RESUMO
Traditionally, patients are positioned in the prone position to access the donor site during the posterior iliac bone graft harvesting procedure. However, this well-established method is associated with complications such as pressure injuries, displacement of the endotracheal tube and intravenous catheter, and blindness. Moreover, the process of turning patients 180° between the supine and prone positions is both laborious and time consuming. However, no updates have been made in the approaches published in the literature to counteract these problems. Therefore, to overcome these challenges and improve patient outcomes, we proposed a pivotal modification: change prone position to the lateral decubitus position. This approach allowed us to effectively avoid the aforementioned complications. In addition, this modification offered significant advantages, including ease of implementation and timesaving benefits. The article presented results of the modification and a comprehensive evaluation of clinical and anesthetic considerations comparing the two methods.
RESUMO
Lumbar disc bulging or herniation (LDBH) is one of the major causes of spinal stenosis and related nerve compression, and its severity is the major determinant for spine surgery. MRI of the spine is the most important diagnostic tool for evaluating the need for surgical intervention in patients with LDBH. However, MRI utilization is limited by its low accessibility. Spinal X-rays can rapidly provide information on the bony structure of the patient. Our study aimed to identify the factors associated with LDBH, including disc height, and establish a clinical diagnostic tool to support its diagnosis based on lumbar X-ray findings. In this study, a total of 458 patients were used for analysis and 13 clinical and imaging variables were collected. Five machine-learning (ML) methods, including LASSO regression, MARS, decision tree, random forest, and extreme gradient boosting, were applied and integrated to identify important variables for predicting LDBH from lumbar spine X-rays. The results showed L4-5 posterior disc height, age, and L1-2 anterior disc height to be the top predictors, and a decision tree algorithm was constructed to support clinical decision-making. Our study highlights the potential of ML-based decision tools for surgeons and emphasizes the importance of L1-2 disc height in relation to LDBH. Future research will expand on these findings to develop a more comprehensive decision-supporting model.
RESUMO
Traditional surgery for thyroid nodule is usually performed via anatomic localization of the recurrent laryngeal nerve (RLN), inferior thyroid artery and parathyroid glands (PTGs) initially. Due to the RLN constantly lying beneath the thyroid gland and low grade malignancy of well-differentiated thyroid cancer (WDTC), it is not necessary to find the nerve initially and impossible to make too deep resection. From May 1998 to July 2005, 33 patients with WDTC underwent total thyroidectomy along the capsule with or without modified radical neck dissection without identifying the RLN and PTGs initially. The isthmus, capsular vessels and Berry's ligament were cut from above and the RLN could be found lying in the surgical bed. The PTGs could be found when the thyroid was retracted medially and removed. The patients were followed-up until December 2007. The safety of the method, complications and clinical outcomes were evaluated. For the patients with WDTC, only one patient (3%) had transient vocal palsy. Incidental parathyroidectomy was found in six (18%) patients, resulting in two (6%) with temporary and two (6%) with permanent hypocalcemia. Only one 86-year-old woman died of disease recurrence; the other patients remained disease-free. Total thyroidectomy for WDTC without identifying the RLN and PTGs initially is an easy and safe alternative method.