7th Postoperative Day Research Articles

Anaesthetic Management in a Patient with Pituitary Macroadenoma: A Case Report

Pituitary tumours are the second most common intracranial tumours. The anaesthetic management of pituitary tumours requires an in-depth understanding of the principles of neuroanaesthesia and pituitary disorders. Immaculate preanaesthetic evaluation, intraoperative management and postoperative care with interdisciplinary teamwork are essential for successful outcomes in surgeries for pituitary tumours. This case report discusses a 34-year-old female patient presenting for the management of a pituitary macroadenoma, illustrating the anaesthetic challenges faced in such cases. The presence of acromegaly, along with co-morbidities such as hypertension, necessitated a detailed anaesthetic management plan. The patient underwent thorough preanaesthetic evaluation and had a transnasal trans-sphenoidal tumour excision under general anaesthesia, following standard protocols for difficult airway management. The patient was intubated using a video laryngoscope and invasive blood pressure and central venous pressure monitoring were conducted. Following surgery, the patient was transferred to the neurosurgery intensive care unit and was subsequently discharged on the 10th postoperative day

Efficacy of collagen and elastin matrix in the treatment of complex lower extremity wounds

Successful engraftment of skin grafts highly depends on the quality of the wound bed. Good quality of blood vessels near the surface is critical to support the viability of the graft. Ischemic, irradiated scar tissue, bone and tendons will not have the sufficient blood supply. In such situations flaps are to be resorted. However, the flaps also need to have good vascularity over the limbs. The introduction of dermal substitutes has provided a novel method for repairing various severe skin defects. These substitutes act as dermal regenerative templates, which facilitate dermal reconstruction and regeneration. This study was done to ascertain the effectiveness of these substitutes in the treatment of complex wounds. Between January 2022 and June 2023, 20 patients who had complex wounds, which could not be treated with simple skin grafting and who were treated with collagen and elastin matrix and split skin grafting (SSG) were retrospectively studied. The percentage of SSG take as per the records was noted at a 10-day post-operative period. Patient characteristics, comorbidities, duration and outcomes of the treatment were noted. Twenty patients were included in the study. The minimum size of the ulcer was 5 × 4 cm (area of 20 cm2) and the maximum size of the ulcer was 15 × 15 cm (225 cm2). Average take of skin graft was 93.7% at 10th post-operative day. Recurrence at 6 months was nil. The scar quality was assessed by patient and observer at 3 months and 6 months post-operatively. The lower-limb ulcers with compromised surrounding tissue are complex. The major goal in these cases is to do simple surgery and prevent recurrence. The collagen and elastin matrices provide structural support for cellular infiltration, which helps maximize a SSG take and a stable long-term scar.

Incidence of Subdural Hygroma on Routine Early Postoperative Imaging Following Foramen Magnum Decompression for Chiari Malformation Type 1 in 156 Patients

To determine the incidence of subdural hygroma(SDH) on routine early post-operative imaging following foramen magnum decompression(FMD) with dural opening in patients with Chiari 1 malformation (CM1). Clinical and radiological data of 156 consecutive patients with CM1 who underwent FMD (2006-2023) were retrospectively analysed. Computed tomography (CT) scans done on the 7th postoperative day or earlier were reviewed for the presence of SDH (infra-and supratentorial) and ventriculomegaly. There were 96 (61.5%) males. The median age was 29.1 years. 64/156 (41 %) patients had SDH on postoperative CT done at median interval of 7 days (IQR, 5.8-7 days) after surgery. 22/64 (34.4%) patients were symptomatic for SDH, the main symptoms being holocranial headache (n=16), CSF leak (n=5) and acute respiratory distress (n=3). There was significant association between development of ventriculomegaly or worsening of preexisting ventriculomegaly and presence of SDH (p=0.004). The associated ventriculomegaly, present in 7/22 patients with symptomatic SDH, was managed with external ventricular drainage (EVD)(n=2), ventriculoperitoneal shunt (n=3) or widening of FMD and EVD (1)/ventriculo peritoneal shunt (1) (n=2). Two patients with SDH and ventriculomegaly died and 2 were moribund at 3 months after surgery. At median follow up of 12 months, the other 18 patients with symptomatic SDH had symptom resolution. SDH is a common finding in the early post-operative scans of patients undergoing FMD and dural opening for CM1. While nearly two-thirds of these patients are asymptomatic, SDH with ventriculomegaly can be associated with mortality and significant morbidity and may require emergency treatment.

SURGICAL APPROACH TO THALAMIC CAVERNOUS MALFORMATIONS

Introduction Thalamus is a high eloquent brain region, because it contains important relay nucleus and is surrounded by vital neural and vascular structures. Cavernous malformations involving deep structures such as the basal ganglia and thalamus account for 5–10% of all cerebral cavernomas and can cause devastating neurological deficits. Surgical approach to thalamic cavernomas is associated with risks of new or worsening neurologic deficits. The benefit of surgery must be carefully weighed on an individualized basis. There are several surgical routes that can be used to approach thalamic lesions, mainly transcortical and interhemispheric approaches. A particular approach should be selected based on the location of the cavernoma in the thalamus to minimize lesion of the unaffected brain. Methods We present the case of a 43-year-old right-handed lady with right bleeding posterolateral thalamic cavernoma, admitted to the neurosurgery department of Sibiu MedLife Polisano Hospital in February 2024. The patient underwent surgery, through a transcortical trans-sulcal para-fascicular, navigation guided approach. Preoperative tractography imaging, tubular cerebral corridor retractor system and intraoperative monitoring of the cortico-spinal tract, through motor evoked potentials (transcortical, cortical and subcortical mapping) and of the spinotahamic tract through somatosensory evoked potentials were used. The postoperative course was uneventful and the patient was discharged on the 7th postoperative day. Conclusions Thalamus is a complex structure located in a deep brain area and surgery for these region carries high risks, so the surgeon must carefully tailor these patients. The transcortical transsulcal para-fascicular approach is feasible and safe using the cerebral tubular corridor, neuronavigation and neuromonitoring. Advanced surgical technology offers the advantages of minimizing the risks of new neurological deficits.

Surgical Outcome in Retroperitoneal Sarcoma Surgery: Accuracy of P-POSSUM, ACS-NSQIP, and Inflammatory Biomarkers Prognostic Index (IBPI) Risk-Calculators for Prediction of Severe and Overall Morbidity.

Retroperitoneal sarcoma often requires comprehensive resection, leading to severe postoperative morbidity. The lack of disease-procedure specific tools for morbidity risk and the questionable accuracy of existing tools (ACS-NSQIP and P-POSSUM) in RPS surgery drove this study to assess these calculators' accuracy. Retrospective analysis of primary RPS cases undergoing surgery at two sarcoma-referral centers was conducted. Predicted morbidity/mortality rates at 90days postsurgery, classified by Clavien-Dindo (CD) and Comprehensive Complication Index (CCI), were compared with observed data. Accuracy was assessed by Brier Score and area under the curve (AUC). Inflammatory Biomarkers Prognostic Index (IBPI) also was tested. A total of 567 patients (median age 62years; 53.6% male) with a median of four resected organs were included. 59% experienced surgical complications by 90 days postoperation, graded CD ≥ 3 in 30.5%, median CCI 20.9, with a mortality rate of 1.6% (8/567). Reoperation was required in 68 of 567 patients (12%). Thirty-day mortality was 1.1%. Severe complications occurred after 30th postoperative day in 3.5% cases. ACS-NSQIP predicted below-average complication for 65.1%, average for 16.9%, and above-average for 18% of patients. P-POSSUM predicted a 66% rate of morbidity and 4% mortality. None of the prediction tools were accurate, with Brier scores ranging 0.155-0.231 and no AUC ≥ 0.7. IBPI accuracy for predicting severe infective complication was low (AUC 0.58, Brier 0.161). The significant morbidity burden after MVR necessitates reliable evaluation, especially in frail patients. Given the limitations of ACS-NSQIP and P-POSSUM, a dedicated prediction tool for perioperative events in RPS candidates for MVR needs urgent development.

Thrombocytopenia Predicts Poor Prognosis of Liver Transplantation

Background/AimPlatelets not only participate in physiological hemostasis but also play a major role in liver ischemia-reperfusion injury, liver damage, tissue repair, and liver regeneration. A decrease in platelet count can lead to spontaneous bleeding, infection, and other complications that can seriously impact patient prognosis. Thrombocytopenia has been associated with increased complications after partial hepatectomy, although the effects of thrombocytopenia on patient outcomes remain unclear. Therefore, this study aimed to examine the impact of thrombocytopenia on short- and long-term prognosis following liver transplantation (LT). MethodsThis was a retrospective analysis comprising 234 adult liver transplant recipients and conducted from January 2019 to June 2022. Preoperative and postoperative daily platelet counts were recorded up to the 30th postoperative day (POD). We defined people with platelet counts <70 × 109/L as the low platelet group, and people with platelet counts >70 × 109/L as the high platelet group. Multivariate analysis was carried out to determine whether low perioperative platelet count was a risk factor for postoperative complications, graft failure, and patient survival. ResultsOf the 234 patients analyzed in this study, approximately half (n = 112, 47.9%) developed persistent thrombocytopenia after LT. The most substantial decrease in platelet levels occurred on POD7. The cumulative survival rates at 1, 2, and 3 years in the high platelet group were higher than those in the low platelet group, 94%, 87%, and 85%, respectively, while those of the low platelet group were 84%, 78%, and 70% (P = .0014). In addition, the high platelet group had a lower incidence of biliary complications compared with the low platelet group (8% vs 19%, P = .020). At the same time, the high platelet group had a lower incidence of posttransplant lung infection (55% vs 75%, P = .040). ConclusionsThrombocytopenia is a common complication of LT. It indicates the severity of the postoperative course and is closely associated with patient survival. In particular, patients who undergo orthotopic liver transplantation (OLT) and have a platelet count <70 × 109/L on the POD7 have significant negative prognostic implications and should be further investigated.

Mean platelet volume as a prognostic indicator in skin graft viability: A clinical study and retrospective analysis

IntroductionSkin grafting is the transplantation of partial-thickness or full-thickness skin from the donor to the recipient site, aiming to close tissue defects. However, skin graft transplantation surgery is not always successful and graft loss may occur after a while. ObjectiveThis study aimed to investigate mean platelet volume (MPV) as a prognostic criterion in patients who underwent wound reconstruction with skin graft. MethodThis study was cross-sectional and descriptive. The study sample consisted of n = 66 patients who underwent skin grafting for tissue loss. Wound and graft characteristics and some blood parameters were analyzed. Friedman, Kruskal Wallis, and Bonferroni tests were used for data analysis. ResultsThe results of this study showed that MPV levels were higher in complex wounds and graft loss than in the others. MPV level was higher in patients with full-thickness skin grafts than in patients with split-thickness grafts. The mean MPV of patients who underwent multiple grafting was higher than single-shot (p < 0.01). There was a positive, strong and statistically significant correlation between serum PCT and MPV in the preoperative period (r = 0.288, p = 0.041) and between MPV and CRP on the 5th postoperative day (r = 0.294, p = 0.045). ConclusionIn this study, MPV increased with increasing wound and graft complexity. Additionally, multiple grafting was statistically associated with an increase in MPV. There was a strong correlation between MPV and serum PCT and CRP at varying measurement times. These results suggest that MPV has the potential to increase in the presence of inflammation just like CRP and serum PCT.

Evaluating Interleukin-2 and Its Receptors As Indicators of Acute Renal Graft Rejection.

Introduction Interleukin-2 (IL-2) is a cytokine that exerts its actions via binding to a variety of interleukin-2 receptors (IL-2R), thereby stimulating T-cell response. Acute renal graft rejection (AR) is known to be mediated by CD8+ T-cells, through the IL-2 pathway. The aim of this study was to determine whether IL-2 and IL-2R could work as prognostic biomarkers of AR. Methods IL-2, IL-2R and Cystatin-C levels were measured in the serum of 50 patients who underwent a kidney transplant, once pre-operatively and at four different time points post-operatively (second, sixth, 14thday and third month). Of the total number of patients, ultimately 10 (20%) had an episode of AR. Results No statistically significant difference in IL-2 levels was found between those who experienced AR and those who did not, at any of the studied time points. On the other hand, measurement of IL-2R levels on the sixthand 14thday post-operatively showed that people with AR had a statistically significant increase in its value compared to patients who did not have an AR episode (p=0.027 and p=0.019, respectively). In addition, comparing the values ​​of IL-2R with that of Cystatin-C in different time periods, it was found that there is a significant positive linear correlation on the second and sixth postoperative day between the values ​​of the associated parameters (r=0.280, p=0.049 and r=0.372, p=0.008 respectively). Conclusion The measurement of IL-2R from the sixthto 14thpostoperative day could be used as a reliable prognostic biomarker of AR, however additional studies and standardised diagnostic thresholds are required before the routine clinical application is feasible.

Is it necessary to use a sling or abduction pillow sling after superior rotator cuff repair? A preliminary report

Objectives: The study aimed to evaluate the effects of the use of a shoulder sling, shoulder sling with a pillow, or not using a sling on the shoulder functional score and pain levels following arthroscopic rotator cuff tear repair. Patients and methods: This randomized prospective study was performed with 90 patients (49 males, 41 females; mean age: 56.2±12.2 year; range, 33 to 77 years) with a small-to-mid, full-thickness rotator cuff tear between July 2020 and October 2022. All patients underwent arthroscopic double-row repair. The nonsling group wore no sling, the sling group wore a sling, and the abduction pillow sling group wore a sling with an abduction pillow. The same rehabilitation program was performed. The Visual Analog Scale (VAS) score, Constant-Murley scores, and degrees of flexion and abduction were recorded preoperatively, on the 15th and 45th days, and at three months, six months, and one year. Results: On the 15th postoperative day, the VAS score was found to be significantly lower in the nonsling group. On the 45th day, the Constant-Murley score was found to be significantly higher in the abduction pillow sling group. There was no significant difference between the groups regarding the Constant-Murley scores at three weeks, six months, and one year. The shoulder forward flexion angle was significantly lower in the nonsling group on the 45th day. There was no significant difference between the three groups in respect of the shoulder forward flexion at three months, six months, and one year. Conclusion: No difference was determined between the groups at the six-month and one-year functional results. Not using a sling bandage can be recommended by reducing pain in the early postoperative period.

The Development of Postoperative Hydrocephalus following Midline Posterior Cranial Fossa Tumors with Hydrocephalus Surgery with Preoperative Ventriculoperitoneal (V-P) shunt in Pediatric Patients

Background: Posterior cranial fossa tumors are the most common tumors in children and constitute about two-thirds of pediatric brain tumors. Such pediatric patient presents with symptoms and signs of raised intracranial pressure. All pediatric patients were diagnosed with midline posterior cranial fossa tumors with hydrocephalus. The ventriculoperitoneal shunt was done before definitive surgery for all patients. Definitive surgery was done later on. These patients were followed up to the 7th postoperative day following definitive surgery. We assessed the development of postoperative hydrocephalus. Objectives: The objective of the study was to assess the development of postoperative hydrocephalus of midline posterior cranial fossa tumors with hydrocephalus after definitive surgery following ventriculoperitoneal (V-P) shunt in pediatric patients. Methods: This cross-sectional experimental study was conducted in the Department of Neurosurgery, Bangabandhu Sheikh Mujib Medical University, and the Department of Pediatrics Neurosurgery, National Institute of Neurosciences &amp; Hospital, Dhaka from March 2018 to September 2019. A total of 43 pediatric patients were included in this study. All pediatric patients were diagnosed with midline posterior cranial fossa tumors with hydrocephalus. The ventriculoperitoneal shunt was done before definitive surgery. Later on, definitive surgery was performed. Follow-up of these patients was done up to the 7th postoperative day. The development of postoperative hydrocephalus was observed. Data were processed and then analyzed. Demographic data were expressed in numbers and percentages. The development of postoperative hydrocephalus was expressed in number and percentage. Logistic regression was done to predict the relationship between the dependent variable (development of hydrocephalus) and independent variables (age, sex, and the extent of tumor removal). The odds ratio (OR) was calculated by using the Chi-square test. The chi-square test gave a Wald statistic by observing at the 95% CI of the odds ratio. Statistical significance was set to p-value &lt;0.05. Results: A total of 43 pediatric patients were included in the study from March 2018 to September 2019. In the study, the maximum patients were in the age group 11-15 years. The mean age of the patients was 8.25 years ± 4.14. The male-to-female ratio was 1.26:1. The study showed preoperative clinical features which includes headache 40 (93%), vomiting 37 (86%), visual disturbance 24 (55.8%), altered level of consciousness 3 (7.0%), gait disturbance 30 (69.8%), swallowing disturbance 9 (20.9%), papilledema 38 (88.4%), lower cranial nerves palsy 8 (18.6%). Among them, 25 patients developed postoperative complications after definitive surgery. Development of postoperative hydrocephalus was found in 2 (4.65%) patients. Logistic regression was found to be statistically non-significant in this study. Conclusion: The development of postoperative hydrocephalus of midline posterior cranial fossa tumors with hydrocephalus after definitive surgery following ventriculoperitoneal (V-P) shunt in pediatric patients was not the major complication among others. Bang. J Neurosurgery 2024; 13(2): 86-95

A case-series study of hepatic left lateral segment inversion for surgical field exposure in laparoscopic gastrectomy

PurposeRetraction of the hepatic left lateral segment (HLLS) is a crucial maneuver for surgical field exposure during laparoscopic gastrectomy with systematic lymphadenectomy. Though various methods of retraction are available, there is no perfect solution. Here, we report the results of our initial 42 cases with HLLS inversion method and discuss the feasibility, safety, effectiveness and technical aspects of this method.MethodsThe intraoperative and postoperative short-term outcomes of 42 patients who underwent HLLS inversion during laparoscopic total gastrectomy and proximal gastrectomy in our department September, 2023 to January, 2024 were reviewed. HLLS inversion was performed by mobilizing the HLLS and inverting it to the right supra-hepatic space through an incision at the falciform ligament.Results42 patients underwent HLLS inversion successfully with an average time of 13.9 min. 7 patients needed re-inversion due to slipping back of the HLLS during operation. Optimal exposure of the surgical field was achieved in all patients. No intra-operative complications occurred, except for 1 patient presented with mild intraoperative hepatic hemorrhage requiring electrocoagulation for hemostasis. Alanine aminotransferase and glutamine aminotransferase elevated in some patients on postoperative day 1(POD1), but declined to preoperative levels on the 7th postoperative day. There were no Clavien-Dindo II grade or higher digestive complications after surgery. In 5 patients with preservation the hepatic branch of the vagus nerve, the contractile function of the gall bladder was intact or slightly impaired 2 weeks after operation.ConclusionFor laparoscopic proximal gastrectomy (LPG) and laparoscopic total gastrectomy (LTG), HLLS inversion is a feasible method for optimizing visualization of the surgical field with preservation of the function of the hepatic branch of the vagus nerve. It is safe and acceptable as to the manipulation time. Re-inversion is easy and effective even in case of failure of inversion. HLLS inversion seems to be a promising technique for retraction of the liver during laparoscopic gastrectomy.

EVALUATION OF POSTOPERATİVE MORBİDİTY FOLLOWİNG OPERATIONS OF IMPACTED MANDIBULAR THIRD MOLARS WITH BONE RETENTION

This study is aimed to see how gender and whether tooth is placed on the right or left affected the length of the operation, edema, trismus, and discomfort after surgical extraction of an impacted mandibular third molar. This prospective study was conducted in the Inonu University. The study included 104 mandibular wisdom tooth with bone retention. There were 55 females and 49 males among the 104 patients, with 53 left and 51 right impacted mandibular third molar. The operations were performed by the same surgeon in the same operating room. The time between the incision and the suture was determined and recorded as the operation time for each procedure. Before surgery, on the 2nd postoperative day, and on the 7th postoperative day, the patients were compared in terms of facial swelling impacted mandibular third molar, discomfort, and trismus. IBM SPSS V23 was used to evaluate the data. The left impacted mandibular third molar extraction takes longer than the right impacted mandibular third molar extraction. Tooth 38, which have a longer operation time, are more prone to swelling, discomfort, and trismus. When tooths are extracted, right-handed surgeons cause less postoperative morbidity 48. We recommend that both right-handed, left-handed surgeons operate in clinics that conduct impacted tooth extractions.

Higher erythrocytes in cerebrospinal fluid on the first and seventh postoperative day: Associated with poor outcome in aneurysmal subarachnoid hemorrhage patients.

Aneurysmal subarachnoid hemorrhage is an acute cerebrovascular disease with high disability and mortality. We intended to explore the association between levels of erythrocytes in cerebrospinal fluid at different times of hemorrhage and the outcome of patients. One retrospective study including 216 patients with aneurysmal subarachnoid hemorrhage undergoing surgeries in the First Affiliated Hospital of Yangtze University from January 2020 to July 2023 was carried. The univariable analysis and multivariable logistic regression analysis were used for factors associated with poor outcome. The level of erythrocytes in cerebrospinal fluid on the 1st postoperative day in patients with poor outcome was 311 × 103/µL, significantly higher than patients with good outcome (108 × 103/µL), P < .001. The level of erythrocytes in cerebrospinal fluid on 7th postoperative day was 86.5 × 103/µL, also significantly higher than patients with good outcome (26.0 × 103/µL). The multivariable logistic regression analysis results showed that erythrocytes in cerebrospinal fluid on the 1st postoperative day (≥177 × 103/µL) and on the 7th postoperative day (≥53.5 × 103/µL) were possibly associated with poor outcome in aneurysmal subarachnoid hemorrhage patients. Treatment with tranexamic acid and continuous lumbar drainage did not result in a decrease of erythrocytes in cerebrospinal fluid. Higher erythrocytes in cerebrospinal fluid on the 1st and 7th postoperative days were associated with poor outcome in aneurysmal subarachnoid hemorrhage patients.

DIFFUSE PUNCTATE DEPOSITS ON THE SURFACE OF HYDROPHILIC ACRYLIC INTRAOCULAR LENSES EARLY POSTOPERATIVELY: CASE SERIES AND LABORATORIAL ANALYSES

Purpose: To describe cases of hydrophilic acrylic intraocular lenses (IOLs) (Eyecryl, Biotech) exhibiting surface punctate deposits early postoperatively, and provide laboratorial analyses of unused lenses of the same model. Setting: Altino Ventura Foundation (FAV), Recife, Brazil, and John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA. Design: Observational, descriptive, clinical study with laboratorial analysis. Methods: A thorough review of records of patients undergoing phacoemulsification with Eyecryl implantation in December 2022 at FAV was performed, with data collection. Five Eyecryl IOLs (never implanted/unused) were removed from the original package and underwent gross examination, light microscopy, and ultrastructural analyses using scanning electron microscopy/energy dispersive X-ray spectroscopy (SEM/EDS). Results: Details on 5 clinical cases exhibiting surface IOL deposits on the first postoperative day after uneventful surgery, and followed for at least 6 months were included. The deposits disappeared by the 60th postoperative day. No inflammatory or toxic reactions were noted, visual outcomes were favorable, and IOL explantation was not necessary. Three of the 5 unused lenses undergoing laboratorial analyses revealed diffuse, star-like shaped deposits that could not be removed by thorough irrigation with distilled water. SEM/EDS revealed a composition of the deposits that primarily consisted of carbon and oxygen. Conclusion: Laboratorial findings suggest the etiology of the deposits might be related to the manufacturing/packaging process of lenses from specific lots. While the deposits did not appear to be associated with inflammatory or toxic reactions in the clinical cases, further investigations are necessary to elucidate their precise origin.

Systemic iodine levels increase with povidone-iodine irrigation, but does this affect thyroid functions? A case-control study.

Intraoperative irrigation with diluted povidone iodine (PI) can be used to reduce the incidence of infection-related complications in arthroplasty surgeries. Since PI is associated with many interventions, especially skin antisepsis, its systemic effects are being studied. The aim of our study is to evaluate the systemic effects of PI, which we use as an irrigation solution, by means of urine iodine and thyroid function tests. In this case-control study, 96 patients who underwent knee or hip arthroplasty were included and divided into two groups according to the irrigation solution. In the first group, PI was added to the standard irrigation. The second group was considered as the control group and only standard irrigation was applied. Urine iodine, thyroid stimulating hormone, free T3 and free T4 values were compared in the preoperative and postoperative periods of these two groups. In this way, the effect of absorbed iodine on thyroid functions was investigated. In the diluted PI group, urinary iodine levels were measured at maximum levels (450µg/L) in the early postoperative period in most of the patients. The statistically significant difference in urinary iodine levels between the PI group and the control group, which started in the early postoperative period, continued until the last follow-up on the 14th postoperative day. In terms of thyroid functions, the observed differences were not statistically significant. Studies to reduce periprosthetic infection show that PI can be preferred for irrigation before the closure of the joint area in total joint arthroplasty. Although the success of this treatment in periprosthetic infection has been investigated, its systemic examination has not been demonstrated. It was determined that PI treatment, which was seen to decrease in the systemic circulation within 14 days, did not show a statistically significant change in terms of thyroid functions when used at the determined concentration and duration. These results should be evaluated with larger and longer-term studies. Clinical trials ID no. NCT05599841.

The association of pre-operative biomarkers of endothelial dysfunction with the risk of post-operative neurocognitive disorders: results fromthe BioCog study.

Endothelial dysfunction (ED) promotes the development of atherosclerosis, and studies suggest an association with age-related neurocognitive disorders. It is currently unclear whether ED is also associated with the risk of perioperative neurocognitive disorders. We included 788 participants aged ≥ 65 years of the BioCog study. Patients were scheduled to undergo elective surgery with expected duration > 60 min. Blood was collected before surgery for measurement of 5 biomarkers of ED: asymmetric and symmetric dimethylarginine (ADMA; SDMA), intercellular and vascular adhesion molecule (ICAM-1, VCAM-1), and von Willebrand factor (vWF). Patients were monitored for the occurrence of postoperative delirium (POD) daily until the 7th postoperative day. 537 (68.1%) patients returned for a 3-month follow-up. Post-operative cognitive dysfunction (POCD) was defined from the change in results on a battery of 6 neuropsychological tests between baseline and 3 months, compared to the change in results of a control group during the 3-month interval. The associations of each of the 5 ED biomarkers with POD and POCD respectively were determined using multiple logistic regression analyses with adjustment for age, sex, surgery type, pre-morbid IQ, body mass index,hypertension, diabetes,HbA1C, triglyceride, total and HDL cholesterol. 19.8% of 788 patients developed POD; 10.1% of 537 patientshad POCDat 3 months. Concentrations of ED biomarkers were not significantly associated with a POD. A higher VCAM-1 concentration was associated with a reduced POCD risk (adjustedodds ratio 0.55; 95% CI: 0.35-0.86). No further statistically significant results were found. Pre-operative concentrations of ED biomarkers werenot associated with POD risk. We unexpectedly found higher VCAM-1 to be associated with a reduced POCD risk. Further studies are needed to evaluate these findings.

Impact of Dipyrone Administration on Postoperative Analgesia and Aspirin Effect in Patients Undergoing Coronary Artery Bypass Grafting: The Prospective Randomized DipASA Study

ObjectiveThe aim of the study was to investigate the impact of dipyrone administration on postoperative analgesia and acetylsalicylic acid (ASA) effect in patients undergoing coronary artery bypass grafting (CABG). DesignA prospective randomized study. SettingSingle-university hospital setting. ParticipantsNinety-eight patients who underwent CABG between April 2022 and May 2023. InterventionsASA effect were measured at six time points with impedance aggregometry (Multiplate) and thromboelastography (TEG6sPlateletMapping). Patients were randomized to one of three groups: intravenous ASA and dipyrone at the same time (group 1), intravenous ASA and dipyrone with a 2-hour delay (group 2), and intravenous ASA alone (group 3). Postoperative analgesic effects (numeric rating scale, NRS) and the prevalence of potential ASA non-response (defined as ASPI>40U and TEG-ASA-inhibition<50%) were recorded. Measurements and Main Results80 of 90 analyzed patients took ASA preoperatively. All patients received intravenous ASA 100mg from postoperative day 1. The effect of ASA did not significantly differ between the study groups at any time for either platelet function test. NRS values did not differ between the study groups at any time (p=0.469). Patients in group 3 received significantly more additional co-analgesics than patients who received dipyrone (p=0.005). ASA non-response was detected in 38.9% and 67.8% on 7th postoperative day, respectively. ConclusionsDipyrone given after CABG seems to be safe and did not show any significant effect on platelet inhibition after ASA administration. Patients taking dipyrone postoperatively need significantly less additional co-analgesics. The ASA effect on platelet function should be checked at least once after surgery.

Incidence of Subclinical Venous Thromboembolism after Pulmonary Resection for Lung Cancer

Abstract Background Deep venous thrombosis DVT, in post-surgical patients, is more common in lung cancer patients undergoing resection. The combination of malignancy, surgical trauma, chemotherapy, and smoking are all synergistic factors raising the risk. Most of the patients developing post-operative DVT are subclinical and asymptomatic. Subclinical DVT means presence of thrombus in deep veins of lower limb without any signs and symptoms. DVT can be prevented more successfully in its subclinical phase than that in its clinical phase. Aim The present study was undertaken to estimate the occurrence and associated risk factors of subclinical deep vein thrombosis at our institute after lung resection for lung cancer patients in the elective and urgent setting. Methods This is a prospective study of 150 patients who underwent different types of lung resection for lung cancer. Patients younger than 18 years old, symptoms of lower limb DVT and pregnant patients were excluded. Caprini risk score was assessed in all patients. All patients received prophylactic stockings and anticoagulant. On the 5th postoperative day, a duplex venous ultrasound of bilateral lower limbs was performed in every asymptomatic patient to look for presence of thrombus in the deep veins. Results Out of 150 patients enrolled in the study, we completed the study on 147 patients. According to the results of Doppler US, the patients were divided into 2 groups: group 1 (n = 143) post-lung resection and no DVT. Group 2 (n = 4) with post-lung resection subclinical DVT. 4 patients (2.721%) developed subclinical deep vein thrombosis. No patient developed postoperative clinical DVT. Incidence was maximum in the group with longer ICU stay (P-value = 0.04.). Among the various pathologies, incidence was more in patients who received preoperative chemotherapy (P-value = 0.001). One patient (25%) died in the group who developed subclinical DVT while no mortality was observed in the No DVT group. Conclusion It can be concluded that incidence of subclinical deep vein thrombosis is low in the post operative period among the patients undergoing lung resection for lung cancer. However, patients of old age, those with preoperative chemotherapy and those with longer periods of immobilization are at a higher risk to develop postoperative DVT despite anticoagulant prophylaxis. It might be justified to screen these high-risk groups to detect subclinical DVT to allow for post discharge prophylaxis.

Evaluation of the Outcomes of Primary Closure after Open Common Bile Duct Exploration for Common Bile Duct Stones

Abstract Background The incidence of CBD stone develops in about 10–15% of patients with gall bladder stones and encountered in approximately 7–15% of patients undergoing cholecystectomy. It is common to be treated by endoscopic retrograde cholangiopancreatography (ERCP) with endoscopic sphincterotomy (EST), however in cases who has large or multiple CBD stone or difficult to be cleared by ERCP. Aim of the Work To evaluate of the outcomes of primary closure after open common bile duct exploration for removal of common bile duct stones. Methods This descriptive prospective randomized clinical controlled trial was conducted on 30 patients at Hepatobiliary Pancreatic Department (HBP) - Faculty of Medicine – Ain Shams University from January 2022 until March 2023. Primary closure was performed after removal of CBD stones with follow up for 6 months. Results Operative time ranged from 1.3 to 3 hours with mean 2.03 and ± SD 0.48 hours. Biliary leakage was estimated 13.3% of the candidates (4 cases). One of the 30 patients developed CBD stricture. Total and direct bilirubin levels were statistically significant decrease in T and direct bilirubin in follow up “1st 5 days and post-operative 10th day”. Conclusion The primary closure after open common bile duct exploration for removal of common bile duct stones is a safe, effective and time saving procedure.

Outcomes of Retro Colic Retro Pyloric Roux En Y Hepaticojejunostomy In Biliary Reconstruction

OBJECTIVES To assess the effectiveness of retro pyloric Roux-En-Y Hepaticojejunostomy in cases of choledochal cysts and bile duct injuries to reduce complications, such as delayed gastric emptying and acute cholangitis. METHODOLOGY This retrospective cohort study was conducted in the surgical C unit of Hayatabad Medical Complex, Peshawar (January 2019 - December 2022). This study included 37 patients treated for bile duct injuries and choledochal cysts. All patients had an ASA III or above, aged 5 to 36 years. Amongst the 35 patients, 21 patients underwent surgery for choledochal cysts, while 14 patients were treated for bile duct injuries. Patients with type 1choledochal cysts were admitted through OPD after getting diagnosed by ultrasound abdomen and, in some cases, MRCP. RESULTSOut of 36 patients, 23 (63.71%) presented with type I choledochal cysts, while 14 (40%) exhibited bile duct injuries (BDI). Among the 14 BDI cases, 57.14% underwent open cholecystectomy, 42.85% underwent laparoscopic cholecystectomy, and 5.71% received immediate repair during the primary surgery. Conversely, 8.57% of patients with CBD ligation underwent exploration on the 3rd postoperative day upon early detection of the injury. Among the patients diagnosed with BDI after the 7th postoperative day, 25.71% underwent delayed repair at three months. Postoperatively, patients were authorized for fluid consumption within 24-48 hours. Moreover, 4 (11.42%) patients developed a fever of approximately 100°F, managed with intravenous Paracetamol in 2 (5.71%) cases. Patients also presented with subsequent wound infections, which were treated on an outpatient basis through oral antibiotics and wound dressing. CONCLUSION The Retropyloric Roux-en-Y hepaticojejunostomy is a modified biliary reconstruction procedure with minimal morbidity and better outcomes than traditional methods. It reduces complications like delayed gastric emptying and acute cholangitis. We recommend its frequent use for biliary reconstruction when appropriate.