Cirugia y cirujanos最新文献

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: Our study aims to explore the predictive value of the hemoglobin, albumin, lymphocyte, and platelet (HALP) score, calculated from routine blood tests measuring HALP levels, for perioperative morbidity in rectal cancer surgery patients.

Method: We conducted a retrospective study focusing on patients who underwent elective rectal cancer surgery from January 2017 to September 2023. The study analyzed demographic, clinical, and laboratory data, including the HALP score, to assess its correlation with perioperative morbidity using logistic and linear regression analyses.

Results: Univariate analysis showed no correlation between the HALP score and perioperative morbidity. Intriguingly, an increase of each centimeter in tumor size was associated with a significant reduction in the HALP score (p = 0.042), and operation time exhibited an inverse relationship with HALP scores (p < 0.001). Further, our study identified sex (male, p = 0.017) and age (> 65, p = 0.016) as significant predictors of perioperative morbidity.

Conclusions: Our study found that pre-operative HALP scores did not significantly predict perioperative morbidity or local recurrence in rectal cancer surgery, challenging their presumed prognostic value. However, a notable association was observed between higher HALP scores, reduced tumor size, and shorter operative times, suggesting a potential indirect relationship of HALP in surgical outcomes.

Objective: Survival in lung transplantation (LT) may be influenced by recipient-related variables, donor factors, donor-recipient interaction, surgical approach, and medical center expertise. The objective of this study was to describe the sociodemographic, clinical characteristics, and survival of patients who have undergone LT.

Method: We conducted an observational analysis between 2014 and 2022. Survival was calculated using the Kaplan-Meier method at the 1^st, 3^rd, and 5^th years of follow-up post-transplantation.

Results: We analyzed data from 50 subjects, of whom 56% (28/50) were men, with a median age of 54 years (interquartile range: 39-59). The unadjusted survival rates post lung transplantation were 81.4% at 12-months, 65.8% at 3-years, and 53.6% at 5-years. Excluding mortality attributed to COVID-19, survival rates were 78.2% at 12-months, 68.8% at 3-years, and 63.5% at 5-years. The survival of pulmonary fibrosis with a non-usual interstitial pneumonia (N-UIP) pattern was 85% at 1 year and 54% at 5 years, while pulmonary fibrosis with a usual interstitial pneumonia (UIP) pattern demonstrated a solid survival rate of 80% at 1 year and 60% at 5 years.

Conclusions: Patients with pulmonary fibrosis with a N-UIP pattern demonstrated superior survival after 1 year of follow-up, while those with pulmonary fibrosis with a UIP pattern described the highest survival at the 5^th year. COVID-19 decreased long-term survival in transplant patients.

Objective: To assess the pluripotency profile of human mesenchymal stem cells (hMSCs) as influenced by delivery mode and obstetric-gynecological background.

Methods: Thirty-nine placentas were included. A fragment of the AM (5 cm) was utilized to obtain the AM-hMSCs. The cell cultures were monitored until 90% confluence, before carrying out expansion (passages). The cultures, cell morphology, adhesion, immunophenotyping characterization, and differentiation capacity were evaluated and compared with hMSC from bone marrow (BM-hMSC). T-student and Mann-Whitney U tests were carried out. Statistical significance was set at a p < 0.05.

Results: No differences were observed in the proliferation and expansion of AM-hMSC obtained by vaginal or cesarean delivery route. Similar results were observed in the immunological characterization; however, CD105 was significantly lower compared with BM-hMSC. Nevertheless, cells from vaginal or cesarean delivery route showed great differentiation capacity to adipogenic, chondrogenic, and osteogenic lineages.

Conclusions: The delivery route, clinical data, and obstetric and gynecologic histories are no limitations for using the AM to obtain hMSC and its possible application in Regenerative Medicine.

Objective: We aimed to investigate the changes in renal aquaporins (AQP) of rats in renal ischemia-reperfusion (I/R) injury and the protective effects of caffeic acid phenethyl ester (CAPE) against these changes.

Methods: Forty-five adult rats were divided into six groups: control, sham (right nephrectomy), I/R (right nephrectomy + left kidney I/R), I/R+CAPE (I/R procedure after i.p. CAPE), sham + CAPE, and sham + dimethyl sulfoxide. Blood urea nitrogen, Cr, and K⁺ levels were measured in the sera. Tissues were stained with hematoxylin and eosin for histopathological examination. For immunohistochemical analysis, AQP2 was applied using the streptavidin/biotin/peroxidase system. AQP2 gene expression in kidney tissues was examined by polymerase chain reaction (PCR).

Results: In the I/R, congestion, inflammation, and necrosis were found to increase compared to the control. In the I/R+CAPE, improvement was observed in necrosis compared to the I/R. There was a decrease in AQP2 expression in the I/R. In PCR, no significant difference was observed in AQP2 gene expression between the I/R and control and between the I/R+CAPE and I/R.

Conclusion: Renal I/R inhibits the production of AQP2 in the kidney and causes histological and biochemical damage. CAPE administration before I/R has a protective effect on the kidney.

Objective: Integrated pulmonary index (IPI^™) is a device working with fuzzy logic principle that analyzes patient's end-tidal carbon dioxide (ETCO2), respiratory rate (RR), peripheral oxygen saturation (SpO2), and pulse rate and provides a number between 1 and 10. We aimed to investigate the usefulness of IPI monitor in pediatric patients.

Methods: After the Investigational Review Board approval pediatric patients undergoing gastrointestinal endoscopy under sedation were recruited. Propofol (Group P) and ketamine (Group K) were used for sedation. The primary outcome measure was average periprocedural IPI values. Secondary outcome measures were recovery time, endoscopist, and anesthetist satisfactions. Correlation of IPI values with physiological parameters was examined as well.

Results: Periprocedural IPI scores were comparable between the groups (6.3 [4.9-7] vs. 6.8 [5.3-7.6] in Group P and Group K, respectively, p = 0.153). Recovery time was significantly longer in Group K (p < 0.001). Endoscopist and anesthetist satisfaction scores were comparable. Low IPI scores were significantly associated with low ETCO2, RR, and SpO2 values (p < 0.001).

Conclusions: IPI monitor is a valuable tool in the monitorization of the pediatric patients undergoing sedation with propofol and ketamine. Both drugs are associated with comparable IPI scores. ETCO2, RR, and SpO2 values are measured lower in patients with low IPI scores (1-3 points).

Objective: We aimed to evaluate the role of attenuation values of perirenal fat calculated by computed tomography (CT) in differentiating aggressive renal masses.

Methods: The data of 83 patients with histologically confirmed local stage renal cell carcinoma (RCC), who were treated with nephrectomy in our center, and 78 control group cases were analyzed. All measurements including renal mass volume, abdominal subcutaneous fat area and subcutaneous fat area pelvic subcutaneous fat area, and perirenal fat thickness and Hounsfield unit (perirenal fat tissue thickness [PFT]-hounsfield unit of perirenal fat [PFHU]) were performed on CT by the same radiologist.

Results: In the statistical analysis of PFT and PFHU measurements between the groups, fat thickness was found to be lower in the patient group compared with the control group. However, hounsfield unit measurements were statistically significantly higher in the patient group (p < 0.0001). A cutoff value of -98.1 for the PFHU can identify the patient group with a sensitivity of 89.2% and a specificity of 84.6% (area under the curve = 0.9; 95% confidence interval: 0.86-0.95 p < 0.0001). In the multivariate logistic regression analysis, a PFHU ≥ -98.1 was independently associated with RCC after accounting for clinical and radiologic parameters.

Conclusion: We believe that measurement of the HU values of perirenal adipose tissue with the CT may be useful in differentiating aggressive renal masses and therefore in determining the appropriate treatment selection.