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Souza RCD, Morais LLSD, Ghefter MC, Franceschini JP, Pinto FCG. Comparison between use of a pleural drainage system with flutter valve and a conventional water-seal drainage system after lung resection: a randomized prospective study. SAO PAULO MED J 2024; 142:e2023224. [PMID: 38655983 DOI: 10.1590/1516-3180.2023.0224.r1.08022024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 02/08/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND There is still a debate regarding the most appropriate pleural collector model to ensure a short hospital stay and minimum complications. OBJECTIVES To study aimed to compare the time of air leak, time to drain removal, and length of hospital stay between a standard water-seal drainage system and a pleural collector system with a unidirectional flutter valve and rigid chamber. DESIGN AND SETTING A randomized prospective clinical trial was conducted at a high-complexity hospital in São Paulo, Brazil. METHODS Sixty-three patients who underwent open or video-assisted thoracoscopic lung wedge resection or lobectomy were randomized into two groups, according to the drainage system used: the control group (WS), which used a conventional water-seal pleural collector, and the study group (V), which used a flutter valve device (Sinapi® Model XL1000®). Variables related to the drainage system, time of air leak, time to drain removal, and time spent in hospital were compared between the groups. RESULTS Most patients (63%) had lung cancer. No differences were observed between the groups in the time of air leak or time spent hospitalized. The time to drain removal was slightly shorter in the V group; however, the difference was not statistically significant. Seven patients presented with surgery-related complications: five and two in the WS and V groups, respectively. CONCLUSIONS Air leak, time to drain removal, and time spent in the hospital were similar between the groups. The system used in the V group resulted in no adverse events and was safe. REGISTRATION RBR-85qq6jc (https://ensaiosclinicos.gov.br/rg/RBR-85qq6jc).
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Affiliation(s)
- Rodrigo Caetano de Souza
- MD, MSc. Thoracic surgeon, Preceptor of the Residency Program in Thoracic Surgery, Hospital do Servidor Público Estadual de São Paulo (IAMSPE) Francisco Morato Oliveira, São Paulo (SP), Brazil
| | - Lilianne Louise Silva de Morais
- MD, Thoracic surgeon, Hospital do Servidor Público Estadual de São Paulo (IAMSPE) Francisco Morato Oliveira, São Paulo (SP), Brazil
| | - Mario Claudio Ghefter
- MD. Thoracic surgeon, Director of the Thoracic Surgery Service, Hospital do Servidor Público Estadual de São Paulo (IAMSPE) Francisco Morato Oliveira, São Paulo (SP), Brazil
| | | | - Fernando Campos Gomes Pinto
- MD, PhD. Neurosurgeon, Head of the Cerebral Hydrodynamics Group, Functional Neurosurgery Division, Institute of Psychiatry, Hospital das Clínicas, Faculty of Medicine, Universidade de São Paulo (USP), São Paulo (SP), Brazil
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Alifano M. Digital vs Traditional Chest Drainage System: Let's Move (With Prudence) Toward Stronger Evidence. Ann Thorac Surg 2023; 116:110. [PMID: 37028739 DOI: 10.1016/j.athoracsur.2023.03.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 03/26/2023] [Indexed: 04/09/2023]
Affiliation(s)
- Marco Alifano
- Department of Thoracic Surgery, Cochin Hospital, University of Paris Cité, 27 Rue de Faubourg Saint Jacques, 75014 Paris, France.
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Yang Q, Enríquez Á, Devathasan D, Thompson CA, Nayee D, Harris R, Satoski D, Obeng-Gyasi B, Lee A, Bentley RT, Lee H. Application of magnetically actuated self-clearing catheter for rapid in situ blood clot clearance in hemorrhagic stroke treatment. Nat Commun 2022; 13:520. [PMID: 35082280 PMCID: PMC8791973 DOI: 10.1038/s41467-022-28101-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 01/06/2022] [Indexed: 11/08/2022] Open
Abstract
Maintaining the patency of indwelling drainage devices is critical in preventing further complications following an intraventricular hemorrhage (IVH) and other chronic disease management. Surgeons often use drainage devices to remove blood and cerebrospinal fluid but these catheters frequently become occluded with hematoma. Using an implantable magnetic microactuator, we created a self-clearing catheter that can generate large enough forces to break down obstructive blood clots by applying time-varying magnetic fields. In a blood-circulating model, our self-clearing catheters demonstrated a > 7x longer functionality than traditional catheters (211 vs. 27 min) and maintained a low pressure for longer periods (239 vs. 79 min). Using a porcine IVH model, the self-clearing catheters showed a greater survival rate than control catheters (86% vs. 0%) over the course of 6 weeks. The treated animals also had significantly smaller ventricle sizes 1 week after implantation compared to the control animals with traditional catheters. Our results suggest that these magnetic microactuator-embedded smart catheters can expedite the removal of blood from the ventricles and potentially improve the outcomes of critical patients suffering from often deadly IVH.
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Affiliation(s)
- Qi Yang
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, 47907, USA
- Center for Implantable Devices, Purdue University, West Lafayette, IN, 47907, USA
- Birck Nanotechnology Center, Purdue University, West Lafayette, IN, 47907, USA
- School of Electrical and Computer Engineering, Purdue University, West Lafayette, IN, 47907, USA
| | - Ángel Enríquez
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, 47907, USA
- Center for Implantable Devices, Purdue University, West Lafayette, IN, 47907, USA
- Birck Nanotechnology Center, Purdue University, West Lafayette, IN, 47907, USA
| | - Dillon Devathasan
- College of Veterinary Medicine, Purdue University, West Lafayette, IN, 47907, USA
| | - Craig A Thompson
- College of Veterinary Medicine, Purdue University, West Lafayette, IN, 47907, USA
| | - Dillan Nayee
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, 47907, USA
- Center for Implantable Devices, Purdue University, West Lafayette, IN, 47907, USA
| | - Ryan Harris
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, 47907, USA
- Center for Implantable Devices, Purdue University, West Lafayette, IN, 47907, USA
| | - Douglas Satoski
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, 47907, USA
- Center for Implantable Devices, Purdue University, West Lafayette, IN, 47907, USA
| | - Barnabas Obeng-Gyasi
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, 47907, USA
- Center for Implantable Devices, Purdue University, West Lafayette, IN, 47907, USA
| | - Albert Lee
- Goodman Campbell Brain and Spine, Indianapolis, IN, 46202, USA
| | - R Timothy Bentley
- College of Veterinary Medicine, Purdue University, West Lafayette, IN, 47907, USA
| | - Hyowon Lee
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, 47907, USA.
- Center for Implantable Devices, Purdue University, West Lafayette, IN, 47907, USA.
- Birck Nanotechnology Center, Purdue University, West Lafayette, IN, 47907, USA.
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de Moya M, Brasel KJ, Brown CVR, Hartwell JL, Inaba K, Ley EJ, Moore EE, Peck KA, Rizzo AG, Rosen NG, Sperry J, Weinberg JA, Martin MJ. Evaluation and management of traumatic pneumothorax: A Western Trauma Association critical decisions algorithm. J Trauma Acute Care Surg 2022; 92:103-107. [PMID: 34538823 DOI: 10.1097/ta.0000000000003411] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT This is a recommended algorithm of the Western Trauma Association for the management of a traumatic pneumothorax. The current algorithm and recommendations are based on available published prospective cohort, observational, and retrospective studies and the expert opinion of the Western Trauma Association members. The algorithm and accompanying text represents a safe and reasonable approach to this common problem. We recognize that there may be variability in decision making, local resources, institutional consensus, and patient-specific factors that may require deviation from the algorithm presented. This annotated algorithm is meant to serve as a basis from which protocols at individual institutions can be developed or serve as a quick bedside reference for clinicians. LEVEL OF EVIDENCE Consensus algorithm from the Western Trauma Association, Level V.
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Affiliation(s)
- Marc de Moya
- From the Department of Surgery, Medical College of Wisconsin (M.dM.), Milwaukee, WI; Oregon Heatlh Science University (K.J.B.), Portland, OR; Department of Surgery, Dell Medical School (C.V.R.B.), University of Texas at Austin, Austin, TX; Department of Surgery, Indiana University School of Medicine (J.L.H.), Indianapolis, IN; Department of Surgery, University of Southern California (K.I.), Los Angeles, CA; Department of Surgery, Cedars-Sinai Medical Center (E.J.L.), Los Angeles, CA; Department of Surgery, Ernest E Moore Shock Trauma center (E.E.M.), Denver, CO; Department of Surgery, Scripps Mercy Hospital (K.A.P., M.J.M.), San Diego, CA; Department of Surgery, Inova Trauma Center (A.G.R.), Falls Church, VA; Department of Surgery, Children's Hospital (N.G.R.), Cincinnati, OH; Department of Surgery, University of Pittsburgh (J.S.), Pittsburgh, PA; Department of Surgery, St. Joseph's Hospital and Medical Center (J.A.W.), Phoenix, AZ
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Kulvatunyou N, Bauman ZM, Zein Edine SB, de Moya M, Krause C, Mukherjee K, Gries L, Tang AL, Joseph B, Rhee P. The small (14 Fr) percutaneous catheter (P-CAT) versus large (28-32 Fr) open chest tube for traumatic hemothorax: A multicenter randomized clinical trial. J Trauma Acute Care Surg 2021; 91:809-813. [PMID: 33843831 DOI: 10.1097/ta.0000000000003180] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The traditional treatment of traumatic hemothorax (HTX) has been an insertion of a large-bore 36- to 40-Fr chest tube. Our previous single-center randomized controlled trial (RCT) had shown that 14-Fr percutaneous catheters (PCs) (pigtail) were equally as effective as chest tube. We performed a multicenter RCT, hypothesizing that PCs are as equally effective as chest tubes in the management of patients with traumatic HTX (NCT03546764). METHODS We performed a multi-institution prospective RCT comparing 14-Fr PCs with 28- to 32-Fr chest tubes in the management of patients with traumatic HTX from July 2015 to September 2020. We excluded patients who were in extremis and required emergent tube placement and those who refused to participate. The primary outcome was failure rate, defined as a retained HTX requiring a second intervention. Secondary outcomes included daily drainage output, tube days, intensive care unit and hospital length of stay, and insertion perception experience (IPE) score on a scale of 1 to 5 (1, tolerable experience; 5, worst experience). Unpaired Student's t test, χ2, and Wilcoxon rank sum test were used with significance set at p < 0.05. RESULTS After exclusion, 119 patients participated in the trial, 56 randomized to PCs and 63 to chest tubes. Baseline characteristics between the two groups were similar. The primary outcome, failure rate, was similar between the two groups (11% PCs vs. 13% chest tubes, p = 0.74). All other secondary outcomes were also similar, except PC patients reported lower IPE scores (median, 1: "I can tolerate it"; interquartile range, 1-2) than chest tube patients (median, 3: "It was a bad experience"; interquartile range, 2-5; p < 0.001). CONCLUSION Small caliber 14-Fr PCs are equally as effective as 28- to 32-Fr chest tubes in their ability to drain traumatic HTX with no difference in complications. Patients reported better IPE scores with PCs over chest tubes, suggesting that PCs are better tolerated. LEVEL OF EVIDENCE Therapeutic, level II.
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Affiliation(s)
- Narong Kulvatunyou
- From the Division of Acute Care Surgery, Department of Surgery (N.K., L.G., A.L.T., B.J.), University of Arizona, Tucson, Arizona; Division of Acute Care Surgery, Department of Surgery (Z.M.B.), University of Nebraska, Omaha, Nebraska; Division of Acute Care Surgery, Department of Surgery (S.B.Z.E., M.d.M.), Medical College of Wisconsin, Milwaukee, Wisconsin; Division of Acute Care Surgery, Department of Surgery (C.K., K.M.), Loma Linda University, Loma Linda, California; and Department of Surgery (P.R.), New York Medical College, Valhalla, New York
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Wu C, Yang JF, Zhang Q, Liu W, Liao K, Hu B. Successful cholangioscopic electrocoagulation for biliary papillomatosis: Report covering six cases (with video). Gastroenterol Hepatol 2021; 44:546-551. [PMID: 33617929 DOI: 10.1016/j.gastrohep.2020.12.012] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 11/29/2020] [Accepted: 12/21/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Biliary papillomatosis is a rare type of papillomatosis. Depending on the location of the disease, radical surgical resection or liver transplants are the treatment of choice. These radical surgical options may be unrealistic in patients who are not surgical candidates or who are unwilling to consider surgery. AIMS To evaluate the effectiveness of endoscopic electrocoagulation for the biliary papillomatosis. METHODS In this case series, we report six patients with unresectable biliary papillomatosis who underwent cholangioscopic electrocoagulation using needle knife and their clinic follow up information. RESULTS After patients received cholangioscopy with electrocoagulation of the residual biliary papilloma, the daily T-tube drainage volume increased to 200-400ml with improvement in the drainage content and significant relief of clinical symptoms, such as jaundice and abdominal pain. CONCLUSION This method of using electrocoagulation to directly target and destroy tumor tissue is a safe and effective alternative for those with unresectable disease, and this method has shown to enhance T-tube drainage volume and improve patients' overall clinical symptoms.
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Affiliation(s)
- Chuncheng Wu
- Department of Gastroenterology, West China Hospital, Sichuan University, China
| | - Juliana F Yang
- Department of Internal Medicine, Division of Digestive and Liver Diseases, The Vanderbilt University Medical Center, Nashville, TN, USA
| | - Qiongying Zhang
- Department of Gastroenterology, West China Hospital, Sichuan University, China
| | - Wei Liu
- Department of Gastroenterology, West China Hospital, Sichuan University, China
| | - Ke Liao
- Department of Gastroenterology, West China Hospital, Sichuan University, China
| | - Bing Hu
- Department of Gastroenterology, West China Hospital, Sichuan University, China.
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Belin PJ, Mundae R, Tzu JH, Chang E, Parke DW. EXTERNAL DRAINAGE OF SUBRETINAL FLUID DURING RHEGMATOGENOUS RETINAL DETACHMENT REPAIR. Retina 2021; 41:1828-1832. [PMID: 33512898 DOI: 10.1097/iae.0000000000003136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To describe the safety and efficacy of rhegmatogenous retinal detachment (RRD) repair with external drainage of subretinal fluid using a 28-gauge External Drainage and Depression device (Vortex Surgical, Chesterfield, MO). METHODS Retrospective review of patients who underwent primary rhegmatogenous retinal detachment repair with scleral buckle, pars plana vitrectomy, or scleral buckle/pars plana vitrectomy using the drainage device from August 2018 through March 2020, performed by four surgeons at two vitreoretinal practices. RESULTS Eighty-three eyes of 83 patients were included. At presentation, 28% had proliferative vitreoretinopathy. Surgery included 65% scleral buckle/pars plana vitrectomy, 33% pars plana vitrectomy, and 2% scleral buckle. There were no cases of retinal incarceration and two subretinal hemorrhages at the drainage site (both < 2 DD), 2 cases of recurrent RD with proliferative vitreoretinopathy (1 had proliferative vitreoretinopathy at presentation), and 6 (10%) new epiretinal membranes (3 were mild). There were no other complications. Mean follow-up was 274 days. Single operation success rate for those with ≥ 6-month follow-up was 97% (57/59). CONCLUSION External drainage of subretinal fluid during rhegmatogenous retinal detachment repair demonstrated a favorable safety profile with a high single operation success rate. Further study of the role of external drainage in rhegmatogenous retinal detachment repair is warranted.
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Affiliation(s)
| | - Rusdeep Mundae
- Department of Ophthalmology, University of Minnesota, Minneapolis, Minnesota; and
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Padmore G, Sutherland FR, Ball CG. The art and craft of biliary T-tube Use. J Trauma Acute Care Surg 2021; 91:e46-e49. [PMID: 33951025 DOI: 10.1097/ta.0000000000003267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Since the universal adoption of Hans Kehr's biliary T-tube in the early twentieth century, use has shifted from routine towards highly selective. Improved interventional endoscopy, percutaneous techniques, and hepato-pancreato-biliary (HPB) training have resulted in less T-tube experience within general surgery. The aim of this technical review is to discuss T-tube indications, technical nuances, and management. METHODS Peer-reviewed literature, combined with high volume HPB experience by the authors, was utilized to construct a 10-step conceptual pathway for safe T-tube usage. RESULTS Essential concepts surrounding T-tube use include: 1. Contemporary indications for T-tube insertion (disease-, patient-, and anatomy-based); 2. Correct instrument availability (open and laparoscopic); 3. T-tube selection and mechanical preparation; 4. Atraumatic T-tube insertion and security; 5. Immediate postoperative management and meticulous T-tube care; 6. Imaging biliary T-tubes; 7. Optimal timing of T-tube removal; 8. Technical aspects of T-tube removal; 9. Management of potential T-tube inpatient complications; and 10. Management of T-tube complications in the outpatient setting. CONCLUSIONS Although their use has decreased substantially, the role of biliary T-tubes in some patients is essential. Given the reality of less frequent experience with T-tube insertion and management, this 10-step pathway will provide an adequate mental and technical framework for safe biliary T-tube use. LEVEL OF EVIDENCE Expert opinion, level V.
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Affiliation(s)
- Greg Padmore
- From the Department of Surgery, Foothills Medical Center, University of Calgary, Calgary, Alberta, Canada
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Scott CK, Timaran DE, Malekpour F, Salhanick M, Soto-Gonzalez M, Baig MS, Timaran CH. Selective Versus Routine Spinal Drain Use for Fenestrated/Branched Endovascular Aortic Repair (F-BEVAR). Ann Vasc Surg 2021; 76:168-173. [PMID: 34147637 DOI: 10.1016/j.avsg.2021.05.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 05/07/2021] [Accepted: 05/14/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Spinal drains are used to ameliorate spinal cord ischemia (SCI), but their use may result in inherent morbidity and mortality. Although prophylactic spinal drain has proven of benefit in open repairs, that is not the case for endovascular repairs. The aim of this study was to assess the outcomes of spinal cord protection with and without the routine use of spinal drains during fenestrated-branched endovascular repair (F-BEVAR). METHODS A retrospective single center study was performed using a prospectively maintained dataset of all patients undergoing F-BEVAR over a 4-year period. The primary endpoint of the study was the frequency of SCI. Prophylactic spinal drain was placed pre-operatively in 33 patients (23%) with a median time for removal of 3 days (IQR, 2-3 days). Routine intraoperative neuromonitoring was used. Spinal cord protection relied primarily on maintaining a perioperative systolic blood pressure between 140 and 160 mm Hg or a mean arterial pressure >90 mm Hg, avoiding hypotension, preservation of as many collateral beds as possible, staged repairs and early lower extremity reperfusion based on neuromonitoring. RESULTS A total of 145 patients, 104 men (71%) and 41 women (28%) with a median age of 70 years (interquartile range [IQR], 53-62) underwent F-BEVAR. Branched custom-made devices (CMDs) (11%), fenestrated CMDs (70%) and off-the-shelf T-Branch device (17%) were used with a median number of branches/fenestrations of 4 (IQR, 3-4). SVS classification of implantation zones were determined as follows: 9 (6%) zone 2, 21 (20%) zone 3, 26 (18%) zone 4 and 89 (61%) zone 5. SCI was present in 8 patients (5.5%) and classified according to the SVS SCI grading system as follows: 1 grade 1, 5 grade 2 and 2 grade 3a. When evaluating implantation zone independently of coverage length and patency of collateral beds, a high implantation zone (1-4) was not associated with SCI (P = 0.9). Similarly, prophylactic spinal drain did not demonstrate association with the occurrence of SCI (3[9%] vs. 5[4%], with and without spinal drain, respectively) (P = 0.3). For patients with high implantation zones, staged repair was performed in 38 patients (26%) at a median time of 2 months (IQR, 2-6 months). Among these patients, the frequency of SCI was 13%. Staged repair was associated with an 80% reduction in the frequency of SCI (OR, 0.19 [95% CI, 0.04-0.084]) (P = 0.02). CONCLUSION F-BEVAR can be performed with a minimal risk of SCI without the need for routine prophylactic spinal drains. High implantation zones did not predict SCI after F-BEVAR; however, staged repair significantly decreased the risk of SCI after F-BEVAR.
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Affiliation(s)
- Carla K Scott
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - David E Timaran
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Fatemeh Malekpour
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Marc Salhanick
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Marilisa Soto-Gonzalez
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Mirza S Baig
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Carlos H Timaran
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX.
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Wang Y, Liu J, Huang W, Xu Y, Cheng M, Shen Z. The best thickness of cornea graft from SMILE surgery as patch graft in glaucoma drainage implant surgery. Medicine (Baltimore) 2021; 100:e25828. [PMID: 34011047 PMCID: PMC8137079 DOI: 10.1097/md.0000000000025828] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 04/05/2021] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE The aim of this study was to determine the best thickness of corneal slices acquired from femtosecond laser surgery-small incision lenticule extraction (SMILE surgery) as patch graft in glaucoma drainage implantation surgery. METHODS This study is a prospective randomized study. Patients who received glaucoma drainage implantation from September 2016 to November 2018 were observed. The patients were randomly divided into 3 groups. Group A included 102 cases (104 eyes), receiving 1 layer (120-150 μm) of allogeneic lamellar corneal tissue as the graft. Group B included 117 cases (120 eyes), receiving 2 layers of lamellar corneal tissue from one donor. Group C included 109 cases (111 eyes), using 3 layers of lamellar corneal tissue from 2 donors. The intraocular pressure, corneal graft, conjunctiva stromalysis, drainage tube exposure, and drainage plate were observed. RESULTS Patients were followed up for 6 to 33 months. The intraocular pressure was significantly reduced after surgery in all three groups. Conjunctiva stromalysis and drainage tubes were exposed in 3 eyes (3%) in group A and 1 eye (0.8%, a special case which has nystagmus and the plate was placed infratemporally) in group B, whereas no conjunctiva stromalysis or tube exposure was reported in group C. CONCLUSIONS The corneal graft acquired from SMILE surgery can effectively prevent drainage tube exposure and give patients a better cosmetic appearance. Two layers of lamellar corneal tissue (240-300 μm) may be the best suitable thickness because it can effectively reduce tube exposure and rejection. In some special cases, 3 layers of lamellar corneal tissue are needed.
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Affiliation(s)
- Yuhong Wang
- Xiamen University Affiliated Xiamen Eye Center, Xiamen
- NHC Key Laboratory of Myopia (Fudan University)
- Key Laboratory of Myopia, Chinese Academy of Medical Science (Fudan University), Shanghai, China
| | - Jinkun Liu
- Xiamen University Affiliated Xiamen Eye Center, Xiamen
| | - Weiyi Huang
- Xiamen University Affiliated Xiamen Eye Center, Xiamen
| | - Yazhang Xu
- Xiamen University Affiliated Xiamen Eye Center, Xiamen
| | - Meizhu Cheng
- Xiamen University Affiliated Xiamen Eye Center, Xiamen
| | - Zhengwei Shen
- Xiamen University Affiliated Xiamen Eye Center, Xiamen
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Sayman Muslubas I, Hocaoglu M, Ersoz MG, Arf S, Karacorlu M. TRANSCORNEAL SUTURELESS SILICONE OIL REMOVAL USING 23-GAUGE TROCAR SYSTEM IN APHAKIA. Retin Cases Brief Rep 2021; 15:266-268. [PMID: 30015773 DOI: 10.1097/icb.0000000000000780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To describe transcorneal sutureless silicone oil removal using 23-gauge trocars as an alternative surgical technique in an aphakic eye. METHODS We retrospectively evaluated the management of a 50-year-old male patient who had a history of bilateral congenital cataract removal at the age of 5 and developed rhegmatogenous retinal detachment. A 3-port 23-gauge pars plana vitrectomy, removal of the vitreous up to the vitreous base, 60° temporal retinotomy, and anterior flap retinectomy were performed. Silicone oil (1,000 cSt) was selected as a tamponading agent. The patients underwent active silicone oil removal at subsequent surgery 2 months after the initial vitrectomy. RESULTS The silicone oil was successfully extracted from the aphakic eye by using transcorneal 23-gauge trocars. No suture was needed at the corneal wound sites. There were no intraoperative or postoperative complications. CONCLUSION Transcorneal silicone oil removal using 23-gauge trocars can be performed easily with today's modern vitreoretinal surgery systems as an alternative treatment modality.
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Kim YJ, Cho E, Park CH. Endoscopic drainage for management of infected necrosis following EUS-TA in a patient with pancreatic cancer: A case report. Medicine (Baltimore) 2021; 100:e25466. [PMID: 33879679 PMCID: PMC8078367 DOI: 10.1097/md.0000000000025466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 03/18/2021] [Indexed: 01/04/2023] Open
Abstract
RATIONALE Endoscopic ultrasonography-guided tissue acquisition (EUS-TA) has become the norm for the diagnosis of pancreatic solid lesions. EUS-TA is relatively safe, but various complications can occur. Infected pancreatic necrosis (IPN) is a rare but serious complication. The latest guidelines suggest that all invasive interventions in patients with IPN should be delayed until walled-off necrosis appears. PATIENT CONCERNS A 73-year-old man was referred to our hospital with double primary cancers including gallbladder and pancreas. We performed EUS-TA on metastatic pancreatic tail cancer to confirm histologic diagnosis. Six days after the procedure, he developed abdominal pain and fever. DIAGNOSES The patient's laboratory findings showed leukocytosis and C-reactive protein elevation. Fluid collection around pancreas tail and stomach was detected in computed tomography (CT) scan, and the patient was diagnosed with IPN. INTERVENTIONS AND OUTCOMES EUS-guided endoscopic transmural drainage (EUS-TD) was performed for the treatment of IPN. Two days after the procedure with antibiotics, his CRP level decreased abruptly, and he received chemotherapy for the treatment of pancreatic ductal adenocarcinoma (PDAC) 5 days after the procedure. He was discharged from our hospital without complications 15 days after chemotherapy. LESSONS In selected patients with PDAC, early endoscopic drainage may be recommended as treatment for IPN resulting from complications of EUS-TA.
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Sethia R, Freeman T, Mead K, Selhorst A, Vala K, Skoracki L, Adelman M, VanKoevering K, Kang SY, Ozer E, Agrawal A, Old MO, Carrau RL, Rocco JW, Seim NB. Patient-Directed Home Drain Removal in Head and Neck Surgery. Laryngoscope 2021; 131:2471-2477. [PMID: 33847392 DOI: 10.1002/lary.29556] [Citation(s) in RCA: 4] [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] [Journal Information] [Subscribe] [Scholar Register] [Revised: 03/27/2021] [Accepted: 03/31/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVES/HYPOTHESIS The purpose of this study was to evaluate the efficacy and safety of at home drain removal in head and neck surgery patients. METHODS The study population included patients who underwent head and neck surgery at an academic tertiary care center between February 2020 and November 2020 and were discharged with one to four drains with instructions for home removal. Prior to discharge, patients received thorough drain removal education. Patients were prospectively followed to evaluate for associated outcomes. RESULTS One hundred patients were evaluated in the study. There was record for ninety-seven patients receiving education at discharge. The most common methods of education were face-to-face education and written instructions with educational video link provided. Of 123 drains upon discharge, 110 drains (89.4%) were removed at home while 13 (10.6%) were removed in office. Most drains were located in the neck (86.4%). There was one seroma, two hematomas, two drain site infections, and five ED visits; however, none of these complications were directly associated with the action of drain removal at home. Calculated cost savings for travel and lost wages was $259.82 per round trip saved. CONCLUSIONS The results demonstrate that home drain removal can provide a safe and efficacious option for patients following head and neck surgery. This approach was safe and associated with patient cost savings and better utilization of provider's time. Furthermore, patients and healthcare providers avoided additional in-person encounters and exposures during the COVID-19 pandemic. Our findings warrant further investigation into cost savings and formal patient satisfaction associated with home drain removal. LEVEL OF EVIDENCE 4 Laryngoscope, 2021.
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Affiliation(s)
- Rishabh Sethia
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A
| | - Taylor Freeman
- College of Medicine, The Ohio State University, Columbus, Ohio, U.S.A
| | - Katherine Mead
- Division of Head and Neck Oncology and Microvascular Reconstructive Surgery, The James Cancer Hospital and Solove Research Institute, Columbus, Ohio, U.S.A
| | - Amanda Selhorst
- Division of Head and Neck Oncology and Microvascular Reconstructive Surgery, The James Cancer Hospital and Solove Research Institute, Columbus, Ohio, U.S.A
| | - Kelly Vala
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A
- Division of Head and Neck Oncology and Microvascular Reconstructive Surgery, The James Cancer Hospital and Solove Research Institute, Columbus, Ohio, U.S.A
| | - Laura Skoracki
- Division of Head and Neck Oncology and Microvascular Reconstructive Surgery, The James Cancer Hospital and Solove Research Institute, Columbus, Ohio, U.S.A
| | - Megan Adelman
- Division of Head and Neck Oncology and Microvascular Reconstructive Surgery, The James Cancer Hospital and Solove Research Institute, Columbus, Ohio, U.S.A
| | - Kyle VanKoevering
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A
| | - Stephen Y Kang
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A
- Division of Head and Neck Oncology and Microvascular Reconstructive Surgery, The James Cancer Hospital and Solove Research Institute, Columbus, Ohio, U.S.A
| | - Enver Ozer
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A
- Division of Head and Neck Oncology and Microvascular Reconstructive Surgery, The James Cancer Hospital and Solove Research Institute, Columbus, Ohio, U.S.A
| | - Amit Agrawal
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A
- Division of Head and Neck Oncology and Microvascular Reconstructive Surgery, The James Cancer Hospital and Solove Research Institute, Columbus, Ohio, U.S.A
| | - Matthew O Old
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A
- Division of Head and Neck Oncology and Microvascular Reconstructive Surgery, The James Cancer Hospital and Solove Research Institute, Columbus, Ohio, U.S.A
| | - Ricardo L Carrau
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A
- Division of Head and Neck Oncology and Microvascular Reconstructive Surgery, The James Cancer Hospital and Solove Research Institute, Columbus, Ohio, U.S.A
| | - James W Rocco
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A
- Division of Head and Neck Oncology and Microvascular Reconstructive Surgery, The James Cancer Hospital and Solove Research Institute, Columbus, Ohio, U.S.A
| | - Nolan B Seim
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A
- Division of Head and Neck Oncology and Microvascular Reconstructive Surgery, The James Cancer Hospital and Solove Research Institute, Columbus, Ohio, U.S.A
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Paglinawan R, Schwab P, Bechert K. Novel Negative-Pressure Wound Therapy System Provides Accurate Pressure Delivery and Exceptional Fluid Handling Capability. Adv Skin Wound Care 2021; 34:176-178. [PMID: 33739946 DOI: 10.1097/01.asw.0000735212.52381.0f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Rey Paglinawan
- The Cutting Edge is sponsored by Medela, LLC. Although this article was not subject to the Advances in Skin & Wound Care peer-review process, this study was reviewed and accepted by the editorial board and presented at the Virtual Annual Symposium on Advanced Wound Care (SAWC) Fall, November 4 to 6, 2020. Acknowledgments: The support of Medela AG (Laettichstrasse 4b, 6340 Baar, Switzerland) for this project is gratefully acknowledged. The authors are employees of Medela, Healthcare
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Marom G, Kostrzewa M, Glazer Y, Swanstrom LL, Shlomovitz E. Percutaneous Cholecystoduodenal Anastomosis for Internal Gallbladder Drainage Using a Lumen-Apposing Metal Stent. J Vasc Interv Radiol 2021; 32:142-143. [PMID: 33388106 DOI: 10.1016/j.jvir.2020.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 04/26/2020] [Accepted: 05/17/2020] [Indexed: 11/18/2022] Open
Affiliation(s)
- Gad Marom
- University Health Network, University of Toronto, Toronto, Ontario, Canada
| | | | - Yair Glazer
- University Health Network, University of Toronto, Toronto, Ontario, Canada
| | | | - Eran Shlomovitz
- University Health Network, University of Toronto, Toronto, Ontario, Canada; Institute of Image-Guided Surgery, Strasbourg, France.
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16
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Affiliation(s)
- Rimal H Dossani
- From the Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport
| | - Devi P Patra
- From the Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport
| | - Danielle L Terrell
- From the Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport
| | - Brian Willis
- From the Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport
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17
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Awwad A, Berman Z, Krinsky M, Minocha J, Roberts A. Daily Infusion of Acetylcysteine via Percutaneous Biliary Drainage Catheter to Reduce Bile Viscosity and Prevent Recurrent Cholangitis. J Vasc Interv Radiol 2020; 32:486-487. [PMID: 33272815 DOI: 10.1016/j.jvir.2020.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 09/17/2020] [Accepted: 10/07/2020] [Indexed: 11/19/2022] Open
Affiliation(s)
- Andy Awwad
- Department of Radiology, University of California San Diego, San Diego, CA
| | - Zach Berman
- Department of Radiology, University of California San Diego, San Diego, CA
| | - Mary Krinsky
- Department of Gastroenterology, University of California San Diego, San Diego, CA
| | - Jeet Minocha
- Department of Radiology, University of California San Diego, San Diego, CA
| | - Anne Roberts
- Department of Radiology, University of California San Diego, San Diego, CA
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18
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Plotkin A, Han SM, Weaver FA, Rowe VL, Ziegler KR, Fleischman F, Mack WJ, Hendrix JA, Magee GA. Complications associated with lumbar drain placement for endovascular aortic repair. J Vasc Surg 2020; 73:1513-1524.e2. [PMID: 33053415 DOI: 10.1016/j.jvs.2020.08.150] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 03/30/2020] [Accepted: 08/27/2020] [Indexed: 01/26/2023]
Abstract
OBJECTIVE We reviewed the complications associated with perioperative lumbar drain (LD) placement for endovascular aortic repair. METHODS Patients who had undergone perioperative LD placement for endovascular repair of thoracic and thoracoabdominal aortic pathologies from 2010 to 2019 were reviewed. The primary endpoints were major and minor LD-associated complications. Complications that had resulted in neurological sequelae or had required an intervention or a delay in operation were defined as major. These included intracranial hemorrhage, symptomatic spinal hematoma, cerebrospinal fluid (CSF) leak requiring intervention, meningitis, retained catheter tip, arachnoiditis, and traumatic (or bloody) tap resulting in delayed operation. Minor complications were defined as a bloody tap without a delay in surgery, asymptomatic epidural hematoma, and CSF leak with no intervention required. Isolated headaches were recorded separately owing to the minimal clinical impact. RESULTS A total of 309 LDs had been placed in 268 consecutive patients for 222 thoracic endovascular aortic repairs, 85 complex endovascular aortic repairs (EVARs; fenestrated branched EVAR/parallel grafting), and 2 EVARs (age, 65 ± 13 years; 71% male) for aortic pathology, including aneurysm (47%), dissection (49%), penetrating aortic ulcer (3%), and traumatic injury (0.6%). A dedicated neurosurgical team performed all LD procedures; most were performed by the same individual, with a technical success rate of 98%. Radiologic guidance was required in 3%. The reasons for unsuccessful placement were body habitus (n = 2) and severe spinal disease (n = 3). Most were placed prophylactically (96%). The overall complication rate was 8.1% (4.2% major and 3.9% minor). Major complications included spinal hematoma with paraplegia in 1 patient, intracranial hemorrhage in 2, meningitis in 2, arachnoiditis in 3, CSF leak requiring a blood patch in 3, bloody tap delaying the operation in 1, and a retained catheter tip in 1 patient. Patients who had undergone previous LD placement had experienced significantly more major LD-related complications (12.2% vs 3%; P = .019). The rate of total LD-associated complications did not differ between prophylactic and emergent therapeutic placements (8.1% vs 7.7%; P = 1.00) nor between major or minor complications. On multivariate analysis, previous LD placement and an overweight body mass index were the only independent predictors of major LD-related complications. CONCLUSIONS The complications associated with LD placement can be severe even when performed by a dedicated team. Previous LD placement and overweight body mass index were associated with a significantly greater risk of complications; however, emergent therapeutic placement was not. Although these risks are justified for therapeutic LD placement, the benefit of prophylactic LD placement to prevent paraplegia should be weighed against these serious complications.
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Affiliation(s)
- Anastasia Plotkin
- Division of Vascular Surgery and Endovascular Therapy, Keck School of Medicine of USC, University of Southern California, Los Angeles, Calif
| | - Sukgu M Han
- Division of Vascular Surgery and Endovascular Therapy, Keck School of Medicine of USC, University of Southern California, Los Angeles, Calif
| | - Fred A Weaver
- Division of Vascular Surgery and Endovascular Therapy, Keck School of Medicine of USC, University of Southern California, Los Angeles, Calif
| | - Vincent L Rowe
- Division of Vascular Surgery and Endovascular Therapy, Keck School of Medicine of USC, University of Southern California, Los Angeles, Calif
| | - Kenneth R Ziegler
- Division of Vascular Surgery and Endovascular Therapy, Keck School of Medicine of USC, University of Southern California, Los Angeles, Calif
| | - Fernando Fleischman
- Division of Cardiothoracic Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, Calif
| | - William J Mack
- Department of Surgery and Department of Neurosurgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, Calif
| | - Joseph A Hendrix
- Department of Surgery and Department of Neurosurgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, Calif
| | - Gregory A Magee
- Division of Vascular Surgery and Endovascular Therapy, Keck School of Medicine of USC, University of Southern California, Los Angeles, Calif.
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19
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Xiao Y, Hu J, Zhang M, Zhang W, Qin F, Zeng A, Wang X, Liu Z, Zhu L, Yu N, Si L, Long F, Ding Y. To use indwelling drainage or not in dual-plane breast augmentation mammoplasty patients: A comparative study. Medicine (Baltimore) 2020; 99:e21305. [PMID: 32702925 PMCID: PMC7373562 DOI: 10.1097/md.0000000000021305] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
To explore the necessity of indwelling drainage in dual-plane breast augmentation mammoplasty patients.Female patients (123 in total) were selected from June 2015 to June 2018 in the Department of Plastic Surgery at Peking Union Medical College Hospital and were randomly divided into 2 different groups: the with drainage group (WD group, 57 patients) and the without drainage group (WOD group, 66 patients). In the 2 groups, the operation time, postoperative stay, and hospitalization expenses were recorded. The BREAST-Q Version 2.0 Augmentation Module Pre- and Postoperative Scales (Chinese Version) were used to evaluate psychosocial well-being, sexual well-being, physical well-being, and satisfaction with breasts preoperatively and postoperatively (1 year after operation).Before the operation, no significant differences were found in psychosocial well-being, sexual well-being, physical well-being, or satisfaction with breasts between these 2 groups. In the WOD group, postoperative stay and hospitalization expenses were remarkably decreased, but the operation time was similar, compared with the WD group. Compared with before the operation, both groups had significantly increased scores in psychosocial well-being, sexual well-being, and satisfaction with breasts after the operation. However, no significant differences were found between the 2 groups. No complications were found in any of the patients.Although the operation time was not significantly decreased, patients without drainage could save much more time and money and simultaneously reach similar postoperative effects in psychosocial well-being, sexual well-being, physical well-being, and satisfaction with breasts. Therefore, drainage may not be necessary in patients who undergo dual-plane breast augmentation mammoplasty.
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Affiliation(s)
- Yiding Xiao
- Department of Plastic Surgery, Peking Union Medical College Hospital, Beijing
| | - Jianqiang Hu
- Department of Orthopaedics, Qingdao Huangdao District Hospital of Traditional Chinese Medicine, Qingdao, Shandong
| | - Mingzi Zhang
- Department of Plastic Surgery, Peking Union Medical College Hospital, Beijing
| | - Wenchao Zhang
- Department of Plastic Surgery, Peking Union Medical College Hospital, Beijing
| | - Feng Qin
- Department of Plastic Surgery, Peking Union Medical College Hospital, Beijing
| | - Ang Zeng
- Department of Plastic Surgery, Peking Union Medical College Hospital, Beijing
| | - Xiaojun Wang
- Department of Plastic Surgery, Peking Union Medical College Hospital, Beijing
| | - Zhifei Liu
- Department of Plastic Surgery, Peking Union Medical College Hospital, Beijing
| | - Lin Zhu
- Department of Plastic Surgery, Peking Union Medical College Hospital, Beijing
| | - Nanze Yu
- Department of Plastic Surgery, Peking Union Medical College Hospital, Beijing
| | - Loubin Si
- Department of Plastic Surgery, Peking Union Medical College Hospital, Beijing
| | - Fei Long
- Department of Plastic Surgery, Peking Union Medical College Hospital, Beijing
| | - Yu Ding
- Department of Information Engineering, Chaoshan Polytechnic College, Puning, Guangdong, China
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20
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Kubo N, Yokobori T, Takahashi R, Ogawa H, Gombodorj N, Ohta N, Ohno T, Saeki H, Shirabe K, Asao T. An abdominal spacer that does not require surgical removal and allows drainage of abdominal fluids in patients undergoing carbon ion radiotherapy. PLoS One 2020; 15:e0234471. [PMID: 32520972 PMCID: PMC7286516 DOI: 10.1371/journal.pone.0234471] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Accepted: 05/27/2020] [Indexed: 11/18/2022] Open
Abstract
Abdominal spacers are useful for maintaining the distance between the target tumors and surrounding tissues, such as the gastrointestinal tract, in patients treated with carbon ion radiotherapy. Surgical intervention to remove the spacers is sometimes necessary because of abdominal infections triggered by long-term spacer placement or intestinal perforation. Therefore, spacers that do not require surgical removal and provide effective drainage against abdominal infections are urgently needed. This study aimed to develop a spacer that could be removed non-surgically and one that provides the therapeutic effect of drainage in patients who receive carbon ion radiotherapy for abdominal tumors. A novel fan-shaped spacer was constructed from a film drain that was folded along the trigger line. Simple withdrawal of the trigger line caused the film drain to fold and the holding lines to become free. We performed laparoscopy-assisted insertion with pneumoperitoneum and blind removal of the spacer fourteen times using a porcine model. Saline in the abdominal cavity was effectively aspirated using the spacer. Our novel fan-shaped spacer could be removed safely without surgery and was able to drain fluid effectively from the abdominal cavity.
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Affiliation(s)
- Norio Kubo
- Department of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Gunma University, Maebashi, Gunma, Japan
- * E-mail:
| | - Takehiko Yokobori
- Division of Integrated Oncology Research, Gunma University Initiative for Advanced Research (GIAR), Maebashi, Gunma, Japan
- Department of Innovative Cancer Immunotherapy, Gunma University, Maebashi, Gunma, Japan
- Department of General Surgical Science, Graduate School of Medicine, Gunma University, Maebashi, Gunma, Japan
| | - Ryo Takahashi
- Department of General Surgical Science, Graduate School of Medicine, Gunma University, Maebashi, Gunma, Japan
| | - Hiroomi Ogawa
- Department of General Surgical Science, Graduate School of Medicine, Gunma University, Maebashi, Gunma, Japan
| | - Navchaa Gombodorj
- Division of Integrated Oncology Research, Gunma University Initiative for Advanced Research (GIAR), Maebashi, Gunma, Japan
| | - Naoya Ohta
- Division of Electronics and Informatics, Gunma University Graduate School of Engineering, Kiryu, Gunma, Japan
| | - Tatsuya Ohno
- Gunma University Heavy Ion Medical Center, Maebashi, Gunma, Japan
| | - Hiroshi Saeki
- Department of General Surgical Science, Graduate School of Medicine, Gunma University, Maebashi, Gunma, Japan
| | - Ken Shirabe
- Department of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Gunma University, Maebashi, Gunma, Japan
| | - Takayuki Asao
- Big Data Center for Integrative Analysis, Gunma University Initiative for Advance Research, Maebashi, Gunma, Japan
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21
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Sharma P, McCarty TR, Chhoda A, Costantino A, Loeser C, Muniraj T, Ryou M, Thompson CC. Alternative uses of lumen apposing metal stents. World J Gastroenterol 2020; 26:2715-2728. [PMID: 32550749 PMCID: PMC7284179 DOI: 10.3748/wjg.v26.i21.2715] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Revised: 03/27/2020] [Accepted: 05/12/2020] [Indexed: 02/06/2023] Open
Abstract
The advent of lumen apposing metal stents (LAMS) has revolutionized the management of many complex gastroenterological conditions that previously required surgical or radiological interventions. These procedures have garnered popularity due to their minimally invasive nature, higher technical and clinical success rate and lower rate of adverse events. By virtue of their unique design, LAMS provide more efficient drainage, serve as conduit for endoscopic access, are associated with lower rates of leakage and are easy to be removed. Initially used for drainage of pancreatic fluid collections, the use of LAMS has been extended to gallbladder and biliary drainage, treatment of luminal strictures, creation of gastrointestinal fistulae, pancreaticobiliary drainage, improved access for surgically altered anatomy, and drainage of intra-abdominal and pelvic abscesses as well as post-surgical fluid collections. As new indications of endosonographic techniques and LAMS continue to evolve, this review summarizes the current role of LAMS in the management of these various complex conditions and also highlights clinical pearls to guide successful placement of LAMS.
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Affiliation(s)
- Prabin Sharma
- Department of Gastroenterology and Hepatology, Yale-New Haven Health-Bridgeport Hospital, Bridgeport, CT 06610, United States
| | - Thomas R McCarty
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, United States
| | - Ankit Chhoda
- Department of Internal Medicine, Yale-New Haven Health-Bridgeport Hospital, Bridgeport, CT 06708, United States
| | - Antonio Costantino
- Department of Gastroenterology and Hepatology, Yale-New Haven Health-Bridgeport Hospital, Bridgeport, CT 06610, United States
| | - Caroline Loeser
- Department of Gastroenterology and Hepatology, Yale-New Haven Health-Bridgeport Hospital, Bridgeport, CT 06610, United States
| | - Thiruvengadam Muniraj
- Section of Digestive Diseases, Yale University School of Medicine, New Haven, CT 06520, United States
| | - Marvin Ryou
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, United States
| | - Christopher C Thompson
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, United States
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22
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Yang W, Zheng S, Xiong P, Wang Y. Treatment of rectovaginal fistula with a homemade device. Asian J Surg 2020; 43:843-844. [PMID: 32327209 DOI: 10.1016/j.asjsur.2020.03.008] [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] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Accepted: 03/11/2020] [Indexed: 11/19/2022] Open
Affiliation(s)
- Weijin Yang
- Department of Genery Surgery, 900th Hospital of the Joint Logistics Team, 156 North Xi-er Huan Road, Fuzhou, Fujian, China.
| | - Shiyao Zheng
- Clinical Institute of Fuzhou General Hospital, Fujian Medical University, Fuzhou, Fujian, China.
| | - Ping Xiong
- Department of Obstetrics and Gynecology, 900th Hospital of the Joint Logistics Team, 156 North Xi-er Huan Road, Fuzhou, Fujian, China.
| | - Yu Wang
- Department of Genery Surgery, 900th Hospital of the Joint Logistics Team, 156 North Xi-er Huan Road, Fuzhou, Fujian, China.
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Yousef YA, ElRimawi AH, Nazzal RM, Qaroot AF, AlAref AH, Mohammad M, Abureesh O, Rejdak R, Nowomiejska K, Avitabile T, Toro MD, AlNawaiseh I. Coats' disease: characteristics, management, outcome, and scleral external drainage with anterior chamber maintainer for stage 3b disease. Medicine (Baltimore) 2020; 99:e19623. [PMID: 32311932 PMCID: PMC7220322 DOI: 10.1097/md.0000000000019623] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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] [Indexed: 11/25/2022] Open
Abstract
To report on the characteristics and outcome of management of Coats' disease, and to describe a novel surgical technique for management of stage 3B with total retinal detachment (RD) by scleral external drainage with anterior chamber (AC-maintainer) placement before the drainage without pars plana vitrectomy.A retrospective study of 26 eyes from 25 Coats' patients. Outcome measures included: demographics, presentation, laterality, stage, treatment, and outcome.The median age at diagnosis was 3.5 years. Twenty patients (80%) were males, and all except 1 girl had unilateral disease. The presenting complaint was impaired vision in 13 (50%) eyes, leukocoria in 6 (23%) eyes, and strabismus in 7 (27%) eyes. Based on the Shields classification; 3(12%) eyes were stage 1, 9 (35%) eyes were stage 2, 10 (38%) eyes were stage 3, 2 (8%) eyes were stag e4, and 2 (8%) eyes were stage 5. Primary management included cryotherapy (54%), laser photocoagulation (27%), intravitreal anti-vascular endothelial growth factor (23%), intravitreal steroids (23%), and surgical drainage (12%). The 3 eyes in stage 3B (with total exudative RD) underwent subretinal fluid drainage with AC maintainer, and all had the retina reattached completely for 6 months follow up after the surgery. At mean follow up 21 months, 4 (15%) eyes were enucleated, 19 (73%) eyes had improvement or stabilization in visual acuity.Coats' disease usually presents at advanced stage with poor visual prognosis, individualized management with close follow up are mandatory to save the eye. Subretinal fluid drainage with AC maintainer is a safe and useful technique for repairing total RD in eyes with stage 3B Coats' disease.
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Affiliation(s)
- Yacoub A. Yousef
- Departments of Surgery (Ophthalmology) King Hussein Cancer Center
| | | | - Rashed M. Nazzal
- Department of Neurology, Medical University of Lublin, Lublin, Poland
| | - Ahmad F. Qaroot
- Department of Ophthalmology, Ibn Al-Haitham Hospital, Amman, Jordan
| | - Adnan H. AlAref
- Department of Ophthalmology, Ibn Al-Haitham Hospital, Amman, Jordan
| | - Mona Mohammad
- Departments of Surgery (Ophthalmology) King Hussein Cancer Center
| | - Omar Abureesh
- Departments of Surgery (Ophthalmology) King Hussein Cancer Center
| | - Robert Rejdak
- Department of Neurology, Medical University of Lublin, Lublin, Poland
| | | | | | - Mario Damiano Toro
- Department of Neurology, Medical University of Lublin, Lublin, Poland
- Faculty of Medicine, Collegium Medicum Cardinal Stefan Wyszynski University, Warsow, Poland
| | - Ibrahim AlNawaiseh
- Departments of Surgery (Ophthalmology) King Hussein Cancer Center
- Department of Ophthalmology, Ibn Al-Haitham Hospital, Amman, Jordan
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Commander CW, Wilson SB, Bilaj F, Isaacson AJ, Burke CT, Yu H. CT-Guided Percutaneous Drainage Catheter Placement in the Abdomen and Pelvis: Predictors of Outcome and Protocol for Follow-up. J Vasc Interv Radiol 2020; 31:667-673. [PMID: 32113797 DOI: 10.1016/j.jvir.2019.09.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 09/25/2019] [Accepted: 09/27/2019] [Indexed: 11/18/2022] Open
Abstract
PURPOSE To determine predictors of outcomes for patients who undergo computed tomography (CT)-guided percutaneous abdominal or pelvic drainage catheter placement and to identify which patients benefit from fluoroscopic drainage catheter interrogation (abscessogram). MATERIALS AND METHODS A retrospective review of 383 patients (mean, 52 years old; range 8-89 years old; 158 males: 225 females) who underwent 442 CT-guided procedures and 489 catheter placements for fluid collections in the abdomen or pelvis from January 1, 2015, to December 31, 2016 was performed. Variables including underlying disease, fluid location, number of collections drained, number of catheter exchanges and follow-up abscessograms performed, catheter size, and fistula detection were analyzed to determine factors associated with fistula formation and increased catheter dwell time. RESULTS A single abscessogram followed by catheter removal was performed for 217 catheters (44%). An increased number of abscessograms was significantly associated with drainage catheter size (P < .001) and presence of a fistula (P < .001). Fistulae were detected in 95 cases (19%) and were significantly associated with an increased number of drain exchanges (P < .001) and an underlying diagnosis of Crohn's disease (P = .02). Based on these data, a clinical algorithm for drain management is presented. CONCLUSIONS Abscessograms performed after CT-guided percutaneous drainage catheter placement are useful to detect catheter malposition, occluded catheters, and fistulae but are not necessary for all patients. If performed selectively, particularly in patients with an underlying diagnosis of Crohn's disease or those at high risk for developing fistulae, unnecessary examinations can be avoided, reducing cost, extra hospital visits, and radiation dose.
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Affiliation(s)
- Clayton W Commander
- Department of Radiology, University of North Carolina, Chapel Hill, Chapel Hill, North Carolina.
| | - Sarah B Wilson
- Department of Radiology, University of North Carolina, Chapel Hill, Chapel Hill, North Carolina
| | - Fatmir Bilaj
- Department of Radiology, University Hospital Center Mother Teresa, Tirana, Albania
| | - Ari J Isaacson
- Divison of Vascular Interventional Radiology, University of North Carolina, Chapel Hill, Chapel Hill, North Carolina
| | - Charles T Burke
- Divison of Vascular Interventional Radiology, University of North Carolina, Chapel Hill, Chapel Hill, North Carolina
| | - Hyeon Yu
- Divison of Vascular Interventional Radiology, University of North Carolina, Chapel Hill, Chapel Hill, North Carolina
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Mazzawi T, Chaiyapo A, Kongkam P, Ridtitid W, Rerknimitr R. EUS-guided transhepatic antegrade stenting of dilated intrahepatic duct due to a pancreatic head malignancy (with videos). Arab J Gastroenterol 2020; 21:65-66. [PMID: 32241697 DOI: 10.1016/j.ajg.2019.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Accepted: 12/01/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Tarek Mazzawi
- Section of Gastroenterology, Department of Medicine, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway; Gastrointestinal Endoscopy Excellence Center and Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand; Pancreas Research Unit, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Auamduan Chaiyapo
- Gastrointestinal Endoscopy Excellence Center and Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand; Pancreas Research Unit, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; Department of Surgery, Prapokklao Hospital, Chanthaburi, Thailand
| | - Pradermchai Kongkam
- Gastrointestinal Endoscopy Excellence Center and Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand; Pancreas Research Unit, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
| | - Wiriyaporn Ridtitid
- Gastrointestinal Endoscopy Excellence Center and Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand; Pancreas Research Unit, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Rungsun Rerknimitr
- Gastrointestinal Endoscopy Excellence Center and Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand; Pancreas Research Unit, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
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Alexandrescu ST, Zlate AC, Grigorie RT, Ionescu M, Popescu I. Deliberate external pancreatic fistula after pancreaticoduodenectomy performed in the setting of acute pancreatitis, and its internalization through fistula-jejunostomy. Hepatobiliary Pancreat Dis Int 2020; 19:94-96. [PMID: 31706857 DOI: 10.1016/j.hbpd.2019.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 10/21/2019] [Indexed: 02/05/2023]
Affiliation(s)
- Sorin T Alexandrescu
- Fundeni Clinical Institute, Dan Setlacec Centre of General Surgery and Liver Transplantation, Sos. Fundeni nr. 258, sector 2, Bucharest, Romania; Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.
| | - Andrei C Zlate
- Fundeni Clinical Institute, Dan Setlacec Centre of General Surgery and Liver Transplantation, Sos. Fundeni nr. 258, sector 2, Bucharest, Romania
| | - Razvan T Grigorie
- Fundeni Clinical Institute, Dan Setlacec Centre of General Surgery and Liver Transplantation, Sos. Fundeni nr. 258, sector 2, Bucharest, Romania
| | - Mihnea Ionescu
- Fundeni Clinical Institute, Dan Setlacec Centre of General Surgery and Liver Transplantation, Sos. Fundeni nr. 258, sector 2, Bucharest, Romania
| | - Irinel Popescu
- Fundeni Clinical Institute, Dan Setlacec Centre of General Surgery and Liver Transplantation, Sos. Fundeni nr. 258, sector 2, Bucharest, Romania; Titu Maiorescu University, Faculty of Medicine, Bucharest, Romania
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Xu J, Zhang S, Jiang T, Zhao YJ. Transanal drainage tubes vs metallic stents for acute malignant left-sided bowel obstruction: A systematic review and meta-analysis. Medicine (Baltimore) 2020; 99:e18623. [PMID: 31914042 PMCID: PMC6959871 DOI: 10.1097/md.0000000000018623] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 11/20/2019] [Accepted: 12/06/2019] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND The surgical management of acute malignant left-sided bowel obstruction is associated with high morbidity and mortality. Recently, transanal drainage tubes (DTs) and metallic stents (MSs) used as a "bridge to surgery" have become widely used decompression methods compared with emergency surgery. This study aims to evaluate the efficacy and safety of DTs and MSs for the decompression of acute left-sided malignant colorectal obstruction. METHODS All studies were acquired from PubMed, Medline, Embase, CNKI and the Cochrane Library. The data were extracted by two of the coauthors independently and were analyzed with RevMan5.3. Mean differences (MDs), odds ratios (ORs) and 95% confidence intervals (CIs) were calculated. The Cochrane Collaboration's risk of bias tool and the Newcastle-Ottawa scale were used to assess the risk of bias. RESULTS Eleven studies, which included three randomized controlled trials (RCTs) and 8 observational studies, were assessed. The methodological quality of the trials ranged from low to moderate. The pooled results of the technical success rate showed that the difference was not statistically significant between the2 devises. The differences in clinical success rate, operative time and complications were statistically significant between MSs and DTs, and MSs were associated with a better clinical success rate, increased operative time and fewer complications. Sensitivity analysis proved the stability of the pooled results, and the publication bias was low. CONCLUSION MS insertion for acute left-sided malignant bowel obstruction is effective and safe with a better technical success rate and with fewer complications than decompression using a DT, and MS insertion can avoid stoma formation. Moreover, MS insertion appears to be a useful treatment strategy for malignant colonic obstruction even if the lesion is located in the right colon. More large-sample, multicenter, high-quality RCTs are needed to verify the outcomes of this meta-analysis.
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Faisal AH, Ng BH. Ways to overcome non-draining indwelling pleural catheter in malignant pleural effusion. Med J Malaysia 2019; 74:555-557. [PMID: 31929490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The indwelling pleural catheter (IPC) is a 16-Fr-multifenestrated catheter. It has become an accepted practice in the management of malignant pleural effusion, especially in patients with non-expandable lung. However, IPC blockage or not draining is common. A 53-year-old female with malignant pleural effusion presented to us with blocked IPC and symptomatic pleural loculation one month after IPC insertion. After failing saline flushing and low-pressure wall suction, intrapleural alteplase was instituted through the IPC with a favourable outcome, and she continued to drain daily thereafter. The present case highlights the safety of intrapleural alteplase via IPC in the non-expandable lung.
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Affiliation(s)
- A H Faisal
- Pusat Perubatan Universiti Kebangsaan Malaysia, Department of Medicine, Pulmonology Unit, Kuala Lumpur, Malaysia.
| | - B H Ng
- Pusat Perubatan Universiti Kebangsaan Malaysia, Department of Medicine, Pulmonology Unit, Kuala Lumpur, Malaysia
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Yuenyongviwat V, Iamthanaporn K, Tuntarattanapong P, Hongnaparak T. The "Cough Trick" Reduces Pain During Removal of Closed-suction Drains after Total Knee Arthroplasty: A Randomized Trial. Clin Orthop Relat Res 2019; 477:2687-2691. [PMID: 31764336 PMCID: PMC6907319 DOI: 10.1097/corr.0000000000000901] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 07/01/2019] [Indexed: 01/31/2023]
Abstract
BACKGROUND Drain removal after TKA can be painful. Prior research suggests that the "cough trick," in which a patient coughs at the same time she or he receives an injection, effectively decreases pain. To our knowledge, this intervention has not been evaluated as a way to reduce pain during other brief but painful interventions, such as removal of closed-suction drains after orthopaedic surgery. QUESTION/PURPOSE Does the cough trick reduce pain while a surgeon is removing a closed-suction drain after TKA? METHODS Fifty-six patients with primary osteoarthritis who underwent primary TKA were randomized into two groups: drain removal as the patient coughed (n = 28 patients; three men, 25 women) or drain removal using the usual process, without the cough trick (n = 28 patients; three men, 25 women). The study groups were not different in terms of gender, BMI, surgical time, or other baseline variables, and other than the addition of the cough trick, there were no differences in surgical treatment or other elements of aftercare. Likewise, at baseline, the verbal numeric rating scale (VNRS) score for pain before the drain was removed was not different between the groups (3.1 ± 1.7 versus 3.3 ± 1.3; p = 0.72). The level of pain before and during drain removal was recorded using a VNRS by an orthopaedic surgeon who was not involved in the care of the study patients. We considered the minimum clinically important difference on the 10-point scale to be 2 points, based on prior evidence. RESULTS The mean ± SD VNRS for the pain level during drain removal was lower in the cough trick group than that in the control group (1.6 ± 1.0 versus 3.7 ± 1.9, mean difference 2.1; 95% CI, 1.3-2.9; p < 0.001). CONCLUSIONS The cough trick during removal of a closed-suction drain tube in patients undergoing TKA reduced the level of pain in this small randomized trial. We suggest that surgeons consider this technique when removing drains after TKA because it is a noninvasive technique and it is easy to perform. Because the cough trick has been shown by others to be effective at reducing pain during venipuncture and parenteral injections, and we found it was effective for that purpose during drain removal after TKA, we believe this finding probably generalizes well to most minor procedures that cause transient, sharp pain. We suggest that it could be used to make such procedures more comfortable for patients, as well as for drain removal in other types of surgery where drains still are commonly used (including spine surgery and tumor surgery). LEVEL OF EVIDENCE Level I, therapeutic study.
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Affiliation(s)
- Varah Yuenyongviwat
- V. Yuenyongviwat, K. Iamthanaporn, P. Tuntarattanapong, T. Hongnaparak, Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, Songkhla Thailand
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Bouremel Y, Lee RMH, Eames I, Brocchini S, Khaw PT. Novel approaches to model effects of subconjunctival blebs on flow pressure to improve clinical grading systems after glaucoma drainage surgery. PLoS One 2019; 14:e0221715. [PMID: 31647822 PMCID: PMC6812775 DOI: 10.1371/journal.pone.0221715] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 08/13/2019] [Indexed: 12/28/2022] Open
Abstract
Clinical grading systems following glaucoma filtration surgery do not include any effects of the bleb on the intra-ocular pressure and are relatively subjective, therefore carrying the risk of inter and/or intra-observer variability. The main objective of the study is to quantify and model the effect of subconjunctival bleb on flow pressure for assessment of clinical grading following glaucoma surgery. Subconjunctival bleb was created by inserting a tube into ex vivo rabbit eyes via an ab externo approach through the anterior chamber and exiting into the subconjunctival space. Sterile dyed water was injected through the tube into the developing bleb. For the in vitro approach a silicone bleb was created by clamping a circular silicone sheet, injecting dyed water through a fixed resistance outlet tube. Photographic measurements of the bleb height, planform area and pressure were taken as a function of time. Clinical blebs were also collected over a few months. Mathematical algorithm software was used to build the bleb model. Bleb height and volume increase as pressure in the bleb increases. The bleb planform area tended to a constant determined by the section of conjunctiva prior to shunt insertion. These increases were in accordance with the bleb model developed in the Appendix. They show that the pressure in the bleb is related to the resistance of the outflow. The linearity of clinical grading systems is reviewed and a new grading approach is proposed. The pressure in the bleb has a strong dependence on bleb extent, height and a weak dependence on conjunctival thickness. The pressure in a bleb can be estimated from bleb height, radius, and flow rate inlet in agreement with the bleb flow model. These results provide support for an improved bleb categorization system.
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Affiliation(s)
- Yann Bouremel
- National Institute for Health Research (NIHR) Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom
- UCL Department of Mechanical Engineering, London, United Kingdom
- UCL School of Pharmacy, London, United Kingdom
| | - Richard M. H. Lee
- National Institute for Health Research (NIHR) Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom
- Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom
| | - Ian Eames
- National Institute for Health Research (NIHR) Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom
- UCL Department of Mechanical Engineering, London, United Kingdom
| | - Steve Brocchini
- National Institute for Health Research (NIHR) Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom
- UCL School of Pharmacy, London, United Kingdom
| | - Peng Tee Khaw
- National Institute for Health Research (NIHR) Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom
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Ashat M, Arora S, Klair JS, Childs CA, Murali AR, Johlin FC. Bilateral vs unilateral placement of metal stents for inoperable high-grade hilar biliary strictures: A systemic review and meta-analysis. World J Gastroenterol 2019; 25:5210-5219. [PMID: 31558868 PMCID: PMC6747295 DOI: 10.3748/wjg.v25.i34.5210] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 07/14/2019] [Accepted: 08/07/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Bilateral vs unilateral biliary stenting is used for palliation in malignant biliary obstruction. No clear data is available to compare the efficacy and safety of bilateral biliary stenting over unilateral stenting.
AIM To assess the efficacy and safety of bilateral vs unilateral biliary drainage in inoperable malignant hilar obstruction.
METHODS PubMed, Embase, Scopus, and Cochrane databases, as well as secondary sources (bibliographic review of selected articles and major GI proceedings), were searched through January 2019. The primary outcome was the re-intervention rate. Secondary outcomes were a technical success, early and late complications, and stent malfunction rate. Pooled odds ratio (OR) and 95% confidence interval (CI) were calculated for each outcome.
RESULTS A total of 9 studies were included (2 prospective Randomized Controlled Study, 5 retrospective studies, and 2 abstracts), involving 782 patients with malignant hilar obstruction. Bilateral stenting had significantly lower re-intervention rate compared with unilateral drainage (OR = 0.59, 95%CI: 0.40-0.87, P = 0.009). There was no difference in the technical success rate (OR = 0.7, CI: 0.42-1.17, P = 0.17), early complication rate (OR = 1.56, CI: 0.31-7.75, P = 0.59), late complication rate (OR = 0.91, CI: 0.58-1.41, P = 0.56) and stent malfunction (OR = 0.69, CI: 0.42-1.12, P = 0.14) between bilateral and unilateral stenting for malignant hilar biliary strictures.
CONCLUSION Bilateral biliary drainage had a lower re-intervention rate as compared to unilateral drainage for high grade inoperable malignant biliary strictures, with no significant difference in technical success, and early or late complication rates.
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Affiliation(s)
- Munish Ashat
- Division of Gastroenterology and Hepatology, University of Iowa Hospital and Clinics, Iowa City, IA 52242, United States
| | - Sumant Arora
- Division of Gastroenterology and Hepatology, University of Iowa Hospital and Clinics, Iowa City, IA 52242, United States
| | - Jagpal S Klair
- Section of Gastroenterology, Seattle, WA 98111, United States
| | - Christopher A Childs
- Hardin Library University of Iowa Hospital and Clinics, Iowa City, IA 52242, United States
| | - Arvind R Murali
- Division of Gastroenterology and Hepatology, University of Iowa Hospital and Clinics, Iowa City, IA 52242, United States
| | - Frederick C Johlin
- Division of Gastroenterology and Hepatology, University of Iowa Hospital and Clinics, Iowa City, IA 52242, United States
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Cho IR, Chung MJ, Jo JH, Lee HS, Park JY, Bang S, Park SW, Song SY. A novel lumen-apposing metal stent with an anti-reflux valve for endoscopic ultrasound-guided drainage of pseudocysts and walled-off necrosis: A pilot study. PLoS One 2019; 14:e0221812. [PMID: 31483821 PMCID: PMC6726198 DOI: 10.1371/journal.pone.0221812] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Accepted: 08/15/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Pancreatic pseudocysts (PC) and walled-off necrosis (WON) are common complications of severe pancreatitis. Endoscopic ultrasound (EUS)-guided drainage has replaced surgery as the standard treatment for PC/WON. We developed a novel lumen-apposing metal stent (LAMS) with an anti-reflux valve to prevent infectious complications caused by food reflux into the cyst cavity. This retrospective study investigated the efficacy and safety of EUS-guided drainage using this LAMS. METHODS We investigated and compared the treatment outcomes and complications rates between EUS-guided drainage using a novel LAMS (n = 10) versus plastic stents (n = 18) from December 2013 to October 2016. Technical success was defined as successful stent placement without immediate complications. Clinical success was defined as resolution of the PC/WON and disappearance of symptoms. RESULTS Among 10 patients in LAMS group, 4 patients had complicated PC and 6 patients had WON. In the plastic stent group, 15 and 3 patients had PC and WON, respectively. The median fluid collection size before treatment was 82.5 (interquartile range [IQR], 60.75-118.25) mm and 92.0 (IQR, 75.75-130.25) mm in the LAMS and plastic stent groups, respectively. There were no statistically significant differences in technical success rates (90% vs. 94.4%; p = 0.999), clinical success rates (80% vs. 77.8%; p = 0.999), and complication rates (20% vs. 27.8%; p = 0.999) between the two groups. CONCLUSIONS Treatment outcomes of EUS-guided drainage using a novel LAMS were feasible despite the significantly high proportion of WON. The LAMS allowed acceptable treatment outcomes for EUS-guided drainage.
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Affiliation(s)
- In Rae Cho
- Department of Internal Medicine, Catholic Kwandong University College of Medicine, Incheon, Korea
| | - Moon Jae Chung
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- * E-mail:
| | - Jung Hyun Jo
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Hee Seung Lee
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Jeong Youp Park
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Seungmin Bang
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Seung Woo Park
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Si Young Song
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
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Abstract
RATIONALE Periorbital cellulitis or an orbital abscess caused by acute sinusitis is a serious acute infectious disease. If not treated in time, serious complications may occur. PATIENT CONCERNS A 16-year-old girl with a history of right-sided proptosis, periorbital swelling, chemosis, hypophasis, restricted ocular movement in the upward direction, and diminution of vision was referred to our institution. The clinic, computed tomography (CT) and magnetic resonance imaging (MRI) examination indicate right orbital abscess in the upper quadrant and sinusitis. DIAGNOSES She was diagnosed with orbital abscess, acute sinusitis. INTERVENTIONS She underwent medical management, transnasal endoscopic surgery and then ultrasound-guided fine needle aspiration (FNA) and catheter drainage. OUTCOMES She was completely cured without any complications or sequelae. LESSONS Performance of surgical drainage in a timely manner and administration of effective antibiotic treatment according to bacterial culture can reduce the complications of orbital abscesses. Ultrasound-guided FNA and catheter drainage is a safe, simple, and effective method for the treatment of orbital abscess.
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Affiliation(s)
- Yan Wang
- Department of Otolaryngology–Head and Neck Surgery
| | - Jie Zhang
- Department of Otolaryngology–Head and Neck Surgery
| | - Lei Dong
- Department of Otolaryngology–Head and Neck Surgery
| | - Hong Jiang
- Department of Ultrasound, Qingdao University Medical College Affiliated Yantai Yuhuangding Hospital, Yantai, Shandong Province, China
| | - Xicheng Song
- Department of Otolaryngology–Head and Neck Surgery
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Coletta D, Del Basso C, Giuliani G, Guerra F. Subcutaneous suction drains do not prevent surgical site infections in clean-contaminated abdominal surgery-results of a systematic review and meta-analysis. Langenbecks Arch Surg 2019; 404:663-668. [PMID: 31468112 DOI: 10.1007/s00423-019-01813-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 05/29/2019] [Accepted: 08/07/2019] [Indexed: 11/26/2022]
Abstract
PURPOSE The role of subcutaneous prophylactic drainage in preventing postoperative abdominal wound complications is still controversial. We aimed to elucidate whether any difference in the incidence of surgical site infection (SSI) exists between patients with or without subcutaneous suction drain following clean-contaminated abdominal surgery. METHODS PubMed, EMBASE, and the CENTRAL were systematically searched for randomized controlled trials (RCT) comparing drained with undrained surgeries featuring gastrointestinal (GI) tract opening. The aim of the analysis was to assess the incidence of wound infection. A meta-analysis of relevant studies was performed using RevMan 5.3. RESULTS A total of 8 studies, including 2833 patients, were considered eligible to collect data necessary. Globally, 187 patients (83 drained versus 104 undrained) experienced some SSI during the postoperative period. The use of subcutaneous suction drains did not exhibit any significant differences between drained and undrained patients in developing SSI (odds ratio 0.76, 95% CI 0.56-1.02; p = 0.07). CONCLUSIONS According to the available, high-level evidence, the use of subcutaneous drains should not be encouraged on a routine basis, as it does not confer any advantage in preventing postoperative wound infection following clean-contaminated abdominal surgery. However, this does not exclude that there might be a benefit in a specific risk group of patients.
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Affiliation(s)
- Diego Coletta
- Department of General Surgery, Emergency Department - Emergency and Trauma Surgery Division, Umberto I University Hospital, Sapienza University of Rome, Viale del Policlinico 155, 00183, Rome, Italy.
| | - Celeste Del Basso
- Department of General Surgery, Emergency Department - Emergency and Trauma Surgery Division, Umberto I University Hospital, Sapienza University of Rome, Viale del Policlinico 155, 00183, Rome, Italy
| | - Giuseppe Giuliani
- Division of General and Minimally Invasive Surgery, Misericordia Hospital, Grosseto, Italy
| | - Francesco Guerra
- Division of General Surgery, Ospedali Riuniti Marche Nord, Pesaro, Italy
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Affiliation(s)
- Danielle S Graham
- Department of General Surgery, University of California, Los Angeles
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Anderloni A, Troncone E, Fugazza A, Cappello A, Del Vecchio Blanco G, Monteleone G, Repici A. Lumen-apposing metal stents for malignant biliary obstruction: Is this the ultimate horizon of our experience? World J Gastroenterol 2019; 25:3857-3869. [PMID: 31413524 PMCID: PMC6689812 DOI: 10.3748/wjg.v25.i29.3857] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 06/20/2019] [Accepted: 07/03/2019] [Indexed: 02/06/2023] Open
Abstract
In the last years, endoscopic ultrasonography (EUS) has evolved from a purely diagnostic technique to a more and more complex interventional procedure, with the possibility to perform several type of therapeutic interventions. Among these, EUS-guided biliary drainage (BD) is gaining popularity as a therapeutic approach after failed endoscopic retrograde cholangiopancreatography in distal malignant biliary obstruction (MBO), due to the avoidance of external drainage, a lower rate of adverse events and re-interventions, and lower costs compared to percutaneous trans-hepatic BD. Initially, devices created for luminal procedures (e.g., luminal biliary stents) have been adapted to the new trans-luminal EUS-guided interventions, with predictable shortcomings in technical success, outcome and adverse events. More recently, new metal stents specifically designed for transluminal drainage, namely lumen-apposing metal stents (LAMS), have been made available for EUS-guided procedures. An electrocautery enhanced delivery system (EC-LAMS), which allows direct access of the delivery system to the target lumen, has subsequently simplified the classic multi-step procedure of EUS-guided drainages. EUS-BD using LAMS and EC-LAMS has been demonstrated effective and safe, and currently seems one of the most performing techniques for EUS-BD. In this Review, we summarize the evolution of the EUS-BD in distal MBO, focusing on the novelty of LAMS and analyzing the unresolved questions about the possible role of EUS as the first therapeutic option to achieve BD in this setting of patients.
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Affiliation(s)
- Andrea Anderloni
- Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research Hospital, Milan 20089, Italy
| | - Edoardo Troncone
- Department of Systems Medicine, University of Rome “Tor Vergata”, Rome 00133, Italy
| | - Alessandro Fugazza
- Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research Hospital, Milan 20089, Italy
| | - Annalisa Cappello
- Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research Hospital, Milan 20089, Italy
| | | | - Giovanni Monteleone
- Department of Systems Medicine, University of Rome “Tor Vergata”, Rome 00133, Italy
| | - Alessandro Repici
- Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research Hospital, Milan 20089, Italy
- Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas University, Milan 20089, Italy
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Pekgöz M. Post-endoscopic retrograde cholangiopancreatography pancreatitis: A systematic review for prevention and treatment. World J Gastroenterol 2019; 25:4019-4042. [PMID: 31413535 PMCID: PMC6689803 DOI: 10.3748/wjg.v25.i29.4019] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 05/19/2019] [Accepted: 07/03/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Post endoscopic retrograde cholangiopancreatography (ERCP) is comparatively complex application. Researchers has been investigated prevention of post-ERCP pancreatitis (PEP), since it has been considered to be the most common complication of ERCP. Although ERCP can lead various complications, it can also be avoided.
AIM To study the published evidence and systematically review the literature on the prevention and treatment for PEP.
METHODS A systematic literature review on the prevention of PEP was conducted using the electronic databases of ISI Web of Science, PubMed and Cochrane Library for relevant articles. The electronic search for the review was performed by using the search terms “Post endoscopic retrograde cholangiopancreatography pancreatitis” AND “prevention” through different criteria. The search was restricted to randomized controlled trials (RCTs) performed between January 2009 and February 2019. Duplicate studies were detected by using EndNote and deleted by the author. PRISMA checklist and flow diagram were adopted for evaluation and reporting. The reference lists of the selected papers were also scanned to find other relevant studies.
RESULTS 726 studies meeting the search criteria and 4 relevant articles found in the edited books about ERCP were identified. Duplicates and irrelevant studies were excluded by screening titles and abstracts and assessing full texts. 54 studies were evaluated for full text review. Prevention methods were categorized into three groups as (1) assessment of patient related factors; (2) pharmacoprevention; and (3) procedural techniques for prevention. Most of studies in the literature showed that young age, female gender, absence of chronic pancreatitis, suspected Sphincter of Oddi dysfunction, recurrent pancreatitis and history of previous PEP played a crucial role in posing high risks for PEP. 37 studies designed to assess the impact of 24 different pharmacologic agents to reduce the development of PEP delivered through various administration methods were reviewed. Nonsteroidal anti-inflammatory drugs are widely used to reduce risks for PEP. Rectal administration of indomethacin immediately prior to or after ERCP in all patients is recommended by European Society for Gastrointestinal Endoscopy guidelines to prevent the development of PEP. The majority of the studies reviewed revealed that rectally administered indomethacin had efficacy to prevent PEP. Results of the other studies on the other pharmacological interventions had both controversial and promising results. Thirteen studies conducted to evaluate the efficacy of 4 distinct procedural techniques to prevent the development of PEP were reviewed. Pancreatic Stent Placement has been frequently used in this sense and has potent and promising benefits in the prevention of PEP. Studies on the other procedural techniques have had inconsistent results.
CONCLUSION Prevention of PEP involves multifactorial aspects, including assessment of patients with high risk factors for alternative therapeutic and diagnostic techniques, administration of pharmacological agents and procedural techniques with highly precise results in the literature.
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Affiliation(s)
- Murat Pekgöz
- Department of Gastroenterology, VM Medical Park Bursa Hospital, Bursa 16022, Turkey
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Abstract
BACKGROUND Indwelling pleural catheters (IPCs) are most frequently used in those with malignant pleural effusions, although their use is expanding to patients with non-malignant diseases. AIM To provide an overview of IPCs and highlight how, when and why they can be used including our own real-life experience. DESIGN Data were collected retrospectively from a large tertiary centre for all individuals who received an IPC between June 2010 and February 2018 inclusive. The data collected included gender, age, origin of malignancy, number of drains prior to IPC, whether they had received pleurodesis prior to IPC, presence of a trapped lung, date of insertion, documented complications, overall outcome and date of death. RESULTS A total of 68 patients received an IPC, the majority were female (n = 38, 57%) with an overall median age of 68 years (range 40-90 years). The most common site of cancer origin was lung (n = 33, 49%) followed by pleura (n = 10, 15%) and breast (n = 9, 13%). The median survival of all patients was 141 days (IQR 26-181). Sixteen percent (n = 11) of patients underwent a spontaneous pleurodesis resulting in their IPC being removed. Only three individuals had a complication (4.4%). CONCLUSIONS IPC insertion is a safe procedure and represents an exciting and expanding field in the management of pleural disease. Further longitudinal studies are required to fully delineate their place in the management of both malignant and benign effusions.
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Affiliation(s)
- S J Messeder
- From the Chest Clinic C, Aberdeen Royal Infirmary, Foresterhill, Aberdeen, UK
| | - M C Thomson
- From the Chest Clinic C, Aberdeen Royal Infirmary, Foresterhill, Aberdeen, UK
| | - M K Hu
- From the Chest Clinic C, Aberdeen Royal Infirmary, Foresterhill, Aberdeen, UK
| | - M Chetty
- From the Chest Clinic C, Aberdeen Royal Infirmary, Foresterhill, Aberdeen, UK
| | - G P Currie
- From the Chest Clinic C, Aberdeen Royal Infirmary, Foresterhill, Aberdeen, UK
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H'ng MWC, Leow KS. Tunneled catheter (PleurX) for long-term chest and abdominal drainages from 2012-2017 in a tertiary institution. Med J Malaysia 2019; 74:352-354. [PMID: 31424051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The PleurX catheter was developed to facilitate long-term intermittent drainage of malignant pleural effusion or ascites. For palliation, it is important that the process of insertion is safe and that this catheter remains complicationfree so as to improve end-of-life quality. We show that this catheter can be safely inserted and discuss methods to reduce infection, which was the most common complication. Our article hopes to enlighten clinicians, patients and their caregivers of this device as a treatment option in palliative patients. Proper case selection and caregiver training are essential in ensuring a successful outcome.
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Affiliation(s)
- M W C H'ng
- Tan Tock Seng Hospital, Department of Diagnostic Imaging, Singapore.
| | - K S Leow
- Tan Tock Seng Hospital, Department of Diagnostic Imaging, Singapore
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Woo PYM, Ng BCF, Xiao JX, Wong D, Seto A, Lam S, Yim C, Lo HY, Po YC, Wong LYW, Lee MWY, Yam KY, Pu JKS, Chan KY, Poon WS. The importance of aspirin, catheterization accuracy, and catheter design in external ventricular drainage-related hemorrhage: a multicenter study of 1002 procedures. Acta Neurochir (Wien) 2019; 161:1623-1632. [PMID: 31222516 DOI: 10.1007/s00701-019-03978-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 03/20/2019] [Accepted: 06/05/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND External ventricular drainage (EVD) is the commonest neurosurgical procedure performed in daily neurosurgical practice, but relatively few studies have investigated the incidence and risk factors of its related hemorrhagic complications. METHODS This was a multicenter retrospective review of consecutive EVD procedures. Patients 18 years or older who underwent EVD and had a routine postoperative computed tomography (CT) scan performed within 24 hours were included. EVD-related hemorrhage was defined as new intracranial hemorrhage immediately adjacent or within the ventricular catheter trajectory. The volume of hemorrhage and the position of the catheter tip were assessed. A review of patient-, disease-, and surgery-related factors including the ventricular catheter design utilized was conducted. The Bonferroni correction was applied to the alpha level of significance (0.05) for multivariable analysis. RESULTS Nine hundred sixty-two patients underwent 1002 EVD performed by neurosurgeons in the operating theater. Sixteen percent (154) of patients were on aspirin before the procedure. Thirty-four percent (333) of patients had intracerebral hemorrhage, 25% (251) had aneurysmal subarachnoid hemorrhage and 16% (158) had traumatic brain injury. The mean duration from EVD to the first postoperative CT scan was 20 ± 4 h. EVD-related hematomas were detected after 81 procedures with a per-catheter risk of 8.1%. Mean hematoma volume was 1.2 ± 3.3 ml. Most were less than 1 ml (grade I, 79%, 64), 1 to 15 ml (grade II) in 20% (16) and a single clot larger than 15 ml (grade III, 1%) were detected. Clinically significant hemorrhage that resulted in catheter occlusion occurred in 1.7% (17) of procedures. Most catheters (62%, 625) were optimally placed, i.e., its tip being within the ipsilateral frontal horn or third ventricle. Three non-antibiotic-impregnated ventricular catheter designs were used with 55% (550) being the 2.2-mm Integra™ catheter, 14% (137) being the 2.8-mm Medtronic™ catheter, and 31% (315) being the 3.1-mm Codman™ catheter. Independent significant predictors for EVD-related hemorrhage were the preoperative prescription of aspirin (adjusted OR 1.94; 95% CI 1.10-3.44), catheter malposition (aOR 1.99; 95% CI 1.22-3.23), and use of the 2.8-mm Medtronic™ catheter (aOR 4.22; 95% CI 2.39-7.41). CONCLUSIONS The per-catheter risk of hemorrhage was 8.1%, but the incidence of symptomatic hemorrhage was low. The only patient risk factor was aspirin intake. This is the first study to evaluate and establish an association between catheter malposition and catheter design with EVD-related hemorrhage.
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Affiliation(s)
- Peter Y M Woo
- Department of Neurosurgery, Kwong Wah Hospital, Hong Kong, China.
| | - Ben C F Ng
- Department of Neurosurgery, Queen Elizabeth Hospital, Hong Kong, China
| | - Jacob X Xiao
- Department of Neurosurgery, Kwong Wah Hospital, Hong Kong, China
| | - Daniel Wong
- Department of Neurosurgery, Kwong Wah Hospital, Hong Kong, China
| | - Andrew Seto
- Department of Neurosurgery, Kwong Wah Hospital, Hong Kong, China
| | - Sandy Lam
- Department of Neurosurgery, Kwong Wah Hospital, Hong Kong, China
| | - Carmen Yim
- Department of Neurosurgery, Kwong Wah Hospital, Hong Kong, China
| | - Hong-Yip Lo
- Department of Neurosurgery, Kwong Wah Hospital, Hong Kong, China
| | - Yin-Chung Po
- Department of Neurosurgery, Princess Margaret Hospital, Hong Kong, China
| | - Larry Y W Wong
- Department of Neurosurgery, Queen Elizabeth Hospital, Hong Kong, China
| | - Michael W Y Lee
- Department of Neurosurgery, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China
| | - Kwong-Yui Yam
- Department of Neurosurgery, Tuen Mun Hospital, Hong Kong, China
| | - Jenny K S Pu
- Division of Neurosurgery, Department of Surgery, Queen Mary Hospital, Hong Kong, China
| | - Kwong-Yau Chan
- Department of Neurosurgery, Kwong Wah Hospital, Hong Kong, China
| | - Wai-Sang Poon
- Division of Neurosurgery, Department of Surgery, Prince of Wales Hospital, Hong Kong, China
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Zhang JJY, Wang S, Foo ASC, Yang M, Quah BL, Sun IS, Ng ZX, Teo K, Pang BC, Yang EW, Lwin S, Chou N, Low SW, Yeo TT, Santarius T, Nga VDW. Outcomes of Subdural Versus Subperiosteal Drain After Burr-Hole Evacuation of Chronic Subdural Hematoma: A Multicenter Cohort Study. World Neurosurg 2019; 131:e392-e401. [PMID: 31369879 DOI: 10.1016/j.wneu.2019.07.168] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [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: 05/10/2019] [Revised: 07/22/2019] [Accepted: 07/23/2019] [Indexed: 02/05/2023]
Abstract
BACKGROUND Although the use of a postoperative drain after burr-hole evacuation of chronic subdural hematoma (CSDH) is known to improve surgical outcomes, the superiority of subdural over subperiosteal drains has not been firmly established. Evidence comparing these 2 drain types is largely restricted to single-center series with limited numbers. Using a multicenter cohort study, we aimed to show noninferiority of subperiosteal drains vis-à-vis subdural drains after burr-hole evacuation of CSDH. METHODS We performed a retrospective analysis of all consecutive patients with CSDH aged 21 years and older who had undergone burr-hole craniostomy across 3 tertiary hospitals from 2010 to 2017. Primary outcome measures included CSDH recurrence and modified Rankin Scale (mRS) score at 6 months. Outcomes of patients in the subdural and subperiosteal drain groups were analyzed and confounders were adjusted for using multivariate logistic regression. RESULTS Of the 570 cases analyzed, 329 (57.7%) received a subdural drain and 241 (42.3%) received a subperiosteal drain. There was no significant difference between the 2 drain groups in CSDH recurrence (13.1% in the subdural group vs. 11.2% in the subperiosteal group; P = 0.502) or 6-month mRS score (27.2% with mRS 4-6 in the subdural group vs. 20.4% in the subperiosteal group; P = 0.188). Independent predictors of CSDH recurrence identified on multivariate analysis included premorbid mRS score 0-3 (P = 0.021), separated CSDH type on preoperative computed tomography scan (P = 0.002), and postoperative pneumocephalus of ≥15 mm (P = 0.005). CONCLUSIONS Outcomes of subdural and subperiosteal drains after burr-hole craniostomy for CSDH are largely equivalent based on our findings.
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Affiliation(s)
- John J Y Zhang
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
| | - Shilin Wang
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Aaron Song Chuan Foo
- Division of Neurosurgery, Department of Surgery, National University Hospital, National University Health System, Singapore
| | - Ming Yang
- Division of Neurosurgery, Department of Surgery, Khoo Teck Puat Hospital, Alexandra Health Private Limited, Singapore
| | - Boon Leong Quah
- Division of Neurosurgery, Department of Surgery, Khoo Teck Puat Hospital, Alexandra Health Private Limited, Singapore
| | - Ira Siyang Sun
- Neurosurgery Service, Ng Teng Fong General Hospital, Jurong Health Campus, National University Health System, Singapore
| | - Zhi Xu Ng
- Division of Neurosurgery, Department of Surgery, Khoo Teck Puat Hospital, Alexandra Health Private Limited, Singapore
| | - Kejia Teo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Division of Neurosurgery, Department of Surgery, National University Hospital, National University Health System, Singapore
| | - Boon Chuan Pang
- Division of Neurosurgery, Department of Surgery, Khoo Teck Puat Hospital, Alexandra Health Private Limited, Singapore
| | - Eugene Weiren Yang
- Division of Neurosurgery, Department of Surgery, Khoo Teck Puat Hospital, Alexandra Health Private Limited, Singapore
| | - Sein Lwin
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Division of Neurosurgery, Department of Surgery, National University Hospital, National University Health System, Singapore
| | - Ning Chou
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Division of Neurosurgery, Department of Surgery, National University Hospital, National University Health System, Singapore
| | - Shiong Wen Low
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Neurosurgery Service, Ng Teng Fong General Hospital, Jurong Health Campus, National University Health System, Singapore
| | - Tseng Tsai Yeo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Division of Neurosurgery, Department of Surgery, National University Hospital, National University Health System, Singapore
| | - Thomas Santarius
- Department of Neurosurgery, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom
| | - Vincent Diong Weng Nga
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Division of Neurosurgery, Department of Surgery, National University Hospital, National University Health System, Singapore
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Li TQ, Ma ZS, Zhang Y, Xu HF, Lei W. Therapeutic effect of minimally invasive catheter drainage and local chemotherapy for the lumbosacral tuberculosis without neural symptoms. Medicine (Baltimore) 2019; 98:e15941. [PMID: 31169716 PMCID: PMC6571358 DOI: 10.1097/md.0000000000015941] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Increasing number of studies have shown growing incidence of lumbosacral tuberculosis and its complications. However, the treatment options for this disorder are still limited.To evaluate the long-term therapeutic effect and prognosis of minimally invasive puncture catheter drainage and Isoniazid local chemotherapy for the treatment of lumbosacral tuberculosis without neural symptoms under the guidance of computed tomography (CT).A total of 45 patients with asymptomatic lumbosacral tuberculosis were treated by minimally invasive catheter drainage under CT guidance. Forty-two cases had been followed up, which included 22 women and 20 men with an average age of 36.45 years old. Isoniazid was injected locally and antituberculotic drugs were administered for postoperative treatment. Oswestry Disability Index (ODI), visual analogue scale (VAS) evaluation and Cobb angle were recorded before and after operation.Forty-two patients had been followed up and the follow-up term was from 1.2 to 8.5 years (average 60 months). All patients were healed without recurrent cases. The ODI were improved from 14.86 ± 2.02 before operation to 1.48 ± 1.55 after operation. The post-operative (4.19 ± 1.17) VAS score was improved compared to the pre-operative VAS score (0.55 ± 0.55). The post-operative Cobb angle (6.19° ± 3.85°) was also improved relatively to the preoperative Cobb angle (5.90° ± 3.71°).Minimally invasive puncture catheter drainage combined with Isoniazid local chemotherapy is an effective method for lumbosacral tuberculosis without neural symptom. Meanwhile, it can be applied for the treatment of spinal tuberculosis before open surgery.
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Abstract
Drainage of the thorax postoperatively using chest tubes is a standard procedure in thoracic surgery. However, chest tubes can induce pain and immobilization, increase risk of infection, deteriorate the ventilation capacity, and increase difficulty of postoperative management, particularly in children. This study aimed to investigate the safety and effect of excluding chest tubes after performing thoracoscopic lobectomy in selected children.A retrospective review of medical records was performed in West China Hospital of Sichuan University from January 2014 to June 2018. Patients who underwent thoracoscopic lobectomy without chest tubes were recorded. Patients with accompanying severe pulmonary infection, extensive thoracic adhesions, or undeveloped interlobar fissure were excluded.In total, 246 patients underwent thoracoscopic lobectomy without a chest tube, and none required chest drain insertion or reintervention during hospitalization and follow-up at 90 days postoperatively. Among them, 2 (0.81%) patients developed a delayed pneumothorax which was found after being discharged, and resolved spontaneously in 2 weeks. No hemothorax, atelectasis, and bronchial fistula were found. Furthermore, 202 (82.1%) patients developed subcutaneous emphysema, which was asymptomatic and spontaneously resolved within 3 to 7 days. The length of postoperative hospital stay was 2 days; patients were discharged in the 3rd day postoperatively. Patients could recover to free mobilization and resume regular diet at 6 hours postoperatively. All patients were followed up for at least 3 months; no other complications were found, and all patients recovered well.This study showed that chest tube placement in selected patients may be unnecessary in children undergoing thoracoscopic lobectomy. The minimally invasive procedure and meticulous resection have been the preconditions of this procedure, which may contribute to a rapid recovery and can avoid the chest tube-related complications effectively.
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Simon S, Coronel C, de Almeida AS, Marcadenti A. Left lateral intercostal region versus subxiphoid position for pleural drain during elective coronary artery bypass graft surgery: randomized clinical trial. SAO PAULO MED J 2019; 137:66-74. [PMID: 31116274 PMCID: PMC9721208 DOI: 10.1590/1516-3180.2018.040940119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Revised: 10/08/2018] [Accepted: 01/04/2019] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND The pleural drain insertion site after coronary artery bypass graft (CABG) surgery may alter lung function, especially respiratory muscle strength. The main objective of this study was to compare the effectiveness and safety of use of the left lateral intercostal region versus the subxiphoid position for pleural drainage during elective CABG surgery using extracorporeal circulation (ECC). DESIGN AND SETTING Randomized trial conducted in a tertiary-level hospital in Porto Alegre, Brazil. METHODS 48 patients were assigned to group 1 (pleural drain in the left lateral intercostal region) or group 2 (pleural drain in the subxiphoid position). Respiratory muscle strength was measured in terms of maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP), in cmH2O, by means of manovacuometry preoperatively, 24 and 72 hours after drain removal and before discharge from hospital. Painand dyspnea scales, presence of infections, pleural effusion and atelectasis, duration of drain use, drainage volumes and surgical reinterventions were also evaluated. RESULTS After adjustments, there were no significant differences between the groups at the end of the study (before discharge), in predicted percentages either for MIP (delta group 1: -17.21% versus delta group 2: -22.26%; P = 0.09) or for MEP (delta group 1: -9.38% versus delta group 2: -13.13%; P = 0.17). Therewere no differences between the groups in relation to other outcomes. CONCLUSION There was no difference in maximal respiratory pressures in relation to the pleural drain insertion site among patients who underwent CABG surgery using ECC. TRIAL REGISTRATION ReBEc V1111.1159.4447.
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Affiliation(s)
- Sandra Simon
- MSc. Registered Nurse, Graduate Program in Health Sciences (Cardiology), Instituto de Cardiologia, Fundação Universitária de Cardiologia (IC/FUC), Porto Alegre (RS), and Registered Nurse, Cardiology and Cardiac Surgery Services, Hospital Nossa Senhora da Conceição Hospital (HNSC), Porto Alegre (RS), Brazil.
| | - Christian Coronel
- MSc. Physiotherapist, Physical Therapy Service, Surgery Service, Instituto de Cardiologia, Fundação Universitária de Cardiologia (IC/FUC), Porto Alegre (RS), and Professor, La Salle University (Unilasalle Canoas), Canoas (RS), Brazil.
| | - Adriana Silveira de Almeida
- PhD. Physician and Cardiovascular Surgeon, Cardiology and Cardiac Surgery Services, Hospital Nossa Senhora da Conceição Hospital (HNSC), Porto Alegre (RS), Brazil.
| | - Aline Marcadenti
- PhD. Professor, Graduate Program in Health Sciences (Cardiology), Instituto de Cardiologia, Fundação Universitária de Cardiologia (IC/FUC), Porto Alegre (RS); Professor, Postgraduate Program on Nutrition Sciences, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre (RS); and Researcher, Instituto de Pesquisa do Hospital do Coração (HCor), São Paulo (SP), Brazil.
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Saunders R, Ramesh J, Cicconi S, Evans J, Yip VS, Raraty M, Ghaneh P, Sutton R, Neoptolemos JP, Halloran C. A systematic review and meta-analysis of metal versus plastic stents for drainage of pancreatic fluid collections: metal stents are advantageous. Surg Endosc 2019; 33:1412-1425. [PMID: 30191310 PMCID: PMC6484810 DOI: 10.1007/s00464-018-6416-5] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 08/31/2018] [Indexed: 01/07/2023]
Abstract
BACKGROUND The use of fully covered metal stents (FCSEMS) and specifically designed lumen apposing metal stents for transmural drainage of pancreatic fluid collections has become widespread. A systematic review published in 2015 did not support the routine use of metal stents for drainage of pancreatic fluid collections. However, recent studies have shown conflicting data; therefore a systematic review and meta-analysis was performed. METHOD We conducted a database search for original comparative studies between plastic and metal stents. The random effects model was used to calculate pooled risk ratios (RR) with 95% confidence intervals (CI). Outcomes analysed were clinical success, adverse events and requirement of further intervention. RESULTS The search identified 936 studies, 7 studies with 681 (340 metal, 341 plastic) patients met inclusion criteria and were included in the meta-analysis. Clinical success was achieved in 93.8% versus 86.2% in the metal and plastic groups, respectively, RR 1.08 [95% CI 1.02-1.14]; p = 0.009. Adverse events were reduced for metal stents when compared with plastic (10.2% vs. 25.0%), RR 0.42 [95% CI 0.22-0.81]; p = 0.010. Metal stent usage reduced bleeding (2.8% vs. 7.9%), RR 0.37; [95% CI 0.18-0.75]; p = 0.006. Further intervention was required in 12.4% of patients in the metal stent group versus 26.7% for plastic stents, RR 0.54; [95% CI 0.22-1.29]; p = 0.165. CONCLUSIONS The use of metal stents for drainage of pancreatic fluid collections is associated with improved clinical success, fewer adverse events and reduced bleeding compared to plastic stents.
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Affiliation(s)
- Rebecca Saunders
- Pancreatitis Research Group, Royal Liverpool University Hospital, Liverpool, UK
| | - Jayapal Ramesh
- Gastroenterology, Royal Liverpool University Hospital, Liverpool, UK
| | - Silvia Cicconi
- Liverpool Cancer Trials Unit, University of Liverpool, Liverpool, UK
| | - Jonathan Evans
- Radiology, Royal Liverpool University Hospital, Liverpool, UK
| | | | | | - Paula Ghaneh
- Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Robert Sutton
- Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - John P Neoptolemos
- General Surgery, Universitatsklinikum Heidelberg Chirurgische Klinik, Heidelberg, Germany
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Yamaguchi Y, Fujita Y, Ikeda T, Mai Y, Miyazawa H, Matsumura W, Nomura T, Shimizu H. Severe Septic Vasculitis Preceding Thoracic Empyema: Staphylococcus aureus Enterotoxin Deposition in Vessel Walls as a Possible Pathomechanism. Acta Derm Venereol 2019; 99:464-465. [PMID: 30653244 DOI: 10.2340/00015555-3122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Yasuyuki Yamaguchi
- Department of Dermatology, Hokkaido University Graduate School of Medicine, Sapporo 060-8638, Japan
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Zhao Z, Song J, Fan X, Fang S, Chen M, Chen W, Wu F, Zheng L, Tu J, Ji J. Primary Clinical Application of Y-Shaped Jogged Stent Implantation in Patients with Malignant Hilar Biliary Obstruction. J Gastrointest Surg 2019; 23:745-750. [PMID: 30790219 DOI: 10.1007/s11605-019-04131-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 01/21/2019] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To assess the feasibility, safety, and efficacy of Y-shaped jogged stent in patients with malignant hilar biliary obstruction. METHODS A total of 196 patients with malignant hilar biliary obstruction treated by biliary tract stent implantation from August 2010 to August 2017 were retrospectively reviewed. Seventeen consecutive patients who were treated with Y-shaped jogged stent implantation were identified as the Y-shaped jogged stent implantation group. Seventeen matched patients undergoing unilateral stent placement combined with percutaneous transhepatic cholangial drainage (PTCD) were enrolled as the control group. Baseline characteristics of patients, stent patency time, and survival time were compared. RESULTS There was no significant difference in the age, gender, tumor type and stage, biliary obstruction classification, bilirubin level at diagnosis, presence of metastasis, or chemotherapy between the Y-stent group and the control group (P > 0.05). One week after surgery, the reduction rate of bilirubin was significantly higher in the Y-stent group (88.2% vs 53.0%, P < 0.05). The mean stent patency time was longer in the Y-stent group (7.3 ± 1.0 months vs 5.7 ± 0.9 months, P < 0.05). The mean survival time of the Y-stent group (9.1 ± 1.5 months) was longer than the control group (7.2 ± 1.1 months, P > 0.05). There was no severe complication occurred in both two groups. CONCLUSION Y-shaped jogged stent implantation was a safe, feasible, and effective approach in the treatment of patients with malignant hilar biliary obstruction, with the significantly prolonged stent patency time and survival time.
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Affiliation(s)
- Zhongwei Zhao
- Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, Lishui Central Hospital, Lishui, 323000, Zhejiang, People's Republic of China
- Department of Interventional Radiology, Zhejiang University Lishui Hospital, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Central Hospital, No. 289 Kuocang Road, Lishui, 323000, Zhejiang, People's Republic of China
| | - Jingjing Song
- Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, Lishui Central Hospital, Lishui, 323000, Zhejiang, People's Republic of China
- Department of Interventional Radiology, Zhejiang University Lishui Hospital, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Central Hospital, No. 289 Kuocang Road, Lishui, 323000, Zhejiang, People's Republic of China
| | - Xiaoxi Fan
- Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, Lishui Central Hospital, Lishui, 323000, Zhejiang, People's Republic of China
- Department of Interventional Radiology, Zhejiang University Lishui Hospital, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Central Hospital, No. 289 Kuocang Road, Lishui, 323000, Zhejiang, People's Republic of China
| | - Shiji Fang
- Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, Lishui Central Hospital, Lishui, 323000, Zhejiang, People's Republic of China
- Department of Interventional Radiology, Zhejiang University Lishui Hospital, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Central Hospital, No. 289 Kuocang Road, Lishui, 323000, Zhejiang, People's Republic of China
| | - Minjiang Chen
- Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, Lishui Central Hospital, Lishui, 323000, Zhejiang, People's Republic of China
- Department of Interventional Radiology, Zhejiang University Lishui Hospital, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Central Hospital, No. 289 Kuocang Road, Lishui, 323000, Zhejiang, People's Republic of China
| | - Weiqian Chen
- Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, Lishui Central Hospital, Lishui, 323000, Zhejiang, People's Republic of China
- Department of Interventional Radiology, Zhejiang University Lishui Hospital, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Central Hospital, No. 289 Kuocang Road, Lishui, 323000, Zhejiang, People's Republic of China
| | - Fazong Wu
- Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, Lishui Central Hospital, Lishui, 323000, Zhejiang, People's Republic of China
- Department of Interventional Radiology, Zhejiang University Lishui Hospital, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Central Hospital, No. 289 Kuocang Road, Lishui, 323000, Zhejiang, People's Republic of China
| | - Liyun Zheng
- Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, Lishui Central Hospital, Lishui, 323000, Zhejiang, People's Republic of China
- Department of Interventional Radiology, Zhejiang University Lishui Hospital, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Central Hospital, No. 289 Kuocang Road, Lishui, 323000, Zhejiang, People's Republic of China
| | - Jianfei Tu
- Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, Lishui Central Hospital, Lishui, 323000, Zhejiang, People's Republic of China
- Department of Interventional Radiology, Zhejiang University Lishui Hospital, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Central Hospital, No. 289 Kuocang Road, Lishui, 323000, Zhejiang, People's Republic of China
| | - Jiansong Ji
- Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, Lishui Central Hospital, Lishui, 323000, Zhejiang, People's Republic of China.
- Department of Interventional Radiology, Zhejiang University Lishui Hospital, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Central Hospital, No. 289 Kuocang Road, Lishui, 323000, Zhejiang, People's Republic of China.
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Skanes M, Martin HM. A Simplified Low-Cost Training Phantom for Placement of Abscess Drainage Catheter. Can Assoc Radiol J 2019; 70:317-319. [PMID: 30853304 DOI: 10.1016/j.carj.2018.12.001] [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] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Revised: 11/06/2018] [Accepted: 12/06/2018] [Indexed: 11/30/2022] Open
Affiliation(s)
- Melissa Skanes
- Department of Radiology, Memorial University of Newfoundland, St John's, Newfoundland and Labrador, Canada
| | - Heather M Martin
- Faculty of Medicine, Memorial University of Newfoundland, St John's, Newfoundland and Labrador, Canada.
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Hussein K, Rabino G, Feder O, Eghbaryeh H, Zayyad H, Sviri G, Benenson R, Paul M. Risk factors for meningitis in neurosurgical patients with cerebrospinal fluid drains: prospective observational cohort study. Acta Neurochir (Wien) 2019; 161:517-524. [PMID: 30666453 DOI: 10.1007/s00701-019-03801-y] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [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: 11/06/2018] [Accepted: 01/04/2019] [Indexed: 01/14/2023]
Abstract
BACKGROUND Cerebrospinal fluid (CSF) drainage or intracranial pressure (ICP) monitoring devices are life-saving devices. We examined the risk factors for infections related to them and assessed the effect of an infection control (IC) intervention. METHODS A prospective observational study was conducted in the Neurosurgical Department of our hospital between 2014 and 2017. We included all consecutive patients undergoing CSF catheter insertions, including external ventricular drainage (EVD), lumbar drainage (LD), and ICP catheters. An IC intervention was implemented between March and August 2016. We examined risk factors for meningitis or ventriculitis, defined according to Healthcare-associated infections surveillance definitions, on univariate and multivariate analysis. RESULTS A total of 232 patients with 437 drains (212 EVDs, 92 LDs, and 133 ICPs) were included. On univariate and multivariate analysis, the infection incidence was 13.7 per 1000 drain days (17.3/1000 before IC intervention, 7.9/1000 during, and 9.2/1000 after the intervention). Most episodes were caused by Gram-negative bacteria, and the most common pathogen was Acinetobacter baumanii. Risk factors for infection per patient included diabetes mellitus (p = 0.017), CSF leak (p = 0.032), drain opening (p = 0.027), and the duration of the drain in days (p = 0.035). Risk factors per catheter included drain opening (p < 0.001), drain days (p = 0.001), and the IC intervention period compared to before the intervention period (p = 0.037). When restricting the analysis to EVDs, drain days (p = 0.001) was the only significant risk factor. CONCLUSIONS Strict adherence to IC, shortening drain duration, and avoiding unnecessary opening and manipulation of the drains are crucial to preventing neurosurgical drain infections.
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Affiliation(s)
- Khetam Hussein
- Infectious Diseases Institute, Rambam Health Care Campus, P.O. Box 9602, 31096, Haifa, Israel.
| | - Galit Rabino
- Infectious Diseases Institute, Rambam Health Care Campus, P.O. Box 9602, 31096, Haifa, Israel
| | - Omri Feder
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Haneen Eghbaryeh
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Hiba Zayyad
- Infectious Diseases Institute, Rambam Health Care Campus, P.O. Box 9602, 31096, Haifa, Israel
| | - Gil Sviri
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
- Department of Neurosurgery, Rambam Health Care Campus, Haifa, Israel
| | - Rima Benenson
- Infectious Diseases Institute, Rambam Health Care Campus, P.O. Box 9602, 31096, Haifa, Israel
| | - Mical Paul
- Infectious Diseases Institute, Rambam Health Care Campus, P.O. Box 9602, 31096, Haifa, Israel
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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