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Rafaqat W, Lagazzi E, Jehanzeb H, Abiad M, Luckhurst CM, Parks JJ, Albutt KH, Hwabejire JO, DeWane MP. Does practice make perfect? The impact of hospital and surgeon volume on complications after intra-abdominal procedures. Surgery 2024; 175:1312-1320. [PMID: 38418297 DOI: 10.1016/j.surg.2024.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 11/26/2023] [Accepted: 01/12/2024] [Indexed: 03/01/2024]
Abstract
BACKGROUND There is increasing interest in the regionalization of surgical procedures. However, evidence on the volume-outcome relationship for emergency intra-abdominal surgery is not well-synthesized. This systematic review and meta-analysis summarize evidence regarding the impact of hospital and surgeon volume on complications. METHODS We identified cohort studies assessing the impact of hospital/surgeon volume on postoperative complications after emergency intra-abdominal procedures, with data collected after the year 2000 through a literature search without language restriction in the PubMed, Web of Science, and Cochrane databases. A weighted overall complication rate was calculated, and a random effect regression model was used for a summary odds ratio. A sensitivity analysis with the removal of studies contributing to heterogeneity was performed (PROSPERO: CRD42022358879). RESULTS The search yielded 2,153 articles, of which 9 cohort studies were included and determined to be good quality according to the Newcastle Ottawa Scale. These studies reported outcomes for the following procedures: cholecystectomy, colectomy, appendectomy, small bowel resection, peptic ulcer repair, adhesiolysis, laparotomy, and hernia repair. Eight studies (2,358,093 patients) with available data were included in the meta-analysis. Low hospital volume was not significantly associated with higher complications. In the sensitivity analysis, low hospital volume was significantly associated with higher complications when appropriate heterogeneity was achieved. Low surgeon volume was associated with higher complications, and these findings remained consistent in the sensitivity analysis. CONCLUSION We found that hospital and surgeon volume was significantly associated with higher complications in patients undergoing emergency intra-abdominal surgery when appropriate heterogeneity was achieved.
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Affiliation(s)
- Wardah Rafaqat
- Division of Trauma, Emergency General Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Emanuele Lagazzi
- Division of Trauma, Emergency General Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Hamzah Jehanzeb
- Department of Surgery, Medical College, Aga Khan University, Karachi, Pakistan
| | - May Abiad
- Division of Trauma, Emergency General Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Casey M Luckhurst
- Division of Trauma, Emergency General Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jonathan J Parks
- Division of Trauma, Emergency General Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Katherine H Albutt
- Division of Trauma, Emergency General Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - John O Hwabejire
- Division of Trauma, Emergency General Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Michael P DeWane
- Division of Trauma, Emergency General Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
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Moayerifar M, Samidoust P, Gholipour M, Moayerifar M, Zamani A, Poorheravi N, Poursadrolah S. Pedunculated focal nodular hyperplasia of the liver in a healthy child born following in vitro fertilization: a case report and review of the literature. J Med Case Rep 2024; 18:185. [PMID: 38616251 PMCID: PMC11017577 DOI: 10.1186/s13256-024-04512-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Accepted: 03/13/2024] [Indexed: 04/16/2024] Open
Abstract
BACKGROUND Focal nodular hyperplasia is a common nonmalignant liver mass. This nonvascular lesion is an uncommon mass in children, especially those with no predisposing factors, namely radiation, chemotherapy, and hematopoietic stem cell therapy. Exophytic growth of the lesion further than the liver margins is not common and can complicate the diagnosis of the lesion. This report observes a focal nodular hyperplasia as a pedunculated lesion in a healthy child. CASE PRESENTATION We describe a 9-year-old healthy Persian child who was born following in vitro fertilization complaining of abdominal pain lasting for months and palpitation. Employing ultrasound and computed tomography, a mass was detected in the right upper quadrant compatible with focal nodular hyperplasia imaging features. The child underwent surgery and the mass was resected. CONCLUSION Diagnosing focal nodular hyperplasia, especially pedunculated form can be challenging, although magnetic resonance imaging with scintigraphy is nearly 100% sensitive and specific. Thus, a biopsy may be needed to rule out malignancies in some cases. Deterministic treatment in patients with suspicious mass, remarkable growth of lesion in serial examination, and persistent symptoms, such as pain, is resection, which can be done open or laparoscopic.
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Affiliation(s)
- Mani Moayerifar
- Razi Clinical Research Development Unit, Razi Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Pirouz Samidoust
- Razi Clinical Research Development Unit, Razi Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Mahboobeh Gholipour
- Department of Cardiology, Healthy Heart Research Center, Heshmat Hospital, School of Medicine, Guilan University Of Medical Sciences, Rasht, Iran
| | - Maziar Moayerifar
- Department of Vascular Surgery, Razi Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Athar Zamani
- Department of Pathology and Laboratory Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Niloofar Poorheravi
- Razi Clinical Research Development Unit, Razi Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Selvana Poursadrolah
- Student Research Committee, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran.
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Tran Z, Cho NY, De Polo N, Mukherjee K, Benharash P, Burruss S. Association of Early Rib Plating on Clinical and Financial Outcomes: A National Analysis. Am Surg 2024; 90:754-761. [PMID: 37903489 DOI: 10.1177/00031348231211041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2023]
Abstract
BACKGROUND With reported improvements in patient outcomes, surgical stabilization of rib fractures (SSRF) has been increasingly adopted. While institutional series have sought to define the role of early SSRF, large scale analysis remains lacking. The present study evaluated clinical and financial outcomes of SSRF in a nationally representative cohort. METHODS Patients (≥16 years) admitted with multiple rib fractures were identified using the 2016-2020 National Inpatient Sample. Those who underwent rib plating >14 days following admission were omitted. Using restricted cubic spline analysis, patients who underwent SSRF within 2 days of hospitalization were classified as Expedited while fixation >2 days were deemed Routine. Multivariable regressions were used to evaluate the association of operative timing on outcomes of interest. RESULTS Of 8150 patients meeting final inclusion criteria, 4090 (50.2%) were Expedited. Compared to Routine, Expedited tended to be older but were of comparable race, primary payer, and income quartile. Traumatic mechanism was also similar but rates of concomitant sternal fracture as well as intra-abdominal and cardiac injuries were higher in Routine. After adjustment, Expedited was associated with lower odds of respiratory complications, which included need for mechanical ventilation, prolonged mechanical ventilation, and pneumonia, compared to Routine. Expedited was associated with similar hospitalization duration but had lower incremental costs (β: -$19.1 K, 95% CI: -24.1 to -14.2). DISCUSSION Early SSRF was associated with lower likelihood of a number of respiratory complications and in-hospital costs. While patient selection criteria may limit our findings, expeditious fixation may limit morbidity while enhancing value of care.
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Affiliation(s)
- Zachary Tran
- Division of Acute Care Surgery, Department of Surgery, Loma Linda University Medical Center, Loma Linda, CA, USA
- Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Nam Yong Cho
- Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Nicole De Polo
- Division of Acute Care Surgery, Department of Surgery, Loma Linda University Medical Center, Loma Linda, CA, USA
| | - Kaushik Mukherjee
- Division of Acute Care Surgery, Department of Surgery, Loma Linda University Medical Center, Loma Linda, CA, USA
| | - Peyman Benharash
- Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Sigrid Burruss
- Division of Acute Care Surgery, Department of Surgery, Loma Linda University Medical Center, Loma Linda, CA, USA
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Bunino FM, Marrano E, Carbone F, Mauri G, Ceolin M, Penazzi R, Zucchini N, Biloslavo A, Kurihara H. Clinical Frailty Score is a good predictor of postoperative mortality in patients undergoing open abdomen surgery: a multicenter retrospective cohort study. Minerva Surg 2024; 79:147-154. [PMID: 38252400 DOI: 10.23736/s2724-5691.23.09981-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
BACKGROUND Open Abdomen (OA) is gaining popularity in damage control surgery (DCS) but there is not an absolute prognostic score to identify patients that may benefit from it. Our study investigates the correlation between the clinical frailty scale score (CFSS) and postoperative morbidity and mortality in patients undergoing OA. METHODS Patients ≥65 yo undergoing OA in two referral centres between 2015 and 2020 were included and stratified according to CFSS in non-frail (NF), frail (F) and highly-frail (HF). The primary endpoint was 30-day mortality. Secondary endpoints were postoperative morbidity and 1- year survival. RESULTS One hundred and thirty-six patients were included: 35 NF (25.7%), 56 F (41.2%), 45 HF (33.1%). Average age 76.8. The 73.5% of cases were non-traumatic diseases with no difference in preoperative characteristics. 95 (71.4%) had one complication, 26 NF (74.3%), 34 F (63.2%), 35 HF (77.8%) (P=0.301) and 59.4% had a complication with a CD≥3, 57.1% NF, 56.6% F and 64.4 HF. The 30-day mortality was 32.4%, higher in HF (46.7%) and F (30.4%) compared to NF (17.1%, P=0.018). The Overall 1-year survival was 41% (SE ±4) with statistically significant difference between HF vs. NF and HF vs. F (P=0.009 and P=0.029, respectively). In the univariate analysis, the only significant prognostic factor impacting mortality was CFSS, with HF having an HR of 1.948 (95% CI 1.097-3.460, P=0.023). CONCLUSIONS When OA is a surgical option, frail patients should not be precluded, while HF should be carefully evaluated. The CFSS might be a good prognostic score for patients that may safely benefit from OA.
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Affiliation(s)
- Francesca M Bunino
- Emergency and Trauma Surgery Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Department of Biomedical Sciences, IRCCS Humanitas Research Hospital, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Enrico Marrano
- Department of General Surgery, Germans Trias i Pujol University Hospital, Badalona, Barcelona, Spain
| | - Fabio Carbone
- Department of Digestive Surgery, European Institute of Oncology IRCCS, Milan, Italy
| | - Giulia Mauri
- Emergency and Trauma Surgery Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Department of Biomedical Sciences, IRCCS Humanitas Research Hospital, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Martina Ceolin
- Emergency and Trauma Surgery Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Riccardo Penazzi
- Department of General Surgery, Cattinara University Hospital, Azienda Sanitaria Universitaria Giuliano Isontina (ASU GI), Trieste University, Trieste, Italy
| | - Nicolas Zucchini
- Department of General Surgery, Cattinara University Hospital, Azienda Sanitaria Universitaria Giuliano Isontina (ASU GI), Trieste University, Trieste, Italy
| | - Alan Biloslavo
- Department of General Surgery, Cattinara University Hospital, Azienda Sanitaria Universitaria Giuliano Isontina (ASU GI), Trieste University, Trieste, Italy
| | - Hayato Kurihara
- Emergency Surgery Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy -
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Kabalar RB, Tutcu Şahin S, Ayhan S. Effect of intra-abdominal boric acid in the experimental adhesion model. ULUS TRAVMA ACIL CER 2024; 30:236-241. [PMID: 38634852 DOI: 10.14744/tjtes.2024.77767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
BACKGROUND The continuous advancement in medical and surgical techniques has led to a rise in the frequency of abdominal operations, subsequently increasing the incidence of intra-abdominal adhesions. Over 90% of laparotomies result in postoperative intra-abdominal adhesions. This study investigates the effect of a 5% boric acid solution on the development of intra-abdominal adhesions in rats, using an adhesion model. METHODS This study was conducted with two groups: a control group, in which the adhesion model was applied without any treatment, and a boric acid group, which was treated with a 5% boric acid solution. Each group comprised 16 rats. On the 14th postoperative day, the rats were sacrificed, re-explored, and the developed adhesions were evaluated both macroscopically and microscopically. The data from macroscopic and microscopic scoring were analyzed using the Mann-Whitney U test in the IBM Statistical Package for the Social Sciences (SPSS) Statistics 24 program. A p-value of less than 0.05 was considered statistically significant. This research was supported by the Manisa Celal Bayar University Scientific Research Projects Commission. RESULTS A statistically significant difference was observed between the boric acid-treated group and the control group, with the boric acid group showing a significant decrease in adhesion development both macroscopically and microscopically (p<0.05). CONCLUSION In the future, boron could play a significant role in reducing and preventing intra-abdominal adhesions after surgery. This investigation could pave the way for further research into the mechanism by which boric acid prevents the development of intra-abdominal adhesions. Moreover, it is imperative to explore the potential side effects of intra-abdominal boron application at the optimum concentration of the solution.
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Affiliation(s)
- Rıdvan Barkın Kabalar
- Department of General Surgery, Izmir Bergama Necla-Mithat Ozture State Hospital, İzmir-Türkiye
| | - Semra Tutcu Şahin
- Department of General Surgery, Manisa Celal Bayar University, Manisa-Türkiye
| | - Semin Ayhan
- Department of Pathology, Manisa Celal Bayar University, Manisa-Türkiye
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Gibson D, Joseph C, Foulis DP, Berney CR. A mimic of peritoneal metastatic disease, multifocal intraabdominal foreign body granulomas secondary to feculent peritonitis. ANZ J Surg 2024; 94:763-764. [PMID: 38321632 DOI: 10.1111/ans.18896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 01/13/2024] [Accepted: 01/23/2024] [Indexed: 02/08/2024]
Affiliation(s)
- Damien Gibson
- Department of Surgery, Bankstown-Lidcombe Hospital, Sydney, New South Wales, Australia
- School of Medicine, The University of New South Wales, Sydney, New South Wales, Australia
- Robotic Research Program, Surgical Outcomes Research Centre, Sydney, New South Wales, Australia
| | - Christo Joseph
- Department of Surgery, Bankstown-Lidcombe Hospital, Sydney, New South Wales, Australia
| | - Diarmid P Foulis
- Department of Anatomical Pathology, Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Christophe R Berney
- Department of Surgery, Bankstown-Lidcombe Hospital, Sydney, New South Wales, Australia
- School of Medicine, The University of New South Wales, Sydney, New South Wales, Australia
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Cristaudo AT, Hitos K, Gunnarsson R, de Costa A, Yuen A. Re: Development and validation of a multivariable prediction model in open abdomen patients for entero-atmospheric fistula. ANZ J Surg 2024; 94:769-770. [PMID: 38156742 DOI: 10.1111/ans.18846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 12/19/2023] [Indexed: 01/03/2024]
Affiliation(s)
- Adam T Cristaudo
- Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
- Westmead Research Centre for Evaluation of Surgical Outcomes, Department of Surgery, Westmead Hospital, Sydney, New South Wales, Australia
| | - Kerry Hitos
- Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
- Westmead Research Centre for Evaluation of Surgical Outcomes, Department of Surgery, Westmead Hospital, Sydney, New South Wales, Australia
| | - Ronny Gunnarsson
- General Practice/Family Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Research, Education, Development & Innovation, Primary Health Care, Region Västra Götaland, Sweden
- Primary Health Care Clinic for Homeless People, Gothenburg, Sweden
| | - Alan de Costa
- College of Medicine & Dentistry, James Cook University, Cairns, Queensland, Australia
| | - Alex Yuen
- Gold Coast University Hospital, Southport, Queensland, Australia
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Natsuki S, Yoshii M, Tanaka H, Mori T, Deguchi S, Miki Y, Tamura T, Toyokawa T, Lee S, Maeda K. Involvement of CX3CR1 + cells appearing in the abdominal cavity in the immunosuppressive environment immediately after gastric cancer surgery. World J Surg Oncol 2024; 22:74. [PMID: 38433196 PMCID: PMC10910822 DOI: 10.1186/s12957-024-03353-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 02/24/2024] [Indexed: 03/05/2024] Open
Abstract
BACKGROUND Gastric cancer is primarily treated by surgery; however, little is known about the changes in the intraperitoneal immune environment and the prognostic impact of surgery. Surgical stress and cancer-associated inflammation cause immune cells to mobilize into the abdominal cavity via numerous cytokines. One such cytokine, CX3CR1, has various immune-related functions that remain to be fully explained. We characterized the intraperitoneal immune environment by investigating CX3CR1+ cells in intraperitoneal lavage fluid during gastric cancer surgery. METHODS Lavage fluid samples were obtained from a total of 41 patients who underwent gastrectomy. The relative expression of various genes was analyzed using quantitative real-time PCR. The association of each gene expression with clinicopathological features and surgical outcomes was examined. The fraction of CX3CR1+ cells was analyzed by flow cytometry. Cytokine profiles in lavage fluid samples were investigated using a cytometric beads array. RESULTS CX3CR1high patients exhibited higher levels of perioperative inflammation in blood tests and more recurrences than CX3CR1low patients. CX3CR1high patients tended to exhibit higher pathological T and N stage than CX3CR1low patients. CX3CR1 was primarily expressed on myeloid-derived suppressor cells and tumor-associated macrophages. In particular, polymorphonuclear myeloid-derived suppressor cells were associated with perioperative inflammation, pathological N, and recurrences. These immunosuppressive cells were associated with a trend toward unfavorable prognosis. Moreover, CX3CR1 expression was correlated with programmed death-1 expression. CONCLUSIONS Our results suggest that CX3CR1+ cells are associated with an acute inflammatory response, tumor-promotion, and recurrence. CX3CR1 expression could be taken advantage of as a beneficial therapeutic target for improving immunosuppressive state in the future. In addition, analysis of intra-abdominal CX3CR1+ cells could be useful for characterizing the immune environment after gastric cancer surgery.
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Affiliation(s)
- Seiji Natsuki
- Department of Gastroenterological Surgery, Osaka City University Graduate School of Medicine, Asahi-machi 1-4-3, Abeno-ku, Osaka, Japan
| | - Mami Yoshii
- Department of Gastroenterological Surgery, Osaka City University Graduate School of Medicine, Asahi-machi 1-4-3, Abeno-ku, Osaka, Japan.
| | | | - Takuya Mori
- Department of Gastroenterological Surgery, Osaka City University Graduate School of Medicine, Asahi-machi 1-4-3, Abeno-ku, Osaka, Japan
| | - Sota Deguchi
- Department of Gastroenterological Surgery, Osaka City University Graduate School of Medicine, Asahi-machi 1-4-3, Abeno-ku, Osaka, Japan
| | - Yuichiro Miki
- Department of Gastroenterological Surgery, Osaka City University Graduate School of Medicine, Asahi-machi 1-4-3, Abeno-ku, Osaka, Japan
| | - Tatsuro Tamura
- Department of Gastroenterological Surgery, Osaka City University Graduate School of Medicine, Asahi-machi 1-4-3, Abeno-ku, Osaka, Japan
| | - Takahiro Toyokawa
- Department of Gastroenterological Surgery, Osaka City University Graduate School of Medicine, Asahi-machi 1-4-3, Abeno-ku, Osaka, Japan
| | - Shigeru Lee
- Department of Gastroenterological Surgery, Osaka City University Graduate School of Medicine, Asahi-machi 1-4-3, Abeno-ku, Osaka, Japan
| | - Kiyoshi Maeda
- Department of Gastroenterological Surgery, Osaka City University Graduate School of Medicine, Asahi-machi 1-4-3, Abeno-ku, Osaka, Japan
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Rafaqat W, Lagazzi E, Jehanzeb H, Abiad M, Hwabejire JO, Parks JJ, Kaafarani HM, DeWane MP. Which Volume Matters More? Systematic Review and Meta-Analysis of Hospital vs Surgeon Volume in Intra-Abdominal Emergency Surgery. J Am Coll Surg 2024; 238:332-346. [PMID: 37991251 DOI: 10.1097/xcs.0000000000000913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2023]
Affiliation(s)
- Wardah Rafaqat
- From the Division of Trauma, Emergency General Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA (Rafaqat, Lagazzi, Abiad, Hwabejire, Parks, Kaafarani, DeWane)
| | - Emanuele Lagazzi
- From the Division of Trauma, Emergency General Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA (Rafaqat, Lagazzi, Abiad, Hwabejire, Parks, Kaafarani, DeWane)
| | - Hamzah Jehanzeb
- Medical College, Aga Khan University, Karachi, Pakistan (Jehanzeb)
| | - May Abiad
- From the Division of Trauma, Emergency General Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA (Rafaqat, Lagazzi, Abiad, Hwabejire, Parks, Kaafarani, DeWane)
| | - John O Hwabejire
- From the Division of Trauma, Emergency General Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA (Rafaqat, Lagazzi, Abiad, Hwabejire, Parks, Kaafarani, DeWane)
| | - Jonathan J Parks
- From the Division of Trauma, Emergency General Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA (Rafaqat, Lagazzi, Abiad, Hwabejire, Parks, Kaafarani, DeWane)
| | - Haytham M Kaafarani
- From the Division of Trauma, Emergency General Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA (Rafaqat, Lagazzi, Abiad, Hwabejire, Parks, Kaafarani, DeWane)
| | - Michael P DeWane
- From the Division of Trauma, Emergency General Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA (Rafaqat, Lagazzi, Abiad, Hwabejire, Parks, Kaafarani, DeWane)
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Tran HD, Tran ST, Le TM, Pham VNT, Le KT, Le ATN, Van Ung V, Hoang TD, Nguyen TH. Conservative versus Surgical Treatment of Pneumatosis Intestinalis: Experience from a Multidisciplinary Center. Am J Case Rep 2024; 25:e943166. [PMID: 38425030 PMCID: PMC10914074 DOI: 10.12659/ajcr.943166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 02/01/2024] [Accepted: 01/24/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND Pneumatosis intestinalis (PI) is an uncommon condition that is not specific to any particular disease. Currently, there is no specific clinical guideline for treating and diagnosing PI. Furthermore, there are numerous causes of PI, which makes it difficult for clinicians - internal medicine physicians as well as surgeons - to take a clinical approach to diagnosis and treatment. CASE REPORT We present 3 clinical scenarios with PI. In the first patient there was a solitary image of PI, which was treated successfully with parenteral nutrition and intravenous antibiotics, and he was discharged after 5 days. The other 2 cases, which involve gas in the hepatic portal vein (HPVG), were handled in 2 distinct ways: surgically and conservatively. One needed diagnostic laparoscopy with necrotic segmentectomy and was discharged from the hospital on postoperative day 16. The last patient, received resuscitation treatment due to severe comorbidities and inability to tolerate surgery. After 3 days, abdominal CT scan revealed no signs of remaining PI. However, the patient was terminally discharged after 7 weeks of treatment due to septic shock caused by sacrococcygeal ulcer and urinary tract infection. By drawing comparisons among these 3 scenarios, we aim to highlight certain indicators for conservative treatment success. CONCLUSIONS PI with HPVG is a sign of severe prognosis, which often requires surgical intervention. However, the decision to manage conservatively or surgically depends on the patient's condition and other criteria such as peritonitis, free fluid in the abdominal cavity, and the presence of shock. Physicians should also weigh the benefits and risks of surgical intervention in critically ill patients.
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Smith AA, Cone JT, McNickle AG, Mitchao DP, Kostka R, Martinez B, Schroeppel T, Cavalea A, Shahan CP, Axtman B, Braverman MA. MultiCenter Study of Intra-Abdominal Abscess Formation After Major Operative Hepatic Trauma. J Surg Res 2024; 295:746-752. [PMID: 38147760 DOI: 10.1016/j.jss.2023.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 09/10/2023] [Accepted: 11/09/2023] [Indexed: 12/28/2023]
Abstract
INTRODUCTION One of the significant complications of operative liver trauma is intra-abdominal abscesses (IAA). The objective of this study was to determine risk factors associated with postoperative IAA in surgical patients with major operative liver trauma. METHODS A retrospective multi-institutional study was performed at 13 Level 1 and Level 2 trauma centers from 2012 to 2021. Adult patients with major liver trauma (grade 3 and higher) requiring operative management were enrolled. Univariate and multivariate analyses were performed. RESULTS Three hundred seventy-two patients were included with 21.2% (n = 79/372) developing an IAA. No difference was found for age, gender, injury severity score, liver injury grade, and liver resections in patients between the groups (P > 0.05). Penetrating mechanism of injury (odds ratio (OR) 3.42, 95% confidence interval (CI) 1.54-7.57, P = 0.02), intraoperative massive transfusion protocol (OR 2.43, 95% CI 1.23-4.79, P = 0.01), biloma/bile leak (OR 2.14, 95% CI 1.01-4.53, P = 0.04), hospital length of stay (OR 1.04, 95% CI 1.02-1.06, P < 0.001), and additional intra-abdominal injuries (OR 2.27, 95% CI 1.09-4.72, P = 0.03) were independent risk factors for IAA. Intra-abdominal drains, damage control laparotomy, total units of packed red blood cells, number of days with an open abdomen, total abdominal surgeries, and blood loss during surgery were not found to be associated with a higher risk of IAA. CONCLUSIONS Patients with penetrating trauma, massive transfusion protocol activation, longer hospital length of stay, and injuries to other intra-abdominal organs were at higher risk for the development of an IAA following operative liver trauma. Results from this study could help to refine existing guidelines for managing complex operative traumatic liver injuries.
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Affiliation(s)
- Alison A Smith
- Surgery Department, Louisiana State University Health Sciences Center New Orleans, New Orleans, Louisiana.
| | - Jennifer T Cone
- Surgery Department, University of Chicago School of Medicine, Chicago, Illinois
| | - Allison G McNickle
- Surgery Department, University of Nevada- Las Vegas School of Medicine, Las Vegas, Nevada
| | - Delbrynth P Mitchao
- Surgery Department, LAC+USC Medical Center, University of Southern California, Los Angeles, California
| | - Ryan Kostka
- Surgery Department, Baylor Scott and White Health, Dallas, Texas
| | - Benjamin Martinez
- Trauma Surgery Division, Our Lady of the Lake Regional Medical Center, Baton Rouge, Louisiana
| | - Thomas Schroeppel
- Surgery Department, University of Colorado Health, Colorado Springs, Colorado
| | - Alexander Cavalea
- Surgery Department, University of Tennessee Knoxville Medical Center, Knoxville, Tennessee
| | | | - Benjamin Axtman
- Trauma Division, Sanford Health Bismarck, Bismarck, North Dakota
| | - Maxwell A Braverman
- Surgery Department, St. Luke University Healthcare Network, Bethlehem, Pennsylvania
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12
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Ye Q, Jia D, Ji J, Liu Y, Wu G. Effects of nano-cerium dioxide on intestinal microflora in rats by oral subchronic exposure. PLoS One 2024; 19:e0298917. [PMID: 38422109 PMCID: PMC10903844 DOI: 10.1371/journal.pone.0298917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 01/31/2024] [Indexed: 03/02/2024] Open
Abstract
OBJECTIVE To investigate intestinal toxicity in rats and the effects of Nano-cerium dioxide on intestinal flora in rats after oral sub-chronic exposure. METHOD Forty healthy male SD rats were randomly divided into four groups: a control group (deionized water) and three groups treated with different doses of Nano-ceria (e.g., 20 mg/kg, 100 mg/kg, and 500 mg/kg), with 10 rats in each group. The rats were given intragastric administrations (every other day) for 90 days. After the last intragastric administration, fresh fecal samples were collected by pressing the abdomen, and the animals were sacrificed. Jejunum, ileum and cecum tissues were retained for pathological analysis by Hematoxylin-eosin staining. The stool samples of rats were sequenced by the Illumina NovaSeq sequencing platform, and the sequencing results were further analyzed by QIIME2 software. RESULTS The histopathology results show that compared with the control group, in the middle- and high-dose groups, epithelial tissue was shed, lamina propria glandular structures were damaged or disappeared, and large numbers of inflammatory cells were distributed in the mucosa. The intestinal flora results show that there were no significant differences in the α-/β-diversities in each Nano-ceria-treated group compared with the control group (P>0.05). Compared with the control group, the intestinal pathogenic bacteria, Mucispirillum and Streptococcus increased significantly after Nano-cerium dioxide ingestion, while Weissella decreased. The abundances of Akkermansia in all Nano-ceria-treated groups were higher than those in the control group, but the abundances decreased with increasing dose. MetagenomesSeq analysis show that, compared with the control group, the abundances of S24-7, Lactobacillus and Clostridiales in all experimental groups significantly decreased. CONCLUSIONS The sub-chronic toxicity of Nano-cerium dioxide to rats can affect the structure and abundance of intestinal microflora, long-term exposure to high doses (>100 mg/kg) causes enteritis, but there was no significant difference in the diversity of gut microbiota. Therefore, we infer that the enteritis in rats may be associated with the relative ratios of the pathogenic bacteria and intestinal probiotics, and increased of the intestinal pathogenic bacteria can disrupted intestinal homeostasis.
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Affiliation(s)
- Qianru Ye
- Department of Basic Medicine and Forensic Medicine, Baotou Medical School, Inner Mongolia University of Science and Technology, Baotou, China
- Clinical Laboratory, the Second Affiliated Hospital of Baotou Medical College, Baotou, China
| | - Dantong Jia
- Department of Basic Medicine and Forensic Medicine, Baotou Medical School, Inner Mongolia University of Science and Technology, Baotou, China
| | - Jun Ji
- The Southern University of Science and Technology, Shenzhen, China
| | - Yang Liu
- Department of Basic Medicine and Forensic Medicine, Baotou Medical School, Inner Mongolia University of Science and Technology, Baotou, China
- The Southern University of Science and Technology, Shenzhen, China
| | - Gang Wu
- Department of Basic Medicine and Forensic Medicine, Baotou Medical School, Inner Mongolia University of Science and Technology, Baotou, China
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13
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Victor BC, Frable BW, Ludt WB. Halichoeres sanchezi n. sp., a new wrasse from the Revillagigedo Archipelago of Mexico, tropical eastern Pacific Ocean (Teleostei: Labridae). PeerJ 2024; 12:e16828. [PMID: 38436023 PMCID: PMC10908266 DOI: 10.7717/peerj.16828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 01/04/2024] [Indexed: 03/05/2024] Open
Abstract
A new labrid fish species, Halichoeres sanchezi n. sp., is described from eight specimens collected in the Revillagigedo Archipelago in the tropical eastern Pacific Ocean, off the coast of Mexico. The new species belongs to the Halichoeres melanotis species complex that is found throughout the region, differing by 2.4% in the mtDNA cytochrome c oxidase I sequence from its nearest relative, H. melanotis from Panama, and 2.9% from Halichoeres salmofasciatus from Cocos Island, off Costa Rica. The complex is distinguished from others in the region by having a black spot on the opercular flap and a prominent black area on the caudal fin of males. The juveniles and initial phase of the new species closely resemble those of H. salmofasciatus and Halichoeres malpelo from Malpelo Island of Colombia, differing in having an oblong black spot with a yellow dorsal margin on the mid-dorsal fin of initial-phase adults as well as on juveniles. In contrast, the terminal-phase male color pattern is distinct from other relatives, being vermilion to orangish brown with dark scale outlines, a white patch on the upper abdomen, and a prominent black band covering the posterior caudal peduncle and base of the caudal fin. The new species adds to the list of endemic fish species for the isolated archipelago and is an interesting case of island endemism in the region. The discovery was made during the joint 2022 collecting expedition to the archipelago, which featured a pioneering collaborative approach to an inventory of an island ichthyofauna, specifically including expert underwater photographers systematically documenting specimens in situ, before hand-collection, and then photographed fresh, tissue-sampled, and subsequently vouchered in museum collections.
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Affiliation(s)
- Benjamin C. Victor
- Guy Harvey Research Institute, Nova Southeastern University, Dania Beach, Florida, United States
- Marine Biology, Ocean Science Foundation, Irvine, California, United States
| | - Benjamin W. Frable
- Marine Vertebrate Collection, Scripps Institution of Oceanography, La Jolla, California, United States
| | - William B. Ludt
- Ichthyology, Natural History Museum of Los Angeles County, Los Angeles, California, United States
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14
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Cramer CL, Cunningham M, Zhang AM, Pambianchi HL, James AL, Lattimore CM, Cummins KC, Turkheimer LM, Turrentine FE, Zaydfudim VM. Safety of postdischarge extended venous thromboembolism prophylaxis after hepatopancreatobiliary surgery. J Gastrointest Surg 2024; 28:115-120. [PMID: 38445932 DOI: 10.1016/j.gassur.2023.11.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 10/22/2023] [Accepted: 10/28/2023] [Indexed: 03/07/2024]
Abstract
BACKGROUND The risk of venous thromboembolism (VTE) after hepatopancreatobiliary (HPB) surgery is high. Extended postdischarge prophylaxis in this patient population has been controversial. This study aimed to examine the safety of postdischarge extended VTE prophylaxis in patients at high risk of VTE events after HPB surgery. METHODS Adult patients risk stratified as very high risk of VTE who underwent HPB operations between 2014 and 2020 at a quaternary care center were included. Patients were matched 1:2 extended VTE prophylaxis to the control group (patients who did not receive extended prophylaxis). Analyses compared the proportions of adverse bleeding events between groups. RESULTS A total of 307 patients were included: 103 in the extended prophylaxis group and 204 in the matched control group. Demographics were similar between groups. More patients in the extended VTE prophylaxis group had a history of VTE (9% vs 3%; P = .045). There was no difference in bleeding events between the extended VTE prophylaxis and the control group (6% vs 2%; P = .091). Of the 6 patients with bleeding events in the VTE prophylaxis group, 5 had gastrointestinal (GI) bleeding, and 1 had hemarthrosis. Of the 4 patients with bleeding events in the control group, 1 had intra-abdominal bleeding, 2 had GI bleeding, and 1 had intra-abdominal and GI bleeding. CONCLUSION Patients discharged with extended VTE prophylaxis after HPB surgery did not experience more adverse bleeding events compared with a matched control group. Routine postdischarge extended VTE prophylaxis is safe in patients at high risk of postoperative VTE after HPB surgery.
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Affiliation(s)
- Christopher L Cramer
- Division of Surgical Oncology, Department of Surgery, University of Virginia, Charlottesville, Virginia, United States; Surgical Outcomes Research Center, University of Virginia, Charlottesville, Virginia, United States
| | - Michaela Cunningham
- Division of Surgical Oncology, Department of Surgery, University of Virginia, Charlottesville, Virginia, United States; Surgical Outcomes Research Center, University of Virginia, Charlottesville, Virginia, United States
| | - Ashley M Zhang
- School of Medicine, University of Virginia, Charlottesville, Virginia, United States
| | - Hannah L Pambianchi
- School of Medicine, University of Virginia, Charlottesville, Virginia, United States
| | - Amber L James
- School of Medicine, University of Virginia, Charlottesville, Virginia, United States
| | - Courtney M Lattimore
- Division of Surgical Oncology, Department of Surgery, University of Virginia, Charlottesville, Virginia, United States; Surgical Outcomes Research Center, University of Virginia, Charlottesville, Virginia, United States
| | - Kaelyn C Cummins
- Division of Surgical Oncology, Department of Surgery, University of Virginia, Charlottesville, Virginia, United States; Surgical Outcomes Research Center, University of Virginia, Charlottesville, Virginia, United States
| | - Lena M Turkheimer
- Division of Surgical Oncology, Department of Surgery, University of Virginia, Charlottesville, Virginia, United States; Surgical Outcomes Research Center, University of Virginia, Charlottesville, Virginia, United States
| | - Florence E Turrentine
- Division of Surgical Oncology, Department of Surgery, University of Virginia, Charlottesville, Virginia, United States; Surgical Outcomes Research Center, University of Virginia, Charlottesville, Virginia, United States
| | - Victor M Zaydfudim
- Division of Surgical Oncology, Department of Surgery, University of Virginia, Charlottesville, Virginia, United States; Surgical Outcomes Research Center, University of Virginia, Charlottesville, Virginia, United States.
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15
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Stanton G, Buren IV, Foster BR. Right Upper Quadrant US Basics: Anatomy, Imaging Techniques, and Differential Diagnoses. Radiographics 2024; 44:e230123. [PMID: 38236748 DOI: 10.1148/rg.230123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Affiliation(s)
- Gail Stanton
- From the Department of Radiology, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, L340, Portland, OR 97239
| | - Inga Van Buren
- From the Department of Radiology, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, L340, Portland, OR 97239
| | - Bryan R Foster
- From the Department of Radiology, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, L340, Portland, OR 97239
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16
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Nguyen YTH, Nguyen LAT, VAN Dong H, Duong HD, Yoshida A. Molecular identification of sparganum of Spirometra mansoni isolated from the abdominal cavity of a domestic cat in Vietnam. J Vet Med Sci 2024; 86:96-100. [PMID: 38030282 PMCID: PMC10849862 DOI: 10.1292/jvms.23-0236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 11/05/2023] [Indexed: 12/01/2023] Open
Abstract
Cats normally play a role of the definitive host in which the plerocercoid (sparganum), the second larval form of Spirometra spp., develops into an adult in the intestines. However, some cases of cats with visceral or subcutaneous sparganosis were sporadically reported worldwide. We herein documented the discovery of a sparganum in abdominal cavity of a domestic cat during a surgery of dystocia. The larva was molecularly identified as Spirometra mansoni, belonging to Type I, that was recently misidentified to be S. erinaceieuropaei in several Asian countries. This is the first report for sparganum of S. mansoni in the cat. The future study is necessary to provide further insights into the species of Spirometra causing sparganosis and spirometrosis in humans and other animals.
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Affiliation(s)
- Yen Thi Hoang Nguyen
- Department of Parasitology, Faculty of Veterinary Medicine, Vietnam National University of Agriculture, Ha Noi, Vietnam
- Department of Public Health, Faculty of Veterinary Medicine, Vietnam National University of Agriculture, Ha Noi, Vietnam
| | - Lan Anh Thi Nguyen
- Department of Parasitology, Faculty of Veterinary Medicine, Vietnam National University of Agriculture, Ha Noi, Vietnam
| | - Hieu VAN Dong
- Department of Public Health, Faculty of Veterinary Medicine, Vietnam National University of Agriculture, Ha Noi, Vietnam
| | - Hieu Duc Duong
- Department of Parasitology, Faculty of Veterinary Medicine, Vietnam National University of Agriculture, Ha Noi, Vietnam
| | - Ayako Yoshida
- Laboratory of Veterinary Parasitic Diseases, Department of Veterinary Sciences, Faculty of Agriculture, University of Miyazaki, Miyazaki, Japan
- Centre for Animal Disease Control (CADIC), University of Miyazaki, Miyazaki, Japan
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17
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Das CJ, Selvaraju A, Aggarwal P, Chumber S. Combined endovascular and percutaneous approach to the management of spontaneous splenic arteriovenous fistula. BMJ Case Rep 2024; 17:e255924. [PMID: 38262721 PMCID: PMC10826506 DOI: 10.1136/bcr-2023-255924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2024] Open
Abstract
A splenic arteriovenous fistula (AVF) is an uncommon splenic vascular disease which can be congenital or acquired. A 40yr old woman, without any history of chronic liver disease, presented with non-specific pain abdomen, underwent contrast-enhanced CT and was diagnosed to have a splenic AVF with multiple intervening venous aneurysms and early filling of the portal vein. The vascular abnormality was successfully treated with a combined percutaneous glue embolisation and endovascular balloon-assisted coil embolisation. Neither recurrence nor other complications were observed in the patient during the follow-up after 6 months.
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Affiliation(s)
- Chandan J Das
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Anup Selvaraju
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Piyush Aggarwal
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Sunil Chumber
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, Delhi, India
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Yang Z, He Y, Chen P, Zhang T, Ke Z, Sun F, Zhou G, Zhao W, Li S. Advantages of single-site laparoscopic orchiopexy for palpable undescended testes in children: a prospective comparison study. Pediatr Surg Int 2024; 40:34. [PMID: 38214758 PMCID: PMC10786978 DOI: 10.1007/s00383-023-05630-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/03/2023] [Indexed: 01/13/2024]
Abstract
PURPOSE To evaluate the feasibility of single-site laparoscopic orchiopexy for palpable undescended testes in children. METHODS We prospectively studied patients with undescended testes between July 2021 and June 2022. In total, 223 patients were included in our study: 105 underwent single-site laparoscopic orchiopexy and 118 underwent conventional laparoscopic orchiopexy. During single-site laparoscopic orchiopexy, 3 ports were inserted within the umbilicus. RESULTS No differences were observed between the groups in terms of age and laterality. For unilateral undescended testes, the operating time was longer in the single site group than in the conventional group at the early stages (55.31 ± 12.04 min vs. 48.14 ± 14.39 min, P = 0.007), but it was similar to the conventional group at the later stages (48.82 ± 13.49 min vs. 48.14 ± 14.39 min, P = 0.78). Testicular ascent occurred in one patient from each group. There was no significant difference in the success rate between the single-site group and the conventional group (99.0% vs. 99.2%, P = 0.93). In the single-site group, no visible abdominal scarring was observed, while in the conventional group, there were two noticeable scars on the abdomen. CONCLUSION Single-site laparoscopic orchiopexy offers superior cosmetic results and comparable success rates compared to conventional laparoscopic orchiopexy for palpable undescended testes.
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Affiliation(s)
- Zhilin Yang
- Department of Urology and Laboratory of Pelvic Floor Muscle Function, Shenzhen Children's Hospital, Futian District, Shenzhen, Guangdong, 518000, P.R. China
| | - Yingying He
- Department of Urology and Laboratory of Pelvic Floor Muscle Function, Shenzhen Children's Hospital, Futian District, Shenzhen, Guangdong, 518000, P.R. China
- Department of Urology, Shenzhen Children's Hospital, China Medical University, Shenzhen, Guangdong, 518000, P.R. China
| | - Pengyu Chen
- Department of Urology and Laboratory of Pelvic Floor Muscle Function, Shenzhen Children's Hospital, Futian District, Shenzhen, Guangdong, 518000, P.R. China
| | - Tiejun Zhang
- Department of Urology and Laboratory of Pelvic Floor Muscle Function, Shenzhen Children's Hospital, Futian District, Shenzhen, Guangdong, 518000, P.R. China
| | - Zhicong Ke
- Department of Urology and Laboratory of Pelvic Floor Muscle Function, Shenzhen Children's Hospital, Futian District, Shenzhen, Guangdong, 518000, P.R. China
| | - Fenghao Sun
- Department of Urology and Laboratory of Pelvic Floor Muscle Function, Shenzhen Children's Hospital, Futian District, Shenzhen, Guangdong, 518000, P.R. China
| | - Guanglun Zhou
- Department of Urology and Laboratory of Pelvic Floor Muscle Function, Shenzhen Children's Hospital, Futian District, Shenzhen, Guangdong, 518000, P.R. China
| | - Weiguang Zhao
- Department of Urology and Laboratory of Pelvic Floor Muscle Function, Shenzhen Children's Hospital, Futian District, Shenzhen, Guangdong, 518000, P.R. China
| | - Shoulin Li
- Department of Urology and Laboratory of Pelvic Floor Muscle Function, Shenzhen Children's Hospital, Futian District, Shenzhen, Guangdong, 518000, P.R. China.
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Colgan AM, Hatfield RG, Dolan A, Velman W, Newton RE, Graves TA. Quantifying effectiveness and best practices for bumblebee identification from photographs. Sci Rep 2024; 14:830. [PMID: 38200017 PMCID: PMC10782012 DOI: 10.1038/s41598-023-41548-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 08/28/2023] [Indexed: 01/12/2024] Open
Abstract
Understanding pollinator networks requires species level data on pollinators. New photographic approaches to identification provide avenues to data collection that reduce impacts on declining bumblebee species, but limited research has addressed their accuracy. Using blind identification of 1418 photographed bees, of which 561 had paired specimens, we assessed identification and agreement across 20 bumblebee species netted in Montana, North Dakota, and South Dakota by people with minimal training. An expert identified 92.4% of bees from photographs, whereas 98.2% of bees were identified from specimens. Photograph identifiability decreased for bees that were wet or matted; bees without clear pictures of the abdomen, side of thorax, or top of thorax; bees photographed with a tablet, and for species with more color morphs. Across paired specimens, the identification matched for 95.1% of bees. When combined with a second opinion of specimens without matching identifications, data suggested a similar misidentification rate (2.7% for photographs and 2.5% specimens). We suggest approaches to maximize accuracy, including development of rulesets for collection of a subset of specimens based on difficulty of identification and to address cryptic variation, and focused training on identification that highlights detection of species of concern and species frequently confused in a study area.
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Affiliation(s)
- A M Colgan
- U.S. Geological Survey, Northern Rocky Mountain Science Center, 38 Mather Drive, West Glacier, MT 59936, USA
| | - R G Hatfield
- Xerces Society for Invertebrate Conservation, 628 NE Broadway, Suite 200, Portland, OR 97221, USA
| | | | - W Velman
- Bureau of Land Management, 5001 Southgate Drive, Billings, MT 59101, USA
| | - R E Newton
- Bureau of Land Management, 5001 Southgate Drive, Billings, MT 59101, USA
| | - T A Graves
- U.S. Geological Survey, Northern Rocky Mountain Science Center, 38 Mather Drive, West Glacier, MT 59936, USA.
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20
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Holmes TW, Yu Z, Thompson R, Oshinski JN, Pourmorteza A. Cardiac-induced motion of the pancreas and its effect on image quality of ultrahigh-resolution CT. Eur Radiol Exp 2024; 8:4. [PMID: 38172486 PMCID: PMC10764702 DOI: 10.1186/s41747-023-00401-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 10/16/2023] [Indexed: 01/05/2024] Open
Abstract
Recent advancements in diagnostic CT detector technology have made it possible to resolve anatomical features smaller than 20 LP/cm, referred to as ultra-high-resolution (UHR) CT. Subtle biological motions that did not affect standard-resolution (SR) CT may not be neglected in UHR. This study aimed to quantify the cardiac-induced motion of the pancreas and simulate its impact on the image quality of UHR-CT. We measured the displacement of the head of the pancreas in three healthy volunteers using Displacement Encoding with Stimulated Echoes (DENSE) MRI. The results were used to simulate SR- and UHR-CT acquisitions affected by pancreatic motion.We found pancreatic displacement in the 0.24-1.59 mm range during one cardiac cycle across the subjects. The greatest displacement was observed in the anterior-posterior direction. The time to peak displacement varied across subjects. Both SR and UHR images showed reduced image quality, as measured by radial modulation transfer function, due to cardiac-induced motion, but the motion artifacts caused more severe degradation in UHR acquisitions. Our investigation of cardiac-induced pancreatic displacement reveals its potential to degrade both standard and UHR-CT scans. To fully utilize the improvement in spatial resolution offered by UHR-CT, the effects of cardiac-induced motion in the abdomen need to be understood and corrected.Relevance statement Advancements in CT detector technology have enhanced CT scanner spatial resolution to approximately 100 µm. Consequently, previously ignored biological motions such as the cardiac-induced motion of the pancreas now demand attention to fully utilize this improved resolution.
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Affiliation(s)
- Thomas Wesley Holmes
- Department of Radiology and Imaging Sciences, Emory University, 1364 Clifton Road NE, Atlanta, GA, 30322, USA
| | - Zhou Yu
- Canon Medical Research USA, Inc, 706 N. Deerpath Drive, Vernon Hills, IL, 60061, USA
| | - Richard Thompson
- Canon Medical Research USA, Inc, 706 N. Deerpath Drive, Vernon Hills, IL, 60061, USA
| | - John N Oshinski
- Department of Radiology and Imaging Sciences, Emory University, 1364 Clifton Road NE, Atlanta, GA, 30322, USA
- Department of Biomedical Engineering, Emory University - Georgia Institute of Technology, 201 Dowman Drive, Atlanta, GA, 30322, USA
- Winship Cancer Institute, Emory University, 1701 Uppergate Dr, Suite 5018A, Atlanta, GA, 30322, USA
| | - Amir Pourmorteza
- Department of Radiology and Imaging Sciences, Emory University, 1364 Clifton Road NE, Atlanta, GA, 30322, USA.
- Department of Biomedical Engineering, Emory University - Georgia Institute of Technology, 201 Dowman Drive, Atlanta, GA, 30322, USA.
- Winship Cancer Institute, Emory University, 1701 Uppergate Dr, Suite 5018A, Atlanta, GA, 30322, USA.
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Truong HH, Ježek J, Kuntscher V. Strangulation ileus caused by malposition of the ureter. Rozhl Chir 2024; 102:261-264. [PMID: 38286656 DOI: 10.33699/pis.2023.102.6.261-264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2024]
Abstract
Ileus is one of the most severe diagnoses of the group of acute abdomen events. Some patients with certain forms of bowel obstruction respond well to conservative therapy. However, the diagnosis of strangulation ileus can be delayed in some situations, resulting in high morbidity and mortality in such cases. Our paper presents the case of an 81-year-old female patient who developed an ileus shortly after ureteral stent placement due to obstructive hydroureteronephrosis. The strangulation of the small intestine was caused by an atypical position of the right ureter in the abdominal cavity.
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Bilyayeva O, Kryzhevsky V, Karol I, Ziablitzev S. The association of TLR4 gene polymorphisms with the severity of peritonitis in acute inflammatory diseases of the abdominal cavity organs. Wiad Lek 2024; 77:35-41. [PMID: 38431805 DOI: 10.36740/wlek202401105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/05/2024]
Abstract
OBJECTIVE Aim: To determine the role of TLR4 gene polymorphisms as risk factors for peritonitis severity in patients undergoing surgery for acute inflammatory diseases of the abdominal cavity. PATIENTS AND METHODS Materials and Methods: The study included 139 patients who were operated on for acute abdominal diseases (acute appendicitis and cholecystitis, perforated gastric or duodenal ulcer, etc.). Depending on the number of points on the modified APACHE II scale, patients were divided into two groups: Group 1 - 1-3 points (63 patients, 45.3%) and Group 2 - 4 or more points (76 patients, 54.7%). Polymorphisms rs1927911, rs2149356 and rs4986790 were determined by polymerase chain reaction. RESULTS Results: The rs1927911 polymorphism of the TLR4 gene was protective for the development of peritonitis (according to the allelic model, OR 0.48; 95% CI 0.27-0.84; p=0.015). Regression analysis revealed a reduced (p=0.015) risk of severe peritonitis in rs1927911 A/A or G/A genotype carriers (OR 0.42; 95% CI 0.21-0.84) compared with G/G genotype carriers. There was no effect on the severity of peritonitis of TLR4 polymorphisms rs2149356 and rs4986790. There was a tendency to increase the frequency of the mutant G rs4986790 allele in patients with severe peritonitis (χ2=2.17; p<0.001). The analysis of the association of TLR4 gene polymorphisms with the phenotype of patients showed that carriers of mutant homozygotes and heterozygotes in the presence of severe peritonitis were older, had a tendency to coagulopathy, higher leukocytosis and leukocyte clotting rate. CONCLUSION Conclusions: Thus, the importance of TLR in the development of severe peritonitis was confirmed and the protective role of the rs1927911 promoter polymorphism was established.
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Affiliation(s)
- Olga Bilyayeva
- SHUPYK NATIONAL HEALTHCARE UNIVERSITY OF UKRAINE, KYIV, UKRAINE
| | | | - Ivan Karol
- SHUPYK NATIONAL HEALTHCARE UNIVERSITY OF UKRAINE, KYIV, UKRAINE
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Kearsey CC, Dritsas S, Mathur M, Wild J. 'It's just a mucocele': a case report of a massive appendiceal mucocele presenting as a left upper quadrant mass. Ann R Coll Surg Engl 2024; 106:93-95. [PMID: 36622245 PMCID: PMC10757871 DOI: 10.1308/rcsann.2022.0068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2022] [Indexed: 01/10/2023] Open
Abstract
Tumours of the appendix are very rare tumours that can and often present with a mucocele. This is a case report highlighting the associated pathology of appendix tumours and the management of a large mucocele. Specifically, how a right hemicolectomy is very rarely needed in these cases regardless of size and local anatomical relationships and some important considerations for the practicing surgeon in the non-tertiary centre that encounters a case like this.
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Affiliation(s)
- CC Kearsey
- The Christie NHS Foundation Trust, UK
- Institute of Translational Medicine, University of Liverpool, UK
| | - S Dritsas
- The Christie NHS Foundation Trust, UK
| | - M Mathur
- The Christie NHS Foundation Trust, UK
| | - J Wild
- The Christie NHS Foundation Trust, UK
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24
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Suleman K, Wokoh U, Iyer P, Yoong W. Pregnancy complicated by massive incisional hernia: challenges in management and review of literature. BMJ Case Rep 2023; 16:e254637. [PMID: 38129081 DOI: 10.1136/bcr-2023-254637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023] Open
Abstract
Pregnancy complicated by incisional hernia is rare but can become an obstetric challenge if the gravid uterus becomes displaced or incarcerated into the hernial sac or if there is ulceration of the overlying dermis as a result of increased intra-abdominal pressure being transmitted to the skin. We report a case of a pregnant woman presenting with a large incisional hernia at 19 weeks of gestation and discuss how problems encountered with progressing pregnancy were managed conservatively by adopting a multidisciplinary team approach (which included surgeons and radiologists). She underwent a caesarean section at 35 weeks of gestation due to active bleeding from the ulcerated skin and foetal growth restriction with subsequent staged secondary hernia repair at a tertiary centre. Close surveillance is mandatory, and a decision on the mode and timing of delivery as well as when to perform the surgical repair of the fascial defect should be team based.
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Affiliation(s)
- Kiran Suleman
- Department of Obstetrics and Gynaecology, North Middlesex University Hospital NHS Trust, London, London, UK
| | - Uloma Wokoh
- Department of Obstetrics and Gynaecology, North Middlesex University Hospital NHS Trust, London, London, UK
| | - Priyanka Iyer
- Department of Obstetrics and Gynaecology, North Middlesex University Hospital NHS Trust, London, London, UK
| | - Wai Yoong
- Department of Obstetrics and Gynaecology, North Middlesex University Hospital NHS Trust, London, London, UK
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25
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Ireland ME, O'Brien M, May D, Shetty D. Surgical admission secondary to perigastric appendagitis: an uncommon cause of acute epigastric pain. BMJ Case Rep 2023; 16:e256783. [PMID: 38129090 DOI: 10.1136/bcr-2023-256783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023] Open
Abstract
A patient in her late 20s presented with severe epigastric pain. A CT scan of the abdomen and pelvis was performed to exclude an upper gastrointestinal perforation. This showed findings of perigastric appendagitis. This is a rare cause of severe upper abdominal pain. The patient was treated with oral and intravenous analgesia medication and discharged the next day. No surgical intervention was required.
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Affiliation(s)
| | | | - Denzil May
- Department of Surgery, Treliske Hospital, Truro, UK
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26
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Lendoire M, Maki H, Haddad A, Jain AJ, Vauthey JN. Liver Anatomy 2.0 Quiz: Test Your Knowledge. J Gastrointest Surg 2023; 27:3045-3068. [PMID: 37803180 DOI: 10.1007/s11605-023-05778-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 07/01/2023] [Indexed: 10/08/2023]
Abstract
The liver is one the largest organs in the abdomen and the most frequent site of metastases for gastrointestinal tumors. Surgery on this complex and highly vascularized organ can be associated with high morbidity even in experienced hands. A thorough understanding of liver anatomy is key to approaching liver surgery with confidence and preventing complications. The aim of this quiz is to provide an active learning tool for a comprehensive understanding of liver anatomy and its integration into clinical practice.
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Affiliation(s)
- Mateo Lendoire
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1484, Houston, TX, 77030, USA
| | - Harufumi Maki
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1484, Houston, TX, 77030, USA
| | - Antony Haddad
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1484, Houston, TX, 77030, USA
| | - Anish J Jain
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1484, Houston, TX, 77030, USA
| | - Jean-Nicolas Vauthey
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1484, Houston, TX, 77030, USA.
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27
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De Dyn S, Demirci I, Prescher A, Kopp A, Klosterhalfen B, Janßen H. Mechanical ileus of the small bowel due to an inflamed Meckel's diverticulum with an enterolith - a case report with literature review. Acta Chir Belg 2023; 123:699-706. [PMID: 36259265 DOI: 10.1080/00015458.2022.2136047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 10/09/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Meckel's diverticula result from incomplete obliteration and regression of the omphaloenteric duct and are the most common congenital intestinal malformations. Many Meckel's diverticula remain asymptomatic and are discovered as incidental findings. They present a diagnostic challenge. METHODS We report the case of a 35-year-old man who presented with an acute abdomen and ileus. Computed tomography of the abdomen showed a mechanical small bowel ileus. There was a calibre jump in the terminal ileum with a round endoluminal definable hyperdense structure of almost 2 cm in diameter. RESULTS An exploratory laparoscopy was performed revealing an inflamed Meckel's diverticulum with impacted enterolith as the cause of the intestinal obstruction. CONCLUSION In symptomatic Meckel's diverticula, haemorrhage and obstruction are the most common complications. The development of ileus due to a Meckel's diverticulum with an enterolith is considered extremely rare but should be taken into account.
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Affiliation(s)
- Stephan De Dyn
- Department of General, Abdominal, Vascular and Thoracic Surgery, Krankenhaus Düren, Düren, Germany
| | - Ilhan Demirci
- Department of Vascular Surgery, Marienhospital Aachen, Aachen, Germany
| | - Andreas Prescher
- Institute of Molecular and Cellular Anatomy, RWTH Aachen, Aachen, Germany
| | - Andreas Kopp
- Department of Diagnostic and Interventional Radiology, Krankenhaus Düren, Düren, Germany
| | | | - Hermann Janßen
- Department of General, Abdominal, Vascular and Thoracic Surgery, Krankenhaus Düren, Düren, Germany
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28
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Senturk A, Gonullu E, Bayhan Z, Akdeniz Y, Ozdemir K, Mantoglu B, Capoglu R, Firat N, Altintoprak F. The wound area as a parameter guiding the timing of abdominal closure in the management of patients undergoing open abdominal procedures. Eur Rev Med Pharmacol Sci 2023; 27:11361-11369. [PMID: 38095385 DOI: 10.26355/eurrev_202312_34576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
OBJECTIVE Surgical site infections (SSI) are incomparably troublesome and complicated, and some of them require an open abdomen (OA) procedure. While deciding the timing of abdominal closure, wound area calculation method and laboratory parameters can be used to guide the timing of abdominal closure after OA procedures. PATIENTS AND METHODS The records of the patients who had undergone open abdomen during their treatment course and were followed up with vacuum-assisted closure (VAC) technique between December 2015 and December 2019 were retrospectively analyzed. The laboratory results before the first VAC application and the results after the VAC change were compared to determine a predictive parameter. The ImageJ program was used in five patients to compare the size of the wounds at the time of the decision to close them and before the first VAC application. RESULTS 102 patients were analyzed. The ratio of the last wound area to the wound area at the time of the first VAC application in five patients was 0.30, 0.41, 0.34, 0.27, 0.46 (mean: 0.36, standard deviation: 0.078) which were measured and calculated by ImageJ software. CONCLUSIONS We think that the concept of wound reduction ratio, which was calculated by a computer program, can be used as a concrete equivalent of the wound closure eligibility criteria decided by clinical experience.
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Affiliation(s)
- A Senturk
- General Surgery Department, Sakarya University Training and Research Hospital, Sakarya, Turkey.
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29
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Leahy PF. A Novel Isobaric (Gas-Less) Laparoscopic Surgery Device. Surg Innov 2023; 30:758-761. [PMID: 37776024 PMCID: PMC10656786 DOI: 10.1177/15533506231206039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/01/2023]
Abstract
BACKGROUND Laparoscopic Surgery is performed using carbon dioxide gas insufflated into the abdominal cavity to create a space for endoscopic visualization. During a laparoscopic surgical dissection plume is formed from electrocautery dissection. This plume contains viruses and sometimes COVID-19 viruses. The plume obscures the visual field. The unfiltered plume release is dangerous to surgeons, nurses, and patients. The loss of visualization during carbon dioxide release delays surgery. The use of carbon dioxide insufflated gas can have side effects such as C02 embolus, pain from diaphragmatic stretching, physiological complications such as respiratory infections and renal problems. The release of carbon dioxide gas into the atmosphere, unfiltered is significant. This accounts for 7% of greenhouse gases globally. This percentage is rising due to expansion of minimally invasive surgery. METHODOLOGY The proposed system for gasless surgery was designed by algorithms of tensegrity and geodesic dome pressures. EXPERIMENT RESULTS 100 simulator studies were performed to develop the device to elevate the abdominal wall to create a gas free (isobaric) space for Laparoscopic Surgery. After design freeze, 4 animal studies were performed using ethical research guidelines at Amsterdam Medical Centre Research Department, Netherlands. 3 cadaveric studies were performed using Ethical guidelines at Hackensack University Medical Centre, New Jersey, USA, to evaluate the device in a human setting. CONCLUSIONS These devices for Laparoscopic Surgery, Robotic Surgery, and Hand Assisted Laparoscopic Surgery (HALS) successfully proved that a superior intra-abdominal space can be created without carbon dioxide insufflation. The devices are patented in USA and Europe.
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Alchoikani N, Donnelly C, Lawther S. The "cut and push" method of removing percutaneous endoscopic gastrostomy tube is not safe in paediatric patients. Pediatr Surg Int 2023; 40:4. [PMID: 37993741 DOI: 10.1007/s00383-023-05575-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/21/2023] [Indexed: 11/24/2023]
Abstract
PURPOSE A "cut and push" (CP) approach has been described in the literature for removal of percutaneous endoscopic gastrostomy (PEG) tubes. The aim of this study is to investigate the safety profile of this method in children. METHOD Our study included all children who underwent CP procedure for either removal or replacement of Freka PEG tube at our centre between January 2016 and August 2021. Parents contacted to establish if the internal component had been seen in the stools post-procedure. If not seen, a plain film of chest, abdomen and pelvis was arranged followed by computerised tomography (CT) scan. The presence of the internal component as a retained foreign body on imaging was evaluated along with any complication. RESULTS Of the 27 patients included, six (22.2%) patients had the internal component seen in the stool. Five (18.5%) patients in total had a retained internal component with three (11.1%) patients had major complications requiring complex surgical interventions, and two (7.4%) patients required endoscopic retrieval. CONCLUSION Our study reports more severe complications that required complex surgical interventions compared to the previous studies. We believe that this method of removal is not safe in children and should be abandoned. Also, patients with Down syndrome might be at higher risk of retention and complications.
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Affiliation(s)
- Nasib Alchoikani
- University Hospital Southampton NHS Foundation Trust, Southampton, UK.
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31
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Novy E, Roger C, Roberts JA, Cotta MO. Pharmacokinetic and pharmacodynamic considerations for antifungal therapy optimisation in the treatment of intra-abdominal candidiasis. Crit Care 2023; 27:449. [PMID: 37981676 PMCID: PMC10659066 DOI: 10.1186/s13054-023-04742-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 11/14/2023] [Indexed: 11/21/2023] Open
Abstract
Intra-abdominal candidiasis (IAC) is one of the most common of invasive candidiasis observed in critically ill patients. It is associated with high mortality, with up to 50% of deaths attributable to delays in source control and/or the introduction of antifungal therapy. Currently, there is no comprehensive guidance on optimising antifungal dosing in the treatment of IAC among the critically ill. However, this form of abdominal sepsis presents specific pharmacokinetic (PK) alterations and pharmacodynamic (PD) challenges that risk suboptimal antifungal exposure at the site of infection in critically ill patients. This review aims to describe the peculiarities of IAC from both PK and PD perspectives, advocating an individualized approach to antifungal dosing. Additionally, all current PK/PD studies relating to IAC are reviewed in terms of strength and limitations, so that core elements for the basis of future research can be provided.
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Affiliation(s)
- Emmanuel Novy
- University of Queensland Centre for Clinical Research (UQCCR), Faculty of Medicine, The University of Queensland, Royal Brisbane & Women's Hospital Campus Herston, Brisbane, QLD, 4029, Australia
- Department of Anaesthesiology, Critical Care and Peri-Operative Medicine, University Hospital of Nancy, Nancy, France
- Université de Lorraine, SIMPA, 54500, Nancy, France
| | - Claire Roger
- Department of Anesthesiology, Critical Care, Pain and Emergency Medicine, Nimes University Hospital, Place du Professeur Robert Debré, 30029, Nîmes Cedex 9, France
- UR UM103 IMAGINE, Univ Montpellier, Montpellier, France
| | - Jason A Roberts
- University of Queensland Centre for Clinical Research (UQCCR), Faculty of Medicine, The University of Queensland, Royal Brisbane & Women's Hospital Campus Herston, Brisbane, QLD, 4029, Australia.
- Department of Anesthesiology, Critical Care, Pain and Emergency Medicine, Nimes University Hospital, Place du Professeur Robert Debré, 30029, Nîmes Cedex 9, France.
- Department of Intensive Care Medicine and Pharmacy, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia.
- Herston Infectious Diseases Institute (HeIDI), Metro North Health, Brisbane, Australia.
| | - Menino Osbert Cotta
- University of Queensland Centre for Clinical Research (UQCCR), Faculty of Medicine, The University of Queensland, Royal Brisbane & Women's Hospital Campus Herston, Brisbane, QLD, 4029, Australia
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32
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Ueki Y, Toyota K, Ohira T, Takeuchi K, Satake SI. Gender identification of the horsehair crab, Erimacrus isenbeckii (Brandt, 1848), by image recognition with a deep neural network. Sci Rep 2023; 13:19190. [PMID: 37957197 PMCID: PMC10643619 DOI: 10.1038/s41598-023-46606-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 11/02/2023] [Indexed: 11/15/2023] Open
Abstract
Appearance-based gender identification of the horsehair crab [Erimacrus isenbeckii (Brandt, 1848)] is important for preventing indiscriminate fishing of female crabs. Although their gender is easily identified by visual observation of their abdomen because of a difference in the forms of their sex organs, most of the crabs settle with their shell side upward when placed on a floor, making visual gender identification difficult. Our objective is to use deep learning to identify the gender of the horsehair crab on the basis of images of their shell and abdomen sides. Deep learning was applied to a photograph of 60 males and 60 females captured in Funka Bay, Southern Hokkaido, Japan. The deep learning algorithms used the AlexNet, VGG-16, and ResNet-50 convolutional neural networks. The VGG-16 network achieved high accuracy. Heatmaps were enhanced near the forms of the sex organs in the abdomen side (F-1 measure: 98%). The bottom of the shell was enhanced in the heatmap of a male; by contrast, the upper part of the shell was enhanced in the heatmap of a female (F-1 measure: 95%). The image recognition of the shell side based on a deep learning algorithm enabled more precise gender identification than could be achieved by human-eye inspection.
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Affiliation(s)
- Yoshitaka Ueki
- Department of Applied Electronics, Faculty of Advanced Engineering, Tokyo University of Science, 6‑3‑1 Niijuku, Katsushika‑ku, Tokyo, 125‑8585, Japan
| | - Kenji Toyota
- Noto Marine Laboratory, Institute of Nature and Environmental Technology, Kanazawa University, Ogi, Noto‑cho, Ishikawa, 927‑0553, Japan
- Department of Biological Science and Technology, Faculty of Advanced Engineering, Tokyo University of Science, 6‑3‑1 Niijuku, Katsushika‑ku, Tokyo, 125‑8585, Japan
- Department of Science, Faculty of Science, Kanagawa University, 3-27-1 Rokkakubashi, Kanagawa-ku, Yokohama-shi, Kanagawa, 221‑8686, Japan
| | - Tsuyoshi Ohira
- Department of Science, Faculty of Science, Kanagawa University, 3-27-1 Rokkakubashi, Kanagawa-ku, Yokohama-shi, Kanagawa, 221‑8686, Japan
| | - Ken Takeuchi
- Oshamambe Division, Institute of Arts and Sciences, Tokyo University of Science, 102-1 Tomino, Oshamambe-cho, Yamakoshi-gun, Hokkaido, 049-3514, Japan
| | - Shin-Ichi Satake
- Department of Applied Electronics, Faculty of Advanced Engineering, Tokyo University of Science, 6‑3‑1 Niijuku, Katsushika‑ku, Tokyo, 125‑8585, Japan.
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Afaque MY, Qaseem SMD, Shah MA, Kujur M, Rab AZU, Rizvi SAA. Surgical Anatomy of Transversus Abdominis Muscle for Transversus Abdominis Release: A CT-Based Study in Three Patient Groups. World J Surg 2023; 47:2718-2723. [PMID: 37713128 DOI: 10.1007/s00268-023-07163-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2023] [Indexed: 09/16/2023]
Abstract
BACKGROUND The anatomy of the transversus abdominis muscle and its aponeurosis is important in transversus abdominis release surgery. We studied the CT anatomy of the transversus abdominis muscle medial to the linea semilunaris at different levels in the abdomen and measured the thickness of this muscle. METHODS In this retrospective study, we analysed 150 abdominal computed tomography at L1, L3, and L5 vertebral levels corresponding to subxiphoid, umbilical, and suprapubic regions, respectively. The patients were divided into three groups based on age and sex: women aged 15-20 years (nulliparous), women aged 30-60 years (multiparous), and men aged 15-60 years, with each group having 50 patients. We compared the thickness of the TA muscle at the L1 level between men and women and between nulliparous and multiparous women. RESULTS Transversus abdominis muscle was consistently present medial to the linea semilunaris at L1 vertebral level in the subxiphoid region (150/150). At the L3 vertebral level in the mid-abdomen, only eight patients had the transversus abdominis muscle there (8/150, 5%). At the L5 vertebral level in the suprapubic region, no patient had the transversus abdominis muscle medial to the linea semilunaris. The mean thickness of the transversus abdominis muscle at the L1 level was 3.4 mm, and at the L3 level, it was 1.6 mm. There was no statistically significant difference in the transversus abdominis muscle thickness between the men and women; however, a significant difference was found between the nulliparous and multiparous women, with thinner TA muscle in later. CONCLUSION There is good transversus abdominis muscle bulk medial to the linea semilunaris for doing transversus abdominis muscle division in the upper abdomen. However, as we move towards the mid-abdomen, we have TA aponeurosis or rarely TA muscle of little bulk.
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Affiliation(s)
- Md Yusuf Afaque
- Department of Surgery, J N Medical College, AMU, Aligarh, Uttar Pradesh, 202002, India.
| | | | - Mudasir Ashraf Shah
- Department of Radiodiagnosis, J N Medical College, AMU, Aligarh, Uttar Pradesh, 202002, India
| | - Maikal Kujur
- Department of Surgery, J N Medical College, AMU, Aligarh, Uttar Pradesh, 202002, India
| | - Atia Zaka Ur Rab
- Department of Surgery, J N Medical College, AMU, Aligarh, Uttar Pradesh, 202002, India
| | - Syed Amjad Ali Rizvi
- Department of Surgery, J N Medical College, AMU, Aligarh, Uttar Pradesh, 202002, India
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Robertson D, Sterke F, van Weteringen W, Arezzo A, Mintz Y, Horeman T. Escape of surgical smoke particles, comparing conventional and valveless trocar systems. Surg Endosc 2023; 37:8552-8561. [PMID: 37794124 PMCID: PMC10615925 DOI: 10.1007/s00464-023-10444-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 09/02/2023] [Indexed: 10/06/2023]
Abstract
BACKGROUND During minimal access surgery, surgical smoke is produced which can potentially be inhaled by the surgical team, leading to several health risks. This smoke can escape from the abdominal cavity into the operating room due to trocar leakage. The trocars and insufflator that are used during surgery influence gas leakage. Therefore, this study compares particle escape from a valveless (Conmed AirSeal iFS), and a conventional (Karl Storz Endoflator) system. MATERIALS AND METHODS Using an in vitro model, a conventional and a valveless trocar system were compared. A protocol that simulated various surgical phases was defined to assess the surgical conditions and particle leakage. Insufflation pressures and instrument diameters were varied as these are known to affect gas leakage. RESULTS The conventional trocar leaked during two distinct phases. Removal of the obturator caused a sudden release of particles. During instrument insertion, an average of 211 (IQR 111) particles per second escaped when using the 5 mm diameter instrument. With the 10 mm instrument, 50 (IQR 13) particles per second were measured. With the conventional trocar, a higher abdominal pressure increased particle leakage. The valveless trocar demonstrated a continuously high particle release during all phases. After the obturator was removed, particle escape increased sharply. Particle escape decreased to 1276 (IQR 580) particles per second for the 5 mm instrument insertion, and 1084 (IQR 630) particles per second for 10 mm instrument insertion. With the valveless trocar system, a higher insufflation pressure lowered particle escape. CONCLUSIONS This study shows that a valveless trocar system releases more particles into the operating room environment than a conventional trocar. During instrument insertion, the leakage through the valveless system is 6 to 20 times higher than the conventional system. With a valveless trocar, leakage decreases with increasing pressure. With both trocar types leakage depends on instrument diameter.
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Affiliation(s)
- Daniel Robertson
- Department of Biomechanical Engineering, Faculty of Mechanical Engineering, Delft University of Technology, Mekelweg 2, 2628 CD, Delft, The Netherlands.
| | - Frank Sterke
- Department of Biomechanical Engineering, Faculty of Mechanical Engineering, Delft University of Technology, Mekelweg 2, 2628 CD, Delft, The Netherlands
- Department of Pediatric Surgery, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Willem van Weteringen
- Department of Pediatric Surgery, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Anesthesiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Alberto Arezzo
- Department of Surgical Sciences, University of Torino, Turin, Italy
| | - Yoav Mintz
- Department of General Surgery, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Tim Horeman
- Department of Biomechanical Engineering, Faculty of Mechanical Engineering, Delft University of Technology, Mekelweg 2, 2628 CD, Delft, The Netherlands
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Quintero-Riaza VM, Chancí-Drago R, Guzmán-Arango N, Posada-Moreno P, López-Sandoval T, Ramírez-Sánchez IC, Vanegas-Munera JM. Aerobic Intraoperative Abdominal Cavity Culture Modifies Antibiotic Therapy and Reduces the Risk of Surgical Site Infection in Complicated Appendicitis with Peritonitis. J Gastrointest Surg 2023; 27:2563-2566. [PMID: 37340103 PMCID: PMC10661740 DOI: 10.1007/s11605-023-05736-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 05/30/2023] [Indexed: 06/22/2023]
Affiliation(s)
| | - Romario Chancí-Drago
- School of Health Sciences, Universidad Pontificia Bolivariana, Medellín, Colombia
| | | | - Pablo Posada-Moreno
- School of Health Sciences, Universidad Pontificia Bolivariana, Medellín, Colombia
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Kashchenko VA, Lodygin AV, Krasnoselsky KY, Zaytsev VV, Kamshilin AA. Intra-abdominal laparoscopic assessment of organs perfusion using imaging photoplethysmography. Surg Endosc 2023; 37:8919-8929. [PMID: 37872427 DOI: 10.1007/s00464-023-10506-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 09/23/2023] [Indexed: 10/25/2023]
Abstract
BACKGROUND An objective evaluation of the functional state and viability of biological tissues during minimally invasive surgery remains unsolved task. Various non-contact methods for evaluating perfusion during laparoscopic surgery are discussed in the literature, but so far there have been no reports of their use in clinical settings. METHODS AND PATIENTS Imaging photoplethysmography (iPPG) is a new method for quantitative assessment of perfusion distribution along the tissue. This is the first study in which we demonstrate successful use of iPPG to assess perfusion of organs during laparoscopic surgery in an operation theater. We used a standard rigid laparoscope connected to a standard digital monochrome camera, and abdominal organs were illuminated by green light. A distinctive feature is the synchronous recording of video frames and electrocardiogram with subsequent correlation data processing. During the laparoscopically assisted surgeries in nine cancer patients, the gradient of perfusion of the affected organs was evaluated. In particular, measurements were carried out before preparing a part of the intestine or stomach for resection, after anastomosis, or during physiological tests. RESULTS The spatial distribution of perfusion and its changes over time were successfully measured in all surgical cases. In particular, perfusion gradient of an intestine before resection was visualized and quantified by our iPPG laparoscope in all respective cases. It was also demonstrated that systemic administration of norepinephrine leads to a sharper gradient between well and poorly perfused areas of the colon. In four surgical cases, we have shown capability of the laparoscopic iPPG system for intra-abdominal assessment of perfusion in the anastomosed organs. Moreover, good repeatability of continuous long-term measurements of tissue perfusion inside the abdominal cavity was experimentally demonstrated. CONCLUSION Our study carried out in real clinical settings has shown that iPPG laparoscope is feasible for intra-abdominal visualization and quantitative assessment of perfusion distribution.
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Affiliation(s)
- Victor A Kashchenko
- First Surgical Department, North-Western District Scientific and Clinical Center Named After L.G. Sokolov of the Federal Medical and Biological Agency, Saint Petersburg, Russia, 194291
- Department of Faculty Surgery, St. Petersburg State University, Saint Petersburg, Russia, 199106
| | - Alexander V Lodygin
- First Surgical Department, North-Western District Scientific and Clinical Center Named After L.G. Sokolov of the Federal Medical and Biological Agency, Saint Petersburg, Russia, 194291
- Department of Faculty Surgery, St. Petersburg State University, Saint Petersburg, Russia, 199106
| | - Konstantin Yu Krasnoselsky
- First Surgical Department, North-Western District Scientific and Clinical Center Named After L.G. Sokolov of the Federal Medical and Biological Agency, Saint Petersburg, Russia, 194291
- Department of Anesthesiology-Resuscitation and Emergency Pediatrics, St. Petersburg State Pediatric Medical University, Saint Petersburg, Russia, 194100
| | - Valeriy V Zaytsev
- Laboratory of New Functional Materials for Photonics, Institute of Automation and Control Processes of the Far Eastern Branch of the Russian Academy of Sciences, Vladivostok, Russia, 690041
- Organizational and Methodological Department, North-Western District Scientific and Clinical Center Named After L.G. Sokolov of the Federal Medical and Biological Agency, Saint Petersburg, Russia, 194291
| | - Alexei A Kamshilin
- Laboratory of New Functional Materials for Photonics, Institute of Automation and Control Processes of the Far Eastern Branch of the Russian Academy of Sciences, Vladivostok, Russia, 690041.
- Organizational and Methodological Department, North-Western District Scientific and Clinical Center Named After L.G. Sokolov of the Federal Medical and Biological Agency, Saint Petersburg, Russia, 194291.
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Deville PE, Marr AB, Cone JT, Hoefer LE, Mitchao DP, Inaba K, Kostka R, Mooney JL, McNickle AG, Smith AA. Multicenter Study of Perioperative Hepatic Angioembolization as an Adjunct for Management of Major Operative Hepatic Trauma. J Am Coll Surg 2023; 237:697-703. [PMID: 37366536 DOI: 10.1097/xcs.0000000000000791] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2023]
Abstract
BACKGROUND The management of major liver trauma continues to evolve in trauma centers across the US with increasing use of minimally invasive techniques. Data on the outcomes of these procedures remain minimal. The objective of this study was to evaluate patient complications after perioperative hepatic angioembolization as an adjunct to management of major operative liver trauma. STUDY DESIGN A retrospective multi-institutional study was performed at 13 level 1 and level 2 trauma centers from 2012 to 2021. Adult patients with major liver trauma (grade 3 and higher) requiring operative management were enrolled. Patients were divided into 2 groups: angioembolization (AE) and no angioembolization (NO AE). Univariate and multivariate analyses were performed. RESULTS A total of 442 patients were included with AE performed in 20.4% (n = 90 of 442) of patients. The AE group was associated with higher rates of biloma formation (p = 0.0007), intra-abdominal abscess (p = 0.04), pneumonia (p = 0.006), deep vein thrombosis (p = 0.0004), acute renal failure (p = 0.004), and acute respiratory distress syndrome (p = 0.0003), and it had longer ICU and hospital length of stay (p < 0.0001). On multivariate analysis, the AE had a significantly higher amount intra-abdominal abscess formation (odds ratio 1.9, 95% CI 1.01 to 3.6, p = 0.05). CONCLUSIONS This is one of the first multicenter studies comparing AE in specifically operative high-grade liver injuries and found that patients with liver injury that undergo AE in addition to surgery have higher rates of both intra- and extra-abdominal complications. This provides important information that can guide clinical management.
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Affiliation(s)
- Paige E Deville
- From the Louisiana State University Health Sciences Center, New Orleans, LA (Deville, Marr, Smith)
| | - Alan B Marr
- From the Louisiana State University Health Sciences Center, New Orleans, LA (Deville, Marr, Smith)
| | - Jennifer T Cone
- University of Chicago School of Medicine, Chicago IL (Cone, Hoefer)
| | - Lea E Hoefer
- University of Chicago School of Medicine, Chicago IL (Cone, Hoefer)
| | - Delbrynth P Mitchao
- University of Southern California to LA General Medical Center, Keck School of Medicine of USC, Los Angeles, CA (Mitchao, Inaba)
| | - Kenji Inaba
- University of Southern California to LA General Medical Center, Keck School of Medicine of USC, Los Angeles, CA (Mitchao, Inaba)
| | - Ryan Kostka
- Baylor Scott and White Health, Dallas, TX (Koska, Mooney)
| | | | - Allison G McNickle
- University of Nevada, Las Vegas School of Medicine, Las Vegas, NV (McNickle)
| | - Alison A Smith
- From the Louisiana State University Health Sciences Center, New Orleans, LA (Deville, Marr, Smith)
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Abstract
ABSTRACT Damage-control surgery (DCS) is a strategy adopted to limit initial operative interventions in the unstable surgical patient, delaying definitive repairs and abdominal wall closure until physiologic parameters have improved. Although this concept of "physiology over anatomy" was initially described in the management of severely injured trauma patients, the approaches of DCS have become common in the management of nontraumatic intra-abdominal emergencies.While the utilization of damage-control methods in emergency general surgery (EGS) is controversial, numerous studies have demonstrated improved outcomes, making DCS an essential technique for all acute care surgeons. Following a brief history of DCS and its indications in the EGS patient, the phases of DCS will be discussed including an in-depth review of preoperative resuscitation, techniques for intra-abdominal source control, temporary abdominal closure, intensive care unit (ICU) management of the open abdomen, and strategies to improve abdominal wall closure.
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Affiliation(s)
- William B Risinger
- From the Department of Surgery, University of Louisville School of Medicine, Louisville, KY
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Humphries A, Speroni S, Eden K, Nolan M, Gilbert C, McNamara J. Horseshoe kidney: Morphologic features, embryologic and genetic etiologies, and surgical implications. Clin Anat 2023; 36:1081-1088. [PMID: 36708162 DOI: 10.1002/ca.24018] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 01/18/2023] [Accepted: 01/22/2023] [Indexed: 01/29/2023]
Abstract
The horseshoe kidney (HSK) is the most common congenital abnormality of the upper urinary tract with an incidence of approximately 1 in 500 in the general population. Although individuals with HSK are often asymptomatic, they are at increased risk for neoplasms, infections, ureteropelvic obstruction secondary to lithiasis or vascular compression. Direct injury from trauma is increased in these individuals as is the risk of intraoperative complications secondary to damage involving the typically complex renal or adrenal vascular supply. We briefly review etiological factors including renal and urinary system embryology, genetic mutations, abnormalities related to faulty cell signaling, aberrant cell migration, and other possible causes including environmental exposures and trauma. In addition, we call attention to factors that might influence the success of surgical procedures in patients with HSK. We argue that an understanding of possible etiologies of the HSK and its different subtypes may be useful when planning surgical procedures or considering risk-benefit ratios associated with different surgical options. We briefly present the organization of a HSK in a 100-year-old male demonstrating an unusual vascular supply discovered during a dissection laboratory session in a medical school anatomy course. We describe the structure of the HSK, the position and relationships of the HSK to other structures within the abdomen, and the associated vascular relationships.
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Affiliation(s)
- Audrey Humphries
- Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA
| | - Samantha Speroni
- Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA
| | - Kristin Eden
- Department of Basic Sciences Education, Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA
| | - Michael Nolan
- Department of Basic Sciences Education, Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA
| | - Carol Gilbert
- Department of Basic Sciences Education, Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA
| | - John McNamara
- Department of Basic Sciences Education, Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA
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40
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Aktokmakyan TV, Peksen C, Savaş OA, Sumer A. Unreported rare but serious complication: Major vascular injuries during bariatric surgery. ULUS TRAVMA ACIL CER 2023; 29:1255-1260. [PMID: 37889033 PMCID: PMC10771246 DOI: 10.14744/tjtes.2023.71829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 09/12/2023] [Accepted: 09/19/2023] [Indexed: 10/28/2023]
Abstract
BACKGROUND The aim of this study was to investigate the incidence, risk factors, clinical presentation, and management of major vascular injuries during bariatric surgery, with a specific focus on the role of different access methods in abdominal cavity entry. METHODS A nationwide survey was conducted among bariatric surgeons to assess the prevalence of major vascular injuries. A questionnaire was distributed to 365 surgeons through WhatsApp groups of two national bariatric surgery societies, with 76 surgeons completing the survey. The study population included general surgeons practicing bariatric surgery, and the questionnaire consisted of 12 questions. RESULTS Among the participants, 16.9% reported experiencing a major vascular injury during bariatric surgery. The majority of injuries (75%) occurred at the trocar entrance, with the remaining cases during the dissection phase. Notably, 66.7% of surgeons used optical trocars for access, while 27.8% employed the Veress needle technique. Early detection varied, with 45% identifying the injury immediately and 30% recognizing it within three minutes. Most injuries (52.4%) were repaired laparoscopically, and only three surgeons sought assistance from cardiovascular surgeons. CONCLUSION Vascular injuries are infrequent but potentially serious complications in laparoscopic bariatric surgery. Understand-ing their incidence, timely recognition, and proper management are crucial to minimize adverse effects. The findings of this study shed light on the patterns of vascular injuries and the potential role of specific access methods, providing valuable insights for enhancing patient safety in bariatric surgery.
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Affiliation(s)
| | - Caghan Peksen
- Department of General Surgery, Istinye University, Istanbul-Türkiye
| | - Osman Anıl Savaş
- Department of General Surgery, Istinye University, Istanbul-Türkiye
| | - Aziz Sumer
- Department of General Surgery, Istinye University, Istanbul-Türkiye
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Jayasundara S, Goonewardene M, Dassanayake L. The association between maternal intra-abdominal pressure and hypertension in pregnancy. PLoS One 2023; 18:e0284230. [PMID: 37851647 PMCID: PMC10584176 DOI: 10.1371/journal.pone.0284230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 10/03/2023] [Indexed: 10/20/2023] Open
Abstract
INTRODUCTION Pregnancy leads to a state of chronically increased intra-abdominal pressure (IAP) caused by a growing fetus, fluid, and tissue. Increased intra-abdominal pressure is leading to state of Intra-Abdominal Hypertension (IAH) and Abdominal Compartment Syndrome. Clinical features and risk factors of preeclampsia is comparable to abdominal compartment syndrome. IAP may be associated with the hypertension in pregnancy (HIP). OBJECTIVES The study aimed to determine the antepartum and postpartum IAP levels in women undergoing caesarean delivery (CD) and association between hypertension in pregnancy, and antepartum and postpartum IAP levels in women undergoing CD. METHOD Seventy pregnant women (55 normotensive, 15 HIP) undergoing antepartum, non-emergency CD, had their intravesical pressure measured before and after the CD, the intravesical pressure measurements obtained with the patient in the supine position were considered to correspond to the IAP. Multivariable linear regression models were used to study associations between intraabdominal pressure and baseline characteristics in normotensive pregnancies and hypertensive pregnancies. RESULTS In normotensive pregnancies at mean gestation age of 38.2 weeks (95%CI 37.9 to 38.6), mean antepartum IAP was 12.7 mmHg(95%CI 11.6 to 13.8) and the mean postpartum IAP was 7.3 mmHg (95% CI 11.6 to 13.8). Multivariable linear regression models showed HIP group antepartum IAP positively associated with coefficient value of 1.617 (p = 0.268) comparing with normotensive pregnancy group. Postpartum IAP in HIP group positively associated with coefficient value of 2.519 (p = 0.018) comparing with normotensive pregnancy group. IAP difference is negatively associated with HIP (coefficient -1.013, p = 0.179). CONCLUSION In normotensive pregnancies at term, the IAP was in the IAH range of the non-pregnant population. Higher Antepartum IAP and Postpartum IAP are associated with HIP. Reduction of IAP from antepartum period to postpartum period was less with HIP.
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Affiliation(s)
| | - Malik Goonewardene
- Academic Obstetric Unit, Teaching Hospital, Galle, Sri Lanka
- Department of obstetrics and gynaecology, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka
| | - Lanka Dassanayake
- Academic Obstetric Unit, Teaching Hospital, Galle, Sri Lanka
- Department of obstetrics and gynaecology, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka
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Chalcarz M, Krokowicz P, Żurawski J. Surgical removal of Aquafilling localized to different sites. Pol Przegl Chir 2023; 96:1-10. [PMID: 38629282 DOI: 10.5604/01.3001.0053.3999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
<b><br>Introduction:</b> Aquafilling, a widely used soft-tissue filler since 2005, shows multiple adverse effects, necessitating the development of effective methods for its removal. We present a surgical method for removal of Aquafilling present in the breasts, breasts with migration to the chest and/or the abdomen, and the buttocks, and elaborate and discuss the advantages of this method.</br> <b><br>Aim:</b> The aim of this study was to present a surgical method for removal of Aquafilling (soft-tissue filler) present in the breasts, breasts with migration to the chest and/or the abdomen, and the buttocks, and to elaborate the advantages of this proposed technique.</br> <b><br>Materials and methods:</b> The surgical Aquafilling removal method described here was used in 25 patients (age, 21-53 years). The technique was used to remove Aquafilling present in the breasts (14 patients), breasts with migration to the chest and/or the abdomen (7 patients), and the buttocks (3 patients). The detailed course of Aquafilling removal surgery and postoperative treatment for these three types of cases is described.</br> <b><br>Results:</b> Surgical removal of Aquafilling with the described method did not cause any of the previously described ailments in each patient, excluding one patient who only showed significant pain reduction in both breasts preceding each menstruation cycle.</br> <b><br>Conclusions:</b> The method described herein can be recommended for removal of Aquafilling present in the breasts, breasts with migration to the chest and/or the abdomen, and buttocks, since it allowed thorough Aquafilling removal and decreased the local inflammatory state and the risk of potential carcinogenesis.</br>.
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Affiliation(s)
| | - Piotr Krokowicz
- Department of General and Colorectal Surgery, University of Medical Sciences in Poznan, Poland
| | - Jakub Żurawski
- Department of Medical Biology, Department of Immunobiology, University of Medical Sciences in Poznan, Poland
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Kustalik S, Klejszmit P, Kordiak J, Santorek-Strumiłło E, Jabłoński S. Analysis of the influence of selected protein markers as markers of nutritional status and inflammation on the occurrence of eventration after laparotomy. Pol Przegl Chir 2023; 96:42-48. [PMID: 38353093 DOI: 10.5604/01.3001.0053.9183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2024]
Abstract
<b><br>Introduction:</b> Eventration is a fairly rare complication after laparotomy, which consists of postoperative wound dehiscence and protrusion of the viscera outside the abdominal cavity. This complication is associated with a higher mortality rate. The known risk factors for this condition include malnutrition and the coexistence of inflammation or cancer.</br> <b><br>Aim:</b> The main aim of the study was to investigate the relationship between the occurrence of eventration after laparotomy and the patient's nutritional status with the intensity of inflammatory processes, expressed using selected protein markers.</br> <b><br>Material and method:</b> The study was based on the analysis of patients treated at our own center from January 2014 to December 2020. It included a group of patients who underwent laparotomy and who experienced eventration, as well as a control group of patients who underwent laparotomy but did not experience eventration after the procedure.</br> <b><br>Results:</b> The analysis showed that a lower serum albumin concentration is associated with a greater risk of eventration in patients who have undergone laparotomy due to acute abdominal disease. The study group and the control group differed significantly in the levels of: Hgb, serum total protein, CRP, lymphocytes, albumin, PCT, NRS.</br>.
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Affiliation(s)
- Sylwia Kustalik
- Department of Thoracic, General and Oncological Surgery, University Clinical Hospital of the Military Medical Academy, Central Veterans Hospital, Lodz, Poland
| | - Piotr Klejszmit
- Department of Thoracic, General and Oncological Surgery, University Clinical Hospital of the Military Medical Academy, Central Veterans Hospital, Lodz, Poland
| | - Jacek Kordiak
- Department of Thoracic, General and Oncological Surgery, University Clinical Hospital of the Military Medical Academy, Central Veterans Hospital, Lodz, Poland
| | - Edyta Santorek-Strumiłło
- Department of Thoracic, General and Oncological Surgery, University Clinical Hospital of the Military Medical Academy, Central Veterans Hospital, Lodz, Poland
| | - Sławomir Jabłoński
- Department of Thoracic, General and Oncological Surgery, University Clinical Hospital of the Military Medical Academy, Central Veterans Hospital, Lodz, Poland
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Thaiss W. Kommentar zu „HYBRID – Simultane Multischicht-DWI vs. Standard-DWI-MRT des Abdomens“. ROFO-FORTSCHR RONTG 2023; 195:874. [PMID: 37793383 DOI: 10.1055/a-2101-8973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Affiliation(s)
- Wolfgang Thaiss
- Nuklearmedizin & Diagnostische und Interventionelle Radiologie, Universitätsklinikum Ulm, Ulm, Germany
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45
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Ji MY, Wilson K, Gandhi J, Baraza W, Hayes J. Alexis® O-based isolation technique for enteroatmospheric fistulae in open abdomen. ANZ J Surg 2023; 93:2529-2530. [PMID: 37357343 DOI: 10.1111/ans.18572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 05/20/2023] [Accepted: 06/07/2023] [Indexed: 06/27/2023]
Affiliation(s)
- Maria Yeonhee Ji
- Department of Surgery, Auckland City Hospital, Auckland, New Zealand
| | - Kasmira Wilson
- Department of Surgery, Auckland City Hospital, Auckland, New Zealand
| | - Jamish Gandhi
- Department of Surgery, Auckland City Hospital, Auckland, New Zealand
| | - Wal Baraza
- Department of Surgery, Auckland City Hospital, Auckland, New Zealand
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - Julian Hayes
- Department of Surgery, Auckland City Hospital, Auckland, New Zealand
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See KC, Tayebi S, Sum CL, Phua J, Stiens J, Wise R, Mukhopadhyay A, Malbrain MLNG. Feasibility analysis of a novel non-invasive ultrasonographic method for the measurement of intra-abdominal pressure in the intensive care unit. J Clin Monit Comput 2023; 37:1351-1359. [PMID: 37133628 DOI: 10.1007/s10877-023-01024-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 04/21/2023] [Indexed: 05/04/2023]
Abstract
Increased intra-abdominal pressure (IAP) is an important vital sign in critically ill patients and has a negative impact on morbidity and mortality. This study aimed to validate a novel non-invasive ultrasonographic approach to IAP measurement against the gold standard intra-bladder pressure (IBP) method. We conducted a prospective observational study in an adult medical ICU of a university hospital. IAP measurements using ultrasonography by two independent operators, with different experience levels (experienced, IAPUS1; inexperienced, IAPUS2), were compared with the gold standard IBP method performed by a third blinded operator. For the ultrasonographic method, decremental external pressure was applied on the anterior abdominal wall using a bottle filled with decreasing volumes of water. Ultrasonography looked at peritoneal rebound upon brisk withdrawal of the external pressure. The loss of peritoneal rebound was identified as the point where IAP was equal to or above the applied external pressure. Twenty-one patients underwent 74 IAP readings (range 2-15 mmHg). The number of readings per patient was 3.5 ± 2.5, and the abdominal wall thickness was 24.6 ± 13.1 mm. Bland and Altman's analysis showed a bias (0.39 and 0.61 mmHg) and precision (1.38 and 1.51 mmHg) for the comparison of IAPUS1 and IAPUS2 and vs. IBP, respectively with small limits of agreement that were in line with the research guidelines of the Abdominal Compartment Society (WSACS). Our novel ultrasound-based IAP method displayed good correlation and agreement between IAP and IBP at levels up to 15 mmHg and is an excellent solution for quick decision-making in critically ill patients.
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Affiliation(s)
- Kay Choong See
- Division of Respiratory & Critical Care Medicine, Department of Medicine, National University Hospital, 1E Kent Ridge Road, NUHS Tower Block Level 10, 119228, Singapore.
| | - Salar Tayebi
- Department of Electronics and Informatics, Vrije Universiteit Brussel, Pleinlaan 2, Brussels, BE-1050, Belgium
| | - Chew Lai Sum
- Alexandra Hospital, 378 Alexandra Road, Singapore
| | - Jason Phua
- Division of Respiratory & Critical Care Medicine, Department of Medicine, National University Hospital, 1E Kent Ridge Road, NUHS Tower Block Level 10, 119228, Singapore
- Alexandra Hospital, 378 Alexandra Road, Singapore
| | - Johan Stiens
- Department of Electronics and Informatics, Vrije Universiteit Brussel, Pleinlaan 2, Brussels, BE-1050, Belgium
| | - Robert Wise
- Adult Intensive Care, John Radcliffe Hospital, Oxford University Hospitals Trust, Oxford, OX3 7LE, UK
- Discipline of Anaesthesia and Critical Care, School of Clinical Medicine, University of KwaZulu-Natal, Durban, 4000, South Africa
- Faculty Medicine and Pharmacy, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Amartya Mukhopadhyay
- Division of Respiratory & Critical Care Medicine, Department of Medicine, National University Hospital, 1E Kent Ridge Road, NUHS Tower Block Level 10, 119228, Singapore
| | - Manu L N G Malbrain
- First Department of Anaesthesiology and Intensive Therapy, Medical University of Lublin, Jaczewskiego street 8, Lublin, 20-954, Poland
- Medical Data Management, Medaman, Geel, 2440, Belgium
- International Fluid Academy, Lovenjoel, 3360, Belgium
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Heinitz S, Müller J, Jenderka KV, Schlögl H, Stumvoll M, Blüher M, Blank V, Karlas T. The application of high-performance ultrasound probes increases anatomic depiction in obese patients. Sci Rep 2023; 13:16297. [PMID: 37770538 PMCID: PMC10539468 DOI: 10.1038/s41598-023-43509-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 09/25/2023] [Indexed: 09/30/2023] Open
Abstract
This study evaluated the impact of obesity on abdominal ultrasound diagnostics and assessed effect of high-performance ultrasound probes increased imaging quality. Lean and obese subjects (n = 40; 58% female) were categorized according to body mass index (BMI, 21 to 48 kg/m2). A highly standardized ultrasound examination of the abdomen was performed by trained examiners using three different probes in randomized order (standard probe versus two high-performance probes). Quality of B-mode and duplex ultrasound were assessed using a custom scoring approach for depiction of liver and kidney anatomy and vascularization. Across probes, imaging quality of hepatic and kidney anatomy was inversely related with BMI (P < 0.03, r < - 0.35). Age, sex, and BMI explained 51% of the variance within the ultrasound quality score, with β = - 0.35, P < 0.0001 for BMI. Compared to the standard probe, high-performance probes allowed for a better depiction of kidney and liver anatomy in subjects above BMI 35 kg/m2 (n = 20, all P < 0.05), resulting in a less pronounced deterioration of imaging quality with increased BMI (all P < 0.05). In conclusion the study shows that obesity impairs ultrasound imaging quality of abdominal anatomy. The application of high-performance probes can increase anatomic depiction in obese patients.Registration number of the German Registry of Clinical Studies: DRKS00023498.
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Affiliation(s)
- Sascha Heinitz
- Clinic for Endocrinology, Nephrology, and Rheumatology, Leipzig University Medical Center, Liebigstrasse 20, 04103, Leipzig, Germany
- Helmholtz Institute for Metabolic, Obesity and Vascular Research, Philipp-Rosenthal-Strasse 27, 04103, Leipzig, Germany
| | - Jürgen Müller
- Department of Diagnostic and Interventional Radiology, Leipzig University Medical Center, Liebigstrasse 20, 04103, Leipzig, Germany
| | - Klaus-Vitold Jenderka
- Department of Physics, Sensor and Ultrasound Technology, University of Applied Sciences Merseburg, Eberhard-Leibnitz-Strasse 2, 06217, Merseburg, Germany
| | - Haiko Schlögl
- Clinic for Endocrinology, Nephrology, and Rheumatology, Leipzig University Medical Center, Liebigstrasse 20, 04103, Leipzig, Germany
- Helmholtz Institute for Metabolic, Obesity and Vascular Research, Philipp-Rosenthal-Strasse 27, 04103, Leipzig, Germany
| | - Michael Stumvoll
- Clinic for Endocrinology, Nephrology, and Rheumatology, Leipzig University Medical Center, Liebigstrasse 20, 04103, Leipzig, Germany
- Helmholtz Institute for Metabolic, Obesity and Vascular Research, Philipp-Rosenthal-Strasse 27, 04103, Leipzig, Germany
| | - Matthias Blüher
- Clinic for Endocrinology, Nephrology, and Rheumatology, Leipzig University Medical Center, Liebigstrasse 20, 04103, Leipzig, Germany
- Helmholtz Institute for Metabolic, Obesity and Vascular Research, Philipp-Rosenthal-Strasse 27, 04103, Leipzig, Germany
| | - Valentin Blank
- Department of Medicine II, Division of Gastroenterology, Leipzig University Medical Center, Liebigstrasse 20, 04103, Leipzig, Germany
- Division of Interdisciplinary Ultrasound, Department of Internal Medicine I, Halle University Medical Center, 06120, Halle (Saale), Germany
| | - Thomas Karlas
- Department of Medicine II, Division of Gastroenterology, Leipzig University Medical Center, Liebigstrasse 20, 04103, Leipzig, Germany.
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48
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Colalillo G, Pletto S, Laudazi M, Asimakopoulos AD. Traumatic testicular dislocation in the abdomen: diagnosis and management. BMJ Case Rep 2023; 16:e254530. [PMID: 37751971 PMCID: PMC10533653 DOI: 10.1136/bcr-2022-254530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2023] Open
Abstract
Testicular dislocation in the abdomen after scrotal trauma is a rare and sometimes unrecognised event.Early detection and timely management reduce possible complications which include the risk of fertility loss, endocrine dysfunction, and future malignancy.We present the case of a man who suffered a traumatic dislocation of the right testis in the abdomen after a motorcycle crash. The large scrotal haematoma did not permit adequate physical examination. Furthermore, during the clinical management of the polytrauma, the main focus was on active arterial bleeding, multiple pelvic fractures and clinical investigation of the integrity of the lower urinary tract. Therefore, the diagnosis and surgical management of the testicular dislocation were delayed.The patient underwent abdominal-inguinal surgical exploration, haematoma evacuation, identification of the right testis and right orchidopexy.After 6 months, the right testis of the patient is of regular volume, consistency and physiologic echogenicity on ultrasound evaluation.Hormonal evaluation and semen analysis were normal after 3 months.
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Affiliation(s)
| | - Simone Pletto
- Facoltà di Medicina e Chirurgia, Università degli Studi di Roma Tor Vergata, Roma, Italy
| | - Mario Laudazi
- Università degli Studi di Roma Tor Vergata, Roma, Italy
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49
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Ren JA. [Surgical rescue strategies and techniques for severe intra-abdominal infection]. Zhonghua Wei Chang Wai Ke Za Zhi 2023; 26:813-817. [PMID: 37709687 DOI: 10.3760/cma.j.cn441530-20230807-00037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 09/16/2023]
Abstract
Severe intra-abdominal infection is complicated with sepsis or septic shock and could also be named as intra-abdominal sepsis. Surgical rescue is an effective intervention for severe intra-abdominal infection, which can be caused by surgery, trauma or acute abdomen. Institutional factors associated with failure of surgical rescue include hospital volume, technology, surgeons and nurses. Patient factors contributing to failure include advanced age, diabetes mellitus and chronic organ dysfunction. The surgical rescue strategy for severe intra-abdominal infection includes damage control surgery and damage control resuscitation. Stepwise escalated procedures based on the severity of the infections should be performed as soon as possible to control the infection source, including removal of catheter in blood vessel, change of intra-abdominal drainage, trochar-assisted percutaneous abscess drainage (TA-PAD), laparotomy and open abdomen therapy. Since most of the pathogenic microorganisms of severe abdominal infections are multi-drug resistant bacteria expressing Klebsiella pneumoniae carbapenemase (KPC), the choice of empirical antibiotics can be guided by rapid identification of the KPC type before the results of antibiotic susceptibility testing are available, namely the antibiotic selection strategy of "enzyme first, then bacteria".
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Affiliation(s)
- J A Ren
- Research Institute of General Surgery, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, China
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50
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Wu XW, Huang JJ, Liu Y, Ren JA. [Interpretation of the Chinese expert consensus on open abdomen therapy (2023 edition)]. Zhonghua Wei Chang Wai Ke Za Zhi 2023; 26:824-826. [PMID: 37709689 DOI: 10.3760/cma.j.cn441530-20230616-00210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 09/16/2023]
Abstract
Open abdomen therapy is an effective method for the treatment of severe intra-abdominal infections, abdominal hypertension and other critical abdominal diseases. Bases on systematic reviews of indications, classification and staging of wounds, principles and approaches of open abdomen therapy, abdominal closure measures, and management of enteroatmospheric fistula, the Chinese expert consensus on open abdomen therapy provides 12 recommendations with evidence and specific explanations. This consensus is the first systematic work in China to elaborate on open abdomen therapy, helping clinicians to standardize this technique and improve the treatment outcomes of critical abdominal diseases. In this review, we make interpretations on key points of this consensus one by one.
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Affiliation(s)
- X W Wu
- Research Institute of General Surgery, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, China
| | - J J Huang
- Research Institute of General Surgery, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, China
| | - Y Liu
- Research Institute of General Surgery, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, China
| | - J A Ren
- Research Institute of General Surgery, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, China
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