124,847 results
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2. Strategies to prevent blood loss and reduce transfusion in emergency general surgery, WSES-AAST consensus paper
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Federico Coccolini, Aryeh Shander, Marco Ceresoli, Ernest Moore, Brian Tian, Dario Parini, Massimo Sartelli, Boris Sakakushev, Krstina Doklestich, Fikri Abu-Zidan, Tal Horer, Vishal Shelat, Timothy Hardcastle, Elena Bignami, Andrew Kirkpatrick, Dieter Weber, Igor Kryvoruchko, Ari Leppaniemi, Edward Tan, Boris Kessel, Arda Isik, Camilla Cremonini, Francesco Forfori, Lorenzo Ghiadoni, Massimo Chiarugi, Chad Ball, Pablo Ottolino, Andreas Hecker, Diego Mariani, Ettore Melai, Manu Malbrain, Vanessa Agostini, Mauro Podda, Edoardo Picetti, Yoram Kluger, Sandro Rizoli, Andrey Litvin, Ron Maier, Solomon Gurmu Beka, Belinda De Simone, Miklosh Bala, Aleix Martinez Perez, Carlos Ordonez, Zenon Bodnaruk, Yunfeng Cui, Augusto Perez Calatayud, Nicola de Angelis, Francesco Amico, Emmanouil Pikoulis, Dimitris Damaskos, Raul Coimbra, Mircea Chirica, Walter L. Biffl, and Fausto Catena
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Blood management ,Mortality ,Morbidity ,Policy ,Management ,Jehovah’s witnesses ,Surgery ,RD1-811 ,Medical emergencies. Critical care. Intensive care. First aid ,RC86-88.9 - Abstract
Abstract Emergency general surgeons often provide care to severely ill patients requiring surgical interventions and intensive support. One of the primary drivers of morbidity and mortality is perioperative bleeding. In general, when addressing life threatening haemorrhage, blood transfusion can become an essential part of overall resuscitation. However, under all circumstances, indications for blood transfusion must be accurately evaluated. When patients decline blood transfusions, regardless of the reason, surgeons should aim to provide optimal care and respect and accommodate each patient’s values and target the best outcome possible given the patient’s desires and his/her clinical condition. The aim of this position paper was to perform a review of the existing literature and to provide comprehensive recommendations on organizational, surgical, anaesthetic, and haemostatic strategies that can be used to provide optimal peri-operative blood management, reduce, or avoid blood transfusions and ultimately improve patient outcomes.
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- 2024
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3. Proposal for the use of angiotensin II in distributive shock after extracorporeal circulation – position paper of the Section of Intensive Care Medicine and the Section of Cardiothoracic Anaesthesiology of the Polish Society of Anaesthesiology and Intensive Therapy
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Łukasz Krzych, Paweł Nadziakiewicz, and Ewa Kucewicz-Czech
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distributive shock ,extracorporeal circulation ,angiotensin ii ,treatment. ,Surgery ,RD1-811 ,Internal medicine ,RC31-1245 - Abstract
Angiotensin II (AT) is a potent vasoconstrictor and hypertensive drug that is registered for the treatment of severe hypotension in vasoplegic shock. Growing experience with the use of AT in cardiac surgery allows the first therapeutic algorithms to be created. This paper is a proposal for the use of AT in distributive shock after extracorporeal circulation.
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- 2024
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4. An Intelligent Decision Support System for the Surgical Preoperative Phase: An Approach Based on Machine Learning
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Bouden, Cheima, Mezioud, Chaker, Kacprzyk, Janusz, Series Editor, Gomide, Fernando, Advisory Editor, Kaynak, Okyay, Advisory Editor, Liu, Derong, Advisory Editor, Pedrycz, Witold, Advisory Editor, Polycarpou, Marios M., Advisory Editor, Rudas, Imre J., Advisory Editor, Wang, Jun, Advisory Editor, Nagar, Atulya K., editor, Jat, Dharm Singh, editor, Mishra, Durgesh, editor, and Joshi, Amit, editor
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- 2024
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5. A Bibliometric Analysis of the Top 100 Papers on Gluteal Augmentation
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Kian Daneshi, Hamid Reza Khademi Mansour, Niels Pacheco-Barrios, Ayobami Asaju, Mauricio Pérez Pachon, Alfredo Hoyos, and Ankur Khajuria
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Surgery ,RD1-811 - Abstract
Abstract BackgroundGluteoplasty or gluteal augmentation is a popular cosmetic procedure that is used to improve the volume, shape, and contour of the buttocks. ObjectivesThis bibliometric analysis aims to characterize emerging research trends and to assess the methodological quality of the highest impact gluteoplasty research. MethodsThe 100 most-cited publications in gluteoplasty were identified on Web of Science, across all available journal years (from Inception to August 2023). Study details, including the citation count, main content focus, and outcome measures, were extracted and tabulated from each publication. Oxford Centre for Evidence Based Medicine level of evidence (LOE) of each study was assessed. ResultsThe 100 most-cited publications regarding gluteoplasty were cited by a total of 2375 publications. Citations per publication ranged from 5 to 176 (mean 23.75 ± 25.86), with the highest-cited study being authored by Simonacci, discussing autologous fat grafting (nnnn ConclusionsThis analysis demonstrates a need for improvement in research methodologies regarding gluteoplasty research. This advancement would be facilitated by robust, high-quality research through randomized control trials and multicenter studies, as well as the further development of validated PROMs for gluteoplasty. Level of Evidence: 2
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- 2024
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6. Autonomy with responsibility ¿Is informed consent just a signature on a paper? Evaluation in patients who underwent spine’s surgery
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Núñez, Jorge H., Jimenez-Jimenez, Maria Jose, Taberner, Anna, Alonzo-González, Francisco, Cisneros, Berta Escudero, and Bosch-García, David
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- 2023
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7. Validity of Ultrasound for the Diagnosis of Arterial Thoracic Outlet SyndromeWHAT THIS PAPER ADDS
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Emilia Stegemann, Jana Larbig, Berthold Stegemann, Irene Portig, Hans Prescher, and Thomas Bürger
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Digital subtraction angiography ,Sonography ,Thoracic outlet syndrome ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 ,Surgery ,RD1-811 - Abstract
Objective: Thoracic outlet syndrome (TOS) is a rare disorder mostly seen in younger individuals. Although patient wellbeing is relevantly impaired, it often takes a long time before the diagnosis is made. Digital subtraction angiography (DSA) is routinely used despite its radiation exposure, which is a major concern in this young patient population. Moreover, DSA offers limited opportunities for functional assessment. By contrast, ultrasonography is widely accessible without causing radiation exposure and allows for flexible functional assessment. The main goal of the study was to investigate whether ultrasound (US) was a viable alternative to DSA in diagnosing arterial TOS (aTOS). Methods: Patients, referred to a tertiary centre for evaluation of suspected TOS, were recruited into the study. DSA was routinely performed with the patient's arms both in the raised (abducted) and neutral (adducted) position. Two vascular surgeons and two radiologists assessed the resulting images for the presence of aTOS. Additionally, two examiners performed US according to a standardised protocol. The reference for presence of aTOS was the DSA based interdisciplinary vascular conference consensus. Inter-rater agreement and latent class analysis (LCA) were performed between assessors and diagnostic methods. Results: Fifty one consecutive patients (two thirds female) aged 39.3 ± 13.0 years were included within 11 months. US agreement was excellent at 0.94 (0.841–0.980), DSA agreement for vascular surgeons was good at 0.779 (0.479–1.000), whereas it was moderate at 0.546 (0.046–1.000) for radiologists. Results suggest that DSA is untenable as the gold standard for aTOS diagnosis. In LCA, US was shown to be a reliable diagnostic tool for the detection of aTOS. Conclusion: US examination is a valid test for the detection of haemodynamically relevant compression of arteries in the diagnostic work up of aTOS using a standardised protocol. The role of DSA as the gold standard should be reviewed and needs to be reconsidered.
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- 2024
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8. PERIOPERATIVE CARE IN DIGESTIVE SURGERY: THE ERAS AND ACERTO PROTOCOLS - BRAZILIAN COLLEGE OF DIGESTIVE SURGERY POSITION PAPER
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José Eduardo de AGUILAR-NASCIMENTO, Ulysses RIBEIRO JUNIOR, Pedro Eder PORTARI-FILHO, Alberto Bicudo SALOMÃO, Cervantes CAPOROSSI, Ramiro COLLEONI NETO, Dan Linetzky WAITZBERG, and Antonio Carlos Ligocki CAMPOS
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Perioperative Care ,Nutrition Therapy ,Crystalloid Solutions ,Guideline ,Surgery ,RD1-811 ,Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
ABSTRACT BACKGROUND: The concept introduced by protocols of enhanced recovery after surgery modifies perioperative traditional care in digestive surgery. The integration of these modern recommendations components during the perioperative period is of great importance to ensure fewer postoperative complications, reduced length of hospital stay, and decreased surgical costs. AIMS: To emphasize the most important points of a multimodal perioperative care protocol. METHODS: Careful analysis of each recommendation of both ERAS and ACERTO protocols, justifying their inclusion in the multimodal care recommended for digestive surgery patients. RESULTS: Enhanced recovery programs (ERPs) such as ERAS and ACERTO protocols are a cornerstone in modern perioperative care. Nutritional therapy is fundamental in digestive surgery, and thus, both preoperative and postoperative nutrition care are key to ensuring fewer postoperative complications and reducing the length of hospital stay. The concept of prehabilitation is another key element in ERPs. The handling of crystalloid fluids in a perfect balance is vital. Fluid overload can delay the recovery of patients and increase postoperative complications. Abbreviation of preoperative fasting for two hours before anesthesia is now accepted by various guidelines of both surgical and anesthesiology societies. Combined with early postoperative refeeding, these prescriptions are not only safe but can also enhance the recovery of patients undergoing digestive procedures. CONCLUSIONS: This position paper from the Brazilian College of Digestive Surgery strongly emphasizes that the implementation of ERPs in digestive surgery represents a paradigm shift in perioperative care, transcending traditional practices and embracing an intelligent approach to patient well-being.
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- 2024
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9. Comparing shared decision making using a paper and digital consent process. A multi-site, single centre study in a trauma and orthopaedic department.
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Dyke, Rory, St-John, Edward, Shah, Hemina, Walker, Joseph, Loughran, Dafydd, Anakwe, Raymond, and Nathwani, Dinesh
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ELECTRONIC paper , *INFORMED consent (Medical law) , *DECISION making , *PATIENT experience , *ELECTRONIC records - Abstract
The importance of shared decision making (SDM) for informed consent has been emphasised in the updated regulatory guidelines. Errors of completion, legibility and omission have been associated with paper-based consent forms. We introduced a digital consent process and compared it against a paper-based process for quality and patient reported involvement in shared decision making. 223 patients were included in this multi-site, single centre study. Patient consent documentation was by either a paper consent form or the Concentric digital consent platform. Consent forms were assessed for errors of legibility, completion and accuracy of content. Core risks for 20 orthopaedic operations were pre-defined by a Delphi round of experts and forms analysed for omission of these risks. SDM was determined via the 'collaboRATE Top Score', a validated measure for gold-standard SDM. 72% (n = 78/109) of paper consent forms contained ≥1 error compared to 0% (n = 0/114) of digital forms (P < 0.0001). Core risks were unintentionally omitted in 63% (n = 68/109) of paper-forms compared to less than 2% (n = 2/114) of digital consent forms (P < 0.0001). 72% (n = 82/114) of patients giving consent digitally reported gold-standard SDM compared to 28% (n = 31/109) with paper consent (P < 0.001). Implementation of a digital consent process has been shown to reduce both error rate and the omission of core risks on consent forms whilst increasing the quality of SDM. This novel finding suggests that using digital consent can improve both the quality of informed consent and the patient experience of SDM. • The paper consent process is associated with errors and omissions of core risks. • A digital consent process improved error rate and omission rate of core risks. • Patients reported a higher level of shared decision making with a digital process. • Documentation of consent can be reliably standardised with an electronic record. [ABSTRACT FROM AUTHOR]
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- 2023
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10. Enhanced perioperative care in emergency general surgery: the WSES position paper
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Marco Ceresoli, Marco Braga, Nicola Zanini, Fikri M. Abu-Zidan, Dario Parini, Thomas Langer, Massimo Sartelli, Dimitrios Damaskos, Walter L. Biffl, Francesco Amico, Luca Ansaloni, Zsolt J. Balogh, Luigi Bonavina, Ian Civil, Enrico Cicuttin, Mircea Chirica, Yunfeng Cui, Belinda De Simone, Isidoro Di Carlo, Andreas Fette, Giuseppe Foti, Michele Fogliata, Gustavo P. Fraga, Paola Fugazzola, Joseph M. Galante, Solomon Gurmu Beka, Andreas Hecker, Johannes Jeekel, Andrew W. Kirkpatrick, Kaoru Koike, Ari Leppäniemi, Ingo Marzi, Ernest E. Moore, Edoardo Picetti, Emmanouil Pikoulis, Michele Pisano, Mauro Podda, Boris E. Sakakushev, Vishal G. Shelat, Edward Tan, Giovanni D. Tebala, George Velmahos, Dieter G. Weber, Vanni Agnoletti, Yoram Kluger, Gianluca Baiocchi, Fausto Catena, and Federico Coccolini
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Surgery ,RD1-811 ,Medical emergencies. Critical care. Intensive care. First aid ,RC86-88.9 - Abstract
Abstract Enhanced perioperative care protocols become the standard of care in elective surgery with a significant improvement in patients’ outcome. The key element of the enhanced perioperative care protocol is the multimodal and interdisciplinary approach targeted to the patient, focused on a holistic approach to reduce surgical stress and improve perioperative recovery. Enhanced perioperative care in emergency general surgery is still a debated topic with little evidence available. The present position paper illustrates the existing evidence about perioperative care in emergency surgery patients with a focus on each perioperative intervention in the preoperative, intraoperative and postoperative phase. For each item was proposed and approved a statement by the WSES collaborative group.
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- 2023
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11. SP25. Design And Implementation Of A Hybrid Paper-electronic Patient Data Tool For Operation Smile: Best Practices And Lessons Learned Across 20 Countries
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Shervin Etemad, MD, Karel-Bart Celie, MD, Atenas Bustamente, MD, Allyn Auslander, PhD, Anthony Dwyer, PhD, Idean Roohani, BS, William Magee, III, MD, DDS, and Caroline Yao, MD, MS
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Surgery ,RD1-811 - Published
- 2024
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12. Management of complicated diaphragmatic hernia in the acute setting: a WSES position paper
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Mario Giuffrida, Gennaro Perrone, Fikri Abu-Zidan, Vanni Agnoletti, Luca Ansaloni, Gian Luca Baiocchi, Cino Bendinelli, Walter L. Biffl, Luigi Bonavina, Francesca Bravi, Paolo Carcoforo, Marco Ceresoli, Alain Chichom-Mefire, Federico Coccolini, Raul Coimbra, Nicola de’Angelis, Marc de Moya, Belinda De Simone, Salomone Di Saverio, Gustavo Pereira Fraga, Joseph Galante, Rao Ivatury, Jeffry Kashuk, Michael Denis Kelly, Andrew W. Kirkpatrick, Yoram Kluger, Kaoru Koike, Ari Leppaniemi, Ronald V. Maier, Ernest Eugene Moore, Andrew Peitzmann, Boris Sakakushev, Massimo Sartelli, Michael Sugrue, Brian W. C. A. Tian, Richard Ten Broek, Carlo Vallicelli, Imtaz Wani, Dieter G. Weber, Giovanni Docimo, and Fausto Catena
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Diaphragm hernia ,Emergency surgery ,Guidelines ,Rupture ,Trauma ,Congenital ,Surgery ,RD1-811 ,Medical emergencies. Critical care. Intensive care. First aid ,RC86-88.9 - Abstract
Abstract Background Diaphragmatic hernia (DH) presenting acutely can be a potentially life-threatening condition. Its management continues to be debatable. Methods A bibliographic search using major databases was performed using the terms “emergency surgery” “diaphragmatic hernia,” “traumatic diaphragmatic rupture” and “congenital diaphragmatic hernia.” GRADE methodology was used to evaluate the evidence and give recommendations. Results CT scan of the chest and abdomen is the diagnostic gold standard to evaluate complicated DH. Appropriate preoperative assessment and prompt surgical intervention are important for a clinical success. Complicated DH repair is best performed via the use of biological and bioabsorbable meshes which have proven to reduce recurrence. The laparoscopic approach is the preferred technique in hemodynamically stable patients without significant comorbidities because it facilitates early diagnosis of small diaphragmatic injuries from traumatic wounds in the thoraco-abdominal area and reduces postoperative complications. Open surgery should be reserved for situations when skills and equipment for laparoscopy are not available, where exploratory laparotomy is needed, or if the patient is hemodynamically unstable. Damage Control Surgery is an option in the management of critical and unstable patients. Conclusions Complicated diaphragmatic hernia is a rare life-threatening condition. CT scan of the chest and abdomen is the gold standard for diagnosing the diaphragmatic hernia. Laparoscopic repair is the best treatment option for stable patients with complicated diaphragmatic hernias. Open repair is considered necessary in majority of unstable patients in whom Damage Control Surgery can be life-saving.
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- 2023
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13. Assessing and managing frailty in emergency laparotomy: a WSES position paper
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Brian W. C. A. Tian, Philip F. Stahel, Edoardo Picetti, Giampiero Campanelli, Salomone Di Saverio, Ernest Moore, Denis Bensard, Boris Sakakushev, Joseph Galante, Gustavo P. Fraga, Kaoru Koike, Isidoro Di Carlo, Giovanni D. Tebala, Ari Leppaniemi, Edward Tan, Dimitris Damaskos, Nicola De’Angelis, Andreas Hecker, Michele Pisano, YunfengCui, Ron V. Maier, Belinda De Simone, Francesco Amico, Marco Ceresoli, Manos Pikoulis, Dieter G. Weber, Walt Biffl, Solomon Gurmu Beka, Fikri M. Abu-Zidan, Massimo Valentino, Federico Coccolini, Yoram Kluger, Massimo Sartelli, Vanni Agnoletti, Mircea Chirica, Francesca Bravi, Ibrahima Sall, and Fausto Catena
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Emergency surgery ,Laparotomy ,Elderly ,Frail ,Frailty ,Surgery ,RD1-811 ,Medical emergencies. Critical care. Intensive care. First aid ,RC86-88.9 - Abstract
Abstract Many countries are facing an aging population. As people live longer, surgeons face the prospect of operating on increasingly older patients. Traditional teaching is that with older age, these patients face an increased risk of mortality and morbidity, even to a level deemed too prohibitive for surgery. However, this is not always true. An active 90-year-old patient can be much fitter than an overweight, sedentary 65-year-old patient with comorbidities. Recent literature shows that frailty—an age-related cumulative decline in multiple physiological systems, is therefore a better predictor of mortality and morbidity than chronological age alone. Despite recognition of frailty as an important tool in identifying vulnerable surgical patients, many surgeons still shun objective tools. The aim of this position paper was to perform a review of the existing literature and to provide recommendations on emergency laparotomy and in frail patients. This position paper was reviewed by an international expert panel composed of 37 experts who were asked to critically revise the manuscript and position statements. The position paper was conducted according to the WSES methodology. We shall present the derived statements upon which a consensus was reached, specifying the quality of the supporting evidence and suggesting future research directions.
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- 2023
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14. Gender analysis of the top classic papers in otolaryngology head and neck surgery
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Beatrice Go, Neeraj Suresh, Cammille Go, Kevin Chorath, Natasha Mirza, Erica Thaler, Alvaro Moreira, and Karthik Rajasekaran
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authorship ,bibliometrics ,citations ,gender ,otolaryngology ,publications ,Otorhinolaryngology ,RF1-547 ,Surgery ,RD1-811 - Abstract
Abstract Objective The aim of this study was to identify and analyze the gender breakdown of first authorship contributing to the most‐cited papers in the field of otolaryngology, with a goal of identifying trends in gender representation in publishing. Methods The top 150 most‐cited papers were identified using the Science Citation Index of the Institute for Scientific Information. Among the first authors, gender, h‐index, percentage of first, last, and corresponding authorship positions, total publications, and citations were analyzed. Results The majority of papers were in the English language, from the United States, of clinical nature, and on otologic topics. Eighty‐one percent of papers (n = 122) had men who were first authors, although there was no difference in h‐index score, authorship position, number of publications, citations, and average citations/year between men and women first authors. Upon subgroup analysis by decade (1950s–2010s), there was no difference in the number of articles by women first authors (P = 0.11); however, there was a statistically significant increase in the percentage of women authors (P = 0.001) in papers published later compared to those published earlier. Conclusions While a promising number of women otolaryngologists are publishing high‐powered articles, future initiatives to promote academic inclusivity of women should be considered.
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- 2023
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15. The 100 most cited papers on total anomalous pulmonary venous connection: a bibliometric analysis
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Chen Wen, Wei Liu, Chenhao Fang, Jin Shentu, Ruixiang Ma, Han Zhang, Hao Zhang, Zhongqun Zhu, and Huiwen Chen
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Total anomalous pulmonary venous connection ,Citation analysis ,Bibliometrics analysis ,Citation classics ,Surgery ,RD1-811 ,Anesthesiology ,RD78.3-87.3 - Abstract
Abstract Background The number of citations a paper receives reflects its impact on the scientific community. We aimed to identify and explore the characteristics of the most cited papers on total anomalous pulmonary venous connection (TAPVC). Methods Web of Science Core Collection Expanded Science Citation Index (1900 to present) was searched and papers on TAPVC were reviewed. Articles were ranked by the number of citations and the 100 most cited papers were analyzed. Results The 100 most cited papers were published between 1952 and 2018 with a mean number of citations of 52 (range 26 to 148). The 1990s was the most productive decade. All articles except one were written in English. The 100 most cited articles were published in 24 journals, led by Journal of Thoracic and Cardiovascular Surgery (21 articles), followed by Annals of Thoracic Surgery (20 articles), and Circulation (16 articles). The United States of America contributed most of the 100 most cited papers (60 articles). Hospital for Sick Children, Toronto led the list of citation classics with six papers. Christopher A. Caldarone, John W. Kirklin, and P. E. F. Daubeney were the most productive authors with 3 articles each. More than half of the papers were cohort studies (51 articles). Surgery, radiology and etiology were the main topics. Thirty-one articles were funded by public foundations, and none received support from commercial companies. Conclusions The bibliometric analysis gives a historical perspective on scientific progress in the field of TAPVC and lays the foundation for future research.
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- 2023
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16. White paper on mitigating risk factors for acute kidney injury in TAVR: A protocol to decrease TAVR-associated AKI
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Sohrab Singh and Ashish Pershad
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AKI ,TAVR ,Surgery ,RD1-811 ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Acute kidney injury (AKI) after transcatheter aortic valve replacement (TAVR) portends a poor prognosis. In the TVT registry, AKI after TAVR occurred in 10% of the patients. The etiology of AKI after TAVR is multifactorial but contrast volume remains one of the few modifiable risk factors. As patients referred for TAVR have multiple touch points within a siloed healthcare system, there remains an unmet clinical need of a well-defined clinical pathway to minimize the risk of AKI from the time of referral for TAVR to the completion of the procedure. This white paper aims to provide such a clinical pathway.
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- 2023
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17. Training curriculum in minimally invasive emergency digestive surgery: 2022 WSES position paper
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Nicola de’Angelis, Francesco Marchegiani, Carlo Alberto Schena, Jim Khan, Vanni Agnoletti, Luca Ansaloni, Ana Gabriela Barría Rodríguez, Paolo Pietro Bianchi, Walter Biffl, Francesca Bravi, Graziano Ceccarelli, Marco Ceresoli, Osvaldo Chiara, Mircea Chirica, Lorenzo Cobianchi, Federico Coccolini, Raul Coimbra, Christian Cotsoglou, Mathieu D’Hondt, Dimitris Damaskos, Belinda De Simone, Salomone Di Saverio, Michele Diana, Eloy Espin‐Basany, Stefan Fichtner‐Feigl, Paola Fugazzola, Paschalis Gavriilidis, Caroline Gronnier, Jeffry Kashuk, Andrew W. Kirkpatrick, Michele Ammendola, Ewout A. Kouwenhoven, Alexis Laurent, Ari Leppaniemi, Mickaël Lesurtel, Riccardo Memeo, Marco Milone, Ernest Moore, Nikolaos Pararas, Andrew Peitzmann, Patrick Pessaux, Edoardo Picetti, Manos Pikoulis, Michele Pisano, Frederic Ris, Tyler Robison, Massimo Sartelli, Vishal G. Shelat, Giuseppe Spinoglio, Michael Sugrue, Edward Tan, Ellen Van Eetvelde, Yoram Kluger, Dieter Weber, and Fausto Catena
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Emergency surgery ,Minimally invasive surgery ,Robotic surgery ,Laparoscopy ,Training curriculum in surgery ,Surgery ,RD1-811 ,Medical emergencies. Critical care. Intensive care. First aid ,RC86-88.9 - Abstract
Abstract Background Minimally invasive surgery (MIS), including laparoscopic and robotic approaches, is widely adopted in elective digestive surgery, but selectively used for surgical emergencies. The present position paper summarizes the available evidence concerning the learning curve to achieve proficiency in emergency MIS and provides five expert opinion statements, which may form the basis for developing standardized curricula and training programs in emergency MIS. Methods This position paper was conducted according to the World Society of Emergency Surgery methodology. A steering committee and an international expert panel were involved in the critical appraisal of the literature and the development of the consensus statements. Results Thirteen studies regarding the learning curve in emergency MIS were selected. All but one study considered laparoscopic appendectomy. Only one study reported on emergency robotic surgery. In most of the studies, proficiency was achieved after an average of 30 procedures (range: 20–107) depending on the initial surgeon’s experience. High heterogeneity was noted in the way the learning curve was assessed. The experts claim that further studies investigating learning curve processes in emergency MIS are needed. The emergency surgeon curriculum should include a progressive and adequate training based on simulation, supervised clinical practice (proctoring), and surgical fellowships. The results should be evaluated by adopting a credentialing system to ensure quality standards. Surgical proficiency should be maintained with a minimum caseload and constantly evaluated. Moreover, the training process should involve the entire surgical team to facilitate the surgeon’s proficiency. Conclusions Limited evidence exists concerning the learning process in laparoscopic and robotic emergency surgery. The proposed statements should be seen as a preliminary guide for the surgical community while stressing the need for further research.
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- 2023
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18. The 100 most cited papers on thymoma: a bibliometric analysis
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Lei Liu, Jiaqi Zhang, Guige Wang, Ke Zhao, Chao Guo, Cheng Huang, Shanqing Li, and Yeye Chen
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Thymoma ,Bibliometric analysis ,Citations ,Thymic carcinoma ,Treatment ,Surgery ,RD1-811 ,Anesthesiology ,RD78.3-87.3 - Abstract
Abstract Objectives The aim of this bibliometric analysis was twofold: to identify the 100 most cited research articles on thymoma and to highlight future research opportunities in light of past and current research efforts. Methods The Web of Science database was queried to identify the 100 most cited articles on thymoma. Imformations relevant to scientific research were extracted and analyzed: first author, journal, impact factor, type of article, year of publication, country, organization and keywords. Results The publication year of the top 100 most cited articles ranged from 1981 to 2018, and the number of citations ranged from 97 to 1182. Most of the included articles are original (75/100) and are mainly retrospective studies (52/75). The United States has the most published articles and citations, and the Annals of Thoracic Surgery is the most sourced journal (n = 16). Through VOSviewer analysis, high-density keywords mainly come from thymic carcinoma/invasive thymoma management, immune-related diseases, and laboratory research. Conclusions To our knowledge, this is the first bibliometric study on thymoma. We found most of the top 100 most cited articles are original and retrospective research. The United States has the published and cited works. Presently, the hot keywords for thymoma research has gradually tilted towards immune-related diseases and laboratory research.
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- 2023
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19. Multidisciplinary paper on patient blood management in cardiothoracic surgery in the UK: perspectives on practice during COVID-19
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Nawwar Al-Attar, Jullien Gaer, Vincenzo Giordano, Emma Harris, Alan Kirk, Mahmoud Loubani, Patrick Meybohm, Rana Sayeed, Ulrich Stock, Jennifer Travers, and Becky Whiteman
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Blood management ,Bleeding ,Cardiothoracic surgery ,COVID-19 ,Haemostats ,Surgery ,RD1-811 ,Anesthesiology ,RD78.3-87.3 - Abstract
Abstract The coronavirus (COVID-19) pandemic disrupted all surgical specialties significantly and exerted additional pressures on the overburdened United Kingdom (UK) National Health Service. Healthcare professionals in the UK have had to adapt their practice. In particular, surgeons have faced organisational and technical challenges treating patients who carried higher risks, were more urgent and could not wait for prehabilitation or optimisation before their intervention. Furthermore, there were implications for blood transfusion with uncertain patterns of demand, reductions in donations and loss of crucial staff because of sickness and public health restrictions. Previous guidelines have attempted to address the control of bleeding and its consequences after cardiothoracic surgery, but there have been no targeted recommendations in light of the recent COVID-19 challenges. In this context, and with a focus on the perioperative period, an expert multidisciplinary Task Force reviewed the impact of bleeding in cardiothoracic surgery, explored different aspects of patient blood management with a focus on the use of haemostats as adjuncts to conventional surgical techniques and proposed best practice recommendations in the UK.
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- 2023
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20. Delivery Of Paper Product Vouchers Intended For Employees Of The Wielkopolska Pulmonology And Thoracic Surgery Center
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Workers ,Surgical clinics ,Paper products industry ,Surgery ,Business, international - Abstract
Tenders are invited for delivery of goods vouchers in paper form intended for employees of the wielkopolska center for pulmonology and thoracic surgery. The subject of the order is the [...]
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- 2024
21. Comparison of Two Generations of Thoracic Aortic Stent Grafts and Their Impact on Aortic Stiffness in an Ex Vivo Porcine ModelWhat this paper adds
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Tim J. Mandigers, Michele Conti, Sara Allievi, Francesca Dedola, Daniele Bissacco, Daniele Bianchi, Stefania Marconi, Maurizio Domanin, Joost A. Van Herwaarden, Ferdinando Auricchio, and Santi Trimarchi
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Aortic stiffness ,Captivia ,Experimental investigation ,Navion ,Pulse wave velocity ,Valiant ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 ,Surgery ,RD1-811 - Abstract
Objective: Little is known about the cardiovascular changes after TEVAR and regarding the impact on aortic stiffness for different stent graft generations specifically, following changes in device design. The present study evaluated the stent graft induced aortic stiffening of two generations of the Valiant thoracic aortic stent graft. Methods: This was an ex vivo porcine investigation using an experimental mock circulatory loop. Thoracic aortas of young healthy pigs were harvested and connected to the mock circulatory loop. At a 60 bpm heart rate and stable mean arterial pressure, baseline aortic characteristics were obtained. Pulse wave velocity (PWV) was calculated before and after stent graft deployment. Paired and independent sample t tests or their non-parametric alternatives were performed to test for differences where appropriate. Results: Twenty porcine thoracic aortas were divided into two equal subgroups, in which a Valiant Captivia or a Valiant Navion stent graft was deployed. Both stent grafts were similar in diameter and length. Baseline aortic characteristics did not differ between the subgroups. Mean arterial pressure values did not change after either stent graft, while pulse pressures increased statistically significantly after Captivia (mean 44 ± 10 mmHg to 51 ± 13 mmHg, p = .002) but not after Navion. Mean baseline PWV increased after both Captivia (4.4 ± 0.6 m/s to 4.8 ± 0.7 m/s, p = .007) and Navion (4.6 ± 0.7 m/s to 4.9 ± 0.7 m/s, p = .002). There was no statistically significant difference in the mean percentage increase in PWV for either subgroup (8 ± 4% vs. 6 ± 4%, p = .25). Conclusion: These experimental findings showed no statistically significant difference in the percentage increase of aortic PWV after either stent graft generation and confirm that TEVAR increases aortic PWV. As a surrogate for aortic stiffness, this calls for further improvements in future thoracic aortic stent graft designs regarding device compliance.
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- 2023
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22. First in Human Implantation of the Thoracoflo Graft: A New Hybrid Device for Thoraco-Abdominal Aortic RepairWhat this paper adds
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Eike Sebastian Debus, Karolina Malik, Tilo Kölbel, Susanne Honig, Jens Brickwedel, Christoph Behem, and Sabine Helena Wipper
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Hybrid device ,Thoracoabdominal repair ,Thoracoflo ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 ,Surgery ,RD1-811 - Abstract
Introduction: Despite a high rate of success when performed in specialised centres, current techniques for thoraco-abdominal aortic repair are associated with serious complications. The problem of spinal cord ischaemia remains unsolved. Surgical technique: The new hybrid graft for thoraco-abdominal aortic repair was developed based on the frozen elephant trunk principle. The device consists of a proximal stent graft for transabdominal retrograde delivery to the descending thoracic aorta, combined with a distal six branched abdominal device for open aortic repair. An additional seventh branch is provided for possible lumbar artery re-implantation. Because the stent graft is implanted via a transabdominal approach, it avoids the need for thoracotomy and extracorporeal circulation. A 56 year old patient with Loeys–Dietz syndrome was placed in a supine position. The aorto-iliac axis was exposed via a midline transperitoneal approach. Following an end to side anastomosis of the iliac branch to the left common iliac artery, the stent graft portion was inserted into the thoracic aorta via the coeliac trunk ostium. After stent implantation and graft de-airing by needle puncture, retrograde blood flow to the abdominal aortic segment, and the lumbar and visceral arteries was established via the end to side iliac anastomosis creating an extra-anatomic bypass. Subsequently, the visceral and renal arteries were anastomosed to the branches. Finally, the aorta was opened and surgical graft attached via the collar. The reconstruction ended with end to end anastomoses of both common iliac arteries to the graft branches. Discussion: The first and successful implantation of the new Thoracoflo hybrid device via a novel surgical technique is reported, eliminating the need for thoracotomy and extracorporeal circulation for thoraco-abdominal aortic repair.
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- 2023
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23. ACUTE CHOLECYSTITIS IN HIGH-RISK PATIENTS. SURGICAL, RADIOLOGICAL, OR ENDOSCOPIC TREATMENT? BRAZILIAN COLLEGE OF DIGESTIVE SURGERY POSITION PAPER
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Júlio Cezar Uili COELHO, Marco Aurélio Raeder da COSTA, Marcelo ENNE, Orlando Jorge Martins TORRES, Wellington ANDRAUS, and Antonio Carlos Ligocki CAMPOS
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Gallbladder ,Acute cholecystitis ,Cholecystectomy ,Cholecystostomy ,Laparoscopic drainage ,Endoscopic drainage ,Surgery ,RD1-811 ,Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
ABSTRACT Acute cholecystitis (AC) is an acute inflammatory process of the gallbladder that may be associated with potentially severe complications, such as empyema, gangrene, perforation of the gallbladder, and sepsis. The gold standard treatment for AC is laparoscopic cholecystectomy. However, for a small group of AC patients, the risk of laparoscopic cholecystectomy can be very high, mainly in the elderly with associated severe diseases. In these critically ill patients, percutaneous cholecystostomy or endoscopic ultrasound gallbladder drainage may be a temporary therapeutic option, a bridge to cholecystectomy. The objective of this Brazilian College of Digestive Surgery Position Paper is to present new advances in AC treatment in high-risk surgical patients to help surgeons, endoscopists, and physicians select the best treatment for their patients. The effectiveness, safety, advantages, disadvantages, and outcomes of each procedure are discussed. The main conclusions are: a) AC patients with elevated surgical risk must be preferably treated in tertiary hospitals where surgical, radiological, and endoscopic expertise and resources are available; b) The optimal treatment modality for high-surgical-risk patients should be individualized based on clinical conditions and available expertise; c) Laparoscopic cholecystectomy remains an excellent option of treatment, mainly in hospitals in which percutaneous or endoscopic gallbladder drainage is not available; d) Percutaneous cholecystostomy and endoscopic gallbladder drainage should be performed only in well-equipped hospitals with experienced interventional radiologist and/or endoscopist; e) Cholecystostomy catheter should be removed after resolution of AC. However, in patients who have no clinical condition to undergo cholecystectomy, the catheter may be maintained for a prolonged period or even definitively; f) If the cholecystostomy catheter is maintained for a long period of time several complications may occur, such as bleeding, bile leakage, obstruction, pain at the insertion site, accidental removal of the catheter, and recurrent AC; g) The ideal waiting time between cholecystostomy and cholecystectomy has not yet been established and ranges from immediately after clinical improvement to months. h) Long waiting periods between cholecystostomy and cholecystectomy may be associated with new episodes of acute cholecystitis, multiple hospital readmissions, and increased costs. Finally, when selecting the best treatment option other aspects should also be considered, such as costs, procedures available at the medical center, and the patient’s desire. The patient and his family should be fully informed about all treatment options, so they can help making the final decision.
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- 2023
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24. INSTITUTE OF NEUROSURGERY invites tenders for Acquisition of Creped and Bilaminated Paper
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Surgery ,Company acquisition/merger ,News, opinion and commentary - Abstract
INSTITUTE OF NEUROSURGERY, Chile has invited tenders for Acquisition of Creped and Bilaminated Paper. Tender Notice No: 1057490-47-LP24 Deadline: May 27, 2024 Copyright © 2011-2022 pivotalsources.com. All rights reserved. Provided [...]
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- 2024
25. ANTIBIOTIC PROPHYLAXIS FOR ABDOMINAL SURGERY: WHEN TO RECOMMEND? BRAZILIAN COLLEGE OF DIGESTIVE SURGERY POSITION PAPER
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Alexandre Coutinho Teixeira de FREITAS, Álvaro Antonio Bandeira FERRAZ, Leandro Cardoso BARCHI, and Ilka de Fátima Santana Ferreira BOIN
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Antibiotic prophylaxis ,Surgical wound infections ,Postoperative complications ,Digestive system surgical procedures ,Surgery ,RD1-811 ,Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
ABSTRACT BACKGROUND: Surgical antibiotic prophylaxis is an essential component of perioperative care. The use of prophylactic regimens of antibiotics is a well-established practice that is encouraged to be implemented in preoperative/perioperative protocols in order to prevent surgical site infections. AIMS: The aim of this study was to emphasize the crucial aspects of antibiotic prophylaxis in abdominal surgery. RESULTS: Antibiotic prophylaxis is defined as the administration of antibiotics before contamination occurs, given with the intention of preventing infection by achieving tissue levels of antibiotics above the minimum inhibitory concentration at the time of surgical incision. It is indicated for clean operations with prosthetic materials or in cases where severe consequences may arise in the event of an infection. It is also suitable for all clean-contaminated and contaminated operations. The spectrum of action is determined by the pathogens present at the surgical site. Ideally, a single intravenous bolus dose should be administered within 60 min before the surgical incision. An additional dose should be given in case of hemorrhage or prolonged surgery, according to the half-life of the drug. Factors such as the patient’s weight, history of allergies, and the likelihood of colonization by resistant bacteria should be considered. Compliance with institutional protocols enhances the effectiveness of antibiotic use. CONCLUSION: Surgical antibiotic prophylaxis is associated with reduced rates of surgical site infection, hospital stay, and morbimortality.
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- 2023
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26. Vatican Paper Condemns Gender Fluidity and Transition Surgery
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Horowitz, Jason and Povoledo, Elisabetta
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Transgender people ,Sex change ,Abused women ,Surgery ,General interest ,News, opinion and commentary - Abstract
The statement is likely to be embraced by conservatives and stir consternation among L.G.B.T.Q. advocates who fear it will be used as a cudgel against transgender people. The Vatican on [...]
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- 2024
27. What is the role of hand surgery in plastic surgery? Analysis of hand surgery papers presented in Turkish national congresses of plastic, reconstructive, and aesthetic surgery
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Gokce Yildiran, Mustafa Sutcu, Erden Erkut Erkol, and Osman Akdag
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congress papers ,hand surgery ,plastic surgery ,Medicine ,Surgery ,RD1-811 - Abstract
Context: Scientific studies are often presented primarily to a group of colleagues at annual scientific meetings. All year rounds are turned into products in congresses. Aims: The aim of the study is to evaluate the extent of the hand surgery in plastic surgery and plastic surgeons' papers related with hand surgery in national congresses; the past eight plastic surgery congresses were classified and presented. Settings and Design: The abstract books of Turkish National Congresses of Plastic, Reconstructive, and Aesthetic Surgery between 2011 and 2018 have been evaluated retrospectively. Subjects and Methods: Distribution of hand surgery according to the topics was evaluated according to the European White Book rules and standards. Distribution of oral and posters and distribution by years were shown. Results: The ratio of hand surgery reports to all reports was 17.3%. Hand and upper extremity surgery topics were presented at 19.7% in the 38th congress, which is the most hand surgery-included congress. The most frequently presented subjects were tumors, flaps, trauma, congenital anomalies, and replantation. Conclusions: Although there are arguments that plastic surgeons have disregarded hand surgery, there is no similar situation for Turkish plastic surgeons in the national platform. It has been found that the most common topics such as tumor excision and repair of the tissue defect were the most presented issues rather than arthroscopy, paralytic hand, and arthritis, which are specific to the hand surgery. Increasing the number of plastic surgery specialists who have been trained with hand surgery as a subspecialty will bring up the subjects that have not been presented in the hand surgery so far, in the future congresses.
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- 2020
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28. Authors should be held responsible for artificial intelligence hallucinations and mistakes in their papers
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Louie Giray
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Medicine ,Surgery ,RD1-811 ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Published
- 2023
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29. Robotic surgery in emergency setting: 2021 WSES position paper
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Nicola de’Angelis, Jim Khan, Francesco Marchegiani, Giorgio Bianchi, Filippo Aisoni, Daniele Alberti, Luca Ansaloni, Walter Biffl, Osvaldo Chiara, Graziano Ceccarelli, Federico Coccolini, Enrico Cicuttin, Mathieu D’Hondt, Salomone Di Saverio, Michele Diana, Belinda De Simone, Eloy Espin-Basany, Stefan Fichtner-Feigl, Jeffry Kashuk, Ewout Kouwenhoven, Ari Leppaniemi, Nassiba Beghdadi, Riccardo Memeo, Marco Milone, Ernest Moore, Andrew Peitzmann, Patrick Pessaux, Manos Pikoulis, Michele Pisano, Frederic Ris, Massimo Sartelli, Giuseppe Spinoglio, Michael Sugrue, Edward Tan, Paschalis Gavriilidis, Dieter Weber, Yoram Kluger, and Fausto Catena
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Emergency surgery ,Robotic surgery ,General surgery ,Minimally invasive surgery ,Surgery ,RD1-811 ,Medical emergencies. Critical care. Intensive care. First aid ,RC86-88.9 - Abstract
Abstract Background Robotics represents the most technologically advanced approach in minimally invasive surgery (MIS). Its application in general surgery has increased progressively, with some early experience reported in emergency settings. The present position paper, supported by the World Society of Emergency Surgery (WSES), aims to provide a systematic review of the literature to develop consensus statements about the potential use of robotics in emergency general surgery. Methods This position paper was conducted according to the WSES methodology. A steering committee was constituted to draft the position paper according to the literature review. An international expert panel then critically revised the manuscript. Each statement was voted through a web survey to reach a consensus. Results Ten studies (3 case reports, 3 case series, and 4 retrospective comparative cohort studies) have been published regarding the applications of robotics for emergency general surgery procedures. Due to the paucity and overall low quality of evidence, 6 statements are proposed as expert opinions. In general, the experts claim for a strict patient selection while approaching emergent general surgery procedures with robotics, eventually considering it for hemodynamically stable patients only. An emergency setting should not be seen as an absolute contraindication for robotic surgery if an adequate training of the operating surgical team is available. In such conditions, robotic surgery can be considered safe, feasible, and associated with surgical outcomes related to an MIS approach. However, there are some concerns regarding the adoption of robotic surgery for emergency surgeries associated with the following: (i) the availability and accessibility of the robotic platform for emergency units and during night shifts, (ii) expected longer operative times, and (iii) increased costs. Further research is necessary to investigate the role of robotic surgery in emergency settings and to explore the possibility of performing telementoring and telesurgery, which are particularly valuable in emergency situations. Conclusions Many hospitals are currently equipped with a robotic surgical platform which needs to be implemented efficiently. The role of robotic surgery for emergency procedures remains under investigation. However, its use is expanding with a careful assessment of costs and timeliness of operations. The proposed statements should be seen as a preliminary guide for the surgical community stressing the need for reevaluation and update processes as evidence expands in the relevant literature.
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- 2022
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30. Paper Tape Improves Scar Aesthetics and Prevents Wound Closure Complications
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Catherine Stratis, Syed Ali Haider, Olachi Oleru, MD, Nargiz Seyidova, MD, Hani Sbitany, MD, and Peter Henderson, MD, MBA, FACS
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Surgery ,RD1-811 - Published
- 2023
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31. USING PENCIL-PAPER TESTS TO MONITOR THE CHILD'S PROGRESS DURING LANGUAGE THERAPY
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Magdalena Dumitrana
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verbal language ,therapy ,monitoring ,the pencil-paper test ,Medicine (General) ,R5-920 ,Surgery ,RD1-811 - Abstract
The paper has as a main objective the comparison between the performances of a subject under the therapy of the verbal language, the performances expressed by her results at two tests, the ‘Draw-a-Man’ test in Jacqueline Royer’s approach and the ‘Star-Wave’ test created by Ursula Avé-Lallemant.The discussion on the results has demonstrated the validity of these tests in the displaying of the progress, as well as their complementarity in what concerns certain psychological aspects.
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- 2019
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32. Marked paper: Type 2 diabetes mellitus indicates increased postoperative complications and poor prognosis in colorectal cancer patients receiving curative surgery
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Daoli Liu, Xubing Zhang, Hong Zhou, Zhiqiang Zhu, Yiren He, Xiao Wan, Bo Zhang, Shaojun Liu, and Liu Liu
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diabetes mellitus ,colorectal cancer ,complication ,prognosis ,surgery ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
PurposeThis study aimed to evaluate the impact of type 2 diabetes mellitus (T2DM) on the short-term outcomes and long-term survival of patients with colorectal cancer (CRC) who underwent curative resection.MethodsThis study retrospectively included 136 patients (T2DM group) with resectable CRC and T2DM from Jan 2013 to Dec 2017. Propensity score-matched control group consisting of 136 patients (non-T2DM group) were selected from 1143 CRC patients without T2DM. The short-term outcomes and prognosis were compared between the T2DM and non-T2DM group.ResultsA total of 272 patients (136 patients for each group) were included in this study. Patients in T2DM group had higher body mass index (BMI), higher proportion of hypertension and cerebrovascular diseases (P
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- 2023
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33. STATE INSTITUTION SCIENTIFIC AND PRACTICAL MEDICAL CENTER OF PEDIATRIC CARDIOLOGY AND CARDIAC SURGERY OF THE MINISTRY OF HEALTH OF UKRAINE invites tenders for Code Dk 021: 2015 30190000-7 Office Equipment and Accessories is Different (office Paper, Consum
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Medical centers ,Pediatric cardiology ,Children -- Health aspects ,Electronic office machines ,Surgery ,News, opinion and commentary - Abstract
STATE INSTITUTION SCIENTIFIC AND PRACTICAL MEDICAL CENTER OF PEDIATRIC CARDIOLOGY AND CARDIAC SURGERY OF THE MINISTRY OF HEALTH OF UKRAINE, Ukraine has invited tenders for Code Dk 021: 2015 30190000-7 [...]
- Published
- 2024
34. Escalation of Antithrombotic Therapy Should Be Considered in the Presence of Intraluminal Prosthetic Graft Thrombus Following Endovascular Aneurysm RepairWhat this paper adds
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Terri-Ann Russell, Sivaram Premnath, Meera Mogan, Grace Langford, Bronte Paice, James Kirk, Timothy Rowlands, and Ganesh Kuhan
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Abdominal aortic aneurysm ,Endovascular techniques ,Thrombus ,Peripheral arterial diseases ,Anticoagulant ,Antiplatelet agents ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 ,Surgery ,RD1-811 - Abstract
Objectives: Intraluminal prosthetic graft thrombus (IPT) following Endovascular Aneurysm Repair (EVAR) can have serious consequences. The aim of this study was to assess the prevalence of IPT and to identify the risk factors for its formation and progression. Methods: This was a retrospective study of 258 patients who had EVAR between 2015 and 2018. Demographic data, comorbidities, operative data, antithrombotic therapy, CT anatomical data, IPT characteristics (site, regression, and progression), and re-interventions were collected. Univariable analysis followed by multivariable logistic regression and Cox regression were used for data analysis. Results: The mean age of patients was 76 years (range 55–95) and 27 (10.5 %) were females. IPT was present in 26 patients (10.1%) with a median time to occurrence of six (range 1– - 24) months. Of the group that developed IPT, six (23.1 %) developed symptoms and two (7.7%) had re-interventions. Multivariable logistic regression analysis revealed peripheral arterial disease to be associated with the formation of IPT (OR 7.4, 95% CI 1.6–35.3, p = 0.02) and escalation of antithrombotic therapy was associated with regression or prevention of progression of IPT (OR 0.1, 95% CI 0.0–0.6, p = 0.01). Conclusion: PAD is associated with the formation of IPT after EVAR and warrants consideration of escalation of antithrombotic therapy to prevent further progression and complications.
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- 2022
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35. Acute Phase Pilot Evaluation of Small Diameter Long iBTA Induced Vascular Graft 'Biotube' in a Goat ModelWHAT THIS PAPER ADDS
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Ryuji Higashita, Yasuhide Nakayama, Yasuyuki Shiraishi, Ryosuke Iwai, Yusuke Inoue, Akihiro Yamada, Takeshi Terazawa, Tsutomu Tajikawa, Manami Miyazaki, Mamiko Ohara, Tadashi Umeno, Keitaro Okamoto, Tomonori Oie, Tomoyuki Yambe, and Shinji Miyamoto
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Biotube ,Chronic limb threatening ischaemia ,In body tissue architecture ,Small diameter artificial vascular graft ,Tissue engineered vascular graft ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 ,Surgery ,RD1-811 - Abstract
Objective: There is a need for small diameter vascular substitutes in the absence of available autologous material. A small diameter, long tissue engineered vascular graft was developed using a completely autologous approach called “in body tissue architecture technology (iBTA)”. The aim of this pilot study was to evaluate “Biotubes”, iBTA induced autologous collagenous tubes, for their potential use as small diameter vascular bypass conduits. Methods: Biotubes (internal diameter 4 mm, length 50 cm, wall thickness 0.85 mm) were prepared by subcutaneous embedding of plastic moulds (Biotube Maker) in three goats for approximately two months. Allogenic Biotubes (length 10 cm [n = 2], 15 cm [n = 2], 22 cm [n = 2]) were bypassed to both carotid arteries by end to side anastomosis with their ligation between the anastomoses in another three goats. Residual Biotubes were examined for their mechanical properties. After four weeks, the harvested Biotubes were evaluated histologically. Results: All Biotubes had sufficient pressure resistance, approximately 3000 mmHg. Although wall thickening occurred at two proximal anastomosis sites, all six grafts were patent without luminal thrombus formation, stenosis, or aneurysm deformation throughout the implantation period. Endothelial cells covered both anastomosis sites almost completely, with partial covering in the central portion of the grafts. Furthermore, α smooth muscle actin positive cells infiltrated the middle layer along almost the entire graft length. Conclusion: This preliminary study showed that small diameter, long, tissue engineered Biotubes could function properly as arterial bypass conduits in a large animal for one month without any abnormal change in vascular shape. Thus, small diameter, long Biotubes are potentially viable conduits, which are biocompatible and labour non-intensive, and therefore, suitable for clinical practice. Additionally, Biotubes can start the regeneration process in a short period of time.
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- 2022
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36. Organ donation after circulatory determination of death in India: A joint position paper
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Avnish Kumar Seth, Ravi Mohanka, Sumana Navin, Alla Gopala Krishna Gokhale, Ashish Sharma, Anil Kumar, Bala Ramachandran, K R Balakrishnan, Darius F Mirza, Dhvani Mehta, Kapil G Zirpe, Kumud Dhital, Manisha Sahay, Srinagesh Simha, Radha Sundaram, Rahul Anil Pandit, Raj Kumar Mani, Roop Gursahani, Subhash Gupta, Vivek Kute, and Sunil Shroff
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deceased donations ,donation after circulatory determination of death ,donation after neurologic determination of death ,living donor transplantation ,Surgery ,RD1-811 - Abstract
Organ donation following circulatory determination of death (DCDD) has contributed significantly to the donor pool in several countries, without compromising the outcomes of transplantation or the number of donations following brain death (BD). In India, majority of deceased donations happen following BD. While existing legislation allows for DCDD, there have been only a few reports of kidney transplantation following DCDD from the country. This document, prepared by a multi-disciplinary group of experts, reviews the international best practices in DCDD and outlines the path for furthering the same in India. The ethical, medical, legal, economic, procedural, and logistic challenges unique to India for all types of DCDD based on the Modified Maastricht Criteria have been addressed. India follows an opt-in system for organ donation that does not allow much scope for uncontrolled DCDD categories I and II. The practice of withdrawal of life-sustaining treatment (WLST) in India is in its infancy. The process of WLST, laid down by the Supreme Court of India, is considered time-consuming, possible only in patients in a permanent vegetative state, and considered too cumbersome for day-to-day practice. In patients where continued medical care is determined to be futile following detailed and repeated assessment, the procedure for WLST, as laid down and published by Vidhi Centre for Legal Policy in conjunction with leading medical experts is described. In controlled DCDD (category-III), the decision for WLST is independent of and delinked from the subsequent possibility of organ donation. Once families are inclined toward organ donation, they are explained the procedure including the timing and location of WLST, consent for antemortem measures, no-touch period, and the possibility of stand down and return to the intensive care unit without donation. While donation following neurologic determination of death (DNDD) is being increasingly practiced in the country, there are instances where the cardiac arrest occurs during the process of declaration of BD, before organ retrieval has been done. Protocol for DCDD category-IV deals with such situations and is described in detail. In DCDD category V, organ donation may be possible following unsuccessful cardiopulmonary resuscitation of cardiac arrest in the intensive care. An outline of organ-specific requisites for kidney, liver, heart, and lung transplantation following DCDD and the use of techniques such as normothermic regional perfusion and ex vivo machine perfusion has been provided. With increasing experience, the outcomes of transplantation following DCDD are comparable to those following DBDD or living donor transplantation. Documents and checklists necessary for the successful execution of DCDD in India are described.
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- 2022
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37. Stochastic Workflow Modeling in a Surgical Ward: Towards Simulating and Predicting Patient Flow
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Back, Christoffer O., Manataki, Areti, Papanastasiou, Angelos, Harrison, Ewen, Filipe, Joaquim, Editorial Board Member, Ghosh, Ashish, Editorial Board Member, Prates, Raquel Oliveira, Editorial Board Member, Zhou, Lizhu, Editorial Board Member, Ye, Xuesong, editor, Soares, Filipe, editor, De Maria, Elisabetta, editor, Gómez Vilda, Pedro, editor, Cabitza, Federico, editor, Fred, Ana, editor, and Gamboa, Hugo, editor
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- 2021
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38. Fluorescence‐guided surgery and intervention — An AAPM emerging technology blue paper
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Pogue, Brian W, Zhu, Timothy C, Ntziachristos, Vasilis, Paulsen, Keith D, Wilson, Brian C, Pfefer, Joshua, Nordstrom, Robert J, Litorja, Maritoni, Wabnitz, Heidrun, Chen, Yu, Gioux, Sylvain, Tromberg, Bruce J, and Yodh, Arjun G
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Biomedical Imaging ,Bioengineering ,4.1 Discovery and preclinical testing of markers and technologies ,Detection ,screening and diagnosis ,Consensus ,Curriculum ,Health Personnel ,Humans ,Optical Imaging ,Patient Safety ,Practice Guidelines as Topic ,Societies ,Medical ,Surgery ,Computer-Assisted ,imaging ,imaging system ,intervention ,molecular ,molecular probe ,resection ,Other Physical Sciences ,Biomedical Engineering ,Oncology and Carcinogenesis ,Nuclear Medicine & Medical Imaging - Abstract
Fluorescence-guided surgery (FGS) and other interventions are rapidly evolving as a class of technologically driven interventional approaches in which many surgical specialties visualize fluorescent molecular tracers or biomarkers through associated cameras or oculars to guide clinical decisions on pathological lesion detection and excision/ablation. The technology has been commercialized for some specific applications, but also presents technical challenges unique to optical imaging that could confound the utility of some interventional procedures where real-time decisions must be made. Accordingly, the AAPM has initiated the publication of this Blue Paper of The Emerging Technology Working Group (TETAWG) and the creation of a Task Group from the Therapy Physics Committee within the Treatment Delivery Subcommittee. In describing the relevant issues, this document outlines the key parameters, stakeholders, impacts, and outcomes of clinical FGS technology and its applications. The presentation is not intended to be conclusive, but rather to inform the field of medical physics and stimulate the discussions needed in the field with respect to a seemingly low-risk imaging technology that has high potential for significant therapeutic impact. This AAPM Task Group is working toward consensus around guidelines and standards for advancing the field safely and effectively.
- Published
- 2018
39. 31. How Many Plastic Surgeons Does it Take to Write A Paper? A 10-year Bibliometric Analysis of Authorship Inflation
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Ledibabari M. Ngaage, MA Cantab, MB BChir, Suvethavarshini Ketheeswaran, MD, and Jaimie T. Shores, MD
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Surgery ,RD1-811 - Published
- 2023
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40. Establishing position papers by the WSES
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Miklosh Bala, Jeffry Kashuk, Ernest E. Moore, Fausto Catena, Ari Leppaniemi, Luca Ansaloni, Walter Biffl, Federico Coccolini, Andrew Peitzman, Massimo Sartelli, Michael Sugrue, Gustavo P. Fraga, Salomone Di Saverio, and Yoram Kluger
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Position paper ,Emergency surgery ,Working group ,Medical consensus ,Surgery ,RD1-811 ,Medical emergencies. Critical care. Intensive care. First aid ,RC86-88.9 - Abstract
Abstract A position paper (PP) should establish a unified voice in areas where controversy occurs based upon multiple practices and/or therapeutic choices. Typically, a position paper should elucidate the knowledge gap, followed by an evidence-based review of options, leading to an “endorsed position.” A position paper should represent more than the opinion or consensus of the authors but should present current opinions and practices supported by the World Society of Emergency Surgery (WSES). Accordingly, position papers should require the approval of an expert group of WSES and in parallel be presented at an annual meeting prior to submission for publication. It is important that a unified approach for drafting of position papers be established and endorsed by WSES in order to establish credibility and prevent misunderstandings during a smooth transition to publication. The purpose of this article is to suggest a uniform process for the development of WSES guidelines.
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- 2018
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41. Diagnosis and management of small bowel obstruction in virgin abdomen: a WSES position paper
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Yousef Amara, Ari Leppaniemi, Fausto Catena, Luca Ansaloni, Michael Sugrue, Gustavo P. Fraga, Federico Coccolini, Walter L. Biffl, Andrew B. Peitzman, Yoram Kluger, Massimo Sartelli, Ernest E. Moore, Salomone Di Saverio, Esfo Darwish, Chikako Endo, Harry van Goor, and Richard P. ten Broek
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Small bowel obstruction ,Virgin abdomen ,Adhesions ,Conservative management ,operative management ,Immediate intervention ,Surgery ,RD1-811 ,Medical emergencies. Critical care. Intensive care. First aid ,RC86-88.9 - Abstract
Abstract Background Small bowel obstruction (SBO) is a common surgical emergency, causing high morbidity and healthcare costs. The majority of SBOs are caused by adhesions that result from previous surgeries. Bowel obstruction, however, also occurs in patients without previous operation or known pathology, a so called virgin abdomen. It is unknown if small bowel obstruction in the virgin abdomen (SBO-VA) can be managed according to the same principles as other cases of small bowel obstruction. The aim of this position paper is to evaluate the available evidence on etiology and management of small bowel obstruction in the virgin abdomen. Methods This is a narrative review with scoping aspects. Clinical topics covered in this review include epidemiology and etiology of SBO-VA, diagnosis and imaging, initial assessment, the role of surgical management in SBO-VA, and the role of non-operative management in SBO-VA. Results Our scoping search revealed seven original studies reporting original patient data related to SBO-VA. All the included studies are retrospective cohorts, with populations ranging between 44 and 103 patients with SBO-VA. Adhesions were found to be the cause of the obstruction in approximately half of the reported cases of SBO-VA. A relatively high number of cases of SBO-VA were managed surgically with studies reporting 39–83%. However, in cases where a trial of non-operative management was started, this was generally successful. Conclusion The data available suggest that etiology and treatment results for patients with SBO-VA are largely comparable to the results in patients with SBO after previous abdominal surgery. We therefore propose that patients with a virgin abdomen could be treated according to existing guidelines for SBO and adhesive small bowel obstruction.
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- 2021
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42. The management of surgical patients in the emergency setting during COVID-19 pandemic: the WSES position paper
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Belinda De Simone, Elie Chouillard, Massimo Sartelli, Walter L. Biffl, Salomone Di Saverio, Ernest E. Moore, Yoram Kluger, Fikri M. Abu-Zidan, Luca Ansaloni, Federico Coccolini, Ari Leppänemi, Andrew B. Peitzmann, Leonardo Pagani, Gustavo P. Fraga, Ciro Paolillo, Edoardo Picetti, Massimo Valentino, Emmanouil Pikoulis, Gian Luca Baiocchi, and Fausto Catena
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COVID-19 ,Emergency surgery ,Personal protective equipment ,2019-nCoV ,SARS-CoV-2 ,Laparoscopy ,Surgery ,RD1-811 ,Medical emergencies. Critical care. Intensive care. First aid ,RC86-88.9 - Abstract
Abstract Background Since the COVID-19 pandemic has occurred, nations showed their unpreparedness to deal with a mass casualty incident of this proportion and severity, which resulted in a tremendous number of deaths even among healthcare workers. The World Society of Emergency Surgery conceived this position paper with the purpose of providing evidence-based recommendations for the management of emergency surgical patients under COVID-19 pandemic for the safety of the patient and healthcare workers. Method A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-analysis Protocols (PRISMA-P) through the MEDLINE (PubMed), Embase and SCOPUS databases. Synthesis of evidence, statements and recommendations were developed in accordance with the GRADE methodology. Results Given the limitation of the evidence, the current document represents an effort to join selected high-quality articles and experts’ opinion. Conclusions The aim of this position paper is to provide an exhaustive guidelines to perform emergency surgery in a safe and protected environment for surgical patients and for healthcare workers under COVID-19 and to offer the best management of COVID-19 patients needing for an emergency surgical treatment. We recommend screening for COVID-19 infection at the emergency department all acute surgical patients who are waiting for hospital admission and urgent surgery. The screening work-up provides a RT-PCR nasopharyngeal swab test and a baseline (non-contrast) chest CT or a chest X-ray or a lungs US, depending on skills and availability. If the COVID-19 screening is not completed we recommend keeping the patient in isolation until RT-PCR swab test result is not available, and to manage him/she such as an overt COVID patient. The management of COVID-19 surgical patients is multidisciplinary. If an immediate surgical procedure is mandatory, whether laparoscopic or via open approach, we recommend doing every effort to protect the operating room staff for the safety of the patient.
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- 2021
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43. Structured Proposal for Rehabilitation Nursing (RN) Care Intervention: Sensitive Gains to RN Care for the Person with Self-care Deficit and in the Surgical Process
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Nascimento, Vânia, Fonseca, César, Ferreira, Rogério, Lopes, Manuel, Moguel, Enrique, Filipe, Joaquim, Editorial Board Member, Ghosh, Ashish, Editorial Board Member, Kotenko, Igor, Editorial Board Member, Prates, Raquel Oliveira, Editorial Board Member, Zhou, Lizhu, Editorial Board Member, Barbosa, Simone Diniz Junqueira, Editorial Board Member, García-Alonso, José, editor, and Fonseca, César, editor
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- 2020
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44. IVC filters - Indications for placement and retrieval trends– experience from a tertiary referral centre in India type of submission- full paper
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Kartik P. Ganga, Akash Vadher, Vineeta Ojha, Aayush Goyal, and Sanjeev Kumar
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IVC filter ,Retrieval ,Deep vein thrombosis ,Surgery ,RD1-811 ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Objectives: There is wide variation in the practice of IVC filter placement and retrievals. We conducted a retrospective study to identify the trends in placement and retrievals of IVC filters in a tertiary referral centre in India. Methods: The data of patients obtained from our hospital records, in whom IVC filter was placed between 2010 and 2018, were analysed for demographics, indications for placement of IVC filter, underlying comorbidities, characteristics of the filters as well as the retrieval rates. Results: IVC filters were placed in 50 patients, and data was retrieved for 31 patients (mean - 51.24 years, 67.74% males). According to ACCP/AHA guidelines, 24 (77.42%) had an absolute indication for IVC filter. All 31 IVC filters were temporary, 23 (74.19%) of which were placed via femoral access. 29(93.55%) patients had infrarenal IVC filter placement. The average tilt at deployment was 3.71°, whereas it was 5.3° at retrieval. There were no periprocedural complications or filter migrations during placement or retrieval. Retrieval was attempted in 11 (35.48%) patients and was successful in 10. The mean indwelling time in this group was 158.55 days (range 55–366 days). Conclusion: Our study reveals low IVC filter implantation rates which are predominantly for absolute rather than relative indications. Though in sync with the worldwide trend, the poor retrieval rates reflect the urgent need for better patient and physician awareness. Periodic follow up is imperative to improve the IVC filter retrieval rate and to prevent complication rates.
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- 2021
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45. Can Interventional Cardiologists Help Deliver the UK Mechanical Thrombectomy Interventional Programme for Patients with Acute Ischaemic Stroke? A Discussion Paper from the British Cardiovascular Interventional Society Stroke Thrombectomy Focus Group
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Helen Routledge, Andrew SP Sharp, Jan Kovac, Mark Westwood, Thomas R Keeble, Raj Bathula, Hany Eteiba, Iris Q Grunwald, and Nick Curzen
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Surgery ,RD1-811 ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
There is a willingness among UK interventional cardiologists to contribute to provision of a 24/7 mechanical thrombectomy (MT) service for all suitable stroke patients if given the appropriate training. This highly effective intervention remains unavailable to the majority of patients who might benefit, partly because there is a limited number of trained specialists. As demonstrated in other countries, interdisciplinary working can be the solution and an opportunity to achieve this is outlined in this article.
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- 2022
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46. The most influential papers in mitral valve surgery; a bibliometric analysis
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N. Allen, K. O’Sullivan, and J. M. Jones
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Mitral valve ,Mitral valve replacement ,Mitral repair ,Bibliometric analysis ,Valve surgery ,Cardiac surgery ,Surgery ,RD1-811 ,Anesthesiology ,RD78.3-87.3 - Abstract
Abstract This study is an analysis of the 100 most cited articles in mitral valve surgery. A bibliometric analysis is a tool to evaluate research performance in a given field. It uses the number of times a publication is cited by others as a proxy marker of its impact. The most cited paper Carpentier et al. discusses mitral valve repair in terms of restoring the geometry of the entire valve rather than simply narrowing the annulus (Carpentier, J Thorac Cardiovasc Surg 86:23–37, 1983). The first successful mitral valve repair was performed by Elliot Cutler at Brigham and Women’s Hospital in 1923 (Cohn et al., Ann Cardiothorac Surg 4:315, 2015). More recently percutaneous and minimally invasive techniques that were originally designed as an option for high risk patients are being trialled in other patient groups (Hajar, Heart Views 19:160–3, 2018). Comparison of percutaneous method with open repair represents an expanding area of research (Hajar, Heart Views 19:160–3, 2018). This study will analyse the top 100 cited papers relevant to mitral valve surgery, identifying the most influential papers that guide current management, the institutions that produce them and the authors involved.
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- 2020
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47. Intraoperative surgical site infection control and prevention: a position paper and future addendum to WSES intra-abdominal infections guidelines
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Belinda De Simone, Massimo Sartelli, Federico Coccolini, Chad G. Ball, Pietro Brambillasca, Massimo Chiarugi, Fabio Cesare Campanile, Gabriela Nita, Davide Corbella, Ari Leppaniemi, Elena Boschini, Ernest E. Moore, Walter Biffl, Andrew Peitzmann, Yoram Kluger, Michael Sugrue, Gustavo Fraga, Salomone Di Saverio, Dieter Weber, Boris Sakakushev, Osvaldo Chiara, Fikri M. Abu-Zidan, Richard ten Broek, Andrew W. Kirkpatrick, Imtiaz Wani, Raul Coimbra, Gian Luca Baiocchi, Micheal D. Kelly, Luca Ansaloni, and Fausto Catena
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Emergency ,Surgical site infection ,Prevention ,Intra-abdominal infection ,Operating room ,Surgery ,RD1-811 ,Medical emergencies. Critical care. Intensive care. First aid ,RC86-88.9 - Abstract
Abstract Background Surgical site infections (SSI) represent a considerable burden for healthcare systems. They are largely preventable and multiple interventions have been proposed over past years in an attempt to prevent SSI. We aim to provide a position paper on Operative Room (OR) prevention of SSI in patients presenting with intra-abdominal infection to be considered a future addendum to the well-known World Society of Emergency Surgery (WSES) Guidelines on the management of intra-abdominal infections. Methods The literature was searched for focused publications on SSI until March 2019. Critical analysis and grading of the literature has been performed by a working group of experts; the literature review and the statements were evaluated by a Steering Committee of the WSES. Results Wound protectors and antibacterial sutures seem to have effective roles to prevent SSI in intra-abdominal infections. The application of negative-pressure wound therapy in preventing SSI can be useful in reducing postoperative wound complications. It is important to pursue normothermia with the available resources in the intraoperative period to decrease SSI rate. The optimal knowledge of the pharmacokinetic/pharmacodynamic characteristics of antibiotics helps to decide when additional intraoperative antibiotic doses should be administered in patients with intra-abdominal infections undergoing emergency surgery to prevent SSI. Conclusions The current position paper offers an extensive overview of the available evidence regarding surgical site infection control and prevention in patients having intra-abdominal infections.
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- 2020
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48. Distal Re-Entry to Treat Lower Limb Chronic Total Occlusions Using a Novel Electrically Guided Re-Entry CatheterWhat this paper adds
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Dennis Lui, Sorin Popa, Robert J. Dickinson, and Lorenzo Patrone
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Chronic total occlusion ,Re-entry catheter ,Retrograde access ,Tibial angioplasty ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 ,Surgery ,RD1-811 - Abstract
Introduction: Endovascular treatment of challenging infra-inguinal peripheral vascular disease is increasingly common because of new techniques and improved tools. The use of a novel electrically guided 5 F re-entry catheter is presented. By emitting a minute electrical field, detected by a target wire inserted from an opposing access, the catheter's orientation is accurately displayed to the operator, allowing precise re-entry without the need for fluoroscopic alignment. Report: An 84 year old man with tissue loss was treated for a long occlusion of the superficial femoral artery and tibial vessels. Successful subintimal recanalisation was achieved with the help of the ePATH re-entry catheter, restoring inline flow to the foot. Conclusion: This re-entry catheter benefits from an intuitive alignment method, smaller profile, and operator adjustable needle travel, making it a versatile tool for endovascular cases.
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- 2021
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49. Physician Modified Low Profile Endograft for Endovascular Repair of Juxtarenal Abdominal Aortic Aneurysms in Patients with Small Access VesselsWhat this paper adds
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Gustavo Paludetto, Stefaan Van der Meulen, Kenneth Ouriel, and Roberto Patarca
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Abdominal aneurysm repair ,EVAR ,INCRAFT ,Modified endograft ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 ,Surgery ,RD1-811 - Abstract
Introduction: Urgent or emergency treatment of patients with abdominal aortic aneurysms that are anatomically unsuitable for conventional repair because of short proximal necks, small diameters and access vessel calcification, and high risk for open repair can be performed with commercially available branched or fenestrated aortic endografts or physician modified stent grafts. Report: A technique is described for modification and successful implantation of a commercially available standard aortic stent graft with a low profile main body in two patients at high risk for open repair, with small access vessels and requiring uni- or bilateral renal artery fenestration for juxtarenal aneurysm repair. Discussion: Based on two case experiences, the use of physician modified off the shelf endografts appears to be a feasible and effective alternative to fenestrated endovascular repair in patients with juxtarenal abdominal aortic aneurysms at high risk for open surgical repair. Studies comparing effectiveness of the different options, including chimney/snorkel technique and debranching, are warranted.
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- 2021
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50. A Completely Endovascular Solution for Transcatheter Aortic Valve Implantation Embolisation and Inversion into the Aortic ArchWhat this paper adds
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Steven J.G. Leeuwerke, Theo P. Menting, Martin G. Stoel, and Robert H. Geelkerken
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Aortic (valve) stenosis ,Embolisation ,Endovascular ,TAVI ,Thoracic stent graft ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 ,Surgery ,RD1-811 - Abstract
Introduction: Transcatheter aortic valve implantation (TAVI) has evolved into the preferred alternative to surgical valve replacement for severe aortic valve stenosis with high surgical risk. With expanding indications, life threatening complications including transcatheter aortic valve embolisation and inversion (TAVEI), in which the valve dislodges, inverts, and migrates caudally, may increase concomitantly. Report: An 80 year old male with severe aortic valve stenosis underwent balloon expandable transcatheter aortic valve implantation (TAVI). Valve embolisation into the aortic arch inverted the bioprothesis, excluding the option of fixation in the descending aorta. Through-valve thoracic endovascular aortic repair (TEVAR) was performed after bifemoral snaring using a through-and-through wire technique and pulling the valve into the descending aorta. Discussion: TAVI is emerging as the preferred treatment for severe aortic valve stenosis and comes with unique procedural complications, such as life threatening transcatheter aortic valve embolisation and inversion (TAVEI). Although some authors prefer treating embolisation of a non-inverted balloon expandable valve into the aorta by using the valvuloplasty balloon to pull the valve distally and fixing it in the descending aorta, this risks further expansion of the valve and consequently fixing it in an undesirable position and is not possible if the valve inverts. Downstream placement of the valve by snaring with a guiding catheter covering/protecting a through-and-through wire technique, combined with through-valve TEVAR, provides a new bail out strategy for this serious complication and may reduce TAVEI associated mortality and morbidity.
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- 2021
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