Extensión del empleo del criterio de expertos. Validez, consistencia y fiabilidad de los resultados científicos

El criterio (juicio o consulta) de expertos, en las últimas décadas, ha sido ampliamente utilizado en las investigaciones cualitativas, puede decirse que para muchos investigadores constituye la "regla de oro" para validar sus hallazgos. El propósito del artículo consistió en proponer un procedimiento para el procesamiento estadístico de los datos cuando se emplea una extensión del método convencional del criterio de expertos, para establecer la validez, consistencia y fiabilidad en los hallazgos científicos. El mismo fue aplicado en la toma de decisiones de una de las tres dimensiones de la variable de los componentes del ejercicio problémico interdisciplinario del proceso de enseñanza-aprendizaje. En el proceso investigativo se utilizaron métodos empíricos como la revisión de documentos, la encuesta y el criterio de expertos. Los tests estadísticos aplicados arrojaron significación estadística (P < 0.05 hasta P < 0.001) entre las comparaciones y/o asociaciones realizadas. Los hallazgos encontrados demostraron, al aplicar el procedimiento, una aproximación hacia la validez, consistencia y fiabilidad de los resultados científicos.

O julgamento de especialistas (julgamento ou consulta) tem sido, nas últimas décadas, amplamente utilizado em pesquisas qualitativas, indiscutivelmente o "padrão ouro" para muitos pesquisadores validarem suas descobertas. O objetivo do artigo foi propor um procedimento para o processamento estatístico de dados ao usar uma extensão do método convencional de julgamento de especialistas para estabelecer validade, consistência e confiabilidade em descobertas científicas. Ele foi aplicado na tomada de decisão de uma das três dimensões dos componentes variáveis do exercício interdisciplinar de solução de problemas do processo de ensino-aprendizagem. Métodos empíricos, como análise de documentos, pesquisa e julgamento de especialistas, foram usados no processo de pesquisa. Os testes estatísticos aplicados mostraram significância estatística (P < 0,05 a P < 0,001) entre as comparações e/ou associações feitas. Os resultados demonstraram, ao aplicar o procedimento, uma abordagem voltada para a validade, a consistência e a confiabilidade dos resultados científicos.

In recent decades, expert judgment has been widely used in qualitative research, and it can be said that for many researchers it constitutes the "golden rule" for validating their findings. The purpose of the article was to propose a procedure for the statistical processing of data when an extension of the conventional method of expert judgment is used to establish the validity, consistency and reliability of scientific findings. It was applied in the decision making of one of the three dimensions of the variable of the components of the interdisciplinary problem-solving exercise of the teaching-learning process. Empirical methods such as document review, survey and expert judgment were used in the research process. The statistical tests applied showed statistical significance (P < 0.05 to P < 0.001) among the comparisons and/or associations made. The findings found demonstrated, when applying the procedure, an approach towards the validity, consistency and reliability of the scientific results.

Procedimiento de evaluación de la fase inicial del tiro libre del baloncesto

El procedimiento que se presenta se elaboró con el objetivo de determinar indicadores para la evaluación de la fase inicial del tiro libre del baloncesto, en la categoría 9-10 años. En la confección del mismo, se tuvieron en cuenta los bajos porcientos de efectividad tanto en intentados y anotados, como las deficiencias en la ejecución obtenidas en el estudio preliminar, realizado a 120 niños de la zona occidental, con un dominio de solo el 25 % de los aspectos biomecánicos a alcanzar, en el proceso de enseñanza; ello constituyó una de las principales motivaciones para la confección del procedimiento evaluativo. El análisis documental, la observación a través de guías estructuradas y las técnicas de videografía, así como la entrevista, permitieron detectar las insuficiencias en la evaluación de la ejecución del tiro libre en la iniciación deportiva. En el trabajo, se realizó la valoración, mediante criterio de especialistas y criterio de usuarios, y deja abierto un espacio para ampliar acciones de orden metodológico y de carácter científico, técnico, fisiológico, teórico y psicológico que sirvan al desarrollo de los profesores y entrenadores de base.

O procedimento apresentado foi elaborado com o objetivo de determinar indicadores para a avaliação da fase inicial do lance livre no basquetebol, na categoria de 9 a 10 anos de idade. Em sua elaboração, foram levados em conta os baixos percentuais de eficácia tanto nos arremessos tentados como nos arremessos marcados, bem como as deficiências na execução obtidas no estudo preliminar, realizado em 120 crianças da zona oeste, com um domínio de apenas 25% dos aspectos biomecânicos a serem alcançados no processo de ensino; isso constituiu uma das principais motivações para a elaboração do procedimento de avaliação. A análise documental, a observação por meio de guias estruturados e técnicas de videografia, bem como a entrevista, permitiram detectar as insuficiências na avaliação da execução do lance livre na iniciação esportiva. No trabalho, a avaliação foi realizada por meio de critérios de especialistas e critérios de usuários, e deixa um espaço aberto para ampliar ações de ordem metodológica e de natureza científica, técnica, fisiológica, teórica e psicológica que sirvam ao desenvolvimento de professores e treinadores de base.

The procedure presented was developed with the objective of determining indicators for the evaluation of the initial phase of the basketball free throw, in the 9-10-year-old category. In its preparation, the low percentages of effectiveness in both attempted and scored were taken into account, as well as the deficiencies in execution obtained in the preliminary study, carried out on 120 children from the western zone, with a mastery of only 25% of the biomechanical aspects to be achieved in the teaching process; this constituted one of the main motivations for the preparation of the evaluation procedure. The documentary analysis, observation through structured guides and videography techniques, as well as the interview, made it possible to detect insufficiencies in the evaluation of the execution of the free throw in sports initiation. In the work, the assessment was carried out, through the criteria of specialists and the criteria of users, and leaves open a space to expand actions of a methodological order and of a scientific, technical, physiological, theoretical and psychological nature that serve the development of teachers and coaches. base.

Fijación externa en pacientes pediátricos con fracturas supracondíleas del húmero

Introducción: Las fracturas supracondíleas del húmero en el niño son por lo general de tratamiento quirúrgico, mediante reducción cerrada o abierta asociada a la colocación de alambres. Por su parte, la fijación externa es una opción aceptada en ciertas circunstancias. Objetivo: Actualizar sobre el uso de la fijación externa en pacientes con fractura supracondílea del húmero en el niño. Métodos: Se realizó una búsqueda y análisis de la información en un periodo de 61 días (primero de junio al 31 de julio de 2023) y se emplearon las siguientes palabras: pediatric supracondylar humeral fractures AND external fixation, external fixation AND elbow, complex fractures AND pediatric supracondylar. A partir de la información obtenida se realizó una revisión bibliográfica de un total de 177 artículos publicados en las bases de datos PubMed, Hinari, SciELO y Medline mediante el gestor de búsqueda y administrador de referencias EndNote. De ellos, se utilizaron 34 citas seleccionadas para realizar la revisión, 32 de los últimos cinco años. Resultados: Se hizo referencia a las indicaciones y contraindicaciones, además de las ventajas de la fijación externa. Se mencionaron las principales diferencias entre la fijación con alambres de Kirschner y la fijación externa. Se expuso la técnica en cinco pasos. Se plasmaron los cuidados posoperatorios, complicaciones y comentarios sobre los resultados. Conclusiones: La fijación externa constituye una modalidad de tratamiento efectiva para pacientes pediátricos con patrones de fractura complejos. Es una técnica factible de realizar y reproducir. Los resultados son iguales o superiores al ser comparados con las otras modalidades quirúrgicas.

Introduction: Supracondylar humerus fractures in children are generally treated surgically, through closed or open reduction associated with placement of the wires. For its part, external fixation is an accepted option in certain circumstances. Objective: To update on the use of external fixation in patients with supracondylar fracture of the humerus in children. Methods: The search and analysis of the information was carried out in a period of 61 days (June 1st to July 31st, 2023) and the following words were used: pediatric supracondylar humeral fractures AND external fixation, external fixation AND elbow, complex fractures AND pediatric supracondylar. Based on the information obtained, a bibliographic review of a total of 177 articles published in the PubMed, Hinari, SciELO and Medline databases was carried out using the EndNote search engine and reference administrator. Of these, 34 selected citations were used to carry out the review, 32 of the last five years. Results: References are made to the indications and contraindications, in addition to the advantages of external fixation. The main differences between Kirschner wire fixation and external fixation are mentioned. The technique is exposed in five steps. Postoperative care, complications and comments on the results are reflected. Conclusions: External fixation is an effective treatment modality for pediatric patients with complex fracture patterns. It is a feasible technique to perform and reproduce. The results are equal or superior when compared with other surgical modalities.

Application of Cut-and-Sew Technique in Thoracoscopic Minimally Invasive Mitral Valve Surgery and Concomitant Maze Procedure

ABSTRACT Introduction: Atrial fibrillation is one of the common complications of mitral valve disease. Currently, in the absence of freezing equipment, it's still impossible to fully conduct a minimally invasive Cox-maze IV procedure to treat atrial fibrillation. Methods: We analyzed the clinical data of 28 patients who underwent thoracoscopic minimally invasive mitral valve full maze surgery in our hospital from October 2021 to September 2022; 13 patients were male and 15 were female, three suffered from paroxysmal atrial fibrillation, and 25 suffered from permanent atrial fibrillation; average age was 61.88±8.30 years, and mean preoperative left atrial diameter was 47.12±8.34 mm. Isolation of left atrial posterior wall (box lesion) was completed in all patients by cut-and-sew technique and bipolar clamp ablation. Results: For these subjects, the median cardiopulmonary bypass time was 169 (109.75-202.75) minutes, aortic cross-clamping time was 106 (77.75-125.50) minutes, and ventilator assistance time was 6.5 (0-10) hours. Among them, eight subjects had the endotracheal tubes removed immediately after surgical operation. Three subjects were in the blanking period; two subjects still had atrial fibrillation at three months after operation, one of whom resumed sinus rhythm after electrical cardioversion therapy; and all the remaining 23 subjects had sinus rhythm. Conclusion: The minimally invasive cut-and-sew technique for electrical isolation of left pulmonary veins can improve sinus conversion rate of patients suffering from both mitral valve disease and atrial fibrillation. In selected subjects, it is safe and has good results in the short-term postoperative period.

Surgical treatment of Stanford type A aortic dissection after coronary artery stenting / 中国胸心血管外科临床杂志

@#Objective    To retrospectively analyze the surgical treatment of Stanford type A aortic dissection after coronary artery stenting, and to explore the surgical techniques and surgical indications. Methods    Clinical data of 1 246 consecutive patients who underwent operations on Stanford type A aortic dissection from April 2016 to July 2019 in Beijing Anzhen Hospital were retrospectively analyzed. Patients with Stanford type A aortic dissection after coronary artery stenting were enrolled. Results    Finally 19 patients were collected, including 16 males and 3 females with an average age of 54±7 years ranging from 35 to 66 years. There were 11 patients in acute phase, 15 patients with AC (DeBakey Ⅰ) type and 4 patients with AS (DeBakey Ⅱ) type. In AC type, there were 10 patients receiving Sun's surgery and 5 patients partial arch replacement. Meanwhile, coronary artery bypass grafting was performed in 7 patients and mitral valve replacement in 1 patient. Stents were removed from the right coronary artery in 4 patients. In this group, 1 patient died of multiple organ failure in hospital after operation combined with malperfusion of viscera. Eighteen patients recovered after treatment and were discharged from hospital. The patients were followed up for 30 (18-56) months. One patient underwent aortic pseudoaneurysm resection, one thoracic endovascular aortic repair, one emergency percutaneous coronary intervention due to left main artery stent occlusion, and one underwent femoral artery bypass due to iliac artery occlusion. Conclusion    Iatrogenic aortic dissection has a high probability of coronary artery bypass grafting at the same time in patients with Stanford type A aortic dissection after coronary artery stenting. Complicated type A aortic dissection after percutaneous coronary intervention should be treated with surgery aggressively.

Assessment of functional outcome following Duhamel retro-rectal pull-through surgery for Hirschsprung's disease: a follow-up study

Context: Hirschsprung's disease (HD) is one of the commonest problems requiring surgery in children. More than 95% of children present during new-born period, when they are treated with leveling colostomy and are followed with pull-through surgery a few months later, once the child has gained adequate weight to withstand a major surgery. The commonest pull through surgery done is the Duhamel retro-rectal pull-through (DRPT) repair. Settings and Design: This is a retrospective study of children who presented to one unit in our institute, a tertiary care referral hospital for children less than 12 years, with HD and underwent DRPT procedure during the period between July 2017 to June 2020. The children were evaluated after three years of follow-up for fecal incontinence and constipation. The study was conducted in children diagnosed with classical segment recto-sigmoid HD who underwent surgery. The children who were diagnosed with HD other than classical segment, who underwent primary pull through surgery and who underwent other repairs for HD were excluded from the study. Results: Thirty-two children underwent DRPT procedure during the study period. Of them, five (15.6%) children were lost on follow-up and one (3.1%) child had expired in the immediate post-operative period. Twenty-six children were included in the study. The bowel function score was calculated. The mean age of definitive surgery was 4.2 years. The follow-up period was a minimum of three years. Only two children had a "good" score of eighteen and above. Nineteen children had a "fair" score of 13-17. Five children had a "poor" score of less than thirteen, and among them, two had a "very poor" score of less than nine. The mean BFS was 13.72. Conclusions: Functional outcomes following Duhamel procedure are satisfactory, with 7.7% of children are in the fringe of requiring another surgery for constipation and pseudo-incontinence. (AU)

Cirugía de Ross en Chile: Tasa libre de reoperación y supervivencia global en una cohorte de más de 10 años de seguimiento

Antecedentes: El autoinjerto de válvula pulmonar (VP) u operación de Ross (OpR) tiene excelentes resultados a largo plazo. Es superior a otros tipos de reemplazo valvular en jóvenes adultos, aunque no el estándar de primera línea. Un tiempo quirúrgico prolongado o alta morbimortalidad son importantes preocupaciones. Objetivos: Establecer la morbimortalidad asociada a la OpR por un período >10 años, considerando el tiempo quirúrgico, tasa de reoperación y supervivencia global (SG). Métodos: Cohorte prospectiva (1996-2012), en seguimiento hasta agosto-2023. La SG fue estimada desde la OpR hasta la última consulta o deceso. Mediante regresión de Cox (Hazard Ratio, HR) se estimaron factores asociados a la SG. Resultados: La serie consta de 161 pacientes: 118 de etiología congénita (73.3%), 17 infecciosa (10.6%), 26 reumática (16.1%). La lesión fue estenótica en 79 (49.1%), insuficiencia en 40 (24.8%), mixta en 42 (26.1%). La OpR fue urgente en 11 (6.8%). The median time of ECC and the operation was 149 y 232 minutos, respectivamente. Veintisiete pacientes requirieron reoperación (16.8%). Con una mediana de 19.7 años (17.2-22.2), 23 pacientes fallecieron (14.3%): 1/23 asociado a OpR, 17/23 por causa cardiovascular y 5/23 por causas no cardiovasculares. La lesión mixta se asoció a mayor mortalidad (HR 3.07; IC 95% 1.11-8.47; p=.029). Conclusiones: La OpR es un procedimiento con baja morbimortalidad. La lesión mixta es un factor de riesgo independiente de mayor mortalidad. Sin embargo, la mediana de tiempo de CEC y quirúrgico es prolongado frente a otras técnicas de reemplazo valvular.

Background: Pulmonary valve (PV) autograftor reoperation or Ross surgery (RS), presents excellent long-term results. It is superior to other types of PV replacement in young adults, although it is not the first-line gold standard. A longer operative time or high morbidity and mortality rates are important concerns. Aim: To establish the morbidity and mortality associated with RS for >10 years, considering operative time, reoperation rate and overall survival (OS). Methods: Prospective cohort (1996-2012), with a follow-up until August/2023. The OS was estimated from RS to the last consultation/death. Factors associated to OS were estimated using Cox regression (Hazard Ratio, HR) Results: 161 patients were included: the etiology was congenital (118, 73%), infectious (17, 10.6%), and rheumatic (26,16.1%). The lesion was stenotic in 79 (49.1%), heart failure in 40 (24.8%), mixed in 42 (26.1%). RS was urgent in 11 (6.8%). Extracorporeal circulation (ECC) and operative times were 149 and 232 minutes, respectively. Twenty-seven patients required reoperation (16.8%). With a median follow up of 19.7 years (17.2-22.2), 23 patients died (14.3%): 1/23 associated with RS, 17/23 due to cardiovascular causes, and 5/23 due to non-cardiovascular causes. Mixed injury was associated with higher mortality (HR 3.07; 95% CI 1.11-8.47; p=.029). Conclusions: RS is a procedure with low morbidity and mortality. Mixed injury is an independent risk factor for increased mortality. However, the median ECC and operative times were higher compared to other valvular replacement techniques.

Aortic valve reconstruction surgery with Ozaki technique: initials results from a single center / Cirugía de reconstrucción de válvula aórtica con técnica de Ozaki: resultados iniciales en un centro de referencia

Abstract Background: Aortic valve (AV) replacement is the gold standard treatment for severe symptomatic AV disease. Recently, AV reconstruction surgery (Ozaki procedure) emerges as a surgical alternative with good results in the medium term. Methods: We retrospectively analyzed 37 patients who underwent AV reconstruction surgery between January 2018 and June 2020 in a national reference center in Lima, Peru. The median age was 62 years, interquartile range (IQR: 42-68). The main indication for surgery was AV stenosis (62.2%), in most cases due to bicuspid valve (19 patients, 51.4%). Twenty-two (59.4%) patients had another pathology with surgical indication associated to AV disease, 8 (21.6%) had dilatation of the ascending aorta with indication for replacement. Results: One in-hospital death occurred (1/38, 2.7%) due to perioperative myocardial infarction. There was a significant reduction in the medians of the peak (70 mmHg, CI 95% = 50.03-79.86 vs. 14 mmHg, CI 95% = 11.93-17.5, p < 0.0001) and mean (45.5 mmHg CI 95% = 30.6-49.68 vs. 7 mmHg, CI 95% = 5.93-9.6, p < 0.0001) AV gradients when we compared baseline characteristics with first 30-days results. In an average of 19 (± 8.9) months of follow-up, survival, reoperation-free survival for valve dysfunction, and survival free of AV insufficiency ≥ II were 97.3%, 100% and 91.9%, respectively. Significant reduction in the medians of the peak and mean AV gradients was maintained. Conclusions: AV reconstruction surgery showed optimal results in term of mortality, reoperation-free survival, and hemodynamic characteristics of the neo-AV.

Resumen Introducción: El reemplazo de la válvula aórtica es el tratamiento de elección para la valvulopatía aórtica severa sintomática. Recientemente, la cirugía de reconstrucción valvular aórtica (procedimiento de Ozaki) emerge como una alternativa quirúrgica con buenos resultados a mediano plazo. Métodos: Analizamos retrospectivamente 37 pacientes intervenidos de reconstrucción de válvula aórtica entre enero de 2018 y junio de 2020 en un centro de referencia nacional en Lima, Perú. La mediana de edad fue de 62 años (rango intercuartílico: 42-68). La estenosis de la válvula fue la principal indicación de cirugía (62.2%), en la mayoría de los casos por válvula bicúspide (19 pacientes, 51.4%). 22 (59.4%) pacientes presentaban otra patología con indicación de cirugía, 8 (21.6%) presentaban dilatación de la aorta ascendente con indicación de reemplazo. Resultados: La mortalidad intrahospitalaria fue de 1/38, 2.7%, por infarto de miocardio perioperatorio. Hubo una reducción significativa en las medianas del gradiente máximo (70 mmHg, IC 95% = 50.03-79.86 vs. 14 mmHg, IC 95% = 11.93-17.5, p < 0.0001) y gradiente medio (45.5 mmHg IC 95% = 30.6-49.68 vs. 7 mmHg, IC 95% = 5.93-9.6, p < 0.0001) de la válvula aórtica cuando comparamos las características basales con los resultados de los primeros 30 días. En una media de 19 (± 8.9) meses de seguimiento la sobrevida fue del 97.3%; la sobrevida libre de reoperación por disfunción valvular, 100% y la sobrevida libre de insuficiencia aórtica ≥ II, 91.9%, respectivamente. Se mantuvo una reducción significativa en las medianas de los gradientes máximo y medio de la válvula aórtica. Conclusiones: La cirugía de reconstrucción de válvula aórtica con pericardio autólogo mostró resultados óptimos en términos de mortalidad, supervivencia libre de reoperación y características hemodinámicas de la neo-válvula.

Endoscopic or Microscopic Tympanoplasty Advantages and Disadvantages: A Theory Domain Systematic Review

Abstract Introduction Tympanoplasty is a reparative surgery that has multiple indications. The aid of a microscope or an endoscope is necessary to carry out the procedure. The classic method utilizes the microscope; however, in the recent decades, the endoscope has been popular. Although many articles try to compare these two techniques, there is still no robust evidence that confirms the superiority of either technique. In the present work, we seek to perform a systematic review contribute with this discussion. Objectives The present systematic review attempted to compare endoscopic and microscopic surgery techniques and to discover whether there would be superiority in the results of any of them, based on data currently available in the literature. Data Synthesis The objectives of the present review were organized according to the PICO planning and strategy adapted for systematic reviews. The inclusion and exclusion criteria were established aiming to select only select primary data. The main medical databases were searched usingan optimized search string with appropriate descriptors. The searched databases were MEDLINE, LILACS, SciELO, and EMBASE. A total of 99 studies were selected and 38 were fully assessed after the inclusion criteria were applied. All included articles were reviewed by all authors and their results were discussed and summarized. Conclusion The endoscopic technique was shown to be a safer technique comparable in effectiveness to the use of microscopy. In addition, it provides possible advantages such as shortening the surgical time and better postoperative pain outcomes.

Temporary stomas after rectal cancer resection; predilection of being permanent and predictors of complications?

Stomas are essential for colorectal surgery and are widely used not only for selected cases for bowel obstructions but also in rectal cancer operations to divert stool away from low rectal anastomosis. On the other hand, complications with stomas/ stomas reversal are not uncommon. In this study, we aimed at studying the frequency and the predictors of temporary stomas being permanent, and the contributing factors of surgical stoma/stoma closure related complications. In our cohort, only about 40% of the patient closed their initially planned temporary stomas. The occurrence of intestinal leak, wound sepsis, or any type of morbidity with 30 days of operation were significant predictors of permanent stomas. In addition, alarmingly although Hartmann's procedure was uncommon in our practice, only 9% of those who underwent Hartmann's have had it reversed. Moreover, the only factor that significantly increased stoma related complications was having an end colostomy. There was a tendency toward late closure of stomas with median 8.2 months, however early closure did not correlate to complications. In conclusion, further studies are needed to delineate the low rate of stoma closure. Patients who develop postoperative complications, even wound sepsis, would be at a higher risk of living with permanent stomas. Hartmann's procedures are commonly associated with stoma problems, and reluctance to reverse the stomas. (AU)

Evaluation of Clinical & Functional Outcomes Bristow Latarjet Procedure in the Management of Recurrent Anterior Shoulder Dislocation

Background: Glenohumeral joint is highly susceptible to dislocation due to its wide range of movements. Recurrent anterior shoulder dislocations are common in young adults. The Bristow Latarjet procedure is one of the effective techniques for the treatment of recurrent anterior shoulder dislocation. This study aimed to assess the clinical and functional outcome of the Bristow Latarjet procedure in the management of recurrent anterior shoulder dislocation. Material & Methods: This prospective interventional study was conducted in the Department of Orthopaedic Surgery, BSMMU, from October 2017 to September 2019. Within this period, a total of 40 cases of recurrent anterior shoulder dislocation that meet inclusion criteria were taken as a sample. Patients were evaluated both pre and postoperatively for functional outcomes according to Rowe’s score for instability. A purposive non-randomized sampling technique was used in this study. All the data were compiled and sorted properly and the quantitative data were analyzed statistically by using Statistical Package for Social Science (SPSS-25). The results were expressed as frequency, percentage and mean ± SD. Paired Student’s‘t’ test was performed to compare pre and final postoperative follow-up. The level of significance was calculated at a confidence interval of 95% and p-value <0.05. Results: : In this study age of the patient ranged from 18-40 years and the mean age was 28.2±6.3. 29(72.5). Surgery was done within 4-6 months of the first dislocation in 5 patients, within 6-12 months in 21 patients and after 12 months in 14 patients. The mean (±SD) Rowe score for instability was significantly (p<0.001) higher 6 months after the Bristow Latarjet procedure at 91.87(±9.00) in comparison to preoperative periods 52.62(±18.40). Results were excellent in 32(80%), good in 4(10%), fair in 3(7.5%) and poor in 1(2.5%) patients. 36(90%) patients were in the satisfactory group and only 4(10%) in the unsatisfactory group. Only 1(2.5%) patient developed screw migration, 2(5%) patients developed subluxation, and 1(2.5%) patient developed postoperative arthritis. Conclusion: It can be concluded that the Bristow-Latarjet procedure is a very effective and safe procedure with reduced complications, presenting very satisfactory functional results in the treatment of recurrent anterior shoulder dislocation.

Use of Extracorporeal Membrane Oxygenation and Cerebral Oximetry in a Stage 1 Norwood Repair for Hypoplastic Left Heart Syndrome

The role of extracorporeal membrane oxygenation (ECMO) and its indications in stage I Norwood palliation are controversial. The decision to initiate ECMO and its timing remains difficult with no definitive cut?off points or evidence?based guidelines. It varies on a case?to?case basis. We report a case where the use of ECMO was beneficial after stage I Norwood palliation with severe ventricular dysfunction. The systemic?to?pulmonary artery shunt was kept open to balance the systemic and pulmonary circulations. Cerebral oximetry can be useful as an additional monitoring modality to guide management, monitor cerebral perfusion, and help detect cerebral steal.

Accessory right hepatic artery and its significance for a surgeon: A case report

Right hepatic artery (RHA) is a branch of the common hepatic artery; however, there are cases documented in the literature showing anatomical variations. Accessory RHA is an incidental finding during hepatobiliary and pancreatic surgery. This artery should be identified, carefully separated, and preserved during these surgeries. We encounter the variation while doing Whipple’s procedure in a 61-year-old patient diagnosed with carcinoma of the head of the pancreas. Intra-operatively, accessory RHA was present which was arising from the superior mesenteric artery. It was identified, carefully separated, and preserved. Variations in the origin of the artery may make it vulnerable to injuries during surgical procedures if due care is not taken

Outcomes of endoscopic percutaneous suture lateralization for neonatal and infantal bilateral vocal ford paralysis

Abstract Objective: Bilateral Vocal Fold Paralysis (BVFP) is a rare but significant resource of respiratory distress in neonates and infants. The objective of this study was to evaluate the efficacy and functional outcomes of Endoscopic Percutaneous Suture Lateralization (EPSL) for the treatment of BVFP in neonates and infants. Methods: A case series study of nine patients undergoing EPSL for BVFP between January 2019 and June 2021 was conducted. All patients were candidates for tracheostomy prior to EPSL. Demographic features including gender, age at diagnosis and surgery, main symptoms, airway comorbidities, airway support, and etiology were collected preoperatively. Patients were evaluated for breathing, swallowing and phonation postoperatively. Surgical success was defined as the ability to avoid tracheostomy. Functional Endoscopic Evaluation of Swallowing (FEES) was conducted to identify aspiration. Voice evaluation was based on clinical observation. Results: Nine patients underwent ten EPSL procedures (one in the left vocal fold, and nine in the right vocal fold). Eight patients (8/9) were able to successfully avoid tracheostomy and feed orally without aspiration after the procedure. One patient experienced clinical improvement in respiratory support requirements and underwent laparoscopic nissen and gastrostomy tube placement. At the last follow-up, two patients regained normal voice, two patients had mild dysphonia, and five patients had moderate dysphonia. Five patients showed partial return of the contralateral vocal fold function. Conclusion: EPSL is an effective and safe treatment for neonatal and infantal BVFP, which enables patients free from tracheostomy without significant impact on swallowing function or phonation. Level of evidence: Level 4.

Williams?Beuren Syndrome with Pseudoaneurysm of Aortic Arch and Infective Vegetations for Modified Broms Procedure: Anesthetic Concerns & Echocardiographic Illustrations

Williams?Beuren syndrome is a rare genetic malformation with predilection for supravalvular aortic stenosis. Apart from cardiovascular malformation, hypocalcemia, developmental delay, and elfin facies, challenging airway make perioperative management more eventful. Association of infective endocarditis within the aortic arch and pseudoaneurysm formation is infrequent. We, hereby report a case of pseudoaneurysm formation and infective vegetation within the aortic arch in a patient with Williams syndrome and the role of transthoracic echocardiography in its perioperative management.

COVID-19 Impact on Operative Management of Pediatric Neck Abscesses

Abstract Introduction For multiple reasons, elective pediatric otolaryngology surgical procedures have declined during the COVID-19 pandemic. Objective The purpose of the present study was to assess whether the prevalence of pediatric neck abscesses managed with operative drainage decreased compared with previous years. Methods Medical records of all pediatric cases at a tertiary care children's hospital diagnosed with abscess of the neck and treated with incision and drainage were evaluated between the dates of April 1 and November 30 from 2015 to 2020. Outcomes were compared for each year from 2015 to 2019 to 2020, which included location, abscess size, duration of antibiotic treatment, microbiology, and the number of cases per year. Results A total of 201 cases were included. The mean ± standard deviation (SD) presenting age in the 2015 to 2019 group was 5.05 ± 5.03 years old and 2.24 ± 1.91 years old in the 2020 group. The mean number of cases between 2015 and 2019 was 35.6 ± 4.2, whereas the number of cases in 2020 was 23 (p = 0.002). Of those patients who underwent IV antibiotic therapy prior to presentation (n = 43), the mean number of days before admission was 1.98 ± 2.95 (n = 40) from 2015 to 2019 and 12.00 ± 10.39 (n = 3) in 2020 (p = 0.008). The percent of cases with multiple strains cultured between 2015 and 2019 was 13.4% versus 18.2% in 2020 (p = 0.007). Conclusion There was a decrease in the number of operative neck abscesses in 2020 compared with the mean number per year from 2015 to 2019. COVID-19 mitigation strategies leading to reduced transmission of other viral and bacterial illnesses and a tendency toward prolonged medical management to avoid surgery are two possible explanations.

ANESTHESIA FOR FETAL SURGERY - PRINCIPLES AND CONSIDERATIONS: A CONCISE REVIEW

Fetal surgery, an integral part of fetal therapy has undergone evolution since is conception, which was possible due to continuous refinements in surgical as well as anesthetic techniques The fetal surgery can be done in various stages of the gestation for corrective treatment. Time tested criteria have been laid down for patient selection which help improve the outcome of the whole exercise. The anesthesia concerns and considerations are unique as are the ethical issues involved in this treatment modality involving two patients with contrasting physiological needs. This article reviews salient aspects of fetal physiology in detail. Anesthesia for the fetal interventions is curated as per the invasive nature of surgical interventions. The type of fetal interventions are classified as minimally invasive procedures, Open mid gestation procedures and Ex-utero intrapartum treatment (EXIT) procedures. Preoperative evaluation is dictated by extent of gestation, and invasiveness of the surgical procedure apart from medical status of mother and fetus. This review also tries to enumerate number of clinically useful pharmacological agents in fetal anesthesia including essential tocolytic agents, in addition to management of common fetal complications with a separate section on fetal bradycardia

Prevalencia de endocarditis infecciosa a partir de procedimientos odontológicos / Prevalence of infective endocarditis from dental procedures

Resumen Introducción: Los procedimientos dentales han sido asociados a bacteriemia y endocarditis infecciosa. Objetivo: Determinar la prevalencia de endocarditis infecciosa a partir de procedimientos odontológicos. Materiales y métodos: Se realizó un estudio descriptivo de tipo retrospectivo cuantitativo. Se incluyeron historias clínicas de pacientes con endocarditis infecciosa a los cuales se les registró identificación general, sexo, edad, estrato socioeconómico, reporte de procedimiento odontológico, tipo de procedimiento odontológico, endocarditis infecciosa no especificada y reporte de procedimiento médico-quirúrgico. Adicionalmente, se registró información sobre el tipo de procedimiento médico-quirúrgico o condición médica relacionada. Los datos fueron compilados en hoja de cálculo para su procesamiento en software estadístico (SPSS ver. 25). Resultados: De 154 casos de endocarditis infecciosa registrados, solo en uno (0.7%) se reportó procedimiento odontológico del tipo endodoncia previo a la hospitalización. La causa relacionada más comúnmente reportada fue cateterismo para hemodiálisis (37%) seguido de bacteriemia no específica (22%) y condición cardiovascular asociada a válvulas cardíacas y marcapasos (18.8%). En el 15.6% de los casos se reportó como endocarditis infecciosa no especificada. Los microorganismos más comúnmente aislados pertenecen al género Staphylococcus, seguido de Streptococcus. Conclusiones: La frecuencia de endocarditis bacteriana relacionada con procedimientos odontológicos fue menor del 1%. Los procedimientos médico-quirúrgicos siguen siendo la causa más común de endocarditis bacteriana.

Abstract Introduction: Dental procedures have been associated with bacteriemia and infective endocarditis. Objective: To determine the prevalence of infective endocarditis from dental procedures. Materials and methods: A descriptive, retrospective quantitative study was carried out. Records of infective endocarditis of which the general identification, sex, age, socioeconomic status, dental procedure report, type of dental procedure and non-specified infective endocarditis information was collected. Additionally, information was recorded on the type of medical/surgical procedure or medical condition that was associated. Categorical variables are presented as absolute and relative frequencies. The data were compiled in a spreadsheet for processing in statistical software (SPSS ver. 25). Results: Of the 154 cases of infective endocarditis registered, only 1 case (0.7%) reported an endodontic-type dental procedure prior to hospitalization. The most reported related cause was catheterization for hemodialysis (37%) followed by unspecified bacteriemia (22%) and cardiovascular condition associated with heart valves and pacemakers (18.8%). In 15.6% of the cases, it was reported as non-specific infective endocarditis. The most isolated microorganisms belonged to the genus Staphylococcus followed by Streptococcus. Conclusions: The frequency of bacterial endocarditis related to dental procedures was less than 1%. Medical-surgical procedures remain the most common cause of bacterial endocarditis.

Efficacy comparison between pneumovesicoscopic Cohen and Politano-Leadbetter technique in transvesicoscopic ureteral reimplantation in children / 中华实用儿科临床杂志

Objective:To compare the efficacy of pneumovesicoscopic Cohen and Politano-Leadbetter procedures in the treatment of vesicoureteral junction obstruction (VUJO) in children.Methods:The data of 48 children with VUJO who underwent operations in the Department of Urology, Anhui Provincial Children′s Hospital from January 2017 to December 2021 were retrospectively analyzed.According to the operation time, the patients were divided into the pneumovesicoscopic Cohen group(group C) (28 cases) and pneumovesicoscopic Politano-Leadbetter group(group P) (20 cases). The operation time, postoperative urinary catheterization duration, hematuria duration, hospitalization time, and the improvement of hydronephrosis, ureteral dilatation, and renal function after surgery were compared between the 2 groups.The enumeration data were compared by the χ2 test or Fisher′ s exact probability method.The measurement data were compared by the t-test. Results:All the 48 children were successfully operated on by the same surgeon, without conversion to open surgery.Six cases in the group C had a megaureter and underwent ureter tailoring.Two cases in the group P had calyceal and ureteral calculi, which were all removed after operation.There was a statistically significant difference in the operation time between group C and group P[(136.5±35.4) min vs.(165.8±33.2) min, t=-3.154, P=0.002]. The patients were followed up for (10.3±2.6) months after operation.There were 8 cases and 6 cases of urinary tract infection in group C and group P within 2 months after the operation, respectively.They all improved after conservative anti-infection treatment, and the infection was well controlled after removal of the D-J tube.Besides, their intravenous pyelography 6 months after operation showed that the ureter was unobstructed.In group C, 6 months after the operation, the anterior and posterior diameters of the renal pelvis [(1.62±0.54) cm vs.(2.55±1.24) cm, t=-5.027, P=0.001] and the largest diameter of the ureter [(0.95±0.27) cm vs.(1.51±0.52) cm, t=-8.495, P<0.001] were significantly decreased, compared with those before operation.However, the renal cortex thickness was increased significantly [(1.47±0.25) cm vs.(0.86±0.46) cm, t=2.028, P=0.004], and the renal function (as indicated by the diuretic nephrogram) was notably improved [(46.27±2.16)% vs.(41.83±3.04)%, t=1.647, P=0.030]. In group P, 6 months after operation, the anterior and posterior diameters of the renal pelvis[(1.48±0.82) cm vs.(2.68±1.41) cm, t=-2.740, P=0.003] and the maximum diameter of the ureter [(1.05±0.46) cm vs.(1.36±0.27) cm, t=-1.635, P=0.040] were significantly smaller than those before operation.However, the renal cortical thickness was increased [(1.38±0.33) cm vs.(0.74±0.39) cm, t=9.073, P<0.001], and the renal function (as indicated by the diuretic nephrogram) was significantly improved [(45.18±3.35)% vs.(39.55±2.49)%, t=1.277, P=0.030]. Politano-Leadbetter surgery outperformed Cohen surgery in promoting the recovery of the anterior and posterior diameters of the renal pelvis [(1.48±0.82) cm vs.(1.62±0.54) cm, t=-1.748, P=0.030]. Conclusions:Pneumovesicoscopic Politano-Leadbetter operation can establish a longer submucosal tunnel without changing the ureteral shape and opening position, having good effects in treating VUJO combined with calyceal and ureteral calculi.Pneumovesicoscopic Politano-Leadbetter operation can also better improve postoperative recovery from hydronephrosis than Cohen operation.However, the pneumovesicoscopic Politano-Leadbetter operation is more difficult and requires longer time.The surgeon should choose a reasonable operation based on his/her own experience.

Mitral Surgery for Severe Mitral Annular Calcification: Calcium Resection or Exclusion Procedure / 日本心臓血管外科学会雑誌

Background: Extensive calcification of the mitral annulus (MAC) represents a problem for mitral surgery due to a technical difficulty for implanting prosthetic valves, because the calcium does not allow placing direct sutures through the annulus and para-prosthetic leakage or cardiac rupture may result. We describe our experience with mitral valve surgery with or without decalcification of the annulus. Methods: Since 2005, we performed mitral valve operations in 1,327 patients and among them, severe mitral annular calcification was present in 25 (1.9%). Results: The mean age was 75±9 years and there were 6 men and 19 women, with hemodialysis in 4. Mitral valve replacement (MVR) was performed in all patients. A concomitant operation was aortic valve replacement in 19 and coronary artery bypass grafting in 4 patients. The MAC was resected in 14 (Group-R) and was excluded in 11 (Group-E). In-hospital mortality was four patients in Group-R. The cause of death was congestive heart failure in two, cerebellar infarction in one, and respiratory failure in one. Postoperative morbidity included one patient with reexploration and one with prolonged respiratory failure The aortic cross clamp time was a mean of 180±44 min (range 108∼266 min) in Group-R and 139±32 min (range 61∼186 min) in Group-E (p=0.009). The size of the prosthetic mitral valve was 24.3±1.0 mm in Group-R and 24.6±0.8 mm in Group-E (p=0.618). The postoperative echocardiography showed no abnormal mean pressure gradient of mitral valve prosthesis nor para-valvular leak in any patients in either group. Conclusions: The mitral valve replacement without annular decalcification in a severely calcified mitral annulus is a safe and an effective approach in an elderly patient.