Cirugia y cirujanos最新文献

Patients with chronic liver disease of any etiology who become infected with SARS-CoV-2 have been found to have a higher risk of mortality compared to those patients who do not have chronic liver disease. A literature review was conducted in the relationship between COVID 19 and preexistence of liver disease. The proportion of COVID-19 patients with abnormal liver function on admission ranged from 40 % to 75 % and the proportion with liver injury was close to 30%. Current studies show an important association between preexisting liver disease and COVID-19. The presence of cirrhosis is now an independent predictor of severity for COVID-19 and prolonged hospitalization in this group of patients. Patients with cirrhosis have a higher mortality rate, and this rate rises with increasing severity.

Objective: Radical prostatectomy is a therapeutic option in organ-confined prostate cancer. As the development of robotic systems progresses, the approach with this technology has begun to impact the functional and oncological outcomes of urological patients. The objective is to report the rate of pentafecta in patients undergoing robot-assisted radical prostatectomy (RARP) stratified by risk groups.

Method: Retrospective, observational, descriptive study from 2013 to 2020 that included 112 patients undergoing RARP.

Results: A rate of pentafecta at 12 months of follow-up of 35.7% (n = 40) was obtained. In the subanalysis by risk groups, at 1-year follow-up, was obtained an index of 43% (n = 26), 26% (n = 9) and 22% (n = 4) in low-, intermediate-, and high-risk patients, respectively.

Conclusions: Prostatectomy showed functional and oncological results similar to those reported in the literature with robotic approach, regardless of the risk group for prostate cancer.

Objective: The study aimed to assess the predictive significance of inflammatory parameters as potential markers for malignancy in individuals with thyroid nodules.

Method: Nine hundred and ninety-one patients with thyroid nodules who had undergone thyroid fine-needle aspiration biopsy were included and classified according to the Bethesda system. Neutrophil lymphocyte ratio (NLR) and systemic immune-inflammation index (SII) values obtained from hemogram parameters were determined for each patient. The study examined the correlation between the Bethesda classification and NLR/SII levels. In addition, a comparison was made between the inflammatory parameters of the benign and malignant Bethesda groups.

Results: Five hundred and seventy-three patients were classified as Bethesda 2 (benign), 34 as Bethesda 6 (malignant). A correlation was observed between the Bethesda classification and NLR and SII levels (r: 0.230, p < 0.001; r: 0.207 p < 0.001, respectively). NLR and SII values were significantly higher in the malignant group (p < 0.001). The cutoff value for SII in predicting benign and malignant thyroid nodules was 489.86 × 10³/mm³ with a sensitivity of 88.2% and a specificity of 63.7%. The cutoff value for NLR for the same prediction was 2.06 with a sensitivity of 82.4% and a specificity of 83.4%.

Conclusions: The findings of this study indicate that SII and NLR may be valuable prognostic markers for predicting the malignancy of thyroid nodules.

Objective: The objective of the study was to explore red cell distribution width (RDW) as a surrogate marker of inflammation, alone and in conjunction with muscle wasting to predict malnutrition-related adverse outcomes.

Methods: This was a single-center observational study including adult hospitalized patients. Demographic variables, malnutrition criteria, and RDW were captured within 24 hours of hospital admission. Correlation tests and regression models were performed between these variables (RDW and muscle wasting) and adverse outcomes (in-hospital mortality and unplanned transfer to critical care areas (CCA).

Results: Five hundred and forty-five patients were included in the final analysis. Muscle wasting showed an independent association with adverse outcomes in every regression model tested. RDW alone showed fair predictive performance for both outcomes' significance and the adjusted model with muscle wasting showed association only for unplanned transfer to CCA.

Conclusion: RDW did not improve the prediction of adverse outcomes compared to muscle wasting assessed by physical examination and simple indexes for acute and chronic inflammation. Malnourished patients presented higher RDW values showing a possible metabolic profile (higher inflammation and lower muscle). It is still unknown whether nutrition support can influence RDW value over time as a response marker or if RDW can predict who may benefit the most from nutritional support.

Objective: This research aims to assess the clinical and radiological outcomes of both dynamic rod system (PLSDR) and rigid rod system (PLSRR) when treating lumbar degenerative disease (LDD).

Method: A retrospective review of 98 patients who underwent posterior stabilization surgery with a posterior approach in our clinic between 2018 and 2023 was conducted. The patients were divided into two groups based on the type of implant used: Those with PLSRR (Group 1) and those with PLSDR (Group 2).

Results: In a comparative study, Group 1 had a higher prevalence of discopathy (49% vs. 24.5%, p = 0.012). Differences in surgical operation levels existed, and notably, only Group 1 had five-level surgeries (8.2%, p = 0.033). Pfirrmann disk degeneration grades differed significantly (p < 0.001), with Group 2 mainly in Grade I (77.6% vs. 36.7% in Group 1). Stenosis (57.1% vs. 28.6%, p = 0.004) and facet hypertrophy (71.4% vs. 47%, p = 0.014) were higher in Group 1. Group 1 also showed a greater adjacent segment degeneration (ASD) incidence (81.6% vs. 51%, p = 0.001). Both groups had primarily proximal ASD degeneration (p = 0.202). Compression fractures were absent. Follow-up durations were similar (p = 0.183).

Conclusions: In treating LDD, the PLSDR shows potential advantages over PLSRR, including preservation of degeneration in adjacent segments.

Objective: The study aimed to determine the association between serum magnesium and Vitamin D levels with the severity and mortality by coronavirus disease 19 (COVID-19) in hospitalized patients.

Method: Men and women over 18 years of age with probable COVID-19 were enrolled in a case-control study. Patients with a positive or negative test for Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) were allocated into case or control groups, respectively. Vitamin D deficiency was defined by concentrations < 20 ng/mL and hypomagnesemia by serum levels < 1.8 mg/dL.

Results: A total of 54 patients, 30 women and 24 men, were enrolled and allocated into the groups with (n = 27) and without (n = 27) COVID-19. The logistic regression analysis showed that Vitamin D deficiency (odds ratio [OR] = 6.13; 95% confidence intervals [CI]: 1.32-28.34) and insufficiency (OR = 0.12; 95% CI: 0.02-0.60) are significantly associated with hospitalization. However, Vitamin D disorders and hypomagnesemia were not associated with mortality.

Conclusions: The results of the present study revealed that Vitamin D disturbances, but not hypomagnesemia, are associated with the severity of SARS-CoV-2.

Introduction: Lipomas are the most common tumors of mesenchymal origin throughout the body. Although they have low incidence in the oral cavity, they surgical approach can be challenging.

Case report: 10-year-old male with a giant lipoma in the buccal and masticator space, an intraoral surgical approach was chosen using by modifying trident technique of Ramírez-Oropeza.

Discussion: The main advantages and limitations of this intraoral approach are examined.

Conclusions: An intraoral approach was selected because of less possibility of injuring the facial nerve, better esthetic results and less invasive, obtaining excellent results.

Objective: The study aimed to investigate whether 3D-printed titanium implants modified with magnesium and zinc ion surfaces can promote oral soft-tissue closure.

Method: New Zealand Great White rabbits were selected as experimental animals, and the left and right side mandibular teeth of each animal were randomly divided into an experimental group and control group, each with 18 cases, and the bilateral first premolar teeth were extracted after general anesthesia, and implants were implanted into the magnesium/zinc ionized surface-treated and the surface-untreated groups, respectively.

Results: Under naked-eye observation, the combination of implant material and surrounding soft tissue in the experimental group was significantly better than that in the control group; fluorescence staining showed that the fluorescence density value of the experimental group was significantly higher than that of the control group (p < 0.05).

Conclusions: 3D-printed titanium implants based on magnesium-zinc ion surface modification promote oral soft-tissue closure with significant results.

Objective: To compare visual acuity, refraction, Schirmer test, tear break-up time (TBUT), esthesiometry, optical quality, higher order aberrations and posterior corneal elevation measurements before and after small-incision lenticule extraction (SMILE) and femtosecond laser-assisted in situ keratomileusis (FS-LASIK).

Method: Paired eye, randomized, cohort study. Follow-up was performed at days 1 and 7, and at months 1, 3, 6 and 12.

Results: Forty-two eyes were enrolled in the study. Over time, a difference in posterior corneal elevation was statistically significant (p < 0.01) with a greater change in patients treated with SMILE. There was no difference in corrected distance visual acuity and uncorrected distance visual acuity and cylinder between the two techniques; however, there was a statistical significant difference in spherical error and spherical equivalent (p < 0.01). There was no difference between the eyes with FS-LASIK and SMILE in the assessment regarding the TBUT, the Schirmer test and esthesiometry.

Conclusions: SMILE showed more changes in the posterior elevation with a progressive backward shift throughout time during follow-up. SMILE and FS-LASIK provides similar results in myopic patients regarding visual acuity, refraction, Schirmer test, TBUT and esthesiometry.

Objective: The study aimed to evaluate three different degrees of correction in the surgical treatment of neglected developmental dysplasia of the hip (DDH) using finite element models based on computed tomography.

Method: Three tridimensional FEA models of hypothetical post-operative (PO) outcomes were developed, based on three tridimensional CT of a pediatric patient diagnosed with luxated neglected DDH: One with the acetabular index of the contralateral hip (CLAT); another based on a theoretical Bombelli biomechanical model (BMB); and another recreating the patient's actual PO.

Results: The stresses in the affected hip were greater than those in the unaffected hip. CLAT showed the greatest stress and the smallest loading zone (LZ). In contrast, BMB showed the smallest stress and the biggest LZs.

Conclusions: The approach based on the BMB gave the best results in terms of the distribution of the stresses over the hip, whereas the worst was CLAT. Qualitatively, estimating the stability and range of movement of the hip, the PO case was considered the best.