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1.
Neurocirugía (Soc. Luso-Esp. Neurocir.) ; 34(1): 40-43, ene.-feb. 2023. ilus
Artigo em Espanhol | IBECS | ID: ibc-214412

RESUMO

La derivación ventrículo biliar se describe como un procedimiento alternativo eficaz en el tratamiento de la hidrocefalia. Presentamos el caso de un paciente de 19 años de edad diagnosticado de quiste aracnoideo supraselar e hidrocefalia, portador de doble sistema valvular de derivación ventrículo peritoneal y cisto peritoneal desde la infancia. Tras varios recambios por fallo peritoneal, fue sometido a derivación ventriculoauricular, con complicaciones asociadas y posterior recolocación a peritoneo. Tras nueva disfunción valvular por complicaciones peritoneales, se planteó la derivación ventriculobiliar como tratamiento alternativo para este paciente, que resultó segura y eficaz en la resolución de la clínica del paciente, siendo dado de alta, manteniendo estabilidad clínica durante más de 2 años de seguimiento. (AU)


Ventriculo-gallbladder shunt is described as an effective alternative procedure in the treatment of hydrocephalus. We present the case of a 19-year-old patient diagnosed with suprasellar arachnoid cyst since his childhood and hydrocephalus, with a double shunt; ventriculoperitoneal and peritoneal cyst shunt. After several replacements due to peritoneal failure, he underwent ventriculoatrial shunt, with associated complications and subsequent repositioning to the peritoneum. After new valve dysfunction due to peritoneal complications, ventriculo-gallbladder shunt was proposed as an alternative treatment for this patient, which was safe and effective in resolving the patient's symptoms, and the patient was discharged, maintaining clinical stability in the follow-up more than 2 years later. (AU)


Assuntos
Humanos , Masculino , Adulto Jovem , Cistos Aracnóideos/complicações , Cistos Aracnóideos/diagnóstico por imagem , Hidrocefalia/etiologia , Derivações do Líquido Cefalorraquidiano/métodos , Derivação Ventriculoperitoneal , Cistos Aracnóideos/cirurgia , Resultado do Tratamento , Seguimentos , Falha de Tratamento
2.
Actas urol. esp ; 47(1): 22-26, jan.- feb. 2023. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-214418

RESUMO

Objetivo Este estudio investiga el impacto del uso de la cobertura de dartos para aumentar la neouretra en los resultados funcionales y cosméticos. Evaluar una técnica novedosa que demuestra cómo fijar la cobertura de dartos como cobertura de barrera de la neouretra en la corrección de hipospadias. Pacientes y métodos Este estudio se realizó en 204 pacientes varones, todos con diferentes grados de hipospadias (HPD: 132, hipospadias coronal: 46 y HPM: 26). Sus edades oscilaban entre 1-23 años (edad media: 2 años). Había incurvación ventral (chorda) en (HPD: 45, hipospadias coronal: 33 y HPM: 26). Todos los pacientes tenían un chorro urinario anormal dirigido hacia abajo. La corrección del hipospadias se realizó mediante la técnica TIP clásica, además de nuestra novedosa modificación con cobertura de dartos. El seguimiento se realizó durante 5 años mediante evaluaciones clínicas de los parámetros funcionales y cosméticos. Resultados Se registraron tasas de éxito en 200 pacientes, 3 pacientes tuvieron complicaciones con una fístula uretrocutánea subcoronal y un paciente presentó la pérdida completa de la reparación. Conclusión La fijación triple de dartos es una técnica sencilla con la que todos los hipospadiólogos pueden reducir la fístula uretrocutánea como complicación común de la corrección de hipospadias con unos buenos resultados funcionales y cosméticos (AU)


Objective This study investigates the impact of the use of dartos covering to augment the neourethra on functional and cosmetic results. To evaluate a novel technique demonstrating how to fix dartos flap to cover the neourethra as a barrier in hypospadias repair. Patients and methods This study comprised 204 male patients with different degree of hypospadias (DPH: 132, coronal hypospadias: 46, MPH: 26). Their ages ranged from 1-23 ys (mean age: 2ys). Penile chordee was in (DPH: 45, coronal hypospadias: 33, MPH: 26). All patients had abnormal downward directed urinary stream. Hypospadias repair was performed by the classic TIP technique in addition to our novel modification of dartos covering. Patients were submitted to 5 years of follow-up including clinical examination of the functional and cosmetic parameters. Results Success rates were reported in 200 patients, 3 patients had complications with subcoronal urethrocutaneous fistula and one patient with complete repair disruption. Conclusion Triple dartos fixation is a simple technique for all hypospadiologists to minimize urethrocutaneous fistula as common complication of hypospadias repair with good functional and cosmetic results (AU)


Assuntos
Humanos , Masculino , Lactente , Pré-Escolar , Criança , Adolescente , Adulto Jovem , Hipospadia/cirurgia , Procedimentos Cirúrgicos Urológicos Masculinos/métodos , Resultado do Tratamento , Seguimentos , Estudos Prospectivos , Uretra/cirurgia
3.
Actas urol. esp ; 47(1): 34-40, jan.- feb. 2023. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-214420

RESUMO

Introducción El tumor vesical músculo-infiltrante (TVMI) tiene una supervivencia libre de recidiva (SLR) del 50% a los cinco años, la quimioterapia neoadyuvante (QTN) ha aumentado la misma un 8%, pero no está claro qué pacientes se pueden beneficiar en mayor grado de la misma. Objetivo Evaluar el valor pronóstico del estado inmunológico-nutricional en los pacientes con TVMI candidatos a cistectomía, y desarrollar un score que permita identificar precistectomía a los pacientes con peor pronóstico (pT3-4 y/o pN0-1). Material y método Se realizó un análisis retrospectivo de 284 pacientes con TVMI tratados con cistectomía radical. Se revisó la analítica preoperatoria y se calcularon índices inmunonutricionales. El método de Kaplan-Meier se utilizó para el cálculo de la SLR. Para el análisis multivariante se utilizó la regresión de Cox. Resultados Mediante análisis univariante se observó una relación estadísticamente significativa con el índice leucocito/linfocito (p = 0,0001), el índice neutrófilo/linfocito (p = 0,02) el índice pronóstico nutricional (p = 0,002), y el ratio plaqueta/linfocito (p = 0,002). En análisis multivariante, el ratio leucocito/linfocito (p = 0,002) y el IPN (p = 0,04) se comportaron como factores pronósticos independientes de disminución de SLR, y se elaboró con ello un score pronóstico que divide a los pacientes en tres grupos pronósticos. El 80% de los pacientes con tumores pT3-4 y/o pN0-1 se encontraban en los grupos de pronóstico medio-malo. Conclusión La incorporación en la práctica clínica de un score inmunonutricional precistectomía ayudaría a seleccionar a un grupo de pacientes con estadio patológico más desfavorable y peor SLR. Creemos que estos pacientes podrían beneficiarse en mayor medida de una QTN (AU)


Introduction Muscle-infiltrating bladder tumor (MIBT) has a recurrence-free survival (RFS) of 50% at 5 years. Although neoadjuvant chemotherapy (NCT) has increased it by 8%, which group of patients benefits the most from this treatment remains unclear. Objective Evaluate the prognostic value of immune-nutritional status in patients with MIBT who are candidates for cystectomy, and to develop a score that allows identifying patients with a worse prognosis (pT3-4 and/or pN0-1). Material and methods A retrospective analysis was carried out on 284 patients with MIBT treated with radical cystectomy. Preoperative laboratory tests were analyzed and immune-nutritional indices were calculated. The Kaplan–Meier method was used to calculate the PFS. Cox regression was used for multivariate analysis. Results Univariate analysis showed a statistically significant relationship with leukocyte/lymphocyte index (p = 0.0001), neutrophil/lymphocyte index (p = 0.02), prognostic nutritional index (p = 0.002), and platelet/lymphocyte ratio (p = 0.002). In multivariate analysis, the leukocyte/lymphocyte ratio (p = 0.002) and PNI (p = 0.04) behaved as independent prognostic factors of decreased RFS. Based on these, a prognostic score was developed to classify patients into 3 prognostic groups. Eighty percent of patients with pT3-4 and/or pN0-1 tumors were in the intermediate–poor prognostic groups. Conclusion The implementation of a precystectomy immune-nutritional score in clinical practice would help in the selection of a group of patients with a more unfavorable pathologic stage and worse PFS. We believe that these patients could benefit more from a NACT (AU)


Assuntos
Humanos , Masculino , Feminino , Idoso , Avaliação Nutricional , Neoplasias da Bexiga Urinária/patologia , Neoplasias da Bexiga Urinária/cirurgia , Invasividade Neoplásica , Cistectomia/métodos , Liberação de Cirurgia , Estudos Retrospectivos , Prognóstico
6.
BMJ Case Rep ; 16(1)2023 Jan 03.
Artigo em Inglês | MEDLINE | ID: mdl-36596628

RESUMO

Listeria monocytogenes can cause severe illnesses such as gastroenteritis, sepsis and neurolisteriosis, especially in infants, the elderly and immunocompromised patients. We report a case of a previously healthy school-aged girl presenting with severe neurological deficits found to have Listeria meningoencephalitis. Her potential exposure to L. monocytogenes was consumption of contaminated cheese. She had some clinical improvement after initiation of tailored Listeria anti-microbial coverage with ampicillin and gentamicin; however, she developed hydrocephalus requiring external ventricular drain placement and tonsillar herniation requiring emergent posterior fossa decompression. The patient made significant improvements after neurosurgical intervention, and along with continued antibiotics and subsequent rehabilitation services, she improved to near full recovery within a year. The case highlights that neurolisteriosis can affect even immunocompetent children, and aggressive neurosurgical interventions should be considered in patients who develop severe complications such as hydrocephalus and tonsillar herniation to improve outcomes.


Assuntos
Hidrocefalia , Listeria monocytogenes , Meningite por Listeria , Lactente , Idoso , Feminino , Humanos , Criança , Meningite por Listeria/diagnóstico , Meningite por Listeria/tratamento farmacológico , Encefalocele/diagnóstico por imagem , Encefalocele/cirurgia , Encefalocele/complicações , Antibacterianos/uso terapêutico , Ampicilina/uso terapêutico , Hidrocefalia/cirurgia , Hidrocefalia/complicações
7.
BMJ Case Rep ; 16(1)2023 Jan 03.
Artigo em Inglês | MEDLINE | ID: mdl-36596626

RESUMO

With increasing utilisation of meshes in inguinal hernia repair, reports of mesh-related complications are emerging, particularly late visceral complications, with mesh migration and erosion into the small bowel, bladder and colon reported after laparoscopic totally extraperitoneal (TEP) inguinal hernia repair. We present a case of spontaneous mesh migration through the superficial inguinal ring with skin erosion following TEP inguinal hernia repair, the first published report in the literature to our knowledge. This case highlights the difficulty in diagnosis due to the long latent period of hernia repair and the onset of erosion. A high index of suspicion is required when diagnosing any patient who presents with an unexplained groin abscess following ipsilateral TEP repair. CT scan should be performed early for diagnosis and assessment. Removal of the migrated portion of the mesh, antibiotic therapy and secondary wound closure are strategies for the successful treatment of this complication.


Assuntos
Hérnia Inguinal , Herniorrafia , Telas Cirúrgicas , Humanos , Hérnia Inguinal/cirurgia , Herniorrafia/efeitos adversos , Herniorrafia/métodos , Laparoscopia , Telas Cirúrgicas/efeitos adversos , Resultado do Tratamento , Bexiga Urinária/cirurgia
8.
Artigo em Chinês | MEDLINE | ID: mdl-36597367

RESUMO

Objective:To investigate the safety and feasibility of transoral vestibular endoscopy in the treatment of patients with thyroid malignant tumors. Methods:120 patients with thyroid cancer admitted to Xi 'an Central Hospital from January 2019 to December 2021 were selected and randomly divided into endoscopic surgery group(60 cases) and traditional open surgery group(60 cases). The general operation conditions, postoperative complications and postoperative quality of life were compared between the two groups. Results:The intraoperative blood loss, indwelling drainage tube time and average length of hospital stay in the endoscopic surgery group were significantly lower than those in the traditional open surgery group (P<0.05), while the operation time and number of lymph nodes dissected were significantly higher than those in the traditional open surgery group (P<0.05). There was no significant differences in VAS score at 24h after surgery, white blood cell count, TgAb (+) and temporary hypothyroidism between the two groups at 24 h after operation (P >0.05). The CRP, total drainage volume, TgAb and serum calcium in the endoscopic surgery group were higher than those in the traditional open surgery group, and the PTH and Tg were lower than those in the traditional open surgery group (P<0.05).One case of hoarseness,2 cases of extremities numbness, 1 case of subcutaneous effusion and 2 cases of chin nerve injury occurred in the endoscopic surgery group, the total incidence of postoperative complications was 10.00%. Five cases of hoarseness, 11 cases of choking cough limbs numbness, 1 case of drinking water, 1 case of postoperative bleeding and 4 cases of subcutaneous effusion occurred in the traditional open surgery group, the total postoperative incidence of complications was 36.67%, the total incidence of complications in endoscopic surgery group was lower than that in traditional open surgery group (P<0.05). The total scores of physiological status, social/family status, emotional status, functional status and quality of life in endoscopic surgery group were significantly lower than those in traditional open surgery group (P<0.05). Conclusion:The application of oral vestibular endoscopy in the treatment of thyroid malignant tumors has the advantages of good surgical status and postoperative recovery, fewer postoperative complications.The patient was well tolerated,with positive safety,this technique has high clinical application value.


Assuntos
Endoscopia , Neoplasias da Glândula Tireoide , Humanos , Endoscopia/efeitos adversos , Endoscopia/métodos , Estudos de Viabilidade , Rouquidão/etiologia , Hipestesia/etiologia , Hipestesia/cirurgia , Complicações Pós-Operatórias/cirurgia , Qualidade de Vida , Estudos Retrospectivos , Neoplasias da Glândula Tireoide/cirurgia , Neoplasias da Glândula Tireoide/patologia
9.
PLoS One ; 18(1): e0279388, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36598892

RESUMO

INTRODUCTION: Anal fistula is the natural evolution of perianal abscess and one of the most common perianal diseases for adults. For complex fistula, it is still very challenging for anorectal surgeons to manage. With the introduction of laser technique in surgery, it is becoming more and more widely used for the treatment of cryptoglandular anal fistula. During the past decade, numerous studies have reported the clinical effectiveness and postoperative outcomes of different forms of laser treatment for anal fistula. However, as these studies were varied in terms of baseline characteristics, the evidence for the true clinical effectiveness of laser treatment for anal fistula need further critical appraisal. Therefore, the purpose of this study is to evaluate the outcomes of surgical laser therapy for cryptoglandular anal fistula stratified by laser type and Parks' classification through a synthesis of quantitative and qualitative evidence. METHODS AND ANALYSIS: This study will be carried out with adherence to the Cochrane Handbook. We will search PubMed, Cochrane Library, and Embase until June, 2022 to identify all relevant interventional and observational studies examining the effects of laser therapy on the clinical outcomes for cryptoglandular anal fistula. Data extraction from eligible studies will be performed independently by two unblinded authors using standardized extraction forms. Risk of bias assessment for each study will be conducted using Cochrane tool for randomized controlled trials (RCTs) and the Newcastle-Ottawa scale (NOS) tool for observational studies. The DerSimonian-Laird random-effects model will be used to calculate the pooled estimates. Heterogeneity will be examined by subgroup analysis stratified by laser type and Parks' classification and other study characteristics. Potential publication bias will be assessed by funnel plot symmetrical and Egger's regression tests. CONCLUSIONS: The synthesis of quantitative and qualitative evidence of this systemic review will yield updated and comprehensive evidence of laser treatment on specific outcomes, which can provide anorectal surgeons with high level evidence-based recommendations to improve patient care and clinical outcomes. OSF registration number: DOI 10.17605/OSF.IO/36ADW.


Assuntos
Doenças do Ânus , Terapia a Laser , Terapia com Luz de Baixa Intensidade , Fístula Retal , Adulto , Humanos , Fístula Retal/cirurgia , Resultado do Tratamento , Doenças do Ânus/cirurgia , Metanálise como Assunto , Revisões Sistemáticas como Assunto
10.
Nutrients ; 15(2)2023 Jan 16.
Artigo em Inglês | MEDLINE | ID: mdl-36678338

RESUMO

Bariatric surgery has shown to be effective in producing sustained weight loss and the resolution of obesity related medical problems. Recent research focused on the role of obesity and adipose tissue in tumorigenesis, finding a strong crosslink through different mechanisms and highlighting an increase in cancer incidence in individuals with obesity. The aim of this meta-analysis is to find if bariatric surgery reduces the incidence of colorectal cancer in patients with obesity. We performed a meta-analysis including 18 studies (PROSPERO ID: CRD4202235931). Bariatric surgery was found to be significantly protective toward colorectal cancer incidence in individuals with obesity (HR: 0.81, p = 0.0142). The protective effect persisted when considering women (RR: 0.54, p = 0.0014) and men (RR: 0.74, p = 0.2798) separately, although this was not significant for the latter. No difference was found when comparing Roux-en-Y gastric bypass and sleeve gastrectomy. Bariatric surgery reduces the incidence of colorectal cancer in individuals with obesity independently from gender and surgical procedure. Prospective large cohort studies are needed to confirm these findings.


Assuntos
Cirurgia Bariátrica , Neoplasias Colorretais , Derivação Gástrica , Laparoscopia , Erros Inatos do Metabolismo , Obesidade Mórbida , Masculino , Humanos , Feminino , Obesidade Mórbida/complicações , Obesidade Mórbida/epidemiologia , Obesidade Mórbida/cirurgia , Estudos Prospectivos , Derivação Gástrica/métodos , Cirurgia Bariátrica/métodos , Neoplasias Colorretais/epidemiologia , Neoplasias Colorretais/etiologia , Neoplasias Colorretais/prevenção & controle , Laparoscopia/métodos , Resultado do Tratamento
11.
Sensors (Basel) ; 23(2)2023 Jan 06.
Artigo em Inglês | MEDLINE | ID: mdl-36679483

RESUMO

Recent developments in robotic technologies in the field of orthopaedic surgery have largely been focused on higher volume arthroplasty procedures, with a paucity of attention paid to robotic potential for foot and ankle surgery. The aim of this paper is to summarize past and present developments foot and ankle robotics and describe outcomes associated with these interventions, with specific emphasis on the following topics: translational and preclinical utilization of robotics, deep learning and artificial intelligence modeling in foot and ankle, current applications for robotics in foot and ankle surgery, and therapeutic and orthotic-related utilizations of robotics related to the foot and ankle. Herein, we describe numerous recent robotic advancements across foot and ankle surgery, geared towards optimizing intra-operative performance, improving detection of foot and ankle pathology, understanding ankle kinematics, and rehabilitating post-surgically. Future research should work to incorporate robotics specifically into surgical procedures as other specialties within orthopaedics have done, and to further individualize machinery to patients, with the ultimate goal to improve perioperative and post-operative outcomes.


Assuntos
Procedimentos Ortopédicos , Robótica , Cirurgia Assistida por Computador , Humanos , Inteligência Artificial , Tornozelo/cirurgia
12.
Stroke ; 54(2): 457-467, 2023 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-36647921

RESUMO

BACKGROUND: There is uncertainty whether elderly patients with symptomatic carotid stenosis have higher rates of adverse events following carotid endarterectomy. In trials, recurrent stroke risk on medical therapy alone increased with age, whereas operative stroke risk was not related. Few octogenarians were included in trials and there has been no systematic analysis of all study types. We aimed to evaluate the safety of carotid endarterectomy in symptomatic elderly patients, particularly in octogenarians. METHODS: We did a systematic review and meta-analysis of studies (from January 1, 1980 through March 1, 2022) reporting post carotid endarterectomy risk of stroke, myocardial infarction, and death in patients with symptomatic carotid stenosis. We included observational studies and interventional arms of randomized trials if the outcome rates (or the raw data to calculate these) were provided. Individual patient data from 4 prospective cohorts enabled multivariate analysis. RESULTS: Of 47 studies (107 587 patients), risk of perioperative stroke was 2.04% (1.94-2.14) in octogenarians (390 strokes/19 101 patients) and 1.85% (1.75-1.95) in nonoctogenarians (1395/75 537); P=0.046. Perioperative death was 1.09% (0.94-1.25) in octogenarians (203/18 702) and 0.53% (0.48-0.59) in nonoctogenarians (392/73 327); P<0.001. Per 5-year age increment, a linear increase in perioperative stroke, myocardial infarction, and death were observed; P=0.04 to 0.002. However, during the last 3 decades, perioperative stroke±death has declined significantly in octogenarians (7.78% [5.58-10.55] before year 2000 to 2.80% [2.56-3.04] after 2010); P<0.001. In Individual patient data multivariate-analysis (5111 patients), age ≥85 years was independently associated with perioperative stroke (P<0.001) and death (P=0.005). Yet, survival was similar for octogenarians versus nonoctogenarians at 1-year (95.0% [93.2-96.5] versus 97.5% [96.4-98.6]; P=0.08), as was 5-year stroke risk (11.93% [9.98-14.16]) versus 12.78% [11.65-13.61]; P=0.24). CONCLUSIONS: We found a modest increase in perioperative risk with age in symptomatic patients undergoing carotid endarterectomy. As stroke risk increases with age when on medical therapy alone, our findings support selective urgent intervention in symptomatic elderly patients.


Assuntos
Estenose das Carótidas , Endarterectomia das Carótidas , Infarto do Miocárdio , Acidente Vascular Cerebral , Idoso de 80 Anos ou mais , Humanos , Idoso , Endarterectomia das Carótidas/efeitos adversos , Estenose das Carótidas/cirurgia , Constrição Patológica/complicações , Estudos Prospectivos , Fatores de Risco , Resultado do Tratamento , Acidente Vascular Cerebral/etiologia , Infarto do Miocárdio/etiologia
13.
Gut Microbes ; 15(1): 2145845, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36691230

RESUMO

Mounting evidence suggests that acute appendicitis (AA) is not one but two diseases: complicated appendicitis, which is associated with necrosis leading to perforation or periappendicular abscess, and uncomplicated appendicitis, which does not necessarily result in perforation. Even though AA is the most frequent cause of surgery from abdominal pain, little is known about the origins and etiopathogenesis of this disease, much less regarding the different disease types. In this study, we investigated the microbiome (inter-domain amplicon and metagenome sequencing) of samples from the appendix, rectum and peritoneum of 60 children and adolescents with AA to assess the composition and potential function of bacteria, archaea and fungi. The analysis of the appendix microbial community revealed a shift depending on the severity of the AA. This shift was reflected by two major community state types that represented the complicated and uncomplicated cases. We could demonstrate that complicated, but not uncomplicated, appendicitis is associated with a significant local expansion of oral, bacterial pathogens in the appendix, most strongly influenced by necrotizing Fusobacterium spp., Porphyromonas and Parvimonas. Uncomplicated appendicitis, however, was characterized by gut-associated microbiomes. Our findings support the hypothesis that two disease types exist in AA, which cannot be distinguished beyond doubt using standard clinical characterization methods or by analysis of the patient's rectal microbiome. An advanced microbiome diagnosis, however, could improve non-surgical treatment of uncomplicated AA.


Assuntos
Apendicite , Apêndice , Microbioma Gastrointestinal , Microbiota , Criança , Adolescente , Humanos , Apendicite/tratamento farmacológico , Apendicite/patologia , Apendicite/cirurgia , Apêndice/microbiologia , Apêndice/patologia , Bactérias , Doença Aguda
14.
J Trauma Acute Care Surg ; 94(2): 248-257, 2023 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-36694334

RESUMO

BACKGROUND: Worse outcomes following injuries are more likely in rural versus urban areas. In 2001, our state established an inclusive trauma system to improve mortality. In 2015, the trauma system had a consultation visit from the American College of Surgeons' Committee on Trauma, who made several recommendations. We hypothesized that continued maturation of this system would lead to more laparotomies prior to transfer to a higher level of care and better outcomes. METHODS: Our trauma registry was queried to identify all patients transferred between January 1, 2010, and December 31, 2020, who underwent laparotomy either before transfer or within 4 hours of arrival. The preconsultation (2010-2015) and postconsultation periods (2016-2020) were compared. Categorical and continuous variables were compared using χ2 and Mann-Whitney U tests, respectively. RESULTS: We included 213 patients; 63 had laparotomy before transfer and 150 within 4 hours after transfer. Age, injury severity scores, systolic blood pressure, and mechanism of injury were not different between periods. Proportions of laparotomy before and after transfer and outcomes (mortality, hospital length of stay, intensive care unit length of stay, ventilator days) were also similar (p = 0.368 for laparotomy, p = 0.840, 0.124, 0.286, 0.822 for outcomes). Compared with the preconsultation period, the proportion of laparotomy performed before transfer for severe injuries (abdominal Abbreviated Injury Scale score >3) significantly increased postconsultation (57.1% vs. 30.6%, p = 0.011). Incidence of damage-control laparotomies (43.9% vs. 23.6%; p = 0.020) and transfusion of plasma and platelets (33.6% vs. 13.2%; p < 0.001, 22.4% vs. 8.5%, p = 0.007, respectively) significantly increased. CONCLUSION: Identification and surgical stabilization of critical patients at the non-Level I facilities prior to transfer, as well as blood product use and damage-control techniques, improved postconsultation, suggesting a shift in the approaches to surgical stabilization and resuscitation efforts in our trauma system. LEVEL OF EVIDENCE: Therapeutic/Care Management; Level IV.


Assuntos
Traumatismos Abdominais , Serviços de Saúde Rural , Centros de Traumatologia , Humanos , Traumatismos Abdominais/cirurgia , Escala de Gravidade do Ferimento , Laparotomia/estatística & dados numéricos , Estudos Retrospectivos
15.
Langenbecks Arch Surg ; 408(1): 65, 2023 Jan 25.
Artigo em Inglês | MEDLINE | ID: mdl-36695921

RESUMO

PURPOSE: The aim is to clarify the use of perioperative chemotherapy in resectable goblet cell carcinoma (GCC). METHODS: A retrospective study was carried out based on the Surveillance, Epidemiology, and End Results study. The population was divided: into patients who received only radical surgery (group A) and those who received radical surgery plus chemotherapy (group B). An entropy balancing was carried out to correct the imbalance between the two groups. Two models were generated. Model 1 contained only high-risk patients: group B and a "virtual" group A with similar characteristics. Model 2 included only low-risk patients: group A and "virtual" group B with identical attributes. The efficacy of entropy balancing was evaluated with the d value. The overall survival was compared and reported with Hazard Ratio (HR) within a confidence interval of 95% (95 CI). RESULTS: The groups A and B were imbalanced for tumor size (d = 0.392), T (d = 1.128), N (d = 1.340), M (d = 1.456), mean number of positive lymph nodes (d = 0.907), and LNR (d = 0.889). Before the balancing, the risk of death was higher in group B than in A (4.3; 2.5 to 7.4). After reweighting, all large differences were eliminated (d < 0.200). In high-risk patients, the risk of death was higher in patients who underwent surgery alone than those who received perioperative chemotherapy (HR 0.5; 0.2 to 1.3) without statistical significance (p = 0.187). In low-risk patients, the risk of death was similar (HR 1.1; 0.3 to 3.3). CONCLUSION: Perioperative chemotherapy could provide some marginal advantages to high-risk patients.


Assuntos
Carcinoma , Células Caliciformes , Humanos , Estudos Retrospectivos , Entropia , Carcinoma/cirurgia , Modelos de Riscos Proporcionais
16.
Urolithiasis ; 51(1): 35, 2023 Jan 25.
Artigo em Inglês | MEDLINE | ID: mdl-36695936

RESUMO

The burden of urolithiasis in children is increasing and this is mirrored by the number of surgical interventions in the form of ureteroscopy (URS). There exist many challenges in performing this surgery for this special patient group as well as a lack of consensus on technique. There is also large variation in how results are described and reported. There exists therefore, a need to improve and standardise the core outcomes, which are reported. To this end, we developed a new checklist to aid studies report the essential items on paediatric URS for stone disease. The Paediatric Ureteroscopy (P-URS) reporting checklist comprises four main sections (study details, pre-operative, operative and post-operative) and a total of 20 items. The tool covers a range of important elements, such as pre-stenting, complications, follow-up, stone-free rate, concomitant medical expulsive therapy and imaging, which are often lacking in studies. The checklist provides a summary of essential items that authors can use as a reference to improve general standards of reporting paediatric URS studies and increase the body of knowledge shared accordingly.


Assuntos
Ureteroscopia , Urolitíase , Humanos , Criança , Ureteroscopia/métodos , Lista de Checagem , Resultado do Tratamento , Urolitíase/cirurgia , Estudos Retrospectivos
17.
Plast Reconstr Surg ; 151(2): 274e-281e, 2023 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-36696325

RESUMO

BACKGROUND: To ensure the feasibility of implementing PROMs in clinical practice, they must be continually appraised for undue burden placed on patients and clinicians and their usefulness for decision-making. This study assesses correlations between the CLEFT-Q psychosocial scales in the International Consortium for Health Outcomes Measurement Standard Set for cleft and explores their associations with patient characteristics and psychosocial care referral. METHODS: Spearman correlation coefficients were calculated for CLEFT-Q psychological function, social function, school function, face, speech function, and speech-related distress scales. Logistic regressions were used to assess the association of cleft phenotype, syndrome, sex, and adoption status on scale scores and clinical referral to psychosocial care for further evaluation and management. RESULTS: Data were obtained from 3067 patients with cleft lip and/or palate at three centers. Strong correlations were observed between social function and psychological function (r > 0.69) and school function (r > 0.78) scales. Correlation between school function and psychological function scales was lower (r = 0.59 to 0.68). Genetic syndrome (OR, 2.37; 95% CI, 1.04 to 5.41), psychological function (OR, 0.92; 95% CI, 0.88 to 0.97), school function (OR, 0.94; 95% CI, 0.90 to 0.98), and face (OR, 0.96; 95% CI, 0.94 to 0.98) were significant predictors for referral to psychosocial care. CONCLUSIONS: Because social function as measured by the CLEFT-Q showed strong correlations with both school and psychological function, its additional value for measuring psychosocial function within the Standard Set is limited, and it is reasonable to consider removing this scale from the International Consortium for Health Outcomes Measurement Standard Set for cleft.


Assuntos
Fenda Labial , Fissura Palatina , Humanos , Fenda Labial/cirurgia , Fenda Labial/psicologia , Fissura Palatina/cirurgia , Fissura Palatina/psicologia , Fala , Avaliação de Resultados em Cuidados de Saúde
18.
Sci Rep ; 13(1): 1429, 2023 Jan 25.
Artigo em Inglês | MEDLINE | ID: mdl-36697472

RESUMO

In total hip arthroplasty and reconstructive orthopedic surgery, pre-operative digital templating is essential for surgical treatment optimization, risk management, and quality control. Calibration is performed before templating to address magnification effects. Conventional methods including fixed calibration factors, individual marker-based calibration and dual-scale marker methods are not reliable. A novel bi-planar calibration method is described aiming to reduce the error below clinical significance. The bi-planar calibration method requires two conventional orthogonal radiographs and a standard radiopaque marker ball. An algorithm computes the hip plane height parallel to the detector in the antero-posterior radiograph. Foreseeable errors (i.e., patient rotation and misplaced markers or lateral offset) are considered in a correction algorithm. Potential effects of errors are quantified in a standard model. Influence of rotation in lateral radiographs and lateral offset of marker on the calibration factor are quantified. Without correction, patient rotation in the lateral radiograph of 30° results in absolute calibration error of 2.2% with 0 mm offset and 6.5% with 60 mm lateral offset. The error is below the threshold of 1.5% for rotation less than 26° with 0 mm offset and 10° with 60 mm offset. The method is supposed to be reliable in precisely predicting the hip plane and thereby the calibration factor. It may be superior to other methods available. In theory, the method allows correction of clinically relevant rotation of at least 30° and marker displacement without impacting the computed calibration factor.


Assuntos
Artroplastia de Quadril , Prótese de Quadril , Humanos , Artroplastia de Quadril/métodos , Articulação do Quadril/diagnóstico por imagem , Articulação do Quadril/cirurgia , Calibragem , Reprodutibilidade dos Testes
19.
Sci Rep ; 13(1): 1402, 2023 Jan 25.
Artigo em Inglês | MEDLINE | ID: mdl-36697462

RESUMO

Thoracic sympathetic nerve block (TSNB) has been widely used in the treatment of neuropathic pain. To reduce block failure rates, TSNB is assisted with several modalities including fluoroscopy, computed tomography, and ultrasonography. The present study describes our experience assessing the usefulness of thoracoscopy in TSNB for predicting compensatory hyperhidrosis before sympathectomy in primary hyperhidrosis. From September 2013 to October 2021, TSNB was performed under local anesthesia using a 2-mm thoracoscope in 302 patients with severe primary hyperhidrosis. Among the 302 patients, 294 were included for analysis. The target level of TSNB was T3 in almost all patients. The mean procedure time was 21 min. Following TSNB, the mean temperature of the left and right palms significantly changed from 31.5 to 35.3 °C and from 31.5 to 34.8 °C, respectively. With TSNB, primary hyperhidrosis was relieved in all patients. Pneumothorax occurred in six patients, in which no chest tube insertion was required. One patient developed hemothorax and was discharged the next day after small-bore catheter drainage. Transient ptosis developed in 10 patients and improved within a day in all patients. Our experiences showed that thoracoscopic TSNB is accurate, safe, and feasible to block the thoracic sympathetic nerve in patients with severe primary hyperhidrosis.


Assuntos
Bloqueio Nervoso Autônomo , Hiperidrose , Humanos , Resultado do Tratamento , Toracoscopia , Hiperidrose/cirurgia , Bloqueio Nervoso Autônomo/métodos , Fluoroscopia , Simpatectomia/métodos
20.
Sci Rep ; 13(1): 1422, 2023 Jan 25.
Artigo em Inglês | MEDLINE | ID: mdl-36697485

RESUMO

Lack of bone volume to place dental implants is frequently a problem in the reconstruction of edentulous patients. Even though autografts are the gold standard for jaw regeneration, morbidity associated with the harvesting site stimulates the demand for other substitutes. The aim of this study is to characterize the incorporation and the osteogenic ability of a viable cryopreserved human bone graft (VC-HBG) in the mandibular augmentation in rats. Bone chips from fresh human vertebrae cadaveric donors were processed, cryoprotected and deep-frozen at - 80 °C maintaining its cell viability. A jaw augmentation model was used in 20 athymic nude rats allocated into 2 groups to either receive the VC-HBG or an acellular graft as control (A-HBG). The assessment of the grafts' incorporation was performed at 4 and 8 weeks by micro-CT, histomorphometry and immunohistochemistry. Bone volume gain was significantly higher for the VC-HBG group at both time points. At 4 weeks, the A-HBG group presented significantly higher mineral density, but at 8 weeks, the VC-HBG group showed significantly higher values than the A-HBG. There was no statistical difference between VC-HBG and A-HBG groups at 4-weeks for remaining graft particles, while at 8 weeks, the VC-HBG group showed significantly less graft remnants. Collagen I, osteopontin and tartrate-resistant acid phosphatase expression were significantly higher in the VC-HBG group at both time points, while osteocalcin expression was significantly higher in the VC-HBG group at 8-weeks compared to the A-HBG group. This experimental research demonstrated that the VC-HBG shows positive osteogenic properties, greater bone formation, higher rate of bone remodeling and a better overall incorporation in rats' mandibles compared to the A-HBG.


Assuntos
Substitutos Ósseos , Osteogênese , Humanos , Ratos , Animais , Mandíbula/cirurgia , Transplante Ósseo , Remodelação Óssea , Autoenxertos
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