A new technique of nephrolithotomy was used to remove calyceal stone in seven cases. Key points of this technique are direct removal of stone through the calicopuncture by forceps without renal vascular clamping and Gelfoam Packing followed by compression with hands for control of bleeding. The results were s follow : 1. With the exception of a single small stone all the targeted calculi were removed (94% in completeness of stone removal). 2. This method did not have any significant renal parenchymal damage and there was no episode of postoperative urine leakage of delayed bleeding. 3. Postoperative complications were a case of urinary obstruction caused by slipped Gelfoam into calyx accidently, which was delivered spontaneously during the voiding on 2nd postoperative day and a case of wound infection. This new technique nephrolithotomy was seemed to be an useful and rapid surgical method of calyceal stone surgery in some situations such as in case of marked adhesion present around the pelvis, narrow infundibulum and failed stone removal during the performing pyelolithotomy.
Calculi* ; Constriction ; Gelatin Sponge, Absorbable ; Hand ; Hemorrhage ; Pelvis ; Postoperative Complications ; Surgical Instruments ; Wound Infection

BACKGROUND: Keloids are benign fibro-proliferative lesion, related to excessive inflammatory reactions in certain anatomical areas, including the auricles. Their specific etiology remains unclear; nonetheless they exhibit tumor-like characteristics of significant recurrence and cause emotional distress, even with various treatment strategies. We applied intermittent magnetic pressure therapy on ear keloids in combination with surgical excision, and present its effectiveness herein.METHODS: Ear keloid patients were treated with surgical excision followed by magnetic pressure therapy. The keloid tissues underwent excision and keloid marginal flaps were utilized for wound closure. Intermittent magnetic pressure therapy was applied 2 weeks after the surgical procedure. The pressure therapy consisted of a 3-hour application and 2-hour resting protocol (9 hr/day), and lasted for 6 months. The results were analyzed 6 months after the therapeutic procedures, using the scar assessment scale.RESULTS: Twenty-two ear keloids from 20 patients were finally reviewed. Among the keloids that completed the therapeutic course, 20 ear keloids out of 22 in total (90.9%) were successfully eradicated. Two patients (2 keloids) exhibited slight under-correction. Postoperative complications such as wound dehiscence or surgical site infection were not noted. The scar assessment scale demonstrated a significant improvement in each index. The intermittent pressure therapy led to patient compliance, and avoided pressure-related pain and discomfort.CONCLUSION: Excision followed by intermittent pressure application using a magnet successfully reduced the burden of fibro-proliferative keloids, and had good patient compliance. The role of intermittent pressure application and resting should be studied with regard to keloid tissue remodeling.
Cicatrix ; Ear ; Humans ; Keloid ; Patient Compliance ; Postoperative Complications ; Recurrence ; Surgical Wound Infection ; Treatment Outcome ; Wounds and Injuries

STUDY DESIGN: Retrospective cohort study. PURPOSE: The purpose of this study was to assess the rate of blood transfusion after cervical fusion surgery, and its effect on complication rates. OVERVIEW OF LITERATURE: Cervical spine fusions have gained interest in the literature since these procedures are now ever more frequently being performed in an outpatient setting with few complications. METHODS: The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was used to identify patients that underwent cervical fusion from 2010 to 2013. Multivariate regression analysis was used to determine postoperative complications associated with transfusion and cervical fusion. RESULTS: We identified 11,588 patients who had cervical fusion between 2010 and 2013. The rate of blood transfusion following cervical fusion found to be 1.47%. All transfused patients were found to have increased risk of venous thromboembolism (TBE) (odds ratio [OR], 3.19; 95% confidence interval [95% CI], 1.16–8.77), myocardial infarction (MI) (OR, 9.12; 95% CI, 2.53–32.8), increased length of stay (LOS) (OR, 28.03; 95% CI, 14.28–55.01) and mortality (OR, 4.14; 95% CI, 1.44–11.93). Single level fusion had increased risk of TBE (OR, 3.37; 95% CI, 1.01–11.33), MI (OR, 10.5; 95% CI, 1.88–59.89), and LOS (OR, 14.79; 95% CI, 8.2–26.67). Multilevel fusion had increased risk of TBE (OR, 5.64; 95% CI, 1.15–27.6), surgical site infection (OR, 16.29; 95% CI, 3.34–79.49), MI (OR, 10.84; 95% CI, 2.01–58.55), LOS (OR, 26.56; 95% CI, 11.8–59.78), and mortality (OR, 10.24; 95% CI, 2.45–42.71). Patients who had anterior cervical discectomy and fusion surgery and received a transfusion had an increased risk of TBE (OR, 4.87; 95% CI, 1.04–22.82), surgical site infection (OR, 9.73; 95% CI, 2.14–44.1), MI (OR, 9.88; 95% CI, 1.87–52.2), increased LOS of more than 2 days (OR, 28.34; 95% CI, 13.79–58.21) and increase in mortality (OR, 6.3; 95% CI, 1.76–22.48). While, transfused patients who had posterior fusion surgery had increased risk of MI (OR, 10.45; 95% CI, 1.42–77.12) and increased LOS of more than 6 days (OR, 4.42; 95% CI, 2.68–7.29). CONCLUSIONS: Our results demonstrate that although cervical fusions can be done as outpatient procedures special precautions and investigations should be done for patients who receive transfusion after cervical fusion. These patients are demonstrated to have higher rate of MI, TBE, wound infection and mortality when compared to those who do not receive transfusion.
Blood Transfusion ; Cohort Studies ; Diskectomy ; Humans ; Length of Stay ; Mortality ; Myocardial Infarction ; Outpatients ; Postoperative Complications ; Prevalence* ; Quality Improvement* ; Retrospective Studies ; Spine* ; Surgeons* ; Surgical Wound Infection ; Venous Thromboembolism ; Wound Infection

BACKGROUNDING AND AIM: Recent reports have suggested that preoperative biliary drainage increases the perioperative morbidity and mortality rates of pancreaticoduodenectomy. We reviewed retrospectively 150 patients who underwent pancreaticoduodenectomy to examine the relationship between preoperative biliarydrainage and the morbidity and mortality associated with pancreaticoduodenectomy. METHODS: Peri-operative morbidity and mortality were evaluated in 150 consecutive patients who underwent pancreaticoduodenectomy at Pusan National University Hospital for 10 years. Univariate and multivariate logistic regression analysis were done to evaluate the relationship between preoperative biliary decompression and the following end points: any complication, any major complication, infectious complications, intraabdominal abscess, pancreaticojejunal anastomotic leak, wound infection, and postoperative death. RESULTS: Preoperative prosthetic biliary drainage was performed in 86 patients (57.3%) (stent group), 17 patients (11.3%) underwent surgical biliary bypass performed during prereferral laparotomy, and the remaining 47 patients(31.3%) (no-stent group) did not undergo any form of preoperative biliary decompression. The overall surgical death rate was 1.3% (two patients); the number of deaths was too small for multivariate analysis. By multivariate logistic regression, no differences were found between the stent and no-stent groups in the incidence of all complications, major complications, infectious complications, intraabdominal abscess, or pancreaticojejunal anastomotic leak. Wound infections were more common in the stent group than the no-stent group. CONCLUSIONS: Preoperative biliary decompression increases the risk for postoperative wound infections after pancreaticoduodenectomy. However, there was no increase in the risk of major postoperative complications or death associated with preoperative stent placement. Patients with extrahepatic biliary obstruction do not necessarily require immediate laparotomy to undergo pancreaticoduodenectomy with acceptable morbidity and mortality rates; such patients can be treated by endoscopic biliary drainage without concern for increased major complications and death associated with subsequent pancreaticoduodenectomy.
Abscess ; Anastomotic Leak ; Busan ; Decompression ; Drainage ; Humans ; Incidence ; Laparotomy ; Logistic Models ; Mortality ; Multivariate Analysis ; Pancreaticoduodenectomy* ; Postoperative Complications ; Retrospective Studies ; Stents ; Surgical Wound Infection ; Wound Infection

Nontuberculous mycobacterial infections can cause destructive tenosynovitis of the hand. We report on and discuss the clinical course and distinctive radiologic findings of two patients with hand tenosynovitis secondary to M. marinum and intracellulare infection, which are different from those of the nontuberculous mycobacterial infections reported in the previous literature.
Female ; *Hand/radiography ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Mycobacterium Infections, Nontuberculous/*diagnosis/etiology/radiography ; Mycobacterium avium-intracellulare Infection/*diagnosis/etiology/radiography ; *Mycobacterium marinum ; Surgical Wound Infection/complications ; Tenosynovitis/diagnosis/*microbiology/radiography ; Wound Infection/complications

Nephrectomy has been one of the most important procedures in the field of urologic surgery, since Gustave Simon performed the first planned nephrectomy in 1869. It may be required in a wide varity of circumstances and various methods of operative procedures has been introduced. And also its complication has been varied according to the operative procedures. A clinical observation on the 149 patients nephrectomized in the Department of Urology, National Medical Center, during the period from January, 1971 to July, 1978 was presented with a brief review of the literature. The results were as follows : 1. The total number of in-patients during above period was 1,287 and nephrectomies were performed in 149 of the 987 total urologic operations (15.1 %). 2. Age distributions showed the highest in 20's with 26.1 % and the youngest was 5 months and the oldest 65 years. Sex distribution was almost equal. 3. The causative lesions of the kidney showed the highest in Tbc 75 cases (50.3 %), calculous disease 21 cases (14.1 %), tumor 18 cases (12.2 %), hydronephrosis 9 cases (6.0 %) and pyonephrosis 8 cases (5.4 %) by sequence. 4. Lumbar approach with resection of 12th rib was the most frequently used method in 72 cases (48.3 %). Postoperative complications were seen in 17 cases (11.4 %), of which wound infection and pneumothorax were common. 5. 77 cases ( 51.7 %) were discharged within 10 days after surgery and only 8 cases (5.3 %) remained more than 1 month.
Age Distribution ; Humans ; Hydronephrosis ; Kidney ; Nephrectomy ; Pneumothorax ; Postoperative Complications ; Pyonephrosis ; Ribs ; Sex Distribution ; Surgical Procedures, Operative ; Urology ; Wound Infection

Patients are increasingly seeking repair of their earlobes following ear gauging. Research has shown that current repair techniques either excessively reduce the lobular volume or leave an obvious scar along the free edge of the earlobe. In our case series, we describe the use of a novel technique for repairing earlobes following ear gauging using a rolling earlobe flap that preserves the lobular volume and avoids leaving a scar on the free edge of the lobule. The procedure was performed on 3 patients (6 earlobes) who had defects from ear gauging that ranged from 3.0 to 6.5 cm. There were no postoperative complications of infection, wound dehiscence, flap necrosis, hypertrophic scars, or keloids, and all patients were highly satisfied with the postoperative results. This versatile technique allows for an aesthetically pleasing reconstruction of the lobule with the advantages of: the absence of a surgical scar on the free edge of the lobule, preserving the lobule volume, and presenting a highly customizable technique that allows lobules to be created with various shapes and volumes.
Body Piercing ; Cicatrix ; Cicatrix, Hypertrophic ; Ear Deformities, Acquired ; Ear* ; Humans ; Keloid ; Necrosis ; Postoperative Complications ; Surgical Flaps ; Wound Infection

Patients are increasingly seeking repair of their earlobes following ear gauging. Research has shown that current repair techniques either excessively reduce the lobular volume or leave an obvious scar along the free edge of the earlobe. In our case series, we describe the use of a novel technique for repairing earlobes following ear gauging using a rolling earlobe flap that preserves the lobular volume and avoids leaving a scar on the free edge of the lobule. The procedure was performed on 3 patients (6 earlobes) who had defects from ear gauging that ranged from 3.0 to 6.5 cm. There were no postoperative complications of infection, wound dehiscence, flap necrosis, hypertrophic scars, or keloids, and all patients were highly satisfied with the postoperative results. This versatile technique allows for an aesthetically pleasing reconstruction of the lobule with the advantages of: the absence of a surgical scar on the free edge of the lobule, preserving the lobule volume, and presenting a highly customizable technique that allows lobules to be created with various shapes and volumes.
Body Piercing ; Cicatrix ; Cicatrix, Hypertrophic ; Ear Deformities, Acquired ; Ear* ; Humans ; Keloid ; Necrosis ; Postoperative Complications ; Surgical Flaps ; Wound Infection

STUDY DESIGN: Prospective study. PURPOSE: To compare the efficacy of 24-hour and 72-hour antibiotic prophylaxis in preventing surgical site infections (SSIs). OVERVIEW OF LITERATURE: Antimicrobial prophylaxis in surgical practice has become a universally accepted protocol for minimizing postoperative complications related to infections. Although prophylaxis is an accepted practice, a debate exists with regard to the antibiotic type and its administration duration for various surgical procedures. METHODS: Our institute is a tertiary care hospital with more than 100 spinal surgeries per year for various spine disorders in the department of orthopedics. We conducted this prospective study in our department from June 2012 to January 2015. A total of 326 patients were enrolled in this study, with 156 patients in the 72-hour antibiotic prophylaxis group (group A) and 170 patients in the 24-hour group (group B). Cefazolin was the antibiotic used in both groups. Two surgeons were involved in conducting all the spinal procedures. Our study compared SSIs among patients undergoing instrumented spinal fusion. RESULTS: The overall rate of SSIs was 1.8% with no statistical difference between the two groups. CONCLUSIONS: The 24-hour antimicrobial prophylaxis is as effective as the 72-hour dosage in instrumented spinal fusion surgery.
Antibiotic Prophylaxis ; Cefazolin ; Humans ; Orthopedics ; Postoperative Complications ; Prospective Studies ; Spinal Fusion* ; Spine ; Surgeons ; Surgical Wound Infection ; Tertiary Healthcare

Objective: This study aims to survey the incidence of surgical site infection (SSI) in China and to analyze its risk factors, so as to prevent and control SSI after colorectal surgery. Methods: An observative study was conducted. Based on a program of Chinese SSI Surveillance from 2018 to 2020, the clinical data of all adult patients undergoing colorectal surgery during this time period were extracted. These included demographic characteristics and perioperative clinical parameters. Minors, pregnant women, obstetric or gynecological surgery, urological system surgery, retroperitoneal surgery, resection of superficial soft tissue masses, and mesh or other implants were excluded. A total of 2122 patients undergoing colorectal surgery from 50 hospitals were included, including 1252 males and 870 females. The median age was 63 (16) years and the median BMI was 23 (4.58) kg/m². The primary outcome was the incidence of SSI within 30 days after colorectal surgery. The secondary outcomes were mortality within 30 days postoperatively, length of ICU stays and postoperative hospital stays, and cost of hospitalization. Patients were divided into the SSI group and non-SSI group based on the occurrence of SSI. Multivariable logistic regression was performed to analyze risk factors of SSI after colorectal surgery, and subgroup analysis was conducted for open and laparoscopic surgery. Results: The incidence of SSI after colorectal surgery was 5.6% (119/2122), including 47 cases (47/119, 39.5%) with superficial incisional infections, 24 cases (24/119, 20.2%) with deep incisional infections, and 48 cases (48/119, 40.3%) with organ/space infections. The occurrence of SSI significantly increased mortality [2.5% (3/119) vs. 0.1%(3/2003), χ²=22.400, P=0.003], the length of ICU stay [0 (1) day vs. 0(0) day, U=131 339, P<0.001], postoperative hospital stay [18.5 (12.8) days vs. 9.0 (6.0) days, U=167 902, P<0.001], and medical expenses [75 000 (49 000) yuan vs. 60 000 (31 000) yuan, U=126 189, P<0.001] (P<0.05). Multivariate analysis revealed that hypertension (OR=1.782, 95%CI: 1.173-2.709, P=0.007), preoperative albumin level (OR=1.680, 95%CI: 1.089-2.592, P=0.019), a contaminated or infected incision (OR= 1.993, 95%CI: 1.076-3.689, P=0.028), emergency surgery (OR=2.067, 95%CI: 1.076-3.972, P=0.029), open surgery (OR=2.132, 95%CI: 1.396-3.255, P<0.001), and surgical duration (OR=1.804, 95%CI: 1.188-2.740, P=0.006) were risk factors for SSI, while preoperative skin preparation (OR=0.478, 95%CI: 0.310-0.737, P=0.001) was a protective factor for SSI. Subgroup analysis was performed on patients undergoing open or laparoscopic surgery. The incidence of SSI in the open surgery group was 10.2%, which was significantly higher than that in the laparoscopic or robotic group (3.5%, χ²=39.816, P<0.001). Subgroup analysis identified that a contaminated or infected incision (OR=2.168, 95%CI: 1.042-4.510, P=0.038) and surgical duration (OR=2.072, 95%CI: 1.171-3.664, P=0.012) were risk factors for SSI after open surgery, while mechanical bowel preparation (OR=0.428, 95%CI: 0.227-0.807, P=0.009) and preoperative skin preparation (OR=0.356, 95%CI: 0.199-0.634, P<0.001) were protective factors for SSI after open surgery. In laparoscopic surgery, diabetes mellitus (OR= 2.292, 95%CI: 1.138-4.617, P=0.020) and hypertension (OR=2.265, 95%CI: 1.234-4.159, P=0.008) were risk factors for SSI. Conclusions: The incidence of SSI after colorectal surgery is 5.6%. Minimally invasive surgery should be selected to reduce the occurrence of postoperative SSI. To prevent the occurrence of SSI after open surgery, skin preparation and mechanical bowel preparation should be performed before the operation, and the duration of the operation should be shortened as much as possible. In the perioperative period, care of patients with hypertension, diabetes, and contaminated or infected incisions should be given particular attention.
Adult ; Albumins ; China/epidemiology* ; Colorectal Surgery/adverse effects* ; Female ; Humans ; Hypertension/complications* ; Male ; Middle Aged ; Pregnancy ; Surgical Wound Infection/etiology*