Purpose The incidence, patient features, risk factors and outcomes of surgery-associated postoperative acute kidney injury (PO-AKI) across different countries and health care systems is unclear. Methods We conducted an international prospective, observational, multi-center study in 30 countries in patients undergoing major surgery (> 2-h duration and postoperative intensive care unit (ICU) or high dependency unit admission). The primary endpoint was the occurrence of PO-AKI within 72 h of surgery defined by the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Secondary endpoints included PO-AKI severity and duration, use of renal replacement therapy (RRT), mortality, and ICU and hospital length of stay. Results We studied 10,568 patients and 1945 (18.4%) developed PO-AKI (1236 (63.5%) KDIGO stage 1500 (25.7%) KDIGO stage 2209 (10.7%) KDIGO stage 3). In 33.8% PO-AKI was persistent, and 170/1945 (8.7%) of patients with PO-AKI received RRT in the ICU. Patients with PO-AKI had greater ICU (6.3% vs. 0.7%) and hospital (8.6% vs. 1.4%) mortality, and longer ICU (median 2 (Q1-Q3, 1–3) days vs. 3 (Q1-Q3, 1–6) days) and hospital length of stay (median 14 (Q1-Q3, 9–24) days vs. 10 (Q1-Q3, 7–17) days). Risk factors for PO-AKI included older age, comorbidities (hypertension, diabetes, chronic kidney disease), type, duration and urgency of surgery as well as intraoperative vasopressors, and aminoglycosides administration. Conclusion In a comprehensive multinational study, approximately one in five patients develop PO-AKI after major surgery. Increasing severity of PO-AKI is associated with a progressive increase in adverse outcomes. Our findings indicate that PO-AKI represents a significant burden for health care worldwide. Supplementary Information The online version contains supplementary material available at 10.1007/s00134-023-07169-7.
The identification of sentinel lymph nodes is a valuable oncological method, which aims at mapping lymphatic drainage and has the advantage of correctly staging the disease and assessing prognosis. Lymph node invasion is an important prognostic feature. In colorectal cancer, lymphadenectomy is not influenced by the positive or negative status of the sentinel lymph node. The identification of lymph nodes with possible invasion by staining the primary tumor with methylene blue can lead to improved staging and management. In other words, the consequent administration of neoadjuvant therapy (chemotherapy) to the appropriate patients may result in lower recurrence rates. Thus, the aim of the present study was to use methylene blue to identify the sentinel node/nodes in colorectal cancer and to determine whether the dye-capturing nodes were invaded by the tumor. This is a non-randomized prospective study, in which 26 patients with colon cancer with surgical indication were enrolled. Two types of methods were utilized: in vivo (16 patients) and ex vivo (10 patients). The identification rate was 75% for the in vivo technique and 60% for the ex vivo technique, resulting in a 69.26% overall identification rate. Of 18 patients with sentinel lymph nodes identified using dye, routine histological examination detected metastases in 6 (33.33%) of these patients. In conclusion, further research should be conducted into how the clinical application of sentinel node detection can be employed in colorectal cancer.
Objective. The purpose of this study is to analyse histopathological and clinical characteristics of EOCRC. Colorectal cancer was formerly considered as a disease of senescent age; in the last years, it is a noticeable trend of growing incidence among young people (aged between 20 and 45 years). Few of newly diagnosed cases are inherited and most of them are sporadic. Material and method. The authors studied retrospectively a series of 33 cases of early onset colorectal cancer, 17 men and 16 women, with ages below 45 years, admitted between January 2009 and January 2015 in II and IV Surgical Wards of Emergency University Hospital Bucharest. Results. Colorectal cancer in young adults tends to be an aggressive disease with dominant distal location (68.5% of all cases), mostly adenocarcinomas (96.6%) with moderate to poorly differentiated types (51.4% G2 and G3), diagnosed in advanced stages (57.6% stages III and IV), with high frequency of complications (33% presented with peritoneal carcinomatosis and 9% died during hospitalization). Conclusions. EOCRC is a heterogenous group regarding etiopathogeny, localization and histopathological features of the tumor, with aggresive histopathological types, diagnosed in advanced stages. It may be necessary to elaborate new screening protocols for colorectal cancer in young adults and to fi nd clinical and biological markers that are indicating high-risk patients.
Gastric cancer is among digestive tract cancers, the second as incidence, following as frequency after colorectal neoplasms. On a lot of 811 gastric cancer patients, hospitalized in SUUB in a period of five years (2010-2014), statistical analysis of casuistry highlights important elements regarding clinical epidemiology and therapeutics of this disease.
Iatrogenic injuries of main bile duct in laparoscopic cholecystectomy are the most severe complications that can occur during surgery. It is presented the causes that favor the occurrence of these injuries, the mechanisms of producing and measures of prevention on who the operator should them know very well and respect them during the surgical act.
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