Application of subcutaneous asymmetric tension reduction combined with dermal buried angular mattress suture in surgical treatment of benign pigmented facial lesions in infants and preschoolers / 中华皮肤科杂志

Objective:To investigate the clinical efficacy of subcutaneous asymmetric tension reduction combined with dermal buried angular mattress suture in surgical treatment of benign pigmented facial lesions in infants and preschoolers.Methods:Totally, 100 infants and preschoolers with pigmented facial lesions were enrolled from the Department of Dermatology, Hanzhong Central Hospital and the Second Affiliated Hospital of Xi′an Jiaotong University from January 2018 to January 2019, and their clinical data were analyzed retrospectively. Among these patients, there were 59 males and 41 females, and their age ranged from 3 months to 5 years, with an average age of 15 months. All patients underwent outpatient surgery under local anesthesia, and sedative drugs were used before operation. The skin lesions were excised once or in stages according to their areas, and incisions were closed by using a subcutaneous asymmetric suture-based tension reduction technique, followed by dermal buried angular mattress sutures. After surgery, medical silicone gels and tension reduction devices were used for 6 months to 1 year, and postoperative follow-up was performed.Results:All patients were followed up for more than 1 year after surgery. Four patients showed suture rejection reaction within two months after surgery, and the incisions completely healed after the suture knots were discharged; cat′s ear-shaped scars were formed at the upper and lower ends of the incisions in 3 cases when the sutures were removed 1 week after surgery, no treatment was given, and the cat′s ear-shaped scars gradually became flat after 1 year of follow-up; fat liquefaction occurred in 1 case 4 days after surgery, re-suturing of the incision was done 1 week after the removal of internal sutures and drainage, and the incision healed well; 1 case developed infection 3 days after surgery, and then received the removal of internal sutures, drainage, and anti-infection treatment, re-suturing was performed after complete regression of the incision swelling, and the incisions healed well; scar hyperplasia occurred in 4 cases 3 to 6 months after surgery, and the scars became flat after the local injection of triamcinolone acetonide. In the remaining children, fine white linear scars were formed after the healing of incisions, the depressions and ridges at both ends of the incisions became flat, and there was no obvious pulling sensation in facial organs or formation of cat′s ear-shaped scars.Conclusions:Subcutaneous asymmetric tension reduction combined with dermal buried angular mattress suture can effectively reduce tension twice during delicate facial surgery in infants and preschoolers, and help to avoid incision widening and scar hyperplasia. The follow-up showed favorable long-term efficacy and aesthetic effect.

Checklist validation for use in safe heart surgery / Validación de la lista de verificación para su uso en cirugía cardiaca segura / Validação de checklist para utilização em cirurgia cardíaca segura

ABSTRACT Objective Build and validate an instrument in checklist format for use in safe cardiac surgery. Method Methodological research carried out in the following stages: literature review; national construction of items and content validation by experts in two stages, at regional level 9 and with 41 judges. For data analysis, the agreement rate per constructed item was determined. Results The construction of version 1 resulted in 49 items, version 2 presented 46 items, and the final version 41 items distributed in Sign in (1 to 27), Time out (28 to 32) and Sign out (33 to 41). All items obtained agreement greater than 80%, considering validated. Conclusion The checklist was built and validated in terms of content, consisting of 41 items, and can be used in the area of cardiac surgery for the implementation of safe care for patients undergoing these procedures.

RESUMEN Objetivo Construya y valide un instrumento en formato de lista de verificación para su uso en cirugía cardíaca segura. Método Investigación metodológica realizada en las siguientes etapas: revisión de la literatura; construcción nacional de ítems y validación de contenido por expertos en dos etapas, a nivel regional 9 y con 41 jueces. Para el análisis de datos, se determinó la tasa de concordancia por ítem construido. Resultados La construcción de la versión 1 resultó en 49 ítems, la versión 2 presentó 46 ítems y la versión final 41 ítems distribuidos en Sign in (1 a 27), Time out (28 a 32) y Sign out (33 a 41). Todos los ítems obtuvieron una concordancia superior al 80%, considerados validados. Conclusión La lista de verificación fue construida y validada en cuanto al contenido, consta de 41 ítems y puede ser utilizada en el área de cirugía cardíaca para la implementación de cuidados seguros para pacientes sometidos a estos procedimientos.

RESUMO Objetivo Construir e validar um instrumento no formato checklist para utilização em cirurgia cardíaca segura. Método Pesquisa metodológica realizada nas seguintes etapas: revisão da literatura; construção dos itens e validação de conteúdo por especialistas em duas etapas, a nível regional com 9 e nacional com 14 juízes. Para análise dos dados, aplicou-se a taxa de concordância por item construído. Resultados A construção da versão 1 resultou em 49 itens, a versão 2 apresentou 46 itens, e a versão final 41 itens distribuídos em Sign in (1 a 27), Time out (28 a 32) e Sign out (33 a 41). Na versão final, todos os itens foram validados com concordância superior a 80%. Conclusão O checklist foi construído e validado quanto ao conteúdo, composto por 41 itens,e poderá ser utilizado na área de cirurgia cardíaca para a implementação de assistência segura aos pacientes submetidos a esses procedimentos.

Práticas educativas no controle da ansiedade de pacientes em pré-operatório de cirurgia cardíaca: revisão integrativa / Educational practices on the anxiety control of patients in pre-operative heart surgery: integration review / Prácticas educativas en el control de la ansiedad de pacientes en preoperatorio de cirugía cardíaca: revisión integrativa

Objetivo: descrever, com base na literatura, as contribuições das práticas educativas para o controle da ansiedade de pacientes em pré-operatório de cirurgia cardíaca. Método: trata-se de uma revisão integrativa realizada no período de novembro a dezembro de 2017 nas Bases de Dados PubMed, Bases de Dados de Enfermagem (BDENF), Biblioteca Regional de Medicina (BIREME), Scientific Electronic Library Online (SCIELO) e Medical Literature Analysis and Retrievel System Online (MEDLINE), com a inclusão de 24 artigos que compuseram esse estudo. Resultados: sobre o diagnóstico ansiedade, os artigos analisados mostraram maior presença no sexo feminino, em diferentes faixas etárias, mas mais prevalente em idades mais avançadas. Educação em saúde tem apresentado excelentes resultados na diminuição da ansiedade, que uma vez realizada pelo enfermeiro, potencializa o cuidado. Conclusão: processos educativos realizados no pré-operatório de cirurgia cardíaca, auxiliam para uma boa recuperação, pois com o envolvimento do paciente no processo, o tornará tranquilo e confortável

Objective: to describe, based on the literature, the contributions of the educational practices to the control of the anxiety of patients in the preoperative period of cardiac surgery. Method: this is an integrative review carried out from November to December 2017 in the PubMed, Bases de Dados de Enfermagem (BDENF), Biblioteca Regional de Medicina (BIREME), Scientific Electronic Library Online (SCIELO) and Medical Literature Analysis and Retrievel System Online (MEDLINE), databases, with the inclusion of 24 articles that composed this study. Results: on the anxiety diagnosis, the articles analyzed showed greater presence in the female sex, in different age groups, but more prevalent at more advanced ages. Health education has presented excellent results in the reduction of anxiety, which once performed by the nurse, potentiates the care. Conclusion: educational processes performed in the preoperative period of cardiac surgery, help to a good recovery, because with the patient's involvement in the process, it will make him calm and comfortable

Objetivo: describir, con base en la literatura, las contribuciones de las prácticas educativas para el control de la ansiedad de pacientes en preoperatorio de cirugía cardíaca. El método: se trata de una revisión integrativa realizada en el período de noviembre a diciembre de 2017 en las Bases de PubMed, Bases de Dados de Enfermagem (BDENF), Biblioteca Regional de Medicina (BIREME), Scientific Electronic Library Online (SCIELO) y Medical Literature Analysis and Retrievel System Online (MEDLINE), con la inclusión de 24 artículos que compusieron ese estudio. Resultados: sobre el diagnóstico ansiedad, los artículos analizados mostraron mayor presencia en el sexo femenino, en diferentes edades, pero más prevalente en edades más avanzadas. La educación en salud ha presentado excelentes resultados en la disminución de la ansiedad, que una vez realizada por el enfermero, potencializa el cuidado. Conclusión: procesos educativos realizados en el preoperatorio de cirugía cardíaca, auxilian para una buena recuperación, pues con la participación del paciente en el proceso, lo hará tranquilo y confortable

Mechanism of metabolic surgery mediated FGF21 in improving insulin resistance / 国际外科学杂志

Insulin resistance refers to a decrease in the physiological utilization of normal concentrations of insulin by target organs such as liver and adipose tissue.Insulin resistance is central to a variety of metabolic diseases caused by obesity.FGF21 is a novel regulator of glycolipid metabolism,which has the effects of improving insulin resistance,reducing body weight,regulating blood lipids,promoting fatty acid oxidation,and increasing energy consumption.Metabolic surgery is effective in the treatment of obesity and insulin resistance,and the level of FGF21 changes after surgery.This article will review the possible mechanisms of metabolic surgery to mediate FGF21 to improve insulin resistance.

Biportal Endoscopic Spinal Surgery for Lumbar Spinal Stenosis

Biportal endoscopic spinal surgery (BESS) is a minimally invasive spinal surgery, which is basically similar to microscopic spinal surgery in terms of the use of floating technique and technically similar to conventional percutaneous endoscopic spinal surgery in terms of the use of endoscopic or arthroscopic instruments. Using two independent portals (viewing and working) and maintaining a certain distance from the bony and neural structures allow closer access to the target lesion through a panoramic view by free handling of the scope and instruments rather than through a fixed view by docking into the Kambin's triangle. Minimally invasive surgery allows for reduced dissection and inevitable muscle injury, preserving stability and reducing risks of restabilization. The purpose of fusion surgery is the same as that of the three surgical techniques stated above. Its wider range of view helps to overcome limitations of conventional endoscopic spinal surgery and to supplement the weak points of microscopic spinal surgery, such as limited working space in a tubular retractor and difficulty in accessing the contralateral area. This technique provides an alternative to unilateral or bilateral decompression of lumbar central spinal stenosis, foraminal stenosis, low-grade spondylolisthesis, and adjacent segment degeneration. Early clinical outcomes are promising despite potential for complications, such as dural tearing and postoperative epidural hematoma, similar to other procedures. Merits of BESS include decreased postoperative infection rate due to continuous irrigation throughout the procedure and decreased need for fusion surgery for one- or two-level lumbar stenosis by wide sublaminar and foraminal decompression with minimal sacrifice of stabilizing structures.

Implementation of enhanced recovery after colorectal surgery (eras) protocol: initial results of the first brazilian experience / Implementação do protocolo de recuperação otimizada após cirurgia colorretal (eras): resultados iniciais da primeira experiência brasileira

ABSTRACT Background: Guidelines for enhanced recovery after surgery have their bases in colonic surgery, through the first protocols published in 2012. Since then, this practice has spread throughout the world, mainly due to improvements in surgical outcomes associated with resource savings. Aim: To analyze the first prospective results after the implementation of the guidelines. Methods: Were retrospectively analyzed 48 patients operated in the institution prior to the standardization. This group was then compared with a series of 25 patients operated consecutively after the guidelines were implemented. Results: With a 68.6% compliance rate, hospital length of stay (p=0.002), use of abdominal drains (p<0.001) and mechanical bowel preparation (p<0.001) were reduced. Mortality rates, anastomotic fistula, abdominal abscesses and reoperations were also reduced, but without statistical significance. Conclusion: Enhanced recovery after surgery protocols benefit patients care, resulting in better outcomes and possibly resource savings. Even with some limitations, its implementation is feasible in the Brazilian Public Health System.

RESUMO Racional: Os protocolos de recuperação otimizada após as operações têm as suas bases na cirurgia colônica, através das primeiras diretrizes publicadas em 2012. Desde então, tal prática difundiu-se pelo mundo, principalmente em virtude de melhorias nos resultados cirúrgicos associadas à economia de recursos. Objetivo: Apresentar os primeiros resultados prospectivos após a implementação das novas medidas. Métodos: Foram analisados de forma retrospectiva 48 pacientes operados na instituição previamente à aplicação do protocolo. Esse grupo foi então comparado com uma série de 25 pacientes operados de forma consecutiva após a implementação das diretrizes. Resultados: Com taxa de adesão de 68.6% às medidas propostas, observou-se redução do tempo de internação hospitalar (p=0.002), do uso de drenos abdominais (p<0.001) e do preparo mecânico do cólon (p<0.001). As taxas de mortalidade, de fístula da anastomose, de abscessos abdominais e de reoperações também foram reduzidas, porém sem significância estatística. Conclusão: A adesão às medidas recomendadas no protocolo é benéfica para pacientes e equipe de assistência, acarretando em melhores resultados e possível economia de recursos. Mesmo com algumas limitações, a sua implementação é factível no Sistema Único de Saúde Brasileiro.

William Polk Longmire Jr. y los primeros 60 años de la cirugía de puentes aorto-coronarios / William Polk Longmire Jr. and the first 60 years of coronary artery bypass graft surgery

Según datos publicados, en el año 1967 se iniciaron los procedimientos quirúrgicos de construcción de anastomosis para el aporte sanguíneo miocárdico, basados en las operaciones realizadas por el argentino René Gerónimo Avaloró en la Cleveland Clinic. Como muchos otros aspectos de la cirugía cardíaca, este hecho ha estado también ensombrecido por imprecisiones históricas, que no han sido adecuadamente dilucidadas; por lo que no se le ha dado el crédito que merece al hombre que realizó la primera anastomosis entre una arteria mamaria interna y un vaso coronario en humanos: el doctor William Polk Longmire Jr. El baipás coronario empezó a salir de su semilla en las expertas manos de Longmire, en Los Ángeles, quizás en una fría mañana del invierno de 1958; unos años antes de que Favaloro decidiera continuar regándola en la Cleveland Clinic. Sirva este artículo -quizás- como el primero de los merecidos homenajes que recibirá este año, sin dudas, el padre de la cirugía coronaria

According to published data, myocardial revascularization procedures to improve blood supply began in 1967, based on the procedures carried out by the Argentine René Gerónimo Favaloro at the Cleveland Clinic. Like many other aspects of cardiac surgery, this fact has also been overshadowed by historical inaccuracies, which have not been adequately clarified; so that the man who performed the first mammary-coronary anastomosis in humans has not been given the credit: Dr. William Polk Longmire Jr. Possibly, the coronary artery bypass began to spring from the seed in the expert hands of Longmire, in Los Angeles on a cold winter morning in 1958. A few years before Favaloro decided to continue watering it at the Cleveland Clinic. This article will hopefully serve as the first of the well-deserved tributes that the undisputed father of coronary surgery will receive this year

Classificação dos pacientes segundo o risco de complicações e mortalidade após cirurgias cardíacas eletivas / Patient's classification according to complications and mortality risks after elective heart surgeries

O objetivo da investigação foi classificar os pacientes segundo o riscode complicações e mortalidade após cirurgias cardíacas eletivas, utilizando o Sistema de Escore Clínico de Risco de Tuman. Estudo descritivo, desenvolvido em um hospital universitário do interior de São Paulo, Brasil, entre agosto de 2013 e fevereiro de 2015. Uma amostra consecutiva e não probabilística foi constituída por pacientes submetidos à primeira cirurgia de revascularização do miocárdio e/ou cirurgias para correção de valvulopatias, e com agendamento eletivo de suas cirurgias. Resultados: participaram 125 pacientes. A maioria apresentou baixo risco para o desenvolvimento de complicações pós-operatórias e mortalidade (n=110; 88%). É esperada uma taxa de complicação pós-operatória de 14,6% e uma taxa de 3,3% de mortalidade para esses pacientes. Nessa pesquisa, a maioria dos pacientes submetidos pela primeira vez às cirurgias cardíacas eletivas apresentou baixo risco para o desenvolvimento de complicações pós-operatórias e mortalidade.

The investigation objective was to classify patients according to the complication and mortality risks after elective heart surgeries, using the Tuman System of Clinical Risk Score. A descriptive study, developed in a university hospital in São Paulo state, Brazil, from August of 2013 to February of 2015. A consecutive and non-probabilistic sample was constituted by patients submitted to a first myocardial revascularization surgery and/or surgeries to correct valvulopathies, and with elective scheduling of their surgeries. Results: One-hundred and twenty five patients participated. The majority presented low risk for development of post-surgery complications and mortality (n = 110; 88%). A rate of 14.6% for complications and 3.3% for mortality are expected for these patients. In this study, most patients submitted for their first time to electiveheart surgeries presented low risk to develop post-surgery complications and mortality.

Sobrevida postoperatoria en pacientes nonagenarios: Estudio pronóstico en cohorte retrospectiva 2001-2010, Clínica Dávila / Postoperative survival among nonagenarians: A retrospective study

Background: As the Chilean population ages, anesthesiologists are regularly faced with elderly and even nonagenarian people undergoing surgical procedures. Aim: To determine the postoperative survival time in nonagenarians and its risk factors at a private clinic. Material and Methods: Review of medical records of the clinic, searching for patients aged 90 years or older, which were subjected to a surgical procedure between 2001 and 2012. Certification ofsurvival or death was obtainedfrom the clinical records or death certification at the National Identification Service. Survival analysis was made using Kaplan-Meier and Gompertz regression. Results: The medical records of167 patients, aged 90 to 101 years (64% women), were reviewed. Sixty four percent had an underlying cardiovascular disease; in 37%, cognitive impairment. Hip fracture surgery was the most common procedure. One intraoperative death occurred. Five percent ofpatients died one month after surgery. The median survival time was two years and the longest, seven years. According to Gompertz probability regression, the predictors of death were the presence of cardiac disease (Hazard ratio (HR): 1.91, 95% confidence intervals (95% CI): 1.16; 3.16), cognitive impairment (HR: 2.10,95% CI: 1.32; 3,22), cancer (HR:2.10,95% CI: 1.32; 3.22), requirement of transfusion (HR: 1.79, 95% CI: 1.13; 2.83) and an American Society of Anesthesiologists (ASA) Class III classification (HR: 1.95, IC95%: 1.21; 3.15). Conclusions: In nonagenarian patients undergoing surgery; 50% mortality was observed 2 years after surgery. The presence of cardiac disease, cognitive impairment, cancer, transfusion and a Class IIIASA classification were predictors of death.

Clinical study of fast track surgery in colorectal cancer patients / 国际外科学杂志

ObjectiveControl study on the clinical efficiency and costs of fast track surgery(FTS) and traditional method was carried out in colorectal cancer patients. Methodsone hundred colorectal cancer patients were randomLy selected, 50 cases treated with conventional therapy as control group and 50 cases treated with FTS programme. The postoperative initial venting time, the incidence of complications, the hospital stay and cost index were compared between the two groups. ResultsThe postoperative initial venting time was in advance and postoperative stay was obviously shortened in FTS group. Hospitalization expenditure in FTS group was lower than that in control group. Patients recovered quickly, the result was satisfactory. The complication was not significantly different between the two groups (P ＞ 0.05 ) . ConclusionsFTS treatment can accelerate postoperative rehabilitation and elevate clinical efficiency in colorectal cancer patients during operation period. FTS treatment is a safe and effective method.

The Double Stapling Technique for Sphincter Preservation Operation in mediate-low Rectal Carcinoma / 医学研究杂志

Objective To evaluate the effect of double stapling technique for sphincter preservation operation in mediate-low rectal carcinoma.Methods The resection through double stapling technique for sphincter preservation approach was performed on 30 patients with mediate-low rectal carcinoma from January 2004 to November 2007.The distance between the anal verge and the lower margin of the tumor was 4～8cm(averaged 6.5 cm),including 22 patients in Dukes A stage,6 Dukes B and 2 Dukes C.Results Fecal continences were preserved successfully in all patients.2 cases had got anastomotic narrowing(6.6%) after operation.At a median follow-up of 46 months,two patients had local recurrences(6.6%).There was no urinary dysfunction in this series.Conclusion Double stapling technique for sphinceter preservation operation was feasible and safe,provide a original operative style for mediate-low rectal carcinoma.