Innovative Surgical Sciences最新文献_第3页

Status of inpatient pain therapy using the example of a general and abdominal surgery normal ward – a prospective questionnaire study to review a pain therapy algorithm (“real-world data”) 以普通外科和腹部外科普通病房为例的住院患者疼痛治疗现状——一项前瞻性问卷研究，以回顾疼痛治疗算法(“真实世界数据”)

Q2 SURGERY

Innovative Surgical Sciences

Pub Date : 2023-10-05 DOI: 10.1515/iss-2023-0016

Michael Brinkers, Mandy Istel, Moritz Kretzschmar, Giselher Pfau, Frank Meyer

Abstract Objectives The mean pain intensity for inpatient consultations, for example in cancer patients, is known. However, the proportion of necessary consultations in the total volume of patients of a ward or a hospital, the general pain intensity in a surgical ward and the relationship between pain medication, length of stay and therapeutic success are unknown. The aim of the study was to examine surgical patients in a single normal ward subclassified into various groups (−/+ surgery, ICU stay, cancer, consultation for pain therapy etc.) during half a year with regard to their pain. For this purpose, the pain score (NAS) was recorded daily for each patient during the entire hospital stay and the change was assessed over the clinical course. Methods In 2017, all consecutive new admissions to a normal ward of general surgery at a university hospital (“tertiary center”) were monitored over half a year according to a standardized procedure. Pain severity (measured by the “Numeric rating scale” [NRS] respectively “Visual analogue scale” [VAS]) from admission to discharge was recorded, as well as the length of stay and the administered medication. Patient groups were sub-classified as surgery, intensive care unit, cancer and pain consultation. An algorithm in two parts (part 1, antipyretics and piritramide; part 2, WHO-scheme and psychotropic drugs), which was defined years before between surgeons and pain therapists, was pursued and consequently used as a basis for the evaluation of the therapeutic success. Results 269 patients were included in the study. The mean pain intensity of all patients at admission was VAS 2.2. Most of the groups (non-cancer, intensive care unit [ICU], non-ICU, surgical intervention (=Operation [OP]), non-OP, pain intensity greater than VAS 3) were significantly reduced in pain at discharge. An exception in this context was patients with cancer-associated pain and, thus, initiated pain consultation. Conclusions Since three quarters of the consultation patients also reported cancer pain, it might be possible that the lack of treatment success in both the consultation and cancer groups is associated with cancer in these patients. However, it can be shown that the successfully treated groups (without ICU-based course) had a mean length of stay from 4.2 ± 3.9 up to 8.4 ± 8.1 days (d), while the two unsuccessfully treated groups experienced a longer stay (mean “cancer” , 11.1 ± 9.4 d; mean “consulation” , 14.2 ± 10.3 d). Twenty-one consultation patients, in whom it had been intended to improve pain intensity, could not be successfully treated despite adapted therapy – this can be considered a consequence of the low number of patients. Since the consultation patients were the only patient group treated with part 2 of the algorithm, it can be concluded that part 1 of the algorithm is sufficient for a mean length of stay up to 9 days. For all patients above this time point, a pain consultation with adaption of medical treatment sh

摘要目的平均疼痛强度为住院咨询，例如在癌症患者，是已知的。然而，一个病房或医院的病人总数中必要的会诊的比例、外科病房的一般疼痛强度以及止痛药、住院时间和治疗成功之间的关系是未知的。本研究的目的是研究在一个普通病房的手术患者，将其细分为不同的组(−/+手术，ICU住院，癌症，疼痛治疗咨询等)，为期半年的疼痛情况。为此，在整个住院期间每天记录每位患者的疼痛评分(NAS)，并在临床过程中评估其变化。方法2017年，对某高校医院(三级中心)普通外科普通病房所有连续新入院患者进行半年以上的规范化监测。记录患者入院至出院期间的疼痛严重程度(分别采用“数字评定量表”[NRS]和“视觉模拟量表”[VAS]测量)、住院时间和给药时间。患者分组被细分为外科、重症监护病房、癌症和疼痛咨询。算法分为两部分(第一部分，退烧药和匹利胺;第2部分(世卫组织方案和精神药物)是外科医生和疼痛治疗师多年前确定的，因此被用作评估治疗成功的基础。结果269例患者纳入研究。所有患者入院时的平均疼痛强度为VAS 2.2。大多数组(非肿瘤组、重症监护病房组(ICU)、非ICU组、手术干预组(=Operation [OP])、非手术干预组、疼痛强度大于VAS 3)出院时疼痛均显著减轻。在这种情况下，一个例外是患有癌症相关疼痛的患者，因此，开始进行疼痛咨询。由于四分之三的会诊患者也报告了癌症疼痛，因此可能会诊组和癌症组的治疗不成功与这些患者的癌症有关。然而，可以看出，成功治疗组(无icu疗程)的平均住院时间为4.2±3.9至8.4±8.1天(d)，而两个治疗失败组的住院时间更长(平均“癌症”，11.1±9.4 d;平均“会诊”，14.2±10.3 d)。21名会诊患者，其目的是改善疼痛强度，尽管采用了适应治疗，但仍不能成功治疗-这可以被认为是患者数量少的结果。由于会诊患者是唯一使用算法第2部分治疗的患者组，因此可以得出结论，算法第1部分足以使平均住院时间达到9天。对于高于此时间点的所有患者，应考虑进行疼痛咨询并适应药物治疗。

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引用次数: 0

Computer assistance in modern craniomaxillofacial surgery 现代颅颌面外科的计算机辅助

Q2 SURGERY

Innovative Surgical Sciences

Pub Date : 2023-09-28 DOI: 10.1515/iss-2023-2002

Nils-Claudius Gellrich, Michael Ehrenfeld

引用次数: 0

Interdisciplinary aspects of abdominal and plastic surgery – what does the (abdominal) surgeon need to know? 腹部和整形外科的跨学科方面——腹部外科医生需要知道什么?

Q2 SURGERY

Innovative Surgical Sciences

Pub Date : 2023-09-21 DOI: 10.1515/iss-2023-0042

Armin Kraus, Hans-Georg Damert, Frank Meyer

Abstract Introduction The aim was to reflect the established interdisciplinary aspects of general/abdominal and plastic surgery by means of a narrative review. Methods: (i) With specific references out of the medical literature and (ii) own clinical and perioperative as well as operating technical and tactical management experiences obtained in surgical daily practice, we present a choice of options for interdisciplinary cooperation that could be food of thought for other surgeons. Content – Decubital ulcers require pressure relieve, debridement and plastic surgery coverage, e.g., by a rotation flap plasty, V-Y flap or “tensor-fascia-lata” (TFL) flap depending on localization (sacral/gluteal defects, ischiadic tuber). – Coverage of soft tissue defects, e.g., after lymph node dissection, tumor lesions or disturbance of wound healing can be managed with fasciocutaneous or muscle flaps. – Bariatric surgery: Surgical interventions such as butt lift, tummy tuck should be explained and demonstrated in advance and performed commonly after reduction of the body weight. – Abdominoperineal rectum extirpation (APE): Holm’s procedure with greater circumferential extent of resection at the mesorectum and the insertion site of the levator muscle at the anal sphicter muscle resulting in a substantial defect is covered by myocutaneous flap plasty. – Hernia surgery: Complicated/recurrent hernias or abdominal wall defect can be covered by flap plasty to achieve functional reconstruction, e.g., using innervated muscle. Thus, abdominal wall can respond better onto changes of pressure and tension. – Necrotising fasciitis: Even in case of suspicious fasciitis, an immediate radical debridement must be performed, followed by intensive care with calculated antibiotic treatment; after appropriate stabilization tissue defects can be covered by mesh graft of flap plasty. – Soft tissue tumor lesions cannot be resected with primary closure to achieve appropriate as intended R0 resection status by means of local radical resection all the time – plastic surgery expertise has to be included into interdisciplinary tumor concepts. – Liposuction/-filling: Liposuction can be used with aesthetic intention after bariatric surgery or for lipedema. Lipofilling is possible for reconstruction and for aesthetic purpose. – Reconstruction of lymphatic vessels: Lymphedema after tumor operations interrupting or blocking lymphatic drainage can be treated with microsurgical reconstructions (such as lympho-venous anastomoses, lympho-lymphatic anastomoses or free microvascular lymph node transfer). – Microsurgery: It is substantial part of modern reconstructive plastic surgery, i.e., surgery of peripheral nerves belongs to this field. For visceral surgery, it can become important for reconstruction of the recurrent laryngeal nerve. – Sternum osteomyelitis: Radical debridement (eventually, complete sternal resection) with conditioning of the wound by vacuum-assisted closure followed by plastic surg

目的是反映建立跨学科方面的一般/腹部和整形外科的叙述回顾的手段。方法:(1)根据医学文献的具体参考，(2)根据自己在外科日常实践中获得的临床和围手术期以及手术技术和战术管理经验，我们提出了跨学科合作的选择，可以为其他外科医生提供思考的食物。内容:侧卧溃疡需要减压、清创和整形手术覆盖，例如，根据定位(骶骨/臀骨缺损、坐骨结节)，通过旋转瓣成形术、V-Y瓣或“阔筋膜张张”(TFL)瓣。-软组织缺损的覆盖，例如淋巴结清扫、肿瘤病变或伤口愈合障碍后，可以用筋膜皮瓣或肌肉皮瓣进行处理。-减肥手术:手术干预，如提臀，腹部除皱，应提前解释和演示，并在减轻体重后通常进行。-腹会阴直肠切除术(APE): Holm的手术在直肠系膜和肛门括约肌处的提肛肌的插入部位进行了更大的环向切除，导致实质性的缺陷，由肌皮瓣成形术覆盖。-疝手术:复杂/复发疝或腹壁缺损可通过皮瓣成形术覆盖，实现功能重建，例如使用神经支配肌肉。因此，腹壁对压力和张力的变化有更好的反应。-坏死性筋膜炎:即使出现可疑的筋膜炎，也必须立即进行根治性清创，然后进行重症监护并计算抗生素治疗;在适当的稳定后，组织缺损可以用网状皮瓣修复。-软组织肿瘤病变不能一直通过局部根治性切除来一期闭合切除以达到预期的R0切除状态-必须将整形外科专业知识纳入跨学科肿瘤概念。-吸脂/填充:吸脂可用于减肥手术后的美容目的或脂肪水肿。脂肪填充是可能的重建和美观的目的。-淋巴管重建:肿瘤手术后淋巴水肿中断或阻断淋巴引流，可采用显微外科重建(如淋巴-静脉吻合、淋巴-淋巴吻合或游离微血管淋巴结转移)。-显微外科:是现代重建整形外科的重要组成部分，即周围神经手术属于这一领域。对于内脏手术，它对于喉返神经的重建很重要。胸骨骨髓炎:根治性清创(最终，完全切除胸骨)，通过真空辅助闭合伤口，然后进行整形手术覆盖，可以防止慢性化，威胁纵隔炎，持续感染风险，长期痛苦或限制生活质量。所提出的单一主题的选择只能是在日常临床和外科实践中外科合作的所有选择的摘录。腹部和整形外科的跨学科方法的特点是在常见的外科干预中高度发达的合作，包括各种技术和策略，突出两个领域的特点。

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引用次数: 0

Fatal heat stroke based on foudroyant irreversible multiple organ dysfunction in German summer 德国夏季由不可逆多器官功能障碍引起的致死性中暑

Q2 SURGERY

Innovative Surgical Sciences

Pub Date : 2023-09-19 DOI: 10.1515/iss-2023-0013

Eric Lorenz, Joerg Herold, Uwe Lodes, Frank Meyer

Abstract Objectives Heat stroke is a serious condition that might lead from moderate organ impairment to multiple organ dysfunction syndrome. Appropriate diagnosis-finding, fast initiation of cooling and intensive care are key measures of the initial treatment. Scientific case report based on i) clinical experiences obtained in the clinical management of a particularly rare case and ii) selected references from the medical scientific literature. Case presentation We present a case of a young and healthy construction worker who suffered from an exertional heat stroke with a body core temperature exceeding 42 °C by previous several hour work at 35 °C ambient temperature. Heat stroke was associated with foudroyant, not reversible multiple organ dysfunction syndrome, in particular, early disturbed coagulation, microcirculatory, liver and respiratory failure, and subsequent fatal outcome despite immediate diagnosis-finding, rapid external cooling and expanded intensive care management. Conclusions Basic knowledge on an adequate diagnosis(-finding in time) and treatment of heat stroke is important for (almost each) physician in the summertime as well as is essential for the initiation of an appropriate management. Associated high morbidity and mortality rates indicate the need for implementation of standard operation protocols.

摘要目的中暑是一种严重的疾病，可能导致中度器官损害到多器官功能障碍综合征。适当的诊断发现、快速降温和重症监护是初始治疗的关键措施。科学病例报告基于i)在临床管理中获得的特别罕见病例的临床经验和ii)从医学科学文献中选择的参考文献。我们报告一例年轻健康的建筑工人，在35°C的环境温度下工作数小时后，遭受了劳累性中暑，核心体温超过42°C。中暑与不可逆的多器官功能障碍综合征相关，特别是早期凝血功能障碍、微循环、肝脏和呼吸衰竭，以及随后的致命结果，尽管及时发现诊断、快速外部冷却和扩大重症监护管理。结论:对夏季中暑的诊断(及时发现)和治疗的基本知识对(几乎每一位)医生来说都很重要，对开始适当的治疗也是必不可少的。相关的高发病率和死亡率表明需要执行标准手术规程。

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引用次数: 0

Paradox inflammatory reaction such as appendicitis epiploica and diverticulitis of the sigmoid colon under ongoing immunosuppression after previous liver transplantation (LTx) 先前肝移植(LTx)后持续免疫抑制的乙状结肠阑尾炎、网膜和憩室炎等矛盾炎症反应

Q2 SURGERY

Innovative Surgical Sciences

Pub Date : 2023-09-15 DOI: 10.1515/iss-2023-0038

Isabella Trautwein, Manuela Petersen, Christine March, Roland S. Croner, Frank Meyer

Abstract Objective Inflammatory reactions caused by immunosuppression appear a particular interesting disease due to its very specific and partly unclear etiopathogenesis. Based on clinical case-specific management experiences and selective references from the literature, the rare case of an acute intraabdominal inflammation as unusual complication or side effect (at the gastrointestinal [GI] tract) of the ongoing immunosuppressive medication using Mycophenolate mofetil and Tacrolimus after previous liver transplantation is to be illustrated. Case presentation Medical history ( hx ): 1) Current : A 68-years old male patient underwent abdominal CT scan because of pain in the left lower abdomen with the suspicious diagnosis of diverticulitis leading to initiation of antibiotic therapy 24 h prior to the transferral to the own hospital for adequate liver transplantation (LTx) follow-up investigation. 2) Medication contained Sitagliptin 1 × 100 mg, Omeprazol 1 × 40 mg, Mesalazin 500 mg 3 × 2, Movicol 1 (on demand), Mycophenolate mofetil 2 × 500 mg, Tacrolimus 2 × 1 mg and Hydrochlorothiazid 1 × 2.5 mg. 3) Additional diagnoses included arterial hypertension, diabetes mellitus and urinary bladder diverticle. 4) Previous surgical intervention profile comprises resection of liver segments IV/V due to HCC (2011), orthotopic liver transplantation because of HCC caused by alcohol-induced liver cirrhosis (2013) and an intervertebral disc operation (2018). Physical examination of the abdomen revealed marked tenderness in the lower left quadrant. The abdominal wall was soft and there were no defensive tension and no peritonism. The patient was in good general condition and nutritional status. He was cardiopulmonarily stable and oriented to all qualities. Diagnostic measures showed a CRP of 38.0 (normal range, < 5) mg/L and a white blood cell count within normal range. Leading diagnoses were found using abdominal CT scan, which demonstrated an extended diverticulosis and an appendicitis epiploica within the immediate subperitoneal region of the left lower abdomen with an oval fat isodense structure in the region of the sigmoid colon with surrounding inflammatory imbibition and pronounced intestinal wall. Suspicious diagnosis was the 1st episode of an uncomplicated diverticulitis of the sigmoid colon associated with an appendicitis epiploica. Therapeutic approach was given by conservative therapy with infusion therapy, analgesia as well as inital “n. p. o.” and following initiation of oral nutrition. In addition, calculated antibiotic therapy with Cefuroxime and Clont was initiated. Clinical course was uneventful, with discharge on the eighth day of hospital stay with no pathological findings and substantial improvement in clinical and laboratory findings. Further advice consisted of clinical and laboratory follow-up control investigations by the family practitioner and nutritional counselling. In addition, a colonoscopy should be performed within four months. Co

摘要目的免疫抑制引起的炎症反应是一种特别有趣的疾病，由于其非常特异性和部分不明确的病因。根据临床病例特异性管理经验和文献的选择性参考，我们将对既往肝移植后持续使用霉酚酸酯和他克莫司进行免疫抑制治疗而出现急性腹内炎症的罕见病例(胃肠道)进行说明。病例介绍病史(hx): 1)目前:68岁男性患者，因左下腹疼痛，可疑诊断为憩室炎，24小时前接受腹部CT扫描，开始抗生素治疗，转到本院进行充分的肝移植(LTx)随访调查。2)药物:西格列汀1 × 100 mg，奥美拉唑1 × 40 mg，美沙拉嗪500 mg 3 × 2，莫维柯1(按需)，霉酚酸酯2 × 500 mg，他克莫司2 × 1 mg，氢氯噻嗪1 × 2.5 mg。3)附加诊断包括动脉高血压、糖尿病、膀胱憩室。4)既往手术干预包括肝细胞癌IV/V节段切除(2011年)、酒精性肝硬化肝细胞癌原位肝移植(2013年)和椎间盘手术(2018年)。腹部体格检查显示左下腹明显压痛。腹壁柔软，无防御性张力，无腹胀。患者一般情况及营养状况良好。他的心肺状况稳定，一切素质都很好。诊断结果显示CRP为38.0(正常范围;5) mg/L，白细胞计数正常。主要诊断为腹部CT扫描，显示左侧下腹腹膜下区延伸憩室和阑尾炎，乙状结肠区呈椭圆形脂肪等致密结构，周围有炎症性吸胀和明显的肠壁。可疑的诊断是一个无并发症的乙状结肠憩室炎合并阑尾炎的第一次发作。治疗方法为保守治疗加输注、镇痛及初始治疗。p。o "然后开始口服营养。此外，计算抗生素治疗头孢呋辛和Clont开始。临床过程平淡无奇，住院第8天出院，无病理发现，临床和实验室检查有实质性改善。进一步的建议包括由家庭医生进行的临床和实验室随访对照调查以及营养咨询。此外，结肠镜检查应在四个月内进行。结论本病例可能是免疫抑制药物霉酚酸酯和他克莫司分别被列为“结肠炎症”和“胃肠道炎症”的众多副作用之一，也可能是移植相关免疫抑制药物引起的易感(胃)肠黏膜或整个肠壁对微生物或微生物颗粒或药物的炎症反应。

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引用次数: 0

Resection rectopexy as part of the multidisciplinary approach in the management of complex pelvic floor disorders. 切除直肠固定术是治疗复杂盆底疾病的多学科方法的一部分。

IF 1.3 Q2 SURGERY

Innovative Surgical Sciences

Pub Date : 2023-07-31 eCollection Date: 2023-03-01 DOI: 10.1515/iss-2022-0027

Georgi Kalev, Christoph Marquardt, Marten Schmerer, Anja Ulrich, Wolfgang Heyl, Thomas Schiedeck

Objectives: Pelvic floor disorders are frequently caused by an organ prolapse involving multiple pelvic floor compartments. In such cases, a multidisciplinary strategy for diagnostic work-up and therapy is required.

Methods: All patients who underwent transabdominal rectopexy/resection rectopexy alone or in combination with simultaneous gynecological pelvic floor reconstruction at our institution between 01/2006 and 12/2021 were included in this retrospective study. The study aimed to evaluate the functional outcome and postoperative complications.

Results: Two hundred and eighty seven patients were assigned to one of the following groups: PG1 - patient group one: after resection rectopexy (n=141); PG2 - after ventral rectopexy (n=8); PG3 - after combined resection rectopexy and sacro (cervico)colpopexy (n=62); PG4 - after combined resection rectopexy and trans-vaginal pelvic floor repair (n=76). The duration of follow-up was 14 months for PG1 (median, IQR 37 months), 11 months for PG2 (mean, SD 9 months), 7 months for PG 3 (median, IQR 33 months), and 12 months for PG 4 (median, IQR 51 Months). The surgical procedure resulted in improvement of symptoms related to obstructed defecation in 56.4 % (22/39) of the patients in PG1, 25 % in PG2 (1/4), 62.5 % (20/32) in PG3, and 71.8 % (28/39) in PG4. "De novo" constipation was reported by 2.4 % (2/141) of patients from PG1. Improvement in fecal incontinence symptoms was reported by 69 % (40/58) of patients in PG1, 100 % in PG2 (2/2), 93.1 % (27/29) in PG3, and 87.2 % (34/39) in PG4. The recurrence rate for external rectal prolapse was 7.1 % in PG1, 50 % in PG2 (1/2), 2.7 % in PG3, and 6.3 % in PG4. A significant difference in terms of severe morbidity (grade ≥ IIIb) and mortality could not be determined between the non-interdisciplinary (PG1 with PG2) and interdisciplinary surgery (PG3 with PG4) (p=0.88, p=0.499).

Conclusions: Based on our results, we can assume that combined surgery is as feasible as rectal surgery alone. In our study, combined interventions were effective and not associated with an increased risk of postoperative complications.

目的：盆底疾病通常是由涉及多个盆底隔间的器官脱垂引起的。在这种情况下，需要采用多学科的诊断检查和治疗策略。方法：本回顾性研究纳入了2006年1月至2021年12月期间在我院单独或同时进行妇科盆底重建的所有患者。本研究旨在评估功能结果和术后并发症。结果：287例患者被分为以下组之一：PG1-患者第一组：切除后直肠固定术（n=141）；PG2-腹侧直肠固定术后（n=8）；PG3-直肠固定和骶（颈）阴道联合切除术后（n=62）；PG4-联合切除直肠固定术和经阴道盆底修复术后（n=76）。PG1的随访时间为14个月（中位数，IQR 37个月），PG2为11个月（平均，SD 9个月）、PG3为7个月（中值，IQR 33个月）和PG4为12个月（中点，IQR 51 月份）。手术治疗改善了56.4例排便障碍相关症状 % （22/39）PG1患者，25 % PG2（1/4），62.5 % PG3中的（20/32）和71.8 % （28/39）在PG4中。2.4 % （2/141）PG1患者。69人报告大便失禁症状有所改善 % （40/58）PG1100患者 % PG2（2/2），93.1 % PG3中的（27/29）和87.2 % （34/39）。直肠外脱垂的复发率为7.1 % 在PG1中，50 % 在PG2（1/2）中，2.7 % PG3和6.3 % 在PG4中。非跨学科（PG1与PG2）和跨学科手术（PG3与PG4）在严重发病率（≥IIIb级）和死亡率方面无法确定显著差异（p=0.88，p=0.499）。结论：根据我们的结果，我们可以假设联合手术与单独直肠手术一样可行。在我们的研究中，联合干预是有效的，并且与术后并发症的风险增加无关。

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引用次数: 0

Impact factor for Innovative Surgical Sciences - heading for the future. 创新外科科学的影响因素-走向未来。

IF 1.3 Q2 SURGERY

Innovative Surgical Sciences

Pub Date : 2023-07-27 eCollection Date: 2023-03-01 DOI: 10.1515/iss-2023-2001

Joachim Jaehne

Innovative Surgical Sciences, founded as Gold Open Access Journal by the German Society of Surgery in 2016 [1, 2], was just recently informed by Clarivate Analytics that the journal gained an impact factor of 1.3. The German Society of Surgery and the publisher DeGruyter would like to thank all members of the Editorial Board, all authors and their coworkers aswell as all reviewers for their continuous support of the journal. Without these efforts and the constant dedication to the journal, such a success after a relatively short period following the launch of the journal in 2016would not have been possible – thank you very much! Additionally, gaining an impact factor as an open access journal shows that open access has become a wellestablished publication method. More and more originally pure print journals with very high reputation switch to open access formats [3, 4]. Open access will most likely substitute the “old-fashioned” printed journals and will represent the standard of scientific communication in the very near future [4]. Now, that the impact factor is reality, one could say: mission accomplished! Although the impact factor was one aim to achieve, it needs to be said that this is just the beginning! The impact factor encourages to put even more effort in the aim to fully establish the journal within the surgical scientific community. In the last years the journal experienced some changes which seemed to be relevant and necessary. The layout was changed from green to blue to fulfill the requirements for a consequent marketing strategy of the German Society of Surgery, which also changed the color. Furthermore, all abstracts of the congress of the German Society of Surgery were published open access as a supplement to the journal so that the congress and the abstracts reach a wide surgical community. To fully support the various surgical societies which are members of the German Society of Surgery a National Editorial Board was established. This board should result in a greater participation of all surgical subspecialties in designing the content and the articles published in Innovative Surgical Sciences. Since the launch in 2016 Innovative Surgical Sciences is listed in all relevant data bases, and the journal has been in Pubmed for some years which may also be another reason for gaining the impact factor. Additionally, the actual Scopus Cite Score is 4.5, so that we feel that our road map for the future is correct. In comparison to other journals, one issue which we strictly follow is the publication of all reviews of the double-blind-review process. To our feeling, this is essential for the transparency of scientific communication, and it is the unique selling point of Innovative Surgical Sciences. Hereby, we also can communicate a rejection rate of 52 % for the years 2021 and 2022. Our aim for the years to come is clearly defined to further increase the impact factor. This aimmay be achieved by a broader internationalization of the j

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引用次数: 0

Extracapsular extension of pN2 lymph node metastases is not prognostically significant in surgically resected patients with non-small cell lung cancer. pN2淋巴结转移的囊外延伸在外科切除的癌症非小细胞肺癌患者中没有预后意义。

IF 1.3 Q2 SURGERY

Innovative Surgical Sciences

Pub Date : 2023-05-04 eCollection Date: 2023-03-01 DOI: 10.1515/iss-2022-0023

Christin Müller, Samantha Taber, Joachim Pfannschmidt, Sergej Griff

Objectives: In patients with non-small cell lung cancer (NSCLC) the pathologic lymph node status N2 is a heterogeneous entity, with different degrees of lymph node involvement representing different prognoses. It is speculated whether extra capsular nodal extension may help to define a subgroup with implications on long-term survival.

Methods: We retrospectively identified 118 patients with non-small cell lung cancer (65 men, 53 women), who were treated between 2013 and 2018 and found to have pathologic N2 lymph node involvement. In all patients lung resection with systematic mediastinal and hilar lymph node dissection was performed with curative intent. In N2 lymph node metastases capsules of affected lymph nodes were examined microscopically as to whether extracapsular extension was present.

Results: 51 patients (43 %) had extracapsular extension (ENE). Most of these patients (n=35) only had ENE in a single lymph node (69 %). The overall 5-year survival rate was 24.6 % and progression-free survival rate 17.8 %. In the multivariate analysis OS was worse for patients with multiple affected pN2 stations, concurrent N1 metastases, increasing age, and larger tumor size. For the percentage of lymph nodes affected with ENE (of total examined) only a non-significant trend towards worse OS could be observed (p=0.06).

Conclusions: Although we could not demonstrate significant prognostic differences between N2 extra capsular nodal involvement within our patient population, other analyses may yield different results. However, clinicians should continue performing thorough lymph nodes dissections in order to achieve local complete resection even in patients with extra capsular tumor spread.

目的：在癌症（NSCLC）患者中，病理性淋巴结状态N2是一个异质性实体，不同程度的淋巴结受累代表不同的预后。据推测，包膜外淋巴结的扩展是否有助于确定一个对长期生存有影响的亚组。方法：我们回顾性确定了118例癌症患者（65名男性，53名女性），他们在2013年至2018年间接受了治疗，发现病理性N2淋巴结受累。所有患者都进行了肺切除术，并进行了系统的纵隔和肺门淋巴结清扫，以达到治疗目的。在N2淋巴结转移中，用显微镜检查受影响淋巴结的包膜是否存在包膜外延伸。结果：51名患者（43名 %) 具有囊外延伸（ENE）。这些患者中的大多数（n=35）仅在单个淋巴结中有ENE（69 %). 总的5年生存率为24.6 % 无进展生存率17.8 %. 在多变量分析中，多个受影响的pN2位点、同时有N1转移、年龄增加和肿瘤大小较大的患者的OS更差。对于受ENE影响的淋巴结百分比（占检查总数），只能观察到OS恶化的非显著趋势（p=0.06）。结论：尽管我们不能证明N2包膜外淋巴结在我们的患者群体中存在显著的预后差异，但其他分析可能会产生不同的结果。然而，临床医生应该继续进行彻底的淋巴结解剖，以实现局部完全切除，即使是囊外肿瘤扩散的患者。

{"title":"Extracapsular extension of pN2 lymph node metastases is not prognostically significant in surgically resected patients with non-small cell lung cancer.","authors":"Christin Müller, Samantha Taber, Joachim Pfannschmidt, Sergej Griff","doi":"10.1515/iss-2022-0023","DOIUrl":"10.1515/iss-2022-0023","url":null,"abstract":"Objectives: In patients with non-small cell lung cancer (NSCLC) the pathologic lymph node status N2 is a heterogeneous entity, with different degrees of lymph node involvement representing different prognoses. It is speculated whether extra capsular nodal extension may help to define a subgroup with implications on long-term survival.Methods: We retrospectively identified 118 patients with non-small cell lung cancer (65 men, 53 women), who were treated between 2013 and 2018 and found to have pathologic N2 lymph node involvement. In all patients lung resection with systematic mediastinal and hilar lymph node dissection was performed with curative intent. In N2 lymph node metastases capsules of affected lymph nodes were examined microscopically as to whether extracapsular extension was present.Results: 51 patients (43 %) had extracapsular extension (ENE). Most of these patients (n=35) only had ENE in a single lymph node (69 %). The overall 5-year survival rate was 24.6 % and progression-free survival rate 17.8 %. In the multivariate analysis OS was worse for patients with multiple affected pN2 stations, concurrent N1 metastases, increasing age, and larger tumor size. For the percentage of lymph nodes affected with ENE (of total examined) only a non-significant trend towards worse OS could be observed (p=0.06).Conclusions: Although we could not demonstrate significant prognostic differences between N2 extra capsular nodal involvement within our patient population, other analyses may yield different results. However, clinicians should continue performing thorough lymph nodes dissections in order to achieve local complete resection even in patients with extra capsular tumor spread.","PeriodicalId":44186,"journal":{"name":"Innovative Surgical Sciences","volume":"8 1","pages":"9-16"},"PeriodicalIF":1.3,"publicationDate":"2023-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10576552/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41239677","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Female physician and pregnancy- effect of the amended German maternity protection act on female doctors' careers. 女医生和怀孕——修订后的德国《产妇保护法》对女医生职业生涯的影响。

IF 1.3 Q2 SURGERY

Innovative Surgical Sciences

Pub Date : 2023-03-31 eCollection Date: 2023-03-01 DOI: 10.1515/iss-2022-0024

Barbara Puhahn-Schmeiser, Eva K Hennel, Christiane Gross, Heike Raestrup, Astrid Bühren, Mandy Mangler

Objectives: In Germany, the 2018 amended Maternity Protection Act frequently leads to fundamental restrictions for female physicians, especially surgeons, and now even also for students impeding the progress of their careers. Our goal was to assess the current situation for pregnant female physicians and students, respectively, and their perspective on this amendment regarding their career path.

Methods: A nationwide survey was conducted in Germany from December 2020 to February 2021. The questionnaire included 790 female physicians and students who were pregnant after the inception of the amended Act. Those women pregnant after the beginning of the corona pandemic were excluded.

Results: The survey revealed that two thirds of female physicians worked a maximum of 50% in their previous professional activity as soon as they reported pregnancy. Amongst medical students this amounted up to 72%. 18% of the female physicians and 17% of the female medical students respectively could not follow the sense of these restrictions. 44% of female medical physicians and 33% of female students felt their career impeded. This led up to 43% amongst female medical doctors and 53% amongst female medical students, respectively, who were concerned to announce their pregnancy. As a consequence, pregnancies were reported at 12 weeks in female physicians compared to 19 weeks in medical students.

Conclusions: Analyses of the current survey revealed that a relevant number of female physicians and medical students felt impeded in their career path through the application of the amended Maternity Act.

目标：在德国，2018年修订的《产妇保护法》经常导致对女医生，尤其是外科医生的根本限制，现在甚至对阻碍职业发展的学生也有限制。我们的目标是分别评估怀孕女医生和学生的现状，以及她们对这项修正案的看法。方法：2020年12月至2021年2月在德国进行了一项全国性调查。调查问卷包括790名女医生和学生，她们在修正法案生效后怀孕。那些在新冠疫情开始后怀孕的妇女被排除在外。结果：调查显示，三分之二的女医生在报告怀孕后，在之前的专业活动中最多工作了50%。在医学生中，这一比例高达72%。18%的女医生和17%的女医学生不能理解这些限制。44%的女医生和33%的女学生认为自己的职业生涯受到阻碍。这导致关注宣布怀孕的女医生和女医学生分别占43%和53%。因此，据报道，女医生怀孕12周，而医学生怀孕19周。结论：对当前调查的分析显示，通过实施修订后的《产妇法》，相关数量的女医生和医学生在职业道路上感到受到阻碍。

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引用次数: 0

Presentation, management and outcomes of iliopsoas abscess at a University Teaching Hospital in Nepal. 尼泊尔一所大学教学医院髂腰肌脓肿的介绍、治疗和结果。

IF 1.3 Q2 SURGERY

Innovative Surgical Sciences

Pub Date : 2023-03-27 eCollection Date: 2023-03-01 DOI: 10.1515/iss-2022-0013

Jayant Kumar Sah, Shankar Adhikari, Ganesh Sah, Bikal Ghimire, Yogendra Prasad Singh

Objectives: Iliopsoas abscess (IPA) is an uncommon clinical disease and is often missed to diagnose due to vague clinical presentation. Early treatment with drainage and appropriate antibiotic therapy is necessary before sepsis sets in and become lethal. We conducted this study to evaluate clinical features, etiology, management strategies, and outcomes in patients with IPA from a University Teaching Hospital in Nepal.

Methods: A retrospective analysis of 32 consecutive IPA cases managed at Tribhuvan University Teaching Hospital, Nepal for the period of January 2019 to February 2022 was carried out.

Results: The mean age was 42.5 ± 19.1 years (range, 19-75 years) and the male: female ratio was 2.2:1. Two-thirds or more patients presented with fever, limp, fixed flexion deformity and/or low back pain. Ultrasonography (US) was diagnostic in 27 (84.4%) patients. Eighteen (56.3%) patients had primary IPAs, and 14 (43.7%) had secondary IPAs. Thirty (93.7%) patients were managed with US guided percutaneous drainage (PCD) and 2 (6.2%) patients underwent open surgical drainage. Drainage procedures were combined with antibiotics in all patients. Pus culture showed Staphylococcus aureus growing in the majority of cases (10 of 23, 43.5%). The hospital stay was longer in patients treated via surgical drainage compared to those who received PCD: 13 days (range 12-14 days) vs. 6.6 days (range 4-13 days), respectively. Recurrence of abscess was seen in 4 (12.5%) cases and all were successfully managed via a second PCD. There was no mortality.

Conclusions: Varying clinical presentation of iliopsoas abscess demand a high index of suspicion for early diagnosis. Initial imaging modality in suspected case of IPA is US. US-guided PCD along with the appropriate antibiotics is a successful frontline treatment of IPAs with shorter hospital stay.

目的：髂腰肌脓肿（IPA）是一种不常见的临床疾病，由于临床表现模糊，常被漏诊。在败血症发作并致命之前，早期引流和适当的抗生素治疗是必要的。我们进行了这项研究，以评估尼泊尔一所大学教学医院IPA患者的临床特征、病因、管理策略和结果。方法：对2019年1月至2022年2月期间在尼泊尔特里布万大学教学医院管理的32例连续IPA病例进行回顾性分析。结果：平均年龄为42.5±19.1岁（19～75岁），男女比例为2.2:1。三分之二或更多的患者出现发烧、跛行、固定屈曲畸形和/或腰痛。超声诊断27例（84.4%）。18名（56.3%）患者患有原发性IPA，14名（43.7%）患者患有继发性IPA。30名（93.7%）患者接受了US引导的经皮穿刺引流术（PCD），2名（6.2%）患者接受开放手术引流。所有患者均采用引流术和抗生素治疗。Pus培养显示，大多数病例（23例中有10例，43.5%）中都有金黄色葡萄球菌生长。与接受PCD的患者相比，通过手术引流治疗的患者住院时间更长：分别为13天（12-14天）和6.6天（4-13天）。脓肿复发4例（12.5%），均通过第二次PCD成功治疗。没有死亡。结论：髂腰肌脓肿的不同临床表现要求早期诊断具有较高的怀疑指数。疑似IPA病例的初始成像模式是美国。美国指导的PCD和适当的抗生素是IPA的成功一线治疗，住院时间更短。

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引用次数: 0