Clinics in surgery最新文献

{"title":"Effect of BMI on Postoperative Outcome, after Off-Pump CABG, A Prospective Observational Study","authors":"M. Khan, S. Gupta, Ambia Afza, B. Basak, Md. Kamrul Hasan, Md. Quamrul Islam Talukder","doi":"10.25107/cis-v6-id3299","DOIUrl":"https://doi.org/10.25107/cis-v6-id3299","url":null,"abstract":"Background: Obesity and its complications are global health concerns with rising interests, and in Bangladesh, the scenario is not different. This study was designed to analyze the effect of BMI on postoperative outcomes in patients who underwent Off-Pump Coronary Artery Bypass (OPCAB)graft surgery. Methods: This prospective observational study was conducted from September 2017 to August 2018 in the department of cardiac surgery, NICVD & 90 patients were divided into two groups. 43 patients in group A, with BMI ≥ 25 kg/m2 and 47 patients in group B, with BMI<25 kg/m2. Results: In between groups, homogenous distribution was noted in terms of age and sex. Pre-operative risk factors, such as hypertension, dyslipidemia, and sternal wound infection, harvest site infection along with post-operative AF, were significantly higher in group A in comparison to group B. Conclusion: Obese patients undergoing OPCAB surgery should undergo maximum care. Meticulous tissue handling during OPCAB surgery in obese patients is needed to avoid or minimize sternal, and harvest site wound infection.","PeriodicalId":91854,"journal":{"name":"Clinics in surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46849828","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":"Monitoring an Ongoing Enhanced Recovery After Surgery (ERAS) Program: Adherence Improves Clinical Outcomes in a Comparison of Three Thousand Colorectal Cases.","authors":"Iris H Wei,&nbsp;Emmanouil P Pappou,&nbsp;J Joshua Smith,&nbsp;Maria Widmar,&nbsp;Garrett M Nash,&nbsp;Martin R Weiser,&nbsp;Philip B Paty,&nbsp;Jose G Guillem,&nbsp;Anoushka Afonso,&nbsp;Julio Garcia-Aguilar","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Aim: </strong>In 2014, Memorial Sloan Kettering Cancer Center was identified as an outlier for increased length of stay (LOS) after colorectal surgery. We subsequently implemented a comprehensive Enhanced Recovery After Surgery (ERAS) program in January 2016, which is continually monitored to target areas for improvement. The primary aim of this study was to evaluate the impact of a newly established ERAS program in a high-volume colorectal center over time.</p><p><strong>Method: </strong>This was a retrospective cohort study, comparing 3000 sequential cancer patients who underwent elective colorectal surgery before and after ERAS implementation. Patients were divided into three groups (Pre-, Early, and Late ERAS). Adherence to ERAS process measures and outcomes (LOS, complications, and 30-day readmission) were compared among the three time periods.</p><p><strong>Results: </strong>Adherence to ERAS metrics significantly increased over time, from a median of 25% Pre-ERAS to 67% Early and 75% Late ERAS (<i>p</i> < 0.0001). Mean LOS decreased from 5.2 days Pre-ERAS to 4.5 Early and 4.0 Late ERAS (<i>p</i> < 0.0001). There were no differences in rates of complications or readmissions, and patients with shorter LOS had lower readmission rates. With ERAS, the readmission rate was 4.4% for patients discharged within 3 days, versus >10% for LOS ≥5 days (<i>p</i> < 0.0001).</p><p><strong>Conclusion: </strong>Initiation of an ERAS program at a high-volume colorectal center was associated with decreased LOS, without increasing morbidity. Increased ERAS adherence was associated with a further decrease in LOS. Multidisciplinary monitoring to promote protocol adherence is necessary for maintaining a safe and effective ERAS program.</p>","PeriodicalId":91854,"journal":{"name":"Clinics in surgery","volume":"5 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7643765/pdf/nihms-1635701.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38583036","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":"Automated Sagittal Craniosynostosis Classification from CT Images Using Transfer Learning.","authors":"Lei You, Guangming Zhang, Weiling Zhao, Matthew Greives R, Lisa David, Xiaobo Zhou","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Purpose: </strong>Sagittal Craniosynostosis (CSO) occurs when the sagittal suture of a growing child's skull is fused. Surgery is the primary treatment for CSO. Surgical treatment involves removing the affected bones and increasing the volume of the cranium by repositioning the bone segments or using external forces to guide growth. These external forces are often achieved by internal springs or external helmet therapy and depend on surgical judgment based on patient age, severity, and subtypes of CSO. Physicians usually classify CSO subtypes by examining CT images. In our previous work, we built an objective computerized system to mimic the physician's diagnostic process based on more than 100 hand-crafted features. However, hand-crafted features-based methods have limitations in representing all aspect features of the CSO images. To improve feature extraction efficiency, classification accuracy, and reduce subjectivity in the choice of surgical techniques, in this study, we developed a deep learning-based method to learn advanced features for the classification of CSO subtypes.</p><p><strong>Methods: </strong>First, a Hounsfield Unit (HU) threshold-based method was used to segment 3D skulls from CT slices. Second, the 3D skulls were mapped to a two-dimension space by hemispherical projection to obtain binary images with a resolution of 512 × 512. These binary images were augmented to generate a new dataset for training deep convolutional neural networks. Finally, the pre-trained deep learning model was fine-tuned on the generated dataset using transfer learning method. Both training accuracy and cross-entropy curves were used to assess the performance of the proposed method.</p><p><strong>Results: </strong>Three deep convolutional neural networks were built based on the manual classification results of CSO patients by three surgeons. The classification difference between surgeons was 54%. The prediction accuracy of the three deep learning models based on the generated dataset was greater than 90%, which was higher than the accuracy from the previous models (72%). The model based on the classification results of the senior surgeon achieved the highest performance accuracy (75%) in unseen real data, compared to 25% and 37.5% for two junior surgeons, respectively.</p><p><strong>Conclusion: </strong>Our experimental results show that deep learning is superior to the hand-crafted feature-based method for sagittal CSO classification. The performance of deep learning models still depends on the quality of the original data. The classification variability of physicians can result in differential model outputs. When given more sagittal CSO images with proper annotations, the deep learning-based models can be more stable, approximate the diagnosis performance of physicians and have the potential to reduce the inter-observer variability thereby providing clinical insight into research and the treatment selection in patients with CSO.</p>","PeriodicalId":91854,"journal":{"name":"Clinics in surgery","volume":"5 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7377631/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38185849","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":"Mesh Sprayer Device with Liquefied Mesh Delivery System: Proposed Alternative for Currently Available Meshes in Hernia Repair and Supplement to Abdominal Closure.","authors":"Alireza Hamidian Jahromi,&nbsp;David H Ballard,&nbsp;F Dean Griffen","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":91854,"journal":{"name":"Clinics in surgery","volume":"5 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7147508/pdf/nihms-1577039.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37827515","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":"Transanal Haemorrhoidal Dearterialisation and Rectal Mucopexy: Clinical Outcomes and Patient Perspectives","authors":"Abdeldayem Ma, Waterman Jl, Haray Pn","doi":"10.25107/cis-v4-id2656","DOIUrl":"https://doi.org/10.25107/cis-v4-id2656","url":null,"abstract":"Introduction: Transanal Haemorrhoidal Dearterialisation (THD) has evolved as a surgical technique over time. THD can be combined with Rectal Mucopexy (THD-RM) to aid in the reduction of haemorrhoidal prolapse. Aims: Our aims were to assess short and long term clinical outcomes after THD-RM and to assess patients’ satisfaction following THD-RM. Methods: All patients who underwent THD-RM at our Hospital from 2014 were included. Data analysis included a structured questionnaire administered via telephone. Results: A total of 55 patients underwent a THD-RM between 2014 and 2019. There was a response rate of 87.27%, 48 patients. The most common presenting symptom was bleeding (85.42%). Within 48 h post-operative, 32 patients (66.67%) complained of discomfort or mild pain. Length of time to normal activities varied between 1 day to 57 days (median 14 days). Long term, 37 patients (77.08%) described complete resolution of symptoms. The patient satisfaction questionnaire found 40 patients (83.33%) were very satisfied with their outcomes. Follow-up ranged from 3-65 months (mean 27 months). Seven patients (14.58%) reported recurrence of some symptoms. Conclusion: Our initial experience with short and long term follow up after THD-RM procedure has been very positive and our results are in line with many others. Waterman JL1, Abdeldayem MA1* and Haray PN1,2 1Department of Colorectal Surgery, Prince Charles Hospital, Merthyr Tydfil, UK 2Department of Colorectal Surgery, University of South Wales, UK","PeriodicalId":91854,"journal":{"name":"Clinics in surgery","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41400813","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 Case of Ascending Aortic Aneurysm and Aortic Insufficiency Years after TGA, Treated by Button Bentall","authors":"Mohammad Alsalaldeh","doi":"10.25107/cis-v4-id2472","DOIUrl":"https://doi.org/10.25107/cis-v4-id2472","url":null,"abstract":"A 20 year old male patient, presented to our clinic complaining from effort dyspnea with history of Transposition of the Great Arteries (TGA) operation 20 years ago, investigations were done and he was found to have ascending aortic aneurysm (60 mm) and severe (4º) aortic insufficiency. Operation decision was taken; after preop preparations had been completed the patient underwent Button Bentall operation, on the post op first day, revision was done in operation room because of bleeding and tamponate. On the 10th day of the operation he was discharged with full recovery and on medical treatment.","PeriodicalId":91854,"journal":{"name":"Clinics in surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45434823","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":"Voice Outcomes in Laryngotracheal Stenosis: Impact of the Montgomery T-tube.","authors":"Vaninder K Dhillon, Lee M Akst, Simon R Best, Alexander T Hillel","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Objectives: </strong>Montgomery T-tubes enable patients with laryngotracheal stenosis to maintain airway patency. They also restore the ability to phonate in many patients. The primary objective is to compare voice quality of life outcomes in patients before and after Montgomery T-tube placement. The secondary objective is evaluating complications associated with T-tube placement.</p><p><strong>Methods: </strong>Retrospective chart review of patients with T-tubes for laryngotracheal stenosis from 2012-2016. Patient demographics, Voice-Related Quality of Life (VRQoL) scores, indication for t-tube placement, t-tube duration and complications were analyzed.</p><p><strong>Results: </strong>Thirteen patients were included. The most common indication for T- tube placement was grade III-IV stenosis with aphonia/significant dysphonia (n=7, 54%). Other indications were grade III/IV stenosis who desired T-tube over tracheostomy (n=2, 15%), primary glottic stenosis (n=3, 23%), and primary tracheomalacia (n=1, 8%). There was a statistically significant improvement (p<0.05) in VRQoL after T-tube placement. Five patients (38%) went from aphonia to voicing. Granulation tissue was the most common complication related to T tube placement. There were no deaths related to T-tube placement after two years.</p><p><strong>Conclusion: </strong>Montgomery T-tubes can restore phonation in a population of patients with iatrogenic high grade stenosis who are aphonic/severely dysphonic with traditional tracheotomies. The complication rate must be considered, with granulation tissue formation the most common.</p>","PeriodicalId":91854,"journal":{"name":"Clinics in surgery","volume":"3 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6291003/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36789740","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":"Antimicrobial Peptides: A Potential Therapeutic Option for Surgical Site Infections.","authors":"Berthony Deslouches,&nbsp;Y Peter Di","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Surgical Site Infections (SSI) represents one of the most common hospital-associated infections worldwide, and many cases of SSI are due to multidrug-resistant bacteria with the propensity to attach to tissues and form biofilm on post-surgical sites. While systemic antibiotic treatment (prophylactically and therapeutically) is usually effective, SSI can be difficult to treat when associated with drug resistance. Antimicrobial Peptides (AMPs) are an untapped resource that could serve as an effective therapeutic option, as they display broad-spectrum antimicrobial activity regardless of antibiotic resistance. In the last decade, it has become increasingly clear that AMPs also display antibiofilm properties. We reviewed herein the potential of AMPs as promising therapeutics for SSI and the need for structural optimization to develop AMPs for clinical applications.</p>","PeriodicalId":91854,"journal":{"name":"Clinics in surgery","volume":"2 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6101250/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36421696","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":"Sildenafil Transiently Delays Early Alveolar Healing of Tooth Extraction Sockets.","authors":"Elysse Orchard, Wanda Green, Renjith Parameswaran Nair, Fleurette Abreo, Gulshan Sunavala-Dossabhoy","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Bone is a unique tissue that has the ability to repair itself and return to full function. Bone regeneration is a well synchronized biological process that recapitulates embryonic bone development. The establishment of a functional vascular supply has been shown to be essential for proper ossification of newly deposited bone, and impaired angiogenesis as in advanced age, diabetes, and anti-cancer treatments affect bone repair. Endothelial Guanosine, 3', 5'-Cyclic Monophophate(cGMP) is known to support angiogenesis, and sildenafil, a Phosphodiesterase 5 (PDE5) antagonist, prevents cGMP hydrolysis and thereby, promotes the formation of new blood vessels. Since the development of functional vascular networks is critical to bone repair, we investigated the effects of sildenafil on early alveolar bone regeneration following exodontia. Our results demonstrate that per-oral administration of sildenafil (10 mg/kg/day) in rats delays the dissolution and replacement of the sanguine clot with granulation tissue. As a result, the number of replicating cells, a hallmark of regenerating tissue, observed on day 4 was remarkably lower in sildenafil-treated animals than their control counterparts (mean±SD; control: 47.35±9.21; sildenafil: 11.47±5.14). Similarly, cells expressing transcription factor Cbfa-1/Runx2 and osteopontin, markers of differentiating osteoblasts, were fewer in treated animals (mean±SD; control: 83.18 ± 4.60; sildenafil: 13.77 ± 4.63). Treatment with hydrolysis-resistant cyclic GMP (cGMP) showed findings similar to sildenafil-treated animals suggesting a negative impact of cGMP on early inflammatory phase of bone healing. However, histological differences were not significant between the 2 groups on day 8. Based on these findings, we conclude that sildenafil temporarily retards early events in alveolar bone healing.</p>","PeriodicalId":91854,"journal":{"name":"Clinics in surgery","volume":"2 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6006518/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36246601","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":"Emergency Transfemoral Amputation in a Severely Sick and Hemodynamically Unstable Patient through Eco-Guided Peripheral Nerve Block: Case Report","authors":"Luis Flavio Franca V Muniz, Jessica Francisco Meireles, Daissuke Kajita, Melissa Ameloti G Avelino","doi":"10.25107/cis-v6-id7782","DOIUrl":"https://doi.org/10.25107/cis-v6-id7782","url":null,"abstract":"Critically ill and/or anticoagulated patients remain a great challenge for anesthesiologists regarding the anesthetic procedure. Its perioperative management should focus on organ preservation and avoid further damage. In this context, ultrasound-guided regional blocks are essential tools, as they avoid neuraxial invasion and deterioration in borderline hemodynamics, conferred by spinal anesthesia and general anesthesia, respectively. In this report, we present a case of a patient with septic shock, anticoagulated, and in need of an emergency surgical approach in the right lower limb in which ultrasound-guided peripheral nerve block was essential for a favorable outcome for the patient. Case Report: Patient in septic shock in need of amputation of the right lower limb at the level of the thigh, with unstable hemodynamics and severe respiratory conditions, undergoing ultrasound-guided peripheral nerve block, of the right femoral, sciatic and lateral cutaneous nerves of the thigh, as a single anesthetic technique. Conclusion: Regional anesthesia of the peripheral nerve guided by ultrasound as a unique anesthetic technique, performed by experienced professionals or under supervision, is effective and safe for lower limb surgical procedures. We suggest this approach, especially in hemodynamically borderline patients or seriously ill with or without anticoagulation.","PeriodicalId":91854,"journal":{"name":"Clinics in surgery","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2016-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69299320","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}