Cirugia y cirujanos最新文献

Objective: The objective of this study was to determine whether there is a change in feto-maternal circulation after amniocentesis (AS) using Doppler ultrasonography.

Methods: In this prospectively designed study, fetuses with singleton pregnancies between 16 and 22 weeks of gestational age with an indication for invasive testing and a healthy AS result were included. Twin pregnancies, fetuses with major anomalies as determined by ultrasound evaluation, and fetuses with chromosomal or genetic diseases resulting from AS were excluded from the study.

Results: A total of 73 patients who underwent AS according to the risky screening result were included in the study. Fetal Doppler measurements were performed at three different time periods. The parameters that were analyzed included the fetal umbilical artery, the ductus venosus, and the maternal right and left uterine arteries. The analysis revealed no statistically significant differences between the measurements.

Conclusions: It has been observed that AS, the most commonly used invasive diagnostic procedure in clinical practice, does not affect feto-maternal circulation and fetal heart function.

Objectives: The difference between mean arterial pressure (MAP) before cardiopulmonary bypass (CPB) and mean perfusion pressure (MPP) during CPB is thought to be a strong predictor of acute kidney injury (AKI). In this study, we aimed to evaluate whether the difference between MAP and MPP is a good index to predict the development of AKI and what the ideal MPP should be during CPB.

Methods: A total of 296 consecutive patients were included in this retrospective study. MAP-MPP differences of patients who developed AKI and those who did not develop AKI according to standard guidelines and their relation with adverse outcomes were evaluated.

Results: MAP values of patients who did not develop AKI and patients who developed AKI were higher in the group with AKI, 67.60 mmHg versus 64.84 mmHg (p = 0.001). The MAP-MPP difference was 5.07 in the group without AKI and 9.44 in the group with AKI (p = 0.000).

Conclusion: We found that the difference between MAP and MPP is a good index for predicting the development of CPB-related AKI and poor outcomes. We also suggest that patients' preoperative arterial blood pressure should be taken into account for an ideal MPP.

Objective: COVID-19 pandemic produced a deficit situation of intensive care units (ICU) beds. To optimize resources, the post-anesthetic resuscitation units and operating rooms were initially used in order to care for these patients, due to their equipment and personnel. This meant a significant surgical suspension. To avoid this, during the second wave, our hospital transformed the major ambulatory surgery unit into a critical care unit. The main objective is to develop the processes carried out in our hospital for this adaptation.

Method: Cross-sectional study developed according to STROBE that exposes the processes carried out for this transformation. We include logistical adaptations, number of patients attended/stays won and the staff with which the unit was equipped. The information was provided by management and the admission and clinical documentation service. Improvement surveys are included.

Results: A total of 44 patients undergoing mechanical ventilation without cessation of surgical activity were achieved at the time of maximum occupancy. The total number of stays won from 01/03/2020 to 31/12/2020 was 755.

Conclusions: The transformation of the major ambulatory surgery unit into an ICU quickly increased the capacity of critical care beds without relenting surgical activity. This transformation process is completely reversible.

Objective: The aim is to share our surgical approaches for the removal of aneurysmatic dilatation by preserving the vascular access pathway in aneurysmatic arteriovenous fistulas (AVF).

Methods: This study includes patients were admitted between September 2017 and May 2022 and were found to have true aneurysms in their upper extremity AVF. Patients were treated with partial aneurysmectomy combined with aneurysmorrhaphy or autologous vein graft interposition after total aneurysmectomy.

Results: Six patients who underwent aneurysmoraphy after partial aneurysmectomy were named Group I. The mean age of the patients was 49, and the aneurysm diameter was 4.1 cm. 14 patients who underwent autologous vein interposition after aneurysmectomy were named Group II. The mean age of the patients was 58, and the aneurysm diameter was 4.4 cm. 13 patients met the need for hemodialysis with new AVF within 31 days (± 4-11 days). Due to the detection of insufficient post-operative flow in 1 patient (flow rate 180-200 mL/min) was taken to dialysis with alternative accesses.

Conclusion: In AVF aneurysms, it is possible to save the vascular access path with surgical treatments applied under elective conditions.