- Goethe-Universität Frankfurt am Main, Medizin, Department MemberUniversità degli Studi di Milano-Bicocca, Medicina e Chirurgia, Department Memberadd
- My name is Konstantinos Panagiotis RODITIS, born on 12-10-1982 in Rhodes, Greece. I live in Halandri, Athens. Greece.... moreMy name is Konstantinos Panagiotis RODITIS, born on 12-10-1982 in Rhodes, Greece. I live in Halandri, Athens. Greece. I am a specialist in Vascular and Endovascular Surgery practicing at Red Cross Hospital, Athens, Greece.edit
- Assoc. Prof. Spyros Vasdekis MD, PhD, DIC, Prof. Anastasios Machairas MD, PhD, Univ.-Prof.Dr.med. Thomas Schmitz-Rixen, Prof. Helen Giamarellou, MD, PhD, Prof. Christos D. Liapis, MD, FACS, FRCS, FEBVS, Dr. Nickolas Kontorinis MBBS, FRACP, Dr. Dimitris Mavros, MD, PhDedit
Introduction: Intraoperative adverse events (iAEs) occur and have the potential to impact the postoperative course. However, iAEs are underreported and are not routinely collected in the contemporary surgical literature. There is no... more
Introduction:
Intraoperative adverse events (iAEs) occur and have the potential to impact the postoperative course. However, iAEs are underreported and are not routinely collected in the contemporary surgical literature. There is no widely utilized system for the collection of essential aspects of iAEs, and there is no established database for the standardization and dissemination of this data that likely have implications for outcomes and patient safety. The Intraoperative Complication Assessment and Reporting with Universal Standards (ICARUS) Global Surgical Collaboration initiated a global effort to address these shortcomings, and the establishment of an adverse event data collection system is an essential step. In this study, we present the core-set variables for collecting iAEs that were based on the globally validated ICARUS criteria for surgical/interventional and anesthesiologic intraoperative adverse event collection and reporting.
Material and Methods:
This article includes three tools to capture the essential aspects of iAEs. The core-set variables were developed from the globally validated ICARUS criteria for reporting iAEs (item 1). Next, the summary table was developed to guide researchers in summarizing the accumulated iAE data in item 1 (item 2). Finally, this article includes examples of the method and results sections to include in a manuscript reporting iAE data (item 3). Then, 5 scenarios demonstrating best practices for completing items 1–3 were presented both in prose and in a video produced by the ICARUS collaboration.
Dissemination:
This article provides the surgical community with the tools for collecting essential iAE data. The ICARUS collaboration has already published the 13 criteria for reporting surgical adverse events, but this article is unique and essential as it actually provides the tools for iAE collection. The study team plans to collect feedback for future directions of adverse event collection and reporting.
Highlights
This article represents a novel, fully-encompassing system for the data collection of intraoperative adverse events.
The presented core-set variables for reporting intraoperative adverse events are not based solely on our opinion, but rather are synthesized from the globally validated ICARUS criteria for reporting intraoperative adverse events.
Together, the included text, figures, and ICARUS collaboration-produced video should equip any surgeon, anesthesiologist, or nurse with the tools to properly collect intraoperative adverse event data.
Future directions include translation of this article to allow for the widest possible adoption of this important collection system.
Intraoperative adverse events (iAEs) occur and have the potential to impact the postoperative course. However, iAEs are underreported and are not routinely collected in the contemporary surgical literature. There is no widely utilized system for the collection of essential aspects of iAEs, and there is no established database for the standardization and dissemination of this data that likely have implications for outcomes and patient safety. The Intraoperative Complication Assessment and Reporting with Universal Standards (ICARUS) Global Surgical Collaboration initiated a global effort to address these shortcomings, and the establishment of an adverse event data collection system is an essential step. In this study, we present the core-set variables for collecting iAEs that were based on the globally validated ICARUS criteria for surgical/interventional and anesthesiologic intraoperative adverse event collection and reporting.
Material and Methods:
This article includes three tools to capture the essential aspects of iAEs. The core-set variables were developed from the globally validated ICARUS criteria for reporting iAEs (item 1). Next, the summary table was developed to guide researchers in summarizing the accumulated iAE data in item 1 (item 2). Finally, this article includes examples of the method and results sections to include in a manuscript reporting iAE data (item 3). Then, 5 scenarios demonstrating best practices for completing items 1–3 were presented both in prose and in a video produced by the ICARUS collaboration.
Dissemination:
This article provides the surgical community with the tools for collecting essential iAE data. The ICARUS collaboration has already published the 13 criteria for reporting surgical adverse events, but this article is unique and essential as it actually provides the tools for iAE collection. The study team plans to collect feedback for future directions of adverse event collection and reporting.
Highlights
This article represents a novel, fully-encompassing system for the data collection of intraoperative adverse events.
The presented core-set variables for reporting intraoperative adverse events are not based solely on our opinion, but rather are synthesized from the globally validated ICARUS criteria for reporting intraoperative adverse events.
Together, the included text, figures, and ICARUS collaboration-produced video should equip any surgeon, anesthesiologist, or nurse with the tools to properly collect intraoperative adverse event data.
Future directions include translation of this article to allow for the widest possible adoption of this important collection system.
Research Interests:
Purpose: We present a case of successful retrieval of a tearaway trocar that was accidentally lost during insertion through the right jugular vein and was trapped in the right atrium of the heart of a patient. Case report / technique:... more
Purpose: We present a case of successful retrieval of a tearaway trocar that was accidentally lost during insertion through
the right jugular vein and was trapped in the right atrium of the heart of a patient.
Case report / technique: Computed Tomography Venography (CTV) was first performed to identify the position of the lost
tearaway trocar. The patient was transferred to the angiographic suite and the trocar was brought up under fluoroscopic
guidance and was temporarily parked near the point of insertion. Transfer to the operating room followed, and open re-
moval was achieved. Successful removal was performed uneventfully, and patient was discharged the next day.
Conclusion: The collaboration of a vascular surgery and an interventional radiology team helped our patient to avoid a
major cardiovascular procedure. This is an example of the results that can be achieved when we cross the boundaries and
different specialists work together for the benefit of the patient.
the right jugular vein and was trapped in the right atrium of the heart of a patient.
Case report / technique: Computed Tomography Venography (CTV) was first performed to identify the position of the lost
tearaway trocar. The patient was transferred to the angiographic suite and the trocar was brought up under fluoroscopic
guidance and was temporarily parked near the point of insertion. Transfer to the operating room followed, and open re-
moval was achieved. Successful removal was performed uneventfully, and patient was discharged the next day.
Conclusion: The collaboration of a vascular surgery and an interventional radiology team helped our patient to avoid a
major cardiovascular procedure. This is an example of the results that can be achieved when we cross the boundaries and
different specialists work together for the benefit of the patient.
Research Interests: Vascular Surgery, Endovascular Therapy, Minimally Invasive Surgery, Interventional Radiology, Endovascular intervention, and 8 moreDialysis & CRRT, Dialysis Vascular Access, Endovascular Surgery, Diagnostic and Interventional Radiology, Vascular Access, Endovascular Procedures, foreign body, and Vascular and Endovascular Surgery
A 21 year old male with a penetrating right axillary bullet wound was transferred from a remote regional hospital. Digital subtraction angiography detected complete axillary artery transection, a large haematoma with displacement and... more
A 21 year old male with a penetrating right axillary bullet wound was transferred from a remote regional hospital. Digital subtraction angiography detected complete axillary artery transection, a large haematoma with displacement and vasospasm of both stumps.
Research Interests:
Background Multimorbidity poses a global challenge to healthcare delivery. This study aimed to describe the prevalence of multimorbidity, common disease combinations and outcomes in a contemporary cohort of patients undergoing major... more
Background Multimorbidity poses a global challenge to healthcare delivery. This study aimed to describe the prevalence of multimorbidity, common disease combinations and outcomes in a contemporary cohort of patients undergoing major abdominal surgery. Methods This was a pre-planned analysis of a prospective, multicentre, international study investigating cardiovascular complications after major abdominal surgery conducted in 446 hospitals in 29 countries across Europe. The primary outcome was 30-day postoperative mortality. The secondary outcome measure was the incidence of complications within 30 days of surgery. Results Of 24,227 patients, 7006 (28.9%) had one long-term condition and 10,486 (43.9%) had multimorbidity (two or more long-term health conditions). The most common conditions were primary cancer (39.6%); hypertension (37.9%); chronic kidney disease (17.4%); and diabetes (15.4%). Patients with multimorbidity had a higher incidence of frailty compared with patients ≤ 1 long-term health condition. Mortality was higher in patients with one long-term health condition (adjusted odds ratio 1.93 (95%CI 1.16-3.23)) and multimorbidity (adjusted odds ratio 2.22 (95%CI 1.35-3.64)). Frailty and ASA physical status 3-5 mediated an estimated 31.7% of the 30-day mortality in patients with one long-term health condition (adjusted odds ratio 1.30 (95%CI 1.12-1.51)) and an estimated 36.9% of the 30-day mortality in patients with multimorbidity (adjusted odds ratio 1.61 (95%CI 1.36-1.91)). There was no improvement in 30-day mortality in patients with multimorbidity who received pre-operative medical assessment. Conclusions Multimorbidity is common and outcomes are poor among surgical patients across Europe. Addressing multimorbidity in elective and emergency patients requires innovative strategies to account for frailty and disease control. The development of such strategies, that integrate care targeting whole surgical pathways to strengthen current systems, is urgently needed for multimorbid patients. Interventional trials are warranted to determine the effectiveness of targeted management for surgical patients with multimorbidity.
Research Interests:
Background: Decision-making when considering major lower limb amputation is complex and requires individualized outcome estimation. It is unknown how accurate healthcare professionals or relevant outcome prediction tools are at... more
Background: Decision-making when considering major lower limb amputation is complex and requires individualized outcome
estimation. It is unknown how accurate healthcare professionals or relevant outcome prediction tools are at predicting outcomes
at 1-year after major lower limb amputation.
Methods: An international, multicentre prospective observational study evaluating healthcare professional accuracy in predicting
outcomes 1 year after major lower limb amputation and evaluation of relevant outcome prediction tools identified in a systematic
search of the literature was undertaken. Observed outcomes at 1 year were compared with: healthcare professionals’ preoperative predictions of death (surgeons and anaesthetists), major lower limb amputation revision (surgeons) and ambulation (surgeons, specialist physiotherapists and vascular nurse practitioners); and probabilities calculated from relevant outcome prediction tools.
Results: A total of 537 patients and 2244 healthcare professional predictions of outcomes were included. Surgeons and
anaesthetists had acceptable discrimination (C-statistic = 0.715), calibration and overall performance (Brier score = 0.200) when
predicting 1-year death, but performed worse when predicting major lower limb amputation revision and ambulation (C- statistics = 0.627 and 0.662 respectively). Healthcare professionals overestimated the death and major lower limb amputation revision risks. Consultants outperformed trainees, especially when predicting ambulation. Allied healthcare professionals marginally outperformed surgeons in predicting ambulation. Two outcome prediction tools (C-statistics = 0.755 and 0.717, Brier scores = 0.158 and 0.178) outperformed healthcare professionals’ discrimination, calibration and overall performance in predicting death. Two outcome prediction tools for ambulation (C-statistics = 0.688 and 0.667) marginally outperformed healthcare professionals.
Conclusion: There is uncertainty in predicting 1-year outcomes following major lower limb amputation. Different professional groups
performed comparably in this study. Two outcome prediction tools for death and two for ambulation outperformed healthcare
professionals and may support shared decision-making.
estimation. It is unknown how accurate healthcare professionals or relevant outcome prediction tools are at predicting outcomes
at 1-year after major lower limb amputation.
Methods: An international, multicentre prospective observational study evaluating healthcare professional accuracy in predicting
outcomes 1 year after major lower limb amputation and evaluation of relevant outcome prediction tools identified in a systematic
search of the literature was undertaken. Observed outcomes at 1 year were compared with: healthcare professionals’ preoperative predictions of death (surgeons and anaesthetists), major lower limb amputation revision (surgeons) and ambulation (surgeons, specialist physiotherapists and vascular nurse practitioners); and probabilities calculated from relevant outcome prediction tools.
Results: A total of 537 patients and 2244 healthcare professional predictions of outcomes were included. Surgeons and
anaesthetists had acceptable discrimination (C-statistic = 0.715), calibration and overall performance (Brier score = 0.200) when
predicting 1-year death, but performed worse when predicting major lower limb amputation revision and ambulation (C- statistics = 0.627 and 0.662 respectively). Healthcare professionals overestimated the death and major lower limb amputation revision risks. Consultants outperformed trainees, especially when predicting ambulation. Allied healthcare professionals marginally outperformed surgeons in predicting ambulation. Two outcome prediction tools (C-statistics = 0.755 and 0.717, Brier scores = 0.158 and 0.178) outperformed healthcare professionals’ discrimination, calibration and overall performance in predicting death. Two outcome prediction tools for ambulation (C-statistics = 0.688 and 0.667) marginally outperformed healthcare professionals.
Conclusion: There is uncertainty in predicting 1-year outcomes following major lower limb amputation. Different professional groups
performed comparably in this study. Two outcome prediction tools for death and two for ambulation outperformed healthcare
professionals and may support shared decision-making.
Research Interests:
Cardiovascular complications after major surgery are associated with increases in morbidity and mortality. There is confusion over definitions of cardiac injury or complications, and variability in the assessment and management of... more
Cardiovascular complications after major surgery are associated with increases in morbidity and mortality. There is confusion over definitions of cardiac injury or complications, and variability in the assessment and management of patients. This international prospective cohort study aimed to define the incidence and timing of these complications and to investigate their impact on 30-day all-cause mortality. We performed a prospective, international cohort study between January 2022 and May 2022. Data were collected on consecutive patients undergoing major abdominal surgery in 446 hospitals from 28 countries across Europe. The primary outcome measure was cardiovascular complications as defined by the Standardised Endpoints for Perioperative Medicine-Core Outcome Measures for Perioperative and Anaesthetic Care initiative up to 30 days after surgery. The secondary outcome was 30-day postoperative mortality. This study included 24,203 patients, of whom 611 (2.5%) developed cardiovascular complications. In total, 458 (1.9%) patients died within 30 days of surgery, of which 123 (26.9%) deaths were judged to be cardiac-related. Mortality rates were higher in patients who developed postoperative cardiovascular complications than in those who did not (19.8% vs. 1.4%), which persisted after risk adjustment (hazard ratio (95%CI) 4.15 (3.14–5.48)). We estimated an absolute risk reduction (95%CI) of 0.4 (0.3–0.5) in mortality in the absence of all cardiovascular complications. This would confer a relative risk reduction in mortality of 21.1% if all cardiovascular complications were prevented. Postoperative cardiovascular complications are relatively common and occur early after major abdominal surgery. However, over 1 in 5 postoperative deaths were attributable to these complications, highlighting an important area for future randomised trials.
Research Interests:
Context Arteriovenous malformations (AVMs) of the temporal skin area, though less common than cerebral AVMs, pose significant challenges in terms of cosmetic and functional outcomes. Over the past decade, substantial advancements have... more
Context
Arteriovenous malformations (AVMs) of the temporal skin area, though less common than cerebral AVMs, pose significant challenges in terms of cosmetic and functional outcomes. Over the past decade, substantial advancements have been made in the understanding and management of these lesions. This paper aims to review the latest developments in the pathophysiology, diagnosis, and treatment of temporal skin AVMs, and to explore ongoing challenges and emerging research directions.
Evidence Acquisition
A comprehensive literature search was conducted using databases such as PubMed, Scopus, and Google Scholar. The focus was on research published in the past ten years related to temporal skin AVMs, including reviews, clinical studies, and advancements in treatment techniques.
Results
The review discusses the evolution in understanding the pathophysiology of temporal skin AVMs, improvements in diagnostic imaging techniques, and the refinement of surgical and non-surgical treatment approaches. The outcomes, including cosmetic and functional results, and complications associated with various treatments, are also presented.
Conclusions
The management of temporal skin AVMs has benefited from multidisciplinary approaches, combining surgery, interventional radiology, and dermatology. However, challenges remain in achieving optimal cosmetic and functional outcomes, necessitating ongoing research and innovation.
Arteriovenous malformations (AVMs) of the temporal skin area, though less common than cerebral AVMs, pose significant challenges in terms of cosmetic and functional outcomes. Over the past decade, substantial advancements have been made in the understanding and management of these lesions. This paper aims to review the latest developments in the pathophysiology, diagnosis, and treatment of temporal skin AVMs, and to explore ongoing challenges and emerging research directions.
Evidence Acquisition
A comprehensive literature search was conducted using databases such as PubMed, Scopus, and Google Scholar. The focus was on research published in the past ten years related to temporal skin AVMs, including reviews, clinical studies, and advancements in treatment techniques.
Results
The review discusses the evolution in understanding the pathophysiology of temporal skin AVMs, improvements in diagnostic imaging techniques, and the refinement of surgical and non-surgical treatment approaches. The outcomes, including cosmetic and functional results, and complications associated with various treatments, are also presented.
Conclusions
The management of temporal skin AVMs has benefited from multidisciplinary approaches, combining surgery, interventional radiology, and dermatology. However, challenges remain in achieving optimal cosmetic and functional outcomes, necessitating ongoing research and innovation.
Research Interests:
This case report aims to elucidate the current practices and efficacy of endovascular repair in managing splenic artery aneurysms (SAAs), particularly focusing on a case of a large, partially ruptured SAA. A 66year-old female presented... more
This case report aims to elucidate the current practices and efficacy of endovascular repair in managing splenic artery aneurysms (SAAs), particularly focusing on a case of a large, partially ruptured SAA. A 66year-old female presented with severe abdominal pain and was later diagnosed with a 53mm saccular, degenerative SAA showing signs of partial rupture. The patient underwent successful endovascular repair using a combination of interlocking detachable coils and fibered coils. Despite the initial success, a followup CT angiogram revealed residual issues, necessitating additional embolization. The patient recovered well, with subsequent follow-ups indicating complete aneurysm closure and no complications. The successful management of this case aligns with current trends in SAA treatment, emphasizing the shift towards endovascular repair methods. This approach, highlighted in the literature, offers a minimally invasive alternative to open surgery, with lower morbidity and mortality rates. This case underscores the importance of individualized treatment planning and vigilant follow-up, particularly in light of the potential need for secondary interventions. This report contributes to the growing body of evidence supporting endovascular repair as a safe and effective treatment for SAAs, advocating for continued research into long-term outcomes and the development of advanced endovascular technologies.
Research Interests:
Background/Objectives: this systematic review aims to explore the efficacy and safety of the laparoscopic ligation of the inferior mesenteric artery (IMA) as an emerging trend for addressing a type II endoleak following endovascular... more
Background/Objectives: this systematic review aims to explore the efficacy and safety of
the laparoscopic ligation of the inferior mesenteric artery (IMA) as an emerging trend for addressing
a type II endoleak following endovascular aortic aneurysm repair (EVAR). Methods: A comprehensive literature search was conducted across several databases including Medline, Scopus, and
the Cochrane Central Register of Controlled Trials, adhering to the PRISMA guidelines. The search
focused on articles reporting on the laparoscopic ligation of the IMA for the treatment of a type
II endoleak post-EVAR. Data were extracted regarding study characteristics, patient demographics, technical success rates, postoperative outcomes, and follow-up results. Results: Our analysis
included ten case studies and two retrospective cohort studies, comprising a total of 26 patients
who underwent a laparoscopic ligation of the IMA between 2000 and 2023. The mean age of the
cohort was 72.3 years, with a male predominance (92.3%). The mean AAA diameter at the time of intervention was 69.7 mm. The technique demonstrated a high technical success rate of 92.3%, with a mean procedure time of 118.4 min and minimal blood loss. The average follow-up duration was 19.9 months, with 73% of patients experiencing regression of the aneurysmal sac, and no reports of an IMA-related type II endoleak during the follow-up period.
Conclusions: The laparoscopic ligation of the IMA for a type II endoleak following EVAR presents a promising, minimally invasive alternative with high technical success rates and favorable postoperative outcomes. Despite
its potential advantages, including reduced contrast agent use and radiation exposure, its application remains limited to specialized centers. The findings suggest the need for further research in larger prospective studies to validate the effectiveness of this procedure and potentially broaden its clinical adoption.
cohort was 72.3 years, with a male predominance (92.3%). The mean AAA diameter at the time of intervention was 69.7 mm. The technique demonstrated a high technical success rate of 92.3%, with a mean procedure time of 118.4 min and minimal blood loss. The average follow-up duration was 19.9 months, with 73% of patients experiencing regression of the aneurysmal sac, and no reports of an IMA-related type II endoleak during the follow-up period.
Conclusions: The laparoscopic ligation of the IMA for a type II endoleak following EVAR presents a promising, minimally invasive alternative with high technical success rates and favorable postoperative outcomes. Despite
its potential advantages, including reduced contrast agent use and radiation exposure, its application remains limited to specialized centers. The findings suggest the need for further research in larger prospective studies to validate the effectiveness of this procedure and potentially broaden its clinical adoption.
Research Interests: Endovascular Therapy, Abdominal Aortic Aneurysms, Endovascular intervention, Aortic Disease, Endovascular Therapy Outcomes, and 7 moreEndovascular Surgery, Abdominal Aortic Aneurysm, Endoluminal Repair of Abdominal Aortic Aneurysms, Endovascular Procedures, Endoleak, Postoperative Complications, and Vascular and Endovascular Surgery
The exploration of miRNA therapies in the realm of PAD opens new horizons, holding the potential to revolutionize vascular health and inspire optimism for enhanced clinical outcomes and improved patient well-being. As research... more
The exploration of miRNA therapies in the realm of PAD
opens new horizons, holding the potential to revolutionize
vascular health and inspire optimism for enhanced clinical
outcomes and improved patient well-being. As research pro-gresses, the confluence of mechanotransduction, miRNAs, and therapeutic modalities is likely to reshape the landscape
of PAD management, ushering in an era characterized by precision medicine in cardiovascular health.
outcomes and improved patient well-being. As research pro-gresses, the confluence of mechanotransduction, miRNAs, and therapeutic modalities is likely to reshape the landscape
of PAD management, ushering in an era characterized by precision medicine in cardiovascular health.
Research Interests:
Objective: This study addresses a critical gap in the management of pediatric vascular arterial trauma, particularly the lack of a standardized protocol to differentiate between cases requiring surgical intervention and those amenable to... more
Objective: This study addresses a critical gap in the management of pediatric vascular arterial trauma, particularly the lack of a standardized protocol to differentiate between cases requiring surgical intervention and those amenable to conservative treatment. The objective is to compare the efficacy of unfractionated heparin as a conservative treatment against surgical interventions in pediatric patients, based on clinical examination and noninvasive imaging techniques.
Methods: A retrospective observational study was conducted at a referral center, reviewing a decade-long institutional hospital record of children up to 13 years of age who suffered arterial trauma. The study
encompassed 27 pediatric patients with various injuries (penetrating, blunt, and iatrogenic), focusing on incidents involving the brachial and femoral arteries. Treatment modalities were categorized into open surgical repair and medical management with unfractionated heparin. Diagnoses were confirmed via physical examinations, color Doppler scans, and angiography. The analysis involved categorizing patients into two age groups (above and below 6 years) to assess treatment efficacy and outcomes.
Results: The study revealed that 17 patients underwent surgical intervention, while 10 received medical management with heparin. The overall limb salvage rate was 87%, with one instance of limb loss and no observed limb-length discrepancies. The surgical group demonstrated effective restoration of palpable distal pulses. Surgical techniques varied based on the specific needs of each case, with interposition vein grafting being the most common. The results underscored the tailored approach
to patient care, emphasizing the importance of age in determining the treatment strategy (Figs 1 and 2).
Conclusions: The findings highlight the effectiveness of both surgical and conservative (unfractionated heparin-based) treatments in pediatric vascular trauma management. The study advocates for age-specific treatment protocols, demonstrating that individualized care leads to high rates of limb salvage and positive outcomes. The results contribute to a better understanding of pediatric vascular trauma treatment, paving the way for more nuanced and age-tailored protocols in clinical practice.
Methods: A retrospective observational study was conducted at a referral center, reviewing a decade-long institutional hospital record of children up to 13 years of age who suffered arterial trauma. The study
encompassed 27 pediatric patients with various injuries (penetrating, blunt, and iatrogenic), focusing on incidents involving the brachial and femoral arteries. Treatment modalities were categorized into open surgical repair and medical management with unfractionated heparin. Diagnoses were confirmed via physical examinations, color Doppler scans, and angiography. The analysis involved categorizing patients into two age groups (above and below 6 years) to assess treatment efficacy and outcomes.
Results: The study revealed that 17 patients underwent surgical intervention, while 10 received medical management with heparin. The overall limb salvage rate was 87%, with one instance of limb loss and no observed limb-length discrepancies. The surgical group demonstrated effective restoration of palpable distal pulses. Surgical techniques varied based on the specific needs of each case, with interposition vein grafting being the most common. The results underscored the tailored approach
to patient care, emphasizing the importance of age in determining the treatment strategy (Figs 1 and 2).
Conclusions: The findings highlight the effectiveness of both surgical and conservative (unfractionated heparin-based) treatments in pediatric vascular trauma management. The study advocates for age-specific treatment protocols, demonstrating that individualized care leads to high rates of limb salvage and positive outcomes. The results contribute to a better understanding of pediatric vascular trauma treatment, paving the way for more nuanced and age-tailored protocols in clinical practice.
Research Interests:
Objectives: This research endeavors to elaborate on the intricate relationship between CYP2C19 genetic polymorphisms and graft patency, with a concentration on the CYP2C19*2 and CYP2C19*17 alleles. The goal is to elucidate the impact of... more
Objectives: This research endeavors to elaborate on the intricate relationship between CYP2C19 genetic polymorphisms and graft patency, with a concentration on the CYP2C19*2 and CYP2C19*17 alleles. The goal is to elucidate the impact of these genetic variants on the durability of grafts and to evaluate the effectiveness of anticoagulant therapy in
refining outcomes for allele carriers, considering the essential role of clopidogrel metabolism in ensuring graft patency.
Methods: A detailed analysis was conducted on 80 patients undergoing femora-distal bypass surgeries. Kaplan-Meier survival analysis was applied to assess graft patency and relative risks among different
genetic resistance groups over a 12-month period. In-depth examination of variables, including specific genetic variants and anticoagulant therapy, yielded insights into their direct consequences on graft
patency.
Results: In this study, we conducted a retrospective analysis of a cohort of patients who underwent vascular graft procedures, focusing on the influence of CYP2C19 resistance and anticoagulant use on graft patency.
Utilizing Kaplan-Meier survival analysis, we discovered notable differences in survival probabilities across the patient groups. Specifically, those without CYP2C19 resistance exhibited higher survival rates at earlier time points, which gradually decreased over time (Fig 1). A similar pattern was observed in patients who were administered anticoagulants (Fig 2).
The log-rank test underscored these findings, showing statistically significant differences in survival for patients categorized by CYP2C19 resistance (P ¼ .02) and anticoagulant use (P ¼ .03). Intriguingly, the
median survival time for both groups was not attained within the duration of the study, suggesting a relatively high graft patency rate and indicating the necessity for extended observation periods in future research.
These insights are crucial for understanding the long-term outcomes of vascular graft procedures and for tailoring patient-specific treatment strategies.
Conclusions: This study emphasizes the significant correlation between CYP2C19*2 and CYP2C19*17 alleles and reduced graft patency, underscoring the increased risks associated with femora-distal bypass surgeries for patients with these genetic variants. It promotes the adoption of personalized therapeutic strategies and the integration of anticoagulant ther-
apy to mitigate risks related to decreased graft longevity in patients possessing these genetic polymorphisms. The crucial importance of genetic profiling in optimizing therapeutic interventions for individuals undergoing extra-anatomic bypasses is underscored, necessitating enhanced research efforts to further investigate the complex interplay
between genetic variants, anticoagulant therapy, and graft patency outcomes.
refining outcomes for allele carriers, considering the essential role of clopidogrel metabolism in ensuring graft patency.
Methods: A detailed analysis was conducted on 80 patients undergoing femora-distal bypass surgeries. Kaplan-Meier survival analysis was applied to assess graft patency and relative risks among different
genetic resistance groups over a 12-month period. In-depth examination of variables, including specific genetic variants and anticoagulant therapy, yielded insights into their direct consequences on graft
patency.
Results: In this study, we conducted a retrospective analysis of a cohort of patients who underwent vascular graft procedures, focusing on the influence of CYP2C19 resistance and anticoagulant use on graft patency.
Utilizing Kaplan-Meier survival analysis, we discovered notable differences in survival probabilities across the patient groups. Specifically, those without CYP2C19 resistance exhibited higher survival rates at earlier time points, which gradually decreased over time (Fig 1). A similar pattern was observed in patients who were administered anticoagulants (Fig 2).
The log-rank test underscored these findings, showing statistically significant differences in survival for patients categorized by CYP2C19 resistance (P ¼ .02) and anticoagulant use (P ¼ .03). Intriguingly, the
median survival time for both groups was not attained within the duration of the study, suggesting a relatively high graft patency rate and indicating the necessity for extended observation periods in future research.
These insights are crucial for understanding the long-term outcomes of vascular graft procedures and for tailoring patient-specific treatment strategies.
Conclusions: This study emphasizes the significant correlation between CYP2C19*2 and CYP2C19*17 alleles and reduced graft patency, underscoring the increased risks associated with femora-distal bypass surgeries for patients with these genetic variants. It promotes the adoption of personalized therapeutic strategies and the integration of anticoagulant ther-
apy to mitigate risks related to decreased graft longevity in patients possessing these genetic polymorphisms. The crucial importance of genetic profiling in optimizing therapeutic interventions for individuals undergoing extra-anatomic bypasses is underscored, necessitating enhanced research efforts to further investigate the complex interplay
between genetic variants, anticoagulant therapy, and graft patency outcomes.
Research Interests:
Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study... more
Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains...
Research Interests: Orthopedic Surgery, Cardiothoracic Surgery, Global Health, Environmental Sustainability, Global Health Policy, and 15 moreMedicine, Cardiac and Thoracic Surgery, Laparoscopic Surgery, Cardiac Surgery, Oral and Maxillofacial Surgery, Green Energy, Cataract surgery, Oral Surgery, Pediatric Surgery, Global Surgery, Delphi method, Orthopaedic Surgery, Green and Sustainability Practices, Head and Neck Surgery, and Medical and Health Sciences
Research Interests:
Research Interests: Surgery, Public Management, Public Health, Medicine, Public Policy Analysis, and 15 moreGeneral Surgery, Health Systems Strengthening, History of Surgery, Medicine and Surgery, Lancet, Preparedness, Global Surgery, Pandemic, Elective Surgery, Public Policy, The Lancet, Coronavirus COVID-19, CoVid, COVID-19 PANDEMIC, and Medical and Health Sciences
Research Interests:
Research Interests:
Basal cell carcinoma (BCC) is the most commonly diagnosed cancer in humans, usually affecting elderly Caucasian men and skin regions mostly exposed to the sun, that rarely metastasizes. We report an unusual and aggressive case of... more
Basal cell carcinoma (BCC) is the most commonly diagnosed cancer in humans, usually affecting elderly Caucasian men and skin regions mostly exposed to the sun, that rarely metastasizes. We report an unusual and aggressive case of multiple, non-syndromic metastatic BCC with an uncommon primary site in the chest and pulmonary metastases, treated successfully with surgery and vismodegib. A 51-year-old woman presented with a large pigmentary lesion of the chest, close to the sternum. She had the lesion for > 25 years and lately noticed multiple facial lesions. The diagnosis of multiple BCC was suspected and a punch biopsy of the primary lesion was performed. Diagnosis was confirmed by immunohistochemistry (BerEp4+, EMA− phenotype). After excision, staging with a thorax computed tomography scan revealed metastatic micro-nodules in the left lung, confirmed histologically after video-assisted thoracic surgical biopsy. Adjuvant chemotherapy with vismodegib was proposed and administered. ...
Research Interests:
Truth is “the first casualty of war”. Many refugees come from war zones, and there is little independent and even less empirical research into the emerging refugee situation in Europe. The authors strongly feel that available data should... more
Truth is “the first casualty of war”. Many refugees come from war zones, and there is little independent and even less empirical research into the emerging refugee situation in Europe. The authors strongly feel that available data should be presented without bias so that readers may make their own judgment. First and foremost, the authors would like to applaud the countless volunteers including health professionals providing assistance to refugees across Europe and beyond. Many are going above and beyond the call of their professional duty to provide healthcare to refugees. The main purpose of this article is to describe the current refugee crisis. However, those providing this valuable assistance should be recognized.
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Research Interests: Surgery, Neurosurgery, Vascular Surgery, Medicine, General Surgery, and 15 moreAnaesthesia, Pulmonary Embolism, Thromboembolism, Clinical Sciences, Cirugia, DVT Prevention, Odds ratio, Venous thromboembolism, Chirurgia, Neurosciences, Cirugía, Deep Venous Thrombosis, Chirurgie, Prospective Cohort Study, and CoVid
Research Interests: Neurosurgery, Epidemiology, Incidence Geometry, Medicine, General Surgery, and 15 moreAnaesthesia, Clinical Sciences, Cirugia, Isolation, Pathways, Carotid Endarterectomy, Chirurgia, Aortic Surgery, Peripheral Arterial Disease, Elective Surgery, Neurosciences, Cirugía, Chirurgie, Arteriogenesis, and CoVid
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BackgroundThe Coronavirus Disease 2019 (COVID-19) pandemic is having an unprecedented impact on healthcare delivery. This international qualitative study captured the global impact on vascular patient care during the first pandemic... more
BackgroundThe Coronavirus Disease 2019 (COVID-19) pandemic is having an unprecedented impact on healthcare delivery. This international qualitative study captured the global impact on vascular patient care during the first pandemic ‘wave’.MethodsAn online structured survey was used to collect regular unit-level data regarding the modification to a wide range of vascular services and treatment pathways on a global scale.ResultsThe survey commenced on 23rd March 2020 worldwide. Over six weeks, 249 vascular units took part in 53 countries (465 individual responses). Overall, 65% of units stopped carotid surgery for anyone except patients with crescendo symptoms or offered surgery on a case-by-case basis, 25% only intervened for symptomatic aortic aneurysms cancelling all ‘elective’ repairs. For patients with symptomatic peripheral arterial disease 60% of units moved to an endovascular-first strategy. For patients who had previously undergone endovascular aortic aneurysm repair, 31.8% o...
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ABSTRACT
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In order to investigate the hypothesis that bacterial translocation from the intestine contributes to death after multiple organ dysfunction syndrome (MODS), a sterile MODS model was studied. MODS was induced in 139 male C57BL/6 mice by... more
In order to investigate the hypothesis that bacterial translocation from the intestine contributes to death after multiple organ dysfunction syndrome (MODS), a sterile MODS model was studied. MODS was induced in 139 male C57BL/6 mice by lipopolysaccharide (LPS) (endotoxin) infusion followed by zymozan infusion in four groups: Α, sham-operation; Β, LPS; C, LPS + 0.8 g/kg zymozan; and D, LPS + 1.2 g/kg zymozan. Mice were sacrificed at 24 and 48 h for quantitative tissue cultures, isolation, and stimulation of splenocytes, measurement of apoptosis of lymphocytes and macrophages, and of serum LPS and survival. Some mice with MODS were treated with the antibiotic ertapenem. Enterobacteriaceae and Enterococcus spp were isolated from tissues. Group D had the highest bacterial load and the shortest survival. Release of interleukin-10, of interleukin-17, and of intgerferon-γ by splenocytes and the rate of apoptosis did not concur with immune paralysis. Serum LPS concentrations were higher in mice with MODS versus controls. Ertapenem prolonged survival and decreased the bacterial load. Bacterial translocation seems to be an important contributor leading from MODS to death and suggests a change in therapy towards adaptation of antimicrobial treatment upon early signs of MODS.
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A 71-year-old female patient with cholelithiasis who had undergone laparoscopic cholecystectomy was admitted with obstructive jaundice (total bilirubin ∼6 mg/dL) three months later. An ERCP was performed, in which a gallstone was found,... more
A 71-year-old female patient with cholelithiasis who had undergone laparoscopic cholecystectomy was admitted with obstructive jaundice (total bilirubin ∼6 mg/dL) three months later. An ERCP was performed, in which a gallstone was found, followed by a sphincterotomy and cleansing of the bile duct. Due to deterioration of jaundice (>25 mg/dL), a new, unsuccessful ERCP and stent placement was carried out. Because of ongoing cardiac failure, she underwent an echocardiogram which revealed restrictive cardiomyopathy possibly due to amyloidosis. A liver biopsy was performed, which was positive for amyloid deposits in the liver, and the diagnosis was confirmed by the detection of monoclonal IgG protein in urine. The patient's jaundice gradually deteriorated and she died one week later from hepatic insufficiency.
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SARS-CoV-2 has been associated with an increased rate of venous thromboembolism in critically ill patients. Since surgical patients are already at higher risk of venous thromboembolism than general populations, this study aimed to... more
SARS-CoV-2 has been associated with an increased rate of venous thromboembolism in critically ill patients. Since surgical patients are already at higher risk of venous thromboembolism than general populations, this study aimed to determine if patients with peri-operative or prior SARS-CoV-2 were at further increased risk of venous thromboembolism. We conducted a planned sub-study and analysis from an international, multicentre, prospective cohort study of elective and emergency patients undergoing surgery during October 2020. Patients from all surgical specialties were included. The primary outcome measure was venous thromboembolism (pulmonary embolism or deep vein thrombosis) within 30 days of surgery. SARS-CoV-2 diagnosis was defined as peri-operative (7 days before to 30 days after surgery); recent (1-6 weeks before surgery); previous (≥7 weeks before surgery); or none. Information on prophylaxis regimens or pre-operative anti-coagulation for baseline comorbidities was not available. Postoperative venous thromboembolism rate was 0.5% (666/123,591) in patients without SARS-CoV-2; 2.2% (50/2317) in patients with peri-operative SARS-CoV-2; 1.6% (15/953) in patients with recent SARS-CoV-2; and 1.0% (11/1148) in patients with previous SARS-CoV-2. After adjustment for confounding factors, patients with peri-operative (adjusted odds ratio 1.5 (95%CI 1.1-2.0)) and recent SARS-CoV-2 (1.9 (95%CI 1.2-3.3)) remained at higher risk of venous thromboembolism, with a borderline finding in previous SARS-CoV-2 (1.7 (95%CI 0.9-3.0)). Overall, venous thromboembolism was independently associated with 30-day mortality (5.4 (95%CI 4.3-6.7)). In patients with SARS-CoV-2, mortality without venous thromboembolism was 7.4% (319/4342) and with venous thromboembolism was 40.8% (31/76). Patients undergoing surgery with peri-operative or recent SARS-CoV-2 appear to be at increased risk of postoperative venous thromboembolism compared with patients with no history of SARS-CoV-2 infection. Optimal venous thromboembolism prophylaxis and treatment are unknown in this cohort of patients, and these data should be interpreted accordingly.
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We aimed to determine the impact of pre-operative isolation on postoperative pulmonary complications after elective surgery during the global SARS-CoV-2 pandemic. We performed an international prospective cohort study including patients... more
We aimed to determine the impact of pre-operative isolation on postoperative pulmonary complications after elective surgery during the global SARS-CoV-2 pandemic. We performed an international prospective cohort study including patients undergoing elective surgery in October 2020. Isolation was defined as the period before surgery during which patients did not leave their house or receive visitors from outside their household. The primary outcome was postoperative pulmonary complications, adjusted in multivariable models for measured confounders. Pre-defined subgroup analyses were performed for the primary outcome. A total of 96,454 patients from 114 countries were included and overall, 26,948 (27.9%) patients isolated before surgery. Postoperative pulmonary complications were recorded in 1947 (2.0%) patients of which 227 (11.7%) were associated with SARS-CoV-2 infection. Patients who isolated pre-operatively were older, had more respiratory comorbidities and were more commonly from areas of high SARS-CoV-2 incidence and high-income countries. Although the overall rates of postoperative pulmonary complications were similar in those that isolated and those that did not (2.1% vs 2.0%, respectively), isolation was associated with higher rates of postoperative pulmonary complications after adjustment (adjusted OR 1.20, 95%CI 1.05-1.36, p = 0.005). Sensitivity analyses revealed no further differences when patients were categorised by: pre-operative testing; use of COVID-19-free pathways; or community SARS-CoV-2 prevalence. The rate of postoperative pulmonary complications increased with periods of isolation longer than 3 days, with an OR (95%CI) at 4-7 days or ≥ 8 days of 1.25 (1.04-1.48), p = 0.015 and 1.31 (1.11-1.55), p = 0.001, respectively. Isolation before elective surgery might be associated with a small but clinically important increased risk of postoperative pulmonary complications. Longer periods of isolation showed no reduction in the risk of postoperative pulmonary complications. These findings have significant implications for global provision of elective surgical care.
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Background: Preoperative SARS-CoV-2 vaccination could support safer elective surgery. Vaccine numbers are limited so this study aimed to inform their prioritization by modelling. Methods: The primary outcome was the number needed to... more
Background: Preoperative SARS-CoV-2 vaccination could support safer elective surgery. Vaccine numbers are limited so this study aimed to inform their prioritization by modelling. Methods: The primary outcome was the number needed to vaccinate (NNV) to prevent one COVID-19-related death in 1 year. NNVs were based on postoperative SARS-CoV-2 rates and mortality in an international cohort study (surgical patients), and community SARS-CoV-2 incidence and case fatality data (general population). NNV estimates were stratified by age (18-49, 50-69, 70 or more years) and type of surgery. Best-and worst-case scenarios were used to describe uncertainty. Results: NNVs were more favourable in surgical patients than the general population. The most favourable NNVs were in patients aged 70 years or more needing cancer surgery (351; best case 196, worst case 816) or non-cancer surgery (733; best case 407, worst case 1664). Both exceeded the NNV in the general population (1840; best case 1196, worst case 3066). NNVs for surgical patients remained favourable at a range of SARS-CoV-2 incidence rates in sensitivity analysis modelling. Globally, prioritizing preoperative vaccination of patients needing elective surgery ahead of the general population could prevent an additional 58 687 (best case 115 007, worst case 20 177) COVID-19-related deaths in 1 year. Conclusion: As global roll out of SARS-CoV-2 vaccination proceeds, patients needing elective surgery should be prioritized ahead of the general population.
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Basal cell carcinoma (BCC) is the most commonly diagnosed cancer in humans, usually affecting elderly Caucasian men and skin regions mostly exposed to the sun, that rarely metastasizes. We report an unusual and aggressive case of... more
Basal cell carcinoma (BCC) is the most commonly diagnosed cancer in humans, usually affecting elderly Caucasian men and skin regions mostly exposed to the sun, that rarely metastasizes. We report an unusual and aggressive case of multiple, non-syndromic metastatic BCC with an uncommon primary site in the chest and pulmonary metastases, treated successfully with surgery and vismodegib. A 51-year-old woman presented with a large pigmentary lesion of the chest, close to the sternum. She had the lesion for > 25 years and lately noticed multiple facial lesions. The diagnosis of multiple BCC was suspected and a punch biopsy of the primary lesion was performed. Diagnosis was confirmed by immunohistochemistry (BerEp4+, EMA− phenotype). After excision, staging with a thorax computed tomography scan revealed metastatic micro-nodules in the left lung, confirmed histologically after video-assisted thoracic surgical biopsy. Adjuvant chemotherapy with vismodegib was proposed and administered. At 30 days follow-up, thorax computed tomography scan was unaltered and her facial lesions showed significant regression. Although prognosis remains poor, early diagnosis and prompt management complimented by novel biological agents, like vismodegib, targeting disease pathogenesis, seems to bring promising results.
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Objective: The aim of the COVER Study is to identify global outcomes and decision making for vascular procedures during the pandemic. Background data: During its initial peak, there were many reports of delays to vital surgery and the... more
Objective:
The aim of the COVER Study is to identify global outcomes and decision making for vascular procedures during the pandemic.
Background data:
During its initial peak, there were many reports of delays to vital surgery and the release of several guidelines advising later thresholds for vascular surgical intervention for key conditions.
Methods:
An international multi-centre observational study of outcomes following open and endovascular interventions.
Results:
In an analysis of 1,103 vascular intervention (57 centres in 19 countries), 71.6% were elective or scheduled procedures. Mean age was 67 ± 14 years (75.6% male). Suspected or confirmed COVID-19 infection was documented in 4.0%. Overall, in-hospital mortality was 11.0%. (aortic interventions mortality 15.2% [23/151], amputations 12.1% [28/232], carotid interventions 10.7% [11/103], lower limb revascularisations 9.8% [51/521]). Chronic obstructive pulmonary disease (Odds ratio [OR] 2.02, 95% CI 1.30–3.15) and active lower respiratory tract infection due to any cause (OR 24.94, 95% CI 12.57–241.70) ware associated with mortality, whereas elective or scheduled cases were lower risk (OR 0.4, 95% CI 0.22–0.73 and 0.60, 95% CI 0.45–0.98 respectively. After adjustment, antiplatelet (Odds Ratio [OR] 0.503, 95% Confidence Interval [CI]:0.273 - 0.928) and oral anticoagulation (OR 0.411, 95% CI: 0.205 - 0.824) were linked to reduced risk of in-hospital mortality.
Conclusions:
Mortality following vascular interventions during this period was unexpectedly high. Suspected or confirmed COVID-19 cases were uncommon. Therefore an alternative cause e.g. recommendations for delayed surgery, should be considered. The vascular community must anticipate longer term implications for survival.
The aim of the COVER Study is to identify global outcomes and decision making for vascular procedures during the pandemic.
Background data:
During its initial peak, there were many reports of delays to vital surgery and the release of several guidelines advising later thresholds for vascular surgical intervention for key conditions.
Methods:
An international multi-centre observational study of outcomes following open and endovascular interventions.
Results:
In an analysis of 1,103 vascular intervention (57 centres in 19 countries), 71.6% were elective or scheduled procedures. Mean age was 67 ± 14 years (75.6% male). Suspected or confirmed COVID-19 infection was documented in 4.0%. Overall, in-hospital mortality was 11.0%. (aortic interventions mortality 15.2% [23/151], amputations 12.1% [28/232], carotid interventions 10.7% [11/103], lower limb revascularisations 9.8% [51/521]). Chronic obstructive pulmonary disease (Odds ratio [OR] 2.02, 95% CI 1.30–3.15) and active lower respiratory tract infection due to any cause (OR 24.94, 95% CI 12.57–241.70) ware associated with mortality, whereas elective or scheduled cases were lower risk (OR 0.4, 95% CI 0.22–0.73 and 0.60, 95% CI 0.45–0.98 respectively. After adjustment, antiplatelet (Odds Ratio [OR] 0.503, 95% Confidence Interval [CI]:0.273 - 0.928) and oral anticoagulation (OR 0.411, 95% CI: 0.205 - 0.824) were linked to reduced risk of in-hospital mortality.
Conclusions:
Mortality following vascular interventions during this period was unexpectedly high. Suspected or confirmed COVID-19 cases were uncommon. Therefore an alternative cause e.g. recommendations for delayed surgery, should be considered. The vascular community must anticipate longer term implications for survival.
Research Interests:
Peri-operative SARS-CoV-2 infection increases postoperative mortality. The aim of this study was to determine the optimal duration of planned delay before surgery in patients who have had SARS-CoV-2 infection. This international,... more
Peri-operative SARS-CoV-2 infection increases postoperative mortality. The aim of this study was to determine the optimal duration of planned delay before surgery in patients who have had SARS-CoV-2 infection. This international, multicentre, prospective cohort study included patients undergoing elective or emergency surgery during October 2020. Surgical patients with pre-operative SARS-CoV-2 infection were compared with those without previous SARS-CoV-2 infection. The primary outcome measure was 30-day postoperative mortality. Logistic regression models were used to calculate adjusted 30-day mortality rates stratified by time from diagnosis of SARS-CoV-2 infection to surgery. Among 140,231 patients (116 countries), 3127 patients (2.2%) had a pre-operative SARS-CoV-2 diagnosis. Adjusted 30-day mortality in patients without SARS-CoV-2 infection was 1.5% (95%CI 1.4-1.5). In patients with a pre-operative SARS-CoV-2 diagnosis, mortality was increased in patients having surgery within 0-2 weeks, 3-4 weeks and 5-6 weeks of the diagnosis (odds ratio (95%CI) 4.1% (3.3-4.8), 3.9% (2.6-5.1) and 3.6% (2.0-5.2), respectively). Surgery performed ≥ 7 weeks after SARS-CoV-2 diagnosis was associated with a similar mortality risk to baseline (odds ratio (95%CI) 1.5% (0.9-2.1%)). After a ≥ 7 week delay in undertaking surgery following SARS-CoV-2 infection, patients with ongoing symptoms had a higher mortality than patients whose symptoms had resolved or who had been asymptomatic (6.0% (95%CI 3.2-8.7) vs. 2.4% (95%CI 1.4-3.4) vs.
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This online structured survey has demonstrated the global impact of the COVID‐19 pandemic on vascular services. The majority of centres have documented marked reductions in operating and services provided to vascular patients. In the... more
This online structured survey has demonstrated the global impact of the COVID‐19 pandemic on vascular services. The majority of centres have documented marked reductions in operating and services provided to vascular patients. In the months during recovery from the resource restrictions imposed during the pandemic peaks, there will be a significant vascular disease burden awaiting surgeons.
Research Interests: Public Health, Vascular Surgery, Abdominal Aortic Aneurysms, Peripheral Vascular Disease, Carotid Endarterectomy, and 11 moreVascular Medicine, Carotid Artery Stenosis, Carotid Artery Disease, Covid-19, Coronavirus COVID-19, Coronavirus (COVID-19), Pandemic Coronavirus COVID19, SARS-CoV-2, CORONAVIRUS (SARS-CoV-2), COVID-19 PANDEMIC, and Post-COVID 19 recovery and risk management strategy and approach
Background: The effect of biphasic positive airway pressure (BPAP) at individualized pressures on the postoperative pulmonary recovery of morbidly obese patients (MOP) undergoing open bariatric surgery (OBS) and possible placebo... more
Background: The effect of biphasic positive airway pressure (BPAP) at individualized pressures on the postoperative pulmonary recovery of morbidly obese patients (MOP) undergoing open bariatric surgery (OBS) and possible placebo device-related effects (sham BPAP) were investigated.
Methods: Forty-eight MOP scheduled for OBS were initially enrolled. Subjects were randomly assigned to: A) the BPAP group in which BPAP, at individualized inspiratory positive airway pressure/expiratory positive airway pressure (IPAP/EPAP), was applied for 3 days postoperatively and B) the sham BPAP group in which sham BPAP was applied for the same time. Pulmonary function was assessed by spirometry 24 h prior to surgery and at 24, 48 and 72 h postoperatively and respiratory complications were recorded.
Results: Thirty-five subjects, 21 in the BPAP group and 14 in the sham BPAP group, completed the study. Baseline characteristics and pulmonary function were similar between groups preoperatively. Subjects in the BPAP group showed in general better spirometric performance and SpO2 values postoperatively and expedited pulmonary recovery. Atelectasis combined with respiratory distress syndrome (RDS) symptoms was observed in 21% of subjects in the sham BPAP group and one of these subjects developed lower respiratory tract infection. No respiratory complications were recorded in the BPAP group. Use of higher BPAP pressures was not associated with anastomosis leakage or disruption in any patient.
Conclusion: Use of BPAP, at individualized pressures, expedites postoperative pulmonary recovery and eliminates respiratory complications in MOP who have undergone OBS.
Methods: Forty-eight MOP scheduled for OBS were initially enrolled. Subjects were randomly assigned to: A) the BPAP group in which BPAP, at individualized inspiratory positive airway pressure/expiratory positive airway pressure (IPAP/EPAP), was applied for 3 days postoperatively and B) the sham BPAP group in which sham BPAP was applied for the same time. Pulmonary function was assessed by spirometry 24 h prior to surgery and at 24, 48 and 72 h postoperatively and respiratory complications were recorded.
Results: Thirty-five subjects, 21 in the BPAP group and 14 in the sham BPAP group, completed the study. Baseline characteristics and pulmonary function were similar between groups preoperatively. Subjects in the BPAP group showed in general better spirometric performance and SpO2 values postoperatively and expedited pulmonary recovery. Atelectasis combined with respiratory distress syndrome (RDS) symptoms was observed in 21% of subjects in the sham BPAP group and one of these subjects developed lower respiratory tract infection. No respiratory complications were recorded in the BPAP group. Use of higher BPAP pressures was not associated with anastomosis leakage or disruption in any patient.
Conclusion: Use of BPAP, at individualized pressures, expedites postoperative pulmonary recovery and eliminates respiratory complications in MOP who have undergone OBS.
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Truth is “the first casualty of war”. Many refugees come from war zones, and there is little independent and even less empirical research into the emerging refugee situation in Europe. The authors strongly feel that available data... more
Truth is “the first casualty of war”. Many
refugees come from war zones, and there is
little independent and even less empirical
research into the emerging refugee situation
in Europe. The authors strongly feel that
available data should be presented without
bias so that readers may make their own
judgment.
First and foremost, the authors would like
to applaud the countless volunteers including
health professionals providing assistance
to refugees across Europe and beyond.
Many are going above and beyond the call
of their professional duty to provide healthcare
to refugees. The main purpose of this
article is to describe the current refugee crisis.
However, those providing this valuable
assistance should be recognized.
refugees come from war zones, and there is
little independent and even less empirical
research into the emerging refugee situation
in Europe. The authors strongly feel that
available data should be presented without
bias so that readers may make their own
judgment.
First and foremost, the authors would like
to applaud the countless volunteers including
health professionals providing assistance
to refugees across Europe and beyond.
Many are going above and beyond the call
of their professional duty to provide healthcare
to refugees. The main purpose of this
article is to describe the current refugee crisis.
However, those providing this valuable
assistance should be recognized.
Research Interests:
Over the last five years, a new generation of trade agreement negotiations has emerged with the purported goal of increasing economic growth. The Trans Pacific Partnership (TPP), Transatlantic Trade and Investment Partnership (TTIP),... more
Over the last five years, a new generation of trade agreement negotiations has emerged with the purported goal of increasing economic growth. The Trans Pacific Partnership (TPP), Transatlantic Trade and Investment Partnership (TTIP), Comprehensive Economic and Trade Agreement (CETA) and Trade in Services Agreement (TiSA) negotiations seek to further trade liberalization while establishing a new global governance framework for trade beyond existing World Trade Organization structures. These deals have the potential to (re)shape public health and health care globally with significant implications for efforts to address health inequities and the social determinants of health, which are both emerging priorities of the World Medical Association.