Suchergebnisse

We report the case of a four years-old female proceeding from rural nor-oriental Colombia, without previous medical history, who was admitted to our institution with an abdominal mass that was noted one month previous to the consult, associated to ictericia, weight loss and hiporexia. A bilateral Wilms tumor was documented on diagnostic images. The patient received preoperative chemotherapy and was treated with bilateral partial nephrectomy. ; En este artículo se reporta el caso de una niña de cuatro años de edad, sin antecedentes perinatales o patológicos de importancia, procedente de área rural, en la región nororiental de Colombia, quien ingresó al Hospital Militar Central de Bogotá, Colombia, remitida por un cuadro de cinco meses de evolución que inició con tinte ictérico, pérdida de peso e hiporexia. Posteriormente, distensión abdominal y masa palpable abdominal de un mes de evolución. Por imágenes diagnósticas se documenta tumor de Wilms bilateral, el cual se trata con quimioterapia preoperatoria y nefrectomía parcial bilateral.

Cardiovascular diseases (CVDs) are the leading cause of mortality in the European Union and accounted for about 36% of all deaths in 2019. Among these diseases, aortic dissection is relatively unknown and difficult to treat, with a survival rate for most severe cases not exceeding 10%. This pathology occurs when an injury leads to a localized tear of the innermost layer of the aorta, called the entry port. It allows blood to flow between the layers of the aortic wall, forcing the layers apart and creating a false lumen. The dissection of these layers may extend over a long portion of the thoracic and abdominal aorta. Endovascular treatment seeks to obliterate the entrances to the false lumen with a stent. The currently available surgical tools for endovascular procedures are selected only from information based on medical imaging techniques. The images are carried out before the intervention and therefore do not consider the deformation of the vascular structure by the implementation of the prosthesis. While many biomechanical studies have been done on the endovascular treatment of aneurysms of the abdominal aorta, there are, however, very few studies on aortic dissections. However,there are few studies as well on the postoperative demonstration of blood flow phenomena in the aortic dissection endovascular treatment. It is crucial to study the hemodynamic of blood in the aorta after an intervention, because the deployment of a stent leads to modifications in the blood flow. For the surgeons, the procedure can only be performed empirically, using MRI-4D images to view the post-operative flow of the patient's blood in the aorta with the stent. The numerical simulation method, instead allows us to simulate the complete endovascular procedure for an adapted recommendation during surgical planning. This thesis aims to present a numerical tool, from the open-source software FOAM-Extend, allowing for Multiphysics numerical simulations, performing the fluid-structure coupling between the hemodynamics and the arterial deformation to assist in the planning process. In addition, using Abaqus software, we realized the placement of the surgical tools in a "biomechano-faithful" aortic dissection model. This model will be able to predict the deformation of the flap and the artery wall during the implementation of the tools. Also, with the numerical simulation, we could obtain the postoperative hemodynamic in the aorta, to predict the modification of flow. Finally, the numerical simulation results are compared with the MRI data to have a validation of the numerical models. There is a parallel thesis that focuses on flows in aorta phantoms PIV applied in AD (same geometry) and enables the confrontation and inter-validation of both model methods at the time of the study. ; Les maladies cardiovasculaires sont la principale cause de mortalité dans le monde. Parmi ces maladies, la dissection aortique constitue une pathologie méconnue et difficile à traiter, avec un taux de survie, pour les cas les plus graves ne dépassant pas les 10%. Cette pathologie survient dans l'aorte et se caractérise par l'irruption de sang à l'intérieur de la paroi de l'aorte. Elle correspond à une déchirure localisée des couches internes de la paroi aortique, appelée porte d'entrée, par laquelle le sang sous pression pénètre et décolle les différentes couches qui constituent la paroi de l'aorte. Le traitement endovasculaire vise à obturer la fausse lumière à l'aide d'un stent. Les outils actuels de la chirurgie endovasculaire reposent uniquement sur les techniques d'imagerie médicale. Comme les images sont prises avant l'intervention, elles ne tiennent pas compte de la déformation de la structure vasculaire par la prothèse. Les phénomènes de flux sanguin postopératoire dans le traitement endovasculaire des dissections aortiques sont rares. L'hémodynamique du sang dans l'aorte après une intervention est critique car le déploiement du stent modifie le flux sanguin. Cette thèse a pour but de présenter un outil numérique, issu du logiciel open-source FOAM-Extend®, permettant des simulations numériques multiphysiques réalisant le couplage fluide-structure entre l'hémodynamique et la déformation artérielle pour aider au processus de planification. En outre, à l'aide du logiciel Abaqus, nous réalisons le placement des outils chirurgicaux dans un AD "bio-fidèle" modèle. Cela permettra de prédire la déformation du lambeau et de la paroi de l'artère lors de la mise en place des outils. Et aussi, avec la simulation numérique, nous pourrons réaliser l'hémodynamique dans l'aorte du postopératoire pour prédire la modification du flux. Enfin, les résultats de la simulation numérique sont comparés aux données de l'IRM pour avoir une validation des modèles numériques.

Abstrak Penggunaan antibiotik profilaksis bedah yang tidak tepat dapat meningkatkan risiko terjadinya Infeksi Luka Operasi (ILO) dan resistensi obat. Penelitian ini bertujuan untuk menilai ketepatan penggunaan antibiotik profilaksis bedah pada bedah bersih di rumah sakit (RS) di Jakarta. Penelitian ini merupakan studi potong lintang di sebuah RS pemerintah di Jakarta. Data yang diambil berasal dari rekam medis pasien dewasa yang menjalani pembedahan dengan kriteria kelas luka bedah bersih. Data diambil pada periode 1 Januari hingga 31 Desember 2013. Analisis data dilakukan secara deskriptif berdasarkan pedoman penggunaan antibiotik baik nasional maupun internasional. Hasil penelitian menunjukkan 837 pasien menjalani bedah bersih pada periode tersebut. Bedah yang banyak dilakukan adalah bedah abdominal (30%) dan thorak-non kardiak (23,5%) dan lebih dari 96% merupakan bedah elektif. Jenis antibiotik yang paling banyak digunakan adalah siprofloksasin (56,5%). Keseluruhan kesesuaian antibiotik profilaksis adalah 27,7% tepat indikasi prosedur bedah dan hanya 0,5% yang tepat obat. Sebagai kesimpulan, ketepatan penggunaaan antibiotik profilasis di salah satu RS di Jakarta masih rendah. Penggunaan antibiotik yang tepat dapat menurunkan risiko ILO dan mengurangi biaya pengobatan dengan mengurangi peresepan yang tidak perlu dan durasi penggunaan antibiotik. Kata kunci: antibiotik, bedah bersih, ketepatan, profilaksis Abstract Inappropriate use of surgical prophylactic antibiotics can increase the risk of Surgical Site Infections (SSI) and drug resistance. This study aimed to assess the appropriateness use of surgical prophylactic antibiotics in clean surgery wounds in a hospital in Jakarta. This cross-sectional study was conducted at a government hospital in Jakarta. Data were collected from medical records of adult patients undergoing surgery with clean surgical wound criteria from January 1 to December 31, 2013. Data were analyzed descriptively based on guidelines for antibiotics use both nationally and internationally. The result showed 837 patients classified into the clean surgical wound during this period. The most common surgeries were abdominal surgery (39%) and non-cardiac thoracic (23.5%) and more than 96% were elective surgeries. The overall antibiotic prophylactic appropriateness showed 27.7% in surgical procedures and only 0.5% in choice of antibiotics. In conclusion, the appropriateness of surgery antibiotics prophylactic use in one of the hospitals in Jakarta was still low. Appropriate use of antibiotics can reduce the risk of SSI and cost treatment by reducing unnecessary prescribing and duration of antibiotics use. Keywords: antibiotic, appropriate, prophylactic, clean surgery

Surgery is the gold standard treatment of colorectal liver metastases. Patients management had a dramatic evolution during the past years: more accurate diagnostic tools and more effective chemotherapy regimens have been introduced and surgical indications have been widely broadened. A multidisciplinary treatment is now mandatory, involving oncologists, radiologists an gastroenterologists. However, many topics are still debated. In the present book all aspects of surgical treatment of colorectal liver metastases are analyzed based on a systematic, updated analysis of the literature. Aim of thi.

Background: Chronic Aorta Iliac Occlusive Disease (CAIOD) is a significant cause of lower limb ischemia and is often found in various age group with varied etiology. Objective: To review recent results achieved treating CAIOD patients with open surgery and endovascular surgery. Methods: From January 2017 to December 2018, 39 patients , who were admitted in Tamilnadu Government Multi Super Specialty Hospital, affiliated to The Tamilnadu Dr.M.G.R Medical University. Tamilnadu, Chennai. were operated with diagnosis of aorta iliac occlusion. Demographic data, co morbidities, clinical presentation and surgical results were analyzed. Results: Thirty six men and 3 women were treated with aortic reconstruction. procedures included aortic bi femoral bypass (ABF; n=18), Ilio- Femoral Bypass ( IFB; n=3), Aorta Iliac Plasty (AIP, n=1 ). Mean age was 53.7 ? 7.3 years (range: 43-79 years) and 30 patients were smokers. Thirty patients (%) had critical limb ischemia. Six of the patients treated with ABF (%) also required additional revascularization ( femoropopliteal procedures). Perioperative mortality was two. Four patients (%) suffered transitory renal dysfunction, but only one patient (%) required hemodialysis. Median follow-up time was 17 months (range: 2-29 months) and there was just one late death, from ischemic heart disease, 7 months after the surgery on the abdominal aorta. Conclusions: Aortic reconstruction with both open and endo- vascular methods is a safe for treating patients with Aorta iliac occlusions, with low perioperative morbidity and mortality rates.

For today damage control surgery is an actual and original direction of the modern medical science and practical medicine. The purpose of our research is representation of possible dangers and complications, that can develop in the group of seriously injured patients with damages of internal organs and further bleeding from these organs. In the same time in our work indicates the list of urgent measures, that necessary to realize in such cases. The material of research were injured persons after severe combined, associated and multiple damages with bleeding from internal organs. Among them considerable rate were persons, who got gunshort wounds, including abdominal cavity, during military actions. In our work used analytic method of investigation. One of danger of damage control surgery is hypothermia. It leads to cardiac arrhythmia, decreasing of cardiac output, supresses immune system also. Long term hypoperfusion of injured persons provokes anaerobic metabolism and development of lactate acidosis. Traumatic damages causing disorders of blood coagulation and fibrinolysis balance. In such cases develops coagulopathy. In considerable amount of cases an enumerated dangers appear simultaneously. Such symptom complex named as ―lethal triad‖. The most severe complication of damage control surgery is appearance of abdominal compartment – syndrome. In remote postoperative period stated a cases of abdominal burst and suppuration of operational wounds. Thus, timely diagnosing and correction of ―lethal triad‖ leads to increasing of survival frequency of severe injured persons; during revealing of dangers and complications of damage control surgery all efforts should be directed on restoration of physiologic processes in the patients. ; Вступ. На сьогодні хірургія damage control представляє собою актуальний та своєрідний напрям сучасної медичної науки та практичної медицини.Мета дослідження. Ознайомлення з можливими небезпеками та ускладненнями, які можуть розвиватися у категорії важко травмованих пацієнтів з пошкодженнями внутрішніх органів і подальшою кровотечою з них. Водночас у роботі вказується перелік невідкладних заходів, які необхідно реалізувати у таких випадках.Матеріали та методи дослідження. Матеріалом дослідження були травмовані особи, які перенесли важкі комбіновані, поєднані, також множинні пошкодження з кровотечою з внутрішніх органів. Серед них значний відсоток становили особи, які отримали вогнепальні поранення, в тому числі черевної порожнини, під час бойових дій. У роботі був застосований аналітичний метод дослідження. Однією з небезпек хірургії damage control є гіпотермія. Вона призводить до серцевої аритмії, зменшення серцевого викиду, також пригнічує імунну систему. Тривала гіпоперфузія травмованих осіб зумовлює анаеробний метаболізм та розвиток лактатного ацидозу. Травматичні пошкодження спричиняють порушення балансу зсідання та протизсідання крові. При цьому розвивається коагулопатія. У значній кількості випадків вищевказані небезпеки виникають водночас. Такий симптомокомплекс називається «летальна тріада». Найважчим ускладненням хірургії damage control є виникнення абдомінального компартмент-синдрому. У віддаленому післяопераційному періоді констатовано випадки евентерації та нагноєння операційних ран. Отже, вчасне діагностування та корекція «летальної тріади» призводить до збільшення частоти виживання важко травмованих осіб; при виявленні небезпек та ускладнень хірургії damage control всі зусилля повинні бути спрямовані на відновлення фізіологічних процесів у пацієнтів.

For today damage control surgery is an actual and original direction of the modern medical science and practical medicine. The purpose of our research is representation of possible dangers and complications, that can develop in the group of seriously injured patients with damages of internal organs and further bleeding from these organs. In the same time in our work indicates the list of urgent measures, that necessary to realize in such cases. The material of research were injured persons after severe combined, associated and multiple damages with bleeding from internal organs. Among them considerable rate were persons, who got gunshort wounds, including abdominal cavity, during military actions. In our work used analytic method of investigation. One of danger of damage control surgery is hypothermia. It leads to cardiac arrhythmia, decreasing of cardiac output, supresses immune system also. Long term hypoperfusion of injured persons provokes anaerobic metabolism and development of lactate acidosis. Traumatic damages causing disorders of blood coagulation and fibrinolysis balance. In such cases develops coagulopathy. In considerable amount of cases an enumerated dangers appear simultaneously. Such symptom complex named as ―lethal triad‖. The most severe complication of damage control surgery is appearance of abdominal compartment – syndrome. In remote postoperative period stated a cases of abdominal burst and suppuration of operational wounds. Thus, timely diagnosing and correction of ―lethal triad‖ leads to increasing of survival frequency of severe injured persons; during revealing of dangers and complications of damage control surgery all efforts should be directed on restoration of physiologic processes in the patients. ; Вступ. На сьогодні хірургія damage control представляє собою актуальний та своєрідний напрям сучасної медичної науки та практичної медицини.Мета дослідження. Ознайомлення з можливими небезпеками та ускладненнями, які можуть розвиватися у категорії важко травмованих пацієнтів з пошкодженнями внутрішніх органів і подальшою кровотечою з них. Водночас у роботі вказується перелік невідкладних заходів, які необхідно реалізувати у таких випадках.Матеріали та методи дослідження. Матеріалом дослідження були травмовані особи, які перенесли важкі комбіновані, поєднані, також множинні пошкодження з кровотечою з внутрішніх органів. Серед них значний відсоток становили особи, які отримали вогнепальні поранення, в тому числі черевної порожнини, під час бойових дій. У роботі був застосований аналітичний метод дослідження. Однією з небезпек хірургії damage control є гіпотермія. Вона призводить до серцевої аритмії, зменшення серцевого викиду, також пригнічує імунну систему. Тривала гіпоперфузія травмованих осіб зумовлює анаеробний метаболізм та розвиток лактатного ацидозу. Травматичні пошкодження спричиняють порушення балансу зсідання та протизсідання крові. При цьому розвивається коагулопатія. У значній кількості випадків вищевказані небезпеки виникають водночас. Такий симптомокомплекс називається «летальна тріада». Найважчим ускладненням хірургії damage control є виникнення абдомінального компартмент-синдрому. У віддаленому післяопераційному періоді констатовано випадки евентерації та нагноєння операційних ран. Отже, вчасне діагностування та корекція «летальної тріади» призводить до збільшення частоти виживання важко травмованих осіб; при виявленні небезпек та ускладнень хірургії damage control всі зусилля повинні бути спрямовані на відновлення фізіологічних процесів у пацієнтів.

Background: To investigate the prognostic effects and risk factors of the omission and delay of postoperative chemotherapy of stage II/III gastric cancer (GC). Methods: The clinicopathological data of 1,520 patients undergoing radical gastrectomy for stage II/III GC were collected and retrospectively analyzed. We defined the chemotherapy delayed until more than 60 days after radical gastrectomy and the complete omission of chemotherapy as unacceptable chemotherapy initiation (UAC), whereas the chemotherapy conducted within 60 days of radical gastrectomy was defined as acceptable chemotherapy initiation (AC). The survival between the two groups was compared, and the trends and risk factors of UAC were analyzed. Results: There were 539 (35.5%) patients with UAC. The overall survival (OS) and disease-free survival of the UAC group patients were significantly inferior to those in the AC group (p 0.05). Logistic analysis showed that female, old age, a self-paid status, a very low social status, high American Society of Anesthesiologists scores, intra-abdominal surgery history, and serious postoperative complications were independent risk factors of UAC (all p < 0.05). The radar chart shows the risk factors of UAC changed with time. Conclusions: UAC after radical gastrectomy is an independent risk factor for the prognosis of stage II/III GC patients. However, no significant decline of UAC has been achieved recently and should call for the attention of both government and clinicians.

Abstract
Background Lower back pain is a frequent cause of emergency department visits and one of the leading causes of the disease burden worldwide. The purpose of this case report and literature review was to discuss atypical abdominal entities mimicking spinal diseases typically presenting with lower back pain.
Methods A 79-year-old man presented with lower back pain and urinary incontinence after receiving a non-image-guided lumbar infiltration treatment 4 weeks prior to admission. The magnetic resonance imaging (MRI) highlighted multisegmental hyperintensities in the intervertebral disk spaces of the lumbar spine indicative for spondylodiscitis. Antibiotic treatment over a week did not lead to significant clinical improvement. Blood cultures, cardiologic, otorhinolaryngologic, and dental examinations turned out negative for a focus of infection. A computed tomography (CT) guided biopsy was indicated after discontinuation of antibiotic treatment for less than 24 hours. Rapid clinical deterioration with concomitant onset of abdominal pain resulted in the diagnosis of cholecystitis, which required cholecystectomy. We performed a systematic literature review using the Pubmed database for the keywords "spondylodiscitis," "spine," "abdominal," and "cholecystitis," to identify abdominal diseases that mimic spine pathologies and spinal diseases that mimic abdominal pathologies.
Results No other report in English literature of cholecystitis associated with initial onset of lower back pain was identified. Eighteen reports referred to abdominal conditions that mimic spinal diseases, among them a patient with cyclic lumbar back pain who received a lumbar spinal fusion who, after persisting symptoms led to further diagnostic procedures, was ultimately diagnosed with endometriosis. Spinal symptoms included paraplegia and urinary incontinence as results of acute aortic pathologies. Eleven reports presented spinal pain mimicking abdominal conditions including abdominal pain and diarrhea as well as have had surgical procedures such as an appendectomy before the spinal condition was discovered.
Conclusion Clinical symptoms of the spine such as lower back pain can be unspecific and lead to false conclusions in the presence of concomitant pathologies in MRI. Only clinical deterioration in our case patient prompted correction of the diagnosis on day 7. Initial workup for alternative common infectious foci such as lung and urinary tract was performed, but further abdominal workup despite the absence of abdominal symptoms may have led to an earlier diagnosis. Our literature review found several cases of misdiagnosed spinal and abdominal conditions. Some had undergone unnecessary surgical procedures before the right diagnosis was made. Because of the high incidence of symptoms such as lumbar back pain and abdominal pain, considering optimal patient care as well as economic aspects, it would be essential to conduct an interdisciplinary clinical management to avoid errors in the early stage of diagnostics.

Introduction. The most common major abdominal surgery in women is caesarean section. Despite being a safe procedure, a variety of complications, both acute and chronic, can occur. About 14.5% of caesarean sections result in complications. Infection followed by postpartum haemorrhage is the most frequent complication. Imaging modalities such as ultrasonography and multidetector computed tomography are often used in the evaluation of suspected uncommon post-caesarean complications. Computed tomography has been found to be a good initial modality for assessing acute postoperative complications after caesarean delivery. The objective of the research was to evaluate the imaging findings and the characteristic visual manifestations of atypical acute complications of caesarean section, other than common complications such as postpartum haemorrhage, wound infection, etc. Materials and Methods. This prospective study was carried out at the Department of Radiodiagnosis and Imaging, Government Medical College, Srinagar from June 2019 to February 2020 in collaboration with the Department of General Surgery and Gynaecology and Obstetrics of the Sher-i-Kashmir Institute of Medical Sciences. All patients with suspected complication in the immediate post-caesarean period were evaluated with contrast-enhanced multidetector computed tomography. Results. Out of 427 patients who underwent caesarean section, 25 patients were suspected of having uncommon acute complications. Out of 25 patients evaluated for suspected immediate post-caesarean complication, only 5 patients had bladder flap hematoma, 8 patients were diagnosed with uterine dehiscence, 6 patients had uterine rupture, 3 patients suffered from ureteral injury, 1 patient had gossypiboma, 2 patients developed pelvic sepsis. Conclusions. Multidetector computed tomography plays an important role in detection and confirmation of multiple acute complications after caesarean delivery and can also help in guiding the management of complications as well.

Peritoneal fibrosis is characterized by abnormal production of extracellular matrix proteins leading to progressive thickening of the submesothelial compact zone of the peritoneal membrane. This process may be caused by a number of insults including pathological conditions linked to clinical practice, such as peritoneal dialysis, abdominal surgery, hemoperitoneum, and infectious peritonitis. All these events may cause acute/chronic inflammation and injury to the peritoneal membrane, which undergoes progressive fibrosis, angiogenesis, and vasculopathy. Among the cellular processes implicated in these peritoneal alterations is the generation of myofibroblasts from mesothelial cells and other cellular sources that are central in the induction of fibrosis and in the subsequent functional deterioration of the peritoneal membrane. Myofibroblast generation and activity is actually integrated in a complex network of extracellular signals generated by the various cellular types, including leukocytes, stably residing or recirculating along the peritoneal membrane. Here, the main extracellular factors and the cellular players are described with emphasis on the cross-talk between immune system and cells of the peritoneal stroma. The understanding of cellular and molecular mechanisms underlying fibrosis of the peritoneal membrane has both a basic and a translational relevance, since it may be useful for setup of therapies aimed at counteracting the deterioration as well as restoring the homeostasis of the peritoneal membrane. ; European Union's Horizon 2020 Research and Innovation Programme under the Marie Sklodowska-Curie grant and Spanish Ministry of Science and Innovation/Fondo Europeo de Desarrollo Regional (PID2019-110132RB-I00/AEI/10.13039/501100011033)

Introduction: Although, non-operative treatment is a well-established method of treatment of intussusception, surgical intervention is still needed in some patients. Early recognition of these patients can reduce morbidity and mortality. The aim of the study was to find out the risk factors for surgery in these patients. Subjects and Methods: A retrospective analysis was performed among 225 patients of intussusception in a tertiary government teaching hospital between 2016 and 2019. Patients were evaluated for demographic features, presenting features with duration, examination findings, attempt for hydrostatic reduction, success and failure of hydrostatic reduction, type of surgery and mortality. Logistic regression analysis was performed to find out the risk factors. Results: Male to female ratio was 2.2:1, age ranged from 1.5 months to 8 years (median 8 months) and median weight was 8 kg. Duration of symptoms ranged from 1 to 14 days (mean 2.61 days). Hydrostatic reduction was attempted in 141 (62.7%) patients and was successful in 125 (88.7% ) patients. 100 (44.4%) patients underwent surgery. The risk factors for surgery were symptoms >48 hours (P<0.01), abdominal distension (P=0.01), per rectal bleeding (P=0.03), constipation (P<0.01), raised temperature (P=0.01), palpable abdominal mass (P=0.01) and presence of red currant jelly (P=0.04). Surgeries performed were manual reduction (65), intestinal resection anastomosis (18), intestinal stoma (13) and intestinal resection anastomosis with proximal stoma (4). There were 6 (2.7%) mortalities, all after surgery. Conclusion: The identified risk factors for surgery may help in the early and prompt referral of patients with intussusception.

Splenectomy is the surgical removal of the spleen and it can lead to complications. Splenectomy is indicated in the case of trauma to the spleen, during tumor reduction surgery or even during another abdominal surgery with secondary lesion. These indications are called surgical. Splenectomy is indicated in haematological diseases, immunological diseases or even in cystic diseases. These indications are said to be medical. Less frequently splenectomy is performed for diagnostic purposes as part of an unsuccessful prior etiological investigation. In order to explore the pathologies which led to perform a diagnostic splenectomy, we studied on two hospital centers, the medical files of 142 patients who underwent a splenectomy for all reasons over a 10 years period. We identified 20 diagnostic splenectomies. Diagnostic splenectomy was mainly performed to explore unexplained splenomegaly for 13 patients and fever of unknown origin since at least 3 weeks for 10 patients. The others patients had the surgery for different causes ( cytopenias, abdominal symptoms , malignant hemopathies relapse suspicion). Splenectomy contributed to the diagnosis in 17 out of 20 cases with a majority of lymphoid hematological malignancies (n=13). The main pathology found is the diffuse large B-cell lymphoma (n=7). Our study made it possible to identify and characterize the patients for whom a diagnostic splenectomy was performed. We have described the etiological surveys in order to specify the pre-operative investigations carried out during the diagnostic process. This highlighted the importance of the PET scanner. ; La splénectomie consiste en l'ablation de la rate. Il s'agit d'une chirurgie à risque de complications. La splénectomie est indiquée en cas de traumatisme de la rate, lors de chirurgie de réduction tumorale ou encore en cas de lésion secondaire à une chirurgie abdominale majeure. Ces indications sont dites chirurgicales. La splénectomie est indiquée dans des maladies hématologiques, immunologiques ou encore dans des pathologies kystiques. Ces indications sont dites médicales. Plus rarement la splénectomie est réalisée à visée diagnostique dans le cadre d'une enquête étiologique préalable infructueuse. Afin d'explorer les pathologies ayant conduit à la réalisation d'une splénectomie diagnostique, nous avons étudié sur deux centres hospitaliers, les dossiers de 142 patients ayant été opérés d'une splénectomie tous motifs confondus sur une période de 10 ans. Nous avons recensé un total de 20 splénectomies réalisées à visée étiologique. Celles-ci ont principalement été réalisées pour explorer des splénomégalies inexpliquées et des fièvres d'origine indéterminée. La splénectomie a contribué au diagnostic dans 17 cas sur 20 avec en majorité des hémopathies lymphoïdes (n=13). La pathologie la plus fréquemment retrouvée est le lymphome B diffus à grandes cellules (n=7). Notre étude a permis d'identifier et de caractériser les patients pour lesquels une splénectomie à visée diagnostique a été effectuée. Nous avons détaillé les enquêtes étiologiques pré-splénectomie pour préciser les examens complémentaires effectués au cours de la démarche diagnostique et leur intérêt. Cette étude souligne la place prépondérante du TEP scanner et l'importance d'une enquête étiologique exhaustive.

Splenectomy is the surgical removal of the spleen and it can lead to complications. Splenectomy is indicated in the case of trauma to the spleen, during tumor reduction surgery or even during another abdominal surgery with secondary lesion. These indications are called surgical. Splenectomy is indicated in haematological diseases, immunological diseases or even in cystic diseases. These indications are said to be medical. Less frequently splenectomy is performed for diagnostic purposes as part of an unsuccessful prior etiological investigation. In order to explore the pathologies which led to perform a diagnostic splenectomy, we studied on two hospital centers, the medical files of 142 patients who underwent a splenectomy for all reasons over a 10 years period. We identified 20 diagnostic splenectomies. Diagnostic splenectomy was mainly performed to explore unexplained splenomegaly for 13 patients and fever of unknown origin since at least 3 weeks for 10 patients. The others patients had the surgery for different causes ( cytopenias, abdominal symptoms , malignant hemopathies relapse suspicion). Splenectomy contributed to the diagnosis in 17 out of 20 cases with a majority of lymphoid hematological malignancies (n=13). The main pathology found is the diffuse large B-cell lymphoma (n=7). Our study made it possible to identify and characterize the patients for whom a diagnostic splenectomy was performed. We have described the etiological surveys in order to specify the pre-operative investigations carried out during the diagnostic process. This highlighted the importance of the PET scanner. ; La splénectomie consiste en l'ablation de la rate. Il s'agit d'une chirurgie à risque de complications. La splénectomie est indiquée en cas de traumatisme de la rate, lors de chirurgie de réduction tumorale ou encore en cas de lésion secondaire à une chirurgie abdominale majeure. Ces indications sont dites chirurgicales. La splénectomie est indiquée dans des maladies hématologiques, immunologiques ou encore dans des pathologies kystiques. Ces indications sont dites médicales. Plus rarement la splénectomie est réalisée à visée diagnostique dans le cadre d'une enquête étiologique préalable infructueuse. Afin d'explorer les pathologies ayant conduit à la réalisation d'une splénectomie diagnostique, nous avons étudié sur deux centres hospitaliers, les dossiers de 142 patients ayant été opérés d'une splénectomie tous motifs confondus sur une période de 10 ans. Nous avons recensé un total de 20 splénectomies réalisées à visée étiologique. Celles-ci ont principalement été réalisées pour explorer des splénomégalies inexpliquées et des fièvres d'origine indéterminée. La splénectomie a contribué au diagnostic dans 17 cas sur 20 avec en majorité des hémopathies lymphoïdes (n=13). La pathologie la plus fréquemment retrouvée est le lymphome B diffus à grandes cellules (n=7). Notre étude a permis d'identifier et de caractériser les patients pour lesquels une splénectomie à visée diagnostique a été effectuée. Nous avons détaillé les enquêtes étiologiques pré-splénectomie pour préciser les examens complémentaires effectués au cours de la démarche diagnostique et leur intérêt. Cette étude souligne la place prépondérante du TEP scanner et l'importance d'une enquête étiologique exhaustive.

Introduction The aims of the study were to evaluate the impact of intra- and postoperative complications on satisfaction one year after hysterectomy for benign conditions, to determine risk factors for low patient satisfaction and to analyze whether complications were associated with the length of hospital stay. Material and Methods A retrospective study of 27938 women from the Swedish National Register for Gynecological Surgery undergoing hysterectomy for benign conditions between January 2004 and June 2016. Data were obtained from prospectively collected pre-, peri- and postoperative forms. Statistical analyses were performed using multivariable logistic regression models. Crude and adjusted odds ratios and 95% confidence intervals are presented. Results More than 90% were satisfied with the hysterectomy. Dissatisfaction was associated with complications. Pelvic pain as indication, preoperatively having less expectations to get rid of symptoms or being alleviated from surgery, and current smoking were also risk factors for low patient satisfaction. Vaginal and abdominal subtotal hysterectomies were associated with high satisfaction. Occurrence of complications intra- and postoperatively before discharge was associated with increased length of hospital stay, as well as occurrence and severity of complications reported after discharge from hospital. Conclusions Complications were strongly associated with lower patient satisfaction. Preoperative expectations of surgery, indication, mode of surgery and life-style factors had impact on the satisfaction. Patient-centered information to ensure realistic expectations and prevention of complications seem to be essential to gain optimal patient satisfaction with surgery. ; Funding Agencies|Swedish National Quality Registry of Gynecological Surgery (GynOp); Swedish Government; Swedish Association of Local Authorities and Regions