Acute cholangitis due to afferent loop syndrome after a Whipple procedure: a case report

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Adjuvant Perioperative Intraperitoneal Chemotherapy in Locally Advanced Colorectal Carcinoma: Preliminary Results

Background and Aims. Intraperitoneal chemotherapy is a basic tool in the treatment of peritoneal malignancy. The purpose of the study is to investigate the effect of adjuvant perioperative intraperitoneal chemotherapy in the treatment of locally advanced colorectal cancer. Patients and Methods. Patients with T3 and T4 colorectal carcinomas that underwent R0 resection received either hyperthermic intraoperative intraperitoneal chemotherapy (HIPEC group = 40 patients) or early postoperative intraperitoneal chemotherapy (EPIC group = 67 patients). The survival, the recurrences and the sites of recurrence were assessed. Results. The 3-year survival rate for HIPEC group was 100% and for EPIC group 69% (P = .011). Nodal infiltration was found to be the single prognostic indicator of survival. The incidence of recurrence in EPIC group was higher than in HIPEC group (P = .009). The independent indicators of recurrence were the use of HIPEC and the degree of differentiation (P < .05). Conclusions. Intraperitoneal chemotherapy, particularly HIPEC, as an adjuvant in locally advanced colorectal carcinomas appears to improve survival and decrease the incidence of recurrence

Wound dehiscence: is still a problem in the 21th century: a retrospective study

<p>Abstract</p> <p>Background</p> <p>The aim of this study was to evaluate the risk factors of wound dehiscence and determine which of them can be reverted.</p> <p>Methods</p> <p>We retrospectively analyzed 3500 laparotomies. Age over 75 years, diagnosis of cancer, chronic obstructive pulmonary disease, malnutrition, sepsis, obesity, anemia, diabetes, use of steroids, tobacco use and previous administration of chemotherapy or radiotherapy were identified as risk factors</p> <p>Results</p> <p>Fifteen of these patients developed wound dehiscence. Emergency laparotomy was performed in 9 of these patients. Patients who had more than 7 risk factors died.</p> <p>Conclusion</p> <p>It is important for the surgeon to know that wound healing demands oxygen consumption, normoglycemia and absence of toxic or septic factors, which reduces collagen synthesis and oxidative killing mechanisms of neutrophils. Also the type of abdominal closure may plays an important role. The tension free closure is recommended and a continuous closure is preferable. Preoperative assessment so as to identify and remove, if possible, these risk factors is essential, in order to minimize the incidence of wound dehiscence, which has a high death rate.</p

Natural recovery of genetic diversity by gene flow in reforested areas of the endemic Canary Island pine, Pinus canariensis

The endemic pine, Pinus canariensis, forms one of the main forest ecosystems in the Canary Islands. In this archipelago, pine forest is a mosaic of natural stands (remnants of past forest overexploitation) and artificial stands planted from the 1940's. The genetic makeup of the artificially regenerated forest is of some concern. The use of reproductive material with uncontrolled origin or from a reduced number of parental trees may produce stands ill adapted to local conditions or unable to adapt in response to environmental change. The genetic diversity within a transect of reforested stands connecting two natural forest fragments has been studied with nuclear and chloroplast microsatellites. Little genetic differentiation and similar levels of genetic diversity to the surrounding natural stands were found for nuclear markers. However, chloroplast microsatellites presented lower haplotype diversity in reforested stands, and this may be a consequence of the lower effective population size of the chloroplast genome, meaning chloroplast markers have a higher sensitivity to bottlenecks. Understory natural regeneration within the reforestation was also analysed to study gene flow from natural forest into artificial stands. Estimates of immigration rate into artificially regenerated forest were high (0.68-0.75), producing a significant increase of genetic diversity (both in chloroplast and nuclear microsatellites), which indicates the capacity for genetic recovery for P. canariensis reforestations surrounded by larger natural stands

The nature of time in the electronic age : by Stavrola Vaxevanidou

This paper refers to the nature of the concept of human time in the twentieth century. The paper is written from the perspective of electronic media of communication and their role in radical changes in the concept of time that has taken place in the twntieth century. A main argument is that electronic media, specifically computers, can simulate more effectively than other media have ever done (as the written word, music, painting etc.) the feeling of intuitive time when, paradoxically enough, computers are basically "intelligent" (rational) technologies. Another basic argument is the bias of modern life towards "presentness" and "materiality", that is the narrowing of human temporal horizons by the orientation of life towards "now", the parallel degradation of history (past), the neutralisation of uncertainty (future) and the extensive materialisation of memory. It is argued that while technologies (of communitation) themselves are becoming more and more abstract (electronic), memory itself becomes more and more materialised. It will be, conclusively, claimed that electronic technologies of communicating human "meaningful interactions" have played a decisive role to the temporal condition of modern life

PUBLIC DIPLOMACY AS A TOOL TO CHANGE THE IMAGE OF A COUNTRY IN CRISIS

The aim of this study is to explore the means, the methods, and the techniques of public diplomacy that a country in crisis, such as Greece, should use. The paper addresses the very issues of whether a country in crisis can conduct public diplomacy and whether it should be recognized as a legitimate and powerful actor in the field. In a broader sense, it focuses on the processes that a country should follow and how a better understanding and framing of its situation, principles, and policy can be provided. A crucial factor for such countries is the choice of communication channels, which includes traditional tools like press releases, letters to editor, editorials, interviews, or more active tools like social media, events, campaigns, and networking. In this paper, three dimensions of public diplomacy are examined, and appropriate tools to be developed in the short, medium and long-term are proposed. The results of the study are based on case studies, methods, and tools employed by Greece during the last years that the country has faced a huge economic crisis. There is a short presentation on the methods that Greece tries to adopt in order to enhance its image worldwide. Keywords: reactive public diplomacy, proactive public diplomacy, relationship buildin

Paediatric anaesthesia in district hospitals

Guidelines setting, the scientific basis for the administration of anaesthesia to children in general hospitals, have been formulated not only for the European Union but also for the United States of America. Nevertheless, the international as well as the Greek reality are a far away from these guidelines. The objective of the present study was to examine the quality of practice of Paediatric Anaesthesia in National District General Hospitals. An effort was made to outline the substructures of the Anaesthetic departments according to their geographical distribution (central, District), the hospitals capacity (small, medium, large), as well as the differences, qualitative (age, education) and quantitative of the anesthetists, that influence the practice of Paediatric Anaesthesia in our country and especially in District area. Three hundred and fifthy eight (358) anesthesiologists, in total, have been approached, 179 from each geographical area (central, District region) and from those selected, 104 replied. The analysis of the results present the mode of practice of Paediatric Anaesthesia in District hospitals. According to them: - A percentage of 57,7% of the regional district hospitals are of a small capacity and are located more than 50 Kilometers away from a specialized paediatric centre. – Only 11,9% of the district hospitals provide a paediatric surgeon and only 1,5% of them a paediatric anesthetist, while none can provide a paediatric-intensive care-consultant. - 28,4% of the regional hospitals provide paediatric anesthetic equipment for emergency care, and 50% of the hospitals provide appropriate equipment for the practice of Paediatric Anaesthesia. – The majority (71,2%) of the paediatric surgical cases of low and medium risk are operated by general surgeons, while in the regional hospitals the percentage increases to 91%. – The emergency paediatric surgical cases do not present a statistically significant difference between central and district areas and this demonstrates the fact that an emergency could be happen anywhere, and therefore it is of vital importance to be treated under circumstances guaranteeing safety. - Under 3 years old is accentuated as the most important criterion of hospital transfers, which are accompanied by doctors who are not specialized in treating children. - The anesthetists in a vast majority (70,7%) are getting anxious when they administer anesthesia to children due to of lack of experience in paediatric anaesthesia. - A low percentage of the anesthetists of our study, 9,8%, have postgraduate studies in the field of Paediatric Anesthesia and Paediatric Intensive Care and 12,6% of them have visited a specialized children paediatric centre in Greece in order to update their skills and knowledges. - Although 58,3% of anesthetists do not wish to anaesthetize children, 85,4% of them support the existence of Paediatric Anesthesia as a subspeciality.Κατευθυντήριες οδηγίες καθώς και προτάσεις για τη χορήγηση αναισθησίας σε παιδιά στο γενικό νοσοκομείο, που στόχο είχαν να τεθούν επιστημονικά δεδομένα για την άσκηση της Παιδιατρικής Αναισθησίας, διατυπώθηκαν τόσο για τις χώρες της Ευρωπαϊκής Κοινότητας όσο και για τις ΗΠΑ. Αυτές οι κατευθυντήριες οδηγίες, απέχουν πολύ από την Ελληνική αλλά και τη διεθνή πραγματικότητα. Σκοπός της παρούσας μελέτης, ήταν να διερευνηθεί το επίπεδο άσκησης της Παιδιατρικής Αναισθησίας στα νοσοκομεία της περιφέρειας της χώρας. Έγινε προσπάθεια να σκιαγραφηθούν οι υποδομές των αναισθησιολογικών τμημάτων ανάλογα με την γεωγραφική τους κατανομή (κέντρο, περιφέρεια), την δυναμικότητα των νοσοκομείων (μικρή, μεσαία, μεγάλη), όπως και τις διαφορές, ποιοτικές (ηλικία, εκπαίδευση) και ποσοτικές των αναισθησιολόγων, που επηρεάζουν την άσκηση της Παιδιατρικής Αναισθησίας στη χώρα μας και ιδιαίτερα στην περιφέρεια. Συνολικά προσεγγίστηκαν 358 αναισθησιολόγοι, 179 από κάθε γεωγραφική έδρα (αστικό κέντρο, περιφέρεια) και από αυτούς απήντησαν οι 104. Η ανάλυση των αποτελεσμάτων των ερωτηματολογίων, στοιχειοθετεί τον τρόπο άσκησης της Παιδιατρικής Αναισθησίας στα νοσοκομεία της περιφέρειας. Σύμφωνα με αυτά: - Ποσοστό 57,7% των νοσοκομείων της περιφέρειας είναι μικρής δυναμικότητας και απέχουν περισσότερο από 50 χιλιόμετρα από εξειδικευμένο για παιδιά κέντρο. - Μόνο το 11,9% των νοσοκομείων της περιφέρειας διαθέτουν σύμβουλο Παιδοχειρουργό και μόλις το 1,5% αυτών Παιδοαναισθησιολόγο, ενώ κανένα δεν διαθέτει σύμβουλο Εντατικολόγο Παίδων. - Μόνο το 28,4% των νοσοκομείων της περιφέρειας διαθέτει παιδοαναισθησιολογικό εξοπλισμό για επείγοντα και το 50% των νοσοκομείων εξοπλισμό συνυφασμένο με την άσκηση της Παιδιατρικής Αναισθησίας. - Το 71,2% των Παιδοχειρουργικών περιστατικών μικρής και μέσης βαρύτητας αντιμετωπίζεται στo σύνολο των νοσοκομείων από Γενικούς Χειρουργούς, ενώ στα νοσοκομεία της περιφέρειας το ποσοστό αυτό φτάνει το 91%. - Τα επείγοντα παιδοχειρουργικά περιστατικά που αντιμετωπίστηκαν από αναισθησιολόγους, δεν παρουσιάζουν στατιστικώς σημαντική διαφορά μεταξύ νοσοκομείων κέντρου και αυτών της περιφέρειας και αυτό αποδεικνύει ότι το επείγον δεν έχει έδρα, μπορεί να συμβεί οπουδήποτε και γιαυτό επιβάλλεται να αντιμετωπίζεται με συνθήκες που να προσδίδουν ασφάλεια. - Ως σπουδαιότερο κριτήριο των διακομιδών αναδεικνύεται η ηλικία κάτω των 3 ετών και τις διακομιδές συνοδεύουν ως επί το πλείστον ιατροί που δεν είναι εκπαιδευμένοι στα παιδιά. - Ποσοστό 70,7% των αναισθησιολόγων απήντησαν ότι ανησυχούν, όταν χορηγούν αναισθησία σε παιδιά κάθε ηλικίας λόγω έλλειψης εμπειρίας τους, στις ιδιαιτερότητες των παιδιών. - Χαμηλό ποσοστό αναισθησιολόγων της μελέτης μας 9,8% έχουν μετεκπαιδευτεί στο αντικείμενο της Παιδιατρικής Αναισθησίας και της ΜΕΘ παίδων και 12,6% αυτών επισκέφτηκαν για επιστημονική ενημέρωση εξειδικευμένο παιδιατρικό κέντρο στην Ελλάδα. - Παρόλο που 58,3% των αναισθησιολόγων δεν επιθυμούν να ασχολούνται με παιδιά, το 85,4% αυτών πιστεύουν ότι πρέπει να υπάρξει εξειδίκευση στην Παιδιατρική Αναισθησία

NATION REBRANDING IN A PERIOD OF CRISIS AND THE ROLE OF PUBLIC DIPLOMACY: THE CASE STUDY OF GREECE

The aim of this paper is to highlight the crucial role of public diplomacy in rebranding a country, especially during a time of economic crisis, and to point out the ways it can become an important tool. Rebranding a country or a nation is the process by which a countrys international image is recreated, essentially representing that nation or country with a new concept, effectively reintroducing it and establishing the countrys modified image. Key tools of this process are communication in general and public diplomacy at state and professional level. Public Diplomacy helps governments launch communication campaigns that can promote a favourable image of the country to international publics, a core factor for successful rebranding. Nevertheless, campaigns alone do not amount to rebranding. Campaigns are good and useful and help reach a strategic goal; they are however only a component of the public diplomacy of a branding strategy.The main question of the study is whether Greece has a brand name and needs to adopt any sort of rebranding strategy. The study also examines whether the campaigns are aligned to a certain branding strategy, it describes the critical factors in rebranding the image of a country and the degree to which public diplomacy has developed.Finally, the paper proposes an integrated model consisting of four basic steps that can be followed by countries facing crises.The methodological approach is based on bibliography, previous studies, published case studies, field research and professional experience.The results of this study may help any scholar and practitioner avoid mistakes common in public diplomacy at times of crisis and add a new dimension to the relationship between nation brand and public diplomacy