The Kirschner wires (K-wires) are stiff and straight wires made of smooth stainless steel. These are used in surgery to aid in repairing the process of a fractured bone. In forefoot elective surgeries, these pins are ...The Kirschner wires (K-wires) are stiff and straight wires made of smooth stainless steel. These are used in surgery to aid in repairing the process of a fractured bone. In forefoot elective surgeries, these pins are mostly used for fixation of the phalangeal or metatarsal area. These wires are usually either buried or exposed, The exposed wires do not require another operation to remove them and are generally preferred. In using the forefoot surgery history of a single surgeon which was taken for 3 years<span>.</span><span> The purpose of this study is to evaluate the occurrence of infections following elective surgeries of the forefoot that were fixed using k-pins and to indicate an effective treatment option for resolving the infection. The inclusion criteria set for this study was to remove any patient having any disease except for diabetes. Moreover, the age limit was set to be 18</span><span> </span><span>-</span><span> </span><span>44, making a final sample of 50 people, prescribed prophylactic antibiotics or early removal of k-pins, where necessary. The researcher recorded demographic and biological data from the patients such as age, BMI, and smoking status were recorded. The researcher conducted a Univariate analysis via a Chi-square test. 50</span><b><span> </span></b><span>Patients (82 K-wires) were analyzed. Results showed that surgery type, BMI, and smoking were three variables that affect the infection growth significantly while diabetes and type of cleaning disinfectant had marginal effects. Further study is required to clarify the best treatments in this area, as the treatment option antibiotics have nearly similar results.</span>展开更多
<strong>Objective</strong><strong>:</strong><span style="font-family:""><span style="font-family:Verdana;"> To compare between the efficacy of the use of or...<strong>Objective</strong><strong>:</strong><span style="font-family:""><span style="font-family:Verdana;"> To compare between the efficacy of the use of oral sildenafil plus low dose aspirin versus the use of oral low dose aspirin alone in pregnancy as preventive measure in women at risk for preeclampsia (PE). </span><b><span style="font-family:Verdana;">Design: </span></b><span style="font-family:Verdana;">A randomized clinical trial. </span><b><span style="font-family:Verdana;">Setting: </span></b><span style="font-family:Verdana;">Outpatient Obstetric clinic of Ain Shams University Maternity Hospital. </span><b><span style="font-family:Verdana;">Population or sample: </span></b><span style="font-family:Verdana;">Women at gestational age of </span></span><span style="font-family:""><span style="font-family:Verdana;">≤</span><span><span style="font-family:Verdana;">16 weeks who at risk for PE between June 2018 and June 2019. </span><b><span style="font-family:Verdana;">Methods:</span></b><span style="font-family:Verdana;"> Participants were randomly allocated into two groups: Group I Included 200 women who received a 25 mg tablet of oral sildenafil citrate tid until delivery plus 100 mg tablet of aspirin orally once daily until gestational age of 36 weeks, Group II Included 200 women who received a 100 mg tablet of aspirin orally once daily until gestational age of 36 weeks. </span><b><span style="font-family:Verdana;">Main Outcome Measures: </span></b><span style="font-family:Verdana;">Incidence of preeclampsia diagnosed per ACOG criteria. </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> The incidence of PE in both groups showed no statistically significant difference. The incidence of PE in the first group is 11.0%, and it is 12.0% in the second group (p-value 0.754). </span><b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"> The addition of sildenafil citrate to low dose aspirin had no impact on the prevention of展开更多
We hereby present a short overview of the anaesthesiological considerations regarding the patient with Charcot-Marie-Tooth disease also known as hereditary muscle and sensory neuropathy, which affects peripheral nerve...We hereby present a short overview of the anaesthesiological considerations regarding the patient with Charcot-Marie-Tooth disease also known as hereditary muscle and sensory neuropathy, which affects peripheral nerves and muscles. Due to pathophysiology of the disease certain anaesthesiological complications associated with HMSN can be related. A case report describing protocol of the total venous anesthesia in the 17-year old patient operated on sacral dermoid with fistulae is presented. The patient recovered without any further complications. In the conclusion we would like to bring the importance of awareness to prepare the HMSN patient for a surgical procedure as well from anesthesiological as from surgical point of view to avoid possible unwanted event such as malignant hyperthermia, hyperkalemia, seizures, prolonged effect of muscle relaxants and worsening of the disease. As an important alternative to general anesthesia regional anesthesia should be considered.展开更多
<strong>Purpose:</strong> We introduce the concept of intraoperative Trifecta during laparoscopic partial nephrectomy (LPN) as the simultaneous achievement of estimated blood loss (EBL) < 500 ml, warm i...<strong>Purpose:</strong> We introduce the concept of intraoperative Trifecta during laparoscopic partial nephrectomy (LPN) as the simultaneous achievement of estimated blood loss (EBL) < 500 ml, warm ischemia time (WIT) < 20 minutes and minimal changes of the intraoperative course. The study’s aim was to find preoperative factors that could predict the likelihood of achieving intraoperative Trifecta and build a surgical nomogram. <strong>Methods:</strong> We retrospectively evaluated 122 patients who underwent LPN. Preoperative factors like age, sex, body-mass index (BMI), kidney function, tumor characteristics (R.E.N.A.L. score) and Charlson-Comorbidity-Index (CCI) were recorded. Intraoperative complication (IOC) was graded according to the Rosenthal classification. R software was used to find a predicting model for achievement of Trifecta using preoperative variables and a nomogram was built. <strong>Results: </strong>The surgical features include median EBL of 100 ml having 6.5% bleed > 500 ml, median WIT of 12 minutes having 7.3% more than 20 minutes. There was recorded a 12.3% IOC with a mean Rosenthal’s grade of 0.2. Intraoperative Trifecta was achieved in 105 patients (86%) and three preoperative factors were chosen for the predictive model: BMI (p = 0.041), CCI (p = 0.037) and RENAL score (p = 0.002). A nomogram was generated and the ROC-AUC of the model was 75.8%. <strong>Conclusion:</strong> We have defined an intraoperative Trifecta concept as the achievement of EBL < 500 ml, WIT < 20 minutes and minimal changes of the intraoperative course. A nomogram was developed from preoperative factors like BMI, CCI and R.E.N.A.L. score. It can be used to estimate the probability of Trifecta achievement in patients treated with LPN.展开更多
<strong>Background:</strong> Breast reduction surgery is increasing in popularity, with so many techniques all around the world, and the community’s knowledge of the details of this procedure increases th...<strong>Background:</strong> Breast reduction surgery is increasing in popularity, with so many techniques all around the world, and the community’s knowledge of the details of this procedure increases thanks to the Internet and easy access to information, which increases breast reduction reviews for plastic surgery clinics. Reduction mammaplasty is an established and effective technique to treat symptomatic macromastia. Variable rates of complications have been reported, and there is a continued need for better outcome assessment studies. <strong>Aim:</strong> The purpose of this study was to identify the complications occurred during the first year of breast reduction surgery. <strong>Materials and Methods:</strong> A prospective study over a 1-year period from October 2018 to October 2019, that included 32 patients who underwent breast reduction surgery using the same technique (inferior pedicle and inverted T scar) in the Department of Plastic Surgery at Al-Mouassat University Hospital, Damascus, Syria. Patients were followed through a whole year after surgery and complications that occurred were recorded. <strong>Results:</strong> Complications that occurred in 14 patients (43%), and, and were more common in patients with larger breasts and worse symptoms before surgery. The most common complication was delayed wound healing, and it was associated with breast volume before surgery and with smoking. In general, the most relevant factor influencing the incidence of complications was the weight of the resected breast tissue, which is mainly related to the size of the breast before surgery. <strong>Conclusion:</strong> The weight of the resected breast tissue was the most important factor influencing the occurrence of complications after breast reduction surgery. The most prevalent complication was delayed wound healing and it was associated with the weight of the removed tissue.展开更多
<strong>Background:</strong> Transcatheter aortic valve implantation (TAVI) is a widely used treatment of severe aortic stenosis. Implantation of a self-expanding valve into a dense calcified aortic annulu...<strong>Background:</strong> Transcatheter aortic valve implantation (TAVI) is a widely used treatment of severe aortic stenosis. Implantation of a self-expanding valve into a dense calcified aortic annulus can be challenging and may result in device malposition and malfunction.<strong> Aim: </strong>The aim of our case report is to present a novel technique of transcatheter aortic valve dislocation treatment. <strong>Case presentation:</strong> An 86-year-old woman with severely calcified aortic valve underwent TAVI using a 27-mm self-expanding Portico valve (Abbott Vasc, USA). In the last phase of implantation, the valve dislocated deep into the left ventricular outflow tract resulting in significant paravalvular regurgitation and patient instability. Repositioning of the valve with a single snare was ineffective because of severe aortic ring calcifications. A novel “double snare” technique was applied and the valve was successfully repositioned upward with an excellent anatomic and haemodynamic result. <strong>Conclusion:</strong> “Double snare” technique can be an effective strategy for repositioning of deeply implanted self-expanding transcatheter aortic valves. It represents an efficient bailout strategy in case of single snare approach failure, especially in cases of severe aortic ring calcifications.展开更多
文摘The Kirschner wires (K-wires) are stiff and straight wires made of smooth stainless steel. These are used in surgery to aid in repairing the process of a fractured bone. In forefoot elective surgeries, these pins are mostly used for fixation of the phalangeal or metatarsal area. These wires are usually either buried or exposed, The exposed wires do not require another operation to remove them and are generally preferred. In using the forefoot surgery history of a single surgeon which was taken for 3 years<span>.</span><span> The purpose of this study is to evaluate the occurrence of infections following elective surgeries of the forefoot that were fixed using k-pins and to indicate an effective treatment option for resolving the infection. The inclusion criteria set for this study was to remove any patient having any disease except for diabetes. Moreover, the age limit was set to be 18</span><span> </span><span>-</span><span> </span><span>44, making a final sample of 50 people, prescribed prophylactic antibiotics or early removal of k-pins, where necessary. The researcher recorded demographic and biological data from the patients such as age, BMI, and smoking status were recorded. The researcher conducted a Univariate analysis via a Chi-square test. 50</span><b><span> </span></b><span>Patients (82 K-wires) were analyzed. Results showed that surgery type, BMI, and smoking were three variables that affect the infection growth significantly while diabetes and type of cleaning disinfectant had marginal effects. Further study is required to clarify the best treatments in this area, as the treatment option antibiotics have nearly similar results.</span>
文摘<strong>Objective</strong><strong>:</strong><span style="font-family:""><span style="font-family:Verdana;"> To compare between the efficacy of the use of oral sildenafil plus low dose aspirin versus the use of oral low dose aspirin alone in pregnancy as preventive measure in women at risk for preeclampsia (PE). </span><b><span style="font-family:Verdana;">Design: </span></b><span style="font-family:Verdana;">A randomized clinical trial. </span><b><span style="font-family:Verdana;">Setting: </span></b><span style="font-family:Verdana;">Outpatient Obstetric clinic of Ain Shams University Maternity Hospital. </span><b><span style="font-family:Verdana;">Population or sample: </span></b><span style="font-family:Verdana;">Women at gestational age of </span></span><span style="font-family:""><span style="font-family:Verdana;">≤</span><span><span style="font-family:Verdana;">16 weeks who at risk for PE between June 2018 and June 2019. </span><b><span style="font-family:Verdana;">Methods:</span></b><span style="font-family:Verdana;"> Participants were randomly allocated into two groups: Group I Included 200 women who received a 25 mg tablet of oral sildenafil citrate tid until delivery plus 100 mg tablet of aspirin orally once daily until gestational age of 36 weeks, Group II Included 200 women who received a 100 mg tablet of aspirin orally once daily until gestational age of 36 weeks. </span><b><span style="font-family:Verdana;">Main Outcome Measures: </span></b><span style="font-family:Verdana;">Incidence of preeclampsia diagnosed per ACOG criteria. </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> The incidence of PE in both groups showed no statistically significant difference. The incidence of PE in the first group is 11.0%, and it is 12.0% in the second group (p-value 0.754). </span><b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"> The addition of sildenafil citrate to low dose aspirin had no impact on the prevention of
文摘We hereby present a short overview of the anaesthesiological considerations regarding the patient with Charcot-Marie-Tooth disease also known as hereditary muscle and sensory neuropathy, which affects peripheral nerves and muscles. Due to pathophysiology of the disease certain anaesthesiological complications associated with HMSN can be related. A case report describing protocol of the total venous anesthesia in the 17-year old patient operated on sacral dermoid with fistulae is presented. The patient recovered without any further complications. In the conclusion we would like to bring the importance of awareness to prepare the HMSN patient for a surgical procedure as well from anesthesiological as from surgical point of view to avoid possible unwanted event such as malignant hyperthermia, hyperkalemia, seizures, prolonged effect of muscle relaxants and worsening of the disease. As an important alternative to general anesthesia regional anesthesia should be considered.
文摘<strong>Purpose:</strong> We introduce the concept of intraoperative Trifecta during laparoscopic partial nephrectomy (LPN) as the simultaneous achievement of estimated blood loss (EBL) < 500 ml, warm ischemia time (WIT) < 20 minutes and minimal changes of the intraoperative course. The study’s aim was to find preoperative factors that could predict the likelihood of achieving intraoperative Trifecta and build a surgical nomogram. <strong>Methods:</strong> We retrospectively evaluated 122 patients who underwent LPN. Preoperative factors like age, sex, body-mass index (BMI), kidney function, tumor characteristics (R.E.N.A.L. score) and Charlson-Comorbidity-Index (CCI) were recorded. Intraoperative complication (IOC) was graded according to the Rosenthal classification. R software was used to find a predicting model for achievement of Trifecta using preoperative variables and a nomogram was built. <strong>Results: </strong>The surgical features include median EBL of 100 ml having 6.5% bleed > 500 ml, median WIT of 12 minutes having 7.3% more than 20 minutes. There was recorded a 12.3% IOC with a mean Rosenthal’s grade of 0.2. Intraoperative Trifecta was achieved in 105 patients (86%) and three preoperative factors were chosen for the predictive model: BMI (p = 0.041), CCI (p = 0.037) and RENAL score (p = 0.002). A nomogram was generated and the ROC-AUC of the model was 75.8%. <strong>Conclusion:</strong> We have defined an intraoperative Trifecta concept as the achievement of EBL < 500 ml, WIT < 20 minutes and minimal changes of the intraoperative course. A nomogram was developed from preoperative factors like BMI, CCI and R.E.N.A.L. score. It can be used to estimate the probability of Trifecta achievement in patients treated with LPN.
文摘<strong>Background:</strong> Breast reduction surgery is increasing in popularity, with so many techniques all around the world, and the community’s knowledge of the details of this procedure increases thanks to the Internet and easy access to information, which increases breast reduction reviews for plastic surgery clinics. Reduction mammaplasty is an established and effective technique to treat symptomatic macromastia. Variable rates of complications have been reported, and there is a continued need for better outcome assessment studies. <strong>Aim:</strong> The purpose of this study was to identify the complications occurred during the first year of breast reduction surgery. <strong>Materials and Methods:</strong> A prospective study over a 1-year period from October 2018 to October 2019, that included 32 patients who underwent breast reduction surgery using the same technique (inferior pedicle and inverted T scar) in the Department of Plastic Surgery at Al-Mouassat University Hospital, Damascus, Syria. Patients were followed through a whole year after surgery and complications that occurred were recorded. <strong>Results:</strong> Complications that occurred in 14 patients (43%), and, and were more common in patients with larger breasts and worse symptoms before surgery. The most common complication was delayed wound healing, and it was associated with breast volume before surgery and with smoking. In general, the most relevant factor influencing the incidence of complications was the weight of the resected breast tissue, which is mainly related to the size of the breast before surgery. <strong>Conclusion:</strong> The weight of the resected breast tissue was the most important factor influencing the occurrence of complications after breast reduction surgery. The most prevalent complication was delayed wound healing and it was associated with the weight of the removed tissue.
文摘<strong>Background:</strong> Transcatheter aortic valve implantation (TAVI) is a widely used treatment of severe aortic stenosis. Implantation of a self-expanding valve into a dense calcified aortic annulus can be challenging and may result in device malposition and malfunction.<strong> Aim: </strong>The aim of our case report is to present a novel technique of transcatheter aortic valve dislocation treatment. <strong>Case presentation:</strong> An 86-year-old woman with severely calcified aortic valve underwent TAVI using a 27-mm self-expanding Portico valve (Abbott Vasc, USA). In the last phase of implantation, the valve dislocated deep into the left ventricular outflow tract resulting in significant paravalvular regurgitation and patient instability. Repositioning of the valve with a single snare was ineffective because of severe aortic ring calcifications. A novel “double snare” technique was applied and the valve was successfully repositioned upward with an excellent anatomic and haemodynamic result. <strong>Conclusion:</strong> “Double snare” technique can be an effective strategy for repositioning of deeply implanted self-expanding transcatheter aortic valves. It represents an efficient bailout strategy in case of single snare approach failure, especially in cases of severe aortic ring calcifications.