Innovative Surgical Sciences最新文献

{"title":"Status of inpatient pain therapy using the example of a general and abdominal surgery normal ward – a prospective questionnaire study to review a pain therapy algorithm (“real-world data”)","authors":"Michael Brinkers, Mandy Istel, Moritz Kretzschmar, Giselher Pfau, Frank Meyer","doi":"10.1515/iss-2023-0016","DOIUrl":"https://doi.org/10.1515/iss-2023-0016","url":null,"abstract":"Abstract Objectives The mean pain intensity for inpatient consultations, for example in cancer patients, is known. However, the proportion of necessary consultations in the total volume of patients of a ward or a hospital, the general pain intensity in a surgical ward and the relationship between pain medication, length of stay and therapeutic success are unknown. The aim of the study was to examine surgical patients in a single normal ward subclassified into various groups (−/+ surgery, ICU stay, cancer, consultation for pain therapy etc.) during half a year with regard to their pain. For this purpose, the pain score (NAS) was recorded daily for each patient during the entire hospital stay and the change was assessed over the clinical course. Methods In 2017, all consecutive new admissions to a normal ward of general surgery at a university hospital (“tertiary center”) were monitored over half a year according to a standardized procedure. Pain severity (measured by the “Numeric rating scale” [NRS] respectively “Visual analogue scale” [VAS]) from admission to discharge was recorded, as well as the length of stay and the administered medication. Patient groups were sub-classified as surgery, intensive care unit, cancer and pain consultation. An algorithm in two parts (part 1, antipyretics and piritramide; part 2, WHO-scheme and psychotropic drugs), which was defined years before between surgeons and pain therapists, was pursued and consequently used as a basis for the evaluation of the therapeutic success. Results 269 patients were included in the study. The mean pain intensity of all patients at admission was VAS 2.2. Most of the groups (non-cancer, intensive care unit [ICU], non-ICU, surgical intervention (=Operation [OP]), non-OP, pain intensity greater than VAS 3) were significantly reduced in pain at discharge. An exception in this context was patients with cancer-associated pain and, thus, initiated pain consultation. Conclusions Since three quarters of the consultation patients also reported cancer pain, it might be possible that the lack of treatment success in both the consultation and cancer groups is associated with cancer in these patients. However, it can be shown that the successfully treated groups (without ICU-based course) had a mean length of stay from 4.2 ± 3.9 up to 8.4 ± 8.1 days (d), while the two unsuccessfully treated groups experienced a longer stay (mean “cancer” , 11.1 ± 9.4 d; mean “consulation” , 14.2 ± 10.3 d). Twenty-one consultation patients, in whom it had been intended to improve pain intensity, could not be successfully treated despite adapted therapy – this can be considered a consequence of the low number of patients. Since the consultation patients were the only patient group treated with part 2 of the algorithm, it can be concluded that part 1 of the algorithm is sufficient for a mean length of stay up to 9 days. For all patients above this time point, a pain consultation with adaption of medical treatment sh","PeriodicalId":44186,"journal":{"name":"Innovative Surgical Sciences","volume":"102 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134948262","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":"Computer assistance in modern craniomaxillofacial surgery","authors":"Nils-Claudius Gellrich, Michael Ehrenfeld","doi":"10.1515/iss-2023-2002","DOIUrl":"https://doi.org/10.1515/iss-2023-2002","url":null,"abstract":"","PeriodicalId":44186,"journal":{"name":"Innovative Surgical Sciences","volume":"129 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135385879","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":"Interdisciplinary aspects of abdominal and plastic surgery – what does the (abdominal) surgeon need to know?","authors":"Armin Kraus, Hans-Georg Damert, Frank Meyer","doi":"10.1515/iss-2023-0042","DOIUrl":"https://doi.org/10.1515/iss-2023-0042","url":null,"abstract":"Abstract Introduction The aim was to reflect the established interdisciplinary aspects of general/abdominal and plastic surgery by means of a narrative review. Methods: (i) With specific references out of the medical literature and (ii) own clinical and perioperative as well as operating technical and tactical management experiences obtained in surgical daily practice, we present a choice of options for interdisciplinary cooperation that could be food of thought for other surgeons. Content – Decubital ulcers require pressure relieve, debridement and plastic surgery coverage, e.g., by a rotation flap plasty, V-Y flap or “tensor-fascia-lata” (TFL) flap depending on localization (sacral/gluteal defects, ischiadic tuber). – Coverage of soft tissue defects, e.g., after lymph node dissection, tumor lesions or disturbance of wound healing can be managed with fasciocutaneous or muscle flaps. – Bariatric surgery: Surgical interventions such as butt lift, tummy tuck should be explained and demonstrated in advance and performed commonly after reduction of the body weight. – Abdominoperineal rectum extirpation (APE): Holm’s procedure with greater circumferential extent of resection at the mesorectum and the insertion site of the levator muscle at the anal sphicter muscle resulting in a substantial defect is covered by myocutaneous flap plasty. – Hernia surgery: Complicated/recurrent hernias or abdominal wall defect can be covered by flap plasty to achieve functional reconstruction, e.g., using innervated muscle. Thus, abdominal wall can respond better onto changes of pressure and tension. – Necrotising fasciitis: Even in case of suspicious fasciitis, an immediate radical debridement must be performed, followed by intensive care with calculated antibiotic treatment; after appropriate stabilization tissue defects can be covered by mesh graft of flap plasty. – Soft tissue tumor lesions cannot be resected with primary closure to achieve appropriate as intended R0 resection status by means of local radical resection all the time – plastic surgery expertise has to be included into interdisciplinary tumor concepts. – Liposuction/-filling: Liposuction can be used with aesthetic intention after bariatric surgery or for lipedema. Lipofilling is possible for reconstruction and for aesthetic purpose. – Reconstruction of lymphatic vessels: Lymphedema after tumor operations interrupting or blocking lymphatic drainage can be treated with microsurgical reconstructions (such as lympho-venous anastomoses, lympho-lymphatic anastomoses or free microvascular lymph node transfer). – Microsurgery: It is substantial part of modern reconstructive plastic surgery, i.e., surgery of peripheral nerves belongs to this field. For visceral surgery, it can become important for reconstruction of the recurrent laryngeal nerve. – Sternum osteomyelitis: Radical debridement (eventually, complete sternal resection) with conditioning of the wound by vacuum-assisted closure followed by plastic surg","PeriodicalId":44186,"journal":{"name":"Innovative Surgical Sciences","volume":"73 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136129513","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":"Fatal heat stroke based on foudroyant irreversible multiple organ dysfunction in German summer","authors":"Eric Lorenz, Joerg Herold, Uwe Lodes, Frank Meyer","doi":"10.1515/iss-2023-0013","DOIUrl":"https://doi.org/10.1515/iss-2023-0013","url":null,"abstract":"Abstract Objectives Heat stroke is a serious condition that might lead from moderate organ impairment to multiple organ dysfunction syndrome. Appropriate diagnosis-finding, fast initiation of cooling and intensive care are key measures of the initial treatment. Scientific case report based on i) clinical experiences obtained in the clinical management of a particularly rare case and ii) selected references from the medical scientific literature. Case presentation We present a case of a young and healthy construction worker who suffered from an exertional heat stroke with a body core temperature exceeding 42 °C by previous several hour work at 35 °C ambient temperature. Heat stroke was associated with foudroyant, not reversible multiple organ dysfunction syndrome, in particular, early disturbed coagulation, microcirculatory, liver and respiratory failure, and subsequent fatal outcome despite immediate diagnosis-finding, rapid external cooling and expanded intensive care management. Conclusions Basic knowledge on an adequate diagnosis(-finding in time) and treatment of heat stroke is important for (almost each) physician in the summertime as well as is essential for the initiation of an appropriate management. Associated high morbidity and mortality rates indicate the need for implementation of standard operation protocols.","PeriodicalId":44186,"journal":{"name":"Innovative Surgical Sciences","volume":"93 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135010793","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":"Paradox inflammatory reaction such as appendicitis epiploica and diverticulitis of the sigmoid colon under ongoing immunosuppression after previous liver transplantation (LTx)","authors":"Isabella Trautwein, Manuela Petersen, Christine March, Roland S. Croner, Frank Meyer","doi":"10.1515/iss-2023-0038","DOIUrl":"https://doi.org/10.1515/iss-2023-0038","url":null,"abstract":"Abstract Objective Inflammatory reactions caused by immunosuppression appear a particular interesting disease due to its very specific and partly unclear etiopathogenesis. Based on clinical case-specific management experiences and selective references from the literature, the rare case of an acute intraabdominal inflammation as unusual complication or side effect (at the gastrointestinal [GI] tract) of the ongoing immunosuppressive medication using Mycophenolate mofetil and Tacrolimus after previous liver transplantation is to be illustrated. Case presentation Medical history ( hx ): 1) Current : A 68-years old male patient underwent abdominal CT scan because of pain in the left lower abdomen with the suspicious diagnosis of diverticulitis leading to initiation of antibiotic therapy 24 h prior to the transferral to the own hospital for adequate liver transplantation (LTx) follow-up investigation. 2) Medication contained Sitagliptin 1 × 100 mg, Omeprazol 1 × 40 mg, Mesalazin 500 mg 3 × 2, Movicol 1 (on demand), Mycophenolate mofetil 2 × 500 mg, Tacrolimus 2 × 1 mg and Hydrochlorothiazid 1 × 2.5 mg. 3) Additional diagnoses included arterial hypertension, diabetes mellitus and urinary bladder diverticle. 4) Previous surgical intervention profile comprises resection of liver segments IV/V due to HCC (2011), orthotopic liver transplantation because of HCC caused by alcohol-induced liver cirrhosis (2013) and an intervertebral disc operation (2018). Physical examination of the abdomen revealed marked tenderness in the lower left quadrant. The abdominal wall was soft and there were no defensive tension and no peritonism. The patient was in good general condition and nutritional status. He was cardiopulmonarily stable and oriented to all qualities. Diagnostic measures showed a CRP of 38.0 (normal range, < 5) mg/L and a white blood cell count within normal range. Leading diagnoses were found using abdominal CT scan, which demonstrated an extended diverticulosis and an appendicitis epiploica within the immediate subperitoneal region of the left lower abdomen with an oval fat isodense structure in the region of the sigmoid colon with surrounding inflammatory imbibition and pronounced intestinal wall. Suspicious diagnosis was the 1st episode of an uncomplicated diverticulitis of the sigmoid colon associated with an appendicitis epiploica. Therapeutic approach was given by conservative therapy with infusion therapy, analgesia as well as inital “n. p. o.” and following initiation of oral nutrition. In addition, calculated antibiotic therapy with Cefuroxime and Clont was initiated. Clinical course was uneventful, with discharge on the eighth day of hospital stay with no pathological findings and substantial improvement in clinical and laboratory findings. Further advice consisted of clinical and laboratory follow-up control investigations by the family practitioner and nutritional counselling. In addition, a colonoscopy should be performed within four months. Co","PeriodicalId":44186,"journal":{"name":"Innovative Surgical Sciences","volume":"184 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135353913","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":"Resection rectopexy as part of the multidisciplinary approach in the management of complex pelvic floor disorders.","authors":"Georgi Kalev,&nbsp;Christoph Marquardt,&nbsp;Marten Schmerer,&nbsp;Anja Ulrich,&nbsp;Wolfgang Heyl,&nbsp;Thomas Schiedeck","doi":"10.1515/iss-2022-0027","DOIUrl":"10.1515/iss-2022-0027","url":null,"abstract":"<p><strong>Objectives: </strong>Pelvic floor disorders are frequently caused by an organ prolapse involving multiple pelvic floor compartments. In such cases, a multidisciplinary strategy for diagnostic work-up and therapy is required.</p><p><strong>Methods: </strong>All patients who underwent transabdominal rectopexy/resection rectopexy alone or in combination with simultaneous gynecological pelvic floor reconstruction at our institution between 01/2006 and 12/2021 were included in this retrospective study. The study aimed to evaluate the functional outcome and postoperative complications.</p><p><strong>Results: </strong>Two hundred and eighty seven patients were assigned to one of the following groups: PG1 - patient group one: after resection rectopexy (n=141); PG2 - after ventral rectopexy (n=8); PG3 - after combined resection rectopexy and sacro (cervico)colpopexy (n=62); PG4 - after combined resection rectopexy and <i>trans</i>-vaginal pelvic floor repair (n=76). The duration of follow-up was 14 months for PG1 (median, IQR 37 months), 11 months for PG2 (mean, SD 9 months), 7 months for PG 3 (median, IQR 33 months), and 12 months for PG 4 (median, IQR 51 Months). The surgical procedure resulted in improvement of symptoms related to obstructed defecation in 56.4 % (22/39) of the patients in PG1, 25 % in PG2 (1/4), 62.5 % (20/32) in PG3, and 71.8 % (28/39) in PG4. \"<i>De novo</i>\" constipation was reported by 2.4 % (2/141) of patients from PG1. Improvement in fecal incontinence symptoms was reported by 69 % (40/58) of patients in PG1, 100 % in PG2 (2/2), 93.1 % (27/29) in PG3, and 87.2 % (34/39) in PG4. The recurrence rate for external rectal prolapse was 7.1 % in PG1, 50 % in PG2 (1/2), 2.7 % in PG3, and 6.3 % in PG4. A significant difference in terms of severe morbidity (grade ≥ IIIb) and mortality could not be determined between the non-interdisciplinary (PG1 with PG2) and interdisciplinary surgery (PG3 with PG4) (p=0.88, p=0.499).</p><p><strong>Conclusions: </strong>Based on our results, we can assume that combined surgery is as feasible as rectal surgery alone. In our study, combined interventions were effective and not associated with an increased risk of postoperative complications.</p>","PeriodicalId":44186,"journal":{"name":"Innovative Surgical Sciences","volume":"8 1","pages":"29-36"},"PeriodicalIF":1.3,"publicationDate":"2023-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10576551/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41239682","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact factor for Innovative Surgical Sciences - heading for the future.","authors":"Joachim Jaehne","doi":"10.1515/iss-2023-2001","DOIUrl":"10.1515/iss-2023-2001","url":null,"abstract":"Innovative Surgical Sciences, founded as Gold Open Access Journal by the German Society of Surgery in 2016 [1, 2], was just recently informed by Clarivate Analytics that the journal gained an impact factor of 1.3. The German Society of Surgery and the publisher DeGruyter would like to thank all members of the Editorial Board, all authors and their coworkers aswell as all reviewers for their continuous support of the journal. Without these efforts and the constant dedication to the journal, such a success after a relatively short period following the launch of the journal in 2016would not have been possible – thank you very much! Additionally, gaining an impact factor as an open access journal shows that open access has become a wellestablished publication method. More and more originally pure print journals with very high reputation switch to open access formats [3, 4]. Open access will most likely substitute the “old-fashioned” printed journals and will represent the standard of scientific communication in the very near future [4]. Now, that the impact factor is reality, one could say: mission accomplished! Although the impact factor was one aim to achieve, it needs to be said that this is just the beginning! The impact factor encourages to put even more effort in the aim to fully establish the journal within the surgical scientific community. In the last years the journal experienced some changes which seemed to be relevant and necessary. The layout was changed from green to blue to fulfill the requirements for a consequent marketing strategy of the German Society of Surgery, which also changed the color. Furthermore, all abstracts of the congress of the German Society of Surgery were published open access as a supplement to the journal so that the congress and the abstracts reach a wide surgical community. To fully support the various surgical societies which are members of the German Society of Surgery a National Editorial Board was established. This board should result in a greater participation of all surgical subspecialties in designing the content and the articles published in Innovative Surgical Sciences. Since the launch in 2016 Innovative Surgical Sciences is listed in all relevant data bases, and the journal has been in Pubmed for some years which may also be another reason for gaining the impact factor. Additionally, the actual Scopus Cite Score is 4.5, so that we feel that our road map for the future is correct. In comparison to other journals, one issue which we strictly follow is the publication of all reviews of the double-blind-review process. To our feeling, this is essential for the transparency of scientific communication, and it is the unique selling point of Innovative Surgical Sciences. Hereby, we also can communicate a rejection rate of 52 % for the years 2021 and 2022. Our aim for the years to come is clearly defined to further increase the impact factor. This aimmay be achieved by a broader internationalization of the j","PeriodicalId":44186,"journal":{"name":"Innovative Surgical Sciences","volume":"8 1","pages":"1"},"PeriodicalIF":1.3,"publicationDate":"2023-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10576547/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41239679","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Extracapsular extension of pN2 lymph node metastases is not prognostically significant in surgically resected patients with non-small cell lung cancer.","authors":"Christin Müller,&nbsp;Samantha Taber,&nbsp;Joachim Pfannschmidt,&nbsp;Sergej Griff","doi":"10.1515/iss-2022-0023","DOIUrl":"10.1515/iss-2022-0023","url":null,"abstract":"<p><strong>Objectives: </strong>In patients with non-small cell lung cancer (NSCLC) the pathologic lymph node status N2 is a heterogeneous entity, with different degrees of lymph node involvement representing different prognoses. It is speculated whether extra capsular nodal extension may help to define a subgroup with implications on long-term survival.</p><p><strong>Methods: </strong>We retrospectively identified 118 patients with non-small cell lung cancer (65 men, 53 women), who were treated between 2013 and 2018 and found to have pathologic N2 lymph node involvement. In all patients lung resection with systematic mediastinal and hilar lymph node dissection was performed with curative intent. In N2 lymph node metastases capsules of affected lymph nodes were examined microscopically as to whether extracapsular extension was present.</p><p><strong>Results: </strong>51 patients (43 %) had extracapsular extension (ENE). Most of these patients (n=35) only had ENE in a single lymph node (69 %). The overall 5-year survival rate was 24.6 % and progression-free survival rate 17.8 %. In the multivariate analysis OS was worse for patients with multiple affected pN2 stations, concurrent N1 metastases, increasing age, and larger tumor size. For the percentage of lymph nodes affected with ENE (of total examined) only a non-significant trend towards worse OS could be observed (p=0.06).</p><p><strong>Conclusions: </strong>Although we could not demonstrate significant prognostic differences between N2 extra capsular nodal involvement within our patient population, other analyses may yield different results. However, clinicians should continue performing thorough lymph nodes dissections in order to achieve local complete resection even in patients with extra capsular tumor spread.</p>","PeriodicalId":44186,"journal":{"name":"Innovative Surgical Sciences","volume":"8 1","pages":"9-16"},"PeriodicalIF":1.3,"publicationDate":"2023-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10576552/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41239677","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Female physician and pregnancy- effect of the amended German maternity protection act on female doctors' careers.","authors":"Barbara Puhahn-Schmeiser,&nbsp;Eva K Hennel,&nbsp;Christiane Gross,&nbsp;Heike Raestrup,&nbsp;Astrid Bühren,&nbsp;Mandy Mangler","doi":"10.1515/iss-2022-0024","DOIUrl":"10.1515/iss-2022-0024","url":null,"abstract":"<p><strong>Objectives: </strong>In Germany, the 2018 amended Maternity Protection Act frequently leads to fundamental restrictions for female physicians, especially surgeons, and now even also for students impeding the progress of their careers. Our goal was to assess the current situation for pregnant female physicians and students, respectively, and their perspective on this amendment regarding their career path.</p><p><strong>Methods: </strong>A nationwide survey was conducted in Germany from December 2020 to February 2021. The questionnaire included 790 female physicians and students who were pregnant after the inception of the amended Act. Those women pregnant after the beginning of the corona pandemic were excluded.</p><p><strong>Results: </strong>The survey revealed that two thirds of female physicians worked a maximum of 50% in their previous professional activity as soon as they reported pregnancy. Amongst medical students this amounted up to 72%. 18% of the female physicians and 17% of the female medical students respectively could not follow the sense of these restrictions. 44% of female medical physicians and 33% of female students felt their career impeded. This led up to 43% amongst female medical doctors and 53% amongst female medical students, respectively, who were concerned to announce their pregnancy. As a consequence, pregnancies were reported at 12 weeks in female physicians compared to 19 weeks in medical students.</p><p><strong>Conclusions: </strong>Analyses of the current survey revealed that a relevant number of female physicians and medical students felt impeded in their career path through the application of the amended Maternity Act.</p>","PeriodicalId":44186,"journal":{"name":"Innovative Surgical Sciences","volume":"8 1","pages":"23-28"},"PeriodicalIF":1.3,"publicationDate":"2023-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10576549/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41239678","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Presentation, management and outcomes of iliopsoas abscess at a University Teaching Hospital in Nepal.","authors":"Jayant Kumar Sah,&nbsp;Shankar Adhikari,&nbsp;Ganesh Sah,&nbsp;Bikal Ghimire,&nbsp;Yogendra Prasad Singh","doi":"10.1515/iss-2022-0013","DOIUrl":"10.1515/iss-2022-0013","url":null,"abstract":"<p><strong>Objectives: </strong>Iliopsoas abscess (IPA) is an uncommon clinical disease and is often missed to diagnose due to vague clinical presentation. Early treatment with drainage and appropriate antibiotic therapy is necessary before sepsis sets in and become lethal. We conducted this study to evaluate clinical features, etiology, management strategies, and outcomes in patients with IPA from a University Teaching Hospital in Nepal.</p><p><strong>Methods: </strong>A retrospective analysis of 32 consecutive IPA cases managed at Tribhuvan University Teaching Hospital, Nepal for the period of January 2019 to February 2022 was carried out.</p><p><strong>Results: </strong>The mean age was 42.5 ± 19.1 years (range, 19-75 years) and the male: female ratio was 2.2:1. Two-thirds or more patients presented with fever, limp, fixed flexion deformity and/or low back pain. Ultrasonography (US) was diagnostic in 27 (84.4%) patients. Eighteen (56.3%) patients had primary IPAs, and 14 (43.7%) had secondary IPAs. Thirty (93.7%) patients were managed with US guided percutaneous drainage (PCD) and 2 (6.2%) patients underwent open surgical drainage. Drainage procedures were combined with antibiotics in all patients. Pus culture showed <i>Staphylococcus aureus</i> growing in the majority of cases (10 of 23, 43.5%). The hospital stay was longer in patients treated via surgical drainage compared to those who received PCD: 13 days (range 12-14 days) vs. 6.6 days (range 4-13 days), respectively. Recurrence of abscess was seen in 4 (12.5%) cases and all were successfully managed via a second PCD. There was no mortality.</p><p><strong>Conclusions: </strong>Varying clinical presentation of iliopsoas abscess demand a high index of suspicion for early diagnosis. Initial imaging modality in suspected case of IPA is US. US-guided PCD along with the appropriate antibiotics is a successful frontline treatment of IPAs with shorter hospital stay.</p>","PeriodicalId":44186,"journal":{"name":"Innovative Surgical Sciences","volume":"8 1","pages":"17-22"},"PeriodicalIF":1.3,"publicationDate":"2023-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10576548/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41239681","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}