Cirugia y cirujanos最新文献

Objective: The objective of the study is to evaluate combined hyperbaric oxygen therapy (HBOT) and steroids on hearing in sudden sensorineural hearing loss (SSNHL) patients.

Method: A total of 50 patients with sudden hearing loss that started within 1 week and who received a combination of intravenous steroid therapy and HBOT in their medical treatment were assigned to the otolaryngology department for 1 week, followed by intravenous steroid therapy at 1 mg/kg/day and then reduced doses for 1 week. They were treated once in a hyperbaric chamber where they breathed 100% oxygen at 2.5 atm pressure for 60 min, for a total of 20 sessions.

Results: Hearing loss was observed in 54% of participants in the right ear. Significant improvements were observed in hearing thresholds across all tested frequencies after treatment with a specific intervention (p < 0.001 for each comparison). Combined steroid and HBOT significantly improved hearing across low and high frequencies (p < 0.001). Improvement in hearing at low frequencies was significantly greater than at high frequencies (p < 0.01). Post hoc analysis showed greater hearing improvement at lower frequencies compared to higher ones.

Conclusions: This study demonstrated that combined steroid and HBOT significantly improves hearing thresholds in patients with idiopathic SSNHL, especially at lower frequencies.

Objective: The effect of a pre-operative biliary stent on complications after pancreaticoduodenectomy (PD) remains controversial.

Materials and method: We conducted a meta-analysis according to the preferred reporting items for systematic reviews and meta-analyses guidelines, and PubMed, Web of Science Knowledge, and Ovid's databases were searched by the end of February 2023. 35 retrospective studies and 2 randomized controlled trials with a total of 12641 patients were included.

Results: The overall complication rate of the pre-operative biliary drainage (PBD) group was significantly higher than the no-PBD group (odds ratio [OR] 1.46, 95% confidence interval [CI] 1.22-1.74; p < 0.0001), the incidence of post-operative delayed gastric emptying was increased in patients with PBD compared those with early surgery (OR 1.21, 95% CI: 1.02-1.43; p = 0.03), and there was a significant increase in post-operative wound infections in patients receiving PBD with an OR of 2.2 (95% CI: 1.76-2.76; p < 0.00001).

Conclusions: PBD has no beneficial effect on post-operative outcomes. The increase in post-operative overall complications and wound infections urges the exact indications for PBD and against routine pre-operative biliary decompression, especially for patients with total bilirubin < 250 umol/L waiting for PD.

Objective: The aim of this study is to evaluate the efficacy and safety of oxidized regenerated cellulose (ORC) in patients who underwent coronary artery bypass grafting (CABG) surgery and to compare the results of patients in whom ORC was used or not used for control of bleeding.

Method: Pre-, intra-, and post-operative demographic and medical parameters of the patients in whom ORC was used or not used were compared. Quantitative data were analyzed with mean and standard deviation. Group differences were assessed with the Mann-Whitney U test.

Results: It was found that the duration of surgery, average numbers of erythrocyte and fresh frozen plasma (FFP) transfusions during surgery, average post-operative FFP transfusion count, duration of intensive care unit stay, and chest tube removal times were lower in the ORC group compared to the control group, and all these differences were statistically significant (p < 0.05 for all of these parameters).

Conclusions: The study successfully demonstrated the effective and safe use of topical ORC in controlling bleeding and preventing oozing during CABG surgeries.

Objective: Laparoscopic cholecystectomy (LC), despite its minimally invasive nature, requires effective control of post-operative pain. The use of local anesthetics (LA) has been studied, but the level of evidence is low, and there is little information on important parameters such as health-related quality of life (HRQoL) or return to work. The objective of the study was to evaluate the efficacy of 0.50% levobupivacaine infiltration of incisional sites in reducing POP after LC.

Methods: This was a prospective, randomized, double-blind study. Patients undergoing elective LC were randomized into two groups: no infiltration (control group) and port infiltration (intervention group). POP intensity (numerical rating scale, NRS), need for rescue with opioid drugs, PONV incidence, HRQoL, and return to work data, among others, were studied.

Results: Two hundred and twelve patients were randomized and analyzed: 105 (control group) and 107 (intervention group). A significant difference was observed in the NRS values (control group mean NRS score: 3.41 ± 1.82 vs. 2.56 ± 1.96) (p < 0.05) and in the incidence of PONV (31.4% vs. 19.6%) (p = 0.049).

Conclusions: Levobupivacaine infiltration is safe and effective in reducing POP, although this does not lead to a shorter hospital stay and does not influence HRQoL, return to work, or overall patient satisfaction.

Objective: Obesity is a global epidemic affecting developing countries. The relationship between obesity and perioperative outcomes during elective lumbar spine surgery remains controversial, especially in those without morbid disease.

Materials and methods: We retrospectively revised the medical records of patients with lumbar spine degeneration subjected to elective surgery. The data retrieved included demographic and clinical characteristics, body mass index (BMI), obesity status (BMI ≥ 30), surgical interventions, estimated blood loss (EBL), operative time, length of stay (LOS), and post-operative complications. Perioperative outcomes were compared between Grade I-II obese and non-obese individuals.

Results: We enrolled 53 patients, 18 with Grade I-II obesity. Their median age was 51, with no differences in gender, comorbidities, laboratory parameters, and surgical procedures received between groups. No clinically relevant differences were found between grade I-II obese and non-obese participants in EBL (300 mL vs. 250 mL, p = 0.069), operative time (3.2 h vs. 3.0 h, p = 0.037), and LOS (6 days vs. 5 days, p = 0.3). Furthermore, BMI was not associated with the incidence of significant bleeding and long stay but showed a modest correlation with operative time.

Conclusion: Grade I-II obesity does not increase surgical complexity nor perioperative complications during open lumbar spine surgery.

Objective: Estimating which patients might require surgical intervention is crucial. Patients with complete bowel obstructions exhibit disrupted enterohepatic cycles of bile and bacteremia due to bacterial translocation. The goal of this study was to develop a prediction index using laboratory inflammatory data to identify patients who may need surgery.

Materials and methods: The patients were divided into two groups based on their management strategy: Non-operative management (Group 1) and surgical management (Group 2).

Results: The indirect bilirubin, direct bilirubin, and total bilirubin were significantly higher in Group 2 than in Group 1 (p = 0.001, p < 0.001, and p < 0.001, respectively). The neutrophil-to-lymphocyte ratio (NLR), platelet-to-NLR (PNLR), and direct bilirubin-to-lymphocyte ratio (DBR) were significantly higher in Group 2 compared to Group 1 (p = 0.041, p = 0.020, and p < 0.001, respectively). In group 2, 78% have viable bowels. Resection was performed in 40% of cases, with 12% mortality and a 10-day average hospital stay. DLR performs the best overall accuracy (72%), demonstrating a well-balanced sensitivity (62%) and specificity (81%).

Conclusions: This study suggested that DBR is a more accurate predictive index for surgical intervention in pediatric adhesive small bowel obstruction patients compared to NLR and PNLR, providing valuable guidance for treatment strategies.

Objective: To determine the usefulness of pelvic lymphadenectomy in the staging of ovarian dysgerminoma.

Method: Patients with a histopathological diagnosis of ovarian dysgerminoma who were staged between January 1995 and December 2013 were retrospectively studied.

Results: We found 39 cases, the mean age was 23.5 years. Histologically, 34 were pure dysgerminomas and 5 were mixed associated with endodermal sinus tumors. According to FIGO, we found stage IA in 15 patients, stage IB in 1 patient, stage IC in 8 patients, stage IIB in 1 patient, stage IIIA in 1 patient, and stage IIIC in 13 patients. Pelvic nodes with metastases were not documented in any of the patients studied.

Conclusions: The lymphatic spread pattern in ovarian dysgerminomas is always towards the retroperitoneal nodes, both paracaval and paraaortic, but there is no spread towards the pelvic lymph nodes. Therefore, we recommend not performing pelvic lymphadenectomy in surgical staging in these patients.

Objective: Throughout the COVID-19 pandemic, care protocols were created to apply in hospital units and care for the vulnerable populationin. The objetive was to describe clini- cal manifestations, comorbidity and mortality in cancer patients with SARS CoV-2 infection, as well as sanitary measures carried out in COVID centers.

Method: Retrospective study of 1752 patients admitted to a respiratory care unit.

Results: 5% of the population studied had a previous diagnosis of cancer; 59.1% were solid neoplasms and 40.9% hematologic neoplasms. Patients with cancer showed lower rates of admission to the intensive care unit (ICU) compared to patients without cancer (8% vs. 17.4%), with no differences in survival.

Conclusions: Oncology patients hospitalized with COVID-19 did not have different survival rates and were less likely to require ICU care compared to non-cancer patients, this is likely due to multidisciplinary teamwork during the pandemic.

Superior mesenteric artery syndrome (SMAS) is a rare cause of duodenal obstruction which is characterized by compression of the duodenum due to narrowing of the space between the superior mesenteric artery and aorta. Incomplete duodenal obstruction due to SMAS in neonates is rarely reported in the literature. In this case, it is a full-term 2-day-old male with the complaint of recurrent vomiting starting soon after birth. The patient was diagnosed with SMAS and duodenoduodenostomy was performed. Accompanying Meckel's diverticulum was excised.

Objective: The objective of the study is to compare the optic coherence tomography (OCT) parameters of the healthy and affected sides of patients with idiopathic sudden sensorineural hearing loss (ISSNHL) and to investigate the relationships between these and the improvement in hearing levels.

Methods: A bilateral eye evaluation of patients diagnosed with ISSNHL was performed with OCT. The ganglion cell complex (GCC) and retina nerve fiber layer (RNFL) thickness values were recorded and the differences between the two eyes were examined.

Results: An evaluation was made of 39 patients with a mean age of 44.82 ± 14.90 years. The RNFL thickness of the eyes was determined to be mean 89.87 ± 3.65 µm on the affected side and 103.87 ± 3.98 µm on the healthy control side (p = 0.0001). The mean GCC was determined to be mean 90.46 ± 3.49 µm on the affected side and 103.77 ± 3.96 µm on the healthy control side (p = 0.0001).

Conclusions: A statistically significant difference was observed between the healthy and affected eyes of patients with ISSNHL with respect to mean GCC and mean RNFL thickness. OCT could be a useful technique for measuring this neural degeneration.