Category: Nevin Manimala

Ann Ital Chir. 2024;95(5):963-971. doi: 10.62713/aic.3547.

ABSTRACT

AIM: This study aimed to investigate the effects of sugammadex on postoperative pulmonary complications and rapid recovery in lung cancer patients undergoing video-assisted thoracic surgery (VATS).

METHODS: A retrospective analysis was conducted on the clinical data of 1131 lung cancer patients. Of these, 631 patients received sugammadex at the end of anesthesia, while 500 patients did not. To mitigate potential confounding factors, propensity score matching (PSM) was employed at a 1:1 ratio. After matching, 435 patients were obtained from each group. Patients who received sugammadex at the end of anesthesia were classified into Group S (n = 435) and those who did not receive sugammadex were Group P (n = 435). Postoperative pulmonary complications, indicators of recovery after surgery, nausea and vomiting, pain and lung infection scores and biochemical indices were compared between the two groups.

RESULTS: Compared to Group P, Group S demonstrated statistically significant improvements across multiple perioperative and postoperative outcomes. Group S exhibited a lower incidence of postoperative pulmonary complications (χ2 = 9.52, p = 0.002), as well as reduced durations for several key time intervals: from the cessation of muscle relaxation to extubation (Z = 12.96, p < 0.001), from the conclusion of surgery to extubation (Z = 13.66, p < 0.001), and total operating theatre occupancy (Z = 5.81, p < 0.001). Furthermore, Group S showed accelerated recovery in terms of time to first oral intake (drink: Z = 3.80, p < 0.001; eat: Z = 3.80, p < 0.001), time to defecate (Z = 3.25, p = 0.001), and time to chest tube removal (Z = 5.04, p < 0.001). Pain management outcomes were also superior in Group S, with lower motor visual analogue scale (VAS) scores at both 24 h (Z = 4.71, p < 0.001) and 48 h (Z = 5.05, p < 0.001) postoperatively. Group S additionally demonstrated a lower modified Clinical Pulmonary Infection Score (mCPIS) (Z = 4.68, p < 0.001), reduced complication rates during the general anesthesia awakening period (χ2 = 23.54, p < 0.001), and a lower incidence of renal function abnormalities (χ2 =12.65, p < 0.001). Certain parameters, including total hospital stay duration and postoperative drainage volume, did not differ significantly between the two groups (p > 0.05).

CONCLUSIONS: Sugammadex can effectively reduce the incidence of postoperative pulmonary complications in lung cancer patients treated with VATS, and help promote their rapid postoperative recovery with significant clinical benefits.

PMID:39467796 | DOI:10.62713/aic.3547

Ann Ital Chir. 2024;95(5):744-759. doi: 10.62713/aic.3577.

ABSTRACT

AIM: Interlocking intramedullary nailing and percutaneous plate implantation are commonly used techniques in the treatment of femoral shaft fractures. This study aimed to determine the most appropriate and effective treatment strategy between interlocking intramedullary nails and percutaneous plate implantation by analyzing and summarizing the available evidence.

METHODS: Relevant articles published from the date of database construction in PubMed, Embase, Web of Science, and Cochrane to 2024 were searched and downloaded according to PRISMA 2020. These studies were screened following pre-established inclusion criteria, and the data were extracted. Methodological quality assessment for retrospective studies was performed using the Newcastle-Ottawa Scale, whereas Review Manager Software was used for methodological quality assessment of randomized controlled trials (RCTs) and statistical analysis.

RESULTS: Only 13 studies containing 1061 patients were included in the meta-analysis. Femoral shaft fractures treated with interlocking intramedullary nailing had shorter operative and fluoroscopic time and less estimated blood loss. Pediatric patients treated with interlocking intramedullary nails had less estimated blood loss and shorter healing time. Interlocking intramedullary nailing group in the retrospective study was associated with shorter operative time and less blood loss, whereas, in the randomized controlled trial (RCT) study, it was associated with less blood loss and shorter healing time.

CONCLUSIONS: Interlocking intramedullary nailing is more advantageous in treating femoral shaft fractures and is a more appropriate option for treating femoral shaft fractures in pediatric patients.

SYSTEMATIC REVIEW REGISTRATION: PROSPERO: CRD42024564563.

PMID:39467794 | DOI:10.62713/aic.3577

Ann Ital Chir. 2024;95(5):901-908. doi: 10.62713/aic.3589.

ABSTRACT

AIM: The aim of this study is to investigate if and how decompression alters histopathologic diagnoses of cystic jaw lesions.

METHODS: A retrospective study was conducted on patients with a histologic diagnosis of an odontogenic cystic lesion that was surgically treated with decompression followed by a definitive surgery. The correlation between variables including age, gender, location of the lesion, decompression time and the change in histopathologic diagnosis following decompression was analyzed.

RESULTS: Thirty-nine patients were included in the study. The mean decompression time was 7.87 ± 3.43 months. Post-decompression histologic examination at time of definitive surgery was consistent with the initial biopsy diagnosis in 83.33% (5 of 6) of odontogenic keratocysts (OKCs), 94.11% (16 of 17) of radicular cysts, 100% of dentigerous cysts, and 100% of residual cysts. The change in histopathologic diagnosis of the cystic lesions was not found to be statistically correlated with the study variables.

CONCLUSIONS: Histopathologic diagnoses of odontogenic cystic lesions predominantly remain unchanged after decompression. A treatment protocol based on the initial diagnosis may be appropriate for odontogenic cystic lesions that are considered for decompression before definitive surgery.

PMID:39467793 | DOI:10.62713/aic.3589

Ann Ital Chir. 2024;95(5):894-900. doi: 10.62713/aic.3596.

ABSTRACT

AIM: This retrospective study aimed to evaluate the effectiveness of a nursing model on the Health Belief Model (HBM) and the Theory of Planned Behavior (TPB) in patients undergoing surgery for limb fractures.

METHODS: A total of 100 patients who underwent limb fracture surgery at Zhongnan Hospital of Wuhan University from February 2023 to February 2024 were selected for this study. The research group (n = 58) received nursing care based on the HBM and TPB, while the control group (n = 42) received conventional nursing care. Comparative analyses were conducted on curative effectiveness, the degree of limb swelling, pain intensity (measured by the Visual Analogue Scale [VAS]), symptom recovery time (including pain duration, swelling duration, ambulation time, and length of stay), and self-care management (assessed through behavior management, psychological activities, and status management).

RESULTS: The results indicated no significant differences in curative effectiveness between the two groups (p > 0.05). The research group had fewer grade I and II limb swelling cases than the control group (p < 0.05). Additionally, the research group reported lower VAS scores on postoperative days 3 and 7, earlier ambulation, shorter pain and swelling durations, and reduced length of hospital stay compared to the control group (p < 0.01). Furthermore, self-care management scores, including behavior management, psychological activities, and status management, were significantly higher in the research group after treatment compared to the control group (p < 0.05).

CONCLUSIONS: The nursing model based on HBM and TPB provides benefits for patients undergoing limb fracture surgery by reducing swelling, relieving pain, promoting symptom disappearance, speeding up rehabilitation, and enhancing self-care management.

PMID:39467791 | DOI:10.62713/aic.3596

Ann Ital Chir. 2024;95(5):840-847. doi: 10.62713/aic.3627.

ABSTRACT

AIM: This study aimed to develop an evaluation index system for hand surgery rehabilitation nursing using the Delphi method.

METHOD: A survey questionnaire on evaluation indicators for hand surgery rehabilitation nursing was developed, and 18 professionals including orthopedic surgeons, orthopedic nursing, and rehabilitation departments were selected. The survey was conducted using the letter method, and a database was established to screen the items, forming a hand surgery rehabilitation nursing evaluation scale. The expert’s positive coefficient, authority coefficient, and coordination coefficient were analyzed, and the mean, standard deviation, coefficient of variation, and weight coefficient were calculated. Based on the correlation assignment results, the Item-level Content Validity Index (I-CVI), Scale-level Content Validity Index (S-CVI), average S-CVI, Probability of random consistency (Pc), and corrected I-CVI Kendall’s coefficient of concordance (K*) were determined.

RESULT: In the first round of expert inquiry, a total of 18 questionnaires were distributed, and 15 valid questionnaires were collected, with an effective response rate of 83.33%. In the second round, 15 questionnaires were distributed and 15 valid questionnaires were collected, with an effective response rate of 100%. The two rounds of expert evaluations yielded judgment scores of 0.91 and 0.95, with proficiency levels of 0.83 and 0.87 and authority coefficients of 0.87 and 0.91, respectively. The Kendall’s W values for the two rounds were 0.313 and 0.224, respectively, with a statistically significant difference (p < 0.01). After screening, 23 indicators were retained, with a coefficient of variation ranging from 0.072 to 0.166. Among the third-level indicators, 12 had an I-CVI of 1.00, 4 had an I-CVI of 0.93, and 7 had an I-CVI of 0.87. The overall S-CVI was 0.80, with an average S-CVI of 0.95. The K* values for the 23 indicators ranged from 0.8662 to 1.0000.

CONCLUSIONS: The evaluation index system for hand injury rehabilitation nursing based on the Delphi method is highly scientific, and is expected to be used to guide the clinical evaluation of hand injury rehabilitation nursing.

PMID:39467788 | DOI:10.62713/aic.3627

Ann Ital Chir. 2024;95(5):848-858. doi: 10.62713/aic.3634.

ABSTRACT

AIM: This study aims to evaluate the clinical effectiveness of percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP) in managing osteoporotic vertebral compression fractures (OVCFs).

METHODS: This retrospective study included 268 elderly OVCF individuals, and 144 individuals were selected after propensity score matching. General patient information, perioperative conditions, vertebral height and Cobb angle, lumbar spinal function, degree of pain, incidence of complications, and fracture recurrence rates were compared and analyzed for the patients.

RESULTS: The PKP group exhibited longer surgical duration, greater intraoperative blood loss, and more frequent X-ray fluoroscopy during the perioperative period compared to the PVP group (p < 0.05). However, there was no significant difference in the length of hospital stay between the two groups. Furthermore, PKP surgery significantly improved vertebral height, corrected spinal posture, and enhanced lumbar spinal function while mitigating pain levels within the 12-month postoperative period (p < 0.05). Additionally, the PKP group showed substantially lower rates of bone cement leakage, nerve injury, and fracture recurrence than the PVP group (p < 0.05).

CONCLUSIONS: Compared to PVP, PKP demonstrates better clinical effectiveness with lower incidence of complications in managing OVCF. However, surgical time and intraoperative trauma should be considered.

PMID:39467787 | DOI:10.62713/aic.3634

Ann Ital Chir. 2024;95(5):809-815. doi: 10.62713/aic.3636.

ABSTRACT

AIM: The study aimed to explore the impact of refined nursing management in the operating room on surgical efficiency, postoperative recovery, and stress responses in patients undergoing laparoscopic general surgery.

METHODS: A retrospective analysis was conducted on 100 patients who underwent laparoscopic surgery at Zhongnan Hospital of Wuhan University between March 2023 and March 2024. The control group comprised 48 cases receiving conventional operating room nursing, while the observation group comprised 52 cases receiving refined nursing management in the operating room in addition to the conventional care. Comparisons were conducted between the two groups regarding surgical efficiency, postoperative recovery, postoperative stress indicators, psychological status before and after nursing, overall treatment comfort, perioperative complications, and nursing satisfaction.

RESULTS: The observation group showed statistically significant improvements in surgical efficiency, postoperative recovery, and stress indicators compared to the control group. After the intervention, the Self-Rating Anxiety Scale (SAS) and Self-Rating Depression Scale (SDS) scores of both groups significantly decreased compared to pre-nursing levels (p < 0.05), while such decrease was notably higher in the observation group (p < 0.05). Patients in the observation group reported significantly higher post-nursing comfort levels (p < 0.05) and exhibited significantly fewer perioperative complications (p < 0.05) compared to the control group. Furthermore, the nurses indicated significantly higher satisfaction with patient care in the observation group (p < 0.05).

CONCLUSIONS: Implementing refined nursing in the operating room for laparoscopic general surgery can facilitate the recovery of gastrointestinal function, reduce postoperative recovery time, prevent complications, improve patients’ psychological state, and enhance their quality of life.

PMID:39467786 | DOI:10.62713/aic.3636

Ann Ital Chir. 2024;95(5):825-831. doi: 10.62713/aic.3811.

ABSTRACT

AIM: Immature granulocytes show bone marrow activation before neutrophil response and there are studies in the literature showing that the number of immature granulocytes is an auxiliary marker in the diagnosis and treatment of different diseases. The Delta Neutrophil Index (DNI), Immature Granulocyte Count (IGC) have previously been studied as markers in thyroid and breast cancers. The aim of this study was to determine whether immature granulocyte IGC and DNI values measured in preoperative blood parameters have a diagnostic benefit for the detection of advanced colon cancer.

METHODS: A study was conducted on patients who had undergone selective operation for colon cancer in our clinic from February 2015 to February 2020. The patients were divided into two groups: early stage (stage I-III) and advanced stage (stage IV) colon cancer. The IGC and DNI values as well as other hematological parameters, demographic parameters (sex, age) in these two groups were compared.

RESULTS: A total of 43 patients with mean age 67.47 (35-96) years were included in the study. Eighteen of the patients were male and 25 were female. When the early stage and advanced stage colon cancer groups were compared, no statistically significant difference was found between age, sex, white blood cell count, lymphocyte-to-monocyte ratio, eosinophil count, basophil count, mean platelet volume and: systemic immune-inflammation index score. It was observed that platelet-to-lymphocyte ratio, IGC and DNI or Immature Granulocyte Percentage (IGP) values were statistically significantly higher in the metastatic colon cancer group compared to the non-metastatic group. When the specificity and sensitivity of laboratory markers in metastatic colon cancer were examined, it was observed that the specificity and sensitivity of DNI or IGP and IGC were statistically higher than other values.

CONCLUSIONS: DNI, IGC and PLR values, which are the parameters measured in the preoperative period are easily measurable laboratory parameters and do not involve additional costs in differentiating metastatic from non-metastatic colon cancer in the preoperative period.

PMID:39467782 | DOI:10.62713/aic.3811

Surgeon. 2024 Oct 27:S1479-666X(24)00126-4. doi: 10.1016/j.surge.2024.10.004. Online ahead of print.

ABSTRACT

BACKGROUND: Multi-ligament knee injury (MLKI) is a complex orthopaedic knee problem, usually following traumatic knee dislocation. Surgical management is preferred and has resulted in better clinical outcomes. However, the optimal surgical treatment protocol is continuously evolving. This study aimed to compare the outcomes of one-stage versus two-stage reconstruction of MLKI.

MATERIALS AND METHODS: This retrospective comparative study was conducted between July 2020 and December 2023 at a government orthopaedic hospital in Nigeria. The inclusion criteria include males and females between 18 and 45 years of age who had one- or two staged knee reconstructions for MLKI and were followed up for a minimum of 12 months. The exclusion criteria were patients below 18 and above 45 years of age, those with previous knee surgery, those associated with femoral or tibia fractures, those with radiological evidence of osteoarthritis, and those with follow-ups less than 12 months. Clinical outcomes using the Lysholm scoring system and complication rate were recorded. The statistical analysis was performed using SPSS version 23.

RESULTS: Fifty-one patients (26 in the OS group and 25 in the TS group) were studied. There was a significant difference between the preoperative and postoperative Lysholm scores in the two groups (p = 0.86 and 0.57 for OS and TS, respectively). However, there was no significant difference between the postoperative Lysholm scores in the two groups (p = 0.918).

CONCLUSION: One-stage and two-stage reconstruction of chronic MLKI give similar excellent clinical outcomes.

PMID:39467729 | DOI:10.1016/j.surge.2024.10.004

Semin Fetal Neonatal Med. 2024 Oct 19:101544. doi: 10.1016/j.siny.2024.101544. Online ahead of print.

ABSTRACT

There is a substantial body of literature that supports neonatal monitoring and signal analysis of the collected data to provide valuable insights for improving patient clinical care and to inform new research studies. This comprehensive monitoring approach extends beyond the collection of conventional vital signs to include the acquisition of continuous waveform data from patient monitors and other bedside medical devices. This paper discusses the necessary infrastructure for waveform retrieval from bedside monitors, and explores options provided by leading healthcare companies, third-party vendors or academic research teams to implement scalable monitoring systems across entire critical care units. Additionally, we discuss the application of advanced signal processing that transcend traditional statistics, including heart rate variability in both the time- and frequency-domains, spectral analysis of EEG, and cerebral pressure autoregulation. The infrastructures and signal processing techniques outlined here are indispensable tools for intensivists, empowering them to enhance care for critically ill infants. In addition, we briefly address the emergence of advanced tools for fetal monitoring.

PMID:39467727 | DOI:10.1016/j.siny.2024.101544