Isn't it time to start speaking about "European surgeons"?

<p>Abstract</p> <p>Background</p> <p>Emergency surgery has become a neglected specialization in Europe and in many other parts of the world. In certain medical fields, emergency surgery isn't even considered an autonomous specialization. However every emergency surgeon must have a good formation in General Surgery but exist huge disparities between different European surgical formative systems.</p> <p>Methods</p> <p>An analysis of the main problems of the European surgical formative system was conducted.</p> <p>Results</p> <p>This discrepancy between formative systems is absolutely unacceptable and presents a notable hazard for the European Union, considering that surgical certifications are reciprocally recognized between programs within all European Union states.</p> <p>Conclusion</p> <p>Considering the increasing possibilities to move inside the European Union, is necessary to improve the European surgical formative system to warrant an uniform formation for all surgeons.</p

Stability of Oscillating Gaseous Masses in Massive Brans-Dicke Gravity

This paper explores the instability of gaseous masses for the radial oscillations in post-Newtonian correction of massive Brans-Dicke gravity. For this purpose, we derive linearized perturbed equation of motion through Lagrangian radial perturbation which leads to the condition of marginal stability. We discuss radius of instability of different polytropic structures in terms of the Schwarzschild radius. It is concluded that our results provide a wide range of difference with those in general relativity and Brans-Dicke gravity.Comment: 31 pages, 11 figures, to appear in IJMP

Management of acute mesenteric ischaemia: Results of a worldwide survey

Acute mesenteric ischaemia; Intestinal failure; SurveyIsquemia mesentérica aguda; Insuficiencia intestinal; EncuestaIsquèmia mesentèrica aguda; Insuficiència intestinal; EnquestaBackground Acute mesenteric ischaemia (AMI) is a condition with high mortality. This survey assesses current attitudes and practices to manage AMI worldwide. Methods A questionnaire survey about the practices of diagnosing and managing AMI, endorsed by several specialist societies, was sent to different medical specialists and hospitals worldwide. Data from individual health care professionals and from medical teams were collected. Results We collected 493 individual forms from 71 countries and 94 team forms from 34 countries. Almost half of respondents were surgeons, and most of the responding teams (70%) were led by surgeons. Most of the respondents indicated that diagnosis of AMI is often delayed but rarely missed. Emergency revascularisation is often considered for patients with AMI but rarely in cases of transmural ischaemia (intestinal infarction). Responses from team hospitals with a dedicated special unit (14 team forms) indicated more aggressive revascularisation. Abdominopelvic CT-scan with intravenous contrast was suggested as the most useful diagnostic test, indicated by approximately 90% of respondents. Medical history and risk factors were thought to be more important in diagnosis of AMI without transmural ischaemia, whereas for intestinal infarction, plasma lactate concentrations and surgical exploration were considered more useful. In elderly patients, a palliative approach is often chosen over extensive bowel resection. There was a large variability in anticoagulant treatment, as well as in timing of surgery to restore bowel continuity. Conclusions Delayed diagnosis of AMI is common despite wide availability of an adequate imaging modality, i.e. CT-scan. Large variability in treatment approaches exists, indicating the need for updated guidelines. Increased awareness and knowledge of AMI may improve current practice until more robust evidence becomes available. Adherence to the existing guidelines may help in improving differences in treatment and outcomes

Optimized Treatment of Nosocomial Peritonitis

Antibiotics; Nosocomial infection; PeritonitisAntibiòtics; Infecció nosocomial; PeritonitisAntibióticos; Infección nosocomial; PeritonitisThis comprehensive review aims to provide a practical guide for intensivists, focusing on enhancing patient care associated with nosocomial peritonitis (NP). It explores the epidemiology, diagnosis, and management of NP, a significant contributor to the mortality of surgical patients worldwide. NP is, per definition, a hospital-acquired condition and a consequence of gastrointestinal surgery or a complication of other diseases. NP, one of the most prevalent causes of sepsis in surgical Intensive Care Units (ICUs), is often associated with multi-drug resistant (MDR) bacteria and high mortality rates. Early clinical suspicion and the utilization of various diagnostic tools like biomarkers and imaging are of great importance. Microbiology is often complex, with antimicrobial resistance escalating in many parts of the world. Fungal peritonitis and its risk factors, diagnostic hurdles, and effective management approaches are particularly relevant in patients with NP. Contemporary antimicrobial strategies for treating NP are discussed, including drug resistance challenges and empirical antibiotic regimens. The importance of source control in intra-abdominal infection management, including surgical and non-surgical interventions, is also emphasized. A deeper exploration into the role of open abdomen treatment as a potential option for selected patients is proposed, indicating an area for further investigation. This review underscores the need for more research to advance the best treatment strategies for NP.J.J.D.W. is supported by the Flanders Research Foundation (1881020N, Sr Clinical Investigator Grant)

The Operative management in Bariatric Acute abdomen (OBA) Survey: long-term complications of bariatric surgery and the emergency surgeon\u27s point of view.

Background: The number of bariatric procedures is increasing worldwide. No consensus or guidelines about the emergency management of long-term complications following bariatric surgery are currently available. The aim of this study is to investigate by a web survey how an emergency surgeon approaches this unique group of patients in an emergency medical scenario and to report their personal experience. Method: An international web survey was sent to 197 emergency surgeons with the aim to collect data about emergency surgeons\u27 experience in the management of patients admitted in the emergency department for acute abdominal pain after bariatric surgery. The survey was conceived as a questionnaire composed by 26 (multiple choice and open) questions and approved by a steering committee. Results: One hundred seventeen international emergency surgeons decided to join the project and answered to the web survey with a response rate of 59.39%. Conclusions: The aim of this WSES web survey was to highlight the current management of patients previously submitted to bariatric surgical procedures by ES.Emergency surgeons must be mindful of postoperative bariatric surgery complications. CT scan with oral intestinal opacification may be useful in making a diagnosis if carefully interpreted by the radiologist and the surgeon.In case of inconclusive clinical and radiological findings, when symptoms fail to improve, surgical exploration for bariatric patients presenting acute abdominal pain, by laparoscopy if expertise is available, is mandatory in the first 12-24 h, to have good outcomes and decrease morbidity rate

The 2023 MANCTRA Acute Biliary Pancreatitis Care Bundle A Joint Effort Between Human Knowledge and Artificial Intelligence (ChatGPT) to Optimize the Care of Patients With Acute Biliary Pancreatitis in Western Countries

Acute biliary pancreatitis; Artificial intelligence (ChatGPT); Care of patientsPancreatitis biliar aguda; Intel·ligència artificial (ChatGPT); Atenció als pacientsPancreatitis biliar aguda; Inteligencia artificial (ChatGPT); Atención a los pacientesObjective: To generate an up-to-date bundle to manage acute biliary pancreatitis using an evidence-based, artificial intelligence (AI)-assisted GRADE method. Background: A care bundle is a set of core elements of care that are distilled from the most solid evidence-based practice guidelines and recommendations. Methods: The research questions were addressed in this bundle following the PICO criteria. The working group summarized the effects of interventions with the strength of recommendation and quality of evidence applying the GRADE methodology. ChatGPT AI system was used to independently assess the quality of evidence of each element in the bundle, together with the strength of the recommendations. Results: The 7 elements of the bundle discourage antibiotic prophylaxis in patients with acute biliary pancreatitis, support the use of a full-solid diet in patients with mild to moderately severe acute biliary pancreatitis, and recommend early enteral nutrition in patients unable to feed by mouth. The bundle states that endoscopic retrograde cholangiopancreatography should be performed within the first 48 to 72 hours of hospital admission in patients with cholangitis. Early laparoscopic cholecystectomy should be performed in patients with mild acute biliary pancreatitis. When operative intervention is needed for necrotizing pancreatitis, this should start with the endoscopic step-up approach. Conclusions: We have developed a new care bundle with 7 key elements for managing patients with acute biliary pancreatitis. This new bundle, whose scientific strength has been increased thanks to the alliance between human knowledge and AI from the new ChatGPT software, should be introduced to emergency departments, wards, and intensive care units

Kidney and uro-trauma : WSES-AAST guidelines

Renal and urogenital injuries occur in approximately 10-20% of abdominal trauma in adults and children. Optimal management should take into consideration the anatomic injury, the hemodynamic status, and the associated injuries. The management of urogenital trauma aims to restore homeostasis and normal physiology especially in pediatric patients where non-operative management is considered the gold standard. As with all traumatic conditions, the management of urogenital trauma should be multidisciplinary including urologists, interventional radiologists, and trauma surgeons, as well as emergency and ICU physicians. The aim of this paper is to present the World Society of Emergency Surgery (WSES) and the American Association for the Surgery of Trauma (AAST) kidney and urogenital trauma management guidelines.Peer reviewe

The need for new "patient-related" guidelines for the treatment of acute cholecystitis

Heterogeneity of patients affected by acute cholecystitis, and their co-morbidities make very difficult to standardize the therapy for this very common condition. The staging system suggested in the recent "Tokyo guidelines", did not show a relevant impact on the management of patients and on the outcome of the disease. The relation among local pathological picture, patient clinical status and treatment algorithm, has to be better studied

Infected pancreatic necrosis: outcomes and clinical predictors of mortality. A post hoc analysis of the MANCTRA-1 international study

Acute pancreatitis; Infected pancreatic necrosis; MortalityPancreatitis aguda; Necrosi pancreàtica infectada; MortalitatPancreatitis aguda; Necrosis pancreática infectada; MortalidadThe identification of high-risk patients in the early stages of infected pancreatic necrosis (IPN) is critical, because it could help the clinicians to adopt more effective management strategies. We conducted a post hoc analysis of the MANCTRA-1 international study to assess the association between clinical risk factors and mortality among adult patients with IPN. Univariable and multivariable logistic regression models were used to identify prognostic factors of mortality. We identified 247 consecutive patients with IPN hospitalised between January 2019 and December 2020. History of uncontrolled arterial hypertension (p = 0.032; 95% CI 1.135–15.882; aOR 4.245), qSOFA (p = 0.005; 95% CI 1.359–5.879; aOR 2.828), renal failure (p = 0.022; 95% CI 1.138–5.442; aOR 2.489), and haemodynamic failure (p = 0.018; 95% CI 1.184–5.978; aOR 2.661), were identified as independent predictors of mortality in IPN patients. Cholangitis (p = 0.003; 95% CI 1.598–9.930; aOR 3.983), abdominal compartment syndrome (p = 0.032; 95% CI 1.090–6.967; aOR 2.735), and gastrointestinal/intra-abdominal bleeding (p = 0.009; 95% CI 1.286–5.712; aOR 2.710) were independently associated with the risk of mortality. Upfront open surgical necrosectomy was strongly associated with the risk of mortality (p < 0.001; 95% CI 1.912–7.442; aOR 3.772), whereas endoscopic drainage of pancreatic necrosis (p = 0.018; 95% CI 0.138–0.834; aOR 0.339) and enteral nutrition (p = 0.003; 95% CI 0.143–0.716; aOR 0.320) were found as protective factors. Organ failure, acute cholangitis, and upfront open surgical necrosectomy were the most significant predictors of mortality. Our study confirmed that, even in a subgroup of particularly ill patients such as those with IPN, upfront open surgery should be avoided as much as possible. Study protocol registered in ClinicalTrials.Gov (I.D. Number NCT04747990).Open access funding provided by Università degli Studi di Cagliari within the CRUI-CARE Agreement