Journal of the College of Physicians and Surgeons--Pakistan : JCPSP最新文献

This study aimed to evaluate the clinical significance of multi-slice spiral CT renal angiography combined with intraoperative ultrasound in laparoscopic partial nephrectomy. Eighty patients were seen at the Affiliated Hospital of Hebei University from January 2021 to December 2022. The patients were divided into two groups, the experimental group and the control group, with 40 cases in each group. The experimental group received laparoscopic partial nephrectomy combined with intraoperative ultrasound, while the control group received only conventional laparoscopic partial nephrectomy. The experimental group had significantly shorter operative time and intraoperative thermal ischaemia time (p <0.05) and had significant advantage in the detection of microscopic cancer foci (p = 0.04). The experimental group also had significantly lower of positive rate of postoperative incisal margin (p = 0.01). The experimental group had significantly lower of recurrence rate (p = 0.03). The study concluded that multi-slice spiral CT renal angiography combined with intraoperative ultrasound boasts various benefits in the treatment of patients with renal cell carcinoma, it is safe and effective with no significant impact on renal function. Key Words: CT renal angiography, Intraoperative ultrasound, Laparoscopic partial nephrectomy, Renal cancer.

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Objective: To determine the clinical efficacy and safety of modified double-channel anastomosis for digestive tract reconstruction in proximal gastrectomy for early gastric cancer (EGC).

Study design: Case series. Place and Duration of the Study: Department of Gastrointestinal Surgery, Heji Hospital, Changzhi Medical College, Shanxi, China, from January to November 2022.

Methodology: Based on inclusion and exclusion criteria, this study included a total of 21 patients with oesophagogastric junction cancer or proximal gastric cancer who underwent laparoscopic proximal gastrectomy with modified double-channel anastomosis. After resection of the proximal stomach, the remaining stomach was shaped into a tube. The distal end of the oesophagus was anastomosed to the jejunum. The jejunum was anastomosed 10-15 cm from the oesophagojejunostomy site laterally to the anterior wall of the stomach 3 cm from the gastric remnant. General data including operative time, anastomosis time, intraoperative blood loss, time to oral intake, length of hospital stay, and postoperative complications were evaluated. Postoperative gastroscopy and gastrointestinal imaging were performed to assess the residual stomach motility and anti-reflux effect.

Results: All twenty-one patients underwent modified double-channel anastomosis. The mean operation time was 254 (211 - 297) minutes. Mean reconstruction time was 65 (60 - 70) minutes. A mean of 19 (15 - 29) lymph nodes were cleared. Mean intraoperative blood loss was 86 (78.5-105ml). Mean time to oral intake was 6 (5 - 6.5) days. Postoperatively, there were two cases of pulmonary infection. There was no occurrence of anastomotic stenosis, anastomotic bleeding, or leakage. Gastrointestinal contrast study at 6 months postoperatively revealed reduced gastrointestinal motility in three cases and good residual gastric motility observed in the remaining patients. Gastroscopic examination at 6 months postoperatively revealed only one case of reflux oesophagitis.

Conclusion: Modified double-channel anastomosis for proximal gastrectomy is safe and feasible. It provides a good anti-reflux effect and gastric emptying function without increasing the risk of postoperative complications.

Key words: Adenocarcinoma of the oesophagogastric junction, Upper gastric carcinoma, Proximal gastrectomy, Double-tract reconstruction.

Objective: To determine whether the right-lateral decubitus or supine position is superior for emergency laparoscopy for traumatic splenic rupture.

Study design: Descriptive study. Place and Duration of the Study: Department of General Surgery, Central Hospital of Shaoxing, Affiliated Hospital of China Medical University, Zhejiang, China, from January 2015 to December 2022.

Methodology: Clinical data of 96 patients who underwent laparoscopic surgery (LS) for traumatic splenic rupture were analysed. The patients were divided into two groups according to surgical position. Group A (n = 42) patients were placed in the right-lateral decubitus position and Group B (n = 54) patients were placed in the supine position. The operation time, intraoperative blood loss, conversion to laparotomy rate, postoperative length of hospital stay, and complications rates were compared between the two groups.

Results: Compared with Group B, Group A had a shorter operation time (145.5 ± 24.4 min vs. 169.0 ± 15.3 min, p = 0.0001), less intraoperative blood loss (75.3 ± 35.3 ml vs. 110.3 ± 50.6 ml, p = 0.0002), fewer conversions to laparotomy (2.4% vs. 16.7%, p = 0.023), fewer cases of postoperative pancreatic leakage (7.1% vs. 24.1%, p = 0.027), and fewer complications (23.8% vs. 53.7%, p = 0.003); all differences were significant. There was no statistically significant difference in the postoperative length of hospital stay, hospital cost, or rate of complications such as fever, postoperative abdominal infection, postoperative bleeding or venous thrombosis between the two groups.

Conclusion: For patients with traumatic splenic rupture, the right-lateral decubitus position is best for LS.

Key words: Laparoscopy, Traumatic splenic rupture, Splenectomy, Surgical position.

Objective: To analyse the outcome of laparoscopic nephrectomy among children.

Study design: An observational study. Place and Duration of the Study: Department of Paediatric Urology, Children's Hospital Lahore, from September 2021 to June 2023.

Methodology: During the study, 100 children aged 5-180 months were included. Data regarding age, gender, cause, side, intraoperative and postoperative outcomes such as number of ports, estimated blood loss, need of transfusion, operative time, hospital stay, analgaesia requirement and complications were recorded. Data were collected through proforma which were entered and analysed through computer software SPSS version 16.0.

Results: Among 100 children, 58.0% were males and the mean age was 79.54 ± 4.427 months while the major cause of laparoscopic nephrectomy was PUJO (Pelvi-Ureteric Junction Obstruction) for 47.0% of children. The mean blood loss was 19.93 ± 65.556 ml and the majority of the children (96.0%) did not require blood transfusion. The mean operative time was 125.31 ± 43.365 minutes and the mean hospital stay was 2.82 ± 1.258 days. Most of the children (90.0%) had no complications while 3.0% had ileus which was managed conservatively and 3.0% were converted to open surgery while 4.0% had wound infection.

Conclusion: Laparoscopic nephrectomy is an effective technique with regard to insignificant blood loss, operative time, hospital stay, and rate of complications.

Key words: Laparoscopy, Nephrectomy, Children, Operative time, Hospital stay, Complications.

Objective: To assess the relationship between vitamin D and haematological inflammatory indices (HII) in chronic low back pain (CLBP) patients.

Study design: Descriptive study. Place and Duration of the Study: Harran University Hospital, Sanliurfa, Turkiye, between September 2023 and February 2024.

Methodology: A total of 100 CLBP patients were divided into three groups according to their vitamin D levels as deficiency (<20 µg/L), insufficiency (20-30 µg/L), and sufficiency (30-80 µg/L). Demographic characteristics, serum parameters, and HII were compared among the three groups. Additionally, the association between vitamin D and other parameters were investigated.

Results: The three groups were similar in terms of age (p = 0.640), gender distribution (p = 0.057), body mass index (BMI, p = 0.855), C-reactive protein (CRP, p = 0.965), leucocyte count (p = 0.979), neutrophil count (p = 0.525), lymphocyte count (p = 0.246), monocyte count (p = 0.485), platelet count (p = 0.878), and HII including neutrophil-to-lymphocyte ratio (NLR, p = 0.335), monocyte-to- lymphocyte ratio (MLR, p = 0.227), platelet-to-lymphocyte ratio (PLR) (p = 0.898), neutrophil-to-lymphocyte*platelet ratio (NLPR, p = 0.543), systemic inflammatory index (SII, p = 0.300), systemic inflammatory response index (SIRI, p = 0.187), and aggregate index of systemic inflammation (AISI, p = 0.219). No significant correlation was found between vitamin D concentration and other parameters (p >0.05).

Conclusion: The coexistence of vitamin D deficiency and increased HII may accompany inflammatory conditions. However, no significant association was found between vitamin D level and HII in non-inflammatory CLBP.

Key words: Inflammation, Low back pain, Neutrophil, Complete blood count, Vitamin D.

Objective: To determine the effect of esketamine in patient-controlled analgaesia after hip replacement on postoperative pain and improve sleep quality in patients.

Study design: Randomised double-blind study. Place and Duration of the Study: Department of Anaesthesiology, The First Affiliated Hospital of Guangxi Medical University, from March 2021 to May 2022.

Methodology: The research enrolled 72 patients who were subjected to unilateral complete hip replacement surgery utilising jointly administered universal and peripheral nerve-obstructing anaesthetics. A randomised numeric table method was used to allocate patients to either the F-D group (fentanyl combined with dexmedetomidine, n = 34) or the Es-D group (esketamine combined with dexmedetomidine, n = 38). The key outcome indicators included the time to first administration of rescue analgaesic, the dose of rescue analgaesics, and postoperative sleep quality.

Results: Baseline characteristics did not differ between the two groups. The time until postoperative analgaesic rescue medication was considerably shorter for those in the Es-D group (p <0.05). In addition, the Es-D group used significantly fewer rescue analgaesics (p = 0.01). The PSQI score and unpleasant responses (PONV, dizziness, nightmare) did not significantly differ between the two groups (p <0.05). Nevertheless, urine retention occurred in four patients in group F-D but not in group Es-D (p <0.05).

Conclusion: Esketamine produced better analgaesia than fentanyl with fewer side effects after surgery. However, no improvement was observed in sleep quality.

Key words: Arthroplasty, Postoperative analgaesia, Esketamine, Sleep quality, Patient-controlled analgaesia.

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Objective: To determine the correlation between the air-bone gap on pure tone audiometry with size of perforation oto-endoscopically.  Study Design: A descriptive study. Place and Duration of the Study: Department of ENT - Head and Neck Surgery, Dow University of Health Sciences (DUHS), from February 2020 to August 2021.  Methodology: A total of 43 patients with dry central pars tensa tympanic membrane perforation were diagnosed through oto-endoscopy during the study. The mean air-bone gap was calculated by assessing each air-bone gap through pure tone audiometry at different frequencies i.e., 250 Hz, 500 Hz, 1,000 Hz, 2,000 Hz, and 4,000 Hz. Air-bone gap was found to be the average value of these frequencies. The photograph of the tympanic membrane was taken oto-endoscopically, and the ratio between size of the perforation to the entire area of the tympanic membrane was measured.

Results: During the course of the study, a total of 43 patients agreed to provide consent for this study. Out of the 43 patients, 16 (37.2%) were males and 27 (62.8%) were females. The age range was from 18 to 50 years with average age of 38.302 ± 5.74 years. The mean perforation size was 28.255 ± 9.16% while the mean air-bone gap was 28.000 ± 3.89 dB. It was concluded that the Pearson's correlation coefficient is directly correlated to perforation size and air-bone gap (r = 0.898, p <0.001). Further, hearing loss decreases with decreased middle ear volume and mastoid pneumatisation. Moreover, no change was seen in the mean air-bone gap according to the location of perforation.

Conclusion: The hearing loss due to perforation of the tympanic membrane was correlated to the size of the perforation. Further, hearing loss decreases with reduced middle ear volume and mastoid pneumatisation.

Key words: Size of perforation, Hearing loss, Air-bone gap, Oto-endoscopy, Conductive deafness, Mastoid pneumatisation.

Cytomegalovirus (CMV) infection is the most common viral infection after haematopoietic stem cell transplantation (HSCT). However, studies on related risk factors give different views without any clear conclusion. Therefore, the purpose of this study was to evaluate the risk variables of CMV infection after HSCT in order to provide recommendations for therapeutic treatment. The National Knowledge Infrastructure [CNKI], Chinese Biomedical Literature database [SinoMed], Wanfang Digital Periodicals [WANFANG] and China Science and Technology Journal [VIP] databases, as well as PubMed, Embase, CENTRAL, Web of Science databases were searched. The search keyword was Cumulative Index of Nursing and Related Health Literature (CINAHL). The search time spanned from the time when the database was created to February 2023. Based on inclusion and exclusion criteria, two researchers independently chose the literature, retrieved data, and assessed the bias risk. The methodological quality of the included studies was assessed by the Newcastle Ottawa scale (NOS). A total of 1,038 literatures were retrieved, of which, 18 studies were finally included. The final results of meta-analysis showed that there were seven risk factors as follows: Acute graft-versus-host disease (aGVHD) grades II-IV (II-IV) [odds ratio = 3.39, 95% CI (2.13, 5.41), p <0.05]; ant-thymocyte globulin (ATG) administration in treatment [odds ratio = 2.53, 95% CI (1.41, 4.53), p <0.05]; cyclosporine level after transplantation (>300 ng/ml) [OR = 3.79, 95% CI (1.24, 11.65), p <0.05]; age [odds ratio = 1.83, 95% CI (1.06, 3.15), p <0.05]; neutrophil deficiency time [odds ratio = 6.58, 95% CI (2.24, 19.30), p <0.05]; CMV infection in recipients before transplantation [odds ratio = 6.32,95% CI (4.03, 9.90), p <0.05]; fungal infection [odds ratio = 2.63, 95% CI (1.09, 6.34), p <0.05]. This study preliminarily revealed that CMV infection after HSCT is related to aGVHD (II-IV), ATG administration in pretreatment, cyclosporine level (>300 ng/ml) after transplantation, age, neutrophil deficiency time, CMV infection in recipients before transplantation and fungal infection. However, the mechanisms behind the risk variables are unclear. Further research is necessary to understand the risk factors and to enhance the care of patients with these risk factors to prevent or control infection. Key Words: Haematopoietic stem cell transplantation, Cytomegalovirus infection, Risk factors, Meta-analysis.