Pub Date : 2022-11-01Epub Date: 2022-09-18DOI: 10.1080/08941939.2022.2123577
Ahmet Hamdi Akgülle, Yavuz Şahbat, Özgür Baysal, Hayati Kart, Bülent Erol
Background: Supracondylar humerus fractures (SCHF) are rarely seen in the youngest age groups (1-3 years). Although there is no difference in the context of treatment options, it has been shown that younger age groups have different characteristics. Few studies have examined toddlers, which have notably different characteristics. This study is the first to report the characteristics, diagnosis, treatment and functional results of SCHF in infants and early toddlers.
Methods: A retrospective analysis was made of the data of patients younger than 30 months old, who were operated on in our clinic for SCHF between 2012 and 2020 with at least 2 years of follow-up. Patient demographic and surgical data, and the functional and radiological results were documented.
Results: Evaluation was made of a total of 52 patients comprising 30 females (58%) and 22 males (42%), with a mean age of 20.75 ± 5.4 months (range, 6-30 months). The injury was in the right elbow in 24 (46%) patients. The mechanism of injury was a fall from an object at home (table, chair, bed, etc.) in 41 (79%) patients. Patients who fell from a height of more than 4 meters had additional injuries (liver laceration, vertebral fracture, etc.). Only 1 patient had anterior interosseous nerve (AIN) damage before the operation, but the final follow-up neurovascular examinations for all patients were normal. The median follow-up period was 4 years (range, 2-7 years). Flynn outcome scores were (88.5%) excellent and variant Hospital for Special Surgery scores were (82.7%) excellent.
Conclusions: With appropriate treatment of SCHF, the clinical outcomes in infants and early toddlers are excellent. Using a medial pin to achieve and protect stability in this age group does not increase the risk of iatrogenic ulnar nerve damage. Patients younger than 20 months tend to have more varus malalignment but similar functional results.
背景:肱骨髁上骨折(SCHF)很少见于年龄最小的年龄组(1-3岁)。虽然在治疗选择的背景下没有差异,但已经表明,较年轻的年龄组具有不同的特征。很少有研究对幼儿进行调查,因为他们有明显不同的特征。本研究首次报道了婴幼儿SCHF的特征、诊断、治疗和功能结果。方法:回顾性分析2012年至2020年在我诊所手术的年龄小于30个月的SCHF患者的资料,随访时间至少2年。记录了患者的人口统计和手术数据,以及功能和放射学结果。结果:共纳入52例患者,其中女性30例(58%),男性22例(42%),平均年龄20.75±5.4个月(范围6-30个月)。24例(46%)患者发生右肘损伤。41例(79%)患者的损伤机制为从家中物体(桌子、椅子、床等)上摔下。从4米以上高处坠落的患者有附加损伤(肝裂伤、椎体骨折等)。只有1例患者术前有前骨间神经损伤,但所有患者最终随访神经血管检查均正常。中位随访期为4年(范围2-7年)。Flynn评分为优(88.5%),variant Hospital for Special Surgery评分为优(82.7%)。结论:患儿经适当治疗,临床疗效良好。在这个年龄组使用内侧针来实现和保护稳定性不会增加医源性尺神经损伤的风险。年龄小于20个月的患者往往有更多的内翻错位,但功能结果相似。
{"title":"Supracondylar Humerus Fractures in Infants and Early Toddlers; Characteristics, Clinical and Radiological Outcomes Compared with Older Children.","authors":"Ahmet Hamdi Akgülle, Yavuz Şahbat, Özgür Baysal, Hayati Kart, Bülent Erol","doi":"10.1080/08941939.2022.2123577","DOIUrl":"https://doi.org/10.1080/08941939.2022.2123577","url":null,"abstract":"<p><strong>Background: </strong>Supracondylar humerus fractures (SCHF) are rarely seen in the youngest age groups (1-3 years). Although there is no difference in the context of treatment options, it has been shown that younger age groups have different characteristics. Few studies have examined toddlers, which have notably different characteristics. This study is the first to report the characteristics, diagnosis, treatment and functional results of SCHF in infants and early toddlers.</p><p><strong>Methods: </strong>A retrospective analysis was made of the data of patients younger than 30 months old, who were operated on in our clinic for SCHF between 2012 and 2020 with at least 2 years of follow-up. Patient demographic and surgical data, and the functional and radiological results were documented.</p><p><strong>Results: </strong>Evaluation was made of a total of 52 patients comprising 30 females (58%) and 22 males (42%), with a mean age of 20.75 ± 5.4 months (range, 6-30 months). The injury was in the right elbow in 24 (46%) patients. The mechanism of injury was a fall from an object at home (table, chair, bed, etc.) in 41 (79%) patients. Patients who fell from a height of more than 4 meters had additional injuries (liver laceration, vertebral fracture, etc.). Only 1 patient had anterior interosseous nerve (AIN) damage before the operation, but the final follow-up neurovascular examinations for all patients were normal. The median follow-up period was 4 years (range, 2-7 years). Flynn outcome scores were (88.5%) excellent and variant Hospital for Special Surgery scores were (82.7%) excellent.</p><p><strong>Conclusions: </strong>With appropriate treatment of SCHF, the clinical outcomes in infants and early toddlers are excellent. Using a medial pin to achieve and protect stability in this age group does not increase the risk of iatrogenic ulnar nerve damage. Patients younger than 20 months tend to have more varus malalignment but similar functional results.</p>","PeriodicalId":16200,"journal":{"name":"Journal of Investigative Surgery","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40368686","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Cholecystoenteric fistula (CEF) is a rare complication of cholelithiasis. CEF refers to one or more pathological perforations between the gallbladder and the adjacent gastrointestinal tract, first described by Bartholin in 1645. The aim of this review is to examine the etiology, symptoms, diagnosis, and treatment of CEF.Methods: A literature search was conducted according to a set of criteria in PubMed for historical and current peer-reviewed studies regarding CEF.Results: Clinical manifestations of CEF are always latent. Despite modern imaging studies and diagnostic methods, it is still very difficult to definitively diagnose CEF preoperatively. Instead, CEF is often accidentally discovered in the perioperative period or via intraoperative exploration.Conclusions: Without appropriate preoperative preparation, gastrointestinal injury and intraoperative bleeding often occur. CEF often goes unreported, and its diagnosis and treatment are still controversial. Early diagnosis of CEF is essential for effective treatment and improved outcome.
{"title":"Developments in the Diagnosis and Management of Cholecystoenteric Fistula.","authors":"Ying-Yu Liu, Shi-Yuan Bi, Quan-Run He, Ying Fan, Shuo-Dong Wu","doi":"10.1080/08941939.2022.2113188","DOIUrl":"https://doi.org/10.1080/08941939.2022.2113188","url":null,"abstract":"<p><p><b>Background:</b> Cholecystoenteric fistula (CEF) is a rare complication of cholelithiasis. CEF refers to one or more pathological perforations between the gallbladder and the adjacent gastrointestinal tract, first described by Bartholin in 1645. The aim of this review is to examine the etiology, symptoms, diagnosis, and treatment of CEF.<b>Methods:</b> A literature search was conducted according to a set of criteria in PubMed for historical and current peer-reviewed studies regarding CEF.<b>Results:</b> Clinical manifestations of CEF are always latent. Despite modern imaging studies and diagnostic methods, it is still very difficult to definitively diagnose CEF preoperatively. Instead, CEF is often accidentally discovered in the perioperative period or via intraoperative exploration.<b>Conclusions:</b> Without appropriate preoperative preparation, gastrointestinal injury and intraoperative bleeding often occur. CEF often goes unreported, and its diagnosis and treatment are still controversial. Early diagnosis of CEF is essential for effective treatment and improved outcome.</p>","PeriodicalId":16200,"journal":{"name":"Journal of Investigative Surgery","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40378629","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-11-01Epub Date: 2022-09-25DOI: 10.1080/08941939.2022.2126566
Ayşe Çakır Gündoğdu, Fatih Kar, Cansu Özbayer
Background: There is a growing interest in the use of natural compounds for the treatment of gastric ulcers. The multifunctional roles of betaine in various diseases make this natural substance a favorable pre-drug for ulcer treatment. This study aims to determine the competence of betaine in gastroprotection against ethanol-induced damage and to explore underlying mechanisms considering its effects on liver and kidney activity and blood parameters.Methods:Wistar albino rats were orally treated with vehicle (distilled water) or betaine (250 mg/kg) for twenty-one days and then ulcer formation was induced by ingestion of 75% ethanol. Gastric mucosal damage was evaluated by gross examination and histopathological analysis. Homocysteine levels, lipid peroxidation, total antioxidant status (TAS), total oxidant status (TAS), antioxidant enzymes and pro-inflammatory and anti-inflammatory cytokines levels were assessed by enzyme-linked immunosorbent assay (ELISA) or immunohistochemistry. Furthermore, routine biochemical tests were performed and hematological parameters were analyzed.Results: Betaine ameliorated any gastric mucosal damage and reduced homocysteine levels significantly. The TOS and malondialdehyde (MDA) levels were decreased while the TAS, glutathione (GSH) levels and catalase (CAT) activity were increased upon the betaine treatment. Betaine reduced apoptosis by regulating Bax and Bcl-2 levels, however, it did not alter inflammatory mediators. Additionally, betaine improved serum potassium (K+) and blood urea nitrogen (BUN) levels, whereas it increased alanine aminotransferase (ALT) levels and impaired hematological parameters.Conclusions: Altogether, these data illustrated that betaine exhibits a gastroprotective effect against ulcers through the homocysteine pathway by modulating oxidative stress in the gastric tissue; however, its systemic effects should not be ignored.
{"title":"Investigation of the Gastroprotective Effect of Betaine-Homocysteine Homeostasis on Oxidative Stress, Inflammation and Apoptosis in Ethanol-Induced Ulcer Model.","authors":"Ayşe Çakır Gündoğdu, Fatih Kar, Cansu Özbayer","doi":"10.1080/08941939.2022.2126566","DOIUrl":"https://doi.org/10.1080/08941939.2022.2126566","url":null,"abstract":"<p><p><b>Background:</b> There is a growing interest in the use of natural compounds for the treatment of gastric ulcers. The multifunctional roles of betaine in various diseases make this natural substance a favorable pre-drug for ulcer treatment. This study aims to determine the competence of betaine in gastroprotection against ethanol-induced damage and to explore underlying mechanisms considering its effects on liver and kidney activity and blood parameters.<b>Methods:</b> <i>Wistar albino</i> rats were orally treated with vehicle (distilled water) or betaine (250 mg/kg) for twenty-one days and then ulcer formation was induced by ingestion of 75% ethanol. Gastric mucosal damage was evaluated by gross examination and histopathological analysis. Homocysteine levels, lipid peroxidation, total antioxidant status (TAS), total oxidant status (TAS), antioxidant enzymes and pro-inflammatory and anti-inflammatory cytokines levels were assessed by enzyme-linked immunosorbent assay (ELISA) or immunohistochemistry. Furthermore, routine biochemical tests were performed and hematological parameters were analyzed.<b>Results:</b> Betaine ameliorated any gastric mucosal damage and reduced homocysteine levels significantly. The TOS and malondialdehyde (MDA) levels were decreased while the TAS, glutathione (GSH) levels and catalase (CAT) activity were increased upon the betaine treatment. Betaine reduced apoptosis by regulating Bax and Bcl-2 levels, however, it did not alter inflammatory mediators. Additionally, betaine improved serum potassium (K<sup>+</sup>) and blood urea nitrogen (BUN) levels, whereas it increased alanine aminotransferase (ALT) levels and impaired hematological parameters.<b>Conclusions:</b> Altogether, these data illustrated that betaine exhibits a gastroprotective effect against ulcers through the homocysteine pathway by modulating oxidative stress in the gastric tissue; however, its systemic effects should not be ignored.</p>","PeriodicalId":16200,"journal":{"name":"Journal of Investigative Surgery","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33480959","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-10-01DOI: 10.1080/08941939.2022.2109226
Stefanie M Croghan, Leah Hayes, Eabhann M O'Connor, Mark Rochester, William Finch, Anne Carrie, Shane W Considine, Frank D'Arcy, Aisling Nic An Riogh, Wasim Mahmalji, Mohammed Elhadi, Helen Thursby, Ian Pearce, Vaibhav Modgil, Hosam Noweir, Eoin MacCraith, Aideen Madden, Rustom Manecksha, Eva Browne, Subhasis K Giri, Connor V Cunnane, John Mulvihill, Michael T Walsh, Niall F Davis, Hugh D Flood
Objectives: To perform a multi-institutional investigation of incidence and outcomes of urethral trauma sustained during attempted catheterization.
Patients & methods: A prospective, multi-center study was conducted over a designated 3-4 month period, incorporating seven academic hospitals across the UK and Ireland. Cases of urethral trauma arising from attempted catheterization were recorded. Variables included sites of injury, management strategies and short-term clinical outcomes. The catheterization injury rate was calculated based on the estimated total number of catheterizations occurring in each center per month. Anonymised data were collated, evaluated and described.
Results: Sixty-six urethral catheterization injuries were identified (7 centers; mean 3.43 months). The mean injury rate was 6.2 ± 3.8 per 1000 catheterizations (3.18-14.42/1000). All injured patients were male, mean age 76.1 ± 13.1 years. Urethral catheterization injuries occurred in multiple hospital/community settings, most commonly Emergency Departments (36%) and medical/surgical wards (30%). Urological intervention was required in 94.7% (54/57), with suprapubic catheterization required in 12.3% (n = 7). More than half of patients (55.56%) were discharged with an urethral catheter, fully or partially attributable to the urethral catheter injury. At least one further healthcare encounter on account of the injury was required for 90% of patients post-discharge.
Conclusions: This is the largest study of its kind and confirms that iatrogenic urethral trauma is a recurring medical error seen universally across institutions, healthcare systems and countries. In addition, urethral catheter injury results in significant patient morbidity with a substantial financial burden to healthcare services. Future innovation to improve the safety of urinary catheterization is warranted.
{"title":"A Prospective Multi-Institutional Evaluation of Iatrogenic Urethral Catheterization Injuries.","authors":"Stefanie M Croghan, Leah Hayes, Eabhann M O'Connor, Mark Rochester, William Finch, Anne Carrie, Shane W Considine, Frank D'Arcy, Aisling Nic An Riogh, Wasim Mahmalji, Mohammed Elhadi, Helen Thursby, Ian Pearce, Vaibhav Modgil, Hosam Noweir, Eoin MacCraith, Aideen Madden, Rustom Manecksha, Eva Browne, Subhasis K Giri, Connor V Cunnane, John Mulvihill, Michael T Walsh, Niall F Davis, Hugh D Flood","doi":"10.1080/08941939.2022.2109226","DOIUrl":"https://doi.org/10.1080/08941939.2022.2109226","url":null,"abstract":"<p><strong>Objectives: </strong>To perform a multi-institutional investigation of incidence and outcomes of urethral trauma sustained during attempted catheterization.</p><p><strong>Patients & methods: </strong>A prospective, multi-center study was conducted over a designated 3-4 month period, incorporating seven academic hospitals across the UK and Ireland. Cases of urethral trauma arising from attempted catheterization were recorded. Variables included sites of injury, management strategies and short-term clinical outcomes. The catheterization injury rate was calculated based on the estimated total number of catheterizations occurring in each center per month. Anonymised data were collated, evaluated and described.</p><p><strong>Results: </strong>Sixty-six urethral catheterization injuries were identified (7 centers; mean 3.43 months). The mean injury rate was 6.2 ± 3.8 per 1000 catheterizations (3.18-14.42/1000). All injured patients were male, mean age 76.1 ± 13.1 years. Urethral catheterization injuries occurred in multiple hospital/community settings, most commonly Emergency Departments (36%) and medical/surgical wards (30%). Urological intervention was required in 94.7% (54/57), with suprapubic catheterization required in 12.3% (n = 7). More than half of patients (55.56%) were discharged with an urethral catheter, fully or partially attributable to the urethral catheter injury. At least one further healthcare encounter on account of the injury was required for 90% of patients post-discharge.</p><p><strong>Conclusions: </strong>This is the largest study of its kind and confirms that iatrogenic urethral trauma is a recurring medical error seen universally across institutions, healthcare systems and countries. In addition, urethral catheter injury results in significant patient morbidity with a substantial financial burden to healthcare services. Future innovation to improve the safety of urinary catheterization is warranted.</p>","PeriodicalId":16200,"journal":{"name":"Journal of Investigative Surgery","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10671599","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-10-01Epub Date: 2022-09-04DOI: 10.1080/08941939.2022.2116134
Hongyan Ren, Hua Duan, Sha Wang, Yanan Chang
Objective: To compare the safety and efficiency of hysteroscopic laser vaporesection and hysteroscopic resection in the treatment of endometrial polyps.Methods: The literatures in databases were searched comprehensively, the literatures that met the inclusion criteria were screened out and the data were extracted. The data were combined with Stata12.0 statistical software.
Results: 4 literatures were included with a total sample size of 334. Meta-analysis showed that intraoperative blood loss in laser group was less than that in electrosurgical group [-3.043, 95% CI (-4.09, -2.00), P < 0.001]. Length of stay in the laser group was shorter than that in the electrotomy group [-1.013, 95% CI (-1.37, -0.65), P < 0.001]. The recurrence rate [0.275, 95%CI (0.135,0.563), P < 0.001] and complication rate [0.148, 95%CI (0.07,0.32), P < 0.001] in the laser group were lower than those in the electrotomy group. There was no significant difference in operative time between hysteroscopy combined with 2 μm laser and hysteroscopic electrotomy for endometrial polyps [-0.38, 95% CI (-1.34, 0.58), P = 0.441 > 0.05].
Conclusion: Hysteroscopic 2 μm laser vaporesection for the treatment of endometrial polyps has better safety and clinical efficacy. Compared with hysteroscopic electroresection, hysteroscopic laser vaporesection in the treatment of endometrial polyps may be safer and more effective. Given the potential limitations, we need larger, well-designed randomized controlled trials to verify our findings.
目的:比较宫腔镜下激光汽化术与宫腔镜下切除术治疗子宫内膜息肉的安全性和有效性。方法:综合检索数据库中的文献,筛选出符合纳入标准的文献,提取数据。数据采用Stata12.0统计软件进行合并。结果:共纳入4篇文献,总样本量334篇。meta分析显示,激光组术中出血量低于电手术组[-3.043,95% CI (-4.09, -2.00), P 0.05]。结论:宫腔镜2 μm激光气相切除治疗子宫内膜息肉具有较好的安全性和临床疗效。与宫腔镜电切术相比,宫腔镜激光气相切除术治疗子宫内膜息肉可能更安全有效。考虑到潜在的局限性,我们需要更大规模、设计良好的随机对照试验来验证我们的发现。
{"title":"Hysteroscopy Combined with Laser Vaporesection for Endometrial Polyps.","authors":"Hongyan Ren, Hua Duan, Sha Wang, Yanan Chang","doi":"10.1080/08941939.2022.2116134","DOIUrl":"https://doi.org/10.1080/08941939.2022.2116134","url":null,"abstract":"<p><strong>Objective: </strong>To compare the safety and efficiency of hysteroscopic laser vaporesection and hysteroscopic resection in the treatment of endometrial polyps.<b>Methods:</b> The literatures in databases were searched comprehensively, the literatures that met the inclusion criteria were screened out and the data were extracted. The data were combined with Stata12.0 statistical software.</p><p><strong>Results: </strong>4 literatures were included with a total sample size of 334. Meta-analysis showed that intraoperative blood loss in laser group was less than that in electrosurgical group [-3.043, 95% CI (-4.09, -2.00), P < 0.001]. Length of stay in the laser group was shorter than that in the electrotomy group [-1.013, 95% CI (-1.37, -0.65), P < 0.001]. The recurrence rate [0.275, 95%CI (0.135,0.563), P < 0.001] and complication rate [0.148, 95%CI (0.07,0.32), P < 0.001] in the laser group were lower than those in the electrotomy group. There was no significant difference in operative time between hysteroscopy combined with 2 μm laser and hysteroscopic electrotomy for endometrial polyps [-0.38, 95% CI (-1.34, 0.58), P = 0.441 > 0.05].</p><p><strong>Conclusion: </strong>Hysteroscopic 2 μm laser vaporesection for the treatment of endometrial polyps has better safety and clinical efficacy. Compared with hysteroscopic electroresection, hysteroscopic laser vaporesection in the treatment of endometrial polyps may be safer and more effective. Given the potential limitations, we need larger, well-designed randomized controlled trials to verify our findings.</p>","PeriodicalId":16200,"journal":{"name":"Journal of Investigative Surgery","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40350006","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract Aim: There is currently no consensus on the best risk assessment technique for predicting complications after hip surgery in the elderly, which is hindering the accuracy of surgical risk assessment. The goal of this study was to build a risk assessment model and evaluate its predictive value using the modified frailty index (5-mFI) and the prognostic nutritional index (PNI). Methods: A retrospective investigation was undertaken on 150 patients (aged ≥60 years) who had hip fracture surgery. Using univariate and multivariate logistic regression models, the relationship between combined 5-mFI and PNI and the evaluation of postoperative unfavorable outcomes such as infection and unscheduled intensive care unit (ICU) admission was investigated. Finally, utilizing receiver operating characteristic (ROC) curve analysis, the model’s predictive value for adverse outcomes following hip fracture surgery in elderly patients was assessed. Results: Univariate and multivariate logistic analyses revealed that preoperative PNI, 5-mFI, ASA, and gender acted as independent predictors of adverse outcomes after hip fracture surgery in the elderly. According to the ROC curve analysis, the predictive model demonstrated a high predictive value for total postoperative complications (AUC: 0.788; 95%CI: 0.715–0.860; p<0.01), infectious complications (AUC: 0.798; 95% CI: 0.727–0.868; P<0.001), and unplanned ICU admission (AUC: 0.783; 95% CI: 0.705–0.861; P<0.001). Conclusions: The multivariable evaluation model, which included 5-mFI and PNI, showed a high predictive value and can hence be applied to predict the adverse outcomes in elderly patients undergoing hip fracture surgery.
{"title":"Modified Frailty Index Combined with a Prognostic Nutritional Index for Predicting Postoperative Complications of Hip Fracture Surgery in Elderly.","authors":"Yanling Zhou, Long Wang, Angyang Cao, Wenjun Luo, Zhipeng Xu, Zhiren Sheng, Jianhua Wang, Binbin Zhu","doi":"10.1080/08941939.2022.2101166","DOIUrl":"https://doi.org/10.1080/08941939.2022.2101166","url":null,"abstract":"Abstract Aim: There is currently no consensus on the best risk assessment technique for predicting complications after hip surgery in the elderly, which is hindering the accuracy of surgical risk assessment. The goal of this study was to build a risk assessment model and evaluate its predictive value using the modified frailty index (5-mFI) and the prognostic nutritional index (PNI). Methods: A retrospective investigation was undertaken on 150 patients (aged ≥60 years) who had hip fracture surgery. Using univariate and multivariate logistic regression models, the relationship between combined 5-mFI and PNI and the evaluation of postoperative unfavorable outcomes such as infection and unscheduled intensive care unit (ICU) admission was investigated. Finally, utilizing receiver operating characteristic (ROC) curve analysis, the model’s predictive value for adverse outcomes following hip fracture surgery in elderly patients was assessed. Results: Univariate and multivariate logistic analyses revealed that preoperative PNI, 5-mFI, ASA, and gender acted as independent predictors of adverse outcomes after hip fracture surgery in the elderly. According to the ROC curve analysis, the predictive model demonstrated a high predictive value for total postoperative complications (AUC: 0.788; 95%CI: 0.715–0.860; p<0.01), infectious complications (AUC: 0.798; 95% CI: 0.727–0.868; P<0.001), and unplanned ICU admission (AUC: 0.783; 95% CI: 0.705–0.861; P<0.001). Conclusions: The multivariable evaluation model, which included 5-mFI and PNI, showed a high predictive value and can hence be applied to predict the adverse outcomes in elderly patients undergoing hip fracture surgery.","PeriodicalId":16200,"journal":{"name":"Journal of Investigative Surgery","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40576372","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-10-01Epub Date: 2022-08-01DOI: 10.1080/08941939.2022.2106392
Lei Liu, Jia-Qi Zhang, Gui-Ge Wang, Ke Zhao, Chao Guo, Cheng Huang, Shan-Qing Li, Ye-Ye Chen
Background. Ectopic mediastinal parathyroid glands are parathyroid glands located completely below the clavicle. At present, most literature reports on ectopic mediastinal parathyroid tumors (EMPT) are case reports or small case sequences.Methods. This study conducted a retrospective analysis of ectopic mediastinal parathyroid tumors cases treated over the past 23 years, summarizing and analyzing general conditions, preoperative positioning, postoperative pathology, intraoperative conditions, and long-term follow-up results.Results. This study enrolled 28 patients. Among them, 27 patients underwent preoperative localization diagnosis using 99mTc-sestamibi scan (MIBI) in conjunction with chest computed tomography (CT), including 26 cases of the anterior superior mediastinum and 2 cases of middle mediastinum. Postoperative pathology revealed 23 cases of parathyroid adenoma, 4 cases of parathyroid hyperplasia, and 1 case of parathyroid cyst. In this study, 12 patients underwent video-assisted thoracoscopic surgery (VATS) and thoracotomy approaches. Using Mann-Whitney U test, we discovered that VATS approach group is significantly superior in surgical time (P = 0.039) and intraoperative bleeding (P < 0.001). Within one week of surgery, 26 patients with primary hyperparathyroidism (PHPT) experienced a significant decrease in blood parathyroid hormone (PTH) (P < 0.001) and blood calcium (P < 0.001), and all achieved long-term remission.Conclusions. EMPT is most frequently performed in the anterior superior mediastinum. EMPT is predominantly parathyroid tumors, and most of them are associated with PHPT. MIBI and chest CT combination can be used for preoperative lesion localization (positive rate 96.15%). VATS can be used as a better surgical approach. PHPT patients before surgery can achieve long-term symptom relief with surgical treatment.
{"title":"Surgical Treatment of Ectopic Mediastinal Parathyroid Tumors: A 23-Year Clinical Data Study in a Single Center.","authors":"Lei Liu, Jia-Qi Zhang, Gui-Ge Wang, Ke Zhao, Chao Guo, Cheng Huang, Shan-Qing Li, Ye-Ye Chen","doi":"10.1080/08941939.2022.2106392","DOIUrl":"https://doi.org/10.1080/08941939.2022.2106392","url":null,"abstract":"<p><p><b>Background.</b> Ectopic mediastinal parathyroid glands are parathyroid glands located completely below the clavicle. At present, most literature reports on ectopic mediastinal parathyroid tumors (EMPT) are case reports or small case sequences.<b>Methods.</b> This study conducted a retrospective analysis of ectopic mediastinal parathyroid tumors cases treated over the past 23 years, summarizing and analyzing general conditions, preoperative positioning, postoperative pathology, intraoperative conditions, and long-term follow-up results.<b>Results.</b> This study enrolled 28 patients. Among them, 27 patients underwent preoperative localization diagnosis using 99mTc-sestamibi scan (MIBI) in conjunction with chest computed tomography (CT), including 26 cases of the anterior superior mediastinum and 2 cases of middle mediastinum. Postoperative pathology revealed 23 cases of parathyroid adenoma, 4 cases of parathyroid hyperplasia, and 1 case of parathyroid cyst. In this study, 12 patients underwent video-assisted thoracoscopic surgery (VATS) and thoracotomy approaches. Using Mann-Whitney U test, we discovered that VATS approach group is significantly superior in surgical time (P = 0.039) and intraoperative bleeding (P < 0.001). Within one week of surgery, 26 patients with primary hyperparathyroidism (PHPT) experienced a significant decrease in blood parathyroid hormone (PTH) (P < 0.001) and blood calcium (P < 0.001), and all achieved long-term remission.<b>Conclusions.</b> EMPT is most frequently performed in the anterior superior mediastinum. EMPT is predominantly parathyroid tumors, and most of them are associated with PHPT. MIBI and chest CT combination can be used for preoperative lesion localization (positive rate 96.15%). VATS can be used as a better surgical approach. PHPT patients before surgery can achieve long-term symptom relief with surgical treatment.</p>","PeriodicalId":16200,"journal":{"name":"Journal of Investigative Surgery","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40574017","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-10-01Epub Date: 2022-09-06DOI: 10.1080/08941939.2022.2118912
Yanhan Ren
investigate a new methodology for managing extensive using a combinational approach, scar-related with spit-thickness large extensive burned on A combinational grafting procedure was performed using autologous scar-related tissue and scalp
{"title":"Tackling Large Area Burn with Combinational Tissue Grafting.","authors":"Yanhan Ren","doi":"10.1080/08941939.2022.2118912","DOIUrl":"https://doi.org/10.1080/08941939.2022.2118912","url":null,"abstract":"investigate a new methodology for managing extensive using a combinational approach, scar-related with spit-thickness large extensive burned on A combinational grafting procedure was performed using autologous scar-related tissue and scalp","PeriodicalId":16200,"journal":{"name":"Journal of Investigative Surgery","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40351471","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-10-01Epub Date: 2022-07-19DOI: 10.1080/08941939.2022.2101164
Zhuoqun Fang, Jun Li, Kejia Wang, Ting He, Hongtao Wang, Songtao Xie, Xuekang Yang, Juntao Han
Background: This study introduced a novel method to reconstruct large areas of scarring caused by burns via combining autologous scar-related tissue with spit-thickness skin grafting (ASTCS).
Methods: 25 patients underwent reconstruction after scar resection surgeries around the joints were analyzed between Jan 2012 and Jan 2018. Patient demographics and clinical parameters were collected, autologous scar-related tissue was modified to meshed structure, and the split-thickness skin was acquired from the scalp. The scar was resected and punched by a meshing machine with a thickness of 0.3-0.5 mm at a ratio of 1:1. The secondary wounds were covered by the epidermis from a donor site. The surgical areas were bandaged for 7-10 days before the first dressing change.
Results: 25 patients (mean [SD] age, 26.4 [18.8] years; 16 [64%] men) underwent wounds reconstructive operations due to scar resection were reviewed. Wound location of 9 (22%), 8 (19.5%), 9 (22%), 7 (17.1%) and 8 (19.5%) cases were reconstructed in axillary, hand and wrist, popliteal fossa, elbow and neck, respectively. 39 sites of transplanted tissues survived well, and 2 sites were cured after two weeks of dressing changes. Except the analysis of injury causes, nutritional status, wound area and hospital days, patients with scar deformities in joint areas achieved satisfactory function by assessing the Vancouver Burn Skin Score and the Barthel Index Scale Scores after 12-month follow-up.
Conclusions: Combining autologous scar-related tissue with skin grafting provided a novel method for treating large areas of burn scars with better functional outcomes.
{"title":"Autologous Scar-Related Tissue Combined with Skin Grafting for Reconstructing Large Area Burn Scar.","authors":"Zhuoqun Fang, Jun Li, Kejia Wang, Ting He, Hongtao Wang, Songtao Xie, Xuekang Yang, Juntao Han","doi":"10.1080/08941939.2022.2101164","DOIUrl":"https://doi.org/10.1080/08941939.2022.2101164","url":null,"abstract":"<p><strong>Background: </strong>This study introduced a novel method to reconstruct large areas of scarring caused by burns via combining autologous scar-related tissue with spit-thickness skin grafting (ASTCS).</p><p><strong>Methods: </strong>25 patients underwent reconstruction after scar resection surgeries around the joints were analyzed between Jan 2012 and Jan 2018. Patient demographics and clinical parameters were collected, autologous scar-related tissue was modified to meshed structure, and the split-thickness skin was acquired from the scalp. The scar was resected and punched by a meshing machine with a thickness of 0.3-0.5 mm at a ratio of 1:1. The secondary wounds were covered by the epidermis from a donor site. The surgical areas were bandaged for 7-10 days before the first dressing change.</p><p><strong>Results: </strong>25 patients (mean [SD] age, 26.4 [18.8] years; 16 [64%] men) underwent wounds reconstructive operations due to scar resection were reviewed. Wound location of 9 (22%), 8 (19.5%), 9 (22%), 7 (17.1%) and 8 (19.5%) cases were reconstructed in axillary, hand and wrist, popliteal fossa, elbow and neck, respectively. 39 sites of transplanted tissues survived well, and 2 sites were cured after two weeks of dressing changes. Except the analysis of injury causes, nutritional status, wound area and hospital days, patients with scar deformities in joint areas achieved satisfactory function by assessing the Vancouver Burn Skin Score and the Barthel Index Scale Scores after 12-month follow-up.</p><p><strong>Conclusions: </strong>Combining autologous scar-related tissue with skin grafting provided a novel method for treating large areas of burn scars with better functional outcomes.</p>","PeriodicalId":16200,"journal":{"name":"Journal of Investigative Surgery","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40606879","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Patients with high-risk prostate cancer (PCa) experience heterogeneous oncological outcomes. In this study, we assessed the patients who underwent an RP procedure because of high-risk prostate cancer in subgroups formed according to D'Amico criteria and analyzed the effects of these criteria on biochemical recurrence (BCR) after RP.
Methods: We retrospectively identified high-risk non-metastatic PCa patients who underwent RP between 2006 and 2020 in our hospital. Groups were formed as follows: group 1 consisted of those with an ISUP grade 4 - 5 biopsy, group 2 consisted of those with a clinical stage T2c, group 3 consisted of those with a tPSA level ≥ 20 ng/ml, and group 4 consisted of those with locally advanced disease. Survival analyses were made by Kaplan-Meier test and Log Rank test. A P value <0.05 was accepted as statistically significant.
Results: Of all patients, 61.8% were cured by only RP and 38.2% had recurrences. Rates of BCR were significantly different among groups (P = 0.003). In group 1, group 2, group 3, and group 4, BCR rates were 30.8%, 13%, 40.8%, and 70.6%, respectively. Mean BCR-free survival was 82.47 ± 11.64 months. In group 2, BCR-free survival was higher than that in group 3 and group 4 (P1 = 0.020 and P2 = 0.001) and in group 1, BCR-free survival was higher than that in group 4 (P = 0.016). There was no significant difference between group 3 and 4 (P > 0.05).
Conclusion: Despite the developments in the imaging technology, an elevated tPSA level remains to be an important predictor for BCR-free survival.
{"title":"Is PSA Still the Best Predictor for Biochemical Recurrence after Radical Prostatectomy in High-Risk Prostate Cancer?","authors":"Serkan Akan, Numan Doğu Güner, Caner Ediz, Aytaç Şahin, Ayhan Verit","doi":"10.1080/08941939.2022.2101165","DOIUrl":"https://doi.org/10.1080/08941939.2022.2101165","url":null,"abstract":"<p><strong>Background: </strong>Patients with high-risk prostate cancer (PCa) experience heterogeneous oncological outcomes. In this study, we assessed the patients who underwent an RP procedure because of high-risk prostate cancer in subgroups formed according to D'Amico criteria and analyzed the effects of these criteria on biochemical recurrence (BCR) after RP.</p><p><strong>Methods: </strong>We retrospectively identified high-risk non-metastatic PCa patients who underwent RP between 2006 and 2020 in our hospital. Groups were formed as follows: group 1 consisted of those with an ISUP grade 4 - 5 biopsy, group 2 consisted of those with a clinical stage T2c, group 3 consisted of those with a tPSA level ≥ 20 ng/ml, and group 4 consisted of those with locally advanced disease. Survival analyses were made by Kaplan-Meier test and Log Rank test. A <i>P</i> value <0.05 was accepted as statistically significant.</p><p><strong>Results: </strong>Of all patients, 61.8% were cured by only RP and 38.2% had recurrences. Rates of BCR were significantly different among groups (<i>P</i> = 0.003). In group 1, group 2, group 3, and group 4, BCR rates were 30.8%, 13%, 40.8%, and 70.6%, respectively. Mean BCR-free survival was 82.47 ± 11.64 months. In group 2, BCR-free survival was higher than that in group 3 and group 4 (<i>P</i>1 = 0.020 and <i>P</i>2 = 0.001) and in group 1, BCR-free survival was higher than that in group 4 (<i>P</i> = 0.016). There was no significant difference between group 3 and 4 (<i>P</i> > 0.05).</p><p><strong>Conclusion: </strong>Despite the developments in the imaging technology, an elevated tPSA level remains to be an important predictor for BCR-free survival.</p>","PeriodicalId":16200,"journal":{"name":"Journal of Investigative Surgery","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40621485","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}