RESUMO
AIM: Distal pancreatectomies (DP) are associated with high risk of postoperative complications, and in many series higher morbidity rate than duodenopancreatectomies has been reported. To evaluate the role of a collagen sponge with human fibrinogen and thrombin film (TachoSil®) in limiting the incidence of complications after DP. METHODS: From 1996 to 2013, 221 patients have been submitted to distal pancreatectomy (± splenectomy) in our Division. A retrospective analysis has been conducted in a group of 36 consecutive and prospectively collected DP treated with intraoperative placement of TachoSil® on pancreatic stump from 2010 to 2013 (group 1). A control series of 36 consecutive patients (group 2) was matched 1:1 from hystorical database. The variables considered in the analysis were: age, gender, ASA score, pancreatic texture (hard vs. soft), histology, operative time, postoperative mortality, morbility (postoperative pancreatic fistula - POPF, postoperative hemorrage - PPH, delayed gastric emptying - DGE) and hospital stay. Differences between POPF, PPH, DGE and hospital stays between grops were investigated with χ² and t-Student test. Univariate analysis was conducted to determine factors related to POPF development. Statistical analysis was performed using freeware Microsoft Excel based program. RESULTS: Post operative mortality was 0% in both groups. POPF were registered in 36.1% (13/36) and 41.6 % (15/36) in groups 1 and 2, respectively (P=n.s.); in group 1 we didn't observe grade C POPF, while 4 patients in control group developed grade C POPF (P<0,05). No differences were found between two groups in terms of incidence of PPH and DGE. The median duration of postoperative hospital stay in group 1 was 21.8 (7-189) days compared with 31.13 (9-249) days in group 2 (P<0.001). CONCLUSION: The use of TachoSil® seems to be associated with lower incidence of grade C POPF but larger controlled trials are needed to surely assess the usefulness of TachoSil® in pancreatic surgery in order to reduce pancreatic specific complications and their severity.
Assuntos
Fibrinogênio/administração & dosagem , Pancreatectomia , Trombina/administração & dosagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Perda Sanguínea Cirúrgica/estatística & dados numéricos , Combinação de Medicamentos , Feminino , Humanos , Incidência , Itália/epidemiologia , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Pancreatectomia/efeitos adversos , Fístula Pancreática/prevenção & controle , Neoplasias Pancreáticas/patologia , Neoplasias Pancreáticas/cirurgia , Estudos Prospectivos , Estudos Retrospectivos , Fatores de Risco , Resultado do TratamentoRESUMO
Surgical site infections (SSIs) are a frequent cause of morbidity following surgical procedures. Gram-positive cocci, particularly staphylococci, cause many of these infections, although Gram-negative organisms are also frequently involved. The risk of developing a SSI is associated with a number of factors, including aspects of the operative procedure itself, such as wound classification, and patient-related variables, such as preexisting medical conditions. Antimicrobial prophylaxis (AP) plays an important role in reducing SSIs, especially if patient-related risk factors for SSIs are present. The main components of antimicrobial prophylaxis are: timing, selection of drugs and patients, duration and costs. Compliance with these generally accepted preventive principles may lead to overall decreases in the incidence of these infections. Ideally the administration of the prophylactic agent should start within 30 minutes from the surgical incision. The duration of the AP should not exceed 24 hours for the majority of surgical procedures. The shortest effective period of prophylactic antimicrobial administration is not known and studies have demonstrated that post-surgical antibiotic administration is unnecessary. Furthermore, there were no proven benefits in multiple dose regimens when compared to single-dose regimens. The choice of an appropriate prophylactic antimicrobial agent should be based primarily on efficacy and safety. Broad spectrum antibiotics should be avoided due to the risk of promoting bacterial resistance. Cephalosporins are the most commonly used antibiotics in surgical prophylaxis; specifically, cefazolin or cefuroxime are mainly used in the prophylaxis regimens for cardio-thoracic surgery, vascular surgery, hip or knee arthroplasty surgery, neurosurgical procedures and gynecologic and obstetric procedures. A review of the prophylactic regimens regarding the main surgical procedures is presented.
Assuntos
Anti-Infecciosos/uso terapêutico , Antibioticoprofilaxia/métodos , Procedimentos Cirúrgicos Operatórios/métodos , Humanos , Infecção da Ferida Cirúrgica/prevenção & controleRESUMO
SUMMARYA prospective cohort study with a 1-year telephone follow-up was performed to estimate the incidence of surgical-site infections (SSIs) in hip and knee prostheses. Twenty-five public hospitals equipped with orthopaedic units in two Italian regions were involved. An 8-month surveillance period was set to obtain significant data at a regional level and data were collected by the infection control nurses of each centre. One-year follow-up was completed in 75% of cases. SSIs were recorded in 45 cases (incidence rate 1·9/100 person-years, 95% CI 1·4-2·5). Thirty-six percent of SSIs were diagnosed during hospitalization and 95·3% within 90 days post-operation. This incidence is similar to that reported by European and USA surveillance systems. The proposed investigative method proved to be reliable and feasible. A prolonged surveillance for at least 3 months post-operation yields a good estimate of SSI in joint replacements.
Assuntos
Infecção Hospitalar/epidemiologia , Procedimentos Ortopédicos/efeitos adversos , Infecções Relacionadas à Prótese/epidemiologia , Infecção da Ferida Cirúrgica/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Seguimentos , Articulação do Quadril/cirurgia , Humanos , Incidência , Itália/epidemiologia , Articulação do Joelho/cirurgia , Masculino , Pessoa de Meia-Idade , Estudos ProspectivosAssuntos
Infecção Hospitalar/epidemiologia , Infecção da Ferida Cirúrgica/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Humanos , Incidência , Lactente , Recém-Nascido , Itália/epidemiologia , Pessoa de Meia-Idade , Vigilância da População , Adulto JovemRESUMO
Survival of pancreatic cancer is improved by surgery and is related to R0 resection. An accurate diagnosis and a careful staging are mandatory. Differential diagnosis must be estabilished between the different pancreatic lesions as carcinoma, chronic pancreatitis, cystic or endocrine neoplasms. Endoscopic ultrasound (EUS) is the best technique for diagnosis and allows cytological examination by fine needle aspiration (FNA). Preoperative resectability is defined by EUS in borderline tumors. EUS is a useful procedure for the surgical strategy of pancreatic cancer.
Assuntos
Endossonografia/métodos , Estadiamento de Neoplasias/métodos , Pâncreas/diagnóstico por imagem , Neoplasias Pancreáticas/diagnóstico por imagem , Algoritmos , Biópsia por Agulha Fina/métodos , Diagnóstico Diferencial , Humanos , Pâncreas/patologia , Cisto Pancreático/diagnóstico por imagem , Cisto Pancreático/patologia , Neoplasias Pancreáticas/patologia , Neoplasias Pancreáticas/cirurgiaRESUMO
Aim of the study is to describe the application of surgical site infection (SSI) control procedures in general surgery operating rooms of Piedmont region hospitals. A specific data collection form was designed to record information. 54 questionnaires were compiled. Piedmont legislation related to operating rooms' equipment is obeyed in more than 90% of hospitals. Nevertheless, there are some critical aspects than could be risk factors for SSI or that are not useful in order to prevent them: use of UV radiation (11.3%), use of tacky mats at the entrance of the operating room (5.7%), special cleaning of operating rooms after contaminated or dirty operations (73.6%) and routine environmental sampling (10%) that is strongly recommended by ISPESL guideline in disagreement with international recommendations. Steam autoclave is used for surgical instruments sterilization by 100% of hospitals, but only 50% of them performs an annual validation of both autoclave performance and sterilization procedures. The study gave useful information in order to promote some structural modifications and personnel education for efficacious SSI prevention and control.
Assuntos
Ambiente Controlado , Controle de Infecções/legislação & jurisprudência , Legislação Hospitalar , Salas Cirúrgicas/normas , Guias de Prática Clínica como Assunto , Infecção da Ferida Cirúrgica/prevenção & controle , Infecção Hospitalar/prevenção & controle , Humanos , Agências Internacionais , Itália , Salas Cirúrgicas/legislação & jurisprudência , Fatores de Risco , Inquéritos e QuestionáriosRESUMO
Between October and December 2000, a region-wide prevalence study of hospital-acquired infections (HAI) was conducted in all public hospitals (59 facilities with ca. 16000 beds; 560000 admission yearly) in Piemonte Region, Italy, and in the one hospital of the neighbouring autonomous region of Valle d'Aosta. The study population comprised a total of 9467 patients hospitalized for at least 24 h. The prevalence of HAI was 7.84%, with marked differences in prevalence among the participating hospitals (range: 0-47.8%). The higher relative frequency of urinary tract infections (UTI; 52.7%) was due to the inclusion of urine cultures obtained on the day of the study from asymptomatic UTI in catheterized patients. A significant correlation was found with major risk factors related to medical procedures (urinary catheter, mechanical ventilation, surgical drainage, intravascular catheters). Patients with HAI were found to be older and to have a greater mean length of stay in hospital. Multiple logistic regression analyses showed that lack of independence, indwelling urinary catheter and mechanical ventilation were the risk factors more significantly associated with HAI. The use of antibiotics, in particular prophylactic agents used in surgery (cephalosporins, glycopeptides), provided an incentive for corrective intervention in antibiotic administration and in training of healthcare workers.
Assuntos
Infecção Hospitalar/epidemiologia , Hospitais Públicos/estatística & dados numéricos , Antibacterianos/uso terapêutico , Infecção Hospitalar/diagnóstico , Infecção Hospitalar/tratamento farmacológico , Infecção Hospitalar/microbiologia , Revisão de Uso de Medicamentos , Feminino , Unidades Hospitalares , Humanos , Profissionais Controladores de Infecções , Itália/epidemiologia , Masculino , Prevalência , Fatores de Risco , Vigilância de Evento Sentinela , Infecções Urinárias/diagnóstico , Infecções Urinárias/epidemiologia , Infecções Urinárias/microbiologiaRESUMO
BACKGROUND: Only a part of patients suffering from Crohn's disease has enteric fistulae and a different behaviour of Crohn's disease with fistulae is reported in the literature. Aim of this paper is to evaluate if enteric fistulae are a factor conditioning mortality, morbidity and overall postoperative course, in patients with Crohn's disease. METHODS: Data on the postoperative course of 126 laparotomies for Crohn's disease, performed between November 1993 and July 1998, have been prospectively examined. Moreover, the presence of enteric fistula has been evaluated during surgery. RESULTS: Out of 126 interventions, in 58 (46%) enteric fistulae were present. Mortality (5.2% vs 0), morbidity (14.5% vs 7.3%), necessity for a temporary ostomy (20.4% vs 3.5%) were greater in those patients with fistula, as compared as those without fistula. CONCLUSIONS: In conclusion, it is suggested that Crohn's disease with fistulae is a different type of disease, with higher mortality and morbidity rates.
Assuntos
Doenças do Colo/cirurgia , Doença de Crohn/cirurgia , Duodenopatias/cirurgia , Doenças do Íleo/cirurgia , Fístula Intestinal/cirurgia , Adulto , Doenças do Colo/etiologia , Doença de Crohn/complicações , Duodenopatias/etiologia , Feminino , Humanos , Doenças do Íleo/etiologia , Ileostomia , Fístula Intestinal/etiologia , Masculino , Estudos Prospectivos , Doenças do Colo Sigmoide/etiologia , Doenças do Colo Sigmoide/cirurgiaRESUMO
We report here that the progression of pancreatic carcinomas in tumor patients is associated with increased serum levels of both the soluble forms of CD95 ligand (CD95L/FasL) and its receptor, CD95 (Fas). Shedding of proteolytically processed soluble CD95L was also observed in pancreatic carcinoma cells in vitro, thus identifying one possible source of CD95L in patients' sera. Because the secreted forms of both CD95 and CD95L have been implicated previously in protection of cells from CD95-mediated cell death, we assessed the effect of soluble CD95L in supernatants of pancreatic carcinoma cells on viability of Jurkat T lymphocytes. We describe that (a) supernatants derived from cultured pancreatic carcinoma cells caused apoptosis of Jurkat cells; (b) soluble tumor-derived CD95L contributed significantly to this effect; and (c) in comparison to Jurkat cells, pancreatic carcinoma cells themselves revealed increased resistance to apoptosis induction by autocrine soluble CD95L. These results are consistent with the notion that in the microenvironment of pancreatic tumors, tumor-derived shed CD95L exerts paracrine pro-apoptotic effects. In addition, because it is released at high levels into the bloodstream, soluble CD95L may have systemic effects in tumor patients that reach beyond the microenvironment of the tumor site.
Assuntos
Apoptose , Carcinoma/metabolismo , Glicoproteínas de Membrana/biossíntese , Neoplasias Pancreáticas/metabolismo , Receptor fas/biossíntese , Adulto , Idoso , Carcinoma/sangue , Separação Celular , Técnicas de Cocultura , Meios de Cultivo Condicionados , Relação Dose-Resposta a Droga , Ensaio de Imunoadsorção Enzimática , Proteína Ligante Fas , Feminino , Citometria de Fluxo , Imunofluorescência , Proteínas de Fluorescência Verde , Humanos , Immunoblotting , Imuno-Histoquímica , Células Jurkat , Proteínas Luminescentes/metabolismo , Masculino , Glicoproteínas de Membrana/sangue , Pessoa de Meia-Idade , Neoplasias Pancreáticas/sangue , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Linfócitos T/metabolismo , Linfócitos T/patologia , Células Tumorais Cultivadas , Receptor fas/sangueAssuntos
Adjuvantes Imunológicos/uso terapêutico , Neoplasias Colorretais/cirurgia , Infecções/tratamento farmacológico , Complicações Pós-Operatórias/tratamento farmacológico , Extratos do Timo/uso terapêutico , Adulto , Idoso , Feminino , Humanos , Infecções/etiologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Resultado do TratamentoRESUMO
The Authors describe a case of somatostatinoma in the pancreatic tail, characterized by the absence of a specific symptomatology, with the exception of a slight hyperglycaemia. The patient underwent a surgical operation of pancreatic resection and splenectomy, and now enjoys very good health. They have examined literature from 1977 to 1988, and overall the 30 cases of pancreatic localization, describing the symptomatology, the pathological anatomy, the therapy, and evaluating the malignity degree. Then the Authors could notice that the prognosis of these neoplasms is often fatal, both for the frequent tumor metastatization, and for the difficulties in making an early diagnosis. The therapy is essentially surgical.
Assuntos
Neoplasias Pancreáticas/diagnóstico , Somatostatinoma/diagnóstico , Humanos , Pessoa de Meia-Idade , Neoplasias Pancreáticas/cirurgia , Somatostatinoma/cirurgiaAssuntos
Doenças Biliares/cirurgia , Mezlocilina/uso terapêutico , Complicações Pós-Operatórias/prevenção & controle , Infecção da Ferida Cirúrgica/prevenção & controle , Adulto , Ensaios Clínicos como Assunto , Esquema de Medicação , Humanos , Mezlocilina/administração & dosagem , Distribuição Aleatória , Infecções Respiratórias/prevenção & controle , Infecções Urinárias/prevenção & controleRESUMO
The rate of postoperative infections is significantly increased in anergic patients. The authors evaluated prospectively, in a controlled, randomized and stratified study, the efficiency of thymostimulin in reducing postoperative infections in 42 such patients. Excluded were those who were malnourished in whom preoperative alimentation corrected the anergy. The incidence of infections was significantly (p less than 0.05) reduced in thymostimulin-treated patients (4.8% versus 28.6%).