Non-steroidal anti-inflammatory drugs in postoperative hand fracture management:Do they positively or negatively impact recovery?

This editorial explores the impact of non-steroidal anti-inflammatory drugs(NSAIDs)on postoperative recovery in hand fracture patients,amidst shifting pain management strategies away from opioids due to their adverse effects.With hand fractures being significantly common and postoperative pain management crucial for recovery,the potential of NSAIDs offers a non-addictive pain control alternative.However,the controversy over NSAIDs'effects on bone healing—stemming from their Cyclooxygenase-2 inhibition and associated risks of fracture non-union or delayed union—necessitates further investigation.Despite a comprehensive literature search,the study finds a lack of specific research on NSAIDs in postoperative hand fracture management,highlighting an urgent need for future studies to balance their benefits against possible risks.

Post-Operative Mortality Analysis in the Urology Department of Conakry University Hospital

Introduction: Death is a major accident which constitutes an element whose evaluation and analysis are necessary in a surgical service. Such a study is especially important in our country where the health structure operates with limited resources and more than half of the population lives below the poverty line. The objective of this study was to determine the frequency of post-operative mortality, to describe the main comorbidity factors responsible for this mortality and to identify the main cause of post-operative death in the urology department of the Ignace Deen National Hospital Material and Method: This was a retrospective descriptive study lasting 5 years from January 1, 2015 to December 31, 2019. It had focussed on all the files of patients operated on at the Urology Department of the Ignace Deen National Hospital, either in an emergency or planned and who died in per or post-operative immediately or 30 days later. Results: We recorded 63 cases of post-operative death, or a frequency of 1.84%. The average age was 61.92 ± 16.91 with the extremes of 12 and 91 years. Bladder (20.63%) and prostate tumours (60.3%) were the main admission diagnoses. High blood pressure was the main comorbidity factor found with 38.09% of cases followed by diabetes with 12.69%. Transurethral resection of the prostate, transurethral resection of the bladder and prostate adenocomectomy were the most performed surgical procedure with respective proportion of 19.04%, 20.63% and 38.09%. Probable cause of death were anemia in 25 cases (39.68%), septic in 20 cases (31.75%), heart failure in 6 cases (9.52%), pulmonary embolism in 5 cases (7.94%), obstructive renal failure 4 cases (6.35%) and stroke in 3 cases (4.76%). Conclusion: The majority of deaths occurred in patients over the age of fifty. Anaemia was the main cause of deaths. Difficulties in procuring blood products as well as the lack of modern therapeutic means are factors that make it difficult for patients to adequately manage.

CLINICAL OBSERVATION ON ACUPOINT DIGITAL PRESSING FOR TREATING IRRITABLE SYMPTOMS AND SIGNS OF POSTOPERATION OF MYOPORTHOSIS

Objective: To explore a new effective approach for treatment of the local irritable symptoms and signs resulted from myoporthosis operation. Methods: 263 cases of radial keratotomy outpatients were divided into control group (n=49, 90 eyes) and treatment group (n=214, 412 eyes). Patients of control group were treated with 0.5% Chloramphenicol eye drops, 3 times daily, 1-2 drops/time, and with 0.5% Erythromycine eye ointment every night. In treatment group, patients were treated with acupoint and hand reflection area digital pressing method except with the same eye drops and eye ointment. Body acupoints used were Cuanzhu (BL 2), Yuyao (EX HN 4), Sizhukong (TE 23), Sibai (ST 2) and Taiyang (EX HN 5). The hand reflex areas used were Eye Area, Liver Area, Kidney Area, Spleen Area, Heart Area and Lung Area. Five days constituted a therapeutic course. Results: Following 3 courses (15 days) of treatment, the markedly effective rate and total effective rate of treatment group and control group were 74.51% and 38.89%, 94.17% and 66.67% respectively. There was a significant difference between two groups in the total effective rate (P<0.05), showing the therapeutic effect of treatment group being better than that of control group. Conclusion: Acupoint digital pressing is rather effective in treatment of myoporthosis post operation irritable symptoms and signs.

Surgical Complications of Kidney Transplantation in a Resource Limited Country: Retrospective Study of the First Five Years

Background: Kidney transplantation is the most efficient treatment for renal failure but may be ruined by complications. Objective: To report the surgical complications of renal transplantation and the therapeutic means applied. Method: It was a retrospective study including 42 files of kidney transplantation in Côte d’Ivoire. We report 11 cases of surgical complications of the recipient’s intervention during the first five years. Results: The mean age was 42.64 years (±15.04). In 90.9% of the cases, there was a comorbidity factor. Lymphocele and stenosis of the uretero vesical anastomosis were the most frequent complications. One death was observed. Conclusion: Kidney transplantation is an effective way of managing chronic renal failure. Postoperative complications are polymorphic and unpredictable.

Predictive factors of short term outcome after liver transplantation: A review

Liver transplantation represents a fundamental therapeutic solution to end-stage liver disease. The need for liver allografts has extended the set of criteria for organ acceptability, increasing the risk of adverse outcomes. Little is known about the early postoperative parameters that can be used as valid predictive indices for early graft function, retransplantation or surgical reintervention, secondary complications, long intensive care unit stay or death. In this review, we present state-of-the-art knowledge regarding the early post-transplantation tests and scores that can be applied during the first postoperative week to predict liver allograft function and patient outcome, thereby guiding the therapeutic and surgical decisions of the medical staff. Post-transplant clinical and biochemical assessment of patients through laboratory tests (platelet count, transaminase and bilirubin levels, INR, factor V, lactates, and Insulin Growth Factor 1) and scores (model for end-stage liver disease, acute physiology and chronic health evaluation, sequential organ failure assessment and model of early allograft function) have been reported to have good performance, but they only allow late evaluation of patient status and graft function, requiring days to be quantified. The indocyanine green plasma disappearance rate has long been used as a liver function assessment technique and has produced interesting, although not univocal, results when performed between the 1th and the 5th day after transplantation. The liver maximal function capacity test is a promising method of metabolic liver activity assessment, but its use is limited by economic cost and extrahepatic factors. To date, a consensual definition of early allograft dysfunction and the integration and validation of the above-mentioned techniques, through the development of numerically consistent multicentric prospective randomised trials, are necessary. The medical and surgical management of transplanted patients could be greatly improved by using clinically reliable tools to predict early graft function.

Endotherapy of leaks and fistula

Perforations, leaks and fistula involving gastrointestinal(GI) tract are increasing encountered in clinical practice. There is a changing paradigm for their management with surgical approach being replaced by conservative approach including endoscopic therapy. Clips(through the scope and over the scope) and covered stent are front runners for endotherapy for GI leaks and fistula.Over the scope clips introduced recently, can treat larger defects compared to through the scope clips. Covered stents are suited for larger defects and those associated with luminal narrowing. However cervical esophagus, gastro-esophageal junction, stomach and right colonic lesions may be better for clip therapy rather than stenting. Recent developments in this field include use of endovac therapy which consists of a sponge with suction device, biodegradable stent, use of fibrin glue and some endo-suturing device. Conservative therapy with no surgical or endoscopic intervention, may be suitable for a small subset of patients. An algorithm based on location, size of defect, associated stricture, infection and available expertise needs to be developed to reduce the mortality and morbidity of this difficult clinical problem.

Treatment Recommendations among Radiation Oncologists in the Treatment of Cutaneous Squamous Cell Carcinoma with Perineural Invasion

Purpose: Post-operative radiotherapy (PORT) for resected cutaneous squamous cell carcinoma (CSCC) with perineural invasion (PNI) is controversial. Therefore, we conducted a survey to review treatment recommendations among Radiation Oncologists (ROs) in the management of CSCC with PNI. Materials & Methods: In March 2011, we contacted all ROs and trainees in the US through email addresses listed in the 2009 ASTRO directory. Our web-based survey presented clinical vignettes involving Mohs micrographically resected CSCC with microscopic PNI (mPNI) or clinical PNI (cPNI). For each vignette, ROs were asked to indicate if PORT was appropriate and to further specify the dose and volume to treat. Results: Three hundred fifty two responses were completed and analyzed. The majority of ROs (72%) had over 10 years of post residency experience. 64% of the sampled ROs had a special interest in treating head and neck cancers, and 64% treated 4 or more cases per year. Approximately 95% recommended PORT for cPNI whereas 59% recommended PORT for mPNI. Post residency experience (10+ yrs vs. <10 yrs) was associated with a greater propensity to recommend PORT for mPNI (48% vs. 30%, p = 0.005) and for mPNI of deep subcutaneous non-named nerve involvement (80% vs. 60%, p = 0.001). ROs treating 8 or more cases per year (vs. <7) were more likely to recommend PORT for mPNI in immunocompromised patients (74% vs. 57%, p = 0.01). Conclusions: Our study demonstrates significant variability among ROs in the management of CSCC with mPNI. For cases of cPNI, an overwhelming majority recommended PORT. In cases of mPNI, there was no consensus for recommending PORT, although experienced practitioners had a lower threshold for offering treatment. These results indicate the need for prospective clinical studies to clarify the role of PORT in CSCC patients with mPNI.

Effects of electroacupuncture at Chéngshān (承山 BL 57) on postoperative pain of mixed hemorrhoids

ABSTRACT Objective To discuss the effect of electroacupuncture at Chengshan （承山 BL 57） on postoperative pain of mixed hemorrhoids. Methods One hundred and twenty cases with postoperative pain of mixed hemorrhoids were divided into an electroacupuncture group （60 cases） and a medication group （60 cases） randomly. In electroacupuncture group disperse-dense wave in frequency of 2 Hz/100 Hz was adopted at Chengshan （承山 BL 57）, the first treatment was given within 30 min after the operation, from the second day on electroacupuncture treatment was applied once a day and each time after hip bath in the morning. While in medication group 2 tablets of Naproxen Sunstained Release Capsule were administered orally within 30 min after operation, later on 2 tablets were taken before dressing change in the day. After 4 times of treatment, evaluate the changed condition of Visual Analogue Scale （VAS） at 5 h, 24 h, 48 h and 72 b after operation. Results In electroacupuncture group all tested pain scores at 5 h, 24 h, 48 h and 72 h after operation （6.78±2.12, 5.56±1.87, 4.34±2.23 and 3.15±2.11） were lower than those in the medication group （7.56±2.01, 6.23±1.15, 5.57±2.21 and 4.34±2.12）, and the difference was statistically significant （all P〈0.05）. Conclusion Electroacupuncture at Chengshan （承山 BL 57） can reduce the postoperative oain of mixed hemorrhoids.

Clinical Study on Early Post-operational Intraperitoneal Chemotherapy and Salviae in Treating Patients of Gastric Cancer

Objective: To evaluate the safety, feasibility and short term efficacy of early post operational intraperitoneal chemotherapy (EPIC) combined with Salviae miltiorrhizae (SM) in treating patients with gastric cancer. Methods: The 136 patients enrolled were divided into 3 groups: the EPIC group, the EPVC group and the control group. The former two groups were treated with SM plus 5 FU started from the second or third day after operation for 5 continuous days by intraperitoneal infusion or intravenous dripping respectively, and the control group was untreated but conventional chemotherapy was given 3 weeks after surgical operation. Toxic and adverse effects of chemotherapy, post operational complications, short term survival rate and intra abdominal tumor recurrence rate were observed and compared.Results: (1) Toxic adverse effects of chemotherapy that occurred in the EPIC group were less than those in the EPVC group significantly ( P <0.05 0.01). (2) Occurrence of serious complications in the EPIC group was not higher than that in the other two groups. (3) The 1 and 2 year survival rate in the EPIC group was higher than those in the other two groups respectively ( P <0.01), while the post operational intra abdominal recurrence rate in EPIC group was significantly lower than that in the other two groups ( P <0.05). Conclusions: Combined therapy of SM and 5 FU in treating patients with gastric cancer by intraperitoneal infusion is not only safe and feasible with mild toxic and side effect, but also produces a more beneficial effects, including less intra abdominal recurrence and satisfactory short term survival rate .

Validation study of postoperative liver failure and mortality risk scores after liver resection for perihilar cholangiocarcinoma

Background:Surgery for perihilar cholangiocarcinoma(PHCC)remains a challenging procedure with high morbidity and mortality.The Academic Medical Center(Amsterdam UMC)and Memorial Sloan Kettering Cancer Center proposed a postoperative mortality risk score(POMRS)and post-hepatectomy liver failure score(PHLFS)to predict patient outcomes.This study aimed to validate the POMRS and PHLFS for PHCC patients at Hokkaido University.Methods:Medical records of 260 consecutive PHCC patients who had undergone major hepatectomy with extrahepatic bile duct resection without pancreaticoduodenectomy at Hokkaido University between March 2001 and November 2018 were evaluated to validate the PHLFS and POMRS.Results:The observed risks for PHLF were 13.7%,24.5%,and 39.8%for the low-risk,intermediate-risk,and high-risk groups,respectively,in the study cohort.A receiver-operator characteristic(ROC)analysis revealed that the PHLFS had moderate predictive value,with an analysis under the curve(AUC)value of 0.62.Mortality rates based on the POMRS were 1.7%,5%,and 5.1%for the low-risk,intermediate-risk,and high-risk groups,respectively.The ROC analysis demonstrated an AUC value of 0.58.Conclusions:This external validation study showed that for PHLFS the threshold for discrimination in an Eastern cohort was reached(AUC>0.6),but it would require optimization of the model before use in clinical practice is acceptable.The POMRS were not applicable in the eastern cohort.Further external validation is recommended.

Drugs used for pain management in gastrointestinal surgery and their implications

Pain is the predominant symptom troubling patients.Pain management is one of the most important aspects in the management of surgical patients leading to early recovery from surgical procedures or in patients with chronic diseases or malignancy.Various groups of drugs are used for dealing with this;however,they have their own implications in the form of adverse effects and dependence.In this article,we review the concerns of different pain-relieving medicines used postoperatively in gastrointestinal surgery and for malignant and chronic diseases.