Increase In Number Of Operations Research Articles

FACTORS ASSOCIATED WITH DISSEMINATION AND COMPLICATIONS OF ACUTE BONE AND JOINT INFECTIONS IN CHILDREN

Paediatric bone and joint infections remain common in low- and middle-income countries (LMICs). We aimed to determine the complication rate and incidence of disseminated infection in paediatric bone and joint infections in an LMIC setting. Secondly, we aimed to elucidate factors associated with complications and disseminated disease.We retrospectively reviewed our database for children that presented with bone and joint infections between September 2015 and March 2019. Data were extracted to identify factors that were associated with development of complications and disseminated infection.We analysed 49 children. The median age at presentation was 6 years (range 1 month to 12 years). Locally advanced disease was present in 13 children (27%). The remaining 36 children were evenly divided (18/49 each, 37%) between isolated AHOM and SA, respectively. Disseminated disease was present in 16 children (33%) and was associated with locally advanced disease, an increase in number of surgeries and an increased length of stay. Twenty-six complications were documented in 22 (45%) children. Chronic osteomyelitis developed in 15/49 (31%) cases, growth arrest in 5/49 (10%), and pathological fracture, DVT and septic shock in 2/49 (4%) each. Complicated disease was associated with locally advanced disease, a higher number of surgeries, disseminated disease and an increased length of stay. Sixty five percent of cases cultured Staphylococcus aureus, while 25% (12/49) were culture negative. The median time from admission to surgery was one day, and the median time from onset of symptoms to surgery was seven days.We found a high complication rate. One third of patients had locally advanced disease, and this was associated with the development of complications and disseminated disease. Further studies are needed to be able to predict which children will have poor outcomes.

Trends in the numbers of spine surgeries and spine surgeons over the past 15 years.

ABSTRACTThe purpose of this study is to examine trends in spine surgeries at ten facilities over 15 years, and to analyze relationships with the number of spine surgeons at these facilities. The subjects were patients who underwent spine surgery at the ten facilities from 2003 to 2017. Data were collected every year via a questionnaire designed to obtain clinicopathological and surgical information. There were 37,601 spine surgeries (60.2% male) recorded in the registry at 9 facilities in the Nagoya Spine Group (NSG) between 2003 and 2017, with an increase in the annual number of surgeries by 2.4 times over 15 years. On the other hand, the number of spine surgeons has increased by just under 1.5 times. Instrumentation surgeries increased from 959 in 2003 to 2,276 in 2017 (2.3 times). There was a particularly marked increase in surgeries for spinal degenerative disease from 1,075 in 2003 to 2,821 in 2017 (2.6 times). The number of surgeries performed per surgeon increased from 61.4 in 2003 to 102.8 in 2017, while the average number of spine surgeons per hospital increased from 2.6 in 2003 to 3.7 in 2017. In conclusion, with heavier burden on spine surgeons and the major changes in the spine surgery environment, training and increasing surgeons with advanced expertise and skills will become increasingly important.

Osteoarthritis of the knee joint. Etiology, treatment, rehabilitation (analytical review of the literature)

According to epidemiological studies, osteoarthritis accounts for 10–12 % of all cases of musculoskeletal diseases. In the general structure of knee pathology, degenerative diseases make up 57.8 %. The urgency of the problems of gonarthrosis is due to not only its widespread prevalence, but also the high risk of developing knee dysfunction, accompanied by a significant reduction in the quality of life of patients and often leading to partial or permanent disability of patients. Gonarthrosis has significant gender features. Women account for about 70 % of the number of patients, while men had this disease almost 2 times less often, but other data indicate that the incidence of gonarthrosis in men under 60 years of age is higher, and in women it begins to increase after 65 years. Knee replacement is a leading method in the treatment of knee osteoarthritis stages III–IV. The tendency towards an increase in the total number of surgeries leads to an increase in the frequency of complications and unsatisfactory results: according to some authors, from 3.3 to 13.2% of patients complain of knee replacement outcomes. Studies of long-term complaints after arthroplasty have shown that in addition to pain reduction, some patients had an increase in varus angle when bending the knee while walking but they didn’t mark an improvement in gait parameters compared to preoperative examination. After unilateral total knee arthroplasty, the load patterns of the frontal plane in the operated knee remain pathological in the long run. After knee arthroplasty, there is muscle weakness, and studies have shown changes in all muscles of the lower extremity. Weakening of some muscles led to compensatory strengthening of others. Studies of the effect of preoperative rehabilitation on the outcome of knee arthroplasty have shown its low efficiency. Many studies have studied motor activity of patients after total knee arthroplasty in recent years. Not only gait features, but also movements of the pelvis, trunk and upper extremities are studied. Modern methods of diagnosing spatial oscillations of the body when walking have shown that disorders of body movements — excessive hand movements, pelvic loosening, asymmetrical flexion of the knee joints, etc., after arthroplasty are preserved in patients and restore slowly, and some disorders remain forever. Conclusions. Knee arthroplasty relieves pain, improves quality of life, but according to many authors, patients complain of incomplete restoration of the functionality of the prosthetic limb. According to the researchers, the main cause for incomplete reco-very of gait parameters is the difference in the frontal angles of the knee joint flexion and the difference in the length of the steps. Special training exercises can reduce the asymmetry of the steps, but it is difficult to completely restore the symmetry of the steps within 2 years. Studies of the effect of preoperative rehabilitation on the outcome of knee arthroplasty have shown its low effectiveness.

The expansion condition of amount and complexity of urologic robotic surgery in 2000 patients

Background: Robot-assisted surgeries have been found to possess a number of advantages over conventional surgeries, and these benefits have promoted the expanded use of robot-assisted procedures in recent years, both in the numbers of procedures performed and the types of procedures to which robotic assistance is applied. This study sought to quantify this expanded use of robot-assisted surgeries over a 13-year period at a single surgeon in Taiwan. Materials and Methods: We retrospectively reviewed a total of 2000 patients who underwent robot-assisted urologic surgeries between December of 2005 and August of 2018. For the purposes of statistical comparison, we divided this 13-year period into four subperiods and classified the surgeries into eight types depending on the body part or parts upon which they were performed. Results: The total number of surgeries in the first, second, third, and fourth subperiods was 124, 173, 738, and 965, respectively; this represented a significant increase in the total number of robot-assisted urologic surgeries performed across the four subperiods. In addition, there were also significant increases in the numbers of surgeries for seven of the eight categories of surgeries across the four subperiods. Conclusion: These results show that our institution's experience with robot assistance in urological surgeries from 2005 to 2018 was consistent with the generally expanded use of such assistance documented by earlier studies, with both the numbers and types of robot-assisted surgeries performed increasing significantly over that period.

Features of Arthroplasty in Bilateral Knee Osteoarthritis

Introduction. Hip and knee arthroplasty are the two of the most frequently used methods of surgical treatment. The techniques of drug support in the perioperative period, as well as the rehabilitation component, are of primary importance. However, due to the increase in number of operations the number of complications is also growing. At the same time, surgical approaches to the treatment of bilateral knee OA are still not sufficiently studied. The literature describes intervals between arthroplasty operations on knee joints from 3 months to 5 years. The epidemiological and pathogenetic aspects of functional recovery in bilateral knee OA patients are also in need of further research.Materials and methods. Authors analysed outcomes in 124 patients with gonarthrosis treated with arthroplasty. 32 patients underwent arthroplasty of the contralateral joint. The outcomes were evaluated with the KSS score and X-ray imaging at 1, 3 and 6 months postop.Results and discussions. In the first month after the operation functional recovery was noted due to the relief of pain, recovery of the muscle tone and regional hemodynamics in the area of the knee joint. It was also noted that the recovery of function in the period from month 1 to month 3 in patients with bilateral gonarthrosis occurs less intensively due to decompensation of the contralateral joint.Conclusion. The study demonstrates the recovery of function in patients in the postoperative period. There is, however, the issue of functional decompensation in the opposite limb, which in turn reduces the effectiveness of motor rehabilitation and leads to the need for endoprosthetic replacement of the second joint.

Caracterização microestrutural de compósitos de hidroxiapatita-alumina confeccionados pelo método da esponja polimérica

Resumo O aumento do número de cirurgias de substituição e reparação óssea propiciou o estudo e a disseminação do uso de biomateriais, devido à sua biocompatibilidade e custo inferior ao de outros materiais utilizados como implantes. A hidroxiapatita é um biomaterial eficaz para utilização em engenharia tecidual, por ela fazer parte da matriz óssea. Porém, sua baixa resistência mecânica torna necessária a adição de outros materiais objetivando aumentar tal propriedade. A alumina é um material bioinerte que tem sido bastante utilizado como reforço mecânico para a hidroxiapatita. Este trabalho buscou desenvolver, pelo método da esponja polimérica, arcabouços cerâmicos de hidroxiapatita-alumina nas proporções em massa 50%-50%, 60%-40% e 70%-30. Os corpos de prova foram calcinados a 550 °C e sinterizados a 1250, 1300 e 1350 °C para avaliar características microestruturais. Os resultados obtidos estão de acordo com a literatura, o que justifica a realização de ensaios de caracterização físico-mecânica.

Burn-Induced Cardiac Dysfunction Increases Length of Stay in Pediatric Burn Patients

The aim of this study was to evaluate cardiac function and clinical outcomes in perioperative pediatric burn patients. Transesophageal echocardiography data were collected on 40 patients from 2004 to 2007. Of the 40 patients who received exams, a complete set of cardiac parameters and outcome variables was obtained in 26 patients. The mean age of the patients was 9.7 ± 0.9 years, and the mean TBSA burn size was 64 ± 3%. Patients were divided into two groups based on systolic function. One group represented patients with ejection fractions of >50% and the other ≤50%. Clinical variables were then compared among the groups. In our cohort, systolic dysfunction was observed in 62% of patients (EF ≤ 50%). Systolic dysfunction was associated with a statistically significant increase in number of surgeries, ventilator days, and length of stay in the intensive care unit. The length of stay in patients with preserved systolic function and those with systolic dysfunction was 34.3 ± 3.3 days and 67.2 ± 4.0 days, respectively. Diastolic function measurements were obtained in 65%, and 88% had evidence of diastolic dysfunction. Diastolic dysfunction was not associated with any statistically significant correlations. This study lends evidence to the well-supported basic science models showing cardiac dysfunction after burns. Additionally, it shows that cardiac dysfunction can have clinical consequences. To our knowledge, this is the first study that shows the clinical sequelae of systolic dysfunction in the perioperative pediatric burn population.

Epidemiology of Primary Hip and Knee Arthroplasties in Germany: 2004 to 2008

The objective of this study was to describe the trend in utilization of primary joint arthroplasties in Germany. Between 2004 and 2008, the number of total knee arthroplasties (TKAs) increased faster than that of total hip arthroplasties (THAs). In 2008, 159000 primary THAs and 146000 primary TKAs were performed. This represented a 15% increase in THAs and a 33% increase in TKAs compared to 2004. The annual increase in number of surgeries was 4500 for THAs and 9,000 for TKAs. Although older adults remained the main recipients of joint arthroplasties, incidence rate increased faster in non-elderly(18–64 years) compared with elderly (≥65 years) in both THAs and TKAs. Obesity, more strongly associated with TKAs than with THAs, could be a contributor to the recent steeper growth in TKAs in Germany.

Risk profile and outcomes of aortic valve replacement in octogenarians

To investigate the patient characteristics, relationship between the Logistic EuroSCORE (LES) and the observed outcomes in octogenarians who underwent surgical aortic valve replacement (AVR). Two hundred and seventy three octogenarians underwent AVR between 1996 and 2008 at Bristol Royal Infirmary. Demographics, acute outcomes, length of hospital stay and mortality were obtained. The LES was calculated to characterize the predicted operative risk. Two groups were defined: LES ≥ 15 (n = 80) and LES < 15 (n = 193). In patients with LES ≥ 15, 30 d mortality was 14% (95% CI: 7%-23%) compared with 4% (95% CI: 2%-8%) in the LES < 15 group (P < 0.007). Despite the increase in number of operations from 1996 to 2008, the average LES did not change. Only 5% of patients had prior bypass surgery. The LES identified a low risk quartile of patients with a very low mortality (4%, n = 8, P < 0.007) at 30 d. The overall surgical results for octogenarians were excellent. The low risk group had an excellent outcome and the high risk group had a poor outcome after surgical AVR. It may be better treated with transcatheter aortic valve implantation.

Management of Multi-Operator Interconnection through Interconnection Exchange - A Case Study of Bangladesh

The liberalization/opening of telecom markets has brought significant value to customers and markets. The open market contributed to improve quality of service, price reduction and introduction of competition among service providers. An operator can no longer prosper simply by offering basic telephone services. Operators are growing very fast and expanding into all types of telephone services – fixed, mobile, Long Distance (National & International) and also into convergent networks. The geographical spread is also increasing at a fast pace. Operators worldwide are realizing need for fixed-mobile, voice-data and carrier-enterprise convergence. But, behind this bright scene, a complexity is also developing, which has not been addressed with a long term perspective at its inception. These developments could lead to a complex situation resulting in monopolistic behaviour by a market leader or incumbent operators, or an increase in cost of interconnecting networks in a multi-operator and multi-service scenario. is one of most important areas which may emerge as a problem with increase in number of operators with open market conditions. With increase of number of operators in different services, number of interconnecting links between operators increase in multiples and will be very soon unmanageable. Incumbents' networks generally in all developing countries do not have adequate interconnection facilities for new entrants. As a result investments made by new entrants are required to wait for availability of interconnect facilities. It leads to higher cost of service, inefficient handling of call, sub-optimal utilization of network and serious increase of CAPEX and OPEX. The research question in this paper is – how can regulators or operators overcome problem arising from bi-lateral interconnection regime in multi operator and multi service environment? The concept of Interconnection Exchange (ICX) can be a solution to above mentioned problem. ICX is a step towards creation of a modern and efficient telecommunications infrastructure. With introduction of ICX, operators can combine their services in most flexible way. This concept refers to an arrangement which provides interconnection among existing/future telecommunication network of operators and allows monitoring, lawful Interception (LI) facilities and roaming number portability. This paper on the case study of ICX based regime in addresses key issues related to Architecture. The paper explains a totally new approach which possibly may provide a solution to facilitate further competition and could be a mechanism as well as launching pad for ICT density growth in multi-operator multi-service scenario in developing countries. It could also provide a solution to a number of issues that are coming in way of getting best results from investments being made in telecom sector. It could further lead to many new value additions for consumers at competitive tariffs. The paper gives opportunity to discuss model, suggest for betterment and in best case, gives chance of framing/replicating ICX model in other developing countries. This paper on Bangladesh gives an overview of:- Objectives of ICX- Policy Background (that guided introduction of ICX in Bangladesh)- Details of existing ICX infrastructure in Bangladesh- Network Architecture- Revenue sharing model- Billing & payment settlement - Traffic distribution pattern- Implication on current interconnection regime

SUPRAHEPATIC POSITION OF THE GALLBLADDER. A REPORT OF AN UNUSUAL CASE.

ANOMALOUS positions of the gallbladder are uncommon. However, with the increase in number of operations on the biliary tract it is expected that they will be more frequently encountered. Consequently, it is well to be cognizant of the possibilities. Such knowledge may aid in arriving at a correct preoperative diagnosis. This report concerns a patient operated upon for another condition at which time the gallbladder was found lying between the superior surface of the liver and the anterior chest wall. We have not encountered a description of this location of the gallbladder in our readings. Report of a Case A clergyman, 40 years of age, was seen in the hospital in April, 1951, at which time his chief complaints were nausea, vomiting, and epigastric discomfort. Five years previously he was found to have active pulmonary tuberculosis. Three thoracoplasties were performed on the right. Two years prior to admission he received

A ten-year study of cesarean section in the St. Louis Maternity Hospital

1.1. The incidence of cesarean section has increased from 1:73.7 (1927–1932) to 1:43.4 (1932–1937).2.2. The explanation of the increase in incidence on the ward service lies in the increase in number of operations performed for “medical” conditions rather than purely obstetric reasons.3.3. The low segment operation is preferred on the ward service. In recent years the transverse incision in the lower segment has been the operation of choice.4.4. The maternal mortality for ten years is 2.9 per cent. The maternal mortality for the past five years is 0.57 per cent.5.5. Forty-four per cent of the maternal deaths were attributed to sepsis.6.6. The use of one per cent acriflavine (neutral) hydrochloride in glycerin as a vaginal instillation before operation is recommended.7.7. The uncorrected fetal mortality for ten years is 8.2 per cent; for the last five years, 5.8 per cent.