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Publisher: Springer-Verlag   (Total: 2280 journals)

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Diabetologia Notes de lecture     Hybrid Journal  
Diabetology Intl.     Hybrid Journal   (Followers: 1, SJR: 0.273, h-index: 5)
Dialectical Anthropology     Hybrid Journal   (Followers: 9, SJR: 0.314, h-index: 9)
Die Weltwirtschaft     Hybrid Journal   (Followers: 2)
Differential Equations     Hybrid Journal   (Followers: 2, SJR: 0.364, h-index: 15)
Differential Equations and Dynamical Systems     Hybrid Journal   (Followers: 1, SJR: 0.63, h-index: 7)
Digestive Diseases and Sciences     Hybrid Journal   (Followers: 4, SJR: 1.19, h-index: 89)
Directieve therapie     Hybrid Journal  
Discrete & Computational Geometry     Hybrid Journal   (Followers: 3, SJR: 1.269, h-index: 40)
Discrete Event Dynamic Systems     Hybrid Journal   (Followers: 3, 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   (Followers: 1)
Drugs : Real World Outcomes     Hybrid Journal   (Followers: 2)
Dynamic Games and Applications     Hybrid Journal   (Followers: 2, SJR: 0.481, h-index: 5)
Dysphagia     Hybrid Journal   (Followers: 87, 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: 13, 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: 8, SJR: 0.18, h-index: 9)
Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity     Hybrid Journal   (Followers: 13, SJR: 0.362, h-index: 27)
EcoHealth     Hybrid Journal   (Followers: 3, SJR: 0.88, h-index: 26)
Ecological Research     Hybrid Journal   (Followers: 8, SJR: 0.847, h-index: 43)
Economia e Politica Industriale     Hybrid Journal  
Economia Politica     Hybrid Journal   (SJR: 0.375, h-index: 6)
Economic Botany     Hybrid Journal   (Followers: 8, SJR: 0.527, h-index: 44)
Economic Bulletin     Hybrid Journal   (Followers: 4)
Economic Change and Restructuring     Hybrid Journal   (SJR: 0.264, h-index: 9)
Economic Theory     Hybrid Journal   (Followers: 16, 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: 23, SJR: 1.909, h-index: 93)
Ecotoxicology     Hybrid Journal   (Followers: 9, SJR: 1.333, h-index: 56)
Education and Information Technologies     Hybrid Journal   (Followers: 74, SJR: 0.366, h-index: 16)
Educational Assessment, Evaluation and Accountability     Hybrid Journal   (Followers: 17, SJR: 0.374, h-index: 15)
Educational Psychology Review     Hybrid Journal   (Followers: 20, SJR: 2.776, h-index: 61)
Educational Research for Policy and Practice     Hybrid Journal   (Followers: 8, SJR: 0.273, h-index: 9)
Educational Studies in Mathematics     Hybrid Journal   (Followers: 14, SJR: 0.825, h-index: 32)
Educational Technology Research and Development     Partially Free   (Followers: 62, SJR: 1.785, h-index: 52)
Electrical Engineering     Hybrid Journal   (Followers: 16, SJR: 0.336, h-index: 18)
Electrocatalysis     Hybrid Journal   (SJR: 0.883, h-index: 10)
Electronic Commerce Research     Hybrid Journal   (Followers: 3, SJR: 0.582, h-index: 16)
Electronic Markets     Hybrid Journal   (Followers: 5, SJR: 0.411, h-index: 8)
Electronic Materials Letters     Hybrid Journal   (Followers: 3, SJR: 1.407, h-index: 15)
Elemente der Mathematik     Hybrid Journal   (Followers: 1)
Emergency Radiology     Hybrid Journal   (Followers: 5, SJR: 0.678, h-index: 25)
Emission Control Science and Technology     Hybrid Journal   (Followers: 1)
Empirica     Hybrid Journal   (Followers: 3, SJR: 0.319, h-index: 16)
Empirical Economics     Hybrid Journal   (Followers: 8, SJR: 0.489, h-index: 31)
Empirical Software Engineering     Hybrid Journal   (Followers: 7, SJR: 1.285, h-index: 39)
Employee Responsibilities and Rights J.     Hybrid Journal   (Followers: 3, SJR: 0.361, h-index: 15)
Endocrine     Hybrid Journal   (Followers: 7, SJR: 0.878, h-index: 57)
Endocrine Pathology     Hybrid Journal   (Followers: 2, SJR: 0.638, h-index: 31)
Energy Efficiency     Hybrid Journal   (Followers: 14, SJR: 0.732, h-index: 14)
Energy Systems     Hybrid Journal   (Followers: 14, SJR: 1.176, h-index: 7)
Engineering With Computers     Hybrid Journal   (Followers: 5, SJR: 0.433, h-index: 30)
Entomological Review     Hybrid Journal   (Followers: 7, SJR: 0.144, h-index: 5)
Environment Systems & Decisions     Hybrid Journal   (Followers: 2)
Environment, Development and Sustainability     Hybrid Journal   (Followers: 32, SJR: 0.419, h-index: 29)
Environmental and Ecological Statistics     Hybrid Journal   (Followers: 6, 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: 5, SJR: 0.725, h-index: 58)
Environmental Chemistry Letters     Hybrid Journal   (Followers: 2, SJR: 0.741, h-index: 28)
Environmental Earth Sciences     Hybrid Journal   (Followers: 12, SJR: 0.724, h-index: 63)
Environmental Economics and Policy Studies     Hybrid Journal   (Followers: 5, SJR: 0.524, h-index: 4)
Environmental Evidence     Open Access   (Followers: 1)
Environmental Fluid Mechanics     Hybrid Journal   (Followers: 3, SJR: 0.437, h-index: 24)
Environmental Geochemistry and Health     Hybrid Journal   (Followers: 3, SJR: 1.013, h-index: 36)
Environmental Geology     Hybrid Journal   (Followers: 11)
Environmental Health and Preventive Medicine     Hybrid Journal   (Followers: 3, SJR: 0.522, h-index: 19)
Environmental Management     Hybrid Journal   (Followers: 38, SJR: 0.942, h-index: 66)
Environmental Modeling & Assessment     Hybrid Journal   (Followers: 11, SJR: 0.533, h-index: 31)
Environmental Monitoring and Assessment     Hybrid Journal   (Followers: 23, SJR: 0.685, h-index: 52)
Environmental Science and Pollution Research     Hybrid Journal   (Followers: 14, SJR: 0.885, h-index: 46)
Epileptic Disorders     Hybrid Journal   (SJR: 0.608, h-index: 38)
EPJ A - Hadrons and Nuclei     Hybrid Journal   (Followers: 1, SJR: 1.287, h-index: 63)
EPJ B - Condensed Matter and Complex Systems     Hybrid Journal   (Followers: 2, SJR: 0.731, h-index: 89)
EPJ direct     Hybrid Journal  
EPJ E - Soft Matter and Biological Physics     Hybrid Journal   (Followers: 1, SJR: 0.641, h-index: 62)
EPMA J.     Open Access   (SJR: 0.284, h-index: 6)
ERA-Forum     Hybrid Journal   (Followers: 4, SJR: 0.128, h-index: 3)
Erkenntnis     Hybrid Journal   (Followers: 15, SJR: 0.621, h-index: 16)
Erwerbs-Obstbau     Hybrid Journal   (SJR: 0.206, h-index: 9)
Esophagus     Hybrid Journal   (SJR: 0.311, h-index: 10)

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Journal Cover European Surgery
  [SJR: 0.166]   [H-I: 13]   [4 followers]  Follow
    
   Hybrid Journal Hybrid journal (It can contain Open Access articles)
   ISSN (Print) 1682-4016 - ISSN (Online) 1682-8631
   Published by Springer-Verlag Homepage  [2280 journals]
  • At mix at fall at rise: surgery in the EU
    • PubDate: 2016-01-27
       
  • Meshfixation in open and endoscopic inguinal hernia repair
    • Abstract: Summary Unfortunately, neither new operation techniques nor advancements in mesh development could change the fact that chronic pain remains the most severe postoperative complication in open and laparoscopic hernia surgery. The main reason seems to be nerve injury due to mesh fixation. New fixation techniques like fibrin sealing, self-fixating meshes and no fixation have replaced conventional traumatic fixation devices. The guidelines by the European Hernia Society and the International Endoscopic Hernia Society represent for the first time a publication of evidence-based data. This review illustrates a practical overview of open and laparoscopic fixation techniques based on these guidelines and up to date studies.
      PubDate: 2016-01-27
       
  • Cholecystectomy in patients aged 80 years and more following ERCP: is it
           necessary?
    • Abstract: Summary Background Long-term outcome in patients aged 80 years and more found that they had common bile duct (CBD) stones at endoscopic retrograde cholangiopancreatography (ERCP) managed under “wait and watch” policy without cholecystectomy. Methods Retrospective analysis was done of a prospectively maintained database and healthcare records on all patients who underwent ERCP between February 2007 and December 2009 in a university teaching hospital. Those found to have gall stones with CBD stones were included in this study. Patients were followed up for 8 years until March 2015. Results A total of 113 consecutive patients with stones in CBD were retrieved. Mean age (range) was 85 years (80–97); there were 71 female and 42 male patients. Six patients died during the same admission, five due to ongoing cholangitis and one due to pneumonia. Of the remaining 107 patients, 10 already had and 6 went on to have cholecystectomy due to personal preferences. The patients who did proceed to a cholecystectomy had a mean hospital stay of 14 days (range 1–25) and 5 (83 %) patients developed post-operative complications. A total of 91 patients were managed conservatively over a mean follow-up period of 41 months (1–89). During the follow-up period 13 (14.3 %) patients re-presented with biliary symptoms, of which 2 patients presented more than once. Conclusions In patients aged 80 years and over, non-operative management after ERCP for CBD stones is a possible alternative with acceptable risks.
      PubDate: 2016-01-27
       
  • Open Access publizieren in der „european surgery“
    • PubDate: 2016-01-18
       
  • Current strategies for preoperative conditioning of the liver to expand
           criteria for resectability of hepatic metastases
    • Abstract: Summary Background Colorectal cancer (CRC) is among the most commonly diagnosed cancers, and the liver is its most frequent metastatic site. Colorectal liver metastases (CLM) are synchronous in 15–25 % of the CRC patients and metachronous in 20–25 %. In recent decades, 5-year-overall survival following curative liver resection of CLM has increased to 35–58 %. This improvement owes largely to advances in CLM multimodality treatment. Methods In recent years, the CLM resectability criteria have also shifted, following several encouraging studies reporting the possibility of R0 resection for all tumors while preserving a sufficient volume of residual liver. In this context, multimodal approaches including portal vein embolization (PVE), associating liver partition with portal vein ligation for staged hepatectomy (ALPPS) and two-stage hepatectomy after neoadjuvant chemotherapy were developed to induce hypertrophy of the future liver remnant (FLR) to fulfill minimal liver volume requirements. Liver function tests and scores could be a helpful tool in patient selection and prediction limit of the hepatic parenchymal reserve. Results Generally, at least 20 % of the total liver volume should be preserved in the case of a healthy liver, whereas at least 30–60 % should be preserved for livers impaired by chemotherapy-associated steatosis or hepatitis. Further use of ischemic or pharmacological preconditioning of FLR tissue such as stem cell transplantation could help to prepare the liver for extended resections and to avoid postoperative liver failure. Conclusion Because of shifting CLM resectability criteria and encouraging survival rates following curative resection in the context of multimodality treatment, extended liver surgery for CLM is increasing. To condition the liver for extensive surgery and to ensure adequate postoperative liver function, several approaches were developed and routinely practiced in clinical centers.
      PubDate: 2016-01-15
       
  • Magnetic resonance imaging and peroxide-enhanced anal endosonography in
           assessment of fistula in anus: comparison with surgery
    • Abstract: Summary Background Although there are numerous modalities to evaluate perianal fistula, there is still a need to determine the most sensitive, specific, and accurate modality. This study was conducted to determine the performance characteristics of magnetic resonance imaging (MRI) and contrast-enhanced three-dimensional endoanal ultrasonography (C-3DEAUS) considering surgery as the gold standard. Methods A total of 36 patients who were diagnosed of having anal fistula with 10-MHz hydrogen peroxide-enhanced three-dimensional EAUS underwent MRI followed by surgery. Both of tests were done the day before surgery. Fistula classification was determined with each modality according to Parks’ criteria as inter-sphincteric, trans-sphincteric, extra-sphincteric, or supra-sphincteric and was compared with the surgical findings in all patients. If the accuracy of each modality was at least 85 % compared with the surgery, it was considered as clinically useful. Results Agreement for the classification of the primary fistula tract was 94.3 % for C-3DEAUS and surgery, 97.1 % for MRI and surgery. Considering a clock face, C-3DEAUS and surgery agreed in location of internal opening in 88.6 % of cases while MRI and surgery agreed in 97.1 %. In detection a collection, agreement between C-3DEAUS and surgery was 82.9 %, and 97.1 % between MRI and surgery. Conclusions Both methods had almost perfect agreement with surgical findings in the classification of the primary fistula tract but MRI had more agreement in distinguishing other aspects of a fistula and it can be used as the most reliable method for preoperative evaluation of perianal fistulas.
      PubDate: 2016-01-15
       
  • The effect of balance training on clinical balance performance in obese
           patients aged 20–50 years old undergoing sleeve gastrectomy
    • Abstract: Summary Background It is estimated that over 1.9 billion people suffer from overweight worldwide, among whom 600 million people are classified as obese. Obesity can result in many health problems. One of them is balance control insufficiency. Obesity treatment and management may include a combination of diet modification, appropriate physical activity, behavior modification, drug consumption, and sometimes surgery. However, to the best of our knowledge the effect of balance training exercises on postural stability has not been examined among the obese individuals undergoing sleeve gastrectomy. This study aimed to assess the effect of weight loss and balance training on clinical balance performance. Methods This clinical trial was conducted on 32 subjects selected through convenience sampling. The subjects were divided into two groups by random allocation (16 in the intervention group and 16 in the control group). Both groups underwent bariatric surgery. The intervention (case) group attended balance exercise sessions for 4 weeks (4 sessions per week), whereas the control group did not attend any balance exercise sessions. Before and after the intervention, the static, dynamic, and functional clinical balance tests were done in the intervention group. The tests were also performed in the control group twice with a 4-week interval. Results After 4 weeks of balance training exercise, a significant difference was found between the intervention and the control groups regarding static, dynamic, and functional balance tests. Conclusion Attending balance exercises program for 4 weeks can improve the balance among obese individuals undergoing sleeve gastrectomy.
      PubDate: 2016-01-15
       
  • Simultaneous resection of primary colorectal cancer and synchronous liver
           metastases is associated with a high cardiovascular complication rate
    • Abstract: Summary Background Optimal timing of liver surgery for synchronous metastases regarding a simultaneous or two-staged procedure is still controversially discussed. As randomized controlled trials are ethically disputable due to potential advantages of the simultaneous approach, the following matched pair analysis was performed to investigate feasibility and short-term outcome of the additional simultaneous hepatic approach compared to colorectal surgery alone. Methods A total of 74 patients undergoing simultaneous resection of primary colorectal cancer and synchronous liver metastases (CRC + LM) were individually case matched with patients receiving only colorectal surgery for Union for International Cancer Control (UICC) stage I-III cancer (CRC) according to: age, gender, American Society of Anesthesiologists (ASA) score, location, and T-stage of the primary tumor. Postoperative complications and risk factors for morbidity and mortality were analyzed retrospectively using univariate, multivariate, and binary logistic regression analyses. Results According to matching criteria both groups showed no differences regarding demographics and operative techniques for the primary colorectal tumor. In the CRC + LM group 4 major hepatectomies, 7 anatomic, 43 nonanatomic and 20 multiple nonanatomic resections were performed. Inhospital mortality (CRC vs. CRC + LM) was 2.7 versus 4.1 % and overall morbidity was 33.8 versus 35.1 %, respectively. Cardiovascular complications were significantly higher in the CRC + LM than in the CRC group (13.5 vs. 2.7 %). Multivariate analysis revealed that not simultaneous resection procedure but presence of chronic pulmonary disease was an independent risk factor. Conclusions Simultaneous resection procedures can be recommended in almost all patients without chronic pulmonary disease as well as chronic heart disease. Careful precautions, especially in patients with chronic pulmonary diseases, should be taken to avoid a high possibility of postoperative cardiovascular complications.
      PubDate: 2016-01-15
       
  • Abdominelles Kompartmentsyndrom, abdominelle Unterdrucktherapie
    • Abstract: Zusammenfassung Die abdominelle Unterdrucktherapie ist ein Therapieverfahren zur chirurgischen Behandlung von Patienten mit offenem Abdomen, dem sogenannten Laparostoma. Die beiden Hauptindikationen sind das abdominelle Kompartmentsyndrom und die abdominelle Sepsis. Die Wirkungsweise der abdominellen Unterdrucktherapie beruht auf den beiden Prinzipien von Okklusion und Unterdruck, welche einen effizienten Drainageeffekt und einen provisorischen dynamischen Bauchdeckenverschluss ermöglichen. Das Abdomen wird dabei mit einer speziellen, die Viszeralorgane schützenden und die Peritonealhöhle drainierenden Folie ausgekleidet und mit einem okklusiven Schaumstoffverband luft- und flüssigkeitsdicht verschlossen. So kann über eine Unterdruckpumpe ein kontinuierlicher oder intermittierender Sog erzeugt werden. Kontraindiziert ist die abdominelle Unterdrucktherapie bei signifikanten Gerinnungsstörungen, abdominellen Blutungen und nicht versorgten Hohlorganfisteln.
      PubDate: 2015-12-10
       
  • The impact of advanced age on short- and long-term results after surgery
           for colorectal cancer
    • Abstract: Summary Background Elderly patients with colorectal cancer are often seen as high-risk candidates for surgical treatment. This study was designed to characterize the outcomes of persons older than 80 years, compared with younger persons. Methods We investigated the short-term surgical outcome and long-term survival of octogenarians undergoing surgery for colorectal cancer in a retrospective analysis. All patients scheduled for surgical resection of colorectal adenocarcinoma at our institution from 2003 to 2010 were included. Results Our study included 699 patients, 126 (18 %) of whom were aged 80 years or older. Presentation with later stage disease was not seen more frequently in the octogenarians. Comorbidities showed a significant increase (p < 0.001) and more emergency operations had to be performed in the elderly (p = 0.015). The probability for postoperative complications was associated with advanced age (p = 0.009) and 1-year mortality was significantly higher in the octogenarians. Overall survival was shorter in octogenarians, but no difference was found in cancer-specific survival or time-to-recurrence, compared with patients under 80. Conclusion Surgery for colorectal cancer in the elderly is challenging due to preexisting comorbidities and an increased rate of emergency operations. Although the short-term outcome of octogenarians is worse compared to younger patients, the long-term oncological results remain satisfactory, leading to the assumption that advanced age alone should not be a contraindication for surgical therapy.
      PubDate: 2015-12-01
       
  • The role of platelets and portal venous pressure fluctuations in
           postoperative liver regeneration
    • Abstract: Summary Background The most relevant factor predicting morbidity and mortality after liver resection is the ability of the remnant liver to regenerate. In line with extensive experimental research, we were recently able to demonstrate that serotonin and thrombospondin-1, two factors abundantly stored in platelets, are closely associated with liver regeneration of patients after liver resection. Methods Within this review, we summarized existing evidence regarding the relevance of platelets in liver regeneration. Results We illustrated a potential interaction of platelet activation and its relation to portal venous pressure during the process of liver regeneration. Conclusions We are able to explore possible effects of specific granule release as a key regulator to allow for platelet-induced liver regeneration. As a second objective, we discussed postoperative portal venous pressure as a potential mechanism and initiating effect in postoperative platelet activation during liver regeneration which may offer new therapeutic targets to promote postoperative liver regeneration.
      PubDate: 2015-12-01
       
  • Metastatic urinary bladder transitional cell carcinoma to the oral cavity
           and oropharynx
    • Abstract: Summary Background Distant metastasis from urinary bladder transitional cell carcinoma (TCC) is a well-reported phenomenon, most commonly occurring in osseous and pulmonary sites. In contrast, metastasis to oral and/or oropharyngeal soft tissues is extremely rare. Methods We present a case of a 75-year-old gentleman with treated urinary bladder TCC who presented 4 years later with a base of tongue metastasis and airway compromise necessitating a tracheostomy. A systematic review of all previously reported cases of metastatic urinary bladder TCC to the oral cavity and/or oropharynx in the English literature was performed and a summary presented. Results A total of six cases, including ours, of the aforementioned presentation have been reported in English literature. Conclusions This is the first systematic review of all previously reported cases of metastatic urinary bladder TCC to the oral cavity and/or oropharynx in the English literature. It is an extremely rare phenomenon with a uniformly dismal prognosis.
      PubDate: 2015-12-01
       
  • Laparoscopic management of diaphragmatic mesothelial cysts in children
    • Abstract: Background Diaphragmatic mesothelial cysts (DMC) are rare congenital lesions arising from coelomic remnants. The DMC may need surgical excision if they become symptomatic. The aim of this study was to present three pediatric DMC cases that successfully managed laparoscopically. Case report Three consecutive children (ages 6, 8 and 12 years), who presented with nonspecific abdominal complaints, referred to our department. Imaging studies demonstrated lobulated cysts in the region of the right posterior lobes of liver. The patients were approached by laparoscopy in a right lateral decubitus position because the preoperative diagnosis is uncertain. Cysts originating from diaphragm were seen, the clear yellowish fluid was aspirated, and unroofing was performed in all patients. Results After a well-tolerated operation, postoperative courses of the patients were uneventful, and they were discharged on the following day. Histopathological examinations of the wall of the lesions showed DMC with no evidence of malignancy. No recurrence or symptom was found during the follow-up period. Conclusions This is the first report of laparoscopic management of the DMC. Laparoscopic approach to symptomatic DMC patients is safe and effective method for diagnosis and treatment, if it is not established a differential diagnosis by imaging studies.
      PubDate: 2015-12-01
       
  • Cardiopulmonary exercise testing versus spirometry as predictors of
           cardiopulmonary complications after colorectal surgery
    • Abstract: Summary Background To determine the predictive value of spirometry and cardiopulmonary exercise testing (CPET) preoperatively in patients scheduled to undergo elective colorectal surgery. We compared the preoperative results with the incidence of postoperative cardiopulmonary complications. Methods A total of 103 patients were scheduled to undergo preoperative CPET and spirometry; 14 patients did not attend their appointments and another 20 were unable to perform the test. In all, 69 patients (median age 60 years (range 25–85), 35 males) successfully completed cycle ergometry and lung function tests. Forced expiratory volume in 1 s (FEV1), percent forced expiratory volume in 1 s (FEV1/forced vital capacity (FVC)) and anaerobic threshold (AT) were measured. Patients were divided postoperatively according to whether cardiopulmonary complications were absent (group A) or present (group B). Results Postoperative cardiopulmonary complications developed in 8 of the 69 patients (12 %). Thirty day mortality was 3 %. AT was significantly higher in group A (mean AT = 13.8; SD ± 3.0; range = 8.1–20.8) than in group B (mean = 10.91; SD ± 3.0; Range = 7.9–12), (p = 0.0006). Spirometric pulmonary function tests (FEV1, p = 0.09) and (FEV1/FVC, p = 0.08) showed no intergroup differences. The median hospital length of stay (HLOS) was significantly higher in the group of patients that suffered cardiopulmonary complications (p = 0.0282). Conclusions CPET allows the prediction of postoperative cardiopulmonary complications which cannot be anticipated by spirometry. Early detection of high risk patients facilitates the planning of patient specific management strategies which are likely to improve outcome through invasive monitoring and optimisation of cardio-respiratory function.
      PubDate: 2015-12-01
       
  • Factors affecting the difficulty of laparoscopic total mesorectal excision
           for mid- to lower rectal cancer
    • Abstract: Summary Background The purpose of this study was to evaluate the predictive value of clinical and anatomical features on magnetic resonance imaging (MRI) that can affect pelvic dissection time for treating mid- to lower rectal cancer. Methods A total of 90 consecutive male patients who underwent total mesorectal excision for mid- to lower rectal cancer were retrospectively assessed. MRI pelvimetry data were analyzed to identify anatomical features that could affect pelvic dissection time. Results Univariate analysis indicated that tumor distance from the anal verge (p = 0.001), preoperative chemoradiotherapy (p  = 0.002), and interspinous distance (p = 0.002) were significantly associated with pelvic dissection time. Conclusion Patients with a short interspinous distance may require a longer pelvic dissection time for treating rectal cancer by resection.
      PubDate: 2015-12-01
       
  • Hiatal repair to reduce dysphagia in patients with impaired oesophageal
           motility having 360 ° fundoplication: the posterior
           ‘sling’ repair
    • Abstract: Summary Background Fundoplication in the presence of oesophageal dysmotility as being concerning for the development of postoperative dysphagia. Many techniques of surgery including partial fundoplication have evolved. Methods The technique of posterior sling repair of the hiatus avoiding heavy rigid to stitch posterior repair has reduced early dysphagia in our practice. Result The operative technique with operative illustrations is described. Conclusion Posterior sling repair of the hiatus during a laparoscopic fundoplication in oesophageal dysmotility is feasible and has reduced postoperative dysphagia.
      PubDate: 2015-12-01
       
  • High volume surgery, flood myths, cancer, and minions
    • PubDate: 2015-11-13
       
  • Austrian expert panel recommendation for radiofrequency ablation of
           Barrett’s esophagus
    • Abstract: Summary Background Barrett’s esophagus (BE) represents the premalignant manifestation of gastroesophageal reflux disease and includes columnar lined esophagus with intestinal metaplasia, low-grade dysplasia, high-grade dysplasia and cancer. Methods An Austrian panel of expert meeting was held at the Medical University Vienna, June 2015, to establish and define recommendations for the endoscopic treatment of BE with and without dysplasia and cancer. Recommendations are based on critical analysis of published evidence. Statistics were not applied. Results Diagnosis of cancer and dysplasia is to be reconfirmed by a second expert pathologist. Advanced cancer (> T1a) requires surgical resection ± adjuvant therapies. Treatment of T1a early cancer, high- and low-grade dysplasia should include endoscopic mucosal resection (EMR) and radiofrequency ablation (RFA). In the presence of increased cancer risk, BE without dysplasia should be treated by RFA within clinical studies only. Elimination of any early cancer, dysplasia and IM defines complete response, that is, post RFA histopathology shows squamous, cardiac or oxyntocardiac mucosa lined esophagus (Chandrasoma classification). Follow-up endoscopies are timed according to the base line histopathology. Down grade from cancer to dysplasia or from dysplasia to non-dysplastic BE defines partial response, respectively. Based on esophageal function testing, reflux is treated by medical or surgical therapy. Conclusion In Austria, RFA ± EMR is recommended for BE containing early cancer or dysplasia. Non-dysplastic BE with an increased cancer risk should be offered RFA within clinical trials to assess the efficacy for cancer prevention in this group of patients.
      PubDate: 2015-10-14
       
  • Season and vitamin D status do not affect probability for surgical site
           infection after colorectal surgery
    • Abstract: Summary Background Regardless of reports on the prevalence of hypovitaminosis D and seasonal effects in the general population and significant worsening of many outcomes there is a scarcity of studies focusing on surgical patients. We, therefore, designed a study to assess the association and difference in surgical-wound infections between patients having colorectal surgery in winter compared with patients having surgery in summer months. Methods Patients were divided into winter and summer surgical procedures depending on their date of surgery. The relationship between seasons (and Vitamin D) and primary outcome of wound infections using multivariable logistic regression was assessed. Results Out of 2919 patients, 241 (7.7 %) experience surgical site infection. The observed incidence of any surgical site infection postoperatively was 6.8 %, 9.9 %, 7.3 %, and 8.2 % for patients having surgery in spring, summer, fall, and winter, respectively. Furthermore, vitamin D concentration was not associated with incidence of surgical site infection (Odds Ratio (OR): 0.51(0.01, 27) for a one-unit increase in vitamin D concentration; p = 0.74). Conclusion Our analysis suggests that perioperative vitamin D concentration is not associated with surgical site infections in colorectal surgical patients, likely because the outcomes are overwhelmingly determined by other baseline and surgical factors.
      PubDate: 2015-10-07
       
  • Case–matched comparison of short and middle term survival after
           laparoscopic versus open rectal and rectosigmoid cancer surgery
    • Abstract: Summary Background Individual surgeons’ experience and surgical outcome remain major contributors towards the successful treatment of rectosigmoid malignancy. Methods Only elective and curative resections (i.e. absence of distant metastases) were selected into each group to ascertain homogeneity and match for tumour stage. In all, 100 successive open rectal and rectosigmoid resections were compared with 100 similar laparoscopic procedures between 1st February 2005 and 31st December 2009 performed. A retrospective analysis was carried out and the patients were subsequently followed up until 30th April 2012. Results Anastomotic insufficiency was found in two patients (laparoscopic) and in five patients (open). The two groups were also compared for hospital stay and operating time (laparoscopic group spent statistically significant less time, operating time were statistically significant shorter). During the follow-up period (laparoscopic group 41.6 months, open group 39.8 months) similar survival and recurrence rates were found: loco-regional recurrence 1 and 4, distant metastases 20 and 22, respectively. There were 13 cancer deaths in laparoscopic group to 19 in open group, the average 3-year survival being 76 % and 69 %, respectively. The long-term oncological results in more advanced tumours are superior, albeit not significantly. The difference in incidence of incisional herniae (laparoscopic:open = 4:18) identified during the follow-up period was found significant. Conclusion When comparing laparoscopic with open rectal and rectosigmoid resections there could be no inferior oncological outcome identified, hence the two techniques can be considered equivalent; in fact, due to its advantages laparoscopic rectosigmoid cancer surgery is the preferred option over open.
      PubDate: 2015-10-05
       
 
 
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