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Lawera NG, Madzia J, Casey LC, Guyton RL, Woodyard De Brito KC, Kinzer A, Ulma RM, Pan BS, Schwentker AR, Leto Barone AA. Keloid Intralesional Excision Reduces Recurrence: A Meta-analytic Study of the Available Literature on 608 Keloids. Plast Reconstr Surg Glob Open 2024; 12:e5652. [PMID: 38463702 PMCID: PMC10923361 DOI: 10.1097/gox.0000000000005652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 01/16/2024] [Indexed: 03/12/2024]
Abstract
Background The objective of this meta-analysis was to examine the effectiveness of keloid intralesional excision (KILE) in preventing recurrence. Treatment of keloids using surgical excision alone leads to high rates of recurrence. To date, there are no widely accepted guidelines for keloid treatment, and a multitude of adjunctive therapies are used to reduce recurrence. Despite these efforts, recurrence remains high. In this study, we conducted a meta-analysis of the existing literature on KILE to determine its role in recurrence reduction. Methods A literature review using PubMed, Scopus, and Web of Science databases was performed. Two authors independently evaluated studies for eligibility. Incidence of keloid recurrence was recorded, and a comprehensive meta-analysis was performed to assess the pooled keloid recurrence rate, as well as the effect of additional therapies. Results Twenty-two studies evaluating intralesional excision of 608 keloids were included in the study. Average time to follow-up was 19.2 months (range 6-35 months). A meta-analysis of proportions was conducted, demonstrating a pooled recurrence rate of 13% (95% confidence interval, 9%-16%). There was no evidence that using therapies in addition to KILE had a significant effect on the overall pooled recurrence rate. Conclusions A meta-analysis of 608 keloids shows that KILE is an effective technique in preventing keloid recurrence, with a pooled recurrence rate of 13% compared with previously reported rates of 45%-100% after complete excision. Although there are no standard guidelines for keloid treatment, our meta-analysis shows that KILE is promising in recurrence reduction.
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Affiliation(s)
- Nathan G. Lawera
- From Division of Pediatric Plastic Surgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Jules Madzia
- From Division of Pediatric Plastic Surgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Liann C. Casey
- From Division of Pediatric Plastic Surgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Rodney L. Guyton
- From Division of Pediatric Plastic Surgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | | | - Alexandra Kinzer
- From Division of Pediatric Plastic Surgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Raquel M. Ulma
- From Division of Pediatric Plastic Surgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Brian S. Pan
- From Division of Pediatric Plastic Surgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Ann R. Schwentker
- From Division of Pediatric Plastic Surgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Angelo A. Leto Barone
- From Division of Pediatric Plastic Surgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- Division of Plastic and Craniofacial Surgery, Nemours Children’s Hospital, Orlando, Fla
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Mosquera C, Mitsakos AT, Guyton RL, Fitzgerald TL, Zervos EE. When Is It Safe to Proceed With Pancreaticoduodenectomy Without Biliary Decompression? Am Surg 2020; 87:825-832. [PMID: 33228390 DOI: 10.1177/0003134820971618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND An absolute bilirubin level where preoperative biliary decompression (PBD) is indicated before pancreaticoduodenectomy has been elusive. Our goal was to identify a total bilirubin level whereby biliary decompression provides clear benefit, despite associated expenses and potential complications. MATERIALS AND METHODS We reviewed a prospectively collected database of patients undergoing pancreaticoduodenectomy at the Vidant Medical Center between 2007 and 2016. Patients were arbitrarily subdivided into 3 groups based on presenting bilirubin level (≤10 mg/dL, 10.1-14.9 mg/dL, and ≥15 mg/dL) to determine the presence of overall complications, severe complications (Clavien-Dindo classification ≥3), prolonged length of stay (>1 SD), readmissions, or mortality. RESULTS Common bile duct stenting independently predicted a higher incidence of complications in patients presenting with bilirubin ≤10 mg/dL (P = .03) vs. those patients going directly to surgery. No differences were observed for patients with bilirubin between 10.1 mg/dL and 14.9 mg/dL. Biliary decompression in patients with bilirubin ≥15 mg/dL independently predicted fewer overall (73.8% vs. 100%, P = .0082) and less severe complications (14.3% vs. 44.5%, P = .03) and lower readmission rates (15.8% vs. 55.6%, P = .03) vs. those going directly to surgery. Patients not undergoing biliary decompression underwent pancreaticoduodenectomy sooner than those decompressed (4.7 days vs. 17.2 days, P = .01). DISCUSSION All patients presenting with bilirubin ≥15 mg/dL should undergo PBD, while those with bilirubin ≤10 mg/dL should forego stent placement to avoid stent-related complications. The decision to stent between 10.1 and 14.9 mg/dL should be made on a case-by-case basis keeping in mind timeliness to definitive cancer treatment.
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Affiliation(s)
- Catalina Mosquera
- Department of Surgery, Division of Surgical Oncology, Brody School of Medicine, 3627East Carolina University, Greenville, NC, USA
| | - Anastasios T Mitsakos
- Department of Surgery, Division of Surgical Oncology, Brody School of Medicine, 3627East Carolina University, Greenville, NC, USA
| | - Rodney L Guyton
- Department of Surgery, Division of Surgical Oncology, Brody School of Medicine, 3627East Carolina University, Greenville, NC, USA
| | - Timothy L Fitzgerald
- Department of Surgery, Division of Surgical Oncology, Brody School of Medicine, 3627East Carolina University, Greenville, NC, USA
| | - Emmanuel E Zervos
- Department of Surgery, Division of Surgical Oncology, Brody School of Medicine, 3627East Carolina University, Greenville, NC, USA
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Celio AC, Kasten KR, Schwoerer A, Guyton RL, Pories WJ, Spaniolas K. Propensity-Matched Analysis of Robotic and Laparoscopic Gastric Bypass Safety. J Am Coll Surg 2016. [DOI: 10.1016/j.jamcollsurg.2016.06.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Torrent DJ, Maness MR, Kachare SD, Zink JN, Haisch CE, Harland RC, Morgan C, Guyton RL, Colomb AG, Barham DW, Katz EC, Stoner MC. Examining Hemodialysis Reliable Outflow catheter performance and cost in hemodialysis access. J Surg Res 2014; 192:1-5. [DOI: 10.1016/j.jss.2014.03.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2014] [Revised: 02/24/2014] [Accepted: 03/05/2014] [Indexed: 11/28/2022]
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Fournier KB, Brown CG, May MJ, Compton S, Walton OR, Shingleton N, Kane JO, Holtmeier G, Loey H, Mirkarimi PB, Dunlop WH, Guyton RL, Huffman E. A geophysical shock and air blast simulator at the National Ignition Facility. Rev Sci Instrum 2014; 85:095119. [PMID: 25273784 DOI: 10.1063/1.4896119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The energy partitioning energy coupling experiments at the National Ignition Facility (NIF) have been designed to measure simultaneously the coupling of energy from a laser-driven target into both ground shock and air blast overpressure to nearby media. The source target for the experiment is positioned at a known height above the ground-surface simulant and is heated by four beams from the NIF. The resulting target energy density and specific energy are equal to those of a low-yield nuclear device. The ground-shock stress waves and atmospheric overpressure waveforms that result in our test system are hydrodynamically scaled analogs of full-scale seismic and air blast phenomena. This report summarizes the development of the platform, the simulations, and calculations that underpin the physics measurements that are being made, and finally the data that were measured. Agreement between the data and simulation of the order of a factor of two to three is seen for air blast quantities such as peak overpressure. Historical underground test data for seismic phenomena measured sensor displacements; we measure the stresses generated in our ground-surrogate medium. We find factors-of-a-few agreement between our measured peak stresses and predictions with modern geophysical computer codes.
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Affiliation(s)
- K B Fournier
- Lawrence Livermore National Laboratory, P.O. Box 808, L-481, Livermore, California 94550, USA
| | - C G Brown
- Lawrence Livermore National Laboratory, P.O. Box 808, L-481, Livermore, California 94550, USA
| | - M J May
- Lawrence Livermore National Laboratory, P.O. Box 808, L-481, Livermore, California 94550, USA
| | - S Compton
- Lawrence Livermore National Laboratory, P.O. Box 808, L-481, Livermore, California 94550, USA
| | - O R Walton
- Lawrence Livermore National Laboratory, P.O. Box 808, L-481, Livermore, California 94550, USA
| | - N Shingleton
- Lawrence Livermore National Laboratory, P.O. Box 808, L-481, Livermore, California 94550, USA
| | - J O Kane
- Lawrence Livermore National Laboratory, P.O. Box 808, L-481, Livermore, California 94550, USA
| | - G Holtmeier
- Lawrence Livermore National Laboratory, P.O. Box 808, L-481, Livermore, California 94550, USA
| | - H Loey
- Lawrence Livermore National Laboratory, P.O. Box 808, L-481, Livermore, California 94550, USA
| | - P B Mirkarimi
- Lawrence Livermore National Laboratory, P.O. Box 808, L-481, Livermore, California 94550, USA
| | - W H Dunlop
- Lawrence Livermore National Laboratory, P.O. Box 808, L-481, Livermore, California 94550, USA
| | - R L Guyton
- National Securities Technologies, Vasco Rd., Livermore, California 94551, USA
| | - E Huffman
- National Securities Technologies, Vasco Rd., Livermore, California 94551, USA
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