Annali italiani di chirurgia最新文献

Background: To compare the clinical effects between wrist arthroscopy-assisted open reduction plus internal fixation, using the triangular fibrocartilage complex (TFCC) as an example, and simple open reduction plus internal fixation in the treatment of distal radius fractures (DRFs). The study aims to assess the efficacy of arthroscopic-assisted open reduction and internal fixation in treating distal radius fractures.

Methods: The study utilized a retrospective cohort research approach, involving 60 patients treated at Binzhou Medical University Hospital between August 2021 and October 2022. These patients met the specified criteria and underwent two distinct surgical procedures for DRFs. Prior to surgery, thorough communication was established with the patients to elucidate the advantages, risks, and associated costs of wrist arthroscopy, and informed consent was obtained. Subsequent to the surgeries, postoperative follow-up was conducted to evaluate the variances between the two treatment modalities. Postoperative analysis and assessment encompassed the patients' Visual Analogue Scale (VAS) scores, Cooney wrist scores, grip strength of the affected limb (in comparison with the healthy side), wrist range of motion, and the frequency of intraoperative fluoroscopy usage.

Results: No surgical complications were observed among all patients. They were followed up for an average duration of (12.1 ± 1.3) months postoperatively, during which all fractures healed successfully. Within the treatment group, arthroscopy detected 14 cases of TFCC tears during the operation, all of which were repaired under a microscope. Conversely, physical examination identified three cases of TFCC injury in the control group, which were treated via incision and suture. At the 3-month postoperative mark, the treatment group exhibited significantly superior comprehensive scores for wrist pain, grip strength, and wrist range of motion compared to the control group (p < 0.05). Cooney's comprehensive wrist joint scoring yielded the following results: treatment group - excellent in 21 cases, good in five cases, and moderate in four cases; control group - excellent in 16 cases, good in nine cases, and moderate in five cases.

Conclusion: Wrist arthroscopy-assisted surgery facilitates precise reduction of the articular surface and alleviation of intraarticular congestion. Moreover, it enables evaluation and repair of concurrent intra-articular injuries such as TFCC tears and other tissue injuries, thereby reducing the likelihood of chronic wrist pain. Consequently, this technique should be deemed valuable in clinical practice owing to its outstanding clinical efficacy.

Aim: This study aims to assess the impact of combining multimodal analgesia with comfort care on pain levels, stress, negative emotions, and quality of life in individuals recovering from traumatic fractures.

Methods: This retrospective study analyzed clinical data from traumatic fracture patients who underwent emergency operations at our hospital between June 2022 and February 2024. Patients were divided into two groups based on their postoperative pain management: the control group, which received standard measures, and the exposure group, which received a combination of multimodal analgesia and comfort-based care. We compared these groups for pain intensity (baseline and activity Visual Analog Scale (VAS) scores), serum stress biomarkers (norepinephrine, adrenaline, cortisol), emotional distress (self-rating depression scale (SDS), and the self-rating anxiety scale (SAS)), and overall quality of life (Comprehensive Quality of Life Assessment Questionnaire (GQOLI-74) score). Overall, this study evaluated differences in postoperative complications between the two pain management approaches.

Results: In this study, we included 101 participants, 41 in the exposed group and 60 in the control group. Before the intervention, baseline characteristics were similar between the two groups (p > 0.05). However, one week after the intervention, the resting and active VAS scores were significantly reduced in the exposed group than in the control group (p < 0.05). Furthermore, one week after the intervention, the exposed group had lower levels of serum sodium, epinephrine, cortisol, stress, and anxiety, as well as higher physical and mental health scores on the GQOLI-74 scale. During the intervention period, there was no significant difference in postoperative complications between the two groups (p > 0.05).

Conclusions: Combining multi-mode analgesia with comfort management for patients with traumatic fractures significantly reduces postoperative pain and stress levels. Additionally, this approach can effectively enhance patients' negative emotions and improve their quality of life. This approach holds significant promise for practical use in clinical settings.

Aim: Cancer-related systemic inflammation causes the increase of proinflammatory markers and acute phase proteins. Activation of systemic inflammatory response has been linked to poorer prognosis in colorectal cancer. This study aims to evaluate the prognostic value of preoperative systemic inflammatory markers and inflammation/nutrition scoring systems in predicting the postoperative early period (first 30 days) complications and mortality outcomes of patients who underwent curative surgery for colorectal cancer in our clinic.

Methods: This study was designed as a retrospective single-arm cross-sectional study. In this study, 300 patients older than 18 years of age who underwent open and laparoscopic surgery for colorectal cancer were included. Demographic characteristics of the patients, preoperative hemogram and biochemical values, operation characteristics, postoperative tumor pathologies and disease stages were recorded.

Results: Neoadjuvant chemoradiotherapy, Systemic Inflammation Score, Modified Glasgow Prognostic Score, Naples Prognostic Score and Prognostic Nutritional Index had a significant effect on the first 30-day mortality (p-values: <0.001, 0.007, <0.001, <0.001, <0.001, respectively).

Conclusions: The results suggest that certain preoperative inflammation and nutrition scores might serve as indicators for potential early postoperative adverse outcomes in colorectal cancer surgery.

Aim: Elbow joint release surgery is commonly used to treat elbow joint stiffness. Though it can restore elbow joint mobility, some patients may still experience range of motion (ROM) loss after surgery. Therefore, this study aims to explore the factors influencing ROM loss after elbow joint release surgery in elderly patients with traumatic elbow stiffness.

Methods: This retrospective study included 122 elderly patients with traumatic elbow stiffness who underwent elbow joint release surgery at Hanzhong Central Hospital from January 2023 to April 2024. The patients with range of motion loss were included in the observation group (n = 41), and those without range of motion loss were placed in the control group (n = 81). The general data of the two groups were compared, and Logistic regression analysis was performed to identify factors influencing the loss of ROM after elbow joint release surgery in elderly patients with traumatic elbow stiffness. A risk prediction model was also established based on the identified risk factors.

Results: Multivariate Logistic regression analysis unveiled that high-energy injury (odds ratio (OR) = 4.632, 95% confidence interval (CI) = 1.363∼15.737), open injury (OR = 3.967, 95% CI = 1.308∼12.029), passive rehabilitation method (OR = 10.115, 95% CI = 1.113∼91.924), injury-to-release surgery time of ≥6 months (OR = 5.983, 95% CI = 1.677∼21.350), heterotopic ossification traumatic factors (OR = 5.409, 95% CI = 1.316∼22.224), and complex elbow joint damage (OR = 5.658, 95% CI = 1.457∼21.962) were all independent risk factors for ROM loss following elbow joint release surgery in elderly patients with traumatic elbow stiffness (p < 0.05). A risk prediction model was developed based on these factors, indicating a predictive sensitivity of 73.17%, a specificity of 69.14%, and an area under the curve (AUC) of 0.767.

Conclusions: Clinically, the independent risk factors identified in this study should be closely monitored. Furthermore, treatment should be tailored based on the specific conditions of the patient, and high-risk factors should be effectively controlled to reduce the risk of ROM loss after elbow joint release surgery in traumatic elbow joint stiffness elderly patients.

Aim: We present a case of adrenocortical adenoma originating from the adrenohepatic fusion (AHF) region, accompanied by advanced hepatosteatosis in the liver tissue, and discuss its distinction from hepatocellular carcinoma.  Case Experience: A 68-year-old male patient was admitted to the hospital following a fall from a height. He was referred to our hospital after an incidental discovery of a liver mass during an abdominal ultrasound examination. Subsequently, magnetic resonance imaging (MRI) imaging was conducted, followed by segmental liver resection with right adrenalectomy, and histological analysis of a biopsy from the lesion.  Results: Upon histologic examination, the case was determined to be an adrenocortical adenoma originating from the AHF.  Discussion: Adrenohepatic fusion (AHF) denotes the histological amalgamation of cells from the right adrenal cortex and right hepatic parenchyma. Only a limited number of cases of neoplasia originating from this region have been documented. These rare instances often present a diagnostic challenge, with preoperative imaging frequently misidentifying them as primary malignancies of either hepatic or adrenal origin, potentially leading to unnecessary extensive resections. The integration of immunohistochemical staining alongside clinical and radiological data proves helpful for accurately diagnosing this condition.  Conclusion: Awareness among clinicians, radiologists, and pathologists regarding the tumors that may arise from this region can mitigate the risk of performing extensive resections unnecessarily.

Background: Colorectal cancer stands as one of the most prevalent malignant tumors affecting the digestive tract, posing a significant threat to human health. Its incidence and fatality rates rank third and second, respectively, among malignant tumors. This study seeks to analyze the efficacy of combining fluorouracil intraperitoneal perfusion chemotherapy with intravenous chemotherapy in patients following radical resection of colorectal cancer.

Methods: This retrospective study analyzed the medical records of 65 patients who underwent radical resection of colorectal cancer at the Affiliated Hospital of Shandong University of Traditional Chinese Medicine from January 2011 to January 2013. These patients were divided into two groups based on their treatment methods: the control group (CG, n = 31, receiving intravenous chemotherapy) and the observation group (OG, n = 32, receiving fluorouracil intraperitoneal perfusion chemotherapy + intravenous chemotherapy). After 6 cycles of treatment, the study compared clinical symptoms, Karnofsky score, body weight, adverse reactions, local recurrence, and liver metastasis between the two groups.

Results: The OG demonstrated superior efficacy in controlling recurrence and metastasis compared to the CG (p < 0.05). However, there were no significant differences observed in clinical symptoms, quality of life, body weight, and drug safety between the two groups (p > 0.05).

Conclusion: Intraperitoneal infusion chemotherapy with fluorouracil significantly impacts the control of recurrence and metastasis following radical resection of colorectal cancer. It also offers valuable references for developing clinical treatment protocols for these patients.

The most important and serious complication of thyroid surgery is recurrent laryngeal nerve (RLN) injury, and it has been noted that this risk increases considerably in the presence of anatomical variations. Double recurrent laryngeal nerve (DRLN) is very rare among RLN anatomical variations. There are only a few case reports on DRLN in the literature It is crucial to possess surgical expertise and ensure complete visualization of the nerve to minimize the likelihood of RLN injury. Intraoperative nerve monitoring (IONM) is particularly useful in identifying anatomical variations. In a 54-year-old woman undergoing diagnostic left lobectomy+isthmectomy, a left DRLN was identified during intraoperative exploration and meticulous nerve exploration with the assistance of IONM monitoring verified that the impulse conduction in both branches was identical. The surgical procedure was successfully performed without causing any harm to the nerve. Based on the case reports in the literature and our experience with this patient, we believe that surgical expertise and the utilization of IONM can decrease RLN nerve damage and reveal its anatomical variations during thyroid surgery.

Aim: Aberrant hepatic artery is particularly common, and its diversity and complexity play a critical role in surgery. The aim of this study was to describe the incidence and type of aberrant hepatic artery, and to compare differences in transarterial chemoembolization (TACE) in patients with hepatocellular carcinoma (HCC) with vs without aberrant hepatic artery.

Methods: This was a retrospective study of patients with HCC who received TACE at the same intervention center between March 15, 2020 and December 31, 2022. All patients who met inclusion criteria were divided into two groups based on whether or not they had aberrant hepatic artery. The aberrant hepatic artery was systematically classified according to variations in origin. We compared differences in baseline characteristics, operation duration, and postoperative hospitalization between the two groups. Postoperative adverse events and laboratory data were also compared.

Results: A total of 1250 patients hospitalized with HCC were included in the study (mean age, 58 ± 10 years, 1019 [81.5%] males). A high incidence of aberrant hepatic artery was found during TACE (21.3%, 266 of 1250), mainly involving a single variation of the aberrant left hepatic artery (aLHA) (6.1%, 76 of 1250) or aberrant right hepatic artery (aRHA) (10.9%, 136 of 1250) origin, as well as complex variations of the aLHA and aRHA origin (2.4%, 30 of 1250). When comparing patients with vs without aberrant hepatic artery, the TACE operation duration was significantly different (p < 0.001), and tended to be greater for patients with aberrant hepatic artery. In addition, differences between aberrant and normal hepatic artery groups in postoperative nausea and vomiting were statistically significant (40.2% vs 30.8%, respectively, p = 0.004). Postoperative laboratory examinations revealed significant differences in aspartate aminotransferase, alanine aminotransferase, and neutrophil percentage between the two groups (p < 0.05).

Conclusions: The incidence of aberrant hepatic artery is extremely high, and the condition is characterized by complex variations. Moreover, aberrant hepatic artery may have a critical impact on the course of TACE treatment.

Aim: The primary aim of our study was to measure the effect of conventional open thyroidectomy performed for patients with multinodular goiter (MNG) on pulmonary volumes measured with respiratory function tests independent from surgical indications. A secondary aim was to determine whether there was a significant improvement in the complaints due to obstructive symptoms after MNG surgeries.

Methods: This study was conducted between October 2020 and June 2022. Patients who were hospitalized to undergo surgery for giant multinodular goiter were prospectively included in the study. Patients were questioned about complaints of pressure, hoarseness, dyspnea, sleep apnea, snoring, and dysphagia before the surgery and during the follow-up 6 months after surgery. In addition, pulmonary function tests were performed preoperatively, 48 hours after surgery and 6 months after surgery. Forced expiratory volume in 0.5 seconds forced expiratory volume in 1 second and forced vital capacity values in pulmonary function test (PFT) measurements were recorded.

Results: A total of 55 patients, 42 females and 13 males, mean age 49.54 ± 13.6 years, were included in the study. Although there was a significant decrease in clinical symptoms caused by the thyroid volume within 6 months in patients who were operated for giant MNG there was no significant change in pulmonary function tests. There was a positive correlation between the thyroid volume and nodule weight in patients with MNG.

Conclusions: Our results suggest that it is not necessary to follow up with patients without obstructive findings in preoperative pulmonary function tests with pulmonary function tests in the postoperative period.

Aim: Identifying and intervening with high-risk postoperative pulmonary infections patients pose challenges in clinical practice. This study aims to conduct a comprehensively analysis of the risk factors and predictive factors associated with post-gastrointestinal surgery pulmonary infections and to develop a predictive model that can predict occurrence of pulmonary infection.

Methods: A retrospective analysis was conducted on 96 patients who underwent gastrointestinal surgery at our hospital from May 2021 to October 2023. The occurrence rate of postoperative pulmonary infections was calculated, and patients were categorized into two groups: those with pulmonary infections (the occurrence group) and those without pulmonary infections (the non-occurrence group). Logistic regression analysis was utilized to identify the risk factors for post-gastrointestinal surgery pulmonary infections and to evaluate the predictive value of soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) and T cell immunoglobulin and mucin domain-4 (TIM-4) using nomograms, calibration curves, and Receiver Operating Characteristic (ROC) curves.

Results: Out of 96 patients, 20 (20.83%) developed postoperative pulmonary infections. Significant differences were noted between occurrence and non-occurrence groups in terms of smoking (65.00% vs. 34.21%, p = 0.013), surgical duration (70.00% vs. 31.58%, p = 0.002), Preoperative hemoglobin level (35.00% vs. 65.79%, p = 0.013), sTREM-1 levels (23.57 ± 3.16 pg/mL vs. 15.62 ± 2.48 pg/mL, p < 0.001), and TIM-4 levels (61.48 ± 6.35 pg/mL vs. 44.73 ± 5.22 pg/mL, p < 0.001). Logistic regression analysis leads to the development of a risk prediction model for post-gastrointestinal surgery pulmonary infections. The high predictive values of sTREM-1 (Area Under Curve (AUC) = 0.962, 95% confidence interval (CI) 0.917~0.999) and TIM-4 (AUC = 0.970, 95% CI 0.925~1.000) were highlighted by the AUC values, underscoring their clinical importance.

Conclusions: A predictive model utilizing sTREM-1 and TIM-4 for pulmonary infection following gastrointestinal surgery was developed. Additionally, other risk factors such as smoking, surgical duration, and preoperative hemoglobin level were evaluated. This finding can be applied in clinical practice to identify potentially susceptible patients and facilitate early intervention measures.