Cirugia y cirujanos最新文献

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.

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.

Objective: Different from physiological pain, post-operative pain is caused by surgical trauma. We aimed to systematically assess the effects of ropivacaine alone or in combination with dexmedetomidine on cesarean section and to conduct a meta-analysis.

Methods: According to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement and Cochrane intervention system review manual, retrieval software and data analysis tools were used for literature retrieval, screening, exclusion and inclusion, data extraction, analysis and statistics, and risk assessment. A total of 37 literatures were retrieved, and 11 literatures were left after 26 duplicates were excluded.

Results: A total of 37 literatures were retrieved in all databases, of which 11 literatures were left and finally 7 all published in English were obtained. They were seven randomized controlled trials on ropivacaine alone or in combination with dexmedetomidine applied in 502 parturients receiving cesarean section. The results of meta-analysis on main outcome indices showed that the number of parturients in need of rescue (c² = 28.62, p < 0.001, I² = 93%), incidence rate of adverse reactions (c² = 28.66, p = 0.007, I² = 55%), satisfaction (c² = 7.97, p = 0.05, I² = 62.3%), visceral respiratory response (c² = 19.26, p < 0.001, I² = 89.6%), satisfaction with muscle relaxation (c² = 6.92, p = 0.03, I² = 71.1%), and spinal anesthesia grade (c² = 25.89, p < 0.01, I² = 92.3%).

Conclusions: Ropivacaine combined with dexmedetomidine has a better prognostic effect on cesarean section and causes fewer adverse reactions.

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.