Patients exposed to a surgical safety checklist experience better postoperative outcomes, but this could simply reflect wider quality of care in hospitals where checklist use is routine.
IntroductionNon-parasitic hepatic cysts are benign entities, occur rarely (5% of the population), and in the majority of cases, are asymptomatic. Cysts can cause symptoms when they become large and produce bile duct compression or portal hypertension, and also when complications such as rupture, infection or hemorrhage take place.Case presentationWe present the case of a 70-year-old Greek-Caucasian man with a large, asymptomatic and non-parasitic liver cyst that presented as an acute surgical abdominal emergency after spontaneous rupture into the peritoneal cavity.ConclusionsWe present an extremely rare complication of simple liver cyst, its rupture in the free abdominal cavity, and its presentation as an acute abdomen. Large simple liver cysts should be treated with intervention at early recognition as conservative management usually results in their recurrence.
Background
The Clavien–Dindo classification is perhaps the most widely used approach for reporting postoperative complications in clinical trials. This system classifies complication severity by the treatment provided. However, it is unclear whether the Clavien–Dindo system can be used internationally in studies across differing healthcare systems in high‐ (HICs) and low‐ and middle‐income countries (LMICs).
Methods
This was a secondary analysis of the International Surgical Outcomes Study (ISOS), a prospective observational cohort study of elective surgery in adults. Data collection occurred over a 7‐day period. Severity of complications was graded using Clavien–Dindo and the simpler ISOS grading (mild, moderate or severe, based on guided investigator judgement). Severity grading was compared using the intraclass correlation coefficient (ICC). Data are presented as frequencies and ICC values (with 95 per cent c.i.). The analysis was stratified by income status of the country, comparing HICs with LMICs.
Results
A total of 44 814 patients were recruited from 474 hospitals in 27 countries (19 HICs and 8 LMICs). Some 7508 patients (16·8 per cent) experienced at least one postoperative complication, equivalent to 11 664 complications in total. Using the ISOS classification, 5504 of 11 664 complications (47·2 per cent) were graded as mild, 4244 (36·4 per cent) as moderate and 1916 (16·4 per cent) as severe. Using Clavien–Dindo, 6781 of 11 664 complications (58·1 per cent) were graded as I or II, 1740 (14·9 per cent) as III, 2408 (20·6 per cent) as IV and 735 (6·3 per cent) as V. Agreement between classification systems was poor overall (ICC 0·41, 95 per cent c.i. 0·20 to 0·55), and in LMICs (ICC 0·23, 0·05 to 0·38) and HICs (ICC 0·46, 0·25 to 0·59).
Conclusion
Caution is recommended when using a treatment approach to grade complications in global surgery studies, as this may introduce bias unintentionally.
Μελετήθηκαν συνολικά 40 περιπτώσεις καρκίνου του μαζικού αδένα εκ των οποίων 6 περιπτώσεις προήλθαν από νεκροτομικό υλικό, 3 παρασκευάσματα από ανθρώπινα πτώματα που χρησιμοποιούνται για την ανατομική άσκηση των δευτεροετών φοιτητών της Ιατρικής Σχολής του Πανεπιστημίου Αθηνών και 31 χειρουργικά παρασκευάσματα ασθενών, 12 περιπτώσεις από Δημόσια Νοσοκομεία και 19 περιπτώσεις από Ιδιωτικά Θεραπευτήρια.Κατά τη μελέτη των προαναφερθέντων παρασκευασμάτων, διαπιστώθηκε η παρουσία υπολειμματικής συμπαθητικής νεύρωσης σε όλα αυτά. Ο ιστός του μαζικού αδένα μελετήθηκε με τη μέθοδο του ανοσοφθορισμού, ο οποίος βασίζεται στην ειδική πρόσδεση του σεσημασμένου αντισώματος με φθορίζον χρωμογόνο στο δικό του αντιγόνο. Για τη μελέτη του συμπαθητικού συστήματος χρησιμοποιήθηκε ως φθορίζον μόριο η φλουορεσκεΐνη, η οποία επιτρέπει να στοχεύσουμε τη φθορίζουσα ουσία σε συγκεκριμένες πρωτεΐνες και κυτταρικές δομές.Η μελέτη είναι πρωτότυπη στην Ελλάδα και από τις σπάνιες στο διεθνή χώρο, διότι έγινε σε ανθρώπινο υλικό μαζικού αδένα, ενώ διεθνώς χρησιμοποιούνται για την αντίστοιχη μελέτη πειραματόζωα.
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