Percutaneous tibial nerve stimulation in patients with severe low anterior resection syndrome: randomized clinical trial

Treatment of low anterior resection syndrome (LARS) is challenging. Percutaneous tibial nerve stimulation (PTNS) can improve select bowel disorders. An RCT was conducted to assess the efficacy of PTNS compared with sham stimulation in patients with severe LARS

Postoperative intravenously administered iron sucrose versus postoperative orally administered iron to treat post-bariatric abdominoplasty anaemia (ISAPA): the study protocol for a randomised controlled trial

BACKGROUND: Anaemia and iron deficiency are common complications following post-bariatric abdominoplasty. Given the low oral absorbability of iron resulting from bariatric surgery, it has been hypothesised that postoperative intravenously administered iron supplementation could be used to treat anaemia and to prevent the development of iron deficiency in these patients. METHODS/DESIGN: In this multicentre open-label randomised clinical trial, 56 adult women undergoing post-bariatric anchor-line abdominoplasty will be allocated at a ratio of 1:1 for postoperative supplementation with two intravenously administered applications of 200 mg of iron saccharate or postoperative supplementation with 100 mg of iron polymaltose complex administered orally, twice a day for 8 weeks. The primary outcome is the difference in mean haemoglobin levels between the two groups at eight postoperative weeks. Secondary outcomes evaluated at one, four and eight postoperative weeks include iron profile, reticulocyte count, overall quality of life measured using the Short-Form 36 Health Survey (SF-36) questionnaire, fatigue measured using the Functional Assessment of Chronic Illness Therapy – Fatigue (FACIT-F), adverse effects and postoperative complications. DISCUSSION: This randomised clinical trial aims to evaluate the haematopoietic effectiveness of intravenously administered iron supplementation in patients undergoing post-bariatric abdominoplasty. A more effective recovery of haemoglobin levels could help improve the patients’ quality of life and could provide an improved haematological status in preparation for the subsequent and frequent plastic surgeries these patients undergo. TRIAL REGISTRATION: Clinicaltrials.gov Identifier: NCT01857011 (8 May 2013), Universal Trial Number U111-1169-6223, Brazilian Clinical Trials Registry (REBEC): RBR-2JGRKQ

Trends and outcome of neoadjuvant treatment for rectal cancer: A retrospective analysis and critical assessment of a 10-year prospective national registry on behalf of the Spanish Rectal Cancer Project

Introduction: Preoperative treatment and adequate surgery increase local control in rectal cancer. However, modalities and indications for neoadjuvant treatment may be controversial. Aim of this study was to assess the trends of preoperative treatment and outcomes in patients with rectal cancer included in the Rectal Cancer Registry of the Spanish Associations of Surgeons. Method: This is a STROBE-compliant retrospective analysis of a prospective database. All patients operated on with curative intention included in the Rectal Cancer Registry were included. Analyses were performed to compare the use of neoadjuvant/adjuvant treatment in three timeframes: I)2006–2009; II)2010–2013; III)2014–2017. Survival analyses were run for 3-year survival in timeframes I-II. Results: Out of 14, 391 patients, 8871 (61.6%) received neoadjuvant treatment. Long-course chemo/radiotherapy was the most used approach (79.9%), followed by short-course radiotherapy ± chemotherapy (7.6%). The use of neoadjuvant treatment for cancer of the upper third (15-11 cm) increased over time (31.5%vs 34.5%vs 38.6%, p = 0.0018). The complete regression rate slightly increased over time (15.6% vs 16% vs 18.5%; p = 0.0093); the proportion of patients with involved circumferential resection margins (CRM) went down from 8.2% to 7.3%and 5.5% (p = 0.0004). Neoadjuvant treatment significantly decreased positive CRM in lower third tumors (OR 0.71, 0.59–0.87, Cochrane-Mantel-Haenszel P = 0.0008). Most ypN0 patients also received adjuvant therapy. In MR-defined stage III patients, preoperative treatment was associated with significantly longer local-recurrence-free survival (p < 0.0001), and cancer-specific survival (p < 0.0001). The survival benefit was smaller in upper third cancers. Conclusion: There was an increasing trend and a potential overuse of neoadjuvant treatment in cancer of the upper rectum. Most ypN0 patients received postoperative treatment. Involvement of CRM in lower third tumors was reduced after neoadjuvant treatment. Stage III and MRcN + benefited the most

Studio sperimentale dell’influenza della qualità dell’acqua sull’innesco del fenomeno della cavitazione nei circuiti idraulici

Lo studio della cavitazione è quanto mai complesso in quanto il fenomeno, dall’insorgenza sino alla cessazione, dipende da numerosi fattori. Uno dei parametri che maggiormente influenza l’insorgenza ed il manifestarsi di tale fenomeno è la “qualità dell’acqua”. Con il termine “qualità dell’acqua” ci si riferisce alle caratteristiche chimico-fisiche del fluido aventi influenza sull’insorgenza, sviluppo e cessazione del fenomeno, tra cui le principali sono: qualità e concentrazione delle sostanze estranee solide e/o gassose (impurità o additivi) presenti nell’acqua; temperatura dell’acqua; viscosità dell’acqua. La qualità dell’acqua può influenzare in maniera apprezzabile il valore della pressione critica alla quale la cavitazione si innesca. Nella presente attività è stato realizzato un banco prove per la misura dei nuclei di cavitazione (Cavitation Susceptibility Meter). Al fine di individuare correlazioni tra parametri idrodinamici e fisici del fluido idonee a caratterizzare il comportamento del fluido stesso rispetto al fenomeno della cavitazione sono state condotte diverse prove sperimentali per esplorare il comportamento del sistema nei riguardi della cavitazione al variare delle caratteristiche chimico-fisiche del fluido (tipologia dell’acqua), della pressione nella sezione ristretta e della portata che fluisce attraverso il misuratore di nuclei. E’ stata inoltre condotta un’analisi teorica per evidenziare l’influenza di sostanze estranee, ed in particolare gas incondensabili, sulla crescita delle bolle e sulla loro nucleazione. L’analisi teorica cosi come quella sperimentale, condotte in tale studio, hanno evidenziato che la presenza di gas non condensabili fa variare il livello di pressione per il quale si innesca la cavitazione

Galea-including forehead flap for lower one-third nasal reconstruction

The first choice for internal mucosal restoration of the nose is a septal mucosal or vestibular local flap. The forehead flap, raised including the galeal layer, is an alternative option for large nasal defects. It can be used in any difficult situation in which septal or vestibular flaps are not adoptable, such as complete loss of lower one-third. The authors intend to describe the inclusion of galea in the traditional median forehead flap for nasal lining reconstruction.Thirteen patients treated with a forehead flap including galea for lower one-third nasal reconstruction were retrospectively reviewed. No complete flaps necrosis occurred. In 1 case, lining was lost due to infection. In 2 cases a moderate nostril stenosis was observed as late complication.The forehead flap with galea is a good option for large nasal full-thickness defects, involving the lower one-third. © 2009 Lippincott Williams &amp; Wilkins, Inc

Limb contouring after massive weight loss: Functional rather than aesthetic improvement

Background: After massive weight loss, both upper and lower limbs show a similar deformity which consists of redundancy and ptosis of the cutaneous mantle. Many disturbances are associated with this abnormality, which can be treated surgically. A retrospective review of limb-contouring procedures after massive weight loss is presented. Methods: Thigh lift and arm lift procedures are described. All surgeries of upper and lower limbs contouring performed between 2003 and 2006 are reviewed with regard to quantity of tissue removed, comorbidities, complications and patients' satisfaction, which was surveyed through a questionnaire exploring functional and esthetic results (maximum score 3). Results: Among 48 bilateral limb-contouring procedures, medial thigh lifts were 35 (73%) and brachioplasties were 13 (27%). Mean age was 46 and average body mass index variation was 20 kg/m2. The most frequent comorbidity was gallstones (28%). In 46% of the whole group of patients, there was no complication to mention. The most frequent complication was acute anaemia in both procedures (43% in thigh lift and 54% in arm lift). Mean quantity of adipose-dermoid tissue removed was 766 g in thigh lift and 463 g in arm lift. In case of surgery combined with liposuction, the average aspirated volume was 1,933 ml (thighs) and 1,117 ml (arms). Patients' satisfaction was 2.7 for thighs and 2.6 for arms, as average. Conclusion: The rate of complications in limb contouring after weight loss is higher than the analogue esthetic procedures. Nevertheless, due to the rehabilitative significance of limb surgery after weight loss, this step is to be included as fundamental in obese patients' surgical therapy. © 2008 Springer Science + Business Media, LLC

A BUNDLE INCLUDING ORAL ANTIBIOTICS AND MECHANICAL BOWEL PREPARATION REDUCES SURGICAL SITE INFECTIONS IN ELECTIVE COLORECTAL SURGERY. PRAGMATIC COHORT STUDY

Abstract Introduction The efficacy of perioperative bundled interventions implemented at a multicenter level has been poorly studied. Methods A colorectal 6-element prevention bundle (antibiotic prophylaxis, oral antibiotic prophylaxis (OAP), mechanical bowel preparation (MBP), laparoscopy, normothermia, and wound retractor), introduced in 61 hospitals, was analysed. Surgical site infection (SSI) rates were compared before (G1, 2011–2016), and after (G2, 2016–2020) the bundle implementation. Results 37849 procedures were included. 5462 overall SSI (14.43%), and 2838 (7.5%) organ-space SSI (O/S-SSI) were detected. SSI decreased from 18.38% to 10.62% with the application of the bundle (OR 0,503). Similarly, O/S-SSI diminished from 9.15% (G1) to 5.72% (G2), OR 0.602. Compared to the previous year, SSI decreased by 23% after the first year of bundle implementation. 29.26% of SSIs were diagnosed post-discharge. 54.5% required readmission. The reduction was similar between high, medium and low volume hospitals. Overall SSI was 16.71%, when no measure was applied, and 6.23% when all 6 were implemented. Lack of application of the bundle increased the probability of SSI (OR 3.020) and O/S-SSI (OR 1.556). In a univariate analysis, all measures except normothermia were associated with a decrease in overall SSI, while only laparoscopy and OAP were for O/S-SSI. Multivariate analysis confirmed that laparoscopy, OAP, and wound protectors decrease overall SSI, but only OAP and laparoscopy had an effect on O/S-SSI. Conclusions A preventive bundle decreased overall and O/S SSI rates in elective colon and rectal surgery. The OR for SSI was 1.5 to 3 times higher before than after the bundle implementation. </jats:sec