Emergency treatment of complicated colorectal cancer

Aim: To find evidence to suggest the best approach in patients admitted as an emergency for complicated colorectal cancer. Methods: The medical records of 131 patients admitted as an emergency with an obstructing, perforated, or bleeding colorectal cancer to Noble’s Hospital, Isle of Man, and the Umberto I University Hospital, Rome, were retrospectively evaluated. Patients were divided in 3 groups on the basis of the emergency treatment they received, namely 1) immediate resection, 2) damage control procedure and elective or semielective resection, and 3) no radical treatment. Demographic variables, clinical data, and treatment data were considered, and formed the basis for the comparison of groups. Primary endpoints were 90-day mortality and morbidity. Secondary endpoints were length of stay, number of lymph nodes analyzed, rate of radical R0 resections, and the number of patients who had chemoradiotherapy. Results: Forty-two patients did not have any radical treatment because the cancer was too advanced or they were too ill to tolerate an operation, 78 patients had immediate resection and 11 had damage control followed by elective resection. There was no statistically significant difference between immediate resections and 2-stage treatment in 90-day mortality and morbidity (mortality: 15.4% vs 0%; morbidity: 26.9% vs 27.3%), number of nodes retrieved (16.6±9.4 vs 14.9±5.7), and rate of R0 resections (84.6% vs 90.9%), but mortality was slightly higher in patients who underwent immediate resection. The patients who underwent staged treatment had a higher possibility of receiving a laparoscopic resection (11.5% vs 36.4%). Conclusion: The present study failed to demonstrate a clear superiority of one treatment with respect to the other, even if there is an interesting trend favoring staged resection

The methodological and reporting quality of systematic reviews from China and the USA are similar

Objective: To compare the methodological and reporting quality of systematic reviews by authors from China and those from the United States (the USA). Study Design: From systematic reviews of randomised trials published in 2014 in English, we randomly selected 100 from China and 100 from the USA. The methodological quality was assessed using the AMSTAR tool, and reporting quality assessed using the PRISMA tool. Results: Compared with systematic reviews from the USA, those from China were more likely to be a meta-analysis, published in low impact journals, and a non-Cochrane review. The mean summary AMSTAR score was 6.7 (95% confidence interval: 6.5 to 7.0) for reviews from China and 6.6 (6.1 to 7.1) for reviews from the USA, and the mean summary PRISMA score was 21.2 (20.7 to 21.6) for reviews from China and 20.6 (19.9 to 21.3) for reviews from the USA. The differences in summary quality scores between China and the USA were statistically non-significant after adjusting for multiple review factors. Conclusions: The overall methodological and reporting quality of systematic reviews by authors from China are similar to those from the USA, although the quality of systematic reviews from both countries could be further improved

Innovations and development of artificial intelligence in Europe: some empirical evidences

The objective of this paper is to analyze the relationship between innovation and the development of artificial intelligence (AI) and digital technologies in Europe. The use of digital technologies among European companies is studied through a composite index, while the relationship between innovation and AI is studied through a log-linear regression model. The results of the model have made possible to develop interesting indications for economic and industrial polic

Žarnyno mikroorganizmų įtaka jungties nesandarumui po storosios žarnos operacijų

Introduction. One of the most common and serious complications of near-postoperative surgery after colon resection with anastomosis is intestinal leakage with a frequency of 1 to 24%. Therefore, it is very important to evaluate the factors that may determine the development of this complication. One of the etiological factors behind the development of this complication is the intestinal microbiota, which is playing an increasingly important role in this process. Nevertheless, there is still a lack of comprehensive clinical evidence on the influence of the intestinal microbiota on postoperative complications such as anastomotic leakage. Purpose. To evaluate the influence of intestinal microorganisms on anastomotic leakage after elective intestines surgery. Methods. A prospective study was performed at the Lithuanian University of Health Sciences Hospital, Kaunas Clinics, Clinic of Surgery. There were included patients who underwent colon surgery (right hemicolectomy, left hemicolectomy, sigmoid resection and closure of ileostomy). Intestinal mucosal biopsy performed before restoring intestinal integrity and sent for microbiological and antibiotic examination. Patients were also observed postoperatively for anastomotic leakage. Results. The majority of patients were treated for colon cancer – 46 (92.0%). In 19 patients crop (38.0%) grown one microorganism, in 12 (24.0%) – 2 microorganisms, in 5 (10.0%) – 3 microorganisms, in 1 (2.0%) – 4 types of bacteria. In the most of the crops were observed growth by E. coli – 30 (60.0%), Enterococcus spp. – 12 (24.0%), Bacteroides spp. – 4 (8.0%), Klebsiella oxytoca – 2 (4.0%), Beta hemolytic streptococcus – 2 (4.0%) patients. Citrobacter fundii, Citrobacter brakii, Parabacteroides distasonis, Proteus mirabilis, Klebsiella pneumoniae, Enterobacteriaceae daacea grew only in 1 (2.0%) patients crop. Postoperative anastomotic leakage diagnosed in 2 (4.0%) patients. Conclusions. The major microorganisms that grown were E. coli. Due to the small sample, tendency can not be predicted, but microorganisms that promote small blood vessels thrombosis may be one of the factors that cause anastomotic leakage.Įžanga. Po rezekcinių storosios žarnos operacijų, kai formuojama jungtis, viena iš dažniausių ir pavojingiausių artimojo po­operacinio laikotarpio komplikacijų yra žarnų jungties nesandarumas (dažnis – 1–24 proc.), todėl labai svarbu įvertinti veiksnius, galinčius lemti šios komplikacijos vystymąsi. Vienas iš etiologinių veiksnių šiai komplikacijai išsivystyti yra žarnyno mikrobiota. Pastaraisiais metais jai skiriama vis daugiau dėmesio, tačiau vis dar trūksta išsamių klinikinių tyrimų apie žarnyno mikrobiotos įtaką pooperaciniam žarnų jungties nesandarumui. Tikslas. Įvertinti žarnyno mikroorganizmų įtaką jungčių nesandarumui po planinių žarnų operacijų. Metodika. Lietuvos sveikatos mokslų universiteto ligoninės Kauno klinikos (LSMUL KK) Chirurgijos klinikoje atliktas perspektyvusis tyrimas. Atrinkti pacientai, kuriems atliktos storosios žarnos operacijos: dešinioji hemikolektomija, kairioji hemikolektomija, riestinės žarnos rezekcija ir ileostomos uždarymas. Tyrimo dalyviams, prieš atkuriant žarnyno vientisumą, paimti žarnos gleivinės bioptatai, jie išsiųsti mikrobiologiniams tyrimams ir antibiotikogramai atlikti. Pacientai stebėti ir po operacijos, vertintas jungties nesandarumas. Rezultatai. Didžioji dalis pacientų stacionarizuoti ir operuoti dėl storosios žarnos vėžio (46 pacientai, 92,0 %). Devyniolikai pacientų (38,0 %) išauginta viena bakterija, dviem pacientams (24,0 %) – dvi, penkiems (10,0 %) – trys, vienam (2,0 %) – keturios skirtingos bakterijos. Didžiojoje dalyje išaugintų pasėlių rasta E. coli bakterija (30 pacientų, 60,0 %), dvylikai pacientų (24,0 %) – Enterococcus spp., 4 (8,0 %) – Bacteroides spp., dviem (4,0 %) – Klebsiella oxytoca, dviem (4,0 %) – Beta hemolitinis streptokokas. Vienam pacientui (2,0 %) išauginta: Citrobacter fundii, Citrobacter brakii, Parabacteroides distasonis, Proteus mirabilis, Klebsiella pneumoniae, Enterobacteriaceae daacea. Ankstyvasis jungties nesandarumas nustatytas dviem atvejais (4,0 %). Išvados. Dažniausiai nustatyta E. coli bakterija. Dėl nedidelės tyrimo apimties negalima numatyti tolesnių tendencijų, tačiau mikroorganizmai, skatinantys smulkiųjų kraujagyslių trombozę, gali būti vienas iš veiksnių, lemiančių jungties nesandarumą

Surgical risk and pathological results of emergency resection in the treatment of acutely obstructing colorectal cancers. A retrospective cohort study

The treatment of acutely obstructing colorectal cancers is still a matter of debate. The most diffuse attitude is to perform an immediate resection whenever possible. This study has been carried out to try to answer the following questions regarding immediate resection: (1) is it safe? (2) is it oncologically valid

Laparoscopic Treatment of a Huge Mesenteric Chylous Cyst

Mesenteric chylous cysts are rare. This study suggests that even large mesenteric chylous cysts may be managed with minimally invasive means

Innovations and development of artificial intelligence in Europe: some empirical evidences

Purpose – The objective of this paper is to analyze the relationship between innovation and the development of artificial intelligence (AI) and digital technologies in Europe. The use of digital technologies among European companies is studied through a composite index, while the relationship between innovation and AI is studied through a log-linear regression model. The results of the model have made possible to develop interesting indications for economic and industrial policy. Design/methodology/approach – The use of digital technologies among European companies is studied through a composite index of AI and information technology (ICT) (using the Fair and Sustainable Welfare methodology) with the aim of measuring territorial gaps and to know which European countries are more or less inclined to its use, while the relationship between innovation and AI is studied through a log-linear regression model. Findings – In the paper, two different methodologies were used to analyze the relationship between innovation and the development of digital technologies in Europe. The synthetic indicator made possible to develop a taxonomy between the different countries, the log-linear model made possible to identify and explain the determinants of innovation. Originality/value – The description of the biunivocal relationship between innovation and AI is a topical and relevant issue that is treated in the paper in an original way using a synthetic indicator and a log-linear model. 研究目的 – 本文旨在探討在歐洲、創新與人工智能和數字技術的發展之間的關係。研究人員透過一個綜合指數、去探討歐洲公司之間數字技術的使用狀況。至於創新與人工智能之間的關係, 則以對數線性回歸模型來進行研究。從模型所得的結果, 為我們提供了建議、去訂定適切的經濟和產業政策。 研究設計/方法/理念 – 研究人員透過一個人工智能和資訊科技的綜合指數, 去探討歐洲企業之間數字技術的使用狀況 (研究人員使用了公平和可持續福利方法論), 其目標為測量領土差距, 以及確定哪些歐洲國家、大體上傾向於使用數字技術;至於創新與人工智能之間的關係, 則以對數性回歸模型來進行研究。 研究結果 – 本文使用了兩個不同的方法、去探討在歐洲、創新與數字技術發展之間的關係。有關的合成指標, 使研究人員可製定一個不同國家間的分類法;而有關的對數線性模型, 則讓研究人員可確立並說明創新的決定因素。 研究的原創性/價值 – 本文使用了合成指標和對數線性模型、去探討創新與人工智能之間的一對一的關係, 這是時下受到關注和適宜的課題;就研究法而言, 本研究確是新穎獨創的

Systematic review and meta-analysis of the variants of the obturatory artery

Background: Knowledge of vascular anatomy and its possible variations is essential for performing embolization or revascularization procedures and complex surgery in the pelvis. The obturator artery (OA) is a branch of the anterior division of the internal iliac artery (IIA), and it has the highest frequency of variation among branches of the internal iliac artery. Possible anomalies of the origin of the obturator artery (OA) should be known when performing pelvic and groin surgery, where its control or ligation may be required. The purpose of this systematic review and meta-analysis, based on Sanudo’s classification, is to analyze the origin of the obturator artery (OA) and its variants. Methods: Thirteen articles published between 1952 and 2020 were included. Results: The obturator artery (OA) was present in almost all cases (99.8%): the pooled prevalence estimate for the origin from the IIA axis was 77.7% (95% CI 71.8–83.1%) vs. 22.3% (95% CI 16.9–28.2%) for the origin from EIA axis. In most cases, the obturator artery (OA) originated from the anterior division trunk of the internal iliac artery (IIA) (61.6%). Conclusions: Performing preoperative radiological examination to determine the pelvic vascular pattern and having the awareness to evaluate possible changes in the obturator artery can reduce the risk of iatrogenic injury and complications

Emergency surgery admissions and the COVID-19 pandemic: did the first wave really change our practice? Results of an ACOI/WSES international retrospective cohort audit on 6263 patients

Introduction The COVID-19 pandemic is having a deep impact on emergency surgical services, with a significant reduction of patients admitted into emergency surgical units world widely. Reliable figures of this reduction have not been produced yet. Our international audit aimed at giving a precise snapshot of the absolute and relative changes of emergency surgical admissions at the outbreak of the pandemic. Materials and methods Datasets of patients admitted as general surgical emergencies into 45 internationally distributed emergency surgical units during the months of March and April 2020 (Covid-19 pandemic outbreak) were collected and compared with those of patients admitted into the same units during the months of March and April 2019 (pre-Covid-19). Primary endpoint was to evaluate the relative variation of the presentation symptoms and discharge diagnoses between the two study periods. Secondary endpoint was to identify the possible change of therapeutic strategy during the same two periods. Results Forty-five centres participated sent their anonymised data to the study hub, for a total of 6263 patients. Of these, 3810 were admitted in the pre-Covid period and 2453 in the Covid period, for a 35.6% absolute reduction. The most common presentation was abdominal pain, whose incidence did not change between the two periods, but in the Covid period patients presented less frequently with anal pain, hernias, anaemia and weight loss. ASA 1 and low frailty patients were admitted less frequently, while ASA>1 and frail patients showed a relative increase. The type of surgical access did not change significantly, but lap-to-open conversion rate halved between the two study periods. Discharge diagnoses of appendicitis and diverticulitis reduced significantly, while bowel ischaemia and perianal ailments had a significant relative increase. Conclusions Our audit demonstrates a significant overall reduction of emergency surgery admissions at the outbreak of the Covid-19 pandemic with a minimal change of the proportions of single presentations, diagnoses and treatments. These findings may open the door to new ways of managing surgical emergencies without engulfing the already busy hospitals

A Systematic Review of Varying Definitions and the Clinical Significance of Fredet’s Fascia in the Era of Complete Mesocolic Excision

Background: Fredet’s fascia represents a crucial landmark for vascular surgical anatomy, especially in minimally invasive complete mesocolic excision (CME) for right-sided colon adenocarcinoma. Fredet’s fascia allows access to the gastrocolic trunk of Henle (GCTH), the most critical step in both open and minimally invasive right-sided CME techniques. Despite this, a recent workshop of expert surgeons on the standardization of the laparoscopic right hemicolectomy with CME did not recognize or include the term of Fredet’s fascia or area. Hence, we undertook a systematic review of articles that include the terms “Fredet’s fascia or area”, or synonyms thereof, with special emphasis on the types of articles published, the nationality, and the relevance of this area to surgical treatments. Methods: We conducted a systematic review up to 15 July 2022 on PubMed, WOS, SCOPUS, and Google Scholar. Results: The results of the study revealed that the term “Fredet’s fascia” is poorly used in the English language medical literature. In addition, the study found controversial and conflicting data among authors regarding the definition of “Fredet’s fascia” and its topographical limits. Conclusions: Knowledge of Fredet’s fascia’s surgical relevance is essential for colorectal surgeons to avoid accidental injuries to the superior mesenteric vascular pedicle during minimally invasive right hemicolectomies with CME. In order to avoid confusion and clarify this fascia for future use, we suggest moving beyond the use of the eponymous term by using a “descriptive term” instead, based on the fascia’s anatomic structure. Fredet’s fascia could, therefore, be more appropriately renamed “sub-mesocolic pre-duodenopancreatic fascia”