scholarly journals Surgery for chronic pancreatitis: the comparison of two high-volume centers reveals lack of a uniform operative management

2021 ◽  
Author(s):  
Niccolò Surci ◽  
Claudio Bassi ◽  
Roberto Salvia ◽  
Giovanni Marchegiani ◽  
Luca Casetti ◽  
...  
Keyword(s):  
Chronic Pancreatitis ◽  
High Volume ◽  
Clinical History ◽  
Operative Management ◽  
Analysis Data ◽  
Time Frame ◽  
Timing Of Surgery ◽  
Operative Techniques ◽  
Surgical Units ◽  
Treatment Disparities

Abstract Purpose Many aspects of surgical therapy for chronic pancreatitis (CP), including the correct indication and timing, as well as the most appropriate operative techniques, are still a matter of debate in the surgical community and vary widely across different centers. The aim of the present study was to uncover and analyze these differences by comparing the experiences of two specialized surgical units in Italy and Austria. Methods All patients operated for CP between 2000 and 2018 at the two centers involved were included in this retrospective analysis. Data regarding the clinical history and the pre- and perioperative surgical course were analyzed and compared between the two institutions. Results Our analysis showed a progressive decrease in the annual rate of pancreatic surgical procedures performed for CP in Verona (no. = 91) over the last two decades (from 3% to less than 1%); by contrast, this percentage increased from 3 to 9% in Vienna (no. = 77) during the same time frame. Considerable differences were also detected with regard to the timing of surgery from the first diagnosis of CP — 4 years (IQR 5.5) in the Austrian series vs two (IQR 4.0) in the Italian series -, and of indications for surgery, with a 12% higher prevalence of groove pancreatitis among patients in the Verona cohort. Conclusion The comparison of the surgical attitude towards CP between two surgical centers proved that a consistent approach to this pathology still is lacking. The identification of common guidelines and labels of surgical eligibility is advisable in order to avoid interinstitutional treatment disparities.

Outcomes of surgical treatment in chronic pancreatitis - 13 years of experience of the high volume center

Pancreatology ◽  
2018 ◽  
Vol 18 (4) ◽  
pp. S113
Author(s):  
Michal Hampel ◽  
Agnieszka Surowiecka-Pastewka ◽  
Marta Matejak-Górska ◽  
Marek Durlik
Keyword(s):  
Chronic Pancreatitis ◽  
Surgical Treatment ◽  
High Volume ◽  
Years Of Experience ◽  
High Volume Center

scholarly journals NutriCatt Protocol Improves Body Composition and Clinical Outcomes in Elderly Patients Undergoing Colorectal Surgery in ERAS Program: A Retrospective Cohort Study

Nutrients ◽  
2021 ◽  
Vol 13 (6) ◽  
pp. 1781
Author(s):  
Emanuele Rinninella ◽  
Alberto Biondi ◽  
Marco Cintoni ◽  
Pauline Raoul ◽  
Francesca Scialanga ◽  
...  
Keyword(s):  
Body Composition ◽  
Colorectal Surgery ◽  
Elderly Patients ◽  
Clinical Outcomes ◽  
Cell Mass ◽  
Length Of Hospital Stay ◽  
Bioelectrical Impedance ◽  
High Volume ◽  
Analysis Data ◽  
Perioperative Outcomes

Background: A poor body composition, often found in elderly patients, negatively impacts perioperative outcomes. We evaluated the effect of a perioperative nutritional protocol (NutriCatt) on body composition and clinical outcomes in a cohort of elderly patients undergoing colorectal surgery in a high-volume center adopting the ERAS program. Methods: 302 out of 332 elderly (>75 years) patients from 2015 to 2020 were identified. Patients were divided according to their adherence, into “NutriCatt + ERAS” (n = 166) or “standard ERAS” patients (n = 136). Anthropometric and bioelectrical impedance analysis data were evaluated for NutriCatt + ERAS patients. Complications, length of hospital stay (LOS), and other postoperative outcomes were compared between both groups. Results: In NutriCatt + ERAS patients, significant improvements of phase angle (pre-admission vs. admission 4.61 ± 0.79 vs. 4.84 ± 0.85; p = 0.001; pre-admission vs. discharge 4.61 ± 0.79 vs. 5.85 ± 0.73; p = 0.0002) and body cell mass (pre-admission vs. admission 22.4 ± 5.6 vs. 23.2 ± 5.7; p = 0.03; pre-admission vs. discharge 22.4 ± 5.6 vs. 23.1 ± 5.8; p = 0.02) were shown. NutriCatt + ERAS patients reported reduced LOS (p = 0.03) and severe complications (p = 0.03) compared to standard ERAS patients. A regression analysis confirmed the protective effect of the NutriCatt protocol on severe complications (OR 0.10, 95% CI 0.01–0.56; p = 0.009). Conclusions: The NutriCatt protocol improves clinical outcomes in elderly patients and should be recommended in ERAS colorectal surgery.

scholarly journals Work Stress among Professionals in Building Construction Industry in Nigeria

2011 ◽  
Vol 11 (3) ◽  
pp. 45-57 ◽  
Author(s):  
Eziyi Offia Ibem ◽  
Michael Nwabueze Anosike ◽  
Dominic Ezenwa Azuh ◽  
Tim O. Mosaku
Keyword(s):  
Construction Industry ◽  
Work Stress ◽  
Management Strategies ◽  
High Volume ◽  
Time Frame ◽  
Building Construction ◽  
Stress Factors ◽  
Project Delivery ◽  
Building Projects ◽  
Structural Engineers

This study was undertaken to identify key stress factors among professionals in building construction industry in Nigeria. This is in view of the fact that to date, very little is known about work stress among professionals in building construction industry in this country. The study involved the administration of questionnaire to 107 professionals including architects, builders, civil/structural engineers and quantity surveyors randomly selected from 60 ongoing building projects in Anambra, Ogun and Kaduna States, Nigeria. The data was analysed using descriptive statistics, and findings show that the principal sources of stress were high volume of work, uncomfortable site office environment, lack of feedback on previous and ongoing building projects, and variations in the scope of work in ongoing building projects. The paper suggests that taking responsibility for work which one has adequate capacity to handle, establishing realistic budgets and time frame for project delivery, provision of spatially adequate, visually and thermally comfortable site offices, adoption of appropriate job design practice and education of professionals on stress management strategies will reduce the incidence of stress among professionals in building industry in Nigeria. 

scholarly journals Diagnostic value of research methods in diagnostics of chronic pancreatitis

2021 ◽  
Vol 102 (4) ◽  
pp. 528-536
Author(s):  
G R Aliyeva
Keyword(s):  
Chronic Pancreatitis ◽  
Early Stage ◽  
Imaging Modality ◽  
Magnetic Resonance Cholangiopancreatography ◽  
Clinical History ◽  
Diagnostic Value ◽  
Diagnostic Tools ◽  
Invasive Approach ◽  
Pancreas Function ◽  
Function Testing

Chronic pancreatitis remains an unsolved problem for clinicians. One of the biggest dilemmas is to establish a clear diagnosis. Diagnosis can be particularly elusive in patients with early chronic pancreatitis. Many studies have been undertaken to improve diagnostics in chronic pancreatitis, but this has been significantly limited by the lack of a gold standard. The evaluation of patients with suspected chronic pancreatitis should follow a progressively non-invasive to more invasive approach. Computed tomography is the best primary imaging modality to obtain as it has good sensitivity for severe chronic pancreatitis and may exclude the need for other diagnostic tests. When ambiguous results are obtained, a magnetic resonance cholangiopancreatography may require for a more detailed evaluation of both the pancreatic parenchyma and ducts. If the diagnosis remains in doubt, endoscopic ultrasound with or without pancreas function testing becomes the preferred method. Endoscopic retrograde cholangiopancreatography remains a last line diagnostic test and generally should be used only for diagnostic purposes. Future researches in the field of diagnosis of early-stage chronic pancreatitis should purpose optimizing current diagnostic tools. A definitive diagnosis of chronic pancreatitis may not be made simply by clinical history, imaging or function testing alone, but rather by the data gathered by a combination of these diagnostic tools.

A Modern Review of the Operative Management of Chronic Pancreatitis

2010 ◽  
Vol 76 (10) ◽  
pp. 1071-1074 ◽  
Author(s):  
Jonathan C. King ◽  
Shannon Abeywardina ◽  
James J. Farrell ◽  
Howard A. Reber ◽  
O. Joe Hines
Keyword(s):  
Quality Of Life ◽  
Chronic Pancreatitis ◽  
Short Form ◽  
Operative Management ◽  
Poor Quality ◽  
Whipple Procedure ◽  
Life Questionnaire ◽  
Historical Controls

Chronic pancreatitis is a debilitating disease resulting in pain, intestinal malabsorption, endocrine dysfunction, and poor quality of life (QoL). Our aim was to analyze surgical outcomes for patients with chronic pancreatitis. Data for patients undergoing operations for chronic pancreatitis between 1990 and 2009 were reviewed. Demographics, operative and perioperative data, and survival were catalogued. QoL was determined (Short Form 36 and European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire + PAN-26) and compared with historical controls. The mean age was 51 ± 2 years, 38 patients were male (53%), the most common indication was pain (71%), the etiology of pancreatitis often was alcohol, and most patients underwent a Whipple procedure (56%). Operative time was 316 ± 17 minutes and blood loss was 363 ± 75 mL. There were 34 complications in 30 patients (42%) and one death. QoL surveys were administered for 25 of 55 (45%) surviving patients at a mean follow-up of 72 ± 16 months. Mean survival was 99 ± 9 months, whereas 5- and 10-year survival were 86 and 75 per cent. QoL scores were uniformly better than historical controls. Our data demonstrate that operations for chronic pancreatitis can be performed with acceptable morbidity and mortality. Patients have excellent survival and improved QoL compared with historical controls. Surgery is an effective and durable treatment option for patients with chronic pancreatitis.

scholarly journals Age- and Occupation-Based Public Health Considerations Related to Osteoarthritis of the Knee Joint: A Cadaveric Study

Cartilage ◽  
2018 ◽  
Vol 10 (2) ◽  
pp. 238-244 ◽  
Author(s):  
Jessica Immonen ◽  
Chris Siefring
Keyword(s):  
Articular Cartilage ◽  
Knee Joint ◽  
Tibial Plateau ◽  
Disease Onset ◽  
Adult Life ◽  
Clinical History ◽  
Cartilage Degeneration ◽  
Time Frame ◽  
Osteoarthritis Of The Knee ◽  
Occupational Class

Objective Osteoarthritis (OA) literature makes minimal suggestion regarding age of disease onset or preventative strategies to reduce risk for onset in various populations. In 2005, the Centers for Disease Control and Prevention estimated that 33.6% of Americans 65+ years old were affected by OA; this cadaveric analysis suggests this is largely underestimated. The objective of this assessment is to identify at-risk populations for OA in the knee joint and make recommendations to prevent or delay disease onset. Design Morphometric analyses of the articular cartilage of the tibial plateau were performed on cadaver specimens using Image Pro software on 3 age populations and surface area measurements for articular cartilage degradation were compared with donors’ reported ages, clinical histories, and occupations. Results Data showed that by the seventh decade of life, when patients are in their 60s, articular cartilage degeneration on the tibial plateau had commenced in 100% of specimen. All “homemakers” displayed above-average medial tibial plateau degeneration (32.33% ± 24.85%) for their age group while simultaneously reporting pathologies in their clinical history that encourage a sedentary lifestyle. Conclusions This assessment identifies an occupational class with a propensity to develop disease and also identifies a more realistic time frame than previous advisory committees have produced regarding age of disease onset and initiation of preventative measures. It is recommended that strengthening of the hip abductors and the musculature supporting the knee commence early in adult life to avoid valgus collapse and shearing at the knee joint.

scholarly journals Patient reported disability of ankle, hindfoot, midfoot and hallux metatarsophalangeal arthritis

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0001
Author(s):  
Matthew Christian ◽  
Clifford Jeng ◽  
Rebecca Cerrato ◽  
John T. Campbell ◽  
Scott Koenig ◽  
...  
Keyword(s):  
Rating Scales ◽  
Short Form ◽  
High Volume ◽  
Data Sets ◽  
Foot And Ankle ◽  
Operative Techniques ◽  
Ankle Arthritis ◽  
Patient Reported ◽  
Study Population ◽  
Component Scores

Category: Ankle, Ankle Arthritis, Hindfoot, Midfoot/Forefoot Introduction/Purpose: There has been in increased interest in foot and ankle arthritis in the literature in recent years. A significant focus of the literature has been which operative techniques are best for managing these problems. Some work has been done analogizing disability due to ankle arthritis to more familiar joints such as the hip. There is little data explaining how much patient reported disability is associated with each type of isolated foot and ankle arthritis. Various clinical rating scales have proven how debilitating foot and ankle arthritides can be to patients. The purpose of our study was to use Functional Foot Index (FFI) and Short Form-12 (SF-12) rating scales to compare the patient reported disability associated with ankle, hindfoot, midfoot, and hallux metatarsalphalangeal (MTP) arthritides. Methods: We retrospectively reviewed the FFI and SF-12 (both Physical Component Scores (PCS) and Mental Component Scores (MCS)) of patients who presented to a high volume orthopaedic foot and ankle practice between 2010 and 2016 with either ankle, hindfoot, midfoot or hallux MTP arthritis. We included patients between 18-65 years of age who underwent a surgical procedure for arthritis within 6 months of their initial presentation. We excluded patients with any medical or surgical co-morbidities known to affect disability scores. A total of 214 FFI and 195 SF-12 data sets were included. Results: Study population SF-12 PCS scores for all patients with ankle or foot arthritis were significantly lower than US age-based norms. Patients with ankle arthritis had the highest disability (FFI score 46.5, SF-12 PCS 32.3). Patients with midfoot and hindfoot arthritis had intermediate disability (Midfoot FFI score 34.9, SF-12 PCS 34.5; Hindfoot FFI score 44.3, SF-12 PCS 34.5). Patients with hallux MTP arthritis had the lowest disability (FFI score 32.9, SF-12 PCS 40.7). All FFI and SF-12 PCS scores were statistically significant. SF 12 MCS were not statistically significant. Conclusion: All patients with foot and ankle arthritis had increased disability compared to US age-based norms. Patients with ankle arthritis experience the most self-reported disability and patients with hallux MTP arthritis experience the least self- reported disability of the isolated types of arthritis in orthopaedic foot and ankle.

Nonoperative management (NOM) in rectal cancer: Physician perspectives on offering NOM as standard of care.

2020 ◽  
Vol 38 (4_suppl) ◽  
pp. 79-79
Author(s):  
Andrea Marie Covelli ◽  
Fayez A. Quereshy ◽  
Erin Diane Kennedy ◽  
Sami A. Chadi ◽  
Frances Catriona Wright
Keyword(s):  
Rectal Cancer ◽  
Neoadjuvant Chemoradiotherapy ◽  
Oncologic Outcome ◽  
Standard Of Care ◽  
High Volume ◽  
Operative Management ◽  
Oncologic Outcomes ◽  
Snowball Sampling ◽  
Structured Interviews ◽  
And Gender

79 Background: 20% of rectal cancer patients will have a complete clinical response (cCR) following neoadjuvant chemoradiotherapy. Non-operative management (NOM) with close surveillance can spare patients proctectomy and avoid the sequelae of surgery. Patients are interested in and advocate for NOM, whereas oncologists appear to be reluctant to offer this option. We wished to identify the perceptions and barriers that oncologists face when considering NOM. Methods: This qualitative study explored oncologists’ experiences treating rectal cancer and identified their perceptions and values around NOM. Purposive and snowball sampling identified medical, radiation and surgical oncologists’ who treat a high volume of rectal cancer across Canada. Oncologists varied in length/location of practice and gender. Data were collected via semi-structured interviews. Constant comparative analysis identified key concepts. Results: Data saturation was achieved after 40 interviews: 20 surgeons, 12 radiation and 8 medical oncologists. The dominant theme was “NOM is not ready for prime time’. Most oncologists felt that there is insufficient long-term data around NOM and single center studies appear ‘too good to be true’. Physicians voiced concerns about worsening oncologic outcomes in the setting of regrowth, the challenges in determining a cCR and apprehension around patient compliance to surveillance. Some oncologists felt that NOM is limited to a very select population and voiced reluctance in offering it to younger patients or patients with more advanced disease. There was little consideration to improved functional outcomes with NOM. Overall the majority of participants felt that NOM is ‘ trading the benefit of saving the rectum for the uncertainty of an inferior oncologic outcome’. Conclusions: Oncologists felt that NOM should not be offered as a standard of care option following a cCR. Most felt that there is insufficient data supporting NOM and are concerned around worse oncologic outcomes. Patient views of NOM are critically needed to assess if patients value the same outcomes. Additional research is needed to address barriers should patients wish to consider NOM as a treatment option in the setting of a cCR.

scholarly journals Current Operative Management of Breast Cancer: An Age of Smaller Resections and Bigger Cures

2012 ◽  
Vol 2012 ◽  
pp. 1-7 ◽  
Author(s):  
Jack W. Rostas ◽  
Donna Lynn Dyess
Keyword(s):  
Breast Cancer ◽  
Adjuvant Radiotherapy ◽  
Cancer Biology ◽  
Operative Management ◽  
Chemotherapeutic Agents ◽  
Therapeutic Interventions ◽  
Modern Concept ◽  
Cancer Microenvironment ◽  
Operative Techniques ◽  
Curative Intent

Surgical resection was the first effective treatment for breast cancer and remains the most important treatment modality for curative intent. Refinements in operative techniques along with the use of adjuvant radiotherapy and advanced chemotherapeutic agents have facilitated increasingly focused breast cancer operations. Surgical management of breast cancer has shifted from extensive and highly morbid procedures, to the modern concept obtaining the best possible cosmetic result in tandem with the appropriate oncological resection. An ever-growing comprehension of breast cancer biology has led to substantial advances in molecular diagnosis and targeted therapies. An emerging frontier involves the breast cancer microenvironment, as a thorough understanding, while currently lacking, represents a critical opportunity for diagnosis and treatment. Collectively, these improvements will continue to push all therapeutic interventions, including operative, toward the goal of becoming more focused, targeted, and less morbid.

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