Postoperative Infectious Complications Research Articles

CONCOMITANT IMMUNE THERAPY IN ONCOLOGY PRACTICE

Radiation and polychemotherapy significantly affect the immune system of a cancer patient, unabling to adequately respond to infectious agents and provide effective antitumor protection. Rehabilitation of immune disorders is an urgent task, the solution of which will contribute to the generalization of experience when suing the immune modulators in cancer patients. To summarize the existing data on the use of concomitant immune therapy in antitumor treatment, the reports published within 30 years in Pubmed, Cochrane Library, ScienceDirect and the Vernadsky National Library of Ukraine were analyzed. It is expedient to use immune correction at different stages of antitumor treatment in the case of compliance with certain criteria for the prescribing the immune modulatory drugs. Their use is most justified after the primary tumor removal, even in the presence of metastases, because the increase in antitumor resistance is achieved in the absence of tumor cells in the patient's body or their presence in minimal quantities. Possibilities and goals of concomitant immune therapy in cancer patients should be considered taking into account the stage of treatment. Immune modulators with additional properties (detoxification, antioxidant) can serve as universal drugs. In the early post−surgery period, it is advisable to use the drugs, affecting the cells of the mononuclear phagocyte system for the prevention of postoperative infectious complications. During radiation and chemotherapy, preference should be given to the drugs with antitoxic effects and capable of preventing the leukopenia development. Thus, the prescribing of concomitant immune therapy in the combined treatment of cancer patients is an important task, demanding a balanced approach. Key words: immune therapy, immune modulators, quality of life, cancer patients.

Gut-Barrier Disruption After Laparoscopic Versus Open Major Liver Resection in the Rat

BackgroundMajor liver resection may compromise gut-barrier function, increasing the risk of postoperative infectious complications. The aim of the present experimental study was to compare the effect of the laparoscopic versus the open technique for major liver resection on integrity as well as inflammatory and immune responses of the gut barrier. MethodsWistar rats were subjected to open 70% hepatectomy (group H), laparoscopic 70% hepatectomy (group LH), sham operation (group S) or no intervention (group C). At various timepoints (1 hour–1 week) after operation, ileal tissue was excised for oxidative state assessment (TBARS levels), histopathologic examination, histomorphometric analysis, immunohistochemical assessment of the mitotic and apoptotic activity, and tissue expression of inflammatory (interleukin-6, tumor necrosis factor-α, nuclear factor-κB and vascular cell adhesion molecule-1) and immune response biomarkers (CD4+ and CD8+ T-lymphocytes) of the intestinal mucosa. ResultsNo changes were noted in oxidative state. The histopathologic profile was less deteriorated in group LH compared to group H. Intestinal mucosa atrophy was less intense in group LH compared to group H and was related to an equally compromised crypt cell mitotic activity. Tissue overexpression of interleukin-6, tumor necrosis factor-α, nuclear factor-κΒ, vascular cell adhesion molecule-1, CD4+, and CD8+ T-lymphocytes was less pronounced in group LH compared to group H. ConclusionThe employment of the laparoscopic technique for major liver resection in the rat attenuated disruption of the gut barrier compared to the open procedure. This was related to less pronounced inflammatory and immune responses of the intestinal mucosa.

Composite Inflammatory Indicators as Early Predictor of Intra-abdominal Infections after General Surgery.

ObjectiveTo identify rapid and accurate early diagnostic indicators for intra-abdominal infection (IAI) after general surgery.MethodsWe conducted a retrospective analysis of 3,810 general surgical patients in our hospital from August 2017 to July 2018. The predictive value of PCT, CRP, TNFα, and IL6 on postoperative days (PODs) 1 and 3 and composite indicators for complicated IAIs among surgical patients was clarified.ResultsThere were 271 patients in the infected group and 614 patients in the uninfected group using IAI diagnostic criteria in this study. CRP, PCT, TNFα, and IL6 in the infected group were significantly higher than the uninfected group on POD1 and POD3. In the infected group, the composition of the four indicators on POD1 (AUC 0.819) and POD3 (AUC 0.848) showed higher predictive efficiency than the individual indicators (AUC 0.670–0.805).ConclusionThe composite of CRP, PCT, TNFα, and IL6 can be used as a predictor of postoperative abdominal infectious complications with high sensitivity and specificity on POD1 and POD3, which can provide a basis for early diagnosis of postoperative abdominal infectious complications.

Результаты применения противоспаечного геля после моделирования контузионного повреждения спинного мозга у крыс

Objective was to investigate an effect of anti-adhesion hyaluronic-containing resorbable gel on the course of traumatic spinal cord disease caused by a simulated contusion spinal cord injury (SCI) in rats. Material and methods A moderate spinal cord injury was simulated at the Th9 level of 40 female Wistar rats that were randomly divided into 2 groups. Group I received hyaluronic-containing absorbable antiadhesion gel Antiadgezin® that was intraoperatively applied to the dura mater of experimental rats; Group II of control rats received no gel. The BBB locomotor rating scale was used to evaluate the extent of recovered pelvic limb function. The animals were sacrificed on days 5, 15, 30, 60 and 90. Paraffin and epoxy semi-thin 1 μm sections were used for morphological examination of the spinal cord using light microscopy. Results The gel used for contusion SCI in rats caused neither significant changes during postoperative period nor local infectious and inflammatory complications, and showed no negative impact on functional results. Morphological examination revealed pathomorphological changes that were identical for both groups and characteristic of contusion SCI showing softening, necrosis of the nervous tissue, tissue and cell detritus of gray and white matter, small cysts in the early stages of the experiment; progression of syringomyelia and formation of large cysts primarily seen in the gray matter and the onset of regenerative processes in the white matter at 60 and 90 days of the experiment. Conclusion The absence of a negative effect of the anti-adhesion hyaluronic-containing resorbable gel on the functional results, and morphological characteristics of the spinal cord offer the opportunity of the further experimental use as a carrier of substance composition initiating beneficial metabolic and neuroprotective action for transdural delivery in simulated SCI.

About the possibility of using physiotherapy in the practice of a surgeon. Literature review

Physiotherapy is a field of medicine based on the study and application of natural and artificially created natural factors on the human body. Physical factors can have both local and systemic effects on the patient’s body. In the postoperative period, physiotherapy helps to solve the most important problems, such as accelerating the processes of tissue regeneration and reducing the risk of infection in the area of surgery. Physical factors, activating fibroblasts, accelerate the synthesis of collagen fibers and increase the regenerative capacity of damaged tissues. In addition, due to bacteriostatic and bactericidal action, microorganisms are destroyed and the risk of postoperative infectious complications is reduced. Understanding the key features of all stages of the wound process allows you to rationally affect the wound. The use of an integrated approach based on drug therapy and the use of physiotherapy procedures significantly increases the effectiveness of treatment and helps the patient to return to their usual level of life as soon as possible. This article is a review of the literature on the most commonly used methods of physiotherapy in the postoperative period. Based on the analysis of publications, the article presents the features and principle of operation of such techniques as electrophoresis, phonophoresis, magnetotherapy, ozone therapy, electrical stimulation, cryotherapy, shock wave therapy, galvanization, darsonvalization, as well as therapy based on the effects of ultraviolet radiation, laser, ultrasound, microcurrents. Examples of physiotherapeutic procedures that should be used at various stages of the wound process, depending on the impact, are given. It is the use of various methods of influence in combination with each other that helps to achieve the maximum effect of treatment in the postoperative period.

Comparison of Perioperative Outcomes and Clinical Characteristics of Calcium, Matrix and Struvite Stones From a Single Institution

ObjectiveTo define risk factors and perioperative outcomes for matrix stones and compare these outcomes with struvite and calcium stone cohorts. MethodsA retrospective cohort study comparing matrix stones (n=32), struvite stones (n=23) and a matched, calcium stone control group (n=32) was performed. Two-way ANOVA was used to compare the groups for continuous variables. Chi-square tests were used to compare categorical variables. Significance was set at P <.05. All statistical tests were performed using R (v1.73). ResultsWe identified no differences in age, gender, or BMI between the three groups. Matrix and struvite stones were more likely to have a history of prior stone surgery and recurrent UTIs compared to calcium stones (P=.027 and P <.001, respectively). Struvite stones were more likely to present as staghorn calculi compared to matrix or calcium stones (56.5% vs 21.7% vs 18.8%, P=.006). There were no significant differences in postoperative stone free rates (P=.378). No significant differences in postoperative infectious complications were identified. Matrix stones were more likely to have Candida on stone culture compared to the struvite or calcium stones (P <.0001). ConclusionMatrix and struvite stones were more likely have a history of stone surgery and preoperative recurrent UTIs. Struvite stones were more likely to present as staghorn calculi. Matrix stones were more likely to have Candida present in stone cultures. However, no difference in postoperative infectious outcomes or stone free rates were identified. Further study with larger cohorts is necessary to distinguish matrix stone postoperative outcomes from struvite and calcium stones.

Antimicrobial activity of antiseptics in the prevention of postoperative infectious complications

Recently, among hospital strains of microorganisms, an increase in the number of antiseptic-resistant strains of opportunistic pathogens has been registered, which significantly affects the effectiveness of these drugs. It is important to study their antimicrobial efficacy to justify rational use. The aim is to conduct a comparative study of the antimicrobial efficacy of antiseptics of decamethoxine, chlorhexidine, polyhexanide. During study we examined the antimicrobial activity against 186 clinical strains of microorganisms (Acinetobacter baumannii, Staphylococcus aureus, Pseudomonas aeruginosa, Enterococcus spp., Enterobacter spp.) isolated from patients with infectious complications in the postoperative period. The minimum inhibitory (MIC) and bactericidal concentrations (MBC) of 0.02 % and 0.1 % decamethoxine, 0.05 % chlorhexidine bigluconate, 0.1 % polyhexanide were determined; antimicrobial efficacy of drugs was evaluated by the index of antiseptic activity by conventional methods. The study found high antimicrobial properties of decamethoxine, chlorhexidine, which had a high bactericidal effect on clinical strains of S. aureus, Enterococcus spp., Enterobacter spp. Proved the benefits of antimicrobial activity of the drug based on decamethoxine (p&lt;0.001). The polyhexanide has pronounced antimicrobial properties against A. baumannii, bacteria of the family Enterobactericae, P. aeruginosa. Thus, the leading gram-positive (Staphylococcus aureus, enterococci) and gram-negative pathogens (enterobacteria, acinetobacteria, pseudomonads) are sensitive to polyhexanide, chlorhexidine and the domestic drug decamethoxin, with a probable advantage of the antimicrobial properties of the latter over all gram-positive and most gram-negative microorganisms.

The effects of preoperative intestinal dysbacteriosis on postoperative recovery in colorectal cancer surgery: a prospective cohort study

BackgroundAccumulating evidence suggests a critical role of intestinal dysbacteriosis in surgical site infections and anastomotic leakage after abdominal surgery. However, a direct correlation between pre-existing dysbacteriosis and postoperative infectious complications has not yet been established clinically.MethodsA total of 353 consecutive patients who underwent colorectal cancer (CRC) surgery were enrolled. Gram-stained faecal smears were tested at admission and the first defecation after surgery. Intestinal dysbacteriosis was graded into three groups: normal or slightly decreased intestinal microflora (grade 1), moderate dysbacteriosis (grade 2), and severe dysbacteriosis (grade 3). Clinical outcomes were postoperative infections and anastomotic leakage within 30 days after surgery.ResultsAt the preoperative assessment, 268 (75.9%) patients had normal or slightly decreased intestinal microflora, 58 (16.4%) patients had moderate dysbacteriosis, and 27 (7.6%) patients had severe dysbacteriosis. The patients with preoperative dysbacteriosis had a higher rate of early postoperative diarrhoea (grade 2: OR = 4.53, 95% CI 2.28–9.00, grade 3: OR = 4.52, 95% CI 1.81–11.31), total complications (grade 3 40.7% vs. grade 2 25.9% vs. grade 1 12.7%, P < 0.001), and anastomotic leakage (grade 3 11.1% vs. grade 2 5.2% vs. grade 1 1.5%, P = 0.002). An interaction effect among preoperative dysbacteriosis and early postoperative diarrhoea on total complications was observed in rectal cancer patients (P for interaction = 0.007).ConclusionsAn imbalance of the intestinal microbiome exists in a considerable proportion of CRC patients before surgery. Preoperative dysbacteriosis is associated with higher rates of early postoperative diarrhoea, which further correlates with infectious complications and anastomotic leakage. However, the contribution of preoperative dysbacteriosis to the occurrence of anastomotic leakage needs to be clarified in further studies.Trial registration ChiCTR, ChiCTR1800018755. Registered 8 October 2018—Retrospectively registered, http://www.chictr.org.cn/ChiCTR1800018755.

Pre-operative immunomodulatory nutrition and post-operative outcomes of surgical treatment of gastrointestinal surgery: a systematic review

Malnutrition is a major health problem in cancer evident in up to 80% of patients. It was associated with high mortality and morbidity, especially with surgical treatment of cancer. That is why many studies are investigating efficient treatment for this problem. One of these treatments is immunomodulatory nutrition. Immunomodulatory nutrition has shown efficacy towards malnutrition, immune status, and other comorbidities. However, there is still a debate about whether it is efficient or not. Five databases were searched using specific search terms. We only included randomized controlled trials that studied the efficacy of preoperative immunomodulatory nutrition before surgical treatment of gastrointestinal carcinoma. The studies were assessed for the quality of evidence. Twenty-three studies were included for the systematic review. Most studies had a low risk of bias. We assessed the efficacy of immunomodulatory nutrition regarding immune markers, infectious complications, non-infectious complications, biological markers, the length of stay, and mortality. Immunomodulatory nutrition has significantly enhanced immune status, biological markers, and post-operative complications. However, it does not have a significant improvement in the mortality rate or hospitalization duration. The immunomodulatory nutrition has promising results in enhancing immune status, and biological markers. However, its effect on post-operative infectious and non-infectious complications is still under debate. Immunomodulatory nutrition had no effect on mortality rates among cancer patients.

The prioritation and gap of preoperative COVID-19 vaccination in cancer surgery of the breast, head and neck, and skin: A cohort study of 367 patients in an Indonesian hospital

BackgroundPostoperative infection of Coronavirus Disease 2019 (COVID-19) has been associated with higher risks of mortality and pulmonary complication. Preoperative vaccination could significantly prevent postoperative-related mortality and morbidity particularly for cancer patients. MethodsCancer patients who were scheduled for elective major surgery were questioned for status and their willingness to receive COVID-19 vaccination and were prospectively monitored for the presence of postoperative COVID-19 infection and major complications. ResultsDuring the period of April–July 2021, 367 patients with median age of 49 years were scheduled for cancer surgery. Procedures for breast cancer were the most frequently performed (N = 166, 45.2%). Surgery procedures with potential aerosol generating procedures (AGPs) were performed in total of 104 patients (28.3%). Only 6 of 367 patients (1.6%) were fully vaccinated in the day of surgery and 351 patients (95.6%) were willing to receive COVID-19 vaccination. Fully vaccinated patients were significantly higher among those who were living in urban areas (OR = 22.897, 95%CI:4.022–130.357, P = 0.0001). Willingness to get the COVID-19 vaccination was significantly higher among female patients (OR = 4.661, 95%CI:1.685–12.896, P = 0.003). Postoperative COVID-19 infection was confirmed in 17 patients (4.6%) and major surgical complications were observed in 12 patients (3.3%). None of preoperatively vaccinated patients experienced postoperative COVID-19 infection or the related major complications. ConclusionAlthough prioritizing COVID-19 vaccination in preoperative cancer patients has been recommended to prevent postoperative fatalities, only a small proportion of our patients have been vaccinated. Preoperatively vaccinated patients show advantages in the prevention of postoperative COVID-19 infection and major surgery complications. The slow rollout and disparity in the vaccination progress for patients requiring a major cancer surgery need to be specifically addressed.

RISK FACTORS AND OUTCOMES FOR SEPTIC COMPLICATIONS AFTER LAPAROSCOPIC APPENDECTOMY

Purpose: The aim of the study is to investigate the postoperative infectious complications after laparoscopic appendectomy of patients with acute appendicitis in UMHATEM "N.I.Pirogov". Material and Methods: For a period of one year from 1.1.2018 to 31.12.2018. a total of 218 patients with acute appendicitis were operated in the General, Visceral and Emergency Surgery Department of UMHATEM "Pirogov". Of these, 143 were laparoscopic apendectomy. Indicators characterizing basic clinical and pathological features (epidemiology, demography, degree of pathological disability), surgical approach and outcomes (postoperative complications, duration of the postoperative period) were analyzed. Results: Of the 143 of the patients- women are 79 (55.24%), male -51 (44.76%). The age of the patients varies from 18 to 79 years. The laparoscopy time interval is 21-117min., and in some cases, with a prolonged operation, the conversions are included. The hospital stay ranged from 2 to 8 days. Postoperative complications were recorded in 13 cases (9.09%) - wound infection in nine (treated with VAC dressing), two patients with (0.92%) intra-abdominal abscess (PTC drained) and other 2-with ileus (with conservative treatment). Conclusion: Aggressive manipulations on infected appendix and irregular lavage can spread bacterial contamination. Compliance with standardized laparoscopic appendectomy rules and systematized training of specialists will significantly improve postoperative results.

SP4.1.13 Management of appendicitis during COVID-19 pandemic; short-term outcomes

AimsCOVID-19 pandemic has predisposed patients undergoing surgery to post-operative infection and resultant complications. Appendicitis is frequently managed by appendicectomy. After the onset of the pandemic, selected cases of appendicitis were managed with antibiotics which is a recognised treatment option. Our objective was to compare the management of appendicitis and post-operative outcomes between pre- and post-COVID-19.MethodsNinety-six patients were identified from before the onset of the pandemic (November 2019) to after the onset of the pandemic (May 2020). Data were collected retrospectively from electronic records including demographics, investigations, treatment, duration of inpatient stay, complications, readmissions and compared between pre- and post-COVID-19 groups.ResultsOne hundred percent underwent surgical treatment before the onset of pandemic, compared with 56.3% from the onset of the pandemic. A greater percentage of patients were investigated with imaging post-COVID-19 (100% versus 60.9%; p < 0.00001). There was no significant difference in the outcomes between the two groups.ConclusionCT/MRI scan was preferred to laparoscopy in diagnosing appendicitis and conservative management of uncomplicated appendicitis was common practice after the onset of pandemic. Health boards can adapt their management of surgical conditions during pandemics without adverse short-term consequences. Long term follow-up of this cohort will identify patients suitable for conservative management.

TP7.2.16 Systematic review and meta analysis of pre operative antibiotics and bowel preparation on ileus following colorectal resection

Abstract Aims Pre-operative oral antibiotics (OAB) and mechanical bowel preparation (MBP) may reduce rates of post-operative infectious complications following colorectal surgery but their effects on post-operative ileus (POI) are not well-established. We conducted a systematic review and meta-analysis to address this question. Methods Medline and Embase databases were searched to identify randomised controlled trials and cohort studies comparing pre-operative MBP or OAB to control in patients undergoing elective colorectal resection and reporting the rate of POI as an outcome. Risk ratios were pooled using a random-effects model to generate a summary risk ratio and 95% confidence interval. Results Five randomised trials and three cohort studies were included which reported the effect of pre-operative MBP on POI. Some 29056 patients received MBP compared to 13077 who did not. The rates of POI were 10.0% vs 12.0% respectively. Meta-analysis gave a risk ratio of 0.85 (0.80-0.91, p &amp;lt; 0.0001) for the development of POI with MBP versus control. Four randomised trials and four cohort studies were included which reported the effect of pre-operative OAB on POI. Some 9.5% of 19,903 patients receiving OAB developed POI compared to 11.8% of 23,884 control patients. The pooled risk ratio for the development of POI with OAB compared to control was 0.86 (0.81-0.91, p &amp;lt; 0.0001). However, when limiting analyses to randomised trials alone, neither MBP (RR 1.13, 0.67-1.90) nor OAB 1.01, 0.75-1.35) had a significant effect on the rate of POI. Conclusions Pre-operative MBP or OAB may reduce POI following colorectal resection but this has not been confirmed in randomised trials.

Diode Laser Lithotription Technique Based on Optothermal Converter

Purpose: evaluation of the efficiency of the “hot spot” method for the fragmentation of urinary stones. Materials and methods: A retrospective analysis of clinical records of 1666 patients with urolithiasis who underwent percutaneous nephrolithoextraction/tripsy and contact ureterolithotripsy/extraction in the period from 2014 to 2017 at the urology clinic was performed to assess the incidence of postoperative infectious and inflammatory complications. The research objects were postoperative urinary stones (n-78). The X-ray density and linear dimensions of the stones were determined. Stone fragmentation was performed with a continuous-wave diode laser operating at wavelengths of 0.81 μm, 0.97 μm, and 1.47 μm. An absorbing coating of micro-size graphite powder was applied on the working tip of the optical fiber. In vitro fragmentation was carried out in liquid. Results: A group of patients (224/1666) (13.4 ± 0.86%) was identified, who developed infectious and inflammatory complications after: percutaneous nephrolithotripsy, 123/361 (34.1 ± 2.5%) cases; percutaneous nephrolithoextraction, 59/240 (24.6 ± 2.78%); contact ureterolithotripsy, 23/294 (7.8 ± 1.57%); and ureterolithoextraction, 19/771 (2.5 ± 0.56%). In liquid, the “hot spot” technique made it possible to fragment stones with an X-ray density of up to 1000 HU at a laser wavelength of 0.81 µm, up to 1400 HU at 0.97 µm, and up to 1400 HU at 1.47 µm.

Low Body Mass Index as a Predictive Factor for Postoperative Infectious Complications after Ureterorenoscopic Lithotripsy

Background and Objectives: In this study, we aimed to evaluate predictive factors of postoperative fever (POF) after ureterorenoscopic lithotripsy (URSL). Materials and Methods: A total of 594 consecutive patients who underwent URSL for urinary stone disease at Gifu Municipal Hospital and Chuno Kosei Hospital between April 2016 and January 2021 were enrolled in this study. In all patients, antibiotics were routinely administered intraoperatively and the next day after surgery. We used rigid and/or flexible ureterorenoscopes depending on the stone location for URSL. Stones were fragmented using a holmium: YAG laser. The fragments of the stone were manually removed as much as possible using a stone basket catheter. A ureteral stent was placed at the end of the surgery in all cases. Results: The median age and body mass index (BMI) in all patients were 62 years and 23.8 kg/m2, respectively. The median operation duration was 52 min. The most common URSL-related complication was POF in 28 (4.7%) patients. In these patients, the rates of antibiotic administration and ureteral stent insertion before surgery were significantly higher than in those without POF. In multivariate analysis, BMI was associated with POF after URSL. There were no significant differences in predicting POF after surgery in patients who had bacteriuria or received antibiotics before surgery. Conclusions: A low BMI was significantly associated with POF after URS or URSL.

1395 The Influence of Shortened Antimicrobial Courses in Surgical Management of Mid 1/3rd Facial Fractures

Abstract Aim Antimicrobial resistance (AMR) is an increasing issue posing a grave threat to global public health. A prospective pilot study within our OMFS unit investigated the effects a shortened course of perioperative antimicrobial cover had on infective post-operative complications in patients who had surgical management of mid 1/3rd facial fractures. Method As per the World Health Organisation (WHO) global action plan on antimicrobial resistance, with our microbiology team we developed and implemented a shortened antimicrobial protocol for use in the surgical management of mid 1/3rd facial fractures. Following protocol implementation, the records of 55 patients who underwent surgery for their mid 1/3 facial fractures between May 2019 and May 2020 were reviewed. Results Of 55 patients who underwent surgical management of mid 1/3rd facial fractures 28/55 (50.9%) were prescribed a shortened course of perioperative antimicrobials depending on whether an intra or extra oral surgical approach was used, whilst 27/55 (49.1%) were prescribed a longer course of antimicrobials. Of those given a shortened course of antimicrobials 1/28 (3.6%) experienced infective post-operative complications. Conversely 4/27 (14.8%) of those given a longer course of antibiotics experienced infective post-operative complications. Conclusions This data supports growing evidence that shorter courses of antimicrobials are appropriate in the surgical management of facial fractures. As OMFS surgeons we can utilise evidence-based medicine to provide optimal surgical care whilst simultaneously contributing to healthcare professionals’ obligations to tackle the increasing challenge of antimicrobial resistance.

ОДНОМОМЕНТНОЕ ВЫПОЛНЕНИЕ ЭНДОСКОПИЧЕСКОЙ ВЕНТРИКУЛОЦИСТЕРНОСТОМИИ ДНА III ЖЕЛУДОЧКА, АКВЕДУКТОПЛАСТИКИ, ФЕНЕСТРАЦИИ СУПРАЦЕРЕБЕЛЛЯРНОЙ КИСТЫ ПРИ ОККЛЮЗИОННОЙ ГИДРОЦЕФАЛИИ У РЕБЕНКА ПЕРВОГО МЕСЯЦА ЖИЗНИ

The article presents a clinical case of the simultaneous execution of endoscopic ventriculocisternostomy of the third ventricle floor (ETV), aqueductoplasty, fenestration of the supracerebellar cyst in occlusive hydrocephalus using a semi-rigid needle neuroendoscope. The authors describe a child who, at the age of 1 month, was admitted to Neurosurgical Department No. 1 of the Federal Center for Neurosurgery of the Ministry of Health of the Russian Federation in Tyumen with a diagnosis of congenital internal occlusive hydrocephalus, subcompensated course. MRI scan of the brain: triventricular occlusive asymmetric hydrocephalus is visualized, adhesions in the upper parts of the aqueduct, supracerebellar arachnoid cyst were visualised. ETV, aqueductoplasty, fenestration of the supracerebellar cyst were performed. There were no postoperative neurological, endocrine and infectious complications. The observation period after surgery is 7 years from today. Conclusion: preoperative MRI analysis of the structures of the third ventricular floor, interventricular and prepontine cisterns is important for understanding endoscopic, microsurgical anatomy and surgical planning. The use of modern improved endoscopic instruments, low-traumatic performance of all stages of the operation allow to restore cerebrospinal fluid circulation and achieve high efficiency in the treatment of occlusive hydrocephalus in the long-term period. This, in turn, relieves patients of the shunt-dependent state, constant correction of the dysfunctions of the shunt system and long-term, and often ineffective, treatment performed by neurologists and pediatricians.

Perioperative Antibiotic Use in Endoscopic Endonasal Skull Base Surgery.

Introduction Improved evidence-based guidelines on the optimal type and duration of antibiotics for patients undergoing endoscopic endonasal transsphenoidal surgery (EETS) are needed. We analyze the infectious complications among a large cohort of EETS patients undergoing a standardized regimen of cefazolin for 24 hours, followed by cephalexin for 7 days after surgery (clindamycin if penicillin/cephalosporin allergic). Methods A retrospective review of 132 EETS patients from 2018 to 2020 was conducted. Patient, tumor, and surgical characteristics were collected, along with infection rates. Multivariate logistic regression determined the variable(s) independently associated with infectious outcomes. Results Nearly all patients (99%) received postoperative antibiotics with 78% receiving cefazolin, 17% receiving cephalexin, 3% receiving clindamycin, and 2% receiving other antibiotics. Fifty-three patients (40%) had an intraoperative cerebrospinal fluid (CSF) leak, and three patients (2%) developed a postoperative CSF leak requiring surgical repair. Within 30 days, no patients developed meningitis. Five patients (4%) developed sinusitis, two patients (3%) developed pneumonia, and one patient (1%) developed cellulitis at a peripheral intravenous line. Two patients (2%) developed an allergy to cephalexin, requiring conservative management. After adjustment for comorbidities and operative factors, presence of postoperative infectious complications was independently associated with increased LOS ( β = 3.7 days; p = 0.001). Conclusion Compared with reported findings in the literature, we report low rates of infectious complications and antibiotic intolerance, despite presence of a heavy burden of comorbidities and high intraoperative CSF leak rates among our cohort. These findings support our standardized 7-day perioperative antibiotic regimen.

The Impact of Infectious Complications after Esophagectomy for Esophageal Cancer on Cancer Prognosis and Treatment Strategy.

Despite advances in the perioperative management of esophagectomy, it is still a highly invasive procedure for esophageal cancer and is associated with severe postoperative complications. The two major postoperative infectious complications after esophagectomy are pulmonary complications and anastomotic leakage. We previously reported that postoperative infectious complications after esophagectomy adversely affect long-term survival significantly in a single institution and meta-analysis. Additionally, we reviewed the mechanisms of proinflammatory cytokines, such as C-X-C motif ligand 8 (CXCL8) and its cognate receptor, C-X-C chemokine receptor 2 (CXCR2), in contributing to tumorigenesis and tumor progression. Moreover, we previously reported that introducing minimally invasive esophagectomy, including robot assistance, laparoscopic gastric mobilization, and multidisciplinary team management, significantly reduced postoperative infectious complications after esophagectomy. Further, this review also suggests future treatment strategies for esophageal cancer, considering the adverse effect of postoperative infectious complications after esophagectomy.

Perioperative Use of Glucocorticoids and Intraoperative Hypotension May Affect the Incidence of Postoperative Infection in Patients with Gastric Cancer: A Retrospective Cohort Study.

BackgroundIn patients undergoing surgical resection for gastric cancer, postoperative complications—in particular, postoperative infections—remain an important problem and can result in delayed recovery and increased postoperative mortality.ObjectiveTo investigate the association between perioperative anesthesia management and postoperative infectious complications in patients undergoing resection for gastric cancer.DesignRetrospective cohort study.SettingA single-center study performed from April 1, 2015, to June 30, 2018, at Peking University Cancer Hospital.PatientsPatients who underwent resection for gastric cancer.Main Outcome MeasuresDemographic information, perioperative data (including anesthesia-related data, surgery-related data, and cancer diagnosis), and information on postoperative recovery were recorded. The primary outcome was incidence of postoperative infection; the secondary outcome was length of hospital stay. The associations between perioperative factors and postoperative infectious complications were analyzed using multivariable logistic regression models and the classification tree method.ResultsA total of 880 patients were included in the study; of these, 111 (12.6%) had postoperative infectious complications during hospitalization, including 78 surgical site infections and 62 remote infections. After correction for confounding factors on logistic multivariable analysis, perioperative use of glucocorticoids was associated with a lower incidence of postoperative infection (hazard ratio 0.968, 95% confidence interval 0.939 to 0.997, P=0.029), and intraoperative systolic blood pressure <90 mmHg for >10 min was associated with a higher incidence of postoperative infection (hazard ratio 2.112, 95% confidence interval 1.174 to 3.801, P=0.013). In addition, older age, preoperative hypoproteinemia, and total gastrectomy were identified as independent predictors of postoperative infection.ConclusionFor patients with gastric cancer, perioperative use of glucocorticoids and avoiding intraoperative hypotension may decrease the incidence of postoperative infectious complications.