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Calisti A, Belay K, Mombo A, Nugud FA, Salman DY, Lelli Chiesa P. Presentations of bladder exstrophy in a resource-limited setting and the role of Mainz II continent diversion for late referrals or failed primary closures: a multicentric report. LA PEDIATRIA MEDICA E CHIRURGICA 2023; 45. [PMID: 37667897 DOI: 10.4081/pmc.2023.323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 08/02/2023] [Indexed: 09/06/2023] Open
Abstract
Primary closure techniques that have been updated and longterm follow-up for CBE (classic bladder exstrophy) may be out of reach for many patients living in resource-limited settings. Late referrals to medical care and primary closures that lack the necessary skills and facilities for comprehensive treatment are still common. Alternative and long-term surgical solutions may improve the lives of these unfortunate patients. During surgical outreach missions, patients with CBE, either non-operated or with a previous unsuccessful bladder closure, who were referred from vast under-resourced rural areas to three Eastern African hospitals, were studied. The following information is provided: mode of presentation, clinical history, diagnostic workout, management, and outcome. There were 25 cases (M/F ratio 17/8) ranging in age from two days to twenty years. Five of the seventeen patients who were not treated (35%) were under 120 days old and eligible for primary closure in a qualified tertiary center when one was available in the country. There were twelve late referred cases (ranging from 120 days to 20 years). Between the ages of ten months and twelve years, eight children arrived following a failed primary closure. In all of them, the bladder plate was too altered to allow closure. Following a preoperative diagnostic workout, a Mainz II continent internal diversion was proposed to fourteen patients with acceptable bowel control and postponed in the other three. Three cases were lost before treatment because parents refused the procedure. Twelve cases ranging in age from three to twenty years (mean seven years) were operated on. Eight people were followed for a total of 53.87 months (range: 36-120). Except for three people who complained of occasional night soiling, day and night continence were good. The average voiding frequency during the day was four and 1.3 at night. There was no evidence of a metabolic imbalance, urinary infection, or significant upper urinary tract dilatation. Two fatalities could not be linked to urinary diversion. Four patients were not followed up on. Due to the limited number of specialist surgical facilities, CBE late referral or failed closure is to be expected in a resource-limited context. In lieu of the primary closure, a continent internal diversion will be proposed and encouraged even at the level of a non-specialist hospital to improve the quality of life of these unfortunate patients. It is recommended that patients be warned about the procedure's potential long-term risks, which will necessitate a limited but regular follow-up.
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Affiliation(s)
| | - Kibreab Belay
- Department of Surgery - Orotta National Referral Hospital, Asmara.
| | - Andrea Mombo
- Department of Urology Consolata Hospital Ikonda, Njombe.
| | | | | | - Pierluigi Lelli Chiesa
- Pediatric Surgery, Santo Spirito Hospital-Pescara-University G. D'Annunzio Chieti-Pescara.
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152
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Koehler A, Koch F, El-Ahmar M, Ristig M, Lehmann K, Ritz JP. Necessity of routine perioperative epidural catheter placement in laparoscopic colorectal resections: a retrospective data analysis. Langenbecks Arch Surg 2023; 408:335. [PMID: 37624426 DOI: 10.1007/s00423-023-03074-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 08/17/2023] [Indexed: 08/26/2023]
Abstract
PURPOSE Whether epidural anesthesia leads to further improvement in the postoperative course of colorectal procedures is under discussion. The aim of this study was to evaluate the effects of minimally invasive colorectal oncological interventions without epidural anesthesia (EDA). METHODS This retrospective data analysis included the clinical data of all patients who underwent minimally invasive oncological colorectal resection at our clinic between January 2013 and April 2019. Of 385 patients who met the inclusion criteria, 183 (group I; 47.5% of 385) received EDA, and 202 (group II; 52.5% of 385) received transversus abdominis plane block instead. The relevant target parameters were evaluated and compared between the groups. The postoperative complications were graded according to the Clavien-Dindo classification. RESULTS The patients in group I (n=183; women, 77; men, 106; age 66.8 years) were younger (p=0.0035), received a urinary catheter more often (99.5% versus [vs.] 28.2% p<0.001), required longer, more frequent arterenol treatment (1.1 vs. 0.6 days; p<0.001), and had a longer intermediate care unit stay than those in group II (2.8 vs. 1.1 days; p<0.001). Postoperative pain levels were not significantly different between the groups (p=0.078). The patients in group I were able to ambulate later than those in group II (4 vs. 2 days; p<0.001). The difference in the postoperative day of the first defecation was not significant between the groups (p=0.236). The incidence of postoperative complications such as bleeding (p=0.396), anastomotic leaks (p=0.113), and wound infections (p=0.641) did not differ between the groups. The patients in group I had significantly longer hospital stays than those in group II (12.2 vs. 9.4 days; p<0.001). CONCLUSION EDA can be safely omitted from elective minimally invasive colorectal resections, and its omission is not accompanied by any relevant disadvantages to the patient.
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Affiliation(s)
- A Koehler
- Clinic for General and Visceral Surgery, Helios Clinics in Schwerin, University Campus of the MSH Medical School Hamburg, Wismarsche Strasse 393-397, Schwerin, 19055, Germany.
- Department of General and Visceral Surgery, Charité Universitätsmedizin Berlin Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany.
| | - F Koch
- Clinic for General and Visceral Surgery, Helios Clinics in Schwerin, University Campus of the MSH Medical School Hamburg, Wismarsche Strasse 393-397, Schwerin, 19055, Germany
| | - M El-Ahmar
- Clinic for General and Visceral Surgery, Helios Clinics in Schwerin, University Campus of the MSH Medical School Hamburg, Wismarsche Strasse 393-397, Schwerin, 19055, Germany
| | - M Ristig
- Clinic for General and Visceral Surgery, Helios Clinics in Schwerin, University Campus of the MSH Medical School Hamburg, Wismarsche Strasse 393-397, Schwerin, 19055, Germany
| | - K Lehmann
- Department of General and Visceral Surgery, Charité Universitätsmedizin Berlin Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - J-P Ritz
- Clinic for General and Visceral Surgery, Helios Clinics in Schwerin, University Campus of the MSH Medical School Hamburg, Wismarsche Strasse 393-397, Schwerin, 19055, Germany
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153
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Kuźma Ł, Kowalewski M, Wańha W, Dąbrowski EJ, Jasiński M, Widenka K, Deja M, Bartuś K, Hirnle T, Wojakowski W, Lorusso R, Tobota Z, Maruszewski BJ, Suwalski P. Validation of EuroSCORE II in atrial fibrillation heart surgery patients from the KROK Registry. Sci Rep 2023; 13:13024. [PMID: 37563207 PMCID: PMC10415263 DOI: 10.1038/s41598-023-39983-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 08/03/2023] [Indexed: 08/12/2023] Open
Abstract
The study aimed to validate the European System for Cardiac Operative Risk Evaluation score (EuroSCORE II) in patients with atrial fibrillation (AF). All data were retrieved from the National Registry of Cardiac Surgery Procedures (KROK). EuroSCORE II calibration and discrimination performance was evaluated. The final cohort consisted of 44,172 patients (median age 67, 30.8% female, 13.4% with AF). The in-hospital mortality rate was 4.14% (N = 1830), and 5.21% (N = 2303) for 30-day mortality. EuroSCORE II significantly underestimated mortality in mild- and moderate-risk populations [Observed (O):Expected (E)-1.1, 1.16). In the AF subgroup, it performed well [O:E-0.99), whereas in the very high-risk population overestimated mortality (O:E-0.9). EuroSCORE II showed better discrimination in AF (-) [area under curve (AUC) 0.805, 95% CI 0.793-0.817)] than in AF (+) population (AUC 0.791, 95%CI 0.767-0.816), P < 0.001. The worst discriminative performance for the AF (+) group was for coronary artery bypass grafting (CABG) (AUC 0.746, 95% CI 0.676-0.817) as compared with AF (-) population (AUC 0.798, 95% CI 0.774-0.822), P < 0.001. EuroSCORE II is more accurate for patients with AF. However, it underestimated mortality rates for low-to-moderate-risk patients and had a lower ability to distinguish between high- and low-risk patients with AF, particularly in those undergoing coronary artery bypass grafting.
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Affiliation(s)
- Łukasz Kuźma
- Department of Invasive Cardiology, Medical University of Bialystok, Bialystok, Poland
| | - Mariusz Kowalewski
- Clinical Department of Cardiac Surgery and Transplantology, National Medical Institute of the Ministry of Interior and Administration, Warsaw, Poland.
- Thoracic Research Centre, Innovative Medical Forum, Collegium Medicum Nicolaus Copernicus University, Bydgoszcz, Poland.
- Cardio-Thoracic Surgery Department, Heart and Vascular Centre, Maastricht University Medical Centre (MUMC), Cardiovascular Research Centre Maastricht (CARIM), Maastricht, The Netherlands.
| | - Wojciech Wańha
- Thoracic Research Centre, Innovative Medical Forum, Collegium Medicum Nicolaus Copernicus University, Bydgoszcz, Poland
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Emil Julian Dąbrowski
- Department of Invasive Cardiology, Medical University of Bialystok, Bialystok, Poland
| | - Marek Jasiński
- Department and Clinic of Cardiac Surgery, Wroclaw Medical University, Wroclaw, Poland
| | - Kazimierz Widenka
- Clinical Department of Cardiac Surgery, District Hospital No. 2, University of Rzeszów, Rzeszów, Poland
| | - Marek Deja
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
- Department of Cardiac Surgery, Upper-Silesian Heart Center, Katowice, Poland
| | - Krzysztof Bartuś
- Department of Cardiovascular Surgery and Transplantology, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland
| | - Tomasz Hirnle
- Department of Cardiosurgery, Medical University of Bialystok, Bialystok, Poland
| | - Wojciech Wojakowski
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Roberto Lorusso
- Cardio-Thoracic Surgery Department, Heart and Vascular Centre, Maastricht University Medical Centre (MUMC), Cardiovascular Research Centre Maastricht (CARIM), Maastricht, The Netherlands
| | - Zdzisław Tobota
- Department of Pediatric Cardiothoracic Surgery, The Children's Memorial Health Institute, Warsaw, Poland
| | - Bohdan J Maruszewski
- Department of Pediatric Cardiothoracic Surgery, The Children's Memorial Health Institute, Warsaw, Poland
| | - Piotr Suwalski
- Clinical Department of Cardiac Surgery and Transplantology, National Medical Institute of the Ministry of Interior and Administration, Warsaw, Poland
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154
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Kanlioz M, Ekici U. A New and Effective Technique in the Endoscopic Treatment of Obesity and Regulation of Diabetes: The Pyloric Revision. Cureus 2023; 15:e43357. [PMID: 37701000 PMCID: PMC10493824 DOI: 10.7759/cureus.43357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2023] [Indexed: 09/14/2023] Open
Abstract
AIM This study aimed to investigate the role of the functional structure of the pylorus in obesity and diabetes and to determine the efficacy of a new method, pyloric revision (PR), in the treatment. METHODS The pyloric structures of the patients who applied for endoscopic obesity treatment were examined, and the patients were classified as normotonic (NP), hypotonic (HP), and atonic (AP) according to their pyloric structures. PR was applied to those with pyloric structural disorders. Patients with NP were also given the preferred endoscopic treatment (balloon, botulinum toxin, Kanlioz technique). In addition, the pre-procedure fasting blood glucose (FBG) and glycated hemoglobin levels (HbA1c) of the patients were compared with the sixth-month post-procedure status. In order to compare the pyloric structure and other parameters in normal weights with the obese group, a second group of 100 normal-weight (BMI<25) individuals was formed and compared with the study group. RESULTS In patients with HP (93 patients) and AP (61 patients), a statistically significant decrease was found between HbA1c and FBG levels before treatment and six months after treatment (p˂0.02, p<0.001, respectively). There was a statistically significant difference in favor of the endoscopic obesity treatment group (EOTG) in terms of pyloric disorder, HbA1c, and FPG levels between the EOTG and the normal weight group (NWG) (p<0.0001). CONCLUSION We recommend using PR as an easy-to-perform, effective, minimally invasive, reproducible, and cost-effective technique that does not require hospitalization.
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Affiliation(s)
- Murat Kanlioz
- General Surgery, Flora Transplantation Institute, Istanbul, TUR
| | - Ugur Ekici
- General Surgery, Flora Transplantation Institute, İstanbul, TUR
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155
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Evans M, de Courcy J, de Laguiche E, Faurby M, Haase CL, Matthiessen KS, Moore A, Pearson-Stuttard J. Obesity-related complications, healthcare resource use and weight loss strategies in six European countries: the RESOURCE survey. Int J Obes (Lond) 2023; 47:750-757. [PMID: 37258646 PMCID: PMC10359184 DOI: 10.1038/s41366-023-01325-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 04/20/2023] [Accepted: 05/03/2023] [Indexed: 06/02/2023]
Abstract
BACKGROUND Obesity-related complications (ORCs), such as type 2 diabetes (T2D) and cardiovascular disease, contribute considerably to the clinical and economic impacts of obesity. To obtain a holistic overview of health and weight management attempts for people with obesity in Europe, we designed the cross-sectional RESOURCE survey to collect data on comorbidities, healthcare resource use (HCRU) and weight loss strategies from people with obesity in France, Germany, Italy, Spain, Sweden and the UK. METHODS Adults (≥18 years old) with self-reported body mass index (BMI) ≥30 kg/m2 who reported interacting with primary or secondary healthcare services in the past 12 months, but had not been pregnant during this time, were recruited from an existing consumer research panel. All data were self-reported via an online survey (May-June 2021). Weight changes over the past year were calculated from participants' estimated weights. RESULTS Of the 1850 participants in the survey, 26.3% reported that they had ≥3 ORCs from a set of 15 conditions of interest. The most frequently reported ORCs were hypertension (39.3% of participants), dyslipidaemia (22.8%) and T2D (17.5%). Participants in obesity class III (BMI 40 to <70 kg/m2) were more likely to report multiple ORCs than those in lower obesity classes. The presence of multiple ORCs was linked to various types of HCRU, including a significantly increased chance of reporting hospitalization in the past year. Most participants (78.6%) had attempted to lose weight in the past year, but of those who also reported estimated weight changes, 73.4% had not experienced clinically meaningful weight loss of ≥5%. CONCLUSIONS ORCs are common in people with obesity, and are linked to increased HCRU. Together with the low reported success rate of weight loss attempts, this highlights an unmet need in Europe for enhanced weight management support for people with obesity.
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Affiliation(s)
- Marc Evans
- University Hospital Llandough, Penarth, Cardiff, UK.
| | | | | | | | | | | | | | - Jonathan Pearson-Stuttard
- Lane Clark & Peacock LLP, London, UK
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
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156
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Sule AZ, Alayande BT, Ojo EO, Taiwo FO, Riviello RR, Chirdan LB, Ezeome ER, Mshelbwala PM, Ugwu BT, Yawe KDT. The History and Evolution of the West African College of Surgeons/Jos University Teaching Hospital Trauma Management Course. World J Surg 2023; 47:1919-1929. [PMID: 37069318 PMCID: PMC10109223 DOI: 10.1007/s00268-023-07004-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2023] [Indexed: 04/19/2023]
Abstract
BACKGROUND Inadequate trauma care training opportunities exist in Low- and Middle-Income Countries. Jos University Teaching Hospital and the West African College of Surgeons (WACS) have synergized, over the past 15 years, to introduce a yearly, certified, multidisciplinary Trauma Management Course. We explore the history and evolution of this course. METHODS A desk review of course secretariat documents, registration records, schedules, pre- and post-course test records, post-course surveys, and account books complemented by organizer interviews was carried out to elaborate the evolution of the Trauma Management Course. RESULTS The course was started as a local Continuing Medical Education program in 2005 in response to recurring cycles of violence and numerous mass casualty situations. Collaborations with WACS followed, with inclusion of the course in the College's yearly calendar from 2010. Multidisciplinary faculty teach participants the concepts of trauma care through didactic lectures, group sessions, and hands-on simulation within a one-week period. From inception, there has been a 100% growth in lecture content (from 15 to 30 lectures) and in multidisciplinary attendance (from 23 to 133 attendees). Trainees showed statistically significant knowledge gain yearly, with a mean difference ranging from 10.1 to 16.1% over the past 5 years. Future collaborations seek to expand the course and position it as a catalyst for regional emergency medical services and trauma registries. CONCLUSIONS Multidisciplinary trauma management training is important for expanding holistic trauma capacity within the West African sub-region. The course serves as an example for Low- and Middle-Income contexts. Similar contextualized programs should be considered to strengthen trauma workforce development.
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Affiliation(s)
- Augustine Z Sule
- Department of Surgery, Jos University Teaching Hospital, Jos, Nigeria
| | - Barnabas T Alayande
- Department of Surgery, Jos University Teaching Hospital, Jos, Nigeria.
- Center for Equity in Global Surgery, University of Global Health Equity, Kigali Heights, Plot 772, KG 7 Ave., 5Th Floor, PO Box 6955, Kigali, Rwanda.
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA.
| | - Emmanuel O Ojo
- Department of Surgery, Jos University Teaching Hospital, Jos, Nigeria
| | - Femi O Taiwo
- Department of Orthopaedics and Trauma, Jos University Teaching Hospital, Jos, Nigeria
| | - Robert R Riviello
- Center for Equity in Global Surgery, University of Global Health Equity, Kigali Heights, Plot 772, KG 7 Ave., 5Th Floor, PO Box 6955, Kigali, Rwanda
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA
- Centre for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA
| | - Lohfa B Chirdan
- Department of Surgery, Jos University Teaching Hospital, Jos, Nigeria
| | - Emmanuel R Ezeome
- Department of Surgery, College of Medicine, University of Nigeria, Enugu, Nigeria
| | - Philip M Mshelbwala
- Department of Surgery, College of Health Sciences, University of Abuja, Abuja, Nigeria
| | - Benjamin T Ugwu
- Department of Surgery, Jos University Teaching Hospital, Jos, Nigeria
| | - King-David T Yawe
- Department of Surgery, College of Health Sciences, University of Abuja, Abuja, Nigeria
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157
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Standring O, Benitez Sanchez S, Pasha S, Demyan L, Lad N, Ruff SM, Anantha S, Karpeh M, Newman E, Nealon W, Talamini M, Coppa G, Deutsch G, Weiss M, DePeralta DK. Potential Role for Observation in Small Solid Pseudopapillary Neoplasm (SPN). Ann Surg Oncol 2023; 30:5105-5112. [PMID: 37233954 DOI: 10.1245/s10434-023-13496-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 03/28/2023] [Indexed: 05/27/2023]
Abstract
BACKGROUND Solid pseudopapillary neoplasms (SPN) are rare tumors of the pancreas, typically affecting young women. Resection is the mainstay of treatment but is associated with significant morbidity and potential mortality. We explore the idea that small, localized SPN could be safely observed. METHODS This retrospective review of the Pancreas National Cancer Database from 2004 to 2018 identified SPN via histology code 8452. RESULTS A total of 994 SPNs were identified. Mean age was 36.8 ± 0.5 years, 84.9% (n = 844) were female, and most had a Charlson-Deyo Comorbidity Coefficient (CDCC) of 0-1 (96.6%, n = 960). Patients were most often staged clinically as cT2 (69.5%, n = 457) followed by cT3 (17.6%, n = 116), cT1 (11.2%, n = 74), and cT4 (1.7%, n = 11). Clinical lymph node and distant metastasis rates were 3.0 and 4.0%, respectively. Surgical resection was performed in 96.6% of patients (n = 960), most commonly partial pancreatectomy (44.3%) followed by pancreatoduodenectomy (31.3%) and total pancreatectomy (8.1%). In patients clinically staged as node (N0) and distant metastasis (M0) negative, occult pathologic lymph node involvement was found in 0% (n = 28) of patients with stage cT1 and 0.5% (n = 185) of patients with cT2 disease. The risk of occult nodal metastasis significantly increased to 8.9% (n = 61) for patients with cT3 disease. The risk further increased to 50% (n = 2) in patients with cT4 disease. CONCLUSIONS Herein, the specificity of excluding nodal involvement clinically is 99.5% in tumors ≤ 4 cm and 100% in tumors ≤ 2 cm. Therefore, there may be a role for close observation in patients with cT1N0 lesions to mitigate morbidity from major pancreatic resection.
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Affiliation(s)
- Oliver Standring
- Northwell Health, North Shore/Long Island Jewish General Surgery, Manhasset, NY, USA
| | | | - Shamsher Pasha
- Northwell Health Cancer Institute, Lake Success, NY, USA
| | - Lyudmyla Demyan
- Northwell Health, North Shore/Long Island Jewish General Surgery, Manhasset, NY, USA
| | - Neha Lad
- Northwell Health, North Shore/Long Island Jewish General Surgery, Manhasset, NY, USA
- Northwell Health Cancer Institute, Lake Success, NY, USA
| | - Samantha M Ruff
- Northwell Health, North Shore/Long Island Jewish General Surgery, Manhasset, NY, USA
| | - Sandeep Anantha
- Northwell Health, North Shore/Long Island Jewish General Surgery, Manhasset, NY, USA
- Northwell Health Cancer Institute, Lake Success, NY, USA
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Martin Karpeh
- Northwell Health Cancer Institute, Lake Success, NY, USA
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- Department of Surgical Oncology, Northwell Health, Huntington Hospital, Huntington, NY, USA
| | - Elliot Newman
- Northwell Health Cancer Institute, Lake Success, NY, USA
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- Department of Surgical Oncology, Northwell Health, Lenox Hill Hospital, New York, NY, USA
| | - William Nealon
- Northwell Health, North Shore/Long Island Jewish General Surgery, Manhasset, NY, USA
- Northwell Health Cancer Institute, Lake Success, NY, USA
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Mark Talamini
- Northwell Health Cancer Institute, Lake Success, NY, USA
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Gene Coppa
- Northwell Health, North Shore/Long Island Jewish General Surgery, Manhasset, NY, USA
- Northwell Health Cancer Institute, Lake Success, NY, USA
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Gary Deutsch
- Northwell Health, North Shore/Long Island Jewish General Surgery, Manhasset, NY, USA
- Northwell Health Cancer Institute, Lake Success, NY, USA
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Matthew Weiss
- Northwell Health, North Shore/Long Island Jewish General Surgery, Manhasset, NY, USA
- Northwell Health Cancer Institute, Lake Success, NY, USA
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Danielle K DePeralta
- Northwell Health, North Shore/Long Island Jewish General Surgery, Manhasset, NY, USA.
- Northwell Health Cancer Institute, Lake Success, NY, USA.
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.
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158
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Ilyas Khan A, Thomas C, O'Connor H, Dowker F, Horgan L, Khan MA. Impact of the COVID-19 Pandemic on the Management of Gallbladder, Biliary Tract, and Pancreatic Diseases. Cureus 2023; 15:e43473. [PMID: 37711944 PMCID: PMC10499300 DOI: 10.7759/cureus.43473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2023] [Indexed: 09/16/2023] Open
Abstract
Introduction Biliary diseases are a major acute general surgical burden. Laparoscopic cholecystectomy is the gold standard surgical procedure, although it was discontinued during an outbreak. Effective management permits decisive therapy, symptom alleviation, and fewer hospitalizations and complications. Throughout the initial COVID-19 situation, surgical procedures for patients were delayed. Invasive services were required to employ conservative or non-operative therapy, which could lead to increased recurring presentations and biliary-pancreatic problems. Aim Examining the impact of COVID-19 on the outcomes and hospitalizations of patients suffering from gallstone, biliary tract, and pancreatic diseases. Methods The retrospective analysis included patients with the following ICD-10 codes who presented to our unit: cholelithiasis (K80), cholecystitis (K81), and acute pancreatitis (K85). We compared the interval of the first COVID-19 pandemic wave, from March to August 2020, with the period before the pandemic, referred to as Pre-COVID-19. After applying exclusion criteria, a total of 868 patients were enrolled in the trial, having initially recruited around 1,400 individuals using these codes. Patients with inaccurate coding, cancer, or non-stone disease were excluded (e.g., alcoholic pancreatitis). The demographic information, admission details, investigations, surgical therapy, operating specifics, and postoperative complications of the patients were noted. Changes in surgical management, patient representation, and postoperative complications were the key outcomes. Results A statistically significant (p<0.05) rise was seen in repeat presentations in the COVID group, most likely due to the failure of definitive treatment. The other outcome is the distribution of presentations was comparable, patients with acute cholecystitis and gallstone pancreatitis showed statistically significant (p<0.05) lower rates of definitive therapy. Conclusion During the COVID period, all surgeries except those for cancer were halted. Unknown causes led to several consequences related to the gallbladder, biliary tract, and pancreas. Patients with cholecystitis, gallstone pancreatitis, and pancreatic inflammation experienced a lower probability of treatment. The increase in hospitalizations and self-presentations indicated that definitive therapy, designed to restrict COVID-19 exposure, actually increased patient risk. Despite this risk, we had no COVID-19 instances in our cohort. The evaluation of the long-term consequences of the pandemic on acute pancreatitis and its care will require a large-scale, multicenter investigation.
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Affiliation(s)
- Amnah Ilyas Khan
- General Surgery, Northumbria Healthcare NHS Foundation Trust, Newcastle upon Tyne, GBR
| | - Christophe Thomas
- Surgery, Northumbria Healthcare NHS Foundation Trust, Newcastle upon Tyne, GBR
| | | | - Frederick Dowker
- Surgery, Northumbria Healthcare NHS Foundation Trust, Newcastle upon Tyne, GBR
| | - Liam Horgan
- Surgery, Northumbria Healthcare NHS Foundation Trust, Newcastle upon Tyne, GBR
| | - Murad A Khan
- General Surgery, Shifa International Hospital Islamabad, Islamabad, PAK
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159
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Meng M, Hanssen D, Singh A. Radiation Enterocolitis Featuring the Perforation of the Sigmoid Colon, Small Bowel, and Entero-Colonic Fistula: A Case Report. Cureus 2023; 15:e43167. [PMID: 37560055 PMCID: PMC10409519 DOI: 10.7759/cureus.43167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/08/2023] [Indexed: 08/11/2023] Open
Abstract
Radiation enteritis poses a treatment challenge for patients undergoing or completing radiation therapy. A significant issue has been the patient's and surgeon's lack of awareness of the condition and the radiotherapy or associated surgical treatments. A 66-year-old female presented with acute onset of diffuse abdominal pain and peritonitis for one day, status post radiation therapy following a diagnosis of cervical cancer. A review of systems was positive for diffuse sweating, chills, and nausea. The patient was diagnosed with an entero-colonic fistula with mesenteric edema. An entero-colonic fistula due to radiation enterocolitis is a rare but important complication that can occur after radiation therapy for abdominal or pelvic malignancies. With any patient who has a history of abdominal or pelvic cancer and has received radiotherapy and shows up with acute abdomen, bowel perforation should be considered in the differential diagnosis with the possible management of acute complications.
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Affiliation(s)
- Muzi Meng
- School of Medicine, American University of the Caribbean, Miramar, USA
- General Surgery, BronxCare Health System, Bronx, USA
| | | | - Ajit Singh
- General Surgery, BronxCare Health System, Bronx, USA
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Kuwabara S, Kobayashi K, Sudo N, Omori A, Matsuya N, Utsumi S. Comparison of Surgical and Oncological Outcomes of Laparoscopic and Open Gastrectomy for Pathologically Serosa-Invasive (pT4a) Advanced Gastric Cancer-Retrospective Propensity Score-Matched Analysis. J Laparoendosc Adv Surg Tech A 2023; 33:756-762. [PMID: 37126776 DOI: 10.1089/lap.2023.0074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023] Open
Abstract
Background: We aimed to clarify the operative feasibility and oncological efficacy of a laparoscopic gastrectomy (LG) for pT4a gastric cancer through comparison with open gastrectomy (OG). Materials and Methods: We compared surgical and oncological outcomes in 178 patients with pT4a gastric cancer who underwent LG or OG between 2002 and 2016; the background was adjusted using propensity score matching. Results: After score matching, 45 patients were included in each group. The LG group had a significantly longer operation time (277 minutes versus 175 minutes, P < .001) and lower estimated blood loss (50 mL versus 280 mL, P < .001). The total number of dissected lymph nodes did not differ between groups (46 versus 38, P = .119); however, the number of dissected suprapancreatic lymph nodes was significantly higher in the LG group (11 versus 7.5, P = .011). Postoperative morbidity rates did not differ between groups. Postoperative hospitalization was significantly shorter in the LG group (7 days versus 13 days, P < .01), whereas overall survival, disease-free survival, and cancer recurrence rates and patterns were similar between groups. Conclusions: LG for pT4a gastric cancer has feasible and acceptable outcomes compared with OG.
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Affiliation(s)
- Shirou Kuwabara
- Department of Digestive Surgery, Niigata City General Hospital, Niigata City, Japan
| | - Kazuaki Kobayashi
- Department of Digestive Surgery, Niigata City General Hospital, Niigata City, Japan
| | - Natsuru Sudo
- Department of Digestive Surgery, Niigata City General Hospital, Niigata City, Japan
| | - Ai Omori
- Department of Digestive Surgery, Niigata City General Hospital, Niigata City, Japan
| | - Naoki Matsuya
- Department of Digestive Surgery, Niigata City General Hospital, Niigata City, Japan
| | - Shiori Utsumi
- Department of Digestive Surgery, Niigata City General Hospital, Niigata City, Japan
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Panagopoulos A, Argyropoulou E, Kokkalis ZT, Parchas N, Tserpes K. Study protocol: biomechanical testing, finite element analysis and prospective, randomized, clinical study of single screw cephalomedullary nailing versus integrated dual interlocking screw fixation for unstable (31A2 1-3) intertrochanteric fractures in patients > 70 years old. J Orthop Surg Res 2023; 18:542. [PMID: 37507795 PMCID: PMC10386776 DOI: 10.1186/s13018-023-04009-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 07/14/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Hip fractures are an increasingly common consequence of falls in older people that are associated with a high risk of death and reduced function. The vast majority of intertrochanteric fractures require surgical treatment to withstand early mobilization and weight bearing, which prevents complications due to prolonged bed rest and aids in fracture healing. METHODS This study is compromised by two parts, the experimental study and the clinical part. In the first part, a standard 130° nail will be used with the appropriate lag screw(s) and dynamic distal locking in synthetic osteoporotic femurs and the transmission of forces in the proximal femur, measured by a cortical surface-strain distribution, will be evaluated using digital image correlation. Finite element parametric models of the bone, the nails and their interface will be also developed. Finite element computations of surface strains in implanted femurs, after being validated against biomechanical testing measurements, will be used to assist the comparison of the nails by deriving important data on the developed stress and strain fields, which cannot be measured through biomechanical testing. In the other part, will set up a prospective, randomized, comparative clinical study among the Gamma3 and IT cephalomedullary nailing, in order to investigate if there are any statistical important differences in the main radiological measurements and functional status in closed unstable intertrochanteric fractures (A21-3) in patients aged over 70 years old at the 24-week follow-up evaluation using patient reported disease-specific outcomes. DISCUSSION This study will be the first to compare clinical, radiological and biomechanical measurements of the two different cephalomedullary nails. Our main hypothesis is that the IT nail would provide better radiological outcome and probably better clinical results than the Gama3 nail. Clinical trial registration International Standard Randomized Controlled Trial Number (ISRCTN): https://doi.org/10.1186/ISRCTN15588442 , registered on 19/4/2022.
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Affiliation(s)
- Andreas Panagopoulos
- Department of Orthopaedics, Patras University Hospital, Medical School, Patras University, Papanikolaou 1, 26504, Rio-Patras, Greece.
| | - Evangelia Argyropoulou
- Department of Orthopaedics, Patras University Hospital, Medical School, Patras University, Papanikolaou 1, 26504, Rio-Patras, Greece
| | - Zinon T Kokkalis
- Department of Orthopaedics, Patras University Hospital, Medical School, Patras University, Papanikolaou 1, 26504, Rio-Patras, Greece
| | - Nicolaos Parchas
- Department of Orthopaedics, Patras University Hospital, Medical School, Patras University, Papanikolaou 1, 26504, Rio-Patras, Greece
| | - Konstantinos Tserpes
- Laboratory of Technology and Strength of Materials, Department of Mechanical Engineering and Aeronautics, University of Patras, Patras, Greece
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162
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Youssef D, Abou-Abass L, Hassan H. Unveiling the unknown: first comprehensive assessment of the knowledge, attitudes and practices of hospital cleaning services staff regarding COVID-19 in Lebanon during the pandemic. Arch Public Health 2023; 81:134. [PMID: 37461121 DOI: 10.1186/s13690-023-01149-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 07/07/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND Hospital cleaners are the unsung heroes in the fight against the COVID-19 pandemic. This study aimed to assess the knowledge, attitudes, and practices (KAP) of hospital cleaners towards COVID-19 and determine factors associated with good practices. METHODS A cross-sectional study was conducted in Lebanon between the 1st and 14th November 2020. Using a snowball sampling technique, data were collected through an online survey that was sent to governmental and private hospitals. The questionnaire consisted of socio-demographic characteristics and KAP of hospital cleaners towards COVID-19. Descriptive statistics and logistic regression analysis were performed. RESULTS A total of 453 cleaners completed the survey, of whom 54.3% were females. Most participants had a good level of COVID-19 knowledge (98%) and good preventive practices (89.7%). Regarding attitude, 90.7% had a positive attitude toward health facilities, 78.8% toward cleaning and disinfection, and 73.5% toward health authorities. Sociodemographic characteristics, including younger age, higher levels of education, working in private hospitals, and having more than 3 years of experience, were positively associated with good preventive practices. Our results also showed that participants who had good knowledge about COVID-19, COVID-19 prevention and treatment, cleaning and disinfection processes, and COVID-19 risk factors had a higher likelihood of positive preventive practices. Finally, a positive attitude toward health facilities, health authorities, and cleaning and disinfection was positively associated with good practices. CONCLUSION The surveyed cleaners have a high level of knowledge and expressed positive attitudes toward health facilities and health authorities, as well as good preventive practices. Understanding the determinants of cleaning performance is critical in tailoring interventions to improve hospital cleaning.
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Affiliation(s)
- Dalal Youssef
- Clinical Trial Program, Ministry of Public Health, Beirut, Lebanon.
- Bordeaux Research Center for Population Health, Institut de sante publique, d'epidemiologie et de developpement (ISPED), Bordeaux University, Bordeaux, France.
- Lebanese Higher Institute of Technical and Professional, Ministry of Education, Beirut, Lebanon.
| | - Linda Abou-Abass
- Neuroscience Research Center, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
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Jonsson M, Westerdahl E, Reeve J. Physiotherapy provided for patients undergoing thoracic surgery in Sweden - a national survey of practice. Physiother Theory Pract 2023:1-7. [PMID: 37450405 DOI: 10.1080/09593985.2023.2233596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 06/30/2023] [Accepted: 06/30/2023] [Indexed: 07/18/2023]
Abstract
INTRODUCTION Patients undergoing thoracic surgery commonly receive perioperative physio-therapy, typically consisting of education, mobilization, breathing exercises, and mobility exercises. To date, no study has described physiotherapy practice for patients undergoing thoracic surgery in Sweden. PURPOSE To investigate physiotherapy interventions for patients undergoing thoracic surgery in Sweden. METHODS All physiotherapists currently working in thoracic surgery units in Sweden (n = 8) were eligible to participate. A survey was e-mailed to the physiotherapists, to determine physiotherapy interventions offered to patients undergoing thoracoscopy or open thoracic surgery. Of 21 physiotherapists, 13 (62%) responded, representing seven hospitals. RESULTS Physiotherapists reported routinely providing preoperative education and postoperative treatment for all patients undergoing thoracic surgery. Breathing exercises and mobilization were usually initiated on the day of surgery or the first postoperative day. Common treatments were deep breathing exercises, with or without positive expiratory pressure, and airway clearance techniques. Upper limb and shoulder exercises were typically initiated on the first or second day after surgery. The most important factor reported to influence treatment choice was personal experience of the attending physiotherapist. No routine post-discharge rehabilitation was provided. CONCLUSION Physiotherapists in Sweden reported routinely treating patients scheduled for thoracic surgery, both pre and postoperatively. Prehabilitation or post-discharge rehabilitation was not routinely provided.
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Affiliation(s)
- Marcus Jonsson
- Department of Physiotherapy, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Elisabeth Westerdahl
- Department of Physiotherapy, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- Faculty of Medicine and Health, University Health Care Research Center, Örebro, Sweden
| | - Julie Reeve
- School of Clinical Sciences, Faculty of Health and Environmental Sciences, AUT University, Northcote, Auckland, New Zealand
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Adhikari A, Khanal S, Magar SR, Thapa S, Khati S, Lamichhane R, Marasini K. Aspergillus Coinfection in a Hydatid Cyst Cavity of Lung in an Immunocompetent Host: A Case Report and Review of Literature. Case Rep Infect Dis 2023; 2023:6975041. [PMID: 37485286 PMCID: PMC10361833 DOI: 10.1155/2023/6975041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 06/16/2023] [Accepted: 06/21/2023] [Indexed: 07/25/2023] Open
Abstract
Aspergilloma (a saprophytic infection) typically colonizes lung cavities due to underlying diseases such as tuberculosis, bronchiectasis, cavitary lung cancer, sarcoidosis, and pulmonary infarctions. Rarely, aspergilloma has been noted within a hydatid cyst. Even if this was the case, it is more common to find the coexistence of aspergilloma and pulmonary echinococcal cysts in immunocompromised individuals. It is, however, very uncommon to find this coinfection in normal immune status individuals. Here, we report on the successfully treated case of a 30-year-old immunocompetent female from Western Nepal with histologically proven coinfection by these two pathogens. She had a prolonged history of exposure to domesticated dogs. She suffered from hemoptysis from time to time for 3 years with increased frequency in the last 30 days. She was misdiagnosed clinically during a past medical visit at a local health center. Her computed tomography (CT) scans showed well-defined nonenhancing cystic lesions in the anterior basal segment of the right lower lobe adjacent to the major fissure. She underwent enucleation of the cyst via right posterolateral thoracotomy. On further histopathological evaluation, laminated membranes of the ectocyst along with fungal elements were found, and periodic acid-Schiff (PAS) staining revealed Aspergillus in the form of septate hyphae and acute angle branching. Owing to patient's economic constraints and unavailability in our center, DNA testing and molecular characterization could not be performed which further highlights the essence of diagnosing and managing such cases in resource poor settings. Eventually, we reviewed 12 confirmed cases of this coinfection in immunocompetent individuals during a period of 7 years (2015-2022) comparing them to a systematic review of 22 confirmed cases of the same coinfection from 1995 to 2014.
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Affiliation(s)
| | - Surendra Khanal
- Department of Internal Medicine, Piedmont Athens Regional, Athens, Georgia, USA
| | - Sagar Rana Magar
- Maharajgunj Medical Campus, Institute of Medicine, Kathmandu, Nepal
| | - Srijana Thapa
- Manmohan Cardiothoracic Vascular and Transplant Center, Kathmandu, Nepal
| | - Srijana Khati
- Department of Pathology, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Rajan Lamichhane
- Maharajgunj Medical Campus, Institute of Medicine, Kathmandu, Nepal
| | - Kundan Marasini
- Department of Radiology, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
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Rahardjo TM, Nurzaman YA, Natalia J, Hapdijaya I, Devina L, Andrianto H, Mahardhika JC. Adult Hirschsprung's disease presenting as chronic constipation: a case report. J Med Case Rep 2023; 17:308. [PMID: 37403154 DOI: 10.1186/s13256-023-03986-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 05/16/2023] [Indexed: 07/06/2023] Open
Abstract
BACKGROUND Hirschsprung's disease is a congenital disorder identified by the absence of ganglion cells at the Meissner's plexus of the submucosa and Auerbach's plexus of the muscularis. This disease can be found in approximately 1 in 5000 live births. It is a congenital disorder that is rarely diagnosed in adults, where 95% of cases are diagnosed in infants aged under 1 year old. Here we present a rare case of adult Hirschsprung's disease to enrich the body of knowledge in diagnosing adult patients with chronic refractory constipation symptoms. CASE REPORT An 18-year-old Indonesian woman came to the general surgery department of Unggul Karsa Medika Teaching Hospital with a defecating problem (constipation) since childhood. There was no history of her passage of meconium. A contrast enema study showed that the sigmoid colon was dilated and the rectum was narrowed, with rectosigmoid index < 1. With these findings, it was suspected that the patient may have ultra-short segment Hirschsprung's disease. The patient was then referred to the digestive surgery department of referral hospital for surgical treatment. CONCLUSION In adult patients presenting with history of constipation since childhood, it is necessary to consider the possibility of Hirschsprung's disease that was not diagnosed in early childhood. Hirschsprung's disease in adults is usually a short or ultra-short aganglionic segment because it shows relatively mild symptoms. Surgical removal of the aganglionic segment of the gut is the definitive treatment for Hirschsprung's disease.
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Affiliation(s)
- Theresia Monica Rahardjo
- Faculty of Medicine, Maranatha Christian University, Suria Sumantri 65, Bandung, West Java, 40164, Indonesia.
| | - Yeppy Arief Nurzaman
- Unggul Karsa Medika Teaching Hospital, Taman Kopo Indah III Block H-1, Bandung, West Java, 40218, Indonesia
| | - Janice Natalia
- Faculty of Medicine, Maranatha Christian University, Suria Sumantri 65, Bandung, West Java, 40164, Indonesia
| | - Indra Hapdijaya
- Faculty of Medicine, Maranatha Christian University, Suria Sumantri 65, Bandung, West Java, 40164, Indonesia
| | - Livia Devina
- Faculty of Medicine, Maranatha Christian University, Suria Sumantri 65, Bandung, West Java, 40164, Indonesia
| | - Hendrik Andrianto
- Faculty of Medicine, Maranatha Christian University, Suria Sumantri 65, Bandung, West Java, 40164, Indonesia
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Zhang Z, Wang L, Xie C, Liu Y, Ni X, Chen Y. Relationship between IgE-mediated allergy and complicated appendicitis in children. Pediatr Surg Int 2023; 39:223. [PMID: 37392264 DOI: 10.1007/s00383-023-05497-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/16/2023] [Indexed: 07/03/2023]
Abstract
PURPOSE To investigate the relationship of IgE-mediated allergy and complicated appendicitis (CA) and overall prognosis. METHODS We retrospectively analyzed a consecutive series of patients with acute appendicitis (AA) who received appendectomy at Beijing Children's Hospital between July 1, 2018 and June 30, 2020. Patients were classified into two groups, with or without IgE-mediated allergies. Logistic regression adjusting for age, duration of symptoms, WBC count, neutrophil count, C-reactive protein (CRP), Appendicolith and presence of allergy was used to evaluate the association between CA and IgE-mediated allergy. RESULTS In total, 1156 patients were included. 162 (14.0%) of the patients had IgE-mediated allergy while 994 (86.0%) did not. Children with allergies had a decreased chance of developing CA after adjustment for age, duration of symptoms, WBC count, Neutrophil count, CRP, and appendicolith present rate (adjusted OR = 0.582, 0.364-0.929, P = 0.023). There were no significant differences in operative time, length of hospital stay (LOS), readmission, or adhesive intestinal obstruction rate between allergy and non-allergy patients. CONCLUSIONS IgE-mediated allergy is related to a reduction risk of CA in the pediatric population and may not affect the prognosis of patients received appendectomy.
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Affiliation(s)
- Zhiyi Zhang
- Department of General Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No. 56 Nanlishi Road, Xicheng District, Beijing, 100045, China
| | - Li Wang
- Department of Emergency Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No. 56 Nanlishi Road, Xicheng District, Beijing, 100045, China
| | - Chuanping Xie
- Department of General Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No. 56 Nanlishi Road, Xicheng District, Beijing, 100045, China
| | - Yakun Liu
- Department of General Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No. 56 Nanlishi Road, Xicheng District, Beijing, 100045, China
| | - Xin Ni
- Department of Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No. 56 Nanlishi Road, Xicheng District, Beijing, 100045, China.
| | - Yajun Chen
- Department of General Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No. 56 Nanlishi Road, Xicheng District, Beijing, 100045, China.
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Bugada D, Compagnone C, Bettinelli S, Grimaldi S, DE Gregori M, Muscoli C, Berretta R, Cobianchi L, Peloso A, Lorini L, Lavand'homme P, Allegri M. Prolonged continuous wound infusion of local anesthetic and steroid after major abdominal surgery to reduce opioid consumption: a randomized, double-blind trial. Minerva Anestesiol 2023; 89:625-635. [PMID: 37194239 DOI: 10.23736/s0375-9393.23.16547-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
BACKGROUND Continuous wound infusion (CWI) is effective for post-operative pain management, but the effect of prolonged infusions and the use of steroids in the infused mixture have never been addressed. We investigate the effect of prolonged CWI with ropivacaine 0.2% (R) over seven days and methylprednisolone (Mp) 1 mg/kg infused in the wound in the first 24 hours. METHODS This is a randomized, double blind, phase III trial (RCT) in major abdominal surgery with laparotomy. After a 24-hours pre-peritoneal CWI of R-Mp, patients were randomized to receive either R-Mp or placebo for the next 24 hours. Then, patient-controlled CWI with only ropivacaine 0.2% or placebo (according to the randomization group) was planned between 48 hours and seven days after surgery. Morphine equivalents at seven days were analyzed, together with any catheter- or drug-related side effect and PPSP at 3 months. RESULTS We enrolled 120 patients (63 in the CWI group, 57 in the placebo group). Prolonged CWI did not reduce opioid consumption in the first seven postoperative days (P=0.08). CWI was associated with reduced consumption of non-opioid analgesics (P=0.03). Most of the patients continued to require bolus in the surgical wound beyond 48 hours. PPSP prevalence was not different between groups. CONCLUSIONS Prolonged infusion with R-Mp is safe and effective but did not reduce opioid consumption in the seven days after surgery or PPSP prevalence.
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Affiliation(s)
- Dario Bugada
- Department of Emergency and Critical Care Medicine, ASST Papa Giovanni XXIII, Bergamo, Italy -
| | - Christian Compagnone
- Service of Anesthesia, Intensive Care and Pain Therapy, University Hospital of Parma, Parma, Italy
| | - Silvia Bettinelli
- Department of Emergency and Critical Care Medicine, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Stefania Grimaldi
- Department of Anesthesia and Intensive Care Medicine, Humanitas Clinical and Research Center IRCCS, Rozzano, Milan, Italy
| | - Manuela DE Gregori
- Clinical and Experimental Pharmacokinetics Unit, San Matteo IRCCS Foundation, Pavia, Italy
| | - Carolina Muscoli
- Institute of Research for Food Safety & Health (IRC-FSH), Department of Health Science, Magna Graecia University, Catanzaro, Italy
| | - Roberto Berretta
- Department of Gynecology and Obstetrics, University of Parma, Parma, Italy
| | - Lorenzo Cobianchi
- Department of General Surgery, San Matteo IRCCS Foundation, Pavia, Italy
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Andrea Peloso
- Department of General Surgery and Transplantation, University Hospital of Geneva, University of Geneva, Geneva, Switzerland
| | - Luca Lorini
- Department of Emergency and Critical Care Medicine, ASST Papa Giovanni XXIII, Bergamo, Italy
| | | | - Massimo Allegri
- Pain Therapy Service, Policlinico di Monza Hospital, Monza, Monza-Brianza, Italy
- Centre Lemanique d'antalgie et neuromodulation, Ensemble Hospitalier de la Côte, Morges, Switzerland
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Kunnur VS, Singh CS, Shantala G, Kumar SKA. Evaluation of the outcome of right subumbilical transverse incision approach for the management of complicated appendicitis in paediatric age group - A multi-institutional retrospective study. Afr J Paediatr Surg 2023; 20:176-183. [PMID: 37470552 PMCID: PMC10450110 DOI: 10.4103/ajps.ajps_24_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 04/13/2022] [Accepted: 05/10/2022] [Indexed: 01/22/2023] Open
Abstract
Aim The aim is to evaluate the outcome of right subumbilical transverse incision approach for the management of complicated appendicitis in paediatric age group. Materials and Methods This is a retrospective multi-institutional study which was conducted in the Department of Paediatric Surgery, I Q City Medical College and Hospital, Durgapur, West Bengal, India and the Department of Paediatric Surgery, Rajiv Gandhi Super Speciality Hospital/Raichur Institute of Medical Sciences, Raichur, Karnataka, India. In this study, a review of 77 paediatric patients operated for complicated appendicitis using a right subumbilical transverse incision approach was done for a period of 3 years (from December 2017 to December 2020). All patients had proven complicated appendicular pathology like appendicular perforation, appendicular abscess or complicated appendicular lumps on ultrasonography or computed tomography scan, which mandated exploration. Results There was no mortality. Average operative time was 1 h 48 min (ranging from 58 min to 3 h 12 min). Average length of hospital stay was 9 days (ranging from 5 days to 13 days). There was no incidence of fecal fistula. Seventeen (22%) patients developed superficial surgical site infection which subsided with regular dressings. There was no incidence of wound dehiscence or burst abdomen. Five (6.5%) patients required the incision to be extended beyond the midline to the left side to deal with the pathology and to access the entire peritoneal cavity. Nine (11.6%) patients required loop ileostomies, which was fashioned on the lateral aspect of the transverse incision. Only one patient had a doubtful caecal injury which was repaired and loop ileostomy was done. Six patients (7.7%) had adhesive intestinal obstruction postoperatively, of which three required re-exploration. There was no incidence of incisional hernia or any stoma-related complications. Conclusion Complicated appendicitis is a condition which lacks standardisation of approach for management, and is inherently associated with complications. However, with a more logical incision and intra-operative approach we can keep the complications to minimum and improve outcomes to great extent in those patients requiring surgical intervention. We have been using the subumbilical transverse incision in all sizes of patients ranging from small children to adolescents with excellent results, and we believe that the same approach can be applied even in adult patients in similar clinical scenarios.
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Affiliation(s)
- Vijaymahantesh S. Kunnur
- Department of Paediatric Surgery, Rajiv Gandhi Super Speciality Hospital, Raichur Institute of Medical Sciences, Raichur, Karnataka, India
| | - Chandra Shekhar Singh
- Department of Paediatric Surgery, I Q City Medical College and Hospital, Durgapur, West Bengal, India
| | - G. Shantala
- Department of Paediatric Medicine, Rajiv Gandhi Super Speciality Hospital, Raichur Institute of Medical Sciences, Raichur, Karnataka, India
| | - S. K. Anil Kumar
- Department of Anaesthesia, ESI Medical College, Kalburgi, Karnataka, India
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Modekwe VI, Ekwunife OH, Ugwu JO, Ugwunne CA, Ndukwu CU, Obiegbu HO, Obidike AB. Classical bladder exstrophy in an adolescent: A case report on management, challenges and outcome. Afr J Paediatr Surg 2023; 20:233-237. [PMID: 37470562 PMCID: PMC10450118 DOI: 10.4103/ajps.ajps_172_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 04/18/2022] [Accepted: 06/10/2022] [Indexed: 01/22/2023] Open
Abstract
Classical bladder exstrophy is a congenital anomaly whose management and outcome has advanced over years. Management and outcome are better when management starts at the newborn period. This was the management of a neglected bladder exstrophy in a male presenting at 16 years of age. We report our challenges, management and outcome to highlight the rarity of this presentation, and the adaptation to the usual protocol of care. The patient presented at 16 years of age with classic bladder exstrophy. The bladder plate was contracted and had cystitis. The patient had a modification of complete primary repair of exstrophy (CPRE) with bilateral pelvic osteotomy stabilised with a 7-hole plate and 4 screws, then bladder neck reconstruction + bladder augmentation + cross-trigonal neocystoureterostomy in a 12-h procedure. He had surgical site infection, superficial wound breakdown and vesicocutaneous fistula that all healed with dressing and prolonged suprapubic cystostomy drainage. He achieved some degree of urinary continence and ability to void, though he still has stress incontinence and frequency at 6 months of follow-up. He has a micturition interval of 60-120 min, and is expected to improve. Presentation and repair of classic bladder exstrophy in the adolescent is very rare in the literature and therefore no known standard of care. This report adds to the body of knowledge. Again, this experience lends credence to the proponents of CPRE in reducing the number of procedures required to treat exstrophy.
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Affiliation(s)
- Victor Ifeanyichukwu Modekwe
- Department of Surgery, Nnamdi Azikiwe University Awka, Nigeria
- Department of Surgery, Paediatric Surgery Unit, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria
| | - Okechukwu Hyginus Ekwunife
- Department of Surgery, Nnamdi Azikiwe University Awka, Nigeria
- Department of Surgery, Paediatric Surgery Unit, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria
| | - Jideofor Okechukwu Ugwu
- Department of Surgery, Nnamdi Azikiwe University Awka, Nigeria
- Department of Surgery, Paediatric Surgery Unit, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria
| | - Chuka Abunike Ugwunne
- Department of Surgery, Paediatric Surgery Unit, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria
| | - Chibuzo Uchechukwu Ndukwu
- Department of Surgery, Nnamdi Azikiwe University Awka, Nigeria
- Department of Orthopaedics, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria
| | - Henry Obinna Obiegbu
- Department of Surgery, Nnamdi Azikiwe University Awka, Nigeria
- Department of Orthopaedics, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria
| | - Afam Ben Obidike
- Department of Anaesthesia, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria
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Covantsev S, Uzdenov R, Mazuruc N, Turovets D, Belic O. Absent celiac trunk and unusual arterial anatomy of the upper abdomen: into the deep. Folia Med (Plovdiv) 2023; 65:500-507. [PMID: 38351829 DOI: 10.3897/folmed.65.e72710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 10/08/2021] [Indexed: 02/16/2024] Open
Abstract
The celiac trunk is the first major branch of the abdominal aorta. It originates from the ventral aspect of the aorta at the level of T12-L1 vertebrae and was originally described as an artery that branches into the common hepatic artery, left gastric artery, and splenic artery. Absence of the celiac trunk and origin of the three arteries separately from the aorta is a rare entity that is reported in 0.38% to 2.6% of cases. It is even more uncommon that this variation can be accompanied by other vascular variations of the upper abdomen as accessory arteries to the liver, stomach, and pancreas. These cases arise during embryogenesis due to decreased arterial degeneration combined with decreased arterial fusion, which results in the anatomical variations present in the current case. Complex arterial variations are both a risk for iatrogenic injury during surgical procedures and beneficial during endovascular supply as they may provide additional access for embolization and chemotherapy.
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Affiliation(s)
- Serghei Covantsev
- Nicolae Testemitanu State University of Medicine and Pharmacy, Chisinau, Moldova
| | | | - Natalia Mazuruc
- Nicolae Testemitanu State University of Medicine and Pharmacy, Chisinau, Moldova
| | | | - Olga Belic
- Nicolae Testemitanu State University of Medicine and Pharmacy, Chisinau, Moldova
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171
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Rassi R, Muse F, Cuestas E. [Appendicitis predictive score for children younger than 4 years]. REVISTA DE LA FACULTAD DE CIENCIAS MÉDICAS 2023; 80:119-125. [PMID: 37402291 PMCID: PMC10443412 DOI: 10.31053/1853.0605.v80.n2.40962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 05/05/2023] [Indexed: 07/06/2023] Open
Abstract
Introduction The clinical presentation of acute appendicitis in infants and young children is nonspecific. The diagnosis is often delayed and is accompanied by high rates of appendiceal perforation. The aim of the present study was to develop an early diagnostic scale for acute appendicitis in children less than 4 years of age. Results: The scale had a high discrimination index area under the ROC curve of 0.96 (95%CI 0.88-0.99), sensitivity of 95.1% (95%CI 86.3-99.0%), specificity of 90.0% (95%CI 55.7-89.5%), positive predictive value of 98.3% (95%CI 90.0-99.7%) and negative predictive value of 75.0% (95%CI 49.4-90.2). Conclusions: In this study, a risk score based on characteristics of children less than 4 years with abdominal pain was developed that may help predict a patient’s risk of developing acute appendicitis. Patients and methods 100 children less than 4 years of age with a presumptive diagnosis of acute appendicitis were retrospectively evaluated in 4 hospitals. The case group comprised 90 patients with histopathological diagnosis of positive appendicitis (with inflammation in the appendiceal wall) while the control group comprised 10 patients with a histopathological diagnosis of negative appendicitis (without inflammation). Epidemiological, clinical, laboratory, and ultrasound variables were screened using Least Absolute Shrinkage and Selection Operator (LASSO) and logistic regression to construct a predictive risk score. Accuracy of the score was measured by the area under the receiver operating characteristic curve. Final model comprised 4 variables (Blumberg's sign, C-reactive protein, neutrophil-lymphocyte index and positive ultrasound). Results The scale had a high discrimination index area under the ROC curve of 0.96 (95%CI 0.88-0.99), sensitivity of 95.1% (95%CI 86.3-99.0%), specificity of 90.0% (95%CI 55.7-89.5%), positive predictive value of 98.3% (95%CI 90.0-99.7%) and negative predictive value of 75.0% (95%CI 49.4-90.2). Conclusions In this study, a risk score based on characteristics of children less than 4 years with abdominal pain was developed that may help predict a patient’s risk of developing acute appendicitis.
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Affiliation(s)
- Ricardo Rassi
- Hospital Privado Universitario de Córdoba. Córdoba, Argentina..
| | - Florencia Muse
- Servicio de Cirugía Pediátrica, Hospital Infantil Municipal, Córdoba, Argentina.
| | - Eduardo Cuestas
- Departamento de Pediatría y Neonatología, Hospital Privado Universitario de Córdoba, Córdoba, Argentina. .
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172
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Edem S, Goswami AG, Karki B, Acharya P, Chauhan U, Kumar N, Basu S. Superior Mesenteric Artery Syndrome as a Rare Cause of Postoperative Intractable Vomiting: A Case Report. Clin Exp Gastroenterol 2023; 16:101-105. [PMID: 37409311 PMCID: PMC10318104 DOI: 10.2147/ceg.s416391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 06/24/2023] [Indexed: 07/07/2023] Open
Abstract
Background Superior mesenteric artery syndrome is a very rare cause of proximal intestinal obstruction. The objective of this clinical case report is to highlight that this unusual condition can occur in the early postoperative period and medical management may completely cure the condition. Clinical Case A middle-aged female who was being treated for pulmonary tuberculosis underwent exploratory laparotomy with limited ileal resection and a loop ileostomy for multiple ileal perforations. Postoperatively, she was restarted on anti-tubercular drugs (ATD) but developed a drug reaction, recurrent bilious vomiting, and jaundice and ATD had to be stopped. But her vomiting did not abate and she progressively developed septicemia. An abdominal CT scan diagnosed Wilkie's syndrome, and she was managed non-operatively by decubitus, parenteral nutrition, and nasojejunal tube feeding supplemented with prokinetics and antibiotics. But her sepsis did not resolve. Intraoperative histopathology suggested Candida infection, and she recovered only after systemic antifungal therapy. Discussion Debilitation conditions like tuberculosis cause weight loss and loss of intra-abdominal fat pad, which is known to precipitate SMA syndrome. However, its presentation in the early post-operative period is rare. Symptoms may vary from non-specific abdominal fullness and weight loss to features of acute bowel obstruction. CECT of whole abdomen can help in confirming the diagnosis. SMA syndrome is often not considered in differential diagnosis and can delay treatment. Medical management is the mainstay treatment option, although surgery is reserved for cases, which fail medical treatment. Conclusion High suspicion is needed to diagnose SMA syndrome in the postoperative period, which precipitates with intractable bilious vomiting. Medical management may be curative. The precipitating factor for SMA syndrome should also be addressed to improve the overall patient outcome.
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Affiliation(s)
- Sanketh Edem
- Departments of General Surgery, All India Institute of Medical Sciences, Rishikesh, India
| | - Aakansha Giri Goswami
- Departments of General Surgery, All India Institute of Medical Sciences, Rishikesh, India
| | - Bibek Karki
- Departments of General Surgery, All India Institute of Medical Sciences, Rishikesh, India
| | - Preeti Acharya
- Departments of General Surgery, All India Institute of Medical Sciences, Rishikesh, India
| | - Udit Chauhan
- Radiodiagnosis and Imaging, All India Institute of Medical Sciences, Rishikesh, India
| | - Navin Kumar
- Departments of General Surgery, All India Institute of Medical Sciences, Rishikesh, India
| | - Somprakas Basu
- Departments of General Surgery, All India Institute of Medical Sciences, Rishikesh, India
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173
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Bencini L, Minuzzo A. Distal pancreatectomy with or without radical approach, vascular resections and splenectomy: Easier does not always mean easy. World J Gastrointest Surg 2023; 15:1020-1032. [PMID: 37405088 PMCID: PMC10315131 DOI: 10.4240/wjgs.v15.i6.1020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 01/24/2023] [Accepted: 04/17/2023] [Indexed: 06/15/2023] Open
Abstract
Because distal pancreatectomy (DP) has no reconstructive steps and less frequent vascular involvement, it is thought to be the easier counterpart of pancreaticoduodenectomy. This procedure has a high surgical risk and the overall incidences of perioperative morbidity (mainly pancreatic fistula), and mortality are still high, in addition to the challenges that accompany delayed access to adjuvant therapies (if any) and prolonged impairment of daily activities. Moreover, surgery to remove malignancy of the body or tail of the pancreas is associated with poor long-term oncological outcomes. From this perspective, new surgical approaches, and aggressive techniques, such as radical antegrade modular pancreato-splenectomy and DP with celiac axis resection, could lead to improved survival in those affected by more locally advanced tumors. Conversely, minimally invasive approaches such as laparoscopic and robotic surgeries and the avoidance of routine concomitant splenectomy have been developed to reduce the burden of surgical stress. The purpose of ongoing surgical research has been to achieve significant reductions in perioperative complications, length of hospital stays and the time between surgery and the beginning of adjuvant chemotherapy. Because a dedicated multidisciplinary team is crucial to pancreatic surgery, hospital and surgeon volumes have been confirmed to be associated with better outcomes in patients affected by benign, borderline, and malignant diseases of the pancreas. The purpose of this review is to examine the state of the art in distal pancreatectomies, with a special focus on minimally invasive approaches and oncological-directed techniques. The widespread reproducibility, cost-effectiveness and long-term results of each oncological procedure are also taken into deep consideration.
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Affiliation(s)
- Lapo Bencini
- Oncology and Robotic Surgery, Careggi Main Regional and University Hospital, Florence 50131, Italy
| | - Alessio Minuzzo
- Oncology and Robotic Surgery, Careggi Main Regional and University Hospital, Florence 50131, Italy
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174
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Ma Y, Zhang R, Cao X, Zhang L, Bao S, Ren J, Ma W. Effects of intraoperative esketamine addition on gastrointestinal function after benign gynaecological laparoscopic surgery: a double-blind, randomized controlled study. BMC Anesthesiol 2023; 23:220. [PMID: 37353773 PMCID: PMC10288755 DOI: 10.1186/s12871-023-02184-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 06/17/2023] [Indexed: 06/25/2023] Open
Abstract
BACKGROUND Gastrointestinal hypokinesis can occur transiently after benign gynecologic surgery. Opioids cause the side effect of postoperative gastrointestinal hypokinesis, but an opioid-sparing anaesthetic protocol based on esketamine reduces intraoperative opioid consumption. Therefore, this study hypothesised that an opioid-sparing anaesthetic protocol based on esketamine would shorten the gastrointestinal function recovery time after benign gynaecological laparoscopic surgery. METHODS This was a prospective randomized controlled double-blind study conducted in a single centre. All patients scheduled for elective benign laparoscopic gynaecological surgery at Xing'an Meng People's Hospital, Inner Mongolia Autonomous Region, from November 2021 to April 2022 were consecutively enrolled and randomly divided into the opioid-sparing anaesthesia group (Group OS) and the conventional anaesthesia group (Group C). Postoperative first exhaust time, feeding time and postoperative nausea and/or vomiting (PONV) were analyzed in both groups. RESULTS A total of 71 patients were enrolled in this study, including 35 in Group OS and 36 in Group C. The general condition, operative time, type of surgery, intraoperative bleeding, intraoperative fluid volume and intraoperative urine volume were not statistically different between the two groups. Compared with Group C, significantly shorter first postoperative flatus time (11 [8, 14] h vs. 14 [11, 18], p = 0.003) and anaesthesia resuscitation time (7 [6, 9] h vs. 9 [7, 11] h, p = 0.013)were observed in the OS group. The incidence of PONV in Group OS was significantly lower compared with Group C (11.4% vs. 41.7%, p = 0.007). CONCLUSION The esketamine-based opioid-sparing anaesthetic protocol can shorten the postoperative first flatus time after benign laparoscopic surgery in gynaecology, and reduce the incidence of PONV. In addition, the application of esketamine may reduce the postoperative opioid dose requirement of patients. TRIAL REGISTRATION This study was registered with the China Clinical Trials Registry (registration number: ChiCTR2100052528, 30/10/2021).
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Affiliation(s)
- Yuhua Ma
- Department of Anesthesiology, Xing'an Meng People's Hospital, Inner Mongolia Autonomous Region, Xing'an Meng, Inner Mongolia, 137400, China
| | - Ran Zhang
- Department of Anesthesiology, Peking University People's Hospital, Beijing, 100044, China.
| | - Xue Cao
- Department of Anesthesiology, Xing'an Meng People's Hospital, Inner Mongolia Autonomous Region, Xing'an Meng, Inner Mongolia, 137400, China
| | - Lin Zhang
- Department of Anesthesiology, Xing'an Meng People's Hospital, Inner Mongolia Autonomous Region, Xing'an Meng, Inner Mongolia, 137400, China
| | - Suozhu Bao
- Department of Anesthesiology, Xing'an Meng People's Hospital, Inner Mongolia Autonomous Region, Xing'an Meng, Inner Mongolia, 137400, China
| | - Jie Ren
- Department of Anesthesiology, Xing'an Meng People's Hospital, Inner Mongolia Autonomous Region, Xing'an Meng, Inner Mongolia, 137400, China
| | - Weiwei Ma
- Department of Anesthesiology, Xing'an Meng People's Hospital, Inner Mongolia Autonomous Region, Xing'an Meng, Inner Mongolia, 137400, China
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175
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Ahmadi-Amoli H, Rahimi M, Abedi-Kichi R, Ebrahimian N, Hosseiniasl SM, Hajebi R, Rahimpour E. Early closure compared to late closure of temporary ileostomy in rectal cancer: a randomized controlled trial study. Langenbecks Arch Surg 2023; 408:234. [PMID: 37316696 DOI: 10.1007/s00423-023-02934-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Accepted: 05/07/2023] [Indexed: 06/16/2023]
Abstract
BACKGROUND A temporary loop ileostomy is one of the most common methods for the prevention of anastomotic leakage in rectal cancer patients who underwent low anterior resection. However, the optimal timing of loop ileostomy reversal remains unknown. The main objective of this study was to evaluate the debilitating complications caused by early closure of ileostomy in comparison with late closure in rectal cancer patients. DESIGN A randomized, controlled, unblinded, and monocentric trial. METHODS A total of 104 rectal cancer patients were randomly assigned to the case group of early closure of ileostomy (n = 50) and the control group of late closure of ileostomy (n = 54). This trial was undertaken in a single colorectal institution, a university-affiliated teaching hospital in Tehran, Iran. Randomization and allocation to the trial group were conducted by using variable block randomization based on quadruple numbers. The primary endpoint of this trial was determined by the complications of early ileostomy closure versus those of late closure in rectal cancer patients who had undergone low anterior resection. In early closure, loop ileostomy is reversed 2-3 weeks after the first two courses of adjuvant chemotherapy, while in late closure, the ileostomy is reversed 2-3 weeks after the last course of adjuvant chemotherapy. RESULTS Follow-up of 1 year demonstrated a reduction in the risk of complications and an improved quality of life in patients with rectal cancer following low anterior resection and chemotherapy (neoadjuvant and adjuvant) in the case group but did not reach a significant difference (p = 0.555). In addition, there was no significant difference in perioperative outcomes, such as blood loss, operative time, readmission, and reoperation; also, no statistically significant differences were reported between the groups in patients' quality of life or LARS score. CONCLUSION In summary, it seems that early closure of ileostomy is not better than late closure in improving patients' quality of life with rectal cancer following low anterior resection and chemotherapy (neoadjuvant and adjuvant); no statistical difference was observed for reduction of risk of ostomy complications. Thus, neither of these methods (early closure versus late closure) is superior to the other, and controversy still exists. TRIAL REGISTRATION NUMBER AND DATE OF REGISTRATION IRCT20201113049373N1.
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Affiliation(s)
- Hadi Ahmadi-Amoli
- Department of Surgery, Sina Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohsen Rahimi
- Department of Cardiovascular Surgery, Rajaee Cardiovascular Medical and Research Centre, Iran University of Medical Sciences, Tehran, Iran
| | - Raziyeh Abedi-Kichi
- Department of Surgery, Sina Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Nazli Ebrahimian
- Department of Surgery, Sina Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Reza Hajebi
- Department of Surgery, Sina Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Ehsan Rahimpour
- Department of Surgery, Sina Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
- Sina Hospital, Hassan Abad Square, Imam Khomeini Street, Isfahan, Iran.
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176
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Liu C, Shi Q, Zhang X, Xue E, Li H, Wang W. Incidence and risk factors of fasting hyperglycaemia following first-attack acute pancreatitis before discharge: a retrospective study. BMC Gastroenterol 2023; 23:203. [PMID: 37308836 DOI: 10.1186/s12876-023-02775-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 04/20/2023] [Indexed: 06/14/2023] Open
Abstract
BACKGROUND Pancreatic endocrine insufficiency is more likely to occur after acute pancreatitis (AP), but the risk factors affecting pancreatic endocrine function remain controversial. Therefore, exploring the incidence and risk factors of fasting hyperglycaemia following first-attack AP is important. METHODS Data were collected from 311 individuals with first-attack AP without previous diabetes mellitus (DM) or impaired fasting glucose (IFG) history treated in the Renmin Hospital of Wuhan University. Relevant statistical tests were performed. A two-sided p-value < 0.05 was considered statistically significant. RESULTS The incidence of fasting hyperglycaemia in individuals with first-attack AP was 45.3%. Univariate analysis showed that age (χ2 = 6.27, P = 0.012), aetiology (χ2 = 11.184, P = 0.004), serum total cholesterol (TC) (χ2 = 14.622, P < 0.001), and serum triglyceride (TG) (χ2 = 15.006, P < 0.001) were significantly different between the hyperglycaemia and non-hyperglycaemia groups (P < 0.05). The serum calcium concentration (Z=-2.480, P = 0.013) was significantly different between the two groups (P < 0.05). Multiple logistic regression analysis showed that age- ≥60 years (P < 0.001, OR = 2.631, 95%Cl = 1.529-4.527) and TG ≥ 5.65 mmol/L (P < 0.001, OR = 3.964, 95%Cl = 1.990-7.895) were independent risk factors for fasting hyperglycaemia in individuals with first-attack AP (P < 0.05). CONCLUSIONS Old age, serum triglycerides, serum total cholesterol, hypocalcaemia, and aetiology are associated with fasting hyperglycaemia following first-attack AP. Age ≥ 60 years and TG ≥ 5.65 mmol/L are independent risk factors for fasting hyperglycaemia following first-attack AP.
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Affiliation(s)
- Chengsi Liu
- Department of General Surgery, Renmin Hospital of Wuhan University, Wuhan, 430060, Hubei Province, China
| | - Qiao Shi
- Department of Pancreatic Surgery, Renmin Hospital of Wuhan University, Wuhan, 430060, Hubei Province, China
| | - Xiaoyi Zhang
- Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430060, Hubei Province, China
| | - Enfu Xue
- Department of General Surgery, Renmin Hospital of Wuhan University, Wuhan, 430060, Hubei Province, China
| | - Hanjun Li
- Department of Pancreatic Surgery, Renmin Hospital of Wuhan University, Wuhan, 430060, Hubei Province, China.
| | - Weixing Wang
- Department of General Surgery, Renmin Hospital of Wuhan University, Wuhan, 430060, Hubei Province, China.
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Okoroafor SC, Dela Christmals C. Health Professions Education Strategies for Enhancing Capacity for Task-Shifting and Task-Sharing Implementation in Africa: A Scoping Review. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2023:00005141-990000000-00082. [PMID: 37341562 DOI: 10.1097/ceh.0000000000000517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/22/2023]
Abstract
INTRODUCTION To compensate for the shortage of health workers and effectively use the available health workforce to provide access to health services at various levels of the health system, several countries are implementing task-shifting and task-sharing (TSTS). This scoping review was conducted to synthesize evidence on health professions education (HPE) strategies applied to enhance capacities for TSTS implementation in Africa. METHODS This scoping review was conducted using the enhanced Arksey and O'Malley's framework for scoping reviews. The sources of evidence included CINAHL, PubMed, and Scopus. RESULTS Thirty-eight studies conducted in 23 countries provided insights on the strategies implemented in various health services contexts including general health, cancer screenings, reproductive, maternal, newborn, child and adolescent health, HIV/AIDS, emergency care, hypertension, tuberculosis, eye care, diabetes, mental health, and medicines. The HPE strategies applied were in-service training, onsite clinical supervision and mentoring, periodic supportive supervision, provision of job aides, and preservice education. DISCUSSION Scaling up HPE based on the evidence from this study will contribute immensely to enhancing the capacity of health workers in contexts where TSTS are being implemented or planned to provide quality health services based on the population's health needs.
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Affiliation(s)
- Sunny C Okoroafor
- Dr. Okoroafor: Technical Officer, Health Systems Strengthening, Universal Health Coverage-Life Course Cluster, World Health Organization Country Office for Uganda, Kampala, Uganda. Dr. Dela Christmals: Associate Professor, Centre for Health Professions Education, Faculty of Health Sciences, North-West University, Potchefstroom Campus, Potchefstroom, South Africa
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178
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Mardani P, Kamran H, Khosravi F, Shahriarirad R, Shahabinejad P, Geramizadeh B, Soleimani N, Amirian A. Bronchobiliary fistulae as a complication of untreated pulmonary hydatid cyst presenting with bilioptysis: A report of two cases. Clin Case Rep 2023; 11:e7524. [PMID: 37323254 PMCID: PMC10264942 DOI: 10.1002/ccr3.7524] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 03/29/2023] [Accepted: 05/28/2023] [Indexed: 06/17/2023] Open
Abstract
We reported two patients, a 45-year-old lady and a 48-year-old man, known cases of untreated liver and lung hydatid cysts complicated with bronchobiliary fistulae. Surgery was performed, and bronchobiliary fistulae were diagnosed intraoperatively. Lobectomy was done on the lobe, which was chronically infected. Symptoms resolved after surgery in both cases. Green-colored sputum in a patient with a history of echinococcosis should raise the physician's attention to the probability of a connection between the bronchial tree and the biliary tract. Surgery in advanced cases is a suitable therapeutic option.
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Affiliation(s)
- Parviz Mardani
- Thoracic and Vascular Surgery Research CenterShiraz University of Medical ScienceShirazIran
- Department of SurgeryShiraz University of Medical SciencesShirazIran
| | - Hooman Kamran
- Thoracic and Vascular Surgery Research CenterShiraz University of Medical ScienceShirazIran
- Student Research CommitteeShiraz University of Medical SciencesShirazIran
| | - Fateme Khosravi
- Student Research CommitteeShiraz University of Medical SciencesShirazIran
| | - Reza Shahriarirad
- Thoracic and Vascular Surgery Research CenterShiraz University of Medical ScienceShirazIran
| | | | - Bita Geramizadeh
- Department of Pathology, School of MedicineShiraz University of Medical SciencesShirazIran
- Shiraz Transplant Research Center (STRC)Shiraz University of Medical SciencesShirazIran
| | - Neda Soleimani
- Shiraz Transplant Research Center (STRC)Shiraz University of Medical SciencesShirazIran
| | - Armin Amirian
- Thoracic and Vascular Surgery Research CenterShiraz University of Medical ScienceShirazIran
- Department of SurgeryShiraz University of Medical SciencesShirazIran
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179
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Poston LM, Leavitt T, Pope S, Hill H, Tollinche LE, Kaelber DC, Alter JA. Pre-appendectomy hyponatremia is associated with increased rates of complicated appendicitis. Surg Open Sci 2023; 13:88-93. [PMID: 37274135 PMCID: PMC10238878 DOI: 10.1016/j.sopen.2023.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 05/10/2023] [Indexed: 06/06/2023] Open
Abstract
Background Acute appendicitis is one of the most common surgical emergencies worldwide. Preoperative assessment of the risk of complicated appendicitis may aid in treatment planning. We sought to investigate the association between pre-appendectomy hyponatremia and diagnosis of complicated appendicitis. Methods The TriNetX platform, a federated health research network that aggregates de-identified electronic health record data of over 90 million patients across the United States, was queried for patients who underwent appendectomy starting January 2019 and who had at least one sodium value from the preoperative period. The study population was stratified into three age groups: pediatric (age < 18), adult (age 18-64), and older adult (age ≥ 65). These groups were subdivided into patients with preoperative hyponatremia (<135 mmol/L) and normonatremia (135-145 mmol/L). Results Among the 61,245 patients who met inclusion criteria, 17,546 were included for analysis following propensity score matching. The odds of complicated appendicitis were highest in pediatric patients (age < 18) with pre-appendectomy hyponatremia (odds ratio [OR] = 2.91, 95 % CI [2.53, 3.35]). Patients age 18-64 and aged ≥ 65 with preoperative hyponatremia also demonstrated increased odds of a complicated appendicitis diagnosis, but to a lesser extent (OR = 2.11, 95 % CI [1.92, 2.32] (OR = 1.49, 95 % CI [1.25, 1.77], respectively). Conclusions In a large analysis of matched patients with acute appendicitis, we found an association between immediate preoperative hyponatremia and complicated appendicitis. Future studies are indicated to further evaluate the role of hyponatremia as a potential diagnostic marker for complicated appendicitis in all age groups. Key message This study suggests a role of hyponatremia as one of multiple variables to incorporate into future clinical decision tools for complicated acute appendicitis.
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Affiliation(s)
- Lauren M. Poston
- Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA
| | - Tripp Leavitt
- Department of Plastic Surgery, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Samantha Pope
- Department of Anesthesiology, The MetroHealth System, Cleveland, OH 44109, USA
| | - Hannah Hill
- Population Health Research Institute, The MetroHealth System, Cleveland, OH 44109, USA
| | - Luis E. Tollinche
- Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA
- Department of Anesthesiology, The MetroHealth System, Cleveland, OH 44109, USA
| | - David C. Kaelber
- Departments of Internal Medicine, Pediatrics, and Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH 44109, USA
- The Center for Clinical Informatics Research and Education, The MetroHealth System, Cleveland, OH 44109, USA
| | - Jonathan A. Alter
- Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA
- Department of Anesthesiology, The MetroHealth System, Cleveland, OH 44109, USA
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180
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Lim CC, Liew YT, Ghauth S, Bakar MZBA, Narayanan P. A Novel Methylene Blue Guided Neopharynx Closure and a Review of Essential Applications in Otolaryngology. Indian J Otolaryngol Head Neck Surg 2023; 75:1255-1258. [PMID: 37274994 PMCID: PMC10235329 DOI: 10.1007/s12070-022-03192-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 09/23/2022] [Indexed: 12/13/2022] Open
Abstract
Methylene blue has many usages in the field of otolaryngology. We describe a preliminary finding of methylene blue guided neopharynx closure after total laryngectomy. This technique can potentially reduce the risk of pharyngocutaneous fistula and has not been described in the literature. It is also handy in assisting junior surgeons to perform modified Connell suture during neopharynx reconstruction. Concurrently, we reviewed other essential applications of methylene blue in otolaryngology.
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Affiliation(s)
- Chee Chean Lim
- Department of Otorhinolaryngology – Head and Neck Surgery, University of Malaya, Kuala Lumpur, Malaysia
| | - Yew Toong Liew
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Sakina Ghauth
- Department of Otorhinolaryngology – Head and Neck Surgery, University of Malaya, Kuala Lumpur, Malaysia
| | | | - Prepageran Narayanan
- Department of Otorhinolaryngology – Head and Neck Surgery, University of Malaya, Kuala Lumpur, Malaysia
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181
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Isik A, Memis U. Invited Commentary: The Efficacy of VAMMFT Compared to "Bogota Bag" in Achieving Sheath Closure Following Temporary Abdominal Closure at Index Laparotomy for Trauma. World J Surg 2023; 47:1442-1443. [PMID: 36745199 DOI: 10.1007/s00268-023-06931-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2023] [Indexed: 02/07/2023]
Affiliation(s)
- Arda Isik
- School of Medicine, General Surgery Department, Istanbul Medeniyet University, Istanbul, Turkey.
| | - Ufuk Memis
- School of Medicine, General Surgery Department, Erzincan Binali Yildirim University, Erzincan, Turkey
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182
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Jain N. Outbreaks of iatrogenic botulism in Europe: Combating off-label medical use of Botulinum Neurotoxin (BoNT) in bariatric procedures. New Microbes New Infect 2023; 53:101152. [PMID: 37441153 PMCID: PMC10333734 DOI: 10.1016/j.nmni.2023.101152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 05/09/2023] [Indexed: 07/15/2023] Open
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183
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Yousaf MN, Naqvi HA, Kane S, Chaudhary FS, Hawksworth J, Nayar VV, Faust TW. Cerebrospinal fluid liver pseudocyst: A bizarre long-term complication of ventriculoperitoneal shunt: A case report. World J Hepatol 2023; 15:715-724. [PMID: 37305372 PMCID: PMC10251282 DOI: 10.4254/wjh.v15.i5.715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 03/02/2023] [Accepted: 04/10/2023] [Indexed: 05/24/2023] Open
Abstract
BACKGROUND Ventriculoperitoneal (VP) shunt placement has become a standard of care procedure in managing hydrocephalus for drainage and absorption of cerebrospinal fluid (CSF) into the peritoneum. Abdominal pseudocysts containing CSF are the common long-term complication of this frequently performed procedure, mainly because VP shunts have significantly prolonged survival. Of these, liver CSF pseudocysts are rare entities that may cause shunt dysfunction, affect normal organ function, and therefore pose therapeutic challenges.
CASE SUMMARY A 49-year-old man with history of congenital hydrocephalus status post bilateral VP shunt placement presented with progressively worsening dyspnea on exertion, abdominal discomfort/distention. Abdominal computed tomography (CT) scan revealed a large CSF pseudocyst in the right hepatic lobe with the tip of VP shunt catheter into the hepatic cyst cavity. Patient underwent robotic laparoscopic cyst fenestration with a partial hepatectomy, and repositioning of VP shunt catheter to the right lower quadrant of the abdomen. Follow-up CT demonstrated a significant reduction in hepatic CSF pseudocyst.
CONCLUSION A high index of clinical suspicion is required for early detection of liver CSF pseudocysts since their presentation is often asymptomatic and cunning early in the course. Late-stage liver CSF pseudocysts could have adverse outcomes on the treatment course of hydrocephalus as well as on hepatobiliary dysfunction. There is paucity of data to define the management of liver CSF pseudocyst in current guidelines due to rare nature of this entity. The reported occurrences have been managed by laparotomy with debridement, paracentesis, radiological imaging guided fluid aspiration and laparoscopic-associated cyst fenestration. Robotic surgery is an additional minimally invasive option in the management of hepatic CSF pseudocyst; however, its use is limited by lack of widespread availability and cost of surgery.
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Affiliation(s)
- Muhammad Nadeem Yousaf
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Missouri, Columbia, MO 65212, United States
| | - Haider A Naqvi
- Department of Medicine, MedStar Union Memorial Hospital, Baltimore, MD 21218, United States
| | - Shriya Kane
- Department of Surgery, University Iowa School of Medicine, Iowa City, IA 52242, United States
| | - Fizah S Chaudhary
- Department of Medicine, University of Missouri, Columbia, MO 65212, United States
| | - Jason Hawksworth
- Department of Surgery, Transplant Hepatology, MedStar Georgetown University Hospital, Washington, DC 20007, United States
| | - Vikram V Nayar
- Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, DC 20007, United States
| | - Thomas W Faust
- Department of Medicine, Transplant Hepatology, James D. Eason Transplant Institute, Methodist Le Bonheur Healthcare, Memphis, TN 38104, United States
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Alemayehu MA, Azene AG, Mihretie KM. Time to development of surgical site infection and its predictors among general surgery patients admitted at specialized hospitals in Amhara region, northwest Ethiopia: a prospective follow-up study. BMC Infect Dis 2023; 23:334. [PMID: 37198551 DOI: 10.1186/s12879-023-08301-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 05/03/2023] [Indexed: 05/19/2023] Open
Abstract
BACKGROUND Surgical site infection is an infection occurring within 30 days after surgery. It is recently reported that evidence-based information on the specific time when the majority of surgical site infections would develop is a key to early detect the infection as well as to preventing and early intervene against their pressing and fatal complications. Therefore, the current study aimed to determine the incidence, predictors, and time to development of surgical site infection among general surgery patients at specialized hospitals in the Amhara region. METHOD An institution-based prospective follow-up study was conducted. The two-stage cluster sampling procedure was used. A systematic sampling technique with a K interval of 2 was applied to prospectively recruit 454 surgical patients. Patients were followed up for 30 days. Data were collected using Epicollect5 v 3.0.5 software. Post-discharge follow-up and diagnosis were done by telephone call follow-up. Data were analyzed using STATA™ version 14.0. Kaplan-Meier curve was used to estimate survival time. Cox proportional regression model was used to determine significant predictors. Variables with a P-value less than 0.05 in the multiple Cox regression models were independent predictors. RESULT The incidence density was 17.59 per 1000 person-day-observation. The incidence of post-discharge Surgical site infection was 70.3%. The majority of surgical site infections were discovered after discharge between postoperative days 9 to 16. Being male (AHR: 1.98, 95% CI: 1.201 - 3.277, diabetes Mellitus (AHR: 1.819, 95% CI: 1.097 - 3.016), surgical history (AHR: 2.078, 95% CI: 1.345, 3.211), early antimicrobial prophylaxis (AHR: 2.60, 95% CI: 1.676, 4.039), American Society of Anesthesiologists score ≥ III AHR: 6.710, 95% CI: 4.108, 10.960), duration of the surgery (AHR: 1.035 95% CI: 1.001, 1.070), Age (AHR: 1.022 95% CI: 1.000, 1.043), and the number of professionals in the Operation Room (AHR: 1.085 95% CI: 1.037, 1.134) were found to be the predictors of time to development of Surgical site infection. CONCLUSION The incidence of surgical site infection was higher than the acceptable international range. The majority of infections were detected after hospital discharge between 9 to 16 postoperative days. The main predictors of Surgical site infection were Age, Sex, Diabetes Mellitus, previous surgical history, the timing of Antimicrobial prophylaxis, American Society of Anesthesiologists score, pre-operative hospital stay, duration of surgery, and the number of professionals in the operation room. Hence, hospitals should give great emphasis on pre-operative preparation, post-discharge surveillance, modifiable predictors, and high-risk patients, as they found in this study.
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Affiliation(s)
- Meron Asmamaw Alemayehu
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Abebaw Gedef Azene
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Kebadnew Mulatu Mihretie
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
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185
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Shama AT, Terefa O, Gadisa I, Feyera G, Tamiru G, Terefa DR, Merdassa E. Surgical management outcome and its associated factors among intestinal obstruction patients admitted to adult surgical ward of Wollega University Referral Hospital, Ethiopia. BMC Surg 2023; 23:136. [PMID: 37198591 DOI: 10.1186/s12893-023-02043-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 05/11/2023] [Indexed: 05/19/2023] Open
Abstract
BACKGROUND Globally, bowel obstruction is the most common cause of surgical emergencies. It remains a challenge to healthcare workers in spite of improvements in management techniques. There is a lack of the study to determine the surgical management outcome and its associated factors in the area of study. Hence, this study aimed to determine management outcome and its associated factors among surgically treated intestinal obstruction patients at Wollega University Referral Hospital, 2021. METHODS Facility-based cross-sectional study was conducted among all cases surgically managed for intestinal obstruction between September 1, 2018 and September 1, 2021. Data were collected using a structured checklist. The collected data were checked for completeness and entered into data entry software and then exported to SPSS version 24 for data cleaning and analysis. Both bi-variable and multivariable logistic regressions were run. P-value < 0.05 was used to declare a statistically significant association in multivariable logistic regression. The odds ratio along with 95%CI was estimated to measure the strength of the association. RESULT 116 (59.2%) patients had favorable surgical management outcome for intestinal obstruction. Male sex (AOR = 3.694;95%CI:1.501,9.089), absence of fever (AOR = 2.636; 95%CI:1.124,6.18), ≤ 48 h duration of illness before operation (AOR = 3.045; 95%CI:1.399,6.629), viable intraoperative bowel condition (AOR = 2.372; 95%CI:1.088, 5.175), having bowel resection and anastomosis (AOR = 0.234; 95%CI:0.101,0.544) were the significantly associated factors of the favorable surgical management outcome for intestinal obstruction. CONCLUSION AND RECOMMENDATION The favorable management outcome of patients with intestinal obstruction who were treated surgically in this study was low. Factors like sex, fever, short duration of illness, viable intraoperative bowel condition, and bowel resection and anastomosis were found to influence the surgical management outcome of patients with intestinal obstruction. The patient with intestinal obstruction should seek health care on time. Health professionals have to be skilled and provide appropriate care for the patients to reduce the risk of complications.
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Affiliation(s)
- Adisu Tafari Shama
- Department of public health, Institute of health sciences, Wollega University, Nekemte, Ethiopia.
| | - Olana Terefa
- School of Medicine, Institute of health sciences, Wollega University, Nekemte, Ethiopia
| | - Iyasu Gadisa
- School of Medicine, Institute of health sciences, Wollega University, Nekemte, Ethiopia
| | - Gemechu Feyera
- School of Medicine, Institute of health sciences, Wollega University, Nekemte, Ethiopia
| | - Getnet Tamiru
- School of Medicine, Institute of health sciences, Wollega University, Nekemte, Ethiopia
| | - Dufera Rikitu Terefa
- Department of public health, Institute of health sciences, Wollega University, Nekemte, Ethiopia
| | - Emiru Merdassa
- Department of public health, Institute of health sciences, Wollega University, Nekemte, Ethiopia
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186
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Adane F, Dessalegn M. Magnitude and predictors of unfavorable management outcome in surgically treated patients with intestinal obstruction in Ethiopia: a systematic review and meta-analysis. BMC Surg 2023; 23:132. [PMID: 37193961 DOI: 10.1186/s12893-023-02017-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 04/26/2023] [Indexed: 05/18/2023] Open
Abstract
BACKGROUND Unless an emergency surgical intervention is conducted, intestinal obstruction may result in high morbidity and mortality. In Ethiopia, the magnitude and predictors of unfavorable management outcomes in surgically treated patients with intestinal obstruction are highly variable and inconsistent. The aim of this study was; therefore, to estimate the overall prevalence of unfavorable management outcome and its predictors among surgically treated patients with intestinal obstruction in Ethiopia. METHOD We searched articles from databases from June 1, 2022, to August 30, 2022. Cochrane Q test statistics and I2 tests were applied. We used a random-effect meta-analysis model to overcome the impact of heterogeneity among the included studies. In addition, the association between risk factors and unfavorable management outcome in surgically treated patients with intestinal obstruction was investigated. RESULTS This study included a total of twelve articles. The pooled prevalence of unfavorable management outcome in surgically treated patients with intestinal obstruction was 20.22% (95% CI: 17.48-22.96). According to a sub-group analysis by region, Tigray region had the highest prevalence of poor management outcome, which was 25.78% (95% CI: 15.69-35.87). Surgical site infection was the most commonly reported symptom of poor management outcome (8.63%; 95% CI: 5.62, 11.64). The length of postoperative hospital stays (95% CI: 3.02, 29.08), duration of illness (95% CI: 2.44, 6.12), presence of comorbidity (95% CI: 2.38, 10.11), dehydration (95% CI: 2.07, 17.40), and type of intraoperative procedure (95% CI: 2.12, 6.97) were all significantly associated with unfavorable management outcome of intestinal obstruction among surgically treated patients in Ethiopia. CONCLUSION According to this study, the magnitude of unfavorable management outcome was high among surgically treated patients in Ethiopia. Unfavorable management outcome was significantly associated with the length of postoperative hospital stays, duration of illness, comorbidity, dehydration, and type of intraoperative procedure. Medical, surgical and public health measures are pivotal to reduce unfavorable management outcome in surgically treated intestinal obstruction patients in Ethiopia.
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Affiliation(s)
- Fentahun Adane
- Department of Biomedical Sciences, School of Medicine, Debre Markos University, Debre Markos, Ethiopia.
| | - Megbar Dessalegn
- Department of Surgery, School of Medicine, Debre Markos University, Debre Markos, Ethiopia
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187
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Ali A, Gebretsadik D, Desta K. Incidence of surgical site infection, bacterial isolate, and their antimicrobial susceptibility pattern among patients who underwent surgery at Dessie Comprehensive Specialized Hospital, Northeast Ethiopia. SAGE Open Med 2023; 11:20503121231172345. [PMID: 37214212 PMCID: PMC10192803 DOI: 10.1177/20503121231172345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 04/11/2023] [Indexed: 05/24/2023] Open
Abstract
Objective Surgical site infection is the most common postoperative complication worldwide, representing a major burden for patients and health systems. The aim of the study is to determine the incidence and bacterial profile that cause surgical site infection among patients who underwent surgery in parts of Northeast Ethiopia. Methods A health facility-based cross-sectional study was conducted in Dessie Comprehensive Specialized Hospital from July 22 to October 25, 2016. A total of 338 patients from the obstetrics and gynecology and general surgical wards were included, through consecutive sampling technique. The specimens were collected aseptically on the first day when the patients had presented with clinical evidence of infection and then sent to the microbiology laboratory. The data were entered and analyzed by SPSS version 20, and the results were explained by frequency distribution in tables and figures. Results The majority of participants were female (74.3%) and more than half (61.2%) of the surgeries were performed in the gynecology and obstetrics ward. Clinically, 49 patients (14.5%) were diagnosed as developing surgical site infection, and wound swabs were taken for bacteriological study. About 41 (83.7%) swabs showed bacterial growth, indicating 12.13% overall prevalence of bacterial surgical site infection. Out of 48 bacterial isolates, more than half (56.25%) of them were Gram negative. The most frequent isolate was Staphylococcus aureus, 14 (66.67%), followed by Escherichia coli, 9 (33.33%). Out of the total bacterial isolates, 38 (79.2%) isolates were found to be multidrug resistant, and the rate of multidrug resistant was higher among Gram-negative isolates. Conclusion An average rate of surgical site infection was found to be reported and significant numbers of bacterial isolates were also detected. The highest rate of surgical site infection was reported in prostate surgery, followed by small bowel, vaginal hysterectomy, and exploratory laparotomy surgical procedures. Periodic surveillance on the incidence rate and bacterial profile along with the determination of their antibiotic susceptibility should be performed.
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Affiliation(s)
- Abdurrahman Ali
- Department of Medical Laboratory
Science, College of Medicine and Health Sciences, Wollo University, Dessie,
Ethiopia
| | - Daniel Gebretsadik
- Department of Medical Laboratory
Science, College of Medicine and Health Sciences, Wollo University, Dessie,
Ethiopia
| | - Kassu Desta
- Department of Medical Laboratory
Sciences, School of Allied Health Sciences, College of Health Science, Addis Ababa
University, Addis Ababa, Oromia, Ethiopia
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188
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Calini G, Abdalla S, Abd El Aziz MA, Benammi S, Merchea A, Behm KT, Mathis KL, Larson DW. Open approach for ileocolic resection in Crohn's disease in the era of minimally invasive surgery: indications and perioperative outcomes in a referral center. Updates Surg 2023:10.1007/s13304-023-01528-1. [PMID: 37149508 DOI: 10.1007/s13304-023-01528-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 04/29/2023] [Indexed: 05/08/2023]
Abstract
Minimally invasive surgery (MIS) is the first-line approach for ileocolic resection in Crohn's disease (CD), and it is safe and feasible, even with severe penetrating CD or redo surgery. While MIS indications are continually broadening, challenging CD cases might still require an open approach. This study aimed to report rate and indications for an upfront open approach in ileocolic resection for CD. Comprehensive perioperative data for all consecutive patients undergoing ileocolic resection for CD between 2014 and 2021 in a high-volume referral center for CD and MIS, were collected retrospectively. Indications for an upfront open approach were reviewed separately by two authors according to the preoperative visit. Among 319 ileocolic resections for CD, 45 (14%) were open and 274 (86%) MIS. Two or more of the below indications were present in 40 patients (89%) in the open group, while only in 6 patients (2%) in the MIS group (p < 0.0001). Indications for upfront open approach were severe penetrating disease (58%), adhesions at previous surgery (47%), history of abdominal sepsis (33%), multifocal and extensive disease (24%), abdominal wall involvement (22%), concomitant open procedures (9%), small bowel dilatation (9%), and anesthesiologic contraindications (4%). MIS was never performed in a patient with abdominal wall involvement, concomitant open procedure, and anesthesiologic contraindication to MIS. This study can help guide patients, physicians, and surgeons. An abdominal wall involvement or the presence of two of the above indications predicts a high surgical complexity and may be considered as a no-go for the MIS approach. These criteria should prompt surgeons to strongly consider an upfront open approach to optimize the perioperative planning and care of these complex patients.
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Affiliation(s)
- Giacomo Calini
- Division of Colon and Rectal Surgery, Mayo Clinic, 200 First Street Southwest, Rochester, MN, 55905, USA.
| | - Solafah Abdalla
- Division of Colon and Rectal Surgery, Mayo Clinic, 200 First Street Southwest, Rochester, MN, 55905, USA
| | - Mohamed A Abd El Aziz
- Division of Colon and Rectal Surgery, Mayo Clinic, 200 First Street Southwest, Rochester, MN, 55905, USA
| | - Sarah Benammi
- Division of Colon and Rectal Surgery, Mayo Clinic, 200 First Street Southwest, Rochester, MN, 55905, USA
| | - Amit Merchea
- Division of Colon and Rectal Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Kevin T Behm
- Division of Colon and Rectal Surgery, Mayo Clinic, 200 First Street Southwest, Rochester, MN, 55905, USA
| | - Kellie L Mathis
- Division of Colon and Rectal Surgery, Mayo Clinic, 200 First Street Southwest, Rochester, MN, 55905, USA
| | - David W Larson
- Division of Colon and Rectal Surgery, Mayo Clinic, 200 First Street Southwest, Rochester, MN, 55905, USA.
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189
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Williams T, Maher A, Redmond K, Yeung S, Ko BS. Hemobilia in the setting of cystic artery pseudoaneurysm secondary to type I Mirizzi syndrome. Clin J Gastroenterol 2023:10.1007/s12328-023-01806-w. [PMID: 37131114 DOI: 10.1007/s12328-023-01806-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 04/14/2023] [Indexed: 05/04/2023]
Abstract
Hemobilia is an uncommon diagnosis and is often not suspected in the absence of recent hepatobiliary intervention or trauma. Hemobilia in the setting of cystic artery pseudoaneurysm secondary to type I Mirizzi syndrome is a rare occurrence. We report the case of a 61-year-old male who presented with epigastric pain and vomiting. Blood tests demonstrated hyperbilirubinemia with elevated inflammatory markers. Magnetic resonance cholangiopancreatography revealed type I Mirizzi syndrome in the presence of a 21 mm cystic duct stone. During endoscopic retrograde cholangiopancreatography, hemobilia was identified. Subsequent triple phase computed tomography imaging identified a 12 mm cystic artery pseudoaneurysm. Angiography with successful coiling of the cystic artery was accomplished. Cholecystectomy was performed, confirming type I Mirizzi syndrome. This case demonstrates the importance of considering ruptured pseudoaneurysm in patients presenting with evidence of upper gastrointestinal bleeding in the setting of biliary stone disease. Transarterial embolization, followed by surgical management, is effective in both the diagnosis and management of ruptured cystic artery pseudoaneurysm with associated hemobilia.
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Affiliation(s)
- Thomas Williams
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, Brisbane, QLD, 4102, Australia.
- Faculty of Medicine, University of Queensland, Brisbane, Australia.
| | - Adrian Maher
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, Brisbane, QLD, 4102, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Kendal Redmond
- Department of Medical Imaging, Princess Alexandra Hospital, Brisbane, Australia
| | - Shinn Yeung
- Department of Hepatobiliary Surgery, Princess Alexandra Hospital, Brisbane, Australia
| | - Bong Suk Ko
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, Brisbane, QLD, 4102, Australia
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190
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Twomey A, Khan Z. Home-Based Exercise Therapy in the Management of Intermittent Claudication: A Systematic Review and Meta-Analysis. Cureus 2023; 15:e39206. [PMID: 37384085 PMCID: PMC10294279 DOI: 10.7759/cureus.39206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2023] [Indexed: 06/30/2023] Open
Abstract
The current literature strongly supports the use of supervised exercise therapy (SET) as the first-line treatment for symptomatic peripheral arterial disease (PAD) such as intermittent claudication (IC). However, this form of treatment remains underutilised in clinical practice. The home-based exercise therapy (HBET), in which patients must conduct themselves unsupervised is generally less effective than SET in terms of improving functional walking capacity. Nevertheless, it may be a useful alternative where SET is unavailable. The objective of this systematic review is to determine the effectiveness of HBET in reducing symptoms of IC in patients with PAD. Studies eligible for inclusion in this systematic review were parallel-group randomised controlled trials (RCTs) published in the English language that compared the effect of HBET to a comparator arm (SET or no exercise/attention control) in adults with PAD and IC. Studies were eligible if outcome measures were available at baseline and at 12 weeks of follow-up or more. The electronic databases PubMed, Google Scholar, and the Cochrane Library were searched from the earliest records up to January 2021. The Cochrane Collaboration risk of bias tool for RCTs (RoB 2) was used to assess the risk of bias in individual studies, and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) classification system was used to appraise the quality of evidence for each outcome across all studies. The primary investigator independently collected, pooled, and analysed the data. The data was then entered into the ReviewManager 5 (RevMan 5) software, and a meta-analysis was performed by using a fixed or random effects model depending on the presence or absence of statistical heterogeneity. The review author identified seven RCTs involving a total of 754 patients which were included in this study. Overall, the risk of bias in the included studies was moderate. Even though the results were variable, this analysis supported the ability of HBET to improve functional walking capacity and self-reported quality of life (QoL) to an extent. This review shows that a home-based exercise intervention with regular professional support and encouragement is beneficial in improving functional walking capacity as well as some aspects of QoL in patients with PAD and IC when compared to no exercise. However, when HBET is compared to hospital-based supervised exercise intervention, SET yields greater benefits.
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Affiliation(s)
- Alice Twomey
- Podiatry, Homerton University Hospital NHS Foundation Trust, London, GBR
| | - Zahid Khan
- Acute Medicine, Mid and South Essex NHS Foundation Trust, Southend on Sea, GBR
- Cardiology, Barts Heart Centre, London, GBR
- Cardiology and General Medicine, Barking, Havering and Redbridge University Hospitals NHS Trust, London, GBR
- Cardiology, Royal Free Hospital, London, GBR
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191
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Khan H, Lourdusamy V, Bansal R. Cystic Artery Pseudoaneurysm Secondary to Cholecystitis: A Rare Cause of Hemobilia. Cureus 2023; 15:e39161. [PMID: 37332406 PMCID: PMC10275746 DOI: 10.7759/cureus.39161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2023] [Indexed: 06/20/2023] Open
Abstract
Cystic artery pseudoaneurysm (CAP) is usually seen as a complication of cholecystectomy. Infrequently, CAP can develop in the setting of cholecystitis and can present as hemobilia when the aneurysm ruptures. Here, we present the case of an 88-year-old male with hemobilia secondary to CAP which was successfully managed by embolization after an initial biliary stent placement.
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Affiliation(s)
- Haidar Khan
- Internal Medicine, New York City Health + Hospitals/Elmhurst, New York City, USA
| | - Vennis Lourdusamy
- Gastroenterology, New York City Health + Hospitals/Elmhurst, New York City, USA
| | - Raghav Bansal
- Gastroenterology, New York City Health + Hospitals/Elmhurst, New York City, USA
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192
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Kosco E, Keener M, Waack A, Ranabothu AR, Vattipally V. Radiological Diagnosis and Surgical Treatment of Gallstone Ileus. Cureus 2023; 15:e38481. [PMID: 37273410 PMCID: PMC10237051 DOI: 10.7759/cureus.38481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2023] [Indexed: 06/06/2023] Open
Abstract
We report on the diagnosis and treatment of a patient who presented with a small bowel obstruction due to gallstone ileus. This condition is an infrequent complication of cholelithiasis that presents with non-specific and intermittent findings, including bloating, early satiety, constipation, nausea, and vomiting. Contrast-enhanced CT features the classic imaging finding, called Rigler's triad, which includes small bowel distension, gas in the gallbladder, and an ectopic gallstone. Laparoscopic enterolithotomy is employed to prevent further erosion through the gallbladder wall and into the adjacent gastrointestinal structures. The early diagnosis and treatment of gallstone ileus results in decreased morbidity and mortality.
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Affiliation(s)
- Ethan Kosco
- Medicine, The University of Toledo College of Medicine and Life Sciences, Toledo, USA
| | - Myles Keener
- Medicine, The University of Toledo College of Medicine and Life Sciences, Toledo, USA
| | - Andrew Waack
- Medicine, The University of Toledo College of Medicine and Life Sciences, Toledo, USA
| | - Akash R Ranabothu
- Medicine, College of Natural Sciences and Mathematics, The University of Toledo, Toledo, USA
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193
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Sirák I, Fibír A, Slaninka I, Paulík A, Kolářová I, Motyčka P, Grepl J, Paluska P, Vošmik M. Breast reconstruction and radiotherapy. ONKOLOGIE 2023; 17:113-118. [DOI: 10.36290/xon.2023.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/07/2023]
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Jia XY, Guo XP, Yao Y, Deng K, Lian W, Xing B. Surgical management of pituitary adenoma during pregnancy. World J Clin Cases 2023; 11:2694-2707. [PMID: 37214566 PMCID: PMC10198099 DOI: 10.12998/wjcc.v11.i12.2694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 03/01/2023] [Accepted: 03/24/2023] [Indexed: 04/25/2023] Open
Abstract
BACKGROUND Although conservative treatment is typically recommended for pregnant patients with pituitary adenoma (PA), surgical treatment is occasionally necessary for those with acute symptoms. Currently, surgical interventions utilized among these patients is poorly studied.
AIM To evaluate the surgical indications, timing, perioperative precautions and postoperative complications of PAs during pregnancy and to provide comprehensive guidance.
METHODS Six patients with PAs who underwent surgical treatment during pregnancy at Peking Union Medical College Hospital between January 1990 and June 2021 were recruited for this study. Another 35 pregnant patients who were profiled in the literature were included in our analysis.
RESULTS The 41 enrolled patients had acute symptoms including visual field defects, severe headaches or vision loss that required emergency pituitary surgeries. PA apoplexies were found in 23 patients. The majority of patients (55.9%) underwent surgery in the second trimester of pregnancy. A multidisciplinary team was involved in patient care from the preoperative period through the postpartum period. With the exception of 1 patient who underwent an induced abortion and 1 fetus that died due to a nuchal cord, 39 patients delivered successfully. Among them, 37 fetuses were healthy until the most recent follow-up.
CONCLUSION PA surgery during pregnancy is effective and safe during the second and third trimesters. Pregnant patients requiring emergency PA surgery require multidisciplinary evaluation and healthcare management.
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Affiliation(s)
- Xin-Yu Jia
- Department of Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100144, China
- Department of Neurosurgery, Key Laboratory of Endocrinology of Ministry of Health, China Pituitary Adenoma Specialist Council, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Beijing 100730, China
- Department of Plastic Surgery, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Xiao-Peng Guo
- Department of Neurosurgery, Key Laboratory of Endocrinology of Ministry of Health, China Pituitary Adenoma Specialist Council, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Beijing 100730, China
- Department of Neurosurgery, Medical Research Center, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Beijing 100730, China
| | - Yong Yao
- Department of Neurosurgery, Key Laboratory of Endocrinology of Ministry of Health, China Pituitary Adenoma Specialist Council, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Beijing 100730, China
- Department of Neurosurgery, Medical Research Center, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Beijing 100730, China
| | - Kan Deng
- Department of Neurosurgery, Key Laboratory of Endocrinology of Ministry of Health, China Pituitary Adenoma Specialist Council, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Beijing 100730, China
- Department of Neurosurgery, Medical Research Center, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Beijing 100730, China
| | - Wei Lian
- Department of Neurosurgery, Key Laboratory of Endocrinology of Ministry of Health, China Pituitary Adenoma Specialist Council, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Beijing 100730, China
- Department of Neurosurgery, Medical Research Center, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Beijing 100730, China
| | - Bing Xing
- Department of Neurosurgery, Key Laboratory of Endocrinology of Ministry of Health, China Pituitary Adenoma Specialist Council, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Beijing 100730, China
- Department of Neurosurgery, Medical Research Center, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Beijing 100730, China
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Horgan S, Saab MM, Drennan J, Keane D, Hegarty J. Healthcare professionals' knowledge and attitudes of surgical site infection and surveillance: A narrative systematic review. Nurse Educ Pract 2023; 69:103637. [PMID: 37062123 DOI: 10.1016/j.nepr.2023.103637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 03/24/2023] [Accepted: 04/04/2023] [Indexed: 04/18/2023]
Abstract
AIM This systematic review reports on healthcare professionals' knowledge and attitudes of surgical site infection and surgical site infection surveillance as well as interventions aimed at enhancing healthcare professionals' knowledge and attitudes. BACKGROUND Surgical site infection is a serious adverse outcome following surgery. Despite the presence of international guidelines, the prevention of surgical site infections remains a challenge for patients and hospitals. It is critical that healthcare professionals have sufficient knowledge on surgical site infection and on their role in implementing evidence-based prevention strategies. DESIGN This review is reported using the Preferred Reporting Items for Systematic review and Meta-Analysis (PRISMA) guidelines. METHODS A search was undertaken in the following databases: Academic Search Complete, CINAHL, ERIC, MEDLINE, PsycARTICLES, PsycINFO and Web of Science for studies published between January 2010 and March 2022. Studies that examined healthcare professionals' knowledge and attitudes in relation to surgical site infection, surgical site infection surveillance and risk factors for their development were included. We also included studies that examined interventions that aimed to enhance healthcare professionals' knowledge and attitude in relation to surgical site infection, surveillance, and risk factors. We also described the impact of such interventions on the incidence of surgical site infections. RESULTS A total of 26 studies were included. Results were synthesised narratively according to the review objectives. Findings from this review show that knowledge of what surgical site infection is and its prevention was poor amongst healthcare professionals, while attitudes were positive particularly in relation to healthcare professionals' role in prevention. Only three studies examined the effects of interventions on healthcare professionals' knowledge of surgical site infection and surgical site infection prevention. Of those, two used multimodal educational interventions and found statistically significant improvement in knowledge. CONCLUSIONS Overall knowledge of surgical site infection and its prevention is poor amongst healthcare professionals, while attitudes were positive particularly in relation to healthcare professionals' role in prevention. There is a need for more experimental research to evaluate interventions which aim to address healthcare professionals' knowledge and attitudes towards surgical site infection prevention and surveillance. Such studies should include all healthcare professionals involved in the care of a surgical patient. TWEETABLE ABSTRACT Knowledge and attitudes of surgical site infection prevention amongst healthcare professionals.
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Affiliation(s)
- Sinéad Horgan
- Department of Nursing and Midwifery, South/South West Hospitals Group, Erinville, Western Road, Cork, Ireland; Catherine McAuley School of Nursing and Midwifery, College of Medicine and Health, University College Cork, Cork, Ireland.
| | - Mohamad M Saab
- Catherine McAuley School of Nursing and Midwifery, College of Medicine and Health, University College Cork, Cork, Ireland
| | - Jonathan Drennan
- Catherine McAuley School of Nursing and Midwifery, College of Medicine and Health, University College Cork, Cork, Ireland
| | - Danielle Keane
- Catherine McAuley School of Nursing and Midwifery, College of Medicine and Health, University College Cork, Cork, Ireland
| | - Josephine Hegarty
- Catherine McAuley School of Nursing and Midwifery, College of Medicine and Health, University College Cork, Cork, Ireland
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196
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Saleem M, Butt J, Shaukat Z, Hashim I, Majeed F, Kamran M, Saleem U. Functional outcome of Hirschsprung's disease in children: A single center study at The Children's Hospital Lahore. Pediatr Surg Int 2023; 39:176. [PMID: 37039898 DOI: 10.1007/s00383-023-05451-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/27/2023] [Indexed: 04/12/2023]
Abstract
AIM Hirschsprung's disease (HD) is a congenital bowel disorder resulting in functional dysmotility. Advancement in surgical techniques has improved outcomes, but recent studies have identified problems having significant impact on patient's quality of life. The aim of this study is to analyze postoperative functional outcome after definitive surgery for Hirschsprung's disease. METHOD A retrospective study was conducted at the Department of Pediatric Surgery, The Children's Hospital Lahore. The record of 64 patients was reviewed from the year 2009 to 2019. Parents were interviewed on phone calls and a predesigned questionnaire was filled. Degree of constipation, incontinence and voluntary bowel movements was analyzed according to Krickenbeck classification. RESULTS Median age at initial presentation was 11 days, with male to female ratio of 3.9:1. Most common presentation was delayed passage of meconium (38%). Diagnosis was made on biopsy in 70.3%, but contrast enema and biopsy in 29.7%. Aganglionosis was limited to short segment in 81.3% and long segment in 14.5%. Decompressing enterostomy was made in 63% at a mean age of 191 days. Definitive surgery included Duhamel pull-through in 89.1%. Mean age at follow-up was 10.6 ± 4.19 years and alive patients were 95.4%. Postoperative enterocolitis was reported by 27%, while 35.5% reported fecal incontinence and 16.1% complained of constipation. 80% could voluntarily hold bowel movement, among which 5% had a feeling of urge and 15% had the capacity to verbalize. In 25% of the patients, fecal incontinence was a constant social problem and in 25% of these patients constipation was resistant to diet and laxatives. CONCLUSION On long-term follow-up, fecal incontinence was more worrisome, affecting quality of life and requiring help of the bowel management program. Such patients need close follow-up after definitive procedure, so that they have normal stooling habits in their adulthood and lead a normal life.
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Affiliation(s)
- Muhammad Saleem
- The Children's Hospital and University of Child Health Sciences, Ferozpur Road, Lahore, Pakistan.
| | - Jamaal Butt
- The Children's Hospital and University of Child Health Sciences, Ferozpur Road, Lahore, Pakistan
| | - Zubair Shaukat
- The Children's Hospital and University of Child Health Sciences, Ferozpur Road, Lahore, Pakistan
| | - Imran Hashim
- The Children's Hospital and University of Child Health Sciences, Ferozpur Road, Lahore, Pakistan
| | - Fatima Majeed
- The Children's Hospital and University of Child Health Sciences, Ferozpur Road, Lahore, Pakistan
| | - Muhammad Kamran
- The Children's Hospital and University of Child Health Sciences, Ferozpur Road, Lahore, Pakistan
| | - Umer Saleem
- Services Hospital, Jail Road, Lahore, Pakistan
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197
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Malekhosseini SA, Alizadeh B, Hosseinzadeh A, Shahriarirad R, Naseri R, Kazemi K, Shamsaeefar A, Tanideh N. Comparison of the preventive effect of colchicine versus diphenhydramine, prednisolone, and a combination therapy on intraperitoneal adhesion bands: an experimental study in rats. BMC Surg 2023; 23:79. [PMID: 37032367 PMCID: PMC10084595 DOI: 10.1186/s12893-023-01981-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 03/31/2023] [Indexed: 04/11/2023] Open
Abstract
BACKGROUND Peritoneal adhesion formation is an inevitable consequence of abnormal repair of the peritoneum following different peritoneal injuries of intra-abdominal operations with the subsequent morbidity that they represent. Vast efforts have been made to elucidate the cause and prevent the development of abdominal adhesions. The aim of our study is to compare the capability of colchicine versus diphenhydramine (DPH) and methylprednisolone (MP), and also prednisolone in adhesion prevention. METHODS Sixty-one male Wistar stock rats were divided into four groups. The first group attended as the control group. Groups 2, 3, and 4 received oral combination of MP + DPH solution (20 mg/kg), colchicine (0.02 mg/kg), and prednisolone (1 mg/ kg), respectively. Adhesion bands were induced by standardized abrasion of the peritoneum through a midline laparotomy. All rats were sacrificed on the 15th-day post medication administration and the subjects underwent an exploratory laparotomy. The presence of adhesions was evaluated with the modified using Nair's classification. RESULTS The proportion of the control group with substantial adhesion bands (73.3%) was significantly higher than that of the MP + DPH (13.3%), colchicine (33.3%), and prednisolone (31.3%) groups. There were significant differences between the scores of the control and the MP + DPH, colchicine, and prednisolone groups (P = 0.001, 0.028, and 0.019, respectively). There was no statistically significant difference to favor colchicine against MP + DPH (P = 0.390) or MP + DPH against prednisolone (P = 0.394). CONCLUSIONS Both colchicine and combination of DPH + MP prevented postoperative abdominal adhesions separately in our study. However, the lowest adhesion formation rate was observed in the DPH + MP group, even lower than the prednisolone group.
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Affiliation(s)
- Seyed Ali Malekhosseini
- Shiraz Transplant Center, Abu Ali Sina Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Behzad Alizadeh
- Department of Surgery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ahmad Hosseinzadeh
- Department of Surgery, Shiraz University of Medical Sciences, Shiraz, Iran
- Thoracic and Vascular Surgery Research Center, Shiraz University of Medical Science, Shiraz, Iran
| | - Reza Shahriarirad
- Thoracic and Vascular Surgery Research Center, Shiraz University of Medical Science, Shiraz, Iran
- Student Research Committee, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
- School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Reyhaneh Naseri
- Thoracic and Vascular Surgery Research Center, Shiraz University of Medical Science, Shiraz, Iran.
- Student Research Committee, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
- School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Kourosh Kazemi
- Shiraz Transplant Center, Abu Ali Sina Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Alireza Shamsaeefar
- Shiraz Transplant Center, Abu Ali Sina Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Nader Tanideh
- Stem Cells Technology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
- Pharmacology Department, Shiraz University of Medical Sciences, Shiraz, Iran
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198
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Su D, Zhang Z, Xia F, Li X. The safety, benefits and future development of overnight and outpatient thyroidectomy. Front Endocrinol (Lausanne) 2023; 14:1110038. [PMID: 37091845 PMCID: PMC10113618 DOI: 10.3389/fendo.2023.1110038] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 03/10/2023] [Indexed: 04/08/2023] Open
Abstract
With the development of medical care, the safety of thyroidectomy is improving year by year. Due to economic benefits and other advantages of the overnight and outpatient thyroidectomy, more and more patients and medical institutions have favored overnight and outpatient thyroidectomy, and its proportion in thyroidectomy has increased year by year. However, overnight and outpatient thyroidectomy still faces many challenges and remains to be improved. In this review, we focused on the recent progress and the relevant clinical features of overnight and outpatient thyroidectomy, including its safety, economic benefits, etc., which may bring valuable clues and information for further improvements of patient benefits and promotions of overnight or outpatient thyroidectomy in the future.
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Affiliation(s)
- Duntao Su
- Department of General Surgery, Xiangya Hospital, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Zeyu Zhang
- Department of General Surgery, Xiangya Hospital, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Fada Xia
- Department of General Surgery, Xiangya Hospital, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
- *Correspondence: Xinying Li, ; Fada Xia,
| | - Xinying Li
- Department of General Surgery, Xiangya Hospital, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
- *Correspondence: Xinying Li, ; Fada Xia,
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199
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Adugna D, Worku T, Hiko A, Dheresa M, Letta S, Sertsu A, Kibret H. Cancellation of elective surgery and associated factors among patients scheduled for elective surgeries in public hospitals in Harari regional state, Eastern Ethiopia. Front Med (Lausanne) 2023; 10:1036393. [PMID: 37081837 PMCID: PMC10111426 DOI: 10.3389/fmed.2023.1036393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 03/20/2023] [Indexed: 04/07/2023] Open
Abstract
BackgroundCanceling elective surgeries is a significant problem in many hospitals leading to patient dissatisfaction, increased costs, and emotional trauma for patients and their families. Despite this, there is limited information about the cancellation of elective surgeries in Ethiopia, mainly in the study area.ObjectiveThis study aimed to assess the magnitude of cancellation and associated factors among patients scheduled for elective surgeries in public hospitals in the Harari Regional State, Eastern Ethiopia, from 1 August to 30 August 2021.MethodsA hospital-based cross-sectional study was conducted on 378 patients scheduled for elective surgeries. Data were gathered using a non-random sequential sampling approach. In addition, a structured face-to-face interviewer-administered questionnaire was employed. The gathered information was input into Epidata version 3.1 and then exported to Statistical Package for Social Software version 26. To find the variables associated with the cancellation of elective surgeries, binary and multi-variable logistic regression analyses were conducted. In the binary analysis, all variables with a p-value of less than 0.25 were included in the multivariable analysis. Finally, a 0.05 p-value with a 95% confidence interval and an adjusted odds ratio was used to declare a significant association.ResultsThis study included 378 patients scheduled for elective surgeries. Among those, 35.2% of the surgeries were canceled (95% confidence interval: 29.4–39.6). Being female (adjusted odds ratio: 2.46; 95% confidence interval: 1.44–4.203), lack of formal education (adjusted odds ratio: 2.03; 95% confidence interval: 1.15–3.58), place of residence (adjusted odds ratio: 1.70; 95% confidence interval: 1.03–2.81), increase in blood pressure (adjusted odds ratio: 5.09; 95% confidence interval:1.90–13.59), and ophthalmologic surgery (adjusted odds ratio: 3.76; 95% confidence interval: 1.41–10.0) were factors associated with the cancellation of elective surgeries.ConclusionIn this study, nearly one third of scheduled elective surgery was canceled. The primary contributing variables to the surgery cancellations were being female, lack of formal education, place of residence, ophthalmologic surgery, and increased blood pressure. Therefore, timely evidence-based reporting through the supervision team was advised to decrease cancellations.
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200
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Bayhan Z, Ozdemir K, Gonullu E, Harmantepe AT, Capoglu R, Akin E, Aziret M, Altintoprak F. ANALYSIS OF DIAGNOSTIC EXCISIONAL LYMPH NODE BIOPSY RESULTS: 12-YEAR EXPERIENCE OF A SINGLE CENTER. Acta Clin Croat 2023; 62:58-64. [PMID: 38304357 PMCID: PMC10829962 DOI: 10.20471/acc.2023.62.01.07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 10/07/2021] [Indexed: 02/03/2024] Open
Abstract
Lymph node biopsy is indicated in patients with suspected malignancy or lymphadenopathy due to unclarified reasons. Lymph node biopsy can be performed as fine needle aspiration biopsy, core biopsy, or excisional lymph node biopsy. In particular, the diagnosis of malignant lymphoma is considered insufficient for oncological treatment unless classified into subgroups. Core biopsy and excisional biopsy can be performed to diagnose lymphoma and classify it into subgroups. Core biopsy may also be limited in some cases for the diagnosis of lymphoma. Therefore, patients are referred to surgical departments for excisional lymph node biopsy. It was aimed herein to analyze the results of excisional lymph node biopsies performed for diagnostic purposes in our department. Data on 73 patients having undergone diagnostic excisional lymph node biopsy at Sakarya University Medical Faculty Training and Research Hospital between January 2008 and January 2020 were retrospectively analyzed. Patients were evaluated in terms of age, gender, biopsy site, pathological diagnosis, number and diameter of lymph nodes excised. Patients younger than 18 years of age, those with sentinel lymph node biopsies, and lymph node dissections performed for any known malignancy were excluded from the study. Statistical data analysis was done using SPSS statistical software. There were 37 (50.7%) female and 36 (49.3%) male patients, mean age 52.07 (18-90) years. Axillary lymph node biopsy was performed in 32 patients, inguinal lymph node biopsy in 29 patients, cervical lymph node biopsy in 3 patients, intra-abdominal lymph node biopsy in 6 patients, mediastinal lymph node biopsy in 1 patient, and supraclavicular lymph node biopsy in 2 patients. All of the lymph node biopsies were performed as excisional biopsy. Malignancy was detected in 36 (49.3%) patients. In 37 (50.3%) patients, the causes of lymphadenopathy were found to be benign pathologies. When the causes of malignant disease were examined, it was observed that 23 (31.5%) patients were diagnosed with lymphoma. Hodgkin lymphoma was detected in 5 patients diagnosed with lymphoma, and non-Hodgkin lymphoma was found in 18 patients. Metastatic lymphadenopathy was observed in 13 (17.8%) patients. Reactive lymphoid hyperplasia (26%) and lymphadenitis (20.5%) were found among the causes of benign lymphadenopathy. The number of excised lymph nodes was between 1 and 4, and their diameter was between 9 and 75 mm (mean: 29.53±15.56 mm). There was no statistically significant difference between benign and malignant patients according to gender, age, lymph node diameter, number of lymph nodes excised, and excisional lymph node biopsy site. For diagnostic lymph node biopsy, fine-needle aspiration biopsy and core biopsy should be performed primarily. If lymphoma is suspected in the diagnosis, fine-needle aspiration biopsy is not necessary. In this case, it is believed that it is more appropriate to perform core biopsy first. If the core biopsy is insufficient for diagnosis, it is more appropriate to perform surgical biopsy in order to cause no delay in diagnosis and treatment. Excisional biopsy is a method that can be safely performed and does not cause severe morbidity in palpable peripheral lymphadenopathies. Although it does not cause severe morbidity because it is an invasive procedure, excisional biopsy should be performed in a selected patient group.
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Affiliation(s)
- Zulfu Bayhan
- Sakarya University Faculty of Medicine, Department of General Surgery, Sakarya, Turkey
| | - Kayhan Ozdemir
- Sakarya Research and Educational Hospital, Department of General Surgery, Sakarya, Turkey
| | - Emre Gonullu
- Sakarya Research and Educational Hospital, Department of Gastrointestinal Surgery, Sakarya, Turkey
| | - Ahmet Tarik Harmantepe
- Sakarya Research and Educational Hospital, Department of General Surgery, Sakarya, Turkey
| | - Recayi Capoglu
- Sakarya Research and Educational Hospital, Department of General Surgery, Sakarya, Turkey
| | - Emrah Akin
- Sakarya Research and Educational Hospital, Department of General Surgery, Sakarya, Turkey
| | - Mehmet Aziret
- Sakarya Research and Educational Hospital, Department of Gastrointestinal Surgery, Sakarya, Turkey
| | - Fatih Altintoprak
- Sakarya University Faculty of Medicine, Department of General Surgery, Sakarya, Turkey
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