Clinics in surgery最新文献

{"title":"Addressing a common complication after ileostomy creation: a multidisciplinary program to decrease readmission for dehydration.","authors":"Danielle Kong, Sabrina Lin, Georgios Karagkounis, Mohammad Ali Abbass, Maria Widmar, Emmanouil Pappou, J Joshua Smith, Garrett M Nash, Martin R Weiser, Philip B Paty, Julio Garcia-Aguilar, Iris H Wei","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the impact of a multidisciplinary program on dehydration risk after ileostomy creation.</p><p><strong>Background: </strong>Dehydration after ileostomy creation is a significant complication and the most common reason for readmission. We implemented a multidisciplinary program to address this problem, including improved perioperative education and increasing wound ostomy and continence nurse (WOCN) support.</p><p><strong>Methods: </strong>We queried patients who underwent ileostomy creation from 2010-2019. We evaluated patient characteristics (including sex, age, comorbidities), operative characteristics (including approach, class, duration, estimated blood loss), and perioperative characteristics (including WOCN consultation, antimotility agents, ileostomy output, length of stay [LOS], follow up, and adverse events). Primary outcome was 60-day readmission for dehydration. Univariate and multivariate logistic models were created to identify factors associated with dehydration.</p><p><strong>Results: </strong>Nine hundred and ninety-eight patients underwent ileostomy creation, with a median LOS of 6 days. The readmission rate for dehydration was 5.4% (vs 11.5% previously), with a median time to readmission of 8.5 days. Patients readmitted for dehydration had slightly higher ileostomy output prior to discharge (750 vs 500 mL/24h) and later post-operative follow up (13 vs 11 days). On multivariate analysis, risk factors associated with dehydration were diabetes (<i>p</i> = 0.001), open surgery (<i>p</i> = 0.001), adverse events (<i>p</i> < 0.001), and higher ileostomy output (<i>p</i> = 0.004).</p><p><strong>Conclusions: </strong>Readmission for dehydration after ileostomy creation has significantly decreased with the implementation of a multidisciplinary program. A potential area of improvement is close follow up within 1 week for high-risk patients to identify and address early signs of dehydration.</p>","PeriodicalId":91854,"journal":{"name":"Clinics in surgery","volume":"10 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12434592/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145076878","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":"A Clinical Study of Ventral Hernias in Tertiary Hospital, Goa Medical College","authors":"Rodrigues J, A. K., Rodrigues Fcs, R. Cs, Jain P, Cormoli G","doi":"10.25107/cis-v8-di3643","DOIUrl":"https://doi.org/10.25107/cis-v8-di3643","url":null,"abstract":"Background: Ventral hernias are commonly encountered problems in the field of general surgery. Less data is available as to its natural history and hence surgeons prefer surgical treatment. Incisional hernia is a common complication following abdominal surgery that requires reoperation. Aims and Objectives: To study the incidence of ventral hernias, its causes and modes of presentation with the changing trends, various treatment modalities and complications of surgeries and mortality and morbidity owing to ventral hernia. Materials and Methods: This prospective observational study was conducted in the Department of Surgery, Goa Medical College, on a total of 100 patients between May 2019 to March 2021. Detailed history was recorded in all cases. This includes age, sex, weight of the patients. Presence of predisposing factors like obesity and particulars regarding diseases like hypertension, diabetes and other complications were elicited and treatment for the same was undertaken. The data was analyzed using SPSS software. Results: Females were affected more than males. 49% patients complained of swelling, while 23% complained of swelling and pain and about 20% complained of only pain. Para umbilical and incisional hernias were the most common types of hernias diagnosed in the study majority (86 out of 100) had no complications. However, those who did have complications, the most common was infection which was seen among 14% of the participants. 8% had seroma and 5% each had ileus and dehiscence. The recurrence rate was only 3%. Conclusion: Ventral hernia tend to present mainly in the 40- to 60-year age with male to female ratio tends to be 2:1. Para umbilical with umbilical hernia were most common types followed by Incisional hernia. Swelling and pain were the major presenting symptoms. Mesh repair was being more frequently used, compared to primary suture repair.","PeriodicalId":91854,"journal":{"name":"Clinics in surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47232270","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":"Atherosclerotic Disease in a Single Coronary Artery: Right Coronary Artery Supplies Left Anterior Descendens and Left Circumflex Artery with Absent Left Coronary Ostium","authors":"Algoet M, Torky M, Van Kerrebroeck M, D. D, V. E, Oosterlinck W","doi":"10.25107/cis-v8-id3635","DOIUrl":"https://doi.org/10.25107/cis-v8-id3635","url":null,"abstract":"We report a case of a 62-year-old man with a right-sided single coronary ostium supplying the complete myocardium. This case was diagnosed based on an aberrant exercise tolerance test and complementary angiography. The patient was revascularized by a coronary artery bypass graft to the single coronary artery because of a significant stenosis in its course.","PeriodicalId":91854,"journal":{"name":"Clinics in surgery","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45368097","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":"A Rare Case of Floating Hip Treated Successfully with Open Reduction and Internal Fixation: A Case Report and Literature Review","authors":"Krexi A, Papoulidis N, Karampinas P, Vavourakis M, Pneumaticos S, Vlamis J","doi":"10.25107/cis-v8-id3632","DOIUrl":"https://doi.org/10.25107/cis-v8-id3632","url":null,"abstract":"Floating hip describes a rare combination of fractures/dislocation and is usually seen in multiple injured patients, more often in young males involved in high-energy automotive/motorcycle trauma. These fractures are often associated to chest trauma, other skeletal fractures or polytrauma. A “floating hip” injury is rare but a surgical challenging. Each case needs to be planned and addressed. We present a case of floating hip injury in a male patient, treated successfully with ORIF, followed by an uneventful postoperative period.","PeriodicalId":91854,"journal":{"name":"Clinics in surgery","volume":"100 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134999599","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":"A Rare Case of Primary Posterior Mediastinal Pleural Ancient Schwannoma","authors":"Yee Ac, Karim Fw, Giashuddin S","doi":"10.25107/cis-v8-id3628","DOIUrl":"https://doi.org/10.25107/cis-v8-id3628","url":null,"abstract":"Ancient schwannoma is a rare subtype of schwannomas that is generally benign and primarily discovered incidentally through imaging findings. The tumor is characteristically slow-growing and frequently seen to undergo transformative changes such as cystic or myxoid degeneration which can at times lead to erroneous diagnosis of a malignant growth. Ancient schwannomas derive from Schwann cells and can arise at any location with nerve sheaths however they are typically found in the head and neck and less commonly so in the pleura. Here, we report a case of a primary posterior mediastinal ancient schwannoma of the pleura discovered incidentally in a man who initially presented with a chief complaint of cough.","PeriodicalId":91854,"journal":{"name":"Clinics in surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49540517","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":"Correlation between Characteristics of Lymph Node Metastasis and Prognosis of N1-N2 Stage Non-small Cell Lung Cancer","authors":"Ze-ting Cheng, Chuxu Wang, Sheng Ju, S. Pan, Yu Liu, Jun Zhao, Chun Xu","doi":"10.25107/cis-v7-id3494","DOIUrl":"https://doi.org/10.25107/cis-v7-id3494","url":null,"abstract":"Objective: Patients with non-small cell lung cancer have prognostic heterogeneity, chief prognosis factor of them lymph node metastasis. Our study aimed to evaluate the correlation between lymph node ratio, the number of involved lymph node stations and skip-N2 metastasis and prognosis of N1-N2 stage non-small cell lung cancer. Methods: A total of 374 patients with N1 and N2 stage non-small cell lung cancer were retrospectively analyzed who underwent radical resection at the Department of Thoracic Surgery, The First Affiliated Hospital of Soochow University from January 2012 to December 2019. Cox regression was conducted to identify the independent prognosis factors for N1-N2 stage non-small cell lung cancer. Survival curves were plotted by Kaplan-Meier method. Subgroup analyses were performed regarding proposals for the revision of the N descriptors in the 8th edition of the TNM classification. Results: Multivariate analysis of Cox regression model confirmed that smoking history, multiple-station lymph node metastasis and lymph node rate were independent prognosis factors for disease-free survival. Male, smoking history, multiple-station lymph node metastasis, lymph node ratio, adjuvant chemotherapy and targeted therapy were independent prognosis factors for overall survival. The 5-year overall survival was 57.4% in skip N2 group, while being 65.1% in N1 group (P=0.138) and 36.2% in the non-skip N2 group (P=0.007). Conclusion: Combined with lymph node ratio, the number of involved lymph node stations and skip metastasis, we can effectively predict the inter-subgroup survival difference.","PeriodicalId":91854,"journal":{"name":"Clinics in surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47242766","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":"Decision Making for Surgical Approaches to Resection of Benign Presacral Tumors in Adult Women: A Case Series","authors":"Xiao J, L. H., Welch Jr, Koythong T, Guan X","doi":"10.25107/cis-v7-id3418","DOIUrl":"https://doi.org/10.25107/cis-v7-id3418","url":null,"abstract":"Abstract Study Objective: To explore decision making strategies for the surgical approach to resection of benign presacral tumors of different sizes and locations. Design: Retrospective case series. Setting: An academic tertiary care university hospital in Guangzhou, China. Patients: Four adult female patients with benign presacral tumors who were admitted to our department for surgical treatment of benign presacral tumors between 2015 to 2020. Interventions: Minimally invasive surgical resection of presacral tumor. Measurements and Main Results: The incidence of benign presacral tumors is relatively low in adults and is much higher in women than in men. However, there is no standard surgical approach for resection of presacral tumors in women. We report 4 women in which benign presacral tumors were removed via a transvaginal, laparoscopic, and combined laparoscopic-vaginal approach. The surgeries were all carried out successfully, and each patient underwent appropriate post-operative follow up without tumor recurrence. Conclusion: Different approaches to the surgical resection of benign presacral tumors exist, and decision making strategies are necessary to determine the most appropriate intervention in various patients. The transvaginal approach is an uncommon but feasible and safe approach for such resection in adult females.","PeriodicalId":91854,"journal":{"name":"Clinics in surgery","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47198498","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":"Clinics in Surgery 1Remedy Publications LLC., | http://clinicsinsurgery.com/ 2021 | Volume 6 | Article 3380 The Effect of Spinal Steroid Injections on COVID-19 Infection and Its Severity","authors":"Sayantan Bose, Subodh Patil, Joshi George K","doi":"10.25107/cis-v6-id3380","DOIUrl":"https://doi.org/10.25107/cis-v6-id3380","url":null,"abstract":"Aim: This paper is to determine the incidence of COVID-19 infection and severe symptoms following spinal steroid injections for pain control. Methodology: This a retrospective observational study based in the department of neurosurgery, Salford Royal Foundation Trust. Study period is from March 23rd, 2020 till December 31st, 2020. 222 patients had these injections during the time period. Data was collected by telephonic interview and online questionnaire. Data was analyzed to find out how many of the people who received steroid injection got COVID infection and how many had severe infection. It was then compared with local infection rates. Results: Out of 222 patients found, 130 patients opted to take part in the survey. Six patients among them had tested positive after the injection and two more patients had symptoms of COVID who have been considered to be positive. Overall, 6.15% of patients who received steroid injections had positive COVID-19 results. 3.85% patients had the infection within 3 months of injection. One patient (0.77%) needed hospital admission due to COVID. The incidence of COVID during this time period in Salford was 6.17% and rate of hospital admission due to COVID was 0.77%. Conclusion: The rate of COVID-19 infection after steroid injection are lower than the local incidence of COVID in Salford during that time period and equivalent to the rate of hospital admission due to COVID. This suggests that a steroid injection in the spine for pain management does not increase the incidence of COVID or cause severe infections.","PeriodicalId":91854,"journal":{"name":"Clinics in surgery","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46499021","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":"Median Nerve Neuritis after Infection by the SARS-CoV-2 Virus","authors":"Marcelo de Pinho Teixeira Alves, João Pedro Gouveia Nóbrega","doi":"10.25107/cis-v6-id3306","DOIUrl":"https://doi.org/10.25107/cis-v6-id3306","url":null,"abstract":"Background: The spectrum of neurological complications from SARS-CoV-2 infection is under constant investigation. According to numerous publications, occurrence of neurological complications can be about 36.4%. There are no reports to date of the occurrence of bilateral median nerve neuritis in the wrist after SARS-CoV-2 infection. Case: A previously healthy 24 years old female was observed in March 2021 due to dysesthesias in both hands, associated with nocturnal discomfort and decreased grip strength. The symptoms started a month earlier with acroparesthesias. SARS-CoV-2 virus infection was in January 2021 and evolved favorably, with progressive remission in about 10 days. Prior to the infection she didn’t have any of the hand symptoms; denied diabetes or metabolic diseases. Negative tests for SARS-CoV-2 infection since February. April 2021, the patient returned with persistent dysesthesias in her hands. Normal EMG, however with Sensitive Conduction Speed (SCS) of 50 m/sec on the right wrist; on the left SCS 55 m/sec. Sensitive latency 2.8 on the right and 2.6 on the left. Amplitude 17 on the right and 24 on the left. MRI detected an increase in signal in PDFS sequences in both median nerves, in the carpal tunnel, with no detected variations in cross-sectional areas or masses. The treatment was a 30 days 150 mg benfotiamine in two daily doses. Discussion: There is a wide variation in the clinical presentation of SARS-CoV-2 infection, ranging from asymptomatic patients to death. Most frequent symptoms are fever, dry cough, sore throat, dyspnea, myalgia, fatigue, chills, diarrhea, chest pain and vomiting, and the most common complications pneumonia and acute respiratory distress syndrome. Neurological manifestations of viral infection can occur in about 36.4% and in 45.5% in severe disease. They include Guillán-Barré and Miller Fischer syndrome; however, these conditions usually occur in more severe cases of the disease, but this patient hadn’t the typical picture of ataxia, ophthalmoplegia and areflexia. Benfotiamine is a synthetic derivative of thiamine with a multifaceted therapeutic profile, with a therapeutic role especially in diabetic neuropathy. Conclusion: Knowledge and recognition of neurological manifestations of SARS-CoV-2 infection and early detection of secondary peripheral neuropathies result in improvement of patients' clinical results and development of ideal ways of treatment. Although only a small percentage of patients develop peripheral neuropathy, in a pandemic this can result in a major social and health impact. The reported case is the first case of bilateral secondary median nerve neuritis in the literature. Level of evidence 4.","PeriodicalId":91854,"journal":{"name":"Clinics in surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48044587","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":"Kidney Stone Disease of Non Gouty Origin in 264 Popes (34-2005 AD): A Historical Review","authors":"Natale Gapare De Santo, C. Bisaccia, L. D. De Santo","doi":"10.25107/cis-v6-id3307","DOIUrl":"https://doi.org/10.25107/cis-v6-id3307","url":null,"abstract":"A total of 11 non-gouty popes out of 264 (4.1%) died of kidney stones (very probably calcium stones) between the years 34-2005 AD. The prevalence of kidney stones was lower than expected on the basis of recent population-based data. The discrepancy might be due to the changing nutritional habits. Causes of death included acute kidney injury, chronic kidney disease, and stroke. The disease was highly recurrent in 9 of 11 (88.1%). Recurrences were observed 1 to 30 years after the first attack. Mean age at death was 63.1 years, much shorter than expected in popes. Clinically recurrent back-flank-groin pain emerged as a hallmark indicator of kidney stones in the narratives. It was sometimes associated with fever, hematuria, purulent urine and/or frequent urination and dysuria. Some popes were obese, sedentary, voracious and wine drinkers; others were lean, took long walks, ate frugal meals and practiced restraint when it came to drinking alcohol. They were cured with bed rest, diets, donkey milk, mineral waters, decongestant, purgatives, thermal baths, blood-letting, and surgery.","PeriodicalId":91854,"journal":{"name":"Clinics in surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46983701","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}