International journal of surgery
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Observational Study
Multimodal intraoperative monitoring: an observational case series in high risk patients undergoing major peripheral vascular surgery.
Recent guidelines from the National Institute of Health and Care Excellence (NICE) and the UK National Health Service (NHS) have stipulated that intraoperative flow monitoring should be used in high-risk patients undergoing major surgery to improve outcomes and reduce costs. Depth of anaesthesia monitoring is also recommended for patients where excessive anaesthetic depth is poorly tolerated, along with cerebral oximetry in patients with proximal femoral fractures. The aims of this descriptive case series were to evaluate the impact of a multimodal intraoperative strategy and its effect on mortality and amputation rate for patients with critical leg ischaemia. ⋯ Amputation rate was less than 2% at one year. Only 8% of patients (10 of 120) were admitted to a high dependency unit (HDU) postoperatively. 30-day mortality in our case series was lower than predicted by V-POSSUM scoring. Use of multimodal intraoperative monitoring with the specific aim of limiting build-up of oxygen debt should be subjected to a randomised controlled study to assess the reproducibility of these results.
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Effect of local glial derived neurotrophic factor (GDNF) on nerve regeneration was assessed. Eighty male Wistar rats were divided into four experimental groups (n = 20), randomly: In transected group left sciatic nerve was transected and stumps were fixed in adjacent muscle. In treatment group defect was bridged using an artery graft filled with 10 μL GDNF. ⋯ Immunohistochemical reactions to S-100 in IOAG/GDNF were more positive than that in IOAG group. GDNF improved functional recovery and morphometric indices of sciatic nerve. It could be considered as an effective treatment for peripheral nerve repair in practice.
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Randomized Controlled Trial
Open reduction and internal fixation with conventional plate via L-shaped lateral approach versus internal fixation with percutaneous plate via a sinus tarsi approach for calcaneal fractures - a randomized controlled trial.
We aimed to compare the clinical outcomes of intra-articular calcaneus fractures treated with open reduction and internal fixation with conventional plate via L-shaped lateral approach (routine treatment) versus those with percutaneous plate via a sinus tarsi approach (minimally invasive treatment). ⋯ Compared with L-shaped lateral approach treatment of displaced intra-articular calcaneal fractures, sinus tarsi approach for the reduction and internal fixation with percutaneous plate seems to be more safe and effective, with satisfactory clinical therapeutic effects and without postoperative complications.