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Diabetology Intl.     Hybrid Journal   (Followers: 1, SJR: 0.273, h-index: 5)
Dialectical Anthropology     Hybrid Journal   (Followers: 9, SJR: 0.314, h-index: 9)
Die Weltwirtschaft     Hybrid Journal   (Followers: 2)
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: 5, 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: 100, 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: 2, 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: 92, 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: 16, 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: 11, 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: 15, 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: 29, 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: 12, 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: 32, SJR: 0.942, h-index: 66)
Environmental Modeling & Assessment     Hybrid Journal   (Followers: 10, SJR: 0.533, h-index: 31)
Environmental Monitoring and Assessment     Hybrid Journal   (Followers: 9, SJR: 0.685, h-index: 52)
Environmental Science and Pollution Research     Hybrid Journal   (Followers: 15, SJR: 0.885, h-index: 46)
Epidemiologic Perspectives & Innovations     Open Access   (Followers: 4, SJR: 1.4, h-index: 17)
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: 2, 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)

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Journal Cover   European Surgery
  [SJR: 0.166]   [H-I: 13]   [5 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  [2291 journals]
  • Is there: surgery goes inter- and multidisciplinary
    • PubDate: 2015-08-07
  • Erratum to: 8th annual meeting of Chinese College of Surgeons and 19th
           annual meeting of the European Society of Surgery
    • PubDate: 2015-07-25
  • 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
  • The knowledge of Polish medical students about surgical treatment of
    • Abstract: Summary Background Surgical treatment of morbid obesity is becoming an increasingly important approach for the treatment of this condition. However, knowledge about the possibility of surgical procedures among general practitioners is far from satisfactory. The source of the problem might be due to a lack of information about bariatric surgery in university curriculum. Methods We assessed the knowledge of students from four Polish medical universities. The survey was conducted among 468 students, in their sixth (final) year of study. The survey included two parts—the first nine questions assessed of the level of the students’ knowledge about the methods of surgical treatment of obesity, and the following three questions allowed for an evaluation of the amount of information on metabolic surgery provided to students during surgery courses. Results The results demonstrate a low level of knowledge on the possibility of applying metabolic surgery to treat morbid obesity. The students themselves expressed a need to improve their knowledge and favorably assessed the proposition of expanding the curriculum to include more information on the subject of metabolic surgery. Conclusion The awareness of surgical treatment for morbid obesity among medical students should be improved. The development of an interesting curriculum that is based on current guidelines should be undertaken.
      PubDate: 2015-07-09
  • Transanal endoscopic microsurgery in treatment of small rectal T1
           high-risk, T2 and T3 carcinomas combined with radiochemotherapy
    • Abstract: Summary Background The present survey evaluates the value of TEM in the treatment of small T1 high-risk, T2 and T3 carcinomas in combination with neoadjuvant or adjuvant therapy or without radiochemotherapy. Methods In this retrospective survey, patient data from 86 patients suffering from T1 high-risk, T2 or T3 carcinoma was reviewed. Results Overall, Patients with T1 high-risk carcinoma showed a recurrence rate of 12.5 % (n = 16). The recurrence rate of T2 low-risk carcinomas was 11.1 % (n = 36), and of T2 high-risk carcinomas was 31.3 % (n = 17). Patients who had suffered a T3 low-risk carcinoma showed a recurrence rate of 0 % (n = 5). In the group of patients with T3 high-risk carcinomas, 16.7 % (n = 12) showed a recurrence. Conclusions An analysis of the different subgroups has shown that after successful downstaging with neoadjuvant radiochemotherapy, TEM is a curative treatment alternative for T2 low-risk carcinomas. It seems that the degree of downstaging has an effect on the prognosis with regard to the appearance of a local recurrence. The effect of downstaging of T2 low risk carcinomas can possibly be applied to T3 low-risk carcinomas. In the case of high-risk carcinomas, TEM can only be a treatment alternative for comorbid patients or a method for palliation.
      PubDate: 2015-07-01
  • Diagnosis and treatment of benign inflammatory esophageal diseases
    • Abstract: Summary Background Nowadays, benign inflammatory esophageal diseases represent a rising socioeconomic burden. Recently, novel therapeutic approaches have been introduced to enrich personalized surgical options. Methods A PubMed research was conducted and merged with institutional guidelines and data. Results Magnetic sphincter augmentation strengthens the lower esophageal sphincter and therefore recreates the natural reflux barrier. Electrical sphincter stimulation offers the possibility to personalize minimal invasive treatment and considers even changing lifestyles. Endoscopic antireflux procedures try to mimic the outcome of laparoscopic fundoplication and aim to improve the angle of His. However, laparoscopic fundoplication remains the surgical treatment of choice in advanced reflux disease. Reflux can also cause eosinophilic infiltration and therefore hinders diagnosis of eosinophilic esophagitis. Once diagnosis is established, dietary modifications and topical steroids offer relevant relief. Reflux produces Barrett’s esophagus, a neoplastic progression, which is commonly treated with radiofrequency ablation. Conclusion Novel therapeutic options are facing the rising incidence of benign inflammatory diseases.
      PubDate: 2015-07-01
  • 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
  • Surgery with qualities or: “how to foster yourself”
    • PubDate: 2015-06-11
  • Reduction of adhesions with autogen tissue-covered polypropylene mesh
           implants for incisional hernia repair: an experimental study
    • Abstract: Summary Background Incisional hernia is a complication that is encountered with a rate of 2–11 % and can lead to morbidity, work loss, and even mortality. Prosthetic materials that are used in hernia repair are still being tested, and the ideal one has not been proposed yet. While the recurrence rates with primary repair are found to be 30–50 %, these rates are decreased to 0–15 % with mesh repair. These rates emphasize the importance of meshes. The most important criteria in their usage are the advantages and disadvantages of types of meshes. Our aim is to cover the mesh with the subject’s own collagen tissue, then to repair the defect with this autogen collagen-covered propylene mesh, and lastly, to prevent or decrease adhesions against the mesh. Methods A total of 14 male, healthy, 250–300 g Wistar-Albino rats were included in the study. They were separated into two equal groups as Group A (control group) and Group B (study group). In Group A, full-thickness defects were repaired with polypropylene meshes. In Group B, meshes of the same size were placed under the skins of the rats and excised on the ninth day. After creating a full-thickness defect, it was repaired with the rat’s own mesh. On the 21st day, in both groups, the adhesions between intra-abdominal organs and the mesh were evaluated by two independent observers according to adhesion scoring system. The groups were compared in means of fibrosis and inflammation scores. The pathologist was not informed about which preparate belonged to which group. Results In Group A, adhesion area, adhesion strength, inflammation, collagen tissue, and fibroblast activity were significantly higher than Group B. Conclusions According to our results, after in-lay placement of autogen tissue-covered polypropylene meshes, adhesions can decrease and complications due to intra-abdominal adhesions can be prevented, and relatively low costs may contribute to health expenditure.
      PubDate: 2015-06-09
  • 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
  • Magnetic resonance visible 3-D funnel meshes for laparoscopic parastomal
           hernia prevention and treatment
    • Abstract: Summary Background Funnel mesh implants can be used for both prevention and repair of parastomal hernia (PSH). We aimed to prove the practice of such implants as well as the magnetic resonance (MR) presentability in humans. Methods Five patients were surgically treated for laparoscopic PSH prevention, and five patients underwent laparoscopic repair of manifest and symptomatic PSH with iron-loaded 3-D funnel meshes in an intraperitoneal onlay technique. MR investigation was performed on postoperative day 7 to assess mesh delineation, and additionally 6 and 12 months postoperatively to evaluate hernia recurrences and biocompatibility of mesh integration. Results We could demonstrate precise mesh depiction and delineation with MR in all 10 cases, as well as accurate assessment of the surrounding tissue. No funnel alterations and no functional change of the stoma bowel patency occurred due to the tightly fitting funnel implant. We documented no mesh-related complications, no PSH formation, and no stoma prolapse occurrence during the follow-up period of 1 year comprising all ten cases. Conclusion The pilot use of a new method of MR investigation using a mesh with enhanced signal through the addition of iron particles into the polyvinylidene fluoride base material provides detailed mesh depiction. Furthermore, funnel mesh implantation seems to offer a safe and promising surgical alternative for both PSH prevention and treatment.
      PubDate: 2015-05-30
  • Long-term follow-up of patients diagnosed with nonspecific abdominal pain
           (NSAP): identification of pathology as a possible cause for NSAP
    • Abstract: Summary Background Nonspecific abdominal pain (NSAP) accounts for 40 % of all general surgical admissions. Data suggest that conditions such as irritable bowel syndrome and gynaecological pathologies can be misdiagnosed as NSAP. Delayed diagnosis and management can cause increased morbidity. Our aim was to follow-up a cohort of patients with an initial diagnosis of NSAP to determine their eventual diagnosis. Method Hospital episode statistic (HES) data were reviewed to identify 100 acute surgical admissions coded as NSAP at discharge between January and December 2008. Medical records were systematically reviewed over a 3-year follow-up period to identify further investigations, operations and any eventual diagnoses in patients who fulfilled NSAP criteria. General practitioners were contacted to evaluate any further GP surgery visits and hospital referrals for this cohort of patients. Results A total of 59 were incorrectly coded as NSAP; only 41 fulfilled the criteria of NSAP at discharge from the initial acute admission. The majority of patients correctly diagnosed as NSAP were female (71 %) individuals. Median age across both genders was 25.7 years (interquartile range 19.4–37.7 years). At three yearly follow-up, 54 % of patients appropriately labelled as NSAP were diagnosed with a specific pathology. Conclusion This study highlights that around half of patients correctly labelled with NSAP were subsequently diagnosed with a specific pathology. Our results suggest that patients diagnosed with NSAP should be followed up to avoid additional morbidity from misdiagnosis. Furthermore, the current coding system for NSAP needs to be modified.
      PubDate: 2015-05-27
  • Pathophysiology of airway obstruction caused by wound hematoma after
           thyroidectomy: an ex vivo study
    • Abstract: Summary Background Airway obstruction by postoperative hemorrhage after thyroid resection is a serious adverse and potentially life-threatening event. The aim of this study is to investigate if the possible pressure caused by a postoperative hematoma in the neck would be sufficient to compress the trachea and therefore leads to a mechanical airway obstruction. Methods In this ex vivo model varying pressures (0–250 mmHg) were applied on 30 human cadaver tracheas. The primary outcome was the anterior-posterior and latero-lateral tracheal diameter during the application of different pressures. Results At the highest pressures of 250 mmHg, there was an average compression of only 67.80 % in anterior-posterior direction and of 60.09 % in latero-lateral direction. Conclusions This study suggests that even pressures of 250 mmHg in neck-hematomas would be insufficient to cause a mechanical airway occlusion.
      PubDate: 2015-05-12
  • Liposarcoma with lymph node spread: a case presentation and a systematic
           review of the literature
    • Abstract: Summary Background Liposarcomas are neoplasms of mesodermic origin derived from adipose tissue. Metastases at the time of initial presentation are uncommon, and the spread to regional nodes is extremely infrequent. The aim of this work is to present a rare case of a giant liposarcoma, presenting with regional lymph node extension, and composed of three different histological subtypes and present a systematic review of all the cases described in the literature of liposarcoma with lymphatic extension. Methods A 71-year-old woman presented with a giant retroperitoneal liposarcoma with lymph node invasion. Excision of the tumor en bloc with right radical nephrectomy and lymphadenectomy was performed. Histological analysis revealed a mixed-type liposarcoma consisting of well-differentiated, myxoid, and pleomorphic components, and lymph node involvement. A systematic review of the literature of the cases of liposarcoma with lymph node involvement was performed. Results This is the first description of a retroperitoneal liposarcoma with lymphatic involvement. There are only seven articles, including 9 patients, in literature describing lymph node invasion of liposarcomas. The majority are dedifferentiated liposarcomas. Conclusions Giant retroperitoneal liposarcomas with mixed histological pattern and lymph node invasion are rare presentation in the literature and associated with a poor prognosis. The available data are spare, and our understanding of these tumors is limited, with no known effective therapy.
      PubDate: 2015-05-07
  • Antecolic anastomosis and delayed gastric emptying: still a benefit in
           patients without intra-abdominal complications'
    • Abstract: Summary Background/Aims The etiology of delayed gastric emptying (DGE) after pylorus-preserving pancreatoduodenectomy (PPPD) is unclear. This study aimed to ascertain the incidence of DGE in a transmesocolic anastomosis (TA) versus an antecolic anastomosis (AA) group of patients. Methods Retrospective study including the last 40 consecutive patients with TA (2004–2006) and the first 40 consecutive patients with AA (2006–2010) performed at our centre. Preoperative, surgical and postoperative data were prospectively collected until patient discharge. Results No preoperative differences were found. Overall postoperative morbidity was higher in the TA group (75  vs 47 %; p = 0.012). No significant differences in DGE were found (TA: 35 % vs AA: 20 %; p = 0.1). Termino-terminal pancreatic anastomosis, gastrostomy, prophylactic somatostatin and the presence of intra-abdominal collections were associated with DGE. On multivariate analysis, only intra-abdominal collections (OR: 4.95 % CI: 1.36–11.8; p = 0.012) predicted DGE. Among patients without other surgical complications (n = 46), DGE rate was significantly higher in the TA group (TA: 38 % vs AA: 12 %, p = 0.04). Conclusions Overall, no significant differences in DGE were found between groups. AA could be a protective factor for DGE when no other surgical complications appear.
      PubDate: 2015-04-21
  • Surgical intervention does not affect short-term plasma citrulline levels
           in infants: implications for citrulline as a marker of postoperative
           intestinal complications
    • Abstract: Summary Background and aims Detection of intestinal ischemia is often delayed causing extensive complications. Serum citrulline is an important parameter for bowel integrity and functionality; however, no data is available on its response on postoperative intestinal impairment in children. The aim of this study was to evaluate the native effects of intestinal surgery on the postoperative citrulline course in children. Material and methods In two groups, of each five children under the age of 2, undergoing either intestinal surgery (IS) or non-intestinal surgery (NIS), we monitored unspecific intestinal impairment parameters (lactate, C-reactive protein (CRP), leukocytes) and citrulline prior to surgery and on the 3rd postoperative day. Results In both groups the postoperative course was uneventful, including unproblematic transition to a normal diet and regular stool. Postoperatively, CRP levels were slightly increased (IS p > 0.05; NIS p < 0.05) while leukocytes and lactate levels did not show any significant changes. The citrulline levels remained constant in the perioperative period. Conclusions This data suggests that IS does not affect perioperative citrulline levels in children under the age of 2 years with uneventful postoperative course. Changes in citrulline following surgery might be a sign of intestinal impairment and therefore further investigations are necessary on this field.
      PubDate: 2015-04-15
  • Thymoma with extensive ossification in a young woman
    • Abstract: Summary Background Osseous metaplasia is an extremely rare histological variation of thymus tumors. Despite intratumoral calcifications are described ossification is exceptional. Case report A 27-year-old woman with no relevant medical history was referred to our department for the treatment of a full-calcified anterior mediastinal tumor. It was detected on a spinal X-ray performed for chronic back pain and confirmed by a chest X-ray. On the computed tomography, a bulky anterior mediastinal tumor containing heterogeneous calcification was confirmed. The patient underwent a posterolateral thoracotomy. Intraoperatively there was a large hard stony mass in the anterior mediastinum extending to the right hemi thorax. Complete excision of the mass including thymectomy was done. The patient underwent uneventful recovery. Histopathology reported a thymoma type B1 with osseous metaplasia according to the World Health Organization classification and Masaoka I stage according to intraoperative findings. Results To our knowledge it is the third case published in all literature of a thymus tumor with complete osseous metaplasia in an adult and the first case that tumor is almost entirely ossified. Conclusion The mechanism of osseous metaplasia is unknown. Several theories have been given. Certain cell mediators would stimulate and influence connective tissue to be replaced by heterotopic bone. Further cases of osseous metaplasia will be necessary to figure out pathogenesis, prognosis and treatments outcomes of these particular types of thymomas.
      PubDate: 2015-04-10
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