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Outcome of Early Reversal of Intestinal Stoma: A Cross-Sectional Study 早期肠造口逆转的结果:一项横断面研究
Pub Date : 2023-01-01 DOI: 10.26502/jsr.10020320
Md. Monoarul Islam Talukdar, Nazia Islam, Mohammed Tanvir Jalal, Mir Rasekh Alam Ovi, Shamima Nasrin, Md. Shahadot Hossain Sheikh
Background: Early reversal of temporary intestinal stoma might bring good clinical outcome as like as late reversal in the context of anastomotic leakage, postoperative ileus, sepsis, intraoperative bleeding etc. This may avoid stoma related morbidity & complications. This study was designed to find out the short-term outcomes of early reversal of intestinal stoma within 14 days of index surgery.
背景:在吻合口漏、术后肠梗阻、脓毒症、术中出血等情况下,早期进行临时肠造口翻转与晚期翻转一样具有良好的临床效果。这可以避免造口相关的发病率和并发症。本研究旨在了解指数手术后14天内早期肠造口逆转的短期结果。
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引用次数: 0
Use of Indocyanine Green Imaging in Gastroyeyunal Reconstruction For Recalcitrant Gastroparesis - Case Report 顽固性胃轻瘫在胃胃重建中的应用吲哚菁绿显像1例报告
Pub Date : 2023-01-01 DOI: 10.26502/jsr.10020292
Adolfo Leyva Alvizo, Cristina Villar- Canton, Giovanna Yazmin Arteaga-Müller, Meri Yeghiazaryan
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引用次数: 0
Emergency Department Management of Hip Fractures: Factors Predicting Readmission at 30 day, 60 day, 90 day and 1 year Intervals 髋部骨折的急诊科管理:间隔30天、60天、90天和1年再入院的预测因素
Pub Date : 2023-01-01 DOI: 10.26502/jsr.10020295
Brian Begley, Francis Maguire, Tyler Hoskins, Justin M. Miller, James C. Wittig
{"title":"Emergency Department Management of Hip Fractures: Factors Predicting Readmission at 30 day, 60 day, 90 day and 1 year Intervals","authors":"Brian Begley, Francis Maguire, Tyler Hoskins, Justin M. Miller, James C. Wittig","doi":"10.26502/jsr.10020295","DOIUrl":"https://doi.org/10.26502/jsr.10020295","url":null,"abstract":"","PeriodicalId":73961,"journal":{"name":"Journal of surgery and research","volume":"15 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79690316","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
Food Bolus Ileus as a Cause of High-Grade Bowel Obstruction: A Case Report 食物丸引起肠梗阻1例
Pub Date : 2023-01-01 DOI: 10.26502/jsr.10020285
Jin Kook Kang, Zhifei Sun
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引用次数: 0
The Learning Curve for Laparoscopic Totally Extraperitoneal Herniorrhaphy by Logarithmic Function: Consecutive 291 cases Performed by a Single Surgeon 用对数函数分析腹腔镜全腹膜外疝修补术的学习曲线:同一位外科医生连续291例
Pub Date : 2023-01-01 DOI: 10.26502/jsr.10020300
Duyeong Hwang, Y. Baik
Purpose: The Totally extraperitoneal (TEP) herniorrhaphy is not an easy technique for beginner surgeons because of the complexity of inguinal anatomy and narrow space of the operation field. The aim of this study is to estimate learning curve of laparoscopic TEP herniorrhaphy using logarithmic function model and the exponential function model. Revealing the number of cases needs to overcoming the early learning curve and minimizing the recurrence rate. Methods: A retrospective analysis of the first 291 patient who underwent laparoscopic TEP herniorrhaphy by a single surgeon consecutively. A logarithmic function and an exponential function were derived from operating time data. The population was divided into three consecutive groups. Each groups assigned the starting point, the slope of the curve, and the plateau of the curve. We calculated how many operation numbers are needed to achieve reduction expected operating time to mean operating time. Results: 291 patients underwent laparoscopic hernia repair. The mean operation time was 70.3 minutes for unilateral hernias. According to two learning curve models, the operation time was decreased less than mean operation time after the initial 88 cases was performed. As the operation time decreased, the recurrence rate decreased. Conclusion: According to the two learning curve models, 88 cases are required to overcome the learning curve, minimize revision surgery, and achieve a qualified surgery. Further studies on learning curves and training methods are needed to enable a scientific approach to surgical education and quality improvement in surgical education for surgeons and medical services for patients.
目的:由于腹股沟解剖结构复杂,手术范围狭窄,完全腹膜外疝修补术对新手外科医生来说不是一项容易的技术。本研究的目的是利用对数函数模型和指数函数模型估计腹腔镜TEP疝修补术的学习曲线。揭示病例数需要克服早期学习曲线并将复发率降至最低。方法:回顾性分析由同一位外科医生连续行腹腔镜下TEP疝修补术的291例患者。从运行时间数据导出了对数函数和指数函数。这些人被连续分成三组。每组指定起点、曲线的斜率和曲线的平台。我们计算了需要多少次操作才能将预期操作时间减少到平均操作时间。结果:291例患者行腹腔镜疝修补术。单侧疝平均手术时间为70.3分钟。根据两种学习曲线模型,在最初的88例手术后,手术时间的减少幅度小于平均手术时间。随着手术时间的缩短,复发率降低。结论:根据两种学习曲线模型,88例患者需要克服学习曲线,减少翻修手术,达到合格手术。需要进一步研究学习曲线和培训方法,以便科学地开展外科教育,提高外科医生的外科教育和患者的医疗服务质量。
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引用次数: 0
Accessory Breast Cancer: A Case Series 辅助乳腺癌:一个病例系列
Pub Date : 2023-01-01 DOI: 10.26502/jsr.10020299
Nicole Remmert, Nawal Moin, K. Daniele, Rakhsanda Layeequr Rahman
,
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引用次数: 0
To ascertain the awareness among Triage Staff about Clinical Conditions treated in the department of Hand Surgery from their Referral Pattern: A Cross Sectional Observational Study in a Tertiary Care Center 从转诊模式确定分诊人员对手外科临床状况的认识:三级医疗中心的横断面观察研究
Pub Date : 2023-01-01 DOI: 10.26502/jsr.10020308
M. Sethu, S. Rajappa
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引用次数: 0
Geometric changes to the central nervous system organs at risk during chemoradiotherapy for locally advanced nasopharyngeal carcinoma 局部晚期鼻咽癌放化疗期间中枢神经系统器官的几何变化
Pub Date : 2022-07-05 DOI: 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.
背景:在局部晚期鼻咽癌(LA-NPC)的化疗和调强放疗(chemo-IMRT)治疗过程中,已经报道了相当大的危及器官(OARs)的几何变化。本研究旨在量化LA-NPC化疗imrt期间中枢神经系统相关桨叶(CNS-OARs)的几何变化。方法本前瞻性研究纳入20例LA-NPC患者,采用化疗- imrt治疗。患者接受有计划的计算机断层扫描(CT-plan)和静脉造影剂扫描,随后是每周6次不进行造影剂扫描(CT-rep)。对于CNS-OARs,包括脊髓、脑干、视交叉和神经、眼球、晶状体和内耳,分别比较其体积损失、质心位移和空间变形。估计器官体积缩小与患者体重减轻之间的相关性。结果脑干、脊髓和左右侧眼球体积平均分别下降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%)和9.6{+/-}7.8%(8.2、11.1%)。脊髓和脑干体积减少与患者体重减轻有显著相关。除脊髓下部外,所有桨关节的COM位移均在3mm以内。整个治疗过程中脊髓、脑干、眼球的DSC值均>0.85。结论鼻咽癌化疗imrt期间CNS-OARs的体积和形状变化是可量化的,可用于改进放疗方案。
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引用次数: 0
Post-Operative Atrial Fibrillation: Current Treatments and Etiologies for a Persistent Surgical Complication 术后房颤:持续手术并发症的当前治疗和病因
Pub Date : 2022-03-28 DOI: 10.26502/jsr.10020209
Leilani A Lopes, D. Agrawal
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.
术后心房颤动(POAF)是一种持续且严重的外科并发症,发生在20-55%的心脏手术病例中。POAF可能导致不良的健康结果,如中风、血栓栓塞、心脏骤停和死亡,并可能发展为长期的。患者的死亡风险增加了两倍,在医院里多呆了3.7天,在就诊期间多花了1.6万美元的医疗费用。POAF的机制和危险因素仍然知之甚少,但需要一个疾病过程如何发生的坚实基础来提供最有效的治疗。目前被认为有助于POAF的机制包括交感神经张力增加、氧化应激、局部和全身炎症、诱发心房底物变化的触发因素、维持POAF的驱动因素以及电解质紊乱如低镁血症。目前的危险因素包括年龄、男性、心肌梗死或心力衰竭史、高血压、糖尿病、肥胖和慢性阻塞性肺病,但还需要更多的研究。治疗主要包括预防重新使用药物,如-受体阻滞剂、他汀类药物、口服抗凝血剂、抗心律失常药、维生素D和补充电解质。自主神经去支配也是一种很有希望的心脏手术患者预防措施。这篇重要的综述文章提供了最新和全面的POAF的病理生理,目前的临床危险因素和POAF的管理总结,并讨论了进一步研究的新途径。
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引用次数: 11
Impact of Transition from Conventional Open Radical Cystectomy to Laparoscopic Radical Cystectomy for Neobladder: A Retrospective Study 从传统开放根治性膀胱切除术到腹腔镜根治性膀胱切除术对新膀胱的影响:回顾性研究
Pub Date : 2022-03-23 DOI: 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.
背景:早期手术恢复和良好的生活质量是根治性膀胱切除术的重要目标。我们比较了开放式根治性膀胱切除术(ORC)和腹腔镜根治性膀胱切除术(LRC)治疗新膀胱的术前、围手术期和术后数据。患者与方法:回顾性分析13例连续由同一外科医生行根治性膀胱切除术的男性患者。所有患者均诊断为浸润性膀胱癌。腹部和术前分期采用计算机断层扫描。所有患者均未接受新辅助化疗。所有患者均行标准模板双侧盆腔淋巴结切除术。尿道改道包括原位新膀胱。所有患者在参与研究前均获得同意。结果:13例男性患者中,6例ORC合并新膀胱,7例行LRC手术。两组患者的基线特征(年龄、BMI、合并症、肿瘤分级、淋巴结状况)相似。与ORC组相比,LRC组的切口长度明显缩短(p <0.0001)。虽然LRC组的手术时间较ORC组长,但其镇痛时间缩短,住院时间缩短(p<0.05),以及立即拔除鼻胃管的液体摄入时间提前(p<0.001)。与ORC组不同,LRC组未观察到主要并发症,其中1例患者在30天死亡。结论:基于我们小样本研究的观察,LRC的围手术期和术后结果与ORC相比,对于接受新膀胱手术的患者来说,切口长度更小,疼痛和并发症更少,恢复更快,而不会危及肿瘤预后。由ORC向LRC过渡对患者有利。
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Journal of surgery and research
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