Postoperative Management Of Patients Research Articles

EMERGENCY SURGERY FOR OBSTRUCTING COLON CANCER: MORBIDITY AND RISK FACTORS OF EARLY POSTOPERATIVE MORTALITY - A COHORT STUDY OF 118 CASES.

Occlusion is the most common complication of colon cancer. Surgical treatment is associated with the highest morbidity and mortality rate (10-27%) and has the worst prognosis. It is necessary for immediate management, avoiding colic perforation and peritonitis. The increase in mortality in emergency colon cancer surgery is multifactorial. The aim of this study was to identify the risk factors for early postoperative mortality that highlights the therapeutic strategy in the management of obstructive colon cancer. A retrospective study was performed on patients admitted from 2008 to 2020 at the Department of General Surgery due to obstructive colon cancer and operated on as an emergency (within 24h of admission). In all, 118 patients with colon cancer were operated, and the early postoperative mortality was 10.2%. The univariate analysis highlighted that the American Society of Anesthesiology score III or IV, perforation tumor, one postoperative complication, and two simultaneous postoperative complications were considered significant risk factors for early postoperative mortality after emergent surgery. Multivariate analysis showed that only tumor perforation and the occurrence of two postoperative complications were significant risk factors. This study showed that postoperative complication is the leading cause of early postoperative mortality after emergency surgery for obstructive colon cancer. Optimizing the postoperative management of these higher risk patients is still necessary and may reduce the mortality rate.

Basic principles of postoperative management of patients with chronic rhinosinusitis

Basic principles of postoperative management of patients with chronic rhinosinusitis

Efficacy of Low Level Laser Therapy in Reducing Pain, Swelling and Trismus Following Impacted Third Molar Extraction Surgery: A Split-mouth Randomised Controlled Trial

Introduction: The use of local or systemic corticosteroids and non steroidal anti-inflammatory drugs are often recommended after surgical extraction of impacted lower third molars to abolish postoperative pain, but some of them may manifest adverse effects such as gastrointestinal irritation, systemic bleeding tendency, and allergic reactions. Aim: To evaluate the efficacy of low level laser therapy in reducing pain, swelling, and trismus following impacted third molar extraction surgery. Materials and Methods: The present split-mouth randomized controlled clinical trial was carried out in the Department of Oral and Maxillofacial Surgery, Yenepoya Dental College, Mangalore, Karnataka, India. The study sample consisted of nine clinically and radiologically confirmed cases of bilateral symmetrical impacted mandibular third molars indicated for extraction. After extraction surgery, low level laser therapy was administered intraorally and extraorally (Low Level Laser Group). On the contralateral side (Non laser Group), extraction was carried out 15 days prior in the same manner except that patient was not subjected to laser therapy. Trismus, pain, swelling and healing were evaluated on 2nd, 3rd, 4th and 7th day; and were subjected to statistical analysis using Independent-t-Test and Mann-Whitney Test. Results: The study consisted of nine patients, among which six were males and three were females with mean age of 25.89±6.79 years. Pain intensity was lower in the laser group than in the non laser group at all-time points assessed and was non significant (p-value >0.05). Swelling when assessed was less for laser group than non laser group at all-time points and were statistically significant (p-value <0.05) except on the 7th day. The extent of mouth opening was greater in the laser group than in the non laser group at all-time points which was statistically significant only on 2nd day (p-value=0.048). Both laser and non laser group had no statistically significant difference in healing (p-value >0.05). Conclusion: The use of therapeutic laser in the postoperative management of patients undergoing surgical removal of impacted third molars decreases postoperative pain, swelling, and trismus.

Minimal Side-effects and Adequate Analgesia in Spinal Anaesthesia: A Randomised Double Blinded Study Comparing Buprenorphine and Clonidine

Introduction: Postoperative patient management includes managing the acute postoperative pain as well as the sideeffects associated with the use of various medications in pain management. Opioids like buprenorphine are excellent in providing analgesia but causes nausea, vomiting among other side-effects. Clonidine is another class of drugs used as an adjuvant but the dose related sympatholytic effect is troublesome to handle. Aim: To evaluate the efficacy buprenorphine (45 μg) and clonidine (22.5 μg) when used in low doses as an adjuvant in spinal anaesthesia and to study the incidence of the most common side-effects. Materials and Methods: The double-blinded randomised clinical study was conducted in the Bangalore Baptist Hospital, Hebbal, Bengaluru, karnataka, India, from January 2014 to October 2014. Hundred patients, aged between 18-55 years, American Society of Anaesthesiologists (ASA) grade I and II, scheduled for lower limb and lower abdominal surgeries were studied. They were divided randomly into two groups i.e, group X and group Y of 50 each. All patients were given 15 mg (3 mL) of 0.5% hyperbaric bupivacaine and along with that the patients in the group X (buprenorphine group) were given 45 μg (0.15 mL) of buprenorphine and the patients in group Y (clonidine group) were given 22.5 μg (0.15 mL) of clonidine. The duration of analgesia, requirement of supplemental analgesics and incidence of sideeffects were noted. Results: The duration of analgesia was found to be longer in the buprenorphine group (448.47±78.08 min) when compared to the clonidine group (311.70±71.92 min). The requirement of supplemental analgesics were, 94% in buprenorphine group required 1-2 doses and 92% in the clonidine group required 3-5 doses of analgesics in the 1st 24 hours, postoperatively. Among the side-effects, 4% of the patients in the buprenorphine group had bradycardia and hypotension, while 6% had nausea and vomiting. In comparison, 18% of patients in the clonidine group had hypotension, nausea (14%), vomiting (12%) and bradycardia (6%). Conclusion: Both buprenorphine and clonidine, in low doses, provide effective postoperative analgesia with minimal sideeffects; while in comparison, buprenorphine has been found to fair better.

Surgeon placed transverse abdominis plane (TAP) blocks as an alternative to thoracic epidurals

To decrease time in the Operating Room (OR) by utilizing intraoperative Transverse Abdominis Plane (TAP) blocks instead of thoracic epidurals for postoperative pain management in patients undergoing laparotomies for suspected gynecologic malignancies.

Histogram analysis of tensor-valued diffusion MRI in meningiomas: Relation to consistency, histological grade and type

BackgroundPreoperative radiological assessment of meningioma characteristics is of value for pre- and post-operative patient management, counselling, and surgical approach. PurposeTo investigate whether tensor-valued diffusion MRI can add to the preoperative prediction of meningioma consistency, grade and type. Materials and methods30 patients with intracranial meningiomas (22 WHO grade I, 8 WHO grade II) underwent MRI prior to surgery. Diffusion MRI was performed with linear and spherical b-tensors with b-values up to 2000 s/mm2. The data were used to estimate mean diffusivity (MD), fractional anisotropy (FA), mean kurtosis (MK) and its components—the anisotropic and isotropic kurtoses (MKA and MKI). Meningioma consistency was estimated for 16 patients during resection based on ultrasonic aspiration intensity, ease of resection with instrumentation or suction. Grade and type were determined by histopathological analysis. The relation between consistency, grade and type and dMRI parameters was analyzed inside the tumor (“whole-tumor”) and within brain tissue in the immediate periphery outside the tumor (“rim”) by histogram analysis. ResultsLower 10th percentiles of MK and MKA in the whole-tumor were associated with firm consistency compared with pooled soft and variable consistency (n = 7 vs 9; U test, p = 0.02 for MKA 10 and p = 0.04 for MK10) and lower 10th percentile of MD with variable against soft and firm (n = 5 vs 11; U test, p = 0.02). Higher standard deviation of MKI in the rim was associated with lower grade (n = 22 vs 8; U test, p = 0.04) and in the MKI maps we observed elevated rim-like structure that could be associated with grade. Higher median MKA and lower median MKI distinguished psammomatous type from other pooled meningioma types (n = 5 vs 25; U test; p = 0.03 for MKA 50 and p = 0.03 and p = 0.04 for MKI 50). ConclusionParameters from tensor-valued dMRI can facilitate prediction of consistency, grade and type.

The impact of implementing a person-centred pain management intervention on resistance to change and organizational culture

BackgroundResistance to change and organizational culture are essential factors to consider in change management in health care settings. Implementation of structural change remains a challenge. There is a lack of studies providing information on the impact of implementation processes on the organization. The aim of this study was to describe the impact of implementing a systematic change process concerning postoperative person-centred pain management on resistance to change and organizational culture in an orthopaedic spine surgery unit.MethodsThe study was set in an orthopaedic spine surgery unit at a university hospital. Person-centred bundles of care for postoperative pain management of spine surgery patients were developed in co-creation by a multi-professional expert group and implemented throughout the care pathway. The intervention was underpinned by theories on organizational culture and inspired by principles of person-centred care. Quantitative data were collected using the Resistance to Change Scale and the Organizational Culture Assessment Instrument and analysed using descriptive statistics.ResultsThe findings showed a low resistance to change decreasing during the study. The organizational culture shifted from a result-oriented to a formalized and structured culture after the implementation. The culture preferred by the staff was team-oriented and participation-focused throughout the study. The discrepancy between the current and preferred cultures remained extensive over time.ConclusionIt is challenging to describe the influence of the development and implementation of a postoperative pain management program on organizational culture as well as in terms of resistance to change, in a complex health care setting. In the current study the unit was under organizational strain during the implementation. Albeit, the important discrepancy between the current and preferred organizational culture could imply that structural changes aren’t enough when implementing person-centred pain management structures and needs to be combined with relational aspects of change.

Analysis of errors and prevention of complications after perosseous osteosynthesis

Distal fractures rank a special place among all fractures of the long tubular bones of the extremities. Complications are an inevitable companion of any surgical intervention, as well as an integral part of the work of every surgeon. Objective: To analyze the outcomes of treatment of distal fractures of the long bones of the extremities, to identify the causes of errors and the frequency of complications after perosseous osteosynthesis, and to outline ways for their prevention. Patients and methods: 1723 patients with distal fractures of the long bones of the extremities and further perosseous osteosynthesis have been under study. Distal fractures of the humerus were registered in 647 patients, those of the femur – in 392, and the bones of the lower leg were damaged in 684. Results: The most common complication of perosseous osteosynthesis is inflammation of the soft tissues near the pins - 21.8%. Non-infectious complications (secondary displacement of fragments, contractures, impaired innervation and trophism) were observed in 18.2% of cases. Residual effects of neuritis of the radial and peroneal nerves amounted to 0.1%. In the long-term period there were 2.1% of the knee and elbow joints contractures. Conclusions: Complications observed in the process of treatment of distal fractures of long bones of the extremities with the use of perosseous osteosynthesis are not inherent this method of treatment, since they are the result of medical errors in the choice of indications for its use, violations of osteosynthesis’ technique and postoperative management of patients, mainly in the period of minimally invasive technology of surgical intervention development.

Predicting Cancer-Specific Survival Among Patients With Prostate Cancer After Radical Prostatectomy Based on the Competing Risk Model: Population-Based Study.

Introduction: We aimed to develop an easy-to-use individual survival prognostication tool based on competing risk analyses to predict the risk of 5-year cancer-specific death after radical prostatectomy for patients with prostate cancer (PCa).Methods: We obtained the data from the Surveillance, Epidemiology, and End Results (SEER) database (2004–2016). The main variables obtained included age at diagnosis, marital status, race, pathological extension, regional lymphonode status, prostate specific antigen level, pathological Gleason Score. In order to reveal the independent prognostic factors. The cumulative incidence function was used as the univariable competing risk analyses and The Fine and Gray's proportional subdistribution hazard approach was used as the multivariable competing risk analyses. With these factors, a nomogram and risk stratification based on the nomogram was established. Concordance index (C-index) and calibration curves were used for validation.Results: A total of 95,812 patients were included and divided into training cohort (n = 67,072) and validation cohort (n = 28,740). Seven independent prognostic factors including age, race, marital status, pathological extension, regional lymphonode status, PSA level, and pathological GS were used to construct the nomogram. In the training cohort, the C-index was 0.828 (%95CI, 0.812–0.844), and the C-index was 0.838 (%95CI, 0.813–0.863) in the validation cohort. The results of the cumulative incidence function showed that the discrimination of risk stratification based on nomogram is better than that of the risk stratification system based on D'Amico risk stratification.Conclusions: We successfully developed the first competing risk nomogram to predict the risk of cancer-specific death after surgery for patients with PCa. It has the potential to help clinicians improve post-operative management of patients.

Societies of Futures Past: Examining the History and Potential of International Society Collaborations in Addressing the Burden of Rheumatic Heart Disease in the Developing World.

This paper explores the role and place of national, regional, and international society collaborations in addressing the major global burden of rheumatic heart disease (RHD). On the same order of HIV, RHD affects over 40 million people worldwide. In this article, we will outline the background and current therapeutic landscape for cardiac surgery in low- and middle-income countries (LMICs) including the resource-constrained settings within which RHD surgery often occurs. This creates numerous challenges to delivering adequate surgical care and post-operative management for RHD patients, and thus provides some context for a growing movement for and applicability of structural heart approaches, innovative valve replacement technologies, and minimally invasive techniques in this setting. Intertwined and building from this context will be the remainder of the paper which elaborates how national, regional, and international societies have collaborated to address rheumatic heart disease in the past (e.g., Drakensberg Declaration, World Heart Federation Working Group on RHD) with a focus on primary and secondary prevention. We then provide the recent history and context of the growing movement for how surgery has become front and center in the discussion of addressing RHD through the passing of the Cape Town Declaration.

Management of Post-operative LASIK Patients Before and After COVID-19: New Treatment Protocols

Management of Post-operative LASIK Patients Before and After COVID-19: New Treatment Protocols

Paralytic stenosis of the larynx

The aim of the study was to evaluate the effectiveness of various types of surgical treatment of patients with bilateral paralytic stenosis of the larynx. Study involved 28 patients aged 18 to 75 years, suffering from paralytic stenosis of the larynx, who was treated at the ENT department of the multidisciplinary clinic of the Tashkent Medical Academy in the period from 2015 to 2020. The results of treatment with the use of laterofixation of the vocal fold, partial excision of the vocal fold in the posterior third and the vocal process of the arytenoid cartilage showed that after the above methods of surgical intervention, recurrence of stenosis occurs in 20-25% of cases, therefore it is necessary to develop tactics of surgical treatment and postoperative management of this category patients.

Еxperience of surgical treatment of malignant heart tumors

Introduction. Malignant neoplasms among all primary heart tumors are 7–10 %. Hospital mortality of this group of patients is very high (20–50 %). The aim: determining the optimal system of diagnostics, differential diagnosis, and also improving the methods of surgical treatment that provide radical and hemodynamic effect of operations, reducing their risk, and also the system of postoperative management of patients with malignant tumors of the heart (MTH), aimed at improving immediate and long-term results of operations. Materials and methods. At the M.M. Amosov National Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine, in the period from 1970 to 01.01.2021 operated on 67 patients with malignant neoplasms of the heart of different types and localization, which amounted to 7.1 % of the total number of patients with heart tumors (976). Among patients with MTH there were 34 female (50.8 %). The age of patients ranged from 12 days to 72 years and averaged (36.5 ± 1.5) years. Results. Of the 67 operations performed, 57 (83.3 %) were performed using artificial bypass circulation, of which 21 (31.9 %) were performed conditionally radical cardiac surgery with good hemodynamic effect. The most radical removal of the tumor was performed in 29 (43.9 %), which required additional surgical manipulations, including atrial septal plastics, atrial walls plastics, repair correction of valve damage, and prosthetic heart valves. The expanded volume of operation has a significant impact on the immediate outcome of surgery. Hospital mortality during surgery was 19.4 % (13 patients). A scheme of detoxification measures was developed and applied at the operative and early postoperative stages, thanks to the use of which it was possible to reduce hospital mortality from 33.3 % (1970–2001) to 5.5 % (last 10 years). Conclusions. The polymorphism of localization and the nature of MHT significantly complicates the diagnostic process, which in most cases leads to late detection and admission of patients to cardiac surgery centers for surgical treatment. It is necessary to use advanced techniques for reconstruction of damaged heart structures to achieve the maximum hemodynamic effect in some cases, as well as detoxification prophylactic measures in both intraoperative and early postoperative period in this cohort of patients, reducing mortality from 33.3 % to 5.5 %. It is necessary to immediately conduct adequate chemotherapy in the early postoperative period to ensure long-term survival of patients with MHT, which will not allow the activation of metastases, what are often the cause of death of patients after tumor removal. Key words: malignant tumors of the heart, surgical treatment, radicalism, detoxification therapy, chemotherapy.

Anatomical Findings of Renal and Urological Abnormalities in Cardiac Catheterization of Children with congenital heart diseases - A Single Center Experience.

ackground and aims: Congenital heart disease (CHD) is described as an abnormality in the heart structure or intra-thoracic great vessels that leads to functional problems. Since most of these disorders require medical and surgical interventions identifying concomitant disorders such as renal and urinary tract abnormalities is of great importance in the management of these patients. The present study aimed to investigate the relative frequency of abnormal kidney and urinary tract findings in abdominal cineangiography during cardiac catheterization of patients with CHD in Shahid Modarres Cardiovascular Medical and Research Center.Methods: The present study was performed prospectively on 545 patients aged < 18 years with CHD who underwent cardiac catheterization and concurrent abdominal cineangiography in Shahid Modarres Cardiovascular, Medical and Research Center, Tehran, Iran during a three-year period. The required data were extracted using a researcher-made questionnaire from patients’ electronic medical files.Results: Of a total of 545 patients in this study, 26 had both CHD and renal or urinary tract malformation. Patent ductus arteriosus was the most common CHD in patients with renal or urinary tract malformations (odds ratio: 1.2, 95%, CI: 2.25–11.63). In this study, the most common renal and urinary malformations among CHD patients was partial duplication of the kidney followed by Ureteropelvic Junction Obstruction.Conclusion: Since the prevalence of renal and urinary tract malformations is higher in CHD patients, performance of concurrent abdominal cineangiography during cardiac catheterization may lead to early diagnosis and treatment as well as better pre- and post-operative management of patients.

Effects of single versus dual antiplatelet therapy on the adverse events after transcatheter aortic valve implantation: A meta-analysis.

Dual antiplatelet therapy (DAPT) was currently recommended for transcatheter aortic valve implantation (TAVI) postoperative management in clinical application. However, POPular‐TAVI trial showed DAPT increased the incidence of adverse events compared to single antiplatelet therapy (SAPT). Herein, we performed a meta‐analysis to investigate the effect of SAPT versus DAPT on the adverse events after TAVI. Eleven studies were available from PubMed, Embase, Cochrane Library, and Web of Science from inception to April 1, 2021. The pooled effect size was presented as relative risk (RR) with 95% confidence intervals (CIs). The sensitivity analysis was used to assess the stability of analysis results, and Begg's test was applied to evaluate the publication bias. The Cochran Q test and the I 2 statistic were used to evaluate the heterogeneity, and the source of heterogeneity was explored by meta‐regression. A total of 4804 patients were obtained, with 2257 in SAPT group and 2547 in DAPT group. Compared to the DAPT, SAPT was associated with the decreased risk of all‐cause bleeding (RR: 0.51, 95% CI: 0.44–0.61), major bleeding (RR: 0.53, 95% CI: 0.32–0.86), and minor bleeding (RR: 0.58, 95% CI: 0.34–0.98). There were no significant differences in mortality and myocardial infarction events, stroke events, and acute kidney injury between the two groups. SAPT was superior to DAPT in decreasing all‐cause bleeding, major bleeding, and minor bleeding, suggesting that SAPT could be preferentially recommended for TAVI postoperative management in most patients without another indication for DAPT and oral anticoagulation.

Preoperative and postoperative predictors of clinical outcome of fenestrated and branched endovascular repair for complex abdominal and thoracoabdominal aortic aneurysms in an Italian multicenter registry

ObjectiveComplex aortic aneurysms (juxtarenal aortic aneurysms [JAAA], pararenal aortic aneurysms [PAAAs], thoracoabdominal aortic aneurysms TAAAs) are treated with increasing frequency through fenestrated and branched endovascular repair (F/B-EVAR); however, the outcome of these procedures is usually reported separately by single experiences and wider overviews are not frequent. The aim of this study was therefore to report an Italian experience analyzing the results obtained in four academic centers to evaluate the predictors of outcomes. MethodsBetween 2008 and 2019, all consecutive patients undergoing F/B-EVAR in four Italian university centers were recorded prospectively and analyzed retrospectively. Preoperative comorbidities and postoperative complications were classified according with the Society for Vascular Surgery reporting standard. Postoperative complications and 30-day/in-hospital mortality were assessed as early outcomes. Survival, freedom from reinterventions and target visceral vessels patency were assessed as follow-up outcomes by Kaplan-Meier analysis. Risk factors for 30-day/in-hospital mortality and spinal cord ischemia (SCI) were determined by multivariate analysis. Risk factors for follow-up mortality and reinterventions were evaluated by Cox regression model. ResultsFive hundred ninety-six patients underwent F/B-EVAR for 124 JAAAs (21%), 121 PAAAs (20%), and 351 TAAAs (59%). Elective and urgent procedures were performed in 520 (87%) and 76 (13%) cases, respectively. Postoperative cardiac, pulmonary, and renal complications were reported in 41 (7%), 50 (8%), and 80 (13%) patients, respectively. Seven bowel ischemia (1%) and 23 cerebrovascular complications (4%) occurred. Forty-seven (8%) patients suffered SCI with 17 cases (3%) of permanent paraplegia. Crawford's extent I-II-III TAAAs (odds ratio [OR], 13.41; 95% confidence interval [CI], 1.77-101.65; P = .012) and postoperative renal complications (OR, 3.84; 95% CI, 1.70-8.69; P = .001) independently predicted SCI. Thirty-two patients (5%) died in the perioperative period. Preoperative chronic renal failure (OR, 7.81; 95% CI, 7.81-26.31; P = .001), postoperative bowel ischemia (OR, 26.97; 95% CI, 3.37-215.5; P = .002), cardiac complications (OR, 5.77; 95% CI, 1.41-23.64; P ≤ .001), cerebrovascular complications (OR, 28.63; 95% CI, 5.20-157.5; P < .001), and SCI (OR, 5.99; 95% CI, 1.12-32.5; P = .036) were independently correlated with 30-day/in-hospital mortality. The mean follow-up was 25 ± 7 months. Freedom from target visceral vessels occlusion and freedom from reintervention were 96% and 92% at 1 year and 93% and 85% at 3 years, respectively. TAAAs (hazard ratio [HR]. 3.16; 95% CI, 1.68-5.92; P ≤ .001), postdissection TAAAs (HR, 2.20; 95% CI, 1.30-4.90; P = .05) and postoperative bowel ischemia (HR, 11.98; 95% CI, 1.53-93.31; P = .018) were independent predictors of reinterventions. Survival was 88% and 78% at 1 and 3 years, respectively. Preoperative chronic renal failure (HR, 2.39; 95% CI, 1.59-3.59; P ≤ .001), urgent repair (HR, 1.80; 95% CI, 1.03-3.20; P = .039), TAAAs (HR, 2.01; 95% CI, 1.13-3.56; P = .017), postoperative bowel ischemia (HR, 5.55; 95% CI, 2.11-14.59; P = .001), cardiac complications (HR, 3.89; 95% CI, 2.25-6.71; P ≤ .001), and pulmonary complications (HR, 1.97; 95% CI, 1.56-3.35; P = .013) were independent predictors of mortality during follow-up. ConclusionsF/B-EVAR is associated with satisfactory midterm outcomes in a nationwide experience. A variety of risk factors should be considered in F/B-EVAR indications and postoperative patient management to decrease the risk of postoperative complications and improve midterm outcomes.

Остеосинтез у разі переломів шийки та вертлюгової зони стегнової кістки в дітей

Proximal femur fractures are uncommon injuries in children, accounting for less than 1 % of all fractures per year, but usually result in hospitalization and are at risk of complications. We have designed a device for bone fragments fixation in the case of proximal femur fractures and the method of its application in adults. The device consists of rods that are screwed into the cap of the head, the diaphyseal part and the module, which is located in the subtrochanter area. The rods can be connected to the module at any angle in the frontal plane. The device provides a certain stage of installation of the elements, which allows you to effectively place it with minimal bone destruction. Objective. Share your own experience in the treatment of femoral neck and proximal femur fractures in children. Material. The experience of treatment of 28 children with femoral neck fracture or proximal femur fractures for the period 2005–2020 is presented, 11 of them were treated conservatively with the skeletal traction. Osteosynthesis by the author’s device was performed in 17 patients: 15 closed reduction, 2 in case of intertrochanteric fracture, — open reduction. The method of osteosynthesis and postoperative management of patients is described in detail. Results. In children who were treated conservatively, the fracture consolidation was achieved within 5–7 months, in one of them — in the position of varus deformity. In contrast to conservative treatment, children began to walk with crutches after a few days after surgery, with partial weight-bearing on injured limb. The device was removed in 16 patients after 5–8 months, and complete fracture consolidation of the fragments in their anatomical position was noted. There were no pathological tissue reactions to the metal device. Conclusions. The proposed device and method of closed osteosynthesis with its usage in the case of proximal femur and femoral neck fractures in children can be recommended in the practice of pediatric traumatology.

Effectiveness of local anesthetic application methods in postoperative pain control in laparoscopic cholecystectomies; a randomised controlled trial

BackgroundLaparoscopic cholecystectomy is a minimally invasive procedure that causes pain originating from parietal and visceral peritoneum. Many studies have been conducted to improve postoperative pain management and comfort of patients. Various methods such as local anesthetic injection (LAI) at trocar access points, intraperitoneal local anesthetic injection (IPLA), pneumoperitoneum pressure reduction, transversus abdominis plane block (TAPB), and reducing the number of trocars used during the operation were attempted to reduce postoperative pain. MethodsIn this study, we compared LAI, TAPB and IPLA methods with the control group in which no local anesthetic was applied to reduce postoperative pain after laparoscopic cholecystectomy. We also demonstrated the effect of these methods on postoperative pain, need for additional analgesics, length of hospitalization, and patient satisfaction. ResultsOverall, 160 patients aged 18–74 years who underwent laparoscopic cholecystectomy for cholelithiasis between October 2018 and August 2019 were included in the study and divided into four groups as follows: LAI group, TAPB group, IPLA group, and the control group without any intervention. Visual Analog Scale (VAS) values at 1, 2, 4, 6, 12, and 24 h in the control group were significantly higher than in the LAI, TAPB, and IPLA groups. Further, VAS values at 1, 2, 4, 6, 12, and 24 h in the IPLA group were significantly higher than in the LAI and TAPB groups. No significant difference was observed between the LAI and TAPB groups in terms of VAS values at 1, 2, 4, 6, and 24 h. VAS values at 12 h in the LAI group were significantly higher than in the TAPB group. ConclusionsPeroperative local anesthetic administration methods were more effective in preventing pain after laparoscopic cholecystectomy compared to the control group. In addition to reducing postoperative pain, these methods reduced the need for postoperative analgesics and increased patient satisfaction.

Open repair of chronic type B aortic dissection

: Open repair of descending thoracic and thoracoabdominal aortic aneurysms in the setting of chronic aortic dissection is a complex procedure that requires a thorough understanding of the physiology of aortic dissection and cardiopulmonary bypass, efficient reperfusion of vital organs and meticulous surgical technique. Open surgery on the descending thoracic or thoracoabdominal aorta is high risk and has been associated with significant morbidity and mortality. Alternatively, endovascular repair of chronic distal aortic dissection using the currently available thoracic endovascular devices is less invasive and can have low mortality. However, reintervention is quite common, the durability of the repair is questionable and aortic remodeling is uncommon in the abdominal aorta. Endovascular repair is not likely to be durable in the young patient with a genetically triggered or familial aortopathy. For these reasons, we believe that open repair of chronic distal aortic dissection is the definitive and durable solution in the appropriately selected patient. We have a greater than 20-year experience using deep hypothermia and circulatory arrest for repair of complex thoracic and thoracoabdominal aortic aneurysms. Morbidity and mortality in our hands using this perfusion technique in chronic distal aortic dissection is comparable to endovascular procedures with rates of mortality 3.6%, permanent neurological deficit 2.6%, permanent requirement for hemodialysis 0% and cerebrovascular accident 1%. The following article describes, in detail, the intraoperative technique and postoperative management of patients who are suitable for descending thoracic or thoracoabdominal aortic aneurysm repair of chronic distal aortic dissection with deep hypothermia and circulatory arrest.

Should intravenous acetaminophen be considered for post craniotomy pain management? A meta-analysis of randomized controlled trials.

Post-craniotomy pain management with opioids is challenging due to their side effects, which might mask neurological deterioration symptoms. Recently, intravenous (IV) acetaminophen has been tested in this population. This meta-analysis aimed to synthesize evidence from published randomized controlled trials (RCTs) about the efficacy of IV acetaminophen in reducing pain scores in postoperative craniotomy patients. A computer literature search of PubMed, Scopus, Web of Science, and Cochrane Central Register of Controlled Trials (CENTRAL) was conducted. We selected RCTs comparing IV acetaminophen versus placebo for postoperative pain management in craniotomy patients. Data on the Visual Analog Scale (VAS), opioid requirements, hospital stay, and patients' satisfaction were extracted and pooled as standardized mean difference (SMD) with the corresponding 95% confidence intervals (CI) in the meta-analysis model. Five RCTs, with a total of 493 patients, were pooled in the final analysis. Patients in the IV acetaminophen group had significantly lower VAS pain scores compared to the placebo group (SMD=-0.28, 95% CI: -0.46 to -0.10). However, in terms of opioid requirement, hospital stay, and patients' satisfaction, there were no statistically significant differences between both groups (P>0.05). This meta-analysis provides class one evidence that IV Acetaminophen can significantly reduce postoperative pain in craniotomy patients with an excellent safety profile; however, there are not benefits in terms of hospital stay, opioid requirement, or patients' satisfaction.