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1. Goodbye Hartmann trial: a prospective, international, multicenter, observational study on the current use of a surgical procedure developed a century ago

Author

Gennaro Perrone, Mario Giuffrida, Fikri Abu-Zidan, Vitor F. Kruger, Marco Livrini, Gabriele Luciano Petracca, Giorgio Rossi, Antonio Tarasconi, Brian W. C. A. Tian, Elena Bonati, Ricardo Mentz, Federico N. Mazzini, Juan P. Campana, Elisabeth Gasser, Reinhold Kafka-Ritsch, Daniel M. Felsenreich, Christopher Dawoud, Stefan Riss, Carlos Augusto Gomes, Felipe Couto Gomes, Ricardo Alessandro Teixeira Gonzaga, Cassio Alfred Brattig Canton, Bruno Monteiro Pereira, Gustavo P. Fraga, Leticia Gonçalves Zem, Vinicius Cordeiro-Fonseca, Renato de Mesquita Tauil, Boyko Atanasov, Nikolay Belev, Nikola Kovachev, L. Juan José Meléndez, Ana Dimova, Stefan Dimov, Zdravko Zelić, Goran Augustin, Branko Bogdanić, Trpimir Morić, Elie Chouillard, Melinda Bajul, Belinda De Simone, Yves Panis, Francesco Esposito, Margherita Notarnicola, Lelde Lauka, Anna Fabbri, Hassen Hentati, Iskander Fnaiech, Venara Aurélien, Marie Bougard, Maxime Roulet, Zaza Demetrashvili, Irakli Pipia, Giorgi Merabishvili, Konstantinos Bouliaris, Georgios Koukoulis, Christos Doudakmanis, Sofia Xenaki, Emmanuel Chrysos, Stamatios Kokkinakis, Panteleimon Vassiliu, Nikolaos Michalopoulos, Ioannis Margaris, Aristotelis Kechagias, Konstantinos Avgerinos, Jevgeni Katunin, Eftychios Lostoridis, Eleni-Aikaterini Nagorni, Antonio Pujante, Francesk Mulita, Ioannis Maroulis, Michail Vailas, Athanasios Marinis, Ioannis Siannis, Eirini Bourbouteli, Dimitrios K. Manatakis, Nikolaos Tasis, Vasileios Acheimastos, Sotiropoulou Maria, Kapiris Stylianos, Harilaos Kuzeridis, Dimitrios Korkolis, Evangelos Fradelos, George Kavalieratos, Thalia Petropoulou, Andreas Polydorou, Ioannis Papacostantinou, Tania Triantafyllou, Despina Kimpizi, Dimitrios Theodorou, Konstantinos Toutouzas, Alexandros Chamzin, Maximos Frountzas, Dimitrios Schizas, Ioannis Karavokyros, Athanasios Syllaios, Alexandros Charalabopoulos, Maria Boura, Efstratia Baili, Orestis Ioannidis, Lydia Loutzidou, Elissavet Anestiadou, Ioannis Tsouknidas, Georgios Petrakis, Eleni Polenta, Lovenish Bains, Rahul Gupta, Sudhir K. Singh, Archana Khanduri, Miklosh Bala, Asaf Kedar, Marcello Pisano, Mauro Podda, Adolfo Pisanu, Gennaro Martines, Giuseppe Trigiante, Giuliano Lantone, Antonino Agrusa, Giuseppe Di Buono, Salvatore Buscemi, Massimiliano Veroux, Rossella Gioco, Gastone Veroux, Luigi Oragano, Sandro Zonta, Federico Lovisetto, Carlo V. Feo, Antonio Pesce, Nicolò Fabbri, Giulio Lantone, Fabio Marino, Fabrizio Perrone, Leonardo Vincenti, Vincenzo Papagni, Arcangelo Picciariello, Stefano Rossi, Biagio Picardi, Simone Rossi Del Monte, Diego Visconti, Giulia Osella, Luca Petruzzelli, Giusto Pignata, Jacopo Andreuccetti, Rossella D’Alessio, Massimo Buonfantino, Eleonora Guaitoli, Stefano Spinelli, Gianluca Matteo Sampietro, Carlo Corbellini, Leonardo Lorusso, Alice Frontali, Isabella Pezzoli, Alessandro Bonomi, Andrea Chierici, Christian Cotsoglou, Giuseppe Manca, Antonella Delvecchio, Nicola Musa, Massimiliano Casati, Laface Letizia, Emmanuele Abate, Giorgio Ercolani, Fabrizio D’Acapito, Leonardo Solaini, Gianluca Guercioni, Simone Cicconi, Diego Sasia, Felice Borghi, Giorgio Giraudo, Giuseppe Sena, Pasquale Castaldo, Eugenia Cardamone, Giuseppe Portale, Matteo Zuin, Ylenia Spolverato, Marialusia Esposito, Roberta Maria Isernia, Maria Di Salvo, Romina Manunza, Giuseppe Esposito, Marcello Agus, Emanuele Luigi Giuseppe Asti, Daniele Tiziano Bernardi, Tommaso Panici Tonucci, Davide Luppi, Massimiliano Casadei, Stefano Bonilauri, Angela Pezzolla, Annunziata Panebianco, Rita Laforgia, Maurizio De Luca, Monica Zese, Dario Parini, Elio Jovine, Giuseppina De Sario, Raffaele Lombardi, Giovanni Aprea, Giuseppe Palomba, Marianna Capuano, Giulio Argenio, Gianluca Orio, Mariano Fortunato Armellino, Marina Troian, Martina Guerra, Carlo Nagliati, Alan Biloslavo, Paola Germani, Giada Aizza, Igor Monsellato, Ali Chaouki Chahrour, Gabriele Anania, Cristina Bombardini, Francesco Bagolini, Gabriele Sganga, Pietro Fransvea, Valentina Bianchi, Paolo Boati, Francesco Ferrara, Francesco Palmieri, Pasquale Cianci, Domenico Gattulli, Enrico Restini, Nicola Cillara, Alessandro Cannavera, Gabriela Elisa Nita, Jlenia Sarnari, Francesco Roscio, Federico Clerici, Ildo Scandroglio, Stefano Berti, Alessandro Cadeo, Alice Filippelli, Luigi Conti, Carmine Grassi, Gaetano Maria Cattaneo, Marina Pighin, Davide Papis, Giovanni Gambino, Vanessa Bertino, Domenico Schifano, Daniela Prando, Luisella Fogato, Fabio Cavallo, Luca Ansaloni, Roberto Picheo, Nicholas Pontarolo, Norma Depalma, Marcello Spampinato, Stefano D’Ugo, Luca Lepre, Michela Giulii Capponi, Rossella Domenica Campa, Giuliano Sarro, Vincenza Paola Dinuzzi, Stefano Olmi, Matteo Uccelli, Davide Ferrari, Marco Inama, Gianluigi Moretto, Michele Fontana, Francesco Favi, Erika Picariello, Alessia Rampini, Andrea Barberis, Antonio Azzinnaro, Alba Oliva, Luigi Totaro, Ilaria Benzoni, Valerio Ranieri, Gabriella Teresa Capolupo, Filippo Carannante, Marco Caricato, Maurizio Ronconi, Silvia Casiraghi, Giovanni Casole, Desire Pantalone, Giovanni Alemanno, Maximilian Scheiterle, Marco Ceresoli, Marco Cereda, Chiara Fumagalli, Federico Zanzi, Stefano Bolzon, Enrico Guerra, Francesca Lecchi, Paola Cellerino, Antonella Ardito, Rosa Scaramuzzo, Andrea Balla, Pasquale Lepiane, Nicola Tartaglia, Antonio Ambrosi, Giovanna Pavone, Gian Marco Palini, Simone Veneroni, Gianluca Garulli, Claudio Ricci, Beatrice Torre, Iris Shari Russo, Matteo Rottoli, Marta Tanzanu, Angela Belvedere, Marco Milone, Michele Manigrasso, Giovanni Domenico De Palma, Micaela Piccoli, Gianmaria Casoni Pattacini, Stefano Magnone, Paolo Bertoli, Michele Pisano, Paolo Massucco, Marco Palisi, Andrea-Pierre Luzzi, Francesco Fleres, Guglielmo Clarizia, Alessandro Spolini, Yoshiro Kobe, Takayuki Toma, Fumihiko Shimamura, Robert Parker, Sinkeet Ranketi, Mercy Mitei, Saulius Svagzdys, Henrikas Pauzas, Justas Zilinskas, Tomas Poskus, Marius Kryzauskas, Matas Jakubauskas, Andee Dzulkarnaen Zakaria, Zaidi Zakaria, Michael Pak-Kai Wong, Asri Che Jusoh, Muhammad Nazreen Zakaria, Daniel Rios Cruz, Aurea Barbara Rodriguez Elizalde, Alejandro Bañon Reynaud, Edgard Efren Lozada Hernandez, Jose maria Victor Palomo Monroy, Diego Hinojosa-Ugarte, Martha Quiodettis, María Esther Du Bois, José Latorraca, Piotr Major, Michał Pędziwiatr, Magdalena Pisarska-Adamczyk, Maciej Walędziak, Andrzej Kwiatkowski, Łukasz Czyżykowski, Silvia Dantas da Costa, Bela Pereira, Ana Rita Oliveira Ferreira, Filipe Almeida, Ricardo Rocha, Carla Carneiro, Diego Pita Perez, João Carvas, Catarina Rocha, Cátia Ferreira, Rita Marques, Urânia Fernandes, Pedro Leao, André Goulart, Rita Gonçalves Pereira, Sara Daniela Direito Patrocínio, Nuno Gonçalo Gonçalves de Mendonça, Maria Isabel Cerqueira Manso, Henrique Manuel Cardoso Morais, Paulo Sebastião Cardoso, Valentin Calu, Adrian Miron, Elena Adelina Toma, Mahir Gachabayov, Abakar Abdullaev, Andrey Litvin, Taras Nechay, Alexander Tyagunov, Anvar Yuldashev, Alison Bradley, Michael Wilson, Arpád Panyko, Zuzana Látečková, Vladimír Lacko, Dusan Lesko, Marek Soltes, Jozef Radonak, Victor Turrado-Rodriguez, Roser Termes-Serra, Xavier Morales-Sevillano, Pierfrancesco Lapolla, Andrea Mingoli, Gioia Brachini, Maurizio Degiuli, Silvia Sofia, Rossella Reddavid, Andrea de Manzoni Garberini, Angelica Buffone, Eduardo Perea del Pozo, Daniel Aparicio-Sánchez, Sandra Dos Barbeito, Mercedes Estaire-Gómez, Rebeca Vitón-Herrero, Mª de los Ángeles Gil Olarte-Marquez, José Gil-Martínez, Felipe Alconchel, Tatiana Nicolás-López, Aida Cristina Rahy-Martin, María Pelloni, Raquel Bañolas-Suarez, Fernando Mendoza-Moreno, Francisca García-Moreno Nisa, Manuel Díez-Alonso, María Elisa Valle Rodas, María Carmona Agundez, María Inmaculada Pérez Andrés, Claudia Cristina Lopes Moreira, Aintzane Lizarazu Perez, Iñigo Augusto Ponce, Ana María González-Castillo, Estela Membrilla-Fernández, Silvia Salvans, Mario Serradilla-Martín, Pablo Sancho Pardo, Daniel Rivera-Alonso, Jana Dziakova, Jose Mugüerza Huguet, Naila Pagès Valle, Enrique Colás Ruiz, Cristina Rey Valcárcel, Cristina Ruiz Moreno, Yeniffer Tatiana Moreno Salazar, Juan Jesús Rubio García, Silvia Sevila Micó, Joaquín Ruiz López, Silvia Pérez Farré, Maite Santamaria Gomez, Nuria Mestres Petit, Alberto Titos-García, Jose Manuel Aranda-Narváez, Laura Romacho-López, Luis Sánchez-Guillén, Veronica Aranaz-Ostariz, Marina Bosch-Ramírez, Aleix Martínez-Pérez, Elías Martínez-López, Juan Carlos Sebastián-Tomás, Granada Jimenez-Riera, Javier Jimenez-Vega, Jose Aurelio Navas Cuellar, Andrea Campos-Serra, Anna Muñoz-Campaña, Raquel Gràcia-Roman, Javier Martínez Alegre, Francisca Lima Pinto, Sara Nuñez O’Sullivan, Francisco Blanco Antona, Beatriz Muñoz Jiménez, Jaime López-Sánchez, Zahira Gómez Carmona, Rocio Torres Fernández, Isabel Blesa Sierra, Laura Román García de León, Verónica Polaino Moreno, Eva Iglesias, Paola Lora Cumplido, Altea Arango Bravo, Ignacio Rey Simó, Carlota López Domínguez, Aloia Guerreiro Caamaño, Rafael Calleja Lozano, Manuel Durán Martínez, Álvaro Naranjo Torres, Javier Tomas Morales Bernaldo de Quiros, Gianluca Pellino, Miriam Moratal Cloquell, Elsa García Moller, Sami Jalal-Eldin, Ahmed K. Abdoun, Hytham K. S. Hamid, Varut Lohsiriwat, Aitsariya Mongkhonsupphawan, Oussama Baraket, Karim Ayed, Imed Abbassi, Ali Ben Ali, Houssem Ammar, Ali Kchaou, Ahmed Tlili, Imen Zribi, Elif Colak, Suleyman Polat, Zehra Alan Koylu, Ali Guner, Mehmet Arif Usta, Murat Emre Reis, Baris Mantoglu, Emre Gonullu, Emrah Akin, Fatih Altintoprak, Zulfu Bayhan, Necattin Firat, Arda Isik, Ufuk Memis, Mehmet Bayrak, Yasemin Altıntaş, Yasin Kara, Mehmet Abdussamet Bozkurt, Ali Kocataş, Koray Das, Ahmet Seker, Nazmi Ozer, Semra Demirli Atici, Korhan Tuncer, Tayfun Kaya, Zeynep Ozkan, Onur Ilhan, Ibrahim Agackiran, Mustafa Yener Uzunoglu, Eren Demirbas, Yuksel Altinel, Serhat Meric, Nadir Adnan Hacım, Derya Salim Uymaz, Nail Omarov, Emre Balık, Giovanni D. Tebala, Hany Khalil, Mridul Rana, Mansoor Khan, Charlotte Florence, Christie Swaminathan, Cosimo Alex Leo, Lampros Liasis, Josef Watfah, Ivan Trostchansky, Edward Delgado, Marcelo Pontillo, Rifat Latifi, Raul Coimbra, Sara Edwards, Ana Lopez, George Velmahos, Ander Dorken, Anthony Gebran, Amanda Palmer, Jeffrey Oury, James M. Bardes, Sirivan Suon Seng, Lauren S. Coffua, Asanthi Ratnasekera, Tanya Egodage, Karla Echeverria-Rosario, Isabella Armento, Lena M. Napolitano, Naveen F. Sangji, Mark Hemmila, Jacob A. Quick, Tyler R. Austin, Theodore S. Hyman, William Curtiss, Amanda McClure, Nicholas Cairl, Walter L. Biffl, Hung P. Truong, Kathryn Schaffer, Summer Reames, Filippo Banchini, Patrizio Capelli, Federico Coccolini, Massimo Sartelli, Francesca Bravi, Carlo Vallicelli, Vanni Agnoletti, Gian Luca Baiocchi, and Fausto Catena

Subjects
Hartmann’s procedure, Ostomy, Emergency surgery, Resection, Primary anastomosis, Left side, Surgery, RD1-811, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract

Abstract Background Literature suggests colonic resection and primary anastomosis (RPA) instead of Hartmann’s procedure (HP) for the treatment of left-sided colonic emergencies. We aim to evaluate the surgical options globally used to treat patients with acute left-sided colonic emergencies and the factors that leading to the choice of treatment, comparing HP and RPA. Methods This is a prospective, international, multicenter, observational study registered on ClinicalTrials.gov. A total 1215 patients with left-sided colonic emergencies who required surgery were included from 204 centers during the period of March 1, 2020, to May 31, 2020. with a 1-year follow-up. Results 564 patients (43.1%) were females. The mean age was 65.9 ± 15.6 years. HP was performed in 697 (57.3%) patients and RPA in 384 (31.6%) cases. Complicated acute diverticulitis was the most common cause of left-sided colonic emergencies (40.2%), followed by colorectal malignancy (36.6%). Severe complications (Clavien-Dindo ≥ 3b) were higher in the HP group (P

Published
2024
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2. Mucinous adenocarcinoma of the appendix with inguinal node metastases

Author

Ricardo Vaz-Pereira, Rita Marques, Urânia Fernandes, Ana Monteiro, and João Pinto-de-Sousa

Subjects
Appendix, Adenocarcinoma Mucinous, Lymphatic Metastasis, Groin, Medicine, Internal medicine, RC31-1245
Abstract

Mucinous adenocarcinoma of the appendix is a rare neoplasm with a low propensity for lymph node metastasis. The present case refers to an appendicular mucinous adenocarcinoma with inguinal lymph node metastasis. A 71-year-old woman underwent an appendectomy due to a clinical presentation of acute appendicitis. However, the histological examination of the surgical specimen revealed a mucinous adenocarcinoma of the appendix. After staging, the patient underwent a right hemicolectomy and was proposed for adjuvant chemotherapy. At the 3rd year of follow-up, inguinal lymphadenopathy was diagnosed, which biopsy confirmed inguinal node metastases from primary colorectal cancer, with areas of extracellular mucin. Restaging revealed liver and peritoneal metastasis, and the patient was proposed for palliative chemotherapy. Appendicular neoplasms, due to their rarity, represent a diagnostic and therapeutic challenge. This clinical case depicts an unusual metastasis pathway for an unusual neoplasm.

Published
2021

3. Escolaridade materna: correlação com os indicadores obstétricos Maternal educational level: correlation with obstetric indicators

Author

Fátima Hussein Haidar, Urânia Fernandes Oliveira, and Luiz Fernando Costa Nascimento

Subjects
Saúde da Mulher, Fatores de Risco, Escolaridade, Women's Health, Risk Factors, Educational Status, Medicine, Public aspects of medicine, RA1-1270
Abstract

O objetivo deste estudo é estimar as associações entre a escolaridade materna, como variável dependente, e algumas variáveis constantes na Declaração de Nascido Vivo (DNV) do Ministério da Saúde. Em uma análise de 3.843 DNV da região de Guaratinguetá, São Paulo, relativas a partos hospitalares e nascimentos únicos, ocorridos no ano de 1998, foram encontradas associações estatisticamente significativas entre a menor escolaridade e ocorrência de baixo peso ao nascer; número de filhos vivos igual ou maior que três; história pregressa de filhos mortos; maior número de partos e consultas médicas no pré-natal em número até seis. Não se observaram associações entre escolaridade e aborto e tempo de gestação, citadas em outros trabalhos. Assim, a escolaridade materna pode ser considerada um marcador obstétrico de risco para a gestante e o recém-nascido.The aim of this study was to estimate associations between level of maternal education as the dependent variable and several variables present in birth certificates under the official Brazilian Ministry of Health model. A total of 3,843 birth certificates were analyzed from Guaratinguetá, São Paulo State, for singleton hospital deliveries in 1998. Statistically significant associations were found between low maternal educational level and low birth weight, 3 or more live births, history of stillbirth, and prenatal care including up to 6 visits. No association was found between abortions and preterm delivery as described in other studies, perhaps due to insufficient information. Maternal educational level can thus be considered an obstetric marker for some risk factors for the mother and infant.

Published
2001
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4. Escolaridade materna: correlação com os indicadores obstétricos

Author

Fátima Hussein Haidar, Urânia Fernandes Oliveira, and Luiz Fernando Costa Nascimento

Subjects
saúde da mulher, fatores de risco, escolaridade, Medicine, Public aspects of medicine, RA1-1270
Abstract

O objetivo deste estudo é estimar as associações entre a escolaridade materna, como variável dependente, e algumas variáveis constantes na Declaração de Nascido Vivo (DNV) do Ministério da Saúde. Em uma análise de 3.843 DNV da região de Guaratinguetá, São Paulo, relativas a partos hospitalares e nascimentos únicos, ocorridos no ano de 1998, foram encontradas associações estatisticamente significativas entre a menor escolaridade e ocorrência de baixo peso ao nascer; número de filhos vivos igual ou maior que três; história pregressa de filhos mortos; maior número de partos e consultas médicas no pré-natal em número até seis. Não se observaram associações entre escolaridade e aborto e tempo de gestação, citadas em outros trabalhos. Assim, a escolaridade materna pode ser considerada um marcador obstétrico de risco para a gestante e o recém-nascido.

5. De Garengeot hernia in an elderly female: a case report

Author

Gonçalo Guidi, Urânia Fernandes, Daniela Martins, José C. Lage, Francisco Taveira, Fernando Próspero-Luis, and João Pinto-de-Sousa

Subjects
General Medicine
Abstract

A groin hernia is known as De Garengeot hernia when the appendix is located within the sac of a femoral hernia, with or without associated acute appendicitis. The true incidence of de Garengeot’s hernia is difficult to assess due to its rarity. Most of the times, De Garengeot hernia are presented acutely when incarcerated which turn them indistinguishable from other incarcerated femoral hernias at clinical examination. Treatment of De Garengeot hernia is an emergency, as it is for any femoral hernia incarcerated. After initial resuscitation, surgical treatment is mandatory without further delay. The surgical approach and the options to consider are dependent on the presence of incarceration and of septic environment at the time of diagnosis.

Published
2023
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6. Handlebar hernia–unusual complication from blunt trauma

Author

Bruno Vieira, Ana Melo, Carina Gomes, Leandro Lajut, Artur Ribeiro, Urânia Fernandes, Gonçalo Guidi, Clara Leal, and João Pinto-de-Sousa

Subjects
Surgery
Abstract

Handlebar hernia is a rare entity, mainly resulting from blunt abdominal trauma with a sudden deceleration mechanism. Diagnosis of handlebar at admission may be difficult because the rupture of abdominal wall layers often is not clinically recognized in the emergency department, which requires a high degree of suspicion to identify theses lesions. It is very important to rule out the presence of intra-abdominal injuries, and in adults, surgical repair is needed. Herein, the case of an adult man who presented to the emergency department with blunt abdominal trauma caused by a motorcycle handlebar is described.

Published
2022
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8. Patients over 65 years with Acute Complicated Calculous Biliary Disease are Treated Differently-Results and Insights from the ESTES Snapshot Audit

Author

Éanna Ryan, Alan Biloslavo, DIETER MORALES-GARCIA, Júlio Constantino, Ahmad Mohammad Ismail, Michael Kelly, Stefano Fracon, Urânia Fernandes, Gary Alan Bass, Paul Ridgway, Jorge Pereira, Bass, Gary A., Gillis, Amy E., Cao, Yang, Mohseni, Shahin, de Manzini, Nicolo', Biloslavo, Alan, Samardzic, Natasa, Cosola, Davide, and Fracon, Stefano

Subjects
medicine.medical_specialty, Original Scientific Report, Aftercare, Gallstones, Biliary disease, 03 medical and health sciences, 0302 clinical medicine, Postoperative Complications, insight, medicine, Humans, complicated calculous biliary disease, Aged, Retrospective Studies, business.industry, General surgery, 030208 emergency & critical care medicine, Perioperative, Vascular surgery, Length of Stay, medicine.disease, Comorbidity, Patient Discharge, Cardiac surgery, Europe, Cardiothoracic surgery, 030220 oncology & carcinogenesis, Cohort, Surgery, business, Abdominal surgery
Abstract

Background Accrued comorbidities are perceived to increase operative risk. Surgeons may offer operative treatments less often to their older patients with acute complicated calculous biliary disease (ACCBD). We set out to capture ACCBD incidence in older patients across Europe and the currently used treatment algorithms. Methods The European Society of Trauma and Emergency Surgery (ESTES) undertook a snapshot audit of patients undergoing emergency hospital admission for ACCBD between October 1 and 31 2018, comparing patients under and ≥ 65 years. Mortality, postoperative complications, time to operative intervention, post-acute disposition, and length of hospital stay (LOS) were compared between groups. Within the ≥ 65 cohort, comorbidity burden, mortality, LOS, and disposition outcomes were further compared between patients undergoing operative and non-operative management. Results The median age of the 338 admitted patients was 67 years; 185 patients (54.7%) of these were the age of 65 or over. Significantly fewer patients ≥ 65 underwent surgical treatment (37.8% vs. 64.7%, p p = 0.253). However, operated elderly patients did not differ from non-operated in terms of comorbidity burden, mortality, LOS, or post-discharge rehabilitation need. Conclusions Few elderly patients receive surgical treatment for ACCBD. Expectedly, postoperative morbidity, LOS, and the requirement for post-discharge rehabilitation are higher in the elderly than younger patients but do not differ from elderly patients managed non-operatively. With multidisciplinary perioperative optimization, elderly patients may be safely offered optimal treatment. Trial Registration ClinicalTrials.gov (Trial # NCT03610308).

Published
2021

10. Patterns of prevalence and contemporary clinical management strategies in complicated acute biliary calculous disease: an ESTES 'snapshot audit' of practice

Author

Éanna Ryan, Alan Biloslavo, Jessica Ryan, Ahmad Mohammad Ismail, Michael Kelly, Stefano Fracon, Urânia Fernandes, Shahin Mohseni, Gary Alan Bass, Paul Ridgway, Yang Cao, and Jorge Pereira

Subjects
medicine.medical_specialty, Sports medicine, medicine.medical_treatment, Audit, Gallbladder Diseases, Gallstones, Critical Care and Intensive Care Medicine, Biliary disease, Cohort Studies, 03 medical and health sciences, 0302 clinical medicine, Epidemiology, medicine, Prevalence, Humans, Orthopedics and Sports Medicine, Prospective Studies, Prospective cohort study, Aged, business.industry, General surgery, medicine.disease, Cholecystectomy, Laparoscopic, 030220 oncology & carcinogenesis, Acute Disease, Emergency Medicine, Cholecystitis, 030211 gastroenterology & hepatology, Surgery, Cholecystectomy, Female, business, Cohort study
Abstract

Background Acute complications of biliary calculi are common, morbid, and complex to manage. Variability exists in the techniques utilized to treat these conditions at an individual surgeon and unit level. Aim To identify, through an international prospective nonrandomized cohort study, the epidemiology and areas of practice variability in management of acute complicated calculous biliary disease (ACCBD) and to correlate them against reported outcomes. Methods A preplanned analysis of the European Society of Trauma and Emergency Surgery (ESTES) 2018 Complicated Biliary Calculous Disease audit was performed. Patients undergoing emergency hospital admission with ACCBD between 1 October 2018 and 31 October 2018 were included. All eligible patients with acute complicated biliary calculous disease were recorded contemporaneously using a standardized predetermined protocol and a secure online database and followed-up through to 60 days from their admission. Endpoints A two-stage data collection strategy collecting patient demographics, details of operative, endoscopic and radiologic intervention, and outcome metrics. Outcome measures included mortality, surgical morbidity, ICU stay, timing of operative intervention, and length of hospital stay. Results Three hundred thirty-eight patients were included, with a mean age of 65 years and 54% were female. Diagnosis at admission were: cholecystitis (45.6%), biliary pancreatitis (21%), choledocholithiasis with and without cholangitis (13.9% and 18%). Index admission cholecystectomy was performed in just 50% of cases, and 28% had an ERCP performed. Morbidity and mortality were low. Conclusion This first ESTES snapshot audit, a purely descriptive collaborative study, gives rich ‘real world’ insights into local variability in surgical practice as compared to international guidelines, and how this may impact upon outcomes. These granular data will serve to improve overall patient care as well as being hypothesis generating and inform areas needing future prospective study.

Published
2020

11. Thyroid Cancer: A Single Portuguese Center Experience

Author

Ricardo Vaz Pereira, Carlos Santos, Urânia Fernandes, Gonçalo Guidi, Daniela Martins, Clara Leal, Bruno Vieira, Francisca Freitas, Carolina Marques, Ana Melo, Sílvia Silva, Leandro Lajut, João Gaspar, Ana Monteiro, and joão Pinto-Sousa

Subjects
Oncology, Surgery, General Medicine
Published
2022
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15. Self-reported and actual adherence to the Tokyo guidelines in the European snapshot audit of complicated calculous biliary disease

Author

Éanna Ryan, Jessica Ryan, DIETER MORALES-GARCIA, Júlio Constantino, Ahmad Mohammad Ismail, Michael Kelly, Stefano Fracon, Urânia Fernandes, Gary Alan Bass, Paul Ridgway, Yang Cao, Jorge Pereira, Bass, G A, Gillis, A E, Cao, Y, Mohseni, S, and de manzini, N

Subjects
Male, medicine.medical_specialty, Internationality, medicine.medical_treatment, Cholecystitis, Acute, lcsh:Surgery, Gallbladder Diseases, biliary stone, Audit, biliary stones, acute disease, guidelines, Biliary disease, 03 medical and health sciences, 0302 clinical medicine, medicine, Humans, Blood culture, Prospective Studies, General, Tokyo, Prospective cohort study, Aged, Aged, 80 and over, medicine.diagnostic_test, business.industry, General surgery, lcsh:RD1-811, Original Articles, General Medicine, Odds ratio, Middle Aged, medicine.disease, Hospitalization, Cholecystectomy, Laparoscopic, Health Care Surveys, 030220 oncology & carcinogenesis, Cholecystitis, Original Article, Female, 030211 gastroenterology & hepatology, Cholecystectomy, Guideline Adherence, Self Report, business, Trauma surgery
Abstract

Background Complicated acute biliary calculous disease poses clinical challenges. The European Society of Trauma and Emergency Surgery (ESTES) snapshot audit of complicated biliary calculous disease aims to make novel comparisons between self‐reported institutional adherence to the Tokyo guidelines (TG18) and ‘real‐world’ contemporary practice across Europe. Methods A preplanned analysis of a prospective observational multicentre audit that captured patients undergoing emergency admission for complicated biliary calculous disease (complicated cholecystitis, biliary pancreatitis, or choledocholithiasis with or without cholangitis) between 1 and 31 October 2018 was performed. An anonymized survey was administered to participating sites. Results Following an open call for participation, 25 centres from nine countries enrolled 338 patients. All centres completed the anonymized survey. Fifteen centres (60 per cent) self‐reported that a minority of patients were treated surgically on index admission, favouring interval cholecystectomy. This was replicated in the snapshot audit, in which 152 of 338 patients (45·0 per cent) underwent index admission cholecystectomy, 17 (5·0 per cent) had interval cholecystectomy, and the remaining 169 (50·0 per cent) had not undergone surgery by the end of the 60‐day follow‐up. Centres that employed a dedicated acute care surgery model of care were more likely to perform index admission cholecystectomy compared with a traditional general surgery ‘on call’ service (57 versus 38 per cent respectively; odds ratio 2·14 (95 per cent c.i. 1·37 to 3·35), P, The Tokyo Guidelines 2018 (TG18) describe expert consensus for best practice in the management of complex acute biliary calculous disease. Self‐reported adherence (and limitations to this) were compared with ‘real‐world’ patient‐level data from a prospective observational study, the ESTES snapshot audit. Recognition of TG18 was high, but adherence to guidance on both index admission cholecystectomy and microbiological culture‐guided antibiotic therapy was poor. Low self‐reported and actual adherence to guidelines

Published
2020

16. Maternal educational level: correlation with obstetric indicators

Author

Urânia Fernandes Oliveira, Luiz Fernando Costa Nascimento, and Fátima Hussein Haidar

Subjects
Fatores de Risco, medicine.medical_specialty, Saúde da Mulher, Birth weight, Developing country, lcsh:Medicine, Prenatal care, Correlation, Escolaridade, Risk Factors, Medicine, Population statistics, business.industry, Singleton, Obstetrics, lcsh:Public aspects of medicine, lcsh:R, Public Health, Environmental and Occupational Health, lcsh:RA1-1270, Low birth weight, Women's Health, Educational Status, Health education, medicine.symptom, business, Demography
Abstract

O objetivo deste estudo é estimar as associações entre a escolaridade materna, como variável dependente, e algumas variáveis constantes na Declaração de Nascido Vivo (DNV) do Ministério da Saúde. Em uma análise de 3.843 DNV da região de Guaratinguetá, São Paulo, relativas a partos hospitalares e nascimentos únicos, ocorridos no ano de 1998, foram encontradas associações estatisticamente significativas entre a menor escolaridade e ocorrência de baixo peso ao nascer; número de filhos vivos igual ou maior que três; história pregressa de filhos mortos; maior número de partos e consultas médicas no pré-natal em número até seis. Não se observaram associações entre escolaridade e aborto e tempo de gestação, citadas em outros trabalhos. Assim, a escolaridade materna pode ser considerada um marcador obstétrico de risco para a gestante e o recém-nascido. The aim of this study was to estimate associations between level of maternal education as the dependent variable and several variables present in birth certificates under the official Brazilian Ministry of Health model. A total of 3,843 birth certificates were analyzed from Guaratinguetá, São Paulo State, for singleton hospital deliveries in 1998. Statistically significant associations were found between low maternal educational level and low birth weight, 3 or more live births, history of stillbirth, and prenatal care including up to 6 visits. No association was found between abortions and preterm delivery as described in other studies, perhaps due to insufficient information. Maternal educational level can thus be considered an obstetric marker for some risk factors for the mother and infant.

Published
2001

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