Single Surgical Procedures Research Articles

Platelet-derived concentrates influence human keratinocyte proliferation in vitro and induce wound healing in a prospective case series of chronic wounds of different entities in vivo.

ObjectivesSoft tissues defects can extend into the fat layer or even deeper and can cause significant clinical disadvantages like pain, infections, and loss of function. In particular, chronic wounds are difficult to treat, as split-thickness skin grafts (STSGs) have varying success rates. To improve wound healing in chronic wounds, the authors have studied the application of platelet-mediator concentrate (PMC) in a human keratinocyte culture model in vitro and of autologous platelet concentrates (PRP) in a combination with surgical procedures in vivo as second line therapy in patients with initially failed wound closure.MethodsFor in vitro testing on keratinocytes, a PMC was processed with a commercially available bedside system (ATR®, Curasan, Germany). In a clinical, nonrandomized study, five in-house patients with chronic wounds were treated using a combination of surgical debridement and autologous PRP. Time of healing as determined by epithelization as well as laser Doppler imaging to visualize blood flow was analyzed. Additionally, changes in ease of surgical wound closure were determined. Finally, the quality of life of patients was assessed using a validated questionnaire (clinicaltrials.gov # NCT03667638).ResultsIn vitro testing shows a significant effect of PMC on keratinocyte proliferation in cell culture. Clinical studies showed that patients treated with PRP had initiation of wound closure, higher blood flow after PRP injection, and easier wound closure as well as improved quality of life.ConclusionsThe injection of platelet concentrates to treat chronic wound defects presents a favorable addition to treatment where single surgical procedures have failed and may improve current therapy options.

Impact of the COVID-19 pandemic on delays in surgical procedures in Germany: a multi-center analysis of an administrative registry of 176,783 patients

BackgroundWhile extensive data are available on the postponement of elective surgical procedures due to the COVID-19 pandemic for Germany, data on the impact on emergency procedures is limited.MethodsIn this retrospective case–control study, anonymized case-related routine data of a Germany-wide voluntary hospital association (CLINOTEL association) of 66 hospitals was analyzed. Operation volumes, in-hospital mortality, and COVID-19 prevalence rates in digestive surgery procedure groups and selected single surgical procedures in the one-year periods before and after the outbreak of the COVID-19 pandemic were analyzed. The analysis was stratified by admitting department (direct admission or transfer to the general surgical department, i.e., primary or secondary surgical patients) and type of admission (elective/emergent).ResultsThe total number of primary and secondary surgical patients decreased by 22.7% and 11.7%, respectively. Among primary surgical patients more pronounced reductions were observed in elective (-25.6%) than emergency cases (-18.8%). Most affected procedures were thyroidectomies (-30.2%), operations on the anus (-24.2%), and closure of abdominal hernias (-23.9%; all P’s < 0.001). Declines were also observed in colorectal (-9.0%, P = 0.002), but not in rectal cancer surgery (-3.9%, n.s.). Mortality was slightly increased in primary (1.3 vs. 1.5%, P < 0.001), but not in secondary surgical cases. The one-year prevalence of COVID-19 in general surgical patients was low (0.6%), but a significant driver of mortality (OR = 9.63, P < 0.001).ConclusionsCompared to the previous year period, the number of patients in general and visceral surgery decreased by 22.7% in the first pandemic year. At the procedure level, a decrease of 14.8% was observed for elective procedures and 6.0% for emergency procedures. COVID-19 infections in general surgical patients are rare (0.6% prevalence), but associated with high mortality (21.8%).Trial registrationThe present study does not meet the ICMJE definition of a clinical trial and was therefore not registered.

Association of new opioid continuation with surgical specialty and type in the United States

BackgroundThe consequences of opioids—including post-surgical prescriptions—remain a critical public health issue. We sought to determine how procedure type and subspecialty group influence new opioid use after procedures. MethodsWe analyzed 2011–2015 IBM MarketScan Research Databases to identify opioid-naïve adults prescribed opioids for single surgical procedures. We defined new opioid continuation (primary outcome) a priori as receipt of prescription opioids between 90 and 180 days after the procedure. ResultsAmong 912,882 individuals, new opioid continuation was higher for non-operating room compared to operating room procedures (13.1% versus 9.2%; aOR 1.61; 95% CI 1.59–1.64) and higher for subspecialties including colorectal surgery (aOR 1.35; 95% CI 1.26–1.43) and cardiovascular surgery (aOR 1.30; 95% CI 1.12–1.50) compared to urology as a referent. New opioid continuation was also associated with perioperative opioid prescription dosage, days’ supply, preoperative receipt, and multiple prescriptions. ConclusionsOpioids prescriptions associated with non-operating room surgical exposures appear to confer higher risk regarding conversion to new long-term opioid use.

Oncoplastic breast-conserving surgery: More relevant than ever? Results of a survey among breast surgeons.

Oncoplastic breast-conserving surgery has been part of clinical routine for several years without an internationally accepted nomenclature, standardization or a systematic evaluation of single surgical procedures. We carried out a structured survey of breast surgeons (n = 50) during the annual meeting of the German Society for Senology in Berlin 2017. In the run-up to the event, 10 questions were determined and released for an anonymous survey during the consensus meeting. Most surgeons participating in the consensus meeting had an expertise of more than 200 oncologic breast surgeries in the last 3years and approved the need of a higher rate of standardization in oncoplastic techniques. From the oncological standpoint, oncoplastic surgery is considered safe with a comparable rate of compilations as seen in conventional breast-conserving procedures. Most surgeons approve that using oncoplastic surgery, higher rates of breast conservation and improved aesthetic results can be accomplished. The majority of the participants would endorse a more systematic review of subjective aesthetic results in clinical routine. A higher degree in standardization of oncoplastic breast surgery is required for surgical-technical, educational, and scientific reasons as well as for a more differentiated monetary compensation of the surgical procedures. This process has already been started.

Baseline and Postoperative C-reactive Protein Levels Predict Long-Term Survival After Lung Metastasectomy.

Blood level of C-reactive protein (CRP) at diagnosis is a well-know prognostic bio-marker in different primary tumors, but its role has not been investigated in resectable lung metastases. The aim of our study is to assess the predictive value of baseline (CRP0) and 3rd postoperative day (CRP3) levels on long-term survival of patients undergoing lung metastasectomy. A total of 846 consecutive patients underwent the first pulmonary resection for lung metastases between January 2003 and December 2015, including 611 (72%) single surgical procedures, 235 (28%) multiple metastasectomies, 501 (59%) epithelial primary tumors, 276 (33%) sarcomas, 66 (8%) melanomas, 286 (33.8%) with 0 risk factors (CRP0 ≤ 2 and CRP3 ≤ 84mg/L) and 560 (66.2%) with ≥ 1 risk factor (CRP0 > 2 and/or CRP3 > 84mg/L). Cumulative 5-year survival was 57% in patients with low CRP (0 risk factors) versus 43% in high CRP (≥ 1 risk factor, p < 0.0002), 62% versus 50% respectively for epithelial tumors (p < 0.0140), and 51% versus 34% for sarcomas (p < 0.0111). Multivariable Cox analysis confirmed a mortality hazard ratio of 2.5 at 1-year and 1.5 at 5-years in patients with high CRP. Baseline and postoperative CRP levels predict survival of patients with resectable lung metastases. These data provide a rationale for prospective clinical trials testing the efficacy of anti-inflammatory or immune-modulating agents as "adjuvant" therapy after lung metastasectomy, in patients with elevated pre- and/or postoperative CRP levels.

Standardised antibacterial Manuka honey in the management of persistent post‐operative corneal oedema: a case series

BackgroundCorneal oedema is a common post‐operative problem that delays or prevents visual recovery from ocular surgery. Honey is a supersaturated solution of sugars with an acidic pH, high osmolarity and low water content. These characteristics inhibit the growth of micro‐organisms, reduce oedema and promote epithelialisation. This clinical case series describes the use of a regulatory approved Leptospermum species honey ophthalmic product, in the management of post‐operative corneal oedema and bullous keratopathy.MethodsA retrospective review of 18 consecutive cases (30 eyes) with corneal oedema persisting beyond one month after single or multiple ocular surgical procedures (phacoemulsification cataract surgery and additional procedures) treated with Optimel Antibacterial Manuka Eye Drops twice to three times daily as an adjunctive therapy to conventional topical management with corticosteroid, aqueous suppressants, hypertonic sodium chloride five per cent, eyelid hygiene and artificial tears. Visual acuity and central corneal thickness were measured before and at the conclusion of Optimel treatment.ResultsA temporary reduction in corneal epithelial oedema lasting up to several hours was observed after the initial Optimel instillation and was associated with a reduction in central corneal thickness, resolution of epithelial microcysts, collapse of epithelial bullae, improved corneal clarity, improved visualisation of the intraocular structures and improved visual acuity. Additionally, with chronic use, reduction in punctate epitheliopathy, reduction in central corneal thickness and improvement in visual acuity were achieved. Temporary stinging after Optimel instillation was experienced. No adverse infectious or inflammatory events occurred during treatment with Optimel.ConclusionsOptimel was a safe and effective adjunctive therapeutic strategy in the management of persistent post‐operative corneal oedema and warrants further investigation in clinical trials.

Interaction of MIF Family Proteins in Myocardial Ischemia/Reperfusion Damage and Their Influence on Clinical Outcome of Cardiac Surgery Patients.

Aims: Cardiac surgery involves myocardial ischemia/reperfusion (I/R) with potentially deleterious consequences. Macrophage migration inhibitory factor (MIF) is a stress-regulating chemokine-like cytokine that protects against I/R damage, but functional links with its homolog, d-dopachrome tautomerase (MIF-2), and the circulating soluble receptor CD74 (sCD74) are unknown. In this study, we investigate the role of MIF, MIF-2, sCD74, and MIF genotypes in patients scheduled for elective single or complex surgical procedures such as coronary artery bypass grafting or valve replacement. Results: MIF and MIF-2 levels significantly increased intraoperatively, whereas measured sCD74 decreased correspondingly. Circulating sCD74/MIF complexes were detectable in 50% of patients and enhanced MIF antioxidant activity. Intraoperative MIF levels were independently associated with a reduced risk for the development of atrial fibrillation (AF) (odds ratio 0.99 [0.98–1.00]; p=0.007). Circulating levels of MIF-2, but not MIF, were associated with an increased frequency of organ dysfunction and predicted the occurrence of AF (area under the curve [AUC]=0.663; p=0.041) and pneumonia (AUC=0.708; p=0.040). Patients with a high-expression MIF genotype exhibited a reduced incidence of organ dysfunction compared with patients with low-expression MIF genotypes (3 vs. 25; p=0.042). Innovation: The current study comprehensively highlights the kinetics and clinical relevance of MIF family proteins and the MIF genotype in cardiac surgery patients. Conclusion: Our findings suggest that increased MIF levels during cardiac surgery feature organ-protective properties during myocardial I/R, while the soluble MIF receptor, sCD74, may enhance MIF antioxidant activity. In contrast, high MIF-2 levels are predictive of the development of organ dysfunction. Importantly, we provide first evidence for a gene–phenotype relationship between variant MIF alleles and clinical outcome in cardiac surgery patients. Antioxid. Redox Signal. 00, 000–000.

The Use of Single Incision Thoracoscopic Surgery in Diagnostic and Therapeutic Thoracic Surgical Procedures

Background : As a minimal invasive procedure, a standard threeportal videothoracoscopy may have complications such as chronic and residual pain. However, a single incision thoracoscopic surgery is a less invasive procedure with minimal complications. We present our series of patients who had single incision thoracoscopic surgical procedures.Patients and methods : A total of 49 patients, 29 (59.2%) male and 20 (40.8%) female with a mean age of 45.7 ± 17.6 years (range, 16 to 86 years) underwent a total of 59 single incision thoracoscopic surgical procedures. We most often made a 2–2.5 cm single incision on the seventh or eighth intercostal space at the midaxillary line. VAS (Visual analogue scale) scores for pain at postoperative day 1 and the mean of chest tube removal times were recorded for each procedure. The patients were discharged following chest tube removal.Results : We performed an overall of 59 procedures including 8 (13.7%) wedge resections for either histologic diagnosis or spontaneous pneumothorax, 4 (6.8%) pleural biopsies, 23 (38.9%) pleurectomies, 9 (15.2%) deloculation and decortications, 5 (8.6%) traumas in and 10 (17.5%) sympathectomies. No patient required an additional thoracoscopic port or conversion to thoracotomy. The overall mean of postoperative VAS scores for all procedures at postoperative day 1 and day 30 were 3.2 ± 0.9 and 1.4 ± 0.5, respectively (p < 0.0001). The overall mean of chest tube removal time was 2.3 ± 0.8 days (median; 2). We observed neither morbidity nor mortality.Conclusions : In selected patients, single incision thoracoscopic surgery is an effective and a safe procedure with lower levels of pain and shorter hospital stay. A wide spectrum of thoracic surgical procedures can be performed with the use of single incision thoracoscopic surgery.

Hybrid Surgical and Radiological Revascularization for Diabetic and Non-Diabetic Lower Limb Ischaemia

Background: Multi-level occlusive arterial disease involving the iliac and distal arteries can be treated with major bypass, sequential or single stage radiological and surgical procedures. We report our experience with the single stage hybrid approach. Methods: All patients who underwent hybrid intervention between June 2008 and June 2011 were reported. Patients deemed medically unfit for major bypass or with insufficient veins were mainly considered. Prospective database of patients, procedures and complications with retrospective review of inpatient, outpatient and operative notes, computed tomographic angiography and duplex scan was performed. Results: Twenty three patients underwent 24 single stage procedures. The patient age ranged from 49 to 88 years (mean 70) with 19 males. Fifteen (65%) patients presented with intermittent claudication, 12 (52%) with short distance ( &lt;= 100 yards) claudication, 12 (52%) with tissue loss and 8 (35%) with rest pain. Overall, 18 (78%) patients were presented with critical ischemia limb. The commonest procedures were iliac angioplasties with endarterectomies or bypasses, 23 out of 24 procedures (96%) were technically successful and 20 out of 22 patients (91%) followed up had clinically successful outcome. The mean ankle brachial pressure index improved from 0.57 to 0.71. Two patients (9%) died, 2 patients (9%) developed severe complications and 6 patients (26%) developed moderate complications within 30 days. Conclusion: Single stage hybrid radiological and surgical procedure for lower limb ischemia is feasible providing high technical and clinical success in patients unfit for major bypass or with limited vein conduit. It saves one admission providing patient convenience and potential cost savings. doi: http://dx.doi.org/10.4021/jcs101w

Clinicopathological characteristics of ganglioneuroma and ganglioneuroblastoma: A report from the CCG and COG

The International Neuroblastoma Pathology Classification (INPC) was the first to clearly define prognostic subgroups in ganglioneuroma (GN) and ganglioneuroblastoma (GNB). Histopathology and tumor resectability of 552 GN/GNB cases from the Children's Cancer Group (CCG) and Children's Oncology Group (COG) neuroblastoma studies were reviewed. The results were analyzed along with clinical information and biological data of the cases. According to the INPC, 300 tumors were classified into the Favorable Histology (FH) group and 252 were into the Unfavorable Histology (UH) group. Tumors in the FH group included 43 ganglioneuroma-maturing (GN-M), 198 ganglioneuroblastoma-intermixed (GNB-I), and 59 ganglioneuroblastoma-nodular, favorable subset (GNB-N-FS), and were often (91%) resected completely by single or multiple surgical procedures. Patients with the FH tumors had an excellent prognosis with no tumor-related deaths. The UH group included ganglioneuroblastoma-nodular, unfavorable subset (GNB-N-US) tumors. Patients with the UH tumors had a high incidence (53%) of distant metastasis at the time of diagnosis, and their prognosis significantly depended on clinical stage (5-year EFS: 80.1% for non-stage 4 patients; 16.7% for stage 4 patients): Complete primary tumor resection was not beneficial to those GNB-N-US patients, regardless of whether metastasis was present or not. MYCN amplification was detected in four tumors in the FH group and six tumors in the UH group. The majority (160/191, 84%) of GN-M and GNB-I tumors had a diploid pattern determined by flow cytometry. Stringent application of the INPC along with clinical staging was critical for prognostic evaluation of the patients with this group of tumors.

The Influence of Propofol Versus Sevoflurane Anesthesia on Outcome in 10,535 Cardiac Surgical Procedures

The purpose of this study was to evaluate the possible cardioprotective effect of sevoflurane versus propofol anesthesia in patients undergoing cardiac surgery. Ten thousand five hundred thirty-five consecutive single cardiac surgical procedures from 3 cardiac centers were reported to a common registry from 1999 to 2005. The registry was established by the National Board of Health, and reporting was obligatory for all public heart centers in Denmark. The patients were stratified according to preoperative risk factors (EuroSCORE parameters). The outcome parameters were 30-day mortality, the incidence of postoperative myocardial infarction, and the incidence of postoperative arrhythmias. Overall, the 30-day mortality was lower after sevoflurane (2.84%) versus propofol (3.30%), although not significantly so (p = 0.18). No difference was found in the incidence of postoperative myocardial infarction (sevoflurane, 7.76%/propofol, 7.47%). Patients with preoperative unstable angina and/or recent myocardial infarction, and thus already "preconditioned," did not show any difference in mortality between anesthetic groups, whereas patients without these predictors showed a lower postoperative mortality after sevoflurane (2.28% v 3.14%, p = 0.015), which can at least partly be explained by a preconditioning-like effect. The data suggest that patients suffering relatively severe preoperative ischemic stress benefited from propofol anesthesia, which can be related to the antioxidant effects of propofol. Patients in the sevoflurane group had a higher incidence of postoperative atrial fibrillation (28.75% v 24.87%, p < 0.001), whereas patients in the propofol group showed a higher incidence of all other arrhythmias. Sevoflurane and propofol both possess some, although different, cardioprotective properties. Sevoflurane appears to be superior to propofol in patients with little or no ischemic heart disease, such as noncoronary artery bypass graft (CABG) surgery and CABG surgery without severe preoperative ischemia, whereas propofol seems superior in patients with severe ischemia, cardiovascular instability, or in acute/urgent surgery.

Single surgical procedures. Vol. 6. A colour atlas of anterior resection of the rectum. Sir Hugh Lockhart-Mummery, R.J. Heald and R.T. Hutchings. 195 × 265 mm. Pp. 64. Illustrated in black and white and colour. London: Wolfe Medical Publications. £12·00

Single surgical procedures. Vol. 6. A colour atlas of anterior resection of the rectum. Sir Hugh Lockhart-Mummery, R.J. Heald and R.T. Hutchings. 195 × 265 mm. Pp. 64. Illustrated in black and white and colour. London: Wolfe Medical Publications. £12·00

Single surgical procedures. Vol. 9. A colour atlas of treatment for carpal tunnel syndrome W. Bruce Conolly. 200 £ 260 mm. Pp. 96. Illustrated in colour. 1984. London: Wolfe Medical Publications Ltd. £12.00

Single surgical procedures. Vol. 9. A colour atlas of treatment for carpal tunnel syndrome W. Bruce Conolly. 200 £ 260 mm. Pp. 96. Illustrated in colour. 1984. London: Wolfe Medical Publications Ltd. £12.00 Get access Single Surgical Procedures. Vol. 9. A Colour Atlas of Treatment for Carpal Tunnel Syndrome. W Bruce Conolly. 200 £ 260 mm. Pp. 96. Illustrated in colour. 1984. London: Wolfe Medical Publications Ltd. £12.00. J Dinley J Dinley Search for other works by this author on: Oxford Academic Google Scholar British Journal of Surgery, Volume 71, Issue 10, October 1984, Pages 815–816, https://doi.org/10.1002/bjs.1800711031 Published: 08 December 2005

Single surgical procedures. Vol. 11. A colour atlas of surgery for undescended testes L. Spitz. 195 × 265 mm. Pp. 64. Illustrated in colour. 1984. London: Wolfe Medical Publications. £12.00

Single surgical procedures. Vol. 11. A colour atlas of surgery for undescended testes L. Spitz. 195 × 265 mm. Pp. 64. Illustrated in colour. 1984. London: Wolfe Medical Publications. £12.00

A colour atlas of gastric revision operations: Single surgical procedures 33. J. Alexander-Williams. 260 × 195 mm. Pp. 64. Illustrated. 1986. London: Wolfe Medical Publications Ltd. £14.00

Journal Article A colour atlas of gastric revision operations: Single surgical procedures 33. J. Alexander-Williams. 260 × 195 mm. Pp. 64. Illustrated. 1986. London: Wolfe Medical Publications Ltd. £14.00 Get access A Colour Atlas of Gastric Revision Operations: Single Surgical Procedures 33. J Alexander-Williams. 260 × 195 mm. Pp. 64. Illustrated. 1986. London: Wolfe Medical Publications Ltd. £14.00. C S McArdle C S McArdle Search for other works by this author on: Oxford Academic Google Scholar British Journal of Surgery, Volume 73, Issue 12, December 1986, Page 1051, https://doi.org/10.1002/bjs.1800731247 Published: 08 December 2005

Single surgical procedures. Vol. 8. A colour Atlas of surgery for various veins C. V. Ruckley. 195 × 265 mm. Pp. 64. Illustrated in black and white and colour. 1983. London: Wolfe Medical Publications. £12.00

Journal Article Single surgical procedures. Vol. 8. A colour Atlas of surgery for various veins C. V. Ruckley. 195 × 265 mm. Pp. 64. Illustrated in black and white and colour. 1983. London: Wolfe Medical Publications. £12.00 Get access Single Surgical Procedures. Vol. 8. A Colour Atlas of Surgery for Various Veins. C V Ruckley. 195 × 265 mm. Pp. 64. Illustrated in black and white and colour. 1983. London: Wolfe Medical Publications. £12.00. J Brain J Brain Search for other works by this author on: Oxford Academic Google Scholar British Journal of Surgery, Volume 71, Issue 10, October 1984, Page 816, https://doi.org/10.1002/bjs.1800711034 Published: 07 December 2005

Single Surgical Procedures. Vol. 12. A Colour Atlast of Operations on the Internal Carotid Artery H. H. G. Eastcott. 200 × 260 mm. Pp. 63. Illustrated in colour. 1984. London: Wolfe Medical Publications. £12.00

Single Surgical Procedures. Vol. 12. A Colour Atlast of Operations on the Internal Carotid Artery H. H. G. Eastcott. 200 × 260 mm. Pp. 63. Illustrated in colour. 1984. London: Wolfe Medical Publications. £12.00

Single Surgical procedures. Vol. 7. A colour atlas of boari bladder-flap procedure J. G. Gow. 195 × 265 mm. Pp. 64. Illustrated in black and white and colour. 1983. London: Wolfe Medical Publications. £12.00

Single Surgical procedures. Vol. 7. A colour atlas of boari bladder-flap procedure J. G. Gow. 195 × 265 mm. Pp. 64. Illustrated in black and white and colour. 1983. London: Wolfe Medical Publications. £12.00

Behandlung von zerebralen Metastasen beim Mammakarzinom

Treatment of patients with brain metastases is based on an interdisciplinary approach. It is essential to perform a differenciated indication for procedures with consideration of all therapeutical options like modalities of radiotherapy, surgery and oncology. In the case of multiple brain metastases the whole brain radiotherapy is the standard of treatment, while in case of a single or solitary brain metastasis surgical procedures followed by radiotherapy should be preferred.

Ergebnisse der chirurgischen Therapie der chronischen Pankreatitis

The reported surgical spectrum of the treatment of chronic pancreatitis needs a subtle and accurate diagnosis. The literature shows a considerable difference between various authours of single surgical procedures. Relatively good longterm results are commonly described for the pancreaticojejunostomy of Partington-Rochelle. The results of all surgical techniques: the inability to work runs up to 20 to 60%, the endocrine insufficiency to 20% and exocrine insufficiency of the organ to 30%. Additionally, a 20% rate of recurrence and an overall lethality of 15 % are described. Alltogether, the success of treatment of the chronic pancreatitis depends less on the surgical technique, but mainly on the absence of specific pathophysiological noxae in the postoperative period.