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Diabetologia     Hybrid Journal   (Followers: 163, SJR: 3.157, h-index: 161)
Diabetologia Notes de lecture     Hybrid Journal  
Diabetology Intl.     Hybrid Journal   (Followers: 1, SJR: 0.273, h-index: 5)
Dialectical Anthropology     Hybrid Journal   (Followers: 8, 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: 4, SJR: 1.19, h-index: 89)
Directieve therapie     Hybrid Journal  
Discrete & Computational Geometry     Hybrid Journal   (Followers: 2, SJR: 1.269, h-index: 40)
Discrete Event Dynamic Systems     Hybrid Journal   (Followers: 2, SJR: 0.42, h-index: 32)
Distributed and Parallel Databases     Hybrid Journal   (Followers: 4, SJR: 0.766, h-index: 30)
Distributed Computing     Hybrid Journal   (Followers: 2, SJR: 1.41, h-index: 31)
DNP - Der Neurologe und Psychiater     Full-text available via subscription  
Documenta Ophthalmologica     Hybrid Journal   (Followers: 2, SJR: 0.946, h-index: 40)
Doklady Biochemistry and Biophysics     Hybrid Journal   (Followers: 2, SJR: 0.2, h-index: 10)
Doklady Biological Sciences     Hybrid Journal   (SJR: 0.248, h-index: 10)
Doklady Botanical Sciences     Hybrid Journal  
Doklady Chemistry     Hybrid Journal   (SJR: 0.272, h-index: 12)
Doklady Earth Sciences     Hybrid Journal   (SJR: 0.48, h-index: 17)
Doklady Mathematics     Hybrid Journal   (SJR: 0.345, h-index: 13)
Doklady Physical Chemistry     Hybrid Journal   (SJR: 0.299, h-index: 12)
Doklady Physics     Hybrid Journal   (Followers: 1, SJR: 0.293, h-index: 17)
Douleur et Analg├ęsie     Hybrid Journal   (SJR: 0.113, h-index: 6)
Drug Delivery and Translational Research     Hybrid Journal   (Followers: 2, SJR: 0.607, h-index: 8)
Drug Safety - Case Reports     Open Access  
Drugs : Real World Outcomes     Hybrid Journal   (Followers: 1)
Dynamic Games and Applications     Hybrid Journal   (Followers: 2, SJR: 0.481, h-index: 5)
Dysphagia     Hybrid Journal   (Followers: 90, 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: 9, 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: 10, SJR: 1.333, h-index: 56)
Education and Information Technologies     Hybrid Journal   (Followers: 96, SJR: 0.366, h-index: 16)
Educational Assessment, Evaluation and Accountability     Hybrid Journal   (Followers: 18, SJR: 0.374, h-index: 15)
Educational Psychology Review     Hybrid Journal   (Followers: 17, SJR: 2.776, h-index: 61)
Educational Research for Policy and Practice     Hybrid Journal   (Followers: 7, 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: 79, SJR: 1.785, h-index: 52)
Electrical Engineering     Hybrid Journal   (Followers: 14, SJR: 0.336, h-index: 18)
Electrocatalysis     Hybrid Journal   (SJR: 0.883, h-index: 10)
Electronic Commerce Research     Hybrid Journal   (Followers: 4, 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  
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: 2, SJR: 0.361, h-index: 15)
Endocrine     Hybrid Journal   (Followers: 6, 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: 18, SJR: 1.632, h-index: 54)
Environmental Biology of Fishes     Hybrid Journal   (Followers: 4, 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: 11, SJR: 0.724, h-index: 63)
Environmental Economics and Policy Studies     Hybrid Journal   (Followers: 6, 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: 2, 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: 14, 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: 3, 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)

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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  [2302 journals]
  • Significant relationship between preoperative serum concentration of
           anti-heat shock protein 70 antibody and postoperative morbidity in
           patients with esophageal cancer
    • Abstract: Summary Background Heat shock protein 70 is a molecular chaperone important in host responses to stress, including infection, injury, oxidative damage, hypoxia, and thermal stress. This study analyzed the correlation between preoperative serum concentrations of anti-HPS70 antibody and postoperative morbidity in patients with esophageal cancer. Materials and methods Serum samples were obtained preoperatively from 50 esophageal carcinoma patients (46 men and 4 women) who underwent potentially curative surgery without preoperative therapy. Serum anti-HSP70 antibody concentrations were measured by enzyme-linked immunosorbent assays. Results The mean concentration of anti-HSP70 antibody was 187.0 μg/mL. When patients were dichotomized relative to this cutoff, we observed no significant relationships between perioperative inflammatory markers (maximum body temperature, white blood cell count and C-reactive protein concentration) and anti-HSP70 antibody concentration. The incidence of postoperative complications was significantly lower in patients with anti-HSP ≥ 187.0 μg/mL than < 187.0 μg/mL (p = 0.0336). Conclusions Preoperative serum concentration of anti-HSP70 antibody was significantly related to postoperative morbidities in patients with esophageal cancer.
      PubDate: 2015-05-14
  • 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
  • 8th Annual Meeting of Chinese College of Surgeons and 19th Annual Meeting
           of the European Society of Surgery
    • PubDate: 2015-05-01
  • Tamoxifen for the prevention of postoperative intra-abdominal adhesions
    • Abstract: Summary Background Postoperative intra-abdominal adhesion (PIAA) is a common complication following abdominal surgeries. Up to now, no practical method or device has been proven to be the gold standard in PIAA formation prevention. This study was designed to evaluate the effects of oral and intraperitoneal tamoxifen citrate on PIAA formation prevention. Methods A total of 48 guinea pigs weighing 300–350 g were included in four groups (12 pigs in each group). Under general anesthesia, laparotomy was performed, and a part of small bowel was abraded using wet gauze so that serosal petechiae developed on the intestinal surface for induction of peritoneal adhesion. In group 1 (control), only this adhesion induction was performed with no treatment. In the second group, 2.5 mg/kg/day tamoxifen citrate was administered by orogastric gavage postoperatively. Group 3 underwent adhesion induction and then intraperitoneal administration of 2.5 mg/kg tamoxifen citrate diluted in 10 ml of aquapura. Group 4, underwent adhesion induction and intraperitoneal administration of 2.5 mg/kg tamoxifen citrate diluted in 10 ml aquapura and then 2.5 mg/kg/day tamoxifen citrate was administered by orogastric gavage postoperatively. Pigs underwent laparotomy on the eighth postoperative day, and grading of adhesions was performed according to the Adhesion Characteristic and Adhesion Tenacity scoring system. Data were analyzed using SPSS for Windows version 16. Results The control group was significantly different from other groups (p < 0.008), which means usage of tamoxifen (oral or intraperitoneal or both) significantly reduced adhesion formation after laparotomy. Intraperitoneal tamoxifen (group 3) was more effective in prevention of adhesion formation than oral tamoxifen application (group 2; p = 0.006). Also, administration of both oral and intraperitoneal tamoxifen (group 4) reduced adhesions significantly (p = 0.002) in comparison with just oral one (group 2), but it made no difference (p = 0.625) with only intraperitoneal tamoxifen (group 3). Conclusions This study indicated that tamoxifen significantly reduces PIAAs, and intraperitoneal application is more effective than oral administration. This study shows that preventive effects of intraperitoneal application of tamoxifen will not improve when oral tamoxifen is added postoperatively. More studies with focus on evaluation of probable side effects and also performing clinical trials for evaluating tamoxifen for preventing PIAAs are strongly suggested.
      PubDate: 2015-04-23
  • 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
  • The effects of sulforaphane in the rat model of experimental intestinal
           ischemia reperfusion
    • Abstract: Summary Aim The aim of this study is to investigate the effects of sulforaphane (SFN), which has been shown to protect such organs as the brain, kidneys, liver, and heart against the injury caused by ischemia reperfusion (I-R), on the reperfusion injury in the experimental intestinal I-R model. Material and method The study employed 30 Wistar albino rats, and there were three groups: the control group (n = 10), I-R group (n = 10), and SFN + I-R group (n = 10). The rats in the control group were sacrificed after a 3-h follow-up subsequent to the laparotomy. The I-R group was subjected to an hour of ischemia and 2 h of reperfusion afterward. The SFN + I-R group was administered a dose of 3 mg/kg SFN intraperitoneally. The rats were sacrificed after the ileum resection for measurement of tissue malondialdehyde (MDA), superoxide dismutase (SOD), and glutathione peroxidase (GSH-Px) activity and histopathological analysis. Results The I-R and SFN + I-R groups were histopathologically shown to have similar cell injuries. In the SFN + I-R group, the increase in GSH-Px activity was higher than SOD activity and both of the increases were statistically significant compared with the control group (p < 0.001). The SFN application did not yield a significant difference in the tissue MDA level compared with the control group. Conclusion The effect of SFN use on the I-R injury in the intestine did not show an apparent effect histopathologically, although there were statistically significant differences in biochemical parameters.
      PubDate: 2015-04-18
  • 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
  • Light frames the shadow: surgical teaching and education in 2015
    • PubDate: 2015-04-10
  • From colon-sparing techniques to pelvic ileal pouch: history and evolution
           of surgery for ulcerative colitis
    • Abstract: Summary Background Since the first decription of ulcerative colitis(UC) by Sir Wilkins from the London Guy’s Hospital in 1859, medical and surgical management have gradually evolved. Aims of this review are to describe the milestones and pioneers of surgery for UC, taking the readers on a journey through the steps that led to the development of restorative proctocolectomy with ileal pelvic pouch. Methods This is an historical, narrative review. We reviewed scientific literature and historical archives, seeking for documentation of surgery of UC. Information were integrated with our personal experience, taking into accout patients’ perspective. Results Different surgical approaches have been attempted over time, grounding on different concepts. As long as pathophysiology of UC has become clearer, surgeons have profoundly modified their attitudes toward this disease. Early approaches aimed at preserving organs, with “damage-control” surgery. Advances in knowledge and surgical skills led surgeons to demolitive treatments, which proved to be very effective, but with poor quality of life in most patients, especially in young, due to permanent stoma—even if continent ileostomy ameliorated patient satisfaction. On the other hand, straight ileoanal anastomosis, despite preserving trans-anal defaecation, resulted in inacceptably high bowel frequency. Restorative proctocolectomy was the turning point. By combining the concepts of disease removal, continence, and physiological evacuation, it has become the surgical treatment of choice in most UC patients. Conclusion Choice and timing of treatment of UC need to be individualized. Besides surgical knowledge and techniques, the patient’s perspective must be examined closely. Restorative proctocolectomy is the mainstay.
      PubDate: 2015-04-10
  • Functional and clinical outcomes of hand-assisted laparoscopic colorectal
           surgery: a single-institution experience in 255 patients
    • Abstract: Summary Background Hand-assisted laparoscopic colectomy is an alternative technique to laparoscopy: it is technically easier, learning curve and operative time is shorter. We aimed to describe the characteristics of patients admitted due to colorectal cancer for hand-assisted laparoscopic surgery (HALS), intra- and postoperative clinical and functional outcomes. Methods A prospectively maintained database was used to identify all patients who underwent HALS for colorectal cancer at the National Cancer Institute from April 2006 to November 1 2014. Data are presented as frequency (proportion) or median (interquartile range). Results A total of 255 HALS colorectal resections were performed. The mean HALS time was 105 min (50–270). The conversion rate was 1.96 % (5/255). The average number of lymph nodes harvested was 15 (2–54). The average time to first flatus was 1.92 days (1.5–4.5), to tolerance of solid food was 2.85 (1.4–3.4), and to first bowel movements was 3.64 (2.6–4.3). The median length of hospital stay was 6.8 days (3–31). Postoperative complication rate was 9.8 %. Three patients (1.17 %) demanded explorative laparotomy. Postoperative mortality rate was 0.39 % (one patient). There was 3.2 % of local recurrence in the colon and 5.8 % in the rectum and no port site metastasis during 36.3 (1–108) months of surveillance. The 3-year survival rates were 100 % for stage I, 97 % for stage II, 84 % for stage III, and 50 % for stage IV colorectal cancer. Conclusions Hand-assisted laparoscopic colorectal resection preserves nearly all the benefits of laparoscopic colectomy reported in the literature. With experience, it is associated with improved clinical outcomes.
      PubDate: 2015-04-09
  • Is epidural anaesthesia mandatory in fast-track surgery for elective
           colorectal resections?
    • Abstract: Summary Background Epidural anaesthesia is considered as a basic element of enhanced recovery after surgery (ERAS). In regard of the expenditure and the possible complications, the authors established a modified protocol without epidural analgesia. Methods In this prospective single-centre study, 64 consecutive patients undergoing elective colorectal surgery were treated according to the concept of ERAS, replacing epidural analgesia with infiltration of the incision lines. Results Adequate pain control was possible in 52 (81 %) patients; 55 (86 %) did not need any antiemetic drugs, 41 (64 %) tolerated solid food on the first postoperative day and 51 (80 %) had first bowel movement until day 2. Discharge was possible on day 4.3, overall complication rate was 19 % and 30-day mortality was 3 %. Conclusions ERAS in elective colon surgery is feasible using local infiltration of the incision line resulting in comparable outcome in regard of pain control, intestinal paralysis and complications.
      PubDate: 2015-04-03
  • Amount and influence of perioperative fluid administration on outcome in
           routine elective colorectal surgery according to an ERAS protocol
    • Abstract: Summary Background Restrictive perioperative fluid management is an essential element of enhanced recovery after surgery (ERAS), but the exact definition of quality and quantity of administered fluid is missing. In this retrospective analysis, we analysed the amount and effect of fluid administration in routine surgical practice following the recommendation of ERAS. Methods A total of 192 consecutive patients, 72 (38 %) female, with a median (range) age of 64 (19–93) years and a median (range) body mass index of 25 (14–39) kg/m2 were analysed. Patients were divided by the median intraoperative fluid administration of 0.15 ml/kg/min. Results Median (range) volume of fluid administration was 2500 (300–5000) ml cristalloids and 100 (0–3000) ml colloids. Total complication and anastomotic leakage rate was 19 and 3 % in group A with less fluid administration and 25 % (p = 0.23) and 6 % in group B (p = 0.26), respectively. Conclusion Amount of intraoperative fluid administration was within the range of ERAS trials, and complication rate was comparable. Less fluid administration showed a non-significant decrease in the overall complication and anastomotic leakage rate.
      PubDate: 2015-03-18
  • Fast-track Ivor Lewis esophageal resection
    • Abstract: Summary Background Esophagectomy for primary esophageal cancer is a high-risk procedure. The main reason for hospital mortality is respiratory morbidity. A fast recovery protocol has been introduced to enhance recovery and to reduce postoperative morbidity. Methods Patients who underwent minimally invasive, hybrid, or open abdominothoracic esophagectomy and intrathoracic esophagogastrostomy between June 2006 and October 2009 were perioperatively managed according to a multistep recovery protocol. Patients with colon interposition, jejunum interposition, Roux-en-Y reconstruction, or chest or supradiaphragmatic anastomosis were excluded from the respective fast-track protocol. Association between several circumstances and protocol dropout was evaluated. Results Overall, 90 consecutive patients (median age, 64.3 years; 17 female) were intended to be treated according to the fast recovery protocol. Major morbidity was 21.1 %, respiratory morbidity was 11.1 %, and hospital mortality was 3.3 %. Protocol failure occurred in 36.7 %, and readmission rate was 2.2 %. Factors associated with failure were pre-existing combined comorbidities (i.e., ASA 3), blood transfusions, thoracoscopic creation of the esophagogastrostomy, and postoperative major complications. Conclusions The fast-track goal was reached in almost two-thirds of patients undergoing Ivor Lewis resection. Multimodal measures reduce pulmonary complication and pneumonia rate without increasing surgical morbidity.
      PubDate: 2015-03-13
  • Effect of perioperative epidural anesthesia in elective laparoscopic
           colorectal resections
    • Abstract: Summary Background The role of general anesthesia combined with epidural anesthesia in laparoscopic colorectal surgery is still controversial. In this retrospective study of 84 consecutive patients, the rate of successfully placed epidural catheter and its effect on perioperative pain and outcome are analyzed. Methods A total of 84 patients, 36 (43 %) female, with a median (range) age of 64 (19–82) years and a median (range) body mass index of 25 (15–37) kg/m2, were operated; 12 (14 %) procedures were performed via single-incision laparoscopic technique. Results The rate of successfully placed epidural anesthesia was 27 % (23), and less postoperative pain (p = 0.04) and need for opioids (p = 0.00) were observed on the day of surgery and first postoperative day. No effect was observed on bowel function, tolerance of solid food, or hospital stay. Conclusions In daily surgical laparoscopic practice, the rate of epidural anesthesia is low. Less pain and less need for opioids, but no effect on bowel function or hospital stay, could be demonstrated.
      PubDate: 2015-03-13
  • Compliance with and fulfillment of a fast-track protocol in daily surgical
           practice in a university hospital
    • Abstract: Summary Background The aim of this retrospective study was to analyze the fulfillment of different fast-track elements in daily surgical practice. Methods One hundred and forty-nine consecutive patients (69 female, 46 %) with a median(range) age of 68(33–93), were analyzed. Results In 46 % of patients no oral bowel preparation was performed. Successful placement of patent ductus arteriosus (PDA) was reached in 94(63 %) patients. Nasogastric tube was removed in 97 %, a drain was placed in 94(63 %) patients. The urine catheter was removed in 43 % until postoperative day (POD) 3. No intravenous medication was recorded in 25(16 %) patients on POD1. In 47(32 %) patients deviation from the postoperative fast-track protocol was observed. Hospital mortality was 0.7 % and rehospitalization rate was 5 %(n = 7). Conclusion In summary, this study shows that the extension of the enhanced recovery of surgery (ERAS) protocol in a large department with a great number of staff involved is challenging and needs permanent supervision. Bowel preparation and epidural anesthesia were the elements with worse compliance.
      PubDate: 2015-03-13
  • Is fast track rehabilitation already standard in gastrointestinal
    • PubDate: 2015-03-04
  • For the beauty of our globe
    • PubDate: 2015-02-27
  • 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
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