Current Issue : July-September Volume : 2022 Issue Number : 3 Articles : 5 Articles
In orthopaedic oncology, limb salvage procedures are becoming more frequent thanks to recent major improvements in medical imaging, biomechanical modelling and additive manufacturing. For the pelvis, surgical reconstruction with metal implants after tumor resection remains challenging, because of the complex anatomical structures involved. The aim of the present work is to define a consistent overall procedure to guide surgeons and bioengineers for proper implant design. All relevant steps from medical imaging to an accurate 3D anatomical‐based model are here reported. In detail, the anatomical 3D models include bone shapes from CT on the entire pelvic bone, i.e., including both affected and unaffected sides, and position and extension of the tumor and soft tissues from MRI on the affected side. These models are then registered in space, and an initial shape of the personalized implant for the affected side can be properly designed and dimensioned based on the information from the unaffected side. This reported procedure can be fundamental also for virtual pre‐surgical planning, and the design of patient‐specific cutting guides, which would result is a safe margin for tumor cut. The entire procedure is here shown by describing the results in a single real case....
Surgical site infection occurs with high frequency in gastrointestinal surgery, contributing to the high incidence of morbidity and mortality. The accepted practice worldwide for the prevention of surgical site infection is providing single‐ or multiple‐dose antimicrobial prophylaxis. However, most suitable antibiotic and optimal duration of prophylaxis are still debated. The aim of the systematic review is to assess the efficacy of antimicrobial prophylaxis in controlling surgical site infection rate following esophagogastric surgery. PubMed and Cochrane databases were systematically searched until 31 October 2021, for randomized controlled trials comparing different antimicrobial regimens in prevention surgical site infections. Risk of bias of studies was assessed with standard methods. Overall, eight studies concerning gastric surgery and one study about esophageal surgery met inclusion criteria. No significant differences were detected between singleand multiple‐dose antibiotic prophylaxis. Most trials assessed the performance of cephalosporins or inhibitor of bacterial beta‐lactamase. Antimicrobial prophylaxis (AMP) is effective in reducing the incidence of surgical site infection. Multiple‐dose antimicrobial prophylaxis is not recommended for patients undergoing gastric surgery. Further randomized controlled trials are needed to determine the efficacy and safety of antimicrobial prophylaxis in esophageal cancer patients....
Several papers have identified supplements that may relieve symptoms of carpal tunnel syndrome and improve recovery when carpal tunnel surgery is required. 64 patients with clinically and electromyographically confirmed carpal tunnel syndrome were enrolled in a prospective study to evaluate the effectiveness of a nerve supplement on patient rated outcome assessment after carpal tunnel surgery. All the patients underwent endoscopic carpal tunnel surgery. 18 patients also took the NeuroGen nerve supplement as part of their perioperative treatment. Both groups demonstrated a statistically significant improvement in BCTQ (both symptoms and function) at 2 weeks follow up. The supplement group demonstrated a statistically significant difference in improvement on the BCTQ (both symptoms and function) compared to the control group without the supplement. The NeuroGen nerve supplement appears to improve recovery on both the symptoms and function component of the BCTQ after endoscopic carpal tunnel surgery within 2 weeks....
Background and Objectives: For preventing postoperative delirium (POD), identifying the risk factors is important. However, the relationship between blood transfusion and POD is still controversial. The aim of this study was to identify the risk factors of POD, to evaluate the impact of blood transfusion in developing POD among people undergoing spinal fusion surgery, and to show the effectiveness of big data analytics using a clinical data warehouse (CDW). Materials and Methods: The medical data of patients who underwent spinal fusion surgery were obtained from the CDW of the five hospitals of Hallym University Medical Center. Clinical features, laboratory findings, perioperative variables, and medication history were compared between patients without POD and with POD. Results: 234 of 3967 patients (5.9%) developed POD. In multivariate logistic regression analysis, the risk factors of POD were as follows: Parkinson’s disease (OR 5.54, 95% CI 2.15–14.27; p < 0.001), intensive care unit (OR 3.45 95% CI 2.42–4.91; p < 0.001), anti-psychotics drug (OR 3.35 95% CI 1.91–5.89; p < 0.001), old age (≥70 years) (OR 3.08, 95% CI 2.14–4.43; p < 0.001), depression (OR 2.8 95% CI 1.27–6.2; p < 0.001). The intraoperative transfusion (OR 1.1, 95% CI 0.91–1.34; p = 0.582), and the postoperative transfusion (OR 0.91, 95% CI 0.74–1.12; p = 0.379) had no statistically significant effect on the incidence of POD. Conclusions: There was no relationship between perioperative blood transfusion and the incidence of POD in spinal fusion surgery. Big data analytics using a CDW could be helpful for the comprehensive understanding of the risk factors of POD, and for preventing POD in spinal fusion surgery....
Background and objectives: This retrospective cohort study aimed to compare three postoperative antibiotic protocols of different durations on surgical-site-infection (SSI) rates following orthognathic surgery for the correction of jaw deformities. Materials and methods: An analysis on data collected from the medical files of 209 patients who underwent orthognathic surgery between 2010 and 2019 was conducted. The patients were divided into three groups according to the postoperative antibiotic protocol—Group 1 (24 h), Group 2 (2–3 days), and Group 3 (>3 days). Dependent and independent variables were collected, analyzed, and compared between the three groups. Results: Group 1 included 30 patients (14.3%), Group 2 included 123 patients (58.9%), and Group 3 included 56 patients (26.8%). The vast majority of the postoperative antibiotics were amoxicillinand clavulanic acid (87.1%). The duration of the surgery and the use of a feeding tube were significantly different between Groups 1 and 3 (p < 0.001 and p = 0.005, respectively). There was no significant difference in SSI rates between the three groups (p = 0.642). The use of antibiotics beyond the immediate postoperative period provides no increased benefit regarding infection prevention. Conclusions: In young and healthy patients undergoing orthognathic surgery, a 24hregimen of postoperative antibiotics may be sufficient....
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