1st Postoperative Day Research Articles

The Results of RATS and VATS Anatomical Resections in the Initial Phase

Robot-assisted (RATS) anatomical resection is a new method in the treatment of lung tumours, but is controversial due to its cost. The aim of our retrospective study was to compare the clinical results of the RATS and VATS anatomical resections.The first 100 VATS and RATS resections were analysed with regard to tumour stage, intra- and postoperative complications, conversion, operation time, hospital stay and length of drainage treatment, postoperative pain (numerical rating scale, NRS) and mortality. The results were compared using the chi-square, Fisher and independent t tests.In the VATS group, stage I was more frequent, stage II less frequent (stage I: 73.4%, stage II: 19.2%) than in the RATS group (stage I: 65.5%, stage II. 23%, p=0.695). The operating time was longer with RATS (213.5min vs. 190.3min, p=0.008), due to the docking and undocking time of the robotic system to the patient. The proportion of sublobar resections was significantly higher in the RATS group (28% vs. 7%, p<0.001). The proportion of intraoperative complications (7% vs. 14%, p=0.073) and conversion rate (9% vs. 11%, p=0.407) were lower in the RATS surgery. The number of lymph nodes removed was high in both groups and not significantly different (VATS: 21.6, RATS: 22.1). The hospital stay was shorter after RATS (8.8 days) than after VATS (12.5 days, p<0.001), as was the length of postoperative drainage treatment (5.6 vs. 8 days, p<0.001). In the RATS group, postoperative pain on the 1st and 2nd postoperative day was significantly lower, as based on the numeric rating scale (1.68 vs. 2.83, p<0.001, 0.99 vs. 2.41, p<0.001). The complication rate was significantly higher after VATS than after RATS (57% vs. 33%, p=0.001), and fewer reoperations were necessary after RATS (3%) than in the VATS group (8%, p=0.121). Four patients died in the VATS group, none after RATS (p=0.043).The robot-assisted technique enables anatomical resections with lower conversion, complication rates and mortality, as well as less postoperative pain. Robotic surgery has proven to be safe and oncologically comparable to anatomical VATS resections for lung cancer.

Which Technique is Preferable for Grade 2–3 Hemorrhoidal Disease: Laser vs. Rubber Band Ligation? A Retrospective Study

Abstract Background The aim of this study is to compare the short and long-term results (postoperative pain, complications, return to daily life, recurrence) between patients who underwent laser hemorrhoidoplasty (LH) and rubber band ligation (RBL) due to grade 2–3 hemorrhoidal disease. Methods The results of patients who underwent LH and RBL between June 2020 and June 2023 for grade 2–3 hemorrhoidal disease were evaluated retrospectively. The patient information was examined in terms of operation time, postoperative 1st, 7th and 14th day visual analog scale (VAS) values, the amount of analgesic used in the first 7 postoperative days, return to normal life (days), recurrence within 1 year and other complications (postoperative bleeding, thrombosis, urinary retention, infection/abscess, anal stenosis, deterioration in continence). Results A total of 260 patients were included in the study, 166 of whom underwent RBL and 94 LH. Operation time, VAS values, postoperative 7-day analgesic use (mg), worsening of incontinence, time to return to normal life (days), complications and recurrence within 1 year evaluated. LH has statistically significant lower postoperative 1st day pain and less analgesic use (mg) than RBL (p &lt; 0.001). Conclusıons LH and RBL both offer effective treatment options for grade 2–3 hemorrhoidal disease, with comparable recurrence rates and time to return to normal life. However, LH is associated with significantly less postoperative pain and analgesic use on the first postoperative day, potentially enhancing patient satisfaction.

Gabexate mesylate thermo-sensitive in-situ gel is effective for treating grade-III pancreatic trauma in beagle dogs guided by contrast-enhanced ultrasound.

This study evaluates the efficacy of gabexate mesylate thermosensitive in-situ gel (GMTI) in the treatment of beagle grade III pancreatic trauma (PT) with the assistance of contrast-enhanced ultrasound (CEUS) and investigates its mechanism of action. A grade III PT model consisting of 15 beagle dogs with severed main pancreatic ducts was created and treated with cephalic vein injection of gabexate mesylate (GM) (1.54 mL/10 kg, TID) and peripancreatic injection of GMTI (4.63 mL/10 kg, QD) guided by CEUS within 24 h post-surgery. Ascites and serum levels of amylase (AMY), lipase (LPS), C-reactive protein (CRP), interleukin (IL)-6, tumor necrosis factor (TNF)-α, and urinary trypsinogen activating peptide (TAP) were detected by ELISA. Histopathological changes in the canine pancreas were observed by Hematoxylin and Eosin staining. CEUS accurately displayed pancreatic lesions and guided catheterisation. Compared to the control group, the ascites was significantly reduced after treatment (p < 0.01). AMY and LPS ascites significantly decreased on post-operative 1st and 2nd day (p < 0.01). The levels of AMY, LPS, CRP, IL-6, and TNF-α in serum were decreased (p < 0.05 or p < 0.01). Urinary TAP was decreased 1 and 2 days after treatment (p < 0.05 or p < 0.01, respectively). In the control group, pancreatic tissue necrosis was evident in the wound area. Normal glandular cell structures and fibrous tissue hyperplasia were observed in the wound area after GMTI treatment. The GMTI group performed better than the GM group in improving pancreatic histology and reducing AMY levels in the early post-operative period. Guided by CEUS, daily peripancreatic injections of GMTI in Beagles effectively inhibit pancreatic enzyme activity and aid in the adjuvant treatment of pancreatic trauma.

Robot-assisted Kidney Transplantation: The 8-year European Experience.

Evidence regarding perioperative results and long-term functional outcomes of robotic-assisted kidney transplantation (RAKT) is limited. We evaluated perioperative surgical results and long-term functional outcomes of RAKT in patients receiving kidney transplants from living donors. This retrospective analysis is based on a prospective multicenter cohort study conducted from July 2015 to October 2023 across ten European centers. A total of 624 patients who underwent heterotopic RAKT from living donors were included, excluding those who received orthotopic RAKT. The primary outcomes measured were long-term renal function, perioperative complications, and survival rates. Renal function was assessed with the estimated glomerular filtration rate (eGFR). The Clavien-Dindo classification (CDC) was used to describe early (within 30d) and late (from 31 to 90d) postoperative complications. The probabilities of dialysis, graft nephrectomies, and any-cause mortality during follow-up were reported in terms of the 5-yr cumulative incidence. A total of 624 patients with a median age of 35yr (interquartile range [IQR]: 26-52) underwent RAKT. Preemptive RAKT was performed in 52% of cases, and the majority (84%) had the transplant in the right iliac fossa. The median operative time was 210 min (IQR: 180-262), with a rewarming time of 43 min (IQR: 38-50). Intraoperative complications were rare (1.1%), and postoperative graft nephrectomy occurred in 1.9% of patients. High-grade (CDC grade ≥3) early and late postoperative complications were observed in 7.7% and 2.3% of patients, respectively. Rates of incisional hernias, ureteral stenosis, and arterial stenosis were 1.4%, 1.1%, and 0.2%, respectively. The median eGFR values were 19, 52, and 53 ml/min/1.73m2 on the 1st postoperative day, on the 7th postoperative day, and at 6 mo, respectively. Over a median follow-up of 23mo (IQR: 6-49), 17 patients received dialysis, 11 patients underwent graft nephrectomy, and four patients died. None of the deaths were due to RAKT. The main limitation is the absence of a comparator group. With the largest experience worldwide on RAKT, we confirm the perioperative safety and excellent long-term functional outcomes of this procedure. Given the benefits of a minimally invasive robotic approach, these findings support the broader adoption of RAKT as a viable option for kidney transplantation.

Evaluation of bone healing in trabeculae structure of mandibular corpus and angulus fracture patients with fractal dimension analysis.

Fractures of the mandibular corpus and angulus are affected by different forces result from different strength of the muscles that influenced them. Therefore, it is presumed that there is a different in healing rate. Fractal dimension radiologic analysis assesses the trabecular pattern, due to it can be used to observe the healing process of bone fractures. The study aimed to compare the healing process of mandibular corpus and angulus fractures with fractal dimension analysis (FD) of trabecular patterns on panoramic radiographs through ImageJ software as consideration to determine mastication loading time. This retrospective cross-sectional study observed medical records and panoramic radiographs of patients with a diagnosis of corpus and or mandibular angulus fractures undergoing open reduction (ORIF) 1 plate treatment combined with maxillomandibular fixation (MMF) at Hospital in 2017-2023. Observations were carried out on postoperative 1st day, 2nd week, 8-13th week and >13th week respectively. Twenty-five subjects who met the inclusion requirements were involved in the study. The results of Two-Way ANOVA statistical test and Fisher's LSD post-hoc showed that the FD values of corpus fracture were significantly greater than that of mandibular angulus with p 0.000 (H1), 0.003 (H2), 0.03 (H3), 0.000 (H4) respectively. In both groups of mandibular corpus and angulus fractures, there was a significant effect of time with p=0.00 in each group. The longer the observation time, the more trabeculae patterns were formed in the healing process of corpus and angulus fractures. Post ORIF observation of corpus fracture shows a greater trabecula formation value which indicates faster healing when compared to mandibular angulus fracture.

Local anaesthesia vs. brachial plexus block in trapeziometacarpal joint arthroplasty

IntroductionAn established anaesthetic procedure used during total trapeziometacarpal joint (TMCJ) arthroplasty is the brachial plexus block (BPB). It was hypothesized that local anaesthesia (LA) provides advantages in overall cost, enables intraoperative assessment of the prosthesis, and minimises the anaesthetic risk. In this study, LA to BPB was compared and outcomes, safety, and overall patient satisfaction were analyzed.Materials and methodsIn this single-center cohort study, 32 patients (34 operated thumbs) who underwent total TMCJ arthroplasty between February 2018 and July 2021 were included. Two groups were formed depending on the anaesthetic method used. One group was operated under LA, and the other under BPB. Functionality scores were assessed preoperatively and three month postoperatively. Additionally, pain was assessed on the 1st and 12th postoperative day. Data on intraoperative pain and anxiety, overall satisfaction, pain medication use, and willingness to undergo the procedure again were gathered through a retrospective telephone survey.ResultsNo significant differences between LA and BPB were found in terms of functional outcomes, pain reduction, and willingness to repeat the procedure. The analysis further showed significant differences in intraoperative anxiety (higher in the LA group; LA 1.69, SD: 2.65; BPB 0.28, SD: 0.58; measured using a numeric rating scale 0–10; p = 0.045), operation length (higher in BPB group; LA 39 min, SD: 7.46; BPB 45 min, SD: 7.02; p = 0.018) and overall setup time (higher in BPB group; LA 76 min, SD: 15.85; BPB 102 min, SD: 19.66; p < 0.001). No conversion from LA to another anaesthetic method was necessary.ConclusionThe use of LA in total TMCJ arthroplasty is a practical and reliable alternative to the well-established BPB. LA reduces the cost of the procedure, necessity of an anaesthesiology team and the duration of the patients´ hospital stay. Patients should be actively involved in selecting the anaesthetic method to optimize the operative procedure and overall outcome.

Comparison of Temporalis Fascia Graft Uptake in Patients with Large Tympanic Membrane Perforation Undergoing Type 1 Tympanoplasty

Background: Managing a large tympanic membrane perforation without middle ear disease involves reconstruction of tympanic membrane through tympanoplasty. Graft uptake may be highly influenced by the choice of either an endoscopic or microscopic modality. Objective: This study aimed at comparing graft uptake rates and hearing results for patients with large tympanic membrane perforations who received Type 1 tympanoplasty using temporalis fascia grafts via endoscopic and microscopic modalities. Methods: Sixty patients presenting with large-sized tympanic membrane perforations were divided into two different groups, Group A consisting of patients who underwent endoscopic tympanoplasty and Group B consisting of patients who underwent microscopic tympanoplasty. Intraoperative damage to chorda tympani nerve was monitored and post-operative pain was measuered by neumeric pain scale on 1st and 7th post-operative days. The graft uptake after 42 days of operation was analyzed and the hearing improvement was noted by using audiometric tests. The research took place at Sir Salimullah Medical College, Dhaka, Bangladesh, between July 2022 to June 2023. Results: Graft uptake in Group B was 90% while in Group A it was 83.33%. The average postoperative hearing gain in Group A and in Group B was 9.29 dB and 10 dB respectively. There has been no statistical significance found between the two techniques regarding graft uptake and hearing outcome but significant pain score was seen on 1st POD. Conclusion: Both the endoscopic and microscopic tympanoplasty techniques yielded similar graft uptake rates and hearing improvements in patients with large tympanic membrane perforations, thus the choice of technique should depend on surgeon preference rather than the expected outcome. More studies are needed in larger cohorts for the validation of these results.

Evaluating anterior segment stability and corneal endothelium after prolene gonioscopy assisted transluminal trabeculotomy (GATT) in open-angle glaucoma.

This study investigates the short-term effects of prolene gonioscopy-assisted transluminal trabeculotomy (GATT) on anterior segment parameters and corneal endothelium in patients with open-angle glaucoma. This retrospective study included 30 eyes from 30 patients who underwent GATT surgery. Demographic data, ophthalmological examination findings, and intraocular pressure (IOP) measurements using a Goldman applanation tonometer were recorded. Scheimpflug images were acquired at the pre-operative stage, as well as on the 1st day, 1st week, and 1st month postoperatively. Corneal endothelial cell counts were obtained via specular microscopy. The mean age of patients was 60.3 ± 15.5years. Anterior chamber depth and central corneal thickness increased on the 1st postoperative day (p:0.002, p < 0.001, respectively). Changes in anterior chamber depth values at the postoperative 1st week and 1st month compared to baseline were not statistically significant. Central corneal thickness decreased significantly at the 1st postoperative month compared to baseline (p:0.007). Corneal endothelial cell counts at the 1st month were comparable to baseline values (p:0.936). Our findings reveal that prolene gonioscopy-assisted transluminal trabeculotomy induces temporary changes in anterior segment parameters but preserves corneal endothelial cell count within the first month, suggesting a promising profile for GATT in glaucoma management.

Plasma leukocyte-derived extracellular vesicles are related to target vessel revascularization in off-pump coronary artery bypass grafting.

In multivessel coronary disease, interventional therapy is recommended to improve symptoms and survival. Inflammatory activation is postulated as one of the coronary atherosclerosis progression risk factors and prognostic indicators of surgical intervention. Counts of plasma extracellular vesicles (EVs) derived from erythrocytes, leukocytes, and platelets are elevated in patients with inflammatory diseases, including atherosclerosis-based cardiovascular diseases. We aimed to estimate the association between blood flow measurements in coronary artery bypass grafts and EV plasma count changes in patients undergoing surgical coronary revascularization. Forty-four consecutive patients who underwent surgical off-pump revascularization (33 males, 75%) in the median (Q1-Q3) age of 65 (58-69) were included. The blood flow in the implanted coronary artery bypass grafts was measured intraoperatively. EV counts were measured at baseline (hospital admission) and on the 1st and 3rd postoperative days. The numbers of EVs from erythrocytes (CD235+), leukocytes (CD45+) and platelets (CD61+) were measured using flow cytometry with fluorescently labeled antibodies against specific antigens exposed on the EVs. The numbers of leukocyte-derived EVs were lower in patients who received a LIMA-LAD graft (p = 0.020). The total EV plasma count changes were found significant for RIMA-LAD grafting (p = 0.028) and LIMA-LAD (p = 0.015) in arterial and arterio-venous grafting, respectively. Surgical revascularizations affect EV plasma count, including significantly lower postoperative values of leukocyte-derived EVs related to left descending artery grafting.

Post Operative Outcome of Conventional Dacryocystorhinostomy with Mitomycin C and Without Mitomycin C

Background: Dacryocystitis is an inflammatory condition of the lacrimal sac, typically caused by obstruction of the nasolacrimal duct. The purpose of the study compares the results of intra operative Mitomycin C application in DCR surgery compared to external DCR without Mitomycin C. Materials and methods: This was randomized control trial. A total of 80 patients of primary acquired nasolacrimal duct obstruction were divided into 2 groups on the basis of simple random sampling. Group-1 contained 40 patients who received 0.02% solution of MMC at the osteotomy site during surgery and considered as the study group and group-2 contained another 40 patients who did not get MMC during surgery and considered as the control group. Patients were followed on 1st post-operative day, 1st week, 1-, 3-, 6- &amp; 12-months interval. Patency of lacrimal passage was assessed by lacrimal syringing and patient’s symptoms were recorded on each follow up. Results: Data shows that there was statistically significant difference in the study showed 39 (97.50%) patients with patent lacrimal passage, only 1 (2.50%) patient was found blocked in their lacrimal drainage system in 1, 3, 6 Months and finally 1 year follow up time. On the other hand in control, 34 (85%) patients showed patency of the drainage system after 1 year and 6 (15%) patients showed blockage and this results was maintained up to 1 year follow up after treatment. During the follow up period, no complications such as abnormal nasal bleeding, mucosal necrosis or infection were noted in any patients. Conclusion: Distinctly higher success rates were achieved in patients undergoing DCR with intra operative MMC as compared to those undergoing external DCR. IAHS Medical Journal Vol 7(1), June 2024; 22-25

Comparison of mean postoperative decrease in hemoglobin level in patients undergoing transurethral resection of prostate with and without preoperative intraprostatic epinephrine.

Objective: To determine and compare the mean decrease in hemoglobin level from the baseline value in patients undergoing TURP with and without preoperative intraprostatic epinephrine injection. Study Design: Analytical Cross Sectional study. Setting: Department of Urology, Allied Hospital, Faisalabad. Period: Nov 2023 to Feb 2024. Methods: After ERC approval and taking informed consent a total of 40 patients with enlarged prostate and scheduled for TURP, having comparable baseline clinical and laboratory characteristics such as age, preoperative prostate size and baseline hemoglobin were enrolled in the study &amp; were divided in two equal numbered groups called group A and group B, each having 20 patients in it. Before performing monopolar TURP group A patients were given 200mcg of intraprostatic epinephrine injection diluted in 20ml of normal saline (10ml in each right &amp; left lobe) under transrectal ultrasonic guidance via the transperineal route, while no such intervention was done before TURP in group B patients. One pint of whole blood was transfused to the patients of both the groups intraoperatively and blood samples were sent to laboratory on 1st post-operative day to determine the postoperative hemoglobin levels of patients of both the groups. Data was entered on the designated pro forma for analysis. Results: Postoperative hemoglobin levels were significantly higher in group A patients (mean and S.D 11.83 ±1.01 g/dl) as compared to the group B patients (mean and S.D 11.00 ± 1.06 g/dl) with a p value of 0.015, and hence drop of hemoglobin levels from the baseline values were lower in group A patients (mean and S.D 1.28 ± 0.89 g/dl) as compared to the group B patients (mean and S.D 2.31 ± 0.98 g/dl), confirming a statistically significant difference with p value of 0.001. Conclusion: The hemorrhage associated with TURP can be decreased significantly by giving preoperative intraprostatic epinephrine injection. This is a clinically safe technique that can not only reduce the postoperative blood transfusion requirements but can also allow the operating surgeon to resect more tissue within the desired time thus increasing the efficacy of TURP.

Higher erythrocytes in cerebrospinal fluid on the first and seventh postoperative day: Associated with poor outcome in aneurysmal subarachnoid hemorrhage patients.

Aneurysmal subarachnoid hemorrhage is an acute cerebrovascular disease with high disability and mortality. We intended to explore the association between levels of erythrocytes in cerebrospinal fluid at different times of hemorrhage and the outcome of patients. One retrospective study including 216 patients with aneurysmal subarachnoid hemorrhage undergoing surgeries in the First Affiliated Hospital of Yangtze University from January 2020 to July 2023 was carried. The univariable analysis and multivariable logistic regression analysis were used for factors associated with poor outcome. The level of erythrocytes in cerebrospinal fluid on the 1st postoperative day in patients with poor outcome was 311 × 103/µL, significantly higher than patients with good outcome (108 × 103/µL), P < .001. The level of erythrocytes in cerebrospinal fluid on 7th postoperative day was 86.5 × 103/µL, also significantly higher than patients with good outcome (26.0 × 103/µL). The multivariable logistic regression analysis results showed that erythrocytes in cerebrospinal fluid on the 1st postoperative day (≥177 × 103/µL) and on the 7th postoperative day (≥53.5 × 103/µL) were possibly associated with poor outcome in aneurysmal subarachnoid hemorrhage patients. Treatment with tranexamic acid and continuous lumbar drainage did not result in a decrease of erythrocytes in cerebrospinal fluid. Higher erythrocytes in cerebrospinal fluid on the 1st and 7th postoperative days were associated with poor outcome in aneurysmal subarachnoid hemorrhage patients.

Postoperative pain after parotid surgery-comparison between superficial/total parotidectomy and extracapsular dissection: a prospective observational study.

To evaluate postoperative pain and discomfort after parotid surgery with regard to different surgical approaches. This clinical study was carried out at a single tertiary referral center (2021-2022) and included 2 groups of adult patients (mean age 56.6 ± 12.7 vs. 53.4 ± 14.1years) following elective parotid surgery due to a parotid tumor of any entity.The first group (SP/TP group) consisted of 31 patients after superficial parotidectomy (SP) or total parotidectomy (TP) (n = 31). The second group (ECD group) included all patients who had undergone extracapsular dissection (ECD) (n = 51). Primary endpoints comprised pain on ambulation as well as maximum and minimum pain (NRS 0-10) on the first three postoperative days (PODs). A neuropathic pain component (evaluated on POD 1 and 3), the analgesic score (collected from the patient file on POD 1-3), treatment-related side-effects/pain-associated impairments, and patient satisfaction (all measured on the 1st POD) were defined as secondary endpoints. Patients were surveyed using the standardized and validated "Quality Improvement in Postoperative Pain Treatment" (QUIPS) questionnaire and the painDETECT® questionnaire. Comparisons were performed using independent t tests, Wilcoxon tests, and χ2 tests, and the respective effect sizes were calculated. Looking at the first postoperative day, patients of both groups (SP/TP vs. ECD) reported comparable pain on ambulation (2.8 ± 2.0 vs. 2.6 ± 1.8; p = 0.628, r = 0.063), maximum (3.5 ± 2.2 vs. 3.5 ± 2.3; p = 0.992, r = 0.002) and minimum pain (1.1 ± 1.04 vs. 1.0 ± 1.2; p = 0.206, r = 0.157). Furthermore, there were no significant differences in pain-related restrictions or pain medication requirement. The patients in both groups were equally satisfied with their pain therapy (p = 0.282, R = 0.135). The sum score of the painDETECT® questionnaire delivered clearly negative (< 12) results on average (POD1: 6.81; POD3: 6.59); no significant difference between the groups was found (p = 0.991, R2 < .001). Neither surgical technique on the parotid gland was significantly superior to the other in terms of postoperative pain perception. Overall, postoperative pain can be classified as mild to moderate following parotid surgery. A neuropathic pain component could be excluded for the acute postoperative phase. The study was registered in the German Registry for Clinical Studies (DRKS) (application No.: DRKS00016520).

Effect of lateral extent of pulp tissue removal on the outcome of partial pulpotomy for managing cariously exposed mature permanent molars with symptomatic irreversible pulpitis: A randomized clinical trial.

The aim of this study is to compare the outcomes of restricted partial pulpotomy (R-PP) versus extended partial pulpotomy (E-PP) for managing cariously exposed mature permanent molars with symptomatic irreversible pulpitis (SIP). This double-arm, parallel designed randomized clinical trial was registered at clinicaltrials.gov (registration number: NCT05406557). Following random allocation, 43 participants of each group received the designated intervention. In the R-PP group, 2-3 mm of superficial pulp tissue was removed only from the exposure site, while chamber was completely de-roofed and 2-3 mm of superficial pulp tissue from entire chamber was removed in the E-PP group. Haemostasis was achieved using 3% sodium hypochlorite-soaked cotton pellets. Upon haemostasis, ProRoot mineral trioxide aggregate (ProRoot MTA) was placed over the pulpal wound, overlaid with a resin-modified glass ionomer liner, and restored with composite resin in the same visit. Outcome measures included clinical and radiographic success evaluation at 6 and 12 months, and pain assessment using the visual analogue scale pre-operatively and daily for 7 post-operative days. Nonparametric tests were used for variables including patient's age, pain intensities, mean analgesic consumption, and haemostasis time. Categorical variables including gender, caries type, analgesic intake, hard tissue barrier formation, clinical and radiographic success, and pulp sensibility responses were assessed using Chi-square or Fisher's exact test. Tooth survival was analysed using Kaplan-Meier analysis. A total of 81 cases were analysed at 12 months follow-up. Comparable success was observed in both groups (97.6% in E-PP & 97.5% in R-PP; p > .05). The R-PP group reported significantly lower pain scores on the 1st and 2nd post-operative days than E-PP (p < .05) and required significantly less analgesic intake (p < .05). Hard tissue barrier formation was significantly lower in the R-PP group (p < .05). No significant differences were observed between groups regarding haemostasis time, pulp sensibility responses, and tooth survival (p > .05). Both the PP approaches exhibited comparable success for managing cariously exposed mature permanent molars with SIP. Given the conservative nature of R-PP, it may be used as preferred PP approach for managing such cases. Being the first study of this kind, further work is necessary to draw definitive conclusions.

Seroma incidence and risk factors in women undergoing mastectomies as surgical breast cancer treatment.

Seroma is the most common early complication following surgical breast cancer treatment. Its development is associated with pain, scar complications, adjuvant therapy delays, the need for outpatient visits, and increased care costs. Assess seroma incidence and risk factors in women undergoing mastectomies. This study comprises a prospective cohort encompassing women aged 18 or over undergoing mastectomies as a breast cancer treatment. Patients underwent physiotherapy on the 1st, 7th, and 30th postoperative days for kinetic-functional, skin, and wound healing assessments and were attended to by nurses for surgical wound care, draining liquid on the 7th, 14th, and 21st postoperative days. Seroma was defined as the presence of local fluctuations requiring puncture, regardless of the punctured volume. A total of 249 women were evaluated, with a mean age of 57.5 (SD = 11.8). A total of 77.1% were classified as overweight or obese, 60.2% were hypertensive, 21.3% were diabetic, 66.7% underwent neoadjuvant chemotherapy and 62.7% underwent axillary lymphadenectomies. Seroma incidence was 71.1%, requiring, on average, two aspiration punctures until condition resolution. Overweight or obese women and those who underwent axillary lymphadenectomies exhibited 1.92- and 2.06-fold higher risk for seroma development (OR = 1.92; 95% CI 1.02-3.61; p = 0.042; and OR = 2.06; 95% CI 1.17-3.63; p = 0.012), respectively. Seroma incidence was very high. Being overweight or obese and undergoing axillary lymphadenectomy comprise independent seroma development risk factors. This study is part of a randomized clinical trial evaluating the effectiveness of applying compressive taping to prevent post-mastectomy seroma, which was approved by the Brazilian National Cancer Institute, Research Ethics Committee (2,774,824), and it is registered in the ClinicalTrials.gov (NCT04471142, on July 15, 2020).

Efficacy of ozonated autohemotherapy for improvement of myocardial injury following traumatic brain injury

BackgroundTraumatic brain injury is a kind of injury caused by external violence on the head. Its danger is not limited to life rescue in the early stage of the disease. Moreover, the subsequent inflammatory reaction and the change in its oxidative stress level will cause secondary myocardial injury. The purpose of this study is to explore the myocardial protective effect of ozone autohemotherapy (OA) in the progression of acute traumatic brain injury (TBI).MethodsForty patients with acute TBI were recruited and divided into The treatment group (Group OA, n = 18) and the Control group (Group C, n = 19). Patients in Group OA received OA before surgery and on the 1st and 2nd postoperative days, while patients in Group C underwent autologous blood transfusion. Venous blood was collected from all patients before (T0) and after 7 days (T1) days of surgery for measurement of cardiac troponin T (cTnT) and amino-terminal pro-B-type natriuretic peptide (NT-proBNP). At T0 and T1, transthoracic cardiac ultrasound was performed to measure left ventricular ejection fraction (LVEF), tricuspid annular plane systolic excursion (TAPSE), and venous blood was sampled to determine the contents of superoxide dismutase (SOD) and malondialdehyde (MDA). NIH Stroke Scale (NIHSS) and Glasgow Coma Scale (GCS) scores were calculated, and other clinical indexes were recorded.Results(1) The levels of cTnT at T1 were significantly higher as compared with that at T0 in both groups (p < 0.01). Compared with Group C, a remarkable decline in the content of NT-proBNP was found in Group OA at T1 (p = 0.021). (2) The LVEF (p = 0.002) and serum SOD (p = 0.015) at T1 were significantly increased in Group OA as compared with those in Group C. (3) The length of Intensive Care Unit and hospitalization time for patients in Group OA was distinctly shorter than that for patients in Group C (p = 0.021, p = 0.015, respectively).ConclusionPerioperative OA treatment can alleviate the secondary myocardial injury during the disease course of TBI, which might be associated with its myocardial protective effect against oxidative stress.Trial registrationThis study was approved by the Ethical Committee of Changzhou NO.2 People's Hospital. The protocol was registered prospectively with the Chinese Clinical Trial Registry (ChiCTR2000029612) on February 02, 2020.

ThP2.8 - Reducing postoperative length of stay after thyroidectomy through a standardised multidisciplinary postoperative care protocol does not compromise patient safety

Abstract Aims Our unit had a significantly longer length of stay after thyroid surgery. We introduced change of practice through a standardised multidisciplinary postoperative care protocol. We analyse the effect of the protocol on postoperative length of stay and any impacts on patient safety. Methods A multidisciplinary protocol was implemented and embedded into clinical practice. Data was collected prospectively on consecutive patients undergoing thyroid surgery. Outcomes with reference to adverse events, length of stay and readmissions were audited. Comparisons were made with unit's pre-protocol data and national figures published in BAETS (British Association of Endocrine and thyroid Surgeons) audit report. Results A total of 78 patients underwent 37 total thyroidectomies and 41 lobectomies. Three (8.3%) of the total thyroidectomies had transient hypocalcaemia but none were permanent. None had voice changes or recurrent laryngeal nerve palsy. Three patients were reviewed few days after discharge with mild hypocalcaemia symptoms treated with calcium supplements. One was re-admitted 5 days post discharge with wound infection. Twenty-seven (75%) were discharged on 1st postoperative day as opposed to 0% pre-protocol (BAETS audit report 66%). Thirty-seven (90%) of lobectomies were discharged on 1st postoperative day (Units pre-protocol 42%, BAETS audit 81%). There was no postoperative bleed or hypocalcaemia. One patient with a large recurrent retrosternal goitre had transient recurrent laryngeal nerve palsy that recovered subsequently. There were no readmissions or adverse events directly related to early discharge. Conclusion A well embedded dedicated postoperative care protocol can significantly reduce postoperative hospital stay after thyroid surgery without compromising patient safety.

Neutrophil Extracellular Trap Formation in Advanced Heart Failure Patients-Preliminary Report.

In end-stage heart failure, which is characterized by persistent or progressive ventricular dysfunction despite optimal medical therapy, a left ventricular assist device (LVAD) can be beneficial. Congestive heart failure provokes inflammatory and prothrombotic activation. The aim of this study was to evaluate the serum concentration of citrullinated histone 3 (CH3) representing neutrophil extracellular trap (NET) formation in patients referred for LVAD implantation. There were 10 patients with a median age of 61 (57-65) years enrolled in a prospective single-center analysis who underwent LVAD implantation. The CH3 plasma concentration was measured preoperatively and on the 1st and 7th postoperative days, followed by control measurements on the median (Q1-3) 88th (49-143) day. The preoperative CH3 concentration strongly correlated with brain natriuretic peptide (r = 0.879, p < 0.001). Significant differences in CH3 serum concentration were observed between pre- and postoperative measurements, including an increase on the first postoperative day (p < 0.001), as well as a decrease on the seventh day (p = 0.016) and in follow-up (p < 0.001). CH3 concentration, as a marker of NET formation, decreases after LVAD implantation.

Comparative study of postoperative astigmatism in temporal scleral incision phacoemulsification versus temporal clear corneal incision phacoemulsification

Context: Various modifications in cataract surgery have been tried to reduce postoperative astigmatism. Incision length and location are some variable modulations. In this view, we are comparing the astigmatism following scleral incision and clear corneal incision in phacoemulsification surgery with posterior chamber intra-ocular lens implantation. Aims: To compare postoperative astigmatism after temporal scleral incision phacoemulsification and temporal clear corneal incision phacoemulsification. Settings and Design: Nonrandomized Prospective Interventional Comparative hospital-based study. Methods and Materials: In 50 eyes, temporal scleral incision phacoemulsification is performed, and in 50 eyes, temporal clear corneal incision phacoemulsification is performed. The patients were examined on the 1st, 7th, and 30th postoperative days, and surgically induced astigmatism was calculated. Results: Mean surgically induced astigmatism in the temporal clear corneal incision phacoemulsification group Mean surgically induced astigmatism is 0.98 ± 0.39 on 1st postoperative day, 0.71 ± 26 after 1st postoperative week, and 0.68 ± 26 after postoperative 1 month. In the temporal scleral incision phacoemulsification group is 0.81 ± 0.24 on 1st postoperative day, 0.610 ± 0.16 after 1st postoperative week, and 0.55 ± 0.16 after postoperative 1 month. Conclusions: In this study, at any particular time temporal scleral incision group has less astigmatism compared to temporal clear corneal incision phacoemulsification group. Hence it can be stated that temporal scleral incision induces lesser astigmatism as compared to temporal clear corneal incision phacoemulsification.

Outcome of Phacoemulsification Cataract Surgery in Complicated Cataract Due to Uveitis

Background: Surgical removal of cataractous lens is the only of treatment of cataract irrespective of etiology. Phacoemulsification is a modern cataract surgery in which the eyes internal lens is emulsified with an ultrasonic hand-piece and aspirated from the eye. Complicated cataract due to anterior uveitis has difference in morphology and outcome from that of age-related cataract variety. Aim of the study: The purpose of this study was to evaluate the outcome of phacoemulsification in complicated cataract due to uveitis. Methods: This prospective observational cross-sectional study conducted in cataract clinic of National Institute of Ophthalmology &amp; Hospital, Dhaka, Bangladesh, from September 2018 to March 2019. Sample was selected by purposive sampling technique. Total 50 patients suffering from complicated cataract due to uveitis were included according to selection criteria. Data were gathered from the informant and recorded in a structured case report format. Clinical examination and relevant investigation were done meticulously. All acquired data was entered into a Microsoft Excel Work Sheet and analyzed using descriptive statistics in SPSS 24.0. Results: In this study, the maximum number of patients 18(36.0%) were 51-60 years age group, mean age of the patient was 52.7±6.37 years. Male to female ratio was 1:1.17. Postoperative best corrected visual acuity (BCVA) was better progressively and reached significance difference (P&lt;0.05). Astigmatism was measured in different follow up time. There was significant difference (p&lt; 0.05) present in all post-operative days. In time wise comparison revealed, there was also significant difference in between 1st postoperative day and 30th postoperative day but no significance was present between 30th postoperative day and 180th postoperative day (P= 0.161). In this study postoperative complications included posterior capsule opacification (55.5%), posterior synechiae (11.1%), cystoid macular edema (22.2%) &amp; glaucoma (11.1%). Conclusion: Present study concluded that phacoemulsification is safer for the uveitic cataract as less inflammation is induced than that by a manual extracapsular cataract extraction. In order to optimize the postoperative outcome of uveitic cataract surgery, it is necessary to be meticulous and thorough.