Pub Date : 2020-05-19DOI: 10.11648/J.JS.20200803.11
T. Symonds, H. Brien, B. Parkinson, A. Grant, K. Doma
Prosthetic joint infections are responsible for a high morbidity and economic cost in patients undergoing total joint arthroplasty. Staphylococcus aureus (S Aureus) is a key modifiable risk factor in the reduction of surgical site infections (SSI). Evidence suggests that decolonization of S aureus carriers reduces the risk of SSI. Octenidine is an antiseptic active against gram-positive and gram-negative bacteria. The aim of this study is to establish the eradication rate of S aureus in patients undergoing total joint arthroplasty using an Octenidine decolonisation protocol prior to surgery. This was a prospective case series performed at the Cairns Private Hospital during a five month trial period of using Octenidine wash and nasal gel in patients undergoing elective TJA. Patients undergoing total joint arthroplasty during a five-month trial period had pre-operative nasal swabs to screen for S aureus pre and post Octenidine treatment. All patients underwent a body wash and nasal gel protocol for five days using Octenidine. The primary outcome was to determine decolonisation rates in patients following the protocol. A total of 183 patients met inclusion criteria into this study. At the first swab 151 (82.5%) patients had normal regional flora and 32 (17.5%) were positive for S aureus. Of these 32 patients 30 (93.75%) were negative for MRSA and 2 (6.25%) had non-multiresistant MRSA. The decolonization rate for patients with S aureus was 76.6%. It was unsuccessful in clearing the two patients with nmMRSA. Octenidine is effective in reducing S aureus colonisation in patients undergoing total joint arthroplasty. Further studies are required to compare this agent to traditional mupirocin based protocols to determine its efficacy as an alternative for use in pre-operative staphylococcal decolonisation.
{"title":"The Efficacy of an Octenidine Decolonisation Protocol in Reducing Staphylococcus Aureus Carriage in Patients Undergoing Total Joint Arthroplasty","authors":"T. Symonds, H. Brien, B. Parkinson, A. Grant, K. Doma","doi":"10.11648/J.JS.20200803.11","DOIUrl":"https://doi.org/10.11648/J.JS.20200803.11","url":null,"abstract":"Prosthetic joint infections are responsible for a high morbidity and economic cost in patients undergoing total joint arthroplasty. Staphylococcus aureus (S Aureus) is a key modifiable risk factor in the reduction of surgical site infections (SSI). Evidence suggests that decolonization of S aureus carriers reduces the risk of SSI. Octenidine is an antiseptic active against gram-positive and gram-negative bacteria. The aim of this study is to establish the eradication rate of S aureus in patients undergoing total joint arthroplasty using an Octenidine decolonisation protocol prior to surgery. This was a prospective case series performed at the Cairns Private Hospital during a five month trial period of using Octenidine wash and nasal gel in patients undergoing elective TJA. Patients undergoing total joint arthroplasty during a five-month trial period had pre-operative nasal swabs to screen for S aureus pre and post Octenidine treatment. All patients underwent a body wash and nasal gel protocol for five days using Octenidine. The primary outcome was to determine decolonisation rates in patients following the protocol. A total of 183 patients met inclusion criteria into this study. At the first swab 151 (82.5%) patients had normal regional flora and 32 (17.5%) were positive for S aureus. Of these 32 patients 30 (93.75%) were negative for MRSA and 2 (6.25%) had non-multiresistant MRSA. The decolonization rate for patients with S aureus was 76.6%. It was unsuccessful in clearing the two patients with nmMRSA. Octenidine is effective in reducing S aureus colonisation in patients undergoing total joint arthroplasty. Further studies are required to compare this agent to traditional mupirocin based protocols to determine its efficacy as an alternative for use in pre-operative staphylococcal decolonisation.","PeriodicalId":101237,"journal":{"name":"The Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84992217","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 : 2020-04-30DOI: 10.11648/J.JS.20200802.17
L. Qian, Guo Xiaoxia
Objective: We aim to explore the effect of a seamless device for instillation on bladder instillation of drug after transurethral resection of bladder tumor. Methods: There were 24 patients undergoing transurethral resection of bladder tumor in the department of urinary surgery from January 2019 to December 2019, and 150 person-times of bladder instillation of drug in follow-up. We adopted random number table to averagely divide the 150 person-times into experimental group, control group A and control group B. In the experimental group, before bladder instillation of drug, a 50ml injector was used for dissolution and suction of drug. During instillation of drug, we used heparin cap to connect the injector and catheter to make a seamless device for instillation. In the control group A, before instillation, a 50ml injector was also used for dissolution and suction of drug, but at the same time, the syringe nozzle was inserted into the horn-shaped catheter orifice to inject the drug. In the control group B, we used a 50 ml injector for dissolution and suction of drug before instillation and then injected to drug into an aseptic bowel. After that, we used a 50 ml medical irrigator to draw in the liquid in the bowl and inserted the irrigator nozzle into the horn-shaped catheter orifice to inject the liquid. We compared operator’s satisfaction during instillation, drug leakage and time consumption between the three groups. Results: Operator’s satisfaction in the experimental group, control group A and control group B was 100%, 12% and 84% respectively and there was a significant difference in that between the three groups (χ2=57.576, P=0.000). In terms of drug leakage, there was no leakage in the experimental group, and an average of 11.44±2.13 ml of leakage in the control group A and an average of 0.77±1.14 ml of leakage in the control group B. The one-way analysis of variance showed that there was a significant difference in that (F=1041.089, P=0.000). At last, the time consumption in the experimental group was 9.28±1.21min, and the control group A took the longest time 11.58±1.81 min. The one-way analysis of variance showed that there was a significant difference in time consumption between the three groups (F=32.947, P=0.000). Conclusions: the self-designed seamless device for instillation in the bladder instillation of drug for patients who underwent transurethral resection of bladder tumor can not only ensure the dosage of drug, avoid iatrogenic exposure but also reduce time consumption and improve medical staff’s satisfaction. Hence, the seamless device is worth clinical application.
{"title":"Effect of a Seamless Device for Instillation on Bladder Instillation of Drug After Transurethral Resection of Bladder Tumor","authors":"L. Qian, Guo Xiaoxia","doi":"10.11648/J.JS.20200802.17","DOIUrl":"https://doi.org/10.11648/J.JS.20200802.17","url":null,"abstract":"Objective: We aim to explore the effect of a seamless device for instillation on bladder instillation of drug after transurethral resection of bladder tumor. Methods: There were 24 patients undergoing transurethral resection of bladder tumor in the department of urinary surgery from January 2019 to December 2019, and 150 person-times of bladder instillation of drug in follow-up. We adopted random number table to averagely divide the 150 person-times into experimental group, control group A and control group B. In the experimental group, before bladder instillation of drug, a 50ml injector was used for dissolution and suction of drug. During instillation of drug, we used heparin cap to connect the injector and catheter to make a seamless device for instillation. In the control group A, before instillation, a 50ml injector was also used for dissolution and suction of drug, but at the same time, the syringe nozzle was inserted into the horn-shaped catheter orifice to inject the drug. In the control group B, we used a 50 ml injector for dissolution and suction of drug before instillation and then injected to drug into an aseptic bowel. After that, we used a 50 ml medical irrigator to draw in the liquid in the bowl and inserted the irrigator nozzle into the horn-shaped catheter orifice to inject the liquid. We compared operator’s satisfaction during instillation, drug leakage and time consumption between the three groups. Results: Operator’s satisfaction in the experimental group, control group A and control group B was 100%, 12% and 84% respectively and there was a significant difference in that between the three groups (χ2=57.576, P=0.000). In terms of drug leakage, there was no leakage in the experimental group, and an average of 11.44±2.13 ml of leakage in the control group A and an average of 0.77±1.14 ml of leakage in the control group B. The one-way analysis of variance showed that there was a significant difference in that (F=1041.089, P=0.000). At last, the time consumption in the experimental group was 9.28±1.21min, and the control group A took the longest time 11.58±1.81 min. The one-way analysis of variance showed that there was a significant difference in time consumption between the three groups (F=32.947, P=0.000). Conclusions: the self-designed seamless device for instillation in the bladder instillation of drug for patients who underwent transurethral resection of bladder tumor can not only ensure the dosage of drug, avoid iatrogenic exposure but also reduce time consumption and improve medical staff’s satisfaction. Hence, the seamless device is worth clinical application.","PeriodicalId":101237,"journal":{"name":"The Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80420201","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 : 2020-04-17DOI: 10.11648/J.JS.20200802.16
Walid A. Abdelsalam, M. F. Abohashim, Doaa Mandour, T. Baiomy, Ibrahim A. Heggy
Background: Premenopausal females having early-stage EC have a favorable prognosis. The guidelines of surgical treatment of EC have not been modified and it consists of total hysterectomy, bilateral salpingo-oophrectomy, pelvic and para-aortic lymphadenectomy, regardless of patients’ age or EC stage. The drawbacks of performing bilateral BSO are induction of surgical premature menopause which subsequently disturbs physical and psychosexual life in addition to increasing risk of diseases of the cardiovascular system and bone fractures. The aim of our study was to demonstrate if performing BSO in premenopausal females patients with early stage EC had survival benefits and improving long-term outcomes or not. Patients and methods; we included sixty EC patients and we have performed ovarian conservation in 30 (50%) of them, and performed BSO in the remaining 30 patients we have followed our patients for 5 years from December 2014 to December 2019. Results: Age of patients with ovarian conservation was younger than patients with BSO (p=0.032), have smaller tumor size (p=0.02), higher degree of tumor differentiation (p=0.025), less incidence of myomertrial invasion (p=0.004), less liability of lymphovascular invasion (p=0.001), more liability to endometrioid histopathological subtype (p=0.003), and earlier stage (p=0.009) than patients with BSO. There were no significant differences between both studied groups regarding recurrence of the tumor, recurrence free survival and overall survival rates. Conclusion: The current study tried to highlight the benefits of a more conservative approach by ovarian preservation in surgical management and staging of EC patients diagnosed in the early stage in young premenopausal women.
{"title":"Ovarian Conservation in Patients with Early Stage Endometrial Carcinoma (EC) as a Safe Alternative to Oophorectomy","authors":"Walid A. Abdelsalam, M. F. Abohashim, Doaa Mandour, T. Baiomy, Ibrahim A. Heggy","doi":"10.11648/J.JS.20200802.16","DOIUrl":"https://doi.org/10.11648/J.JS.20200802.16","url":null,"abstract":"Background: Premenopausal females having early-stage EC have a favorable prognosis. The guidelines of surgical treatment of EC have not been modified and it consists of total hysterectomy, bilateral salpingo-oophrectomy, pelvic and para-aortic lymphadenectomy, regardless of patients’ age or EC stage. The drawbacks of performing bilateral BSO are induction of surgical premature menopause which subsequently disturbs physical and psychosexual life in addition to increasing risk of diseases of the cardiovascular system and bone fractures. The aim of our study was to demonstrate if performing BSO in premenopausal females patients with early stage EC had survival benefits and improving long-term outcomes or not. Patients and methods; we included sixty EC patients and we have performed ovarian conservation in 30 (50%) of them, and performed BSO in the remaining 30 patients we have followed our patients for 5 years from December 2014 to December 2019. Results: Age of patients with ovarian conservation was younger than patients with BSO (p=0.032), have smaller tumor size (p=0.02), higher degree of tumor differentiation (p=0.025), less incidence of myomertrial invasion (p=0.004), less liability of lymphovascular invasion (p=0.001), more liability to endometrioid histopathological subtype (p=0.003), and earlier stage (p=0.009) than patients with BSO. There were no significant differences between both studied groups regarding recurrence of the tumor, recurrence free survival and overall survival rates. Conclusion: The current study tried to highlight the benefits of a more conservative approach by ovarian preservation in surgical management and staging of EC patients diagnosed in the early stage in young premenopausal women.","PeriodicalId":101237,"journal":{"name":"The Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88558314","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 : 2020-04-14DOI: 10.11648/J.JS.20200802.15
Olivia Makenzie Boyette, B. Casey, Stephanie Tom, Todd N Tom
Intussusception is defined as the telescoping of an intestinal region into an adjacent region of intestine. We present an interesting case of a retrograde intussusception due to an underlying Burkitt lymphoma. Case Presentation: We have a 41-year-old Caucasian male who presented to the Emergency Department (ED) with complaints of left sided periumbilical abdominal pain that began several months prior. Computed tomography (CT) scan of the abdomen and pelvis with oral and IV contrast showed a colonic mass in the region of the ileocecal valve. Patient denied any fever, vomiting, melena, or hematochezia. He was scheduled for a colonoscopy with surgical services. Upon colonoscopy, intussusception in the region of the ileocecal valve was discovered and cecectomy was scheduled for the same day. Intussusception was removed via hand assisted laparoscopic cecectomy with functional end-to-end anastomoses. Gross dissection of the specimen post cecectomy revealed a 5cm by 5cm mass as the lead point for intussusception (Figures 4, 5). The mass was sent for pathology which revealed Burkitt lymphoma. Conclusion: Intussusception is a rare cause of abdominal pain in adults but should be considered because it may be an indicator of underlying malignancy. Unlike intussusception in the pediatric patient, which can be managed non-operatively, treatment in adults is usually surgery.
{"title":"Intussusception Induced by Burkitt Lymphoma in an Adult Patient","authors":"Olivia Makenzie Boyette, B. Casey, Stephanie Tom, Todd N Tom","doi":"10.11648/J.JS.20200802.15","DOIUrl":"https://doi.org/10.11648/J.JS.20200802.15","url":null,"abstract":"Intussusception is defined as the telescoping of an intestinal region into an adjacent region of intestine. We present an interesting case of a retrograde intussusception due to an underlying Burkitt lymphoma. Case Presentation: We have a 41-year-old Caucasian male who presented to the Emergency Department (ED) with complaints of left sided periumbilical abdominal pain that began several months prior. Computed tomography (CT) scan of the abdomen and pelvis with oral and IV contrast showed a colonic mass in the region of the ileocecal valve. Patient denied any fever, vomiting, melena, or hematochezia. He was scheduled for a colonoscopy with surgical services. Upon colonoscopy, intussusception in the region of the ileocecal valve was discovered and cecectomy was scheduled for the same day. Intussusception was removed via hand assisted laparoscopic cecectomy with functional end-to-end anastomoses. Gross dissection of the specimen post cecectomy revealed a 5cm by 5cm mass as the lead point for intussusception (Figures 4, 5). The mass was sent for pathology which revealed Burkitt lymphoma. Conclusion: Intussusception is a rare cause of abdominal pain in adults but should be considered because it may be an indicator of underlying malignancy. Unlike intussusception in the pediatric patient, which can be managed non-operatively, treatment in adults is usually surgery.","PeriodicalId":101237,"journal":{"name":"The Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84533339","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 : 2020-04-01DOI: 10.11648/J.JS.20200802.14
P. Dumlao, Lyndon Bathan, Patrick M. Dizon
Background: Anterior cruciate ligament (ACL) reconstruction is one of the most frequent procedures done by orthopedic surgeons. Successful reconstruction is founded on fast healing and incorporation of tendon graft which translates to earlier and aggressive rehabilitation and faster return to dynamic activities. Recent studies highlighted the importance of biologic strategies in the enhancement of the recuperation process of autologous grafts for reconstruction. Current literature theorized the concept of maintaining the hamstring graft (HG) insertion but was unable to explicitly conclude an advantage of maintaining the attachment of the hamstring graft. Method: A prospective, double-blinded, randomized controlled study was done comparing graft integration through MRI (Figueroa) scoring system, and clinical outcomes through IKDC scores between the detached HG (control group) versus preserved tibial attachment of HG (test group) both augmented with interference screw fixation for ACL reconstruction. Results and Conclusion: A total of 32 patients were enrolled, 18 for the control group, 14 for the test group. Preoperative IKDC scores were similar for both groups. Post-operatively, a significant earlier peak at 3 months and continued improvement at 6 months is in favor of the test group. Consistently, there is also a 2.78-fold increased likelihood of graft healing and its constituent graft integration and ligamentization in the test group. This suggests that preservation of the neurovascular attachment of the HG is a contributory factor for efficient ligamentization and subsequent pain control, activities of daily living and functional capacity.
{"title":"Preserved Tibial Attachment of Hamstring Graft Versus Detached Graft in Anterior Cruciate Ligament Reconstruction: A Randomized Controlled Study","authors":"P. Dumlao, Lyndon Bathan, Patrick M. Dizon","doi":"10.11648/J.JS.20200802.14","DOIUrl":"https://doi.org/10.11648/J.JS.20200802.14","url":null,"abstract":"Background: Anterior cruciate ligament (ACL) reconstruction is one of the most frequent procedures done by orthopedic surgeons. Successful reconstruction is founded on fast healing and incorporation of tendon graft which translates to earlier and aggressive rehabilitation and faster return to dynamic activities. Recent studies highlighted the importance of biologic strategies in the enhancement of the recuperation process of autologous grafts for reconstruction. Current literature theorized the concept of maintaining the hamstring graft (HG) insertion but was unable to explicitly conclude an advantage of maintaining the attachment of the hamstring graft. Method: A prospective, double-blinded, randomized controlled study was done comparing graft integration through MRI (Figueroa) scoring system, and clinical outcomes through IKDC scores between the detached HG (control group) versus preserved tibial attachment of HG (test group) both augmented with interference screw fixation for ACL reconstruction. Results and Conclusion: A total of 32 patients were enrolled, 18 for the control group, 14 for the test group. Preoperative IKDC scores were similar for both groups. Post-operatively, a significant earlier peak at 3 months and continued improvement at 6 months is in favor of the test group. Consistently, there is also a 2.78-fold increased likelihood of graft healing and its constituent graft integration and ligamentization in the test group. This suggests that preservation of the neurovascular attachment of the HG is a contributory factor for efficient ligamentization and subsequent pain control, activities of daily living and functional capacity.","PeriodicalId":101237,"journal":{"name":"The Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80940982","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 : 2020-03-18DOI: 10.11648/J.JS.20200802.13
Liu Rui Jia, Meng Qing Qi, L. Ming
Background: The incidence of proximal humeral fracture is increasing gradually. Many patients choose open reduction and internal fixation. With the maturity of surgical technology and thought, people begin to think about the optimization of surgical effect from the surgical incision, including less trauma, less bleeding, less postoperative complications and fast postoperative recovery. However, due to the complexity of shoulder anatomy, scholars have created different surgical approaches from different perspectives. Objective: Although the effect of open reduction and internal fixation is confirmed, there are still some differences in the effect of different surgical approaches. We need to study the summary and research progress of surgical approach for proximal humeral fracture, which is conducive to the selection of the optimal approach for incision, so as to improve the prognosis. Method: Selective literature review. Result: At present, common surgical approaches include lateral approach, anteromedial approach, anterolateral approach, small incision approach and other approaches. This paper describes and compares the advantages and disadvantages of each approach, so as to choose the best approach for different fracture types. Conclusion: Based on the complexity of the anatomical relationship of the shoulder joint, the displacement, classification of the fracture, the proximal humerus are opened and exposed from different perspectives. Choosing a safe surgical approach is one of the key links of the whole operation and plays an important role in the postoperative effect. In this paper, the common approaches and new approaches of open reduction and internal fixation for proximal humeral fracture are reviewed, which provides new ideas for the design of surgical scheme.
{"title":"Surgical Approach of Open Reduction and Internal Fixation for Proximal Humeral Fracture in the Elderly","authors":"Liu Rui Jia, Meng Qing Qi, L. Ming","doi":"10.11648/J.JS.20200802.13","DOIUrl":"https://doi.org/10.11648/J.JS.20200802.13","url":null,"abstract":"Background: The incidence of proximal humeral fracture is increasing gradually. Many patients choose open reduction and internal fixation. With the maturity of surgical technology and thought, people begin to think about the optimization of surgical effect from the surgical incision, including less trauma, less bleeding, less postoperative complications and fast postoperative recovery. However, due to the complexity of shoulder anatomy, scholars have created different surgical approaches from different perspectives. Objective: Although the effect of open reduction and internal fixation is confirmed, there are still some differences in the effect of different surgical approaches. We need to study the summary and research progress of surgical approach for proximal humeral fracture, which is conducive to the selection of the optimal approach for incision, so as to improve the prognosis. Method: Selective literature review. Result: At present, common surgical approaches include lateral approach, anteromedial approach, anterolateral approach, small incision approach and other approaches. This paper describes and compares the advantages and disadvantages of each approach, so as to choose the best approach for different fracture types. Conclusion: Based on the complexity of the anatomical relationship of the shoulder joint, the displacement, classification of the fracture, the proximal humerus are opened and exposed from different perspectives. Choosing a safe surgical approach is one of the key links of the whole operation and plays an important role in the postoperative effect. In this paper, the common approaches and new approaches of open reduction and internal fixation for proximal humeral fracture are reviewed, which provides new ideas for the design of surgical scheme.","PeriodicalId":101237,"journal":{"name":"The Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89173683","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 : 2020-03-11DOI: 10.11648/J.JS.20200802.12
T. Eberlein, S. Siam
Objective: The purpose of this clinical study was to assess a novel wound model and to compare the wound healing properties of a topical wound healing hydroactive lipogel (MediGel®) promoting moist wound environment versus standard treatment by a standard plaster und dry environmental conditions in patients undergoing catheter de-placement as a model for non-acute wounds affecting all skin layers in real life conditions (moist environment does improve granulation & epithelialization supported by Lipogel – the MEDIGEL trial). Methods: Patients (n=69) admitted to the dialysis ward of a tertiary care institution with acute or chronic renal insufficiency and in need for dialysis were enrolled into a prospective, observer-blind, randomized, controlled, inter-individual experimental comparison study. Patients enrolled were undergoing placement of Sheldon multi-lumen catheter (11 French diameter) in the external jugular vein at the neck by Seldinger technique to enable access for hemodialysis. One group of patients which had catheter displaced after one session of hemodialysis was regarded as acute wound group. A different group of patients had catheter withdrawn after 14 (+/- 2 days) and was classified as non-acute wound group. Topical treatments were randomly allocated, i.e. traditional care with standard plaster (control group) or investigational product (promoting moist environment) beneath a standard plaster (investigational product). Wound healing was assessed (digital photography, visual scoring) and analyzed via comparison of area under curve at day 0, 3 and 7 after displacement of catheter. Results: Evaluation showed significantly faster wound healing results for the investigational product in comparison to standard (all time points) and with significant AUC difference in both patient groups, acute and non-acute. Visible re-epithelialization was recorded from day 3 to day 7 in acute wounds, delayed in non-acute wounds. Standard plaster-treated wounds remained open and had markedly larger wound area. Formation of fibrous scar tissue was minimal but less prominent in patients treated with the hydroactive lipogel in the non-acute group due to faster epithelialization promoted by moist environment. Conclusion: Clinically relevant accelerated epithelialization and faster wound healing were observed for the investigational product compared to traditional treatment indicating superiority of moist wound environmental conditions both in acute and non-acute wounds after displacement of catheter placed into the jugular vein for 5 hours or 2 weeks in patients undergoing hemodialysis. The model is an innovative approach to study acute and non-acute wounds affecting all three skin layers and should be further investigated.
{"title":"Accelerated Wound Healing by a Topical Wound Healing Lipogel in Patients Undergoing Catheter De-placement - Evidence from a Randomized, Controlled Clinical Study","authors":"T. Eberlein, S. Siam","doi":"10.11648/J.JS.20200802.12","DOIUrl":"https://doi.org/10.11648/J.JS.20200802.12","url":null,"abstract":"Objective: The purpose of this clinical study was to assess a novel wound model and to compare the wound healing properties of a topical wound healing hydroactive lipogel (MediGel®) promoting moist wound environment versus standard treatment by a standard plaster und dry environmental conditions in patients undergoing catheter de-placement as a model for non-acute wounds affecting all skin layers in real life conditions (moist environment does improve granulation & epithelialization supported by Lipogel – the MEDIGEL trial). Methods: Patients (n=69) admitted to the dialysis ward of a tertiary care institution with acute or chronic renal insufficiency and in need for dialysis were enrolled into a prospective, observer-blind, randomized, controlled, inter-individual experimental comparison study. Patients enrolled were undergoing placement of Sheldon multi-lumen catheter (11 French diameter) in the external jugular vein at the neck by Seldinger technique to enable access for hemodialysis. One group of patients which had catheter displaced after one session of hemodialysis was regarded as acute wound group. A different group of patients had catheter withdrawn after 14 (+/- 2 days) and was classified as non-acute wound group. Topical treatments were randomly allocated, i.e. traditional care with standard plaster (control group) or investigational product (promoting moist environment) beneath a standard plaster (investigational product). Wound healing was assessed (digital photography, visual scoring) and analyzed via comparison of area under curve at day 0, 3 and 7 after displacement of catheter. Results: Evaluation showed significantly faster wound healing results for the investigational product in comparison to standard (all time points) and with significant AUC difference in both patient groups, acute and non-acute. Visible re-epithelialization was recorded from day 3 to day 7 in acute wounds, delayed in non-acute wounds. Standard plaster-treated wounds remained open and had markedly larger wound area. Formation of fibrous scar tissue was minimal but less prominent in patients treated with the hydroactive lipogel in the non-acute group due to faster epithelialization promoted by moist environment. Conclusion: Clinically relevant accelerated epithelialization and faster wound healing were observed for the investigational product compared to traditional treatment indicating superiority of moist wound environmental conditions both in acute and non-acute wounds after displacement of catheter placed into the jugular vein for 5 hours or 2 weeks in patients undergoing hemodialysis. The model is an innovative approach to study acute and non-acute wounds affecting all three skin layers and should be further investigated.","PeriodicalId":101237,"journal":{"name":"The Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84872976","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 : 2020-03-07DOI: 10.11648/J.JS.20200802.11
Huan Wang, Hong Zhou, Li Cheng
Objective: To explore the preventive effect of electrical stimulation biofeedback combined with family individualized pelvic floor rehabilitation training on postpartum pelvic floor dysfunction (PFD). Methods: From June 2018 to June 2019, 124 women who underwent the first postpartum review (Postpartum4-6 weeks, lochia clean, no vaginal bleeding) in our hospital were randomly divided into observation group and control group, 62 cases in each group. The control group received routine pelvic floor muscle training intervention, while the observation group received family individualized pelvic floor rehabilitation training combined with electrical stimulation biofeedback intervention. Six months after the intervention, the pelvic floor muscular fibre strength and A3 reflex, pelvic organ prolapse quantitative (POP-Q) score, pelvic floor dysfunction questionnaire (PFDI20), pelvic floor disease quality of life questionnaire (PFIQ7) and pelvic organ prolapse, urinary incontinence function questionnaire (PISQ-12) were compared between the two groups. Results: After 6 months of intervention, there was no significant difference in the muscle strength of type I muscle fibers between the two groups (Z=-0.918, P=0.358), while the muscle strength of type II muscle fibers in the observation group was significantly better than that in the control group (Z=-2.372, P=0.018). There was no significant difference in A3 reflex between the two groups before and after treatment (before: χ2=0.387, P=0.534; after: χ2=0.683, P=0.409). The POP-Q score of the observation group was significantly better than that of the control group (Z=-2.073, P=0.038). There was no significant difference in PFDI20, PFIQ7 and PISQ-12 scores between the two groups before and after treatment (P > 005). In the observation group, there were 2 cases of vaginal relaxation, 1 case of mild uterine prolapse, no stress urinary incontinence and vaginal wall bulge, the incidence was 4.84%. In the control group, 4 cases had vaginal relaxation, 2 cases had mild uterine prolapse, 1 case had stress urinary incontinence and no vaginal wall bulge, the incidence was 11.29%. Conclusion: Electrical stimulation biofeedback combined with family individualized pelvic floor rehabilitation training has a better effect on pelvic floor muscle rehabilitation, which is helpful to prevent the occurrence of PFD.
{"title":"Preventive Effect of Electrical Stimulation Biofeedback Combined With Family Individualized Pelvic Floor Rehabilitation Training on Postpartum Pelvic Floor Dysfunction","authors":"Huan Wang, Hong Zhou, Li Cheng","doi":"10.11648/J.JS.20200802.11","DOIUrl":"https://doi.org/10.11648/J.JS.20200802.11","url":null,"abstract":"Objective: To explore the preventive effect of electrical stimulation biofeedback combined with family individualized pelvic floor rehabilitation training on postpartum pelvic floor dysfunction (PFD). Methods: From June 2018 to June 2019, 124 women who underwent the first postpartum review (Postpartum4-6 weeks, lochia clean, no vaginal bleeding) in our hospital were randomly divided into observation group and control group, 62 cases in each group. The control group received routine pelvic floor muscle training intervention, while the observation group received family individualized pelvic floor rehabilitation training combined with electrical stimulation biofeedback intervention. Six months after the intervention, the pelvic floor muscular fibre strength and A3 reflex, pelvic organ prolapse quantitative (POP-Q) score, pelvic floor dysfunction questionnaire (PFDI20), pelvic floor disease quality of life questionnaire (PFIQ7) and pelvic organ prolapse, urinary incontinence function questionnaire (PISQ-12) were compared between the two groups. Results: After 6 months of intervention, there was no significant difference in the muscle strength of type I muscle fibers between the two groups (Z=-0.918, P=0.358), while the muscle strength of type II muscle fibers in the observation group was significantly better than that in the control group (Z=-2.372, P=0.018). There was no significant difference in A3 reflex between the two groups before and after treatment (before: χ2=0.387, P=0.534; after: χ2=0.683, P=0.409). The POP-Q score of the observation group was significantly better than that of the control group (Z=-2.073, P=0.038). There was no significant difference in PFDI20, PFIQ7 and PISQ-12 scores between the two groups before and after treatment (P > 005). In the observation group, there were 2 cases of vaginal relaxation, 1 case of mild uterine prolapse, no stress urinary incontinence and vaginal wall bulge, the incidence was 4.84%. In the control group, 4 cases had vaginal relaxation, 2 cases had mild uterine prolapse, 1 case had stress urinary incontinence and no vaginal wall bulge, the incidence was 11.29%. Conclusion: Electrical stimulation biofeedback combined with family individualized pelvic floor rehabilitation training has a better effect on pelvic floor muscle rehabilitation, which is helpful to prevent the occurrence of PFD.","PeriodicalId":101237,"journal":{"name":"The Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86982754","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 : 2020-03-04DOI: 10.11648/J.JS.20200801.18
A. Ugwu, K. Khan, Kit Chow
Groin hernias are a common reason to attend general surgical clinic with over 71,000 groin hernia repairs carried out in England in 2014/15. Diagnosis of groin hernias is primarily a clinical one, but a significant proportion of them are symptomatic and are not clinically palpable. There are a number of investigative options available which includes herniography, ultrasound, CT and MRI. Herniography is invasive and less sensitive to diagnose occult hernias and some radiologist would consider it, unethical & obsolete. MRI and CT scan are expensive and not always available. We evaluated the role of ultrasound in the surgical management of a cohort of patients with clinically occult groin hernia in a district general hospital. A retrospective list of patients having ultrasound examination for symptomatic groin collected from radiology department. Ultrasound which confirmed presence of hernias were identified. Ultrasound findings and clinical assessment were analyzed. In patients who underwent surgery, intra-operative findings were taken as gold standard and compared with ultrasound results. Total number of hernias included in the study was 68. Male to female distribution of patients was 3.3; 1. The mean age of participants was 42 years. In 93%, the presenting symptoms were pain, lump or combination of both. 40 patients (59%) were operated from which there was PPV of 0.90 with intraoperative findings congruent with intraoperative findings. Ultrasound is non-invasive and non-ionizing radiation imaging modality for diagnosis of impalpable groin hernias with a PPV of 90%. Morbidity associated with this modality is low. It is readily available and cheaper than MRI and CT scan with no harmful ionization radiation thereby conferring a cost benefit as well. We have shown ultrasound is a suitable tool for the initial imaging investigation of occult clinically non-palpable hernia. Our review of current literature has shown wide variance of the choice of imaging technique and the accuracy of their published report.
{"title":"Accuracy of Ultrasound as a Diagnostic Tool for the Assessment of Occult Groin Hernias","authors":"A. Ugwu, K. Khan, Kit Chow","doi":"10.11648/J.JS.20200801.18","DOIUrl":"https://doi.org/10.11648/J.JS.20200801.18","url":null,"abstract":"Groin hernias are a common reason to attend general surgical clinic with over 71,000 groin hernia repairs carried out in England in 2014/15. Diagnosis of groin hernias is primarily a clinical one, but a significant proportion of them are symptomatic and are not clinically palpable. There are a number of investigative options available which includes herniography, ultrasound, CT and MRI. Herniography is invasive and less sensitive to diagnose occult hernias and some radiologist would consider it, unethical & obsolete. MRI and CT scan are expensive and not always available. We evaluated the role of ultrasound in the surgical management of a cohort of patients with clinically occult groin hernia in a district general hospital. A retrospective list of patients having ultrasound examination for symptomatic groin collected from radiology department. Ultrasound which confirmed presence of hernias were identified. Ultrasound findings and clinical assessment were analyzed. In patients who underwent surgery, intra-operative findings were taken as gold standard and compared with ultrasound results. Total number of hernias included in the study was 68. Male to female distribution of patients was 3.3; 1. The mean age of participants was 42 years. In 93%, the presenting symptoms were pain, lump or combination of both. 40 patients (59%) were operated from which there was PPV of 0.90 with intraoperative findings congruent with intraoperative findings. Ultrasound is non-invasive and non-ionizing radiation imaging modality for diagnosis of impalpable groin hernias with a PPV of 90%. Morbidity associated with this modality is low. It is readily available and cheaper than MRI and CT scan with no harmful ionization radiation thereby conferring a cost benefit as well. We have shown ultrasound is a suitable tool for the initial imaging investigation of occult clinically non-palpable hernia. Our review of current literature has shown wide variance of the choice of imaging technique and the accuracy of their published report.","PeriodicalId":101237,"journal":{"name":"The Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84747127","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 : 2020-03-03DOI: 10.11648/J.JS.20200801.17
Chen Jiarong, H. Jingjing, Shi Qunfeng, Zeng Danping
Purpose: To observe the clinical effect of laparoscopic surgery on Meckel's diverticulum in children with (MD). Method: The clinical data of 20 children were analyzed retrospectively. All children were treated with laparoscopic surgery at single part of the umbilical cord, and the operation, clinical effects and postoperative complications were observed. Result: All the 20 children completed the operation successfully, and the operation time was 50. 5%. 2 ±5. 4) there were no complications such as abdominal pain, abdominal distension, vomiting, bleeding, intestinal adhesion obstruction, intestinal stricture and intestinal anastomotic fistula during and after min,. During the follow-up of 1 ~ 26 months, all the children ate and defecated normally and there was no recurrence. Conclusion: Umbilical laparoscopy is effective in the treatment of pediatric MD with less trauma, simple operation, short operation time and quick recovery after operation. Background Meckel's diverticulum is the most common congenital developmental malformation of the gastrointestinal tract, which is a mesenteric malformation caused by embryonic yolk tube degeneration. The incidence in the population is 2.0%, most patients have no clinical symptoms, occasionally found in autopsy, laparotomy, clinical diagnosis is more difficult. The clinical manifestations of its complications are easy to be confused with other diseases such as intussusception, colonic polyps, necrotizing enteritis and acute appendicitis perforation. Date sources Based on the progress in the treatment of Meckel's diverticulum in children at home and abroad, the clinical data of 20 children with Meckel's diverticulum treated in our hospital were analyzed retrospectively to observe the clinical effect of laparoscopy-assisted operation in the treatment of Meckel's diverticulum in children. Results All the 20 children completed the operation successfully, and the operation time was 50. 5%. 2 ±5. 4) there were no complications such as abdominal pain, abdominal distension, vomiting, bleeding, intestinal adhesion obstruction, intestinal stricture and intestinal anastomotic fistula during and after min,. During the follow-up of 1 ~ 26 months, all the children ate and defecated normally and there was no recurrence. Conclusions Surgical resection is the first choice for symptomatic Meckel diverticulum in children, and laparoscopic surgery is the first choice. The operative method of laparoscopic treatment of Meckel diverticulum in children with single part of umbilical cord has the advantages of less trauma, simple operation, short operation time and quick recovery after operation, and the operative effect is good.
{"title":"Clinical Effect of Single-Site Laparoscopy in the Treatment of Meckel's Diverticulum in Children","authors":"Chen Jiarong, H. Jingjing, Shi Qunfeng, Zeng Danping","doi":"10.11648/J.JS.20200801.17","DOIUrl":"https://doi.org/10.11648/J.JS.20200801.17","url":null,"abstract":"Purpose: To observe the clinical effect of laparoscopic surgery on Meckel's diverticulum in children with (MD). Method: The clinical data of 20 children were analyzed retrospectively. All children were treated with laparoscopic surgery at single part of the umbilical cord, and the operation, clinical effects and postoperative complications were observed. Result: All the 20 children completed the operation successfully, and the operation time was 50. 5%. 2 ±5. 4) there were no complications such as abdominal pain, abdominal distension, vomiting, bleeding, intestinal adhesion obstruction, intestinal stricture and intestinal anastomotic fistula during and after min,. During the follow-up of 1 ~ 26 months, all the children ate and defecated normally and there was no recurrence. Conclusion: Umbilical laparoscopy is effective in the treatment of pediatric MD with less trauma, simple operation, short operation time and quick recovery after operation. Background Meckel's diverticulum is the most common congenital developmental malformation of the gastrointestinal tract, which is a mesenteric malformation caused by embryonic yolk tube degeneration. The incidence in the population is 2.0%, most patients have no clinical symptoms, occasionally found in autopsy, laparotomy, clinical diagnosis is more difficult. The clinical manifestations of its complications are easy to be confused with other diseases such as intussusception, colonic polyps, necrotizing enteritis and acute appendicitis perforation. Date sources Based on the progress in the treatment of Meckel's diverticulum in children at home and abroad, the clinical data of 20 children with Meckel's diverticulum treated in our hospital were analyzed retrospectively to observe the clinical effect of laparoscopy-assisted operation in the treatment of Meckel's diverticulum in children. Results All the 20 children completed the operation successfully, and the operation time was 50. 5%. 2 ±5. 4) there were no complications such as abdominal pain, abdominal distension, vomiting, bleeding, intestinal adhesion obstruction, intestinal stricture and intestinal anastomotic fistula during and after min,. During the follow-up of 1 ~ 26 months, all the children ate and defecated normally and there was no recurrence. Conclusions Surgical resection is the first choice for symptomatic Meckel diverticulum in children, and laparoscopic surgery is the first choice. The operative method of laparoscopic treatment of Meckel diverticulum in children with single part of umbilical cord has the advantages of less trauma, simple operation, short operation time and quick recovery after operation, and the operative effect is good.","PeriodicalId":101237,"journal":{"name":"The Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88947006","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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