Tag: pubmed

Cir Cir. 2023;91(5):690-697. doi: 10.24875/CIRU.22000309.

ABSTRACT

BACKGROUND: Colorectal anastomosis leak (AL) is the most feared complication of rectal cancer surgery (1-19%) as it increases morbidity and mortality and worsens oncological outcomes in terms of local recurrence and survival. The publication of the REAL-score index makes it possible to predict the risk of AL and compare the expected results with those obtained.

METHOD: Observational, descriptive, longitudinal and retrospective study of patients operated on for rectal cancer at the Miguel Servet University Hospital, in Zaragoza, Spain, in 2019. Statistical analysis of morbidity and mortality outcome variables and the REAL-score index using ROC curves.

RESULTS: Of 80 patients operated on for rectal cancer, colorectal anastomosis was performed in 52 and temporary ileostomy in 11 (21.2%). Morbidity was high (38.4%), but severe only in 7.7% (Clavien-Dindo IIIb), with no deaths. There were four dehiscences: one type B and three type C. A direct relationship between high risk of AL and the practice of temporary stoma is observed when the cut-off point of the REAL-score exceeds 14.74%.

CONCLUSIONS: REAL-score can help in decision-making in rectal cancer surgery. Above a cut-off point, the risk of AL would imply a selective ileostomy.

PMID:37844900 | DOI:10.24875/CIRU.22000309

Cir Cir. 2023;91(5):703-708. doi: 10.24875/CIRU.21000797.

ABSTRACT

BACKGROUND: Developmental dysplasia of the hip (DDH) is a complex clinical entity that is usually underdiagnosed, if not detected and managed early, will turn the affected individual into a disabled being, with negative social, economic and emotional effects.

OBJECTIVE: To determine the capacity for the timely radiographic detection of DDH before and after an educational intervention.

METHOD: An educational intervention is carried out in family medicine resident, where they are given training on detection in DDH radiographic projections. Pre- and post-training evaluation is carried out. Statistical analysis is performed using Student’s t and χ², taking p ≤ 0.05 as significant.

RESULTS: 94 residents participated. In the pre-intervention evaluation, 87.2% had no knowledge of the early detection protocol (p = 0.525). It was observed that 98.9% incorrectly drew the Perkins line (p = 0.427), 96.8% the Hilgenreiner line (p = 0.177) and 87.2% did not consider the data of bilateral dysplasia (p = 0.956). After the educational intervention, 87.2% correctly drew the Perkins line (p = 0.926), 97.8% the Hilgenreiner line (p = 0.325) and 78.7% if they considered the data of bilateral dysplasia (p = 0.826).

CONCLUSIONS: After this training, 80% of family medicine residents were able to detect DDH in a timely manner.

PMID:37844899 | DOI:10.24875/CIRU.21000797

Cir Cir. 2023;91(5):641-647. doi: 10.24875/CIRU.23000311.

ABSTRACT

OBJECTIVE: In this randomized and prospective research, we aimed to relieve surgical and muscle-related pain early after lumbar disc operations with caudal preemptive analgesia.

MATERIALS AND METHODS: A total of 120 patients with single-level lumbar disc herniation were included in this study. The caudal epidural injection was performed for all patients 20 min before surgery. The patients were divided into three groups. Non-steroidal anti-inflammatory drugs or tramadol use were recorded. Pre-operative and post-operative pain was interpreted through a visual analog scale.

RESULTS: There was a difference between the groups in all post-operative measurements (p < 0.05), between Group 1 and Group 3, and between Group 2 and Group 3. A statistical significance has been achieved between the groups at the 1^st h, 2^nd h, 4^th h, and 24^th h (p < 0.05). The difference between the pain intensities of the patients at the 24^th h and the 1^st week was statistically significant in Groups 1 and 2 (p < 0.05). Evaluation of the effects of medical treatments reduced the severity of back pain and foot pain.

CONCLUSION: The preemptive bupivacaine or in combination with methylprednisolone caudal injection is an effective and safe method to reduce post-operative pain and ameliorate functional capacity for the treatment of lumbar disc herniation.

PMID:37844891 | DOI:10.24875/CIRU.23000311

Cir Cir. 2023;91(5):627-632. doi: 10.24875/CIRU.22000578.

ABSTRACT

OBJECTIVE: Acidosis is the most dangerous complication in subarachnoid hemorrhage (SAH). This study aimed to investigate the effect of acidic cerebrospinal fluid on central canal structures after SAH.

MATERIALS AND METHODS: Twenty-eight hybrid rabbits were studied. Blood and cerebrospinal fluid pH values were recorded before/during/after the experimental procedures. The structures related to the central canals at the level of C5 of the cervical spinal cord were then examined histopathologically. The relationship between pH values of ependymal cells and degenerated epithelial cell densities was statistically analyzed.

RESULTS: Mean blood pH values and degenerated ependymal cell density (n/mm²) were as follows: 7.351 ± 0.033/23 ± 7 in control, 7.322 ± 0.059/78 ± 13 in SHAM, and 7.261 ± 0.048/254 ± 62 in study animals. Gross examinations revealed swelling, edema, pia-arachnoid adhesions, ventral canal dilatation, arachnoiditis, central canal hemorrhage, occlusions, and dilatation in the spinal cord.

CONCLUSION: Cerebrospinal fluid acidosis-induced central channel pathologies should be considered an important complication of SAH following SAH.

PMID:37844888 | DOI:10.24875/CIRU.22000578

Cir Cir. 2023;91(5):658-663. doi: 10.24875/CIRU.22000419.

ABSTRACT

BACKGROUND: Open abdomen is an alternative for the management of trauma patient, and negative pressure therapy of the wound using VAC^® device is a genuine sort of treatment. Although the device poses technical advantages, risks are present and a critical complication is the enteroatmospheric fistula formation (EAF).

OBJECTIVE: To analize the role of negative pressure therapy length and VAC^® device number of changes on the EAF formation in trauma patients udergoing open abdomen.

METHOD: Cut-off points were calculated using receiver operational characteristics curve. Values were compared with Student’s t or Mann-Withney U tests, considering statistically significant p < 0.05.

RESULTS: EAF were present in 39 cases (5.9%). A significant difference in the presence of EAF was present in patients with negative pressure therapy of the wound length ≥ 11.2 days (46.9 vs. 1.3%; relative risk [RR]: 3.67; 95% confidence interval [95% IC]: 2.4-6.68; p = 0.017) and when ≥ 2.6 VAC^® device changes were performed (34.6 vs. 0.5%; RR: 6.92; 95% IC: 1.1-4.3; p < 0.001).

CONCLUSIONS: At our institution, the practice of >3 VAC^® device changes and length of therapy > 11 days should be carefully considered leading to reduce the risk of EAF formation.

PMID:37844886 | DOI:10.24875/CIRU.22000419

Cir Cir. 2023;91(5):596-600. doi: 10.24875/CIRU.22000203.

ABSTRACT

OBJECTIVE: To compare the protective effect of nitroglycerin ointment 2% and Dimethylsulfoxide (DMSO) in dorsal flaps of the rat.

METHODS: A blind, experimental study was conducted in 24 male Wistar rats, with a mean weight of 320 (286-376) grams. Group 1: Control. Petrolatum jelly (Vaseline), n = 8, Group 2: Nitroglycerin (NTG) ointment 2% (Nitro-Bid, Altana Co.) n = 8, and Group 3: DMSO gel 90% (Neogen corp. Lexington KY, 40611), n = 8.

RESULTS: A total of 24 rats were operated on in the 6-month period of this study. Using a non-parametric Mann-Whitney U-test analysis, a statistically significant p was obtained between the control group and 2% NTG ointment, both in the area of necrosis and in the healthy area (p = 0.026). In contrast, the comparison between DMSO [CH3) 2SO] and the control group (p = 0.180) and between both study groups, with a p = 0.18, was not significant.

CONCLUSIONS: Our study concluded that there is a protective effect of 2% NTG ointment for flap survival in relation to the control group (petrolatum). DMSO administered topically did not show a protective effect, compared to the control group.

PMID:37844881 | DOI:10.24875/CIRU.22000203

Am J Clin Nutr. 2023 Oct 13:S0002-9165(23)66178-7. doi: 10.1016/j.ajcnut.2023.10.004. Online ahead of print.

NO ABSTRACT

PMID:37844874 | DOI:10.1016/j.ajcnut.2023.10.004

SLAS Technol. 2023 Oct 14:S2472-6303(23)00060-2. doi: 10.1016/j.slast.2023.10.002. Online ahead of print.

ABSTRACT

Rapid and accurate measurements of immune protein markers are essential for diagnosis and treatment in all clinical settings. The recent pandemic has revealed a stark need for developing new tools and assays that could be rapidly used in diverse settings and provide useful information to clinicians. Here, we describe the development and test application of a novel one-step CRP/IP-10 duplex assay for the LightDeck platform capable of delivering reproducible and accurate measurements in under eight minutes. We used the optimized assay to measure CRP and IP-10 levels in human blood and serum samples from healthy, SARS-CoV-2 (COVID-19) positive, and influenza-like illness (ILI) presenting patients. Our results agreed with previously published analyte levels and enabled us to make statistically significant comparisons relevant to multiple clinical parameters. Our duplex assay is a simple and powerful tool for aiding prognostic decision-making in diverse settings.

PMID:37844868 | DOI:10.1016/j.slast.2023.10.002

J Shoulder Elbow Surg. 2023 Oct 14:S1058-2746(23)00734-6. doi: 10.1016/j.jse.2023.09.009. Online ahead of print.

ABSTRACT

BACKGROUND: Giant cell tumors of bone (GCTB) are rare aggressive tumors and proximal humerus is a relatively rare location for GCTB as well, limited evidence exists on which surgical approaches and reconstruction techniques are optimal. Here, using the largest case series to date, we evaluated the recurrence rate of proximal humerus GCTBs and the functional outcomes of different resection and reconstruction options in this multicenter study.

METHODS: All 51 patients received initial surgical treatment for proximal humerus GCTBs from January 2007 to December 2020, with a minimum two-year follow-up. Local recurrence and functional outcomes were statistically analyzed in relation to demographic, clinical, and primary surgical variables. Functional outcomes were patient-reported and assessed by the Musculoskeletal Tumor Society (MSTS) score and the Disabilities of the Arm, Shoulder and Hand (QuickDASH) instrument.

RESULTS: Mean follow-up was 81.5 months (range, 30-191 months), and overall recurrence rate was 17.6% (9/51). The majority of the recurrence (N=7) occurred in the first two years of follow-up. The intralesional curettage group (N=23) had a statistically significant difference in recurrence rate compared to en-bloc resection (N=28) (34.8% vs. 3.6%, p=0.007). Among patients receiving en-bloc resection, 16 shoulders were reconstructed with hemiarthroplasty, 8 with reverse total shoulder arthroplasty (rTSA) with allograft-prosthetic composite (APC) reconstruction, and 4 with arthrodesis. Based on intention-to-treat analysis, the mean functional MSTS scores of the curettage groups, rTSA with APC, hemiarthroplasty, or arthrodesis was 26.0±3.1 vs. 26.0±1.7 vs. 20.3±2.8 vs. 22.5±1.3 (p<0.001 [curettage vs. hemiarthroplasty, p<0.001; rTSA with APC vs. hemiarthroplasty, p=0.004]), respectively, while for QuickDASH, it was 14.0±11.0 vs. 11.6±4.5 vs. 33.1±11.8 vs. 21.6±4.7 (p<0.001 [curettage vs. hemiarthroplasty, p<0.001; rTSA with APC vs. hemiarthroplasty, p=0.003]), respectively.

CONCLUSIONS: Based on our data, en-bloc resection followed by reverse shoulder arthroplasty showed a lower recurrence rate, and no significant difference in functional outcome scores for proximal humerus GCTBs compared with intralesional curettage. Therefore, we believe that rTSA with APC may be reasonable for initial treatment of proximal humerus GCTBs.

PMID:37844829 | DOI:10.1016/j.jse.2023.09.009

J Affect Disord. 2023 Oct 14:S0165-0327(23)01259-4. doi: 10.1016/j.jad.2023.10.077. Online ahead of print.

ABSTRACT

BACKGROUND: The purpose of this study was to validate the Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5) Cross-Cutting Symptom Measure (CCSM) as a screening tool for a wide variety of disorders within busy community outpatient mental health settings.

METHOD: Participants (N = 851) were referred for coordinated specialty care services (mean age = 20.26 years (SD = 2.97); 82.5 % Caucasian, 7.5 % African American, 0.7 % Native American, 0.7 % Pacific Islander, 0.8 % Asian, 7.8 % Multiracial; 15.1 % Latinx; 53.1 % female, 45.5 % male, 1.4 % other gender).

RESULTS: At optimal cut-score, specificity ranged from 57 to 77 % for depression, anxiety, substance use and psychosis domains; sensitivity ranged from 63 to 72 %. Scores for depression, anxiety, substance use and psychosis domains differed significantly by groups with and without diagnoses. Correlations among domains were larger where expected (r = 0.52, depression-suicidal ideation), and relatively smaller where expected (r = 0.28, suicidal ideation-inattention). Depression, anxiety, substance use and psychosis domains evidenced incremental validity for their respective diagnoses (change in explained variance, 3-15 %). Psychometric features of CCSM were broadly supported.

LIMITATIONS: Criterion measures did not have inter-rater reliabilities as this is generally prohibitive in clinic settings.

CONCLUSION: The CCSM could provide a first step in screening for multiple disorders; however, it cannot replace structured interviews for making diagnoses related to these conditions.

PMID:37844781 | DOI:10.1016/j.jad.2023.10.077