After-hours colorectal surgery: a risk factor for anastomotic leakage

__Purpose:__ This study aims to increase knowledge of colorectal anastomotic leakage by performing an incidence study and risk factor analysis with new potential risk factors in a Dutch tertiary referral center. __Methods:__ All patients whom received a primary colorectal anastomosis between 1997 and 2007 were selected by means of operation codes. Patient records were studied for population description and risk factor analysis. __Results:__ In total 739 patients were included. Anastomotic leakage (AL) occurred in 64 (8.7%) patients of whom nine (14.1%) died. Median interval between operation and diagnosis was 8 days. The risk for AL was higher as the anastomoses were constructed more distally (p = 0.019). Univariate analysis showed duration of surgery (p = 0.038), BMI (p = 0.001), time of surgery (p = 0.029), prophylactic drainage (p = 0.006) and time under anesthesia (p = 0.012) to be associated to AL. Multivariate analysis showed BMI greater than 30 kg/m2(p = 0.006; OR 2.6 CI 1.3-5.2) and "after hours" construction of an anastomosis (p = 0.030; OR 2.2 CI 1.1-4.5) to be independent risk factors. __Conclusion:__ BMI greater than 30 kg/m2and "after hours" construction of an anastomosis were independent risk factors for colorectal anastomotic leakage

Gastrointestinal decontamination in the acutely poisoned patient

ObjectiveTo define the role of gastrointestinal (GI) decontamination of the poisoned patient.Data sourcesA computer-based PubMed/MEDLINE search of the literature on GI decontamination in the poisoned patient with cross referencing of sources.Study selection and data extractionClinical, animal and in vitro studies were reviewed for clinical relevance to GI decontamination of the poisoned patient.Data synthesisThe literature suggests that previously, widely used, aggressive approaches including the use of ipecac syrup, gastric lavage, and cathartics are now rarely recommended. Whole bowel irrigation is still often recommended for slow-release drugs, metals, and patients who "pack" or "stuff" foreign bodies filled with drugs of abuse, but with little quality data to support it. Activated charcoal (AC), single or multiple doses, was also a previous mainstay of GI decontamination, but the utility of AC is now recognized to be limited and more time dependent than previously practiced. These recommendations have resulted in several treatment guidelines that are mostly based on retrospective analysis, animal studies or small case series, and rarely based on randomized clinical trials.ConclusionsThe current literature supports limited use of GI decontamination of the poisoned patient

Quelle prise en charge de la grossesse après une chirurgie bariatrique ?

International audienceObesity represents a major public health issue and a potential threat for people health. Moreover, the incidence of obesity has been increasing and therefore, the incidence of women with an history of bariatric surgery with a pregnancy desire has been also increased. Although the weight loss after bariatric surgery has positive effects on pregnancy outcomes, these surgical procedures may be associated with adverse outcomes as well, for example micronutrient deficiencies, dumping syndrome, surgical complications such as internal hernias, and obstetrical complications such as small for gestational age as instance. Nevertheless, physician knowledge about pregnancy management after bariatric surgery is currently insufficient and a multidisciplinary approach is therefore mandatory. The aim of this article is to provide to readers general and recent data regarding the management of pregnancy after bariatric surgery. (C) 2020 Elsevier Masson SAS. All rights reserved.L’obésité représente un problème de santé publique majeur et une menace pour la santé des populations. L’incidence de l’obésité augmentant, il en résulte parallèlement un nombre accru de femmes souffrant d’obésité et ayant un désir de grossesse. Sur le plan thérapeutique, la chirurgie bariatrique a d’abord été décrite en 1969 et a été démocratisée de façon importante à la fin des années 1990 avec l’avènement de la cœlioscopie. Elle s’est imposée comme le traitement le plus efficace pour traiter l’obésité morbide. Bien que la perte de poids obtenue grâce à la chirurgie bariatrique ait un impact positif sur le déroulement de la grossesse, il existe des effets indésirables potentiels associés tels que des déficits nutritionnels, un dumping syndrome, de potentielles complications chirurgicales, et des complications obstétricales comme le retard de croissance intra-utérin, notamment en absence de suivi adéquat et régulier. Cependant, les connaissances des soignants concernant la prise en charge de la grossesse après une chirurgie bariatrique sont parfois insuffisantes. Ainsi, le but de ce travail est de fournir aux lecteurs des informations générales et récentes sur la prise en charge des patientes ayant bénéficié d’une chirurgie bariatrique et qui ont un désir de grossesse

Étude d'une décharge électrique dans l'hydrogène et le deutérium

The discharge of a capacitor bank between electrodes in deuterium or hydrogen under 50 mm of pressure creates a spark channel. Its behaviour has been recorded as a function of time. During the first quarter period, its radial expansion is a linear function of time. By means of optical methods, the electron density along the discharge axis could be determnined. Hence, a discharge channel structure is derived.La décharge d'une batterie de condensateurs entre deux électrodes placées dans du deutérium ou de l'hydrogène à 50 mm de pression conduit à la formation d'un canal d'étincelle dont nous avons pu suivre l'évolution au cours du temps. La propagation radiale est une fonction linéaire du temps pendant le premier quart de période. Nous avons pu par des méthodes optiques déterminer à différents instants la densité électronique sur l'axe de la décharge. Nous avons, à partir de là, déterminé la structure du canal de décharge

MEDINFO 2013 : proceedings of the 14th world congress and medical and health informatics : part 1 and 2

Non-alcoholic fatty liver disease (NAFLD) is a hepatic dis-ease associated with metabolic syndrome. NAFLD covers a spectrum of liver disease from steatosis to non-alcoholic stea-tohepatitis (NASH) and cirrhosis. NASH is a disease evolving under the influence of various stimuli still poorly understood. In this paper we present new clinical decision support system (CDSS) for the diagnosis of NASH and the comparison of this system with machine learn-ing algorithms

Fibrosis in human adipose tissue : composition, distribution, and link with lipid metabolism and fat mass loss [plus Appendix : Experimental procedures and results]

Objective : Fibrosis is a newly appreciated hallmark of the pathological alteration of human white adipose tissue (WAT). We investigated the composition of subcutaneous (scWAT) and omental WAT (oWAT) fibrosis in obesity and its relationship with metabolic alterations and surgery-induced weight loss. Research design and methods : Surgical biopsies for scWAT and oWAT were obtained in 65 obese (BMI 48.2 ± 0.8 kg/m(2)) and 9 lean subjects (BMI 22.8 ± 0.7 kg/m(2)). Obese subjects who were candidates for bariatric surgery were clinically characterized before, 3, 6, and 12 months after surgery, including fat mass evaluation by dual energy X-ray absorptiometry. WAT fibrosis was quantified and characterized using quantitative PCR, microscopic observation, and immunohistochemistry. Results : Fibrosis amount, distribution and collagen types (I, III, and VI) present distinct characteristics in lean and obese subjects and with WAT depots localization (subcutaneous or omental). Obese subjects had more total fibrosis in oWAT and had more pericellular fibrosis around adipocytes than lean subjects in both depots. Macrophages and mastocytes were highly represented in fibrotic bundles in oWAT, whereas scWAT was more frequently characterized by hypocellular fibrosis. The oWAT fibrosis negatively correlated with omental adipocyte diameters (R = -0.30, P = 0.02), and with triglyceride levels (R = -0.42, P < 0.01), and positively with apoA1 (R = 0.25, P = 0.05). Importantly, scWAT fibrosis correlated negatively with fat mass loss measured at the three time points after surgery. Conclusions : Our data suggest differential clinical consequences of fibrosis in human WAT. In oWAT, fibrosis could contribute to limit adipocyte hypertrophy and is associated with a better lipid profile, whereas scWAT fibrosis may hamper fat mass loss induced by surgery