Uneventful Outcome Research Articles

Outcome of Non-operative Management of Perforated Peptic Ulcer Disease

Background: Peptic ulcer perforation management is still an enigma. Though the overall incidence has been reduced worldwide due to wide use of anti-ulcerants, still it is not uncommon. But there is a debate regarding its conservative management over surgical management.
 Objective: To determine whether surgery could be avoided in selected patients with perforated peptic ulcer disease
 Methods: This study was conducted in the department of Surgery of Sir Salimullah Medical College and Mitford Hospital during the period from 1st March 2016 to 31st August 2016. After approval from the institutional ethics committee, 30 patients of suspected perforated peptic ulcer disease were successively assigned in this study on clinical and radiological basis. All were given non-operative regimen up to 24 hours. Then they were closely monitored to see improvement of clinical condition or development of any complication. Non-operative treatment was abandoned if the patient failed to improve or deteriorated within 24 hours of non-operative treatment. The data were collected by active participation of patients’ interview in preformed data collection sheet. Results: The data analysis of 30 patients yielded that most of them (86.67%) recovered well after receiving non-operative management, whereas only 4 patients (13.33%) showed no progression and were treated by laparotomy. 73.08% patients with uneventful outcome left the hospital within 10 days of admission and the others were a little late to leave.
 Conclusion: Patients with perforated peptic ulcer disease can be effectively treated by conservative approach in properly selected cases by proper monitoring under strict supervision of an experienced consultant.
 Journal of Surgical Sciences (2018) Vol. 22 (2) : 95-98

Severe Cervicofacial Cellulitis in Pregnancy- A Review of 18 Cases.

Introduction:Cervicofacial cellulitis can be rapidly complicated with a difficult airway when prompt management is not instituted. It may have some serious consequences for developing baby when a pregnant woman is involved. This study presented the experiences gained from the management of cervicofacial cellulitis in pregnant women.Materials and Methods:The present study was conducted on 18 pregnant women with cervicofacial cellulitis affecting more than one facial space at the presentation in a regional tertiary hospital within a five-year period (January 2013 to December 2017). The collected information included patient age, clinical diagnosis, number of involved facial spaces, gestational periods, and duration of hospital stay. The collected data were analyzed using SPSS software (version 15.0).Results:A total of 131 patients with cervicofacial cellulitis were admitted during the study period, out of which 18 patients met the inclusion criteria and were investigated in the present study. These 18 patients were within the age range of 20-43 years with the mean age of 29±7.1 years. There was a statistically significant relationship between the number of fascial spaces involved and duration of hospital stay (P=0.04). All the patients had incision and drainage of the affected facial spaces under local anesthesia with good outcomes.Conclusion:The prompt management of pregnant women with cervicofacial cellulitis in a multidisciplinary manner is important to ensure uneventful outcomes in the lives of both the pregnant woman and unborn child.

Chilaiditi's and Ogilvie syndromes.

We read the interesting case study of interposition of the colon between the liver and the right diaphragm (Chilaiditi's sign) that was recently reported by Ruiz Pardo et al. in a 73-year-old male with epigastric pain, ectopic cholecystitis and segmental hepatic hypoplasia. The condition was managed by laparoscopic cholecystectomy with an uneventful outcome. This sign was first described in 1910 by the Greek radiologist Demetrius Chilaiditi. The incidence of Chilaiditi's sign in plain imaging studies is from 0.025 % to 0.28 % and may be reported by abdominal computed tomography in between 1.18 % and 2.40 % of cases.

Knowledge, attitude, and practice toward COVID-19 among pregnant women in a tertiary care hospital during the COVID-19 outbreak

Background: During COVID-19 pandemic, Indian health authorities implemented massive measures to control the rapid spread of infection. Nonetheless, even during pandemic, pregnant women need constant obstetrics consultations during the antepartum period and adequate care during intrapartum and postpartum period for uneventful outcome. Undeniably, adherence to these control measures is largely affected by knowledge, attitude, and practices (KAP) towards COVID-19. Aims and Objectives: To assess knowledge, attitude, and practice towards COVID-19 amongst pregnant women and to find the association of demographic variables (age, place of residence, and education) with KAP. Materials and Methods: The cross-sectional, descriptive study was conducted for pregnant women attending the outpatient department of Obstetrics in a tertiary care Defense hospital. We investigated 506 pregnant women serially from Obstetrics OPD of the hospital for KAP towards COVID-19 with a questionnaire of 14 questions. The study population was assessed for the KAP score and association of demographic variables with KAP. Descriptive statistics were used to describe the findings. Median and standard deviation (SD) were calculated for KAP and Pearson's Chi-square test was used to analyze the association of demographic variables with KAP. Results: In our study scores for adequate knowledge, positive attitude, and good practices were 75.3 %, 73.9%, and 92.7 % respectively. The analysis of the association of various demographic variables with KAP about COVID-19 revealed significant association. Conclusion: The majority of pregnant women was knowledgeable about COVID-19 and had positive attitude and good practices. However, health authorities may need to take proactive steps for this vulnerable subpopulation.

Surgical Repair of VSD and their Short Term Outcome in a Tertiary Care Hospital

Background: Ventricular Septal Defect (VSD) is the commonest congenital cardiac anomaly in Bangladesh. For this reason, patch repair of VSD is commonly performed cardiac surgery here. Aim: To observe the short term outcome of patch repair of VSD. Methods: 50 consecutive patients were enrolled in the study by purposive sampling who received treatment for isolated VSD in Department of Paediatric Cardiac Surgery of Dhaka Shishu Hospital, Dhaka, Bangladesh. They underwent ventricular patch repair from January, 2017 to December, 2017. A prospective observational cross-sectional study was conducted for this 12 months period. A pre-structured, interview and observation based, peer reviewed data collection sheet was prepared. Data regarding Sociodemographic, clinical, surgical and outcome profile were recorded. Data were compiled, edited and analyzed with SPSS version 23. Data were presented as mean and standard deviation, frequency percentage and median with range. Results: The mean birth weight of 50 patients was 2.8 kg (range: 2.1-3.5 kg) whereas the median of gestational age was 38 weeks. Among these 50 patients, 22 (44%) and 28 (56%) were boys and girls respectively. The indication of surgery was volume load, failure to thrive and repeated respiratory tract infection. Out of 50 patients, 46 (92%) had perimembranous variety. On the contrary, 4 (8%) experienced Double committed type of VSD. The mean Bypass time and Aortic cross-clamp time were recorded as 70 ± 13.7 minutes and 35 ± 6.85 minutes respectively. Out of 50 patients who underwent ventricular patch repair, 2 (4%) experienced pneumothorax, 1 (2%) got chylothorax and 1 (2%) had transient heart block. Total 45 (90%) patients showed uneventful outcome. Conclusion: Contemporary results of ventricular patch repair in case of VSD showed unparallel outcome with extremely low morbidity in our perspective.

DOZ047.53: Esophageal balloon dilatation for strictures developing after esophageal atresia surgery

Abstract Aim The aim of this study is to evaluate the results of esophageal balloon dilatation (BD) for strictures after esophageal atresia (EA) surgery. Methods Flexible endoscopic BD was done under fluoroscopic and manometric control. The balloon placed in the stricture was inflated by contrast. The target pressure and the diameter were decided in compliance with the manufacturer's directions as well as fluoroscopic guidance. The balloon was kept inflated for 3 minutes. Prospectively collected data over 10 years were retrospectively evaluated. Cure was defined as no need for dilatation during the last 12 months. Results A total of 79 patients with variable diagnoses underwent 481 BD. Forty (51%) had strictures which developed after EA surgery. They underwent 175 (36%) BD (P < 0.05). There were 21 males and 19 females. The atresia was distal fistula type in 31 (77.5%) patients and isolated EA in nine (22.5%). The BD was done for primary esophago-esophageal anastomosis site in 37 patients. The remaining three patients with long gap EA had undergone previous replacement surgery and the BD was done for the proximal esophago-colonic anastomosis. The median age at the time of the first BD was 14 months with 17 (43%) patients below the age of 1 year. The maximal inflation diameter varied between 5–20 mm. Esophageal BD catheters were used in all except two occasions where 5 mm ureteral balloons were used. The median number of BD was four (n = 1–15). Thirty-four (85%) patients underwent more than one BD. A transmural perforation was encountered in one occasion (0.6%) and the patient eventually underwent esophageal replacement surgery with an uneventful outcome. There was no mortality. Fundoplication was done in nine patients. Thirty-three patients (82.5%) were regarded as ‘cure’. Conclusion Esophageal BD is employed for strictures caused by a variety of reasons. Patients with EA comprise a substantial number of cases needing BD and have strictures less resistant to dilatation. The technique employed in this study is advantageous because it enables direct endoscopic visualization of the stricture and both gradual and controlled increase of the dilatation pressure. BD is safe and efficient yet there is a risk of esophageal perforation as in the other dilatation techniques.

Management of isolated high grade blunt pancreatic injury; case report on lesser aggressive approach

Isolated high grade pancreatic injury is rare after blunt abdominal trauma. It is a rare entity to appreciate intra-operatively and a high index of suspicion should always be kept in mind to reach the diagnosis. We are presenting our experience of four cases with moderate to high grade isolated pancreatic injury which were managed in a lesser aggressive approach and had an uneventful outcome.

Successful postoperative pancreatic fistula treatment with the use of somatostatin infusion after duodenal gastrointestinal stromal tumor resection

Introduction. According to the International Study Group on Pancreatic Fistula, a postoperative pancreatic fistula is defined as every case of fluid leak on the third (or later) postoperative day, in which the level of amylase in the collected fluid is at least three times higher than the serum amylase level. Depending on the stage and the designated management, pancreatic fistulas are divided into the following three categories: A (mild), B, and C (severe). Regardless of favorable conditions, exocrine pancreatic secretion is the key factor in fistula formation. The decrease in pancreatic secretion caused by somatostatin and its analogues combined with parenteral nutrition is a well-established treatment method in pancreatic fistula management. Case outline. The case of a 69-year-old patient who had undergone a resection of a duodenal gastrointestinal stromal tumor located directly above the major duodenal papilla is presented. Excessive drainage of amylase-rich fluid was observed in the postoperative period. Treatment comprised continuous infusion of somatostatin and parenteral nutrition. Fistula closure was accomplished on postoperative day 14, confirmed by a radical decrease in the volume of drainage and low amylase levels in the collected fluid. The patient remained in a good clinical state and was discharged from hospital on postoperative day 20. Conclusion. This is an example of the early diagnosis of a postoperative pancreatic fistula, treated conservatively with the use of somatostatin. Post-surgery clinical awareness of the importance of direct contact between the stromal tumor and pancreatic tissues, in connection with routine amylase level assessment, led to a quick diagnosis of pancreatic fistula and the therapy led to an uneventful outcome.

MP10-18 SEPTIC SHOCK FOLLOWING SURGICAL DECOMPRESSION OF OBSTRUCTING URETERAL STONES: A PROSPECTIVE ANALYSIS

You have accessJournal of UrologyInfections/Inflammation/Cystic Disease of the Genitourinary Tract: Kidney & Bladder I1 Apr 2018MP10-18 SEPTIC SHOCK FOLLOWING SURGICAL DECOMPRESSION OF OBSTRUCTING URETERAL STONES: A PROSPECTIVE ANALYSIS Paulo Moscardi, Victor Srougi, Giovanni Marchini, Ricardo Haidar, Fabio Torricelli, Miguel Srougi, William Nahas, and Eduardo Mazzucchi Paulo MoscardiPaulo Moscardi More articles by this author , Victor SrougiVictor Srougi More articles by this author , Giovanni MarchiniGiovanni Marchini More articles by this author , Ricardo HaidarRicardo Haidar More articles by this author , Fabio TorricelliFabio Torricelli More articles by this author , Miguel SrougiMiguel Srougi More articles by this author , William NahasWilliam Nahas More articles by this author , and Eduardo MazzucchiEduardo Mazzucchi More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.364AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To investigate risk factors for septic shock and death in patients with obstructive pyelonephritis due to ureteral stone, who underwent urinary tract decompression. METHODS We prospectively enrolled patients who presented at the emergency room of our institution with clinical signs of pyelonephritis, systemic inflammatory reaction syndrome (SIRS) and obstructive ureteral stone confirmed by computed tomography. Forty patients that underwent urinary tract decompression were included. Demographical, medical and laboratorial characteristics were recorded; antibiotics regimen and time from presentation to decompression were compared between patients with septic complications and patients with uneventful outcomes. RESULTS Septic shock and death occurred in 6 (15%) and 2 (5%) patients, respectively. Gender, age and co-morbidities were not associated with septic complications. Urinary culture was negative in 40% of the cohort and the most prevalent pathogen was Escherichia coli (Table 1). Administration of antibiotics other than cephalosporines was associated with septic shock (p=0.02). There was no difference between groups regarding the time of antibiotics use (p = 0.63) and time from presentation to urinary tract decompression (4.0±6.9 vs. 1.4±1.8; p=0.07; Table 2). Preoperative leucocyte count receiver operator curve for intra-operative and post-operative septic shock revealed AUC = 0.879 (p = 0.014) and AUC = 0.788 (p = 0.027), respectively (Figure 1A,B). CONCLUSIONS Time of antibiotics use and time from presentation to urinary tract decompression were not determinant to preclude patients of septic shock. Patients with elevated serum leukocytes are at substantial risk of septic shock and should undergo prompt surgical intervention. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e124 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Paulo Moscardi More articles by this author Victor Srougi More articles by this author Giovanni Marchini More articles by this author Ricardo Haidar More articles by this author Fabio Torricelli More articles by this author Miguel Srougi More articles by this author William Nahas More articles by this author Eduardo Mazzucchi More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Diagnostic value and prognostic implications of early cardiac magnetic resonance in survivors of out-of-hospital cardiac arrest

In patients who survived out-of-hospital cardiac arrest (OHCA), it is crucial to establish the underlying cause and its potential reversibility. The purpose of this study was to assess the incremental diagnostic and prognostic role of early cardiac magnetic resonance (CMR) in survivors of OHCA. Among 139 consecutive OHCA patients, the study enrolled 44 patients (median age 43 years; 84% male) who underwent coronary angiography and CMR ≤7 days after admission. The CMR protocol included T2-weighted sequences for myocardial edema and late gadolinium enhancement (LGE) sequences for myocardial fibrosis. Coronary angiography identified obstructive coronary artery disease in 18 of 44 patients in whom CMR confirmed the diagnosis of ischemic heart disease by demonstrating subendocardial or transmural LGE. The presence of myocardial edema allowed differentiation between acute myocardial ischemia (n = 12) and postinfarction myocardial scar (n = 6). Among the remaining 26 patients without obstructive coronary artery disease, CMR in 19 (73%) showed dilated cardiomyopathy in 5, myocarditis in 4, mitral valve prolapse associated with LGE in 3, ischemic scar in 2, idiopathic nonischemic scar in 2, arrhythmogenic cardiomyopathy in 1, hypertrophic cardiomyopathy in 1, and takotsubo cardiomyopathy in 1. In this subgroup of 26 patients, 6 (23%) had myocardial edema. During mean follow-up of 36 ± 17 months, all 18 patients with myocardial edema had an uneventful outcome, whereas 9 of 26 (35%) without myocardial edema experienced sudden arrhythmic death (n = 1), appropriate defibrillator interventions (n = 5), and nonarrhythmic death (n = 3; P = .006). In survivors of OHCA, early CMR with a comprehensive tissue characterization protocol provided additional diagnostic and prognostic value. The identification of myocardial edema was associated with a favorable long-term outcome.

Listeria monocytogenes-associated respiratory infections: a study of 38 consecutive cases

ObjectivesListeria monocytogenes (Lm) is a foodborne human pathogen responsible for severe infections, including septicaemia, neurolisteriosis, and maternal–foetal and focal infections. Little is known about Lm-associated respiratory tract or lung infections. MethodsWe conducted a retrospective study of culture-proven cases of Lm pleural infections and pneumonia reported to the French National Reference Centre for Listeria from January 1993 to August 2016. ResultsThirty-eight consecutive patients with pleural infection (n = 32), pneumonia (n = 5), or both (n = 1) were studied; 71% of these were men. Median age was 72 (range 29–90). Two patients presented with concomitant neurolisteriosis. All patients but one reported at least one immunosuppressive condition (97%), with a median number of 2 (range 0–5), including 29% (8/28) with current exposure to immunosuppressive therapy and 50% (17/34) with ongoing neoplasia; 75% (21/28) reported previous pleural or pulmonary disease. Antibiotic therapy mostly consisted in amoxicillin (72%) associated with aminoglycoside in 32%. Chest-tube drainage was performed in 7/19 patients with empyema (37%); 25% of the patients (7/30) required intensive care management. In-hospital mortality reached 35% and occurred after a median time interval of 4 days (range 1–33 days). Three patients had recurrence of empyema (time interval of 1 week to 4 months after treatment completion). Altogether, only 13/31 patients (42%) diagnosed with Lm respiratory infection experienced an uneventful outcome at 2-year follow-up. ConclusionLm is a rare but severe cause of pneumonia and pleural infection in older immunocompromised patients, requiring prompt diagnosis and adequate management and follow-up.

Demographic factors in Swedish adults undergoing root filling and subsequent extraction of a maxillary first molar: a comparative study.

To study the demographics of Swedish adults who had received a root filling, followed by extraction during the following 5-6years in comparison with subjects who had undergone a corresponding root filling with an uneventful outcome. The root filled maxillary first molar was chosen as the comparison model. The Swedish Social Insurance Agency provided data on all teeth reported as root filled in Sweden during 2009. A comparison group, equally large as the study group, was constructed by randomly selecting subjects with root filled maxillary first molars, which had not subsequently been extracted, that is, an uneventful outcome. Demographic data on the subjects were obtained from Statistics Sweden: country of birth, disposable income, educational level, age, civil status and gender. Chi-square, t-tests and logistic regression were used for statistical analyses. In the year 2009, 36139 maxillary first molar teeth were reported to have been root filled, 4362 (12.1%) of which were then recorded as extracted during the following 5-6year period. Only minor intergroup differences were noted: 86.5% of the studygroup were Swedish-born, compared with 84.4% of the comparison group (P=0.007). Women comprised 53.2% of the study group and 50.5% (P=0.01) of the comparison group. There was an association between extractions and gender as well as age; men had a lower odds ratio (OR) for extraction OR, 0.87; confidence interval (CI), 0.80-0.95. For every additional year, the chance for extraction was higher OR, 1.01; CI, 1.01-1.01. No other significant differences were detected. There was only little or no demographic differences between the study group, comprising Swedish adults who had undergone root filling of one of their maxillary first molars in 2009 and subsequent extraction during the following 5-6years, and the comparison group, with uneventful outcomes after a corresponding root filling.

A Retrospective 10-Year Analysis of Water Absorbent Bead Ingestion in Children.

Aim This retrospective case series was designed to evaluate the clinical experience of pediatric patients who had ingested water absorbent beads (WABs) and review the relevant literature. Materials and Methods A retrospective chart analysis of 21 children who were admitted to the emergency service or outpatient clinic with complaints of swallowing WABs during a 10-year period was performed. The patients were divided into two groups: 6 patients who were hospitalized and 15 patients who were observed as outpatients for groups 1 and 2, respectively. All data were screened with respect to presentation, age, gender, clinical and radiological findings, modalities of treatment, and follow-up. Results All patients were asymptomatic with uneventful outcomes. Laboratory studies, X-ray, and ultrasound examinations revealed normal results. None of the patients underwent surgery or other medical procedures. Gastrointestinal system obstruction or any other pathological findings were not detected after WAB ingestion. No complications were identified during follow-up. Discussion This first clinical study showed that asymptomatic patients do not require inpatient observation and laboratory investigations, X-ray, and ultrasound. However, results of the present study cannot be generalized to children of all ages due to the few cases of bowel obstruction reported to date in small children.

On The 2017 Man Booker Prize

On The 2017 Man Booker Prize Merritt Moseley (bio) On October 17, at the splendid annual dinner in London's Guildhall, broadcast live on the BBC, George Saunders received the 2017 Man Booker Prize for his novel Lincoln in the Bardo. This was, by Booker Prize standards, an uneventful outcome. There were no obvious fissures among the judging panel, none of the losing novelists walked out, and the bookmakers, who play an outsized role in the lead-up to the prize, had installed Saunders as the favorite, so there was no upset angle to the story. The chair of the judges, Lola, Baroness Young, paid tribute to Saunders's book: This tale of the haunting and haunted souls in the afterlife of Abraham Lincoln's young son paradoxically creates a vivid and lively evocation of the characters that populate this other world. Lincoln in the Bardo is both rooted in and plays with history, and explores the meaning and experience of empathy. [End Page 146] Baroness Young handed the prize winnings to a man who might be considered an aristocrat in his own field. The fifty-nine-year-old Saunders is an acclaimed author of short stories (six published collections) and nonfiction. He received a 2006 MacArthur Fellowship, and in 2014 his book Tenth of December won the inaugural Folio Prize. (This is a troubled alternative, or competitor, to the Man Booker, established by literary figures unhappy with what seemed Booker insistence on readable books that zip along. It has faltered, though, changing sponsors and giving no prize in 2016.) Despite his visibility and success, Saunders's winning book was his first novel. This put him in a somewhat odd group of newcomers. Half the books on the six-title short list were first novels; the two others besides Lincoln in the Bardo were written by young, essentially unknown women: the British Fiona Mozley (twenty-nine-year-old author of Elmet) and the American Emily Fridlund (History of Wolves), aged thirty-eight. Fridlund is the product of the MFA program at Washington University in St. Louis, holds a PhD from the University of Southern California, and teaches at Cornell. Mozley is much more of a dark horse: a graduate student in history and a part-time clerk in a London bookshop who only recently began to think of herself as a writer, she composed her book on the train from York to London, on her smart phone. The division between beginners and veterans is one way to map the short list. The other three novels were Exit West by Mohsin Hamid, Autumn by Ali Smith, and 4321 by Paul Auster. Hamid, author of three other novels and a collection of short stories, appeared on the 2007 short list. The Scottish Ali Smith has been on the Booker short list three times before, in 2001, 2005, and 2014. And the American Paul Auster, author of more than fifteen novels, is so firmly established that he has published his collected novels in four volumes. He is seventy. [End Page 147] There were three American finalists and three from the UK or its commonwealth. There were three women and three men. There were even three books identified by reviewers as "coming-of-age novels." Three are set in a more or less recognizable contemporary world—History of Wolves, Elmet, and Exit West (maybe a future world)—and three at least partly in the past: Autumn, which shimmers back and forth between a very contemporary setting, in which Brexit is a key theme, and the main character's childhood; Lincoln in the Bardo, set in the early years of the American Civil War; and 4321, which begins in the early twentieth century and brings its protagonist up to 1970. The short list, which was announced on September 13, actually provided the second taste of where things were headed for the 2017 Man Booker. The first came in July, when the judges revealed the thirteen-title long list. Aside from some restlessness about the four Americans on the list, attention was focused on the major names included, and not, as in most years, on those excluded. (Roddy Doyle and Salman Rushdie, previous Booker winners, were...

Connections between radial and ulnar nerve at high humeral level in cadavers: incidence, topography, and literature review.

Although communications between branches and cords of the brachial plexus have been extensively published, there is a scarcity of reports concerning radial and ulnar nerve (RN-UN) communication in the arm. The current study aims to demonstrate the incidence, topography, and length of communicating branches between RN and UN. Any additional coexisted variations were also recorded. Two hundred and sixty-six upper limbs collected from one hundred and thirty-three (81 males and 52 females) Greek cadavers were dissected. Three out of one hundred and thirty-three cadavers, accounting for an incidence of up to 2.3%, were found to have an atypical communicating branch originating at a high humeral level from RN towards UN. In two cadavers, communicating branches were detected on the left side and in one cadaver bilaterally. The study of atypical communications between RN and UN attracts great attention for its clinical importance, mainly in cases of peripheral neuropathies with diagnostic dilemma or upper limb nerve injury producing an otherwise unexpected symptomatology due to the aberrant nerve supply. Familiarity with these variations is crucial in avoiding misdiagnosis and preserving valuable communicating branches, thus achieving an uneventful outcome in cases of upper limb nerve injury repair.

Are there any relations among transplant centre volume, surgical technique and anatomy for donor graft selection? Ten-year multicentric Italian experience on mini-invasive living donor nephrectomy.

Selection of the right or left living donor kidney for transplantation is influenced by many variables. In the present multi centric study including 21 Italian transplant centres, we evaluated whether centre volume or surgical technique may influence the selection process. Intra- and perioperative donor data, donor kidney function, and recipient and graft survival were collected among 693 mini-invasive living donor nephrectomies performed from 2002 to 2014. Centre volume (LOW, 1-50 cases; HIGH, >50 cases) and surgical technique (FULL-LAP, full laparoscopic and robotic; HA-LAP, hand-assisted laparoscopy; MINI-OPEN, mini-lumbotomy) were correlated with selection of right or left donor kidney and with donor and recipient outcome. HIGH-volume centres retrieved a higher rate of donor right kidneys (29.3% versus 17.6%, P < 0.01) with single artery (83.1% versus 76.4%, P < 0.05) compared with LOW-volume centres. Surgical technique correlated significantly with rate of donor right kidney and presence of multiple arteries: MINI-OPEN (53% and 13%) versus HA-LAP (29% and 22%) versus FULL-LAP (11% and 23%), P < 0.001 and P < 0.05, respectively. All donors had an uneventful outcome; donor bleeding was more frequent in LOW-volume centres (4% versus 0.9%, P < 0.05). Centre volume and surgical technique influenced donor kidney side selection. Donor nephrectomy in LOW-volume centres was associated with higher risk of donor bleeding.

Right anterolateral thoracotomy: an attractive alternative to repeat sternotomy for high-risk patients undergoing reoperative mitral and tricuspid valve surgery

BackgroundReoperative cardiac valve surgery via sternotomy is associated with a substantial morbidity and mortality. This study evaluated the right anterolateral thoracotomy for high-risk patients undergoing mitral and tricuspid valve redo procedures.MethodsOut of a series of 173 patients undergoing redo cardiac valve surgery, 24 patients were reoperative via the right anterolateral thoracotomy as the high-risk group on the basis of the proximity of the heart and great vessels to the sternum and the presence and location of patent bypass grafts.ResultsIn all cases, sternotomy was avoided. The mitral valve and tricuspid valve were replaced in 4 and 19 patients and repaired in 1 and 2 patients, respectively. Moreover, left atrial folding was performed in 5 patients. Mortality was 8.3%. All other patients had uneventful outcomes and normal valve function at follow-up.ConclusionsReoperative cardiac valve surgery can be performed safely using the right anterolateral thoracotomy in high-risk patients. It offers enough exposure. It minimizes the need for cardiac dissection, and thus, the risk for injury. Avoiding a high-risk resternotomy increases patients comfort and safety of redo mitral and tricuspid valve surgery.

Relevance of Endothelial Cell-Specific Molecule 1 (Endocan) Plasma Levels for Predicting Pulmonary Infection after Cardiac Surgery in Chronic Kidney Disease Patients: The Endolung Pilot Study

Objectives: This pilot study aimed to evaluate the relevance of endocan plasma levels for predicting pulmonary infection after cardiac surgery in patients with chronic kidney disease (CKD). Methods: Serum collected in a previous prospective cohort study (from 166 patients with preoperative CKD who underwent cardiac surgery) was used. Five patients with postoperative pulmonary infection were compared with 15 randomly selected CKD patients with an uneventful outcome. Blood samples were tested at 4 time points (preoperatively and 6, 12, and 24 h after the end of surgery). Endocan, procalcitonin, and C-reactive protein plasma levels were compared between the two groups. Results: At 6 h, the patients with pulmonary infection had significantly higher levels of endocan than the patients without pulmonary infection (24.2 ± 15.6 vs. 6.4 ± 3.2 ng/mL; p = 0.03). A receiver operating characteristic curve analysis showed 80% sensitivity and 100% specificity for endocan to predict pulmonary infection (area under the curve 0.84), with a cutoff value of 15.9 ng/mL. The time saved by assessment of the endocan dosage compared to a clinical diagnosis of pulmonary infection was 47 h. Conclusion: This pilot study showed that a specific study to assess the link between endocan plasma levels and pulmonary infection after cardiac surgery in CKD patients is of potential utility.

The use of laparoscopy in managing penetrating thoracoabdominal injuries in Africa: 83 cases reviewed.

BackgroundThe use of laparoscopy in managing haemodynamically stable patients with penetrating thoracoabdominal injuries in developed countries is wildly practiced, but in Africa, the use of laparoscopy is still in its infancy stage. We reviewed a single centre experience in using laparoscopy in Africa for management of patients with both isolated diaphragmatic injuries as well as diaphragmatic injuries associated with intra-abdominal injuries requiring intervention.MethodsA retrospective analysis of prospectively collected data of patients presenting with penetrating thoracoabdominal injuries was done. All patients offered laparoscopic exploration and repair from January 2012 to December 2015 at Dr. George Mukhari Academic Hospital were analysed. Means (±SD) were presented for continuous variables, and frequencies (%) were presented for categorical variables. All analyses were performed using SAS version 9.3 (SAS Institute, Cary, NC).ResultsA total of 83 stable patients with penetrating thoracoabdominal injuries managed with laparoscopy met the inclusion criteria and were included in the study. The Injury Severity Score ranged from 8 to 24, with a median of 18. The incidence of diaphragmatic injuries was 54%. Majority (46.8%) of patients had Grade 3 (2–10 cm defect) diaphragmatic injury. Associated intra-abdominal injuries requiring intervention were encountered in 28 (62%) patients. At least 93.3% of the patients were treated exclusively with laparoscopy. The morbidity was encountered in 7 (16%) patients; the most common cause was a clotted haemothorax Clavien-Dindo III-b, but only 1 patient required a decortication. There was one non-procedure-related mortality.ConclusionsA success rate of 93% in using laparoscopy exclusively was documented, with an overall 82% uneventful outcome. The positive outcomes found in this study when laparoscopy was used in stable patients with thoracoabdominal injuries support similar work done in other trauma centres. However, in addition, this study seem to suggest that the presence of peritonitis in stable patient is not a contra-indication to laparoscopy and thoracoscopy may be useful especially in right side diaphragmatic injury where the liver can preclude adequate visualization of the entire diaphragm and to thoroughly clean the chest cavity and prevent future complication such as residual clotted haemothorax.Clinical relevance: The presence of peritonitis in stable patients with penetrating thoracoabdominal injury is not a contra-indication to laparoscopy provided the operating surgeon has adequate laparoscopic skills.

Acute surgical abdomen as presentation of undiagnosed midgut malrotation in adults

Acute presentation in adulthood of the indolent developmental midgut malformations constitutes a diagnostic problem and emergent surgery may result to an operative surprise. In the last five years two women (case I: 46 years, case II: 88 years) and two men (case III: 42 years, case IV: 50 years) underwent urgent laparotomy for acute abdomen due to bowel obstruction (all cases) and peritonitis (cases II, III). Right colon volvulus in cases I, II and IV, ileocolonic intussusception in case II, gaseous distension of bowel loops and abdominal abscess in case III, and enlargement of the entire colon and megasigmoid in case IV were revealed by preoperative imaging. Symptoms of severe abdominal pain, abdominal distension with tenderness, vomiting and complete constipation were evident in all cases. At surgery, features of malrotation, mainly lack of fixation of the right colon which was volvulised, were found in all cases. Right-sided small intestine and Meckel’s diverticulum abscess were found in case III, and an incompletely volvulised megasigmoid coexisted in case IV. We performed resection of peritoneal bands, right hemicolectomy with ileotransversostomy in cases I, II and IV, and enterectomy and right colon fixation in case III. A Hartmann’s sigmoidectomy completed the operation in case IV. All cases had uneventful outcome, except for some delay in wound healing in a diabetic patient. Histology revealed ischaemia in all segments excised, ileocolonic intussusception associated with a caecal adenocarcinoma in case II, and inflammed Meckel’s diverticulum in case III. Adult bowel malrotation complicated with right colon volvulus and/or ileocolonic intussusception requires emergent surgery.