1,720,988 research outputs found
Elektrokemijska stabilnost titanizirane kirurške mrežice u fiziološloj otopini
Get PDFCilj: Cilj ovoga istraživanja je dokazati elektrokemijsku stabilnost titanizirane kirurške mrežice u fiziološkoj otopini te dokazivanje stabilnosti pri promjeni fizoloških uvjeta.
Metode: U ovom radu je mjerenjem potencijala otvorenog strujnog kruga te primjenom impedancijske spektroskopije ispitana elektrokemijska stabilnost medicinske titanizirane mrežice u standardnoj fiziološkoj otopini (pH 6.5) te fiziološkoj otopini snižene pH vrijednosti (pH 5.5).
Rezultati: Dobiveni rezultati ukazali su na izrazitu stabilnost mrežice u fiziološkoj otopini (pH 6.5) te izuzetno zadovoljavajuću stabilnost u uvjetima koji odgovaraju upalnim procesima u organizmu (snižena pH vrijednost na 5.5).
Zaključak: Ispitivanja mrežice ukazuju na zaključak da je mrežica izuzetno stabilna pri izlaganju fiziološkoj otopini i pH od 6.5 te je pokazala i stabilnost pri uvjetima koji simuliraju upalne procese u organizmu (pH 5.5).Objective: Objective of this research is to prove electrochemical stability of titanized surgical mesh in saline, and to prove its stability during the changes of physiological conditions as well.
Methods: By measuring potentials of open electric circuit and using impedance spectroscopy, stability of titanized medical mesh was tested in standard saline (pH 6,5), and also in saline with lower pH (pH=5,5).
Results: Results showed outstanding mesh stability in physiological saline (pH 6,5), and exceptionally satisfying stability in conditions that are similar to inflammatory processes in the organism (pH lowered to 5,5).
Conclusion: We can conclude, from the tests, that mesh is exceptionally stable when exposed to saline and pH 6,5, as well when is exposed to conditions that are simulating inflammatory processes in the organism (pH=5,5)
The outcomes of surgical treatement in operation of colon cancer by anterior Dixon resection : influence of ERAS-protocol : L
No full textCILJ ISTRAŽIVANJA: ERAS protokol je multimodalni način peripoerativne kirurške njege koji se sastoji od znanstveno dokazanih postupaka. Neki od postupaka, iako su znanstveno dokazani, teško su prihvaćeni od strane kirurga i ostalog osoblja jer se protive dosad ustaljenoj praksi. Spomenuti protokol je dio Odjela za koloproktologiju KBC-a Split od listopada 2016. godine. Koristi se za svakog elektivno operiranog pacijenta s dijagnozom kolorektalnog karcinoma. Cilj istraživanja je usporediti duljine postoperativnog boravka, učestalost komplikacija i neplaniranih operacija između skupina koje su se pridržavale ERAS protokola i onih koje nisu.
ISPITANICI I METODE: Ova studija uključuje sve pacijente s dijagnozom kolorektalnog karcinoma elektivno operirane donjom anteriornom resekcijom (operacija po Dixonu) u razdoblju od listopada 2016. do svibnja 2018. Pacijenti su podijeljeni u 3 skupine- otvoreno operirani s loše provedenim ERAS protokolom (Otvoreno ne-ERAS ili „ONE”), otvoreno operiranim s dobro provedenim ERAS protokolom (Otvoreno ERAS ili „OER”), laparoskopski operirani s dobro provedenim ERAS protokolom (Laparoskopski ERAS ili „LER”). Više od 60% primjenjenih ERAS stavki (od ukupno 24 koje smo bilježili) smo smatrali dobro provedenim ERAS protokolom. Analizirani su duljina postoperativnog boravka, broj komplikacija i neplaniranih reoperacija.
REZULTATI: Pacijenti koji su bili dio „ONE” grupe su imali dulje vrijeme postoperativnog boravka od obje grupe u kojima je dobro provođen ERAS protokol (“OER” i “LER”): 11,32±5,57 dana, 95% CI 8,63-14,00 naspram 8,57±2,79 dana, 95% CI 6,96-10,18 za grupu “OER” i 6,21±3,50, 95% CI 4,91-7,47 za grupu “LER”. Statistički značajna razlika pronađena je samo između skupine „ONE” i “LER” (P<0,001). Prateći postoperativne komplikacije uočena je statistički značajna povećana učestalost komplikacija kod ispitanika grupe „ONE” u odnosu na grupe “OER” i “LER” (P= 0,002).
ZAKLJUČAK: Rezultati naše studije sugeriraju da primjena ERAS protokola može smanjiti postoperativni boravak i morbiditet te posljedično poboljšati vrijednost kirurške njege za pacijenta. Potpuna primjena ERAS protokola trebala bi smanjiti i troškove liječenja i poboljšati općenito klinički ishod.OBJECTIVE: The ERAS (Enhanced Recovery After Surgery) protocol is multimodal care pathway of perioperative surgical care consisting of evidence-based procedures. Some of the procedures, in spite of being scientifically proven, are hardly accepted by surgeons and other staff because it opposes well established practice. Mentioned protocol is a part of Department for colorectal surgery in University Hospital Split since October 2016. It is used for every patient with colorectal cancer that undergoes elective surgery. Objective of our research was to compare length of postoperative stay, frequency of complications and unplanned reoperations among groups with or without well performed ERAS protocol.
PATIENTS AND METHODS: This study includes all patients undergoing lower anterior (Dixon) resection in University Hospital Split in from October 2016. to May 2017. Patients were divided in three groups: open operation with poorly performed ERAS (Open non ERAS or „ONE”), open operation with well performed ERAS (Open ERAS or „OER”) and minimal invasive surgery with well performed ERAS (Laparoscopy ERAS or „LER”). More than 60% of all ERAS steps (total of 24 steps have been noted in our ERAS protocol) applied in one patient was considered as a well performed ERAS protocol. Length of hospital stay, number of complications and unexpected reoperations were analyzed.
RESULTS: Patients that were part of „ONE” group had a longer postoperative stay than patients in groups with well performed ERAS protocol („OER” and „LER”): 11.32±5.57 days, 95% CI 8.63-14.00 comparing to 8.57±2.79 days, 95% CI 6.96-10.18 for group “OER” and 6.21±3.50 days, 95% CI 4.91-7.47 for group“LER”. Statistically significant difference was found only between groups „ONE” and „LER” (P<0.001) By keeping track of postoperative complications statistically significant higher rate was noticed in group „ONE” in relation to other two groups (P=0.002).
CONCLUSION: Results of our study suggest that application of ERAS protocol can decrease hospital stay and morbidity, and consequently improve the value of surgical care for patients. The complete ERAS implementation should result in major improvements in clinical outcomes and cost
Endoscopic hernioplasty results without use of titanium tacks
Get PDFUvod: Operacija preponske hernije jedna je od najčešće izvedenih kirurških zahvata u cijelom svijetu. Trenutno laparoskopska operacija preponske kile s pojačanjem mrežicom je odgovarajuća alternativa klasičnoj otvorenoj operaciji preponske kile. Korištenje zavojnica za pričvršćivanje mrežice, šavova i obujmice za zatvaranje peritonealnog režnja je uobičajena praksa. S druge strane, to je povezano sa većom incidencijom postoperativne kronične boli. Druga alternativa TAPP operaciji preponske kile je korištenje tehnike bez fiksacije mrežice da bi se smanjio rizik od kroničnih bolova, ali još uvijek postoji rasprava o učestalosti recidiva nakon operacije bez fiksacije mrežice, pogotovo ukoliko se radi o velikom defektu. Dakle, to je kratka studija procjene TAPP operacije koristeći sintetičko ljepilo za fiksaciju mrežice i peritonelanog režnja.
Metode: Svi su bolesnici koji su podvrgnuti TAPP operaciji preponske kile tijekom 2017. godine bili uključeni u studiju. Tip kirurškog zahvata i metoda fiksacije mrežice bio je kirurgov izbor. Titanizirana mrežica je korištena kod svakog pacijenta. U prvoj skupini mreža je fiksirana sintetičkim ljepilom (Ifabond, Fimed, Quincié-En-Beaujolais, Francuska) i peritonealni režanj je zatvoren istim. U drugoj skupini mrežica je fiksirana pomoću zavojnica (Protack ™, Covidien Surgical, Mansfield, MA, SAD), dok je peritonealni režanj bio zatvoren s kontinuiranom kirurškom šavom (V-Loc, Covidien Surgical, Mansfield, MA, SAD) ili pomoću zavojnica. Promatrane su postoperativne komplikacije, kao što su infekcija kirurškog mjesta ili opstrukcija tankog crijeva. Osim toga, proveden je telefonski intervju za procjenu kronične postoperativne boli, vremena oporavka, zadovoljstva pacijenta ili mogućeg recidiva.
Rezultati: Tijekom 2017. godine 42 bolesnika (5 žena i 37 muškaraca) podvrgnuta su operaciji preponske kile pomoću konvencionalnog laparoskopskog transabdominalnog preperitonealnog pristupa (TAPP). Kod 31 pacijenta mrežica je fiksirana i peritonealni režanj zatvoren sintetičkim ljepilom. U ostalih 11 pacijenata mrežica je bila fiksirana, pri čemu je peritonealni režanj bio zatvoren bilo sa stalnim bodljikavim kirurškim šavom ili zavojnicom. Većina tih pacijenata bila je prikladna za jednodnevni operacijski program. Na anketno istraživanje odgovorila su 26 pacijenta. U trenutku provođnja ankete mali broj pacijenata je još uvijek osjećao bol, pri čemu nije bilo statistički značajne razlike ovisno o vrsti učvršćivanja mrežice
Zaključak: Naši rezultati pokazali su da su svi bolesnici postoperativno osjećali bol. Nema značajne razlike u osjećaju postoperativne boli među bolesnicima kod kojih je mrežica fiksirana zavojnicom ili ljepilom te je statistička analiza pokazala približno jednaku potrošnju analgetika u obje skupine.Introduction: Inguinal hernia repair is one of the most commonly performed surgical procedures worldwide. Nowadays, laparoscopic inguinal hernia repair with mesh reinforcement is suitable alternative to classical open inguinal hernia repair. The use of tacks for mesh fixation, or tacks, sutures and staples for peritoneal flap closure is common practice. In the other hand it is associated with higher incidence of postoperative chronic pain. Another alternative of TAPP ingvinal hernia repair is use of technique without mesh fixation to reduce risk of chronic pain but there is still discussion about recurrence rate following no-fixation mesh repair in larger and medial hernias. Therefore, this short study evaluates TAPP repair using synthetic glue for fixation of both mesh and peritoneal flap.
Methods: All patients who underwent TAPP inguinal hernia repair during 2017 were included in the study. Type of mesh fixation and peritoneal closure method was surgeon's choice. The titanized mesh was used in every patient. In first group mesh was fixed using synthetic glue (Ifabond, Fimed, Quincié-En-Beaujolais, France) and peritoneal flap was closed using same glue. In second groupmesh was fixed using tacks (Protack™, Covidien Surgical, Mansfield, MA, USA) while peritoneal flap was closed either with continuous barbed surgical suture (V-Loc, Covidien Surgical, Mansfield, MA, USA) or a tacker device. Postoperative complications, such as surgical site infection or small-bowel obstruction were observed. Additionally, a telephone interview was conducted to assess chronic postoperative pain, recovery time, patient satisfaction or possible recurrence.
Results: During 2017 forty-two patients (5 women and 37 men) underwent surgery for inguinal hernias repair using the conventional laparoscopic transabdominal preperitoneal approach (TAPP) on the Department of Surgery, University Hospital of Split. In 31 patient mesh was fixed and peritoneal flap was closed using synthetic glue. In other 11 patients mesh was fixed using tacks while peritoneal flap was closed either with continuous barbed surgical suture or tacks. The mean hospital stay in both groups was similar. The majority of these patients were appropriate for one-day surgery program. 26 patients filled out the questionnaire. At the time of the survey, a small number of patients still experienced pain, with no statistically significant differences depending on the type of meshing
Conclusion: Our results show that all patients postoperatively felt pain. There are no significant differences in the feeling of postoperative pain in patients in whom the mesh is fixed by tacks or adhesive and statistical analysis showed approximately equal consumption of analgesics in both groups
Lateral thermal damage to the tissue of the abdominal wall and small intestine in rats and pigs using UltraCision R
No full textUVOD: Visokofrekventno titranje za rezanje tkiva i zaustavljanje krvarenja razvijeno je kao svojevrsna zamjena visokofrekventnoj struji koja može biti uzrokom različitih komplikacija. Danas se rabi u čitavom nizu otvorenih i endoskopskih operacija. Primjenom visokofrekventnog titranja na tkivo se prenosi manje energije i manje je postranično toplinsko oštećenje tkiva jer se razvijaju temperature od svega 50 ºC do 100 ºC. Nema ni prolaska električne energije kroz tijelo bolesnika. Načelo rada titrajućih rezača je da se električna energija pomoću piezoelektričnog pretvarača pretvara u mehaničku energiju uzdužnog titranja radnog dijela instrumenta. CILJ ISTRAŽIVANJA: Istražiti djelovanje različitih vremena primjene kao i različitih izlaznih snaga generatora visokofrekventnog titranja na eksperimentalnom modelu tkiva trbušne stijenke štakora i svinje te na tankom crijevu svinje. METODE: Korišteni su albino štakori soja Wistar tjelesne mase oko 200 g. Životinje su omamljene eterom, te anestezirane Ketaminom u dozi od 100 ml/kg. Titrajućim rezačem djelovalo se na mišićno–fascijalni dio trbušne stijenke u različitim vremenima primjene za svaku skupinu posebno. Za svaku eksperimentalnu skupinu izvršeno je od tri do pet pojedinačnih primjena titrajućeg rezača. Korištena je domaća svinja tjelesne mase oko 40 kg. Životinja je sedirana, relaksirana i anestezirana sljedećom kombinacijom anestetika: xylazin 2 %, 2 mg/kg, atropin sulfat 1 %, 3 mL i propofolom 1 %, 3 mL. Zatim je intubirana i podvrgnuta općoj endotrahealnoj anesteziji koja je provođena kombinacijom izoflurana (1–1,5 vol%), dušičnog oksida (max. 75 vol%) i kisika (25 vol%). Primijeni se visokofrekventno-titrajući rezač na mišićno-fascijalni dio trbušne stijenke i jejunum. Za svaku eksperimentalnu skupinu učinjeno je po deset pojedinačnih primjena titrajućeg rezača. Nakon pokusa životinja je žrtvovana injekcijom 7,4 % kalij klorida. Izrađeni su parafinski blokovi koji su rezani na debljinu od 5 µm i bojani klasičnom histološkom metodom hemalaun-eozin. Pod svjetlosnim mikroskopom izmjerena je širina nekroze od mjesta primjene titrajućeg rezača. REZULTATI: Na modelu trbušne stijenke štakora, pri izlaznoj snazi 3, prosječno termičko oštećenje je pri primjeni u trajanju od 5 s bilo 0,0522 (SD ± 0,0097) mm, a pri izlaznoj razini snage 5 iznosilo je 0,0702 (SD ± 0,0129) mm. Pri izlaznoj razini snage 3, u trajanju od 10 s iznosilo je 0,1544 (SD ± 0,0419) mm, a pri izlaznoj razini snage 5 iznosilo je 0,2085 (SD ± 0,0433) mm. S druge strane, primjena od 5 s trajanja, 5 s bez aktivacije i ponovno 5 s aktivacije uzrokovala je prosječno termičko oštećenje koje je pri izlaznoj razini snage 3 iznosilo 0,1020 (SD ± 0,0430) mm, a pri izlaznoj razini snage 5 iznosilo je 0,1419 (SD ± 0,0248) mm. Na modelu trbušne stijenke svinje, pri izlaznoj snazi 3, prosječno termičko oštećenje je pri primjeni u trajanju od 5 s bilo 0,0825 (SD ± 0,0234) mm, a pri izlaznoj razini snage 5 iznosilo je 0,2969 (SD ± 0,0848) mm. Pri izlaznoj razini snage 3, u trajanju od 10 s iznosilo je 0,3850 (SD ± 0,0590) mm, a pri izlaznoj razini snage 5 iznosilo je 0,4793 (SD ± 0,1047)mm. S druge strane, primjena od 5 s trajanja, 5 s bez aktivacije i ponovno 5 s aktivacije uzrokovala je prosječno termičko oštećenje koje je pri izlaznoj razini snage 3 iznosilo 0,1876 (SD ± 0,0652) mm, a pri izlaznoj razini snage 5 iznosilo je 0,2013 (SD ± 0,0810) mm. Na modelu tankog crijeva svinje, pri izlaznoj snazi 3, prosječno termičko oštećenje je pri primjeni u trajanju od 5 s bilo 0,1302 (SD ± 0,0238) mm, a pri izlaznoj razini snage 5 iznosilo je 0,1771 (SD ± 0,0198) mm. Pri izlaznoj razini snage 3, u trajanju od 10 s iznosilo je 0,2655 (SD ± 0,0533) mm, a pri izlaznoj razini snage 5 iznosilo je 0,2983 (SD ± 0,0689)mm. S druge strane, primjena od 5 s trajanja, 5 s bez aktivacije i ponovno 5 s aktivacije uzrokovala je prosječno termičko oštećenje koje je pri izlaznoj razini snage 3 iznosilo 0,2011 (SD ± 0,0447) mm, a pri izlaznoj razini snage 5 iznosilo je 0,2258 (SD ± 0,0373) mm. ZAKLJUČAK: S obzirom na navedeno, može se reći da je koagulacijska nekroza pri istoj izlaznoj snazi veća pri dugotrajnijoj primjeni, te se proporcionalno povećava s povećanjem izlazne snage generatora visokofrekventnog titranja. Također, nekroza je veća ako je primjena neprekidna, nego ako se primjena prekine i ponovno primijeni u istom ukupnom trajanju.INTRODUCTION: Harmonic scalpel for tissue cutting and coagulation is a replacement for the high frequency current that may cause different complications. It is frequently used in many open and endoscopic operations. Using Harmonic scalpel the lower amount of energy is transduced to the tissue with less possibility of the lateral thermal damage or penetration depth because of low temperatures, only 50-100º C, and also the body is free of electric passing current. The working principle of the Harmonic scalpel is to transform the electric power into mechanical longitudinal movement of the working part of the instrument by piezoelectrical transducer situated in the hand piece. AIM: To determinate the effects of different employing times at application on the experimental model of rat's and pig’s abdominal tissue and pig’s small intestine. METHODS: Two hundred grams weight Wistar rats were used. The animals were etherized and anaesthetized with Ketamin with a dose of 100 ml/kg and the laparathomy was done. Using Harmonic scalpel we performed the operation on the muscular facial part of the abdominal tissue employing different time for each group separately. Between three and five individual approaches were done using Harmonic scalpel for each experimental group. Forty kilograms weight pigs were used as the second experimental model. The animals were anesthetized using the following sedation, relaxation, and narcosis regimen: ketamine 10% with a dose of 20 mg/kg, xylazine 2% in a dose of 2 mg/kg, atropine sulfate 1% in a dose of 3 mL/animal, and propofol 1% in a dose of 2–5 mL/animal. Endotracheal anesthesia was with isoflurane (1–1.5 vol%), nitrous oxide (max. 75 vol%), and oxygen (25 vol%). After anesthesia, the animals were fixed to an operative table, and a laparotomy was performed. The muscular part of the abdominal wall without skin or small intestine was coagulated using different application regimens for each group. Ten individual approaches were performed for each experimental group using the Harmonic Scalpel. After the experiment all animals were euthanized with 7,4% solution of KCl. After the animals were euthanized the tissue was cut out and inserted in paraffin. The paraffin blocks were cut in 5μm thick pieces and colored using classic histological method hemalaun-eozin. Under the light microscope the width of necrosis was measured from the point where the Harmonic scalpel was used. RESULTS: The rat’s abdominal tissue suffered thermal damage of 0,0522 (SD ± 0,0097) mm employing time of 5 s, at the output power at 3, and 0,0702 (SD ± 0,0129) mm at the output power at 5. For employing time of 10 s it was 0,1544 (SD ± 0,0419) mm, at the output power at 3, and 0,2085 (SD ± 0,0433) mm at the output power at 5. On the other hand, the employing time of 5 s, 5 s of inactivity and again 5 s of activity, thermal damage was 0,1020 (SD ± 0,0430) mm, at the output power at 3, and 0,1419 (SD ± 0,0248) at the output power at 5. The pig’s abdominal tissue suffered thermal damage of 0,0825 (SD ± 0,0234) mm employing time of 5 s, at the output power at 3, and 0,2969 (SD ± 0,0848) mm at the output power at 5. For employing time of 10 s it was 0,3850 (SD ± 0,0590) mm, at the output power at 3, and 0,4793 (SD ± 0,1047) mm at the output power at 5. On the other hand, the employing time of 5 s, 5 s of inactivity and again 5 s of activity, thermal damage was 0,1876 (SD ± 0,0652) mm, at the output power at 3, and 0,2013 (SD ± 0,0810) at the output power at 5. The pig’s small intestine tissue suffered thermal damage of 0,1302 (SD ± 0,0238) mm employing time of 5 s, at the output power at 3, and 0,1771 (SD ± 0,0198) mm at the output power at 5. For employing time of 10 s it was 0,2655 (SD ± 0,0533) mm, at the output power at 3, and 0,2983 (SD ± 0,0689) mm at the output power at 5. On the other hand, the employing time of 5 s, 5 s of inactivity and again 5 s of activity, thermal damage was 0,2011 (SD ± 0,0447) mm, at the output power at 3, and 0,2258 (SD ± 0,0373) at the output power at 5. CONCLUSION: Considering the above, we can conclude that the coagulation necrosis, at the same output power, is larger employing longer usage. Also necrosis is more extensive if the employing time is continuous then if it is disconnected and connected again in the same entire duration
Lateral thermal damage to the tissue of the abdominal wall and small intestine in rats and pigs using UltraCision R
No full textUVOD: Visokofrekventno titranje za rezanje tkiva i zaustavljanje krvarenja razvijeno je kao svojevrsna zamjena visokofrekventnoj struji koja može biti uzrokom različitih komplikacija. Danas se rabi u čitavom nizu otvorenih i endoskopskih operacija. Primjenom visokofrekventnog titranja na tkivo se prenosi manje energije i manje je postranično toplinsko oštećenje tkiva jer se razvijaju temperature od svega 50 ºC do 100 ºC. Nema ni prolaska električne energije kroz tijelo bolesnika. Načelo rada titrajućih rezača je da se električna energija pomoću piezoelektričnog pretvarača pretvara u mehaničku energiju uzdužnog titranja radnog dijela instrumenta. CILJ ISTRAŽIVANJA: Istražiti djelovanje različitih vremena primjene kao i različitih izlaznih snaga generatora visokofrekventnog titranja na eksperimentalnom modelu tkiva trbušne stijenke štakora i svinje te na tankom crijevu svinje. METODE: Korišteni su albino štakori soja Wistar tjelesne mase oko 200 g. Životinje su omamljene eterom, te anestezirane Ketaminom u dozi od 100 ml/kg. Titrajućim rezačem djelovalo se na mišićno–fascijalni dio trbušne stijenke u različitim vremenima primjene za svaku skupinu posebno. Za svaku eksperimentalnu skupinu izvršeno je od tri do pet pojedinačnih primjena titrajućeg rezača. Korištena je domaća svinja tjelesne mase oko 40 kg. Životinja je sedirana, relaksirana i anestezirana sljedećom kombinacijom anestetika: xylazin 2 %, 2 mg/kg, atropin sulfat 1 %, 3 mL i propofolom 1 %, 3 mL. Zatim je intubirana i podvrgnuta općoj endotrahealnoj anesteziji koja je provođena kombinacijom izoflurana (1–1,5 vol%), dušičnog oksida (max. 75 vol%) i kisika (25 vol%). Primijeni se visokofrekventno-titrajući rezač na mišićno-fascijalni dio trbušne stijenke i jejunum. Za svaku eksperimentalnu skupinu učinjeno je po deset pojedinačnih primjena titrajućeg rezača. Nakon pokusa životinja je žrtvovana injekcijom 7,4 % kalij klorida. Izrađeni su parafinski blokovi koji su rezani na debljinu od 5 µm i bojani klasičnom histološkom metodom hemalaun-eozin. Pod svjetlosnim mikroskopom izmjerena je širina nekroze od mjesta primjene titrajućeg rezača. REZULTATI: Na modelu trbušne stijenke štakora, pri izlaznoj snazi 3, prosječno termičko oštećenje je pri primjeni u trajanju od 5 s bilo 0,0522 (SD ± 0,0097) mm, a pri izlaznoj razini snage 5 iznosilo je 0,0702 (SD ± 0,0129) mm. Pri izlaznoj razini snage 3, u trajanju od 10 s iznosilo je 0,1544 (SD ± 0,0419) mm, a pri izlaznoj razini snage 5 iznosilo je 0,2085 (SD ± 0,0433) mm. S druge strane, primjena od 5 s trajanja, 5 s bez aktivacije i ponovno 5 s aktivacije uzrokovala je prosječno termičko oštećenje koje je pri izlaznoj razini snage 3 iznosilo 0,1020 (SD ± 0,0430) mm, a pri izlaznoj razini snage 5 iznosilo je 0,1419 (SD ± 0,0248) mm. Na modelu trbušne stijenke svinje, pri izlaznoj snazi 3, prosječno termičko oštećenje je pri primjeni u trajanju od 5 s bilo 0,0825 (SD ± 0,0234) mm, a pri izlaznoj razini snage 5 iznosilo je 0,2969 (SD ± 0,0848) mm. Pri izlaznoj razini snage 3, u trajanju od 10 s iznosilo je 0,3850 (SD ± 0,0590) mm, a pri izlaznoj razini snage 5 iznosilo je 0,4793 (SD ± 0,1047)mm. S druge strane, primjena od 5 s trajanja, 5 s bez aktivacije i ponovno 5 s aktivacije uzrokovala je prosječno termičko oštećenje koje je pri izlaznoj razini snage 3 iznosilo 0,1876 (SD ± 0,0652) mm, a pri izlaznoj razini snage 5 iznosilo je 0,2013 (SD ± 0,0810) mm. Na modelu tankog crijeva svinje, pri izlaznoj snazi 3, prosječno termičko oštećenje je pri primjeni u trajanju od 5 s bilo 0,1302 (SD ± 0,0238) mm, a pri izlaznoj razini snage 5 iznosilo je 0,1771 (SD ± 0,0198) mm. Pri izlaznoj razini snage 3, u trajanju od 10 s iznosilo je 0,2655 (SD ± 0,0533) mm, a pri izlaznoj razini snage 5 iznosilo je 0,2983 (SD ± 0,0689)mm. S druge strane, primjena od 5 s trajanja, 5 s bez aktivacije i ponovno 5 s aktivacije uzrokovala je prosječno termičko oštećenje koje je pri izlaznoj razini snage 3 iznosilo 0,2011 (SD ± 0,0447) mm, a pri izlaznoj razini snage 5 iznosilo je 0,2258 (SD ± 0,0373) mm. ZAKLJUČAK: S obzirom na navedeno, može se reći da je koagulacijska nekroza pri istoj izlaznoj snazi veća pri dugotrajnijoj primjeni, te se proporcionalno povećava s povećanjem izlazne snage generatora visokofrekventnog titranja. Također, nekroza je veća ako je primjena neprekidna, nego ako se primjena prekine i ponovno primijeni u istom ukupnom trajanju.INTRODUCTION: Harmonic scalpel for tissue cutting and coagulation is a replacement for the high frequency current that may cause different complications. It is frequently used in many open and endoscopic operations. Using Harmonic scalpel the lower amount of energy is transduced to the tissue with less possibility of the lateral thermal damage or penetration depth because of low temperatures, only 50-100º C, and also the body is free of electric passing current. The working principle of the Harmonic scalpel is to transform the electric power into mechanical longitudinal movement of the working part of the instrument by piezoelectrical transducer situated in the hand piece. AIM: To determinate the effects of different employing times at application on the experimental model of rat's and pig’s abdominal tissue and pig’s small intestine. METHODS: Two hundred grams weight Wistar rats were used. The animals were etherized and anaesthetized with Ketamin with a dose of 100 ml/kg and the laparathomy was done. Using Harmonic scalpel we performed the operation on the muscular facial part of the abdominal tissue employing different time for each group separately. Between three and five individual approaches were done using Harmonic scalpel for each experimental group. Forty kilograms weight pigs were used as the second experimental model. The animals were anesthetized using the following sedation, relaxation, and narcosis regimen: ketamine 10% with a dose of 20 mg/kg, xylazine 2% in a dose of 2 mg/kg, atropine sulfate 1% in a dose of 3 mL/animal, and propofol 1% in a dose of 2–5 mL/animal. Endotracheal anesthesia was with isoflurane (1–1.5 vol%), nitrous oxide (max. 75 vol%), and oxygen (25 vol%). After anesthesia, the animals were fixed to an operative table, and a laparotomy was performed. The muscular part of the abdominal wall without skin or small intestine was coagulated using different application regimens for each group. Ten individual approaches were performed for each experimental group using the Harmonic Scalpel. After the experiment all animals were euthanized with 7,4% solution of KCl. After the animals were euthanized the tissue was cut out and inserted in paraffin. The paraffin blocks were cut in 5μm thick pieces and colored using classic histological method hemalaun-eozin. Under the light microscope the width of necrosis was measured from the point where the Harmonic scalpel was used. RESULTS: The rat’s abdominal tissue suffered thermal damage of 0,0522 (SD ± 0,0097) mm employing time of 5 s, at the output power at 3, and 0,0702 (SD ± 0,0129) mm at the output power at 5. For employing time of 10 s it was 0,1544 (SD ± 0,0419) mm, at the output power at 3, and 0,2085 (SD ± 0,0433) mm at the output power at 5. On the other hand, the employing time of 5 s, 5 s of inactivity and again 5 s of activity, thermal damage was 0,1020 (SD ± 0,0430) mm, at the output power at 3, and 0,1419 (SD ± 0,0248) at the output power at 5. The pig’s abdominal tissue suffered thermal damage of 0,0825 (SD ± 0,0234) mm employing time of 5 s, at the output power at 3, and 0,2969 (SD ± 0,0848) mm at the output power at 5. For employing time of 10 s it was 0,3850 (SD ± 0,0590) mm, at the output power at 3, and 0,4793 (SD ± 0,1047) mm at the output power at 5. On the other hand, the employing time of 5 s, 5 s of inactivity and again 5 s of activity, thermal damage was 0,1876 (SD ± 0,0652) mm, at the output power at 3, and 0,2013 (SD ± 0,0810) at the output power at 5. The pig’s small intestine tissue suffered thermal damage of 0,1302 (SD ± 0,0238) mm employing time of 5 s, at the output power at 3, and 0,1771 (SD ± 0,0198) mm at the output power at 5. For employing time of 10 s it was 0,2655 (SD ± 0,0533) mm, at the output power at 3, and 0,2983 (SD ± 0,0689) mm at the output power at 5. On the other hand, the employing time of 5 s, 5 s of inactivity and again 5 s of activity, thermal damage was 0,2011 (SD ± 0,0447) mm, at the output power at 3, and 0,2258 (SD ± 0,0373) at the output power at 5. CONCLUSION: Considering the above, we can conclude that the coagulation necrosis, at the same output power, is larger employing longer usage. Also necrosis is more extensive if the employing time is continuous then if it is disconnected and connected again in the same entire duration
Lateral thermal damage to the tissue of the abdominal wall and small intestine in rats and pigs using UltraCision R
No full textUVOD: Visokofrekventno titranje za rezanje tkiva i zaustavljanje krvarenja razvijeno je kao svojevrsna zamjena visokofrekventnoj struji koja može biti uzrokom različitih komplikacija. Danas se rabi u čitavom nizu otvorenih i endoskopskih operacija. Primjenom visokofrekventnog titranja na tkivo se prenosi manje energije i manje je postranično toplinsko oštećenje tkiva jer se razvijaju temperature od svega 50 ºC do 100 ºC. Nema ni prolaska električne energije kroz tijelo bolesnika. Načelo rada titrajućih rezača je da se električna energija pomoću piezoelektričnog pretvarača pretvara u mehaničku energiju uzdužnog titranja radnog dijela instrumenta. CILJ ISTRAŽIVANJA: Istražiti djelovanje različitih vremena primjene kao i različitih izlaznih snaga generatora visokofrekventnog titranja na eksperimentalnom modelu tkiva trbušne stijenke štakora i svinje te na tankom crijevu svinje. METODE: Korišteni su albino štakori soja Wistar tjelesne mase oko 200 g. Životinje su omamljene eterom, te anestezirane Ketaminom u dozi od 100 ml/kg. Titrajućim rezačem djelovalo se na mišićno–fascijalni dio trbušne stijenke u različitim vremenima primjene za svaku skupinu posebno. Za svaku eksperimentalnu skupinu izvršeno je od tri do pet pojedinačnih primjena titrajućeg rezača. Korištena je domaća svinja tjelesne mase oko 40 kg. Životinja je sedirana, relaksirana i anestezirana sljedećom kombinacijom anestetika: xylazin 2 %, 2 mg/kg, atropin sulfat 1 %, 3 mL i propofolom 1 %, 3 mL. Zatim je intubirana i podvrgnuta općoj endotrahealnoj anesteziji koja je provođena kombinacijom izoflurana (1–1,5 vol%), dušičnog oksida (max. 75 vol%) i kisika (25 vol%). Primijeni se visokofrekventno-titrajući rezač na mišićno-fascijalni dio trbušne stijenke i jejunum. Za svaku eksperimentalnu skupinu učinjeno je po deset pojedinačnih primjena titrajućeg rezača. Nakon pokusa životinja je žrtvovana injekcijom 7,4 % kalij klorida. Izrađeni su parafinski blokovi koji su rezani na debljinu od 5 µm i bojani klasičnom histološkom metodom hemalaun-eozin. Pod svjetlosnim mikroskopom izmjerena je širina nekroze od mjesta primjene titrajućeg rezača. REZULTATI: Na modelu trbušne stijenke štakora, pri izlaznoj snazi 3, prosječno termičko oštećenje je pri primjeni u trajanju od 5 s bilo 0,0522 (SD ± 0,0097) mm, a pri izlaznoj razini snage 5 iznosilo je 0,0702 (SD ± 0,0129) mm. Pri izlaznoj razini snage 3, u trajanju od 10 s iznosilo je 0,1544 (SD ± 0,0419) mm, a pri izlaznoj razini snage 5 iznosilo je 0,2085 (SD ± 0,0433) mm. S druge strane, primjena od 5 s trajanja, 5 s bez aktivacije i ponovno 5 s aktivacije uzrokovala je prosječno termičko oštećenje koje je pri izlaznoj razini snage 3 iznosilo 0,1020 (SD ± 0,0430) mm, a pri izlaznoj razini snage 5 iznosilo je 0,1419 (SD ± 0,0248) mm. Na modelu trbušne stijenke svinje, pri izlaznoj snazi 3, prosječno termičko oštećenje je pri primjeni u trajanju od 5 s bilo 0,0825 (SD ± 0,0234) mm, a pri izlaznoj razini snage 5 iznosilo je 0,2969 (SD ± 0,0848) mm. Pri izlaznoj razini snage 3, u trajanju od 10 s iznosilo je 0,3850 (SD ± 0,0590) mm, a pri izlaznoj razini snage 5 iznosilo je 0,4793 (SD ± 0,1047)mm. S druge strane, primjena od 5 s trajanja, 5 s bez aktivacije i ponovno 5 s aktivacije uzrokovala je prosječno termičko oštećenje koje je pri izlaznoj razini snage 3 iznosilo 0,1876 (SD ± 0,0652) mm, a pri izlaznoj razini snage 5 iznosilo je 0,2013 (SD ± 0,0810) mm. Na modelu tankog crijeva svinje, pri izlaznoj snazi 3, prosječno termičko oštećenje je pri primjeni u trajanju od 5 s bilo 0,1302 (SD ± 0,0238) mm, a pri izlaznoj razini snage 5 iznosilo je 0,1771 (SD ± 0,0198) mm. Pri izlaznoj razini snage 3, u trajanju od 10 s iznosilo je 0,2655 (SD ± 0,0533) mm, a pri izlaznoj razini snage 5 iznosilo je 0,2983 (SD ± 0,0689)mm. S druge strane, primjena od 5 s trajanja, 5 s bez aktivacije i ponovno 5 s aktivacije uzrokovala je prosječno termičko oštećenje koje je pri izlaznoj razini snage 3 iznosilo 0,2011 (SD ± 0,0447) mm, a pri izlaznoj razini snage 5 iznosilo je 0,2258 (SD ± 0,0373) mm. ZAKLJUČAK: S obzirom na navedeno, može se reći da je koagulacijska nekroza pri istoj izlaznoj snazi veća pri dugotrajnijoj primjeni, te se proporcionalno povećava s povećanjem izlazne snage generatora visokofrekventnog titranja. Također, nekroza je veća ako je primjena neprekidna, nego ako se primjena prekine i ponovno primijeni u istom ukupnom trajanju.INTRODUCTION: Harmonic scalpel for tissue cutting and coagulation is a replacement for the high frequency current that may cause different complications. It is frequently used in many open and endoscopic operations. Using Harmonic scalpel the lower amount of energy is transduced to the tissue with less possibility of the lateral thermal damage or penetration depth because of low temperatures, only 50-100º C, and also the body is free of electric passing current. The working principle of the Harmonic scalpel is to transform the electric power into mechanical longitudinal movement of the working part of the instrument by piezoelectrical transducer situated in the hand piece. AIM: To determinate the effects of different employing times at application on the experimental model of rat's and pig’s abdominal tissue and pig’s small intestine. METHODS: Two hundred grams weight Wistar rats were used. The animals were etherized and anaesthetized with Ketamin with a dose of 100 ml/kg and the laparathomy was done. Using Harmonic scalpel we performed the operation on the muscular facial part of the abdominal tissue employing different time for each group separately. Between three and five individual approaches were done using Harmonic scalpel for each experimental group. Forty kilograms weight pigs were used as the second experimental model. The animals were anesthetized using the following sedation, relaxation, and narcosis regimen: ketamine 10% with a dose of 20 mg/kg, xylazine 2% in a dose of 2 mg/kg, atropine sulfate 1% in a dose of 3 mL/animal, and propofol 1% in a dose of 2–5 mL/animal. Endotracheal anesthesia was with isoflurane (1–1.5 vol%), nitrous oxide (max. 75 vol%), and oxygen (25 vol%). After anesthesia, the animals were fixed to an operative table, and a laparotomy was performed. The muscular part of the abdominal wall without skin or small intestine was coagulated using different application regimens for each group. Ten individual approaches were performed for each experimental group using the Harmonic Scalpel. After the experiment all animals were euthanized with 7,4% solution of KCl. After the animals were euthanized the tissue was cut out and inserted in paraffin. The paraffin blocks were cut in 5μm thick pieces and colored using classic histological method hemalaun-eozin. Under the light microscope the width of necrosis was measured from the point where the Harmonic scalpel was used. RESULTS: The rat’s abdominal tissue suffered thermal damage of 0,0522 (SD ± 0,0097) mm employing time of 5 s, at the output power at 3, and 0,0702 (SD ± 0,0129) mm at the output power at 5. For employing time of 10 s it was 0,1544 (SD ± 0,0419) mm, at the output power at 3, and 0,2085 (SD ± 0,0433) mm at the output power at 5. On the other hand, the employing time of 5 s, 5 s of inactivity and again 5 s of activity, thermal damage was 0,1020 (SD ± 0,0430) mm, at the output power at 3, and 0,1419 (SD ± 0,0248) at the output power at 5. The pig’s abdominal tissue suffered thermal damage of 0,0825 (SD ± 0,0234) mm employing time of 5 s, at the output power at 3, and 0,2969 (SD ± 0,0848) mm at the output power at 5. For employing time of 10 s it was 0,3850 (SD ± 0,0590) mm, at the output power at 3, and 0,4793 (SD ± 0,1047) mm at the output power at 5. On the other hand, the employing time of 5 s, 5 s of inactivity and again 5 s of activity, thermal damage was 0,1876 (SD ± 0,0652) mm, at the output power at 3, and 0,2013 (SD ± 0,0810) at the output power at 5. The pig’s small intestine tissue suffered thermal damage of 0,1302 (SD ± 0,0238) mm employing time of 5 s, at the output power at 3, and 0,1771 (SD ± 0,0198) mm at the output power at 5. For employing time of 10 s it was 0,2655 (SD ± 0,0533) mm, at the output power at 3, and 0,2983 (SD ± 0,0689) mm at the output power at 5. On the other hand, the employing time of 5 s, 5 s of inactivity and again 5 s of activity, thermal damage was 0,2011 (SD ± 0,0447) mm, at the output power at 3, and 0,2258 (SD ± 0,0373) at the output power at 5. CONCLUSION: Considering the above, we can conclude that the coagulation necrosis, at the same output power, is larger employing longer usage. Also necrosis is more extensive if the employing time is continuous then if it is disconnected and connected again in the same entire duration
Comparison of three-port laparoscopic cholecystectomy with laparoscopic assisted transvaginal cholecystectomy
Get PDFCILJ ISTRAŽIVANJA: Razvoj novih tehnika minimalno invazivne kirurgije poput NOTES i hibridnih NOTES zahvata dodatno smanjuje traumu i ozljedu tkiva jer se za ulazak u tjelesne prostore koriste prirodni tjelesni otvori. Cilj ovog istraživanja je usporediti razinu stresnog odgovora u laparoskopskoj kolecistektomiji s pomoću triju troakara i laparoskopski asistiranoj transvaginalnoj kolecistektomiji mjerenjem razine upalnih parametara: interleukina-6 (IL-6), C-reaktivnog proteina (CRP) i leukocita (L).
ISPITANICI I METODE: Ovo je prospektivna, longitudinalna, kontrolirana studija u koju su uključene pacijentice operirane u Klinici za abdominalnu kirurgiju KBC-a Split u razdoblju od prosinca 2013. godine do studenog 2015. godine. U studiji je analizirano 30 pacijentica: 18 pacijentica kod kojih je učinjena laparoskopska kolecistektomija s pomoću triju troakara - skupina LP, i 12 pacijentica kod kojih je učinjena laparoskopski asistirana transvaginalna kolecistektomija - skupina TV. Pacijenticama u obe skupine su mjerene serumske koncentracije interleukina-6 (IL-6), C-reaktivnog proteina (CRP) i leukocita (L) u 3 vremenska intervala: 24 sata prije operacije, 24 sata nakon i 48 sati nakon operacije.
REZULTATI: Dobiveni su rezultati u kojima nije bilo značajne razlike u serumskim koncentracijama upalnih parametara IL-6, CRP i L između skupina LP i TV u nijednom vremenskom intervalu u kojemu su mjerene.
Koncentracija IL-6 u serumu je iznosila 60,94±125,00 pg/mL u skupini LP i 13,91±15,65 pg/mL u skupini TV 24 sata nakon operacije (p=0,16) te 13,50±12,66 pg/mL u skupini LP i 6,52±4,30 pg/mL u skupini TV 48 sata nakon operacije (p=0,20).
Koncentracija CRP-a u serumu bila je 23,19±28,67mg/L u skupini LP i 20,37±32,97 mg/L u skupini TV 24 sata nakon operacije (p=0,82) te 49,56±61,72 mg/L u skupini LP i 28,68±44,84 mg/L u skupini TV 48 sata nakon operacije (p=0,21).
Broj leukocita u serumu je iznosio 9,45±3,15 x 109/L u skupini LP i 9,38±2,25 x 109/L u skupini TV 24 sata nakon operacije (p=0,23) te 7,48±2,52 x 109/L u skupini LP i 7,19±1,84 x 109/L u skupini TV 48 sata nakon operacije (p=0,60).
ZAKLJUČAK: Naše istraživanje je pokazalo da su razine upalnih parametara interleukina-6 i C-reaktivnog proteina kao i broj leukocita niži u laparoskopski asistiranoj transvaginalnoj kolecistektomiji u odnosu na laparoskopsku kolecistektomiju s pomoću triju troakara, ali bez statističke značajnosti.OBJECTIVE: The development of new techniques of minimal invasive surgery such as NOTES and hybrid NOTES even more reduces trauma and tissue injury. The aim of this study is to compare the stress response in three-port laparoscopic cholecystectomy with laparoscopic assisted transvaginal cholecystectomy by measuring levels of inflammatory parameters: interleukin-6 (IL-6), C-reactive protein (CRP) and leukocyte (L).
PATIENTS AND METHODS: This is a prospective, longitudinal, controlled study that includes patients operated in the Department of Abdominal Surgery KBC Split in the period from December 2013 to November 2015. The study analyzed 30 patients: 18 patients underwent three-port laparoscopic cholecystectomy - group LP and 12 patients underwent laparoscopic assisted transvaginal cholecystectomy - group TV. Interleukin-6 (IL-6), C-reactive protein (CRP) and leukocyte (L) were measured in all patients 24 hours prior to surgery, 24 hours after and 48 hours after surgery.
RESULTS: No significant differences in serum inflammatory parameters of IL-6, CRP and L was found between groups LP and TV in any period of time in which they were measured.
The concentration of IL-6 in serum was 60.94 ± 125.00 pg / mL in group LP and 13.91 ± 15.65 pg / mL in group TV 24 hours after surgery (p = 0.16) and 13.50 ± 12.66 pg / mL in group LP and 6.52 ± 4.30 pg / mL in group TV 48 hours after surgery (p = 0.20).
The concentration of CRP in serum was 23.19 ± 28.67mg / L in Group LP and 20.37 ± 32.97 mg / L in the group TV 24 hours after surgery (p = 0.82), and 49.56 ± 61.72 mg / L in group LP and 28.68 ± 44.84 mg / L in the group TV 48 hours after surgery (p = 0.21).
The leukocyte count in serum was 9.45 ± 3.15 x 109/L in group LP and 9.38 ± 2.25 x 109/L in the group TV 24 hours after surgery (p = 0.23) and 7.48 ± 2.52 x 109/L in group LP and 7.19 ± 1.84 x 109/L in a group of TV 48 hours after surgery (p = 0.60).
CONCLUSION: Our study has shown that levels of inflammatory parameters interleukin-6 and C-reactive protein and leukocyte count were lower in laparoscopic assisted transvaginal cholecystectomy compared to three-port laparoscopic cholecystectomy, but without statistical significance
Phase angle : risk predictor in colorectal surgery
Get PDFCilj istraživanja: Cilj ovoga istraživanja bio je utvrditi povezanost faznoga kuta u različitim vremenskim intervalima kao rizičnoga faktora za razvoj komplikacija, povećanja broja rehospitalizacija, reoperacija i smrti te ga povezati sa stadijem bolesti, PHD nalazom i dijagnozom. Fazni kut je i promatran kao prediktor malnutricije, te je istražena njegova korelacija s parametrima dobivenih biometrijskom analizom sastava tijela.
Materijal i metode: U svrhu dobivanja podataka o broju i karakteristikama pacijenata korišteni su podaci ERAS protokola za 2017.godinu s mjerenjima TANITA version 3.2.5 vage, NRS 2002 nutritivnim probirom, te medicinska dokumentacija pacijenata na kolorektalnoj kirurgiji: povijesti bolesti i PHD nalazi, za ukupno 199 pacijenata.
Rezultati: Utvrđen je statistički značajan pad u vrijednosti faznoga kuta prije operacije te u razdoblju između 1. i 2. tjedna nakon operacije i to u smjeru da je fazni kut prije operacije statistički značajno viši od faznoga kuta u razdoblju od 1. - 2.tjedna nakon operacije. Dokazano je postojanje negativne korelacija između dobi i vrijednosti faznoga kuta. Statistički značajna korelacija s faznim kutom postojala je za predoperativne vrijednosti faznoga kuta, za razdoblje između 1. - 2., te mjesec dana nakon operacije dok na dan operacije i za razdoblje između 3.-4. tjedna ne postoji statistički značajna korelacija između faznoga kuta i dobi. Nadalje, dokazano je i postojanje statistički značajne razlike faznoga kuta među spolovima. Žene u prosjeku imaju niže vrijednosti faznoga kuta, a kroz razdoblje statistički značajna razlika vidi se za predoperativne vrijednosti faznoga kuta, za razdoblje između 1. - 2., te mjesec dana nakon operacije dok na dan operacije i za razdoblje između 3. - 4.tjedna ne postoji statistički značajna razlika između faznoga kuta u odnosu na spol. Zbog prevelikoga uzorka dijagnoza i PHD nalaza nije moguće napraviti valjanu statističku obradu koja bi povezala vrijednost faznoga kuta u vremenu s određenom dijagnozom i PHD nalazom te nije utvrđena statistički značajna povezanost između vrijednosti faznoga kuta i stadija bolesti određenoga modificiranom Dukesovom klasifikacijom. Fazni kut se nije pokazao kao statistički značajan za razvoj komplikacija kao uzroka rehospitalizacije, odnosno reoperacije. Nije utjecao na broj reoperacija, rehospitalizacija ni na duljinu hospitalizacije. Vrijednosti faznoga kuta prije operacije te u razdoblju između prvoga i drugoga tjedna nakon operacije ne pokazuju statistički značajnu povezanost s ITM-om. Dokazano je kako s faznim kutom postoji pozitivna korelacija s mišićnom masom, TBW-om, koštanom masom te metaboličkom dobi u oba promatrana razdoblja, te da s faznim kutom postoji negativna korelacija s ECW/TBW-om, negativna korelacija s količinom masnoga tkiva, ali samo za predoperativne vrijednosti, te ne postoji korelacija faznoga kuta s vrijednostima visceralne masti. Utvrđeno je da s faznim kutom postoji negativna korelacija s predoperativnim NRS-om te da postoji pozitivna korelacija s vrijednostima albumina na dan operacije. Utvrđen je i statistički značajan pad albumina u odnosu na prvu obavljenu operaciju u usporedbi s vrijednostima albumina nakon reoperacije.
Zaključak: Fazni kut se nije pokazao kao dobar prediktor rizika, ali s obzirom na njegovu dobru povezanost s već poznatim prediktorima pothranjenosti, fazni kut ima potencijal ubrojiti se ovoj skupini. S obzirom na snažnu korelaciju faznoga kuta s gotovo svim sastavnicama tijela, ostavlja se prostor za istraživanje kretanja pojedinih sastavnica tijela u vremenu koje svojim promjenama utječu na promjenu faznoga kuta.Objective: The aim of the study was to establish the association of Phase angle at different time intervals as a risk factor for the development of complications, increase the number of hospitalization, reoperation and death and associate it with the stage of disease, PHD and diagnosis. Phase angle was observed as a predictor of malnutrition and its correlation with parameters obtained by biometric analysis of body composition was investigated.
Materials and Methods: Data for the number and characteristics of patients were used for the TANITA version 3.2.5 scales for 2017, the NRS 2002 nutritional probe and the medical documentation of patients in colorectal surgery: the history of the disease and the PHD, for a total of 199 patients.
Results: A statistically significant decrease in the value of Phase angle before surgery and in the period between the 1st and 2nd weeks after the operation was established in the direction that the Phase angle before surgery was statistically significantly higher than the Phase angle in the period of 1. -2. week after surgery. There is evidence of a negative correlation between age and value of Phase angle. A statistically significant correlation with Phase angle existed for the preoperative value of Phase angle for the period between 1-2 months and one month after the operation, while there was no statistically significant difference between the day of surgery and the 3-4 week period correlation between Phase angle and age. Furthermore, there is also a statistically significant difference in the Phase angle between the sexes. Women average have lower Phase angle values, and for the period statistically significant differences are seen for the preoperative value of Phase angle for the period between 1-2 months and one month after surgery until the day of surgery for a period of between 3 There is no statistically significant difference between Phase-Angle and Gender. Because of the oversized diagnosis and PHD, it is not possible to make a valid statistical treatment that would link the Phase angle value to the time with a specific diagnosis and PHD and no statistically significant correlation was found between the Phase angle value and the disease stages determined by the modified Dukes classification. Phase angle did not prove to be statistically significant for the development of complications as a cause of rehospitalization or reoperation. It did not affect the number of reoperations, hospitalization or length of hospitalization. Phase angle values prior to surgery and in the period between first and second weeks after surgery do not show statistically significant association with BMI. It has been shown that with Phase angle there is a positive correlation with muscle mass, TBW, bone mass and metabolic age in both observed periods, and that with Phase angle there is a negative correlation with ECW / TBW, negative correlation with the amount of fatty tissue , but only for preoperative values, and there is no correlation of the Phase angle with visceral fat values. It has been established that there is a negative correlation with Phase angle with preoperative NRS and that there is a positive correlation with albumin values on the day of surgery. There was also a statistically significant drop in albumin relative to the first performed operation compared to albumin after re-operation.
Conclusion: Phase angle has not shown a good predictor of risk, but due to its good correlation with already known maladaptive predictors, the Phase angle has the potential to be included in this group. Given the strong correlation of the Phase angle with almost all body components, space is left to explore the movements of individual body components in the time that their changes affect the change of Phase angle
Going Beyond Counting First Authors in Author Co-citation Analysis
Get PDFThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
- …
