Pub Date : 2020-01-01DOI: 10.29011/2575-9760.001296
Samantha Tarras, J. Webber, D. Weaver, D. Edelman
Background: Documentation of operative proficiency is important in surgery training. Our institution developed a smart phone application to provide real time GAGES scores of residents performing flexible endoscopy. Objective: Establish the feasibility of integrating the usage of this innovation application into the workflow of busy, academic clinician educator surgeons. Methods: This is a prospective, pilot study that occurred from February 2017 through August 2017. Four attending surgeons participated. After initial training, no additional reminders were given to the faculty. Data collected were the number of evaluations completed by each faculty member, the date and time of each evaluation, and the actual GAGE score for each resident. Descriptive statistics were used to describe the distribution of evaluations and ratings. Ease of use was evaluated by conducting unstructured interviews. Results: During the study period, four attending surgeons (100%) completed 239 (43% of all available endoscopies [558]) evaluations on 21 residents (100% of residents on service were included). Of the evaluations completed, 163 used the GAGES upper endoscopy form, and 76 used the GAGES lower endoscopy form. Of the 239 evaluations, additional comments were made on 91 (38%) of the evaluations. Conclusion: This study shows the feasibility of using real-time smartphone application to evaluate resident’s skill using GAGES scores. Future steps include opening this smart phone application to all members of the department of surgery and use it throughout the residency. Incorporation of the real time GAGES scores into the 6-month summative evaluation that the Clinical Competency Committee performs would be ideal.
{"title":"Feasibility of Real-Time Measurement of Technical Skills in Flexible Endoscopy using a Smart Phone Application","authors":"Samantha Tarras, J. Webber, D. Weaver, D. Edelman","doi":"10.29011/2575-9760.001296","DOIUrl":"https://doi.org/10.29011/2575-9760.001296","url":null,"abstract":"Background: Documentation of operative proficiency is important in surgery training. Our institution developed a smart phone application to provide real time GAGES scores of residents performing flexible endoscopy. Objective: Establish the feasibility of integrating the usage of this innovation application into the workflow of busy, academic clinician educator surgeons. Methods: This is a prospective, pilot study that occurred from February 2017 through August 2017. Four attending surgeons participated. After initial training, no additional reminders were given to the faculty. Data collected were the number of evaluations completed by each faculty member, the date and time of each evaluation, and the actual GAGE score for each resident. Descriptive statistics were used to describe the distribution of evaluations and ratings. Ease of use was evaluated by conducting unstructured interviews. Results: During the study period, four attending surgeons (100%) completed 239 (43% of all available endoscopies [558]) evaluations on 21 residents (100% of residents on service were included). Of the evaluations completed, 163 used the GAGES upper endoscopy form, and 76 used the GAGES lower endoscopy form. Of the 239 evaluations, additional comments were made on 91 (38%) of the evaluations. Conclusion: This study shows the feasibility of using real-time smartphone application to evaluate resident’s skill using GAGES scores. Future steps include opening this smart phone application to all members of the department of surgery and use it throughout the residency. Incorporation of the real time GAGES scores into the 6-month summative evaluation that the Clinical Competency Committee performs would be ideal.","PeriodicalId":101237,"journal":{"name":"The Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80412117","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Dogjani, K. Haxhirexha, A. Gjata, S. Dogjani, Hysni Bendo
Background; “Acute Appendicitis” is one of the most usual causes of emergency hospital admissions and appendectomy is one of the most common emergency procedures performed in the contemporary medicine. This study aims to identify the Alvarado Score System as a simplified tool for the emergency doctor in the abdominal emergency in general and for the Acute Appendicitis in particular. Materials and methods; The study is of retrospective character and includes 130 cases presented with abdominal Pain in University Hospital Centre” Mother Theresa” Tirana, Albania, in the period 1 April 2019 - 30 May 2019 from which 100 allegedly suspected with “Appendicitis Acute”. Results; Gender distribution has a slight male predominance. The predominant age group was 14-21 years old. The most frequent clinical data has been the tenderness in right iliac fossa. In our study 3% of cases belonged to the group 1-4 Alvarado points, 17% of the cases belonged to the group 5-6 Alvarado points and 80% of the cases belonged to the group 7-10 Alvarado points. Conclusions; In underdeveloped or developing countries where the decision to operate depends on clinical judgment, the Alvarado Score can serve as a precise and consistent tool to exclude Acute Appendicitis. Alvarado Score can also serve the emergency doctor as a tool with predictive value in the abdominal emergency. Key Words: Acute Appendicitis, appendectomy, Alvarado Score
{"title":"Alvarado Score System, how useful is in Emergency Department? Some consideration about it.","authors":"A. Dogjani, K. Haxhirexha, A. Gjata, S. Dogjani, Hysni Bendo","doi":"10.21203/rs.2.19100/v1","DOIUrl":"https://doi.org/10.21203/rs.2.19100/v1","url":null,"abstract":"\u0000 Background; “Acute Appendicitis” is one of the most usual causes of emergency hospital admissions and appendectomy is one of the most common emergency procedures performed in the contemporary medicine. This study aims to identify the Alvarado Score System as a simplified tool for the emergency doctor in the abdominal emergency in general and for the Acute Appendicitis in particular. Materials and methods; The study is of retrospective character and includes 130 cases presented with abdominal Pain in University Hospital Centre” Mother Theresa” Tirana, Albania, in the period 1 April 2019 - 30 May 2019 from which 100 allegedly suspected with “Appendicitis Acute”. Results; Gender distribution has a slight male predominance. The predominant age group was 14-21 years old. The most frequent clinical data has been the tenderness in right iliac fossa. In our study 3% of cases belonged to the group 1-4 Alvarado points, 17% of the cases belonged to the group 5-6 Alvarado points and 80% of the cases belonged to the group 7-10 Alvarado points. Conclusions; In underdeveloped or developing countries where the decision to operate depends on clinical judgment, the Alvarado Score can serve as a precise and consistent tool to exclude Acute Appendicitis. Alvarado Score can also serve the emergency doctor as a tool with predictive value in the abdominal emergency. Key Words: Acute Appendicitis, appendectomy, Alvarado Score","PeriodicalId":101237,"journal":{"name":"The Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85860814","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-01-22DOI: 10.11648/j.js.20180606.16
Adrián Fernando Narvaez Muñoz, J. Herrera, D. Vargas, C. Suárez, Maxwell Ruben Velasco Salazar, C. Arteaga
Introduction: Superior vena cava syndrome (SVCS) is the clinical manifestation of superior vena cava (SVC) obstruction, with a severe reduction in venous backflow to the right atrium. Symptoms classically include neck, facial and upper limb swelling, development of swollen collateral veins on the front of the chest wall, shortness of breath, coughing, headache, stridor and other neurological complaints, which may all be exacerbated by different postures. CASE REPORT: A 31-year-old man, with a sinus venosus atrial septal defect (SVASD) and partial anomalous pulmonary venous return (PAPVC), was undergone to surgery, in the postoperative course showed a superior vena cava syndrome (SVCS). A second surgery to solve this complication was performed nevertheless, some days after this intervention, the patient developed SVCS symptom’s once again. A new strategy with a large stent implantation in the superior vena cava had acceptable results. The patient kept asymptomatic during four months. Discussion: This syndrome is a rare complication after cardiac surgery; it is associated mostly with bicaval cannulation; various causes such as localized hematoma, swollen absorbable hemostat, and narrowing of the SVC by surgical sutures have been reported. There are no exact guidelines for the clinical management of SVCS. The treatments include long-term anticoagulation, thrombolysis, percutaneous transluminal balloon angioplasty, stent implantation, and open surgical reconstruction. CONCLUSION: This article highlights the importance of bear in mind the potential risk of SVCS during cardiac surgery with bicaval cannulation, whereby the proper precautions must be taken into account. Another outstanding fact of this case report shows the value of working with interventional cardiology department as a team to reach successful results in the benefit of the patients.
{"title":"Complicated Evolution of Superior Vena Cava Syndrome Post Cardiac Surgery","authors":"Adrián Fernando Narvaez Muñoz, J. Herrera, D. Vargas, C. Suárez, Maxwell Ruben Velasco Salazar, C. Arteaga","doi":"10.11648/j.js.20180606.16","DOIUrl":"https://doi.org/10.11648/j.js.20180606.16","url":null,"abstract":"Introduction: Superior vena cava syndrome (SVCS) is the clinical manifestation of superior vena cava (SVC) obstruction, with a severe reduction in venous backflow to the right atrium. Symptoms classically include neck, facial and upper limb swelling, development of swollen collateral veins on the front of the chest wall, shortness of breath, coughing, headache, stridor and other neurological complaints, which may all be exacerbated by different postures. CASE REPORT: A 31-year-old man, with a sinus venosus atrial septal defect (SVASD) and partial anomalous pulmonary venous return (PAPVC), was undergone to surgery, in the postoperative course showed a superior vena cava syndrome (SVCS). A second surgery to solve this complication was performed nevertheless, some days after this intervention, the patient developed SVCS symptom’s once again. A new strategy with a large stent implantation in the superior vena cava had acceptable results. The patient kept asymptomatic during four months. Discussion: This syndrome is a rare complication after cardiac surgery; it is associated mostly with bicaval cannulation; various causes such as localized hematoma, swollen absorbable hemostat, and narrowing of the SVC by surgical sutures have been reported. There are no exact guidelines for the clinical management of SVCS. The treatments include long-term anticoagulation, thrombolysis, percutaneous transluminal balloon angioplasty, stent implantation, and open surgical reconstruction. CONCLUSION: This article highlights the importance of bear in mind the potential risk of SVCS during cardiac surgery with bicaval cannulation, whereby the proper precautions must be taken into account. Another outstanding fact of this case report shows the value of working with interventional cardiology department as a team to reach successful results in the benefit of the patients.","PeriodicalId":101237,"journal":{"name":"The Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91236687","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-12-19DOI: 10.11648/J.JS.20180606.13
B. Premkumar, Sayed Mohammed Afsal, Ramamurthee Kannaiyan, S. Pandian, R. Ramachandran
Abdominal cocoon syndrome is also known as sclerosing encapsulating peritonitis, characterized by small bowel encapsulation by a fibro-collagenous membrane or “cocoon”. It is a rare cause of intestinal obstruction and has been reported predominantly in adolescent girls living in tropical/subtropical region. The cause and pathogenesis of the condition have not been elucidated. Prolonged administration of practalol, meconium peritonitis, and tuberculous infection of the female genital tract have been incriminated as possible causes. Timely and accurate imaging and diagnosis is important to avoid morbidity and mortality. Preoperative diagnosis is difficult. It is usually diagnosed during surgery. Simple excision of the membrane and lysis of the adhesions produces optimal results. Breaking of adhesions needs to be done carefully; to prevent damage to serosal surface and perforation. This case report is of a 38yr old lady who presented with sub-acute intestinal obstruction that was secondary to an abdominal cocoon and was managed by Laparoscopic surgery in our hospital.
{"title":"Abdominal Cocoon Syndrome as a cause of Intestinal Obstruction: A Case Report","authors":"B. Premkumar, Sayed Mohammed Afsal, Ramamurthee Kannaiyan, S. Pandian, R. Ramachandran","doi":"10.11648/J.JS.20180606.13","DOIUrl":"https://doi.org/10.11648/J.JS.20180606.13","url":null,"abstract":"Abdominal cocoon syndrome is also known as sclerosing encapsulating peritonitis, characterized by small bowel encapsulation by a fibro-collagenous membrane or “cocoon”. It is a rare cause of intestinal obstruction and has been reported predominantly in adolescent girls living in tropical/subtropical region. The cause and pathogenesis of the condition have not been elucidated. Prolonged administration of practalol, meconium peritonitis, and tuberculous infection of the female genital tract have been incriminated as possible causes. Timely and accurate imaging and diagnosis is important to avoid morbidity and mortality. Preoperative diagnosis is difficult. It is usually diagnosed during surgery. Simple excision of the membrane and lysis of the adhesions produces optimal results. Breaking of adhesions needs to be done carefully; to prevent damage to serosal surface and perforation. This case report is of a 38yr old lady who presented with sub-acute intestinal obstruction that was secondary to an abdominal cocoon and was managed by Laparoscopic surgery in our hospital.","PeriodicalId":101237,"journal":{"name":"The Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83554276","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-12-19DOI: 10.11648/J.JS.20180606.15
H. Abudeeb, A. Ugwu, L. Campbell, A. Mukherjee
Rectal cancer treatment outcome has improved considerably in the TME era often with the use neoadjuvant chemoradiotherapy. However, the risk of local recurrence/distant metastases could be as high as 10%. We have designed a retrospective cohort study to assess risk factors associated with local recurrence/distant metastasis after primary curative rectal resection. Our analysis of the colorectal database in a district general hospital involved review of 131 patients who had a curative resection between 2007 and 2013. 22 patients of the 131 had local recurrence/distant metastases. We reviewed the risk factors as gender, neoadjuvant chemoradiotherapy, type of operation, anastomotic leak, tumour differentiation, EMVI, CRM and Dukes C and performed a quantitative assessment. Looking at risk factors, the presence of EMVI was found to have a statistically significant association with recurrence and distant metastases (p=0.0006) followed by poor differentiation (p= 0.038) and Dukes C (p=0.045) while CRM involvement (p=0.054), Neoadjuvant chemoradiotherapy (p=0.657), type of resection (p=0.740), Anastomotic leak (p=0.761) and gender (p=0.901) shown no obvious statistical association with recurrence or distant metastases A larger multi-centre study may help in validating our observation.
在TME时代，直肠癌的治疗效果有了很大的改善，通常采用新辅助放化疗。然而，局部复发/远处转移的风险可高达10%。我们设计了一项回顾性队列研究来评估原发性治愈性直肠切除术后局部复发/远处转移的相关危险因素。我们对一家地区综合医院的结直肠数据库进行了分析，回顾了2007年至2013年期间进行根治性切除的131例患者。131例中有22例局部复发/远处转移。我们回顾了性别、新辅助放化疗、手术类型、吻合口漏、肿瘤分化、EMVI、CRM和Dukes C等危险因素，并进行了定量评估。观察危险因素，EMVI的存在与复发和远处转移(p=0.0006)具有统计学意义，其次是分化不良(p= 0.038)和Dukes C (p=0.045)，而CRM参与(p=0.054)，新辅助放化疗(p=0.657)，切除类型(p=0.740)，吻合口漏(p=0.761)和性别(p=0.901)与复发或远处转移无明显统计学关联。一项更大规模的多中心研究可能有助于验证我们的观察结果。
{"title":"Quantitative Assessment of Prognosticators for Rectal Cancer’s Local Recurrence and Distant Metastases","authors":"H. Abudeeb, A. Ugwu, L. Campbell, A. Mukherjee","doi":"10.11648/J.JS.20180606.15","DOIUrl":"https://doi.org/10.11648/J.JS.20180606.15","url":null,"abstract":"Rectal cancer treatment outcome has improved considerably in the TME era often with the use neoadjuvant chemoradiotherapy. However, the risk of local recurrence/distant metastases could be as high as 10%. We have designed a retrospective cohort study to assess risk factors associated with local recurrence/distant metastasis after primary curative rectal resection. Our analysis of the colorectal database in a district general hospital involved review of 131 patients who had a curative resection between 2007 and 2013. 22 patients of the 131 had local recurrence/distant metastases. We reviewed the risk factors as gender, neoadjuvant chemoradiotherapy, type of operation, anastomotic leak, tumour differentiation, EMVI, CRM and Dukes C and performed a quantitative assessment. Looking at risk factors, the presence of EMVI was found to have a statistically significant association with recurrence and distant metastases (p=0.0006) followed by poor differentiation (p= 0.038) and Dukes C (p=0.045) while CRM involvement (p=0.054), Neoadjuvant chemoradiotherapy (p=0.657), type of resection (p=0.740), Anastomotic leak (p=0.761) and gender (p=0.901) shown no obvious statistical association with recurrence or distant metastases A larger multi-centre study may help in validating our observation.","PeriodicalId":101237,"journal":{"name":"The Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86181019","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-12-19DOI: 10.11648/j.js.20180606.14
G. Abel, Carnero Martín de Soto Pablo, Fernández de Arróyabe Sáez de Ojer Naiara, Montes Molinero David, A. Francisco, G. David
Background: To present the short-term complications that required revision surgery on total knee arthroplasty (TKAs) performed during the 2012-2013 period. Objective: To study the relation of complication appearance and type with the prosthesis model and surgical team experience. Methods: Study of patients undergoing TKA at our center between January 2012 and June 2013. Surgical teams were stratified according to the experience of the surgeon. Two different implants were utilized for this study. The following postoperative data were collected: indication for review, time of follow-up from the intervention to the indication for review (in months) and the reason for revision. A total of 322 TKAs were performed. The follow-up time from the placement of the first prosthesis was 35.48 ± 10.23 months. A revision was indicated for 60 of the 322 implanted prostheses (18.6%). The most frequent causes were aseptic loosening in 22 cases (37.9%), and anterior pain in 19 cases (32.8%). According to the prosthetic model, 11 revisions belonged to the A model (18.3%), and 49 (81%) to the B model. These results were statistically significant (p <0.001). Odds Ratio 5.78 (95% CI: 2.87-11.62). In teams with no expert in arthroplasty, the percentage of revision for instability was 8.3%; in teams with one expert, it was 4%; and in teams with two experts, it was 0%. Discussion: There is an increase in the number of reviews in knee arthroplasty surgery. The reasons for failure of total knee arthroplasty depend on several factors, including surgical techniques, implants, demographic variants, etc. The experience of the surgeon seems to influence the number of revisions. Patellofemoral kinematics also influences the evolution of total knee arthroplasty. One of the most important factors is the trochlear groove. Although the optimal troclear design has not been established. Conclusions: The prosthetic model seems to influence the survival of total knee arthroplasty. It is preferable that the surgical team always include a surgeon with expertise in knee arthroplasty.
{"title":"Factors Associated with a Short-Term Revision of Total Knee Arthroplasty","authors":"G. Abel, Carnero Martín de Soto Pablo, Fernández de Arróyabe Sáez de Ojer Naiara, Montes Molinero David, A. Francisco, G. David","doi":"10.11648/j.js.20180606.14","DOIUrl":"https://doi.org/10.11648/j.js.20180606.14","url":null,"abstract":"Background: To present the short-term complications that required revision surgery on total knee arthroplasty (TKAs) performed during the 2012-2013 period. Objective: To study the relation of complication appearance and type with the prosthesis model and surgical team experience. Methods: Study of patients undergoing TKA at our center between January 2012 and June 2013. Surgical teams were stratified according to the experience of the surgeon. Two different implants were utilized for this study. The following postoperative data were collected: indication for review, time of follow-up from the intervention to the indication for review (in months) and the reason for revision. A total of 322 TKAs were performed. The follow-up time from the placement of the first prosthesis was 35.48 ± 10.23 months. A revision was indicated for 60 of the 322 implanted prostheses (18.6%). The most frequent causes were aseptic loosening in 22 cases (37.9%), and anterior pain in 19 cases (32.8%). According to the prosthetic model, 11 revisions belonged to the A model (18.3%), and 49 (81%) to the B model. These results were statistically significant (p <0.001). Odds Ratio 5.78 (95% CI: 2.87-11.62). In teams with no expert in arthroplasty, the percentage of revision for instability was 8.3%; in teams with one expert, it was 4%; and in teams with two experts, it was 0%. Discussion: There is an increase in the number of reviews in knee arthroplasty surgery. The reasons for failure of total knee arthroplasty depend on several factors, including surgical techniques, implants, demographic variants, etc. The experience of the surgeon seems to influence the number of revisions. Patellofemoral kinematics also influences the evolution of total knee arthroplasty. One of the most important factors is the trochlear groove. Although the optimal troclear design has not been established. Conclusions: The prosthetic model seems to influence the survival of total knee arthroplasty. It is preferable that the surgical team always include a surgeon with expertise in knee arthroplasty.","PeriodicalId":101237,"journal":{"name":"The Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78605328","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-12-19DOI: 10.11648/J.JS.20180606.12
N. Wanjala, Ogallo John Paul, Ochieng Raduma Sephania
Burns contributes to significant mortality. Among reasons for high mortality is inadequate burn wound management especially in patients with extensive burns and limited donor sites. Majority of the resource constrained countries donot have allografts or tissue cultures that would enable prompt and easy cover ages of such wounds. Skin graft Harvesting techiques such as the Meek micrografts are considered expensive and are thus not available. Patients with extensive burn wounds in many resource constrained countries as a result of this do have poor outcomes with high mortality and prolonged hospital stay. This was a prospective study on patients with extensive burns operated on with theMeek micro-grafting technique in a tertiary teaching Hospital in Kenya. Variables analysed included, total burn surface area, sessions of skin grafts, length of Hospital stay, donor site morbidity and mortality. Twenty five patients with extensive burn wounds were managed with the micro grafting technique over the last three years. The mean total burn surface area for the patients was 46.7 percent with the range of 24 to 72 percent. Five patients died while undergoing treatment giving a mortality rate of 20 percent compared to a mortality rate of 35 percent reported in our centre for patients with the similar burn surface area operated on with the mesh technique. The mean length of Hospital stay was 73.92 days compared to a Hospital stay length of 97.4 days previously reported prior to this technique. The mean donor size surface area was 15.8%. The average length of time the donorsite wounds healed was 16.7 days. Three patients had wound sepsis at the donor site that healed after dressing with silver based dressing materials. Meek micro grafting technique allows for extensive coverage of burn wounds with a relatively small donorsite. The technique is associated with reduced donor site morbidity, mortality and length of Hospital stay. This technique should be encouraged in many burn centers in developing countries where there are patients with extensive burn wounds.
{"title":"Meek Micro-grafting Technique in Reduction of Mortality and Hospital Stay in Patients With Extensive Burns in a Resource Constrained Setting","authors":"N. Wanjala, Ogallo John Paul, Ochieng Raduma Sephania","doi":"10.11648/J.JS.20180606.12","DOIUrl":"https://doi.org/10.11648/J.JS.20180606.12","url":null,"abstract":"Burns contributes to significant mortality. Among reasons for high mortality is inadequate burn wound management especially in patients with extensive burns and limited donor sites. Majority of the resource constrained countries donot have allografts or tissue cultures that would enable prompt and easy cover ages of such wounds. Skin graft Harvesting techiques such as the Meek micrografts are considered expensive and are thus not available. Patients with extensive burn wounds in many resource constrained countries as a result of this do have poor outcomes with high mortality and prolonged hospital stay. This was a prospective study on patients with extensive burns operated on with theMeek micro-grafting technique in a tertiary teaching Hospital in Kenya. Variables analysed included, total burn surface area, sessions of skin grafts, length of Hospital stay, donor site morbidity and mortality. Twenty five patients with extensive burn wounds were managed with the micro grafting technique over the last three years. The mean total burn surface area for the patients was 46.7 percent with the range of 24 to 72 percent. Five patients died while undergoing treatment giving a mortality rate of 20 percent compared to a mortality rate of 35 percent reported in our centre for patients with the similar burn surface area operated on with the mesh technique. The mean length of Hospital stay was 73.92 days compared to a Hospital stay length of 97.4 days previously reported prior to this technique. The mean donor size surface area was 15.8%. The average length of time the donorsite wounds healed was 16.7 days. Three patients had wound sepsis at the donor site that healed after dressing with silver based dressing materials. Meek micro grafting technique allows for extensive coverage of burn wounds with a relatively small donorsite. The technique is associated with reduced donor site morbidity, mortality and length of Hospital stay. This technique should be encouraged in many burn centers in developing countries where there are patients with extensive burn wounds.","PeriodicalId":101237,"journal":{"name":"The Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84141541","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-11-07DOI: 10.11648/J.JS.20180606.11
K. Vertesich, T. Mayrhofer, R. Windhager, K. Kühn
Prosthetic joint infection represents a major issue in arthroplasty. Local anti-infective treatment is not established in cementless prosthetic surgery. The aim of this study was to perform simulate a perioperative application of agent-fatty acid complexes on surfaces of primary and revision prosthetic material. Further, it was aimed to investigate the efficacy of these coatings by in vitro microbiological tests. Coating of cemetless titanium prostheses with gentamicin-palmitate and octenidine-laurate was performed by using a spray gun system. Coating with vancomycin eluted in trilaurin was performed by dipping of the prostheses in the solution. The prostheses were incubated in phosphate buffered saline for 7 days. Microbiological testing was performed with inhibition areolae testing for S. aureus, S. epidermidis, MRSA and C. albicans. Coating of prosthetic material was reliable and reproducible with two different techniques, dipping and spraying. The surface-concentrations of agents have reached 195μg/cm2 for gentamicin, 460μg/cm2 for octenidine and 323μg/cm2 for vancomycin. Agents inhibited S. epidermidis and S. aureus growth for seven days, C. albicans for three days and MRSA for two days. Agent-fatty acid coatings used in this study represent a biodegradable layer with good biocompatibility and comparable anti-infective efficacy as in cemented surgery due to the use of established agents, even if low concentrations are used. Modular and individual anti-infective coating was reproducibly and reliably performed by dipping coating, which may represent a potential perioperative coating approach.
{"title":"Accessible Agent-Fatty Acid Coatings of Titanium Prostheses for Local Prevention and Treatment of Anti-Microbial Infections","authors":"K. Vertesich, T. Mayrhofer, R. Windhager, K. Kühn","doi":"10.11648/J.JS.20180606.11","DOIUrl":"https://doi.org/10.11648/J.JS.20180606.11","url":null,"abstract":"Prosthetic joint infection represents a major issue in arthroplasty. Local anti-infective treatment is not established in cementless prosthetic surgery. The aim of this study was to perform simulate a perioperative application of agent-fatty acid complexes on surfaces of primary and revision prosthetic material. Further, it was aimed to investigate the efficacy of these coatings by in vitro microbiological tests. Coating of cemetless titanium prostheses with gentamicin-palmitate and octenidine-laurate was performed by using a spray gun system. Coating with vancomycin eluted in trilaurin was performed by dipping of the prostheses in the solution. The prostheses were incubated in phosphate buffered saline for 7 days. Microbiological testing was performed with inhibition areolae testing for S. aureus, S. epidermidis, MRSA and C. albicans. Coating of prosthetic material was reliable and reproducible with two different techniques, dipping and spraying. The surface-concentrations of agents have reached 195μg/cm2 for gentamicin, 460μg/cm2 for octenidine and 323μg/cm2 for vancomycin. Agents inhibited S. epidermidis and S. aureus growth for seven days, C. albicans for three days and MRSA for two days. Agent-fatty acid coatings used in this study represent a biodegradable layer with good biocompatibility and comparable anti-infective efficacy as in cemented surgery due to the use of established agents, even if low concentrations are used. Modular and individual anti-infective coating was reproducibly and reliably performed by dipping coating, which may represent a potential perioperative coating approach.","PeriodicalId":101237,"journal":{"name":"The Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73703314","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-10-30DOI: 10.11648/j.js.20180605.16
B. Kumar, S. Ghose, Gaurav Pandey, M. Ghosh
In a surgical setting there is always a possibility of cross infection between patient and surgeon and surgical gloves act as an important barrier to prevent this infection. Use of double gloves provides more effective barrier for transfer of pathogens from surgical team to patient and vice versa. This study compares the benefit of using double gloves versus single gloves in various departments and its role in preventing Surgical Site Infection (SSI). This study was conducted at Army Hospital (R&R) where surgical gloves used by the operating surgeon were checked for any perforation in outer and inner gloves. In case of perforation was detected, culture of both gloves and surgical part were taken and examined for any cross infection. This study reveals that simultaneous perforation rate of both outer and inner gloves was very less and hence chances of cross infection between patient and surgeon was less when compared to single glove use. Also, the rate of perforation was less in laparoscopic surgery compared to open surgery however this is controversial as various studies which shows more perforation in laparoscopic surgery. The departments where surgeries were complex and were of longer duration had more perforation rate of gloves and consequently SSI. This study concludes that the use of double surgical gloves has got low chances of cross infection between patient and surgeon and hence low rate of Surgical Site Infection and hence should be encouraged.
{"title":"Study the Incidence of Surgical Glove Perforation during Surgery and Evaluation for the Risk of Perforation and Risk of Surgical Site Infection","authors":"B. Kumar, S. Ghose, Gaurav Pandey, M. Ghosh","doi":"10.11648/j.js.20180605.16","DOIUrl":"https://doi.org/10.11648/j.js.20180605.16","url":null,"abstract":"In a surgical setting there is always a possibility of cross infection between patient and surgeon and surgical gloves act as an important barrier to prevent this infection. Use of double gloves provides more effective barrier for transfer of pathogens from surgical team to patient and vice versa. This study compares the benefit of using double gloves versus single gloves in various departments and its role in preventing Surgical Site Infection (SSI). This study was conducted at Army Hospital (R&R) where surgical gloves used by the operating surgeon were checked for any perforation in outer and inner gloves. In case of perforation was detected, culture of both gloves and surgical part were taken and examined for any cross infection. This study reveals that simultaneous perforation rate of both outer and inner gloves was very less and hence chances of cross infection between patient and surgeon was less when compared to single glove use. Also, the rate of perforation was less in laparoscopic surgery compared to open surgery however this is controversial as various studies which shows more perforation in laparoscopic surgery. The departments where surgeries were complex and were of longer duration had more perforation rate of gloves and consequently SSI. This study concludes that the use of double surgical gloves has got low chances of cross infection between patient and surgeon and hence low rate of Surgical Site Infection and hence should be encouraged.","PeriodicalId":101237,"journal":{"name":"The Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80511615","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-09-19DOI: 10.11648/j.js.20180605.13
B. Kumar, S. Ghose, V. Sharma, M. Ghosh
Laparoscopic Cholecystectomy has become the standard of care for Gall Stone Disease. There are numerous studies and scoring system which considers the pre-operative factors for conversion to open cholecystectomy but there was no scoring system which considers intra operative findings. The objective of this study was to outline the scoring system based on intra operative findings to predict the conversion of laparoscopic cholecystectomy to open cholecystectomy. This prospective study was carried out on 158 patients who underwent cholecystectomy. Surgery in all patients were started with laparoscopic cholecystectomy and based on multiple factors the surgery was completed as open or laparoscopic cholecystectomy. Based on the intra operative findings the patients were divided into easy, moderate, very difficult and extreme. The patients with severe and extreme scoring had highest number of conversions to open cholecystectomy and those patients who had total score of less than 5 had negligible conversion to open cholecystectomy. This paper reports the scoring system which considers the intra operative findings during laparoscopic cholecystectomy. Based on this scoring system it can be predicted weather conversion to open cholecystectomy is required or not.
{"title":"Grading System Based on Intra Operative Findings at Laparoscopic Cholecystectomy","authors":"B. Kumar, S. Ghose, V. Sharma, M. Ghosh","doi":"10.11648/j.js.20180605.13","DOIUrl":"https://doi.org/10.11648/j.js.20180605.13","url":null,"abstract":"Laparoscopic Cholecystectomy has become the standard of care for Gall Stone Disease. There are numerous studies and scoring system which considers the pre-operative factors for conversion to open cholecystectomy but there was no scoring system which considers intra operative findings. The objective of this study was to outline the scoring system based on intra operative findings to predict the conversion of laparoscopic cholecystectomy to open cholecystectomy. This prospective study was carried out on 158 patients who underwent cholecystectomy. Surgery in all patients were started with laparoscopic cholecystectomy and based on multiple factors the surgery was completed as open or laparoscopic cholecystectomy. Based on the intra operative findings the patients were divided into easy, moderate, very difficult and extreme. The patients with severe and extreme scoring had highest number of conversions to open cholecystectomy and those patients who had total score of less than 5 had negligible conversion to open cholecystectomy. This paper reports the scoring system which considers the intra operative findings during laparoscopic cholecystectomy. Based on this scoring system it can be predicted weather conversion to open cholecystectomy is required or not.","PeriodicalId":101237,"journal":{"name":"The Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89334088","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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