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Diabetologia Notes de lecture     Hybrid Journal  
Diabetology Intl.     Hybrid Journal   (Followers: 1)
Dialectical Anthropology     Hybrid Journal   (Followers: 7, SJR: 0.109, h-index: 7)
Die Weltwirtschaft     Hybrid Journal   (Followers: 2)
Differential Equations     Hybrid Journal   (Followers: 2, SJR: 0.28, h-index: 14)
Differential Equations and Dynamical Systems     Hybrid Journal   (Followers: 1, SJR: 0.337, h-index: 5)
Digestive Diseases and Sciences     Hybrid Journal   (Followers: 4, SJR: 0.803, h-index: 84)
Directieve therapie     Hybrid Journal  
Discrete & Computational Geometry     Hybrid Journal   (Followers: 2, SJR: 1.088, h-index: 37)
Discrete Event Dynamic Systems     Hybrid Journal   (Followers: 2, SJR: 1.028, h-index: 30)
Distributed and Parallel Databases     Hybrid Journal   (Followers: 4, SJR: 0.82, h-index: 29)
Distributed Computing     Hybrid Journal   (Followers: 2, SJR: 1.361, h-index: 29)
DNP - Der Neurologe und Psychiater     Full-text available via subscription  
Documenta Ophthalmologica     Hybrid Journal   (Followers: 2, SJR: 1.418, h-index: 37)
Doklady Biochemistry and Biophysics     Hybrid Journal   (Followers: 2, SJR: 0.18, h-index: 8)
Doklady Biological Sciences     Hybrid Journal   (SJR: 0.193, h-index: 9)
Doklady Botanical Sciences     Hybrid Journal  
Doklady Chemistry     Hybrid Journal   (SJR: 0.261, h-index: 11)
Doklady Earth Sciences     Hybrid Journal   (SJR: 0.386, h-index: 15)
Doklady Mathematics     Hybrid Journal   (SJR: 0.299, h-index: 12)
Doklady Physical Chemistry     Hybrid Journal   (SJR: 0.316, h-index: 10)
Doklady Physics     Hybrid Journal   (Followers: 1, SJR: 0.274, h-index: 14)
Douleur et Analg├ęsie     Hybrid Journal   (SJR: 0.135, h-index: 5)
Drug Delivery and Translational Research     Hybrid Journal   (Followers: 2, SJR: 0.624, h-index: 6)
Drug Safety - Case Reports     Open Access  
Drugs : Real World Outcomes     Hybrid Journal  
Dynamic Games and Applications     Hybrid Journal   (Followers: 2)
Dysphagia     Hybrid Journal   (Followers: 229, SJR: 0.684, h-index: 46)
e & i Elektrotechnik und Informationstechnik     Hybrid Journal   (Followers: 9, 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: 6, 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)
Economia e Politica Industriale     Hybrid Journal  
Economia Politica     Hybrid Journal  
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: 9, SJR: 1.857, h-index: 31)
Economic Theory Bulletin     Hybrid Journal   (Followers: 2)
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: 229, SJR: 0.207, h-index: 15)
Educational Assessment, Evaluation and Accountability     Hybrid Journal   (Followers: 17, SJR: 0.519, h-index: 14)
Educational Psychology Review     Hybrid Journal   (Followers: 15, 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: 11, SJR: 0.946, h-index: 27)
Educational Technology Research and Development     Partially Free   (Followers: 215, SJR: 1.124, h-index: 45)
Electrical Engineering     Hybrid Journal   (Followers: 13, 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: 5, 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)
Emission Control Science and Technology     Hybrid Journal  
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: 5, 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: 18, 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: 11, 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: 11, 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: 12, SJR: 0.62, h-index: 14)
Erwerbs-Obstbau     Hybrid Journal   (SJR: 0.173, h-index: 8)

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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  [2300 journals]
  • Evolution of a surgical service for adrenal pathology and impact of
           surgical intervention on resistant hypertension
    • Abstract: Summary Background An insight into the impact of adrenalectomy on the management of hypertension is helpful in counselling patients when deciding on surgical intervention. Methods We prospectively studied the outcome after surgical intervention for proven functional adrenal adenomas, particularly in regard to post-operative requirement of antihypertensive medications. All patients were prospectively logged onto a comprehensive database, which allowed subsequent long-term follow-up. Account was taken of morbidity encountered. Results A total of 77 patients (78 adrenal glands) underwent adrenal surgery between 1995 and 2013. In all, 44 patients (44/77) had proven functional adenomas, phaeochromocytoma (15/44, 34 %), Conn’s (25/44, 56 %), Cushing’s 4 (4/44, 10 %). A minimum follow-up of 12 months revealed all patients to have a reduction in their disease-specific medication with 75 % Cushing’s, 72 % Conn’s and 60 % phaeochromocytoma patients medicine free. Conclusions Despite the potential for functioning adenomas to produce irreversible change, the intervention of adrenalectomy appears to be beneficial in the vast majority of patients with at least half independent of antihypertensive medication. A reduction in morbidity was demonstrated as experience increased.
      PubDate: 2015-02-28
  • For the beauty of our globe
    • PubDate: 2015-02-27
  • Minimally invasive surgery for benign esophageal disorders: first 200
    • Abstract: Summary Background To evaluate the method of introduction, feasibility, and early results of a laparoscopic surgery for benign foregut disorders in a single high volume center. Methods A retrospective clinical study included consecutively laparoscopically operated patients due to benign foregut disorders. The study was conducted at the Department of Esophagogastric Surgery, First Surgical University Hospital, School of Medicine, University of Belgrade from March 2010 until July 2014. Complete preoperative diagnostics data, details of surgical procedures, and follow-up results are included. Results Overall, 200 consecutive patients were enrolled in the study. GERD and achalasia were the most common indications for laparoscopic surgery, with 81 and 72 patients respectively. Due to giant hiatal hernia, 37 patients were operated on, while the rest were less common indications. There were no conversions to open procedures. In three patients, pneumothorax resulted from intraoperative pleural lesion. One mucosal perforation occurred in an achalasia patient. One reoperation was conducted due to excessive port site bleeding. Short term follow-up results are highly satisfactory, and are presented in detail for every patient group. Conclusion Introduction of laparoscopy in a foregut surgery high volume center for the treatment of benign foregut disorders can be obtained with low incidence of complications, and satisfactory short term functional results.
      PubDate: 2015-02-13
  • Differences in quality of surgery for advanced gastric cancer between
    • Abstract: Summary Background Gastric cancer is one of the most common diseases in Japan, and surgery for gastric cancer is conducted in many general hospitals. However, there has been little investigation of the differences between institutions in terms of postoperative results in gastric cancer patients. This study aimed to compare the quality of treatment for gastric cancer between university hospital and general hospital. Methods We previously performed a multicenter trial in patients with stage II or III gastric cancer who underwent curative surgery followed by adjuvant S-1 chemotherapy. We selected 39 patients with similar backgrounds from this cohort: 16 from the Tottori University Hospital and 23 from a general hospital (Tottori Prefectural Central Hospital). Quality of surgery, postoperative patient nutrition and immunity, relapse-free survival, and overall survival were compared between the two groups. Results Operation time was significantly longer, but postoperative hospital stay was significantly shorter in the university group. Postoperative neutrophil/lymphocyte ratio and prognostic nutritional index improved significantly in the university group but remained unchanged in the general-hospital group. Relapse-free survival and overall survival both were better in the university group compared with the general-hospital group, although the difference in relapse-free survival was not significant. Conclusions Surgery and follow-up for advanced gastric cancer should be conducted by trained surgeons and gastric cancer specialists.
      PubDate: 2015-02-06
  • 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
  • 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: 2014-11-01
  • 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
  • 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
  • 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
  • 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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