Postoperative complications and waiting time for surgical intervention after radiologically guided drainage of intra-abdominal abscess in patients with Crohn’s disease

Postoperative complications; DrainageComplicacions postoperatòries; DrenatgeComplicaciones postoperatorias; DrenajeBackground In patients with active Crohn’s disease (CD), treatment of intra-abdominal abscess usually comprises antibiotics and radiologically guided percutaneous drainage (PD) preceding surgery. The aim of this study was to investigate the risk of postoperative complications and identify the optimal time interval for surgical intervention after PD. Methods A multicentre, international, retrospective cohort study was carried out. Details of patients with diagnosis of CD who underwent ultrasonography- or CT-guided PD were retrieved from hospital records using international classification of disease (ICD-10) diagnosis code for CD combined with procedure code for PD. Clinical variables were retrieved and the following outcomes were measured: 30-day postoperative overall complications, intra-abdominal septic complications, unplanned intraoperative adverse events, surgical-site infections, sepsis and pathological postoperative ileus, in addition to abscess recurrence. Patients were categorized into three groups according to the length of the interval from PD to surgery (1–14 days, 15–30 days and more than 30 days) for comparison of outcomes. Results The cohort comprised 335 CD patients with PD followed by surgery. Median age was 33 (i.q.r. 24–44) years, 152 (45.4 per cent) were females, and median disease duration was 9 (i.q.r. 3.6–15) years. Overall, the 30-day postoperative complications rate was 32.2 per cent and the mortality rate was 1.5 per cent. After adjustment for co-variables, older age (odds ratio 1.03 (95 per cent c.i. 1.01 to 1.06), P < 0.012), residual abscess after PD (odds ratio 0.374 (95 per cent c.i. 0.19 to 0.74), P < 0.014), smoking (odds ratio 1.89 (95 per cent c.i. 1.01 to 3.53), P = 0.049) and low serum albumin concentration (odds ratio 0.921 (95 per cent c.i. 0.89 to 0.96), P < 0.001) were associated with higher rates of postoperative complications. A short waiting interval, less than 2 weeks after PD, was associated with a high incidence of abscess recurrence (odds ratio 0.59 (95 per cent c.i. 0.36 to 0.96), P = 0.042). Conclusion Smoking, low serum albumin concentration and older age were significantly associated with postoperative complications. An interval of at least 2 weeks after successful PD correlated with reduced risk of abscess recurrence

Watchful Waiting After Radiological Guided Drainage of Intra-abdominal Abscess in Patients With Crohn’s Disease Might Be Associated With Increased Rates of Stoma Construction

Crohn’s disease; Abscess; StomaMalaltia de Crohn; Abscés; EstomaEnfermedad de Crohn; Absceso; EstomaBackground Management of spontaneous intra-abdominal abscess (IAA) in patients with Crohn’s disease (CD) with radiologically guided percutaneous drainage (PD) was debated. Methods This is a secondary analysis from a multicenter, retrospective cohort study of all the patients with CD who underwent PD followed by surgery at 19 international tertiary centers. Results Seventeen patients (4.8%) who did not undergo surgery after PD were compared to those who had PD followed by surgical intervention 335/352 (95.2%). Patients who had PD without surgery were those with longer disease duration, more frequently had previous surgery for CD (laparotomies/laparoscopies), enteric fistula, on steroid treatment before and continue to have it after PD. Patients who had PD without subsequent surgical resection had a higher risk of stoma construction at later stages 8/17 (47.1%) versus 90/326 (27.6%) (P < .01). Patients with PD with no subsequent surgery had numerically higher rates of abscess recurrence 5/17 (29.4%) compared to those who had PD followed by surgery 45/335 (13.4%) the difference was not statistically significant (P = .07). Conclusions Even with the low number of patients enrolled in this study who had PD of IAA without subsequent surgery, the findings indicate a markedly worse prognosis in terms of recurrence, length of stay, readmission, and stoma construction. Watchful waiting after PD to treat patients with spontaneous IAA might be indicated in selected patients with poor health status or poor prognostic factors

Postoperative complications and waiting time for surgical intervention after radiologically guided drainage of intra-abdominal abscess in patients with Crohn's disease

In patients with active Crohn's disease (CD), treatment of intra-abdominal abscess usually comprises antibiotics and radiologically guided percutaneous drainage (PD) preceding surgery. The aim of this study was to investigate the risk of postoperative complications and identify the optimal time interval for surgical intervention after PD

Self-assessment of Industry 4.0 Technologies in Intralogistics for SME’s

Part 5: Industry 4.0 ImplementationsInternational audienceThe 4th industrial revolution generates a high potential for smart production systems. Many manufacturing companies considering therefore the application of cyber-physical systems in the sector of intralogistics. The aim is to achieve better logistics performance or lower costs. However, small and medium sized enterprises (SME) are hesitant about introducing Industry 4.0 technologies. They fear high implementation costs, low benefits and the lack of know-how increases the reluctance of the companies.This paper presents a procedure which enables SME’s to assess the benefits of Industry 4.0 technologies by themselves. The model follows the recognized principle: First improve your processes, then automate them:Methodical basis is a process model intralogistics, which also considers self-controlling cyber-physical systems. In addition, the benefit aspects are assigned to the individual process steps.In the specific application, the company first determines the digitization potential of the individual activities and then the associated benefits of Industry 4.0 technologies.The procedure reduces on the one hand the uncertainty regarding of wrong decisions and creates on the other hand the possibility for companies to select Industry 4.0 technologies goal-oriented. The described procedure was validated with SMEs

Association between traumatic bone marrow abnormalities of the knee, the trauma mechanism and associated soft-tissue knee injuries

OBJECTIVES: To determine the association between traumatic bone marrow abnormalities, the knee injury mechanism, and associated soft tissue injuries in a larger cohort than those in the published literature. METHOD: Retrospective study including 220 patients with traumatic knee injuries. Knee MRIs were evaluated for trauma mechanism, soft tissue injury, and the location of bone marrow abnormalities. The locations of the abnormalities were correlated with trauma mechanisms and soft tissue injuries using the chi-square test with Bonferroni correction. RESULTS: One hundred and forty-four valgus injuries, 39 pivot shift injuries, 25 lateral patellar dislocations, 8 hyperextensions, and 4 dashboard injuries were included. Valgus and pivot shift injuries showed traumatic bone marrow abnormalities in the posterolateral regions of the tibia. Abnormalities after patellar dislocation were found in the anterolateral and centrolateral femur and patella. Hyperextension injuries were associated with abnormalities in almost all regions, and dashboard injuries were associated with changes in the anterior regions of the tibia and femur. CONCLUSIONS: Our study provides evidence of associations between traumatic bone marrow abnormality patterns and different trauma mechanisms in acute knee injury, and reveals some overlap, especially of the two most common trauma mechanisms (valgus and pivot shift), in a large patient cohort. KEY POINTS• Specific bone marrow oedema patterns after knee trauma were confirmed. • New associations between bone marrow oedema patterns and knee trauma were shown. • Bone marrow oedema patterns help in identifying associated soft tissue injuries

Comparison of the deflated preconditioned conjugate gradient method and algebraic multigrid for composite materials

Many applications in computational science and engineering concern composite materials, which are characterized by large discontinuities in the material properties. Such applications require fine-scale finite-element meshes, which lead to large linear systems that are challenging to solve with current direct and iterative solutions algorithms. In this paper, we consider the simulation of asphalt concrete, which is a mixture of components with large differences in material stiffness. The discontinuities in material stiffness give rise to many small eigenvalues that negatively affect the convergence of iterative solution algorithms such as the preconditioned conjugate gradient (PCG) method. This paper considers the deflated preconditioned conjugate gradient (DPCG) method in which the rigid body modes of sets of elements with homogeneous material properties are used as deflation vectors. As preconditioner we consider several variants of the algebraic multigrid smoothed aggregation method. We evaluate the performance of the DPCG method on a parallel computer using up to 64 processors. Our test problems are derived from real asphalt core samples, obtained using CT scans. We show that the DPCG method is an efficient and robust technique for solving these challenging linear systems.Structural EngineeringCivil Engineering and Geoscience