Subjects -> MEDICAL SCIENCES (Total: 8529 journals)
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DERMATOLOGY AND VENEREOLOGY (164 journals)                     

Showing 1 - 164 of 164 Journals sorted alphabetically
Acta Dermato-Venereologica     Open Access   (Followers: 12)
Acta Dermatovenerologica Croatica     Open Access   (Followers: 1)
Actas Dermo-Sifiliograficas     Full-text available via subscription   (Followers: 3)
Actas Dermo-Sifiliográficas (English Edition)     Full-text available via subscription   (Followers: 2)
Advances in Dermatology     Full-text available via subscription   (Followers: 16)
Advances in Skin & Wound Care     Hybrid Journal   (Followers: 31)
African Journal of AIDS Research     Hybrid Journal   (Followers: 8)
AIDS     Hybrid Journal   (Followers: 23)
AIDS Care: Psychological and Socio-medical Aspects of AIDS/HIV     Hybrid Journal   (Followers: 9)
AIDS Patient Care and STDs     Hybrid Journal   (Followers: 3)
AIDS Research and Human Retroviruses     Hybrid Journal   (Followers: 9)
AIDS Research and Therapy     Open Access   (Followers: 15)
AIDS Research and Treatment     Open Access   (Followers: 2)
Aktuelle Dermatologie     Hybrid Journal   (Followers: 7)
Allergo Journal     Full-text available via subscription   (Followers: 2)
American Journal of Clinical Dermatology     Full-text available via subscription   (Followers: 26)
American Journal of Dermatopathology     Hybrid Journal   (Followers: 17)
Anais Brasileiros de Dermatologia     Open Access   (Followers: 2)
Anaplastology     Open Access  
Annales de Dermatologie et de Vénéréologie     Full-text available via subscription  
Archives de Pédiatrie     Full-text available via subscription  
Archives de sciences sociales des religions     Open Access   (Followers: 1)
Archives des Maladies du Coeur et des Vaisseaux - Pratique     Hybrid Journal  
Archives of Dermatological Research     Hybrid Journal   (Followers: 7)
Archives of Gerontology and Geriatrics     Hybrid Journal   (Followers: 13)
Archives of Industrial Hygiene and Toxicology     Open Access   (Followers: 8)
Archives of Medical Research     Hybrid Journal   (Followers: 3)
Archives of Physical Medicine and Rehabilitation     Hybrid Journal   (Followers: 55)
Archivio di Ortopedia e Reumatologia     Hybrid Journal  
Asian Journal of Dermatology     Open Access   (Followers: 2)
ästhetische dermatologie & kosmetologie     Full-text available via subscription  
Australasian Journal of Dermatology     Hybrid Journal   (Followers: 8)
Berkala Ilmu Kesehatan Kulit dan Kelamin / Periodical of Dermatology and Venereology     Open Access  
Biomedical Dermatology     Open Access  
BMC Dermatology     Open Access   (Followers: 13)
BMJ Sexual & Reproductive Health     Hybrid Journal   (Followers: 2)
British Journal of Dermatology     Hybrid Journal   (Followers: 54)
Case Reports in Dermatological Medicine     Open Access   (Followers: 2)
Case Reports in Dermatology     Open Access   (Followers: 10)
Clinical and Experimental Dermatology     Hybrid Journal   (Followers: 14)
Clinical Dermatology Review     Open Access   (Followers: 5)
Clinical Skin Cancer     Full-text available via subscription  
Clinical, Cosmetic and Investigational Dermatology     Open Access   (Followers: 10)
Clinics in Dermatology     Hybrid Journal   (Followers: 15)
Contact Dermatitis     Hybrid Journal   (Followers: 8)
Cosmetics     Open Access   (Followers: 5)
Current Dermatology Reports     Hybrid Journal   (Followers: 7)
Current Fungal Infection Reports     Hybrid Journal   (Followers: 5)
Current HIV Research     Hybrid Journal   (Followers: 7)
Current HIV/AIDS Reports     Hybrid Journal   (Followers: 6)
Current Sexual Health Reports     Hybrid Journal   (Followers: 3)
Cutaneous and Ocular Toxicology     Hybrid Journal   (Followers: 10)
Der Hautarzt     Hybrid Journal   (Followers: 2)
Dermatitis     Hybrid Journal   (Followers: 1)
Dermato-Endocrinology     Open Access   (Followers: 2)
Dermatología Venezolana     Open Access  
Dermatologic Clinics     Full-text available via subscription   (Followers: 4)
Dermatologic Reviews     Hybrid Journal  
Dermatologic Surgery     Hybrid Journal   (Followers: 8)
Dermatologic Therapy     Hybrid Journal   (Followers: 2)
Dermatologica Sinica     Open Access  
Dermatological Nursing     Full-text available via subscription   (Followers: 2)
Dermatology     Full-text available via subscription   (Followers: 20)
Dermatology and Cosmetic     Open Access   (Followers: 8)
Dermatology and Therapy     Open Access   (Followers: 4)
Dermatology Online Journal     Open Access   (Followers: 1)
Dermatology Reports     Open Access   (Followers: 3)
Dermatology Research and Practice     Open Access   (Followers: 4)
Dermatology Times     Free  
Dermatopathology     Open Access   (Followers: 3)
Egyptian Journal of Dermatology and Venerology     Open Access   (Followers: 1)
EMC - Cosmetologia Medica e Medicina degli Inestetismi Cutanei     Full-text available via subscription  
EMC - Dermatología     Full-text available via subscription   (Followers: 1)
European Journal of Dermatology     Hybrid Journal   (Followers: 15)
Experimental Dermatology     Hybrid Journal   (Followers: 10)
Expert Review of Dermatology     Hybrid Journal   (Followers: 14)
Forum Dermatologicum     Hybrid Journal  
Graefe's Archive for Clinical and Experimental Ophthalmology     Hybrid Journal   (Followers: 8)
Güncel Dermatoloji Dergisi     Open Access  
HautinForm     Full-text available via subscription  
hautnah     Hybrid Journal  
hautnah dermatologie     Hybrid Journal  
HIV & AIDS Review     Full-text available via subscription   (Followers: 13)
HIV Clinical Trials     Hybrid Journal   (Followers: 5)
HIV Medicine     Hybrid Journal   (Followers: 3)
Indian Dermatology Online Journal     Open Access   (Followers: 3)
Indian Journal of Dermatology     Open Access   (Followers: 2)
Indian Journal of Dermatology, Venereology and Leprology     Open Access   (Followers: 4)
Indian Journal of Dermatopathology and Diagnostic Dermatology     Open Access  
Indian Journal of Drugs in Dermatology     Open Access   (Followers: 1)
Indian Journal of Paediatric Dermatology     Open Access   (Followers: 2)
Indian Journal of Sexually Transmitted Diseases and AIDS     Open Access   (Followers: 2)
International Archives of Medicine     Open Access   (Followers: 3)
International Journal of Dermatology     Hybrid Journal   (Followers: 15)
International Journal of Dermatology and Clinical Research     Open Access   (Followers: 2)
International Journal of Research in Dermatology     Open Access   (Followers: 1)
International Journal of STD & AIDS     Hybrid Journal   (Followers: 7)
International Journal of Women's Dermatology     Open Access   (Followers: 1)
International STD Research & Reviews     Open Access   (Followers: 1)
JAAD Case Reports     Open Access   (Followers: 1)
JAIDS : Journal of Acquired Immune Deficiency Syndromes     Hybrid Journal   (Followers: 4)
JAMA Dermatology     Full-text available via subscription   (Followers: 49)
JAMA Facial Plastic Surgery     Full-text available via subscription   (Followers: 12)
JMIR Dermatology     Open Access   (Followers: 1)
Journal of AIDS & Clinical Research     Open Access   (Followers: 3)
Journal of Clinical & Experimental Dermatology Research     Open Access   (Followers: 6)
Journal of Clinical and Investigative Dermatology     Open Access   (Followers: 2)
Journal of Cosmetic Dermatology     Hybrid Journal   (Followers: 10)
Journal of Cosmetics, Dermatological Sciences and Applications     Open Access   (Followers: 7)
Journal of Cutaneous Immunology and Allergy     Open Access  
Journal of Cutaneous Medicine and Surgery     Full-text available via subscription  
Journal of Dermatological Research     Open Access  
Journal of Dermatological Science     Hybrid Journal   (Followers: 2)
Journal of Dermatological Science Supplement     Full-text available via subscription   (Followers: 1)
Journal of Dermatological Treatment     Hybrid Journal   (Followers: 2)
Journal of Dermatology & Dermatologic Surgery     Open Access   (Followers: 1)
Journal of General-Procedural Dermatology & Venereology Indonesia     Open Access  
Journal of HIV/AIDS & Social Services     Hybrid Journal   (Followers: 9)
Journal of Investigative Dermatology     Hybrid Journal   (Followers: 28)
Journal of Investigative Dermatology Symposium Proceedings     Full-text available via subscription  
Journal of Sexual Medicine     Hybrid Journal   (Followers: 6)
Journal of Sexually Transmitted Diseases     Open Access   (Followers: 3)
Journal of Skin and Stem Cell     Open Access   (Followers: 3)
Journal of Skin Cancer     Open Access   (Followers: 3)
Journal of Surgical Dermatology     Open Access   (Followers: 1)
Journal of the American Academy of Dermatology     Full-text available via subscription   (Followers: 37)
Journal of the Dermatology Nurses' Association     Hybrid Journal   (Followers: 3)
Journal of the Egyptian Women’s Dermatologic Society     Partially Free  
Journal of the European Academy of Dermatology and Venereology     Hybrid Journal   (Followers: 15)
Journal of the International AIDS Society     Open Access   (Followers: 10)
Journal of the Saudi Society of Dermatology & Dermatologic Surgery     Open Access   (Followers: 1)
Karger Kompass Dermatologie     Full-text available via subscription  
Karger Kompass Pneumologie     Full-text available via subscription   (Followers: 1)
Langenbeck's Archives of Surgery     Hybrid Journal   (Followers: 4)
Medical and Surgical Dermatology     Hybrid Journal   (Followers: 1)
Medical Mycology     Open Access   (Followers: 4)
Nepal Journal of Dermatology, Venereology & Leprology     Open Access   (Followers: 1)
Neurobehavioral HIV Medicine     Open Access   (Followers: 2)
OA Dermatology     Open Access   (Followers: 1)
Open AIDS Journal     Open Access  
Open Dermatology Journal     Open Access  
Perspectives On Sexual and Reproductive Health     Hybrid Journal   (Followers: 7)
Pigment International     Open Access   (Followers: 1)
Psoriasis : Targets and Therapy     Open Access   (Followers: 4)
Revista Internacional de Ciencias Podológicas     Open Access  
SAHARA : Journal of Social Aspects of HIV / AIDS Research Alliance     Open Access   (Followers: 5)
Scars, Burns & Healing     Open Access  
Serbian Journal of Dermatology and Venereology     Open Access   (Followers: 1)
Sex Education: Sexuality, Society and Learning     Hybrid Journal   (Followers: 5)
Sexual & Reproductive Healthcare     Hybrid Journal   (Followers: 2)
Sexual Health     Hybrid Journal   (Followers: 4)
Sexually Transmitted Diseases     Hybrid Journal   (Followers: 6)
Sexually Transmitted Infections     Hybrid Journal   (Followers: 6)
Skin Appendage Disorders     Full-text available via subscription   (Followers: 1)
Skin Pharmacology and Physiology     Full-text available via subscription   (Followers: 7)
Skin Research and Technology     Hybrid Journal   (Followers: 7)
Southern African Journal of HIV Medicine     Open Access   (Followers: 3)
Sri Lanka Journal of Sexual Health and HIV Medicine     Open Access  
Studies in Gender and Sexuality     Hybrid Journal   (Followers: 21)
Surgical & Cosmetic Dermatology     Open Access   (Followers: 3)
The Journal of Dermatology     Hybrid Journal   (Followers: 5)
The Rose Sheet     Full-text available via subscription   (Followers: 2)
Vestnik dermatologii i venerologii     Open Access  
Veterinary Dermatology     Hybrid Journal   (Followers: 8)


Similar Journals
Journal Cover
Langenbeck's Archives of Surgery
Journal Prestige (SJR): 1.053
Citation Impact (citeScore): 2
Number of Followers: 4  
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 1435-2451 - ISSN (Online) 1435-2443
Published by Springer-Verlag Homepage  [2624 journals]
  • Local, semi-automatic, three-dimensional liver reconstruction or external
           provider' An analysis of performance and time expense
    • Abstract: Purpose In hepatobiliary surgery, preoperative three-dimensional reconstruction based on CT or MRI can be provided externally or by local, semi-automatic software. We analyzed the time expense and quality of external versus local three-dimensional reconstructions. Methods Three first-year residents reconstructed data from 20 patients with liver pathologies using a local, semi-automatic, server-based program. Initially, five randomly selected patient datasets were segmented, with the visualization of an established external company available for comparison at all times (learning phase). The other fifteen cases were compared with the external datasets after completing local reconstruction (control phase). Total time expense/case and for specific manual and semi-automated reconstruction steps were recorded. Segmentation quality was analyzed by testing the equivalence for liver and tumor volumes, portal vein sectors, and hepatic vein territories. Results The median total reconstruction time was reduced from 2.5 h (learning phase) to 1.5 h (control phase) (− 42%; p < 0.001). Comparing the total and detailed liver volumes (sectors and territories) as well as the tumor volumes in the control phase equivalence was proven. In addition, a highly significant correlation between the external and local analysis was obtained over all analyzed segments with a very high ICC (median [IQR]: 0.98 [0.97; 0.99]; p < 0.01). Conclusion Local, semi-automatic reconstruction performed by inexperienced residents was feasible with an expert level time expense and the quality of the three-dimensional images was comparable with those from an external provider.
      PubDate: 2020-03-25
  • How to reduce anastomotic leakage in colorectal surgery—report from
           German expert meeting
    • Abstract: Aims Anastomotic leakage is one of the most worrisome complications in colorectal surgery. An expert meeting was organized to discuss and find a consensus on various aspects of the surgical management of colorectal disease with a possible impact on anastomotic leakage. Methods A three-step Delphi-method was used to find consensus recommendations. Results Strong consensus was achieved for the use of mechanical bowel preparation and oral antibiotics prior to colorectal resections, the abundance of non-selective NSAIDs, the preoperative treatment of severe iron deficiency anemia, and for attempting to improve the patients’ general performance in the case of frailty. Concerning technical aspects of rectal resection, there was a strong consensus in regard to routinely mobilizing the splenic flexure, to dividing the inferior mesenteric vein, and to using air leak tests to check anastomotic integrity. There was also a strong consensus on not to oversew the stapled anastomoses routinely, to use protective ileostomies for low rectal and intersphincteric, but not for high-rectal anastomoses. Furthermore, a consensus was reached in regard to using CT-scans with rectal contrast enema to evaluate suspected anastomotic leakage as well as measuring C-reactive protein routinely to monitor the postoperative course after colorectal resections. No consensus was found concerning the indication and technique for testing bowel perfusion, the routine use of endoscopy to check the integrity of the anastomosis, the placement of transanal drains for rectal anastomoses and the management of anastomotic leakage with peritonitis. Conclusion Consensus could be found for several practice details in the perioperative management in colorectal surgery that might have an influence on anastomotic leakage.
      PubDate: 2020-03-18
  • Endoscopic parathyroidectomy using a three-port submental approach
    • Abstract: Purpose The three-port submental endoscopic approach and its variations were introduced in 2016 and have been used for thyroidectomy since. However, there has been no report of this approach being used for parathyroidectomy [1, 2]. The objective of this paper was thus to report our experience using a three-port submental approach for endoscopic parathyroidectomy in challenging cases such as tertiary parathyroidism. Methods We compared the outcomes before and after endoscopic removal of the parathyroid glands using a three-port submental endoscopic approach. Results Endoscopic subtotal parathyroidectomy was performed using submental approach in five patients with tertiary hyperparathyroidism from January 2018 to June 2019. The parathyroid hormone levels of the patients dropped significantly after undergoing subtotal parathyroidectomy (mean difference 2260 pg/ml; 95% CI 1883.74 to 2636.65), as did calcium levels (mean difference 2.84 mg/dl; 95% CI 1.90 to 3.78). No major adverse events occurred in this study. Conclusions Submental approach parathyroidectomy allows for visualization of all parathyroid glands. Surgical scarring was minor and was hidden under the chin. The surgical outcomes were promising, and there were no major complications.
      PubDate: 2020-03-13
  • Comparing the efficacy and safety of laparoscopic and robotic
           adrenalectomy: a meta-analysis and trial sequential analysis
    • Abstract: Purpose A systematic literature review and a meta-analysis were designed and conducted, in order to provide an up-to-date comparison of the robotic (RA) and laparoscopic (LA) adrenalectomy in terms of perioperative efficacy and safety. Methods The present meta-analysis was completed in accordance with the guidelines provided by the PRISMA study group and the Cochrane Handbook for Systematic Reviews of Interventions. The electronic scholar databases (Medline, Web of Science, Scopus) were screened. For the reduction of type I errors, a trial sequential analysis (TSA) was performed. Results Overall, 21 studies and 2997 patients were included in this study. RA was associated with a significantly lower open conversion rate (OR: 1.79; 95%CI: 1.10, 2.92) and length of hospitalization (LOS WMD: 0.52; 95%CI: 0.2, 0.84). Marginal results regarding blood loss were recorded (WMD: 2.02; 95%CI: 0.0, 4.03). TSA could not validate the superiority of RA in open conversion rate and blood loss. LA and RA were similar in terms of operative duration (P = 0.18) and positive margin (P = 0.81), complications (P = 0.94) and mortality rate (P = 0.45). Conclusions Even though RA and LA were equivalent regarding perioperative safety, RA was associated with a favorable LOS.
      PubDate: 2020-03-04
  • Role of lymphadenectomy, adjuvant chemotherapy, and treatment at
           high-volume centers in patients with resected pancreatic cancer—a
           distinct view on lymph node yield
    • Abstract: Purpose While the importance of lymphadenectomy is well-established for patients with resectable pancreatic cancer, its direct impact on survival in relation to other predictive factors is still ill-defined. Methods The National Cancer Data Base 2006–2015 was queried for patients with resected pancreatic adenocarcinoma (stage IA–IIB). Patients were dichotomized into the following two groups, those with 1–14 resected lymph nodes and those with ≥ 15. Optimal number of resected lymph nodes and the effect of lymphadenectomy on survival were assessed using various statistical modeling techniques. Mediation analysis was performed to differentiate the direct and indirect effect of lymph node resection on survival. Results A total of 21,912 patients were included; median age was 66 years (IQR 59–73), 48.9% were female. Median number of resected lymph nodes was 15 (IQR 10–22), 10,163 (46.4%) had 1–14 and 11,749 (53.6%) had ≥ 15 lymph nodes retrieved. Lymph node positivity increased by 4.1% per lymph node up to eight examined lymph nodes, and by 0.6% per lymph node above eight. Five-year overall survival was 17.9%. Overall survival was better in the ≥ 15 lymph node group (adjusted HR 0.91, CI 0.88–0.95, p < 0.001). On a continuous scale, survival improved with increasing LNs collected. Patients who underwent adjuvant chemotherapy and were treated at high-volume centers had improved overall survival compared with their counterparts (adjusted HR 0.59, CI 0.57–0.62, p < 0.001; adjusted HR 0.86, CI 0.83–0.89, p < 0.001, respectively). Mediation analysis revealed that lymphadenectomy had only 18% direct effect on improved overall survival, while 82% of its effect were mediated by other factors like treatment at high-volume hospitals and adjuvant chemotherapy. Discussion While higher number of resected lymph nodes increases lymph node positivity and is associated with better overall survival, most of the observed survival benefit is mediated by chemotherapy and treatment at high-volume centers.
      PubDate: 2020-02-10
  • Radiologically occult metastatic pancreatic cancer: how can we avoid
           unbeneficial resection'
    • Abstract: Purpose This study aimed to clarify the key factors for minimizing unsuitable surgical interventions for patients with radiologically occult metastatic pancreatic cancer (ROMPC), defined as a distant metastasis detected during surgery or within 6 months after resection. Methods This study involved 502 patients planned to undergo curative resection for pancreatic cancer between 2008 and 2015. Patients were divided into ROMPC and non-ROMPC groups and evaluated preoperative factors associated with ROMPC. Results Overall survival (OS) was significantly lower in the ROMPC group (n = 145) than the non-ROMPC group (n = 357, median survival time [MST] 10.8 vs. 35.3 months, P < 0.001). In the ROMPC group, OS tended to be worse for patients who had pancreatectomies (n = 84) than those who did not (n = 61, MST 10.1 vs. 13.2 months, P = 0.057), and the next chemotherapy started significantly later in patients who had pancreatectomies (P < 0.001). Moreover, OS was significantly lower for patients with (n = 82) than without (n = 63) liver metastases (MST 9.7 vs. 13.0 months, respectively, P = 0.020). The best indicator for patients at higher risk of ROMPC was a combination of carbohydrate antigen 19-9 concentration ≥ 300 U/ml and tumor size ≥ 30 mm. Conclusions In the ROMPC group, patients who underwent pancreatectomy had a poorer prognosis than patients not undergoing pancreatectomy. Given that the liver was the most frequent distant metastatic site for ROMPC and had the poorest prognosis, establishing a strategy featuring new imaging modalities to detect radiologically occult liver metastases is necessary.
      PubDate: 2020-02-01
  • Gender comparison of clinical, histopathological, therapeutic and outcome
           factors in 185,967 colon cancer patients
    • Abstract: Introduction Colorectal carcinomas represent the third most common cause of cancer-related deaths in Germany. Although the incidence is significantly higher in men compared with women and gender is a well-established crucial factor for outcome in other diseases, detailed gender comparisons for colon cancer are lacking. Methods This retrospective population-based cohort study included all patients diagnosed with colon cancer in Germany between 2000 and 2016 who were included in the common dataset of colorectal cancer patients from the quality conference of the German Cancer Society. We compared clinical, histopathological, and therapeutic characteristics as well as overall and recurrence-free survival. Results A total of 185,967 patients were included in the study, of which 85,685 were female (46.1%) and 100,282 were male (53.9%). The proportion of women diagnosed with colon cancer decreased from 2000 to 2016 (f: 26.6 to 40.1%; m: 24.9 to 41.9%; p < 0.001), and the proportion of very old patients was especially high in women (f: 27.3%; m: 15.6%; p < 0.001). The localization in women was more right-sided (f: 45.0%, m: 36.7%; p < 0.001), and women had a higher tumor grading and a higher UICC stage (especially stage III nodal-positive) at diagnosis of primary colon cancer (UICC III: f: 22.7%, m: 21.0%; p < 0.001). We could detect a significantly better overall (hazard ratio: 0.853, lower 95%: 0.841, upper 95%: 0.864; p < 0.001) and recurrence-free survival (hazard ratio: 0.857, lower 95%: 0.845, upper 95%: 0.868; p < 0.001) in women compared with men, even though women received chemotherapy less frequently compared with men (f: 26.1%, m: 28.1%; p < 0.001). Conclusion We could detect several variables that differed significantly between men and women regarding clinical, histopathological, therapeutic, and outcome factors. We believe that it is crucial to consider gender as a key factor in the diagnosis and treatment of colon cancer. Sex-specific diagnostic tools could lead to an earlier diagnosis of colon cancer in women, and ways to increase the rate of chemotherapy in women should be evaluated. Furthermore, we recommend stratifying randomized trials by gender.
      PubDate: 2020-01-31
  • Live surgical demonstrations for minimally invasive colorectal training
    • Abstract: Purpose Live surgical demonstrations are considered an effective educational tool providing a chance for trainees to observe a real-time decision-making process of expert surgeons. No data exists evaluating the impact of live surgical demonstrations on the outcomes of minimally invasive colorectal surgery. This study evaluates perioperative and short-term postoperative outcomes in patients undergoing minimally invasive colorectal surgery in the setting of live surgical demonstrations. Methods Patients undergoing minimally invasive colorectal surgery which was performed as live surgical demonstrations (the study group) performed between 2006 and 2018 were reviewed. These patients were case-matched with those undergoing operations in routine practice (the control group). The study and control group were compared for intraoperative and short-term postoperative outcomes. Results Thirty-nine live surgery cases in the study group were case-matched with its thirty-nine counterparts as the control group. Operating time was longer (200 vs 165 min; p = 0.002) and estimated intraoperative blood loss was higher in the study group (100 vs 55 ml; p = 0.008). Patients in the study group stayed longer in the hospital (6 vs 5 days; p = 0.001). While conversion (n = 4 vs n = 1, p = 0.358) and intraoperative complications (n = 6 vs n = 2, p = 0.2) were more frequent in the study group, these outcomes did not reach statistical significance. Overall complications were higher in the study group (n = 22 vs n = 9, p = 0.003). One patient underwent a reoperation due to postoperative bleeding, and one mortality occurred in the live surgery group. Conclusions Live surgical demonstrations in minimally invasive colorectal surgery seem to be associated with increased risk of operative morbidity.
      PubDate: 2020-01-31
  • Diffusion-weighted MRI predicts the histologic response for neoadjuvant
           therapy in patients with pancreatic cancer: a prospective study (DIFFERENT
    • Abstract: Purpose Pre-operative prediction of histological response to neoadjuvant therapy aids decisions regarding surgical management of borderline resectable pancreatic cancer (BRPC). We elucidate correlation between pre-/post-treatment whole-tumor apparent diffusion coefficient (ADC) value and rate of tumor cell destruction. We newly verify whether post-treatment ADC value at the site of vascular contact predicts R0 resectability of BRPC. Methods We prospectively reviewed 28 patients with BRPC who underwent diffusion-weighted magnetic resonance imaging before neoadjuvant chemotherapy and surgery. Correlation between the percentage of tumor cell destruction and various parameters was analyzed. Strong parameters were assessed for their ability to predict therapeutic histological response and R0 resectability. Results Pre-/post-treatment whole-tumor ADC value correlated with tumor cell destruction rate by all parameters (R = 0.630/0.714, P < 0.001/< 0.0001). The post-treatment cutoff value of ADC at the site of vascular contact for discriminating histological response of tumor destruction of ≤ 50% and tumor destruction of > 50% was determined at 1.42 × 10−3 mm2/s. It predicts R0 with 88% sensitivity, 50% specificity, and 61% accuracy. For histological response, the post-treatment whole-tumor ADC cutoff value for discriminating between tumor destruction of ≤ 50% and tumor destruction of > 50% was determined at 1.40 × 10−3 mm2/s. It predicts histological response with 100% sensitivity, 81% specificity, and 89% accuracy. It predicts R0 with 88% sensitivity, 70% specificity, and 75% accuracy. Conclusions Post-treatment whole-tumor ADC value may be a predictor of R0 resectability in patients with BRPC. Tumor cell destruction rate is indicated by the difference between pre-/post-treatment ADC values. This difference is strongly affected by the pre-treatment ADC value. The cutoff value of ADC at the site of vascular contact could not discriminate R0 resectability.
      PubDate: 2020-01-28
  • Pancreaticojejunostomy—a review of modern techniques
    • Abstract: Background Pancreaticojejunal anastomosis is one of the most demanding procedures in surgery. Up to now, no technique has been proven to reduce the incidence of POPF when compared to the other methods. Purpose The aim of this review was to provide a concise and illustrated description of the most recent methods of pancreaticojejunostomy. Their development was directly related to the still ongoing search by surgeons for such a technique of anastomosis that would eliminate the problem of POPF. Conclusions Knowledge of various techniques of anastomosis may help the surgeon to find the most suitable and optimal method of pancreatic-intestinal anastomosis for the patient.
      PubDate: 2020-01-23
  • Comparison of short-term surgical outcome between 3D and 2D laparoscopy
           surgery for gastrointestinal cancer: a systematic review and meta-analysis
    • Abstract: Background Three-dimensional (3D) laparoscopic surgery is becoming more popular with the development of laparoscopic devices. The objective of this study was to explore whether the 3D imaging system could improve surgical outcomes of laparoscopic surgery for gastrointestinal cancer compared with the 2D imaging system. Methods Systematic literature search was performed using PubMed and Embase databases and relevant data were extracted. Surgical quality, postoperative complications, and postoperative recovery between 3D and 2D laparoscopic surgery groups were compared using a fixed or random effect model. Results A total of 12 studies involving 1456 patients (3D group 683 patients and 2D group 773 patients) were included in this meta-analysis. The results indicated that mean operation time was significantly shorter in 3D group than in 2D group (WMD, − 9.08; 95% CI, − 14.77, − 3.40; P = 0.002; I2 = 70.3%), especially for gastric cancer patients (WMD, − 14.61; 95% CI, − 26.00, − 3.23, P = 0.012; I2 = 74.1%). In addition, 3D laparoscopic surgery for gastric cancer had an advantage than 2D group in reducing the amount of intraoperative blood loss (WMD, − 13.60, 95% CI, − 21.48, − 5.72; P = 0.001; I2 = 0%). The number of retrieved lymph nodes in 3D group was not significantly different from that in 2D group, regardless of laparoscopic gastrectomy (WMD, 1.10; 95% CI, − 0.67, 2.88; P = 0.222; I2 = 18.8%) and laparoscopic colorectal surgery (WMD, 0.55, 95% CI; − 1.99, 3.09; P = 0.671; I2 = 76.9%). In addition, there was no significant difference between 3D and 2D laparoscopic surgery for postoperative complications and postoperative recovery. Conclusion Main advantages of 3D laparoscopic gastrectomy for gastric cancer were that it could shorten the operation time and reduce the amount of intraoperative blood loss. However, 3D laparoscopic surgery had no obvious advantage over 2D laparoscopic surgery for colorectal cancer patients.
      PubDate: 2020-01-22
  • Sleeve gastrectomy for treatment of delayed gastric
           emptying—indications, technique, and results
    • Abstract: Introduction Delayed gastric emptying (DGE) can be caused by gastric motility disorders such as gastroparesis with idiopathic background, diabetic neuropathy, or postsurgical nerve damage. Currently, a variety of endoscopic and surgical treatment options are available. We noted clinical improvement of gastric emptying with reduction of the gastric fundus following both fundoplication and fundectomy. As a consequence, we explored the effect of sleeve gastrectomy on gastric emptying. The focus of this paper is to investigate the role of laparoscopic sleeve gastrectomy (LSG) in the treatment of gastroparesis. Methods Patients with symptoms suggestive of gastroparesis received diagnostic work-up (gastric emptying scintigraphy and/or Radiographic Barium-Sandwich Emptying studies). Patients with fundic emptying problems and moderate gastric dilation were selected for a LSG. All perioperative parameters were documented regarding patients characteristics, complications, and outcomes expressed as symptoms and quality of life (GIQLI gastrointestinal quality of life index). Assessment of DGE: Barium Emptying Radigraphy Index (BERI) 0–5. Results From 122 patients with gastroparesis, 19 patients were selected for LSG (mean age 54 years (23–68); 10 males/9 females. Morbidity 2/19; no mortality; follow-up mean 24 months (12–60); preop/postop: BERI: 2, 31/1, 27 (p < 0.01); we noted significant improvement of the quality of life (preoperative GIQLI 78 (44–89)) to postoperative values of 114 (range 87–120) (p < 0.0001). Preoperative median BMI of these 19 patients was 24 [1–10], which was not significantly changed in the 15 patients at > 1 year follow-up with 23 [1–8]. Postoperative recurrence of DGE occurred in 3 patients who were reoperated after >1 year follow-up. Conclusion LSG is a potential surgical treatment option for selected patients with gastroparesis and fundic emptying problems.
      PubDate: 2020-01-20
  • Intra-abdominal pressure may be elevated in patients with open abdomen
           after emergent laparotomy
    • Abstract: Purpose To estimate the change in intra-abdominal pressure (IAP) among critically ill patient who were left with open abdomen and temporary abdominal closure after laparotomy, during the first 48 h after admission. Methods A cohort study in a single ICU in a tertiary care hospital. All adult patients admitted to the ICU after emergent laparotomy for acute abdomen or trauma, who were left with temporary abdominal closure (TAC), were included. Patients were followed up to 48 h. IAP was routinely measured at 0, 6, 12, 24, and 48 h after admission to ICU. Results Thirty-nine patients were included, 34 were operated due to acute abdomen and 5 due to abdominal trauma. Seventeen patients were treated with skin closure, 13 with Bogota bag, and 9 with negative pressure wound therapy (NPWT). Eleven patients (28.2%) had IAP of 15 mmHg or above at time 0, (mean pressure 19.0 ± 3.0 mmHg), and it dropped to 12 ± 4 mmHg within 48 h (p < 0.01). Reduction in lactate level (2.4 ± 1.0 to 1.2 ± 0.2 mmol/L, p < 0.01) and increase in PaO2/FiO2 ratio (163 ± 34 to 231 ± 83, p = 0.03) were observed as well after 48 h. Conclusions This is the first large report of IAP in open abdomen. Elevated IAP may be measured in open abdomen and may subsequently relieve after 48 h.
      PubDate: 2020-01-18
  • Extended hepatic metastasectomy for renal cell carcinoma—new aspects in
           times of targeted therapy: a single-center experience over three decades
    • Abstract: Purpose Despite the introduction of novel targeted therapies on patients with renal cell carcinoma, syn- and metachronous metastases (including hepatic lesions) are observed frequently and significantly influence patient survival. With introduction of targeted therapies as an effective alternative to surgery, therapeutical strategies in stage IV disease must be reevaluated. Methods This is a retrospective analysis of 40 patients undergoing hepatic resection of histologically confirmed RCC metastases at our institution between April 1993 and April 2017. Results The interval between nephrectomy for renal cell carcinoma and hepatic metastasectomy was 44.0 months (3.3–278.5). Liver resections of different extents were performed, including multivisceral resections. The median follow-up was 37.8 months (0.5–286.5). Tumor recurrence after resection of hepatic metastases occurred in 19 patients resulting in a median disease-free survival of 16.2 months (0.7–265.1) and a median overall survival of 37.8 months (0.5–286.5). Multivariable analysis identified multivisceral resection as an independent risk factor for disease-free and overall survival (p = 0.043 and p = 0.001, respectively). A longer interval between nephrectomy and hepatic metastasectomy was identified as an independent significant protective factor for overall survival (p < 0.001). Patients undergoing metastasectomy after introduction of sunitinib in Europe in 2006 (n = 15) showed a significantly longer overall survival (45.2 (9.1–111.0) versus 27.5 (0.5–286.52) months in the preceding era; p = 0.038). Conclusion Hepatic metastasectomy, including major and extended resections, on patients with metastasized renal cell carcinoma can be performed safely and may facilitate long-term survival. Due to significant morbidity and increased mortality, multivisceral resections must be weighed against other options, such as targeted therapy.
      PubDate: 2020-01-14
  • Interdisciplinary approach allows minimally invasive, nerve-sparing
           removal of retroperitoneal peripheral nerve sheath tumors
    • Abstract: Purpose En bloc resection of retroperitoneal peripheral nerve sheath tumors (PNST) is advocated by a variety of surgical disciplines. Yet, microsurgical, nerve-sparing tumor resection might be better suited to improve symptoms and maintain neurological function, especially in cases where patients present with preoperative neurological deficits. However, neurosurgeons, versed in nerve-sparing techniques to remove PNST, are generally unfamiliar with the visceral approaches to retroperitoneal PNST. Methods We retrospectively evaluate a series of 16 patients suffering from retroperitoneal PNST. Patients were treated by a unique interdisciplinary approach, combining the visceral surgeon’s skills to navigate the complex anatomy of the retroperitoneal space and the neurosurgeon’s familiarity with microsurgical, nerve-sparing tumor removal. Specifically, we assess whether our interdisciplinary approach is suited to improve preoperative symptoms and maintain neurological function and study whether oncological outcome, surgical morbidity, and operative times are comparable to those reported for “classical” retroperitoneal PNST resection. In addition, we study two cases of suspected PNST that were diagnosed as malignant peripheral nerve sheath tumors (MPNST) after surgery. Results Total macroscopic tumor resection was achieved in 14/16 PNST patients. Mean intraoperative blood loss was 680.6 ml (95% CI, 194.3–1167.0 ml) and mean operative time was 162.5 min (95% CI, 121.6–203.4 min). We did not record any major postoperative surgical or neurological complications. A total of 8/11 patients with preoperative pain symptoms reported long-lasting improvement of their symptoms. In terms of oncological outcome, all patients that had been subjected to total tumor removal and for whom follow-up was available, were tumor-free after a mean follow-up of 761.9 days (95% CI, 97.6–1426.0 days). One of the two MPNST patients, who presented with tumor progress 15 months after initial surgery, was subjected to radical re-resection. Conclusions Interdisciplinary, nerve-sparing removal of retroperitoneal PNST is well suited to improve preoperative symptoms and maintain neurological function, while achieving an oncological outcome and a surgical morbidity similar to previously reported results for radical retroperitoneal PNST resection. Radical re-resection was feasible in a patient with post hoc MPNST diagnosis.
      PubDate: 2020-01-11
  • Surgical technique for placement of the automated low flow ascites pump
    • Abstract: Abstract Approximately 10% of patients with ascites associated with cirrhosis fail to respond to dietary rules and diuretic treatment and therefore present with refractory ascites. In order to avoid iterative large-volume paracentesis in patients with contraindication to TIPS, the automated low flow ascites pump system (Alfapump) was developed to pump ascites from the peritoneal cavity into the urinary bladder, where it is eliminated spontaneously by normal micturition. This manuscript reports the surgical technique for placement of the Alfapump.
      PubDate: 2020-01-08
  • Albumin difference as a new predictor of pancreatic fistula following
           distal pancreatectomy: a retrospective study of 211 consecutive patients
    • Abstract: Purpose The level of albumin declines after surgery, and whether the difference between preoperative and postoperative albumin levels on postoperative day 1 has an effect on the development of postoperative pancreatic fistula (POPF) after distal pancreatectomy (DP) is unclear. Our aim was to evaluate the effect of albumin difference on POPF. Methods A retrospective analysis of consecutive patients who had undergone DP between January 2016 and October 2018 at a single institution was conducted. Patient demographic data and perioperative data were analysed using univariate and multivariate models. Pancreatic fistula was defined by the 2016 International Study Group of Pancreatic Surgery criteria. All patients were followed for up to 90 days. Results A total of 211 consecutive patients were identified. The POPF rate was 15.64%, and no 90-day mortality was observed. Five predictors were independently associated with POPF: albumin difference (OR 6.60, 95% CI 2.36–18.45, P < 0.001), pancreatic texture (OR 4.15, 95% CI 1.62–10.63, P = 0.003), operative time (OR 3.13, 95% CI 1.19–8.24, P = 0.021), intraoperative fluid transfusion (OR 4.85, 95% CI 1.70–13.79, P = 0.003), and cardiovascular disease (OR 5.38, 95% CI 1.99–14.55, P = 0.001). Conclusions Although DP can be performed with a low rate of mortality, POPF remains a common complication. Albumin difference is a new, accessible predictor for POPF following DP.
      PubDate: 2020-01-03
  • A retrospective case control study identifies peripheral blood mononuclear
           cell albumin RNA expression as a biomarker for non-alcoholic fatty liver
    • Abstract: Purpose Non-alcoholic fatty liver disease (NAFLD) improves after bariatric surgery. The aim of this study was to determine whether peripheral blood mononuclear cell albumin gene expression was related to NAFLD and whether albumin (ALB) and alpha fetoprotein (AFP) expression could be detected in whole blood and visceral adipose tissue. Methods Using a retrospective case control study design, RNA isolated from peripheral blood mononuclear cells from patients prior to undergoing bariatric surgery was used for pooled microarray analysis. Quantitative polymerase chain reaction (QPCR) was used to analyze whole blood and visceral adipose tissue. Liver histology was obtained via intra-operative biopsy and clinical data extracted from the electronic health record. Results The albumin (ALB) gene was the second most up-regulated found in microarray analysis of peripheral blood mononuclear cell RNA from patients with hepatic lobular inflammation versus normal liver histology. Transcript levels of ALB were significantly different across those with normal (n = 50), steatosis (n = 50), lobular inflammation (n = 50), and peri-sinusoidal fibrosis (n = 50) liver histologies, with lobular inflammation 3.9 times higher than those with normal histology (p < 0.017). Albumin expression levels decreased in 11/13 patients in paired samples obtained prior to and at 1 year after Roux-en-Y gastric bypass surgery. ALB expression could be detected in 23 visceral adipose tissue samples obtained intra-operatively and in 18/19 available paired whole blood samples. No significant correlation was found between ALB expression in visceral adipose tissue and whole blood RNA samples. Alpha fetoprotein expression as a marker of early hepatocytic differentiation was detected in 17/17 available VAT RNA samples, but in only 2/17 whole blood RNA samples. Conclusion Albumin RNA expression from blood cells may serve as a biomarker of NAFLD. Albumin and alpha fetoprotein appear to be ubiquitously expressed in visceral adipose tissue in patients with extreme obesity.
      PubDate: 2019-12-11
  • Development of a severe mesenteric traction syndrome during major
           abdominal surgery is associated with increased postoperative morbidity:
           Secondary data analysis on prospective cohorts
    • Abstract: Purpose MTS is elicited during open abdominal surgery and is characterized by facial flushing, hypotension, and tachycardia in response to the release of prostacyclin (PGI2) to plasma. MTS seems to affect postoperative morbidity, but data from larger cohorts are lacking. We aimed to determine the impact of severe mesenteric traction syndrome (MTS) on postoperative morbidity in patients undergoing open upper gastrointestinal surgery. Methods The study was a secondary analysis of data from three cohorts (n = 137). The patients were graded for severity of MTS intraoperatively, and hemodynamic variables and blood samples for plasma 6-keto-PGF1α, a stable metabolite of PGI2, were obtained at defined time points. Postoperative morbidity was evaluated by the comprehensive complication index (CCI) and the Dindo-Clavien classification (DC). Results Patients undergoing either esophagectomy (n = 70), gastrectomy (n = 22), liver- (n = 23), or pancreatic resection (n = 22) were included. Severe MTS was significantly associated with increased postoperative morbidity, i.e., CCI ≥ 26.2 (OR 3.06 [95% CI 1.1–6.6]; p = 0.03) and risk of severe complications, i.e., DC ≥3b (OR 3.1 [95% CI 1.2–8.2]; p = 0.023). Furthermore, patients with severe MTS had increased length of stay (OR 10.1 [95% CI 1.9–54.3]; p = 0.007) and were more likely to be admitted to the intensive care unit (OR = 7.3 [95% CI 1.3–41.9]; p = 0.027), but there was no difference in 1-year mortality. Conclusion Occurrence of severe MTS during upper gastrointestinal surgery is associated with increased postoperative morbidity as indicated by an increased rate of severe complications, length of stay, and admission to the ICU. It remains to be determined whether inhibition of MTS enhances postoperative recovery.
      PubDate: 2019-12-09
  • Training in endocrine surgery
    • Abstract: Background/purpose In Europe, the Division of Endocrine Surgery (DES) determines the number of operations (thyroid, neck dissection, parathyroids, adrenals, neuroendocrine tumors of the gastro-entero-pancreatic tract (GEP-NETs)) to be required for the European Board of Surgery Qualification in (neck) endocrine surgery. However, it is the national surgical boards that determine how surgical training is delivered in their respective countries. There is a lack of knowledge on the current situation concerning the training of surgical residents and fellows with regard to (neck) endocrine surgery in Europe. Methods A survey was sent out to all 28 current national delegates of the DES. One questionnaire was addressing the training of surgical residents while the other was addressing the training of fellows in endocrine surgery. Particular focus was put on the numbers of operations considered appropriate. Results For most of the operations, the overall number as defined by national surgical boards matched quite well the views of the national delegates even though differences exist between countries. In addition, the current numbers required for the EBSQ exam are well within this range for thyroid and parathyroid procedures but below for neck dissections as well as operations on the adrenals and GEP-NETs. Conclusions Training in endocrine surgery should be performed in units that perform a minimum of 100 thyroid, 50 parathyroid, 15 adrenal, and/or 10 GEP-NET operations yearly. Fellows should be expected to have been the performing surgeon of a minimum of 50 thyroid operations, 10 (central or lateral) lymph node dissections, 15 parathyroid, 5 adrenal, and 5 GEP-NET operations.
      PubDate: 2019-11-07
School of Mathematical and Computer Sciences
Heriot-Watt University
Edinburgh, EH14 4AS, UK
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