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[PMID]:28449642
[Au] Autor:Polat I; Yücel B; Gedikbasi A; Aslan H; Fendal A
[Ad] Endereço:Department of Obstetrics and Gynecology, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Turkey.
[Ti] Título:The effectiveness of double incision technique in uterus preserving surgery for placenta percreta.
[So] Source:BMC Pregnancy Childbirth;17(1):129, 2017 04 27.
[Is] ISSN:1471-2393
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Placenta percreta is a life-threatening condition that places patients at risk of massive bleeding. It necessitates very complicated surgery and can result in mortality. Caesarean hysterectomy is the accepted procedure worldwide; however, recent studies discussing conservative treatment with segmental resections have been published. Foetal extraction and segmental resection can be performed through the same incision (single uterine incision) or through two different incisions (double uterine incision). In this study, we aimed to evaluate the effectiveness and results of the double incision technique. METHODS: Twenty-two patients with a diagnosis of placenta percreta who underwent conservative surgery were included. Segmental resection was performed via single incision in ten patients and double incision in twelve patients. RESULTS: There was no difference between the patients who underwent segmental resection via single and double incision in terms of age, gravida, number of previous caesarean deliveries, gestational age at delivery, or rate of elective surgeries. The operation time, transfusion requirement, intensive care unit admission, total hospitalization and success of conservative surgery were comparable between the groups. CONCLUSIONS: Based on the outcomes of our study, double uterine incision allows for the safe extraction of the foetus during uterus-preserving surgery in patients with placenta percreta without worsening the results compared to single uterine incision. TRIAL REGISTRATION: NCT02702024 , Date of registration: February 26, 2016, retrospectively registered.
[Mh] Termos MeSH primário: Tratamentos com Preservação do Órgão/métodos
Placenta Acreta/cirurgia
Ferida Cirúrgica
Útero/cirurgia
[Mh] Termos MeSH secundário: Adulto
Feminino
Seres Humanos
Gravidez
Estudos Retrospectivos
Resultado do Tratamento
Adulto Jovem
[Pt] Tipo de publicação:EVALUATION STUDIES; JOURNAL ARTICLE
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180309
[Lr] Data última revisão:
180309
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170429
[Cl] Clinical Trial:ClinicalTrial
[St] Status:MEDLINE
[do] DOI:10.1186/s12884-017-1262-3


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[PMID]:29443762
[Au] Autor:Sun Y; Wang H; Tang Y; Zhao H; Qin S; Xu L; Xia Z; Zhang F
[Ad] Endereço:Department of Foot and Ankle Surgery, the Third Hospital of Hebei Medical University.
[Ti] Título:Incidence and risk factors for surgical site infection after open reduction and internal fixation of ankle fracture: A retrospective multicenter study.
[So] Source:Medicine (Baltimore);97(7):e9901, 2018 Feb.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Information on surgical site infection (SSI) after surgical treatment of ankle fracture is limited and remains controversial. The purpose of the present study was to determine the incidence and risk factors for SSI after open reduction and internal fixation (ORIF) of ankle fracture. Patients who underwent ORIF for ankle fracture at 3 centers between January 2015 and December 2016 were included. The potential risk factors for SSI included demographic variables, including age, sex, body mass index (BMI), hypertension, diabetes mellitus, heart disease, smoking, and excessive alcohol intake; blood test variables including preoperative white blood cell count, neutrophil count, red blood cell count, hemoglobin, total protein, albumin and globulin; injury- and surgery-related variables, including duration of operation (minutes), intraoperative blood loss, surgeon level, fracture site, accompanied dislocation, use of a drainage tube, and antibiotic use. Factors related with SSI occurrence were investigated by univariate analysis, and then by multivariate analysis. During hospitalization, 4.37% (66/1511) of patients developed SSI, which was deep in 1.32% (20/1510) and superficial in 3.05% (46/1510). The most common causative agent was polymicrobial (causing approximately half of all SSIs), followed by methicillin-resistant Staphylococcus aureus (MRSA). Multivariate analysis revealed that the significant risk factors for SSI occurrence were open injury, advanced age, incision cleanliness II - IV, high-energy injury, more experienced surgeon level, greater BMI, chronic heart disease, history of allergy, and preoperative neutrophil count > 75%. Preoperative preventative measures should be taken in patients with these conditions to lower the incidence of SSI after ORIF of ankle fracture. LEVEL OF EVIDENCE: Level III - Retrospective Comparative Study.
[Mh] Termos MeSH primário: Fraturas do Tornozelo
Fixação Interna de Fraturas/efeitos adversos
Staphylococcus aureus Resistente à Meticilina/isolamento & purificação
Redução Aberta/efeitos adversos
Infecção da Ferida Cirúrgica
Ferida Cirúrgica/microbiologia
[Mh] Termos MeSH secundário: Idoso
Fraturas do Tornozelo/epidemiologia
Fraturas do Tornozelo/cirurgia
Antibacterianos/uso terapêutico
China/epidemiologia
Coinfecção/diagnóstico
Coinfecção/terapia
Feminino
Fixação Interna de Fraturas/métodos
Seres Humanos
Incidência
Masculino
Meia-Idade
Redução Aberta/métodos
Estudos Retrospectivos
Fatores de Risco
Infecção da Ferida Cirúrgica/diagnóstico
Infecção da Ferida Cirúrgica/etiologia
Infecção da Ferida Cirúrgica/terapia
[Pt] Tipo de publicação:JOURNAL ARTICLE; MULTICENTER STUDY
[Nm] Nome de substância:
0 (Anti-Bacterial Agents)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180222
[Lr] Data última revisão:
180222
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180215
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000009901


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[PMID]:29254291
[Au] Autor:Omar NN; El-Tawdi AH; Tash RF; Shoukry Y; Mahmoud NA; El Bakly W
[Ad] Endereço:Department of Biochemistry, Faculty of Pharmacy, Modern University for Technology and Information, Cairo, Egypt.
[Ti] Título:Tumor potential in rat wounds after short- and long-term administration of platelet-rich plasma.
[So] Source:J Biol Regul Homeost Agents;31(4):889-899, 2017 Oct-Dec.
[Is] ISSN:0393-974X
[Cp] País de publicação:Italy
[La] Idioma:eng
[Ab] Resumo:Platelet-rich plasma (PRP) has been recognized as an effective strategy for tissue regeneration, how-ever, the safety of PRP in wound healing in terms of tumorigenicity has not yet been addressed. Therefore, the aim of this study was to examine the impact of PRP administration on the expression of the inflammatory marker, tenascin-C (TnC) and the myofibroblast markers, α-smooth muscle actin (α-SMA) and vimentin. The immune suppressive response was examined by determining the level of forkhead box protein 3 (Foxp3). PRP was administered for both long-term (two times weekly for four weeks) and short-term (for the fourth week only) post-wounding. Collagen I (col1) and lysyl oxidase (LOX) were used to indicate complete healing, after which any increase in the myofibroblast or in the inflammatory markers would suggest tumor potential. Collagen III (col3), a marker for granulation tissue, was used to remark non-healing. Quantitative real-time reverse transcriptase polymerase chain reaction (QRT-PCR) and Western blot showed that after long-term administration of PRP, the expression of TnC, α-SMA and vimentin was barely detected, while being markedly expressed in the wounded non-treated group and in the short-term administration group. Moreover, the active expression of α-SMA in the two groups was associated positively with the expression of col3 and negatively with the expression of col1. The low expression of Foxp3 after short-term administration relative to the control group indicated active immunity against tumor development. In conclusion, these findings indicate that PRP can be safely used in short- and long-term administration without tumorigenesis concern.
[Mh] Termos MeSH primário: Plasma Rico em Plaquetas/fisiologia
Ferida Cirúrgica/terapia
Cicatrização/fisiologia
[Mh] Termos MeSH secundário: Actinas/genética
Actinas/metabolismo
Animais
Biomarcadores/metabolismo
Carcinogênese
Colágeno Tipo I/genética
Colágeno Tipo I/metabolismo
Colágeno Tipo III/genética
Colágeno Tipo III/metabolismo
Feminino
Fatores de Transcrição Forkhead/genética
Fatores de Transcrição Forkhead/metabolismo
Expressão Gênica
Miofibroblastos/metabolismo
Miofibroblastos/patologia
Ratos
Ratos Sprague-Dawley
Ferida Cirúrgica/genética
Ferida Cirúrgica/metabolismo
Ferida Cirúrgica/patologia
Tenascina/genética
Tenascina/metabolismo
Vimentina/genética
Vimentina/metabolismo
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Actins); 0 (Biomarkers); 0 (Collagen Type I); 0 (Collagen Type III); 0 (Forkhead Transcription Factors); 0 (Foxp3 protein, rat); 0 (Tenascin); 0 (Vimentin); 0 (smooth muscle actin, rat)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180222
[Lr] Data última revisão:
180222
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171220
[St] Status:MEDLINE


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[PMID]:29180177
[Au] Autor:Ismail A; Abushouk AI; Elmaraezy A; Menshawy A; Menshawy E; Ismail M; Samir E; Khaled A; Zakarya H; El-Tonoby A; Ghanem E
[Ad] Endereço:Al-Azhar Research Network, Cairo, Egypt; Faculty of Medicine, Al-Azhar University, Cairo, Egypt; Al-Azhar Medical Students' Association, Cairo, Egypt; NovaMed Medical Research Association, Cairo, Egypt.
[Ti] Título:Cutting electrocautery versus scalpel for surgical incisions: a systematic review and meta-analysis.
[So] Source:J Surg Res;220:147-163, 2017 Dec.
[Is] ISSN:1095-8673
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Although cutting electrocautery can be superior to the scalpel in reducing blood loss and incisional time, several reports associated electrocautery with higher rates of wound infection, impaired healing, and worse cosmesis. We performed this systematic review and meta-analysis to compare cutting electrocautery versus scalpel for surgical incisions. MATERIALS AND METHODS: We conducted a computerized literature search of five electronic databases and included all published original studies comparing cutting electrocautery and scalpel surgical incisions. Relevant data were extracted from eligible studies and pooled as odds ratios (ORs) or standardized mean difference (SMD) values in a meta-analysis model, using RevMan and Comprehensive Meta-analysis software. RESULTS: Forty-one studies (36 randomized trials, four observational, and one quasirandom study) were included in the pooled analysis (6422 participants). Compared with the scalpel incision, cutting electrocautery resulted in significantly less blood loss (SMD = -1.16, 95% CI [-1.60 to -0.72]), shorter incisional (SMD = -0.63, 95% CI [-0.96 to -0.29]) and operative times (SMD = -0.59, 95% CI [-1.12 to -0.05]), and lower pain scores (SMD = -0.91, 95% CI [-1.27 to -0.55]) with no significant differences in terms of wound infection rates (OR = 0.92, 95% CI [0.74-1.15]) or overall subjective scar score (SMD = -0.49, 95% CI [-1.72 to 0.75]). CONCLUSIONS: Surgical incision using electrocautery can be quicker with less blood loss and postoperative pain scores than the scalpel incision. No statistically significant difference was found between both techniques in terms of postoperative wound complications, hospital stay duration, and wound cosmetic characteristics. Therefore, we recommend routine use of cutting electrocautery for surgical incisions.
[Mh] Termos MeSH primário: Cicatriz/epidemiologia
Eletrocoagulação/efeitos adversos
Instrumentos Cirúrgicos/efeitos adversos
Infecção da Ferida Cirúrgica/epidemiologia
Ferida Cirúrgica/complicações
Cicatrização
[Mh] Termos MeSH secundário: Perda Sanguínea Cirúrgica/estatística & dados numéricos
Cicatriz/etiologia
Seres Humanos
Tempo de Internação
Duração da Cirurgia
Dor Pós-Operatória/epidemiologia
Dor Pós-Operatória/etiologia
Resultado do Tratamento
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE; META-ANALYSIS; REVIEW
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171211
[Lr] Data última revisão:
171211
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171129
[St] Status:MEDLINE


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[PMID]:29016508
[Au] Autor:Smid MC; Dotters-Katz SK; Grace M; Wright ST; Villers MS; Hardy-Fairbanks A; Stamilio DM
[Ad] Endereço:Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, Utah; the Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, and the Health Sciences Library, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina; the Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Duke University, Durham, North Carolina; and the Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Iowa, Iowa City, Iowa.
[Ti] Título:Prophylactic Negative Pressure Wound Therapy for Obese Women After Cesarean Delivery: A Systematic Review and Meta-analysis.
[So] Source:Obstet Gynecol;130(5):969-978, 2017 Nov.
[Is] ISSN:1873-233X
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To summarize available studies on wound complication outcomes after prophylactic negative pressure wound therapy for obese women (body mass index 30 or greater). DATA SOURCES: We conducted a systematic review and meta-analysis using electronic database search (PubMed, Cumulative Index to Nursing and Allied Health Literature, EMBASE, Google scholar, and Web of Science), Cochrane, and trial registries including ClinicalTrials.gov. METHODS OF STUDY SELECTION: We conducted an electronic search of research articles from 1966 to January 2017 for randomized controlled trials (RCTs), prospective cohort, and retrospective cohort studies of negative pressure wound therapy compared with standard dressing after cesarean delivery among obese women. Our primary outcome was defined as a composite of wound complication, including wound or surgical site infection, cellulitis, seroma, hematoma, wound disruption, or dehiscence. For cohort studies and RCTs, we performed a descriptive systematic review. For available RCTs, we performed a meta-analysis and pooled risk ratios using a random-effects model. We assessed for heterogeneity using χ test for heterogeneity and I test. We assessed for publication bias using a funnel plot. TABULATION, INTEGRATION, AND RESULTS: Of 10 studies meeting eligibility criteria, five were RCTs and five were cohort studies. Results of cohort studies were varied; however, all had a high potential for selection bias. In the meta-analysis, there was no difference in primary composite outcome among those women with negative pressure wound therapy (16.8%) compared with those who had standard dressing (17.8%) (risk ratio 0.97, 95% CI 0.63-1.49). There was no statistically significant heterogeneity (χ test 4.80, P=.31, I=17%). CONCLUSION: Currently available evidence does not support negative pressure wound therapy use among obese women for cesarean wound complication prevention. SYSTEMATIC REVIEW REGISTRATION: PROSPERO: International prospective register of systematic reviews, 42016033948.
[Mh] Termos MeSH primário: Cesárea/métodos
Tratamento de Ferimentos com Pressão Negativa/métodos
Obesidade/cirurgia
Complicações Pós-Operatórias/prevenção & controle
Complicações na Gravidez/cirurgia
Procedimentos Cirúrgicos Profiláticos/métodos
Ferida Cirúrgica/terapia
[Mh] Termos MeSH secundário: Adulto
Índice de Massa Corporal
Feminino
Seres Humanos
Obesidade/complicações
Complicações Pós-Operatórias/etiologia
Gravidez
Complicações na Gravidez/etiologia
Ferida Cirúrgica/etiologia
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS; REVIEW
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171102
[Lr] Data última revisão:
171102
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171011
[St] Status:MEDLINE
[do] DOI:10.1097/AOG.0000000000002259


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Azevedo, Ramiro Anthero de
Martins, José Luiz
Texto completo SciELO Brasil
[PMID]:28902943
[Au] Autor:Vicentine FPP; Gonzalez AM; Beninni BB; Azevedo RA; Linhares MM; Goldenberg A; Lopes GJ; Martins JL; Salzedas AA
[Ad] Endereço:Fellow PhD degree, Postgraduate Program in Interdisciplinary Surgical Sciences, Universidade Federal de São Paulo (UNIFESP), Brazil. Conception and design of the study; acquisition, analysis and interpretation of data; statistics analysis; final approval of the version to be published.
[Ti] Título:Use of fibrinogen and thrombin sponge in pediatric split liver transplantation.
[So] Source:Acta Cir Bras;32(8):673-679, 2017 Aug.
[Is] ISSN:1678-2674
[Cp] País de publicação:Brazil
[La] Idioma:eng
[Ab] Resumo:Purpose:: To analyze the use of this sponge in pediatric patients undergoing split-liver transplantation. Methods:: Retrospective study, including 35 pediatric patients undergoing split-liver transplantation, divided into two groups according to the use of the sponge: 18 patients in Group A (no sponge) and 17 in Group B (with sponge). Results: : The characteristics of recipients and donors were similar. We observed greater number of reoperation due to bleeding in the wound area in Group A (10 patients - 55.5%) than in Group B (3 patients - 17.6%); p = 0.035. The median volume of red blood cells transfused in Group A was significantly higher (73.4 ± 102.38 mL/kg) than that in Group B (35.1 ± 41.67 mL/kg); p = 0.048. Regarding bile leak there was no statistical difference. Conclusion:: The use of the human fibrinogen and thrombin sponge, required lower volume of red blood cell transfusion and presented lower reoperation rates due to bleeding in the wound area.
[Mh] Termos MeSH primário: Fibrinogênio/uso terapêutico
Hemostasia Cirúrgica/métodos
Hemostáticos/uso terapêutico
Transplante de Fígado/métodos
Tampões de Gaze Cirúrgicos
Trombina/uso terapêutico
[Mh] Termos MeSH secundário: Perda Sanguínea Cirúrgica/prevenção & controle
Transfusão de Eritrócitos
Feminino
Hepatectomia/métodos
Seres Humanos
Lactente
Fígado/cirurgia
Transplante de Fígado/efeitos adversos
Masculino
Reoperação
Reprodutibilidade dos Testes
Estudos Retrospectivos
Estatísticas não Paramétricas
Ferida Cirúrgica/tratamento farmacológico
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Hemostatics); 9001-32-5 (Fibrinogen); EC 3.4.21.5 (Thrombin)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171011
[Lr] Data última revisão:
171011
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170914
[St] Status:MEDLINE


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[PMID]:28832796
[Au] Autor:Garg P; Bishnoi AK; Lakhia K; Surti J; Siddiqui S; Solanki P; Pandya H
[Ad] Endereço:Department of Cardiovascular and Thoracic Surgery of the U. N. Mehta Institute of Cardiology and Research Center (affiliated to BJ Medical College, Ahmedabad), Gujarat, India.
[Ti] Título:Transverse Sternal Split: a Safe Mini-invasive Approach for Perventricular Device Closure of Ventricular Septal Defect.
[So] Source:Braz J Cardiovasc Surg;32(3):184-190, 2017 May-Jun.
[Is] ISSN:1678-9741
[Cp] País de publicação:Brazil
[La] Idioma:eng
[Ab] Resumo:Objective:: Perventricular device closure of ventricular septal defect through midline sternotomy avoids the cardiopulmonary bypass, however, lacks the cosmetic advantage. Perventricular device closure of ventricular septal defect with transverse split sternotomy was performed to add the cosmetic advantage of mini-invasive technique. Methods:: Thirty-six pediatric patients with mean age 7.14±3.24 months and weight 5.00±0.88 kg were operated for perventricular device closure of ventricular septal defect through transverse split sternotomy in 4th intercostal space under transesophageal echocardiography guidance. In case of failure or complication, surgical closure of ventricular septal defect was performed through the same incision with cervical cannulation of common carotid artery and internal jugular vein for commencement of cardiopulmonary bypass. All the patients were postoperatively followed, and then discharged from hospital due to their surgical outcome, morbidity and mortality. Results:: Procedure was successful in 35 patients. Two patients developed transient heart block. Surgical closure of ventricular septal defect was required in one patient. Mean duration of ventilation was 11.83±3.63 hours. Mean intensive care unit and hospital stay were 1.88±0.74 days and 6.58±1.38 days, respectively. There was no in-hospital mortality. A patient died one day after hospital discharge due to arrhythmia. No patients developed wound related, vascular or neurological complication. In a mean follow-up period of 23.3±18.45 months, all 35 patients were doing well without residual defect with regression of pulmonary artery hypertension as seen on transthoracic echocardiography. Conclusion:: Transverse split sternotomy incision is a safe and effective alternative to a median sternotomy for perventricular device closure of ventricular septal defect with combined advantage of better cosmetic outcomes and avoidance of cardiopulmonary bypass.
[Mh] Termos MeSH primário: Comunicação Interventricular/cirurgia
Dispositivo para Oclusão Septal
Esternotomia/instrumentação
Esternotomia/métodos
[Mh] Termos MeSH secundário: Adolescente
Ponte Cardiopulmonar
Criança
Pré-Escolar
Ecocardiografia Transesofagiana
Feminino
Seguimentos
Ventrículos do Coração/cirurgia
Seres Humanos
Tempo de Internação
Masculino
Duração da Cirurgia
Desenho de Prótese
Reprodutibilidade dos Testes
Ferida Cirúrgica
Fatores de Tempo
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE; OBSERVATIONAL STUDY
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170925
[Lr] Data última revisão:
170925
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170824
[St] Status:MEDLINE


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[PMID]:28822559
[Au] Autor:Ghahramani L; Minaie MR; Arasteh P; Hosseini SV; Izadpanah A; Bananzadeh AM; Ahmadbeigi M; Hooshanginejad Z
[Ad] Endereço:Department of surgery, Colorectal Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
[Ti] Título:Antibiotic therapy for prevention of fistula in-ano after incision and drainage of simple perianal abscess: A randomized single blind clinical trial.
[So] Source:Surgery;162(5):1017-1025, 2017 Nov.
[Is] ISSN:1532-7361
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Much controversy exists regarding the role of antibiotics in the development of fistula in-ano after incision and drainage. We evaluated the role of postoperative antibiotics in the prevention of fistula in-ano after incision and drainage of perianal abscess. METHODS: In a randomized single blind clinical trial study, 307 patients were randomly selected from those referring for incision and drainage of perianal abscess at Shahid Faghihi Hospital, Shiraz, Iran, during September 2013 to September 2014. Patients were allocated randomly either to receive 7 days of oral metronidazole and ciprofloxacin in addition to their standard care or to only receive standard care without any antibiotics after they were discharged from the hospital. Patients were followed for 3 months and final results were evaluated. The study was registered at the clinical trial registry (www.irct.ir; Irct201311049936n7). RESULTS: Seven patients were lost to follow-up. Those who used prophylactic antibiotics (n = 155) had significantly lower rates of fistula formation compared with those who did not use any medication (n = 144; P < .001). Men had higher rates of fistula formation (P = .002). Patients who used more cigarettes had higher rates of fistula development (P = .001). In the univariate analysis, only postoperative antibiotic use showed a protective role against fistula formation (odds ratio = 0.426; confidence interval, 0.206-0.881). In the regression analysis postoperative antibiotic use remained protective against fistula development (odds ratio = 0.371; confidence interval, 0.196-0.703), furthermore male sex presented as a risk factor for developing fistula in-ano (odds ratio = 3.11; confidence interval, 1.31-7.38). CONCLUSION: Postoperative prophylactic antibiotic therapy including ciprofloxacin and metronidazole play an important role in preventing fistula in-ano formation. Considering the complications of fistula in-ano formation and the minor side effects of antibiotic therapy, based on our results, a 7-10 course of postoperative antibiotics is advised after incision and drainage of perianal abscess.
[Mh] Termos MeSH primário: Abscesso/cirurgia
Antibacterianos/uso terapêutico
Doenças do Ânus/cirurgia
Drenagem/efeitos adversos
Fístula Retal/prevenção & controle
[Mh] Termos MeSH secundário: Antibioticoprofilaxia
Ciprofloxacino/uso terapêutico
Drenagem/métodos
Seres Humanos
Metronidazol/uso terapêutico
Fístula Retal/etiologia
Método Simples-Cego
Ferida Cirúrgica/complicações
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Nm] Nome de substância:
0 (Anti-Bacterial Agents); 140QMO216E (Metronidazole); 5E8K9I0O4U (Ciprofloxacin)
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171109
[Lr] Data última revisão:
171109
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170821
[St] Status:MEDLINE


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[PMID]:28688643
[Au] Autor:Tseng TH; Jiang CC; Fu SH; Lee TL; Chuang YH; Chiang H
[Ad] Endereço:Department of Orthopaedic Surgery, Taoyuan General Hospital, Taoyuan, Taiwan; Department of Orthopaedic Surgery, National Taiwan University Hospital, Taipei, Taiwan.
[Ti] Título:Topical anesthesia for staple removal from surgical wounds on the knee: a prospective, double-blind, randomized trial.
[So] Source:J Surg Res;215:167-172, 2017 Jul.
[Is] ISSN:1095-8673
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Staple removal from surgical wounds is painful. Only a few articles have provided expert opinions using anesthetic cream for such a problem; however, direct application of the anesthetic cream to a wound may cause infection. A safe alternative can be an anesthetic patch without wound contact. MATERIALS AND METHODS: This was a prospective, double-blind, randomized clinical trial. Sixty patients who underwent primary total knee replacement were assigned to an experimental group or control group. One lidocaine patch was applied around the surgical wound for each patient in the experimental group. Alternatively, the adhesive sides of the lidocaine patches were shielded with waterproof films in the control group. A resident peeled off the patch before a single nursing practitioner removed the staples. Pain was assessed with the 10-cm visual analog scale, and a face pain scale-revised was performed. The patients and the nursing practitioner were blind to the management. RESULTS: Mean visual analog scale and face pain scale-revised scores were significantly lower in the experimental group. The mean pain score was significantly lower in the experimental group if the application time was >47 min; for patients with application time of 47 min or shorter, the score was comparable with the mean pain scores of the control group (P = 0.215). CONCLUSIONS: Removal of the metal skin staples after total knee arthroplasty is associated with moderate-to-severe pain. The lidocaine patch applied topically around the surgical wound could effectively reduce the pain during the procedure, without remarkable complications such as systemic adverse effects or wound contamination.
[Mh] Termos MeSH primário: Anestesia Local/métodos
Anestésicos Locais/administração & dosagem
Artroplastia do Joelho
Remoção de Dispositivo
Lidocaína/administração & dosagem
Ferida Cirúrgica/cirurgia
Suturas
[Mh] Termos MeSH secundário: Administração Tópica
Adulto
Idoso
Idoso de 80 Anos ou mais
Anestesia Local/instrumentação
Método Duplo-Cego
Feminino
Seguimentos
Seres Humanos
Masculino
Meia-Idade
Avaliação de Resultados (Cuidados de Saúde)
Medição da Dor
Estudos Prospectivos
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Nm] Nome de substância:
0 (Anesthetics, Local); 98PI200987 (Lidocaine)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171003
[Lr] Data última revisão:
171003
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170710
[St] Status:MEDLINE


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[PMID]:28688638
[Au] Autor:Wang-Chan A; Gingert C; Angst E; Hetzer FH
[Ad] Endereço:Department of Surgery and Orthopedics, Hospital Linth, Uznach, Switzerland. Electronic address: anastasija.wang-chan@spital-linth.ch.
[Ti] Título:Clinical relevance and effect of surgical wound classification in appendicitis: Retrospective evaluation of wound classification discrepancies between surgeons, Swissnoso-trained infection control nurse, and histology as well as surgical site infection rates by wound class.
[So] Source:J Surg Res;215:132-139, 2017 Jul.
[Is] ISSN:1095-8673
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Surgical wound classification (SWC) is used for risk stratification of surgical site infection (SSI) and serves as the basis for measuring quality of care. The objective was to examine the accuracy and reliability of SWC. This study was purposed to evaluate the discrepancies in SWC as assessed by three groups: surgeons, an infection control nurse, and histopathologic evaluation. The secondary aim was to compare the risk-stratified SSI rates using the different SWC methods for 30 d postoperatively. METHODS: An analysis was performed of the appendectomies from January 2013 to June 2014 in the Cantonal Hospital of Schaffhausen. SWC was assigned by the operating surgeon at the end of the procedure and retrospectively reviewed by a Swissnoso-trained infection control nurse after reading the operative and pathology report. The level of agreement among the three different SWC assessment groups was determined using kappa statistic. SSI rates were analyzed using a chi-square test. RESULTS: In 246 evaluated cases, the kappa scores for interrater reliability among the SWC assessments across the three groups ranged from 0.05 to 0.2 signifying slight agreement between the groups. SSIs were more frequently associated with trained infection control nurse-assigned SWC than with surgeons based SWC. CONCLUSIONS: Our study demonstrated a considerable discordance in the SWC assessments performed by the three groups. Unfortunately, the currently practiced SWC system suffers from ambiguity in definition and/or implementation of these definitions is not clearly stated. This lack of reliability is problematic and may lead to inappropriate comparisons within and between hospitals and surgeons.
[Mh] Termos MeSH primário: Apendicectomia
Apendicite/cirurgia
Disparidades em Assistência à Saúde/estatística & dados numéricos
Padrões de Prática em Enfermagem/estatística & dados numéricos
Padrões de Prática Médica/estatística & dados numéricos
Infecção da Ferida Cirúrgica/prevenção & controle
Ferida Cirúrgica/classificação
[Mh] Termos MeSH secundário: Adulto
Idoso
Idoso de 80 Anos ou mais
Feminino
Seguimentos
Seres Humanos
Controle de Infecções/métodos
Masculino
Meia-Idade
Variações Dependentes do Observador
Reprodutibilidade dos Testes
Estudos Retrospectivos
Medição de Risco
Cirurgiões/estatística & dados numéricos
Ferida Cirúrgica/diagnóstico
Ferida Cirúrgica/patologia
Infecção da Ferida Cirúrgica/diagnóstico
Infecção da Ferida Cirúrgica/epidemiologia
Infecção da Ferida Cirúrgica/etiologia
Suíça
[Pt] Tipo de publicação:JOURNAL ARTICLE; VALIDATION STUDIES
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171003
[Lr] Data última revisão:
171003
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170710
[St] Status:MEDLINE



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