Hidradenitis suppurativa is a chronic disease that significantly reduces patients’ quality of life. Patients are chronically treated with systemic therapies, which are often ineffective. Surgical treatment for severe cases of hidradenitis suppurativa is one option for affected patients. Surgical treatment has its limitations, and wound closure may be particularly problematic. This requires the use of reconstructive techniques. The methods of choice for wound closure are split-thickness skin grafts or local flaps reconstructions. However, each method has its limitations. This is a presentation of a new reconstructive surgical method in hidradenitis suppurativa surgery: the use of a co-graft of Acellular dermal matrix and split thickness skin graft as a novel method in wound closure after wide excisions, based on two cases. The results of this method are very promising: we achieved very fast wound closure with good aesthetic results regarding scar formation. In this paper, we used several examinations: laser speckle analysis, cutometer tests, and health-related quality of life (QoL) questionnaire to check the clinical impact of this method. Our initial results are very encouraging. ADM with STSG as a co-graft could be widely used in reconstructive surgery. This is a preliminary study, which should be continued in further, extended research.
Background Many surgeons routinely place intraperitoneal drains after elective colorectal surgery. However, enhanced recovery after surgery guidelines recommend against their routine use owing to a lack of clear clinical benefit. This study aimed to describe international variation in intraperitoneal drain placement and the safety of this practice. Methods COMPASS (COMPlicAted intra-abdominal collectionS after colorectal Surgery) was a prospective, international, cohort study which enrolled consecutive adults undergoing elective colorectal surgery (February to March 2020). The primary outcome was the rate of intraperitoneal drain placement. Secondary outcomes included: rate and time to diagnosis of postoperative intraperitoneal collections; rate of surgical site infections (SSIs); time to discharge; and 30-day major postoperative complications (Clavien–Dindo grade at least III). After propensity score matching, multivariable logistic regression and Cox proportional hazards regression were used to estimate the independent association of the secondary outcomes with drain placement. Results Overall, 1805 patients from 22 countries were included (798 women, 44.2 per cent; median age 67.0 years). The drain insertion rate was 51.9 per cent (937 patients). After matching, drains were not associated with reduced rates (odds ratio (OR) 1.33, 95 per cent c.i. 0.79 to 2.23; P = 0.287) or earlier detection (hazard ratio (HR) 0.87, 0.33 to 2.31; P = 0.780) of collections. Although not associated with worse major postoperative complications (OR 1.09, 0.68 to 1.75; P = 0.709), drains were associated with delayed hospital discharge (HR 0.58, 0.52 to 0.66; P < 0.001) and an increased risk of SSIs (OR 2.47, 1.50 to 4.05; P < 0.001). Conclusion Intraperitoneal drain placement after elective colorectal surgery is not associated with earlier detection of postoperative collections, but prolongs hospital stay and increases SSI risk.
Road accidents are generating economic and public high costs. They include: losses resulting from the long-lasting or temporary impossibility of creating GDP, expenses on the treatment and rehabilitation of people injured in the accidents, costs of emergency services involvment, payment of compensations and benefits, financial losses or emotional suffering of the accidents' victims and perpetrators' relatives, leading to reduce their economic activity. Statistical data presented in the point out to the high risk of road accidents. Also causes of unsatisfactory level of the road safety improvement in Poland were presented.
Abstract. European transport policy for the first half the 21st century assumes creating the transport system organised with the respect of the principle of sustainable development, providing economic, social and ecological needs of the society and supporting construction of the integrated society and entirely integrated and competitive Europe. Applying alternative fuels and drives in public transport vehicles, including the development of electric-powered vehicles is an essential instrument of this policy. In the paper fuels applied in the public transport and alternative drives were described. Methodological establishments of evaluation of the investment's financial and economical effectiveness associated with acquiring public means of transport with the alternative drive were discussed. Using the method of the econometric modelling, operational and maintenance costs of use buses with the conventional and alternative drive were described. They constitute the basis of assessment of the financial effectiveness of replacing conventional vehicles with alternative propulsion vehicles. They pointed to benefits resulting from limiting the influence of public transport using alternative propulsion vehicles on the natural environment. They find expression in decreasing transport's external expenses, confirming the economic effectiveness of their application. A special attention was paid on vehicles with the electric propulsion. Their application in the urban transport is a crucial factor of improvement of the air quality in cities. Based on conducted examinations it was pointed at the purpose of applying means of transport with the alternative drive.
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