Number Of Postoperative Complications Research Articles

Institutionally Adopted Perioperative Blood Management Program Significantly Decreased the Transfusion Rate of Patients Having Primary Total Hip Replacement Surgery

Perioperative transfusion in patients undergoing orthopedic surgery increases the number of postoperative complications. Thus, we have introduced an institution-tailored perioperative blood management program (PBM) to decrease the amount of blood transfused in patients going through primary total hip replacement (THR) surgery. We have conducted a before-after observational cohort study in two predetermined observational periods. Demographic and clinical data, ASA scores, laboratory parameters, features of surgical procedure, and anesthesia were registered. Parameters of perioperative fluid administration, transfusion rate, and postoperative complications were also assessed. One hundred patients in the first and 108 patients in the second observational period were enrolled. Eventhough the ratio of posttraumatic THR procedures increased (9% vs. 17%), the PBM protocol has been utilized effectively and a significant decrease in perioperative blood transfusion rate has been observed (61% vs. 21%). The abolishment of routine preoperative LMWH prophylaxis (90% vs. 16%), intraoperative use of tranexamic acid (10% vs. 84%), and the encouraged exploitation of our postoperative observational facility (5% vs. 39%) were abided by our colleagues. Patients still requiring transfusion had lower preoperative hemoglobin levels (129 vs. 147 g/l), scored higher in ASA (ASA III: 46% vs. 19%), and more often presented postoperative hypotension (40% vs. 7%), oliguria (23% vs. 5%), and infections (9% vs. 2%). We conclude that the individualized perioperative blood management protocol was successfully implemented and yielded a lower transfusion rate and better outcomes. Our study suggests that a partial, institution-tailored PBM program may be suitable and beneficial in countries where the modalities of perioperative blood management are limited.

Topographic, anatomical and clinical rationale of the optimal minimally invasive technique of parathyroidectomy

Introduction. The information presented in the literature on the use of minimally invasive interventions in the treatment of hyperparathyroidism is not fully justified by topographical and anatomical studies and does not take into account individual features of the location and syntopia of the parathyroid glands, which requires additional scientific research.Objective.Based on the topographical and anatomical features of the structure of the anterior neck region, we determined the most rational methods of minimally invasive interventions on the parathyroid glands and evaluated their clinical effectiveness in patients with hyperparathyroidism.Methods and materials. The design of the study consisted of two stages – topographical and anatomical, and clinical. Topographical and anatomical stage was performed on 2 levels: 1) on anatomical material, which included 15 human cadavers; 2) on plastinated cross sections of the neck (n=44) of human cadavers. During the clinical stage, we studied results of examination and treatment of 53 patients with hyperparathyroidism, who underwent surgery using three methods: Сonventional (n=18/34 %); Minimally Invasive Video-Assisted Parathyroidectomy (n=32/60 %) and Transoral Endoscopic Parathyroidectomy Vestibular Approach (n=3/6 %).Results. During the topographical and anatomical stage, the validity and safety of minimally invasive video-assisted parathyroidectomy was proved. The use of this access in clinical practice as an alternative to the conventional one has shown its effectiveness in reducing the frequency of specific postoperative complications from 16.7 to 6.3 % with an acceptable increase in the duration of surgery from (42.8±15.7) to (64.4±23.5) minutes and maintaining the average duration of inpatient treatment after surgery at the level of (3.4±0.6) days.Conclusion. Minimally invasive video-assisted parathyroidectomy can be considered the operation of choice in the treatment of patients with hyperparathyroidism. The use of this technique with the implementation of lateralization of the thyroid lobe, the preservation of the superior and inferior thyroid vessels, as well as the use of intraoperative neuromonitoring and identification of pathological and normal parathyroid tissue by fluorescent labeling with 5-aminolevulinic acid can improve the results of surgical treatment, reduce the number of postoperative complications, the frequency of persistence and relapse of the disease, and improve the quality of life of patients.

Extracorporeal Membrane Oxygenation: Opportunities for Expanding Nurses' Roles.

Extracorporeal Membrane Oxygenation: Opportunities for Expanding Nurses' Roles.

Chronobiological approach to the treatment of patients with benign prostate hyperplasia and chronic prostatitis: results of a morphological examination

MATERIALS AND METHODS: 60 patients with benign prostatic hyperplasia (BPH) and category II chronic prostatitis (NIH, 1995) were examined. The average age of the patients was 60.55.5 years. The patients were divided into two groups of 30 people each. The comparison group (GC) included patients who received standard therapy with drugs from the group of alpha-blockers and fluoroquinolones. The main group (MG) consisted of patients who received standard therapy in combination with physiotherapy sessions with the device SMART-PROST, which were carried out in the acrophase of the chronorhythm. After the end of the course of therapy all patients underwent transurethral resection of the prostate, after which a morphological and morphometric (immunohistochemical) study of the obtained material was carried out.
 RESULTS: According to the results of the morphological and morphometric examination of the histological material in patients of the CG and MG, statistically significant differences were revealed in all the studied parameters, which testify to the persistence of signs of the inflammatory process in the CG, while in the MG, the severity of inflammation was significantly lower.
 CONCLUSION: According to the results of the study, personalized complex therapy of patients with benign prostatic hyperplasia in combination with chronic prostatitis using a combined physiotherapeutic effect of the SMART-PROST device, taking into account the individual chronobiological characteristics of patients, allows to more effectively arrest the inflammatory process in the prostate tissue, which can lead to a decrease in the number of postoperative complications. However, the last statement requires further more detailed study.

Does epidural analgesia modify the risk of complications after gastrectomy?

Introduction. The surgical treatment of Gastric Cancer is associated with overall complication rates as high as 50%. The intent of this study was to assess the impact of epidural analgesia (EA) on postoperative complication rates among patients undergoing gastric resections. Materials and methods. Of the 617 gastric cancer patients who between 2002 and 2010 had undergone stomach resection, 246 (39.8%) were administered EA. Groups with and without EA were compared. Results. The general rate of complications was lower in the EA group in the univariable analysis – 38.5% vs. 54.2% (odds ratio [OR]: 0.47, 95% confidence interval [CI]: 0.34–0.66, p < 0.001), intra-abdominal abscess (OR 0,28, 95% CI: 0.14–0.59, p = 0.001), pneumonia (OR 0,39, 95% CI: 0.24–0.63, p < 0.001), temperature > 38°C (OR 0.53, 95% CI: 0.37–0.74, p < 0.001) and re-operation (OR 0.53, 95% CI: 0.28–1.00, p = 0.049). These relationships were confirmed in a multivariable analysis for the general number of complications (OR 0.53, 95% CI: 0.37–0.75, p < 0.001), intra-abdominal abscess (OR 0.36, 95% CI: 0.16–0.77, p = 0.009), temperature > 38°C (OR 0.56, 95% CI: 0.39–0.82, p = 0.009), pneumonia (OR 0.42, 95% CI: 0.25–0.71, p = 0.001). Conclusions. Our findings indicate that postoperative treatment with EA for patients undergoing stomach resection is safe and contributes to a reduction in the number of postoperative complications.

To Study the Repair of Incisional Hernia by Preperitoneal Meshplasty

The preperitoneal mesh repair an excellent method called as Rive’s stoppa technique where mesh was placedbetween peritoneum and abdominal wall or rectus muscle and posterior rectus sheath(9). The main advantageof pre peritoneal mesh repair are - Less chance of mesh infection and erosion through skin because thegraft lies in preperitoneal plane between posterior rectus sheath and peritoneum, avoids adhesions, bowelobstruction, enterocutaneous fistula and erosion of mesh, minimal morbidity and duration of hospitalstay is less compared to other techniques. The main disadvantage is it is more time consuming, extensivepreparation of preperitoneal plane and surgical experience. In our study 30 patients of incisional hernia weresubjected to preperitoneal mesh repair by Rive’s stoppa technique.It was found that there were :1. Less number of postoperative complications.2. No recurrence was noticed in this study.3. Preperitoneal mesh repair had excellent long-term results with minimal morbidity.As Compared withother types of mesh repair techniques (in literature), the preperitoneal mesh repair is the gold standardtreatment for incisional hernia repair.

Implementation of mini-invasive methods of bile drainage in the treatment of blastomatous mechanical jaundice

Tumor diseases of the BPDZ (biliopancreatoduodenal zone) occupy one of the leading places among the causes of disability and mortality of the population, both according to global and domestic statistics, while in 85–90 % of cases, patients with distal tumor biliary obstruction are detected. The most common symptom of malignant tumors of periampullary localization is OJ(obstructive jaundice), which is found in 86–95 % of patients and becomes the first manifestation of the disease in 65–70 % of cases. Purpose. Optimization of surgical treatment in surgically incurable patients with obstructive blastomatous jaundice. Materials and methods. The study was clinical in nature, it was carried out on the basis of CCH №17 (Kharkov, Ukraine) and the State Institution “Institute of General and Emergency Surgery named after V. I. Zaitsev National Academy of Medical Sciences of Ukraine ") and consisted of two stages. The main task of the first stage was a retrospective assessment of the results of antegrade and retrograde minimally invasive interventions performed in the period from 2006 to 2011 in 122 patients. The main objective of the second stage of the study was to assess the results of surgical treatment of 75 patients with blastomatous breast, who were treated from 2012 to 2019. using the developed treatment algorithm. Results. At the first stage of the study, the effectiveness of endoscopic transpapillary and transhepatic biliary excretion methods in patients with distal malignant obstruction of the gastrointestinal tract was compared, for which patients who underwent minimally invasive interventions were divided into two subgroups: group A (63 observations) biliary excretion, and in group b (59 observations) as biliary decompression antegrade percutaneous-transhepatic methods of drainage of bilious ways were applied. Endoscopic transpapillary surgery showed itself to be, not inferior to open surgery in effectiveness of biliary decompression, instead it has a number of advantages, such as low trauma, relative safety, low complication and mortality. Conclusions. The developed algorithm of bile excretion in incurable patients with blastomatous MF allowed to minimize the number of postoperative complications to 4.0 %, to avoid the development of transient hyperamylasemia and postmanipulation pancreatitis. Endoscopic retrograde methods of RV prosthetics as the final stage of surgical treatment in this category of patients have certain advantages over antegrade methods of external drainage, primarily due to the preservation of the natural passage of bile in the duodenum and better adaptation and tolerability by patients

Comparison of the Outcomes of Manual Small Incision Cataract Surgery (MSICS) and Phacoemulsification (PHACO) in Ghana

Background: The growing middle-class population of Ghana has seen more people being employed in visually demanding occupations and hence there is an increased desire for quality post-cataract surgical visual outcomes. This study aimed at comparing the outcomes of manual small incision cataract surgery (MSICS) and phacoemulsification (PHACO) among Ghanaians.
 Methods: This was a retrospective cross-sectional study in which records of patients who underwent MSCIS or phacoemulsification by the same surgeon were reviewed.
 Results: Medical records of 248 eyes were reviewed, out of which 132 underwent PHACO and 116 had MSICS. A significant number of the PHACO group had good (6/6–6/18) uncorrected visual acuity (UCVA) compared to the MSICS group at 1–2 weeks follow-up (p = 0.003) and 4–6 weeks follow-up (p = 0.002). MSICS resulted in a higher total astigmatic change compared to PHACO (p < 0.001). The PHACO grouphad a higher number of postoperative complications compared with the MSICS group (p <0.001). Postoperative borderline and poor uncorrected visual acuity were associated with age, total astigmatic change, and postoperative complications.
 Conclusion: The postoperative UCVA outcomes at 4–6 weeks’ follow-up indicates that PHACO resulted in noticeably less spectacle dependency when compared to MSICS.

Appendectomy during the COVID-19 pandemic in Italy: a multicenter ambispective cohort study by the Italian Society of Endoscopic Surgery and new technologies (the CRAC study)

Major surgical societies advised using non-operative management of appendicitis and suggested against laparoscopy during the COVID-19 pandemic. The hypothesis is that a significant reduction in the number of emergent appendectomies was observed during the pandemic, restricted to complex cases. The study aimed to analyse emergent surgical appendectomies during pandemic on a national basis and compare it to the same period of the previous year. This is a multicentre, retrospective, observational study investigating the outcomes of patients undergoing emergent appendectomy in March–April 2019 vs March–April 2020. The primary outcome was the number of appendectomies performed, classified according to the American Association for the Surgery of Trauma (AAST) score. Secondary outcomes were the type of surgical technique employed (laparoscopic vs open) and the complication rates. One thousand five hundred forty one patients with acute appendicitis underwent surgery during the two study periods. 1337 (86.8%) patients met the inclusion criteria: 546 (40.8%) patients underwent surgery for acute appendicitis in 2020 and 791 (59.2%) in 2019. According to AAST, patients with complicated appendicitis operated in 2019 were 30.3% vs 39.9% in 2020 (p = 0.001). We observed an increase in the number of post-operative complications in 2020 (15.9%) compared to 2019 (9.6%) (p < 0.001). The following determinants increased the likelihood of complication occurrence: undergoing surgery during 2020 (+ 67%), the increase of a unit in the AAST score (+ 26%), surgery performed > 24 h after admission (+ 58%), open surgery (+ 112%) and conversion to open surgery (+ 166%). In Italian hospitals, in March and April 2020, the number of appendectomies has drastically dropped. During the first pandemic wave, patients undergoing surgery were more frequently affected by more severe appendicitis than the previous year's timeframe and experienced a higher number of complications. Trial registration number and date: Research Registry ID 5789, May 7th, 2020

Еndoscopic papillosphincterotomy with balloon dilation in treatment of patients with coldocholithiasis and parapapillary diverticule (balloon dilation for coldocholithiasis)

Performing a limited papillosphincterotomy, supplemented by endoscopic balloon dilation, and only endoscopic papillosphincterotomy in patients with choledocholithiasis and parapapillary diverticulum resulted in complete lithoextraction in 92.9% of cases, and adequate drainage of the common bile duct in 100% and 96.4% of cases, respectively. The use of balloon dilation after limited papillosphincterotomy definitely reduces the need for mechanical lithotripsy and the number of postoperative complications.

Surgical treatment of lung cancer in patients with coronary artery surgery

The objective was to improve the surgical treatment tactics in patients with non-small cell lung cancer (NSCLC) and coronary heart disease (CHD), requiring myocardial revascularization.Methods and materials. Two groups consisting of 24 patients operated on for NSCLC were examined. In one group, operations for NSCLC were performed in the second stage after coronary artery bypass grafting (CABG). Survival rates in both groups and factors influencing them were evaluated.Results. The number of postoperative complications in both groups was comparable: 20.8 % in patients with CABG and 16.6 % in the group operated only for NSCLC. Indicators of relapse-free and overall survival did not differ significantly from each other (p=0.90 and p=0.95). Only the stage of the disease (p=0.009) and the implementation of complex cancer treatment in case of its necessity (p=0.035) had a reliably impact on the long-term results of the operation. The first stage of myocardial revascularization surgery did not affect the results of treatment (p=0.94), as well as the age of patients, the volume of performed surgery, the morphological picture of the tumor.Conclusion. The staging approach to the treatment of patients with NSCLC and critical forms of CHD requiring myocardial revascularization is reliable, convenient and does not affect the long-term results of treatment.

Laparoscopic Resection for the Treatment of Liver Tumors

Open hepatectomy remains the fundamental and one of the most common surgical techniques for the treatment of primary and secondary liver tumors, but Laparoscopic Liver Resection (LLR) is now gaining more and more importance. The aim of the study was to evaluate the efficacy and safety of laparoscopic resection of liver tumors based on the clinical experience of the authors. LLR was performed in 53 patients (26 women and 27 men). The most common indication for the laparoscopic resection of liver tumors was metastatic colon cancer. We performed 19 non-anatomical (wedge) resections, 11 segmentectomies, 10 anatomical resections, 8 hemihepatectomies, 3 radicalizations due to gallbladder cancer, and 2 liver cyst fenestrations. Simultaneous procedures were performed in 5 cases. The mean operating time for the laparoscopic resection of liver tumors was 307 min. The mean intraoperative blood loss was 270 ml. Complications were reported in 10% of cases. The mean hospitalization time was 7 days. Slightly longer operating time and greater blood loss were found in patients treated with LLR compared to those who had open surgery. Recovery time was shorter in patients who had laparoscopic surgery. Early results of cancer treatment were comparable to those for open surgeries. LLR was associated with lower rates of postoperative complications. Laparoscopic liver resections reduce intraoperative trauma and the number of postoperative complications, and shorten the hospitalization time and recovery. These procedures are safe in cancer patients. A particular advantage of laparoscopic surgery is observed in patients with cirrhosis, the elderly, and patients with coexisting internal diseases.

"Spine Surgery Checklist": A Step towards Perfection through Protocols.

Study DesignA retrospective study.PurposeThis study aimed to evaluate the effectiveness of a novel checklist that was designed specifically for the “spine-surgery-subspecialty” to reduce the incidence of some common preventable human errors and major perioperative complications in spine surgery.Overview of LiteratureWe propose a unique spine surgery-specific checklist that recognizes the risk factors, anticipates the possible human errors, and thus helps in preventing these errors. This checklist is associated with increased patient safety awareness, improved communication (keeps everyone updated regarding their responsibilities), reduction in the surgical claims, and reduction in the number of postoperative complications, including mortality.MethodsThis retrospective pilot study was performed at single center on 858 spine surgery patients. The patients were divided into the following two groups: the study group (after implementation of the checklist [2016–2017]) and the control group (before the implementation of the checklist [2015–2016]). The incidence of common preventable human errors and major perioperative complications in spine surgeries were recorded and compared between the two groups.ResultsThe prevalence of wrong-level surgeries was 0%, and the overall prevalence of the preventable errors was 1.63% (7/428). The rate of adverse, near-miss, and no-harm events was 0.23% (1/428), 0.70% (3/428), and 0.70% (3/428), respectively. The preoperative, intraoperative, and postoperative errors were 0.70% (3/428), 0.23% (1/428), and 0.70 (3/428), respectively. The reoperation rate related to preventable errors reduced after the checklist was used. There were significant differences in the total preventable errors related to complications, such as infections, prolonged hospital stays, and unplanned hospital readmission/revision surgeries (p=0.001).ConclusionsThe authors propose the first-of-its kind spine surgery-specific checklist that is comprehensive and involves perioperative parameters. The checklist is easy to use, safe, and effective for reducing the unforgiving errors and perioperative complications. However, its broader implementation would require validation in large, multi-center, randomized control studies.

LASER TECHNOLOGIES IN SURGERY BENEFICIAL PROSTATE HYPERPLASIA

Benign prostatic hyperplasia is one of the most common diseases in urological practice. The classical method of surgical treatment of benign prostatic hyperplasia is transurethral resection of the prostate gland. However, this operation is accompanied by a fairly large number of postoperative complications and is not recommended for patients with a large prostate volume, with a high cardiovascular risk, and receiving anticoagulant therapy. In recent years, the medical community has been paying close attention to laser technologies. The article provides an overview of the literature on laser methods for the treatment of benign prostatic hyperplasia. Modern laser systems are considered: holmium, thulium, diode, «green» lasers. The advantages and disadvantages of each technique are described. The results of studies of the efficacy and safety of laser surgical methods for the treatment of benign prostatic hyperplasia and their influence on the indicators of urodynamics, symptoms of the disease, and the quality of life of patients are presented. Based on the analysis of scientific literature sources, it was concluded that laser methods of surgical treatment of benign prostatic hyperplasia are clinically effective and safe. Compared with transurethral resection of the prostate, laser technologies can shorten the period of hospitalization and catheterization of patients, have a low number of complications, provide good hemostasis, and can be used regardless of the volume of the gland in patients with concomitant diseases who are taking anticoagulants. Laser methods of surgical treatment of benign prostatic hyperplasia are currently a full-fledged worthy alternative to transurethral resection of the prostate gland. Among the disadvantages of using laser systems are the duration of the operation and the need to train specialists in the technique of surgical intervention.

Patient-specific fluid–structure interaction model of bile flow: comparison between 1-way and 2-way algorithms

Gallbladder disease is one of the most spread pathologies in the world. Despite the number of operations dealing with biliary surgery increases, the number of postoperative complications is also high. The aim of this study is to show the influence of the biliary system pathology on bile flow character and to numerically assess the effect of surgical operation (cholecystectomy) on the fluid dynamics in the extrahepatic biliary tree, and also to reveal the difference between 1-way and 2-way FSI algorithms on the results. Moreover, the bile viscosity and biliary tree geometry influence on the choledynamics were evaluated. Bile velocity, pressure, wall shear stress (WSS), displacements and von Mises stress distributions in the extrahepatic biliary tree are presented, and comparison is made between a healthy and a lithogenic bile. The patient-specific biliary tree model is created using magnetic resonance imaging (MRI) and imported in a commercial finite element analysis software. It is found that in the case of lithogenic bile, velocities have lower magnitude while pressures are higher. Furthermore, stress analysis of the bile ducts shows that the WSS distribution is found mostly prevailing in the common hepatic duct and common bile duct areas. It is shown that when it is necessary to evaluate the bile flow dynamics in urgent medical situations, 1-way analysis is acceptable. Nevertheless, 2-way FSI provides more accurate data, if necessary to evaluate the stress–strain state of bile ducts. The proposed model can be applied to medical practice to reduce the number of post-operative complications.

Arthroscopic, Single-Incision, and Double-Incision Approaches to Flexor Hallucis Longus Tendon Transfer Following Achilles Tendon Rupture: A Literature Review.

Achilles tendon rupture is a common athletic injury that results in a painful and antalgic gait. Flexor hallucis longus tendon transfer through arthroscopic, single-incision, or double-incision techniques is used as a treatment approach to address this rupture; however, no studies have compared postoperative complications between these three techniques. A systematic search of published articles was conducted using keywords "Achilles rupture," "flexor hallucis tendon," "transfer," and "recovery." Articles were then selected based on their title, abstract, and content following full-text review. From each article's reported surgical outcomes, a comparison was made between arthroscopic and single- and double-incision postoperative complications using a χ2 test with significance set at a value of P < .05 followed by post hoc analysis. The arthroscopic approach maintained the lowest rate of postoperative complications, followed by the single- and double-incision techniques. A significant difference in the number of postoperative complications was found between all incisional approaches. The pairwise comparisons, however, could not identify which incisional approaches significantly differed between each other. A reduction in postoperative complications places arthroscopy and the single-incision techniques as the preferred approaches for flexor hallucis longus tendon transfer following an Achilles tendon rupture. Although current literature shows arthroscopy to be superior to single- and double-incision methods, this review demonstrates the need for a greater number of published cases using arthroscopy to establish significance regarding postoperative complications.

Benigní asymptomatické pneumoperitoneum u pacientky po CT kolografi i

Pneumoperitoneum is a condition that refers to the presence of free air (gas) in the abdominal cavity. Differential diagnosis of the causes of pneumoperitoneum varies widely and represents varying degrees of severity. In the patients who have not recently underwent laparotomy or laparoscopy, the finding of pneumoperitoneum is usually a sign of gastrointestinal perforation that requires immediate surgical approach due to the risk of peritonitis with subsequent life-threatening sepsis. However, not all causes of pneumoperitoneum require surgery. In our case report, we present a rare case of clinically asymptomatic pneumoperitoneum that developed in a 66-year-old patient after CT colonography. In this diagnostic method, we inflate colon with carbon dioxide (CO2 ); therefore this kind of pneumoperitoneum can de facto be called capnoperitoneum. In this patient, free air (gas) in the abdominal cavity manifested itself in the so-called benign pneumoperitoneum, which is defined as asymptomatic free air in the abdominal cavity and pneumoperitoneum without peritonitis. Despite the fact that CT colonography is considered a method with a very low incidence of complications, it is necessary to take into account the presence of risk factors in its indication and to contraindicate to avoid the number of postoperative complications. The fundamental message of our case report is that extensive pneumoperitoneum after proven CT colonography can be asymptomatic and can be treated conservatively (if clinical and laboratory results are favorable).

Effectiveness of Mannheim peritonitis index scoring system in predicting the morbidity and mortality in peritonitis due to hollow viscous perforation

Background: To study the spectrum and prognostic factor in perforation peritonitis. To evaluate the outcome of patients and identification of high risk patients using Mannheim peritonitis index.Methods: 80 patients with hollow viscous perforation admitted in the Dept. of Surgery Adhichuchanagiri Institute of Medical sciences from January 2019 to June 30 2020 were included in the study. Necessary data was collected; MPI score was calculated for each patient and analysis done.Results: The number of post-operative complications, hospital stay and mortality proportionately increased with the MPI score. In our study Age &gt;50 years, Organ failure at admission pre operatively and MPI scoring found to be statistically significant. Out of the 8 variables used in this scoring system, age more than 50 years and organ failure on admission carried more significance in predicting the morbidity and mortality in the post operative period than the other variables.Conclusions: Mannheim peritonitis index is a simple and effective method in predicting the mortality and morbidity of patients with hollow viscous perforation.

The Use of BT-ESD Technology under General Intravenous Anesthesia in the Treatment of Nonmuscle Invasive Bladder Cancer and the Effect of PI3K/Akt Signaling Pathway on Tumor Recurrence

Objective. The objective is to investigate the effect of minimally invasive treatment of nonmuscle invasive bladder cancer (NMIBC) by transurethral endoscopic submucosal dissection of bladder tumor (BT-ESD) under general intravenous anesthesia and the expression of Akt in NMIBC and to study the effect of upregulation of intracellular phosphatidylinositol kinase (PI3K)/protein kinase B (Akt) on tumor recurrence. Method. 130 patients with NMIBC were selected as the research subjects, including 101 males and 29 females. The patients were divided into transurethral resection of bladder tumor (TURBT) group, BT-ESD learning group A (early 20 cases of chief surgeon), and BT-ESD learning group B (follow-up cases of the chief surgeon). The general information (male and female prevalence ratio and average age), operation duration, postoperative bladder irrigation duration, postoperative indwelling catheter time, postoperative hospitalization time, and postoperative complications were compared among the patients in all groups. The normal bladder tissues and pathological tissues of NMIBC patients were stained by immunohistochemistry. Results. No significant difference is identified in age among the three groups (P&gt;0.05), but there are significant differences in the operation duration, postoperative bladder irrigation time, postoperative indwelling catheter time, and postoperative hospital stay (P&gt;0.05). At the same time, compared with BT-ESD group A and BT-ESD group B, the number of postoperative complications in TURBT group is statistically different (P&lt;0.05). Akt has a strong positive expression in the nucleus of patients, which indicates that Akt activated by cellular PI3K will form the PI3K/Akt signaling pathway and reduce the recurrence rate of bladder tumor.

Crohn\u2019s disease: a population-based study of surgery in the age of biological therapy

PurposeDespite primary conservative therapy for Crohn’s disease, a considerable proportion of patients ultimately needs to undergo surgery. Presumably, due to the increased use of biologics, the number of surgeries might have decreased. This study aimed to delineate current case numbers and trends in surgery in the era of biological therapy for Crohn’s disease.MethodsNationwide standardized hospital discharge data (diagnosis-related groups statistics) from 2010 to 2017 were used. All patients who were admitted as inpatient Crohn’s disease cases in Germany were included. Time-related development of admission numbers, rate of surgery, morbidity, and mortality of inpatient Crohn’s disease cases were analyzed.ResultsA total number of 201,165 Crohn’s disease cases were included. Within the analyzed time period, the total number of hospital admissions increased by 10.6% (n = 23,301 vs. 26,069). While gender and age distribution remained comparable, patients with comorbidities such as stenosis formation (2010: 10.1%, 2017: 13.4%) or malnutrition (2010: 0.8%, 2017: 3.2%) were increasingly admitted. The total number of all analyzed operations for Crohn’s disease increased by 7.5% (2010: n = 1567; 2017: n = 1694). On average, 6.8 ± 0.2% of all inpatient patients received ileocolonic resections. Procedures have increasingly been performed minimally invasive (2010: n = 353; 2017: n = 687). The number of postoperative complications remained low.ConclusionDespite the development of novel immunotherapeutics, the number of patients requiring surgery for Crohn’s disease remains stable. Interestingly, patients have been increasingly hospitalized with stenosis and malnutrition. The trend towards more minimally invasive operations has not relevantly changed the rate of overall complications.