Life-saving Surgery Research Articles

Incidence and Risk Factors of Emergency Peripartum Hysterectomy

Background: Emergency peripartum hysterectomy (EPH) is a life-saving surgical surgery performed during or after childbirth to preserve the lives of women and newborns in life-threatening conditions. It is linked to high rates of maternal morbidity and mortality. This study aimed to determine the incidence and risk factors for EPH at a tertiary care maternity hospital in Jammu and Kashmir, India. Methods: Between January 2020 and December 2022, retrospective descriptive cohort research was carried out. All pregnant patients scheduled for delivery at the Obstetrics and Gynecology department of SMGS, GMC Jammu, were included in the study. Maternal demographics, medical and obstetric history, EPH indications, surgical and obstetric care, and maternal and newborn outcomes were all gathered from medical records and hospital databases. Descriptive analysis and statistical tests were performed using SPSS Statistics. Results: The study comprised 104 cases of EPH, with an incidence of 2.40/1000 deliveries. The usual maternal age at delivery was 36 years, and the median number of children was two. Previous cesarean delivery was a substantial risk factor, with at least one previous cesarean in 69.2% of cases. The most common cause of EPH, accounting for 73.0% of cases, was aberrant placentation. Less common indicators were uterine atony, uterine rupture, uterine myoma, and placental abruption. Total hysterectomy was performed in 83.3% of cases, with general anesthesia being the predominant type of anesthesia. The median estimated blood loss was 2100 mL, and intraoperative complications were observed in 29.8% of cases. No maternal deaths were reported. Conclusion: In the examined cohort, the incidence of EPH was 2.40/1000 deliveries. Abnormal placentation, including placenta previa and placenta accreta spectrum, as well as previous cesarean birth, were significant risk factors for EPH.

Life-saving emergency surgery due to delayed massive hemothorax 7days after fall injury: a case report.

Delayed hemothorax after thoracic trauma complicates approximately 7.4-36% of blunt traumas. Cases of delayed hemothorax that suddenly increase and require surgery are rare. We report a case of delayed massive hemothorax that was not relieved by vascular embolization but was successfully treated with surgery. The patient was a 45-year-old man. He was rushed to the emergency room after falling from the 4th floor, and he underwent emergency surgery. The patient was weaned off the ventilator on postoperative day (POD) 3 but had bleeding of 500ml/h from his left chest drain on POD 7. We initially performed intrathoracic angiography for the bleeding. Bleeding from the 9th and 10th intercostal arteries was confirmed. Although vascular embolization was performed, 6h later, 500ml/h of bleeding was observed again from the drain, and emergency surgery was performed. We performed ligation of the left 9th and 10th intercostal arteries and intrathoracic hematoma removal. The patient was weaned off the ventilator 14days after the second surgery and was transferred for rehabilitation on day 50. It is necessary to constantly monitor chest drainage and hemodynamics, especially within 7days after injury, and to consider the possibility of emergency surgery.

Three <i>Bad Kids</i>, One Loving Killer: Red China Noir in Blakean Symmetry

The twelve-episode Chinese TV series Yinmi de Jiaoluo (隱秘的角落 Hidden Corner, translated as The Bad Kids [2020]) dances on a Blakean “The Tyger and the Little Lamb” tightrope between childlike innocence and homicidal nihilism, between an art house sensibility and a pop culture chained to party propaganda. Amidst the flood of ethnocentric and jingoistic police procedurals “with Chinese characteristics” on TV, director Xin Shuang (辛爽) energizes his tour de force with a sensibility ranging far beyond Chinese shores, flirting with Western artists and metaphysical self-reflexiveness torn between good and evil, innocence and meaninglessness. Xin Shuang adapts Zijin Chen’s (紫金陈) eponymous web novel while imbuing the series with an off-kilter, haunting Yeatsian “terrible beauty” of violence and attraction.1 The Bad Kids made a killing not so much in profits as in the true art of Sino Noir, or Red China Noir. The eponymous “bad kids” blackmail a murderer to obtain funds for a life-saving surgery. Courting his own death, this “loving” killer saves one of the three kids from an asthma attack and spares the other two out of a fatherly compulsion to sire his own offspring, to pass on the legacy of revenge and guilt, to prolong his life—his afterlife, rather—as he confides: “I want you all to live—to live like me.” The Bad Kids’ Red China Noir teeters on a Blakean symmetry of love and hate, East and West.

Less-Suture Vascular Anastomosis: Development of Alternative Protocols with Multifunctional Self-Wrapping, Transparent, Adhesive, and Elastic Biomaterials.

Blood vessel anastomosis by suture is a life-saving, yet time-consuming and labor-intensive operation. While suture-less alternatives utilizing clips or related devices are developed to address these shortcomings, suture anastomosis is still overwhelmingly used in most cases. In this study, practical "less-suture" strategies are proposed, rather than ideal "suture-less" methods, to reflect real-world clinical situations. In the case of rat artery (d = 0.64mm) anastomosis, the less-suture anastomosis involves the application of thin, adhesive, transparent, and self-wrapping films to the site. This surprisingly reduces the number of stitches required from ten (without films) to four (with films), saving 27min of operating time per vessel. Furthermore, the decreased number of stitches largely alleviates fibrosis-mediated wall-thickening. Thus, a less-suture strategy is particularly useful for anastomosis of multiple vessels in emergency conditions and small-diameter vessels.

Perceptions and attitudes of pregnant women towards caesarean section in Ado Local Government Area, Ekiti, Southwest Nigeria.

Caesarean Section (CS) is a life-saving obstetric surgery, often necessitated to resolve complications of pregnancy. This study investigated the perceptions and attitudes of women of childbearing age in Ado Local Government, Ekiti State, Nigeria, concerning Caesarean section as a delivery option. A quantitative, descriptive research design of survey type was adopted for the study. One hundred and twenty-two pregnant women attending antenatal clinic were randomly selected as study participants. Data for the study were collected using researcher-administered questionnaires. The reliability and validity of the instruments were ascertained. The participants were aware of their rights and responsibilities as study participants. Data were analyzed with descriptive and inferential statistics. The hypotheses formulated were tested at 0.05 significance level. Findings revealed that the study participants have positive perception and attitude towards cesarean. The study indicated no significant relationship between Caesarean section delivery and reproductive failure since the calculated significance value (0.072) was greater ( >) than the significance value (0.05). The study also revealed no significant relationship between Caesarean section delivery and death warrant as the calculated significance value (0.067) was greater ( >) than the significance value (0.05). Awareness programs on the importance and advantages of Caesarean section should be included in antenatal clinics education and mass media propaganda.

Hepatic allograft rejection after liver transplantation: Clinicopathological debates!

Liver transplantation (LT) represents a life-saving surgical procedure and is considered the current standard of care for the majority of patients having end-stage liver disease. As known, significant progress in organ preservation techniques, perioperative care, and strict immunosuppression protocols are associated with favorable patient/graft survival post-LT. Hence, proper evaluation of liver allograft-related complications among survivors has paid great attention, particularly the rejection sequel after LT. It is a seriously underestimated cause of allograft injury, which pushes researchers for understanding the exact pathogenesis of different types and proper time diagnosis for better management of such complications. However, it still represents a challenge because of the complexities related to diagnosis and histopathology. Hence, increasing clinical awareness with earlier diagnosis of post-LT rejection is essential through stimulating further studies. Therefore, our review will focus on the clinicopathological debates regarding liver allograft loss after transplantation.

N°31 – Life-saving epilepsy surgery for refractory status epilepticus due to focal cortical dysplasia and tuberous sclerosis

N°31 – Life-saving epilepsy surgery for refractory status epilepticus due to focal cortical dysplasia and tuberous sclerosis

Racial and ethnic disparities in surgery for kidney cancer: a SEER analysis, 2007–2014

ABSTRACT Background and Objectives: Compared with White patients, Black and American Indian/Alaskan Native (AI/AN) patients experience higher rates of kidney cancer incidence, and Black, AI/AN, and Hispanic patients face later stages of disease at diagnosis, poorer survival rates, and greater risk of mortality. Despite the importance that appropriate treatment has in ensuring positive outcomes, little is known about the association between race and ethnicity and receipt of treatment for kidney cancer. Accordingly, the aim of this study was to explore differences in receipt of treatment and patterns of refusal of recommended treatment by race and ethnicity. Design: 96,745 patients ages 45–84 with kidney cancer were identified in the Surveillance, Epidemiology, and End Results (SEER) program between 2007 and 2014. Logistic regression models were used to examine the association of race and ethnicity with treatment and with patient refusal of recommended treatment. Outcomes of interest were (1) receiving any surgical procedure, and (2) refusing recommended surgery. Results: Relative to White patients, Black and AI/AN patients had lower odds of undergoing any surgical procedure (OR = 0.76; 95% CI: 0.72–0.81; p < 0.001, and OR = 0.92; 95% CI: 0.76–1.10; p = 0.36, respectively) after adjusting for gender, age, insurance status, stage at diagnosis, unemployment status, education status, and income as additive effects. Black and AI/AN patients also had higher odds of refusing recommended surgery (OR = 1.93; 95% CI: 1.56–2.39; p < 0.001, and OR = 1.99; 95% CI: 1.05–3.76; p = 0.035, respectively). Hispanic patients had slightly higher odds of undergoing any surgical procedure (OR = 1.10; 95% CI: 1.04–1.17; p = 0.001) and lower odds of refusal (OR = 0.67; 95% CI: 0.50–0.90; p = 0.007, respectively). Conclusions: Compared with White patients, Black patients were less likely to receive potentially life-saving surgery, and both Black and AI/AN patients were more likely to refuse recommended surgery.

Hemicorporectomy; Describing a Single-Stage Surgical Technique: A Case Report

Background: Hemicorporectomy is a life-saving operation to maintain the survival of patients with severe and irreversible pelvis and lower extremities injuries. In the typical procedure, removing lower extremities and pelvic viscera in the two stages might result in hemodynamic instability, intraoperative and postoperative morbidities, and more deficient patients' survival. In this study, we aim to describe our experience with a new technique for one-stage hemicorporectomy, which minimizes surgical time and intraoperative bleeding&#x0D; Case Report: A 77-year-old male patient with lower limb gangrene after previous vascular surgery for an abdominal aortic aneurysm in an unstable situation underwent hemicorporectomy in one step.&#x0D; Conclusion: We believe that achieving a one-step procedure, especially in non-malignant cases or in the absence of severe trauma lesions, may be a viable option in emergency surgery cases or hemodynamic instability. However, there is still a need to modify the single-stage surgical technique in later experiments.

First Anatomy Annual Congress in Rwanda - October 13 – 15, 2022

Theme: Promoting anatomy to enlighten safe and effective clinical practice&#x0D; It is with a greater honor that I welcome you to this Anatomy Annual Congress, the first of its kind in Rwanda. Anatomy is an essential fundamental science in medical education and medical practice and it deserve to be vibrant scientifically. The S-CAR have been founded with the aim of growing the anatomy sciences and this congress is a wonderful outcome of this common commitment. The congress has 4 events that include: a pre-conference workshop on the peripheral nervous system, the S-CAR annual congress, the scientific conference and the world anatomy day (WAD).&#x0D; Reinforcing the importance of the PNS, Dr. David HAKIZIMANA, a Senior Consultant Neurosurgeon wrote this, I quote: “Peripheral nerve surgery is used to improve function and minimize pain and disability in people with peripheral nerve disorders, such as acute nerve injuries, entrapment neuropathies, and nerve sheath tumors. It involves rerouting healthy nerves to take over the function of the nerves affected by injury, disease, or condition. Surgical treatment for peripheral nerve injuries involves a team which may include: neurosurgeons, plastic surgeons, orthopedic surgeons. Globally the status of peripheral nerve surgery practice within the global landscape of surgery has long been in the shadow of the more prominent areas. The reasons are many, one of them plausibly being the conceptual frame of the very word “peripheral”, which evoke the notions of marginality and lesser importance especially for neurosurgeons. Some of the related common misconceptions are that neurological deficit in peripheral nerve injury is permanent and irreversible, that peripheral nerves do not have the ability to regenerate, that the results of surgical treatment are insignificant. In Rwanda and Africa in general peripheral nerve surgery in almost non-existing or at embryonic phase at best. Although peripheral nerve surgery is not a life-saving surgery, it has been proved to be a life-changing surgery, with a major impact on the quality of patient’s life, as it improves the patient’s ability to perform every day and professional activities and thus affects his/her physical and psychological well-being. Moreover, since most patients with peripheral nerve injuries and brachial plexus injuries belong to the working-age population, peripheral nerve surgery also has substantial socioeconomic implications. Contrary to the previously held view, the peripheral nerve system has been shown to have a huge regeneration potential, with significant results enhanced by different modalities of stimulation, whereby recent research on brain plasticity indicates that experience-dependent reorganization of neural networks plays an important role in functional recovery. For all these reasons, systematic research, education, and practice in peripheral nerve surgery is definitely worth the effort. The aim of this course will be to train residents and interested surgeons from Rwanda in peripheral nerve surgery skills”. The rich scientific conference program with 37 presentations subdivided in sessions on medical education, congenital defects, anatomy and anatomical variations, neurosciences, free presentations, closure lecture, scientific forum for PhD and MSC candidates, cadavers for education and research will give to you an excellent experience. On behalf of S-CAR, I am grateful to the sponsors (MoH, UR, UGHE, AUCA-ASOME, Operation Smile, CHUK and MMI).

Conflicting attitudes between clinicians and women regarding maternal requested caesarean section: a qualitative evidence synthesis

BackgroundCaesarean section (CS) can be a life-saving operation but might also negatively affect the health of both the woman and the baby. The aim of this study was to synthesize and contrast women’s and clinicians’ attitudes toward maternal-requested CS, and their experiences of the decision-making process around CS.MethodsThe databases of CINAHL, MEDLINE, PsycInfo and Scopus were screened. All qualitative studies that answered the study question and that were assessed to have minor or moderate methodological limitations were included. Synthesised findings were assessed using GRADE-CERQual.ResultsThe Qualitative Evidence Synthesis included 14 qualitative studies (published 2000–2022), involving 242 women and 141 clinicians. From the women’s perspectives, two themes arose: women regarded CS as the safest mode of birth; and women’s rights to receive support and acceptance for a CS request. From the clinicians’ perspectives, four themes emerged: clinicians were concerned about health risks associated with CS; demanding experience to consult women with a CS request; conflicting attitudes about women’s rights to choose a CS; and the importance of respectful and constructive dialogue about birthing options.ConclusionWomen and clinicians often had different perceptions regarding the right of a woman to choose CS, the risks associated with CS, and the kind of support that should be part of the decision-making process. While women expected to receive acceptance for their CS request, clinicians perceived that their role was to support the woman in the decision-making process through consultation and discussion. While clinicians thought it was important to show respect for a woman’s birth preferences, they also felt the need to resist a woman’s request for CS and encourage her to give birth vaginally due to the associated increases in health risks.

Sodium glucose co-transporter 2 inhibition with empagliflozin on metabolic, cardiac and renal outcomes in recent cardiac transplant recipients (EMPA-HTx): protocol for a randomised controlled trial

IntroductionCardiac transplantation (CTx) is a life-saving operation that can improve the quality and length of a recipient’s life. Immunosuppression medication, required to prevent rejection, can result in adverse metabolic and...

Analysis of emergency hysterectomies at Zinder mother and child health center (CSME)

Introduction: Emergency obstetric hysterectomy is a life-saving surgery performed as a last resort in the face of a serious accident during parturition. The objective is to describe the risk factors, the indications, the types of hysterectomy performed and their complications encountered. Patients and methods: To achieve our objectives, we carried out a retrospective study from January 1, 2016 to December 31, 2018. Were included, patients who underwent a hysterectomy of obstetric origin at the CSME of Zinder. Results the study focused on 100 cases of obstetric hysterectomy recorded out of 10,124 deliveries, i.e. a frequency of 0.98%. The age of our patients varied between 16 years for the youngest and 45 for the oldest with an average of 30.5 years. They were uneducated in 84% of cases, mostly multiparous 72%, 71% of whom lived in rural areas. Pregnancy was not continued in 81%. The main indications were uterine rupture, uterine atony and PRH in 68%, 16% and 14% respectively. The hysterectomy was total in 41% and subtotal in 59%. Maternal morbidity was dominated by anemia with 84.2%. Perinatal and maternal mortality were respectively 76.69% and 9%. Conclusion: Obstetric hysterectomy is frequent at the CSME of Zinder, all ages were concerned, and they were mostly multiparous, with the deadliest obstetric complications. Maternal and perinatal morbidity and mortality were very high.

Decompressive Craniectomy in Severe Traumatic Brain Injury: The Intensivist’s Point of View

Traumatic brain injury (TBI) represents a severe pathology with important social and economic concerns, decompressive craniectomy (DC) represents a life-saving surgical option to treat elevated intracranial hypertension (ICP). The rationale underlying DC is to remove part of the cranial bones and open the dura mater to create space, avoiding secondary parenchymal damage and brain herniations. The scope of this narrative review is to summarize the most relevant literature and to discuss main issues about indication, timing, surgical procedure, outcome, and complications in adult patients involved in severe traumatic brain injury, underwent to the DC. The literature research is made with Medical Subject Headings (MeSH) terms on PubMed/MEDLINE from 2003 to 2022 and we reviewed the most recent and relevant articles using the following keywords alone or matched with each other: decompressive craniectomy; traumatic brain injury; intracranial hypertension; acute subdural hematoma; cranioplasty; cerebral herniation, neuro-critical care, neuro-anesthesiology. The pathogenesis of TBI involves both primary injuries that correlate directly to the external impact of the brain and skull, and secondary injuries due to molecular, chemical, and inflammatory cascade inducing further cerebral damage. The DC can be classified into primary, defined as bone flap removing without its replacement for the treatment of intracerebral mass, and secondary, which indicates for the treatment of elevated intracranial pressure (ICP), refractory to intensive medical management. Briefly, the increased brain compliance following bone removal reflects on CBF and autoregulation inducing an alteration in CSF dynamics and so, eventual complications. The risk of complications is estimated around 40%. The main cause of mortality in DC patients is due to brain swelling. In traumatic brain injury, primary or secondary decompressive craniectomy is a life-saving surgery, and the right indication should be mandatory in multidisciplinary medical-surgical consultation.

Bentall procedure as a lifesaving surgery: A single center experience.

The Bentall procedure is a surgical technique used in the management of aortic root abnormalities with ascending aorta and aortic valve issues. The present study aimed to evaluate the outcomes of 18 patients treated with the Bentall procedure in a single center. The present study was a single-center retrospective case series conducted over a period of 3 years. The patients had either acute ascending dissection and/or dilated ascending aorta with aortic valve dysfunction. The Bentall procedure was performed via standard median sternotomy. St. Jude Medical composite grafts with a valve were applied in all cases. A total number of 18 patients with either acute ascending dissection and/or dilated ascending aorta with aortic valve dysfunction were included in the study. The age of the participants ranged from 27-60 years. The ratio of males to females was 16:2 (males, 88.8%). The symptoms developed 3-4 days prior to hospital admission. Chest pain was the most common presenting symptom (n=10, 55.5%). Hypertension was the most common risk factor (n=12, 66.6%). In total, 14 cases underwent emergency surgery (77.7%). The emergency surgery was performed in 9 patients within 24 h of arrival owing to the association of aortic root dissection with tamponade. For the other cases, the surgery was performed within 2 and 7 days (n=5, 27.7% and n=4, 22.2%) respectively. Early post-operative complications occurred in 5 patients (27.7%). On the whole, as demonstrated herein, the modifications of the Bentall procedure have a notable impact on decreasing the overall mortality rates. Raising the awareness of clinicians and the general population as regards aortic dissection may aid in the early referral of patients to specialized centers and may thus decrease the overall mortality rate.

A Review of Caesarean Delivery at the Kogi State Specialist Hospital, Lokoja, Nigeria

Background: Caesarean delivery rate is increasing globally including in Nigeria. Caesarean delivery is a life-saving surgery for both mother and child. Objective: The aim of the study was to assess the caesarean delivery rate at the Kogi State Specialist Hospital, Lokoja, Nigeria over a one-year period. Methods: This was a prospective assessment of the demographic characteristics of patients, indications, types, rates and outcomes of Caesarean delivery in Kogi State Specialist Hospital, Lokoja, Nigeria from December 15, 2020 to December 14, 2021. Data collected were analyzed using SPSS version 20.0 statistical package (IBM Corp. Released 2011. IBM SPSS Statistics for Windows, Version 20.0. Armonk, NY: IBM Corp). The categorical data were displayed using tables and charts. Results: There was a total of 491 deliveries, out of which were 113 Caesarean deliveries and 378 spontaneous vaginal deliveries making the Caesarean delivery rate in Kogi State Specialist Hospital, Lokoja, Nigeria 23.0%. There were no instrumental deliveries during the study period. The commonest indication for Caesarean section was obstructed labour in 31% of cases. There was no maternal mortality. There were three early neonatal deaths due to severe birth asphyxia. Conclusion: The rate of Caesarean delivery in this study was 23.0% and obstructed labour was the leading indication in 31% of cases. The rate of Caesarean delivery in this study is high, albeit the overall outcome was good for both mother and child. Caesarean delivery, therefore, remains one of the means for reducing maternal and perinatal morbidity and mortality in Nigeria.

Non-medical reasons affecting cesarean section rate in teaching hospitals in Anbar province, Iraq

Background: Globally, there is an increment in the cesarean section rate. Although the cesarean section is a lifesaving surgery in some cases, it is not safer than vaginal delivery and associated with higher maternal and perinatal complications. Many cesarean sections nowadays are performed for non-medical reasons, and decision-making is affected by social factors and the health standards of the community. Objectives: The objective of this study is to assess the non-medical reasons for cesarean sections. Method: This cross-sectional descriptive study was conducted in two teaching hospitals in Anbar province/Iraq. Women who underwent planned cesarean section at term were included. The inclusion criteria were cephalic fetal presentation, normally sited placenta, and no previous uterine scar. A questionnaire was set regarding the medical causes of planned cesarean section and any non-medical reasons that affect the decision-making. Seniors in obstetrics and gynecology in these hospitals responsible for these women were asked to fill in these questionnaires. Results: Out of 82 women included in the study, 11% were aged 35 years or more and 65.9% were nullipara. About 43.9% of the cesarean sections were performed for a purely medical cause and 34.1% had a medical cause for terminating the pregnancy. Still, decision-making was affected by non-medical reasons, and in 22% of the cases, cesarean sections were done without medical causes. A maternal request for cesarean section was the most common reason for those who underwent cesarean section without a medical cause. Conclusion: Proper maternal counseling about the potential risks of cesarean section and improving health care in the labor room can help in decreasing the cesarean section rate and its associated mortality and morbidity.

Introduction of Dr Mannikam Suthanthiran as Recipient of the Medawar Prize for 2022.

Introduction of Dr Mannikam Suthanthiran as Recipient of the Medawar Prize for 2022.

The Role of the Gallbladder, the Intestinal Barrier and the Gut Microbiota in the Development of Food Allergies and Other Disorders.

The microbiota present in the gastrointestinal tract is involved in the development or prevention of food allergies and autoimmune disorders; these bacteria can enter the gallbladder and, depending on the species involved, can either be benign or cause significant diseases. Occlusion of the gallbladder, usually due to the presence of calculi blocking the bile duct, facilitates microbial infection and inflammation, which can be serious enough to require life-saving surgery. In addition, the biliary salts are secreted into the intestine and can affect the gut microbiota. The interaction between the gut microbiota, pathogenic organisms, and the human immune system can create intestinal dysbiosis, generating a variety of syndromes including the development of food allergies and autoimmune disorders. The intestinal microbiota can aggravate certain food allergies, which become severe when the integrity of the intestinal barrier is affected, allowing bacteria, or their metabolites, to cross the intestinal barrier and invade the bloodstream, affecting distal body organs. This article deals with health conditions and severe diseases that are either influenced by the gut flora or caused by gallbladder obstruction and inflammation, as well as putative treatments for those illnesses.

The evolution of a novel approach to building surgical capacity for cervical cancer in Africa.

The human, financial, and infrastructural resources required to effectively treat invasive cancer of the cervix are grossly inadequate in the African region, inclusive of a paucity of surgeons capable of performing life-saving radical pelvic surgery for early-stage disease, and the requisite medical ecosystem (blood banking, anesthesia, laboratory, imaging, diagnostics, etc.) Death without treatment, therefore, is a common sequela of cervical cancer in Africa. As African American gynaecologic oncology sub-specialists working in Africa and its Diaspora, we set out to find a way to alter these circumstances. Herein, we provide an overview of our efforts and how they evolved into a novel method of training that rapidly builds surgical capacity for the treatment of early-stage cervical cancer in resource-constrained environments.