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Phan R, Xie Y, Seth I, Atkinson CJ, Thomas D, Hunter-Smith DJ, Rozen WM, Cuomo R. Free hemi-hamate arthroplasty: A review of donor site outcomes. JPRAS Open 2024; 40:206-214. [PMID: 38633374 PMCID: PMC11021908 DOI: 10.1016/j.jpra.2024.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 03/24/2024] [Indexed: 04/19/2024] Open
Abstract
Introduction The use of the dorsal hamate as a free osteochondral bone graft or vascularized bone flap has become the mainstay for large, comminuted middle phalanx volar lip fractures. To date, few studies have been conducted in the assessment of donor site morbidity for the hemi-hamate graft or flap, and none have discussed modes of repair or reconstruction of this donor site. Methods A retrospective analysis of 14 hemi-hamate arthroplasty (HHA) procedures, including 6 vascularized and 8 non-vascularized grafts, from two surgeons was performed. Four hamate defect reconstruction techniques were utilized: no formal reconstruction, autologous bone grafting, gel foam, or synthetic bone substitute. The dorsal capsule was repaired with either extensor retinaculum grafting or by direct closure. Wrist range of motion, pain scores, and radiographic alignment were assessed. Results At 6 months follow-up, all patients achieved full, pain-free wrist motion compared to the uninjured side, with visual analog scale pain scores of 0. Serial radiographs showed maintained carpal alignment without instability or subluxation. No differences based on the hamate defect reconstruction method or capsular repair technique was demonstrated. Conclusion Safe return to pain free, unrestricted wrist function is achievable after HHA, regardless of hamate donor site management. Adequate dorsal capsular repair appears critical to prevent instability. Further study is needed to compare techniques, but choice may be guided by surgeon preference in the absence of clear evidence.
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Affiliation(s)
- Robert Phan
- Peninsula Health, Frankston Hospital, 2 Hastings Road, Frankston, Victoria 3199, Australia
| | - Yi Xie
- Peninsula Health, Frankston Hospital, 2 Hastings Road, Frankston, Victoria 3199, Australia
| | - Ishith Seth
- Peninsula Health, Frankston Hospital, 2 Hastings Road, Frankston, Victoria 3199, Australia
| | - Connor J. Atkinson
- Peninsula Health, Frankston Hospital, 2 Hastings Road, Frankston, Victoria 3199, Australia
| | - Damon Thomas
- Peninsula Health, Frankston Hospital, 2 Hastings Road, Frankston, Victoria 3199, Australia
| | - David J. Hunter-Smith
- Peninsula Health, Frankston Hospital, 2 Hastings Road, Frankston, Victoria 3199, Australia
| | - Warren M. Rozen
- Peninsula Health, Frankston Hospital, 2 Hastings Road, Frankston, Victoria 3199, Australia
| | - Roberto Cuomo
- Department of Medicine, Surgery and Neuroscience, University of Siena, Italy
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Brundell K, Vasilevski V, Farrell T, Sweet L. Sustainability of rural Victorian maternity services: 'We can work together'. Women Birth 2024; 37:101596. [PMID: 38492507 DOI: 10.1016/j.wombi.2024.101596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 01/21/2024] [Accepted: 03/04/2024] [Indexed: 03/18/2024]
Abstract
BACKGROUND Rural maternity service closures and service level reductions are continually increasing across Victoria. There is limited understanding of how rural board members and executives make decisions about their maternity service's operations and sustainability. AIM To examine perspectives of rural Victorian board members and executives on the sustainability of rural maternity services. METHODS This was a qualitative study. Interviews were conducted via Zoom™ with 16 rural Victorian hospital board members and executives. Data were thematically analysed. FINDINGS Severe shortages in the rural maternity workforce, primarily midwives, have contributed to service sustainability decisions. Challenges in offering midwifery workforce incentives cause difficulty in overcoming workforce shortages. A rural maternity workforce strategy harnessing connection with regional services was called for. Innovative models of maternity care were often actioned at the point of service suspension or closure. Participants requested a government policy position and funding for innovative, safe, and sustainable models of care in rural settings. DISCUSSION There is an opportunity for workforce planning to occur between regional and rural services to ensure the development of sustainable maternity models such as midwifery group practice and incentivise the workforce to address current deficits and sustain service provision. CONCLUSION Models of care developed with rural communities, in collaboration with regional services, have the potential to strengthen the delivery of safe, sustainable maternity services. Workforce modelling and centralised government policies aimed at arresting workforce deficits are suggested to provide rural health service leaders with strategic and operational directions to support the delivery of safe, sustainable maternity services.
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Affiliation(s)
- Kath Brundell
- School of Nursing and Midwifery, Deakin University, Victoria, Australia; Institute of Health and Wellbeing, Federation University, Victoria, Australia.
| | - Vidanka Vasilevski
- School of Nursing and Midwifery, Deakin University, Victoria, Australia; Centre for Quality and Patient Safety Research, Western Health Partnership, Victoria, Australia
| | - Tanya Farrell
- Centre for Quality and Patient Safety Research, Western Health Partnership, Victoria, Australia; School of Nursing and Midwifery, Latrobe University, Victoria, Australia
| | - Linda Sweet
- School of Nursing and Midwifery, Deakin University, Victoria, Australia; Centre for Quality and Patient Safety Research, Western Health Partnership, Victoria, Australia
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MacIntosh A, Oldfield DT, Cendón DI, Langendam AD, Howell N, Howard DL, Cresswell T. Naturally occurring radioactive materials in offshore infrastructure: Understanding formation and characteristics of baryte scale during decommissioning planning. J Hazard Mater 2024; 465:133506. [PMID: 38237435 DOI: 10.1016/j.jhazmat.2024.133506] [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] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 01/06/2024] [Accepted: 01/09/2024] [Indexed: 02/08/2024]
Abstract
Contaminants, including naturally occurring radioactive material (NORM) of the 238-uranium and 232-thorium decay series, have been recognized as a global research priority to inform offshore petroleum infrastructure decommissioning decisions. This study aimed to characterize pipeline scale retrieved from a decommissioned subsea well tubular pipe through high-resolution elemental mapping and isotopic analysis. This was achieved by utilizing transmission electron microscopy, Synchrotron x-ray fluorescence, photostimulated luminescence autoradiography and Isotope Ratio Mass Spectrometry. The scale was identified as baryte (BaSO4) forming a dense crystalline matrix, with heterogenous texture and elongated crystals. The changing chemical and physical microenvironment within the pipe influenced the gradual growth rate of baryte over the production life of this infrastructure. A distinct compositional banding of baryte and celestine (SrSO4) bands was observed. Radioactivity attributed by the presence of radionuclides (226Ra, 228Ra) throughout the scale was strongly correlated with baryte. From the detailed scale characterization, we can infer the baryte scale gradually formed within the internals of the tubular well pipe along the duration of production (i.e., 17 years). This new knowledge and insight into the characteristics and formation of petroleum waste products will assist with decommissioning planning to mitigate potential radiological risks to marine ecosystems.
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Affiliation(s)
- Amy MacIntosh
- Australian Nuclear Science and Technology Organisation (ANSTO), Lucas Heights, Locked Bag 2001, NSW, 2232, Australia; School of Natural Sciences, Wallumattagal Campus, Macquarie University, Ryde, Sydney, NSW, Australia.
| | - Daniel T Oldfield
- Australian Nuclear Science and Technology Organisation (ANSTO), Lucas Heights, Locked Bag 2001, NSW, 2232, Australia
| | - Dioni I Cendón
- Australian Nuclear Science and Technology Organisation (ANSTO), Lucas Heights, Locked Bag 2001, NSW, 2232, Australia; School of Biological, Earth and Environmental Sciences, UNSW Sydney, NSW 2052, Australia
| | | | - Nicholas Howell
- Australian Nuclear Science and Technology Organisation (ANSTO), Lucas Heights, Locked Bag 2001, NSW, 2232, Australia
| | | | - Tom Cresswell
- Australian Nuclear Science and Technology Organisation (ANSTO), Lucas Heights, Locked Bag 2001, NSW, 2232, Australia
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Apostolos A, Drakopoulou M, Trantalis G, Ioakeimidis M, Koroboki E, Tsalamandris S, Aggeli C, Ntaios G, Tsioufis C, Tsivgoulis G, Toutouzas K. Management of patent foramen ovale; findings from a nationwide survey. J Stroke Cerebrovasc Dis 2024; 33:107551. [PMID: 38241951 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 12/16/2023] [Accepted: 12/20/2023] [Indexed: 01/21/2024] Open
Abstract
OBJECTIVES Several clinical trials have provided evidence supporting the transcatheter closure of patent foramen ovale (PFO) in selected patients following a cryptogenic stroke. However, it remains unknown to what extent these guidelines have been implemented in everyday clinical practice and the familiarity of physicians from different specialties with PFO closure. The aim of our nationwide survey is to explore the implementation of transcatheter PFO occlusion in Greek clinical practice. MATERIALS AND METHODS Attending level cardiologists, internal medicine physicians and neurologists involved in the management of PFO-related strokes working in Greece were invited to complete an online questionnaire. The questionnaire consisted of 19 questions and was designed to obtain comprehensive data on provider demographics, PFO characteristics, and specific clinical scenarios. RESULTS A total of 51 physicians (56.9 % cardiologists, 25.5 % neurologists and 17.6 % internal medicine physicians) completed the survey, resulting in a response rate of 53 %. Cardiologists, internal medicine physicians and neurologists agree on several issues regarding PFO closure, such as PFO closure as first line treatment, management of patients with DVT or prior decompression sickness, and post-closure antithrombotic treatment, but different approaches were reported regarding closure in patients with thrombophilia treated with oral anticoagulation (p=0.012) and implantable loop recorder placement for atrial fibrillation exclusion (p=0.029 and p=0.020). CONCLUSIONS Our findings show that cardiologists, internal medicine physicians and neurologists agree in numerous issues, but share different views in the management of patients with thrombophilia and rhythm monitoring duration. These results highlight the significance of collaboration among physicians from different medical specialties for achieving optimal results.
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Affiliation(s)
- Anastasios Apostolos
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece.
| | - Maria Drakopoulou
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece
| | - Georgios Trantalis
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece
| | - Michael Ioakeimidis
- Second Department of Neurology, School of Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Eleni Koroboki
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Sotirios Tsalamandris
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece
| | - Constantina Aggeli
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece
| | - Georgios Ntaios
- Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Costas Tsioufis
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece
| | - Georgios Tsivgoulis
- Second Department of Neurology, School of Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Konstantinos Toutouzas
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece
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Radtke S, Arms R, Son MA, Sanchez S, Singh V, Bencomo M, Mccall E, Rodriguez S, Olivas-Cardiel K. Reducing patient's perception of postoperative vaginal bleeding after laparoscopic hysterectomy via independent closure of the vaginal cuff angles (RCT). Eur J Obstet Gynecol Reprod Biol 2024; 294:111-116. [PMID: 38237308 DOI: 10.1016/j.ejogrb.2024.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 01/06/2024] [Accepted: 01/12/2024] [Indexed: 02/21/2024]
Abstract
STUDY OBJECTIVE Determine if independently suturing the vaginal cuff angles in addition to running barbed suture has an effect on patients' perception of postoperative bleeding after laparoscopic hysterectomy. DESIGN Randomized controlled trial. SETTING University-based medical center. PATIENTS Females ages 18-60 undergoing laparoscopic hysterectomy. INTERVENTIONS Patients were randomly assigned to either cuff closure via single layer of barbed suture (control) vs adding figure-of-eight stitches at each angle (intervention). A survey was given between 10 and 25 days after surgery inquiring about bleeding and dyspareunia. A second survey was given between postoperative days 90-114. Chart review was performed to record emergency room visits, complications, infections, and reoperations during the first 90 postoperative days. RESULTS n = 117 patients were analyzed. 62 (control) and 55 (intervention). Groups were similar in terms of age (42.92 v 44.29p =.35), BMI (33.79 v 34.06p =.85), diabetes (5.26 % (3/55) v 15.09 % (8/53) p =.08) p =.97). Bleeding was decreased in intervention arm (24.19 % (15/62) v 9.09 % (5/55) p =.03). Median (IQR) pelvic pain score was similar (2.0 (0-5.0) v 2.0 (0-4.0) p =.26). Median total operative time (IQR) (129 min (102, 166) v 139 min (120, 163) p =.39) and median EBL (IQR) (50 mL (30-75) vs 50 mL (20-75) p =.43) were similar. Cuff closure in seconds (IQR) was higher in intervention group (373 sec (323, 518) v 571 sec (520, 715) p <.01). 8/60 control patients visited the ED (13.33 %) v 7/54 (12.96 %) p =.95. Readmissions (1.67 % (1/60) v 1.85 % (1/55) p = 1), re-operations (0 % (0/60) v 1.85 % (1/55) p =.47) and postoperative infections (5.0 % (3/60) v 1.85 % (1/54) p =.62) were similar. Secondary survey showed no significant difference in bleeding (15.38 % (4/26) v 4.35 % (1/23) p =.35) and SF-36 results were similar. CONCLUSION Independently suturing the vaginal cuff angles reduces patients' perception of vaginal bleeding in the early postoperative period. Incidence of complications, reoperations, and long-term quality of life are similar.
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Affiliation(s)
- Steven Radtke
- Texas Tech University Health Sciences Center El Paso, USA.
| | - Richard Arms
- Texas Tech University Health Sciences Center El Paso, USA
| | - Mary Ann Son
- Texas Tech University Health Sciences Center El Paso, USA
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Meucci F, Rapillo CM, Stolcova M, Scrima GD, Nardi G, Nistri R, Ristalli F, D'Ettore N, Mattesini A, Buonamici F, Piccardi B, Tudisco L, Cramaro A, Trapani S, Pracucci G, Nencini P, Di Mario C, Sarti C. Quality control in treating patients with patent foramen ovale: 7-year-experience of the Heart and Brain team of the Careggi University Hospital. Neurol Sci 2024; 45:671-678. [PMID: 37624543 DOI: 10.1007/s10072-023-07023-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 08/16/2023] [Indexed: 08/26/2023]
Abstract
BACKGROUND The right comprehension of ischemic stroke pathogenesis guarantees the best prevention therapy. The term "patent foramen ovale (PFO) related stroke" has been proposed for those events where PFO is supposed to be pathogenetic, but their definition is challenging. A multidisciplinary evaluation in a "Heart & Brain" team (HBteam) including stroke neurologists and interventional cardiologists was therefore highly recommended in the recent guidelines of secondary stroke prevention. OBJECTIVE We aimed at describing the organization of the HBteam of Careggi-University-Hospital of Florence (Italy), and the results of the first seven years of activity. METHODS In 2016 Interventional Cardiologists and Stroke Neurologists set up an outpatient clinic for the joined evaluation of patients with PFO and other cardio/neurological conditions. A specific diagnostic-therapeutic hospital plan was produced for PFO patients. Patient empowerment was guaranteed by a hospital explicative webpage, a booklet regarding risks/benefits of PFO closure and a 3D heartmodel to simulate the intervention. Data were collected in a dedicated registry. RESULTS We evaluated 594 patients for PFO, 40 for left atrial appendage closure and 38 for other conditions. In 20% of PFO-patients, HBteam diagnosis was discordant from that of referring physicians, 14% were stroke misdiagnoses. We advised against closure in 53% of patients. At follow-up 94% of closed patients had no/minimum residual shunt; 3 patients had a cerebral ischemic event. CONCLUSIONS A dedicated HBteam represents a unique opportunity to share decisions with patients after a thorough empowerment process. The joining of cardioneurological skills allows a better classification of PFO-patients, reducing futile interventions.
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Affiliation(s)
- Francesco Meucci
- Structural Interventional Cardiology, Careggi University Hospital, Florence, Italy
| | | | - Miroslava Stolcova
- Structural Interventional Cardiology, Careggi University Hospital, Florence, Italy
| | - Giulia Domna Scrima
- NEUROFARBA Department, Neuroscience Section, University of Florence, Florence, Italy
| | - Giulia Nardi
- Structural Interventional Cardiology, Careggi University Hospital, Florence, Italy
| | - Rita Nistri
- Department of Heart and Vessel, Careggi University Hospital, Florence, Italy
| | - Francesca Ristalli
- Structural Interventional Cardiology, Careggi University Hospital, Florence, Italy
| | - Nicoletta D'Ettore
- Structural Interventional Cardiology, Careggi University Hospital, Florence, Italy
| | - Alessio Mattesini
- Structural Interventional Cardiology, Careggi University Hospital, Florence, Italy
| | - Francesco Buonamici
- Department of Industrial Engineering, University of Florence, Florence, Italy
| | | | - Laura Tudisco
- Stroke Unit, Careggi University Hospital, Florence, Italy
| | | | - Sara Trapani
- Neurosonology Unit, Careggi University Hospital, Florence, Italy
| | - Giovanni Pracucci
- NEUROFARBA Department, Neuroscience Section, University of Florence, Florence, Italy
| | | | - Carlo Di Mario
- Structural Interventional Cardiology, Careggi University Hospital, Florence, Italy
- Department of Experimental & Clinical Medicine, University of Florence, Florence, Italy
| | - Cristina Sarti
- NEUROFARBA Department, Neuroscience Section, University of Florence, Florence, Italy
- Stroke Unit, Careggi University Hospital, Florence, Italy
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Yu Y, Wang Z, Wang J, Qi B, Liu L, Jin ZB, Liu W. Closure Grading and Visual Outcome in Patients with Large Idiopathic Macular Holes: A Spectral-Domain Optical Coherence Tomography Observation. Ophthalmic Res 2024; 67:192-200. [PMID: 38253044 DOI: 10.1159/000536205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 01/07/2024] [Indexed: 01/24/2024]
Abstract
INTRODUCTION So far, there has been no closure grade system synthesizing morphological and microstructural features for large idiopathic macular holes (IMHs) treated by vitrectomy and internal limiting membrane (ILM) peeling. This study aimed to propose a concise one and explore its relevance with visual acuity and the related preoperative factors. METHODS Consecutive patients with large IMHs (minimum diameter >400 μm), undergoing vitrectomy and ILM peeling, obtaining primary closure and regularly followed-up were enrolled. Preoperative clinical charts and spectral-domain optical coherence tomography (SD-OCT) parameters were reviewed. SD-OCT images and best corrected visual acuity (BCVA) were assessed at 1, 4, and 10 months postoperatively. SD-OCT features at last visit were categorized by BCVA significance, and preoperative risk factors were analyzed. RESULTS Sixty-eight eyes from 64 patients were enrolled. The 10-month postoperative SD-OCT images were categorized into closure grade 1, 2, and 3 with successively decreased BCVA (p < 0.001). During early follow-up, part of grades 2 and 3 could evolve into the upper grade, respectively, but grade 3 could never evolve into grade 1 and exhibited the least satisfactory long-term BCVA. Binary logistic regression showed that large minimum linear diameter (MLD) was a risk factor for grade 3 occurrence (p < 0.001), with a cutoff value of 625.5 μm from the receiver operating characteristic curve for MLD predicting grade 3 occurrence (p = 0.001). CONCLUSION Long-term closure status of large IMHs could be categorized into three grades with BCVA significance. Large horizontal MLD is a risk factor for occurrence of grade 3 closure with unsatisfactory visual recovery.
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Affiliation(s)
- Yanping Yu
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Zengyi Wang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Jing Wang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Biying Qi
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Lingzi Liu
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Zi-Bing Jin
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Wu Liu
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
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Lloyd AJ, Hardy NP, Jordan P, Ryan EJ, Whelan M, Clancy C, O'Riordan J, Kavanagh DO, Neary P, Sahebally SM. Efferent limb stimulation prior to loop ileostomy closure: a systematic review and meta-analysis. Tech Coloproctol 2023; 28:15. [PMID: 38095756 DOI: 10.1007/s10151-023-02875-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 11/01/2023] [Indexed: 12/18/2023]
Abstract
BACKGROUND Postoperative ileus (POI) remains a common phenomenon following loop ileostomy closure. Our aim was to determine whether preoperative physiological stimulation (PPS) of the efferent limb reduced POI incidence. METHODS A PRISMA-compliant meta-analysis searching PubMed, EMBASE and CENTRAL databases was performed. The last search was carried out on 30 January 2023. All randomized studies comparing PPS versus no stimulation were included. The primary endpoint was POI incidence. Secondary endpoints included the time to first passage of flatus/stool, time to resume oral diet, need for nasogastric tube (NGT) placement postoperatively, length of stay (LOS) and other complications. Random effects models were used to calculate pooled effect size estimates. Trial sequential analyses (TSA) were also performed. RESULTS Three randomized studies capturing 235 patients (116 PPS, 119 no stimulation) were included. On random effects analysis, PPS was associated with a quicker time to resume oral diet (MD - 1.47 days, 95% CI - 2.75 to - 0.19, p = 0.02), shorter LOS (MD - 1.47 days, 95% CI - 2.47 to - 0.46, p = 0.004) (MD - 1.41 days, 95% CI - 2.32 to - 0.50, p = 0.002, I2 = 56%) and fewer other complications (OR 0.42, 95% CI 0.18 to 1.01, p = 0.05). However, there was no difference in POI incidence (OR 0.35, 95% CI 0.10 to 1.21, p = 0.10), the requirement for NGT placement (OR 0.50, 95% CI 0.21 to 1.20, p = 0.12) or time to first passage of flatus/stool (MD - 0.60 days, 95% CI - 1.95 to 0.76, p = 0.39). TSA revealed imprecise estimates for all outcomes (except LOS) and further studies are warranted to meet the required information threshold. CONCLUSIONS PPS prior to stoma closure may reduce LOS and postoperative complications albeit without a demonstrable beneficial effect on POI. Further high-powered studies are required to confirm or refute these findings.
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Affiliation(s)
- A J Lloyd
- Department of Surgery, Tallaght University Hospital, Dublin, Ireland.
- Department of Colorectal Surgery, Tallaght University Hospital, Dublin , Ireland.
| | - N P Hardy
- Department of Surgery, Tallaght University Hospital, Dublin, Ireland
| | - P Jordan
- Department of Surgery, Tallaght University Hospital, Dublin, Ireland
| | - E J Ryan
- Department of Surgery, Tallaght University Hospital, Dublin, Ireland
| | - M Whelan
- Department of Surgery, Tallaght University Hospital, Dublin, Ireland
| | - C Clancy
- Department of Surgery, Tallaght University Hospital, Dublin, Ireland
| | - J O'Riordan
- Department of Surgery, Tallaght University Hospital, Dublin, Ireland
| | - D O Kavanagh
- Department of Surgery, Tallaght University Hospital, Dublin, Ireland
- Department of Surgical Affairs, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - P Neary
- Department of Surgery, Tallaght University Hospital, Dublin, Ireland
| | - S M Sahebally
- Department of Surgery, Tallaght University Hospital, Dublin, Ireland
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Jain AK, Bhargava R, Rawat A. Designing regression approach for mode frequency prediction of empty and filled steel silos. Heliyon 2023; 9:e22764. [PMID: 38144310 PMCID: PMC10746427 DOI: 10.1016/j.heliyon.2023.e22764] [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: 07/27/2023] [Revised: 10/10/2023] [Accepted: 11/18/2023] [Indexed: 12/26/2023] Open
Abstract
In this study the primary objective is to design prediction model for the free vibration analysis of thin circular cylindrical steel silos having various aspect ratios in empty and varying filled conditions for different types of closures. A finite element method (FEM) is used to carry out the free vibration analysis of steel silos. It is found that the effect of different aspect ratios slender, intermediate slender and squat steel silos is very significant for dynamic response of silo. The silos are considered having open, flat and cone type of closures at its top end. The clamped-free (cantilever) boundary condition is taken for this approach as actual silos are fixed at flat-base. The structural mass of thin cylindrical shell steel silo is made constant for a particular height and diameter. The eigenvalues of the thin cylindrical shell steel silos are extracted by using block Lanczos method. The free vibrations of thin cylindrical shell steel silo with different aspect ratios, radius to thickness ratio are studied. From the present studies it is seen that as aspect ratio increases the fundamental frequency is reduced in empty silo. It is more in the case of squat silo. It can be seen that the fundamental frequency is less in the case of flat closure in all the aspect ratios of the silo. The frequency values are more in the case of cone closure is observed. Also as the mode number increases the modal frequency value increases. Further, as the filling level is increased the modal frequency also increases. Finally, regression approach is adopted for predicting the mode frequency of empty and filled silos for wide range of aspect ratios.
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Affiliation(s)
- Aashish Kumar Jain
- Department of Civil Engineering, University Institute of Technology (UIT), Rajiv Gandhi Proudyogiki Vishwavidyalaya (RGPV), Bhopal, 462 033, Madhya Pradesh, India
| | | | - Aruna Rawat
- Department of Civil Engineering, University Institute of Technology (UIT), Rajiv Gandhi Proudyogiki Vishwavidyalaya (RGPV), Bhopal, 462 033, Madhya Pradesh, India
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10
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Clancy C, Connelly TM, Jia X, Lipman J, Lightner AL, Hull T, Steele SR, Holubar SD. Defining the safety of early ileostomy closure after ileal pouch anal anastomosis. Tech Coloproctol 2023; 27:1257-1263. [PMID: 37209279 DOI: 10.1007/s10151-023-02811-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 04/24/2023] [Indexed: 05/22/2023]
Abstract
PURPOSE The safety of early ileostomy reversal after ileal pouch anal anastomosis (IPAA) has not been established. Our hypothesis was that ileostomy reversal before 8 weeks is associated with negative outcomes. METHODS This was a retrospective cohort study from a prospectively maintained institutional database. Patients who underwent primary IPAA with ileostomy reversal between 2000 and 2021 from a Pouch Registry were stratified on the basis of timing of reversal. Those reversed before 8 weeks (early) and those reversed from 8 weeks to 116 days (routine) were compared. The primary outcome was overall complications according to timing and reason for closure. RESULTS Ileostomy reversal was performed early in 92 patients and routinely in 1908. Median time to closure was 49 days in the early group and 93 days in the routine group. Reasons for early reversal were stoma-related morbidity in 43.3% (n = 39) and scheduled closure in 56.7% (n = 51). The complication rate in the early group was 17.4% versus 11% in the routine group (p = 0.085). When early patients were stratified according to reason for reversal, those reversed early for stoma-related morbidity had an increased complication rate compared to the routine group (25.6% vs. 11%, p = 0.006). Patients undergoing scheduled reversal in the early group did not have increased complications (11.8% vs. 11%, p = 0.9). There was a higher likelihood of pouch anastomotic leak when reversal was performed early for stoma complications compared to routinely (OR 5.13, 95% CI 1.01-16.57, p = 0.049). CONCLUSIONS Early closure is safe but could be delayed in stoma morbidity as patients may experience increased complications.
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Affiliation(s)
- C Clancy
- Department of Colon and Rectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - T M Connelly
- Department of Colon and Rectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - X Jia
- Department of Colon and Rectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - J Lipman
- Department of Colon and Rectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - A L Lightner
- Department of Colon and Rectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - T Hull
- Department of Colon and Rectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - S R Steele
- Department of Colon and Rectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - S D Holubar
- Department of Colon and Rectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA.
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11
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Funayama M, Sato S, Koishikawa H, Satake N, Kato O, Noguchi M, Takata T, Hasegawa Y, Wada H, Akahane T, Tsujino N, Nishimura K. Resilience in adversity: Navigating financial challenges and closure risks in general hospital psychiatric units - Japanese Society of General Hospital Psychiatry's initiatives. Asian J Psychiatr 2023; 89:103756. [PMID: 37666029 DOI: 10.1016/j.ajp.2023.103756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 08/17/2023] [Accepted: 08/25/2023] [Indexed: 09/06/2023]
Affiliation(s)
- Michitaka Funayama
- Department of Neuropsychiatry, Ashikaga Red Cross Hospital, Tochigi, Japan.
| | - Shigeki Sato
- Department of Psychiatry, Narita Red Cross Hospital, Chiba, Japan
| | - Hiraki Koishikawa
- Department of Psychosomatic Medicine and Psychiatry, Kameda Medical Center, Chiba, Japan
| | - Naoko Satake
- Department of Psychiatry, Konodai Hospital of National Center for Global Health and Medicine, Chiba, Japan
| | - On Kato
- Department of Psychiatry, Center Hospital of the National Center for Global Health and Medicine, Tokyo, Japan
| | - Masayuki Noguchi
- Mental Health Welfare Center in Okayama Prefecture, Okayama, Japan
| | - Tomoji Takata
- Department of Psychiatry, Gifu Prefectural Tajimi Hospital, Gifu, Japan
| | - Yusuke Hasegawa
- Department of Psychiatry, Toyama City Hospital, Toyama, Japan
| | - Hisashi Wada
- Department of Psychiatry, Osaka Red Cross Hospital, Osaka, Japan
| | - Takaki Akahane
- Department of Psychiatry, Okitama Public General Hospital, Yamagata, Japan
| | - Naohisa Tsujino
- Department of Psychiatry, Saiseikai Yokohamashi Tobu Hospital, Kanagawa, Japan
| | - Katsuji Nishimura
- Department of Neuropsychiatry, Tokyo Woman's Medical University, Tokyo, Japan
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12
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Roh JL. Frey syndrome after conservative parotidectomy: Importance of closing the remnant parotid parenchyma. J Plast Reconstr Aesthet Surg 2023; 85:149-154. [PMID: 37494848 DOI: 10.1016/j.bjps.2023.07.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 07/01/2023] [Accepted: 07/04/2023] [Indexed: 07/28/2023]
Abstract
BACKGROUND Frey syndrome (FS) is a typical late complication following parotidectomy. Parotid surgery without proper coverage or reconstruction of exposed parotid parenchyma may contribute to the development of FS. Therefore, this study compared the closure versus the non-closure of exposed parotid parenchyma in the occurrence of FS. METHODS This study included 195 patients with parotid lesions who underwent partial or superficial parotidectomy plus closure or non-closure of exposed parotid parenchyma, both with the application of fibrin glue. Two surgical methods of closure and non-closure were allocated to patients without randomization and blinding processes. The primary outcome was FS, and the second outcome was other complication rates. RESULTS The closure and non-closure of exposed parotid parenchyma were performed in 102 and 93 patients, respectively. Early postoperative complications occurred with temporary events: transient facial weakness, 32 (16.4%); hematoma, 13 (6.7%); and wound infection, 2 (1.0%), without statistical difference between the two groups (P > 0.1). However, sialocele occurred in the non-closure group (n = 19) more than in the closure group (n = 7) (P = 0.005). In the first postoperative year, decreased sensation and local pain were found in 16 patients (8.2%) and 9 patients (4.6%), respectively, with no statistical difference between the two groups (P > 0.1). FS was found more in the non-closure group (n = 19, 20.4%) than in the closure group (n = 4, 3.9%) (P < 0.001). CONCLUSION The closure of exposed parotid parenchyma and covering fascia is preferred over the non-closure to prevent FS.
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Affiliation(s)
- Jong-Lyel Roh
- Department of Otorhinolaryngology-Head and Neck Surgery, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea.
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13
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Ding WY, Lip GYH, Gupta D. Left Atrial Appendage Occlusion-A Choice or a Last Resort? How to Approach the Patient. Card Electrophysiol Clin 2023; 15:133-140. [PMID: 37076225 DOI: 10.1016/j.ccep.2023.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2023]
Abstract
Left atrial appendage (LAA) occlusion is emerging as a viable alternative to oral anticoagulation in high-risk patients with atrial fibrillation. However, there remains limited evidence for this approach, especially in certain subgroups, and therefore patient selection is an important aspect of treatment. Here, the authors present arguments for LAA occlusion as either a last resort versus patient choice by evaluating contemporary studies on this topic and discuss practical steps in the approach of patients who may be suitable for LAA occlusion. Overall, an individualized and multidisciplinary team approach should be adopted in patients who are being considered for LAA occlusion.
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Affiliation(s)
- Wern Yew Ding
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK; Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Dhiraj Gupta
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK.
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14
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Hoffmann J, Dresbach T, Hagenbeck C, Scholten N. Factors associated with the closure of obstetric units in German hospitals and its effects on accessibility. BMC Health Serv Res 2023; 23:342. [PMID: 37020222 PMCID: PMC10077609 DOI: 10.1186/s12913-023-09204-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 02/20/2023] [Indexed: 04/07/2023] Open
Abstract
BACKGROUND An increase in regionalization of obstetric services is being observed worldwide. This study investigated factors associated with the closure of obstetric units in hospitals in Germany and aimed to examine the effect of obstetric unit closure on accessibility of obstetric care. METHODS Secondary data of all German hospital sites with an obstetrics department were analyzed for 2014 and 2019. Backward stepwise regression was performed to identify factors associated with obstetrics department closure. Subsequently, the driving times to a hospital site with an obstetrics department were mapped, and different scenarios resulting from further regionalization were modelled. RESULTS Of 747 hospital sites with an obstetrics department in 2014, 85 obstetrics departments closed down by 2019. The annual number of live births in a hospital site (OR = 0.995; 95% CI = 0.993-0.996), the minimal travel time between two hospital sites with an obstetrics department (OR = 0.95; 95% CI = 0.915-0.985), the availability of a pediatrics department (OR = 0.357; 95% CI = 0.126-0.863), and population density (low vs. medium OR = 0.24; 95% CI = 0.09-0.648, low vs. high OR = 0.251; 95% CI = 0.077-0.822) were observed to be factors significantly associated with the closure of obstetrics departments. Areas in which driving times to the next hospital site with an obstetrics department exceeded the 30 and 40 min threshold slightly increased from 2014 to 2019. Scenarios in which only hospital sites with a pediatrics department or hospital sites with an annual birth volume of ≥ 600 were considered resulted in large areas in which the driving times would exceed the 30 and 40 min threshold. CONCLUSION Close distances between hospital sites and the absence of a pediatrics department at the hospital site associate with the closure of obstetrics departments. Despite the closures, good accessibility is maintained for most areas in Germany. Although regionalization may ensure high-quality care and efficiency, further regionalization in obstetrics will have an impact on accessibility.
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Affiliation(s)
- Jan Hoffmann
- Faculty of Medicine and University Hospital Cologne, Faculty of Human Sciences, Institute for Medical Sociology, Health Services Research, and Rehabilitation Science (IMVR), University of Cologne, Eupener Str. 129, 50933, Cologne, Germany.
| | - Till Dresbach
- University Hospital Bonn, Department of Neonatology and Pediatric Intensive Care Medicine, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Carsten Hagenbeck
- Department of Obstetrics and Gynecology, University Hospital Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany
| | - Nadine Scholten
- Faculty of Medicine and University Hospital Cologne, Faculty of Human Sciences, Institute for Medical Sociology, Health Services Research, and Rehabilitation Science (IMVR), University of Cologne, Eupener Str. 129, 50933, Cologne, Germany
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15
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Ng JJ, Blum JD, Cho DY, Cheung L, Romeo DJ, Low DW, Taylor JA, Heuer GG, Swanson JW, Flanders TM. Spinal pseudomeningocele closure: capsulofascial interposition technique. Childs Nerv Syst 2023; 39:1045-1049. [PMID: 36790495 DOI: 10.1007/s00381-023-05849-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 01/14/2023] [Indexed: 02/16/2023]
Abstract
INTRODUCTION The development of a spinal pseudomeningocele is a complication of dural repair or reconstruction that carries significant morbidity for pediatric patients. In addition to cerebrospinal fluid (CSF) hypotension and positional headaches, CSF leaking into the extradural space increases the risk for incisional breakdown, meningitis, and cosmetic deformity. Spinal pseudomeningocele management is challenging, and reported techniques range from local wound revisions/exploration to shunt placement for permanent CSF diversion. METHODS At our institution, we have recently implemented a multidisciplinary approach of capsulofascial interposition for the surgical repair of the symptomatic spinal pseudomeningocele with a combined neurosurgery-plastic surgery team. To our knowledge, this technique has not previously been characterized, and we describe the technical aspects of this surgery here. RESULTS Among 10 patients treated with this technique, none required reoperation or developed infections following pseudomeningocele closure; 2 patients received postoperative transfusions; and 2 patients underwent CSF diversion procedures. CONCLUSION We propose that this capsulofascial interposition technique should be employed in the surgical treatment of symptomatic spinal pseudomeningoceles.
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Affiliation(s)
- Jinggang J Ng
- The Childrens Hospital of Philadelphia, Division of Plastic Surgery, Philadelphia, PA, 19104, USA
| | - Jessica D Blum
- The Childrens Hospital of Philadelphia, Division of Plastic Surgery, Philadelphia, PA, 19104, USA
| | - Daniel Y Cho
- The Childrens Hospital of Philadelphia, Division of Plastic Surgery, Philadelphia, PA, 19104, USA
| | - Liana Cheung
- The Childrens Hospital of Philadelphia, Division of Plastic Surgery, Philadelphia, PA, 19104, USA
| | - Dominic J Romeo
- The Childrens Hospital of Philadelphia, Division of Plastic Surgery, Philadelphia, PA, 19104, USA
| | - David W Low
- The Childrens Hospital of Philadelphia, Division of Plastic Surgery, Philadelphia, PA, 19104, USA
| | - Jesse A Taylor
- The Childrens Hospital of Philadelphia, Division of Plastic Surgery, Philadelphia, PA, 19104, USA
| | - Gregory G Heuer
- The Childrens Hospital of Philadelphia, Division of Neurosurgery, Philadelphia, PA, 19104, USA
| | - Jordan W Swanson
- The Childrens Hospital of Philadelphia, Division of Plastic Surgery, Philadelphia, PA, 19104, USA
| | - Tracy M Flanders
- The Childrens Hospital of Philadelphia, Division of Neurosurgery, Philadelphia, PA, 19104, USA.
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16
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Hoang LX, Tuyen LK, Gia TM, Anh NK, Dan DB, Phuong PK, Tin DN, Hoa T, Duc NM. Large isolated major aortopulmonary collateral artery causing dilated left ventricle. Radiol Case Rep 2023; 18:1530-5. [PMID: 36815146 DOI: 10.1016/j.radcr.2023.01.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 01/13/2023] [Accepted: 01/16/2023] [Indexed: 02/10/2023] Open
Abstract
Isolated major aortopulmonary collateral artery (MAPCA), in the absence of evidence of structural heart disease, is a very rare observation. This anomaly usually appears in preterm newborns. In the majority of babies, isolated MAPCAs cause no symptoms and regress spontaneously after birth and their conservative management is usually sufficient. We report a case of an asymptomatic full-term 5-month-old infant presenting with heart murmur as the only sign during clinical evaluation. Echocardiography revealed a dilated left ventricle, with no pulmonary hypertension. Computed tomography angiogram showed a large MAPCA arising from the descending thoracic aorta and supplying blood to the left lower lobe. The condition was managed successfully by percutaneous obliteration with Amplatzer vascular plugs. Isolated MAPCA is usually a benign anomaly, presenting no clinical finding and requiring no specific treatment. However, in a small minority of infants, this congenital disorder may progress, with detrimental impacts on cardiac structure before clinical symptoms appear. Early intervention may be required to prevent irreversible sequelae.
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17
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Murphy DC, Al-Zubaidy M, Lois N, Scott N, Steel DH. The Effect of Macular Hole Duration on Surgical Outcomes: An Individual Participant Data Study of Randomized Controlled Trials. Ophthalmology 2023; 130:152-163. [PMID: 36058348 DOI: 10.1016/j.ophtha.2022.08.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 07/25/2022] [Accepted: 08/25/2022] [Indexed: 01/25/2023] Open
Abstract
TOPIC To define the effect of symptom duration on outcomes in people undergoing surgery for idiopathic full-thickness macular holes (iFTMHs) by means of an individual participant data (IPD) study of randomized controlled trials (RCTs). The outcomes assessed were primary iFTMH closure and postoperative best-corrected visual acuity (BCVA). CLINICAL RELEVANCE Idiopathic full-thickness macular holes are visually disabling with a prevalence of up to 0.5%. Untreated BCVA is typically reduced to 20/200. Surgery can close holes and improve vision. Symptom duration is thought to affect outcomes with surgery, but the effect is unclear. METHODS A systematic review identified eligible RCTs that included adults with iFTMH undergoing vitrectomy with gas tamponade in which symptom duration, primary iFTMH closure, and postoperative BCVA were recorded. Bibliographic databases were searched for articles published between 2000 and 2020. Individual participant data were requested from eligible studies. RESULTS Twenty eligible RCTs were identified. Data were requested from all studies and obtained from 12, representing 940 eyes in total. Median symptom duration was 6 months (interquartile range, 3-10). Primary closure was achieved in 81.5% of eyes. There was a linear relationship between predicted probability of closure and symptom duration. Multilevel logistic regression showed each additional month of duration was associated with 0.965 times lower odds of closure (95% confidence interval [CI], 0.935-0.996, P = 0.026). Internal limiting membrane (ILM) peeling, ILM flap use, better preoperative BCVA, face-down positioning, and smaller iFTMH size were associated with increased odds of primary closure. Median postoperative BCVA in eyes achieving primary closure was 0.48 logarithm of the minimum angle of resolution (logMAR) (20/60). Multilevel logistic regression showed for eyes achieving primary iFTMH closure, each additional month of symptom duration was associated with worsening BCVA by 0.008 logMAR units (95% CI, 0.005-0.011, P < 0.001) (i.e., ∼1 Early Treatment Diabetic Retinopathy Study letter loss per 2 months). ILM flaps, intraocular tamponade using long-acting gas, better preoperative BCVA, smaller iFTMH size, and phakic status were also associated with improved postoperative BCVA. CONCLUSIONS Symptom duration was independently associated with both anatomic and visual outcomes in persons undergoing surgery for iFTMH. Time to surgery should be minimized and care pathways designed to enable this.
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Affiliation(s)
- Declan C Murphy
- Bioscience Institute, Newcastle University, Newcastle Upon Tyne, United Kingdom
| | - Mo Al-Zubaidy
- Bioscience Institute, Newcastle University, Newcastle Upon Tyne, United Kingdom
| | - Noemi Lois
- Wellcome Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, United Kingdom
| | - Neil Scott
- Medical Statistics Team, University of Aberdeen, Aberdeen, United Kingdom
| | - David H Steel
- Bioscience Institute, Newcastle University, Newcastle Upon Tyne, United Kingdom; Sunderland Eye Infirmary, Queen Alexandra Road, Sunderland, United Kingdom.
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Abrahamyan L, Barker M, Dharma C, Lee DS, Austin PC, Asghar A, Muthuppalaniappan A, Benson L, Osten M, Horlick EM. Real world long-term outcomes among adults undergoing transcatheter patent foramen closure with amplatzer PFO occluder. Int J Cardiol 2023; 371:109-115. [PMID: 36165815 DOI: 10.1016/j.ijcard.2022.09.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 08/22/2022] [Accepted: 09/15/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Patent foramen ovale (PFO) is a congenital heart defect associated with an increased risk of cryptogenic stroke. We aimed to evaluate real-world outcomes of adult patients undergoing transcatheter PFO closure with the Amplatzer PFO Occluder. METHODS In this single centre, retrospective cohort study, we linked a detailed clinical registry with provincial administrative databases to obtain short and long-term outcomes. Validated algorithms were used to established baseline comorbidities and adverse outcomes. RESULTS Between 1999 and 2017, 479 patients had PFO closure with an Amplatzer PFO Occluder. The average age of the patients was 47.3 years (standard deviation (SD) = 12.4), and 54.7% were males. The procedural success was 100%, and 96% of patients were discharged on the same day. Any in-hospital complication was observed in 2.5% (n = 12) of patients. At 30 days post-discharge, 18% of patients had an ED visit and 5% a hospitalization. Over a mean follow-up of 9.1 (SD = 3.8) years, 4% experienced TIA, 1.5% stroke, and 7.6% atrial fibrillation. The composite outcome of stroke/TIA/death was observed in 10.9% of patients (1.22 events per 100 person-years). Patients >60 years old experienced higher rates of adverse events than younger patients. CONCLUSIONS In this large real-world cohort of patients with cryptogenic stroke, we observed excellent safety and effectiveness outcomes for PFO closure conducted with Amplatzer PFO Occluder, similar to randomized controlled trials or other long-term cohort studies. New onset atrial fibrillation was one of the most commonly adverse events. Future studies should investigate early post-discharge management of patients to prevent readmissions.
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Affiliation(s)
- Lusine Abrahamyan
- Toronto General Hospital Research Institute, University Health Network (UHN), Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Madeleine Barker
- Center for Cardiovascular Innovation - Centre d'Innovation Cardiovasculaire (CCI-CIC), University of British Columbia, Vancouver, BC, Canada
| | | | - Douglas S Lee
- ICES, Toronto, ON, Canada; Division of Cardiology, Peter Munk Cardiac Centre, UHN, Toronto, ON, Canada
| | - Peter C Austin
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada; ICES, Toronto, ON, Canada
| | - Areeba Asghar
- Toronto General Hospital Research Institute, University Health Network (UHN), Toronto, ON, Canada; McMaster University, Hamilton, ON, Canada
| | | | - Lee Benson
- The Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Mark Osten
- Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, UHN, Toronto, ON, Canada
| | - Eric M Horlick
- Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, UHN, Toronto, ON, Canada.
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Blazek S, Unterhuber M, Rommel KP, Kresoja KP, Kister T, Besler C, Fengler K, Rosch S, Daehnert I, Thiele H, Lurz P, von Roeder M. Fate of iatrogenic atrial septal defects following mitral transcatheter edge-to-edge repair - a subanalysis of the MITHRAS trial. Int J Cardiovasc Imaging 2023; 39:519-30. [PMID: 36371488 DOI: 10.1007/s10554-022-02750-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Accepted: 10/17/2022] [Indexed: 11/15/2022]
Abstract
Persisting iatrogenic atrial septal defects (iASD) after transcatheter mitral edge-to-edge repair (M-TEER) are associated with impaired outcomes. We investigated the natural history of relevant iASDs with left-to-right shunting post-M-TEER, predictors of spontaneous closure of iASD between 1 and 6 months post-M-TEER, and outcomes (heart failure [HF] hospitalization) in patients with spontaneous closure versus those with persistent iASD 6 months post-M-TEER. Patients with a relevant iASD 1-month post-M-TEER, who were treated conservatively in the randomized controlled MITHRAS trial, underwent clinical follow-up including transesophageal echocardiography 6 months post-M-TEER. Overall, 36 patients (median 77 [interquartile range 65-81] years; 36% women) completed the 6-months follow-up. Six (17%) patients had a spontaneous closure of the iASD. The eccentricity index of the iASD 1-month after M-TEER was the strongest predictor for spontaneous closure (Odds ratio 3.78; 95% confidence interval 1.26-11.33, p = 0.01) and an eccentricity index of < 1.9 provided a sensitivity of 77% at a specificity of 83% for iASD persistence (Area under the curve 0.83, p < 0.001) within 6-months post M-TEER.At follow-up, a numerical difference in the endpoint of HF hospitalization between the spontaneous closure and the residual shunt group (0% vs. 20%, p = 0.25) was observed. The eccentricity of the iASD was the strongest predictor for spontaneous closure at 1-months and an eccentricity index of < 1.9 is associated with a high persistence rate for 6 month after M-TEER. Clinical Trial Registration ClinicalTrials.gov https://clinicaltrials.gov/ct2/show/NCT03024268 Identifier: NCT03024268. a (red) is reflecting the mayor lengthwise dimension and b (blue) the mayor oblique dimension. The eccentricity index is calculated by dividing a through b. (Open circle) is depicting an example for a round iASD and (Open rhombus) an example for an eccentric iASD 1 month after M-TEER.
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Yao Z, Tian W, Huang M, Xu X, Zhao R. Effect of placing double-lumen irrigation-suction tube on closure of anastomotic defect following rectal cancer surgery. Surg Endosc 2023; 37:412-420. [PMID: 35984523 DOI: 10.1007/s00464-022-09523-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 07/31/2022] [Indexed: 01/18/2023]
Abstract
PURPOSE This study aimed to investigate the effect of placement of double-lumen irrigation-suction tubes (DLIST) on the closure of anastomotic defect (AD) after rectal cancer surgery. METHODS The study was carried out at two centers managed by one surgeon, both adopted the same treatments. Patients with postoperative AD after rectal cancer surgery from January 2011 to June 2020 were eligible and were divided into a passive drainage (PD) group and a DLIST group according to whether the PD, placed in the rectal cancer surgery, had been replaced with the DLIST. The effect of DLIST on the AL was evaluated. RESULT There distributed 76 patients in the DLIST group and 52 in the PD group. A higher closure rate was reported in the DLIST group (46 patients in DLIST group, for a closure rate of 60.5%, and 21 patients in PD group, for a closure rate of 40.4%. HR = 3.05; 95% CI: 1.79-5.19; P < 0.001). Both length of stay and costs of the treatment in the DLIST group were lower (54 days [interquartile range, IQR: 41-17] days vs. 112 days [IQR: 66-27] days, P = 0.005; and $18,721 [IQR: $14,982-4,960] vs. $40,840 [IQR: $20,932-50,529], P < 0.001). CONCLUSION Placement of DLIST might serve as an effective method for treating AD following rectal cancer surgery. In comparison with PD, it costs lower to apply DLIST in the treatment of AD and the length of stay is shorter.
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Affiliation(s)
- Zheng Yao
- Department of General Surgery, Jiangning Hospital, Nanjing, Jiangsu, China. .,Department of Enterocutaneous Fistula Surgery, Jiangning Hospital, Hushan Road NO.169, Nanjing, Jiangsu, China.
| | - Weiliang Tian
- Department of General Surgery, Jinling Hospital, Nanjing, Jiangsu, China
| | - Ming Huang
- Department of General Surgery, Jiangning Hospital, Nanjing, Jiangsu, China
| | - Xin Xu
- Department of General Surgery, Jiangning Hospital, Nanjing, Jiangsu, China
| | - Risheng Zhao
- Department of General Surgery, Jiangning Hospital, Nanjing, Jiangsu, China. .,Department of Enterocutaneous Fistula Surgery, Jiangning Hospital, Hushan Road NO.169, Nanjing, Jiangsu, China.
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Sahoo NK, Suresh A, Patil A, Ong J, Kazi E, Tyagi M, Narayanan R, Nayak S, Jacob N, Venkatesh R, Chhablani J. Novel En Face OCT-Based Closure Patterns in Idiopathic Macular Holes. Ophthalmol Retina 2022:S2468-6530(22)00638-8. [PMID: 36584899 DOI: 10.1016/j.oret.2022.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 12/14/2022] [Accepted: 12/22/2022] [Indexed: 12/28/2022]
Abstract
PURPOSE To determine the postoperative en face OCT pattern of closure in idiopathic macular holes (MHs). DESIGN Retrospective, multicentric, observational study. PARTICIPANTS Patients aged > 18 years with a diagnosis of idiopathic MH, with well documented en face OCT images. METHODS Baseline characteristics and preoperative OCT and en face OCT parameters like horizontal and vertical minimum linear diameter (MLD), horizontal and vertical basal hole diameter (BHD), hole height, acircularity index, and hole orientation were measured. MAIN OUTCOME MEASURE The type of hole closure on en face OCT, and a comparison of baseline parameters and final visual acuity among the en face closure types. RESULTS A total of 64 eyes of 62 patients (24 men and 40 women) with a mean age of 63.8 ± 12.4 years. The median duration of symptoms was 3 months (interquartile range, 1.75-10.5). The eyes had a mean baseline visual acuity of 0.97 ± 0.46 logarithm of minimum angle of resolution (logMAR). The baseline horizontal MLD was 591.7 ± 219.4 μm and the vertical MLD was 552.9 ± 198.2 μm. Baseline horizontal and vertical BHD were 1240.3 ± 521.1 μm and 1142.1 ± 478.1 μm, respectively. The mean hole height was 394.8 ± 123.2 μm. Two different patterns were noted on en face OCT: round, or linear. A total of 38 eyes had a round/centripetal closure and 26 eyes had a linear closure (17 eyes had a horizontal closure, 7 eyes had an oblique closure, while 2 eyes had a vertical closure). The mean final visual acuity was 0.80 ± 0.43 logMAR (Snellen equivalent of 20/125). Eyes with linear closure (0.76 ± 0.23 logMAR) had a significantly (P = 0.03) better visual acuity than the round closure group (1.07 ± 0.28 logMAR), only in eyes with horizontal MLD of > 650 μm, but not when other MLD cut-offs were used. CONCLUSION We describe 2 different patterns of hole closure (linear and round) on en face OCT. Further studies will be required to determine its functional significance. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found after the references.
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Affiliation(s)
- Niroj Kumar Sahoo
- Anant Bajaj retina Institute, Kode Venkatadri Chowdary Campus, L V Prasad Eye Institute, Vijayawada, India.
| | - Anjali Suresh
- Anant Bajaj retina Institute, Kode Venkatadri Chowdary Campus, L V Prasad Eye Institute, Vijayawada, India
| | - Ashika Patil
- Anant Bajaj retina Institute, Kode Venkatadri Chowdary Campus, L V Prasad Eye Institute, Vijayawada, India
| | - Joshua Ong
- UPMC Eye Centre, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Eman Kazi
- UPMC Eye Centre, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Mudit Tyagi
- Anant Bajaj Retina Institute, L V Prasad Eye Institute, Hyderabad, India
| | - Raja Narayanan
- Anant Bajaj Retina Institute, L V Prasad Eye Institute, Hyderabad, India
| | - Sameera Nayak
- Anant Bajaj retina Institute, Kode Venkatadri Chowdary Campus, L V Prasad Eye Institute, Vijayawada, India
| | - Ninan Jacob
- Anant Bajaj retina Institute, Kode Venkatadri Chowdary Campus, L V Prasad Eye Institute, Vijayawada, India
| | - Ramesh Venkatesh
- Department of Retina and Vitreous, Narayana Nethralaya, Benguluru, India
| | - Jay Chhablani
- UPMC Eye Centre, University of Pittsburgh, Pittsburgh, Pennsylvania
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22
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Ali O, Canakis A, Huang Y, Patel H, Alizadeh M, Kim RE. Closure of Mucosal Defects Using Endoscopic Suturing Following Endoscopic Submucosal Dissection: A Single-Center Experience. Tech Innov Gastrointest Endosc 2022; 25:46-51. [PMID: 37799128 PMCID: PMC10552729 DOI: 10.1016/j.tige.2022.11.002] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/07/2023]
Abstract
Background and Aims Endoscopic submucosal dissection (ESD) is a therapeutic technique for en-bloc resection of both large (>20 mm) and smaller, complex gastrointestinal neoplasms. ESD has a higher success rate of en-bloc resection and a lower rate of local recurrence compared to endoscopic mucosal resection (EMR). Removal of lesions via ESD can leave large mucosal defects, raising unique challenges leading to adverse events. We aimed to determine clinical outcomes including delayed bleeding, perforation and hospitalization in patients undergoing endoscopic suturing following ESD. Methods Single-center retrospective study of a prospectively collected database of consecutive adult patients who underwent ESD with mucosal defect closure using endoscopic suturing. Primary outcomes were adverse events, specifically, delayed bleeding or perforation. Secondary outcomes included need for hospitalization and suturing complications. Results 55 patients (mean age: 67 years) were included with a mean lesion size of 27.4 mm ± 15. Defect closure occurred in the esophagus (6), gastroesophageal junction (2), stomach (30), cecum (2), sigmoid colon (2) and rectum (13). A mean of 1.8 ± 1.0 sutures were required for defect closure. Hospital admission rates were 14% (8/55) with an average length of stay 2 days (range: 1-3 days). Intra-procedure perforation occurred in two patients and both were successfully treated with endoscopic suturing. There was one case of delayed bleeding and no cases of delayed perforation or suturing complications. Conclusion The use of endoscopic suturing following ESD is a safe and clinically reliable method to close mucosal defects. This approach is associated with minimal adverse events and need for hospitalization. Larger studies are needed to further validate these findings.
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Affiliation(s)
- Osman Ali
- Division of Gastroenterology & Hepatology, University of Maryland School of Medicine, Baltimore, MD
| | - Andrew Canakis
- Division of Gastroenterology & Hepatology, University of Maryland School of Medicine, Baltimore, MD
| | - Yuting Huang
- Department of Medicine, University of Maryland Medical Center Midtown Campus, Baltimore, MD
| | - Harsh Patel
- Department of Medicine, University of Maryland Medical Center Midtown Campus, Baltimore, MD
| | - Madeline Alizadeh
- Division of Gastroenterology & Hepatology, University of Maryland School of Medicine, Baltimore, MD
| | - Raymond E. Kim
- Division of Gastroenterology & Hepatology, University of Maryland School of Medicine, Baltimore, MD
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23
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Ahmed O, Abdel-Fattah HM, Elbadan HEM. Stapler Assisted Total Laryngectomy: A Prospective Randomized Clinical Study. Indian J Otolaryngol Head Neck Surg 2022; 74:2205-2213. [PMID: 36452624 PMCID: PMC9702215 DOI: 10.1007/s12070-020-02086-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 08/20/2020] [Indexed: 11/25/2022] Open
Abstract
Closure of the pharyngeal defect after total laryngectomy had been traditionally performed with manual suturing techniques that invert the mucosal edge this technique though effective, yet it is time-consuming. Recently the use of stapling devices to successfully close the pharyngeal defect after total laryngectomy has been advocated to shorten the operative time, especially in the high-risk cancer patients where a prolonged operative time is not preferred. The present study aimed at comparing stapler assisted total laryngectomy to suture closure total laryngectomy in a prospective randomized manner. This is a prospective clinical study conducted on 60 patients undergoing total laryngectomy at Alexandria Main University Hospital, Egypt. Patients with tumor extension to the hypopharynx or base of the tongue were excluded from the study. The surgical time is reduced with shorter hospital stays and no increase in postoperative complications rate. The use of the stapler is technically easy to perform and as equally as effective as the traditional neopharyngeal suturing techniques in patients undergoing total laryngectomy.
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Affiliation(s)
- Omar Ahmed
- ENT Registrar at East Kent Hospitals University NHS Foundation Trust, Kent, UK
| | - Hesham Mustafa Abdel-Fattah
- Department of Otorhinolaryngology and Head& Neck Surgery, Faculty of Medicine, University of Alexandria, Alexandria, Egypt
| | - Hisham E. M. Elbadan
- Department of Otorhinolaryngology and Head& Neck Surgery, Faculty of Medicine, University of Alexandria, Alexandria, Egypt
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24
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Kalvach J, Ryska O, Martinek J, Hucl T, Pazin J, Hadac J, Foltan O, Kristianova H, Ptacnik J, Juhasova J, Ryska M, Juhas S. Randomized experimental study of two novel techniques for transanal repair of dehiscent low rectal anastomosis. Surg Endosc 2022; 36:4050-4056. [PMID: 34495386 DOI: 10.1007/s00464-021-08726-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 08/30/2021] [Indexed: 01/29/2023]
Abstract
BACKGROUND Anastomotic leak after low anterior rectal resection is a dreadful complication. Early diagnosis, prompt management of sepsis followed by closure of anastomotic defect may increase chances of anastomotic salvage. In this randomized experimental study, we evaluated two different methods of trans-anal anastomotic repair. METHODS A model of anastomotic leak was created in 42 male pigs. Laparoscopic low anterior resection was performed with anastomosis created using a circular stapler with half of the staples removed. Two days later, animals were randomized into a TAMIS (trans-anal minimally invasive surgery) repair, endoscopic suture (ENDO) or control group with no treatment (CONTROL). Signs of intraabdominal infection (IAI), macroscopic anastomotic healing and burst tests were evaluated to assess closure quality after animals were sacrificed on the ninth postoperative day. RESULTS Closure was technically feasible in all 28 animals. Two animals had to be euthanized due to progressive sepsis at four and five days after endoscopic closure. Healed anastomosis with no visible defect was observed in 10/14 and 11/14 animals in TAMIS and ENDO groups, respectively, versus 2/14 in CONTROL (p < 0.05). Overall IAI rate was significantly lower in TAMIS (4/14; p = 0.006) and ENDO (5/14; p = 0.018) compared to CONTROL (12/14). Burst tests confirmed sealed closure in healed anastomosis with a median failure pressure of 190 (110-300) mmHg in TAMIS and 200 (100-300) mmHg in ENDO group (p = 0.644). CONCLUSION In this randomized experimental study, we found that both evaluated techniques are effective in early repair of dehiscent colorectal anastomosis with a high healing rate.
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Affiliation(s)
- J Kalvach
- Institute of Animal Physiology and Genetics, Czech Academy of Science, Libechov, Czech Republic. .,Surgery Department 2nd Faculty of Medicine, Charles University and Central Military Hospital, Severovýchodní II 580/22, Záběhlice, Prague, 14100, Czech Republic.
| | - O Ryska
- Institute of Animal Physiology and Genetics, Czech Academy of Science, Libechov, Czech Republic.,Royal Lancaster Infirmary, University Hospitals of Morecambe Bay, NHS Foundation Trust, Lancaster, UK
| | - J Martinek
- Institute of Animal Physiology and Genetics, Czech Academy of Science, Libechov, Czech Republic.,Department of Hepatogastroenterology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - T Hucl
- Institute of Animal Physiology and Genetics, Czech Academy of Science, Libechov, Czech Republic.,Department of Hepatogastroenterology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - J Pazin
- Institute of Animal Physiology and Genetics, Czech Academy of Science, Libechov, Czech Republic.,Surgery Department 2nd Faculty of Medicine, Charles University and Central Military Hospital, Severovýchodní II 580/22, Záběhlice, Prague, 14100, Czech Republic
| | - J Hadac
- Institute of Animal Physiology and Genetics, Czech Academy of Science, Libechov, Czech Republic.,Surgery Department 2nd Faculty of Medicine, Charles University and Central Military Hospital, Severovýchodní II 580/22, Záběhlice, Prague, 14100, Czech Republic
| | - O Foltan
- Institute of Animal Physiology and Genetics, Czech Academy of Science, Libechov, Czech Republic.,1st Department of Surgery, The General University Hospital in Prague, Prague, Czech Republic
| | - H Kristianova
- Institute of Animal Physiology and Genetics, Czech Academy of Science, Libechov, Czech Republic.,1st Department of Surgery, The General University Hospital in Prague, Prague, Czech Republic
| | - J Ptacnik
- Institute of Animal Physiology and Genetics, Czech Academy of Science, Libechov, Czech Republic.,1st Department of Surgery, The General University Hospital in Prague, Prague, Czech Republic
| | - J Juhasova
- Institute of Animal Physiology and Genetics, Czech Academy of Science, Libechov, Czech Republic
| | - M Ryska
- Surgery Department 2nd Faculty of Medicine, Charles University and Central Military Hospital, Severovýchodní II 580/22, Záběhlice, Prague, 14100, Czech Republic
| | - S Juhas
- Institute of Animal Physiology and Genetics, Czech Academy of Science, Libechov, Czech Republic
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25
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Ding WY, Lip GYH, Gupta D. Left Atrial Appendage Occlusion-A Choice or a Last Resort? How to Approach the Patient. Interv Cardiol Clin 2022; 11:135-142. [PMID: 35361458 DOI: 10.1016/j.iccl.2021.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Left atrial appendage (LAA) occlusion is emerging as a viable alternative to oral anticoagulation in high-risk patients with atrial fibrillation. However, there remains limited evidence for this approach, especially in certain subgroups, and therefore patient selection is an important aspect of treatment. Here, the authors present arguments for LAA occlusion as either a last resort versus patient choice by evaluating contemporary studies on this topic and discuss practical steps in the approach of patients who may be suitable for LAA occlusion. Overall, an individualized and multidisciplinary team approach should be adopted in patients who are being considered for LAA occlusion.
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Affiliation(s)
- Wern Yew Ding
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK; Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Dhiraj Gupta
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK.
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26
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D'Ancona G, Arslan F, Safak E, Weber D, Al Ammareen R, Ince H. Actual management costs of patients with non-valvular atrial fibrillation treated with percutaneous left atrial appendage closure or oral anticoagulation. Int J Cardiol 2021; 351:61-64. [PMID: 34929249 DOI: 10.1016/j.ijcard.2021.12.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 12/01/2021] [Accepted: 12/15/2021] [Indexed: 11/17/2022]
Abstract
AIMS Comparing actual management costs in patients with non-valvular atrial fibrillation (AF) treated with percutaneous left atrial appendage closure (LAAC) or OAC only. METHODS AND RESULTS Patients undergoing percutaneous LAAC and AF patients treated with OAC only were matched for gender, age, and diagnosis related groups (DRG) clinical complexity level (CCL). Costs for cardiovascular outpatient clinic visits and hospitalizations were derived from the actual reimbursement records. Between 1/2012 and 12/2016, 8478 patients were referred: 7801 (92%) managed with OAC and 677 (8%) with percutaneous LAAC. Matching resulted in 558 patients (279 per group) for final analysis. Age was 74.9 ± 7.5 years, 244 were female (43.7%), and DRG CCL was 1.8 ± 1.1. Annualized management cost before percutaneous LAAC was € 3110 (IQR: € 1281-8127). After 4.5 ± 1.4 years follow-up, annualized management cost was € 1297 (IQR: € 607-2735) in OAC patients and € 1013 (IQR: € 0-4770) in patients after percutaneous LAAC (p = 0.003). Percutaneous LAAC was the strongest independent determinant to reduce follow-up costs (B = -0.8; CI: -1.09 ̶̶̶̶̶ -0.6; p < 0.0001). Estimated 3-year survival was 92% in percutaneous LAAC and 90% in OAC patients (p = 0.7). CONCLUSION Percutaneous LAAC significantly reduces management costs. Management costs are significantly higher for patients treated with only OAC compared to patients after percutaneous LAAC. In spite of their complex comorbid profile, percutaneous LAAC patients show a follow-up survival rate similar to patients solely treated with OAC. Future studies are necessary to investigate the potential net economic and clinical benefit of percutaneous LAAC in patients treated with OAC only.
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Affiliation(s)
- Giuseppe D'Ancona
- Department of Cardiology, Vivantes Klinikum Am Urban and im Friedrichshain, Berlin, Germany and Rostock University, Rostock, Germany.
| | - Fatih Arslan
- Department of Cardiology, Vivantes Klinikum Am Urban and im Friedrichshain, Berlin, Germany and Rostock University, Rostock, Germany; Department of Cardiology, Leiden University Medical Center, Leiden, NL, the Netherlands
| | - Erdal Safak
- Department of Cardiology, Vivantes Klinikum Am Urban and im Friedrichshain, Berlin, Germany and Rostock University, Rostock, Germany
| | - Denise Weber
- Department of Cardiology, Vivantes Klinikum Am Urban and im Friedrichshain, Berlin, Germany and Rostock University, Rostock, Germany
| | - Raid Al Ammareen
- Department of Cardiology, Vivantes Klinikum Am Urban and im Friedrichshain, Berlin, Germany and Rostock University, Rostock, Germany
| | - Hüseyin Ince
- Department of Cardiology, Vivantes Klinikum Am Urban and im Friedrichshain, Berlin, Germany and Rostock University, Rostock, Germany
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27
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Abdelfattah OM, Sayed A, Elgendy IY, Munir M, Saleh Y, Kapadia SR, Abela GS, Jneid H. Patent foramen ovale closure and decompression sickness among divers. Cardiovasc Revasc Med 2021:S1553-8389(21)00745-4. [PMID: 34810112 DOI: 10.1016/j.carrev.2021.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 11/15/2021] [Accepted: 11/15/2021] [Indexed: 01/10/2023]
Abstract
BACKGROUND Decompression sickness is a diving-related disease that results in various clinical manifestations, ranging from joint pain to severe pulmonary and CNS affection. Complications of this disease may sometimes persist even after treatment with hyperbaric oxygen therapy. In addition, it may hamper the quality of life by forcing divers to restrict their recreational practice. The presence of a patent foramen ovale (PFO) increases the risk of decompression sickness by facilitating air embolization. Therefore, PFO closure may play a role in reducing such complications. However, PFO closure remains associated with its own set of risks and complications. We sought to assess the benefit and harm of PFO closure for the prevention of decompression sickness in divers. METHODS We conducted a comprehensive search of MEDLINE, Embase, CENTRAL, and Web of Science. Two-armed studies comparing the incidence of decompression sickness with or without PFO closure were included. We used a random-effects model to compute risk ratios comparing groups undergoing PFO closure to those not undergoing PFO closure. RESULTS Four observational studies with a total of 309 divers (PFO closure: 141 and no closure: 168) met inclusion criteria. PFO closure was associated with a significantly lower incidence of decompression sickness (PFO-closure: 2.84%; no closure: 11.3%; RR: 0.29; 95% CI: 0.10 to 0.89; NNTB = 11), with low heterogeneity (I2 = 0%). The mean follow-up was 6.12 years (Standard deviation 0.70). Adverse events occurred in 7.63% of PFO closures, including tachyarrhythmias and bleeding. CONCLUSION PFO closure may potentially reduce the risk of decompression sickness among divers; however, it is not free of potential downsides, with nearly one in thirteen patients in our analysis experiencing an adverse event.
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28
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Jin D, Xu M, Huang K, Peng L, Li X, Li L, Dang Y, Ye F, Zhang G. The efficacy and long-term outcomes of endoscopic full-thickness suturing for chronic gastrointestinal fistulas with an Overstitch device: is it a durable closure? Surg Endosc 2021; 36:1347-1354. [PMID: 34792629 DOI: 10.1007/s00464-021-08412-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 12/14/2020] [Accepted: 02/15/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIM Endoscopic closure of chronic gastrointestinal fistulas (CGFs) is challenging due to their epithelialized surfaces. The aim of this study was to assess the efficacy and long-term closure rate of endosuturing for CGFs with an Apollo Overstitch device. PATIENTS AND METHODS Consecutive CGF patients undergoing endosuturing for fistula closure from April 2018 to January 2020 at the First Affiliated Hospital of Nanjing Medical University were enrolled for retrospective review. Demographics, fistula characteristics, details of the suturing procedures and outcomes were collected for analysis. RESULTS Twenty patients (mean age 59.8 ± 9.1 years; 85% males) with a total of 23 CGFs underwent sutured fistula closure. Esophagotracheal fistulas were the most common CGFs (12/23, 52.2%), and prior cancer surgery was the most common fistulization etiology (14/20, 70%). Twelve patients (12/20, 60%) had undergone failed endoscopic attempts at fistula closure before suturing. Additional endoscopic therapies used during suturing were 100% argon plasma coagulation, 50% clip fixation, and 10% stent placement. Although all patients undergoing suturing achieved immediate technical success of fistula closure, sustained fistula closure was observed in only 5 patients (5/20, 25.0%) on surveillance endoscopy 3 months after suturing with a mean follow-up of 19.5 months. Esophagotracheal fistula patients were predisposed to shorter dehiscence-free survival than those with other fistulas (HR 3.378; 95% CI 1.127-10.13). CONCLUSIONS Endosuturing is safe and should be considered for use as the first-line or salvage therapy for CGF closure, primarily for patients with fistulas not involving the trachea. However, the long-term healing of CGFs by suturing is challenging, and CGF patients might not benefit from repeated suturing.
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Affiliation(s)
- Duochen Jin
- Department of Gastroenterology, The First Affiliated Hospital of Nanjing Medical University, No. 300 of Guangzhou Road, Nanjing, 210029, China.,First Clinical Medical College of Nanjing Medical University, Nanjing, China
| | - Miao Xu
- Department of Gastroenterology, The First Affiliated Hospital of Nanjing Medical University, No. 300 of Guangzhou Road, Nanjing, 210029, China.,First Clinical Medical College of Nanjing Medical University, Nanjing, China
| | - Keting Huang
- Department of Gastroenterology, The First Affiliated Hospital of Nanjing Medical University, No. 300 of Guangzhou Road, Nanjing, 210029, China.,First Clinical Medical College of Nanjing Medical University, Nanjing, China
| | - Lei Peng
- Department of Gastroenterology, The First Affiliated Hospital of Nanjing Medical University, No. 300 of Guangzhou Road, Nanjing, 210029, China
| | - Xuan Li
- Department of Gastroenterology, The First Affiliated Hospital of Nanjing Medical University, No. 300 of Guangzhou Road, Nanjing, 210029, China
| | - Lurong Li
- Department of Gastroenterology, The First Affiliated Hospital of Nanjing Medical University, No. 300 of Guangzhou Road, Nanjing, 210029, China
| | - Yini Dang
- Department of Gastroenterology, The First Affiliated Hospital of Nanjing Medical University, No. 300 of Guangzhou Road, Nanjing, 210029, China
| | - Feng Ye
- Department of Gastroenterology, The First Affiliated Hospital of Nanjing Medical University, No. 300 of Guangzhou Road, Nanjing, 210029, China
| | - Guoxin Zhang
- Department of Gastroenterology, The First Affiliated Hospital of Nanjing Medical University, No. 300 of Guangzhou Road, Nanjing, 210029, China. .,First Clinical Medical College of Nanjing Medical University, Nanjing, China.
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29
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Wang S, Liu D, Li Y, Gao B. Transthoracic minimally invasive closure for the treatment of arch penetrating aortic ulcer: a case report. J Cardiothorac Surg 2021; 16:285. [PMID: 34627316 PMCID: PMC8501624 DOI: 10.1186/s13019-021-01659-9] [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: 12/08/2020] [Accepted: 09/19/2021] [Indexed: 11/24/2022] Open
Abstract
Penetrating aortic ulcer (PAU) is one of the three subtypes of acute aortic syndrome. PAUs occur at any point throughout the aorta, most commonly in the descending thoracic aorta and less frequently in the aortic arch. Open surgical repair and total/hybrid endovascular repair are currently available to treat aortic arch PAUs. Herein, we present a patient with aortic arch PAU who underwent transthoracic minimally invasive closure, which is a novel method for the treatment of PAU. We describe a 52-year old Asian man who presented with sudden chest and back pain for 8 h. Computed tomography angiography showed that the PAU occurred in the aortic arch and had a diameter of 16 mm and a depth of 6 mm. The opening was successfully closed via transthoracic minimally invasive closure with an atrial septal defect occluder.
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Affiliation(s)
- Shixiong Wang
- Department of Cardiac Surgery, Lanzhou University Second Hospital, No. 82 Cuiyingmen, Lanzhou, 730030, Gansu, People's Republic of China
| | - Debin Liu
- Department of Cardiac Surgery, Lanzhou University Second Hospital, No. 82 Cuiyingmen, Lanzhou, 730030, Gansu, People's Republic of China
| | - Yongnan Li
- Department of Cardiac Surgery, Lanzhou University Second Hospital, No. 82 Cuiyingmen, Lanzhou, 730030, Gansu, People's Republic of China
| | - Bingren Gao
- Department of Cardiac Surgery, Lanzhou University Second Hospital, No. 82 Cuiyingmen, Lanzhou, 730030, Gansu, People's Republic of China.
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30
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Max SA, Çelik M, Durko A, Mahtab EAF. Weaning from cardiopulmonary bypass, decannulation, and closure. Multimed Man Cardiothorac Surg 2021; 2021. [PMID: 34569197 DOI: 10.1510/mmcts.2021.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
In 1952, John Gibbon performed the first successful cardiac procedure using cardiopulmonary bypass, which turned out to be one of the most important clinical advances of that year. Cardiopulmonary bypass has also been described as "One of the most impressive evidences of the role of investigative surgery in the history of medicine in the persevering efforts of Dr. Gibbon for more than 20 years, which finally culminated in a practical heart-lung machine," at the first John H. Gibbon, Jr, Lecture at the annual meeting of the American College of Surgeons [1]. Due to the subsequent advancement of cardiopulmonary bypass, many patients with complex heart disease requiring surgical care undergo cardiac surgery while the other organs remain adequately oxygenated and perfused.
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Affiliation(s)
- Samuel A Max
- Department of Cardio-Thoracic Surgery Erasmus University Medical Center Rotterdam The Netherlands
| | - Mevlüt Çelik
- Department of Cardio-Thoracic Surgery Erasmus University Medical Center Rotterdam The Netherlands
| | - Andras Durko
- Department of Cardio-Thoracic Surgery Erasmus University Medical Center Rotterdam The Netherlands
| | - Edris A F Mahtab
- Department of Cardio-Thoracic Surgery Erasmus University Medical Center Rotterdam The Netherlands
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Tosaka M, Prevedello DM, Yamaguchi R, Fukuhara N, Miyagishima T, Tanaka Y, Aihara M, Shimizu T, Yoshimoto Y. Single-Layer Fascia Patchwork Closure for the Extended Endoscopic Transsphenoidal Transtuberculum Transplanum Approach: Deep Suturing Technique and Preliminary Results. World Neurosurg 2021; 155:e271-84. [PMID: 34418608 DOI: 10.1016/j.wneu.2021.08.051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 08/10/2021] [Accepted: 08/11/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To describe a single-layer fascia patchwork closure (FPWC) without nasoseptal flap (NSF) and compare postoperative cerebrospinal fluid (CSF) leakage between FPWC using NSF and single-layer FPWC without NSF for the extended endoscopic transsphenoidal transtuberculum transplanum approach. METHODS Forty-five cases of suprasellar tumor in 42 patients were treated with extended endoscopic transsphenoidal removal, resulting in extensive, high-flow CSF leakage. Following the intradural procedure for treatment of various suprasellar tumors, fascia lata was inlaid subdurally on the cranial base defect and patch-sutured around its entire circumference under endoscope visualization, using an average of 17 stitches. Septal bone or hydroxyapatite plate was used for the hard support material against pulsatile intracranial pressure. NSF was added in the earlier 17 cases. Closure was completed without NSF in the more recent 28 cases when the Valsalva maneuver confirmed watertight closure. Two recent cases required NSF after Valsalva maneuver and were included in the FPWC + NSF group. RESULTS Postoperative CSF leakage did not occur in the FPWC + NSF group but occurred in 2 patients in the single-layer FPWC group (7.1%) (P = 0.52). There was no significant difference in CSF leakage between single-layer FPWC and FPWC + NSF. The mean suturing time for FPWC was 85.8 minutes, and the shortest was 39 minutes in a recent case (mean, 17 stitches; n = 35, video analysis). CONCLUSIONS Single-layer FPWC may be a viable technical option for effective skull base reconstruction after the extended endoscopic transsphenoidal transtuberculum transplanum approach.
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Bradow J, Smith SDV, Davis D, Atchan M. A systematic integrative review examining the impact of Australian rural and remote maternity unit closures. Midwifery 2021; 103:103094. [PMID: 34329966 DOI: 10.1016/j.midw.2021.103094] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 06/01/2021] [Accepted: 07/08/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Rural and remote Australian women are less able to access locally situated maternity care and birthing facilities, largely due to the gradual closures of rural and remote birthing services. Closures have occurred due to workforce issues, safety and quality issues and economic rationalisation of services to offset rising health system costs. An examination of the published literature to gain a deeper understanding of this phenomenon is warranted. QUESTION What are the impacts of rural and remote maternity unit closures in Australia? METHODS A systematic integrative review of published literature on Australian maternity unit closures was undertaken using Whittemore and Knafl's (2005) framework. A database search was conducted with date limiters of 2010 to 2020 on papers within the search parameters "maternity unit*" AND closure* AND women AND (midwife OR midwives) AND Australia, also with "birth unit", "labour ward" and "rural" in varying combinations. This search resulted in 348 papers. After applying the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) process and the Crowe Critical Appraisal Tool (CCAT) and discarding those non-relevant, seven papers remained. FINDINGS A methodological analysis of seven papers occurred, three qualitative studies, three quantitative studies and one mixed methods study. Two main stakeholders were identified, the woman, and the health service. Women identified risks associated with travel, lack of access to services, costs or financial issues, safety, and emotional burdens. Women explicitly stated that access to local maternity services would negate many of their concerns. Health services indicated closures were due to safety and quality considerations and workforce issues. CONCLUSION Conflict exists in trying to meet the perceived needs of both stakeholder groups. Published evidence supports midwifery models for low-risk women. National policy also supports woman-centred care; however, local service uptake is minimal due to organisational barriers.
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Affiliation(s)
- Jeannine Bradow
- School of Nursing, Midwifery & Public Health, University of Canberra, 11 Kirinari Street, Bruce ACT 2617, Australia.
| | - Sally De-Vitry Smith
- School of Nursing, Midwifery & Public Health, University of Canberra, 11 Kirinari Street, Bruce ACT 2617, Australia.
| | - Deborah Davis
- School of Nursing, Midwifery & Public Health, University of Canberra, 11 Kirinari Street, Bruce ACT 2617, Australia.
| | - Marjorie Atchan
- School of Nursing, Midwifery & Public Health, University of Canberra, 11 Kirinari Street, Bruce ACT 2617, Australia.
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Ego M, Abe S, Nonaka S, Suzuki H, Yoshinaga S, Oda I, Saito Y. Endoscopic Closure Utilizing Endoloop and Endoclips After Gastric Endoscopic Submucosal Dissection for Patients on Antithrombotic Therapy. Dig Dis Sci 2021; 66:2336-44. [PMID: 32797345 DOI: 10.1007/s10620-020-06508-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [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: 06/03/2020] [Accepted: 07/21/2020] [Indexed: 02/08/2023]
Abstract
OBJECTIVES Antithrombotic therapy is a well-known independent risk factor for bleeding after endoscopic submucosal dissection (ESD) of early gastric cancer (EGC). A novel method of ulcer base closure using an endoloop and endoclips has been reported. This study aimed to evaluate the effectiveness of endoscopic closure using an endoloop and endoclips in preventing post-ESD bleeding in patients undergoing gastric ESD on antithrombotic therapy. METHODS This was a single center, retrospective study. Patients on antithrombotic therapy who underwent gastric ESD were divided into two groups, the closure group and the non-closure group. We analyzed procedural outcomes, post-ESD bleeding rate and factors associated with post-ESD bleeding. RESULTS Among 400 ESDs with EGCs in 311 patients, 131 ESDs in 110 patients were in the closure group, and 269 ESDs in 217 patients were in the non-closure group (16 patients were overlapped in both groups). Post-ESD bleeding rate was 11.5% (15/131) in the closure group, and 11.9% (32/269) in the non-closure group (p = 0.89). Total sustained closure rate during second look endoscopy was 47.8% (33/69). Post-ESD bleeding rate tended to be lower in the closure group than in the non-closure group for lesions located in the greater curvature (3.6% vs. 11.1%, p = 0.11). In addition, sustained closure rate was significantly higher in the greater curvature than in the lesser curvature (72.0% vs. 34.1%, p < 0.01). Multivariate analysis revealed resection size > 40 mm and heparin bridge were the independent risk factor for post-ESD bleeding. CONCLUSION Ulcer base closure using endoloop and endoclips did not prevent post-ESD bleeding in patients on antithrombotic therapy.
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May CK. Coastal Community Resilience and Power in the United States: A Comparative Analysis of Adaptability in North Carolina and Louisiana. Environ Manage 2021; 68:100-116. [PMID: 34018064 DOI: 10.1007/s00267-021-01482-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 05/03/2021] [Indexed: 06/12/2023]
Abstract
Community adaptations to increase resilience and reduce vulnerability depend on adaptability, which is constituted by how power shapes collective mobilization of differential capacities across scales and levels of governance systems. A multidimensional power framework (MPF) to track the role of power in adaptability is presented and applied in a qualitative, comparative case study of two historical fishing communities in the United States. The MPF conceptualizes power as differential capacities at the individual and group levels, structural at the policy level, and systemic, reflective of generalized norms, strategies, and technologies of political economic imperatives. The first case, Two Rivers, North Carolina represents an example of collective action failure resulting in transformation to a new resilience regime consisting of fundamentally altered community functions, structures, and identity. The second case, Delcambre, Louisiana represents collective action success; community adaptations resulted in continuity in change for fisher livelihoods. Success here is defined as the ability to maintain a semblance of structure, function, or identity of the original resilience regime without connotations of positive or negative desirability. The cases were similar in demographics, vulnerabilities, and differential capacities. Key differences existed in systemic political economic imperatives, structural power at the policy level, and the ways closure, the ability to enforce a common sense of place within the communities reflected systemic power. The utility of the MPF is mapping vulnerabilities and differential capacities against broader structures and systemic processes to inform effective mobilization for improved socio-ecological resilience and sustainability.
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Affiliation(s)
- Candace K May
- Department of Sociology and Rural Studies, South Dakota State University, Brookings, SD, USA.
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Lu YX, Wu Y, Liang PF, Wu RC, Tian LY, Mo HY. Efficacy of combination of localized closure, ethacridine lactate dressing, and phototherapy in treatment of severe extravasation injuries: A case series. World J Clin Cases 2021; 9:4599-4606. [PMID: 34222426 PMCID: PMC8223846 DOI: 10.12998/wjcc.v9.i18.4599] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 02/24/2021] [Accepted: 04/06/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The management of severe extravasation injuries is still controversial. Extravasation injuries can be treated in many ways.
AIM To present a series of patients with severe extravasation injuries due to infusion who were managed with ethacridine lactate dressing combined with localized closure and phototherapy.
METHODS In this study, we evaluated the data of eight patients, including six from the Department of Burn, one (with colorectal carcinoma) from the Veteran Cadre Department, and one (with leukemia) from the Hematology Department. Of these, three patients were male and five were female. Age of the patients ranged from 10 mo to 72 years, including two children (10 and 19 mo of age). In this study, the infusion was stopped immediately when the extravasation was identified. The extravasation event was managed routinely using a blocking solution. A ring-shaped localized closure was performed using the blocking agents. Moreover, ethacridine lactate dressing and phototherapy were applied for 3-5 d.
RESULTS In this study, the drugs contained in the infusates were iodixanol, norepinephrine, alprostadil, amino acids, fat emulsion, cefoselis, cefoxitin, and potassium chloride + concentrated sodium chloride. All of the patients achieved complete healing after treatment and no obvious adverse reactions were observed.
CONCLUSION The treatment of severe extravasation injuries using a combination of localized closure, ethacridine lactate dressing, and phototherapy resulted in satisfactory outcomes in patients.
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Affiliation(s)
- Yan-Xu Lu
- Xiangya Stomatological Hospital & School of Stomatology , Central South University, Changsha 410000, Hunan Province, China
| | - Ying Wu
- Teaching and Research Section of Clinical Nursing, Department of Burn and Reconstructive Surgery, Xiangya Hospital of Central South University, Changsha 410008, Hunan Province, China
| | - Peng-Fei Liang
- Department of Burn and Reconstructive Surgery, Xiangya Hospital of Central South University, Changsha 410008, Hunan Province, China
| | - Rong-Chan Wu
- Phase 1 Clinical Trial Center, Xiangya Hospital of Central South University, Changsha 410008, Hunan Province, China
| | - Ling-Yun Tian
- School of Nursing, Anhui University of Chinese Medicine, Hefei 230012, Anhui Province, China
| | - Hui-Ying Mo
- Department of Burn and Reconstructive Surgery, Xiangya Hospital of Central South University, Changsha 410008, Hunan Province, China
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Kaczmarek T, Perez K, Demir E, Zaremba A. How to survive a pandemic: The corporate resiliency of travel and leisure companies to the COVID-19 outbreak. Tour Manag 2021; 84:104281. [PMID: 36530604 PMCID: PMC9734087 DOI: 10.1016/j.tourman.2020.104281] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 12/03/2020] [Accepted: 12/21/2020] [Indexed: 05/05/2023]
Abstract
What protects travel and leisure companies from a global pandemic, such as COVID-19? To answer this question, we investigate data on over 1200 travel and leisure companies in 52 countries. We consider 80 characteristics, such as company financial ratios, macroeconomic variables, and government policy responses. Using regressions and machine learning tools, we demonstrate that firms with low valuations, limited leverage, and high investments have been more immune to the pandemic-induced crash. We also find a beneficial effect of stringent containment and closure policies. Finally, our results indicate that countries with less individualism may be better positioned to cope with the pandemic. Our findings have implications for regulatory bodies, managers, and investors concerning future pandemic outbreaks.
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Affiliation(s)
- Tomasz Kaczmarek
- Department of Investment and Financial Markets, Institute of Finance, Poznan University of Economics and Business, Al. Niepodległości 10, 61-875, Poznań, Poland
| | - Katarzyna Perez
- Department of Investment and Financial Markets, Institute of Finance, Poznan University of Economics and Business, Al. Niepodległości 10, 61-875, Poznań, Poland
| | - Ender Demir
- University of Social Sciences, Lodz, Poland
- Faculty of Tourism, Istanbul Medeniyet University, Istanbul, Turkey
| | - Adam Zaremba
- Montpellier Business School, 2300, Avenue des Moulins, 34185, Montpellier, France
- Department of Investment and Financial Markets, Institute of Finance, Poznan University of Economics and Business, Al. Niepodległości 10, 61-875, Poznań, Poland
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Magouliotis DE, Tzovaras G, Tasiopoulou VS, Christodoulidis G, Zacharoulis D. Closure of Mesenteric Defects in Laparoscopic Gastric Bypass: a Meta-Analysis. Obes Surg 2021; 30:1935-1943. [PMID: 31955371 DOI: 10.1007/s11695-020-04418-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
INTRODUCTION The purpose of the current study was to review the available literature on morbidly obese patients treated with laparoscopic Roux-en-Y gastric bypass (LRYGB) in order to assess the clinical outcomes of the routine closure of the mesenteric defects. METHODS A literature search was performed in PubMed, Cochrane library, and Scopus, in accordance with the PRISMA guidelines. RESULTS Nine studies met the inclusion criteria. A total of 16,520 patients were incorporated with a mean follow-up ranging from 34 to 120 months. The closure of the mesenteric defects was associated with a lower incidence of internal hernias (odds ratio, 0.25 [95% confidence interval 0.20, 0.31]; p < 0.01), small bowel obstruction (SBO) (0.30 [0.17, 0.52]; p < 0.0001) and reoperations (0.28 [0.15, 0.52]; p < 0.001). Both approaches presented similar complication rates and % excess weight loss (%EWL). CONCLUSION The present meta-analysis is the best currently available evidence on the topic and supports the routine closure of the mesenteric defects.
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Affiliation(s)
- Dimitrios E Magouliotis
- Department of Surgery and Interventional Sciences, UCL, London, UK.,Department of Surgery, University Hospital of Larissa, Larissa, Greece
| | - George Tzovaras
- Department of Surgery, University of Thessaly, Biopolis, 41110, Larissa, Greece
| | | | | | - Dimitris Zacharoulis
- Department of Surgery, University of Thessaly, Biopolis, 41110, Larissa, Greece.
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Amankwah-Amoah J, Khan Z, Wood G. COVID-19 and business failures: The paradoxes of experience, scale, and scope for theory and practice. Eur Manag J 2021; 39:179-184. [PMID: 38620607 PMCID: PMC7474582 DOI: 10.1016/j.emj.2020.09.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 08/13/2020] [Accepted: 09/03/2020] [Indexed: 05/06/2023]
Abstract
In light of growing scholarly works on business failure, across the social science domains, it is surprising that past studies have largely overlooked how extreme environmental shocks and 'black swan' events such as those caused by the coronavirus (COVID-19) pandemic and other global crises, can precipitate business failures. Drawing insights from the current literature on business failure and the unfolding event of COVID-19, we highlight the paradoxes posed by novel exogenous shocks (that is, shocks that transcend past experiences) and the implications for SMEs. The pandemic has accelerated the reconfiguration of the relationship between states and markets, increasing the divide between those with political connections and those without, and it may pose new legitimacy challenges for some players even as others seem less concerned by such matters, whilst experiential knowledge resources may be both an advantage and a burden.
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Affiliation(s)
| | - Zaheer Khan
- The University of Aberdeen, University of Aberdeen Business School, King's College, Aberdeen, AB24 3FX, UK
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Guillotreau P, Bihan VL, Morineau B, Pardo S. The vulnerability of shellfish farmers to HAB events: An optimal matching analysis of closure decrees. Harmful Algae 2021; 101:101968. [PMID: 33526184 DOI: 10.1016/j.hal.2020.101968] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 11/02/2020] [Accepted: 12/10/2020] [Indexed: 06/12/2023]
Abstract
Harmful Algal Blooms (HAB) events may have serious economic consequences for shellfish farmers. When toxic algae blooms threaten human health, public authorities may decide to shut down the farming business for a while, i.e. ranging from a few days to several weeks or months, according to the severity of risks. The impact of closures being temporally and spatially distributed, shellfish farmers can avoid the risky zones or develop adaptive strategies to mitigate the economic consequences and therefore reduce significantly their business sensitivity to HABs. A sequential approach by optimal matching analysis is applied to an original data set of shellfish area closure decrees between April 2004 and December 2018 in Southern Brittany and Pays de la Loire (France) to build a typology of 79 aquaculture zones affected by various HAB and microbiological hazards (ASP, DSP, Norovirus, E. Coli, oil spills). The hypothesis is that the degree of exposure to the HAB hazard assessed by zonal closures may not be correlated to the level of sensitivity revealed by the economic results of the shellfish farming industry which can develop avoidance strategies.
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Affiliation(s)
- Patrice Guillotreau
- Université de Nantes, LEMNA, Nantes, France; MARBEC, Univ Montpellier, CNRS, Ifremer, IRD, Séte, France.
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Podnar T, Plank F, Müller S, Mair J. A case report on the successful interventional treatment of a rare cause of left heart failure in a 69-year-old woman. Eur Heart J Case Rep 2020; 4:1-5. [PMID: 33628999 PMCID: PMC7891253 DOI: 10.1093/ehjcr/ytaa440] [Citation(s) in RCA: 1] [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: 05/14/2020] [Revised: 06/16/2020] [Accepted: 10/17/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND Dyspnoea is very common in elderly patients and can be caused by a variety of different diseases. However, the initial diagnosis of patent ductus arteriosus (PDA) as a cause of left heart failure is very rare in this patient population. CASE SUMMARY A 69-year-old physically active woman with known hypertension presented with worsening exertional dyspnoea. Echocardiography showed a dilated left ventricle with moderately reduced left ventricular ejection fraction, and evidence for PDA. The PDA was confirmed by computed tomography angiography and successfully closed by implantation of an Amplatzer PDA occluder II 06-06 mm. As a result, the heart failure symptoms receded completely. DISCUSSION Congenital heart diseases should be considered as heart failure causes even in older adults. In addition to the standard medical therapy, there may be effective interventional treatment options to reverse the symptoms of heart failure in such patients.
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Affiliation(s)
- Tomaz Podnar
- Department of Child and Adolescent Health, Pediatrics III – Cardiology and Pulmonology, Medical University Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria
| | - Fabian Plank
- Department of Internal Medicine III – Cardiology and Angiology, Medical University Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria
| | - Silvana Müller
- Department of Internal Medicine III – Cardiology and Angiology, Medical University Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria
| | - Johannes Mair
- Department of Internal Medicine III – Cardiology and Angiology, Medical University Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria
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Xu J, Chang R, Zhang W, Zhang C, Zhu D, Liu F, Yang Y. Skin stretch suturing with Nice knots in the treatment of small- or medium-sized wounds. J Orthop Surg Res 2020; 15:488. [PMID: 33092648 PMCID: PMC7579834 DOI: 10.1186/s13018-020-02007-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 10/06/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND To investigate the clinical efficacy and outcomes of skin stretch suturing with self-locking sliding Nice knots in the treatment of small- or medium-sized wounds. METHODS From June 2015 to May 2018, 26 patients with small- or medium-sized wounds were included in the present study. Skin stretch suturing with self-locking slide Nice knots was performed to gradually close the soft-tissue defects in these patients. The time of wound closure and healing was recorded. The color and blood supply of the skin, cutaneous sensation, the stretch of skin, and the hair growth situation of the skin wound were observed and recorded. RESULTS There were 17 males and 9 females with an average age of 30.65 years (range, 15-48 years). The areas of the soft-tissue defects were between 3.2 × 7.1 cm and 8.0 × 15.2 cm. All patients underwent stretch suturing with self-locking slide Nice knots to close the soft-tissue defects. All wounds were successfully closed and healed. The mean time of wound closure was 10.69 days (range, 5-20 days), and the mean time of wound healing was 16.85 days (range, 10-24 days). The cutaneous sensation of skin wound recovered normally, and the color of the skin wounds was the same as that of normal skin at the last follow-up. The hair growth situation of the skin wounds also returned to normal. CONCLUSIONS This study revealed that Nice knots yielded an accepted clinical result as a new method to close small- or medium-sized wounds that was simple and less minimally invasive, resulted in progressive tension, did not return to previous results, and partially replace flaps or free skin grafts.
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Affiliation(s)
- Jianmin Xu
- Department of Orthopaedics, Juye People's Hospital, Heze, Shandong, China
| | - Rui Chang
- Department of Orthopaedics, Juye People's Hospital, Heze, Shandong, China
- Yudong Gu's Academician Workstation, Heze Boai External Microscopic Orthopedic Hospital, Heze, Shandong, China
| | - Wei Zhang
- Department of Orthopaedics, Juye People's Hospital, Heze, Shandong, China
| | - Chengcheng Zhang
- Department of Orthopedics, Shandong Provincial Hospital Affiliated to Shandong University, No. 324, Road Jing Wu Wei Qi, Jinan, 250021, Shandong, China
| | - Dezhi Zhu
- Department of Orthopedics, Heze Peony People's Hospital, Heze, Shandong, China
| | - Fanxiao Liu
- Department of Orthopedics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, 250021, Jinan, Shandong, China.
| | - Yongliang Yang
- Department of Orthopedics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, 250021, Jinan, Shandong, China.
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Prabhakar G, Bullock TS, Martin CW, Ryan JC, Cabot JH, Makhani AA, Griffin LP, Shah K, Zelle BA. Skin closure with surgical staples in ankle fractures: a safe and reliable method. Int Orthop 2020; 45:275-280. [PMID: 32951119 DOI: 10.1007/s00264-020-04816-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 09/15/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of this study is to examine the rates of surgical site complications of staple closure versus suture closure following open reduction and internal fixation of closed unstable ankle fractures. METHODS Between 2014 and 2016, a total of 545 patients with closed ankle fractures were treated at our level-1 trauma centre by means of open reduction and internal fixation. A total of 360 patients matched the inclusion criteria and were included in the final analysis of this study. This included 119 patients undergoing wound closure using sutures and 241 patients using surgical staples. The demographics, clinical data, and injury characteristics were recorded. The primary outcome measure was the adverse event of any type of surgical site complication. RESULTS The overall rate of patients with a surgical site complication was 15.6%. There was a trend towards a higher risk of surgical site complication in patients undergoing wound closure with sutures as compared with staples (20.2% versus 13.3%); however, this difference was not statistically significant (P = 0.0897). The rate of superficial surgical site infection also trended higher in patients undergoing wound closure with sutures versus staples without demonstrating statistical significance (10.1% versus 5%, P = 0.0678). The rate of deep surgical site infection was similar in both groups. CONCLUSION The use of metal staples remains controversial in the setting of orthopedic surgery, particularly involving the foot and ankle. The current study supports that metal staples are a safe and reliable option in the closure of traumatic ankle fractures.
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Affiliation(s)
- Gautham Prabhakar
- Department of Orthopaedics, UT Health San Antonio, Floyd Curl Dr, MC 7774, San Antonio, TX, 78229, USA
| | - Travis S Bullock
- Long School of Medicine, UT Health San Antonio, San Antonio, TX, 78229, USA
| | - Case W Martin
- Department of Orthopaedics, UT Health San Antonio, Floyd Curl Dr, MC 7774, San Antonio, TX, 78229, USA
| | - James C Ryan
- Department of Orthopaedics, UT Health San Antonio, Floyd Curl Dr, MC 7774, San Antonio, TX, 78229, USA
| | - John H Cabot
- Long School of Medicine, UT Health San Antonio, San Antonio, TX, 78229, USA
| | - Ahmed A Makhani
- Long School of Medicine, UT Health San Antonio, San Antonio, TX, 78229, USA
| | - Leah P Griffin
- Medical Solutions Division, 3M Health Care, San Antonio, TX, 78249, USA
| | - Kush Shah
- Department of Orthopaedics, UT Health San Antonio, Floyd Curl Dr, MC 7774, San Antonio, TX, 78229, USA
| | - Boris A Zelle
- Department of Orthopaedics, UT Health San Antonio, Floyd Curl Dr, MC 7774, San Antonio, TX, 78229, USA.
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Kelly-Schuette K, Wilkes A, Kyriakakis R, Ogilvie J. Predictors of hernia after loop ileostomy closure: a single-center retrospective review. Int J Colorectal Dis 2020; 35:1695-702. [PMID: 32451647 DOI: 10.1007/s00384-020-03637-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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] [Accepted: 05/14/2020] [Indexed: 02/04/2023]
Abstract
PURPOSE Our aims were to determine the rate of incisional hernia after closure of a loop ileostomy (LI) and to identify any perioperative risk factors that may be associated with hernia development. METHODS We performed an IRB-approved retrospective review that included consecutive patients who underwent LI closure from January 1, 2012, to December 31, 2014. The primary outcome was identification of hernia on physical exam or by abdominal imaging. A stepwise logistic regression analysis was used to determine predictors of ileostomy site hernia. RESULTS A total of 243 consecutive patients had LI closure during the study timeframe. The overall rate of hernia formation was 11.9% (29/243). The median time to discovery of the hernia was 16.4 (range, 2.2-55.9) months with a median follow-up time of 49 months. Although LI performed in conjunction with sigmoidectomy for diverticulitis consisted of only 19% of ileostomy cases, 62% of hernias were (18/29) identified in this cohort. Rates of hernia formation increased with respect to body mass index (underweight 0%; normal 4.6%; overweight 13.8%; obese 21%). The multivariable model identified increased BMI (underweight/normal weight versus overweight: OR 4.13, 95% CI 1.06-16.04; underweight/normal weight versus obese: OR 8.74, 95% CI 2.17-35.23) and surgical indication (reference variable: diverticulitis; rectal cancer: OR 0.21, 95% CI 0.06-0.76; Crohn's/ulcerative colitis: OR 0.06, 95% CI 0.01-0.53; other: OR 0.15, 95% CI 0.04-0.64) as significant predictors of ileostomy site hernia. CONCLUSION The development of a hernia at the site of LI closure was influenced mostly by BMI, surgical indication, and operative time.
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Abstract
INTRODUCTION Laparostomy is important in the management of patients with intra-abdominal gastrointestinal catastrophe or trauma. It carries significant risk and is resource intensive, both in terms of nursing and surgically. The main goal is to achieve prompt myofascial closure (MFC) in order to minimise morbidity and mortality. Early MFC was initially defined as within 2-3 weeks but there is growing evidence that this should be measured in days. METHODS Retrospective analysis was undertaken of laparostomy cases between 2016 and 2018 at an acute trust and trauma centre serving a population of 500,000. Indication, duration of open abdomen (OA), number of relook procedures and consultant presence were examined to see whether they affected MFC rates, morbidity and mortality. RESULTS Overall, 76 laparostomies were performed during the 3-year study period. The most common indication was peritonitis (68.4%). As duration of OA and number of relook procedures increased, the chances of MFC fell significantly. After day 1, MFC rates fell by 20% with each subsequent 24 hours. Leaving the abdomen open primarily at index procedure compared with performing laparostomy following a postoperative complication was associated with significantly higher MFC rates (92.6% vs 68.2%, (p=0.006). The mortality rate was 15.8%. CONCLUSIONS If the OA is not closed within five days or by the third relook procedure, then achieving MFC is unlikely. Alternative methods should be employed to close the abdomen rather than continuing to take the patient back to theatre for relook laparotomies while increasing the risk of morbidity and mortality. A proactive strategy to forming primary laparostomy at the index procedure has high closure rates.
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Tomassini F, Pron PG, Ferrua S, Varbella F, Capriolo M, Senatore G. Incomplete Left Atrial Appendage Closure Successfully Treated With a Redo Procedure. Cardiovasc Revasc Med 2020; 21:69-72. [PMID: 32473911 DOI: 10.1016/j.carrev.2020.05.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Accepted: 05/21/2020] [Indexed: 11/21/2022]
Abstract
A 68 year's old man with permanent atrial fibrillation, underwent a left atrial appendage closure because of high bleeding risk. However, after one month, an incomplete occlusion of the left atrial appendage due to a too deep position of the device, was detected by a transesophageal echocardiogram. Considering the residual high risk of thrombi formation, a new different device was successfully implanted with a correct closure of the appendage.
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Cooper JB, Kim MG, Mohan A, Tobias ME. Decompressive craniectomy with scalp expansion graft using a temporary synthetic skin substitute in the pediatric population: case series and review of the literature. Childs Nerv Syst 2020; 36:1319-1324. [PMID: 31965291 DOI: 10.1007/s00381-019-04494-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Accepted: 12/30/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION The use of decompressive craniectomy in children is controversial and often reserved for patients with refractory intracranial hypertension. Following decompression, skin closure in select cases can be challenging due to brain herniation and swelling through the craniectomy defect. In these cases, partial cortical debridement is sometimes performed. METHODS We describe two cases in which a synthetic skin substitute was used to facilitate a tension-free closure, rather than performing a partial lobectomy. RESULTS At 6-month follow-up, both patients are at preoperative cognitive baseline, with some residual hemiparesis. DISCUSSION We believe that use of a synthetic skin substitute for skin closure after decompression is a suitable option for closure of traumatic scalp wounds and may contribute to improved functional outcome in patients with severe intraoperative brain swelling.
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Affiliation(s)
- Jared B Cooper
- Department of Neurosurgery, Westchester Medical Center, New York Medical College, 100 Woods Road, Valhalla, NY, 10595, USA.
| | - Michael G Kim
- Department of Neurosurgery, Westchester Medical Center, New York Medical College, 100 Woods Road, Valhalla, NY, 10595, USA
| | - Avinash Mohan
- Department of Neurosurgery, Westchester Medical Center, New York Medical College, 100 Woods Road, Valhalla, NY, 10595, USA
| | - Michael E Tobias
- Department of Neurosurgery, Westchester Medical Center, New York Medical College, 100 Woods Road, Valhalla, NY, 10595, USA
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Capion T, Lilja-Cyron A, Bartek J, Forsse A, Logallo N, Juhler M, Mathiesen T. Discontinuation of External Ventricular Drainage in Patients with Hydrocephalus Following Aneurysmal Subarachnoid Hemorrhage - a Scandinavian Multi-institutional Survey. Acta Neurochir (Wien) 2020; 162:1363-1370. [PMID: 32322997 DOI: 10.1007/s00701-020-04317-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 03/29/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Hydrocephalus requiring external ventricular drainage is common following aneurysmal subarachnoid hemorrhage (aSAH). Timing and strategy for the discontinuation of the external ventricular drain (EVD) are, however, controversial as guidelines are based on limited scientific evidence. A recent similar survey showed that guidelines and recommendations are not being followed. We conducted a questionnaire survey regarding the management of EVD treatment in patients with aSAH and investigated current treatment practice, consensus, and adherence to guidelines within the neurosurgical departments in Scandinavia. METHODS A questionnaire concerning the management of EVD discontinuation in patients with hydrocephalus following aSAH was distributed to all 14 neurosurgical departments in Scandinavia (Norway, Sweden, and Denmark). Neurosurgeons and neurosurgical trainees at all levels were asked to complete the questionnaire individually. A total of 175 completed questionnaires were received between May 2018 and April 2019, resulting in a response rate of 64 %. RESULTS Eighty-five percent of respondents reported no knowledge of international guidelines regarding EVD discontinuation in patients with hydrocephalus following aSAH. Within every department, respondents disagreed on whether a common discontinuation strategy was followed or not. Seventy-four percent decided upon the EVD discontinuation strategy mainly determined by patients' clinical condition and drainage volume. Forty-five percent considered Glasgow Coma Score (GCS) the most important clinical variable when assessing the timing of EVD discontinuation. There was general agreement towards the initiation of EVD discontinuation 4-7 days after ictus of aSAH in a stable patient with a drainage volume of < 150 ml/day and intracranial pressure (ICP) < 15 mmHg. CONCLUSION Awareness of and adherence to international guidelines regarding EVD discontinuation in patients with hydrocephalus following aSAH were limited in Scandinavia. Internal consensus at department level was absent. Initiation of the discontinuation process appeared to be case dependent and mainly influenced by the patients' clinical condition and drainage volume. GCS was the clinical variable considered most important when deciding on the initiation of EVD discontinuation.
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Sundaram K, Warren JA, Klika A, Piuzzi NS, Mont MA, Krebs V. Barbed sutures reduce arthrotomy closure duration compared to interrupted conventional sutures for total knee arthroplasty: a randomized controlled trial. Musculoskelet Surg 2020; 105:275-281. [PMID: 32146687 DOI: 10.1007/s12306-020-00654-y] [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: 10/09/2019] [Accepted: 02/25/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND The broad aim of this study was to compare the safety and efficacy of using barbed sutures versus standard-of-care sutures for closure of arthrotomy during total knee arthroplasty. Specifically, we compared the duration of arthrotomy closure, the number of sutures utilized for arthrotomy closure, and 90-day outcomes, including wound-related readmission, reoperation, and complications. MATERIALS AND METHODS A total of 60 patients undergoing primary total knee arthroplasty were enrolled in a prospective, blinded trial and randomized to receive either running closure of the arthrotomy with barbed sutures (n = 30) or interrupted closure with standard-of-care sutures (n = 30). RESULTS Arthrotomy closure time was significantly shorter in the barbed suture group (3 min ± 2 min) versus the standard-of-care group (13 min ± 5 min, p < 0.001). The average suture utilization for arthrotomy closure was 1 suture (range 1-2) versus 3 sutures (range 2-4) in the standard-of-care group (p < 0.001). The overall number of wound-related complications in the barbed suture group was 3/30 (10%) versus 3/30 (10%) in the standard-of-care group (p = 1.00). There was one dehiscence 1/30 (3%) in the standard-of-care group versus zero in the barbed suture group (p = 1.00). The rate of superficial surgical site infection was 1/30 (3%) in barbed suture versus zero in the standard-of-care groups (p = 1.00). CONCLUSION These results suggest barbed suture utilization may be faster and more resource-efficient than the use of standard-of-care sutures for arthrotomy closure in primary total knee arthroplasty without increased complications. CLINICALTRIALS. GOV IDENTIFIER NCT03285529.
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Affiliation(s)
- K Sundaram
- Department of Orthopedic Surgery, Cleveland Clinic, A41, 9500 Euclid Ave, Cleveland, OH, 44195, USA
| | - J A Warren
- Department of Orthopedic Surgery, Cleveland Clinic, A41, 9500 Euclid Ave, Cleveland, OH, 44195, USA
| | - A Klika
- Department of Orthopedic Surgery, Cleveland Clinic, A41, 9500 Euclid Ave, Cleveland, OH, 44195, USA
| | - N S Piuzzi
- Department of Orthopedic Surgery, Cleveland Clinic, A41, 9500 Euclid Ave, Cleveland, OH, 44195, USA.
| | - M A Mont
- Department of Orthopedic Surgery, Lenox Hill Hospital, New York, NY, 10075, USA
| | - V Krebs
- Department of Orthopedic Surgery, Cleveland Clinic, A41, 9500 Euclid Ave, Cleveland, OH, 44195, USA
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Velazquez JLP. On the emergence of cognition: from catalytic closure to neuroglial closure. J Biol Phys 2020; 46:95-119. [PMID: 32130568 DOI: 10.1007/s10867-020-09543-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 02/12/2020] [Indexed: 10/24/2022] Open
Abstract
In an analogous manner as occurred during the development of a connected metabolism that at some point reached characteristics associated with what is called "life"-due mainly to a catalytic closure phenomenon when chemicals started to autocatalyze themselves forming a closed web of chemical reactions-it is here proposed that cognition and consciousness (or features associated with them) arose as a consequence of another type of closure within the nervous system, the brain especially. Proper brain function requires an efficient web of connections and once certain complexity is attained due to the number and coordinated activities of the brain cell networks, the emergent properties of cognition and consciousness take place. Seeking to identify main features of the nervous system organization for optimal function, it is here proposed that while catalytic closure yielded life, neuroglial closure produced cognition/consciousness.
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Ghirardello S, Raffaeli G, Crippa BL, Gulden S, Amodeo I, Consonni D, Cavallaro G, Schena F, Mosca F. The Thromboelastographic Profile at Birth in Very Preterm Newborns with Patent Ductus Arteriosus. Neonatology 2020; 117:316-323. [PMID: 32485708 DOI: 10.1159/000507553] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 01/29/2020] [Accepted: 03/27/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND The role of hemostasis in the closure of patent ductus arteriosus (PDA) in preterm infants is controversial. OBJECTIVE To assess thromboelastography (TEG) at birth in very-low-birth-weight (VLBW) infants affected by PDA. METHODS This was an ancillary study of a prospective observational study aimed at defining the TEG profile in healthy VLBW infants in the first month of life. In this analysis, we included neonates of <33 weeks' gestational age (GA) with PDA and compared TEG traces based on (1) spontaneous closure versus the need for pharmacological treatment and (2) treatment response. We collected blood samples in the 1st day of life to perform recalcified native-blood TEG (reaction time, maximum amplitude, and lysis at 30 min [Ly30)]), standard coagulation tests, and a full blood count. RESULTS We enrolled 151 infants with a PDA at the first echocardiogram; 111 experienced spontaneous PDA closure while 40 required treatment. Mean GA was 29.7 ± 1.7 and 27.6 ± 2.1 weeks, and birth weight was 1,158 ± 256 and 933 ± 263 g in the 2 groups, respectively (p < 0.001). The hemostatic profile was similar between groups. Median hematocrit (44.6 and 48.7%; p = 0.01) and platelet count (187 and 216 × 103/μL; p = 0.04) were lower in the treated group, although differences lost significance after controlling for GA and illness severity in the multivariate analysis. Responders to PDA treatment (n = 20) had a significantly lower median Ly30 than nonresponders (0 and 0.7%; p = 0.02). CONCLUSION TEG at birth does not predict spontaneous PDA closure in preterm newborns. Fibrinolysis is enhanced in nonresponders to PDA treatment; this observation warrants further investigation.
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Affiliation(s)
- Stefano Ghirardello
- NICU, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Genny Raffaeli
- NICU, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy,
| | | | - Silvia Gulden
- NICU, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Ilaria Amodeo
- NICU, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Dario Consonni
- Epidemiology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giacomo Cavallaro
- NICU, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Federico Schena
- NICU, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Fabio Mosca
- NICU, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
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