Cirugia y cirujanos最新文献

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.

Objective: The systemic inflammation response index (SIRI) is a marker used to predict survival. The aim of this study is to examine the relationship between SIRI and clinicopathological features and survival.

Method: The relationship between clinicopathological characteristics and survey and SIRI was retrospectively investigated.

Results: A total of 178 patients were included in the study. Poor prognostic factors such as tumor size, t, T-stage, tumor-node-metastasis (TNM) stage, and CA19-9 level were found to have a statistically significant relationship with patients with high SIRI (p = 0.039, p = 0.001, p = 0.001 and p = 0.013, respectively). A high SIRI was found to be an independent and poor prognostic factor for 3-year and 5-year survival (p = 0.014 and p = 0.027, respectively).

Conclusions: High SIRI was associated with a poor survival rate, as were advanced TNM stage, advanced T stage, larger tumor size, and elevated CA19-9 level; all these are poor prognostic markers for gastric cancer.

Objective: Hepatocellular carcinoma (HCC) is the third leading cause of cancer-related mortality globally. In our region, there is a scarcity of studies addressing its epidemiology and treatment. The aim was to characterize a cohort of HCC patients in a high-complexity public center in Argentina over a span of 10 years.

Method: This study employed a retrospective observational and analytical cohort design. All patients aged 18 and above, diagnosed with HCC between January 2013 and December 2022 at Hospital El Cruce, were included.

Results: The cohort comprised 380 patients, 75% being male, average age of 57 ± 10.14 years. Cirrhotic liver was evident in 94% of cases. Surgery was employed in 182 (138 hepatic transplants, 44 surgical resections), locoregional therapies in 121 (104 sole transarterial chemoembolization, and 17 in combination), and one radiofrequency ablation. Systemic treatment was administered to 34 patients, 17 of whom received it as monotherapy. Mortality within the series according to the Barcelona Clinic Liver Cancer (BCLC) staging: 0, 1/2 (50%); A, 92/220 (41.8%); B, 60/98 (61.2%); C, 21/23 (91.3%); D, 37/37 (100%).

Conclusions: HCC emerges as a complex tumor with an unfavorable prognosis, underscoring the pivotal role of prevention and early detection in improving outcomes.

Objective: According to the Tokyo 2018 guidelines, white blood cells (WBCs) are the only markers used in the staging of acute cholecystitis. We aimed to investigate the role of thiol-disulfide and ischemia-modified albumin (IMA), which are used in the diagnosis of inflammatory diseases, in the diagnosis, and severity of acute cholecystitis.

Materials and methods: A total of 108 patients hospitalized with acute cholecystitis and 42 healthy volunteers were included in the study. Plasma total thiol (TT), native thiol (NT), and disulfide levels were measured and IMA was calculated using disulfide/native, disulfide/total, and native/TT ratios.

Results: Significant differences were found in both inflammatory and antioxidant markers, age, and symptom duration between disease stages (Stages I, II, and III) and control group (p < 0.001). Age and symptom duration were negatively correlated with antioxidant parameters (albumin, NT, and TT) (r = -0.321, p < 0.00). C-reactive protein and WBC correlated negatively with albumin and antioxidant parameters and positively with disulfide (r = 0.776, p < 0.001; r = 0.358, p < 0.001).

Conclusion: The oxidative stress markers in our study can be used to assist radiologic examinations in determining the severity of acute cholecystitis.

Objective: We aimed to predict the risk of hypotension due to spinal anesthesia (HSA) by measuring the diameter and area of the inferior vena cava (IVC-D, IVC-A) through ultrasound and pleth variability index (PVI) in patients who underwent endovenous radiofrequency ablation under spinal anesthesia (SA).

Methods: This cross-sectional, observational, and prospective study was completed with 64 patients. Before SA, PVI IVC-D, and IVC-A were measured. Patients were divided into two groups as hypotension group (Group 1) and patients who did not developed hypotension after SA (Group 2). Shapiro-Wilk normality test and student's t-test were used for statistical analysis.

Results: The mean PVI of Group 1 was higher than Group 2, whereas the mean IVC-D and IVC-A in Group 2 was significantly higher than Group 1 (p = 0.000, p = 0.000, p = 0.001). Cutoff values for hypotension PVI > 15% and IVC-A ≤ 2.98 mm2 (p = 0.001, p < 0.05).

Conclusion: PVI and IVC-D and IVC-A measurements are effective and reliable methods that should be used to predict the risk of developing HSA in patients who will undergo surgery under SA.

Objective: This study evaluates the acute therapeutic effect of manual lymphatic drainage (MLD).

Methods: Eighty-two individuals (164 upper limbs) participating in the study were divided into two groups: MLD and sham. Before and after treatment, measurements of pressure pain threshold (PPT), pain tolerance, muscle strength (using a hand dynamometer and pinchmeter), and two-point discrimination (2PD) with an esthesiometer were conducted.

Results: Age, height, weight, body mass index, gender, and dominant extremity of the participants showed similar characteristics (p > 0.05). There was a difference hypothenar PPT (p = 0.038) and pain tolerance (p = 0.009), thenar PPT (p = 0.021) and pain tolerance (p = 0.001), mid-ulnar PPT (p = 0.028), biceps PPT (p < 0.001), pain tolerance (p < 0.001), and grip strength (p = 0.030) between the groups after the therapy. When comparison was made between the groups at baseline and after the treatment all were found to differ (p < 0.05).

Conclusions: MLD reduced PPR, pain tolerance, hand grip, and pinch strength in young adults. However, in this population, the distance felt in 2PD evaluation with MLD decreased.

Objective: In this study, it was aimed to investigate the effects of age, body mass index, and diet factors on sperm parameters and developing a novel index (Artuklu Sperm Quality Index [ASQI]).

Method: The study incorporated a total of 115 patients who sought medical attention due to infertility and underwent semen analysis (spermiogram). The ASQI score was developed.

Results: About 73% reported eating three meals daily, while 62% consume fruits a few times a week. When considering grain consumption, 30% rarely do, mirroring the 25% who never do. Carbonated drinks are consumed a few times in 15 days by 39% of respondents. Salt consumption showed 47% taking very little, whereas 42% consume caffeine very minimally. Sausage/salami is minimally consumed by 44%, and 32% of participants reported never being exposed to air pollution. ASQI score ranges from 6 to 61 point. A lower score indicates good nutrition and quality of life, while a higher score suggests deteriorating nutrition and increasing unhealthy habits. Cronbach alfa value was noted as 0.72. A negative correlation was found between ASQI and sperm progressive motility (p < 0.001, r = -0.405).

Conclusions: This study revealed a clear negative correlation between the ASQI score, which signifies deteriorating nutrition and escalating unhealthy habits, and sperm progressive motility.

Objective: The post-operative analgesic efficacy of transversalis fascia plane (TFP) block is controversial in pediatric patients undergoing herniotomy. This study aims to compare the efficacy of TFP block and standard analgesic methods.

Methods: Sixty patients aged 1-8 years who underwent the open procedure of herniotomy were randomly divided into two groups TFP block (n = 30) or control group (n = 30). The TFP group received 0.25% bupivacaine at 0.5 mL/kg. Routine analgesia protocol was applied to Group C. Pain scores (FLACC), family satisfaction, block complications, nausea, sedation score, and additional analgesic requirements were recorded.

Results: FLACC pain scores at post-anesthesia care unit (PACU), 1st, 2nd, and 4th h were statistically significantly lower in Group TFP compared to group control (p < 0.05). Three patients in Group TFP and 12 in group control required rescue analgesics at PACU (p = 0.015). Ibuprofen was required in two patients in Group TFP and 11 in Group Control (p = 0.010). Parental satisfaction is higher in the TFP group than in Group Control (p < 0.001). There was no statistically significant difference between the groups in terms of post-operative nausea and sedation scores (p > 0.05).

Conclusion: We conclude that TFP block in pediatric patients is an appropriate approach as a part of multimodal analgesia. It creates fewer pain scores in the early post-operative period, requires less additional analgesia, and increases family satisfaction.

Objective: Cisplatin (CP) toxicity causes ovarian damage by oxidative stress, inflammation and fibrosis. The aim of the present study is to investigate the possible beneficial effects of exenatide on the experimental ovarian damage model produced by CP.

Method: For 14 rats, CP was administered by intraperitoneally (i.p) twice a week for 5 weeks. No drug was administered to the remainder of rats (n = 7) (Group 0). The rats taken CP were divided into two groups. Group 1 rats (n = 7) were given 1 mL/kg/day saline i.p., and Group 2 rats (n = 7) was given with 20 μg/kg/day exenatide.

Results: The number of primordial, primary, secondary, and tertiary follicle was significantly lower in Group1 compared with Group 0 and Group 2. The ovarian fibrosis percent was significantly higher in Group 1 than Group 0 and 2. The plasma anti-Mullerian hormone value was lower in Group1compared with Group 0 and 2. Over Nuclear factor-erythroid factor 2-related factor 2 level, Over Toll-like receptor 4 level and over nucleotide-binding domain leucine-rich repeat and pyrin domain containing receptor 3 were higher in Group 1 compared with Group 0 and 2.

Conclusion: Exenatide has possible beneficial effect on ovarian damage induced by CP by anti-inflammatory actions and can be a promising candidate for ovarian damage caused by CP.