Teresa Schreckenbach

Posthepatectomy liver failure.

Background: Posthepatectomy liver failure (PHLF) is one of the most serious complications after liver resection and is still reported in up to 8% after liver resection. Aims: To provide an overview about the current status of risk analysis and definition of PHLF. Prevention and treatment is also discussed. Methods: A literature review was carried out on PubMed using the terms ‘liver failure’, ‘posthepatectomy’ and ‘liver surgery’ to search relevant papers. Discussion: PHLF remains a serious problem in patients undergoing major liver resection. Adequate preoperative risk assessment and an optimal postoperative treatment are essential for PHLF prevention.

Education in thyroid surgery: a matched-pair analysis comparing residents and board-certified surgeons

PurposeResident participation in operative procedures is mandatory in educational residency programs but remains controversial, especially in the context of patient safety. This study compared the surgical quality and outcomes of thyroidectomies performed by surgical residents (RESs) and board-certified surgeons (BCSs).MethodsThis retrospective matched-pair study included patients undergoing thyroidectomies for multinodular goiter, Grave’s disease and early-stage thyroid cancer that were performed by a RES with BCS supervision between 2006 and 2014. The intraoperative and postoperative course, complication rates and handling of the recurrent laryngeal nerve (RLN) and parathyroid glands were analyzed.ResultsIn total, 112 thyroidectomies that were performed by a RES fulfilled the inclusion criteria and were matched 1:1 with BCS patients. We included 88 hemithyroidectomies, 80 subtotal thyroidectomies and 56 total thyroidectomies. No significant differences in the handling of the RLN or parathyroid glands, the rates of postoperative RLN palsies or the rates of hypocalcaemia were found. No intraoperative complications led to the replacement of the RES as the surgeon-in-charge. Three RES and two BCS patients experienced postoperative haemorrhages (p = 0.205), and three surgical site infections (p = 1.000) occurred in each group. The mean operative time and the length of stay did not differ significantly between the two groups.ConclusionsMajor aspects of patient safety in thyroid surgery are not affected by resident participation. Thyroidectomies performed by RES are not significantly longer and reveal no differences in length of stay or complication rates. The economic burden of resident involvement is modest.

Rare cause of acute liver failure

ZusammenfassungEine sehr seltene Ursache des akuten Leberversagens ist der adulte Morbus Still, eine systemische rheumatische Erkrankung. Wir berichten von einer 24-jährigen Frau mit unklarem akutem Leberversagen. Aufgrund des fulminanten Verlaufs wurde eine Lebertransplantation erforderlich. Die Diagnose des Morbus Still konnte unter Berücksichtigung der Yamaguchi-Kriterien mit Arthralgien, Fieber, Halsschmerzen, Hauterscheinungen und Hepatosplenomegalie gestellt werden. Die frühzeitige Diagnose und Therapie eines Morbus Still kann die Entwicklung eines akuten Leberversagens mit hoher Letalität verhindern.AbstractA rare cause of acute liver failure is adult onset Still’s disease (AOSD), a systemic inflammatory disorder. We present the case of a 24-year-old woman who presented with acute liver failure necessitating high urgency liver transplantation. The diagnosis of AOSD was established in accordance with the Yamaguchi classification criteria, including arthralgia, fever, sore throat, rash and hepatosplenomegaly. The early detection and therapy of AOSD can possibly avoid the development of liver failure with a poor prognosis.A rare cause of acute liver failure is adult onset Stills disease (AOSD), a systemic inflammatory disorder. We present the case of a 24-year-old woman who presented with acute liver failure necessitating high urgency liver transplantation. The diagnosis of AOSD was established in accordance with the Yamaguchi classification criteria, including arthralgia, fever, sore throat, rash and hepatosplenomegaly. The early detection and therapy of AOSD can possibly avoid the development of liver failure with a poor prognosis.

Identification of factors predictive of postoperative morbidity and short-term mortality in older patients after colorectal carcinoma resection: A single-center retrospective study

OBJECTIVES The aim of this study is to investigate the effect of age on patient outcome after colorectal carcinoma (CRC) resection in patients over 65 years of age. METHODS This study included patients aged 65 years and older who underwent CRC resection between 2003 and 2013 at a single-center institution. Patients were divided into two groups: Group A (65-74 years old) and Group B (≥75 years old). RESULTS Multivariable logistic analysis of 415 patients revealed serum albumin levels on the third postoperative day (POD) (Odds Ratio (OR), 0.44; 95% CI, 0.21-0.94; P = 0.03) and C-reactive protein (CRP) levels (OR, 1.05; 95% CI, 1.00-1.01; P = 0.04) in patients with colon cancer as predictive factors for morbidity. In addition, the multivariable logistic analysis revealed serum albumin levels (OR, 0.27; 95% CI, 0.08-0.87; P = 0.03) in patients with rectal cancer as predictive factors for morbidity. The multivariate Cox Proportional Hazards Model identified re-intervention for colon cancer (Hazard Ratio (HR), 4.57; 95% CI, 1.36-15.4 P = 0.01) and for rectal cancer (HR, 11.8; 95% CI, 1.08-129 P = 0.04) as a predictive factor for 30-day mortality. Serum albumin level on the third POD was predictive of 30-day mortality (HR, 0.30; 95% CI, 0.13-0.71; P = 0.01) and of 1-year mortality (HR, 0.34; 95% CI, 0.17-0.66; P < 0.01) in patients with colon cancer. CONCLUSION Age is not predictive of postoperative morbidity and mortality in patients with CRC. Serum albumin levels on the third POD can predict morbidity and mortality for colon and rectal carcinoma in older patients undergoing colorectal resections.

Emotion recognition and extraversion of medical students interact to predict their empathic communication perceived by simulated patients.

BackgroundThis study assessed the impact of medical students’ emotion recognition ability and extraversion on their empathic communication, as perceived by simulated patients in a training context.MethodsThis study used a crossed-effect data structure and examined 245 students in their fourth year of medical school. The students’ personality traits were assessed based on a self-assessment questionnaire of the short form of the Big Five Inventory; their emotion recognition ability was measured using a performance test (Diagnostic Analysis of Nonverbal Accuracy-2, Adult Facial Expressions). Simulated patients evaluated the medical students’ empathic communication.ResultsStudents with a combination of high emotion recognition ability and extraversion received more positive ratings from simulated patients than their fellow students with a combination of emotion recognition ability and low extraversion. The main effects of emotion recognition or extraversion were not sufficient to yield similar effects. There were no other effects related to the remaining Big Five variables.ConclusionsThe results support the hypothesis that to build rapport with patients, medical staff need to combine emotional capabilities with a dispositional interest in interpersonal encounters.

Seltene Ursache eines akuten Leberversagens@@@Rare cause of acute liver failure

ZusammenfassungEine sehr seltene Ursache des akuten Leberversagens ist der adulte Morbus Still, eine systemische rheumatische Erkrankung. Wir berichten von einer 24-jährigen Frau mit unklarem akutem Leberversagen. Aufgrund des fulminanten Verlaufs wurde eine Lebertransplantation erforderlich. Die Diagnose des Morbus Still konnte unter Berücksichtigung der Yamaguchi-Kriterien mit Arthralgien, Fieber, Halsschmerzen, Hauterscheinungen und Hepatosplenomegalie gestellt werden. Die frühzeitige Diagnose und Therapie eines Morbus Still kann die Entwicklung eines akuten Leberversagens mit hoher Letalität verhindern.AbstractA rare cause of acute liver failure is adult onset Still’s disease (AOSD), a systemic inflammatory disorder. We present the case of a 24-year-old woman who presented with acute liver failure necessitating high urgency liver transplantation. The diagnosis of AOSD was established in accordance with the Yamaguchi classification criteria, including arthralgia, fever, sore throat, rash and hepatosplenomegaly. The early detection and therapy of AOSD can possibly avoid the development of liver failure with a poor prognosis.A rare cause of acute liver failure is adult onset Stills disease (AOSD), a systemic inflammatory disorder. We present the case of a 24-year-old woman who presented with acute liver failure necessitating high urgency liver transplantation. The diagnosis of AOSD was established in accordance with the Yamaguchi classification criteria, including arthralgia, fever, sore throat, rash and hepatosplenomegaly. The early detection and therapy of AOSD can possibly avoid the development of liver failure with a poor prognosis.

Seltene Ursache eines akuten Leberversagens

ZusammenfassungEine sehr seltene Ursache des akuten Leberversagens ist der adulte Morbus Still, eine systemische rheumatische Erkrankung. Wir berichten von einer 24-jährigen Frau mit unklarem akutem Leberversagen. Aufgrund des fulminanten Verlaufs wurde eine Lebertransplantation erforderlich. Die Diagnose des Morbus Still konnte unter Berücksichtigung der Yamaguchi-Kriterien mit Arthralgien, Fieber, Halsschmerzen, Hauterscheinungen und Hepatosplenomegalie gestellt werden. Die frühzeitige Diagnose und Therapie eines Morbus Still kann die Entwicklung eines akuten Leberversagens mit hoher Letalität verhindern.AbstractA rare cause of acute liver failure is adult onset Still’s disease (AOSD), a systemic inflammatory disorder. We present the case of a 24-year-old woman who presented with acute liver failure necessitating high urgency liver transplantation. The diagnosis of AOSD was established in accordance with the Yamaguchi classification criteria, including arthralgia, fever, sore throat, rash and hepatosplenomegaly. The early detection and therapy of AOSD can possibly avoid the development of liver failure with a poor prognosis.A rare cause of acute liver failure is adult onset Stills disease (AOSD), a systemic inflammatory disorder. We present the case of a 24-year-old woman who presented with acute liver failure necessitating high urgency liver transplantation. The diagnosis of AOSD was established in accordance with the Yamaguchi classification criteria, including arthralgia, fever, sore throat, rash and hepatosplenomegaly. The early detection and therapy of AOSD can possibly avoid the development of liver failure with a poor prognosis.