Publications by authors named "H E Doran"

89 Publications

Early Complications after Gastrectomies for Locally Advanced Gastric Cancer.

Chirurgia (Bucur) 2021 May-Jun;116(3):294-299

The post-operative results as well as the short and middle-term outcome of surgical procedures for gastric cancer depend on several general and local conditions, mainly on the stage of neoplasia. Delayed diagnosis and intervention are correlated with a high rate of postoperative morbidity and mortality. 76 consecutive patients underwent surgical treatment for gastric cancer over a time span of 5 years (2015-2019), in the 1st Surgical Department of "Dr.I.Cantacuzino" Clinical Hospital. There have been 46 distal gastrectomies, 12 DI total gastrectomies and 18 DII total gastrectomies, 8 of them with multi-organ resection. Among them, 50 patients had a favorable evolution, 7 developed complications which were manageable through a conservative approach, while 19 needed one or more reinterventions. We encountered 10 cases of severe sepsis and MSOF, followed by exitus. The surgical treatment of locally advanced gastric cancer poses many challenges both in terms of postoperative evolution and oncologic prognosis.
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http://dx.doi.org/10.21614/chirurgia.116.3.294DOI Listing
July 2021

UK National Registry Data supports safety of selective day case hemithyroidectomy by high volume thyroid surgeons.

Br J Surg 2021 Jun 11. Epub 2021 Jun 11.

Department of Surgery, Aberdeen Royal Infirmary, UK.

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http://dx.doi.org/10.1093/bjs/znab207DOI Listing
June 2021

Post-thyroidectomy bleeding: analysis of risk factors from a national registry.

Br J Surg 2021 Jul;108(7):851-857

Department of Surgery, Aberdeen Royal Infirmary, Aberdeen, UK.

Background: Post-thyroidectomy haemorrhage occurs in 1-2 per cent of patients, one-quarter requiring bedside clot evacuation. Owing to the risk of life-threatening haemorrhage, previous British Association of Endocrine and Thyroid Surgeons (BAETS) guidance has been that day-case thyroidectomy could not be endorsed. This study aimed to review the best currently available UK data to evaluate a recent change in this recommendation.

Methods: The UK Registry of Endocrine and Thyroid Surgery was analysed to determine the incidence of and risk factors for post-thyroidectomy haemorrhage from 2004 to 2018.

Results: Reoperation for bleeding occurred in 1.2 per cent (449 of 39 014) of all thyroidectomies. In multivariable analysis male sex, increasing age, redo surgery, retrosternal goitre and total thyroidectomy were significantly correlated with an increased risk of reoperation for bleeding, and surgeon monthly thyroidectomy rate correlated with a decreased risk. Estimation of variation in bleeding risk from these predictors gave low pseudo-R2 values, suggesting that bleeding is unpredictable. Reoperation for bleeding occurred in 0.9 per cent (217 of 24 700) of hemithyroidectomies, with male sex, increasing age, decreasing surgeon volume and redo surgery being risk factors. The mortality rate following thyroidectomy was 0.1 per cent (23 of 38 740). In a multivariable model including reoperation for bleeding node dissection and age were significant risk factors for mortality.

Conclusion: The highest risk for bleeding occurred following total thyroidectomy in men, but overall bleeding was unpredictable. In hemithyroidectomy increasing surgeon thyroidectomy volume reduces bleeding risk. This analysis supports the revised BAETS recommendation to restrict day-case thyroid surgery to hemithyroidectomy performed by high-volume surgeons, with caution in the elderly, men, patients with retrosternal goitres, and those undergoing redo surgery.
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http://dx.doi.org/10.1093/bjs/znab015DOI Listing
July 2021

Algorithm of Medical-Surgical Treatment in the Peripheral Arterial Disease of the Diabetic Patient.

Maedica (Bucur) 2020 Sep;15(3):310-317

1st General Surgery Clinique, "I. Cantacuzino" Clinical Hospital, Bucharest, Romania.

We live in a society with a growing number of diabetics. That is why the number of diabetic patients with peripheral arterial disease is expanding, as is the number of cases of chronic ischemia, which threatens limb viability, or chronic limb-threatening ischemia (CLTI). The appearance of diabetic foot ulcers with an ischemic component represents the maximum risk of amputation in the absence of a firm and rapid revascularization intervention. In our study, we aim at early detection of patients who need infusion treatment immediately after surgical revascularization. This is a six-year retrospective study of 115 patients with infrainguinal occlusive disease and CLTI. All subjects were classified according to the WIfI system before and after revascularization. We made a score based on the postoperative clinical evolution in the first three days in order to have an objective image of patients who received infusion treatment with PG E1. All patients included in our study had diabetes. They were divided into two groups, one comprising 86 patients who underwent exclusively surgical treatment, and the other comprising 29 patients, who received a combined surgical and medical treatment. We showed that subjects who had a low postoperative score and received infusion treatment had a higher rate of limb rescue in the first year. In diabetic patients with infrainguinal occlusive disease who were treated in the Clinic, without the possibility of endovascular or hybrid interventions, the combination of infusion treatment with PG E1 after surgical revascularization led to a higher rate of limb rescue and healing of ischemic trophic lesions after one year.
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http://dx.doi.org/10.26574/maedica.2020.15.3.310DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7726507PMC
September 2020

A 2021 Horizon Scan of Emerging Global Biological Conservation Issues.

Trends Ecol Evol 2021 01;36(1):87-97

Conservation Science Group, Department of Zoology, Cambridge University, The David Attenborough Building, Pembroke Street, Cambridge CB2 3QZ, UK.

We present the results from our 12th annual horizon scan of issues likely to impact biological conservation in the future. From a list of 97 topics, our global panel of 25 scientists and practitioners identified the top 15 issues that we believe society may urgently need to address. These issues are either novel in the biological conservation sector or represent a substantial positive or negative step-change in impact at global or regional level. Six issues, such as coral reef deoxygenation and changes in polar coastal productivity, affect marine or coastal ecosystems and seven relate to human and ecosystem-level responses to climate change. Identification of potential forthcoming issues for biological conservation may enable increased preparedness by researchers, practitioners, and decision-makers.
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http://dx.doi.org/10.1016/j.tree.2020.10.014DOI Listing
January 2021
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