Abdominoperineal Resection for Rectal Cancer: Is the Pelvic Drain Externalization Site an Independent Risk Factor for Perineal Wound Healing?

Aim. The aim of this paper is to investigate if the insertion of the pelvic drainage tube via the perineal wound could be considered as an independent risk factor for perineal healing disorders, after abdominoperineal resection for rectal malignancy. Patients and Methods. The last two decades, 75 patients underwent elective abdominoperineal resection for malignancy. In 42 patients (56%), the pelvic drain catheter was inserted through the perineal wound (PW group), while in the remaining 33 (44%) through a puncture skin wound of the perineum (SW group). Patients' data with respect to age (P = 0.136), stage (P > 0.05), sex (P = 0.188) and comorbidity (P = 0.128) were similar in both groups. 25 patients (PW versus SW: 8 versus 17, P = 0.0026) underwent neoadjuvant radio/chemotherapy. Results. The overall morbidity rate was 36%, but a significant increase was revealed in PW group (52.4% versus 9%, P = 0.0007). In 33.3% of the patients in the PW group, perineal healing was delayed, while in the SW group, no delay was noted. Perineal healing disorders were revealed as the main source of increased morbidity in this group. Conclusion. The insertion of the pelvic drain tube through the perineal wound should be considered as an independent risk factor predisposing to perineal healing disorders

Cosmopolitanism and transnational elite entrepreneurial practices: manifesting the cosmopolitan disposition in a cosmopolitan city

Purpose The paper aims to focus on the role that cosmopolitanism and, in particular, “the cosmopolitan disposition” (Woodward et al., 2008) plays in the process of entrepreneurial business by transnational business elites in Dubai. Design/methodology/approach Adopting a relational perspective based on Bourdieu and Wacquant’s (1992) Reflexive Sociology, as well as an inductive design, the authors conducted 30 semi-structured interviews focusing on both expatriates and Emiratis (locals/nationals) who displayed key features of a transnational business elite. Findings The findings indicate that the cosmopolitan disposition is an asset for transnational business elites when they venture in the context of Dubai. Research limitations/implications The findings would have to be further replicated in similar contexts, i.e. other major cities displaying similar cosmopolitan features with Dubai. A theoretical framework that calls for further study of transnational entrepreneurship via the lens of cosmopolitan disposition and Bourdieuan “habitus” is proposed. Practical implications The research outlines cosmopolitan skills for a transnational business elite which are required when entrepreneurial ventures are developed in the context of a city like Dubai. Social implications Cosmopolitanism and transnational entrepreneurship change cities like Dubai around the world constantly. Therefore, this study aims at achieving a better understanding of these changes and the ways in which they occur. Originality/value Studies on transnational entrepreneurship have already adopted Bourdieu’s theory (1977/1986), but this is the first time the cosmopolitan perspective and disposition is researched using this approach

Nadroparine-induced skin necrosis on a patient with essential thrombocythaemia: a case report

Skin necrosis is a rare but serious complication of subcutaneously administered low-molecular-weight heparin. We report a case of a 53-year-old female patient with skin necrosis induced by subcutaneous administration of nadroparine. The patient suffered from essential thrombocythaemia on a background of chronic myeloproliferative disease. She was admitted to our clinic with a subacute ileus due to endometriosis of the rectosigmoid junction. She underwent a high anterior resection and she received pre- and postoperative antithrombotic prophylaxis with subcutaneous nadroparine on a daily basis. On the 6th and 7th postoperative days, two skin necroses occurred at two injection sites

New insights into the role of age and carcinoembryonic antigen in the prognosis of colorectal cancer

The aim of this study was to verify through relative survival (an estimate of cancer-specific survival) the true prognostic factors of colorectal cancer. The study involved 506 patients who underwent locally radical resection. All the clinical, histological and laboratory parameters were prognostically analysed for both overall and relative survival. This latter was calculated from the expected survival of the general population with identical age, sex and calendar years of observation. Univariate and multivariate analyses were applied to the proportional hazards model. Liver metastases, age, lymph node involvement and depth of bowel wall involvement were independent prognosticators of both overall and relative survival, whereas carcinoembryonic antigen (CEA) was predictive only of relative survival. Increasing age was unfavourably related to overall survival, but mildly protective with regard to relative survival. Three out of the five prognostic factors identified are the cornerstones of the current staging systems, and were confirmed as adequate by the analysis of relative survival. The results regarding age explain the conflicting findings so far obtained from studies considering overall survival only and advise against the adoption of absolute age limits in therapeutic protocols. Moreover, the prechemotherapy CEA level showed a high clinical value

Phase noise characterisation of a 2-km hollow-core nested antiresonant nodeless fibre for twin-field quantum key distribution

The performance of quantum key distribution (QKD) is heavily dependent on the physical properties of the channel over which it is executed. Propagation losses and perturbations in the encoded photons' degrees of freedom, such as polarisation or phase, limit both the QKD range and key rate. The maintenance of phase coherence over optical fibres has lately received considerable attention as it enables QKD over long distances, e.g., through phase-based protocols like Twin-Field (TF) QKD. While optical single mode fibres (SMFs) are the current standard type of fibre, recent hollow core fibres (HCFs) could become a superior alternative in the future. Whereas the co-existence of quantum and classical signals in HCF has already been demonstrated, the phase noise resilience required for phase-based QKD protocols is yet to be established. This work explores the behaviour of HCF with respect to phase noise for the purpose of TF-QKD-like protocols. To achieve this, two experiments are performed. The first, is a set of concurrent measurements on 2 km of HCF and SMF in a double asymmetric Mach-Zehnder interferometer configuration. The second, uses a TF-QKD interferometer consisting of HCF and SMF channels. These initial results indicate that HCF is suitable for use in TF-QKD and other phase-based QKD protocols

Internal sphincterotomy reduces postoperative pain after Milligan Morgan haemorrhoidectomy

<p>Abstract</p> <p>Background</p> <p>Over the last few years, there has been increasing attention on surgical procedures to treat haemorrhoids. The Milligan-Morgan haemorrhoidectomy is still one of the most popular surgical treatments of haemorrhoids. The aim of the present work is to assess postoperative pain, together with other early and late complications, after Milligan-Morgan haemorrhoidectomy as we could observe in our experience before and after performing an internal sphincterotomy.</p> <p>Methods</p> <p>from January 1980 to May 2007, we operated 850 patients, but only 699 patients (median age 53) were included in the present study because they satisfied our inclusion criteria. The patients were divided into two groups: all the patients operated on before 1995 (group A); all the patients operated on after 1995 (group B). Since 1995 an internal sphincterotomy of about 1 cm has been performed at the end of the procedure. The data concerning the complications of these two groups were compared. All the patients received a check-up at one and six months after operation and a telephone questionnaire three years after operation to evalue medium and long term results.</p> <p>Results</p> <p>after one month 507 patients (72.5%) did not have any postoperative complication. Only 192 patients (27.46%) out of 699 presented postoperative complication and the most frequent one (23.03%) was pain. The number of patients who suffered from postoperative pain decreased significantly when performing internal sphincterotomy, going from 28.8% down to 10.45% (χ²: 10,880; p = 0,0001); 95% Confidence Interval (CI) 24.7 to 28.9 (group A) and 10.17 to 10.72 (group B). In 51 cases (7.29%) urinary retention was registered. Six cases of bleeding (0.85%) were registered. Medium and long term follow up did not show any difference among the two groups.</p> <p>Conclusion</p> <p>internal sphincterotomy: reduces significantly pain only in the first postoperative period, but not in the medium-long term follow up; does not increase the incidence of continence impairment when performed; does not influence the incidence of the other postoperative complications especially as regard medium and long term results.</p