Minerva Surgery最新文献

Background: Peristomal skin complications represent one of the main clinical concerns in people with an ostomy. Existing assessment tools do not include preventive approaches and active participation of the patient. S.A.C.S. Evolution was created to fill this gap, introducing the concept of healthy peristomal skin (L0) as a primary clinical reference and developing a dual interface dedicated to the healthcare professional and the patient.

Methods: A prospective multicenter observational study validated the psychometric properties of S.A.C.S.

Evolution: Phase one tested face validity, phase two tested content validity and phase three evaluated criterion and predictive validity with the longitudinal application on patients with intestinal or urinary ostomy, followed at 1, 3, and 6 months.

Results: Face validity reached unanimous consensus among both healthcare professionals and patients. Content validity showed a Content Validity Index > 0.96 among professionals and 1.00 among patients. Criterion validity showed a 95.5% agreement between S.A.C.S. Evolution and S.A.C.S. 2.0 assessments, and a high overlap between patient and stoma nurse evaluations. Longitudinal analysis showed a significant reduction in lesion severity over time, with an increase in the marginal probability of maintaining a healthy skin state (L0) above 90% at six months. Age was confirmed as a predictive factor of greater severity.

Conclusions: S.A.C.S. Evolution proved valid, reliable, and clinically sensitive in the assessment of peristomal skin condition and consequent prevention of peristomal alterations. Its dual interface, clear terminology, and focus on healthy peristomal skin support early prevention, patient empowerment, and standardization of stoma care pathways. Digital integration could further enhance its impact.

Cervical spine fractures are a critical concern in emergency medicine, often resulting in significant morbidity and mortality. Early recognition and management are essential to prevent secondary spinal cord injuries and optimize patient outcomes. This review examines current assessment and treatment strategies for cervical spine fractures in the emergency department. Clinical decision rules such as the Canadian C-Spine Rule and the National Emergency X-Radiography Utilization Study (NEXUS) aid in determining the need for imaging, while computed tomography remains the gold standard for diagnosis. Traditional immobilization techniques, including manual inline spinal immobilization and cervical collars, are widely used, though recent evidence challenges their effectiveness in reducing neurological deterioration. Management approaches vary depending on the severity and stability of the fracture, with stable injuries often treated conservatively and unstable fractures requiring surgical intervention. New evidence suggests that a more individualized approach to immobilization and management may be beneficial, balancing patient comfort and clinical outcomes. Adherence to established trauma protocols remains critical in ensuring timely intervention and reducing complications. Further research is necessary to refine immobilization practices and develop more targeted treatment strategies to improve long-term outcomes for patients with cervical spine fractures.

Respiratory disorders can be broadly classified into two primary categories: those triggered by infectious agents and those stemming from noninfectious factors. The infectious group comprises a wide array of pathogens, including bacteria, viruses, and fungi. In contrast, the noninfectious category encompasses conditions such as immune system dysfunctions, as well as both malignant and benign tumors. Given the intricate and diverse nature of these diseases, accurate diagnosis often requires more than just routine clinical assessments and conventional imaging techniques. To address this complexity, the medical community has increasingly turned to minimally invasive diagnostic methods, which provide enhanced precision in managing complex cases. This comprehensive review delves into the utilization of these cutting-edge minimally invasive technologies within the field of respiratory medicine. It meticulously outlines their current applications, highlights their benefits and limitations, and also explores potential directions for future research endeavors, aiming to shed light on the evolving landscape of respiratory disease diagnosis and management.

Background: Pancreatoduodenectomy (PD) is one of the most challenging surgical procedures among abdominal surgeries. The most common complication after PD is postoperative pancreatic fistula (POPF), which can be severe and entail other complications, such as post-pancreatectomy hemorrhage (PPH), which can be fatal. Several surgical techniques have been proposed to reduce the incidence of POPF and PPH.

Methods: In this study, we describe inframesocolic pancreatic anastomosis, which involves segregating the pancreatic anastomosis into the inframesocolic area by mobilizing the pancreatic remnant and creating a small window into the transverse mesocolon.

Results: This surgical technique was performed in 17 patients, with promising results in terms of delayed PPH prevention. In particular, we had only one case of PPH that was successfully treated by placing a stent into the SMA. No other bleeding events were reported, even in cases of anastomotic leakage.

Conclusions: In the context of mitigation strategies, this technique might be efficient in reducing the incidence of delayed PPH due to leakage of pancreatic juice into the supramesocolic area and consequent vascular erosion.

Background: Tube ileostomy can prevent anastomotic leakage (AL) on the patients underwent lower anterior resection. However, it has one major disadvantage: the inability to control fecal diversion efficacy (FDE). In this single-center, prospective randomized controlled trial (RCT), we evaluated a novel technique, pressure-controlled tube ileostomy (PCTI), which uses cuff-pressure adjustment to maintain reliable FDE, and assessed its safety and effectiveness.

Methods: This study was conducted as a single-center prospective RCT. Patients were randomly allocated (1:1) to PCTI or LI (Ll) using a computer-generated sequence with allocation concealment via sealed opaque envelopes; blinding of surgeons/patients was not feasible.

Results: Baseline characteristics were comparable between groups. The anastomotic leakage rates were 9.2% (23/250) in the PCTI group and 9.7% (24/248) in the LI group received the initial surgery (P=0.85). The rates of stoma-related complications including infections, irritant dermatitis, herniation and so on, were 8.8% in PCTI group and 16.2% in LI group (P=0.0133), respectively. Fifteen patients received LI retained their stoma, compared with 2 in the PCTI group (P=0.0013). In PCTI group, the time of cannula extubation and stoma closure after cannula extubation were 20.5±4.6 and 7.2±4.4 days, respectively.

Conclusions: The PCTI can effectively inhibit the occurrence of grade C anastomotic leakage and reduce the occurrence of serious complications caused by anastomotic leakage through the FDE control by adjusting the cuff pressure and can avoid secondary reversal surgery. We consider that the improved PCTI is a safe and practical-surgical technique in protecting the anastomosis.