Hasil untuk "Surgery"

Shukri F. Khuri, J. Daley, W. Henderson et al.

Yasin Taşkın, Fatih Ersay Deniz, Veysel Kıyak et al.

Abstract Background This study aimed to evaluate the histomorphological cellular and fibrotic responses in rat brain tissue following direct placement of platinum coils, simulating potential coil protrusion or extravasation scenarios encountered during endovascular treatment of ruptured intracranial aneurysms. Methods A burr hole was made in the biparietal bone region of 40 Winstar albino rats to pass through the dura and pia mater, and a platinum coil was placed in the interhemispheric area. The rats were sacrificed on days 3 and 10 to evaluate the changes in the acute and chronic periods, respectively. Subsequently, brain tissues were removed and histomorphological changes were examined. Results The lowest amount of reparative tissue in the treated area was formed in the coil + 3-day group, whereas the highest amount of reparative tissue was formed in the coil-free 10-day group. Further, the amount of reparative tissue in the coil-free 3-day group and the coil + 10-day group was high compared to the coil + 3-day group, whereas low compared to the coil-free 10-day group. These two groups (coil-free 3-day and coil + 10-day) were statistically similar to each other and different from the others. Conclusıons Platinum coil is expected to reduce the development of tissue reaction, which may be a disadvantage for the development of complete occlusion; however, it is important for reducing the possibility of thromboembolism and showing that the protruding coil has no irritating effect on brain tissue.

Omar David Mayorga Dimian, Ricardo Andrade Becerra

El dedo en resorte pediátrico es una afección poco frecuente en la que un dedo, excepto el pulgar, permanece flexionado. Su frecuencia es 10 veces menor y sus causas son variadas, a diferencia del pulgar en resorte, por lo que el tratamiento es completamente diferente. Algunas de las causas son la relación anormal de los tendones profundo y superficial, una decusación más proximal del tendón flexor superficial de los dedos (FDS), nódulos en el FDS o en el flexor profundo de los dedos (FDP), y un engrosamiento de la polea A2 o A3.

Jinfang Ma, Mao Li, Lingxiao Yang et al.

ABSTRACT The pancreatic islets of Langerhans, which are composed of α, β, δ, ε, and PP cells, orchestrate systemic glucose homeostasis through tightly regulated hormone secretion. Although the precise mechanisms involving β cells in the onset and progression of diabetes have been elucidated and insulin replacement therapy remains the primary treatment modality, the regulatory processes, functions, and specific roles of other pancreatic islet hormones in diabetes continue to be the subject of ongoing investigation. At present, a comprehensive review of the secretion and regulation of pancreatic islet cell hormones as well as the related mechanisms of diabetes is lacking. This review synthesizes current knowledge on the secretion mechanisms of insulin, glucagon, somatostatin, ghrelin, and pancreatic polypeptides, emphasizing their functional crosstalk in diabetes. Emerging advances include CRISPR‐based β‐cell regeneration, bioengineered islet transplantation, and bioelectronic interventions aimed at restoring pancreatic function. Future research directions highlight artificial intelligence‐guided prediction of hormone dynamics, therapeutics targeting the gut microbiome–islet axis, and tissue‐engineered artificial islets. By integrating mechanistic insights, physiological roles, and translational innovations, this review outlines precision strategies for targeting islet hormone networks, offering a roadmap toward restoring metabolic equilibrium in diabetes.

Manuel Fuertes-Recuero, José L. López-Hernández, Alejandra Ramírez-Lago et al.

Chimpanzees (<i>Pan troglodytes</i>) rescued from the illegal wildlife trade often suffer from chronic, traumatic injuries that require specialized and prolonged medical treatment in wildlife rehabilitation centers. We present the case report of a two-year-old male chimpanzee admitted at the Tchimpounga Chimpanzee Rehabilitation Center in the Republic of Congo with a chronic periorbital abscess, likely caused by a machete wound sustained during the poaching of his mother. Despite receiving extended antimicrobial therapy, his condition was never fully controlled and progressed to a chronic orbital infection, causing him discomfort and producing chronic purulent discharge. Enucleation was performed under general anesthesia using ketamine and medetomidine, with surgical approach adapted to the distinctive orbital anatomy of chimpanzees. During the procedure, ligation of the optic nerve and ophthalmic vessels was required due to the confined orbital apex and extensive vascularization, ensuring adequate haemostasias and procedural safety. The chimpanzee made an uneventful postoperative recovery, resuming normal feeding and social behavior within 48 h, with complete wound healing occurring within two weeks. This case report highlights the importance of prompt surgical intervention when conservative medical management fails to resolve refractory ocular infections in chimpanzees. It also emphasizes the importance of specific anesthetic protocols, refined surgical techniques and tailored postoperative care in wildlife rehabilitation centers. Documenting and sharing detailed case reports such as this contributes to the limited veterinary literature on great ape surgery and supports evidence-based clinical decision-making to improve the welfare and treatment outcomes of rescued chimpanzees.

Yasushi Oshima, Nobuyoshi Watanabe, Yoshiteru Kajikawa et al.

Abstract Background Meniscal injury and/or extrusion have been indicated as causes of subchondral insufficiency fracture (SIFK). However, mediolateral knee laxity has not been discussed as a risk factor. This is a case report of SIFK potentially caused by mediolateral laxity in the absence of a meniscal disorder. Case presentation A 59-year-old male patient presented with SIFK in the medial femoral condyle without meniscal injury or extrusion. Tibial condylar valgus osteotomy (TCVO) was performed, and the preoperative total mediolateral laxity of 8° in extension and 6° in 80° flexion decreased to 6° and 4°, respectively, two years postoperatively. Moreover, the magnetic resonance images revealed no bone marrow lesions, and the knee injury and osteoarthritis outcome score improved from 61.4 to 79.7. Conclusion A case of SIFK with mediolateral laxity, without meniscal disorder, was successfully treated by TCVO, indicating knee laxity as a potential risk factor for SIFK.

Yiming Mao, Ting Li, Wenqiang Lu et al.

Abstract Glioblastoma (GBM) is an extremely aggressive and diverse type of brain tumor that is associated with a poor prognosis. Immunogenic cell death (ICD) is a particular form of cellular demise that is closely linked to antineoplastic immune responses. However, it is important to note that the function of ICD in GBM is not yet fully understood. Utilizing single-cell analysis, AddModuleScore, and weighted gene co-expression network analyses (WGCNA), ICD-related genes were identified at both the bulk transcriptome and single-cell levels. Based on these newly identified ICD-related genes, a novel signature for GBM was developed employing three machine learning methods: LASSO, XGBoost, and RandomForest. This prognostic model comprises four characteristic genes: G0S2, NEUROD1, SERPINE2, and LZTS1. The overall survival was significantly lower for the high-risk group compared to the low-risk group in the TCGA-GBM cohort (P < 0.001), CGGA693 cohort (P < 0.001), CGGA325 cohort (P < 0.001), and CGGA301 cohort (P < 0.001). This dichotomy indicates that the riskscore encapsulates a spectrum of tumor microenvironment phenotypes, ranging from immune-permissive (high-risk group) to immune-excluded (low-risk group), with direct implications for therapeutic response. Tumor microenvironment profiling has revealed that the high-risk patients display elevated stromal and immune scores, alongside reduced tumor purity, indicative of a densely infiltrated, macrophage-rich microenvironment. By elucidating the interaction between ICD and macrophage biology, this study establishes a robust prognostic model that surpasses traditional clinical parameters, offering insights into tumor microenvironment immunity and therapeutic vulnerabilities in GBM.

Guilin Zhang, Guixing Xu, Yao Tang et al.

Background: Postoperative pain is a significant yet inadequately managed complication following surgery, and auriculotherapy to alleviate acute postoperative pain (APP) and reduce the use of opioids remains controversial. Methods: We searched the MEDLINE, Web of Science, Embase, Cochrane Library, CINAHL Complete, and ClinicalTrials.gov from inception to January 23, 2024 for all randomized controlled trials (RCTs) of auriculotherapy in the treatment of APP. The extracted data underwent risk of bias assessment, meta-analysis, subgroup analyses, sensitivity analysis, meta-regression analysis, and evidence rating. Results: A total of 24 studies involving 2131 patients were included in the meta-analysis. Low-quality evidence indicated that auriculotherapy was effective in reducing pain intensity at 24 [MD(95 %CI)=-0.64(-1.09, −0.19), I2=77 %, P＜0.01], 48 [MD(95 %CI)=-0.49(-0.97, 0.00), I2=71 %, P=0.05], and 72 [MD(95 %CI)=-0.80(-1.32, −0.28), I2=52 %, P＜0.01] hours after surgery, while moderate-quality evidence showed a decrease in total opioid consumption [MD(95 %CI)=-24.41 OME (-38.28, −10.54), I2=95 %, P＜0.01]. However, no significant effects were observed in reducing postoperative nausea or vomiting [RR(95 %CI)=0.61(0.32, 1.16), I2=71 %, P=0.13; RR(95 %CI)=0.32(0.09, 1.18), I2=71 %, P=0.09; RR (95 %CI)=0.34(0.11, 1.06), I2=28 %, P=0.06; for postoperative nausea and vomiting (PONV), postoperative nausea or postoperative vomiting respectively], with evidence ranging from moderate to very low. Additionally, two RCTs found that auriculotherapy could delay the time to the first request for analgesia. Conclusions: The summary estimates indicate that auriculotherapy may be beneficial in reducing APP and opioid consumption in specific surgeries based on low-to-moderate quality evidence. However, high-quality RCTs are still further studied in different surgical populations. Systematic Review Registration: PROSPERO database, CRD42024506989.

Jason W. Savage

John-Anker Zwart, Kjersti Storheim, Anne Marie Fenstad et al.

Objectives The purpose of this study was to investigate whether self-reported musculoskeletal pain (MSP) was associated with a future anterior cruciate ligament reconstruction (ACLR).Methods In this population-based prospective cohort study, we included 8087 participants from the adolescent part of the Trøndelag Health Study (Young-HUNT) in Norway. The exposure was self-reported MSP from the Young-HUNT3 study (2006–2008), which was categorised into two MSP load groups (high MSP and low MSP) based on frequency and number of pain sites. The outcome was ACLRs recorded in the Norwegian Knee Ligament Register between 2006 and 2019. Logistic regression was used to investigate association between MSP load and ACLR, given as ORs with 95% CIs. All tests were two-sided and p values of ≤0.05 were considered statistically significant.Results 8087 adolescents were included. We identified a total of 99 ACLRs, with 6 ACLRs (0.9%) in adolescents who reported high MSP load and 93 ACLRs (1.3%) among those who reported low MSP load. Adolescents reporting high MSP load had 23% lower odds of an ACLR (OR 0.77, 95% CI 0.31 to 1.91) compared with adolescents with low MSP load. However, the CIs were very wide.Conclusion Self-reported high MSP load in adolescents was not associated with increased risk of future ACLR. Although the number of participants was high, the relatively few cases of ACLR mean that we cannot be conclusive about the presence or absence of an association.

Shigeki Arase, Kiminobu Arima, Tomoki Kusafuka et al.

Introduction Retropubic parasymphyseal cysta are rare, and few cases have been reported in men. Case presentation A 65‐year‐old male patient presented with a 6‐month history of pelvic and perineal pain. Magnetic resonance imaging revealed a high‐intensity, irregular‐shaped mass extending from the pubic symphysis to the bladder. Contrast enhancement revealed no uptake in the central part of the mass, indicating a cystic component. Computed tomography showed erosion of the pubic symphysis and pubic osteophytes. Pathological findings of biopsy specimens revealed inflammatory fibrous tissue but no malignancy. The definitive diagnosis was retropubic parasymphyseal cyst associated with inflammation. The patient was treated with cefazolin from 1 day before surgery until postsurgical day 7. Oral antibiotic therapy was then prescribed for 1 month to maximize treatment. After 2 months, the patient’s symptoms resolved. Conclusion Retropubic parasymphyseal cysts with inflammation and smaller asymptomatic cysts can be managed effectively with conservative or minimally invasive treatment.

Elise Piraux, Gregory Reychler, Louise Maertens de Noordhout et al.

Abstract Background Substantial postoperative complications occur after tumor resection for esophagogastric cancers. Physical prehabilitation programs aim to prepare patients for surgery by improving their functional status with the aim of reducing postoperative complications. This systematic review aims to summarize the effects of physical prehabilitation programs on exercise capacity, muscle strength, respiratory muscle function, postoperative outcomes, and health-related quality of life and to determine the optimal design of such a program to improve these outcomes in esophagogastric cancer patients undergoing tumor resection. Methods A systematic literature review was conducted using PubMed, The Cochrane Library, Scopus, and PEDro databases to identify studies evaluating the effects of physical prehabilitation program on exercise capacity, muscle strength, respiratory muscle function, postoperative complications, length of hospital stay, mortality, and health-related quality of life in patients with esophagogastric cancer awaiting surgery. Data from all studies meeting the inclusion criteria were extracted. The quality of each selected study was determined using the Downs and Black checklist. Results Seven studies with 645 participants were included. The preoperative exercise program consisted of respiratory training alone in three studies, a combination of aerobic and resistance training in two studies, and a combination of respiratory, aerobic, and resistance training in two studies. Training frequency ranged from three times a day to twice a week and each session lasted between 20 and 75 min. Four studies were of fair quality and three of good quality. Some studies reported improvements in maximal inspiratory pressure, inspiratory muscle endurance, postoperative (pulmonary) complications, and length of hospital stay in the preoperative exercise group compared to the control group. Conclusion This systematic review reports the current evidence for physical prehabilitation programs in patients with esophagogastric cancer awaiting surgery. However, due to the limited number of randomized controlled trials, the significant heterogeneity of exercise programs, and the questionable quality of the studies, higher quality randomized controlled trials are needed. Trial registration PROSPERO Registration Number: CRD42020176353 .

Sang Hyun Park, Ki Hoon Kim

Ureteral injuries reportedly occur in 2–5% of gunshot wounds to the abdomen, and are even rarer in abdominal stab wounds. Ureteral injuries are usually silent and produce no early signs or symptoms. An unrecognized or mismanaged ureteral injury can lead to significant morbidity and mortality. A 34-year-old woman was transferred to our emergency department from another hospital after removal of a knife on her abdomen. She was diagnosed with isolated ureter injury. An uretero-ureterostomy was performed after stenting of the ureteral catheter. The postoperative course was uneventful, and the patient was discharged on postoperative day 12. Keywords: Ureteral injuries, Stab wounds, Uretero-ureterostomy

Samson Jacky

Slade Ms, Simmons Rl, E. Yunis et al.

Usha Gurunathan, Shakeel Meeran Kunju, Karen Elizabeth Hay et al.

Abstract Background Optimal patient positioning is perceived as an essential factor to increase the success of performing neuraxial blockade. The primary objective of this study was to evaluate the benefit of using a visual image in addition to verbal instructions in order to optimize positioning for spinal block. Methods This was a prospective randomized controlled trial on 85 adult patients undergoing lower limb joint replacements at a tertiary academic hospital. Group 1(n = 43) randomized to receive standardized verbal instructions; Group 2 (n = 42) received standardized verbal instructions in conjunction with visual aids to achieve positioning for spinal anesthesia. The primary outcome measure was the time taken to successful dural puncture. Secondary endpoints were the number of skin punctures, number of intervertebral levels attempted, success at the first intervertebral space attempted and satisfaction of patients and anesthesiologists. Results The unadjusted geometric mean time taken for the procedure using verbal instruction alone was 301 s (95% CI: 236–385) compared to 183 s (95% CI: 143–235) when both verbal and visual instructions were used. Out of the participants in group 2, 90% required ≤2 skin punctures and 10% required ≥3 skin punctures compared to 65% and 35% of the participants in group 1 respectively (p = 0.001). Group 1 required a second anesthesiologist to successfully complete the procedure in 6 patients out of 43 (14%) patients whereas the first anesthesiologist was noted to be successful in all the 42 cases in group 2 (p = 0.03). There were no significant differences in the satisfaction scores of anesthesiologists or patients between the groups. First-pass success was strongly associated with patient satisfaction (Odds ratio: 5.2; 95% CI: 1.0–9.5, p = 0.049). Conclusions Use of a visual aid in addition to verbal instructions to optimize positioning for a spinal block, significantly reduces the time taken for the procedure by an average of 2 min, reduces the number of skin punctures and increases the success rate of the first anesthesiologist. First pass success was strongly associated with patient satisfaction. Trial registration This study was retrospectively registered 30 August 2016, with the Australian New Zealand Clinical trials registry (ACTRN12616001197426).

Lucky Jeyaseelan FRCS(Tr&Orth), Nicholas Cullen FRCS(Orth), Andrew Goldberg MD, MBBS, FRCS(Tr&Orth) et al.

Category: Hindfoot Introduction/Purpose: Tibiotalocalcaneal (TTC) arthrodesis using a hindfoot intramedullary nail has been shown to be a safe and reliable technique in patients with severe ankle and hindfoot disease. There is debate about the use of straight nails versus curved nails. Proponents of the curved nail argue that straight nails predispose to greater risk of lateral plantar nerve injury, poor calcaneal bone purchase and inability to maintain satisfactory hindfoot valgus alignment. However, the subtalar joint is a condyloid joint enabling rotation of the talus on the calcaneum to create varus/valgus position of the calcaneal tuberosity. We present a clinical series of patients undergoing TTC fusion using a straight nail assessed by clinical and radiological outcomes to establish whether theoretical risks of straight nails are reflected in clinical practice. Methods: This single centre, retrospective study of prospectively collected data on a sequential series of patients to undergo TTC fusion, with pre and post-operative weight bearing CT imaging. Data was collected on indication for procedure, co-morbidities, post-operative complications, union rate as well as clinical scores, EQ5D and MOXFQ. Weight bearing CT imaging was analysed using the validated TALUS™ (torque ankle lever arm system) method on weight bearing CT, providing calcaneal offset, hindfoot angle and hindfoot alignment. These were used as markers of hindfoot alignment. Results: 65 patients (37 males, 28 females) were included in the study, with an average age of 57 years. Average follow-up was 20 months. Indications for TTC fusion included Charcot arthropathy, talar avascular necrosis, post traumatic arthritis and non-union of previous arthrodeses. Union rate was 91% (59/65). Overall complication rate was 11% (7/65) and most were minor wound complications. There were no plantar nerve injuries noted. There were no nail cut outs from the calcaneum. On all markers of hindfoot alignment, cases showed a more physiological degree of hindfoot valgus compared to pre-operative measures. There were significant improvement in both EQ5D and MOXFQ scores (p<0.05). Conclusion: We present the largest series of TTC fusion using a straight intramedullary nail and the first series to analyse hindfoot alignment using weight bearing 3D CT imaging. Our data regarding correction of hindfoot alignment is supported by biomechanical theories of subtalar varus/valgus, being related to rotatory changes at the subtalar joint, questioning the perceived need for a curved nail. This is particularly at the level of the entry point of the nail. The principles of valgus hindfoot nails are based on biomechanical laboratory studies and cadaveric studies, neither of which reflect our findings in clinical practice.

Maria Antonietta Gambacorta, Antonino De Paoli, Marco Lupattelli et al.

Purpose: The aim of this study is to evaluate the long term survival of the addition of gefitinib to chemoradiotherapy (CRT) in locally advanced rectal cancer (LARC). Methods and materials: This previously published multicentre, open-label, phase I-II study, enrolled patients (pts) with LARC to receive CRT with concurrent 5-fluorouracil continuous intravenous infusion and a dose escalation of orally administered gefitinib, followed 6–8 weeks later by surgery. An intra-operative radiotherapy boost of 10 Gy was planned. Adjuvant chemotherapy was administrated in ypN1-2 pts. After a median f/u of >10 years, we analyzed Local Control (LC), Metastasis Free Survival (MFS), Disease Free Survival (DFS), Disease Specific Survival (DSS) and Overall Survival (OS). Predictive endpoints of clinical outcomes were tested by univariate and multivariate analysis. Variables analyzed included: age, gefitinib dose and interruptions, adjuvant CT, surgery type, ypT, ypN, and TRG grade. We have also analyzed late toxicity according to CTCAEv4. Results: Of the 41 initially enrolled pts, 39 were evaluable (27M, 12F). With a median f/u of 133 months, LC, MFS, DFS, OS and DSS at 5 years were 84%; 71%; 64%; 87% and 92%, respectively. The OS and DSS at 10 years were 61,5% and 76%, respectively. Grade 3-4 late toxicity occurred in 38% of pts: sexual (28,2%) and gastrointestinal toxicities (10,2%). Conclusion: Long term outcomes and late toxicity were similar to previously reported series. The addition of gefitinib did not improve outcomes in LARC. Gefitinib is not recommended for rectal cancer patients who received 5-FU based preoperative CRT. Further studies may identify if gefitinib is beneficial in selected group of patients. Keywords: Rectal cancer, Gefitinib, Log term follow-up, Chemoradiotherapy

Rohit Aggarwal, Ruchi Gautam, Dhiraj Jhamb et al.

Thoracic venous aneurysms are a rare clinical entity and contrast-enhanced computed tomography has been the cornerstone of their diagnosis. We are reporting a rare case of isolated left brachiocephalic vein aneurysm, which was surgically managed, highlighting the role of dynamic contrast-enhanced magnetic resonance imaging as a definitive diagnostic modality in this patient.

H. Stone, C. Hooper, L. Kolb et al.