Background: Two strategies for same-admission cholecystectomy in mild gallstone pancreatitis (MGP) exist: early surgery (within 48-72 h from admission) and delayed surgery until resolution of symptoms and normalization of pancreatic tests.Methods: This was a single-center, open-label RCT. Patients with MGP according to revised Atlanta classification-2012 and SIRS criteria were randomly assigned to early laparoscopic cholecystectomy (E-LC) within 72 h from admission or delayed laparoscopic cholecystectomy (D-LC). Laparoscopicendoscopic rendezvous was performed when common bile duct stones were found at systematic intraoperative cholangiography. The primary outcome was length of stay (LOS), and the secondary outcomes were complications at 90 days, need for ERCP/choledocolithiasis, conversion, and readmission. One year of follow-up was carried-on.Results: At interim analysis, 52 patients were randomized (26 E-LC, 26 D-LC). E-LC versus D-LC was associated with a significantly shorter LOS (median 58 versus 167 h; P = 0.001). There were no differences in ERCP necessity for choledocolithiasis between the two approaches (E-LC 26.9% versus D-LC 23.1%, P = 1.00). No differences in postoperative complications were found.Conclusions: E-LC approach in patients with MGP significantly reduced LOS and was not associated with clinically relevant postoperative complications.Trial registration: clinicaltrials.gov (NCT02590978).
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The impact of primary tumour location (sidedness) in colorectal cancer has been thoroughly investigated in first-lineand palliative chemotherapystudies. While in these patients, right-sided tumours were associated with worse outcome, data on impact of sidedness concerning postoperative long-term survival after resection for colorectal liver metastasis (CRLM) are scarce. Methods: All patients undergoing hepatic resection for newly diagnosed CRLM in two Austrian high-volume centres between 2003e2016 were analysed. Influence of patient, treatment and tumour characteristics on postoperative survival was evaluated. Results: A total of 252 patients (40% female; median 64a) underwent resection with a 90-day-mortality of 1.2% (31% major resections, 55% received preoperative chemotherapy). Primary tumour characteristics were: 25% rightsided, 57% nodal positive. Metastasis characteristics were: synchronous metastasis in 64%, 38% bilobar hepatic
Uvod. Gangrena je stanje koje se karakteriše nekrozom i odumiranjem tkiva, čiji je najčešći uzrok loša cirkulacija krvi. Neblagovremeno prepoznata i lečena, može imati fatalan ishod. Kod dijabetičara predstavlja jednu od najtežih komplikacija koja, u osnovi, ima hronično lošu glikoregulaciju. U razvijenim društvima predstavlja vodeći uzrok amputacija sa posledičnom invalidnošću i povećanom stopom mortaliteta. Takođe, utiče najpre na kvalitet života pacijenata, kao i na zdravstvene i socijalne sisteme. Prikaz slučaja. Zapuštena vlažna gangrena desnog stopala kod pacijenta starosti 63 godine, dugogodišnjeg insulinzavisnog dijabetičara poreklom iz ruralne oblasti. Na predlog izabranog lekara da se hospitalizuje, pacijent zahteva da se sprovede kućno lečenje. Debridman hronične rane započinje se alginatnim oblogama sa srebrom, uz peroralnu i lokalnu antibiotsku terapiju. Lečenje se nastavlja čišćenjem rane i primenom antibiotske masti, te odstranjivanjem kalusa oštrim debridmanom da bi se već u fazi značajnog povlačenja i zarastanja hronične rane upotrebile i hidrofilne obloge od poliuretanske pene. Nakon šesnaestomesečnog lečenja postiže se zarastanje hronične rane uzrokovane vlažnom gangrenom desnog stopala. Zaključak. Pacijenta je lečio tim opšte medicine, pri čemu savremena sredstva za lečenje hroničnih rana značajno ubrzavaju zarastanje rana i mogu se primenjivati i u primarnoj zdravstvenoj zaštiti. Vremenski dugo i teško lečenje je bilo posledica pacijentovih nezadovoljavajućih socioepidemioloških i ekonomskih uslova i, najvažnije, odbijanja pacijenta da sa lekarom uspostavi potpunu saradnju koja je preduslov uspešnog lečenja. U sistemu zdravstvene zaštite primarna zdravstvena zaštita čini njen nezamenljiv deo ne samo u sprečavanju nastanka gangrene, već i u samom lečenju. Ključne reči: vlažna gangrena, hronična rana, autolitički debridman, primarna zdravstvena zaštita.
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