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A Prospective Multi-Institutional Evaluation of Iatrogenic Urethral Catheterization Injuries. 医源性导尿损伤的前瞻性多机构评估。
IF 1.9 4区 医学 Q2 SURGERY Pub Date : 2022-10-01 DOI: 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.

目的:对导尿过程中尿道创伤的发生率和结果进行多机构调查。患者和方法:一项前瞻性多中心研究在指定的3-4个月期间进行,纳入了英国和爱尔兰的七家学术医院。我们记录了因尝试导尿引起尿道创伤的病例。变量包括损伤部位、治疗策略和短期临床结果。导管损伤率是根据每个中心每月发生的导管估计总数来计算的。对匿名数据进行整理、评估和描述。结果:共发现尿置管损伤66例(7个中心;平均3.43个月)。平均损伤率为6.2±3.8 /1000(3.18 ~ 14.42/1000)。所有患者均为男性,平均年龄76.1±13.1岁。导尿损伤发生在多个医院/社区环境中,最常见的是急诊科(36%)和内科/外科病房(30%)。94.7%(54/57)患者需要泌尿外科干预,12.3% (n = 7)患者需要耻骨上导尿。超过一半(55.56%)的患者出院时留置导尿管,全部或部分原因是导尿管损伤。90%的患者出院后至少需要一次进一步的医疗护理。结论:这是同类研究中规模最大的一项研究,证实了医源性尿道创伤是一种反复出现的医疗错误,在各个机构、医疗系统和国家都普遍存在。此外,尿道导管损伤会导致严重的患者发病率,给医疗保健服务带来巨大的经济负担。未来的创新,以提高尿导尿的安全性是必要的。
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引用次数: 2
Recognizing and Managing Pancreaticopleural Fistulas in Children. 儿童胰胸膜瘘的识别和处理。
IF 1.9 4区 医学 Q2 SURGERY Pub Date : 2022-09-01 Epub Date: 2022-07-24 DOI: 10.1080/08941939.2022.2103603
Konstantina Dimopoulou, Anastasia Dimopoulou, Nikolaos Koliakos, Andrianos Tzortzis, Dimitra Dimopoulou, Nikolaos Zavras

Background: Pancreaticopleural fistula, an abnormal communication between the pancreas and the pleural cavity, is a rare complication of pancreatic disease in children and is mainly associated with acute pancreatitis, chronic pancreatitis, trauma or iatrogenicinjury. The present review presents the current available data concerning the pathogenesis, clinical features, diagnosis and management of this unusual but difficult clinical problem among children, in order to shed light on its pathologic manifestation and raise clinical suspicion.Methods: The review of the literature was performed through a PubMed search of pediatric original articles and case reports, using the key words "pancreaticopleural fistula", "pancreatitis", "pleural effusion", "pseudocyst" and "children". The literature search revealed 47 cases of pediatric patients with pancreaticopleural fistula.Results: Diagnosis is based on the patient's medical history, physical examination and imaging, while the cornerstone of diagnosis is the presence of high pleural effusion amylase levels. The management of this disorder includes conservative, endoscopic and surgical treatment options. If treated promptly and properly, this clinical entity could have a lower rate of complications.Conclusions: The incidence of pancreaticopleural fistula in children may be underestimated in the literature, due to a reduced degree of clinical suspicion. A more heightened awareness of this entity is needed to improve the quality of life in children that suffer from this condition, as early diagnosis is essential for effective treatment and improved outcome.

背景:胰腺胸膜瘘是胰腺和胸膜腔之间的异常通信,是儿童胰腺疾病的罕见并发症,主要与急性胰腺炎、慢性胰腺炎、创伤或医源性损伤有关。本文综述了目前关于儿童这一罕见但困难的临床问题的发病机制、临床特征、诊断和治疗的现有资料,以阐明其病理表现和提高临床怀疑。方法:以“胰胸瘘”、“胰腺炎”、“胸腔积液”、“假性囊肿”、“儿童”为关键词,通过PubMed检索儿科原创文章和病例报告进行文献综述。通过文献检索,发现47例小儿胰胸瘘。结果:诊断依据患者的病史、体格检查和影像学检查,而诊断的基础是是否存在高水平的胸腔积液淀粉酶。这种疾病的治疗包括保守、内窥镜和手术治疗方案。如果治疗及时和适当,这种临床实体可以有较低的并发症率。结论:由于临床怀疑程度降低,文献中儿童胰胸膜瘘的发生率可能被低估。需要提高对这一实体的认识,以改善患有这种疾病的儿童的生活质量,因为早期诊断对于有效治疗和改善结果至关重要。
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引用次数: 0
Erector Spinae Plane Block versus Transversus Abdominis Plane Block for Postoperative Analgesia in Abdominal Surgery: A Systematic Review and Meta-Analysis. 竖脊肌平面阻滞与腹横平面阻滞对腹部手术术后镇痛的影响:系统回顾和荟萃分析。
IF 1.9 4区 医学 Q2 SURGERY Pub Date : 2022-09-01 Epub Date: 2022-07-17 DOI: 10.1080/08941939.2022.2098426
Lin Liheng, Cai Siyuan, Cai Zhen, Wu Changxue

Background: Regional anesthesia technique has been reported to exert excellent analgesic efficacy for various surgeries. Erector spinae plane block (ESPB) and transversus abdominis plane (TAP) block are good ways to relieve postoperative pain after abdominal surgery. However, the analgesic efficacy between them remains controversial. This meta-analysis evaluated the analgesic effect between these two blocks in abdominal surgery with statistical and clinical interpretation.

Methods: PubMed, Web of Science, the Cochrane Library, ClinicalTrials.gov register, and Embase databases were systematically searched by two independent investigators from the inception to December 2021.

Results: 10 randomized controlled trials (RCTs) comprising 570 patients were included in the final meta-analysis. Meta-analysis revealed that ESPB decreased the opioid consumption and improved the pain scores during the first 24 postoperative hours compared with TAP groups statistically, while the magnitude of this difference did not reach the clinically significant threshold (10 mg of intravenous morphine consumption and 1.3 cm on the VAS scale). In addition, ESPB prolonged blockade duration and decreased the occurrence of postoperative nausea and vomiting (PONV). However, it did not improve the patients' satisfaction.

Conclusions: Although ESPB does not provide better clinical analgesia than the TAP block, it could be a comparable nerve block technique for abdominal wall analgesia.

背景:区域麻醉技术已被报道在各种手术中具有良好的镇痛效果。竖脊平面阻滞(ESPB)和腹横平面阻滞(TAP)是缓解腹部手术后疼痛的好方法。然而,它们之间的镇痛效果仍存在争议。本meta分析评估了这两种阻滞在腹部手术中的镇痛效果,并进行了统计和临床解释。方法:从研究开始到2021年12月,由两名独立研究者系统地检索PubMed、Web of Science、Cochrane图书馆、ClinicalTrials.gov注册和Embase数据库。结果:10项随机对照试验(rct)包括570例患者被纳入最终的荟萃分析。meta分析显示,与TAP组相比,ESPB组术后前24小时阿片类药物消耗减少,疼痛评分改善,但差异幅度未达到临床显著阈值(静脉吗啡消耗10 mg, VAS评分1.3 cm)。此外,ESPB延长阻断持续时间,减少术后恶心和呕吐(PONV)的发生。然而,它并没有提高患者的满意度。结论:虽然ESPB的临床镇痛效果不如TAP阻滞,但它可以作为一种可比较的用于腹壁镇痛的神经阻滞技术。
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引用次数: 4
Near-Infrared Autofluorescence Imaging in Thyroid Surgery: A Systematic Review and Meta-Analysis. 近红外自体荧光成像在甲状腺手术中的应用:一项系统综述和荟萃分析。
IF 1.9 4区 医学 Q2 SURGERY Pub Date : 2022-09-01 Epub Date: 2022-07-03 DOI: 10.1080/08941939.2022.2095468
Wei Lu, Qiang Chen, Pei Zhang, Anping Su, Jingqiang Zhu

Objective: This meta-analysis aimed to assess the position of near-infrared autofluorescence (NIRAF) imaging in the recognition and protection of the parathyroid gland (PG) during thyroidectomy.

Methods: The PubMed, MEDLINE, EMBASE, Web of Science, and Cochrane Library databases were searched up to June 2021. The primary outcome was to evaluate the rates of postoperative hypocalcemia, inadvertent PG resection, and autotransplantation of PG when adopting NIRAF imaging compared with standard naked-eye (N-E) surgery.

Results: Eight studies with 2,889 patients were enrolled in the analysis. Our analysis showed that the incidence of transient hypocalcemia was 7.11% (60/844) in the NIRAF group and 22.40% (458/2045) in the N-E group (p < 0.0001) and the rate of transient hypoparathyroidism was 28.31% (126/445) and 33.36% (496/1487) in the NIRAF and N-E groups (p = 0.0008). The rate of inadvertent resection of PGs was 7.65% (55/719) in the NIRAF group and 14.39% (132/917) in the N-E group (p < 0.0001). No significant difference was observed in other indexes including the pooled proportion of permanent hypocalcemia and rate of PG autotransplantation.

Conclusions: The application of NIRAF imaging in thyroidectomy can help lower the incidence of inadvertent PG resection and reduce the risk of postoperative hypocalcemia and hypoparathyroidism compared with N-E recognition.

目的:本荟萃分析旨在评估近红外自身荧光(NIRAF)成像在甲状腺切除术中对甲状旁腺(PG)的识别和保护中的地位。方法:检索截至2021年6月的PubMed、MEDLINE、EMBASE、Web of Science和Cochrane Library数据库。主要结果是评估采用NIRAF成像与标准裸眼(N-E)手术相比,术后低钙、无意PG切除和PG自体移植的发生率。结果:8项研究,2889例患者纳入分析。我们的分析显示,NIRAF组的短暂性低钙血症发生率为7.11% (60/844),N-E组为22.40% (458/2045)(p p = 0.0008)。NIRAF组和N-E组的PG误切率分别为7.65%(55/719)和14.39%(132/917)。(p)结论:与N-E识别相比,NIRAF成像在甲状腺切除术中的应用有助于降低PG误切的发生率,降低术后低钙血症和甲状旁腺功能低下的风险。
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引用次数: 5
The Comparison of Postoperative Analgesic Efficacy of Ultrasound-Guided Paravertebral Block and Mid-Point Transverse Process Pleura Block in Mastectomy Surgeries: A Randomized Study. 超声引导椎旁阻滞与胸膜横突中点阻滞在乳房切除术术后镇痛效果的比较:一项随机研究。
IF 1.9 4区 医学 Q2 SURGERY Pub Date : 2022-09-01 Epub Date: 2022-07-17 DOI: 10.1080/08941939.2022.2098544
Agâh Abdullah Kahramanlar, Mehmet Aksoy, Ilker Ince, Aysenur Dostbıl, Erdem Karadenız

Purpose/aim of the study: The purpose of this triple-blind randomized study is to compare the postoperative analgesic efficacy of Mid-Point Transverse Process Pleura Block (MTP) and Paravertebral Block (PVB) in patients undergoing breast surgery.

Materials and methods: The study was retrospectively registered on ClinicalTrials.gov (NCT05332028). A total of 64 patients undergoing unilateral simple mastectomy operation due to breast cancer were included in the study. Before the anesthesia procedure, participants were randomly assigned to one of two groups: Group 1: Participants undergoing PVB or Group 2: Participants undergoing MTP block. All block applications were performed using 20 mL of 0.25% bupivacaine. Routine general anesthesia protocol was performed on all patients. In the postanesthetic care unit, fentanyl infusion was given to all patients postoperatively via a patient-controlled analgesia device. Postoperative fentanyl consumption, time to the first request for analgesia, VAS score values at rest and in motion, and blocked dermatome areas were recorded.

Results: Postoperative total opioid consumption, the number of patients given rescue analgesia, the time requiring postoperative supplemental analgesia, postoperative pain scores at rest and in motion, and blocked dermatome areas at both anterior and posterior lower and upper limits were not different between groups (p > 0.05, for all).

Conclusions: It was concluded that ultrasound-guided PVB and MTP blocks have similar postoperative analgesic efficacy in patients undergoing breast surgery. The MTP block may be preferred as an alternative to PVB for breast surgeries with less risk of complications.

研究目的/目的:本三盲随机研究的目的是比较胸膜中点横突阻滞(MTP)和椎旁阻滞(PVB)在乳房手术患者术后的镇痛效果。材料和方法:该研究在ClinicalTrials.gov (NCT05332028)上回顾性注册。本研究共纳入64例因乳腺癌行单侧乳房切除术的患者。在麻醉之前,参与者被随机分配到两组中的一组:第一组:接受PVB的参与者或第二组:接受MTP阻滞的参与者。所有阻滞应用均使用20ml 0.25%布比卡因。所有患者均行常规全身麻醉。在麻醉后护理单元,所有患者术后均通过患者自控镇痛装置输注芬太尼。记录术后芬太尼用量、第一次请求镇痛的时间、静止和运动时的VAS评分值以及皮肤组织阻塞区域。结果:术后阿片类药物总用量、给予抢救性镇痛的患者人数、术后需要补充镇痛的时间、术后静息和运动疼痛评分、前、后下限和上限皮肤组织阻塞面积组间差异均无统计学意义(p > 0.05)。结论:超声引导下PVB阻滞与MTP阻滞对乳腺手术患者的术后镇痛效果相似。在乳房手术中,MTP阻滞可作为PVB的替代方案,并发症风险较小。
{"title":"The Comparison of Postoperative Analgesic Efficacy of Ultrasound-Guided Paravertebral Block and Mid-Point Transverse Process Pleura Block in Mastectomy Surgeries: A Randomized Study.","authors":"Agâh Abdullah Kahramanlar,&nbsp;Mehmet Aksoy,&nbsp;Ilker Ince,&nbsp;Aysenur Dostbıl,&nbsp;Erdem Karadenız","doi":"10.1080/08941939.2022.2098544","DOIUrl":"https://doi.org/10.1080/08941939.2022.2098544","url":null,"abstract":"<p><strong>Purpose/aim of the study: </strong>The purpose of this triple-blind randomized study is to compare the postoperative analgesic efficacy of Mid-Point Transverse Process Pleura Block (MTP) and Paravertebral Block (PVB) in patients undergoing breast surgery.</p><p><strong>Materials and methods: </strong>The study was retrospectively registered on ClinicalTrials.gov (NCT05332028). A total of 64 patients undergoing unilateral simple mastectomy operation due to breast cancer were included in the study. Before the anesthesia procedure, participants were randomly assigned to one of two groups: Group 1: Participants undergoing PVB or Group 2: Participants undergoing MTP block. All block applications were performed using 20 mL of 0.25% bupivacaine. Routine general anesthesia protocol was performed on all patients. In the postanesthetic care unit, fentanyl infusion was given to all patients postoperatively via a patient-controlled analgesia device. Postoperative fentanyl consumption, time to the first request for analgesia, VAS score values at rest and in motion, and blocked dermatome areas were recorded.</p><p><strong>Results: </strong>Postoperative total opioid consumption, the number of patients given rescue analgesia, the time requiring postoperative supplemental analgesia, postoperative pain scores at rest and in motion, and blocked dermatome areas at both anterior and posterior lower and upper limits were not different between groups (<i>p</i> > 0.05, for all).</p><p><strong>Conclusions: </strong>It was concluded that ultrasound-guided PVB and MTP blocks have similar postoperative analgesic efficacy in patients undergoing breast surgery. The MTP block may be preferred as an alternative to PVB for breast surgeries with less risk of complications.</p>","PeriodicalId":16200,"journal":{"name":"Journal of Investigative Surgery","volume":"35 9","pages":"1694-1699"},"PeriodicalIF":1.9,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40601829","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}
引用次数: 3
Three-Dimensional in Vivo Anatomical Study of Female Iliac Vein Variations. 女性髂静脉变异的三维体内解剖研究。
IF 1.9 4区 医学 Q2 SURGERY Pub Date : 2022-09-01 Epub Date: 2022-07-06 DOI: 10.1080/08941939.2022.2095469
Wenling Zhang, Chunlin Chen, Guidong Su, Hui Duan, Zhiqiang Li, Ping Shen, Jiaxin Fu, Ping Liu

Objective: To investigate female iliac vein variations by using the computed tomography angiography (CTA) three-dimensional (3 D) reconstruction technique.

Methods: We retrospectively studied 1623 patients undergoing abdominal and pelvic CTA scanning for gynecological diseases from December 2009 to December 2018. Accurate digital 3 D models of the iliac vein were constructed using Mimics 19.0 software and used to study the morphology and variations. Variations in the common iliac vein (CIV), external iliac vein (EIV) and internal iliac vein (IIV) were classified as type I, abnormal number of veins; type II, abnormal communicating branches; or type III, other variations.

Results: The overall variation rates of the iliac vein and CIV were 51.57% (837/1623) and 20.33% (330/1623), respectively. The main type of CIV variation was type II. The main type I CIV variation was the absence of the CIV (98.15%), which mostly occurred on the right side (64.81%, 35/54). Type II CIV variation was the most common, with abnormal communicating branches between the left CIV and right IIV (81.78%, 211/258). The overall variation rates of the EIV and IIV were 36.66% (595/1623) and 49.60% (805/1623), respectively, mainly on the right side. The main type of variation was type I. Among them, the division of the IIV into two branches plus convergence with the ipsilateral EIV was the most common (22.98%, 373/1623).

Conclusion: In this study, approximately half of the patients had iliac vein variations. The preoperative identification of iliac vein variation may reduce vascular injury in pelvic surgery.

目的:应用计算机断层血管造影(CTA)三维重建技术研究女性髂静脉病变。方法:回顾性分析2009年12月至2018年12月1623例接受腹部和盆腔CTA扫描的妇科疾病患者。利用Mimics 19.0软件构建精确的髂静脉数字三维模型,研究其形态及变化。髂总静脉(CIV)、髂外静脉(EIV)和髂内静脉(IIV)的变异为I型,静脉数量异常;II型,通信分支异常;或III型,其他变种。结果:髂静脉和CIV的总变异率分别为51.57%(837/1623)和20.33%(330/1623)。CIV变异类型以II型为主。I型CIV变异以无CIV为主(98.15%),多发生在右侧(64.81%,35/54)。II型CIV变异最为常见,左侧CIV与右侧CIV之间的交流分支异常(81.78%,211/258)。EIV和IIV的总体变异率分别为36.66%(595/1623)和49.60%(805/1623),以右侧为主。变异类型以i型为主,其中以IIV分为两支并与同侧EIV汇合最为常见(22.98%,373/1623)。结论:在这项研究中,大约一半的患者有髂静脉变异。术前识别髂静脉变异可减少骨盆手术中的血管损伤。
{"title":"Three-Dimensional in Vivo Anatomical Study of Female Iliac Vein Variations.","authors":"Wenling Zhang,&nbsp;Chunlin Chen,&nbsp;Guidong Su,&nbsp;Hui Duan,&nbsp;Zhiqiang Li,&nbsp;Ping Shen,&nbsp;Jiaxin Fu,&nbsp;Ping Liu","doi":"10.1080/08941939.2022.2095469","DOIUrl":"https://doi.org/10.1080/08941939.2022.2095469","url":null,"abstract":"<p><strong>Objective: </strong>To investigate female iliac vein variations by using the computed tomography angiography (CTA) three-dimensional (3 D) reconstruction technique.</p><p><strong>Methods: </strong>We retrospectively studied 1623 patients undergoing abdominal and pelvic CTA scanning for gynecological diseases from December 2009 to December 2018. Accurate digital 3 D models of the iliac vein were constructed using Mimics 19.0 software and used to study the morphology and variations. Variations in the common iliac vein (CIV), external iliac vein (EIV) and internal iliac vein (IIV) were classified as type I, abnormal number of veins; type II, abnormal communicating branches; or type III, other variations.</p><p><strong>Results: </strong>The overall variation rates of the iliac vein and CIV were 51.57% (837/1623) and 20.33% (330/1623), respectively. The main type of CIV variation was type II. The main type I CIV variation was the absence of the CIV (98.15%), which mostly occurred on the right side (64.81%, 35/54). Type II CIV variation was the most common, with abnormal communicating branches between the left CIV and right IIV (81.78%, 211/258). The overall variation rates of the EIV and IIV were 36.66% (595/1623) and 49.60% (805/1623), respectively, mainly on the right side. The main type of variation was type I. Among them, the division of the IIV into two branches plus convergence with the ipsilateral EIV was the most common (22.98%, 373/1623).</p><p><strong>Conclusion: </strong>In this study, approximately half of the patients had iliac vein variations. The preoperative identification of iliac vein variation may reduce vascular injury in pelvic surgery.</p>","PeriodicalId":16200,"journal":{"name":"Journal of Investigative Surgery","volume":"35 9","pages":"1679-1685"},"PeriodicalIF":1.9,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40476097","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}
引用次数: 2
Quantification of Dermal Microcirculatory Changes after Topical Administration of Capsaicin: A Randomized Placebo-Controlled Study in 46 Subjects. 局部施用辣椒素后皮肤微循环变化的量化:一项46名受试者的随机安慰剂对照研究。
IF 1.9 4区 医学 Q2 SURGERY Pub Date : 2022-09-01 Epub Date: 2022-07-14 DOI: 10.1080/08941939.2022.2091694
Ruth Christine Schäfer, Anna Sohn, Anabel Kersten, Amro Amr, Manuel Held, Andrea Wenger

Background: Dermal blood flow is crucial for wound healing and survival of flaps in dermatologic surgery. To improve flap viability in cases of compromised perfusion topical agents can easily be applied. The aim of this placebo-controlled study was to characterize changes of DBF in healthy subjects by quantitatively assessing perfusion dynamics after application of capsaicin to establish a reference for measurements at injured sites.

Methods: In 46 healthy subjects perfusion dynamics after local application with capsaicin and placebo was noninvasively assessed, determining cutaneous oxygen saturation, relative hemoglobin count and blood flow using an Oxygen-to-See device.

Results: A significant raise in superficial (162% p = 0.000) and deep (144%, p = 0.000) skin oxygenation after 30 min was provoked. A highly significant raise in measurements of flow and velocity was present in superficial (523%, p = 0.000) and deep (242%, p = 0.000) sites.

Conclusion: With the introduced model applied to observe changes in parameters of dermal blood flow in healthy subjects the authors can reliably monitor effects of topically administered capsaicin. This baseline can be used as reference for further studies in the settings of endangered flap survival or critically perfused wounds as has been proven in animal studies.

背景:真皮血流对皮肤外科创面愈合和皮瓣存活至关重要。在血流灌注受损的情况下,局部药物可以很容易地改善皮瓣的生存能力。这项安慰剂对照研究的目的是通过定量评估辣椒素应用后灌注动力学来表征健康受试者DBF的变化,为损伤部位的测量建立参考。方法:对46名健康受试者局部应用辣椒素和安慰剂后的灌注动态进行无创评估,使用oxygen -to- see装置测定皮肤氧饱和度、相对血红蛋白计数和血流。结果:诱发30 min后,皮肤表层氧合显著升高(162% p = 0.000),深层氧合显著升高(144% p = 0.000)。在浅层(523%,p = 0.000)和深层(242%,p = 0.000)地点的流量和速度测量值有非常显著的提高。结论:将所建立的模型应用于观察健康受试者皮肤血流参数的变化,可以可靠地监测辣椒素局部给药的效果。这一基线可作为进一步研究的参考,在濒危皮瓣存活或严重灌注伤口的情况下,已经在动物研究中得到证实。
{"title":"Quantification of Dermal Microcirculatory Changes after Topical Administration of Capsaicin: A Randomized Placebo-Controlled Study in 46 Subjects.","authors":"Ruth Christine Schäfer,&nbsp;Anna Sohn,&nbsp;Anabel Kersten,&nbsp;Amro Amr,&nbsp;Manuel Held,&nbsp;Andrea Wenger","doi":"10.1080/08941939.2022.2091694","DOIUrl":"https://doi.org/10.1080/08941939.2022.2091694","url":null,"abstract":"<p><strong>Background: </strong>Dermal blood flow is crucial for wound healing and survival of flaps in dermatologic surgery. To improve flap viability in cases of compromised perfusion topical agents can easily be applied. The aim of this placebo-controlled study was to characterize changes of DBF in healthy subjects by quantitatively assessing perfusion dynamics after application of capsaicin to establish a reference for measurements at injured sites.</p><p><strong>Methods: </strong>In 46 healthy subjects perfusion dynamics after local application with capsaicin and placebo was noninvasively assessed, determining cutaneous oxygen saturation, relative hemoglobin count and blood flow using an Oxygen-to-See device.</p><p><strong>Results: </strong>A significant raise in superficial (162% <i>p</i> = 0.000) and deep (144%, <i>p</i> = 0.000) skin oxygenation after 30 min was provoked. A highly significant raise in measurements of flow and velocity was present in superficial (523%, <i>p</i> = 0.000) and deep (242%, <i>p</i> = 0.000) sites.</p><p><strong>Conclusion: </strong>With the introduced model applied to observe changes in parameters of dermal blood flow in healthy subjects the authors can reliably monitor effects of topically administered capsaicin. This baseline can be used as reference for further studies in the settings of endangered flap survival or critically perfused wounds as has been proven in animal studies.</p>","PeriodicalId":16200,"journal":{"name":"Journal of Investigative Surgery","volume":"35 9","pages":"1673-1678"},"PeriodicalIF":1.9,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40617330","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}
引用次数: 0
Minimally Invasive Concepts in Treating Synchronous Liver Metastases Rectal Cancer Patients: Report of Six Cases. 微创治疗同步性肝转移直肠癌6例报告。
IF 1.9 4区 医学 Q2 SURGERY Pub Date : 2022-09-01 Epub Date: 2022-07-10 DOI: 10.1080/08941939.2022.2088905
Hao Zhang, Yinghu Jin, Rui Huang, Guiyu Wang

Background: Rectal cancer patients with synchronous liver metastases (SLM) is common in clinical practice. However, the application of conventional natural orifice specimen extraction surgery (NOSES) and NOSES with specimen extraction via stoma/hepatectomy incision in the special population is rarely explored.

Case report: Six SLM rectal cancer patients were treated with simultaneous surgical resection and the specimens were extracted via anal/stoma/hepatectomy incision. Respectively, intraoperative and postoperative data, anal function 3 months after surgery and long-term prognosis were reviewed.

Results: Intraoperative and postoperative data and anal function were reliable for the six cases. Only one patient died of brain and bone metastases at 84 months after surgery and the other five patients were alive at their last follow-up.

Conclusions: Simultaneous surgical resection with the concept of conventional NOSES and NOSES with specimen extraction via stoma/hepatectomy incision is safety for SLM rectal patients.

背景:直肠癌伴同步肝转移(SLM)在临床上较为常见。然而,传统的自然口标本提取手术(鼻)和鼻与经口/肝切除切口标本提取在特殊人群中的应用很少被探索。病例报告:6例SLM直肠癌患者行同期手术切除,标本经肛门/造口/肝切除切口取出。分别回顾术中、术后资料、术后3个月肛门功能及远期预后。结果:6例患者术中、术后资料及肛门功能可靠。只有一名患者在手术后84个月死于脑和骨转移,其他5名患者在最后一次随访时还活着。结论:直肠SLM患者同时行常规鼻及鼻联合造口/肝切除切口取标本是安全的。
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引用次数: 0
Impact of Diameter of Perforator in Pedicle and Different Managements of Intermediate Non-Pedicle Perforator on Flap Survival in Rats. 椎弓根穿支直径及中间非椎弓根穿支不同处理对大鼠皮瓣存活的影响。
IF 1.9 4区 医学 Q2 SURGERY Pub Date : 2022-09-01 Epub Date: 2022-07-19 DOI: 10.1080/08941939.2022.2097345
Donghong Liu, Fang Fang, Yuehong Zhuang

Backgrounds: The quantified relationship between perforator diameter and flap length can be supported, and the impact of different strategies of managements of a non-pedicled perforator with two major subfascial divisions on flap survival has never been explored.

Materials and methods: This study was divided into two parts. In Part I, 48 Sprague-Dawley rats underwent flap harvesting based on six perforators with a diameter gradient. Then, the flap length and perforator diameter were measured for establishment of an equation. In Part II, 32 rats underwent harvest of a transverse flap based on the right superficial epigastric perforator. In 16 rats the right intermediate iliolumbar perforator was severed in a distal-to-division approach, whereas, in the other 16 rats, it was severed with in a proximal-to-division approach. Necrosis rates and blood perfusion were also compared.

Results: The equation y = 13.02 × x + 2.29 could be established between the perforator diameter in the pedicle (x) and the flap length (y) that could be supported with R2=0.8963 and P < 0.001.The transverse flap with a distal-to-division management of the intermediate iliolumbar perforasome was weaker in perfusion and had a necrosis rate of 49±4%, whereas the flap with a proximal-to division management had a significantly stronger perfusion and a lower necrosis rate of 21±2% (P<0.001).

Conclusions: The safe flap length that can be estimated based on a perforator with a known diameter can be calculated using y=13.02× x +2.29. A short segment of the stem of an intermediate perforator with two major subfascial branches should be preserved to augment flap survival.

背景:穿支直径与皮瓣长度之间的量化关系可以得到支持,但对于具有两个主要筋膜下分隔的无蒂穿支,不同的处理策略对皮瓣存活的影响从未被探讨过。材料与方法:本研究分为两部分。在第一部分中,48只Sprague-Dawley大鼠进行了基于六个直径梯度穿支的皮瓣收获。然后,测量皮瓣长度和穿孔直径,建立方程。在第二部分中,32只大鼠接受了基于右侧腹壁浅穿支的横向皮瓣。在16只大鼠中,右中间髂腰穿支在远端至分裂入路中被切断,而在另外16只大鼠中,它在近端至分裂入路中被切断。并比较坏死率和血流灌注。结果:经椎弓根穿支直径(x)与皮瓣可支撑长度(y)之间建立方程y = 13.02 × x + 2.29, R2=0.8963, P < 0.001。髂中段穿支远端分束管理的横瓣灌注较弱,坏死率为49±4%,而近端分束管理的皮瓣灌注较强,坏死率较低,为21±2% (p)结论:根据已知直径的穿支估计的安全皮瓣长度可以用y=13.02× x +2.29计算。中间穿支茎的短段与两个主要的筋膜下分支应保留,以增加皮瓣的生存。
{"title":"Impact of Diameter of Perforator in Pedicle and Different Managements of Intermediate Non-Pedicle Perforator on Flap Survival in Rats.","authors":"Donghong Liu,&nbsp;Fang Fang,&nbsp;Yuehong Zhuang","doi":"10.1080/08941939.2022.2097345","DOIUrl":"https://doi.org/10.1080/08941939.2022.2097345","url":null,"abstract":"<p><strong>Backgrounds: </strong>The quantified relationship between perforator diameter and flap length can be supported, and the impact of different strategies of managements of a non-pedicled perforator with two major subfascial divisions on flap survival has never been explored.</p><p><strong>Materials and methods: </strong>This study was divided into two parts. In Part I, 48 Sprague-Dawley rats underwent flap harvesting based on six perforators with a diameter gradient. Then, the flap length and perforator diameter were measured for establishment of an equation. In Part II, 32 rats underwent harvest of a transverse flap based on the right superficial epigastric perforator. In 16 rats the right intermediate iliolumbar perforator was severed in a distal-to-division approach, whereas, in the other 16 rats, it was severed with in a proximal-to-division approach. Necrosis rates and blood perfusion were also compared.</p><p><strong>Results: </strong>The equation y = 13.02 × x + 2.29 could be established between the perforator diameter in the pedicle (x) and the flap length (y) that could be supported with R<sup>2</sup>=0.8963 and P < 0.001.The transverse flap with a distal-to-division management of the intermediate iliolumbar perforasome was weaker in perfusion and had a necrosis rate of 49±4%, whereas the flap with a proximal-to division management had a significantly stronger perfusion and a lower necrosis rate of 21±2% (P<0.001).</p><p><strong>Conclusions: </strong>The safe flap length that can be estimated based on a perforator with a known diameter can be calculated using y=13.02× x +2.29. A short segment of the stem of an intermediate perforator with two major subfascial branches should be preserved to augment flap survival.</p>","PeriodicalId":16200,"journal":{"name":"Journal of Investigative Surgery","volume":"35 9","pages":"1686-1693"},"PeriodicalIF":1.9,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40519707","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}
引用次数: 0
Systemic Inflammation Response Index and Systemic Immune Inflammation Index Are Associated with Clinical Outcomes in Patients with Acute Pancreatitis? 全身性炎症反应指数和全身性免疫炎症指数与急性胰腺炎患者的临床结局有关?
IF 1.9 4区 医学 Q2 SURGERY Pub Date : 2022-08-01 DOI: 10.1080/08941939.2022.2084187
Murat Biyik, Zeynep Biyik, Mehmet Asil, Muharrem Keskin

Objectives: The inflammatory response is critically important in acute pancreatitis (AP). Systemic immune-inflammation (SII) index and systemic inflammation response index (SIRI), which are novel inflammatory markers, have been linked to determining outcomes in various diseases. The goal of the current study was to examine the relation of the SII index and SIRI with disease severity and acute kidney injury (AKI) in subjects with AP.

Methods: A total of 332 subjects with AP were analyzed retrospectively. SII index was calculated using the formula; platelet (P)×neutrophil (N)/lymphocyte (L), while SIRI was calculated as N × monocyte (M)/L count. Multivariate regression (MR) was done to determine the independent risk factors for AKI and severe AP (SAP).

Results: Statistical analyses showed that both median SII index and median SIRI increased gradually with higher AP severity (p < 0.001). Both SII index and SIRI were higher in subjects with AKI compared to controls (p < 0.001). Using MR analysis, the SII index was found to independently predict both SAP (OR = 1.004, 95% CI: 1.001-1.008, p = 0.018) and AKI (OR = 1.005, 95% CI: 1.003-1.008, p < 0.001). ROC analysis showed that the SII index could accurately differentiate SAP (AUC = 0.809, p < 0.001) and AKI (AUC = 0.820, p = 0.001) in patients with acute pancreatitis. ROC analysis also showed that SIRI could also accurately differentiate SAP (0.782, p < 0.001) and AKI (AUC = 0.776, p = 0.001).

Conclusions: SIRI and the SII indexes can be used as potential biomarkers in predicting both disease severity and AKI development in subjects with AP.

目的:炎症反应在急性胰腺炎(AP)中至关重要。系统性免疫炎症(SII)指数和系统性炎症反应指数(SIRI)是一种新的炎症标志物,与多种疾病的预后有关。本研究旨在探讨AP患者SII指数和SIRI与疾病严重程度和急性肾损伤(AKI)的关系。方法:对332例AP患者进行回顾性分析。SII指数采用公式计算;血小板(P)×neutrophil (N)/淋巴细胞(L), SIRI计算为N ×单核细胞(M)/L计数。采用多变量回归(MR)确定AKI和严重AP (SAP)的独立危险因素。结果:统计分析显示,急性胰腺炎患者SII指数中位值和SIRI中位值随AP严重程度(p p = 0.018)和AKI (OR = 1.005, 95% CI: 1.003-1.008, p p p = 0.001)的升高而逐渐升高。ROC分析也显示SIRI也能准确区分SAP (0.782, p p = 0.001)。结论:SIRI和SII指标可作为预测AP患者疾病严重程度和AKI发展的潜在生物标志物。
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引用次数: 9
期刊
Journal of Investigative Surgery
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