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Introduction: Treatment of the primary tumor in asymptomatic patients with unresectable colorectal metastases remains controversial. Methods: Data from patients with synchronous stage IV colon cancer and an untreated primary tumor who started treatment aimed at metastatic disease at a specialized cancer center between 2014 and 2018 were analyzed retrospectively. Main outcome was primary tumor-related complications comparing left-sided and right-sided colon cancer. A competing-risk regression model was used to identify predictors of complications. Results: Of 523 patients with metastatic colon cancer at presentation, 221 started treatment aimed at metastatic disease; these patients constituted the study cohort. The primary tumor was left-sided in 109 patients (49%) and right-sided in 112 patients (51%). In total, 46 patients (21%) developed a complication that required invasive intervention. Complications occurred more frequently in patients with left-sided tumors than in patients with right-sided tumors (29% vs 13%, P = 0.003). Eighteen patients (8%) underwent non-surgical intervention. Six patients (33%) failed non-surgical management and underwent surgery. Of 34 patients (15%) who underwent surgical intervention, 20 underwent an emergency colectomy and 14 underwent diversion with a permanent stoma. Overall, 10% of patients ended up with a permanent stoma. In competing-risk analysis, only left-sided primary tumor (hazard ratio 2.62; 95% CI 1.40–4.89; P = 0.003) was significantly associated with primary tumor-related complications requiring invasive intervention. Conclusions: Patients with asymptomatic metastatic left-sided tumors have a higher risk for primary tumor-related complications than patients with right-sided tumors. Close monitoring and early surgical rescue should be considered for patients with left-sided colon cancer who are managed nonoperatively.

Hypoplastic Left Heart Syndrome (HLHS) is a congenital heart defect that requires a three-stage surgical palliation to create a single ventricle system in the right side of the heart. Of patients undergoing this cardiac palliation series, 25% will develop tricuspid regurgitation (TR), which is associated with an increased mortality risk. Valvular regurgitation in this population has been extensively studied to understand indicators and mechanisms of comorbidity. In this article, we review the current state of research on TR in HLHS, including identified valvular anomalies and geometric properties as the main reasons for the poor prognosis. After this review, we present some suggestions for future TR-related studies to answer the central question: What are the predictors of TR onset during the three palliation stages? These studies involve (i) the use of engineering-based metrics to evaluate valve leaflet strains and predict tissue material properties, (ii) perform multivariate analyses to identify TR predictors, and (iii) develop predictive models, particularly using longitudinally tracked patient cohorts to foretell patient-specific trajectories. Regarded together, these ongoing and future efforts will result in the development of innovative tools that can aid in surgical timing decisions, in prophylactic surgical valve repair, and in the refinement of current intervention techniques.

Objective. This work sought to establish the relationship between the degree of dependency with hospitalization time of patients intervened surgically in a regional hospital of Peru. Methods. The study was analytical, cross-sectional with retrospective data collection, studying 380 patients treated in the surgical service at Regional hospital Docente in the municipality of Cajamarca (Peru). The patients’ demographic and clinical information was obtained from the daily care records in the hospital’s surgery service. The univariate description was conducted through absolute and relative frequencies and confidence intervals for proportions at 95%; for the association between the degree of dependency and hospitalization time Log Rank (Mantel-Cox) – Chi-square was applied, as well as the Kaplan-Meier survival analysis, with statistical significance of p<0.05. Results. The study had 53.4% male patients, with mean age of 35.3 years, referrals from operating room (64.7%), surgery specialty (66.6%) and the most-frequent surgical intervention was appendectomy (49.7%). Mean hospitalization time was 10 days; 88.1% of the patients had grade-II dependency. The degree of patient dependency had a significant impact on the days of post-surgery hospitalization with direct relationship between both variables (p=0.038). Conclusion. Hospitalization time is determined by the degree of dependency of patients subjected to a surgical intervention; thereby, it is fundamental to anticipate all the necessary resources for proper care management., Objetivo. Estabelecer a relação entre o grau de dependência e o tempo de internação de pacientes operados em um hospital regional do Peru. Métodos. O estudo foi transversal analítico com obtenção retrospectiva de informações. Foram estudados 380 pacientes atendidos no serviço de cirurgia do Hospital Universitário Regional do município de Cajamarca (Peru). As informações demográficas e clínicas dos pacientes foram obtidas da ficha de atendimento diário do serviço de cirurgia do hospital. Resultados. 53.4% dos doentes eram do sexo masculino, com idade média de 35.3 anos, provenientes do bloco operatório (64.7%), especialidade cirúrgica (66.6%) e a intervenção cirúrgica mais frequente foi a apendicectomia (49.7%). O tempo médio de internação foi de 10 dias, 88.1% dos pacientes apresentavam dependência grau II. De acordo com o teste de Log Rank (Mantel-Cox) o grau de dependência dos pacientes teve impacto significativo nos dias de internação após a cirurgia com relação direta entre ambas as variáveis (p=0.038). Conclusão. O tempo de internação é determinado pelo grau de dependência apresentado pelos pacientes que se submetem à cirurgia, portanto, é essencial fornecer todos os recursos necessários para o gerenciamento adequado de seus cuidados., Objetivo. Establecer la relación entre el grado de dependencia con el tiempo de hospitalización de pacientes intervenidos quirúrgicamente en un hospital regional de Perú. Métodos. El estudio fue analítico, transversal con toma retrospectiva de la información. Se estudiaron 380 pacientes atendidos en el servicio de cirugía del Hospital Regional Docente de Cajamarca (Perú). La información demográfica y clínica de los pacientes se obtuvo del registro de atenciones diarias del servicio de cirugía del hospital. La descripción univariada se hizo a través de frecuencias absolutas y relativas e intervalos de confianza para proporciones al 95% y para la asociación entre el grado de dependencia y el tiempo de hospitalización se aplicó Log Rank (Mantel-Cox) – Chi-cuadrado y el análisis de supervivencia de Kaplan-Meier, con una significancia estadística de p<0.05. Resultados. El 53.4% de pacientes fueron varones, con edad promedio de 35.3 años, referidos de sala de operaciones (64.7%), especialidad de cirugía (66.6%) y la intervención quirúrgica más frecuente fue la apendicectomía (49.7%). El tiempo medio de hospitalización fue de 10 días, el 88.1% de pacientes tuvieron dependencia de grado II. El grado de dependencia de los pacientes repercutió significativamente en los días de hospitalización pos-cirugía con una relación directa entre ambas variables (p=0.038). Conclusión. El tiempo de hospitalización está determinado por el grado de dependencia que presentan los pacientes que son sometidos a una intervención quirúrgica, por ello es fundamental la previsión de todos los recursos necesarios para la gestión adecuada del cuidado.

Background and purpose Evidence guiding the decision on whether to treat proximal hamstring tendon avulsions (PHA) operatively or non-operatively is very limited. The aim of this study was to identify the current practices and the rationale behind PHA treatment decisions in the Nordic countries. Methods A survey was sent to orthopaedic surgeons in Sweden, Norway, Finland and Denmark. The study population consisted of responding surgeons with exposure to surgical treatment of PHA (n = 125). The questions covered surgeon and unit characteristics, and surgeons' understanding of the evidence for treatment, and they explored which patient and injury factors influence treatment allocation. Results Although some surgeons indicated a preference for one of the treatments, 84% stated that the treatment decision was based on patient and injury-related factors. Severe obesity, drug abuse, a sedentary lifestyle, age > 60 years and delayed diagnosis (> 6 weeks) were considered contraindications to surgical treatment. Also, there was agreement that patients expressing a preference for non-operative treatment should not be operated. Complete avulsions with tendon dislocation >= 2-3 cm on MRI were relative indications for surgical treatment. The majority of surgeons did not believe that operatively treated patients did better than non-operatively treated patients and experienced that patients, generally, were satisfied with the treatment result, regardless of the type of treatment. Most surgeons had experienced significant complications to operative treatment. Conclusion Current practices varied among different units, and despite the lack of evidence for their prognostic value, several factors were inconsistently being used as decision modifiers when selecting patients for surgical treatment.

Background and purpose Evidence guiding the decision on whether to treat proximal hamstring tendon avulsions (PHA) operatively or non-operatively is very limited. The aim of this study was to identify the current practices and the rationale behind PHA treatment decisions in the Nordic countries. Methods A survey was sent to orthopaedic surgeons in Sweden, Norway, Finland and Denmark. The study population consisted of responding surgeons with exposure to surgical treatment of PHA (n = 125). The questions covered surgeon and unit characteristics, and surgeons' understanding of the evidence for treatment, and they explored which patient and injury factors influence treatment allocation. Results Although some surgeons indicated a preference for one of the treatments, 84% stated that the treatment decision was based on patient and injury-related factors. Severe obesity, drug abuse, a sedentary lifestyle, age > 60 years and delayed diagnosis (> 6 weeks) were considered contraindications to surgical treatment. Also, there was agreement that patients expressing a preference for non-operative treatment should not be operated. Complete avulsions with tendon dislocation >= 2-3 cm on MRI were relative indications for surgical treatment. The majority of surgeons did not believe that operatively treated patients did better than non-operatively treated patients and experienced that patients, generally, were satisfied with the treatment result, regardless of the type of treatment. Most surgeons had experienced significant complications to operative treatment. Conclusion Current practices varied among different units, and despite the lack of evidence for their prognostic value, several factors were inconsistently being used as decision modifiers when selecting patients for surgical treatment.

Background and purpose Evidence guiding the decision on whether to treat proximal hamstring tendon avulsions (PHA) operatively or non-operatively is very limited. The aim of this study was to identify the current practices and the rationale behind PHA treatment decisions in the Nordic countries. Methods A survey was sent to orthopaedic surgeons in Sweden, Norway, Finland and Denmark. The study population consisted of responding surgeons with exposure to surgical treatment of PHA (n = 125). The questions covered surgeon and unit characteristics, and surgeons' understanding of the evidence for treatment, and they explored which patient and injury factors influence treatment allocation. Results Although some surgeons indicated a preference for one of the treatments, 84% stated that the treatment decision was based on patient and injury-related factors. Severe obesity, drug abuse, a sedentary lifestyle, age > 60 years and delayed diagnosis (> 6 weeks) were considered contraindications to surgical treatment. Also, there was agreement that patients expressing a preference for non-operative treatment should not be operated. Complete avulsions with tendon dislocation >= 2-3 cm on MRI were relative indications for surgical treatment. The majority of surgeons did not believe that operatively treated patients did better than non-operatively treated patients and experienced that patients, generally, were satisfied with the treatment result, regardless of the type of treatment. Most surgeons had experienced significant complications to operative treatment. Conclusion Current practices varied among different units, and despite the lack of evidence for their prognostic value, several factors were inconsistently being used as decision modifiers when selecting patients for surgical treatment.

Background and purpose Evidence guiding the decision on whether to treat proximal hamstring tendon avulsions (PHA) operatively or non-operatively is very limited. The aim of this study was to identify the current practices and the rationale behind PHA treatment decisions in the Nordic countries. Methods A survey was sent to orthopaedic surgeons in Sweden, Norway, Finland and Denmark. The study population consisted of responding surgeons with exposure to surgical treatment of PHA (n = 125). The questions covered surgeon and unit characteristics, and surgeons' understanding of the evidence for treatment, and they explored which patient and injury factors influence treatment allocation. Results Although some surgeons indicated a preference for one of the treatments, 84% stated that the treatment decision was based on patient and injury-related factors. Severe obesity, drug abuse, a sedentary lifestyle, age > 60 years and delayed diagnosis (> 6 weeks) were considered contraindications to surgical treatment. Also, there was agreement that patients expressing a preference for non-operative treatment should not be operated. Complete avulsions with tendon dislocation >= 2-3 cm on MRI were relative indications for surgical treatment. The majority of surgeons did not believe that operatively treated patients did better than non-operatively treated patients and experienced that patients, generally, were satisfied with the treatment result, regardless of the type of treatment. Most surgeons had experienced significant complications to operative treatment. Conclusion Current practices varied among different units, and despite the lack of evidence for their prognostic value, several factors were inconsistently being used as decision modifiers when selecting patients for surgical treatment.

Introduction: The aim was to assess the relationship between airway morphology and surgical intervention in a cohort of patients presenting with increased body mass index (BMI) and a confirmed diagnosis of obstructive sleep apnoea (OSA). A secondary aim was to revisit the relationship between morphology and OSA severity. Methods: A retrospective analysis was conducted of pre-operative maxillofacial 3D-CT scans of thirty-two patients with a confirmed diagnosis of OSA who received treatment from an ear nose and throat specialist (ENT). Lateral cephalograms were imported into Quick Ceph Studio (Quick Ceph Systems Inc, San Diego, CA, USA) after which linear and angular measurements of selected hard and soft tissues were obtained. 3D-CT images were loaded into the software program 3dMDVultus (3dMD) which permitted 3D visualisation of the airway. Measurements were repeated 3 times on the images of six patients after an interval of two weeks to establish the intraclass correlation coefficient (ICC) for intra-examiner accuracy and reliability. Logistic regression was applied to determine the relationships between morphology, OSA and surgical treatments. Results: A positive correlation was found between age and the apnoea-hypopnea index (AHI). Morphological measurements of the airway did not exhibit a positive relationship with OSA severity. Posterior airway space at the level of the uvula and tongue, the length of the soft palate and position of the hyoid bone were significantly associated with BMI. No variables were found to be correlated with uvulopalatopharyngoplasty (UPPP) surgery. Notwithstanding, airway length and posterior airway space at the level of the uvula tip were significantly associated with tongue channelling. Conclusions: Radiographic airway assessment is an invaluable and opportunistic tool for screening OSA but requires judicial use in its prescription and interpretation. There is little correlation between OSA severity and airway morphology and between s

Background and purpose Evidence guiding the decision on whether to treat proximal hamstring tendon avulsions (PHA) operatively or non-operatively is very limited. The aim of this study was to identify the current practices and the rationale behind PHA treatment decisions in the Nordic countries. Methods A survey was sent to orthopaedic surgeons in Sweden, Norway, Finland and Denmark. The study population consisted of responding surgeons with exposure to surgical treatment of PHA (n = 125). The questions covered surgeon and unit characteristics, and surgeons' understanding of the evidence for treatment, and they explored which patient and injury factors influence treatment allocation. Results Although some surgeons indicated a preference for one of the treatments, 84% stated that the treatment decision was based on patient and injury-related factors. Severe obesity, drug abuse, a sedentary lifestyle, age > 60 years and delayed diagnosis (> 6 weeks) were considered contraindications to surgical treatment. Also, there was agreement that patients expressing a preference for non-operative treatment should not be operated. Complete avulsions with tendon dislocation >= 2-3 cm on MRI were relative indications for surgical treatment. The majority of surgeons did not believe that operatively treated patients did better than non-operatively treated patients and experienced that patients, generally, were satisfied with the treatment result, regardless of the type of treatment. Most surgeons had experienced significant complications to operative treatment. Conclusion Current practices varied among different units, and despite the lack of evidence for their prognostic value, several factors were inconsistently being used as decision modifiers when selecting patients for surgical treatment.

Purpose: To report the clinical course of a patient with central serous chorioretinopathy (CSCR) secondary to subclinical hypercortisolism before and after adrenalectomy. Observations: A 50-year-old female patient with multifocal, chronic CSCR was found to have an adrenal incidentaloma and was diagnosed with subclinical hypercortisolism. Patient elected to undergo minimally-invasive adrenalectomy and presented at 3 months after surgery without subretinal fluid. Conclusions and importance: Subclinical Cushing's Syndrome (SCS) may present an underrecognized risk factor for developing chronic CSCR. Further investigation is needed to determine the threshold of visual comorbidity that may influence surgical management.

Female genital mutilation and/or cutting (FGM/C) is classified into four types and leads to various health consequences for girls and women. Surgical interventions can be successful in alleviating or reversing physical consequences of FGM/C. The three most commonly performed procedures are defibulation, clitoral reconstruction and cyst removal. Through critical examination of the available research on the subject, this thesis aims to provide insight into how successfully surgical interventions in industrialized countries are presently applied to women who have undergone FGM/C. Special attention will be paid to what factors result in being perceived as satisfactory by the women who underwent these interventions. Furthermore, the findings will be used to create a practice transfer and recommendations for midwives providing care to affected women. The results show women with FGM/C require adequate information about surgical possibilities in order to ensure an informed decision. Thus, an appropriate intervention for the woman can be chosen together with the healthcare professional. The majority of women with FGM/C are pleased with the outcome after the surgical intervention. There is a need for further investigation into the long-term outcomes of the different procedures.

Introduction: Surgical activity has taken on a notable role within the area of patient care with situations whose danger to life is immediate or not. However, there are few studies focused on their analysis. Objective: To describe the emergency surgical interventions was carried out at the Hospital General Universitario "Gustavo Aldereguía Lima", in Cienfuegos, during the first quarter of 2021. Method: An observational, descriptive, retrospective cross-sectional study on a sample of 196 interventions emergency surgical procedures, out of a universe of 252, performed at the aforementioned institution. The variables were studied: month of intervention, sex, age group, nosological entity, type of surgery and color code. Information was collected from the individual operative report. Results: The month of March provided 116 interventions (59%). Male sex predominated with 103 cases (52.55%) and the age group 18-35 (59 patients, 30.10%). Acute appendicitis was the outstanding entity with 49 cases (25%). Clean contaminated surgeries represented 61.73% (121 interventions). Code yellow cases constituted 92.35% of the total (181 cases). Conclusions: Most of the complications were located in young men and young adults, some cases moved towards middle age. Acute appendicitis was the outstanding manifestation, hence the highest number of clean surgeries contaminated and classified as code yellow according to the color scale., Introdução: A atividade cirúrgica tem assumido papel de destaque dentro da área de atendimento ao paciente em situações de perigo de vida imediato ou não. No entanto, existem poucos estudos voltados para sua análise. Objetivo: Descrever as intervenções cirúrgicas de emergência realizadas no Hospital General Universitario "Gustavo Aldereguía Lima", em Cienfuegos, durante o primeiro trimestre de 2021. Método: Estudo transversal observacional, descritivo, retrospectivo, realizado em amostra de 196 intervenções procedimentos cirúrgicos de emergência, de um universo de 252, realizados na referida instituição. As variáveis estudadas foram: mês da intervenção, sexo, faixa etária, entidade nosológica, tipo de cirurgia e código de cores. As informações foram coletadas do relatório operatório individual. Resultados: O mês de março proporcionou 116 intervenções (59%). O sexo masculino predominou com 103 casos (52,55%) e a faixa etária de 18 a 35 anos (59 pacientes, 30,10%). A apendicite aguda foi a entidade de destaque com 49 casos (25%). As cirurgias limpas contaminadas representaram 61,73% (121 intervenções). Os casos de código amarelo constituíram 92,35% do total (181 casos). Conclusões: A maioria das complicações localizou-se em homens jovens e adultos jovens, alguns casos avançaram para a meia-idade. A apendicite aguda foi a manifestação de destaque, daí o maior número de cirurgias limpas contaminadas e classificadas como código amarelo de acordo com a escala de cores., Introducción: La actividad quirúrgica ha cobrado un notable papel dentro del área de atención al paciente con situaciones cuyo peligro para la vida es inmediato o no. Sin embargo, se cuenta con escasos estudios enfocados en el análisis de las mismas. Objetivo: Describir las intervenciones quirúrgicas de urgencia realizadas en el Hospital General Universitario "Gustavo Aldereguía Lima", de Cienfuegos, durante el primer trimestre de 2021. Método: Se realizó un estudio observacional, descriptivo, retrospectivo de corte transversal sobre una muestra de 196 intervenciones quirúrgicas de urgencia, de un universo de 252, realizadas en la institución antes mencionada. Se estudiaron las variables: mes de la intervención, sexo, grupo etario, entidad nosológica, tipo de cirugía y código de color. Se recopiló la información a partir del informe operatorio individual. Resultados: El mes de marzo aportó 116 intervenciones (59 %). Predominó el sexo masculino con 103 casos (52,55 %) y el grupo etario 18-35 (59 pacientes, 30,10 %). La apendicitis aguda fue la entidad sobresaliente con 49 casos (25 %). Las cirugías limpias contaminadas representaron el 61,73 % (121 intervenciones). Los casos código amarillo constituyeron el 92,35 % del total (181 casos). Conclusiones: La mayoría de las complicaciones se localizaron en hombres jóvenes y adultos jóvenes, algunos casos se desplazaron hacia la mediana edad. La apendicitis aguda fue la manifestación sobresaliente, de ahí, el mayor número de cirugías limpias contaminadas y catalogadas como código amarillo según la escala de colores.

Female genital mutilation and/or cutting (FGM/C) is classified into four types and leads to various health consequences for girls and women. Surgical interventions can be successful in alleviating or reversing physical consequences of FGM/C. The three most commonly performed procedures are defibulation, clitoral reconstruction and cyst removal. Through critical examination of the available research on the subject, this thesis aims to provide insight into how successfully surgical interventions in industrialized countries are presently applied to women who have undergone FGM/C. Special attention will be paid to what factors result in being perceived as satisfactory by the women who underwent these interventions. Furthermore, the findings will be used to create a practice transfer and recommendations for midwives providing care to affected women. The results show women with FGM/C require adequate information about surgical possibilities in order to ensure an informed decision. Thus, an appropriate intervention for the woman can be chosen together with the healthcare professional. The majority of women with FGM/C are pleased with the outcome after the surgical intervention. There is a need for further investigation into the long-term outcomes of the different procedures.

Diplomová práce má teoreticko-průzkumný charakter a zabývá se problematikou výživy u pacientů, kteří jsou v rozmezí 1. - 5. den po operaci v ORL oblasti a chirurgický výkon podstoupili z důvodu jiné než onkologické diagnózy. V teoretické části je popsána oblast, která se týká výživy pacienta vztahující se k oboru otorinolaryngologie. Průzkumná část diplomové práce je zaměřena na zhodnocení změn ve výživě nemocných, kteří jsou po chirurgickém zákroku v ORL oblasti. Šetření probíhalo formou zápisu potřebných údajů do záznamového archu a prostřednictvím nestandardizovaného dotazníkového šetření. Změny ve výživě v pooperačním období byly nejčastěji zaznamenány u pacientů po uvulopalatofaryngoplastice (UPPP) a tonsilektomii., The diploma thesis deals with the issue of nutrition in patients who are on the 1st - 5th day after the ENT operation and underwent surgery due to other than oncological diagnosis. The theoretical part describes the area of patient nutrition related to the field of otorhinolaryngology. The exploratory part of the diploma thesis is focused on the evaluation of changes in the nutrition of patients who are after ENT surgery. The survey took the form of entering the necessary data in a record sheet and through a non-standardized questionnaire survey. Changes in nutrition in the postoperative period were most often observed in patients after uvulopalatopharyngoplasty (UPPP) and tonsillectomy., Fakulta zdravotnických studií, Doplňující otázky oponenta: 1. Jaký validovaný nástroj pro hodnocení rizika malnutrice jste použila v dotazníku? 2. Jak je možné zjistit riziko proteinové malnutrice u obézních pacientů? 3. Jak by mohla být ovlivněna bolest pacientů při polykání? Obhajoba diplomové práce s prezentací velmi dobrá., Dokončená práce s úspěšnou obhajobou

type:Text, We describe two cases of spontaneously perforated pyometra (SPP) in elderly women treated with two different surgical approaches. An 88-year-old woman underwent emergency laparotomy for presumed diagnosis of gastrointestinal (GI) tract perforation. During surgery, SPP and a tumor of the sigmoid colon were identified. Total hysterectomy and sigmoid colon resection were performed. Despite exhaustive postoperative treatments, the patient died on postoperative day (POD) 189 due to peritonitis and pneumonia. A 93-year-old woman with acute abdomen was diagnosed with severe pyometra and primarily treated with transcervical drainage. Due to progression of generalized peritonitis, laparoscopic surgery was performed. Intraoperatively, scar from a uterine body perforation was identified, leading to the diagnosis of SPP. Only peritoneal irrigation and drainage were performed, in consideration of her advanced age. She improved and was discharged from the hospital on POD 35. The prognosis for SPP is sometimes poor, especially in older women. Minimally invasive surgical intervention might be considered for primary treatment in such cases.

In this paper we present three prehistoric cases (two previously reported and one recently discovered) of trepanation from Croatia: Rudine, Bezdanjaca and Jagodnjak, all dated to the Bronze Age. By using a detailed macroscopic analysis as well as radiographic imaging (x-ray and CT scanning) of the skulls, we provide a new assessment and interpretation for this type of surgical intervention during the Bronze Age. The first case was that of an adult male from the Rudine site dated to the Early Bronze Age; the second trepanation was recorded on an adult female from the Bezdanjaca Cave, dated to the Middle/Late Bronze Age; the third case was observed on a juvenile cranium from the Jagodnjak site, dated to the Middle Bronze Age. All three cases exhibit several similarities: (i) all are located on the right side of the frontal bone; (ii) all three are of similar dimension/shape; (iii) in all cases all three layers of calvarium were breached; and (iv) similar techniques for trepanation procedure were used in all cases. These three crania represent the oldest cases of intentional medical interventions in the territory of modern-day Croatia, while the Jagodnjak individual is the youngest person thus far discovered with this kind of treatment in the region.

Background. Replacement of large joints is one of the most successful surgical interventions over the last century. Every year we observe an increase in the number of total arthroplasties, both all over the world and in our country. Accordingly, the number of implant types is growing and the methods of their installation are improving. In case of a simple primary joint replacement, preoperative planning can be performed using standard templates or appropriate software. In case of a complex primary arthroplasty, when surgical intervention has been preceded by injuries, osteo-tomy, osteosynthesis, it is very difficult to carry out a comprehensive preoperative planning without a thorough time-consu-ming preparation. Objective: to analyze preoperative planning and intraoperative navigation when preparing for a primary total hip replacement using spatial 3D modeling and prototyping. Materials and methods. Our patients: 2 females and 1 male, aged 31, 48, and 56 years, respectively. Observation period ranged from 3 to 16 months after total hip arthroplasty. All patients had been previously operated on the hip. At the stages of preoperative examination, a multislice computed tomography and magnetic resonance imaging were carried out and, accordingly, full-size plastic prototypes were printed. Preoperative planning was done, and an intervention plan was elaborated. Results. The patients underwent uncemented total hip arthroplasty. Two patients underwent an osteotomy of the proximal femur. One patient was subjected to bone grafting of the acetabulum. Three months after surgical treatment, a complete restoration of the function was observed, with Harris Hip Score of 95.6 (95–97) points. Conclusions. Preoperative planning is a very important part of preparation for surgical intervention. When preparing for a complex primary joint replacement, it is advisable to use additive technologies for manufacturing a plastic model that will allow for elaboration of a detailed plan for a f, Актуальность. Эндопротезирование крупных суставов — одно из наиболее успешных оперативных вмешательств за последнее столетие. С каждым годом мы наблюдаем увеличение количества тотальных артропластик как во всем мире, так и в нашей стране. Соответственно, растет количество разновидностей имплантов и совершенствуются методики их установки. В случае простого первичного эндопротезирования предоперационное планирование можно провести при помощи стандартных шаблонов или соответствующего программного софта. При сложном первичном эндопротезировании, когда оперативному вмешательству предшествовали травмы, остеотомии, операции остеосинтеза, провести полноценное предоперационное планирование без длительной и трудоемкой подготовки очень тяжело. Цель работы: выполнить анализ предоперационного планирования и интраоперационной навигации при подготовке к сложному первичному эндопротезированию тазобедренного сустава с использованием пространственного 3D-моделирования и прототипирования. Материалы и методы. Наши пациенты — 2 женщины и 1 мужчина, возраст которых составил 31 год, 48 и 56 лет соответственно. Срок наблюдения — от 3 до 16 месяцев после тотального эндопротезирования тазобедренного сустава. Все пациенты до этого перенесли оперативные вмешательства в данной зоне. На этапах предоперационного обследования была проведена мультиспиральная компьютерная и магнитно-резонансная томография, на основании этих данных были напечатаны прототипы из пластика в натуральную величину. Было проведено предоперационное планирование и составлен план проведения оперативного вмешательства. Результаты. Пациентам выполнено тотальное эндопротезирование тазобедренного сустава с использованием имплантов механической фиксации. У двух пациентов выполнена корригирующая остеотомия проксимального отдела бедренной кости. Одному пациенту проведена костная ауто-пластика дна вертлужной впадины. Через 3 месяца после оперативного лечения наблюдалось полное восстановление функции, оценка по шкале Харриса составила, Актуальність. Ендопротезування великих суглобів — одне з найбільш успішних оперативних втручань за останнє сторіччя. З кожним роком ми спостерігаємо збільшення кількості тотальних артропластик як у всьому світі, так і в нашій країні. Відповідно, зростає кількість різновидів імплантів і вдосконалюється методика їх імплантації. У випадку простого первинного ендопротезування передопераційне планування можна провести за допомогою стандартних шаблонів або відповідного програмного софта. При складному первинному ендопротезуванні, коли оперативному втручанню передували травми, остеотомії, операції остеосинтезу, провести повноцінне передопераційне планування без тривалої та трудомісткої підготовки дуже складно. Мета роботи: виконати аналіз передопераційного планування й інтраопераційної навігації при підготовці до складного первинного ендопротезування кульшового суглоба з використанням просторового 3D-моделювання та прототипування. Матеріали та методи. Наші пацієнти — 2 жінки та 1 чоловік, вік яких становив 31 рік, 48 та 56 років. Строк спостереження — від 6 до 19 місяців після тотального ендопротезування кульшового суглоба. Усі пацієнти раніше перенесли оперативні втручання в даній зоні. На етапах передопераційного обстеження була проведена мультиспіральна комп’ютерна та магнітно-резонансна томографія, на підставі цих даних були надруковані прототипи з пластика в натуральну величину. Було проведено передопераційне планування та складено план проведення оперативного втручання. Результати. Пацієнтам виконано тотальне ендопротезування кульшового суглоба з використанням імплантів механічної фіксації. У двох пацієнтів виконана коригуюча остеотомія проксимального відділу стегнової кістки. Одному пацієнтові проведена кісткова автопластика дна вертлюжної западини. Через 3 місяці після оперативного лікування спостерігалося повне відновлення функції, оцінка за шкалою Харріса становила 95,6 (95–97) бала. Висновки. Передопераційне планування — дуже важлива частина підготовки до операт

The aim of this study was to identify predictive factors and develop a model to assess individualized risk of postnatal surgical intervention in patients with antenatal hydronephrosis. This is a retrospective cohort study of 694 infants with prenatally detected congenital anomalies of kidney and urinary tract with a median follow-up time of 37 months. The main event of interest was postnatal surgical intervention. A predictive model was developed using Cox model with internal validation by bootstrap technique. Of 694 patients, 164 (24%) infants underwent surgical intervention in a median age of 7.8 months. Predictors of the surgical intervention in the model were: baseline glomerular filtration rate, associated hydronephrosis, presence of renal damage and the severity of renal pelvic dilatation. The optimism corrected c statistic for the model was 0.84 (95%CI, 0.82–0.87). The predictive model may contribute to identify infants at high risk for surgical intervention. Further studies are necessary to validate the model in patients from other settings.

The survival of newborns with congenital heart disease has increased in recent de-cades. After guaranteeing this, scientific studies began to show that these children presented slowness in some areas of neurodevelopmental, becoming more palpable at later ages. A systematic review is carried out to gain in-depth knowledge of the existing studies on the neurodevelopmental of children with congenital heart disea-se, without associated chromosomal anomalies and underwent surgery, consulting 149 studies located in the databases of Scopus and Pubmed from 2008 to 2018. Fif-teen studies that met the eligibility criteria were analyzed in depth. Scientific studies show that people with congenital heart disease obtain lower than average scores in some areas of neurodevelopmental (language and motor). Children with congenital heart disease need to be referred to early care services to prevent difficulties that may arise in the school setting., La supervivencia de los recién nacidos con cardiopatías congénitas ha aumenta-do en las últimas décadas. Tras garantizar esto, estudios científicos empezaron a evidenciar que estos menores presentaban lentificaciones en algunas áreas del neurodesarrollo, haciéndose más palpables en edades posteriores. Se realiza una revisión sistemática para conocer en profundidad los estudios existentes sobre el neurodesarrollo de menores con cardiopatías congénitas, sin anomalías cromosó-micas asociadas y sometidos a intervención quirúrgica, consultándose 149 investi-gaciones ubicadas en las bases de datos de Scopus y Pubmed desde 2008 hasta 2018. Se analizaron en profundidad quince estudios que cumplían con los criterios de elegibilidad. Los estudios científicos muestran que las personas con cardiopa-tías congénitas obtienen puntuaciones inferiores a la media en algunas áreas del neurodesarrollo (lenguaje y motor). Es necesario que los menores con cardiopatías congénitas se deriven a los servicios de atención temprana para prevenir las dificul-tades que puedan generarse en el ámbito escolar.

Introduction and objective: Cleft lip and palate are the most frequent congenital facial defects. The objective of the study is to describe the characteristics of these clefts intervened from 2012 to 2017 at the Miguel Servet University Hospital of Zaragoza. Material and methods: Retrospective study of cleft patients operated during the period 2012-2017. A descriptive analysis was made of the characteristics of the sample, type of cleft, intervention and associated sequelae. Results: 132 cleft patients were selected, of which 87 met the inclusion criteria. 10.3% (N = 9) were cleft lip, 35.6% (N = 31) cleft palate and 52.9% (N = 46) cleft lip and palate. 11.5% (N = 10) associated some syndrome or sequence. 59.8% (N = 52) were operated of the first surgery, 6.9% (N = 6) of the second one, 16.1% (N = 14) of sequelae and 17.2% (N = 15) several interventions were made. In 20.5% (N = 16) of cleft palate and lip and palate, it was necessary to perform pharyngoplasty due to velopharyngeal incompetence, and 26.9% (N = 21) presented palatal fistula. 21.8% (N = 12) of cleft lip and lip and palate were reoperated due to lip sequelae. Conclusions: in our midst, the majority of cleft patients undergoing surgery have palate and lip and palate clefts, with the latter group accounting for half of the total. When there is affectation of the palate, syndromic association should be ruled out. The timing of the intervention and the technique used in our sample is in accordance with what is proposed in national and international protocols., Introducción y objetivo: Las fisuras labiales y palatinas son los defectos congénitos faciales más frecuentes. El objetivo del estudio es describir las características de estas fisuras intervenidas durante los años 2012-2017 en el Hospital Universitario Miguel Servet de Zaragoza. Material y métodos: Estudio retrospectivo de los pacientes fisurados intervenidos durante el periodo 2012-2017. Se realizó un análisis descriptivo de las características de la muestra, tipo de fisura, intervención y secuelas asociadas. Resultados: Se seleccionaron 132 fisurados, de los cuales 87 cumplían los criterios de inclusión. El 10,3% (N = 9) eran fisuras labiales; el 35,6% (N = 31) fisuras palatinas, y el 52,9% (N = 46), fisuras labiopalatinas. Un 11,5% (N = 10) se asociaba a algún síndrome o secuencia. El 59,8% (N = 52) fueron intervenidos del primer tiempo quirúrgico; un 6,9% (N = 6), del segundo; un 16,1% (N = 14) de secuelas, y a un 17,2% (N = 15) se les realizaron varias intervenciones. En un 20,5% (N = 16) de las fisuras palatinas y labiopalatinas se necesitó realizar faringoplastia por incompetencia velofaríngea, y un 26,9% (N = 21) presentó fístula palatina. Un 21,8% (N = 12) de las fisuras labiales y labiopalatinas fueron reintervenidas por secuelas labiales. Conclusiones:En nuestro medio, la mayoría de los pacientes fisurados intervenidos presentan fisuras palatinas y labiopalatinas, suponiendo este último grupo la mitad del total. Cuando hay afectación del paladar, se debe descartar asociación sindrómica. El momento de la intervención y la técnica empleada en nuestra serie se ajustan a lo propuesto en protocolos nacionales e internacionales.

The survival of newborns with congenital heart disease has increased in recent de-cades. After guaranteeing this, scientific studies began to show that these children presented slowness in some areas of neurodevelopmental, becoming more palpable at later ages. A systematic review is carried out to gain in-depth knowledge of the existing studies on the neurodevelopmental of children with congenital heart disea-se, without associated chromosomal anomalies and underwent surgery, consulting 149 studies located in the databases of Scopus and Pubmed from 2008 to 2018. Fif-teen studies that met the eligibility criteria were analyzed in depth. Scientific studies show that people with congenital heart disease obtain lower than average scores in some areas of neurodevelopmental (language and motor). Children with congenital heart disease need to be referred to early care services to prevent difficulties that may arise in the school setting., La supervivencia de los recién nacidos con cardiopatías congénitas ha aumenta-do en las últimas décadas. Tras garantizar esto, estudios científicos empezaron a evidenciar que estos menores presentaban lentificaciones en algunas áreas del neurodesarrollo, haciéndose más palpables en edades posteriores. Se realiza una revisión sistemática para conocer en profundidad los estudios existentes sobre el neurodesarrollo de menores con cardiopatías congénitas, sin anomalías cromosó-micas asociadas y sometidos a intervención quirúrgica, consultándose 149 investi-gaciones ubicadas en las bases de datos de Scopus y Pubmed desde 2008 hasta 2018. Se analizaron en profundidad quince estudios que cumplían con los criterios de elegibilidad. Los estudios científicos muestran que las personas con cardiopa-tías congénitas obtienen puntuaciones inferiores a la media en algunas áreas del neurodesarrollo (lenguaje y motor). Es necesario que los menores con cardiopatías congénitas se deriven a los servicios de atención temprana para prevenir las dificul-tades que puedan generarse en el ámbito escolar.

[ES] El trabajo fin de grado consistirá en el estudio y análisis de los requerimientos de diseño, establecidos por cirujanos traumatólogos y referdias al protocolo de intervención propias de una operación de ligamento cruzado anterior, al objeto de desarrollar una guía multipropósito para la correcta perforación del cóndilo externo del paciente a intervenir de tal suerte que el cirujano no requiera de establecer referencias en quirófano (durante la intervención) y pueda ejecutar dicha perforación de manera más precisa y rápìda. Para todo lo anterior se analizarán y digitalizarán distintos TAC¿s y Resonancias magnéticas de distintas historias clínicas seleccionadas para el estudio con el propósito de establecer un área de intervención normalizada para el posterior diseño del instrumental que resuelva el problema analizado. Dicha área de los distintos cóndilos digitalizados se establecerá mediante su previa parametrización y tratamiento de imágenes para desarrollar una superficie susceptible de impresión en 3D. Establecidas las áreas de los distintos casos clínicos se determinará la superficie de apoyo de la guía a diseñar. Tras la validación conceptual de las posibles alternativas por parte del equipo médico se procederá al desarrollo en detalle de aquella que resulte validada. Por último se prototipará en tecnología 3D, de elevada calidad y material plástico compatible quirurgicamente, la pieza definitiva para ser nuevamente evaluada por los usuarios (los cirujanos). Tras las posibles modificaciones finales y el ajuste paramétrico de los taladros multifunción y de las dimensiones del producto, se realizará el prototipo definitivo para su posterior validación clínica en una intervención planificada., [EN] The final work will consist of the study and analysis of the design requirements, established by trauma surgeons and references to the intervention protocol characteristic of an anterior cruciate ligament operation, in order to develop a multipurpose guide for correct perforation of the external condyle Of the patient to intervene in such a way that the surgeon does not need to establish references in the operating room (during the procedure) and can perform such drilling more accurately and quickly. For all of the above, different TACs and magnetic resonance of different clinical histories selected for the study will be analyzed and digitized with the purpose of establishing a normalized intervention area for the later design of the instruments that solve the analyzed problem. This area of ​​the different digitized condyles will be established by means of their previous parameterization and treatment of images to develop a surface capable of printing in 3D. Establishing the areas of the different clinical cases will determine the support surface of the guide to be designed. After the conceptual validation of the possible alternatives by the medical team will proceed to the development in detail of the one that is validated. Finally it will be prototyped in 3D technology, of high quality and plastic material compatible surgically, the definitive piece to be evaluated again by the users (the surgeons). After the possible final modifications and the parametric adjustment of the multifunctional drills and the dimensions of the product, the final prototype will be made for later clinical validation in a planned intervention.

[ES] El trabajo fin de grado consistirá en el estudio y análisis de los requerimientos de diseño, establecidos por cirujanos traumatólogos y referdias al protocolo de intervención propias de una operación de ligamento cruzado anterior, al objeto de desarrollar una guía multipropósito para la correcta perforación del cóndilo externo del paciente a intervenir de tal suerte que el cirujano no requiera de establecer referencias en quirófano (durante la intervención) y pueda ejecutar dicha perforación de manera más precisa y rápìda. Para todo lo anterior se analizarán y digitalizarán distintos TAC¿s y Resonancias magnéticas de distintas historias clínicas seleccionadas para el estudio con el propósito de establecer un área de intervención normalizada para el posterior diseño del instrumental que resuelva el problema analizado. Dicha área de los distintos cóndilos digitalizados se establecerá mediante su previa parametrización y tratamiento de imágenes para desarrollar una superficie susceptible de impresión en 3D. Establecidas las áreas de los distintos casos clínicos se determinará la superficie de apoyo de la guía a diseñar. Tras la validación conceptual de las posibles alternativas por parte del equipo médico se procederá al desarrollo en detalle de aquella que resulte validada. Por último se prototipará en tecnología 3D, de elevada calidad y material plástico compatible quirurgicamente, la pieza definitiva para ser nuevamente evaluada por los usuarios (los cirujanos). Tras las posibles modificaciones finales y el ajuste paramétrico de los taladros multifunción y de las dimensiones del producto, se realizará el prototipo definitivo para su posterior validación clínica en una intervención planificada., [EN] The final work will consist of the study and analysis of the design requirements, established by trauma surgeons and references to the intervention protocol characteristic of an anterior cruciate ligament operation, in order to develop a multipurpose guide for correct perforation of the external condyle Of the patient to intervene in such a way that the surgeon does not need to establish references in the operating room (during the procedure) and can perform such drilling more accurately and quickly. For all of the above, different TACs and magnetic resonance of different clinical histories selected for the study will be analyzed and digitized with the purpose of establishing a normalized intervention area for the later design of the instruments that solve the analyzed problem. This area of ​​the different digitized condyles will be established by means of their previous parameterization and treatment of images to develop a surface capable of printing in 3D. Establishing the areas of the different clinical cases will determine the support surface of the guide to be designed. After the conceptual validation of the possible alternatives by the medical team will proceed to the development in detail of the one that is validated. Finally it will be prototyped in 3D technology, of high quality and plastic material compatible surgically, the definitive piece to be evaluated again by the users (the surgeons). After the possible final modifications and the parametric adjustment of the multifunctional drills and the dimensions of the product, the final prototype will be made for later clinical validation in a planned intervention.

[ES] El trabajo fin de grado consistirá en el estudio y análisis de los requerimientos de diseño, establecidos por cirujanos traumatólogos y referdias al protocolo de intervención propias de una operación de ligamento cruzado anterior, al objeto de desarrollar una guía multipropósito para la correcta perforación del cóndilo externo del paciente a intervenir de tal suerte que el cirujano no requiera de establecer referencias en quirófano (durante la intervención) y pueda ejecutar dicha perforación de manera más precisa y rápìda. Para todo lo anterior se analizarán y digitalizarán distintos TAC¿s y Resonancias magnéticas de distintas historias clínicas seleccionadas para el estudio con el propósito de establecer un área de intervención normalizada para el posterior diseño del instrumental que resuelva el problema analizado. Dicha área de los distintos cóndilos digitalizados se establecerá mediante su previa parametrización y tratamiento de imágenes para desarrollar una superficie susceptible de impresión en 3D. Establecidas las áreas de los distintos casos clínicos se determinará la superficie de apoyo de la guía a diseñar. Tras la validación conceptual de las posibles alternativas por parte del equipo médico se procederá al desarrollo en detalle de aquella que resulte validada. Por último se prototipará en tecnología 3D, de elevada calidad y material plástico compatible quirurgicamente, la pieza definitiva para ser nuevamente evaluada por los usuarios (los cirujanos). Tras las posibles modificaciones finales y el ajuste paramétrico de los taladros multifunción y de las dimensiones del producto, se realizará el prototipo definitivo para su posterior validación clínica en una intervención planificada., [EN] The final work will consist of the study and analysis of the design requirements, established by trauma surgeons and references to the intervention protocol characteristic of an anterior cruciate ligament operation, in order to develop a multipurpose guide for correct perforation of the external condyle Of the patient to intervene in such a way that the surgeon does not need to establish references in the operating room (during the procedure) and can perform such drilling more accurately and quickly. For all of the above, different TACs and magnetic resonance of different clinical histories selected for the study will be analyzed and digitized with the purpose of establishing a normalized intervention area for the later design of the instruments that solve the analyzed problem. This area of ​​the different digitized condyles will be established by means of their previous parameterization and treatment of images to develop a surface capable of printing in 3D. Establishing the areas of the different clinical cases will determine the support surface of the guide to be designed. After the conceptual validation of the possible alternatives by the medical team will proceed to the development in detail of the one that is validated. Finally it will be prototyped in 3D technology, of high quality and plastic material compatible surgically, the definitive piece to be evaluated again by the users (the surgeons). After the possible final modifications and the parametric adjustment of the multifunctional drills and the dimensions of the product, the final prototype will be made for later clinical validation in a planned intervention.

Operative intervention is a strong stress that creates preconditions for the acute exacerbation of cronic inflammatory processes of the mucous membrane of the stomach and duodenum, and the development of ulcers / erosions in previously conditionally healthy individuals, the so-called “stress-induced changes”. The article deals with the role of the traumatic operation in the formation of stress-induced changes (SIС) of the mucous membrane of the upper gastrointestinal tract (GIT) in the postoperative period in children. The calculation algorithm and the values of the coefficient of traumatic severity (СТS) of operative intervention are presented, which increase the risk of development of SIС in the postoperative period. The problem of SIС of the mucous membrane of the upper gastrointestinal tract infections in pediatri c surgery has not been considered for a long time, however, with the development of surgical techniques of treatment, the e mergence of new methods to expand the scope of surgical intervention, the relevance of the latter has become rosacea. Also, a separate role should be attributed to the development of market relations and the formation of a modern system of financing medical diagnostic process., Оперативное вмешательство является сильным стрессом, что создает предпосылки как для обострення хронических воспалительных процессов слизистой оболочки желудка и двенадцатиперстной кишки, так и развития язв / эрозий в ранее условно-здоровых лиц – так называемых “стресс-индуцированных изменений”. В статье рассматриваются вопросы роли травматичности операции в формировании стресс-индуцированных изменений (СИЗ) слизистой оболочки верхних отделов желудочно-кишечного тракта (ЖКТ) в постоперационном периоде у детей. Приведены алгоритм расчета и пороговое значение коэффициента степени травматичности (КСТ) оперативного вмешательства, которие увеличивают риск развития СИЗ в постоперационном периоде.Проблема СИЗ слизистой оболочки верхние отделов ЖКТ в детской хирургии долгое время не рассматривалась, однако с развитием оперативной техники лечения, появлением новых методов, позволяющих расширить объем оперативного вмешательства, актуальность последней стала рости. Также отдельную роль следует отнести развития рыночных отношений и формирования современной системы финансирования лечебно-диагностического процесса., Оперативне втручання є сильним стресом, що створює передумови як для загострення хронічних запальних процесів слизової оболонки шлунку та дванадцятипалої кишки, так і розвитку виразок/ерозій у раніше умовно-здорових осіб – так званих “стрес-індукованих змін”. В статті розглядаються питання ролі травматичності операції у формуванні стрес-індукованих змін (СІЗ) слизової оболонки верхніх відділів шлунково-кишкового тракту (ШКТ) в постопераційному періоді в дітей. Приведено алгоритм розрахунку та порогові значення коефіцієнта ступеня травматичності (КСТ) оперативного втручання, що збільшують ризик розвитку СІЗ в постопераційному періоді. Проблема СІЗ слизової оболонки верхнії відділів ШКТ в дитячій хірургії тривалий час не розглядалась, однак з розвитком оперативної техніки лікування, появою нових методів, що дозволяють розширити обсяг оперативного втручання, актуальність останньої стала рости. Також окрему роль слід віднести розвитку ринкових відносин і формування сучасної системи фінансування лікувально-діагностичного процесу.

[ES] El trabajo fin de grado consistirá en el estudio y análisis de los requerimientos de diseño, establecidos por cirujanos traumatólogos y referdias al protocolo de intervención propias de una operación de ligamento cruzado anterior, al objeto de desarrollar una guía multipropósito para la correcta perforación del cóndilo externo del paciente a intervenir de tal suerte que el cirujano no requiera de establecer referencias en quirófano (durante la intervención) y pueda ejecutar dicha perforación de manera más precisa y rápìda. Para todo lo anterior se analizarán y digitalizarán distintos TAC¿s y Resonancias magnéticas de distintas historias clínicas seleccionadas para el estudio con el propósito de establecer un área de intervención normalizada para el posterior diseño del instrumental que resuelva el problema analizado. Dicha área de los distintos cóndilos digitalizados se establecerá mediante su previa parametrización y tratamiento de imágenes para desarrollar una superficie susceptible de impresión en 3D. Establecidas las áreas de los distintos casos clínicos se determinará la superficie de apoyo de la guía a diseñar. Tras la validación conceptual de las posibles alternativas por parte del equipo médico se procederá al desarrollo en detalle de aquella que resulte validada. Por último se prototipará en tecnología 3D, de elevada calidad y material plástico compatible quirurgicamente, la pieza definitiva para ser nuevamente evaluada por los usuarios (los cirujanos). Tras las posibles modificaciones finales y el ajuste paramétrico de los taladros multifunción y de las dimensiones del producto, se realizará el prototipo definitivo para su posterior validación clínica en una intervención planificada., [EN] The final work will consist of the study and analysis of the design requirements, established by trauma surgeons and references to the intervention protocol characteristic of an anterior cruciate ligament operation, in order to develop a multipurpose guide for correct perforation of the external condyle Of the patient to intervene in such a way that the surgeon does not need to establish references in the operating room (during the procedure) and can perform such drilling more accurately and quickly. For all of the above, different TACs and magnetic resonance of different clinical histories selected for the study will be analyzed and digitized with the purpose of establishing a normalized intervention area for the later design of the instruments that solve the analyzed problem. This area of ​​the different digitized condyles will be established by means of their previous parameterization and treatment of images to develop a surface capable of printing in 3D. Establishing the areas of the different clinical cases will determine the support surface of the guide to be designed. After the conceptual validation of the possible alternatives by the medical team will proceed to the development in detail of the one that is validated. Finally it will be prototyped in 3D technology, of high quality and plastic material compatible surgically, the definitive piece to be evaluated again by the users (the surgeons). After the possible final modifications and the parametric adjustment of the multifunctional drills and the dimensions of the product, the final prototype will be made for later clinical validation in a planned intervention.

Introduction: This study was designed to analyse wide spectrum magnitude of extra pulmonary tuberculosis in surgical aspect with its clinico-patho-radiological profile and treatment modalities. Material and Methods: The study was conducted in postgraduate Department of Surgery in collaboration with Department of Chest and Tuberculosis,Pathology and Radio diagnosis of Rohilkhand Medical College and Hospital Bareilly, Uttar Pradesh, India, after formal approval from institutional ethics committee. This study is of prospective study, in duration of January 2015 to April2018. Inclusion criteria: All suspected cases of extra pulmonary tuberculosis (EPTB). Exclusion Criteria: (1) HIV patients (2) Patients with pulmonary tuberculosis. Result: A total of 59 patients with suspected EPTB were included, investigated and treated with or without surgical intervention followed by standard ATT regimes. Pathological / Microbiological: FNAC, Histopathology, AFB insputum &CBNAAT, BACTEC 460, ADA. Radiological: X–Ray chest, X-ray abdomen.Ultra-Sonography (USG), Contrast Enhanced Computer Tomography (CECT). Patients admitted in emergency department and attending surgical out patient department were investigated and treated as per protocol. In our study 39 patients out of 59 underwent different surgical procedure and followed by antitubercular treatment regime. 20 Non-operated patients treated medically with antitubercular treatment regime [ATT]. Conclusion: EPTB has same national health issue as pulmonary tuberculosis. For tuberculosis control, EPTB-A challenging disease should be early diagnosed and surgically and medically treated to decrease related morbidity and mortality.

Introduction: This study was designed to analyse wide spectrum magnitude of extra pulmonary tuberculosis in surgical aspect with its clinico-patho-radiological profile and treatment modalities. Material and Methods: The study was conducted in postgraduate Department of Surgery in collaboration with Department of Chest and Tuberculosis,Pathology and Radio diagnosis of Rohilkhand Medical College and Hospital Bareilly, Uttar Pradesh, India, after formal approval from institutional ethics committee. This study is of prospective study, in duration of January 2015 to April2018. Inclusion criteria: All suspected cases of extra pulmonary tuberculosis (EPTB). Exclusion Criteria: (1) HIV patients (2) Patients with pulmonary tuberculosis. Result: A total of 59 patients with suspected EPTB were included, investigated and treated with or without surgical intervention followed by standard ATT regimes. Pathological / Microbiological: FNAC, Histopathology, AFB insputum &CBNAAT, BACTEC 460, ADA. Radiological: X–Ray chest, X-ray abdomen.Ultra-Sonography (USG), Contrast Enhanced Computer Tomography (CECT). Patients admitted in emergency department and attending surgical out patient department were investigated and treated as per protocol. In our study 39 patients out of 59 underwent different surgical procedure and followed by antitubercular treatment regime. 20 Non-operated patients treated medically with antitubercular treatment regime [ATT]. Conclusion: EPTB has same national health issue as pulmonary tuberculosis. For tuberculosis control, EPTB-A challenging disease should be early diagnosed and surgically and medically treated to decrease related morbidity and mortality.

Вивчені загально-біологічні та індивідуальні особливості структурної організації, а також гістотопографія структур гемомікроциркуляторного русла капсули колінного суглоба в тварин з різним характером опори та типом локомоції., Изучены общебиологические и индивидуальные особенности структурной организации, а также гистотопография структур гемомикроциркуляторного русла капсулы коленного сустава у животных с разным характером опоры и типом локомоции., The general biological and individual features of structural organization and histotopography of blood vessels capsule of knee-joint with animals with different sustentaculum character and type of locomotion are studied.

Вивчені загально-біологічні та індивідуальні особливості структурної організації, а також гістотопографія структур гемомікроциркуляторного русла капсули колінного суглоба в тварин з різним характером опори та типом локомоції., Изучены общебиологические и индивидуальные особенности структурной организации, а также гистотопография структур гемомикроциркуляторного русла капсулы коленного сустава у животных с разным характером опоры и типом локомоции., The general biological and individual features of structural organization and histotopography of blood vessels capsule of knee-joint with animals with different sustentaculum character and type of locomotion are studied.

Вивчені загально-біологічні та індивідуальні особливості структурної організації, а також гістотопографія структур гемомікроциркуляторного русла капсули колінного суглоба в тварин з різним характером опори та типом локомоції., Изучены общебиологические и индивидуальные особенности структурной организации, а также гистотопография структур гемомикроциркуляторного русла капсулы коленного сустава у животных с разным характером опоры и типом локомоции., The general biological and individual features of structural organization and histotopography of blood vessels capsule of knee-joint with animals with different sustentaculum character and type of locomotion are studied.

type:Case Report, source:http://igakkai.kms-igakkai.com/wp/wp-content/uploads/2017en/KMJ-E43(1)5.pdf

Antecedentes: O joelho é uma unidade funcional anatômica móvel que desempenha um papel fundamental na função desporto. Lesões nessa articulação e, mais especificamente, quebra ACL são extremamente graves obrigando o atleta a ser longo para fora da competição. Nos últimos anos, o trabalho no ambiente aquático tem aumentado devido às diversas vantagens que ela proporciona. Como para a reabilitação de tais lesões, terapia da água pode ser favorável devido à sua implementação em estágios iniciais é necessária para minimizar o impacto sobre a articulação lesada. Objetivos: Descubra se a reciclagem no ambiente aquático produz benefícios durante as várias fases de lesão recuperação ACL sobre um retrofit em terra. Método: Realizou uma revisão de artigos têm mostrado os benefícios obtidos a partir de uma reabilitação aquática e outra tradicional e complementação de ambos. Resultados: Os resultados não mostram diferenças significativas na maioria das variáveis (dor, ROM, força, etc.), embora melhorias no tempo de recuperação são evidentes durante o exercício em ambiente aquático. As diferenças negativas também são encontrados na isquitibial força de trabalho no ambiente aquático em relação à formação tradicional. Conclusões: Ejercicio física no meio aquático é útil para recuperação complemeto terrestre. Além disso, facilita a recuperação na fase inicial da lesão, Introduction: The knee is a mobile anatomical functional unit that plays a key role in sports function. The injuries produced in this joint and, more specifically, anterior cruciate ligament tears are of great gravity, forcing the athlete to be a long time away from the competition. In recent years, work in the aquatic environment has increased due to the different advantages it provides. Regarding the rehabilitation of this type of lesions, aquatic therapies may be favorable due to their implementation in the early stages in which it is required to minimize the impact on the injured joint. Objectives: To determine if the readaptation in the aquatic environment produces benefits during the different phases of recovery of the anterior cruciate ligament injury with respect to a readaptation in the terrestrial environment. Method: A review has been carried out of articles that have verified the benefits obtained between an aquatic and a traditional readaptation, as well as the complementation of both. Results: The results obtained do not show significant differences in the majority of variables (pain, ROM, force, etc.), although there is evidence of improvement in recovery time during exercise in the aquatic environment. There are also negative differences in the work of isquitibial force in the aquatic environment compared to traditional training. Conclusions: Physical exercise in the aquatic environment is a useful supplement for terrestrial recovery. It also facilitates recovery at the early stage of the injury., Antecedentes: La rodilla es una unidad funcional anatómica móvil que juega un papel clave en la función deportiva. Las lesiones producidas en esta articulación y, más específicamente, las roturas de ligamento cruzado anterior son de gran gravedad obligando al deportista a estar mucho tiempo apartado de la competición. En los últimos años, el trabajo en el medio acuático se ha incrementado debido a las diferentes ventajas que este proporciona. En cuanto a la readaptación de este tipo de lesiones, las terapias acuáticas pueden ser favorables debido a su implementación en etapas tempranas en las que se requiere minimizar el impacto en la articulación lesionada. Objetivos: Averiguar si la readaptación en el medio acuático produce beneficios durante las distintas fases de recuperación de la lesión del ligamento cruzado anterior respecto a una readaptación en el medio terrestre. Método: Se ha llevado a cabo una revisión de artículos que han comprobado los beneficios obtenidos entre una readaptación acuática y otra tradicional, así como la complementación de ambas. Resultados: Los resultados obtenidos no muestran diferencias significativas en la mayoría de variables (dolor, ROM, fuerza, etc.), aunque si se evidencian mejoras en cuanto al tiempo de recuperación durante el ejercicio en el medio acuático. También se encuentran diferencias negativas en el trabajo de fuerza isquitibial en el medio acuático respecto al entrenamiento tradicional. Conclusiones: El ejerccio físico en el medio acuático es un complemeto útil para la recuperación terrestre. Además, facilita la recuperación en la etapa temprana de la lesión

The skeletal material of 299 individual skeletons was recovered from 78 graves in central Copenhagen in 2006. The graves were part of a temporary cemetery serving the Copenhagen Hospital for the Poor in the period 1842–1858. It is known that the hospital supplied cadavers for teaching and dissection. Fifty-two skeletons and bones were found to have cut marks and saw marks, indicative of post mortem surgical interventions: dissection, autopsy, anatomical specimens and surgical practice. The material was closely examined for healing at the sawn edges and signs of diseases. It was attempted to differentiate the surgical procedures from one another and give an overview of the material and historical context. We were mostly unable to attach a specific post mortem surgical procedure to the skeletal elements; however, we present some cases that most likely represent a specific surgical intervention. An excavation of similarly processed bone material from London Hospital from the same time period was used as the main reference material. The skeletal material described here offers a view upon the medical development, teaching and training amongst surgeons and anatomists in mid-19th century.

INTRODUCTION: Desamino D-arginine vasopressin (DDAVP or desmopressin) is a useful and effective haemostatic treatment for patients with von Willebrand Disease (VWD). However, there are still issues regarding in which subtypes of VWD DDAVP is appropriate and little consensus on its use in different surgical settings. We also lack information concerning the appropriate laboratory parameters that should be monitored. AIM: The European Haemophilia Therapy Strategy Board (EHTSB) wished to investigate published information and clinical use of DDAVP in VWD patients. METHODS: We conducted a literature survey on management of VWD during surgical interventions and undertook a survey of specialist haematologist centres across Europe to assess current management of VWD patients. RESULTS: DDAVP is ineffective in type 3 VWD and its use in type 2B remains controversial due to the possibility of thrombocytopenia. It can, however, be used effectively to cover minor surgery and dental procedures in most other VWD patients. For major surgery there is wider use of factor concentrate in preference to DDAVP depending on the subtype of VWD. We give consensus recommendations on the use of DDAVP for surgical interventions in VWD including laboratory parameters that denote an adequate response and contraindications to its use. CONCLUSIONS: DDAVP can be recommended to cover invasive procedure in selected patients with VWD, however, we need more information and systematic recording of adverse events associated with DDAVP use in VWD. A companion paper will be published covering the use of factor concentrates in VWD patients.

Surgical trauma induces activation of the immune system and may cause an increase of inflammatory biomarkers tested postoperatively in septic patients treated for bloodstream infection. The aim of this study was to determine the impact of surgical interventions on the novel sepsis biomarker soluble urokinase plasminogen activator receptor (suPAR) and to compare results with those of routine laboratory parameters CRP, PCT, and IL-6 in patients with culture-proven bloodstream infection. Forty-six adult patients with positive blood culture undergoing minor or major surgical intervention were investigated, 12 blood culture positive patients served as control group. Blood was collected 24 hours before and after surgical intervention for determination of the sepsis biomarkers suPAR, CRP, PCT, and IL-6. Within the surgical study cohort, a non-significant increase of suPAR, CRP, and PCT was observed postoperatively (p 0.642; p 0.773; p 0.087). In contrast, a slight decrease of IL-6 (p 0.599) was observed. A significant correlation was calculated for the pre- and postoperative difference of CRP (p 0.028) and PCT (p 0.008) and type of surgical intervention received: after minor surgical intervention only PCT decreased significantly (p <0.001), while after major surgical interventions no significant differences were observed for all biomarkers evaluated. In the control group, a significant decrease of CRP (p 0.005) and PCT (p 0.005) was observed. In patients treated adequately for bloodstream infections, postoperative suPAR levels remained uninfluenced of the surgical trauma and might therefore be a reliable parameter for postoperative infectious monitoring. After minor surgical intervention, PCT seems to be the most reliable parameter.

A 23 year old patient is presented at the surgery consultation because of abdominal pain localized in the epigastrium radiating to the right upper quadrant and to the back, is also accompanied by shortness of breath, associated with a pregnancy of 24 weeks, she is entered in the Gynecology consultation , it was performed in anteroposterior chest radiograph and right side view showing a well-defined mass with intrathoracic component in rear projection on the right diaphragmatic region and moves to the surgery department to complete its study. Computed tomography which reports at the right lung base supporting hyperdense image density of liver tissue which measures84 mmby58 mmposterior position entering the chest through a diaphragmatic hernia which has a ring is made5 cm. It was operated by a right thoracotomy hernia tumor mass into the abdominal cavity was reduced in a diaphragmatic herniorrhaphy and atypical resection of the lower lobe of the right lung hypoplasia is performed. It happens this rare entity and even the right side, associated with pregnancy, so it is decided to present this case as well as the most relevant and current issues regarding this condition., Se presentó una paciente de 23 años de edad a consulta en cuerpo de guardia de cirugía por presentar dolor abdominal localizado en epigastrio con irradiación a hipocondrio derecho y hacia la espalda, se acompaña además de falta de aire, asociado a un embarazo de 24 semanas, se ingresa en la sala de Ginecobstetricia, se le realiza radiografía del tórax en vista anteroposterior y lateral derecha que muestra una masa bien definida con componente intratorácico en proyección posterior en la región diafragmática derecha y se traslada al servicio de cirugía para completar su estudio. Se realizó tomografía axial computarizada donde se informa a nivel de la base pulmonar derecha imagen hiperdensa compatible con densidad de tejido hepático la cual mide84 mmpor58 mmde localización posterior que penetra en el tórax a través de una hernia diafragmática la cual tiene un anillo de5 cm. Fue intervenida quirúrgicamente mediante una toracotomía derecha se redujo la masa tumoral herniaria hacia la cavidad abdominal, se realizó herniorrafia diafragmática y resección atípica de parte del lóbulo inferior del pulmón derecho hipoplásico. Por lo raro que acontece esta entidad y más aun del lado derecho, asociada a embarazo, es por lo cual se decidió presentar este caso así como los aspectos más relevantes y actuales respecto a esta afección.

The European Convention for the Protection of Pet Animals was opened for signature in Strasbourg on 13 November 1987 and entered into force on I May 1992. This Convention states that: 'Surgical operations for the purpose of modifying the appearance of a pet animal or for other non-curative purposes shall be prohibited and, in particular: the docking of tails'. At present, 15 of the 27 States in the European Union have ratified this Convention (with or without reserving their position on tail docking) and have prohibited cosmetic surgical operations. In addition, four European States have prohibited these operations, even though they did not ratify the Convention. These policy positions agree with both the current knowledge on tail amputations in dogs and the opinions of official veterinary associations in Europe and North America.