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Dysphagia     Hybrid Journal   (Followers: 166, SJR: 0.684, h-index: 46)
e & i Elektrotechnik und Informationstechnik     Hybrid Journal   (Followers: 7, SJR: 0.146, h-index: 8)
e-Neuroforum     Hybrid Journal  
Early Childhood Education J.     Hybrid Journal   (Followers: 12, SJR: 0.367, h-index: 12)
Earth Science Informatics     Hybrid Journal   (Followers: 3, SJR: 0.245, h-index: 5)
Earth, Moon, and Planets     Hybrid Journal   (Followers: 5, SJR: 0.436, h-index: 28)
Earthquake Engineering and Engineering Vibration     Hybrid Journal   (Followers: 7, SJR: 0.433, h-index: 17)
Earthquake Science     Hybrid Journal   (Followers: 9, SJR: 0.486, h-index: 7)
East Asia     Hybrid Journal   (Followers: 7, SJR: 0.165, h-index: 9)
Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity     Hybrid Journal   (Followers: 6, SJR: 0.289, h-index: 23)
EcoHealth     Hybrid Journal   (Followers: 1, SJR: 0.651, h-index: 22)
Ecological Research     Hybrid Journal   (Followers: 7, SJR: 0.698, h-index: 38)
Economic Botany     Hybrid Journal   (Followers: 8, SJR: 0.666, h-index: 40)
Economic Bulletin     Hybrid Journal   (Followers: 3)
Economic Change and Restructuring     Hybrid Journal   (Followers: 1, SJR: 0.263, h-index: 6)
Economic Theory     Hybrid Journal   (Followers: 5, SJR: 1.857, h-index: 31)
Economic Theory Bulletin     Hybrid Journal  
Economics of Governance     Hybrid Journal   (Followers: 2, SJR: 0.367, h-index: 12)
Ecosystems     Hybrid Journal   (Followers: 19, SJR: 1.793, h-index: 83)
Ecotoxicology     Hybrid Journal   (Followers: 10, SJR: 1.041, h-index: 53)
Education and Information Technologies     Hybrid Journal   (Followers: 144, SJR: 0.207, h-index: 15)
Educational Assessment, Evaluation and Accountability     Hybrid Journal   (Followers: 11, SJR: 0.519, h-index: 14)
Educational Psychology Review     Hybrid Journal   (Followers: 14, SJR: 1.781, h-index: 52)
Educational Research for Policy and Practice     Hybrid Journal   (Followers: 6, SJR: 0.211, h-index: 8)
Educational Studies in Mathematics     Hybrid Journal   (Followers: 8, SJR: 0.946, h-index: 27)
Educational Technology Research and Development     Partially Free   (Followers: 154, SJR: 1.124, h-index: 45)
Electrical Engineering     Hybrid Journal   (Followers: 9, SJR: 0.352, h-index: 17)
Electrocatalysis     Hybrid Journal   (SJR: 0.542, h-index: 7)
Electronic Commerce Research     Hybrid Journal   (Followers: 3, SJR: 0.636, h-index: 14)
Electronic Markets     Hybrid Journal   (Followers: 5, SJR: 0.326, h-index: 5)
Electronic Materials Letters     Hybrid Journal   (Followers: 2, SJR: 0.566, h-index: 11)
Elemente der Mathematik     Hybrid Journal  
Emergency Radiology     Hybrid Journal   (Followers: 4, SJR: 0.446, h-index: 22)
Empirica     Hybrid Journal   (Followers: 3, SJR: 0.185, h-index: 12)
Empirical Economics     Hybrid Journal   (Followers: 7, SJR: 0.5, h-index: 29)
Empirical Software Engineering     Hybrid Journal   (Followers: 4, SJR: 2.319, h-index: 33)
Employee Responsibilities and Rights J.     Hybrid Journal   (Followers: 2, SJR: 0.21, h-index: 13)
Endocrine     Hybrid Journal   (Followers: 4, SJR: 0.659, h-index: 55)
Endocrine Pathology     Hybrid Journal   (Followers: 2, SJR: 0.555, h-index: 27)
Energy Efficiency     Hybrid Journal   (Followers: 11, SJR: 1.056, h-index: 10)
Energy Systems     Hybrid Journal   (Followers: 9, SJR: 0.589, h-index: 5)
Engineering With Computers     Hybrid Journal   (Followers: 5, SJR: 0.497, h-index: 26)
Entomological Review     Hybrid Journal   (Followers: 3, SJR: 0.128, h-index: 5)
Environment Systems & Decisions     Hybrid Journal   (Followers: 2)
Environment, Development and Sustainability     Hybrid Journal   (Followers: 29, SJR: 0.319, h-index: 26)
Environmental and Ecological Statistics     Hybrid Journal   (Followers: 5, SJR: 0.389, h-index: 29)
Environmental and Resource Economics     Hybrid Journal   (Followers: 17, SJR: 1.651, h-index: 46)
Environmental Biology of Fishes     Hybrid Journal   (Followers: 3, SJR: 0.486, h-index: 53)
Environmental Chemistry Letters     Hybrid Journal   (Followers: 3, SJR: 0.664, h-index: 22)
Environmental Earth Sciences     Hybrid Journal   (Followers: 10, SJR: 0.601, h-index: 55)
Environmental Economics and Policy Studies     Hybrid Journal   (Followers: 6, SJR: 0.35, h-index: 3)
Environmental Evidence     Open Access  
Environmental Fluid Mechanics     Hybrid Journal   (Followers: 2, SJR: 0.732, h-index: 23)
Environmental Geochemistry and Health     Hybrid Journal   (Followers: 2, SJR: 0.909, h-index: 32)
Environmental Geology     Hybrid Journal   (Followers: 11)
Environmental Health and Preventive Medicine     Hybrid Journal   (Followers: 2, SJR: 0.388, h-index: 14)
Environmental Management     Hybrid Journal   (Followers: 30, SJR: 0.773, h-index: 60)
Environmental Modeling & Assessment     Hybrid Journal   (Followers: 11, SJR: 0.413, h-index: 27)
Environmental Monitoring and Assessment     Hybrid Journal   (Followers: 9, SJR: 0.671, h-index: 46)
Environmental Science and Pollution Research     Hybrid Journal   (Followers: 11, SJR: 0.878, h-index: 42)
Epidemiologic Perspectives & Innovations     Open Access   (Followers: 1, SJR: 1.002, h-index: 14)
Epileptic Disorders     Hybrid Journal   (Followers: 1, SJR: 0.669, h-index: 34)
EPJ A - Hadrons and Nuclei     Hybrid Journal   (Followers: 1, SJR: 1.435, h-index: 58)
EPJ B - Condensed Matter and Complex Systems     Hybrid Journal   (Followers: 3, SJR: 0.749, h-index: 85)
EPJ direct     Hybrid Journal  
EPJ E - Soft Matter and Biological Physics     Hybrid Journal   (Followers: 1, SJR: 0.661, h-index: 57)
EPMA J.     Open Access   (SJR: 0.161, h-index: 4)
ERA-Forum     Hybrid Journal   (Followers: 2, SJR: 0.13, h-index: 2)
Erkenntnis     Hybrid Journal   (Followers: 11, SJR: 0.62, h-index: 14)
Erwerbs-Obstbau     Hybrid Journal   (SJR: 0.173, h-index: 8)
Esophagus     Hybrid Journal   (SJR: 0.268, h-index: 9)
Estuaries and Coasts     Hybrid Journal   (Followers: 3, SJR: 1.111, h-index: 61)
Ethical Theory and Moral Practice     Hybrid Journal   (Followers: 7, SJR: 0.278, h-index: 8)
Ethics and Information Technology     Hybrid Journal   (Followers: 160, SJR: 0.363, h-index: 20)
Ethik in der Medizin     Hybrid Journal   (SJR: 0.204, h-index: 6)
Euphytica     Hybrid Journal   (Followers: 7, SJR: 0.709, h-index: 57)
Eurasian Soil Science     Hybrid Journal   (Followers: 2, SJR: 0.271, h-index: 10)
EURO J. of Transportation and Logistics     Hybrid Journal   (Followers: 4)
EURO J. on Computational Optimization     Hybrid Journal  
EURO J. on Decision Processes     Hybrid Journal  
Europaisches J. fur Minderheitenfragen     Hybrid Journal  
European Actuarial J.     Hybrid Journal   (Followers: 3)
European Archives of Oto-Rhino-Laryngology     Hybrid Journal   (Followers: 4, SJR: 0.737, h-index: 37)
European Archives of Paediatric Dentistry     Hybrid Journal   (Followers: 1, SJR: 0.446, h-index: 12)
European Archives of Psychiatry and Clinical Neuroscience     Hybrid Journal   (Followers: 2, SJR: 1.334, h-index: 62)
European Biophysics J.     Hybrid Journal   (Followers: 4, SJR: 0.979, h-index: 53)
European Child & Adolescent Psychiatry     Hybrid Journal   (Followers: 4, SJR: 1.269, h-index: 51)
European Clinics in Obstetrics and Gynaecology     Hybrid Journal   (Followers: 4)
European Food Research and Technology     Hybrid Journal   (Followers: 8, SJR: 0.773, h-index: 49)
European J. for Education Law and Policy     Hybrid Journal   (Followers: 5)
European J. for Philosophy of Science     Partially Free   (Followers: 4, SJR: 0.165, h-index: 2)
European J. of Ageing     Hybrid Journal   (Followers: 8, SJR: 0.49, h-index: 17)
European J. of Applied Physiology     Hybrid Journal   (Followers: 7, SJR: 1.044, h-index: 74)
European J. of Clinical Microbiology & Infectious Diseases     Hybrid Journal   (Followers: 10, SJR: 0.958, h-index: 74)
European J. of Clinical Pharmacology     Hybrid Journal   (Followers: 9, SJR: 0.916, h-index: 69)
European J. of Dermatology     Hybrid Journal   (Followers: 7)
European J. of Drug Metabolism and Pharmacokinetics     Hybrid Journal   (Followers: 6, SJR: 0.24, h-index: 25)
European J. of Epidemiology     Hybrid Journal   (Followers: 17, SJR: 1.946, h-index: 60)
European J. of Forest Research     Hybrid Journal   (Followers: 3, SJR: 0.864, h-index: 25)
European J. of Health Economics     Hybrid Journal   (Followers: 11, SJR: 0.67, h-index: 25)

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Journal Cover European Surgery
   Journal TOC RSS feeds Export to Zotero [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  [2210 journals]   [SJR: 0.135]   [H-I: 13]
  • Two class medicine: the essence hits it all
    • PubDate: 2014-08-19
  • Efficacy of modified Limberg flap in surgical treatment of infected
           pilonidal abscess: a case–control study
    • Abstract: Summary Objectives Despite several surgical techniques in the treatment of pilonidal sinus, the ideal management is still under debate. Recently, Limberg flap has revealed promises owing to a lower recurrence rate. Our study aimed to assess mid-term outcomes of Limberg flap in patients with pilonidal abscesses. Methods Through a prospective case–control study, we enrolled 90 consecutive patients with pilonidal disease attending department of surgery in one of the university hospitals in Tehran, Iran, between January 2010 and April 2011. Patients with simple sinus (control group) underwent wide excision of the sinus, while those with infected pilonidal abscess received incision and drainage of the abscess and then excision (case group), and ultimately all the patients were treated with Limberg flap. Patients were followed by regular outpatient visits at 1 week, 2 weeks, 1 month, 6 months, and 1 year. Results Of 90 patients, 17 were in the case group (18.88 %) and 73 in the control group (81.12 %). All patients were treated with Limberg flap and then followed at regular outpatient visits for a median of 11 months. With regard to the early complications, hematoma occurred in one patient (1.4 %) and infection in three patients (4.1 %) of the control group, while late complications occurred only in two patients of the control group as paresthesia, which did not differ significantly. Conclusions This study showed that Limberg flap is effective in the surgical treatment of infected pilonidal abscess, with desirable mid-term outcomes.
      PubDate: 2014-08-01
  • Solid organ recipients are at increased risk for recurrent        
    • Abstract: Summary Background Solid organ transplant (SOT) recipients carry a high risk of developing Clostridium difficile-associated colitis (CDAC) and an increased risk for recurrence. Patients and methods Between December 1996 and September 2007, a total of 227 patients with CDAC were identified when querying our institutional surgical infection database. This included 169 nontransplant patients and 58 SOT recipients, including 1 cardiac, 19 renal, 2 pancreas, 5 renal/pancreas, and 31 liver recipients. Results Overall, we recorded 556 infectious episodes at any site in the 227 patients analyzed who eventually developed CDAC (2.4 episodes/patient); the total number of CDAC episodes was 255: 204 patients had a single episode and 23 patients had multiple episodes of CDAC. There were 19 patients with two episodes, 3 with three episodes, and 1 with four episodes. Of the 23 patients with recurrent CDAC, 11 (48 %) were SOT recipients. A total of 19 % of SOT recipients had recurrent CDAC as compared with only 7 % for nontransplant patients (p = 0.0197). Time to first CDAC recurrence was a median of 58 (range, 17–1372) days for SOT recipients and a median of 30 (range, 6–108) days for nontransplant patients (p = 0.047). Conclusions SOT recipients at our institution were found to be a high-risk group for CDAC and had an almost threefold risk for recurrent disease. Double-drug coverage, extended application of metronidazole, and profound reduction in the level of immunosuppression may help to cope with this emerging problem.
      PubDate: 2014-08-01
  • Over-the-scope endoclipping for foregut leaks and perforations
    • Abstract: Summary Background Foregut leaks and perforations continue to account for high morbidity and mortality rates. Novel endoscopic techniques have recently changed the approach to the management of these complications. The purpose of this study was to evaluate the efficacy and safety of the Over-The-Scope Clipping system (OTSC) in a consecutive series of patients presenting with foregut leaks and perforations. Patients and methods We retrospectively reviewed the charts of seven consecutive patients treated between November 2010 and December 2013 in our tertiary care hospital. A parallel review of the literature was made including only patients treated with OTSC after upper gastrointestinal surgery. Results The median time between surgery and OTSC clipping was 18.4 days (range 7–53), and the median size of the defect was 6 mm (range 2–10). The overall OTSC success rate was 85.7 %. In 6 patients, 3 of whom had a chronic leak, the OTSC was successfully used as first-line treatment. The literature review showed that the overall success rate of the OTSC procedure was 66.7 % in esophageal defects and 80 % in gastric defects. Conclusions The OTSC system is a simple and safe method for the management of postoperative foregut leaks and perforations, resulting in complete and durable closure of small (< 1 cm) visceral defects. Use of the OTSC system, along with drainage of perivisceral collections, may represent a safe alternative to stents in selected patients.
      PubDate: 2014-07-22
  • Poor sensitivity of        class="a-plus-plus">99mTc-labeled ubiquicidin
           scintigraphy in diagnosis of acute appendicitis
    • Abstract: Summary Background Ubiquicidin 29–41 (UBI) is an antimicrobial peptide. Methods In total eight men and two women with high probability of acute appendicitis were serially imaged for up to 30 min after the intravenous administration of 370 MBq of 99mTc-UBI, before surgical exploration Results The scan showed mild to moderate increased uptake in the right lower quadrant in six patients. Quantitative analysis failed to show any difference between suppurative and gangrenous appendicitis. Conclusion 99mTc-UBI scintigraphy has 20 % sensitivity for diagnosis of acute appendicitis.
      PubDate: 2014-07-22
  • Malondialdehyde kinetics following coronary artery bypass grafting and its
           relation to osteopontin
    • Abstract: Summary Background Cardiac surgery is associated with inflammation and oxidative stress; malondialdehyde (MDA) is a marker of oxidative stress and osteopontin (OPN) is a proinflammatory cytokine. We studied MDA kinetics following coronary artery bypass grafting (CABG) and its relation to OPN. Methods We evaluated 50 consecutive patients (60 ± 10 year-old, 44 men and 6 women) with stable coronary artery disease and left ventricular ejection fraction of 50 ± 8 % undergoing elective CABG on pump. Peripheral plasma samples were drawn at baseline, 24 and 72 h postoperatively. OPN was evaluated at baseline and MDA and cardiac enzymes at all time points. Results MDA levels increased significantly at 72 h postoperative compared with preoperative and 24 h postoperative levels whereas there was no difference between the pre and first postoperative values (p = 0.67). MDA change was positively correlated with the change in troponin at baseline and at 72 h (r = 0.6, p = 0.022) as well as with preoperative OPN levels (r = 0.28, p = 0.047). There was a significant positive correlation between MDA at 72 h and age (r = 0.27, p = 0.039). In addition, MDA change differed significantly in relation to diabetes at baseline and at 72 h—2.99 (4.77) in diabetics versus 0.69 (3.82) in non-diabetics (p = 0.05). Conclusions MDA increases post on-pump CABG but only at 72 h and this increase correlates with preoperative OPN levels. In addition, MDA increase is related to age and diabetes as well as troponin increase following surgery.
      PubDate: 2014-07-22
  • The effect of using methylene blue in surgical treatments of pilonidal
           disease: a prospective randomized study
    • Abstract: Summary Objectives The aim of this study was to examine the effect of using intraoperative methylene blue (MB) in the treatment of pilonidal disease in the Karydakis flap practice on wound infection and recurrence and also by investigating other factors that affect wound infection and recurrence. Patients and methods In our research, the data of 231 patients, 129 of whom were in the MB [+] group and 102 of whom were in the MB [−] group, were obtained. Each patient’s age, gender, body mass index, whether they underwent pilonidal sinus surgery previously, the number of primary orifices, the number of secondary orifices, any preoperative infection, abscess drainage, and the use of antibiotic, if any, were recorded. Results The rate of postoperative wound infection in the entire group was found to be 25.1 %. While 19.4 % of the patients in MB [+] group had a wound infection, 32.4 % of the patients in the MB [−] group had a wound infection. The usage of MB was found to be a preventing factor in the occurrence of wound infection (p = 0.024). Conclusion MB is beneficial owing to its reducing effect on wound infections, which in turn is associated with a lower recurrence rate and a fast postoperative recovery. We suggest the use of MB at the beginning of acute or chronic pilonidal sinus surgeries, as MB is nontoxic and is of very low cost.
      PubDate: 2014-07-19
  • An unusual case of excessive sweating affecting the right upper limb after
           bilateral endoscopic thoracic sympathectomy for primary palmar
           hyperhidrosis: recurrence or compensatory hyperhidrosis'
    • Abstract: Summary Introduction Hyperhidrosis is excessive perspiration beyond physiological needs and can be primary (essential, idiopathic) or secondary to drugs, toxins, substance abuse, and several medical conditions. Primary hyperhidrosis generally involves the palms, axillae, and face. Herein, we report an unusual case of excessive sweating after endoscopic thoracic sympathectomy, which was misinterpreted as recurrence due to improper surgery. Methods A 31-year-old male patient underwent bilateral T3-T4 videothoracoscopic sympathicotomy for primary palmar hyperhidrosis. Results After the surgery, the patient complained about sweating of the right axillae and palm, and underwent reoperation at the right side, which revealed correct division of the sympathetic chain and absence of visible communicating nerves between the stubs. Subsequently, the patient presented with excessive sweating, greater than that prior to surgery, in the right upper limb. This condition was difficult to contextualise as either recurrence, given the correctness of the surgical procedure and higher amount of sweating compared with the preoperative state, or as compensatory hyperhidrosis, given the involvement of body areas affected by surgery. Conclusions Compensatory hyperhidrosis may involve areas affected by endoscopic thoracic sympathectomy and thus may be confused with recurrence due to incomplete surgery, leading to unnecessary surgical re-interventions.
      PubDate: 2014-07-19
  • Management of atherosclerotic supraaortic lesions
    • Abstract: Background Prevention of cerebrovascular ischemic lesions due to atherosclerotic occlusive disease (AOD) of supraaortic vessels plays a major role in the daily workload of a vascular surgeon. The aim of this study was to give an overview of current endovascular and surgical treatment options for patients suffering from internal carotid artery (ICA), vertebral artery (VA), proximal subclavian artery (SA), and common carotid artery (CCA) AOD within a modern multidisciplinary management concept. Methods A systemic review of the literature on management of supraaortic AOD was undertaken. Medline (1995–2014) and Cochrane Electronic Databases (2014) were searched for publications dealing with surgical and endovascular treatment of ICA, VA, SA, and/or CCA lesions, respectively. Results ICA stenosis is the most common supraaortic lesion and is regarded as an indicator for endarterectomy (eversion or standard) in both symptomatic and asymptomatic patients. Percutaneous transluminal angioplasty (PTA) with stent should be restricted to patients with hostile neck, contralateral laryngeal nerve palsy, high-grade restenosis, or very distal ICA stenosis. Other supraaortic lesions like VA, SA, and CCA stenosis/occlusion were initially operated via a transthoracic approach but high complication rates brought extrathoracic surgical techniques forward. Since the 1980s PTA with its minimally invasive character and its progressive stent technology has become the treatment of choice for patients with VA, SA, or CCA lesions. Conclusions Primary ICA stenosis should be treated by endarterectomy first. All other supraaortic lesions should be managed endovascularly but surgery poses a good treatment alternative if endovascular management fails or is contraindicated.
      PubDate: 2014-07-12
  • The effects of sleeve gastrectomy on hormonal regulation of glucose
           metabolism in Goto–Kakizaki rats
    • Abstract: Summary Background The antidiabetic effect of sleeve gastrectomy (SG) has been interpreted as a conceivable result of surgically induced weight loss in the obese type 2 diabetes mellitus (T2DM) subjects. However, the blood glucose control often occurs within days, before significant weight loss has been reached. This work aims to investigate the major mechanism and persistence regarding how SG improves glucose metabolism in nonobese T2DM rats. Methods These Goto Kakizaki rats (n = 21) were randomly assigned into three groups: SG, sham SG, and pair-fed (PF) group, whose weight, food intake, oral glucose tolerance test, insulin tolerance test, plasma insulin, homeostasis model assessment for insulin resistance (HOMA-IR), ghrelin, and glucagon-like peptide-1 (GLP-1) were measured. Results According to the experiment, from the 2nd week until the 24th week, the fasting blood glucose of the rats in the SG group had significantly decreased with the improved glucose tolerance. At the 2nd week postoperation, the area under the blood glucose concentration curve (AUC) received a distinct reduction of 28.1 % (P < 0.0001). The ghrelin secretion of the SG group was significantly decreased (P < 0.005). The GLP-1 had increased (P < 0.0001), while the HOMA-IR values decreased (P < 0.05) throughout the experimental period. These effects were not seen in the sham-SG and PF groups despite similar changes of weight loss or food intake. Conclusions The above results suggest that SG can conduct a direct control on T2DM instead of secondarily to weight loss or food intake around the whole experimental period. The changes of the gastrointestinal hormones may be the major mechanism of the antidiabetic effect.
      PubDate: 2014-07-10
  • Giant cell and granulomatous myocarditis necessitating cardiac
           transplantation: clinical, gross, and histopathological findings
    • Abstract: Summary Background Giant cell myocarditis and granulomatous myocarditis are rare diseases, leading to severe heart symptoms like tachyarrhythmia or atrial fibrillation with frequently fatal outcome. Typically, diagnosis is confirmed at necropsy or in explanted hearts, as the majority of cases remain clinically unrecognized. Methods Explanted heart specimens of 355 heart transplant recipients receiving cardiac transplantation between January 1994 and December 2011 were examined. Unexpected granulomatous myocarditis was found in the explanted hearts of three patients and giant cell myocarditis in four patients. We investigated preoperative and postoperative course and gross and histopathological findings of these two different disorders, which were thought to be the same disease for a long time. Results Preoperatively, both groups suffered from mild to severe symptoms of heart failure. Gross findings of resected heart specimens showed right and left ventricular hypertrophy. Histological examination revealed a left ventricular endomyocardial fibrosis and inflammation infiltrates including giant cells with the presence or absence of granulomas. All patients with granulomatous myocarditis are alive. Three patients suffering from giant cell myocarditis showed a complicated postoperative clinical course, one heart transplant recipient developed Guillain–Barré syndrome due to cytomegalovirus reactivation 6 months after heart transplantation, another patient died due to cerebral edema shortly after transplantation, and another one died because of myocardial and cerebral infarction after tricuspid valve replacement. Conclusions In consideration of the limitation of this study that a small number of patients were included, our results suggest that patients suffering from granulomatous myocarditis are older at heart transplantation and have a more favorable outcome compared with heart transplant recipients with giant cell myocarditis.
      PubDate: 2014-07-09
  • Supraclavicular node metastasis in thoracic esophageal squamous cell
    • Abstract: Summary Background Supraclavicular node metastasis is common in patients with esophageal cancer. However, considerable controversy remains regarding whether the supraclavicular node metastasis means regional node or distant metastasis. This research investigated the frequency of supraclavicular node metastasis in patients with esophageal squamous cell carcinoma (ESCC), identified the factors correlated with supraclavicular node metastasis, and evaluated the clinical relevance of supraclavicular node metastasis in thoracic ESCC. Methods We retrospectively analyzed the clinical data of 276 consecutive patients with thoracic ESCC who underwent esophagectomy with three-field lymph node dissection in the First Affiliated Hospital of Zhengzhou University from January 2000 to December 2008. Results The frequency of supraclavicular node metastasis was 26.1 %. Correlation analysis showed that higher tumor location, longer tumor length, higher pathologic T stage, and lower histologic grade were associated with a higher frequency of supraclavicular node metastasis (all p < 0.05). Patients with solitary supraclavicular node metastasis had a significantly lower 5-year cumulative survival rate than those with solitary cervical paraesophageal node metastasis (26.9 vs 50.3 %, p < 0.05). Conclusions Higher tumor location, longer tumor length, higher pathologic T stage, and lower histologic grade are associated with a higher frequency of supraclavicular node metastasis. Supraclavicular node metastasis indicates a worse prognosis for patients with thoracic ESCC compared with cervical paraesophageal node metastasis, and it should be classified as M1.
      PubDate: 2014-07-09
  • Effects of different intra-abdominal pressure values on different organs:
           what should be the ideal pressure'
    • Abstract: Summary Background and purpose The control of intra-abdominal pressure (IAP) values clinically has gained considerable importance, as they affect organ functions and organ damage. Hence, the discussions on secure IAP values to be used in laparoscopic interventions still continue. In this study, the effects of low IAP values simultaneously on intrathoracic, intra-abdominal, and extra-abdominal organ damage are presented. Methods This study was conducted on 40 male Sprague Dawley rats in total, with an average weight of 300 ± 20 g. A saline infusion of 10 ml/kg/h was administered to all the rats from the tail vein. Mechanical ventilator support was maintained for 1 h after the tracheotomy was opened. The rats in the study were separated into four equal groups. No pneumoperitoneum, 6-mmHg pneumoperitoneum, 9-mmHg pneumoperitoneum, and 12-mmHg pneumoperitoneum was applied to Group A (control), Group B, Group C, and Group D, respectively. A total of 30 min after completion of the procedure, lung, terminal ileum, and testicle tissues taken from the rats were examined histopathologically. The results obtained were evaluated, and a statistical package was used for statistical analysis. Results A statistically significant difference was not detected between groups in the evaluation of presence of organ damage with respect to intestinal damage (p > 0.05). However, statistically significant difference was detected between groups with respect to lung damage (χ2 = 16.684; p = 0.001 < 0.05) and testicle damage (χ2 = 15.508; p = 0.001 < 0.05). With respect to group variable, although a statistically significant difference was not determined between mean intestinal damage scores in the groups (p > 0.05), a statistically significant difference was determined between mean lung damage scores (Kruskal–Wallis H (KW) = 16.743; p = 0.001 < 0.05) and mean testicle damage scores (KW = 15.088; p = 0.002 < 0.05). Conclusion In line with the data obtained from the study, when organs in different compartments of the body are evaluated as a whole, we predict that secure IAP values are between 6 and 9 mmHg.
      PubDate: 2014-07-09
  • Early protective ileostomy closure following stoma formation with a
           dual-sided absorbable adhesive barrier
    • Abstract: Summary Background Usually, a temporary and diverting ileostomy is reversed not earlier than 8 weeks because of adhesions and edema along with vulnerability of the intestinal wall. We aimed to evaluate whether early closure of loop ileostomy during index admission using an antiadhesive bioabsorbable membrane is feasible and safe. Methods We included all patients undergoing ileostomy formation due to conventional or laparoscopy-assisted colorectal resections and stoma closure within 2 weeks using a dual-sided film between January 2011 and June 2012. Evaluation comprised patients’ demographic and disease characteristics, with objective to assess the rate and time interval of planned early stoma closure and length of hospital stay. Complications were divided related to stoma formation and closure. Follow-up data were collected by defined oncological aftercare. Results A total of 14 patients with a median age of 66 years were included. Median length of hospital stay was 27 days (range, 19–34 days), time between stoma formation and closure was 10 days (range, 8–14 days), and time of discharge was 8 days (range, 6–10 days) after stoma closure. Two complications related to stoma formation occurred in the form of one parastomal hernia and one wound infection. Complications related to stoma closure occured in five patients—one small bowel anastomotic leak in one patient and incisional hernias at stoma site in four patients. Conclusion Early ileostomy closure at index admission using an adhesive barrier appears to be a safe alternative to traditional closure.
      PubDate: 2014-06-17
  • Can obstetrical brachial plexus palsy be caused by a cervical rib'
    • Abstract: Summary Background The incidence of obstetric brachial plexus palsy (OBPP) is between 0.38 to 2.6 per 1000 live births. However, incidence of OBPP caused by cervical rib is unknown. Cervical ribs prevalence is 0.74–12 % and is higher in females. We describe such a case of OBPP successfully treated with early operative intervention. Method Patient with normal weight and uncomplicated vaginal birth suffered from brachial plexus injury (Narakas II) with no clinical improvement postpartum, after 3 months of observation. Preoperative imaging (X-ray/magnetic resonance imaging) showed no findings, but intraoperative exploration revealed that C7 root was riding on the cervical rib with a thick neuroma-incontinuity involving C5, C6, and C7 roots. After resecting the neuroma and cervical rib, nerve defects were reconstructed microsurgically with spinal-accessory nerve transfer and nerve grafts. Results Postoperatively, shoulder- and arm-function after 1 year were nearly fully restored (Gilbert 120 and Mallet V). Shoulder strength rated M4. Elbow and hand strength rated M4 and M5 with Gilbert and Raimondi functional scores of IV and V, respectively. Conclusion While OBPP caused by cervical rib is rare, this etiology should be identified during the prenatal screening sonography. Thus, extra precautions can be taken during deliveries to decrease incidence of OBPP secondary to cervical rib. Early surgical intervention for OBPP is successful in achieving functional restoration of the arm.
      PubDate: 2014-06-07
  • Short hospital stays after laparoscopic gastric surgery under an Enhanced
           Recovery After Surgery (ERAS) pathway: experience at a single center
    • Abstract: Summary Introduction Recently, first reports on benefits from Enhanced Recovery After Surgery (ERAS) pathway in patients undergoing gastric surgery have appeared. It seems that maximal reduction of unfavorable surgery-induced trauma in patients with gastric malignancy via ERAS protocol combined with minimally invasive techniques can improve outcomes. Objective The aim of this study was to determine the influence of laparoscopic surgery and ERAS protocol in oncological gastric surgery on early outcomes. Materials and methods Prospective analysis involved 28 patients (18 female and 10 male) with gastric malignancy who underwent laparoscopic gastric resection between 2009 and 2013. Gastric tumors (gastrointestinal stromal tumors or adenocarcinoma) were the indication for the surgery. A total of 17 patients underwent laparoscopic local excision, and 11 patients with adenocarcinoma or multiple neuroendocrine tumors underwent laparoscopic D2 total gastrectomy. Perioperative care was based on ERAS principles. Length of hospital stay, postoperative course, perioperative complications, and readmission rates were analyzed. Results There was one conversion in the gastrectomy group. All patients were mobilized on the day of surgery. Oral fluids were introduced on day 0 and were well tolerated. Full hospital diet was started on day 2 in all patients, but was well tolerated in only 18 of them. One postoperative complication requiring reoperation was noted. The length of stay after gastrectomy and gastric wedge resection was 4.6 (2–6) and 3.3 (2–6) days, respectively. No readmissions were noted in the entire group. Conclusions The implementation of ERAS protocol to clinical practice in combination with laparoscopy in patients with gastric tumors can result in improved postoperative care quality, shortening of hospital stay, and quicker return to normal activity.
      PubDate: 2014-06-07
  • The lemon taste of limos
    • PubDate: 2014-06-01
  • Selected commentary to “Radiofrequency ablation vs endoscopic
           surveillance for patients with Barrett esophagus and low-grade dysplasia.
           A randomized clinical trial”
    • Abstract: Summary Background Barrett’s esophagus (BE) results from gastroesophageal reflux disease (GERD) and harbors an increased cancer risk. Via low (LGD) and high grade dysplasia (HGD) BE may progress towards cancer (0.5 %–0.75 % annual risk). Radiofrequency ablation (RFA) represents a novel endoscopic method for durable elimination of BE. RFA is effective for cancer prevention persons with HGD. Remains to be questioned the value of RFA in those with LGD. Methods Critical analysis of the paper by Phoa K et al., published in the recent issue of JAMA. The randomized clinical study compared the effect of surveillance vs. RFA in persons with BE and LGD. Results After 3 years, RFA was superior vs. surveillance as it significantly inhibited progression to cancer and/or high grade dysplasia (1.5 % vs. 26.5 %). The number necessary to treat to prevent cancer/HGD and cancer was 4.0 and 13.6, respectively. Conclusions RFA is superior to surveillance to prevent the progression of BE with LGD to HGD/cancer and cancer. Thus RFA should be recommended as the treatment of choice for the management of BE with LGD in those fit for the endoscopic procedure. Future studies will have to elicit the impact of orchestrated therapy of dysplastic BE including anti reflux surgery. Finally the value of RFA for cancer development in those with non-dysplastic BE should be addressed.
      PubDate: 2014-05-21
  • Is day surgery safe' A systematic literature review
    • Abstract: Summary Background In many countries, day surgery is very common for some indications, especially in the USA, the UK and Scandinavia. In other countries—for example, Austria, Germany and Switzerland—day surgery is rare. This is due to financial disincentives, different systemic structures and shorter waiting lists for surgery. Methods We focused on the 15 most frequently delivered operations in Austria, from which we selected those that could be done in day surgery. For these 11 interventions, we made a systematic literature search in various databases. Results We researched 35 studies for data synthesis. On the basis of the summarised studies, we concluded that the following operations can be done safely (and effectively) in both day surgery and in inpatient setting in those patients who fulfil the eligibility criteria for day surgery: cataract surgery, arthroscopic operations of the knee, vein ligation (stripping), cholecystectomy (laparoscopic), adenoidectomy and repair of inguinal and femoral hernia. For the removal of implanted devices from bone, appendectomy, paracentesis, carpal tunnel decompression of median nerve and curettage, studies with a higher evidence level for robust assessment of the safety (and effectiveness) of day surgery are required, although these operations are already undertaken in a day surgery setting in many countries. Conclusion Day surgery can be defined as safe for selected interventions and patients. Day surgery requires increasing attention in countries such as Austria with a low level of day surgery, which is particularly evident when making international comparisons.
      PubDate: 2014-04-24
  • A systematic review of hernia surgery in SIL (single-incision laparoscopy)
    • Abstract: Summary Background Hernia repair in single-incision laparoscopic surgery (SIL) technique has become increasingly common at specialized centers. Still, safety issues and potential benefits of SIL hernia repair have to be elucidated. This review summarizes available literature and provides an overview of current developments. Materials and methods A literature search was performed in PubMed, the Cochrane Database, and Google for peer-reviewed publications on SIL hernia repair. Main outcome parameters were defined, and it was attempted to define clinical recommendations. Results SIL technique can be applied for inguinal, ventral, and hiatal hernia repair. Operation times and early results seem to be comparable with standard multiport laparoscopy. Conclusion Distinct advantages of SIL hernia surgery have yet to be demonstrated, as the level of evidence in this field is low. Randomized controlled trials investigating the incidence of incisional hernias at the trocar site and safety in large cohorts are missing.
      PubDate: 2014-04-17
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