British Hospital

About: British Hospital is a healthcare organization based out in Montevideo, Uruguay. It is known for research contribution in the topics: Population & Lung cancer. The organization has 445 authors who have published 358 publications receiving 7878 citations. The organization is also known as: British Hospital.

Systematic and Specific Treatment of Patients with Enteroatmospheric Fistulas: From Initial Conservative Treatment to Definitive Surgery.

Abstract: INTRODUCTION The open abdomen is a widespread therapeutic resource; however, it is also a source of complications, of which the enteroatmospheric fistulas (EAFs) pose one of the greatest problems. The objective of this study was to describe the implemented strategy for handling enteroatmospheric fistulas, and secondarily, to analyze the differential results based on a change in the conservative local treatment specifically designed for the stated complication. MATERIALS AND METHODS From March 2002 to March 2014, patients treated for EAF were retrospectively analyzed. They were divided into 2 groups: Group 1 (G1: 2002 - 2007), treated with an occlusive vacuum device (SIVACO), similar to that used for other enterocutaneous fistulas, and Group 2 (G2: 2008 - 2014), covered in a specific modality for EAF. Results of conservative and surgical treatment were described and then the two groups were statistically compared. RESULTS Study participants comprised 62 patients. Twelve cases (19.4%) healed with conservative treatment. This was statistically related with a baseline albumin level >3 g/dL, single lesions with no visible mucosa and baseline output <700 mL/d. In G1, the output fall was higher, while G2 required fewer wound dressing changes and enteral nutrition was feasible in a significantly higher number of patients. Forty-seven patients underwent reconstructive surgery. The mortality-associated variables were preoperative hypoalbuminemia and 2 or more anastomoses. Overall mortality was 8% (5 patients). In the multivariate model, only initial output (<700 mL/d) was an independent predictor for spontaneous closure, whereas 2 or more anastomoses and hypoalbuminemia were negative independent predictors. CONCLUSION Systematic management of enteroatmospheric fistulas, following a rigorous protocol and a two-step specific treatment, resulted in a practical approach and yielded good results in healing and mortality.

Commentary: The Ideal Carotid Stent? Time Will Tell:

Abstract: In this issue of the JEVT, Schönholz et al. describe the first implantation of a stent that has been eagerly awaited by interventionists for a long time. We were all aware that we needed an adaptable, flexible closed-cell stent for our carotid cases. This new stent from W. L. Gore is applicable in tortuous anatomy and overall in patients with soft plaques, which produce more particles and also potentially protrude through the interstices of stents. I believe that this is a big step forward for carotid stent users. I have no question that I would select this stent for many of my patients. Currently, I am using the carotid Wallstent, which has the smallest interstices of all the stents on the market. My results are remarkably good, and I do not see transient ischemic attacks or stroke after the procedure. Using transcranial Doppler (TCD) monitoring, particles detected in the middle cerebral artery after the procedure are almost nonexistent. The problem with the Wallstent is its rigidity. When applied in internal carotid arteries with tortuosity, it translates the curves cephalad to the distal end of the stent, potentially producing kinks. It is obvious that we need to follow these patients with Gore’s new design for a long time to see tissue reaction and the incidence of restenosis. What surprises me is that Gore & Associates elected to use filters instead their superb flow reversal device. It is common knowledge that filters produce more strokes, more high-intensity transient signals (HITS), and more new lesions seen on diffusion-weighted magnetic resonance imaging than flow reversal. The presence of mural thrombus in the lumen of a carotid stenosis was 24% in our study of .300 endarterectomy specimens (Figure), and in the study done in Stanford, the figure was almost to 50%. According to our experience using TCD, routinely crossing lesions with filters is not desirable. We have enough information about these findings and even the CREST II trial decided to include flow reversal as a subgroup of carotid artery stenting (CAS).

The Diagnosis and Treatment of Lower Urinary Tract Symptoms Due to Benign Prostatic Hyperplasia by Primary Care Family Physicians in Portugal

Abstract: Background The shift towards primarily pharmacological management of lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH) has led to an increasing proportion of patients being treated in the primary care setting