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Dynamic Games and Applications     Hybrid Journal   (Followers: 2)
Dysphagia     Hybrid Journal   (Followers: 216, SJR: 0.684, h-index: 46)
e & i Elektrotechnik und Informationstechnik     Hybrid Journal   (Followers: 8, SJR: 0.146, h-index: 8)
e-Neuroforum     Hybrid Journal  
Early Childhood Education J.     Hybrid Journal   (Followers: 13, 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: 8, 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: 8, SJR: 0.289, h-index: 23)
EcoHealth     Hybrid Journal   (Followers: 1, SJR: 0.651, h-index: 22)
Ecological Research     Hybrid Journal   (Followers: 8, SJR: 0.698, h-index: 38)
Economic Botany     Hybrid Journal   (Followers: 9, SJR: 0.666, h-index: 40)
Economic Bulletin     Hybrid Journal   (Followers: 4)
Economic Change and Restructuring     Hybrid Journal   (Followers: 1, SJR: 0.263, h-index: 6)
Economic Theory     Hybrid Journal   (Followers: 8, SJR: 1.857, h-index: 31)
Economic Theory Bulletin     Hybrid Journal   (Followers: 1)
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: 209, SJR: 0.207, h-index: 15)
Educational Assessment, Evaluation and Accountability     Hybrid Journal   (Followers: 15, 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: 7, SJR: 0.211, h-index: 8)
Educational Studies in Mathematics     Hybrid Journal   (Followers: 10, SJR: 0.946, h-index: 27)
Educational Technology Research and Development     Partially Free   (Followers: 204, SJR: 1.124, h-index: 45)
Electrical Engineering     Hybrid Journal   (Followers: 12, SJR: 0.352, h-index: 17)
Electrocatalysis     Hybrid Journal   (SJR: 0.542, h-index: 7)
Electronic Commerce Research     Hybrid Journal   (Followers: 4, SJR: 0.636, h-index: 14)
Electronic Markets     Hybrid Journal   (Followers: 6, SJR: 0.326, h-index: 5)
Electronic Materials Letters     Hybrid Journal   (Followers: 3, SJR: 0.566, h-index: 11)
Elemente der Mathematik     Hybrid Journal   (Followers: 1)
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: 8, 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: 5, 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: 10, 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: 28, 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: 4, SJR: 0.486, h-index: 53)
Environmental Chemistry Letters     Hybrid Journal   (Followers: 2, 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: 32, SJR: 0.773, h-index: 60)
Environmental Modeling & Assessment     Hybrid Journal   (Followers: 10, SJR: 0.413, h-index: 27)
Environmental Monitoring and Assessment     Hybrid Journal   (Followers: 8, SJR: 0.671, h-index: 46)
Environmental Science and Pollution Research     Hybrid Journal   (Followers: 14, SJR: 0.878, h-index: 42)
Epidemiologic Perspectives & Innovations     Open Access   (Followers: 2, 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: 4, 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: 207, 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: 5, SJR: 1.269, h-index: 51)
European Clinics in Obstetrics and Gynaecology     Hybrid Journal   (Followers: 5)
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: 6)
European J. for Philosophy of Science     Partially Free   (Followers: 4, SJR: 0.165, h-index: 2)
European J. of Ageing     Hybrid Journal   (Followers: 10, SJR: 0.49, h-index: 17)
European J. of Applied Physiology     Hybrid Journal   (Followers: 8, SJR: 1.044, h-index: 74)
European J. of Clinical Microbiology & Infectious Diseases     Hybrid Journal   (Followers: 11, 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: 7, 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)

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Journal Cover European Surgery     [SJR: 0.135]   [H-I: 13]
   [6 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]
  • From Ockham’s razor to Hickam’s dictum and
           back—Saint’s theory and the insights in herniosis
    • Abstract: Summary Introduction The goal of this review article is to present the relationship between the theory of herniosis and Saint’s triad through the two philosophical stand points frequently encountered in diagnostic medicine, Ockham’s razor and Hickam’s dictum. The Saint’s triad was recognized when association between hiatal hernia, colonic diverticular disease, and gallstones have been proven to appear more often than just by pure chance alone. Methodology A systematic review of the literature was performed using MEDLINE (PubMed search), EMBASE, and the Cochrane databases, and it included papers published from 1948 until 2014. Results The data obtained by search are presented to analyze the theory of herniosis. Connective tissue disorder is being recognized as a cornerstone beneath the Saint’s triad, and the facts backing up this stand point are now systematically displayed to readers. Special emphasis is given on review of current literature reports on origin of hiatal hernia and its influence on everyday surgical perceptive. Conclusion Saint’s triad, once the most cited example of Hickam’s dictum is now being put to trial with the theory of herniosis, proving a sharper edge to Ockham razor stand point. It is upon the reader, from the arguments given, to choose which principle will prevail, in further thinking about this particular problem.
      PubDate: 2015-01-21
  • Giant paratracheal ancient schwannoma in 57-year-old male patient: case
    • Abstract: Summary Background A 57-year-old male patient who presented with a massive paratracheal tumor was admitted for tumor extirpation. The presented tumor was exposed by a growth spurt in approximately 6 months’ time. This manifested in tracheoesophageal compression symptoms (tracheal deviation on roentgenography, significant dyspnea, and dysphagia). Surgical extirpation was recommended as a treatment of choice. Method After positioning patient with rotated head on the contralateral side, a longitudinal incision was made on the anterior border of the sternocleidomastoid muscle extending from the clavicular head to the retromandibular area. The tumor was carefully dissected from structures present in the carotid sheath and fully extirpated in one piece from its bed, which extended proximally to the collar bone and cranially to the angle of the mandible. A histological examination of the extirpated tumor was performed. Results After the paratracheal tumor was extirpated, an instant relief from the tracheoesophageal compression symptom was described by the patient. Final diagnosis was determined by a histological examination as an ancient schwannoma. Conclusion Currently, the only available treatment for this type of tumor is surgical extirpation. Histological examination is the only method that can establish final diagnosis.
      PubDate: 2014-12-04
  • In memoriam Prof. Georg Kretschmer
    • PubDate: 2014-12-02
  • Surgery today: smile clears the tide
    • PubDate: 2014-12-02
  • 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: 2014-12-01
  • The times they are a-changing’
    • PubDate: 2014-11-21
  • The all autologous vein policy in infrainguinal bypass surgery
    • Abstract: Summary Background Femorodistal vein bypass is regarded as gold standard for the treatment of limb threatening ischemia. Initially the procedure has been reported using saphenous vein (Rev Chir 70:206–35, 1951), mainly due to the lack of adequate vascular substitutes. Later vascular grafts have become available, and the enthusiasm to use autologous vein has faded, especially in difficult situations with no saphenous vein, although it is known that vein grafts perform superior to alloplastic vascular grafts. Methods A variety of methods gathered from literature have been collected and proven for their usefulness in everyday practice by the authors. We have a long-standing experience with femorodistal vein bypass using exclusively autologous vein allowing to critically evaluate current opinions on this topic. Results The availability and technique of vein harvest of alternative vein for distal bypass is discussed, as well as the sequence of vein use, which is discussed in literature. Measures to increase vein availability, vein quality assessment, and methods for prevention of vein exhaustion are described. Conclusions More of 90 % of femorodistal bypass procedures can be accomplished with a vein graft even today. This requires a combination of dedication to bypass surgery, careful search for adequate vein, meticulous vein harvest, and attentive care to use vein resourced sensibly.
      PubDate: 2014-11-21
  • Can polyglactin mesh be used for prevention of seroma after mastectomy: an
           experimental study
    • Abstract: Summary Background Seroma formation is still a common problem in breast surgery. Seroma formation is associated with morbidity and financial loss. Fibrin glue was used in several studies for solution, but the results were controversial. On the other hand surgical meshes are promising to prevent the seroma formation. Methods A total of 48 female Sprague-Dawley rats were randomly assigned to four groups. Each underwent radical mastectomy, axillary lymph node dissection, and disruption of the dermal lymphatic vessels. Group 1 is the control group (n = 12). In group 2 (n = 12), 1 × 1 cm polyglactin 910 mesh (Vicryl, Ethicon Johnson&Johson USA) is placed over the chest wall under the skin flaps prior to closure. The animals in group 3 received 0.5 mL fibrin glue (Baxter Healthcare Ltd. United Kingdom) topically throughout the wound before the closure (n = 12). The animals in group 4 (n = 12) received 0.5 mL fibrin glue topically throughout the wound, and 1 × 1 cm polyglactin 910 mesh is placed under the skin flaps prior to the closure. Full thickness tissue samples from both the chest wall and the skin were harvested. The harvested tissue samples were evaluated by a single pathologist in a blind fashion. Results The mean seroma volume of the control group was 1.536 mL whereas the mean seroma volume of the groups 2, 3, and 4 were 1.189, 0.438, and 0.556 respectively. Mean seroma volume was significantly lower, adhesion index and foreign body reaction were higher in group 4. Conclusion Although various studies show controversial results to prevent the seroma formation. This experimental study is an evidence that fibrin glue and polyglican mesh reduce seroma with increasing inflammatory reaction.
      PubDate: 2014-11-21
  • Xanthogranulomatous cholecystitis: an analysis of 55 cases
    • Abstract: Summary Background/objective Xanthogranulomatous cholecystitis (XGC) is a rare inflammatory disease of the gallbladder characterized by a focal or diffuse destructive inflammatory process. The aim of this study was to identify the common clinical and surgical characteristics of XGC patients. Methods The records of all cases of XGC histopathologically diagnosed between January 2009 and March 2014 at the Antalya Training and Research Hospital, Antalya, were analyzed retrospectively for collection of data regarding clinical and histopathological characteristics, imaging and surgical findings, comorbidities, nature and duration of surgery, additional procedures performed, and postoperative complications. Results The incidence of pathologically diagnosed XGC among the 5765 patients who had undergone cholecystectomy during the study period was 0.95 % (55 patients). The incidence of elevated liver enzymes and elevated bilirubin levels was 25.5 % (14 patients) and 14.5 % (8 patients), respectively. Laparoscopic cholecystectomy could be performed for 45.5 % of cases (25 patients), while the remaining 54.5 % cases (30 patients) required open cholecystectomy. All cases were pathologically characterized by a focal or diffuse destructive inflammatory process that produced varying proportions of lipid-laden macrophages, inflammatory cells, and fibroblasts and by the presence of foam cells and xanthomatous changes. The incidence of postoperative wound infection and wound gaping was 18.2 % (10 patients) and 1.8 % (1 patient), respectively. Conclusion Although XGC is a rare condition with a low mortality rate, its treatment is associated with a relatively high incidence of postoperative wound infections and other complications, a fact that should be considered when deciding on the ideal surgical option.
      PubDate: 2014-11-13
  • 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: 2014-11-01
  • Surgery today: How to keep the golden mean within our academy'
    • PubDate: 2014-10-28
  • Case numbers in carotid surgery training can be accomplished and are not
           associated with an inferior outcome. Results of a university based
           tertiary care center study
    • Abstract: Summary Background Carotid endarterectomy (CEA) is regarded as a standard procedure in vascular surgery (VS), but training in CEA is often withheld, because an inferior outcome is feared. Yet, VS training guidelines require minimum caseload experience as the primary operator and/or first assistant for training recognition. Methods Retrospective analysis of the vascular database of a university based tertiary care center. Training procedures were defined as procedures performed by a trainee vascular surgeon under supervision of a vascular surgeon; teaching procedures as procedures performed by a vascular surgeon assisted by a trainee. All other procedures were routine. Results From February 2002 to April 2011 nine VS trainees performed 816 CEAs either as primary surgeon (n = 353, 43 %) or as first assistant (n = 463, 57 %). A total of 244 months of VS training was evaluated. The average number of CEAs was 1.8 as primary operator and 3.9 as first assistant per month. There was no significant difference in the incidence of perioperative stroke and death between patients undergoing CEA performed by VS trainees or by senior surgeons. Conclusions A VS trainee can expect to perform an average of 50 or more CEAs as primary operator and 80 or more CEAs as first assistant during a training period of 36 months. This exceeds the numbers required by the Austrian Medical Council and the European Vascular Board. There was neither an inferior overall outcome nor a higher complication rate between patients undergoing CEA performed by trainees as primary operator or as first assistant.
      PubDate: 2014-10-24
  • Comparison between simultaneous resection and staged resection of
           synchronous colorectal cancer with resectable liver metastases: a
    • Abstract: Summary Background Previously, the surgical management of synchronous colorectal liver metastases has been a staged resection. Now, it is shifting toward the simultaneous resection of colorectal primary and liver metastases. The aim of this study is to compare the outcomes between simultaneous resection and staged resection. Methods The studies were identified searching the database including PubMed, Medline, and Cochrane library. The pooled odds ratios (OR) or weighted mean differences (WMD) with 95 % confidence interval (CI) were calculated using either the fixed effect or random effect model. Results A total of 20 studies were included with 3194 patients: 1137 to simultaneous resection group and 2057 to staged resection group. The overall survival at 1 year (OR = 0.73, 95 % CI = 0.48–1.11, P = 0.14), 3 year (OR = 1.13, 95 % CI = 0.88–1.44, P = 0.34), and 5 year (OR = 1.08, 95 % CI = 0.84–1.38, P = 0.54) and disease-free survival at 1 year (OR = 0.77, 95 % CI = 0.47–1.2, P = 0.29), 3 year (OR = 0.72, 95 % CI = 0.44–1.18, P = 0.19), and 5 year (OR = 0.60, 95 % CI = 0.34–1.04, P = 0.07) showed no significant difference between the two groups. The operative time (WMD = − 38.61, 95 % CI = − 89.26–12.04, P = 0.14), and postoperative recurrence (OR = 0.86, 95 % CI = 0.58–1.29, P = 0.47) were similar between the two groups. Shorter hospital stay (WMD = 5.49, 95 % CI = − 7.04 to − 3.94, P = 0.00001) and lower overall complication rate (OR = 0.73, 95 % CI = 0.61–0.87, P = 0.0004) were observed in simultaneous resection group. Conclusion In appropriately selected patients, simultaneous resection might be considered as the preferred treatment. Simultaneous resection is safe and efficient in the treatment of these patients with the elimination of second major operation.
      PubDate: 2014-10-15
  • Female choice for surgical specialties: development in Germany, Austria,
           and Switzerland over the past decade
    • Abstract: Summary Background The number of female medical graduates and women in academic medicine is steadily increasing, contrary to the number of women in surgery and surgical subspecialties. This study is aimed at revealing the development of women in surgical and nonsurgical specialties in three different European countries. Methods The German registry of physicians, Austrian registry of physicians, and registry of the Swiss Medical Association were searched for the total number of female and male physicians. Data were retrieved from 2000 to 2010. Results In the year 2000, the number of women practicing general surgery (Germany: n = 1922, 11.3 %; Austria: n = 107, 9.0 %; Switzerland: n = 46, 5.0 %), pediatric surgery (n = 67, 22.6 %; n = 8, 25.8 %; n = 11, 21.2 %), plastic and reconstructive surgery (n = 48, 18.4 %; n = 18, 18.8 %; n = 22, 20.0 %), or vascular surgery (n = 83, 10.0 %; n = 8, 5.0 %; n = 2, 5.7 %) was significantly lower compared with specialties known to be more appealing to women like anesthesiology (Germany: n = 6000, 40.5 %; Austria: n = 675, 42.1 %; Switzerland: n = 274, 34.3 %), dermatology (n = 2082, 45.0 %; n = 204, 40.8 %; n = 107, 37.3 %), or pediatrics (n = 5520, 49.3 %; n = 399, 42.8 %; n = 313, 36.1 %). Comparing numbers from 2000 to 2010, all specialties except for anesthesiology in Germany and vascular surgery in Switzerland demonstrated increasing numbers of female physicians. Although the absolute number of female general surgeons in Switzerland tripled over the past decade, the absolute percentage still remains low (12.2 %; + 7.1 %). Conclusions Women are not as attracted to surgical specialties compared with nonsurgical ones. Further efforts will be needed to meet future demands.
      PubDate: 2014-10-10
  • Postoperative blood pressure in patients undergoing eversion carotid
           endarterectomy with or without resection of the carotid sinus nerve
    • Abstract: Summary Background The carotid sinus nerve (CSN) is important for regulation of blood pressure (BP) and heart rate. The aim of our study was to investigate whether dissection of the carotid bifurcation during eversion carotid endarterectomy (eCEA) causes a histologically proven compromise of the CSN and how the postoperative BP was affected thereby. Methods Consecutive patients undergoing eCEA for primary high-grade internal carotid artery (ICA) stenosis without contralateral pathology were selected for this study. In all patients, histological specimens of the periadventitial tissue within the carotid bifurcation were taken during eCEA. Nerval structures of the CSN within the carotid bifurcation were detected by immunohistochemistry. BP was continuously monitored postoperatively. Results From March 2007 to March 2008, 100 patients were selected. In 55 patients (Group A), nerval structures could be detected within specimens resected during eCEA. In 45 patients (Group B), nerval structures could not be found histologically. Both groups were equal regarding cardiovascular risk factors, degree of ICA stenosis, and indication for surgery. There was a significant difference of diastolic BP values between Group A and B 7 h postoperatively (p = 0.005). We observed a significant difference of mean systolic BP values between both groups 30 days after operation (p = 0.011). All other mean BP values were equal between both groups at any point of time. Conclusions Our study showed that eCEA does not always imply a histologically proven compromise of the CSN and that BP is mainly equal in patients with and without histologically proven compromise of the CSN.
      PubDate: 2014-10-01
  • Buried penis accompanied by undescended testicles and megameatus
           hypospadias as a severe genital manifestation of Robinow Syndrome
    • PubDate: 2014-09-26
  • What is the role of the sleeve gastrectomy in the surgical treatment of
           morbid obesity'
    • Abstract: Background Laparoscopic sleeve gastrectomy (SG) is a relatively new procedure that is gaining wide acceptance and represents an innovative new approach to the surgical management of morbid obesity. Our purpose is to evaluate the SG as a surgical bariatric procedure. Methods We conducted a literature review on “PubMed” based on all publications related to SG since 2000 to July 30, 2014. Results The complication rate after SG varies in the literature, ranging from 0 to 29 %. The most feared complication after SG is leakage on the staple line, occurring in 0–7 % of cases. The mortality rate reported varies between 0 and 3.3 %. No consensus has developed on the types of stapling used or the methods of strengthening the staple line. SG may aggravate and be responsible for gastroesophageal reflux disease (GERD). SG improves comorbidities in more than 50 % after 5 years. Conclusions SG can be proposed as a surgical technique at first intension in patients not having GERD.
      PubDate: 2014-09-26
  • 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
  • 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
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