[Videofluorescence navigation during parenchymal-sparing liver resections using a domestic fluorescence imaging system]. / Videofluorestsentnaya navigatsiya pri parenkhimosokhrannykh rezektsiyakh pecheni s ispol'zovaniem otechestvennoi sistemy fluorestsentnoi vizualizatsii.

Parenchyma- sparing liver resections are aimed at maximizing the possible preservation of parenchyma not affected by the tumor - a current trend in hepatopancreatobiliary surgery. On the other hand, a prerequisite for operations is to ensure their radicality. To effectively solve this problem, all diagnostic imaging methods available in the arsenal are used, which make it possible to comprehensively solve the issues of perioperative planning of the volume and technical features of the planned operation. Diagnostic imaging methods that allow intraoperative navigation through intraoperative, instrumentally based determination of the tumor border and resection plane have additional value. One of the methods of such mapping is ICG video fluorescence intraoperative navigation. An analysis of the clinical use of the domestic video fluorescent navigation system "MARS" for parenchymal-sparing resections of focal liver lesions is presented. An assessment was made of the dynamics of the distribution of the contrast agent during ICG videofluorescent mapping during parenchymal-sparing resection interventions on the liver, with the analysis of materials from histological examination of tissues taking into account three-zonal videofluorescent marking of the resection edge, performed using the domestic videofluorescence imaging system «MARS¼.

Grade 3 Proximal Humerus Giant Cell Tumour: Is Resection and Reconstruction with Prosthesis a Valuable Option?

Grade 3 proximal humerus giant cell tumours are uncommon and the results of their surgical management with prosthetic replacement are not well established. We retrospectively studied patients with grade 3 giant cell tumours of proximal humerus treated with excision and prosthetic replacement from January 2009 and December 2018. We identified 13 patients who underwent tumour excision and prosthetic replacement. There were 7 (53.8%) men and 6 (46.2%) women. The mean age at diagnosis was 30.4 years (range 16-48 years). The mean follow-up period was 72.2 months (range 24-132). Margins were positive in 4 (30.8%) patients, ≤ 1 mm in 8 (61.5%) patients, and negative in 1 (7.7%) patient. Local recurrence was seen in 2 (15.4%) patients. 1 out of 2 (50%) patients with local recurrence had pathological fracture at presentation and margins were positive in both (100%) patients. There were 3 (23.1%) complications-1 patient with joint subluxation, 1 patient with fracture post trauma, and 1 patient with surgical site infection. The mean overall Musculoskeletal Tumour Society score was 24 out of 30 (range 21-29). Resection of grade 3 proximal humerus giant cell tumour and reconstruction with prosthesis results in low recurrence rate and good functional outcome and is a valuable treatment option for such tumours.

Necesidad de información preoperatoria en pacientes intervenidos en el servicio de otorrinolaringología / Need for preoperative information in patients undergoing surgery in the Otorhinolaryngology Department

Resumen Objetivo: determinar las necesidades de información en el preoperatorio de los pacientes atendidos en el servicio de otorrinolaringología del Hospital Nacional Arzobispo Loayza de Lima, Perú. Métodos: investigación de tipo descriptiva y de corte transversal. Se estudiaron 127 pacientes quirúrgicos del servicio de otorrinolaringología. Se utilizó un cuestionario de demandas de información y conocimiento de los pacientes en cuanto a su derecho de decidir una cirugía; contiene preguntas referentes a la descripción de la técnica quirúrgica, complicaciones y riesgos que conlleva la cirugía. Se utilizó una muestra no probabilística por conveniencia, así como el análisis de los datos, el cual se realizó con el paquete estadístico SPSS en versión 25. Para evaluar la correlación entre variables se empleó la prueba chi-cuadrado. Resultados: participaron 127 pacientes, más de 75% de ellos deseaban conocer más información sobre su enfermedad y el tratamiento quirúrgico, 90% manifestaron el deseo de tener una explicación de cómo se realizará la cirugía, 85% necesitaban conocer las complicaciones frecuentes, 20% deseaba ignorar la información sobre posibilidad de muerte. Los adultos jóvenes y el grupo con educación superior demandaban más información (p<0.05), no presentaron diferencias respecto al sexo, salvo en la necesidad de conocer el riesgo de muerte a causa de la cirugía, a favor del sexo femenino (p<0,05). Conclusiones: la mayoría de los pacientes necesitan una información detallada durante la evaluación preoperatoria, principalmente en los grupos de adultos jóvenes y con educación superior. Los médicos debemos brindar información suficiente, clara y con expectativas reales, respetando la autonomía del paciente en la toma de decisiones.

Abstract Aim: To determine the informational needs of preoperative patients being attended at the Otorhinolaryngology Service of the Hospital Nacional Arzobispo Loayza of Lima, Peru. Methods: Using cross-sectional descriptive research, 127 surgical patients from the Otorhinolaryngology Service were studied. A questionnaire asked what information and knowledge the patients had when exercising their right to decide surgery. It contained questions concerning the description of the surgical technique, complications, and risks involved in the surgery. A non probability sample by convenience was used and the data analysis was performed with the SPSS statistical package in version 25 and the chisquare test was used to evaluate the correlation between variables. Results: 127 patients participated, more than 75% of patients wanted to know more information about their disease and the surgical treatment, 90% stated that they needed an explanation of how the surgery would be performed, 85% wanted to know the common complications, and 20% wanted to ignore the possibility of death. Young adults and the group with higher education demanded more information (p<0.05). Concerning sex, there were no differences between the men and women in their answers other than the females needing to know the risk of death due to surgery (p<0.05). Conclusions: Most patients need detailed information during the preoperative evaluation, especially young adults and those with higher education. Physicians should provide sufficient, clear information with realistic expectations, respecting the patient's autonomy in decision-making.

Predicción de toxicidad de la quimioterapia y radioterapia en el paciente oncológico quirúrgico

Fundamento la toxicidad asociada a los tratamientos de quimioterapia y radioterapia eleva la morbilidad y la mortalidad en los pacientes oncológicos. Objetivo diseñar un modelo predictivo de toxicidad de la quimioterapia y la radioterapia en el paciente oncológico quirúrgico. Métodos estudio analítico, de casos y controles, en pacientes oncológicos quirúrgicos que cumplieron los criterios de inclusión para la predicción de toxicidad preoperatoria, en el periodo enero a diciembre de 2022, en el Hospital Provincial Docente Oncológico María Curie, de Camagüey. Mediante el paquete estadístico Statistical Package for the Social Sciences, se seleccionó una muestra aleatoria de 334 pacientes, 197 sin toxicidad (grupo control) y 137 con toxicidad (grupo de estudio). Se realizó estimación de predictores de toxicidad mediante regresión logística binaria. Se seleccionó el modelo de mejor ajuste. Resultados el modelo en el paso tres predice un porcentaje global de 83,5 % con respecto a los valores observados. La sensibilidad resultó ser de 81,8; y la especificidad, 84,8. El modelo presentó buen poder discriminativo. Las variables en la ecuación fueron: hipertensión arterial, fracción de eyección del ventrículo izquierdo y anemia. La comparación de la predicción con la realidad, mediante curva Receiver Operating Characteristic determinó un área bajo la curva de 0,901. Conclusión se obtuvo una función de regresión logística que permitió la estimación de la probabilidad de toxicidad en pacientes oncológicos quirúrgicos electivos, la cual proporcionó una herramienta para su predicción desde el preoperatorio.

Foundation the toxicity associated with chemotherapy and radiotherapy treatments increases morbidity and mortality in cancer patients. Objective to design a predictive model of chemotherapy and radiotherapy toxicity in surgical cancer patients. Methods analytical, case-control study, in surgical oncology patients who met the inclusion criteria for the prediction of preoperative toxicity, from January to December 2022, at the María Curie Provincial Teaching Oncology Hospital in Camagüey. Using the Statistical Package for the Social Sciences, a random sample of 334 patients was selected, 197 without toxicity (control group) and 137 with toxicity (study group). Toxicity predictors were estimated using binary logistic regression. The model with the best fit was selected. Results the model in step three predicts an overall percentage of 83.5% with respect to the observed values. The sensitivity turned out to be 81.8; and the specificity, 84.8. The model presented good discriminative power. The variables in the equation were: arterial hypertension, left ventricular ejection fraction, and anemia. The comparison of the prediction with reality, using the Receiver Operating Characteristic curve, determined an area under the curve of 0.901. Conclusion a logistic regression function was obtained that allowed the estimation of the toxicity probability elective surgical cancer patients, which provided a tool for its prediction from the preoperative period.

Current scientific evidence for why periodontitis should be included in diabetes management.

This Perspective provides a brief summary of the scientific evidence for the two-way links between periodontal diseases and hyperglycemia (diabetes mellitus [DM] and pre-DM). It delivers in a nutshell current scientific evidence for manifestations of hyperglycemia on periodontal health status and effects of periodontal diseases on blood glucose levels and in turn incidence, progression, and complications of diabetes. Of outmost importance is presentation of scientific evidence for the potential of routine periodontal treatment to lower blood glucose levels, providing a novel, economical tool in DM management. Non-surgical periodontal treatment ("deep cleaning") can be provided by dental hygienists or dentists in general dental offices, although severe cases should be referred to specialists. Such therapy can decrease the costs of DM care and other health care costs for people with DM. The great importance of a healthy oral cavity free of infection and subsequent inflammation - especially periodontitis that if untreated will cause loosening and eventually loss of affected teeth - has largely gone unnoticed by the medical community as the health care curricula are largely void of content regarding the bi-directional links between oral health and systemic health, despite elevation of blood glucose levels being an integral part of the general systemic inflammation response. The importance of keeping disease-free, natural teeth for proper biting and chewing, smiling, self-esteem, and pain avoidance cannot be overestimated. Medical and dental professionals are strongly encouraged to collaborate in patient-centered care for their mutual patients with - or at risk for - hyperglycemia.

Desenvolvimento e implementação de sistema de gerenciamento de cirurgias voltado a um hospital universitário / Development and implementation of a surgery management system aimed at a university hospital / Desarrollo e implementación de um sistema de gestión de cirugías dirigido a un hospital universitario

Objetivo: desenvolver e implementar o sistema de gerenciamento de cirurgias contendo a Lista Cirúrgica e Mapa Cirúrgico. Método: este estudo é de natureza exploratória e descritiva do tipo pesquisa metodológica aplicada. A metodologia utilizada baseia-se no processo de desenvolvimento de software fundamentada no modelo de ciclo de vida de desenvolvimento de sistemas de Pressman. Resultados: o sistema foi desenvolvido e disponibilizado em todos os computadores do hospital em sua rede interna. Implementado em todos as áreas cirúrgicas e Centro Cirúrgico. Conclusão: o sistema de gerenciamento de cirurgias disponibiliza informações em tempo real de informações dos pacientes cirúrgicos a todos setores envolvidos com pacientes cirúrgicos

Objectives: to develop and implement the surgical management system containing the Surgical List and Surgical Map. Method: this study is of exploratory and descriptive nature of the applied methodological research type. The methodology used is based on the software development process based on the Pressman system development life cycle model. Results: the system was developed and made available on all hospital computers on its internal network. Implemented in all surgical areas and Surgical Center. Conclusion: the surgical management system provides real-time information on surgical patient information to all departments involved with surgical patients

Objetivos: desarrollar e implementar el sistema de gestión de cirugías que contenga la Lista Quirúrgica y el Mapa Quirúrgico. Método: este estudio es de naturaleza exploratoria y descriptiva del tipo investigación metodológica aplicada. La metodología utilizada se basa en el proceso de desarrollo de software fundamentada en el modelo de ciclo de vida de desarrollo de sistemas de Pressman. Resultados: el sistema fue desarrollado y puesto a disposición en todas las computadoras del hospital en su red interna. Implementado en todas las áreas quirúrgicas y el Centro Quirúrgico. Conclusión: el sistema de gestión de cirugías proporciona información en tiempo real de los pacientes quirúrgicos a todos los sectores involucrados con pacientes quirúrgicos

La evaluación preoperatoria en intervenciones quirúrgicas no cardiacas en el Hospital de Especialidades Carlos Andrade Marín / Preoperative evaluation of non-cardiac surgical interventions at Carlos Andrade Marín Specialties Hospital

INTRODUCCIÓN. La evaluación preoperatoria determina el estado de salud del paciente que será sometido a una intervención quirúrgica, minimiza su riesgo y optimiza los recursos humanos y materiales del escenario perioperatorio. OBJETIVO. Determinar el proceso de evaluación preoperatorio y su capacidad para prevenir eventos clínicos adversos durante el postoperatorio inmediato de pacientes adultos sometidos a un procedimiento quirúrgico no cardiaco. MATERIALES Y MÉTODOS. Estudio retrospectivo de corte transversal. Población de 6 250 adultos y muestra de 912 Historias Clínicas electrónicas de pacientes atendidos en el Hospital de Especialidades Carlos Andrade Marín, en el año 2017. Criterios de inclusión: pacientes mayores de 18 años, que se sometieron a una evaluación preoperatoria de manera ambulatoria y fueron operados de intervenciones no cardiacas hasta el mes de enero del 2019, o suspensión de cirugía por contraindicaciones determinadas en la cita médica. Criterios de exclusión: pacientes menores a 18 años, no intervenidos quirúrgicamente, hospitalizados por cualquier motivo entre la revisión y la cirugía, embarazadas e individuos con consulta preoperatoria fuera del hospital. Los programas informáticos utilizados para el registro de datos y su análisis fueron Microsoft Excel e International Business Machines Statistical Package for the Social Sciences. RESULTADOS. El 82,68% (754; 912) presentó un antecedente clínico y el 82,13% (749; 912) uno de tipo quirúrgico. Se reportó un 2,00% (18; 912) de complicaciones postoperatorias, y un caso de muerte pasadas las 72 horas postquirúrgicas. No se encontró correlación estadísticamente significativa p>0,05 entre las conclusiones clínicas del control preoperatorio y la ocurrencia de complicaciones en el postoperatorio. CONCLUSIÓN. Se evidenció que el proceso de evaluación preoperatoria fue realizado de manera sistemática a pacientes con características sociodemográficas y clínicas heterogéneas y no existió correlación estadística entre sus resultados y la presencia de complicaciones perioperatorias.

INTRODUCTION. The preoperative evaluation determines the health status of a patient that will undergo a surgical intervention, minimizes its risk, and optimizes the human and material resources of the perioperative scenario. OBJECTIVE. To determine the preoperative evaluation process and its ability to prevent adverse clinical events during the immediate postoperative period in adult patients undergoing a noncardiac surgical procedure. MATERIALS AND METHODS. This is a retrospective cross-sectional study. The sample of 912 medical records was calculated upon a population of 6 250 adults treated at the Carlos Andrade Marín Specialties Hospital in 2017. Inclusion criteria: patients over 18 years of age, who underwent a preoperative evaluation on an outpatient basis, and were operated on for non-cardiac interventions until January 2019, or suspension of surgery due to contraindications determined in the medical appointment. Exclusion criteria: patients under 18 years of age, not undergoing surgery, hospitalized for any reason between revision and surgery, pregnant women, and individuals with preoperative consultation outside the hospital. The computer programs used for data collection and analysis were Microsoft Excel and the International Business Machines Statistical Package for the Social Sciences. RESULTS. 82,68% (754; 912) had a previous clinical condition and 82,13% (749; 912) had a previous surgical intervention. 2,00% (18; 912) of postoperative complications were reported, and one case of death after 72 postoperative hours. No statistically significant correlation p>0,05 was found between the clinical conclusions of the preoperative control and the occurrence of postoperative complications. CONCLUSION. It was evidenced that the preoperative evaluation process was carried out systematically to patients with heterogeneous sociodemographic and clinical characteristics and there was no statistical correlation between its results and the presence of perioperative complications.

Prognostic impact of incomplete surgical clearance of radioiodine sensitive local lymph node metastases diagnosed by post-operative (124)I-NaI-PET/CT in patients with papillary thyroid cancer.

PURPOSE: Nodal involvement is an independent risk factor of recurrence in papillary thyroid cancer (PTC). Neither the international guidelines nor the recently introduced ongoing risk adaptation concept consider the extent of initial surgical clearance of radioiodine sensitive lymph node metastases in their stratification systems. We investigated the prognostic relevance of incomplete initial surgical clearance in patients with purely lymphogeneous metastatic PTC (pN1 M0) despite successful radioiodine therapy. Accurate assessment of pre-ablative nodal status was attempted using PET/CT studies with both (124)I-NaI and (18)F-FDG along with high-resolution cervical ultrasound. METHODS: Sixty-five patients with histologically diagnosed lymph node metastases (pN1 M0) were retrospectively analyzed. Patients with iodine-negative lymph node metastases diagnosed by (18)F-FDG PET/CT or distant metastases were excluded from the analysis. The association of disease recurrence with the pre-ablative nodal status, as well as other baseline characteristics, were examined applying nonparametric tests for independent samples and multiple regression analysis. Patients with persistent lymph node metastases in (124)I-NaI PET/CT were further divided according to the additional presence or absence of FDG-uptake in (18)F-FDG PET/CT. Survival analyses were performed using Kaplan-Meier curves and the Cox proportional hazards model for uni- and multivariate analyses to assess the influence of prognostic factors on progression free survival (PFS). RESULTS: Incomplete metastatic lymph node resection captured by (124)I-NaI PET/CT (n = 33) was an independent risk factor for recurrence (61 % vs 25 %, p = 0.006) and shorter PFS (46 months vs not reached, HR 4.0 [95 %-CI, 1.7-9.2], p = 0.001). Ultrasound could detect lymph node metastases only in 19/33 patients (58 %). Among patients with positive nodal status, FDG-avidity of metastatic iodine positive lymph nodes worsened the outcome (16 vs 69 months, p = 0.047). From all other investigated factors including age, N-stage (N1a vs N1b), and T-Stage (T4 vs T1-3), only large tumor size (pT4) had a significant impact on PFS (HR 2.9 [95 %-CI, 1.3-6.4], p = 0.007). CONCLUSIONS: Incomplete initial surgical clearance of lymph node metastases even after successful radioiodine therapy may increase the chances of recurrence and is an independent risk factor for impaired survival of patients with PTC. Pre-ablative (dual tracer PET/CT) imaging with (124)I-Na and (18)F provides a prognostic tool for these patients and may considerably complement the current risk stratification systems.