Outcomes of obstructed abdominal wall hernia: results from the UK national small bowel obstruction audit

Background: Abdominal wall hernia is a common surgical condition. Patients may present in an emergency with bowel obstruction, incarceration or strangulation. Small bowel obstruction (SBO) is a serious surgical condition associated with significant morbidity. The aim of this study was to describe current management and outcomes of patients with obstructed hernia in the UK as identified in the National Audit of Small Bowel Obstruction (NASBO). Methods: NASBO collated data on adults treated for SBO at 131 UK hospitals between January and March 2017. Those with obstruction due to abdominal wall hernia were included in this study. Demographics, co-morbidity, imaging, operative treatment, and in-hospital outcomes were recorded. Modelling for factors associated with mortality and complications was undertaken using Cox proportional hazards and multivariable regression modelling. Results: NASBO included 2341 patients, of whom 415 (17·7 per cent) had SBO due to hernia. Surgery was performed in 312 (75·2 per cent) of the 415 patients; small bowel resection was required in 198 (63·5 per cent) of these operations. Non-operative management was reported in 35 (54 per cent) of 65 patients with a parastomal hernia and in 34 (32·1 per cent) of 106 patients with an incisional hernia. The in-hospital mortality rate was 9·4 per cent (39 of 415), and was highest in patients with a groin hernia (11·1 per cent, 17 of 153). Complications were common, including lower respiratory tract infection in 16·3 per cent of patients with a groin hernia. Increased age was associated with an increased risk of death (hazard ratio 1·05, 95 per cent c.i. 1·01 to 1·10; P = 0·009) and complications (odds ratio 1·05, 95 per cent c.i. 1·02 to 1·09; P = 0·001). Conclusion: NASBO has highlighted poor outcomes for patients with SBO due to hernia, highlighting the need for quality improvement initiatives in this group

Outcomes of obstructed abdominal wall hernia: results from the UK national small bowel obstruction audit

Background Abdominal wall hernia is a common surgical condition. Patients may present in an emergency with bowel obstruction, incarceration or strangulation. Small bowel obstruction (SBO) is a serious surgical condition associated with significant morbidity. The aim of this study was to describe current management and outcomes of patients with obstructed hernia in the UK as identified in the National Audit of Small Bowel Obstruction (NASBO). Methods NASBO collated data on adults treated for SBO at 131 UK hospitals between January and March 2017. Those with obstruction due to abdominal wall hernia were included in this study. Demographics, co‐morbidity, imaging, operative treatment, and in‐hospital outcomes were recorded. Modelling for factors associated with mortality and complications was undertaken using Cox proportional hazards and multivariable regression modelling. Results NASBO included 2341 patients, of whom 415 (17·7 per cent) had SBO due to hernia. Surgery was performed in 312 (75·2 per cent) of the 415 patients; small bowel resection was required in 198 (63·5 per cent) of these operations. Non‐operative management was reported in 35 (54 per cent) of 65 patients with a parastomal hernia and in 34 (32·1 per cent) of 106 patients with an incisional hernia. The in‐hospital mortality rate was 9·4 per cent (39 of 415), and was highest in patients with a groin hernia (11·1 per cent, 17 of 153). Complications were common, including lower respiratory tract infection in 16·3 per cent of patients with a groin hernia. Increased age was associated with an increased risk of death (hazard ratio 1·05, 95 per cent c.i. 1·01 to 1·10; P = 0·009) and complications (odds ratio 1·05, 95 per cent c.i. 1·02 to 1·09; P = 0·001). Conclusion NASBO has highlighted poor outcomes for patients with SBO due to hernia, highlighting the need for quality improvement initiatives in this group

National prospective cohort study of the burden of acute small bowel obstruction

Background Small bowel obstruction is a common surgical emergency, and is associated with high levels of morbidity and mortality across the world. The literature provides little information on the conservatively managed group. The aim of this study was to describe the burden of small bowel obstruction in the UK. Methods This prospective cohort study was conducted in 131 acute hospitals in the UK between January and April 2017, delivered by trainee research collaboratives. Adult patients with a diagnosis of mechanical small bowel obstruction were included. The primary outcome was in‐hospital mortality. Secondary outcomes included complications, unplanned intensive care admission and readmission within 30 days of discharge. Practice measures, including use of radiological investigations, water soluble contrast, operative and nutritional interventions, were collected. Results Of 2341 patients identified, 693 (29·6 per cent) underwent immediate surgery (within 24 h of admission), 500 (21·4 per cent) had delayed surgery after initial conservative management, and 1148 (49·0 per cent) were managed non‐operatively. The mortality rate was 6·6 per cent (6·4 per cent for non‐operative management, 6·8 per cent for immediate surgery, 6·8 per cent for delayed surgery; P = 0·911). The major complication rate was 14·4 per cent overall, affecting 19·0 per cent in the immediate surgery, 23·6 per cent in the delayed surgery and 7·7 per cent in the non‐operative management groups (P < 0·001). Cox regression found hernia or malignant aetiology and malnutrition to be associated with higher rates of death. Malignant aetiology, operative intervention, acute kidney injury and malnutrition were associated with increased risk of major complication. Conclusion Small bowel obstruction represents a significant healthcare burden. Patient‐level factors such as timing of surgery, acute kidney injury and nutritional status are factors that might be modified to improve outcomes

Outcomes following small bowel obstruction due to malignancy in the national audit of small bowel obstruction

Introduction Patients with cancer who develop small bowel obstruction are at high risk of malnutrition and morbidity following compromise of gastrointestinal tract continuity. This study aimed to characterise current management and outcomes following malignant small bowel obstruction. Methods A prospective, multicentre cohort study of patients with small bowel obstruction who presented to UK hospitals between 16th January and 13th March 2017. Patients who presented with small bowel obstruction due to primary tumours of the intestine (excluding left-sided colonic tumours) or disseminated intra-abdominal malignancy were included. Outcomes included 30-day mortality and in-hospital complications. Cox-proportional hazards models were used to generate adjusted effects estimates, which are presented as hazard ratios (HR) alongside the corresponding 95% confidence interval (95% CI). The threshold for statistical significance was set at the level of P ≤ 0.05 a-priori. Results 205 patients with malignant small bowel obstruction presented to emergency surgery services during the study period. Of these patients, 50 had obstruction due to right sided colon cancer, 143 due to disseminated intraabdominal malignancy, 10 had primary tumours of the small bowel and 2 patients had gastrointestinal stromal tumours. In total 100 out of 205 patients underwent a surgical intervention for obstruction. 30-day in-hospital mortality rate was 11.3% for those with primary tumours and 19.6% for those with disseminated malignancy. Severe risk of malnutrition was an independent predictor for poor mortality in this cohort (adjusted HR 16.18, 95% CI 1.86 to 140.84, p = 0.012). Patients with right-sided colon cancer had high rates of morbidity. Conclusions Mortality rates were high in patients with disseminated malignancy and in those with right sided colon cancer. Further research should identify optimal management strategy to reduce morbidity for these patient groups

STUDY OF STABILITY OF CELL CARRIERS AND CELLULAR FORMS OF VINKRISTIN AND VINBLASTIN IN STORAGE

Employees of the department of pharmaceutical chemistry and phar-maceutical technology received modified forms of terpene-indole alkaloids (TIA) - vincristine (VCR) and vinblastine (VBL) known in the therapy of oncological diseases by incorporating them into erythrocyte carriers (EN). This method of modification allows solving simultaneously the problems of directional transport of effective antitumor drugs and reducing the frequency and strength of side effects, and, consequently, increasing the patient's compliance to the prescribed treatment. In this paper, stability and shelf life studies of encapsulated TIAs in EN have been carried out. It was found that keeping TIA encapsulated erythrocyte form at +4 °С for 7 days is the optimal condition for storage of TIA preparations without significant reduction of the therapeutic dose (not less than 95% of the encapsulated amount)

CELL CARRIERS AS SYSTEMS OF DELIVERY OF ANTITUMOR DRUGS (REVIEW)

Introduction. Drug delivery systems are defined as systems that deliver the optimal amount of a drug to a target target, increase the effectiveness of treatment, and reduce adverse effects. Regulation of the rate of release of drugs and bringing to specific tissues where active ingredients are needed are the main objectives of drug delivery systems. The development of systems for targeted, organ-specific and controlled delivery of medicinal, prophylactic and diagnostic agents is currently a relevant area of research for pharmacy and medicine. Of particular interest is the actual problem of increasing the frequency of manifestations of side effects of drugs. The side effect of drugs, their low efficiency is often explained by the inaccessibility of drugs directly to the target.Text. Currently, targeted delivery of chemotherapeutic agents and drug delivery systems has completely changed the tactics and approaches in the drug treatment of cancer, allowing to reduce the side effects of the drug and generally increase the effectiveness of the course of treatment. This paper summarizes and systematizes information about targeted systems for drug delivery of antitumor activity, described in the scientific literature and used in pharmacy and medicine. Most of the methods for obtaining cellular forms of toxic drugs discussed in this review are still at the development stage, and some methods are gradually finding practical application abroad in medicine and other fields. Vincristine (VCR) and vinblastine (VBL) are the most widely used and effective drugs in chemotherapeutic practice. Despite their effectiveness against various oncological diseases, there are a number of harmful side effects that limit the widespread use of these drugs.Conclusion. There is the possibility of using cellular carriers as a VCR and VBL delivery system. In scientific publications, there is still no data on the use of cellular carriers for encapsulating VCR and VBL. Therefore, relevant studies are devoted to the possibility of using cellular carriers to reduce side effects, improve efficiency, and develop dosage forms for the delivery of VCR and VBL to pathological foci. This topic is currently being actively developed by members of the Department of Pharmaceutical Chemistry and Pharmaceutical Technology, Pharmaceutical Faculty, Voronezh State University

MORPHOLOGICAL AND PHYSICO-CHEMICAL PROPERTIES OF ERYTHROCYTE CARRIERS INCAPULATED BY TERPINEINDOLICALK ALOIDS

Morphological and physico-chemical properties of erythrocytes encapsulated by terpenoindol alkaloids (TIA) by nephelometry and osmotic resistance of erythrocytes in a medium with low concentrations of sodium chloride have been studied. Changes in the morphological and physico-chemical parameters of TIA-loaded erythrocyte carriers and freshly isolated erythrocytes have been studied. It was found that during the process of encapsulation of TIA by a modified hypotonic swelling method, the morphological and physicochemical parameters of erythrocytes change insignificantly in comparison with the control

DNA-BASED HYBRID LIQUID CRYSTALLINE NANO ORGANOMETALLIC COMPOSITES FOR TARGETED DRUG DELIVERY IN NEUTRON CAPTURE THERAPY

Objective: The aim of this work was focused on the obtaining a DNA-based hybrid nano liquid crystalline organometallic composites for targeted drug delivery in neutron capture therapy.Methods: The formation of a cholesteric liquid crystalline DNA (CLCD-DNA) dispersion has performed using ultrasonic depolymerized calf thymus DNA(MW-0.6-0.8×106Da)2×10-7M, mixing with polyethylene glycol8.5×10-5M, dissolved in the 0.3 M NaCl solution and incubated over 1,0 h at 20 °C. CLCD-DNA formation process was determined and controlled by measuring absorption value of circular dichroism (CD) spectrum in the range of 350-600 nm. The organometallic DNA-Gd compound was formed by processing the obtained CLCD-DNA with 2.49 × 10-4M, 4.97 × 10-4M, 9.8 × 10-4 M, 1.48× 10-3M, 2.92 × 10-3M GdCl3 aqueous solutions. CLCD-DNA-gadolinium complex formation process was registered over the appearance of 2nd amplitude in the CD spectrum. DNA-Gd complex dispersion toxicity was evaluated over 40 min, 24h and 72h incubation with 1×106cells in the RPMI-40 medium supplemented with 3×10-4 M Gd3+.Results: The obtained CLCD-DNA-Gd (d~500 nm) particles was shown less toxicity and higher viability percentage of macrophages after 40 min incubation with CLCD-DNA-Gd contains Gd3+ions concentration 3×10-4 M showed 100% viability and after 72 h ours approximately 89%. The cells immobilized with CLCD-DNA-Gd particles contains 3×10-4M Gd3+, neutron irritation was caused a 100% cell deaths.Conclusion: Obtained relatively stable, non-cytotoxic drug forms with a maximum local concentration of gadolinium (400 µg/ml). The effectiveness of these nanosystems for targeted drug delivery has markedly superior efficacy than 10B and other products were based on gadolinium

Surgeons’ practice and preferences for the anal fissure treatment: results from an international survey

The best nonoperative or operative anal fissure (AF) treatment is not yet established, and several options have been proposed. Aim is to report the surgeons' practice for the AF treatment. Thirty-four multiple-choice questions were developed. Seven questions were about to participants' demographics and, 27 questions about their clinical practice. Based on the specialty (general surgeon and colorectal surgeon), obtained data were divided and compared between two groups. Five-hundred surgeons were included (321 general and 179 colorectal surgeons). For both groups, duration of symptoms for at least 6 weeks is the most important factor for AF diagnosis (30.6%). Type of AF (acute vs chronic) is the most important factor which guide the therapeutic plan (44.4%). The first treatment of choice for acute AF is ointment application for both groups (59.6%). For the treatment of chronic AF, this data is confirmed by colorectal surgeons (57%), but not by the general surgeons who prefer the lateral internal sphincterotomy (LIS) (31.8%) (p = 0.0001). Botulin toxin injection is most performed by colorectal surgeons (58.7%) in comparison to general surgeons (20.9%) (p = 0.0001). Anal flap is mostly performed by colorectal surgeons (37.4%) in comparison to general surgeons (28.3%) (p = 0.0001). Fissurectomy alone is statistically significantly most performed by general surgeons in comparison to colorectal surgeons (57.9% and 43.6%, respectively) (p = 0.0020). This analysis provides useful information about the clinical practice for the management of a debated topic such as AF treatment. Shared guidelines and consensus especially focused on operative management are required to standardize the treatment and to improve postoperative results