Concepte contemporane în chirurgia reconstructivă a defectelor diafragmatice

Defectele diafragmatice congenitale și dobândite continuă să fie o problemă majoră în chirurgia pediatrică. În ultimii ani, tratamentul chirurgical al defectelor diafragmatice congenitale a evoluat de la o abordare urgentă la intervenții chirurgicale amânate, efectuate după stabilizarea stării copilului. Autorul descrie mai multe opinii conform cărora intervențiile chirurgicale de urgență rămân preferabile în herniile Bochdalek sau herniile diafragmatice majore asociate cu alte afecțiuni patologice: volvul gastric acut, perforația stomacului cu pneumotorax, peritonită perforativă, etc. În articol sunt descrise avantajele și dezavantajele a diferitor aborduri de- schise (thoracic, abdominal), strategiile de tratament miniinvaziv, cât și diverse procedeie tehnice de închidere a defectelor diafragmatice. Autorul conchide, că deși au fost înregistrate unele rezultate promițătoare în tratamentul herniilor și eventrațiilor diafragmatice congenitale, tratamentul consensusal al acestor malformații rămâne eluziv, dovezile clinice în sprijinul mai multor modalități terapeutice fiind limitate, impunându-se necesitatea unei evaluări atente cu estimarea realistă a potențialelor riscuri.Congenital and acquired diaphragmatic defects continue to be a major problem in pediatric surgery.Last years, the surgical treatment of congenital diaphragmatic defects has evolved from an urgent approach to delayed surgery after the child's condition has been sta- bilized. The author describes the opinion of several authors that emergency operations remain preferable in Bochdalek hernias or major diaphragmatic hernia associated with other pathological conditions: acute gastric volvulus, perforation of the stomach with pneumothorax, peritonitis, etc. There are described the advantages and disadvantages of thoracic and abdominal approach, the miniinvasive treatment strategies and the techniques of diaphragmatic defect closure. The author concludes that although some promising results have been recorded in the treatment of diaphragmatic hernias and eventrations, the consensus treatment of these malformations remains elusive, clinical evidence supporting several therapeutic modalities being limited, requiring a careful assessment with the realistic estimation of potential risks

Aspecte clinico-morfologice în chistul de arc II branchial la copil

Cazul prezentat ilucidează principiile de diagnostic și tratament chirurgical în chistul de arc II branchial la copii, autorii descriind și modificările morfopatologice caracteristice în această formațiune malformativă. Raritatea cazului prezentat are ca scop de a atenționa necesitatea unui indice de suspiciune sporit în cazurile unor formațiuni cervicale laterale pentru un diagnostic adecvat și un tratament corespunzător, examenul histologic al piesei de rezecție fiind obligator.The case illustrates the principles of diagnosis and treatment of branchial second arch cyst in children, the authors also described the morphopathological changes found in this malformative formation. The rarity of the presented case aims to warn of the need for an increased index of suspicion in cases of lateral cervical formations for proper diagnosis and treatment, the histological examination of the resection piece being mandatory

Particularitățile proceselor regenerative în reconstrucția defectelor diafragmatice cu alogrefe decelularizate de pericard porcin în model experimental

Actualmente se depun eforturi considerabile în elaborarea unor materiale biologice decelularizate ca alternativă de corecție chirurgicală a defectelor diafragmatice. Scopul acestui studiu a fost evaluarea eficienței, siguranței și particularităților proceselor de regenerare și remodelare tisulară ale alogrefelor decelularizate de pericard porcin crioprezervate, utilizate în reconstrucția defectelor diafragmatice, create chirurgical în model experimental la porci. Lotul de studiu a inclus 6 purcei cu greutatea de 10 kg, supuși laparotomiei subcostale stângi cu reconstrucția defectului diafragmatic, creat chirurgical, cu grefe decelularizate de pericard porcin (lotul 1 - 3 animale) și peritoneu porcin (lotul 2 - 3 animale). Exameul radilogic efectuat în loul 1 la 15 zile postoperator a stabilit o configurație normală a neohemidiafragmului creat, la a 60 zi postoperator fiind documentată eventrația nesemnificativă a neohemidiafragmului. În lotul 2 la a 15 zi postoperator a fost observată o eventrație neînsemnată a neohemidiafragmului, ulterior, ambele animale acestui lot decedînd subit la a 54 și a 60 zi postoperator din cauza dehiscenței grefei. În lotul I au fost observate zone cu o fibrilogeneză atipică (malformativă) care se evidențiau printr-un aspect multichistic sau lacunarcavitar, cu suprafețe interne tapetate cu epiteliu mezotelial peritoneal unistratificat aplatizat fără aspecte de activitate mitotică. Formațiunea cavitar-chistică putea fi și o pseudotumoră chistică cu septuri mai subțiri, cu o carcasă redusă din fibre de colagen. La animalele lotului 2 în ambele cazuri s-a constatat un hemidiafragm cu defect persistent determinat de reabsorbția parțială a materialului biologic, necătînd că putea fi observat și zone de țesut neoformat. Așadar, grefele decelularizate de peritoneu porcin utilizate în reconstrucția chirurgicală a diafragmului sunt caracterizate de o biorezistență redusă, care poate contribui la reabsorbția parțială a acestui material biologic cu dezvoltarea unor complicații grave. Grefele decelularizate de pericard au o biorezistență acceptabilă comparativ cu cele de peritoneu porcin, aceste date sugend necesitatea unor studii suplimentare pe termen lung, care ar avea ca scop obținerea unor rezultate mai durabile.Considerable efforts are currently underway in the development of decellularized biologic materials as an alternative to surgical correction of diaphragmatic defects. The aim of this study was to evaluate the efficiency, safety and particularities of tissue regeneration and remodeling processes of allograft decellularized cryopreserved porcine pericardium, used in the reconstruction of diaphragmatic defects, surgically created in experimental model in pigs. The study group included 6 pigs weighing 10 kg, subjected to left subcostal laparotomy with surgical reconstruction of diaphragmatic defect, with decellularized grafts of porcine pericardium (1-3 animals) and porcine peritoneum (group 2- 3 animals). The radilogic examination performed in group 1 at 15 days postoperatively a normal configuration of the neohemidiaphragm created, at 60 postoperative day being documented the insignificant eventration of neohemidiaphragm. In group 2 to 15 postoperatively, a slight incidence of neohemidiaphragm was observed, after which both animals of this group died suddenly at 54 and 60 days postoperatively due to graft dehiscence. In 2 cases areas with atypical (malformative) fibrillogenesis were observed, which were evidenced by a multicystic or lacunar-cavity aspect, with internal surfaces covered with unistratified peritoneal mesothelial epithelium flattened without aspects of mitotic activity. The mesothelial cavity-cystic aspect has also been shown on border, in some cavities being present fibro-epithelial conjunctival micro-polyps. The cavity-cyst formation could also be a cystic pseudotumor with thinner septa, with a reduced collagen fiber housing. In the animals of lot 2, in both cases, there was a hemidiaphragm with persistent defect determined by the partial reabsorption of the biological material, although neoformed tissue areas could be observed. Therefore, decellularized porcine peritoneum grafts used in surgical reconstruction of the diaphragm are characterized by a low bioresistence which can contribute to the partial reabsorption of this biological material with the development of serious complications. Decellularized grafts of porcine pericardium have an acceptable bioresistence compared to porcine peritoneum, and this data suggests the need for further long-term studies that would seek to achieve more sustainable outcomes

Social norms towards smoking and electronic cigarettes among adult smokers in seven European Countries: Findings from the EUREST-PLUS ITC Europe Surveys

Introduction: This study explores whether current smokers’ social norms towards smoking and electronic cigarettes (e-cigarettes) vary across seven European countries alongside smoking and e-cigarette prevalence rates. At the time of surveying, England had the lowest current smoking prevalence and Greece the highest. Hungary, Romania and Spain had the lowest prevalence of any e-cigarette use and England the highest. // Methods: Respondents were adult (≥18 years) current smokers from the 2016 EUREST-PLUS ITC (Romania, Spain, Hungary, Poland, Greece, Germany) and ITC 4CV England Surveys (N=7779). Using logistic regression, associations between country and (a) smoking norms and (b) e-cigarette norms were assessed, adjusting for age, sex, income, education, smoking status, heaviness of smoking, and e-cigarette status. // Results: Compared with England, smoking norms were higher in all countries: reporting that at least three of five closest friends smoke (19% vs 65–84% [AOR=6.9–24.0; Hungary–Greece]), perceiving that people important to them approve of smoking (8% vs 14–57% [1.9–51.1; Spain–Hungary]), perceiving that the public approves of smoking (5% vs 6–37% [1.7–15.8; Spain–Hungary]), disagreeing that smokers are marginalised (9% vs 16–50% [2.3–12.3; Poland–Greece]) except in Hungary. Compared with England: reporting that at least one of five closest friends uses e-cigarettes was higher in Poland (28% vs 36% [2.7]) but lower in Spain and Romania (28% vs 6–14% [0.3–0.6]), perceiving that the public approves of e-cigarettes was higher in Poland, Hungary and Greece (32% vs 36–40% [1.5–1.6]) but lower in Spain and Romania in unadjusted analyses only (32% vs 24–26%), reporting seeing e-cigarette use in public at least some days was lower in all countries (81% vs 12–55% [0.1–0.4]; Spain–Greece). // Conclusions: Smokers from England had the least pro-smoking norms. Smokers from Spain had the least pro-e-cigarette norms. Friend smoking and disagreeing that smokers are marginalised broadly aligned with country-level current smoking rates. Seeing e-cigarette use in public broadly aligned with countrylevel any e-cigarette use. Generally, no other norms aligned with product prevalence

Smoking in public places in six European countries: Findings from the EUREST-PLUS ITC Europe Survey

Introduction: Surveillance of tobacco consumption in public places is an important measure to evaluate the impact of tobacco control interventions over time. The objective of this study was to estimate the prevalence of smoking as seen by smokers and their smoking behaviour in public places, in six European countries. Methods: We used baseline data of the International Tobacco Control Six European countries (ITC 6E) Survey, part of the EUREST-PLUS Project, conducted in 2016 in national representative samples of about 1000 adult smokers aged 18 years and older in Germany, Greece, Hungary, Poland, Romania and Spain. For each setting (workplaces, restaurants, bars/pubs and discos) participants were asked whether they had seen someone smoking during their last visit there and whether they too had smoked there. We report the overall and by-country weighted prevalence of seeing someone smoking and the smokers’ own smoking behaviour at each setting. We also assess the relationship between seeing someone smoking and smoking themselves at these settings. Results: The prevalence of smoking as seen by smokers was 18.8% at workplaces, with high variability among countries (from 4.7% in Hungary to 40.8% in Greece). Among smokers visiting leisure facilities in the last year, during their last visit 22.7% had seen someone smoking inside restaurants and 12.2% had smoked themselves there, while for bars/pubs the corresponding prevalences were 33.9% and 20.4%, and inside discos 44.8% and 34.8%. Conclusions: Smoking is still prevalent at leisure facilities, particularly at discos in Europe, with high variability among countries. More extensive awareness campaigns and stricter enforcement are needed to increase the compliance of smokefree regulations, especially in leisure facilities

Patterns of tobacco use, quit attempts, readiness to quit and self-efficacy among smokers with anxiety or depression: Findings among six countries of the EUREST-PLUS ITC Europe Surveys

Introduction: We compared smoking behaviors, past quit attempts, readiness to quit and beliefs about quitting among current cigarette smokers with probable anxiety or depression (PAD) to those without PAD, from six European Union (EU) Member States (MS). Methods: A nationally representative cross-sectional sample of 6011 adult cigarette smokers from six EU MS (Germany, Greece, Hungary, Poland, Romania, Spain) was randomly selected through a multistage cluster sampling design in 2016. Respondents were classified as having PAD based on self-reported current diagnosis or treatment for anxiety or depression, or a positive screen for major depression, according to a validated two-item instrument. Sociodemographic characteristics, patterns of tobacco use, past quitting, readiness to quit, self-efficacy and beliefs about quitting were assessed for patients with and without PAD. Logistic regression was used to examine predictors of PAD. All analyses were conducted using the complex samples package of SPSS. Results: Among smokers sampled, 21.0% (95% CI: 19.3–22.9) were identified as having PAD. Logistic regression analyses controlling for socioeconomic variables and cigarettes smoked per day found smokers with PAD were more likely to have made an attempt to quit smoking in the past (AOR=1.48; 95% CI: 1.25–1.74), made a quit attempt in the last 12 months (AOR=1.75; 95% CI: 1.45–2.11), and report lower self-efficacy with quitting (AOR=1.83; 95% CI: 1.44–2.32) compared to smokers without PAD. Additionally, it was found that individuals with PAD were more likely to report having received advice to quit from a doctor or health professional and having used quitline support as part of their last quit attempt. Conclusions: Smokers with PAD report a greater interest in quitting in the future and more frequent failed quit attempts than smokers without PAD; however, the high rates of untreated anxiety or depression, nicotine dependence, low confidence in the ability to quit, infrequent use of cessation methods, as well as socioeconomic factors may make quitting difficult

Secondhand exposure to e-cigarette aerosols among smokers: A cross-sectional study in six European countries of the EUREST-PLUS ITC Europe Surveys

Introduction: Electronic cigarette (e-cigarette) use has grown significantly in some European Union (EU) Member States (MS). A better understanding of the exposure to secondhand e-cigarette aerosols (SHA) is necessary to develop and implement comprehensive regulations on e-cigarette use in public places. This study aims to assess the observation of e-cigarette use in public places, the self-reported exposure to SHA, and the level of users’ comfort using e-cigarettes in the presence of others. Methods: This is a cross-sectional study of the Wave 1 International Tobacco Control 6 European Countries Survey recruiting adult smokers (n=6011) across six EU MS: Germany, Greece, Hungary, Poland, Romania, and Spain, within the EURESTPLUS Project. A descriptive analysis was conducted to estimate the prevalence (%) of observed e-cigarette use in different places, frequency of self-reported exposure to SHA, and level of comfort using e-cigarettes in the presence of others. Results: In all, 31.0% of smokers observed others using e-cigarette in public places, 19.7% in indoor places where smoking is banned, and 14.5% indoors at work. Almost 37% of smokers reported to be ever exposed to SHA, ranging from 17.7% in Spain to 63.3% in Greece. The higher prevalence of observed e-cigarette use and passive exposure to SHA was reported by smokers of younger age, of higher educational level and those being current or former e-cigarette users. Part (8.8%) of the smokers who were also e-cigarette users reported feeling uncomfortable using e-cigarettes in the presence of others. Conclusions: A third of smokers from six EU MS reported being exposed to SHA. Prevalence differences were observed among the countries. In the context of scarce evidence on long-term health effects of exposure to SHA, precautionary regulations protecting bystanders from involuntary exposure should be developed

Receiving support to quit smoking and quit attempts among smokers with and without smoking related diseases: Findings from the EUREST-PLUS ITC Europe Surveys

Introduction: Having a chronic disease either caused or worsened by tobacco smoking does not always translate into quitting smoking. Although smoking cessation is one of the most cost-effective medical interventions, it remains poorly implemented in healthcare settings. The aim was to examine whether smokers with chronic and respiratory diseases were more likely to receive support to quit smoking by a healthcare provider or make a quit attempt than smokers without these diseases. Methods: This population-based study included a sample of 6011 adult smokers in six European countries. The participants were interviewed face-to-face and asked questions on sociodemographic characteristics, current diagnoses for chronic diseases, healthcare visits in the last 12 months and, if so, whether they had received any support to quit smoking. Questions on smoking behavior included nicotine dependence, motivation to quit smoking and quit attempts in the last 12 months. The results are presented as weighted percentages with 95% confidence intervals (CI) and as adjusted odds ratios with 95% CI based on logistic regression analyses. Results: Smokers with chronic respiratory disease, those aged 55 years and older, as well as those with one or more chronic diseases were more likely to receive smoking cessation advice from a healthcare professional. Making a quit attempt in the last year was related to younger age, high educational level, higher motivation to quit, lower nicotine dependence and having received advice to quit from a healthcare professional but not with having chronic diseases. There were significant differences between countries with smokers in Romania consistently reporting more support to quit as well as quit attempts. Conclusions: Although smokers with respiratory disease did indeed receive smoking cessation support more often than smokers without disease, many smokers did not receive any advice or support to quit during a healthcare visit