Requirement For Surgical Treatment Research Articles

Factors Associated with Surgical Treatment in Postpartum Women with Mastitis or Breast Abscess: A Retrospective Cohort Study.

Objective: The aim of this study was to identify factors associated with requiring surgical treatment for mastitis or breast abscess in postpartum mothers. Materials and Methods: This was a retrospective cohort study using the Japan Medical Data Center Claims Database. Information on pairs of infants born between April 2012 and December 2016 and their mothers were extracted. Data regarding the baseline characteristics, medical history, medical practice, and prescription drugs of mothers and their infants were collected. Multivariable logistic regression analysis was used to examine factors associated with undergoing surgical treatment. Results: The data of 69,363 eligible mothers were analyzed. The proportion of mothers who were diagnosed with mastitis or breast abscess within 1 year after childbirth was 10.8% (7,516/69,363). There were 114 mothers who underwent surgical treatment within 1 year after childbirth. This was 0.2% of all mothers and 1.5% of those diagnosed with mastitis or breast abscess. Surgical treatment was significantly associated with mothers having their first child (adjusted odds ratio [AOR], 2.58; 95% confidence interval [CI], 1.63-4.07) compared to those with a second or later child; it was also significantly associated with the diagnosis of breast abscess (AOR, 10.38; 95% CI, 5.28-20.40). Conclusions: This was the first report of the prevalence of mastitis or breast abscess and the requirement for surgical treatment among postpartum mothers in Japan. A first diagnosis of breast abscess and having a first child were associated with requiring surgical treatment. Health care professionals providing postpartum care should be aware of these factors.

Surgical Approach in a Giant Ovarian Endometrioma

<h3>Study Objective</h3> Report surgical approach in a difficult case of Giant Ovarian Endometrioma. <h3>Design</h3> Case report with imaging exams and description of the surgical approach, with narrated surgical video. <h3>Setting</h3> The prevalence of endometrioma is unknown, but it is expected to affect around 17-44% of women with endometriosis. The surgical management is recommended in cases as the large endometriomas. Usually, the endometrioma is adhered to the surrounding structure, therefore it is fundamental the surgeon's anatomic landmark knowledge and their experience in deep endometriosis surgery. <h3>Patients or Participants</h3> Female, 40 years old with previous nephrectomy and a giant ovarian endometrioma associated with deep endometriosis. <h3>Interventions</h3> Patient was submitted to laparoscopic surgery. A giant ovarian endometrioma occupied all the pelvis. The first step was to drain it, to make it possible to view the pelvis. Adhesiolysis was performed followed by left oophorectomy. It was primordial to dissect and visualize her only ureter. Her ureter was enlarged due to its adherence with a paracervical endometriosis nodule. After the ureterolysis and endometriosis nodule removal, there was no sign of ureter dilatation anymore. To perform a complete treatment for deep endometriosis, segmental rectosigmoidectomy and appendicectomy were done. <h3>Measurements and Main Results</h3> The patient was stable after the procedure, with hospital discharge on the 5^th day after surgery. In the follow-up, the diet was slowly re-introduced, with good response. The pathology reports showed endometriosis in all specimens. The renal labs remained normal. <h3>Conclusion</h3> Giant ovarian endometrioma cases are challenging due to its requirement of surgical treatment. The imaging exams as magnetic resonance and ultrasound would give the surgeon a clue, but the final aspect of the pelvis is only known during the surgery. Therefore, it is very relevant to start the procedure with a strategy in mind.

Comparison of percutaneous vs endoscopic drainage in the management of pancreatic fluid collections: A prospective cohort study.

Currently, endoscopic drainage (ED) and percutaneous drainage (PD) are both widely used effective interventions in the management of patients with symptomatic pancreatic fluid collections (PFCs). This study aimed to compare the clinical effectiveness and safety of ED to those of PD in the treatment of PFCs. A prospective cohort study of PFC patients who underwent ED or PD was conducted between January 2009 and December 2017. In this study, the initial success rate, adverse events, intervention, requirement of surgical treatment, hospital mortality within 30days, length of hospital stay, and expenses during hospitalization were monitored, and a follow-up investigation of treatment outcome was conducted. Long-term recovery, recurrence, and mortality were determined according to telephone follow up. In total, 129 patients were included in the study; 62 patients underwent ED, and 67 patients underwent PD during the 8-year study period. Initial treatment success was considerably higher in patients whose PFCs were managed by ED than in patients whose PFCs were managed by PD (94.9% vs 65.0%, P=0.003). The rate of procedural adverse events, reintervention, length of hospitalization, and expense were all higher in the PD group than in the ED group, but the long-term recovery rate and requirement of surgical intervention were not clearly different between patients who underwent the two treatment measures. ED of symptomatic PFCs was associated with higher rates of initial treatment success, lower rates of reintervention and adverse events, and a shorter hospital stay than PD of symptomatic PFCs.

Our experiences in bipolar radiofrequency thermotherapy system as an alternative treatment in LUTS.

We aimed to evaluate the efficacy of the bipolar radiofrequency thermotherapy system as a minimally invasive treatment method in lower urinary tract symptom treatment and its effect on the patients' quality of life (QoL). The thermotherapy system was applied to 118 patients between May 2016 and September 2017 with the requirement of surgical treatment for benign prostatic hyperplasia, who either could not be operated upon due to their comorbidities or preferred to undergo this procedure as an alternative treatment method. The International Prostate Symptom Score (IPSS) and QoL scores and maximal flow rate (Qmax) and post-voiding residue (PVR) values were evaluated before and after treatment. For the 80 patients who completed the 2-year follow-up period, the Qmax values were observed to be increased at each follow-up evaluation and PVR, QoL and IPSS were observed to be decreased. These changes were statistically significant from the baseline. In this study we found there was 48.8% increase in Qmax, 72.1% decrease in IPSS, 70.8% decrease in the QoL score, 51.1% decrease in PVR of 80 patients who underwent bipolar radiofrequency prostate ablation. The bipolar radiofrequency prostate thermotherapy system can be safely applied as an outpatient treatment in high-risk cases or for those who are anxious about surgical interventions.

Evaluating the effectiveness of the national hip dysplasia early diagnosis and treatment program

A significant decrease in late diagnosis and requirement for surgical treatment have been observed due to the implementation of the National Developmental Hip Dysplasia (DDH) Early Diagnosis and Treatment Program, which has been in existence for about 10 years. However, patients with delayed diagnosis are still admitted to our clinic for treatment. In this study, we aimed to evaluate the effectiveness of this program and reveal its deficiencies. Patients and methods: Sixty-one patients diagnosed or treated for ddh later than six months of life were included in the study. Patients born between 2011 and 2014 (Group 1) and between 2015 and 2018, during which time the early screening program was performed intensively (Group 2), were compared. The patients’ risk factors, whether a hip ultrasound (US) was performed, and the reasons for the delay in diagnosis and treatment were questioned retrospectively. The number of DDH patients in Group 2 decreased by approximately 3 times (45/16) (p = 0.0009). Although 37 (61%) patients had a hip US assessment within the first 6 months, their treatment was delayed, and normal USs were reported for 20 (33%) of them. Hip US was not performed in 24 (39%) patients within the first 6 months. The number of late-diagnosed and -treated babies with DDH decreased significantly in recent years, but this is not sufficient. Preventing late diagnoses should be the main goal. This study detected families’ negligence and lack of information, family physicians’ non-compliance with the program, and improper US assessment as the confounding reasons.

Fetal anteroposterior renal pelvic diameter for predicting antenatal hydronephrosis requiring postnatal surgery

To assess the value of fetal anteroposterior renal pelvic diameter (APD) in predicting antenatal hydronephrosis requiring surgical treatment after birth. A total of 525 cases of antenatal hydronephrosis detected by prenatal ultrasonography (ultrasound index APD ≥ 4 mm in the second trimester and APD ≥ 7 mm in the third trimester) in Zhejiang Prenatal Diagnosis Center from June 2007 to June 2018 were retrospectively analyzed. ROC curve was used to analyze the relationship between these ultrasound indicators and the requirement for surgical treatment after birth. There were 162 cases (30.9%) diagnosed in the second trimester and 363 cases (69.1%) diagnosed in the third trimester; 131 cases were diagnosed pathologically after birth, of which 121 finally underwent surgical treatment. The area under ROC curve (AUC) of APD in middle pregnancy for prediction of requiring surgery 1-12 years after birth was 0.910; the cut-off value of APD was 8.45 mm with a sensitivity of 97.1%, specificity of 70.9%, positive predictive value (PPV) of 47.9%, and negative predictive value (NPV) of 98.9%. The AUC of APD in late pregnancy for prediction of requiring surgery 1-12 years after birth was 0.800; the cut-off value of APD was 12.25 mm with a sensitivity of 66.7%, specificity of 81.2%, PPV of 51.7%, and NPV of 89.1%. APD in pregnancy can be used to predict whether the fetus with hydronephrosis needs surgical treatment after birth, and the prediction value of APD in the middle pregnancy is better.

Management of acid burns: Experience from Bangladesh

Acid burn injuries in Bangladesh primarily occur as a result of intentional attacks although there are incidences of accidental acid burns in industry, on the street, and at home. A total of 126 patients with acid burns, 95 from attacks and 31 from accidents, were studied from July 2004 to December 2012. A diagnosis of acid burn was made from history, physical examination and in some cases from chemical analysis of the patients’ clothing. Alkali burns were excluded from the study.In the burn unit of Dhaka Medical College Hospital, we applied a slightly different protocol for management of acid burns, beginning with plain water irrigation of the wound, which effectively reduced burn depth and the requirement of surgical treatment. Application of hydrocolloid dressing for 48–72h helped with the assessment of depth and the course of treatment. Early excision and grafting gives good results but resultant acid trickling creates a marble cake-like appearance of the wound separated by the vital skin. Excision with a scalpel and direct stitching of the wounds are often a good option. Observation of patients on follow-up revealed that wounds showed a tendency for hypertrophy. Application of pressure garments and other scar treatments were given in all cases unless the burn was highly superficial.

UP-01.49: Prostatic abscess - Indian scenario

Prostatic abscess is not uncommon in clinical practice. Most often it is seen in diabetic and immuno compromised individuals. Transrectal ultrasound guided aspiration has been the treatment of the choice in early cases. In Indian scenario complicated prostatic abscess, tuberculosis and malignancy presenting as an abscess and requirement of surgical treatment appears to be more common.