Strategic management and demarketing in UNESCO WHSs: a comparative analysis of two Croatian tourist destinations

This paper studies the protected cultural property strategic management conducted by UNESCO, the World Heritage Sites (WHS). Its purpose is to explore the measure to which the system of such cultural property management is developed, since its meaning goes beyond the touristic purpose and indicates the world’s cultural property. Two Croatian tourist destinations are examined – Dubrovnik and Poreč. At the end of the paper, a comparative analysis of the two investigated cases is presented with the aim of presenting the research results and designing a personal model and conceptual frame of action to create a more efficient management system for protected heritage at all levels

Post-Operative Functional Outcomes in Early Age Onset Rectal Cancer

Background: Impairment of bowel, urogenital and fertility-related function in patients treated for rectal cancer is common. While the rate of rectal cancer in the young (<50 years) is rising, there is little data on functional outcomes in this group. Methods: The REACCT international collaborative database was reviewed and data on eligible patients analysed. Inclusion criteria comprised patients with a histologically confirmed rectal cancer, <50 years of age at time of diagnosis and with documented follow-up including functional outcomes. Results: A total of 1428 (n=1428) patients met the eligibility criteria and were included in the final analysis. Metastatic disease was present at diagnosis in 13%. Of these, 40% received neoadjuvant therapy and 50% adjuvant chemotherapy. The incidence of post-operative major morbidity was 10%. A defunctioning stoma was placed for 621 patients (43%); 534 of these proceeded to elective restoration of bowel continuity. The median follow-up time was 42 months. Of this cohort, a total of 415 (29%) reported persistent impairment of functional outcomes, the most frequent of which was bowel dysfunction (16%), followed by bladder dysfunction (7%), sexual dysfunction (4.5%) and infertility (1%). Conclusion: A substantial proportion of patients with early-onset rectal cancer who undergo surgery report persistent impairment of functional status. Patients should be involved in the discussion regarding their treatment options and potential impact on quality of life. Functional outcomes should be routinely recorded as part of follow up alongside oncological parameters

Das akute Abdomen im Alter

Das akute Abdomen bei älteren Patienten weist im Vergleich zu jüngeren Patienten einige Besonderheiten auf: So unterscheidet sich die relative Häufigkeit der zugrunde liegenden Erkrankungen in einigen Entitäten deutlich. Darüber hinaus weisen ältere Patienten wegen einer Atrophie der muskulären Bauchdecken und einer ggf. begleitenden Immunkompromittierung eine für das jeweilige Krankheitsbild weniger typische Präsentation bis zur fehlenden Ausbildung von Peritonitiszeichen auf. Nicht selten handelt es sich um multimorbide Patienten in reduziertem Allgemein- und Ernährungszustand, sodass eine höhere Morbidität und Mortalität in diesem Patientenkollektiv besteht. Diese Aspekte müssen sowohl in der Diagnostik als auch in der Therapie Berücksichtigung finden

ORGANIZATION AND IMPLEMENTATION OF INTEGRATED MANAGEMENT SYSTEM PROCESSES - CRUISE PORT DUBROVNIK

World cruise market is very dynamic and it is characterised by constant changes in offer and demand. Dubrovnik, as one of the leading port in the Mediterranean is faced with the problem of large concentrations of ships and passengers in a short period of time. Paper provides answers to the questions: how to manage cruise tourism in Dubrovnik? What are the guidelines for the further development of cruising in Dubrovnik? Modern ports management system must be organized and managed in a manner that will ensure the recognition requirements of stakeholders and their fulfilment. All this requires a more complex integrated management system, in which the requirements of quality management will be the basis, and requirements of environmental management needed an upgrade

Pitfalls of Laparoscopic Re-TAPP in Recurrent Inguinal Hernia Repair—a Plea for Extended Preoperative Diagnostic

According to international guidelines, recurrent inguinal hernia should be treated by a surgical approach opposing of the primary strategy (anterior–posterior or posterior–anterior). However, recent evidence demonstrates feasibility and safety of re-laparoscopic repair of recurrent inguinal hernia after primary laparoscopy. For such a strategy, correct identification of anatomical structures is challenging, but absolutely crucial for a satisfactory postoperative result. This case of an unrecognized sliding hernia of the sigmoid colon during re-laparoscopy highlights that a precise physical examination as well as an extended preoperative radiological workup (ultrasound, computed tomography and/or magnetic resonance imaging of the abdomen and pelvis) should be considered prior to re-laparoscopy of recurrent inguinal hernia

Defining Global Benchmarks in Elective Secondary Bariatric Surgery Comprising Conversional, Revisional, and Reversal Procedures

Objective: To define "best possible" outcomes for secondary bariatric surgery (BS). Background: Management of poor response and of long-term complications after BS is complex and under-investigated. Indications and types of reoperations vary widely and postoperative complication rates are higher compared to primary BS. Methods: Out of 44,884 BS performed in 18 high-volume centers from 4 continents between 06/2013-05/2019, 5,349 (12%) secondary BS cases were identified. Twenty-one outcome benchmarks were established in low-risk patients, defined as the 75th percentile of the median outcome values of centers. Benchmark cases had no previous laparotomy, diabetes, sleep apnea, cardiopathy, renal insufficiency, inflammatory bowel disease, immunosuppression, thromboembolic events, BMI> 50 kg/m2 or age> 65 years. Results: The benchmark cohort included 3143 cases, mainly females (85%), aged 43.8 ± 10 years, 8.4 ± 5.3 years after primary BS, with a BMI 35.2 ± 7 kg/m2. Main indications were insufficient weight loss (43%) and gastro-esophageal reflux disease/dysphagia (25%). 90-days postoperatively, 14.6% of benchmark patients presented ≥1 complication, mortality was 0.06% (n = 2). Significantly higher morbidity was observed in non-benchmark cases (OR 1.37) and after conversional/reversal or revisional procedures with gastrointestinal suture/stapling (OR 1.84). Benchmark cutoffs for conversional BS were ≤4.5% re-intervention, ≤8.3% re-operation 90-days postoperatively. At 2-years (IQR 1-3) 15.6% of benchmark patients required a reoperation. Conclusion: Secondary BS is safe, although postoperative morbidity exceeds the established benchmarks for primary BS. The excess morbidity is due to an increased risk of gastrointestinal leakage and higher need for intensive care. The considerable rate of tertiary BS warrants expertise and future research to optimize the management of non-success after BS

Online Survey on Factors Influencing Patients' Motivation to Undergo Bariatric Surgery

Given the worldwide increasing prevalence of severe obesity and considering the amount of scientific evidence demonstrating the beneficial effects of bariatric surgery (BS), it is surprising that only a fraction of patients with obesity undergo BS. We therefore conducted an anonymized online survey among individuals with a history of BS to understand factors influencing the deciding process leading to BS. Respondents were recruited on a voluntary basis from obesity-related social media groups between April and June 2020. The self-designed, non-validated questionnaire consisted of 20 questions and was open to any participants with a history of BS. Of 851 participants who started the survey, 665 completed the questionnaire (completion rate of 78.1%). Five years after BS, still 70% of the survey-participants were very satisfied or satisfied with the surgical result. However, the majority (73.3%) would have undergone BS earlier. The main motivation to choose BS was related to health status or quality of life. Important characteristics for a bariatric surgeon to obtain patients' trust are "taking time and listen" (74.7%), empathy (64%) and sympathy (56%). Post-operative satisfaction with the surgical outcome was high and long-lasting in this large cohort of BS patients. However, most participants would retrospectively have undergone BS earlier. The main reason to choose BS as treatment for their obesity were impaired physical health or reduced quality of life. Nearby location to patients' residence and availability of surgeons with empathy were decisive motives for bariatric centre selection. Keywords: bariatric surgery; characteristics of bariatric surgeons; choice for bariatric centre; decision-making for bariatric surgery; reasons for bariatric surgery; survey

Microsatellite instability in young patients with rectal cancer: molecular findings and treatment response

No abstract available