Clinical guidelines for the management of gastrointestinal fistula – developed by experts of the Polish Surgical Society

2021 ◽  
Vol 93 (4) ◽  
pp. 57-69
Author(s):  
Jacek Sobocki ◽  
Marek Jackowski ◽  
Adam Dziki ◽  
Wiesław Tarnowski ◽  
Tomasz Banasiewicz ◽  
...  
Keyword(s):  
Delphi Method ◽  
Gastrointestinal Surgery ◽  
Cochrane Library ◽  
High Morbidity ◽  
Review Of The Literature ◽  
Cost Of Treatment ◽  
Gastrointestinal Fistula ◽  
Mortality And Morbidity ◽  
Based Medicine ◽  
Related Mortality

Introduction: Gastrointestinal fistula is one of the most difficult problems in gastrointestinal surgery. It is associated with high morbidity and mortality, numerous complications, prolonged hospitalization, and high cost of treatment. </br>Aim: This project aimed to develop recommendations for the treatment of gastrointestinal fistulas, based on evidence-based medicine and best clinical practice to reduce treatment-related mortality and morbidity. </br>Material and methods: The preparation of these recommendations is based on a review of the literature from the PubMed, Medline, and Cochrane Library databases from 1.01.2010 to 31.12.2020, with particular emphasis on systematic reviews and clinical recommendations of recognized scientific societies. Recommendations in the form of a directive were formulated and assessed using the Delphi method. </br>Results and conclusions: Nine recommendations were presented along with a discussion and comments of experts. Treatment should be managed by a multidisciplinary team (surgeon, anesthetist, clinical nutritionist/dietician, nurse, pharmacist, endoscopist).

The Commitment of the Documentation Service of the Swiss Academy of Medical Sciences for the Impartment of Evidence Based Medicine

Swiss Surgery ◽  
1999 ◽  
Vol 5 (4) ◽  
pp. 183-185
Author(s):  
Bleuer
Keyword(s):  
Evidence Based Medicine ◽  
Cochrane Library ◽  
Evidence Based ◽  
Medical Sciences ◽  
Based Medicine

Die mit dem Aufkommen der elektronischen Medien einhergehende Informationsflut hat die Erwartungen an den Dokumentationsdienst (DOKDI) der Schweizerischen Akademie der Medizinischen Wissenschaften verändert: Insbesondere Evidence Based Medicine (EBM) verlangt nicht nur die Beschaffung von Information, sondern auch eine Selektion hinsichtlich Qualität und Relevanz: Die sich aus der klinischen Situation ergebende Frage fordert eine Antwort, die inhaltlich richtig ist und in der konkreten Situation auch weiterhilft. Dem Ideal, sich durch kritische Lektüre der Originalarbeiten ein Bild über die vorhandene Evidenz für die Richtigkeit eines bestimmten Prozederes zu verschaffen, stehen in der Praxis meist Zeitmangel und methodische Schwierigkeiten im Weg; man wird sich deshalb oft auf die durch andere erarbeitete Evidenz abstützen müssen und z.B. die Cochrane Library konsultieren. Der DOKDI engagiert sich sowohl bei der Erarbeitung von systematischen Übersichtsarbeiten als auch bei der Dissemination der gefundenen Evidenz, indem er seine Erfahrung in der Dokumentation mit elektronischen Medien und die entsprechende Infrastruktur zur Verfügung stellt. Als Ergänzung zu diesen Aktivitäten hat die Akademie einen Grant zur Ausbildung von EBM-Tutoren gesprochen. In einem einwöchigen Kurs in Oxford werden Kliniker zu EBM-Tutoren ausgebildet: Dies wird zukünftig ermöglichen, vermehrt EBM-Workshops in der Schweiz durchzuführen.

scholarly journals Suprafascial Free Flaps: Classification and Comprehensive Review of the Literature

2021 ◽  
Vol 6 ◽  
pp. 247275122110205
Author(s):  
Sebastian Rios ◽  
María Isabel Falguera-Uceda ◽  
Alicia Dean ◽  
Susana Heredero
Keyword(s):  
Survival Rate ◽  
Preoperative Planning ◽  
Donor Site ◽  
Free Flaps ◽  
Donor Site Morbidity ◽  
Anterolateral Thigh Flap ◽  
Cochrane Library ◽  
Review Of The Literature ◽  
Comprehensive Review ◽  
Search Terms

Study Design: Suprafascial free flaps have become common place in reconstructive surgery units. Nomenclature related to these flaps has not been uniform throughout the scientific literature, especially in regard to planes of dissection. This study is designed as a comprehensive review of the literature. Objectives: Our study highlights which flaps are used most frequently, their main indications, their survival rate, and how they have evolved in the last few decades as innovations have been introduced. Methods: A review of the literature was performed using keywords and Medical Subject Headings search terms. PubMed, Embase, and Cochrane Library were searched using the appropriate search terms. Data collected from each study included flap type, dissection plane, preoperative planning, area of reconstruction, as well as complications, donor-site morbidity and survival rate. Results: Seven hundred and fifty-five studies were found based on the search criteria. After full-text screening for inclusion and exclusion criteria 34 studies were included. A total of 1332 patients were comprised in these studies. The most common types of flaps used were superficial circumflex iliac perforator flap (SCIP), anterolateral thigh flap (ALT), and radial forearm flap. The most common areas of reconstruction were head & neck and limbs. There was no significant difference in survival rates between flaps that were raised in different planes of dissection. Conclusions: Based on the author’s review of the literature, suprafascial flaps are reliable, they have low donor site morbidity, and there is a wide selection available for harvest. The use of new technologies for preoperative planning, such as CT-Angiography and UHF ultrasound, have contributed to have more predictable results. We propose a standardized classification for these flaps, in order to create a uniform nomenclature for future reference.

scholarly journals A Review of the Major Prosthetic Factors Influencing the Prognosis of Implant Prosthodontics

2021 ◽  
Vol 10 (4) ◽  
pp. 816
Author(s):  
Javier Montero
Keyword(s):  
Animal Studies ◽  
Treatment Approach ◽  
Treatment Plan ◽  
Meta Analysis ◽  
Good Prognosis ◽  
Cochrane Library ◽  
Review Of The Literature ◽  
Hand Search ◽  
Related Risk

Background: The treatment plan of prosthetic restorations supported by dental implants requires comprehensive scientific knowledge to deliver prostheses with good prognosis, even before the implant insertion. This review aims to analyze the main prosthetic determinants of the prognosis of implant-supported prostheses. Methods: A comprehensive review of the literature was conducted with a PICO (Patient Intervention Comparison Outcomes) question: “For partially or complete edentulous subjects treated with implant-supported prostheses, which prosthetic factors could affect clinical outcomes?”. A literature search was performed electronically in PubMed (MEDLINE), Scopus and Cochrane Library with the following equation [PROGNOS * OR RISK] FACTOR IMPLANT DENTAL, and by hand search in relevant journals and throughout the selected papers. Results: This revision was carried out based on 50 papers focused on several prosthodontics-related risk factors that were grouped as follows: implant-connection, loading protocol, transmucosal abutments, prosthetic fit, provisionalization, type of retention, impression technique, fabrication technique, and occlusion. More than a half of the studies were systematic reviews (30%), meta-analysis (16%), or prospective evaluations of prosthesis with various kinds of events (18%). However, narrative reviews of literature (14%) and in vitro/animal studies (16%) were also found. Conclusions: The current literature provides insufficient evidence for most of the investigated topics. However, based on the accumulated data, it seems reasonable to defend that the best treatment approach is the use of morse taper implants with transmucosal abutments, recorded by means of rigidly splinted copings through the pick-up technique, and screwed by milled prosthesis occlusally adjusted to minimize functional overloading.

Postvaricella Acute Transverse Myelitis: A Case Presentation and Review of the Literature

PEDIATRICS ◽  
1978 ◽  
Vol 62 (2) ◽  
pp. 202-204
Author(s):  
John T. McCarthy ◽  
Jules Amer
Keyword(s):  
Transverse Myelitis ◽  
Sensory Loss ◽  
Review Of The Literature ◽  
Case Presentation ◽  
Mortality And Morbidity ◽  
Acute Transverse Myelitis ◽  
Significant Mortality

Although the complications and sequelae of varicella are rare, they can cause significant mortality and morbidity in both the normal and compromised patient. Eight cases of "pure" acute transverse myelitis (ATM) following varicella have previously been reported in the literature. We report the ninth case of postvaricella ATM in a 9-year-old girl. Her course was characterized by paraplegia, sensory Loss, hvperesthesia, and incontinence of urine and feces. All patients, except ours, recovered fully from ATM.

Abstract 3680: Transfusion-Induced Tissue Hypoxia is Ameliorated by S -nitrosohemoglobin Repletion of Stored Red Blood Cells

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Diana L Diesen ◽  
Jonathan S Stamler
Keyword(s):  
Animal Models ◽  
Red Blood Cells ◽  
Blood Cells ◽  
Tissue Oxygenation ◽  
Ex Vivo ◽  
Tissue Hypoxia ◽  
Mouse Blood ◽  
Mortality And Morbidity ◽  
Stored Blood ◽  
Related Mortality

Transfusion of stored red blood cells (RBCs) is associated with a decrease in tissue oxygenation in animal models and with increased mortality and morbidity in patients. Recent studies have demonstrated that stored RBCs are deficient in vasodilatory ability and depleted of S -nitrosohemoglobin (SNO-Hb), and that renitrosylation ex vivo can increase SNO-Hb levels and restore vasoactivity. We have examined in a mouse model the extent to which transfusion impairs tissue oxygenation and whether SNO-Hb repletion can ameliorate that impairment. We report here that transfusion of (mouse) RBCs stored for 1 day or 1 week results in tissue hypoxia that is largely prevented by SNO-Hb repletion prior to transfusion ( 1 day stored blood : % decrease in oxygenation 58+/−10% untreated vs. 92+/−0.7% SNO-Hb repleted, p<0.05, n=3– 6; 1 week stored blood : % decrease in oxygenation 66+/−10% untreated vs. 91+/−2.8% SNO-Hb repleted, p<0.05, n=3– 6). Storage of mouse blood beyond human expiration-equivalents (1 month) resulted in substantial lysis and the death of all mice transfused (native and SNO-Hb repleted blood, n=5). In conclusion, repletion of SNO-Hb ameliorates the decrease in tissue oxygenation that results from transfusion of untreated stored blood. Therefore, SNO-Hb repletion may provide a simple and efficacious method to reduce transfusion-related mortality and morbidity.

Study of factors affecting mortality and morbidity in patients presenting with peritonitis due to duodenal ulcer perforation

2021 ◽  
Vol 19 (2) ◽  
pp. 35-39
Author(s):  
Pradeep Chandra Sharma ◽  
Keyword(s):  
Duodenal Ulcer ◽  
Previous History ◽  
Common Factors ◽  
Duodenal Perforation ◽  
High Morbidity ◽  
Delayed Presentation ◽  
Mortality And Morbidity ◽  
Factors Affecting ◽  
Ulcer Perforation ◽  
Duodenal Ulcer Perforation

Background: Peptic ulcer disease in the general population had lifetime prevalence of 5-10% with incidence of 0.1–0.3% per year. Despite the tremendous improvement in preventive therapies, the rate of complication of this disease is still high and is burdened by high morbidity and mortality. In present study, we aimed to study factors affecting mortality and morbidity in patients presenting with peritonitis due to duodenal ulcer perforation at our tertiary hospital. Material and Methods: Present study was single-center, prospective, observational study conducted in patients admitted, diagnosed with duodenal ulcer perforation and surgically treated at our hospital. Results: In present study period total 56 patients were studied. All were male, most common age group was 51-60 years (37.5%) followed by 41-50 years (23.21%). Duration from onset of symptoms to admission was >24 hours (30.36%) in most of patients followed by 12-24 hours (28.57%). Most commons symptoms were pain in abdomen (100%), vomiting (100%). Anaemia (37.5%), LRTI and Pulmonary complications (19.64%), Diabetes mellitus (12.5%) and Hypertension (10.71%) were common comorbidities noted. Associated risk factors were previous history of PUD (41.07%), Alcohol use (64.29%), Cigarette smoking (51.79%) and Use of NSAIDs (12.5%). Presence of free gas under diaphragm was noted in 83.93% patients. Intraoperatively duodenal perforation diameter was 1–5 mm (60.71%) in most of patients followed by 6–10 mm (23.21%). Only 1 patient had duodenal perforation diameter was > 20mm. Common postoperative complications were wound infection (37.5%) and pulmonary infection (21.43%). In present study mortality within 1 month was noted in 13 patients (23.21%). Most common factors related to mortality were delayed presentation > 24 hours (61.54%), age > 60 years (46.15%), diabetes mellites (38.46%), Size of perforation > 1 cm (38.46%) and septicaemic shock (23.08%). Conclusion: Delayed presentation > 24 hours, age > 60 years size of perforation > 1 cm were common factors related to mortality in duodenal ulcer perforation patients.

scholarly journals Capsule endoscopy in Italy: An unbalanced review of the literature

2010 ◽  
Vol 26 (3) ◽  
pp. 354-356
Author(s):  
Cristiano Spada ◽  
Roberto de Franchis ◽  
Marco Pennazio ◽  
Riccardo Marmo ◽  
Emanuele Rondonotti ◽  
...  
Keyword(s):  
Short Version ◽  
Review Of The Literature ◽  
Careful Evaluation ◽  
Level Of Evidence ◽  
Source Data ◽  
Critical Issues ◽  
Expert’S Opinion ◽  
Blind Comparison ◽  
Based Medicine ◽  
Sequential Studies

We read the recently published study by Lo Scalzo et al. (4). The study is a short version of a more extensive report published on the Italian Ministry of Health Web site (1). A careful evaluation of both documents reveals several critical issues that cast doubts on the correctness of their conclusions. Usually, decisions about clinical practice should be based on levels of evidence in literature and on the strength of recommendations issued in the guidelines of international scientific societies, many of which rely on the Oxford system (Oxford Center for Evidence based Medicine) (http://cebm.jr2.ox.ac.uk/docs/level.html). As far as diagnostic tests are concerned, the Oxford system assigns the highest level of evidence to systematic reviews supported by homogeneous results. The same system assigns the second highest level of evidence to the “independent blind comparison of an appropriate spectrum of consecutive patients all of whom have undergone both the diagnostic test and the reference standard,” while the expert's opinion ranks at the lowest level. Surprisingly, the authors flatly dismissed all sequential studies that fulfill the criteria of independent blind comparison, based on the fact that they were not randomized. At the same time, they cited as source data the results of a questionnaire presented to the attendees of an Italian meeting, never published in literature, which is plainly an “expert opinion.”

scholarly journals Współczesne kierunki rehabilitacji w zespołach bólowych kręgosłupa lędźwiowo-krzyżowego – przegląd systematyczny

2018 ◽  
Vol 64 (3) ◽  
Author(s):  
Wioletta Łubkowska ◽  
Bożena Mroczek
Keyword(s):  
Evidence Based Medicine ◽  
Google Scholar ◽  
Cochrane Library ◽  
Evidence Based ◽  
Based Medicine

ABSTRAKT Wstęp: Zespoły bólowe kręgosłupa lędźwiowo-krzyżowego ze względu na powszechność zjawiska oraz coraz młodszy wiek pacjentów uznaje się za schorzenie cywilizacyjne. Celem artykułu była krytyczna analiza dostępnych wytycznych, raportów i dowodów dostarczających argumentów dotyczących postępowania diagnostyczno-terapeutycznego w bólach krzyża. W pracy przedstawiono epidemiologię, etiologię, diagnozę oraz wybrane metody leczenia i profilaktyki bólu krzyża. Materiały i metody: Dokonano przeglądu danych literaturowych w oparciu o bazę komputerową Polska Bibliografia Lekarska oraz anglojęzyczną bazę danych PubMed i Cochrane Library. Dodatkowo wykorzystano wyszukiwarkę Google Scholar. Prezentowane prace przeanalizowano pod względem ich referencyjności naukowej i zgodności z zasadami Evidence-Based Medicine. W celu uzyskania rekomendacji na najwyższym poziomie w przeglądzie zostały uwzględnione aktualne dowody naukowe oparte na recenzowanych publikacjach naukowych, przeglądach systematycznych, metaanalizach i przeprowadzonych randomizowanych badaniach kontrolnych. Wyniki: Według licznych badań leżenie w łóżku jest nieskuteczne i nie powinno być zalecane. Literatura w odniesieniu do wpływu akupunktury, TENS, terapii zimnem i trakcji (wyciąg) na leczenie bólu krzyża jest zbyt niejednorodna i potrzebne są dalsze wysokiej jakości badania, zanim jakikolwiek końcowy wniosek zostanie postawiony. Mocno rekomendowane w leczeniu objawów bólu krzyża są: ćwiczenia fizyczne, terapia manualna oraz edukacja. Wnioski: Konieczne są dalsze badania w celu zidentyfikowania skutecznych niefarmakologicznych metod leczenia bólu krzyża oraz zrozumienia dodatkowych korzyści wynikających z łączenia poszczególnych interwencji, a także tego, które kombinacje leczenia i sekwencje są najbardziej skuteczne.

scholarly journals Mobiluncus curtisii Bacteremia: Case Study and Literature Review

2022 ◽  
Vol 14 (1) ◽  
pp. 82-87
Author(s):  
Cade Arries ◽  
Patricia Ferrieri
Keyword(s):  
Blood Culture ◽  
Gastrointestinal Surgery ◽  
Gastrointestinal Symptoms ◽  
Clinical Work ◽  
Review Of The Literature ◽  
Case Study Method ◽  
Culture Bottle ◽  
Source Of Infection ◽  
Curved Rod

Background: There are few reports of bacteremia caused by Mobiluncus curtisii in the literature. We present a review of the literature in addition to a case study. Method: We describe the case of an 82-year-old patient who underwent gastrointestinal surgery and subsequently presented with dehydration, nausea, and hyperkalemia secondary to diarrhea. Further clinical work included blood cultures, and the patient was started empirically on piperacillin/tazobactam. Results: After five days, the blood culture bottle showed growth of a gram-variable, curved rod-shaped organism. After culture under anaerobic conditions on sheep blood agar, the organism was identified as Mobiluncus curtisii by MALDI-TOF mass spectrometry and enzymatic technology. A review of the literature reveals five additional cases of Mobiluncus curtisii bacteremia. Conclusions: This is the sixth case in the literature describing Mobiluncus species bacteremia. This organism is rarely identified in blood culture and is most often thought of in the context of bacterial vaginosis. However, the reported cases of bacteremia show gastrointestinal symptoms and presumed gastrointestinal source of infection. The pathogenesis of infection of this organism requires further investigation.

Sign in / Sign up

Export Citation Format

Share Document