bluuebunny/crossref_metadata_2025_split huggingface dataset:
Minimally Invasive Repair for Treating Pectus Excavatum — Early Results
Authors: Hurme T. , Savola J. , Vilkki V. 
Published: January 2017

Minimally invasive repair of pectus excavatum (MIRPE) is the preferred technique for repair of funnel chest deformity. The aim of this study is to evaluate our initial postoperative results, to identify factors related to postoperative complications and to examine the acceptability of MIRPE by the patients. Patients, Materials and Methods: 25 MIRPE patients (20 male and 5 female) were operated on between November 2002 and February 2007 at the Department of Pediatric Surgery, Turku University Central Hospital. The median age of the patients was 14 years (range from 5 to 23 years). One patient had undergone previously open Sulamaa reconstruction and one had a history of intrathoracic lymphoma. The remaining 23 patients had primary pectus excavatum. A right thoracoscopy was performed to every patient. Results: Operative mortality was zero and there were no clinically significant bleeding complications. Epidural analgesia was necessary for adequate pain control. Small symptomless residual pneumothoraxes and pleural effusions were common after the operation but neither required intervention. One patient had a hemothorax 7 months postoperatively, which was cured with a single puncture. Bar displacement took place in 2 patients but required correction in only one of these patients. There were 2 wound infections, one superficial and one which led to removal of the bar was 6 months after the operation. This may have been unnecessary. Two patients had pneumonia, one probably unrelated to the operation. One patient required psychiatric ward treatment, and 3 patients had mild psychological symptoms not requiring specific therapy. The preliminary cosmetic results were good or excellent in 90% of the cases, but a longer follow-up is needed for information on the final outcome. Conclusions: MIRPE is a safe operation and gives a cosmetically good result. Thoracoscopy is needed during the operation. The early postoperative period in hospital is painful and there the patients need intensive care. We found the high epidural analgesia beneficial and safe during early period of pain treatment. The bar is removed not earlier than 3 years after the operation as a day care surgical procedure.
Quality of Life after Emergency Vs. Elective Esophagectomy with Cervical Reconstruction
Authors: Schneider L. , Hartwig W. , Aulmann S. , Lenzen Ch , Strobel O. , Fritz S. , Hackert T. , Keller M. , Buchler M. W. , Werner J. 
Published: January 2017

Introduction: Esophagectomy with reconstruction by collar anastomosis has an impact on the patients' quality of life (QOL). The aim of this study was to explore a potential difference in QOL between elective and emergency esophagectomy with collar reconstruction. Patients and Methods: Quality of life questionnaires were evaluated in 17 patients prior to esophagectomy, shortly after surgery, hospital discharge, and at least > 9 months after surgery using the EORTC QLQ C30 and EORTC OES 18 forms. In all patients reconstruction was performed by high collar anastomosis. Patients in group A received elective esophageal resection. In group B emergency esophagectomy was performed because of esophageal perforation for various reasons apart from cancer. In this group, delayed reconstruction was performed in a second operation 3–6 months after esophagectomy. Results: There was a temporary decrease of postoperative QOL in both groups, which returned to preoperative values in the follow-up except for physical functioning, which remained decreased in group A (p < 0,05). There were no persisting differences in QOL after elective and emergency esophagectomy in the follow-up. Discussion: Patients with elective and emergency esophagectomy and reconstruction by high collar anastomosis gained a good long-term QOL in our cohort of patients. This gives evidence that the observed QOL after elective resection of esophageal cancer is not only caused by a relief of cancer burden, but also due to a surgical procedure which is able to provide a good long-term QOL.
Influence of Splenectomy on Morbidity of Esophageal Cancer Surgery
Authors: Aminian A. , Mirsharifi R. , Karimian F. , Khorgami Zh , Nasiri Sh , Yazdankhah-Konari A. , Alibakhshi A. 
Published: January 2017

Background and Aim: During esophagectomy, splenic injury may occur due to unintentional operative trauma, caused by excessive traction on the splenic ligaments or mis-placement of retractors. The role of spleen in immune system is well recognized and the addition of splenectomy to esophagectomy may increase the rate of complications. The goal of this study was to determine the influence of splenectomy on postoperative morbidity and mortality after esophageal resection for esophageal cancer. Materials and Methods: Between January 2001 and April 2006, 420 cases with esophageal cancer underwent esophagectomy in a referral cancer institute. In 14 patients (3.3%) splenectomy was added because of unwanted splenic injury during operation. In-hospital morbidities and mortality and hospital stay were compared between patients with and without concomitant splenectomy. Results: Although the overall complication rate in splenectomized patients was higher than other patients (43% vs. 30%), this figure was not statistically significant (P value: 0.3). Cervical anastomotic leakage occurred in 35.7% of splenectomized patients in comparison to 12.2% of control group (P value: 0.01, Odds Ratio: 3.93, CI95%: 1.27–12.2). There were no significant differences in cardiac and pulmonary complications, and in-hospital mortality rate between patients with and without splenectomy (P value > 0.05). Splenectomy did significantly affect post operative hospital stay (19 ± 13 vs. 13 ± 7 days, P value: 0.004). Conclusions: During esophagectomy, unplanned splenectomy may increase the incidence of anastomotic leakage and hospital stay. Therefore, whenever possible preservation of the spleen should be considered. An unexpected relationship between splenectomy and anastomotic leaks needs further investigation.
Infiltration of Wounds and Extraperitoneal Space with Local Anesthetic in Patients Undergoing Laparoscopic Totally Extraperitoneal Repair of Unilateral Inguinal Hernias: A Randomized Double-Blind Placebo-Controlled Trial
Authors: Abbas M. H. , Hamade A. , Choudhry M.N. , Hamza N. , Nadeem R. , Ammori B. J. 
Published: January 2017

Background: The potential analgesic benefit of infiltration of the wounds and extraperitoneal space with local anesthetic in patients undergoing laparoscopic totally extraperitoneal (TEP) repair of inguinal hernias remains unclear. Methods: Consenting adults scheduled to undergo laparoscopic TEP repair of unilateral inguinal hernias were recruited to this randomized double-blind placebo-controlled clinical trial of 0.25% bupivacaine (group I) versus saline (group II) infiltration of abdominal wounds and the extraperitoneal space. Pain scores were assessed at 4 and 24 hours postoperatively using the short-form MCGill pain questionnaire (SF-MPQ), the Present Pain Index (PPI) score and the visual analogue scale (VAS). The intravenous and oral analgesic requirements were recorded. Each patient completed questionnaire to assess their satisfaction with the postoperative analgesia. Results: 40 patients were randomized (group I, n = 20; group II, n = 20). The two groups were comparable for age, gender, body mass index, and operating time. Minor complications occurred in one patient in each group. There were no significant differences in the postoperative SF-MPQ scores, PPI and VAS at 4 hours (p = 0.413, p = 0.631, p = 0.615 respectively) and 24 hours (p = 0.116, p = 0.310, p = 0.100 respectively) post-operatively. The parenteral and oral analgesics consumed post-surgery were comparable (p = 0.605, p = 0.235). No difference was observed in the patient satisfaction scores. Conclusions: Infiltration of abdominal wounds and extraperitoneal space with bupivacaine in patients undergoing laparoscopic TEP repair of unilateral inguinal hernias does not appear to offer analgesic benefits.
Alendronate Reduces Periprosthetic Bone Loss after Uncemented Primary Total Hip Arthroplasty — A 5-Year Follow-up of 16 Patients
Authors: Tapaninen T. S. , Venesmaa P. K. , Jurvelin J. S. , Miettinen H. J. A. , Kröger H.P.J. 
Published: January 2017

Background and Aims: Periprosthetic bone loss, especially in the proximal part of the femur, is common after cemented and uncemented total hip arthroplasty (THA). Short-term studies suggest that bisphosponates can minimize this bone loss related to stress-shielding phenomenon. The aim of the present randomized study was to investigate whether the positive effect of a 6 months alendronate treatment postoperatively still exists at five-year follow up. Materials and Methods: Sixteen uncemented primary THA patients were randomized to receive either 10mg alendronate + 500 mg calcium (n = 7) or 500 mg calcium only (n = 9) daily for 6 months postoperatively. Periprosthetic bone mineral density (BMD) was measured with the dual X-ray absorptiometry (DXA) postoperatively and at 6, 12, 24, 36 and 60 months follow-up. Results: At the 5-year follow up, the calcium group showed mean BMD decreases of 23.1% (SD 14.6) in the proximal part of the femur (prROI) and 9.6% (SD 14.9) in total femoral regions of interest (totROI). In the alendronate group the corresponding BMD decreases were 13.6% (SD 19.0) and 3.9% (SD 7.6) respectively. The positive effect of alendronate was already demonstrated during the first six months postoperatively. Subsequently the bone loss was equal in both groups, and the 5-year BMD changes were not significantly different between the groups. Conclusions: Alendronate seems to decrease early periprosthetic bone loss after arthroplasty but this pilot study could not provide enough evidence that the positive effect noted in the early postoperative period is still maintained 5 years after the operation.
Pediatric Tibial Eminence Fractures: Arthroscopic Treatment Using K-Wire
Authors: Furlan D. , Pogorelić Z. , Biočić M. , Jurić I. , Meštrović J. 
Published: January 2017

Background: Fractures of the tibial intercondylar eminence are observed mostly in children and adolescents, often after minimal trauma. The purpose of this paper is to evaluate the use of K-wire fixation for the arthroscopic treatment of tibial eminence fractures in children. Patients and Methods: From January 2002 through January 2009 ten patients were treated arthroscopically because of the intercondylar eminence fracture in a Department of pediatric surgery, University Hospital Split. Arthroscopically controlled reposition was done, and using mobile X-ray two crossed K-wires were introduced percutaneously from the proximal part of the tibia to the fractured intercondylar eminence. Subjective outcome was obtained using IKDC subjective questionnaire. Results: Average hospitalization time was 11 days. Average duration of treatment was 12.5 weeks. Average follow-up was 42 months. Follow-up radiographs showed union in all cases. The mean IKDC subjective score was 96/100. Clinically, all patients exhibited a solid endpoint on the Lachman test. The global IKDC objective score was normal in eight knees and nearly normal in two knees. Conclusion: Arthroscopic reduction and fixation by Kirschner wires or a small fragment screw is the best way for treatment intercondylar tibial eminence fractures, in the pediatric population, because is not crossing the epiphyseal plate.
Early Complications after Nipple-Sparing Mastectomy and Immediate Breast Reconstruction with Silicone Prosthesis: Results of 214 Procedures
Authors: Radovanovic Z. , Radovanovic D. , Golubovic A. , Ivkovic-Kapicl T. , Bokorov B. , Mandic A. 
Published: January 2017

Background and Aims: Breast reconstruction with silicone prosthesis following nipple-sparing mastectomy has become widely accepted as a reconstruction option in women requiring mastectomy for cancer. The purpose of this study was to evaluate the incidence and some factors influencing early local complications in patients undergoing NSM with immediate implant reconstruction. Material and Methods: Prospective study was performed on a consecutive series of 214 breast reconstructions in 205 patients. All complications during the six weeks after surgery were recorded. 42 prostheses were implanted after neoadjuvant chemotherapy, 27 patients previously had radiotherapy due to breast conserving surgery and in all other cases surgery was the primary treatment for cancer. Results: The overall six-week complication rate was 16% (35) and included: major skin flap necrosis (4%, 9 procedures), minor skin necrosis (3%, 7), major infection (2%, 5), minor infection (3%, 7), prolonged seroma formation (3%, 6), haematoma (1%, 2) and epidermolysis (1%, 2). In 6% (12) reconstruction procedures explantation of prosthesis was done. Neoadjuvant chemotherapy and radiotherapy were not associated with higher rate of complications. Conclusion: Nipple-sparing mastectomy with immediate implant reconstruction has acceptable morbidity rate in the hand of experienced oncoplastic surgeon and therefore should be considered as treatment option to women requiring mastectomy.
Tension-Free by Mesh-Plug Technique for Inguinal Hernia Repair in Elderly Patients
Authors: Pavlidis T. E. , Symeonidis N. G. , Rafailidis S. F. , Psarras K. , Ballas K. D. , Baltatzis M. E. , Pavlidis E. T. , Marakis G. N. , Sakantamis A. K. 
Published: January 2017

Background: Elderly patients are steadily becoming a growing part of the population. The aim of this study is to evaluate the outcome of open inguinal hernia repair in patients aged over 65 years. Methods: From January 1999 to December 2008, a total of 719 patients underwent open tension-free inguinal hernia repair with mesh-plug; 301 among them were ≥ 65 years old. Results: Elderly patients had a mean age of 72.4 years (women 3.3%), while the mean age of younger patients was 48.7 years (women 5.7%). According to the ASA score, patients aged ≥ 65 years were at significantly higher risk than the younger patients. Spinal anesthesia was used most frequently in both groups. No significant differences were found in postoperative pain, mortality and recurrence. Morbidity and hospital stay were significantly higher in patients aged ≥ 65 years. Conclusions: Open hernia repair in the elderly is safe and well tolerated, but it is associated with higher morbidity and longer hospitalization.
Non-Absorbable Interrupted versus Absorbable Continuous Skin Closure in Pediatric Appendectomies
Authors: Pauniaho S.-L. , Lahdes-Vasama T. , Helminen M. T. , Iber T. , Mäkelä E. , Pajulo O. 
Published: January 2017

Background and Aims: Appendectomy wounds are still commonly closed with non-absorbable sutures. Stitch removal has financial costs and causes anxiety in children. Our aim was to compare interrupted non-absorbable (NA) and continuous intradermal absorbable (A) sutures in appendectomy wounds to evaluate whether absorbable suturing increases the risk of complications. Material and Methods: 198 children (age 4–18 years) including perforated cases were prospectively randomized into two groups (NA and A skin closure). The wounds and inflammatory markers were evaluated on the first two postoperative days. The appearance of the wound was evaluated one week postoperatively by a district nurse. Follow-up data were obtained from 166 patients (87 in NA group and 79 in A group). Results: In NA group 86 % and in A group 81 % had appendicitis (8 % and 15.6 % perforated and 9.3 % and 25 % gangrenous cases in NA and A groups, respectively). The total wound infection rate was low, 1.8 % (2.3 % in NA Group and 1.3% in A Group). No differences in the inflammatory markers or the appearance of the wound were noted between the groups, but nine children in NA Group (10.3 %) had a partial wound dehiscence after stitch removal. Conclusion: Appendectomy wounds in children can be closed with continuous, absorbable sutures, even in complicated cases.
Immunonutrition in Patients Undergoing Major Upper Gastrointestinal Surgery: A Prospective Double-Blind Randomised Controlled Study
Authors: Sodergren M. H. , Jethwa P. , Kumar S. , Duncan H. D. , Johns T. , Pearce C. B. 
Published: January 2017

Introduction: Current studies suggest immunonutrition decreases the inflammatory process, infection rates and reduces length of hospital stay in surgical patients, however studies are often conducted on heterogeneous groups of patients with varying composition of the immunonutrition. We aim to investigate the effect of immunonutrition on patients undergoing major upper gastrointestinal surgery by assessment of (i) the inflammatory and immune response and (ii) changes in clinical outcome when compared to a randomised control receiving conventional feeding. Method: A prospective double-blind randomised controlled study was undertaken to compare a feed supplemented with glutamine, arginine, ω-3 fatty acids and tributyrin, vitamin C, E and B-carotene and micronutrients (zinc, selenium and chromium) to an isonitrogenous, isocaloric control feed in patients undergoing major upper GI surgery. The primary end-points were defined as C-reactive protein (CRP), prealbumin and retinol binding protein (RBP) levels. Secondary end-points included performance scoring systems, length of hospital stay, adverse events and protein and nutrient assays. Variables were measured pre-operatively and routinely up to the 4th post-operative day. Results: There was no statistically significant change in primary end-points between the immunonutrition group and the control group. There was no difference in length of hospital stay between the groups. The vitamin C level in the study group was significantly higher at the end of the study period. Both groups tolerated the feeds well with adequate target feeding rate. There were no other significant changes in clinical outcomes between the two groups. Conclusion: This study has not shown a benefit of immunonutrition through changes in inflammatory or nutritional markers, a decrease in length of hospital stay, or other morbidity. This may be because of inadequate numbers recruited to the study. Further, multi-centre, randomised trials on homogeneous patient groups are necessary to investigate the role of immunonutrition in major upper GI surgery.
Quality of Life in Patients Operated for Pelvic Fractures Caused by Suicide Attempt by Jumping
Authors: Borg T. , Holstad M. , Larsson S. 
Published: January 2017

Background and Aims: Jumping from great height is an aggressive method of suicide attempt where the frequent combination of psychiatric disorder and somatic injuries makes treatment difficult. Our aim was to evaluate survival rate and get patient-reported outcome in patients operated for a pelvic or acetabular fracture sustained when jumping from a height as a suicide attempt. Patients and Methods: During the period 2003–2004, 12 patients (11 women) of whom eight were below 30 years of age, were prospectively included. At two years HRQoL (Health-Related Quality of Life) questionnaires (SF-36 and LiSat-11) were used to describe outcome, and at four years a structured psychiatric interview SCID-I (Structured Clinical Interview for DSM-IV Axis I Disorders) was done. Results: At four years all patients were alive. One patient had made a new suicide attempt. Eight patients gave adequate reply on SF-36 and LiSat-11 at two years. In all domains patients scored lower than a norm group with the relatively lowest values in physical domains. Younger patients assessed life as better when compared with middle aged patients. Conclusions: This study showed a very low recurrence rate into suicidal behaviour in a group of jumpers and all patients were alive at four years after a suicidal attempt by jumping. The high proportion of psychiatric disorder in these patients highlights the need for a combined treatment effort between orthopaedic and psychiatric expertise.
Cold Intolerance after Flexor Tendon Injury. Disposing Factors and Long Term Prognosis
Authors: Lied L. , Lydersen S. , Finsen V. 
Published: January 2017

Background and Aims: Cold intolerance after hand injuries is often debilitating. We wished to determine what factors make it more likely to occur and whether it improves or worsens with time. Patients and Methods: We retrospectively studied 103 patients who had sustained a simple cut leading to a flexor tendon injury in the finger between 3 months and 20 years earlier. A total of 48 had also injured a digital nerve. At review patients indicated on a VAS scale their discomfort during the first winter after injury and the last winter before review and also gave a VAS evaluation of pain in the hand after keeping it in a bath of water at 1–4 degrees centigrade for 60 seconds. Results: Cold sensitivity during the first winter after injury was reported by 66% patients. Its development was unrelated to the age at injury. The proportions of smokers, injury of more than one finger, and re-operation or with postoperative complications were significantly higher among patients with cold sensitivity. At review 49% indicated that they had improved, 41% that cold sensitivity was unchanged and 10% that they were worse. Conclusions: Standardized immersion in cold water showed that on average cold sensitivity was slightly worse with time.
Impact of Perceptual Ability and Mental Imagery Training on Simulated Laparoscopic Knot-Tying in Surgical Novices Using a Nissen Fundoplication Model
Authors: Jungmann F. , Gockel I. , Hecht H. , Kuhr K. , Räsänen J. , Sihvo E. , Lang H. 
Published: January 2017

Background: Performing minimally invasive surgery requires training and visual-spatial intelligence. The aim of our study was to examine the impact of visual-spatial perception and additional mental training on the simulated laparoscopic knot-tying task performed by surgical novices. Methods: A total of 40 medical students randomly assigned to two groups underwent two sessions of laparoscopic basic training on a VR simulator (SimSurgery®, Oslo, Norway). The variables time and tip trajectory (total path length of the instrument tip trajectory) were used to assess the performance of the intracorporeal knot-tying task using a laparoscopic Nissen fundoplication model. The experimental group completed additional mental practice during the interval between the two training sessions. All performed a cube subtest of a standard intelligence test (I-S-T 2000 R) to evaluate visual-spatial ability. Results: All participants achieved an improvement in time ( t = 9.861; p < 0.001) and tip trajectory ( t = 6.833; p < 0.001) in the second training session. High scores on the visual-spatial test correlated with a faster performance ( r = −0.557; p < 0.001) and more precise movements ( r = −0.377; p = 0.016). Comparison of the two groups did not show any statistical significant differences in the parameters time and tip trajectory. Conclusions: Visual-spatial intelligence tested by a cube test correlated with simulated laparoscopic knot-tying skills in surgical novices. Additional mental practice did not improve the overall knot-tying performance. Further studies are therefore required to determine whether mental practice might be beneficial for experienced laparoscopic surgeons or for more complex tasks.