Postoperative Parameters Research Articles

Single-incision laparoscopic hepaticojejunostomy with selective ductoplasty for type IV-A Choledochal cysts in children: a retrospective study.

Type IV-A choledochal cyst (CDC) has been considered to have a poor prognosis due to the high incidence of postoperative anastomotic strictures and intrahepatic stones. This study aimed to evaluate the surgical outcomes of children with type IV-A CDC and to provide insights for clinical diagnosis and treatment. The study retrospectively analyzed patients from June 2015 to December 2018 at our center, 76 children were diagnosed with type IV-A CDC. All patients underwent single-incision laparoscopic choledochal cyst excision and Roux-en-Y hepaticojejunostomy. The decision to perform ductoplasty was made by comprehensively considering the intrahepatic duct dilatation (IHDD) and stricture. All patients were followed up 1, 3, and 6 months postoperatively, and then every 1 year thereafter. Patients were categorized into two groups based on IHDD changes postoperatively: the long-term group (LTG), with IHDD persisting for over a year, and the short-term group (STG), where IHDD normalized within a year. Single/multiple factor logistic regression was used to analyse the factors influencing postoperative IHDD. The median follow-up period was 80 months, with a range from 64 to 101 months. The decrease in postoperative liver function parameters, compared to preoperative levels, was statistically significant. Two patients (2.63%) developed bile leaks. One patient (1.32%) developed anastomotic stricture. All patients' IHDD returned to normal size. Fifty-six (73.7%) patients showed normalization of IHDD within one-year postoperatively. The median recovery time for IHDD in patients was 1.65 months, ranging from 3 days to 74 months postoperatively. There were significant differences in intrahepatic biliary sludge and stones and maximum diameter of IHDD between STG and LTG. Logistic regression was used to analyse the factors and found that intrahepatic biliary sludge and a wider maximum diameter of IHDD were risk factors for postoperative long-term IHDD in patients. Single-incision laparoscopic hepaticojejunostomy with selective ductoplasty are safe and effective for children with Type IV-A CDC. Long-term follow-up is recommended for children presenting with intrahepatic biliary sludge and larger IHDD.

Outcomes and complications of cataract surgery using phacoemulsification in eyes with and without pseudo exfoliation syndrome

Cataract remains a significant cause of visual impairment globally, with pseudo exfoliation syndrome (PEX) posing additional challenges for cataract surgery. This study aimed to compare outcomes and complications in patients with and without PEX undergoing phacoemulsification for senile cataract. A total of 70 patients were divided into two groups: PEX (Group 1) and non-PEX (Group 2). Surgical procedures were performed, and outcomes were evaluated. Group 1 exhibited smaller pupil diameter and higher rates of advanced cataracts and intraoperative complications. Despite similar postoperative parameters, Group 1 showed increased inflammatory response and poorer initial visual recovery. Tailored management strategies for PEX patients undergoing cataract surgery are warranted.

Analysis of intraocular lens tilt and decentration after cataract surgery in eyes with high myopia using the anterior segment optical coherence tomography.

This retrospective study investigated the degree of intraocular lens (IOL) tilt and decentration after cataract surgery in eyes with varying degrees of myopia using the anterior segment optical coherence tomography (AS-OCT). Eyes of 76 patients were analyzed and divided into three groups: mild myopia (emmetropia to - 1.5 diopter [D], Group 1), moderate myopia (- 1.5 D to - 6.0 D, Group 2), and high myopia (over - 6.0 D, Group 3). Postoperative IOL decentration, tilt, and lens diameter were evaluated using swept-source AS-OCT under mesopic conditions without dilation eyedrop. Postoperative parameters revealed no difference in IOL tilt, but IOL decentration was significantly different among the groups, and the degree of decentration was greater in Group 3 (P = 0.007). Univariable regression analysis indicated that age, sex, preoperative uncorrected distant visual acuity, corrected distant visual acuity, intraocular pressure, spherical equivalent, preoperative anterior chamber depth and lens thickness had no influence on postoperative IOL decentration, but axial length (AL) was significantly related to IOL decentration (P = 0.001). This association was confirmed using multivariable regression analysis, establishing a significant correlation between AL and IOL decentration (P = 0.001) on AS-OCT, showing an increase in IOL decentration associated with increasing AL.

Correlation of preoperative CT features with intra- and postoperative parameters of endoscopic resection in patients with gastric submucosal tumor (1~3cm).

Endoscopic resection of gastric submucosal tumors (SMTs) possesses minimal trauma, expedited recovery, and reduced costs. Nonetheless, intraoperative challenges, including imprecise surgical risk assessment, prevail. Hence, we investigated the correlation between preoperative CT observation features and perioperative parameters for predicting outcomes in SMT patients. Subjects diagnosed with SMT and undergoing endoscopic surgery conducted at West China Hospital's Endoscopy Center from September 2019 to October 2023 were retrospectively selected. Endoscopic ultrasonography (EUS) and computer tomography (CT) were utilized for evaluating SMT. The study assessed the correlation between preoperative CT findings and perioperative parameters. Increased lesion size on contrast-enhanced CT correlates with increased operative duration, hospital stay, postoperative antibiotic use. Of utmost significance, we observed a significantly higher intraoperative perforation rate for patients with tumor outgrowth compared to those with lesion involvement of the lumen (96.88% vs 29.11%, P < 0.001). These patients also demonstrated an increased risk of postoperative blood stream infections (P = 0.012), necessitating higher antibiotic grade (P = 0.048), along with prolonged gastrostomy tube retention (P = 0.001) and hospitalization (P = 0.018). In addition, CT provides a more accurate and comprehensive assessment of tumor size (P = 0.037) and growth pattern (P = 0.026) than EUS. CT assessment of tumor size closer to reality than EUS. Importantly, these features can assist in pinpointing lesions with elevated surgical complexity and high risk of complications, leading to improved preoperative preparation, thereby increasing anticipation of surgical risks and reducing incidence of complications.

Posterior lenticule laser scan influence the ultra-early postoperative visual acuity and quality of SMILE

This is a prospective case-control study investigated the factors influencing ultra-early visual acuity and quality after Small Incision Lenticule Extraction (SMILE) surgery, with a specific focus on the morphology and distribution of “black clefts” observed in posterior lenticule laser scanning images. A total of 174 patients who underwent SMILE surgery were included, and their preoperative ocular clinical parameters, visual quality indicators, and posterior lenticule laser scanning images were analyzed. The morphological features of black clefts were calculated using image processing techniques. Univariate and multivariate logistic analyses were conducted to identify factors impacting ultra-early visual acuity recovery, while correlation analysis was used to explore the association between black cleft morphology and postoperative visual quality. The results showed that although patients experienced significant visual acuity improvement one day after surgery, 26% had poor early recovery. Postoperative visual quality parameters were significantly lower, while the Object Scatter Index (OSI) was higher compared to preoperative values. Patients with poor visual recovery had a higher number of irregular black clefts in their laser scanning images. Logistic regression analysis revealed that intraoperative morphological parameters of black clefts were independent factors influencing early postoperative visual acuity recovery. Additionally, correlation analysis demonstrated a negative correlation between black cleft morphology and postoperative visual quality parameters, and a positive correlation with OSI. In conclusion, the morphology and distribution of black clefts during SMILE surgery significantly affect ultra-early postoperative visual acuity and quality, with increased variability in black cleft area leading to higher OSI, thereby impacting visual quality recovery.

Multifidus Degeneration: The Key Imaging Predictor of Adjacent Segment Disease.

Retrospective cohort study. To identify imaging predictors on pre- and perioperative imaging that are associated with a future revision surgery for adjacent segment disease (ASD) following lumbar fusion. Patients undergoing open posterior lumbar fusion between 2014-2022 were followed-up for >2-year. The initial MRI was evaluated for disc degeneration by Pfirrmann (grade 1-5); Modic changes (0-3); as well as fatty infiltration and functional cross-sectional area (fCSA) of the multifidus, erector spinae, and psoas. Spinopelvic alignment was measured pre- and postoperatively. Of 216 patients, 14.8% (n = 32) required revision surgery for ASD in the further course. There were no significant differences in Modic changes or Pfirrmann grades between the ASD group and controls. Fatty infiltration was significantly higher in the ASD group for both the erector spinae (40.5% vs 36.9%, P = 0.043) and multifidus muscles (61.0% vs 53.9%, P = 0.003). Additionally, the multifidus fCSA was smaller in patients who developed ASD (5.7cm2 vs 6.7cm2). Pre- and postoperative spinopelvic parameters were not significantly different between groups, and no other MRI measurements showed a significant difference. In a multivariable logistic regression model adjusting for age and sex, multifidus fatty infiltration emerged as the only significant predictor of ASD revision surgery (P = 0.004). Patients with more than 58% multifidus fatty infiltration had over double the risk of developing ASD (OR 2.7, 95% CI: 1.1-6.5, P = 0.032). Multifidus fatty infiltration is the key imaging predictor for the development of ASD requiring surgical revision. Disc degeneration and spinopelvic alignment appear to have less impact.

Long-term effect of postoperative radioactive iodine therapy on parathyroid function in patients with differentiated thyroid cancer.

The study aimed to assess the impact of postoperative radioactive iodine (RAI) therapy on parathyroid function in patients who underwent total or subtotal thyroidectomy for differentiated thyroid cancer (DTC). Data from 150 patients treated with RAI for DTC and 76 patients with low-risk DTC not receiving RAI were retrospectively analyzed. Clinical characteristics, preoperative and 1-month postoperative biochemical parameters, and adjusted calcium, phosphorus, parathyroid hormone (PTH), and 25-hydroxyvitamin D3 (25-OH-D) levels at 3months, 1year, 3years, and 5years post-RAI (or in the low-risk group) were recorded. A total of 226 DTC patients were included in the study (80.5% female, mean age 42.7 ± 13.2years). Total thyroidectomy was performed in 97.3% (n = 220) of patients, with central lymph node dissection (CLND) in 41.6% (n = 94). No significant preoperative differences in PTH, aCa, P, Mg, or 25-hydroxyvitamin D3 levels were observed. However, patients receiving ≥ 3.7GBq (or 100mCi) RAI (n = 70) had lower calcium and PTH levels at the end of the first year following RAI treatment (p = 0.048, p = 0.032). The non-RAI group showed significantly higher calcium levels at one month postoperatively (p = 0.031) and lower rates of CLND and neck dissection. No significant differences in biochemical parameters were found at the five-year follow-up, except for one patient who developed normocalcemic hyperparathyroidism after RAI. High-dose RAI therapy may lead to transient decreases in calcium and PTH levels in the early post-treatment period. However, long-term parathyroid function appears to remain unaffected in DTC patients, regardless of the RAI dose administered. Nonetheless, close monitoring of calcium and PTH levels is recommended, particularly in the early post-treatment period, to promptly manage any potential transient hypoparathyroidism.

Prognosis of lower urinary tract symptoms and function after robot-assisted radical prostatectomy in patients with preoperative low bladder contractility: A prospective, observational study.

To examine the prognosis of lower urinary tract symptoms and function after robot-assisted radical prostatectomy (RARP) in patients with low preoperative bladder contractility. A total of 115 patients who underwent RARP were enrolled and divided into two groups by preoperative urodynamic findings: normal (patients with bladder contractility index [BCI] ≥ 100; n = 70) and low contractility (patients with BCI < 100; n = 45) groups. Lower urinary tract symptoms and function parameters were prospectively evaluated at 1, 3, 6, 9, and 12 months after RARP in both groups. International Prostatic Symptom Score voiding scores 1, 3, 6, 9, and 12 months after RARP were significantly higher (p < 0.05), and the maximum flow rate (Qmax) values before and 1, 3, 9, and 12 months after RARP were significantly lower in the low contractility group (p < 0.05). Comparing preoperative and postoperative parameters, IPSS voiding scores in the normal contractility group were significantly improved from 6 months after RARP, whereas those in the low contractility group were almost unchanged. Qmax and the 1-h pad test in both groups temporarily deteriorated 1 month after RARP, whereas voided volume and postvoiding residual volume significantly decreased from 1 to 12 months after RARP. This observational study showed that patients with low preoperative bladder contractility might have a weak improvement in voiding symptoms and function after RARP.

Comparison of Diagnostic Accuracies of Commonly Used Trial of Void Parameters.

Understanding the diagnostic accuracy of postoperative trial of void (TOV) parameters is important for decision making related to postoperative catheterization. The aim of the study was to compare the diagnostic accuracies of common postoperative TOV parameters. The study population comprised a prospective cohort undergoing outpatient urogynecologic procedures at a tertiary referral center from September 2018 to June 2021. Participants recorded their postvoid residual volume (PVR), voided volume, and subjective force of stream (sFOS) for all postoperative voids until meeting criteria to stop. The primary outcome was the sensitivity of TOV parameters in predicting postoperative urinary retention, defined as PVR ≥1/2 voided volume on the first 2 postoperative voids. Sample size was set at 183 to detect a 20% difference (α = 0.05, β = 0.2, up to 20% with missing data) in sensitivity between TOV parameters. Diagnostic accuracies were compared with McNemar's test for paired proportions, with Youden's index calculated to determine optimal thresholds. The 160 participants had a mean age of 52.1 ± 11.4 years and a mean body mass index of 28.9 ± 5.8 kg/m2 (calculated as weight in kilograms divided by height in meters squared). Mean preoperative PVR was 25.8 ± 29.9 mL. Most participants had surgery that included a midurethral sling (137/160, 85.6%). Thirty-four (34/160, 21.3%) participants met criteria for postoperative urinary retention. The optimal recovery room TOV thresholds to predict postoperative urinary retention were PVR ≥87 mL (sensitivity 96.8%, specificity 60.0%), voided volume ≤ 150 mL (sensitivity 83.9%, specificity 72.3%), and sFOS ≤60% (sensitivity 100%, specificity 50.8%). Voided volume ≤ 150 mL had greater diagnostic accuracy than PVR ≥100 mL (156.2 vs 151.8). In this cohort, PVR ≥87 mL, voided volume ≤ 150 mL, and sFOS ≤60% had optimal diagnostic accuracy for postoperative urinary retention.

Improved clinical and radiographic outcomes with expandable cages in transforaminal lumbar interbody fusion: a propensity-matched cohort analysis.

The restoration of sufficient overall lumbar lordosis (LL) and segmental LL (SL) is associated with achieving optimal sagittal balance, decreasing back pain, and enhancing functional outcomes for patients. Expandable cages were developed in hopes of improving radiographic parameters and clinical outcomes, although current clinical evidence is inconclusive. Here, the authors aimed to evaluate the clinical and radiographic outcomes in patients undergoing one- or two-level open transforaminal lumbar interbody fusion (TLIF) with expandable versus static cage placement, using propensity-matched cohorts. An institutional retrospective cohort of patients who underwent one- or two-level open TLIF with either expandable cage or static cage placement was identified. Using relevant preoperative covariates, including age, primary versus revision operation, number of cages implanted, and surgical level implanted, the authors built propensity-matched cohorts. They identified clinical outcomes in both cohorts, including operative characteristics and complication rates, along with pain, weakness, and sensory deficits over follow-up. Furthermore, they extracted and examined preoperative, postoperative, and last follow-up radiographic parameters. A total of 148 patients were included, and they were followed for a mean of 1.7 years (range 0.5-4.3 years). Propensity matching was used to create cohorts of patients who were similar with respect to age, surgical indication, revision status, number of cages implanted, surgical level implanted, and length of follow-up. Patients in both groups had similar preoperative radiographic parameters. Patients with expandable cages saw larger increases in SL, both postoperatively (5.3° ± 7.5° vs 1.6° ± 5.6°, p = 0.006) and at last follow-up (5.7° ± 7.4° vs 1.0° ± 6.1°, p = 0.003). They also saw significant improvements in pelvic incidence minus LL mismatch at last follow-up (-4.4° ± 13.2° vs 5.8° ± 13.8°, p = 0.009). No differences in intraoperative or perioperative complications were found, but patients with expandable cages were less likely to require readmission, develop adjacent-segment disease, or require revision surgery. They were also more likely to be symptom free at 1 month after surgery and at last follow-up. Expandable cages lead to better restoration of radiographic features, including SL and improvements in clinical outcomes, compared with static cages in propensity-matched cohorts in patients undergoing one- or two-level open TLIFs.

Effect of Belin-Ambrósio deviation index on 2-year refractive outcomes of PRK.

To assess the effect of preoperative Belin-Ambrósio deviation (BAD-D) index on 2-year visual, refractive, and tomographic outcomes, as well as the efficacy and safety of photorefractive keratectomy (PRK) surgery. Eye clinic, Mashhad, Iran. Prospective cohort study. This study included 66 patients (66 eyes) who underwent PRK surgery, with a minimum follow-up period of 2 years. Participants were divided into 2 groups: preoperative BAD-D ≥1.60 (high BAD-D) and preoperative BAD-D <1.60 (low BAD-D). Preoperative and postoperative visual, refractive, and tomographic parameters were evaluated, and the efficacy and safety of the procedure were compared between groups. 66 patients with a mean age of 35.50 ± 8.21 years (range 22 to 55 years) were included. Postoperatively, the mean spherical equivalent (SE) of refractive error was +0.32 ± 0.65 diopters (D) in the high BAD-D group and +0.18 ± 0.66 D in the low BAD-D group ( P = .40). In addition, at 2 years of follow-up, the mean uncorrected distance visual acuity was 0.98 ± 0.07 in the high BAD-D group and 0.97 ± 0.08 in the low BAD-D group ( P = .905). Among the postoperative tomographic parameters, front elevation thickness, maximum Ambrósio relational thickness, astigmatism, and central corneal thickness were significantly different between the 2 groups (all, P < .05). At the 2-year follow-up, the mean Safety Index was 1.02 ± 0.04, and 1.01 ± 0.04 in high and low BAD-D groups, respectively ( P = .37), and the mean Efficacy Index was 0.99 ± 0.07 and 0.98 ± 0.06 in high and low BAD-D groups, respectively ( P = .40). The preoperative BAD-D index does not predict postoperative visual, refractive, and tomographic outcomes in patients with low-to-moderate myopia. However, in patients with normal preoperative BAD-D values, higher agreement was expected between the attempted and achieved SE.

Assessment of post-pyeloplasty renal drainage in antenatally detected hydronephrosis by 99mTc-L, L-Ethylenedicysteine renal scintigraphy: the importance of delayed imaging.

Diuretic renal scintigraphy is important in diagnosing pelvi-ureteric junction obstruction (PUJO) in antenatally detected hydronephrotic (ANH) kidneys. Early-phase dynamic renal scintigraphy has several pitfalls contributing to the false interpretation of obstructed drainage, especially after pyeloplasty. This study explores the utility of delayed imaging in 99mTc-L,L-Ethylenedicysteine (EC) diuretic renal scintigraphy to assess post-pyeloplasty renal drainage in ANH. Data from May 2019 to January 2024 was retrospectively studied to identify infants with ANH who underwent surgery for PUJO and pre-and post-surgical assessment of renal drainage using 99mTc-L,L-EC diuretic renal scintigraphy. Dynamic and post-void static images were analyzed to calculate percentage drainage till 3h. Pre- and post-operative quantitative parameters were compared. Receiver operator curve analysis was done to calculate the threshold drainage to detect renal obstruction on postvoid images. In a cohort of 104 patients with a mean age of 10.1 ± 6.5months (range 2-36months) at surgery, 106 renal units (bilateral involvement in two patients) were analyzed. There was no significant difference in the sum of obstructive and equivocal curve patterns (105 vs 79, p = 0.06) and T1/2 values (105 vs 82, p = 0.093) before and after surgery. However, there was a significant difference between the pre-and post-surgery median 3-h percentage drainage (26 vs 80%, p < 0.001). A drainage threshold of less than 59% at 3h had 93.4% sensitivity and 92.5% specificity to detect obstructive drainage. Delayed images in diuretic renal scintigraphy are crucial in accurately interpreting post-pyeloplasty drainage patterns and help overcome pitfalls of the dynamic study.

Comparison of Awake Craniotomy with Craniotomy Under General Anesthesia for Resection of Tumors in Eloquent Areas of Brain

Objective: To compare awake craniotomy with craniotomy under general anesthesia for early post-operative parameters in patients undergoing resection of tumors in eloquent areas of brain. Study Design: Quasi experimental study. Place and Duration of Study: Department of Anesthesia, Combined Military Hospital, Rawalpindi Pakistan Apr 2021 to May 2022. Methodology: All the patients who underwent resection surgeries for brain tumors in eloquent areas of brain were included in the study. They were divided into two Groups via lottery method. Group A underwent awake craniotomy while Group B underwent craniotomy under general anesthesia. Relevant intraoperative and early post-operative parameters were compared in both the Groups. Results: A total of 60 patients who underwent resection of eloquent area brain tumors in our hospital during the study period were included in the final analysis. Out of these 40(66.7%) underwent craniotomy under general anesthesia while 20(33.3%) underwent awake craniotomies. Mean age of the study participants was 45.61±7.889 years. Frontal lobe tumors were the most encountered brain tumors in our study participants. Patients who underwent awake craniotomy had statistically significantly lower KORNAFSKY score, lesser days of post-operative admission days and lesser neurological deficits (p-value &lt;0.005) as compared to those who underwent craniotomy under general anesthesia. Conclusion: Awake craniotomy emerged as superior option as compared to craniotomy under general anesthesia in terms of early post-operative parameters. Lower KORNAFSKY score, lesser days of post-operative admission days and lesser neurological deficits were seen in patients undergoing awake craniotomy.

Aortic Stent Graft Treatment in a Medium-Size Aortic Center Performed by a Cardiac Surgeon Only-The 9 Years Experience in Poland.

Background: The incidence of thoracic aortic aneurysms is estimated at 3.0-8.3/100,000 persons per year. There is a lack of reports in the literature on the outcomes of small- and medium-sized thoracic endovascular aortic repairs. The aim of this study is to present the results of thoracic endovascular aortic repairs at a single medium-sized center performed exclusively by a cardiac surgeon. Methods: Ninety patients who had undergone aortic stent graft implantations for the treatment of thoracic aortic anomalies were comprehensively, retrospectively evaluated. The detailed preoperative, surgical, and postoperative parameters of the patients, including the survival rate up to five years, were recorded and further analyzed. Results: The patients' Euroscores were four (2.1-9). The 30-day mortality rate was 8.9%, the 1-year mortality rate was 15.6%, and the 5-year mortality rate was 38.9% for all causes. Postoperative complications were observed in 10% of the patients. Statistically significant differences were observed between the urgency of surgery at 30 days and survival at one year, but not at five years. The most common complications were related to respiratory (4.4%), renal (3.3%), and neurological (3.3%) dysfunction. Conclusions: Thoracic endovascular aortic repair can be safely performed in small- and medium-sized centers with optimal long-term results.

PIRCHE-II: a new tool to predict rejection in cardiac transplantation?

Abstract Aim This retrospective observational study aims to compare patients diagnosed with antibody-mediated or cell-mediated rejection with patients without episodes of rejection and study any predictors of rejection at follow-up with particular attention to PIRCHE-II scores. Materials and Methods We performed a retrospective evaluation of prospectively collected data of heart transplant patients from January 2022 to August 2023, at a single hospital. Preoperative, intraoperative and postoperative parameters are collected anonymously in our institutional database used for internal quality control. The primary endpoint was the incidence of rejection in one of three control endomyocardial biopsies. As pre-operative data, age, sex, BSA, blood group mismatch, risk such as dyslipidemia, hypertension, diabetes, peripheral vascular disease, COPD, previous cardiac surgery, PRA, ischemia time and post-operative infections. We evaluated patients at a mean follow-up of 106 (78 – 180) days. In patients who tested positive for cell-mediated or antibody-mediated rejection, the PIRCHE-II score was calculated. Results There were 45 patients with no diagnosis of rejection and they were aged 61 [50-65]; 22.2% were women, with a mean BSA of 1.87 ± 0.19. 22.2% had a blood type mismatch. They had a mean PIRCHE-II of 111.88 ± 43.6. There were 15 patients diagnosed with rejection and they were 63 years old [52 – 66]; 20.0% were women, with a mean BSA of 1.84 ± 0.23. 13.3% had a blood type mismatch. They had a mean PIRCHE-II of 113.70 ± 33.90. In multivariable analysis, the main predictors of rejection were plasma transfusions [OR 0.053, 95% CI, p=0.02], post-operative infections [OR 0.076, 95% CI, p=&amp;lt;0, 02] and the PIRCHE – II [OR 3.284, 95% CI, p=0.04]. The mean PIRCHE-II of patients who presented antibody-mediated or cell-mediated rejection was 113.70 ± 33.90 and that of patients who did not present any rejection was 111.88 ± 33.90; Conclusion According to the results obtained, the PIRCHE-II algorithm could be a tool in immunological risk stratification in patients undergoing cardiac transplantation. It is necessary, however, to apply PIRCHE-II to a larger number of patients and should also be considered in light of other factors such as the immunological status of the recipients, the immediate post-operative course (infections, CMV reactivation, blood component transfusions), which could constitute an immunological trigger and patient compliance in immunosuppressive therapy.Patients' featuresResuts

Comparison of intrathecal fentanyl as an adjunct in spinal anaesthesia to ultrasound-guided quadratus lumborum block as an effective postoperative analgesia for Caesarean section surgery.

Postoperative pain in patients, if dealt with inadequately, has been a significant cause of morbidity. The present study compared the postoperative analgesic efficacy of intrathecal fentanyl and ultrasound-guided quadratus lumborum block following Caesarean surgery. A prospective randomised controlled study was planned for parturients who underwent Caesarean surgery under spinal anaesthesia. Patients received bupivacaine (10mg) and 25µg of intrathecal fentanyl in the spinal anaesthesia (group intrathecal fentanyl, n = 30) or 20mL of 0.375% ropivacaine bilateral quadratus lumborum block (group quadratus lumborum; n = 30) after surgery. The visual analogue scale score, quality of recovery-15 score and incidence of ill effects were recorded. The postoperative haemodynamic parameters were comparable between the two groups. The visual analogue scale score at different time intervals decreased after the quadratus lumborum block (p < 0.05). The mean global quality of recovery score was better in the quadratus lumborum group (p < 0.001). In the quadratus lumborum group, the mean time to first ambulation was lower than that in the intrathecal fentanyl group (p < 0.05). The requirement for first-rescue analgesia was earlier in the intrathecal fentanyl group (4.67 ± 0.72) than in the quadratus lumborum group (4.92 ± 0.88). Intrathecal fentanyl and quadratus lumborum block had effective postoperative analgesic effects on Caesarean surgery patients. However, the quadratus lumborum block group exhibited better analgesia and early ambulation than the intrathecal fentanyl group, with an improved quality of recovery.

Quality of Recovery in Pediatrics After Tonsillectomy Under Total Intravenous Anesthesia Versus Sevoflurane Anesthesia

Introduction: Inhalational anesthetics are often the first choice in pediatric anesthesia. However, the most recent literature demonstrates possible advantages of total intravenous anesthesia (TIVA). The goal of this study was to compare the postoperative quality in children submitted to tonsillectomy under TIVA versus sevoflurane anesthesia. Materials and Methods: Prospective observational case-control study (Sevoflurane vs TIVA) including children submitted to (adeno) tonsillectomy to compare the quality of anesthesia considering intra and postoperative parameters. Data was collected from clinical records, anesthetic monitoring and interviews. Results: From the 52 children included, 25% received TIVA. TIVA group had a shorter time for liquid diet reintroduction (42 minutes vs. 95 minutes) (p&lt;0.05) and the Sevoflurane group had a lower mean blood pressure variation (p=0.027). Mean wake up time was similar for both groups (11.3±6.2 minutes for TIVA and 11.6±5.3 minutes for Sevoflurane). In PACU, TIVA group demonstrated, although not statistically significant, a shorter time of stay (40 minutes vs. 41 minutes), less emergence delirium (7.7% vs. 12.5%) and less nausea and vomiting (0% vs. 5.1%). At 24 hours, TIVA group presented, although not statistically significant, less nausea and vomiting (7.7% vs 13.5%), lower pain (69.2% with &lt;5 on the numerical pain scale vs 56.8%) and higher parental satisfaction (10 vs 8). Conclusion: This study suggests that TIVA for tonsillectomy may be associated with better recovery quality. However, given the limited sample size of this study, it should be repeated in a larger sample, or in a multicentric study, for more robust conclusions.

A closer look: sperm analysis and clinical outcomes of microscopic and loupe-assisted varicocele repair in male infertility due to moderate-to-severe varicocele.

The aim of the study was to compare the clinical outcomes, sperm parameters, and complications of loupe-assisted and microscopic varicocele repair in patients with infertility due to moderate-to-severe varicocele. We included all male individuals over 18years of age who underwent inguinal varicocele repair at our center due to infertility. Subjects with azoospermia, genetic abnormalities such as Kallmann syndrome, incomplete medical records, or those lost to follow-up were excluded from the study. Patients were divided into two groups based on the magnification tool used (microscope or loupe). Follow-ups were conducted at 3months and 1year post-surgery. Sperm parameters, pregnancy rates, and surgical complications were recorded to compare the efficacy of the magnification tools. The Improvement Index for sperm parameters was calculated by dividing the difference between the post-operative and pre-operative parameters by the pre-operative parameter. An Improvement Index above 0.5 was considered a good outcome. Out of 104 patients, 58 underwent loupe-assisted and 46 underwent microscopic varicocele repair. Sperm concentration and progressive motility increased significantly in the semen analyses at three months and one year post-operation compared to pre-operative semen analyses. However, increases in sperm morphology were not statistically significant in either follow-up semen analysis. An Improvement Index greater than 0.5 (indicating a good outcome) was observed in 35.3%, 34.1%, and 15.2% of patients for sperm concentration, progressive motility, and morphology, respectively, after 3months, and 38.9%, 43.4%, and 22.4% after 1year. Nonetheless, there were no significant differences in the Improvement Index of sperm parameters between the two magnification methods. The operative duration was significantly longer with microscopic magnification (median of 70.0 [20.0] minutes vs. 45.0 [20.0] minutes) (p value < 0.001). Conversely, the pregnancy rates were 34.5% (20 patients) in the loupe-assisted group and 37.0% (17 patients) in the microscopic group, which was not significantly different (p value: 0.794). Similarly, the rate of complications was not significantly different, with 5 patients (10.9%) experiencing complications (4 hydroceles and 1 wound infection) in the microscopic group compared to 4 patients (6.9%) (3 hydroceles and 1 wound infection) in the loupe-assisted group (p value: 0.504). The current study's results indicate that the clinical outcomes, sperm parameters, and complications associated with loupe-assisted varicocele repair are comparable to those of microsurgical varicocele repair, which is considered the gold standard. We suggest conducting prospective studies to assess whether loupe-assisted varicocele repair is a safe alternative, especially in centers with limited or no access to surgical microscopes.

The value of postoperative contrast-enhanced ultrasound parameters in lymph node metastasis, tumor node metastasis, and treatment response evaluation of resected hepatocellular carcinoma.

To explore the application value of postoperative contrast-enhanced ultrasound (CEUS) parameters for lymph node metastasis (LNM), tumor, node, metastasis staging, and treatment response evaluation of resected hepatocellular carcinoma (HCC). We retrospectively analyzed 100 patients with liver cancer who underwent liver CEUS at our hospital between October 2020 and October 2022. The patient's LNM, pathological staging, and therapeutic effects were recorded based on the histopathological results. CEUS parameters were analyzed and compared CEUS parameters between different lymph node metastases, pathological stages, and therapeutic effects. Twenty-three patients experienced LNM, 77 patients did not experience LNM; and the rise time (RT), peak intensity (PI), and area under the curve (AUC) of the metastatic group were significantly smaller than those of the nonmetastatic group (P < .05). 44 cases were classified into groups I to II by pathological staging, and 56 cases were classified into groups III to IV. The RT, PI, and AUC of groups III to IV were significantly lower than those of groups I-II (P < .05). Seventy-nine cases were complete necrosis, 21 cases were residual or recurrent; The RT, PI, and AUC of the residual or recurrent group were significantly lower than those of the complete necrosis group (P < .05). The receiver operating characteristic curve shows that RT, PI, and AUC have a certain value in evaluating LNM, pathological staging, and treatment response of HCC, and the combined evaluation/evaluation value of these 3 factors is relatively high. The postoperative CEUS parameters RT, PI, and AUC can be used for LNM, pathological staging evaluation, and treatment response evaluation of HCC. Moreover, the combination of the 3 parameters is feasible and valuable in evaluating LNM, tumor, node, metastasis staging, and treatment response of HCC.

Spring-Wire Technique as a Cost-Effective Alternative for Volar Rim Fragment Fixation in Distal Radius Fractures.

Introduction Volar rim fragment fixation is difficult to manage, as it is distal to the watershed line, rendering normal volar plates unable to securely capture it. This fragment must be precisely addressed as volar carpal subluxation is unavoidable when fixation is not efficient. The spring-wire technique maintains a stable fixation of this key fragment, which has been previously described in a small series. Materials and methods This is a prospective study of 20 patients who presented to El-Hadara University Hospital in Alexandria between the years 2020 and 2022, with complex distal radius fractures and small volar rim fragments, who were treated by open reduction and internal fixation using the spring-wire technique. The study was approved by the institutional review board of Alexandria Main University Hospital, and informed consent was taken from all patients in this study ensuring compliance with ethical standards. All patients underwent open reduction and internal fixation using the spring-wire technique. The procedure was performed by the same surgical team to ensure consistency. Postoperative radiographs were taken to assess reduction quality and fixation. Postoperative radiographic parameters, range of motion, grip strength and the El-Hadara wrist function scoring system were obtained after one year of follow-up, to evaluate results of fixation. Results All patients achieved a functional range of motion and grip strength and showed radiological union of the volar rim fragment with no volar carpal subluxation or escape of the volar rim fragment. The El-Hadara wrist function average score was 18.85±2.66, which represented a good overall result. No complications occurred during follow-up, and none of the patients required removal of the implant. Conclusion The spring-wire technique maintains a stable fixation of the volar rim fragment that cannot be held securely by volar plating alone. This method offersa low-profile implant that is readily available and simple to apply. Also, the fragment is stabilized by a dual effect by both the spring wire and the volar plate that act as a buttress to volar displacement.