Complicated intra-abdominal infections in Europe: preliminary data from the first three months of the CIAO Study

Peer reviewe

Complicated intra-abdominal infections in Europe: a comprehensive review of the CIAO study

Peer reviewe

Prospective Observational Study on acute Appendicitis Worldwide (POSAW)

Background: Acute appendicitis (AA) is the most common surgical disease, and appendectomy is the treatment of choice in the majority of cases. A correct diagnosis is key for decreasing the negative appendectomy rate. The management can become difficult in case of complicated appendicitis. The aim of this study is to describe the worldwide clinical and diagnostic work-up and management of AA in surgical departments.Methods: This prospective multicenter observational study was performed in 116 worldwide surgical departments from 44 countries over a 6-month period (April 1, 2016-September 30, 2016). All consecutive patients admitted to surgical departments with a clinical diagnosis of AA were included in the study.Results: A total of 4282 patients were enrolled in the POSAW study, 1928 (45%) women and 2354 (55%) men, with a median age of 29 years. Nine hundred and seven (21.2%) patients underwent an abdominal CT scan, 1856 (43.3%) patients an US, and 285 (6.7%) patients both CT scan and US. A total of 4097 (95.7%) patients underwent surgery; 1809 (42.2%) underwent open appendectomy and 2215 (51.7%) had laparoscopic appendectomy. One hundred eighty-five (4.3%) patients were managed conservatively. Major complications occurred in 199 patients (4.6%). The overall mortality rate was 0.28%.Conclusions: The results of the present study confirm the clinical value of imaging techniques and prognostic scores. Appendectomy remains the most effective treatment of acute appendicitis. Mortality rate is low.</p

Global validation of the WSES Sepsis Severity Score for patients with complicated intra-abdominal infections : a prospective multicentre study (WISS Study)

Background: To validate a new practical Sepsis Severity Score for patients with complicated intra-abdominal infections (cIAIs) including the clinical conditions at the admission (severe sepsis/septic shock), the origin of the cIAIs, the delay in source control, the setting of acquisition and any risk factors such as age and immunosuppression. Methods: The WISS study (WSES cIAIs Score Study) is a multicenter observational study underwent in 132 medical institutions worldwide during a four-month study period (October 2014-February 2015). Four thousand five hundred thirty-three patients with a mean age of 51.2 years (range 18-99) were enrolled in the WISS study. Results: Univariate analysis has shown that all factors that were previously included in the WSES Sepsis Severity Score were highly statistically significant between those who died and those who survived (p <0.0001). The multivariate logistic regression model was highly significant (p <0.0001, R-2 = 0.54) and showed that all these factors were independent in predicting mortality of sepsis. Receiver Operator Curve has shown that the WSES Severity Sepsis Score had an excellent prediction for mortality. A score above 5.5 was the best predictor of mortality having a sensitivity of 89.2 %, a specificity of 83.5 % and a positive likelihood ratio of 5.4. Conclusions: WSES Sepsis Severity Score for patients with complicated Intra-abdominal infections can be used on global level. It has shown high sensitivity, specificity, and likelihood ratio that may help us in making clinical decisions.Peer reviewe

Prospective Observational Study on acute Appendicitis Worldwide (POSAW)

Acute appendicitis (AA) is the most common surgical disease, and appendectomy is the treatment of choice in the majority of cases. A correct diagnosis is key for decreasing the negative appendectomy rate. The management can become difficult in case of complicated appendicitis. The aim of this study is to describe the worldwide clinical and diagnostic work-up and management of AA in surgical departments.info:eu-repo/semantics/publishedVersio

Parathyroidectomy in the treatment of secondary hyperparathyroidism. Clinical and laboratory outcomes/ Paratiroidectomia în tratamentul hiperparatiroidismului secundar. Aspecte clinice şi de laborator

Introducere. Hiperparatiroidismul secundar este frecvent întâlnit la pacienţii dializaţi. Paratiroidectomia rămâne o soluţie terapeutică în cazul hiperparatiroidismului secundar refractar şi a celui terţiar. Scopul acestui studiu este de a urmări impactul paratiroidectomiei, indiferent de tehnica chirurgicală utilizată, asupra simptomatologiei şi principalelor constante biologice. Material şi metodă. Am studiat 29 de pacienţi la care s-a efectuat paratiroidectomie pentru hiperparatiroidism secundar şi terţiar, la Clinica Chirurgie II, Spitalul Clinic Judeţean de Urgenţă Mureş, în perioada februarie 2010- mai 2013. Paramentrii urmăriţi au fost clinici şi de laborator (parathormonul, calciul total, fosforul şi fosfataza alcalină serică, hemoglobina şi hematocritul) determinaţi preoperator, imediat postoperator şi pe termen scurt şi mediu de urmărire. Rezultate. Simptomele clinice s-au ameliorat la majoritatea pacienţilor incluşi. Valorile parathormonului seric s-au redus semnificativ, rămânând scăzute pe întreaga perioadă de urmărire; valorile medii ale calcemiei, fosfatemiei, fosfatazei alcaline s-au redus semnificativ statistic în perioada de urmărire după paratiroidectomie. Hemoglobina şi hematocritul au prezentat creşteri semnificativ statistice atât pe termen scurt cât şi mediu de urmărire. Am întâlnit două cazuri de hiperparatiroidism persistent după prima intervenţie (6,89%); 8 pacienţi au prezentat hipocalcemii în prima lună postoperator (sindrom “hungry bones”). Nu am întâlnit mortalitate în seria studiată. Concluzii. Paratiroidectomia, indiferent de tehnica chirurgicală utilizată, rămâne o soluţie fezabilă în tratamentul hiperparatiroidismului secundat şi terţia