Preoperative calculation of risk for prolonged intensive care unit stay following coronary artery bypass grafting

Objective  

Patients who have prolonged stay in intensive care unit (ICU) are associated with adverse outcomes. Such patients have cost implications and can lead to shortage of ICU beds. We aimed to develop a preoperative risk prediction tool for prolonged ICU stay following coronary artery surgery (CABG).     

Biliary metal stents are superior to plastic stents for preoperative biliary decompression in pancreatic cancer

Background  

It is unclear whether plastic or metal stents are more suitable for preoperative biliary decompression in pancreatic cancer. The objective of this study was to compare the rate of endoscopic reinterventions in patients with pancreatic cancer undergoing plastic or self-expandable metal stent (SEMS) placements for preoperative biliary decompression.     

An analysis of risk factors for pancreatic fistula after pancreaticoduodenectomy: clinical impact of bile juice infection on day 1

Background  

Postoperative pancreatic fistula (POPF) is a most striking complication after pancreatic resection. The objective of this study is to reveal the risk factors for POPF defined by the international study group after pancreaticoduodenectomy in a Japanese high-volume center.     

Pancreatectomy combined with superior mesenteric vein-portal vein resection for pancreatic cancer: a meta-analysis

Background  

Pancreatectomy combined with superior mesenteric vein–portal vein resection (VR) for pancreatic cancer remains a matter of debate. The present study is a meta-analysis of the available evidence.     

Laparoscopic Surgery for Pancreatic Insulinomas: A Single-Institution Experience of 29 Cases

Background  

Laparoscopic approach has been increasingly used in the treatment of pancreatic benign diseases. This report evaluates our experience with laparoscopic surgery for pancreatic insulinomas.     

Traitements antifongiques en réanimation au cours des infections fongiques invasives documentées ou suspectées

Objective

Describe systemic antifungal therapy in non-neutropenic adult patients in intensive care unit (ICU).

Patients and method

A prospective, observational study was conducted during the first half of 2010 in the 7 ICU in a hospital with medical consultant on antimicrobial therapy. All non-neutropenic consecutive adult patients receiving systemic antifungal therapy for documented or suspected invasive fungal infection (IFI) apart from aspergillosis were included.

Results

Out of 1502 patients admitted in ICU, 104 (7 %) underwent systemic antifungal therapy, including 30 (29 %) for a documented IFI and 74 (71 %) for a suspected IFI. Candida albicans was identified in 23 (77 %) of the IFI and 45/52 (86 %) of the broncho-pulmonary and/or urinary colonizations in suspected IFI. Echinocandin was significantly more prescribed in patients with a documented infection (19/30 patients) and fluconazole in patients with a suspected infection (48/74 patients). The first line therapy was primarily stopped after recovery (11/30 patients) or de-escalation (9/30 patients) in documented infections, and for lack of indication (34/74 patients) or due to recovery (21/74 patients) in suspected infections after on average of 7 days of treatment.

Conclusion

For ICU non-neutropenic adult patients in our center, antifungal therapy is prescribed two times out of three for suspected, unproved infections, in most cases with fluconazole. Documented infections were more often treated by echinocandin with secondary de-escalation. An interventional prospective study to assess the role of antifungal pre-emptive or empirical therapy is necessary.     

Bispectral index correlates well with Richmond agitation sedation scale in mechanically ventilated critically ill patients

Purpose  

The clinical sedation scores available for assessing sedation in the intensive care unit (ICU) have drawbacks and limit their usefulness in paralyzed and deeply sedated patients. An objective tool, the bispectral index (BIS), could prove beneficial in such circumstances. We evaluated the ability of BIS to assess the level of sedation and its correlation with the Richmond agitation sedation scale (RASS) in ICU.     

Is there a role for endoscopic ultrasonography in evaluation of the left liver in colorectal liver metastasis patients selected for right hepatectomy

Background  

Meticulous assessment of the left liver for patients scheduled for right hepatectomy is essential. Endoscopic ultrasonography (EUS) is frequently used for the locoregional staging or biopsy of pancreatic tumours and has shown some value in the evaluation of the left liver.     

Effects of an Education Program on Intensive Care Unit Nurses' Attitudes and Behavioral Intentions to Advocate Deceased Donor Organ Donation

Introduction

Organ shortage limits the application of organ transplantation. The attitudes of intensive care unit (ICU) staff play an important role in organ advocating. The effects of an education program for ICU nurses on organ advocating were uncertain. The purpose of this study was to explore the effects of an education program based on the Theory of Planned Behavior (TPB) on ICU nurses' attitudes and behavioral intentions to advocate deceased organ donation.

Methods

Participants were recruited from 3 different ICU units in medical centers and were randomly assigned to either an experimental group (n = 61) or a control group (n = 62). The nurses in the experimental group received comprehensive education programs, and the control groups received a brochure only. The outcome parameters were measured by questionnaires at 3 different time points of pretest, posttests immediately after education, and 2 months later.

Results

Before education, there was no difference in attitude and behavior intentions between the control and experimental groups. After TPB training, the nurses significantly changed their attitudes and behavior intentions on organ advocating, both immediately (P < .01) and 2 months after the education program (P < .01). In addition, multivariate analysis indicated that TPB training is significantly associated with the change of attitude (P < .01) and behavior intention (P < .05) of organ donation advocacy.

Conclusions

TPB education programs enhanced the ICU nurses' attitudes and behavioral intentions on advocating organ donation. Repeated education is advised to increase the participation of ICU nurses on organ advocacy.     

Intraoperative Assessment of Pancreatic Neck Margin at the Time of Pancreaticoduodenectomy Increases Likelihood of Margin-Negative Resection in Patients with Pancreatic Cancer

Background  

The utility of intraoperative assessment of surgical margins is often debated by experienced pancreatic surgeons. We sought to review our experience with pancreaticoduodenectomy (PD) for pancreatic cancer to determine the impact of intraoperative frozen section (FS) analysis on margin-negative resection and long-term outcome.     

Prolonged peri-firing compression with a linear stapler prevents pancreatic fistula in laparoscopic distal pancreatectomy

Background  

Laparoscopic distal pancreatectomy (Lap-DP) is one of the most accepted laparoscopic procedures in the field of pancreatic surgery. However, pancreatic fistula remains a major and frequent complication in Lap-DP, as in open surgery. The aim of this retrospective study is to clarify the advantages of prolonged peri-firing compression (PFC) with a linear stapler for prevention of pancreatic fistula after laparoscopic distal pancreatectomy.     

Lymph Node Ratio Versus Number of Affected Lymph Nodes as Predictors of Survival for Resected Pancreatic Adenocarcinoma

Background  

The objective of this study was to compare the prognostic significance of the lymph node ratio (LNR) with the absolute number of affected lymph nodes for resected pancreatic ductal adenocarcinoma.     

Pancreatoduodenectomy for Ductal Adenocarcinoma in the Very Elderly; Is It Safe and Justified?

Background  

The outcomes of complex major surgery in the elderly are being scrutinized because of the demands on surgical services by an aging population and the concern whether such endeavors are justified. Pancreatoduodenectomy (PD) for pancreatic adenocarcinoma presents special challenges because of the high morbidity of the procedure, dismal prognosis of the disease, and the increasing incidence of pancreatic cancer with age.     

After Distal Pancreatectomy Pancreatic Leakage from the Stump of the Pancreas May Be Due to Drain Failure or Pancreatic Ductal Back Pressure

Hypothesis  

The method to lower postoperative pancreatic fistula (POPF) after distal pancreatectomy (DP) involves controlling risk factors for leakage from the pancreatic stump.     

A novel antiangiogenic approach for adjuvant therapy of pancreatic carcinoma

Introduction  

Surgical therapy remains the only curative option for pancreatic ductal adenocarcinoma. But even after complete resection, almost all patients suffer from local tumor recurrence. Current standard adjuvant therapy with gemcitabine does not impressively affect the recurrence rate. The aim of this study was to evaluate a novel anti-angiogenic adjuvant treatment strategy by targeting the vascular endothelial growth factor receptor (VEGFR). We assayed the effects of a novel VEGFR inhibitor (ZK261991) on pancreatic carcinoma. ZK261991 is a highly selective and potent VEGFR-kinase inhibitor, which is orally available.     

The Influence of Prognostic Factors and Adjuvant Chemoradiation on Survival After Pancreaticoduodenectomy for Ampullary Carcinoma

Introduction  

The prognosis after pancreaticoduodenectomy (PD) for ampullary carcinoma (AC) is superior to that of pancreatic cancer. Decisions regarding adjuvant therapy are influenced by factors such as nodal status, stage, and grade, but the influence of these individual variables on survival is unclear.     

Defining Criteria for Selective Operative Management of Pancreatic Cystic Lesions: Does Size Really Matter?

Introduction  

Proposed criteria for resection of pancreatic cystic lesions have included symptoms, size (>3 cm), and suspicious features by endoscopic ultrasound (EUS). The objective of this study was to evaluate risk factors for malignancy in a large series of patients undergoing resection of suspected pancreatic cystic neoplasms.     

Zinc Deficiency in Patients Undergoing Pancreatoduodenectomy for Periampullary Tumors Is Associated with Pancreatic Exocrine Insufficiency

Background and purpose  

The present study was done to investigate the prevalence of zinc deficiency after pancreatoduodenectomy (PD) and its correlation with pancreatic exocrine insufficiency.     

Dual-Phase Computed Tomography for Assessment of Pancreatic Fibrosis and Anastomotic Failure Risk Following Pancreatoduodenectomy

Introduction  

Delayed or decreased computed tomography (CT) enhancement characteristics in pancreatic fibrosis have been described.     

Preservation of Replaced or Accessory Right Hepatic Artery During Pancreaticoduodenectomy for Adenocarcinoma: Impact on Margin Status and Survival

Aim  

The aim of the study was to determine the impact of replaced or accessory right hepatic artery (RARHA) during pancreaticoduodenectomy (PD) for pancreatic adenocarcinoma (PA).