1
|
Norčič G, Smrekar N, Marković S, Barišić G, Kiudelis G, Paužas H, Molnár T, Szijarto A, Šerclová Z, Roblek T, Uršič V, White I. Insights into treatment of complex Crohn's perianal fistulas. BMC Proc 2024; 18:7. [PMID: 38658942 PMCID: PMC11044286 DOI: 10.1186/s12919-024-00291-4] [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: 04/26/2024] Open
Abstract
Complex perianal fistula is a common complication of Crohn's disease (CD) which leads to negative impact on patient's quality of life. Successful management of the disease requires a multidisciplinary approach, including a gastroenterologist and a colorectal surgeon, applying combined surgical and medical therapy. One of frequently practiced surgical procedures is seton placement in the fistula tract, which is used to control perianal sepsis and drain the fistula, while preventing recurrent abscess formation.Darvadstrocel, a suspension of expanded, allogeneic, adipose-derived, mesenchymal stem cells, is safe and effective for treatment-refractory complex perianal fistulas in patients with Crohn's disease. Following approval of darvadstrocel, the INSPIRE registry is being conducted in order to evaluate long-term safety and effectiveness of the drug on a large, heterogenous population.An online expert meeting was held from March 20 to March 30, 2023, which provided relevant insights into the decision-making process regarding seton use and obtained feedback on the first experiences with darvadstrocel. The aim of this article is to present the perspectives from gastroenterologists and colorectal surgeons practicing in Czechia, Hungary, Israel, Lithuania, Serbia, and Slovenia in topics such as diagnosis and treatment options for patients with complex Crohn's perianal fistulas (CPF), specifically focusing on the use of setons and darvadstrocel.During this virtual session, unavailability of comprehensive data on safety and efficacy of available treatment procedures was emphasized as an important obstacle towards development of standardized recommendations and improvement of outcomes in treatment of (CPF). Furthermore, achieving consensus in seton use, duration of its placement, and frequency of change is recognized as one of CPF treatments major challenges. Despite these issues, it is important to promote better understanding and treatment of complex perianal fistulas in order to improve the quality of life of those affected by this condition.
Collapse
Affiliation(s)
- Gregor Norčič
- University Medical Centre Ljubljana, Zaloška Cesta 2, Ljubljana, Slovenia
| | - Nataša Smrekar
- University Medical Centre Ljubljana, Zaloška Cesta 2, Ljubljana, Slovenia
| | - Srđan Marković
- Clinical Hospital Centre Zvezdara, Preševska 31, Belgrade, Serbia
| | - Goran Barišić
- University Clinical Centre of Serbia, Pasterova 2, Belgrade, Serbia
| | - Gediminas Kiudelis
- Lithuanian University of Health Sciences Kaunas Clinics, Eivenių G. 2, Kaunas, Lithuania
| | - Henrikas Paužas
- Lithuanian University of Health Sciences Kaunas Clinics, Eivenių G. 2, Kaunas, Lithuania
| | - Tamás Molnár
- University of Szeged, Dugonics Tér 13, Szeged, Hungary
| | | | - Zuzana Šerclová
- Military University Hospital, U Vojenské Nemocnice 1200, Prague, Czechia
| | - Tina Roblek
- Takeda Pharmaceuticals, d.o.o., Bleiweisova Cesta 30, Ljubljana, Slovenia
| | - Viktor Uršič
- Takeda Pharmaceuticals, d.o.o., Bleiweisova Cesta 30, Ljubljana, Slovenia
| | - Ian White
- Beilinson Hospital, Rabin Medical Center, Ze'ev Jabotinsky Street 39, Petah Tikva, Israel.
- Tel Aviv University, Ramat Aviv, Tel Aviv, Israel.
| |
Collapse
|
2
|
Boyle J, Hassanzadeh H, Khanna S, Biki B, Syed F, Borkwood E, Sweeney L. Modelling Planned vs. Actual Start Time to Control the Efficiency of Surgery. Stud Health Technol Inform 2024; 310:785-789. [PMID: 38269916 DOI: 10.3233/shti231072] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
To control the efficiency of surgery, it is ideal to have actual starting times of surgical procedures coincide with their planned start time. This study analysed over 4 years of data from a large metropolitan hospital and identified factors associated with surgery commencing close to the planned starting time via statistical modelling. A web application comprising novel visualisations to complement the statistical analysis was developed to facilitate translational impact by providing theatre administrators and clinical staff with a tool to assist with continuous quality improvement.
Collapse
Affiliation(s)
- Justin Boyle
- CSIRO, Australian E-Health Research Centre, Australia
| | | | | | - Barbara Biki
- Fiona Stanley Hospital, Perth, Western Australia
| | - Faraz Syed
- Fiona Stanley Hospital, Perth, Western Australia
| | | | | |
Collapse
|
3
|
Kim BR, Yoon SH, Lee HJ. Practical strategies for the prevention and management of chronic postsurgical pain. Korean J Pain 2023; 36:149-162. [PMID: 36973967 PMCID: PMC10043790 DOI: 10.3344/kjp.23080] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 03/17/2023] [Accepted: 03/18/2023] [Indexed: 03/29/2023] Open
Abstract
Chronic postsurgical pain (CPSP) is a multifactorial condition that affects a significant proportion of patients undergoing surgery. The prevention and management of CPSP require the identification of preoperative risk factors to screen high-risk patients and establish appropriate perioperative pain management plans to prevent its development. Active postoperative pain management should be provided to prevent CPSP in patients with severe pain following surgery. These tasks have become important for perioperative team members in the management of CPSP. This review article provides a comprehensive overview of the latest research on the role of perioperative team members in preventing and managing CPSP. Additionally, it highlights practical strategies that can be employed in clinical practice, covering the definition and risk factors for CPSP, including preoperative, intraoperative, and postoperative factors, as well as a risk prediction model. The article also explores various treatments for CPSP, as well as preventive measures, including preemptive analgesia, regional anesthesia, pharmacological interventions, psychoeducational support, and surgical technique modification. This article emphasizes the importance of a comprehensive perioperative pain management plan that includes multidisciplinary interventions, using the transitional pain service as an example. By adopting a multidisciplinary and collaborative approach, perioperative team members can improve patient outcomes, enhance patient satisfaction, and reduce healthcare costs. However, further research is necessary to establish targeted interventions to effectively prevent and manage CPSP.
Collapse
Affiliation(s)
- Bo Rim Kim
- Department of Anesthesiology and Pain Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Soo-Hyuk Yoon
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Korea
| | - Ho-Jin Lee
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Korea
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, Korea
| |
Collapse
|
4
|
Dursun M, Altun G, Ozsahin M. SURGICAL TREATMENT OF ACROMIOCLAVICULAR DISLOCATION: HOOK PLATE VERSUS SUTURE BUTTON. Acta Ortop Bras 2023; 31:e252916. [PMID: 37082163 PMCID: PMC10112356 DOI: 10.1590/1413-785220233101e252916] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 05/04/2022] [Indexed: 04/22/2023]
Abstract
Objectives We aimed to compare the functional and radiographical outcomes of reconstruction of acute unstable acromioclavicular joint (ACJ) dislocation using Hook Plate (HP) versus Suture Endobutton (SE) fixation techniques. Methods Forty-six consecutive patients with grade III to V ACJ dislocation according to Rockwood classification who underwent either HP or SE fixation in the period between January 2017 and June 2020 were evaluated. The treatment modalities were divided into either HP or SE fixation. The radiological assessment included standard anterior-posterior (AP) views to evaluate coracoclavicular (CC) distances for vertical reduction. Results CC distances were grouped as preoperative (CC1), early postoperative (CC2), and late postoperative (CC3). The distance variance between CC2 and CC3 was referred as ΔCC (CC3 - CC2). A statistically significant difference was found in ΔCC between the two groups (p=0.008). ΔCC was significantly higher in the SE group compared to the HP group (p<0.05). The Constant and UCLA Scores of patients in the SE group were found to be significantly higher than in the HP group patients. Conclusion Clinical outcomes were more satisfactory in patients with acute unstable ACJ dislocation who underwent SE compared to HP procedures, at the end of the first year. Evidence Level IV; Case Series.
Collapse
Affiliation(s)
- Muhsin Dursun
- EPC Special Hospital, Department of Orthopedics and Traumatology, Adana, Turkey
| | - Guray Altun
- University of Health Sciences Umraniye Training and Research Hospital, Department of Orthopedics and Traumatology, Istanbul, Turkey
| | - Murat Ozsahin
- Middle East Special Hospital, Department of Orthopedics and Traumatology, Adana, Turkey
| |
Collapse
|
5
|
Bhatti AM, Ahsin S, Mansoor S. Feasibility of video assessment of operative skills in FCPS vascular surgery. Pak J Med Sci 2023; 39:12-16. [PMID: 36694732 PMCID: PMC9843004 DOI: 10.12669/pjms.39.1.6737] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 07/26/2022] [Accepted: 11/15/2022] [Indexed: 11/24/2022] Open
Abstract
Objective To explore the feasibility of assessment of operative skills of FCPS vascular surgery trainees based on video recordings of the surgical procedures with a view to introduce it in the curriculum. Methods This qualitative study was carried out from 9th April 2021 - 15th July 2021 at Shifa Tameer e Millat University, Islamabad, Pakistan. It is a qualitative study based on constructivist grounded theory. Semi structured interviews of 16 participants, including five vascular surgical trainees, six vascular surgical consultants/supervisors/examiners, and five medical educationists were conducted, recorded and transcribed. Open and axial coding method was employed to identify recurring themes. Results Six themes could be identified. (1) There was consensus among participants on deficiency in current assessment of surgical skills. (2) Most participants believed that this is a useful method, although four out of 16 participants believed that current methods were sufficient. (3) There was a unanimous opinion that its purpose should be initially formative assessment and later for summative assessment. (4) It was suggested that it is practical with logistic support; it can be made part of trainee's record to be reviewed later; maybe by independent observers. (5) Participants believed that the logistic issue in term of equipment and trained manpower will be a challenge in implementing this mode of assessment. Other barriers included medicolegal and ethical issue and acceptability by the stake holders. (6) Participants also suggested remedies for the barriers. Conclusion Video review of surgical procedures can improve assessment of operative skills of trainees provided it is used as formative tool initially with a need to overcome logistics, medicolegal and cultural barriers.
Collapse
Affiliation(s)
| | - Sadia Ahsin
- Sadia Ahsin, Department of Physiology, Foundation University, Islamabad, Pakistan
| | - Sumreena Mansoor
- Sumreena Mansoor, Department of Biochemistry, Shifa Tameer-e-Milat University, Islamabad, Pakistan
| |
Collapse
|
6
|
Lindeboom JJ, Colnot DR, Buwalda J. Bioactive glass (S53P4) as obliteration material in subtotal petrosectomy: initial experience. J Laryngol Otol 2023; 137:105-7. [PMID: 35535475 DOI: 10.1017/S0022215122001116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Subtotal petrosectomy for chronic suppurative otitis media requires obliteration of the mastoid cavity and middle ear. Usually, abdominal fat is used for this purpose. However, infection is a risk of using fat, which might require revision surgery. The use of S53P4 bioactive glass with antibacterial properties seems an attractive alternative. METHODS Two patients with a history of chronic suppurative otitis media, complicated by profound perceptive hearing loss, had already been surgically treated, and were thereafter extensively treated conservatively. Because of recurrent chronic otorrhoea and pain, subtotal petrosectomy with obliteration of the cavity with S53P4 bioactive glass was performed. RESULTS Follow-up duration was 84 months and 18 months, respectively. No complications occurred peri-operatively. A dry ear was obtained and no late adverse events were observed. CONCLUSION S53P4 bioactive glass is feasible to use for obliteration after subtotal petrosectomy. Elimination of chronic suppurative otitis media can be achieved with this technique. The bioactive glass granules might be an attractive alternative to abdominal fat, which has a risk of infection.
Collapse
|
7
|
Song J, Chen J, Zheng S. Lateral dorsal infundibular approach: an alternative option for the safe completion of difficult laparoscopic cholecystectomy. BMC Surg 2022; 22:439. [PMID: 36567315 PMCID: PMC9790120 DOI: 10.1186/s12893-022-01894-4] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 12/22/2022] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Difficult laparoscopic cholecystectomy (LC) due to acute cholecystitis (AC) increases the risk of bile duct injuries and postoperative complications. Here, we added the lateral dorsal infundibular approach as an initial surgical maneuver during LC to improve outcomes. METHODS We describe the detailed technical procedure of the lateral dorsal infundibular approach in patients with AC resulting in difficult LC. This technique was developed after nearly 10 years of experience in laparoscopic surgery, and has been routinely used in the past 5 years. We also retrospectively analyzed the perioperative data for 469 patients with difficult LC. RESULTS A total of 469 patients with AC received difficult LC between July 2016 and June 2021, of which 438 (93.4%) performed a lateral dorsal infundibular approach. Sixty-four patients (13.6%) had variations of the hepatic bile duct and cystic duct according to preoperative magnetic resonance cholangiopancreatography, 438 patients (93.4%) received elective surgery, 31 (6.6%) received emergency surgery, and 10 (2.1%) underwent conversion. There was no postoperative bile leaks and no bile duct injuries in the described technique. CONCLUSION During difficult LC, the critical view of safety can be gradually achieved by changing the surgical approach to achieve cholecystectomy.
Collapse
Affiliation(s)
- Juxian Song
- Department of Hepatobiliary Surgery, The 925Th Hospital of the Chinese People’s Liberation Army, Guiyang, 550009 China
| | - Jian Chen
- Institute of Hepatobiliary Surgery, First Affiliated Hospital, Army Military Medical University, Shapingba District, Gaotanyan Main Street 29, Chongqing, 400038 China
| | - Shuguo Zheng
- Institute of Hepatobiliary Surgery, First Affiliated Hospital, Army Military Medical University, Shapingba District, Gaotanyan Main Street 29, Chongqing, 400038 China
| |
Collapse
|
8
|
Cruz S, Quintal C, Antunes P. [Risk Factors Associated with the Refusal of Surgery Vouchers: The Case of Central Portugal]. ACTA MEDICA PORT 2022; 35:201-208. [PMID: 34984971 DOI: 10.20344/amp.15357] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 04/28/2021] [Accepted: 05/17/2021] [Indexed: 11/20/2022]
Abstract
INTRODUCTION In Portugal, the rate of refusals regarding transfer between hospitals through surgery vouchers is high, which makes it difficult to meet maximum waiting times for elective surgeries. The objectives of this study are to examine how many vouchers were issued and refused between the third quarter of 2016 and the fourth quarter of 2019 and the risk factors associated with their refusal, in Central Portugal Material and Methods: Data was obtained in the database of cancelled vouchers and the waiting list for surgery on the 31st December 2019. Multiple logistic regression was used to investigate risk factors. RESULTS The number of issued vouchers increased after 2018 and the rate of refusals has been above 55% since the 3rd quarter of 2018. Refusal was more likely for individuals aged 55 years or above (OR = 1.136; CI = 1.041 - 1.240; OR = 1.095; CI = 1.005 - 1.194; OR = 1.098; CI = 1.002 - 1.203, for the age bands 55 - 64, 65 - 74 and 75 - 84, respectively), for inpatient surgery when compared to ambulatory (OR = 2.498; CI = 2.343 - 2.663) and for Orthopaedics when compared to General Surgery (OR = 1.123; CI = 1.037 - 1.217). The odds of refusal also varied across hospitals (for example OR = 3.853; CI = 3.610 - 4.113; OR = 3.600; CI = 3.171 - 4.087; OR = 2.751; CI =3.383 - 3.175 e OR = 1.337; CI = 1.092 - 1.637, for hospitals identified as HO_2, HO_7, HO_4 and HO_6, respectively). CONCLUSION In this study, we have confirmed that the number of issued surgery vouchers increased after the administrative reduction of maximum waiting times in 2018 and that the rate of transfer refusals has been increasing since 2016 and has remained above 55% from the third trimester of 2018 onwards. Some of the factors for which we obtained a positive association with refusal are age, inpatient surgery (compared to ambulatory) and Orthopaedics (compared to General Surgery).
Collapse
Affiliation(s)
- Salomé Cruz
- Economia Financeira. Faculdade de Economia. Universidade de Coimbra. Coimbra. Portugal
| | - Carlota Quintal
- Economia Financeira. Faculdade de Economia. Universidade de Coimbra. Coimbra. Portugal
| | - Patrícia Antunes
- Unidade Regional de Gestão do Acesso. Administração Regional de Saúde do Centro. Coimbra. Portugal
| |
Collapse
|
9
|
Chapman KB, Spiegel MA, Dickerson DM, Billet B, Patel KV, Hunter C, Antony A, van Helmond N, Deer T, Kallewaard JW, Hagedorn JM, Yang A. A Paramedian Approach for Dorsal Root Ganglion Stimulation Placement Developed to Limit Lead Migration and Fracture. Pain Pract 2021; 21:991-1000. [PMID: 34328256 DOI: 10.1111/papr.13063] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 07/26/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Dorsal root ganglion stimulation (DRG-S), has demonstrated superiority in the treatment of complex regional pain syndrome and causalgia. Lead migration and fracture impact DRG-S therapeutic stability. Lead anchoring reduces DRG-S lead migration without increasing lead fracture. Lead fracture may be related to lead entrapment in the superficial fascial plane. A novel medialized approach for lead placement and anchoring is presented to address these issues. METHODS We suggest an alternative technique for implanting percutaneous DRG-S leads at the T10-L5 levels. RESULTS A novel medialized ipsilateral technique for lead placement and anchoring for single, bilateral, and adjacent segment placement is presented. The Tuohy needle puncture site is medial to the pedicle and adjacent to the spinous process, two vertebral levels caudad to the target foramen. Trajectory is maintained in the sagittal plane, to access the caudad interlaminar space near the midline. This technique allows for ipsilateral or contralateral lead placement. After epidural access, the introducer sheath is rotated toward the targeted foramen and advanced. The guidewire followed by the lead is passed, and once lead position is confirmed, tension 'S' loops are created, followed by anchoring to the deep fascia. CONCLUSION We describe a new paramedian technique for DRG-S lead placement. We propose it will decrease DRG-S complication rates through anchoring to reduce migration and by avoiding the fascial planes thought to be responsible for fracture. Long-term outcomes applying our proposed techniques are required for determining the true impact, however, early anecdotal results suggest that these new techniques are favorable.
Collapse
Affiliation(s)
- Kenneth B Chapman
- The Spine & Pain Institute of New York, New York, NY, USA.,Department of Anesthesiology, NYU Langone Medical Center, New York, NY, USA.,Northwell Health, New York, NY
| | - Matthew A Spiegel
- The Spine & Pain Institute of New York, New York, NY, USA.,Northwell Health, New York, NY
| | - David M Dickerson
- Department of Anesthesiology, NorthShore University Health System, Evanston, IL, USA.,Department of Anesthesia & Critical Care, University of Chicago, Chicago, IL, USA
| | - Bart Billet
- Department of Anesthesiology, AZ Delta, Roeselare, Belgium
| | - Kiran V Patel
- The Spine & Pain Institute of New York, New York, NY, USA.,Northwell Health, New York, NY
| | - Corey Hunter
- Ainsworth Institute of Pain Management, New York, NY, USA
| | | | - Noud van Helmond
- Cooper Medical School of Rowan University, Cooper University Hospital, Camden, NJ
| | - Timothy Deer
- The Spine and Nerve Center of the Virginias, Charleston, WV
| | | | - Jonathan M Hagedorn
- Department of Anesthesiology and Perioperative Medicine, Division of Pain Medicine, Mayo Clinic, Rochester, MN, USA
| | - Ajax Yang
- The Spine & Pain Institute of New York, New York, NY, USA.,Northwell Health, New York, NY
| |
Collapse
|
10
|
Chilinda G, Massamba L, Meja S, Ngo C, Dupre PF. Implementing a comprehensive cervical cancer program in Southern Malawi: a 'Médecins Sans Frontières', Ministry of Health, and College of Medicine of Blantyre Collaborative Project. Int J Gynecol Cancer 2021; 31:1606-1607. [PMID: 34083379 DOI: 10.1136/ijgc-2021-002743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/07/2021] [Indexed: 12/24/2022] Open
Affiliation(s)
- George Chilinda
- Department of Obstetrics, Gynecology & Gynecological Oncology, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Leo Massamba
- Department of Oncology, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Samuel Meja
- Department of Obstetrics and Gynecology, Queen Elizabeth Central Hospital, Blantyre, Malawi.,University of Malawi College of Medicine, Blantyre, Malawi
| | - Charlotte Ngo
- Oncology Department, Médecins Sans Frontières Oncology Département MSF OCP Paris, Paris, France
| | - Pierre-Francois Dupre
- Breast & Gynaecological Oncology, CHU Brest, Brest, France .,Team GTCA, INSERM U1078, Brest, France
| |
Collapse
|
11
|
Wainger JJ, Cheaib JG, Patel HD, Huang MM, Biles MJ, Metcalf MR, Canner JK, Singla N, Trock BJ, Allaf ME, Pierorazio P. Volume-outcome relationships for kidney cancer may be driven by disparities and patient risk. Urol Oncol 2021; 39:439.e1-439.e8. [PMID: 34078583 DOI: 10.1016/j.urolonc.2021.04.036] [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] [Received: 10/17/2020] [Revised: 04/04/2021] [Accepted: 04/25/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE Provider and hospital factors influence healthcare quality, but data are lacking to assess their impact on renal cancer surgery. We aimed to assess factors related to surgeon and hospital volume and study their impact on 30-day outcomes after radical nephrectomy. MATERIALS AND METHODS Renal surgery data were abstracted from Maryland's Health Service Cost Review Commission from 2000 to 2018. Patients ≤18 years old, without a diagnosis of renal cancer, and concurrently receiving another major surgery were excluded. Volume categories were derived from the mean annual cases distribution. Multivariable logistic and linear regression models assessed the association of volume on length of stay, intensive care days, cost, 30-day mortality, readmission, and complications. RESULTS 7,950 surgeries, completed by 573 surgeons at 48 hospitals, were included. Demographic, surgical, and admission characteristics differed between groups. Radical nephrectomies performed by low volume surgeons demonstrated increased post-operative complication frequency, mortality frequency, length of stay, and days spent in intensive care relative to other groups. However, after logistic regression adjusting for clinical risk and socioeconomic factors, only increased length of stay and ICU days remained associated with lower surgeon volume. Similarly, after adjusted logistic regression, hospital volume was not associated with the studied outcomes. CONCLUSIONS Surgeons and hospitals differ in regards to patient demographic and clinical factors. Barriers exist regarding access to high-volume care, and thus some volume-outcome trends may be driven predominantly by disparities and case mix.
Collapse
Affiliation(s)
- Julia J Wainger
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
| | - Joseph G Cheaib
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Hiten D Patel
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Mitchell M Huang
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Michael J Biles
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Meredith R Metcalf
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Joseph K Canner
- Johns Hopkins Surgery Center for Outcomes Research, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Nirmish Singla
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Bruce J Trock
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Mohamad E Allaf
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Phillip Pierorazio
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| |
Collapse
|
12
|
Steib JP. [Spine surgery in elderly: place and indication]. Rev Prat 2021; 71:530-534. [PMID: 34553532] [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] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
"Spine surgery in elderly: place and indication. The ageing affects every component of spine resulting in pain, balance disorders and loss of independence with acceleration of the general aging process. Surgery is possible facing to mechanical problems. Osteoporotic fractures can be cured by vertebroplasty. Opening vertebral canal is a common practice in stenosis, restoring a normal walk. Osteosynthesis of the spine is indicated in instability or in deformity and regularly used in metastasis. Disc arthroplasty can be discussed in uncodiscarthrosis. The progresses of anesthesiology and of the surgical techniques allow this practice. The patient operated gets up immediately generally without any brace. Minimal invasive surgery preserving soft tissues increases the indications. Spine surgery is too often forgotten by lack of diagnosis, in front of back pain, difficulty to walk and progressive deformity. We have to forget the terrible sentence: "There is nothing to be done because it is the spine, because the patient is too old."".
Collapse
Affiliation(s)
- Jean-Paul Steib
- Service de chirurgie du rachis, hôpital de Hautepierre 2 - Hôpitaux universitaires de Strasbourg, Strasbourg, France
| |
Collapse
|
13
|
Belghiti J, Pinar U, Roupret M, Belghiti J, Uzan C, Canlorbe G, Betser L, Iquille J, Roussel A, Castier Y, Mordant P, Valverde A. [Robots set up in the operating theater]. Rev Prat 2021; 71:335-340. [PMID: 34161044] [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] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
"Robots set up in the operating theater. The patient's benefit after a minimally invasive approach stimulated the robotic approach of abdominal and thoracic surgical procedures. Although much more expensive, the robots improve the vision of the operating field, the precision of the gestures with a faster training course for the surgeon who operates more comfortably. Surgeons eager for technological progress quickly adopted this technique in urology and gynecology and then in thoracic and digestive procedures. In France, the support for this innovation by academic and medical institutions is limited by several factors including the supremacy of Intuitive which imposes its prices, the absence of scientifically proven superiority, the absence of surveys under the responsibility of scientific societies and the lack of criteria concerning the surgeon training."
Collapse
Affiliation(s)
- Jacques Belghiti
- "Professeur émérite de chirurgie, université de Paris-Diderot ; ancien membre du collège de la Haute Autorité de santé et président de la Commission d'évaluation des actes et des dispositifs médicaux, Paris, France"
| | - Ugo Pinar
- "Service d'urologie de l'hôpital La Pitié-Salpêtrière, Assistance publique-Hôpitaux de Paris (AP-HP), Sorbonne Université, Paris, France"
| | - Morgan Roupret
- "Service d'urologie de l'hôpital La Pitié-Salpêtrière, Assistance publique-Hôpitaux de Paris (AP-HP), Sorbonne Université, Paris, France"
| | - Jérémie Belghiti
- "Service de chirurgie et cancérologie gynécologique, hôpital La Pitié-Salpêtrière, AP-HP, Sorbonne Université, Paris, France"
| | - Catherine Uzan
- "Service de chirurgie et cancérologie gynécologique, hôpital La Pitié-Salpêtrière, AP-HP, Sorbonne Université, Paris, France"
| | - Geoffroy Canlorbe
- "Service de chirurgie et cancérologie gynécologique,hôpital La Pitié-Salpêtrière, AP-HP, Sorbonne Université, Paris, France"
| | - Léa Betser
- "Service de chirurgie vasculaire, thoracique, et transplantation pulmonaire, hôpital Bichat, AP-HP Université de Paris, Paris, France"
| | - Jules Iquille
- "Service de chirurgie vasculaire, thoracique, et transplantation pulmonaire, hôpital Bichat, AP-HP Université de Paris, Paris, France"
| | - Arnaud Roussel
- "Service de chirurgie vasculaire, thoracique, et transplantation pulmonaire, hôpital Bichat, AP-HP Université de Paris, Paris, France"
| | - Yves Castier
- "Service de chirurgie vasculaire, thoracique, et transplantation pulmonaire, hôpital Bichat, AP-HP Université de Paris, Paris, France"
| | - Pierre Mordant
- "Service de chirurgie vasculaire, thoracique, et transplantation pulmonaire, hôpital Bichat, AP-HP Université de Paris, Paris, France"
| | - Alain Valverde
- Groupe hospitalier Diaconesses Croix-Saint-Simon, 125, rue d'Avron, 75020, Paris, France
| |
Collapse
|
14
|
Pérez-López LM, Subirá-Álvarez T, Martínez-Ruíz A, Noguera-Julian A, Moreno-Romo D, Torner-Rubies F, Fontecha CG. Non-axial osteoarticular tuberculosis in the paediatric age. Rev Esp Cir Ortop Traumatol (Engl Ed) 2021; 65:186-194. [PMID: 33495138 DOI: 10.1016/j.recot.2020.09.004] [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] [Received: 07/01/2020] [Revised: 09/06/2020] [Accepted: 09/15/2020] [Indexed: 10/22/2022] Open
Abstract
INTRODUCTION AND OBJECTIVES Osteoarticular tuberculosis, caused by a member of the Mycobacterium genus, represents approximately 10% of the total extrapulmonary tuberculosis in pediatric patients. Its low prevalence and nonspecific clinical presentation lead to a late diagnosis and elevated risk of sequelae. PATIENTS AND METHODS This retrospective study included seven pediatric patients with non-vertebral osteoarticular tuberculosis diagnosed between 2006 and 2019. The patients were classified in accordance with the radiographic criteria of Kerri and Martini. RESULTS The mean patient age was 7,4 years (median, 5 years; range, 2-16 years). The mean follow-up time was 18,5 months (range, 10-32 months). The mean diagnostic delay was 4,7 months (range, 1-8 months). The locations were femoral head osteoarthritis (two patients) and proximal humerus osteomyelitis, talus dome osteoarthritis, distal clavicle osteoarthritis, proximal ulna epiphysis osteoarthritis, and tibiotalar arthritis along with subtalar gland (one patient each). The clinical findings were lameness (four patients), localized pain (two patients), functional impotence, constitutional syndrome (asthenia, anorexia, and involuntary loss of>5% of total body weight) (two patients), local inflammatory signs (one patient), and fever (one patient). One patient was asymptomatic and received a diagnosis during pulmonary radiological analysis. Medical treatment with four drugs was performed in all patients; five patients required surgical treatment for abscess drainage, three of them open drainage, and two with laparoscopic drainage. CONCLUSIONS The final results were satisfactory, such that 71% of patients recovered joint balance but with radiological sequelae in 57,1% patients. Good prognosis, according to our results, depends on younger age and early diagnosis with early medical or surgical treatments.
Collapse
Affiliation(s)
| | - Teresa Subirá-Álvarez
- Servicio de Cirugía Ortopédica y Traumatología, Consorci de Terrassa, Barcelona, España
| | - Amalia Martínez-Ruíz
- Servicio de Cirugía Ortopédica y Traumatología, Consorci de Terrassa, Barcelona, España
| | - Antoni Noguera-Julian
- Enfermedades Infecciosas y Respuesta Inflamatoria Sistémica en Pediatría, Unidad de Infecciones, Instituto de Investigación Pediátrica Hospital Sant Joan de Déu, Barcelona, España; Departamento de Pediatría, Universidad de Barcelona, Barcelona, España; CIBER de Epidemiología y Salud Pública, CIBERESP, Madrid, España; Red de Investigación Translacional en Infectología Pediátrica, RITIP, Madrid, España
| | - David Moreno-Romo
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Sant Joan de Déu, Barcelona, España
| | - Ferran Torner-Rubies
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Sant Joan de Déu, Barcelona, España
| | - César Galo Fontecha
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Sant Joan de Déu, Barcelona, España
| |
Collapse
|
15
|
Parhiz A, Parvin M, Pirayvatlou SS. Clinical Assessment of Retromandibular Antero-Parotid Approach for Reduction of Mandibular Subcondylar Fractures: Report of 60 Cases and Review of the Literature. Front Dent 2020; 17:1-9. [PMID: 33615293 PMCID: PMC7883655 DOI: 10.18502/fid.v17i17.4180] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 06/13/2020] [Indexed: 11/24/2022] Open
Abstract
This study assessed the efficacy of the retromandibular antero-parotid approach for open reduction and internal fixation (ORIF) of subcondylar fractures. Sixty patients with the mean age of 31.03 years underwent surgical reduction with a 20–25mm incision in the retromandibular area with an antero-parotid transmasseteric approach. All patients were followed between 6 to 12 months. At the end of the first week, six patients exhibited postoperative malocclusion. At the next visits, all patients had optimal occlusion. Maximal interincisal opening (MIO) of 56 patients (93.3%) was >37mm, and only four patients (6.7%) had MIO<37mm. In three patients (5%), weakness of the buccal branch of the facial nerve was noticed postoperatively. No salivary gland complications were seen. The surgical scar was hardly noticeable. Retromandibular access with transmasseteric antero-parotid approach is the technique of choice for treatment of high- and low-level subcondylar fractures with adequate visibility and direct access to the condylar area.
Collapse
Affiliation(s)
- Alireza Parhiz
- Dental Research Center, Dentistry Research Institute, Tehran University of Medical Sciences, Tehran, Iran.,Department of Oral and Maxillofacial Surgery, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
| | - Milad Parvin
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
| | - Sasan Sanjari Pirayvatlou
- Dental Research Center, Dentistry Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
16
|
MacLean CD, Fujii M, Ahern TP, Holoch P, Russell R, Hodges A, Moore J. Impact of Policy Interventions on Postoperative Opioid Prescribing. Pain Med 2020; 20:1212-1218. [PMID: 30412235 DOI: 10.1093/pm/pny215] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To assess postoperative opioid prescribing in response to state and organizational policy changes. METHODS We used an observational study design at an academic medical center in the Northeast United States over a time during which there were two important influences: 1) implementation of state rules regarding opioid prescribing and 2) changes in organization policies reflecting evolving standards of care. Results were summarized at the surgical specialty and procedure level and compared between baseline (July-December 2016) and postrule (July-December 2017) periods. RESULTS We analyzed data from 17,937 procedures from July 2016 to December 2017, two-thirds of which were outpatient. Schedule II opioids were prescribed in 61% of cases and no opioids at all in 28%. The median morphine milligram equivalent (MME) prescribed at discharge decreased 40%, from 113 MME in the baseline period to 68 MME in the postrule period. Decreases were seen across all the surgical specialties. CONCLUSIONS Postoperative opioid prescribing at the time of hospital discharge decreased between 2016 and 2017 in the setting of targeted and replicable state and health care organizational policies. POLICY IMPLICATIONS Policies governing the use of opioids are an effective and adoptable approach to reducing opioid prescribing following surgery.
Collapse
Affiliation(s)
- Charles D MacLean
- Larner College of Medicine, University of Vermont, Burlington, Vermont
| | - Mayo Fujii
- Larner College of Medicine, University of Vermont, Burlington, Vermont.,Department of Surgery, University of Vermont Medical Center, Burlington, Vermont, USA
| | - Thomas P Ahern
- Department of Surgery, University of Vermont Medical Center, Burlington, Vermont, USA
| | - Peter Holoch
- Larner College of Medicine, University of Vermont, Burlington, Vermont.,Department of Surgery, University of Vermont Medical Center, Burlington, Vermont, USA
| | - Ruby Russell
- Larner College of Medicine, University of Vermont, Burlington, Vermont
| | - Ashley Hodges
- Larner College of Medicine, University of Vermont, Burlington, Vermont
| | - Jesse Moore
- Larner College of Medicine, University of Vermont, Burlington, Vermont.,Department of Surgery, University of Vermont Medical Center, Burlington, Vermont, USA
| |
Collapse
|
17
|
Busato WFS, Girardi F, Almeida GL. Training of Brazilian Urology residents in laparoscopy: results of a national survey. Int Braz J Urol 2020; 46:203-213. [PMID: 32022508 PMCID: PMC7025843 DOI: 10.1590/s1677-5538.ibju.2018.0668] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Accepted: 08/04/2019] [Indexed: 11/21/2022] Open
Abstract
Objectives To evaluate the familiarity of Brazilian urology residents with laparoscopy, methods of training and perspectives. Material and methods a questionnaire with 23 questions was sent by e-mail to all urological residents of 86 Urology Residence Programs certified by the Brazilian Society of Urology (BSU). Results 225 valid answers (85% of all residents) responded. Most residences belong to academic hospitals mainly in the Southeast region of Brazil. Women account for 5% of residents and 82% of programs perform less than 100 procedures per year. Residents have access to LESS, RAL and 98% to surgical laparoscopy and 87% of these participate actively at the surgery, but 84.9% do not have access to RAL. The most common laparoscopic procedure is radical nephrectomy (73.2%), but only 28.8% of residents acted as surgeons, and third year residents (R3) are those that mainly performed this procedure (statistical significance, p <0.05). 61% of residents do not participate in hands-on courses or fellowship in laparoscopy, among those who attended these fellowships, 23.47% were sponsored by BSU in equal regions of the country. Although there are several opportunities of training in laparoscopy, 42% of residents do not have access to any kind of preparation and 52% have no structured specific program. R3 perception of laparoscopy experience is significantly higher than R2 and R1 residents. Almost 30% of them affirms that they are prepared for professional life regarding urologic laparoscopy. Conclusion Brazilian urologic residents have access to laparoscopy and actively participate in the learning process. Robotic surgery is expanding in the country, although still very far from residents. Brazilian resident, at the end of medical residency, is motivated to perform laparoscopic procedures.
Collapse
Affiliation(s)
- Wilson Francisco Schreiner Busato
- Disciplina de Urologia Universidade do Vale do Itajai - UNIVALI, Itajaí, SC, Brasil.,Departamento de Uro-oncologia da Sociedade Brasileira de Urologia, Brasil
| | | | | |
Collapse
|
18
|
Chen KS, Sagher O. Awake Implantation of Thoracic Spinal Cord Stimulator Paddle Electrode and Generator: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2019; 17:E100. [PMID: 30566657 DOI: 10.1093/ons/opy376] [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] [Received: 05/31/2018] [Accepted: 11/15/2018] [Indexed: 11/13/2022] Open
Abstract
In this surgical video, the operative technique is presented for awake implantation of a thoracic paddle electrode for spinal cord stimulation. In the first stage, a laminotomy is performed with the patient under conscious sedation. Once the paddle is in optimal position, the patient is tested intraoperatively to confirm adequate coverage and absence of untoward side effects. This paddle electrode is used for the trial period. If the patient derives satisfactory pain relief during the trial, they are returned for the second stage implantation of pulse generator, without moving the initial paddle electrode now already placed in an optimal location. Particular attention in this video is provided toward the optimal positioning and technique for the awake laminotomy to ensure patient comfort and reliability during testing, the use of extension leads tunneled opposite the planned pulse generator site, and the method of removing extension leads to preserve the placement of the initial paddle electrode.
Collapse
Affiliation(s)
- Kevin S Chen
- Department of Neurosurgery, University of Michigan Health System, Ann Arbor, Michigan
| | - Oren Sagher
- Department of Neurosurgery, University of Michigan Health System, Ann Arbor, Michigan
| |
Collapse
|
19
|
Jang DS, Shin DH, Han W, Kong TH, Seo YJ. Baha Attract Implantation Using a Small Incision: Initial Report of Surgical Technique and Surveillance. Clin Exp Otorhinolaryngol 2019; 13:15-22. [PMID: 31273968 PMCID: PMC7010491 DOI: 10.21053/ceo.2019.00381] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 05/30/2019] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES To determine the appropriate anatomical borders of implantation on the temporal bone in a cadaver study, and to develop a simplified surgical technique for Baha Attract implantation through a small incision along the hairline using anatomical evidence and a navigation system. METHODS In a cadaver study, 20 human adult dry skulls were used to find flat areas of the temporal bone for Baha Attract magnet implantation. Four borders of the "optimal surgical site" were defined: Asterion line, occipitomastoid suture line, sigmoid sinus line, and digastric groove line. In three patients, we implanted the Baha Attract according to the newly developed surgical procedure and validated the feasibility of this technique with a navigation system. RESULTS We identified the appropriate position of the implant on the temporal bone, suggesting a simplified surgical technique for Baha Attract with a small incision. We determined the spot of implantation, and the implants were inserted through a small surgical incision (<2.5 cm) under local anesthesia; the procedure lasted approximately 30 minutes. CONCLUSION The optimal surgical site of the temporal bone is a safe and easily accessible location for implantation of the Baha Attract.
Collapse
Affiliation(s)
- Dong Su Jang
- Department of Sculpture, Hongik University, Seoul, Korea
| | - Dong Hyo Shin
- Department of Fine Arts Education, Kyungnam University, Changwon, Korea
| | - Woojae Han
- Department of Speech Pathology and Audiology, Research Institute of Audiology and Speech Pathology, College of Natural Sciences, Hallym University, Chuncheon, Korea
| | - Tae Hoon Kong
- Department of Otorhinolaryngology, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Young Joon Seo
- Department of Otorhinolaryngology, Yonsei University Wonju College of Medicine, Wonju, Korea
| |
Collapse
|
20
|
Talebpour M, Zabihi-Mahmoudabadi H, Payandemehr P, Momen M, Zali Z. An Effective Method for Controlling Bleeding in a Ruptured Hepatic Hemangioma: A Case Report. Adv J Emerg Med 2019; 3:e10. [PMID: 31172121 DOI: 10.22114/AJEM.v0i0.114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Introduction Hepatic hemangioma is the most common benign tumor in the liver. Although intra-abdominal bleeding associated with its rupture is rare, but life-threatening. Here we report a case of ruptured hepatic hemangioma and applied method for controlling its bleeding. Case Report The patient was a 45-year-old man who was referred after crashing his motorcycle into a car. The patient's primary survey revealed intra-abdominal free fluid, but stable vital signs. Thirty minutes later, the patient's systolic blood pressure dropped to 85 mmHg. Laparotomy was performed a large hemangioma was observed involving almost the entire left lobe of the liver. Using a liver needle and 2-0 chromic suture, we entered the hemangioma at the perforation site of the lower portion of the liver and exit from the upper part. Then, we entered the upper part of the liver and exited from the lower part, and then it was tied. According to this approach, hemangioma was packed from the lower segment of the liver. Conclusion In this case, the patient's abdomen was primarily closed without extra packing and embolization. The proposed method thus may be more effective compared to conventionally used methods.
Collapse
|
21
|
Faraj KS, Abdul-Muhsin HM, Navaratnam AK, Rose KM, Castle EP. Intracorporeal orthotopic neobladder formation: Why not to do it? ARCH ESP UROL 2019; 72:318-325. [PMID: 30945659] [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] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
There has been growing interest in intracorporeal techniques to urinary diversion during cystectomy in the modern area. There is little high-quality evidence that this technique is superior to extracorporeal diversion in patients who are obtaining an orthotopic intracorporeal neobladder urinary diversion. This study describes the proposed advantages and disadvantages of intracorporeal orthotopic neobladder urinary diversion and expert opinion on preference. METHODS: We reviewed the literature for all studies discussing the outcomes and advantages of intracorporeal orthotopic neobladder urinary diversion, including those comparing the intracorporeal and extracorporeal approach. The studies were reviewed and these findings were summarized based on categories of the proposed advantages and disadvantages of the intracorporeal approach. We provided an assessment of the claims made in favor of the intracorporeal approach and discussed advantages of the extracorporeal approach that may persuade even the most experienced robotic surgeons to lean away from the former. RESULTS AND CONCLUSIONS: Herein we review the studies that propose advantages of the intracorporeal diversion, as well as the studies that do not demonstrate any advantage to this approach. Some of the proposedadvantages addressed include decreased stricture rate, lower complications and shorter hospitalization. Furthermore, we address the issues of the steep learningcurve and the impact on resident education. We conclude that the proposed benefits of an intracorporeal approach to urinary diversion are not substantiated and it is the preference of the authors to primarily perform extracorporeal urinary diversions.
Collapse
Affiliation(s)
- Kassem S Faraj
- Department of Urology. Mayo Clinic Arizona. Phoenix. Arizona. USA
| | | | | | - Kyle M Rose
- Department of Urology. Mayo Clinic Arizona. Phoenix. Arizona. USA
| | - Erik P Castle
- Department of Urology. Mayo Clinic Arizona. Phoenix. Arizona. USA
| |
Collapse
|
22
|
Habib A. Management of advanced hypopharyngeal carcinoma: systematic review of survival following surgical and non-surgical treatments. J Laryngol Otol 2018; 132:385-400. [PMID: 29891019 DOI: 10.1017/S0022215118000555] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Advanced hypopharyngeal carcinoma has a dismal prognosis. The optimal treatment for these patients remains under debate. This systematic review aimed to compare survival following surgical and non-surgical treatments. METHODS A systematic review was conducted of randomised studies, with a descriptive analysis of retrospective observational studies. RESULTS Two randomised trials and 11 observational studies were included in the review. A meta-analysis of randomised trials reported a hazard ratio of 0.89 for overall survival in favour of surgical treatment (p = 0.44). Neither treatment was favoured in terms of overall survival. Observational studies did not report a survival advantage with either treatment. The five-year larynx preservation rates for non-surgically treated patients were between 38 and 58 percent. CONCLUSION Chemoradiotherapy offers similar survivorship compared to surgery in advanced disease, while also making larynx preservation feasible. It can be used as a treatment in all patients as an alternative to surgery.
Collapse
|
23
|
Swords C, Patel A, Smith ME, Williams RJ, Kuhn I, Hopkins C. Surgical and interventional radiological management of adult epistaxis: systematic review. J Laryngol Otol 2017; 131:1108-30. [PMID: 29280696 DOI: 10.1017/S0022215117002079] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND There is variation regarding the use of surgery and interventional radiological techniques in the management of epistaxis. This review evaluates the effectiveness of surgical artery ligation compared to direct treatments (nasal packing, cautery), and that of embolisation compared to direct treatments and surgery. METHOD A systematic review of the literature was performed using a standardised published methodology and custom database search strategy. RESULTS Thirty-seven studies were identified relating to surgery, and 34 articles relating to interventional radiology. For patients with refractory epistaxis, endoscopic sphenopalatine artery ligation had the most favourable adverse effect profile and success rate compared to other forms of surgical artery ligation. Endoscopic sphenopalatine artery ligation and embolisation had similar success rates (73-100 per cent and 75-92 per cent, respectively), although embolisation was associated with more serious adverse effects (risk of stroke, 1.1-1.5 per cent). No articles directly compared the two techniques. CONCLUSION Trials comparing endoscopic sphenopalatine artery ligation to embolisation are required to better evaluate the clinical and economic effects of intervention in epistaxis.
Collapse
|
24
|
Luis-Alejandro G, Bárbara G. Adductor Tenotomy Combined with Palmar Capsulodesis for Spastic Thumb-in-Palm Deformity in Cerebral Palsy: Description of a Surgical Technique and Clinical Results. J Hand Surg Asian Pac Vol 2017; 22:315-319. [PMID: 28774242 DOI: 10.1142/s0218810417500368] [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: 11/18/2022]
Abstract
BACKGROUND Spastic thumb deformity in cerebral palsy significantly impedes hand function. Flexion-adduction forces across the first ray is the result from imbalance between intrinsic and extrinsic muscles. Multiples surgeries have been devised for the treatment of this condition such as contracture release and by tendon transfers for balancing the muscles forces. We report the results of a less demanding surgical technique, intended to avoid hyperextension of the metacarpophalangeal joint previously described in other series. METHODS Five patients with cerebral palsy who underwent a surgical correction for their thumb-in-palm deformity between January 2013 and August 2014 were included. All patients were assessed postoperatively with a minimum follow up of six months. Three criteria were chosen to evaluate functional ability: capacity to perform pinch, volitional muscle control and usefulness of the hand in daily life activities. RESULTS Patients who had surgery for spastic thumb deformity were reviewed. The thumb was maintained out of the palm in all patients. Three patients were able to perform correct pinch, achieved volitional muscle control and a more functional hand. One patient had limitation to achieve one of the evaluated daily life activities and one patient lacked active thumb movement for pinch, motor control and achieved no daily life activities. No postoperative complications were recorded. CONCLUSIONS We present a less challenging technique that should be taken into account for the treatment of thumb-in-palm deformity. Appearance and functional improvement can be achieved with this surgical procedure avoiding disadvantages of secondary deformities.
Collapse
Affiliation(s)
- García Luis-Alejandro
- 1 Department of Orthopaedics and Traumatology, Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, Bogotá-Colombia, Colombia
| | - Gómez Bárbara
- 1 Department of Orthopaedics and Traumatology, Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, Bogotá-Colombia, Colombia
| |
Collapse
|
25
|
Binar M, Akcam TM, Karakoc O, Sagkan RI, Musabak U, Gerek M. Effect of modern surgical treatment on the inflammatory/anti-inflammatory balance in patients with obstructive sleep apnoea. J Laryngol Otol 2017; 131:719-27. [PMID: 28534455 DOI: 10.1017/S0022215117001116] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To investigate the inflammatory/anti-inflammatory cytokine balance - T helper 1/T helper 2 ratios - in obstructive sleep apnoea patients, before and after treatment. METHODS Twenty-eight patients received continuous positive airway pressure treatment and 29 patients who could not tolerate continuous positive airway pressure were scheduled for surgery. Serum levels of interleukins 2, 4 and 10, tumour necrosis factor-alpha, and interferon gamma were analysed by enzyme-linked immunosorbent assays before and three months after treatment. RESULTS The success rate of surgical treatment was 65.5 per cent. Mean compliance for the continuous positive airway pressure group was 40.9 per cent. The apnoea/hypopnoea index significantly decreased in both groups after treatment (p < 0.001). The interferon gamma/interleukin-4 ratio decreased following surgical treatment (p = 0.014), and the interleukin-2/interleukin-4 ratio decreased after treatment in 57 patients in the overall cohort (p = 0.032). CONCLUSION After treatment for obstructive sleep apnoea, some ratios reflecting T helper 1/T helper 2 cytokine balance favoured the T helper 2 direction, suggesting a shift to an anti-inflammatory state. Successful surgery and better continuous positive airway pressure compliance can help ameliorate inflammation in obstructive sleep apnoea patients, which may reduce associated morbidities.
Collapse
|
26
|
Song YY, Liu R, Zhao GD, Tang WB, Hu MG, Li CG. [Clinical exploratory application of robotic resection of tumor in segment Ⅷ: a report for 7 cases]. Zhonghua Yi Xue Za Zhi 2017; 97:1256-1258. [PMID: 28441857 DOI: 10.3760/cma.j.issn.0376-2491.2017.16.016] [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] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To investigate the feasibility and security of robotic resection of tumor in segment Ⅷ primarily. Methods: The clinicopathologic data of 7 patients who underwent robotic resection of tumor in segment Ⅷ using daVinci robotic system in the Department of Hepato-pancreato-biliary Surgical Oncology, Chinese PLA General Hospital from June 2016 to December 2016 were retrospectively analyzed. The lesion size, the tumor malignance degree mean operation time, intraoperative blood loss and the rate of conversion to laparotomy, postoperative hospital stay, mobidity and motality of all the 7 patients were collected. Results: All the 7 operations were successfully performed with radical resection.The mean tumor diameter was (4.6±1.2)cm. The mean operation time, intraoperative blood loss and postoperative hospital stay were(120.7±21.7)min, (100±106.7)ml, and(7.3±1.8)days respectively.All the patients were discharged successfully with no severe complications. Conclusions: According to our experiences, as a new operationmodel of minimally invasive surgery, robotic resection of tumor in segment Ⅷ has manyadvantages in laparoscopic like less trauma, less intraoperative bleeding, light postoperative pain, shorter postoperative hospital stay and so on. There are some certain advantages in exposure of Ⅷ segment under robotic surgery system. Robotic surgery system is safe and feasible for tumorresection of segmentⅧ, andhas clinical promoting value and application prospect.
Collapse
Affiliation(s)
- Y Y Song
- The Department of Hepato-pancreato-biliary Surgical Oncology, PLA General Hospital, Beijing 100853, China
| | | | | | | | | | | |
Collapse
|
27
|
Daniels CJ, Wakefield PJ, Bub GA, Toombs JD. A Narrative Review of Lumbar Fusion Surgery With Relevance to Chiropractic Practice. J Chiropr Med 2016; 15:259-271. [PMID: 27857634 DOI: 10.1016/j.jcm.2016.08.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Revised: 06/23/2016] [Accepted: 08/05/2016] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE The purpose of this narrative review was to describe the most common spinal fusion surgical procedures, address the clinical indications for lumbar fusion in degeneration cases, identify potential complications, and discuss their relevance to chiropractic management of patients after surgical fusion. METHODS The PubMed database was searched from the beginning of the record through March 31, 2015, for English language articles related to lumbar fusion or arthrodesis or both and their incidence, procedures, complications, and postoperative chiropractic cases. Articles were retrieved and evaluated for relevance. The bibliographies of selected articles were also reviewed. RESULTS The most typical lumbar fusion procedures are posterior lumbar interbody fusion, anterior lumbar interbody fusion, transforaminal interbody fusion, and lateral lumbar interbody fusion. Fair level evidence supports lumbar fusion procedures for degenerative spondylolisthesis with instability and for intractable low back pain that has failed conservative care. Complications and development of chronic pain after surgery is common, and these patients frequently present to chiropractic physicians. Several reports describe the potential benefit of chiropractic management with spinal manipulation, flexion-distraction manipulation, and manipulation under anesthesia for postfusion low back pain. There are no published experimental studies related specifically to chiropractic care of postfusion low back pain. CONCLUSIONS This article describes the indications for fusion, common surgical practice, potential complications, and relevant published chiropractic literature. This review includes 10 cases that showed positive benefits from chiropractic manipulation, flexion-distraction, and/or manipulation under anesthesia for postfusion lumbar pain. Chiropractic care may have a role in helping patients in pain who have undergone lumbar fusion surgery.
Collapse
Affiliation(s)
| | | | - Glenn A Bub
- Veteran Affairs Saint Louis Health Care System, St. Louis, MO
| | - James D Toombs
- Veteran Affairs Saint Louis Health Care System, St. Louis, MO
| |
Collapse
|
28
|
Agalato E, Jose J, England RJ. Is pharyngeal pouch stapling superior to open pharyngeal pouch repair? An analysis of a single institution's series. J Laryngol Otol 2016; 130:873-7. [PMID: 27515737 DOI: 10.1017/S0022215116008641] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Endoscopic stapling has become the primary procedure for pharyngeal pouch surgery because it is quick, less invasive and safe, but less is known about long-term outcomes. METHOD Medical records were reviewed to compare rates of morbidity, operative failure, symptom control and revision surgery between open and closed procedures. RESULTS A total of 120 pharyngeal pouch procedures, carried out on 97 patients from 2000 to 2014, were studied. These included 80 endoscopic stapling and 40 open procedures. Twelve patients had complications (15 per cent) and there was one mortality (1.2 per cent) in the endoscopic stapling group. Ten patients (25 per cent) developed complications in the open procedure group, with no mortalities. Symptom recurrence was significantly greater in the endoscopic stapling group (26 per cent) than in the open procedure group (7.5 per cent). Multiple surgical procedures were required for 22 endoscopically stapled patients (32 per cent); none were required in the open procedure group. Although the male-to-female ratio for pharyngeal pouch incidence was 2:1, the ratio for multiple surgical procedures was 10:1. CONCLUSION Endoscopic stapling outcomes are not as good as those following an open approach on long-term follow up, and the early advantages are eliminated if pouch excision is avoided.
Collapse
|
29
|
Patnaik U, Srivastava A, Sikka K, Thakar A. Surgery for vertigo: 10-year audit from a contemporary vertigo clinic. J Laryngol Otol 2015; 129:1182-7. [PMID: 26654639 DOI: 10.1017/S0022215115002935] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To present the profile of patients undergoing surgical treatment for vertigo at a contemporary institutional vertigo clinic. STUDY DESIGN A retrospective analysis of clinical charts. METHODS The charts of 1060 patients, referred to an institutional vertigo clinic from January 2003 to December 2012, were studied. The clinical profile and long-term outcomes of patients who underwent surgery were analysed. RESULTS Of 1060 patients, 12 (1.13 per cent) were managed surgically. Of these, disease-modifying surgical procedures included perilymphatic fistula repair (n = 7) and microvascular decompression of the vestibular nerve (n = 1). Labyrinth destructive procedures included transmastoid labyrinthectomy (n = 2) and labyrinthectomy with vestibular nerve section (n = 1). One patient with vestibular schwannoma underwent both a disease-modifying and destructive procedure (translabyrinthine excision). All patients achieved excellent vertigo control, classified as per the American Academy of Otolaryngology - Head and Neck Surgery 1995 criteria. CONCLUSION With the advent of intratympanic treatments, surgical treatments for vertigo have become further limited. However, surgery with directed intent, in select patients, can give excellent results.
Collapse
|
30
|
Pinto JA, Hernandes AC, Buchaim TP, Blumetti FC, Chertman C, Yamane PC, da Rocha Corrêa Fernandes A. RADIOGRAPHIC ABNORMALITIES OF THE TALUS IN PATIENTS WITH CLUBFOOT AFTER SURGICAL RELEASE USING THE MCKAY TECHNIQUE. Rev Bras Ortop 2011; 46:293-8. [PMID: 27047821 DOI: 10.1016/S2255-4971(15)30198-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2010] [Accepted: 11/29/2010] [Indexed: 11/24/2022] Open
Abstract
Objective: To analyze morphological abnormalities of the talus in patients with clubfoot after surgical treatment using the McKay technique. Method: Lateral standing-position radiographs of the feet of 14 patients with unilateral clubfoot who underwent treatment by means of the doubleincision McKay technique were retrospectively analyzed. All the patients were operated by the same surgeon, with an average of 6.53 years between surgery and the radiograph. We compared the radiographic characteristics of the talus between the operated and the contralateral foot. We assessed the presence of deformity of the talar dome and head (sphericity evaluation); the talar length and height; the percentage and degree of navicular subluxation; abnormalities of the Gissane angle; and the trabecular bone pattern. Results: Abnormalities of the talar head occurred in 92.8% of the patients; of the talar dome in 92.8%; and of the trabecular pattern in 100%. The talar length ratio between the operated and the contralateral foot ranged from 0.61 to 0.88 (mean 0.79; SD = 0.09), while the height ratio ranged from 0.57 to 0.98 (mean 0.82; SD = 0.12). The Gissane angle was greater in all of the operated feet, and all of them also showed navicular subluxation, at a rate ranging from 6.43 to 59.75% (mean 26.34%; SD = 16.66%). Conclusion: Talar abnormalities occurred in 100% of the feet treated using the McKay technique. It was shown that establishing radiographic parameters to describe and quantify these deformities was feasible, through simple and easy-to-perform techniques.
Collapse
|
31
|
Nouri S, Sharif MR, Afzali H, Sharif A, Satkin M. The Advantages and Disadvantages of Methods Used to Control Liver Bleeding: A Review. Trauma Mon 2015; 20:e28088. [PMID: 26839866 PMCID: PMC4727474 DOI: 10.5812/traumamon.28088] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Revised: 08/15/2015] [Accepted: 08/17/2015] [Indexed: 01/22/2023] Open
Abstract
Context: Despite advancements in the science of surgery, minimizing bleeding from parenchymal tissue of the liver continues to be one of the challenges surgeons are facing to protect patients’ lives. However, the number of surgeries needing incisions in the liver tissue, e.g. metastatectomy, is constantly increasing. Evidence Acquisition: A MEDLINE and conventional search of the past 50 years of the medical literature was performed to identify relevant articles on hemostasis in the liver parenchymal tissue. Results: The studies that have been published on hemostasis in the liver parenchymal tissue can be classified into 3 categories: 1. surgical procedures; 2. methods affecting body hemodynamic; 3. pharmacological methods. The purpose of these studies are to identify the best therapeutic approaches that not only minimize the bleeding, but also save the maximum amount of the liver tissue and minimize the use of partial liver resections. Conclusions: The excessive blood loss and the long time needed to control the bleeding during liver surgery impose several side effects and complications on patients. Topical hemostatic agents such as ferric chloride, potassium aluminum sulfate (alum) and aluminum chloride are safely applicable in patients. These agents might be used along with other current methods to minimize the blood loss and the need for blood products during liver surgeries.
Collapse
Affiliation(s)
- Saeed Nouri
- Department of Neurology, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | - Mohammad Reza Sharif
- Trauma Research Center, Kashan University of Medical Sciences, Kashan, IR Iran
- Corresponding author: Mohammad Reza Sharif, Trauma Research Center, Kashan University of Medical Sciences, Kashan, IR Iran. Tel: +98-9123788713, Fax: +98-3615558900, E-mail:
| | - Hasan Afzali
- Trauma Research Center, Kashan University of Medical Sciences, Kashan, IR Iran
| | - Alireza Sharif
- Trauma Research Center, Kashan University of Medical Sciences, Kashan, IR Iran
| | - Mojtaba Satkin
- Behavioral Sciences Research Center, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
| |
Collapse
|
32
|
Sawaia RN, Belangero WD. THE MINUS(®) SYSTEM MINIMALLY INVASIVE TECHNIQUE FOR THE TREATMENT OF TRANTROCHANTERIC FRACTURES. Rev Bras Ortop 2012; 47:113-7. [PMID: 27027090 DOI: 10.1016/S2255-4971(15)30354-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2010] [Accepted: 05/25/2011] [Indexed: 11/20/2022] Open
Abstract
The MINUS system was developed as a minimally invasive procedure that uses a diaphyseal cephalic extramedullary implant for the treatment of transtrochanteral fractures of the femur in elderly patients. The implant consists of a sliding screw coupled to a plate adapted to the minimally invasive technique. The surgical access is approximately three centimeters in length located on the lateral surface of the hip, below the projection of the small trochanter. A perfectly adapted instrument was used for the procedure, which also requires the use of an image intensifier, reducing surgery time and rate of bleeding. The objective of this study is to present a new instrument and implant, developed specifically for treatment with the minimally invasive technique, reducing the length of the conventional surgical access from 10 to three centimetres. This new implant was given the commercial name of MINUS System.
Collapse
|
33
|
Hosseini S, Salek R, Nasrolahi H, Mohammadianpanah M, Judi M. Small Cell Carcinoma of the Esophagus: Clinicopathological Features and Outcome of 22 Cases. Iran Red Crescent Med J 2015; 17:e20353. [PMID: 26734479 PMCID: PMC4698141 DOI: 10.5812/ircmj.20353] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Revised: 03/26/2015] [Accepted: 04/28/2015] [Indexed: 12/26/2022]
Abstract
BACKGROUND Small cell esophageal carcinoma (SCEC) is a highly aggressive and rare neoplasm. OBJECTIVES This study aimed to report the characteristics, prognostic factors, and treatment outcomes of 22 patients with SCEC. PATIENTS AND METHODS This brief report was carried out by reviewing the medical records of 22 patients with newly histologically proven SCEC that were treated between 2000 and 2010 at 2 tertiary academic hospitals. All the potential prognostic variables, including the patients' characteristics, tumor features, and treatment modalities were analyzed to establish their influence on the patients' survival rates. RESULTS This study was conducted on 7 males and 15 females with a median age of 61 years. Dysphagia and weight loss were the most prevalent symptoms. According to the results, 14 patients (64%) had limited diseases and 8 cases (36%) had extensive diseases. In those with extensive diseases, liver, lung, and lymph nodes (LNs) were the most metastatic sites. Besides, most tumors were located in lower (50%) and middle (32%) part of the esophagus. Most patients (91%) were treated with sequential (55%) or concurrent (36%) chemoradiation (CRT). Surgical resection was also performed for 7 patients. Chemotherapy regimen consisted of cisplatin and etoposide in 14 patients (64%). The median follow up time was 12 months. The 1, 3, and 5-year overall survival rates were 27%, 14%, and 4%, respectively. Yet, no prognostic factors were found because of the small sample size of the study. CONCLUSIONS Primary SCEC is a rare and highly aggressive tumor. However, prognosis is poor and long-term survival is exceptional. CRT could be an appropriate alternative to operation.
Collapse
Affiliation(s)
- Sare Hosseini
- Cancer Research Centre, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, IR Iran
| | - Roham Salek
- Cancer Research Centre, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, IR Iran
- Corresponding Author: Roham Salek, Cancer Research Centre, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, IR Iran. Tel/Fax: +98-5138414499, E-mail:
| | | | | | - Mona Judi
- Cancer Research Centre, Mashhad University of Medical Sciences, Mashhad, IR Iran
| |
Collapse
|
34
|
Omidi-Kashani F, Ebrahimzadeh MH, Salari S. Lumbar spondylolysis and spondylolytic spondylolisthesis: who should be have surgery? An algorithmic approach. Asian Spine J 2014; 8:856-63. [PMID: 25558333 DOI: 10.4184/asj.2014.8.6.856] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Revised: 07/27/2014] [Accepted: 08/03/2014] [Indexed: 11/29/2022] Open
Abstract
Lumbar spondylolysis and spondylolisthesis are common spinal disorders that most of the times are incidental findings or respond favorably to conservative treatment. In a small percentage of the patients, surgical intervention becomes necessary. Because too much attention has been paid to novel surgical techniques and new modern spinal implants, some of fundamental concepts have been forgotten. Identifying that small but important number of patients with lumbar spondylolysis or spondylolisthesis who would really benefit from lumbar surgery is one of those forgotten concepts. In this paper, we have developed an algorithmic approach to determine who is a good candidate for surgery due to lumbar spondylolysis or spondylolisthesis.
Collapse
|
35
|
Baharestani B, Rezaei S, Jalili Shahdashti F, Omrani G, Heidarali M. Experiences in surgical closure of atrial septal defect with anterior mini-thoracotomy approach. J Cardiovasc Thorac Res 2014; 6:181-4. [PMID: 25320666 PMCID: PMC4195969 DOI: 10.15171/jcvtr.2014.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Accepted: 08/09/2014] [Indexed: 11/14/2022] Open
Abstract
Introduction: Anterior mini-thoracotomy approach is a good alternative to median sternotomy in Atrial Septal Defect (ASD) repair. Our purpose is to explain the details of our technique and peresent the results.
Methods: Seventy five patients with ASD (52 female and 23 male) were operated with anterior mini-thoracotomy approach in our tertiary center between March 2012 and March 2014. The mean age was 14±10 ranged from 2 to 42 years. Outcomes were defined according to cardiopulmonary and aortic cross-clump time, intensive care unit stay time, morbidity, mortality, the size of incision, the amount of post-operative bleeding, need for blood transfusion and reoperation.
Results: Mean Cardiopulmonary bypass time was 49.62 minutes (26 to 105 minutes) and mean aortic cross clamp time was 22.29±6.77 minutes (11 to 47 minutes). The mean amount of blood transfusion was 47.49± 62.22 mm (0 to 200 cc) and the mean chest tube drainage after surgery was 80.17 ±121.06 mm (0 to 600 cc). One patient re-operated for dehiscence of ASD surgical sutures and there was no reoperation for surgical bleeding or tamponade drainage in these patients. In 74 cases the defect was secundum type, in 2 patients it was sinus venosus type and in one with associated partial Anomalous repair.
Conclusion: Anterior thoracotomy approach is safe and may be the surgical technique of choice for secundum ASD repair in all age groups and we can utilize this technique also for more complicated kinds of surgery for instance, sinus venosus type ASD with or without Partial Anomalous Defect.
Collapse
Affiliation(s)
- Bahador Baharestani
- Interventional Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Shahabedin Rezaei
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Farshad Jalili Shahdashti
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Gholamreza Omrani
- Interventional Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mona Heidarali
- Cardiac Electrophysiology Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
36
|
Amoozgar H, Amirghofran AA, Salaminia S, Cheriki S, Borzoee M, Ajami G, Peiravian F. Evaluation of electrocardiographic changes after arterial switch operation. Int Cardiovasc Res J 2014; 8:99-104. [PMID: 25177672 PMCID: PMC4109044] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Revised: 04/14/2014] [Accepted: 05/20/2014] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Transposition of Great Arteries (TGA) is a serious congenital heart disease which can be accompanied by good outcomes with anatomic correction within the first few weeks of life. OBJECTIVES The present study aimed to evaluate electrocardiographic changes in the children with uncomplicated Arterial Switch Operation (ASO). PATIENTS AND METHODS Twelve lead electrocardiograms were obtained from thirty-three patients with TGA after ASO. Then, the patients' QT-dispersion and P-wave dispersion were compared to those of 33 age- and gender-matched individuals as the normal control group. Both groups were also evaluated by M-mode echocardiography. Student's t-test and Pearson correlation were used to analyze the data. Besides, P < 0.05 was considered as statistically significant. RESULTS The mean age of the patients and the control group was 41 ± 3.7 and 40.12 ± 4.2 months, respectively. Comparison of P wave, T wave, QRS complex, PR interval, QT segment, and corrected QT segment showed significant differences in the frequency of inverted T wave in pericardial leads [V3, V4, V5, and V6] (P = 0.004; more in patients), P wave amplitude in lead II (P < 0.001; more in patients), R wave amplitude in V1 (P = 0.016; smaller in patients), R and S waves amplitude in V6 (P = 0.004 and P = 0.001; taller in patients), corrected QT segment (in lead V5; P < 0.0001: prolonger in patients), and PR interval (P = 0.001; prolonger in patients). However, no significant differences were found regarding the vector axis and heart rate. Right bundle branch block (18% vs. 0%), Bifascicular (3% vs. 0%), and first-degree blocks (15% vs. 0%) were significantly more in the patients. Besides, the PR interval was longer in the corrected complex TGA (146 ± 24.4 vs. 127.7 ± 23.1, P = 0.001). Moreover, R/S ratio in lead V1 was significantly prolonger, among the patients (2.86 ± 3.35 vs. 0.706 ± 0.53, P = 0.002). Nonetheless, no significant was observed between the patients and controls concerning the mean of QT dispersion. On the other hand, the two groups were significantly difference in terms of P wave dispersion (25.7 ± 13.8 vs. 33.74 ± 12.9, P = 0.024). CONCLUSIONS In this study, first-degree block and right bundle branch were detected in the operated patients with TGA. Increased P dispersion in these patients may increase the risk of atrial arrhythmia. Thus, long-term follow-up is necessary in these patients.
Collapse
Affiliation(s)
- Hamid Amoozgar
- Cardiovascular Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran
| | - Ahmad Ali Amirghofran
- Department of Cardiac Surgery, Shiraz University of Medical Sciences, Shiraz, IR Iran
| | - Shirvan Salaminia
- Department of Cardiac Surgery, Shiraz University of Medical Sciences, Shiraz, IR Iran,Corresponding author: Shirvan Salaminia, Department of Cardiac Surgery, Shiraz University of Medical Sciences, Shiraz, IR Iran, Tel/Fax: +98-7116474298, E-mail:
| | - Sirous Cheriki
- Division of Pediatric Cardiology, Department of Pediatrics, Shiraz University of Medical Sciences, Shiraz, IR Iran
| | - Mohammad Borzoee
- Division of Pediatric Cardiology, Department of Pediatrics, Shiraz University of Medical Sciences, Shiraz, IR Iran
| | - Gholamhossein Ajami
- Division of Pediatric Cardiology, Department of Pediatrics, Shiraz University of Medical Sciences, Shiraz, IR Iran
| | - Farah Peiravian
- Department of Pediatric, Islamic Azad University, Kazerun Branch, Kazerun, IR Iran
| |
Collapse
|
37
|
Merrikhi A, Raji Asadabadi H, Beigi AA, Marashi SM, Ghaheri H, Nasiri Zarch Z. Comparison of percutaneous versus open surgical techniques for placement of peritoneal dialysis catheter in children: A randomized clinical trial. Med J Islam Repub Iran 2014; 28:38. [PMID: 25250279 PMCID: PMC4154274] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2013] [Accepted: 12/25/2013] [Indexed: 11/20/2022] Open
Abstract
UNLABELLED Background This research compares the outcomes of percutaneous technique and open surgical peritoneal dialysis catheter placement in children. METHODS In this randomized controlled trial, between 2010 and 2011,a total of 35 pediatric uremic patients were enrolled and randomized into two study groups. Follow up data included duration of operation (minute), duration of hospitalization (days) and onset time of peritoneal dialysis. Complications were considered as mechanical and infectious. RESULTS The percutaneous procedure was significantly faster than the open surgical technique (9.5 ± 1.81 versus 27.00 ± 2.61 minutes, p= 0.0001). The onset of dialysis was earlier in percutaneous insertion. There were no cases of hollow viscous perforation, early peritonitis and exit site infection at the 3rd, 7th, and 14th day in both groups. Complications in open surgical group were include wrapped omentum in 4 (23.5%), catheter malposition in 3 (17.6%),delayed exit site infection in 2 (11.7%), Incisional hernia in 1 (5.8%)and hemoperitoneum in 2 (11.7%)cases. Complications in percutaneous insertion group were include catheter malposition and wrapped omentum each in one case. CONCLUSION Percutaneous method with secure insertion of the catheter reduced the rate of some complications. Although they were not statistically significant, this technique reduces the time of hospitalization and operation without need to general anesthesia. The onset of dialysis was earlier significantly. Trial registry code: IRCT2013091514670N1.
Collapse
Affiliation(s)
- Alireza Merrikhi
- 1. Assistant Professor of Pediatric Nephrology, Alzahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Hojatollah Raji Asadabadi
- 2. Resident of Pediatric Surgery, Bahrami Children Hospital, Tehran University of Medical Sciences, Tehran, Iran.
| | - Ali Akbar Beigi
- 3. Associate Professor of Vascular Surgery, Alzahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Sayed Mahdi Marashi
- 4. Legal Medicine Research Center, Legal Medicine Organization,Tehran, Iran.
| | - Hafez Ghaheri
- 5. Assistant Professor of Vascular Surgery, Alzahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Zohre Nasiri Zarch
- 6. PhD Student in Educational Psychology, Department of Psychology, Faculty of Psychology, Shahid Beheshti University, Tehran, Iran.
| |
Collapse
|
38
|
Amoozgar H, Salaminia S, Amirghofran AA, Cheriki S, Borzoee M, Ajami G, Peiravian F. Evaluation of cardiac and valvular function after arterial switch operation: a midterm follow-up. Int Cardiovasc Res J 2013; 7:83-9. [PMID: 24757628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Revised: 06/15/2013] [Accepted: 07/28/2013] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES Transposition of Great Arteries (TGA) is a serious congenital heart disease and anatomic correction in the first few weeks of life has revealed good outcomes nowadays. In this study, we aimed to evaluate the myocardial and valvular function at midterm postoperative follow-up. PATIENTS AND METHODS In this study, thirty-three patients with TGA and Arterial Switch Operation (ASO) were evaluated by 2-dimensional, M-mode, Doppler, and pulsed Tissue Doppler. These patients were compared with 33 healthy children of the same age and gender as the normal control group. Student's t-test and Pearson correlation were used to analyze the data. Besides, P<0.05 was considered as statistically significant. RESULTS The mean follow up time was 40.9±5.6 months. Among the 33 patients with ASO, 6% had mild pulmonary stenosis, while 3% had mild pulmonary insufficiency. Aortic stenosis and aortic insufficiency of trivial to mild degree was seen in 12% and 12% of the patients, respectively. The patients' systolic velocity of tricuspid (S), early diastolic velocity of tricuspid (Ea), and late velocity of tricuspid valve (Aa) were significantly different from those of the controls (P<0.001). Also, pulmonary annulus diameter was significantly dilated in the patients compared to the controls (1.67±0.41 vs. 1.29±0.28, P≤0.001). Besides, aortic annulus diameter (1.56±0.42 vs. 1.24±0.21, P=0.001) and also aortic sinus diameter (2.06±0.41 vs. 1.44±0.34, P=0.002) were significantly dilated, while sinutuboar junction diameter (1.65±0.5 vs. 1.28±0.29, P=0.094) was not dilated. Left ventricular function was in the normal range. CONCLUSIONS This study showed good left ventricular function, but some abnormalities in lateral tricuspid tissue Doppler velocities. Neoaortic and pulmonary diameters were significantly dilated, while aortic and pulmonary insufficiencies were clinically insignificant in most of the patients. Long-term follow-up is necessary in these patients.
Collapse
|
39
|
Heidarian A, Abbasi H, Hasanzadeh Hoseinabadi M, Hajialibeyg A, Kalantar Motamedi SM, Seifirad S. Comparison of Knifelight Surgery versus Conventional Open Surgery in the Treatment of Carpal Tunnel Syndrome. Iran Red Crescent Med J 2013; 15:385-8. [PMID: 24349724 PMCID: PMC3838646 DOI: 10.5812/ircmj.4180] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/13/2012] [Revised: 06/13/2012] [Accepted: 07/08/2012] [Indexed: 12/31/2022]
Abstract
Background A variety of surgical treatment methods for carpal tunnel syndrome are introduced recently, including open surgery, endoscopic and the Knifelight. It is hypothesized that Knifelight method could decrease scar tenderness and time before return to daily activities for patients and is accompanied with less disturbance to fine sensory nerves. Objectives To compare the Knifelight instrument and open carpal tunnel release with respect to scar length, operation duration, recovery time needed before return to work and amount of pain three weeks after surgery in patients with neurophysiologically confirmed carpal tunnel syndrome. Patients and Methods Fifty nine patients with indication for carpal tunnel release randomly assigned into two groups: open (n=30) or Knifelight (n=29). The patients compared regarding scar length, operation duration, time to return to daily activities and amount of pain at three weeks after operation based on Visual Analog Scale. Results There was no significant differences regarding age and sex in the two groups. The scar length, operation duration and time before return to daily activities were significantly lower in the Knifelight group. Although the mean visual analogue scale of Knifelight group found to be lower than the other, it was not statistically significant. Conclusions The Knifelight technique is accompanied with advantages over the open surgery regarding operation time, scar length and time to return to daily activities. The pain relieve based on Visual Analog Scale was not statistically different from conventional open surgery.
Collapse
Affiliation(s)
- Amin Heidarian
- School of Medicine, Hamadan University of Medical Sciences, Hamadan, IR Iran
| | - Hamidreza Abbasi
- School of Medicine, Hamadan University of Medical Sciences, Hamadan, IR Iran
| | | | - Azin Hajialibeyg
- School of Medicine, Hamadan University of Medical Sciences, Hamadan, IR Iran
| | | | - Soroush Seifirad
- Endocrinology and Metabolism Research Center, Tehran University of Medical Sciences, Tehran, IR Iran
- Corresponding author: Soroush Seifirad, Endocrinology and Metabolism Research Center, Shariati Hospital, Tehran, IR Iran. Tel: +98-9355799979, Fax: +98-9355799979, E-mail:
| |
Collapse
|
40
|
Marlow WJ, Ralte P, Morapudi SP, Bassi R, Fischer J, Waseem M. Intramedullary fixation of diaphyseal clavicle fractures using the rockwood clavicle pin: review of 86 cases. Open Orthop J 2012; 6:482-7. [PMID: 23173024 PMCID: PMC3502893 DOI: 10.2174/1874325001206010482] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2012] [Revised: 10/03/2012] [Accepted: 10/04/2012] [Indexed: 11/22/2022] Open
Abstract
Aim: This study reports the safety, efficacy and functional and patient centred outcomes of the largest published series of patients treated with the Rockwood clavicle pin (intramedullary device) to date. Patients and Methods: A retrospective review of case notes, radiographs and follow-up by questionnaire was conducted. 86 patients were operated upon, 70 for acute fractures (group A) and 16 for non-union (group B). Results: Rate of non-union was 2 (2.9%) in group A and 0 in group B. Mean Disability of the Arm, Shoulder and Hand (DASH) scores were 5.9 for group A and 8.7 for group B. Satisfaction was rated as good or excellent in 61 (96.8%) of responders and all patients would have the procedure again. Pin prominence was the predominant complication in both groups and all patients underwent a second procedure for metalwork removal. Discussion: Rockwood clavicle pins are as effective as plates in achieving union and maintaining length, however the advantages of this less invasive technique should be weighed against the common complication of pin prominence and the inconvenience of removal of metalwork in all cases.
Collapse
Affiliation(s)
- William J Marlow
- Department of Trauma & Orthopaedics, Macclesfield District General Hospital, Victoria Road, Macclesfield, SK10 3BL, UK
| | | | | | | | | | | |
Collapse
|
41
|
Ghayem-Hasankhani E, Omidi-Kashani F. Generalized Ligamentous Laxity; a Parameter Should not to be Forgotten in Preoperative Planning of Adolescent Idiopathic Scoliosis. Iran Red Crescent Med J 2012; 14:702-4. [PMID: 23396267 PMCID: PMC3560538 DOI: 10.5812/ircmj.2554] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/04/2011] [Revised: 02/22/2012] [Accepted: 03/10/2012] [Indexed: 11/16/2022]
Abstract
BACKGROUND Many factors effect on management (surgical and nonsurgical) of adolescent idiopathic scoliosis (AIS). OBJECTIVES The purpose of this study was evaluation of the effects of generalized ligamentous laxity (GLL) on surgical treatment of AIS. MATERIALS AND METHODS 72 patients with AIS were studied between 2002 and 2009. 24 cases (33.4%) were placed in group A (normal) while 48 patients (66.6%) with GLL in group B. Our threshold for adding anterior approach was a curve which could not be corrected to < 50° on the supine lateral bending view. RESULTS The mean age and follow up period were 16.4 (12-22 years) and 3.8 (2-6.5 years), respectively. In the first group, 12 (50%) were operated with combined anterior and posterior approaches while in the later; there were only 6 (12.5%). Curve correction was 73.3% in patients with GLL and 57.1% in patients without it. Both of these differences were significant statistically (P = 0.001). CONCLUSIONS In preoperative planning of surgical treatment of AIS, GLL is an important factor. In this special group of patients due to much more flexibility, relatively larger scoliotic curves can be safely treated by single posterior approach.
Collapse
Affiliation(s)
- Ebrahim Ghayem-Hasankhani
- Orthopedic Research Center, Emam Reza Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Farzad Omidi-Kashani
- Orthopedic Research Center, Emam Reza Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
- Corresponding author: Farzad Omidi-Kashani, No 226, South Bozorgmehr 20, Sajad Street, Mashhad, Iran. Tel.: +98-9155149248, Fax: +98-5118595023, E-mail:
| |
Collapse
|
42
|
Du Y, Su T, Ding Y, Cao G. Effects of antiviral therapy on the recurrence of hepatocellular carcinoma after curative resection or liver transplantation. Hepat Mon 2012; 12:e6031. [PMID: 23166535 PMCID: PMC3500771 DOI: 10.5812/hepatmon.6031] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2011] [Revised: 01/09/2012] [Accepted: 02/02/2012] [Indexed: 02/07/2023]
Abstract
CONTEXT Hepatocellular carcinoma (HCC) is a fatal disease. Chronic hepatitis B virus (HBV) and/or hepatitis C virus (HCV) infection is the major cause of HCC. High viral replication rate and related hepatic/systematic inflammation are the major risk factors in HCC recurrence after hepatectomy or liver transplantation. EVIDENCE ACQUISITION Some of the carcinogenesis-related HBV mutations are also associated with poor prognosis for HCC patients. Antiviral therapy is an option for improving HCC prognosis after surgery. In case of HBV-associated HCC, treatment with interferon and nucleos(t)ide analogues (NAs), especially interferon, is effective in improving the prognosis. However, long-term use of NAs increases the possibility of developing drug-resistant viral mutations such as the HBV rtA181T/sW172 mutation, which increases the risk of HCC recurrence. RESULTS In cases of HCV-associated HCC, standard interferon with or without ribavirin therapy is effective in improving the prognosis of HCV-associated HCC; however, some HCV mutations, such as the amino acid substitution M91L, are associated with treatment failure and a poor prognosis. Therapeutic efficacy needs to be confirmed using largescale, randomized, placebo-controlled clinical trials. CONCLUSIONS Surveillance of viral mutations during antiviral treatment and a better understanding of the associations of HCC recurrence with viral load, inflammation-associated signaling, and environmental factors can aid the development of more effective strategies for the prevention of HCC recurrence after surgery.
Collapse
Affiliation(s)
- Yan Du
- Department of Epidemiology, Shanghai Key Laboratory of Medical Biodefense, Second Military Medical University, Shanghai, China
| | - Tong Su
- Department of Epidemiology, Shanghai Key Laboratory of Medical Biodefense, Second Military Medical University, Shanghai, China
| | - Yibo Ding
- Department of Epidemiology, Shanghai Key Laboratory of Medical Biodefense, Second Military Medical University, Shanghai, China
| | - Guangwen Cao
- Department of Epidemiology, Shanghai Key Laboratory of Medical Biodefense, Second Military Medical University, Shanghai, China
- Corresponding author: Guangwen Cao, Department of Epidemiology, Second Military Medical University, 800 Xiangyin Rd., Shanghai 200433, China. Tel.: +86-2181871060, Fax: +86-2181871060, E-mail:
| |
Collapse
|
43
|
Towliat Kashani SM, Mehrvarz S, Mousavi Naeini SM, Erfanian R. Milligan-Morgan Hemorrhoidectomy vs Stapled Hemorrhoidopexy. Trauma Mon 2012; 16:175-7. [PMID: 24749096 PMCID: PMC3989568 DOI: 10.5812/kowsar.22517464.3363] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2011] [Revised: 11/10/2011] [Accepted: 11/15/2011] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The stapled hemorrhoidopexy (SH) is a procedure for prolapse and hemorrhoids . At first SH seemed to be a good alternative for the Milligan Morgan (MM) hemorrhoidectomy and preliminary results in early 2000 confirmed it. However, further studies and evaluation of long-term results showed poorer outcomes. OBJECTIVES This study aimed to evaluate and compare the results of these 2 surgical procedures in terms of recovery, improvement of symptoms and incidence of complications. MATERIALS AND METHODS This study was conducted from April 2008 to August 2010. A total of 80 patients were divided into 2 groups of 40 each. In the SH group, there were 24 males (60%) and 16 females (40%) with a mean age of 48 ± 12.5 yrs. In the MM group, there were 30 males (75%) and 10 females (25%) with a mean age of 50.6 ± 17.3 yrs. Patients with grade 3 and 4 prolapsed hemorrhoids were entered in the study. Data were entered using SPSS software and analyzed using t-test and Chi-square test. RESULTS The two groups had no significant difference in terms of age or sex. Duration of surgery was 35 ± 7 minutes in the SH and 23.6 ± 13.5 minutes in the MM group. This difference was statistically significant (P = 0.000). Post-operative pain and complete pain relief was slightly lower in the MM group (not significant). Hospital stay was significantly longer in the MM group (P = 0.003). Return to work was similar in both groups. Three patients in the SH group (7.5%) and 2 in the MM group (5%) had hemorrhoid recurrence. CONCLUSIONS Both techniques are efficient treatment methods for grade III and IV hemorrhoids and are associated with greater than 95% recovery rate. Overall, outcomes are the same in both techniques. Lower postoperative pain was the only advantage of SH over MM technique.
Collapse
Affiliation(s)
| | - Shaban Mehrvarz
- Trauma Research Center, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
- Corresponding author: Shaban Mehrvarz, Trauma Research Center, Baqiyatallah University of Medical Sciences, Tehran, IR Iran Vanak, Square, Mollasadra Ave, Tehran, IR Iran, Tel-Fax: +98-2188033539, E-mail:
| | | | | |
Collapse
|
44
|
Sawaia RN, Galvão AFM, Oliveira FM, Secunho GR, Filho GV. MINIMALLY INVASIVE ANTEROLATERAL ACCESS ROUTE FOR TOTAL HIP ARTHROPLASTY. Rev Bras Ortop 2011; 46:183-8. [PMID: 27027008 PMCID: PMC4799206 DOI: 10.1016/s2255-4971(15)30237-8] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2010] [Accepted: 11/30/2010] [Indexed: 11/26/2022] Open
Abstract
Objective: The aim of this study was to present a minimally invasive anterolateral access route and to ascertain whether this enables total hip replacement without compromising the quality of the implant positioning, while maintaining the integrity of the gluteus muscles. Method: A retrospective study was conducted on 260 patients (186 females and 74 males) with an average age of 62 years. There were 18 bilateral cases, totaling 278 hips. All the patients had osteoarthritis and had undergone non-cemented total hip arthroplasty (metal-metal or metal-polyethylene) between October 2004 and December 2007. A minimally invasive anterolateral access route was used, measuring 7 to 10 cm in length, according to body weight and the size of the femoral head. The patients were assessed clinically regarding age, sex and presence of the Trendelenburg sign, and radiologically regarding acetabular and femoral positioning. Results: The acetabular inclination was between 30° and 40° in 78 patients, between 41° and 50° in 189 patients, and 51° or over in 11 patients. On anteroposterior radiographs to study femoral positioning, the positioning was central in 209 cases, 41 presented valgus deviation and 28 presented varus deviation. On lateral views, 173 were central, 67 anterior and 38 posterior. The mean duration of the procedure was 63 minutes. Regarding complications, there were five cases of infection, three of deep vein thrombosis, two of hip dislocation, 80 of lengthening of the lower limbs and five of shortening of the operated limb. The Trendelenburg sign was present in four cases, of which one showed superior gluteal nerve injury. Conclusion: The minimally invasive anterolateral access route made it possible to perform total hip arthroplasty without compromising the positioning of the implants, thereby maintaining the integrity of the gluteus muscles.
Collapse
Affiliation(s)
- Rogério Naim Sawaia
- Orthopedic Doctor, Specialist in Hip Surgery, Head of the Hip Group of the Hospital Municipal Antonio Giglio (HMAG-Osasco-SP), Staff Doctor of the Hospital Samaritano-SP
| | - Antonio Felipe Martensen Galvão
- Orthopedic Doctor, Medical Residency Preceptor in Orthopedics and Traumatology and Assistant of the Hip Group of the Hospital Municipal Antonio Giglio (HMAG-Osasco-SP); Orthopedic Doctor, Medical Residency Preceptor in Orthopedics and Traumatology and Assistant of the Hip Group of the Hospital Municipal Antonio Giglio (HMAG-Osasco-SP)
| | - Fernando Machado Oliveira
- Orthopedic Doctor, Medical Residency Preceptor in Orthopedics and Traumatology and Assistant of the Hip Group of the Hospital Municipal Antonio Giglio (HMAG-Osasco-SP)
| | - Guilherme Rondinelli Secunho
- Orthopedic Doctor, Medical Residency Preceptor in Orthopedics and Traumatology and Assistant of the Hip Group of the Hospital Municipal Antonio Giglio (HMAG-Osasco-SP)
| | - Geraldo Vilela Filho
- Orthopedic Doctor, Specialist in Hip Surgery at the Hospital Municipal Antonio Giglio (HMAG-Osasco-SP)
| |
Collapse
|
45
|
Abstract
Approximately 5-30% of the ovarian cancers are metastatic malignancies. The prevalence of metastatic ovarian tumors varies with the incidence rates and spread patterns of primary malignancies. We evaluated the prevalence, pre- and postoperative characteristics of metastatic ovarian cancer in Korean women. We reviewed the records for 821 ovarian malignancies with pathological consultation from 1996-2006 and recorded patient demographical, radiological, histopathological, and survival data. The study included 112 cases of histologically confirmed metastatic ovarian cancer. Metastatic ovarian cancer accounted for 13.6% of all ovarian malignancy, primarily arising from the gastrointestinal tract. The preoperative detection rate with imaging was 75%, and none of the radiological or serological features were useful for differential diagnosis. In multivariate analysis for prognostic variables, the only significant factor was the primary tumor site (p=0.004). Furthermore, extensive resection increased survival for some patients. The differential diagnosis of metastatic ovarian cancer can be problematic, so multiple diagnostic approaches are necessary. The extent of cytoreductive surgery for this type of tumor must be decided on a case-by-case basis.
Collapse
Affiliation(s)
- Sung-Jong Lee
- Department of Obstetrics and Gynecology, The Catholic University of Korea, Seoul, Korea
| | - Jeong-Hoon Bae
- Department of Obstetrics and Gynecology, The Catholic University of Korea, Seoul, Korea
| | - A-Won Lee
- Department of Pathology, The Catholic University of Korea, Seoul, Korea
| | - Seo-Yun Tong
- Department of Medical Statistics, The Catholic University of Korea, Seoul, Korea
| | - Yong-Gyu Park
- Department of Obstetrics and Gynecology, East-West Neo Medical Center, Kyunghee University, Seoul, Korea
| | - Jong-Sup Park
- Department of Obstetrics and Gynecology, The Catholic University of Korea, Seoul, Korea
| |
Collapse
|