Delay In Surgical Treatment Research Articles

Managing Gallstone during Pregnancy

Transient physiological changes in the biliary system during pregnancy increased the risk of gallbladder diseases. Nonoperative management of symptomatic cholelithiasis increases the risk of complications of biliary lithiasis, such as cholecystitis and empyema, while obstruction common bile duct stones with or without cholangitisb and biliary pancreatitis raise maternal mortality. Delay in definitive surgical treatment of biliary diseases during pregnancy increases the likelihood acute biliary pancreatitis which impact on preterm delivery until fetal lost. Laparoscopic cholesystectomy during pregnancy
 has advantages for the mother in that it speeds up her recovery, giving her less pain and facilitated natural birth without a cesarean section. On the fetus side, laparoscopic cholecystectomy is safe since it does not induce preterm delivery or abortion. Identification of gallbladder stone during pregnancy warrant a preventive laparoscopic cholesystectomy or endoscopic CBD exploration, both of which promise good outcomes.
 
 [Indones J Obstet Gynecol 2013; 1-4: 219-21]
 
 Keywords: adult choledochal cyst, biliary cyst, biliary dilatation, mixed type

Management of a Critical Case of Double Outlet Right Ventricle (DORV) and Cerebral Abscess by Multiple Interventions

Tetralogy of Fallot (TOF) is the commonest type of cyanotic congenital heart disease which accounts for 10% of all congenital heart disease. Delay in surgical treatment leads to polycythaemia, cerebral abscess, thrombotic episodes etc. Corrective surgery in a case with cerebral abscess always has risk of intracranial hemorrhage during bypass1. We are hereby reporting a case of TOF who had multiple cerebral abscess managed with burr hole operation and extra ventricular drainage. Later 5 coronary stents were placed in Right Ventricular Outflow Tract (RVOT) to Main Pulmonary Artery (MPA) to overcome infundibular and valvular stenosis and thus reducing right to left shunt and cyanosis. This is the first ever palliation with RVOT stenting in a case of Double Outlet Right Ventricle (DORV), Ventricular Septal Defect (VSD), Pulmonary Stenosis (PS) with cerebral abscess where surgery was contraindicated at that time and patient condition was unstable. Later on she had bidirectional Glenn shunt on 8th December 2015 by Saudi charity team.Journal of Armed Forces Medical College Bangladesh Vol.11(1) 2015: 81-84

Survival implications of time to surgical treatment of endometrial cancers

Optimal care for women with endometrial cancers often involves transfer of care from diagnosing physicians (eg, obstetrician-gynecologists) to treating physicians (eg, gynecologic oncologists.) It is critical to determine the effect of time to treatment on cancer outcomes to set best practices guidelines for referral processes. We sought to determine the impact of time from diagnosis of endometrial cancer to surgical treatment on mortality and to characterize those patients who may be at highest risk for worsened survival related to surgical timing. The National Cancer Database was queried for incident endometrial cancers in adults from 2003 through 2012. Cancers were classified as low risk (grade 1 or 2 endometrioid histologies) or high risk (nonendometrioid and grade 3 endometrioid histologies) and analyzed separately. Demographic, clinicopathologic, and health system factors were collected. Unadjusted and adjusted hazard ratios for mortality were calculated by interval between diagnosis and surgery. Linear regression of patient and health care system characteristics was performed on diagnosis-to-surgery interval. For low-risk cancers (N= 140,078), surgery in the first and second weeks after diagnosis was independently associated with mortality risk (hazard ratio, 1.4; 95% confidence interval, 1.3-1.5; and hazard ratio, 1.1; 95% confidence interval, 1.0-1.2, respectively). The 30-day postoperative mortality was significantly higher among patients undergoing surgery in the first or second week postdiagnosis, compared to patients treated in the third or fourth week postdiagnosis (0.7% vs 0.4%; P< .001). Mortality risk was also significantly higher than baseline when time between diagnosis and surgery was >8 weeks. Independent associations with added time to surgery of at least 1 week were seen with black race (1.1 weeks; 95% confidence interval, 0.9-1.4), uninsurance (1.3weeks; 95% confidence interval, 1.1-1.5), Medicaid insurance (1.7weeks; 95% confidence interval, 1.5-1.9), and Charlson-Deyo comorbidity score >1 (1.0 weeks; 95% confidence interval, 0.8-1.2). For high-risk cancers (N= 68,360), surgery in the first and second weeks after diagnosis was independently associated with mortality risk (hazard ratio, 1.5; 95% confidence interval, 1.3-1.6; and hazard ratio, 1.2; 95% confidence interval, 1.1-1.2, respectively). The 30-day postoperative mortality was significantly higher among patients undergoing surgery in the first or second week postdiagnosis, compared to patients treated in the third or fourth week postdiagnosis (2.5% vs 1.0%; P < .001). Surgery after the third week postdiagnosis was not associated with a statistically significant increase in the adjusted risk of mortality. Independent associations with added time to surgery of at least 1 week were seen with uninsurance (1.4 weeks; 95% confidence interval, 0.9-1.9) and Medicaid insurance (1.4 weeks; 95% confidence interval, 1.1-1.7). Surgery in the first 2 weeks after diagnosis of endometrial cancer was associated with worsened survival associated with elevated perioperative mortality and treatment in low-volume hospitals. Delay in surgical treatment was a risk factor for mortality in low-risk cancers only and was likely associated with poor access to specialty care. We suggest that the target interval between diagnosis and treatment of endometrial cancers be ≤8 weeks; however, referral to an experienced surgeon and adequate preoperative optimization should be prioritized over expedited surgery.

Technical Considerations in the Surgical Management of External Laryngotracheal Trauma: Surgical Outcomes

Introduction: External laryngotracheal (ELT) trauma is rarely encountered in clinical practice. In most circumstances, this injury is overlooked by the primary attending team. Surgical management of ELT trauma is complicated, because there is no established management approach for this potentially life-altering, high morbidity injury. It is important for this injury to be identified early, as any delay in surgical intervention may result in poor airway and phonatory outcomes. The aim of surgical reconstruction is to minimise the above debilitating morbidities by restoring the main laryngeal functions as much as possible. Methods: We reviewed the outcomes of six surgical interventions for ELT trauma at Tengku Ampuan Afzan Hospital from June 2007 to June 2014. Clinical presentations, computed tomography (CT) scans features, intraoperative findings, and postoperative outcomes were evaluated. Results: All patients made a good recovery in terms of phonation except for one patient who had reduced speech function. After one year, one patient was still dependent on a fenestrated tracheostomy. This article describes the surgical reconstruction techniques used to achieve these positive outcomes. Stenting is helpful to aid healing and re-epithelialisation. Conclusion: Prompt recognition and non-traumatised airway control are essential for addressing laryngotracheal trauma. Subcutaneous emphysema is an important hallmark that should alert the attending physician to the possibility of ELT trauma. Immediate surgical intervention using appropriate techniques can produce favorable patient outcomes.

Parathyroidectomy for primary hyperparathyroidism in the elderly: experience of a single endocrine surgery center.

Primary hyperparathyroidism is a common endocrine disease, and its incidence increases with age. Our aim was to retrospectively evaluate the impact of age on patient outcomes following parathyroidectomy for primary hyperparathyroidism. Two-hundred fifty-six consecutive patients undergoing parathyroidectomy with preoperative diagnosis of primary hyperparathyroidism were divided into three groups according to patient age: group A, ≤64 years; group B, 65-74 years; and group C, ≥75 years. Thyroid disease was associated with the hyperparathyroidism in 44 patients (28.2%) in group A, 34 (44.7%) in B, and 10 (41.7%) in C (p<0.01). Minimally invasive parathyroidectomy was performed in 104 patients (66.7%) in group A, 35 (46.1%) in B, and 8 (33.3%) in C (p<0.01). Conversion to bilateral exploration was carried out in five cases in group A (4.6%), three in B (8.3%), and two in C (20%). Multiglandular disease was observed in six patients (3.8%) in group A, seven (9.2%) in B, and five (20.8%) in C (p=0.012). Mean postoperative stay was similar between groups; no major complications and no cases of mortality occurred. Multiglandular disease is more common in older patients than younger individuals, and minimally invasive approaches are less used in this patient group. Increased surgical risk and paucity of symptoms in these patients sometimes result in a delay in surgical treatment. Parathyroidectomy is a safe and effective procedure to perform in elderly patients. Multiglandular disease was found to be more prevalent in older patients, but minimally invasive parathyroidectomy can be performed safely. Surgeons should consider parathyroidectomy in patients with primary hyperparathyroidism regardless of age.

Three-dimensional reconstruction using stereoradiography for evaluating adult spinal deformity: a reproducibility study.

In addition to the sagittal alignment, impact of transverse plane parameters (TPP) and rotatory subluxation on patients reported outcomes were highlighted. One of the hypotheses for genesis of degenerative scoliosis is disc degeneration with increased axial vertebral (AVR) and intervertebral rotation (AIR). Therefore, TPP analysis at early stage of the scoliosis seems of particular interest. This study aims at assessing reliability of tridimensional (3D) reconstructions of adult spinal deformity (ASD) patients. Thirty ASD patients underwent biplanar radiographs and were divided into two groups (Cobb angle >30° or <30°). Spinal parameters and TPP (apical AVR, AIR of upper and lower level of main curve) were measured. Four operators performed 3D reconstructions twice. Intra and inter-observer reliabilities were analyzed using ISO standard 5725-2, to quantify the global standard deviation of reproducibility (S R). Mean Cobb angle was 31°, mean age 55years (70% of female). Mean values of apical AVR, upper and lower level AIR were, respectively, 16°±15°, 6°±6° and 5°±5°. Spinopelvic parameters S R were below 4.5°. For Cobb angle <30°, S R was 7.8°, 9.6°, 4.5° and 4.9°, respectively, for AVR apex, torsion index, upper and lower AIR. Reliability was worse in the group of patients with Cobb angle above 30°. 3D analysis was reliable for Cobb and sagittal parameters. 3D analysis for TPP was reproducible when Cobb is below 30°. However, uncertainty is larger for Cobb above 30°. Nevertheless, 3D reconstructions could help surgeons to anticipate onset of rotatory subluxation while assessing axial rotation evolution for small deformity and choose best delay for surgical treatment.

Functional Outcome and Complications of Open Reduction and Internal Fixation With Low-Profile Plates in Hand Fractures

Introduction: Fractures of the metacarpals and phalanges are common injuries that account for up to 40% of upper extremity fractures. Such fractures occur in the age range between 10 and 40 years, are more common in men, and have a particular association with sports. Although conservative treatment is presented as an alternative therapy, the results are not always satisfactory. Plate fixation has demonstrated superior over other surgical methods in repeated biomechanical and clinical studies. There has been published literature that proves low-profile plates have even fewer complications than other surgical techniques that are less aggressive such as percutaneous pinning. The aim of this study is the retrospective evaluation of the clinical results and complications of patients with fractures of metacarpals and phalanges treated by open reduction internal fixation with low-profile plates. Materials and Methods: A retrospective review of the patient database for the period 2003-2014 was performed. Seventy-two patients who met the inclusion criteria were obtained. We identified 62 male and 14 female patients. The average age was 30.62 years (range, 15-58 years). An injury in the dominant hand was identified in 34 patients. For metacarpal fractures, a dorsal metacarpal approach over the affected bone was performed. A longitudinal incision is made on the periosteum, with the aim of preserving bone vascularity. The plate was placed dorsally. In the case of fractures of the proximal phalanx, a dorsolateral approach was performed. Bone was exposed through a longitudinal approach on the periosteum. The plate was placed dorsolateral in all cases. Additional compression screws were placed as needed according to the fracture type. The immediate postoperative period includes a wound coverage with padded bandages associated with immobilization antebrachiopalmar in intrinsic plus position. Passive motion and active immobilization were initiated at first and third week, respectively. Results: The final range of motion as rated by Duncan was grade I in 42 patients, grade II in 16 patients, grade III in 11 patients, and grade IV in 3 patients. The proportion of grip strength averaged 81.3% compared with the contralateral side. The time to fracture healing was 2.3 months. Complications were described: 4 cases of hypertrophic scar and keloid, 2 cases of complex regional pain syndrome, 6 cases of delayed union, 1 patient had a case of refracture. No cases of infection associated with osteosynthesis material were observed. We found that fractures in nondominant hand, intra-articular fractures, and delay in surgical treatment are associated with poorer functional outcomes ( P &lt; .05). Conclusion: The low-profile plates are valid for the treatment for metacarpal and phalangeal fractures. Progress in implant design has reduced the complications attributed to the material. However, the range of mobility and functional end complications depend largely on the presence or absence of factors associated with the patient, the fracture, and the circumstances. In this study, we have shown that the presence of lesions in nondominant hand, the intra-articular commitment, and delayed surgical treatment are factors associated to low-end range of functional mobility.

Association between Delay in Surgical Treatment and Perforation in Acute Appendicitis

Introduction: Acute appendicitis is a prevalent emergency surgical pathology and without prompt intervention may lead to gangrene, perforation and death. Increased mortality and morbidity will increase the hospital stay and the costs. We aimed to see the association between surgical treatment and perforation. Patient and Method: 130 patients who were undergone emergency appendectomy were included in the study. Patients were divided into three groups based on the time from symptom onset to the operation (Group 1, 36 hours). Perforation rates, surgical site infections, operation time and hospital stay was compared. Result: Hospital stay was shorter in Group 1 compared to Group 2 and 3 and were respectively 1.9 days, 3.4 days, 4.8 days. Surgical site infection was 5.4% for Group 1, 7.2% for Group 2, 10% for Group 3 (p<0.02). When the perforation rate was compared it was found 3% for group 1, 13% for Group 2, 31% for Group 3 and it was statistically significant (p<0.001). Conclusion: Surgical site infections, hospital stay, perforation and complications associated with perforation were less in patients with acute appendicitis who were diagnosed and treated within 24 hours of symptom onset than patients who were diagnosed after 24 hours.

Risk factors for surgical treatment delay in women with endometrial cancer

Risk factors for surgical treatment delay in women with endometrial cancer

Postoperative outcomes in patients with perforated bowel: early versus late intervention

BackgroundTime to intervention is suggested to be a crucial factor for a number of surgical conditions. In this study, we aim to examine the postoperative outcomes associated with the timing of surgical intervention in patients with perforated bowel. Materials and methodsCross-sectional study using the Nationwide Inpatient Sample database, 2003-2010. The study population included adult (≥18 y) inpatients who had perforated intestine or colon and underwent bowel surgery. ResultsA total of 5412 (64.6%) patients who had an early surgical intervention on same day of admission and 2985 (35.4%) patients who had a delayed surgery were included. Patients with comorbidities or those in hospitals in the Northeast region of the United States were more likely to have a delayed intervention (P < 0.01). In low-risk patients who are aged <65 y old and with no comorbidities, the timing of surgery did not associate with the risk of postoperative complications (P = 0.77) and mortality (P = 0.08), whereas in high-risk patients who are aged ≥65 y old or with comorbidities, an early surgical intervention was associated with a lower risk of complications (odds ratio: 0.77; 95% CI: 0.69-0.87; P < 0.001), and a lower mortality risk (odds ratio: 0.79; 95% CI: 0.68-0.92; P = 0.002). Patients with a delayed intervention were associated with a hospital stay >15 d (P < 0.001) and a higher cost of health services (P < 0.01). ConclusionsPatients treated in the Northeast of the United States were more likely to experience a delayed surgery. Delay of surgical intervention is associated with unfavorable outcomes only in older patients or those with comorbidities.

Malignant Biliary Obstruction: Evidence for Best Practice.

What should be done next? Is the stricture benign? Is it resectable? Should I place a stent? Which one? These are some of the questions one ponders when dealing with biliary strictures. In resectable cases, ongoing questions remain as to whether the biliary tree should be drained prior to surgery. In palliative cases, the relief of obstruction remains the main goal. Options for palliative therapy include surgical bypass, percutaneous drainage, and stenting or endoscopic stenting (transpapillary or via an endoscopic ultrasound approach). This review gathers scientific foundations behind these interventions. For operable cases, preoperative biliary drainage should not be performed unless there is evidence of cholangitis, there is delay in surgical intervention, or intense jaundice is present. For inoperable cases, transpapillary stenting after sphincterotomy is preferable over percutaneous drainage. The use of plastic stents (PS) has no benefit over Self-Expandable Metallic Stents (SEMS). In case transpapillary drainage is not possible, Endoscopic Ultrasonography- (EUS-) guided drainage is still an option over percutaneous means. There is no significant difference between the types of SEMS and its indication should be individualized.

Return to work after knee replacement: a qualitative study of patient experiences

ObjectiveAn increasing number of patients in the working population are undergoing total knee replacement (TKR) for end-stage osteoarthritis. The timing and success of return to work is becoming increasingly important...

Usefulness of ¹¹C-methionine positron emission tomography for treatment-decision making in cases of non-enhancing glioma-like brain lesions.

The present study evaluated usefulness of the positron emission tomography with (11)C-methionine for prediction of the clinical course and treatment decision-making in adult patients with newly diagnosed non-enhancing brain lesions mimicking low-grade gliomas. Retrospective analysis was done in 163 cases. In overall, 131 tumors underwent surgical resection, which in 34 cases was done after initial period of observation. Among the latter 5 patients were operated on after significant clinical deterioration. In overall, 3 resected neoplasms corresponded to WHO histopathological grade I, 87 to grade II, 39 to grade III, and 2 to grade IV. In all 163 cases the tumor/normal brain uptake ratio (T/N ratio) of (11)C-methionine ranged from 0.68 to 8.02 (mean 2.21 ± 1.16, median 1.81). Mean T/N ratios of non-operated lesions, low-grade and high-grade tumors were 1.60 ± 0.85, 2.27 ± 1.22, and 2.54 ± 1.09, respectively (P < 0.0001), but overlap between 3 groups was prominent. In patients who had clinical deterioration during the period of observation T/N ratios of the lesion varied from 1.49 to 3.38 (mean 2.23 ± 0.70, median 2.15). Comparison of the deterioration-free survival of patients with T/N ratios of the lesion above and below 1.90 revealed statistically significant difference (P < 0.0001). In conclusion, "wait-and-scan" strategy with delay of surgical treatment does not seem reasonable option if T/N ratio of (11)C-methionine in the non-enhancing glioma-like brain lesion constitutes ≥1.90, since it may be associated with significant risk of tumor progression and clinical deterioration during follow-up.

A multi-outcome analysis of the effects of treatment timing in the management of zygomatic fractures

The aim of this study was to analyze the effects of surgical treatment delay in the management of zygomatic fractures. A retrospective case series of 99 patients was undertaken. Four outcome measures were analyzed in relation to delay: facial symmetry, facial scarring, trismus, and radiographic outcome. Five additional variables were subsequently analyzed: operation, diagnosis, primary operator, regular alcohol use, and regular cigarette use. Statistically significant associations were found between delay and facial scarring, and delay and radiographic outcome. For each additional delay of a day, the odds of facial scarring being present, compared to absent, decreased by 13% (odds ratio (OR) 0.87, 95% confidence interval (CI) 0.76–0.98). For regular cigarette users, for each additional day of delay there was a 306-fold increased risk of having a radiographic outcome of major deviation from premorbid compared to equivalent to premorbid (OR 306.38, 95% CI 2.08–45,161.49). For non-regular cigarette users/non-users, for each additional day of delay there was a 1.5-fold increased risk of having a radiographic outcome of major deviation from premorbid compared to equivalent to premorbid (OR 1.50, 95% CI 1.08–2.09). These findings correlate with commonly held beliefs and anecdotal evidence. Despite the limitations, this study allows for an evidence-based approach to the timing of treatment of zygomatic fractures.

The effect of surgical timing on the outcome of patients with neck of femur fracture.

To investigate the effect of surgical timing (in hours versus after hours and weekdays versus weekends) on the outcome of patients with neck of femur fracture. Patients who were admitted to a single tertiary referral hospital for surgical management of femoral neck fractures over a continuous period from 1/11/2002 to 12/7/2012 were identified from medical records and the operating theatre database. A consecutive series of 2334 patients were included in the study. Of the patients who underwent surgery during the weekday and during usual hours, 18% (207/1135) experienced an adverse event, compared to 16% (193/1199) outside of these times. The difference between the two groups was not significant (p = 0.17). The same conclusion was made for the comparison between those who had surgery during the week with those who had surgery on the weekend (17%, 267/1546 and 17%, 133/788, respectively, p > 0.05). The proportion of patients who underwent surgery during hours that experienced an adverse event was significantly higher than those undergoing surgery out of hours (18%, 327/1789 and 13%, 73/545, respectively, p = 0.0081). When adjusted for age, ASA score and pre-operative stay, there was no statistical difference between those different sub-groups. There was no difference in the rates of adverse events between patients who had surgery during hours and weekdays with those who had surgery after hours or weekends. The careful selection of patients with appropriate hospital staff, resources and adequate theatre access, surgery during after hours and weekends may be safely considered to prevent a delay in surgical treatment for patient with neck of femur fracture.

Female genital mutilation/cutting: an update

Female genital mutilation/cutting (FGM/C) is a cultural practice involving several types of external female genitalia cutting. FGM/C is known to occur in all parts of the world but is most prevalent in 28 countries in Africa and the Middle East and among immigrant communities in Europe, Australia, New Zealand, Canada, and the United States. Studies of FGM/C suffer from many methodological problems including inadequate analysis and an unclear reporting of results. The evidence to link FGM/C to infertility is weak. The management of epidermal clitoral inclusion cysts includes expensive investigations like comprehensive endocrinology tests and MRI resulting in unnecessary anxiety due to delay in surgical treatment. Similarly, unnecessary cesarean sections or rupture of the infibulation scar continue to occur because of the inadequate use of intrapartum defibulation. A significant amount of efforts is required to improve and correct the inadequate care of FGM/C women and girls.

C-reactive protein measurement is not associated with an improved management of acute cholecystitis: a plié for a change

BackgroundThe diagnosis of acute cholecystitis (AC) is challenging and may result in a delay in surgical treatment and increased mortality. The 2007 and 2013 Tokyo Guidelines for AC proposed to use C-reactive protein (CRP) as an additional bench mark of AC. The aim of this study was to evaluate whether CRP measurement influences management of patients with AC. MethodsFor more than a period of 5 y (May 2004 to June 2009), 1959 patients were identified from the audit of cholecystectomies in North Shore, Waitakere and Southern Cross hospitals at Waitemata District Health Board, Auckland, New Zealand. The exclusion criteria were elective and private patients, patients without AC on histologic examination of gallbladders, and patients with acute acalculous cholecystitis. ResultsA total of 414 patients met eligibility criteria. Compared with the non-CRP group, patients who had CRP measured had a longer time to operation theater and a greater proportion of acute gangrenous cholecystitis on histologic examination of excised gallbladders, but similar postoperative complication rate, index, and total hospital stay. Time to operation theater was not associated with development of acute gangrenous cholecystitis (odds ratio, 1.0; 95% confidence interval, 0.996–1.01; P = 0.797), but correlated with the index hospital admission length (correlation coefficient, 0.6092; P < 0.001). ConclusionsCRP measurement does not influence management of patients with AC. To improve quality of care and to minimize health care provider costs physiologically fit patients with more advanced forms of AC and higher values of CRP should have their operation performed earlier than patients with mild AC and a lower concentration of CRP.

Displaced supracondylar humeral fractures: influence of delay of surgery on the incidence of open reduction, complications and outcome.

Closed reduction and pinning is the accepted treatment choice for dislocated supracondylar humeral fractures in children (SCHF). Rates of open reduction, complications and outcome are reported to be dependent on delay of surgery. We investigated whether delay of surgery had influence on the incidence of open reduction, complications and outcome of surgical treatment of SCHFs in the authors' institution. Three hundred and forty-one children with 343 supracondylar humeral fractures (Gartland II: 144; Gartland III: 199) who underwent surgery between 2000 and 2009 were retrospectively analysed. The group consisted of 194 males and 149 females. The average age was 6.3years. Mean follow-up was 6.2months. Time interval between trauma and surgical intervention was determined using our institutional database. Clinical and radiographical data were collected for each group. Influence of delay of treatment on rates of open reduction, complications and outcome was calculated using logistic regression analysis. Furthermore, patients were grouped into 4 groups of delay (<6h, n=166; 6-12h, n=95; 12-24h, n=68;>24h, n=14) and the aforementioned variables were compared among these groups. The incidence of open procedures in 343 supracondylar humeral fractures was 2.6%. Complication rates were similar to the literature (10.8%) primarily consisting of transient neurological impairments (9.0%) which all were fully reversible by conservative treatment. Poor outcome was seen in 1.7% of the patients. Delay of surgical treatment had no influence on rates of open surgery (p=0.662), complications (p=0.365) or poor outcome (p=0.942). In this retrospective study delay of treatment of SCHF did not have significant influence on the incidence of open reduction, complications, and outcome. Therefore, in SCHF with sufficient blood perfusion and nerve function, elective treatment is reasonable to avoid surgical interventions in the middle of the night which are stressful and wearing both for patients and for surgeons. III (retrospective comparative study).

Acute appendicitis in pregnancy: literature review.

suspected appendicitis is the most common indication for surgery in non-obstetric conditions during pregnancy and occurs in about one in 500 to one in 635 pregnancies per year. This occurs more often in the second trimester of pregnancy. Acute appendicitis is the most common general surgical problem encountered during pregnancy. a literature review on research of scientific articles, under the terms "acute appendicitis" and "pregnancy", in PubMed, Lilacs/SciELO, Scopus, Cochrane Library and Uptodate databases. the clinical manifestations of appendicitis are similar to non-pregnant women, however, without a classic presentation, which often occurs, diagnosis is difficult and must be supported by imaging. clinical diagnosis should be strongly suspected in pregnant women with classic findings such as abdominal pain that migrates to the right lower quadrant. The main purpose of imaging is to reduce delays in surgical intervention due to diagnostic uncertainty. A secondary objective is to reduce, but not eliminate, the negative appendectomy rate. Differential diagnosis of suspected acute appendicitis usually includes pathologies considered in non-pregnant people. the imaging study of choice is ultrasound, MRI may be used when the former is not conclusive and, as a last resort, a CT scan can be performed. The treatment remains appendectomy by laparotomy, since the feasibility of video- assisted surgery in these cases remains controversial.

MP18-19 DELAY OF SURGICAL TREATMENT OF PENILE FRACTURE RESULTS IN POOR FUNCTIONAL OUTCOME: RESULTS FROM A LARGE RETROSPECTIVE MULTICENTER EUROPEAN STUDY.

You have accessJournal of UrologyTrauma/Reconstruction: Ureter, Bladder, External Genitalia and Urotrauma I1 Apr 2015MP18-19 DELAY OF SURGICAL TREATMENT OF PENILE FRACTURE RESULTS IN POOR FUNCTIONAL OUTCOME: RESULTS FROM A LARGE RETROSPECTIVE MULTICENTER EUROPEAN STUDY. Giorgio Bozzini, Maarten Albersen, Javier Romero Otero, Juan Ignacio Martinez-Salamanca, Markus Margreiter, Christian Gratzke, Eduardo Garcia Cruz, Alex Mueller, Ege Can Serefoglu, and Paolo Verze Giorgio BozziniGiorgio Bozzini More articles by this author , Maarten AlbersenMaarten Albersen More articles by this author , Javier Romero OteroJavier Romero Otero More articles by this author , Juan Ignacio Martinez-SalamancaJuan Ignacio Martinez-Salamanca More articles by this author , Markus MargreiterMarkus Margreiter More articles by this author , Christian GratzkeChristian Gratzke More articles by this author , Eduardo Garcia CruzEduardo Garcia Cruz More articles by this author , Alex MuellerAlex Mueller More articles by this author , Ege Can SerefogluEge Can Serefoglu More articles by this author , and Paolo VerzePaolo Verze More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1051AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Penile fracture is a rare clinical entity, which represents a urological emergency. It involves traumatic rupture of the tunica albuginea of the corpora cavernosa due to twisting or bending of the penile shaft during erection. To determine the differences in preoperative diagnostic evaluation patterns and outcomes of penile fracture patients in order to investigate the impact of delaying the surgery on functional outcomes. METHODS A retrospective analysis of the data obtained from 137 patients presenting with penile fracture from 7 different European academic medical centers between 1996 and 2013 was carried out. Age, imaging modalities used, timing of surgical intervention, length of tunica albuginea defect and surgical technique were recorded. Postoperative erectile function outcomes were assessed with IIEF-5 and presence of postoperative penile curvature was noted. The association between timing of surgical intervention and postoperative IIEF-5 results was evaluated with discriminant function analysis. RESULTS The mean age of the patients was 38.96±13.55 (range 18–87). Of the 137 patients, 82 (59.85%) underwent penile Doppler ultrasound and 5 patients (3.64%) were evaluated with MRI. All of the patients were treated surgically and the duration between ER admission and surgical intervention was 13.01±0.51 (range 1.5-240) hours. The mean length of tunica albuginea defect was 15.32 ± 8.30 mm (range 7–50). Postoperative penile curvature was observed in 5/137 (3.64%) patients. Postoperative IIEF-5 scores were 15.09±7.8 and 16.85±8.96 at 1st and 3rd postoperative months, respectively. Discriminant function analysis revealed that if the surgical intervention was performed later than 8.23 hours after ER admission, postoperative erectile function was significantly worsened (p=0.0051 and p=0.0057 at 1st and 3rd months, respectively). CONCLUSIONS Our multicentric study shows that delaying the surgical intervention for more than 8.23 hours after presentation to the ER results in significantly impaired erectile function. Therefore, surgical treatment must be planned as soon as possible in order to avoid postoperative erectile dysfunction. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e214 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Giorgio Bozzini More articles by this author Maarten Albersen More articles by this author Javier Romero Otero More articles by this author Juan Ignacio Martinez-Salamanca More articles by this author Markus Margreiter More articles by this author Christian Gratzke More articles by this author Eduardo Garcia Cruz More articles by this author Alex Mueller More articles by this author Ege Can Serefoglu More articles by this author Paolo Verze More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...