Preoperative Procedures Research Articles

Thoracic outlet compression neuropathy and decompression surgery at chang gung memorial hospital

Thoracic outlet syndrome (TOS) has many controversies that include nomenclature, etiology, diagnosis, treatment and surgical approach. The aim of this article is to give a comprehensive review of our experience of treatment of TOS for more than 35 years. From 1985 to 2021, a total of 100 TOS patients were treated and 114 surgeries were performed. They all had decompression surgeries for their compression neuropathy in the thoracic outlet with at least one year postoperative follow-up. Fourteen patients were bilateral TOS, undergoing bilateral TOS surgeries. Preoperative evaluation covered “TOS Examination Sheet” and imaging studies MRI and CT. Diagnosis was confirmed by intraoperative findings. All had near-total resection of the anterior scalene muscle and the first rib. Additional structual abnormalities were treated at the same time. The operative time was typically 2–3 h. Major postoperative complications were rare. Nearly all patients (96%) experienced significant symptoms and signs relief after a period of clinical follow-up and rehabilitation. TOS is a real clinical entity. Once the preoperative diagnosis is made, conservative treatment is followed but failed, decompression surgery with extensive resection of anterior scalene muscle and the 1 st rib, and any other structural abnormalities is recommended to resolve the problems. Long-term postoperative follow-up is crucial and important to resolve the residual problems. Our result carries a 96% success rate with a favorable benefit:risk ratio. • A total of 100 thoracic outlet syndrome (TOS) patients were treated and 114 surgeries were performed. • Preoperative evaluation, intraoperative findings and procedure, and postoperative follow-up were included. • Decompression surgery included resection of anterior scalene muscle, the 1st rib, and any other structural abnormalities. • Our result carries a 96% success rate with a favorable benefit:risk ratio.

Real-World Data Showing Lack of Complications Without Use of Closure Devices in the Office-based Vascular Procedure Center

Closure devices are available in a range of different schemata to close the percutaneous arteriotomy. Although they may contribute to room turnover and increased time to ambulation, they carry the risk of dissection, thrombosis, failure, and expense that may bring a patient back for an avoidable operation, causing undue stress to a patient who elected to avoid the hospital to seek office-based care. In addition, there is hardship of a foreign object in the skin, increasing inflammation and scarring should the groin need to be reaccessed or exposed. In an office-based setting where adequate manual pressure can be held, their use may be obviated and unnecessary. Without real-world examples of protocols and complication rates, many surgeons may be uncomfortable with this transition. Using our Vascular Quality Initiative database, all patients who underwent an office-based endovascular procedure in which groin access was employed (aortic, iliac, or peripheral stenting, balloon angioplasty, atherectomy, and diagnostic angiograms) from 2015 to 2021 were identified. These procedures were elective and mainly for occlusive disease. Preoperative patient characteristics, procedure characteristics, and access-related outcomes were analyzed. Access guidance was uniformly obtained with ultrasound imaging. In our protocol, protamine is administered routinely. Fifteen minutes of pressure is uniformly held on each groin by the surgical technician, over an area marked out by the surgeon. The patient lays flat for 3-4 hours afterward, depending on sheath size. Patients are reached by telephone 1-3 days after their procedure to assess their immediate postprocedure status. Five hundred eighty-three patients met inclusion criteria. These were 61% male, 67% White, and 30% African American, with an average body mass index of 28. Thirty-six percent needed assistance with daily activities. Thirty percent had coronary artery disease, 22% chronic obstructive pulmonary disease, 45% diabetes mellitus, and 45% were smokers. Preoperative medications that included 73% aspirin and 57% clopidogrel. Redo-groin status was in 61% of patients. On average, largest sheath size was 6F, ranging from 4F to 8F. Protamine was administered in >80% of cases. Access site complication requiring additional observation was 0.5% (n = 3) and these were all hematomas. There were no postprocedure bleeds on follow-up. Any sort of postprocedure complication was 0.9%. Complication causing hospital admission was 0.2%, and none were related to access. The use of closure devices incurs the added risk. These data show a 6-year experience in the office-based setting that not using closure devices and instead using manual pressure is safe without significant complication. This should prompt discussion regarding the necessity of using closure devices in office-based endovascular procedures.

How to better identify patients at high risk of inappropriate shocks before S-ICD implantation: Results from a multicenter experience

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Despite the recent improvements, inappropriate shocks (IAS) in patients implanted with subcutaneous implantable cardioverter-defibrillator (S-ICD) remain a challenge in "real-life" practice. The purpose of this study was to assess the preoperative predictive factors of IAS with the latest generation of S-ICD, with a particular focus on data obtained during the screening procedure. Methods Between January 2017 and March 2020, 300 patients implanted with Generation 3 S-ICD system for primary and secondary prevention were included in this multicentric study. Follow-up (FU) of at least 6 months and preoperative screening procedure data were mandatory for all patients. Results After a mean follow-up of 22.8 (±11.4) months, appropriate therapies occurred in 12.3% patients; while 26 patients (8.7%) experienced inappropriate therapies (incidence 4.9 per 100 patient-years). The total number of inappropriate shock episodes was 48; 9 patients experienced multiple episodes. Causes of IAS were: supraventricular arrhythmias (34.6%), cardiac (30.7%) and extra-cardiac noise oversensing (38.4%). In univariate analysis, availability of all 3 sensing vectors during preoperative screening significantly reduced inappropriate therapies occurrence (hazard ratio [HR], 0.32; 95% confidence interval [CI], 0.12-0.89, P=0.028). Clinical preoperative S-ICD inappropriate shocks predictors were: history of Supraventricular Tachycardia (SVT)(HR, 4.42; 95% CI, 1.45-13.47; P=0.009); overweight (BMI>25: HR, 1.93; 95% CI, 0.83-0.4.48; P=0.13); QRS duration (HR, 1.01; 95% CI, 0.1-1.03; P=0.14) and lower QRS/T wave ratio in lead I (for a threshold < 3: HR, 4.44; 95% CI, 1.88-10.48; P=0.001). By multivariate analysis, independent factors associated with IAS were: the availability of less than 3 sensing vectors during preoperative screening (p<0.05), a low QRS/T wave ratio in lead I (for a threshold <3; p<0.001), history of SVT (p<0.001) and overweight (BMI> 25; p<0.05). Conclusion Automatic preoperative screening data is of high interest as a predictor of IAS with a quantitative value. ECG specificities in association with other clinical factors should be taken into consideration to identify patients at high risk for IAS.

Effects of vaginal microecology and immunity on the pregnancy outcome of cervical cerclage

ObjectiveTo investigate the effects of vaginal microecology and immune status on the pregnancy outcome of cervical cerclage.MethodsThe clinical data of 125 patients with cervical incompetence who underwent transvaginal cervical cerclage in our hospital from January 2018 to January 2021 were collected, based on which the associations of vaginal microecology and related immune cytokines (IL-1β, IL-6, IL-8 and TNF-α) with the cervical cerclage outcome were explored.ResultsAll of the 125 patients had singleton pregnancies, who were aged 20–43 years, with a mean of (32.34 ± 5.17) years. The surgery was successful in 104 patients (full-term delivery or survival of premature infants), while unsuccessful in 21 patients (late miscarriage or death of premature infants), revealing a success rate of 83.20%. There were 70 full-term deliveries, 34 premature deliveries (28 survived while 6 died), and 15 late miscarriages. Univariate analysis revealed statistically significant differences in the timing of surgery, gestational age of cerclage, preoperative cervical canal length, genital tract infections and preoperative invasive procedures between the successful and unsuccessful groups (P < 0.05). Insignificant differences were found in the pre-pregnancy body mass index (BMI) (P > 0.05). According to the multivariate analysis results, cerclage timing and genital tract infections were independent risk factors for postoperative pregnancy failure (P < 0.05). The pathogen detection rates in the two groups of pregnant women were analyzed, finding significantly higher incidence of bacterial vaginosis (BV) in the unsuccessful group than in the successful group (P < 0.05). Inter-group comparison revealed that the positive rates for vaginal microenvironmental factors (LE, NAG, SNA, H2O2 and pH) were all significantly higher in the unsuccessful group than in the successful group (P < 0.05). Besides, the immune cytokine levels in the cervicovaginal secretions were also all significantly higher in the unsuccessful group than in the successful group (P < 0.05).ConclusionThe pregnancy outcome of patients undergoing cervical cerclage is associated with the imbalance of vaginal microecology and the levels of IL-1β, IL-6, IL-8 and TNF-α in cervicovaginal secretions.

Impact of Preoperative Diagnostic Biopsy Procedure on Spread Through Airspaces and Related Outcomes in Resected Stage I Non-Small Cell Lung Cancer

Tumor spread through airspaces (STAS) is a recently determined pathologic phenomenon of lung cancer with significant prognostic impact. This study aimed to analyze the unexplored correlation between preoperative biopsy procedure and a higher risk of STAS and its impact on STAS-related outcomes in resected stage I non-small cell lung cancer (NSCLC). Does preoperative biopsy procedure affect the risk of STAS and STAS-related outcomes in surgically treated stage I NSCLC? We examined 2,169 patients who underwent surgery for pathologic stage I NSCLC from January 2011 through December 2019 at the Seoul National University Bundang Hospital, a tertiary center in South Korea. Factors including percutaneous needle biopsy (PCNB) and bronchoscopic biopsy were assessed for determining the association between preoperative biopsy procedure and an elevated risk of STAS. In addition, the impact of preoperative biopsy on STAS-related prognosis (recurrence and lung cancer-specific mortality) was evaluated with multivariate Cox regression analyses. STAS findings were positive in 638 of 2,169 patients (29.4%). An insignificant association was found between preoperative biopsy (both PCNB and bronchoscopic biopsy) and STAS. After adjustments for preoperative tumor biopsy, STAS was a significant risk factor for cancer recurrence (hazard ratio [HR], 1.72; 95%CI, 1.20-2.48). Additionally, sublobar resection remained a significant risk factor for recurrence (HR, 3.20; 95%CI, 1.65-6.21) and lung cancer-specific mortality (HR, 12.71; 95%CI, 3.68-43.92) in patients with positive STAS findings. However, this association was insignificant for patients without STAS. Preoperative biopsy was not a significant risk factor for either recurrence and mortality, regardless of STAS positivity. Preoperative biopsy in stage I NSCLC neither was associated with an elevated risk of STAS nor influenced the prognosis related to STAS. Physicians can be less apprehensive about performing preoperative biopsy in relationship to STAS.

Accuracy, costs and radiation exposure of current preoperative localization procedures in patients with primary hyperparathyroidism, a retrospective cohort study in a Swiss tertiary referral center

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Automatic surgical planning based on bone density assessment and path integral in cone space for reverse shoulder arthroplasty.

Reverse shoulder arthroplasty (RSA) is an effective surgery for severe shoulder joint diseases. Traditionally, the preoperative planning procedure of RSA is manually conducted by experienced surgeons, resulting in prolonged operating time and unreliable drilling paths of the prosthetic fixation screws. In this study, an automatic surgical planning algorithm for RSA was proposed to compute the optimal path of screw implantation. Firstly, a cone-shaped space containing alternative paths for each screw is generated using geometric parameters. Then, the volume constraint is applied to automatically remove inappropriate paths outside the bone boundary. Subsequently, the integral of grayscale value of the CT is used to evaluate the bone density and to compute the optimal solution. An automatic surgical planning software for RSA was also developed with the aforementioned algorithms. Twenty-four clinical cases were used for preoperative planning to evaluate the accuracy and efficiency of the system. Results demonstrated that the angles among the prosthetic fixation screws were all within constraint angle(45°), and the stability rate of the planned prosthesis was 94.92%. The average time for the automatic planning algorithm was 4.39s, and 83.96s for the whole procedure. Repetitive experiments were also conducted to demonstrate the robustness of our system, and the variance of the stability coefficient was 0.027%. In contrast to the cumbersome manual planning of the existing methods for RSA, our method requires only simple interaction operations. It enables efficient and precise automatic preoperative planning to simulate the ideal placement of the long prosthetic screws for the long-term stability of the prosthesis. In the future, it will have great clinical application prospects in RSA.

Determining the accuracy of preoperative total hip replacement 2D templating using the mediCAD\xae software

BackgroundTemplating is a preoperative planning procedure that improves the efficiency of the surgical process and reduces postoperative complications of total hip arthroplasty (THA) by improving the precision of prediction of prosthetic implant size. This study aimed to evaluate the accuracy of the preoperative cup and stem size digital 2D templating of THA with mediCAD® software and find the factors that influence the accuracy, such as indication for surgery, patients’ demographics, implant brand, and the assessors’ grade of education.MethodsWe retrospectively retrieved 420 patient template images of all patients who underwent THA between March 2018 and March 2021. Templating of all included images was processed using mediCAD® software a day before surgery by a newcomer physician to hip arthroplasty course (PGY-2 orthopedic resident or hip surgery fellow). Preoperative templating cup and stem sizes were compared with the actual inserted implant sizes.ResultAfter excluding ineligible patients, this study included 391 patients, 193 (49.4%) males and 198 (50.6%) females with a mean age of 43.3 ± 14.9. The average cup sizes predicted before and after surgery were 52.12 ± 14.28 and 52.21 ± 15.05 respectively, and the mean delta cup size (before and after surgery) was 2.79 ± 2.94. The delta stem size before and after surgery has a mean value of 1.53 ± 1.49. The acetabular cup components, measured within ± 0, ± 1, and ± 2 sizes, were 28.9%, 63.9%, 83.1% accurate, respectively. The femoral stem design component measured within ± 0, ± 1, and ± 2 sizes were 27.2%, 61.0%, 78.6% accurate, respectively. Wagner Cone® stem brand, DDH patients, and females showed significantly higher accuracy of stem size templating. Revision THA has the lowest accuracy in terms of cup size templating. The compression of accuracy rate between resident and fellow revealed no significant differences. Also, no significant difference was detected between the accuracy of templating performed in the first months with the second months of the arthroplasty course period.ConclusionOur study showed that under mentioned condition, templating using mediCAD® has acceptable accuracy in predicting the sizes of femoral and acetabular components in THA patients. Digital software like mediCAD® remains favorable because of the short learning curve, user-friendly features, and low-cost maintenance, leading to level-up patient care and THA efficacy. Further studies are necessary for clarifying the role of the assessor’s experience and expertise in THA preoperative templating.Level of evidenceLevel III (retrospective observational study).

Risk analysis and preventive strategies of implant placement in patients with hypertension

Recently, among the edentulous patients who undergo dental implants, the proportion of hypertensive patients remains high, which poses a greater challenge for clinicians to operate and to maintain the therapeutic effect. The present review comprehensively summarized clinical researches about the adverse effects on dental implants, outlined molecular mechanisms of the positive effects of various antihypertensive drugs on bone metabolism, and proposed that clinicians should select preventive strategies during preoperative and intraoperative procedures according to the blood pressure of patients with hypertension.

C-reactive protein predicts early clinical outcomes and long-term mortality after left ventricular assisted device.

Left ventricular assist device (LVAD) implantation has become a reliable therapeutic strategy in patients with advanced heart failure. C-reactive protein (CRP) is a well-established biomarker of inflammation. This study aims to determine the prognostic effect of CRP level on clinical outcomes of patients who undergo LVAD implantation. This is a single-center, observational, retrospective study. One hundred fifty-three patients who received continuous-flow LVAD implantation were included and were divided into two groups of high (>3.9 mg/dL) versus low CRP (⩽3.9 mg/dL). Patients with high pre-implant CRP levels were prone to severe preoperative clinical conditions and complicated intraoperative procedures. Compared with patients in the low CRP group, elevated pre-implant CRP was associated with increased hospital mortality (31.4% vs 8.4%, p < 0.001), postoperative right ventricular failure (47.1% vs 30.1%, p = 0.031), right ventricular assist device use (34.3% vs 16.9%, p = 0.013), AKI (70% vs 51.8%, p = 0.022) and significantly prolonged duration of postoperative mechanical ventilation and intensive care unit length of stay. Univariate Cox regression showed that high pre-implant CRP was significantly associated with increased risk of long-term mortality (Hazard ratio (HR) 2.632 95%; CI: 1.657-4.183, p < 0.001), and multivariable Cox regression also revealed the higher risk of long-term mortality in patients with elevated pre-implant CRP (HR, 2.848 95%CI: 1.659-4.888, p < 0.001). These results remained stable when treating pre-implant CRP as a continuous variable. Besides, the prognostic effect of post-implant CRP was also observed. CRP is a reliable risk-stratification biomarker in patients receiving continuous-flow -LVAD and can be used as a predictor for short- and long-term outcomes.

Virtual-assisted lung mapping using dual staining with indocyanine green and indigo carmine enhanced marking detectability.

BackgroundVirtual-assisted lung mapping (VAL-MAP) is a preoperative bronchoscopic multispot dye-marking procedure to facilitate sublobar lung resection for unidentifiable lung nodules. To increase detectable markings, we performed VAL-MAP using dual staining (VAL-MAP DS) with indocyanine green (ICG) and indigo carmine. This study was designed to evaluate the efficacy and safety of the modified technique.MethodsWe retrospectively reviewed the records of patients who underwent VAL-MAP DS. Twenty patients with 27 lesions underwent 72 VAL-MAP DS markings. We investigated the overall detectable marking rate, visible marking rate, successful resection rate, and complications.ResultsThe overall detectable marking rate, thanks to both ICG and indigo carmine, tended to be higher than the indigo carmine visible marking rate (95.7% vs. 85.5%, P=0.08). The successful resection rate with sufficient margins was 92.0%. There were no adverse events related to the use of ICG. ICG markings of the lungs of patients with a history of smoking more than 50 pack-years tended to be visible, but the staining was too extensive compared with the staining in patients who smoked less or not at all (58.8% vs. 0.0%, P<0.001).ConclusionsVAL-MAP DS is likely be efficacious and safe in enhancing the detectability of markings. This bronchoscopic technique should be considered as one of the optimal preoperative marking methods in thoracic surgery.

Risk factors, risk stratification and risk-specific surveillance strategies after endovascular aneurysm repair: study protocol for a Delphi study by the International RIsk Stratification in EVAR (IRIS-EVAR) working group

IntroductionSeveral risk factors for adverse events after endovascular aneurysm repair (EVAR) have been described, but there is no consensus on their comparative prognostic significance, use in risk stratification and application...

Impact of preoperative biliary drainage on 30 Day outcomes of patients undergoing pancreaticoduodenectomy for malignancy.

Preoperative biliary drainage (PBD) has been advocated to address the plethora of physiologic derangements associated with cholestasis. However, available literature reports mixed outcomes and is based on largely outdated and/or single-institution studies. Patients undergoing PBD prior to pancreaticoduodenectomy (PD) for periampullary malignancy between 2014-2018 were identified in the ACS-NSQIP pancreatectomy dataset. Patients with PBD were propensity-score-matched to those without PBD and 30-day outcomes compared. 8,970 patients met our inclusion criteria. 4,473 with obstruction and PBD were matched to 829 with no preoperative drainage procedure. In the non-jaundiced cohort, 711 stented patients were matched to 2,957 without prior intervention. PBD did not influence 30-day mortality (2.2% versus 2.4%) or major morbidity (19.8% versus 20%) in patients with obstructive jaundice. Superficial surgical site infections (SSIs) were more common with PBD (6.8% versus 9.2%), however, no differences in deep or organ-space SSIs were found. Patients without obstruction prior to PBD exhibited a 3-fold increase in wound dehiscence (0.5% versus 1.5%) additionally to increased superficial SSIs. PBD was not associated with an increase in 30-day mortality or major morbidity but increased superficial SSIs. PBD should be limited to symptomatic, profoundly jaundiced patients or those with a delay prior to PD.

Effects of tizanidine premedication on the duration of perioperative maintenance dose of vecuronium bromide

Aim. The aim of this study was to evaluate the effects of preoperative administration of tizanidine on the maintenance dose duration of the nondepolarizing muscle relaxant, i.e. vecuronium bromide.Material and Methods. This prospective clinical study was conducted in 30 adult male patients scheduled for elective inguinal hernia surgery. Patients were categorised into two randomised groups based on the premedication use. Group 1 included patients (n = 15) who received oral diazepam (Diazem) in the evening prior to the surgery, as well as meperidine (Dolantin) 1 mg/kg-1 (max. 50 mg) i.m. with 50 ml water by mouth 1 hour before the procedure. Group 2 comprised patients (n = 15) who were given oral tizanidine 4 mg in the evening before the surgery, as well as oral tizanidine 4 mg with 50 ml water 1 hour prior to the operation. The following parameters were recorded in both groups: pre-operative and perioperative diastolic arterial blood pressure, systolic arterial blood pressure, mean arterial blood pressure, heart rate, respiratory rate, pre-operative vecuronium bromide maintenance doses, procedure time and postoperative score according to the Ramsay scale in 1st, 2nd and 3rd hour.Results. No significant difference was observed between the two groups with regard to the pre-operative and perioperative haemodynamic variables and the respiratory rate (P &gt; 0.05), although it was found that vecuronium maintenance dose duration was significantly higher in the tizanidine premedicated group (P = 0.015). In addition, the operative time (P = 0.128) and the postoperative patients’ Ramsay scores did not differ statistically between the two groups (P &gt; 0.05). Conclusions. The prolonged duration of vecuronium maintenance dose, the increased nondepolarizing block time, as well as haemodynamic stability preservation in patients undergoing inguinal hernia surgery following preoperative oral administration of tizanidine support the view that tizanidine can be used as an effective and safe myotonolytic premedication agent.

Racial disparities in mitral valve surgery: A statewide analysis

ObjectiveRacial disparities in health care have come to the forefront. We hypothesized that Black race was associated with worse preoperative risk, lower repair rates, and worse outcomes among patients who underwent mitral valve surgery. MethodsAll patients who underwent mitral valve repair or replacement with or without coronary artery bypass grafting from 2011 to 2020 in a statewide collaborative database were stratified into 3 racial groups, White, Black, and other. Preoperative characteristics, procedure type, and outcomes were evaluated. ResultsA total of 9074 mitral valve operations were performed at 33 centers (Black 1009 [11.1%], White 7862 [86.6%]). Preoperative combined Society of Thoracic Surgeons morbidity and mortality was higher for Black patients (Black 32%, White 22%, other 23%, [P < .001]) because of a greater proportion of diabetes, hypertension, and chronic lung disease. White patients were more likely to undergo mitral repair (White 66%, Black 53.3%, other 57%; P < .001). Operative mortality was similar across racial groups (White 3.7%, Black 4.6%, other 4.5%; P = .36). After adjusting for preoperative factors, mitral etiology, and hospitals, race was not associated with mitral valve repair, complications, or mortality, but Black patients had higher odds of extended care facility utilization and readmission. ConclusionsContrary to our hypothesis, there was no difference in the odds of repair or operative mortality across races after accounting for risk and etiology. However, Black patients were more likely to be readmitted after discharge. These findings support a greater focus on reducing disparities in mitral valve surgery.

Diagnostic office hysteroscopy; why is it still painful procedure despite the surgical experience and mini-hysteroscope?

To evaluate the effect of cervical canal features on pain during outpatient hysteroscopy performed by experienced surgeons using mini-hysteroscope. A prospective observational study was conducted on 303 women undergoing diagnostic hysteroscopy without anesthesia. Pain intensity was evaluated using the visual analog scale (VAS) when the cervical canal was passed. The patients were divided into two groups according to the VAS score: painless or mild pain (VAS <4) and moderate or severe pain (VAS ≥ 4). The relationship between cervical canal characteristics (length, version, and flexion positions, history of cervical intervention, stenosis, synechiae), obstetric and gynecological history, preoperative anxiety level, procedure duration, and pain intensity was examined. Moderate pain (4 ≤ VAS < 7) was observed in 38% of patients (n= 117) and 14 patients (5%) experienced severe pain (VAS ≥ 7). In multivariate analysis, nulliparity (p= 0.01; OR, 4.6; 95% CI, 1.7-13.2), postmenopausal state (p= 0.02; OR, 2.2; 95% CI, 1.2-4.3), excessive flexion of the cervix and retroverted uterus (p<0.001; OR, 4.1; 95% CI, 2.0-8.5) were identified as risk factors for a painful procedure. Diagnostic hysteroscopy was successful in 98% of the patients. The pain was the primary cause of the failed hysteroscopy. In addition to nulliparity and postmenopausal status, unfavorable features of the cervical canal, such as the excessive flexion position of the cervix and uterine retroversion are significant causes of pain during outpatient hysteroscopy.

Validation of Non-invasive Language Mapping Modalities for Eloquent Tumor Resection: A Pilot Study.

Many studies have established a link between extent of resection and survival in patients with gliomas. Surgeons must optimize the oncofunctional balance by maximizing the extent of resection and minimizing postoperative neurological morbidity. Preoperative functional imaging modalities are important tools for optimizing the oncofunctional balance. Transcranial magnetic stimulation (TMS) and functional magnetic resonance imaging (fMRI) are non-invasive imaging modalities that can be used for preoperative functional language mapping. Scarce data exist evaluating the accuracy of these preoperative modalities for language mapping compared with gold standard intraoperative data in the same cohort. This study compares the accuracy of fMRI and TMS for language mapping compared with intraoperative direct cortical stimulation (DCS). We also identified significant predictors of preoperative functional imaging accuracy, as well as significant predictors of functional outcomes. Evidence from this study could inform clinical judgment as well as provide neuroscientific insight. We used geometric distances to determine copositivity between preoperative data and intraoperative data. Twenty-eight patients were included who underwent both preoperative fMRI and TMS procedures, as well as an awake craniotomy and intraoperative language mapping. We found that TMS shows significantly superior correlation to intraoperative DCS compared with fMRI. TMS also showed significantly higher sensitivity and negative predictive value than specificity and positive predictive value. Poor cognitive baseline was associated with decreased TMS accuracy as well as increased risk for worsened aphasia postoperatively. TMS has emerged as a promising preoperative language mapping tool. Future work should be done to identify the proper role of each imaging modality in a comprehensive, multimodal approach to optimize the oncofunctional balance.

Thực trạng tuân thủ quy trình chuẩn bị người bệnh trước mổ phiên tại bệnh viện Chợ Rẫy thành phố Hồ Chí Minh năm 2021

A cross-sectional study was employed to describe the situation of compliance with patient preparation before surgery session of nurses at Cho Ray Hospital in 2021. This study was conducted from 03/2021 to 08/2021, by using an observational checklist of 113 prepared surgeries. The results showed that the compliance rate of patient preparation checklist at Cho Ray Hospital was 75.2%. In which, the highest compliance rate with the checklist was the stage of patient handover (85.8%), followed by 78.8% in the preparation stage and 75.2% in the stage of transferring the patient to surgery. The rate of adherence to the preoperative preparation procedures at the Department of Neurology and the Department of General Surgery was 76.2% and 74.0%, respectively. In conclusion, the compliance rate with the checklist is quite high, however, it is still necessary to organize the training for nurses to improve their personal awareness and practice of the pre-operative patient preparation checklist. Keywords: Preparation before surgery, Cho Ray Hospital.

Semillas radiactivas y no radiactivas como método de localización quirúrgica de las lesiones mamarias no palpables

The increasingly early diagnosis of breast disease and the more widespread use of primary systemic therapy leads to an increasing number of surgeries for non-palpable breast lesions (NPL) in clinical practice.Breast-conserving surgery often requires the use of an image-guided preoperative localization procedure, in which a device is placed within the lesion to be removed to guide the surgeon during surgery. These are patients with small, non-palpable tumors detected in the population screening mammogram, cases with significant reduction of the lesion after neoadjuvant chemotherapy and sometimes it is even necessary to mark axillary lymphadenopathies prior to systemic treatment.For decades, wire localization has been the standard for preoperative marking in breast cancer. Due to the external component of this device, extreme care must be taken not to alter its position before surgery, which is why it is placed hours before surgery and entails complex and limited flexibility in surgical programming.Intraoperative ultrasound improves this drawback but has the limitation that it can only be performed in those NPLs that have ultrasound translation. The Radioguided Occult Lesion Localization (ROLL) technique, although it is another alternative adopted by many institutions, is not without complications, among which the possibility of diffusion of the radiotracer into healthy tissue stands out.To overcome these problems, more recently, 125I radioactive seeds began to be used. Subsequently, thanks to technological advances, non-radioactive seed alternatives such as radar reflectors, magnetic seeds and radio frequency markers have emerged. These locating devices can be placed days before surgery, avoiding wire-related problems and complications. They are introduced percutaneously and identified intraoperatively using a detector device.There is no perfect intraoperative localization method for NPL excision, but fortunately, we have multiple techniques with different advantages and disadvantages that must be assessed and adapted to the center's own resources, the type of surgery, and always to the benefit of the patient.

Radioactive and non-radioactive seeds as surgical localization method of non-palpable breast lesions

The increasingly early diagnosis of breast disease and the more widespread use of primary systemic therapy leads to an increasing number of surgeries for non-palpable breast lesions (NPL) in clinical practice.Breast-conserving surgery often requires the use of an image-guided preoperative localization procedure, in which a device is placed within the lesion to be removed to guide the surgeon during surgery. These are patients with small, non-palpable tumors detected in the population screening mammogram, cases with significant reduction of the lesion after neoadjuvant chemotherapy and sometimes it is even necessary to mark axillary lymphadenopathies prior to systemic treatment.For decades, wire localization has been the standard for preoperative marking in breast cancer. Due to the external component of this device, extreme care must be taken not to alter its position before surgery, which is why it is placed hours before surgery and entails complex and limited flexibility in surgical programming.Intraoperative ultrasound improves this drawback but has the limitation that it can only be performed in those NPLs that have ultrasound translation. The Radioguided Occult Lesion Localization (ROLL) technique, although it is another alternative adopted by many institutions, is not without complications, among which the possibility of diffusion of the radiotracer into healthy tissue stands out.To overcome these problems, more recently, 125I radioactive seeds began to be used. Subsequently, thanks to technological advances, non-radioactive seed alternatives such as radar reflectors, magnetic seeds and radio frequency markers have emerged. These locating devices can be placed days before surgery, avoiding wire-related problems and complications. They are introduced percutaneously and identified intraoperatively using a detector device.There is no perfect intraoperative localization method for NPL excision, but fortunately, we have multiple techniques with different advantages and disadvantages that must be assessed and adapted to the center's own resources, the type of surgery, and always to the benefit of the patient.