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Ileo-sigmoid knotting: A case series of 25 patients 乙状结肠打结25例报告
IF 1 Q3 Medicine Pub Date : 2023-09-01 DOI: 10.1016/j.ijso.2023.100664
Yohannis Derbew Molla, Mensur Osman Yasin, Samrawit Andarge Kassa

Introduction

and importance: Ileosigmoid knotting (ISK), also known as double volvulus or compound volvulus is a rare cause of intestinal obstruction in which small bowel or sigmoid colon wrap around each other, causing double loop obstruction and frequently leading to bowel strangulation. This study aimed to determine the characteristics, presentation, morbidity, and mortality associated with ISK at University Hospital.

Methods

A retrospective medical record review of all patients operated for ISK between January 2018 and January 2023. A data collection format that was tested on five patients was used to collect data on sociodemographic characteristics, clinical presentation, preoperative investigations, preoperative stabilization, intraoperative findings, type of surgical procedure performed, and patients’ treatment outcomes.

Outcomes

A total of 29 patients were operated on for ISK during the study period. Of these, the medical records of 25 patients were retrieved, reviewed, and analyzed. Males were commonly affected with a male-to-female ratio of 2:1(16:9). The peak age for ISK was between 30 and 50 years. The mean age of the patients was 42.6 years (SD ± 15.9) and ranged from 20 to 70 years. Only one of the patients had comorbidity (retroviral infection). The average duration of illness was 1.6 days (SD ± 0.65), and the majority (23, 92%) presented within 48 h. Four-fifth (20, 80%) of patients are from the rural areas and the majority of them (15 (75%)) presented later than 24 h, while 3 (25%) of patients from urban settings presented within 24 h. Abdominal pain was present in all patients followed by vomiting (24, 96%), abdominal distention (22, 88%), and failure to pass feces or flatus (15, 52%). Four (16%) of the patients were in shock at the presentation. The leading abdominal findings were guarding (25, 100%), tenderness (24, 96%), rebound tenderness (21, 84%), and hyper-tympanic abdomen (11, 44%). On digital rectal examination, a stool was found in more than half (17, 68%), followed by an empty rectum (7, 28%) and blood in 2 (8%) of the patients. Preoperative imaging (plain abdominal x-ray) was done in 13 patients with symptoms of obstruction and with no features of diffuse peritonitis.

Conclusion

The performance of prompt, individualized surgical treatment in conjunction with the use of advanced measures of critical care to combat the disastrous consequences of multiple organ failures may contribute greatly to improving the survival rate of victims of this dreadful entity.

简介及重要性:回肠乙状结肠结(ISK),又称双扭转或复合扭转,是一种罕见的肠梗阻原因,小肠或乙状结肠相互缠绕,造成双环梗阻,常导致肠绞窄。本研究旨在确定大学医院ISK的特征、表现、发病率和死亡率。方法回顾性分析2018年1月至2023年1月期间所有ISK手术患者的病历。采用对5例患者进行测试的数据收集格式来收集有关社会人口学特征、临床表现、术前调查、术前稳定、术中发现、手术类型和患者治疗结果的数据。结果研究期间共有29例ISK患者接受手术治疗。其中,检索、审查和分析了25名患者的医疗记录。男性通常受影响,男女比例为2:1(16:9)。ISK的高峰年龄在30到50岁之间。患者平均年龄为42.6岁(SD±15.9),年龄在20 ~ 70岁之间。只有1例患者有合并症(逆转录病毒感染)。平均病程为1.6天(SD±0.65),大多数(23,92%)在48小时内出现。五分之四(20,80%)的患者来自农村地区,其中大多数(15(75%))在24小时后出现,而3(25%)来自城市地区的患者在24小时内出现。所有患者均出现腹痛,随后出现呕吐(24,96%),腹胀(22,88%),排便或放屁失败(15,52%)。4例(16%)患者在报告时感到震惊。主要腹部表现为守卫性(25,100%)、压痛(24,96%)、反跳性压痛(21,84%)和超鼓室性腹部(11,44%)。在直肠指检中,超过一半(17.68%)的患者发现大便,其次是直肠空(7.28%),2例(8%)的患者发现血。术前影像学检查(腹部x线平片)13例患者均有梗阻症状,无弥漫性腹膜炎特征。结论及时、个体化的手术治疗,结合先进的重症监护措施来对抗多器官衰竭的灾难性后果,可能有助于提高这一可怕疾病患者的生存率。
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引用次数: 0
Surgical intervention to treat neglected tropical diseases (NTDs): Caring for the neglected 外科干预治疗被忽视的热带疾病:关爱被忽视的人
IF 1 Q3 Medicine Pub Date : 2023-09-01 DOI: 10.1016/j.ijso.2023.100661
L.V. Simhachalam Kutikuppala, Siva Santosh K. Pentapati, Venkataramana Kandi, Snehasish Mishra, Ranjan K. Mohapatra, Aroop Mohanty, Ranjit Sah
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引用次数: 0
Single-incision laparoscopic cholecystectomy using totally homemade glove port versus conventional laparoscopic approach: A cross-sectional study in a developing country 全自制手套口单切口腹腔镜胆囊切除术与传统腹腔镜胆囊切除术:一项在发展中国家的横断面研究
IF 1 Q3 Medicine Pub Date : 2023-09-01 DOI: 10.1016/j.ijso.2023.100678
Van Thuong Pham , Ngoc Son Vu , Huu Doan Hoang , Minh-Tung Do

Purpose

Several home made glove ports for single-incision laparoscopic cholecystectomy (SILC) has been proposed but no comparison in surgical outcomes with conventional laparoscopic cholecystectomy (CLC) was made. Therefore, we aimed to compare the outcomes of SILC using a totally homemade glove port versus CLC.

Methods

This cross-sectional study compared the surgical outcomes between 90 patients, who underwent SILC and 123 patients who underwent CLC. Patients with acute cholecystitis grade 3 according to the Tokyo Guidelines 2018, body mass index ≥30, and previous abdominal surgeries were excluded. Totally homemade glove port was made of a small and a big rubber ring and a surgical glove to creat the wound retractor. Trocars were inserted into the glove's fingers.

Results

The proportion of patients with acute cholecystitis was lower in the SILC group (7.78%) than in CLC (21.79%). Intraoperative complication rate, the prevalence of additional trocar or conversion to open surgery, success rate, and postoperative complication rate were similar between the two groups. However, SILC showed a significantly longer operative time (62.9 ± 25.1 verus 50.4 ± 20.7 min) and lower postoperative pain than CLC. The discrepancy in operative time was more likely to be remarkable in acute cholecystitis (50.43 min) compared with symptomatic cholelithiasis (14.28 min).

Conclusions

The SILC using a totally homemade glove port is feasible and safe compared with the CLC. However, in the case of acute cholecystitis, SILC should be indicated with caution because of the longer operative time than CLC.

目的提出了几种用于单切口腹腔镜胆囊切除术(SILC)的国产手套端口,但没有将其与传统腹腔镜胆囊切除手术(CLC)的手术结果进行比较。因此,我们旨在比较使用完全自制的手套端口和CLC的SILC的结果。方法这项横断面研究比较了90名接受SILC的患者和123名接受CLC的患者的手术结果。根据《东京指南2018》,急性胆囊炎患者为3级,体重指数≥30,既往腹部手术除外。完全自制的手套端口是由一个大大小小的橡胶圈和一个外科手套制成的,用来制作伤口牵开器。Trocar被插入手套的手指。结果SILC组急性胆囊炎患者比例(7.78%)低于CLC组(21.79%),两组术中并发症发生率、追加套管针或转为开放手术的发生率、成功率和术后并发症发生率相似。然而,SILC的手术时间明显长于CLC(62.9±25.1比50.4±20.7分钟),术后疼痛较低。急性胆囊炎(50.43min)与症状性胆结石(14.28min)的手术时间差异更为显著。结论与CLC相比,使用完全自制的手套口SILC是可行和安全的。然而,在急性胆囊炎的情况下,由于SILC的手术时间比CLC长,因此应谨慎使用。
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引用次数: 0
Emergency partial splenectomy for splenic ectopic pregnancy: A rare case report 脾脏异位妊娠急诊脾部分切除术一例报告
IF 1 Q3 Medicine Pub Date : 2023-09-01 DOI: 10.1016/j.ijso.2023.100656
Quach Van Kien , Quynh Lien Dam , Quang Hieu Tong , Quang Thai Pham , Đuc An Thai , Vu Hong Tuan

Introduction and importance

Ectopic pregnancy can occur in many locations such as the fallopian tube, cervical, ovary or the abdomen. Splenic ectopic pregnancy (SEP) which is rarely reported in the literature, is a very dangerous condition because the spleen capsule is very thin and the spleen parenchyma is rich in blood vessels.

Presentation of case

A 40-year-old woman, gravida 2, Para 2, had not menstruated for 37 days, presented in the emergency department with a chief complaint of vaginal bleeding and mild hypogastric pain for 1 week. Her serum Beta-human gonadotropin (β-HCG) level was 34279 IU/L. Abdominal ultrasound demonstrated a homogeneous echogenic structure in the upper pole parenchyma of the spleen, measuring 46 × 48 mm in diameter, containing the gestational sac and embryonal heart rate. Magnetic resonance imaging revealed a mass located in the upper pole of the spleen. Partial splenectomy was successfully and safely performed.

Clinical discussion

Surgical treatment of SEP is indicated for symptomatic or having a fetal heart rate or an elevated β-HCG level >30000 IU/L. The surgical methods are total splenectomy, laparoscopically injecting Methotrexate. This is the first case of partial splenectomy in the treatment of SEP.

Conclusion

Diagnosis of splenic ectopic pregnancy is mainly based on clinical and abdominal ultrasound. MRI may be indicated in cases when the patient arrives early and helps to identify the location of the lesion. Partial splenectomy is indicated when the ectopic pregnancy mass is located at one splenic pole.

宫外孕可发生在输卵管、子宫颈、卵巢或腹部等多个部位。脾异位妊娠(SEP)是一种非常危险的疾病,由于脾包膜非常薄,脾实质血管丰富,在文献中很少报道。病例介绍:一名40岁女性,妊娠2期,第2段,37天未来月经,主诉阴道出血,轻度下腹疼痛1周。血清β-人促性腺激素(β-HCG)水平为34279 IU/L。腹部超声示脾上极实质均匀回声结构,直径46 × 48 mm,包含妊娠囊和胚胎心率。磁共振成像显示脾脏上极有肿块。部分脾切除术成功且安全。临床讨论:有症状或有胎儿心率或β-HCG水平升高(≤30000 IU/L)时,应手术治疗SEP。手术方法为全脾切除术、腹腔镜注射甲氨蝶呤。结论脾异位妊娠的诊断主要依靠临床和腹部超声检查。在患者到达较早的情况下可能需要MRI,并有助于确定病变的位置。当异位妊娠肿块位于脾极时,应行部分脾切除术。
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引用次数: 0
Leg length discrepancy complications from osteotomy procedures in pediatric developmental dysplasia of the hip: A systematic review 儿童髋关节发育不良截骨手术引起的腿长差异并发症:系统回顾
IF 1 Q3 Medicine Pub Date : 2023-09-01 DOI: 10.1016/j.ijso.2023.100665
Hilmi Muhammad , Paramita Ayu Saraswati , Adrian Fakhri Ismiarto , Yoyos Dias Ismiarto

Background

In pediatric patients with developmental dysplasia of the hip (DDH), leg discrepancy may occur from treatment complications or from the treatment itself. Surgeons should be mindful that performing osteotomies with the purpose of providing better pelvic joint fit comes with risks of unequal bone growth. This article aimed to systematically review the reported leg length discrepancy (LLD) as a potential complication from osteotomy procedures in surgical treatment of pediatric patients with DDH.

Methods

This systematic review followed the Preferred Reporting Items for Systematic Reviews and MetaAnalyses (PRISMA) guidelines. The study protocol was registered on the International Prospective Register of Systematic Reviews. A comprehensive search was performed on PubMed (MEDLINE), Scopus, the Cochrane Library and Europe PubMed Central in March 2022. Studies reporting outcomes of leg length discrepancy after osteotomy was performed were the main inclusion criteria. Quality and risk of bias assessment were performed by individual reviewers.

Results

From existing literatures, a total of eight studies were included in the review. From the data extracted, a total of 94 cases of DDH reported various LLD from 836 published cases with mean incidence of 11.2%. According to the patients’ age when the operation was performed, LLD of 2.20 cm was reported from the youngest patient operated on at 1.6 years old and LLD of 1.50 cm from the oldest patient operated on at 18 years old. The median LLD across the included studies was 1.30 cm. Limitations to this systematic review include study risk of bias, LLD reporting inconsistencies and assumptions when extracting the data which might have caused abnormal data distribution. Since no agreement exists regarding how much discrepancy between limb lengths is considered pathological, reports of cases and management of LLD vary widely. These results underline the importance of creating specific criteria to classify LLD severity and recommend appropriate treatment. WC:298.

背景:在患有发育性髋关节发育不良(DDH)的儿童患者中,腿部差异可能由治疗并发症或治疗本身引起。外科医生应注意,以提供更好的骨盆关节配合为目的的截骨术会带来骨生长不均匀的风险。本文旨在系统回顾报道的腿长差异(LLD)作为手术治疗小儿DDH患者截骨手术的潜在并发症。方法本系统评价遵循系统评价和荟萃分析首选报告项目(PRISMA)指南。该研究方案已在国际前瞻性系统评价登记册上注册。我们于2022年3月在PubMed (MEDLINE)、Scopus、Cochrane Library和european PubMed Central进行了全面的检索。报道截骨术后腿长差异的研究是主要的纳入标准。质量和偏倚风险评估由个别审稿人进行。结果从已有文献中,共纳入8项研究。从所提取的数据中,共有94例DDH报告了836例已发表病例中的各种LLD,平均发病率为11.2%。根据患者手术时的年龄,年龄最小的患者在1.6岁手术时报告LLD为2.20 cm,年龄最大的患者在18岁手术时报告LLD为1.50 cm。纳入研究的中位LLD为1.30 cm。本系统综述的局限性包括研究偏倚风险、LLD报告不一致以及提取数据时可能导致异常数据分布的假设。由于对于肢体长度之间的差异在多大程度上被认为是病理性的尚无一致意见,因此LLD的病例报告和治疗方法差异很大。这些结果强调了制定特定标准对LLD严重程度进行分类并推荐适当治疗的重要性。WC: 298。
{"title":"Leg length discrepancy complications from osteotomy procedures in pediatric developmental dysplasia of the hip: A systematic review","authors":"Hilmi Muhammad ,&nbsp;Paramita Ayu Saraswati ,&nbsp;Adrian Fakhri Ismiarto ,&nbsp;Yoyos Dias Ismiarto","doi":"10.1016/j.ijso.2023.100665","DOIUrl":"10.1016/j.ijso.2023.100665","url":null,"abstract":"<div><h3>Background</h3><p>In pediatric patients with developmental dysplasia of the hip (DDH), leg discrepancy may occur from treatment complications or from the treatment itself. Surgeons should be mindful that performing osteotomies with the purpose of providing better pelvic joint fit comes with risks of unequal bone growth. This article aimed to systematically review the reported leg length discrepancy (LLD) as a potential complication from osteotomy procedures in surgical treatment of pediatric patients with DDH.</p></div><div><h3>Methods</h3><p>This systematic review followed the Preferred Reporting Items for Systematic Reviews and MetaAnalyses (PRISMA) guidelines. The study protocol was registered on the International Prospective Register of Systematic Reviews. A comprehensive search was performed on PubMed (MEDLINE), Scopus, the Cochrane Library and Europe PubMed Central in March 2022. Studies reporting outcomes of leg length discrepancy after osteotomy was performed were the main inclusion criteria. Quality and risk of bias assessment were performed by individual reviewers.</p></div><div><h3>Results</h3><p>From existing literatures, a total of eight studies were included in the review. From the data extracted, a total of 94 cases of DDH reported various LLD from 836 published cases with mean incidence of 11.2%. According to the patients’ age when the operation was performed, LLD of 2.20 cm was reported from the youngest patient operated on at 1.6 years old and LLD of 1.50 cm from the oldest patient operated on at 18 years old. The median LLD across the included studies was 1.30 cm. Limitations to this systematic review include study risk of bias, LLD reporting inconsistencies and assumptions when extracting the data which might have caused abnormal data distribution. Since no agreement exists regarding how much discrepancy between limb lengths is considered pathological, reports of cases and management of LLD vary widely. These results underline the importance of creating specific criteria to classify LLD severity and recommend appropriate treatment. WC:298.</p></div>","PeriodicalId":43872,"journal":{"name":"International Journal of Surgery Open","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47794258","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Malignant hyperthermia in a young man: A case report 青年恶性高热1例
IF 1 Q3 Medicine Pub Date : 2023-09-01 DOI: 10.1016/j.ijso.2023.100675
Samar J. Mkhayel, Sarine V. Sarkis

Introduction and Importance

Malignant hyperthermia (MH) is a hypermetabolic reaction caused by exposure to halogenated volatile anesthetics or succinylcholine. Symptoms include unexplained elevations in end-tidal carbon dioxide and body temperature, muscle rigidity, hemodynamic instability, and electrolyte disturbances. Delayed diagnosis and treatment end up with detrimental consequences.

Case presentation

A 19-year-old healthy patient with a negative surgical history for anesthesia complications presented for an elective otolaryngology surgery. Following a smooth induction of general anesthesia and while maintained on sevoflurane, the patient started having elevation in end-tidal carbon dioxide and body temperature followed by hemodynamic instability. MH reaction was suspected. Dantrolene was directly administered intravenously along with cold physiologic saline. Consequently, body temperature as well as end tidal CO2 gradually decreased; the patient improved hemodynamically. The surgery was completed, and the patient was transferred to the intensive care unit for continuity of care.

Clinical discussion

MH is challenging for both anesthesia and surgical teams as well as for hospitals in general. Although symptoms are non-specific, the diagnosis of MH reaction and the subsequent initiation of treatment with dantrolene should be prompt. As such, hospitals should be logistically prepared for such scenarios. Furthermore, the treating medical team should be trained in advance in order to avoid any possible delay that might result in catastrophic consequences on the patient.

Conclusion

Early recognition and initiation of treatment are important for survival in MH. This can be achieved by proper staff education along with logistical preparedness.

恶性热疗(MH)是暴露于卤代挥发性麻醉剂或琥珀胆碱引起的高代谢反应。症状包括无法解释的潮末二氧化碳和体温升高、肌肉僵硬、血流动力学不稳定和电解质紊乱。延误的诊断和治疗最终会带来有害的后果。病例介绍:19岁健康患者,无麻醉并发症手术史,因择期耳鼻喉外科手术就诊。在顺利诱导全身麻醉并维持七氟醚的同时,患者开始出现潮末二氧化碳和体温升高,随后出现血流动力学不稳定。怀疑有MH反应。丹曲林与冷生理盐水一起直接静脉注射。因此,体温和末潮CO2逐渐降低;患者血流动力学改善。手术完成后,患者被转移到重症监护病房继续治疗。临床讨论mh对麻醉和外科团队以及一般的医院来说都是具有挑战性的。虽然症状是非特异性的,但MH反应的诊断和随后开始用丹曲林治疗应及时。因此,医院应该为这种情况做好后勤准备。此外,治疗医疗小组应事先接受培训,以避免任何可能对患者造成灾难性后果的延误。结论早期识别和早期治疗对住院患者的生存至关重要,这可以通过适当的工作人员教育和后勤准备来实现。
{"title":"Malignant hyperthermia in a young man: A case report","authors":"Samar J. Mkhayel,&nbsp;Sarine V. Sarkis","doi":"10.1016/j.ijso.2023.100675","DOIUrl":"10.1016/j.ijso.2023.100675","url":null,"abstract":"<div><h3>Introduction and Importance</h3><p>Malignant hyperthermia (MH) is a hypermetabolic reaction caused by exposure to halogenated volatile anesthetics or succinylcholine. Symptoms include unexplained elevations in end-tidal carbon dioxide and body temperature, muscle rigidity, hemodynamic instability, and electrolyte disturbances. Delayed diagnosis and treatment end up with detrimental consequences.</p></div><div><h3>Case presentation</h3><p>A 19-year-old healthy patient with a negative surgical history for anesthesia complications presented for an elective otolaryngology surgery. Following a smooth induction of general anesthesia and while maintained on sevoflurane, the patient started having elevation in end-tidal carbon dioxide and body temperature followed by hemodynamic instability. MH reaction was suspected. Dantrolene was directly administered intravenously along with cold physiologic saline. Consequently, body temperature as well as end tidal CO2 gradually decreased; the patient improved hemodynamically. The surgery was completed, and the patient was transferred to the intensive care unit for continuity of care.</p></div><div><h3>Clinical discussion</h3><p>MH is challenging for both anesthesia and surgical teams as well as for hospitals in general. Although symptoms are non-specific, the diagnosis of MH reaction and the subsequent initiation of treatment with dantrolene should be prompt. As such, hospitals should be logistically prepared for such scenarios. Furthermore, the treating medical team should be trained in advance in order to avoid any possible delay that might result in catastrophic consequences on the patient.</p></div><div><h3>Conclusion</h3><p>Early recognition and initiation of treatment are important for survival in MH. This can be achieved by proper staff education along with logistical preparedness.</p></div>","PeriodicalId":43872,"journal":{"name":"International Journal of Surgery Open","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41810385","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 1
Comparison of the effects of pregabalin and famotidine with pregabalin and diphenhydramine on postoperative abdominal pain 普瑞巴林、法莫替丁与普瑞巴林、苯海拉明治疗术后腹痛的疗效比较
IF 1 Q3 Medicine Pub Date : 2023-09-01 DOI: 10.1016/j.ijso.2023.100674
Masoud Saadat Fakhr , Parnian Motamed Chaboki , Hemin Ashayeri , Pouria Sahranavard , Somayeh Mohammadipanah , Mahnaz Narimani Zamanabadi

Objectives

Pain is one of the most significant problems, and its uncontrolled management can lead to complications such as increased blood pressure, myocardial ischemia, etc. An effective approach to control postoperative pain is preemptive pain management with a combination of drugs prior to surgery. The present study aims to compare the level of postoperative abdominal pain in patients receiving pregabalin and famotidine versus pregabalin and diphenhydramine.

Materials and methods

In this double-blind clinical trial, a total of 34 candidates for abdominal surgery (laparotomy) with ASA physical status classification of 1 or 2 were enrolled from the patients referring to (XXX). They were divided into two groups of 17 (Group A: pregabalin and famotidine, Group B: pregabalin and diphenhydramine). The drugs were administered to the patients 2 h before the surgery. The patients' pain levels were measured using the Visual Analog Scale (VAS) at the recovery stage after complete consciousness and at 6, 12, and 24 h postoperatively. Additionally, the amount of analgesic consumed within the first 24 h after the surgery was recorded and compared between the two groups.

Results

The average pain intensity score at 6 h postoperatively was (6 ± 0.2) in patients who received pregabalin and diphenhydramine, and (7.1 ± 0.1) in patients who received pregabalin and famotidine (p = 0.002). The average pain intensity score at 12 h postoperatively was (6.1 ± 0.3) in patients who received pregabalin and famotidine, and (5.6 ± 0.2) in patients who received pregabalin and diphenhydramine (p = 0.021). Furthermore, the average pain intensity score at 24 h postoperatively was (5.2 ± 0.2) in patients who received pregabalin and famotidine, and (4.2 ± 0.2) in patients who received pregabalin and diphenhydramine (p = 0.014). The results demonstrated that the pain intensity score decreased in all four measured time intervals in the overall patient population (p < 0.001), and this reduction was significantly different between the two groups (p = 0.002), with the final average pain score being lower in the group receiving pregabalin and diphenhydramine compared to the other group.

Conclusion

The results of this study indicate that the use of drugs such as diphenhydramine and pregabalin as preemptive medications can be effective in controlling postoperative abdominal pain and reducing the consumption of analgesics in patients after abdominal surgery.

目的:西班牙是最重要的问题之一,其管理不善可导致血压升高、心肌缺血等并发症。控制术后疼痛的有效方法是在手术前结合药物进行先发制人的疼痛管理。本研究旨在比较普瑞巴林联合法莫替丁与普瑞巴林联合苯海拉明患者术后腹痛的程度。材料与方法本双盲临床试验从文献(XXX)中选取ASA身体状态分类为1或2的腹部手术(剖腹手术)患者34例,分为两组,每组17例,a组普瑞巴林联合法莫替丁,B组普瑞巴林联合苯海拉明。术前2小时给药。在完全意识恢复期及术后6、12、24 h采用视觉模拟评分法(VAS)测量患者的疼痛水平。此外,记录两组患者术后24小时内镇痛药的用量并进行比较。结果普瑞巴林联合苯海拉明组术后6 h平均疼痛强度评分为(6±0.2)分,普瑞巴林联合法莫替丁组术后6 h平均疼痛强度评分为(7.1±0.1)分(p = 0.002)。普瑞巴林联合法莫替丁组术后12 h平均疼痛强度评分为(6.1±0.3)分,普瑞巴林联合苯海拉明组术后12 h平均疼痛强度评分为(5.6±0.2)分(p = 0.021)。普瑞巴林联合法莫替丁组术后24 h平均疼痛强度评分为(5.2±0.2)分,普瑞巴林联合苯海拉明组术后24 h平均疼痛强度评分为(4.2±0.2)分(p = 0.014)。结果表明,疼痛强度评分在所有四个测量时间间隔内均下降(p <0.001),两组之间的这种减少有显著差异(p = 0.002),接受普瑞巴林和苯海拉明的组的最终平均疼痛评分低于另一组。结论应用苯海拉明、普瑞巴林等药物作为预防用药,可有效控制腹部手术患者术后腹痛,减少镇痛药的使用。
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引用次数: 0
Vaginal leiomyoma: A case report 阴道平滑肌瘤1例
IF 1 Q3 Medicine Pub Date : 2023-09-01 DOI: 10.1016/j.ijso.2023.100663
Huda Muhaddien Muhammad , Rezheen J. Rashid , Snur Othman , Nahidah Hamah Ameen Ahmed , Rawa M. Ali , Ari M. Abdullah , Hadeel Adnan Yasseen , Fakher Abdullah , Fahmi H. Kakamad

Introduction and importance

Leiomyomas can affect 20–30% of women of reproductive age and are commonly observed in the uterus. Their occurrence in the vagina is exceedingly rare, representing the least common presentation among all locations. Herein, we report a case of vaginal leiomyomas in a 48-year-old lady.

Case presentation

A 48-year-old female presented to our gynecology clinic complaining of feeling a mass within her vagina. Physical examination revealed a round, smooth mass in the anterior vaginal wall with a normal-looking cervix. Ultrasound examination showed an enlarged anteverted uterus with an endometrial thickness of 14 mm and an endometrial polyp of 15 × 7mm arising from the left upper anterolateral wall. Magnetic resonance imaging demonstrated a well-defined, fusiform, submucosal vaginal mass originating from the anterior vaginal wall, measuring 37× 22 × 36 mm. Hysteroscopy was performed, and the uterine and vaginal masses were resected. The masses were confirmed to be conventional leiomyomas.

Clinical discussion

The diagnosis is seldom established preoperatively and the preferred therapeutic approach for treating vaginal leiomyoma is surgical removal via the vaginal route. However, in the case of large tumors, the abdominoperineal route may be necessary.

Conclusion

Vaginal leiomyoma is a rare tumor with approximately 300 reported cases worldwide. It can be asymptomatic or cause to feel it within the vagina. Besides the necessity of surgical resection, colporrhaphy as a reconstructive surgery may be required.

子宫肌瘤可影响20-30%的育龄妇女,常见于子宫。它们在阴道的发生极为罕见,是所有部位中最不常见的。在此,我们报告一位48岁女性的阴道平滑肌瘤病例。病例介绍一名48岁女性到我妇科就诊,主诉阴道内有肿块。体格检查发现阴道前壁有一圆形光滑肿块,宫颈外观正常。超声检查示前倾子宫增大,子宫内膜厚度14mm,左侧前外侧上壁有15 × 7mm的子宫内膜息肉。磁共振成像显示一个清晰的梭状阴道粘膜下肿块,起源于阴道前壁,尺寸为37x22x36mm。行宫腔镜检查,切除子宫及阴道肿物。肿块证实为常规平滑肌瘤。临床讨论阴道平滑肌瘤的诊断很少术前确定,治疗阴道平滑肌瘤的首选治疗方法是经阴道途径手术切除。然而,在大肿瘤的情况下,腹部-会阴路径可能是必要的。结论阴道平滑肌瘤是一种罕见的肿瘤,全世界报道病例约300例。它可以是无症状的,也可以引起阴道内的感觉。除了手术切除的必要性外,可能还需要进行结肠修补术作为重建手术。
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引用次数: 0
FDA approves first leadless dual-chamber pacing system; A breakthrough in therapy of bradycardia FDA批准首个无引线双腔起搏系统;治疗心动过缓的突破
IF 1 Q3 Medicine Pub Date : 2023-09-01 DOI: 10.1016/j.ijso.2023.100660
Eman Ali
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引用次数: 0
Potentially pandemic MERS-CoV constantly circulating in the Middle East threatens the globe: Preparedness and prevention with commentaries on the ‘one health’ model 中东持续传播的中东呼吸综合征冠状病毒潜在大流行威胁全球:防范和预防与“一个健康”模式评论
IF 1 Q3 Medicine Pub Date : 2023-09-01 DOI: 10.1016/j.ijso.2023.100670
Ranjan K. Mohapatra, Snehasish Mishra, Lucia Pintilie, Lawrence Sena Tuglo
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引用次数: 0
期刊
International Journal of Surgery Open
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