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1.
Acta Chir Orthop Traumatol Cech ; 88(2): 101-106, 2021.
Artículo en Checo | MEDLINE | ID: mdl-33960922

RESUMEN

PURPOSE OF THE STUDY Diagnosis and treatment of fractures of the facial skeleton in children can be difficult due to the skeletal growth. MATERIAL AND METHODS The 9-year retrospective study included patients admitted with the orbital fracture diagnosis to the University Hospital Brno, Children s Hospital, Department of Paediatric ENT, Department of Paediatric Anaesthesiology and Resuscitation, and Department of Paediatric Surgery, Orthopaedics and Traumatology. We looked into the number of patients admitted to the hospital with the orbital fracture diagnosis and the cause of the injury, the age of patients, and the used treatment method - surgical or non-operative treatment were analysed. The following assumptions were applied: 1. Incidence of the injury (orbital fracture) increases with the age of the patient, 2. Incidence of the injury in individual years is constant. RESULTS In the followed-up period, between 2010 and 2018, a total of 47 patients, of whom 8 girls and 39 boys, with the orbital fracture diagnosis were treated. 12 patients underwent surgery, 35 patients were treated non-operatively. The study group included 47 patients with the age range of 1 to 18 years, with the median age 12 years. When the results were processed, a trend was revealed showing an increase in the number of injuries as well as an in the age of patients at the time of injury. The number of injuries increases with age and year. Both the correlations, however, are statistically insignificant and the trend can be considered statistically insignificant. DISCUSSION Both the non-operative and surgical treatment of patients lead to excellent results, even in the long-term follow-up. In paediatric patients, the surgical approach should be opted for only in cases when the non-operative approach is impossible due to the extent and characteristics of fracture and damage to soft tissues. CONCLUSIONS The surgical treatment aims at the best possible anatomical reconstruction of the orbit with no subsequent functional or cosmetic defects. If surgical treatment is necessary, then the transconjunctival approach is most appropriate in children, namely because of the good overview over the operating field, simple procedure as well as the cosmetic outcome. In most cases it is enough to reposition the orbital soft tissues. In complicated cases, with an orbital floor defect, it needs to be covered with a suitable material. Also, the non-operative approach has its place in therapy and the case-by-case approach must be applied. Orbital fractures should always be treated by experienced specialists (ENT, dental surgeon, traumatologist) specialising in paediatric patients. Key words: fracture, orbit, childhood, surgical, non-operative treatment.


Asunto(s)
Fracturas Orbitales , Procedimientos Ortopédicos , Adolescente , Niño , Preescolar , Femenino , Humanos , Lactante , Masculino , Fracturas Orbitales/diagnóstico , Fracturas Orbitales/epidemiología , Fracturas Orbitales/cirugía , Complicaciones Posoperatorias , Estudios Retrospectivos , Resultado del Tratamiento
2.
Georgian Med News ; (312): 14-22, 2021 Mar.
Artículo en Ruso | MEDLINE | ID: mdl-33964819

RESUMEN

The level of calcium in the blood serum, voice function, thyroid status and quality of life of patients up to 1 year after removal of the thyroid gland were studied. Thyroidectomy is an operation associated with a high risk of postoperative hypocalcemia with clinical manifestations (19.6%), which is transient in 15.5%, and permanent in 4.1%. After thyroidectomy transient voice disorders are observed that are not associated with paresis of the laryngeal nerves. These voice disorders spontaneously resolve in the period from 2 to 6 months after the operation. The effectiveness and safety of therapy for postoperative hypothyroidism, the correct selection of the dose of L-thyroxine depends not only on the level of TSH, but also on the genetic characteristics of the patient. Pharmacogenetic testing allows predicting the effectiveness of hypothyroidism correction. The quality of life after thyroidectomy is generally worse than after organ-preserving operations. To a large extent, it is determined by hypothyroidism. In the long term, the quality of life after thyroidectomy approaches the estimates of patients after organ-preserving operations. For an adequate assessment of the results of the operation, it is necessary to analyze the results no earlier than 1 year later.


Asunto(s)
Calidad de Vida , Glándula Tiroides , Humanos , Glándulas Paratiroides , Complicaciones Posoperatorias/cirugía , Glándula Tiroides/cirugía , Tiroidectomía
3.
Georgian Med News ; (312): 36-42, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33964823

RESUMEN

Goal - to determine efficacy of the Ileosigmo-pouch (ISP) as a method of transrectal urinary diversion in invasive bladder cancer (BC) treatment. Retrospective analysis of clinical data of patients that undergone radical cystectomy (RC), followed by ISP method of urinary diversion. Study compared two groups of patients: the first group of 22 (23.6%) patients with ISP and the control group included 71 (76.4%) patients with Mainz pouch II (MP II) diversion. The groups were statistically comparable by major clinical parameters. Complication rates were evaluated with Clavien-Dindo classification. There were no significant differences in the duration of surgery procedure, - ISP 210 - 562 (380.4±38.4) minutes vs. 190 - 557 (311.3±49.5) minutes for MP II. Levels of intraoperative blood loss in both groups were comparable: 110 - 2850 (707.42±97.2) ml vs. 170 - 3000 (788.51±141.3) ml. Peroiperative complications after ISP and MP II (1 (4.5%) vs. 6 (4.8%)) did not exceed 3 grade according to Clavien-Dindo. The frequency of postoperative chronic pyelonephritis (CP) was higher in MP II 26 (24.3%) vs. ISP 3 (15.7%). Gas reflux into the kidneys was observed only in MP II 18 (16.8%). Metabolic acidosis was revealed in 27 (25.2%) after MP II and in 2 (10.5%) after ISP. During the ISP formation comparing to MP II, the pouch volume increased in average up to 1000 ml vs. 750 ml., the pressure in a sigmoid colon decreases to 18 cm of water column against 35 cm wc. Urination/defecation frequency was improved in patients after ISP - every 3-4 hours during the day and 5-6 hours at night vs. MP II every 2-3 hours during the day and 3-4 hours at night. The ISP method of urinary diversion in our study showed improvements of urodynamic parameters and eliminated the body metabolic disorders when compared to transrectal diversion with MP2. This viable option of diversion in patients with invasive bladder cancer who are not candidates for neobladder, but strongly afraid of cutaneous urinary stoma.


Asunto(s)
Neoplasias de la Vejiga Urinaria , Derivación Urinaria , Cistectomía/efectos adversos , Humanos , Músculos , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Estudios Retrospectivos , Resultado del Tratamiento , Neoplasias de la Vejiga Urinaria/cirugía
4.
Zhong Nan Da Xue Xue Bao Yi Xue Ban ; 46(4): 400-403, 2021 Apr 28.
Artículo en Inglés, Chino | MEDLINE | ID: mdl-33967087

RESUMEN

OBJECTIVES: Thoracoabdominal aortic aneurysm (TAAA) prosthetic vessel replacement is one of the most complex operations in the field of cardiovascular surgery. The key to success of this operation is to prevent and avoid ischemia of important organs while repairing TAAA. This study aims to summarize and analyze the effect of prosthetic vessel replacement under left heart bypass in the treatment of TAAA. METHODS: Data of 15 patients with TAAA who underwent prosthetic vessel replacement under left heart bypass in Xiangya Hospital of Central South University were retrospectively analyzed. According to Crawford classification, there were 2 cases of type I, 8 cases of type II, 3 cases of type III, and 2 cases of type V. There were 14 cases of selective operation and 1 case of emergency operation. All operations were performed under left heart bypass, and cerebrospinal fluid drainage was performed before operation. Left heart bypass was established by intubation of left inferior pulmonary vein and distal abdominal aorta or left femoral artery. The thoracoabdominal aorta was replaced segment by segment. After aortic dissection, the kidneys were perfused with cold crystalloid renal protective solution, and the celiac trunk and superior mesenteric artery were perfused with warm blood. RESULTS: One patient with TAAA after aortic dissection of type A died. During the operation, straight blood vessels were used to repair TAAA, and the celiac artery branches were trimmed into island shape and anastomosed with prosthetic vessels. After the operation, massive bleeding occurred at the anastomotic stoma, then anaphylactic reaction occurred during massive blood transfusion, resulting in death. One patient suffered from paraplegia due to ischemic injury of spinal cord. The other patients recovered well and were discharged. The postoperative ventilation time was (16.5±13.8) h and the postoperative hospital stay was (10±4) d. The amount of red blood cell transfusion was (13±9) U. The patients were followed up for 2 months to 2 years, and the recovery was satisfactory. CONCLUSIONS: The effect of prosthetic vessel replacement under left heart bypass in the treatment of TAAA is good, which is worthy of clinical promotion.


Asunto(s)
Aneurisma Disecante , Aneurisma de la Aorta Torácica , Implantación de Prótesis Vascular , Aneurisma Disecante/cirugía , Aneurisma de la Aorta Torácica/cirugía , Puente Cardíaco Izquierdo , Humanos , Complicaciones Posoperatorias , Estudios Retrospectivos , Resultado del Tratamiento
5.
Curr Opin Anaesthesiol ; 34(3): 238-245, 2021 Jun 01.
Artículo en Inglés | MEDLINE | ID: mdl-33935171

RESUMEN

PURPOSE OF REVIEW: Obesity is a major health epidemic, with the prevalence reaching ∼40% in the United States in recent years. It is associated with increased risk of hypertension, diabetes, heart disease, stroke, obstructive sleep apnea (OSA), and gynecologic conditions requiring surgery. Those comorbidities, in addition to the physiologic changes associated with obesity, lead to increased risk of perioperative complications. The purpose of this review is to highlight the anesthetic considerations for robotic assisted hysterectomy in obese patients. RECENT FINDINGS: In the general gynecologic population, minimally invasive surgery is associated with less postoperative fever, pain, hospital length of stay, total cost of care and an earlier return to normal function. This also applies to robotic surgery in obese patients, which is on the rise. The physiologic changes of obesity bring different anesthetic challenges, including airway management and intraoperative ventilation. Vascular access and intraoperative blood pressure monitoring can also be challenging and require modifications. Optimizing analgesia with a focus on opioid-sparing strategies is crucial due to the increased prevalence of OSA in this patient population. SUMMARY: Anesthesia for obese patients undergoing robotic hysterectomy is challenging and must take into consideration the anatomic and physiologic changes associated with obesity.


Asunto(s)
Anestésicos , Procedimientos Quirúrgicos Robotizados , Femenino , Humanos , Histerectomía/efectos adversos , Obesidad/complicaciones , Obesidad/epidemiología , Complicaciones Posoperatorias , Procedimientos Quirúrgicos Robotizados/efectos adversos
6.
Curr Opin Anaesthesiol ; 34(3): 357-363, 2021 Jun 01.
Artículo en Inglés | MEDLINE | ID: mdl-33935185

RESUMEN

PURPOSE OF REVIEW: Anesthetics are known to have immunomodulatory effects. These can be detrimental, inducing immunosuppression and facilitating the development of opportunistic infections, especially when used at high doses, for prolonged periods, or in patients with preexisting immune deficiency; or beneficial, modulating the inflammatory response, particularly in critical illness and systemic hyperinflammatory states. RECENT FINDINGS: Anesthetics can have microbicidal properties, and both anti- and pro-inflammatory effects. They can act directly on immune cells as well as modulate immunity through indirect pathways, acting on the neuroimmune stress response, and have recently been described to interact with the gut microbiota. SUMMARY: Anesthesiologists should take into consideration the immunomodulatory properties of anesthetic agents in addition to their hemodynamic, neuroprotective, and other impacts. In future, patient stratification according to the perioperative assessment of serum biomarkers associated with postoperative complications may be used to guide anesthetic agent selection based on their immunomodulatory properties.


Asunto(s)
Anestesia , Anestésicos , Anestesia/efectos adversos , Anestésicos/efectos adversos , Humanos , Factores Inmunológicos/efectos adversos , Complicaciones Posoperatorias
7.
Curr Opin Anaesthesiol ; 34(3): 381-386, 2021 Jun 01.
Artículo en Inglés | MEDLINE | ID: mdl-33935187

RESUMEN

PURPOSE OF REVIEW: After successfully reducing mortality in the operating room, the time has come for anesthesiologists to conquer postoperative complications. This review aims to raise awareness about myocardial injury after noncardiac surgery (MINS), its definition, diagnosis, clinical importance, and treatment. RECENT FINDINGS: MINS, defined as an elevated postoperative troponin judged to be due to myocardial ischemia (with or without ischemic features), occurs in up to one in five patients having noncardiac surgery and is responsible for 16% of all postoperative deaths within 30 days of surgery. New evidence on risk factors, etiology, potential prevention strategies, treatment options, and the economic impact of MINS highlights the actionability of perioperative clinicians in caring for adult patients who are considered to be at risk of cardiovascular complications. SUMMARY: Millions of patients safely going through surgery suffer MINS and die shortly after the procedure every year. Without a structured approach to predicting, preventing, diagnosing, and treating MINS, we lose the opportunity to provide our patients with the best chance of deriving benefit from noncardiac surgery. The perioperative community needs to come together, appreciate the clinical relevance of MINS, and step up with high-quality research in the future.


Asunto(s)
Isquemia Miocárdica , Procedimientos Quirúrgicos Operativos , Humanos , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Periodo Posoperatorio , Factores de Riesgo , Procedimientos Quirúrgicos Operativos/efectos adversos , Troponina
8.
Eur J Med Res ; 26(1): 39, 2021 Apr 30.
Artículo en Inglés | MEDLINE | ID: mdl-33931102

RESUMEN

BACKGROUND: The purpose of this article is to summarize the epidemiologic characteristics and double-buffered strategy for patients in orthopedic surgery during the COVID-19 outbreak in Wuhan, China, based on our own experience in our hospital. METHODS: A retrospective and comparative study was performed to identify all inpatients at our clinic from February 17 to April 20, 2020 (epidemic group), and from February 17 to April 20, 2019 (control group). Epidemiologic characteristics, screening effect, perioperative complications, and nosocomial infection were analyzed. RESULTS: In the epidemic group, 82 patients were identified, a decrease by 76.0% than the 342 patients in the same period in the 2019. Patients in the epidemic group (54.6 ± 20.2 years) were older than those in the control group (49.6 ± 22.5 years). For the epidemic group, the proportion rates of traumatic factures (69.5%) and low-energy injuries (86.0%) were higher than that in the control group, respectively (35.4% and 37.2%). The preoperative waiting time (7.0 ± 2.6 days) in the epidemic group was longer than that in the control group (4.5 ± 2.1 days). The postoperative complication rate (12.2%) in the epidemic group was higher than that in the control group (3.5%). No nosocomial infection of orthopedic staff and patients with COVID-19 was noted in the epidemic group. CONCLUSION: During the COVID-19 outbreak in Wuhan, China, orthopedic inpatients showed unique epidemiological characteristics. The double-buffered strategy could effectively avoid nosocomial infections among medical staff and patients. Doctors should fully evaluate the perioperative risks and complications.


Asunto(s)
/epidemiología , Procedimientos Ortopédicos/estadística & datos numéricos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , China/epidemiología , Infección Hospitalaria/epidemiología , Tratamiento de Urgencia , Femenino , Personal de Salud/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Procedimientos Ortopédicos/efectos adversos , Equipo de Protección Personal , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Estudios Retrospectivos , Adulto Joven
9.
Bone Joint J ; 103-B(5): 976-983, 2021 May.
Artículo en Inglés | MEDLINE | ID: mdl-33934644

RESUMEN

AIMS: To evaluate the perioperative complications associated with total en bloc spondylectomy (TES) in patients with spinal tumours, based on the extent and level of tumour resection. METHODS: In total, 307 patients who underwent TES in a single centre were reviewed retrospectively. There were 164 male and 143 female patients with a mean age at the time of surgery of 52.9 years (SD 13.3). A total of 225 patients were operated on for spinal metastases, 34 for a malignant primary tumour, 41 for an aggressive benign tumour, and seven with a primary of unknown origin. The main lesion was located in the thoracic spine in 213, and in the lumbar spine in 94 patients. There were 97 patients who underwent TES for more than two consecutive vertebrae. RESULTS: Major and minor perioperative complications were observed in 122 (39.7%) and 84 (27.4%) patients respectively. The breakdown of complications was as follows: bleeding more than 2,000 ml in 60 (19.5%) patients, hardware failure in 82 (26.7%), neurological in 46 (15.0%), surgical site infection in 23 (7.5%), wound dehiscence in 16 (5.2%), cerebrospinal fluid leakage in 45 (14.7%), respiratory in 52 (16.9%), cardiovascular in 11 (3.6%), digestive in 19 (6.2%)/ The mortality within two months of surgery was four (1.3%). The total number of complications per operation were 1.01 (SD 1.0) in the single vertebral resection group and 1.56 (SD 1.2) in the group with more than two vertebral resections. Cardiovascular and respiratory complications, along with hardware failure were statistically higher in the group who had more than two vertebrae resected. Also, in this group the amount of bleeding in patients with a lumbar lesion or respiratory complication in patients with a thoracic lesion, were statistically higher. Multivariate analysis showed that using a combined anterior and posterior approach, when more than two vertebral resections were significant independent factors. CONCLUSION: The characteristics of perioperative complications after TES were different depending on the extent and level of the tumour resection. In addition to preoperative clinical and pathological factors, it is therefore important to consider these factors in patients who undergo en bloc resection for spinal tumours. Cite this article: Bone Joint J 2021;103-B(5):976-983.


Asunto(s)
Laminectomía/métodos , Osteotomía/métodos , Complicaciones Posoperatorias , Neoplasias de la Columna Vertebral/cirugía , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Tempo Operativo , Estudios Retrospectivos , Neoplasias de la Columna Vertebral/diagnóstico por imagen
10.
Bone Joint J ; 103-B(5): 951-957, 2021 May.
Artículo en Inglés | MEDLINE | ID: mdl-33934646

RESUMEN

AIMS: The aim of this study was to define the complications and long-term outcome following adolescent mid-shaft clavicular fracture. METHODS: We retrospectively reviewed a consecutive series of 677 adolescent fractures in 671 patients presenting to our region (age 13 to 17 years) over a ten-year period (2009 to 2019). Long-term patient-reported outcomes (abbreviated version of the Disabilities of the Arm, Shoulder and Hand (QuickDASH) score and EuroQol five-dimension three-level (EQ-5D-3L) quality of life score) were undertaken at a mean of 6.4 years (1.2 to 11.3) following injury in severely displaced mid-shaft fractures (Edinburgh 2B) and angulated mid-shaft fractures (Edinburgh 2A2) at a minimum of one year post-injury. The median patient age was 14.8 years (interquartile range (IQR) 14.0 to 15.7) and 89% were male (n = 594/671). RESULTS: The majority of fractures were mid-shaft (n = 606) with angulation (Edinburgh 2A2, n = 241/606, 39.8%) or displacement (Edinburgh 2B1/2, n = 263/606, 43.4%). Only 7% of the displaced mid-shaft fractures underwent acute fixation (n = 18/263). The incidence of refracture over ten years following nonoperative management of mid-shaft fractures was 3.2% (n = 19/588) and all united without surgery. Fracture type, severity of angulation, or displacement were not associated with refracture. One nonunion occurred following nonoperative management in a displaced mid-shaft fracture (0.4%, n = 1/245). Of the angulated fractures, 61 had angulation > 30°, of which 68.9% (n = 42/61) completed outcome scores with a median QuickDASH of 0.0 (IQR 0.0 to 0.6), EQ-5D-3L 1.0 (1.0 to 1.0), and 98% satisfaction with shoulder function. For the displaced fractures, 127 had displacement beyond one cortical width of bone for which completed outcome scores were provided in 72.4% (n = 92/127). Of these 15 had undergone acute fixation. Following nonoperative treatment, the median QuickDASH was 0.0 (IQR 0.0 to 2.3), EQ-5D-3L 1.0 (1.0 to 1.0), and satisfaction with shoulder function was 95%. There were no significant differences in the patients' demography or functional outcomes between operative and nonoperative treatments. CONCLUSION: Nonoperative management of adolescent mid-shaft clavicle fractures results in excellent functional outcomes at long-term follow-up. Nonunion is exceptionally rare following nonoperative management and the relative indications for surgical intervention in adults do not appear to be applicable to adolescents. Cite this article: Bone Joint J 2021;103-B(5):951-957.


Asunto(s)
Clavícula/lesiones , Fijación de Fractura/métodos , Fracturas Óseas/terapia , Fracturas no Consolidadas/terapia , Adolescente , Evaluación de la Discapacidad , Femenino , Estudios de Seguimiento , Curación de Fractura , Humanos , Masculino , Medición de Resultados Informados por el Paciente , Complicaciones Posoperatorias , Calidad de Vida , Estudios Retrospectivos
11.
Bone Joint J ; 103-B(5): 809-812, 2021 May.
Artículo en Inglés | MEDLINE | ID: mdl-33934656

RESUMEN

The use of tourniquets in lower limb trauma surgery to control bleeding and improve the surgical field is a long established practice. In this article, we review the evidence relating to harms and benefits of tourniquet use in lower limb fracture fixation surgery and report the results of a survey on current tourniquet practice among trauma surgeons in the UK.


Asunto(s)
Pérdida de Sangre Quirúrgica/prevención & control , Fijación Interna de Fracturas/métodos , Traumatismos de la Pierna/cirugía , Pautas de la Práctica en Medicina/estadística & datos numéricos , Torniquetes , Medicina Basada en la Evidencia , Humanos , Dimensión del Dolor , Complicaciones Posoperatorias , Encuestas y Cuestionarios , Reino Unido
12.
Bone Joint J ; 103-B(5): 864-871, 2021 May.
Artículo en Inglés | MEDLINE | ID: mdl-33934661

RESUMEN

AIMS: Debate remains whether the patella should be resurfaced during total knee replacement (TKR). For non-resurfaced TKRs, we estimated what the revision rate would have been if the patella had been resurfaced, and examined the risk of re-revision following secondary patellar resurfacing. METHODS: A retrospective observational study of the National Joint Registry (NJR) was performed. All primary TKRs for osteoarthritis alone performed between 1 April 2003 and 31 December 2016 were eligible (n = 842,072). Patellar resurfacing during TKR was performed in 36% (n = 305,844). The primary outcome was all-cause revision surgery. Secondary outcomes were the number of excess all-cause revisions associated with using TKRs without (versus with) patellar resurfacing, and the risk of re-revision after secondary patellar resurfacing. RESULTS: The cumulative risk of all-cause revision at ten years was higher (p < 0.001) in primary TKRs without patellar resurfacing (3.54% (95% confidence interval (CI) 3.47 to 3.62)) compared to those with resurfacing (3.00% (95% CI 2.91 to 3.11)). Using flexible parametric survival modelling, we estimated one 'excess' revision per 189 cases performed where the patella was not resurfaced by ten years (equivalent to 2,842 excess revisions in our cohort). The risk of all-cause re-revision following secondary patellar resurfacing was 4.6 times higher than the risk of revision after primary TKR with patellar resurfacing (at five years from secondary patellar resurfacing, 8.8% vs 1.9%). CONCLUSION: Performing TKR without patellar resurfacing was associated with an increased risk of revision. Secondary patellar resurfacing led to a high risk of re-revision. This represents a potential substantial healthcare burden that should be considered when forming treatment guidelines and commissioning services. Cite this article: Bone Joint J 2021;103-B(5):864-871.


Asunto(s)
Artroplastia de Reemplazo de Rodilla , Rótula/cirugía , Complicaciones Posoperatorias/prevención & control , Reoperación/estadística & datos numéricos , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Osteoartritis de la Rodilla/cirugía , Falla de Prótesis , Sistema de Registros , Estudios Retrospectivos
13.
Hinyokika Kiyo ; 67(3): 91-95, 2021 Mar.
Artículo en Japonés | MEDLINE | ID: mdl-33957028

RESUMEN

We retrospectivelyevaluated postoperative inguinal hernias (PIHs) after robot-assisted radical prostatectomy(RARP) with a technique for preventing hernias byspermatic cord isolation. Among the RARPs performed from 2016 to 2018, 191 cases were evaluated 12 or more months after surgery. In all the cases, the peritoneum was isolated from the spermatic cord by5 cm or more as a hernia prevention technique during RARP. We compared the background factors between PIH-positive and PIH-negative groups. The PIH-positive group had a significantlylower bodymass index (BMI) than the PIH-negative group (20.6 kg/m2 vs 23.8 kg/m2, p=0.0079), but there were no significant differences in other background factors. When patients were classified into three groups byBMI, low (<21.9 kg/m2), intermediate (21.9 to 25.5 kg/m2), and high (>25.5 kg/m2), the rate of PIH was 8.5% for the low group, 2.1% for the intermediate group, and 0% for the high group. Our findings suggest that incidences of inguinal hernias after the preventive technique of spermatic cord isolation in RARP, and the BMIs tended to be low in the hernia cases.


Asunto(s)
Hernia Inguinal , Neoplasias de la Próstata , Robótica , Cordón Espermático , Hernia Inguinal/cirugía , Humanos , Masculino , Complicaciones Posoperatorias/prevención & control , Prostatectomía , Neoplasias de la Próstata/cirugía , Cordón Espermático/cirugía
14.
Complement Ther Clin Pract ; 43: 101370, 2021 May.
Artículo en Inglés | MEDLINE | ID: mdl-33894576

RESUMEN

In 1954, the term "probiotics" was coined by Ferdinand Vergin in his article. Although there are many clinical reports on the use of pro/synbiotics and other microbial preparations to prevent postoperative infections and related complications in patients with Colorectal cancer (CRC), their effectiveness remains divided. Therefore, we collected relevant high-quality randomized controlled trial (RCT) studies and conducted systematic review and meta-analysis. We electronically searched online databases (the PubMed, EMBASE, MEDLINE, Cochrane Central Register of Controlled Trials (CENTRAL), Allied and Alternative Medieine (AMED), China National Knowledge Infrastructure (CNKI), Wanfang, and Weipu) for literature published until December 2020. These reports were rigorously screened, and the data extracted, assessed for risk of bias (ROB), and subjected to meta-analysis and subgroup analysis. Postoperative infections were the main criteria for outcomes. Nineteen high-quality articles were included, involving 1975 patients. Compared with the control group, the pro/synbiotics group had reduced total postoperative infections ((odds ratio)OR = 0.28, 95% (confidence interval)CI: 0.20; 0.39, p < 0.0001), which included surgical site infections (SSI) (OR = 0.43, 95% CI: 0.31; 0.58, p < 0.0001) and non-surgical site infections (non-SSI) (OR = 0.28 95% CI: 0.20; 0.39, p < 0.0001).What is more, in aspects of inflammatory factors, intestinal dysbiosis, non-infectious complications, and systemic symptoms, the treatment group was better than the control group. However, there were no differences in perineal infections (OR = 0.45, 95% CI: 0.13; 1.50, p = 0.1933), celiac infections (OR = 0.54, 95% CI: 0.11; 2.66, p = 0.4471), or systemic inflammatory response syndrome (SIRS) incidence (OR = 0.63, 95% CI: 0.31; 1.30, p = 0.2139), etc. There were no differences in intervention (probiotics or synbiotics), strain type (multistrain or non-multistrain probiotics), and intervention time (administration preoperatively or pre-and-postoperatively). Pro/synbiotics can effectively prevent postoperative infections and related complications in patients with CRC. The strain type and intervention time did not affect the treatment effects.


Asunto(s)
Neoplasias Colorrectales , Probióticos , Simbióticos , China , Humanos , Complicaciones Posoperatorias/tratamiento farmacológico , Probióticos/uso terapéutico
15.
Medicine (Baltimore) ; 100(17): e25583, 2021 Apr 30.
Artículo en Inglés | MEDLINE | ID: mdl-33907109

RESUMEN

RATIONALE: Subdural contrast extravasation (SCE) is a rare and possible complication following the intravascular injection of a contrast agent. We report a case of interhemispheric SCE detected by computed tomography (CT) after percutaneous coronary intervention. PATIENT CONCERNS: A 71-year-old man suddenly lost consciousness and fainted 2 hours prior with a head trauma history. Percutaneous coronary intervention was performed on the second day. DIAGNOSES: Head CT findings showed that the anterior longitudinal fissure of the brain was banded with high density and was uneven in thickness. The edge of the falx side of the brain was straight, smooth, and sharp, and the edge of the brain parenchyma was clear, without obvious edema or a space-occupying effect. INTERVENTIONS: Ticagrelor was given as an antiplatelet therapy; analgesic, antispasmodic symptomatic and supportive treatment was also administered. OUTCOMES: Two days later, the band-like high density between cerebral hemispheres was completely absorbed, and the patient's condition improved and his headache resolved. LESSONS: SCE is relatively uncommon during or after the intravascular injection of contrast media. Familiarity with the clinical features and CT findings of SCE may increase clinicians' awareness of this disease, thus avoiding potential misdiagnosis and mistreatment.


Asunto(s)
Extravasación de Materiales Terapéuticos y Diagnósticos/diagnóstico , Hematoma Subdural Agudo/diagnóstico , Intervención Coronaria Percutánea/efectos adversos , Complicaciones Posoperatorias/diagnóstico , Anciano , Diagnóstico Diferencial , Extravasación de Materiales Terapéuticos y Diagnósticos/etiología , Humanos , Masculino , Complicaciones Posoperatorias/etiología , Espacio Subdural
16.
Medicine (Baltimore) ; 100(17): e25636, 2021 Apr 30.
Artículo en Inglés | MEDLINE | ID: mdl-33907120

RESUMEN

ABSTRACT: The cartilage endplate plays an important role in the stress distribution and nutrition metabolism of the intervertebral disc. The healing morphology of the endplate after spinal fracture and its effect on the intervertebral disc degeneration are still unclear.This was a retrospective study. Patients with traumatic single-level thoracolumbar fractures treated in our orthopedic trauma service center from June 2011 to May 2019 were included and the relevant data were collected from the medical records. Based on combined computed tomography and MRI images, the endplate injury status was determined (no endplate injury, unilateral and bilateral endplate injury). According to the location of the injury, endplate injury was further divided into endplate central injury and endplate peripheral injury. The degree of posttraumatic disc lesions and disc degeneration during follow-up were classified based on the Sander classification and the Pfirrmann classification, respectively. According to the T1 image of MRI at the final follow-up, the healing morphology of endplates was determined and classified. Univariate analyses and correlation analyses were performed to evaluate the within- and between-group differences.There were in total 51 patients included in this study. Cartilage endplate fracture was significantly closely related to the degree of degeneration of the intervertebral disc (P = .003). Injuries in different parts of the endplate have no significant effect on the intervertebral disc degeneration (P = .204). The healing morphology after endplate fracture significantly affected the degree of intervertebral disc degeneration (P = .001). The comparisons of groups showed that the effects of irregular healing and traumatic Schmorl nodes on disc degeneration were not statistically significant, but were significantly significant with increased curvature.These results suggest that the irregular healing and the traumatic Schmorl nodes are closely related to intervertebral disc degeneration. The presence and severity of the endplate injury can provide valuable information for individualized clinical decision-making processes.


Asunto(s)
Curación de Fractura , Degeneración del Disco Intervertebral/patología , Tornillos Pediculares/efectos adversos , Complicaciones Posoperatorias/patología , Fracturas de la Columna Vertebral/patología , Adulto , Cartílago Articular/patología , Femenino , Fijación Interna de Fracturas/efectos adversos , Fijación Interna de Fracturas/instrumentación , Humanos , Disco Intervertebral/patología , Degeneración del Disco Intervertebral/etiología , Vértebras Lumbares/lesiones , Vértebras Lumbares/cirugía , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/etiología , Estudios Retrospectivos , Fracturas de la Columna Vertebral/cirugía , Vértebras Torácicas/lesiones , Vértebras Torácicas/cirugía , Tomografía Computarizada por Rayos X , Adulto Joven
17.
Medicine (Baltimore) ; 100(17): e25648, 2021 Apr 30.
Artículo en Inglés | MEDLINE | ID: mdl-33907124

RESUMEN

BACKGROUND: Robot-assisted and laparoscopic surgery are the most minimally invasive surgical approaches for the removal of liver lesions. Minor hepatectomy is a common surgical procedure. In this study, we evaluated the advantages and disadvantages of robot-assisted vs laparoscopic minor hepatectomy (LMH). METHODS: A systematic literature search was performed in PubMed, Embase, and the Cochrane Library to identify comparative studies on robot-assisted vs. laparoscopicminor hepatectomy up to February, 2020. The odds ratios (OR) and mean differences with 95% confidence intervals were calculated using the fixed-effects model or random-effects model. RESULTS: A total of 12 studies involving 751 patients were included in the meta-analysis. Among them, 297 patients were in the robot-assisted minor hepatectomy (RMH) group and 454 patients were in the LMH group. There were no significant differences in intraoperative blood loss (P = .43), transfusion rates (P = .14), length of hospital stay (P > .64), conversion rate (P = .62), R0 resection rate (P = .56), complications (P = .92), or mortaliy (P = .37) between the 2 groups. However, the RMH group was associated with a longer operative time (P = .0003), and higher cost (P < .00001) compared to the LMH group. No significant differences in overall survival or disease free survival between the 2 groups were observed. In the subgroup analysis of left lateral sectionectomies, RMH was still associated with a longer operative time, but no other differences in clinical outcomes were observed. CONCLUSIONS: Although RMH is associated with longer operation times and higher costs, it exhibits the same safety and effectiveness as LMH. Prospective randomized controlled clinical trials should now be considered to obtain better evidence for clinical consensus.


Asunto(s)
Hepatectomía/métodos , Laparoscopía/estadística & datos numéricos , Procedimientos Quirúrgicos Robotizados/estadística & datos numéricos , Adulto , Anciano , Anciano de 80 o más Años , Pérdida de Sangre Quirúrgica/estadística & datos numéricos , Transfusión Sanguínea/estadística & datos numéricos , Femenino , Humanos , Laparoscopía/métodos , Masculino , Persona de Mediana Edad , Estudios Observacionales como Asunto , Tempo Operativo , Complicaciones Posoperatorias/etiología , Ensayos Clínicos Controlados Aleatorios como Asunto , Procedimientos Quirúrgicos Robotizados/métodos , Resultado del Tratamiento
18.
Pan Afr Med J ; 38: 141, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33912311

RESUMEN

To the best of our knowledge there are no publications about Tunisian experience in constrictive pericarditis (CP); the aim of this study was therefore to review our twenty-one years' experience in terms of clinical and surgical outcomes and risk factors of death after pericardiectomy. An analytic bicentric and retrospective study carried out on 25 patients (20 male) with CP underwent pericardiectomy, collected over a 21-years period. The mean age was 40.46±16.74 years [7.5-72]. The commonest comorbid factor was tabagism (52%). The most common etiology was tuberculosis (n = 11, 44%). Dyspnea was the most common functional symptom (n = 21, 84%). Pericardiectomy was performed in all our patients within 2.9±3.19 months after confirmation of diagnosis. It was subtotal in 96% of cases. The commonest postoperative complications are pleural effusion (20%). Dyspnea was regressed within 1.8 months in 80% of cases and clinical signs of right heart failure within a mean duration of 1.62 months in 53% of cases. Perioperative mortality was 12% (3 deaths), late mortality was 4% (1 patient). Cardiopulmonary bypass, New York Heart Association (NYHA) over class II and right ventricular dysfunction are the prognostic factors of mortality (p = 0.001, 0.046, 0.019). Tuberculosis as etiology of CP had no impact on mortality. CP is a rare disease, with non-specific clinical signs. Pericardiectomy is effective with a significant improvement of the functional status of patients and favorable outcome at short and long term nevertheless hospital mortality is not negligible and depends on many factors.


Asunto(s)
Puente Cardiopulmonar , Mortalidad Hospitalaria , Pericardiectomía/métodos , Pericarditis Constrictiva/cirugía , Complicaciones Posoperatorias/epidemiología , Adolescente , Adulto , Anciano , Puente Cardiopulmonar/efectos adversos , Puente Cardiopulmonar/métodos , Niño , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pericardiectomía/efectos adversos , Pericarditis Constrictiva/mortalidad , Pericarditis Constrictiva/fisiopatología , Complicaciones Posoperatorias/mortalidad , Estudios Retrospectivos , Factores de Riesgo , Túnez , Adulto Joven
19.
Klin Monbl Augenheilkd ; 238(4): 510-520, 2021 Apr.
Artículo en Alemán | MEDLINE | ID: mdl-33930927

RESUMEN

BACKGROUND: To the best of our knowledge, there is no validated classification to assess intraoperative adverse events (iAEs) in ophthalmic surgery. ClassIntra is a newly developed classification for surgery- and anaesthesia-related iAEs that has been recently validated in various surgical disciplines, but not in ophthalmic surgery. We aim to assess the validity and practicability of ClassIntra in patients undergoing ophthalmic surgery. METHODS: A consecutive sample of in-hospital patients undergoing any type of ophthalmic surgery was included in this single-centre prospective cohort study. iAEs were classified using ClassIntra, consisting of 5 severity grades according to the symptoms of the patient and the required treatment. All patients were followed for two weeks to record all postoperative adverse events according to Clavien-Dindo. The primary endpoint was the risk-adjusted association between the most severe iAE and the weighted sum of all postoperative adverse events within the two-week follow-up using the Comprehensive Complication Index (CCI). In addition, ophthalmologists and anaesthesiologists were asked to complete an online survey assessing the severity of iAEs for 10 fictitious clinical case scenarios. Reliability was assessed by comparing the clinicians' ratings to the prespecified benchmark rating of the study team. RESULTS: In this study, 100 in-hospital patients with an average age of 64 years (SD 15) were included. The majority of all patients were ASA II (n = 53, 53%) or III (n = 42, 42%). Thirty-two iAEs were recorded in 22 patients (17 grade I, 12 grade II, 3 grade III). Ninety-four postoperative adverse events occurred in 50 patients (44 grade I, 36 grade II, 14 grade IIIa). We found a mean difference in CCI of 2,1 (95% confidence interval [CI] - 2,5 to 6,8) per one unit increase in severity grades of ClassIntra. Fifty ophthalmologists and anaesthesiologists completed the online survey (response rate 54%). The intraclass correlation coefficient was 0,79 (95% CI 0,64 to 0,94). CONCLUSIONS: The application of ClassIntra during daily routine in ophthalmic surgery showed the usefulness and practicability of this classification for the standardised assessment of intraoperative adverse events. Although construct validity could not be demonstrated, the good reliability in the survey's rating underlines the criterion validity of this newly developed classification in ophthalmic surgery.


Asunto(s)
Hospitales , Complicaciones Intraoperatorias , Humanos , Complicaciones Intraoperatorias/epidemiología , Persona de Mediana Edad , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Periodo Posoperatorio , Estudios Prospectivos , Reproducibilidad de los Resultados
20.
Ann R Coll Surg Engl ; 103(5): 345-353, 2021 May.
Artículo en Inglés | MEDLINE | ID: mdl-33852340

RESUMEN

AIMS: Persistent wound leakage following joint arthroplasty is a known risk for periprosthetic joint infection. Little is known of the predictors of wound leakage, particularly in patients with a fractured neck of femur. We aimed to determine patient and surgical risk factors for wound leakage in this cohort. MATERIALS AND METHODS: All patients undergoing surgery for a fractured neck of femur at Leicester Royal Infirmary between May and August 2017 were included. Patients were identified from a prospective database and placed into two groups: those with wound leakage later than three days postoperatively and those without leakage. All previously reported potential risk factors for wound leakage were compared between groups using a chi-square test and logistic regression. A Kattan-style nomogram was also created to allow probabilities output for the regression predictive models in a visual representation. RESULTS: Two hundred patients underwent surgery for a fractured neck of femur. Overall, 17% of patients (33/200) developed a persistent leaky wound. A multivariable model highlighted increased age (p = 0.01), raised body mass index (BMI; > 25 kg/m2; p = 0.047), diabetes (p = 0.03) and intramedullary hip screw fixation (p = 0.03) as significant risk factors for wound leakage. Patients with persistent wound leakage had significantly longer hospital admission than those without (p = 0.001). DISCUSSION: Our analysis identified four perioperative risk factors for wound leakage following fractured neck of femur surgery. We also developed a novel tool to identify those patients at highest risk of leakage. Once identified, the aggressive management of certain medical comorbidities in these patients may help to reduce their incidence of wound issues and the prolonged admissions that result.


Asunto(s)
Artroplastia de Reemplazo de Cadera , Fracturas del Cuello Femoral/cirugía , Complicaciones Posoperatorias/epidemiología , Herida Quirúrgica/patología , Adulto , Anciano , Anciano de 80 o más Años , Artroplastia de Reemplazo de Cadera/efectos adversos , Artroplastia de Reemplazo de Cadera/estadística & datos numéricos , Tornillos Óseos , Femenino , Fijación Interna de Fracturas/efectos adversos , Fijación Interna de Fracturas/estadística & datos numéricos , Hemiartroplastia/efectos adversos , Hemiartroplastia/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/patología , Factores de Riesgo , Herida Quirúrgica/epidemiología
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