Evaluation of prosthetic mesh closure in semiopen-abdomen patients

Abstract Background. To avoid the adverse consequences of abdominal compartment syndrome and to reduce the high mortality the celiotomy wound in patients with abdominal sepsis was closed without tension using prosthetic mesh. This produces a semiopen situation that permits staged reinterventions together with the functional reconstitution of the continuity of the abdominal wall. Material and Methods. Twenty-five patients with intra-abdominal sepsis of various causes were evaluated retrospectively to assess the results of semiopen management of the septic abdomen and reoperations on demand in severe peritonitis. All of the patients were in a state of neglected peritonitis, and had at least one failing organ system. The Mannheim Peritonitis Index (MPI) scoring system was used for stratification of abdominal sepsis. Results. The mean MPI score of 25 patients was 24, ranging 10 to 33. Eight (32%) patients were reexplored (MPI=21). There were overall 9 (36%) complications in patients with mean MPI score of 23. Six (24%) mesh-related complications (infection and enterocutaneous fistulas) developed (MPI=19). The mean MPI score of patients without complications was 24. Four (16%) patients died with index MPI score of 26 due to fulminant hepatitis, myocardial infarction, and multiple organ failure. The admission period averaged 63 days. Conclusions. In 25 critically ill patients with abdominal sepsis the mortality was lower than expected, relative to heterogeneous data from the literature; also, major complications occurred less frequently although the mean MPI score was high. The authors conclude that this approach is a reliable contribution to the complex treatment of these patients. Electronic Publication     

Treatment of malignant dysphagia with nitinol stents

Self-expanding nitinol stents were used in 22 patients for palliative treatment of malignant esophagogastric strictures. All patients but 5 were men (age range 47–75 years). The strictures were caused by squamous cell carcinoma (n = 12), adenocarcinoma (n = 8), and recurrent anastomotic carcinoma (n = 2). No technical failure or procedural complications occurred. After the procedure, the severity of dysphagia decreased at least one grade in all patients. Tumor ingrowth into the stent was seen in 7 patients of 22 (32%). Four of these patients were treated with additional stents, and in 3 patients, due to refusal, only balloon dilations were performed, which caused temporary relief. Tumor ingrowth into the stent was noted from 10 days to 7 months (mean 3 months). This seems to be a disadvantage of nitinol stents. At the end of the study 10 patients had died dead with a mean survival of 3 months (range 1 week to 6 months) and 12 patients were still alive with a mean follow-up of 4 months (range 1–8 months). It is concluded that nitinol stents provide satisfactory palliation in patients with malignant dysphagia with neglectable procedural morbidity and mortality rates.     

PS2 and HSP70 expression in rectal adenocarcinomas: an immunohistochemical investigation of 45 cases.

OBJECTIVE: To evaluate the expression of HSP70 and pS2 and to determine whether it may be an additional prognostic variable in the prediction of recurrence and survival in rectal adenocarcinomas. METHODS: The paraffin sections of 45 patients with rectal carcinoma who were treated with surgical resection were stained with HSP70 and pS2 antibodies by using the standard biotin immunoperoxidase method. Cytoplasmic staining for both antibodies was scored semiquantitatively. RESULTS: Only 16 (35.6%) tumors showed a positive cytoplasmic reaction with HSP70 antibody, while pS2 expression was observed in 26 (57.8%) tumors. There was an association between HSP70 and pS2 expression (P=0.002). No correlations were found between HSP70 and pS2 expression and tumor recurrence or overall survival and other prognostic factors. However, the type of surgical resection was significantly associated with pS2 expression status (P=0.013). Significant correlations were detected between tumor recurrence and other clinicopathologic parameters, such as clinical stage, lymph node involvement, and resection type (P=0.015, P=0.015, and P=0.03, respectively). Resection type was significantly associated with clinical outcome, recurrence, and metastasis (P=0.009, P=0.03, P<0.01, respectively). In addition, there was a statistically significant relationship between clinical stage and final outcome (P=0.005). CONCLUSIONS: The strong correlation between pS2 expression and incomplete surgical resection suggests that pS2 may be related to invasive tumor behavior and may also play a role in tumor recurrence, although this latter association did not reach statistical significance in this study. HSP70 expression does not appear to be related to tumor invasiveness or tumor recurrence.     

COVID-19 in Kidney Transplant Patients From a Large UK Transplant Center: Exploring Risk Factors for Disease Severity

BackgroundThe novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has raised concern for the health of immunocompromised individuals, who are potentially at higher risk of more severe infection and poorer outcomes. As a large London transplant center serving a diverse patient population, we report the outcomes of SARS-CoV-2 infection in our cohort of 2848 kidney and/or pancreas transplant patients.MethodsData were obtained retrospectively for all transplant patients who attended hospital during the peak of the pandemic and had a positive nasopharyngeal SARS-CoV-2 test.ResultsSixty-six patients were found to be positive for SARS-CoV-2. Twenty percent were treated as outpatients, 59% were admitted to the general ward, and 21% required intensive care. Treatment consisted of reduced immunosuppression, antibiotics for pneumonia or sepsis, and other supportive treatments. Within our cohort, 12 patients died (18%), with an overall mortality of 0.4%. Predictive risk factors for COVID-19 severity were explored.ConclusionsSevere disease was associated with lower hemoglobin prior to COVID-19 diagnosis and lower lymphocyte count at the time of diagnosis but not age, sex, ethnicity, or preexisting comorbidities. Lower glomerular filtration rate and higher C-reactive protein were associated with more severe disease. Despite no use of hydroxychloroquine, azithromycin, antiviral, or immunomodulatory medications, our mortality rate (kidney and pancreas transplant patients) is similar to current international rates.     

Evaluation of Job Strain of Family Physicians in COVID-19 Pandemic Period- An Example from Turkey

Journal of Community Health - The purpose of this study was to evaluate family physicians’ job strain during the Covid-19 pandemic and determine the effective factors. The study was carried...     

Usefulness of coronary angiography for assessing left ventricular systolic function

OBJECTIVE: In previous echocardiographic studies, a correlation between ejection fraction of the left ventricle and change in the movement of the mitral annular ring was found. In the light of these studies, we planned to investigate the relationship between systolic shortening (SS) and percent of systolic shortening (PSS), calculated from the long axis frame in coronary angiography and left ventricular systolic function. METHODS AND RESULTS: One hundred and thirty-eight patients (40 men and 98 women; mean age 58 +/- 10 years) who had been referred for coronary angiography and left ventriculography were included in the study. Ejection fraction (EF) was calculated from left ventriculography obtained from 30 degrees right anterior oblique projection. Distance from the lower border of the ostium of the left coronary artery to the most apical border of the left anterior descending (LAD) artery was measured at end-systole (ES) and end-diastole (ED) using coronary angiography obtained from the same projection. SS as ED-ES and PSS as SS/ED were calculated. Correlation of SS and PSS with EF was calculated (EF = 13.7 + 4.8 x SS, r = 0.91, p < 0.001 and EF = 14.2 + 6.5 x PSS, r = 0.90, p < 0.01). SS < 7 mm (criterion A) and PSS < 6% (criterion B) suggested that left ventricle EF was less than 50%, with a sensitivity, specificity and diagnostic accuracy of 83%, 100%, 95%; 95%, 86% and 88%, respectively. CONCLUSION: SS and PSS highly significantly correlate with left ventricular EF. Therefore, left ventriculography could be omitted in selected patients undergoing coronary angiography if it is not necessary to define the anatomic structure of the left ventricle.     

Meaningful Living to Promote Complete Mental Health Among University Students in the Context of the COVID-19 Pandemic

Maintaining positive mental health can be challenging during the COVID-19 pandemic which undoubtedly caused devastating consequences on people’s lives. There is need to determine factors contributing to mental health of people during the pandemic. The current study aims to examine the effect of meaning in life on complete mental health, which represents the presence of positive functioning and the absence of psychopathological symptoms. The participants of the study included 392 (70.9% female) undergraduate students, ranging in age from 18 to 43 years (M?=?20.67 years, SD?=?3.66) and they have predominantly been imposed stay-at-home orders for coronavirus right after announcement of COVID-19 restrictions in Turkey. Latent variable path analyses demonstrated significant paths from meaning in life to all components of psychological distress, positive mental health, and subjective well-being. Multi-group analysis showed significant gender differences across the study variables. These findings corroborate the critical role of meaning in life in promoting complete mental health and shed further light on why people high in meaning in life tend to have better mental health than those low in meaning in life within the context of COVID-19.