Risk factors for unfavourable postoperative outcome in patients with Crohn's disease undergoing right hemicolectomy or ileocaecal resection An international audit by ESCP and S-ECCO

Background Patient and disease-related factors, as well as operation technique all have the potential to impact on postoperative outcome in Crohn's disease. The available evidence is based on small series and often displays conflicting results. Aim To investigate the effect of pre- and intra-operative risk factors on 30-day postoperative outcome in patients undergoing surgery for Crohn's disease. Method International prospective snapshot audit including consecutive patients undergoing right hemicolectomy or ileocaecal resection. This study analysed a subset of patients who underwent surgery for Crohn's disease. The primary outcome measure was the overall Clavien-Dindo postoperative complication rate. The key secondary outcomes were anastomotic leak, re-operation, surgical site infection and length of stay at hospital. Multivariable binary logistic regression analyses were used to produce odds ratios (OR) and 95% confidence intervals (CI). Results Three hundred and seventy five resections in 375 patients were included. The median age was 37 and 57.1% were female. In multivariate analyses, postoperative complications were associated with preoperative parenteral nutrition (OR 2.36 95% CI 1.10-4.97)], urgent/expedited surgical intervention (OR 2.00, 95% CI 1.13-3.55) and unplanned intraoperative adverse events (OR 2.30, 95% CI 1.20-4.45). The postoperative length of stay in hospital was prolonged in patients who received preoperative parenteral nutrition (OR 31, CI [1.08-1.61]) and those who had urgent/expedited operations (OR 1.21, CI [1.07-1.37]). Conclusion Preoperative parenteral nutritional support, urgent/expedited operation and unplanned intraoperative adverse events were associated with unfavourable postoperative outcome. Enhanced preoperative optimization and improved planning of operation pathways and timings may improve outcomes for patients

Remember the Thirteenth

My idea in this essay is simple, but I hope significant. It can be summed up in three words: Remember the Thirteenth. (By which I mean, of course, the Thirteenth Amendment to the United States Constitution.) My proposition is that however true generally the notion that the Constitution applies only to action of the state-the government-the Thirteenth Amendment is an important counterexample, and its significance is underappreciated in a wide range of contexts where issues of state action and private power have been problematic. I will discuss three applications today: first, the DeShaney case involving child abuse; second, the racial hate speech and cross-burning at issue in last term\u27s R.A. V v. City of St. Paul; and third, the notion of minimal entitlements-what I like to call 40 acres and a mule

Minnesota Burning: R.A.V. v. City of St. Paul and First Amendment Precedent

The Supreme Court has long held that it would strictly scrutinize restrictions which burdened protected speech based on the content of the speech. In the past, fighting words have been considered as having such slight social value that they did not merit First Amendment protection. In R.A.V., the Court entered uncharted First Amendment territory when it added an underinclusiveness standard to the content based test. Under the new standard, St. Paul, Minnesota\u27s hate speech law was found invalid as viewpoint discrimination aimed at a subset of fighting words. The test adopted by the majority is problematic. Contrary to the majority\u27s conclusion, a review of the Court\u27s prior cases does not support the new test. Moreover, the three exceptions announced by the majority undermine the rationale for the test. Reconciling the test and its exception for Title VII\u27s prohibitions is troublesome because the R.A. V. test is poorly conceived and represents a considerable change in Fist Amendment doctrine. As a result, the test casts a long shadow over related fields of law

Colored Speech: Cross Burnings, Epistemics, and the Triumph of the Crits?

This Essay examines the Court\u27s recent decision in Virginia v. Black. It argues that Black signifies a different approach to the constitutionality of statutes regulating cross burnings. It shows how the Court\u27s conservatives have essentially accepted the intellectual framework and the mode of analysis suggested previously by the critical race theorists. In particular, this Essay explores the role that Justice Thomas plays in the case. The Essay explains Justice Thomas\u27s active participation as a matter of epistemic authority and epistemic deference

Colored Speech: Cross Burnings, Epistemics, and the Triumph of the Crits?

This Essay examines the Court\u27s recent decision in Virginia v. Black. It argues that Black signifies a different approach to the constitutionality of statutes regulating cross burnings. It shows how the Court\u27s conservatives have essentially accepted the intellectual framework and the mode of analysis suggested previously by the critical race theorists. In particular, this Essay explores the role that Justice Thomas plays in the case. The Essay explains Justice Thomas\u27s active participation as a matter of epistemic authority and epistemic deference