Mean Time Of Ischemia Research Articles

Partial Nephrectomy Versus Radical Nephrectomy for Localized Renal Masses: Critical Analysis of Oncological Outcome and Impact on the Renal Function

Background: Management of renal tumors remains a controversial issue especially in small size tumors or special situations as bilateral disease, single kidney, or compromised renal function, nephron-sparing surgery is the case in such situations. Objective: Comparing oncological outcome and impact on renal function of open radical nephrectomy and open partial nephrectomy for management of renal tumors. Patients and methods: Our study was conducted as a non-randomized prospective observational study at the Urology Department, Menoufia University Hospital between December 2018 and June 2020. Forty-eight patients with organ-confined renal masses were included in the study. They were divided into two equal groups; (group 1) 24 patients and was treated by PN, and (group 2) 24 patients and was treated by RN. Results: The mean age of our study is 56.6±13.2. Thirty-two patients were males (66.7%), while females represented 16 (33.3%). Hot ischemia was done for all partial nephrectomy cases with a mean time of ischemia 13.2±4.1. We used different techniques included simple enucleation in 17 patients (70.8%), polar nephrectomy in 4 patients (16.7%), and wedge resection in 3 patients (12.5%). Regarding surgical margin, it was free in 21 patients (87.5%) of PN and positive in 3 patients (12.5%) 2 of them missed follow up and 1 showed no recurrence till now. Our patients showed a smooth postoperative course. Conclusion: Both techniques (RN&PN) were comparable in terms of oncological outcomes. Patients tolerated both techniques with no major complications, however partial nephrectomy is advised in the localized renal tumors when technically feasible with less probability of complications and good follow-up data regarding the renal function, the oncological outcome is the same as radical surgery.

Left Hepatic Lobectomy in the Living Donor—Comparison Between Open vs Laparoscopic Surgery

Laparoscopic hepatic surgery dramatically changed surgical practice in the last decades, improving outcomes in correctly selected patients. The reduction of postoperative pain, lower rate of complication, early return to work activities, and better esthetic result have been well described in several studies. The success of these procedures would inevitably clash in the more complex and delicate field of hepatectomy in the living donor. The 2nd International Consensus of the Conference on Laparoscopic Liver Surgery considers laparoscopic hepatectomy in the donor as an ideal procedure. The aim of this study is to compare the results between conventional and laparoscopic surgery; prospective data and retrospective analysis of 55 cases of live liver donor lobectomy were collected between January 2013 and June 2018. The mean age was 30.4 years in the video laparoscopic technique and 32.1 years in conventional surgery; the majority of donors were male in both groups. The mean time of ischemia was 70.2 minutes (range, 50–120 minutes) in laparoscopic surgery and 80.2 minutes (range, 50–165 minutes) in conventional surgery. The surgical time ranged from 270 to 800 minutes (mean, 452 minutes) in laparoscopic surgery and ranged from 300 to 600 minutes (mean, 424 minutes) in conventional surgery. The mean length of hospital stay was 2.2 days in laparoscopy and 3.97 days in conventional surgery. Laparoscopic left liver lobectomy in the living donor is safe and feasible. There was no significant difference in surgical time; however, the time of hospitalization was lower in patients submitted to laparoscopic technique.

Severe mutilating injuries with complex macroamputations of the upper extremity - is it worth the effort?

IntroductionAn amputation of the upper extremity and the following replantation is still one of the most challenging operations in the field of reconstructive surgery, especially in extremely severe cases of combined mutilating macroamputations including avulsion and multilevel injuries. Specialists agree that macroamputations with sharp wound edges are an absolute indication for replantation. However, there is no agreement in disastrous cases including avulsion and multilevel injuries. The outcome of the operation is depending on several factors, including the type of accident, age and pre-existing disease of the patient, as well as time of ischemia and appropriate physical therapy.MethodsBetween January 1st 2003 and December 31st 2011 six patients underwent a macroreplantation with disastrous combined and complex injuries of the upper extremity in our department. We performed a follow up and evaluated the functional outcome of the upper extremity function using the DASH questionnaire (average follow up of 3.1 years).ResultsThe mean time of ischemia was 04:50 h (02:46 h–06:17 h). The mean time for the operation was 05:30 h (01:55 h–08:20 h). The mean operations needed per patient were 7 (2–16). The average hospital stay was 29d (16–59d). According to the DASH-Score from five out of six patients the functional outcome of the replanted extremity has a mean score of 71 points. The versatility of the replanted extremity in the field of work had 95, and sport, music was assessed with a mean score of 96 points.ConclusionsSevere and disastrous combined and complex macroamputations of the upper extremity may also have an absolute indication for replantation even though the functional outcome is poor. Not only the feeling of physical integrity can be restored, but the replantation of an amputated upper extremity enables complete or partial recovery of function and sensibility of the arm which is important for the individual. Although our results show a very high DASH-Score, those achievements justify time and person consuming operations. In most cases a replanted extremity is still superior to a secondary allotransplantation. Usually the use of prosthesis is not favored by the treated patients.

Distal forearm tourniquet for hand surgery.

To evaluate the usefulness of the tourniquet placed at the distal forearm, 30 patients were operated with the tourniquet set at the distal forearm using nerve-block anaesthesia. Pain during surgery, flexion of the fingers, bloodless field, and general complications during surgery and 18 months thereafter were recorded. The mean time of ischemia was 19.6+/-7.5 (10-50) min. A bloodless field was achieved in all cases, and pain during operation was low. Flexion of the fingers were found in most cases but was reducible and not annoying for the surgeon. There were no serious complications during surgery or at follow-up. The tourniquet placed at the distal forearm is painless, safe, and useful in hand surgery.

Trasplante unipulmonar y fracaso primario del injerto

To quantify primary graft failure (PGF) and its impact on perioperative and early mortality in single-lung transplant (SLT). We analyzed 35 SLT procedures performed using similar techniques. PGF was defined as a PaO2/FiO2 coefficient lower than 200 mmHg during the first 72 hours or ventilation assistance lasting longer than 5 days attributable to primary lung dysfunction. We defined perioperative mortality as occurring within 30 days of surgery and early mortality within 90 days. Twenty-five men and 10 women received lungs, 22 for pulmonary fibrosis and 13 for emphysema; the mean age was 53.26 10.77 years. Twenty right SLTs were performed and 15 left SLTs. Twenty-nine donors were men and 6 were women, with a mean age of 29.31 12.33 years. Twenty-six died from cranial trauma, 8 from stroke and 1 from a brain tumor. The mean time of intubation was 1.69 1.35 days. The mean PaO2 was 470.71 70.82 mmHg. The mean time of ischemia was 201.77 62.64 minutes. Four patients (11.42%) developed PGF and 3 died during the perioperative period. Two additional patients died within the early postoperative period. Survival was 91.4% at one month and 85.5% at three months. The cause of donor death was the only variable that influenced the development of PGF. We observed a low incidence of PGF and of perioperative and early mortality, with one and three month survival rates similar to those reported internationally.