جستجوی مقالات مرتبط با کلیدواژه "Postoperative complications" در نشریات گروه "پزشکی"
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Surgery is pivotal in treating esophageal cancer; hybrid esophagectomy, which combines minimally invasive and open techniques, shows promising outcomes. This historical cohort study compared the surgical outcomes of standard open esophagectomy with hybrid esophagectomy. Overall, 58 patients who underwent either hybrid or open esophagectomy at the Ulyanovsk Regional Clinical Oncology Clinic, Russia, from January 2015 to December 2023 were included. Data on demographics, surgical details, and postoperative outcomes were analyzed. The primary measures were overall complications and anastomotic leakage rates. Statistical analysis was performed using Pearson’s Chi square test and t test via StatTech software (version 2.8.8). The number of removed lymph nodes was higher in the hybrid group (24±9) than in the open group (15±7) (P<0.001). In addition, the hybrid esophagectomy group showed significant reductions in operational time and blood loss (P<0.001 and P=0.014, respectively). The need for blood transfusion was higher in the open esophagectomy group (P=0.043). The postoperative length of stay in the hospital did not differ significantly between the two groups (open=20±8 days, hybrid=17±7 days, P=0.178). Cardiac complications were more frequent after an open esophagectomy (P=0.044). Hybrid esophagectomy reduced postoperative cardiac complications and other adverse events while maintaining satisfactory oncological outcomes. It had advantages over standard open esophagectomy in terms of lymphadenectomy, operative time, blood loss, and transfusion requirements, suggesting its efficacy for esophageal cancer patients.
Keywords: Esophageal Neoplasms, Esophagectomy, Postoperative Complications -
Background
The role of opium use history in complications after coronary artery bypass grafting (CABG) is still unclear. This study aimed to systematically review the effect of opium use history on the outcomes of CABG in patients with coronary heart disease.
MethodsThe present systematic review followed the guidelines for the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA). Manuscript databases, including PubMed, Web of Science, and Scopus, were deeply searched by two blinded investigators for all studies based on the relevant keywords. Google Scholar, Research Gate, and the Cochrane Library were searched as well. Of the twenty-four studies initially collected by database searching, eight were eligible for the final analysis.
ResultsThe results revealed that opium use history led to an increase in the risk of pulmonary and neurological complications, infections, bleeding volume, and atrial fibrillation in-hospital outcomes. In the evaluation of one-year outcomes after surgery, the findings showed an increase in hospital admissions in opium-consuming patients. In addition, in the examination of long-term outcomes, an increase in the risk of long-term mortality and, as a result, a decrease in the long-term survival of opium-using patients could be predicted following the use of opium; however, opium use did not have a significant effect on the long-term major adverse cardiovascular events of patients.
ConclusionOpium use history is a risk factor for the occurrence of postoperative hospital complications, the need for hospital readmission, and long-term CABG postoperative mortality.
Keywords: CABG, Opium Dependence, Postoperative Complications, Long-Term Outcome, Mortality -
Background
The current study aims to investigate the superior mesh fixation</strong> method, single absorbable tacker versus conventional method, in patients undergoing bilateral inguinal hernia repair through the laparoscopic total abdominal preperitoneal (TAPP) approach.
Materials and MethodsThe current randomized clinical trial has been conducted on 81 patients undergoing bilateral hernia repair through TAPP. The patients were randomly assigned into one of the mesh fixation groups including single absorbabletacker (Group S) (n = 41) and conventional method (Group C) (n = 40). All atients were assessed during the hospital stay and 1 month postoperatively to assess the surgery?associated complications and days for return to daily activity. Eura?Hs questionnaire was applied to assess the quality of life (QOL) after hernia surgery during 12?month follow?up. </strong>
ResultsThe duration of bilateral inguinal hernia operation (P = 0.067), postoperative urinary catheterization (P = 0.813), and hospital stay duration (P = 0.779) did not differ between the groups; whereas Group C significantly required a longer time for returning to daily activity (P < 0.001). Only a patient in Group Crepresented hematoma (P = 0.494). Seroma incidence was not statistically ifferent between the two groups (P = 0.712). Postoperative pain was statistically less in Group S (P < 0.001 for all the assessments). Postoperative QOL within a year after hernia repair revealed an insignificant difference between the groups in general (P > 0.05); however, a pain subscale was significantly less in Group S (P = 0.002).
ConclusionBased on the findings of this study, a single absorbable tacker was generally superior to the conventional method considering its less pre- and postoperative complications. However, the two methods did not differ regarding 1?year follow?up QOL.
Keywords: Hernia, Inguinal, Laparoscopy, Postoperative Complications, Quality Of Life, Surgical Mesh -
ObjectivesIdentification of modifiable comorbid conditions in the preoperative period is important in optimizing outcomes. We evaluate the association between such risk factors and postoperative outcomes after upper extremity surgery using a national database.MethodsThe National Surgical Quality Improvement Program (NSQIP) 2006-2016 database was used to identify patients undergoing an upper extremity principle surgical procedure using CPT codes. Modifiable risk factors were defined as smoking status, use of alcohol, obesity, recent loss of >10% body weight, malnutrition, and anemia. Outcomes included discharge destination, major complications, bleeding complications, unplanned re-operation, sepsis, and prolonged length of stay. Chi square and multivariable logistic regressions were used to identify significant predictors of outcomes. Significance was defined as P<0.01.ResultsAfter applying exclusion criteria, 53,780 patients were included in the final analysis. Preoperative malnutrition was significantly associated with non-routine discharge (OR=4.75), major complications (OR=7.27), bleeding complications (OR=7.43), unplanned re-operation (OR=2.44), sepsis (OR=10.22), and prolonged length of stay (OR=5.27). Anemia was associated with non-routine discharge (OR=2.67), bleeding complications (OR=13.27), and prolonged length of stay (OR=3.26). In patients who had a weight loss of greater than 10%, there was an increase of non-routine discharge (OR=2.77), major complications (OR=2.93), and sepsis (OR=3.7). Smoking, alcohol use, and obesity were not associated with these complications.ConclusionBehavioral risk factors (smoking, alcohol use, and obesity) were not associated with increased complication rates. Malnutrition, weight loss, and anemia were associated with an increase in postoperative complication rates in patients undergoing upper limb orthopaedic procedures and should be addressed prior to surgery, suggesting nutrition labs should be part of the initial blood work. Level of evidence: IIIKeywords: Modifiable, NSQIP, Orthopaedic, Postoperative complications, Risk factors, Upper Extremity Surgery
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Background
Maintaining hemostasis is considered a remarkable challenge during total thyroidectomy. The use of thermal ultrasonic electrocoagulation (harmonic scalpel) for total thyroidectomy was recently introduced to substitute the conventional ligation methods. However, controversies exist on the efficacy of this technique compared to the classic method.
MethodsThe data regarding this prospective cohort study was gathered between March 2019 to March 2020. Ninety participants were enrolled in the study. Forty-five subjects received harmonic scalpel ligation and the other forty-five participants underwent conventional total thyroidectomy. Afterward, these two groups were statistically compared regarding surgical time, postoperative hypocalcemia, drainage volume, postoperative pain, hospital stay, and recurrent nerve damage.
ResultsNo significant difference was detected in the group undergoing harmonic ligation concerning postoperative pain, postoperative hospital stay, drainage volume, and postoperative hypocalcemia in the first 48 hours post-operation. However, using a harmonic scalpel significantly reduced the surgical time (56 ± 2 minutes in the harmonic scalpel group versus 67 ± 9 in the conventional technique group, p < 0.001). Also, no recurrent nerve damage was detected in the study.
ConclusionsUtilizing a harmonic scalpel has a remarkably higher time efficacy in total thyroidectomy. However, the study suggests no further advantage for this method compared to the conventional techniques in total thyroidectomy.
Keywords: Total Thyroidectomy, Harmonic Scalpel, Surgical Time, Postoperative Complications -
Background & Objective
Although the safety of cesarean sections has increased, there are still considerations, especially for women with a history of repeated cesarean sections. This study was conducted with the aim of investigating maternal and neonatal outcomes in candidates for cesarean sections due to repeat cesarean sections according to the number of previous cesarean sections.
Materials & MethodsThis prospective descriptive study was conducted from April 2020 to June 2022 at Taleghani Hospital. All candidates for cesarean sections due to repeated cesarean sections were included in the study. According to the number of previous cesarean sections, they were divided into three groups. Statistical analysis was performed with Kruskal-Wallis, Chi-squared and Fisher’s exact tests. A P value < 0.05 indicated statistical significance.
ResultsA total of 345 women were included in the study. The results of this study showed that these three groups were significantly different in terms of duration of surgery (P<0.001), abnormal placental adhesion (0.012), and the presence of intraperitoneal adhesions (P<0.001), but there was not a significant difference in terms of other maternal and neonatal outcomes (P<0.05).
ConclusionThe results of this study showed that an increase in the number of previous cesarean sections does not increase most maternal and neonatal complications during a current cesarean section. Of course, it should be noted that the number of women with a history of three or more previous cesarean sections was small in this study, and for this reason, more studies are needed.
Keywords: Repeat cesarean section, Outcome assessment, Intraoperative Complications, Postoperative complications -
Introduction
Complementary medicine presents a viable avenue for mitigating side effects after surgery. This study aimed to compare the effects of acupressure and peppermint essential oil on the quality of recovery in patients undergoing laparoscopic cholecystectomy (LC).
MethodsIn this clinical trial, 210 patients referred to the Besat and Beheshti hospitals in Hamadan, Iran, were included. After giving their informed consent and completing the demographics survey, they were randomly assigned to 3 equal groups of control, peppermint essential oil, and acupressure. The study primarily assessed recovery quality through a 15- item questionnaire and secondarily evaluated postoperative nausea and satisfaction. Data were analyzed using Kruskal-Wallis, Wilcoxon, and Friedman tests in SPSS 23.
ResultsIn pre-intervention, there was no significant difference between the groups in the total score of recovery quality, nausea, and demographic data. There was a significant increase in the quality of recovery score in the acupressure group when compared to the peppermint group on the second postoperative day (P<0.001). In post-intervention, the mean score of nausea improvement in the control group was significantly less than those of the peppermint and acupressure groups (P<0.05). However, neither the acupressure nor peppermint groups displayed a significant reduction in nausea severity (P=0.439). Furthermore, the patient’s satisfaction in the acupressure group was significantly higher than that of other groups on the second postoperative day (P<0.001).
ConclusionThe administration of acupressure was found to be successful in improving recovery quality, patient satisfaction, and mitigating nausea compared to peppermint and standard treatment.
Keywords: Herbal medicine, Postoperative complications, Nausea, Complementary therapies, Post-surgery recovery -
Introduction
Hospital length of stay (LOS) remains a vital metric for assessing patient outcomes and healthcare resource utilization. Given the substantial financial impact of diagnosing and treating colorectal anomalies, coupled with an increased susceptibility to postoperative complications, it is crucial to understand the factors affecting LOS following colorectal surgery. Our primary objective was to investigate the preoperative, intraoperative, and postoperative risk factors that have substantial influence over LOS following a colorectal procedure.
MethodsThis study analyzed data from a retrospective study of adults who underwent various colorectal surgeries (colostomy, ileostomy, small bowel resection, etc.) at Cleveland Clinic Foundation (January 2005 - December 2014). Predictor variables were categorized into preoperative (patient demographics, medical history, comorbidities, lifestyle factors), intraoperative, and postoperative factors. LOS was grouped into short-term (SLOS) (≤ 7 days), medium-term (MLOS) (8-30 days), and long-term (LLOS) (> 30 days) stays. Multinomial logistic regression models assessed predictor effects on LOS.
ResultsAmong the 7874 patients, 50.7% were females, with a minimum age of 20 years. SLOS were observed in 61.1%, MLOS in 37.6%, and LLOS in 1.3% of patients. Advanced age correlated with prolonged LOS, possibly due to age-related health challenges like weak immune systems. Coagulopathy, and fluid and electrolyte disorders raised MLOS and LLOS risk, likely due to complications like significant bleeding and electrolyte imbalances. Surgery duration predicted longer LOS, elevating LLOS and MLOS by 52% and 42%. Postoperative infections were associated to extended stays, possibly due to subsequent interventions, monitoring and recovery delays.
ConclusionOur study revealed that key preoperative predictors of LOS included Age, coagulopathy, fluid and electrolyte disorders, severe weight loss, and drug abuse. Notably, intraoperative factors such as surgical approach (open vs laparoscopic) and surgery duration, alongside postoperative complications including superficial and serious infections, significantly influenced LOS. By incorporating these insights into the preoperative planning, clinicians could potentially develop tailored interventions to mitigate risk factors and enhance postoperative recovery, thus potentially reducing LOS and improving patient outcomes.
Keywords: Colorectal surgery, Hospital length of stay, Preoperative factors, Intraoperative factors, Postoperative complications, Risk factors -
Following the initial liver biopsy attempts, several techniques using a wide range of methodologies and materials were developed. Many studies on the evaluation of post-liver biopsy complications were conducted. However, their fundamental limitation was significant variance in patient demographics and methodology, which might account for the inconsistent outcomes. Therefore, a uniform methodology to perform percutaneous liver biopsies that result in comparable outcomes around the world is required. This study aimed to determine the precise complication rate following percutaneous liver biopsy using a consistent method in all individuals. It also aimed to establish a consistent operating procedure for a percutaneous liver biopsy that yielded comparable outcomes. Between July 2018 and July 2019, 116 patients were enrolled in this retrospective study for percutaneous liver biopsy. All individuals underwent a biopsy using the same procedure. There was an attempt to exclude elements that could have an impact on the complication rate. For this purpose, the same type and size of needle were utilized. Moreover, a single needle pass, a subcostal approach, deep inspiration breath holding, identical pre- and post-biopsy preparation, real-time ultrasonography guidance, the use of a single operator, and the absence of sedation or general anesthesia were the other approaches that were used to minimize the impact of variables that could raise complication rates. The overall complication rate was 19.8%, of which 18.9% of patients experienced pain and mild bleeding, and one patient (0.9%) experienced hematoma necessitating precautionary hospitalization. The overall percentage of patients who experienced pain was 13.8%. No further complications were observed. The findings of this study could provide an accurate estimate of the post-liver biopsy complication rate. Furthermore, due to a lower complication rate than other practiced procedures, this uniform methodology could be an attractive alternative in clinical practice. However, more research is required to confirm these results.
Keywords: Biopsy, Ultrasonography, Liver, Bleeding, Postoperative complications -
زمینه و هدف
آپاندیسیت شایع ترین وضعیت جراحی اورژانسی است. از عوارض پس از جراحی آپاندکتومی می توان به عوارض پوستی، عفونت، درد پس از عمل و فتق و انسداد اشاره کرد. بین جراحان بر سر بستن صفاق بعد از عمل های جراحی شکمی تفاوت نظر وجود دارد. لذا هدف از این مطالعه تعیین و تاثیرترمیم یا عدم ترمیم پریتوین بر عوارض پس از آپاندکتومی باز بود.
روش بررسیاین یک مطالعه کارآزمایی بالینی می باشد که در سال 13991398در بیمارستان شهید بهشتی یاسوج بر روی 126 نفر از بیماران مراجعه کننده که شرایط ورود به مطالعه جهت انجام جراحی آپاندکتومی به روش باز را داشتند، انجام گرفت. در این مطالعه تصادفی سازی به روش سیستماتیک انجام گرفت. مشاهدات بالینی و پیگیری بیماران یک هفته، سه ماه و شش ماه پس از عمل جراحی انجام شد. داده های جمع آوری شده با استفاده از آزمون های آماری آنالیز واریانس، تی تست و مجذور کای تجزیه و تحلیل شدند.
یافته هااز 126 نفر کاندید برای عمل جراحی آپاندکتومی، 60 نفر مرد و 66 نفر زن بودند. در این میان 64(8/50 درصد) نفر تحت عمل جراحی همراه با ترمیم پریتوین و 62 نفر(2/49 درصد) تحت جراحی بدون ترمیم پریتوین قرار گرفتند. میانگین سنی این جمعیت 82/13±88/26 سال بود و در محدوده بین 5 تا 65 سال قرار داشت .نتایج نشان داد که هم در گروه با ترمیم پریتوین و هم در گروه بدون ترمیم پریتوین، 62 نفر(9/69 درصد) بدون عفونت و 2 نفر(1/3 درصد) همراه با تخلیه چرکی، علایم عفونت وعفونت محل جراحی(SSI) بودند. هم چنین در گروه با ترمیم پریتوین، 42 نفر(6/65 درصد) بدون درد، 16 نفر(0/25 درصد) میزان درد خفیف و 6 نفر(4/9 درصد) میزان درد متوسط داشتند. در گروه عدم ترمیم پریتوین 50 نفر(6/80 درصد) بدون درد، 11 نفر (7/17 درصد) درد خفیف و 1 نفر(6/1 درصد) درد متوسط داشتند. بین دو گروه عمل جراحی آپاندکتومی با ترمیم پریتوین و بدون ترمیم پریتوین، در وجود عفونت، فتق و انسداد و هم چنین شدت درد اختلاف معنی داری مشاهده نشد(076/0=p)، اما وجود درد در بیماران بدون ترمیم پریتوین به طور معنی داری کمتر بود(044/0=p).
نتیجه گیرینتایج به دست آمده از این مطالعه نشان داد که استفاده از دو برش جراحی پریتوین باز و پریتوین بسته در عمل جراحی آپاندکتومی در مولفه های عفونت محل زخم تفاوت معنی داری باهم نداشتند، مولفه فتق اینسیژنال بعد از یک سال مشاهده نشد، هم چنین در مقایسه مولفه درد پس از عمل مشاهده شد که درد در گروه پریتوین باز کمتر است، لذا در بیماران با تشخیص آپاندیسیت پیشنهاد می شود از روش جراحی آپاندکتومی بدون ترمیم پریتوین استفاده شود.
کلید واژگان: آپاندکتومی, ترمیم پریتوئن, آپاندیس, صفاق, عوارض پس از جراحیArmaghane-danesh, Volume:28 Issue: 5, 2023, PP 591 -604Background & aimAppendicitis is the most common condition of emergency surgery. Complications after appendectomy include skin complications, infection, postoperative pain, hernia and obstruction. There is a difference of opinion among surgeons on peritoneal repair after abdominal surgery. Therefore, we aimed here to evaluate the effect of peritoneal repair versus non-repair in appendectomy patients in terms of postoperative complications.
MethodsThe present clinical trial study that was conducted on 126 patients who underwent open appendectomy at Shahid Beheshti Hospital of Yasuj, Iran, from 2019 to 2020 who had the inclusion criteria. In the present study, randomization was performed systematically. Clinical observations and follow-up of patients was one week, three months and six months after surgery. After collecting and forming the data file in the computer, the information was analyzed using descriptive analytical statistics (including frequency distribution table, analysis of variance, T-test, chi-square) through SPSS software.
ResultsOut of 126 candidates for appendectomy, 60 were male and 66 were female. Among them, 64 (50.8%) underwent surgery with peritoneal repair and 62 (49.2%) underwent surgery without peritoneal repair. The mean age of this population was 26.88 13 13.82 years and ranged from 5 to 65 years. The results indicated that in both the peritoneal repair and non-peritoneal repair groups, 62 patients (69.9%) had no infection and 2 patients (3.1%) had purulent drainage, symptoms of infection, and SSI. Moreover, in the group with peritoneal repair, 42 patients (65.6%) had moderate pain, 16 patients (25.0%) had mild pain and 6 patients (9.4%) had moderate pain. In the non-peritoneal repair group, 50 patients (80.6%) had no pain, 11 patients (17.7%) had mild pain and 1 patient (1.6%) had moderate pain. There was no marked difference between the two groups of appendectomy with peritoneal repair and without peritoneal repair, in the presence of infection, hernia and obstruction, as well as pain intensity, but the presence of pain in patients without peritoneal repair was significantly less.
ConclusionThe results of the present study revealed that the appendectomy surgical methods, including open and closed peritoneum, did not indicate a significant difference for wound site infection. On the other hand, the amount of postoperative pain was lower in the open peritoneum group. Therefore, it is suggested to use appendectomy without peritoneal repair in patients with appendicitis.
Keywords: Appendectomy, Peritoneal repair, Appendix, Peritoneum, Postoperative complications -
Purpose
To investigate the impact of reducing post-operative oral corticosteroid regimen on associated postoperative surgical complication rate, patient and graft survival in kidney transplant patients.
Materials and MethodsIn this retrospective cohort study, we enrolled patients who received a kidney transplant during two periods of distinct corticosteroid protocols. 592 patients in group 1 received prednisone 2 mg/kg (maximum dose 120 mg) on post-operative days (POD) 1, 2 and 3, 1mg/kg for a week, and tapered it to 10 mg by 3 months post-transplant and sustained the daily 10mg from 3 months post-transplant as maintenance therapy. 639 patients in group 2 received prednisone 50 mg on POD 1, 40mg on POD 2, 30mg on POD 3, 20mg on POD 4, 15mg on POD 5 and continued with 10mg daily from POD 6, as maintenance therapy. The two groups were similar in terms of other immunosuppression drug regimens.
Results75 (12.7%) patients in group 1 and 24 (3.4%) patients in group 2 developed corticosteroid-related postoperative surgical complications (P < .001). Wound infection (P = .035), incisional hernia (P = .003), infectious collection (P = .004), post-op hemorrhage (P = .005) and ureteral fistula (P = .076) occurred with lower frequency in group 2. Patient survival (1-year: 97.3% vs 97.1%, respectively; P = .85, 5-year: 89.9% vs 94.9%, respectively; P = .06) and graft survival (1-year: 94.6% vs 93.3%, respectively; P = .29, 5-year: 81.2% vs 85.1%, respectively; P = .39) were similar in both groups.
ConclusionPost-operative corticosteroid dosage decrement through our protocol would lessen the serious associated postoperative surgical complications, without negative impacts on overall patient and graft survival.
Keywords: kidney transplantation, corticosteroid, administration, dosage, postoperative complications, survival analysis -
Background
To investigate the use of uniportal video-assisted thoracoscopic surgery (U-VATS) in the treatment of non-small cell lung cancer (NSCLC).
Materials and MethodsA total of 82 patients with early NSCLC in our hospital from May 2019 to January 2021 were enrolled to this study. Forty-one patients treated with spontaneous breathing U-VATS were the research group (RG), and 41 with conventional thoracoscopy were the control group (CG). Fasting peripheral blood was drawn from patients before (T0), one (T1) and three days after surgery (T2), respectively. White blood cells (WBC), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), matrix metalloproteinase-9 (MMP-9) and T-lymphocyte subsets were measured in the blood. In addition, we counted the conversion rate to open chest and tracheal intubation in the RG, and compared the operation time, intraoperative bleeding, chest drainage, chest tube retention time, antibiotic application time, postoperative hospital stays and complications between groups. Finally, a 1-year prognostic follow-up was performed to record overall survival, chemotherapy rate, and recurrent metastasis rate.
ResultsAt T1, WBC, IL-6, TNF-α, and MMP-9 were lower in the RG than in the CG, while immune function was better in the RG at T1 and T2 (P<0.05). Complication rates were lower in the RG than in the CG when compared (P>0.05). The prognosis of 1-year overall survival, chemotherapy rate, and recurrence rate were not different between the two groups (P>0.05).
ConclusionSpontaneous breathing U-VATS can effectively reduce the inflammation and enhance the stability of immune function in NSCLC patients undergoing surgery.
Keywords: Video-assisted thoracic surgeries, non-small cell lung cancer, immune system phenomena, inflammation, postoperative complications -
مقدمهشکستگی دیستال رادیوس (زند زبرین) بسیار شایع است. این شکستگی می تواند در همه گروه های سنی رخ دهد. روش های مختلفی برای درمان این نوع شکستگی ها وجود دارد. بررسی نتایج درمان شکستگی دیستال رادیوس با کاربرد فیکساتور خارجی به همراه پین گذاری زیرپوستی (bridging external fixator + (percutaneous pinning هدف ما در این مطالعه است.مواد و روش هااین مطالعه مقطعی بین سال های 1397 تا 1400، در مرکز آموزشی درمانی بیمارستان کاشانی در شهر اصفهان، بر روی 72 بیمار انجام شد. شکستگی بیماران از نوع فرناندز 3، 4 و 5 بود و تحت درمان فیکساتور خارجی و پین گذاری برای شکستگی دیستال رادیوس قرار گرفته بودند. بیماران در فواصل 3 و 6 ماه پس از عمل، تحت معاینه مجدد قرار گرفتند.یافته ها72 بیمار در این مطالعه بررسی شدند. میانگین سنی 2/44 سال بود. 55 درصد از بیماران مرد و بقیه زن بودند. شایع ترین علت ایجاد شکستگی، تصادفات وسایل نقلیه بود. 4 مورد بدجوش خوردگی (malunion)، 4 مورد آسیب عصب رادیال سطحی، 2 مورد شل شدگی فیکساتور خارجی و 6 مورد عفونت سطحی در نتایج مطالعه یافت شد.نتیجه گیریکاربرد فیکساتور خارجی یک روش درمانی مناسب برای درمان شکستگی های دیستال رادیوس، همراه با عوارض کم و سطح رضایت بالای بیمار است.کلید واژگان: شکستگی های سر رادیوس, فیکساتور خارجی, عوارض بعد از عمل, فیکساسیون شکستگیBackgroundDistal radius fractures are among the most common fractures. They can happen at any age group, and there are several treatment options and several classification systems for these fractures. One of these classifications is that of Fernandez. In this study, we evaluated the results of treatment of distal radius fractures by bridging external fixator and percutaneous pinning.MethodsIn a cross-sectional study, 72 patients with Fernandez type 3, 4 and 5 that underwent external fixation and percutaneous pinning for comminuted distal radius fractures were followed and assessed after 3 and 6 months.ResultsThe 72 patients had mean age of 44.2 years. 55% were male. The most common cause of fractures was vehicle accidents. 4 cases of malunion, 4 radial nerve injuries, 2 fixator loosening and 6 cases of infection were encountered.ConclusionExternal fixator supplemented by percutaneous pinning is an efficient technique for treatment of unstable distal radius fractures. It has low rate of complication and high rate of patient's satisfaction.Keywords: Distal Radius Fractures, External Fixator, Postoperative complications, Fracture fixation
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زمینه و هدف
ایجاد تنگی مری شایع ترین عارضه بلع مواد سوزاننده است. بیمارانی که چندین تلاش ناموفق برای اتساع آندوسکوپیک دارند باید برای جراحی ترمیمی ارزیابی شوند. در مورد روش جراحی ارحج با توجه به میزان عوارض اتفاق نظر وجود ندارد. لذا، این پژوهش جهت تعیین ارتباط عوامل زمینه ای شامل سن، جنس، شاخص توده بدنی و نوع ماده مصرفی در تعیین میزان موفقیت روش جراحی بالا کشیدن معده (Gastric Pull-up) انجام شد تا در تعیین بیماران کاندید این روش جراحی در نظر گرفته شوند.
روش کاردر این مطالعه مقطعی گذشته نگر 70 بیمار مبتلا به سوختگی شیمیایی مری که تحت درمان با روش ازوفاژکتومی و Gastric Pull-up قرار گرفته بودند از نظر فاکتور های زمینه ای با استفاده از آزمون های آماری مجذور کای و تی مستقل مورد بررسی قرار گرفتند. از نرم افزار آماری SPSS 20 استفاده شد. 05/0 P< معنی دار در نظر گرفته شد.
یافته هابر اساس نتایج این مطالعه ارتباط معنی داری بین عوارض کوتاه مدت، بلند مدت، طول مدت بستری (در بخش مراقبت های ویژه و در بیمارستان) و میزان مرگ با فاکتور های زمینه ای بیماران شامل سن، جنس و نمایه توده بدنی و نوع ماده بلعیده شده، مشاهده نشد (05/0 P<).
نتیجه گیریفاکتورهای زمینه ای مورد مطالعه در این پژوهش در بیماران دچار سوختگی مری تاثیری در عوارض کوتاه مدت و بلند مدت و میزان مرگ و میر آنان پس از جراحی به روش Gastric Pull up نداشته و به عنوان معیاری برای انتخاب بیماران کاندید این روش جراحی قابل استفاده نیستند.
کلید واژگان: مواد سوزاننده, تنگی مری, عوارض بعد از عملBackground & AimsThe ingestion of caustic agents is one of the most consequential and dangerous poisonings associated with a high mortality rate. Esophageal stricture is the most common complication associated with caustic ingestion. Up to one-third of patients with caustic injury of the esophagus develop strictures, especially in patients with severe injuries (1). Although endoscopic dilation is the primary treatment for this complication, patients who have had several unsuccessful attempts at endoscopic dilation should be evaluated for reconstructive surgery, which may include selective esophagectomy with esophagogastric anastomosis or colonic interposition (2,3). These can play an effective role in improving the prognosis of patients given the potential for stenosis and malignancy in the burned esophagus. Multiple factors affect the success rate of this surgery. However, there is no consensus on the optimal surgical approach given the morbidity rates. The decision is often based on the extent of injury, patient age, overall health, and the surgical team's expertise (4).This study aimed to determine the role of other background factors including age, sex, BMI and type of caustic agent, in determining the success rate of the Gastric Pull-up surgical procedure to identify candidate patients for this surgical method.
MethodsIn this retrospective cross-sectional study, after obtaining the ethics code IR.IUMS.REC.1398.1358 from the Ethics Committee of Iran University of Medical Sciences, the clinical records of 70 patients with chemical burns of the esophagus who were hospitalized …. hospitals in Tehran between 2011-2019 and underwent treatment with esophagectomy and Gastric Pull-up, and met the inclusion criteria were reviewed, using chi-square and independent t-tests. It was done using SPSS 16 statistical software. P<0.05 was considered significant.The inclusion criteria were as follows: definitive diagnosis of esophageal burns due to caustic chemicals based on endoscopic findings performed within the first 48 hours after ingestion of caustic substances, treatment with esophagectomy and Gastric Pull-up, complete patient records in terms of follow-up, and presence of informed consent from the patient or parents (for children) regarding the use of file contents for research purposes. Exclusion criteria were lack of access to patient records and outcomes, treatment of patients with other therapeutic methods, and lack of informed consent for the use of file content for research purposes.After reviewing the medical records, 70 patients were included in the study. Data were collected using a checklist that included demographic and clinical information forms and short-term (infection, length of ICU stay, anastomotic leakage, and bleeding) and long-term (dysphagia, stricture, and mortality rate) outcome forms.The appropriate sample size was calculated based on a complication prevalence of 80% in the study by Hamza et al. (5) and using the following formula, considering an alpha of 0.05and d of 0.1, the sample size was calculated as 64.
n = (z^2 * p * (1 - p)) / d^2Statistical analysis was performed using SPSS 16, based on variable types and sample sizes, using the appropriate tests.ResultsOf the 70 patients studied, 64.3% were male and 35.7% were female with a mean age of 15.6 ± 5.4 years (range 1-33 years). The mean follow-up duration was 42 ± 15.6 months. The prevalence of short-term complications including vomiting, anastomosis leakage, infection and bleeding was 52.8% and the most common short-term complication was nausea (24.3%). Long-term complications including mortality, anastomotic stenosis, dysphagia and reflux were reported in 81% of the cases. Dysphagia was the most common long-term complication (25.7%). A total of 3.4% of caustic ingestion cases resulted in patient death. There was no significant association between short-term complications, long-term complications, length of hospital stay (in ICU and hospital), mortality rate, and patients' demographic characteristics, including age, sex, body mass index, and type of substance used (p>0.05).
ConclusionIn the present study, which was conducted on 70 patients undergoing Gastric Pull-up surgery to correct esophageal strictures following caustic ingestion, no significant association was found between long-term and short-term complications, length of hospital stay, and mortality rate with variables of age, sex, BMI, and type of substance used.Harlak et al. in their study reported few complications associated with this surgical method. They attributed this to the common anatomical location of the esophageal burns and the presence of suitable esophageal tissue after removing the involved section (6). The results of the present study also emphasize that other background factors do not affect short- and long-term complications of this surgery.
Contini et al. attributed the better outcomes of esophagectomy in children to their better tissue repair capability (7). In the present study, no significant differences were observed in short- and long-term complications or mortality rates between children and adults. This finding could be due to the fact that both age groups usually undergo similar surgical procedures to repair or reduce damage caused by ingestion of leaches, using advanced medical techniques and postoperative care strategies, which could contribute to similar outcomes (8). Furthermore, regardless of age, the human esophagus has basic physiologic characteristics that respond to injury and subsequent surgical interventionin a comparable manner (9). It is also important to consider that comprehensive preoperative assessment and postoperative care, including nutritional support and infection management, were performed equally in both groups and may have influenced the observed outcomes. provides (10).According to a 1992 study by Zargar et al., both acidic and alkaline substances cause serious damage to the esophageal tissue; however, they noted greater tissue damage by alkaline substances (11). Based on this, Harlak et al. also reported a greater need for reconstructive surgery after the acute phase following ingestion of alkaline substances. Based on the results of the present study, no significant differences were observed in the short- and long-term complications and mortality between acidic and alkaline substances.In a study by Chirica et al. on long-term complications of reconstructive esophageal surgery after caustic ingestion by Colon Interposition, the only factor affecting these complications was delay in reconstructive surgery, and age, sex, and type of ingested substance did not affect the long-term complications of this corrective surgery (12), which is consistent with the results of the present study regarding complications of gastric pull-up surgery.Based on the results of this study, factors including age, sex, body mass index, and type of ingested substance in patients with esophageal burns did not affect the short- and long-term complications and mortality rate after gastric pull-up surgery and cannot be used as criteria for selecting candidates for this surgical procedure.Keywords: Caustics, Esophageal Stenosis, Postoperative Complications -
Introduction
The occurrence of nausea and vomiting following anesthesia and surgery is a prevalent and distressing issue, ranking second only to pain. In this study, the effects of ginger and ondansetron in mitigating these symptoms in patients who underwent cesarean section surgery were compared.
MethodsThis double-blinded randomized clinical trial included 150 eligible patients who were randomly assigned to one of three groups: ginger, ondansetron, and control. The ginger group was given one 1000 mg ginger capsule, the ondansetron group was given one 16 mg ondansetron capsule, and the control group was given one placebo capsule. Participants took their designated capsules with 30 mL of water one hour before their scheduled surgery. Nausea intensity and vomiting frequency were assessed throughout the surgical procedure and at post-operation intervals of 0.5, 1, 2, and 4 hours.
ResultsCompared to the control group, the ginger group had significantly less severe nausea during the surgery (P = 0.03) and one hour after surgery (P = 0.01). The ginger group also had significantly fewer vomiting episodes during the surgery (P = 0.007) and half an hour after surgery (P = 0.001). There was no significant difference between the ginger and ondansetron groups regarding the severity of nausea and the number of vomiting (P > 0.05).
ConclusionThe administration of ginger was found to be successful in alleviating the severity of nausea and vomiting both during and after spinal anesthesia for cesarean section procedures. It could be a viable alternative to ondansetron.
Keywords: Antiemetics, Herbal medicine, Obstetrics, Postoperative complications, Visual analog scale -
Background
Data on perioperative risk stratification in patients with multiple sclerosis (MS) are limited. In this regard, the present study was conducted to investigate Iranian specialists’ approach to surgical counseling for patients with MS (PwMS).
Methods21 MS specialists were asked about 11 case scenarios with different MS disease statuses, disease-modifying therapies (DMTs), and urgency of the operation. The reasons for refusing surgery or factors that have to be considered before surgery were studied.
ResultsOverall, Fleiss Kappa was estimated to be 0.091 [95% confidence interval (CI): 0.090-0.093, P < 0.001] indicating a very poor level of agreement among responders.
ConclusionPwMS face surgery for various reasons. Risk assessment of surgery, the effect of various drugs such as anesthetics and DMT on patients, as well as many other aspects of MS are issues challenging the practitioners. Clarifying the various dimensions of these issues requires further research.
Keywords: Infections, Multiple Sclerosis, Postoperative Complications, Surgery -
Pituitary apoplexy following cardiac surgery is a very rare complication and can be a potentially life-threatening clinical syndrome. It could be caused by acute infarction, hemorrhage or edema and sudden enlargement of a pre-existing and unknown pituitary adenoma. We report a case of hemorrhagic apoplexy of a pituitary gland macro-adenoma successfully managed by urgent trans-sphenoidal tumor resection in a patient after elective coronary artery bypass grafting (CABG).
Keywords: Pituitary apoplexy, CABG, Cardiac Surgery, Postoperative complications -
Background
Percutaneous nephrolithotomy (PCNL) is one of the five interventions offered to patients with renal stones.
ObjectivesThis study compared the effects of previous therapeutic interventions for renal stones on subsequent PCNL regarding success rate and complications.
MethodsIn this descriptive-analytical study, the data from 375 patients who had undergone PCNL were reviewed retrospectively. Patients were categorized into four groups based on their previous therapeutic interventions as no history of open renal stone surgery (n = 196), PCNL (n = 64), extracorporeal shockwave lithotripsy (ESWL) (n = 88), and open surgery (n = 27). We compared surgery duration, the surgical procedure's success rate, complications, as well as the site and size of the stone between the groups.
ResultsThe mean operation duration was significantly longer in the fourth group (61.66 ± 19.85), while there were no statistically significant differences in surgery duration between other groups (P = 0.88). The mean hospital stay, stone size, and site were also similar between the groups. All groups had a high number of pelvic stones, and the rate of upper calyceal stones was higher than middle calyceal and ureteral stones in all groups. Access time was higher in groups one and four, but no significant difference was observed (P = 0.31). Grade 1 and 2 complications were frequent among the patients. The overall immediate success rate was high in all groups.
ConclusionsThe present study indicates that patients with a history of open surgery for kidney-related conditions may have higher blood loss and longer surgery duration, likely due to anatomical and histological changes in the kidney.
Keywords: Nephrolithotomy, Percutaneous, Postoperative Complications -
زمینه و هدف
عوارض گوارشی بعد از جراحی قلب باز شیوع کم دارد اما می تواند منجر به جراحی مجدد در دوره بعد از عمل شود. هدف از این مطالعه گزارش یک مورد نادر اتساع روده، بزوار بعد از عمل CABG می باشد.
گزارش مورد:
بیمار خانمی 76 ساله با شکایت درد قفسه سینه، تنگی نفس و تعریق به اورژانس بیمارستان مراجعه کرد. طی گزارش آنژیوگرافی عروق قلبی دچار انسداد شده بود. عمل CABG برای وی انجام شد. بیمار بعد از عمل دچار عارضه تهوع و استفراغ شد و توانایی بلع خود را از دست داد. بدنبال تداوم شرایط بیمار، پس از انجام CT SCAN تشخیص انسداد روده بعلت بزوار داده شد. بعد از جراحی باز شکمی توده خارج و بیمار با بهبودی از بیمارستان مرخص شد.
نتیجه گیری:
بر اساس یافته های گزارش یک مورد بزوار بعد از عمل جراحی قلب باز، کادر درمان باید احتمال عوارض گوارشی بخصوص انسداد روده را در بیمارانی که تهوع، استفراغ مکرر و عدم بلع دارند بدهند. بنابراین پس از جراحیهای قلب جهت اطمینان از تشخیص زود هنگام و اتخاذ درمان مناسب برای جلوگیری از عوارض بیشتر و پیامدهای نامطلوب به اهمیت بروز بزوار توجه نمایند.
کلید واژگان: عوارض بعد از عمل, اتساع روده, بزوار, CABG, گزارش موردBackground and ObjectivesGastrointestinal complications after open heart surgery are rare, but can lead to re-surgery in the postoperative period. The purpose of this study is to report a rare case of intestinal dilatation due to bezouar after CABG.
Case report:
A 76-year-old female patient came to the emergency department of the hospital with complaints of chest pain, shortness of breath and sweating. During the angiography report, the heart vessels were blocked. CABG was performed for him. After the operation, the patient suffered from nausea and vomiting and lost the ability to swallow. Following the continuation of the patient's condition, after CT SCAN, intestinal obstruction was diagnosed as a cause. After open abdominal surgery, the mass was removed and the patient was discharged from the hospital with recovery.
ConclusionBased on the findings of a case report of bezoar after open heart surgery, the treatment staff should consider the possibility of gastrointestinal complications, especially intestinal obstruction in patients who have nausea, frequent vomiting and inability to swallow. Therefore, after heart surgeries, to ensure early diagnosis and appropriate treatment to prevent further complications and adverse outcomes, pay attention to the importance of the event.
Keywords: postoperative complications, intestinal dilatation, bezoar, CABG, case report -
Background
Reconstruction of facial skin defects is challenging. Skin flaps and grafts are well-known techniques for reconstructing these defects. The outcomes of the surgeries can vary depending on the surgical procedures and the patient's characteristics.
ObjectivesThis study aimed to compare the results of reconstructing facial skin defects using skin grafts and flaps in patients referred to Imam Reza Hospital, Birjand, Iran.
MethodsThis quasi-experimental study was performed on 100 patients with tumors and traumatic lesions in the facial area referred to the plastic surgery service of Imam Reza Hospital, Birjand, Iran. For comparison, the data of 50 patients with skin grafts and 50 patients with flaps who underwent facial skin defect repair surgery were collected. Patients' demographic characteristics were extracted from their hospital records. The final reconstruction results were evaluated based on the presence or absence of aesthetic or functional complications three months after surgery.
ResultsThe mean ages of participants were 64.6±14.0 and 58.3±19.1 in the flap and graft groups, respectively. Women comprised 26 (52%) of the flap and 22 (44%) of the graft groups. The mean size of lesions in the graft group was 21.3±17.3 cm and 4.7±3.9 cm in the flap group (P=0.001). The frequency of aesthetic and functional complications in the flap group was 13 (26%) and 9 (18%), and in the graft group was 24 (48%) and 15 (30%), respectively. The frequency of aesthetic complications in the flap group was significantly lower than that in the graft group (P=0.023). There was no significant difference between the two groups in terms of the frequency of functional complications (P=0.160). The frequency of disease recurrence was not significantly related to surgical technique (P=0.749). Furthermore, the lesion location had a significant association with the surgical technique (P=0.009); however, the number of surgeries had no significant association with the surgical technique (P=0.389).
ConclusionIn general, except for when there is an indication for using a method, the reconstruction of facial skin defects using a skin flap will have better results than a skin graft.
Keywords: Dermatologic surgical procedures, Postoperative complications, Reconstructive surgical procedures, Skin transplantation, Surgical flaps
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