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Erskine J, Abrishami P, Charter R, Cicchetti A, Culbertson R, Faria E, Hiatt JC, Khan J, Maddern G, Patel A, Rha KH, Shah PC, Sooriakumaran P, Tackett S, Turchetti G, Chalkidou A. BEST PRACTICE CONSIDERATIONS ON THE ASSESSMENT OF ROBOTIC-ASSISTED SURGICAL SYSTEMS: RESULTS FROM AN INTERNATIONAL CONSENSUS EXPERT PANEL. Int J Technol Assess Health Care 2023:1-28. [PMID: 37272397 DOI: 10.1017/s0266462323000314] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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Patiniott P, Jacombs A, Kaul L, Hu H, Warner M, Klosterhalfen B, Karatassas A, Maddern G, Richter K. Are late hernia mesh complications linked to Staphylococci biofilms? Hernia 2022; 26:1293-1299. [PMID: 35286510 PMCID: PMC9525333 DOI: 10.1007/s10029-022-02583-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 12/21/2021] [Accepted: 02/09/2022] [Indexed: 11/27/2022]
Abstract
Purpose The purpose of this study was to investigate the link between bacterial biofilms and negative outcomes of hernia repair surgery. As biofilms are known to play a role in mesh-related infections, we investigated the presence of biofilms on hernia meshes, which had to be explanted due to mesh failure without showing signs of bacterial infection. Methods In this retrospective observational study, 20 paraffin-embedded tissue sections from explanted groin hernia meshes were analysed. Meshes have been removed due to chronic pain, hernia recurrence or mesh shrinkage. The presence and bacterial composition of biofilms were determined. First, specimens were stained with fluorescence in situ hybridisation (FISH) probes, specific for Staphylococcus aureus and coagulase-negative staphylococci, and visualised by confocal laser scanning microscopy. Second, DNA was extracted from tissue and identified by S. aureus and S. epidermidis specific PCR. Results Confocal microscopy showed evidence of bacterial biofilms on meshes in 15/20 (75.0%) samples, of which 3 were positive for S. aureus, 3 for coagulase-negative staphylococci and 9 for both species. PCR analysis identified biofilms in 17/20 (85.0%) samples, of which 4 were positive for S. aureus, 4 for S. epidermidis and 9 for both species. Combined results from FISH/microscopy and PCR identified staphylococci biofilms in 19/20 (95.0%) mesh samples. Only 1 (5.0%) mesh sample was negative for bacterial biofilm by both techniques. Conclusion Results suggest that staphylococci biofilms may be associated with hernia repair failure. A silent, undetected biofilm infection could contribute to mesh complications, chronic pain and exacerbation of disease.
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Affiliation(s)
- P Patiniott
- Surgery Department, The Queen Elizabeth Hospital and Basil Hetzel Institute for Translational Health Research, The University of Adelaide, Adelaide, Australia
| | - A Jacombs
- Macquarie University Hospital, Macquarie University, Sydney, Australia
| | - L Kaul
- Surgery Department, The Queen Elizabeth Hospital and Basil Hetzel Institute for Translational Health Research, The University of Adelaide, Adelaide, Australia.,Institute of Pharmaceutical Sciences, Department of Pharmaceutical Technology and Biopharmacy, University of Freiburg, Freiburg, Germany
| | - H Hu
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | - M Warner
- Microbiology and Infectious Diseases Directorate, SA Pathology, Adelaide, Australia.,Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia.,Infectious Diseases Unit, Central Adelaide Local Health Network, Adelaide, Australia
| | - B Klosterhalfen
- MVZ für Histologie, Zytologie und Molekulare Diagnostik Düren GmbH, Düren, Germany
| | - A Karatassas
- Surgery Department, The Queen Elizabeth Hospital and Basil Hetzel Institute for Translational Health Research, The University of Adelaide, Adelaide, Australia.,Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
| | - G Maddern
- Surgery Department, The Queen Elizabeth Hospital and Basil Hetzel Institute for Translational Health Research, The University of Adelaide, Adelaide, Australia.,Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
| | - K Richter
- Surgery Department, The Queen Elizabeth Hospital and Basil Hetzel Institute for Translational Health Research, The University of Adelaide, Adelaide, Australia. .,Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia. .,Institute for Photonics and Advanced Sensing, The University of Adelaide, Adelaide, Australia.
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Price T, Cehic G, Wachter E, Sebben R, Reid J, Alawawdeh A, McGregor M, Kirkwood I, Rodrigues D, Neuhaus S, Maddern G. 1106P Phase I study of hepatic intralesional rose bengal disodium (PV10), an autolytic immunotherapy, in metastatic neuroendocrine neoplasms. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Ludbrook G, Lloyd C, Story D, Maddern G, Riedel B, Richardson I, Scott D, Louise J, Edwards S. The effect of advanced recovery room care on postoperative outcomes in moderate-risk surgical patients: a multicentre feasibility study. Anaesthesia 2020; 76:480-488. [PMID: 33027534 DOI: 10.1111/anae.15260] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2020] [Indexed: 01/03/2023]
Abstract
Postoperative complications are common and may be under-recognised. It has been suggested that enhanced postoperative care in the recovery room may reduce in-hospital complications in moderate- and high-risk surgical patients. We investigated the feasibility of providing advanced recovery room care for 12-18 h postoperatively in the post-anaesthesia care unit. The primary hypothesis was that a clinical trial of advanced recovery room care was feasible. The secondary hypothesis was that this model may have a sustained impact on postoperative in-hospital and post-discharge events. This was a multicentre, prospective, feasibility before-and-after trial of moderate-risk patients (predicted 30-day mortality of 1-4%) undergoing non-cardiac surgery and who were scheduled for postoperative ward care. Patients were managed using defined assessment checklists and goals of care in an advanced recovery room care setting in the immediate postoperative period. This utilised existing post-anaesthesia care unit infrastructure and staffing, but extended care until the morning of the first postoperative day. The advanced recovery room care trial was deemed feasible, as defined by the recruitment and per protocol management of > 120 patients. However, in a specialised cancer centre, recruitment was slow due to low rates of eligibility according to narrow inclusion criteria. At a rural site, advanced recovery room care could not be commenced due to logistical issues in establishing a new model of care. A definitive randomised controlled trial of advanced recovery room care appears feasible and, based on the indicative data on outcomes, we believe this is warranted.
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Affiliation(s)
- G Ludbrook
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia
| | - C Lloyd
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia
| | - D Story
- Centre for Integrated Critical Care, University of Melbourne, Melbourne, Australia
| | - G Maddern
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia
| | - B Riedel
- Department of Anaesthetics, Peri-operative and Pain Medicine, the Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, Australia
| | - I Richardson
- Department of Anaesthetics, Peri-operative and Pain Medicine, the Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, Australia
| | - D Scott
- School of Medicine, Western Sydney University, Sydney, Australia
| | - J Louise
- Adelaide Health Technology Assessment, University of Adelaide, Adelaide, Australia
| | - S Edwards
- Adelaide Health Technology Assessment, University of Adelaide, Adelaide, Australia
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Ong YLR, Tivey D, Huang L, Sambrook P, Maddern G. Factors affecting surgical mortality of oral squamous cell carcinoma resection. Int J Oral Maxillofac Surg 2020; 50:1-6. [PMID: 32773113 DOI: 10.1016/j.ijom.2020.07.011] [Citation(s) in RCA: 2] [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] [Received: 02/11/2020] [Revised: 04/16/2020] [Accepted: 07/03/2020] [Indexed: 01/04/2023]
Abstract
Survival rates for oral squamous cell carcinoma (OSCC) has remained stagnant in recent years and improving surgical mortality could be an avenue to enhance outcomes. This systematic review aims to identify the causes of mortalities, determine both the modifiable and non-modifiable factors involved and target a reduction in postoperative 30-day mortality. In May 2019, a comprehensive search of key databases including PubMed, EMBASE, Cochrane Library was conducted. Blinded selection by two researchers identified papers that included participants who received oral squamous cell carcinoma resection and suffered an in-hospital or 30-day mortality. Selection identified two relevant papers that meet the inclusion criteria. One study had one death in its population sample but only had the cause of death described. Another study had an overall surgical mortality rate of 1% in a population of 21,681. Patients with multiple factors had the highest mortality rates; 4.6% in patients >85 years old and have a T4 diagnosis, 3.9% in patients with a Comorbidity Index ≥1 and a T4 diagnosis. These studies did not determine relationships between factors and causes of death. There are significant knowledge gaps in the literature, that can be addressed through further population analysis studies.
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Affiliation(s)
- Y L R Ong
- University of Adelaide, Adelaide, SA, Australia.
| | - D Tivey
- Royal Australasian College of Surgeons
| | - L Huang
- Department of Surgery, Flinders Medical Centre, Bedford Park, South Australia; College of Medicine and Public Health, Flinders University, Bedford Park, South Australia
| | - P Sambrook
- Department of Oral and Maxillofacial Surgery, University of Adelaide, Royal Adelaide Hospital, Adelaide, SA, Australia; Royal Australasian College of Dental Surgeons
| | - G Maddern
- Discipline of Surgery, The University of Adelaide, The Queen Elizabeth Hospital, Adelaide, SA, Australia; Australian and New Zealand Audit of Surgical Mortality, Royal Australasian College of Surgeons, Adelaide, SA, Australia
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Chan J, Kiermeier A, Worthington M, Maddern G. Recent Australian Trends in Prosthetic Heart Valve Selection. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.02.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Price T, Cehic G, Kirkwood I, Maddern G, Wachter E, Sarson D, Sebben R, Leopardi L, Reid J, Neuhaus S. A phase I study of oncolytic immunotherapy of metastatic neuroendocrine tumours using intralesional rose bengal disodium. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy293.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Gostlow H, Marlow N, Thomas MJW, Hewett PJ, Kiermeier A, Babidge W, Altree M, Pena G, Maddern G. Non-technical skills of surgical trainees and experienced surgeons. Br J Surg 2017; 104:777-785. [DOI: 10.1002/bjs.10493] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Revised: 12/09/2016] [Accepted: 12/18/2016] [Indexed: 11/10/2022]
Abstract
Abstract
Background
In addition to technical expertise, surgical competence requires effective non-technical skills to ensure patient safety and maintenance of standards. Recently the Royal Australasian College of Surgeons implemented a new Surgical Education and Training (SET) curriculum that incorporated non-technical skills considered essential for a competent surgeon. This study sought to compare the non-technical skills of experienced surgeons who completed their training before the introduction of SET with the non-technical skills of more recent trainees.
Methods
Surgical trainees and experienced surgeons undertook a simulated scenario designed to challenge their non-technical skills. Scenarios were video recorded and participants were assessed using the Non-Technical Skills for Surgeons (NOTSS) scoring system. Participants were divided into subgroups according to years of experience and their NOTSS scores were compared.
Results
For most NOTSS elements, mean scores increased initially, peaking around the time of Fellowship, before decreasing roughly linearly over time. There was a significant downward trend in score with increasing years since being awarded Fellowship for six of the 12 NOTSS elements: considering options (score −0·015 units per year), implementing and reviewing decisions (−0·020 per year), establishing a shared understanding (−0·014 per year), setting and maintaining standards (−0·024 per year), supporting others (−0·031 per year) and coping with pressure (−0·015 per year).
Conclusion
The drop in NOTSS score was unexpected and highlights that even experienced surgeons are not immune to deficiencies in non-technical skills. Consideration should be given to continuing professional development programmes focusing on non-technical skills, regardless of the level of professional experience.
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Affiliation(s)
- H Gostlow
- Division of Surgery, University of Adelaide, Queen Elizabeth Hospital, Woodville, Australia
- Australian Safety and Efficacy Register of New Interventional Procedures – Surgical (ASERNIP-S), Royal Australasian College of Surgeons, North Adelaide, Australia
| | - N Marlow
- Australian Safety and Efficacy Register of New Interventional Procedures – Surgical (ASERNIP-S), Royal Australasian College of Surgeons, North Adelaide, Australia
| | - M J W Thomas
- Westwood-Thomas Associates, Norton Summit, South Australia, Australia
| | - P J Hewett
- Division of Surgery, University of Adelaide, Queen Elizabeth Hospital, Woodville, Australia
| | - A Kiermeier
- Statistical Process Improvement Consulting and Training, Gumeracha, South Australia, Australia
| | - W Babidge
- Division of Surgery, University of Adelaide, Queen Elizabeth Hospital, Woodville, Australia
- Australian Safety and Efficacy Register of New Interventional Procedures – Surgical (ASERNIP-S), Royal Australasian College of Surgeons, North Adelaide, Australia
| | - M Altree
- Australian Safety and Efficacy Register of New Interventional Procedures – Surgical (ASERNIP-S), Royal Australasian College of Surgeons, North Adelaide, Australia
| | - G Pena
- Division of Surgery, University of Adelaide, Queen Elizabeth Hospital, Woodville, Australia
- Australian Safety and Efficacy Register of New Interventional Procedures – Surgical (ASERNIP-S), Royal Australasian College of Surgeons, North Adelaide, Australia
| | - G Maddern
- Division of Surgery, University of Adelaide, Queen Elizabeth Hospital, Woodville, Australia
- Australian Safety and Efficacy Register of New Interventional Procedures – Surgical (ASERNIP-S), Royal Australasian College of Surgeons, North Adelaide, Australia
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Price T, Karapetis C, Piantadosi C, Rico GT, Padbury R, Maddern G, Moore J, Carruthers S, Roder D, Townsend A. Brain metastasis in advanced colorectal cancer: Results from the South Australian metastatic colorectal cancer (SAmCRC) registry. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw370.34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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10
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Price T, Townsend A, Beeke C, Roder D, Padbury R, Maddern G, Roy A, Patel D, Moore J, Karapetis C. 2163 BRAF testing in the community setting; are we testing enough given the importance of BRAF mutation and the clinical implications? Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)31083-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Price T, Beeke C, Padbury R, Roder D, Townsend A, Maddern G, Roy A, Karapetis C. Does Exact Primary Site Impact on Outcome for Metastatic Colorectal Cancer (Mcrc)? Ann Oncol 2014. [DOI: 10.1093/annonc/mdu333.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Bhardwaj N, Kanhere H, Lord A, Maddern G. Handheld modification of the laparoscopic hook using the Trewavis(©) arthroscopic lateral release hook. Ann R Coll Surg Engl 2014; 96:318-9. [PMID: 24780034 DOI: 10.1308/rcsann.2014.96.4.318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- N Bhardwaj
- Queen Elizabeth Hospital, Woodville, SA, Australia
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Broadbridge VT, Karapetis CS, Beeke C, Woodman RJ, Padbury R, Maddern G, Kim SW, Roder D, Hakendorf P, Price TJ. Do metastatic colorectal cancer patients who present with late relapse after curative surgery have a better survival? Br J Cancer 2013; 109:1338-43. [PMID: 23860523 PMCID: PMC3778277 DOI: 10.1038/bjc.2013.388] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Revised: 06/17/2013] [Accepted: 06/24/2013] [Indexed: 12/12/2022] Open
Abstract
Background: Patients who relapse after potentially curative surgery for colorectal cancer tend to relapse within 5 years. There is, however, a group of patients who relapse beyond 5 years after resection and this late relapsing group may have a different behaviour and prognosis. Methods: We analysed data from a prospective population-based registry to compare the characteristics and survival of relapsed patients with metachronous mCRC. Patients were categorised into relapse at <2, 2–5 and >5 years following their initial surgery. Univariate log-rank tests and multivariate Cox regression was performed to determine whether time to relapse (TTR) and other factors were associated with overall survival (OS). Results: A total of 750 metachronous mCRC patients were identified. In all, 56% relapsed ⩽2 years, 32.4% at 2–5 years and 11.6% >5 years. Median survival time from the time of diagnosis of mCRC for the three groups was 17.6, 26.1 and 27.5 months, respectively. Short TTR (<2 years) was significantly associated with survival (HR=0.75, 95% confidence interval (CI)=0.60–0.93 and HR=0.73, 95% CI=0.53–1.01, respectively, for 2–5 and >5 years vs <2 years, P<0.05). However, there was no significant difference in survival between patients who relapsed at 5 years or later compared with those who relapsed between 2 and 5 years (HR=0.98, 95% CI=0.69–1.38, P=0.90). Conclusion: TTR within 2 years is an independent predictor of shorter survival time for mCRC patients who experience a relapse. These data do not support the hypothesis that patients who have late relapse late (>5 years) have a ‘better' biology or survival compared with patients with a TTR of 2–5 years.
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Affiliation(s)
- V T Broadbridge
- Department of Medical Oncology, The Queen Elizabeth Hospital, Woodville, South Australia, Australia
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Maddern G, Smith J, Babidge W, Guy G. Hospital mortality under surgical care. Ann R Coll Surg Engl 2012; 94:66. [PMID: 22524941 DOI: 10.1308/003588412x13171221499900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Bishnoi S, Price T, Beeke C, Karapetis C, Townsend A, Maddern G, Padbury R. 6040 POSTER Liver Only Metastatic Disease in Patients With Metastatic Colorectal Cancer (mCRC), Impact of Surgery and Chemotherapy. Eur J Cancer 2011. [DOI: 10.1016/s0959-8049(11)71685-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Barber C, Watt A, Pham C, Humphreys K, Penington A, Mutimer K, Edwards M, Maddern G. Influence of bioengineered skin substitutes on diabetic foot ulcer and venous leg ulcer outcomes. J Wound Care 2008; 17:517-27. [PMID: 19052516 DOI: 10.12968/jowc.2008.17.12.31766] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- C. Barber
- ASERNIP-S, Royal Australasian College of Surgeons, Stepney, Australia
| | - A. Watt
- ASERNIP-S, Royal Australasian College of Surgeons, Stepney, Australia
| | - C. Pham
- ASERNIP-S, Royal Australasian College of Surgeons, Stepney, Australia
| | - K. Humphreys
- ASERNIP-S, Royal Australasian College of Surgeons, Stepney, Australia
| | - A. Penington
- Department of Surgery, St Vincent’s Hospital and University of Melbourne, Australia
| | - K. Mutimer
- Brighton Plastic Surgery Centre, Royal Children’s Hospital Victoria, Australia
| | | | - G. Maddern
- ASERNIP-S, Royal Australasian College of Surgeons, Stepney, Australia; Department of Surgery, University of Adelaide and The Queen Elizabeth Hospital, Adelaide, Australia
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Barnes M, Boult M, Maddern G, Fitridge R. A Model to Predict Outcomes for Endovascular Aneurysm Repair Using Preoperative Variables. Eur J Vasc Endovasc Surg 2008; 35:571-9. [DOI: 10.1016/j.ejvs.2007.12.003] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2007] [Accepted: 12/12/2007] [Indexed: 10/22/2022]
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Barnes M, Boult M, Maddern G, Fitridge R. A Model to Predict Outcomes for Endovascular Aneurysm Repair Using Preoperative Variables. J Vasc Surg 2008. [DOI: 10.1016/j.jvs.2008.02.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Boult M, Maddern G, Barnes M, Fitridge R. Factors Affecting Survival after Endovascular Aneurysm Repair: Results from a Population Based Audit. J Vasc Surg 2007. [DOI: 10.1016/j.jvs.2007.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Affiliation(s)
- J Wang
- ASERNIP-S, Royal Australasian College of Surgeons, Stepney, Australia
| | - J Smith
- Royal District Nursing Service of South Australia Inc, Glenside, Australia
| | - W Babidge
- Research, Audit and Academic Surgery Division, Royal Australasian College of Surgeons, Stepney, and Department of Surgery, Adelaide University, Queen Elizabeth Hospital, Woodville, Australia
| | - G Maddern
- ASERNIP-S, Royal Australasian College of Surgeons, Stepney, and Department of Surgery, Adelaide University, Queen Elizabeth Hospital, Woodville, Australia
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Boult M, Maddern G, Barnes M, Fitridge R. Factors Affecting Survival after Endovascular Aneurysm Repair: Results from a Population Based Audit. Eur J Vasc Endovasc Surg 2007; 34:156-62. [PMID: 17475519 DOI: 10.1016/j.ejvs.2007.02.020] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2007] [Accepted: 02/27/2007] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To determine the effect of pre-operative factors on mid-term survival of patients enrolled in an Australian audit of endovascular aneurysm repair (EVAR). DESIGN Prospective longitudinal national register (audit) of patients undergoing EVAR. METHODS 961 individuals who had elective or semi-urgent EVAR of abdominal aortic aneurysms were enrolled in the audit between November 1999 and May 2001. Data was contributed by 81 surgeons from 64 hospitals. Kaplan-Meier survival analysis was used to determine survival rates and factors significantly influencing survival. Parametric survival analysis with log-exponential distribution was used to estimate expected 3 and 5 year survival for different ages, ASA, creatinine and aneurysm sizes. RESULTS Overall survival was 93% at 1 year, 80% at 3 years and 67% at five years. Survival rates were found to be statistically associated with ASA, age, aneurysm size and creatinine levels. ASA has the largest effect. Five year survival rates for aneurysms >or=65 mm and <55 mm were 54% and 76% respectively. Pre-operative creatinine levels >or=160 micromol/L lowered the survival rate from 71% to 40%. CONCLUSIONS Survival for EVAR patients is strongly correlated with a number of pre-operative factors. This survival analysis provides a useful decision-making tool for surgeons particularly for individuals with smaller aneurysms.
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Affiliation(s)
- M Boult
- Australian Safety and Efficacy Register of New Interventional Procedures - Surgical, Royal Australasian College of Surgeons, Stepney, SA
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Anderson JL, Fitridge R, Boult M, Barnes M, Maddern G. VS01 PREDICTIVE MODEL OF SUCCESS FOR EVAR. ANZ J Surg 2007. [DOI: 10.1111/j.1445-2197.2007.04134_1.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Price TJ, Roder D, Pittman K, Patterson K, Rieger N, Hewett P, Rodda D, Colbeck M, Maddern G, Luke C. Survival trends for advanced colorectal cancer (CRC): Are improvements only for patients in clinical trials? J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.6124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
6124 Background: Significant improvements in the outcome for patients with advanced CRC have been achieved. We have reviewed the prospective CRC database at our institution from 1992 to 2004 to explore whether the availability of new chemotherapy drugs (irinotecan & oxaliplatin) and surgical advances has impacted on survival in the normal population. Earlier results had suggested a trend to improved survival (1). Methods: In Australia the first of these drugs became available at the end of 1997 thus we have taken this as the time point to compare outcomes pre and post. Disease-specific survivals were analysed from the date of diagnosis for stage D, and from the date of distant recurrence for stages A, B and C, with a date of censoring of live cases at December 31st, 2004. The Kaplan-Meier product-limit estimate was used for univariate analyses and Cox proportional hazards regression for multivariable analyses. Results: The current analysis is of 744 patients; 92–97 n=313, 98–04 n=431. Survival for the respective time periods were 47.6% and 54.9% 12 mths; 28.0% and 34.8% 24 mths; 18.9% and 23.0% 36 mths; 12.6% and 17.2% 48 mths; and 10.4% and 14.9% 60 mths. Cox proportional hazards regression indicated a lower risk of case fatality for 1998–2004 than 1992–1997 cases (p=0.048) after adjusting for age measured in years. The key predictors of case fatality in a multivariate analysis were found to be period (i.e., 1992–97/1998–04), age, and stage of disease at time of initial diagnosis. While an upward trend in survival was recorded for all ages, it was most pronounced for 70–79 year olds (n=272), where the increase in 24 mth survival was from 21.1% for 1992–97 to 36.1% for 1998–2004 (p=0.015). For patients aged 80 years and over (1992–97 n=40 & 1998–2004 n=67) the 24mth survivals were 18.6% (6.7%) and 26.4% (6.9%) respectively (p>0.200). Conclusions: Clinical trials have shown improvements in survival for highly selected patients. This current analysis confirms an improvement in survival over time for advanced CRC and this is seen in unselected patients including the elderly. Preliminary data has suggested that a number of factors have contributed to the trend of improved survival. Final analysis, including updated chemotherapy trends, will be presented at the meeting. (1) Proc ASCO 2004, #3707 No significant financial relationships to disclose.
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Affiliation(s)
- T. J. Price
- Queen Elizabeth Hospital, Adelaide, Australia; Cancer Council SA, Adelaide, Australia; Department of Health, Adelaide, Australia
| | - D. Roder
- Queen Elizabeth Hospital, Adelaide, Australia; Cancer Council SA, Adelaide, Australia; Department of Health, Adelaide, Australia
| | - K. Pittman
- Queen Elizabeth Hospital, Adelaide, Australia; Cancer Council SA, Adelaide, Australia; Department of Health, Adelaide, Australia
| | - K. Patterson
- Queen Elizabeth Hospital, Adelaide, Australia; Cancer Council SA, Adelaide, Australia; Department of Health, Adelaide, Australia
| | - N. Rieger
- Queen Elizabeth Hospital, Adelaide, Australia; Cancer Council SA, Adelaide, Australia; Department of Health, Adelaide, Australia
| | - P. Hewett
- Queen Elizabeth Hospital, Adelaide, Australia; Cancer Council SA, Adelaide, Australia; Department of Health, Adelaide, Australia
| | - D. Rodda
- Queen Elizabeth Hospital, Adelaide, Australia; Cancer Council SA, Adelaide, Australia; Department of Health, Adelaide, Australia
| | - M. Colbeck
- Queen Elizabeth Hospital, Adelaide, Australia; Cancer Council SA, Adelaide, Australia; Department of Health, Adelaide, Australia
| | - G. Maddern
- Queen Elizabeth Hospital, Adelaide, Australia; Cancer Council SA, Adelaide, Australia; Department of Health, Adelaide, Australia
| | - C. Luke
- Queen Elizabeth Hospital, Adelaide, Australia; Cancer Council SA, Adelaide, Australia; Department of Health, Adelaide, Australia
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Boult M, Babidge W, Maddern G, Barnes M, Fitridge R. Predictors of Success Following Endovascular Aneurysm Repair: Mid-term Results. Eur J Vasc Endovasc Surg 2006; 31:123-9. [PMID: 16202630 DOI: 10.1016/j.ejvs.2005.08.013] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2005] [Accepted: 08/07/2005] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Australian cases of endovascular aneurysm repair (EVAR) performed between 1999 and 2001 have been evaluated to determine the mid-term (6 months to 5 years) safety and efficacy of the procedure. This study looks at predictors of success, based on mid-term follow-up data. DESIGN OF STUDY This study uses results obtained from a prospective semi-voluntary register (audit) of Australian data obtained from surgeons in the private and public sector. RESULTS Peri-operative mortality for patients enrolled in the audit was 1.8%. Ninety-three percent of procedures were technically successful (890/961). Nearly 13% of patients have had re-interventions (mostly endoluminal) at follow-up. Analysis of audit data shows that the likelihood of experiencing post-operative complications or requiring additional procedures increases with ASA rating, increasing age, large pre-operative aneurysm size, aneurysm angle >45 degrees and number of co-morbid conditions diagnosed. CONCLUSIONS This study confirms satisfactory mid-term results in a, national rather than unit specific, setting. Predictors of clinical failure or need for re-intervention include large aneurysm size, neck angulation >or=45 degrees and short infrarenal neck.
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Affiliation(s)
- M Boult
- Australian Safety and Efficacy Register of New Interventional Procedures-Surgical, Royal Australasian College of Surgeons, Stepney, SA, Australia
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26
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Affiliation(s)
- H Iswariah
- Department of Surgery, The Queen Elizabeth Hospital, Woodville, South Australia, Australia
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Price TJ, Pittman K, Patterson K, Colbeck M, Sim S, Roder D, Rieger N, Hewett P, Maddern G, Luke C. Survival and treatment trends for advanced colorectal cancer (CRC) treated in a University Hospital, 1992–2001. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.3707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- T. J. Price
- QEH, Adelaide, Australia; Cancer Council South Australia, Adelaide, Australia; DHS, Adelaide, Australia
| | - K. Pittman
- QEH, Adelaide, Australia; Cancer Council South Australia, Adelaide, Australia; DHS, Adelaide, Australia
| | - K. Patterson
- QEH, Adelaide, Australia; Cancer Council South Australia, Adelaide, Australia; DHS, Adelaide, Australia
| | - M. Colbeck
- QEH, Adelaide, Australia; Cancer Council South Australia, Adelaide, Australia; DHS, Adelaide, Australia
| | - S. Sim
- QEH, Adelaide, Australia; Cancer Council South Australia, Adelaide, Australia; DHS, Adelaide, Australia
| | - D. Roder
- QEH, Adelaide, Australia; Cancer Council South Australia, Adelaide, Australia; DHS, Adelaide, Australia
| | - N. Rieger
- QEH, Adelaide, Australia; Cancer Council South Australia, Adelaide, Australia; DHS, Adelaide, Australia
| | - P. Hewett
- QEH, Adelaide, Australia; Cancer Council South Australia, Adelaide, Australia; DHS, Adelaide, Australia
| | - G. Maddern
- QEH, Adelaide, Australia; Cancer Council South Australia, Adelaide, Australia; DHS, Adelaide, Australia
| | - C. Luke
- QEH, Adelaide, Australia; Cancer Council South Australia, Adelaide, Australia; DHS, Adelaide, Australia
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Boult M, Babidge W, Maddern G, Fitridge R. Endoluminal Repair of Abdominal Aortic Aneurysm—Contemporary Australian Experience. Eur J Vasc Endovasc Surg 2004; 28:36-40. [PMID: 15177229 DOI: 10.1016/j.ejvs.2004.03.025] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2004] [Indexed: 10/26/2022]
Abstract
OBJECTIVE An audit was established in November 1999 by the Australian Government Department of Health and Ageing to determine the mid- to long-term safety and efficacy of endoluminal graft repair (ELG) of abdominal aortic aneurysm (AAA). The audit has been undertaken by the Australian Safety and Efficacy Register for New Interventional Procedures-Surgical (ASERNIP-S). This study reviews contemporary Australian practice, based on audit data supplied to ASERNIP-S. DESIGN OF STUDY This study is a prospective voluntary register (audit) of Australian data obtained from the private and public sector. Data were collected for ELG repairs performed between 1 November 1999 and 16 May 2001. Follow-up is continuing. Results. Seventy-nine vascular surgeons have contributed data on 950 patients (816 male, 134 female, of median age 75.5 (range 36-94)). The mean aneurysm size was 57.5 mm (+/-10.2) and 44% of procedures were performed on aneurysms less than 55 mm in diameter. Fifty four percent of patients were considered suitable for open repair. Most ELG procedures were performed in an angiography or endovascular suite, under general anaesthetic using an open technique via the femoral arteries. Perioperative mortality was 1.7%, mostly from cardiac causes. Prior to discharge 7.2% of patients experienced an endoleak and 18.6% had systemic complications. The average length of stay was 7.4 days (median 5 days). Unsuccessful exclusion of the aneurysm occurred in 6.7% of cases. CONCLUSIONS Endovascular repair of AAAs is a well accepted procedure and is performed by the majority of vascular surgeons in Australia. Australian surgeons are taking a rather aggressive approach to the management of aortic aneurysms, particularly in the moderate to higher risk patient groups. Mortality rates are low, given the elderly population in question and morbidity rates acceptable. ASERNIP-S is continuing to collect follow-up data for this patient cohort.
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Affiliation(s)
- M Boult
- Australian Safety and Efficacy Register of New Interventional Procedures-Surgical, Royal Australasian College of Surgeons, North Adelaide, SA, Australia
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Garcea G, Lloyd TD, Aylott C, Maddern G, Berry DP. The emergent role of focal liver ablation techniques in the treatment of primary and secondary liver tumours. Eur J Cancer 2003; 39:2150-64. [PMID: 14522372 DOI: 10.1016/s0959-8049(03)00553-7] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Only 20% of patients with primary or secondary liver tumours are suitable for resection because of extrahepatic disease or the anatomical distribution of their disease. These patients could be treated by ablation of the tumour, thus preserving functioning liver. This study presents a detailed review of established and experimental ablation procedures. The relative merits of each technique will be discussed and clinical data regarding the efficacy of the techniques evaluated. A literature search from 1966 to 2003 was undertaken using Medline, Pubmed and Web of Science databases. Keywords were Hepatocellular carcinoma, liver metastases, percutaneous ethanol injection, cryotherapy, microwave coagulation therapy, radiofrequency ablation, interstitial laser photocoagulation, focused high-intensity ultrasound, hot saline injection, electrolysis and acetic acid injection. Ablative techniques offer a promising therapeutic modality to treat unresectable tumours. Large-scale randomised controlled trials are required before widespread acceptance of these techniques can occur.
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Affiliation(s)
- G Garcea
- Department of Hepatobiliary Surgery, The Leicester General Hospital, Gwendolen Road, Leicester LE2 7LX, UK.
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30
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Affiliation(s)
- P Kleinig
- Department of Radiology, North Western Adelaide Health Service, University of Adelaide, The Queen Elizabeth Hospital, South, Woodville South, Australia
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Affiliation(s)
- B Launois
- Department of Surgery, University of Rennes, 35000 Rennes, France
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Abstract
BACKGROUND Ultrasound-assisted lipoplasty (UAL) has been associated with particular types of complications and uncertain long-term effects arising from interactions between ultrasonic energy and living tissue. The present review seeks to address these issues. METHODS Search strategy Three search strategies were devised to retrieve literature from Medline, Current Contents, Embase and Cochrane Library databases up until April 2000. Study selection Inclusion of papers was largely determined using a predetermined protocol. English language papers were selected. Acceptable study designs included randomized controlled trials, controlled clinical trials, case series or case reports. Data collection and analysis Thirty-six papers met the inclusion criteria. They were tabulated and critically appraised in terms of methodology and design, outcomes, and the possible influence of bias, confounding and chance. Other papers were also included to provide background material. RESULTS There was little high-level evidence available comparing UAL and suction-assisted lipoplasty (SAL), with no conclusive evidence that UAL has a safety benefit, although low-quality evidence suggests that UAL is associated with reduced surgeon fatigue as well as increased operating times, slower aspiration rates and an increased learning curve. There is inadequate evidence to determine whether the theoretical potential for DNA damage from ultrasound is realized in the clinical setting. CONCLUSIONS The evidence base for UAL is inadequate to determine the procedure's safety and efficacy. The potential for DNA damage must be investigated with appropriate in vivo animal models. Recommendations for the safe use of UAL are discussed.
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Affiliation(s)
- R Cooter
- Australian Safety and Efficacy Register of New Interventional Procedures-Surgical (ASERNIP-S), Royal Australian College of Surgeons, North Adelaide
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Merlin T, Arnold E, Petros P, MacTaggart P, Tulloch A, Faulkner K, Maddern G. A systematic review of tension-free urethropexy for stress urinary incontinence: intravaginal slingplasty and the tension-free vaginal tape procedures. BJU Int 2001; 88:871-80. [PMID: 11851606 DOI: 10.1046/j.1464-4096.2001.01667.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- T Merlin
- Australian Safety and Efficacy Register of New Interventional Procedures - Surgical (ASERNIP-S), North Adelaide, South Australia
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Babidge W, Maddern G. Evidence-based surgery at ASERNIP-S. Can this improve quality in surgical practice? Australian Safety and Efficacy Register of New Interventional Procedures-Surgical. J Qual Clin Pract 2000; 20:164-6. [PMID: 11207956 DOI: 10.1046/j.1440-1762.2000.00380.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The Australian Safety and Efficacy Register of New Interventional Procedures-Surgical (ASERNIP-S) project has been established to form a register of new surgical procedures which have been assessed for their safety and efficacy. The ASERNIP-S project systematically reviews the evidence and produces recommendations on the future use of surgical procedures in clinical practice. Further data may be collected to provide information on the outcomes of procedures in use in Australia. Horizon Scanning of new and emerging techniques and technologies complements the ASERNIP-S process. This research identifies procedures that will impact on clinical practice in the near future. Dissemination of information from ASERNIP-S assessments, both locally and internationally, is important for quality improvement. The ultimate aim is for appropriate changes in practice to ensure the highest quality of Australian healthcare.
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Abstract
BACKGROUND Aneurysms of visceral arteries are rare, but may lead to dramatic situations of intraabdominal or retroperitoneal hemorrhage in case of rupture. CASE REPORT We report the case of a 72-year-old patient who developed a hemorrhagic shock following a total hip replacement due to the rupture of an aneurysm of the gastroduodenal artery. Angiography also demonstrated a high-grade stenosis of the celiac trunk. The ruptured aneurysm was ligated as a live-saving procedure, but due to the stenosis in the celiac trunk the patient developed a splenic infarction followed by partial tissue liquefication. This was treated conservatively and after 3 months, the computed tomography showed an atrophic residual spleen. SUMMARY Diagnostic and therapeutic approaches to visceral vascular aneurysms are discussed including the potential complications of splenic infarction.
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Affiliation(s)
- W Schweizer
- Department of Surgery, Kantonsspital Schaffhausen (Head: Dr. W. Schweizer), Switzerland
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Abstract
BACKGROUND The provision of information before medical or surgical procedures should improve knowledge and allay anxiety about the pending procedure. This trial aimed to assess the value of an information video in this process. METHODS Patients scheduled to undergo colonoscopy were approached about 1 week before the procedure. All patients were given an information leaflet about colonoscopy, and completed a Spielberger state anxiety inventory (STAI) questionnaire to assess baseline anxiety. The patients were then randomly assigned to watch or not watch the information video. Immediately before colonoscopy, all patients completed a second anxiety questionnaire and a knowledge questionnaire. FINDINGS 198 patients were screened. 31 declined to participate and 17 were unable to complete the forms. Of the remaining 150 patients, 72 were assigned the video, and 78 no video. The groups were similar with regard to age, sex, educational attainment, and initial anxiety score. Female patients had higher baseline anxiety than male patients (mean STAI 46.3 [95% CI 44.9-47.7] vs 36.9 [35.5-38.3]; difference 9.4 [7.8-12.2], p=0.0008). Patients who had not had a previous colonoscopy had higher baseline anxiety scores than those who had prior experience of the procedure (46.9 [45.4-48.5] vs 36.3 [34.7-37.9]; difference 10.6 [7.5-13.8], p=0.0008). Patients who watched the video were significantly less anxious before colonoscopy than those who did not. The former also scored more highly in the knowledge questionnaire than the latter with regard to the purpose of the procedure, procedural details, and potential complications of colonoscopy. INTERPRETATION An information video increases knowledge and decreases anxiety in patients preparing for colonoscopy.
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Affiliation(s)
- A Luck
- Division of Surgery, Queen Elizabeth Hospital, Woodville South, South Australia, Australia
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El Rassi ZE, Partensky C, Scoazec JY, Henry L, Lombard-Bohas C, Maddern G. Peripheral cholangiocarcinoma: presentation, diagnosis, pathology and management. Eur J Surg Oncol 1999; 25:375-80. [PMID: 10419707 DOI: 10.1053/ejso.1999.0660] [Citation(s) in RCA: 66] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
AIMS To report the clinical presentation, diagnosis and results of aggressive surgical management in patients with intrahepatic cholangiocarcinoma. METHODS From February 1988 to June 1998, 21 patients underwent laparotomy with a 90% resectability rate (19 resections). The 19 liver resections included right trisegmentectomy in six patients, right lobectomy in five, wedge resection in four, left lobectomy in two, left trisegmentectomy in one and a lateral segmentectomy in one. Resection of the biliary confluence with reconstruction by a Roux en Y hepaticojejunostomy was performed in three patients. RESULTS Mild abdominal pain, weight loss and gastrointestinal disturbances were the most frequent clinical signs. Jaundice was present in only four patients. Pre-operative radiological investigations (abdominal ultrasound, computed tomography, arteriography) correlated with pathological findings in only 60% of cases. Pre-operative histological findings (fine-needle cytology, liver biopsy), available for 19 patients, did not always provide an accurate diagnosis. The mortality and morbidity rates were 5 and 47%, respectively. The median survival of resected patients was 18 months. Overall patient and tumour-free survival rates were 83 and 31% at 1 year, 33 and 16.5% at 2 years and 16.5 and 16.5% at 3 years in the resected group. Lymph-node spread, vascular invasion, positive margins and bilobar distribution were associated with a high recurrence rate and poor prognosis. CONCLUSION Despite the advanced stage of these tumours at presentation, patient survival can be improved by aggressive surgical resection. As intrahepatic cholangiocarcinoma usually develops in a non-cirrhotic liver, major hepatic resections to obtain disease-free margins can be performed with low mortality.
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Affiliation(s)
- Z E El Rassi
- Department of Digestive Diseases, Edouard Herriot Hospital, Lyon, 69437, Cedex 03, France
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Abstract
The detailed knowledge of the segmental anatomy of the liver has led to a rapid evolution in resectional surgery based on the intrahepatic distribution of the portal trinity (the hepatic artery, hepatic duct and portal vein). The classical intrafascial or extrahepatic approach is to isolate the appropriate branch of the portal vein, hepatic artery and the hepatic duct, outside the liver substance. Another method, the extrafascial approach, is to dissect the whole sheath of the pedicle directly after division of a substantial amount of the hepatic tissue to reach the pedicle, which is surrounded by a sheath, derived from Glisson's capsule. This Glissonian sheath encloses the portal trinity. In the transfissural or intrahepatic approach, these sheaths can be approached either anteriorly (after division of the main, right or umbilical fissure) or posteriorly from behind the porta hepatis. We describe the technique for approaching the Glissonian sheath and hence the hepatic pedicle structures and their branches by the intrahepatic posterior approach that allows early delineation of the liver segment without the need for ancillary techniques. In addition, the indications for the use of this technique in the technical and oncologic settings are also discussed.
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Affiliation(s)
- B Launois
- University of Rennes, St. Grégoire, France
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Abstract
The last of the therapeutic modalities proposed for exocrine adenocarcinoma of the pancreas which appears to be potentially resectable, neoadjuvant chemoradiotherapy has many prerequisites: validation of the diagnosis, determination of resectability with a high degree of confidence and palliation of biliary obstruction when present. This rather complex strategy does not seem to have major deleterious effects on the operative procedure or the postoperative course. Only multicentric protocols will, in the near future, give an answer to the question of secondary toxic effects and improvement of survival of this new therapeutic strategy.
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Affiliation(s)
- C Partensky
- Fédération des spécialitiés digestives, hôpital Edouard-Herriot, Lyon, France
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Cuschieri A, Ferreira E, Goh P, Idezuki Y, Maddern G, Marks G, Stiegmann G, Taylor B. Guidelines for conducting economic outcomes studies for endoscopic procedures. Surg Endosc 1997; 11:308-14. [PMID: 9079618 DOI: 10.1007/s004649900352] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- A Cuschieri
- European Association for Endoscopic Surgery (EAES)
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Launois B, Jamieson GG, Maddern G, Landen S, Campion JP, Coeurdacier P, Bardaxoglou E. Venous allografts: a useful alternative to venous autografts in digestive surgery. Aust N Z J Surg 1995; 65:579-81. [PMID: 7661799 DOI: 10.1111/j.1445-2197.1995.tb01699.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Over a 16 month period seven patients underwent surgery using venous allografts either to reconstruct the portal vein, or to construct a mesocaval 'H' graft or a shunt between the coronary vein and the subhepatic inferior vena cava. The allografts were harvested during multiorgan procurement from the bifurcation of the inferior vena cava, the common iliac vein and the external iliac vein and kept in a preservation solution at 4 degrees C for a mean time of 6 days (range 1-29) before use. Subsequent thrombosis was clinically evident in only two patients. The use of venous allografts appears to be a useful alternative to other venous replacements.
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Affiliation(s)
- B Launois
- Clinique Chirgicale, Hopital de Pontchaillou, Rennes, France
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44
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Maddern G, Meunier B, Launois B. Surgical management of portal hypertension. Aust N Z J Surg 1994; 64:818-22. [PMID: 7980253 DOI: 10.1111/j.1445-2197.1994.tb04555.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The surgical management of portal hypertension depends on the location of the obstruction. Suprahepatic obstruction is usually optimally treated by a surgical portacaval shunt. In extrahepatic obstruction the treatment should be sclerotherapy. For intrahepatic obstruction in emergency situations, sclerotherapy is the first choice, with portacaval systemic shunts or transjugular intrahepatic portal systemic stent shunt the second option. Liver transplantation in other situations should, if possible, be considered ahead of a portal diversion.
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Affiliation(s)
- G Maddern
- Department of Digestive Surgery and Transplantation, Pontchaillou University Hospital, Rennes, France
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Le Prise E, Etienne PL, Meunier B, Maddern G, Ben Hassel M, Gedouin D, Boutin D, Campion JP, Launois B. A randomized study of chemotherapy, radiation therapy, and surgery versus surgery for localized squamous cell carcinoma of the esophagus. Cancer 1994. [PMID: 8137201 DOI: 10.1002/1097-0142(19940401)73:7<1779::aid-cncr2820730702>3.0.co;2-t] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Despite well-established surgical approaches, the prognosis for patients with squamous cell carcinoma of the esophagus remains dismal. To assess the benefit of adjuvant chemotherapy and radiation therapy (CRT), a randomized trial with and without sequential preoperative CRT was undertaken; CRT combined 20 Gy and two courses of 5-FU and cisplatin. METHODS Patients were included on the basis of the following criteria: squamous cell carcinoma of the esophagus, younger than 70 years of age, World Health Organization status below 2, estimated survival time greater than 3 months, and no previous treatment for the cancer. Patients were not included if they had experienced a loss in body weight greater than 15% or had tracheoesophageal fistula, metastases, or uncontrollable infection. RESULTS Eighty-six patients thus fulfilled the criteria for inclusion (41 CRT, 45 non-CRT). The groups were well-matched for age, sex, tumor location, size, and grade. Operative mortality was 8.5% and 7%, respectively, for each group with a 27-day hospital stay for both groups. Long-term survival was not significantly different, with 47% of both groups alive at 1 year. CONCLUSIONS The authors concluded that this neoadjuvant treatment did not change operative mortality or survival time for patients with squamous cell carcinoma of the esophagus.
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Affiliation(s)
- E Le Prise
- Regional Cancer Institute, Centre Eugène Marquis, Rennes, France
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46
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Le Prise E, Etienne PL, Meunier B, Maddern G, Ben Hassel M, Gedouin D, Boutin D, Campion JP, Launois B. A randomized study of chemotherapy, radiation therapy, and surgery versus surgery for localized squamous cell carcinoma of the esophagus. Cancer 1994. [PMID: 8137201 DOI: 10.1002/1097-0142(19940401)73::7<1779::aid] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Despite well-established surgical approaches, the prognosis for patients with squamous cell carcinoma of the esophagus remains dismal. To assess the benefit of adjuvant chemotherapy and radiation therapy (CRT), a randomized trial with and without sequential preoperative CRT was undertaken; CRT combined 20 Gy and two courses of 5-FU and cisplatin. METHODS Patients were included on the basis of the following criteria: squamous cell carcinoma of the esophagus, younger than 70 years of age, World Health Organization status below 2, estimated survival time greater than 3 months, and no previous treatment for the cancer. Patients were not included if they had experienced a loss in body weight greater than 15% or had tracheoesophageal fistula, metastases, or uncontrollable infection. RESULTS Eighty-six patients thus fulfilled the criteria for inclusion (41 CRT, 45 non-CRT). The groups were well-matched for age, sex, tumor location, size, and grade. Operative mortality was 8.5% and 7%, respectively, for each group with a 27-day hospital stay for both groups. Long-term survival was not significantly different, with 47% of both groups alive at 1 year. CONCLUSIONS The authors concluded that this neoadjuvant treatment did not change operative mortality or survival time for patients with squamous cell carcinoma of the esophagus.
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Affiliation(s)
- E Le Prise
- Regional Cancer Institute, Centre Eugène Marquis, Rennes, France
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Le Prise E, Etienne PL, Meunier B, Maddern G, Ben Hassel M, Gedouin D, Boutin D, Campion JP, Launois B. A randomized study of chemotherapy, radiation therapy, and surgery versus surgery for localized squamous cell carcinoma of the esophagus. Cancer 1994. [PMID: 8137201 DOI: 10.1002/1097-0142(19940401)73:7%3c1779::aid-cncr2820730702%3e3.0.co;2-t] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Despite well-established surgical approaches, the prognosis for patients with squamous cell carcinoma of the esophagus remains dismal. To assess the benefit of adjuvant chemotherapy and radiation therapy (CRT), a randomized trial with and without sequential preoperative CRT was undertaken; CRT combined 20 Gy and two courses of 5-FU and cisplatin. METHODS Patients were included on the basis of the following criteria: squamous cell carcinoma of the esophagus, younger than 70 years of age, World Health Organization status below 2, estimated survival time greater than 3 months, and no previous treatment for the cancer. Patients were not included if they had experienced a loss in body weight greater than 15% or had tracheoesophageal fistula, metastases, or uncontrollable infection. RESULTS Eighty-six patients thus fulfilled the criteria for inclusion (41 CRT, 45 non-CRT). The groups were well-matched for age, sex, tumor location, size, and grade. Operative mortality was 8.5% and 7%, respectively, for each group with a 27-day hospital stay for both groups. Long-term survival was not significantly different, with 47% of both groups alive at 1 year. CONCLUSIONS The authors concluded that this neoadjuvant treatment did not change operative mortality or survival time for patients with squamous cell carcinoma of the esophagus.
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Affiliation(s)
- E Le Prise
- Regional Cancer Institute, Centre Eugène Marquis, Rennes, France
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Le Prise E, Etienne PL, Meunier B, Maddern G, Ben Hassel M, Gedouin D, Boutin D, Campion JP, Launois B. A randomized study of chemotherapy, radiation therapy, and surgery versus surgery for localized squamous cell carcinoma of the esophagus. Cancer 1994. [PMID: 8137201 DOI: 10.1002/1097-0142(19940401)73] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Despite well-established surgical approaches, the prognosis for patients with squamous cell carcinoma of the esophagus remains dismal. To assess the benefit of adjuvant chemotherapy and radiation therapy (CRT), a randomized trial with and without sequential preoperative CRT was undertaken; CRT combined 20 Gy and two courses of 5-FU and cisplatin. METHODS Patients were included on the basis of the following criteria: squamous cell carcinoma of the esophagus, younger than 70 years of age, World Health Organization status below 2, estimated survival time greater than 3 months, and no previous treatment for the cancer. Patients were not included if they had experienced a loss in body weight greater than 15% or had tracheoesophageal fistula, metastases, or uncontrollable infection. RESULTS Eighty-six patients thus fulfilled the criteria for inclusion (41 CRT, 45 non-CRT). The groups were well-matched for age, sex, tumor location, size, and grade. Operative mortality was 8.5% and 7%, respectively, for each group with a 27-day hospital stay for both groups. Long-term survival was not significantly different, with 47% of both groups alive at 1 year. CONCLUSIONS The authors concluded that this neoadjuvant treatment did not change operative mortality or survival time for patients with squamous cell carcinoma of the esophagus.
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Affiliation(s)
- E Le Prise
- Regional Cancer Institute, Centre Eugène Marquis, Rennes, France
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Le Prise E, Etienne PL, Meunier B, Maddern G, Ben Hassel M, Gedouin D, Boutin D, Campion JP, Launois B. A randomized study of chemotherapy, radiation therapy, and surgery versus surgery for localized squamous cell carcinoma of the esophagus. Cancer 1994; 73:1779-84. [PMID: 8137201 DOI: 10.1002/1097-0142(19940401)73:7<1779::aid-cncr2820730702>3.0.co;2-t] [Citation(s) in RCA: 425] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Despite well-established surgical approaches, the prognosis for patients with squamous cell carcinoma of the esophagus remains dismal. To assess the benefit of adjuvant chemotherapy and radiation therapy (CRT), a randomized trial with and without sequential preoperative CRT was undertaken; CRT combined 20 Gy and two courses of 5-FU and cisplatin. METHODS Patients were included on the basis of the following criteria: squamous cell carcinoma of the esophagus, younger than 70 years of age, World Health Organization status below 2, estimated survival time greater than 3 months, and no previous treatment for the cancer. Patients were not included if they had experienced a loss in body weight greater than 15% or had tracheoesophageal fistula, metastases, or uncontrollable infection. RESULTS Eighty-six patients thus fulfilled the criteria for inclusion (41 CRT, 45 non-CRT). The groups were well-matched for age, sex, tumor location, size, and grade. Operative mortality was 8.5% and 7%, respectively, for each group with a 27-day hospital stay for both groups. Long-term survival was not significantly different, with 47% of both groups alive at 1 year. CONCLUSIONS The authors concluded that this neoadjuvant treatment did not change operative mortality or survival time for patients with squamous cell carcinoma of the esophagus.
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Affiliation(s)
- E Le Prise
- Regional Cancer Institute, Centre Eugène Marquis, Rennes, France
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Abstract
A successful method for controlling intractable bleeding after endoscopic sphincterotomy is described. By passing a Fogarty catheter into the duodenum, balloon tamponade of the bleeding point is possible. By such a technique, major resective surgery can be avoided.
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Affiliation(s)
- E Bardaxoglou
- Department of Surgery, Hôpital Pontchaillou, Rennes, France
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