Cirugia y cirujanos最新文献

Background: Endometrial cancer is the fourth gynecologic cancer with the highest incidence and mortality worldwide. In Mexico it holds the second place with 5,500 new cases and 1,100 deaths and constitutes an important public health issue.

Objective: To develop recommendations for the diagnosis and management of endometrial cancer from an interinstitutional perspective of the Mexican health system.

Methods: The consensus was performed through a modified Delphi panel. A committee of oncologists defined 10 specific subjects to be discussed by the work groups of experts with professional experience in the management of endometrial cancer. The consensus was performed in-person by voting to decide if a recommendation was adequate for inclusion in the present report, with an agreement cut-off point of 80%.

Results: Consensus was obtained in 33 recommendations based on the identified evidence evaluated by the experts who reached a formal consensus on the final draft of all clinical recommendations.

Conclusions: The present guideline provides clinical recommendations for the diagnosis and management of endometrial cancer, contributing to the quality of care in patients with endometrial cancer in Mexico.

Objective: To compare the accuracy of four biomarkers as predictors of post-appendectomy abdominal abscess (PAA).

Methods: Diagnostic study of patients under 15 years of age operated for appendicitis in a pediatric hospital between 2010 and 2022 was analyzed. Neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), C-reactive protein (CRP) and procalcitonin (PCT) were compared between patients with PAA and those without such complication (NPAA).

Results: 86 patients with PAA (64% men; mean age: 9.4 ± 3.5 years) and 91 patients NPAA (65% men; mean age: 10.2 ± 2.9 years) were included. NLR, PLR, CRP and PCT values were higher in the PAA group than in the NPAA group (p < 0.0001). PCT had the highest area under the ROC curve (0.761), a cutoff point of 0.37, sensitivity 74%, specificity 75%, and positive predictive value of 74% for predicting the occurrence of PAA.

Conclusions: PCT is a good predictor of abdominal abscess after appendectomy. Considering preoperative PCT values to optimize postoperative management and antibiotics could be an additional tool in the prevention of this complication.

Objective: Reasons such as difficulty in payment, long waiting times, and the distance from health institutions and health-care needs of individuals may not be met. This study aims to determine the prevalence of health needs consisting of medical care, dental care, and prescribed drugs that are not met due to insolvency in Turkey and to evaluate whether features such as gender, age, education status, marital status, employment status, perceived health status, chronic disease status, and health insurance status affect these unmet health needs.

Methods: The study data consist of the Turkey Health Survey dataset conducted in 2019 on a sample determined in the Turkish population by the Turkish Statistical Institute.

Results: As a result of the analyzes carried out, it was found that the participants who were under 65 years of age, had a low level of education, had a poor perceived health status, had a chronic disease, were not covered by social security, were married, divorced and widowed had high medical care, dental care and prescribed medication needs that could not be met due to insolvency.

Conclusion: In this context, it is recommended for policymakers to develop policies for individuals in disadvantaged groups.

Breast cancer-related lymphedema is a common complication after axillary lymph node dissection and radiotherapy, significantly affecting patients' quality of life. This review aims to outline the latest surgical advances for his management, highlighting current techniques and their role in prevention and treatment at various stages of the disease. An extensive literature review was performed in major databases (PubMed, Scopus, Web of Science), focusing on original studies, systematic reviews, and meta-analyses addressing surgical techniques for the management of breast cancer-related lymphedema. Articles published in the last 10 years were included. Several surgical approaches are described, including lymphaticovenous anastomosis, vascularized lymph node transfer, immediate lymphatic reconstruction, and liposuction. The choice of procedure depends on the clinical stage of lymphedema, the availability of expertise and micro-surgical equipment. Current evidence shows that early surgical management can reduce disease progression, improve quality of life, and lower the incidence of infectious episodes. Lymphatic surgery offers promising outcomes in both prevention and treatment of breast cancer-related lymphedema. Although significant advances -such as supermicrosurgery and immediate prophylactic procedures- have been made, there is still a need for randomized clinical trials to strengthen clinical recommendations. An interdisciplinary approach and careful patient selection are critical to optimizing outcomes.

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.