scholarly journals Surgery for acute mediastinitis in oesophageal perforations and descending necrotising infection: complications, mortality and protective factors

2011 ◽  
Vol 1 (1) ◽  
pp. 15
Author(s):  
Jon Zabaleta ◽  
Borja Aguinagalde ◽  
Marta G Fuentes ◽  
Nerea Bazterargui ◽  
Stephany M. Laguna ◽  
...  
Keyword(s):  
Protective Factors ◽  
Oesophageal Perforation ◽  
Surgical Interventions ◽  
Common Causes ◽  
Early Tracheotomy ◽  
Life Threatening ◽  
Threatening Situation ◽  
Acute Necrotising ◽  
Overall Mortality ◽  
Acute Mediastinitis

Acute mediastinitis is a life-threatening situation that is associated with high rates of morbidity and mortality. The most common causes of mediastinitis are: oesophageal perforation, acute necrotising mediastinitis (ANM) and post-sternotomy mediastinitis. The aim of this study was to analyze prognostic factors and the differences between mediastinitis from various origins. A retrospective analysis was carried out on all patients operated on for acute mediastinitis between 2000 and 2009. Surgical interventions were performed on 33 patients (69.7% male), the majority as a consequence of oesophageal perforation (21 cases). The overall mortality rate was 30%. Better survival was seen in subjects less than 60 years of age, subjects with no comorbidities, and subjects who had undergone early tracheotomy. Patients with ANM were younger, had less comorbidities, diagnosed later and required more repeat interventions compared to those patients who had mediastinitis caused by oesophageal perforations. Mortality was lower in the ANM group, but this was not statistically significant. Protective factors in mediastinitis are: early diagnostic and treatment, age under 60 years, absence of major comorbidity and early tracheotomy.

Gendered Impact of Corruption in Healthcare Service Delivery in Nigeria

2013 ◽  
Vol 11 (1) ◽  
Author(s):  
Yetunde A. Aluko
Keyword(s):  
Service Delivery ◽  
Public Hospitals ◽  
Public Health Care ◽  
Women's Voices ◽  
Medical Supplies ◽  
Poor Women ◽  
Level Information ◽  
Life Threatening ◽  
Threatening Situation ◽  
The Impact

This paper supports the hypothesis that corruption and non-delivery of services in key sectors such as health have gender-specific poverty consequences. The study utilized qualitative micro-level information about the structures of corruption and its impact on poor women. Respondents expressed their perceptions on the occurrence of corrupt practices in public health care system and its wider impact on society. The findings revealed that the impact of corruption is felt disproportionately by women and the poor, who are most dependent on public services, and have no alternative even when facing corrupt practices in a life threatening situation, such as complicated birth delivery. Pregnant women denied access to doctors tended to deliver at home, which increased the likelihood of complications and maternal and child mortality. Medical supplies meant for public hospitals are sold to private clinics who charge more for drugs and supplies. There is need to strengthen sectoral oversight mechanisms and transparency as well as increase women’s voices in service delivery.

OPERATIONS FOR ANEURISM OF THE ABDOMINAL AORTIC DEPARTMENT - RESECTION WITH THE FOLLOWING PROSTHETICS AND ENDOPROSTHETICS: A COMPARATIVE ANALYSIS OF COMPLICATIONS

2020 ◽  
pp. 43-49
Author(s):  
Андрей Анатольевич Иванов ◽  
Александр Иванович Жданов ◽  
Максим Сергеевич Шевелин ◽  
Александр Сергеевич Брежнев
Keyword(s):  
Comparative Analysis ◽  
Postoperative Complications ◽  
Statistical Significance ◽  
Aortic Aneurysms ◽  
Surgical Interventions ◽  
Vein Thrombosis ◽  
Scientific Hypothesis ◽  
Abdominal Aortic ◽  
Life Threatening ◽  
High Level

В статье представлены данные оригинального исследования по улучшению хирургического лечения аневризм брюшного отдела аорты. С этой целью произведен сравнительный анализ двух альтернативных друг другу операций: 1) резекции аневризмы с последующим протезированием аорты; 2) эндопротезирования аорты. Сформулировано научное предположение о том, что замена «классических» операций резекции аневризмы на «альтернативные» операции эндопротезирования приведет к принципиальному снижению уровня послеоперационных осложнений. В независимых группах пациентов с использованием сравниваемых хирургических вмешательств произведена точная качественная и количественная оценка послеоперационных осложнений: нетромботических - кардиальных, пульмональных, ренальных и тромботических - тромбозов глубоких вен и тромбозов браншей протеза. После реализации исследования было установлено, что замена «классических» операций на «альтернативные» достоверно приводит к принципиальному снижению уровня наиболее жизнеопасных осложнений - кардиальных (острых форм ишемической болезни сердца, нарушений сердечного ритма), пульмональных (пневмоний, тромбоэмболии легочной артерии, респираторного дистресс-синдрома взрослых) и ренальных (острой почечной недостаточности). Некоторое исключение составили менее жизнеопасные тромботические осложнения. Полученные результаты имеют высокий уровень статистической значимости, что позволяет рекомендовать их к рассмотрению к использованию в практике сосудистой хирургии The article presents data from an original study to improve the surgical treatment of abdominal aortic aneurysms. For this purpose, a comparative analysis of two alternate operations was performed: 1) aneurysm resection followed by aortic prosthetics; 2) aortic endoprosthetics. The scientific hypothesis is formulated that the replacement of the «classical» operations of resection of the aneurysm with «alternative» operations of endoprosthetics will lead to a fundamental decrease in the level of postoperative complications. In independent groups of patients using the compared surgical interventions, an accurate qualitative and quantitative assessment of postoperative complications was made: non-thrombotic - cardiac, pulmonary, renal and thrombotic - deep vein thrombosis and prosthetic jaw thrombosis. After the study was completed, it was found that the fundamental replacement of «classical» operations with «alternative» reliably leads to a fundamental decrease in the level of the most life-threatening complications - cardiac (acute forms of coronary heart disease, cardiac arrhythmias), pulmonary (pneumonia, pulmonary thromboembolism, respiratory distress syndrome of adults) and renal (acute renal failure). Some exceptions were less life-threatening thrombotic complications. The results obtained have a high level of statistical significance, which allows us to recommend them for consideration in the practice of vascular surgery

Telemedicine-guided point-of-care ultrasound can be feasible and effective in a life-threatening situation: The case of a field hospital during the COVID-19 pandemic (Preprint)

2020 ◽  
Author(s):  
Tarso Accorsi ◽  
Karine De Amicis Lima ◽  
Alexandra Brigido ◽  
Deborah Belfort ◽  
Fabio Habrum ◽  
...  
Keyword(s):  
Point Of Care ◽  
Image Interpretation ◽  
Acquisition Time ◽  
Point Of Care Ultrasound ◽  
Field Hospital ◽  
Portable Ultrasound ◽  
Local Staff ◽  
Assessment Protocol ◽  
Life Threatening ◽  
Threatening Situation

BACKGROUND Lightweight portable ultrasound is widely available, especially in inaccessible geographical areas. It demonstrates effectiveness and diagnosis improvement even in field conditions but no precise information about protocols, acquisition time, image interpretation, and the relevance in changing medical conduct exists. The COVID-19 pandemic implied many severe cases and the rapid construction of field hospitals with massive general practitioner (GP) recruitment. OBJECTIVE This prospective and descriptive study aimed to evaluate the feasibility of telemedicine guidance using a standardized multi-organ sonographic assessment protocol in untrained GPs during a COVID-19 emergency in a field hospital. METHODS Eleven COVID-19 in-patients presenting life-threatening complications, attended by local staff who spontaneously requested on-time teleconsultation, were enrolled. All untrained doctors successfully positioned the transducer and obtained key images guided by a remote doctor via telemedicine, with remote interpretation of the findings. RESULTS Only four (36%) general practitioners obtained the appropriate key heart image on the left parasternal long axis window, and three (27%) had an image interpreted remotely on-time. The evaluation time ranged from seven to 42 minutes, with a mean of 22.7 + 12. CONCLUSIONS Telemedicine is effective in guiding GPs to perform portable ultrasound in life-threatening situations, showing effectiveness in conducting decisions.

scholarly journals Surgical Interventions in Patients Hospitalised with COVID-19. A Review of Seven Months of Experience Working in a COVID-19 Dedicated Centre

2021 ◽  
Vol 10 (3) ◽  
pp. 395
Author(s):  
Justyna Rymarowicz ◽  
Michał Pędziwiatr ◽  
Piotr Major ◽  
Bryan Donohue ◽  
Karol Ciszek ◽  
...  
Keyword(s):  
Emergency Surgery ◽  
Surgical Procedure ◽  
Surgical Care ◽  
Major Surgery ◽  
Surgical Specialty ◽  
Surgical Interventions ◽  
Face To Face ◽  
Overall Mortality

The Coronavirus Disease 2019 (COVID-19) pandemic has made changes to the traditional way of performing surgical consultations. The aim of the present study was to assess the need for surgical care performed by various surgical specialties among patients infected with COVID-19 hospitalized in a COVID-19 dedicated hospital. All surgical consultations performed for patients infected with COVID-19 in a COVID dedicated hospital in a seven month period were evaluated. Data on demographics, surgical specialty, consult reason, procedure performed, and whether it was a standard face to face or teleconsultation were gathered. Out of 2359 COVID-19 patients admitted to the hospital in the seven month period, 229 (9.7%) required surgical care. Out of those 108 consultations that did not lead to surgery, 71% were managed by telemedicine. A total of 36 patients were operated on while suffering from COVID-19. Out of them, only three patients admitted primarily for COVID-19 pneumonia underwent emergency surgery. The overall mortality among those operated on was 16.7%. Conclusions: Patients hospitalised with COVID-19 may require surgical care from various surgical specialties, especially during peaks of the pandemic. However, they rarely require a surgical procedure and only occasionally require major surgery. A significant portion of potentially surgical problems could be managed by teleconsultations.

scholarly journals Development of a Vaccine against Human Cytomegalovirus: Advances, Barriers, and Implications for the Clinical Practice

Vaccines ◽  
2021 ◽  
Vol 9 (6) ◽  
pp. 551
Author(s):  
Sara Scarpini ◽  
Francesca Morigi ◽  
Ludovica Betti ◽  
Arianna Dondi ◽  
Carlotta Biagi ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Human Cytomegalovirus ◽  
Congenital Infection ◽  
Health Concern ◽  
Live Vaccines ◽  
Target Populations ◽  
Immune Correlates ◽  
Common Causes ◽  
The Status ◽  
Life Threatening

Human cytomegalovirus (hCMV) is one of the most common causes of congenital infection in the post-rubella era, representing a major public health concern. Although most cases are asymptomatic in the neonatal period, congenital CMV (cCMV) disease can result in permanent impairment of cognitive development and represents the leading cause of non-genetic sensorineural hearing loss. Moreover, even if hCMV mostly causes asymptomatic or pauci-symptomatic infections in immunocompetent hosts, it may lead to severe and life-threatening disease in immunocompromised patients. Since immunity reduces the severity of disease, in the last years, the development of an effective and safe hCMV vaccine has been of great interest to pharmacologic researchers. Both hCMV live vaccines—e.g., live-attenuated, chimeric, viral-based—and non-living ones—subunit, RNA-based, virus-like particles, plasmid-based DNA—have been investigated. Encouraging data are emerging from clinical trials, but a hCMV vaccine has not been licensed yet. Major difficulties in the development of a satisfactory vaccine include hCMV’s capacity to evade the immune response, unclear immune correlates for protection, low number of available animal models, and insufficient general awareness. Moreover, there is a need to determine which may be the best target populations for vaccine administration. The aim of the present paper is to examine the status of hCMV vaccines undergoing clinical trials and understand barriers limiting their development.

Surgical resection of locally recurrent cervical cancer: a single institutional 70 patient series

2004 ◽  
Vol 14 (5) ◽  
pp. 846-851 ◽  
Author(s):  
V. Moutardier ◽  
G. Houvenaeghel ◽  
M. Martino ◽  
B. Lelong ◽  
V. J. Bardou ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Local Control ◽  
Cancer Recurrence ◽  
Palliative Surgery ◽  
Morbidity Rate ◽  
Actuarial Survival ◽  
Recurrent Cervical Cancer ◽  
Actuarial Survival Rate ◽  
Life Threatening ◽  
Threatening Situation

Pelvic recurrence of cervical cancer is a life-threatening situation and only local control can provide hope for remission. The aim of this study was to evaluate the role of surgery in the treatment of cervical cancer recurrence. This retrospective study analyzed a series of 70 patients who underwent resection of cervix locoregional recurrence. Thirteen patients had palliative salvage surgery for pelvic complications. Twenty-nine resections were considered as curative. Fifty recurrences required pelvic exenterations. The hospital mortality rate was 9% and the morbidity rate was 44%. Overall 5-year actuarial survival rate was 23%. Survival was significantly higher: (a) after curative resection and (b) after centropelvic recurrence resection. Local control was obtained in 48% of the cases and 13 patients are alive with a median follow-up of 75 months. In conclusion, the results of this small and heterogen series seem to justify an attempt to resection for centropelvic recurrences whenever possible. Palliative surgery should be reserved to salvage therapy and highly selected patients.

Ventricular Arrhythmias in Long Term LVAD Patients - Life Threatening Situation or Nothing to Worry About?

2017 ◽  
Vol 36 (4) ◽  
pp. S432 ◽  
Author(s):  
J.G. Jungschleger ◽  
M.M. Mydin ◽  
A. Woods ◽  
M. Urban ◽  
N. Robinson ◽  
...  
Keyword(s):  
Ventricular Arrhythmias ◽  
Life Threatening ◽  
Threatening Situation

Excused Necessity in Western Legal Philosophy

2006 ◽  
Vol 19 (1) ◽  
pp. 31-65 ◽  
Author(s):  
Khalid Ghanayim
Keyword(s):  
Criminal Law ◽  
Legal Philosophy ◽  
Life Threatening ◽  
Threatening Situation ◽  
High Seas

Should a person in a life-threatening situation have a defence when he saves his life by causing death to a person who was not involved in creating the life-threatening situation? Viz., does the perpetrator have an excused necessity defence that negates imposing the punishment? This issue - excused necessity defence - has fascinated the legal world since antiquity and has been described as one of the most complicated issues in criminal law. The well-known case is the “plank of Carneades” or “two men and the plank”. Two men, A and B, are shipwrecked on the high seas; as their strength ebbs and they are about to drown, they see a wooden plank that is just large enough to support only one of them. A reaches the plank first and grabs it, but B, faced with the prospect of certain death, pushes A off the plank, resulting in the death of A by drowning. B then grabs the plank and manages to save his own life. Should B have a defence if he is prosecuted for pushing A off the plank in these circumstances?

scholarly journals Endoscopic follow-up of cyanoacrylate obliteration of gastric varices

2009 ◽  
Vol 46 (1) ◽  
pp. 81-84 ◽  
Author(s):  
Fernanda Prata Martins ◽  
Erika Pereira de Macedo ◽  
Gustavo Andrade de Paulo ◽  
Frank Shigueo Nakao ◽  
José Celso Ardengh ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Portal Hypertension ◽  
Gastric Varices ◽  
Study Endpoint ◽  
Mild Abdominal Pain ◽  
Threatening Condition ◽  
Life Threatening ◽  
Related Mortality ◽  
Overall Mortality

Bleeding from gastric varices is a life-threatening condition. We report our experience with cyanoacrylate injection. Twenty three patients with portal hypertension and gastric varices underwent intra-variceal injection of a cyanoacrylate/lipiodol solution (1:1). Study endpoint was variceal obliteration. Mean follow-up was 25.3 months. Variceal obliteration was achieved in 87% of patients. Recurrence occurred in one patient (4.3%) and rebleeding in another case (4.3%). Mild abdominal pain was described in 13% of patients. Overall mortality was 21.7% and rebleeding related mortality rate was 4.3%. Our results confirm that cyanoacrylate injection is effective and safe to eradicate gastric varices.

scholarly journals God help us: Spirituality and religiosity amid corona pandemic in Pakistan

2021 ◽  
Vol 5 (2) ◽  
pp. 43-60
Author(s):  
Kausar Ali ◽  
Huang Minxing
Keyword(s):  
Qualitative Analysis ◽  
Religious Coping ◽  
Coping Strategy ◽  
The State ◽  
Research Articles ◽  
Religious People ◽  
Secondary Sources ◽  
The People ◽  
Life Threatening ◽  
Threatening Situation

This research discusses the response of the religious people to the corona pandemic in Pakistan. The study aims to answer why the Islamists refused to cooperate with the state authorities in its struggle against the pandemic? This study is based on the theory of existential security which states that natural calamities and disasters always increase religiosity in the people. This study is based on analysing all the existing primary and secondary sources in the form of books, research articles and government reports. The discussion in this paper is based on the qualitative analysis of all the existing sources. This study has argued that the Islamists refused to support the state policymakers because they firmly believed that the virus emerged because of Allah’s wrath. The study has also found that the response of the Tablighi Jamaat (henceforth TJ), other religious organisations, and clerics amid the coronavirus in the country was indeed a religious coping strategy. This strategy is commonly used by people whenever they face a life-threatening situation. The study suggests that Pakistan could not resist the Islamists because resisting them could cause severe problems in the country.

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