients with a median hospital stay of 4 (range 2-7) days. A total of 7508 patients (16.8%) developed one or more postoperative complication and 207 died (0.5%). The overall mortality among patients who developed complications was 2.8%. Mortality following complications ranged from 2.4% for pulmonary embolism to 43.9% for cardiac arrest. A total of 4360 (9.7%) patients were admitted to a critical care unit as routine immediately after surgery, of whom 2198 (50.4%) developed a complication, with 105 (2.4%) deaths. A total of 1233 patients (16.4%) were admitted to a critical care unit to treat complications, with 119 (9.7%) deaths. Despite lower baseline risk, outcomes were similar in low- and middle-income compared with high-income countries. CONCLUSIONS: Poor patient outcomes are common after inpatient surgery. Global initiatives to increase access to surgical treatments should also address the need for safe perioperative care. STUDY REGISTRATION: ISRCTN5181700
TEP versus TAPP: comparison of the perioperative outcome in 17,587 patients with a primary unilateral inguinal hernia
The combined use of serum neurotensin and IL-8 as screening markers for colorectal cancer
This pilot study aimed to determine the feasibility of serum
neurotensin/IL-8 values being used as a screening tool for colorectal
cancer. Fifty-six patients and 15 healthy controls were assigned to
seven groups according to their disease entity based on theater records
and histology report. Blood samples for neurotensin and IL-8 were
measured using an enzyme-linked immunosorbent assay. There were no
differences in the clinical and biochemical parameters of patients and
controls. Group (p = 0.003) and age (p = 0.059, marginally significant)
were independent predictors of neurotensin plasma values. Neurotensin (p
= 0.004) and IL-8 (p = 0.029) differed between healthy and colorectal
cancer patients. Neurotensin values differentiate the control group from
all remaining groups. The value of plasma neurotensin a parts per
thousand currency sign54.47 pg/ml at enrollment selected by receiver
operating characteristic (ROC) curves demonstrated a sensitivity of 77
%, specificity of 90 %, and an estimate of area under ROC curve
(accuracy) of 85 % in predicting colorectal cancer. At enrollment, the
value of plasma IL-8 a parts per thousand yen8.83 pg/ml had a
sensitivity of 85 %, specificity 80 %, and an estimate of area under
ROC curve (accuracy) of 81 % in predicting colorectal cancer. IL-8
should be used complementary to neurotensin due to its lower
specificity. None of the colorectal cancer patients displayed a
combination of high neurotensin and low IL-8 values (beyond cutoffs). It
seems that a blood neurotensin/IL-8 system may be used as a screening
tool for colorectal cancer, but much has to be done before it is
validated in larger-scale prospective studies
Efficacy of the open anterior prosthetic repair in the surgical management of recurrent inguinal hernia in old patients
Endoscopic total extraperitoneal repair of recurrent inguinal hernia: a 5-year review
10.1007/s10029-010-0675-yHernia145477-48