Cirugia Y Cirujanos最新文献

Objective: To determine if the systemic immune-inflammation index (SII) is a prognostic marker of mortality in COVID-19 patients.

Method: Retrospective study that included patients admitted to a general hospital in Mexico City with diagnostic of COVID-19, confirmed by quantitative polymerase chain reaction from nasopharyngeal swab specimens in addition to characteristic symptomatology and computerized thoracic tomography imaging. Upon admission an hematic biometry was taken to calculate the SII (neutrophils × platelets/lymphocytes). The optimal cut-off point was determined from a ROC curve; the chi-square test was used to evaluate the association of SII with mortality, the strength of the association was estimated through the odds ratio (OR) and, finally, a multivariate binary logistic regression analysis was performed.

Results: 140 individuals were included, 86 (61.4%) men and 54 women (38.6%), the mean age of patients was 52 (± 13.81) years old. The best prognostic cut-off point found was 2332.30 × 10⁹ (area under the curve: 0.68; 95% confidence interval [95% CI]: 0.59-0.77; p < 0.05). The OR was 3.78 (95% CI: 1.83-7.82; p < 0.05).

Conclusions: We demonstrated that the SII is an easily available tool, effective and a prognostic marker of mortality in hospitalized COVID-19 patients.

Objectives: This case report presented cases with spontaneous hemoperitoneum during pregnancy.

Case report: Case 1 presented with acute abdominal pain with signs of shock. Cases 2 and 3 both presented with stable vital signs and the sudden decline of fetal heart rate. Cesarean section was performed at 27, 36⁺⁴, and 34 gestational weeks, respectively. Bleeding sites were founded on the surface of the uterus or the parametrium. The perinatal outcome was stillbirth, live birth, and neonatal severe asphyxia.

Conclusion: Careful physical examination, strict monitoring of vital signs, and timely surgical intervention are critical for improving the prognosis.

Background: The prevalence of intertrochanteric hip fractures is approximately 30%. The usual management of hip fractures is performed by dynamic hip screw (DHS) or central medullary nailing (CMN). The COVID-19 pandemic has changed medical treatment guidelines in all specialties around the world.

Objective: To recognize the prevalence and management of unstable trochanteric hip fractures during the COVID-19 pandemic.

Method: An observational study was conducted in a third-level care hospital in patients with fractures of type AOOTA 31A2.1 and A2.2 managed with CMN or DHS. The management trends by orthopedic surgeons were analyzed.

Results: The prevalence during 2019 was 38%, in 2020 it was 21.3% and in 2021 it was 32.6%. The male-to-female ratio found was 1:1.7. The age was 66.48 ± 21.6 years (range: 17-92). Of orthopedic surgeons surveyed, 80.4% preferred CMN.

Conclusions: The prevalence decreased during 2020. The treatment trend during the pandemic was higher for the DHS system; the use of CMN decreased by 86%. The treatment of intertrochanteric hip fractures was influenced due to the COVID-19 pandemic towards a cheaper method.

Objective: The objective of the study is to identify the prevalence, causes, and clinical evolution of patients with surgical reintervention due to complications during cesarean section.

Materials and methods: The file of the Toco-Surgical Unit of the Gynecological Obstetrics Hospital No. 3 of the National Medical Center "La Raza" Mexican Institute of Social Security was reviewed to know the total number of patients undergoing cesarean section from January to December 2019 and cases with reintervention due to complications during cesarean section were selected. Their general data, the cause of reintervention, stay in the intensive care unit (ICU), hospital stay, and mortality were studied. The data were analyzed with descriptive statistics using the statistical program SPSS version 20.

Results: It was found that 3371 patients underwent cesarean section, of which 1.60% (54 cases) underwent reoperation for the following reasons: Unpacking 27.79%, obstetric hemorrhage 20.37%, bleeding due to uterine atony 20.37%, hysterotomy commissure hematoma 18.52%, uterine infiltration 3.70%, vascular injury 3.70%, bladder injury 3.70%, and colonic injury 1.85%. The ICU stay was 3.79 ± 2.03 days, hospital stay was 13.67 ± 11.16 days, and mortality was 1.85%.

Conclusion: The prevalence of reintervention was reduced, bleeding was the main cause, and the clinical evolution was satisfactory with low mortality.

Objectives: The predictive factors affecting the survival of hilar cholangiocarcinoma (HC) are ambiguous. This study aimed to identify the predictors and recurrence patterns of HC.

Methods: A retrospective analysis of the clinicopathological findings of 126 patients with HC from 2009 to 2019 was performed.

Results: The proportion of Bismuth I and II HC in the recurrence group was higher than that in the non-recurrence group (p < 0.01). The recurrence group had poorer tumor differentiation, a more advanced N stage, and a higher incidence of perineural invasion compared with the non-recurrence group. N stage and tumor differentiation were independently associated with disease-free and overall survival of patients (p < 0.01). Bile duct resection (BDR) combined with hepatectomy was more favorable to disease-free and overall survivals than BDR alone in Bismuth I and II HC, although p values were marginal (p = 0.072 and p = 0.045). A higher proportion of patients in the non-recurrence group underwent BDR combined with hepatectomy than that in the recurrence group (p < 0.01).

Conclusions: N stage and tumor differentiation are the two independent predictors of patient survival. BDR combined with hepatectomy is recommended for patients with Bismuth I and II hilar cholangiocarcinoma.

Objective: We investigated the effects of the Health Belief Model (HBM)-based intervention on nurses' behaviors in terms of keeping surgical instruments moist.

Materials and methods: Pre- and post-training surveys about instrument moistening were conducted with the same 356 nurses from a hospital in China. Both of the surveys contained questionnaire concerning general knowledge relating to instrument moistening, perception scale-based questions concerning the same issue, and an inspection form concerning the implementation of moistening procedures. Three months' training was provided for the nurses.

Results: After training, the nurses' knowledge, attitudes, beliefs, and behaviors for instrument moistening were improved.

Conclusions: The HBM-based intervention can bring about a significant improvement in nurses' compliance with surgical instrument moistening requirements, and corresponding improvements in instrument cleanliness and patient safety.

Background: Although the cavernous sinus (CS) has been studied since 1695, its anatomy and name are still under discussion.

Method: Anatomy and histology of 40 CS from human cadavers were studied, included both from a newborn specimen.

Results: Two walls limit the CS, an inferior medial one composed only of the dura's outer layer and a superior lateral one consisting of both dura's layers. Sinusoidal veins pass through the lateral wall of the CS as a transition between venous tributaries and the CS. An endothelial layer covers the inner surface of the CS and the outer surface of the internal carotid artery. The space within the CS shows trabeculae, which are rarer in adults compared to the newborn. The loss of trabeculae in the CS may be a natural process along with life.

Conclusions: In conclusion, the CS is a real sinus, and the term "cavernous sinus" is appropriately applied.

Background: The identification of gastric polyps incidentally in endoscopies of the upper digestive tract has increased its incidence, varying between 0.5% and 23%. 10% of these polyps have symptoms, 40% are hyperplastic. We allow ourselves to propose a laparoscopic technique for the management of giant hyperplastic polyps associated with a pyloric syndrome, not susceptible to endoscopic resection.

Method: A series of patients approached by laparoscopic transgastric polypectomy due to the giant gastric polyps associated with pyloric syndrome, in Bogotá, Colombia, from January 2015 to December 2018.

Results: Seven patients, 85% female, with an average age of 51 years, who were admitted for pyloric syndrome and were taken to laparoscopic management, with an average surgical time of 42 min, intraoperative bleeding 7-8 cc, tolerance to the oral route 24 hours, no conversion, without mortality.

Conclusions: Transgastric polypectomy for the management of benign giant gastric polyps that cannot be resected endoscopically turns out to be a feasible method, with a low rate of complications and without mortality.

Background: Currently there are no studies that determine the safety and quality of life of kidney donors in Mexico.

Objective: To determine the safety of being a kidney donor and the quality of life, comparing the open approach with hand-assisted laparoscopic technique.

Method: Observational, cross-sectional, analytical study of the kidney donors in our hospital from January 2015 to December 2018, in two groups: open technique and hand-assisted laparoscopic. To determine safety, the Clavien-Dindo scale and transoperative bleeding were used, and the SF-36 health-related quality of life questionnaire was applied.

Results: There are no reports of peri-operative complications in any type of approach. All the patients obtained a grade I in the Clavien-Dindo scale. When the difference in the score of the SF-36 health-related quality of life questionnaire in kidney donor patients with hand-assisted laparoscopic surgical approach versus open approach was compared, a difference between both means of 14.05 was obtained, with p < 0.0001 in favor of the hand-assisted approach.

Conclusions: Being a kidney donor is safe and the approach that we recommend is hand-assisted laparoscopic nephrectomy.