Browsing by Subject "3126 Surgery, anesthesiology, intensive care, radiology"

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  • Puolakkainen, Tero; Toivari, Miika; Puolakka, Tuukka; Snäll, Johanna (2022)
    Background Numerous guidelines highlight the need for early airway management in facial trauma patients since specific fracture patterns may induce airway obstruction. However, the incidence of these hallmark injuries, including flail mandibles and posterior displacement of the maxilla, is contentious. We aim to evaluate specific trauma-related variables in facial fracture patients, which affect the need for on-scene versus in-hospital airway management. Methods This retrospective cohort study included all patients with any type of facial fracture, who required early airway management on-scene or in-hospital. The primary outcome variable was the site of airway management (on-scene versus hospital) and the main predictor variable was the presence of a traumatic brain injury (TBI). The association of fracture type, mechanism, and method for early airway management are also reported. Altogether 171 patients fulfilled the inclusion criteria. Results Of the 171 patients included in the analysis, 100 (58.5) had combined midfacial fractures or combination fractures of facial thirds. Altogether 118 patients (69.0%) required airway management on-scene and for the remaining 53 patients (31.0%) airway was secured in-hospital. A total of 168 (98.2%) underwent endotracheal intubation, whereas three patients (1.8%) received surgical airway management. TBIs occurred in 138 patients (80.7%), but presence of TBI did not affect the site of airway management. Younger age, Glasgow Coma Scale-score of eight or less, and oro-naso-pharyngeal haemorrhage predicted airway management on-scene, whereas patients who had fallen at ground level and in patients with facial fractures but no associated injuries, the airway was significantly more often managed in-hospital. Conclusions Proper preparedness for airway management in facial fracture patients is crucial both on-scene and in-hospital. Facial fracture patients need proper evaluation of airway management even when TBI is not present.
  • Böttiger, B. W.; Lockey, A.; Aickin, R.; Castren, M.; de Caen, A.; Escalante, R.; Kern, K. B.; Lim, S. H.; Nadkarni, V.; Neumar, R. W.; Nolan, J. P.; Stanton, D.; Wang, T. -L.; Perkins, G. D. (2018)
    "All citizens of the world can save a life". With these words, the International Liaison Committee on Resuscitation (ILCOR) is launching the first global initiative - World Restart a Heart (WRAH) - to increase public awareness and therefore the rates of bystander cardiopulmonary resuscitation (CPR) for victims of cardiac arrest. In most of the cases, it takes too long for the emergency services to arrive on scene after the victim's collapse. Thus, the most effective way to increase survival and favourable outcome in cardiac arrest by two-to fourfold is early CPR by lay bystanders and by "first responders". Lay bystander resuscitation rates, however, differ significantly across the world, ranging from 5 to 80%. If all countries could have high lay bystander resuscitation rates, this would help to save hundreds of thousands of lives every year. In order to achieve this goal, all seven ILCOR councils have agreed to participate in WRAH 2018. Besides schoolchildren education in CPR ("KIDS SAVE LIVES"), many other initiatives have already been developed in different parts of the world. ILCOR is keen for the WRAH initiative to be as inclusive as possible, and that it should happen every year on 16 October or as close to that day as possible. Besides recommending CPR training for children and adults, it is hoped that a unified global message will enable our policy makers to take action to address the inequalities in patient survival around the world.
  • Kozyrev, Danil; Thiarawat, Peeraphong; Rezai Jahromi, Behnam; Intarakhao, Patcharin; Choque-Velasquez, Joham; Hijaz, Ferzat; Teo, Mario K.; Hernesniemi, Juha (2017)
    Meticulous haemostasis is one of the most important factors during microneurosurgical resection of brain arteriovenous malformation (AVM). Controlling major arterial feeders and draining veins with clips and bipolar coagulation are well-established techniques, while managing with bleeding from deep tiny vessels still proves to be challenging. This technical note describes a technique used by the senior author in AVM surgery for last 20 years in dealing with the issue highlighted. "Dirty coagulation" is a technique of bipolar coagulation of small feeders carried out together with a thin layer of brain tissue that surrounds these fragile vessels. The senior author uses this technique for achieving permanent haemostasis predominantly in large and/or deep-seated AVMs. To illustrate the efficacy of this technique, we retrospectively reviewed the outcome of Spetzler-Martin (SM) grade III-V AVMs resected by the senior author over the last 5 years (2010-2015). Thirty-five cases of AVM surgeries (14 SM grade III, 15 SM grade IV and 6 SM grade V) in this 5-year period were analysed. No postoperative intracranial haemorrhage was encountered as a result of bleeding from the deep feeders. Postoperative angiograms showed complete resection of all AVMs, except in two cases (SM grade V and grade III). "Dirty coagulation" provides an effective way to secure haemostasis from deep tiny feeders. This cost-effective method could be successfully used for achieving permanent haemostasis and thereby decreasing postoperative haemorrhage in AVM surgery.
  • Vikke, Heidi Storm; Vittinghus, Svend; Betzer, Martin; Giebner, Matthias; Kolmos, Hans Jorn; Smith, Karen; Castren, Maaret; Lindström, Veronica; Mäkinen, Marja; Harve, Heini; Mogensen, Christian Backer (2019)
    BackgroundHand hygiene (HH), a cornerstone in infection prevention and control, lacks quality in emergency medical services (EMS). HH improvement includes both individual and institutional aspects, but little is known about EMS providers' HH perception and motivations related to HH quality. Therefore, we aimed to investigate the HH perception and assess potential factors related to self-reported HH compliance among the EMS cohort.MethodsA cross-sectional, self-administered questionnaire consisting of 24 items (developed from the WHOs Perception Survey for Health-Care Workers) provided information on demographics, HH perceptions and self-reported HH compliance among EMS providers from Denmark.ResultsOverall, 457 questionnaires were answered (response rate 52%). Most respondents were advanced-care providers, males, had >5years of experience, and had received HH training
  • Choque-Velasquez, Joham; Colasanti , Roberto; Rezai Jahromi, Behnam; Hernesniemi, Juha (2017)
    OBJECTIVE: The preservation of normal peri/intralesional bridging veins is extremely important in every micro-neurosurgical operation. The purpose of our study was to describe the "squeeze maneuver"assisted by indocyanine green videoangiography (ICGV), a simple technique to "resuscitate" partially occluded bridging veins during microneurosurgical operations. METHODS: When a bridging vein is inadvertently stretched up to its collapse during microneurosurgical procedures, a precise identification of the partially occluded zone is carried out under high magnification (10-153), as well as with the aid of the ICGV. If a continuous irrigation with isotonic saline solution does not allow one to reestablish the venous flow, the "squeeze maneuver" is carried out. This consists of squeezing and sliding with the bipolar forceps the occluded vessel along the normal venous flow direction. This procedure is repeated several times, while a continuous saline irriga-tion is applied. The ICGV is performed to confirm an adequate patency of the vein. RESULTS: This maneuver permits to restore the normal diameter of the vein and blood flow inside it. CONCLUSION: The "squeeze maneuver"assisted by ICGV represents a safe, clean, fast, and even cheap method for restoring the flow of partially occluded bridging veins during microneurosurgical operations.
  • Herajärvi, Johanna; Jormalainen, Mikko; Mustonen, Caius; Kesävuori, Risto; Raivio, Peter; Biancari, Fausto; Juvonen, Tatu (2022)
    Background. Acute type B aortic dissection (TBAD) is catastrophic event associated with significant mortality and lifelong morbidity. The optimal treatment strategy of TBAD is still controversial. Methods. This analysis includes patients treated for TBAD at the Helsinki University Hospital, Finland in 2007-2019. The endpoints were early and late mortality, and intervention of the aorta. Results. There were 205 consecutive TBAD patients, 59 complicated and 146 uncomplicated patients (mean age of 66 +/- 14, females 27.8%). In-hospital and 30-day mortality rates were higher in complicated patients compared with uncomplicated patients with a statistically significant difference (p = 0.035 and p = 0.015, respectively). After a mean follow-up of 4.9 +/- 3.8 years, 36 (25.0%) and 22 (37.9%) TBAD -related adverse events occurred in the uncomplicated and complicated groups, respectively (p = 0.066). Freedom from composite outcome was 83 +/- 3% and 69 +/- 6% at 1 year, 75 +/- 4% and 63 +/- 7% at 5 years, 70 +/- 5% and 59 +/- 7% at 10 years in the uncomplicated group and in the complicated group, respectively (p = 0.052). There were 25 (39.1%) TBAD-related deaths in the overall series and prior aortic aneurysm was the only risk factor for adverse aortic-related events in multivariate analysis (HR 3.46, 95% CI 1.72-6.96, p < 0.001). Conclusion. TBAD is associated with a significant risk of early and late adverse events. Such a risk tends to be lower among patients with uncomplicated dissection, still one fourth of them experience TBAD-related event. Recognition of risk factors in the uncomplicated group who may benefit from early aortic repair would be beneficial.
  • Sartelli, Massimo; Viale, Pierluigi; Catena, Fausto; Ansaloni, Luca; Moore, Ernest; Malangoni, Mark; Moore, Frederick A.; Velmahos, George; Coimbra, Raul; Ivatury, Rao; Peitzman, Andrew; Koike, Kaoru; Leppäniemi, Ari; Biffl, Walter; Burlew, Clay Cothren; Balogh, Zsolt J.; Boffard, Ken; Bendinelli, Cino; Gupta, Sanjay; Kluger, Yoram; Agresta, Ferdinando; Di Saverio, Salomone; Wani, Imtiaz; Escalona, Alex; Ordonez, Carlos; Fraga, Gustavo P.; Pereira Junior, Gerson Alves; Bala, Miklosh; Cui, Yunfeng; Marwah, Sanjay; Sakakushev, Boris; Kong, Victor; Naidoo, Noel; Ahmed, Adamu; Abbas, Ashraf; Guercioni, Gianluca; Vettoretto, Nereo; Diaz-Nieto, Rafael; Gerych, Ihor; Trana, Cristian; Faro, Mario Paulo; Yuan, Kuo-Ching; Kok, Kenneth Yuh Yen; Mefire, Alain Chichom; Lee, Jae Gil; Hong, Suk-Kyung; Ghnnam, Wagih; Siribumrungwong, Boonying; Sato, Norio; Murata, Kiyoshi; Irahara, Takayuki; Coccolini, Federico; Segovia Lohse, Helmut A.; Verni, Alfredo; Shoko, Tomohisa (2013)
  • Ansaloni, L.; Pisano, M.; Coccolini, F.; Peitzmann, A. B.; Fingerhut, A.; Catena, F.; Agresta, F.; Allegri, A.; Bailey, I.; Balogh, Z. J.; Bendinelli, C.; Biffl, W.; Bonavina, L.; Borzellino, G.; Brunetti, F.; Burlew, C. C.; Camapanelli, G.; Campanile, F. C.; Ceresoli, M.; Chiara, O.; Civil, I.; Coimbra, R.; De Moya, M.; Di Saverio, S.; Fraga, G. P.; Gupta, S.; Kashuk, J.; Kelly, M. D.; Koka, V.; Jeekel, H.; Latifi, R.; Leppaniemi, A.; Maier, R. V.; Marzi, I.; Moore, F.; Piazzalunga, D.; Sakakushev, B.; Sartelli, M.; Scalea, T.; Stahel, P. F.; Taviloglu, K.; Tugnoli, G.; Uraneus, S.; Velmahos, G. C.; Wani, I.; Weber, D. G.; Viale, P.; Sugrue, M.; Ivatury, R.; Kluger, Y.; Gurusamy, K. S.; Moore, E. E. (2016)
    Acute calculus cholecystitis is a very common disease with several area of uncertainty. The World Society of Emergency Surgery developed extensive guidelines in order to cover grey areas. The diagnostic criteria, the antimicrobial therapy, the evaluation of associated common bile duct stones, the identification of "high risk" patients, the surgical timing, the type of surgery, and the alternatives to surgery are discussed. Moreover the algorithm is proposed: as soon as diagnosis is made and after the evaluation of choledocholitiasis risk, laparoscopic cholecystectomy should be offered to all patients exception of those with high risk of morbidity or mortality. These Guidelines must be considered as an adjunctive tool for decision but they are not substitute of the clinical judgement for the individual patient.
  • Ansaloni, L.; Pisano, M.; Coccolini, F.; Peitzmann, A. B.; Fingerhut, A.; Catena, F.; Agresta, F.; Allegri, A.; Bailey, I.; Balogh, Z. J.; Bendinelli, C.; Biffl, W.; Bonavina, L.; Borzellino, G.; Brunetti, F.; Burlew, C. C.; Camapanelli, G.; Campanile, F. C.; Ceresoli, M.; Chiara, O.; Civil, I.; Coimbra, R.; De Moya, M.; Di Saverio, S.; Fraga, G. P.; Gupta, S.; Kashuk, J.; Kelly, M. D.; Khokha, V.; Jeekel, H.; Latifi, R.; Leppaniemi, A.; Maier, R. V.; Marzi, I.; Moore, F.; Piazzalunga, D.; Sakakushev, B.; Sartelli, M.; Scalea, T.; Stahel, P. F.; Taviloglu, K.; Tugnoli, G.; Uraneus, S.; Velmahos, G. C.; Wani, I.; Weber, D. G.; Viale, P.; Sugrue, M.; Ivatury, R.; Kluger, Y.; Gurusamy, K. S.; Moore, E. E. (2016)
  • Birindelli, Arianna; Sartelli, Massimo; Di Saverio, Salomone; Coccolini, Federico; Ansaloni, Luca; van Ramshorst, Gabrielle H.; Campanelli, Giampiero; Khokha, Vladimir; Moore, Ernest E.; Peitzman, Andrew; Velmahos, George; Moore, Frederick Alan; Leppaniemi, Ari; Burlew, Clay Cothren; Biffl, Walter L.; Koike, Kaoru; Kluger, Yoram; Fraga, Gustavo P.; Ordonez, Carlos A.; Novello, Matteo; Agresta, Ferdinando; Sakakushev, Boris; Gerych, Igor; Wani, Imtiaz; Kelly, Michael D.; Gomes, Carlos Augusto; Faro, Mario Paulo; Tarasconi, Antonio; Demetrashvili, Zaza; Lee, Jae Gil; Vettoretto, Nereo; Guercioni, Gianluca; Persiani, Roberto; Trana, Cristian; Cui, Yunfeng; Kok, Kenneth Y. Y.; Ghnnam, Wagih M.; Abbas, Ashraf El-Sayed; Sato, Norio; Marwah, Sanjay; Rangarajan, Muthukumaran; Ben-Ishay, Offir; Adesunkanmi, Abdul Rashid K.; Lohse, Helmut Alfredo Segovia; Kenig, Jakub; Mandala, Stefano; Coimbra, Raul; Bhangu, Aneel; Suggett, Nigel; Biondi, Antonio; Portolani, Nazario; Baiocchi, Gianluca; Kirkpatrick, Andrew W.; Scibe, Rodolfo; Sugrue, Michael; Chiara, Osvaldo; Catena, Fausto (2017)
    Emergency repair of complicated abdominal wall hernias may be associated with worsen outcome and a significant rate of postoperative complications. There is no consensus on management of complicated abdominal hernias. The main matter of debate is about the use of mesh in case of intestinal resection and the type of mesh to be used. Wound infection is the most common complication encountered and represents an immense burden especially in the presence of a mesh. The recurrence rate is an important topic that influences the final outcome. A World Society of Emergency Surgery (WSES) Consensus Conference was held in Bergamo in July 2013 with the aim to define recommendations for emergency repair of abdominal wall hernias in adults. This document represents the executive summary of the consensus conference approved by a WSES expert panel. In 2016, the guidelines have been revised and updated according to the most recent available literature.
  • Pisano, Michele; Zorcolo, Luigi; Merli, Cecilia; Cimbanassi, Stefania; Poiasina, Elia; Ceresoli, Marco; Agresta, Ferdinando; Allievi, Niccolo; Bellanova, Giovanni; Coccolini, Federico; Coy, Claudio; Fugazzola, Paola; Martinez, Carlos Augusto; Montori, Giulia; Paolillo, Ciro; Penachim, Thiago Jose; Pereira, Bruno; Reis, Tarcisio; Restivo, Angelo; Rezende-Neto, Joao; Sartelli, Massimo; Valentino, Massimo; Abu-Zidan, Fikri M.; Ashkenazi, Itamar; Bala, Miklosh; Chiara, Osvaldo; de' Angelis, Nicola; Deidda, Simona; De Simone, Belinda; Di Saverio, Salomone; Finotti, Elena; Kenji, Inaba; Moore, Ernest; Wexner, Steven; Biffl, Walter; Coimbra, Raul; Guttadauro, Angelo; Leppäniemi, Ari; Maier, Ron; Magnone, Stefano; Mefire, Alain Chicom; Peitzmann, Andrew; Sakakushev, Boris; Sugrue, Michael; Viale, Pierluigi; Weber, Dieter; Kashuk, Jeffry; Fraga, Gustavo P.; Kluger, Ioran; Catena, Fausto; Ansaloni, Luca (2018)
    Obstruction and perforation due to colorectal cancer represent challenging matters in terms of diagnosis, life-saving strategies, obstruction resolution and oncologic challenge. The aims of the current paper are to update the previous WSES guidelines for the management of large bowel perforation and obstructive left colon carcinoma (OLCC) and to develop new guidelines on obstructive right colon carcinoma (ORCC). Methods: The literature was extensively queried for focused publication until December 2017. Precise analysis and grading of the literature has been performed by a working group formed by a pool of experts: the statements and literature review were presented, discussed and voted at the Consensus Conference of the 4th Congress of the World Society of Emergency Surgery (WSES) held in Campinas in May 2017. Results: CT scan is the best imaging technique to evaluate large bowel obstruction and perforation. For OLCC, selfexpandable metallic stent (SEMS), when available, offers interesting advantages as compared to emergency surgery; however, the positioning of SEMS for surgically treatable causes carries some long-term oncologic disadvantages, which are still under analysis. In the context of emergency surgery, resection and primary anastomosis (RPA) is preferable to Hartmann's procedure, whenever the characteristics of the patient and the surgeon are permissive. Rightsided loop colostomy is preferable in rectal cancer, when preoperative therapies are predicted. With regards to the treatment of ORCC, right colectomy represents the procedure of choice; alternatives, such as internal bypass and loop ileostomy, are of limited value. Clinical scenarios in the case of perforation might be dramatic, especially in case of free faecal peritonitis. The importance of an appropriate balance between life-saving surgical procedures and respect of oncologic caveats must be stressed. In selected cases, a damage control approach may be required. Medical treatments including appropriate fluid resuscitation, early antibiotic treatment and management of co-existing medical conditions according to international guidelines must be delivered to all patients at presentation. Conclusions: The current guidelines offer an extensive overview of available evidence and a qualitative consensus regarding management of large bowel obstruction and perforation due to colorectal cancer.
  • Sartelli, Massimo; Guirao, Xavier; Hardcastle, Timothy C.; Kluger, Yoram; Boermeester, Marja. A.; Rasa, Kemal; Ansaloni, Luca; Coccolini, Federico; Montravers, Philippe; Abu-Zidan, Fikri M.; Bartoletti, Michele; Bassetti, Matteo; Ben-Ishay, Offir; Biffl, Walter L.; Chiara, Osvaldo; Chiarugi, Massimo; Coimbra, Raul; De Rosa, Francesco Giuseppe; De Simone, Belinda; Di Saverio, Salomone; Giannella, Maddalena; Gkiokas, George; Khokha, Vladimir; Labricciosa, Francesco M.; Leppäniemi, Ari; Litvin, Andrey; Moore, Ernest E.; Negoi, Ionut; Pagani, Leonardo; Peghin, Maddalena; Picetti, Edoardo; Pintar, Tadeja; Pupelis, Guntars; Rubio-Perez, Ines; Sakakushev, Boris; Segovia-Lohse, Helmut; Sganga, Gabriele; Shelat, Vishal; Sugrue, Michael; Tarasconi, Antonio; Trana, Cristian; Ulrych, Jan; Viale, Pierluigi; Catena, Fausto (2018)
    Skin and soft-tissue infections (SSTIs) encompass a variety of pathological conditions that involve the skin and underlying subcutaneous tissue, fascia, or muscle, ranging from simple superficial infections to severe necrotizing infections. SSTIs are a frequent clinical problem in surgical departments. In order to clarify key issues in the management of SSTIs, a task force of experts met in Bertinoro, Italy, on June 28, 2018, for a specialist multidisciplinary consensus conference under the auspices of the World Society of Emergency Surgery (WSES) and the Surgical Infection Society Europe (SIS-E). The multifaceted nature of these infections has led to a collaboration among general and emergency surgeons, intensivists, and infectious disease specialists, who have shared these clinical practice recommendations.
  • European Soc Cardiology ESC; Konstantinides, Stavros V.; Meyer, Guy; Harjola, Veli-Pekka; Luis Zamorano, Jose (2019)
  • Sartelli, Massimo; Di Bella, Stefano; McFarland, Lynne V.; Khanna, Sahil; Furuya-Kanamori, Luis; Abuzeid, Nadir; Abu-Zidan, Fikri M.; Ansaloni, Luca; Augustin, Goran; Bala, Miklosh; Ben-Ishay, Offir; Biffl, Walter L.; Brecher, Stephen M.; Camacho-Ortiz, Adrian; Cainzos, Miguel A.; Chan, Shirley; Cherry-Bukowiec, Jill R.; Clanton, Jesse; Coccolini, Federico; Cocuz, Maria E.; Coimbra, Raul; Cortese, Francesco; Cui, Yunfeng; Czepiel, Jacek; Demetrashvili, Zaza; Di Carlo, Isidoro; Di Saverio, Salomone; Dumitru, Irina M.; Eckmann, Christian; Eiland, Edward H.; Forrester, Joseph D.; Fraga, Gustavo P.; Frossard, Jean L.; Fry, Donald E.; Galeiras, Rita; Ghnnam, Wagih; Gomes, Carlos A.; Griffiths, Ewen A.; Guirao, Xavier; Ahmed, Mohamed H.; Herzog, Torsten; Kim, Jae Il; Iqbal, Tariq; Isik, Arda; Itani, Kamal M. F.; Labricciosa, Francesco M.; Lee, Yeong Y.; Juang, Paul; Karamarkovic, Aleksandar; Kim, Peter K.; Kluger, Yoram; Leppäniemi, Ari; Lohsiriwat, Varut; Machain, Gustavo M.; Marwah, Sanjay; Mazuski, John E.; Metan, Gokhan; Moore, Ernest E.; Moore, Frederick A.; Ordonez, Carlos A.; Pagani, Leonardo; Petrosillo, Nicola; Portela, Francisco; Rasa, Kemal; Rems, Miran; Sakakushev, Boris E.; Segovia-Lohse, Helmut; Sganga, Gabriele; Shelat, Vishal G.; Spigaglia, Patrizia; Tattevin, Pierre; Trana, Cristian; Urbanek, Libor; Ulrych, Jan; Viale, Pierluigi; Baiocchi, Gian L.; Catena, Fausto (2019)
    In the last three decades, Clostridium difficile infection (CDI) has increased in incidence and severity in many countries worldwide. The increase in CDI incidence has been particularly apparent among surgical patients. Therefore, prevention of CDI and optimization of management in the surgical patient are paramount. An international multidisciplinary panel of experts from the World Society of Emergency Surgery (WSES) updated its guidelines for management of CDI in surgical patients according to the most recent available literature. The update includes recent changes introduced in the management of this infection.
  • Leppäniemi, A.; Tolonen, M.; Tarasconi, A.; Segovia-Lohse, H.; Gamberini, E.; Kirkpatrick, A.W.; Ball, C.G.; Parry, N.; Sartelli, M.; Wolbrink, D.; Van Goor, H.; Baiocchi, G.; Ansaloni, L.; Biffl, W.; Coccolini, F.; Di Saverio, S.; Kluger, Y.; Moore, E.; Catena, F. (2019)
    Although most patients with acute pancreatitis have the mild form of the disease, about 20-30% develops a severe form, often associated with single or multiple organ dysfunction requiring intensive care. Identifying the severe form early is one of the major challenges in managing severe acute pancreatitis. Infection of the pancreatic and peripancreatic necrosis occurs in about 20-40% of patients with severe acute pancreatitis, and is associated with worsening organ dysfunctions. While most patients with sterile necrosis can be managed nonoperatively, patients with infected necrosis usually require an intervention that can be percutaneous, endoscopic, or open surgical. These guidelines present evidence-based international consensus statements on the management of severe acute pancreatitis from collaboration of a panel of experts meeting during the World Congress of Emergency Surgery in June 27-30, 2018 in Bertinoro, Italy. The main topics of these guidelines fall under the following topics: Diagnosis, Antibiotic treatment, Management in the Intensive Care Unit, Surgical and operative management, and Open abdomen. © 2019 The Author(s).
  • World Society of Emergency Surgery; Sartelli, M.; Leppäniemi, Ari; Rasa, K.; Tolonen, Matti (2020)
    Acute colonic diverticulitis is one of the most common clinical conditions encountered by surgeons in the acute setting. An international multidisciplinary panel of experts from the World Society of Emergency Surgery (WSES) updated its guidelines for management of acute left-sided colonic diverticulitis (ALCD) according to the most recent available literature. The update includes recent changes introduced in the management of ALCD. The new update has been further integrated with advances in acute right-sided colonic diverticulitis (ARCD) that is more common than ALCD in select regions of the world. © 2020 The Author(s).
  • Pisano, Michele; Allievi, Niccolo; Gurusamy, Kurinchi; Borzellino, Giuseppe; Cimbanassi, Stefania; Boerna, Djamila; Coccolini, Federico; Tufo, Andrea; Di Martino, Marcello; Leung, Jeffrey; Sartelli, Massimo; Ceresoli, Marco; Maier, Ronald; Poiasina, Elia; De Angelis, Nicola; Magnone, Stefano; Fugazzola, Paola; Paolillo, Ciro; Coimbra, Raul; Di Saverio, Salomone; De Simone, Belinda; Weber, Dieter G.; Sakakushev, Boris E.; Lucianetti, Alessandro; Kirkpatrick, Andrew W.; Fraga, Gustavo P.; Wani, Imitaz; Biffl, Walter L.; Chiara, Osvaldo; Abu-Zidan, Fikri; Moore, Ernest E.; Leppäniemi, Ari; Kluger, Yoram; Catena, Fausto; Ansaloni, Luca (2020)
    Background: Acute calculus cholecystitis (ACC) has a high incidence in the general population. The presence of several areas of uncertainty, along with the availability of new evidence, prompted the current update of the 2016 WSES (World Society of Emergency Surgery) Guidelines on ACC. Materials and methods: The WSES president appointed four members as a scientific secretariat, four members as an organization committee and four members as a scientific committee, choosing them from the expert affiliates of WSES. Relevant key questions were constructed, and the task force produced drafts of each section based on the best scientific evidence from PubMed and EMBASE Library; recommendations were developed in order to answer these key questions. The quality of evidence and strength of recommendations were reviewed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria (see ). All the statements were presented, discussed and voted upon during the Consensus Conference at the 6th World Congress of the World Society of Emergency Surgery held in Nijmegen (NL) in May 2019. A revised version of the statements was voted upon via an online questionnaire until consensus was reached. Results: The pivotal role of surgery is confirmed, including in high-risk patients. When compared with the WSES 2016 guidelines, the role of gallbladder drainage is reduced, despite the considerable technical improvements available. Early laparoscopic cholecystectomy (ELC) should be the standard of care whenever possible, even in subgroups of patients who are considered fragile, such as the elderly; those with cardiac disease, renal disease and cirrhosis; or those who are generally at high risk for surgery. Subtotal cholecystectomy is safe and represents a valuable option in cases of difficult gallbladder removal. Conclusions, knowledge gaps and research recommendations: ELC has a central role in the management of patients with ACC. The value of surgical treatment for high-risk patients should lead to a distinction between high-risk patients and patients who are not suitable for surgery. Further evidence on the role of clinical judgement and the use of clinical scores as adjunctive tools to guide treatment of high-risk patients and patients who are not suitable for surgery is required. The development of local policies for safe laparoscopic cholecystectomy is recommended.
  • Kondelin, Johanna; Tuupanen, Sari; Gylfe, Alexandra E.; Aavikko, Mervi; Renkonen-Sinisalo, Laura; Järvinen, Heikki; Bohm, Jan; Mecklin, Jukka-Pekka; Andersen, Claus L.; Vahteristo, Pia; Pitkanen, Esa; Aaltonen, Lauri A. (2015)
    Approximately 15 % of colorectal cancers exhibit instability of short nucleotide repeat regions, microsatellites. These tumors display a unique clinicopathologic profile and the microsatellite instability status is increasingly used to guide clinical management as it is known to predict better prognosis as well as resistance to certain chemotherapeutics. A panel of five repeats determined by the National Cancer Institute, the Bethesda panel, is currently the standard for determining the microsatellite instability status in colorectal cancer. Recently, a quasimonomorphic mononucleotide repeat 16T/U at the 3' untranslated region of the Ewing sarcoma breakpoint region 1 gene was reported to show perfect sensitivity and specificity in detecting mismatch repair deficient colorectal, endometrial, and gastric cancers in two independent populations. To confirm this finding, we replicated the analysis in 213 microsatellite unstable colorectal cancers from two independent populations, 148 microsatellite stable colorectal cancers, and the respective normal samples by PCR and fragment analysis. The repeat showed nearly perfect sensitivity for microsatellite unstable colorectal cancer as it was altered in 212 of the 213 microsatellite unstable (99.5 %) and none of the microsatellite stable colorectal tumors. This repeat thus represents the first potential single marker for detecting microsatellite instability.
  • Öman, Olli; Mäkelä, Teemu; Salli, Eero; Savolainen, Sauli; Kangasniemi, Marko (2019)