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1.
J Perianesth Nurs ; 2024 Jun 20.
Artigo em Inglês | MEDLINE | ID: mdl-38904600

RESUMO

PURPOSE: This study aimed to reveal the effects of a glycemic control protocol directed by nurses during the perioperative period on glycemic outcomes in diabetic patients undergoing major abdominal surgery. DESIGN: This was a prospective cohort study METHODS: The study was conducted at the Department of General Surgery of a research and training hospital in Turkey. The study included 47 patients with type 2 diabetes mellitus who underwent elective major abdominal surgery between September 2017 and December 2018. The number of patients in the intervention and the control groups was 22 and 25, respectively. Routine clinical glycemic control was implemented in the control group, whereas a glycemic management protocol developed by a multidisciplinary team was implemented in the intervention group. We collected data on the control group first, followed by the introduction of the glycemic management protocol to clinical staff and glycemia data collection using the new protocol. Blood glucose (BG) levels in patients and the factors that may affect BG were measured in the preoperative, intraoperative, and postoperative periods. Data on glycemic control was also collected. Furthermore, we measured the satisfaction of the nurses implementing the glycemic management protocol. FINDINGS: The rate of hyperglycemia in intensive care unit was 21% in the intervention group and 59% in the control group (P < .05). Time spent in the target BG range during insulin infusion was 76% in the intervention group and 35% in the control group (P < .05). The time required to achieve target BG range during insulin infusion was 6 hours for the intervention group and 15 hours for the control group, indicating that less time was required to achieve the target BG range in the intervention group (P < .05). Moreover, the insulin consumption rate in the intensive care unit was lower in the intervention group (P < .05). The satisfaction levels of the nurses that used the glycemic management protocol was 92.61 ± 7.93%. CONCLUSIONS: Results of this study showed that the implementation of a glycemic management protocol by nurses for patients undergoing major abdominal surgery decreases the rate of hyperglycemia, insulin consumption rate, and the time required to achieve the targeted BG range during the perioperative period. Therefore, it is recommended to use a glycemia management protocol to control glycemia in patients during the surgical process.

2.
Surgery ; 175(6): 1587-1594, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38570225

RESUMO

BACKGROUND: The use of robot-assisted and laparoscopic pancreatoduodenectomy is increasing, yet large adjusted analyses that can be generalized internationally are lacking. This study aimed to compare outcomes after robot-assisted pancreatoduodenectomy and laparoscopic pancreatoduodenectomy in a pan-European cohort. METHODS: An international multicenter retrospective study including patients after robot-assisted pancreatoduodenectomy and laparoscopic pancreatoduodenectomy from 50 centers in 12 European countries (2009-2020). Propensity score matching was performed in a 1:1 ratio. The primary outcome was major morbidity (Clavien-Dindo ≥III). RESULTS: Among 2,082 patients undergoing minimally invasive pancreatoduodenectomy, 1,006 underwent robot-assisted pancreatoduodenectomy and 1,076 laparoscopic pancreatoduodenectomy. After matching 812 versus 812 patients, the rates of major morbidity (31.9% vs 29.6%; P = .347) and 30-day/in-hospital mortality (4.3% vs 4.6%; P = .904) did not differ significantly between robot-assisted pancreatoduodenectomy and laparoscopic pancreatoduodenectomy, respectively. Robot-assisted pancreatoduodenectomy was associated with a lower conversion rate (6.7% vs 18.0%; P < .001) and higher lymph node retrieval (16 vs 14; P = .003). Laparoscopic pancreatoduodenectomy was associated with shorter operation time (446 minutes versus 400 minutes; P < .001), and lower rates of postoperative pancreatic fistula grade B/C (19.0% vs 11.7%; P < .001), delayed gastric emptying grade B/C (21.4% vs 7.4%; P < .001), and a higher R0-resection rate (73.2% vs 84.4%; P < .001). CONCLUSION: This European multicenter study found no differences in overall major morbidity and 30-day/in-hospital mortality after robot-assisted pancreatoduodenectomy compared with laparoscopic pancreatoduodenectomy. Further, laparoscopic pancreatoduodenectomy was associated with a lower rate of postoperative pancreatic fistula, delayed gastric emptying, wound infection, shorter length of stay, and a higher R0 resection rate than robot-assisted pancreatoduodenectomy. In contrast, robot-assisted pancreatoduodenectomy was associated with a lower conversion rate and a higher number of retrieved lymph nodes as compared with laparoscopic pancreatoduodenectomy.


Assuntos
Laparoscopia , Pancreaticoduodenectomia , Complicações Pós-Operatórias , Pontuação de Propensão , Procedimentos Cirúrgicos Robóticos , Humanos , Pancreaticoduodenectomia/métodos , Pancreaticoduodenectomia/efeitos adversos , Masculino , Feminino , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Procedimentos Cirúrgicos Robóticos/métodos , Laparoscopia/métodos , Laparoscopia/efeitos adversos , Estudos Retrospectivos , Pessoa de Meia-Idade , Europa (Continente)/epidemiologia , Idoso , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Mortalidade Hospitalar , Neoplasias Pancreáticas/cirurgia , Neoplasias Pancreáticas/mortalidade , Resultado do Tratamento
4.
Oncol Res Treat ; 42(10): 516-522, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31437835

RESUMO

BACKGROUND: Colorectal cancer (CRC) is a rare disease amongst children and adolescents. Previous studies have reported a number of differences between children/adolescents, young adults, and adult patients with CRC. However, none of these studies compared these age groups according to their clinicopathologic and prognostic characteristics. In the current study, we compare these three age groups. METHODS: A total of 173 (1.1% of 15,654 patients) young CRC patients (≤25 years) were included in the study. As a control group, 237 adult CRC patients (>25 years) were also included. Patients were divided into three age groups: child/adolescent (10-19 years), young adult (20-25 years), and adult (>25 years). RESULTS: Statistical differences amongst the three groups in terms of gender (p = 0.446), family history (p = 0.578), symptoms of presentation (p = 0.306), and interval between initiation of symptoms and diagnosis (p = 0.710) could not be demonstrated. Whilst abdominal pain (p < 0.001) and vomiting (p = 0.002) were less common in young adults than in other groups, rectal bleeding and changes in bowel habits were relatively less common in adolescents than in other groups. Rectal localisation (p = 0.035), mucinous adenocarcinoma (p < 0.001), and a poorly differentiated histologic subtype (p < 0.001) were less common in the adult group than in other groups. The percentage of patients with metastasis and sites of metastasis (e.g., peritoneum and lung) differed between groups. The median overall survival was 32.6 months in the adolescent group, 57.8 months in the young adult group and was not reached in the adult group (p = 0.022). The median event-free survival of the adolescent, young adult, and adult groups was 29.0, 29.9, and 61.6 months, respectively (p = 0.003). CONCLUSIONS: CRC patients of different age groups present different clinicopathologic and prognostic characteristics. Clinicians should be aware of and manage the disease according to these differences.


Assuntos
Neoplasias Colorretais/epidemiologia , Neoplasias Colorretais/patologia , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Criança , Neoplasias Colorretais/diagnóstico , Neoplasias Colorretais/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Análise de Sobrevida , Resultado do Tratamento , Turquia/epidemiologia , Adulto Jovem
6.
Int J Nurs Stud ; 87: 40-48, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30053681

RESUMO

BACKGROUND: Nausea and vomiting are common postoperative complications that occur within the first 24 h in adults. Clinical practice guidelines and a Cochrane review recommend stimulating the P6 acupoint to prevent or reduce postoperative nausea and vomiting. However, there are currently no standards and optimal timing is not known. OBJECTIVES: The purpose of this study was to evaluate the effect of acupressure application on the P6 acupoint, using acupressure wristbands, in the prevention of postoperative nausea and vomiting and the antiemetic drug requirement in patients who had high postoperative nausea and vomiting risk related to laparoscopic cholecystectomy. DESIGN: This was a longitudinal, randomized controlled clinical study. SETTINGS: The study was conducted in the general surgery department of a training and research hospital (105 beds), from March 2015 to March 2016. PARTICIPANTS: A total of 111 female patients who underwent laparoscopic surgery were divided into three groups of 37, using a block randomization method. METHODS: Training on acupressure wristband use was provided to the intervention group and an acupressure wristband with a plastic cap was placed at the P6 acupoint. A wristband with the same appearance as the acupressure wristband, but without a cap, was used in the placebo group. No intervention was used in the control group. The wristband was placed approximately one hour before the surgery and removed six hours after the surgery in both the intervention and placebo groups. The data were collected at the 2nd, 6th, and 24th postoperative hours. RESULTS: The application of the acupressure wristband to the P6 acupoint in patients who underwent laparoscopic cholecystectomy was found to be more effective in decreasing the severity of nausea at the 2nd postoperative hour and the nausea incidence at 2-6 h, postoperatively, when compared to the placebo group (p < 0.05). However, there was no statistically significant difference between the intervention group and the control group. Therefore, acupressure application to the P6 acupoint was not found to be clinically effective in decreasing postoperative vomiting, antiemetic drug requirement, and in decreasing pain, anxiety, or the need for analgesic drugs (p > 0.05). CONCLUSIONS: We did not find the stimulation of the P6 acupoint with an acupressure wristband to be clinically effective in reducing postoperative nausea and vomiting or antiemetic drug requirement in patients who underwent laparoscopic cholecystectomy.


Assuntos
Acupressão , Colecistectomia Laparoscópica/efeitos adversos , Náusea e Vômito Pós-Operatórios/prevenção & controle , Adolescente , Adulto , Idoso , Feminino , Humanos , Estudos Longitudinais , Pessoa de Meia-Idade , Placebos , Adulto Jovem
7.
Case Rep Surg ; 2018: 8782328, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29850361

RESUMO

The main method of fighting against colon cancer is targeted treatment. BRAF inhibitors, which are accepted as standard treatment for V600E mutant malign melanomas, are the newest approach for targeted treatment of V600E mutant colorectal cancers. In this case report, we share our experience about the use of BRAF inhibitor vemurafenib on a V600E mutant metastatic right colon adenocarcinoma patient. A 59-year-old male with only lung multiple metastatic V600E mutant right colon cancer presented to our clinic. The patient was evaluated and FOLFOX + bevacizumab treatment was initiated, which was then continued with vemurafenib. A remarkable response was achieved with vemurafenib treatment in which the drug resistance occurred approximately in the sixth month. Even though the patient benefited majorly from vemurafenib, he died on the 20th month of the diagnosis. The expected overall survival for metastatic V600E mutant colon adenocarcinoma patients is 4.7 months. BRAF inhibitors provide new treatment alternatives for V600E mutant colorectal cancers, with prolonged overall survival. BRAF inhibitors in combination with MEK inhibitors are reported as feasible treatment to overcome BRAF inhibitor drug resistance on which phase studies are still in progress. To conclude, BRAF inhibitors alone or in combination with other drugs provide a chance for curing BRAF V600E mutant colorectal cancer patients.

9.
Balkan Med J ; 34(1): 35-40, 2017 01.
Artigo em Inglês | MEDLINE | ID: mdl-28251021

RESUMO

BACKGROUND: Intraabdominal adhesions remain a significant cause of morbidity and mortality. Moreover, intraabdominal adhesions can develop in more than 50% of abdominal operations. AIMS: We compared the anti-adhesive effects of two different agents on postoperative adhesion formation in a cecal abrasion model. STUDY DESIGN: Experimental animal study. METHODS: Forty Wistar albino type female rats were anesthetized and underwent laparotomy. Study groups comprised Sham, Control, Mitomycin-C, 4% Icodextrin, and Mitomycin-C +4% Icodextrin groups. Macroscopic and histopathological evaluations of adhesions were performed. RESULTS: The frequencies of moderate and severe adhesions were significantly higher in the control group than the other groups. The mitomycin-C and Mitomycin-C +4% Icodextrin groups were associated with significantly lower adhesion scores compared to the control group and 4% Icodextrin group scores (p=0.002 and p=0.008, respectively). The adhesion scores of the Mitomycin-C group were also significantly lower than those of the 4% Icodextrin group (p=0.008). CONCLUSION: Despite its potential for bone marrow toxicity, Mitomycin-C seems to effectively prevent adhesions. Further studies that prove an acceptable safety profile relating to this promising anti-adhesive agent are required before moving into clinical trials.


Assuntos
Glucanos/farmacologia , Glucose/farmacologia , Mitomicina/farmacologia , Aderências Teciduais/prevenção & controle , Alquilantes/farmacologia , Alquilantes/uso terapêutico , Animais , Glucanos/uso terapêutico , Glucose/uso terapêutico , Icodextrina , Mitomicina/uso terapêutico , Complicações Pós-Operatórias/tratamento farmacológico , Complicações Pós-Operatórias/patologia , Complicações Pós-Operatórias/prevenção & controle , Ratos , Ratos Wistar/cirurgia
10.
Int J Nurs Stud ; 62: 108-17, 2016 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-27474943

RESUMO

BACKGROUND: Evidence on the effectiveness of using a binder following abdominal surgery and its effect on gastrointestinal function, mobilization, pulmonary function, and pain is currently unclear. OBJECTIVE: The purpose of this study is to determine the effect of abdominal binder usage on gastrointestinal function, mobilization, pulmonary function, and postoperative pain in patients undergoing major abdominal surgery. DESIGN: This research was conducted as a randomized controlled trial. SETTINGS: The study was conducted at the Department of General Surgery at a military education and research hospital in Ankara, Turkey, between September 2013 and April 2014. PARTICIPANTS: 104 patients were assessed for eligibility. The study was conducted on 84 eligible patients. METHODS: The study sample consisted of 84 patients who underwent effective major abdominal surgery. The patients were randomized into two groups, the intervention group, which used an abdominal binder and the control group, which did not. Gastrointestinal function, mobilization, pulmonary function, and the pain status of both groups were evaluated on the first, fourth, and seventh days before and after surgery, and the intergroup results were compared. RESULTS: No significant difference was found between the two groups in terms of gastrointestinal and pulmonary function on the first, fourth, and seventh days following surgery (p>0.05). A comparative assessment of mobility by walking distance showed that patients in the intervention group were able to walk further on the fourth [mean (SD); 221.19 (69.08) m] and seventh [227.85 (60.02) m] days after surgery (p=0.003, p<0.001). There were differences in the acute pain status between patients in both groups (p<0.05). On the first [mean (SD); 8.80 (5.03)], fourth [4.83 (2.78)], and seventh [3.09 (3.17)] days after surgery, the sensory sub-scale pain scores were higher in the control group (p<0.001). On the first [mean (SD); 10.16 (6.14)], fourth [5.28 (3.52)], and seventh [3.30 (3.51)] days after surgery the total pain scores were higher in the control group (p<0.001). The visual analogue scale scores were also higher in the control group on the first [mean (SD) 6.26 (1.86)], fourth [4.50 (2.10)], and seventh [3.04 (2.43)] days after surgery (p<0.001). CONCLUSION: The study's findings reveal that the use of an abdominal binder does not have any effect on postoperative gastrointestinal and pulmonary function. However, an abdominal binder increases patient mobility soon after surgery. There was also a measurable effect on pain, with lower scores reported by patients who used an abdominal binder after any exercise or activity. These results indicate that the use of a routine abdominal binder is helpful for patients undergoing major abdominal surgery.


Assuntos
Abdome/cirurgia , Dor Pós-Operatória/prevenção & controle , Testes de Função Respiratória , Procedimentos Cirúrgicos Operatórios , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Período Pós-Operatório , Turquia
11.
Eur Surg Res ; 56(3-4): 132-40, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26845699

RESUMO

BACKGROUND/PURPOSE: The presentation of scientific studies at major meetings serves to rapidly share study results with the scientific community. On the other hand, full-text publication of abstracts in peer-reviewed journals ensures the dissemination of science. This study examines the publication rate (PR) of meeting abstracts presented at the European Society for Surgical Research (ESSR) congresses and determines/compares the factors affecting the PRs. METHODS: All presentations at the ESSR congresses held during 2008-2011 were retrospectively assessed. Manuscripts indexed in PubMed were included. The meeting year, journal impact factor (IF) in the publication year, study type, presentation type, time to publication and geographic origin of studies were assessed. RESULTS: Among a total of 1,368 oral and poster abstracts, 48.7% (n = 391) of the oral presentations (OPs) and 29.7% (n = 168) of the poster presentations (PPs) were published in medical journals indexed in PubMed. The mean IF of the journals was 2.696 (0.17-14.95). The journals that published OPs had a higher IF than the journals in which PPs were published (2.944 vs. 2.118; p < 0.001). The PR was also higher in the OP group than in the PP group of journals (p < 0.001). The time to publication was 17.5 months (-166 to 82) and was shorter for PPs than for OPs (14.02 vs. 19.09 months; p = 0.01). According to the study type, experimental studies had a significantly higher PR (53.7%; p < 0.001); however, there was no significant difference in PR in terms of the prospective or retrospective nature of clinical studies. The clinical studies were also compared according to the IF values of the journals in terms of the prospective or retrospective nature of the study, and no significant difference was found (p = 0.62). CONCLUSION: The ESSR congress is an efficient meeting for researchers from varied surgical disciplines and has a PR equivalent to that of similar scientific meetings. The congress has achieved a PR of 40.9% over 4 years with an average IF of 2.696 and a mean time to publication of 17.5 months, which is equivalent to that of similar scientific meetings. OPs have a higher PR in journals with greater IF values as compared with PPs.


Assuntos
Congressos como Assunto , Cirurgia Geral , Editoração/estatística & dados numéricos , Europa (Continente) , Publicações Periódicas como Assunto , Sociedades Médicas , Fatores de Tempo
12.
J Laparoendosc Adv Surg Tech A ; 23(8): 651-62, 2013 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-23755853

RESUMO

Evolutions in minimally invasive surgical techniques and advances in sentinel node navigation surgery (SNNS) have had considerable impact on current insights into surgical treatment of gastric cancer. Extensive data on this method of surgical application have accumulated but have been principally derived from single-institute studies. Isosulfan blue and patent blue violet have been the most frequently used dye tracers in the past; however, indocyanine green has now is increasingly popular. The double-tracer method, where dye and radioisotope tracers are used together, seems to be more effective than any single tracer. Among newly emerging adjunct techniques and promising alternative in particular are infrared ray electronic endoscopy, florescence imaging, nanoparticles, and near-infrared technology. Hematoxylin and eosin (H&E) staining is still the method of choice for the detection of sentinel lymph node (SLN) metastases. Immunohistochemical staining can be used to support H&E findings, but the equipment costs of ultrarapid processing systems are currently slowing down their worldwide spread. We believe minimally invasive function-preserving resection of the stomach, together with lymphatic basin dissection navigated by SLNs, can represent the ideal approach for SNNS to detect clinically node-negative early gastric cancer, although this remains to be elucidated. Patients with cT3 or more advanced disease should still be treated by means of standard D2 dissection.


Assuntos
Linfonodos/patologia , Biópsia de Linfonodo Sentinela/métodos , Neoplasias Gástricas/patologia , Neoplasias Gástricas/cirurgia , Previsões , Humanos , Metástase Linfática/patologia , Seleção de Pacientes , Biópsia de Linfonodo Sentinela/tendências
13.
World J Gastrointest Surg ; 5(1): 5-8, 2013 Jan 27.
Artigo em Inglês | MEDLINE | ID: mdl-23515236

RESUMO

Liver resection (LR) and primary liver transplantation (LT) are two potentially curative treatment modalities for patients with hepatocellular carcinoma (HCC). If an underlying chronic liver disease exists, however, making a decision on which method should be selected is difficult. If a patient has no chronic liver disease, LR may be the preferable option with salvage transplantation (ST) in mind in case of recurrence. Presence of a moderate-to-severe liver failure accompanying HCC usually warrants primary LT. The treatment of patients with HCC and early-stage chronic liver disease remains controversial. The advantages of "LR-followed-by-ST-if-needed" strategy include less complicated index operation, no need for immunosuppression, use of donor livers for other patients in today's organ shortage setting and comparable survival rates. However, primary LT has its own advantages as it also treats underlying chronic liver disease with carcinogenic potential, removes undetected tumor nodules and potentially eliminates need for a ST. An article recently published by Fuks et al in Hepatology offers an approach by which selecting between LR-followed-by-ST and immediate LT might be easier. Here we discuss the results of the aforementioned report in the light of currently available knowledge.

14.
Int Surg ; 98(1): 33-42, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23438274

RESUMO

The aim of the present study was to investigate the effect of hyperbaric oxygen therapy (HBOT) on colon anastomosis after chemoradiotherapy (CRT). Sixty female Wistar-Albino rats were divided into 5 groups and underwent left colon resection and end-to-end anastomosis. CRT simulation was performed on 2 sham groups before the anastomosis, and 1 of these groups was administered additional postoperative HBOT. Two groups were administered CRT before the anastomosis, and 1 of them received additional postoperative HBOT. On postoperative day 5, all groups underwent relaparotomy; burst pressure was measured and samples were obtained for histopathologic and biochemical analysis. There was a significant weight loss in the CRT groups and postoperative HBOT had an improving effect. Significantly decreased burst pressure values increased up to the levels of the controls after HBOT. Hydroxyproline levels were elevated in all groups compared to the control group. Hydroxyproline levels decreased with HBOT after CRT. No significant difference was observed between the groups regarding fibrosis formation at the anastomosis site. However, regression was observed in fibrosis in the group receiving HBOT after CRT. Preoperative CRT affected anastomosis and wound healing unfavorably. These unfavorable effects were alleviated by postoperative HBOT. HBOT improved the mechanical and biochemical parameters of colon anastomosis in rats.


Assuntos
Fístula Anastomótica/prevenção & controle , Quimiorradioterapia Adjuvante/efeitos adversos , Colo/cirurgia , Oxigenoterapia Hiperbárica , Terapia Neoadjuvante/efeitos adversos , Cuidados Pós-Operatórios/métodos , Cicatrização , Anastomose Cirúrgica , Animais , Colectomia , Colo/patologia , Feminino , Distribuição Aleatória , Ratos , Ratos Wistar , Cicatrização/efeitos dos fármacos , Cicatrização/efeitos da radiação
15.
Ulus Cerrahi Derg ; 29(2): 92-5, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-25931855

RESUMO

The aim of this report is to assess clinical findings and surgical treatment of left paraduodenal hernia, which is an unusual type of internal herniation, in light of the literature. The diagnosis and treatment course of a 42-year-old male patient with findings of intestinal obstruction was assessed and presented together with literature search. The patient underwent surgery with a preliminary diagnosis of intestinal obstruction and the definitive diagnosis of internal herniation was made intraoperatively. Nearly two-thirds of the small intestine was found to be herniated into the retroperitoneal space from the left paraduodenal region. Small bowel loops were pulled out of the hernia sac and anatomically positioned in the intraperitoneal area. The hernia sac was repaired primarily. The patient was discharged on the fourth postoperative day, uneventfully. Left paraduodenal hernia should be considered as a part of differential diagnosis in patients who have recurring abdominal pain episodes accompanied by symptoms suggestive of intestinal obstruction. Timely diagnosis is important to prevent complications. Reduction of hernia content followed by primary repair of the defect appears to be a safe and effective treatment.

16.
World J Gastrointest Surg ; 3(9): 131-7, 2011 Sep 27.
Artigo em Inglês | MEDLINE | ID: mdl-22007282

RESUMO

Development of sentinel node navigation surgery (SNNS) and advances in minimally invasive surgical techniques have greatly shaped the modern day approach to gastric cancer surgery. An extensive body of knowledge now exists on this type of clinical application but is principally composed of single institute studies. Certain dye tracers, such as isosulfan blue or patent blue violet, have been widely utilized with a notable amount of success; however, indocyanine green is gaining popularity. The double tracer method, a synchronized use of dye and radio-isotope tracers, appears to be superior to any of the dyes alone. In the meantime, the concepts of infrared ray electronic endoscopy, florescence imaging, nanoparticles and near-infrared technology are emerging as particularly promising alternative techniques. Hematoxylin and eosin staining remains the main method for the detection of sentinel lymph node (SLN) metastases. Several specialized centers have begun to employ immunohistochemical staining for this type of clinical analysis but the equipment costs involving the associated ultra-rapid processing systems is limiting its widespread application. Laparoscopic function-preserving resection of primary tumor from the stomach in conjunction with lymphatic basin dissection navigated by SLN identification represents the current paramount of SNNS for early gastric cancer. Patients with cT3 stage or higher still require standard D(2) dissection.

17.
Am J Surg ; 200(3): 318-27, 2010 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-20122682

RESUMO

BACKGROUND: There is still no consensus as to the optimal treatment for sacrococcygeal pilonidal disease (SPD). Many recommend off-midline closure, if any excisional procedure is to be selected. METHODS: The authors prospectively studied 145 patients with SPD who presented at 3 hospitals. Patients were randomly assigned to undergo either modified Limberg flap (MLF) transposition (n = 72) or Karydakis flap reconstruction (n = 73). Surgical findings, complications, recurrence rates, and degree of patient satisfaction, evaluated via a standardized telephone interview, were compared. RESULTS: Operation time was longer in the MLF group. There were no significant differences between the two groups in terms of complication rate, length of stay, or recurrence rate. Patients in the Karydakis group reported feeling completely healed more quickly postoperatively. The two groups reported similar rates of satisfaction. Mandatory patient withdrawal from a given study arm because of the orifice straying from the midline occurred more frequently in the Karydakis group. CONCLUSIONS: The MLF technique and the Karydakis procedure appear to generate comparable outcomes. With laterally situated orifices, however, the applicability of the Karydakis method may be limited.


Assuntos
Seio Pilonidal/cirurgia , Região Sacrococcígea/cirurgia , Retalhos Cirúrgicos , Adulto , Distribuição de Qui-Quadrado , Feminino , Humanos , Entrevistas como Assunto , Masculino , Estudos Prospectivos , Procedimentos de Cirurgia Plástica , Estatísticas não Paramétricas , Resultado do Tratamento
18.
Surg Today ; 39(7): 580-6, 2009.
Artigo em Inglês | MEDLINE | ID: mdl-19562445

RESUMO

PURPOSE: There is a high incidence of sacrococcygeal pilonidal disease (SPD) among young males. Despite increasing data on the treatment of SPD, no standard treatment has yet been established. The goal of this study was to compare the Karydakis flap reconstruction with a primary midline closure (PMC) in the treatment of patients with SPD. METHODS: The study included 200 patients treated over a period of 30 months. After a power analysis, the study was run on a two-directional basis (both retrospective reviews of patient charts and a telephone interview for prospective evaluation). The surgical findings, complications, recurrence rates, and degree of satisfaction based on a questionnaire were assessed. RESULTS: The duration of the surgery was longer in the Karydakis group. Complications were more frequently seen in the PMC group. The recurrence rate was 4.6% for the Karydakis group and 18.4% for the PMC group. Of patients who underwent the Karydakis operation, 70.8% were completely satisfied with the procedure, while only 32.6% of patients who underwent the PMC reported excellent satisfaction. A significantly higher number of patients in the Karydakis group recommended the same procedure to other patients with SPD. CONCLUSION: The Karydakis method may be a preferable option in the treatment of SPD, due to the low rate of recurrence and the promising satisfaction rates.


Assuntos
Seio Pilonidal/cirurgia , Retalhos Cirúrgicos , Adulto , Humanos , Entrevistas como Assunto , Masculino , Militares , Estudos Prospectivos , Estudos Retrospectivos , Inquéritos e Questionários , Adulto Jovem
19.
Nutrition ; 25(1): 72-7, 2009 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-18849145

RESUMO

OBJECTIVE: Preoperative carbohydrate loading with clear fluids is thought to reduce surgery-related insulin resistance (IR). However, IR per se is already present in some patients scheduled for elective surgery. Data on the safety of preoperative oral carbohydrate loading in patients with IR undergoing surgery is lacking. We aimed to evaluate the effects of preoperative carbohydrate loading on the glucometabolic state and gastric content of patients with and without IR. METHODS: Thirty-four non-diabetics received 800 mL of a special carbohydrate-containing drink on the evening before the operation and then 400 mL 2 h before surgery. Blood samples for glucose, insulin, and cortisol levels were taken immediately before the second dose, at 40 and 90 min after intake of the drink, and at the onset of surgery. Patients with a homeostasis model assessment IR score >2.5 were considered to have IR. The differences between patients with and without IR were then evaluated. RESULTS: Eight of the 34 patients had IR and the remaining 26 did not. Glucose levels in the IR group were higher than those in the non-IR group, but the differences did not reach significance. The initially elevated insulin concentrations then tended to decrease to the corresponding levels detected in the non-IR group. The cortisol concentrations were similar in both groups. CONCLUSION: Patients with IR receiving a carbohydrate-rich drink before surgery appear not to be affected adversely by the beverage. Furthermore, they also obtain the probable beneficial effects related to these drinks and, like patients without IR, can undergo surgery safely.


Assuntos
Glicemia/metabolismo , Carboidratos da Dieta/administração & dosagem , Carboidratos da Dieta/metabolismo , Resistência à Insulina , Insulina/sangue , Cuidados Pré-Operatórios/métodos , Administração Oral , Adulto , Idoso , Índice de Massa Corporal , Colecistectomia , Feminino , Ácido Gástrico/química , Conteúdo Gastrointestinal/química , Humanos , Hidrocortisona/sangue , Concentração de Íons de Hidrogênio , Insulina/metabolismo , Resistência à Insulina/fisiologia , Masculino , Pessoa de Meia-Idade , Cuidados Pré-Operatórios/normas , Tireoidectomia , Adulto Jovem
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