158 research outputs found
Acute mesenteric ischemia and duodenal ulcer perforation: a unique double pathology
Background: Acute mesenteric ischaemia and duodenal perforation are surgical emergencies with serious
consequences. Patients presenting with acute mesenteric ischaemia alone face a high mortality rate as high as 60%
whereas those presenting with peptic ulcer perforation the mortality rates range from 6-14%. There are very few
reported cases of patients presenting with this dual pathology.
Case presentation: We report a unique case of a 53 year old Italian lady who presented with acute mesenteric
ischaemia and duodenal perforation. This is the first report of massive bowel ischaemia and duodenal perforation
with no apparent underlying common pathophysiology leading to this presentation.
Conclusion: Early management in the intensive care unit and appropriate surgical intervention maximised the
patient’s chances of survival despite the poor prognosis associated with her dual pathology. The rare pathology of
the patient described can be explained by two possible hypotheses: peptic ulcer disease causing duodenal
ulceration, which precipitated ischaemic infarction of the small bowel. The second hypothesis is the patient
developed a stress related ulcer following ischaemic bowel infarction secondary to arterial thrombosis
Aspectes ètics de la innovació clínica: la cirurgia com a exemple
Ètica; Innovació quirúrgica; TransparènciaÉtica; Innovación quirúrgica; TransparenciaEthics; Surgical innovation; TransparencyAquest document no pot ser de caràcter normatiu, més quan es tracta d’un terreny difícil de
delimitar. El que es pretén es impulsar un debat entre totes les parts implicades en la
innovació quirúrgica (intervencionisme en general), és a dir, entre pacients i associacions que
els representen, professionals i societats científiques i institucions i finançadors de
l’assistència i la recerca en ciències de la salut, per tal que el procés d’innovació clínica es
pugui portar a terme en unes condicions més favorables al progrés i millora de la qualitat en
l’atenció i en la seguretat dels pacients
Evaluation and management of primary hyperparathyroidism: summary statement and guidelines from the fifth international workshop
The last international guidelines on the evaluation and management of primary hyperparathyroidism (PHPT) were published in 2014. Research since that time has led to new insights into epidemiology, pathophysiology, diagnosis, measurements, genetics, outcomes, presentations, new imaging modalities, target and other organ systems, pregnancy, evaluation, and management. Advances in all these areas are demonstrated by the reference list in which the majority of listings were published after the last set of guidelines. It was thus, timely to convene an international group of over 50 experts to review these advances in our knowledge. Four Task Forces considered: 1. Epidemiology, Pathophysiology, and Genetics; 2. Classical and Nonclassical Features; 3. Surgical Aspects; and 4. Management. For Task Force 4 on the Management of PHPT, Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) methodology addressed surgical management of asymptomatic PHPT and non-surgical medical management of PHPT. The findings of this systematic review that applied GRADE methods to randomized trials are published as part of this series. Task Force 4 also reviewed a much larger body of new knowledge from observations studies that did not specifically fit the criteria of GRADE methodology. The full reports of these 4 Task Forces immediately follow this summary statement. Distilling the essence of all deliberations of all Task Force reports and Methodological reviews, we offer, in this summary statement, evidence-based recommendations and guidelines for the evaluation and management of PHPT. Different from the conclusions of the last workshop, these deliberations have led to revisions of renal guidelines and more evidence for the other recommendations. The accompanying papers present an in-depth discussion of topics summarized in this report. © 2022 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR)
Surgeon-Performed Ultrasound as Preoperative Localization Study in Patients with Primary Hyperparathyroidism
Background: Minimally invasive parathyroidectomy is the treatment of choice for single-gland primary hyperparathyroidism. However, the exact location of the abnormal gland has to be established. Sestamibi scintigraphy, computed tomography and ultrasound (US) are commonly used modalities. We describe our experience in a non-academic center with surgeon-performed US (S-US) of the neck as preoperative localization study in patients with primary hyperparathyroidism (PHPT). Methods: Patients with a biochemically proven diagnosis of PHPT and preoperative S-US were included. Data were recorded prospectively. Perioperative gland location was compared to the preoperative S-US to determine sensitivity, specificity and accuracy rates. Results: Two of the 50 patients who underwent S-US were not subjected to surgery. In 85% of the patients analyzed by S-US, the appropriate abnormal gland(s) were identified. In 11%, no gland was identified, but abnormal glands were found during surgery. Sensitivity of S-US in our hospital is 85%, with a positive predictive value of 97%. Conclusions: We achieved a satisfactory sensitivity rate. S-US provides anatomic information to the surgeon which enables a more detailed operation planning, and it is a valuable diagnostic modality for patients with PHPT in our opinion. We hope that our data encourage other centers to implement this technique as well. Copyrigh
Intraoperative Nerve Monitoring Can Reduce Prevalence of Recurrent Laryngeal Nerve Injury in Thyroid Reoperations: Results of a Retrospective Cohort Study
Anamnestic risk factor questionnaire as reliable diagnostic instrument for osteoporosis (reduced bone morphogenic density)
<p>Abstract</p> <p>Background</p> <p>Osteoporosis is a major health problem worldwide, and is included in the WHO list of the top 10 major diseases. However, it is often undiagnosed until the first fracture occurs, due to inadequate patient education and lack of insurance coverage for screening tests. Anamnestic risk factors like positive family anamnesis or early menopause are assumed to correlate with reduced BMD.</p> <p>Methods</p> <p>In our study of 78 patients with metaphyseal long bone fractures, we searched for a correlation between anamnestic risk factors, bone specific laboratory values, and the bone morphogenic density (BMD). Each indicator was examined as a possible diagnostic instrument for osteoporosis. The secondary aim of this study was to demonstrate the high prevalence of osteoporosis in patients with metaphyseal fractures.</p> <p>Results</p> <p>76.9% of our fracture patients had decreased bone density and 43.6% showed manifest osteoporosis in DXA (densitometry) measurements. Our questionnaire, identifying anamnestic risk factors, correlated highly significantly (p = 0.01) with reduced BMD, whereas seven bone-specific laboratory values (p = 0.046) correlated significantly.</p> <p>Conclusions</p> <p>Anamnestic risk factors correlate with pathological BMD. The medical questionnaire used in this study would therefore function as a cost-effective primary diagnostic instrument for identification of osteoporosis patients.</p
Case-case-control study on factors associated with vanB vancomycin-resistant and vancomycin-susceptible enterococcal bacteraemia
Management of intra-abdominal infections : recommendations by the WSES 2016 consensus conference
This paper reports on the consensus conference on the management of intra-abdominal infections (IAIs) which was held on July 23, 2016, in Dublin, Ireland, as a part of the annual World Society of Emergency Surgery (WSES) meeting. This document covers all aspects of the management of IAIs. The Grading of Recommendations Assessment, Development and Evaluation recommendation is used, and this document represents the executive summary of the consensus conference findings.Peer reviewe
Antimicrobials: a global alliance for optimizing their rational use in intra-abdominal infections (AGORA)
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