Clostridium Difficile Infection in Rectal Cancer Patients after Diverted Loop Ileostomy Closure.

AIM: Clostridium difficile infection is a cause of increased morbidity and mortality in hospitals, particularly in patients with cancer pathology. There are several factors favouring the development of Clostridium difficile infection among cancer patients, including age, exposure to antibiotic and proton pump inhibitors therapy, and chemotherapy. This study was conducted to observe the prevalence of Clostridium difficile infection after the reversal of ileostomy loop for rectal cancer surgery, which were initially operated either open or laparoscopic. METHOD: A retrospective study was performed on patients who were operated in a single surgical team for rectal cancer who benefited of a diverted loop ileostomy over a 4-year period. Results: 23 patients were documented with Clostridium difficile infection out of a total of 63. All 23 patients underwent ileostomy closure later than 3 months after primary surgery, and postoperatively received antibiotic therapy associated with proton pump inhibitors in the first 24 hours. Conclusions: Closure of ileostomy later than 3 months after primary surgery, combined with chemotherapy, antibiotic therapy and proton pump inhibitors, increases the risk of developing Clostridium difficile infection.

Residual Gallbladder and Cystic Duct Stump Stone after Cholecystectomy: Laparoscopic Management.

Background: Cholecystectomy is the standard treatment for symptomatic gallstones, and the persistence of symptoms after surgery defines postcholecystectomy syndrome. Biliary causes of postcholecystectomy syndrome include subtotal cholecystectomy and remnant cystic duct stump stone; causes that are encountered with a low frequency, but which require diagnosis and provocative treatment. Laparoscopic management of such cases is recommended, but requires well-trained teams in laparoscopic surgery. Methods: This study is a retrospective analysis of patients who required surgical treatment for residual gallbladder and cystic duct stump stone after a cholecystectomy, hospitalized in the Surgery Department of Constanta County Hospital, who required completion of resection and were operated laparoscopically. Results: Between January 2010 and March 2020, 14 patients were hospitalized with residual gallbladder and cystic duct stump stone that required surgery. All patients underwent laparoscopic surgery. Symptomatology was dominated by recurrent biliary colic (50%). The period between the primary surgery and the surgery to complete the resection varied between 2-22 years. There were 4 cases of subtotal cholecystectomies, and 10 cases of remnant cystic duct stump stones. Intraoperative complications were encountered in only one case (7.14%), the number of days of hospitalization was on average 3 days. No patient showed any symptoms at 6-month postoperative follow-up. Conclusions: Postcholecystectomy syndrome is difficult to diagnose, symptomatic patients with remnant cystic duct stump stone/ subtotal cholecystectomy requiring surgery are difficult to manage. Laparoscopic surgery is preferred for the benefits that laparoscopic surgery brings, but requires an experienced surgeon in advanced laparoscopic techniques.

Prevention of delayed gastric emptying after right colectomy with extended lymphadenectomy: A randomized controlled trial.

BACKGROUND: Delayed gastric emptying sometimes occurs after right colectomy with extended lymphadenectomy. The aim of this randomized controlled trial is to evaluate the effect on delayed gastric emptying after performing a fixation of the stomach to the retrogastric tissue to return the stomach to a physiological position after right colectomy with lymphadenectomy, including gastrocolic lymph nodes dissection for proximal transverse colon cancer. METHODS: From January 2015 to December 2020, patients undergoing right colectomy with extensive lymphadenectomy for proximal transverse colon cancer were randomly assigned to either the gastropexy group or the conventional group. In the gastropexy group, the posterior wall of the stomach, at the level of the antrum, was sutured to the retrogastric tissue to prevent the abnormal shape that the gastric antrum acquires together with the duodeno-pancreatic complex, the shape that leads to an obstruction of the antrum region and to the delay in emptying the gastric contents. RESULTS: Mean age, sex, comorbidities, and right colectomy procedures were similar in the 2 groups. Delayed gastric emptying developed in twelve patients in the conventional group (38.7%) versus 4 patients (12.1%) in the gastropexy group (P = .014). The total number of complications was higher in the conventional group (14 complications) than in the gastropexy group (7 complications). According to univariate analysis, gastropexy significantly lowered the risk of delayed gastric emptying (P = .014). Overall morbidity was 9.7% in the conventional group versus none in the gastropexy group. Postoperative hospitalization was longer in the conventional group (7.61 ±â€…3.26 days) than in the gastropexy group (6.24 ±â€…1.3 days; P = .006). CONCLUSION: Gastropexy decreases the occurrence of delayed gastric emptying after right colectomy with extended lymphadenectomy for proximal transverse colon cancer.

Job Demands and Exhaustion in Firefighters: The Moderating Role of Work Meaning. A Cross-Sectional Study.

Emotional exhaustion and other symptoms of burnout are often found among emergency services professions, such as firefighting. Given the social importance of this activity and the high responsibility it requires, prevention and alleviation of burnout symptoms become primary concerns in ensuring the well-being of firefighters. Although work meaning is one of the factors associated with a lower risk of developing burnout, its protective role has not been studied in firefighters. Therefore, the purpose of this study was to assess the buffering role of work meaning in the health-impairment process of the Job Demands-Resources model, targeting the relationship between job demands and related emotional exhaustion. A cross-sectional survey design was used to collect data from a sample consisting of Romanian firefighters (n = 1096). Structural equation modeling indicated a positive link between job demands and exhaustion. In addition, deriving personal meaning from work was associated with lower levels of exhaustion in firefighters. A small but significant interaction effect between work meaning and job demands showed that higher levels of work meaning attenuated the positive relationship between job demands and exhaustion. In conclusion, our findings suggest that work meaning has a buffering effect on the impact of various job demands on job-related exhaustion. Nevertheless, the small effect sizes warrant further research on this topic.

Ventralex® ST Patch for Laparoscopic Repair of Ventral Hernias.

INTRODUCTION: The surgical approach for treating ventral hernia is still under debate, as well as the optimal devices to be used for such treatment. For small size defects, the tendency is to use the open approach, due to the lower cost/efficiency ratio. However, for medium-size defects, even though costlier, laparoscopy provides better results. The present study analyzes the results of a simple and effective laparoscopic technique for mesh repairing of small and medium size ventral defects using Ventralex® ST patch. METHOD: Between January 1, 2015 and January 31, 2020, 93 patients with ventral primary nonobstructive abdominal wall defects (up to 3 cm) treated laparoscopically using the intraperitoneal onlay mesh repair technique with Ventralex® patch (22 patients) and Ventralex® ST patch (71 patients). Results were prospectively analyzed based on postoperative complications, postoperative pain, recurrent hernia, and quality of life. RESULTS: The technique was used in 60 patients with umbilical hernia (64.5%), 18 patients with juxta-umbilical hernia (19.3%), and 15 patients with epigastric hernia (16.1%). Out of these, 22 patients had nonreducible (nonobstructive) hernia. The median operating time was 55 minutes (range 40-80 min). Minor complications were recorded in 15 cases (16.1%). The mean hospitalization time was 1.24 days (range 1-2). After a median follow-up of 39 months (range 20-81), the recurrence rate was 11.1% and nil (p = 0.010), and other complaints were recorded in 11.1% and 3.3% of patients (p = 0.293), for Ventralex® patch and Ventralex® ST patch, respectively. CONCLUSIONS: In conclusion, the use of Ventralex® ST patch for laparoscopic intraperitoneal onlay mesh repair of small and medium size ventral hernia is simpler and more cost-effective than standard laparoscopic patches, with superior results when compared to Ventralex® patch.

The Dark Triad Traits of Firefighters and Risk-Taking at Work. The Mediating Role of Altruism, Honesty, and Courage.

Firefighting is considered a dangerous profession that imposes unique safety hazards. In this research, we investigated the relationship between the Dark Triad traits of firefighters (N = 1434, Mage = 39.03, SD = 6.9) and their risk-taking at work, considering the mediation role of altruism, honesty, and courage. We showed that firefighters high on Machiavellianism and psychopathy reported high risk-taking. Altruism, honesty, and courage mediated the relationship between Machiavellianism and risk-taking in firefighters. Honesty and courage mediated the association between psychopathy and risk-taking. Theoretical and practical implications are discussed.

Job Crafting and Performance in Firefighters: The Role of Work Meaning and Work Engagement.

The Job Demands-Resources (JD-R) model was often utilized as an explanatory framework when investigating the strain process among first responders in general and firefighters in particular. Yet, little is known about the motivational processes whithin firefighters. The aim of this study is to expand the knowledge regarding the motivational process of firefighters by investigating job crafting and introducing work meaning within the motivational framework of the JD-R model, in relation to job performance. A cross-sectional survey design was used to collect data from one sample consisting of Romanian firefighters (n = 1,151). Structural equation modeling indicated the existence of both a direct and an indirect effect between job crafting and job performance through work meaning and work engagement. Our findings suggest that firefighters actively engage in job crafting behaviors and also that work meaning can be an outcome of job crafting. Results also encourage further research related to the way work meaning impacts job performance, through its link with work engagement. This study raises attention on how Fire departments may be able to create a climate that emphasizes meaningfulness and engagement, together with opportunities toward job redesign and a focus process based on efficiency gain.