ABSTRACT
Fungal infections are generally observed in immunosuppressed patients only, with a diagnostic challenge due to non-specific symptoms. For this reason, appropriate management may be delayed. This case report concerns a 36-year-old man with history of pancreas and kidney transplantation. He had chemotherapy for post-transplant B-cell lymphoma and presented with left upper abdominal pain and fever. Multiple investigations led to a final diagnosis of disseminated abdominal mucormycosis with multiple Rhizomucor abscesses in the liver, spleen and kidney transplant. Treatment was antifungal therapy and laparotomy with splenectomy, wedge resection of two fungal abscesses in segments II and IVb, and segmental left colic resection.
Subject(s)
Abdominal Abscess/diagnosis , Kidney Transplantation , Mucormycosis/diagnosis , Pancreas Transplantation , Postoperative Complications/diagnosis , Rhizomucor/isolation & purification , Abdominal Abscess/etiology , Abdominal Abscess/surgery , Adult , Hepatectomy , Humans , Liver Diseases/diagnosis , Liver Diseases/etiology , Liver Diseases/surgery , Male , Mucormycosis/etiology , Mucormycosis/surgery , Postoperative Complications/surgery , Splenectomy , Splenic Diseases/diagnosis , Splenic Diseases/etiology , Splenic Diseases/surgeryABSTRACT
BACKGROUND: The death of a patient is experienced at some time by most surgeons. The aim of this review was to use existing literature to establish how surgeons have dealt with the death of patients. METHODS: A systematic review of the medical literature was performed. MEDLINE/PubMed, Ovid, Web of Science, Embase, and Google Scholar were searched for qualitative and quantitative studies on surgeon reactions when facing death or a dying patient. This systematic review was performed following the recommendations of the Cochrane collaboration and reported following the PRISMA guidelines. Individual and interview-based opinions were summarized and synthesized. RESULTS: An initial search found 652 articles. After exclusion of articles that did not satisfy the inclusion criteria, 20 articles remained and seven were included. Two of these articles were personal opinion of the author and five were interviews or surveys. The main findings were that facing death routinely induces a strong psychological burden and that surgeons are more at risk than the general population to develop psychological morbidity. CONCLUSION: Although it is a frequent and emotional subject in the surgical world, the impact of patient death on surgeons is not abundantly studied in the literature. Dealing with patient death or taking care of a dying patient might have long-lasting psychological impact on surgeons.
ANTECEDENTES: La mayoría de los cirujanos sufren en algún momento la muerte de un paciente. El objetivo de esta revisión fue analizar la literatura disponible para determinar cómo los cirujanos afrontan la muerte de los pacientes. MÉTODOS: Se realizó una revisión sistemática de la literatura médica. Se llevó a cabo una búsqueda en las bases de datos MEDLINE/PubMed, Ovid, Web of Science, Embase y Google Scholar de estudios cualitativos y cuantitativos de las reacciones de los cirujanos cuando se enfrentan con la muerte o frente a un paciente que se está muriendo. Se siguieron las recomendaciones de la colaboración Cochrane para efectuar la revisión y los resultados se presentan de acuerdo con las directrices PRISMA. Se resumieron y sintetizaron las opiniones individuales y las basadas en entrevistas. RESULTADOS: En la búsqueda inicial se identificaron 652 artículos. Después de excluir los artículos que no cumplían los criterios de inclusión, la muestra se redujo a 20 artículos, 7 de los cuales fueron finalmente incluidos. De ellos, 2 artículos eran la opinión personal del autor y 5 eran entrevistas o encuestas. Los hallazgos principales fueron que enfrentarse a la muerte en la práctica rutinaria supone una carga psicológica importante y que los cirujanos tienen un mayor riesgo de morbilidad psicológica que la población general. CONCLUSIÓN: El impacto de la muerte en los cirujanos no es un tema ampliamente tratado en la literatura, a pesar de que se trata de un problema frecuente y emocional en el mundo quirúrgico. Afrontar la muerte de un paciente o cuidar a un paciente que se está muriendo podría tener un impacto psicológico duradero en los cirujanos.
Subject(s)
Attitude of Health Personnel , Attitude to Death , Physician-Patient Relations , Surgeons/psychology , Humans , Occupational Stress/etiologySubject(s)
Hepatectomy , von Willebrand Diseases/surgery , Female , Humans , Middle Aged , Treatment OutcomeABSTRACT
In superficial venous insufficiency, surgery remains the treatment of choice. Endovenous therapies are a minimal invasive alternative, whose long-term results are not demonstrated yet. In the treatment of abdominal aortic aneurysm, endovascular repair (EVAR) and laparoscopic approach are comparatively studied with open repair, to define their precise indications. In occlusive arterial disease, endovascular treatment offers inferior results in term of durability and patency, however with a decrease in morbidity and mortality.
