Laparoscopic splenectomy: how minimal can we make it?

Aims Laparoscopic splenectomy (LS) is routinely performed in children, however, a large spleen in a small child can pose significant operative challenges. We instigated a highly standardised surgical and anaesthetic approach to LS to minimise surgical trauma and enhance recovery. The aim of this study was to assess the outcomes of this programme. Methods Prospective study of all LS’s performed 2018–2021. Surgical approach was via one 10 mm and three 5 mm ports. Early hilar control was accomplished with Hem-o-loks. Splenic retrieval via the 10 mm incision used finger morcellation within an Espiner EcoSac. Anaesthesia utilised a standardised regime of agents and bupivacaine was infiltrated to the splenic bed and wound sites. Post-operative opiates were minimised. Data are presented as median [IQR]. Results Twenty consecutive children were included. Indications for LS were hereditary spherocytosis (n = 12), sickle cell disease (n = 6), beta-thalassaemia (n = 1) and splenic haemangiomatosis (n = 1). Age at surgery was 101 months [75–117] and weight 30 kg [21–37]. Splenic size was 13.4 cm [12–14.4]. Operative time was 178 min [156–185]. There were no open conversions and no significant intra or post-operative bleeding. One patient developed pancreatitis. Median post-operative pain score was 1 [1–3]. Median length of stay was 2 days [2–3]. Conclusion LS is feasible, safe and efficient in smaller children with large spleens. This standardised programme of anaesthesia and surgery based around a core team reliably results in few complications, good analgesia and short length of stay.

Colectomy and desmoid tumours in familial adenomatous polyposis: a systematic review and meta-analysis

Desmoid tumours (DT) are one of the main causes of death in patients with familial adenomatous polyposis (FAP). Surgical trauma is a risk factor for DT, yet a colectomy is inevitable in FAP to prevent colorectal cancer. This systematic review and meta-analysis aimed to synthesize the available evidence on DT risk related to type, approach and timing of colectomy. A search was performed in MEDLINE, EMBASE and the Cochrane Library. Studies were considered eligible when DT incidence was reported after different types, approaches and timing of colectomy. Twenty studies including 6452 FAP patients were selected, all observational. No significant difference in DT incidence was observed after IRA versus IPAA (OR 0.99, 95% CI 0.69–1.42) and after open versus laparoscopic colectomy (OR 0.88, 95% CI 0.42–1.86). Conflicting DT incidences were seen after early versus late colectomy and when analysing open versus laparoscopic colectomy according to colectomy type. Three studies reported a (non-significantly) higher DT incidence after laparoscopic IPAA compared to laparoscopic IRA, with OR varying between 1.77 and 4.09. A significantly higher DT incidence was observed in patients with a history of abdominal surgery (OR 3.40, 95% CI 1.64–7.03, p = 0.001). Current literature does not allow to state firmly whether type, approach, or timing of colectomy affects DT risk in FAP patients. Fewer DT were observed after laparoscopic IRA compared to laparoscopic IPAA, suggesting laparoscopic IRA as the preferred choice if appropriate considering rectal polyp burden. PROSPERO registration number CRD42020161424.

Efficacy analysis of one-stage posterior-only surgical treatment for thoracic spinal tuberculosis in the T4–6 segments with minimum 5-year follow-up

In recent years, with the in-depth research on spinal tuberculosis, posterior surgery alone has been praised highly by more and more surgeons due to the better correction of kyphosis, better maintenance of spinal physiological curvature, smaller surgical trauma and fewer surgical complications. However, there is currently lack of relevant reports about the efficacy of posterior surgery alone in the treatment of tuberculosis in the T4–6 segments. This study aimed to evaluate the clinical study efficacy and feasibility of one-stage posterior-only surgical treatment for thoracic spinal tuberculosis in the T4–6 segments. 67 patients with tuberculosis in T4–6 segments who underwent one-stage posterior-only surgery were included in this study. The clinical efficacy was evaluated using statistical analysis based on the data about erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), Oswestry Dability Index (ODI) score, Visual Analogue Scale (VAS) score and Cobb angle before surgery, after surgery and at the last follow-up. All patients completed fusion during the follow-up period of 6–9 months. ESR and CRP were returned to normal for all patients at 6 months follow-up. In the meanwhile, among the 27 patients combined with neurological impairment, neurological functions of 22 cases (81.48%) recovered completely at the last follow-up (P < 0.05). Cobb angle of the kyphosis was improved from preoperative 34.8 ± 10.9° to postoperative 9.6 ± 2.8°, maintaining at 11.3 ± 3.2° at the last follow-up, The ODI and VAS scores were improved by 77.10% and 81.70%, respectively. This 5-year follow-up study shows that better clinical efficacy can be achieved for tuberculosis in T4–6 segments using one-stage posterior-only approach by costotransverse debridement in combination with bone graft and internal fixation. The posterior surgical method cannot only effectively accomplish debridement, obtain satisfactory clinical results, but also well correct kyphotic deformity and maintain it.

Identification of the occurrence and potential mechanisms of heterotopic ossification associated with 17-beta-estradiol targeting MKX by bioinformatics analysis and cellular experiments

Background Tendon heterotopic ossification (HO) is a common condition occurring secondary to tendon injury or surgical trauma that significantly affects the patient’s quality of life. The treatment of tendon HO remains challenging due to a lack of clarity regarding the pathological mechanism. Mohawk (MKX) is a key factor in preventing tendon HO; however, its upstream regulatory mechanism remains to be understood. This study aimed to identify potential compounds that target and regulate MKX and explore their functional mechanisms. Methods Bioinformatics analysis of MKX-related compounds and proteins was performed based on data from the STITCH and OncoBinder databases. Subsequently, the SymMap database was used to study MKX-related traditional Chinese medicine drugs and symptoms. Next, the OncoBinder genomic and proteomic discovery model was applied to identify potential regulators of MKX. The analytical tool Expert Protein Analysis System for proteomics was used to predict the three-dimensional structure of MKX, and the AutoDockTools software was used to identify pockets of activity at potential sites for molecular docking. Furthermore, we evaluated the effect of different doses of 17-beta-estradiol on bone marrow-derived mesenchymal stem cells (BM-MSCs). Results By predicting the three-dimensional structure of MKX and simulating molecular docking, Pro-Tyr and 17-beta-Estradiol were found to target and bind to MKX. Analysis of the STITCH and OncoBinder databases showed that MKX had a significant regulatory correlation with suppressor interacting 3 A/histone deacetylase 1 (SIN3A/HDAC1). The GO and KEGG pathway enrichment analysis revealed that the functions of MKX and its associated proteins were mainly enriched in osteogenic-related pathways. Assessment of the proliferation of BM-MSCs revealed that 17-beta-estradiol possibly upregulated the mRNA expression of the HDAC1-SIN3A/BMP pathway-related RUNX2, thereby promoting the proliferation of BM-MSCs. Conclusions The compounds Pro-Tyr and 17-beta-Estradiol may bind to MKX and thus affect the interaction of MKX with SIN3A/HDAC1.

Sutureless Manual Extracapsular Cataract Extraction with Lollipop

Purpose: To evaluate the efficacy and safety of cataract extraction through small pupil with the help of a specially designed instrument called lollipop. Study Design: Interventional case series. Place and Duration of Study: Euro eye clinic from January 2019 to December 2019. Methods: Seventeen consecutive patients with pupil diameter of <4mm after maximal pharmacological dilatation were recruited for study. Inclusion criteria was patients with less than 4mm pupil size after maximum pharmacological dilation. Patient with previous anterior segment surgery and small pupil with posterior synechea were excluded. The instrument (lollipop) was originally designed for breaking posterior synechae. Sutureless Manual Extracapsular Cataract Extraction (SMECE), more commonly known as MSICS, was performed in all cases. After tunnel formation and capsulotomy, lollipop was used to bring lens edge out in pupillary margin. Lens was then maneuvered into anterior chamber and expressed out. Results: All 17 patients had successful SMECE. In one patient pupil was stretched before applying instrument. None of the patients had posterior capsular rupture or hyphaema. Conclusion: This instrument designed in Center of Ophthalmic Instrument and Equipment Designing (COIED) is very useful, safe and cost effective. In Extra Capsular Cataract Extraction (ECCE) or SMECE, surgeons usually do keyhole iridotomy, mechanical stretching or multiple sphincterotomies for managing small pupil. With this new instrument, cataract extraction can be done without surgical trauma to the pupil, thus preserving pupil shape. Key Words: Sutureless Manual Extra capsular Cataract Extraction (SMECE), Manual Small Incision Cataract Surgery (MSICS), Miosis.

PECULIARITIES OF THE REHABILITATION PROGRAM IN ELDERLY PATIENTS IN THE POST-OPERATIVE PERIOD WITH ACUTE CALCULOUS CHOLECYSTITIS

Currently, the elderly and senile account for 10 to 25% of all hospitalized for acute calculous cholecystitis. High operative-anesthetic risk, concomitant diseases and low resistance to surgical trauma are the cause of high frequency of postoperative complications and fatalities in this category of patients. In recent years, a reduction in postoperative mortality in acute cholecystitis, which is currently 0.28-2.9%, with gangrenous cholecystitis, it is higher to 17.8%. The aim of the study is to analyze and develop a rehabilitation program in the postoperative period in elderly and senile patients after surgery with acute calculous cholecystitis. Materials and methods We conducted an analysis of surgical treatment of 53 elderly and senile patients with acute calculous cholecystitis. In all patients, this diagnosis was confirmed intraoperatively and histologically. The age of all patients ranged from 61 to 89 years (mean 72.4 ± 8.7 years). Among the examined sick men there were 12 (22.6%), women - 41 (77.4%). The main criteria for assessing and creating a rehabilitation program in patients after surgery with acute calculous cholecystitis were the following processes: improving the general condition of patients, restoring intestinal motility, restoring or improving all impaired cardiovascular and respiratory functions, prevention of general complications (cardiovascular, respiratory, urinary, digestive and other systems), local (from the wound), normalization of blood parameters, One of the important components of successful surgical treatment of patients in the postoperative period is the timely restoration of respiratory, cardiovascular, digestive system after surgery. a guarantee of prevention of probable postoperative complications which are formed in the first 3-5 days after surgery. Objectives of the rehabilitation program in the early postoperative period in elderly and senile patients with acute calculous cholecystitis: to reduce the impact of drugs and accelerate the excretion of toxic substances from the body; restore adequate respiration and oxygen saturation; improve external respiration function, bronchial patency and bronchial drainage function; stabilize central hemodynamics to reduce peripheral circulatory disorders; prevent complications from the gastrointestinal tract, thromboembolic complications; prevent complications from the postoperative wound. Conclusions: Development of a rehabilitation program is a mandatory component in operated patients. Particular attention is paid to elderly and senile patients, who require a set of rehabilitation measures to be minimal, but sufficient to restore lost or reduced body functions in the early postoperative period, but at the same time, it should not exceed the patient's capabilities and ensure maximum efficiency. restoration. Start a rehabilitation program (breathing exercises, kinesiotherapy, massage, inhalation in combination with physiotherapy procedures) should be 12 - 16 hours after surgery. Prospects for further development Continue to develop a rehabilitation program for elderly and senile patients, taking into account the functional capabilities of the body in the long period of rehabilitation.

Acute phase proteins in veterinary medicine: A review

The acute phase proteins (APPs) are a group of blood proteins that contribute to restoring homeostasis and limiting microbial growth in an antibody-independent manner in animals which are exposed to different pathological conditions like infection, inflammation, surgical trauma and stress. In the last two decades, many advances have been made in monitoring APPs in both farm and companion animals for clinical and experimental purposes. Also, the mechanism of the APPs response is receiving attention in veterinary science in connection with the innate immune systems of animals. This review describes the many of new results of research and role APPs in farm animal, with special reference to their functions, types, induction and regulatory expression, some of biological functions, and their current and future applications to veterinary diagnosis and animal production.

THE ROLE AND PLACE OF DAMAGE CONTROL SURGERY IN MILITARY MEDICAL EVACUATION DOCTRINE DURING HOSTILITIES IN MODERN WAR

Introduction: The severity of the combined injury, traumatic shock, blood loss and traumatic prolonged primary surgery are the cause of high mortality injured patients. In civilian medicine, damage control technology is widely used to treat patients with severe polytrauma, which has improved the survival of this group of patients. Objective: Analyze the effectiveness of using "damage control" technology in wounded with polytrauma at the second level of medical care during war conflict in Eastern Ukraine and organization of combat casualty care. Methods: Medical and statistical analysis of the effectiveness medical treatment for patients combat-ralated injuried and polytrauma performed on the basis of a mobile military hospital during 2015-2019 period. Results: In 660 patients with combat multiple and combined injuries and in 1027 - with severe military combined trauma, medical tratment was provide by "damage control" technology. The main task of the first stage of surgery intervention was to stop the bleeding and stabilize the patient condition. 130 patients with intra-abdominal bleeding underwent laparotomy, temporary stop of bleeding, blood sampling for autotransfusion and temporary closure of the abdominal cavity. For the purpose of temporary hemostasis in 15 patients abdominal tamponade was performed, in 26 - liver tamponade, in 24 - splenectomy, in 6 - nephrectomy and in 6 - put the clamps were applied to bleeding vessels. In 14% injured patients definitive stage of surgical procedures were performed at the second level of medical care on the background of abdominal compartment syndrome in 10, visceral edema in 14 and peritonitis in 40 patients. Conclusions: Providing emergency medical treatment, surgical procedures and intensive care at the second level of medical tretment using the technology of "damage control" and timely patients evacuation are the key to reducing mortality and complications of military surgical trauma

Bone Damage during Dental Implant Insertion: A Pilot Study Combining Strain Gauge and Histologic Analysis

Besides alveolar bone quality, the drilling protocol applied in conjunction with the design of an implant are the major determinants of primary implant stability. Surgical trauma and bone compression resulting from implant insertion may constitute one cause for marginal bone resorption. Inserting two current bone-level implant designs (Astra; Straumann; n = 5) in bovine ribs, primary stability, strain development on the buccal bone plate and histologic signs of bone damage were recorded. Besides comparing the implant designs (Welch t-tests), all measurement parameters were checked for potential correlations (Pearson product moment correlation coefficients) with the level of significance set at α = 0.05. Considerable numbers of crack formation and plastic deformation of bone were observed after implant insertion. Straumann implants showed slightly greater values for insertion torque (p = 0.772), strain development (p = 0.893) and implant stability (p = 0.642). Significantly greater bone to implant contact (cortical p = 0.014; trabecular p = 0.016) was observed in Straumann implants, while Astra implants caused a significantly greater number of microcracks in cortical bone (p = 0.020). In Straumann implants, insertion torque correlated with bone to implant contact in the cortical area (p = 0.029) and the number of macrocracks in trabecular bone correlated with bone to implant contact (p = 0.029). In Astra implants, insertion torque and bone to implant contact in the trabecular area correlated (p = 0.007) as well as the number of macrocracks in trabecular bone and implant stability (p = 0.016). Additionally, in the area of cortical bone, the number of macrocracks correlated with bone to implant contact (p = 0.019). Implant placement results in bone damage of varying magnitude, which is governed by the drill protocol, implant macrodesign and bone quality.