ABSTRACT
BACKGROUND: Closure of the appendiceal stump is a critical step during an appendectomy. There is a lack of knowledge about the feasibility of using electrosurgical devices for the occlusion of the appendix. This study aims to determine the safety of this technique in pediatric patients. METHODS: We performed a cross-sectional analytical study in patients less than 18 years of age treated at Hospital Militar Central Colombia between 2012 and 2021. Our institution's ethics committee approved the study. We analyzed the data using SPSS 22 statistical program. We present frequencies for qualitative variables and measures of central tendency or dispersion for quantitative variables depending on the distribution measured by the Kolmogorov-Smirnov test. In addition, we measured the association of nominal variables with the Chi-square test or Fisher's exact test. For numerical variables, the difference of means with the Student's t-test or the difference of medians with the Mann-Whitney U test. RESULTS: We treated 209 patients. One hundred sixteen (55.5%) were boys, and the mean age was 9.7 years (SD 3.2). The median intraoperative time was 60 min, and the hospital stay was 2.8 days on average. There were no cases of stump leakage, and only two patients (1%) had an organ-space surgical site infection, which was unrelated to the closure technique. We found no association between procedural complications and appendicular status (p = 0.450). CONCLUSIONS: Our research suggests that using a bipolar sealing device (Ligasure, Medtronic, USA) for appendiceal stump closure in pediatric patients undergoing laparoscopic appendectomy is feasible and should be further studied. TYPE OF STUDY: Treatment study. LEVEL OF EVIDENCE: Level III.
Subject(s)
Appendicitis , Appendix , Laparoscopy , Male , Humans , Child , Female , Appendectomy/adverse effects , Cross-Sectional Studies , Appendicitis/surgery , Laparoscopy/methods , Appendix/surgery , Postoperative Complications/epidemiology , Postoperative Complications/etiology , Postoperative Complications/surgeryABSTRACT
Abstract Objectives: although mortality and perinatal asphyxia in newborns have been considerably reduced, there are still deficiencies in screening and diagnosis methods for intrapartum fetal well being that aim to detect its early alterations. Therefore, the purpose of this research was to apply a methodology based on probability and entropy and confirm its capacity to detect normal and abnormal fetal cardiac dynamics from 20-minute cardiotocographic tracings. Methods: 80 cardiotocographic tracings of pregnant women in the last trimester were collected, of which the minimum and maximum fetal heart rate were evaluated every 10 seconds, as well as its repetitions along with their probability and the diagnostic S/k ratio. Finally, the statistical analysis was carried out to establish the diagnostic capacity of the method concerning the clinical evaluation and interpretation of the cardiotocographic tracing, taken as the Gold Standard. Results: it was confirmed that S/k ratio values differentiated normal from abnormal fetal cardiac dynamics with sensitivity and specificity values of 100% and a Kappa coefficient of 1. Conclusion: the applicability of a diagnostic mathematical method of cardiotocography was confirmed, which suggests its implementation in the clinical context to detect alterations in fetal well-being in 20 minutes.
Resumo Objetivos: aunque se ha logrado reducir considerablemente la mortalidad y asfixia perinatal en neonatos, aún hay deficiencias en los métodos de tamizaje y diagnóstico del bienestar fetal intraparto que detecten sus alteraciones tempranas. Por lo anterior, el propósito de esta investigación fue aplicar una metodología basada en la probabilidad y la entropía y confirmar su capacidad para diagnosticar la dinámica cardíaca fetal normal de la anormal a partir de trazados cardiotocográficos de 20 minutos. Métodos: se recolectaron 80 trazados cardiotocográficos de gestantes en el último trimestre, de los cuales se evaluaron frecuencia cardíaca fetal mínima y máxima cada 10 segundos al igual que sus repeticiones, su probabilidad y la proporción S/k diagnóstica. Finalmente, se realizó un análisis estadístico para establecer la capacidad diagnóstica del método con respecto a la interpretación el trazado cardiotocográfico y la evaluación clínica, tomadas como Gold Standard. Resultados: se confirmó que los valores de la proporción S/k diferenciaron las dinámicas cardíacas fetales normales de las anormales con valores de sensibilidad y especificidad del 100% y un coeficiente Kappa de 1. Conclusión: se confirmó la aplicabilidad de un método matemático diagnóstico de la cardiotocografía, lo cual sugiere que su implementación en la clínica para detectar alteraciones del bienestar fetal en 20 minutos.
Subject(s)
Humans , Female , Pregnancy , Pregnancy Trimester, Third , Heart Rate, Fetal , Cardiotocography/methods , Neonatal Screening , Perinatal Care , EntropyABSTRACT
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Subject(s)
Humans , Male , Aged , Contrast Media/adverse effects , Liver/diagnostic imaging , Liver/pathology , Tomography, X-Ray ComputedABSTRACT
BACKGROUND: The diagnosis of cervix cytology has problems of inter-observer reproducibility. Methodologies based on fractal geometry objectively differentiated normal, low-grade squamous intraepithelial lesion (L-SIL) and high-grade squamous intraepithelial lesion (H-SIL) states. AIMS: The aim was to develop a mathematical-physical diagnosis and a theoretical generalization of the evolution paths of cervical cells from normal to carcinoma based on their occupation in the box-counting space. SUBJECTS AND METHODS: Overlaying a grid of 8 x 8 pixels, the a number of squares occupying the nucleus surface and cytoplasm of 5 normal cells, 5 ASCUS, 5 L-SIL and 5 H-SIL were evaluated, as well as the ratio C/N, establishing differences between states. Sensitivity, specificity, negative likelihood ratio, and Kappa coefficient over the gold standard were calculated. Also was developed a generalization of all possible paths from normality to carcinoma. RESULTS: The occupancy spaces of the nuclear surface allow differentiating normal L-SIL and H-SIL thus avoiding the indeterminacy of ASCUS cells. Compared to the Gold Standard, this method has sensitivity and specificity of 100%, negative likelihood ratio of 0, and Kappa coefficient of 1. 62,900 possible routes of evolution were determined between normal and H-SIL, states, based on the structural basis of the cells. CONCLUSIONS: it was obtained an objective and reproducible diagnostic methodology of the development of preneoplastic and neoplastic cervical cells for clinical application. Additionally were developed all possible paths of preneoplastic cellular alteration to carcinoma which facilitates the tracking of patients over time to clinical level, warning of alterations that lead to malignancy, based on the spatial occupation measurements of the nucleus in fractal space regardless of causes or risk factors.
