Annali italiani di chirurgia
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Comparative Study Observational Study
Does the status of surgical resident compared to that of consultant have an impact on patient's satisfaction over the informed consent process?
The informed consent process is a fundamental element of best practice in the surgical patient's care. The aim of the present study is to investigate the value of informed consent from the patient's perspective in a Teaching Hospital. In particular, the role of the Residents within this process is analyzed to compare their performance with that of Consultants. ⋯ Educational program, Informed consent, Informed consent process, Patient's satisfaction, Resident.
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The aim of the study was to investigate the effect of neutrophil lymphocyte (NLR) and platelet lymphocyte ratio (PLR) on prognosis in acute ischemic stroke (AIS) patients undergoing mechanical thrombectomy. ⋯ Ischemia, Mechanical thrombectomy, Neutrophil lymphocyte ratio, Platelet lymphocyte ratio, Stroke.
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Neoadjuvant chemotherapy is being used with increasing frequency in the multidisciplinary treatment of patients with operable breast cancer. Although large clinical trials have shown no differences between the same systemic therapy given pre- or post-surgery on diseasefree and overall survival, neoadjuvant therapy may have several advantages. By downstaging of the tumor, chemotherapy can convert patients who are candidates for mastectomy to breast-conserving surgery candidates. ⋯ To optimize the oncological and aesthetic results and minimize local recurrence rates, there are essential procedures to be respected as: - Careful local and systemic staging before chemotherapy (Ultrasonography, Mammography, Magnetic Resonance and PET- TAC); - Use of the technique of breast tattooing as practical method to delimit the initial tumor size and its margins before chemotherapy; - Placement of clips before chemotherapy to mark the primary tumor site and metastatic lymph nodes; - Accurate clinical restaging of the disease performed at the completion of chemotherapy; - Adequate radiological preoperative study with localization of residual tumor and/or calcifications and/or clips especially after a good response to neoadjuvant chemotherapy; - Use of innovative oncoplastic techniques that gives more options to have wide resections without compromising the cosmetic outcome; - Intraoperative radiological and pathological evaluation of the specimen, for the definition of the lesion and the margins of resection; - Accurate pathological management and assessment of the specimen using histological large sections (macrosections). In conclusion, sufficient evidence is now available to suggest that breast conservation after neoadjuvant chemotherapy is safe and effective for selected patients. Though neoadjuvant chemotherapy may increase the complexity of breast conservative treatment, a close collaboration between a multidisciplinary team and use of oncoplastic surgical techiques permit to optimize oncological and cosmetis outcomes.
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Nausea and vomiting are among the most frequent complications following anesthesia and surgery. Due to anesthesia seems to be primarily responsible for post operative nausea and vomiting (PONV) in Day Surgery facilities, the aim of the study is to evaluate how different methods of anesthesia could modify the onset of postoperative nausea and vomiting in a population of patients undergoing inguinal hernia repair. ⋯ Compared to Remifentanil, Fentanyl has a major influence in causing PONV. Nonetheless, an appropriate antiemetic prophylaxis can significantly reduce this undesirable complication. Key words: Day Surgery, Fentanyl, Inguinal, Hernia repair, Nausea, Vomiting.
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Controlled Clinical Trial
Controlled hypotension during middle ear surgery: hemodynamic effects of remifentanil vs nitroglycerin.
Controlled hypotension is a well-known technique used by anesthesiologists to limit intraoperative bleeding in patients undergoing middle ear surgery and improve visibility of the surgical field. Nitroglycerin and remifentanil are among the drugs used to induce controlled hypotension.The aim of our study was to compare the hemodynamic effects of remifentanil and nitroglycerin in this patient population. ⋯ Controlled hypotension, Middle ear surgery, Nitroglycerin, Remifentanil.