A retrospective analysis of emergency hysterectomy intervention strategy in obstetrics

Objectives: To investigate the indications of obstetric emergency hysterectomy and analyze the clinical effects of subtotal hysterectomy and total hysterectomy. Methods: We included 247 hospitalized women who had undergone abdominal hysterectomy due to obstetric reasons in Fujian Province Maternity and Child Health Hospital (a provincial class-A hospital) and Ningde People’s Hospital (a primary Class-B hospital) between January 2002 and December 2018. We identified surgical indications and clinical characteristics of the patients. Furthermore, the patients from Fujian Provincial Maternity and Child Health Hospital were subdivided into subtotal hysterectomy group and total hysterectomy group to examine general operation conditions, and postoperative complications. Results: The main surgical indications for emergency obstetric hysterectomy in Fujian Maternity and Child Health Hospital were placental implantation (49.6%) and uterine weakness (31.9%), while uterine weakness (37.5%) was the most important indication in Ningde People’s Hospital. No differences were found in operation time, hospitalization time, intraoperative blood loss, postpartum blood loss, and intraoperative fresh frozen plasma transfusion between the subtotal hysterectomy group and the total hysterectomy group. Postoperative test parameters, including postoperative prothrombin time (PT), thrombin time (TT), activated partial thromboplastin time (APTT), hemoglobin (HGB), and hematocrit (HCT), were not significantly different between the two groups. No significant difference was noted in postoperative vesicoureteral injury, pelvic hematoma, infection, and disseminated intravascular coagulation (DIC) incidence, but renal failure incidence was different (P=0.040). Conclusion: The treatment effect of subtotal hysterectomies for the cases without placenta accreta and placenta previa was similar in the two hospitals. There is no statistically significant difference in therapeutic effect between total hysterectomy and subtotal hysterectomy. doi: https://doi.org/10.12669/pjms.38.3.5335 How to cite this:Fang Z, Zhang H, Zheng S, Weng L, Yan J. A retrospective analysis of emergency hysterectomy intervention strategy in obstetrics. Pak J Med Sci. 2022;38(3):---------. doi: https://doi.org/10.12669/pjms.38.3.5335 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

External fixation in distal radius fractures

Background: Distal radius fractures are frequent in emergency departments, treatment is generally conservative, but there are patients who meet certain criteria of instability who need surgical treatment, including external fixation. Aim: To update on the most important elements regarding the use of external fixation in unstable fractures of the distal radius. Methods: The search and analysis of the information was carried out in a period of 30 days (from April 1 to April 30, 2021) and the following words were used: distal radius fractures, distal radius fractures and external fixation and unstable radius fractures from the information obtained, a bibliographic review of a total of 809 articles published in the PubMed databases, Hinari, SciELO and Medline was carried out using the search manager and EndNote reference manager, of which 44 selected citations were used to perform the review, 37 from the last five years. Development: The criteria to be taken into account for the instability described by various authors are indicated, as well as the imaging parameters. The two most used classification systems are mentioned. Reference is made to general surgical indications, external fixation, and placement of additional wires. Complications are discussed and a comparison is made between external fixation and blocked volar plates.

Decreasing Number of Urodynamics in Urological and Gynaecological Clinics Reflects Decreased Importance for Surgical Indications: German Population-Based Data from 2013 to 2019

<b><i>Introduction:</i></b> The routine use of urodynamic studies (UDS) has been questioned. Additionally, the material and personnel costs are poorly remunerated. We aimed to analyse the UDS utilization in Germany. <b><i>Methods:</i></b> We analysed UDS performed by hospitals based on quality reports from 2013 to 2019. A representative sample of 4 million insured persons was used to estimate outpatient UDS utilization from 2013 to 2018. <b><i>Results:</i></b> There was an overall decrease of 14% in UDS in Germany from 2013 to 2018 (60,980 to 52,319; <i>p</i> = 0.003). In the outpatient sector, there was a slight non-continuous drop of 11% from 34,551 to 30,652 from 2013 to 2018 (<i>p</i> = 0.06). UDS utilization in hospitals decreased by 26% from 26,429 in 2013 to 19,453 in 2019 (<i>p</i> = 0.004). University hospitals showed a smaller decrease (3,007 to 2,685; <i>p</i> = 0.02). In urology, the number of UDS (11,758 to 6,409; <i>p</i> &#x3c; 0.001) and the number of performing departments (328 to 263 clinics; <i>p</i> &#x3c; 0.001) decreased. Gynaecological departments also showed a decrease in UDS (1,861 to 866; <i>p</i> &#x3c; 0.001) and performing departments (159 to 68; <i>p</i> &#x3c; 0.001). However, in paediatrics, there was an increase in UDS (1,564 to 2,192; <i>p</i> = 0.02). By age, the number of children remained constant (1,371 to 1,252; <i>p</i> = 0.2), but there was a strong decrease seen in 60- to 79-year-olds (9,792 to 5,564; <i>p</i> &#x3c; 0.001). <b><i>Conclusion:</i></b> UDS appear to be less important in the indication for surgery. Despite high resource expenditure and low remuneration, the decrease in urodynamics in the outpatient sector is less pronounced, indicating a trend to perform UDS in an outpatient setting.

The Value of CT-based Radiomics Nomogram in Differential Diagnosis of Different Histological Types of Gastric Cancer

Purpose: To establish and verify a nomogram based on computed tomography (CT) radiomics analysis to predict the histological types of gastric cancer preoperatively for patients with surgical indications.Methods: A sum of 143 patients with gastric cancer in Sir Run Run Shaw Hospital from January 2019 to December 2020 (differentiated type: 46 cases; undifferentiated type: 97 cases) were included into this retrospective study, and were randomly divided into training (n=99) and test cohort (n=44). The least absolute shrinkage and selection operator(LASSO) was used for feature selection while the multivariate Logistic regression method was used for radiomics model and nomogram building. The area under curve(AUC) was used for performance evaluation in this study.Results: The radiomics model got AUCs of 0.755 (95%CI, 0.650-0.859) and 0.71 (95%CI,0.543-0.875) for histological prediction in the training and test cohorts, respectively. The radiomics nomogram based on radiomics features and Carbohydrate antigen 125 (CA125) achieved an AUC of 0.777 (95%CI:0.679-0.875) in the training cohort with 0.726 (95%CI:0.559-0.893) in the test cohort. The calibration curve of the radiomics nomogram also showed good results. The decision curve analysis(DCA) shows that the radiomics nomogram is clinically practical.Conclusion: The radiomics nomogram established and verified in this study showed good performance for the preoperative histological prediction of gastric cancer, which might contribute to the formulation of a better clinical treatment plan.

A PROSPECTIVE OBSERVATIONAL STUDY ON SURGICAL INDICATIONS FOR SPLENECTOMY IN A TERTIARY CARE CENTER.

Background: Spleen mediates important immunologic, storage and hematologic functions. A person can undergo a splenectomy for various causes which includes both surgical and non surgical. The recent trend being towards spleen preservation, it is necessary to critically analyse the indications for splenectomy and assess if the desired post operative outcomes are achieved by splenectomy. Materials and Methods: This prospective observational study was carried out on patients of Department of General Surgery, Mysore Medical College and Research Institute, Mysore, from august 2017 to November 2019. 45 adult subjects (both male and females) aged ≥ 18 years, who underwent elective or emergency splenectomy for various indications were studied. Results: The most common indication for splenectomy was trauma in 27 patients(60%) followed by splenic abscess(15.6%). Most of the patients underwent emergency splenectomy i.e., 25 cases(55%) . In our study the majority received blood transfusion, 15.5% developed wound infection and 2 cases(4.4%) needed reexploration due to rebleeding.

Role of Partial Splenectomy in Hematologic Childhood Disorders

The spleen is a secondary lymphoid organ that belongs to the reticular-endothelial system, directly connected to blood circulation. The spleen is greatly involved in the immune response, especially against capsulated bacteria. Splenectomy plays a fundamental role in the treatment of numerous pediatric hematologic disorders. Taking into account all the possible complications (especially infections) linked to this procedure, alternatives to total splenectomy have been sought. Partial splenectomy has been proposed as a treatment that allows the reduction of infectious risk. This approach has proven safe and feasible in most patients, but multicentric and prospective studies are necessary to more accurately define the indications for performing partial splenectomy. However, vaccinations and antibiotic prophylaxis remain fundamental for preventing serious infections, even in the case of partial splenectomy. We review anatomical and functional properties of the spleen, with a focus on medical or surgical indications to splenectomy, aiming to give practical educational information to patients and their families after splenectomy. Furthermore, we discuss the feasibility of partial splenectomy in children with hematologic diseases who require splenectomy.

Updates on the Latest Surgical Approach of the Aortic Stenosis

Over the last twenty years, we marked significant progresses in the field of tissue engineering and the development of new aortic valve structural and delivery systems. These continuous iterations on the field, have completely changed the surgical indications and approaches for AVR. Nowadays, therapeutic decisions are endorsed by international guidelines; however, new technical advances need a new integrated approach. The clinical scenarios issued from the interaction between the Guidelines and the newest approaches and technologies are regularly on debate by the Heart Team. We will present some of our most encountered situations and the pattern of our therapeutic decisions. To easily navigate through Guidelines and clinical scenarios, we reported in this review a simplified and easy to use Clinical decision-making algorithm that may be a valuable tool in our daily practice.

Efficacy and Mechanisms of Gastric Volume-Restriction Bariatric Devices

Obesity is a chronic disease that affects over 795 million people worldwide. Bariatric surgery is an effective therapy to combat the epidemic of clinically severe obesity, but it is only performed in a very small proportion of patients because of the limited surgical indications, the irreversibility of the procedure, and the potential postoperative complications. As an alternative to bariatric surgery, numerous medical devices have been developed for the treatment of morbid obesity and obesity-related disorders. Most devices target restriction of the stomach, but the mechanism of action is likely more than just mechanical restriction. The objective of this review is to integrate the underlying mechanisms of gastric restrictive bariatric devices in obesity and comorbidities. We call attention to the need for future studies on potential mechanisms to shed light on how current gastric volume-restriction bariatric devices function and how future devices and treatments can be further improved to combat the epidemic of obesity.

Association between RNF213 c.14576G>A Variant (rs112735431) and Peripheral Pulmonary Artery Stenosis in Moyamoya Disease

<b><i>Background:</i></b> Moyamoya disease (MMD) and peripheral pulmonary artery stenosis (PPAS) are relatively rare and demonstrate steno-occlusive vascular lesions in different organs. Genetic studies identified <i>RNF213</i> polymorphism c.14576G&#x3e;A (rs112735431) as a susceptibility variant for East Asian MMD. <i>RNF213</i> polymorphism c.14576G&#x3e;A is further associated with various vascular lesions of other organs. In this study, we aimed to clarify the incidence and clinical manifestations of PPAS in MMD patients and analyze the correlation between <i>RNF213</i> genotype and PPAS. <b><i>Methods:</i></b> This retrospective case-control study investigated the association between <i>RNF213</i> polymorphism and PPAS in 306 MMD/quasi-MMD patients, reviewing the medical charts and imaging records of consecutive patients with MMD admitted from January 2015 to December 2020. <b><i>Results:</i></b> PPAS was observed in 3 MMD/quasi-MMD patients (0.98%, 3/306). <i>RNF213</i> polymorphism c.14576G&#x3e;A was determined for all 306 MMD/quasi-MMD patients. The incidence of PPAS in <i>RNF213</i>-wildtype, <i>RNF213</i>-heterozygote, and <i>RNF213</i>-homozygote MMD/quasi-MMD patients was 0% (0/101), 0.5% (1/200), and 40% (2/5), respectively. The association between PPAS and homozygote polymorphism of <i>RNF213</i> c.14576G&#x3e;A was statistically significant in MMD/quasi-MMD patients (<i>p</i> = 0.0018). In all cases, pulmonary artery hypertension due to PPAS was evident during their childhood and young adolescent stages. Surgical indications for MMD were discouraged in 1 case due to her severe cardiopulmonary dysfunction. <b><i>Conclusions:</i></b> The homozygote variant of <i>RNF213</i> polymorphism c.14576G&#x3e;A can be a potential predisposing factor for PPAS in MMD/quasi-MMD patients. Despite the relatively rare entity, PPAS should be noted to determine surgical indications for MMD/quasi-MMD patients.

A Clinical Analysis of 640 Inpatients With Pathologic Nipple Discharge

Objective To discuss the value of early confirmation of breast cancer in patients with pathologic nipple discharge based on double surgical indications under fiberoptic ductoscopy (FDS) followed by staining with methylene blue. Methods From October 2012 to October 2019, a total of 640 inpatients with pathologic nipple discharge from Wuhan University Zhongnan Hospital underwent fiberoptic ductoscopy, followed by injection of methylene blue into the lesional duct through the discharged hole that would be resected as a segment according to the range of the staining duct on the next day. Based on double surgical indications, different findings by fiberoptic ductoscopy were defined as surgical indications, both with space-occupying intraductal lesions scanned by FDS and without space-occupying intraductal lesions but with dark red bloody fluid or yellow serous fluid spillage at the opening of the terminal mammary duct or extensive erosive duct lesions. We retrospectively analyzed the relations between results from fiberoptic ductoscopy and pathologic diagnosis. Results Inpatients with pathological neoplasm accounted for 87.3%(452/518) of the 518 inpatients with space-occupying intraductal lesions scanned by FDS, but the 122 inpatients without space-occupying intraductal lesions only accounted for 28.7%(35/122) of the patients (P=0.00). However, patients pathologically diagnosed with breast cancer accounted for 11.8% (61/518) of the 518 inpatients with space-occupying lesions and 10.7%(13/122) of the 122 inpatients without space-occupying lesions (P=0.728). Conclusions According to the double standards of surgical indication with or without space-occupying intraductal lesions scanned by fiberoptic ductoscopy, the method of fiberoptic ductoscopy followed by staining of the mammary duct by methylene blue could not only avoid missed diagnosis of breast cancer caused by ductoscopy itself, but also reduce the rate of missed diagnosis on account of inoperative inaccurate resection range, which greatly improved the early diagnosis rate of breast cancer with nipple discharge as the only initial clinical manifestation.