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Differential Equations     Hybrid Journal   (Followers: 2, SJR: 0.364, h-index: 15)
Differential Equations and Dynamical Systems     Hybrid Journal   (Followers: 1, SJR: 0.63, h-index: 7)
Digestive Diseases and Sciences     Hybrid Journal   (Followers: 4, SJR: 1.19, h-index: 89)
Directieve therapie     Hybrid Journal  
Discrete & Computational Geometry     Hybrid Journal   (Followers: 2, SJR: 1.269, h-index: 40)
Discrete Event Dynamic Systems     Hybrid Journal   (Followers: 2, SJR: 0.42, h-index: 32)
Distributed and Parallel Databases     Hybrid Journal   (Followers: 4, SJR: 0.766, h-index: 30)
Distributed Computing     Hybrid Journal   (Followers: 2, SJR: 1.41, h-index: 31)
DNP - Der Neurologe und Psychiater     Full-text available via subscription  
Documenta Ophthalmologica     Hybrid Journal   (Followers: 2, SJR: 0.946, h-index: 40)
Doklady Biochemistry and Biophysics     Hybrid Journal   (Followers: 2, SJR: 0.2, h-index: 10)
Doklady Biological Sciences     Hybrid Journal   (SJR: 0.248, h-index: 10)
Doklady Botanical Sciences     Hybrid Journal  
Doklady Chemistry     Hybrid Journal   (SJR: 0.272, h-index: 12)
Doklady Earth Sciences     Hybrid Journal   (SJR: 0.48, h-index: 17)
Doklady Mathematics     Hybrid Journal   (SJR: 0.345, h-index: 13)
Doklady Physical Chemistry     Hybrid Journal   (SJR: 0.299, h-index: 12)
Doklady Physics     Hybrid Journal   (Followers: 1, SJR: 0.293, h-index: 17)
Douleur et Analg├ęsie     Hybrid Journal   (SJR: 0.113, h-index: 6)
Drug Delivery and Translational Research     Hybrid Journal   (Followers: 2, SJR: 0.607, h-index: 8)
Drug Safety - Case Reports     Open Access  
Drugs : Real World Outcomes     Hybrid Journal   (Followers: 1)
Dynamic Games and Applications     Hybrid Journal   (Followers: 2, SJR: 0.481, h-index: 5)
Dysphagia     Hybrid Journal   (Followers: 95, SJR: 0.822, h-index: 52)
e & i Elektrotechnik und Informationstechnik     Hybrid Journal   (Followers: 9, SJR: 0.279, h-index: 9)
e-Neuroforum     Hybrid Journal  
Early Childhood Education J.     Hybrid Journal   (Followers: 14, SJR: 0.466, h-index: 16)
Earth Science Informatics     Hybrid Journal   (Followers: 3, SJR: 0.282, h-index: 7)
Earth, Moon, and Planets     Hybrid Journal   (Followers: 7, SJR: 0.303, h-index: 29)
Earthquake Engineering and Engineering Vibration     Hybrid Journal   (Followers: 7, SJR: 0.482, h-index: 21)
Earthquake Science     Hybrid Journal   (Followers: 8, SJR: 0.418, h-index: 9)
East Asia     Hybrid Journal   (Followers: 7, SJR: 0.18, h-index: 9)
Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity     Hybrid Journal   (Followers: 9, SJR: 0.362, h-index: 27)
EcoHealth     Hybrid Journal   (Followers: 3, SJR: 0.88, h-index: 26)
Ecological Research     Hybrid Journal   (Followers: 8, SJR: 0.847, h-index: 43)
Economia e Politica Industriale     Hybrid Journal  
Economia Politica     Hybrid Journal   (SJR: 0.375, h-index: 6)
Economic Botany     Hybrid Journal   (Followers: 8, SJR: 0.527, h-index: 44)
Economic Bulletin     Hybrid Journal   (Followers: 4)
Economic Change and Restructuring     Hybrid Journal   (Followers: 1, SJR: 0.264, h-index: 9)
Economic Theory     Hybrid Journal   (Followers: 9, SJR: 2.557, h-index: 34)
Economic Theory Bulletin     Hybrid Journal   (Followers: 2)
Economics of Governance     Hybrid Journal   (Followers: 2, SJR: 0.408, h-index: 14)
Ecosystems     Hybrid Journal   (Followers: 19, SJR: 1.909, h-index: 93)
Ecotoxicology     Hybrid Journal   (Followers: 9, SJR: 1.333, h-index: 56)
Education and Information Technologies     Hybrid Journal   (Followers: 95, SJR: 0.366, h-index: 16)
Educational Assessment, Evaluation and Accountability     Hybrid Journal   (Followers: 19, SJR: 0.374, h-index: 15)
Educational Psychology Review     Hybrid Journal   (Followers: 18, SJR: 2.776, h-index: 61)
Educational Research for Policy and Practice     Hybrid Journal   (Followers: 8, SJR: 0.273, h-index: 9)
Educational Studies in Mathematics     Hybrid Journal   (Followers: 13, SJR: 0.825, h-index: 32)
Educational Technology Research and Development     Partially Free   (Followers: 84, SJR: 1.785, h-index: 52)
Electrical Engineering     Hybrid Journal   (Followers: 16, SJR: 0.336, h-index: 18)
Electrocatalysis     Hybrid Journal   (SJR: 0.883, h-index: 10)
Electronic Commerce Research     Hybrid Journal   (Followers: 3, SJR: 0.582, h-index: 16)
Electronic Markets     Hybrid Journal   (Followers: 5, SJR: 0.411, h-index: 8)
Electronic Materials Letters     Hybrid Journal   (Followers: 3, SJR: 1.407, h-index: 15)
Elemente der Mathematik     Hybrid Journal   (Followers: 1)
Emergency Radiology     Hybrid Journal   (Followers: 4, SJR: 0.678, h-index: 25)
Emission Control Science and Technology     Hybrid Journal   (Followers: 1)
Empirica     Hybrid Journal   (Followers: 3, SJR: 0.319, h-index: 16)
Empirical Economics     Hybrid Journal   (Followers: 8, SJR: 0.489, h-index: 31)
Empirical Software Engineering     Hybrid Journal   (Followers: 7, SJR: 1.285, h-index: 39)
Employee Responsibilities and Rights J.     Hybrid Journal   (Followers: 3, SJR: 0.361, h-index: 15)
Endocrine     Hybrid Journal   (Followers: 7, SJR: 0.878, h-index: 57)
Endocrine Pathology     Hybrid Journal   (Followers: 2, SJR: 0.638, h-index: 31)
Energy Efficiency     Hybrid Journal   (Followers: 12, SJR: 0.732, h-index: 14)
Energy Systems     Hybrid Journal   (Followers: 11, SJR: 1.176, h-index: 7)
Engineering With Computers     Hybrid Journal   (Followers: 5, SJR: 0.433, h-index: 30)
Entomological Review     Hybrid Journal   (Followers: 3, SJR: 0.144, h-index: 5)
Environment Systems & Decisions     Hybrid Journal   (Followers: 2)
Environment, Development and Sustainability     Hybrid Journal   (Followers: 30, SJR: 0.419, h-index: 29)
Environmental and Ecological Statistics     Hybrid Journal   (Followers: 5, SJR: 0.458, h-index: 32)
Environmental and Resource Economics     Hybrid Journal   (Followers: 17, SJR: 1.632, h-index: 54)
Environmental Biology of Fishes     Hybrid Journal   (Followers: 5, SJR: 0.725, h-index: 58)
Environmental Chemistry Letters     Hybrid Journal   (Followers: 2, SJR: 0.741, h-index: 28)
Environmental Earth Sciences     Hybrid Journal   (Followers: 13, SJR: 0.724, h-index: 63)
Environmental Economics and Policy Studies     Hybrid Journal   (Followers: 5, SJR: 0.524, h-index: 4)
Environmental Evidence     Open Access   (Followers: 1)
Environmental Fluid Mechanics     Hybrid Journal   (Followers: 2, SJR: 0.437, h-index: 24)
Environmental Geochemistry and Health     Hybrid Journal   (Followers: 3, SJR: 1.013, h-index: 36)
Environmental Geology     Hybrid Journal   (Followers: 11)
Environmental Health and Preventive Medicine     Hybrid Journal   (Followers: 3, SJR: 0.522, h-index: 19)
Environmental Management     Hybrid Journal   (Followers: 33, SJR: 0.942, h-index: 66)
Environmental Modeling & Assessment     Hybrid Journal   (Followers: 11, SJR: 0.533, h-index: 31)
Environmental Monitoring and Assessment     Hybrid Journal   (Followers: 10, SJR: 0.685, h-index: 52)
Environmental Science and Pollution Research     Hybrid Journal   (Followers: 15, SJR: 0.885, h-index: 46)
Epileptic Disorders     Hybrid Journal   (SJR: 0.608, h-index: 38)
EPJ A - Hadrons and Nuclei     Hybrid Journal   (Followers: 1, SJR: 1.287, h-index: 63)
EPJ B - Condensed Matter and Complex Systems     Hybrid Journal   (Followers: 2, SJR: 0.731, h-index: 89)
EPJ direct     Hybrid Journal  
EPJ E - Soft Matter and Biological Physics     Hybrid Journal   (Followers: 1, SJR: 0.641, h-index: 62)
EPMA J.     Open Access   (SJR: 0.284, h-index: 6)
ERA-Forum     Hybrid Journal   (Followers: 3, SJR: 0.128, h-index: 3)
Erkenntnis     Hybrid Journal   (Followers: 13, SJR: 0.621, h-index: 16)
Erwerbs-Obstbau     Hybrid Journal   (SJR: 0.206, h-index: 9)
Esophagus     Hybrid Journal   (SJR: 0.311, h-index: 10)
Estuaries and Coasts     Hybrid Journal   (Followers: 7, SJR: 1.332, h-index: 67)
Ethical Theory and Moral Practice     Hybrid Journal   (Followers: 10, SJR: 0.297, h-index: 10)
Ethics and Information Technology     Hybrid Journal   (Followers: 87, SJR: 0.484, h-index: 23)
Ethik in der Medizin     Hybrid Journal   (SJR: 0.163, h-index: 6)

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Journal Cover   European Surgery
  [SJR: 0.166]   [H-I: 13]   [4 followers]  Follow
   Hybrid Journal Hybrid journal (It can contain Open Access articles)
   ISSN (Print) 1682-4016 - ISSN (Online) 1682-8631
   Published by Springer-Verlag Homepage  [2280 journals]
  • Laparoscopic surgery for gastric cancer: a systematic review
    • Abstract: Summary Background The objective of this paper is to systematically review current literature on laparoscopic surgery for gastric cancer in terms of current indications and feasibility as well as short-term and long-term postoperative outcomes. Methods A systematic review was conducted with respect to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines using PubMed and is up-to-date until January 1, 2014. Results A total of 99 papers matched the inclusion criteria and comprised of 92 case-control studies and 7 randomized controlled trials (RCTs). The majority of these papers focused on short-term outcomes of laparoscopy-assisted distal gastrectomy (LADG), which are superior compared to open distal gastrectomy (ODG). Lymphadenectomy extent, morbidity, and mortality rates as well as disease-free and overall survival did not differ significantly between LADG and ODG groups. Finally, the implementation of laparoscopic gastrectomy was assessed in advanced gastric carcinoma, obese, and elderly patients. Conclusions This systematic review revealed that laparoscopic surgery is safe and effective for the treatment of gastric cancer. LADG offers better short-term and similar long-term results to ODG. Well-designed multicenter RCTs are needed to better understand the limitations of oncologic laparoscopic gastrectomy.
      PubDate: 2015-09-25
  • Hiatal repair to reduce dysphagia in patients with impaired oesophageal
           motility having 360 ° fundoplication: the posterior
           ‘sling’ repair
    • Abstract: Summary Background Fundoplication in the presence of oesophageal dysmotility as being concerning for the development of postoperative dysphagia. Many techniques of surgery including partial fundoplication have evolved. Methods The technique of posterior sling repair of the hiatus avoiding heavy rigid to stitch posterior repair has reduced early dysphagia in our practice. Result The operative technique with operative illustrations is described. Conclusion Posterior sling repair of the hiatus during a laparoscopic fundoplication in oesophageal dysmotility is feasible and has reduced postoperative dysphagia.
      PubDate: 2015-09-23
  • The role of platelets and portal venous pressure fluctuations in
           postoperative liver regeneration
    • Abstract: Summary Background The most relevant factor predicting morbidity and mortality after liver resection is the ability of the remnant liver to regenerate. In line with extensive experimental research, we were recently able to demonstrate that serotonin and thrombospondin-1, two factors abundantly stored in platelets, are closely associated with liver regeneration of patients after liver resection. Methods Within this review, we summarized existing evidence regarding the relevance of platelets in liver regeneration. Results We illustrated a potential interaction of platelet activation and its relation to portal venous pressure during the process of liver regeneration. Conclusions We are able to explore possible effects of specific granule release as a key regulator to allow for platelet-induced liver regeneration. As a second objective, we discussed postoperative portal venous pressure as a potential mechanism and initiating effect in postoperative platelet activation during liver regeneration which may offer new therapeutic targets to promote postoperative liver regeneration.
      PubDate: 2015-09-23
  • Vivian E. Strong (Ed) Gastric cancer: principles and practice
    • PubDate: 2015-09-15
  • Vesicovaginal fistulas: transperitoneal surgical repair using omentum or
           peritoneal tissue interposition, a summary of 35 years of experience
    • Abstract: Summary Objective To report the result of primary vesicovaginal fistula (VVF) repair using the transabdominal approach with omental or peritoneal flap interposition. Methods The study evaluated 38 patients who were treated with transabdominal approach with omental or peritoneal flap. The omental flap was used as the first choice if it was of sufficient length; otherwise, a peritoneal flap was created. Patients were followed postoperatively for 1 year and by telephone survey thereafter. Results The age of patients ranged from 29 to 68 years, with a median of 52 years. The main causes of VVF in this study cohort were hysterectomy for benign conditions (60.5 %), hysterectomy for malignant conditions (34.2 %), and radiation therapy (5.3 %). Peritoneal flap interposition was used in 6 patients and omental flap was used in 32 patients. All patients were continent following catheter removal. Overall, 89.5 % (34 out of 38) of fistulae were successfully repaired at first attempt. The success with omental flap interposition was 100 %. Recurrence of the fistula was reported in four patients (all with primary peritoneal flap interposition). Two of them were successfully cured by peritoneal flap re-interposition. While in two patients, with a history of radiation therapy, sigma rectum pouch was performed. Conclusion Transperitoneal surgical repair using omentum or peritoneal tissue interposition should be considered in the first attempt of repair of supratrigonal VVFs. However, successful repair depends on the experience of the surgeon.
      PubDate: 2015-09-15
  • The assay and clinical significance of serum thymidine kinase 1 in
           patients with colorectal carcinoma
    • Abstract: Summary Background Thymidine kinase 1 was regarded as a good serological marker for cell proliferation. In recent years, the role of thymidine kinase 1 in occurrence, development, and prognosis of tumors gradually attracted people’s attention and had been regarded as a sensitive indicator of tumor. The aim of the present study was to investigate the clinical value of detection of serum thymidine kinase 1 in colorectal carcinoma. Methods In this study, the level of serum thymidine kinase 1 in 150 patients with colorectal carcinoma, 36 patients with benign colorectal diseases, and 40 normal controls was determined by a chemiluminescence dot blot assay. Results The level of serum thymidine kinase 1 in patients with colorectal carcinoma was much higher than that in patients with benign colorectal diseases and normal controls (P < 0.01), but there was no significant difference between the level of serum thymidine kinase 1 in patients with benign colorectal diseases and that in normal controls (P > 0.05). The level of serum thymidine kinase 1 declined significantly 1 month after operation. The positive rate of serum thymidine kinase 1 in patients with colorectal carcinoma was much higher than other digestive tumor markers [carcinoembryonic antigen (CEA), carbohydrate antigen (CA-199, CA-724)]. Conclusions The detection of serum thymidine kinase 1 might have high clinical value in auxiliary diagnosis, curative effect monitoring, and prognosis judgment of colorectal carcinoma.
      PubDate: 2015-08-26
  • Selected commentary to “Treatment of Barrett’s esophagus with
           a novel focal cryoablation device: a safety and feasibility study”
    • PubDate: 2015-08-25
  • The complex interplay between Notch signaling and Snail1 transcription
    • Abstract: Summary Background The epithelial–mesenchymal transition (EMT) is a highly coordinated process observed during embryonic development and adult tissue repair. It is characterized by the loss of cell–cell adhesion and apicobasal polarity, and the transition to a cell type with a spindle-like phenotype able to migrate through the basal membranes. Methods This review article includes available date from peer-reviewed publications associated with the role of Notch signaling and Snail1 transcription factor in activation and regulation of EMT. Results Growing evidences in the past few years demonstrated a significant role of Notch in EMT activation. It is not surprising because this pathway is the nexus of a unique and versatile signaling network, that regulates and is regulated by a variety of cellular mechanisms highly dependent on the biological context—especially tissue microenvironment. This compartment sends signals promoting and regulating EMT, which usually acts as a transcriptional repressors. Among them, Snail1 has been shown to be crucial for cellular movement during cancer progression and metastasis. In cancer patients, increased level of Snail1 is usually connected with poor clinical outcome, probably due to downregulation of E-cadherin expression. Moreover, the continuous expression of E-cadherin during developmental EMT in Snail1-deficient mouse embryos clearly supports the idea that its transcriptional repression is mostly related to Snail1 activity. Conclusion Cooperation of Notch signaling and Snail1 plays very significant role in such pathologies as wound healing and cancer development. Nevertheless, they are also involved in tissue embryonic development.
      PubDate: 2015-08-19
  • Metastatic urinary bladder transitional cell carcinoma to the oral cavity
           and oropharynx
    • Abstract: Summary Background Distant metastasis from urinary bladder transitional cell carcinoma (TCC) is a well-reported phenomenon, most commonly occurring in osseous and pulmonary sites. In contrast, metastasis to oral and/or oropharyngeal soft tissues is extremely rare. Methods We present a case of a 75-year-old gentleman with treated urinary bladder TCC who presented 4 years later with a base of tongue metastasis and airway compromise necessitating a tracheostomy. A systematic review of all previously reported cases of metastatic urinary bladder TCC to the oral cavity and/or oropharynx in the English literature was performed and a summary presented. Results A total of six cases, including ours, of the aforementioned presentation have been reported in English literature. Conclusions This is the first systematic review of all previously reported cases of metastatic urinary bladder TCC to the oral cavity and/or oropharynx in the English literature. It is an extremely rare phenomenon with a uniformly dismal prognosis.
      PubDate: 2015-08-07
  • Is there: surgery goes inter- and multidisciplinary
    • PubDate: 2015-08-07
  • Laparoscopic management of diaphragmatic mesothelial cysts in children
    • Abstract: Background Diaphragmatic mesothelial cysts (DMC) are rare congenital lesions arising from coelomic remnants. The DMC may need surgical excision if they become symptomatic. The aim of this study was to present three pediatric DMC cases that successfully managed laparoscopically. Case report Three consecutive children (ages 6, 8 and 12 years), who presented with nonspecific abdominal complaints, referred to our department. Imaging studies demonstrated lobulated cysts in the region of the right posterior lobes of liver. The patients were approached by laparoscopy in a right lateral decubitus position because the preoperative diagnosis is uncertain. Cysts originating from diaphragm were seen, the clear yellowish fluid was aspirated, and unroofing was performed in all patients. Results After a well-tolerated operation, postoperative courses of the patients were uneventful, and they were discharged on the following day. Histopathological examinations of the wall of the lesions showed DMC with no evidence of malignancy. No recurrence or symptom was found during the follow-up period. Conclusions This is the first report of laparoscopic management of the DMC. Laparoscopic approach to symptomatic DMC patients is safe and effective method for diagnosis and treatment, if it is not established a differential diagnosis by imaging studies.
      PubDate: 2015-08-04
  • Bilateral superficial cervical plexus block combined with bilateral
           greater occipital nerve block reduces the impact of different sources of
           pain after thyroid surgery with less consumption of morphine-PCA: a
           randomized trial
    • Abstract: Summary Background Our aim was to demonstrate the analgesic efficacy of the bilateral superficial cervical plexus block (BSCPB) combined with bilateral greater occipital nerve block (BGONB) on different sources of pain after thyroid surgery; in terms of pain scores and morphine-PCA consumption in the first 24 h. Materials and method Sixty patients were randomized into three groups; Group C (n = 20) to receive management without blocks; Group GS (n = 20), the combination of BSCPB and BGONB; and Group S (n = 20), BSCPB alone. Levobupivacaine of 0.25 % (15 ml (each side) for BSCPB; 5 ml (each side) BGONB) was used for nerve blocks. All patients received morphine-PCA for the first 24 h postoperatively. In all, 0 h, 1 h, 2 h, 4 h, 6 h, 12 h, and 24 h were the measurement times for incision pain at rest, pain on swallowing, headache, and posterior neck pain scores (VAS) and PONV. Requirement for rescue analgesics and 24 h morphine consumption were recorded. Results Incision pain scores at rest and on swallowing was lower in Groups GS and S (p  < 0.001). Posterior neck pain scores were lower in Group GS (p  < 0.001). Headache was similar in all groups, but the number of patients with pain scores VAS > 3 was lower in Group GS (p < 0.001). In Groups GS and S 24 h morphine consumption was lower, compared to Group C (p  < 0.001). PONV and rescue analgesic use were similar. Conclusion The combination of three-injection technique BSCPB with BGONB performed before surgical incision by using 0.25 % levobupivacaine, significantly reduced incision pain at rest, incision pain on swallowing, headache and posterior neck pain after thyroid surgery, while reducing morphine consumption in 24 h postoperatively.
      PubDate: 2015-08-01
  • “Rendez-vous” over-the-scope endoclipping for
           tracheoesophageal fistula: case report and review of the literature
    • Abstract: Summary Background Management of tracheoesophageal fistula is challenging and is associated with high morbidity and mortality. Malignancy and cuff-related tracheal decubitus are the most common causes of tracheoesophageal fistula. Open surgical division and closure of the fistula orifices with or without tissue interposition has represented the standard of care for decades. Endoscopic management of tracheoesophageal fistula is still debated and only a few cases have been described in the literature. Methods A 57-year-old male patient with chronic tracheoesophageal fistula occurring 1 year after esophagectomy for squamous-cell carcinoma was treated with a “rendez-vous” over the scope endoclipping technique using the OVESCO R system. The pertinent literature on the topic has been reviewed and compared to the present case. Results The patient was discharged home on postoperative day 6 on a semisolid diet and remains asymptomatic at 5 month follow-up. Conclusions The OVESCO R system seems to be safe and effective in the treatment of small tracheoesophageal fistula.
      PubDate: 2015-08-01
  • Patch, interposition graft or stent for treatment of restenosis after
           carotid endarterectomy: a retrospective study
    • Abstract: Summary Background Uncertainty surrounding the indication for treatment of post carotid-endarterectomy restenosis (pCEAR) exists. Conventional patch angioplasty (rCEA), carotid interposition graft (CIG), and stent-assisted angioplasty (CAS) have been studied; comparisons of these techniques have not been performed. Methods A time to event analysis of consecutive patients undergoing treatment for pCEAR was performed. Primary end-point was any cerebrovascular or myocardial event or death. Long-term results were expressed in Kaplan–Meier estimates. Results From 02/1997 to 03/2013, 93 procedures for severe pCEAR were performed in 89 consecutive patients. Group 1 consisted of 37 rCEA (40 %), group 2 included 33 CIG (35 %), and group 3 contained 23 CAS (25 %). Median time from primary CEA was significantly longer in group 2 compared with group 3 (118 vs. 54 months; p = 0.02). Groups were comparable with regard to degree of stenosis and cardiovascular risk factors. Five patients (6 %) underwent initial angiography with intention of CAS, but the procedures could not be completed (insufficient access n = 3, neurological symptoms n = 2) and open surgery was performed (rCEA: n = 4; CIG: n = 1). One perioperative death related to major stroke occurred in group 3 (3.6 %). There were no differences in 4-year estimated survival and event-free survival, whereas patients in group 3 were more likely to undergo a tertiary intervention (13 % at 4 years 95 % CI: 11–45 % p = 0.014). Conclusions All three groups presented with similar long-term outcome with regard to the predefined endpoints. Although associated with less perioperative complications, CAS required significantly more tertiary interventions. Carotid interposition graft was not superior to redo patch plasty.
      PubDate: 2015-08-01
  • High correlation of lung ultrasound and chest X-ray after tube drainage in
           patients with primary spontaneous pneumothorax: can we omit X-rays for
           tube management'
    • Abstract: Summary Background Primary spontaneous pneumothorax (PSP) is a common medical condition in the emergency department. Clinically stable patients with large pneumothoraces usually undergo chest tube drainage. During the course of hospital stay, several chest X-rays are ordered at various time points. Because the number of chest X-rays during diagnosis and management of PSP can be quite high and lung ultrasound has a proven efficacy for the assessment of lung re-expansion, we decided to investigate the use of lung ultrasound for the management and decision-making regarding chest drains for PSP. Material and methods A total of 25 patients with PSP were evaluated. A comparison between chest X-rays and lung ultrasound was made at four different time points during patient hospitalization (T1—immediately after drainage, T2–third or fourth post-drainage day, T3—before chest tube removal, T4—after chest tube removal). The rate of agreement between the two investigations was analyzed, as their result impacts decision-making regarding chest tube management and removal. Results Overall, positive and negative agreements were high in all time points, except time point 3. Calculated p values using Fisher’s and Barnard’s test were also good for time points 1, 2, and 4 (< 0.05). Conclusions For all time points except the third, we can safely reject the null hypothesis, thereby arriving at the conclusion that lung ultrasound can substitute chest X-rays after tube drainage of PSP.
      PubDate: 2015-07-23
  • Morbidity reduction using the vessel sealing device LigaSure™ in
           breast cancer surgery
    • Abstract: Summary Background Seroma formation is the major morbidity nuisance after breast cancer surgery. It prolonges hospital stay and causes infections and wound healing problems. The aim of the study was to evaluate the impact of the vessel sealing device LigaSure™ on postoperative morbidity especially seroma formation. Methods Between 2011 and 2012, data were retrospectively evaluated from 59 women with breast cancer who underwent axillary dissection at a university hospital. The Clavien Dindo Classification (CDC) was used to assess the severity of postoperative complications. Surgery was performed with LigaSure™ in 23 patients (39.0 %) compared with monopolar electrocautery in the control group. Results A total of 36 patients (61.0 %) had breast conserving surgery, and 5 patients (8.5 %) underwent isolated axillary dissection. Morbidity-associated re-operations were reported in 5.1 %. Seroma rates were nearly twice as high in the control group compared with LigaSure™ patients (p = 0.056). Hospital stay was shortened by 1 day using LigaSure™. The rate of punctures at the outpatient ward was half as high in the LigaSure™ cohort (21.7 vs. 41.7 %; p = 0.115). The frequency of aspirations (≤ 2 times) was lower in LigaSure™ patients. Despite this, the median puncture volume was higher (195 ml; IQR: 112.5–265 ml) in the LigaSure™ cohort as compared with the control group (100 ml; IQR: 60–180 ml). Overall, the CDC was significantly lower in the LigaSure™ group compared with the conventional cohort (p = 0.038). Conclusions The vessel sealing device LigaSure™ leads to a reduction of postoperative morbidity, hospital stay, and puncture frequency, which is desirable in terms of cost-effectiveness.
      PubDate: 2015-07-15
  • Littoral cell angioma of the spleen: case report and literature review
    • Abstract: Summary Background Littoral cell angioma (LCA) is a rare vascular tumor of the spleen which is usually benign and sometimes associated with other malignancies. The diagnosis of LCA is based on histopathological examination with specific immunohistochemical stainings. Material and methods We report a case of LCA 40-year-old male patient. Results The patient admitted with nonspecific left upper abdominal pain and identified splenomegaly and nodular splenic lesion by abdominal ultrasonography and magnetic resonance imaging. Splenectomy was performed, and tumor cells were stained diffusely with factor 8 and CD68, focally with S-100 in the immunohistochemical examination. The vascular structures of the lesion were stained with CD34 without CD31. Conclusions Long-term follow-up for suspicious malignant potential is advised.
      PubDate: 2015-07-01
  • How to report multiple outcome metrics in virtual reality simulation
    • Abstract: Summary Background Virtual reality (VR) simulation is increasingly used in surgical disciplines. Since VR simulators measure multiple outcomes, standardized reporting is needed. Methods We present an algorithm for combining multiple VR outcomes into dimension summary measures, which are then integrated into a meaningful total score. We reanalyzed the data of two VR studies applying the algorithm. Results The proposed algorithm was successfully applied to both VR studies. Conclusions The algorithm contributes to standardized and transparent reporting in VR-related research.
      PubDate: 2015-06-16
  • Stent-supported percutaneous transluminal angioplasty in patients
           suffering from symptomatic benign or malignant central venous occlusive
    • Abstract: Summary Background The aim of this study was to investigate the outcome of patients suffering from benign or malignant superior vena cava (SVC), brachiocephalic (BCV), and subclavian (SV) vein lesions treated with nitinol stents. Methods Retrospective analysis of consecutive patients in a university-based tertiary care center. Results Twenty-two patients suffering from central venous occlusive disease (CVD) (9 malignant, mean age 58 years; 13 benign, mean age 66 years) were treated 2/2003–1/2012. In total, 89 % of malignant central venous occlusive disease (mCVD) patients underwent successful primary stenting (one reintervention 6 months after primary stenting). Two stent occlusions (22 %) were seen at last follow-up. All mCVD patients died within a median follow-up of 2 months (range: 0.8–54 months). In all, 92 % of benign central venous occlusive disease (bCVD) patients underwent primary stenting of SV (n = 8), BCV (n = 5), and SVC (n = 1). Six repeat interventions were performed in 42 % of patients. There was one stent occlusion (8 %) at last follow-up. Of all, 69 % of bCVD patients died within a median follow-up of 12.7 months (range: 1.3–82 months); 22 % of mCVD and 8 % of bCVD patients underwent bypass surgery as bail out procedure due to primary (n = 2) or secondary (n = 1) endovascular failure. All CVD patients experienced immediate post-interventional relief of symptoms. Conclusion Technical success of CVD stenting is high and leads to immediate relief of symptoms in patients with short life expectancy.
      PubDate: 2015-06-16
  • Extensive pancreatic heterotopia in distal esophagus mimicking esophageal
    • Abstract: Summary Background We report an unusual and rare case of a young adult patient with extensive symptomatic pancreatic heterotopia in the distal esophagus that appeared on imaging as a malignant tumor. After comprehensive preoperative workup, the soft tissue mass was treated surgically according to intraoperative histology that revealed its benign nature. Methods A young male patient with worsening epigastric pain, gastroesophageal reflux, and weight loss presented in a university hospital for a comprehensive diagnostic workup. Apart from clinical examination and laboratory tests, he underwent gastroscopy, esophageal manometry, endoscopic ultrasound, barium meal study, computed tomography (CT), and positron emission tomography (PET-CT). Finally an interdisciplinary board recommended surgical removal of a mediastinal mass and final diagnosis was reached by intraoperative histology. Results The clinical examination and laboratory test were unremarkable, esophageal manometry suggested achalasia due to simultaneous spastic and retrograde contractions with high amplitude. Barium meal showed mild compliant stenosis of the distal esophagus, but gastroscopy found no explanation. CT and later also PET-CT revealed a large soft tissue mass with avid accumulation of 18F-fluorodeoxyglucose surrounding the distal esophagus. Endoscopic ultrasound was very limited and no representative tissue samples were obtained prior to surgery. The surgeon accessed the mediastinum through the left thoracotomy and found a noncompliant well-defined mass surrounding the distal esophagus. Intraoperative histology showed nothing but common structures of pancreatic tissue. Conclusions A large soft-tissue mass of pancreatic heterotopia in the distal esophatus is extremely rare and preoperative workup inconclusive. Only surgical exploration and (intraoperative) histology are in a position to reveal its true nature.
      PubDate: 2015-06-02
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