International journal of surgery
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Operation notes are the only comprehensive account of what took place during surgery. Accurate and detailed documentation of surgical operation notes is crucial, both for post-operative management of patients and for medico-legal clarity. The aims of this study were to compare operation documentation against the Royal College of Surgeons of England guidelines and to compare the before-and-after effect of introducing an electronic operation note system. ⋯ We used our pilot audit to target specific information that was commonly omitted and we 'enforced' these areas using drop-down selections in electronic operation note. This study has demonstrated that implementation of an electronic operation note system markedly improved the quality of documentation, both in terms of information detail and readability. We would recommend this template system as a standard for operation note documentation.
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Regenerative properties of stem cells at the service of nerve repair have been initiated during recent decades. Effects of transplantation of characterized uncultured stromal vascular fraction (SVF) on peripheral nerve regeneration were studied using a rat sciatic nerve transection model. A 10-mm sciatic nerve defect was bridged using a chitosan conduit filled with SVF. ⋯ Morphometric indices of the regenerated fibers showed the number and diameter of the myelinated fibers were significantly higher in SVF transplanted animals than in control group. In immunohistochemistry, location of reactions to S-100 in SVF transplanted animals was clearly more positive than that in control group. SVF transplantation combined with chitosan conduit could be considered as a readily accessible source of stromal cells that improve functional recovery of sciatic nerve.
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Observational Study
Multimodal intraoperative monitoring: an observational case series in high risk patients undergoing major peripheral vascular surgery.
Recent guidelines from the National Institute of Health and Care Excellence (NICE) and the UK National Health Service (NHS) have stipulated that intraoperative flow monitoring should be used in high-risk patients undergoing major surgery to improve outcomes and reduce costs. Depth of anaesthesia monitoring is also recommended for patients where excessive anaesthetic depth is poorly tolerated, along with cerebral oximetry in patients with proximal femoral fractures. The aims of this descriptive case series were to evaluate the impact of a multimodal intraoperative strategy and its effect on mortality and amputation rate for patients with critical leg ischaemia. ⋯ Amputation rate was less than 2% at one year. Only 8% of patients (10 of 120) were admitted to a high dependency unit (HDU) postoperatively. 30-day mortality in our case series was lower than predicted by V-POSSUM scoring. Use of multimodal intraoperative monitoring with the specific aim of limiting build-up of oxygen debt should be subjected to a randomised controlled study to assess the reproducibility of these results.
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Intestinal obstruction is an abdominal disease associated to mortality, especially if complicated with sepsis. Resuscitation increases survival, although controversies remain concerning to therapeutic strategy. ⋯ Hypertonic saline and pentoxifylline, both alone and in combination, attenuated oxidative stress and the activation of NF-κB, leading to a decrease in the inflammatory response.
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Effects of vitamin E and pyrroloquinoline quinone on peripheral nerve regeneration were studied using a rat sciatic nerve transection model. Ninety male healthy White Wistar rats were divided into three experimental groups (n = 15), randomly: Sham-operation (SHAM), transected control (TC), chitosan conduit (Chit) and three treatment groups (Vit E, PQQ and PQQ + Vit E). In SHAM group after anesthesia, left sciatic nerve was exposed through a gluteal muscle incision and after homeostasis muscle was sutured. ⋯ Morphometric indices of regenerated fibers showed number and diameter of the myelinated fibers in PQQ + Vit E was significantly higher than in other treatment groups. In immunohistochemistry, location of reactions to S-100 in PQQ + Vit E was clearly more positive than in other treatment groups. Response to PQQ + Vit E treatment demonstrates that it influences and improves functional recovery of peripheral nerve regeneration.