Primjena autologne fibrinske membrane obogaćene trombocitima (PRF) u liječenju dubokih čireva rožnice u pasa

The aim of this study was to evaluate the clinical efficacy of a platelet-rich fibrin (PRF) membrane, which is considered to be a new alternative surgical method in the treatment of vision-threatening corneal ulcers in dogs. Fourteen dogs (17 eyes) of various breeds and ages with deep corneal ulcers were treated surgically with a PRF membrane transplantation. The corneal ulcer of all the patients was closed with an autologous platelet-rich fibrin membrane. In the first 10 days after the operation, it was observed that the fibrin membrane partially melted, and corneal epithelialization and granulation tissue occurred in and around the ulcer area due to the graft material. Pain was significantly relieved, and conjunctival inflammation was noticeably improved. From the 20th day after the surgery, the granulation tissue was gradually cleaned. It was determined that all the eyes had vision. The most common complications after surgery were corneal pigmentation and fibrosis of varying severity. The use of autologous fibrin membranes is a safe and effective surgical alternative for the closure and healing of corneal ulcers. Our findings show that the autologous platelet-rich fibrin membrane is useful and effective in treating canine corneal deep ulcers.Čirevi rožnice mogu oštetiti vid u pasa. Cilj je ovog istraživanja bio procijeniti kliničku učinkovitost fibrinske membrane obogaćene trombocitima (PRF), kao nove alternative kirurških metoda u liječenju čireva rožnice. Četrnaest pasa (17 očiju) različitih pasmina i dobi, s dubokim čirevima rožnice liječeno je kirurški transplantacijom. Čir na rožnici u svih je pacijenata bio zatvoren autolognom fibrinskom membranom obogaćenom trombocitima. Prvih 10 dana nakon kirurškog zahvata uočeno je da se fibrinska membrana parcijalno talila, dok se na čiru i oko njega pojavilo epitelizacijsko i granulacijsko tkivo zbog graft materijala. Bol je znatno ublažena, a upala konjunktive osjetno smanjena. Od 20. dana nakon kirurškog zahvata granulacijsko je tkivo postupno očišćeno. Pokazalo se da je svim psima vraćen vid. Najčešće su komplikacije nakon kirurškog zahvata bile pigmentacija rožnice i fibroza različita stupnja. Rezultati istraživanja pokazuju da je autologna fibrinska membrana obogaćena trombocitima sigurna, korisna i učinkovita kirurška alternativa u liječenju dubokih čireva rožnice u pasa

Laparoscopic surgery for complex and recurrent Crohn's disease

Crohn's disease (CD) is a chronic inflammatory disease of digestive tract. Approximately 70\% of patients with CD require surgical intervention within 10 years of their initial diagnosis, despite advanced medical treatment alternatives including biologics, immune suppressive drugs and steroids. Refractory to medical treatment in CD patients is the common indication for surgery. Unfortunately, surgery cannot cure the disease. Minimally invasive treatment modalities can be suitable for CD patients due to the benign nature of the disease especially at the time of index surgery. However, laparoscopic management in fistulizing or recurrent disease is controversial. Intractable fibrotic strictures with obstruction, fistulas with abscess formation and hemorrhage are the surgical indications of recurrent CD, which are also complicating laparoscopic treatments. Nevertheless, laparoscopy can be performed in selected CD patients with safety, and may provide better outcomes compared to open surgery. The common complication after laparoscopic intervention is postoperative ileus seems and this may strongly relate excessive manipulation of the bowel during dissection. But additionally, unsuccessful laparoscopic attempts requiring conversion to open surgery have been a major concern due to presumed risk of worse outcomes. However, recent data show that conversions do not to worsen the outcomes of colorectal surgery in experienced hands. In conclusion, laparoscopic treatment modalities in recurrent CD patients have promising outcomes when it is used selectively.4APR 16149-152

Breast hamartoma: a clinicopathologic analysis of 27 cases and a literature review

OBJECTIVES: Breast hamartoma is an uncommon breast tumor that accounts for approximately 4.8% of all benign breast masses. The pathogenesis is still poorly understood and breast hamartoma is not a well-known disorder, so its diagnosis is underestimated by clinicians and pathologists. This study was designed to present our experience with breast hamartoma, along with a literature review. METHOD: We reviewed the demographic data, pathologic analyses and imaging and results of patients diagnosed with breast hamartoma between December 2003 and September 2013. RESULTS: In total, 27 cases of breast hamartoma operated in the Ankara University Medicine Faculty's Department of General Surgery were included in the study. All patients were female and the mean age was 41.8±10.8 years. The mean tumor size was 3.9±2.7 cm. Breast ultrasound was performed on all patients before surgery. The most common additional lesion was epithelial hyperplasia (22.2%). Furthermore, lobular carcinoma in situ was identified in one case and invasive ductal carcinoma was observed in another case. Immunohistochemical staining revealed myoid hamartoma in one case (3.7%). CONCLUSION: Breast hamartomas are rare benign lesions that may be underdiagnosed because of the categorization of hamartomas as fibroadenomas by pathologists. Pathologic examinations can show variability from one case to another. Thus, the true incidence may be higher than the literature indicates

Is local resection sufficient for parathyroid carcinoma?

OBJECTIVES: Parathyroid carcinoma is a rare malignant disease of the parathyroid glands that appears in less than 1% of patients with primary hyperparathyroidism. In the literature, the generally recommended treatment is en bloc tumor excision with ipsilateral thyroid lobectomy. Based on our 12 years of experience, we discuss the necessity of performing thyroid lobectomy on parathyroid carcinoma patients. RESULTS: Eleven parathyroid carcinoma cases were included in the study. All operations were performed at the Department of Endocrine Surgery at Ankara University Medical School. Seven of the patients were male (63.6%), and the mean patient age was 48.9 ± 14.0 years. Hyperparathyroidism was the most common indication for surgery (n ϝ 10, 90.9%). Local disease was detected in 5 patients (45.5%), invasive disease was detected in 5 patients (45.5%) and metastatic disease was detected in 1 patient (9.1%). The mean follow-up period was 99.6 ± 42.1 months, and the patients' average disease-free survival was 96.0 ± 49.0 months. During the follow-up period, only 1 patient died of metastatic parathyroid carcinoma. CONCLUSION: Parathyroid carcinoma has a slow-growing natural progression, and regional lymph node metastases are uncommon. Although our study comprised few patients, it nevertheless showed that in selected cases, parathyroid carcinoma could be solely treated with parathyroidectomy

La banque de Finlande, les banques privées et les établissements hypothécaires en 1912

Suomen virallinen tilasto (SVT

Evaluation of patients with fibrotic interstitial lung disease: Preliminary results from the Turk-UIP study

OBJECTIVE: Differential diagnosis of idiopathic pulmonary fibrosis (IPF) is important among fibrotic interstitial lung diseases (ILD). This study aimed to evaluate the rate of IPF in patients with fibrotic ILD and to determine the clinical-laboratory features of patients with and without IPF that would provide the differential diagnosis of IPF. MATERIAL AND METHODS: The study included the patients with the usual interstitial pneumonia (UIP) pattern or possible UIP pattern on thorax high-resolution computed tomography, and/or UIP pattern, probable UIP or possible UIP pattern at lung biopsy according to the 2011 ATS/ERSARS/ALAT guidelines. Demographics and clinical and radiological data of the patients were recorded. All data recorded by researchers was evaluated by radiology and the clinical decision board. RESULTS: A total of 336 patients (253 men, 83 women, age 65.8 +/- 9.0 years) were evaluated. Of the patients with sufficient data for diag-nosis (n=300), the diagnosis was IPF in 121 (40.3%), unclassified idiopathic interstitial pneumonia in 50 (16.7%), combined pulmonary fibrosis and emphysema (CPFE) in 40 (13.3%), and lung involvement of connective tissue disease (CTD) in 16 (5.3%). When 29 patients with definite IPF features were added to the patients with CPFE, the total number of IPF patients reached 150 (50%). Rate of male sex (p<0.001), smoking history (p<0.001), and the presence of clubbing (p=0.001) were significantly high in patients with IPE None of the women <50 years and none of the men <50 years of age without a smoking history were diagnosed with IPE Presence of at least 1 of the symptoms suggestive of CTD, erythrocyte sedimentation rate (ESR), and antinuclear antibody (FANA) positivity rates were significantly higher in the non-IPF group (p<0.001, p=0.029, p=0.009, respectively). CONCLUSION: The rate of IPF among patients with fibrotic ILD was 50%. In the differential diagnosis of IPF, sex, smoking habits, and the presence of clubbing are important. The presence of symptoms related to CTD, ESR elevation, and EANA positivity reduce the likelihood of IPF

Burnout among surgeons before and during the SARS-CoV-2 pandemic: an international survey

Background: SARS-CoV-2 pandemic has had many significant impacts within the surgical realm, and surgeons have been obligated to reconsider almost every aspect of daily clinical practice. Methods: This is a cross-sectional study reported in compliance with the CHERRIES guidelines and conducted through an online platform from June 14th to July 15th, 2020. The primary outcome was the burden of burnout during the pandemic indicated by the validated Shirom-Melamed Burnout Measure. Results: Nine hundred fifty-four surgeons completed the survey. The median length of practice was 10&nbsp;years; 78.2% included were male with a median age of 37&nbsp;years old, 39.5% were consultants, 68.9% were general surgeons, and 55.7% were affiliated with an academic institution. Overall, there was a significant increase in the mean burnout score during the pandemic; longer years of practice and older age were significantly associated with less burnout. There were significant reductions in the median number of outpatient visits, operated cases, on-call hours, emergency visits, and research work, so, 48.2% of respondents felt that the training resources were insufficient. The majority (81.3%) of respondents reported that their hospitals were included in the management of COVID-19, 66.5% felt their roles had been minimized; 41% were asked to assist in non-surgical medical practices, and 37.6% of respondents were included in COVID-19 management. Conclusions: There was a significant burnout among trainees. Almost all aspects of clinical and research activities were affected with a significant reduction in the volume of research, outpatient clinic visits, surgical procedures, on-call hours, and emergency cases hindering the training. Trial registration: The study was registered on clicaltrials.gov "NCT04433286" on 16/06/2020

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p&lt;0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p&lt;0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised

Etlik Piliçlerde Karma Yeme Farklı Esansiyel Yağlar ve Karışımlarının İlavesinin Performans ve Karkas Özellikleri Üzerine Etkisi

Bu çalışma, etlik piliçlerde kekik (Thymus vulgaris L.), biberiye (Rosmarinus officinalis L.) ve karabaş otu (Lavandula stoechas L.) esansiyel yağları ve bunların karışımlarının canlı ağırlık, canlı ağırlık artışı, yem tüketimi, yemden yararlanma oranı ve karkas özellikleri üzerine etkisini tespit etmek için yapılmıştır. Çalışmada, günlük yaşta toplam 640 adet etlik civciv (Ross 308) kullanılmış ve 5 tekerrürlü olacak şekilde 8 muamele grubuna tesadüfü olarak yerleştirilmiştir. Her bir muamele grubunda 80 adet civciv bulunmaktadır. Deneme rasyonları sırasıyla kontrol (0 mg/kg), ilave kekik esansiyel yağı (50 mg/kg), biberiye esansiyel yağı (50 mg/kg), karabaş otu esansiyel yağı (50 mg/kg), kekik + biberiye (25+25 mg/kg), kekik + karabaş otu (25+25 mg/kg), biberiye + karabaş otu (25+25 mg/kg) ve kekik+biberiye+karabaş otu (16,7 + 16,7 + 16,7 mg/kg) oluşmaktadır. Yem ve su ad libitum olarak sağlanmıştır. Çalışma 6 hafta sürmüştür. Performans parametreleri haftalık olarak belirlenmiştir. Denemenin 42. gününde hayvanlar kesilerek karkas özellikleri tespit edilmiştir. Çalışma sonuçlarına göre, rasyon farklı esansiyel yağ ve bunların karışımlarının etlik piliçlerde canlı ağırlık, canlı ağırlık artışı, yem tüketimi, yem değerlendirme oranı ve karkas özellikleri üzerine etkisi önemli olmamıştır