Preoperative CT thorax as a COVID‐19 screen Senent‐Boza, Ana; Jurado‐Serrano, Juan; Beltrán‐Miranda, Pablo ...
British journal of surgery,
October 2020, Letnik:
107, Številka:
11
Journal Article
Abstract
Enteroatmospheric fistulae are challenging clinical conditions that require surgical expertise and that can result in chronic debilitating conditions placing the patient in a vicious cycle ...characterized by non healing wounds and malnutrition. They are a complex entity that presents great variability depending on the number, shape, and size of the fistulous orifices, their debit, and the dimensions of the wound. This means that, at present, there is no device that adapts to the anatomical characteristics of each patient and manages to control the spillage of intestinal effluvium from the wound. The aim of this study is to describe the manufacturing technique and to assess the preliminary results of a custom device designed through bioscanner imaging and manufactured using 3D printing for use with negative pressure wound therapy (NPWT) in the management of enteroatmospheric fistula. A proof of concept is given, and the design of the device is presented for the first time. After obtaining images of each fistula with a bioscanner, a personalised device was designed for each patient by 3D printing shape of a prism and a hollow base, taking into account the dimensions of the fistulous area in order to perform a floating ostomy to isolate the wound from the debit enteric. The polycaprolactone (PCL) device was placed including inside the fistulous surface and surrounding it with the NPWT system in order to accelerate wound healing.
Quick implementation of specific protocols and protective measures in a tertiary hospital in Spain allowed for the early diagnosis and optimal management of patients with SARS-CoV-2 infection and ...proper protection of staff and inpatients. From the COVID-19 outbreak in this country until the time of writing, 14 patients in our hospital underwent surgery with COVID-19, or COVID-19 developed postoperatively. Their postoperative outcomes did not differ from those in our routine clinical practice, with a 0% respiratory failure rate and a 7.14% mortality rate, in contrast with other published series. COVID-19 did not develop in any of the healthcare workers present in the operating room during these procedures or in those who cared for these patients on the ward.
Introduction
Frailty is a geriatric syndrome, leading to declines in homeostatic reserve and physical resistance. It has been considered as a risk factor for falls, fractures, need of ...institutionalization, length of stay and mortality. Our aim was to evaluate the relationship between frailty, 30-day postoperative mortality and morbidity, for elderly patients undergoing surgical emergencies.
Material and methods
Prospective, observational cohort Study (September 2017–April 2019), using four different frailty scales (Clinical Frailty Scale, FRAIL scale, TRST and Share-FI) as a risk factor of 30-day postoperative outcomes, for patients older than 70 years undergoing emergency surgery. We analyzed diagnoses, clinical examination at admission, surgical procedures, and postoperative outcomes during the first 30 days or until discharge.
Results
92 patients were included, with a mean age was 78.7 years (SD 6.3). Frailty prevalence varied since 14.1% obtained using FRAIL scale, to 25%, 29.2% and 30.4%, from Clinical Frailty Scale, TRST and Share-FI, respectively. All four frailty scales show statistical differences to predict major complication and mortality in our sample. FRAIL scale showed the highest sensitivity–specificity pair to predict mortality in our sample (AUC = 0.870). TRST and FRAIL scales showed the strongest measure of association (OR 7.69 and 5.92, respectively) for major complications. Regarding need for admission to the ICU, hospital stay or reoperation rate, only FRAIL scale showed a statistically significant association.
Conclusion
Frailty represents a predictive marker of mortality and major complications, in surgical emergencies. FRAIL score, shows the strongest relationship with mortality and complications, compared to other frailty scales.
Abstract
Additive manufacturing techniques allow the customized design of medical devices according to the patient's requirements. Enteroatmospheric fistula is a pathology that benefits from this ...personalization due to its extensive clinical variability since the size and morphology of the wound differ extensively among patients. Standard prosthetics do not achieve proper isolation of the wound, leading to a higher risk of infections. Currently, no effective personalized technique to isolate it has been described. In this work, we present the workflow for the design and manufacture of customized devices adapted to the fistula characteristics as it evolves and changes during the treatment with Negative Pressure Wound Therapy (NPWT). For each case, a device was designed with dimensions and morphology depending on each patient's requirements using white light scanning, CAD design, and additive manufacturing. The design and manufacture of the devices were performed in 230.50 min (184.00–304.75). After the placement of the device, the wound was successfully isolated from the intestinal content for 48–72 h. The therapy was applied for 27.71 ± 13.74 days, and the device was redesigned to adapt to the wound when geometrical evolutionary changes occur during the therapy. It was observed a decrease in weekly cures from 23.63 ± 10.54 to 2.69 ± 0.65 (
p
= 0.001). The fistulose size was reduced longitudinal and transversally by 3.25 ± 2.56 cm and 6.06 ± 3.14 cm, respectively. The wound depth also decreased by 1.94 ± 1.08 cm. In conclusion, customization through additive manufacturing is feasible and offers promising results in the generation of personalized devices for the treatment of enteroatmospheric fistula.
To evaluate the safety, efficacy, and cost-effectiveness of outpatient appendectomy in patients with uncomplicated acute appendicitis.
Given that acute appendicitis is the most common cause of acute ...abdomen, the introduction of outpatient appendectomy protocols could significantly improve the effectiveness and sustainability of health care systems.
A total of 300 patients were enrolled from October 2018 to June 2021 in the PENDI-CSI randomized clinical trial: 149 were assigned to the outpatient surgery (OPS) group and 151 to the inpatient surgery (IPS) group, followed by 1 month postoperatively. All patients were aged older than 14 years and had uncomplicated acute appendicitis. Exclusion criteria were pregnancy, neoplasms, inflammatory bowel disease, and high anesthetic risk (ASA IV). The OPS group was discharged from the postanesthesia care unit while the IPS group was admitted.
In total, 128 patients in the OPS group (85.9%) were discharged without admission. Predictors whether patients in the OPS group had to be admitted were aged over 31 years relative risk (RR): 2.42 (1.04-5.65), hypertension RR: 6.21 (3.22-11.97), anesthetic risk II-III RR: 2.63 (1.17-5.94), previous abdominal surgery RR: 3.34 (1.55-7.20), postoperative pain with visual analog scale >6 RR: 4.28 (2.67-6.86), and postoperative fear RR: 2.2 (1.04-4.67). There were no differences in terms of complications, readmissions, and reinterventions, and the perceived quality was similar in both groups. The outpatient modality produced savings of €1 034.97 per patient ( P < 0.001).
Outpatient appendectomy is safe and effective for uncomplicated acute appendicitis. Patient-perceived quality is similar to that of IPS, although it successfully reduces hospital costs compared with inpatient appendectomy.
Purpose
Specific training in the management of trauma patients is beneficial for surgeons. Training through specific courses in this area has a direct impact on the care of these patients. The aim of ...this work is to understand the participation and specific training in the care of trauma patients by Spanish surgeons.
Methods
A national survey was conducted and administered to all members of the Spanish Association of Surgeons. The survey assessed their degree of participation in emergency surgery, and therefore the probability of attending trauma patients, their assessment of the initial care of trauma patients in their centre, and their specific training in this field.
Results
The survey was completed by 510 surgeons from 47 Spanish provinces, with Catalonia and Andalusia being the most represented regions. In total, 456 (89.41%) of those surveyed work in the emergency department on a routine basis. Only 171 (33.53%) refer to having a registry of trauma patients in their hospital. While 79.02% of surgeons reported that general surgeons are not involved in care of severe trauma from the outset, only 66.47% have completed the ATLS course, 40.78% the DSTC course and 18.82% the MUSEC course. Despite this, 85.69% believe that the ATLS course should be compulsory during residency and 43.33% believe that severe trauma care in their hospital is poor or very poor.
Conclusion
Only 40% have received specific training in definitive surgical management of severe trauma. Despite this, a large percentage of surgeons work in the emergency department on a routine basis and potentially face the challenge of managing these patients.
Hirschsprung's disease is characterized by absence of ganglion cells in submucosal and myenteric plexus of distal bowel. Most cases become manifest during the neonatal period, but in rare instances, ...this disease is initially diagnosed in adult age. It usually presents as severe constipation with colonic dilatation proximal to the aganglionic segment. The treatment is surgical, removing the aganglionic segment and restoring continuity of digestive tract. The disease rarely presents as an acute intestinal obstruction. We report a case not previously diagnosed, which presented as a massive colonic dilatation with a maximum diameter of 44 cm, with imminent risk of drilling that forced to perform an emergency surgery. We include a review of existing literature.
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