Cirugia y cirujanos最新文献

Objective: Analyzing global research trends on osteochondroma to reveal insights into scientific focus, collaboration, and direction.

Methods: Articles from WOS database were analyzed based on citation counts, titles, authors, journals, years, and countries using tools such as CiteSpace, Bibliometrix, and VOSviewer.

Results: Analysis of 1588 publications from 593 journals and 7067 authors across 83 countries shows the USA published the most articles (335, 21.1%) followed by China (200, 12.1%). Leiden University had 79 publications, and Hogendoorn PCW contributed 24 (H index 19). Flemming DJ, Kransdorf MJ, and Murphey MD each received 314 local citations. Cureus Journal of Medical Science published 37 papers, while Skeletal Radiology had 33. The Journal of Bone and Joint Surgery leads in local citations with 1,339. The most influential reference is Murphey MD, 2000, Radiographic. Keywords such as solitary osteochondroma and hereditary exostoses experienced citation bursts. Thematic maps indicate gaps in the literature on lesser-researched keywords such as expression and heparan sulfate, underscoring the need for more genetic research.

Conclusions: This analysis provides an overview of key articles on osteochondromas, highlighting trends and contributions that address literature gaps and guide future research.

Objective: To develop personalized 3D-printed testicular prostheses using polypropylene (PP) that closely mimic natural testicles in size, shape, and particularly weight.

Methods: Clinical data from two testicular resection patients were analyzed. Reference testicular density (0.99 g/mL) was derived from three specimens (mean weight: 6.67 g, volume: 6.70 mL). Target prostheses (volume: 16.75 cm³, weight: 16.58 g) were modeled through magnetic resonance imaging/computed tomography scans using SolidWorks/Mimics and printed with PP filament on a Bambu X1-Carbon printer. Comparative experiments with polylactic acid (PLA) included power analysis (Pass21 software) to determine a sample size of 14 (seven per group). Weight and density were compared using independent and single-sample t-tests, respectively.

Results: Out of five printing trials, three yielded successful PP prostheses with optimized parameters, whereas two failed due to inadequate supports or material overflow. Among the two groups, PP prostheses exhibited a mean weight of 15.41 ± 1.53 g (vs. target: 16.58 g), whereas PLA prostheses were significantly heavier (19.95 ± 0.93 g, p < 0.001). PP density (0.98 ± 0.01 g/mL) closely matched reference testicles (p = 0.062), whereas PLA density (1.23 ± 0.01 g/mL) deviated significantly (p < 0.001).

Conclusions: 3D printing with PP could enable the creation of personalized testicular prostheses that meet clinical needs for size, shape, and particularly weight, potentially improving patient satisfaction.

Objective: To evaluate the care process in the rehabilitation of patients with sequelae of language, speech and swallowing, secondary to cerebrovascular disease, in a third-level hospital in Mexico.

Methods: Retrospective and descriptive study. Sociodemographic and clinical characteristics were obtained from 233 records of patients with sequelae of language, speech and swallowing, secondary to cerebrovascular disease, who received therapy. A descriptive analysis was performed; χ2 and Wilcoxon tests were used to assess differences before and after therapy. Three indicators were created to evaluate and identify the factors that participated in the rehabilitation process of the patients.

Results: A significant difference was found in the affected structure and level of disability in function, activity and participation categories between the initial and final evaluation. The quality indicators showed the beginning of rehabilitation at 8.9 months, elaboration of the work program in the first two weeks in 90.1% of cases and revaluation by the medical area at 6 effective months of therapy in 81.1%.

Conclusions: The care process shows opportunities for improvement. The most important corresponds to the time that passes for the patient to start rehabilitation. Therapeutic intervention decreases the degree of disability.

Objective: To describe the auditory function in a sample of patients with ankylosing spondylitis and to determine the conditional probability of occurrence among variables related to auditory characteristics through joint probability analysis.

Methods: This was a cross-sectional and descriptive study. Sociodemographic and auditory characteristics were collected from 49 patients. Descriptive analysis and probabilistic intersection analysis were conducted to determine the joint probability between variables.

Results: Superficial hearing loss was observed in 22.4%, a decline in high frequencies in 20.4%, a sensorineural hearing loss pattern in 47% of right ears and 49% of left ears, As-type tympanograms in 49% of right ears and 57.1% of left ears, and absence of ipsilateral stapedius reflexes (predominantly in the left ear) in 55.1%. Transient otoacoustic emissions exhibited inadequate reproducibility, particularly 4000 and 1000 Hz, in both ears, with tinnitus being the most common audiovestibular symptom (36.7%). The joint probability that a patient is male, has ankylosing spondylitis with 10 years of disease progression, and presents a sensorineural hearing loss pattern in either the right or left ear, is 27.7%.

Conclusions: Sensorineural hearing loss is highly prevalent among patients with ankylosing spondylitis. The duration of the disease is a significant factor influencing the presentation of hearing loss and audiovestibular symptoms.

Objective: This study aimed to evaluate whether the pelvic index/mesorectal length (PI/ML) ratio is an effective factor in recurrence, anastomotic leakage, mesorectal excision status, and low anterior resection syndrome (LARS) development in rectal cancer patients undergoing total mesorectal excision.

Methods: A total of 47 patients who underwent surgery for rectal cancer between January 2016 and December 2021 were included. Demographics, clinical data, and pre-operative PI measurements were recorded. Post-operative LARS was assessed using the LARS questionnaire in patients followed for at least 12 months.

Results: A significant association was found between PI/ML ratio and tumor recurrence (p < 0.0001). Receiver operating characteristic analysis identified a cutoff value of PI/ML < 1.6 for predicting tumor recurrence, with 100% sensitivity and 84.6% specificity. After applying Bonferroni correction for multiple comparisons (n = 4, adjusted significance threshold p < 0.0125), this association remained statistically significant. The association between PI/ML ratio and anastomotic leakage (cutoff < 2.15; sensitivity 100%, specificity 53.7%) showed marginal significance (p = 0.009). No significant association was found between PI/ML ratio and LARS or mesorectal excision status after correction.

Conclusions: PI/ML ratio appears to be a useful predictor for tumor recurrence and may help identify patients at risk for anastomotic leakage in rectal cancer surgery. However, this ratio was not significantly associated with the development of LARS. Further research with larger cohorts is needed to validate these findings and clarify the potential prognostic value of the ratio.

Objective: The objective of the study was to study the strategy of one-stage emergency treatment of open Pilon fracture with the concept of accelerated rehabilitation surgery.

Methods: The data of 18 patients with open Pilon fracture treated by first-stage emergency debridement, fracture internal fixation, bone grafting, negative pressure closed drainage covering the wound, leg incision reduction, and second-stage skin grafting or flap transfer in the Department of Orthopedics of our hospital from January 2014 to December 2018 were retrospectively analyzed. Joint surface reduction was evaluated by radiological evaluation criteria such as Burwell-Charnley, fracture healing quality was evaluated by Merchant score, and ankle joint function was evaluated by Tornetta and other criteria at the last follow-up.

Results: All 18 patients were followed up, and the anatomical reduction rate was 94% (17/18) according to radiological evaluation criteria such as Burwell-Charnley. According to Merchant scoring criteria, the fracture healing rate was 83.3% (15/18). At the last follow-up, the ankle function was evaluated according to Tornetta and other criteria, and the excellent rate was 88.9% (16/18).

Conclusions: Using the concept of accelerated rehabilitation surgery to treat open Pilon fractures in the first emergency can effectively avoid soft-tissue complications and is an effective treatment strategy.

Objective: The prevalence of cholelithiasis in Mexico is high, and cholecystectomy is a very frequent procedure where antimicrobials are employed, being important to sample and culture the bile fluid to identify local susceptibility to antibiotics to avoid complications and reduce antimicrobial resistance.

Methods: An observational, cross-sectional, prospective study was designed to identify bile fluid flora in patients undergoing cholecystectomy in a secondary-care teaching hospital with identification, sensitivity, and antimicrobial resistance testing.

Results: There were 60 patients (47 female and 13 male), which yielded 15 cases with bactibilia. Bacterial identification was Enterococcus faecalis in 6 cases (40%), Escherichia coli in 5 cases (33.3%), Klebsiella pneumoniae in 2 cases (13.3%), and Raoutella planticola and Streptococcus infantarius, each in one patient. E. faecalis, E. coli, R. planticola, and S. infantarius were mostly sensitive to quinolones, whereas K. Pneumoniae was sensitive to carbapenems and tigecycline. Resistance occurred for ampicillin, benzylpenicillin, and trimethoprim/sulfamethoxazole.

Conclusion: Based on our local microbial findings, it is proposed that in cases of acute biliary pathology in patients above the seventh decade of life, empirical antibiotic prophylaxis be used and a bile fluid sample be taken before starting gallbladder dissection, for later adjustment of antibiotic therapy.

Objective: Skeletal muscle ion channelopathies are a rare genetically inherited orphan disease. Due to the unique characteristics of the symptoms of the disease, misdiagnosis of patients leads to irreversible losses. This study aims to raise awareness on this issue.

Methods: 35 patients with a definitive diagnosis of skeletal muscle ion channelopathy were included in the study. The diagnoses of all patients were confirmed by gene analysis. Demographic and clinical characteristics of the patients were examined. After a definitive diagnosis was made, mimic symptoms and misdiagnoses were evaluated separately.

Results: It was determined that 30 of the patients included in the study had multiple different diagnoses until they got the correct diagnosis. It is thought that due to delayed diagnosis or misdiagnosis, patients experience physical and mental loss, are exposed to ineffective drugs, and their daily lives are adversely affected, as well as serious cost losses.

Conclusions: It is stated that the names of misdiagnoses for imitation symptoms have changed with aging, and drug treatments are applied for each diagnosis. It is stated that health authorities should pay attention to this situation to reduce this.

Objective: Herein, we identified risk factors (RFs) for post-operative pancreatitis among elderly sufferers of choledocholithiasis undergoing endoscopic retrograde cholangiopancreatography (ERCP) along with endoscopic sphincterotomy (EST), and to develop a predictive model for pancreatitis occurrence.

Methods: We retrospectively collected clinical data of elderly patients (≥ 65 years old) with choledocholithiasis undergoing ERCP+EST at Affiliated Liupanshui Hospital of Zunyi Medical University from January 2017 to April 2024. Participants were stratified into pancreatitis and non-pancreatitis cohorts according to their post-operative outcomes.

Results: Using multivariate analysis, we determined stand-along RFs for post-operative acute pancreatitis as follows: Age under 75 years, a history of acute pancreatitis, pancreatography, difficult intubation, and multiple guidewire insertions into the pancreatic duct (p < 0.05). The area under the curve of the predictive model was 0.783 (95% confidence interval: 0.705-0.862), indicating good predictive capability. Calibration curves showed consistency between predicted risks and observed outcomes (Hosmer-Lemeshow test, p > 0.05). Clinical decision curves demonstrated the model's clinical utility.

Conclusions: In elderly patients with choledocholithiasis, factors such as younger age (under 75), history of acute pancreatitis, challenging intubation, pancreatography, and multiple guidewire insertions into the pancreatic duct are significant RFs for post-ERCP pancreatitis.

Objective: To investigate the different impacts of neoadjuvant chemotherapy (NCT) and neoadjuvant chemoradiotherapy (NCRT) on anastomotic leakage after esophageal cancer resection.

Methods: The data of three clinical studies (222 patients) launched were retrospectively collected, including 113 patients in the NCRT group and 109 patients in the NCT group. The NCT group received platinum-based doublet chemotherapy once every 3-4 weeks, whereas the NCRT group received platinum-based doublet chemotherapy weekly (taxane-containing regimen) or once every 3-4 weeks (5-Fu-containing regimen) concurrently with thoracic radiotherapy. After neoadjuvant therapy, all patients underwent Ivor-Lewis or McKeown esophagectomy. The study compared the pathologic complete remission (pCR) rate, 30-day post-operative mortality rate, incidence of anastomotic leakage, post-operative complications, and survival rates between the two groups.

Results: The pCR rate, 30-day post-operative mortality rate, and the incidence of anastomotic leakage were 39.8% versus 5.5% (p < 0.001), 2.7% versus 0% (p = 0.043), and 28.3% versus 5.5% (p < 0.001) in the NCRT group and NCT group, respectively. Multivariate analysis showed that only NCRT significantly increased the incidence of anastomotic leakage (odds ratio 7.28, 95% confidence interval 2.44-21.78, p < 0.001).

Conclusion: The results show that NCRT can improve the pathological response rate but will increase the incidence of anastomotic leakage. Radiation dose-volume parameters were not associated with anastomotic leakage risk.