Surgical Treatment Of Patients Research Articles

Features of Performing Single-port Laparoscopic Cholecystectomy

The advantages of endoscopic surgery are well known, which has been confirmed by domestic and world experience in the use of minimally invasive technologies. Along with this, the widespread introduction of operative laparoscopy has led to complications specific to this technology. When performing laparoscopic operations, 3 to 6 trocars are inserted into the abdominal cavity. A large number of undesirable consequences of the introduction of trocars into the abdominal cavity, the so-called trocar complications (iatrogenic damage to internal organs, blood vessels, extraperitoneal insufflation, development of trocar hernias with deterioration of the aesthetic result, increased postoperative pain, increased risk of complications associated with the occurrence of hematomas, wound infections), served as the basis for the search for less invasive techniques. The rapid development of endoscopic surgery has contributed to the emergence of a wide range of surgical methods that do not leave gross scar changes on the skin of the anterior abdominal wall. These include single-port laparoscopic cholecystectomy, which reduces trauma to the anterior abdominal wall and improves cosmetic results. The clinical significance of the single laparoscopic approach (SLA) technique in the surgical treatment of patients with chronic calculous cholecystitis should be substantiated. The study included 116 patients hospitalized for planned surgical treatment with a diagnosis of gallstone disease. Chronic calculous cholecystitis” from 2019 to 2023 on the basis of the National Chemical Center named after M.M. Mamakeev of the Ministry of Health of the Kyrgyz Republic, Bishkek. The use of a single laparoscopic access technique for removing the gallbladder with proper selection of patients and strict adherence to methodological and technical principles makes it possible to achieve better results in the treatment of patients with cholelithiasis with access along the upper edge around the navel than with a longitudinal transubial approach.

Bariatric Surgery in Patients with Previous Cardiac Revascularization: Review of Literature.

Background: The diet and physical activity of the world's population determine the increase in the number of bariatric surgeries. The most common types of bariatric surgery are laparoscopic sleeve gastrectomy (LSG) and Roux-Y gastric bypass (RYGB). Surgical interventions are carried out in patients with numerous comorbidities, among which the most common are cardiovascular diseases. The aim of the present study was to review the literature regarding the safety and results of surgical treatment in patients with cardiac revascularization prior to surgery. Methods: We performed an online search in Pubmed in September 2023 to identify articles that reported cardiac revascularization prior to bariatric surgery. The extracted information included details of the working method, number of patients, types of cardiovascular disease-heart failure (HF) and cardiac artery disease (CAD), types of revascularization-coronary artery bypass graft (CABG), percutaneous coronary intervention (PCI) or both CABG + PCI, demographic data (age, gender, race), clinical characteristics (body mass index-BMI, smoking status), comorbidities (diabetes mellitus, hypertension, prior myocardial infarction), postoperative complications, and postoperative results. Results: A total of 171 records were identified by the initial search, and 165 papers were excluded after applying the exclusion criteria (types of cardiovascular disease, types of revascularization, and demographic data). We evaluated a group of 9479 patients of which 730 had HF, 2621 CAD, and 1426 underwent prior cardiac revascularization. The analysis of the demographic data showed an average age of 55.5 years and a fluctuation of the male gender between 39% and 71.1%, and the female gender between 28.9% and 61%. The main types of bariatric interventions were RYGB (3659 cases) and LSG (659 cases), to which adjustable gastric band (AGB) and bilio-pancreatic diversion-duodenal switch (BPD-DS) were added. Among the most postprocedural complications were ST-segment elevation myocardial infarction (2 patients), gastro-intestinal bleeding (51 cases), pulmonary embolism (1 patient), arrhythmia (3 patients) and pacemaker insertion (1 patient). The recorded postoperative mortality rate was 0.42% (6 cases). Conclusions: Bariatric surgery remains safe in patients with cardiac revascularization. These finding need to be confirmed in more large-scale randomized trials.

Connective tissue disorder is a risk factor for ileoanal pouch failure: A case-control study

IntroductionIleal-pouch anal anastomosis (IPAA) is a widely preferred surgical intervention in patients with medically refractory ulcerative colitis, familial adenomatous polyposis, and indeterminate colitis. Concerns have been raised regarding the impact of connective tissue disorders on the outcomes of IPAA owing to potential alterations in collagen metabolism. To date, there is a lack of studies assessing the feasibility, long-term viability, and pouch function of IPAA in patients with connective tissue disorders. We hypothesized that the presence of a connective tissue disorder was associated with an increased risk of pouch failure. MethodsData were collected from a prospectively maintained pouch database and chart review. Patients with connective tissue disorders were propensity score matched in a 1:5 ratio with control pouch patients without connective tissue disorders. A comparative analysis of the demographics, long-term complications, functional outcomes, and QoL was conducted. ResultsNineteen patients with connective tissue disorders were matched with 95 control pouch patients. Postoperative diagnoses included ulcerative colitis (82.5%), indeterminate colitis (7%), constipation (5.3%), Crohn's disease (4.4%), and familial adenomatous polyposis (1%). The connective tissue disorders identified included unspecified diffuse connective tissue disorders (26.3%), Ehlers-Danlos syndrome (15.7%), Sjögren's syndrome (15.7%), and others (31.2%). Patients with connective tissue disorders were more likely to have pouch leaks (OR 4.8, 95% CI: 1.54,15, p=0.007), pouchitis (OR 3.02, 95% CI: 1.09, 8.37, p=0.034), pouch revisions (OR 3.83, 95% CI: 1.31,11.2, p=0.014), and pouch failure (OR 3.55, 95% CI: 1.25, 10.1, p=0.017). When questioned, patients with connective tissue diseases were more likely to have work restrictions (OR 4.68, 95% CI: 0.74, 6.38, p=0.005) and a worse quality of life (std. estimate -0.15, 95% CI: -0.28,-0.19, p=0.025). ConclusionPatients with connective tissue diseases are more likely to be affected by pouch-related complications and pouch failure and report worse quality of life. Physicians treating patients with these disorders should counsel patients appropriately and be aware of the elevated risks of leaks, pouchitis, and pouch failure.

Variation in surgical treatment by body mass index in patients with invasive lobular carcinoma of the breast

PurposePatients with invasive lobular carcinoma (ILC) face high rates of positive margins and completion mastectomy, which can be improved with the use of specific techniques, such as oncoplastic surgery. However, prior studies have shown that type of breast cancer surgery performed is also associated with patient factors such as elevated body mass index (BMI). Thus, this study investigates whether BMI impacts the type of surgical interventions in patients with ILC.MethodsA retrospective analysis of 705 patients with stage I–III ILC from an institutional database was conducted. Patients were stratified by BMI (underweight, normal weight, overweight, obese). Pearson’s Chi-square, ANOVA, and multivariable logistic regression were used to evaluate the relationship between BMI and surgical procedures.ResultsBreast-conserving surgery (BCS) was the initial operation in 60% of patients, with no significant difference by BMI. Among those undergoing BCS, patients with obese BMI were significantly more likely to undergo oncoplastic surgery (46.9% vs. 7.7%, 37.3%, and 33.6% for underweight, normal, and overweight, respectively, p = 0.032). Obese BMI patients undergoing mastectomy were less likely to have reconstruction compared to those with underweight, normal weight, and overweight BMI (44.2% vs. 50%, 71.1%, and 64.1%, p = 0.002).ConclusionOverweight/obese BMI patients with ILC underwent different surgical interventions compared to those with lower BMI. While initial BCS rates were similar, overweight/obese patients had higher oncoplastic surgery rates in BCS and lower reconstruction rates in mastectomy. Further research is needed to understand BMI’s impact on surgical decisions and outcomes in ILC.

Course of the extensor pollicis longus tendon considering the different functional positions of the wrist and the first ray-an anatomical study.

The aim of this anatomical study was to evaluate the course of the extensor pollicis longus (EPL) tendon, its positional relationship to adjacent structures, and the resulting clinical relevance under consideration of various functional positions. Twenty upper extremities from ten adult human cadavers embalmed using Thiel's method were included in this study. The greatest possible movement/slippage of the EPL tendon, the angle at which the tendon wraps around Lister's tubercle, and its course across the extensor carpi radialis longus and brevis (ECRL and ECRB) were recorded and defined in all functional positions. Our findings demonstrate ahigh range of motion of the tendon in relation to clinically relevant structures. Understanding the anatomical course of the EPL tendon, its potential extent of movement, and its resulting positional changes is essential for the diagnosis and surgical treatment of patients with complaints or injuries in the dorsoradial wrist region.

Analysis of long-term results of conservative and surgical treatment in patients with locally advanced squamous cell carcinoma of the nasal cavity and paranasal sinuses

Introduction. Surgical intervention with subsequent chemoradiation therapy is one of the treatment standards in squamous cell carcinoma of the nasal cavity and paranasal sinuses. However, the question of the optimal therapy for this pathology remains open.Aim. To compare treatment results in patients with locally advanced squamous cell carcinoma of the nasal cavity and paranasal sinuses after conservative and surgical treatment.Materials and methods. The study included 86 patients with squamous cell carcinoma of the nasal cavity and paranasal sinuses, stages III–Iva, who between 2000 and 2020 received treatment at the N.N. Blokhin National medical Research Oncology Center. Surgical treatment with subsequent radiation or chemoradiation therapy was performed in 31 patients, conservative treatment (radiation or chemoradiation therapy) was performed in 55 patients.Results. Five-year overall survival in the conservative treatment group was 46.2 %, in the surgical treatment group – 59.7 % (р = 0.081); 5-year progression-free survival was 17 and 50.5 %, respectively (p = 0.002). In patients with Т3N0 tumor who received surgical treatment, 5-year progression-free survival was significantly higher than in patients who received conservative treatment (p <0,05). Comparison of overall survival and progression-free survival of patients who achieved objective response (complete response + partial response) after conservative treatment (n =36) and after surgical treatment (n = 31) did not show statistically significant differences (р = 0.469 and р = 0.183, respectively). The overall 5-year survival rate in the salvage surgery treatment group (24/55) was 63.1 % compared with 59.7 % in the surgical treatment group (n = 31), there were also no significant differences (p = 0.95). In patients with T3 tumor who received conservative treatment in this study, higher risk of progression was observed compared to patients who underwent surgical treatment.Conclusion. Surgical intervention remains an important treatment method for patients with locally advanced squamous cell carcinoma of the nasal cavity and paranasal sinuses, especially in cases of smaller tumor extent. Conservative therapy seems promising but large-scale prospective controlled randomized clinical trials are necessary to confirm its effectiveness and safety in various patient groups.

Impact of BMI on Dyspnea and Need for Surgical Intervention in Bilateral Vocal Fold Immobility.

Bilateral vocal fold paralysis (BVFP) and posterior glottic stenosis (PGS) are causes of bilateral vocal fold immobility (BVFI) and may cause shortness of breath, stridor, and need for surgical intervention. Although increased body mass index (BMI) is associated with restrictive breathing patterns in patients with normal upper airways, it is unclear how BMI impacts dyspnea and need for surgical intervention in BVFI patients. Retrospective cohort study. Three tertiary academic centers in the United States. Demographics, BMI, Dyspnea Index (DI), etiology, presence of tracheostomy and surgical intervention (dilation, tracheostomy, cordotomy, arytenoidectomy, open reconstruction) were collected. Primary outcomes included dyspnea measured by DI and need for surgery to improve airway. Linear regressions were performed to assess continuous outcomes. Mann-Whitney U-test was utilized to assess categorical outcomes. Among 121 patients, 52 presented with BVFP and 69 with PGS. Previous neck surgery was the most common cause of BVFI (40.2%). 44.3% of patients received a tracheostomy. Through multivariate linear regression, increased BMI was significantly associated with increased DI in the entire cohort (β = .43, P = .016). Increased BMI was also associated with need for any surgical intervention (odds ratio [OR] = 1.07, 95% confidence interval [CI] = [1.01-1.13]) in the overall cohort. When stratifying our data, BMI was only significantly associated with DI in BVFP (β = .496) and need for surgical intervention in PGS (OR = 1.11, 95% CI = [1.01-1.21]), although a positive trend was seen in all analyses. Increased BMI may correlate with worsening dyspnea symptoms and need for surgical intervention in patients with BVFI. Weight-loss-related counseling may benefit symptom management.

Two-Year Functional Outcomes of Nonsurgical Treatment in Concomitant Anterior Cruciate Ligament and Medial Collateral Ligament Injuries: A Case-Control Study.

The anterior cruciate ligament (ACL) is a common knee injury in high-intensity sports, which can cause early career loss in young athletes. Concomitant damage to other knee stabilizers may occur, such as the medial collateral ligament (MCL). Recent studies have shown that knee stability can increase without surgical intervention in patients with ACL and MCL injuries. Regarding the importance of functional tests in return to exercise prediction, this study aims to measure nonsurgical approach's long-term outcome for concomitant ACL and MCL injuries with a focus on functional tests. This is a case-control study with a 2-year follow-up. The case group consisted of patients who had provided written consent and completed their 2-year follow-up, and the control group was made up of healthy people who did not have any knee medical conditions and were matched by age, gender, and activity level. Physical examinations, Tegner and International Knee Documentation Committee questionnaires, and knee magnetic resonance imaging were conducted, and functional performance tests were performed after a 10-minute warm-up. Lody's index (the ratio of injured-to-uninjured knee results) was calculated. The data were analyzed using independent t-test, one-way analysis of variance, chi-squared test, and Fisher's exact test. The study involved 11 patients in each concomitant ACL and MCL injury cases and healthy control groups with a mean age of 32.4 and 28 years, respectively. None of the patients reported knee instability symptoms in the 2-year follow-up. More than half of the patients continued their sports field without reinjury, with no significant difference in activity levels between case and control groups. The 6-meter hop test and single-leg hop test showed no significant difference between case and control groups (p-value: 0.326, 0.859), and no significant difference was observed in the three Carioca, cocontraction, and Shuttle tests in the 2-year follow-up. Functional tests in ACL and MCL injuries revealed normal outcomes, implying a nonsurgical approach for patients with proximal ACL tears, better knee stability, and no significant differences between the injured and control groups.

Latest knowledge on a comprehensive understanding of cervical deformity and selection of effective treatment methods using recent classification systems: a narrative review.

Surgical treatment for patients with cervical spine deformities is challenging for both patients and doctors. For successful surgical treatment, mastery of processes is important to objectively evaluate and classify the degree of deformity. Recently, efforts have been increasing to systematically understand, evaluate, and effectively treat complex cervical spine deformities. Various parameters are being developed to quantify and objectively evaluate the degree of cervical spine deformity, and classification methods are being introduced to help establish the treatment scope by categorizing it according to the degree of deformity. However, a comprehensive and systematic understanding of complex deformities using only the currently introduced classification methods and related knowledge is not easy. Through this review, we aimed to introduce various classification methods and their pros and cons to evaluate cervical deformities, analyze their meaning, and provide a basic understanding of the evaluation and classification of patients with cervical spine deformities. This review also aimed to aid in the decision-making process for the treatment of cervical spine deformities by presenting a structured treatment algorithm based on recently known classification systems and lay the foundation for efficient treatment.

Outcomes and prognosis of postpartum hemorrhage according to management protocol: an 11-year retrospective study from two referral centers

BackgroundNo standard treatment guidelines have been established for postpartum hemorrhage (PPH). We aimed to assess the differences in outcomes and prognoses between patients with PPH who underwent surgical and non-surgical treatment.MethodsThis retrospective study included 230 patients diagnosed with PPH at two referral hospitals between August 2013 and October 2023. The patients were divided into non-surgical (group 1, n = 159) and surgical intervention groups (group 2, n = 71). A subgroup analysis was performed by dividing the surgical intervention group into immediate (n = 45) and delayed surgical intervention groups (n = 26).ResultsInitial lactic acid levels and shock index were significantly higher in group 2 (2.85 ± 1.37 vs. 4.54 ± 3.63 mmol/L, p = 0.001, and 0.83 ± 0.26 vs. 1.10 ± 0.51, p < 0.001, respectively). Conversely, initial heart rate and body temperature were significantly lower in group 2 (92.5 ± 21.0 vs. 109.0 ± 28.1 beat/min, p < 0.001, and 37.3 ± 0.8 °C vs. 37.0 ± 0.9 °C, p = 0.011, respectively). Logistic regression analysis identified low initial body temperature, high lactic acid level, and shock index as independent predictors of surgical intervention (p = 0.029, p = 0.027, and p = 0.049, respectively). Regarding the causes of PPH, tone was significantly more prevalent in group 1 (57.2% vs. 35.2%, p = 0.002), whereas trauma was significantly more prevalent in group 2 (24.5% vs. 39.4%, p = 0.030). Group 2 had worse overall outcomes and prognoses than group 1. The subgroup analysis showed significantly higher rates of uterine atony combined with other causes, hysterectomy, and disseminated intravascular coagulopathy in the delayed surgical intervention group than the immediate surgical intervention group (42.2% vs. 69.2%, p = 0.027; 51.1% vs. 73.1%, p = 0.049; and 17.8% vs. 46.2%, p = 0.018, respectively).ConclusionsPatients with PPH presenting with increased lactic acid levels and shock index and decreased body temperature may be surgical candidates. Additionally, immediate surgical intervention in patients with uterine atony combined with other causes of PPH could improve prognosis and reduce postoperative complications.

No Clinical Advantage of Harvesting a Patellar Bone Block Compared With All Soft-Tissue Graft in Primary Quadriceps Tendon Anterior Cruciate Ligament Reconstruction

PurposeTo compare patient-reported outcomes measurements (PROMs) and subsequent surgical interventions in patients treated with anterior cruciate ligament reconstruction (ACLR) using either quadriceps tendon autograft with a patellar bone block (bQT) or soft tissue only (sQT). MethodsAll ACLRs performed between 01.2010 and 03.2022 were prospectively followed for 24 months and retrospectively evaluated. All primary ACLRs with full 24 months of follow-up data, without any previous surgery or any additional ligamentous interventions, were matched for major ACL risk factors, including gender, age, Tegner activity level (TAL), pivoting sports, and concomitant injuries. PROMs (Lysholm score, Visual Analog Scale (VAS) for pain, and TAL) and subsequent surgical interventions were registered after 6, 12, and 24 months postoperative. Binary logistic regression was used to assess the influence of graft type, age, preinjury TAL, gender, pivoting sports and concomitant interventions on the need to undergo subsequent surgery. ResultsAfter matching, 246 patients were included in the final analysis. Both groups did not differ regarding any preoperative patient demographics or intraoperative details. At final follow-up, no significant difference in mean Lysholm score (sQT: 90.8±10.6, bQT: 91.8±10.6, p= .46), median TAL (sQT: 6 [1-10], bQT: 6 [1-10], p= .53) and VAS for pain (sQT: 0.7±1.1, bQT: 0.7±1.2, p= .70) was reported between both groups. 70.3% (sQT-A: 70.7%, bQT: 69.9%, p= .89) of patients returned to or exceeded their preinjury activity level. In terms of revision ACLR, there was no statistically significant difference between bQT (3.3%) and sQT (4.1%). Similarly, no difference was observed in contralateral ACLR (bQT: 7.3% sQT: 11.4%). Regression analysis indicated that none of the studied factors, including the use of a patellar bone block, influenced subsequent surgery, revision ACLR, or contralateral ACLR. ConclusionHarvesting an additional patellar bone block in quadriceps tendon ACL reconstruction does not seem to impact postoperative patient-reported outcomes, ACL revision- or contralateral ACL reconstruction rates. Level of EvidenceLevel 3 – Cohort Study

Evaluation of aesthetic results of surgical treatment in patients with sagittal craniosynostosis using anthropometry

Evaluation of aesthetic results of surgical treatment in patients with sagittal craniosynostosis using anthropometry

Clinical and Audiological Outcome of Surgical Treatment in Patients with Adenoid Hypertrophy

Background: Adenoid hypertrophy is a common condition in childhood, which may be associated with recurring acute otitis media, otitis media with effusion (OME), and obstructive sleep apnoea syndrome. There is close relationship between adenoids and possible middle ear pathology leading to conductive deafness. Objective: To find out the outcome of surgery regarding clinical features and hearing status in children with adenoids. Methods: This hospital based prospective study was conducted at the Department of Otolaryngology&amp; Head-Neck Surgery, Shaheed Suhrawardy Medical College &amp; Hospital, for a period of 6 months following approval from IRB. Patients having enlarged adenoids with or without OME of 3-12 years and both sex group were approached for inclusion of the study. Informed written consent was taken from the guardian. Proper surgical intervention was chosen according to condition of the child. Before and after intervention, data were collected by the researcher himself. Data were recorded into the case record form. Following collection, data were analyzed by the SPSS 26 (SPSS Inc, Chicago, IL, USA). Results: Among 100 patients, 66% were males and 34% were females. Mean age was 7.2±2.34 SD (years). Of all, 60% underwent adenoidectomy (AT), 20% underwent adenoidectomy with myringotomy (AM), and remaining 20% underwent adenoidectomy with myringotomy with grommet insertion (AMG). The PTA findings (baseline) of adenoidectomy, adenoidectomy with myringotomy, and adenoidectomy with myringotomy with grommet insertion group were 15.466±1.395, 37.8±3.349 and 38.2±3.548 db, respectively. Similarly, significant improvement was noticed in all of the three groups as evidenced by PTA value in three groups were 11.91±1.12, 18.65±.933 and 17.45±1.31 db, respectively (p&lt;0.05). Improvements in PTA among different groups also showed significant changes following operation (p&lt;0.05). Conclusion: Clinical improvement are noticed following surgical intervention in both ............

Postoperative body weight change and its influencing factors in patients with gastric cancer.

The high incidence and mortality of gastric cancer (GC) pose a significant threat to human life and health, and it has become an important public health challenge in China. Body weight loss is a common complication after surgical treatment in patients with GC and is associated with poor prognosis and GC recurrence. However, current attention to postoperative weight change in GC patients remains insufficient, and the descriptions of postoperative weight change and its influencing factors are also different. To investigate body weight changes in patients with GC within 6 mo after gastrectomy and identify factors that influence dynamic body weight changes. We conducted a prospective longitudinal study of 121 patients with GC and collected data before (T0) and 1 (T1), 3 (T2), and 6 (T3) mo after gastrectomy using a general data questionnaire, psychological distress thermometer, and body weight measurements. The general estimation equation (GEE) was used to analyze the dynamic trends of body weight changes and factors that influence body weight changes in patients with GC within 6 mo of gastrectomy. The median weight loss at T1, T2, and T3 was 7.29% (2.84%, 9.40%), 11.11% (7.64%, 14.91%), and 14.75% (8.80%, 19.84%), respectively. The GEE results showed that preoperative body mass index (BMI), significant psychological distress, religious beliefs, and sex were risk factors for weight loss in patients with GC within 6 mo after gastrectomy (P < 0.05). Compared with preoperative low-weight patients, preoperative obese patients were more likely to have weight loss (β = 14.685, P < 0.001). Furthermore, patients with significant psychological distress were more likely to lose weight than those without (β = 2.490, P < 0.001), and religious patients were less likely to lose weight 6 mo after gastrectomy than those without religious beliefs (β = -6.844, P = 0.001). Compared to female patients, male patients were more likely to experience weight loss 6 mo after gastrectomy (β = 4.262, P = 0.038). Male patients with GC with high preoperative BMI, significant psychological distress, and no religious beliefs are more likely to lose weight after gastrectomy.

Recommendations for 46,XY Disorders/Differences of Sex Development Across Two Decades: Insights from North American Pediatric Endocrinologists and Urologists

Clinical decision-making for individuals with 46,XY disorders/differences of sex development (DSD) remains unsettled and controversial. The North American DSD Clinician Survey examines the recommendations of a large group of clinical specialists over the last two decades. Active members of the (Lawson Wilkins) Pediatric Endocrine Society and the Societies for Pediatric Urology were invited to respond to a web-based survey at three different timepoints: 2003–2004 (T1), 2010–2011 (T2), and 2019–2020 (T3). Data from 429 participants in T1, 435 in T2, and 264 in T3 were included in this study. The participants were presented with three XY newborn clinical case scenarios—micropenis, partial androgen insensitivity syndrome, and iatrogenic penile ablation—and asked for clinical management recommendations. The main outcomes assessed included the recommended gender of rearing, surgical decision-maker (parent or patient), timing of genital surgery, and age at which to disclose medical details and surgical history to the patient. For all scenarios, the overwhelming majority recommended rearing as male, including a significant increase across timepoints in those recommending a male gender of rearing for the infant with penile ablation. The proportions recommending female gender of rearing declined significantly across timepoints. In general, most recommended parents (in consultation with the physician) serve as surgical decision-makers, but these proportions declined significantly across timepoints. Recommendations on the timing of surgery varied based on the patient’s gender and type of surgery. There has been a shift in recommendations away from the “optimal gender policy” regarding gender of rearing and surgical interventions for patients with XY DSD.

Nursing Interventions in Surgical Patients with Hypertension: Strategies for Optimal Perioperative Blood Pressure Management

This study explores nursing interventions for surgical patients with hypertension, emphasizing strategies for optimal perioperative blood pressure management. Hypertension significantly increases surgical risk, necessitating tailored perioperative care. The objective of this research is to identify and evaluate effective nursing interventions that mitigate these risks and improve patient outcomes. A systematic review was conducted, including randomized controlled trials, cohort studies, and clinical guidelines from 2010 to 2023. The analysis focused on preoperative, intraoperative, and postoperative phases, assessing interventions such as medication management, lifestyle modification counseling, patient education, and monitoring protocols. The findings reveal that preoperative optimization of blood pressure through medication adherence and lifestyle adjustments is crucial. Education about the importance of blood pressure control and adherence to prescribed antihypertensive regimens significantly reduces perioperative complications. Intraoperative strategies include continuous blood pressure monitoring and the administration of antihypertensive agents as needed to maintain stability. Postoperative care focuses on regular blood pressure monitoring, early identification of complications, and patient education to ensure long-term management. The study concludes that a multidisciplinary approach involving nurses, surgeons, and anesthesiologists is essential for effective perioperative management in hypertensive patients. Continuous patient education and engagement in their care, combined with vigilant monitoring and timely intervention, significantly reduce adverse outcomes. These findings underscore the importance of comprehensive, patient-centered nursing interventions in enhancing surgical outcomes for hypertensive patients. Future research should focus on developing standardized protocols and exploring the long-term effects of these interventions on surgical morbidity and mortality.

Late-Term Outcomes of Surgical Treatment of Infective Endocarditis.

Background: This study aims to evaluate the long-term outcomes of surgical interventions in patients with infective endocarditis (IE) who underwent surgical treatment and to determine the treatment approach for new patients. Patients and Methods: We retrospectively examined the long-term results of patients who underwent surgical treatment for IE between 2007 and 2017. The evaluation included late-term outcomes of IE surgery, surgical procedures, complications, the postoperative period, and clinical findings. Results: The study included 20 patients (12 male, 8 female) with a mean age of 45.1 ± 17.25. The most common cardiac risk factors for endocarditis development were the presence of prosthetic valves and heart valve disease. In addition, non-cardiac risk factors included chronic renal failure, systemic lupus erythematosus, and pemphigus vulgaris. Preoperative and postoperative laboratory findings were compared with in terms of morbidity and mortality, revealing no significant differences. The most prevalent preoperative laboratory findings were anemia (100%), elevated CRP (100%), and leukocytosis (50%). Anemia persisted as the most common laboratory finding in the postoperative evaluation. Conclusion: Our study identified comorbid chronic medical conditions, neurological complications because of IE, postoperative impaired left ventricular function, and treatment strategies such as monotherapy as poor prognostic factors in patients who underwent surgical treatment for IE. The management of IE is observed to be complex in the presence of comorbidities and complications, adversely affecting both survival and quality of life.

Comparative analysis of different treatment strategies for septic spondylitis: a retrospective study of one hundred and twelve patients.

To compare the clinical efficacy and prognosis differences between conservative treatment and surgical treatment in patients with non-serious neurologically intact pyogenic spondylitis (Nsi-Nsni-PS), and to provide theoretical reference for the clinical treatment of Nsi-Nsni-PS patients. A retrospective analysis was conducted on 112 cases of Nsi-Nsni-PS patients treated in our hospital from June 2016 to June 2021. According to different treatment methods, they were divided into conservative treatment group (53 cases) and surgical treatment group (59 cases). The general data, laboratory tests, imaging examinations, length of hospital stay, duration of antibiotic use, VAS for pain before and after treatment, ODI, local kyphotic angle correction of diseased vertebrae, and recurrence rate were collected and analyzed in both groups. SPSS 26.0 statistical software was used for analysis. Measurement data were expressed as mean ± standard deviation, and independent sample t-test or rank sum test was used for comparison between groups, while variance analysis was used for intra-group comparison. Count data were expressed as number (%) and compared between groups using chi-square test or Fisher's exact test. Mann-Whitney U test was used to evaluate the changes in local kyphotic angle between the two groups. A p value < 0.05 was considered statistically significant. There were no significant differences in general data and imaging characteristics between the two groups (P > 0.05); there were no statistically significant differences in the positive culture rate of pathogens, length of hospital stay, duration of antibiotic use, treatment complications, WBC, CRP, ESR levels at admission and discharge, VAS and ODI at admission and last follow-up between the two groups (P > 0.05). The WBC and CRP levels of patients in the conservative group at discharge were lower than those in the surgical group (P < 0.05), and there was no significant difference in the decrease in inflammatory indicators (WBC, CRP, ESR) between the two groups (P > 0.05). By the last follow-up, the neurological function of patients in both groups had significantly improved compared to admission (P < 0.05), with 12 out of 15 ASIA grade D patients in the conservative group recovering to grade E, and 21 out of 25 grade D patients in the surgical group recovering to grade E, with no worsening of neurological function in either group. The differences in VAS and ODI scores at the last follow-up compared to before treatment were statistically significant in both groups (P < 0.05), and all patients regained normal activity. Compared with before treatment, the correction degree of local kyphotic angle in the surgical group at the last follow-up was 0.93 ± 4.94°, slightly higher than that in the conservative group (-0.83 ± 3.37°), and the difference was statistically significant(P < 0.05). During our follow-up, we found that both conservative and surgical treatments achieved satisfactory clinical outcomes in patients with Nsi-Nsni-PS. Compared to conservative treatment, surgical intervention did not demonstrate significant advantages in reducing hospitalization time and antibiotic usage duration, increasing pathogen culture positivity rate, lowering treatment complications, or controlling recurrence. However, surgical intervention showed superiority in correcting the local kyphotic angle of spinal lesions, albeit with relatively increased surgical trauma, risks, and treatment costs. At the last follow-up, the surgical group did not exhibit better long-term efficacy. Therefore, when formulating clinical treatment strategies for patients with Nsi-Nsni-PS, it may be preferable to prioritize conservative treatment, supplemented by the use of sensitive or empiric antibiotics for infection management, to improve patient prognosis.

Raman Spectroscopy in Optical Non-Invasive Diagnostics of Skin Neoplasms

Introduction. Recent decades indicate a significant increase in the incidence of skin cancer. Aim. To upgrade the specialized device and to improve the quality of skin neoplasm diagnostics. Materials and methods. The study mainly involved the method of non-invasive differential diagnostics of skin neoplasms. The method relies upon optical research methods, including Raman spectroscopy, a spectroscopic technique. A 10-year study, conducted by the Department of Oncology, the Samara Regional Clinical Oncology Dispensary (SOKOD), included more than 500 observations. The study used samples of various skin neoplasms obtained during surgical treatment of patients. Experimental tests provided a certain spectrum of various benign and malignant human skin neoplasms, including melanoma. Results. A series of experimental tests resulted in an experimental setup that is absolutely safe to use. Discussion. The study involved comparison of individual characteristics of the Raman spectra, obtained in the examination of neoplasm and healthy skin for each patient, thereby individualizing the method. The study revealed a high accuracy rate of 92% (with sensitivity of 89%, specificity of 93%), thus minimizing risks of false negative results, which is essential for mass examination. Conclusion. Since the proposed device setup does not require consumable products and different reagents, the method is marked with lower time costs and maintenance burden. Raman spectroscopy obtains a significant potential, thus, can be widely used for skin neoplasms in various medical and preventive institutions.

Effectiveness of 3D visualization technologies in planning and performing reconstructive plastic surgeries in patients with elbow contractures caused by ossification

Background. Open reconstructive plastic surgeries are the most radical method of treating patients with elbow contractures caused by ossification. However, these surgeries pose a serious problem due to the large number of unsatisfactory results. The aim of the study is a comparative assessment of the effectiveness between standard techniques and 3D visualization technologies in the surgical treatment of patients with elbow contractures caused by ossification. Methods. Using random number generation, all patients (n = 71) were randomized into two groups. The first group included 34 patients with elbow contractures caused by ossification that underwent surgical intervention using 3D technologies to assess the ossification process. The second group enrolled 37 patients with a similar nosology that underwent standard examination and surgical treatment. The results were evaluated intraoperatively and 180 days after the surgery. The data were obtained from primary medical records and further survey. Results. The application of new planning technology and tactics for onstructive plastic surgeries made it possible to reduce the surgery time by 1.2 times (p0.05), reduce blood loss by 1.3 times (p0.05) and increase the relative number of patients with sufficient movement volume by 10.6% (p0.05). The assessment of various performance parameters (range of motion, pain syndrome, quality of life etc.) showed that after 6 months in the main group, the relative number of patients with problems related to the operated joint was significantly lower than in the control group: 20.5% vs 84.7% (p0.05). Conclusions. The data obtained indicate that the use of the new technique for planning and performing reconstructive plastic surgery in patients with elbow contractures caused by ossification contributes to a less invasive intervention and achievement of better intraoperative and medium-term treatment results.