International Journal of Surgery Open最新文献

Background

Due to their advanced age and the prevalence of numerous co-morbid conditions, elderly patients scheduled for surgery are at risk for preoperative ECG abnormalities. Although preoperative ECG is frequently used to identify cardiovascular diseases and reduce intraoperative morbidity and mortality, its impact in predicting perioperative cardiovascular complications is under debate.

Objective

The aim of this study was to determine the impact of preoperative abnormal ECG on anesthesia management among older surgical patients in southern Ethiopia, 2022.

Method

ology: A multicenter prospective observational study on 246 elderly surgical patients recruited consecutively was conducted at three teaching hospitals in southern Ethiopia. Data were entered into Epidata version 4.6, then exported and analyzed in STATA version 16. The data was presented in the appropriate manner, using numbers, frequencies, tables, charts, and figures. To test categorical variables, the Chi-square test was used. P-values of 0.05 were considered statistically significant.

Result

In this study, 120 (48.78%) of older surgical patients had abnormal preoperative ECGs. In terms of severity, 55.3% were classified as minor, while 44.16% were major ECG abnormalities. 26 (21.66%) of patients with abnormal ECG were decided as unfit for anesthesia and reasons for the decision were the need for further investigation, consultation, and optimization. In addition, 7.31% of patients were delayed due to an abnormal ECG with a mean operative delay of 4.23 days. Preoperative abnormal ECG influenced the decision of anesthesia plan in four (1.62%) of the cases. Patients with an abnormal ECG prior to surgery were more likely to experience an intraoperative arrhythmia (p-value = 0.001).

Conclusion

and recommendation: Almost half (48.78%) of elderly patients presenting for surgery have an abnormal ECG, which impacts patients by postponing surgery and necessitating further investigation. Preoperative ECG is recommended prior to any elective surgery as early as 50 years, especially for those with risk factors.

Introduction

Secondary spontaneous pneumothorax (SSP) is a rare disease that accumulates air in the pleural cavity caused by complications from previous illnesses.

Case presentation

An Indonesian male, 59 years old, complained of breathlessness and chest pain. The patient was examined for Mycobacterium tuberculosis and not detected. Chest X-ray and thorax high-resolution computer tomography (HRCT) scan showed SSP and centrilobular emphysema in the left hemithorax. The patient underwent water seal drainage (WSD) installation on the left lung and experienced improvement and was followed up every month in the outpatient clinic.

Clinical discussion

Diagnosis of SSP is based on age, gender, smoker, and radiological description. WSD installation in the left lung showed improvement and did not experience recurrence because several cases were reported to have been repaired without surgery.

Conclusion

Conservative management is the first recommendation in the SSP case if it increases the prognosis without surgery.

Introduction

Colorectal cancer (CRC) accounts for 10% of all cancer incidences globally and often affects older populations and people with poor nutrition. As such, we developed a prediction model for low functional status following CRC surgery using inpatient data collected during routine practice, and investigated the relationship between low functional status and outcomes.

Methods

Data from 690 patients who underwent CRC surgery were analysed, and the Barthel Index was used to evaluate functional status [activity of daily living (ADL)]. A low-ADL status was defined as a lower score at discharge than at admission, and unchanged complete dependence from admission to discharge. The model input data included 10 basic characteristics, eight comorbidities, and four laboratory parameters. The final model was developed using stepwise logistic regression.

Results

The low-ADL predictive model was successfully developed using nine variables: age, ADL dependence, nursing home residency, ambulance use, disturbance of consciousness on admission, diabetes, cerebrovascular disease, low creatinine, and low protein (c-statistics = 0.857). Only 6.5% of high-ADL patients were unable to return home following discharge; in contrast, 53.5% of low-ADL patients were unable to return home. Low-ADL patients also had significantly longer post-operative hospital stays and higher medical costs than high-ADL patients.

Conclusion

Low-ADL patients had decreased rates of discharge to homes, experienced longer hospital stays, and incurred higher medical costs than high-ADL patients. Pre-operative prediction of low ADL status is important, and essential for taking efficient preventive measures.

Introduction and importance

Bowel obstruction is known as an increasing complication during pregnancy. This case report showed a pregnant woman with intestinal necrosis in the context of torsion.

Case presentation

A 33-year-old Asian woman, primigravida at 25 weeks and 4 days gestation, presented to hospital with a history of nausea and epigastric pain. Patient’ past medical history showed usual evaluating abdominal pain with vaginal bleeding and leaking of fluid in her obstetric history.

Clinical discussion

The patient was discharged from hospital in a good general condition one week after the surgery. A full-term infant weighted 3000 g was delivered by caesarean section in 39 weeks gestational age with 1–5 minute Apgar scores of 7–10.

Conclusion

The aim of the study is to report a new case of intestinal necrosis in a pregnant woman.

Recently, Ruxolitinib (Opzelura) has been approved by the Food and Drug Administration (FDA) as the first treatment for non-segmental vitiligo, which results in chalky white macules with clear edges due to an autoimmune disorder. The mode of action of this cream is JAK inhibition which progressively enhances the growth of new, healthy skin cells, and eventually, repigmentation occurs in the affected area. Indeed, this medication represents significance in the field of dermatology as almost 3/4th % of facial vitiligo was resolved but the high cost will be a hindrance in facilitating the patients and should be subsidized. Moreover, prescribers and pharmacists should be aware of the black box warnings issued by FDA as severe caution is indicated. More clinical trials should be conducted to know the safety of children under 12 years of age.

Tooth autotransplantation is a tooth replacement treatment modality in which a tooth from an individual is transplanted into another site in the same person. Transplantation of tooth germ with unformed roots or in early stages of root development is seldom practiced even among clinicians who usually practice tooth transplantation. In this paper, we discuss this debatable topic and provide experience-based perspective regarding autologous transplantation of teeth that lack sufficient root length. This paper raises the possibility of performing autotransplantation of donor teeth that were previously considered sub-optimal.

Introduction

Fluoroscopic-guided retrograde ureteric stent exchange is a commonly performed procedure at our institution for patients with treated gynaecological malignancy. Technical challenges are often met during the procedure. This approach is well-tolerated and does not require general anaesthetic. Routine exchange is required every 16–20 weeks.

Presentation of cases

We describe the technique of fluoroscopic-guided retrograde transurethral ureteric stent exchange and outline potential technical pitfalls through a series of recent cases at our institution. Challenges encountered include stent encrustation, stent malposition, tangled stents and loss of access.

Discussion

The case series demonstrates a variety of solutions to challenging technical situations including manual breakdown of luminal debris, stent repositioning and snaring techniques, and methods for overcoming loss of access. Successful outcomes were achieved in the majority of cases.

Conclusion

Fluoroscopic-guided retrograde ureteric stent exchange is a challenging technique, not universally performed in all interventional departments. The technique is generally well tolerated and avoids the need for general anaesthesia.