151
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Lin S, Wang Y, Guan W. Fatal middle cerebral artery aneurysm from Mycobacterium tuberculosis infection. Clin Case Rep 2019; 7:580-582. [PMID: 30899501 PMCID: PMC6406166 DOI: 10.1002/ccr3.2006] [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: 11/04/2018] [Accepted: 12/06/2018] [Indexed: 11/12/2022] Open
Abstract
Aneurysms caused by Mycobacterium tuberculosis infection are a rare disease. For such patients, cerebral artery aneurysm is a rare but evenly fatal lesion that is not diagnosed in time; combined antituberculosis treatment and surgical intervention provide the best chance of cure.
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Affiliation(s)
- Shan Lin
- Department of Respiratory MedicineQinghai University Affiliated HospitalXiningChina
| | - Yan Wang
- Department of Respiratory MedicineQinghai University Affiliated HospitalXiningChina
| | - Wei Guan
- Department of Respiratory MedicineQinghai University Affiliated HospitalXiningChina
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152
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Abstract
Abdominal surgery might contribute to postoperative intraperitoneal adhesions, with a high rate of recurrence. In the present study, we aimed to analyze potential factors for the surgical intervention of operated adhesive postoperative small bowel obstruction (SBO) in pediatric patients and compare the outcomes of patients managed by conservative treatment or surgical operation for an episode of SBO.From January 2007 to January 2017, the records of 712 patients admitted with SBO to Children's Hospital, Chongqing Medical University, were reviewed retrospectively. The patients were divided according to surgical intervention or conservative management. Potential predictors for surgical intervention were investigated, including the initial operation data and the current clinical variables. A Cox regression model was used to determine the independent risk factors of surgical intervention. A systematic follow-up for recurrence was performed based on surgical intervention or conservative management.Among the 712 patients admitted with SBO, 266 patients were managed surgically and 446 patients were managed conservatively. In the multivariate analysis, the predictors for the surgical intervention included initial surgical features, such as elevated markers of inflammation (WBC, CRP), incision location (HR, 2.31; 95CI, 1.29-5.26; P = .031), and emergency procedure (HR, 1.46; 95%CI, 1.13-3.42; P = .014), and current variables, such as crampy pain (HR, 4.66; 95%CI, 1.69-9.48; P < .001), ascites (HR, 5.43; 95%CI, 1.84-13.76; P < .001) and complete small bowel obstruction (HR, 3.21; 95%CI, 1.45-8.74; P < .001). The median follow-up time (interquartile range) was 3.6 years (range, 1 month-8 years) for the entire study population. Twenty-one patients (9.2%) who had undergone surgical intervention were rehospitalized for a new SBO episode, as were 53 patients (14.9%) who had been managed conservatively (P = .028; OR, 1.72, 95% CI, 1.00-2.95).Operated adhesive postoperative SBO with the following characteristics should heighten vigilance for surgical intervention: an initial emergency procedure with midline incisions and the current strangulation status. New hospitalizations were lower after surgical management than conservative treatment.
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Affiliation(s)
- Yuhua Deng
- Department of Pediatric General Surgery and Liver Transplantation
| | - Yongming Wang
- Department of Pediatric General Surgery and Liver Transplantation
- Department of Neonatology
| | - Chunbao Guo
- Department of Pediatric General Surgery and Liver Transplantation
- Ministry of Education Key Laboratory of Child Development and Disorders, Children's Hospital, Chongqing Medical University, Chongqing, PR China
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153
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Abstract
Facioscapulohumeral muscular dystrophy (FSHD) also known as Landouzy-Dejerine disease, is an autosomal-dominant disorder of the skeletal muscles with the name according to the various muscle groups it affects: the face, shoulders and upper arms. It is the third most common genetic degenerative disorder of the skeletal muscles without specific patterns in all the affected individuals. At present there is no cure for the disease but numerous management strategies are available to improve the quality of life and prevent further degeneration of various muscle groups. This review aims to provide an insight on the management strategies for FSHD patients including both lifestyle and medical intervention.
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Affiliation(s)
- Junren Lu
- Department of Orthopedic Surgery, Zhongshan Hospital affiliated with Fudan University, Shanghai, China
| | - Zhenjun Yao
- Department of Orthopedic Surgery, Zhongshan Hospital affiliated with Fudan University, Shanghai, China
| | - Yi Yang
- Department of Orthopedic Surgery, Zhongshan Hospital affiliated with Fudan University, Shanghai, China
| | - Chi Zhang
- Department of Orthopedic Surgery, Zhongshan Hospital affiliated with Fudan University, Shanghai, China
- Address correspondence to:Dr. Chi Zhang and Dr. Jian Zhang, Department of Orthopedic Surgery, Zhongshan Hospital affiliated with Fudan University, 180 Fenglin Road, Shanghai 200032, China. E-mail: (CZ), zhang.jian@ zs-hospital.sh.cn (JZ)
| | - Jian Zhang
- Department of Orthopedic Surgery, Zhongshan Hospital affiliated with Fudan University, Shanghai, China
- Address correspondence to:Dr. Chi Zhang and Dr. Jian Zhang, Department of Orthopedic Surgery, Zhongshan Hospital affiliated with Fudan University, 180 Fenglin Road, Shanghai 200032, China. E-mail: (CZ), zhang.jian@ zs-hospital.sh.cn (JZ)
| | - Ying Zhang
- Department of Nursing, Zhongshan Hospital affiliated with Fudan University, Shanghai, China
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154
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Argenson JN, Arndt M, Babis G, Battenberg A, Budhiparama N, Catani F, Chen F, de Beaubien B, Ebied A, Esposito S, Ferry C, Flores H, Giorgini A, Hansen E, Hernugrahanto KD, Hyonmin C, Kim TK, Koh IJ, Komnos G, Lausmann C, Loloi J, Lora-Tamayo J, Lumban-Gaol I, Mahyudin F, Mancheno-Losa M, Marculescu C, Marei S, Martin KE, Meshram P, Paprosky WG, Poultsides L, Saxena A, Schwechter E, Shah J, Shohat N, Sierra RJ, Soriano A, Stefánsdóttir A, Suleiman LI, Taylor A, Triantafyllopoulos GK, Utomo DN, Warren D, Whiteside L, Wouthuyzen-Bakker M, Yombi J, Zmistowski B. Hip and Knee Section, Treatment, Debridement and Retention of Implant: Proceedings of International Consensus on Orthopedic Infections. J Arthroplasty 2019; 34:S399-S419. [PMID: 30348550 DOI: 10.1016/j.arth.2018.09.025] [Citation(s) in RCA: 94] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Key Words
- acute periprosthetic joint infection (PJI)
- antibiotic combination
- antibiotic duration
- antibiotic therapy
- antibiotic treatment
- biofilm
- chronic obstructive pulmonary disease (COPD)), and C-reactive protein (CRP) >115 mg/L (C), rheumatoid arthritis (R), indication prosthesis (I), male (M), exchange of mobile components (E), age > 80 years (80) (CRIME80) scores
- chronic renal failure (K), liver cirrhosis (L), index surgery (I), cemented prosthesis (C), and C-reactive protein (CRP) >115 mg/L (KLIC) score
- contraindications
- debridement antibiotics and retention of the prosthesis
- debridement, antibiotics, implant retention (DAIR)
- emergency management
- exchange of modular components
- failed debridement, antibiotics, implant retention (DAIR) management
- fluoroquinolone
- gram-negative acute periprosthetic joint infection (PJI)
- indications
- infection recurrence
- intra-articular antibiotic infusion
- irrigation
- irrigation and debridement
- irrigation solution
- length of antibiotics
- megaprosthesis
- methicillin-resistant Staphylococcus aureus (MRSA)
- pathogen identification
- patient optimization
- periprosthetic joint infection (PJI) recurrence
- povidone-iodine
- rifampicin
- risk stratification
- surgical factors
- surgical intervention
- surgical outcome
- surgical outcomes
- surgical site infection (SSI) recurrence
- surgical timing
- treatment failure
- treatment success
- two-stage exchange arthroplasty
- unicompartmental knee arthroplasty debridement, antibiotics, implant retention (DAIR)
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155
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Xu C, Yu T, Zhang G, Rajah GB, Wang Y, Li Y. Concordance between the interictal focal EEG pattern and MRI lesions as a predictor of a favorable surgical outcome in patients with epileptic spasms: a Chinese study. J Neurosurg Pediatr 2019; 23:422-431. [PMID: 30717039 DOI: 10.3171/2018.10.peds18380] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 10/29/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the electro-clinical features, etiology, treatment, and postsurgical seizure outcomes in patients with intractable epileptic spasms (ESs). METHODS The authors retrospectively studied the medical records of all patients who had presented with medically intractable ESs and had undergone surgery in the period between October 2009 and August 2015. The interictal electroencephalography (EEG) pattern, MRI studies, magnetoencephalography findings, and postsurgical seizure outcomes were compared. RESULTS Twenty-six patients, 12 boys and 14 girls (age range 3-22 years), were eligible for study inclusion. Of these 26 patients, 84.6% (22) presented with multiple seizure types including partial seizures (PSs) independent of the ESs (30.8%); ESs followed by tonic seizures (30.8%); myoclonic seizures (19.2%); tonic seizures (19.2%); ESs followed by PSs (19.2%); focal seizures with secondary generalization (15.4%); atypical absence (11.5%); PSs followed by ESs (7.7%); and myoclonic followed by tonic seizures (7.7%). Seventeen patients underwent multilobar resection and 9 underwent unilobar resection. At the last follow-up (mean 36.6 months), 42.3% of patients were seizure free (outcome classification [OC] 1), 23.1% had > 50% reduction in seizure frequency (OC2-OC4), and 34.6% had < 50% reduction in seizure frequency or no improvement (OC5 and OC6). Predictors of favorable outcomes included an interictal focal EEG pattern and concordance between interictal EEG and MRI-demonstrated lesions (p = 0.001 and 0.004, respectively). CONCLUSIONS A favorable surgical outcome is achievable in a highly select group of patients with ESs secondary to structural lesions. Interictal EEG can help in identifying patients with the potential for favorable resective outcomes.
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Affiliation(s)
- Cuiping Xu
- Departments of1Functional Neurosurgery and
- 2Beijing Institute of Functional Neurosurgery, Beijing, People's Republic of China; and
| | - Tao Yu
- Departments of1Functional Neurosurgery and
- 2Beijing Institute of Functional Neurosurgery, Beijing, People's Republic of China; and
| | - Guojun Zhang
- Departments of1Functional Neurosurgery and
- 2Beijing Institute of Functional Neurosurgery, Beijing, People's Republic of China; and
| | - Gary B Rajah
- 3Department of Neurosurgery, Wayne State University School of Medicine, Detroit, Michigan
| | - Yuping Wang
- 4Neurology, Xuanwu Hospital, Capital Medical University, Beijing
| | - Yongjie Li
- Departments of1Functional Neurosurgery and
- 2Beijing Institute of Functional Neurosurgery, Beijing, People's Republic of China; and
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156
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Chotanaphuti T, Courtney PM, Fram B, In den Kleef NJ, Kim TK, Kuo FC, Lustig S, Moojen DJ, Nijhof M, Oliashirazi A, Poolman R, Purtill JJ, Rapisarda A, Rivero-Boschert S, Veltman ES. Hip and Knee Section, Treatment, Algorithm: Proceedings of International Consensus on Orthopedic Infections. J Arthroplasty 2019; 34:S393-S397. [PMID: 30348575 DOI: 10.1016/j.arth.2018.09.024] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
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157
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Tumanyan SV, Shepelenko AV, Chekmezova SA. [Modern approaches to components of therapy of patients with diabetes mellitus operated on for malignant neoplasms of small pelvic organs]. Khirurgiia (Mosk) 2019:79-83. [PMID: 29992930 DOI: 10.17116/hirurgia2018779] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The purpose of this study was assessment of the effect of cytoflavin preparation inclusion in surgical treatment of patients with malignant neoplasms of small pelvic organs and diabetes mellitus. A prospective examination of 51 patients aged 56 to 76 years suffering from diabetes mellitus and malignant neoplasms of the pelvic organs was performed. Patients were divided into two groups: the first group consisted of 27 patients whose adaptive potential was characterized by tension of adaptation mechanisms, the second one - 24 patients with poor adaptation. In turn, in each group, patients were divided into subgroups depending on the treatment regimen: in the main subgroup of the first group (14 people) the treatment program was supplemented with cytoflavin (10 ml 2 times a day), in the main subgroup of the second group were 13 patients with cytoflavin supplement (20 ml 2 times a day). Patients of control groups underwent standard therapy. State of energy deficiency was assessed by methemoglobin, carbohemoglobin, P50, oxygen delivery, consumption and extraction. Concentration of glucose, lactate, lactate dehydrogenase was assessed. The results of the study showed clear relationship between the nature of changes in transport and oxygen consumption, adaptation adaptive reactions, allowing to identify mechanisms that characterize formation of various types of energy deficiency in perioperative period in patients with malignant diseases of the pelvic organs and diabetes. Use of cytoflavin contributed to a qualitative and effective correction of energy deficiency as well as reduction in the patients stay in the hospital.
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Affiliation(s)
- S V Tumanyan
- FGBU 'Rostov Research Institute of Oncology' of the Ministry of Health of the Russian Federation, 14th Line, 63, Rostov-on-Don, Russia
| | - A V Shepelenko
- FGBU 'Rostov Research Institute of Oncology' of the Ministry of Health of the Russian Federation, 14th Line, 63, Rostov-on-Don, Russia
| | - S A Chekmezova
- FGBU 'Rostov Research Institute of Oncology' of the Ministry of Health of the Russian Federation, 14th Line, 63, Rostov-on-Don, Russia
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158
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Yuan YS, Niu SP, Yu YL, Zhang PX, Yin XF, Han N, Zhang YJ, Zhang DY, Xu HL, Kou YH, Jiang BG. Reinnervation of spinal cord anterior horn cells after median nerve repair using transposition with other nerves. Neural Regen Res 2019; 14:699-705. [PMID: 30632511 PMCID: PMC6352579 DOI: 10.4103/1673-5374.247474] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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] [Indexed: 01/02/2023] Open
Abstract
Our previous studies have confirmed that during nerve transposition repair to injured peripheral nerves, the regenerated nerve fibers of motor neurons in the anterior horn of the spinal cord can effectively repair distal nerve and target muscle tissue and restore muscle motor function. To observe the effect of nerve regeneration and motor function recovery after several types of nerve transposition for median nerve defect (2 mm), 30 Sprague-Dawley rats were randomly divided into sham operation group, epineurial neurorrhaphy group, musculocutaneous nerve transposition group, medial pectoral nerve transposition group, and radial nerve muscular branch transposition group. Three months after nerve repair, the wrist flexion test was used to evaluate the recovery of wrist flexion after regeneration of median nerve in the affected limbs of rats. The number of myelinated nerve fibers, the thickness of myelin sheath, the diameter of axons and the cross-sectional area of axons in the proximal and distal segments of the repaired nerves were measured by osmic acid staining. The ratio of newly produced distal myelinated nerve fibers to the number of proximal myelinated nerve fibers was calculated. Wet weights of the flexor digitorum superficialis muscles were measured. Muscle fiber morphology was detected using hematoxylin-eosin staining. The cross-sectional area of muscle fibers was calculated to assess the recovery of muscles. Results showed that wrist flexion function was restored, and the nerve grew into the distal effector in all three nerve transposition groups and the epineurial neurorrhaphy group. There were differences in the number of myelinated nerve fibers in each group. The magnification of proximal to distal nerves was 1.80, 3.00, 2.50, and 3.12 in epineurial neurorrhaphy group, musculocutaneous nerve transposition group, medial pectoral nerve transposition group, and radial nerve muscular branch transposition group, respectively. Nevertheless, axon diameters of new nerve fibers, cross-sectional areas of axons, thicknesses of myelin sheath, wet weights of flexor digitorum superficialis muscle and cross-sectional areas of muscle fibers of all three groups of donor nerves from different anterior horn motor neurons after nerve transposition were similar to those in the epineurial neurorrhaphy group. Our findings indicate that donor nerve translocation from different anterior horn motor neurons can effectively repair the target organs innervated by the median nerve. The corresponding spinal anterior horn motor neurons obtain functional reinnervation and achieve some degree of motor function in the affected limbs.
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Affiliation(s)
- Yu-Song Yuan
- Peking University People's Hospital, Beijing, China
| | - Su-Ping Niu
- Peking University People's Hospital, Beijing, China
| | - You-Lai Yu
- The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu Province, China
| | | | | | - Na Han
- Peking University People's Hospital, Beijing, China
| | - Ya-Jun Zhang
- Peking University People's Hospital, Beijing, China
| | | | - Hai-Lin Xu
- Peking University People's Hospital, Beijing, China
| | - Yu-Hui Kou
- Peking University People's Hospital, Beijing, China
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159
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Abstract
Although acute osteomyelitis is rare in neonates, it might result in severe sequelae such as joint destruction and growth failure if it is not diagnosed and treated early. However, few studies have focused on the clinical features and treatment of this disease.A retrospective review of 17 cases of neonatal osteomyelitis, for which the patients underwent medical treatment alone or combined with surgery at the Children's Hospital of Zhejiang University School of Medicine between January 2009 and September 2016, was conducted. Medical treatment included the use of antibiotics and supportive care. Surgery was performed in cases with subperiosteal abscess (>1 cm) or clinical deterioration despite antibiotic therapy.All of the patients (11 men and 6 women) were term neonates. The main complaints were redness or swelling around the affected bone and fever. The most common sites were the femur (29.4%) and humerus (23.5%). There were 14 (82.35%) cases with positive cultures: Staphylococcus accounted for 71.43% (n = 10), followed by Salmonella (n = 1), Streptococcus pneumoniae (n = 1), Klebsiella pneumoniae (n = 1), and Escherichia coli (n = 1). X-rays (n = 14), ultrasound (n = 6), computed tomography (CT) (n = 5), or magnetic resonance imaging (MRI) (n = 7) were performed. Three of 14 x-rays were not pathological at the onset of the disease, while the positive rate of MRI in detecting osteomyelitis was 100%. Eleven of 17 cases underwent surgical drainage, and higher white blood cell (WBC) counts were found in patients requiring surgery (P < .05). The prognosis for all patients was good without severe sequelae with a mean follow-up period of 49.47 ± 23.43 months.In conclusion, the prognosis of neonatal osteomyelitis with early active treatment is good. MRI is advocated for detecting early osteomyelitis. Additionally, neonates with higher WBC count together with osteomyelitis have an increased risk for surgery.
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Affiliation(s)
| | - Bo Zhou
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Jing Du
- Department of Neonatology, Children's Hospital
| | - Lihua Chen
- Department of Neonatology, Children's Hospital
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160
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Mojhová M, Mikysková I, Dubová O, Homolková E, Mašek M, Zikán M. A case report of acute apendicitis in puerperium. Ceska Gynekol 2019; 84:341-344. [PMID: 31826630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVE This article stresses an impact of appropriate management work up in the diagnosis of acute apendicitis in puerperium. Atypical clinical symptoms may cause doubts in diagnosis and may delay necessary surgical intervention. DESIGN Case report. SETTINGS Department of Gynecology and Obstetrics, 1st Faculty of Medicine, Charles University, and Hospital Na Bulovce, Prague. METHODS We present a case report describing an atypical presentation of acute apendicitis in early puerperium. Due to atypical course of the disease and atypical imaging locality and morphology, there were doubts about the diagnosis of acute apendicitis, patient was treated conservativelly and the disease later resulted in extensive surgical intervention. CONCLUSION Acute appendicitis is the most common cause of non-urogenital morbidity in puerperium. Management of work up and timing of surgical intervention have key impact on maternal mortality and morbidity.
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161
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Vasconcelos MA, Oliveira EA, Simões E Silva AC, Dias CS, Mak RH, Fonseca CC, Campos APM, Steyerberg EW, Vergouwe Y. A Predictive Model of Postnatal Surgical Intervention in Children With Prenatally Detected Congenital Anomalies of the Kidney and Urinary Tract. Front Pediatr 2019; 7:120. [PMID: 31001505 PMCID: PMC6454042 DOI: 10.3389/fped.2019.00120] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 12/11/2018] [Accepted: 03/11/2019] [Indexed: 12/11/2022] Open
Abstract
The aim of this study was to identify predictive factors and develop a model to assess individualized risk of postnatal surgical intervention in patients with antenatal hydronephrosis. This is a retrospective cohort study of 694 infants with prenatally detected congenital anomalies of kidney and urinary tract with a median follow-up time of 37 months. The main event of interest was postnatal surgical intervention. A predictive model was developed using Cox model with internal validation by bootstrap technique. Of 694 patients, 164 (24%) infants underwent surgical intervention in a median age of 7.8 months. Predictors of the surgical intervention in the model were: baseline glomerular filtration rate, associated hydronephrosis, presence of renal damage and the severity of renal pelvic dilatation. The optimism corrected c statistic for the model was 0.84 (95%CI, 0.82-0.87). The predictive model may contribute to identify infants at high risk for surgical intervention. Further studies are necessary to validate the model in patients from other settings.
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Affiliation(s)
- Mariana A Vasconcelos
- Pediatric Nephrology Unit, Department of Pediatrics, Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Eduardo A Oliveira
- Pediatric Nephrology Unit, Department of Pediatrics, Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil.,Division of Pediatric Nephrology, Rady Children's Hospital San Diego, University of California, San Diego, San Diego, CA, United States
| | - Ana Cristina Simões E Silva
- Pediatric Nephrology Unit, Department of Pediatrics, Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil.,National Institute of Science and Technology (INCT) of Molecular Medicine, Belo Horizonte, Brazil
| | - Cristiane S Dias
- Pediatric Nephrology Unit, Department of Pediatrics, Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Robert H Mak
- Division of Pediatric Nephrology, Rady Children's Hospital San Diego, University of California, San Diego, San Diego, CA, United States
| | - Carolina C Fonseca
- Department of Pediatrics, Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Ana Paula M Campos
- Department of Pediatrics, Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Ewout W Steyerberg
- Department of Public Health, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Yvonne Vergouwe
- Department of Public Health, Erasmus University Medical Center, Rotterdam, Netherlands
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162
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Bonafede MM, Pohlman SK, Miller JD, Thiel E, Troeger KA, Miller CE. Women with Newly Diagnosed Uterine Fibroids: Treatment Patterns and Cost Comparison for Select Treatment Options. Popul Health Manag 2018; 21:S13-S20. [PMID: 29649369 DOI: 10.1089/pop.2017.0151] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [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: 11/12/2022] Open
Abstract
The primary objective of this study was to describe surgical treatment patterns among women with newly diagnosed uterine fibroids (UF). A secondary objective was to estimate the medical costs associated with other common surgical interventions for UF. Claims-based commercial and Medicare data (2011-2016) were used to identify women aged ≥30 years with continuous enrollment for at least 12 months before and after a new diagnosis of UF. Receipt of a surgical or radiologic procedure (hysterectomy, myomectomy, endometrial ablation, uterine artery embolization, and curettage) was the primary outcome. Health care resource utilization and costs were calculated for women with at least 12 months of continuous enrollment following a UF surgical procedure. Among women who met selection criteria, 31.7% of patients underwent a surgical procedure; 20.9% of these underwent hysterectomy. An increase was observed over time in the percentage of women undergoing outpatient hysterectomy (from 27.0% to 40.2%) and hysteroscopic myomectomy (from 8.0% to 11.5%). The cost analysis revealed that total health care costs for hysteroscopic myomectomy ($17,324) were significantly lower (P < 0.001) than those for women who underwent inpatient hysterectomy ($24,027) and those for women undergoing the 3 comparison procedures. Hysterectomy was the most common surgical intervention. Patients undergoing inpatient hysterectomy had the highest health care costs. Although less expensive, minimally invasive approaches are becoming more common; they are performed infrequently in patients with newly diagnosed UF. The results of this study may be useful in guiding decisions regarding the most appropriate and cost-effective surgical treatment for UF.
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Affiliation(s)
| | | | - Jeffrey D Miller
- 1 Truven Health Analytics, an IBM Company , Cambridge, Massachusetts
| | - Ellen Thiel
- 1 Truven Health Analytics, an IBM Company , Cambridge, Massachusetts
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163
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Nouhi M, Hadian M, Olyaeemanesh A. The clinical and economic consequences of practice style variations in common surgical interventions: A protocol for systematic review. Medicine (Baltimore) 2018; 97:e12439. [PMID: 30334941 PMCID: PMC6211928 DOI: 10.1097/md.0000000000012439] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Surgical intervention is one of the common therapeutic interventions applied to a vast class of diseases. Unwarranted variation in practice style in different locations is considered as practice style variations (PSVs), which cause undesirable effects on patient health status and economic consequences. The magnitude of the variations in surgical interventions and its effects on clinical outcomes of patients and also utilization of resources have been investigated in recent years. But the findings show considerable heterogeneities in magnitude and consequences. We develop a protocol to systematically review the current literature of PSV to explain the magnitude of PSV and its clinical and economic consequences. METHOD This systematic review will include observational and experimental studies to investigate magnitude and consequences of PSV in common surgical interventions, cardiovascular disease, urological, and ophthalmological diseases. Source of information is scientific databases, theses, clinical trials registrations website, and grey literature. A comprehensive electronic search will be conducted through PubMed, Web of Science, EBSCO, EMBASE, and Scopus databases. Studies are assessed systematically by 2 investigators. Methodological quality of the included studies is evaluated by the STROBE and CONSORT checklists. In case of data availability, we will pool findings of included studies by meta-analysis techniques in the CMA software. Subgroup analyses are based on the type of the interventions and selected diseases. RESULTS This study has ethical approval from ethical committee of Iran University of Medical Sciences, ethic code: IR.IUMS.REC1395.9221504203. The results will be published in a peer-reviewed journal. CONCLUSION A systematic review is considered as an appropriate scientific method for reaching a consensus on magnitude as well as consequences of PSV. Results of this study will help clinical experts to attain more knowledge about PSV and encourage them to use some tools such as clinical guidelines and shared decision making to alleviate its consequences.
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Affiliation(s)
- Mojtaba Nouhi
- School of Health Management and Information Sciences, Iran University of Medical Sciences
| | - Mohamad Hadian
- School of Health Management and Information Sciences, Iran University of Medical Sciences
| | - Alireza Olyaeemanesh
- National Institute of Health Research
- Health Equity Research Center, Tehran University of Medical Sciences, Tehran, Iran
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164
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Dahm P, Hollingsworth JM. A tale of two cities: Divergent management of patients with ureteral colic. CAN J EMERG MED 2018; 20:658-9. [PMID: 30205861 DOI: 10.1017/cem.2018.441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Jahdi F, Khabbaz AH, Kashian M, Taghizadeh M, Haghani H. The impact of calendula ointment on cesarean wound healing: A randomized controlled clinical trial. J Family Med Prim Care 2018; 7:893-897. [PMID: 30598929 PMCID: PMC6259546 DOI: 10.4103/jfmpc.jfmpc_121_17] [Citation(s) in RCA: 1] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Cesarean is one of the most common surgical interventions. Wound complications are one of the most common morbidities following cesarean section. Calendula promotes wound healing and might be effective in shortening the duration of wound healing. Limited researches have been done regarding the healing of this plant as the effect of this ointment on cesarean wound healing has not been studied. Therefore, the purpose of this study was to examine the impact of calendula on cesarean wound healing in primiparous females. METHODS This clinical trial involves 72 qualified primiparous females with surgical childbirth admitted in the Akbar-Abadi Educational Hospital. They were randomly categorized into two groups of experimental (n = 1) and control (n = 2) groups. The females in experimental group used calendula ointment every 12 h and the control group used hospital routine for 10 days. Wound healing was assessed on the 3rd, 6th, 9th days postcesarean using the REEDA scale (REEDA stands for redness, edema, ecchymosis, discharge, and approximation), which had criteria including redness, edema, ecchymosis, discharge, and approximation. The data were collected by demographic questionnaire and redness, edema were used Chi-square test and independent T-test for data analysis. RESULTS Seventy-two females were included in the study. Thirty-six cases in the drug group and 36 cases in control group were studied. The age of patients in the two groups did not differ significantly (27/17 ± 4/72, 28/97 ± 4/99 years, respectively; P = 0/276). Moreover, there was no significant difference between studied groups regarding the education level of patients and their husbands, the mother's job and the economic situation. CONCLUSION According to the results, using calendula ointment considerably increases the speed of cesarean wound healing so it can be used for quickening the cesarean healing.
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Affiliation(s)
- Fereshteh Jahdi
- Department of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | | | - Maryam Kashian
- Department of Obstetrics and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Mohsen Taghizadeh
- Department of Biochemistry and Nutrition, Kashan University of Medical Sciences, Kashan, Iran
| | - Hamid Haghani
- Department of Statistics, Tehran University of Medical Sciences, Tehran, Iran
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Dogra M, Samanta R, Singh P, Singh SR, Bajgai P, Sharma A, Bansal R, Gupta V, Dogra MR, Singh R. Surgical Intervention in Inciting Eyes of Patients with Sympathetic Ophthalmia: A Case Series and Review of Literature. Ocul Immunol Inflamm 2018; 27:1154-1159. [PMID: 30081702 DOI: 10.1080/09273948.2018.1497663] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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: 10/28/2022]
Abstract
Purpose: To analyze the outcomes of surgical procedures on inciting eye of patients with Sympathetic ophthalmia (SO). Methods: Retrospective study of patients with SO who underwent surgical procedures on inciting eyes between January 2000 and December 2015. Outcome measures included flare up of inflammation in either eye and change in visual acuity in the inciting eye. Results: Four SO patients underwent surgeries in their inciting eyes after adequate control of inflammation. Surgical procedures included penetrating keratoplasty, glaucoma drainage device implantation, pars plana vitrectomy, and silicon oil removal. Keratoplasty, glaucoma surgery, and silicon oil removal were well tolerated, with no flare up of disease. The patient who underwent pars plana vitrectomy, however, had a poor outcome. Conclusions: Surgical intervention in inciting eyes of patients with SO, after being adequately treated with oral steroids and immunosuppression, is a viable option for improving anatomic and functional outcomes in these eyes.
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Affiliation(s)
- Mohit Dogra
- Advanced Eye Center, Post Graduate Institute of Medical Education and Research (PGIMER) , Chandigarh , India
| | - Ramanuj Samanta
- Advanced Eye Center, Post Graduate Institute of Medical Education and Research (PGIMER) , Chandigarh , India
| | - Pallavi Singh
- Advanced Eye Center, Post Graduate Institute of Medical Education and Research (PGIMER) , Chandigarh , India
| | - Simar Rajan Singh
- Advanced Eye Center, Post Graduate Institute of Medical Education and Research (PGIMER) , Chandigarh , India
| | - Priya Bajgai
- Advanced Eye Center, Post Graduate Institute of Medical Education and Research (PGIMER) , Chandigarh , India
| | - Aman Sharma
- Department of Rheumatology, Post Graduate Institute of Medical Education and Research (PGIMER) , Chandigarh , India
| | - Reema Bansal
- Advanced Eye Center, Post Graduate Institute of Medical Education and Research (PGIMER) , Chandigarh , India
| | - Vishali Gupta
- Advanced Eye Center, Post Graduate Institute of Medical Education and Research (PGIMER) , Chandigarh , India
| | - Mangat R Dogra
- Advanced Eye Center, Post Graduate Institute of Medical Education and Research (PGIMER) , Chandigarh , India
| | - Ramandeep Singh
- Advanced Eye Center, Post Graduate Institute of Medical Education and Research (PGIMER) , Chandigarh , India
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167
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Kingston K, Curry EJ, Galvin JW, Li X. Shoulder adhesive capsulitis: epidemiology and predictors of surgery. J Shoulder Elbow Surg 2018; 27:1437-43. [PMID: 29807717 DOI: 10.1016/j.jse.2018.04.004] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 03/27/2018] [Accepted: 04/09/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND Adhesive capsulitis is characterized by a gradual, painful loss of shoulder motion. This study evaluated patient variables significantly associated with developing adhesive capsulitis compared with a sex-matched control group without adhesive capsulitis. We also sought to determine those factors associated with adhesive capsulitis patients requiring surgical intervention. METHODS All patients presenting to our hospital with adhesive capsulitis between 2004 and 2014 were identified. Demographic characteristics were collected, and a sex-matched control group was randomly generated from the electronic medical record and used for comparison. Patients who underwent surgical intervention for adhesive capsulitis were also identified, and factors associated with surgical intervention were identified with logistic regression analysis. RESULTS Included were 2190 adhesive capsulitis patients with a normal age distribution of 56.4 ± 13.1 years. Most were classified as overweight (30.7%) or obese (27.0%). Compared with controls, adhesive capsulitis patients were more likely to be younger (<50 vs. ≥50 years; odds ratio [OR], 0.69; P < .001), obese (OR, 1.26; P < .001), black/African American (OR, 1.71; P < .001), Hispanic/Latino (OR, 4.85; P < .001), or diabetic (OR, 1.12; P < .001) and less likely to have hypertension (OR, 0.93; P = .006). Overall, 361 subsequently underwent surgical intervention. Older patients, racial minorities, and government-sponsored/uninsured patients were significantly less likely to have surgery for adhesive capsulitis (P < .01), whereas workers' compensation patients were 8 times more likely to receive surgery compared with privately insured patients (P < .001). CONCLUSIONS Obesity and diabetes were significantly associated with adhesive capsulitis and should be considered modifiable patient factors. Additionally, younger patients and racial minorities were also significantly more likely to be diagnosed with adhesive capsulitis. Younger, white, and workers' compensation patients were more likely to receive surgery, whereas patients with government-sponsored or no insurance status were more likely to receive nonoperative treatment.
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168
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Abstract
Bilateral clavicle fractures are not frequently seen. To treat these injuries surgically or non-surgically is still a debatable issue. Implant option for surgical management is also in doubt. We would like to share our experience in treating a patient with bilateral clavicle fracture surgically. He had excellent outcomes in terms of function and radiology. Surgical option for bilateral clavicle fractures promises excellent outcome in terms of early rehabilitation and return in function.
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Affiliation(s)
- M Y Bajuri
- Department of Orthopaedics and Traumatology, Universiti Kebangsaan Malaysia, Cheras, Malaysia
| | - H W Boon
- Department of Orthopaedics and Traumatology, Universiti Kebangsaan Malaysia, Cheras, Malaysia
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169
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Cai YB, Chen HY, He JJ, Hu YT, Yang Q, Chen LB, Xiao Q, Ding KF. The role of surgical intervention in primary colorectal lymphoma: A SEER population-based analysis. Oncotarget 2018; 7:72263-72275. [PMID: 27708217 PMCID: PMC5342160 DOI: 10.18632/oncotarget.12344] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [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: 01/24/2016] [Accepted: 08/08/2016] [Indexed: 12/26/2022] Open
Abstract
Background Primary colorectal lymphoma (PCL) is a rare colorectal malignancy. The standard treatment and prognostic factors of PCL remain unexplored. Therefore, a large population-based study should be conducted to provide a detailed review of this disease. Methods We extracted the data of eligible patients with PCL registered in the SEER database from 1973 to 2011. All statistical analyses were performed using SPSS 19.0. Results A total of 2050 (61.3%) of the 3342 patients with PCL underwent surgical intervention, and 1292 (38.7%) patients received no surgical treatment. The median overall survival was 95 months, and patients receiving surgery exhibited significantly prolonged survival (adjusted HR =0.69, P <0.001). Young age, early tumor stage, and indolent lymphoma were independent predictors of improved survival. Further survival analyses demonstrated the potential benefit of surgery in patients with early tumor stage, right-sided lesions, or diffuse large B-cell PCL. Conversely, surgical intervention did not improve the survival of patients with advanced-stage, left-sided, or indolent PCL. Conclusion PCL is a rare tumor that can be effectively treated. Surgical intervention may play an important role in the treatment of PCL. Early tumor stage, a right-sided lesion, and diffuse large B-cell histological PCL seem to be the clinical characteristics of optimal surgical candidates.
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Affiliation(s)
- Yi-Bo Cai
- Department of Surgical Oncology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.,Cancer Institute, Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education, Key Laboratory of Molecular Biology in Medical Sciences, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Hai-Yan Chen
- Department of Surgical Oncology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.,Cancer Institute, Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education, Key Laboratory of Molecular Biology in Medical Sciences, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Jin-Jie He
- Department of Surgical Oncology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.,Cancer Institute, Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education, Key Laboratory of Molecular Biology in Medical Sciences, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Ye-Ting Hu
- Department of Surgical Oncology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.,Cancer Institute, Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education, Key Laboratory of Molecular Biology in Medical Sciences, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Qi Yang
- Department of Surgical Oncology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.,Cancer Institute, Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education, Key Laboratory of Molecular Biology in Medical Sciences, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Liu-Bo Chen
- Department of Surgical Oncology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.,Cancer Institute, Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education, Key Laboratory of Molecular Biology in Medical Sciences, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Qian Xiao
- Department of Surgical Oncology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.,Cancer Institute, Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education, Key Laboratory of Molecular Biology in Medical Sciences, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Ke-Feng Ding
- Department of Surgical Oncology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.,Cancer Institute, Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education, Key Laboratory of Molecular Biology in Medical Sciences, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
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170
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Imai R, Akimoto T, Kimura T, Kohara M, Shimizu T, Oka K, Shuto M, Asakura M, Nagayama I, Takeda SI, Yagisawa T, Muto S, Nagata D. Peritoneal Dialysis and Retroperitoneal Laparoscopic Radical Nephrectomy: A Favorable Experience With a Patient Complicated by Renal Cell Carcinoma. Clin Med Insights Case Rep 2017; 10:1179547617746362. [PMID: 29270039 PMCID: PMC5731611 DOI: 10.1177/1179547617746362] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 11/10/2017] [Indexed: 01/23/2023]
Abstract
Peritoneal dialysis (PD) is an accepted modality for managing end-stage kidney disease. We herein report a 75-year-old female patient on chronic PD who was complicated by renal cell carcinoma. She was successfully treated with retroperitoneal laparoscopic radical nephrectomy followed by a prompt resumption of the procedure. Various surgeries disturbing the abdominal wall integrity often disrupt the regular PD schedule, and using minimally invasive approaches is therefore an attractive therapeutic option. Our experience emphasizes the feasibility and safety of a retroperitoneal approach–based laparoscopic technique based on several empirical examples. However, systemic studies on this topic are obviously lacking, so we strongly recommend the accumulation of more cases similar to our own. Several surgical concerns that need to be dealt with among PD patients are also discussed.
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Affiliation(s)
- Reika Imai
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Shimotsuke-Shi, Japan
| | - Tetsu Akimoto
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Shimotsuke-Shi, Japan
| | - Takaaki Kimura
- Division of Renal Surgery and Transplantation, Department of Urology, Jichi Medical University, Shimotsuke-Shi, Japan
| | - Marina Kohara
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Shimotsuke-Shi, Japan
| | - Toshihiro Shimizu
- Division of Renal Surgery and Transplantation, Department of Urology, Jichi Medical University, Shimotsuke-Shi, Japan
| | - Kentaro Oka
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Shimotsuke-Shi, Japan
| | - Miwa Shuto
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Shimotsuke-Shi, Japan
| | - Maki Asakura
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Shimotsuke-Shi, Japan
| | - Izumi Nagayama
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Shimotsuke-Shi, Japan
| | - Shin-Ichi Takeda
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Shimotsuke-Shi, Japan
| | - Takashi Yagisawa
- Division of Renal Surgery and Transplantation, Department of Urology, Jichi Medical University, Shimotsuke-Shi, Japan
| | - Shigeaki Muto
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Shimotsuke-Shi, Japan
| | - Daisuke Nagata
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Shimotsuke-Shi, Japan
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171
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Monroy GL, Pande P, Nolan RM, Shelton RL, Porter RG, Novak MA, Spillman DR, Chaney EJ, McCormick DT, Boppart SA. Noninvasive in vivo optical coherence tomography tracking of chronic otitis media in pediatric subjects after surgical intervention. J Biomed Opt 2017; 22:1-11. [PMID: 29275547 PMCID: PMC5745859 DOI: 10.1117/1.jbo.22.12.121614] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Accepted: 12/15/2017] [Indexed: 05/12/2023]
Abstract
In an institutional review board-approved study, 25 pediatric subjects diagnosed with chronic or recurrent otitis media were observed over a period of six months with optical coherence tomography (OCT). Subjects were followed throughout their treatment at the initial patient evaluation and preoperative consultation, surgery (intraoperative imaging), and postoperative follow-up, followed by an additional six months of records-based observation. At each time point, the tympanic membrane (at the light reflex region) and directly adjacent middle-ear cavity were observed in vivo with a handheld OCT probe and portable system. Imaging results were compared with clinical outcomes to correlate the clearance of symptoms in relation to changes in the image-based features of infection. OCT images of most all participants showed the presence of additional infection-related biofilm structures during their initial consultation visit and similarly for subjects imaged intraoperatively before myringotomy. Subjects with successful treatment (no recurrence of infectious symptoms) had no additional structures visible in OCT images during the postoperative visit. OCT image findings suggest surgical intervention consisting of myringotomy and tympanostomy tube placement provides a means to clear the middle ear of infection-related components, including middle-ear fluid and biofilms. Furthermore, OCT was demonstrated as a rapid diagnostic tool to prospectively monitor patients in both outpatient and surgical settings.
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Affiliation(s)
- Guillermo L. Monroy
- University of Illinois at Urbana-Champaign, Department of Bioengineering, Urbana, Illinois, United States
- Beckman Institute for Advanced Science and Technology, Urbana, Illinois, United States
| | - Paritosh Pande
- Beckman Institute for Advanced Science and Technology, Urbana, Illinois, United States
| | - Ryan M. Nolan
- Beckman Institute for Advanced Science and Technology, Urbana, Illinois, United States
| | - Ryan L. Shelton
- Beckman Institute for Advanced Science and Technology, Urbana, Illinois, United States
- University of Illinois at Urbana-Champaign, Department of Electrical and Computer Engineering, Urbana, Illinois, United States
| | - Ryan G. Porter
- Carle Foundation Hospital, Department of Otolaryngology, Urbana, Illinois, United States
- University of Illinois at Urbana-Champaign, Carle–Illinois College of Medicine, Urbana, Illinois, United States
| | - Michael A. Novak
- Carle Foundation Hospital, Department of Otolaryngology, Urbana, Illinois, United States
- University of Illinois at Urbana-Champaign, Carle–Illinois College of Medicine, Urbana, Illinois, United States
| | - Darold R. Spillman
- Beckman Institute for Advanced Science and Technology, Urbana, Illinois, United States
| | - Eric J. Chaney
- Beckman Institute for Advanced Science and Technology, Urbana, Illinois, United States
| | | | - Stephen A. Boppart
- University of Illinois at Urbana-Champaign, Department of Bioengineering, Urbana, Illinois, United States
- Beckman Institute for Advanced Science and Technology, Urbana, Illinois, United States
- University of Illinois at Urbana-Champaign, Department of Electrical and Computer Engineering, Urbana, Illinois, United States
- University of Illinois at Urbana-Champaign, Carle–Illinois College of Medicine, Urbana, Illinois, United States
- Address all correspondence to: Stephen A. Boppart, E-mail:
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172
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Akimoto T, Yamazaki T, Kohara M, Nakagawa S, Kanai Y, Izawa S, Yamamoto H, Nakazawa E, Masuda T, Kobayashi T, Saito O, Muto S, Kusano E, Nagata D. Pleuroperitoneal Communication and Ovarian Cancer Complicating Peritoneal Dialysis: A Case Report of a Patient with End-Stage Kidney Disease. Clin Med Insights Case Rep 2017; 10:1179547617735818. [PMID: 29085240 PMCID: PMC5648088 DOI: 10.1177/1179547617735818] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 09/05/2017] [Indexed: 12/31/2022]
Abstract
Peritoneal dialysis has been a widely accepted modality for treating end-stage kidney disease, but a regular dialysis schedule can be seriously disrupted by various comorbid conditions requiring surgical intervention. A 40-year-old woman who had been receiving peritoneal dialysis was sequentially but separately complicated by pleuroperitoneal communication and ovarian cancer. Despite the need for temporary interruption of her peritoneal dialysis schedule, it was successfully resumed after the relevant surgeries for each disease. Several concerns regarding overall postoperative dialytic management strategies, including how to deal with the peritoneal dialysis catheter during the postoperative period as well as how long peritoneal dialysis should be interrupted, which remain an unresolved issue in the field of nephrology, are also discussed.
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Affiliation(s)
- Tetsu Akimoto
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Shimotsuke, Japan
| | - Tomoyuki Yamazaki
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Shimotsuke, Japan
| | - Marina Kohara
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Shimotsuke, Japan
| | - Saki Nakagawa
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Shimotsuke, Japan
| | - Yoshihiko Kanai
- Division of Thoracic Surgery, Department of Medicine, Japan Community Health Care Organization Utsunomiya Hospital, Utsunomiya, Japan
| | - Sayoko Izawa
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Shimotsuke, Japan
| | - Hisashi Yamamoto
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Shimotsuke, Japan.,Division of Nephrology, Department of Medicine, Japan Community Health Care Organization Utsunomiya Hospital, Utsunomiya, Japan
| | - Eiko Nakazawa
- Division of Nephrology, Department of Medicine, Japan Community Health Care Organization Utsunomiya Hospital, Utsunomiya, Japan
| | - Takahiro Masuda
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Shimotsuke, Japan
| | - Takahisa Kobayashi
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Shimotsuke, Japan
| | - Osamu Saito
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Shimotsuke, Japan
| | - Shigeaki Muto
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Shimotsuke, Japan
| | - Eiji Kusano
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Shimotsuke, Japan.,Division of Nephrology, Department of Medicine, Japan Community Health Care Organization Utsunomiya Hospital, Utsunomiya, Japan
| | - Daisuke Nagata
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Shimotsuke, Japan
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173
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Abstract
RATIONALE Solitary eosinophilic granuloma (EG), the most benign, common form of Langerhans cell histiocytosis, has a self-limiting process and is associated with a good prognosis. Immobilization is recommended as the first treatment strategy for solitary EG, although the treatment protocols are still controversial. Radiotherapy and surgery are secondary treatment choices. Lesions of the upper cervical spine react differently to treatment because of their specific anatomical and motor features. PATIENT CONCERNS We discuss the case of a 29-year-old man with axis EG who underwent immobilization, radiotherapy, and finally surgery. DIAGNOSIS Eosinophilic granuloma (EG). INTERVENTIONS An initial conservative protocol, including immobilization with a collar and radiotherapy, effectively relieved his neck pain, whereas torticollis secondary to atlantoaxial subluxation was not improved. Therefore, he underwent tumor resection through the anterior approach and spinal reconstruction, fixation, and fusion through the posterior approach. OUTCOMES The deformity was well corrected and follow-up was satisfactory. LESSONS Upon review of the literature, we found that EG lesions affecting the axis have more risk factors for instability or deformity, and they have particular anatomical and motor characteristics; thus, they require more consideration and attention in terms of treatment, prognosis, and follow-up.
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Affiliation(s)
- Yu Song
- Department of Orthopedics, Union Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei
| | - Wen Geng
- Department of Ophthalmology, Shengjing Hospital of China Medical University, Shenyang, Liaoning
| | - Tao Guo
- Department of Pathology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yong Gao
- Department of Orthopedics, Union Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei
| | - Yukun Zhang
- Department of Orthopedics, Union Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei
| | - Shuai Li
- Department of Orthopedics, Union Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei
| | - Kun Wang
- Department of Orthopedics, Union Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei
| | - Ji Tu
- Department of Orthopedics, Union Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei
| | - Cao Yang
- Department of Orthopedics, Union Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei
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174
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Mathew MJ, Pruthi N, Savardekar AR, Tiwari S, Rao MB. Midline depressed skull fracture presenting with quadriplegia: A rare phenomenon. Surg Neurol Int 2017; 8:39. [PMID: 28458953 PMCID: PMC5369256 DOI: 10.4103/sni.sni_431_16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 10/29/2016] [Accepted: 01/03/2017] [Indexed: 11/22/2022] Open
Abstract
Background: Midline depressed skull fractures (MDSFs) deserve a special mention among skull fractures and should always be treated with caution. Here, an extremely unusual clinical presentation of a case of MDSF is highlighted along with its successful surgical management. Case Description: A 26-year-old male presented with quadriplegia following assault on the head with sharp weapons. The patient had multiple lacerated wounds on the scalp with underlying cranial fractures. On evaluation, computerized tomography (CT) of the brain showed a midline depressed skull fracture compressing the superior sagittal sinus (SSS) causing bilateral frontoparietal venous infarction. CT venogram showed a filling defect of the SSS due to the penetrating bone fragment. He underwent elevation of the depressed fracture and repair of the sinus with pericranial graft. Patient improved neurologically, and follow-up magnetic resonance venogram showed a patent SS. Conclusion: MDSF can present with quadriparesis/quadriplegia due to middle one-third SSS obstruction/thrombosis leading to bilateral motor cortical venous infarction. Such MDSFs may require emergent surgical elevation of the depressed bone fragment for restoration of the patency of the sinus.
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Affiliation(s)
- Manish J Mathew
- Department of Neurosurgery, NIMHANS, Bengaluru, Karnataka, India
| | - Nupur Pruthi
- Department of Neurosurgery, NIMHANS, Bengaluru, Karnataka, India
| | | | - Sarbesh Tiwari
- Department of Neuro-radiology, NIMHANS, Bengaluru, Karnataka, India
| | - Malla B Rao
- Department of Neurosurgery, NIMHANS, Bengaluru, Karnataka, India
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175
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Abstract
Williams-Beuren syndrome is a multisystem genetic disorder caused by hemizygous deletion on chromosome 7q11.23, encompassing about 28 genes including the elastin gene, ELN. Cardiovascular abnormalities are frequent and are related to elastin insufficiency. These abnormalities include supravalvular aortic stenosis (SVAS) in 70% of case, pulmonic valve stenosis, and renal artery stenosis. Definitive therapy for supravalvar aortic stenosis consists of surgical correction of the arteriopathies. Outcomes after surgical correction of SVAS depend on the extent of the arteriopathy and the presence of other associated lesions. We present a case of a 4-year-old boy, with Williams - Beuren syndrome with an SVAS. The patient was assessed with computerized tomography angiography to determine the extent of the aortopathy before surgical intervention.
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Affiliation(s)
- Neale Nicola Kalis
- Mohammed Bin Khalifa Bin Salman Al Khalifa Cardiac Center, Bahrain Defense Force Hospital, Manama, Kingdom of Bahrain
| | - Leena Khalifa Sulaibikh
- Mohammed Bin Khalifa Bin Salman Al Khalifa Cardiac Center, Bahrain Defense Force Hospital, Manama, Kingdom of Bahrain
| | - Saud Rashid Al Amer
- Mohammed Bin Khalifa Bin Salman Al Khalifa Cardiac Center, Bahrain Defense Force Hospital, Manama, Kingdom of Bahrain
| | - Haya Yousif Al Amer
- Mohammed Bin Khalifa Bin Salman Al Khalifa Cardiac Center, Bahrain Defense Force Hospital, Manama, Kingdom of Bahrain
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176
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Abstract
Breakage of epidural catheter though rare is a well-known but worrisome complication. Visualization of retained catheter is difficult even with modern radiological imaging techniques, and active surgical intervention might be necessary for removal of catheter fragment. We report such a case of breakage of an epidural catheter during its removal which led to surgical intervention.
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Affiliation(s)
| | - Amala G Kudalkar
- Department of Anaesthesiology, LTMMC and LTMGH, Sion, Mumbai, Maharashtra, India
| | - Smita M Gaikwad
- Department of Anaesthesiology, LTMMC and LTMGH, Sion, Mumbai, Maharashtra, India
| | - Shailendra Modak
- Department of Anaesthesiology, LTMMC and LTMGH, Sion, Mumbai, Maharashtra, India
| | - Hema B Gupta
- Department of Anaesthesiology, LTMMC and LTMGH, Sion, Mumbai, Maharashtra, India
| | - Bharati A Tendolkar
- Department of Anaesthesiology, LTMMC and LTMGH, Sion, Mumbai, Maharashtra, India
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177
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Tamkus A, Rice KS, Kim HL. Intraoperative Neuromonitoring Alarms: Relationship of the Surgeon's Decision to Intervene (or Not) and Clinical Outcomes in a Subset of Spinal Surgical Patients with a New Postoperative Neurological Deficit. Neurodiagn J 2017; 57:276-287. [PMID: 29236604 DOI: 10.1080/21646821.2017.1369236] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [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: 06/07/2023]
Abstract
BACKGROUND The goal of intraoperative neurophysiologic monitoring (IONM) is to minimize neurologic injury during surgery, yet patients still emerge with postoperative deficits. Few studies focus on outcomes relative to IONM alarms and interventions in this population. The authors sought to analyze the influence of IONM alarms with and without surgical intervention on patient outcome in spinal surgical patients who suffered immediate postoperative neurologic deficits. METHODS Of 62,038 spinal surgeries with multimodality IONM, 90 patients with new or worsened postoperative neurologic deficits and whose outcomes were reported immediate to the surgery and at discharge were analyzed. Outcomes at discharge were compared for surgeries in which an IONM alarm versus no alarm occurred. Outcomes where surgical intervention was performed versus not performed were also compared. RESULTS By discharge, 48 (53.3%) of 90 patients had complete or partial recovery of their postoperative deficit. Patients with IONM alarms and surgical interventions had an 80% (39/49) recovery rate overall versus only 26% (7/27) recovery rate of patients with IONM alarms but no interventions, and only 14% (2/14) of patients without IONM alarms and without interventions (P < 0.001). CONCLUSIONS These data showed significantly more patients recovered by the time of discharge when a surgical intervention was precipitated by an IONM alarm versus when it was not. The authors conclude that surgical interventions based on IONM alarms do improve patient outcomes despite immediate postoperative deficit.
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Affiliation(s)
- Arvydas Tamkus
- a Nuvasive Clinical Services (formerly Biotronic NeuroNetwork) , Ann Arbor , Michigan
| | - Kent S Rice
- a Nuvasive Clinical Services (formerly Biotronic NeuroNetwork) , Ann Arbor , Michigan
| | - Howard L Kim
- b Kaiser Permanente Oakland Medical Center , Oakland , California
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178
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Mousavi SH, Sekula RF, Gildengers A, Gardner P, Lunsford LD. Concomitant depression and anxiety negatively affect pain outcomes in surgically managed young patients with trigeminal neuralgia: Long-term clinical outcome. Surg Neurol Int 2016; 7:98. [PMID: 28168085 PMCID: PMC5223392 DOI: 10.4103/2152-7806.194145] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [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: 04/25/2016] [Accepted: 09/21/2016] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Onset of trigeminal neuralgia (TN) is uncommon in young adults with less favorable benefit from surgical interventions. The aim of this study was to evaluate the role of concomitant psychosomatic disorders in long-term surgical outcomes in this population. METHODS Twenty-one patients younger than 30 years of age were diagnosed initially as having medically refractory TN, and each patient underwent microvascular decompression (MVD) as initial surgical management. Correlation of clinical outcome and psychosomatic disorders (DSM-IV) was evaluated during a 15-year interval. RESULTS A total of 93 procedures were performed for the management of TN and subsequent iatrogenic craniofacial pain disorders. At a median of 81 months, 8 of 21 patients were free of facial pain. Fourteen patients with concomitant major depressive disorder (MDD) or other anxiety disorders underwent a higher median of procedures compared with 7 patients without known MDD or anxiety (4.5 versus 1 intervention, P = 0.038). Two of 14 patients who were diagnosed with MDD or other anxiety disorders were free of craniofacial pain, whereas 6 of 7 patients without mood or anxiety disorders were free of craniofacial pain (P = 0.0005). Thirteen patients developed treatment-related complications that required further surgical procedures. Presence of MDD or other anxiety disorders was associated with higher rate of complications (P = 0.026). One patient with past medical history of severe anxiety died of unknown causes. CONCLUSIONS In young patients with TN, comorbid MDD or anxiety disorders was associated with seeking multiple invasive procedures in multiple academic centers with limited benefit and high rates of surgical induced complications.
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Affiliation(s)
- Seyed H Mousavi
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Raymond F Sekula
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Ariel Gildengers
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Paul Gardner
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - L Dade Lunsford
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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Abstract
Aspirin-exacerbated respiratory disease (AERD) is a late onset condition characterized by the Samter triad (aspirin sensitivity [as well as sensitivity to any nonselective cyclooxygenase inhibitor], nasal polyps, asthma) and additional features, including eosinophilic chronic rhinosinusitis, hypereosinophilia, anosmia, frequent absence of atopy, and, intolerance to ingestion of red wine and other alcoholic beverages. The diagnosis is rare, and, because of this, it is also often missed by physicians. However, it is highly overexpressed in patients with severe asthma (and severe chronic rhinosinusitis with nasal polyps), which makes its recognition essential. For this review, we considered mechanisms involved in the pathogenesis of this disease and discussed the clinical symptoms of AERD. We also discussed the role of aspirin desensitization in the treatment of AERD. Also, we considered medications (e.g, leukotriene modifiers) and surgical interventions that have a role in the treatment of AERD.
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Affiliation(s)
- Joshua L. Kennedy
- From the Department of Pediatrics
- Department of Internal Medicine
- Arkansas Children's Research Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | | | - Larry Borish
- Department of Medicine
- Department of Microbiology, and
- Carter Immunology Center, University of Virginia Health Systems, Charlottesville, Virginia
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Abstract
Clinical Scenario: There are 2 approaches available for surgical repair of the Achilles tendon: open or percutaneous. However, there is controversy over which repair is superior. Focused Clinical Question: Which type of surgery is better in providing the best overall patient outcome, open or percutaneous repair, in physically active men and women with acute Achilles tendon ruptures? Summary of Search, "Best Evidence" Appraised, and Key Findings: The literature was searched for studies of level 3 evidence or higher that investigated the effectiveness of open repair versus percutaneous repair on acute Achilles tendon ruptures in physically active men and women. The literature search resulted in 3 studies for possible inclusion. All 3 good-quality studies were included. Clinical Bottom Line: There is supporting evidence to indicate that percutaneous repair is the best option for Achilles tendon surgery when it comes to the physically active population. Percutaneous repair has faster surgery times, less risk of complications, and faster recovery times over having an open repair, although it is acknowledged that every patient has a different situation and best individual option may vary patient to patient.
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181
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Noblett K, Benson K, Kreder K. Detailed analysis of adverse events and surgical interventions in a large prospective trial of sacral neuromodulation therapy for overactive bladder patients. Neurourol Urodyn 2016; 36:1136-1139. [PMID: 27491027 DOI: 10.1002/nau.23076] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 07/06/2016] [Indexed: 11/09/2022]
Abstract
INTRODUCTION The InSite trial is a prospective, multicenter study of sacral neuromodulation (SNM) therapy with the InterStim® System in subjects with overactive bladder (OAB). One of the primary aims of the study is to report on long-term safety of the tined lead. This analysis provides detailed descriptions of device-related adverse events (AEs) and surgical interventions to 12 months. METHODS Analysis included those subjects who completed test stimulation with a tined lead, received a full implant, and reported device-related AEs out to 12 months. A Clinical Events Committee (CEC) adjudicated AEs to 12 months. RESULTS Device-related AEs occurred in 30% (82/272) of subjects, with only one considered serious. Fifty-six percent of the device-related AEs occurred between implant and 3 months. The most frequent device-related AEs were undesirable change in stimulation (12%, 32/272); implant site pain (7%, 20/272); and implant site infection (3%, 9/272). Of the 26 events of implant site pain, 13 required surgical intervention, with only two resulting in explant. Ten subjects experienced 13 events of a surgical site infection (including an additional cellulitis), five of which resolved with antibiotics and eight required explantation. The overall surgical intervention rate was 13% with the most common reasons being pain at the surgical site (4%), lack/loss of efficacy (4%), and infection (3%). CONCLUSIONS Although a 30% AE rate was reported, most AEs were minor and were resolved without surgical intervention. Surgical intervention was required in 13% of subjects, with the majority being revision or replacement. Neurourol. Urodynam. 36:1136-1139, 2017. © 2016 Wiley Periodicals, Inc.
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van den Heuvel CNAM, Tijssen MAJ, van de Warrenburg BPC, Delnooz CCS. The Symptomatic Treatment of Acquired Dystonia: A Systematic Review. Mov Disord Clin Pract 2016; 3:548-558. [PMID: 30363468 DOI: 10.1002/mdc3.12400] [Citation(s) in RCA: 9] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 05/12/2016] [Accepted: 05/23/2016] [Indexed: 12/27/2022] Open
Abstract
Background Acquired dystonia is caused by an acquired or exogenous event. Although the therapeutic armamentarium used in clinical practice is more or less similar to that used for inherited or idiopathic dystonia, formal proof of the efficacy of these interventions in acquired dystonia is lacking. Methods The authors attempt to provide a comprehensive and systematic review of the current evidence for medical and allied health care treatment strategies in acquired dystonias. The PubMed, Cochrane Library, MEDLINE, Web of Science, PiCarta, and PsycINFO databases were searched up to December 2015, including randomized controlled trials, patient-control studies, and case series or single case reports containing a report on clinical outcome. Results There are level 3 practice recommendations for botulinum toxin injections and globus pallidus pars interna deep brain stimulation for tardive dystonia and dystonic cerebral palsy as well as intrathecal baclofen for dystonic cerebral palsy. There are insufficient and conflicting data on the effect (vs. the hazard) of other pharmacological interventions, and limited work has been done on other forms of neurostimulation and allied health care. Because no class A1 or A2 studies were identified, level 1 or 2 practice recommendations could not be deducted for a specific treatment intervention. Conclusions To improve the current medical and allied health care treatment options for patients with acquired dystonia, high-quality trials that examine the efficacy of therapies need to be performed.
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Affiliation(s)
- Corina N A M van den Heuvel
- Department of Neurology, Donders Institute for Brain, Cognition, and Behavior Radboud University Medical Center Nijmegen the Netherlands
| | - Marina A J Tijssen
- Department of Neurology University Medical Center Groningen Groningen the Netherlands
| | - Bart P C van de Warrenburg
- Department of Neurology, Donders Institute for Brain, Cognition, and Behavior Radboud University Medical Center Nijmegen the Netherlands
| | - Cathérine C S Delnooz
- Department of Neurology University Medical Center Groningen Groningen the Netherlands
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183
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Ranawat CS, Park CN, White PB, Meftah M, Bogner EA, Ranawat AS. Severe Hand Osteoarthritis Strongly Correlates With Major Joint Involvement and Surgical Intervention. J Arthroplasty 2016; 31:1693-7. [PMID: 26968694 DOI: 10.1016/j.arth.2016.01.044] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Revised: 01/13/2016] [Accepted: 01/25/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The presence of hand osteoarthritis (OA) increases the risk for developing OA in other major joints. Although genetic predisposition has been implicated in its causation, its exact role has yet to be established. The association of hand OA with symptomatic and asymptomatic major joints has not been previously studied. METHODS Hundred consecutive patients had a hand photo taken for visual documentation of the hand joints. Radiographs of hand and all major symptomatic joints were analyzed and classified using the Kellgren-Lawrence scale by 2 independent observers including an orthopedic radiologist. RESULTS Severe hand OA was present in 91% of the patients. Radiographic analysis showed that the hip was involved in 88% of the patients, of whom 85.2% (75) were symptomatic and 14.7% (13) were asymptomatic. Hip arthroplasty was required by 62.5% (55) of symptomatic hip patients. Knee involvement was present in 37% of the patients; all were symptomatic and 81.1% (30) of these required knee arthroplasty. Bilateral surgery was performed in 33% (28) and "2 joint (hip and knee)" surgery was performed in 6% (5). Spine involvement was present in 72% of the patients. There was a significant correlation between hand radiographic findings of OA and hip (r = 0.68; P = .03), knee (r = 0.58; P = .042), and spine (r = .39; P = .05) involvement. CONCLUSION There was a significant correlation between severe hand OA and hip, knee, and spine involvement. Severity of Hand OA can have a predictive value on multiple joint involvement and risk of surgical intervention. This study emphasizes the need to investigate the genetic predisposition in causation of OA.
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Rabensteiner J, Prüller F, Prattes J, Valentin T, Zollner-Schwetz I, Krause R, Hoenigl M. suPAR remains uninfluenced by surgery in septic patients with bloodstream infection. GMS Infect Dis 2016; 4:Doc04. [PMID: 30671318 PMCID: PMC6301737 DOI: 10.3205/id000022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Surgical trauma induces activation of the immune system and may cause an increase of inflammatory biomarkers tested postoperatively in septic patients treated for bloodstream infection. The aim of this study was to determine the impact of surgical interventions on the novel sepsis biomarker soluble urokinase plasminogen activator receptor (suPAR) and to compare results with those of routine laboratory parameters CRP, PCT, and IL-6 in patients with culture-proven bloodstream infection. Forty-six adult patients with positive blood culture undergoing minor or major surgical intervention were investigated, 12 blood culture positive patients served as control group. Blood was collected 24 hours before and after surgical intervention for determination of the sepsis biomarkers suPAR, CRP, PCT, and IL-6. Within the surgical study cohort, a non-significant increase of suPAR, CRP, and PCT was observed postoperatively (p 0.642; p 0.773; p 0.087). In contrast, a slight decrease of IL-6 (p 0.599) was observed. A significant correlation was calculated for the pre- and postoperative difference of CRP (p 0.028) and PCT (p 0.008) and type of surgical intervention received: after minor surgical intervention only PCT decreased significantly (p<0.001), while after major surgical interventions no significant differences were observed for all biomarkers evaluated. In the control group, a significant decrease of CRP (p 0.005) and PCT (p 0.005) was observed. In patients treated adequately for bloodstream infections, postoperative suPAR levels remained uninfluenced of the surgical trauma and might therefore be a reliable parameter for postoperative infectious monitoring. After minor surgical intervention, PCT seems to be the most reliable parameter.
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Affiliation(s)
- Jasmin Rabensteiner
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Austria
| | - Florian Prüller
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Austria
| | - Jürgen Prattes
- Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Austria
| | - Thomas Valentin
- Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Austria
| | - Ines Zollner-Schwetz
- Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Austria
| | - Robert Krause
- Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Austria
| | - Martin Hoenigl
- Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Austria.,Division of Infectious Diseases, Department of Medicine, University of California, San Diego, CA, USA
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185
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Gürsoy A, Candaş B, Güner Ş, Yılmaz S. Preoperative Stress: An Operating Room Nurse Intervention Assessment. J Perianesth Nurs 2016; 31:495-503. [PMID: 27931701 DOI: 10.1016/j.jopan.2015.08.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Revised: 06/08/2015] [Accepted: 08/08/2015] [Indexed: 11/29/2022]
Abstract
PURPOSE The purpose of this research study was to determine the effect of preoperative visits by the operating room (OR) nurse on patient stress levels before undergoing surgery. DESIGN This research was a quasi-experimental study. METHODS The research sample included patients (N = 179) who were hospitalized for surgery during 6 months in the general surgery department of a public hospital in the Eastern Black Sea Region. The OR nurse, part of the medical staff for surgery, visited patients in the experimental group 1 day before surgery. The OR nurse collected information that was consistent with the requirements of the patients. Patients in the control group were provided with preoperative care that was consistent with hospital procedure. Research data were collected using question forms, patient satisfaction scores, and Burford Distress Thermometer scale. Statistical evaluations included t tests and receiver operating characteristic analysis for independent groups. FINDING Most patients stated that they felt stressed because of the impending surgery. Patients made the following most common statements of the factors that caused stress; fear of unknown, anesthesia phobia, and fear of OR environment and complications that may occur during surgery. Patients in both groups experienced a significant decrease in postoperative stress levels. The perceived distress in the experimental group was significantly lower than the control group during the postoperative period. Patients in the experimental group reported that the OR nurse's visit effectively minimized their stress levels. CONCLUSIONS OR nurse visits to patients before surgery contributed to decreased preoperative stress levels.
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186
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Tan STS, Tan WPM, Jaipaul J, Chan SP, Sathappan SS. Clinical outcomes and hospital length of stay in 2,756 elderly patients with hip fractures: a comparison of surgical and non-surgical management. Singapore Med J 2016; 58:253-257. [PMID: 26915390 DOI: 10.11622/smedj.2016045] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [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: 12/21/2022]
Abstract
INTRODUCTION The purpose of this study was to compare the clinical outcomes of elderly hip fracture patients who received surgical treatment with those who received non-surgical treatment. METHODS This retrospective study involved 2,756 elderly patients with hip fractures who were admitted over a six-year period. The patients' biodata, complications, ambulatory status at discharge and length of hospital stay were obtained from the institution's hip fracture registry. RESULTS Among the 2,756 hip fracture patients, 2,029 (73.6%) underwent surgical intervention, while 727 (26.4%) opted for non-surgical intervention. The complication rate among the patients who underwent surgical intervention was 6.6%, while that among the patients who underwent non-surgical intervention was 12.5% (p < 0.01). The mean length of hospital stay for the surgical and non-surgical hip fracture patients was 15.7 days and 22.4 days, respectively (p < 0.01). CONCLUSION Surgical management of hip fractures among the elderly is associated with a lower complication rate, as well as a reduced length of hospital stay.
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Affiliation(s)
| | - Wei Ping Marcus Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Siew Pang Chan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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187
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Abstract
BACKGROUND This systematic review and meta-analysis of the clinical efficacy of different surgical methods in the therapy of popliteal cysts may provide evidence about effective surgical treatments. METHODS PubMed, EMBASE, and OVID were searched with the following terms: (popliteal cyst* OR baker's cyst*) AND (arthroscopic OR excision OR operative OR treat* OR surgery). Inclusion criteria included the following: studies reported the efficacy of different surgical methods in popliteal cyst patients; patients were ≥ 16 years; and studies must have involved a minimum of 10 patients. Studies were grouped according to the surgical methods, and a meta-analysis was employed to identify the success rate based on the pooled data. RESULTS A total of 11 studies were included: The communication between the cyst and the articular cavity was enlarged in 7 studies; this communication was closed in 3 studies; and only intra-articular lesions were managed in 1 study. After the data were pooled, the success rates were 96.7 and 84.6 % in the communication-enlargement group and communication-closure group, respectively. Studies with communication enlargement were subgrouped into the cyst wall resection group and the non-cyst wall resection group, for which the success rates were 98.2 and 94.7 %, respectively. CONCLUSIONS Based on the current available evidence, at present, any how arthroscopic excision of the cyst wall, arthroscopic management of intra-articular lesions, and enlarging the communication between the cyst and the articular cavity is an ideal strategy for the popliteal cyst. The current literature on the treatment of popliteal cysts is limited to retrospective case series. Future prospective studies with high-quality methodology and uniform scoring system are required to directly compare communication-enlargement surgery and communication-closure surgery and determine the optimal treatment of popliteal cysts. Cyst wall resection may improve the therapeutic efficacy, to draw definitive conclusions, and high-level clinical researches with a large number of patients and long-term follow-up should be initiated.
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Affiliation(s)
- Xiao-nan Zhou
- Department of Orthopaedics, Shengjing Hospital, China Medical University, 36 Sanhao Street, Heping District, Shenyang, Liaoning, 110004, People's Republic of China.
| | - Bin Li
- Department of Orthopaedics, Shengjing Hospital, China Medical University, 36 Sanhao Street, Heping District, Shenyang, Liaoning, 110004, People's Republic of China.
| | - Jia-shi Wang
- Department of Orthopaedics, Shengjing Hospital, China Medical University, 36 Sanhao Street, Heping District, Shenyang, Liaoning, 110004, People's Republic of China.
| | - Lun-hao Bai
- Department of Orthopaedics, Shengjing Hospital, China Medical University, 36 Sanhao Street, Heping District, Shenyang, Liaoning, 110004, People's Republic of China.
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188
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Shierk A, Lake A, Haas T. Review of Therapeutic Interventions for the Upper Limb Classified by Manual Ability in Children with Cerebral Palsy. Semin Plast Surg 2016; 30:14-23. [PMID: 26869859 DOI: 10.1055/s-0035-1571256] [Citation(s) in RCA: 7] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The aim of this literature review was to assemble an inventory of intervention strategies utilized for children diagnosed with cerebral palsy (CP) based on the Manual Ability Classification System (MACS). The purpose of the inventory is to guide physicians and therapists in intervention selection aimed at improving upper limb function in children with CP. The following databases were searched: CINAHL (Cumulative Index to Nursing and Allied Health Literature), Cochrane Database of Systematic Reviews, ERIC (Educational Research Information Center), Google Scholar, OTSeeker (Occupational Therapy Systematic Evaluation of Evidence), OVID (Ovid Technologies, Inc.), and PubMed. Inclusion criteria were whether the study (1) identified MACS levels of participants, and (2) addressed the effectiveness of intervention on upper limb function. Overall, 74 articles met the inclusion criteria. The summarized data identified 10 categories of intervention. The majority of participants across studies were MACS level II. The most frequently cited interventions were constraint-induced movement therapy (CIMT), bimanual training, and virtual reality and computer-based training. Multiple interventions demonstrated effectiveness for upper limb improvement at each MACS level. However, there is a need for additional research for interventions appropriate for MACS levels IV and V. To fully develop an intervention inventory based on manual ability, future studies need to report MACS levels of participants, particularly for splinting and therapy interventions used in combination with surgery.
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Affiliation(s)
- Angela Shierk
- Occupational Therapy, Texas Scottish Rite Hospital for Children, Dallas, Texas
| | - Amy Lake
- Occupational Therapy, Texas Scottish Rite Hospital for Children, Dallas, Texas
| | - Tara Haas
- Physical Medicine and Rehabilitation, Texas Children's Hospital, Houston, Texas
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189
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Zhang W, Okello E, Nyakoojo W, Lwabi P, Mondo CK. Proportion of patients in the Uganda rheumatic heart disease registry with advanced disease requiring urgent surgical interventions. Afr Health Sci 2015; 15:1182-8. [PMID: 26958019 DOI: 10.4314/ahs.v15i4.17] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
INTRODUCTION Since the establishment of the Uganda Rheumatic Heart Registry, over 900 patients have been enrolled. We sought to stratify the patients in the registry according to disease severity and optimal management strategy. METHODS We reviewed data of 618 patients who had enrolled in the Registry between March 2010 and February 2013. The 67 patients who had died were excluded leaving 551 patients who were recruited. The optimum management strategy was determined according to the 2012 European Society of Cardiology guidelines on the management of valvular heart disease. RESULTS Out of the 551 patient's records evaluated, 398 (72.3%) required invasive intervention, with 332(60.3%) patients requiring surgery and 66 (12.0%) requiring percutaneous mitral commissurotomy (PMC). This leaves only 27.7% of patients who required only medical management. Currently, majority of the patients (498, 90.4%) in the registry are on medical treatment. Of the 60.3% requiring surgical intervention, only 8.0% (44 patients) underwent valvular surgery and 5(1.0%) patients of the 66 (12.0%) underwent PMC successfully. CONCLUSION There is a high proportion of patients with severe disease that require surgical treatment yet they cannot access this therapy due to absence of local expertise.
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Plaschke K, Müller AK, Kopitz J. Surgery-induced changes in rat IL-1β and acetylcholine metabolism: role of physostigmine. Clin Exp Pharmacol Physiol 2015; 41:663-70. [PMID: 24890001 DOI: 10.1111/1440-1681.12267] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Revised: 05/19/2014] [Accepted: 05/21/2014] [Indexed: 11/30/2022]
Abstract
Pharmacological enhancement of cholinergic activity following administration of physostigmine is known to induce protective effects generally. However, it is unclear whether the effect of physostigmine on inflammation and acetylcholine (ACh) metabolism is related to different types of surgical intervention or anaesthesia alone. To investigate this, rats were subjected to partial liver resection (PLR) or sham surgery, with a control group receiving anaesthesia alone. Half of each treatment group received a single intra-operative dose of physostigmine (0.04 mg/kg); the others received placebo. Acetylcholinesterase (AChE) activity and plasma and brain concentrations of interleukin (IL)-1β and ACh were determined. Both PLR and sham operation induced a time-dependent increase in plasma concentrations of IL-1β compared with rats receiving anaesthesia alone (3.9- and 4.8-fold increases, respectively). In the brain, IL-1β concentrations had increased approximately twofold after surgery compared with the control group. Blood AChE was transiently decreased after surgery. Brain AChE activity increased 1.3-fold (P = 0.014) only after PLR; consequently, cerebral ACh concentrations were significantly reduced. Physostigmine administration significantly reduced IL-1β and AChE levels. Cerebral ACh concentrations were markedly increased from 544 ± 122 ng/mg protein following placebo administration to 654 ± 93 ng/mg protein after physostigmine administrations (P < 0.001). We conclude that a single dose of physostigmine intra-operatively has a sustained anti-inflammatory effect (up to 120 min after injection) that is especially pronounced under the conditions of PLR surgery. In addition to its protective peripheral action, physostigmine exerts a neuroprotective action by increasing levels of the neurotransmitter ACh.
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Affiliation(s)
- Konstanze Plaschke
- Department of Anaesthesiology, Experimental Anaesthesiology, Medical Faculty, University of Heidelberg, Heidelberg, Germany
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He W, Tu J, Huo Z, Li Y, Peng J, Qiu Z, Luo D, Ke Z, Chen X. Surgical interventions for gastric cancer: a review of systematic reviews. Int J Clin Exp Med 2015; 8:13657-13669. [PMID: 26550311 PMCID: PMC4612996] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2015] [Accepted: 05/28/2015] [Indexed: 06/05/2023]
Abstract
AIM To evaluate methodological quality and the extent of concordance among meta-analysis and/or systematic reviews on surgical interventions for gastric cancer (GC). METHODS A comprehensive search of PubMed, Medline, EMBASE, the Cochrane library and the DARE database was conducted to identify the reviews comparing different surgical interventions for GC prior to April 2014. After applying included criteria, available data were summarized and appraised by the Oxman and Guyatt scale. RESULTS Fifty six reviews were included. Forty five reviews (80.4%) were well conducted, with scores of adapted Oxman and Guyatt scale ≥ 14. The reviews differed in criteria for avoiding bias and assessing the validity of the primary studies. Many primary studies displayed major methodological flaws, such as randomization, allocation concealment, and dropouts and withdrawals. According to the concordance assessment, laparoscopy-assisted gastrectomy (LAG) was superior to open gastrectomy, and laparoscopy-assisted distal gastrectomy was superior to open distal gastrectomy in short-term outcomes. However, the concordance regarding other surgical interventions, such as D1 vs. D2 lymphadenectomy, and robotic gastrectomy vs. LAG were absent. CONCLUSION Systematic reviews on surgical interventions for GC displayed relatively high methodological quality. The improvement of methodological quality and reporting was necessary for primary studies. The superiority of laparoscopic over open surgery was demonstrated. But concordance on other surgical interventions was rare, which needed more well-designed RCTs and systematic reviews.
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Affiliation(s)
- Weiling He
- Department of Gastrointestinal and Pancreatic Surgery, Centre of Gastric Cancer, The First Affiliated Hospital, Sun Yat-sen UniversityGuangzhou 510080, Guangdong Province, P. R. China
| | - Jian Tu
- Musculoskeletal Center, Department of Orthopaedic Surgery, The First Affiliated Hospital, Sun Yat-sen UniversityGuangzhou City 510080, Guangdong Province, China
| | - Zijun Huo
- Department of Endocrinology, The First Affiliated Hospital of Sun Yat-sen UniversityGuangzhou City 510080, Guangdong Province, China
| | - Yuhuang Li
- Department of Molecular & Medical Genetics, Oregon Health & Science University3181 S.W. Sam Jackson Park Rd. Portland, Oregon 97239, USA
| | - Jintao Peng
- The Sixth Affiliated Hospital of Sun Yat-sen UniversityGuangzhou City 510080, Guangdong Province, China
| | - Zhenwen Qiu
- The First Affiliated Hospital, Guangzhou University of Chinese MedicineGuangzhou 510405, Guangdong Province, P. R. China
| | - Dandong Luo
- The First Affiliated Hospital, Guangzhou University of Chinese MedicineGuangzhou 510405, Guangdong Province, P. R. China
| | - Zunfu Ke
- Department of Pathology, The First Affiliated Hospital, Sun Yat-sen UniversityGuangzhou 510080, Guangdong Province, China
| | - Xinlin Chen
- School of Basic Medical Sciences, Guangzhou University of Chinese Medicine, Guangzhou Higher Education Mega CenterGuangzhou 510006, Guangdong Province, P. R. China
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192
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Windyga J, Dolan G, Altisent C, Katsarou O, López Fernández MF, Zülfikar B. Practical aspects of DDAVP use in patients with von Willebrand Disease undergoing invasive procedures: a European survey. Haemophilia 2015. [PMID: 26207933 DOI: 10.1111/hae.12763] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [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: 12/19/2022]
Abstract
INTRODUCTION Desamino D-arginine vasopressin (DDAVP or desmopressin) is a useful and effective haemostatic treatment for patients with von Willebrand Disease (VWD). However, there are still issues regarding in which subtypes of VWD DDAVP is appropriate and little consensus on its use in different surgical settings. We also lack information concerning the appropriate laboratory parameters that should be monitored. AIM The European Haemophilia Therapy Strategy Board (EHTSB) wished to investigate published information and clinical use of DDAVP in VWD patients. METHODS We conducted a literature survey on management of VWD during surgical interventions and undertook a survey of specialist haematologist centres across Europe to assess current management of VWD patients. RESULTS DDAVP is ineffective in type 3 VWD and its use in type 2B remains controversial due to the possibility of thrombocytopenia. It can, however, be used effectively to cover minor surgery and dental procedures in most other VWD patients. For major surgery there is wider use of factor concentrate in preference to DDAVP depending on the subtype of VWD. We give consensus recommendations on the use of DDAVP for surgical interventions in VWD including laboratory parameters that denote an adequate response and contraindications to its use. CONCLUSIONS DDAVP can be recommended to cover invasive procedure in selected patients with VWD, however, we need more information and systematic recording of adverse events associated with DDAVP use in VWD. A companion paper will be published covering the use of factor concentrates in VWD patients.
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Affiliation(s)
- J Windyga
- Department of Disorders of Hemostasis and Internal Medicine, Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | - G Dolan
- Queen's Medical Centre, University Hospital, Nottingham, UK
| | - C Altisent
- Servicio de Hematologia - Unidad de Hemofilia, Hospital Vall D'Hebron, Barcelona, Spain
| | - O Katsarou
- Thrombosis and Haemostasis Unit, Laikon General Hospital, Athens, Greece
| | - M-F López Fernández
- Servicio Hematologia, Complexo Hospitalario A Coruña, INIBIC. Avenida del Pasaje., La Coruña, Spain
| | - B Zülfikar
- Department of Pediatric Hematology, Istanbul University Cerrahpasa Faculty of Medicine, Cerrahpasa, Istanbul, Turkey
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Stake CE, Talbert PY, Hopkinson WJ, Daley RJ, Alden KJ, Domb BG. Hip Arthroplasty or Medical Management: A Challenging Treatment Decision for Younger Patients. J Arthroplasty 2015; 30:950-4. [PMID: 25682208 DOI: 10.1016/j.arth.2015.01.032] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Revised: 01/16/2015] [Accepted: 01/20/2015] [Indexed: 02/01/2023] Open
Abstract
The two main treatment options for total hip arthroplasty (THA), medical management and surgical intervention, have advantages and disadvantages, creating a challenging decision. Treatment decisions are further complicated in a younger population (≤50) as the potential need for revision surgery is probable. We examined the relationship of selected variables to the decision-making process for younger patients with symptomatic OA. Thirty-five participants chose surgical intervention and 36 selected medical management for their current treatment. Pain, activity restrictions, and total WOMAC scores were statistically significant (P < .05) for patients selecting surgical intervention. No difference in quality of life was shown between groups. Pain was the only predictor variable identified, however, activity restrictions were also influential variables as these were highly correlated with pain.
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Affiliation(s)
- Christine E Stake
- Hinsdale Orthopaedics, American Hip Institute in Westmont, Westmont, Illinois; University of Phoenix, Phoenix, Arizona
| | | | | | - Robert J Daley
- Hinsdale Orthopaedics, American Hip Institute in Westmont, Westmont, Illinois
| | - Kris J Alden
- Hinsdale Orthopaedics, American Hip Institute in Westmont, Westmont, Illinois
| | - Benjamin G Domb
- Hinsdale Orthopaedics, American Hip Institute in Westmont, Westmont, Illinois; Loyola University Chicago Stritch School of Medicine, Maywood, Illinois
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194
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Carballo-Molina OA, Velasco I. Hydrogels as scaffolds and delivery systems to enhance axonal regeneration after injuries. Front Cell Neurosci 2015; 9:13. [PMID: 25741236 PMCID: PMC4330895 DOI: 10.3389/fncel.2015.00013] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [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: 10/21/2014] [Accepted: 01/09/2015] [Indexed: 01/24/2023] Open
Abstract
Damage caused to neural tissue by disease or injury frequently produces a discontinuity in the nervous system (NS). Such damage generates diverse alterations that are commonly permanent, due to the limited regeneration capacity of the adult NS, particularly the Central Nervous System (CNS). The cellular reaction to noxious stimulus leads to several events such as the formation of glial and fibrous scars, which inhibit axonal regeneration in both the CNS and the Peripheral Nervous System (PNS). Although in the PNS there is some degree of nerve regeneration, it is common that the growing axons reinnervate incorrect areas, causing mismatches. Providing a permissive substrate for axonal regeneration in combination with delivery systems for the release of molecules, which enhances axonal growth, could increase regeneration and the recovery of functions in the CNS or the PNS. Currently, there are no effective vehicles to supply growth factors or cells to the damaged/diseased NS. Hydrogels are polymers that are biodegradable, biocompatible and have the capacity to deliver a large range of molecules in situ. The inclusion of cultured neural cells into hydrogels forming three-dimensional structures allows the formation of synapses and neuronal survival. There is also evidence showing that hydrogels constitute an amenable substrate for axonal growth of endogenous or grafted cells, overcoming the presence of axonal regeneration inhibitory molecules, in both the CNS and PNS. Recent experiments suggest that hydrogels can carry and deliver several proteins relevant for improving neuronal survival and axonal growth. Although the use of hydrogels is appealing, its effectiveness is still a matter of discussion, and more results are needed to achieve consistent recovery using different parameters. This review also discusses areas of opportunity where hydrogels can be applied, in order to promote axonal regeneration of the NS.
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Affiliation(s)
- Oscar A. Carballo-Molina
- Instituto de Fisiología Celular-Neurociencias, Universidad Nacional Autónoma de MéxicoMexico, D.F., Mexico
| | - Iván Velasco
- Instituto de Fisiología Celular-Neurociencias, Universidad Nacional Autónoma de MéxicoMexico, D.F., Mexico
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195
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Abstract
Sialorrhea or drooling represents quite a common problem in patients with amyotrophic lateral sclerosis (ALS). In this review, we describe the possible treatments for this issue. Current medical management is not always effective: anticholinergic drugs (atropine, glycopyrrolate, amitriptyline, hyoscyamine, and transdermal scopolamine) are often used, but there is very little evidence of their effectiveness in patients with ALS. More invasive treatments, such as botulinum toxin injections and/or radiation therapy in the salivary glands, can be considered when anticholinergic drugs are not effective. In this review, we also explore the possible surgical options for treatment of sialorrhea. Although no specific studies have been conducted on patients with ALS, surgical therapies might represent a valid option for treatment of sialorrhea since there is no tachyphylaxis or need for repeated therapeutic sessions.
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Affiliation(s)
| | - Nicola Ticozzi
- Unit of Neurology and Laboratory of Neuroscience, Istituto Auxologico Italiano, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy and the Department of Pathophysiology and Transplantation, Dino Ferrari Center, Università degli Studi di Milano, Milan, Italy
| | - Agata Lax
- Don Carlo Gnocchi Foundation, Milan, Italy
| | - Giulia Andrea Guidugli
- San Giuseppe Hospital, Ospedale Classificato, Istituto di Ricovero e Cura a Carattere Scientifico Multimedica, Milan, Italy
| | | | - Vincenzo Silani
- Unit of Neurology and Laboratory of Neuroscience, Istituto Auxologico Italiano, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy and the Department of Pathophysiology and Transplantation, Dino Ferrari Center, Università degli Studi di Milano, Milan, Italy
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Abstract
Purpose Examining the early and late results of adult urethroplasty in the adult patients. Materials and methods During the period from January 2006 to December 2013 at the Republican Specialized Center of Urology (training base of Tashkent Medical Academy) urethroplasty using various techniques was performed in 68 men. Mean age was 23.4 ±2.6 years (from 18 to 26 years). All patients have had previously foreskin removing (circumcision). Some form of surgical intervention on the penis was performed in 48 (70%) men formerly. Typically, earlier in childhood, there had been an unsuccessful attempt in urethroplasty in 39 patients, and straightening of the penis (excision of the chord) in seven cases. Dermal urethral fistula in the urethra was formed in 23 (34%) males: in 12 cases the aperture was situated in penoscrotal zone; in eight patients—in the shaft of the penis and in three patients - located in the coronary sulcus. Deformity of the penis due to insufficiently removing of the chord was in three patients. Causes of patients complaints were dissatisfaction with aesthetic appearance of the penis (all patients), the presence of a fistula and the absence of children after marriage (12 men). All the patients underwent routine clinical and laboratory investigations, biochemical analyzes, the investigation of sexual hormones levels, ultrasonography (to avoid abnormalities of the urinary tract) and uroflowmetry (to exclude bladder outlet obstruction). All patients have had an antibacterial therapy before the surgery in the case urinary tract of infection and urethroplasty was performed in the presence of sterile urine. Sine qua non of urethra plastic surgery was the decompression of the lower urinary tract, which was performed by setting a catheter into the bladder cavity via percutaneous suprapubic access. In to the neouretral lumen was performed of a small diameter catheter. Restoration of natural urination occurred 12-15 days after the surgery. Results The formation of the neourethra in all patients was completed in several stages. The first stage included the chord excision in seven patients with deformed penile curvature. S. E. Duplay method of urethral plastic surgery was performed in 32 (47%) patients, in 28 cases the meatus was formed at coronal sulcus, whereas in four men using glanduloplasty we managed to form the outer aperture of the urethra at the tip of the penis. After the surgery in 12 (37%) cases, because of purulent urethritis and wound dehiscence, the urinary fistulas were accured. The fistulas self-cured in two of the cases, in the remaining patients this occurred three months after the surgical repair. Due to the scarcity of the skin on the penis in 36 (53%) cases for the technique proposed by Cecil was used in creation of the urethra: the first stage creates the urethra and the skin defect on the penile skin flap is closed using the skin from the scrotum; the second stage (after three months) the uncoupling of the penoscrotal anastomosis was performed. After the Cecil surgery the purulent urethritis occurred in 10 (27%) patients, which caused the formation of urethral urinary fistulas in eight cases. After three months, urethral fistula was successfully eliminated surgically. It should be noted that in all patients in this group the urethral meatus was formed at the coronal sulcus, as the specialized nature of these operations according to Cecil do not provide another option. Conclusions Due to the scarcity of the skin on the penis in adult patients (including the lack of foreskin) urethroplasty should be performed in a multi-step process. There is no need to form the outer opening of the urethra on the penis balanus, however the location of the meatus on a physiological level allows for the best aesthetical result. Because of the risk of urethritis in men it is advisable before performing uretroplastic surgery to perform a derivation of urine using cystostomy.
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197
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Bonfield CM, Naran S, Adetayo OA, Pollack IF, Losee JE. Pediatric skull fractures: the need for surgical intervention, characteristics, complications, and outcomes. J Neurosurg Pediatr 2014; 14:205-11. [PMID: 24905840 DOI: 10.3171/2014.5.peds13414] [Citation(s) in RCA: 33] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Head trauma is a common cause of morbidity and mortality in the pediatric population and often results in a skull fracture. Pediatric skull fractures are distinct from adult fractures. Pediatric fractures have a greater capacity to remodel, but the pediatric brain and craniofacial skeleton are still developing. Although pediatric head trauma has been extensively studied, there is sparse literature regarding skull fractures. The authors' aim was to investigate the characteristics, injuries, complications, and outcomes of the patients in whom surgical intervention was needed for skull fractures. METHODS The authors performed a retrospective review of patients presenting to the emergency department of a pediatric Level I trauma center between 2000 and 2005 with skull fractures. Patient demographics, mechanism of injury, associated injuries, fracture bone involvement, surgical intervention, complications, and outcomes were analyzed. Groups treated nonoperatively, for skull fracture repair, and for traumatic brain injury were compared. RESULTS A total of 897 patients with a skull fracture were analyzed. Most patients (n = 772, 86.1%) were treated nonoperatively (Non-Op group). Fifty-eight patients (6.5%) underwent repair of the fracture (Repair group) and 67 (7.5%) required intervention for treatment of traumatic brain injury (TBI group). The Non-Op group was significantly younger, and the TBI group had a lower initial Glasgow Coma Scale (GCS) score. A fall (51.2%) was the most common mechanism of injury in the Non-Op group, whereas a motor vehicle crash (23.9%) and being hit in the head with an object (48.2%) were most prevalent in the TBI and Repair groups, respectively. Associated injuries were seen in all 3 groups, with brain injury (hematoma) being the most common. Frontal bone fracture was seen most in the Repair and TBI groups, and the parietal bone was the most frequent bone fractured in the Non-Op group. Patients in the TBI group were much more likely to have 2 or 3 skull bones fractured. In the Repair group, 36.2% had a complication (38.0% intervention related and 62.0% trauma related), but no patient had a worsening of their neurological status. In the TBI group, 48.7% of the patients suffered a complication, the vast majority (90.6%) of which were related to the trauma. CONCLUSIONS The majority of pediatric skull fractures can be managed conservatively. Of those requiring surgical intervention, fewer than half of the surgeries are performed solely for skull fracture repair only. Patients hit in the head with an object or involved in a motor vehicle crash are more likely to need surgical intervention either to repair the skull fracture or for TBI management, respectively. Frontal bone fractures are more likely to necessitate repair, and those patients treated for TBI have a greater incidence of 2 or 3 bones involved in the fracture. Complications occurred but most were related to underlying trauma, not the surgery. No patients who underwent intervention for repair of their skull fracture only had a worsening of their neurological status.
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198
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Nishi E, Takamizawa S, Iio K, Yamada Y, Yoshizawa K, Hatata T, Hiroma T, Mizuno S, Kawame H, Fukushima Y, Nakamura T, Kosho T. Surgical intervention for esophageal atresia in patients with trisomy 18. Am J Med Genet A 2013; 164A:324-30. [PMID: 24311518 DOI: 10.1002/ajmg.a.36294] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [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: 04/05/2013] [Accepted: 09/16/2013] [Indexed: 11/10/2022]
Abstract
Trisomy 18 is a common chromosomal aberration syndrome involving growth impairment, various malformations, poor prognosis, and severe developmental delay in survivors. Although esophageal atresia (EA) with tracheoesophageal fistula (TEF) is a potentially fatal complication that can only be rescued through surgical correction, no reports have addressed the efficacy of surgical intervention for EA in patients with trisomy 18. We reviewed detailed clinical information of 24 patients with trisomy 18 and EA who were admitted to two neonatal intensive care units in Japan and underwent intensive treatment including surgical interventions from 1982 to 2009. Nine patients underwent only palliative surgery, including six who underwent only gastrostomy or both gastrostomy and jejunostomy (Group 1) and three who underwent gastrostomy and TEF division (Group 2). The other 15 patients underwent radical surgery, including 10 who underwent single-stage esophago-esophagostomy with TEF division (Group 3) and five who underwent two-stage operation (gastrostomy followed by esophago-esophagostomy with TEF division) (Group 4). No intraoperative death or anesthetic complications were noted. Enteral feeding was accomplished in 17 patients, three of whom were fed orally. Three patients could be discharged home. The 1-year survival rate was 17%: 27% in those receiving radical surgery (Groups 3 and 4); 0% in those receiving palliative surgery (Groups 1 and 2). Most causes of death were related to cardiac complications. EA is not an absolute poor prognostic factor in patients with trisomy 18 undergoing radical surgery for EA and intensive cardiac management.
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Affiliation(s)
- Eriko Nishi
- Division of Medical Genetics, Nagano Children's Hospital, Azumino, Japan; Department of Medical Genetics, Shinshu University Graduate School of Medicine, Matsumoto, Japan
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199
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Abstract
The nonneoplastic diseases of the human pancreas generally comprise the inflammatory and degenerative conditions that include acute and chronic pancreatitis, with cystic fibrosis being arguably one of the most important diseases that induce the condition. Both acute and chronic conditions vary in severity, but both can be life threatening; and because of this fact, the study of their progression, and their responsiveness to therapy, is largely conducted by indirect means using serum markers of damage and repair such as amylase and lipase activities that normally occur at very low levels in the circulation but can be significantly increased during inflammatory episodes. Progress in the understanding the pathogenesis of both conditions has therefore been largely due to time course studies in animal models of pancreatitis, and it is in this context that animal model development has been so significant. In general terms, the animal models can be divided into the invasive, surgical procedures, and those induced by the administration of chemical secretagogues that induce hypersecretion of the pancreatic enzymes. The former include ligation and/or cannulation of the biliopancreatic ducts with infusion of solutions of various kinds, or the formation of closed duodenal loops. Secretagogue administration includes administration of caerulein or l-arginine in various protocols. An additional model involves administration of dibutyltin dichloride, which induces a partial blockage of the pancreatic ducts to induce pancreatic disease through enzymic reflux into the gland. The models have been invaluable in generating testable hypotheses for the human diseases. These hypotheses for the production of cellular damage as the initiating events in the disease include (1) intracellular chemical activation, (2) pancreatic secretion reflux, (3) intracellular production of reactive oxygen species, and (4) intracellular production of free radicals.
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Affiliation(s)
- John R Foster
- 1AstraZeneca Pharmaceuticals, Cheshire, United Kingdom
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200
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Wang C, Zheng B, Chen Y, Cao X, Zhang R, Shi Y. Imatinib as preoperative therapy in Chinese patients with recurrent or metastatic GISTs. Chin J Cancer Res 2013; 25:63-70. [PMID: 23372343 DOI: 10.3978/j.issn.1000-9604.2012.12.01] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2012] [Accepted: 12/05/2012] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVE Imatinib has dramatically altered the options for management of patients with gastrointestinal stromal tumours. However, it has become clear that secondary resistance to the drug develops during long-term therapy. The purpose of our study was to retrospectively analyze safety and long-term outcomes in Chinese patients with recurrent or metastatic GISTs treated with imatinib preoperatively. METHODS Between June 2003 and June 2011, 22 patients underwent surgery for recurrent or metastatic GISTs after preoperative treatment with imatinib. RESULTS Complete resection was accomplished in 8 of the 10 responsive disease (RD) patients (80%), and in 3 of the 12 patients (25%) who had progression disease (PD). The amount of blood loss during the operation in PD patients was higher than in RD patients. There was 1 hospital death in PD group related to surgery, while the other patients recovered with conservative therapy because complications were mild. The difference in median PFS between patients with RD and those with PD was significant (24.8 vs. 2.81 months, P<0.001). The difference in 2-year OS rate between patients with RD and those with PD was not significant (100% vs. 87.5%, P>0.05). CONCLUSIONS Our study indicates that surgical intervention can improve the PFS of Chinese patients with recurrent or metastatic GISTs responsive to imatinib, but does not prolong OS as well as in patients who develop imatinib resistance. Surgical resection following imatinib treatment is feasible and can be considered for patients with advanced GISTs responsive to imatinib.
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Affiliation(s)
- Chunmeng Wang
- Gastric Cancer and Soft Tissue Sarcoma Department, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
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