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  1. Article ; Online: Is there a standard reaction of surgeons to surgical complications? Study on an interesting historical case.

    Tebala, Giovanni D

    Medical hypotheses

    2020  Volume 144, Page(s) 110006

    Abstract: The surgeon has been recognised as the "second victim" of a surgical complication and the long term psychological impact of a surgical adverse event has been demonstrated. However, the immediate and early psychological response to a surgical complication ...

    Abstract The surgeon has been recognised as the "second victim" of a surgical complication and the long term psychological impact of a surgical adverse event has been demonstrated. However, the immediate and early psychological response to a surgical complication has not been properly investigated. In this manuscript we analyse a well-known historical case of a surgical complication and discuss the early reaction of the surgeon. Sir Anthony Eden, UK Prime Minister in the '50s, underwent a cholecystectomy for gallstones, but the operation complicated with a biliary fistula causing jaundice and sepsis. The reaction of the surgeon followed a precise three-stage pattern that can be identified in almost every case of surgical complication. Initially he denied the complication, with a simplistic attitude, but subsequently he felt overwhelmed by the environmental pressure and gave up. The early psychological response of a surgeon to a surgical complication usually follows the three phases of "denial", "desperation" and "action or get-away". In the denial phase the surgeon tries to reassure him or herself by diminishing the real burden of the complication and to demonstrate self-confidence. After few days, when it is evident that the complication is more severe than expected, the surgeon changes completely his or her attitude and becomes more and more depressed and anxious. The reaction to phase 2 will determine the subsequent phase 3, where the surgeon would choose between a positive and proactive attitude or getting-away, thus disengaging from the complicated patient. Acknowledging these three phases would help team leaders and colleagues to recognise the need for a supportive, friendly and blame-free environment and to act timely to help the surgeon to overcome the negative impact on his or her personality and career.
    MeSH term(s) Female ; Humans ; Male ; Surgeons
    Language English
    Publishing date 2020-06-19
    Publishing country United States
    Document type Journal Article
    ZDB-ID 193145-3
    ISSN 1532-2777 ; 0306-9877
    ISSN (online) 1532-2777
    ISSN 0306-9877
    DOI 10.1016/j.mehy.2020.110006
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: The Emperor's New Clothes: a Critical Appraisal of Evidence-based Medicine.

    Tebala, Giovanni D

    International journal of medical sciences

    2018  Volume 15, Issue 12, Page(s) 1397–1405

    Abstract: Evidence-Based Medicine (EBM) is the way we are expected to deliver our healthcare in the ... ...

    Abstract Evidence-Based Medicine (EBM) is the way we are expected to deliver our healthcare in the 21
    MeSH term(s) Decision Making ; Evidence-Based Medicine ; Humans ; Knowledge ; Physicians ; Reproducibility of Results
    Language English
    Publishing date 2018-09-07
    Publishing country Australia
    Document type Journal Article ; Review
    ZDB-ID 2151424-0
    ISSN 1449-1907 ; 1449-1907
    ISSN (online) 1449-1907
    ISSN 1449-1907
    DOI 10.7150/ijms.25869
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article: Calculation and internal validation of a new synthetic and autocorrelate index to combine the determinants of health of a population.

    Tebala, Domenico / Tebala, Giovanni Domenico

    Archives of public health = Archives belges de sante publique

    2021  Volume 79, Issue 1, Page(s) 65

    Abstract: Background: The status of health of an individual and - more broadly - of a community or population is defined by the status of their determinants of health. A "systemic" approach to define the health determinants is necessary in order to explore the ... ...

    Abstract Background: The status of health of an individual and - more broadly - of a community or population is defined by the status of their determinants of health. A "systemic" approach to define the health determinants is necessary in order to explore the complex relations existing among them. This study is aimed at identifying a 'composite systemic' index of health to measure the impact of socioeconomic factors on public health at local level and to analyze possible spatial autocorrelations between neighboring regions.
    Results: A Composite Index of Health (CIH) was constructed on the basis of known indicators of socio-economic well-being by using the COMIC (COMposite Indices Creator) Software and was validated on the Italian population and a nationwide comparison has been performed. Analysis of the determinants showed a significant direct correlation between health, environment, work and wealth and inverse correlation between health and social distress. The analysis of data from Italian provinces confirmed the South-North gradient of well-being.
    Conclusion: The CIH is a reliable and robust index to evaluate the health of a local population. Although it was validated on Italian data, the index can be easily adapted to any Country.
    Language English
    Publishing date 2021-04-29
    Publishing country England
    Document type Journal Article
    ZDB-ID 1117688-x
    ISSN 2049-3258 ; 0778-7367 ; 0003-9578
    ISSN (online) 2049-3258
    ISSN 0778-7367 ; 0003-9578
    DOI 10.1186/s13690-021-00590-8
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: The duodenal window approach to pancreatoduodenectomy.

    Tebala, Giovanni Domenico / Desiderio, Jacopo / Di Nardo, Domenico / Gemini, Alessandro / Cirocchi, Roberto

    Annals of hepato-biliary-pancreatic surgery

    2024  

    Abstract: The pancreatoduodenectomy (PD) technique is yet to be standardized. One of the most difficult passages in PD is the mobilization of the second, third, and fourth parts of the duodenum. This maneuver is classically performed from the supramesocolic space ... ...

    Abstract The pancreatoduodenectomy (PD) technique is yet to be standardized. One of the most difficult passages in PD is the mobilization of the second, third, and fourth parts of the duodenum. This maneuver is classically performed from the supramesocolic space after the division of the gastrocolic ligament, but traction on the transverse mesocolon and the superior mesenteric pedicle can cause bleeding from the venous and arterial branches of the pancreatic head and uncinate process. We hereby describe a technique to access and mobilize the distal duodenum and proximal jejunum (D2 to J1) through the duodenal window and the Treitz's foramen, performing an almost complete Kocher's maneuver before opening the gastrocolic ligament and mobilizing the hepatic flexure. The anatomical basis and the surgical technique of the duodenal-window-first PD are discussed. The duodenal-window-first approach is a standardizable step of PD that allows an easy and safe mobilization of D2 to J1. This technique has been applied to 15 cases of PD, both open and robotic, with no specific morbidity. Therefore, we propose the adoption of the duodenal-window-first technique as a routine standardized step of PD.
    Language English
    Publishing date 2024-01-09
    Publishing country Korea (South)
    Document type Journal Article
    ZDB-ID 3012179-6
    ISSN 2508-5859 ; 2508-5778
    ISSN (online) 2508-5859
    ISSN 2508-5778
    DOI 10.14701/ahbps.23-109
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article ; Online: Correction to: War trauma in Homer's Iliad: a trauma registry perspective.

    Chicco, Maria / Tebala, Giovanni D

    European journal of trauma and emergency surgery : official publication of the European Trauma Society

    2020  Volume 47, Issue 3, Page(s) 779–780

    Language English
    Publishing date 2020-05-29
    Publishing country Germany
    Document type Published Erratum
    ZDB-ID 2275480-5
    ISSN 1863-9941 ; 1863-9933
    ISSN (online) 1863-9941
    ISSN 1863-9933
    DOI 10.1007/s00068-020-01393-2
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article ; Online: War trauma in Homer's Iliad: a trauma registry perspective.

    Chicco, Maria / Tebala, Giovanni D

    European journal of trauma and emergency surgery : official publication of the European Trauma Society

    2020  Volume 47, Issue 3, Page(s) 773–778

    Abstract: Purpose: Homer's Iliad reports detailed descriptions of war traumas, with precise anatomical references, so that the Iliad can be considered the first trauma registry. We aimed to analyse the Iliad from the perspective of a modern trauma registry: that ... ...

    Abstract Purpose: Homer's Iliad reports detailed descriptions of war traumas, with precise anatomical references, so that the Iliad can be considered the first trauma registry. We aimed to analyse the Iliad from the perspective of a modern trauma registry: that is, to find historical and local prognostic factors through the epidemiological study of the reported traumas.
    Methods: Two different editions of Homer's Iliad-one in English and one in Italian-were thoroughly studied and epidemiological data were statistically analysed.
    Results: 148 reports of human traumas were analysed. The majority of traumas (73.6%) involved Trojan warriors, with spears being the most frequent wounding agent (71%). Overall mortality was 84.5% and was higher in the Trojan field (90.8% vs 61.5%). Despite the high mortality, median New Injury Severity Score (NISS) was low, probably due to high prevalence of penetrating mono-systemic trauma. Median NISS was higher in the Trojan group. Compared to the Achaeans, the Trojans had more torso injuries, whereas Achaeans had more injuries to limbs and superficial tissues. However, in both fields, head and neck were more frequently injured.
    Conclusions: Homer's Iliad gives us an interesting insight into war traumas during the siege of Troy. The reported higher mortality within the Trojan army can be explained not only by poetic reasons but also by different military skills.
    MeSH term(s) Extremities ; History, Ancient ; Humans ; Medicine in Literature ; Registries ; Wounds, Penetrating
    Language English
    Publishing date 2020-04-18
    Publishing country Germany
    Document type Historical Article ; Journal Article
    ZDB-ID 2275480-5
    ISSN 1863-9941 ; 1863-9933
    ISSN (online) 1863-9941
    ISSN 1863-9933
    DOI 10.1007/s00068-020-01365-6
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  7. Article ; Online: Iatrogenic Biliary Injury during Cholecystectomy: Critical Review of a Historical Case and Its Political Consequences.

    Tebala, Giovanni Domenico / Nuzzo, Gennaro

    Digestive surgery

    2020  Volume 38, Issue 2, Page(s) 91–103

    Abstract: Biliary injuries during cholecystectomy represent serious adverse events that can have a profound impact on the patient's quality of life and on the surgeon's well-being and career. Sometimes, they can have an unexpectedly disastrous effect on the whole ... ...

    Abstract Biliary injuries during cholecystectomy represent serious adverse events that can have a profound impact on the patient's quality of life and on the surgeon's well-being and career. Sometimes, they can have an unexpectedly disastrous effect on the whole community, as demonstrated by the case of Anthony Eden, former foreign secretary and prime minister of Britain in the 1950s. Mr. Eden, later Lord Avon, had been suffering from biliary symptoms for a while when he had his cholecystectomy performed on April 12, 1953. On post-op day 1, a bile leak was evident, possibly due to a complete transection of the common bile duct. After a first reoperation to drain a bile collection, the definitive repair was performed in Boston by Dr. Cattell on June 10, 1953, with a loop hepatico-jejunostomy. Unfortunately, the bilioenteric anastomosis became gradually narrow, causing recurrent cholangitis, and Mr. Eden started a symptomatic treatment with pethidine, barbiturate, and amphetamine. These could have affected his perception of reality and his political judgement during the Suez Canal Crisis and, other than being the ultimate reason for 3,000+ war casualties, might have caused a Third World War. The historical and clinical implications of this case are thoroughly discussed.
    MeSH term(s) Bile Ducts/injuries ; Biliary Tract Diseases/history ; Biliary Tract Diseases/surgery ; Boston ; Cholecystectomy/adverse effects ; Cholecystectomy/history ; England ; History, 19th Century ; History, 20th Century ; Humans ; Iatrogenic Disease ; World War II
    Language English
    Publishing date 2020-12-16
    Publishing country Switzerland
    Document type Biography ; Historical Article ; Journal Article
    ZDB-ID 605888-7
    ISSN 1421-9883 ; 0253-4886
    ISSN (online) 1421-9883
    ISSN 0253-4886
    DOI 10.1159/000512176
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  8. Article ; Online: Laparoscopic repair of a large rectal injury during colonoscopy: challenging an old-fashioned paradigm - a video vignette.

    Tebala, G D / Symons, N

    Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland

    2020  Volume 22, Issue 12, Page(s) 2355–2356

    MeSH term(s) Colonic Diseases ; Colonoscopy ; Humans ; Laparoscopy
    Language English
    Publishing date 2020-09-30
    Publishing country England
    Document type Letter ; Video-Audio Media
    ZDB-ID 1440017-0
    ISSN 1463-1318 ; 1462-8910
    ISSN (online) 1463-1318
    ISSN 1462-8910
    DOI 10.1111/codi.15351
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  9. Article ; Online: Gastroesophageal reflux disease. Are we acting in the best interest of our patients?

    Tebala, G D

    European review for medical and pharmacological sciences

    2016  Volume 20, Issue 21, Page(s) 4553–4556

    Abstract: Oesophageal adenocarcinoma is strictly related to gastroesophageal reflux and cylindrical metaplasia of the epithelium of the distal esophagus (Barrett's esophagus) due to chronic inflammation. Worldwide incidence of oesophageal adenocarcinoma is rising ... ...

    Abstract Oesophageal adenocarcinoma is strictly related to gastroesophageal reflux and cylindrical metaplasia of the epithelium of the distal esophagus (Barrett's esophagus) due to chronic inflammation. Worldwide incidence of oesophageal adenocarcinoma is rising despite the availability of precise international guidelines for the treatment of gastroesophageal reflux disease and the increasing use of proton-pump inhibitors (PPIs). While PPIs can control GERD symptoms in a significant amount of cases, still a large number of patients progress to Barrett's esophagus and adenocarcinoma. Recent investigations have demonstrated that in one-third of the patients their reflux symptoms are due to non-acid reflux, obviously not affected by PPIs. Robust evidences are available to demonstrate the role of non-acid reflux in the development of Barrett's esophagus and adenocarcinoma. Therefore, PPIs are not effective in preventing the worst complications of GERD. It is mandatory to develop new and more effective guidelines on the treatment of GERD; that would take into account the fact that GERD should be considered a "surgical" disease, as it is due, at least in its late stages, to an anatomical defect of the lower oesophageal sphincter. Medical treatment should be considered in early stage GERD, when reflux is due to transient relaxations of the lower oesophageal sphincter, whereas surgery should be considered in late stages, in the presence of a demonstrated mechanical failure of the sphincter.
    MeSH term(s) Adenocarcinoma/etiology ; Adenocarcinoma/prevention & control ; Barrett Esophagus/complications ; Esophageal Neoplasms/diagnosis ; Esophageal Neoplasms/etiology ; Esophageal Neoplasms/prevention & control ; Esophageal Sphincter, Lower/anatomy & histology ; Esophageal Sphincter, Lower/physiopathology ; Esophageal Sphincter, Lower/surgery ; Gastroesophageal Reflux/complications ; Humans ; Proton Pump Inhibitors/therapeutic use
    Chemical Substances Proton Pump Inhibitors
    Language English
    Publishing date 2016-11
    Publishing country Italy
    Document type Journal Article
    ZDB-ID 605550-3
    ISSN 2284-0729 ; 1128-3602 ; 0392-291X
    ISSN (online) 2284-0729
    ISSN 1128-3602 ; 0392-291X
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  10. Article ; Online: The "Left Ureteral Triangle" as an Anatomic Landmark for the Identification of the Left Ureter in Laparoscopic Distal Colectomies.

    Tebala, Giovanni D

    Surgical laparoscopy, endoscopy & percutaneous techniques

    2016  Volume 26, Issue 5, Page(s) e100–e102

    Abstract: Ureteral injury is one of the possible complications of distal colectomies. It may be caused by misidentification of the anatomic landmarks during the left lateral dissection, due to factor pertaining to the patient, the disease, and the surgeon. The ... ...

    Abstract Ureteral injury is one of the possible complications of distal colectomies. It may be caused by misidentification of the anatomic landmarks during the left lateral dissection, due to factor pertaining to the patient, the disease, and the surgeon. The only way to reduce the risk of this avoidable complication is the perfect knowledge and identification of the anatomy of the left ureter. In this article, we describe an anatomic triangle that can be a valid help in the identification of the ureter in the area where higher is the risk of iatrogenic injury. The left ureteric triangle can be prepared after the dissection of the left Toldt plane, as soon as the dissection reaches the superior mesorectum. Sides of this triangle are (a) superiorly, the dissected mesosigmoid, (b) right side, upper mesorectum and sacral promontorium, and (c) inferiorly, the margin of the incised posterior parietal peritoneum. The left ureter runs within this triangle.
    MeSH term(s) Anatomic Landmarks ; Colectomy/methods ; Humans ; Intraoperative Complications/prevention & control ; Laparoscopy/methods ; Organ Sparing Treatments/methods ; Risk Factors ; Ureter/anatomy & histology ; Ureter/injuries
    Language English
    Publishing date 2016-10
    Publishing country United States
    Document type Journal Article
    ZDB-ID 1475108-2
    ISSN 1534-4908 ; 1530-4515 ; 1051-7200
    ISSN (online) 1534-4908
    ISSN 1530-4515 ; 1051-7200
    DOI 10.1097/SLE.0000000000000311
    Database MEDical Literature Analysis and Retrieval System OnLINE

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