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BACKGROUND: Although attempts have been made in the past to establish consensus regarding the definitions and grading of the severity of colorectal anastomotic leakage, widespread adoption has remained limited. OBJECTIVE: A systematic review of the literature was conducted to examine the various elements used to report and define anastomotic leakage in colorectal cancer resections. DATA SOURCES: A systematic review was conducted using the PubMed, Embase, and Cochrane Library Database. STUDY SELECTION: All published randomized controlled trials, systematic reviews, and meta-analyses containing data related to adult patients undergoing colorectal cancer surgery and reporting anastomotic leakage as a primary or secondary outcome, with a definition of anastomotic leakage were included. MAIN OUTCOME MEASURES: Definitions of anastomotic leakage, clinical symptoms, radiological modalities and findings, findings at reoperation, and grading terminology or classifications for anastomotic leakage. RESULTS: Of the 471 articles reporting anastomotic leakage as a primary or secondary outcome, a definition was reported in 95 studies (45 randomized controlled trials, 13 systematic reviews, and 37 meta-analyses) involving a total of 346,140 patients. Of these 95 articles, 68% reported clinical signs and symptoms of anastomotic leakage, 26% biochemical criteria, 63% radiological modalities, 62% radiological findings, and 13% findings at reintervention. Only 45% (n = 43) of included studies reported grading of anastomotic leakage severity or leak classification, and 41% (n = 39) included a time frame for reporting. LIMITATIONS: There was a high level of heterogeneity between the included studies. CONCLUSIONS: This evidence synthesis confirmed incomplete and inconsistent reporting of anastomotic leakage across the published colorectal cancer literature. There is a great need to develop and implement a consensus framework for defining, grading, and reporting anastomotic leakage. REGISTRATION: Prospectively registered at PROSPERO (ID 454660).

Study designRetrospective cohort study of prospectively accrued data.ObjectiveTo evaluate a large, prospective, multicentre dataset of surgically treated degenerative cervical myelopathy (DCM) cases on the contemporary risk of C5 palsy with surgical approach.Summary of background dataThe influence of surgical technique on postoperative C5 palsy after decompression for DCM is intensely debated. Comprehensive, covariate-adjusted analyses are needed using contemporary data.MethodsPatients with moderate to severe DCM were prospectively enrolled in the multicenter, randomized, Phase III CSM-Protect clinical trial and underwent either anterior or posterior decompression between Jan 31, 2012 and May 16, 2017. The primary outcome was the incidence of postoperative C5 palsy, defined as the onset of muscle weakness by at least one grade in manual muscle test at the C5 myotome with slight or absent sensory disruption after cervical surgery. Two comparative cohorts were made based on the anterior or posterior surgical approach. Multivariate hierarchical mixed-effects logistic regression was used to estimate odds ratios (OR) with 95% confidence intervals (CI) for C5 palsy.ResultsA total of 283 patients were included, and 53.4% underwent posterior decompression. The total incidence of postoperative C5 palsy was 7.4% and was significantly higher in patients who underwent posterior decompression compared with anterior decompression (11.26% vs. 3.03%, P =0.008). After multivariable regression, the posterior approach was independently associated with greater than four times the likelihood of postoperative C5 palsy ( P =0.017). Rates of C5 palsy recovery were comparable between the two surgical approaches.ConclusionThe odds of postoperative C5 palsy are significantly higher after posterior decompression compared to anterior decompression for DCM. This may influence surgical decision-making when there is equipoise in deciding between anterior and posterior treatment options for DCM.Level of evidenceTherapeutic Level-II.

BACKGROUND: Endoscopic spine surgery has recently grown in popularity due to the potential benefits of reduced pain and faster recovery time as compared to open surgery. Biportal spinal endoscopy has been successfully applied to lumbar disc herniations and lumbar spinal stenosis. Obesity is associated with increased risk of complications in spine surgery. Few prior studies have investigated the impact of obesity and associated medical comorbidities with biportal spinal endoscopy. METHODS: This study was a prospectively collected, retrospectively analyzed comparative cohort design. Patients were divided into cohorts of normal body weight (Bone Mass Index (BMI)18.0-24.9), overweight (BMI 25.0-29.9) and obese (BMI > 30.0) as defined by the World Health Organization (WHO). Patients underwent biportal spinal endoscopy by a single surgeon at a single institution for treatment of lumbar disc herniations and lumbar spinal stenosis. Demographic data, surgical complications, and patient-reported outcomes were analyzed. Statistics were calculated amongst treatment groups using analysis of variance and chi square where appropriate. Statistical significance was determined as p

ObjectiveThoracic outlet syndrome (TOS) has life-changing impacts on young athletes. As the level of competition increases between the high school (HS) and collegiate (CO) stage of athletics, the impact of TOS may differ. Our objective is to compare surgical outcomes of TOS in HS and CO athletes.MethodsThis was a retrospective review of HS and CO athletes within a prospective surgical TOS database. The primary outcome was postoperative return to sport. Secondary outcomes were resolution of symptoms assessed with somatic pain scale (SPS), QuickDASH, and Derkash scores. Categorical and continuous variables were compared using χ2 and analysis of variance, respectively. Significance was defined as P < .05.ResultsThirty-two HS and 52 CO athletes were identified. Females comprised 82.9% HS and 61.5% CO athletes (P = .08). Primary diagnoses were similar between groups (venous TOS: HS 50.0% vs CO 42.3%; neurogenic TOS: 43.9% vs 57.7%; pectoralis minor syndrome: 6.3% vs 0.0%) (P = .12). Pectoralis minor syndrome was a secondary diagnosis in 3.1% and 3.8% of HS and CO athletes, respectively (P = 1.00). The most common sports were those with overhead motion, specifically baseball/softball (39.3%), volleyball (12.4%), and water polo (10.1%), and did not differ between groups (P = .145). Distribution of TOS operations were similar in HS and CO (First rib resection: 94.3% vs 98.1%; scalenectomy: 0.0% vs 1.9%, pectoralis minor tenotomy: 6.3% vs 0.0%) (P = .15). Operating room time was 90.0 vs 105.3 minutes for HS and CO athletes, respectively (P = .14). Mean length of stay was 2.0 vs 1.9 days for HS and CO athletes (P = .91). Mean follow-up was 6.9 months for HS athletes and 10.5 months for CO athletes (P = .39). The majority of patients experienced symptom resolution (HS 80.0% vs CO 77.8%; P = 1.00), as well as improvement in SPS, QuickDASH, and Derkash scores. Return to sport was similar between HS and CO athletes (72.4% vs 73.3%; P = .93). Medical disability was reported in 100% HS athletes and 58.3% CO athletes who did not return to sport (P = .035).ConclusionsDespite increased level of competition, HS and CO athletes demonstrate similar rates of symptom resolution and return to competition. Of those that did not return to their sport, HS athletes reported higher rates of medical disability as a reason for not returning to sport compared with CO athletes.

Despite the known higher risk of cardiovascular disease in individuals with type 2 diabetes, the pathophysiology and optimal management of diabetic foot ulcers (DFUs), a leading complication associated with diabetes, is complex and continues to evolve. Complications of type 2 diabetes, such as DFUs, are a major cause of morbidity and mortality and the leading cause of major lower extremity amputation in the United States. There has recently been a strong focus on the prevention and early treatment of DFUs, leading to the development of multidisciplinary diabetic wound and amputation prevention clinics across the country. Mounting evidence has shown that, despite these efforts, amputations associated with DFUs continue to increase. Furthermore, due to increasing patient complexity of management secondary to comorbid conditions, such as cardiovascular disease, the management of peripheral artery disease associated with DFUs has become increasingly difficult, and care delivery is often episodic and fragmented. Although structured, process-specific approaches exist at individual institutions for the management of DFUs in the cardiovascular patient population, there is insufficient awareness of these principles in the general medicine communities. Furthermore, there is growing interest in better understanding the mechanistic underpinnings of DFUs to better define personalized medicine to improve outcomes. The goals of this scientific statement are to provide salient background information on the complex pathogenesis and current management of DFUs in cardiovascular patients, to guide therapeutic and preventive strategies and future research directions, and to inform public policy makers on health disparities and other barriers to improving and advancing care in this expanding patient population.

INTRODUCTION: As surgical technologies grow, so too do demands on surgical trainees to master increasing numbers of skill sets. With the rise of endovascular surgery, trainees have fewer opportunities to practice open vascular techniques in the operating room. Simulation can bridge this gap. However, existing published open vascular simulation curricula are basic or based on expensive models. METHODS: We iteratively developed an open vascular skills curriculum for second-year surgery residents comprising six 2-hour sessions. We refined the curriculum based on feedback from learners and faculty. The curriculum required skilled facilitators, vascular instruments, and tissue models. We evaluated the latest iteration with a survey and by assessing participants technical skills using the Objective Structured Assessment of Technical Skills (OSATS) form. RESULTS: Over the past 10 years, 101 residents have participated in the curriculum. Nine of 13 residents who participated in the latest curricular iteration completed the survey. All respondents rated the sessions as excellent and strongly agreed that they had improved their abilities to perform anastomoses with tissue and prosthetic. Facilitators completed 18 OSATS forms for residents in the fifth and sixth sessions of the latest iteration. Residents scored well overall, with a median 26.5 (interquartile range: 24-29) out of a possible score of 35, with highest scores on knowledge of instruments. DISCUSSION: This simulation-based curriculum facilitates open vascular surgical skill acquisition among surgery residents. The curriculum allows residents to acquire critical vascular skills that are challenging to learn in an increasingly demanding operative setting.

INTRODUCTION: The fibrous posterior atlanto-occipital membrane (PAOM) at the craniocervical junction is typically removed during decompression surgery for Chiari malformation type I (CM-I); however, its importance and ultrastructural architecture have not been investigated in children. We hypothesized that there are structural differences in the PAOM of patients with CM-I and those without. METHODS: In this prospective study, blinded pathological analysis was performed on PAOM specimens from children who had surgery for CM-I and children who had surgery for posterior fossa tumors (controls). Clinical and radiographic data were collected. Statistical analysis included comparisons between the CM-I and control cohorts and correlations with imaging measures. RESULTS: A total of 35 children (mean age at surgery 10.7 years; 94.3% white) with viable specimens for evaluation were enrolled: 24 with CM-I and 11 controls. There were no statistical demographic differences between the two cohorts. Four children had a family history of CM-I and five had a syndromic condition. The cohorts had similar measurements of tonsillar descent, syringomyelia, basion to C2, and condylar-to-C2 vertical axis (all p>0.05). The clival-axial angle was lower in patients with CM-I (138.1 vs. 149.3 degrees, p = 0.016). Morphologically, the PAOM demonstrated statistically higher proportions of disorganized architecture in patients with CM-I (75.0% vs. 36.4%, p = 0.012). There were no differences in PAOM fat, elastin, or collagen percentages overall and no differences in imaging or ultrastructural findings between male and female patients. Posterior fossa volume was lower in children with CM-I (163,234 mm3 vs. 218,305 mm3, p

Background: Self-Directed Learning (SDL) is a subjective concept with no universally agreed definition. The aim of this project was to obtain the perspectives of Orthopaedic trainee registrars on SDL. Methods: Seven Orthopaedic trainees in the Southwest Peninsula region were recruited in person by the primary author as an Orthopaedic trainee on the same programme as the participants. A one-hour Microsoft teams video interview was arranged at a mutually convenient time exploring several topics including learning resources, experiential learning, learning strategies, training programme requirements and assessment. The interviews were audio recorded and transcribed verbatim. Transcripts were coded using Corbin's and Strauss's published coding method and analysed to develop a model of SDL in this training context. Results: Six learning stages were identified from the coded transcripts and these stages were like Knowles's stages of SDL. Participants felt less autonomous during the identification of knowledge gaps, goal setting and evaluation of learning stages. Participants perceived to have more control over the selection of strategies, and learning stages of SDL. The factors which influenced autonomy at various stages of SDL included supervisors, experiential learning opportunities, service provision competing with learning opportunities, training programme requirements and the power dynamic between trainees and supervisors. Self-advocacy by the trainees for experiential learning opportunities and for their progression was an additional action relevant to SDL that was evident. Online learning resources such as Orthobullets.com, YouTube videos, external revision courses, collaboration and webinars encouraged more autonomy with SDL. Conclusions: Although the United kingdom's Trauma and Orthopaedic curriculum is described as trainee led and SDL is encouraged, in practice Orthopaedic trainees felt limited autonomy with the various stages of SDL due to external factors including their level of experience and the training environment. Trainees' experiences around self-advocacy highlighted the importance of a collaborative and supportive learning culture emphasising dialogue, receiving high quality feedback, and openness for successful progression. [ABSTRACT FROM AUTHOR]

Background: The prevalence of abnormal electrocardiography (ECG) increases with aging, and these abnormalities may have an impact on anesthesia management. Although a normal ECG does not guarantee a healthy heart, an abnormal ECG can quickly identify a patient who is at high risk of cardiac complications. Objective: The aim of this study was to determine the prevalence and associated factors of preoperative abnormal electrocardiography among older surgical patients at selected teaching hospitals in southern Ethiopia, from February 15 to June 15, 2022. Methodology: A multicenter cross-sectional study was conducted at three randomly selected teaching hospitals in southern Ethiopia on 246 elderly surgical patients recruited consecutively. Data were entered into Epidata version 4.6, then exported and analyzed in STATA version 16. A binary logistic regression model was used to examine factors associated with abnormal ECG, and variables with a P-value < 0.2 were entered into the multivariate analysis to identify independent factors. Both crude and adjusted odds ratios were reported, and a P-value < 0.05 was considered statistically significant. The data were presented using frequencies, tables, charts, and figures. Result: In the current study, 120 (48.78%) of older surgical patients had abnormal preoperative ECGs. In terms of severity, 55.3% were classified as minor, while 44.16% were major ECG abnormalities. The most common ECG abnormalities were left axis deviation (LAD), left ventricular hypertrophy (LVH), and ST segment changes. The presence of comorbidity (AOR = 3.44, P = 0.001), age ≥ 70 years (AOR = 2.5, P = 0.011), history of angina (AOR = 5.9, P = 0.011), history of smoking (AOR = 5.07, P = 0.024) and urban residency (AOR = 1.89, P = 0.039) were the strongest risk factors for an abnormal ECG. Conclusion and recommendation: Our study shows that older patients are more likely to have an abnormal ECG before surgery, regardless of symptoms or risk factors. Therefore, it is suggested that all older patients undergo preoperative ECG screening. Further prospective cohort studies are needed to investigate the impact and outcome of patients with preoperative abnormal ECG. [ABSTRACT FROM AUTHOR]

Introduction Surgical volume at Military Treatment Facilities (MTFs) has been gradually decreasing for roughly the past 2 decades. The Knowledge, Skills, and Abilities (KSA) Clinical Readiness Program linked surgical volume and readiness using a tool known as the KSA metric. However, the extent to which military medical missions contribute to the readiness of critical wartime specialties has not been evaluated using this metric. Methods In this study, a retrospective analysis was conducted using the surgical case logs from the US Naval Ship (USNS) Comfort missions in 2018 and 2019. The comprehensive case log data were categorized by year, surgeon, procedure, and location. The analysis focused on providing detailed descriptive statistics, including percentages pertaining to the types of procedures performed during these missions. The 2018 mission was 11 weeks in duration, and supported activities in Ecuador, Peru, Colombia, and Honduras. The USNS Comfort mission in 2019 lasted 6 months (June-November 2019), and visited 12 countries in Central America, South America, and the Caribbean. Results The 2019 mission case log, spanning 6 months, was evaluated using the KSA score in order to assess readiness and compare against 6 months of MTF KSA values within the same calendar year. In 2019, the orthopedic surgeon aboard the USNS Comfort had a total KSA score of 44,006, but the 6-month USNS Comfort mission only contributed 5,364 points (12% of the annual score). The general surgery practice aboard the USNS Comfort produced lower KSA scores compared to each surgeon's respective MTF practice (Table III). Analyzing the cases logged by general surgeons also highlights minimal surgical diversity during these missions, with more than 90% of cases being hernia repairs or laparoscopic cholecystectomies (Table I). In addition, 35% of total procedures performed in 2018 and 2019 were performed laparoscopically. Conclusions The analysis of operative data from the 2019 USNS Comfort mission, in comparison with the surgeons' work at their respective MTFs, reveals limited benefit in the ability of hospital-ship missions to bolster surgical readiness as measured by the KSA score. However, this is not a reflection on the value of Global Health Engagement (GHE) itself but a review of the way in which it is leveraged to support surgical readiness. Military surgeons participate in GHE as part of a larger strategy to strengthen relationships with partner nations, improve military medical force interoperability, and bolster partner nation medical capacity and capabilities. The KSA score offers an excellent tool to compare readiness metrics across significantly different GHE missions, and facilitates the opportunity for future prospective studies to improve case volume, diversity, and ultimately readiness. [ABSTRACT FROM AUTHOR]

Airway management is a key intervention during the resuscitation of critically ill trauma patients. Emergency surgical airway (ESA) placement is taught as a backup option when endotracheal intubation (ETI) fails. We sought to (1) describe the incidence of the emergency department (ED) ESA, (2) compare ESA versus ETI-only recipients, and (3) determine which factors were associated with receipt of an ESA. We searched within the Trauma Quality Improvement Program datasets from 2017 to 2022 for all emergency department surgical airway placement and/or endotracheal intubations recipients. We compared ESA versus ETI-only recipients. From 2017 to 2022, there were 6,477,759 within the datasets, of which 238,128 met inclusion for this analysis. Within that, there were 236,292 ETIs, 2264 ESAs, with 428 (<1 %) having documentation of both. Of the ESAs performed, there were 82 documented in children <15 years of age with the youngest being 1 year of age. The ETI-only group had a lower proportion serious injuries to the head/neck (52 % versus 59 %), face (2 % versus 8 %), and skin (3 % versus 6 %). However, the ETI-only group had a higher proportion of serious injuries to the abdomen (15 % versus 9 %) and the extremities (19 % versus 12 %). Survival at 24-h was higher in the ETI-only group (83 % versus 76 %) as well as survival to discharge (70 % versus 67 %). In the subanaysis of children <15 years (n = 82), 34 % occurred in the 1–4 years age group, 35 % in the 5–9 years age group, and 30 % in the 10–14 years age group. In our multivariable logistic regression analysis, serious injuries to the head/neck (odds ratio [OR] 1.37, 95 % CI 1.23–1.54), face (OR 3.41, 2.83–4.11), thorax (OR 1.19, 1.06–1.33), and skin (OR 1.53, 1.15–2.05) were all associated with receipt of cricothyrotomy. Firearm (OR 3.62, 3.18–4.12), stabbing (2.85, 2.09–3.89), and other (OR 2.85, 2.09–3.89) were associated with receipt of ESA when using collision as the reference variable. ESA placement is a rarely performed procedure but frequently used as a primary airway intervention in this dataset. Penetrating mechanisms, and injuries to face were most associated with ESA placement. Our findings reinforce the need to maintain this critical airway skill for trauma management. • Emergency surgical airway (ESA) access is often used as a primary airway intervention. • ESA access is documented in children as young as 1 with similar survival to adults. • Serious injuries to the face, firearms, and stabbings are associated with receipt of ESA. [ABSTRACT FROM AUTHOR]

The article discusses the rapid evolution of computer vision methods in the field of pathology image analysis, particularly focusing on the advancements in artificial intelligence (AI) technology. It highlights the potential benefits and challenges of using AI in pathology, emphasizing recent methodological advances in computer vision that aim to minimize errors and enhance pathologist involvement. The article also discusses the development of computational pathology foundation models, the use of multiple-instance learning frameworks, and innovations in annotation techniques to reduce the burden on pathologists. Additionally, it mentions the emergence of user-friendly software and the introduction of the first pathology AI copilot, PathChat, as tools to facilitate pathologists' engagement with AI-based pathology tools. [Extracted from the article]

Primary patellar dislocation has a certain recurrence rate after either conservative or surgical treatment, and the optimal treatment for patients with primary patellar dislocation of different ages remains unclear. This study aims to compare the clinical efficacy of surgical and conservative treatments for primary patellar dislocation across different age groups. According to the Preferred Reporting Items for Systematic Reviews and Meta‐analyses (PRISMA) checklist, we conducted a systematic search for randomized controlled trials. We searched the PubMed, EMBASE, Cochrane Library, and Web of Science databases for randomized controlled trials of primary patellar dislocation treated surgically or conservatively up to January 2023. Data searching, extraction, analysis, and quality assessment were carried out in accordance with the Cochrane Collaboration guidelines. A total of nine studies with 433 patients were included in our study. There was no statistically significant difference between the two treatment modalities in terms of Kujala score, pain score, patient satisfaction, reoperation, and Tegner score. The rate of re‐dislocation after surgical treatment is lower than that after conservative treatment. Subgroup analysis based on mean age showed that when the age was >20 years, Kujala scores were higher after surgical treatment than after conservative treatment (p < 0.0001, 95% confidence interval [CI] = 10.41–21.30). When the age was ≤20 years, the difference in Kujala scores between the two treatment modalities was not statistically significant. When the age was >20 years, the recurrence rate of patellar dislocation was lower after surgical treatment than after conservative treatment (p = 0.009, 95% CI = 0.08–0.70). When the age was ≤20 years, the difference in the recurrence rate of patellar dislocation between the two treatment modalities was not statistically significant. When the age of patients with primary patellar dislocation is ≤20 years, both surgical and conservative treatments result in similar clinical outcomes. When the age is >20 years, better clinical outcomes can be achieved by opting for surgical treatment. Therefore, surgery may be a better option for patients with primary patellar dislocation whose age is >20 years. [ABSTRACT FROM AUTHOR]

OBJECTIVES Endoscopic evaluation of anastomosis is effective for the early detection of anastomotic complications after a bronchoplastic procedure. Herein, we aimed to clarify important findings for predicting anastomotic complications. METHODS This single-centre retrospective study included patients who underwent bronchoplastic surgery between April 2013 and September 2023. Only cases in which bronchoscopy was performed both 1 and 2 weeks after surgery were included. Endoscopic findings (classification by Ludwig and Stoelben, mucosa colour, oedema, slough area and colour and depression) were reviewed for all cases. The accuracy of these findings for predicting anastomotic complications was evaluated. RESULTS Of the 190 patients included in this study, 14 (7.4%) experienced anastomotic abnormalities, 11 had fistulas (5.8%) and 7 had stenosis (3.7%). The onsets of fistula and stenosis were 20–28 and 20–44 days after surgery, respectively. In 102 patients (53.7%), the slough worsened from the first to the second week postsurgery. Therefore, it was easier to evaluate slough 2 weeks postsurgery rather than 1-week postsurgery. The positive/negative predicted values of anastomotic complications in endoscopic findings 2 weeks postsurgery were circular slough, 34.2%/99.3%; slough with dark colour, 39.3%/98.1%; and depression, 54.2%/99.4%. The incidence of anastomotic abnormalities was 0% in cases without the 3 findings, 10% in cases with at least 1 finding and 67% in cases with all 3 findings. CONCLUSIONS The endoscopic findings of slough on the anastomosis 2 weeks after bronchoplasty can be easily evaluated and accurately predict complications. Three important endoscopic findings were circular slough, dark colour and depression. [ABSTRACT FROM AUTHOR]

Introduction. Bone metastases occurring distally to the elbow or knee joint are called acrometastases. Acrometastases make up only 0.1% of all bone metastases, but only 0.007% to 0.3% occur in the bones of the foot or hand. In 10% of patients, bone metastases occur as the first sign of a previously undiagnosed primary tumor. Case report. A 64-year-old male reported to the hospital due to painful swelling and redness of the fifth finger of the dominant hand. Osteolysis of the proximal phalanx of the fifth finger was diagnosed radiographically. A working diagnosis of osteomyelitis and phlegmon of the proximal phalanx was made. After incisional drainage, a tumor mass was observed intraoperatively. Amputation of the finger was performed at the level of the metacarpophalangeal joint. Pathohistological analysis revealed squamous cell carcinoma metastasis. After a computed tomography scan and bronchoscopy with biopsy, a diagnosis of squamous cell carcinoma of the bronchus was made. The patient was given chemotherapy. During the application of the second cycle, there was a fatal outcome. Conclusion. Pathohistological verification and determination of the location of the primary tumor are important when acrometastasis is found because starting novel immunotherapy and targeted therapy in a timely manner could change the median survival of these patients. [ABSTRACT FROM AUTHOR]

Bone Anchored Hearing Aids (BAHAs) are currently well-utilized for treatment of hearing-impaired patients with unilateral or bilateral mixed and conductive hearing loss as well as patients with single sided deafness. The objective of this study is to evaluate outcome of BAHA Attract system in terms of surgical, functional,audiological and cosmetic results This is a prospective observational study of 15 consecutive patients of single sided deafness (SSD) who qualified for and underwent BAHA Attract surgery at a tertiary care hospital over a duration of two years. Parameters analysed were: (1) Surgery and wound healing, (2) Post-operative functional results (Bern Benefit for Single sided deafness questionnaire (BBSSQ)), (3) audiological results (free field speech in noise audiometry in two situations: with signal from implanted side and from contralateral side), (4) Cosmetic results (introduction of novel Three Points Scoring System (TPSS). Clinico-radiological planning of surgical site for implant is also described.Mean surgical time was 39 minutes and healing was uneventful in 73 % of patients. All patients reported improvement in all ten hearing situations with maximum improvement for sound localization. Significant improvement of speech in noise was seen especially when signal was presented from implanted side. All patient had full score in TPSS for cosmesis except one patient. This was the same patient in whom clinico-radiologically planned site was discarded intraoperatively due to overpneumatised temporal bone.BAHA Attract system is safeand effective solution for single sided deafness with acceptable cosmesis. [ABSTRACT FROM AUTHOR]

Background Anastomotic leakage following colorectal surgery remains a significant complication despite advances in surgical techniques. Recent findings on serosal injury repair in coelomic cavities, such as the peritoneum, challenge the current understanding of the cellular origins and mechanisms underlying intestinal anastomotic healing. Understanding the contribution of each layer of the intestinal wall during anastomotic healing is needed to find new therapeutic strategies to prevent anastomotic leakage. The aim of this experimental study was to investigate the role of the serosal layer of the intestinal wall in anastomotic healing. Materials and methods Comprehensive histologic analysis of human and murine anastomoses was performed to elucidate histologic changes in the different intestinal layers during anastomotic healing. In vivo staining of the extracellular matrix (ECM) in the serosal layer was performed using a fluorophore-conjugated N -hydroxysuccinimide-ester before anastomosis surgery in a murine model. Results Histological examination of both human and murine anastomoses revealed that closure of the serosal layer occurred first during the healing process. In vivo serosal ECM staining demonstrated that a significant portion of the newly formed ECM within the anastomosis was indeed deposited onto the serosal layer. Furthermore, mesenchymal cells within the anastomotic scar were positive for mesothelial cell markers, podoplanin and Wilms tumour protein. Conclusions In this experimental study, the results suggest that serosal scar formation is an important mechanism for anastomotic integrity in intestinal anastomoses. Mesothelial cells may significantly contribute to scar formation during anastomotic healing through epithelial-to-mesenchymal transition, potentially suggesting a novel therapeutic target to prevent anastomotic leakage by enhancing physiological healing processes. [ABSTRACT FROM AUTHOR]

Background Anastomotic leak rates after colorectal surgery remain high. In most left-sided colon and rectal resection surgeries, a circular stapler is utilized to create the primary bowel anastomosis. However, it remains unclear whether a relationship between circular stapler technology and anastomotic leak in left-sided colorectal surgery exists. Methods A post-hoc analysis was conducted using a prospectively collected data set of patients from the 2017 European Society of Coloproctology snapshot audit who underwent elective left-sided resection (left hemicolectomy, sigmoid colectomy, or rectal resection) with a manual circular stapled anastomosis. Rates of anastomotic leak and unplanned intensive care unit stay in association with manual circular stapling were assessed. Patient-, disease-, geographical-, and surgeon-related factors as well as stapler brand were explored using multivariable regression models to identify predictors of adverse outcomes. Results Across 3305 procedures, 8.0% of patients had an anastomotic leak and 2.1% had an unplanned intensive care unit stay. Independent predictors of anastomotic leak were male sex, minimal-access surgery converted to open surgery, and anastomosis height C11 (lower third rectum) (all P < 0.050). Independent predictors of unplanned intensive care unit stay were minimal-access surgery converted to open surgery and American Society of Anesthesiologists grade IV (all P < 0.050). Stapler device brand was not a predictor of anastomotic leak or unplanned intensive care unit stay in multivariable regression analysis. There were no differences in rates of anastomotic leak and unplanned intensive care unit stay according to stapler head diameter, geographical region, or surgeon experience. Conclusion In patients undergoing left-sided bowel anastomosis, choice of manual circular stapler, in terms of manufacturer or head diameter, is not associated with rates of anastomotic leak and unplanned intensive care unit stay. [ABSTRACT FROM AUTHOR]

The prognosis in gastrointestinal system malignancies is directly correlated with the stage of the disease at the time of presentation. There are debates and variations in the preferred methods for staging (3,4). Despite being part of the recommendations of international associations in preoperative staging, the adequacy of CT is controversial. In our study, we aimed to investigate the effectiveness of CT in the decision of inoperability based on our case series of patients who were admitted to our clinic with a preliminary diagnosis of gastrointestinal system malignancy and deemed inoperable. At the General Surgery Clinic of - University Training and Research Hospital, demographic data of patients with intraoperatively detected inoperable gastrointestinal malignancies between 2018 and 2023, preoperative CT and endoscopy findings, surgical reports, and neoadjuvant treatment applications were retrospectively analyzed. Preoperative endoscopic and cross-sectional imaging findings were compared with intraoperative findings. The study included 91 patients. The sensitivity of preoperative endoscopy was found to be 80.2%, while the sensitivity of preoperative CT was 69.2%. When comparing organ-based intraoperative findings with the distant invasion signs findings detected in preoperative investigations, no significant difference was found. When the correlation of intraoperative inoperable and widely accepted findings with preoperative treatment was examined, no statistically significant relationship was found in the statistical analysis. In our study, the sensitivity and specificity of CT were found within ranges consistent with the literature. However, the adequacy of CT in invasive and metastatic disease was again found to be low, in line with the literature. Therefore, to prevent misinterpretation, we believe that adding advanced imaging modalities (MRI, PET, EUS) during the preoperative period in addition to CT may help reduce unnecessary laparotomies. [ABSTRACT FROM AUTHOR]

Surgical resection of the stenotic segment with end-to-end anastomosis is considered the gold standard in postintubation tracheal stenosis. However, outcomes of this concrete aetiology are not well described. With the aim to examine the extent, range and characteristics of the existing evidence, a scoping review was performed. Data sources included MEDLINE, Scopus, Ovid and the Cochrane databases. Inclusion criteria consisted of studies in adult patients with postintubation tracheal stenosis that reported characteristics, surgical management and outcomes. A total of 125 articles were identified, of which 10 were included in the final analysis. All studies were case reports or case series (level 4 evidence) grouping 110 patients, 75 males and 35 females. The age ranged from 15 to 71 years. Cotton–Myer stenosis grade was 1 [1 (0.9%)], 2 [25 (22.7%)], 3 [70 (63.6%)] and 4 [14 (12.7%)]. Stenosis location was in the tracheal upper-third in 108 (98.2%), in the middle-third in 1 (0.9%) and in the lower-third in 1 (0.9%). Stenosis length ranged from 1 to 5.6 cm. Follow-up ranged from 1 to 60 months (2 years for the most). Most frequent complications were transitory dysphagia in 13 (11.3%), granuloma formation in 8 (7.3%), dehiscence or air leak in 5 (4.5%) and wound infection in 4 (3.6%). Restenosis rate ranged from 2% to 25%. There was no perioperative mortality. Tracheal resection and primary anastomosis in postintubation tracheal stenosis appear to be safe and effective in the short and mid-terms; however, the very low level of evidence found prevents definitive conclusions. [ABSTRACT FROM AUTHOR]

Background: Virtual reality modeling (VRM) is a 3-dimensional simulation created from patient-specific 2-dimensional (2D) imaging. VRM creates a more accurate representation of the patient anatomy and can improve anatomical perception. We surveyed surgeons on their operative plan in complex pediatric oncology cases based on review of 2D imaging and subsequently after review of VRM. We hypothesized that the confidence level would increase with the use of virtual reality and that VRM may change the operative plan. Methods: Patients were selected and enrolled based on age (<18) and oncological diagnosis. VRM was created based on the 2D imaging. Surgeons identified surgical plans based on 2D imaging and again after VRM. A blinded surgeon not involved with the case also gave opinions on surgical plans after viewing both the 2D and the VRM imaging. These assessments were compared with the actual operation. Results: A total of 12 patients were enrolled. Diagnoses included six neuroblastomas, two Wilms tumors, one Ewing's sarcoma, one pseudopapillary tumor of the pancreas, one rhabdomyosarcoma, and one mediastinal germ cell tumor. VRM increased the operating surgeon's confidence 63% of the time. The operative plan changed 8.3% of the time after VRM. Conclusion: VRM is useful to help clarify operative plans for more complex pediatric cases. [ABSTRACT FROM AUTHOR]

Enucleation is a surgical technique to resect peripheral nerve schwannomas. The procedure has a low risk for postoperative deficit, but a small chance for recurrence, because tumor cells may remain inside the pseudocapsule that is left after resection. Magnetic resonance imaging (MRI) scans are frequently performed after surgery to investigate potential residual tumor, but currently there is little information in the literature on the value of follow-up with MRI. All patients who underwent enucleation of a peripheral nerve schwannoma between October 2013 and June 2022 were included. Postoperative MRI scans (gadolinium-enhanced) made at different time points after the surgery were re-examined for residual enhancement. Patients with residual enhancement were contacted to inform whether symptoms had recurred. A total of 75 schwannoma enucleations in 74 patients were included. The first postoperative MRI scan, performed 3 months after the surgery, showed no residual enhancement in 50 patients. In the remaining 24 patients, another MRI scan was made 1 year after the surgery, which still showed a possible remnant in 11 patients. On the third MRI scan, performed 2 years after enucleation, there were 7 suspected cases (9%). None of these patients had clinical symptoms at a mean postoperative follow-up of 5 years. Our data show that the value of postoperative MRI scans after enucleation of peripheral nerve schwannomas is limited, because residual enhancement in the beginning can be non-specific and the small percentage of patients, that persistently had a potential remnant, were all asymptomatic. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the mid‐term clinical outcomes for the non‐surgical and surgical management of acute proximal hamstring avulsions. Methods: Sixty physically active individuals were offered surgical or non‐surgical management for their proximal hamstring avulsion injuries. Distal retraction was defined as greater than 2 cm. Primary outcome measures were the Victorian Institute of sport assessment‐proximal hamstring tendons (VISA‐H) and functional assessment scale for acute hamstring injuries (FASH). Secondary outcome measures included palpable gap (cm), return to sport (RTS) and the ability to perform Nordic hamstring curls. Outcome variables were adjusted in regression models for gender, age, and treatment. Results: Thirty‐one patients elected to undertake non‐surgical management, and 29 chose surgery with a mean follow‐up of 34.8 ± 8.7 and 34.9 ± 7.0 months, respectively. The mean VISA‐H for the non‐surgical and surgical groups were 87.3 ± 3.4 and 87.9 ± 4.1 (n.s.), respectively. The mean FASH for the non‐surgical group was 89.3 ± 2.4 and 88 ± 3.6 for the surgical group (n.s.). This was consistent after adjusting for confounders. The mean gap for the non‐surgical group was 4.5 ± 1.09 and 4.9 ± 1.19 cm for the surgical group (n.s.). No significant differences were found in the abilities to perform Nordic hamstring curls (n.s.). Both groups achieved comparable RTS rates (n.s.). On average, the non‐surgical group achieved RTS at 5.5 ± 1.2 months post‐injury, whereas the surgical group was at 5.7 ± 0.7 months (n.s.). Conclusion: Physically active individuals with acute proximal hamstring avulsions and distal retraction of the tendon stump can be managed non‐surgically, achieving similar functional levels and RTS compared to patients treated surgically. Level of Evidence: Level III. [ABSTRACT FROM AUTHOR]

Mohs Micrographic Surgery (MMS) for treatment of melanoma offers several advantages over wide local excision (WLE), including complete histologic margin evaluation, same-day resection and closure, and sparing of healthy tissue in critical anatomic sites. Recently, a large volume of clinical data demonstrating efficacy in MMS treatment of melanoma was published, leading to emerging patient safety considerations of incurred treatment costs, risk of tumor upstaging, and failure of care coordination for sentinel lymph node biopsy (SLNB). MMS offers a safe, effective, and value-based treatment for both melanoma in situ (MIS) and invasive melanoma (IM), particularly with immunohistochemistry use on frozen sections. Compared to wide local excision, MMS treatment demonstrates similar or improved outcomes for local tumor recurrence, melanoma-specific survival, and overall survival at long-term follow-up. Tumor upstaging risk is low, and if present, alteration to clinical management is minimal. Discussion of SLNB for eligible head and neck IM cases should be done prior to MMS. Though challenging, successful multidisciplinary coordination of SLNB with MMS has been demonstrated. Herein, we provide a detailed clinical review of evidence for MMS treatment of cutaneous melanoma and offer recommendations to address current controversies surrounding the evolving paradigm of surgical management for both MIS and invasive melanoma (IM). [ABSTRACT FROM AUTHOR]

Copyright of Ege Journal of Medicine is the property of Ege University, Faculty of Medicine and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract Background Self-Directed Learning (SDL) is a subjective concept with no universally agreed definition. The aim of this project was to obtain the perspectives of Orthopaedic trainee registrars on SDL. Methods Seven Orthopaedic trainees in the Southwest Peninsula region were recruited in person by the primary author as an Orthopaedic trainee on the same programme as the participants. A one-hour Microsoft teams video interview was arranged at a mutually convenient time exploring several topics including learning resources, experiential learning, learning strategies, training programme requirements and assessment. The interviews were audio recorded and transcribed verbatim. Transcripts were coded using Corbin’s and Strauss’s published coding method and analysed to develop a model of SDL in this training context. Results Six learning stages were identified from the coded transcripts and these stages were like Knowles’s stages of SDL. Participants felt less autonomous during the identification of knowledge gaps, goal setting and evaluation of learning stages. Participants perceived to have more control over the selection of strategies, and learning stages of SDL. The factors which influenced autonomy at various stages of SDL included supervisors, experiential learning opportunities, service provision competing with learning opportunities, training programme requirements and the power dynamic between trainees and supervisors. Self-advocacy by the trainees for experiential learning opportunities and for their progression was an additional action relevant to SDL that was evident. Online learning resources such as Orthobullets.com, YouTube videos, external revision courses, collaboration and webinars encouraged more autonomy with SDL. Conclusions Although the United kingdom’s Trauma and Orthopaedic curriculum is described as trainee led and SDL is encouraged, in practice Orthopaedic trainees felt limited autonomy with the various stages of SDL due to external factors including their level of experience and the training environment. Trainees’ experiences around self-advocacy highlighted the importance of a collaborative and supportive learning culture emphasising dialogue, receiving high quality feedback, and openness for successful progression.

Abstract Background The prevalence of abnormal electrocardiography (ECG) increases with aging, and these abnormalities may have an impact on anesthesia management. Although a normal ECG does not guarantee a healthy heart, an abnormal ECG can quickly identify a patient who is at high risk of cardiac complications. Objective The aim of this study was to determine the prevalence and associated factors of preoperative abnormal electrocardiography among older surgical patients at selected teaching hospitals in southern Ethiopia, from February 15 to June 15, 2022. Methodology A multicenter cross-sectional study was conducted at three randomly selected teaching hospitals in southern Ethiopia on 246 elderly surgical patients recruited consecutively. Data were entered into Epidata version 4.6, then exported and analyzed in STATA version 16. A binary logistic regression model was used to examine factors associated with abnormal ECG, and variables with a P-value

Aims: The primary aim of this study is to quantify and compare outcomes following a dorsally displaced fracture of the distal radius in elderly patients (aged ≥ 65 years) who are managed conservatively versus with surgical fixation (open reduction and internal fixation). Secondary aims are to assess and compare upper limb-specific function, health-related quality of life, wrist pain, complications, grip strength, range of motion, radiological parameters, healthcare resource use, and cost-effectiveness between the groups. Methods: A prospectively registered (ISRCTN95922938) randomized parallel group trial will be conducted. Elderly patients meeting the inclusion criteria with a dorsally displaced distal radius facture will be randomized (1:1 ratio) to either conservative management (cast without further manipulation) or surgery. Patients will be assessed at six, 12, 26 weeks, and 52 weeks post intervention. The primary outcome measure and endpoint will be the Patient-Rated Wrist Evaluation (PRWE) at 52 weeks. In addition, the abbreviated version of the Disabilities of Arm, Shoulder and Hand questionnaire (QuickDASH), EuroQol five-dimension questionnaire, pain score (visual analogue scale 1 to 10), complications, grip strength (dynamometer), range of motion (goniometer), and radiological assessments will be undertaken. A cost-utility analysis will be performed to assess the cost-effectiveness of surgery. We aim to recruit 89 subjects per arm (total sample size 178). Discussion: The results of this study will help guide treatment of dorsally displaced distal radial fractures in the elderly and assess whether surgery offers functional benefit to patients. This is an important finding, as the number of elderly distal radial fractures is estimated to increase in the future due to the ageing population. Evidence-based management strategies are therefore required to ensure the best outcome for the patient and to optimize the use of increasingly scarce healthcare resources. Cite this article: Bone Jt Open 2024;5(10):920–928.

Abstract Preventive treatments for unruptured intracranial aneurysms (UIAs) are used worldwide. However, the long-term effects to cognition have been underestimated. Using representative sample data from the National Health Insurance Service-Senior Cohort database, we compared cumulative risk of incident dementia between two groups: (1) treatment versus observation group, and (2) within the treatment group (surgical versus endovascular treatment). Cox proportional hazard ratios were estimated after applying one-to-one propensity score matching. Subgroup analyses were conducted to investigate interactions between treatment effects and sex, age and history of stroke, respectively. After matching, 3,763 participants were included in each group. The 10-year incidence rates of dementia were 9.82 and 8.68 per 1,000 person-years in the treatment and observation groups, respectively (HR: 1.11, 95% CI: 0.90–1.38, P = 0.33). Furthermore, the risk of incident dementia was not different between the surgical and endovascular treatment groups (HR: 0.98, 95% CI: 0.70–1.37, P = 0.91). In the subgroup analysis, surgical treatment was associated with an increased risk of developing dementia, particularly among male patient (HR: 2.34, 95% CI: 1.04–5.28). Preventive treatment of UIAs appears acceptable in terms of long-term effects to cognition. However, further researches are strongly required to identify the high risk patients of development of dementia.

IntroductionRigid proctosigmoidoscopy (RP) and flexible sigmoidoscopy (FS) are two modalities commonly used for intraoperative evaluation of colorectal anastomoses. This study seeks to determine whether there is an association between the endoscopic modality used to evaluate colorectal anastomoses and the rate of anastomotic leak (AL), organ space infection, and overall infectious complication.MethodsThe 2012-2018 American College of Surgeons National Surgical Quality Improvement Program database was queried for patients undergoing colorectal anastomoses. Anastomotic evaluation method (RP versus FS) was identified by Current Procedural Terminologycoding and used for group classification. Outcomes measured included AL, organ space infections, and overall infection. Multivariable logistic regression analysis for predicting AL was performed.ResultsWe identified 7100 patients who underwent a colorectal anastomosis with intraoperative endoscopic evaluation. RP was utilized in 3397 (47.8%) and FS in 3703 (52.2%) patients. RP was used more commonly in diverticulitis (44.5% versus 36.2%, P

BACKGROUND: Traditionally, arteriovenous fistulas (AVF) involving the basilic vein (BV) have been created in 1 or 2 stages to allow time for the vein to enlarge before superficialization for potential better fistula maturation. Previous single institution studies and meta-analyses have found conflicting outcomes between single-stage and 2-stage procedures. Our study aims to use a large national database to assess the difference in outcomes between single-stage and 2-stage procedures for dialysis access. METHODS: We studied all patients undergoing BV AVF creation in the Vascular Quality Initiative (VQI) from 2011 to 2021. Patients were split into single-stage or a planned 2-stage procedure for dialysis access. Primary outcomes included dialysis use with index fistula, maturity rate, and number of days from surgery to fistula use. Secondary outcomes included patency (defined by physical exam or imaging on follow-up), 30-day mortality, and postoperative complications (bleeding, steal syndrome, thrombosis, or neuropathy). Logistic regression models were used to assess the association between staged dialysis access procedures and primary outcomes of interest. RESULTS: The cohort consisted of 22,910 individuals of which 7,077 (30.9%) had a 2-staged dialysis access procedure and 15,833 (69.1%) had a single-staged procedure. Average follow-up was 345 days in the single stage and 420 days for 2-stage. Baseline characteristics were significantly different between the 2 groups in terms of medical comorbidities. Primary outcomes were significant for more patients in the 2-stage group undergoing dialysis with the index fistula compared to single stage (31.5% vs. 22.2%, P

Abstract Background Excessive intraoperative bleeding remains a challenge in limb surgeries. The exsanguination tourniquet ring has emerged as a potential solution for effective exsanguination and hemostasis. This study aims to evaluate its efficacy and safety compared to the conventional exsanguination and hemostasis approach (pneumatic tourniquet combined with Esmarch bandage). Methods This randomized controlled trial evaluates the exsanguination tourniquet ring’s effectiveness and safety versus the conventional approach in 220 participants undergoing various limb surgeries. Allocation included experimental and control groups, assesses through efficacy (including intraoperative and total blood loss, hemoglobin levels, and exsanguination and hemostasis effectiveness) and safety (adverse event occurrence) indicators. Results The experimental group (n = 110) utilizes the exsanguination tourniquet ring, while the control group (n = 110) employs the conventional approach. As for intraoperative blood loss, the experimental group is non-inferior to the control group (p-value

Introduction: Pain is the most unpleasant subjective feeling comprising of innumerable emotional and psychological components that require medical advice for relief, regardless of the cause. Transversus Abdominis Plane (TAP) block and Erector Spinae Plane (ESP) block are effectively studied blocks that provide adequate pain control. Aim: To compare postoperative analgesic efficacy in pregnant women undergoing caesarean section under spinal anaesthesia with Ultrasound (USG)-guided TAP block and USG-guided ESP block. Materials and Methods: In this institution-based interventional randomised clinical study, two categories comprising 30 subjects in group I with USG-guided bilateral TAP block and group II with USG-guided bilateral ESP block using Ropivacaine were involved. Visual Analogue Scale (VAS) was used to compare analgesic efficacy. Other parameters for analysis included time of first rescue analgesia, total number of administrations of rescue analgesia within 24 hours, together with Adverse Drug Reactions (ADRs). Statistical analysis was done using Statistical Package for the Social Sciences (SPSS) version 21.0. Student’s t-test and Chi-square test were used for data analysis. Results: Subjects in group I had a mean age of 24.9±4.66 years while those in group II were 25.5±3.99 years. The VAS score at 24 hours in group I was 7.22±0.89 and in group II was 6.8±0.83, which was statistically significant with a p-value of 0.0241. USG-guided ESP block was superior to USG-guided TAP block, providing analgesia for 24 hours. Following the first dose, there was a significant delay in rescue analgesia and a reduction in the total administration of rescue analgesia within 24 hours. The first rescue analgesia in group I was at 10.66±2.32 hours and in group II was at 16.66±2.53 hours, with a p-value of 0.0001 indicating a statistically significant difference. No ADRs were reported in either group of participants. Conclusion: ESP block provided a prolonged duration of analgesia, as shown by a decrease in the total VAS score. There was also a significant reduction in the total number of administrations of rescue analgesia within 24 hours when compared to TAP block, suggesting that ESP block provides superior analgesia. Hence, for pain relief in postcaesarean section individuals, ESP block can be regarded as a novel potent option.

Background: The discipline of surgery has become an increasingly less attractive medical specialization for medical students in Saudi Arabia. There has been growing worry over the last decade regarding the reduction in the number of medical students who wish to pursue a career in surgery. This trend has been attributed to various factors that include lifestyle, income, and gender. For the new generation, lifestyle issues and family considerations have become increasingly significant. In addition, there are fewer female role models in surgery for the ever-increasing number of female medical students. Therefore, this study aimed to assess the popularity of surgery among the medical students at Jazan University in Saudi Arabia, as well as the factors that influence their decision. Materials and Methods: A cross-sectional observational study was conducted at Jazan University, Saudi Arabia, from November 2021 to March 2022. The study population comprised 407 medical students enrolled in Jazan University. Data were collected using a self-administered online survey, distributed via students’ E-mail addresses, and shared across various social media platforms to ensure maximum participation. The survey was designed to gather comprehensive information on students’ demographics, including age, gender, academic year, and parental background. In addition, Likert scale questions were included to assess students’ opinions on various factors influencing their preference for a surgical career, particularly about their father’s and mother’s profession. Data analysis was done using the Statistical Package for the Social Sciences (SPSS version 23) by IBM Inc. Descriptive statistics were calculated to summarize the demographic characteristics of the participants and the distribution of responses to Likert scale questions. Results: The study’s findings revealed that multiple factors play a significant role in shaping the popularity of surgery among medical students. Notably, personal traits emerged as influential factors affecting students’ decision pursuing a career in surgery. In addition, gender was found to have a pronounced impact, with differences observed in the inclination toward surgery between male and female students. Furthermore, the place of residence was identified as another contributing factor influencing students’ preferences for a surgical career. Conclusions: The popularity of the surgical career in Saudi Arabia depends on the factors that discourage or encourage the students to choose the career. Thus, enhanced student awareness is required to meet the required workforce in surgical specialties.

Abstract Introduction Abdominal trauma in children is a significant health concern that often leads to severe complications and even death. Children experience trauma more frequently than adults, with approximately one in four pediatric patients suffering from serious abdominal injuries. Falls are the leading cause of such trauma among children, which is intriguing considering that most hospital admissions for pediatric abdominal injuries result from blunt force impacts. Method A retrospective cross-sectional analysis of medical records was conducted to examine all patients under the age of 16 who underwent exploratory laparotomy for abdominal trauma between January 1, 2020, and January 1, 2023. The clinical data were gathered using a data extraction sheet from each patient’s medical charts. Information on socio-demographic characteristics, injury mechanisms, clinical conditions at the initial presentation, intraoperative findings and complications, and patient outcomes were collected. Results The study involved a total of 90 patients, consisting of 72 males (80%) and 18 females (20%). The average age of the patients was 10, with a standard deviation of 4.7, ranging from 2 to 16 years. Half of the patients were below the age of 10, accounting for 46 individuals (51%). The causes of the injuries varied among patients below and above the age of 10. However, overall, bullet injuries were the most common cause, accounting for 28 cases (31%), followed by falls in 21 cases (23.3%), horse or donkey kicks in 10 cases (11.1%), stab injuries in 10 cases (11.1%), horn injuries in 7 cases (7.8%), and road traffic accidents in 6 cases (6.7%). Physical assault, blasts, and other types of injuries, such as hen bites and metal rod injuries, were observed in 8 cases (8.9%) of the patients. Fall accidents, horse or donkey kicks, and horn injuries were particularly more common among children below the age of 10, while bullet injuries and stab injuries were most common among those above the age of 10. Conclusion Following abdominal trauma in children, a range of complications may arise, including immediate issues such as infections and hemorrhaging, as well as long-term consequences like impaired organ functionality and psychological distress. In our region, young children are particularly vulnerable to accidents involving falls, kicks from horses or donkeys, and injuries caused by horns. Therefore, it is crucial to educate parents about these hazards. Additionally, providing appropriate guidance on firearm safety is essential for individuals who possess such weapons.

Abstract Purpose To compare the clinical outcomes between nonsurgical and surgical treatment of distal radius fracture. Methods We performed a systematic literature search by using multiple databases, including Medline, PubMed, and Cochrane. All databases were searched from the earliest records through February 2023. The study compared nonsurgical versus surgical treatment of distal radius fractures and included only randomized controlled trials (RCTS). Results There were seventeen randomized controlled trials retrieved. A total of 1730 patients were included: 862 in the nonsurgical group and 868 in the surgical group. The results showed a significant reduction in DASH score with surgical treatment (WMD 3.98, 95% CI (2.00, 5.95), P

Abstract Background Ameloblastic fibrosarcoma (AFS) is a rare malignant odontogenic tumor, commonly occurring in young adults and typically affecting the mandibular region. We report an exceptionally rare and highly atypical case of AFS in an elderly female patient originating from the maxillary bone. Case presentation A 66-year-old woman was admitted with a two-week history of a lump in her left upper molar. CT scans suggested a cyst in the maxillary bone. An incisional biopsy revealed a spindle cell neoplasm. MRI showed abnormalities in the left maxilla, indicating a possible tumorous lesion. The patient underwent a subtotal maxillectomy, wide tumor excision, intraoral epithelial flap transplantation, and dental extraction. Histology identified atypical tumor cells with visible mitotic figures. Immunohistochemistry showed negative for PCK and CD34 expression, but positive for Vimentin and SMA expression. The Ki-67 proliferation index ranged from 30 to 50%. These findings suggested a potentially malignant soft tissue tumor in the left maxilla, leaning towards a diagnosis of AFS. The patient received postoperative radiotherapy. There was no recurrence during the six-month follow-up. Conclusion Based on repeated pathological evidence, we report a rare case of an elderly female with AFS originating from the maxillary bone. Surgery and postoperative radiotherapy resulted in a favorable outcome.

Introduction: Patients with head and neck cancer often necessitate complex reconstructions, considering both functional and esthetic concerns. Reconstructions are further complicated by previous radiation therapy and patient co-morbidities, which impair wound healing. A recently introduced synthetic hybrid-scale fiber matrix has been shown to provide durable wound coverage and promote tissue healing as an alternative to traditional biologic allogenic and xenogenic skin substitutes. Case Presentation: Thirteen patients were treated at a single academic hospital between December 1, 2021, and May 1, 2023 with the synthetic matrix in head and neck reconstructions. Reconstructions included exposed muscle, scalp wounds, intra-oral defects, and radial forearm free flap donor sites. Wound sizes ranged from 2 × 2 cm to 18 × 10 cm. Serial photographs were taken to evaluate wound healing at 1, 4, 8, 12, and 16 weeks timepoints after application. Outcomes measured at each timepoint included wound size, presence of granulation tissue, and extent of epithelialization. No hematomas or wound complications were encountered. Complete wound healing was noted between 6 and 12 weeks, dependent on wound size. The synthetic matrix significantly promoted wound healing via early granulation tissue formation and epithelialization, or mucosalization, in all head and neck applications. Scar formation and contracture were acceptable in all cases. Conclusion: The use of synthetic hybrid-scale fiber matrix promotes wound healing and avoids patient morbidity associated with traditional allogenic and biogenic treatments, such as split-thickness skin grafts. This synthetic matrix has been demonstrated to be a valuable asset in the head and neck reconstructive armamentarium.

Background: Excessive intraoperative bleeding remains a challenge in limb surgeries. The exsanguination tourniquet ring has emerged as a potential solution for effective exsanguination and hemostasis. This study aims to evaluate its efficacy and safety compared to the conventional exsanguination and hemostasis approach (pneumatic tourniquet combined with Esmarch bandage). Methods: This randomized controlled trial evaluates the exsanguination tourniquet ring's effectiveness and safety versus the conventional approach in 220 participants undergoing various limb surgeries. Allocation included experimental and control groups, assesses through efficacy (including intraoperative and total blood loss, hemoglobin levels, and exsanguination and hemostasis effectiveness) and safety (adverse event occurrence) indicators. Results: The experimental group (n = 110) utilizes the exsanguination tourniquet ring, while the control group (n = 110) employs the conventional approach. As for intraoperative blood loss, the experimental group is non-inferior to the control group (p-value < 0.001). While no significant difference is found in total blood loss (for the full analysis set, p-value = 0.442; for the per protocol set, p-value = 0.976) and differences in postoperative and preoperative hemoglobin levels (for the full analysis set, p-value = 0.502; for the per protocol set, p-value = 0.928). Regarding exsanguination and hemostasis effectiveness, the full analysis set reveals significantly superior ratings in the experimental group compared to the control group (p-value = 0.002 < 0.05), while the per protocol set analysis indicates no significant difference between the groups (p-value = 0.504). As for safety indicators, adverse events related to the device are minimal in two groups, with only one severe event unrelated to the device. Conclusions: The exsanguination tourniquet ring is an effective and safe device for intraoperative blood loss control in various limb surgeries. Trial registration: Comparison of Exsanguination and Hemostasis Devices for Limb Surgery A Prospective Multicenter Randomized Controlled Study, ChiCTR2300077998, 11/27/2023. [ABSTRACT FROM AUTHOR]

Background: Anxiety before surgery is one of the most challenging aspects of preoperative care. Preoperative anxiety has a number of postoperative complications. There are only a few studies that report on preoperative anxiety in surgical patients in Ethiopia, and their prevalence differs from one study to the next. Objective: The aim of this study was to assess the level of preoperative anxiety and associated factors among surgical patients admitted at public hospitals in southern Ethiopia. Methods: From July to August 2022, a facility-based cross-sectional study was conducted among patients admitted to surgical wards at public hospitals. Data collection was conducted using a pretested, structured questionnaire administered by an interviewer. Preoperative anxiety was assessed using the State-Trait Anxiety Inventory scale. The data were coded and entered in Epi Data Version 4.6, then exported to Statistical Package for Social Sciences version 25 for analysis. To describe the study variables, descriptive statistics were used. The associated factors were then identified using bivariate and multivariate logistic regression analyses. Results were declared at a p-value of less than 0.05 based on an adjusted odds ratio with a 95% confidence interval. Result: A total of 220 patients were enrolled, with a 99.5% response rate. The observed preoperative anxiety level was 57.5% (95%CI: 54.63–62.35). High preoperative anxiety was associated with no formal educational status (AOR: 3.75; 95%CI = 1.36, 10.39), fear of death (AOR =2.01; 95%CI = 1.09, 3.73), fear of waking up in middle of surgery (AOR =3.42; 95%CI =1.19, 9.77), fear of postoperative pain (AOR = 2.56; 95%CI = 1.15, 5.74). Conclusion: This study found that five out of ten patients scheduled for surgery in public hospitals had high levels of preoperative anxiety. Anxiety levels were associated with factors such as the educational status of respondents, fear of death, fear of waking up in the middle of surgery, and fear of postoperative pain. Preoperative anxiety assessments should be conducted regularly in each hospital, and appropriate anxiety-reducing methods must be implemented. [ABSTRACT FROM AUTHOR]

Introduction: Pain is the most unpleasant subjective feeling comprising of innumerable emotional and psychological components that require medical advice for relief, regardless of the cause. Transversus Abdominis Plane (TAP) block and Erector Spinae Plane (ESP) block are effectively studied blocks that provide adequate pain control. Aim: To compare postoperative analgesic efficacy in pregnant women undergoing caesarean section under spinal anaesthesia with Ultrasound (USG)-guided TAP block and USG-guided ESP block. Materials and Methods: In this institution-based interventional randomised clinical study, two categories comprising 30 subjects in group I with USG-guided bilateral TAP block and group II with USG-guided bilateral ESP block using Ropivacaine were involved. Visual Analogue Scale (VAS) was used to compare analgesic efficacy. Other parameters for analysis included time of first rescue analgesia, total number of administrations of rescue analgesia within 24 hours, together with Adverse Drug Reactions (ADRs). Statistical analysis was done using Statistical Package for the Social Sciences (SPSS) version 21.0. Student's t-test and Chi-square test were used for data analysis. Results: Subjects in group I had a mean age of 24.9±4.66 years while those in group II were 25.5±3.99 years. The VAS score at 24 hours in group I was 7.22±0.89 and in group II was 6.8±0.83, which was statistically significant with a p-value of 0.0241. USG-guided ESP block was superior to USG-guided TAP block, providing analgesia for 24 hours. Following the first dose, there was a significant delay in rescue analgesia and a reduction in the total administration of rescue analgesia within 24 hours. The first rescue analgesia in group I was at 10.66±2.32 hours and in group II was at 16.66±2.53 hours, with a p-value of 0.0001 indicating a statistically significant difference. No ADRs were reported in either group of participants. Conclusion: ESP block provided a prolonged duration of analgesia, as shown by a decrease in the total VAS score. There was also a significant reduction in the total number of administrations of rescue analgesia within 24 hours when compared to TAP block, suggesting that ESP block provides superior analgesia. Hence, for pain relief in postcaesarean section individuals, ESP block can be regarded as a novel potent option. [ABSTRACT FROM AUTHOR]

OBJECTIVES The objective of this study was to enhance the efficiency of aortic arch replacement through the development of a novel frozen elephant trunk (FET) prosthesis with an endovascular side branch for left subclavian artery (LSA) connection. After successful pre-clinical testing, the feasibility and safety of implementing this innovative prosthesis in human subjects were investigated. METHODS Between September 2020 and September 2021, 4 patients (mean age 67) with conditions such as penetrating ulcer, non A–non B aortic dissection and chronic arch aneurysm underwent surgery utilizing the customized device. Surgeries were performed under high moderate hypothermia (27°C), employing bilateral selective antegrade cerebral perfusion (SACP) and distal aortic perfusion. Anastomosis of the FET prosthesis with the aortic arch occurred in zone 1, followed by separate reimplantation of the left common carotid artery and the brachiocephalic artery. RESULTS All patients were discharged in good clinical condition. The mean aortic cross-clamp, antegrade selective cerebral perfusion and distal aortic perfusion times were 111, 71 and 31 min, respectively. Endovascular extension of the side branch for the LSA was required in all cases to prevent endoleak formation. One patient received a stent graft extension at the end of the operation, while 2 others underwent the procedure during their hospital stay. One patient was diagnosed with an endoleak at the first follow-up after 3 months, and endoleak sealing was achieved via the brachial artery with an extension stent graft. CONCLUSIONS Preliminary clinical outcomes suggest that the newly designed FET prosthesis shows promise in simplifying total arch replacement. These initial findings provide a foundation for planned clinical studies to further assess the effectiveness of this modified surgical hybrid graft, with particular attention to the length and diameter of the LSA sidearm. [ABSTRACT FROM AUTHOR]

Studies suggest that ambulation after major lower extremity amputation (LEA) is low and mortality after LEA is high. Successful prosthetic fitting after LEA has a significant quality of life benefit; however, it is unclear if there are benefits in post-LEA mortality. Our objective was to examine a contemporary cohort of patients who underwent LEA and determine if there is an association between fitting for a prosthetic and mortality. We reviewed all patients who underwent LEA between 2015 and 2022 at two academic health care systems in a large metropolitan city. The exposure of interest was prosthetic fitting after LEA. The primary outcomes were mortality within 1 and 3 years of follow-up. Ambulation after LEA was defined as being ambulatory with or without an assistive device. Patients with prior LEA were excluded. Extended Cox models with time-dependent exposure were used to evaluate the association between prosthetic fitting and mortality at 1 and 3 years of follow-up. Among 702 patients who underwent LEA, the mean (SD) age was 64.3 (12.6) years and 329 (46.6%) were fitted for prosthetic. The study population was mostly male (n = 488, 69.5%), predominantly non-Hispanic Black (n = 410, 58.4%), and nearly one-fifth were non-ambulatory before LEA (n = 139 [19.8%]). Of note, 14.3% of all subjects who were nonambulatory at some point after LEA, and 28.5% of patients not ambulatory preoperatively were eventually ambulatory after LEA. The rate of death among those fitted for a prosthetic was 12.0/100 person-years at 1 year and 5.8/100 person-years at 3 years of follow-up; among those not fitted for a prosthetic, the rate of death was 55.7/100 person-years and 50.7/100 person-years at 1 and 3 years of follow-up, respectively. After adjusting for several sociodemographic data points, comorbidities, pre- or post- coronavirus disease 2019 pandemic timeframe, and procedural factors, prosthetic fitting is associated with decreased likelihood of mortality within 1 year of follow-up (adjusted hazard ratio, 0.24; 95% confidence interval, 0.14-0.40) as well as within 3 years (adjusted hazard ratio, 0.40; 95% confidence interval, 0.29-0.55). Prosthetic fitting is associated with improved survival, and preoperative functional status does not always predict postoperative functional status. Characterizing patient, surgical, and rehabilitation factors associated with receipt of prosthetic after LEA may improve long-term survival in these patients. Process measures employed by the Department of Veterans Affairs, such as prosthetic department evaluation of all amputees, may represent a best practice. [ABSTRACT FROM AUTHOR]

Lymphedema and specifically cancer-related lymphedema is not the main focus for both patients and physicians dealing with cancer. Its etiology is an unfortunate complication of cancer treatment. Although lymphedema treatments have gained an appreciable consensus, many practitioners have developed and prefer their own specific protocols and this is especially true for conventional (manual) versus surgical treatments. This collection of presentations explores the incidence and genetics of cancer-related lymphedema, early detection and monitoring techniques, both conventional and operative treatment options, and the importance and role of exercise for patients with cancer-related lymphedema. These assembled presentations provide valuable insights into the challenges and opportunities presented by cancer-related lymphedema including the latest research, treatments, and exercises available to improve patient outcomes and quality of life. [ABSTRACT FROM AUTHOR]

Purpose: To compare the clinical outcomes between nonsurgical and surgical treatment of distal radius fracture. Methods: We performed a systematic literature search by using multiple databases, including Medline, PubMed, and Cochrane. All databases were searched from the earliest records through February 2023. The study compared nonsurgical versus surgical treatment of distal radius fractures and included only randomized controlled trials (RCTS). Results: There were seventeen randomized controlled trials retrieved. A total of 1730 patients were included: 862 in the nonsurgical group and 868 in the surgical group. The results showed a significant reduction in DASH score with surgical treatment (WMD 3.98, 95% CI (2.00, 5.95), P < 0.001). And in grip strength (%), the results showed a significant improvement in surgical treatment compared with non-surgical treatment (WMD − 6.60, 95% CI (-11.61, -1.60), P = 0.01). There was significant difference in radial inclination, radial length, volar title, range of wrist pronation, range of wrist supination. However, no difference in radial deviation, ulnar deviation, ulnar variance, range of wrist extension and range of wrist flexion was observed. Conclusions: The results of this meta-analysis suggest that some patients with surgical treatment of distal radius fractures not only improved the grip strength (%), decreased the DASH score, but also improved the range of wrist pronation and the range of wrist supination compared with nonsurgical treatment. Based on the present meta-analysis, we suggest that some patients with surgical treatment might be more effective in patients with distal radius fracture. [ABSTRACT FROM AUTHOR]

Introduction: Abdominal trauma in children is a significant health concern that often leads to severe complications and even death. Children experience trauma more frequently than adults, with approximately one in four pediatric patients suffering from serious abdominal injuries. Falls are the leading cause of such trauma among children, which is intriguing considering that most hospital admissions for pediatric abdominal injuries result from blunt force impacts. Method: A retrospective cross-sectional analysis of medical records was conducted to examine all patients under the age of 16 who underwent exploratory laparotomy for abdominal trauma between January 1, 2020, and January 1, 2023. The clinical data were gathered using a data extraction sheet from each patient's medical charts. Information on socio-demographic characteristics, injury mechanisms, clinical conditions at the initial presentation, intraoperative findings and complications, and patient outcomes were collected. Results: The study involved a total of 90 patients, consisting of 72 males (80%) and 18 females (20%). The average age of the patients was 10, with a standard deviation of 4.7, ranging from 2 to 16 years. Half of the patients were below the age of 10, accounting for 46 individuals (51%). The causes of the injuries varied among patients below and above the age of 10. However, overall, bullet injuries were the most common cause, accounting for 28 cases (31%), followed by falls in 21 cases (23.3%), horse or donkey kicks in 10 cases (11.1%), stab injuries in 10 cases (11.1%), horn injuries in 7 cases (7.8%), and road traffic accidents in 6 cases (6.7%). Physical assault, blasts, and other types of injuries, such as hen bites and metal rod injuries, were observed in 8 cases (8.9%) of the patients. Fall accidents, horse or donkey kicks, and horn injuries were particularly more common among children below the age of 10, while bullet injuries and stab injuries were most common among those above the age of 10. Conclusion: Following abdominal trauma in children, a range of complications may arise, including immediate issues such as infections and hemorrhaging, as well as long-term consequences like impaired organ functionality and psychological distress. In our region, young children are particularly vulnerable to accidents involving falls, kicks from horses or donkeys, and injuries caused by horns. Therefore, it is crucial to educate parents about these hazards. Additionally, providing appropriate guidance on firearm safety is essential for individuals who possess such weapons. [ABSTRACT FROM AUTHOR]

The continuous progression in scientific research and technological innovation, alongside the burgeoning field of artificial intelligence, has catalyzed the assimilation of intelligent human-machine integration systems into the surgical domain. Despite the significant enhancement in surgical precision and patient convenience afforded by the adoption of surgical robots, the practical application of this technology is not without its risks. This paper reviews the literature on HRA within surgical contexts, scrutinizing the typology of human errors, their underlying factors, utilization of HRA techniques, and the assessment of surgeons' skills, to champion the need for HRA methodologies that are specific to the healthcare sector. Our analysis of 37 articles suggests that HRA implementation in healthcare is still in its infancy. The predominant method, Observational Human Factors Reliability Analysis (OCHRA), has been in use since 1999, yet it is limited in its capacity to evaluate internal error patterns and falls short in methodological advancement compared to techniques utilized in industries like nuclear energy and aviation. Therefore, the healthcare community must earnestly reevaluate the suitability and sophistication of existing methods, ensuring they capture the intricate interplay of cognitive processes inherent in medical practice. This critical step is essential in the development of tailored methodologies that are contextually grounded and cognitively oriented. Furthermore, investigating the modulating factors of human error behavior in intelligent human-robot integration systems is set to become a focal point for future research into personnel reliability within this evolving domain. [ABSTRACT FROM AUTHOR]

Understanding the causes of amputation is crucial for defining health policies that seek to avoid such an outcome, but only a few studies have investigated the epidemiology of patients submitted to amputations in developing countries. The objective of this study was to analyse all lower limb amputations performed in the public health system in Brazil over a 13 year period, evaluating trends in the number of cases, patient demographics, associated aetiologies, hospital length of stay, and in hospital mortality rate. This was a retrospective, population based analysis of all lower limb amputations performed in the Brazilian public health system between 1 January 2008 and 31 December 2020. Using a public database, all types of amputations were selected, defining the number of procedures, their main aetiologies, anatomical level of limb loss, demographic data, regional distribution, and other variables of interest. A total of 633 455 amputations were performed between 2008 and 2020, mostly (55.6%) minor amputations, predominantly in males (67%). There was an upward trend in the number of amputations, determined mainly by the increase in major amputations (50.4% increase in the period). Elderly individuals have the highest rates of amputation. Diabetes mellitus (DM) is becoming the main primary diagnosis associated with amputations over the years. The highest in hospital mortality rate occurred after major amputations and was associated with peripheral arterial disease (PAD). Amputation rates in Brazil show an upward trend. DM is becoming the most frequent associated primary diagnosis, although PAD is the diagnosis most associated with major amputations and in hospital death. [ABSTRACT FROM AUTHOR]

Dental implants are a reliable treatment option for restoring missing teeth, but adequate bone quantity and quality are crucial for success. This case series presents four cases treated by different clinicians, all following very similar concepts for combined periodontal and vertical ridge augmentation using recombinant human platelet-derived growth factor-BB. All cases involved a severe periodontal defect requiring either extraction of the adjacent tooth or periodontal regeneration. Different bone grafts and membrane types were utilised. Although true periodontal regeneration cannot be said categorically to have occurred due to a lack of histological evidence, the clinical and radiographic findings suggest almost complete bone fill in all cases. This case series demonstrates that combined periodontal and vertical ridge augmentation using recombinant human platelet-derived growth factor-BB could be successful, but proper case selection and patient preparation for the possibility of multiple surgical procedures are recommended. [ABSTRACT FROM AUTHOR]