Diagnosis and surveillance of Barrett’s esophagus (BE)

Sp. Cl “Sf. Maria”, Clinica de Chirurgie Generală și Esofagiană, București, România, Al XI-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” din Republica Moldova și cea de-a XXXIII-a Reuniune a Chirurgilor din Moldova „Iacomi-Răzeșu” 27-30 septembrie 2011Introducere: EB este o afecțiune ce apare în urma refluxului gastro-esofagian cronic și care este factor de risc în apariția adenocarcinomului esofagian. Scop: evaluarea metodelor de diagnostic și de urmărire a pacienților cu EB. Metoda: În perioada 2006-2010, 36 de pacienți au fost diagnosticați cu EB prin Endoscopie Digestivă Superioară (EDS) cu biopsie. S-a folosit manometria esofagiană și pH-metria pe 24 ore pentru evaluarea răspunsului la tratament. Pacienții au primit 3-6 luni tratament medical. În urma lipsei de răspuns sau a complianței la tratamentul medical s-a efectuat tratament chirurgical. Pacienții au fost supravegheați conform protocoalelor. Rezultate: EDS a diagnosticat 15 pacienți fără leziuni asociate, 8 cu esofagită grd.A-C, 8 cu hernie hiatală asociată, 2 cu ulcer esofagian și 3 cu reflux biliar. Sfinterul esofagian inferior (SEI) incompetent și pH-metrie modificată au fost decelate la 3, respectiv 4 din pacienții fără leziuni asociate, la 5 din cei cu esofagită și la 8, respectiv 7 din cei cu hernie hiatală. Examenul histologic a decelat 2 pacienți cu displazie low-grade. După tratamentul medical sau chirurgical s-a obținut ameliorarea simptomatologiei și vindecarea leziunilor de esofagită. După fundoplicatura, parametrii pH-metrici și manometrici au revenit la normal, iar după Diversie Duodenala Totală s-a observat absența refluxului biliar esofagian. Concluzii: Diagnosticul și supravegherea pacienților cu esofag Barrett sunt foarte importante datorită riscului de evoluție către adenocarcinom.Introduction: BE is a disease induced by chronic gastro-esophageal reflux and is a risk factor for the development of esophageal adenocarcinoma. Aim: to evaluate the methods of diagnosis and follow-up of the patients with BEMethods: Between 2006 and 2010, 36 patients were diagnosed with BE using Upper Endoscopy (UE) with multiple biopsies. We used esophageal manometry and 24 hours pH-metry for assessing the outcome. The patients received initially for 3-6 month medical treatment. When lacking response or compliance at drug therapy, the surgical treatment was applied. The patient’s follow-up was made according to protocols.Results: The UE diagnosed 15 patients with no associated findings, 8 had grd.A-C esophagitis, 8 had hiatal hernia, 2 had esophageal ulcer and 3 presented biliar reflux. The lower esophageal sphincter (LES) was incompetent and the pH-metry was abnormal in 3, respective 4 of patients with no associated findings, in 5 of those with esophagitis and in 8, respective 7 of those with hiatal hernia. The histological exam finds 2 patients with low-grade dysplasia. The improvement of symptomatology and the healing of esophagitis were noticed after medical treatment and in all patients surgically treated. After fundoplication, the pH-metric and manometric values restored to normal and after total duodenal diversion no more biliary reflux was noticed. Conclusions: The diagnosis and surveillance of Barrett’s esophagus are very important due to the risk of development of adenocarcinoma

Postoperative outcomes in oesophagectomy with trainee involvement

BACKGROUND: The complexity of oesophageal surgery and the significant risk of morbidity necessitates that oesophagectomy is predominantly performed by a consultant surgeon, or a senior trainee under their supervision. The aim of this study was to determine the impact of trainee involvement in oesophagectomy on postoperative outcomes in an international multicentre setting. METHODS: Data from the multicentre Oesophago-Gastric Anastomosis Study Group (OGAA) cohort study were analysed, which comprised prospectively collected data from patients undergoing oesophagectomy for oesophageal cancer between April 2018 and December 2018. Procedures were grouped by the level of trainee involvement, and univariable and multivariable analyses were performed to compare patient outcomes across groups. RESULTS: Of 2232 oesophagectomies from 137 centres in 41 countries, trainees were involved in 29.1 per cent of them (n = 650), performing only the abdominal phase in 230, only the chest and/or neck phases in 130, and all phases in 315 procedures. For procedures with a chest anastomosis, those with trainee involvement had similar 90-day mortality, complication and reoperation rates to consultant-performed oesophagectomies (P = 0.451, P = 0.318, and P = 0.382, respectively), while anastomotic leak rates were significantly lower in the trainee groups (P = 0.030). Procedures with a neck anastomosis had equivalent complication, anastomotic leak, and reoperation rates (P = 0.150, P = 0.430, and P = 0.632, respectively) in trainee-involved versus consultant-performed oesophagectomies, with significantly lower 90-day mortality in the trainee groups (P = 0.005). CONCLUSION: Trainee involvement was not found to be associated with significantly inferior postoperative outcomes for selected patients undergoing oesophagectomy. The results support continued supervised trainee involvement in oesophageal cancer surgery

Результаты исследований, полученные механизированным комплексом на шахте Лупень – Румыния

In article results of research of operation of the mechanized complex on mine Lupen are considered. After brief presentation of mountain-geological and operational conditions, and also design data-operational of a complex, in the ratio with the received results, a number of conclusions which promote improvement of operational characteristics of the given complex is resulted.In article results of research of operation of the mechanized complex on mine Lupen are considered. After brief presentation of mountain-geological and operational conditions, and also design data-operational of a complex, in the ratio with the received results, a number of conclusions which promote improvement of operational characteristics of the given complex is resulted

Globalizing Gramsci: The Resuscitation of a Repressed Intellectual

In the last four decades the name of Gramsci has spread well beyond the boundaries of Italian political theory and Marxist thought where it was originally confined, reaching disciplinary fields as diverse as literary criticism, sociology, communication studies, anthropology, international relations, history, and linguistics, and countries as far from Italy as Korea, India, and South Africa. Why this success and still before how this success has been possible? What social conditions had to be fulfilled to have Gramsci recognized as such a key author in so many intellectual fields and regions of the world? Making use of an exceptional data set, i.e. the Gramscian Bibliography created and managed by the “Gramsci institute” in Rome, which encompasses more than 19 thousands items (books, journal articles, conference proceedings about Gramsci, as well as the whole Gramscian production including translations and different editions), our research aims at tracing the global diffusion of Gramsci’s work in Italy and out of it since the 1940s, identifying patterns, trajectories, timing, agents, and modes of its reception in different national contexts and languages. Focusing on both translations of Gramscian texts and critical writings on and about Gramsci, the chapter will provide quantitative data about the global circulation of a thought whose international success has been certainly favored by Marxist internationalism and the Italian geopolitical location after WWII, but also hampered by the original language and the textual genres (private letters and personal notebooks written while in prison) in which it was embedded, as well as the strong national focus and disarming fragmentation of its content. We suggest that all these seemingly negative conditions exerted indeed a positive effect on the reception process, allowing for highly selective (and idiosyncratic) local appropriations, flexibility in publishing strategies, and the building of context-specific consecration strategies

Postoperative outcomes in oesophagectomy with trainee involvement

Abstract Background: The complexity of oesophageal surgery and the significant risk of morbidity necessitates that oesophagectomy is predominantly performed by a consultant surgeon, or a senior trainee under their supervision. The aim of this study was to determine the impact of trainee involvement in oesophagectomy on postoperative outcomes in an international multicentre setting. Methods:Data from the multicentre Oesophago-Gastric Anastomosis Study Group (OGAA) cohort study were analysed, which comprised prospectively collected data from patients undergoing oesophagectomy for oesophageal cancer between April 2018 and December 2018. Procedures were grouped by the level of trainee involvement, and univariable and multivariable analyses were performed to compare patient outcomes across groups. Results: Of 2232 oesophagectomies from 137 centres in 41 countries, trainees were involved in 29.1 per cent of them (n = 650), performing only the abdominal phase in 230, only the chest and/or neck phases in 130, and all phases in 315 procedures. For procedures with a chest anastomosis, those with trainee involvement had similar 90-day mortality, complication and reoperation rates to consultant-performed oesophagectomies (P = 0.451, P = 0.318, and P = 0.382, respectively), while anastomotic leak rates were significantly lower in the trainee groups (P = 0.030). Procedures with a neck anastomosis had equivalent complication, anastomotic leak, and reoperation rates (P = 0.150, P = 0.430, and P = 0.632, respectively) in trainee-involved versus consultant-performed oesophagectomies, with significantly lower 90-day mortality in the trainee groups (P = 0.005). Conclusions: Trainee involvement was not found to be associated with significantly inferior postoperative outcomes for selected patients undergoing oesophagectomy. The results support continued supervised trainee involvement in oesophageal cancer surgery

The influence of anastomotic techniques on postoperative anastomotic complications: Results of the Oesophago-Gastric Anastomosis Audit

Background: The optimal anastomotic techniques in esophagectomy to minimize rates of anastomotic leakage and conduit necrosis are not known. The aim of this study was to assess whether the anastomotic technique was associated with anastomotic failure after esophagectomy in the international Oesophago-Gastric Anastomosis Audit cohort. Methods: This prospective observational multicenter cohort study included patients undergoing esophagectomy for esophageal cancer over 9 months during 2018. The primary exposure was the anastomotic technique, classified as handsewn, linear stapled, or circular stapled. The primary outcome was anastomotic failure, namely a composite of anastomotic leakage and conduit necrosis, as defined by the Esophageal Complications Consensus Group. Multivariable logistic regression modeling was used to identify the association between anastomotic techniques and anastomotic failure, after adjustment for confounders. Results: Of the 2238 esophagectomies, the anastomosis was handsewn in 27.1%, linear stapled in 21.0%, and circular stapled in 51.9%. Anastomotic techniques differed significantly by the anastomosis sites (P <.001), with the majority of neck anastomoses being handsewn (69.9%), whereas most chest anastomoses were stapled (66.3% circular stapled and 19.3% linear stapled). Rates of anastomotic failure differed significantly among the anastomotic techniques (P <.001), from 19.3% in handsewn anastomoses, to 14.0% in linear stapled anastomoses, and 12.1% in circular stapled anastomoses. This effect remained significant after adjustment for confounding factors on multivariable analysis, with an odds ratio of 0.63 (95% CI, 0.46-0.86; P =.004) for circular stapled versus handsewn anastomosis. However, subgroup analysis by anastomosis site suggested that this effect was predominantly present in neck anastomoses, with anastomotic failure rates of 23.2% versus 14.6% versus 5.9% for handsewn versus linear stapled anastomoses versus circular stapled neck anastomoses, compared with 13.7% versus 13.8% versus 12.2% for chest anastomoses. Conclusions: Handsewn anastomoses appear to be independently associated with higher rates of anastomotic failure compared with stapled anastomoses. However, this effect seems to be largely confined to neck anastomoses, with minimal differences between techniques observed for chest anastomoses. Further research into standardization of anastomotic approach and techniques may further improve outcomes

Postoperative outcomes in oesophagectomy with trainee involvement

Background The complexity of oesophageal surgery and the significant risk of morbidity necessitates that oesophagectomy is predominantly performed by a consultant surgeon, or a senior trainee under their supervision. The aim of this study was to determine the impact of trainee involvement in oesophagectomy on postoperative outcomes in an international multicentre setting. Methods Data from the multicentre Oesophago-Gastric Anastomosis Study Group (OGAA) cohort study were analysed, which comprised prospectively collected data from patients undergoing oesophagectomy for oesophageal cancer between April 2018 and December 2018. Procedures were grouped by the level of trainee involvement, and univariable and multivariable analyses were performed to compare patient outcomes across groups. Results Of 2232 oesophagectomies from 137 centres in 41 countries, trainees were involved in 29.1 per cent of them (n = 650), performing only the abdominal phase in 230, only the chest and/or neck phases in 130, and all phases in 315 procedures. For procedures with a chest anastomosis, those with trainee involvement had similar 90-day mortality, complication and reoperation rates to consultant-performed oesophagectomies (P = 0.451, P = 0.318, and P = 0.382, respectively), while anastomotic leak rates were significantly lower in the trainee groups (P = 0.030). Procedures with a neck anastomosis had equivalent complication, anastomotic leak, and reoperation rates (P = 0.150, P = 0.430, and P = 0.632, respectively) in trainee-involved versus consultant-performed oesophagectomies, with significantly lower 90-day mortality in the trainee groups (P = 0.005). Conclusion Trainee involvement was not found to be associated with significantly inferior postoperative outcomes for selected patients undergoing oesophagectomy. The results support continued supervised trainee involvement in oesophageal cancer surgery.The aim of this study was to determine the impact of trainee involvement in oesophagectomy on perioperative outcomes in the international multicentre Oesophago-Gastric Anastomosis Audit (OGAA). Analysis of 2232 oesophagectomies has shown that trainee involvement did not negatively impact perioperative outcomes

Postoperative outcomes in oesophagectomy with trainee involvement

Background The complexity of oesophageal surgery and the significant risk of morbidity necessitates that oesophagectomy is predominantly performed by a consultant surgeon, or a senior trainee under their supervision. The aim of this study was to determine the impact of trainee involvement in oesophagectomy on postoperative outcomes in an international multicentre setting. Methods Data from the multicentre Oesophago-Gastric Anastomosis Study Group (OGAA) cohort study were analysed, which comprised prospectively collected data from patients undergoing oesophagectomy for oesophageal cancer between April 2018 and December 2018. Procedures were grouped by the level of trainee involvement, and univariable and multivariable analyses were performed to compare patient outcomes across groups. Results Of 2232 oesophagectomies from 137 centres in 41 countries, trainees were involved in 29.1 per cent of them (n = 650), performing only the abdominal phase in 230, only the chest and/or neck phases in 130, and all phases in 315 procedures. For procedures with a chest anastomosis, those with trainee involvement had similar 90-day mortality, complication and reoperation rates to consultant-performed oesophagectomies (P = 0.451, P = 0.318, and P = 0.382, respectively), while anastomotic leak rates were significantly lower in the trainee groups (P = 0.030). Procedures with a neck anastomosis had equivalent complication, anastomotic leak, and reoperation rates (P = 0.150, P = 0.430, and P = 0.632, respectively) in trainee-involved versus consultant-performed oesophagectomies, with significantly lower 90-day mortality in the trainee groups (P = 0.005). Conclusion Trainee involvement was not found to be associated with significantly inferior postoperative outcomes for selected patients undergoing oesophagectomy. The results support continued supervised trainee involvement in oesophageal cancer surgery.The aim of this study was to determine the impact of trainee involvement in oesophagectomy on perioperative outcomes in the international multicentre Oesophago-Gastric Anastomosis Audit (OGAA). Analysis of 2232 oesophagectomies has shown that trainee involvement did not negatively impact perioperative outcomes