Search results for: parathyroid surgery

Authors: Thampi Rawther, Jack Cecire, Andrew Sutherland

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Introduction: CT facilitates the diagnosis of potentially life-threatening injuries and facilitates early management. There is evidence that reduced CT acquisition time reduces mortality and length of hospital stay. Currently, there are variable recommendations for ideal timing. Indeed, the NHS standard contract for a major trauma service and STAG both recommend immediate access to CT within a maximum time of 60min and appropriate reporting within 60min of the scan. At Coffs Harbour Health Campus (CHHC), a CT radiographer is on site between 8am-11pm. Aim: To investigate the average time to CT at CHHC and assess for any significant relationship between time to CT and injury severity score (ISS) or time of triage. Method: All major trauma calls between Jan 2021-Oct 2021 were audited (N=87). Patients were excluded if they went from ED to the theatre. Time to CT is defined as the time between triage to the timestamp on the first CT image. Median and interquartile range was used as a measure of central tendency as the data was not normally distributed, and Chi-square test was used to determine association. Results: The median time to CT is 51.5min (IQR 40-74). We found no relationship between time to CT and ISS (P=0.18) and time of triage to time to CT (P=0.35). We compared this to other centres such as John Hunter Hospital and Gold Coast Hospital. We found that the median CT acquisition times were 76min (IQR 52-115) and 43min, respectively. Conclusion: This shows an avenue for improvement given 35% of CT’s were >30min. Furthermore, being proactive and aware of time to CT as an important factor to trauma management can be another avenue for improvement. Based on this, we will re-audit in 12-24months to assess if any improvement has been made.

Keywords: imaging, rural surgery, trauma surgery, improvement

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Authors: Hakan Duger, Alparslan Ersoy, Canan Ersoy

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The improvement of surgical techniques in recent years has reduced the frequency of postoperative complications in kidney transplant recipients. Novel immunosuppressive agents have reduced rates of graft loss due to acute rejection to less than 1%. However, surgical complications may still lead graft loss and morbidity in recipients. Because of potent immunosuppression, impaired wound healing and complications are frequent after transplantation. We compared the frequency of post-operative surgical complications in diabetic and non-diabetic patients after kidney transplantation. Materials and Methods: This retrospective study conducted in consecutive patients (213 females, 285 males, median age 39 years) who underwent kidney transplant surgery at our center between December 2005 and October 2015. The patients were divided into two groups: diabetics (46 ± 10 year, 26 males, 16 females) and non-diabetics (39 ± 12 year, 259 males, 197 females). Characteristics of both groups were obtained from medical records. Results: We performed 225 living and 273 deceased donor transplantations. Renal replacement type was hemodialysis in 60.8%, peritoneal dialysis in 17.3% and preemptive in 12%. The mean body mass indexes of the recipients were 24 ± 4.6 kg/m², donor age was 48.6 ± 14.3 years, cold ischemic time was 11.3 ± 6.1 hours, surgery time was 4.9 ± 1.2 hours, and recovery time was 54±31 min. The mean hospitalization duration was 19.1 ± 13.5 days. The frequency of postoperative surgical complications was 43.8%. There was no significant difference between the ratios of post-operative surgical complications in non-diabetic (43.5%) and diabetic (47.4%) groups (p=0.648). Post-operative surgical complications were lymphocele (24.6% vs. 23.7%), delayed wound healing (13.2% vs. 7.6%), hematoma (7.8% vs.15.8 %), urinary leak (4.6% vs. 5.3%), hemorrhage (5.1% vs. 0%), hydronephrosis (2.2% vs. 0%), renal artery thrombosis (1.5% vs. 0%), renal vein thrombosis (1% vs. 2.6%), urinoma (0.7% vs. 0%), urinary obstruction (0.5% vs. 0%), ureteral stenosis (0.5% vs. 0%) and ureteral reflux (0.2% vs. 0%) in non-diabetic and diabetic groups, respectively (p > 0.05). Mean serum creatinine levels in non-diabetics and diabetics were 1.43 ± 0.81 and 1.61 ± 0.96 mg/dL at 1st month (p=0.198). At the 6th month, the mean graft and patient survival times in patients with post-operative surgical complications were significantly lower than in those who did not (162.9 ± 3.4 vs. 175.6 ± 1.5 days, p=0.008, and 171 ± 2.9 vs. 176.1 ± 1.6 days, p=0.047, respectively). However, patient survival durations of non-diabetic (173 ± 27) and diabetic (177 ± 13 day) groups were comparable (p=0.396). Conclusion: As a result, we concluded that surgical complications such as lymphocele and delayed wound healing were common and that frequency of these complications in diabetic recipients did not differ from non-diabetic one. All persons involved in the postoperative care of kidney transplant recipients be aware of the potential surgical complications for rapid diagnosis and treatment.

Keywords: kidney transplantation, diabetes mellitus, surgery, complication

Procedia PDF Downloads 160

Authors: Karuna Sutthibenjakul, Sunisa Chatmongkolchart

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Background: Postinduction hypotension is common and occurs more often in elderly patients. We aimed to determine risk factors for hypotension after induction among elderly patients (aged 65 years and older) who underwent elective non-cardiac surgery under general anesthesia. Methods: This cohort study analyzed from 580 data between December 2017 and July 2018 at a tertiary university hospital in south of Thailand. Hypotension is defined as more than 30% decrease mean arterial pressure from baseline after induction within 20 minutes or the use of vasopressive agent to treat low blood pressure. Intraoperative parameters were blood pressure and heart rate at T0, TEI, T5, T10, T15 and T20 (immediately after arrival at operating room, time after intubation, 5, 10, 15 and 20 minutes after intubation) respectively. Results: The median age was 72.5 (68, 78) years. A prevalence of post-induction hypotension was 64.8%. The highest prevalence (39.7%) was at 15 minutes after intubation. The association of post-induction hypotension is rising with diuretic drug as preoperative medication (P-value=0.016), hematocrit level (P-value=0.031) and the degree of hypertension immediately after arrival at operating room (P-value<0.001). Increasing fentanyl dosage during induction was associated with hypotension at intubation time (P-value<0.01) and 5 minutes after intubation (P-value<0.001). There was no statistically significant difference in the increasing propofol dosage. Conclusion: The degree of hypertension immediately after arrival at operating room and increasing fentanyl dosage were a significant risk factors for postinduction hypotension in elderly patients.

Keywords: risk factors, post-induction, hypotension, elderly

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Authors: Kwei Huan Liw, Sashi B. Darshan

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Background: Double eyelid surgery has become one of the most sought-after aesthetic procedures among Asians. Many surgeons perform surgical blepharoplasty and various other methods of non-incisional blepharoplasty. Face-Q is a validated method of measuring patient satisfaction for facial aesthetic procedures. Here we have analyzed the overall eye satisfaction score, the upper eyelid appraisal score and the adverse effect on eyes score Methods: 274 patients (548 eyes), aged between 18 to 40 years old, were recruited from 2015-2018. Each patient underwent a non-incisional double-eyelid blepharoplasty using a single-knotted continuous buried suture. 3 – 5 stab incisions were made depending on the upper eyelid size. A needle loaded with 7-0 nylon is passed from the lateral most wound through the dermis and the conjunctiva in an alternate fashion into the remaining stab wounds. The suture is then tunneled back laterally in the deeper dermis and knotted securely with the suture end. The knot is then buried within the orbicularis oculi muscle. Each patient was required to fill the Face-Q questionnaire before the procedure and 2 weeks post procedure. The results are described based on the percentage of the maximum achievable score. Patients were reviewed after 12 to 18 months to assess the long-term outcome. Results: The overall eye satisfaction score demonstrated a high level of post-operative satisfaction (97.85%), compared to 27.32% pre-operatively. The appraisal of upper eyelid scores showed drastic improvement in perception post-operatively (95.31%) compared to 21.44% pre-operatively. Adverse effect on eyes score showed a very low post-operative complication rate (0.4%) The long-term follow-up showed 6 cases that had developed asymmetrical folds. Only 1 patient agreed for revision surgery. The other 5 patients were still satisfied with the outcome and were not keen for revision surgery. None of the cases had loosening of knots. Conclusion: Modified single-knot continuous buried suture technique is a simple and non-invasive method to create aesthetically pleasing non-surgical double-eyelids, which has long-term effects. Proper patient selection is crucial and good surgical technique is required to achieve a desirable outcome.

Keywords: blepharoplasty, double-eyelid, face-Q, non-incisional

Procedia PDF Downloads 100

Authors: Junhong Li, Danni Cheng, Yaxin Luo, Xiaowei Yi, Ke Qiu, Wendu Pang, Minzi Mao, Yufang Rao, Yao Song, Jianjun Ren, Yu Zhao

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Background: The number of multiple cancer patients was increasing, and the impact of prior cancer history on salivary gland cancer patients remains unclear. Methods: Clinical, demographic and pathological information on salivary gland cancer patients were retrospectively collected from the Surveillance, Epidemiology, and End Results (SEER) database from 2004 to 2017, and the characteristics and prognosis between patients with a prior cancer and those without prior caner were compared. Univariate and multivariate cox proportional regression models were used for the analysis of prognosis. A risk score model was established to exam the impact of treatment on patients with a prior cancer in different risk groups. Results: A total of 9098 salivary gland cancer patients were identified, and 1635 of them had a prior cancer history. Salivary gland cancer patients with prior cancer had worse survival compared with those without a prior cancer (p<0.001). Patients with a different type of first cancer had a distinct prognosis (p<0.001), and longer latent time was associated with better survival (p=0.006) in the univariate model, although both became nonsignificant in the multivariate model. Salivary gland cancer patients with a prior cancer were divided into low-risk (n= 321), intermediate-risk (n=223), and high-risk (n=62) groups and the results showed that patients at high risk could benefit from surgery, radiation therapy, and chemotherapy, and those at intermediate risk could benefit from surgery. Conclusion: Prior cancer history had an adverse impact on the survival of salivary gland cancer patients, and individualized treatment should be seriously considered for them.

Keywords: prior cancer history, prognosis, salivary gland cancer, SEER

Procedia PDF Downloads 122

Authors: Emma Carr, Bilal Aslam-Pervez, David Laraway

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Litigation against surgeons and hospitals continues to increase in Western countries. While verbal consent is all that is required legally, it has for a long time been considered that written consent offers proof of discussion and interaction between the surgeon and the patient. Inadequate consenting of patients continues in the United Kingdom leaving surgeons and Health Trusts open to litigation. We present a standardised consent form which improves patient autonomy and engagement. The General Medical Council recommends that all material risks relevant to the patient are discussed and recorded prior to undergoing surgery, regardless of how likely they are to occur. Current literature was reviewed to evaluate complications associated with surgical management of mandible fractures. Analysis of risks on 52 consent forms were analysed within the Glasgow OMFS department, leading to a procedure-specific form being designed and implemented. This audit showed that the documentation of risks on consent forms was extremely variable- with uncommon risks not being recorded. Interestingly, not a single consent form was found which highlighted all the risks associated with mandible fractures. Our re-audit data confirms 100% of risks being discussed when a procedure specific form is utilised. Our hope, is to introduce further forms for inclusion on the BAOMS website and peripheral distribution. The forms are quick and easy to print and leave more time for consultation with the patient. Whilst we are under no illusion that the forms may not decrease the incidence of intended litigation, we feel confident that they will decrease the chances of it being successful.

Keywords: consent, litigation, mandible fracture, surgery

Procedia PDF Downloads 165

Authors: Nasrin Galehdar, Sedigheh Nadri, Elham Nazari, Isan Darvishi, Abouzar Mohammadi

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Background and aim:Nausea and vomiting are complications of cesarean section. The pharmacological and non-pharmacological approaches were applied to decrease postoperative nausea and vomiting. The aim of the present study was to compare the effects of Ondansetron and acupressure on postoperative nausea and vomiting in patients undergone an elective cesarean section. Materials and method: The study was designed as a randomized clinical trial. A total of 120 patients were allocated to two equal groups. Four mgs of Ondansetron was administered for the Ondansetron group after clamping the umbilical cord. The acupressure bracelets were fastened in the PC6 point for acupressure group for 15 minutes. The patients were monitored in terms of incidence, severity, and episodes of nausea and vomiting. The data obtained were analyzed by SPSS software version 18 with a significance level of 0.05. Results: There was no significant statistical difference in nausea severity among the groups intra-operatively, in the recovery and surgery wards. The incidence and episodes of vomiting were significantly higher in patients undergone acupressure intra-operatively, in the recovery and surgery wards (P< 0.05). No significant effect of acupressure was reported in reducing postoperative nausea and vomiting. Conclusion: No significant effect of acupressure was reported in reducing postoperative nausea and vomiting. Thus, it is suggested to perform the studies with larger size and comparing the effects of acupressure with other antiemetic medications.

Keywords: ondansetron, acupressure, nausea, vomiting

Procedia PDF Downloads 86

Authors: Sujeet Poudyal

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Introduction: Renal cell carcinoma is the most common malignancy associated with Inferior vena cava (IVC) thrombosis. Radical nephrectomy with tumor thrombectomy provides durable cancer-free survival. Other renal malignancies like Wilms’ tumors are also associated with IVC thrombus. We describe our experience with the management of renal malignancies associated with IVC thrombus. Methods: This prospective study included 28 patients undergoing surgery for renal malignancies associated with IVC thrombus from February 2017 to March 2023. Demographics of patients, types of renal malignancy, level of IVC thrombus, intraoperative details, need for venovenous bypass, cardiopulmonary bypass and postoperative outcomes were all documented. Results: Out of a total of 28 patients, 24 patients had clear cell Renal Cell Carcinoma,1 had renal osteosarcoma and 3 patients had Wilms tumor. The levels. of thrombus were II in eight, III in seven, and IV in six patients. The mean age of RCC was 62.81±10.2 years, renal osteosarcoma was 26 years and Wilms tumor was 23 years. There was a need for venovenous bypass in four patients and cardiopulmonary bypass in four patients, and the Postoperative period was uneventful in most cases except for two mortalities, one in Level III due to pneumonia and one in Level IV due to sepsis. All cases followed up till now have no local recurrence and metastasis except one case of RCC with Level IV IVC thrombus, which presented with paraaortic nodal recurrence and is currently managed with sunitinib. Conclusion: The complexity in the management of renal malignancy with IVC thrombus increases with the level of IVC thrombus. As radical nephrectomy with tumor thrombectomy provides durable cancer-free survival in most cases, the surgery should be undertaken in an expert and experienced setup with a strong cardiovascular backup to minimize morbidity and mortality associated with the procedure.

Keywords: renal malignancy, IVC thrombus, radical nephrectomy with tumor thrombectomy, renal cell carcinoma

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Authors: Ahmed Gonnah, Omar Masoud, Mohamed Abdel-Wahab, Ahmed ElMosalamy, Abdulrahman Al-Naseem

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Introduction: Fibroadenomas are solid, mobile, and non-tender benign breast lumps, with the highest prevalence amongst young women aged between 15 and 35. Symptoms can include discomfort, and they can become problematic, particularly when they enlarge, resulting in many referrals for biopsies, with fibroadenomas accounting for 30-75% of the cases. Diagnosis is based on triple assessment that involves a clinical examination, ultrasound imaging and mammography, as well as core needle biopsies. Current management includes observation for 6-12 months, with the indication of definitive surgery, in cases that are older than 35 years or with fibroadenoma persistence. Serious adverse effects of surgery might include nipple-areolar distortion, scarring and damage to the breast tissue, as well as the risks associated with surgery and anesthesia, making it a non-feasible option. Methods: A literature search was performed on the databases EMBASE. MEDLINE/PubMed, Google scholar and Ovid, for English language papers published between 1st of January 2000 and 17th of March 2021. A structured protocol was employed to devise a comprehensive search strategy with keywords and Boolean operators defined by the research question. The keywords used for the search were ‘HIFU’, ‘High-Intensity Focused Ultrasound’, ‘Fibroadenoma’, ‘Breast’, ‘Lesion’. This review was carried out in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Results: Recently, a thermal ablative technique, High Intensity Focused Ultrasound (HIFU), was found to be a safe, non-invasive, and technically successful alternative, having displayed promising outcomes in reducing the volume of fibroadenomas, pain experienced by patients, and the length of hospitalization. Quality of life improvement was also evidenced, exhibited by the disappearance of symptoms, and enhanced physical activity post-intervention, in addition to patients’ satisfaction with the cosmetic results and future recommendation of the procedure to other patients. Conclusion: Overall, HIFU is a well-tolerated treatment associated with a low risk of complications that can potentially include erythema, skin discoloration and bruising, with the majority of this self-resolving shortly after the procedure.

Keywords: ultrasound, HIFU, breast, efficacy, side effects, fibroadenoma

Procedia PDF Downloads 185

Authors: Abdullah Saeidi, Aydin Gülses, Christan Flörke

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Skin cancer of the face region is the most common type of malignancy and surgical excision is the preferred approach. However, the clinical long term results reported in the literature are still controversial. Objectives: To describe; 1. Demographical characteristics 2. Affected site, distribution and TNM classification regarding tumor type 3. Surgical aspects • Surgical removal: excision principles, safety margins, the need for secondary resection, primary reconstruction/ defect closure, anesthesia protocol, duration of hospital stay (if any) • Secondary intervention for defect closure/reconstruction: Flap technique, anesthesia protocol, duration of hospital stay (if any), postoperative wound management etc. 4. Tumor recurrences 5. Clinical outcomes 6. Studying the possible therapy approach throw Biostatistical relation and correlation between multiple Histological, diagnostics and clinical Faktors. following surgical ablation of the skin cancer of the head and neck region. Methods: Selection and statistical analysis of medical records of patients who had admitted to the Department of Oral and Maxillofacial Surgery, Universitätsklinikum Schleswig Holstein, Campus Kiel during the period of 2015-2019 will be retrospectively evaluated. Data will be collected via ORBIS Information-Management-System (ORBIS AG, Saarbrücken, Germany).

Keywords: non melanoma skin cancer, face skin cancer, skin reconstruction, non melanoma skin cancer recurrence, non melanoma skin cancer metastases

Procedia PDF Downloads 90

Authors: Obinna K. Ihesiulor, Krishna Shankar, Paul Smith, Alan Fien

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Excessive fretting wear at the taper-trunnion junction (trunnionosis) apparently contributes to the high failure rates of hip implants. Implant wear and corrosion lead to the release of metal particulate debris and subsequent release of metal ions at the taper-trunnion surface. This results in a type of metal poisoning referred to as metallosis. The consequences of metal poisoning include; osteolysis (bone loss), osteoarthritis (pain), aseptic loosening of the prosthesis and revision surgery. Follow up after revision surgery, metal debris particles are commonly found in numerous locations. Background: A stable connection between the femoral ball head (taper) and stem (trunnion) is necessary to prevent relative motions and corrosion at the taper junction. Hence, the importance of component assembly cannot be over-emphasized. Therefore, the aim of this study is to determine the influence of head-stem junction assembly by press fitting and the subsequent disengagement/disassembly on the connection strength between the taper ball head and stem. Methods: CoCr femoral heads were assembled with High stainless hydrogen steel stem (trunnion) by Push-in i.e. press fit; and disengaged by Pull-out test. The strength and stability of the two connections were evaluated by measuring the head pull-out forces according to ISO 7206-10 standards. Findings: The head-stem junction strength linearly increases with assembly forces.

Keywords: wear, modular hip prosthesis, taper head-stem, force assembly and disassembly

Procedia PDF Downloads 379

Authors: Shiamaa Eltantawy, Gihan Sobhy, Alif Alaam

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Wilson disease, or hepatolenticular degeneration, is an autosomal recessive disease that results in excess copper buildup in the body. It primarily affects the liver and basal ganglia of the brain, but it can affect other organ systems. Musculoskeletal abnormalities, including premature osteoarthritis, skeletal deformity, and pathological bone fractures, can occasionally be found in WD patients with a hepatic or neurologic type. The aim was to assess the prevalence of osteoporosis and osteopenia in Wilson’s disease patients. This case-control study was conducted on ninety children recruited from the inpatient ward and outpatient clinic of the Paediatric Hepatology, Gastroenterology, and Nutrition department of the National Liver Institute at Menofia University, aged from 1 to 18 years. Males were 49, and females were 41. Children were divided into three groups: (Group I) consisted of thirty patients with WD; (Group II) consisted of thirty patients with chronic liver disease other than WD; (Group III) consisted of thirty age- and sex-matched healthy The exclusion criteria were patients with hyperparathyroidism, hyperthyroidism, renal failure, Cushing's syndrome, and patients on certain drugs such as chemotherapy, anticonvulsants, or steroids. All patients were subjected to the following: 1- Full history-taking and clinical examination. 2-Laboratory investigations: (FBC,ALT,AST,serum albumin, total protein, total serum bilirubin,direct bilirubin,alkaline phosphatase, prothrombin time, serum critine,parathyroid hormone, serum calcium, serum phosphrus). 3-Bone mineral density (BMD, gm/cm2) values were measured by dual-energy X-ray absorptiometry (DEXA). The results revealed that there was a highly statistically significant difference between the three groups regarding the DEXA scan, and there was no statistically significant difference between groups I and II, but the WD group had the lowest bone mineral density. The WD group had a large number of cases of osteopenia and osteoporosis, but there was no statistically significant difference with the group II mean, while a high statistically significant difference was found when compared to group III. In the WD group, there were 20 patients with osteopenia, 4 patients with osteoporosis, and 6 patients who were normal. The percentages were 66.7%, 13.3%, and 20%, respectively. Therefore, the largest number of cases in the WD group had osteopenia. There was no statistically significant difference found between WD patients on different treatment regimens regarding DEXA scan results (Z-Score). There was no statistically significant difference found between patients in the WD group (normal, osteopenic, or osteoporotic) regarding phosphorus (mg/dL), but there was a highly statistically significant difference found between them regarding ionised Ca (mmol/L). Therefore, there was a decrease in bone mineral density when the Ca level was decreased. In summary, Wilson disease is associated with bone demineralization. The largest number of cases in the WD group in our study had osteopenia (66.7%). Different treatment regimens (zinc monotherapy, Artamin, and zinc) as well as different laboratory parameters have no effect on bone mineralization in WD cases. Decreased ionised Ca is associated with low BMD in WD patients. Children with WD should be investigated for BMD.

Keywords: wilson disease, Bone mineral density, liver disease, osteoporosis

Procedia PDF Downloads 34

Authors: Naomi Sakamoto, Eisuke Fukuma, Mika Nashimoto, Yoshitomo Koshida

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Background: Selective localization of the metastatic lymph node with clip and removal of clipped nodes with sentinel lymph node (SLN), known as targeted axillary dissection (TAD), reduced false-negative rates (FNR) of SLN biopsy (SLNB) after neoadjuvant chemotherapy (NAC). For the patients who achieved nodal pathologic complete response (pCR), accurate staging of axilla by TAD lead to omit axillary lymph node dissection (ALND), decreasing postoperative arm morbidity without a negative effect on overall survival. This study aimed to investigate the ultrasound (US) identification rate and success removal rate of two kinds of ultrasound-visible clips placed in metastatic lymph nodes during TAD procedure. Methods: This prospective study was conducted using patients with clinically T1-3, N1, 2, M0 breast cancer undergoing NAC followed by surgery. A US-visible clip was placed in the suspicious lymph node under US guidance before neoadjuvant chemotherapy. Before surgery, US examination was performed to evaluate the detection rate of clipped node. During the surgery, the clipped node was removed using several localization techniques, including hook-wire localization, dye-injection, or fluorescence technique, followed by a dual-technique SLNB and resection of palpable nodes if present. For the fluorescence technique, after injection of 0.1-0.2 mL of indocyanine green dye (ICG) into the clipped node, ICG fluorescent imaging was performed using the Photodynamic Eye infrared camera (Hamamatsu Photonics k. k., Shizuoka, Japan). For the dye injection method, 0.1-0.2 mL of pyoktanin blue dye was injected into the clipped node. Results: A total of 29 patients were enrolled. Hydromark™ breast biopsy site markers (Hydromark, T3 shape; Devicor Medical Japan, Tokyo, Japan) was used in 15patients, whereas a UltraCor™ Twirl™ breast marker (Twirl; C.R. Bard, Inc, NJ, USA) was placed in 14 patients. US identified the clipped node marked with the UltraCore Twirl in 100% (14/14) and with the Hydromark in 93.3% (14/15, p = ns). Success removal of clipped node marked with the UltraCore Twirl was achieved in 100% (14/14), whereas the node marked with the Hydromark was removed in 80% (12/15) (p = ns). Conclusions: The ultrasound identification rate differed between the two types of ultrasound-visible clips, which also affected the success removal rate of clipped nodes. Labelling the positive node with a US-highly-visible clip allowed successful TAD.

Keywords: breast cancer, neoadjuvant chemotherapy, targeted axillary dissection, breast tissue marker, clip

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Authors: Teagan Fink, Lynn Chong, Michael Hii, Brett Knowles

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Background: Telemedicine is a rapidly advancing field providing healthcare to patients at a distance from their treating clinician. There is a paucity of high-quality evidence detailing the safety and acceptability of telemedicine for postoperative outpatient follow-up. This randomized controlled trial – conducted prior to the COVID 19 pandemic – aimed to assess patient satisfaction and safety (as determined by readmission, reoperation and complication rates) of telephone compared to face-to-face clinic follow-up after uncomplicated general surgical procedures. Methods: Patients following uncomplicated laparoscopic appendicectomy or cholecystectomy and laparoscopic or open umbilical or inguinal hernia repairs were randomized to a telephone or face-to-face outpatient clinic follow-up. Data points including patient demographics, perioperative details and postoperative outcomes (eg. wound healing complications, pain scores, unplanned readmission to hospital and return to daily activities) were compared between groups. Patients also completed a Likert patient satisfaction survey following their consultation. Results: 103 patients were recruited over a 12-month period (21 laparoscopic appendicectomies, 65 laparoscopic cholecystectomies, nine open umbilical hernia repairs, six laparoscopic inguinal hernia repairs and two laparoscopic umbilical hernia repairs). Baseline patient demographics and operative interventions were the same in both groups. Patient or clinician-reported concerns on postoperative pain, use of analgesia, wound healing complications and return to daily activities at clinic follow-up were not significantly different between the two groups. Of the 58 patients randomized to the telemedicine arm, 40% reported high and 60% reported very high patient satisfaction. Telemedicine clinic mean consultation times were significantly shorter than face-to-face consultation times (telemedicine 10.3 +/- 7.2 minutes, face-to-face 19.2 +/- 23.8 minutes, p-value = 0.014). Rates of failing to attend clinic were not significantly different (telemedicine 3%, control 6%). There was no increased rate of postoperative complications in patients followed up by telemedicine compared to in-person. There were no unplanned readmissions, return to theatre, or mortalities in this study. Conclusion: Telemedicine follow-up of patients undergoing uncomplicated general surgery is safe and does not result in any missed diagnosis or higher rates of complications. Telemedicine provides high patient satisfaction and steps to implement this modality in inpatient care should be undertaken.

Keywords: general surgery, telemedicine, patient satisfaction, patient safety

Procedia PDF Downloads 99

Authors: Raphael C. Zero, Marita V. Cardozo, Thiago A. S. S. Rocha, Mariana T. Kihara, Fernando A. Ávila, Fabrício S. Oliveira

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There are several fixative and preservative solutions for use on cadavers, many of them using formaldehyde as the fixative or anatomical part preservative. In some countries, such as Brazil, this toxic agent has been increasingly restricted. The objective of this study was to microbiologically identify and quantify the key agents in tanks containing 96GL ethanol or sodium chloride solutions, used respectively as fixatives and preservatives of cat cadavers. Eight adult cat corpses, three females and five males, with an average weight of 4.3 kg, were used. After injection via the external common carotid artery (120 ml/kg, 95% 96GL ethyl alcohol and 5% pure glycerin), the cadavers were fixed in a plastic tank with 96GL ethanol for 60 days. After fixing, they were stored in a 30% sodium chloride aqueous solution for 120 days in a similar tank. Samples were collected at the start of the experiment - before the animals were placed in the ethanol tanks, and monthly thereafter. The bacterial count was performed by Pour Plate Method in BHI agar (Brain Heart Infusion) and the plates were incubated aerobically and anaerobically for 24h at 37ºC. MacConkey agar, SPS agar (Sulfite Polymyxin Sulfadizine) and MYP Agar Base were used to isolate the microorganisms. There was no microbial growth in the samples prior to alcohol fixation. After 30 days of fixation in the alcohol solution, total aerobic and anaerobic (<1.0 x 10 CFU/ml) were found and Pseudomonas sp., Staphylococcus sp., Clostridium sp. were the identified agents. After 60 days in the alcohol fixation solution, total aerobes (<1.0 x 10 CFU/ml) and total anaerobes (<2.2 x 10 CFU/mL) were found, and the identified agents were the same. After 30 days of storage in the aqueous solution of 30% sodium chloride, total aerobic (<5.2 x 10 CFU/ml) and total anaerobes (<3.7 x 10 CFU/mL) were found and the agents identified were Staphylococcus sp., Clostridium sp., and fungi. After 60 days of sodium chloride storage, total aerobic (<3.0 x 10 CFU / ml) and total anaerobes (<7.0 x 10 CFU/mL) were found and the identified agents remained the same: Staphylococcus sp., Clostridium sp., and fungi. The microbiological count was low and visual inspection did not reveal signs of contamination in the tanks. There was no strong odor or purification, which proved the technique to be microbiologically effective in fixing and preserving the cat cadavers for the four-month period in which they are provided to undergraduate students of University of Veterinary Medicine for surgery practice. All experimental procedures were approved by the Municipal Legal Department (protocol 02.2014.000027-1). The project was funded by FAPESP (protocol 2015-08259-9).

Keywords: anatomy, fixation, microbiology, small animal, surgery

Procedia PDF Downloads 258

Authors: Hsiu-Chuan Hsueh, Kuei-Feng Shen Jr., Chia-Ling Chao, Hui-Chuan Pan

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This article described a 75 years old woman who has suffered from intestinal perforation and accepted surgery with temporary enterostomy, the operation makes her depressed, refused relatives and friend's care, facing low willingness to participate in various activities due to fear of changing body appearance caused by surgery and leave enterostomy. The author collected information through observation talks, physical evaluation, and medical records during the period of care from November 14 to November 30, 2016, we used the four aspects of physiology, psychology, society and spirituality as a whole sexual assessment to establish the nursing problems of patient, included of acute pain, disturbance of body image,coping ineffective individual. For patient care issues, to encouraged case to express their inner feelings and take part in self-care programs through providing good therapeutic interpersonal relationships with their families. However, it provided clear information about the disease and follow-up treatment plan, give compliments in a timely manner, enhanced self-confidence of individual cases and their motivation to participate in self-care of stoma, further face the disease in a positive manner. At the same time, cross-section team care model and individual care measures were developed to enhance the care skills after returning home and at the same time assist the individual in facing the psychological impact caused by stoma. Hope to provide this experience, as a reference for the future care of the disease.

Keywords: enterostomy, intestinal perforation, nursing experience, ostomy

Procedia PDF Downloads 116

Authors: Fedili Benamar, Beloulou Mohamed Lamine, Ouahes Hassane, Ghattas Samir

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 Background and aims: Peripheral regional anesthesia has been integrated into most analgesia protocols for total knee arthroplasty which considered among the most painful surgeries with a huge potential for chronicization. The adductor canal block (ACB) has gained popularity. Similarly, the IPACK block has been described to provide analgesia of the posterior knee capsule. This study aimed to evaluate the analgesic efficacy of this block in patients undergoing primary PTG. Methods: 90 patients were randomized to receive either an IPACK, an anterior sciatic block, or a sham block (30 patients in each group + multimodal analgesia and a catheter in the KCA adductor canal). GROUP 1 KCA GROUP 2 KCA+BSA GROUP 3 KCA+IPACK The analgesic blocks were done under echo-guidance preoperatively respecting the safety rules, the dose administered was 20 cc of ropivacaine 0.25% was used. We were to assess posterior knee pain 6 hours after surgery. Other endpoints included quality of recovery after surgery, pain scores, opioid requirements (PCA morphine)(EPI info 7.2 analysis). Results: -groups were matched -A predominance of women (4F/1H). -average age: 68 +/-7 years -the average BMI =31.75 kg/m2 +/- 4. -70% of patients ASA2 ,20% ASA3. -The average duration of the intervention: 89 +/- 19 minutes. -Morphine consumption (PCA) significantly higher in group 1 (16mg) & group 2 (8mg) group 3 (4mg) - The groups were matched . -There was a correlation between the use of the ipack block and postoperative pain Conclusions :In a multimodal analgesic protocol, the addition of IPACK block decreased pain scores and morphine consumption ,

Keywords: regional anesthesia, analgesia, total knee arthroplasty, the adductor canal block (acb), the ipack block, pain

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Authors: Choppala Pratheek, Vineet Ahuja

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Background: Crohn's disease (CD) recurrence following surgery is a common challenge, and current detection methods rely on risk factors identified in Western populations. This study aimed to investigate the risk factors and rates of postoperative CD recurrence in a tuberculosis-endemic region like India. Retrospective data was collected from a structured database from a specialty IBD clinic by reviewing case files from January 2005 to December 2021. Inclusion criteria involved CD patients diagnosed based on the ECCO-ESGAR consensus guidelines, who had undergone at least one intestinal resection and had a minimum follow-up period of one year at the IBD clinic. Results: A total of 90 patients were followed up for a median period of 45 months (IQR, 20.75 - 72.00). Out of the 90 patients, 61 received ATT prior to surgery, with a mean delay in diagnosis of 2.5 years, although statistically non-significant (P=0.078). Clinical recurrence occurred in 50% of patients, with the cumulative rate increasing from 13.3% at one year to 40% at three years. Among 63 patients who underwent endoscopy, 65.7% showed evidence of endoscopic recurrence, with the cumulative rate increasing from 31.7% at one year to 55.5% at four years. Smoking was identified as a significant risk factor for early endoscopic recurrence (P=0.001) by Cox regression analysis, but no other risk factors were identified. Initiating post-operative medications prior to clinical recurrence delayed its onset (P=0.004). Subgroup analysis indicated that endoscopic monitoring aided in the early identification of recurrence (P=0.001). The findings contribute to enhancing post-operative CD management strategies in such regions where the disease burden is escalating.

Keywords: crohns, post operative, tuberculosis-endemic, risk factors

Procedia PDF Downloads 47

Authors: Hamidreza Hoshyarmanesh, Hosein Madieh, Sanju Lama, Yaser Maddahi, Garnette R. Sutherland, Kourosh Zareinia

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This paper illustrates the concept of an algorithm to register specified markers on the neuroArm surgical manipulators, an image-guided MR-compatible tele-operated robot for microsurgery and stereotaxy. Two range-finding algorithms, namely time-of-flight and phase-shift, are evaluated for registration and supervisory control. The time-of-flight approach is implemented in a semi-field experiment to determine the precise position of a tiny retro-reflective moving object. The moving object simulates a surgical tool tip. The tool is a target that would be connected to the neuroArm end-effector during surgery inside the magnet bore of the MR imaging system. In order to apply flight approach, a 905-nm pulsed laser diode and an avalanche photodiode are utilized as the transmitter and receiver, respectively. For the experiment, a high frequency time to digital converter was designed using a field-programmable gate arrays. In the phase-shift approach, a continuous green laser beam with a wavelength of 530 nm was used as the transmitter. Results showed that a positioning error of 0.1 mm occurred when the scanner-target point distance was set in the range of 2.5 to 3 meters. The effectiveness of this non-contact approach exhibited that the method could be employed as an alternative for conventional mechanical registration arm. Furthermore, the approach is not limited by physical contact and extension of joint angles.

Keywords: 3D laser scanner, intraoperative MR imaging, neuroArm, real time registration, robot-assisted surgery, supervisory control

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Authors: Bahador Bardshiri, Omid Moradi, Amir Komeilian, Nima Panahifar

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Formation of a conjunctival membrane over the corneal surface is a condition unique to rabbits that has been labeled aberrant corneal occlusion or pseudopterygium. In the summer of 2013, a five years old male Standard Chinchilla rabbit were presented to Karaj Central Veterinary hospital and the owner complained that his rabbit shows degrees of blindness and there were opacities on both eyes of the presented rabbit. Ophthalmic examination of the affected eyes revealed a conjunctival fold stretching over the cornea of both eyes. The fold originated from limbus and it was vascularized and centrally thickened. There were no attachments to the corneal epithelium and the fold could be easily lifted. Surgery was performed under general anesthesia. The conjunctival fold was incised centrifugally up to its attachment at the limbus and the lid margin using small scissors. The central rim of the segment was then replaced to its normal position in the fornix and fixed with mattress sutures (7/0) passing through outside skin. After the surgery, eye drops containing dexamethasone, gentamicin and polymixin were applied twice daily up to 3 weeks. Within the observation period (8 months) no recurrence was noted. "Pseudo" in the term pseudopterygium refers to the fact that the conjunctival membrane is not adhering to the underlying cornea, but growing over it. In rare cases, the membrane may be loosely attached to the cornea, but can be easily separated without causing damage. It can cover only a small part of the cornea with an annular peripheral opacification of the cornea, or cover it almost fully, leading to blindness. Ethiopathogenesis remains unclear and recurrence of the problem is very likely. The surgical technique that used here decreases probability of recurrence of conjunctival fold.

Keywords: rabbit, cornea, aberrant corneal occlusion, pseudopterygium

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Authors: Lalit Tejwani, Reetika Sharma, Arun Singhvi, Himanshu Shekhar

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Purpose: To assess the efficacy of collagen matrix implant (Ologen) in phacotrabeculectomy augmented with mitomycin C (MMC). Methods: A biodegradable collagen matrix (Ologen) was placed in the subconjunctival and subscleral space in twenty-two eyes of 22 patients with glaucoma and cataract who underwent combined phacoemulsification and trabeculectomy augmented with MMC. All of them were examined preoperatively and on the first postoperative day. They were followed for twelve months after surgery. Any intervention needed in follow-up period was noted. Any complication was recorded. The primary outcome measure was postoperative intraocular pressure at one year follow-up. Any additional postoperative treatments needed and adverse events were noted. Results: The mean age of patients included in the study was 57.77 ± 9.68 years (range=36 to 70 years). All the patients were followed for at least one year. Three patients had history of failed trabeculectomy. Fifteen patients had chronic angle closure glaucoma with cataract, five had primary open angle glaucoma with cataract, one had uveitic glaucoma with cataract, and one had juvenile open angle glaucoma with cataract. Mean preoperative IOP was 32.63 ± 8.29 mm Hg, eighteen patients were on oral antiglaucoma medicines. The mean postoperative IOP was 10.09 ± 2.65 mm Hg at three months, 10.36 ± 2.19 mm Hg at six months and 11.36 ± 2.72 mm Hg at one year follow up. No adverse effect related to Ologen was seen. Anterior chamber reformation was done in five patients, and three needed needling of bleb. Four patients needed additional antiglaucoma medications in the follow-up period. Conclusions: Combined phacotrabeculectomy with MMC with Ologen implantation appears to be a safe and effective option in glaucoma patients needing trabeculectomy with significant cataract. Comparative studies with longer duration of follow-up in larger number of patients are needed.

Keywords: combined surgery, ologen, phacotrabeculectomy, success

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Authors: Jemini Vyas, Oluwatobi Adeyoe, Jenny Branagan, Chandran Tanabalan, Aakash Pai

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Introduction: Radical prostatectomy and radiotherapy are both viable options for the treatment of localised prostate cancer. Over the years medicine has evolved towards a patient-centred approach. Patient decision-making is not motivated by clinical outcomes alone. Geographical location and ease of access to treating clinician are contributory factors. With the development of robotic surgery, prostatectomy has been centralised into tertiary centres. This has impacted on the distances that patients and their families are expected to travel. Methods: A single centre retrospective study was undertaken over a five-year period. All patients with localised prostate cancer, undergoing radical radiotherapy or prostatectomy were collected pre-centralisation. This was compared to the total number undergoing these treatments post centralisation. Results: Pre-centralisation, both radiotherapy and prostatectomy groups had to travel a median of less than five miles for treatment. Post-centralisation of pelvic surgery, prostatectomy patients had to travel a median of more than 40 miles, whilst travel distance for the radiotherapy group was unchanged. In the post centralisation cohort, there was a 63% decline in the number of patients undergoing radical prostatectomy per month from a mean of 5.1 to 1.9. The radical radiotherapy group had a concurrent 41% increase in patient numbers with a mean increase from 13.3 to 18.8 patients per month. Conclusion: Choice of radical treatment in localised prostate cancer is based on multiple factors. This study infers that local availability can influence choice of radical treatment. It is imperative that efforts are made to maintain accessibility to all viable options for prostate cancer patients, so that patient choice is not compromised.

Keywords: prostate, prostatectomy, radiotherapy, centralisation

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Authors: Amenah Galo, Mohammed Farid, Kareem Alsharkawy, Robert Warner, Karthikeyan Srinivasan, Haitham Khalil, Ruth Waters

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Introduction: The cessation of elective surgery, particularly breast reconstruction, continue to be affected by the COVID-19 pandemic. The restructuring of medical services and staff redeployment severely affected the ability to return to normality for surgical specialties. The aim of this study is to determine the decline in breast reconstruction affected by the COVID-19 pandemic in a tertiary center. Methods: A retrospective review of breast reconstruction cases (autologous, non-autologous) or mastectomies Pre- COVID (March 2019-March 2020) and during COVID (March 2020- March 2021) at Queen Elizabeth Hospital, Birmingham, were collated. Data included patient demographics, BMI, previous and recent reconstruction, length of hospital stay, and mastectomies, including risk-reducing. Results: The number of patients who had breast reconstruction was significantly lower during COVID (n=62) compared to pre-COVID (n=199). The mean age (pre-COVID 51, COVID 59 years), BMI (Pre-COVID and COVID = 27), previous reconstruction (pre-COVID n=101, 51%, COVID n=33, 53%) and length hospital stay was less during COVID (3 days) compared to Pre-COVID (4 days). The proportion of risk-reducing mastectomies and reconstruction during COVID (32%, n=20) were higher than pre-COVID (21%, n=41). A higher proportion rate of autologous reconstruction (DIEP 56, TRAM 17) Pre-COVID compared to COVID (DIEP 22, TRAM 7). Implant reconstructions were higher during COVID (n=19, 31%) than pre-COVID (n=31, 16%). Conclusion: The lack of regular provision for breast reconstruction continues to decline during the pandemic. This will have a tremendous impact on waiting lists without a timeline for reconstruction to offer patients. An international survey highlights the disparities in offering breast reconstruction and strategies to rectify this issue.

Keywords: breast reconstruction, COVID-19 pandemic, mastectomy, autologous, implant

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Authors: Ehsan Ahmed Yahia

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Introduction: The nursing role in nutrition screening and assessing hospitalized patients is important. Malnutrition is a common and costly problem, particularly among hospitalized patients, and can have an adverse effect on the healing process. The study's goal is to assess the prevalence of malnutrition among adult hospitalized orthopedic patients and to detect the barriers to the nutrition screening process. Aim of the study: This study aimed to (a) assess the prevalence of malnutrition in hospitalized orthopedic patients and (b) evaluate the relationship between malnutrition and selected clinical outcomes. Material and Methods: This prospective field study was conducted for three months between 03/2022 and 06/2022 in the selected orthopedic departments in a teaching hospital affiliated withCairo University, Egypt. with a total number of one hundred twenty (120) patients. Patients' assessment included checking for malnutrition using the Nutritional Risk Screening Questionnaire. Patients at risk for malnourishment were defined as NRS score ≥ 3. Clinical outcomes under consideration included 1) length of hospitalization, 2) mobilization after surgery and conservative treatment, and 3) rate of adverse events. Results: This study found that malnutrition is a significant problem among patients hospitalized in an orthopedic ward. The prevalence of malnutrition was the highest in patients with lumbar spine and pelvis fractures, followed by the proximal femur and proximal humerus fractures. Patients at risk for malnutrition had significantly prolonged hospitalization, delayed postoperative mobilization, and increased incidence of adverse events.27.8% of the study sample were at risk for malnutrition. The highest prevalence of malnourishment was found in Septic Surgery with 32%, followed by Traumatology with 19.6% and Arthroplasty with 15.3%. A higher prevalence of malnutrition was detected among patients with typical fractures, such as lumbar spine and pelvis (46.7%), proximal femur (34.4%), and proximal humeral (23.7%) fractures. Additionally, patients at risk for malnutrition showed prolonged hospitalization (14.7 ± 11.1 vs. 21.2 ± 11.7 days), delayed postoperative mobilization (2.3 ± 2.9 vs. 4.1 ± 4.9 days), and delayed to mobilize after conservative treatment (1.1 ± 2.7 vs. 1.8 ± 1.9 days). A significant statistical correlation of NRS with individual parameters (Spearman's rank correlation, p < 0.05) was observed. The rate of adverse incidents in patients at risk for malnutrition was significantly higher than that of patients with a regular nutritional status (37.2% vs. 21.1%, p < 0.001). Conclusions: Our results indicate that the prevalence of malnutrition in surgical patients is significant. The nutritional status of patients with typical fractures is especially at risk. Prolonged hospitalization, delayed postoperative mobilization, and delayed mobilization after conservative treatment is significantly associated with malnutrition. In addition, the incidence of adverse events in patients at risk for malnutrition is significantly higher.

Keywords: malnutrition, nutritional risk screening, surgery, nursing, orthopedic nurse

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Authors: Hayden R Schott, John M Felder III

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Introduction: Chronic lower extremity wounds in the diabetic and vasculopathic populations are associated with a high degree of morbidity.When wounds require more extensive treatment than can be offered by wound care centers, more aggressive solutions involve local tissue transfer and microsurgical free tissue transfer for achieving definitive soft tissue coverage. These procedures of autologous tissue transfer (ATT) offer resilient, soft tissue coverage of limb-threatening wounds and confer promising limb salvage rates. However, chronic osteomyelitis and recalcitrant soft tissue infections are common in severe diabetic foot wounds and serve to significantly complicate ATT procedures. Stimulan is a resorbable calcium sulfate antibiotic carrier. The use of stimulan antibiotic beads to treat chronic osteomyelitis is well established in the orthopedic and plastic surgery literature. In these procedures, the beads are placed beneath the skin flap to directly deliver antibiotics to the infection site. The purpose of this study was to quantify the success of Stimulan antibiotic beads in treating recalcitrant infections in patients with diabetic foot wounds receiving ATT. Methods: A retrospective review of clinical and demographic information was performed on patients who underwent ATT with the placement of Stimulan antibiotic beads for attempted limb salvage from 2018-21. Patients were analyzed for preoperative wound characteristics, demographics, infection recurrence, and adverse outcomes as a result of product use. The primary endpoint was 90 day infection recurrence, with secondary endpoints including 90 day complications. Outcomes were compared using basic statistics and Fisher’s exact tests. Results: In this time span, 14 patients were identified. At the time of surgery, all patients exhibited clinical signs of active infection, including positive cultures and erythema. 57% of patients (n=8) exhibited chronic osteomyelitis prior to surgery, and 71% (n=10) had exposed bone at the wound base. In 57% of patients (n=8), Stimulan beads were placed beneath a free tissue flap and beneath a pedicle tissue flap in 42% of patients (n=6). In all patients, Stimulan beads were only applied once. Recurrent infections were observed in 28% of patients (n=4) at 90 days post-op, and flap nonadherence was observed in 7% (n=1). These were the only Stimulan related complications observed. Ultimately, lower limb salvage was successful in 85% of patients (n=12). Notably, there was no significant association between the preoperative presence of osteomyelitis and recurrent infections. Conclusions: The use of Stimulanantiobiotic beads to treat recalcitrant infections in patients receiving definitive skin coverage of diabetic foot wounds does not appear to demonstrate unnecessary risk. Furthermore, the lack of significance between the preoperative presence of osteomyelitis and recurrent infections indicates the successful use of Stimulan to dampen infection in patients with osteomyelitis, as is consistent with the literature. Further research is needed to identify Stimulan as the significant contributor to infection treatment using future cohort and case control studies with more patients. Nonetheless, the use of Stimulan antibiotic beads in patients with diabetic foot wounds demonstrates successful infection suppression and maintenance of definitive soft tissue coverage.

Keywords: wound care, stimulan antibiotic beads, free tissue transfer, plastic surgery, wound, infection

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Authors: Sophie Mills, Constantinos Aristotelous, Leila L. Touil, Richard C. W. James

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Objectives: Historical studies of the anatomy of the spinal accessory nerve (SAN) have reported conflicting results regarding its relationship with the internal jugular vein (IJV). A literature review was undertaken to establish the prevalence of anatomical variations of the SAN encountered during routine neck dissection surgery in order to increase awareness and reduce morbidity associated with iatrogenic SAN injury. Materials and Methods: The largest systematic review to date was performed using PRISMA-ScR guidelines, which yielded nine articles following the application of inclusion and exclusion criteria. A case report is also included, which demonstrates the rare anatomical relationship of the SAN traversing a fenestrated IJV, seen for the first time in the senior author’s career. Results: The mean number of dissections per study was 119, of which 55.6% (n=5) studies were performed on cadaver subjects, and 44.4% (n=4) were surgical dissections. Incidences of the SAN lateral to the IJV and medial to the IJV ranged from 38.9%-95.7% and 2.8%-57.4%, respectively. Over half of the studies reported incidences of the SAN traversing the IJV in 0.9%-2.8% of dissections. One study reported an isolated variant of the SAN dividing around the IJV with a prevalence of 0.5%. Conclusion: At the level of the posterior belly of the digastric muscle, the surgeon can anticipate the identification of the SAN lateral to the IJV in approximately three-quarters of cases, whilst around one-quarter are estimated to be medial. A mean of 1.6% of SANs traverses a fenestration of the vein. It is essential for surgeons to be aware of these anatomical variations and their prevalence to prevent injury to vital structures during surgery.

Keywords: anatomical variant, internal jugular vein, neck dissection, spinal accessory nerve

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Authors: Ya-Yi Yen

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The operating room is a medical environment full of high-risk, high-complexity and high-cost. In addition to assuring patient safety, the operating room should effort on the efficient and safe medical quality for the surgical patients of high risk, elders, and children. If the nursing staffs of operation room carry on the pre-operative visiting prior to surgery, the patient's anxiety and complications are expected to be alleviated, and the hospitalization days may also be shortened. Purpose: Applying the information system to enhance pre-operative visiting, case tracking, and effectiveness recording Method: (I) Application the information system to screen cases by integrating the operation scheduling, and linking the severe surgery codes, for to shorten the time to track cases of operative visiting. Through the improvement, the time required decreased to 1.5 minutes per day from 20 minutes per day, and nursing staffs’ satisfaction with satisfaction for tracking and visiting procedure of case increased to 86% from 54%. (II)The electronic establishment of the operative visiting record enhanced the integrity of the operative visiting record. The integrity rate was rise to 92% from 66%, while nursing staffs’ satisfaction with the visiting record increased to 82% from 61.3%. Since information technology continues evolving, the application of information technology is helpful to the integration of nursing information, simplification of processes, and saving of man-hours. This article introduces the application of information systems to simplify the processes and improve the effectiveness of operation visiting and tracking, including the saving of time, improving the integrity rate of record, and improving the satisfaction of nursing staffs.

Keywords: effectiveness, information system, perioperative nursing, pre-operative visiting

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Authors: Nita Nurlaila Kadarwaty

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Purpose: This study presents a rare case of bilateral Acute Primary Angle Closure Glaucoma (PACG). Method: A case report of a 64-year-old woman with a good outcome Acute PACG in both eyes who underwent phacotrabeculectomy surgery. Result: A 64-year-old woman complained of acute pain in both eyes, accompanied by decreased vision, photophobia, and seeing halos for three weeks. There was no history of trauma, steroid or other systemic drugs used, or intraocular surgery before. Ophthalmologic examination revealed a right eye (RE) visual acuity of 0.1, left eye (LE) 0.2. RE intraocular pressure (IOP) was 12 mmhg and LE: 36.4 mmHg in medication of timolol maleat ED and acetazolamide oral. Both eyes' anterior segments revealed mixed injection, corneal edema, shallow anterior chamber, posterior synechiae, mid-dilatation pupil with negative pupillary reflection, and cloudy lens without intumescent. There was a glaucomatous optic and closed iridocorneal angle on the gonioscopy. Initial treatments included oral acetazolamide and potassium aspartate 250 mg three times a day, timolol maleate ED 0.5% twice a day, and prednisolone acetate ED 1% four times a day. This patient underwent trabeculectomy, phacoemulsification, and implantation of IOL in both eyes. One week after the surgeries, both eyes showed decreased IOP and good visual improvement. Conclusion: Bilateral simultaneous Acute PACG is generally severe and results in a poor outcome. It causes rapidly progressive visual loss and is often irreversible. Phacotrabeculectomy has more benefits compared to only phacoemulsification for the intervention regarding the reduced IOP post-surgical.

Keywords: acute primary angle closure glaucoma, intraocular pressure, phacotrabeculectomy, glaucoma

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Authors: M. A. Askari, M. A. Nazari, P. Perrier, Y. Payan

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Growth and remodeling of biological structures have gained lots of attention over the past decades. Determining the response of the living tissues to the mechanical loads is necessary for a wide range of developing fields such as, designing of prosthetics and optimized surgery operations. It is a well-known fact that biological structures are never stress-free, even when externally unloaded. The exact origin of these residual stresses is not clear, but theoretically growth and remodeling is one of the main sources. Extracting body organs from medical imaging, does not produce any information regarding the existing residual stresses in that organ. The simplest cause of such stresses is the gravity since an organ grows under its influence from its birth. Ignoring such residual stresses might cause erroneous results in numerical simulations. Accounting for residual stresses due to tissue growth can improve the accuracy of mechanical analysis results. In this paper, we have implemented a computational framework based on fixed-point iteration to determine the residual stresses due to growth. Using nonlinear continuum mechanics and the concept of fictitious configuration we find the unknown stress-free reference configuration which is necessary for mechanical analysis. To illustrate the method, we apply it to a finite element model of healthy human face whose geometry has been extracted from medical images. We have computed the distribution of residual stress in facial tissues, which can overcome the effect of gravity and cause that tissues remain firm. Tissue wrinkles caused by aging could be a consequence of decreasing residual stress and not counteracting the gravity. Considering these stresses has important application in maxillofacial surgery. It helps the surgeons to predict the changes after surgical operations and their consequences.

Keywords: growth, soft tissue, residual stress, finite element method

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Authors: Predrag Kavaric, Vladimir L. Jubic, Maxim Cadenovic

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The patient was transferred from his dentist to our tertiary medical institution. In anamnesis, we got information that his dental intervention was two years ago when he got dental implants but because of the coronavirus pandemic event, he didn’t finish the whole procedure. After two years, he decided that he will continue his work at his dentist, then his dentist noticed that there is no earlier inserted implant in the upper jaw on the right side. They do Panoramic X-ray and find that the implant is all in the maxillary sinus cavity. The flour of the maxilla was intact without any fistula on the place where the implant was inserted in the maxilla bone, After that initial diagnostic they sent the patient to maxillofacial surgery and otorhinolaryngology. We asked for a CT scan of paranasal sinuses, which confirmed the foreign body in the right maxillary sinus. The plan was that in general anesthesia we do FESS and try to find a foreign body in the maxillary sinus or in case of failure to do Caldwel Luc on that side. After preoperative preparation in GA, we do FESS. In inspection, we find small polyps and chronically changed mucosa of osteomeatal complex and right maxillary sinus. After removing polyps we did uncinectomy and medial maxillectomy. With Heuweiser Antrum grasping forceps after several attempts we managed to extract a foreign body from the bottom of the right maxillary sinus. On the first postoperative day we did detamponade, and then we discharge the patient from hospital. The Covid pandemic has contributed to the postponement of a large number of planned operations, which has resulted in various complications in the treatment of a number of patients. In this case, it happened that the implant was most likely rejected by the bone but in the direction of the maxillary sinus, which is not a common cause. On the other hand, the success was that less traumatic intervention was able to remove the foreign body from the maxillary sinus in which it was located. Since the sinus floor is free of bone defects, it can be continued relatively quickly with dental procedures.

Keywords: x-ray, surgery, maxillar sinus, complication, fees

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