Journal of surgery and research最新文献

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Medical Emergency Services in Albania, the Challenges and Improvements of Concepts in Management 阿尔巴尼亚医疗急救服务:管理理念的挑战与改进

Journal of surgery and research

Pub Date : 2022-01-01 DOI: 10.26502/jsr.10020242

A. Dogjani, K. Haxhirexha, A. Ibrahimi, Amarildo Blloshmi

Introduction: Emergency medical service for patients in emergency situations is the most important aspect of all health systems in the world, as this is the first and most delicate point of confrontation of the patient with the health system of a country. All patients seeking urgent medical care, and the slightest delay in access to this service, by the population, is understood as a matter of "life or death" for them, to which they are quite sensitive. While learning or training during the process of exercising said activity combined with actual study data and comparisons with the results of international emergency medical services remains a challenge of the future. Thus the evaluation criteria of performance indicators of the emergency service based on scientific research evidence are unified. Ambulance services were basically just small vehicles, some with two stretchers, without the necessary equipment. Managers working as emergency personnel had only a few hours of limited first aid training which were referred to as "suitable personnel". The duties of the ambulance service personnel were two-fold. On the one hand, they transported the sick and planned the so-called regulated ambulance service… Conclusion: The changes and diversity of medical emergencies including increasing trends of traumatic, mortal, and post-traumatic morbidity emergencies constantly put pressure on medical emergency services. All of these improvements will yield results in increasing efficiency by improving the quality of treatment and reducing the cost of medical care.

在紧急情况下为患者提供紧急医疗服务是世界上所有卫生系统中最重要的方面，因为这是患者与一个国家卫生系统的第一个也是最微妙的对抗点。所有寻求紧急医疗服务的病人，以及在获得这种服务方面的最轻微延误，对他们来说都被理解为"生与死"的问题，他们对此相当敏感。虽然在锻炼过程中学习或培训上述活动，结合实际研究数据，并与国际紧急医疗服务的结果进行比较，仍然是未来的挑战。从而统一了基于科研证据的应急服务绩效指标评价标准。救护车服务基本上只有小型车辆，有些只有两个担架，没有必要的设备。作为应急人员工作的管理人员只接受过几个小时的有限急救培训，这些培训被称为“合适的人员”。救护人员的职责是双重的。结论:医疗紧急事件的变化和多样性，包括创伤性、致命和创伤后发病紧急事件的增加趋势，不断给医疗紧急服务带来压力。所有这些改进都将通过改善治疗质量和降低医疗费用来提高效率。

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引用次数: 2

Caustic Esophageal Strictures in Children: Diagnosis, Treatment and Evolution in the City of Douala 儿童腐蚀性食管狭窄:杜阿拉市的诊断、治疗和演变

Journal of surgery and research

Pub Date : 2022-01-01 DOI: 10.26502/jsr.10020248

Pauline Mantho, Jean Paul Ndamba Engbang, Calixte Danielle Ndzana Awono, B. Essola, Théophile Kamguep, D. Noah Noah, M. Ngowe Ngowe

Background: Pediatric caustic ingestion remains frequent and the formation of esophageal strictures is one it’s most dangerous and major complications. The treatment is usually long and difficult and the success of treatment usually depends on the characteristics of the esophageal stricture. The main purpose of our study was to evaluate the diagnosis, treatment and the evolution of cases of caustic esophageal strictures in children in 3 hospitals of the city of Douala. Methods: It was a retrospective and analytic study conducted at the general hospital of Douala, Laquintie hospital of Douala and the Douala gyneco-obstetric and pediatric hospital of Douala from January, 1 st 2011 to December 31 st 2020, from which we had 31 cases of esophageal strictures post ingestion of caustic substances. Results: Cases of caustic esophageal strictures accounted for 23.7% of caustic ingestions and represented 88.6% of the cases of esophageal strictures in children. The mean age of patients was 3.8±2.1 year with extremes going from 1 to 11 years and 61.3% (n=19) of our patients were aged from 2 to 6 years. The male sex was the most predominant with a sex ratio of 1.6. The ingestion was accidental in all the cases, with caustic soda being the most ingested substance in 32.3% of the cases. Drooling was the most frequent initial sign in 45.2% of the cases and dysphagia developed in 93.5% of patients at the stricture phase. 61.3% of our patients had signs of malnutrition and feeding gastrostomy was done in 64.5% of patients. The upper third esophagus was the most frequent localization in 65.6% of the cases. 64.5% of patients were treated by endoscopic dilation and 9.7% required an esophageal replacement. The average duration of treatment was 11.53±4.6 months; it was significantly shorter for patient with short and passable strictures. Dysphagia, drooling, weight loss and ingestion of alkaline were significantly associated with the formation of esophageal strictures. Conclusion: Cases of caustic substance ingestion remain common in our hospitals; endoscopic dilatation occupies the first place in the treatment of caustic esophageal strictures. Prevention still remains the key treatment in the formation of esophageal strictures.

背景:儿童腐蚀性食入仍然是常见的，食管狭窄的形成是最危险的和主要的并发症之一。治疗通常是漫长而困难的，治疗的成功通常取决于食管狭窄的特点。本研究的主要目的是评价杜阿拉市3家医院儿童腐蚀性食管狭窄的诊断、治疗和演变情况。方法:对2011年1月1日至2020年12月31日在杜阿拉总医院、杜阿拉Laquintie医院和杜阿拉妇产儿科医院收治的31例误食腐蚀性物质后食管狭窄患者进行回顾性分析。结果:腐蚀性食道狭窄病例占腐蚀性食入的23.7%，占儿童食道狭窄病例的88.6%。患者平均年龄为3.8±2.1岁，极值为1 ~ 11岁，61.3% (n=19)的患者年龄为2 ~ 6岁。以男性居多，性别比为1.6。所有病例均为意外摄入，其中以苛性钠为最多摄入物质，占32.3%。在45.2%的病例中，流口水是最常见的初始症状，93.5%的患者在狭窄期出现吞咽困难。61.3%的患者有营养不良的迹象，64.5%的患者进行了胃造口手术。65.6%的病例中，上三食道是最常见的定位。64.5%的患者接受内镜扩张治疗，9.7%的患者需要食管置换术。平均治疗时间11.53±4.6个月;对于狭窄可通过的患者，手术时间明显缩短。吞咽困难、流口水、体重减轻和摄入碱性物质与食管狭窄的形成显著相关。结论:我院误食腐蚀性物质病例较多;内镜下扩张术是治疗腐蚀性食管狭窄的首选方法。预防仍然是治疗食管狭窄形成的关键。

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引用次数: 2

De-Implementation of Urinary Catheters in Neurosurgical Patients during the Operation and on the Ward: A Mixed-Methods Multicentre Study Protocol 神经外科患者在手术中和病房中弃用导尿管:一项多中心混合方法研究方案

Journal of surgery and research

Pub Date : 2022-01-01 DOI: 10.26502/jsr.10020208

Jeanne-Marie Nollen RN, MSc, Anja H Brunsveld-Reinders RN, PhD, MSc, Wilco C Peul MD, PhD, MPH, MBA, Wouter R Van Furth MD, PhD

Background Indwelling urinary catheters (IDUCS) are routinely inserted during transsphenoidal pituitary gland tumour surgery or spinal fusion surgery, despite literature stating that there are no indications for using IDUCS during or following these surgeries. The aim of the study is to reduce the number of inappropriately inserted IDUCS during or post transsphenoidal pituitary gland tumour surgery and spinal fusion surgery with an operation time of less than 4 hours. observational study was initiated in a multicentre neurosurgical context. This study includes medical chart analysis, satisfaction surveys with patients and healthcare professionals, and multidisciplinary group interviews to assess the effectiveness of, and experiences with, This paper presents the study protocol of a multi-centred before and after trial that aims to reduce inappropriate IDUC use after transsphenoidal pituitary gland tumour surgery and spinal fusion surgery, thereby reducing UTIs, shortening length of hospital stay, and increasing patient comfort. The results can be used to de-implement IDUCS after a broad range of surgeries on several wards. The

背景留置导尿管(IDUCS)在经蝶脑垂体肿瘤手术或脊柱融合手术中是常规的，尽管文献表明在这些手术中或手术后没有使用IDUCS的适应症。本研究的目的是减少经蝶脑垂体肿瘤手术和脊柱融合手术期间或之后不适当插入IDUCS的数量，手术时间少于4小时。观察性研究是在多中心神经外科背景下发起的。本研究包括医学图表分析，对患者和医疗保健专业人员的满意度调查，以及多学科小组访谈，以评估有效性和经验。本文提出了一项多中心的前后试验的研究方案，旨在减少经蝶脑垂体肿瘤手术和脊柱融合手术后不适当的IDUC使用，从而减少尿路感染，缩短住院时间，增加患者舒适度。该结果可用于在多个病房进行广泛手术后取消实施IDUCS。的

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引用次数: 0

Cherry Fruit-Stem Stapled into J-J anastomoses during Roux-en-Y Gastric Bypass: A Case Report of a Rare Complication Roux-en-Y胃旁路术中樱桃果茎钉入J-J吻合口1例罕见并发症

Journal of surgery and research

Pub Date : 2022-01-01 DOI: 10.26502/jsr.10020212

Logan D Glosser, Alexander Young, Justin A. Smith, Conner V. Lombardi, Abdullah Alalwan, Motaz Al-yafi, Stephen M. Stanek

Cherry Fruit-Stem Stapled into J-J anastomoses during Roux-en-Y Gastric Bypass: A Case Report of a Rare Complication. Journal of Surgery and Research 5 (2022): 194-201. Abstract gastrointestinal bleeding, internal herniation, and marginal ulceration. No prior literature discusses intermittent obstructive symptoms secondary to a foreign body anchored by the anastomotic staples. Furthermore, there are currently no universal dietary guidelines for patients in the immediate pre-operative period with regard to avoiding certain foods that could get stapled during the anastomotic construction. Conclusion There are two main take-away lessons from this case. First, this case denotes an unusual complication following RYGB surgery requiring surgical intervention in which the stem of a cherry fruit was stapled into the JJ anastomosis causing obstruction-related intermittent abdominal pain. Second, there is a need for standardized guidelines to outline foods to avoid, such as cherries with a stem, leading up to the procedure.

Roux-en-Y胃旁路术中樱桃果茎钉入J-J吻合口1例罕见并发症。中华外科杂志5(2022):194-201。胃肠道出血，内部疝和边缘溃疡。先前没有文献讨论吻合钉固定异物继发的间歇性梗阻性症状。此外，对于手术前的患者，目前还没有通用的饮食指南来避免在吻合口构建过程中可能被钉住的某些食物。结论本案例主要有两点启示。首先，本病例显示RYGB手术后的不寻常并发症，需要手术干预，其中樱桃果茎被钉入JJ吻合口，导致梗阻相关的间歇性腹痛。其次，有必要制定标准化的指导方针，列出在手术前要避免的食物，比如带茎的樱桃。

引用次数: 0

Novel Recognition of HER2 Amplification in Enteroblastic Colonic Adenocarcinoma. Diagnostic Clues and Future Perspectives 小肠母细胞结肠腺癌中HER2扩增的新识别。诊断线索和未来展望

Journal of surgery and research

Pub Date : 2022-01-01 DOI: 10.26502/jsr.10020256

Leoncini Giuseppe, Sabella Giovanna, Milione Massimo

Enteroblastic differentiation in sporadic colonic adenocarcinoma was a rare event that lacks to be fully elucidated. It was characterized by an aggressive biological behavior, with early metastatic spread and poor prognosis. Diagnostic clues and molecular features were not completely elucidated so far. Histological features including tubulo-papillary architecture, cleared neoplastic cells, fetal oncoproteins expression were diagnostic requirements. We describe a new case of enteroblastic colonic adenocarcinoma (CAED) in the sigmoid, exhibiting small intestinal phenotype, higher stage at diagnosis and early liver metastases. At molecular level, CAED shared both TP53 gene mutation and beta-catenin nuclear translocation with conventional colonic adenocarcinoma. Altered human epidermal growth factor receptor (HER) 2 signaling has been described in a small subset of conventional colonic adenocarcinoma. At best of our knowledge our report represents the first immunohistochemical recognition of HER2 gene amplification in CAED. Given its aggressive clinical behavior, clinicians should be aware of the possible HER2 amplification, that could point toward further treatment options.

散发性结肠腺癌的肠母细胞分化是一种罕见的事件，缺乏充分的阐明。其特点是具有侵袭性的生物学行为，具有早期转移扩散和预后差。迄今为止，诊断线索和分子特征尚未完全阐明。组织学特征包括小管-乳头状结构，肿瘤细胞清除，胎儿癌蛋白表达是诊断要求。我们报告一例乙状结肠肠母细胞腺癌(CAED)的新病例，表现为小肠表型，诊断阶段较高，早期肝转移。在分子水平上，CAED与传统的结肠腺癌具有TP53基因突变和β -连环蛋白核易位。人类表皮生长因子受体(HER) 2信号的改变已经在一小部分常规结肠腺癌中被描述。据我们所知，我们的报告代表了CAED中HER2基因扩增的首次免疫组织化学识别。鉴于其积极的临床行为，临床医生应该意识到可能的HER2扩增，这可能指向进一步的治疗选择。

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引用次数: 0

T-shaped Uterus, Other Studies are Needed But What Can We Do in The Meantime? t型子宫，需要其他研究，但同时我们能做些什么?

Journal of surgery and research

Pub Date : 2022-01-01 DOI: 10.26502/jsr.10020252

L. Marin, G. Ambrosini, Simone Antonio Laganà, G. Capobianco, F. Dessole, A. Andrisani

Affiliation: 1Department of Women's and Children's Health, University of Padua, Salus Pueri, Padua, Italy. 2Unit of Gynecology Oncology, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialities (PROMISE), University of Palermo, 90127 Palermo, Italy. 3Department of Surgical, Microsurgical and Medical Sciences, Gynecologic and Obstetric Clinic, University of Sassari, Sassari, Italy.

隶属单位:1帕多瓦大学妇幼卫生系，帕多瓦Salus Pueri，意大利。2巴勒莫大学健康促进、妇幼保健、内科和医学专业(PROMISE)妇科肿瘤科，巴勒莫90127，意大利。3萨萨里大学妇产科门诊外科、显微外科和医学学系，意大利萨萨里。

引用次数: 0

The Stage III Melanoma in Cervical Region, Prognostic Impact of The Lymph Node Ratio of The Neck Dissections 颈部III期黑色素瘤，颈部淋巴结比例对预后的影响

Journal of surgery and research

Pub Date : 2022-01-01 DOI: 10.26502/jsr.10020235

Quiriny M, Shall F, M. M, Willemse E, Sales F, A. G., Digonnet A

引用次数: 0

A Comparative Study Between Fine Needle Aspiration Cytology and Core Needle Biopsy in the Diagnosis of Palpable Breast Lumps 细针穿刺细胞学与核心针活检诊断可触及乳腺肿块的比较研究

Journal of surgery and research

Pub Date : 2022-01-01 DOI: 10.26502/jsr.10020215

Sharang S Kulkarni, S. Murchite, A. Patil

A Comparative Study Between Fine Needle and Core Biopsy in the Palpable Abstract Background Breast carcinoma is a frequently diagnosed cancer in women worldwide. An effective diagnosis is necessary to manage this cancer in its preliminary stages. After a radiological examination of the palpable breast lumps, a core needle biopsy (CNB) or fine needle aspiration cytology (FNAC), is performed. The study focuses on comparing the accuracy and efficacy of FNAC and CNB in diagnosing palpable breast lumps. Design A randomized, open-labeled, comparative research. Setting selected The randomization technique was used to divide patients into two groups, i.e., undergoing FNAC or CNB. The results thus obtained were compared the post-operative histopathological Biostatistical parameters such as sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy. Results The sensitivity of CNB and FNAC was 92.8% and 86.6% respectively, whereas the specificity and positive predictive value of both the tests were 100%. NPV of CNB was 95%, and that of FNAC was 90%. The accuracy of CNB was 96.96% and that of FNAC was 93.90%. Conclusion Better cellularity, the possibility of immunohistochemical analysis and better characterization of specimens make core needle biopsy more efficacious than FNAC. It is more sensitive and accurate than FNAC. Core needle biopsy provides a more dependable preoperative diagnosis which can help in creating a prudent algorithm for management of a palpable breast lump, thereby more often leading to definitive surgical treatment.

摘要背景乳腺癌是世界范围内女性常见的一种癌症。有效的诊断对于控制这种癌症的早期阶段是必要的。在对可触及的乳房肿块进行放射检查后，进行核心针活检(CNB)或细针穿刺细胞学检查(FNAC)。比较FNAC和CNB诊断可触及乳腺肿块的准确性和有效性。设计一项随机、开放、比较的研究。采用随机化技术将患者分为两组，分别为FNAC组和CNB组。比较两组术后组织病理学生物统计学参数的敏感性、特异性、阳性预测值(PPV)、阴性预测值(NPV)和准确性。结果CNB和FNAC的敏感性分别为92.8%和86.6%，特异性和阳性预测值均为100%。CNB的NPV为95%，FNAC的NPV为90%。CNB的准确率为96.96%，FNAC的准确率为93.90%。结论芯针活检优于FNAC，具有更好的细胞性、免疫组化分析的可能性和更好的标本表征。它比FNAC更灵敏、准确。芯针活检提供了更可靠的术前诊断，可以帮助创建一个谨慎的算法管理可触及的乳房肿块，从而更经常导致明确的手术治疗。

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引用次数: 0

Giant Anterior Mediastinal Mass Requiring Awake Veno-Venous Extracorporeal Membrane Oxygenation Therapy: Case Report and Review of the Literature 巨大前纵隔肿块需要清醒的静脉-静脉体外膜氧合治疗:病例报告和文献复习

Journal of surgery and research

Pub Date : 2022-01-01 DOI: 10.26502/jsr.10020230

Dichtwald Sara, M. Avraham, Gorfil Dan M, Ifrach Nisim

Background Anterior mediastinal masses may be the result of hematological or solid malignancies. Giant masses may cause significant compression on vital structures, including the trachea and main bronchi, and might lead to airway obstruction and respiratory collapse. Extracorporeal membrane oxygenation (ECMO) support may be life-saving in these extreme situations. mediastinal and causing impending airway obstruction and severe narrowing of the trachea, awake ECMO may be a considerable option, with a potential to avoid difficult intubation and post-intubation airway obstruction with life-threatening respiratory collapse. ECMO support may be used as a bridge to chemotherapy, in cases of hematological malignancies, or to surgery, in cases of solid tumors.

背景前纵隔肿块可能是血液学或实体性恶性肿瘤的结果。巨大的肿块可能对重要结构造成严重压迫，包括气管和主支气管，并可能导致气道阻塞和呼吸衰竭。在这些极端情况下，体外膜氧合(ECMO)支持可能会挽救生命。清醒ECMO可能是一个相当好的选择，有可能避免插管困难和插管后气道阻塞导致危及生命的呼吸衰竭。在血液系统恶性肿瘤的情况下，ECMO支持可以作为化疗的桥梁，或者在实体肿瘤的情况下，作为手术的桥梁。

引用次数: 0

Heterogeneous Population of Immune cells Associated with Early Thrombosis in Arteriovenous Fistula. 与动静脉瘘早期血栓形成相关的异质免疫细胞群。

Journal of surgery and research

Pub Date : 2022-01-01 Epub Date: 2022-07-07 DOI: 10.26502/jsr.10020237

Gunimat Samra, Vikrant Rai, Devendra K Agrawal

End-Stage Renal Disease (ESRD) is a growing cause of morbidity and mortality in the practice of modern medicine. Advances in medicine have elongated the average life span and subsequently made chronic diseases prevalent. Hemodialysis is the main treatment that is used to treat ESRD and is a clinical procedure that is being re-imagined with novel approaches to improve patient and clinic practicality and effectiveness. Arteriovenous Fistulas (AVF) are now used in place of catheters due to their higher success and lower co-morbidities. The main drawback of AVF is the time gap that is needed from the surgical creation of AVF to its use. During this time, the AVF is susceptible to thrombosis and occlusion rendering the fistula ineffective for treatment. Immune cells play a major role in vascular pathologies and macrophages, dendritic cells, and T-regulatory cells are the main cells seen during the inflammatory and anti-inflammatory phases. However, the role of immune response and immune cells in AVF maturation is poorly understood. This study aimed to investigate the immune response and immune cell expression in femoral vessels after AVF creation in a miniswine model of AVF using immunohistochemistry and qRT-PCR. The results of this study revealed an increased expression of immune cells in AVF vessels and suggest an association of immune response with AVF creation and maturation.

终末期肾脏疾病(ESRD)是一个日益增长的原因发病率和死亡率在现代医学的实践。医学的进步延长了平均寿命，从而使慢性病变得普遍。血液透析是用于治疗终末期肾病的主要治疗方法，也是一种正在用新方法重新设想的临床程序，以提高患者和临床的实用性和有效性。动静脉瘘(AVF)由于其较高的成功率和较低的并发症，现在被用来代替导管。AVF的主要缺点是从手术产生AVF到使用它的时间间隔。在此期间，AVF容易形成血栓和闭塞，使瘘无法治疗。免疫细胞在血管病变中起主要作用，巨噬细胞、树突状细胞和t调节细胞是炎症和抗炎阶段的主要细胞。然而，免疫反应和免疫细胞在AVF成熟中的作用尚不清楚。本研究旨在利用免疫组织化学和qRT-PCR技术研究AVF形成后的免疫反应和股血管中免疫细胞的表达。本研究结果显示，AVF血管中免疫细胞的表达增加，提示免疫应答与AVF的产生和成熟有关。

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引用次数: 8

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