Pub Date : 2022-07-05DOI: 10.1101/2022.07.01.22277168
W. Tan, J. Li, Z. Jiang
BackgroundConsiderable geometric changes to the organs at risk (OARs) have been reported during treatment with chemotherapy and intensity modulated radiotherapy (chemo-IMRT) for locally advanced nasopharyngeal carcinoma (LA-NPC). This study aimed to quantify geometric changes to the central nervous system-related OARs (CNS-OARs), during chemo-IMRT for LA-NPC. MethodsThis prospective study included 20 patients with LA-NPC, treated with chemo-IMRT. Patients underwent a planning computed tomography (CT-plan) scan with intravenous contrast, followed by six weekly scans without contrast (CT-rep). For CNS-OARs, including the spinal cord, brainstem, optic chiasm and nerves, the globes of the eye, lens, and inner ears, their volume loss, the center of mass (COM) displacement, and spatial deformation was compared among weeks, respectively. The correlation between organ volume reduction and patients weight loss was estimated. ResultsThe volume of the brainstem, spinal cord, and the globe of left-and right-side eye averagely decreased by 2.6{+/-}2.3% (95% CI: 2.1%, 3.1%), 6.5{+/-}4.8% (5.6%,7.4%), 9.4{+/-}6.9% (8.1%, 10.6%) and 9.6{+/-}7.8% (8.2, 11.1%) respectively. The volume reduction of the spinal cord and that of the brainstem were significantly correlated with patients weight loss. For all OARs, the COM displacement was within 3 mm, except for the lower level of the spinal cord. The DSC value of the spinal cord, brainstem, and the globes of the eye was of >0.85 throughout treatment. ConclusionsThe volume and shape changes to the CNS-OARs during chemo-IMRT for NPC were quantifiable, which could be useful to refine radiation treatment protocols.
{"title":"Geometric changes to the central nervous system organs at risk during chemoradiotherapy for locally advanced nasopharyngeal carcinoma","authors":"W. Tan, J. Li, Z. Jiang","doi":"10.1101/2022.07.01.22277168","DOIUrl":"https://doi.org/10.1101/2022.07.01.22277168","url":null,"abstract":"BackgroundConsiderable geometric changes to the organs at risk (OARs) have been reported during treatment with chemotherapy and intensity modulated radiotherapy (chemo-IMRT) for locally advanced nasopharyngeal carcinoma (LA-NPC). This study aimed to quantify geometric changes to the central nervous system-related OARs (CNS-OARs), during chemo-IMRT for LA-NPC. MethodsThis prospective study included 20 patients with LA-NPC, treated with chemo-IMRT. Patients underwent a planning computed tomography (CT-plan) scan with intravenous contrast, followed by six weekly scans without contrast (CT-rep). For CNS-OARs, including the spinal cord, brainstem, optic chiasm and nerves, the globes of the eye, lens, and inner ears, their volume loss, the center of mass (COM) displacement, and spatial deformation was compared among weeks, respectively. The correlation between organ volume reduction and patients weight loss was estimated. ResultsThe volume of the brainstem, spinal cord, and the globe of left-and right-side eye averagely decreased by 2.6{+/-}2.3% (95% CI: 2.1%, 3.1%), 6.5{+/-}4.8% (5.6%,7.4%), 9.4{+/-}6.9% (8.1%, 10.6%) and 9.6{+/-}7.8% (8.2, 11.1%) respectively. The volume reduction of the spinal cord and that of the brainstem were significantly correlated with patients weight loss. For all OARs, the COM displacement was within 3 mm, except for the lower level of the spinal cord. The DSC value of the spinal cord, brainstem, and the globes of the eye was of >0.85 throughout treatment. ConclusionsThe volume and shape changes to the CNS-OARs during chemo-IMRT for NPC were quantifiable, which could be useful to refine radiation treatment protocols.","PeriodicalId":73961,"journal":{"name":"Journal of surgery and research","volume":"35 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83762077","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}
Post-operative atrial fibrillation (POAF) is a persistent and serious surgical complication that occur in 20-55% of cardiac surgery cases. POAF may lead to adverse health outcomes such as stroke, thromboembolism, cardiac arrest, and mortality, and may develop long-term. Patients have a 2-fold increase in mortality risk and spend about 3.7 more days in the hospital and $16,000 more in medical costs during their visit. The mechanisms and risk factors of POAF are still poorly understood, yet a strong foundation of how a disease process occurs is needed to provide the most effective treatment. Current mechanisms that are postulated to contribute to POAF include an increase in sympathetic tone, oxidative stress, local and systemic inflammation, a trigger that induces atrial substrate changes, a driver to sustain POAF, and electrolyte disturbances such as hypomagnesemia. While needing more research, current risk factors include age, male sex, history of myocardial infarction or heart failure, hypertension, diabetes, obesity, and COPD. Treatments mostly include prophylaxis of repurposed drugs such as beta-blockers, statins, oral anticoagulants, antiarrhythmics, and Vitamin D and electrolyte supplementation. Autonomic denervation has also been a promising preventative measure for patients undergoing cardiac surgery. This critical review article provides an up-to-date and comprehensive summary of the pathophysiology of POAF, current clinical risk factors and management for POAF and discusses new pathways for further investigation.
{"title":"Post-Operative Atrial Fibrillation: Current Treatments and Etiologies for a Persistent Surgical Complication","authors":"Leilani A Lopes, D. Agrawal","doi":"10.26502/jsr.10020209","DOIUrl":"https://doi.org/10.26502/jsr.10020209","url":null,"abstract":"Post-operative atrial fibrillation (POAF) is a persistent and serious surgical complication that occur in 20-55% of cardiac surgery cases. POAF may lead to adverse health outcomes such as stroke, thromboembolism, cardiac arrest, and mortality, and may develop long-term. Patients have a 2-fold increase in mortality risk and spend about 3.7 more days in the hospital and $16,000 more in medical costs during their visit. The mechanisms and risk factors of POAF are still poorly understood, yet a strong foundation of how a disease process occurs is needed to provide the most effective treatment. Current mechanisms that are postulated to contribute to POAF include an increase in sympathetic tone, oxidative stress, local and systemic inflammation, a trigger that induces atrial substrate changes, a driver to sustain POAF, and electrolyte disturbances such as hypomagnesemia. While needing more research, current risk factors include age, male sex, history of myocardial infarction or heart failure, hypertension, diabetes, obesity, and COPD. Treatments mostly include prophylaxis of repurposed drugs such as beta-blockers, statins, oral anticoagulants, antiarrhythmics, and Vitamin D and electrolyte supplementation. Autonomic denervation has also been a promising preventative measure for patients undergoing cardiac surgery. This critical review article provides an up-to-date and comprehensive summary of the pathophysiology of POAF, current clinical risk factors and management for POAF and discusses new pathways for further investigation.","PeriodicalId":73961,"journal":{"name":"Journal of surgery and research","volume":"63 1","pages":"159 - 172"},"PeriodicalIF":0.0,"publicationDate":"2022-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80323224","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}
Pub Date : 2022-03-23DOI: 10.1101/2022.03.20.22272324
R. Shah, A. Trivedi, K. Rajyaguru, P. Bhatt
Background: Early operative recovery and good Quality of life are important goals of radical cystectomy. We compare the pre, peri and post operative data between Open radical cystectomy (ORC) and Laparoscopic radical cystectomy (LRC) surgery of neobladder. Patients and Methods: Retrospective analysis of 13 male consecutive patients who underwent radical cystectomy by a single surgeon was done. Diagnosis of all patients was of invasive bladder cancer. Abdominal and preoperative staging was done using computed tomography. None of them received neoadjuvant chemotherapy. All the patients received same standard template bilateral pelvic lympadenenectomy. The urinary diversion included orthotopic neobladder. All patients were consented prior to study participation. Results: Of the 13 male patients, six had ORC with neobladder while 7 underwent LRC surgery. Baseline characteristics (age, BMI, comorbidities, tumour grade, lymph node status) were similar in both groups. Incision length was significantly smaller in LRC as compared to ORC group (p <0.0001). Although the operative time was longer in LRC group as compared to ORC it was sufficed by reduced time for analgesics, shorter hospital stay (p<0.05), besides earlier time to liquid intake with immediate removal of nasogastric tube (p<0.001). No major complications were observed in the LRC unlike ORC group where one patient died at 30 days. Conclusions: Based on the observations of our small study sample peri and postoperative outcomes are promising for LRC compared to ORC for patients undergoing neobladder in terms of the smaller incision length associated with less pain and complications, with speedy recovery without jeopardizing oncological outcomes.Transition of surgeon from ORC to LRC was advantageous to patients.
{"title":"Impact of Transition from Conventional Open Radical Cystectomy to Laparoscopic Radical Cystectomy for Neobladder: A Retrospective Study","authors":"R. Shah, A. Trivedi, K. Rajyaguru, P. Bhatt","doi":"10.1101/2022.03.20.22272324","DOIUrl":"https://doi.org/10.1101/2022.03.20.22272324","url":null,"abstract":"Background: Early operative recovery and good Quality of life are important goals of radical cystectomy. We compare the pre, peri and post operative data between Open radical cystectomy (ORC) and Laparoscopic radical cystectomy (LRC) surgery of neobladder. Patients and Methods: Retrospective analysis of 13 male consecutive patients who underwent radical cystectomy by a single surgeon was done. Diagnosis of all patients was of invasive bladder cancer. Abdominal and preoperative staging was done using computed tomography. None of them received neoadjuvant chemotherapy. All the patients received same standard template bilateral pelvic lympadenenectomy. The urinary diversion included orthotopic neobladder. All patients were consented prior to study participation. Results: Of the 13 male patients, six had ORC with neobladder while 7 underwent LRC surgery. Baseline characteristics (age, BMI, comorbidities, tumour grade, lymph node status) were similar in both groups. Incision length was significantly smaller in LRC as compared to ORC group (p <0.0001). Although the operative time was longer in LRC group as compared to ORC it was sufficed by reduced time for analgesics, shorter hospital stay (p<0.05), besides earlier time to liquid intake with immediate removal of nasogastric tube (p<0.001). No major complications were observed in the LRC unlike ORC group where one patient died at 30 days. Conclusions: Based on the observations of our small study sample peri and postoperative outcomes are promising for LRC compared to ORC for patients undergoing neobladder in terms of the smaller incision length associated with less pain and complications, with speedy recovery without jeopardizing oncological outcomes.Transition of surgeon from ORC to LRC was advantageous to patients.","PeriodicalId":73961,"journal":{"name":"Journal of surgery and research","volume":"58 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91038632","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}
Objectives: To determine the clinicopathological aspects and factors determining the recurrence and 5-year survival of patients diagnosed with retroperitoneal soft-tissue sarcoma in a Pakistani cohort of patients. Methods: This retrospective descriptive study was conducted at the Department of Surgical Oncology, Shaukat Khanum Memorial Hospital & Research Centre (SKMCH&RC), Lahore, Pakistan. Patients who underwent surgery for retroperitoneal sarcoma from January 2011 to December 2015 were included and followed for 5 years (December 2020). A total of 54 patients was included in this study. Results: Fifty-seven percent (n=31) cases were male with a median age at the time of presentation 43 (30-60) years. Well-differentiated liposarcoma was the most common variant. Non-compartmental resection was done in 40 (74%) of the cases. The overall 5-year survival was 74% with median Disease-Free Survival (DFS) of 14 (6-48) months. Recurrence was seen in 28 cases (52%). Conclusions: In the Pakistani cohort of patients. retroperitoneal soft-tissue sarcoma was more commonly seen in males at the median age of 43 years. The most common presentations were abdominal pain and mass. Well-differentiated liposarcoma was the most common histological variant. The overall 5-year survival was 74% that was affected by histological variant and grade. Recurrence was affected by histological variant and grade, margin positivity, and use of neoadjuvant therapy.
{"title":"Retroperitoneal Soft-Tissue Sarcoma: Retrospective Study from a Cancer Hospital in Pakistan","authors":"J. Mohsin, A. Jamal, Noor Mubeen, A. Syed","doi":"10.26502/JSR.10020110","DOIUrl":"https://doi.org/10.26502/JSR.10020110","url":null,"abstract":"Objectives: To determine the clinicopathological aspects and factors determining the recurrence and 5-year survival of patients diagnosed with retroperitoneal soft-tissue sarcoma in a Pakistani cohort of patients. \u0000 \u0000Methods: This retrospective descriptive study was conducted at the Department of Surgical Oncology, Shaukat Khanum Memorial Hospital & Research Centre (SKMCH&RC), Lahore, Pakistan. Patients who underwent surgery for retroperitoneal sarcoma from January 2011 to December 2015 were included and followed for 5 years (December 2020). A total of 54 patients was included in this study. \u0000 \u0000Results: Fifty-seven percent (n=31) cases were male with a median age at the time of presentation 43 (30-60) years. Well-differentiated liposarcoma was the most common variant. Non-compartmental resection was done in 40 (74%) of the cases. The overall 5-year survival was 74% with median Disease-Free Survival (DFS) of 14 (6-48) months. Recurrence was seen in 28 cases (52%). \u0000 \u0000Conclusions: In the Pakistani cohort of patients. retroperitoneal soft-tissue sarcoma was more commonly seen in males at the median age of 43 years. The most common presentations were abdominal pain and mass. Well-differentiated liposarcoma was the most common histological variant. The overall 5-year survival was 74% that was affected by histological variant and grade. Recurrence was affected by histological variant and grade, margin positivity, and use of neoadjuvant therapy.","PeriodicalId":73961,"journal":{"name":"Journal of surgery and research","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90819913","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}
Pub Date : 2022-01-20DOI: 10.21203/rs.3.rs-1240719/v1
A. Gopurathingal, Amar M. Kamat
The study aimed to find if an earlier fixation of proximal hip fractures in the elderly, leads to a better outcome, physically and mentally. Current guidelines recommend that hip fracture surgery should be done within 24 hours of injury. But those favoring a delay in surgery believe that it provides sufficient time to medically optimize patients, and thereby decrease the risk for perioperative complication. Our study was carried out in a tertiary care center. A total of 58 patients was enrolled in the study. Analysis showed, in comparison with the delayed fixation group, the early fixation group didn’t enjoy a statistically better physical quality of life at the end of 6 months, but mental health scores were significantly above the delayed fixation group. It also showed the most common reason for the delay was late presentation followed by delayed insurance clearance. An increased hospital stay was also seen for the delayed fixation group.
{"title":"Physical Activity Outcome In Early Vs Delayed Elderly Hip Fracture Surgery","authors":"A. Gopurathingal, Amar M. Kamat","doi":"10.21203/rs.3.rs-1240719/v1","DOIUrl":"https://doi.org/10.21203/rs.3.rs-1240719/v1","url":null,"abstract":"\u0000 The study aimed to find if an earlier fixation of proximal hip fractures in the elderly, leads to a better outcome, physically and mentally. Current guidelines recommend that hip fracture surgery should be done within 24 hours of injury. But those favoring a delay in surgery believe that it provides sufficient time to medically optimize patients, and thereby decrease the risk for perioperative complication. Our study was carried out in a tertiary care center. A total of 58 patients was enrolled in the study. Analysis showed, in comparison with the delayed fixation group, the early fixation group didn’t enjoy a statistically better physical quality of life at the end of 6 months, but mental health scores were significantly above the delayed fixation group. It also showed the most common reason for the delay was late presentation followed by delayed insurance clearance. An increased hospital stay was also seen for the delayed fixation group.","PeriodicalId":73961,"journal":{"name":"Journal of surgery and research","volume":"5 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85151469","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}
Mubariz Mahmood, D. Cottam, Momen Sid Ahmed, N. Nkwam, T. Rampal
Surgery causes a physiological and psychological stress response which can lead to a decline in functional capacity (1). The adoption of prehabilitation into existing pathways can improve postoperative outcomes. HoLEP (Holmium laser enucleation of the prostate) is a minimally invasive surgical treatment for men with benign prostatic hyperplasia. We aim to assess the feasibility of providing multimodal prehabilitation to patients with an ASA score of 2 or more. The prehabilitation interventions include supervised cardiopulmonary exercise, muscle conditioning, dietary/lifestyle advice and exploration of psychosocial needs. Patients will also receive a medication review by a specialist pharmacist. Compliance is to be assessed with a phonecall 2 weeks into the program and 6 weeks post procedure. Viability of the project will be determined by the ability of the organisation to deliver and sustain the program. The data to be collected will include project costs, time spent, patient satisfaction, length of stay, early and later surgical complications and daycase rate. This project will assess feasibility of perioperative optimisation programmes for non-oncology surgical pathways for maximal patient benefit.
{"title":"Research Protocol: Prehabilitation for Holmium Laser Enucleation of the Prostate (HoLEP)","authors":"Mubariz Mahmood, D. Cottam, Momen Sid Ahmed, N. Nkwam, T. Rampal","doi":"10.26502/jsr.10020219","DOIUrl":"https://doi.org/10.26502/jsr.10020219","url":null,"abstract":"Surgery causes a physiological and psychological stress response which can lead to a decline in functional capacity (1). The adoption of prehabilitation into existing pathways can improve postoperative outcomes. HoLEP (Holmium laser enucleation of the prostate) is a minimally invasive surgical treatment for men with benign prostatic hyperplasia. We aim to assess the feasibility of providing multimodal prehabilitation to patients with an ASA score of 2 or more. The prehabilitation interventions include supervised cardiopulmonary exercise, muscle conditioning, dietary/lifestyle advice and exploration of psychosocial needs. Patients will also receive a medication review by a specialist pharmacist. Compliance is to be assessed with a phonecall 2 weeks into the program and 6 weeks post procedure. Viability of the project will be determined by the ability of the organisation to deliver and sustain the program. The data to be collected will include project costs, time spent, patient satisfaction, length of stay, early and later surgical complications and daycase rate. This project will assess feasibility of perioperative optimisation programmes for non-oncology surgical pathways for maximal patient benefit.","PeriodicalId":73961,"journal":{"name":"Journal of surgery and research","volume":"4 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75127364","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}
M. Shibata, A. Inukai, Daigo Yoshimori, M. Ashizawa, T. Nakajima, Makoto Takada, T. Yazawa, K. Mimura, N. Inoue, Takafumi Watanabe, Kazunos .
Immune checkpoint inhibitors (ICIs) are not equally effective for all patients, regardless type of cancer. Immune-suppressor cells, including regulatory T tumor and their metabolic microenvironment (TME) play important roles in resistance to ICIs. Although Treg cells, TAMs and MDSCs play significant roles in immunosuppression in the TME, these cells are very important in the orchestration of metabolism such as angiogenesis and production of indoleamine 2,3-dioxygenase (IDO) and nitric oxide (NO) towards tumor escape, progression and expansion. Cancer immunotherapies tailored with metabolic characterizations such as parameters of angiogenesis, inflammation or obesity may be needed for the establishment of a successful treatment modality in the immunotherapy era.
{"title":"Metabolic Impact of Immune-Suppressor Cells in Cancer Patients","authors":"M. Shibata, A. Inukai, Daigo Yoshimori, M. Ashizawa, T. Nakajima, Makoto Takada, T. Yazawa, K. Mimura, N. Inoue, Takafumi Watanabe, Kazunos .","doi":"10.26502/jsr.10020207","DOIUrl":"https://doi.org/10.26502/jsr.10020207","url":null,"abstract":"Immune checkpoint inhibitors (ICIs) are not equally effective for all patients, regardless type of cancer. Immune-suppressor cells, including regulatory T tumor and their metabolic microenvironment (TME) play important roles in resistance to ICIs. Although Treg cells, TAMs and MDSCs play significant roles in immunosuppression in the TME, these cells are very important in the orchestration of metabolism such as angiogenesis and production of indoleamine 2,3-dioxygenase (IDO) and nitric oxide (NO) towards tumor escape, progression and expansion. Cancer immunotherapies tailored with metabolic characterizations such as parameters of angiogenesis, inflammation or obesity may be needed for the establishment of a successful treatment modality in the immunotherapy era.","PeriodicalId":73961,"journal":{"name":"Journal of surgery and research","volume":"24 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77965607","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}
{"title":"Hepatocellular Carcinoma in Transposition of Great Arteries (TGA) with Atrial Switch Procedure: A Case Report and Review of the Literature","authors":"P. Fontanges, O. Domanski, F. Godart","doi":"10.26502/jsr.10020262","DOIUrl":"https://doi.org/10.26502/jsr.10020262","url":null,"abstract":"","PeriodicalId":73961,"journal":{"name":"Journal of surgery and research","volume":"37 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88859221","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}
J. Stelmar, Shannon M Smith, Andrew Chen, J. Masterson, Vivian Hu, Maurice M. Garcia
Objective To describe a novel method to convert a closed-system suction drain to a highly efficient closed-system gravity-dependent drain and demonstrate its efficacy in an ex-vivo model. Methods We reviewed the 5 top-selling urology and surgery text/reference books for information on drainage systems. An ex-vivo model was designed with a reservoir of fluid connected to a Jackson-Pratt bulb drain. We measured the volume of fluid drained from the reservoir into the bulb while on-suction and off-suction. This was repeated using a novel modified bulb, where the bulb's outflow stopper was replaced with a one-way valve oriented to allow release of pressure from the bulb. Results With the bulb on-suction, drainage was maintained regardless of the height of the drain relative to the reservoir. With the bulb off-suction, closed passive gravity-dependent drainage occurred only when the drain was below the fluid reservoir; drainage ceased at minimal volumes. With addition of a one-way valve and maintenance of the bulb below the level of the reservoir, drainage proceeded to completion. Conclusion How surgical drains work is not described in the leading urology and general surgery textbooks/reference books. Closed-system suction drains cannot be used to achieve passive gravity-dependent drainage without allowing release of displaced air from the bulb-lumen. The novel modified drain we describe affords reversible closed-system suction and passive drainage.
{"title":"Procedures Never Explained in Textbooks: How to Correctly Convert a Closed-Suction Drain to a Closed-Gravity Drain, and How to Correctly Remove a Closed-Suction Drain Off Suction.","authors":"J. Stelmar, Shannon M Smith, Andrew Chen, J. Masterson, Vivian Hu, Maurice M. Garcia","doi":"10.26502/jsr.10020236","DOIUrl":"https://doi.org/10.26502/jsr.10020236","url":null,"abstract":"Objective To describe a novel method to convert a closed-system suction drain to a highly efficient closed-system gravity-dependent drain and demonstrate its efficacy in an ex-vivo model. Methods We reviewed the 5 top-selling urology and surgery text/reference books for information on drainage systems. An ex-vivo model was designed with a reservoir of fluid connected to a Jackson-Pratt bulb drain. We measured the volume of fluid drained from the reservoir into the bulb while on-suction and off-suction. This was repeated using a novel modified bulb, where the bulb's outflow stopper was replaced with a one-way valve oriented to allow release of pressure from the bulb. Results With the bulb on-suction, drainage was maintained regardless of the height of the drain relative to the reservoir. With the bulb off-suction, closed passive gravity-dependent drainage occurred only when the drain was below the fluid reservoir; drainage ceased at minimal volumes. With addition of a one-way valve and maintenance of the bulb below the level of the reservoir, drainage proceeded to completion. Conclusion How surgical drains work is not described in the leading urology and general surgery textbooks/reference books. Closed-system suction drains cannot be used to achieve passive gravity-dependent drainage without allowing release of displaced air from the bulb-lumen. The novel modified drain we describe affords reversible closed-system suction and passive drainage.","PeriodicalId":73961,"journal":{"name":"Journal of surgery and research","volume":"5 1","pages":"419-422"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89284277","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}
Cédric Niggli, Philipp Vetter, Jan Hambrecht, Philipp Niggli, Jindřich Vomela, Richard Chaloupka, Hans-Christoph Pape, Ladislav Mica
IBM and the University Hospital Zurich have developed an online tool for predicting outcomes of a patient with polytrauma, the IBM WATSON Trauma Pathway Explorer® . The three predicted outcomes are Systemic Inflammatory Response Syndrome (SIRS) and sepsis within 21 days as well as early death within 72 hours since the admission of the patient. The validated Trauma Pathway Explorer® offers insights into the most common laboratory parameters, such as procalcitonin (PCT). Sepsis is one of the most important complications after polytrauma, which is why it is crucial to detect it early. This study aimed to examine the time-dependent relationship between PCT values and sepsis, based on the WATSON technology. A total of 3653 patients were included, and ongoing admissions are incorporated continuously. Patients were split into two groups (sepsis and non-sepsis), and the PCT value was assessed for 21 days (1, 2, 3, 4, 6, 8, 12, 24, 48 hours, and 3, 4, 5, 7, 10, 14 and 21 days). The Mann-Whitney U-Test was used to evaluate the difference between the two groups. Binary logistic regression was utilized to examine the dependency of prediction. The Closest Top-left Threshold Method provided time-specific thresholds at which the PCT level is predictive for sepsis. At p <0.05, the data were declared significant. R was used to conduct all statistical analyses. The Mann-Whitney U-test showed a significant difference in PCT values in sepsis and non-sepsis patients between 12 and 24 hours, including post-hoc analysis (p <0.05). Likewise, the p-value started to be significant between 12 and 24 hours in the binary logistic regression (p <0.05). The threshold value of PCT to predict sepsis at 24 hours is 0.7μg/l, and at 48 hours 0.5μg/l. The presented time course of PCT levels in polytrauma patients shows the PCT as a separate predictor for sepsis relatively early. Even later, during the 21-day observation period, time-dependent PCT values may be utilized as a benchmark for the early and preemptive detection of sepsis, which may reduce death from septic shock and other deadly infectious episodes.
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