Search

The aim of the study was to determine the efficacy of using digital technologies in patients with post-traumatic deformities of the zygomatico-orbital complex (ZOC) by comparing the results with the conventional methods of surgical treatment. Materials and Methods. The article summarizes treatment results of 231 patients with ZOC injuries who underwent surgery at the clinical facilities of Privolzhsky Research Medical University (Nizhny Novgorod) in 2011–2019. There were treated 44.2% (102/231) of patients with post-traumatic deformities of ZOC, including 38.2% (39/102) with post-traumatic defects and deformities of the orbital floor. Based on clinical and radiological planning of surgical operations, the patients were divided into two groups: group 1 included patients who underwent surgery without preoperative virtual planning (54.9% (56/102) of cases), group 2 included patients who underwent virtually planned surgical interventions (45.1% (46/102) of cases). There were 22 and 17 patients with orbital deformities in groups 1 and 2, respectively. Results. The optimal restoration of ZOC anatomy was observed in 75% (42/56) of patients in group 1 and 93.5% (43/46) of patients in group 2. During reconstruction of the orbital floor in patients of group 1, successful results were achieved in 68.2% (15/22) of cases and 88.2% (15/17) in group 2, various complications were observed in the rest of cases. Based on the analysis of surgical treatment results, there was developed a personalized approach to manufacturing of zygomatic bone and orbital floor implants using computer modeling and 3D printing technologies. Conclusion. In contrast to the conventional methods, the use of digital technologies in the surgical treatment of post-traumatic deformities of ZOC allows avoiding the problematic issues of implant positioning and the development of complications during reconstruction, significantly reducing surgical injury and improving patient rehabilitation.

Overshooting trocar insertion in Iaparoscopic surgery has been extensively cited as a major cause of surgical injury. The complexity and extensive insertion force required of the current handheld insertion method increases the risk of overshooting and is difficult for novice and female operators. Hence, we developed a trocar insertion device to make the procedure easier and safer. The device is designed so it is easy to handle and assemble. It used negative pressure and pneumatic cylinders to lift the abdominal wall and two motors to drive the trocar insertion. In addition, we interpreted the characteristics of the insertion force and developed an algorithm to detect whether the trocar is properly inserted. By monitoring changes in the insertion force with this device, the trocar insertion can be stopped automatically and immediately. The development of this device has realized the automation of trocar insertion. It reduces the demand on operators and improves the safety of the procedure.

Recent work utilizing ultrasound imaging demonstrated that individuals with low back pain (LBP) have increased thickness and decreased mobility of the thoracolumbar fascia (TLF), an indication that the TLF may play a role in LBP. This study used a porcine injury model (microsurgically induced local injury)—shown to produce similar results to those observed in humans with LBP—to test the hypothesis that TLF mechanical properties may also be altered in patients with LBP. Perimuscular TLF tissue was harvested from the noninjured side of vertebral level L3-4 in pigs randomized into either control (n = 5) or injured (n = 5) groups. All samples were tested with a displacement-controlled biaxial testing system using the following protocol: cyclic loading/unloading and stress relaxation tests at 25%, 35%, and then 45% of their resting length. Tissue anisotropy was also explored by comparing responses to loading in longitudinal and transverse orientations. Tissues from injured pigs were found to have greater stretch–stretch ratio moduli (measure of tissue stiffness), less energy dissipation, and less stress decay compared to tissues from control pigs. Responses across these variables also depended on loading orientation. Clinical significance: these findings suggest that a focal TLF injury can produce impairments in tissue mechanical properties away from the injured area itself. This could contribute to some of the functional abnormalities observed in human LBP.

Обширные операции в ортопедии вызывают значительные изменения в системе гемостаза. Центральное место в регуляции гемокоагуляционных процессов занимает эндотелий сосудов. В обзоре рассматриваются механизмы, с помощью которых при повреждении сосуда формируется сгусток, эффективно закрывающий травмированный участок. Обсуждается роль эндотелия в развитии патологических тромбов при крупных ортопедических операциях., Extensive orthopedic operations cause signifi cant changes in hemostasis. The endothelium of blood vessels plays a central role in regulation of hemocoagulation processes. This review focuses on the mechanisms which form a clot in the case of vessel damage. The role of endothelium in the development of pathological blood clots in orthopedic surgery is discussed., №2(74) (2018)

Jan Máca,1 Matúš Peteja,2 Petr Reimer,1 Ondřej Jor,1 Věra Šeděnková,1 Lucie Panáčková,1 Peter Ihnát,2 Michal Burda,3 Pavel Ševčík1 1Department of Anesthesiology and Intensive Care Medicine, University Hospital Ostrava, Ostrava, Czech Republic; 2The Clinic of Surgery, University Hospital Ostrava, Ostrava, Czech Republic; 3Institute for Research and Applications of Fuzzy Modeling, Centre of Excellence IT4Innovations, University of Ostrava, Ostrava, Czech Republic Background: Major abdominal surgery (MAS) is high-risk intervention usually accompanied by tissue injury leading to a release of signaling danger molecules called alarmins. This study evaluates the surgical injury caused by two fundamental types of gastrointestinal surgical procedures (open surgery and laparoscopy) in relation to the inflammation elicited by alarmins. Patients and methods: Patients undergoing MAS were divided into a mixed laparoscopy group (LPS) and an open surgery group (LPT). Serum levels of alarmins (S100A8, S100A12, HMGB1, and HSP70) and biomarkers (leukocytes, C-reactive protein [CRP], and interleukin-6 [IL-6]) were analyzed between the groups. The secondary objectives were to compare LPT and LPS cancer subgroups and to find the relationship between procedure and outcome (intensive care unit length of stay [ICU-LOS] and hospital length of stay [H-LOS]). Results: A total of 82 patients were analyzed. No significant difference was found in alarmin levels between the mixed LPS and LPT groups. IL-6 was higher in the LPS group on day 2 (p=0.03) and day 3 (p=0.04). Significantly higher S100A8 protein levels on day 1 (p=0.02) and day 2 (p=0.01) and higher S100A12 protein levels on day 2 (p=0.03) were obtained in the LPS cancer subgroup. ICU-LOS and H-LOS were longer in the LPS cancer subgroup. Conclusion: The degree of surgical injury elicited by open MAS as reflected by alarmins is similar to that of laparoscopic procedures. Nevertheless, an early biomarker of inflammation (IL-6) was higher in the laparoscopy group, suggesting a greater inflammatory response. Moreover, the levels of S100A8 and S100A12 were higher with a longer ICU-LOS and H-LOS in the LPS cancer subgroup. Keywords: open surgery, laparoscopy, gastrointestinal surgery, alarmins, surgical injury, major surgery

Systems-wide molecular analysis of the metabolic, inflammatory and immune response to surgical trauma has yet to be translated into the operating room. Surgical patients are exposed to a large number of heterogeneous environmental insults that cannot only be quantified by genome-orientated ‘omics platforms. Furthermore, surgery demands rapid or near real-time analysis. Systems-level metabolic phenotyping provides a novel ‘global’ perspective of an organism’s metabolic response to surgical injury and, therefore, serves as an ideal platform for the development of personalized therapies in surgery. This article reviews current personalized approaches to healthcare in surgery and explores future directions for personalized surgical biomarker discovery and therapeutics. In particular, this article discusses our vision of ‘personalized metabolic phenotyping’ in surgery, and outlines next-generation technologies that will make this approach a reality.

ObjectivesTo analyse a potential association between surgical quality and time of day.DesignA retrospective analysis of complete sets of quality forms filled out by the procuring and accepting surgeon on organs from deceased donors.SettingProcurement procedures in the Netherlands are organised per region. All procedures are performed by an independent, dedicated procurement team that is associated with an academic medical centre in the region.ParticipantsIn 18 months’ time, 771 organs were accepted and procured in The Netherlands. Of these, 17 organs were declined before transport and therefore excluded. For the remaining 754 organs, 591 (78%) sets of forms were completed (procurement and transplantation). Baseline characteristics were comparable in both daytime and evening/night-time with the exception of height (p=0.003).Primary outcome measureAll complete sets of quality forms were retrospectively analysed for the primary outcome, procurement-related surgical injury. Organs were categorised based on the starting time of the procurement in either daytime (8:00–17:00) or evening/night-time (17:00–8:00).ResultsOut of 591 procured organs, 129 organs (22%) were procured during daytime and 462 organs (78%) during evening/night-time. The incidence of surgical injury was significantly lower during daytime; 22 organs (17%) compared with 126 organs (27%) procured during evening/night-time (p=0.016). This association persists when adjusted for confounders.ConclusionsThis study shows an increased incidence of procurement-related surgical injury in evening/night-time procedures as compared with daytime. Time of day might (in)directly influence surgical performance and should be considered a potential risk factor for injury in organ procurement procedures.

Introduction: Inflammatory response (IR) is a fundamental reaction to the cell and tissue injury. It is aimed at correcting the pathologic condition and maintaining the structural and functional integrity of the organism. The insult with too extensive or prolonged effect can lead to dysregulation of IR to the systemic level. Major abdominal surgery (MAS) can be considered as a potentially significant insult. Alarmins are endogenous, intracellular proteins that are passively or actively released upon the cell injury to extracellular space where they express their bioactive effect. Alarmins has therefore potential reflect the degree of surgical injury. Purpose: The main goal of the study was elucidating the role of selected alarmins in inflammatory response after MAS. The secondary aims were: 1) determining the relationship between alarmins and outcome prediction, 2) to determine relationship of alarmins and place of surgical intervention, 3) to determine correlation between alarmins and some of the surgery characteristics, e.g. length of surgery, blood loss, and intraoperative fluid load, 4) compare injury caused by laparoscopy and open surgery reflected by alarmins, and 5) to confirm previous results by determining the role of alarmins in surgical injury in subgroup of patients undergoing colorectal...

Supraspinatus tears often result in the setting of chronic tendinopathy. However, the typical repair model utilizes an acute injury. In recognition of that distinction, our laboratory developed an overuse animal model; however it is unclear whether induced overuse is necessary in the repair model. We studied the repair properties of overuse-induced tendons compared to normal tendons. We hypothesized that histological and mechanical properties would not be altered between the overuse-induced and normal tendons 1 and 4 weeks after repair. Thirty-one adult male Sprague-Dawley rats were subjected to either overuse or cage activity for 4 weeks prior to bilateral supraspinatus tendon repair surgery. Rats were sacrificed at 1 and 4 weeks post-surgery and evaluated for histology and mechanics. Results at 1 week showed no clear histologic changes, but increased inflammatory protein expression in overuse tendons. At 4 weeks, percent relaxation was slightly increased in the overuse group. No other alterations in mechanics or histology were observed. Our results suggest that the effects of the surgical injury overshadow the changes evoked by overuse. Because clinically relevant mechanical parameters were not altered in the overuse group, we conclude that when examining tendons 4 weeks after repair in the classic rat supraspinatus model, inducing overuse prior to surgery is likely to be unnecessary.

Desde el punto de vista del metabolismo hídrico, el parto normal no es un factor de stress y sí lo es la operación cesárea. La injuria quirúrgica producida por la operación cesárea es mayor que la originada por una intervención quirúrgica de mediana gravedad. En el post-operatorio de cesárea se produce una sobrehidratación que es mayor en el extra-celular que en el intracelular. La acción del stress producida por la operación cesárea cesa alrededor del cuarto día del post-peratorio, lo que se traduce por una mayor diuresis y salida del agua del intra-al extracelular.

This study evaluates different wavelengths of LED therapy in Wistar rats skin injuries. LEDs (Light Emitting Diodes) are phototherapeutic resource nowadays, since it is considered a good alternative to Low Level Laser Therapy in injury healing because of the lower cost. Twenty-five male Wistar rats were divided in five groups: Control, Red LED (630-780 nm), Green LED (490-565 nm), Blue LED (440-490 nm) and Yellow LED (590-630 nm). It´s a experimental research that it was performed during 4 weeks. Twenty-four hours after surgical injury (1cm²) was applied LED therapy for 6 minutes during five days. Red LED presented best anti-edematous effects in comparison to the other wavebands. The perimeters were reduced in all groups, but in Green and Red LED groups were significantly diminished (p

Many anesthesiologists are unfamiliar with the rate of surgical neurological complications of the shoulder and elbow procedures for which they provide local anesthetic–based anesthesia and/or analgesia. Part 1 of this narrative review series on neurological complications of elective orthopedic surgery describes the mechanisms and likelihood of peripheral nerve injury associated with some of the most common shoulder and elbow procedures, including open and arthroscopic shoulder procedures, elbow arthroscopy, and total shoulder and elbow replacement. Despite the many articles available, the overall number of studied patients is relatively low. Large prospective trials are required to establish the true incidence of neurological complications following elective shoulder and elbow surgery. What’s New As the popularity of regional anesthesia increases with the development of ultrasound guidance, anesthesiologists should have a thoughtful understanding of the nerves at risk of surgical injury during elective shoulder and elbow procedures.

Many anesthesiologists may not be familiar with the rate of surgical neurological complications of the hip and knee procedures for which they are providing local anesthetic–based anesthesia and/or analgesia. Part 2 of this narrative review series on neurological complications of elective orthopedic surgery describes the mechanisms and likelihood of peripheral nerve injury associated with some of the most common hip and knee procedures, including arthroscopic hip and knee surgery and total hip and knee replacement. What’s New As the popularity of regional anesthesia continues to increase with the development of ultrasound guidance, anesthesiologists should have a thoughtful understanding of the nerves at risk of surgical injury during elective hip and knee procedures.

Fifteen years ago, laparoscopic surgery of rectal cancer was considered as radical in terms of oncology as open surgery. A trend to reduce surgical injury may be observed in surgery in recent years. In this paper the first experience in the new minimally invasive method of anterior rectal resection is described – through the transanal way. The procedure duration was 130 min. The use of transanal access in rectal cancer surgery is undoubtedly an alternative method to standard laparoscopic surgery. In patients with a large tumour in the lower rectum, the technique allows a longer rectal stump to be left below the resection border.

The closure and repair of wounds after traumatic or surgical injury is of significant clinical and research importance. While sutures remain the common wound closure technique, they have many disadvantages. Consequently, polymeric hydrogel adhesives have emerged as essential materials for wound management and repair because of their tunable chemical and physical properties, which enable them to adhere or stick to tissues, possess sufficient mechanical strength to stay intact and be subsequently removed, provide complete wound occlusion, and act as a barrier to bacterial infection. Moreover, these materials absorb wound exudates and keep the wound moist for faster healing. This tutorial review summarizes the key chemical features that enabled the development and use of polymeric hydrogels as wound adhesives, sealants, and hemostats, their design requirements, synthetic routes, determination of properties, and the tests needed to evaluate their performances. This tutorial review is a reference and a starting point for scientists and clinicians working or interested in the field of wound management and, importantly, for the general audience who is interested in polymers for medical applications.

Purpose: To evaluate the efficacy of the application of the human amniotic membrane (HAM) on the inflammatory process, fibroblast proliferation, formation of collagenand reduction of skin wound areas in rats. Methods: Thirty six rats were submitted to a surgical injury induction and divided into two groups (n = 18): group C (control) and T (treated with the HAM). The macroscopic evolution in the wound area and the histological characteristics of the skin samples were evaluated. Results: The regression of the wound area was greater in group T. The histological analysis revealed a significant reduction (p < 0.05) in the inflammatory infiltrate in group T at all experimental periods compared with that in the control group. Furthermore, the group T presented a significant increase in the proliferation of fibroblasts at 14 and 21 days compared with group C (p < 0.05). Regarding the deposition of mature collagen fibers, there was an increase in the replacement of type III collagen by type I collagen in group T (p < 0.05). Conclusion: Treatment with the HAM reduced the healing time as well as the inflammatory responses, increased the proliferation of fibroblasts, and induced a higher concentration of mature collagen fibers.

Our present study investigates the cellular and molecular inflammatory events in male albino rat arterial injury. Male albino rats were subjected to longitudinal incision and carotid artery clamping for the duration of 45 days. Heat shock protein (HSP) 27, HSP70, HSP47 and Nuclear Factor kappa B (NF-κB) expressions were determined by qPCR and Western blot method. The morphology of vessel wall alteration was studied by the light microscopy. The expression of NF-κB was found to be increased after ten days of carotid artery injury. The qPCR and Western blot analysis showed elevation in HSP47, HSP27, and HSP70 expression, ten days following the surgical injury. The neointima-formation and the media layer discontinuity were evidenced by light microscopy. The dendritic-like cells were in close contact with the lymphocytes. Our study reports that the surgical injury induces an inflammatory response through the increased NF-κB and HSPs expression.

Adhesion of freely moving tissues and organs due to surgical injury and trauma can be a serious postoperative complication. High rates of incidence due to surgical intervention, especially associated with abdominal procedures, have been reported. This chapter gives an introduction to the formation of adhesions, with particular focus on peritoneum, urinary and reproductive (female) systems, tendon, ligament, joint, and pericardium. A number of techniques, treatments, and materials have been proposed for the prevention/reduction of adhesion formation. Of these, barrier methods are considered the only effective method currently available. An overview of biomaterials currently used as barriers for postsurgical tissue adhesion is presented. Current clinical practice utilizes solid membranes/mechanical barriers, spray-on, and gel and liquid barriers. These barriers can be either resorbable, nonresorbable, or a combination of both. Complications of barrier films are examined, and design criteria for barrier membranes are presented. Adhesion formation can be beneficial in particular circumstances, such as for anchoring implants, and these uses are commented upon. Much advancement has been made in this area, thanks to the increasing knowledge and understanding regarding the events that control adhesion formation, but there is still a long way to go before an optimum solution to this problem is found.

With the improvement of laparoscopic instruments and surgical experience, significant development has been gained in laparoscopic liver surgery. However, it is still the dream of both surgeons and patients to reduce the surgical injury to the maximum extent. In recent years, laparoscopic single-site surgery has been constantly tried as a new challenging technique. Laparoscopic single-site hepatectomy may play a promising role in the field of the minimally invasive surgery.

Variations of the sciatic nerve anatomy and blood supply are complex and largely not dealt with in common anatomy texts. Variations of the sciatic nerve anatomy can be divided into the height of division of its branches, relation of the branches to the piriformis muscle, and its blood supply. These variations should be well known to any surgeon operating in this anatomical region. It is unknown whether these variations increase the risk of surgical injury and consequent morbidity. This paper will review the current knowledge regarding anatomical variations of the sciatic nerve and its blood supply.

Staged bilateral total knee arthroplasty (TKA) may provide an ideal clinical model for the study of central sensitization. In staged TKA, hyperalgesia may be induced as a result of repeated surgical injury possibly via central sensitization, which can decrease functional outcomes. Therefore, we hypothesized that in staged bilateral TKA, patients would have greater pain in the second operated knee than in the first. Thirty patients undergoing staged bilateral TKA at a 1-week interval were enrolled. Postoperative pain, which was reported on the basis of a visual analog scale (VAS; primary outcome) at rest and at maximum knee flexion, and the amount of patient-controlled analgesic (i.v. fentanyl) and rescue analgesic (i.v. ketoprofen; secondary outcomes) administered during the 48 h after the operation, were compared between the first and second TKA. VAS scores at rest and at maximum knee flexion were greater on the second operated knee (P.001 and P.01, respectively). The cumulative amounts of patient-controlled analgesic and the rescue analgesic were greater in the second than in the first TKA (P.001 and P.05, respectively). Patients undergoing staged bilateral TKA experience greater postoperative pain in the second operated knee than the first. This suggests extension of hyperalgesia beyond the initially injured site to remote regions after surgical injury, in which central sensitization may be involved. Therapeutic approaches to reduce such hyperalgesia induced in the course of staged operations are required.

Facial synkinesis is the simultaneous contraction of the certain facial musculature accompanying a motion of designated muscle in the face. With the exception of rare afflictions that are congenital in origin, most patients develop as a sequel to facial nerve paralysis due to trauma, tumor, and surgical injury. As an idiopathic congenital form, oculo-nasal synkinesis which reveals co-contraction of orbicularis oculi and the compressor narium minor muscles which are innervated by separate branches of the facial nerve have been already reported. In addition to oculo-nasal synkinesis, the authors describe 2 more rare patients with facial synkinesis; oculo-zygomatic and fronto-nasal synkinesis with video documentation, which to the best of our knowledge, have not been reported previously in detail. This will help plastic surgeons prevent being involved in legal issues when they might neglect these rare phenomena in preoperative evaluation during cosmetic surgery.

OBJECTIVE. Implanted microelectrodes provide a unique means to directly interface with the nervous system, but have been limited by the lack of stable functionality. There is growing evidence suggesting that substantially reducing the mechanical rigidity of neural electrodes promotes tissue compatibility and improves their recording stability in both short- and long-terms. However, the miniaturized dimensions and ultraflexibility desired for mitigating tissue responses preclude the probe’s self-supported penetration into the brain tissue. APPROACH. Here we demonstrate the high-throughput implantation of multi-shank ultraflexible neural electrode arrays with surgical footprints as small as 200 μm(2) in a mouse model. This is achieved by using arrays of tungsten microwires as shuttle devices, and bio-dissolvable adhesive polyethylene glycol (PEG) to temporarily attach a shank onto each microwire. MAIN RESULTS. We show the ability to simultaneously deliver electrode arrays in designed patterns, to adjust the implantation locations of the shanks by need, to target different brain structures, and to control the surgical injury by reducing the microwire diameters to the cellular scale. SIGNIFICANCE. These results provide a facile implantation method to apply ultraflexible neural probes in scalable neural recording.

Tissue injury causing immune response is an integral part of surgical procedure. Evaluation of the degree of surgical trauma could help to improve postoperative management and determine the clinical outcomes.We analyzed serum levels of alarmins, including S100A5, S100A6, S100A8, S100A9, S100A11, and S100A12; high-mobility group box 1; and heat-shock protein 70, after elective major abdominal surgery (n = 82). Blood samples were collected for three consecutive days after surgery. The goals were to evaluate the relationships among the serum levels of alarmins and selected surgical characteristics and to test potential of alarmins to predict the clinical outcomes.Significant, positive correlations were found for high-mobility group box 1 with the length of surgery, blood loss, and intraoperative fluid intake for all three days of blood sampling. The protein S100A8 serum levels showed positive correlations with intensive care unit length of stay, 28-day and in-hospital mortality. The protein S100A12 serum levels had significant, positive correlations with intensive care unit length of stay, 28-day mortality, and in-hospital mortality. We did not find significant differences in alarmin levels between cancer and noncancer subjects.The high-mobility group box 1 serum levels reflect the degree of surgical injury, whereas proteins S100A8 and S100A12 might be considered good predictors of major abdominal surgery morbidity and mortality.

Sepsis following surgical injury remains a growing and worrisome problem following both emergent and elective surgery. Although early resuscitation efforts and prompt antibiotic therapy have improved outcomes in the first 24 to 48 h, late onset sepsis is now the most common cause of death in modern intensive care units. This time shift may be, in part, a result of prolonged exposure of the host to the stressors of critical illness which, over time, erode the health promoting intestinal microbiota and allow for virulent pathogens to predominate. Colonizing pathogens can then subvert the immune system and contribute to the deterioration of the host response. Here, we posit that novel approaches integrating the molecular, ecological, and evolutionary dynamics of the evolving gut microbiome/pathobiome during critical illness are needed to understand and prevent the late onset sepsis that develops following prolonged critical illness.

A pseudoaneurysm (false aneurysm) develops when all three walls of an artery (intima, media, and adventitia) are violated. In the sellar region, pseudoaneurysms of the internal carotid artery (ICA) usually occur iatrogenically as a result of surgical injury.

Amac: Bu prospektif calismada major gogus cerrahisi uygulanan hastalarda ameliyat sonrasi komplikasyon riski ile sistemik inflamasyan arasindaki birliktelik arastirildi. Ca­lis­ma­pla­ni:­Akciger rezeksiyonu icin torakotomi uygulanan 37 hasta (23 erkek, 14 kadin; ort yas 53.9 yil; dagilim 44-72 yil) calismaya dahil edildi. Serum prokalsitonin, interlokin 6 (IL-6) ve tumor nekroz faktor alfa (TNF-a) konsantrasyonlari cerrahi oncesi ve cerrahi sonrasi bir, bes ve yedinci gunlerde olculdu. Demografik bilgiler, torakotomi nedenleri, akciger rezeksiyon tipi, ameliyat suresi, hastanede kalis suresi ve ameliyat sonrasi komplikasyonlar kaydedildi. Bul gu lar: Ameliyat sonrasi serum prokalsitonin, IL-6 ve TNF-a konsantrasyonlari ameliyat oncesi degerler ile karsilastirildiginda anlamli olarak daha yuksek idi. Ameliyat sonrasi komplikasyonlu hastalar, komplikasyon gelismeyen hastalar ile karsilastirildiginda ameliyat sonrasi bir ve besinci gunlerde prokalsitonin seviyesi yaklasik uc kat, ameliyat sonrasi yedinci gun IL-6 seviyesi iki kat yuksek idi. Ameliyat sonrasi bir ve besinci gunlerde prokalsitonin, ameliyat sonrasi yedinci gun IL-6 duzeylerinde, ameliyat sonrasi komplikasyon olan ve olmayan gruplar arasinda anlamli fark vardi. So­nuc:­ Ameliyat sonrasi birinci gun yukselmis prokalsitonin seviyesi ameliyat sonrasi komplikasyonlarin umit verici erken bir gostergesidir. Ameliyat sonrasi donemde prokaksitonin, IL-6 ve TNF-a konsantrasyonlarinin yukselmesi cerrahi travmanin ciddiyetinin gostergesidir. Bu bulgular tetikte olmamizi ve ileri incelemelerde bulunmamiza yardimci olabilir. Anah tar soz cuk ler: Komplikasyonlar; interlokin 6; prokalsitonin; torasik cerrahi; tumor nekroz faktor alfa. Background:­This prospective study aims to investigate the association between systemic inflammation and risk for postoperative complications in patients undergoing major thoracic surgery. Methods: Thirty-seven patients (23 males, 14 females; mean age 53.9 years; range 44 to 72 years) undergoing thoracotomy for lung resection were included. Serum procalcitonin, interleukin 6 (IL-6), and tumor necrosis factor alpha (TNF-a) concentrations were measured at baseline and on the first, fifth and seventh day following surgery. Demographic data, reasons for thoracotomy, type of lung resection, duration of surgery, length of hospital stay, and postoperative complications were recorded. Results:­Serum concentrations of procalcitonin, IL-6, and TNF-a after surgery were significantly higher compared to the preoperative values. Patients with postoperative complications had approximately a three-fold elevation in procalcitonin levels at postoperative days one and five, and a two-fold elevation in IL-6 levels at postoperative day seven, compared to patients without pulmonary complications. The procalcitonin levels on postoperative days one and five and IL-6 levels on postoperative day seven were significantly different between the groups with and without postoperative complications. Conclusion:­ An elevated procalcitonin level on postoperative day one is a promising early marker of postoperative complications. Elevated concentrations of procalcitonin, IL-6, and TNF-a in the postoperative period are markers of the severity of surgical injury. These findings may contribute to alert us and make further examinations.

Minimally invasive surgery (MIS) was initially used for the treatment of colorectal benign disease. However, the indications for MIS techniques have progressively been expanded to include cancers. Nowadays, the indications for MIS are almost the same as those for open surgery. The scientific validation of MIS for colorectal cancer has favorably evolved. The advantages awaited for the short-term outcome were confirmed, although at the cost of longer operating time and higher costs. In parallel, tangible evidence of oncologic safety was demonstrated, and long-term results of MIS have been found comparable to those of open surgery. In the current state of MIS short-term superiority and log-term equality, less surgical injury, lower immune function depression and better postoperative outcome make MIS particularly suitable for delicate and difficult patients, such as elderly or obese; on the contrary, the lower costs have led to still consider open surgery as a valid alternative for low-impact resections (such as right colectomy). The continuous development in the field of MIS has recently led to the introduction of the single-port (SILS) and natural-orifice (NOTES) techniques, which allow better esthetic results, even if the their validation has not yet reached scientific evidence.

A laserterapia é um procedimento utilizado em larga escala nas lesões musculoesqueléticas, devido as suas diversas propriedades, antiinflamatórias, cicatrizantes entre outras. Além disso, há tipos distintos de aparelhos de laser. Mesmo com os diversos modelos experimentais existentes na literatura, não há um consenso sobre a faixa de utilização, bem como o tipo de laser que promove melhor reparo no tecido muscular. Este estudo visa analisar os efeitos da laserterapia de baixa intensidade na expressão de colágeno após lesão muscular. Camundongos Swiss albinos (n=18) foram submetidos à lesão muscular cirúrgica e divididos em dois grupos, controle (C) e teste (T). Os animais foram submetidos a uma irradiação diária de 5 J/cm² pelos lasers AsGaAl 830 nm e AsGa 904 nm e, em diferentes tempos de sacrifício (7 e 14 dias). Os resultados não demonstraram diferença estatística significativa na expressão de colágeno em ambos os grupos analisados. Contudo, os dados apontam que a dose de 5 J/cm² do laser AsGa 904 nm promoveu maior deposição de fibras colágenas após 14 dias de tratamento, sugerindo que a terapia seja efetiva na síntese de colágeno. Outros estudos experimentais, em humanos, devem ser propostos para maiores inferências sobre os resultados do laser no tratamento da lesão muscular. The laser therapy is a procedure utilized at long scale in the musculoskeletal injuries, due its anti-inflammatory and reparatory proprieties and others. Besides, there are differents types of laser equipments. Despites with the many experimental models at literature, there is no consensus about the range of application as well as the type of laser that promove of the best repair in muscular tissue. The aim of this study is to analyze the effects of the low level laser therapy in the expression of collagen after muscular injury. Mice Swiss albinos (n=18) were subjected to the muscular surgical injury and separated in two groups, control (C) and test (T). The animals were submitted a daily radiation of 5 J/cm² for the lasers AsGaAl 830 nm and AsGa 904 nm and, in different times of sacrifice (7 and 14 days). The results didn't demonstrate significant statistical difference in the expression of collagen in both analyzed groups. However, the data appear that the dose of 5 J/cm² of the laser AsGa 904 nm promoted larger deposition of fibers collagens after 14 days of treatment, suggesting that the therapy is effective in the synthesis of collagen. Others studies will be proposed at humans to bigger inferences about the results of laser in the treatment muscular injury.

The treatment of relatively large cerebral aneurysms by direct clipping has been reported to significantly increase operative morbidity. In this article, we introduce a newly conducted surgical technique of aneurysmoplasty, which is most suitable for clipping of these ruptured aneurysms and implies additional methods to prevent surgical injury to surrounding vessels and brain tissues. The main concept of aneurysmoplasty includes tentative clipping in the early stage of aneurysm dissection and reduction in size of aneurysms by low output bipolar-coagulation. These methods are systemically arranged and titrated according to the aneurysm’s size and location. Transforming large ruptured aneurysms to small unruptured aneurysms apparently improves safety and reliability in clipping procedure by direct inspection around the neck and behind the dome of aneurysms.

Rationale: A 35-year old Chinese female was admitted to hospital with refractory pericardial effusions 10 days post mitral valve replacement via median sternotomy. We performed an exploratory resternotomy and found lymphatic leakage on the surface of the diaphragm which was continuously emitting a light yellow fluid. Patient concerns: The patient complained of no obvious discomfort except for the concern of massive pericardial effusion drainage. Diagnoses: Exploratory resternotomy and biochemical testing lead to a supradiaphragmatic lymphatic fistula being diagnosed as the cause of the refractory pericardial effusion. Interventions: The fistula was closed with a continuous suture and no other fistulas were found after a thorough exploration. Outcomes: The patient was discharged home on postoperative day 5 and recovery was uneventful. Lessons: In this case a timely exploratory resternotomy proved effective in seeking the cause of and treating pericardial effusion following cardiac surgery.

The content of basic fibroblast growth factor (bFGF) and also interleukins 1beta and 6 (IL-1beta and IL-6) has been investigated in rat buccal mucosa after its surgical injury by an erbium laser (Er:YAG laser) and a scalpel. The laser emission caused a sharp increase in the content of these regulators on the second day after treatment followed by decrease observed on the seventh day. These results may reflect synergistic effect of these peptide regulators in the wound defect. Changes in time-course of bFGF, IL-1beta and IL-6 release in the wound formed by the laser beam compared with the wound induced by the cutting instrument may promote earlier appearance of the proliferation phase.

Disturbed flow patterns, material mismatch, and surgical injury are often cited as being significant contributors to failure at the distal end of femoropopliteal bypass grafts. The objective of this research is to propose a novel bypass graft design concept which seeks to reduce the incidence of disturbed flow in the bypass junction and to establish the surgical feasibility of the proposed device. A preliminary evaluation of the hemodynamic benefit associated with the proposed device was made using computational fluid dynamics. A prototype of the device was then constructed from commercially available materials, and it was prepared for implantation into the aorta of a pig. The computational model of the proposed device showed that significant flow correction was occurring in the in vitro model due to the geometric configuration of the design. The magnitude of the peak wall shear stress in the recirculation region was noted to decrease by 78%. Surgical feasibility of the proposed device was verified by successful implantation into the aorta of the pig. The pig was sacrificed after 7 weeks, the graft and host artery were excised, and histological examination downstream from the distal junction showed that intimal hyperplasia had developed in the host artery. The proposed device is surgically feasible and may offer a significant hemodynamic advantage over current graft designs.

Surgical injury causes acute sequestration of interstitial fluid in injured tissue. Fluid sequestration treated with IV fluid administration can lead to postoperative complications related to excessive intravascular volume. Quantitative prediction of interstitial fluid sequestration may foster a better understanding of the relationship between fluid administered and the resulting balance between intra- and extravascular fluid.We developed a mathematical model describing the dynamic distribution and transport of fluid and proteins with the goal of quantifying the balance of fluid between intra- and extravascular compartments. Fluid volume changes in the plasma, interstitial and urine compartments were calculated for a simulated 4 h abdominal surgery in a 70 kg male. To validate the model, we compared the results obtained with those measured by segmental bioelectrical impedance on 30 patients undergoing elective abdominal surgery.The model predicted that, compared to the normal state, surgical injury would result in the sequestration of 705 mL of interstitial fluid in injured tissue, whereas plasma volume would undergo a 356 mL decrease. During surgery, it was not possible to obtain a normal plasma volume, even with fluid replacement at a rate of almost 20 mL x kg(-1) x h(-1). Bias and limit of agreement on interstitial fluid volume changes in body segments between bioelectrical impedance and model prediction were -131 and 325 mL, respectively for limbs, and -157 and 834 mL for the trunk.The model shows that increasing the fluid replacement rate above 10 mL x kg(-1) x h(-1) does not have the desired effect on plasma volume but instead increases the interstitial volume.

The method of anesthetic management of simultaneous surgeries in women with combination of gynaecological and extragenital surgical pathology was developed. In carrying out surgical interventions in patients with large volume of operations, on two or more organs, there were mainly used isolated anesthetic management techniques (general anesthesia, epidural or spinal anesthesia). The used method of anesthetic management is characterized by a combination of regional anesthesia with intravenous anesthesia using an additional combined with mechanical ventilation on the background of miorelaxsation that enables to reduce the depressive effects of anesthesia on the central nervous and cardiovascular systems, to carry out the correction of hemodynamic controlled within the normotension or hypotension. Conducting prolonged regional anesthesia makes it possible to reduce the dose of narcotic analgesics in the postoperative period, to normalize the function of the gastrointestinal tract, to reesteblish physical activity of women, to reduce the potential risk of postoperative complications. Using this method of anesthesia increase in surgical intervention does not significantly affect on the degree of surgical injury.

Highlights • Laparoscopic gastrectomy had satisfactory results in patients with gastric cancer. • Natural orifice surgery (NOS) is an ever-evolving advanced laparoscopic technique. • NOS promises minimizing surgical injury, less wound complications and faster recovery. • Laparoscopy plus NOS can potentiate the advantages of both minimal invasive techniques. • We presented a transvaginal extraction of an advanced gastric cancer after laparoscopic gastrectomy., Purpose Natural orifice specimen extraction (NOSE) is an ever-evolving advanced laparoscopic technique. NOSE minimizes surgical injury, involving a low risk of wound complications, fewer incisional hernias, faster recovery and less postoperative pain. Laparoscopic gastrectomy combined with NOSE is a procedure that can potentiate the advantages of both minimal invasive techniques. We aim to demonstrate the feasibility of laparoscopic subtotal gastrectomy with transvaginal specimen extraction in advanced gastric cancer. Case A 72-year-old woman with a 2 cm adenocarcinoma in gastric antrum was treated by laparoscopic subtotal gastrectomy and lymph node dissection. A totally laparoscopic Roux-en-Y gastrojejunostomy was constructed. Specimen was extracted through the posterior fornix of vagina without difficulty. Histopathology confirmed pT3pN0 tumor. After a 10-month follow-up the patient was asymptomatic and getting adjuvant chemoradiotherapy. Conclusions Transvaginal specimen extraction after laparoscopic gastric resection for advanced gastric cancer is a feasible procedure. It is offered to selected patients and of course only to female patients. Natural orifice surgery may provide faster recovery and decrease the wound related complications which may cause a delay on postoperative adjuvant chemo–radio therapies. We have presented, as far as we know, the first human case of a transvaginal extraction of an advanced gastric cancer after laparoscopic gastrectomy.

Traumatic and/or surgical injury as well as hemorrhage induces profound suppression of cellular immunity. Although local anesthetics have been shown to impair immune responses, it remains unclear whether lidocaine affects lymphocyte functions following trauma-hemorrhage (T-H). We hypothesized that lidocaine will potentiate the suppression of lymphocyte functions after T-H. To test this, we randomly assigned male C3H/HeN (6–8 wk) mice to sham operation or T-H. T-H was induced by midline laparotomy and ∼90 min of hemorrhagic shock (blood pressure 35 mmHg), followed by fluid resuscitation (4× shed blood volume in the form of Ringer lactate). Two hours later, the mice were killed and splenocytes and bone marrow cells were isolated. The effects of lidocaine on concanavalin A-stimulated splenocyte proliferation and cytokine production in both sham-operated and T-H mice were assessed. The effects of lidocaine on LPS-stimulated bone marrow cell proliferation and cytokine production were also assessed. The results indicate that T-H suppresses cell proliferation, Th1 cytokine production, and MAPK activation in splenocytes. In contrast, cell proliferation, cytokine production, and MAPK activation in bone marrow cells were significantly higher 2 h after T-H compared with shams. Lidocaine depressed immune responses in splenocytes; however, it had no effect in bone marrow cells in either sham or T-H mice. The enhanced immunosuppressive effects of lidocaine could contribute to the host's enhanced susceptibility to infection following T-H.

The exact frequency and clinical consequences of surgical hepatic injuries during organ procurement are unknown. We analyzed the incidence, risk factors, and clinical outcome of surgical injuries in 241 adult liver grafts. Hepatic injuries were categorized as parenchymal, vascular, or biliary. Outcome variables were bleeding complications, hepatic artery thrombosis (HAT), and graft survival. In 82 livers (34%), 96 injuries were detected. Most injuries were minor, but clinically relevant injuries were detected in 6.6% (16/241) of the livers. Fifty (21%) liver grafts had some degree of parenchymal or capsular injury, 40 (17%) had vascular injury, and 6 (2%) had an injury to the bile duct. Procurement region was the only risk factor significantly associated with surgical injury. The rate of hepatic artery injury was significantly higher in livers with aberrant arterial anatomy. Bleeding complications were found in 18% of patients who received livers with a parenchymal or capsular injury in contrast to 9% without parenchymal injury (P = 0.065). HAT was found in 23% of the patients who received a liver with arterial injury compared to 4% without arterial injury (P = 0.001). Overall graft survival rates were not significantly different for grafts with or without anatomical injury. In conclusion, surgical injuries of donor livers are an underestimated problem in liver transplantation and can be observed in about one-third of all cases. Clinically relevant injuries are detected in 6.6% of all liver grafts. Arterial injuries are associated with an increased risk of HAT.

Objective To determine the sensitivity of conventional sensory assessment in monitoring lingual nerve recovery subsequent to third molar surgery and to evaluate if the assessment methods can be predictive of injury outcome. Method A prospective case series of 94 patients presenting with lingual nerve injuries evaluated using objective mechanosensory and subjective methods during the recovery period of up to 12 months. Results The conventional tests were often unable to diagnose the presence of injury due to variability and they were not predictive of outcome. As a result of this study, we are able to identify patients more likely to have permanent rather than temporary lingual nerve injury at four to eight weeks post injury, using patient reported subjective function. The subjective function test also minimises the requirements for specialist training or equipment providing an ideal method for general dental practice. Conclusions The development of these simple subjective tests may enable us to identify which patients are at risk of permanent lingual nerve injuries in the early post injury phase, thus allowing expeditious therapy when indicated.

Summary This study seeks to determine the ability of enzyme-linked immunosorbent assays (ELISAs) of vocal fold secretions to detect and describe the acute tissue response to injury in a rabbit vocal fold model. Vocal fold secretions were collected before the induction of a unilateral surgical injury to the vocal fold and at 6 timepoints after injury (1, 5, 7, 10, 14, and 21 days). Secretions were then subjected to ELISAs to assess concentrations of interleukin-1 beta (IL-1β) and prostaglandin-E2 (PGE-2). The results indicate that ELISAs may be useful in documenting fluctuations in these markers associated with the wound healing process in the rabbit model. The temporal expression of both IL-1β and PGE-2 was consistent with their proposed roles in the wound healing cascade in other systems, pointing to the potential that surface secretions may be at least partial indicators of wound healing events within the tissue.

Despite unique tumour epidemiology, a higher cancer incidence and modest survival improvement compared to paediatric patients, adolescents and young adults aged 15-30 have not been considered as a separate, 'special' group of patients in the frame of medical oncology. In an effort to emphasise this need, we review the particular characteristics of diagnosed tumours, a aetiologic associations, nosologic classification, management, outcome and late toxic effects. Adolescents and young adults are in need of specialised care for intensive treatment of curable malignancies, skilled nursing care, interaction with peers, family and physicians as well as continuous psychosocial support. Enrolment in clinical research trials and close follow-up via the development of a cooperative infrastructure are imperative for the optimisation of management and avoidance of late effects. Similar to geriatric and paediatric oncology, we call for the intensification of treatment, support and research multidisciplinary efforts in order to better fulfil the pressing demands of this patient group. © 2005 European Society for Medical Oncology. 16 2 181 188

Background. The precise incidence and cause of atrioventricular block (AVB) after heart transplantation remain uncertain. Methods and Results. After surgery, immediate and follow-up electrocardiograms from 1,047 consecutive patients who underwent heart transplantation were reviewed for AVB and correlated with clinical symptoms, laboratory data, rejection grade, and echocardiogram and coronary angiography findings. A total of 113 patients demonstrated various kinds of AVB; the incidence was 10.8%. First-degree AVB occurred in 87 patients, 37 of whom also demonstrated persistent atrial tachyarrhythmias (ATAs). In 30 patients, first-degree AVB occurred 7 days to 120 months after heart transplantation. Among those, 88% demonstrated cellular rejection, and 20% developed transplant coronary artery disease (TCAD). Fifty patients demonstrated first-degree AVB without ATA, 32 of whom developed AVB from operative day 7 to 156 months. The incidence of cellular rejection was significantly lower (36%, P