Hemorrhoidectomy under local anesthesia with pudendal block with ropivacaine and sedation reduced postoperative pain, analgesic requirements, and postoperative complications, and can be performed as day-case procedure. Ligasure diathermy hemorrhoidectomy reduced operating time and was equally effective than conventional diathermy in long-term symptom control.
BACKGROUND
Preoperative anemia prevalence among colorectal cancer (CRC) patients is high and may adversely influence postoperative outcome. This study assesses the efficacy of a preoperative anemia managing protocol in CRC.
STUDY DESIGN AND METHODS
This was a retrospective analysis of consecutive CRC resections at two Spanish centers (January 2012 to December 2013). Preoperative anemia was defined as a hemoglobin (Hb) level of less than 13 g/dL and treated with intravenous iron (IVI) or standard care (oral iron or no iron). Red blood cell transfusion (RBCT) requirements was the primary outcome variable. Postoperative infection rate and length of hospital stay (LOS) were secondary outcome variables. Patients were managed with a restrictive transfusion trigger (Hb < 8 g/dL). Infection was diagnosed clinically and confirmed by laboratory, microbiologic, and/or radiologic evidence.
RESULTS
Overall, 322 of 571 patients (56%) presented with anemia: 232 received IVI and 90 standard care. There were differences in RBCT rate between no anemia and anemia (2% vs. 16%; p < 0.01), but not in postoperative infections (19% vs. 22%; p = NS) or LOS. Compared to those on standard care, anemic patients on IVI presented with lower Hb (10.8 g/dL vs. 12.0 g/dL; p < 0.001) at baseline, but similar Hb on day of surgery and Postoperative Day 30. There were no between‐group differences in RBCT rates (16% vs. 17%; p = NS), but infection rates were lower among IVI‐treated patients (18% vs. 29%; p < 0.05). No relevant IVI‐related side effects were recorded.
CONCLUSION
Compared to standard care, IVI was more effective in treating preoperative anemia in CRC patients and appeared to reduce infection rate, although it did not reduce postoperative RBCT.
Participatory planning networks made of government agencies, stakeholders, citizens and scientists are receiving attention as a potential pathway to build resilient landscapes in the face of increased wildfire impacts due to suppression policies and land-use and climate changes. A key challenge for these networks lies in incorporating local knowledge and social values about landscape into operational wildfire management strategies. As large wildfires overcome the suppression capacity of the fire departments, such strategies entail difficult decisions about intervention priorities among different regions, values and socioeconomic interests. Therefore there is increasing interest in developing tools that facilitate decision-making during emergencies. In this paper we present a method to democratize wildfire strategies by incorporating social values about landscape in both suppression and prevention planning. We do so by reporting and critically reflecting on the experience from a pilot participatory process conducted in a region of Catalonia (Spain). There, we built a network of researchers, practitioners and citizens across spatial and governance scales. We combined knowledge on expected wildfires, landscape co-valuation by relevant actors, and citizen participation sessions to design a wildfire strategy that minimized the loss of social values. Drawing on insights from political ecology and transformation science, we discuss what the attempt to democratize wildfire strategies entails in terms of power relationships and potential for social-ecological transformation. Based on our experience, we suggest a trade-off between current wildfire risk levels and democratic management in the fire-prone regions of many western countries. In turn, the political negotiation about the landscape effects of wildfire expert knowledge is shown as a potential transformation pathway towards lower risk landscapes that can re-define agency over landscape and foster community re-learning on fire. We conclude that democratizing wildfire strategies ultimately entails co-shaping the landscapes and societies of the future.
We recommend a conservative treatment for patients with the following conditions: good general health, unnoticed perforation during endoscopy, early diagnosis, no signs of diffuse peritonitis, proper colonic preparation, and a different injury mechanism to traction. Patients treated surgically after the first 24 h are likely to have a greater degree of peritonitis and more intestinal resections, ostomies, and complications.
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