Conservative management for an esophageal perforation in a patient presented with delayed diagnosis: a case report review of the literature

Esophageal perforation is a serious condition with a high mortality rate. Successful therapy depends on the size of the rupture; the time elapsed between rupture and diagnosis, and the underlying health of the patient. Common causes of esophageal perforation include medical instrumentation, foreign-body ingestion, and trauma. A case of esophageal perforation due to fish bone ingestion in a 67-year-old male is described here, with a review of the pertinent literature. The patient presented with chest pain, fever and right-sided pleural effusion. Initial evaluation was nondiagnostic. The water-soluble contrast swallow test showed no evidence of leakage. Computed tomography scan demonstrated a pneumomediastinum, and right-sided hydropneumothorax. The patient was successfully treated using conservative measures

Meckel's Diverticulum in Adults: Surgical Concerns

Since Meckel's diverticulum (MD) is rarely diagnosed in adults, there is no consensus on what type of procedure to be performed for symptomatic MD and whether to resect or not an accidentally discovered MD. Treatment of symptomatic MD is definitive surgery, including diverticulectomy, wedge, and segmental resection. The type of procedure depends on: (a) the integrity of diverticulum base and adjacent ileum; (b) the presence and location of ectopic tissue within MD. The presence of ectopic tissue cannot be accurately predicted intraoperatively by palpation and macroscopic appearance. When present, its location can be predicted based on height-to-diameter ratio. Long diverticula (height-to-diameter ratio >2) have ectopic tissue located at the body and tip, whereas short diverticula have wide distribution of ectopic tissue including the base. When indication of surgery is simple diverticulitis, diverticulectomy should be performed for long and wedge resection for short MD. When indication of surgery is complicated diverticulitis with perforated base, complicated intestinal obstruction and tumor, wedge, or segmental resection should be performed. When the indication of surgery is bleeding, wedge and segmental resection are the preferred methods for resection. Regarding management of incidentally discovered MD, routine resection is not indicated. The decision making should be based on risk factors for developing future complications, such as: (1) patient age younger than 50 years; (2) male sex; (3) diverticulum length >2 cm; and (4) ectopic or abnormal features within a diverticulum. In this case, diverticulectomy should be performed for long and wedge resection for short MD

Small & Medium-Sized Enterprises, Organizational Resilience Capacity and Flash Floods: Insights from a Literature Review

From a managerial standpoint, sustainability poses numerous challenges for the business community. One of the prominent concerns in the context of organizational sustainability is the impact of climate change and extreme weather events (EWEs), which create discontinuity and damages to business operations. In this respect, small and medium-sized enterprises (SMEs) are particularly vulnerable to EWEs, such as flash floods, having disastrous consequences to SMEs that tend to be ill-prepared. Taking into consideration that these negatives effects are also transferred into the local communities in which SMEs are located, it is crucial to create appropriate mechanisms that will enable these enterprises to build relevant capacities and acquire necessary resources in order to deal with relevant disruptive events. With this in mind, this paper attempts to delineate the emerging literature in relation to strategic approaches in dealing with high impact/low probability EWEs. With this analysis, we aim to provide insights for enhancing the robustness of SMEs against such natural hazards through effective resilience and adaptation strategies. The paper reveals that resilience to EWEs is indeed a multifaceted issue posing numerous challenges to SMEs. Taking into account their intrinsic characteristics, there is a need for a holistic management approach that will assist SMEs to safeguard their assets against extreme weather

Assessing Greek small and medium-sized enterprises' flood resilience capacity: index development and application

Floods signify one of the most common, widespread and destructive natural perils, affecting approximately 250 million people and causing billions in losses on an annual basis. Such high impact – low probability environmental perturbations can cause abrupt changes and disruption to business entities in flood-prone areas in terms of asset damages, operational interruptions and increased costs which result in loss of capital and labour, declining revenue and growth. It is therefore critical for businesses to identify such risks and, ultimately, to effectively build their resilience to such physical challenges. Small and medium-sized enterprises (SMEs) in particular are more ill-prepared to face flooding compared to large companies. Understanding the ability of SMEs to become more resilient to floods is crucial as they account for 99% of all enterprises, constitute the major employer and contributor of the total value-added of the private sector. In this study, a composite index of factors linked to the resilience capacity of SMEs to flooding is proposed and tested. A sample of Greek SMEs located in three flood-prone areas (n = 391) was administered a structured questionnaire pertaining to cognitive, managerial and contextual factors that affect the ability to prepare, withstand and recover from flooding events. Through the proposed index, a bottom-up, self-assessment, approach is set forth that could assist in standardising such assessments with an overarching aim of reducing the vulnerability of SMEs to floods. This is achieved by examining critical internal and external parameters affecting SMEs' resilience capacity which is particularly important taking into account the limited resources these enterprises tend to have at their disposal and that they can generate single points of failure in dense supply chain networks

The impact of EAES Fellowship Programme:a five-year review and evaluation

Background: The European Association of Endoscopic Surgery (EAES) fellowship programme was established in 2014, allowing nine surgeons annually to obtain experience and skills in minimally invasive surgery (MIS) from specialist centres across the Europe and United States. It aligns with the strategic focus of EAES Education and Training Committee on enabling Learning Mobility opportunities. To assess the impact of the programme, a survey was conducted aiming to evaluate the experience and impact of the programme and receive feedback for improvements.Methods: A survey using a 5-point Likert scale was used to evaluate clinical, education and research experience. The impact on acquisition of new technical skills, change in clinical practice and ongoing collaboration with the host institute was assessed. The fellows selected between 2014 and 2018 were included. Ratings were analysed in percentage; thematic analysis was applied to the free-text feedbacks using qualitative analysis.Results: All the fellows had good access to observing in operating theatres and 70.6% were able to assist. 91.2% participated in educational activities and 23.5% were able to contribute through teaching. 44.1% participated in research activities and 41.2% became an author/co-author of a publication from the host. 97.1% of fellows stated that their operative competency had increased, 94.3% gained new surgical skills and 85.7% was able to introduce new techniques in their hospitals. 74.29% agreed that the clinical experience led to a change in their practices. The most commonly suggested improvements were setting realistic target in clinical and research areas, increasing fellowship duration, and maximising theatre assisting opportunities. Nevertheless, 100% of fellows would recommend the fellowship to their peers.Conclusion: EAES fellowship programme has shown a positive impact on acquiring and adopting new MIS techniques. To further refine the programme, an individualised approach should be adopted to set achievable learning objectives in clinical skills, education and research.</p

Surgical Infections

Surgical infections are caused by the breakdown of the equilibrium existing between organisms and the host. This may occur after a breach in a protective surface, as occurs after surgical trauma, changes in host resistance, or particular characteristics of the organism. The possible outcomes are abscess formation, local spread with/without tissue death, distant spread or resolution. A surgical infection is an infection requiring operative treatment (excision or drainage), and occupies an unvascularized space in tissue, or may occur in an operated site. Common examples of the former group are furuncles and carbuncles, hollow viscus inflammations, such as appendicitis, cholecystitis, and most abscesses. The latter group comprises all surgical site infections. This Research Topic provides comprehensive information on the biology, mechanisms, prevention and treatment of surgery-related infections