Fourth Postoperative Day Research Articles

Combined Less-invasive Surgical and Endovascular Technique to Minimise Operative Trauma and Treat Excessive Aortoiliac Thrombotic Obliteration with Popliteo-crural Involvement and Acute Limb Ischaemia

This article demonstrates a less-invasive combined surgical and endovascular alternative approach in a case in which an excessive thrombotic formation in the infrarenal aorta caused occlusion of the iliac artery and the ipsilateral crural arteries. A 51-year-old man was admitted to the authors’ hospital with symptomatology of acute lower limb ischaemia. He had undergone endovascular treatment with placement of kissing stents in the common iliac arteries 2 years previously. A CT angiography scan revealed an extensive thrombus formation in the entire infrarenal aorta occluding the distal infrarenal aorta, the iliac artery and the crural arteries. He underwent a hybrid approach, with exposure of only the right common femoral artery and over-the-wire embolectomy of the infrarenal aorta and the iliac artery, and after the restoration of the inflow, an embolectomy of the peripheral vessels was carried out. To cover the residual aortic thrombus and to restore the severe in-stent restenosis of the previously deployed bare stents, three covered balloon-expandable stents were deployed in kissing technique. The patient was discharged on the fourth postoperative day with palpable peripheral pulses. Combined surgical and endovascular techniques minimise the operative trauma and length of hospital stay for the patient, successfully restoring the perfusion in a physiological manner.

The Effect of Text Messaging on Medication Adherence After Outpatient Knee Arthroscopy: A Randomized Controlled Trial

The purpose of this project was to examine if text message reminders can increase postoperative adherence to treatment with acetaminophen among outpatients undergoing arthroscopic knee surgery. A nonblinded randomized control trial. In this study, 187 patients were randomized to either an intervention group (text message reminders) or a control group (no text message reminders). On the fourth postoperative day, all patients received an electronic questionnaire concerning (1) adherence to treatment with acetaminophen (main outcome), (2) pain intensity, and (3) unscheduled health care contacts. Data were available from 134 patients (intervention group, n=70; control group, n = 64). No significant differences between groups were found regarding the median number of missed acetaminophen doses (1 vs 2.5; P = .06), pain intensity at rest and during walking, or the number of unscheduled health care contacts (7 vs 4; P = .35). A nonsignificant trend toward an increased medication adherence of acetaminophen was found.

Increased perioperative C-reactive protein and decreased postoperative albumin is associated with acute posttraumatic osteomyelitis in patients with high-energy tibial fractures

BackgroundEarly diagnosis of acute posttraumatic osteomyelitis (POM) is of vital importance for avoiding devastating complications. Diagnosing POM is difficult due to the lack of a highly specific and sensitive test, such as in myocardial infarct, stroke and intracranial bleeding. Serum inflammatory markers, C-reactive protein (CRP), procalcitonin (PCT), white blood cells (WBC) can support clinical findings but they are not able to differentiate between inflammatory response to infection and the host response to non-infection insult with high specificity and sensitivity. AimThe objectives of the study were to investigate whether the biochemical and immunoinflammatory patient profile could facilitate postoperative monitoring, guide the antibiotic treatment and timing of revision surgery. Patients and methodsThis prospective nonrandomised cohort study included 86 patients after high-energy injury to the shin requiring primary surgical treatment (open or closed reduction and internal fixation of tibial fracture). Values of the biochemical and immunoinflammatory profile were measured on admission (ADD), first postoperative day (POD1) and fourth-postoperative day (POD4). ResultsWe discovered on our sample that the development of POM is associated with increased CRP on ADD, POD1 and decreased albumins on POD4. Further studies are needed to prove that these differences can be useful in diagnosing the risk of infection. The assessment of other important risk factors such as: the extent of soft tissue damage, multiple fractures, transfusion rate, need for conversion primary external fixation to intramedullary (IM) nailing or locking plate fixation can empower our clinical judgment of POM. ConclusionsWe can improve prediction of posttraumatic osteomyelitis by using the perioperative inflammatory biomarker CRP in combination with postoperative albumins levels and other associated independent risk factors.

Validation of Duplex Ultrasound Graft Surveillance in the Immediate Postoperative Period.

A femoral crossover polytetrafluoroethylene graft was performed in a patient immediately, after a failed iliac endograft limb recanalization, performed 2 years after endovascular aortic aneurysm repair. Although graft patency was confirmed clinically by palpation of groin pulses as well as noninvasively by segmental pressure measurements and Doppler examination, in the immediate postoperative period, duplex ultrasound failed to show any blood flow inside the graft lumen until the fourth postoperative day. Subcutaneous air and air tapped within the wall structure of the graft are possible explanation for the failure to show flow.

Posterior fossa hibernoma: A rare case in unexpected location radiologically mimicking arteriovenous malformation

Abstract Background Hibernomas are rare tumors histologically originate from the fetal brown adipose tissue. Here, we reported the first hibernoma case located in posterior fossa radiologically mimicking arteriovenous malformation (AVM), presenting with abrupt onset of dizziness, and hiccups. This is the first case of hibernoma location in the posterior fossa. Case description A previously well 32-year-old man, presented with a headache for three days and abrupt onset of dizziness, nausea, vomiting, and hiccups. He had left-sided muscle weakness and hypoesthesia. Non-contrast enhanced computed tomography revealed hemorrhagic lesion at the inferoventral portion of the posterior lobe of cerebellum with compression to medulla oblongata with partial obstruction of fourth ventricle. Magnetic Resonance Imaging (MRI) revealed a mass lesion neighbouring at medulla oblongata which had intratumoral large vessels with branching segments. On T1 weighted images the lesion was isointense, on T2 weighted images it was hyperintense. On contrast-enhanced MRI images, heterogeneous contrast pattern was observed which is highly suspicious for AVM. Emergent surgery was performed and total excision was achieved. Histopathological analysis with Hematoxylin and eosin staining revealed yellow coloured, minimal hemorrhagic areas and well-defined encapsulated solid structure. The specimen showed brown adipose tissue content, with well-defined cytoplasm, large granular or multivacuolated cytoplasmic cells. Besides, small groups of univacuolar adipocytes were also observed. The histopathologic diagnosis was typical hibernoma. The postoperative period was uneventful and the patient was discharged in the fourth postoperative day with full neurological recovery. His neurological examination at the sixth postoperative month was completely normal. Radiological evaluation revealed total excision without any recurrence. Conclusions Hibernoma located in the posterior fossa is a unique condition, which may cause acute deterioration of the patient. These lesions may radiologically mimic vascular malformations. The neurological surgeons must kept in mind that hibernoma could also be seen in posterior fossa.

Pediatric patients with mesenteric cystic lymphangioma: A case series

IntroductionMesenteric cystic lymphangioma (MCL) is a benign malformation of the lymphatic system. MCL seldomly occurs with a very rare incidence of around 1: 250,000. This neoplasm is more common in pediatric patients. Symptoms can appear with various clinical features ranging from asymptomatic abdominal mass to acute abdomen. Presentation of casesHere we report four pediatric patients with MCL: two males presented with bilious vomiting and ileus, one female with abdominal pain, and one female with asymptomatic abdominal mass. All patients underwent explorative laparotomy and mass excision was done and/or marsupialization. All patients were discharged at the third – fourth postoperative day uneventfully. DiscussionAlthough benign, lymphangioma can cause other symptoms such as bleeding, torsion, or lymphangioma rupture. Therefore, MCL should be considered as one of the differential diagnoses in acute abdominal and abdominal mass cases in children. ConclusionIn conclusion, although sometimes asymptomatic and found incidentally, the MCL should be resected because it has the potential to grow and invade vital organs and cause life-threatening complications.

Toxic Epidermal Necrolysis A Diagnostic Dilemma in Puerperium: A Case Report

Toxic epidermal necrolysis is a potentially life threatening dermatologic disorder characterized by widespread erythema, necrosis and bullas, detachment of epidermis and mucous membrane resulting in exfoliation, possible sepsis and even death. This is the first case report in Nepal of toxic epidermal necrolysis in puerperium. We present a case of a 28-years-old, P1L1 on fourth postoperative day following emergency lower segment caesarean section for cephalopelvic disproportion in latent phase of labour with uneventful antenatal period. She developed fever followed by rashes all over the body with hypotension, tachypnea and shortness of breath. Initially, she was diagnosed as a case of septic shock and transferred to intensive care unit from postnatal ward. She was managed with broad spectrum antibiotics and inotropes. Later on, it was found to be the case of Toxic epidermal necrolysis and managed with vancomycin and corticosteroids under the supervision of gynecology, dermatology and medicine team. Keywords: puerperium; toxic epidermal necrolysis; vancomycin.

Innovative laparoscopic distal pancreatectomy with splenic preservation mimicking the advantages of a robotic approach

Background: In laparoscopic distal pancreatectomies with splenic preservation (LDPSP) it is crucial to stablish a wide and stable operative field.[1] One potential advantage of the robotic approach is that a forth robotic arm operated by the surgeon allows to place retraction in a desired position that remains completely stable.[2] We describe a LDPSP in which a tape retraction of the stomach and a suture retraction of the pancreatic tale allowed a excellent operative field with the use of only three laparoscopic ports mimicking the robotic approach without its additional costs.[3] Methods: Female patient with a 3 cm intraductal pancreatic mucinous nepolasia of the pancreatic body. Three laparoscopic ports were used on the lower left quadrant. A tape was passed around the gastric body and fixed to the falciform ligament to expose the retroperitoneum. A silk suture with straight needle was inserted in the abdomen though a predetermined place in the skin,passed in the pancreatic tail and exteriorized again. It allowed efficient and safe retraction and mobilization of the pancreatic tail from the splenic vessels. Results: Operative time was 170 minutes. Estimated blood loss was 30 mililiters. Postoperative period was uneventful. Patient was discharged on the fourth postoperative day. Conclusion: A tape retraction of the stomach with suture retraction of the pancreatic tail allowed an wide and stable operative field that mimicked the operative field of a robotic procedure. Also allowed to perform a LDPSP with only three ports. References [2] Esposito MP, (2005), Use of fourth arm in da Vinci robot-assisted extraperitoneal laparoscopic prostatectomy: novel technique., 649 [1] de Rooij T, (2015), Technical Aspects of Laparoscopic Distal Pancreatectomy for Benign and Malignant Disease: Review of the Literature., Gastroenterol Res Pract. [3] Surjan RC, (2015), Innovative technique for gastric retraction during laparoscopic distal pancreatectomy: the marionette., J Surg Case Rep

Importance of intraoperative laparoscopic sonography in pancreatic surgery: turning a pancreaticoduodenectomy into a laparoscopic uncinatectomy

Background: The pancreatic uncinatectomy is a more conservative approach than a pancreaticoduodenectomy and an adequate procedure to treat benign lesions and low grade malignancies. Despite the fact that it has some advantages as lower postoperative morbidity and parenchymal preservation, it is a rarely reported surgery.[1] [2] We report a patient in which preoperative image studies showed a neuroendocrine tumor of the uncinate process of the pancreas with close relation to the pancreatic head and Wirsung. Initial idea was to perform a laparoscopic pancreaticoduodenectomy, but a intraoperative sonography demonstrated that a parechymal sparing procedure would be possible. Methods: A 62 year old patient with a 2,4 cm lesion on the uncinate process with close relation to Wirsung duct on MRI. eondocopic sonography guided biopsy disclosed a neuroendocrine tumor. Patient was submitted to laparoscopy with intent of performing a pancreaticoduodenectomy but an intraoperative sonography showed that the tumor was a few milimeters away from the Wirsung duct. Option was to perform a laparoscopic uncinatectomy. Results: Operative time was 220 minutes. Estimated blood loss was 80 ml. Discharged at fourth postoperative day. Developed a grade A fistulae and the drain was removed two weeks after the surgery. Conclusion: The use of intraoperative laparoscopic sonography in pancreatic procedures may add important additional anatomical information that can make possible parenchymal sparing procedures and avoid unecessary exterded surgeries.

Recurrent abdominal pain with thrombocytosis

Splenic congenital anomalies are many. Wandering spleen (WS) is a rare anomaly account for about 0.2%. It is usually associated with absent or maldevelopment of one or all splenic ligaments that hold the spleen in its place. A 15-year-old girl had complaints of repeated attacks of mid-abdominal pain for the last month. Abdominal examination revealed a central fixed and slightly tender abdominal mass in the umbilical region. Complete blood count revealed platelets (790 × 103/mL), white blood cells (9700 × 103/mL), and hemoglobin (8 g/dL), and other investigations were normal, but unfortunately ultrasound and computed tomography report revealed WS. Abdominal exploration revealed the spleen not in the anatomical place, and there is a mass in the umbilical region surrounded by dense adhesions. The adhesions were released and this mass discovered to be WS, splenectomy was done. Vaccination against pneumococci and Haemophilus influenza were given, and the patient discharged uneventfully on the fourth postoperative day. Asymptomatic WS could be found incidentally during surgery or during abdominal imaging for any reason. Furthermore, WS can present with an acute abdomen or recurrent abdominal pain. The only treatment is surgery even in asymptomatic cases because of the high possibility of complications. Splenopexy can be done if the spleen showed no torsion or splenomegaly or hypersplenism otherwise splenectomy is the second option.

Innovative laparoscopic distal pancreatectomy with splenic preservation mimicking the advantages of a robotic approach

Background: In laparoscopic distal pancreatectomies with splenic preservation (LDPSP) it is crucial to stablish a wide and stable operative field.[1] One potential advantage of the robotic approach is that a forth robotic arm operated by the surgeon allows to place retraction in a desired position that remains completely stable.[2] We describe a LDPSP in which a tape retraction of the stomach and a suture retraction of the pancreatic tale allowed a excellent operative field with the use of only three laparoscopic ports mimicking the robotic approach without its additional costs.[3] Methods: Female patient with a 3 cm intraductal pancreatic mucinous nepolasia of the pancreatic body. Three laparoscopic ports were used on the lower left quadrant. A tape was passed around the gastric body and fixed to the falciform ligament to expose the retroperitoneum. A silk suture with straight needle was inserted in the abdomen though a predetermined place in the skin,passed in the pancreatic tail and exteriorized again. It allowed efficient and safe retraction and mobilization of the pancreatic tail from the splenic vessels. Results: Operative time was 170 minutes. Estimated blood loss was 30 mililiters. Postoperative period was uneventful. Patient was discharged on the fourth postoperative day. Conclusion: A tape retraction of the stomach with suture retraction of the pancreatic tail allowed an wide and stable operative field that mimicked the operative field of a robotic procedure. Also allowed to perform a LDPSP with only three ports. References [2] Esposito MP, (2005), Use of fourth arm in da Vinci robot-assisted extraperitoneal laparoscopic prostatectomy: novel technique., 649 [1] de Rooij T, (2015), Technical Aspects of Laparoscopic Distal Pancreatectomy for Benign and Malignant Disease: Review of the Literature., Gastroenterol Res Pract. [3] Surjan RC, (2015), Innovative technique for gastric retraction during laparoscopic distal pancreatectomy: the marionette., J Surg Case Rep

Microsurgical Resection of Craniocervical Dermoid Cyst by Far Lateral Approach: Case Report and Literature Review

Introduction Intracranial dermoid tumors represent a rare clinical entity that accounts for 0.04 to 0.6% of all intracranial tumors. Their location in the posterior fossa is uncommon. Objectives To report the case of a young woman with a posterior fossa dermoid cyst treated by right far lateral approach. Case Report A 17-year-old woman presenting with swallowing difficulties for 6 weeks was referred for a neurological investigation. A magnetic resonance imaging (MRI) scan showed a hyperintense T1-weighted large expansive lesion occupying the posterior fossa and compressing the anterior face of the brain stem and cerebellum. The patient underwent surgical treatment by right far lateral approach with decompression of vascular and neural structures. The patient presented an uneventful recovery, and was discharged home on the fourth postoperative day without any additional neurological deficits. The anatomopathological analysis confirmed the diagnosis of dermoid cyst. Conclusion The far lateral approach is a safe and feasible route to appropriately treat large posterior fossa dermoid cysts. Decompression of vascular and neural structures is essential to achieve good symptom control.

Procedure-Specific Pain Intensity Four Days After Day Surgery and the Relationship with Preoperative Pain: A Prospective Cohort Study.

BackgroundIdentification of painful procedures is essential for the development of procedure-specific pain-treatment schedules. The aim of this study was firstly, to analyze the prevalence of acute postsurgical pain (APSP) after various types of day surgery on the fourth postoperative day, and secondly, to assess the predictive value of preoperative pain for the development of APSP after different types of surgical procedures. MethodsFrom November 2008 to April 2010, patients scheduled for elective day surgery were enrolled in this prospective cohort study. Data were collected one week preoperatively and four days postoperatively. The 11-point Numeric Rating Scale (NRS) was used for pain measurement. Moderate pain was defined as an NRS 4 to 5, and severe pain as an NRS > 5. The predictive value of preoperative pain for development of APSP was analyzed using a univariate logistic regression, stratified for the surgical procedure.ResultsFrom a total of 1123 included patients, 182 patients experienced moderate pain (16.3%) and 136 patients experienced severe pain (12.1%) on the fourth postoperative day. A large procedure-specific variability in APSP was observed, with shoulder, anal and dental surgery associated with the highest pain levels. Overall, preoperative pain significantly predicted postoperative pain on the fourth day (OR 4.45). This predictive value showed a procedure-specific variation and was not noted after various well-defined procedures. ConclusionsThe prevalence of moderate to severe APSP was high four days after day surgery and showed a significant procedure-specific variation. Furthermore, there was a strong relationship between preoperative and postoperative pain, likewise characterized by a significant procedure-specific variation.

Da Vinci robot assistance surgical coordination for the resection of azygous vein aneurysm: a case report

Objective Summary of a patient who was diagnosed as an azygous vein aneurysm during Da Vinci robotic surgery, which continue to complete surgical resection of varicose veins by Da Vinci robot assistance. Methods After the patient is diagnosed as the azygos vein aneurysm during the operation, the emergency plan is started immediately, and the nursing cooperation is determined according to the operative coordination of the main problems during the operation. Results With the close cooperation of the medical team, an azygous vein aneurysm with a size of approximately 5 cm×4 cm×3 cm was successfully removed with the Da Vinci robot assistance, no complications occurred after surgery, and good recovery occurred, the patient was discharged on the fourth postoperative day. Conclusions It is essential to make corresponding emergency plan and exercise for Da Vinci robot operation, and to start contingency plan immediately when needed, which is an important guarantee to continue to complete misdiagnosis surgery under the aid of Da Vinci robot. Key words: Azygous vein aneurysm; Mediastinal mass; Da Vinci robot; Contingency plan

Neurocognitive dysfunctions and functional state of patients after internal carotid endarterectomy

Introduction. Carotid endarterectomy (CEA) is a method of treatment of carotid stenosis, which significantly reduces the risk of ischemic stroke. This procedure may affect the patient’s neurocognitive functioning. The aim of the study was to evaluate the occurrence of neurocognitive disorders and to determine the functional status of the patients undergoing CEA. Material and methods. The study group consisted of 102 people who underwent CEA. Studies were performed preoperatively and repeated on the fourth postoperative day. The following scales were used: the Mini-Mental State Examination (MMSE), Activities of Daily Living Scale (ADL), Instrumental Activities of Daily Living (IADL) and the Hamilton Depression Rating Scale (HAM-D). Results. The average number of points obtained by patients in the MMSE, both before and after surgery is 26 points to 30 that may be obtained, which shows a subtle cognitive impairment. Almost every patient showed fitness both in terms of basic (ADL), as well as complex (IADL) activities before and after surgery. Conclusions. Low or average level of cognitive performance is observed in most subjects, both before and after CEA. There are many different factors that can affect the cognitive functions. The functional status of patients stood without significant changes.

Biomechanical and histological analyses of the fracture healing process after direct or prolonged reduction

BackgroundReduction of femoral shaft fractures remains a challenging problem in orthopaedic surgery. Robot-assisted reduction might ease reduction and fracture treatment. However, the influence of different reduction pathways on patients’ physiology is not fully known yet. Therefore, the aim of this study was to examine the biomechanics and histology of fracture healing after direct and prolonged robot-assisted reduction in an in vivo rat model.Methods144 male CD® rats were randomly assigned to 12 groups. Each animal received an external fixator and an osteotomy on the left femoral shaft. On the fourth postoperative day, the 1× reduction groups received a single reduction maneuver, whereas the 10× reduction groups received the same reduction pathway with ten repetitions. The control groups did not undergo any reduction maneuvers. Animals were killed after 1, 2, 3 and 4 weeks, respectively, and the composition of the fracture gap was analyzed by µCT and non-decalcified histology. Biomechanical properties were investigated by a three-point bending test, and the bone turnover markers PINP, bCTx, OPG, sRANKL, TRACP-5b, BALP, and OT/BGP were measured.ResultsOne week after the reduction maneuver, µCT analysis showed a higher cortical bone volume in the 1× reduction group compared to the 10× reduction group. Biomechanically, the control group showed higher maximum force values measured by three-point bending test compared to both reduction groups. Furthermore, less collagen I formation was examined in the 10× reduction group compared to the control group after 1 week of fracture healing. PINP concentration was decreased in 10× reduction group after 1 week compared to control group. The same trend was seen after 3 weeks.ConclusionA single reduction maneuver has a beneficial effect in the early phase of the fracture healing process compared to repeated reduction maneuvers. In the later phase of fracture healing, no differences were found between the groups.

Ruptured Bilateral Pericallosal Artery Aneurysm in Mirror Position: Case Report

Introduction Pericallosal artery (PA) aneurysms represent 2 to 9% of all intracranial aneurysms, and their management remains difficult. Objective The aim of the present study is to describe the case of an adult woman with subarachnoid hemorrhage and bilateral PA aneurysm in mirror position. Case Report A 46-year-old woman was referred to our institution 20 days after a sudden severe headache. She informed that she was treating her arterial hypertension irregularly, and consumed ∼ 20 cigarettes/day. The patient was neurologically intact at admission. A non-contrast computed tomography (CT) on the first day of the onset of the symptoms revealed hydrocephaly and subarachnoid hemorrhage (Fisher III). An angio-CT/digital subtraction arteriography showed bilateral PA aneurysms in mirror position. The patient was successfully treated with surgery via the right interhemispheric approach (because the surgeon is right-handed); the surgeon performed the proximal control with temporary clipping, and introduced an external ventricular drain at the end of the surgery. The patient was discharged on the fourth postoperative day without any additional neurological deficits or ventricular shunts. Conclusion Ruptured PA aneurysm is a surgically challenging aneurysm due to the many anatomical nuances and risk of rebleeding. However, the operative management of ruptured bilateral PA aneurysms is feasible and effective.

Preoperative oral thyroid hormones to prevent euthyroid sick syndrome and attenuate myocardial ischemia-reperfusion injury after cardiac surgery with cardiopulmonary bypass in children: A randomized, double-blind, placebo-controlled trial.

Background:Both euthyroid sick syndrome and myocardial ischemia-reperfusion injury are common and have been significantly associated with morbidity and mortality after pediatric cardiac surgery with cardiopulmonary bypass. This single-center, prospective, double-blind, randomized placebo-controlled clinical pilot trial was designed to assess if preoperative oral thyroid hormone therapy could prevent the occurrence of euthyroid sick syndrome (ESS) and attenuate myocardial ischemia-reperfusion injury (IRI) after cardiac surgery with cardiopulmonary bypass (CPB) in children.Methods:Forty children aged 3 to 12 year, scheduled for elective congenital heart disease repair surgery with CPB, were randomized into 2 groups of equal size to receive the following treatments in a double-blind manner: placebo (control group) and thyroid tablet 0.4 mg/kg (trial group) taken orally once a day for 4 days before surgery. The perioperative serum thyroid hormone levels and hemodynamic variables were determined. The extubation time, duration of intensive care unit (ICU) stay, and use of inotropic drugs in the ICU were recorded. The myocardial expressions of heat shock protein 70 (HSP70), myosin heavy chain (MHC) mRNA, and thyroid hormone receptor (TR) mRNA were detected. The serum creatine kinase-MB (CK-MB) activity and troponin I (TnI) positive ratio at 24 hour after surgery were assessed.Results:There were no significant differences in hemodynamic variables at all observed points, extubation time, and duration of ICU stay between groups. As compared with baselines on administration, serum triiodothyronine (T3) and free T3 (FT3) levels on the first, second, and fourth postoperative day, and serum thyrotropic-stimulating hormone (TSH), tetraiodothyronine (T4), and free T4 (FT4) levels on the first postoperative day were significantly decreased in the 2 groups. Serum T3, FT3, and T4 levels on the first and second postoperative day, and serum FT4 level on the first postoperative day were significantly higher in the trial group than in control group. As compared with the control group, the number of patients requiring inotropic drugs in the ICU, serum CK-MB activity, serum positive TnI ratio, and myocardial expression of MHCβ mRNA were significantly decreased, and myocardial expressions of both HSP70 and MHCα mRNA were significantly increased in the trial group.Conclusions:In children undergoing cardiac surgery with CPB, preoperative oral small-dose thyroid hormone therapy reduces severity of postoperative ESS and provides a protection against myocardial IRI by increasing HSP70 and MHCα expression.

The utility of celiac plexus block as an adjunct for control of postooperative pain after major open hepato-pancreatico-biliary surgery

Introduction: Celiac plexus block (CPB) has been commonly described as a procedure for control of pain in patients with chronic pancreatic pain. We are exploring the use of CPB together with continuous wound infiltration via pre-peritoneal catheters to reduce post-operative pain after major open hepato-pancreatico-biliary surgery. Method: Five patients underwent open hepato-pancreatico-biliary surgery; 2 open liver resections via reverse L-incisions and 3 open pylorus-preserving-pancreaticoduodenectomy via rooftop incisions. For the CPB, the celiac axis was identified and 10-20mls of 0.25% Marcaine was infiltrated around the celiac axis at the end of surgery. As per standard regime, pre-peritoneal catheters were inserted and 20ml Ropivacaine 0.2% bolus was injected into each catheter to initiate the pre-peritoneal analgesia. Post-operatively, Patient-Controlled-Anlagesia (PCA) opioid was commenced. The pre-perioneal infusion were continued till post-operative day (POD) 5. The opioid consumption is tabulated in Table 1 below.EP02F-027 TablePatientOpioid Usage POD 1POD 2POD 3POD 41Oxycodone 20 mg5 mg002PCA Fentanyl 60 mcg340 mcg003PCA Morphine 16 mg41 mgPO Oxycodone 30mgPO Oxycodone 5 mg4PCA Morphine 2 mg7 mg005PCA Fentanyl 400 mcg120 mcg00 Open table in a new tab Results: The Visual Analog Score (VAS) for pain was assessed up to fourth POD. All patients had pain scores of 3 or less at rest. For VAS on movement, 2 patients had VAS of 4 to 5 on first POD. By second POD, dynamic VAS scores were 3 or less and all patients were ambulating Conclusion: Our case series demonstrate that CPB, together with pre-peritoneal infusion, helped to minimise the post-operative opioid consumption and pain of patients. Patients are able to mobilise early and this is an important measure of good pain control.

Complications and outcome after free flap surgery for cancer of the head and neck

We retrospectively studied 136 patients who had free flap reconstruction for cancer of the head and neck at a single centre (2008–2015) to evaluate complications, assess factors associated with them, and analyse their impact on outcome. Preoperative and perioperative data, and surgical and medical complications were recorded, and the impact of the complications on duration of hospital stay and survival were assessed. A total of 86 (63%) patients had complications. Compared with those who did not, they had a higher rate of alcohol abuse (21/86, compared with 5/50, p=0.039), longer operations (median (IQR) 565 (458–653 compared with 479 (418–556) minutes, p<0.001), and greater intraoperative loss of blood (725 (400–1150) compared with 525 (300–800) ml, p=0.042). Complications were more common in patients who had fibular flaps and T4 disease (22/86 compared with 4/50, p=0.010; 47/80 compared with 16/47, p=0.015, respectively). Those who had complications also stayed in hospital longer (median (IQR) 9 (7–12) compared with 15 (10–21) days, p<0.001). Cumulative mortality was higher in patients with late complications (those that occurred after the fourth postoperative day) (61% compared with 36%, p=0.004). In conclusion, complications in more than half the patients were related to alcohol abuse, a more complicated intraoperative course, and fibular flaps. Complications were associated with a longer hospital stay, and survival was higher in those who did not have late complications than in those who did.