ANZ Journal of Surgery最新文献

英文中文

Surgical Robotics Abstracts 2024 年手术机器人与创新峰会。

IF 1.5 4区医学 Q3 SURGERY

ANZ Journal of Surgery

Pub Date : 2024-08-12 DOI: 10.1111/ans.19152

引用次数: 0

Surgical Innovation Abstracts 2024 年手术机器人与创新峰会。

IF 1.5 4区医学 Q3 SURGERY

ANZ Journal of Surgery

Pub Date : 2024-08-12 DOI: 10.1111/ans.19151

引用次数: 0

Anteroposterior cervical spine canal diameter: exploring ethnic variation between European and Polynesian populations. 颈椎前路椎管直径：探索欧洲人和波利尼西亚人之间的种族差异。

IF 1.5 4区医学 Q3 SURGERY

ANZ Journal of Surgery

Pub Date : 2024-08-10 DOI: 10.1111/ans.19186

Daniel Goddard-Hodge, Baptiste Boukebous, Joseph F Baker

Background: Reduced spinal canal anteroposterior (AP) diameter and AP-transverse diameter ratio have been linked to the development of spinal cord injury and myelopathy. Previously unpublished data has suggested Maori and Pacifica individuals may have narrower cervical spine canals than their NZ European counterparts.

Purpose: We evaluate the existence of potential differences in dimensions of the sub-axial cervical spine canal between New Zealand European, Māori and Polynesian individuals.

Study design: A computed tomography (CT) analysis of 645 intact adult sub-axial cervical vertebrae from 129 patients.

Methods: A total of 645 human sub-axial (C3-C7) cervical vertebrae were analysed radiographically, using 1 mm resolution CT scans to measure AP diameter, transverse diameter and AP:transverse ratio. CT data were obtained from normal trauma scans demonstrating no acute pathology. CT data was reformatted in digital software allowing multi-planar reconstruction (MPR) to increase accuracy of measurements. Statistical analysis was performed using analysis of variance (ANOVA).

Results: A total of 245 vertebrae were from Māori individuals, 245 from NZ European and 155 from Polynesians. There were 455 male vertebrae and 215 female vertebrae. Statistically significant differences were found in AP canal diameter between all ethnic groups, at all spinal levels. The average cervical spine canal was around 2.5 mm narrower in Polynesians and around 1.5 mm narrower in Māori than NZ Europeans. No differences in Transverse canal diameter were observed, however statistically significant differences were found in the AP:transverse ratio at all spinal levels.

Conclusions: Our study, utilizing a normal patient cohort, confirms differences in canal dimensions between ethnic groups.

Clinical significance: Ethnic variation in cervical canal dimensions as herein described, must be considered when defining and diagnosing congenital stenosis. Neglecting to account for these differences may lead to misdiagnosis of congenital stenosis in normal individuals in certain ethnic groups.

背景：椎管前后径和前后径比减小与脊髓损伤和脊髓病的发生有关。以前未发表的数据表明，毛利人和太平洋岛民的颈椎管可能比新西兰欧洲人的颈椎管狭窄。目的：我们评估了新西兰欧洲人、毛利人和波利尼西亚人颈椎管轴下尺寸的潜在差异：研究设计：对129名患者的645块完整的成人颈椎轴下椎体进行计算机断层扫描（CT）分析：通过 1 毫米分辨率的 CT 扫描测量 AP 直径、横向直径和 AP:Transverse 比值，对总共 645 个人体次轴（C3-C7）颈椎进行放射学分析。CT 数据来自正常的外伤扫描，未显示急性病变。CT 数据经过数字软件重新格式化，可进行多平面重建 (MPR)，以提高测量的准确性。统计分析采用方差分析（ANOVA）：共有245块脊椎骨来自毛利人，245块来自新西兰欧洲人，155块来自波利尼西亚人。其中男性脊椎骨 455 节，女性脊椎骨 215 节。在所有脊柱级别上，所有种族群体之间的椎管AP直径都存在明显的统计学差异。与欧洲新西兰人相比，波利尼西亚人的平均颈椎管狭窄约2.5毫米，毛利人的平均颈椎管狭窄约1.5毫米。横向椎管直径没有发现差异，但在所有脊柱水平上，AP:横向比率都存在统计学意义上的显著差异：我们的研究利用正常患者队列，证实了不同种族之间颈椎管尺寸的差异：临床意义：在定义和诊断先天性颈椎管狭窄时，必须考虑本文所述的颈椎管尺寸的种族差异。忽视这些差异可能会导致某些种族群体中的正常人被误诊为先天性颈椎管狭窄。

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引用次数: 0

Umbilical vein herniating as a hernia in a cirrhotic: a tale of complexity. 肝硬化患者的脐静脉疝：一个复杂的故事。

IF 1.5 4区医学 Q3 SURGERY

ANZ Journal of Surgery

Pub Date : 2024-08-10 DOI: 10.1111/ans.19193

Gishanthan Shanthamoorthy, Rohan Chaminda Siriwardana, Suchintha Tillakaratne, Mohamed Azmi Ashik Ahamed, Serasinghe Gampathige Sayuri Serasinghe

引用次数: 0

Watch and wait in rectal cancer treatment- is it time to talk about regrowth? 直肠癌治疗中的观察与等待--现在是谈论再生的时候了吗？

IF 1.5 4区医学 Q3 SURGERY

ANZ Journal of Surgery

Pub Date : 2024-08-10 DOI: 10.1111/ans.19192

Amy Jayne Thomas, Amrish K S Rajkomar, Alexander Heriot, Satish Warrier

引用次数: 0

The sac of gall; trans-parastomal hernia cholecystectomy for incarcerated, acalculous cholecystitis. 胆囊；经腹膜旁疝胆囊切除术治疗嵌顿性、结石性胆囊炎。

IF 1.5 4区医学 Q3 SURGERY

ANZ Journal of Surgery

Pub Date : 2024-08-10 DOI: 10.1111/ans.19190

Julia Shearer, Jonathan Johns, Cain Anderson, Jacques Marnewick, Mark Omundsen

引用次数: 0

Pregnancy and stomas: a 9-year retrospective series at a major metropolitan hospital in Brisbane Queensland 妊娠与口腔溃疡：昆士兰州布里斯班一家大型都市医院的 9 年回顾性系列研究。

IF 1.5 4区医学 Q3 SURGERY

ANZ Journal of Surgery

Pub Date : 2024-08-08 DOI: 10.1111/ans.19142

Madeleine Louise Kelly MBBS, MPHTM, MSurg, Alexandra Fullerton MBBS, ARANZCOG(P), Amy Millicent Yesheng Cao MBBS, MSurg, MMed (Clin epi), MBiostat, FRACS, Rachel Colbran MBBS, BSc, MTrauma, Rebecca Kimble MBBS, FRANZCOG, MHLM, GAICD, AFRACMA, David A. Clark MBBS, FRACS, FRCSEd, PhD, FCSSANZ

Background

Over 42 000 Australians live with a stoma, and this number increases annually. Pregnancy in stoma patients is a rare but complex condition and there is limited published literature regarding surgical and obstetric complications in pregnant stoma patients. The aim of this paper was to review stoma outcomes, perinatal morbidity and mortality, and early postpartum period in pregnant stoma patients.

Methods

Data was retrospectively obtained on women of childbearing age, with a stoma, who had been pregnant and birthed in the last nine years at the Royal Brisbane and Women's Hospital between January 2014 to December 2022. Data recorded included patient demographics, type of stoma, indication for stoma, need for additional abdominal surgeries, method of conception, pregnancy complications, length of stay, neonatal outcomes and post pregnancy stomal complications.

Results

In total, there were 16 births from 13 mothers with stomas. Of 10 births to IBD patients, 40% experienced a serious stomal complication. Caesarean section (CS) rate was 90% for IBD and 83% for non-IBD. In-vitro fertilisation rates were 40% in IBD patients and 0% in non-IBD patients. The average gestational age at delivery was 36 weeks in IBD and 35 weeks in non-IBD patients. Neonates delivered to IBD mothers had a birth weight under 2500g in 40% of cases and in non IBD mothers at 33.3% (p = 0.62). Of the sixteen births there was five complications (31.25%) associated with the stoma either during pregnancy or during the sixty-day postpartum period.

Conclusion

Pregnancy in stoma patients is a rare occurrence and appears to be associated with high rates of CS, preterm delivery, low birth weight and stomal complication.

背景：超过 42,000 名澳大利亚人患有造口，而且这一数字每年都在增加。造口患者怀孕是一种罕见但复杂的情况，有关怀孕造口患者手术和产科并发症的文献发表有限。本文旨在回顾妊娠造口患者的造口预后、围产期发病率和死亡率以及产后早期情况：方法：对布里斯班皇家妇女医院在 2014 年 1 月至 2022 年 12 月期间过去九年内怀孕和分娩的造口育龄妇女进行了回顾性数据采集。记录的数据包括患者的人口统计学特征、造口类型、造口适应症、是否需要额外的腹部手术、受孕方式、妊娠并发症、住院时间、新生儿结局和妊娠后造口并发症：共有 16 名新生儿来自 13 位有造口的母亲。在 10 名 IBD 患者的新生儿中，40% 出现了严重的口腔并发症。IBD患者的剖腹产率为90%，非IBD患者的剖腹产率为83%。IBD患者的体外受精率为40%，非IBD患者为0%。IBD 患者分娩时的平均胎龄为 36 周，非 IBD 患者为 35 周。IBD 母亲分娩的新生儿中，40%的新生儿出生体重低于 2500 克，非 IBD 母亲为 33.3%（P = 0.62）。在 16 例新生儿中，有 5 例（31.25%）在怀孕期间或产后 60 天内出现与造口相关的并发症：结论：造口患者妊娠是一种罕见的现象，似乎与高CS率、早产、低出生体重和造口并发症有关。

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引用次数: 0

If the peri-operative patient pathway was right, what would it look like? 如果围手术期患者路径是正确的，它会是什么样子？

IF 1.5 4区医学 Q3 SURGERY

ANZ Journal of Surgery

Pub Date : 2024-08-06 DOI: 10.1111/ans.19179

David Allan Watters BSc (Hons), MB ChB, ChM, FRCSEd, FRACS, DipPOM, David A. Scott MBBS, PhD, FANZCA, FFPMANCA, DipPOM, Tarik Sammour MBBS, PhD, FRACS, Ben Harris BA/BEc MPPM, Guy Lawrence Ludbrook MBBS PhD MSc FANZCA DipPOM

Background

Patients undergoing surgery deserve the best possible peri-operative outcomes. Each stage of the peri-operative patient journey offers opportunities to improve care delivery, with shorter lengths of stay, less complications, reduced costs and better value.

Methods

These opportunities were identified through narrative review of the literature, with consultation and consensus at the hidden pandemic (of postoperative complications) summit 2, July 2023 in Adelaide, Australia

Results

Before surgery: Some patients who receive timely alternative treatments may not need surgery at all. The period of waiting after listing should be a time of preparation. Risk assessment at the time of surgical listing facilitates recognition of need for comorbidity optimisation and identifies those who will most benefit from prehabilitation, particularly frail and deconditioned patients.

During surgery

During the surgical admission, ERAS programs result in less postoperative complications, shorter length of stay and better patient experience but require agreement between clinicians, and coordinated monitoring of delivery of the elements in the ERAS bundle of care.

After surgery

At-risk patients need to have the appropriate levels of monitoring for cardiovascular instability, renal impairment or respiratory dysfunction, to facilitate timely, proactive management if they develop. Access to allied health in the early postoperative period is also critical for promoting mobility, and earlier discharge, particularly after joint surgery. Where appropriate, provision of rehabilitation services at home improves patient experience and adds value. The peri-operative patient journey begins and ends with primary care so there is a need for clear communication, documentation, around sharing of responsibility between practitioners at each stage.

Conclusion

Identifying and mitigating risk to reduce complications and length of stay in hospital will improve outcomes for patients and deliver the best value for the health system.

背景介绍接受手术的患者理应获得最佳的围手术期治疗效果。围手术期患者旅程的每个阶段都提供了改善护理服务的机会，可缩短住院时间、减少并发症、降低成本和提高价值：这些机会是通过对文献进行叙述性回顾，并在 2023 年 7 月于澳大利亚阿德莱德举行的 "隐性流行病（术后并发症）峰会 2 "上进行磋商和达成共识后确定的：一些及时接受替代治疗的患者可能根本不需要手术。列名后的等待期应该是准备期。在手术排期时进行风险评估，有助于认识到合并症优化的必要性，并确定哪些患者（尤其是体弱多病的患者）最能从术前康复中获益：在手术入院期间，ERAS 计划可减少术后并发症，缩短住院时间，改善患者体验，但需要临床医生之间达成一致，并协调监督 ERAS 护理包中各项要素的实施：术后：高危患者需要接受适当程度的心血管不稳定、肾功能损伤或呼吸功能障碍监测，以便在出现这些情况时及时、主动地进行处理。术后早期获得专职医疗服务对于促进活动能力和尽早出院也至关重要，尤其是在关节手术后。在适当的情况下，在家中提供康复服务可以改善患者的体验并增加价值。围手术期患者的治疗过程始于基础医疗，也终于基础医疗，因此在每个阶段都需要有明确的沟通、文件记录以及从业人员之间的责任分担：结论：识别和降低风险以减少并发症和住院时间将改善患者的治疗效果，并为医疗系统带来最大价值。

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引用次数: 0

Measurement of the distal bile duct density on computed tomography can differentiate choledocholithiasis from a control population. 通过计算机断层扫描测量远端胆管密度可将胆总管结石与对照人群区分开来。

IF 1.5 4区医学 Q3 SURGERY

ANZ Journal of Surgery

Pub Date : 2024-08-05 DOI: 10.1111/ans.19189

Nicholas Bull, Janindu Goonawardena, Lina Hua, Dee Lim, King Tung Cheung, Vivek Ramachandran, Adrian Fox, Sayed Hassen

Purpose: Hounsfield unit density of biliary fluid on CT may be a useful clinical marker that has not been described in the literature. This method has been used to differentiate pyonephrosis from hydronephrosis in obstructed collecting systems of the kidney. We aimed to create a user-friendly technique to measure the density of the distal bile duct using CT. The bile duct density of cases with proven choledocholithiasis at ERCP were compared with those of a control group (no biliary pathology).

Methods: A total of 106 patients with proven choledocholithiasis at ERCP and 50 control patients were analysed. The distal bile duct density was calculated using the 4-point and max ellipse methods. Two blinded, independent investigators calculated the bile duct density.

Results: The HU is significantly higher in the presence of choledocholithiasis (P < 0.0001). Using the Youden index a cut-off value of 28.6 HU for the 4-point technique is useful to predict the presence of choledocholithiasis (Sensitivity 58%, Specificity 86%).

Conclusion: Calculation of the distal bile duct density can differentiate choledocholithiasis from a control population. It may be useful alone or as a component of a scoring system to select patients more effectively for intervention. The improved use of CT may also decrease use of MRCP and reduce time to ERCP, which have potential cost benefits.

目的：CT 上胆汁液的 Hounsfield 单位密度可能是一种有用的临床标记物，但文献中尚未对此进行描述。这种方法已被用于区分肾盂肾积水和肾集合系统阻塞性肾积水。我们的目标是创建一种用户友好型技术，利用 CT 测量远端胆管的密度。将 ERCP 证实为胆总管结石的病例的胆管密度与对照组（无胆道病变）的胆管密度进行比较：方法：共分析了 106 名经 ERCP 证实患有胆总管结石的患者和 50 名对照组患者。采用四点法和最大椭圆法计算远端胆管密度。两名盲人独立研究人员计算胆管密度：结果：存在胆总管结石时，HU 值明显升高（P＜0.05）：计算远端胆管密度可将胆总管结石与对照人群区分开来。它可以单独使用，也可以作为评分系统的一部分，更有效地选择患者进行干预。改进 CT 的使用还可减少 MRCP 的使用并缩短 ERCP 的时间，从而带来潜在的成本效益。

{"title":"Measurement of the distal bile duct density on computed tomography can differentiate choledocholithiasis from a control population.","authors":"Nicholas Bull, Janindu Goonawardena, Lina Hua, Dee Lim, King Tung Cheung, Vivek Ramachandran, Adrian Fox, Sayed Hassen","doi":"10.1111/ans.19189","DOIUrl":"https://doi.org/10.1111/ans.19189","url":null,"abstract":"<p><strong>Purpose: </strong>Hounsfield unit density of biliary fluid on CT may be a useful clinical marker that has not been described in the literature. This method has been used to differentiate pyonephrosis from hydronephrosis in obstructed collecting systems of the kidney. We aimed to create a user-friendly technique to measure the density of the distal bile duct using CT. The bile duct density of cases with proven choledocholithiasis at ERCP were compared with those of a control group (no biliary pathology).</p><p><strong>Methods: </strong>A total of 106 patients with proven choledocholithiasis at ERCP and 50 control patients were analysed. The distal bile duct density was calculated using the 4-point and max ellipse methods. Two blinded, independent investigators calculated the bile duct density.</p><p><strong>Results: </strong>The HU is significantly higher in the presence of choledocholithiasis (P < 0.0001). Using the Youden index a cut-off value of 28.6 HU for the 4-point technique is useful to predict the presence of choledocholithiasis (Sensitivity 58%, Specificity 86%).</p><p><strong>Conclusion: </strong>Calculation of the distal bile duct density can differentiate choledocholithiasis from a control population. It may be useful alone or as a component of a scoring system to select patients more effectively for intervention. The improved use of CT may also decrease use of MRCP and reduce time to ERCP, which have potential cost benefits.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141888309","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Patient satisfaction with nurse-led coordination of colorectal cancer treatment: a short survey. 患者对护士主导的结直肠癌治疗协调工作的满意度：一项简短调查。

IF 1.5 4区医学 Q3 SURGERY

ANZ Journal of Surgery

Pub Date : 2024-08-05 DOI: 10.1111/ans.19185

Wilson Petrushnko, Joanne Perry, Zachary Bunjo, Ryash Vather, Mark Lewis, Tarik Sammour

引用次数: 0

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