Extent Of Surgical Intervention Research Articles

Influence of overweight on the course of a mechanical injury

A literature review deals with the importance of overweight in victims with severe mechanical injury. Mechanical trauma remains an important medical and social problem for humanity. The course of injury and its consequences depend not only on the nature of the trauma, but also on the initial status of victim. The individual characteristics of the patient (gender, age, concomitant somatic pathology, etc.) and the treatment strategy are of great importance, in particular the timing and extent of surgical interventions. In this aspect, the role of overweight, which is a serious health problem worldwide, deserves attention. Many clinical studies and meta-analyses have shown the impact of overweight and obesity on the severity of certain injuries, the course of the post-traumatic period, the frequency of general and local complications, and mortality. Most studies have found that obesity is a marker of a negative prognosis in abdominal injury, and increases the risk of major complications and death. Obesity has been found to be a risk factor for wound complications, intra-abdominal hypertension and abdominal compartment syndrome, acute kidney injury, infectious complications, deep vein thrombosis, thromboembolism and pneumonia. Obese patients who underwent laparotomy for abdominal trauma had higher mortality, longer duration of hospital treatment, and longer duration of stay in the intensive care unit. In addition, obesity impedes interventional manipulations (the placement of the central venous catheter, tracheal intubation, ventilation) and surgical interventions (fracture stabilization, abdominal and thoracic interventions), and reduces the diagnostic value of traditional methods for examination of patients. The negative impact of overweight and obesity should be taken into account when planning diagnostic and treatment strategy, but needs to be further investigated.

Characterization of self-anticipated pain score prior to elective surgery - a prospective observational study

BackgroundCurrent principles of postoperative pain management are primarily based on the types and extent of surgical intervention. This clinical study measured patient’s self-anticipated pain score before surgery, and compared the anticipated scores with the actual pain levels and analgesic requirements after surgery.MethodsThis prospective observational study recruited consecutive patients who received elective surgery in the E-Da Hospital, Taiwan from June to August 2018. Patients were asked to subjectively rate their highest anticipated pain level (numeric rating scale, NRS 0–10) for the scheduled surgical interventions during their preoperative anesthesia assessment. After the operation, the actual pain intensity (NRS 0–10) experienced by the patient in the post-anesthesia care unit and the total dose of opioids administered during the perioperative period were recorded. Pain scores ≥4 on NRS were regarded as being unacceptable levels for anticipated or postoperative pain that required more aggressive intervention.ResultsA total of 996 patients were included in the study. Most of the patients (86%) received general anesthesia and 73.9% of them had a history of previous operation. Female anticipated significantly higher overall pain intensities than the male patients (adjusted odd ratio 1.523, 95% confidence interval 1.126–2.061; P = 0.006). Patients who took regular benzodiazepine at bedtime (P = 0.037) and those scheduled to receive more invasive surgical procedures were most likely to anticipate for higher pain intensity at the preoperative period (P < 0.05). Higher anticipated pain scores (preoperative NRS ≥ 4) were associated with higher actual postoperative pain levels (P = 0.007) in the PACU and higher total equivalent opioid use (P < 0.001) for acute pain management during the perioperative period.ConclusionThis observational study found that patients who are female, use regular benzodiazepines at bedtime and scheduled for more invasive surgeries anticipate significantly higher surgery-related pain. Therefore, appropriate preoperative counseling for analgesic control and the management of exaggerated pain expectation in these patients is necessary to improve the quality of anesthesia delivered and patient’s satisfaction.

Molecular testing for cytologically suspicious and malignant (Bethesda V and VI) thyroid nodules to optimize the extent of surgical intervention: a retrospective chart review

BackgroundMolecular testing has been used for cytologically indeterminate thyroid nodules (Bethesda III and IV), where the risk of malignancy is 10–40%. However, to date, the role of molecular testing in cytologically suspicious or positive for malignancy (Bethesda V and VI) thyroid nodules has been controversial. The aim of this study was to determine whether patients who had molecular testing in Bethesda V and VI thyroid nodules had the optimal extent of surgery performed more often than patients who did not have molecular testing performed.MethodsA retrospective chart review of 122 cases was performed: 101 patients from the McGill University teaching hospitals and 21 patients from the Hillel Yaffe Medical center, Technion University. Patients included in the study were those with Bethesda V or VI thyroid nodules who underwent molecular testing (ThyGenext® or ThyroseqV3®) (McGill n = 72, Hillel Yaffe n = 14). Patients with Bethesda V or VI thyroid nodules who did not undergo molecular testing were used as controls (McGill n = 29, Hillel Yaffe n = 7). Each case was reviewed in order to determine whether the patient had optimal surgery. This was defined as total thyroidectomy in the presence of either a positive lymph node, extrathyroidal extension, or an aggressive pathological variant of papillary thyroid carcinoma (tall cell, hobnail, columnar cell, diffuse sclerosing, and solid/trabecular) documented on the final pathology report. In all other cases, a lobectomy/hemi/subtotal thyroidectomy was considered as optimal surgery. Chi-squared testing was performed to compare groups.ResultsWhen molecular testing was done, 91.86% (79/86) of surgeries in the molecular testing group were optimal, compared to 61.11% (22/36) in the control group. At McGill University teaching hospitals and at Hillel Yaffe, 91.67% (66/72) and 92.86% (13/14) of surgeries in the intervention group were considered as optimal, respectively. This compares to 58.62% (17/29) at McGill and 71.43% (5/7) at Hillel Yaffe when molecular testing was not performed (p = .001, p = .186).ConclusionsIn this study, molecular testing in Bethesda V and VI thyroid tumors significantly improved the likelihood of optimal surgery. Therefore, molecular testing may have an important role in optimizing surgical procedures performed in the setting of Bethesda V and VI thyroid nodules. Prospective studies with larger sample sizes are required to further investigate this finding.Graphical abstract

The method of automated adjustment and controlled maintenance of surgical stage of anesthesia in modern anesthesia machines

The method of automatical adjustment controlled maintenance of the surgical stage of anesthesia of patient during general anesthesia by means of volatile anesthetic dosage regulation depending on BIS level is described and explained. There was conducted a theoretical analysis of possibilities and perspectives of anesthesia depth’s automatical adjustment during general anesthesia by bispectral index individual monitoring depending on volatile anesthetic dosage and individual patient’s condition along with extent of surgical intervention. The possibilities of currently available medical devices allowing to implement the method into the practice have been analyzed. The technical explanation of interaction between modern volatile anesthetic vaporizer and bispectral index monitoring by feedback from integrated microprocessor, breathing circuit and multiple gas monitor of anesthesia machine and microprocessor of vaporizer has been presented.

Surgical therapy of oropharyngeal cancer-state of the art

Surgical therapy, regardless of the procedure, remains of great importance for today's treatment of oropharyngeal carcinomas, despite advances in radiation and immunotherapy. The individual treatment plan should be defined in discussion with the patient and in an interdisciplinary tumor conference, taking into account the likelihood of achieving of tumor-free resection margins and an acceptable postoperative quality of life. With regard to conventional and possibly also open surgical procedures, agood overview of the surgical site-particularly in the case of more extensive carcinomas and challenging patient anatomy-and simplified reconstructability of the defect region are decisive aspects. Endoscopically, microsurgically, or even robot-assisted minimally invasive procedures have the advantage of precise and gentle removal of tumor tissue with improved maintenance of function. Overall, selection of the appropriate surgical procedure remains an individual decision based on tumor size, the facilities at the tumor center, and the surgeon's experience. The extent of surgical intervention, also with regard to simultaneous neck dissection, depends on tumor stage. In the case of oropharyngeal carcinomas, there will be an increasing distinction between human papillomavirus (HPV)-negative and HPV-positive tumors in the future; however, the therapeutic strategy is currently identical. Upcoming clinical trials will show whether treatment de-escalation is appropriate depending on HPV infection status.

Surgical care to the wounded with large bowel battle truma during the anti-terrorist operation

A study of surgical treatment at the stages of medical evacuation of 83 wounded with a battle trauma to the abdomen and damage to the large bowel, received during the anti-terrorist operation. The wounded patients were divided into two groups: the comparison group — 42 patients with a traditional surgical management, and the main group — 41 patients with a priority surgical management, which depended on the severity of the condition, the severity of internal injuries and operational and tactical circumstances. At the second level of medical care, the surgical management and the extent of surgical interventions were determined: full, abbreviated or damage control surgery. At the III–IV levels of medical care, planned repeated operations “damage control surgery”, “second look”, as well as comprehensive treatment of the consequences and complications of gunshot wounds were performed.A new approach to the choice of surgical management, as well as the standardization of the estent of surgical interventions have reduced the number of postoperative abdominal complications by 27% and mortality rate — by 16.4%.

Practice Patterns in the Surgical Management of Pediatric Traumatic Cataracts.

To facilitate the development of standardized guidelines for the surgical management of patients with pediatric traumatic cataracts by assessing current ophthalmologists' practice patterns. This was a cross-sectional, observational, and retrospective study. A 24-question electronic survey of current practices pertaining to the surgical management of pediatric traumatic cataracts was sent to pediatric ophthalmologists worldwide. Preferences for pre-operative evaluation, surgical timing and techniques, and postoperative management were analyzed. Of the 56 respondents, 62.5% practiced in academic settings. Of the 49 respondents (87.5%) who performed pediatric ruptured globe repair, 41.7% would perform simultaneous cataract extraction if anterior capsular violation existed, whereas 4.1% would do so without capsular violation (P < .001). Most respondents (50.9%) would remove visually significant cataracts within 4 weeks in patients within the amblyogenic age range (P = .02), whereas 63.6% would wait longer outside the amblyogenic range. Preferences for intraocular lens selection, primary posterior capsulotomy, and timing of amblyopia therapy differed. Individual management practices regarding pediatric traumatic cataracts vary depending on associated globe injuries and patient age. Trends exist in surgical planning, intraoperative techniques, and visual rehabilitation methods, but no single approach has achieved complete unanimity. Therefore, further investigation into optimal timing and the extent of surgical intervention, refractive correction, and postoperative care is necessary prior to developing evidence-based guidelines for enhancing visual outcomes in this population. [J Pediatr Ophthalmol Strabismus. 2020;57(3):190-198.].

Gastric Neuroendocrine Neoplasias: Literature Review

A brief retrospective journey into the history of neouroendocrine neoplasias serves to remind the histology and distribution of neuroendocrine cells in the gastric mucosa, followed by chronological review of NEN discovery and theory development up to the present moment. The morphological classification of gastric NET consisting of 4 possible types is highlighted: the correct interpretation of the pathological findings, taking into account not only the histological features of the tumor itself, but also of the adjacent mucosa, allows to suggest the appropriate managment, which fundamentally affects patient survival.&#x0D; The review provides other current classifications of the gastric neuroendocrine neoplasia depending on its location, embryogenesis, functional activity, histological grade (with a focus on the Ki-67 labeling index counting, and ways to improve the interobserver reliability in routine practice). Moreover, the differences in the gastric NET and NEC TNM classification are emphasized. The drawbacks of all classifications are discussed and the possibilities for their further development are considered. An important part of the review is the description of a possible immunohistochemical markers, since immunohistochemistry is widely used to confirm the diagnosis. In addition, INSM1 (insulinomaassociatedprotein 1), the new immunohistochemical and molecular marker for NEN is discussed: according to the literature, it contributes to more accurate assessment of the tumor malignant potential and the metastatic risk.&#x0D; Furthermore, modern methods of endoscopic and PET/CT imaging (68-gallium DOTATATE PET/CT, molecular imaging using SSTR (somatostatin receptor) PET/CT or GLP-1R (Glucagon-like peptide-1 receptor) SPECT (single photon emission computed tomography)/CT), which allows the clinician to suspect a NEN even before morphological analysis of the resected specimen and adequately select the extent of surgical intervention are shown.&#x0D; In conclusion, we would like to reiterate the importance of further research on the gastric NET subtype pathogenesis and their clinical behavior, also of the correlation of the endoscopic, morphological, and immunohistochemical picture with the patient prognosis to improve managment tactics.

A CLINICAL PRESENTATION AND SURGICAL MANAGEMENT OF ABDOMINAL TUBERCULOSIS AT IMCHRC, INDORE

Tuberculosis is an important cause of morbidity in India. Abdominal Tuberculosis is difficult to diagnose. This prospective observational study is based on those patients who were diagnosed to be suffering from Abdominal Tuberculosis only after they presented with an acute abdomen. This study aims to document the nature of different types of acute presentation in Abdominal Tuberculosis according to concerned clinical presentation &amp; surgical management. The study also discusses the indications and extent of surgical intervention.&#x0D; Keywords: Surgical, Abdominal &amp; Tuberculosis.

Practice patterns in the surgical management of pediatric traumatic cataracts

PURPOSE To facilitate the development of standardized guidelines for the surgical management of patients with pediatric traumatic cataracts by assessing current ophthalmologists' practice patterns. METHODS This was a cross-sectional, observational, and retrospective study. A 24-question electronic survey of current practices pertaining to the surgical management of pediatric traumatic cataracts was sent to pediatric ophthalmologists worldwide. Preferences for pre-operative evaluation, surgical timing and techniques, and postoperative management were analyzed. RESULTS Of the 56 respondents, 62.5% practiced in academic settings. Of the 49 respondents (87.5%) who performed pediatric ruptured globe repair, 41.7% would perform simultaneous cataract extraction if anterior capsular violation existed, whereas 4.1% would do so without capsular violation (P < .001). Most respondents (50.9%) would remove visually significant cataracts within 4 weeks in patients within the amblyogenic age range (P = .02), whereas 63.6% would wait longer outside the amblyogenic range. Preferences for intraocular lens selection, primary posterior capsulotomy, and timing of amblyopia therapy differed. CONCLUSIONS Individual management practices regarding pediatric traumatic cataracts vary depending on associated globe injuries and patient age. Trends exist in surgical planning, intraoperative techniques, and visual rehabilitation methods, but no single approach has achieved complete unanimity. Therefore, further investigation into optimal timing and the extent of surgical intervention, refractive correction, and postoperative care is necessary prior to developing evidence-based guidelines for enhancing visual outcomes in this population. [J Pediatr Ophthalmol Strabismus. 2020;57(3):190-198.].

Reproductive surgery: decreasing skills and advancing technology—an existential conundrum

Our article endeavors to be both a review of the recent past and a preview of the future of reproductive surgery. By reflecting on the rate of technological advancement over the past decade, we attempt to predict the trajectory of the next. We also delve into the changing nature and practical challenges of the practice of gynecologic surgery for the reproductive endocrinology and infertility subspecialist. We will explain how technological advances may alter our perception and expectations regarding the indications, timing and extent of surgical intervention in the infertile patient and in the patient seeking preservation of fertility. This review does not aim to be comprehensive, choosing instead to focus on those innovations that hold, in our view, true potential to shape the future of surgical practice. Ours is primarily a technology review. As such, it does not focus on novel surgical techniques, including uterine transplantation and ovarian tissue transplantation.

Алгоритм определения объема хирургического вмешательства при деформации Хаглунда у спортсменов

Objective: to develop an algorithm for determining the extent of surgical intervention for pain in the heel region based on a comprehensive clinical and instrumental assessment of the functional state of the lower extremities. Materials and methods: during the examination of 18 athletes with pain in the heel area, we used a thermal imaging examination (at rest and after exercise) in combination with magnetic resonance imaging data. Infrared thermography was performed using an infrared camera. Data analysis was carried out using the specialized online service tvision.pro, which allows you to track the dynamics of the patient's thermographic picture. The combination of images of thermographic and MRI studies makes it possible to assess the functional state of the structures of the heel region with the identification of the structures most involved in the pathological process. Results: based on the experience of treating athletes with pain in the heel area, we developed an algorithm for determining the extent of surgical intervention for Haglund deformity. The algorithm is based on the analysis of MRI data and their comparison with the results of the examination of the soft tissue of the heel area using functional thermal imaging. Conclusions: a comprehensive analysis of the data of thermographic and tomographic studies allows you to perform an objective assessment of the functional state of the patient based on the primary localization of the pathological process. The developed algorithm is applicable for planning the extent of surgical intervention and making a choice of preferable technique. The proposed tactic contributes to early return to competitive load. The infrared thermography technique provides important additional data on the functional state of the athlete's musculoskeletal system. It is absolutely safe for both the patient and the specialist who conducts the study.

Clinical and experimental studies of tissues in thermal injuries

The article is devoted to studies used in the clinic and in the experiment in the study of tissue damage caused by exposure to high temperature. Determining the area and depth of tissue damage during thermal injury is of fundamental importance not only for treatment, but also for prognosis. The use of laser Doppler flowmetry, magnetic resonance imaging, pH-metry, contactless infrared thermometry of burn wounds, the method of assessing tissue viability based on the study of dielectric parameters allows to evaluate the viability and the state of damaged tissues in dynamics. The importance of tissue research methods for establishing an accurate diagnosis, assessing the readiness of wounds for autodermoplasty and determining the extent of surgical interventions is shown. The use of morphological methods in experimental studies and in the treatment of victims with burns is substantiated. Using histological and cytological methods, the condition of the burn wound is monitored, the efficacy of surgical interventions and the use of therapeutic agents is evaluated, the wound process phase is determined, and medical tactics is planned. The histochemical method is used to study the composition and state of the tissues of a burn wound paranecrosis area, and the immunohistochemical method is used to assess the intensity of regeneration processes by determining the tissue proliferation and differentiation markers. Ultramicroscopic examination of tissues at different times after thermal injury is informative for understanding the dynamics of pathomorphological changes in burns. Review of the pathogenesis of burn disease, taking into account the data of ultramicroscopic studies, creates the prospect of developing methods for targeted correction of the condition of patients with burns at the subcellular level. The role of experimental studies in the investigation of thermal damage, preclinical trials of medicinal products used to influence the wound process, improving the existing methods and developing the new ones for treatment of burn injury has been determined.

Incidence and clinical significance of postoperative delirium after brain tumor surgery

Delirium is an acute and reversible deterioration of mental state. Postoperative delirium (POD) can develop after surgical procedures and is associated with impaired health status and worse recovery. So far, there is little data about postoperative delirium after brain surgery. The aim of this study was to evaluate frequency, risk factors, and prognostic value of POD in predicting short-term postoperative outcomes after brain tumor surgery. Five-hundred and twenty-two patients who underwent elective brain tumor surgery in 2010-2017 were included in this prospective study. Patients were monitored for POD using the Confusion Assessment Method for the ICU (CAM-ICU) for 2 to 7days after the surgery. At hospital discharge, outcomes were evaluated using the Glasgow Outcome Scale (GOS). POD was diagnosed in 22 (4.2%) patients. Risk factors of POD were low level of hemoglobin, poor functional status at time of admission, low education level and older age (65years and older). POD incidence was not associated with brain tumor laterality, location, extent of resection, histological diagnosis, or affected brain lobe. POD was associated with greater risk for unfavorable outcomes at hospital discharge (OR = 5.3; 95% CI [2.1-13.4], p = 0.001). POD is not a common complication after elective brain tumor surgery. Older age, poor functional status, low education level and anemia are associated with greater POD risk. Extent of surgical intervention and brain tumor location are not associated with POD risk. POD is associated with worse outcome at hospital discharge.

The pathology of mesenchymal tumors of the mediastinum

Soft tissue tumors of the mediastinum (MST) are rare, but can pose considerable diagnostic and differential diagnostic problems due to morphological overlap with non-mesenchymal tumors. Many MST occur in quite typical mediastinal compartments, in typical age groups or with a specific gender predilection, or show important clinical clues. Consideration of clinical, epidemiological and anatomic background information is therefore essential to reach a correct diagnosis. With very few exceptions, the morphology and molecular features of MST are identical to their respective counterparts elsewhere in the body, although their prognosis may be different due to, e.g., late diagnosis, anatomic restrictions and the possible extent of surgical interventions. In the era of personalized medicine, many MST require both an extended panel of immunohistochemical antibodies and molecular tests for their diagnosis. In this brief review, we will outline a practical pathohistological approach to MST that tries to incorporate morphological and clinical features that aid in the diagnosis.

The application of orthodontic miniplates to Sendai surgery first

Current Surgery First (SF) approaches can be classified into two rather different styles. One is the orthodontic-driven style. In this style, skeletal problems are solved by surgery, and dental problems are fixed orthodontically. The other is the surgery-driven style. In this approach, the aim is to solve both skeletal and dental problems by orthognathic surgery (OGS) as much as possible. The concept of SF that we practice is the orthodontic-driven style, referred to as Sendai SF (SSF). This approach was made possible by the application of the Skeletal Anchorage System (SAS) which enables predictable control of the entire dentition, including the three-dimensional control of the bimaxillary molars. With SAS in combination with the multi-bracketed system, the extent of surgical intervention is significantly reduced, and complex orthodontic problems in post-surgical orthodontics can be solved. In this article, the SAS biomechanics of the post-surgical orthodontics in SSF is described.

Cytophlavin inclusion in complex treatment of diabetic foot syndrome with signs of lower limb blood vessels medicalcinosis

The aim of this study was to evaluate the effect of cytoflavin inclusion in therapy regimens of patients with diabetic foot syndrome and medicalcinosis on the microcirculation of the lower limb blood vessels. For this purpose, 64 patients with type II diabetes mellitus (subcompensated form), diabetic foot syndrome and signs of medicalcinosis foot blood vessels of various severity were examined. All patients were divided into 2 groups depending on the therapy scheme: patients of group I (33 people) received insulin, antibiotics, disaggregants, statins, anti-inflammatory drugs, painkillers, detoxification therapy. Patients of group II (31 patients) in addition to the main therapy received cytoflavin according to the scheme: 10 ml per 0.9 ml NaCl 200 ml intravenously, drip at a rate of 60 cap/min, 10 days course, then 2 tablets 2 times a day for 1 month. The severity of the microangiopathy of the lower extremities was assessed considering transcutaneous oximetry data in dynamics (before treatment, on the 10th and 40th day of therapy) gained using TCM-2 device (RADIOMETER, Denmark) with has heating oxygen electrode type Clarc. Before the treatment subcompensated level of metabolic disorders corresponding to the II degree of microcirculatory disorders was registered in all patients. Against the backdrop of cytoflavin inclusion in the complex therapy, there was an improvement in the metabolic rate (up to compensated) with a decrease in the degree of microcirculation disorders up to I degree. Positive dynamics of metabolic disorders significantly reduced frequency and extent of surgical interventions. The results obtained suggest that cytoflavin should be included in the treatment regimens of patients with this pathology.

DIAGNOSIS AND TREATMENT OF STOMACH CANCERCOMPLICATED BY BLEEDING

The article presents an analysis of domestic and foreign literature on the diagnosis and treatment of stomach cancer complicated by bleeding. The absence of unanimity in the choice of treatment strategy, timing and extent of surgical intervention, the feasibility and scope of lymphadenectomy

Anesthetic management in bronchial asthma

In daily practice, acute and chronic pulmonary diseases are common issues presenting to the anesthetist. Respiratory physiology in general is affected by both general and regional anesthesia, which results in an increased number of perioperative complications in pulmonary risk patients. Therefore, anesthetic management of patients with bronchial asthma needs to address different clinical topics: the physical appearance of pulmonary disease, type and extent of surgical intervention as well as effects of therapeutic drugs, anesthetics and mechanical ventilation on respiratory function. The present work describes important precautions in preoperative scheduling of the asthmatic patient. In the operative course, airway manipulation and a number of anesthetics are able to trigger intraoperative bronchial spasm with possibly fatal outcome. It is essential to avoid these substances to prevent asthma attack. If asthmatic status occurs, appropriate procedures according to therapeutic standards have to be applied to the patient. Postoperatively, sufficient pain therapy avoids pulmonary complications and improves outcome.

Cleft Lip Rhinoplasty - A Review

Cleft lip nasal deformity presents an extreme challenge to the facial plastic surgeon. The deformity is complex and involves all tissue layers, including skeletal platform, inner lining, osseocartilaginous structure, and overlying skin. Ever since Blair and Brown first described the intricacies of the cleft pathology in 1931, the appropriate approach has been extensively debated in the literature with respect to timing, technique, and extent of surgical intervention. Secondary repair of the cleft lip nasal defect requires an understanding of the pathological nasal anatomy associated with congenital clefting. The basic cleft nasal deformity is characteristic and defendant upon the original extent of clefting of the lip. However, the secondary nasal defect varies greatly and is a result of: 1) the original malformation, 2) any interim surgery performed, and 3) growth of the nose and face. The cleft surgeon must therefore have a treatment philosophy and technique flexible enough to reconstruct a variable range of associated nasal problems. By reviewing the literature, this article described and summerised the various modalities for achieving a successful rhinoplasty in the patient with a cleft nasal deformity.