The use of probiotics has been widely documented to benefit human health, but their clinical value in
surgical patients remains unclear. The present study investigated the effect of perioperative oral
administration of probiotic bifidobacteria to patients undergoing colorectal surgery. Sixty patients
undergoing colorectal resection were randomized to two groups prior to resection. One group (n=31) received a
probiotic supplement, Bifidobacterium longum BB536, preoperatively for 7–14 days and
postoperatively for 14 days, while the other group (n=29) received no intervention as a control. The
occurrences of postoperative infectious complications were recorded. Blood and fecal samples were collected
before and after surgery. No significant difference was found in the incidence of postoperative infectious
complications and duration of hospital stay between the two groups. In comparison to the control group, the
probiotic group tended to have higher postoperative levels of erythrocytes, hemoglobin, lymphocytes, total
protein, and albumin and lower levels of high sensitive C-reactive proteins. Postoperatively, the proportions
of fecal bacteria changed significantly; Actinobacteria increased in the probiotic group, Bacteroidetes and
Proteobacteria increased in the control group, and Firmicutes decreased in both groups. Significant
correlations were found between the proportions of fecal bacteria and blood parameters; Actinobacteria
correlated negatively with blood inflammatory parameters, while Bacteroidetes and Proteobacteria correlated
positively with blood inflammatory parameters. In the subgroup of patients who received preoperative
chemoradiotherapy treatment, the duration of hospital stay was significantly shortened upon probiotic
intervention. These results suggest that perioperative oral administration of bifidobacteria may contribute to
a balanced intestinal microbiota and attenuated postoperative inflammatory responses, which may subsequently
promote a healthy recovery after colorectal resection.
Tuberculous endocarditis is an exceptionally rare disease, and its surgical operation has been reported in only one case. This is a successful surgical report of acute aortic insufficiency caused by tuberculous endocarditis associated with annular subvalvular left ventricular aneurysm (ASLVA) beneath the aortic valve. This patient had acute left ventricular failure and cardiorespiratory arrest and suffered from multiple organ dysfunction and coagulopathy disorder. Urgent surgery was performed to replace the aortic valve with the approximation of ASLVA. Histopathological findings of the excised aortic cusps gave the diagnosis of tuberculous endocarditis, and antituberculous drug administration started on the first postoperative day. Postoperative recovery has been uneventful without relapse of tuberculosis for 7 postoperative years.
A 68-year-old woman with symptoms of dyspnea and peripheral edema was referred to our hospital. Chest computed tomography (CT) scans revealed a huge mass occupying the pulmonary trunk and invading the right main pulmonary artery, with metastatic nodules in the left main and left lower pulmonary artery. She was given a diagnosis of pulmonary thromboembolism and was anticoagulated to no effect, which suggested a neoplasm. Palliative resection of the tumor was carried out even though she was in serious condition with right ventricular failure, liver congestion, renal dysfunction, and coagulopathy disorder. The histopathology, postoperative systemic CT scan, and bone scintigram provided a definitive diagnosis of a primary right ventricle osteosarcoma. Primary cardiac osteosarcoma has a poor prognosis, and this patient was at an advanced stage with pulmonary metastases. Surgical intervention should offer these patients significant palliation to relieve the clinical symptoms due to obstruction.
Aims
There have been some reports about the efficacy of trauma team activation. In November 2015, we implemented a trauma call system, wherein a general surgeon, neurosurgeon, and orthopedic surgeon are called to the emergency department when severe trauma patients are transferred to our emergency department. In this study, we evaluated the efficacy of this trauma call system.
Methods
The purpose of the present study was to evaluate the efficacy of a trauma call system for trauma cases with an Injury Severity Score ≥16. We compared the mortality of trauma cases and the time from arrival to the start of the examination and intervention before and after implementing this trauma call system.
Results
There was no significant difference in the mortality rates before and after the implementation of the trauma call system. The median time from arrival to the start of contrast‐enhanced computed tomography or transcatheter arterial embolization improved from 54 to 19 min (P = 0.015) and 171 to 84 min (P = 0.030), respectively, after the implementation of the trauma call system.
Conclusion
Our trauma call system did not significantly improve the mortality of trauma patients with an Injury Severity Score ≥16. However, it was effective for reducing the time from the arrival to the start of contrast‐enhanced computed tomography or transcatheter arterial embolization.
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