Medicolegal Cases in Bariatric Surgery in the United Kingdom.

PURPOSE OF REVIEW: To evaluate the current state of bariatric medicolegal activity and explore the reasons of litigation in bariatric surgery. The underlying legal principles in bariatric medicolegal cases and most frequent pitfalls will also be discussed. RECENT FINDINGS: There is a growing number of litigations in bariatric surgery, particularly relating to complications and long waiting lists for bariatric surgery within the public-funded health systems. The main issues are related to consent, lack of follow-up, delayed identification of complications and lack of appropriate emergency management of complications, involving bariatric surgeons, clinicians, general practitioners and multidisciplinary team members. Appropriate multidisciplinary involvement pre- and postoperatively and robust follow-up protocols can help to mitigate the risks. Bariatric surgery requires a unique paradigm with a multidisciplinary approach both pre- and postoperatively to improve the long-term functional outcomes of patients. There is a rising incidence of medicolegal claims following bariatric surgery. The underlying reasons for this are multifactorial including an increase in the volume of surgery, high patient expectations, the incidence of long-term postoperative complications and the requirement of long-term follow-up

Il rischio di tensocorrosione da H2S all’esterno di condotte sottomarine: una metodologia di valutazione quantitativa

Una sempre crescente attenzione è rivolta allo sviluppo di nuovi materiali da impiegare per la realizzazionedi condotte sottomarine da posare in acque molto profonde. In tali ambienti si possono presentare condizionianossiche in cui è favorita la proliferazione di batteri anaerobici, quali i solfato riduttori, che generanosignificative quantità di H2S che si accumula nei sedimenti di fondo. Tali condizioni, che potrebberopregiudicare l’integrità della condotta, si possono peraltro verificare anche in bacini chiusi,non necessariamente profondi. È noto che l’acciaio al carbonio comunemente utilizzato nelle condotte a mareè suscettibile a fenomeni di tensocorrosione da H2S umido, e tale problematica è potenzialmente riscontrabileladdove parti metalliche incidentalmente non coperte dai rivestimenti protettivi si trovino a contattoo in prossimità di sedimenti ricchi di H2S. Obbiettivo del presente articolo è proporre una metodologiache sia di supporto, in fase di progettazione, per la quantifica del rischio di tensocorrosione da H2Se che consideri, in termini probabilistici, i parametri ambientali, le condizioni di posa ed il materialedella condotta, in coerenza alle normative tecniche che ad oggi inquadrano lo stato dell’arte per le condottesottomarine e per i materiali da utilizzarsi in ambienti sour

Pancreaticoduodenectomy with right hemicolectomy for advanced malignancy: a single UK hepatopancreaticobiliary centre experience

Aim Locally advanced intestinal neoplasms including colon cancer may require radical en bloc pancreaticoduodenectomy and right hemicolectomy (PD-RC) to achieve curative, margin-negative resection, but the safety and benefit of this uncommon procedure has not been established. The Association of Coloproctology of Great Britain and Ireland IMPACT initiative has also highlighted a lack of awareness about current services available within the UK for patients with advanced colorectal cancer and concerns about low-volume centres managing complex cases. Thus, we aimed to review the feasibility, safety and long-term outcomes of this procedure at a single high-volume hepatopancreaticobiliary surgery unit in the UK. Method A retrospective cohort study was performed using a database of all consecutive patients with intestinal cancer who had been referred to our regional advanced multidisciplinary team and undergone PD-RC in a 7-year period (2013–2020). Clinico-pathological and outcome data were reviewed. Results Ten patients (mean age 54 ± 13, 8/10 men) were identified. Final histology revealed the primary tumour sites were colon (n = 7) and duodenum (n = 3). R0 resection was achieved in all cases. The major complication rate (Clavien–Dindo ≥ 3) was 10% (1/10) with no deaths within 90 days of surgery. The Kaplan–Meier estimated 5-year overall survival was 83.3% (95% CI 58.3%–100%). Univariate survival analysis identified perineural invasion and extra-colonic origin as predictors of poor survival (log-rank P < 0.05). Conclusion En bloc PD-RC for locally advanced intestinal cancer can be performed safely with a high proportion of margin-negative resections and resultant long-term survival in carefully selected patients

Development of high strength self-compacting fibre reinforced concrete for prefabricated concrete industry

Prefabricated construction is an emerging industry in Australia and considered a key mechanism to boost productivity in the construction industry. The use of fibre reinforced concrete has a huge potential in the prefabricated industry as the concrete can be delivered straight to the precast mould, eliminating in many cases the steel reinforcement, thus increasing production quotas and cost savings. Such results can be further improved by utilising self-compacting concrete reinforced with fibres. Although the use of steel fibres as reinforcement is now well established, in the precast industry thin walls and shape of the moulds can be a limitation to steel fibre as well as work health and safety concerns for handling. Under such conditions, the use of polymeric fibres can be extremely beneficial, reducing labour hours and placement time as well as improving safety. This paper reports the development of high strength self-compacting fibre reinforced concrete for application in prefabricated concrete industry, exploring the effect of Forta-Ferro and ReoShore fibres on concrete fresh and mechanical properties

Exchange of Best Practices Within the European Union:Surgery Standardization of Abdominal Organ Retrieval

AbstractConsidering the growing organ demand worldwide, it is crucial to optimize organ retrieval and training of surgeons to reduce the risk of injury during the procedure and increase the quality of organs to be transplanted. In the Netherlands, a national complete trajectory from training of surgeons in procurement surgery to the quality assessment of the procured organs was implemented in 2010. This mandatory trajectory comprises training and certification modules: E-learning, training on the job, and a practical session. Thanks to the ACCORD (Achieving Comprehensive Coordination in Organ Donation) Joint Action coordinated by Spain and co-funded under the European Commission Health Programme, 3 twinning activities (led by France) were set to exchange best practices between countries. The Dutch trajectory is being adapted and implemented in Hungary as one of these twinning activities. The E-learning platform was modified, tested by a panel of Hungarian and UK surgeons, and was awarded in July 2013 by the European Accreditation Council for Continuing Medical Education of the European Union of Medical Specialists. As a pilot phase for future national training, 6 Hungarian surgeons from Semmelweis University are being trained; E-learning platform was fulfilled, and practical sessions, training-on-the-job activities, and evaluations of technical skills are ongoing. The first national practical session was recently organized in Budapest, and the new series of nationwide selected candidates completed the E-learning platform before the practical. There is great potential for sharing best practices and for direct transfer of expertise at the European level, and especially to export this standardized training in organ retrieval to other European countries and even broader. The final goal was to not only provide a national training to all countries lacking such a program but also to improve the quality and safety criteria of organs to be transplanted