Cirugia y cirujanos最新文献

Congenital tracheal stenosis is an entity that causes acute airway obstruction and is associated with high morbidity and mortality due to diagnostic delay and its accompanying comorbidity. Slide tracheoplasty is the procedure of choice that traditionally requires the use of cardiopulmonary bypass to facilitate the tracheal reconstruction technique. There are no national reports of this tracheoplasty. With a modification to the original description, the surgical technique is described and a case report executed without the use of cardiopulmonary bypass. A review of the literature is proposed to guide the comprehensive approach and treatment.

Objective: The study aimed at analyzing the effect of Shenqi Fuzheng Decoction directional penetration for treating advanced lung cancer patients with cancer-related pain.

Method: Eighty-six cases with advanced lung cancer received in Zhoushan Hospital of Traditional Chinese Medicine from June 2022 to June 2023 were divided randomly into a study group (n = 43) and control group (n = 43). Two groups were treated with the same conservative treatment plan, on the basis of which the control group treated with placebo, and study group received Shenqi Fuzheng Decoction directional penetration treatment. The cancer-related pain intensity, analgesic onset time, the frequency of pain outbreak, and analgesic duration were assessed and recorded. Before and after treatment, the cancer-related fatigue, quality of life, and Karnofsky Performance Status (KPS) score were assessed in two groups. Moreover, the adverse reactions of two groups during treatment were recorded.

Results: Compared to the control group, the cancer-related pain intensity of the study group was reduced, the analgesic onset time was shortened, the frequency of pain outbreak was reduced, and the analgesic duration was prolonged (p < 0.05). After treatment, Piper Fatigue Scale (PFS) scores in the study group were lower than the control group, and the generic quality of life inventory-74 (GQOLI-74) and KPS scores in the study group were higher than the control group (p < 0.05). During the treatment period, no significant adverse reactions were observed in both groups (p > 0.05).

Conclusion: Shenqi Fuzheng Decoction directional penetration treatment has a remarkable effect in advanced lung cancer patients with cancer pain, which can relief the pain intensity, prolong the duration of pain relief, reduce the number of pain attacks, relieve patients' cancer-related fatigue, and improve patients' life quality and health status.

Objective: We evaluated the long-term clinical and radiographic outcomes of femoral valgus extension osteotomy combined tectoplasty in Herring group C Perthes disease patients with hinge abduction.

Method: A total of 13 patients underwent this procedure between 2002 and 2009. In this retrospective study, all patients were classified as Herring group C. The mean age at diagnosis was 8.6 ± 2.2 years. The mean age at surgery was 9.3 ± 1.7 years. The mean age at the most recent follow-up was 23.3 years (range 19-29 years). All patients were followed at least 11.5 years after surgery.

Results: All patients had hinge abduction deformity preoperatively. The mean Harris hip score improved from 70.23 ± 10.43 points preoperatively to 91.76 ± 7.25 points at the final follow-up. No patient had a limping gait at the final follow-up. The pre-operative visual analog scale score was 7.84 ± 0.22, and the last follow-up was 1.03 ± 0.25 (p < 0.001). According to the Stulberg classification, good radiological outcomes were obtained in 7 hips, whereas fair or poor outcomes were noted in 6 hips.

Conclusions: In severely affected hips of Perthes, patients who underwent femoral valgus extension osteotomy combined tectoplasty revealed satisfactory long-term clinical and radiological outcomes.

Objective: In sedation practices, respiratory monitoring, particularly for endoscopic procedures, remains crucial due to the risk of respiratory complications. Despite standard monitoring recommendations, significant hypoventilation may occur, leading to adverse events. Integrated pulmonary index^® (IPI) offers comprehensive respiratory status assessment, yet its utility in endoscopic sedation remains unclear.

Methods: A prospective, double-blind, randomized controlled trial was conducted at Kartal City Hospital between July and September 2022. Patients aged 18-80 undergoing endoscopic procedures were randomized into standard monitoring (Group 1) or capnography with IPI monitoring (Group 2). Both groups received standard monitoring, whereas Group 2 additionally had capnography monitoring.

Results: Of the 200 patients included, no significant differences were observed in demographics or procedure types between groups. Apnea duration was significantly lower in Group 2 (IPI group). Group 2 showed higher peripheral oxygen saturation (SpO₂) and IPI values at specific intervals compared to Group 1. However, the occurrence of apnea did not significantly differ between groups.

Conclusion: While capnography with IPI monitoring showed advantages in reducing apnea duration and maintaining higher SpO₂ levels, these differences were not clinically significant. Capnography's role as an adjunct to standard monitoring in preventing respiratory complications during endoscopic procedures needs further evaluation, considering its cost implications.

Objective: The aim of this study was to present our clinical experience in patients undergoing subcutaneous venous port catheter (SVPC) placement through subclavian vein for chemotherapy.

Methods: We retrospectively investigated 770 patients undergoing SVPC placement. Two different catheters were used (polyurethane [n = 100, 13%] and silicone [n = 670, 87%]). Port reservoir (PR) was placed by removing subcutaneous fatty tissue equivalent to the resevoir size (n = 220, 29%), or buried directly under fatty tissue (n = 550, 71%). Results and complications according to catheter types and placement techniques were investigated.

Results: There were 59 complications (7.7%). Port-site infection and wound dehiscence were higher when the reservoir was placed after removing subcutaneous fatty tissue (p < 0.05). Port-site infection, wound dehiscence, subclavian vein thrombosis, and catheter occlusion were common in polyurethane catheters (p < 0.05). Of 192 patients who were followed-up (mean 18 months), SVPC was removed in 25% due to the death of the patients (n = 100), completion of treatment (n = 87), and development of complication (n = 5).

Conclusion: During SVPC insertion, the placement of PR under the adipose tissue and preferring silicone catheters may reduce the complication rates.

Objective: Our aim was to examine the effectiveness of human breast milk exosomes in treating testicular torsion.

Methods: Rats were divided randomly into three equal groups. Group 1 was our control group. A torsion/detorsion model was created for the rats in Group 2. After the torsion/detorsion model, 1 mg/kg intraperitoneally human breast milk exosomes were given 30 min before detorsion in Group 3. All testicles were removed at the 6^th h of the experiment, for biochemical and histopathological examination.

Results: There was a statistically significant decrease in Group 3 MDA values compared to Group 2. When Group 3 and Group 2 SOD and CAT values were compared, it was seen that these values were higher in Group 3. Histopathologically a statistically significant difference was found in Group 3 compared to Group 1 and Group 2 in terms of ischemia/reperfusion injury.

Conclusion: We have shown that human breast milk exosomes in testicular torsion do not completely prevent reperfusion injury but significantly preserve testicular tissue.

This review outlines the role of regenerative medicine in surgical applications, focusing on stem cells and exosomes. Among the most important features of stem cells are their unique ability to differentiate into various cell types, which make them stand out in regeneration and repair. Recent advances highlight the effectiveness of not only these cells themselves but also the exosomes, the nano-sized extracellular vesicles they produce, in this regeneration. On the other hand, exosomes assure additional advantages concerning low immunogenicity and high bioavailability but have raised problems in standardization and safety. In fact, the introduction of these stem cell and exosome technologies is changing the management of surgical pathologies and offering hope for diseases hitherto considered incurable. In this review, the use of stem cell therapies in various surgical diseases is categorized and examined, their clinical importance is emphasized, and the deficiencies in research studies are indicated. Therefore, the results are promising for treatments, but more standardized protocols and expanded research on long-term safety and effectiveness are needed.

Objectives: The objective of the study was to assess the role of complete blood count (CBC) parameters in the detection of acute appendicitis (AA) severity in children and adults.

Method: This is a retrospective analytic cross-sectional study on cases operated for AA between June 1, 2020, and February 28, 2021, in Salmaniya Medical Complex, Bahrain. Patients of all ages and genders were included in the study. Exclusion criteria included other appendiceal pathologies, the presence of another intraoperative pathology that is the likely cause of abdominal pain, normal appendix, and missing parameters. Data included patient demographics, CBC parameters, and histopathology. Patients were divided into groups based on age and severity of AA.

Results: A total of 569 patients were included in the study. Ages ranged from 4 to 75 years. Majority of the patients were males (74.87%) and adults (89.81%). A quarter of the patients were diagnosed with complicated AA, while the rest had simple AA. A statistically significant difference was observed between adults with complicated and simple AA in white blood cell (WBC), absolute neutrophil count (ANC), absolute lymphocyte count (ALC), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR). None of the parameters was statistically significant in children.

Conclusion: WBC, ANC, ALC, NLR, and PLR can be useful parameters in the discrimination between complicated and simple AA in adults. PLR was found to be the least predictive.