Cirugia Y Cirujanos最新文献

Medical care must be supported by research that meets reliable, valid, ethical, and reproducible principles. However, an essential fraction of research carried out in the medical field is inadequately reported due to omitting relevant information when it is published. This reduces their impact and the possibility that other researchers can realize critical appraisal, thereby compromising their application within medical practice. Because of this, guidelines have been developed to reduce this problem; their purpose is to increase research reports' methodological quality, transparency, validity, and reliability. Despite their importance, incorporating these guidelines in various journals and the knowledge and use by a significant part of the medical community is limited. In this context, this article aims to synthesize the main guidelines for reporting research in medicine.

Background: Acute care surgery decreased during the first wave of the COVID-19 pandemic.

Objective: To study the evolution of acute care surgery and its relationship with the pandemic severity.

Method: Retrospective cohort study which compared patients who underwent acute care surgery during the pandemic to a control group.

Results: A total of 660 patients were included (253 in the control group, 67 in the first-wave, 193 in the valley, and 147 in the second wave). The median daily number of acute care surgery procedures was 2 during the control period. This activity decreased during the first wave (1/day), increased during the valley (2/day), and didn't change in the second wave (2/day). Serious complications were more common during the first wave (22.4%). A negative linear correlation was found between the daily number of acute care surgery procedures, number of patients being admitted to the hospital each day and daily number of patients dying because of COVID-19.

Conclusions: Acute care surgery was reduced during the first wave of the COVID-19 pandemic, increased during the valley, and returned to the pre-pandemic level during the second wave. Thus, acute care surgery was related to pandemic severity, with fewer surgeries being performed when the pandemic was more severe.

Objective: To determine the efficacy of serum procalcitonin (PCT) and C-reactive protein (CRP) in the early diagnosis of anastomotic leak (AL) in patients undergoing colorectal surgery.

Method: Diagnostic test in a tertiary care hospital. Patients who did not have preoperative measurements of PCT and CRP were excluded. Those with postoperative infection not related to AL were eliminated. The diagnostic efficacy measures were sensitivity (Sn), specificity (Sp), positive (PPV) and negative (NPV) predictive values, positive (LR+) and negative (LR-) likelihood ratios, and area under the receiver operating characteristic curve (AUROC).

Results: Thirty-nine patients were analyzed; six had AL (15.4%). PCT and CRP increased on the second postoperative day, only in patients with AL. The cut-off points at the second postoperative day were 1.55 ng/mL for PCT and 11.25 mg/L for CRP. The most efficacious test was PCR at second postoperative day (AUROC: 1.00; Sn: 100%; Sp: 96.7%; PPV: 85.7%; NPV: 100%; LR+: 33.0).

Conclusions: CRP at second postoperative day was the most effective test in the early diagnosis of AL in patients undergoing colorectal surgery, with a cut-off point lower than that reported in the international literature.

Objective: In this study, we aimed to compare the anti-adhesive effects of contractubex and dicalcium phosphate dihydrate (DCPD) particles in rats treated with the uterine horn adhesion model.

Materials and methods: Newly adult, 60 Wistar albino rats were used as experimental animals. The modified rat uterine horn adhesion model was used to induce intra-abdominal adhesion. Tumor necrosis factor (TNF)-α, interleukin (IL)-1, vascular endothelial growth factor (VEGF) and transforming growth factor (TGF)-β1 were studied for biochemical and immunohistochemical examination.

Results: TNF-α decreased in each group, while it decreased more in G2 and G3 than in G1. IL-1β decreased in each group, while it decreased the most in G3. TGF-β1 and VEGF localization was less in the G2 compared to G1, the least TGF-β1 and VEGF immunolocalization was detected in the G3 and G4. For both antibodies, the least localization among all groups belonged to G3. From day 7 to day 21, the highest TGF-β1 immunolocalization was observed in G1, lesser localization in G2 and lowest in G3.

Conclusion: DCPD nanoparticles show promise as a clinical antiadhesive agent and should be further evaluated in experimental animal models and human trials.

Objective: To evaluate the skills achieved by the undergraduate medical student in performing an open appendectomy and purse string in the simulation model created, to evaluate the degree of satisfaction of its use and to determine its costs.

Method: Pre-experimental, prospective and longitudinal study. The skills achieved by 24 undergraduate medical students in performing an open appendectomy and purse string in the simulator were evaluated using the OSATS (Objective Structured Assessment of Technical Skills) through virtual teaching. A survey was conducted to the students to evaluate the simulator and its costs were determined.

Results: There was a significant increase in the OSATS of the skills achieved, from 7 (pre-test) to 26 ± 5.71 points (final post-test) (p = 0.0001) and reduction in the operative time from 12 ± 3.81 minutes (first post-test) to 8 ± 2.02 minutes (final post-test) (p = 0.0001). 41% of the students were totally satisfied with the achievements obtained and 59% partially satisfied. The cost of the simulator was 4.64 USD.

Conclusions: The students achieved an improvement in their skills in the surgical technique. This simulation model is low cost and presents an adequate level in the satisfaction of the achievements obtained by the students.

Purpose: The COVID-19-induced effects of primary bladder cancer (BC) patients have not yet been clarified. The aim of this study was to investigate the effects of the pandemic on the diagnosis, treatment, and follow-up of primary BC patients.

Material and methods: A retrospective single-center analysis was made of all patients who underwent diagnostic and surgical procedures due to primary BC between November 2018 and July 2021. A total of 275 patients were identified and allocated to one of the groups: Pre-COVIDBC (BC diagnosed before the COVID-19 pandemic) or COVIDBC (during the pandemic).

Results: The BC patients diagnosed during the pandemic were mostly at higher stages (T2) (p = 0.04), the risk of non-muscle invasive BC (NMIBC) was higher (p = 0.02), and recurrence and progression scores were increased (p = 0.001) compared to patients diagnosed before the pandemic. The time to surgery from diagnosis (p = 0.001) and symptom duration (p = 0.04) were significantly prolonged during the pandemic and the rate of follow-up significantly decreased (p = 0.03).

Conclusions: The study results highlight the significant increase in muscle invasive BC and the very high risk of NMIBC in patients presenting during the COVID-19 pandemic.

Background: This study aimed at comparing the effects of cylindrical- and conical-cuff endotracheal tubes (ETTs) inflated with saline on cuff pressures, post-operative sore throat, and post-operative analgesic consumption in surgeries taking longer than 120 min.

Objective: This study aimed at comparing the effects of cylindrical- and conical-cuff endotracheal tubes (ETTs) inflated with saline on cuff pressures, post-operative sore throat, and post-operative analgesic consumption in surgeries taking longer than 120 min.

Methods: The study was performed on a total of 100 patients, aged 18-65 years, in the ASA I-III risk group, with cylindrical cuff (Group C, n = 50) and conical cuff (Group T, n = 50) ETT patients. Cuff pressure values of all patients were recorded.

Results: The cuff pressure values at all measurement times and maximum cuff pressure value were significantly lower in Group T than in Group C (p < 0.05). In the post-operative 24-h period, sore throat and total analgesic consumption were significantly lower in Group T than in Group C (p < 0.05).

Conclusion: conical cuff ETTs prevent the increase in intraoperative cuff pressures, reduce the incidence of post-operative sore throat, and accordingly reduce post-operative analgesic consumption compared to cylindrical cuff ETTs.

Background: One of the most serious complications of cholecystectomy is bile duct disruption, which can be associated with concomitant vascular injury in up to 3.4%. The incidence, demographic characteristics and treatment are underreported worldwide.

Objective: To determine the incidence of vascular lesions in patients with a diagnosis of bile duct disruption secondary to cholecystectomy from January 1, 2015 to December 31, 2019, confirmed by preoperative CT angiography or intraoperative findings.

Method: Retrospective, observational and analytical study of a series of cases between 2015 and 2019. Where a total of 144 cases of bile duct disruption were found, 15 cases (10%) with concomitant vascular injury.

Results: The most frequent vascular injury was of the right hepatic artery in 13 patients (87%). The level of biliary disruption most frequently associated was Strasberg E3 and E4 in 5 patients (36%), respectively. The treatment of vascular injury was ligation of the injured vessel in 11 patients (73%). The treatment established for the repair of biliary disruption was the hepatic jejunum anastomosis in 14 patients (93%).

Conclusions: The presence of injury at the level of the right hepatic artery is the most frequent and its ligation did not show a significant impact on biliodigestive reconstruction, as long as an adequate technique is performed (Hepp-Couinaud).

Objective: To compare the evolution of hospitalized patients infected with SARS-CoV-2 who received corticosteroid-based treatment versus patients who received standard therapy.

Method: Retrospective, observational, and analytical study. Clinical records were collected from the different intensive care units, and data were obtained from confirmed COVID-19 patients over 18 years of age who were hospitalized. The population was divided into two groups: patients who received corticosteroid treatment, and those who received standard therapy.

Results: A total of 1603 patients were admitted to hospital, and of these 984 (62.9%) were discharged due to death. The main result was the identification by odds ratio (OR: 4.68; 95% confidence interval [95% CI]: 3.75-5.83; p = 0.001) as risk for death to the use of systemic steroids, as well as the use of invasive mechanical ventilation (OR: 2.26; 95% CI: 1.80-2.82; p < 0.001). The male gender was the most affected with 1051 (65.6%) patients. Mean age was 56 years (± 14).

Conclusions: Corticosteroid use was associated with poor prognosis in patients hospitalized for COVID-19 compared to those receiving standard therapy.

We present the case of a 75-year-old man with a history of COVID-19 and splenic infarct treated with enoxaparin, who presented with intense abdominal pain and tomographic findings of free peri-splenic fluid and a hyperdense image in the spleen. An emergency laparotomy was performed, with findings of a splenic rupture at the vascular hilum. Spontaneous splenic rupture is a rare and fatal entity that should be suspected in a patient with history of COVID-19 who presents with acute abdominal pain after the administration of heparin.