scholarly journals COMPARISON OF SURGICAL AND NON-SURGICAL APPROACHES TO SPLENIC TRAUMA

2020 ◽  
Vol 17 (34) ◽  
pp. 125-134
Author(s):  
Seyed Hamzeh MOUSAVIE ◽  
Kamran BEIGI RIZI ◽  
Parisa HOSSEINPOUR ◽  
Ali Reza NEGAHI
Keyword(s):  
Surgical Approach ◽  
Length Of Hospital Stay ◽  
Diagnostic Methods ◽  
Surgical Approaches ◽  
Splenic Trauma ◽  
Trauma Patients ◽  
Car Accidents ◽  
Surgical Ward ◽  
Significant Difference ◽  
Surgical Group

The spleen loss leads to increase the risk of sepsis, pyelonephritis, pneumonia, and pulmonary embolism throughout the lifetime of patients with splenic trauma. Regarding the sensitivity of the spleen and the importance of appropriate therapies for spastic trauma, this study aimed to determine the consequences of spinal trauma based on different therapeutic methods. This retrospective cohort study was conducted on the splenic trauma patients who were referred to Rasool Akram Hospital in Tehran, Iran, during 2011-2017. All medical records of 133 splenic trauma patients were gathered from 2011-2017. The data were gathered related to ultrasound, and computed tomography scan or other diagnostic methods of the patients admitted in the surgical ward. Finally, splenic trauma patients with a surgical approach were compared to the subjects with a non-surgical approach. Surgical and non-surgical approaches were performed on 80% (n=104) and 20% (n=26) of the subjects, respectively. There was a significant difference between the two groups regarding the length of intensive care unit stay and total hospitalization duration. The comparison between the two groups showed that there was no significant difference in term of the related side effects (P>0.05). Overall, 80.8% (n=84) and 96.4% (n=27) of the patients were discharged in surgical and non-surgical groups, respectively. In addition, 19.2% (n=20) and 3.6% (n=1) of the cases died in surgical and non-surgical groups. The comparison of survived patients showed that there was a significant difference between the groups (P=0.045). This study showed that there was no difference regarding the consequences of surgical and non-surgical approaches in patients with splenic trauma. The length of hospital stay was shorter in the non-surgical group, compared to that of the surgical group. The most commoncause of trauma in both groups was car accidents. Retroperitoneal hematoma was the most common intraabdominal trauma. The mortality rate was higher in the surgical group in comparison to that of the non-surgical group.

scholarly journals Comparing Two Approaches for Thyroidectomy: A Health Technology Assessment through DMAIC Cycle

Healthcare ◽  
2022 ◽  
Vol 10 (1) ◽  
pp. 124
Author(s):  
Carlo Ricciardi ◽  
Adelmo Gubitosi ◽  
Donatella Vecchione ◽  
Giuseppe Cesarelli ◽  
Francesco De Nola ◽  
...  
Keyword(s):  
Health Technology Assessment ◽  
Total Thyroidectomy ◽  
Technology Assessment ◽  
Statistical Tests ◽  
Length Of Hospital Stay ◽  
Health Technology ◽  
Endocrine Surgery ◽  
Surgical Approaches ◽  
New Device ◽  
Significant Difference

Total thyroidectomy is very common in endocrine surgery and the haemostasis can be obtained in different ways across surgery; recently, some devices have been developed to support this surgical phase. In this paper, a health technology assessment is conducted through the define, measure, analyse, improve, and control cycle of the Six Sigma methodology to compare traditional total thyroidectomy with the surgical operation performed through a new device in an overall population of 104 patients. Length of hospital stay, drain output, and time for surgery were considered the critical to qualities in order to compare the surgical approaches which can be considered equal regarding the organizational, ethical, and security impact. Statistical tests (Kolmogorov–Smirnov, t test, ANOVA, Mann–Whitney, and Kruskal–Wallis tests) and visual management diagrams were employed to compare the approaches, but no statistically significant difference was found between them. Considering these results, this study shows that the introduction of the device to perform total thyroidectomy does not guarantee appreciable clinical advantages. A cost analysis to quantify the economic impact of the device into the practice could be a future development. Healthy policy leaders and clinicians who are requested to make decisions regarding the supply of biomedical technologies could benefit from this research.

scholarly journals Diagnosis and Surgical Treatment of Orbital Tumors of Various Localizations and Histostructures.

2020 ◽  
Vol 6 (1) ◽  
pp. 01-11
Author(s):  
O.I. Lystratenko ◽  
A.M. Kardash ◽  
D.O. Lystratenko ◽  
A.V. Vashchenko ◽  
O.F. Smyrnova
Keyword(s):  
Surgical Approach ◽  
Radiation Treatment ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
Diagnostic Methods ◽  
Surgical Approaches ◽  
Universal Method ◽  
Orbital Tumors ◽  
Tumor Removal ◽  
Results Of Treatment

The article reviews and analyzes the results of treatment of 32 patients with orbital tumors operated in the clinic, neurosurgery until the period from 2015 till September 2019. Goals and objectives: coverage of clinical signs and symptoms, histology, diagnostic methods and treatment of patients operated on with orbital tumors during the period 2015-2019. Determination of optimal surgical approach to the tumors with different localization for performing the radical organ-preserving surgery, with maximal saving of visual functions, minimization of oculomotor disorders, patient disability. Materials and Methods: we analyzed the clinical cases of 32 patients undergoing treatment in DOKTMO with orbital tumors for the period from 2015 till September 2019. Patients were operated on with various approaches - transcutaneous, subconjunctive (without orbitotomy), fronto-orbito-zygomatic, pterional, subfrontal (neurosurgical approaches), transmaxillary, transethmoidal (ENT approaches). The choice of surgical approaches were individual. In 2 cases we become a backset of tumor growth: one patient with aggressive adenocarcinoma, after 18 months, leading to orbital exentration and the child, 9 years old with rhabdomyosarcoma after non-radical removal of tumors of subconjunctival approach. In all other cases, relapses were not detected, operation were organ-preserving oriented. Conclusions: the results of treatment of patients with tumors directly depend on the choice of radicality tumor removal, which is associated with the choice of surgical approach, chemical, radiation treatment in postoperative period depending on the histological response. From our point of view, the most universal method for tumor removal with various localizations and sizes is fronto-orbito-zygomatic approach which provides the performance of radical organ-preserving operation with maximal vision saving, minimizing oculomotor disorders, disability of the patient, despite its technical complexity for ophthalmologist surgeons. In this regard, surgery of orbital tumors is subject to the competence of doctors of related specialties.

STUDY ON THE APPLICATION OF ISS AND RTS FOR THE EVALUATION OF SEVERITY OF TRAUMATIC PATIENTS TREATED IN BACH MAI HOSPITAL

2017 ◽  
pp. 91-95
Author(s):  
Ngoc Son Do ◽  
Quang Anh Pham ◽  
Hieu Hoc Tran
Keyword(s):  
Emergency Room ◽  
Severe Case ◽  
Accurate Diagnosis ◽  
Trauma Patients ◽  
Diagnosis And Prognosis ◽  
Severity Scores ◽  
Significant Difference ◽  
Surgery Department ◽  
Moderate Case ◽  
Surgical Group

Background: Injury is a common surgical emergency causing serious burden for patients and the society. Accurate diagnosis and prognosis of trauma patients are helpful in the treatment of these patients. Objectives: To apply ISS and RTS for the evaluation of the severity of trauma patients admitted Emergency room of Surgery Department, Bach Mai Hospital. Subjects and methods: A retrospective study on 194 trauma patients treated at the Emergency room of the Surgery Department, Bach Mai Hospital from 8/2015 to 12/2016. Results: There were total 194 patients, 131 males (67.5%), 63 females (32.5%). The average age was 41.7±18.7. Median RTS score was 7.84 in 96.6% of the patients with corresponding survival probability was 0.988. There was 114 minor case (59.7%), 59 moderate case (30.9%), 16 severe case (8.4%), 2 critical case (1.1%) and 0 unsurvivable case based on the ISS classification. There was no significant difference in ISS between preservation and surgical group. Conclusion: Most of our patients was mild and moderate. Severity scores such as RTS and ISS were useful in these patients. Key words: Injury, ISS, RTS, preservation, surgery

scholarly journals Liver Surgical Anatomy: Vascular Control and Mobilization

2018 ◽  
Vol 3 (1) ◽  
pp. 753-758
Author(s):  
Rubén Algieri ◽  
María Ferrante ◽  
Maria Bernadou ◽  
Juan Ugartemendía ◽  
Carolina Brofman
Keyword(s):  
Surgical Approach ◽  
Surgical Anatomy ◽  
Liver Trauma ◽  
Surgical Approaches ◽  
Trauma Patients ◽  
Vascular Control ◽  
Adequate Knowledge ◽  
Surgical Residents ◽  
Anatomical Knowledge ◽  
Second Year

A successful surgery cannot be done without adequate knowledge of the surgical anatomy, especially in liver trauma, where anatomical knowledge plays a key role when it comes to making quick decisions that will allow saving the life of patients with this pathology in the emergency. Assess liver anatomical knowledge and related structures for conducting emergency surgical approaches mobilization maneuvers and vascular control. A 3-year training program for vascular control maneuvers and liver mobilization, for 11 surgical residents during their second, third and fourth year, while 3 fresh corpses and 20 formolized at 10 % corpses were used. Different maneuvers of liver mobilization and vascular control were performed from the second year onward for three consecutive years. A decrease of 57 % was observed in the time of realization of the maneuvers and recognition of structures in second year residents who conducted this test for three consecutive years, and a decrease of 38 % in second and third year residents who performed it for two consecutive years with similar results. Anatomical knowledge in stage training improves the surgical approach to trauma patients, decreasing the time of realization of the maneuvers and the risk of complications.

scholarly journals Diaphragmatic injuries, a retrospective analysis of 50 patients

2016 ◽  
Vol 11 (4) ◽  
Author(s):  
Amer Bilal ◽  
Salim M ◽  
Tahira Nishtar ◽  
Shoaib Nabi ◽  
Muslim M ◽  
...  
Keyword(s):  
Diaphragmatic Injury ◽  
Diagnostic Methods ◽  
Organ Injury ◽  
Surgical Approaches ◽  
Medical Institute ◽  
Management Approach ◽  
Trauma Patients ◽  
Chest Ultrasonography ◽  
Space Problem ◽  
Diaphragmatic Repair

Objective:: This study seeks to define the clinical presentation, the usefulness of diagnostic tests, surgical management approach and outcome of treatment of diaphragmatic injuries in our trauma patients. Design:: An observational descriptive study. Place and duration of study:: Department of Cardiothoracic Surgery, Postgraduate Medical Institute, Lady Reading Hospital, Peshawar from March 2001 to April 2005. Subjects and methods: In this retrospective study, 50 patients admitted to our department with diaphragmatic injury were evaluated according to the type of injury, diagnostic methods, associated organ injury, treatment, modality, morbidity and mortality. Results: The average age of patients was 32 years. There were 35 (70%) male and 15 (30%0 female patients, 38 (76%) of these patients sustained blunt and 12 (24%) had penetrating chest injury. The diaphragmatic injury was right sided in 4 and left sided in 46 patients. Thirty nine (78%) patients presented in respiratory distress within 48 hours of in jury while 11 (22%) presented with bowel obstructive symptoms months and years after injury. A chest x-ray on admission suggested the diagnosis in 70% of the cases while chest ultrasonography and contrast studies were required in others. Surgery was emergent in 35 (70%), semi-emergent in 9 (18%) and effective in 6 (12%) cases. Surgical approaches were left thoracotomy (40 patients), left thoracolaprotomy (6 patients) and right thoracotomy (4 patients). The diaphragmatic repair was achieved by direct suture in 45 cases while prolene Mesh was required in 5 cases. The mortality rate was 6% (n = 3). Recurrence occurred in one (2%), wound infection in 3 (6%), pleural, space, problem in 1 and chest infection in 2 (4%) patients. Conclusion: A high index of suspicion and early surgical treatment determine the successful management of traumatic diaphragmatic injury with or without the herniation of abdominal organs. The surgical approach is individualized. We prefer the thoracic approach adding laporotomy when necess ary.

scholarly journals Evaluation treatment modalities of the pilonidal disease

2019 ◽  
Vol 6 (12) ◽  
pp. 4248
Author(s):  
Muhammed H. Jaffar Al-Saadi
Keyword(s):  
Recurrence Rate ◽  
Surgical Approach ◽  
Primary Closure ◽  
Average Length ◽  
Pilonidal Disease ◽  
Length Of Hospital Stay ◽  
Treatment Modalities ◽  
Surgical Approaches ◽  
Wound Complications ◽  
Simple Excision

Background: The pilonidal disease is a minor surgical pathology that has distressful complications. Many original and newer treatment modalities have been used in its management (including excisional and conservative surgical approaches). However, there is non-consensus on any one of them and the main reason is the significant recurrence rate. The objective of the study was to evaluate the excisional surgical modalities and conservative surgical approach in management the pilonidal disease.Methods: A prospective study enrolled 98 patients (80 males vs. 18 females) with chronic sacrococcygeal pilonidal disease. The ages range is 15-42 years. Group IA were treated by simple excision with primary closure, group IB by simple excision with Z- plasty and group II by conservative surgical approach. The wound complications (wound disruption and infection), length of hospital stays, recurrence rate, patients' satisfaction, and the cosmetic appearance were recorded.Results: The excision and Z-plasy has the least recurrence rate, wound complications rate and average time off work days. The simple excision with primary closure has the highest patient's cosmetic satisfaction. Conservative surgical approach has the worst results (recurrence rate 75%, wound infection rate 65%, 21 days average time off work and two days average length of hospital stay)..Conclusions: The Z-plasty is superior to other methods (has the least recurrence rate). The conservative treatment has non-encouraging results, we recommend it for patients unwilling excisional surgery.

Effect of Chewing Gum on Bowel Motility in Women Undergoing Post-Operative Cesarean Section

2018 ◽  
Vol 3 (06) ◽  
Author(s):  
Dr.Randa Mohammed AboBaker
Keyword(s):  
Cesarean Section ◽  
Hospital Stay ◽  
Demographic Data ◽  
Length Of Hospital Stay ◽  
Chewing Gum ◽  
Control Group ◽  
Controlled Clinical Trial ◽  
Bowel Motility ◽  
Gum Chewing ◽  
Significant Difference

Postoperative Ileus (POI) is one of the most common problems after obstetrics, gynecologic and abdominal surgeries. Sham feeding, such as gum chewing, accelerates the return of bowel function and the length of hospital stay. The present study aims to evaluate the effect of chewing gum on bowel motility in women undergoing post-operative cesarean section. Intervention study was used at the Postpartum Department of Maternity and Children Hospital, KSA. A randomized controlled clinical trial research design. Through a convenience technique, 80 post Caesarian Section (CS) women were included in the study. Data were collected through three tools: Tool (I): Socio-demographic data and reproductive history interview schedule. Tool (II): Postoperative Assessment Sheet. Tool (III): Outcomes of gum chewing and the length of hospital stay.  Method: subjects were assigned randomly into two groups of (40) the experimental and (40) the control. Subjects in the study group were asked to chew two pieces of sugarless gum for 30 min/three times daily in the morning, noon, and evening immediately after recovery from anesthesia and in Postpartum Department; while subjects in the control group followed the hospital routine care. Each woman in both groups was tested abdominally using a stethoscope to auscultate the bowel sounds and asked to report immediately the time of either passing flatus or stool. Results: illustrated that a highly statistically significant difference was observed between the two groups concerning their gum chewing outcomes. Where, P = 0.000. The study concluded that gum chewing is safe, well tolerated and appears to be effective in reducing the incidence and consequences of POI following CS.

Revising the Indications of Transtemporal Surgical Approaches in the Modern Endoscopic Era of Skull Base Surgery: A Dying Art

2020 ◽  
Author(s):  
Ravi Sankar Manogaran ◽  
Raj Kumar ◽  
Arulalan Mathialagan ◽  
Anant Mehrotra ◽  
Amit Keshri ◽  
...  
Keyword(s):  
Skull Base ◽  
Surgical Approach ◽  
Nerve Palsy ◽  
Tertiary Care ◽  
Surgical Approaches ◽  
Microsurgical Anatomy ◽  
Complete Excision ◽  
Lateral Skull Base ◽  
The Individual ◽  
Selection Of

Abstract Objectives The aim of the study is to emphasize and explore the possible transtemporal approaches for spectrum of complicated lateral skull base pathologies. Design Retrospective analysis of complicated lateral skull base pathologies was managed in our institute between January 2017 and December 2019. Setting The study was conducted in a tertiary care referral center. Main Outcome Measures The study focused on the selection of approach based on site and extent of the pathology, the surgical nuances for each approach, and the associated complications. Results A total of 10 different pathologies of the lateral skull base were managed by different transtemporal approaches. The most common complication encountered was facial nerve palsy (43%, n = 6). Other complications included cerebrospinal fluid (CSF) collection (15%, n = 2), cosmetic deformity (24%, n = 4), petrous internal carotid artery injury (7%, n = 1), and hypoglossal nerve palsy (7%, n = 1). The cosmetic deformity included flap necrosis (n = 2) and postoperative bony defects leading to contour defects of the scalp (n = 2). Conclusion Surgical approach should be tailored based on the individual basis, to obtain adequate exposure and complete excision. Selection of appropriate surgical approach should also be based on the training and preference of the operating surgeon. Whenever necessary, combined surgical approaches facilitating full tumor exposure are recommended so that complete tumor excision is feasible. This requires a multidisciplinary team comprising neurosurgeons, neuro-otologist, neuroanesthetist, and plastic surgeons. The surgeon must know precise microsurgical anatomy to preserve the adjacent nerves and vessels, which is necessary for better surgical outcomes.

scholarly journals Surviving Burn Injury: Drivers of Length of Hospital Stay

2021 ◽  
Vol 18 (2) ◽  
pp. 761
Author(s):  
Chimdimma Noelyn Onah ◽  
Richard Allmendinger ◽  
Julia Handl ◽  
Ken W. Dunn
Keyword(s):  
Mental Status ◽  
Burn Injury ◽  
Length Of Hospital Stay ◽  
Care Plan ◽  
Burn Patients ◽  
Emotional Needs ◽  
Effective Care ◽  
Significant Difference ◽  
Unitary Model ◽  
Hospital Resources

With a reduction in the mortality rate of burn patients, length of stay (LOS) has been increasingly adopted as an outcome measure. Some studies have attempted to identify factors that explain a burn patient’s LOS. However, few have investigated the association between LOS and a patient’s mental and socioeconomic status. There is anecdotal evidence for links between these factors; uncovering these will aid in better addressing the specific physical and emotional needs of burn patients and facilitate the planning of scarce hospital resources. Here, we employ machine learning (clustering) and statistical models (regression) to investigate whether segmentation by socioeconomic/mental status can improve the performance and interpretability of an upstream predictive model, relative to a unitary model. Although we found no significant difference in the unitary model’s performance and the segment-specific models, the interpretation of the segment-specific models reveals a reduced impact of burn severity in LOS prediction with increasing adverse socioeconomic and mental status. Furthermore, the socioeconomic segments’ models highlight an increased influence of living circumstances and source of injury on LOS. These findings suggest that in addition to ensuring that patients’ physical needs are met, management of their mental status is crucial for delivering an effective care plan.

Stereotactic Electroencephalography Is Associated With Reduced Pain and Opioid Use When Compared with Subdural Grids: A Case Series

2021 ◽  
Author(s):  
Jonathan P Scoville ◽  
Evan Joyce ◽  
Joshua Hunsaker ◽  
Jared Reese ◽  
Herschel Wilde ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Chart Review ◽  
Statistical Tests ◽  
Case Series ◽  
Length Of Hospital Stay ◽  
Retrospective Chart Review ◽  
Opioid Use ◽  
Pain Scores ◽  
Surgical Methods ◽  
Significant Difference

Abstract BACKGROUND Minimally invasive surgery (MIS) has been shown to decrease length of hospital stay and opioid use. OBJECTIVE To identify whether surgery for epilepsy mapping via MIS stereotactically placed electroencephalography (SEEG) electrodes decreased overall opioid use when compared with craniotomy for EEG grid placement (ECoG). METHODS Patients who underwent surgery for epilepsy mapping, either SEEG or ECoG, were identified through retrospective chart review from 2015 through 2018. The hospital stay was separated into specific time periods to distinguish opioid use immediately postoperatively, throughout the rest of the stay and at discharge. The total amount of opioids consumed during each period was calculated by transforming all types of opioids into their morphine equivalents (ME). Pain scores were also collected using a modification of the Clinically Aligned Pain Assessment (CAPA) scale. The 2 surgical groups were compared using appropriate statistical tests. RESULTS The study identified 43 patients who met the inclusion criteria: 36 underwent SEEG placement and 17 underwent craniotomy grid placement. There was a statistically significant difference in median opioid consumption per hospital stay between the ECoG and the SEEG placement groups, 307.8 vs 71.5 ME, respectively (P = .0011). There was also a significant difference in CAPA scales between the 2 groups (P = .0117). CONCLUSION Opioid use is significantly lower in patients who undergo MIS epilepsy mapping via SEEG compared with those who undergo the more invasive ECoG procedure. As part of efforts to decrease the overall opioid burden, these results should be considered by patients and surgeons when deciding on surgical methods.

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