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Increased liver regeneration rate and decreased liver function after synchronous liver and colon resection in rats. 增加大鼠肝结肠同步切除后肝脏再生率,降低肝功能。
Pub Date : 2009-12-24 DOI: 10.1186/1750-1164-3-16
Hideki Sasanuma, Frank Viborg Mortensen, Anders Riegels Knudsen, Peter Funch-Jensen, Masaki Okada, Hideo Nagai, Yoshikazu Yasuda

Background: The surgical strategy for the treatment of colorectal cancer and synchronous liver metastases remains controversial. The aim of the present study was to investigate the effects of colonic resection on liver function and regeneration in a rat model.

Methods: Ninety-six Sprague-Dawley rats were block-randomized into six groups: Group I had a laparotomy performed. Group II had 1 cm colon resected and anastomosed. Group III and V had 40% or 70% of the liver resected, respectively. Additionally Group IV and VI had 1 cm colon resected and anastomosed, respectively. Body weight was recorded on postoperative day 0, 3, 5 and 7. Rats were sacrificed on postoperative day 7 by rapid collection of blood from the inferior vena cava, and endotoxin levels were measured. Remnant liver function was evaluated by means of branched amino acids to tyrosine ratio. Liver regeneration was calculated by (liver weight per 100 g of the body weight at sacrifice/preoperative projected liver weight per 100 g of the body weight) x 100.

Results: The total number of complications was significantly higher in Group VI than Group I, III, IV, and V. Body weight and branched amino acids to tyrosine ratio were both significantly lower in rats that had simultaneous colonic and liver resection performed. Hepatic regeneration rate was significantly higher in the simultaneous colectomy group. Systemic endotoxin levels were unaffected by simultaneous colectomy on postoperative day 7.

Conclusions: In our model morbidity seems to be related to the extent of hepatic resection. In rats undergoing liver resection, simultaneous colectomy induced a higher degree of hepatic regeneration rate. Body weight changes and branched amino acids to tyrosine ratio were negatively affected by simultaneous colectomy.

背景:结直肠癌和同步肝转移的手术治疗策略仍然存在争议。本研究的目的是探讨结肠切除对大鼠肝脏功能和再生的影响。方法:96只Sprague-Dawley大鼠随机分为6组:1组行剖腹手术;II组切除1 cm结肠并进行吻合。III组和V组分别切除40%和70%的肝脏。另外,IV组和VI组分别切除1 cm结肠并进行吻合。术后第0、3、5、7天分别记录体重。术后第7天采用下腔静脉快速采血处死大鼠,测定内毒素水平。用支链氨基酸与酪氨酸比值评价残肝功能。肝脏再生计算公式为(献祭时每100克体重的肝脏重量/术前预计每100克体重的肝脏重量)× 100。结果:VI组并发症总数明显高于I、III、IV和v组。同时行结肠和肝脏切除的大鼠体重和支链氨基酸/酪氨酸比值均明显降低。同期结肠切除术组肝再生率明显高于同期结肠切除术组。术后第7天同时结肠切除术对全身内毒素水平无影响。结论:在我们的模型中,发病率似乎与肝切除的程度有关。在肝切除的大鼠中,同时结肠切除术诱导了更高程度的肝再生率。同时结肠切除术对体重变化和支链氨基酸与酪氨酸的比值有负面影响。
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引用次数: 5
Emergency treatment of complicated incisional hernias: a case study. 复杂切口疝的急诊治疗一例。
Pub Date : 2009-12-17 DOI: 10.1186/1750-1164-3-15
Francesco La Mura, Roberto Cirocchi, Eriberto Farinella, Umberto Morelli, Vincenzo Napolitano, Lorenzo Cattorini, Alessandro Spizzirri, Barbara Rossetti, Pamela Delmonaco, Carla Migliaccio, Diego Milani, Piero Covarelli, Carlo Boselli, Giuseppe Noya, Francesco Sciannameo

Background: The emergency treatment of incisional hernias is infrequent but it can be complicated with strangulation or obstruction and in some cases the surgical approach may also include an intestinal resection with the possibility of peritoneal contamination. Our study aims at reporting our experience in the emergency treatment of complicated incisional hernias.

Methods: Since January 1999 till July 2008, 89 patients (55 males and 34 females) were treated for complicated incisional hernias in emergency. The patients were divided in two groups: Group I consisting of 33 patients that were treated with prosthesis apposition and Group II, consisting of 56 patients that were treated by performing a direct abdominal wall muscles suture.

Results: All the patients underwent a 6-month follow up; we noticed 9 recurrences (9/56, 16%) in the patients treated with direct abdominal wall muscles suture and 1 recurrence (1/33, 3%) in the group of patients treated with the prosthesis apposition.

Conclusions: According to our experience, the emergency treatment of complicated incisional hernias through prosthesis apposition is always feasible and ensures less post-operative complications (16% vs 21,2%) and recurrences (3% vs 16%) compared to the patients treated with direct muscular suture.

背景:切口疝的急诊治疗并不常见,但它可能并发绞窄或梗阻,在某些情况下,手术可能还包括肠切除术,可能导致腹膜污染。我们的研究旨在报告我们在复杂切口疝急诊治疗中的经验。方法:自1999年1月至2008年7月,对89例复杂切口疝患者(男55例,女34例)进行急诊治疗。患者分为两组:I组33例采用假体对位治疗,II组56例采用腹壁肌直接缝合治疗。结果:所有患者随访6个月;我们发现直接腹壁肌缝合组9例复发(9/ 56,16%),假体对位组1例复发(1/ 33,3%)。结论:根据我们的经验,与直接肌肉缝合相比,采用假体对位术急诊治疗复杂切口疝始终是可行的,术后并发症(16%对21.2%)和复发率(3%对16%)均较低。
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引用次数: 7
Topical recombinant thrombin at a concentration of 1000 IU/mL reliably shortens in vivo TTH and delivers durable hemostasis in the presence of heparin anticoagulation and clopidogrel platelet inhibition in a rabbit model of vascular bleeding. 在兔血管出血模型中,外用浓度为1000 IU/mL的重组凝血酶可靠地缩短体内TTH,并在肝素抗凝和氯吡格雷血小板抑制存在下提供持久止血。
Pub Date : 2009-11-19 DOI: 10.1186/1750-1164-3-14
Steven D Hughes, Paul D Bishop, Richard Garcia, Tracy Zhang, W Allan Alexander

Background: This study was designed to evaluate the effect of recombinant human thrombin (rThrombin) concentration on time to hemostasis (TTH), clot durability, and clot strength in settings that replicate the heparinization and platelet inhibition often found in surgical populations.

Methods: A modified, anticoagulated rabbit arteriovenous shunt preparation was selected to model vascular anastomotic bleeding. Rabbits were treated with heparin or heparin + clopidogrel and TTH was measured after applying a range of topical rThrombin concentrations or placebo, in combination with absorbable gelatin sponge, USP. Treatments (placebo, rThrombin) were randomly assigned and the investigator was blinded to treatment. TTH was evaluated with the Kaplan-Meier method. After hemostasis was achieved, clot burst assessment was performed for heparin + clopidogrel treated animals. Clot viscoelastic strength and kinetics were measured in ex-vivo samples using thromboelastography (TEG) methods.

Results: TTH decreased with increasing concentrations of rThrombin in heparin-treated animals and was shorter after treatment with 1000 IU/mL rThrombin (73 seconds) than with 125 IU/mL rThrombin (78 seconds; p = 0.007). TTH also decreased with increasing concentrations of rThrombin in heparin + clopidogrel treated animals; again it was significantly shorter after treatment with 1000 IU/mL rThrombin (71 seconds) than with 125 IU/mL rThrombin (177 seconds; p < 0.001). Variability in TTH was significantly smaller after treatment with 1000 IU/mL rThrombin than after 125 IU/mL rThrombin, indicating greater reliability of clot formation (p < 0.001 for heparin or heparin + clopidogrel treatments). Clot durability was examined in heparin + clopidogrel treated animals. Clots formed in the presence of 1000 IU/mL rThrombin were significantly less likely to rupture during clot burst assessment than those formed in the presence of 125 IU/mL rThrombin (0% versus 79%, p < 0.001). In vitro clot strength and clot kinetics, as determined by TEG in heparin + clopidogrel samples, were positively associated with the amount of rThrombin activity added for clot initiation.

Conclusion: In an animal model designed to replicate the anti-coagulation regimens encountered in clinical settings, topical rThrombin at 1000 IU/mL more reliably controlled the pharmacological effects of heparin or heparin + clopidogrel on hemostasis than rThrombin at 125 IU/mL. Results from in vitro assessments confirmed a positive relationship between the amount of rThrombin activity and both the rate of clot formation and clot strength.

背景:本研究旨在评估重组人凝血酶(r凝血酶)浓度对手术人群中常见的肝素化和血小板抑制情况下的止血时间(TTH)、凝块耐久性和凝块强度的影响。方法:采用改良抗凝兔动静脉分流器制备血管吻合口出血模型。用肝素或肝素+氯吡格雷治疗家兔,在应用一定范围的局部凝血酶浓度或安慰剂,联合可吸收明胶海绵(USP)后测量TTH。治疗(安慰剂、凝血酶)随机分配,研究者对治疗采取盲法。用Kaplan-Meier法对TTH进行评价。止血完成后,对肝素+氯吡格雷治疗的动物进行凝块破裂评估。使用血栓弹性成像(TEG)方法测量离体样品的凝块粘弹性强度和动力学。结果:肝素治疗动物TTH随凝血酶浓度的增加而降低,1000iu /mL r凝血酶治疗后(73秒)较125iu /mL r凝血酶治疗后(78秒)缩短;P = 0.007)。在肝素+氯吡格雷治疗的动物中,TTH也随着凝血酶浓度的增加而降低;同样,1000iu /mL r凝血酶治疗后(71秒)明显短于125iu /mL r凝血酶治疗后(177秒;P < 0.001)。1000iu /mL凝血酶治疗后TTH变异性明显小于125iu /mL凝血酶治疗后,表明凝块形成的可靠性更高(肝素或肝素+氯吡格雷治疗的p < 0.001)。在肝素+氯吡格雷治疗的动物中检测凝块耐久性。在血块破裂评估中,1000iu /mL凝血酶形成的血块破裂的可能性明显低于125iu /mL凝血酶形成的血块(0% vs 79%, p < 0.001)。肝素+氯吡格雷样品中TEG测定的体外凝块强度和凝块动力学与用于凝块起始的凝血酶活性添加量呈正相关。结论:在一个旨在复制临床抗凝方案的动物模型中,局部使用1000iu /mL的凝血酶比125 IU/mL的凝血酶更可靠地控制肝素或肝素+氯吡格雷的止血药理作用。体外评估的结果证实了凝血酶活性与凝块形成率和凝块强度之间的正相关关系。
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引用次数: 14
Expression of TNF-related apoptosis-inducing ligand (TRAIL) in keratinocytes mediates apoptotic cell death in allogenic T cells. 角质形成细胞中tnf相关凋亡诱导配体(TRAIL)的表达介导同种异体T细胞的凋亡细胞死亡。
Pub Date : 2009-11-19 DOI: 10.1186/1750-1164-3-13
Kerstin Reimers, Christine Radtke, Claudia Y Choi, Christina Allmeling, Susanne Kall, Paul Kiefer, Thomas Muehlberger, Peter M Vogt

The objective of the present study was to evaluate the aptitude of TRAIL gene expression for inducing apoptosis in co-cultivated T-cells. This should allow preparing a strategy for the development of a durable, allogenic skin substitute based on the induction of an immune-privileged transplant. In order to counteract the significant potential of rejection in transplanted allogenic keratinocytes, we created a murine keratinocyte cell line which expressed TRAIL through stable gene transfer. The exogenic protein was localized on the cellular surface and was not found in soluble condition as sTRAIL. Contact to TRAIL expressing cells in co-culture induced cell death in sensitive Jurkat-cells, which was further intensified by lymphocyte activation. This cytotoxic effect is due to the induction of apoptosis. We therefore assume that the de-novo expression of TRAIL in keratinocytes can trigger apoptosis in activated lymphocytes and thus prevent the rejection of keratinocytes in allogenic, immune-privileged transplants.

本研究的目的是评估TRAIL基因表达诱导共培养t细胞凋亡的能力。这应该可以为开发一种基于诱导免疫特权移植的持久的同种异体皮肤替代品制定策略。为了抵消移植异体角化细胞的排斥反应,我们通过稳定的基因转移创造了一种表达TRAIL的小鼠角化细胞细胞系。外源蛋白定位于细胞表面,在可溶性条件下未发现sTRAIL。在共培养中与TRAIL表达细胞接触可诱导敏感jurkat细胞死亡,并通过淋巴细胞活化进一步加剧。这种细胞毒性作用是由于诱导细胞凋亡。因此,我们假设在角质形成细胞中去novo表达TRAIL可以触发活化淋巴细胞的凋亡,从而防止异体免疫特权移植中角质形成细胞的排斥反应。
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引用次数: 4
Fibrin glue in the treatment of anal fistula: a systematic review. 纤维蛋白胶治疗肛瘘的系统综述。
Pub Date : 2009-11-14 DOI: 10.1186/1750-1164-3-12
Roberto Cirocchi, Eriberto Farinella, Francesco La Mura, Lorenzo Cattorini, Barbara Rossetti, Diego Milani, Patrizia Ricci, Piero Covarelli, Marco Coccetta, Giuseppe Noya, Francesco Sciannameo

Background: New sphincter-saving approaches have been applied in the treatment of perianal fistula in order to avoid the risk of fecal incontinence. Among them, the fibrin glue technique is popular because of its simplicity and repeatability. The aim of this review is to compare the fibrin glue application to surgery alone, considering the healing and complication rates.

Methods: We performed a systematic review searching for published randomized and controlled clinical trials without any language restriction by using electronic databases. All these studies were assessed as to whether they compared conventional surgical treatment versus fibrin glue treatment in patients with anal fistulas, in order to establish both the efficacy and safety of each treatment. We used Review Manager 5 to conduct the review.

Results: The healing rate is higher in those patients who underwent the conventional surgical treatment (P = 0,68), although the treatment with fibrin glue gives no evidence of anal incontinence (P = 0,08). Furthermore two subgroup analyses were performed: fibrin glue in combination with intra-adhesive antibiotics versus fibrin glue alone and anal fistula plug versus fibrin glue. In the first subgroup there were not differences in healing (P = 0,65). Whereas in the second subgroup analysis the healing rate is statistically significant for the patients who underwent the anal fistula plug treatment instead of the fibrin glue treatment (P = 0,02).

Conclusion: In literature there are only two randomized controlled trials comparing the conventional surgical management versus the fibrin glue treatment in patients with anal fistulas. Although from our statistical analysis we cannot find any statistically significant result, the healing rate remains higher in patients who underwent the conventional surgical treatment (P = 0,68), and the anal incontinence rate is very low in the fibrin glue treatment group (P = 0,08). Anyway the limited collected data do not support the use of fibrin glue. Moreover, in our subgroup analysis the use of fibrin glue in combination with intra-adhesive antibiotics does not improve the healing rate (P = 0.65), whereas the anal fistula plug treatment compared to the fibrin glue treatment shows good results (P = 0,02), although the poor number of patients treated does not lead to any statistically evident conclusion. This systematic review underlines the need of new RCTs upon this issue.

背景:新的保括约肌入路已被应用于肛周瘘的治疗,以避免大便失禁的风险。其中,纤维蛋白胶技术以其简单、可重复性广受欢迎。本综述的目的是比较纤维蛋白胶的应用与单独手术,考虑愈合和并发症的发生率。方法:我们通过电子数据库系统检索已发表的无语言限制的随机对照临床试验。所有这些研究都被评估是否比较了肛瘘患者的常规手术治疗与纤维蛋白胶治疗,以确定每种治疗的有效性和安全性。我们使用Review Manager 5来进行评审。结果:采用常规手术治疗的肛瘘患者治愈率较高(P = 0.68),但纤维蛋白胶治疗未出现肛门失禁(P = 0.08)。此外,还进行了两个亚组分析:纤维蛋白胶联合黏附抗生素与单独使用纤维蛋白胶和肛瘘塞与纤维蛋白胶。在第一个亚组中,愈合没有差异(P = 0.65)。而在第二亚组分析中,肛瘘封堵治疗比纤维蛋白胶治疗的治愈率有统计学意义(P = 0.02)。结论:文献中比较传统手术治疗与纤维蛋白胶治疗肛瘘的随机对照试验仅有两项。虽然从我们的统计分析中没有发现有统计学意义的结果,但常规手术治疗组的治愈率仍然较高(P = 0.68),纤维蛋白胶治疗组的肛门失禁率很低(P = 0.08)。无论如何,有限的收集数据不支持使用纤维蛋白胶。此外,在我们的亚组分析中,纤维蛋白胶联合黏附抗生素并没有提高治愈率(P = 0.65),而肛瘘塞治疗与纤维蛋白胶治疗相比效果较好(P = 0.02),虽然治疗人数较少,但没有统计学上明显的结论。本系统综述强调了在这一问题上开展新的随机对照试验的必要性。
{"title":"Fibrin glue in the treatment of anal fistula: a systematic review.","authors":"Roberto Cirocchi,&nbsp;Eriberto Farinella,&nbsp;Francesco La Mura,&nbsp;Lorenzo Cattorini,&nbsp;Barbara Rossetti,&nbsp;Diego Milani,&nbsp;Patrizia Ricci,&nbsp;Piero Covarelli,&nbsp;Marco Coccetta,&nbsp;Giuseppe Noya,&nbsp;Francesco Sciannameo","doi":"10.1186/1750-1164-3-12","DOIUrl":"https://doi.org/10.1186/1750-1164-3-12","url":null,"abstract":"<p><strong>Background: </strong>New sphincter-saving approaches have been applied in the treatment of perianal fistula in order to avoid the risk of fecal incontinence. Among them, the fibrin glue technique is popular because of its simplicity and repeatability. The aim of this review is to compare the fibrin glue application to surgery alone, considering the healing and complication rates.</p><p><strong>Methods: </strong>We performed a systematic review searching for published randomized and controlled clinical trials without any language restriction by using electronic databases. All these studies were assessed as to whether they compared conventional surgical treatment versus fibrin glue treatment in patients with anal fistulas, in order to establish both the efficacy and safety of each treatment. We used Review Manager 5 to conduct the review.</p><p><strong>Results: </strong>The healing rate is higher in those patients who underwent the conventional surgical treatment (P = 0,68), although the treatment with fibrin glue gives no evidence of anal incontinence (P = 0,08). Furthermore two subgroup analyses were performed: fibrin glue in combination with intra-adhesive antibiotics versus fibrin glue alone and anal fistula plug versus fibrin glue. In the first subgroup there were not differences in healing (P = 0,65). Whereas in the second subgroup analysis the healing rate is statistically significant for the patients who underwent the anal fistula plug treatment instead of the fibrin glue treatment (P = 0,02).</p><p><strong>Conclusion: </strong>In literature there are only two randomized controlled trials comparing the conventional surgical management versus the fibrin glue treatment in patients with anal fistulas. Although from our statistical analysis we cannot find any statistically significant result, the healing rate remains higher in patients who underwent the conventional surgical treatment (P = 0,68), and the anal incontinence rate is very low in the fibrin glue treatment group (P = 0,08). Anyway the limited collected data do not support the use of fibrin glue. Moreover, in our subgroup analysis the use of fibrin glue in combination with intra-adhesive antibiotics does not improve the healing rate (P = 0.65), whereas the anal fistula plug treatment compared to the fibrin glue treatment shows good results (P = 0,02), although the poor number of patients treated does not lead to any statistically evident conclusion. This systematic review underlines the need of new RCTs upon this issue.</p>","PeriodicalId":87428,"journal":{"name":"Annals of surgical innovation and research","volume":"3 ","pages":"12"},"PeriodicalIF":0.0,"publicationDate":"2009-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/1750-1164-3-12","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28507567","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 65
Virtual colonoscopy in stenosing colorectal cancer. 狭窄性结直肠癌的虚拟结肠镜检查。
Pub Date : 2009-11-09 DOI: 10.1186/1750-1164-3-11
Marco Coccetta, Carla Migliaccio, Francesco La Mura, Eriberto Farinella, Ioanna Galanou, Pamela Delmonaco, Alessandro Spizzirri, Vincenzo Napolitano, Lorenzo Cattorini, Diego Milani, Roberto Cirocchi, Francesco Sciannameo

Background: Between 5 and 10% of the patients undergoing a colonoscopy cannot have a complete procedure mainly due to stenosing neoplastic lesion of rectum or distal colon. Nevertheless the elective surgical treatment concerning the stenosis is to be performed after the pre-operative assessment of the colonic segments upstream the cancer. The aim of this study is to illustrate our experience with the Computed Tomographic Colonography (CTC) for the pre-operative assessment of the entire colon in the patients with stenosing colorectal cancers.

Methods: From January 2005 till March 2009, we observed and treated surgically 43 patients with stenosing colorectal neoplastic lesions. All patients did not tolerate the pre-operative colonoscopy. For this reason they underwent a pre-operative CTC in order to have a complete assessment of the entire colon. All patients underwent a follow-up colonoscopy 3 months after the surgical treatment. The CTC results were compared with both macroscopic examination of the specimen and the follow-up coloscopy.

Results: The pre-operative CTC showed four synchronous lesions in four patients (9.3% of the cases). The macroscopic examination of the specimen revealed three small sessile polyps (3-4 mm in diameter) missed in the pre-operative assessment near the stenosing colorectal cancer. The follow-up colonoscopy showed four additional sessile polyps with a diameter between 3-11 mm in three patients. Our experience shows that CTC has a sensitivity of 83,7%.

Conclusion: In patients with stenosing colonic lesions, CTC allows to assess the entire colon pre-operatively avoiding the need of an intraoperative colonoscopy. More synchronous lesions are detected and treated at the time of the elective surgery for the stenosing cancer avoiding further surgery later on.

背景:在接受结肠镜检查的患者中,有 5%至 10%的患者无法完成完整的手术,主要原因是直肠或结肠远端有狭窄的肿瘤病变。尽管如此,在术前对结肠癌上行部分进行评估后,还是要对狭窄部分进行选择性手术治疗。本研究的目的是介绍我们使用计算机断层扫描结肠成像(CTC)对狭窄性结直肠癌患者的整个结肠进行术前评估的经验:从 2005 年 1 月到 2009 年 3 月,我们对 43 名患有狭窄性结肠直肠肿瘤病变的患者进行了观察和手术治疗。所有患者均不能耐受术前结肠镜检查。因此,他们在术前接受了 CTC 检查,以便对整个结肠进行全面评估。所有患者都在手术治疗 3 个月后接受了结肠镜复查。CTC 结果与标本的宏观检查和后续结肠镜检查结果进行了比较:结果:术前 CTC 结果显示,4 名患者(占病例总数的 9.3%)有 4 处同步病变。标本的宏观检查显示,术前评估时漏诊了靠近狭窄性结直肠癌的三个无柄小息肉(直径 3-4 毫米)。后续的结肠镜检查显示,3 名患者中又有 4 个直径在 3-11 毫米之间的无柄息肉。我们的经验表明,CTC 的灵敏度高达 83.7%:结论:对于结肠狭窄病变患者,CTC 可以在术前对整个结肠进行评估,避免了术中结肠镜检查。更多的同步病变可在狭窄性癌症的择期手术中被发现和治疗,避免了日后的进一步手术。
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引用次数: 0
Antibiotic prophylaxis in thyroid surgery: a preliminary multicentric Italian experience. 甲状腺手术中的抗生素预防:意大利多中心初步经验。
Pub Date : 2009-08-05 DOI: 10.1186/1750-1164-3-10
Nicola Avenia, Alessandro Sanguinetti, Roberto Cirocchi, Giovanni Docimo, Mark Ragusa, Roberto Ruggiero, Eugenio Procaccini, Carlo Boselli, Fabio D'Ajello, Francesco Barberini, Domenico Parmeggiani, Lodovico Rosato, Francesco Sciannameo, Giorgio De Toma, Giuseppe Noya

Post-operatory wound infections are a very uncommon finding after thyroidectomy. For these reasons international guidelines do not routinely recommend systemic antibiotic prophylaxis. The benefits of this antibiotic prophylaxis is not supported by clinical evidence in the literature. We have conducted a multicentric randomized double-blind trial on 500 patients who had undergone thyroidectomy for goitre or thyroid carcinoma. The 500 patients enrolled in the study (mean age 47 years) were randomized in two subgroups of 250 patients. 250 patients were treated with standard antibiotic prophylaxis with sulbactam/ampicillin 1 fl (3 gr.) 30 min before surgery. No antibiotic prophylaxis was instituted in the remainder 250 patients. Our RCT showed that prophylactic antibiotic treatment is not beneficial in patients younger than eighty years old, with no concomitant metabolic, infective and hematologic disease, with no cardiac valvulopathies, not under steroidal or immunosuppressive treatment, and not severely obese. Our study should be regarded only as a preliminary RCT, and should be followed by a study in which a larger number of patients should be enrolled so that statistically significant data can be obtained.

甲状腺切除术后伤口感染并不常见。因此,国际指南并不建议常规使用全身性抗生素进行预防。这种抗生素预防性治疗的益处并没有得到文献中临床证据的支持。我们对500名因甲状腺肿或甲状腺癌而接受甲状腺切除术的患者进行了一项多中心随机双盲试验。参加研究的500名患者(平均年龄47岁)被随机分为两组,每组250人。250名患者在手术前30分钟接受舒巴坦/氨苄西林1 fl(3克)的标准抗生素预防治疗。其余 250 名患者未使用抗生素预防。我们的研究表明,对于年龄小于 80 岁,没有合并代谢、感染和血液疾病,没有心脏瓣膜病,没有接受类固醇或免疫抑制治疗,没有严重肥胖的患者,预防性抗生素治疗并无益处。我们的研究只能被视为一项初步的 RCT 研究,随后还应该进行一项研究,招募更多的患者,以便获得具有统计学意义的数据。
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引用次数: 0
A dry lab for medical engineers? 医学工程师的干实验室?
Pub Date : 2009-07-31 DOI: 10.1186/1750-1164-3-9
Francesco Rulli, Angelo Maura, Gabriele Galatà, Giulia Olivi, Michele Grande, Attilio M Farinon

Introduction: We describe a teaching and training method with objective evaluation to improve medical engineering students' knowledge and analysis skills about Minimally Invasive Surgery (MIS) instrumentation and techniques through hands-on experience. Training has been scheduled during a three-month course.

Methods: Twenty medical engineering students were trained to perform three times on a pelvic trainer a sequence of standardized drills connected with the selected MIS techniques, in order to improve their dexterity. The time required to perform each dexterity drill was recorded in seconds.Then, the participants were divided into groups and asked to write an essay about an instrument they chose, analyzing and criticizing the instrument itself.

Results: All the trainees showed steady improvement in skill acquisition on the laparoscopic simulator and discussed their essays, making proposals in order to improve the instrument they tested.

Conclusion: Significant improvement in performance with increasing skillness has been measured; during the course and during their discussion the participants showed deep knowledge of the instrument, ability to analyze and criticize it and ability to make improvement proposals.Dry lab experience for medical engineering students is useful for teaching and improving analysis and management of laparoscopic devices, allowing identification of problems and developing better devices.

前言:我们描述了一种客观评价的教学和训练方法,通过实践经验提高医学工程专业学生对微创外科(MIS)仪器和技术的知识和分析能力。培训计划为期三个月。方法:对20名医学工程专业学生进行三次骨盆训练,并结合所选的MIS技术进行一系列标准化训练,以提高他们的灵活性。进行每一次灵巧训练所需的时间都以秒为单位记录下来。然后,参与者被分成小组,并被要求写一篇关于他们选择的乐器的文章,分析和批评乐器本身。结果:所有学员在腹腔镜模拟器上的技能习得都有稳定的提高,并讨论了他们的论文,提出了改进他们所测试的仪器的建议。结论:随着技能的增加,成绩有了显著的改善;在课程和讨论过程中,参与者展示了对乐器的深入了解,分析和批评它的能力以及提出改进建议的能力。医学工程专业学生的干燥实验室经验有助于教学和改进腹腔镜设备的分析和管理,允许识别问题并开发更好的设备。
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引用次数: 2
Contamination of equipment in emergency settings: an exploratory study with a targeted automated intervention. 紧急情况下设备污染:一项有针对性的自动干预的探索性研究。
Pub Date : 2009-07-30 DOI: 10.1186/1750-1164-3-8
Chidi Obasi, Allison Agwu, Wale Akinpelu, Roger Hammons, Clyde Clark, Ralph Etienne-cummings, Peter Hill, Richard Rothman, Stella Babalola, Tracy Ross, Karen Carroll, Bolanle Asiyanbola

Background: Despite standard manual decontamination, hospital equipment remains contaminated with microorganisms, contributing to nosocomial transmission and hospital acquired infections. This has the potential to negate the effects of healthcare workers' hand-washing protocols. In order to decrease the likelihood of equipment contamination, there has been a rise in the use of disposable pieces of equipment, especially non-critical disposables. However, these carry a significant cost, both a direct financial cost (running into billions of dollars), as well as a cost to the environment. This is important because we hope to contain the cost of healthcare, one way to do that, is to look to the hospitals themselves, for innovative solutions that maintain the standard of care.

Objective: To develop and evaluate the effectiveness of an simple decontamination device for use with portable hospital equipment, by comparing rates of residual contamination after use of the novel device versus those seen with standard manual decontamination methods.

Methods: The Self-cleaning Unit for the Decontamination of Small instruments (SUDS) is a user-friendly, automated instrument developed via multi-disciplinary collaboration for decontamination in the clinical area. Pre- and post- utilization of portable medical equipment in an emergency department (ED) setting were cultured. To evaluate durability of the decrease in antimicrobial contamination, objects were re-cultured 48 hours after SUDS cleaning and following re-introduction into the clinical setting.

Results: After manual decontamination, 25% (23/91) of the tested objects in the ED were found to be culture positive with clinically significant microorganisms(CSO). Fifteen percent (ED) of non-critical equipment tested had multiple organisms. Following the use of SUDS, the colonization rate decreased to 0%. Following SUDS treatment and re-introduction into the clinical settings, after 48 hours the contamination rates as reflected by the cultures remained 0%.

Conclusion: Standard non-critical equipment is contaminated with clinically significant microorganisms. The SUDS device allows for effective and durable decontamination of hospital equipment of varying sizes in the clinical area without disrupting patient care.

背景:尽管标准的人工消毒,医院设备仍然被微生物污染,导致医院传播和医院获得性感染。这有可能抵消医护人员洗手方案的效果。为了减少设备污染的可能性,一次性设备的使用有所增加,特别是非关键的一次性设备。然而,这些都带来了巨大的成本,既包括直接的财政成本(高达数十亿美元),也包括环境成本。这很重要,因为我们希望控制医疗保健的成本,实现这一目标的一种方法,是关注医院本身,寻找保持护理标准的创新解决方案。目的:通过比较新型设备使用后的残留污染率与标准手动去污方法的残留污染率,开发和评估便携式医院设备使用的简单去污装置的有效性。方法:小型仪器去污自洁装置(SUDS)是一种用户友好的自动化仪器,是多学科合作开发的用于临床去污的仪器。培养了在急诊科(ED)环境中便携式医疗设备的前后使用情况。为了评估抗菌污染减少的持久性,在SUDS清洁后48小时重新培养对象,然后重新引入临床环境。结果:经人工消毒后,25%(23/91)的检测对象临床显著微生物(CSO)培养阳性。15% (ED)的非关键设备测试有多种生物。使用SUDS后,定植率降至0%。经过SUDS治疗并重新引入临床环境后,48小时后,培养物反映的污染率仍然为0%。结论:标准非关键设备被临床重要微生物污染。该SUDS设备允许有效和持久的去污医院设备的不同大小的临床领域,而不中断病人的护理。
{"title":"Contamination of equipment in emergency settings: an exploratory study with a targeted automated intervention.","authors":"Chidi Obasi,&nbsp;Allison Agwu,&nbsp;Wale Akinpelu,&nbsp;Roger Hammons,&nbsp;Clyde Clark,&nbsp;Ralph Etienne-cummings,&nbsp;Peter Hill,&nbsp;Richard Rothman,&nbsp;Stella Babalola,&nbsp;Tracy Ross,&nbsp;Karen Carroll,&nbsp;Bolanle Asiyanbola","doi":"10.1186/1750-1164-3-8","DOIUrl":"https://doi.org/10.1186/1750-1164-3-8","url":null,"abstract":"<p><strong>Background: </strong>Despite standard manual decontamination, hospital equipment remains contaminated with microorganisms, contributing to nosocomial transmission and hospital acquired infections. This has the potential to negate the effects of healthcare workers' hand-washing protocols. In order to decrease the likelihood of equipment contamination, there has been a rise in the use of disposable pieces of equipment, especially non-critical disposables. However, these carry a significant cost, both a direct financial cost (running into billions of dollars), as well as a cost to the environment. This is important because we hope to contain the cost of healthcare, one way to do that, is to look to the hospitals themselves, for innovative solutions that maintain the standard of care.</p><p><strong>Objective: </strong>To develop and evaluate the effectiveness of an simple decontamination device for use with portable hospital equipment, by comparing rates of residual contamination after use of the novel device versus those seen with standard manual decontamination methods.</p><p><strong>Methods: </strong>The Self-cleaning Unit for the Decontamination of Small instruments (SUDS) is a user-friendly, automated instrument developed via multi-disciplinary collaboration for decontamination in the clinical area. Pre- and post- utilization of portable medical equipment in an emergency department (ED) setting were cultured. To evaluate durability of the decrease in antimicrobial contamination, objects were re-cultured 48 hours after SUDS cleaning and following re-introduction into the clinical setting.</p><p><strong>Results: </strong>After manual decontamination, 25% (23/91) of the tested objects in the ED were found to be culture positive with clinically significant microorganisms(CSO). Fifteen percent (ED) of non-critical equipment tested had multiple organisms. Following the use of SUDS, the colonization rate decreased to 0%. Following SUDS treatment and re-introduction into the clinical settings, after 48 hours the contamination rates as reflected by the cultures remained 0%.</p><p><strong>Conclusion: </strong>Standard non-critical equipment is contaminated with clinically significant microorganisms. The SUDS device allows for effective and durable decontamination of hospital equipment of varying sizes in the clinical area without disrupting patient care.</p>","PeriodicalId":87428,"journal":{"name":"Annals of surgical innovation and research","volume":" ","pages":"8"},"PeriodicalIF":0.0,"publicationDate":"2009-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/1750-1164-3-8","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40000864","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 18
A versatile breast reduction technique: conical plicated central U shaped (COPCUs) mammaplasty. 一种多功能的乳房缩小技术:锥形复杂中央U形(COPCUs)乳房成形术。
Pub Date : 2009-07-03 DOI: 10.1186/1750-1164-3-7
Eray Copcu

Background: There have been numerous studies on reduction mammaplasty and its modifications in the literature. The multitude of modifications of reduction mammaplasty indicates that the ideal technique has yet to be found. There are four reasons for seeking the ideal technique. One reason is to preserve functional features of the breast: breastfeeding and arousal. Other reasons are to achieve the real geometric and aesthetic shape of the breast with the least scar and are to minimize complications of prior surgical techniques without causing an additional complication. Last reason is the limitation of the techniques described before. To these aims, we developed a new versatile reduction mammaplasty technique, which we called conical plicated central U shaped (COPCUs) mammaplasty.

Methods: We performed central plication to achieve a juvenile look in the superior pole of the breast and to prevent postoperative pseudoptosis and used central U shaped flap to achieve maximum NAC safety and to preserve lactation and nipple sensation. The central U flap was 6 cm in width and the superior conical plication was performed with 2/0 PDS. Preoperative and postoperative standard measures of the breast including the superior pole fullness were compared.

Results: Forty six patients were operated with the above mentioned technique. All of the patients were satisfied with functional and aesthetic results and none of them had major complications. There were no changes in the nipple innervation. Six patients becoming pregnant after surgery did not experience any problems with lactation. None of the patients required scar revision.

Conclusion: Our technique is a versatile, safe, reliable technique which creates the least scar, avoids previously described disadvantages, provides maximum preservation of functions, can be employed in all breasts regardless of their sizes.

背景:文献中有大量关于乳房缩小成形术及其修改的研究。乳房缩小成形术的众多修改表明,理想的技术尚未找到。寻求理想的技术有四个原因。一个原因是为了保持乳房的功能特征:母乳喂养和唤醒。其他的原因是为了达到真实的几何和美学形状的乳房,以最少的疤痕,并尽量减少以前的手术技术的并发症,而不会造成额外的并发症。最后一个原因是前面描述的技术的局限性。为了达到这些目的,我们开发了一种新的多功能缩小乳房成形术,我们称之为锥形复杂中央U形(COPCUs)乳房成形术。方法:我们在乳房的上极行中心皮瓣,以达到年轻的外观,防止术后假眼,并使用中心U形皮瓣,以达到最大的NAC安全性,并保留泌乳和乳头感觉。中央U型皮瓣宽度为6cm,采用2/0 PDS进行上锥形应用。比较术前和术后乳房的标准测量,包括上极丰满度。结果:46例患者均行上述手术。所有患者均获得满意的功能和美观效果,无重大并发症发生。乳头神经支配未见改变。6例手术后怀孕的患者没有出现任何哺乳问题。没有患者需要疤痕修复。结论:我们的技术是一种多功能、安全、可靠的技术,它创造了最少的疤痕,避免了先前描述的缺点,提供了最大限度的功能保存,可用于所有乳房,无论其大小。
{"title":"A versatile breast reduction technique: conical plicated central U shaped (COPCUs) mammaplasty.","authors":"Eray Copcu","doi":"10.1186/1750-1164-3-7","DOIUrl":"https://doi.org/10.1186/1750-1164-3-7","url":null,"abstract":"<p><strong>Background: </strong>There have been numerous studies on reduction mammaplasty and its modifications in the literature. The multitude of modifications of reduction mammaplasty indicates that the ideal technique has yet to be found. There are four reasons for seeking the ideal technique. One reason is to preserve functional features of the breast: breastfeeding and arousal. Other reasons are to achieve the real geometric and aesthetic shape of the breast with the least scar and are to minimize complications of prior surgical techniques without causing an additional complication. Last reason is the limitation of the techniques described before. To these aims, we developed a new versatile reduction mammaplasty technique, which we called conical plicated central U shaped (COPCUs) mammaplasty.</p><p><strong>Methods: </strong>We performed central plication to achieve a juvenile look in the superior pole of the breast and to prevent postoperative pseudoptosis and used central U shaped flap to achieve maximum NAC safety and to preserve lactation and nipple sensation. The central U flap was 6 cm in width and the superior conical plication was performed with 2/0 PDS. Preoperative and postoperative standard measures of the breast including the superior pole fullness were compared.</p><p><strong>Results: </strong>Forty six patients were operated with the above mentioned technique. All of the patients were satisfied with functional and aesthetic results and none of them had major complications. There were no changes in the nipple innervation. Six patients becoming pregnant after surgery did not experience any problems with lactation. None of the patients required scar revision.</p><p><strong>Conclusion: </strong>Our technique is a versatile, safe, reliable technique which creates the least scar, avoids previously described disadvantages, provides maximum preservation of functions, can be employed in all breasts regardless of their sizes.</p>","PeriodicalId":87428,"journal":{"name":"Annals of surgical innovation and research","volume":"3 ","pages":"7"},"PeriodicalIF":0.0,"publicationDate":"2009-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/1750-1164-3-7","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28361410","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 7
期刊
Annals of surgical innovation and research
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