7th Postoperative Day Research Articles

Incidence of upper extremity deep vein thrombosis in the retrosternal reconstruction after esophagectomy

BackgroundUpper extremity deep vein thrombosis (UEDVT) is relatively rare but cannot be negligible because it can cause fatal complications. Although it is reported that the occurrence rate of UEDVT has increased due to central venous catheter (CVC), cancer, and surgical invasion, there is still limited information for esophagectomy. The aim of this study was to evaluate the clinical factors, including CVC placement and thromboprophylaxis approach, as well as retrosternal space’s width as a predictive factor for UEDVT in patients receiving esophagectomy.MethodsThis study included 66 patients who underwent esophagectomy with retrosternal reconstruction using a gastric tube. All patients routinely underwent contrast-enhanced computed tomography (CT) on the 4th postoperative day. Low-molecular-weight-heparin (LMWH) was routinely administered by the 2nd postoperative day. To evaluate retrosternal space’s width, (a) The distance from sternum to brachiocephalic artery and (b) the distance from sternum to vertebra were measured by preoperative CT, and the ratio of (a) to (b) was defined as the width of retrosternal space.ResultsAmong all patients, 11 (16.7%) suffered from UEDVT, and none was preoperatively received CVC placement, while 7 were inserted in non-UEDVT cases. Retrosternal space’s width in patients with UEDVT was significantly smaller than that in patients without UEDVT (0.17 vs. 0.26; P < 0.0001). A cutoff value of the width was 0.21, which has high sensitivity (87%) and specificity (82%) for UEDVT prediction, respectively.ConclusionThe existence of CVC may not affect the development of UEDVT, but preoperative evaluation of retrosternal ratio may predict the occurrence of UEDVT.

An Early Experience of Microvascular Surgery in a Tertiary Cancer Centre in North East

BACKGROUNDMicrovascular surgery is a highly technique sensitive and evolving speciality in reconstructive oncosurgery. There is a definite learning curve associated with it. In this case series, we describe our initial experience in microvascular surgery at a tertiary cancer centre in North East India. METHODSIt is a retrospective observational case series done at a tertiary cancer centre in North East India from May 2018 to Jul 2018. The first ten cases of our free flap journey till now were included in the study. Data were collected from patient records and the hospital online reporting system. All data were analysed using SPSS.RESULTSIn our series, 8 patients were male and 2 patients were female. The mean age in the series was 37 years. Squamous cell carcinoma accounts for 4 the patients, osteosarcoma for 2 of patients and adenoid cystic carcinoma, Ewing sarcoma, rhabdomyosarcoma and low-grade soft tissue sarcoma 1 case each. Out of the ten free tissue transfers, one free ALT flap for total maxillary defect failed during the 4th postoperative day and the patient was managed with a prosthesis. The average hospital stay during the case series was 10.6 days.CONCLUSIONMicrovascular surgeries are very complex surgeries. The presence of a good, well-trained plastic surgery team working in conjunction with other specialities is paramount for a good outcome. A dedicated team, cooperative administration, fine and good infrastructure with high-quality equipment are the basic necessities for creating a good microsurgery unit.

Comparison of antimicrobial and wound-healing effects of silver nanoparticle and chlorhexidine mouthwashes: an in vivo study in rabbits

The objective is to formulate a silver nanoparticle mouthwash and then evaluate its antimicrobial and wound-healing effects in rabbit animal models. Microbial samples were collected from the oral cavity of 60 rabbits. Thereafter, standardized wounds were created in the lateral border of the tongue on the right side for all rabbits. After surgery, digital photographs were obtained from the wounds with standardized settings. To characterize the silver nanoparticles used in the synthetic mouthwash, transmission electron microscopy (TEM) and digital light scattering analysis were used. The animal models were then randomly divided into 4 groups: group 1 received 9.80 wt% silver nanoparticle mouthwash; group 2 received all the ingredients of the formulated mouthwash except for silver nanoparticles; group 3 received chlorhexidine 2.0% mouthwash; and the negative control group did not receive any postoperative mouthwash. Microbial samples were collected from oral cavity of the rabbits each day for four postoperative days. Colony-forming unit (CFU) counts were compared post-operatively with the pre-operative counts. In addition, standardized digital photographs were taken each day from the wounds and the area of the wounds was compared in postoperative and pre-operative images. Data were statistically analyzed using one-way ANOVA and repeated measures variance analysis (α = 0.05). TEM revealed spherical morphology of silver nanoparticles and digital light scattering showed an average size of 5 nm and optimal distribution of the nanoparticles. CFU count significantly decreased in groups 1 and 3 (P < 0.001), while it significantly increased in groups 2 and 4 (P < 0.001). Moreover, a significant difference was observed between the experimental groups (P < 0.001). In addition, wound area decreased significantly in all groups (P < 0.001). However, the difference between wound areas in the groups was not significant, except for the 4th postoperative day (P < 0.001). However, the antibacterial effects and the wound-healing characteristics of the synthetic silver nanoparticle and chlorhexidine mouthwashes were not significantly different (P > 0.05). Silver nanoparticle mouthwash possesses favorable antibacterial and wound-healing effects. The formulated 9.80 wt% silver nanoparticle mouthwash with a particle size of 5 nm can be a promising alternative for application after oral surgical procedures.

Management of Chest Drains after Elective, Thoracoscopic, Anatomical Lung Resections. A Survey in Thoracic Surgical Departments in Germany

The increasing use of minimally invasive techniques along with the introduction of the "Enhanced Recovery After Surgery" (ERAS) guidelines have reduced the perioperative risk of anatomic lung resections. However, the prolonged postoperative air leak still remains one of the major postoperative issues. The purpose of this survey was to evaluate the perioperative management of chest drains and the current clinical practice in treating prolonged air leaks after elective, thoracoscopic, anatomic lung resections in Germany. We performed a survey among the thoracic surgical units, which are listed in the Database of the German Thoracic Society (n=160). Based on the number of resections annually, the centres were divided into high- and low-volume and the results were presented accordingly. The response rate was 35.6%. Most of the units routinely place a single, 24 Ch. chest drain, which they connect to a digital system on suction. 42.1% of the thoracic units treat a postoperative air leak after the 7th postoperative day. The majority of the surgeons either reduce the suction or use other conservative measures to deal with the air leak. There is no significant difference in the drain management between high- and low-volume centres. The postoperative hospital stay after an uncomplicated lobectomy has come down to a few days whereas the lower limit of the length of stay has been reduced to 2 days. Nevertheless, 80% of the German thoracic surgeons define a postoperative air leak as prolonged, when it lasts beyond the 5th postoperative day and 65% deal with it only after the 5th postoperative day. The available evidence on this field is limited. New prospective clinical studies are required in order to improve the management of this common complication.

Application of a combined approach in the patient treatment with aggressive hemangiomas of the spine

Aggressive hemangioma of the spine is a benign vascular tumor. Stabilization, vertebroplasty, partial resection or total corpectomy of the affected vertebra, radiation therapy are known methods of treatment. Vertebral hemangiomas are more likely to be asymptomatic. Accordind to literature review 3–5 % of hemangiomas are symptomatic (pain). In 1.0 % of cases, hemangiomas cause symptoms of compression of nerve structures, spreading epidurally around the spinal cord and / or radicular nerves. A clinical case of a 63-year-old patient who underwent surgery in 2016 at another clinic for aggressive vertebral hemangiomas Th4 was presented. Bisphosphonate treatment was performed. Despite treatment, progressive lower extremities paraparesis was observed. Spinal angiography and total embolization of hemangiomas with liquid embolizing substances were performed. Immediately after embolization, the patient noted a pain intensity decrease. Surgery was performed in 40 minutes after transarterial embolization (removal of transpedicular stabilizing metal system, laminectomy of Th4 vertebra, decompression of the spinal cord, partial removal of Th4 hemangioma biopsy). The volume of intraoperative blood loss was 200 ml. Wound suction drainage was removed on the second postoperative day. No systemic complications (deep vein thrombosis, pneumonia) were noted. The patient was verticalized on the second postoperative day. After surgery, neurological function corresponded to the preoperative level (Frankel C). Regression of neurological deficit was observed (increased strength and range of motion of the lower extremities, bladder function improvement) the 5th postoperative day (Frankel D-E), Histological examination confirmed the diagnosis of hemangiomas. The patient was discharged from hospital with neurological improvement. Radiation therapy was recommended. 3 months after surgery, neurological function was assessed as Frankel E.

Pain monitoring to determine the optimal timing of activation of patients after reconstructive surgery for transverse flatfoot

In 30 patients with flat foot and hallux valgus reconstructive operations by CITO and Shev- rons techniques were performed on both feet. Pain monitoring using Card of pain audit was carried out at rest and under load. In 15 patients feet loading was started on the 6 postoperative day and in other 15 patients on the 4 day. Pain audit showed that the optimum time for the patient activization was the 4th postoperative day with use of special postoperative shoes and without plaster dressing and additional support. Use of computer system Balance test was shown to be a perspective for the objective evaluation of postoperative weight-bearing ability, efficacy of patient activization as well as for the acceleration of patient adaptation to postoperative loads.

Titanium elastic nail used for repair of radius-ulna fracture in dogs

Two young dogs with history of traumatic injury were presented with primary complaint of not bearing weight on one forelimb. Radiographic examinations of the limb had revealed complete transverse diaphyseal fracture of distal third of radius-ulna in both the cases. The fracture in both the cases was repaired under general anesthesia by introduction of titanium elastic nail through the pre-drilled hole in the metaphyseal cortex followed by passing the nail through the medullary canal into the other fracture fragment after reducing both the fracture fragments by open reduction technique. Both the dogs had shown uneventful recovery with partial weight bearing on the operated limb in between 5th-7th and complete weight bearing at 60th post-operative day. The nail in both the cases was removed at 60th post-operative day after radiographic examinations which had shown callus formation along with bridging of both the cortices at the fractured site. All the physiological and haemato-biochemical parameters were found within the normal clinical range at different time intervals of examination. Overall both the cases had shown good clinical outcome without any local or systemic adverse effect.

Comparison of alternative arterial anastomosis site during liver transplantation when the recipient's hepatic artery is unusable.

Few studies have analyzed outcomes of liver transplantation (LT) when the recipient hepatic artery (HA) was not usable. We retrospectively evaluated the outcomes of LT performed using the different alternative sites to HA. Between 2002 and 2017, 1,677 LT were performed in our institution among which 141 (8.4%) with unusable recipient HA were analyzed. Four groups were defined according to the site of anastomosis: the splenic artery (SA group, n=26), coeliac trunk (CT group, n=12), aorta using or not the donor's vessel (Ao group, n=91) and aorta using a vascular prosthesis (Ao-P group, n=12) as conduit. The median number of intraoperative red blood cell transfusions was significantly increased in the Ao and Ao-P groups (5, 5, 8.5 and 16 for SA, CT, Ao and Ao-P group respectively, P=0.002), as well as fresh frozen plasma (4.5, 2.5, 10, 17 for the SA, CT, Ao and Ao-P groups respectively, P=0.001). Hospitalization duration was also significantly increased in the Ao and Ao-P groups (15, 16, 24, 26.5 days for the SA, CT, Ao and Ao-P groups respectively, P<0.001). The occurrence of early allograft dysfunction (EAD) (P=0.07) or arterial complications (P=0.26) was not statistically different. Level of factor V, INR, bilirubin and creatinine during the 7th postoperative days (POD) was significantly improved in the SA group. No difference was observed regarding graft (P=0.18) and patient (P=0.16) survival. In case of unusable HA, intraoperative and postoperative outcomes are improved when using the SA or CT compared to aorta.

Brazilian initial experience with lung transplantation due to irreversible lung fibrosis post-COVID-19 in a national reference center: a cohort study.

Lung transplantation (LTx) has been discussed as an option for treating irreversible lung fibrosis post-coronavirus disease 2019 (COVID-19), in selected cases. To report on the initial experience and management of end-stage lung disease due to COVID-19 at a national center reference in Brazil. Cohort study conducted at a national reference center for lung transplantation. Medical charts were reviewed regarding patients' demographics and pre-COVID-19 characteristics, post-LTx due to COVID-19. Between March 2020 and September 2021, there were 33 cases of LTx. During this period, we evaluated 11 cases of severe COVID-19-related acute respiratory distress syndrome (ARDS) that were potentially candidates for LTx. Among these, LTx was only indicated for three patients (9.1%). All of these patients were on venovenous extracorporeal membrane oxygenation (ECMO), and the procedure that they underwent was central venoarterial ECMO. All three patients were still alive after the first 30 postoperative days. However, patient #1 and patient #2 subsequently died due to fungal sepsis on the 47th and 52nd postoperative days, respectively. Patient #3 was discharged on the 30th postoperative day. LTx is feasible among these complex patients. Survival over the first 30 days was 100%, and this favors surgical feasibility. Nonetheless, these were critically ill patients.

FRONTiER: A feasibility trial of nivolumab with neoadjuvant CF or DCF, FLOT therapy for locally advanced esophageal carcinoma (JCOG1804E)—Short-term results for cohorts C and D.

286 Background: The standard neoadjuvant chemotherapy (NAC) in Japan for locally advanced esophageal squamous cell carcinoma (ESCC) consists of CDDP + 5-FU (CF). Recently, neoadjuvant DTX plus CF (DCF) therapy has shown promising efficacy for locally advanced ESCC. In addition, immune checkpoint inhibitors (ICIs) have demonstrated a survival benefit in ESCC and potential as an NAC in several cancers, including lung, breast, skin, and bladder. We previously reported that neoadjuvant CF plus nivolumab (Nivo) therapy was tolerable and showed promising efficacy for ESCC; however, the efficacy of ICI with DCF as an NAC and the safety of subsequent surgery for ESCC patients remain unclear. Methods: FRONTiER is a multi-cohort phase I study designed to evaluate the safety and efficacy of ICI combined with NAC in ESCC. The eligibility criteria were histologically proven ESCC with cT1N1-3M0 or cT2-3N0-3M0 (8th-UICC TNM classification), patient age of 20-75 years, PS ≤1, and no prior cancer therapies. The primary endpoint was the incidence of dose-limiting toxicities (DLT) from the initial dose to the 30th postoperative day. This study contained 5 experimental cohorts: cohort C received 3 courses of DTX (70 mg/m2), CDDP (70 mg/m2), and Nivo (360 mg/body) on day 1 and 5-FU (750 mg/m2) on days 1–5 every three weeks. Cohort D received one administration of Nivo (240 mg/body) 2 weeks before chemotherapy followed by the same regimen as cohort C. Results: Twelve patients were enrolled in cohort C (n = 6) and D (n = 6) (median age [range]: 60 [31-74] years, PS 0/1: 11/1, clinical stage I/II/III/IVA: 2/2/7/1). Only one patient in cohort D developed DLT (grade 3 dyspnea and rash); no other DLT were seen. Grade ≥3 adverse events were neutropenia (n = 1), leukopenia (n = 7), anorexia (n = 3), hyponatremia (n = 2), febrile neutropenia (n = 1), nausea (n = 1), and lymphopenia (n = 1) during NAC, and lung infection (n = 2), peritoneal infection (n = 1), anemia (n = 1), lymph leakage (n = 1), vagal reflex (n = 1), dyspnea (n = 1), rash (n = 1), septic shock (n = 1), pleural effusion (n = 1), and pneumatosis intestinalis (n = 1) during the postoperative period. No treatment-related deaths were observed. All patients received 3 courses of NAC, and 11 patients (91.7%) achieved an R0 resection without treatment interruption. One patient (16.7%) in cohort C and 3 patients (50.0%) in cohort D achieved pathological complete responses. Conclusions: Neoadjuvant DCF + Nivo with/without prior Nivo administration followed by surgery for locally advanced ESCC was well tolerated and showed an extremely promising efficacy. Clinical trial information: NCT03914443.

Comparative Study of two Flap Designs on Postoperative Sequelae after Removal of Impacted Mandibular Third Molar

Objective: The purpose of current study was to have comparison between the postoperative outcomes of triangular (wards) flap versus an envelope flap after surgical extraction of impacted mandibular third molar. Methods: Current study was a double-blinded randomized controlled trial conducted at the Department of Oral &amp; Maxillofacial surgery, Fatima Memorial Hospital, Lahore. Sixty patients were randomly recruited in two groups with random number table. Both groups consisted of 30 patients each. Among the patients of Group A, envelope flap was used for surgical access whereas patients of Group B received triangular flap for surgical access. Both Groups were followed on 2nd and 7th day postoperatively for pain status and trismus. Results: Mean±SD of pain score at postoperative day 7th for group A was 23.47±6.75 and for group B it was 24.03±10.5 which was statistically insignificant (p&gt;0.05). The difficulty index was found to have statistically significant (P&lt;0.05) on 7th postoperative day pain. On the 7th postoperative day group A (envelope flap) had a mouth opening mean of 41.03mm and group B (triangular flap) which had a mean of 40.47mm which was statistically insignificant (p&gt;0.05). The difficulty index was found to have statistically significant effect (P&lt;0.05) on 7th postoperative day Conclusion: The study concluded that there was no statistically significant difference between the two flap designs on postoperative pain and trismus while the difficulty of impaction was found to have statistically significant effect on postoperative pain and trismus Keywords: envelope flap, triangular flap, trismus

Efficacy of Cyanoacrylate in Intraoral Surgical Wound Closure

Objective: To evaluate the efficacy of cyanoacrylate tissue adhesives in the management of intraoral surgical wounds in term of wound healing. Material &amp; Methods: Descriptive case series study. Department of oral and maxillofacial surgery. Punjab Dental Hospital, Lahore. 6 months i.e. from: 10-08-2017 to 10-02-2018. After meeting the inclusion criteria 140 patients were enrolled. Strict aseptic measures were taken. Tissue glue applied on the incision line in form of drops at equidistant intervals and then allowed to flow and set for 1-2 minutes. The researcher evaluated the efficacy of wound healing clinically on 15‘, 2"d and 7th postoperative day. All the collected data was entered and analyzed on SPSS version 21. Results: The mean age of patients was 34.16±9.57 years. Male to female ratio was 0.79:1. The wound healing was found in 128(91.4%) patients and the efficacy achieved in 128(91.43%) patients. Conclusion: The cyanoacrylate tissue adhesives is efficacious for the management of intraoral surgical wounds in term of wound healing Keywords: Wound Healing, Efficacy, Cyanoacrylate, Surgery

Взаємозв’язок патофізіологічних процесів, що відбуваються в плевральній порожнині при згорнутому гемотораксі та аутогемоплевродезі

Актуальність. Незважаючи на широке впровадження в торакальну хірургію малоінвазивних методів резекції, плевродез залишається у ряді випадків єдиним визначальним методом радикальної хірургічної корекції. Особливо яскраво це проявляється при операціях у хворих із поширеними формами бульозної емфіземи легенів. У той же час існуючі види плевродезу викликають серйозні супутні ускладнення. З урахуванням цього був розроблений метод аутогемоплевродезу, заснований на патофізіології процесів, що виникають у плевральній порожнині після попадання в неї крові, в основу якого були покладені процеси, характерні для розвитку і перетворення згорнутого гемотораксу. Метою дослідження стало вивчення патофізіології плевральної порожнини при штучному створенні в ній гемотораксу. Матеріали та методи. Контрольну групу склали 36 хворих, у яких гемоторакс був викликаний проникаючими колото-різаними пораненнями грудної клітки. Із них у 21 пацієнта відзначався малий або середній гемоторакс, у 15 хворих у зв’язку зі згорнутим гемотораксом була виконана його ВТС-евакуація. Основну групу склали 40 хворих, у яких гемоторакс виникав унаслідок виконання їм ВТС-резекції легені і плевродезу з приводу бульозної емфіземи, з них у 24 був виконаний коагуляційний східчастий плевродез, у 16 — аутогемоплевродез за розробленою методикою. Як основний показник, що відображає процеси формування фібрину і фібринолізу в плевральній порожнині, досліджувався плазміноген, відсоток активності якого визначався в сироватці крові і плевральному ексудаті триразово: через 1 годину і 24 години після операції, а також на 5-ту післяопераційну добу. Результати. У перші години після операції відбувалося зниження рівня плазміногену крові в усіх хворих, окрім тих, яким була виконана ВТС-резекція зі східчастим плевродезом. Через добу після операції в групі хворих із малим і середнім гемотораксом розпочиналося повільне відновлення рівня плазміногену, через 5 діб його концентрація в крові повністю відновлювалася. У пацієнтів, що перенесли евакуацію згорнутого гемотораксу, через 1 годину після операції відзначалося стандартне зниження плазміногену. На 5-ту добу рівень плазміногену в крові відновився тільки наполовину. Такі ж значення плазміногену в часових проміжках 1 година та 5 діб були в групі хворих, яким після ВТС-резекції був виконаний аутогемоплевродез, а через 24 години після аутогемоплевродезу вже починалося відновлення рівня плазміногену. У плевральному ексудаті відзначалося помірне зниження плазміногену в пацієнтів, що перенесли ВТС-резекцію зі східчастим плевродезом і ПХО з дренуванням плевральної порожнини через 1 годину після операції, та потім його рівномірне відновлення до 5-ї доби. У хворих зі згорнутим гемотораксом було більш глибоке падіння рівня плазміногену через 1 годину після операції і рівномірне, але не остаточне його відновлення до 5-ї доби. Аутогемоплевродез призводив до різкого зниження плазміногену в плевральному ексудаті через 1 годину після операції, та його рівень не виріс до 5-ї доби. Висновки. Зниження плазміногену в плевральному ексудаті стало прямим відображенням виснажуючої дії аутокрові. Аутогемоплевродез є втручанням, що моделює процеси, які відбуваються в плевральній порожнині при згорнутому гемотораксі в більш м’якому варіанті; при ньому відбувається пригнічення лікворного фібринолізу, аналогічне такому при згорнутому гемотораксі.

Characteristics of Interleukin-6 Signaling in Elective Cardiac Surgery-A Prospective Cohort Study.

Interleukin-6 (IL-6) can cause pro- and anti-inflammatory effects via different signaling pathways. This prospective study investigated the perioperative kinetics of IL-6, soluble IL-6 receptor (sIL-6R), and soluble glycoprotein 130 (sgp130) in elective patients undergoing cardiopulmonary bypass (CPB). IL-6, sIL-6R, and sgp130 were measured simultaneously and consecutively at 19 timepoints until the 10th postoperative day (POD). The proportion of pro- and anti-inflammatory pathways were determined by calculating sIL-6R/IL-6 and sIL-6R/sgp130 ratios. We analyzed 93 patients. IL-6 increased during surgery with reaching a plateau two hours after CPB and peaking on POD 1 (188.5 pg mL−1 (IQR, 126.6; 309.2)). sIL-6R decreased at the beginning of the surgical procedure, reaching a nadir level on POD 2 (26,311 pg mL−1 (IQR, 22,222; 33,606)). sgp130 dropped immediately after CPB initiation (0.13 ng mL−1 (IQR, 0.12; 0.15)), followed by a continuous recovery until POD10. The sIL-6R/IL-6 ratio decreased substantially at the beginning of the procedure, reaching a nadir on POD 1 (149.7 (IQR, 82.4; 237.4)), while the sIL-6R/sgp130 ratio increased simultaneously until 6 h post CPB (0.219 (IQR 0.18; 0.27)). In conclusion, IL-6 exhibited high inter-individual variability reflecting an inhomogeneous inflammatory response. Pro-inflammatory effects and overwhelming inflammation were rare and predominantly anti-inflammatory effects were found.

Mechanical ventilation during cardiopulmonary bypass in neonates improves postoperative outcome.

Cardiopulmonary bypass generates a systemic inflammatory response. This inflammatory response is reduced if patients are ventilated during bypass, as evidenced by lower levels of postoperative circulating inflammatory mediators. However, this does not appear to make much clinical difference in adults, at least not consistently, but, to our knowledge, has never been assessed in paediatric cardiac surgery, which is the objective of this study. This is a prospective clinical study of 12 consecutive neonates operated for the correction of either transposition of the great arteries ± ventricular septal defect or aortic arch hypoplasia ± ventricular septal defect, who were ventilated during cardiopulmonary bypass. These were compared to 11 neonates with the same malformations, who had undergone the same operations but without being ventilated during bypass (historical control group). One patient from the control group died on the 15th postoperative day due to sepsis and multi-organ failure. Bypass times and cross-clamp times were similar in the 2 groups. Ventilation on bypass was associated with significantly lower postoperative serum concentrations of C-reactive protein, shorter mechanical ventilation and lower vasoactive-inotropic score. Duration of stay on intensive care unit (ICU) showed a tendency to be shorter in patients who were ventilated on bypass, but this did not reach statistical significance. There were no differences between the 2 groups with respect to postoperative mixed venous oxygen saturations and serum concentrations of lactate and troponin I. Mechanical ventilation during cardiopulmonary bypass in neonates improves postoperative outcome.

Rare as hen’s teeth: laparoscopic management of primary pelvic hydatid cyst

Hydatid disease is a zoonotic parasitic disease most frequently caused by echinococcus granulose Primary peritoneal hydatidosis is very rare. We report a case of primary hydatid disease of the intraperitoneal pelvic space. A 22-year-old male patient presented with a history of abdominal pain since 5 months. Abdominal examination revealed a smooth, firm, mildly tender, non-mobile lump in suprapubic region, on digital rectal examination, a smooth spherical mass was felt anteriorly and laterally outside the rectal wall, rectal mucosa was normal. All routine investigations including liver function tests were within normal limits Computed tomography scan of the whole abdomen showed giant cyst of 10×10 cm with multiple well-defined cysts in rectovesical pouch. Diagnostic laparoscopy was performed. The liver, spleen, mesentery, omentum was found to be normal. A large tense hydatid cyst was noted in the pelvic cavity. Partial peri-cystectomy with endo-cystectomy was performed. Postoperative period was uneventful and patient was discharged on 4th postoperative day. Primary intra-abdominal but extra-peritoneal localization has been reported in only 0.2-2% cases making it a very rare entity. The treatment of choice for pelvic hydatid cyst is principally a careful surgical excision. Here with minimum invasive technique this case was operated and results were excellent.

Comparative Study of the Efficacy of Low-Level Laser Therapy and Dexamethasone in Reducing the Severity of Post-Operative Inflammatory Response Following Surgical Extraction of Mandibular Third Molars.

To assesses the efficacy of low-level laser therapy (LLLT) over dexamethasone in reducing postoperative edema and trismus following surgical removal of mandibular third molars. A single-center, parallel group, randomized, prospective, single-blind clinical trial on 50 patients between the age 18-40years, requiring surgical extraction of mandibular third molars classified as mesioangular, class II and position B impactions, was selected for the study. The selected patients were randomly divided into two groups:Group 1, n = 25, Soft Tissue Diode laser was applied intra-orally and extra-orally at the insertion of the masseter.Group 2, n = 25, 8mg of Dexamethasone was given intravenously preoperatively.Trismus and edema were calculated preoperatively and on the 1st and 5th postoperative day. The collected data were subjected to statistical analysis using student's t test. Trismus (4.61 ± 0.26cm [p = 0.0001]) in the LLLT group was significantly less than the dexamethasone group (trismus: 3.82 ± 0.73cm). Edema at different anatomic locations in the LLLT group was also significantly less than the dexamethasone group (Angle-tragus [p = 0.0008], angle-canthus [p = 0.0021], angle-ala [p = 0.0258], angle-commissure [p = 0.0168], angle-mentus [p = 0.0227]). This study demonstrates that LLLT was beneficial in reduction in edema and trismus compared to dexamethasone following surgical extraction of third molars.

Short-term efficacy and safety of TurboHawk atherectomy for in-stent restenosis in peripheral artery disease: a single-centre experience.

Information regarding the efficacy of the TurboHawk atherectomy for the treatment of in-stent restenosis (ISR) in patients with peripheral artery disease (PAD) of the lower extremity is scarce. This study was performed to investigate the curative efficacy and safety of the TurboHawk system for ISR in PAD patients over 60 years old. The TurboHawk atherectomy device was used to treat ISR in 28 patients with PAD. The intraoperative, 2-day postoperative, 3-month, and 2-year follow-up data were obtained. Differences in the ankle-brachial index (ABI), Rutherford class and minimum diameter of the femoral-popliteal artery were analysed along with the correlations of the factors associated with patency. Twenty-six patients (92.86%) had successful surgeries. All patients reported alleviation of pain and intermittent claudication after surgery. One patient who had a malignant hepatoma and coronary heart disease received an amputation on the 76th postoperative day and another patient who had atrial fibrillation received a thrombectomy on the 40th postoperative day. TurboHawk atherectomy increased the ABI (from 0.30 to 0.70, P < 0.0001) and minimum diameter (from 0 to 4.93 mm, P < 0.0001) and reduced the Rutherford class (from 4.00 to 2.00, P < 0.0001). During the 3-month follow-up, the median minimum diameter, ABI, and Rutherford class were 4.12, 0.69, and 2.00, respectively. No death happened during the 3-month follow-up. The TurboHawk atherectomy is a safe and effective technique for ISR in PAD patients over 60 years old.

Intensive physical therapy after emergency laparotomy: Pilot phase of the Incidence of Complications following Emergency Abdominal surgery Get Exercising randomized controlled trial.

Postoperative pneumonia and delayed physical recovery are significant problems after emergency laparotomy. No randomized controlled trial has assessed the feasibility, safety, or effectiveness of intensive postoperative physical therapy in this high-risk acute population. The internal pilot phase of the Incidence of Complications after Emergency Abdominal Surgery: Get Exercising (ICEAGE) trial was a prospective, randomized controlled trial that evaluated the feasibility, safety, and clinical trial processes of providing intensive physical therapy immediately following emergency laparotomy. Fifty consecutive patients were recruited at the principal participating hospital and randomly assigned to standard-care or intensive physical therapy of twice daily coached breathing exercises for 2 days and 30 minutes of daily supervised rehabilitation over the first 5 postoperative days. Interventions were provided exactly as per protocol in 35% (78 of 221 patients) of planned treatment sessions. Main barriers to protocol delivery were physical therapist unavailability on weekends (59 of 221 patients [27%]), awaiting patient consent (18 of 99 patients [18%]), and patient fatigue (26 of 221 patients [12%]). Despite inhibitors to treatment delivery, the intervention group still received twice as many breathing exercise sessions and four times the amount of physical therapy over the first 5 postoperative days (23 minutes [interquartile range, 12-29 minutes] vs. 86 minutes [interquartile range, 53-121 minutes]; p < 0.001). One adverse event was reported from 78 rehabilitation sessions (1.3%), which resolved fully on cessation of activity without escalation of medical care. Intensive postoperative physical therapy can be delivered safely and successfully to patients in the first week after emergency laparotomy. The ICEAGE trial protocol resulted in intervention group participants receiving more coached breathing exercises and spending significantly more time physically active over the first 5 days after surgery compared with standard care. It was therefore recommended to progress into the multicenter phase of ICEAGE to definitively test the effect of intensive physical therapy to prevent pneumonia and improve physical recovery after emergency laparotomy. Therapeutic/Care Management; Level II.

FACTORS ASSOCIATED WITH LENGTH OF HOSPITAL STAY AFTER CARDIAC SURGERY

Cardiac surgery involves both morbidity and mortality. Length of hospital stay can depend on many factors. The aim of this study is to analyse the factor which were responsible for prolonged hospital stay in a tertiary care center .We retrospectively analysed cardiac surgery patients over a period of four months from hospital registers. Only elective surgery was considered. 83 patients were studied. The patients were divided into two groups(Group 1 and Group 2) based on length of hospital stay in cardiac intensive care postoperatively. We considered prolonged hospital stay if patient was discharged after 4th postoperative day. Data was analysed using Chi squared test , One way ANOVA and Unpaired t test. We observed that the mean duration of stay in the intensive care unit during this study period was 3.98 days in Group 1 and 6 days in Group 2 which is signicant(t=-11.70, and p&lt;0.0001).Diabetes mellitus, hypertension ,left ventricular systolic dysfunction ,chronic kidney disease and increased creatinine were factors responsible for prolonged hospital stay in our study