Hennebergsantiago7536

bile duct injury is a complication that occurs mainly after cholecystectomy. Outcomes of biliary repair surgery are worse when the stricture level is above the biliary confluence.

A single centred retrospective study was carried out on patients operated in our department for biliary stricture after a major bile duct injury over the period from January 2010 to May 2018. Only patients operated for biliary stricture were included. This study aimed to determine the independent factors influencing the occurrence of a stricture above de biliary confluence. Univariate and multivariate binary regression was used for data analysis.

Fifty-three patients were included, they were 43 women and 10 men, sex-ratio was 0.23. Thirty-one patients had Grade E3-E4-E5 stricture (58,5%), and patients who had a failure of a previous repair surgery accounted for 36% (n=19) of our patients.After univariate and multivariate analysis, only laparoscopic cholecystectomy (OR=7.58, CI=[1.47-38, 91], P=0.015) and failure of anterior biliary repair surgery (OR=7, 12, CI=[1.29-39.42], P=0.025) were independent factors associated with more frequent occurrence of biliary strictures above the confluence.

Failure of biliary repair surgery makes the pre-existing biliary stricture progress and compromises subsequent surgery's outcomes. It is important to refer all cases of bile duct injury to specialized centers to increase the chances of success of the first biliary repair surgery.

Failure of biliary repair surgery makes the pre-existing biliary stricture progress and compromises subsequent surgery's outcomes. It is important to refer all cases of bile duct injury to specialized centers to increase the chances of success of the first biliary repair surgery.

A head injury is a very dangerous condition that threatens human life. This study examines the use of caffeic acid phenethyl ester (CAPE) in reducing cerebral edema in cases of head injury. The purpose of this study is to demonstrate whether CAPE can improve various parameters related to the expression of Aquaporin-4 (AQP4) mRNA and the serum AQP4 levels in rat subjects.

This is a randomized controlled study using a posttest-only control group design that uses experimental animals-specifically, male

(

strain) rats aged 10-12 weeks and weighing 200-300g. This study used a head injury model according to Marmarou (1994) with minor modifications to the animal model fixation tool. The parameters of the AQP4 mRNA were examined with real-time PCR, while serum AQP4 levels were examined with sandwich ELISA.

The AQP4 mRNA expression in rats that were given CAPE was lower than those not given CAPE, both on the fourth and seventh days; serum AQP4 levels in rats that were given CAPE were also lower than those not given CAPE, both on the fourth and seventh days.

Administration of CAPE in a rat model with head injury can reduce cerebral edema, mediated by AQP4.

Administration of CAPE in a rat model with head injury can reduce cerebral edema, mediated by AQP4.

Periampullary adenocarcinoma (PAAC) had a poor prognosis, and pancreaticoduodenectomy (PD) remains the only potentially curative treatment. The study aimed to identify the impact of different clinicopathological factors on long-term survival following PD for PAAC.

This study is a retrospective cohort study for the patients who underwent PD for pathologically proven PAAC from January 2010 to January 2019. Statistical analysis was done using Cox regression multivariate analyses for independent risk factors for survival.

There were 137 patients with PAAC who underwent PD, 79 patients (57.7%) underwent pylorus-preserving PD. Pancreatico-jejunostomy was done in 108 patients (78.8%). The primary analysis showed that risk factors for poor long-term survival include patients with co-morbidities like hypertension or ischemic heart disease, Carbohydrate Antigen 19-9 > 400U/ml, tumor size > 3cm, poor tumor differentiation, positive lymph nodes invasion, lymphovascular invasion, and Perineural invasion. Multivariate analysis demonstrated that large tumor size > 3cm (HR 0.177, 95%CI 0.084-0.374, P=0.002), poorly differentiated tumor (HR 0.059, 95%CI 0.020-0.0174, P=0.016), and perineural invasion in the pathological study (HR 0.101, 95%CI 0.046-0.224, P=0.006) were independent risk factors for poor 5-years survival. The prognosis was better in ampullary adenocarcinoma (5-year survival was 42.1%) than pancreatic adenocarcinoma (5-year survival was 24.3%). The 1, 3, 5 and 7-year overall survival rates were 84.5%, 57.4%, 35.9% and 20.1% respectively.

It seems from the current study that Tumor size > 3cm, poor tumor differentiation, and Perineural invasion were independent predictors of poor survival in patients with PAAC.

3 cm, poor tumor differentiation, and Perineural invasion were independent predictors of poor survival in patients with PAAC.

Poorer patient outcomes for emergency general surgery have been observed in patients admitted to hospital over the weekend. This paper reports the outcomes of a Consultant-delivered service model for weekend admissions and its impact for patients undergoing emergency laparotomy.

Operative data was analysed from a prospectively collected database over 5-years. Primary outcome measures were 30-day all-cause mortality and Clavien-Dindo class ≥2 morbidity. Secondary outcomes included time from admission to diagnostic imaging and time to surgery, post-operative length of stay and requirement for Intensive Care Unit admission.

263 patients underwent an emergency laparotomy. Overall 30-day mortality was 4.6% and all-cause morbidity was 55.9%. The most common indications for laparotomy were mechanical small bowel obstruction (32.7%) and hollow viscus perforation (30.4%) of the 263 emergency laparotomies, 92 patients in the cohort were weekend admissions (Saturday or Sunday). There was no significant difference amongst patients admitted during the weekend in ASA grade, age, gender, or proportion of patients receiving a pre-operative computed tomography scan, when compared to those during the week. AGI-6780 price Compared to weekdays, weekend admission was not associated with a significant difference in mortality (5.3% and 3.3%, respectively p=0.458), all-cause morbidity (p=0.509), post-operative length of stay (p=0.681), or Intensive Care Unit admission (p=0.761).

A Consultant Surgeon delivered emergency service can avoid the poor patient outcomes associated with weekend admissions and the 'weekend effect'.

A Consultant Surgeon delivered emergency service can avoid the poor patient outcomes associated with weekend admissions and the 'weekend effect'.