Cirugia y cirujanos最新文献

Objective: We aimed to elucidate the histopathological pre-diagnosis of cranial gliomas with magnetic resonance imaging (MRI) techniques in gliomas.

Method: A total of 82 glioma patients were enrolled to our study. Pre-operative conventional MRI images (non-contrast T1/T2/flair/contrast-enhanced T1) and advanced MRI images (DAG and ADC mapping, MRI spectroscopy and perfusion MRI [PMRI]) were analyzed.

Results: Conventional MRI alone is useful in radiological pre-evaluation in low-grade glioma in 54.8% and 86.3% in high-grade glioma. Additional advanced MRI techniques were beneficial in comparing low-grade gliomas in 98% and 83.9% in high-grade glioma. On ROC analysis, ADC cutoff value 0.905 mm2/s (p = 0.001), rCBV cutoff value 1.77 (p = 0.001), Cho/NAA cut-off value 2.20 (p = 0.001), and Cho/Cr cutoff value 2.01 (p = 0.001) were achieved. Significant results were obtained when ADC, Cho/NAA, and Cho/Cr were analyzed into four histopathologically grade groups besides (p = 0.001). NAA/Cr values were not significant in pathological grading. rCBV measurements were statistically significant between Grades I and IV and between II and IV.

Conclusion: Using additional advanced MRI techniques such as PMRI, magnetic resonance spectroscopy, and DWI with conventional MRI could enhance the accuracy of histopathological grading in cranial glioma.

Objective: To report the statistics of complications in gender reassignment surgery (vaginoplasty) observed in the first surgical center in Mexico for public transgender surgery.

Method: We conducted a descriptive, observational study of patients treated and postoperatively underwent vaginoplasty surgery in the period 2019 to 2022. Intraoperative, immediate and late complications were evaluated. Intraoperative complications were taken as: rectal perforation and bleeding. Immediate complications: wound dehiscence, hematoma, and necrosis of the vaginal segment. Late complications: urethrovaginal fistula, rectovaginal fistula, and stenosis of the vaginal introitus.

Results: Twenty-two patients who underwent vaginoplasty with inversion of the foreskin were evaluated. Regarding immediate complications, the most frequent were alterations in scarring and tissue integration, being necrosis of the vaginal segment the most frequent. As for late complications, only vaginal prolapse and urethral stricture were found.

Conclusion: Foreskin inversion vaginoplasty is the most widely used and safest technique worldwide, above colovaginoplasty and peritoneal vaginoplasty techniques, and fortunately serious complications are rare. In our report, tissue alterations were the common ones and that is secondary alteration of vascular integration and devascularization factors during the dissection.

Objective: The agitation that can occur in patients undergoing vitreoretinal surgery on awakening from general anesthesia is a serious post-operative problem. In our study, we aimed to compare the effects of different anesthesia methods on emergence agitation in patients undergoing vitreoretinal surgery.

Method: Patients undergoing vitreoretinal surgery were divided into two groups: Total intravenous anesthesia (Group T) and inhalation anesthesia (Group D) according to the maintenance of anesthesia applied by consulting the records. Patients' heart rate, mean blood pressure, extubation quality scores, and Richmond Agitation and Sedation Scale values were examined.

Results: For the study, data were available from 100 patients undergoing vitrectomy surgery. It was observed that in the total intravenous anesthesia group the quality of extubation and the patients' additional analgesic requirements were better, and the patients' agitation levels at min 0 were lower.

Conclusion: In our study, it was observed that the choice of total intravenous anesthesia as an anesthetic method in patients undergoing vitreoretinal surgery reduced agitation upon awakening compared to those receiving inhalational anesthesia.

Objective: Minimally invasive liver resection is employed worldwide for the management of benign and malignant liver lesions. There is no description of postoperative outcomes in the Mexican population. This study aims to report the initial experience in Mexico.

Method: A cross-sectional analysis was performed on 20 patients undergoing minimally invasive liver resection between 2018 and 2024 at a reference center in Mexico. Quantitative variables are reported as mean ± standard deviation or median with range, while qualitative variables as frequencies with percentages.

Results: The most frequently performed procedures were left lateral sectionectomy in five cases, 7/20 were classified as intermediate and 10/20 as expert difficulty, according to the IWATE scoring criteria. Additional results included major complication (35%), intrahospital mortality (5%), surgical reintervention (0%), median hospital length of stay (6 [3-54] days) and R0 resection rate (76.9%).

Conclusions: The initial experience of minimally invasive liver resection in Mexico includes complex cases, with great difficulty according to the IWATE criteria, with comparable R0 resection rates.

Objective: Dysregulation of lipid metabolism can be one of the pathophysiological mechanisms linking high-density lipoprotein cholesterol (HDL-C) dysfunction to obesity. The aim of the study is to show possible changes in lipid metabolism with atherogenic indices in obese patients after sleeve gastrectomy (SG) surgery.

Method: Thirty patients who had SG surgery for obesity were included in the prospective study. The atherogenic risk indices were calculated pre-operatively, at 3 and 6 months post-operatively. Furthermore, serum paraoxonase-1 (PON-1), apolipoprotein-A1 (Apo-A1), and platelet-activating factor acetylhydrolase (PAF-AH) levels, amount of oxidized low-density lipoprotein (Ox-LDL) was measured.

Results: We observed improvement in atherogenic risk indices and improved HDL-C functionality after SG. Increases were observed in HDL-C and HDL-C-related Apo-A1 levels 6 months after obesity surgery. Besides, the amount of serum triglycerides (TGs), PON-1 activity, and atherogenic risk indices decreased significantly within 6 months.

Conclusion: As far as we know, there is no study in the literature examining the dynamic changes in SG and PON-1, PAF-AH, Apo-A1, and Ox-LDL parameters. This preliminary study dynamically detected improvement in HDL-C function and reduction in atherogenic risk indices after SG.

Objectives: To evaluate changes in prostate-specific antigen (PSA) values in patients with coronavirus disease 2019 (COVID-19).

Method: Male patients who were admitted to our flu outpatient clinic with cough, fever, weakness, and bone and joint pain were evaluated. The acute phase reactants of erythrocyte sedimentation rate, C-reactive protein, ferritin, and fibrinogen were measured both at the time the patients first presented at the clinic and 1 month after recovery from COVID-19 infection. PSA and free PSA were also measured at the same time. The difference in acute phase reactants and PSA values during active COVID-19 infection and after recovery was assessed using the paired samples t-test.

Results: The mean PSA values of the patients were 2.73 ± 3.7 μg/L in the period of active infection, and 2.04 ± 2.32 μg/L 1 month later (p = 0.12). In the 29 patients with PSA values in the gray zone, the PSA values were determined as 6.6 ± 4.4 μg/L during infection and 4.1 ± 2.9 μg/L after treatment (p = 0.001).

Conclusion: The results of this study showed that PSA values in the gray zone during COVID-19 infection decreased after treatment when the patient recovered.

Objective: To evaluate whether the systemic immune-inflammation index (SII), neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and De-Ritis ratio (DRR) are determinants of progression-free survival (PFS), recurrence-free survival (RFS) and overall survival (OS) in patients aged ≥ 70 years diagnosed with non-muscle invasive bladder cancer (NMIBC).

Method: The study included 173 elderly patients diagnosed with NMIBC between January 2015 and March 2022. The clinical and pathological data of the patients were examined. Cox regression analysis was performed.

Results: The patient's mean age was 75.6 ± 4.57 years. A statistically significant correlation was determined between higher mean NLR, PLR, and SII values and PFS (p = 0.04, p = 0.009, and p = 0.007, respectively) and OS (p = 0.001, p = 0.003, and p < 0.001, respectively). The multivariate analysis results showed that tumor size (≥ 3 cm) and PLR (> 144.6) were independent risk factors for PFS (HR: 2.09, p = 0.03; HR:3.2, p = 0.01, respectively), the presence of multiple tumors for RFS (HR: 1.73, p = 0.01), and comorbid diseases for OS (HR: 2.18, p = 0.006).

Conclusion: Inflammatory parameters were found to have no independent effects on RFS and OS in patients of advanced age with NMIBC, and only PLR could be used to predict PFS.

Objective: The aim of this study was to compare the effects of Pectoral Nerve Block 2 (PECS-2) and Erector Spinae Plane Block (ESP), which are accepted to have an effect on post-operative pain control after breast cancer surgery, on both acute and chronic pain.

Method: In this double-blind, prospective, randomized study, patients were randomized using a sealed envelope method into two groups: those who underwent PECS-2 (Group P) and those who underwent ESP (Group E) before extubation at the end of the operation. The numerical rating scale (NRS) of patients was queried by a blinded researcher at post-operative 1, 2, 6, 12, and 24 h. In addition, patients were queried for the presence of chronic pain at the 3rd month using NRS.

Results: The NRS scores at 1 h and 2 h in Group P were significantly lower compared to Group E. There was no significant difference in NRS scores at 6 h, 12 h, and 24 h between the groups. The rate of chronic pain was similar between the groups.

Conclusion: In this study examining the effects of ESP and PECS-2 on acute and chronic pain after BCS due to breast cancer, PECS-2 was associated with less post-operative pain.

Objective: Understanding the relationship between genetic structure and the molecular changes involved in endometrial cancer (EC) provides an opportunity to personalize treatments and incorporate targeted therapies.

Method: We compared cytogenetic and molecular features observed in tumoral and adjacent healthy tissue endometrium samples in EC patients.

Results: Non-clonal chromosome aberrations (NCCAs) frequently in patients with EC, especially in 10,15,17,22, X chromosomes and were monitored in 73.7%, clonal chromosomal alterations were observed in 26.3% of the patients. Down POLE gene expression in 42.1%, up p53gene expression in 57.9%, PTEN down-regulation in 47.3%, down ARID1A gene expression in 42.1%, PIK3CA up-regulation was observed in 68% of patients.

Conclusion: The up-regulation of tumor suppressor genes in our study shows that not only these genes are involved but also different pathways and factors play a role in tumorigenesis. Furthermore, an increased number of NCCAs shows an essential role in the development of ECs.

Objective: This study aimed to identify the high-risk events in the operating room so as to provide a decision-making basis for emergency management.

Method: The Kaiser model-based Hazard vulnerability analysis (HVA) was used to determine the risk matrix. The Delphi method was used to create the risk assessment form. The potential risk events were quantitatively evaluated. The relative risk percentages of the risk events were calculated to identify the top high-risk events.

Results: A risk matrix containing 4 components (natural disasters; technological hazards; human hazards; and hazardous materials) was determined, and a risk assessment form was created using the Delphi method. The top three high-risk events are as follows: internal radiation exposure (41%), infectious disease outbreaks (38%), and internal fires (33%). The emergency management measures for high-risk events were developed.

Conclusions: The Kaiser model-based HVA in event risk assessment of operating room can effectively identify potential high-risk events, determine emergency priorities, and optimize resource allocation, thereby ensuring the quality and safety of surgical treatment.