Operative Indications Research Articles

Role of cerebral imaging on diagnosis and management in patients with suspected infective endocarditis.

Cerebral embolic events (CEEs) are common complications of infective endocarditis (IE) and their presence can modify diagnosis and therapeutic plans. The aim of the present study was to assess the role of cerebral imaging (Cer-Im) on diagnosis and management of patients with suspected IE. This study was conducted at the Lausanne University Hospital, Lausanne, Switzerland, from January 2014 to June 2022. CEEs and IE were defined according to modified Duke criteria of the European Society of Cardiology (ESC) guidelines. Among 573 patients with IE suspicion and Cer-Im, 239 (42%) patients had neurological symptoms. At least one CEE was found in 254 (44%) episodes. Based on Cer-Im findings, episodes were reclassified from rejected to possible or from possible to definite IE in 3 (1%) and 25 (4%) patients, respectively (0% and 2% in asymptomatic patients, respectively). Among the 330 patients with possible or definite IE, at least one CEE was found in 187 (57%) episodes. A new surgical indication (in association with left-side vegetation >10mm) was established in 74/330 (22%) IE patients; 30/155 (19%) asymptomatic IE patients, respectively. Cer-Im in asymptomatic patients with IE suspicion showed limited potential for improving the diagnosis of IE. Contrariwise, performing Cer-Im in asymptomatic patients with IE may be useful for decision making, since Cer-Im findings led to the establishment of new operative indication for valvular surgery in one fifth of patients according to ESC guidelines.

Анализ результатов хирургического лечения пациентов с облитерацией слезоотводящих путей вследствие терапии радиоактивным йодом

Relevance. Nasolacrimal duct obstruction occurs in 9% of patients after radioiodine therapy for thyroid cancer. The surgical interventions used in this case have not been studied enough; indications for certain operations have not been developed. Purpose. To evaluate clinical efficacy of surgical treatment in patients with nasolacrimal duct obstruction due to radioactive iodine therapy. Material and methods. The outcomes of 47 surgeries in patients with secondary acquired nasolacrimal duct obstruction due to radioiodine therapy were analyzed, among them 30 cases of dacryocystorinostomy and 17 cases of recanalization of the tear ducts. In 15 cases, dacryocystorinostomy was supplemented by the formation of an anastomosis in the area of the Hasner's valve. A comparative analysis of the effectiveness of surgical intervention depending on the localization of obstruction was carried out. Results. Dacryocystorinostomy was effective in 90% of cases, recanalization of the tear ducts – in 13% of cases. The analysis revealed that in cases of obstruction at the level of the lacrimal sac, the success of dacryocystorinostomy was 100% (5 observations), with obstruction at the level of the middle part of the nasolacrimal duct – 85.7% (12 observations), with obstruction at the level of the Hasner's valve – 100% (6 observations). Recanalization of the tear ducts was characterized by success in 100% of cases (1 observation) with obstruction of the middle part of the nasolacrimal duct and in 6.3% of cases (1 observation) with obstruction at the level of Hasner's valve. Conclusion. Dacryocystorinostomy is an effective intervention in patients with secondary acquired nasolacrimal duct obstruction due to radioiodine therapy. Recanalization of the tear ducts is characterized by low efficiency. The analysis of the effectiveness of these interventions, considering the localization of obstruction of the tear ducts, showed that the effectiveness of surgical treatment may vary depending on the level of obstruction. In cases of anatomically low obstruction of the tear ducts, dacryocystorinostomy was supplemented by the formation of an anastomosis in the area of the Hasner's valve. Recanalization of the tear ducts was characterized by greater efficiency in cases where the level of obstruction of the tear ducts was higher than the Hasner's valve than directly at Hasner's valve. The choice of treatment tactics for patients with secondary acquired nasolacrimal duct obstruction due to radioiodine therapy should be differentiated depending on the localization of the tear duct obstruction. Key words: tear ducts, radioiodine, dacryocystorhinostomy, nasolacrimal duct intubation

Late outcome of coronary artery bypass grafting with or without mitral repair for moderate or moderate-severe ischemic mitral regurgitation.

Operative indication of the additional mitral repair for moderate ischemic mitral regurgitation (MR) in the setting of coronary artery bypass grafting (CABG) is still unclear. This study was designed as the nation-wide multi-center retrospective analysis with additional survival data. CABGs without past heart surgery registered in 2014 and 2015 were included. Concomitant surgery other than tricuspid or arrhythmia surgery, mitral replacement, and off-pump cases, was excluded. Grade 1 or 4 MR, and ejection fraction < 20 or > 50 were excluded. Additional questionnaire was sent to each hospital, regarding the pathology of MR and clinical outcomes. Additional data were registered between May 28, 2021 and Dec 31, 2021, and the primary outcomes were all-death and cardiac death. The secondary outcomes were heart failure and cerebrovascular event requiring admission, mitral re-intervention. Patients underwent on-pump CABG (CABG only group 221 cases) and CABG with mitral repair (CABG + Mitral repair group 276 cases) were enrolled. After Propensity score matching, 362 cases (CABG only 181cases vs CABG + mitral repair 181 cases) were matched. Cox regression model showed no statistical difference in the long-term survival between CABG alone group and combined procedure group (p = 0.52). Cardiac death (p = 1.00), heart failure (p = 0.68), and cerebrovascular event (p -0.80) requiring admission were not different between groups as well. The incidence of mitral re-intervention was very few (2 cases in CABG only group, 4 cases in CABG + mitral repair group). In patients with moderate ischemic MR, additional mitral repair to CABG did not improve long-term survival, freedom from heart failure, or cerebrovascular event.

Declining Rates of Legg-Calvé-Perthes Surgery in the United States: National Trends Using the Kids' Inpatient Database and Pediatric Health Information System.

In 2004 and 2008 two large prospective, multicenter studies were published which resulted in improved understanding of operative indications for the treatment of Legg-Calvé-Perthes disease (LCPD) based on patient age, disease severity, and resultant radiographic outcomes. The primary aim of this study is to evaluate the trends in surgical management of LCPD in the United States prior, and subsequent to, the publication of these landmark studies. Cross-sectional retrospective analysis of US pediatric hospitalizations for the surgical management of LCPD was conducted using the Kids' Inpatient Database from 2000 to 2016. Patients 12 years of age and younger were included who had a primary admission diagnosis of LCPD and a LCPD-related procedure during the hospitalization. Data was subsequently weighted to produce national-level estimates and variables pertaining to patient age group, procedure, demographics, and hospital characteristics were analyzed. In a post hoc analysis, the results of the Kids' Inpatient Database were also corroborated with the Pediatric Health Information System database. A weighted sample of 2786 LCPD surgical admissions met inclusion and exclusion criteria; 11.2% of surgical admissions were patients below 6 years of age, 35.9% were 6 to 8 years of age, and 52.9% were above 8 years of age. There was a significant decrease in admissions for surgical management of LCPD in all age groups over time, however there was no appreciable change in the proportion of LCPD surgical admissions performed among the above 8 to below 12, above 6 to below 8, or below 6 years age groups. Femoral osteotomy remained the most common surgical procedure, while other osteotomy types, including pelvic and unspecified osteotomies involving the hip, decreased over time ( P <0.001). There is a decreasing rate of hospital admissions for LCPD surgery since 2000, perhaps indicating a decline in incidence of disease. Furthermore, despite evidence supporting LCPD surgical outcomes related to patient age, there has been no change in the proportion of patients undergoing surgery by age group over time. Level III-retrospective study.

Analysis of 783 Cases of Total Laparoscopic Hysterectomy for Benign Indications: Experience from a Turkish University Hospital

Background: This study aimed to assess the results of 783 total laparoscopic hysterectomies performed in our clinic for benign reasons. Methods: This study was conducted at a tertiary hospital between January 2017 and December 2020. The results of 783 patients who underwent total laparoscopic hysterectomy for benign indications were evaluated retrospectively, with major and minor complications thoroughly analyzed. Patients’ demographic characteristics were evaluated, including mean age, mean parity, body mass index (BMI), current medical diseases, previous surgeries, hysterectomy indications, operation time, uterus weights, estimated blood loss, and length of hospital stay. The ethics committee of Istanbul Kanuni Sultan Süleyman Training and Research Hospital provided the study’s ethical approval (Approval No. 2021.11.290). SPSS for Windows 24.0 (SPSS Inc., Chicago, IL, USA) was used for statistical analysis, and data were presented as mean, standard deviation, and ratio, with statistical significance set at p &lt; 0.05. Preoperative and postoperative variables were compared using a paired t-test. Results: For the study’s 783 patients, the average age was 50.16 years (range, 33–82), average parity was 3.26 (0–16), and average BMI was 24.37 (21–33) kg/m2. Uterine myoma was the most common reason for hysterectomy in 244 (31.16%) patients, followed by abnormal uterine bleeding in 239 (30.52%) patients. The rate of major complications was 46 (5.8%), and the rate of minor complications was 42 (5.5%). Overall, there were 88 (11.30%) complications. The complication rate and operation indications were comparable to those reported in the literature. Conclusions: Although Laparoscopic hysterectomy is a minimally invasive type of hysterectomy, surgeons should be aware of potential complications during the procedure. Early diagnosis and management of complications reduce morbidity and mortality.

Long-term outcomes and quantitative radiologic analysis of extracranial–intracranial bypass for hemodynamically compromised chronic large artery occlusive disease

This study aimed to demonstrate the effectiveness of nonemergent extracranial-to-intracranial bypass (EIB) in symptomatic chronic large artery atherosclerotic stenosis or occlusive disease (LAA) through quantitative analysis of computed tomography perfusion (CTP) parameters using RAPID software. We retrospectively analyzed 86 patients who underwent nonemergent EIB due to symptomatic chronic LAA. CTP data obtained preoperatively, immediately postoperatively (PostOp0), and 6 months postoperatively (PostOp6M) after EIB were quantitatively analyzed through RAPID software, and their association with intraoperative bypass flow (BF) was assessed. The clinical outcomes, including neurologic state, incidence of recurrent infarction and complications, were also analyzed. The time-to-maximum (Tmax) > 8 s, > 6 s and > 4 s volumes decreased significantly at PostOp0 and up through PostOp6M (preoperative, 5, 51, and 223 ml (median), respectively; PostOp0, 0, 20.25, and 143 ml, respectively; PostOp6M, 0, 7.5, and 148.5 ml, respectively; p < 0.001, p < 0.001, and p < 0.001, respectively). The postoperative improvement in the Tmax > 6 s and > 4 s volumes was significantly correlated with the BF at PostOp0 and PostOp6M (PostOp0, r = 0.367 (p = 0.001) and r = 0.275 (p = 0.015), respectively; PostOp6M r = 0.511 (p < 0.001) and r = 0.391 (p = 0.001), respectively). The incidence of recurrent cerebral infarction was 4.7%, and there were no major complications that produced permanent neurological impairment. Nonemergent EIB under strict operation indications can be a feasible treatment for symptomatic, hemodynamically compromised LAA patients.

Retroperitoneal Liposarcoma: Rational Extent of Surgery Tailored to Grade of Malignancy.

This study was aimed at determining the indications for combined and organ-preserving operations. The study included 190 patients with retroperitoneal liposarcoma (RLPS). The influence of the following factors on the overall survival (OS) and recurrence-free survival (RFS) were studied: involvement of adjacent organs in the tumor, volume of surgical intervention. OS and RFS were worse in pathologically confirmed visceral invasion in the both RLPS low grade and high grade (p = 0.000). In RLPS low grade, there was no significant difference in OS and RFS between the group of patients who underwent combined surgery without confirmed visceral invasion and the group of patients who underwent organ-preserving surgery (p > 0.080). In RLPS high grade, OS and RFS were higher in the group of patients who underwent combined surgery without confirmed visceral invasion than in the group of patients who underwent organ-preserving surgery (p < 0.050). In RLPS low grade, it is advisable to perform organ-preserving operations, including nephrosaving operations. In RLPS high grade, the organ-preserving operations worsen long-term results and prognosis. Combined operations including nephrectomy are justified in RLPS high grade.

FUNCTIONAL OUTCOME OF BILATERAL CEMENTLESS TOTAL HIP ARTHROPLASTY IN DEGENERATIVE ARTHRITIS

Introduction : Bilateral hip degenerative arthritis is a frequent nding in 42% population with osteoarthritis. Unbearable pain restrict daily activities of living to a great extent. Bilateral total hip arthroplasty is an well established reconstructive procedure for advanced arthritis. The objective of this study was to evaluate functional outcome of bilateral cementless total hip arthroplasty using Harris Hip Score. A prospective study conducted in 20 patients with 40 hips w Materials And Methods : ere analyzed for clinical and functional outcome. Age, sex , operative indication and preoperative Harris Hip Score were documented. Operative time and complications were noted. Patients were evaluated immediate post operative period ,3 month and at 6 months . Harris Hip Score , Visual Analogue score , range of movement evaluation was done and documented. Mean preoperative Harris hip score w Results : as 38.6 on left side and 39.3 on right side . This score improved to 88.04 on left and 86.03 on right side immediate post operative period and 94 on left and 93 on right side on 6 month followup. A signicant improvement in Visual analogue score (VAS ) and range of movements were observed in post operative follow up. The outcome after bilateral total hip replacement was excellent in 95% and good in 5% of cases. Current generation of prosthesis used in cement less Conclusion : bilateral total hip arthroplasty for degenerative arthritis of hip, provides satisfactory functional and radiological outcomes . It is an effective and safe procedure and improves the quality of life by relieving pain and improving functional disability

Konservative Behandlung der distalen Radiusfraktur

Distal radius fractures are the third most frequent fractures in Germany. The decision for conservative treatment and the weighing up of surgical treatment need an exact consideration of the indications based on instability criteria and the extent of possible articular involvement. Indications for an emergency operation must be excluded. In cases of stable fractures or multimorbid patients in a poor general condition conservative treatment is indicated. The principles for asuccessful treatment are the precise reduction and stable retention in aplaster splint. In the further course, fractures are closely monitored by biplanar radiography. This is necessary to rule out asecondary displacement until the swelling of the soft tissues has subsided and the plaster splint is changed to acircular cast approximately 11days after the traumatic event. The total duration of immobilization is 4weeks. Physiotherapy and ergotherapy including adjacent joints, starts after 2weeks of treatment. This treatment is extended to the wrist after removal of the circular cast.

Use of WeChat applet in the management of ambulatory surgery.

Dear Editor, Ambulatory surgery has several advantages, such as diminishing the patients’ burden, shortening the hospital stay, improving the bed turnover rate, and reducing the rate of nosocomial infection1,2. However, the accompanying issues are inevitably highlighted in the implementation of ambulatory surgery. First, the lack of effective preoperative education and preparation of patients must be seriously taken into account, as both play a pivotal role in the surgical process and contribute to a higher rate of surgery cancellations3. Moreover, proper management of discharged patients following ambulatory surgery increases the bed turnover rate4. The WeChat applet is a revolutionary yet simple application that does not require download or installation. It improves interpersonal communication between medical surgeons and patients and makes remote management more flexible and convenient. Here, we describe the development of the WeChat applet by the Ambulatory Surgery Center of the First Affiliated Hospital of Anhui Medical University (Fig. 1).Figure 1: Overview of WeChat applet. (A) The users and characteristic functions of the WeChat applet. (B) The procedure of using the WeChat applet before and after surgery.Medical counseling Patients undergoing ambulatory surgery can communicate with their attending physician before and after surgery by using one of three medical counseling methods provided by the applet. In contrast to conventional medical consultation, patients can gain access to their data, communicate with their physician, and send texts or pictures in a timely manner through the applet. Voice calls can be conveniently made through the applet, especially in cases of emergency. In addition to the above methods, the applet allows video calls for consultation on personal and complex issues. Perioperative follow-up By evaluating the patient’s general condition, the anesthesia regimen can be optimized to reduce the risks of adverse events and mortality. Although patients are unable to meet the anaesthesiologist in person, a preliminary assessment via video call through the applet can help the anaesthesiologist to understand the patient’s physical condition better and preliminarily estimate whether the patient meets the requirements of ambulatory surgery. In addition, the rapid discharge of patients following ambulatory surgery increases the difficulty of postoperative follow-up. Through the applet, patients can report their postoperative physical condition on the official follow-up form, which allows surgeons to understand better the patient’s postoperative recovery. Surgery appointment date query The applet allows the patients who meet the operation indications after the surgeon’s evaluation to schedule their ambulatory surgery at their discretion and at any time. Additionally, patients only need to enter their hospitalization number to query the surgery date, which is convenient and fast. The applet uses the cloud server to send automatic reminder notifications to the patients reminding them of their surgery date and preoperative preparation appointment. Another key function of the applet is to allow surgeons to access, display, and manage scheduled ambulatory operation information to optimize their workflow. Perioperative medical science popularization The applet allows regular posts of popular science articles related to ambulatory surgery in order to educate patients on preoperative preparation for and postoperative management following ambulatory surgery. The aim of the function is to improve patient compliance and reduce the nursing workload in the postoperative setting. Because relevant content is easily accessible via the applet, it can be reviewed repeatedly for personal reasons, thus reducing the need for repeated consultations with the surgeon. Remote ward rounds Ward rounds can be challenging because patients must be discharged within 24 h after ambulatory surgery. The applet allows surgeons to conduct ward rounds via video calls with recently discharged patients at a regular time every day, which supports better problem-solving for relevant clinical problems and ensures the safety of patients after discharge. In summary, the WeChat-based applet helps cultivate an interactive relationship between patients, surgeons, and ambulatory surgery center managers. It is a convenient method of communication that is equipped with a variety of practical yet advanced functions that can encourage the use of Connected Health in the future. Thus, we cautiously suggest that it is an advanced and practical application that can be used to benefit more patients. Ethical approval Not applicable. Sources of funding None. Author contribution H.L.: WeChat applet development, visualization, and writing – original draft, review, and editing; X.L.: writing – original draft preparation, reviewing, and editing; Y.L.: conceptualization, visualization, and writing – original draft preparation, reviewing, and editing. Conflicts of interest disclosure The authors declare that they have no conflicts of interest. Research registration unique identifying number (UIN) Name of the registry: not applicable. Unique identifying number or registration ID: not applicable. Hyperlink to your specific registration (must be publicly accessible and will be checked): not applicable. Guarantor Yao Lu. Data availability This communication article does not contain research data, so this item is not applicable.

МУЛЬТИ-ИМПЛАНТАЦИОННАЯ КОНЦЕПЦИЯ ДЕНТАЛЬНОЙ ИМПЛАНТАЦИИ В УСЛОВИЯХ РЕДУЦИРОВАННЫХ АЛЬВЕОЛЯРНЫХ ОТРОСТКОВ КОСТИ ЧЕЛЮСТЕЙ

Older people have special features. With age, the reserve abilities of the body are depleted, the immune and endocrine systems are suppressed, combined pathological conditions develop that require an integrated approach to treatment and force the doctor to prescribe numerous and varied drugs to one patient. Therefore, the doctor must take into account the physiological characteristics of the body in people of the older age group. The consequences of tooth loss have been covered in various works. It is accompanied by atrophy of the jaw bone tissue, which complicates the rehabilitation of the masticatory-speech apparatus using the method of dental implantation. At the same time, foreign and domestic authors confirm that the current level of development of dentistry allows for implant treatment, despite the insufficient amount of jaw bone tissue. In case of insufficient volume of bone tissue, the installation of implants requires the use of additional osteoplastic surgeries (OCS), which allow increasing the volume of the bone to the required level. The preferred bone material is an autoaugmentation from the donor zones of the jaws. Medical practice shows that in people with complete loss of teeth in the upper or lower jaw, adaptation to complete removable dentures is difficult. Discussing this with a dentist, patients often choose implant treatment. The choice of such treatment must be made taking into account the relationship of the masticatory-speech apparatus and the body as a whole. A dental implant cannot be considered as a separate object, it is part of the system “the patient's teeth - the prosthetic part of the implant - the implant - the bone tissue - the mucous membrane - the body" as a whole. One of the current priorities of modern dentistry is dental implantation. Implantology in the dental care of the population has played a significant role over the past decades. Over the past decades, negative trends have emerged in dental implantology: - a simplified idea of the method of implantation and plastics of the alveolar processes of the jaws; - superficial, insufficient examination of patients before treatment; - insufficient professional training of the dentist, dental technician, as well as the patient for implantation; - expansion of indications for osteoplastic and soft tissue operations accompanying the method of dental implantation - inflating prices for dental implantation before treatment and replacing expensive implants with cheap, uncertified ones. All this leads to negative results of dental treatment. The increase in the number of local and general complications in patients is increasing, there is a loss of time at the dentist and the discrediting of the implantation method itself.

Factors affecting the development of complications in Crohn's disease in patients undergoing intestinal resection.

Surgery is a common form of management for Crohn disease (CD) in the presence of intra-abdominal complications. In this study, we investigated the effect of various factors on the development of postoperative complications in patients who underwent surgery for complicated CD. Patients who underwent surgery between 2011 and 2018 were included in this study. Information on age, sex, presence of extraintestinal findings, operation indications, operation type, and postoperative complications was obtained. Groups with and without postoperative complications were compared according to body mass index, American Society of Anesthesiologists score, comorbidities, smoking status, preoperative drug use, presence of perianal disease, presence of a stoma, synchronous small intestine resection surgery, duration of hospital stay, and preoperative biochemical parameters. A total of 192 patients were included, of which 53.1% were female and 46.9% were male. Patients were indicated for surgery for reasons such as stricture, abscess, fistula, and tumor development. As the surgical method, patients were operated on by open or laparoscopic method (86% and 14%, respectively). Postoperative complications occurred in 30 female and 33 male patients (15.6% and 17.1%, respectively). Patient age, smoking status, steroid use, perianal disease, presence of stoma, and presence of extra intestinal findings were significantly higher in the complicated group. Surgery may be inevitable for CD in the presence of complications. In cases of patient age, smoking, steroid use, perianal disease, stoma opening, and presence of extra intestinal findings, patients with CD who undergo surgery should be followed up closely in terms of the development of complications.

Medical student preparation for the operating room

BackgroundThis study examines student perceptions of preparedness for the operating room (OR), resources used, and time spent in preparation. MethodsThird-year medical and second-year physician assistant students across two campuses at a single academic institution were surveyed to assess perceptions of preparedness, time spent in preparation, resources used, and perceived benefits of preparation. Results95 responses (response rate 49%) were received. Students reported being most prepared to discuss operative indications and contraindications (73%), anatomy (86%), and complications (70%), but few felt prepared to discuss operative steps (31%). Students spent a mean of 28 min preparing per case, citing UpToDate and online videos as the most used resources (74%; 73%). On secondary analysis, only the use of an anatomic atlas was weakly correlated with improved preparedness to discuss relevant anatomy (p = 0.005); time spent, number of resources or other specific resources were not associated with increased preparedness. ConclusionStudents felt prepared for the OR, though there is room for improvement and a need for student-oriented preparatory materials. Understanding the deficits in preparation, preference for technology-based resources, and time constraints of current students can be used to inform optimisation for medical student education and resources to prepare for operating room cases.

Elbow Ulnar Collateral Ligament Tears: A Modified Consensus Statement

To establish consensus statements on the treatment of ulnar collateral ligament (UCL) injuries and to investigate whether consensus on these distinct topics could be reached. A modified consensus technique was conducted among 26 elbow surgeons and 3 physical therapists/athletic trainers. Strong consensus was defined as 90% to 99% agreement. Of the 19 total questions and consensus statements 4 achieved unanimous consensus, 13 achieved strong consensus, and 2 did not achieve consensus. There was unanimous agreement that the risk factors include overuse, high velocity, poor mechanics, and previous injury. There was unanimous agreement that advanced imaging in the form of either magnetic resonance imaging or magnetic resonance arthroscopy should be performed in a patient presenting with suspected/known UCL tear that plans to continue to play an overhead sport, or if the imaging study could change the management of the patient. There was unanimous agreement regarding lack of evidence for the use of orthobiologics in the treatment of UCL tears as well as the areas pitchers should focus on when attempting a course of nonoperative management. The statements that reached unanimous agreement for operative management were regarding operative indications and contraindications for UCL tears, prognostic factors that should be taken into consideration in when performing UCL surgery, how to deal with the flexor-pronator mass during UCL surgery, and use of an internal brace with UCL repairs. Statements that reached unanimous agreement for return to sport (RTS) were regarding portions of the physical examination should be considered when determining whether to allow a player to RTS; unclear how velocity, accuracy, and spin rate should be factored into the decision of when players can RTS and sports psychology testing should be used to determine whether a player is ready to RTS. V, expert opinion.

Spine Fractures of Patients with Ankylosing Spondylitis and Diffuse Idiopathic Skeletal Hyperostosis: Fracture Severity and Injury-Related Mortality at a Level I Trauma Center.

Retrospective review of prospectively collected cohort. To identify differences in treatment and mortality of spine fractures in patients with ankylosing conditions of the spine. Ankylosing spondylitis (AS) and diffuse idiopathic skeletal hyperostosis (DISH) are the two most common etiologies of ankylosing spinal disorder (ASD). However, studies on the treatment and outcomes of spine fractures in AS and DISH patients remain few. Patients presenting with a spine fracture were diagnosed with AS or DISH at a single tertiary care center between 2010 and 2019. We excluded those who lacked cross-sectional imaging or fractures occurring at spinal segments affected by ankylosis, as well as polytraumatized patients. Patient demographics, injury mechanism, fracture level, neurologic status, treatment, and 1-year mortality were recorded. Computed tomography imaging was reviewed by two independent readers and graded according to the indicated AO Spine Injury Classification System. Differences in fracture severity, treatment method, and mortality were examined using Student t -tests, chi-square tests, and two-proportion Z-tests with significance set to p <0.05. We identified 167 patients with spine fracture diagnosed with AS or DISH. Patients with AS had more severe fractures and more commonly had surgery than patients with DISH (p <0.001). Despite these differences, 1-year mortality did not significantly differ between AS and DISH patients (p =0.14). Although patients with AS suffered more severe fractures compared to DISH and more frequently underwent surgery for these injuries, outcomes and 1-year mortality did not differ significantly between the two groups. For patients with ASDs and fractures, outcomes appear similar regardless of treatment modality. Consequently, there may be an opportunity for critical reappraisal of operative indications in ASD and a larger role for nonoperative management in these challenging patients.

Neurological, psychiatric and psychosocial consequences of cardiosurgical interventions in the conditions of artificial blood circulation and general approaches to their prevention

Cardiac surgery is a modern, effective, and promising direction of treatment of patients with severe cardiac pathology. An integral component of modern surgical interventions on the heart is artificial blood circulation, which is accompanied by several risks for the patient both during the operation and in the postoperative period. Despite the improvement of the surgical technique and the technological support of sur- gical interventions on the heart, the expansion of the spectrum of indications for operations and the increase in the average age of patients, the frequency of postoperative complications in CPH remains high, and the search for ways to reduce them is an extremely important task of modern medical science and practice. Among the postoperative complications of CVC, a significant place belongs to neurologi- cal disorders cerebral infarction, postoperative encephalopathy, and postoperative cognitive dysfunction. Also, negative clinical-psychopathological and psychosocial consequences occupy a significant place. Current scientific data on the pathogenesis, clinical and phenomenologi- cal features, and ways of treatment and prevention of complications of CHD are incomplete, contra dictory, and require additional research. Based on the above, a conclusion was made about the relevance of a number of important problems regarding the treatment and rehabilitation of patients with neurological consequences of surgical interventions on the heart, which require careful study and further resolution.

Esophageal diverticula: from diagnosis to therapeutic management-narrative review.

Esophageal diverticulum (ED) is a relatively rare condition, characterized by high etio- and pathophysiological versatility, with an uncommon clinical impact, consequently requiring a complete and complex diagnostic evaluation, so that the therapeutic decision is "appropriate" to a specific case. The aim of the paper is, therefore, a reassessment of the diagnostic possibilities underlying the establishment of the therapeutic protocol and the available therapeutic resources, making a review of the literature, and a non-statistical retrospective analysis of cases hospitalized and operated in a tertiary center. Thus, classical investigations (upper digestive endoscopy, barium swallow) need to be correlated with complex, manometric, and imaging evaluations with direct implications in therapeutic management. Moreover, in the absence of a precise etiology, the operative indication needs to be established sparingly, with the imposition of the identification and interception of the pathophysiological mechanisms through the therapeutic gesture. The identification of the pathophysiological mechanisms is mandatory for the management of diverticular disease, the result obtained-restoring swallowing and comfort/good quality of life in the postoperative period-is directly related to the chosen therapeutic procedure. In addition, management appears to be a difficult goal in the context of the low incidence of ED but also of the results that emphasize important differences in the reports in the medical literature. Although ED is a benign condition, surgical techniques are demanding, impacted by significant morbidity and mortality. The causes of these results are multiple: possible localizations anywhere in the esophagus, diverticulum size/volume from a few millimeters to an impressive one, over 10-12 cm, metabolic impact in direct relation to the alteration swallowing, numerous diverticular complications but, perhaps most importantly, alteration of the quality of the diverticular wall by inflammatory phenomena, with an impact on the quality of the suture. The accumulation of cases in a tertiary profile center, with volume/hospital, respectively volume/surgeon + gastroenterologist could be a solution in improving the results. One consequence would be the identification of alternative solutions to open surgical techniques, a series of minimally invasive or endoscopic variants can refine these results.

Suprascapular Nerve Decompression With Rotator Cuff Repair; Indications, and Techniques

Repair of the rotator cuff is a common procedure with a relatively high success rate. Failures do occur for a variety of issues, most related to healing and trauma. Neuropathy may also be a cause of failure of repair, more often related to cervical myelopathy or nerve root compression, but also due to compression, traction, or scarring of the suprascapular nerve at either the suprascapular notch or the spinoglenoid notch. In primary cases, the patient presents with weakness out of proportion to the history and physical examination. In revision cases one may observe progressive atrophy with eventual failure of the repair. Early imaging may show edema in the muscle and inflammation around the suprascapular or spinoglenoid notch, with later imaging showing significant atrophy of the muscle of the supraspinatus and/or infrapinatus. Electromyography should demonstrate evidence of nerve compression or inflammation with changes in the muscle consistent with compromise of the nerve. Operative indications include proper diagnosis, and the suprascapular nerve may be decompressed at both the suprascapular notch and spinoglenoid notch.

A Technical Solution to Solve the Operation Difficulties of Single-Port Laparoscopic Surgical Instruments.

Mutual interference between the instruments and the lens is inevitable because lenses and instruments used in the surgical field are inserted through a small incision. This problem has seriously affected the popularization and application of single-port laparoscopic surgery. The author used a self-developed single incision sealing device, the hard material operation panel supports the lens and equipment so that one can expose the operation field from any angle. The panel helps the assistant to expose and maintain a stable visual field with one hand holding the mirror and the other holding the plier. While the assistant maintains a stable surgical field, the operator can control the instrument from any angle during the main operation. The new approach guarantees the safety of the operation, so the indications for a single-port operation will be promoted. The author presents a method that reduces the difficulty of single-port laparoscopic surgery and a more practical technical solution for the use of surgical instruments during a difficult single-port laparoscopic surgery.

Bipolar Transurethral Resection of the Prostate: Short-Term Outcome Evaluation in Regional Hospital in Senegal

Introduction: Transurethral resection of the prostate is still the most popular procedure that use for the surgical treatment of lower urinary tract symptoms due to benign prostatic obstruction in developed countries. Bipolar transurethral resection of the prostate (B-TURP) is a recent technique in our urological practice. The aim of this study was to evaluate our preliminary results on the use of a B-TURP in Kolda (Senegal) in a benign prostatic hyperplasia (BPH). Materials and Methods: This was a 15-month, retrospective and descriptive study from June 2021 to August 31, 2022. It examined the records of patients who had BPH requiring surgical treatment and who received Bipolar transurethral resection of the prostate (B-TURP) during the study period at the Kolda Regional Hospital in Senegal. We used a Karl STORZ bipolar endoscopy column with a 26 sheath and 30˚ optics. The parameters studied were the civil status of the patients, the clinical and para-clinical data as well as the operative indications. The data were entered and analyzed using Epi-info 3.5.1.1. Results: A total of 31 patients underwent bipolar transurethral resection of the prostate during the study period. The mean age of patients was 68.5 ± 12.6 years (range, 56 - 77 years). The mean total PSA was 4 ± 2.3 ng/ml (range, 0.5 - 11 ng/ml). The mean prostate size assessed by ultrasound was 54 ± 12.3 ml (range, 30 - 90 ml). The operative indication was dominated by BPH with impact on the upper urinary tract. The mean of bladder irrigation time was 21.4 ± 3.9 hours (range, 12 - 26 hours). In the immediate post-operative period, blood transfusions were performed in 2 patients (6.5%). In the medium-term follow-up, we noted one 1 (3.2%) case of urine retention requiring bladder catheterization. Conclusion: Bipolar Transurethral resection of the prostate B-TURP in saline system is efficacious and safe. The results of this preliminary study of B-TURP are satisfactory with a low complication rate. B-TURP decreases the duration of the hospitalization and the port of the probe. Our perspectives are oriented towards endoscopy of the upper urinary tract.