Total invasion of the pancreatic gland by a rare aggressive IPMN: Report of a case

AbstractINTRODUCTIONThe intraductal papillary mucinous neoplasms (IPMNs) are increasingly diagnosed entities with high potential of malignancy and significant recurrence rates.PRESENTATION OF CASEIn this case report a rare mixed IPMN with full invasion of the pancreatic ducts was identified.DISCUSSIONDifficulties in determining the grade of pancreatic duct involvement make the surgical management tough.CONCLUSIONIn multifocal IPMNs the management of the patients is even more challenging. In this case the patient was treated successfully with total pancreatectomy

Bullying and Sexual Discrimination in the Greek Health Care System

INTRODUCTION: Modern medicine is based on teamwork and communication. Bullying and discrimination can have a serious effect on these, affecting the standard of medical training and patient care. AIM: To determine the incidence of bullying and sex discrimination in the Greek health care system. METHODS: An online questionnaire was designed and circulated among Greek medical professionals. RESULTS: We received 1349 completed questionnaires with a response rate of 48% and with 45% of them being female. Equal opportunities in specialty training were reported by 55% of the participants. Female doctors in medicine and in surgery reported no equal opportunities at an incidence of 15% and 30%, respectively (p < 0.001). Family obligations and lack of family support were considered as the main obstacles in female doctors’ professional development by 92% and 59% of the participants, respectively. Both sexes appeared to have suffered from various forms of abusive behavior with characteristics that vary between them. Verbal abuse, threatening behavior, and sexual harassment were reported by 50%, 38%, and 20%, respectively, with women being 3 times more likely to be victims of sexual harassment (34% vs. 9%, p < 0.001). Finally, the availability of official support mechanisms was reported in only 15% of the cases, whereas friends and colleagues were the main support for 46.17% of the cases. CONCLUSION: This is the first study attempting to preliminary describe the extent of bullying and sexual discrimination in the Greek national health care system. Despite the limitations of this study, it is imperative that more research is performed on this issue from the appropriate national authorities. (C) 2017 Association of Program. Directors in Surgery. Published by Elsevier Inc. All rights reserved

Household cleaning activities as noningestion exposure determinants of urinary trihalomethanes

Previous epidemiological studies linking drinking water total trihalomethanes (THM) with pregnancy disorders or bladder cancer have not accounted for specific household cleaning activities that could enhance THM exposures. We examined the relation between household cleaning activities (washing dishes/clothes, mopping, toilet cleaning, and washing windows/surfaces) and urinary THM concentrations accounting for water sources, uses, and demographics. A cross-sectional study (n = 326) was conducted during the summer in Nicosia, Cyprus, linking household addresses to the geocoded public water pipe network, individual household tap water, and urinary THM measurements. Household tap water THM concentrations ranged between 3-129 μg L -1, while the median (Q1, Q3) creatinine-adjusted urinary THM concentration in females (669 ng g-1 (353, 1377)) was significantly (p 0.05) association was observed between ingestion-based THM exposure equivalency units and urinary THM. Noningestion routes of THM exposures during performance of routine household cleaning activities were shown for the first time to exert a major influence on urinary THM levels. It is warranted that future pregnancy-birth cohorts include monitoring of noningestion household THM exposures in their study design

Efficacy and safety of telavancin in clinical trials: a systematic review and meta-analysis.

INTRODUCTION: The epidemiology and antibiotic resistance of Staphylococcus aureus have evolved, underscoring the need for novel antibiotics, particularly against methicillin-resistant S. aureus (MRSA). Telavancin is a bactericidal lipoglycopeptide with potent activity against Gram-positive pathogens. OBJECTIVE: To systematically review and synthesize the available evidence from randomized controlled trials (RCTs) evaluating telavancin in the treatment of patients with infections due to Gram-positive organisms with the methodology of meta-analysis. RESULTS: Six RCTs comparing telavancin with vancomycin were included; 4 (2229 patients) referred to complicated skin and soft tissue infections (cSSTIs) and 2 (1503 patients) to hospital-acquired pneumonia (HAP). Regarding cSSTIs, telavancin and vancomycin showed comparable efficacy in clinically evaluable patients (odds ratio [OR] =1.10 [95% confidence intervals: 0.82-1.48]). Among patients with MRSA infection, telavancin showed higher eradication rates (OR=1.71 [1.08-2.70]) and a trend towards better clinical response (OR=1.55 [0.93-2.58]). Regarding HAP, telavancin was non-inferior to vancomycin in terms of clinical response in two Phase III RCTs; mortality rates for the pooled trials were comparable with telavancin (20%) and vancomycin (18.6%). Pooled data from cSSTIs and HAP studies on telavancin 10 mg/kg indicated higher rates of serum creatinine increases (OR=2.22 [1.38-3.57]), serious adverse events (OR=1.53 [1.05-2.24]), and adverse event-related withdrawals (OR=1.49 [1.14-1.95]) among telavancin recipients. CONCLUSION: Telavancin might be an alternative to vancomycin in cases of difficult-to-treat MRSA infections. The potent antistaphylococcal activity of telavancin should be weighted against the potential for nephrotoxicity

Use of a biological mesh for the treatment of perineal fistula following radical colorectal resection

Key Clinical Message Patients with postradiation therapy for malignancies and/or extensive colorectal surgery are prone to the development of enteroperineal fistulas. Application of biological meshes may prove beneficial in treating complicated enteroperineal fistulas as they provide a stable ground for closing pelvic defects even in contaminated fields

Flow diagram of the selection process of the included studies.

<p>Flow diagram of the selection process of the included studies.</p

Efficacy and safety.

<p>Abbreviations: ITT = intention-to-treat; CE = clinically evaluable; ME = microbiologically evaluable; TEAE = treatment-emergent adverse events; SAE = serious adverse events; Cr = creatinine.</p>a<p>Compared to baseline.</p>b<p>Serum creatinine level ≥1.5 mg/dl at the end-of-therapy visit with an increase of at least 50% or 0.5 mg/dl over the pretreatment level.</p>c<p>Pooled data from both ATLAS studies.</p>d<p>Pooled data from both ATTAIN studies.</p

The main characteristics of the included studies.

<p>Abbreviations: ref = reference; MC = multicenter; DB = double-blinded; vs = versus; RCT = randomized controlled trial; TLV = telavancin; VAN = vancomycin; PCN = penicillin; AZT = aztreonam; MET = metronidazole; PIP-TAZ = piperacillin-tazobactam; yr = years; q12h = every 12 hours; pts = patients; CrCL = creatinine clearance; QTcF = Fridericia-corrected QT; iv = intravenous; cSSTI = complicated skinn and soft tissue infection; HAP = hospital acquired-pneumonia; ITT = intention-to-treat; CE = clinically evaluable; ME = microbiologically evaluable.</p>a<p>All studies used telavancin iv at 10 mg/kg q24h, except for FAST 1 (7.5 mg/kg q24h).</p>b<p>Nafcillin 2 g or oxacillin 2 g or cloxacillin 0.5–1 g.</p