Letteratura scientifica selezionata sul tema "Digestive organs Surgery"

This chapter discusses all the tumours arising from the digestive tract and its associated organs such as the liver and gall bladder. The chapter covers epidemiological and aetiological factors and links to these changes in recent years in the frequency of each type of tumour, which often relates to lifestyle changes such as frequency of smoking, patterns of alcohol use, consumption of various foods, obesity, and various infective agents. The contribution of genetic factors and hereditary diseases is discussed for each tumour type. The appropriateness of screening programmes is considered. Clinical presentations are described and the investigations required for diagnosis (with imaging and molecular marker measurement) and staging, which, for most tumours, is according to the Union for International Cancer Control (UICC) system. The management, and the timing and use of combinations of surgery, radiotherapy, chemotherapy, and other systemic treatments, whether given alone, concomitantly, or sequentially, are included for localized, advanced, and metastatic disease in each anatomical area. Special techniques such as liver transplantation, various ablative procedures, and the use of brachytherapy are discussed where relevant. Ways of palliating incurable disease are given. Outcomes and prognosis vary considerably between tumour types and show differing patterns of change over time. For example, there has been an improvement in the outcomes of treatment for colorectal cancers but little improvement yet overall in the cure rates for cancers of the oesophagus.

This chapter deals with the concept of medicine as it is foregrounded in Indigenous and settler cultures, looking to the ways in which settler medicine was part of the biopolitics of capital, the administration of the body and the annihilation of its affects, and the foreclosure of bodily desire. Indigenous medicine, in contrast, draws upon forms of ephemeral experience, of feelings, of dreams, to reconfigure the body; or reconfigures the body to bring about experiences of the ephemeral. Reading the work of Dr. William Beaumont, an army surgeon who served in the Black Hawk War, this chapter looks to Beaumont’s experiments in digestion with his captive subject, Alexis St. Martin, to explore the excesses and limitations of desire in relation to food. Proper respect for the digestive process and the suppression of the desire for more is essential to the maintenance of the capacity for labor. As a counterpoint, this chapter looks to Black Hawk’s 1833 narrative for an account of medicine as an embodied practice that is nonetheless best understood in relation to dreaming and mourning, ways of relating to the ineffable that are personally and socially transformative and that are unforgivably slow, stealing time, labor, and value.

Gastroenterology and hepatology encompass a vast array of organs that have diverse structure and function and are affected by a multitude of disease processes. Diseases of the digestive tract are a major cause of morbidity and mortality in the United Kingdom (UK) and worldwide. There have been great advances in our understanding, diagnosis, and management of gastrointestinal (GI) disease, and knowledge continues to develop at a great pace. Understanding the physiology and cellular and molecular events that drive pathological processes, as well as the devel­opment of sophisticated endoscopic and radiological tests, have trans­formed diagnostic capability. Therapeutic endoscopy has progressed to replace surgical management of common GI emergencies such as upper GI tract bleeding and decompressing biliary tract obstruction. However, as ever, there is still much work to be done. For example, the advances in biologic immunotherapy in inflammatory bowel disease has greatly im­proved patients’ quality of life and a reduction in the need for surgery, though the overall impact of these medications on the natural history of the disease is debatable at present. Hepatology is a greatly misunderstood specialty. The physiological changes that occur as cirrhosis and portal hypertension develop are the key to understanding all manifestations of a decompensating liver. Recently, there has been a significant increase in the prevalence of chronic liver disease in the UK, and as a result, hospital admissions have increased. Liver disease is the only major cause of death still increasing year on year, and twice as many people now die from liver disease than in 1991. The 2013 National Confidential Enquiry into Patient Outcome and Death (NCEPOD) of patients with alcohol- related liver disease (ARLD) found that less than half the number of patients who died from ARLD received ‘good care’, and avoidable deaths were identified. Allied to this, the enquiry shed light on a cultural pessimism regarding outcomes and prognosis of chronic liver disease and, in particular, ARLD from both the public and the medical profession as a whole. There is now a concerted drive towards improving awareness of chronic liver disease, and initial simple supportive treatments can greatly improve sur­vival, more so than previously thought.

Total laryngectomy is still the final therapeutic solution in cases of locally advanced laryngeal cancer, as well as in cases of therapeutic failure of organ-sparing surgery or radiation therapy. Following excision of the larynx, the remaining pharynx is reconstructed to obtain continuity of the upper digestive tract. One of the most common complications in these patients, despite constant refinement of the procedure, is the development of a pharyngo-cutaneous fistula. These fistulas prolong hospital stay and often require a second surgical procedure, increasing morbidity and cost for the patient, while diminishing his quality of life. Some risk-factors have been identified, but only some may be corrected before surgery to lower this risk. Managing the fistula once present depends on multiple factors, essential being the size of the fistula as well as the position and concomitant factors, with options ranging from conservative measures to aggressive reconstructive surgery with local miocutaneous flaps. Modern vocal rehabilitation with T.E.P. (tracheo-esophageal puncture) and vocal prosthesis placement presents a new challenge – because of the risk of developing a tracheo-esophageal fistula, with an even higher risk for the patient because of tracheal aspiration. Understanding healing mechanisms of these structures is key to proper management of this complication.

In recent years, there has been a surge in antibiotic resistance in both humans and animals, as well as increased public concern over medication residues in animal products. As a result, the use of antibiotics as growth promoters in chicken has been banned in the European Union, and consumer pressure is likely to lead to their removal in other countries. More recently, the United States of America adopted the same restriction in 2017. Different alternatives to antibiotics have been proposed as a measure to eliminate pathogens or to improve growth and feed conversion in poultry, such as probiotics, enzymes, bacteriophages and antimicrobial peptides, herbal compounds and organic acids. These substances exert their effects on the gastrointestinal biota and digestion processes, directly or indirectly. Humic substances (HS) in animal applications have shown improved live-weight, growth rates and feed intakes by improving immune functions and gut health. In poultry nutrition as an alternative to growth-promoting has been proven with promising results on the growth and health of birds. Additional research suggests that HS can increase gut integrity and performance when combined with good nutrition, management, and biosecurity policies. Therefore, recent results of HS extracted from vermicompost in poultry will be described in this chapter.