Etiologic factors in falls from height in pediatric cases

Objective  

In this study, factors causing falls from height and precautions taken for their prevention were investigated.     

Fungal colonisation in burn wounds: An Indian scenerio

Abstract  

Burn patients are susceptible hosts for fungal colonisation.     

Day-case inguinal hernia repair in the elderly: a surgical priority

Purpose  

To compare patients over 70 years old with those under 50 years old undergoing inguinal hernia repair.     

Assessing the utility of ultrasound-guided vascular access placement with longer catheters in critically ill pediatric patients

Background

Critically ill pediatric patients can have difficulty with establishing and maintaining stable vascular access. A long-dwelling peripheral intravenous catheter placement decreases the need for additional vascular interventions.

Aim

The study sought to compare longevity, catheter-associated complications, and the need for additional vascular interventions when using ultrasound-guided longer peripheral intravenous catheters comparing to a traditional approach using standard-sized peripheral intravenous catheters in pediatric critically ill patients with difficult vascular access.

Methods

This single-center retrospective cohort study included children 0–18 years of age with difficult vascular access admitted to the pediatric intensive care unit between 01/01/2018–06/01/2021.

Results

One hundred and eighty seven placements were included in the study, with 99 ultrasound-guided long intravenous catheters placed and 88 traditionally placed standard-sized intravenous catheters. In the univariate analysis, patients in the traditional approach were at a higher risk of intravenous failure compared to those in the ultrasound-guided approach (HR = 2.20, 95% CI [1.45–3.34], p = .001), with median intravenous survival times of 108 and 219 h, respectively. Adjusting for age, patients in the traditional approach remained at higher risk of intravenous failure (HR = 1.99, 95% CI: [1.28–3.08], p = .002). Adjusting for hospital length of stay, patients in the ultrasound-guided approach were less likely to have additional peripheral intravenous access placed during hospitalization (OR = 0.39, 95% CI [0.18–0.85] p = .017).

Conclusion

In critically ill pediatric patients with difficult vascular access, ultrasound-guided long peripheral intravenous catheters provide an alternative to traditional approach standard-sized intravenous catheters with improved longevity, lower failure rates, and reduced need for additional vascular interventions.     

Towards a diagnostic and therapeutic consensus in male osteoporosis

Summary  

The consensus views on osteoporosis in men are reported.     

Nationwide survey on adult type chronic intestinal pseudo-obstruction in surgical institutions in Japan

Background  

No appropriate management of chronic intestinal pseudo-obstruction (CIP) has been established.     

Pain assessment by pupil dilation reflex in response to noxious stimulation in anaesthetized adults

Background

In response to noxious stimulation, pupillary dilation reflex (PDR) occurs even in anaesthetized patients. The aim of the study was to evaluate the ability of pupillometry with an automated increasing stimulus intensity to monitor intraoperative opioid administration.

Methods

Thirty‐four patients undergoing elective surgery were enrolled. Induction by propofol anaesthesia was increased progressively until the sedation depth criteria (SeD) were attained. Subsequently, a first dynamic pupil measurement was performed by applying standardized nociceptive stimulation (SNS). A second PDR evaluation was performed when remifentanil reached a target effect‐site concentration. Automated infrared pupillometry was used to determine PDR during nociceptive stimulations generating a unique pupillary pain index (PPI). Vital signs were measured.

Results

After opioid administration, anaesthetized patients required a higher stimulation intensity (57.43 mA vs 32.29 mA, P < .0005). Pupil variation in response to the nociceptive stimulations was significantly reduced after opioid administration (8 mm vs 28 mm, P < .0005). The PPI score decreased after analgesic treatment (8 vs 2, P < .0005), corresponding to a 30% decrease. The elicitation of PDR by nociceptive stimulation was performed without changes in vital signs before (HR 76 vs 74/min, P = .09; SBP 123 vs 113 mm Hg, P = .001) and after opioid administration (HR 63 vs 62/min, P = .4; SBP 98.66 vs 93.77 mm Hg, P = .032).

Conclusions

During propofol anaesthesia, pupillometry with the possibility of low‐intensity standardized noxious stimulation via PPI protocol can be used for PDR assessment in response to remifentanil administration.     

Extracellular matrix remodeling in the human gubernaculum during fetal testicular descent and in cryptorchidic children

Purpose  

We evaluated extracellular matrix remodeling in human fetal and cryptorchidic gubernacula.     

Acute diverticulitis in immunosuppressed patients: a 12-year management experience

Background

Diverticular disease of the colon occurs commonly in developed countries. Immunosuppressed patients are thought to be more at risk of developing acute diverticulitis, worse disease, and higher complications secondary to therapy. This study aimed to assess outcomes for immunosuppressed patients with acute diverticulitis.

Method

A retrospective single-centre review was conducted of all patients presenting with acute diverticulitis at a major tertiary Australian hospital from 2006 to 2018.

Result

A total of 751 patients, comprising of 46 immunosuppressed patients, were included. Immunosuppressed patients were found to be older (62.25 versus 55.96, p = 0.016), have more comorbidities (median Charlson Index 3 versus 1, P < 0.001), and undergo more operative management (13.3% versus 5.1%, P = 0.020). Immunosuppressed patients with paracolic/pelvic abscesses (Modified Hinchey 1b/2) were more likely to undergo surgery (56% versus 24%, P = 0.046), while in patients with uncomplicated diverticulitis, there was no difference in immunosuppressed patients undergoing surgery (6.1% versus 5.1% P = 0.815). Immunosuppressed patients were more likely to have Grade III-IV Clavien-Dindo complication (P < 0.001).

Conclusion

Immunosuppressed patients with uncomplicated diverticulitis can be treated safely with non-operative management. Immunosuppressed patients were more likely to have operative management for Hinchey 1b/II and more likely to have grade III/IV complications.     

The effect of tadalafil on anastomotic healing in ischemic small intestine in rats

Purpose  

To investigate the effect of tadalafil on anastomotic healing in an ischemic small intestine.     

Treatment outcome in the most severely affected Legg-Perthes patients, comparing prolonged traction in abduction with femoral varus derotation treatment

Purpose  

Compare conservative and operative treatment in the most severely affected Legg-Perthes disease patients.     

Triceps tears in athletes: different injury patterns and surgical treatment

Introduction  

Triceps muscle tears requiring surgical treatment are uncommon injuries.     

Endotoxin elimination in sepsis: physiology and therapeutic application

Purpose  

The present review summarizes key papers on the elimination of endotoxin in human.     

Management of complex urogenital fistulae in the female

Objective  

To present our experience in the management of complex genitourinary fistulae in the female.     

Trends in the treatment outcomes for advanced colorectal cancer: An analysis at a single community hospital in Japan

Purpose  

To evaluate the trends in the treatment outcomes for patients with colorectal cancer in Japan.     

Wear Damage in Mobile-bearing TKA is as Severe as That in Fixed-bearing TKA

Background  

Mobile-bearing TKAs reportedly have no clinical superiority over fixed-bearing TKAs, but a potential benefit is improved polyethylene wear behavior.     

Short-term after-effect of forearm cast removal in children

Purpose  

To investigate the sensation in the hand after forearm cast removal in children.     

Prospective randomized evaluation of prophylactic antibiotic usage in patients undergoing tension free inguinal hernioplasty

Objectives  

Assessment of the usefulness of antibiotic prophylaxis in inguinal hernioplasty.     

Mentorship in surgical training: a systematic review

Objective  

This review systematically examines the literature regarding mentor–mentee relationships in surgery.     

Squeaking sound in total hip arthroplasty using ceramic-on-ceramic bearing surfaces

Purpose  

To evaluate the causes and frequency of the squeaking sound in ceramic-on-ceramic THA.