The Surgery Journal最新文献

{"title":"Short-Term Outcomes of COVID-19 Pandemic on Non-Small Cell Lung Cancer Screening and Management","authors":"Felix Orelaru, Melanie Edwards, Ruth Raleigh, Ali Abunayla, Rachel Bush, Shannon Porter, Kate E Schumaker, Jeremy Albright, Kumari N. Adams","doi":"10.1055/s-0043-1777856","DOIUrl":"https://doi.org/10.1055/s-0043-1777856","url":null,"abstract":"Abstract Background  To assess the impact of coronavirus disease 2019 (COVID-19) pandemic on non-small cell lung cancer (NSCLC) screening, staging, and management in a single health care system. Materials and Methods  From November 2015 to December 2020, a total of 1,547 NSCLC cases was reported at our institution including 1,329 cases pre-COVID-19 and 218 cases during COVID-19. Pre-COVID-19 was defined as November 2015 to February 2020, while during COVID-19 was March 2020 to December 2020. Data were collected from tumor registry and medical record review. Patients with mesothelioma, lymphoma, small cell, or mixed small cell cancer were excluded from the study. Results  Both pre-COVID-19 and during COVID-19 cohorts had similar comorbidities including age (70 vs. 71 years), current smokers (35 vs. 32%), and chronic obstructive lung disease (32 vs. 28%). The number of low-dose computed tomography lung cancer screening scans decreased by 25% during COVID-19 compared with pre-COVID-19 era. There were more cases of stage 1A NSCLC pre-COVID-19 (31 vs. 25%) and more stage 4 cancer during COVID-19 (42 vs. 33%); p  = 0.01. The proportion of patients treated with radiotherapy was similar between pre-COVID-19 and during COVID-19 (49 vs. 50%), but fewer patients underwent surgery during COVID-19 (17 vs. 27%; p  = 0.004). The median time to radiotherapy (67 days) and surgery (29 days) was similar between the groups. The unadjusted overall 6-month mortality after lung cancer diagnoses was higher during COVID-19 compared with pre-COVID-19 (28 vs. 22%; p  = 0.04). Conclusion  The COVID-19 pandemic resulted in delayed lung cancer screening scans, and more patients had diagnosis of advanced NSCLC; however, short-term mortality was unchanged.","PeriodicalId":400091,"journal":{"name":"The Surgery Journal","volume":"24 1","pages":"e156 - e161"},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139327445","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endoscopic Ultrasound-Guided Transrectal Pelvic Abscess Drainage (EUS-PAD) – Bridging to Surgery: Report of Two Cases","authors":"Tina Goerl, Christoph Speck, A. Gehring, R. Wiessner","doi":"10.1055/s-0043-1777791","DOIUrl":"https://doi.org/10.1055/s-0043-1777791","url":null,"abstract":"Abstract Background  Currently, the methods for drainage of pelvic abscess primarily use computed tomography- or ultrasound-guided percutaneous drainage or surgical drainage. Endoscopic ultrasound-guided pelvic abscess drainage (EUS-PAD) is an alternative, minimally invasive tool to drain an abscess, localized close to the rectum or left colon, and therefore not accessible by other means. Methods  We report on the success of endoscopic ultrasound-guided drainage of peridiverticulitic abscess based on the two cases presented here. Using endoscopic ultrasound guidance an aspiration of the abscess from the endoluminal could be realized. After successive balloon dilatation via a guidewire while using X-ray imaging, the placement of pigtail or flap stent was performed. In addition, conservative therapy measures such as antibiotics, diet, and pain management were performed. Results  The interventions were successful in both patients, resulting in rapid recourse of discomfort, abscess size, and sepsis. After controlling the consequences of complicated diverticulitis, both patients underwent laparoscopic sigmoid resection with primary anastomosis and without ileostomy during an inflammation-free interval. Conclusion  Both cases demonstrate the advantages of EUS-PAD. A laparoscopic operation with primary anastomosis, lower perioperative risk, and without need of a protective ileostomy in early elective setting became possible by bridging the time until surgery by using EUS-PAD.","PeriodicalId":400091,"journal":{"name":"The Surgery Journal","volume":"51 1","pages":"e145 - e148"},"PeriodicalIF":0.0,"publicationDate":"2023-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139350200","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Collagen Application in Pediatric Superficial Burns: The Right Time!","authors":"Al-Iqyan Juzar Fidvi, Surendra Kumar Patil, Aniket Jaiprakash Baraskar, Ganesh Deepak Jadhav, Adarsh Kumar Kankam","doi":"10.1055/s-0043-1777790","DOIUrl":"https://doi.org/10.1055/s-0043-1777790","url":null,"abstract":"Abstract Introduction  Delayed presentation of burn patients, in a developing country with the patient being referred from one center to another higher one, is a common occurrence. Efficient management of such delayed burn wounds thus becomes critical to decrease the morbidity of the patient within economic constraints. The advantages of collagen dressing are numerous. However, there is scarce literature on the timing of its application. Traditionally, it is thought that collagen sheets should be applied within 24 hours of burns as the wound is still sterile. This thus becomes ironical as patients are presenting late. Hence, we studied retrospectively the result of collagen application in delayed presentation of burns. Methods  A retrospective study was conducted in which records of pediatric patients of less than 10 years with less than 30% total body surface area scald burns were considered. Collagen dressing was done in all these patients. Presentation time from burns, timing of collagen application, status of wound at various check dresses, complication of burn wound, and total healing times were recorded. Appropriate statistical formulas were used to calculate significance levels for continuous and categorical variables. Result  Fifty-three patients, 33 male and 20 female were studied. The most common cause of scald was hot water spillage from baths and cooking, with the anterior trunk being the most involved site. The mean time of presentation of the patient from burns is 71.74 hours and that of collagen application was 76.4 hours. Fourteen (25.4%) patients had wound complications in the form of soakage, fever, and pus. Eight patients had their collagen removed. The average healing time for patients with intact collagen was 12.15 days and that for those on daily dressing was 21.9 days. Conclusion  Collagen should be preferred even when the patient presents after 24 hours of burns. A thoroughly washed wound is a necessary prerequisite before collagen application. Burn patients presenting after 3 days have a higher incidence of wound infection. No such time stamp of application of collagen sheets within 24 hours can thus be given for its use as the advantages of adhered and successful collagen dressings outweigh those on daily dressings.","PeriodicalId":400091,"journal":{"name":"The Surgery Journal","volume":"33 1","pages":"e135 - e144"},"PeriodicalIF":0.0,"publicationDate":"2023-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139350323","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Inefficiency in Delivery of General Surgery to Black Patients: A National Inpatient Sample Study","authors":"J. Bliton","doi":"10.1055/s-0043-1777811","DOIUrl":"https://doi.org/10.1055/s-0043-1777811","url":null,"abstract":"Abstract Background  Racial disparities in outcomes among patients in the United States are widely recognized, but disparities in treatment are less commonly understood. This study is intended to identify treatment disparities in delivery of surgery and time to surgery for diagnoses managed by general surgeons—appendicitis, cholecystitis, gallstone pancreatitis, abdominal wall hernias, intestinal obstructions, and viscus perforations. Methods  The National Inpatient Sample (NIS) was used to estimate and analyze disparities in delivery of surgery, type of surgery received, and timing of surgery. Age-adjusted means were compared by race/ethnicity and trends in treatment disparities were evaluated from 1993 to 2017. Linear modeling was used to measure trends in treatment and outcome disparities over time. Mediation analysis was performed to estimate contributions of all available factors to treatment differences. Relationships between treatment disparities and disparities in mortality and length of stay were similarly evaluated. Results  Black patients were less likely to receive surgery for appendicitis, cholecystitis, pancreatitis, and hernias, and more likely to receive surgery for obstructions and perforations. Black patients experienced longer wait times prior to surgery, by 0.15 to 1.9 days, depending on the diagnosis. Mediation analysis demonstrated that these disparities are not attributable to the patient factors available in the NIS, and provided some insight into potential contributors to the observed disparities, such as hospital factors and socioeconomic factors. Conclusion  Treatment disparities are present even with common indications for surgery, such as appendicitis, cholecystitis, and gallstone pancreatitis. Black patients are less likely to receive surgery with these diagnoses and must wait longer for surgery if it is performed. Surgeons should plan institution-level interventions to measure, explain, and potentially correct treatment disparities.","PeriodicalId":400091,"journal":{"name":"The Surgery Journal","volume":"78 1","pages":"e123 - e134"},"PeriodicalIF":0.0,"publicationDate":"2023-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139368217","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}