Amaç: Daha önce "ışık mikroskopi çalışması" ile elde edilen "Femur boyun kırığı olan osteopenik ve osteoporotik hastalarda kemik mikromimarisi benzerdir" bulgusunu ki, önemli ve yenidir, teyit etmek amaçlandı. Hastalar ve yöntemler: Düşük enerjili travma sonrası femur proksimal uç kırığı nedeniyle başvuran 14 hasta (5 erkek, 9 kadın) çalışmaya alındı (ışık mikroskopi çalışmasına katılan hastalar). Hastalar kemik mineral yoğunluğu (KMY) ölçümlerine göre osteopenik (n=7, ort. yaş 69 yıl; dağılım 63-74 yıl) ve osteoporotik (n=7, ort. yaş 74.1 yıl; dağılım 67-78 yıl) olarak iki gruba ayrıldı. Parsiyel kalça artroplastisi sırasında endoprotez uygulanan hastalardan kortikal ve trabeküler kemik örnekleri alındı ve alınan bu örnekler, daha gelişmiş ve yüksek çözünürlüklü transmisyon ve taramalı elektron mikroskopisiyle incelendi. Bulgular: Ortalama kortikal kemik kalınlığı osteopenik grupta 3622.14 mm; osteoporotik grupta ise 2323.14 mm idi (p<0.005). Transmisyon elektron mikroskopisi ve taramalı elektron mikroskopisi değerlendirmesinde her iki grupta da benzer bulgular saptandı. Sonuç: Gruplar arasında kortikal kalınlık açısından anlamlı farklılık bulunmuş olsa da, transmisyon ve taramalı elektron mikroskopisi, daha önceki ışık mikroskopi çalışma-sında olduğu gibi, kemik mikromimarisi düşük enerjili femur boyun kırığı olan osteopenik ve osteoporotik hastalarda benzer özellikler taşıdığını teyit etmiştir.Anahtar sözcükler: Kemik mikromimarisi; osteopeni; taramalı elektron mikroskopisi; osteoporoz; transmisyon elektron mikroskopisi.
Objectives:The objective was to confirm the finding of "Bone microstructure is similar in osteopenic and osteoporotic patients with femoral neck fracture." obtained in previous "light microscopy study", which was new and important data. Patients and methods: Fourteen patients (5 males, 9 females) who were admitted with proximal femoral fracture following low energy trauma (patients who participated in the light microscopy study) were included. The patients were divided into two groups based on the bone mineral density (BMD) measurement, including osteopenic group (n=7, mean age 69 years; range 63 to 74 years) and osteoporotic group (n=7, mean age 74.1 years; range 67 to 78 years). Cortical and trabecular bone samples were taken from the patients who underwent endoprosthesis during partial hip arthroplasty and these samples were analyzed using transmission electron microscopy and scanning electron microscopy evaluations which are more sophisticated higher resolution techniques. Results: The mean cortical bone thickness was 3622.14 mm in osteopenic group and 2323.14 mm in osteoporotic group (p<0.005). Transmission electron microscopy and scanning electron microscopy evaluations revealed similar findings for both groups. Conclusion: Although a significant difference in cortical thickness was found between the groups, transmission and scanning electron microscopy confirmed that bone microstructure shared similar characteristics in osteopenic and osteoporotic patients with low-energy femoral neck ...
Background
Many surgeons routinely place intraperitoneal drains after elective colorectal surgery. However, enhanced recovery after surgery guidelines recommend against their routine use owing to a lack of clear clinical benefit. This study aimed to describe international variation in intraperitoneal drain placement and the safety of this practice.
Methods
COMPASS (COMPlicAted intra-abdominal collectionS after colorectal Surgery) was a prospective, international, cohort study which enrolled consecutive adults undergoing elective colorectal surgery (February to March 2020). The primary outcome was the rate of intraperitoneal drain placement. Secondary outcomes included: rate and time to diagnosis of postoperative intraperitoneal collections; rate of surgical site infections (SSIs); time to discharge; and 30-day major postoperative complications (Clavien–Dindo grade at least III). After propensity score matching, multivariable logistic regression and Cox proportional hazards regression were used to estimate the independent association of the secondary outcomes with drain placement.
Results
Overall, 1805 patients from 22 countries were included (798 women, 44.2 per cent; median age 67.0 years). The drain insertion rate was 51.9 per cent (937 patients). After matching, drains were not associated with reduced rates (odds ratio (OR) 1.33, 95 per cent c.i. 0.79 to 2.23; P = 0.287) or earlier detection (hazard ratio (HR) 0.87, 0.33 to 2.31; P = 0.780) of collections. Although not associated with worse major postoperative complications (OR 1.09, 0.68 to 1.75; P = 0.709), drains were associated with delayed hospital discharge (HR 0.58, 0.52 to 0.66; P < 0.001) and an increased risk of SSIs (OR 2.47, 1.50 to 4.05; P < 0.001).
Conclusion
Intraperitoneal drain placement after elective colorectal surgery is not associated with earlier detection of postoperative collections, but prolongs hospital stay and increases SSI risk.
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