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Ectopic Pregnancy: Extrauterine Pregnancy and Pregnancy of Unknown Location
Published in Botros Rizk, A. Mostafa Borahay, Abdel Maguid Ramzy, Clinical Diagnosis and Management of Gynecologic Emergencies, 2020
Early TVU controls to determine the location of a pregnancy may help to detect an EP early. TVU facilities are currently better than ever before and help to establish the correct diagnosis. Emergency surgery can be avoided. Elective minimally invasive surgery or medical treatment can be used as therapeutic options. The gold standard in surgery for women with a tubal pregnancy should be a laparoscopic salpingotomy. A sufficiently skilled surgeon should also perform a tubal suture. This raises fertility rates in women with EPs. Regular β-hCG controls after the intervention are essential to determine the success of treatment and also indicate the need for reintervention on a timely basis.
Anesthetic Management of Laproscopic Colorectal Surgery
Published in Haribhakti Sanjiv, Laparoscopic Colorectal Surgery, 2020
Important causes of in-hospital deaths were septic shock, terminal cancer, cardiac failure, broncho-pneumonia, acute respiratory distress, myocardial infarction, multiorgan failure, gastrointestinal hemorrhage, and stroke. The 30-day, in-hospital mortality during emergency surgery is three to four times higher in comparison to elective surgery. A wide variety of medical complications can occur after bowel surgery, with cardiovascular and pulmonary complications being the most frequent. Patients with renal failure have a significantly raised complication risk after bowel surgery, due to uremia and immunosuppression. Another frequent complication after abdominal surgery is postoperative delirium, with an incidence of 25%–35%, especially in the older patient population [23].
Wound infections and dehiscence
Published in Alexander Trevatt, Richard Boulton, Daren Francis, Nishanthan Mahesan, Take Charge! General Surgery and Urology, 2020
Operative factors (look at operation notes): Was the procedure performed electively or as an emergency? Patients undergoing emergency surgery are usually unwell and recovery is more likely to be complicated, despite a normal pre-operative nutritional state.Was the wound clean or contaminated? A contaminated wound is at greater risk of post-operative wound infection.How long was the surgery? Surgery longer than 7 hours increases the risk of wound infection.Were they given antibiotic prophylaxis?How was the wound closed? Were there difficulties achieving closure (high tension)? Was it closed in layers? What type of suture (or clip) was used?
YKL-40 promotes proliferation and invasion of HTR-8/SVneo cells by activating akt/MMP9 signalling in placenta accreta spectrum disorders
Published in Journal of Obstetrics and Gynaecology, 2023
Weifang Liu, Runfang Wang, Suxin Liu, Xiaoqian Yin, Yan Huo, Ruiling Zhang, Jia Li
In the present study, 47 maternal cases were included, and the gestational age in the PAS group was lower and caesarean hysterectomy was higher than that in normal control group. The timing of delivery should be individualised. Hysterectomy has become the cornerstone of treatment in patients with PAS and postpartum haemorrhage. As for the termination time of PAS, when the mother and foetus are stable, the planned termination time varies according to different associations, and the American College of Obstetricians and Gynaecologists (ACOG) considered the best termination time to be 34–35+6 weeks (Allen et al. 2018). In addition, elective surgery under the condition of adequate preparation significantly reduced the risk of bleeding than emergency surgery, and also reduced the occurrence of many related complications (Miller et al. 2020). Therefore, the gestational age at termination of pregnancy in the PAS group was shorter than that in the control group, and no normal control pregnant women matched with the gestational age of PAS were obtained, which was also the limitation of this study. However, both groups were pregnant women in late pregnancy, which had limited impact on the study results. Among the 25 PAS cases, there was no significant difference in YKL-40 expression between 13 cases of placenta increta and 12 cases of placenta percreta (P > 0.05), which may be related to insufficient sample size and individual differences.
Linear Stapler versus Circular Stapler for Patients Undergoing Anastomosis for Laparoscopic Gastric Surgery: A Meta-Analysis
Published in Journal of Investigative Surgery, 2022
Tao Jin, Han-Dong Liu, Ze-Hua Chen, Jian-Kun Hu, Kun Yang
The exclusion criteria for this meta-analysis were as follows:Patients who underwent hand-sewn reconstruction.Patients who underwent emergency surgery.Laparoscopic Roux-en-Y gastric bypass (RYGB) for obese patients undergoing a primary weight loss procedure because of referral source, or certain factors associated with the patient, such as comorbidities or initial weight, were not considered.Patients who had gastric cancer with metastasis and those with remnant gastric cancer.Noncomparative research, for instance, reviews, meta-analyses, letters, and case reports.Studies that did not mention reconstruction methods.Studies lacking sufficient data for statistical analyses.
An unusual presentation of non-IBD related colorectal primary extranodal diffuse large B cell lymphoma with a colo-colonic fistula
Published in Journal of Community Hospital Internal Medicine Perspectives, 2021
Rima Nakrani, Ho-Man Yeung, Matan Arnon, Alexandra Selby, Christine Burgert-Lon, Bhishak Kamat
Primary colorectal DLBCL is a rare entity and effective frontline treatment of this condition (i.e., chemoradiotherapy or upfront surgery) has always remained a topic of controversy. Patients with complications, such as perforation, obstruction, or hemorrhage necessitate emergency surgery. Otherwise, clinical and tumor features should be taken into account in non-emergent cases [13]. Some investigators believe that surgery may provide better prognostication, enhance survival outcomes, and reduce the likelihood of future complications. Other authors believe that chemotherapy is adequate to achieve disease control [14]. However, localized disease (Stage I and II) fares better with surgical resection followed by R-CHOP chemotherapy, whereas unresectable disease (Stage III and IV) typically requires a full six cycles of R-CHOP chemotherapy followed by radiation for bulky disease [5]. Nevertheless, as with the treatment of all conditions, the risk and benefits must be weighted along with other factors including age, performance status, clinical condition and comorbidities, and patient/family preferences. In our case, the patient had advanced age, poor nutrition, poor performance status, and advanced stage IV disease. The patient and his oncologist elected for chemoradiation with reduced dosage and close outpatient monitoring for potential complications.