Peculiarities of microflora in an acute appendicitis and its impact on the postoperative purulent-inflammatory complications rate

Bacteriological investigation of processus vermiformis contents was performed in 102 patients suffering an acute appendicitis (AA) and of abdominal cavity exudate--in 82 patients, operated for an AA. The microflora identification was done, as well as probable connection between microorganisms associations, the rate of the AA destructive forms revealing and postoperative purulent-inflammatory complications occurrence.     

Stereotactic biopsy of intracranial brain lesions. High diagnostic yield without increased complications: 65 consecutive biopsies with early postoperative CT scans

Diagnostic yield and complication rate were analyzed for a series of 65 consecutive stereotactic biopsies of intra-axial brain lesions. The diagnostic yield was 98.5 +/- 1.5% and the complication rate was 1.5%. A median number of 14 biopsies (range 1-48) were taken per lesion. The biopsy sites followed a clockwise pattern, going from the superficial margin to the center and the deep margin of the lesion with respect to the inner table of the skull. A side window cannula biopsy needle was used. All patients underwent immediate postoperative CT scans within 4 h of biopsy to rule out intracranial complications. All patients were discharged within 24 h after biopsy, unless medical reasons unrelated to the biopsy required further hospitalization. We attribute the high diagnostic yield in our series to the high number of systematically taken biopsies per lesion. The higher number of biopsies did not lead to an increase in complications. From our experience, it appears safe to discharge patients the same day or within 24 h after a stereotactic biopsy if the postoperative CT shows no complication. Stereotactic biopsy could often safely be performed on an outpatient basis.     

Evaluation of negative appendicectomy rate in cases of suspected acute appendicitis and to study the usefulness of ultrasonography in improving the diagnostic accuracy

Context  

Acute appendicitis poses a significant diagnostic challenge to the surgeon. Despite modern advances, the diagnosis of appendicitis remains essentially clinical. Ultrasonography is effective in supplementing the clinical diagnosis.     

The impact of an acute care surgery clinical care pathway for suspected appendicitis on the use of CT in the emergency department

Background

The natural evolution of an acute care surgery (ACS) service is to develop disease-specific care pathways aimed at quality improvement. Our primary goal was to evaluate the implementation of an ACS pathway dedicated to suspected appendicitis on patient flow and the use of computed tomography (CT) in the emergency department (ED).

Methods

All adults within a large health care system (3 hospitals) with suspected appendicitis were analyzed during our study period, which included 3 time periods: pre-and postimplementation of the disease-specific pathway and at 12-month follow-up.

Results

Of the 1168 consultations for appendicitis that took place during our study period, 349 occurred preimplementation, 392 occurred postimplementation, and 427 were follow-up visits. In all, 877 (75%) patients were admitted to the ACS service. Overall, 83% of patients underwent surgery within 6 hours. The mean wait time from CT request to obtaining the CT scan decreased with pathway implementation at all sites (197 v. 143 min, p < 0.001). This improvement was sustained at 12-month follow-up (131 min, p < 0.001). The pathway increased the number of CTs completed in under 2 hours from 3% to 42% (p < 0.001). No decrease in the total number of CTs or the pattern of ultrasonography was noted (p = 0.42). Wait times from ED triage to surgery were shortened (665 min preimplementation, 633 min postimplementation, 631 min at the 12-month follow-up, p = 0.040).

Conclusion

A clinical care pathway dedicated to suspected appendicitis can decrease times to both CT scan and surgical intervention.     

Fast-track surgery decreases the incidence of postoperative delirium and other complications in elderly patients with colorectal carcinoma

Objective

This study aims to investigate the role of fast-track surgery in preventing the development of postoperative delirium and other complications in elderly patients with colorectal carcinoma.

Methods

A total of 240 elderly patients with colorectal carcinoma (aged ≥70 years) undergoing open colorectal surgery was randomly assigned into two groups, in which the patients were managed perioperatively either with traditional or fast-track approaches. The length of hospital stay (LOS) and time to pass flatus were compared. The incidence of postoperative delirium and other complications were evaluated. Serum interleukin-6 (IL-6) levels were determined before and after surgery.

Results

The LOS was significantly shorter in the fast-track surgery (FTS) group than that in the traditional group. The recovery of bowel movement (as indicated by the time to pass flatus) was faster in the FTS group. The postoperative complications including pulmonary infection, urinary infection and heart failure were significantly less frequent in the FTS group. Notably, the incidence of postoperative delirium was significantly lower in patients with the fast track therapy (4/117, 3.4 %) than with the traditional therapy (15/116, 12.9 %; p?=?0.008). The serum IL-6 levels on postoperative days 1, 2, and 3 in patients with the fast-track therapy were significantly lower than those with the traditional therapy (p?<?0.001).

Conclusions

Compared to traditional perioperative management, fast-track surgery decreases the LOS, facilitates the recovery of bowel movement, and reduces occurrence of postoperative delirium and other complications in elderly patients with colorectal carcinoma. The lower incidence of delirium is at least partly attributable to the reduced systemic inflammatory response mediated by IL-6.     

Nonfocused enhanced CT evaluation of acute appendicitis increases length of stay in the emergency department but does not increase perforation rate

Nonfocused enhanced CT (NFECT) using intravenous and oral contrast is highly sensitive and specific for the diagnosis of acute appendicitis but requires additional time for transit of oral contrast and imaging interpretation. The aim of this study was to review our use of NFECT for the evaluation of acute appendicitis. Over a 2-year period, 295 adult patients presented to our emergency department and were diagnosed with acute appendicitis. Of these patients, 240 (81%) had undergone some form of cross-sectional imaging of the abdomen, and the majority (n = 193 [65%]) had NFECT scans performed during their evaluation. Fifty-five (19%) patients did not undergo cross-sectional radiographic evaluation (nonimaging group). Compared with the nonimaging group, patients who underwent NFECT were older (37 vs 32 years; P = 0.015) and more likely to be female (49% vs 20%; P < 0.001). Length of stay in the emergency department was significantly greater for patients who underwent NFECT (606 vs 321 minutes; P < 0.001), but there was no significant difference in the rate of acute appendiceal perforation (15% vs 9%; P = 0.297). In conclusion, use of NFECT for the diagnosis of acute appendicitis nearly doubles the patient's time in the emergency department with no significant increase in the acute perforation rate.     

Increasing the size of ureteral access sheath during retrograde intrarenal surgery improves surgical efficiency without increasing complications

Purpose

To directly compare intraoperative and post-operative outcomes and complications between three groups undergoing ureteroscopy: no ureteral access sheath, 12/14 Fr and larger 14/16 Fr ureteral access sheaths (UAS).

Methods

We retrospectively reviewed demographic, pre-operative, intraoperative, and post-operative data of 257 patients who underwent ureteroscopy for nephrolithiasis by a single surgeon from January 2013 through July 2015. Patients were separated into three groups: no UAS, a 12/14 Fr UAS, or 14/16 Fr UAS. Outcomes included differences in stone-free rate, post-procedure-related events (PRE), ureteral injury rate (measured by early post-operative hydronephrosis), and post-operative complications.

Results

A UAS was used in 65.4% (168/257) patients, with 73.8% (124/168) utilizing a 12/14 Fr UAS and 26.2% (44/168) utilizing a 14/16 Fr UAS. Those patients in whom a 14/16 Fr UAS was employed had greater stone burden compared to the 12/14 Fr UAS group (180.8 ± 18.0 vs. 104 ± 9.1 mm², p < 0.001). When comparing 12/14 Fr and 14/16 Fr ureteral access sheaths, there was no significant difference in ureteral injury rate, complications (10.5 vs. 11.4%, respectively; p = 0.87), or overall stone-free rate (78.1 vs. 81.3%, p = 0.70). The mean amount of stone burden treated per minute of operative time was more than 30% higher in the 14/16 Fr UAS group compared to 12/14 Fr UAS group (2.11 vs. 1.62 mm²/min; p = 0.01).

Conclusion

The use of a 14/16 Fr UAS allows for similar stone-free rate and improved operative efficiency with no increased risk of ureteral injury or post-operative complications when compared to the 12/14 Fr UAS.

     

Does a one-time colonic or rectal resection without protective colostomy increase the rate of postoperative complications?]

The rate of postoperative complications is the decisive criterion in evaluating the preoperative preparation of the large intestine, the operative methods, and the technique of anastomosis. Preparations for colorectal surgery include administration of antibiotics and the use of a three-row suture method of anastomosis without the protection of an intestinal fistula. The results of 1054 colorectal resections are promising: The rate of anastomotic insufficiency was 3.9% after resection of tumors and 4.9% after resection of inflamed diverticula. Lethality from local causes was 1.2% and 1.9%, respectively. Disturbance of wound healing occurred in 10.7% of the cases.     

The growth patterns of normal skull by using CT scans and their clinical applications for preoperative planning and postoperative follow-up in craniofacial surgery

Summary In the operative treatment of craniosynostosis, the accurate criteria for the extent of fronto-orbital advancement and/or reshaping have not been published. In this study, the growth and configuration of the forehead, anterior cranial base and occipital region have been investigated using CT scans. In addition to its intrinsic worth, the information obtained is also useful for preoperative planning of advancement and/or reshaping in craniosynostosis surgery, and also for post-operative follow-up.Presented at the 2nd International Congress of Craniomaxillofacial Surgery, Florence, Italy, June 1989     

One hundred and twenty-five consecutive choledochotomies for suspected lithiasis without mortality. Current state of complications from common bile duct surgery]

The postoperative courses of 125 consecutive surgical common bile duct explorations performed between 1983 and 1990 were analysed. All cases of common bile duct lithiasis, but three, were operated on. Intraoperative cholangiography was performed in 98 percent and cholangioscopy in 92 percent of patients; common bile duct stones were found in 95 patients (76 percent); the common bile duct was sutured without drainage in 78 patients (58 percent). There were no deaths. Morbidity was 14 percent, of which 10 percent were serious. Four percent of common bile ducts retained stones. The specific morbidity was 4 percent. These results confirm the reliability of surgical management of common bile duct stones and therefore should be considered for the evaluation of new procedures, such as laparoscopic treatment of common duct stones, or combined laparoscopic cholecystectomy and endoscopic sphincterotomy.     

术后液体负平衡对胃癌D3切除术手术死亡率和并发症的预测价值

目的 评估术后液体负平衡对胃癌淋巴结D3切除术手术死亡率和并发症的预测价值.方法 回顾性分析我院1994年1月～2006年3月间行胃癌淋巴结D3切除术82例的临床资料.根据术后液体负平衡出现的时间将病例分为A、B两组.A组为术后3 d内出现负平衡的病人(70例),B组为术后3 d内未出现负平衡的病人(12例).结果 对两组围手术期的相关因素进行比较,无显著性差异(P＞0.05);A组手术死亡率及并发症发生率明显低于B组(P＜0.01).结论 术后液体负平衡出现的迟早是反映手术死亡率和并发症发生率高低的一项重要指标.     

Intrasphincteric botulinum toxin decreases the rate of hospitalization for postoperative obstructive symptoms in children with Hirschsprung disease

Background

Although most children with Hirschsprung disease do well after pull-through surgery, some continue to have persistent obstructive symptoms. The purpose of this study was to evaluate the effect of intrasphincteric botulinum toxin in the management of these children.

Methods

A retrospective review of patients with Hirschsprung disease treated over 10 years was performed.

Results

Twenty-two patients who had previously undergone pull-through surgery received a median number of 2 botulinum toxin injections (range, 1-23). The number of hospitalizations for obstructive symptoms significantly decreased from preinjection (median, 1.5; interquartile range [IQR], 1-3) to postinjection (median, 0; IQR, 0-1) (P = .0003). The number of injections was lower in children with a rectosigmoid transition zone (median, 1 injection; IQR, 1-3.5) than in those with long-segment disease (median, 3 injections; IQR, 1-15) (P = .04). Eighty percent of patients had a good response to the first dose of botulinum toxin, and 69% of them required additional injections. There were no short-term or long-term complications related to botulinum toxin.

Conclusions

Intrasphincteric botulinum toxin significantly decreased the need for obstruction-related hospitalization in children who had undergone pull-through surgery for Hirschsprung disease. Botulinum toxin should be strongly considered in the management algorithm for postoperative obstructive symptoms in children with Hirschsprung disease.     

Obesity is associated with an improved cancer-specific survival, but an increased rate of postoperative complications after surgery for renal cell carcinoma

Abstract Objective. This study aimed to assess the impact of preoperative body mass index (BMI) on postoperative complications, cancer-specific survival (CSS) and overall survival (OS) in patients operated for renal cell carcinoma (RCC). Material and methods. The study included 397 patients with BMI values, who underwent surgery for RCC between 1 January 1997 and 31 December 2010. Obese patients (BMI > 30 kg/m(2)) were compared to non-obese patients (BMI < 30 kg/m(2)) in regard to CSS and OS. A Cox proportional hazard model was used for the multivariate survival analyses. The mean age of the patients was 62.1 years. There were 259 males (65%) and 325 patients (82%) were non-obese. Mean BMI was 26 kg/m(2). Results. In the total material, CSS was 94.7% for obese patients and 74.8% for non-obese patients (p = 0.06). The obese group had significantly better CSS in univariate analysis for presumed radically treated disease (pT1-3N0M0). Obesity was a significant protective prognostic factor in multivariate analysis. An accelerating protective effect for CSS was found with increasing levels of BMI. In regard to OS, no difference was found between the two groups. Obese patients had a significantly lower age, and a higher rate of diabetes mellitus, hypertension and incidental detection. Obese patients had a significantly higher total incidence of postoperative complications, but not surgery-related complications. Conclusions. In this material, increasing BMI was associated with improved CSS for presumed radically treated patients. However, obese patients had a higher total rate of postoperative complications.