Introduction The covid‐19 pandemic has had a drastic impact on all medical services. Acute cholecystitis is a serious condition that accounts for a considerable percentage of general surgical acute admissions. Therefore, the Royal College of Surgeons' Commissioning guidance' recommended urgent admission to secondary care and early cholecystectomy. During the first wave of hospital admissions associated with COVID‐19, most guidelines recommended conservative treatment in order to limit the admission rates and free up spaces for COVID‐19‐infected patients. However, reviews of this approach have not been widely done to assess the results and, in turn, planning our future management approach when future pressures on in‐patient admissions are inevitable. Methods Our study included all acute cholecystitis patients who needed surgical intervention in one Centre in the UK over three distinct periods (pre‐COVID‐19, during the first lockdown, and lockdown ease). Comparison between these groups were done regarding intraoperative and postoperative results. Results The conservative management led to a high rate of readmission. Moreover, delayed cholecystectomy was associated with increased operative difficulties such as extensive adhesions, intraoperative blood loss, and/or complicated gall bladder pathologies such as perforated or gangrenous gall bladder (29.9%, 16.7%, and 24.8%, respectively). The resulting postoperative complications of surgical and nonsurgical resulted in a longer hospital stay (13.5 d). Conclusion The crisis approach for acute cholecystitis management failed to deliver the hoped outcome. Instead, it backfired and did the exact opposite, leading to longer hospital stays and extra burden to the patient and the healthcare system.
Objective: Diffuse coronary artery disease makes cardiac surgeons hesitant regarding whether coronary artery bypass grafting (CABG) surgery is feasible or not. Coronary artery reconstruction using the internal thoracic artery (ITA) allows bypassing of coronary arteries with diffuse atheromatous plaques without systematically resorting to endarterectomy. The aim of the present study was to evaluate the medium-term results of coronary artery reconstruction. Methods: All patients undergoing coronary artery reconstruction using the ITA between 1999 and 2002 (233 patients) were included in the study. The mean age was 61.9 ± 9.8 years. Two hundred and eighty-one coronary artery reconstructions using the ITA were performed (mean length 3.6 ± 2 cm) for 514 CABGs. Coronary artery reconstruction using the ITA was associated with endarterectomy in 48 cases (17%). Results: In-hospital mortality was 2.6%. Follow-up data were compiled in December 2008. Mean follow-up was 73.4 ± 16.7 months. The actuarial survival rate at 7 years was 89.3 ± 2.1%, and 88% of patients were free of major cardiac events at 7 years. Conclusions: Coronary artery reconstruction gives comparable medium-term results to conventional coronary surgery, even though it is indicated for patients with more severe lesions.
To better understand the effect of the internal thoracic artery on endothelial growth after open coronary endarterectomy, we designed an experimental test of the hypothesis that closing an endarterectomized artery by an arterial patch improves re-endothelialization. The two carotid arteries were endarterectomized in nine sheep and were randomly chosen for closure by native arterial femoral (ART) patch or polytetrafluoroethylene (PTFE) patch. Three animals were randomly chosen for sacrifice at 8, 15 and 21 days each. The endarterectomized segments were studied macroscopically and microscopically. The endarterectomized area covered with adhesive thrombus was more extensive in the PTFE than in the ART group (P=0.0117). In the ART group, the regenerated endothelium was normal and sprouted from the edges of both the endarterectomy and the arterial patch towards the central endarterectomized area. In the PTFE group, it sprouted from the edges of the endarterectomy and never reached the central endarterectomized area, where abnormal endothelium was observed. The endarterectomized area covered with normal endothelium was more extensive in the ART than in the PTFE group at 8 days, at 15 days, and 21 days (P<0.001). Arterial patch closure of open-endarterectomized artery improved regenerated endothelium quality.
AIMS: The main outcome of this study was to use the transanal total mesorectal excision (TaTME) technique for rectal cancer resection and to assess as a primary endpoint the short-term oncological outcome; in terms of circumferential resection margin, longitudinal resection margins (proximally and distally), and lymph nodes (LN) retrieval, while secondary endpoints were operative time, estimated blood loss, length of hospital stay, cost per case, and overall complication rate. METHODS: This was a prospective cohort study. Forty patients were included and subjected to TaTME from May 2018 to January 2020 and patients were followed up for a period of 6 months. RESULTS: Primary endpoint: Depending on the post-operative specimen pathological assessment; circumferential resection margin (CRM) was free in all patients, proximal resection margins had a mean 14.37 2.87 cm, distal resection margins had a mean 2.08 ± 0.4 cm and LNs retrieval had a mean 13.27 ± 5.9, and number of positive LNs had a mean 2.40 ± 3.77. Secondary endpoints: Mean total operative time (from induction of anesthesia till skin closure) was 179.10, estimated blood loss (using gauze visual analog plus what was obtained in the OR suction device) was 133.67 66.59 ml, the length of hospital stay (admission till discharge) was 5.27 ± 1.08 days, cost per case had a mean (in 1000 USD) 2.95 ± 0.12, and overall complication rate was 10%. CONCLUSION: TaTME represents a promising complementary technique to laparoscopic TME in the step of low rectal dissection.
<p>Generic programming has turned out very useful in the development of reusable software. With the Java programming language, genericity is not only meant for reusability, but also for type-safety. Java generics constrain a container object (e.g., list, hash table) to store objects of a pre-specified data type. Nevertheless, safe programming with aliasing (multiple pointers in a program may point to the same object) is still a concern in object-oriented programming language research. A pointing object can mutate the state of the aliased object, reflecting the changes to all of the other pointers (aka aliases) thus affecting their behaviour. As programs grow larger and more complex, such changes in behaviour can be undesirable and difficult to detect and reason about. With respect to container objects, the iterator pattern critically violates encapsulation, allowing aliases to the state (and thereof the components) of its container. Object ownership is one of the well-researched paradigms in the area of alias management. Ownership types support hierarchical object encapsulation rather than the traditional class-level encapsulation. This thesis introduces an extension of Java 6 with support for ownership types as supplementary generic types. That is, Java generics are extended with the ability of carrying ownership information. This extension provides generic ownership support for all of Java; that is, all major language features are addressed so that programs can safely manage and express their aliasing properties. The resulting language is expressive enough to support common programming idioms, with little programming and runtime overhead. We evaluated the programmability of the language by refactoring a major (the most essential) portion of the Java Collections Framework. We also evaluated the performance impact of our refactoring by conducting a small micro-benchmark study to measure the performance time overhead the refactored collections may impose.</p>
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