Postoperative Day Research Articles

Pseudoaneurysm of Muscular Artery in the Thigh Following Low-Energy Trauma: A Case Report

This report presents the case of a 38-year-old female who developed a pseudoaneurysm in the left thigh two years after a low-energy fall. Progressive thigh swelling prompted further evaluation. Initial computed tomography (CT) revealed a large vascular lesion, approximately 15 cm, but lacked definitive pseudoaneurysm characteristics. Doppler ultrasound provided diagnostic clarity, demonstrating the characteristic "yin-yang" sign indicative of bidirectional blood flow. The patient underwent successful surgical resection, with an aspirative drain removed on the tenth postoperative day. This case emphasizes the diagnostic complexities of pseudoaneurysms, particularly in delayed trauma presentations, and underscores the vital role of Doppler ultrasound in identifying vascular flow dynamics. Additionally, it highlights the necessity of a multidisciplinary approach in managing complex vascular lesions, combining diagnostic precision and tailored therapeutic strategies.

Anorectal malformation with rectoperineal fistula in males treated with a posterior rectal advancement anoplasty (PRAA) - report of early outcomes.

A novel modification of the cutback procedure, a posterior rectal advancement anoplasty (PRAA) for select male patients with an anorectal malformation and a rectoperineal fistula was recently described which incised only within the limits of the sphincteric ellipse and eliminated an anterior rectal dissection, thus avoiding any possibility of a urethral injury. This report provides longer term postoperative outcomes after PRAA. Method A retrospective, single institution study was performed examining male patients with a rectoperineal fistula between 1/2020-12/2023. PRAA was done only if the rectoperineal fistula was located within the anterior extent of the sphincteric ellipse, which was true for all patients encountered during this study period. We assessed post-operative outcomes, length of stay, time to first feeding, and early stooling patterns. Results Eighteen patients underwent PRAA at a median age of 5.4 months (range 1 day-8 months) with median follow up of fourteen months (range 4-40). Seven patients (39%) were repaired within the first month of life. Thirteen (72%) were repaired primarily and five (28%) had a diverting ostomy placed before referral. There were no instances of wound dehiscence, rectal prolapse, or urethral injury. Two (11%) patients developed an anal stricture requiring dilation or Heineke-Mikulicz anoplasty. All patients resumed feeds on post operative day one. Median discharge was on post operative day one (range 1-6). Fifteen (83%) were utilizing laxatives at their most recent follow up. Conclusions The PRAA avoids any potential urethral injury or perineal dehiscence, has a low rate of anal stenosis (11%), and appears to be applicable to all male patients with a rectoperineal fistula. The technique allows for early return to diet and discharge and can be safely done in the neonatal period or in a delayed fashion without the need for a stoma.

How Much Pain Medication Do Patients Require After Posterior Iliac Crest Bone Graft to the Alveolar Cleft?

The purpose of this study was to quantify analgesic use following alveolar cleft bone grafting (ABG) utilizing a posterior iliac crest (PIC) donor site. This is a prospective cohort study of consecutive patients that underwent ABG with PIC in a 10 month period from November 2022 to September 2023. Tertiary care free-standing pediatric hospital. Patients with cleft lip and alveolus with or without cleft of the secondary palate undergoing alveolar bone graft with cancellous marrow from the PIC. All patients underwent ABG and recorded analgesic use afterwards. The main outcome variable was total pain medication utilization during the first 10 postoperative days (PODs). 22 subjects (72.7% male, 54.5% Caucasian 72.7% unilateral and 27.3% bilateral clefts) recorded pain medication use. Total duration of analgesic use (any type) was 3.86 ± 1.7 postoperative days. 10 subjects (45.5%) did not use opioid medication postoperatively. The remaining 12 subjects (54.5%) used a median of 12 (0, 19) morphine milli-equivalents (MME), equal to 1.6 (0, 2.53) doses of 5 mg oxycodone. An average of 9.9 ± 5.6 doses of acetaminophen and 9.1 ± 4.7 doses of a non-steroidal anti-inflammatory drug (NSAID) were administered. No subject used opioids after POD3. Patients with unilateral clefts used more acetaminophen (p = 0.02); otherwise, there were no significant differences in outcomes based on any predictor variable (p > 0.05). Analgesic requirements after ABG with PIC were minimal, with nearly half of patients taking no postoperative opioids. As such, judicious opioid prescribing is prudent. .

Indocyanine green fluorescence-guided laparoscopic central pancreatectomy for complete pancreatic transection trauma: a rare case and literature review.

Pancreatic trauma is a rare solid organ injury. Conservative treatment is often indicated in patients with no pancreatic duct injury, while patients with high-grade pancreatic damage most often require surgical intervention. Laparoscopic central pancreatectomy (LCP) is a parenchyma-sparing approach and can prevent endocrine and exocrine insufficiency after pancreatic resection. Indocyanine green (ICG) fluoroscopy can help the surgeon assess the blood supply of the target organ. The case we describe here is a 33-year-old male patient who was transferred to our hospital due to blunt abdominal trauma caused by a car accident. The patient was hemodynamically stable on admission and was diagnosed with isolated pancreatic trauma by a multidisciplinary team that included radiologists, emergency physicians, and pancreatic surgeons. The patient then underwent emergency laparoscopic central pancreatectomy, during which we used ICG fluoroscopy to assess the blood perfusion of the damaged pancreas to determine the extent of resection. The patient developed a biochemical fistula (grade A pancreatic fistula) after surgery, and no other intervention was performed except for continuous drainage. The patient was discharged on postoperative day 13. At the 3-month follow-up, the patient did not present any clinical manifestations of pancreatic endocrine and exocrine insufficiency. To the best of our knowledge, there have been no reports of ICG-guided emergency LCP for blunt abdominal trauma. In selected patients, emergency LCP is feasible and should be supported by a multidisciplinary team and performed by an experienced pancreatic surgeon with advanced laparoscopic skills.

Effect of intramuscular vs intra-articular betamethasone injection on pain and inflammatory factors among patients with severe traumatic knee osteoarthritis.

The aim of this study was to comprehensively investigate the clinical efficacy of intraoperative local joint injection and intramuscular injection of betamethasone in patients with severe traumatic knee osteoarthritis (KOA). 80 patients with severe traumatic KOA undergoing total knee arthroplasty were retrospectively recruited and rolled into S1 group (intra-articular injection of ropivacaine + betamethasone and isotonic saline mixture at joint incision), S2 group (muscle local injection of betamethasone before incision closure, simultaneously intra-articular injection of ropivacaine + isotonic saline mixture at joint incision), and D group (intra-articular injection of ropivacaine + isotonic saline mixture at the joint incision). Visual analog scale (VAS) score, serum inflammatory factors (IFs), hospital for special surgery (HSS)score, Pittsburgh sleep quality index (PSQI), and adverse reaction events (AREs) were analyzed. Pain scores of patients in all three groups decreased drastically over time on postoperative days (PDs) 1, 2, and 3, with the scores in S1 and S2 groups markedly inferior to D group (P < 0.05). HSS scores of patients in S1 and S2 groups at postoperative months 1, 3, and 6 were considerably superior to those in D group (P < 0.05). PSQI scores of patients in S1 and S2 groups at postoperative months 1, 3, and 6 were notably inferior to those in D group (P < 0.05). Both intraoperative local joint injection and muscle injection of betamethasone are effective in patients with severe traumatic KOA.

Keyhole Mini-Craniotomy Middle Fossa Approach for Tegmen Repair: A Case Series and Technical Instruction

Background and Importance: Tegmen defects associated with cerebrospinal fluid (CSF) leaks are a rare pathology that can result in severe complications if left untreated. There is no universal optimal surgical algorithm for repair, though the most common techniques are the middle fossa craniotomy (traditionally 25 cm2 in area), the transmastoid approach, or both. Here, we describe successful use of a keyhole mini-craniotomy, only 6 cm2 in area, without mastoidectomy or days of lumbar drainage. Clinical Presentation: Three patients presented with right-sided CSF otorrhea and hearing loss, with varying sizes of tegmen defects and associated encephaloceles. Keyhole craniotomies measuring 3 x 2 cm were used to perform a multilayer repair comprising an intradural collagen dural substitute, extradural fascial graft, extradural collagen dural substitute, fibrin sealant, and sometimes bony reconstruction using partial thickness craniotomy grafting. All patients were discharged on postoperative day one or two, with no recurrence of symptoms at six months. Conclusion: The keyhole craniotomy approach does not sacrifice the extent of operative access for this pathology. This minimally invasive approach can likely be used more often without need for concomitant mastoidectomy, ultimately enabling shorter hospital stays and more rapid recovery.

Effects of Scalp Nerve Block on Symptomatic Cerebral Hyperperfusion Syndrome After Combined Revascularization Surgery for Moyamoya Disease.

Strict blood pressure control can be used to prevent or treat cerebral hyperperfusion syndrome. This study investigated whether scalp nerve block (SNB) is associated with a reduced risk of postoperative symptomatic cerebral hyperperfusion syndrome (SCHS) by reducing postoperative blood pressure in adult patients who underwent combined revascularization surgery for moyamoya disease. Patients were retrospectively divided into the SNB (n=167) and control (n=221) groups depending on whether SNB was performed immediately before placement of wound dressings at the end of surgery. Postoperative SCHS was defined as new-onset postoperative neurological deficits with a focal increase in cerebral blood flow at the perianastomosis site in the absence of infarction or hemorrhage on postoperative brain imaging. Inverse probability of treatment weighting was used to balance preoperative variables between the 2 groups. The incidence of postoperative SCHS did not differ between the SNB and control groups (61 [36.5%] vs. 102 [46.2%], P=0.072), but its duration was shorter in the SNB group (4 [2-6] vs. 5 [3-7] days, P=0.021). Although of limited clinical relevance, the SNB group had lower postoperative pain scores and systolic blood pressures at postoperative days 0 to 1 and a shorter intensive care unit stay. Despite some potential benefits, SNB was not associated with a reduced incidence of postoperative SCHS in adult patients who underwent combined revascularization surgery for moyamoya disease.

Metabolomic Analysis of Patients With Patent Foramen Ovale and Migraine Using Liquid Chromatography-Mass Spectrometry Technology.

This study aims to examine the changes in metabolic profiles in patients with patent foramen ovale (PFO) and migraine, as well as in patients with isolated migraine, before and after surgical intervention using metabolomics. Patients were categorized into four groups: the simple migraine (SM) group, the PFO with migraine preoperative group (PRE), the PFO with migraine postoperative Day 3 group (POST_3d), and the PFO with migraine postoperative Day 30 group (POST_30d). Untargeted metabolomics using liquid chromatography-mass spectrometry (LC-MS) were employed to identify differential metabolites across these groups. Differential metabolites were identified, their clinical diagnostic value was assessed, and a correlation analysis was conducted to examine changes in metabolic pathways before and after surgery. The expression levels of metabolites such as linoleic acid, quinolinic acid, homophenylalanine, and amphetamine showed significant changes in patients with PFO and migraine following surgery. Notably, linoleic acid demonstrated strong diagnostic potential for this patient population. Trend analysis revealed that the levels of 3-phenylpropionic acid and caffeine decreased on postoperative Day 3 and subsequently increased by postoperative Day 30, whereas gallic acid continuously declined. Compared to the PRE group, differential metabolites in the SM group were primarily associated with α-linolenic acid metabolism, niacin and nicotinamide metabolism, sphingolipid signaling, and tyrosine metabolism. In contrast, differential metabolites in the POST_3d group were predominantly enriched in phenylalanine metabolism, niacin and nicotinamide metabolism, protein digestion and absorption, and caffeine metabolism. Linoleic acid may serve as a potential biomarker, and the activation of inflammation and oxidative stress-related pathways could contribute significantly to the development of complicated migraine in patients with PFO.

Liver stiffness: a novel imaging biomarker by ultrasound elastography for prediction of early allograft failure following liver transplantation.

The objective of this study was to evaluate the role of Liver Stiffness Measurement (LSM) and serum transaminase levels for predicting early allograft failure (EAF) after liver transplantation (LT). A total of 189 patients who underwent LT were prospectively recruited in the study. Of these patients, 13 cases died or received re-transplantation within 90 days after surgery were classified as EAF group, while rest 176 patients were included in the non-EAF group. LSM values and serum transaminase levels within 1 week after operation were recorded and compared between two groups. The area under the curve (AUC) was utilized to assess the performance of LSM, serum transaminase and their combination in predicting EAF. The earliest significant difference in LSM between EAF and non-EAF group was observed on postoperative day 3 (POD-3) (p = 0.046). Comparing to non-EAF group, patients in the EAF group had higher aspartate-aminotransferase (AST) and alanine aminotransferase (ALT) on postoperative day 2 (POD-2)(p = 0.009, 0.033), and also demonstrated higher AST on POD-3 (p = 0.021). Furthermore, the reduction rate of AST/ALT from day 1 to day 3 (AST/ALT Red) were slower (p = 0.001, 0.014) in EAF group. Using a LSM value > 12.1kPa and an AST level > 339U/L on POD-3 predicted EAF with a sensitivity of 89%, a specificity of 86%, and an AUC of 0.926, surpassing the traditional early allograft dysfunction (EAD) model. The combination of LSM values and AST levels on the third day after LT can effectively predict EAF and facilitate timely interventions.

Do transversus abdominis plane (TAP) blocks improve pain after laparoscopic bilateral inguinal hernia repairs beyond the recovery unit? A randomized control trial.

While surgeons agree that perioperative field blocks should be performed for open inguinal hernia surgery, there lacks consensus in the minimally invasive context. Prior small-scale randomized trials study pain scores only up to 24h postoperatively. Thus, we sought to investigate the analgesic benefits of a bupivacaine transversus abdominis plane (TAP) block in the first 4 postoperative days. This is a prospective single-institution randomized control trial involving patients undergoing elective totally extraperitoneal inguinal hernia repairs, who received either a TAP block with bupivacaine 0.25% or saline placebo. Postoperatively, patients completed a pain survey (based on a 0-10 visual analog score) and an opioid/non-opioid pain medication log. Differences were detected using a Wilcoxon rank sum test for continuous variables, and a Fisher's exact test or chi-squared for categorical variables. A total n = 90 patients were included in the per-protocol analysis, of which n = 46 received TAP blocks with bupivacaine versus n = 44 placebo. Patient characteristics were similar between the groups, including recurrent hernias and number of tacks placed (p > 0.05). All cases were bilateral. Postoperatively, pain scores (at rest and with movement) and pain medication use were similar for all postoperative days 1-4. Our study shows no significant difference in pain or opioid requirement within the first 4days postoperatively, suggesting that the analgesic benefits of plain bupivacaine TAP blocks in totally extraperitoneal inguinal hernia repairs do not exist beyond the recovery unit. This will help inform anesthesiologists and patients in discussing risks and benefits of a TAP block in their surgical context.

Laparoscopic peritoneal mucinous cystadenoma debulking: A case report.

Peritoneal mucinous cystadenoma is rare in the clinic, lacks specific clinical manifestations, tumor markers, and imaging features, and is easily misdiagnosed and missed. Clinical practitioners should maintain a high level of vigilance. Here, we report a case of laparoscopic peritoneal mucinous cystadenoma stripping to improve our understanding of the disease. A 34-year-old woman was admitted to our hospital with a history of epigastric pain over the past year that had worsened over the previous 4 months. The patient had no history of trauma or surgery. A computed tomography scan of the whole abdomen, as well as hepatobiliary and pancreatic scans and magnetic resonance cholangiopancreatography examinations, showed a low-density mass of approximately 5.8 × 4.8 cm between the right lobe of the liver and the right kidney. The lesion showed no significant enhancement on the enhanced scan, and analysis of tumor markers was normal. The preoperative diagnosis was cholelithiasis with cholecystitis and hepatic cysts. It was proposed to perform "laparoscopic cholecystectomy + hepatic cyst decapitation and decompression" under general anesthesia; however, intraoperative exploration revealed that the abdominal cyst had originated from the right side of the peritoneum and was located between the liver and kidney. The surgical procedure was thus changed to "laparoscopic abdominal cyst removal + cholecystectomy." The patient recovered well and was discharged on the fourth postoperative day. Postoperative pathological examination (abdominal cyst) showed mostly serous cells partially covered with high columnar mucus cells, which was consistent with mucinous cystadenoma. The postoperative diagnosis was peritoneal mucinous cystadenoma and cholecystolithiasis with cholecystitis. Clinical diagnosis of mucinous cystadenoma of the abdominal wall is difficult. The possibility of the disease should be considered when a cystic space is found in the abdominal cavity. Diagnosis depends on postoperative pathological examination, and surgery is the preferred treatment option. During the operation, attention should be paid to avoid rupture of the cyst wall and overflow of cyst fluid, and to avoid blind fenestration and drainage or puncture and aspiration sclerotherapy when the diagnosis is unclear.

Foundations for Developing a Hospital in the Home Pathway Following Low Trauma Hip Fracture: Using Data to Inform the Path

Care pathways incorporating Hospital in the Home (HITH) programs are available for people following low-trauma (osteoporotic) hip fracture (LTHF) as a strategy to reduce total length of stay (LOS), but there is no published evidence supporting the development of key components of such programs for this specific population. As a precursor to program implementation, a multidisciplinary team devised criteria for HITH eligibility and considerations for readiness for HITH transfer. This study aimed to describe the rates and timing of suitability for HITH when these criteria and considerations were applied prospectively to adults admitted with LTHF who underwent surgical fixation. Prospective, 5-month audit of patients admitted to a single facility following LTHF. Criteria for HITH inclusion/exclusion and 3 time-based safety considerations for readiness for HITH transfer (time [post-operative day, POD] to first complication, time to medical stability, time to mobilization threshold) were applied to patient-level data routinely available in the medical record. Eligibility: Of 114 patients screened, 61 (54%) were initially eligible with 41 (36%) remaining eligible over the episode-of-care. Transfer considerations: 75% of those who experienced a complication did so by POD4; 75% achieved medical stability by POD5; 75% achieved the mobility criterion by POD7; and, 75% of patients met all criteria by POD7. Using data-informed criteria and considerations, we estimate that one-third of LTHF patients will be eligible for HITH with most ready for transfer within a week post-surgery. A HITH program using safety-focused criteria may help reduce LOS for patients with LTHF.

Is the Rate of Early mobilization in Hip fracture patients using Alfentanil Better than standard opioid analgesia (REHAB)? A protocol for a prospective cohort study.

The primary aim of this study is to compare mobility status of patients receiving oral oxycodone with those receiving subcutaneous alfentanil as analgesic methods prior to mobilization to help physiotherapy compliance after hip fracture surgery. The secondary aims are to assess postoperative pain, health-related quality of life, in-hospital length of stay, total use of analgesia over postoperative days 1 and 2 (POD 1 and POD 2), complication rates within 30 days, and 30-day mortality rates. A single-centre, prospective cohort study of 64 patients will be undertaken. Patients undergoing surgery for femoral neck fractures at the study centre will be recruited. Patients with a hip fracture meeting the inclusion/exclusion criteria will be enrolled on admission. Patients who have been administered oral oxycodone will be compared to those prescribed alfentanil for pain prior to mobilization with physiotherapists on POD 1 and POD 2. Which drug a patient receives is reliant of the prescriptions given by the medical team, and in current practice this varies at approximately 50:50. Mobilization will be defined as the ability to stand on and weightbear both feet with or without assistance. Visual analogue scale pain scores, mobility status, and total analgesia use will be assessed on POD 1 and POD 2. EuroQol five-dimension health questionnaire scores, complication rates, and mortality rates will be assessed up to 30 days following surgery (POD 1, 2, 7, and 30). This study will help to build a wider protocol aiming to improve early mobilization after hip fracture surgery. The results of this study will provide pain scores and mobility status which will either support use of subcutaneous alfentanil as the standard analgesic modality prior to physiotherapy sessions, or highlight its limitations compared to the standard oral oxycodone. Secondary outcomes will also help to assess if early mobilization improves outcomes compared to delayed mobilization.

Early mobilization program with nonweight-bearing brace improves functional capacity after diabetic foot ulcer surgery: a randomized controlled trial

PurposeThis study aimed to evaluate the effectiveness of early mobilization program with nonweight-bearing braces in improving functional outcomes and clinical indicators after diabetic foot ulcer surgery.MethodsWe conducted a randomized trial involving patients with diabetic foot ulcers (DFUs) who underwent surgery at a tertiary university hospital. Participants were randomized to receive either early mobilization with nonweight-bearing braces or standard rehabilitation care. The primary outcome was the ability to walk a distance of three meters without human assistance upon hospital discharge. Secondary outcomes included activity of daily living (ADL), measured by the Barthel Index survey; reduction in lean body mass, assessed via thigh circumference on postoperative day 10 (POD 10); length of stay (LOS); and the incidence of postoperative complications such as deep venous thrombosis (DVT), pain, and wound dehiscence.ResultsA total of 46 patients were enrolled, with 23 assigned to the early mobilization program with nonweight-bearing braces (intervention group) and 23 to the standard rehabilitation care group (control group). The primary outcome was achieved in 16 patients (69.6%) in the intervention group and 6 patients (26.1%) in the control group [RD43.5%, 95%CI (17.5%,69.5%); P = 0.003]. The intervention group demonstrated improved outcomes in ADL. Additionally, the intervention facilitated earlier discharge with a LOS of 12 days in the intervention group compared to 18 days in the control group.ConclusionAn early postoperative mobilization program with nonweight-bearing brace is demonstrated to be feasible and effective in improving functional capacity in patients with diabetic foot ulcers undergoing surgery.

Protein alterations in patients with delirium after cardiac surgery: An exploratory case-control sub-study of the VISION Cardiac Surgery Biobank.

Delirium is an acute state of confusion associated with adverse postoperative outcomes. Delirium is diagnosed clinically using screening tools; most cases go undetected. Identifying a delirium biomarker would allow for accurate diagnosis, application of therapies, and insight into causal pathways. To agnostically discover novel biomarkers of delirium, we conducted a case-control sub-study using the VISION-Cardiac Surgery biobank. Our objective was to identify candidate biomarkers to investigate in future studies. We obtained a convenience sample of 30 patients with delirium on postoperative day 1 matched to 30 matched controls by age, sex, ethnicity, center and cardiopulmonary bypass time. The Olink Explore 3K platform was used to identify blood protein alterations on postoperative day 3. Protein concentrations were expressed as normalized protein expression (NPx) units (log2 fold scale). We compared protein expression between cases and controls using a paired t-test and reported significantly different biomarkers based on a False Discovery Rate (FDR)-adjusted p-value<0.05. Of 2,865 unique serum proteins, 26 (0.9%) were significantly associated with delirium status; all were elevated in cases versus controls at an FDR<0.05. Pathway analysis identified "calcium-release channel activity" (Padj=0.02) and "Guanosine 5' triphosphate (GTP)-binding" (Padj=0.005) functions as characteristic of proteins associated with delirium. The top three differentially expressed biomarkers were FKBP1B (Padj=0.003), C2CD2L (Padj=0.004), and RAB6B (Padj=0.004). The inflammatory biomarker IL-8 (CXCL8) (mean difference = 2.36; P=3.6x10-4) was also associated with delirium. We identified 26 biomarkers significantly associated with delirium; all are novel except for IL-8. We did not identify an association between delirium and recognized neuro-inflammatory proteins and markers of brain injury, which supports using biomarkers to differentiate between delirium and other neurological conditions. While exploratory, our findings support using biomarkers to diagnose postoperative delirium and validate using agnostic screens to identify potential delirium biomarkers.

Machine learning algorithms for predicting delayed hyponatremia after transsphenoidal surgery for patients with pituitary adenoma

This study aimed to develop and validate machine learning (ML) models to predict the occurrence of delayed hyponatremia after transsphenoidal surgery for pituitary adenoma. We retrospectively collected clinical data on patients with pituitary adenomas treated with transsphenoidal surgery between January 2010 and December 2020. From January 2021 to December 2022, patients with pituitary adenomas were prospectively enrolled. We trained seven ML models to predict delayed hyponatremia using the clinical variables in the training set. The final model was internally validated using a test set and a prospective dataset. The SHapley Additive exPlanations (SHAP) algorithm was used to determine the significance of each variable in the occurrence of delayed hyponatremia. In the training dataset, the best predictive performance was observed for XGBoost (area under the ROC curve; AUC = 0.821), followed by Random Forest (AUC = 0.8), Logistic Regression (AUC = 0.793), Support Vector Machine (AUC = 0.776), naïve Bayes (AUC = 0.774), K-Nearest Neighbors (AUC = 0.742), and Decision Tree (AUC = 0.717). The AUC of the XGBoost model for the test and prospective datasets are 0.831 and 0.785, respectively. The differences in pituitary stalk deviation angle, the “measurable pituitary stalk” length before and after surgery, and blood sodium concentration between preoperative and postoperative day 2 were important variables for predicting delayed hyponatremia as determined by the SHAP algorithm. The XGBoost model was best able to predict delayed hyponatremia after transsphenoidal surgery for pituitary adenomas. The differences in pituitary stalk deviation angle, pre- versus postoperative “measurable pituitary stalk” length, and pre- versus postoperative day 2 blood sodium concentrations were important variables for predicting delayed hyponatremia.

Living Donor Liver Transplantation Using Right Posterior Section Graft in a Human Immunodeficiency Virus/Hepatitis C Virus-Coinfected Patient With Hemophilia: A Case Report.

Liver transplantation is an important treatment option for liver cirrhosis in patients with HIV/HCV coinfection. In Japan, the limited number of deceased donors may force the selection of living donor liver transplantation. Appropriate graft selection is the key to success. The patient, a 66-year-old male with hemophilia A, acquired HIV and HCV through blood transfusions. He had a multidrug-resistant HIV strain, requiring frequent changes in antiretroviral therapy. Although his HCV cleared spontaneously, liver fibrosis progressed. With a Child-Pugh score of 9 and a MELD score of 13, liver transplantation was considered. His child became the living donor. A factor VIII concentrate test was performed preoperatively, and his HIV treatment was adjusted to avoid drug interactions. The chosen graft was a posterior segment (graft-to-recipient weight ratio of 0.8), and surgery lasted 787 min with a blood loss of 7046 g. Factor VIII concentrate was stopped on the second postoperative day as activity increased. The patient was discharged on postoperative day 47. This is the first reported living donor liver transplantation using a posterior segment graft in a hemophilia patient coinfected with HIV and HCV. Liver transplantation can be safely performed by formulating a preoperative coagulation factor supplementation protocol.

Outcomes of internal rib fixation through complete video-assisted thoracoscopic surgery for multiple rib fractures and flail chest in severe chest trauma

BackgroundSurgical stabilization of rib fractures (SSRF) is a standard treatment for multiple rib fractures and flail chest. The aim of this study is to evaluate the outcomes of internal rib fixation through complete video-assisted thoracoscopic surgery (VATS) for multiple rib fractures and flail chest in patients with severe chest trauma.MethodsThirty-nine patients with multiple rib fractures caused by severe chest trauma were divided into two groups according to the surgical approach used. Twenty-one patients were diagnosed with flail chest. In the thoracoscopic surgery group, 17 patients underwent internal rib fixation through complete VATS. In the open surgery group, 22 patients underwent surgery with open reduction and internal fixation. Surgical variables, such as operation time, intraoperative blood loss, chest tube drainage volume, complications, visual analog scale (VAS) of pain score, postoperative ventilator days, Intensive Care Unit (ICU) stay and hospital stay, were compared between the two groups.ResultsThere were no differences in operation time, intraoperative blood loss, chest tube drainage volume, postoperative ventilator days, ICU stay or hospital stay between the two groups (P > 0.05). Although there was no significant difference in overall postoperative complications (P = 0.358), the incidence of postoperative pleural effusion was lower in the thoracoscopic surgery group than in the open surgery group (P = 0.025). The VAS score in the thoracoscopic surgery group was also significantly lower than that in the open surgery group on the seventh day after surgery (P = 0.014).ConclusionsInternal rib fixation through complete VATS is a feasible and safe approach for treating multiple rib fractures and flail chest in patients with severe chest trauma.

Effectiveness of Perioperative Finger Sensory Rehabilitation in Patients Undergoing Fingertip Amputation and Reimplantation: A Retrospective Study.

Finger reimplantation is an effective method for the treatment of amputated fingertips. However, there are several shortcomings in traditional postoperative rehabilitation programs, which may affect a patient's functional recovery after surgery. Finger sensory rehabilitation is a comprehensive program that helps patients restore sensory and motor function to their fingers through the use of specific training methods and equipment. Thus, this study aimed to analyze the effect of finger sensory rehabilitation on a group of patients who had undergone fingertip amputation and reimplantation. The medical records of 106 patients having undergone fingertip amputation and reimplantation from January 2022 to January 2024 were retrospectively analyzed. The patients were classified into experimental group (n = 52, receiving conventional rehabilitation training + finger sensory rehabilitation training) and the control group (n = 54, receiving only conventional rehabilitation training). Patients in both groups participated in a 20-week rehabilitation training, and the Semmes-Weinstein monofilament test was used to evaluate the finger touch pressure sensation after completing the rehabilitation training in both groups, and the Visual Analogue Scale (VAS) score, Generic Quality of Life Inventory-74 (GQOLI-74) score to evaluate their pain sensation and quality of life on the 2nd postoperative day and at the end of rehabilitation training. After completing rehabilitation, a specialized method for assessing the patient's tactile sensory deficits was used, showing that the number of cases with light tactile hypoesthesia to single-fiber sensation in the reimplanted fingertips was higher in the experimental group than in the control group (p < 0.01), while there was no significant difference in the number of cases of protective hypoesthesia between the two groups (p > 0.05), the number of cases of protective sensory loss was significantly lower in the experimental group than in the control group (p < 0.01). There was no significant difference in the pain scores and comfort scores between the two groups before management (p > 0.05). However, the pain level of the two groups after management was significantly lower than that before management (p < 0.01), whereas the post-management comfort scores of both groups were significantly higher than that before management (p < 0.001). The experimental group's degree of improvement was significantly higher than that of the control group (p < 0.001). The pre-management GQOLI-74 scores were not significantly different between the groups (p > 0.05), whereas after management, the experimental group outperformed the control group in all dimensions of the scores, except in thinking ability (p < 0.01). Although not statistically significant (p > 0.05), the total perioperative complication rate of the experimental group was lower than that of the control group. The implementation of finger sensory rehabilitation training is effective for restoring tactile function, reducing pain levels, and improving quality of life among patients who had undergone fingertip amputation and reimplantation. This finding can inform the development and selection of subsequent rehabilitation programs.

Impact of Pterygium Excision Combined with Autologous Limbal Stem Cell Transplantation on Microvascular Density, Tear Film Stability, and Corneal Wound Healing.

This study aimed to evaluate the impact of pterygium excision combined with autologous limbal stem cell transplantation on microvascular density, tear film stability, and corneal wound healing in the management of pterygium. A retrospective analysis was conducted on 317 patients with pterygium who underwent treatment between January 2021 and January 2024. Patients were divided into a control group (pterygium excision alone, n = 161) and a study group (pterygium excision combined with autologous limbal stem cell transplantation, n = 156) based on the surgical approach. The study compared the surgical efficacy, perioperative outcomes, and corneal healing between the two groups. Preoperative and postoperative changes in conjunctival microvascular density, tear film stability indicators, and ocular comfort scores were also assessed. The effective treatment rate was significantly higher in the study group compared to the control group (p < 0.05). Postoperative uncorrected visual acuity, vertical corneal curvature, and horizontal corneal curvature were significantly better in the study group, whereas corneal astigmatism was lower than in the control group (p < 0.05). The postoperative levels of pigment epithelial derived factor (PEDF) were higher in the study group, while levels of vascular endothelial growth factor (VEGF) and microvascular density (MVD) were lower than in the control group (p < 0.05). Corneal healing scores on postoperative days 1, 3, and 7 were lower in the study group than in the control group, and the time resolution of corneal wound congestion and corneal epithelial coverage was significantly shorter compared to the control group (p < 0.05). Tear film stability, as indicated by the Schirmer I test (SIt) and tear breakup time (BUT), was improved in the study group than that in the control group (p < 0.05). Postoperative ocular comfort scores were lower in the study group compared to the control group (p < 0.05). No significant difference in postoperative complication rates was observed between the groups (p > 0.05). Pterygium excision combined with autologous limbal stem cell transplantation effectively inhibits angiogenesis, improves visual function, enhances tear film stability, and accelerates corneal wound healing, making it a superior treatment option for pterygium.