儿童误食磁性异物致消化道损伤的临床经验总结

目的:探讨儿童误食磁性异物致消化道损伤的临床特点、致病机制及诊治方法,为临床决策提供理论依据。方法:回顾性分析2017年10月—2021年9月安徽省儿童医院收治的46例消化道磁性异物患儿的临床资料,根据是否存在消化道穿孔将患儿分为消化道穿孔组( n＝28)和消化道未穿孔组( n＝18)。观察患儿...     

Resultados preliminares de un trabajo multicéntrico a nivel nacional para el tratamiento de STUI secundario a hiperplasia benigna de próstata mediante el sistema con vapor de agua Rezūm®

Introduction and objectiveRezūm® system is a minimally invasive transurethral therapy that uses convective water vapor energy to ablate prostatic tissue. The objective is to report 1-year functional and security outcomes obtained by using this technique in real clinical practice.Material and methodsProspective study conducted in 5 Spanish hospitals for the treatment of LUTS secondary to BPH using the Rezūm® system. Patients with prostatic medium lobe (ML) and urethral catheter carriers were also included. Pre- and post-operative data were collected using IPSS, IIEF-5 and QoL questionnaires, flowmetry and post-void residual volume. Complications and retreatment rate at one-year follow-up were also reported.Results137 patients, including 64 with ML and 10 patients with urinary retention were treated. Median prostate volume was 50 cm³ (15-131). At 3 months follow-up, significant improvement was observed in IPSS (?6,37 points), Qmax (+4,95 mL/s) and QoL (?1,29); and was maintained until 12 months: ?10,78 points, +4,62 mL/s and ?2,73 respectively (p < 0.001). No significant changes were observed in the sexual sphere. All complications were mild (≤ Clavien II). Retreatment rate at one year was 4%.ConclusionShort-term results of this technique are promising, showing improvement in terms of functional outcomes, with no impact on the sexual sphere or complications. Longer term follow-up should include treatment durability and comparison to standard BPH treatments.     

Antenatal screening and fetal intervention

Congenital malformations are a common cause of reduced life expectancy and disability and can affect all body systems, thus are relevant to all surgeons. One in 50 children will have a major or significant congenital anomaly at birth. Since the advent of antenatal ultrasound (US) there has been the potential to diagnose many congenital anomalies before birth. This can forewarn parents and clinicians, so that treatment can be started promptly following birth rather than waiting for the baby to become symptomatic. It has also raised the possibility of treatment in utero with the goal of stopping or reversing the pathological effects of the anomaly on the developing tissues, which hopefully will reduce morbidity and mortality once the baby is born and thus improve outcomes. This article focuses on congenital anomalies relevant to surgeons, initially looking at screening and diagnosis and how this may affect treatment and surgery following delivery. The second part will look at some of the interventions that have been tried to treat “surgical” congenital anomalies in utero.     

Preoperative Risk Factors for Postoperative Urinary Tract Infection After Primary Total Hip and Knee Arthroplasties

BackgroundEstablishing clear risk factors for complications such as urinary tract infection (UTI) after arthroplasty procedures helps guide clinical practice and provides more information to both surgeons and patients. This study aims to assess selected preoperative patient characteristics as risk factors for postoperative UTI after primary total hip and knee arthroplasties (THA and TKA).MethodsThis was a retrospective analysis using current procedural terminology codes to investigate the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database for patients who underwent THA or TKA from 2010 to 2017. Patients were classified for UTI by NSQIP guidelines. Patient samples with all possible covariates were included for multivariate logistic regression analysis and assessed for independent associations.ResultsIn a cohort of 983 identified patients (983 of 119,096; 0.83%): ages 57+ years, preoperative red blood cell (RBC) transfusion, perioperative RBC transfusion, bleeding disorders, operative time 110+ minutes, preoperative steroid use, diabetes, pulmonary comorbidities, body mass index 30+ kg/m² were independent risk factors for postoperative UTI after THA. In a cohort of 1503 identified patients (1503 of 189,327; 0.8%): ages 60+ years, preoperative RBC transfusion, perioperative RBC transfusion, anemia, platelets less than 150k, preoperative steroid use, diabetes, and body mass index 30+ kg/m² were independent risk factors for postoperative UTI after TKA. Male sex was associated with a decreased risk of UTI in both THA and TKA.ConclusionThis study provides novel evidence on risk factors associated with the development of UTI after THA or TKA. Clinicians should be aware of risk factors in the manifestation of postoperative UTI after primary THA or TKA procedures.     

内镜治疗上消化道神经鞘瘤52例临床分析

目的 探讨内镜治疗上消化神经鞘瘤的安全性和有效性.方法 回顾性分析2011年1月至2016年12月复旦大学附属中山医院内镜中心接受内镜治疗,且病理学检查确诊为上消化道神经鞘瘤52例病人临床资料,分析治疗结果及术后长期随访复发转移情况.结果 52例病人中,21例病变位于食管,31例位于胃.内镜下整块切除51例,整块切除率...     

胆管癌免疫检查点抑制剂治疗研究进展

胆管癌是一种罕见的恶性肿瘤,总体预后较差。根治性手术治疗是目前唯一可使早期胆管癌病人获得长期生存的策略。对于多数晚期胆管癌病人,系统治疗成为主要手段,但目前可用于治疗胆管癌的一线药物选择有限,疗效有限。近年来,免疫检查点抑制剂等免疫治疗策略利用宿主免疫系统进行有效的抗肿瘤反应,在多种实体肿瘤中取得令人鼓舞的结果。笔者回...