Draft of Guidelines for Human Body Dissection for Clinical Anatomy Education and Research and commentary

This article analyses the Draft of Guidelines for Human Body Dissection for Clinical Anatomy Education and Research drawn by the Study Group for Future Training Systems of Surgical Skills and Procedures established by the Fiscal Year 2010 research program of the Ministry of Health, Labor and Welfare. The purpose of the Draft of Guidelines is: First, to lay out the required basic guidelines for human cadaver usage to allow medical and dental faculty to conduct clinical education and research in accordance with existing regulations. Second, the guidelines are expected to give physicians a regulatory framework to carry out cadaver training in accordance with the current legal framework. This article explains the Draft of Guidelines in detail, outlines the future of cadaver training, and describes issues which must still be solved.     

The Association of Body Mass Index with Postoperative Outcomes After Elective Paraesophageal Hernia Repair

Purpose

To evaluate the association between body mass index (BMI) and postoperative outcomes in elective paraesophageal hernia (PEH) repairs.

Methods

A retrospective review of patients who underwent elective PEH repair in the ACS NSQIP database (2005–2015) was performed. Patients were stratified into BMI groups (<?18.5, 18.5–24.9, 25.0–29.9, 30.0–34.9, 35–39.9, and ≥?40.0 kg/m²) according to the World Health Organization classification criteria. A multivariable logistic regression model was developed to characterize the association between BMI class and outcomes, including readmission, reoperation, postoperative complications, and mortality.

Results

The median (IQR) age of the 9641 patients who met inclusion criteria was 64 (55–72) and 72.7% were women. Across each BMI class, age, race, gender, type of procedure, frailty index, smoking, and ASA class varied (p?<?0.05). Underweight patients (BMI <?18.5 kg/m²) had an increased risk of mortality (OR?=?6.35, p?<?0.05). Patients with a BMI 35–39.9 kg/m² (OR?=?0.65, p?<?0.05) and ≥?40 kg/m² (OR?=?0.36, p?<?0.001) were associated with a decreased risk for readmissions.

Conclusion

Underweight patients have an increased risk for postoperative mortality after elective PEH repair. Higher BMI was associated with a diminished risk for readmission, but not for mortality, reoperations, or overall complications.

     

Alcohol Exposure as a Risk Factor for Adverse Outcomes in Elective Surgery

Background and Aims  

Alcohol consumption is a well-documented determinant of adverse perioperative outcome. We sought to determine the effect of active alcohol consumption following elective surgery.     

Umbilical Herniorrhapy in Cirrhosis: Improved Outcomes with Elective Repair

Objective This study was undertaken to examine the effect of cirrhosis on elective and emergent umbilical herniorrhapy outcomes. Methods Procedures were identified from the Veterans’ Affairs National Surgical Quality Improvement Program at 16 hospitals. Medical records and operative reports were physician abstracted to obtain preoperative and intraoperative variables. Results Of the 1,421 cases reviewed, 127 (8.9%) had cirrhosis. Cirrhotics were more likely to undergo emergent repair (26.0% vs. 4.8%, p < 0.0001), concomitant bowel resection (8.7% vs. 0.8%, p < 0.0001), return to operating room (7.9% vs. 2.5%, p = 0.0006), and increased postoperative length of stay (4.0 vs. 2.0 days, p = 0.01). Best-fit regression models found cirrhosis was not a significant predictor of postoperative complications. Significant predictors of complications were emergent case (OR 5.4; 95% CI 3.1–9.4), diabetes (OR 2.1; 95% CI 1.2–3.8), congestive heart failure (OR 4.0; 95% CI 1.4–11.4), and chronic obstructive pulmonary disease (OR 2.0; 95% CI 1.1–3.6). Among emergent repairs, cirrhosis (OR 4.4; 95% CI 1.3–14.3) was strongly associated with postoperative complications. Conclusion Elective repair in cirrhotics is associated with similar outcomes as in patients without cirrhosis. Emergent repair in cirrhotics is associated with worse outcomes. Early elective repair may improve the overall outcomes for patients with cirrhosis.     

马方综合征并发A型主动脉夹层的手术疗效

目的观察并评价马方综合征(Marfan syndrome,MFS)并发A型主动脉夹层(type A aortic dissection,AAD)的手术疗效。方法回顾性分析2006年1月至2012年1月武汉亚洲心脏病医院收治44例MFS并发AAD患者的临床资料,其中男31例,女13例;年龄12～54(33.0±9.8)岁。23例在AAD发病后不同疾病阶段施行外科手术治疗,均行Bentall手术;21例因经济或其它原因未采取手术治疗。采用含时变协变量的COX回归分析,分别以主要终点事件、主要+次要终点事件作为结局变量对相关因素进行分析,观察手术患者术后手术疗效和生活质量,并与未手术患者的随访资料进行对比。结果术后有1例手术患者死于多器官功能衰竭,其余22例手术均成功。随访43例,随访时间1～75个月。22例手术患者术后3年生存率为95.7%,随访期间生活质量良好。未行手术治疗的21例患者生存状况及生活质量较差,13例(61.9%)死亡,主要死亡原因:急性心脏压塞、主动脉夹层破裂、急性心肌梗死并发心源性休克等;发病后3年生存率仅为31.7%。采用含时变协变量COX回归模型分析校正手术时间不一产生影响后的结果显示,手术治疗患者与未手术治疗患者相比较,其临床疗效的差异有统计学意义(T_COV_的OR值=0.088,P=0.028),手术治疗死亡风险仅为非手术治疗的8.8%(P<0.05)。结论 MFS并发AAD预后凶险,应尽早外科手术,不论是急性期还是慢性期均可获益,疗效可靠,随访结果令人满意。     

富林蜜凝胶涂搽创面治疗全身热疗后皮肤烫伤

目的 探讨富林蜜凝胶治疗极限全身热疗导致皮肤烫伤创面的促愈效果。方法 根据全身热疗后皮肤烫伤患者的创面随机将123例分为观察组（61例）和时照组（62例）。观察组采用富林蜜凝胶均匀涂搽烫伤部位，3次／d；对照组采用京万红烫伤软膏治疗（方法同观察组）。结果 观察组Ⅰ、Ⅱ度烫伤痊愈率（77．3％、88．2％）显著高于时照组（53．3％、47．1％，P〈0．05。P〈0．01）．创面愈合时间显著短于对照组（P〈0．01）。结论 富林蜜凝胶时于全身热疗导致皮肤烫伤的愈合有较好的促进作用，可缩短创面愈合时间。     

富林蜜凝胶涂搽创面治疗全身热疗后皮肤烫伤

目的探讨富林蜜凝胶治疗极限全身热疗导致皮肤烫伤创面的促愈效果.方法根据全身热疗后皮肤烫伤患者的创面随机将123例分为观察组(61例)和对照组(62例).观察组采用富林蜜凝胶均匀涂搽烫伤部位,3次/d;对照组采用京万红烫伤软膏治疗(方法同观察组).结果观察组Ⅰ、Ⅱ度烫伤痊愈率(77.3%、88.2%)显著高于对照组(53.3%、47.1%,P＜0.05,P＜0.01),创面愈合时间显著短于对照组(P＜0.01).结论富林蜜凝胶对于全身热疗导致皮肤烫伤的愈合有较好的促进作用,可缩短创面愈合时间.     

Outcomes After Emergency Versus Elective Ventral Hernia Repair: A Prospective Nationwide Study

Background

Early surgical results after emergency repairs for the most frequent ventral hernias (epigastric, umbilical, and incisional) are not well described. Thus, the aim of present study was to investigate early results and risk factors for poor 30-day outcome after emergency versus elective repair for ventral hernias.

Methods

All patients undergoing epigastric, umbilical, or incisional hernia repair registered in the Danish Hernia Database during the period 1 January 2007 to 31 December 2010 were included in the prospective study. Follow-up was obtained through administrative data from the Danish National Patient Register.

Results

In total, 10,041 elective and 935 emergency repairs were included. The risk for 30-day mortality, reoperation, and readmission was significantly higher (by a factor 2–15) after emergency repairs than after elective repairs (p ≤ 0.003). In addition, there were significantly more patients with concomitant bowel resection after emergency repairs than after elective repairs (p < 0.001). Independent risk factors for emergency umbilical/epigastric hernia repair were female gender, older age, hernia defects >2–7 cm, and repair for a primary hernia (vs recurrent hernia) (all p < 0.05). Independent risk factors for emergency incisional hernia repair were female gender, increasing age, and hernia defects ≤7 cm (all p < 0.05).

Conclusions

Emergency umbilical/epigastric or incisional hernia repair was beset with up to 15-fold higher mortality, reoperation, and readmission rates than elective repair. Older age, female gender, and umbilical hernia defects between 2 and 7 cm or incisional hernia defects up to 7 cm were important risk factors for emergency repair.     

Specialization in Acute Type A Aortic Dissection Repair: The Outcomes and Challenges

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全身热疗辅助治疗恶性肿瘤患者的护理

对45例晚期恶性肿瘤患者使用ET-SPACE-I全身热疗系统进行治疗。结果患者瘤体明显缩小，临床症状消失或减轻。提出做好热疗前后的护理，可提高治疗效果，减轻患者痛苦并提高生存质量。     

全身热疗辅助治疗恶性肿瘤患者的护理

对45例晚期恶性肿瘤患者使用ET-SPACE-I全身热疗系统进行治疗。结果患者瘤体明显缩小,临床症状消失或减轻。提出做好热疗前后的护理,可提高治疗效果,减轻患者痛苦并提高生存质量。