Cirugia y cirujanos最新文献

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: 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: 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.

Cavernous malformations have a prevalence of 0.4% to 0.8% in the population. Its symptoms are seizures, headache, and motor and cranial nerve deficits. We present the case of a 10-year-old girl with headache, right hemiparesis, ataxia, and involvement of left cranial nerves VI, VII, IX and X. Magnetic resonance imaging of the brain showed a left pontobulbar lesion. A cavernous malformation was resected. The patient showed resolution of the symptoms one year after surgery. Cavernous malformations of the brainstem in pediatrics are infrequent; when they bleed, surgery is recommended, and in asymptomatic lesions only neurological surveillance.

Objective: This study aimed to synthesize, characterize, and evaluate the histopathological and biochemical efficacy of vaginal gels (VGs) in healing lacerations resulting from vaginal trauma. The bioadhesive gel containing nanoparticles (n-HAp) represents a novel application in this field.

Methods: VGs were synthesized using n-HAp and characterized by field emission scanning electron microscopy (FE-SEM) and X-ray diffraction (XRD). High-resolution FE-SEM images confirmed the presence of n-HAp, while XRD verified its structural properties. Four experimental groups were established: Control, Sham, VG, and VG/n-HAp. Tissue and blood samples were collected on days 7, 14, and 21.

Results: Biochemical parameters such as tumor necrosis factor-alpha (TNF-α), interleukin-1 (IL-1), and vascular endothelial growth factor (VEGF) were evaluated in serum samples. Histological evaluations included inflammation, granulation tissue formation, collagen and reticular fiber density, re-epithelialization, and neovascularization. The VG/n-HAp group exhibited significantly faster healing and more pronounced inflammatory responses over time compared to the other groups.

Conclusion: Overall, the addition of n-HAp to VGs accelerated both biochemical and histopathological recovery in a rat vaginal wound healing model.

Objective: To evaluate the predictive value of the lactate/albumin ratio (LAR) for mortality in patients with abdominal sepsis admitted to the intensive care unit (ICU).

Methods: An analytical cross-sectional study to validate the diagnostic test for abdominal sepsis. Patients over 18 years old with a diagnosis of abdominal sepsis admitted to the ICU. The LAR was calculated in the first 24 hours of admission to the ICU to evaluate its prognostic value for mortality.

Results: We included 85 patients diagnosed with abdominal sepsis. The main causes of abdominal sepsis are secondary to closed abdominal trauma with hollow organ injury in 22 patients (26%) and severe acute pancreatitis in 21 (25%) patients. The LAR was calculated with a cut-off point of 1.04 as a predictor of mortality for abdominal sepsis, with 90.6% sensitivity, 72.5% specificity, 66.5% positive predictive value and 92.75% negative predictive value.

Conclusions: The LAR may be useful in patients with abdominal sepsis as a quick, easy, and inexpensive prognostic marker of mortality, compared to other scales that require multiple values for their performance.

Objective: This study evaluates the venous-arterial CO2 difference (Pv-aCO2) from peripheral venous blood (Pv-aCO2p) as a less invasive alternative to central venous Pv-aCO2 for assessing tissue perfusion in septic shock.

Methods: A prospective, single-center study included 54 septic shock patients with central venous catheters placed within 24 h of intensive care unit admission. Blood samples from arterial, central venous, and peripheral venous sources were analyzed. Correlation analyses and Bland-Altman plots were used to assess agreement between Pv-aCO2p and central Pv-aCO2.

Results: Patients had a mean age of 70 years, and 51.9% were male. The median SOFA score was 8.5, and the mean APACHE-II score was 22.7. The Pv-aCO2p gap was 8 mmHg, whereas the central Pv-aCO2 gap was 6 mmHg. A moderate correlation was found between Pv-aCO2p and central Pv-aCO2 (r = 0.593, p < 0.001), with stronger correlations observed in patients with arterial lactate ≥2 mmol/L (r = 0.673) and hemoglobin <8 g/dL (r = 0.625). Bland-Altman analysis revealed a mean difference of 8.278 mmHg between arterial and peripheral pCO2.

Conclusions: Peripheral Pv-aCO2p correlates well with central Pv-aCO2 and can serve as a less invasive alternative for assessing tissue perfusion in septic shock patients. It offers practical utility when central venous access is not available, aiding in early clinical decisions.