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Thai JN, Sodagari F, Colwell AS, Winograd JM, Revzin MV, Mahmoud H, Mozayan S, Chou SHS, Destounis SV, Butler RS. Multimodality Imaging of Postmastectomy Breast Reconstruction Techniques, Complications, and Tumor Recurrence. Radiographics 2024; 44:e230070. [PMID: 38573814 DOI: 10.1148/rg.230070] [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: 04/06/2024]
Abstract
For women undergoing mastectomy, breast reconstruction can be performed by using implants or autologous tissue flaps. Mastectomy options include skin- and nipple-sparing techniques. Implant-based reconstruction can be performed with saline or silicone implants. Various autologous pedicled or free tissue flap reconstruction methods based on different tissue donor sites are available. The aesthetic outcomes of implant- and flap-based reconstructions can be improved with oncoplastic surgery, including autologous fat graft placement and nipple-areolar complex reconstruction. The authors provide an update on recent advances in implant reconstruction techniques and contemporary expanded options for autologous tissue flap reconstruction as it relates to imaging modalities. As breast cancer screening is not routinely performed in this clinical setting, tumor recurrence after mastectomy and reconstruction is often detected by palpation at physical examination. Most local recurrences occur within the skin and subcutaneous tissue. Diagnostic breast imaging continues to have a critical role in confirmation of disease recurrence. Knowledge of the spectrum of benign and abnormal imaging appearances in the reconstructed breast is important for postoperative evaluation of patients, including recognition of early and late postsurgical complications and breast cancer recurrence. The authors provide an overview of multimodality imaging of the postmastectomy reconstructed breast, as well as an update on screening guidelines and recommendations for this unique patient population. ©RSNA, 2024 Test Your Knowledge questions for this article are available in the supplemental material.
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Affiliation(s)
- Janice N Thai
- From the Department of Radiology, Division of Breast Imaging (J.N.T., F.S., S.H.S.C.); and Department of Surgery, Division of Plastic and Reconstructive Surgery (A.S.C., J.M.W.), Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA 02114; Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT (M.V.R., R.S.B.); Yale New Haven Health, Bridgeport Hospital, Bridgeport, CT (H.M., S.M.); and Elizabeth Wende Breast Care, Rochester, NY (S.V.D.)
| | - Faezeh Sodagari
- From the Department of Radiology, Division of Breast Imaging (J.N.T., F.S., S.H.S.C.); and Department of Surgery, Division of Plastic and Reconstructive Surgery (A.S.C., J.M.W.), Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA 02114; Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT (M.V.R., R.S.B.); Yale New Haven Health, Bridgeport Hospital, Bridgeport, CT (H.M., S.M.); and Elizabeth Wende Breast Care, Rochester, NY (S.V.D.)
| | - Amy S Colwell
- From the Department of Radiology, Division of Breast Imaging (J.N.T., F.S., S.H.S.C.); and Department of Surgery, Division of Plastic and Reconstructive Surgery (A.S.C., J.M.W.), Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA 02114; Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT (M.V.R., R.S.B.); Yale New Haven Health, Bridgeport Hospital, Bridgeport, CT (H.M., S.M.); and Elizabeth Wende Breast Care, Rochester, NY (S.V.D.)
| | - Jonathan M Winograd
- From the Department of Radiology, Division of Breast Imaging (J.N.T., F.S., S.H.S.C.); and Department of Surgery, Division of Plastic and Reconstructive Surgery (A.S.C., J.M.W.), Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA 02114; Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT (M.V.R., R.S.B.); Yale New Haven Health, Bridgeport Hospital, Bridgeport, CT (H.M., S.M.); and Elizabeth Wende Breast Care, Rochester, NY (S.V.D.)
| | - Margarita V Revzin
- From the Department of Radiology, Division of Breast Imaging (J.N.T., F.S., S.H.S.C.); and Department of Surgery, Division of Plastic and Reconstructive Surgery (A.S.C., J.M.W.), Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA 02114; Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT (M.V.R., R.S.B.); Yale New Haven Health, Bridgeport Hospital, Bridgeport, CT (H.M., S.M.); and Elizabeth Wende Breast Care, Rochester, NY (S.V.D.)
| | - Hagar Mahmoud
- From the Department of Radiology, Division of Breast Imaging (J.N.T., F.S., S.H.S.C.); and Department of Surgery, Division of Plastic and Reconstructive Surgery (A.S.C., J.M.W.), Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA 02114; Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT (M.V.R., R.S.B.); Yale New Haven Health, Bridgeport Hospital, Bridgeport, CT (H.M., S.M.); and Elizabeth Wende Breast Care, Rochester, NY (S.V.D.)
| | - Sara Mozayan
- From the Department of Radiology, Division of Breast Imaging (J.N.T., F.S., S.H.S.C.); and Department of Surgery, Division of Plastic and Reconstructive Surgery (A.S.C., J.M.W.), Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA 02114; Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT (M.V.R., R.S.B.); Yale New Haven Health, Bridgeport Hospital, Bridgeport, CT (H.M., S.M.); and Elizabeth Wende Breast Care, Rochester, NY (S.V.D.)
| | - Shinn-Huey S Chou
- From the Department of Radiology, Division of Breast Imaging (J.N.T., F.S., S.H.S.C.); and Department of Surgery, Division of Plastic and Reconstructive Surgery (A.S.C., J.M.W.), Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA 02114; Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT (M.V.R., R.S.B.); Yale New Haven Health, Bridgeport Hospital, Bridgeport, CT (H.M., S.M.); and Elizabeth Wende Breast Care, Rochester, NY (S.V.D.)
| | - Stamatia V Destounis
- From the Department of Radiology, Division of Breast Imaging (J.N.T., F.S., S.H.S.C.); and Department of Surgery, Division of Plastic and Reconstructive Surgery (A.S.C., J.M.W.), Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA 02114; Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT (M.V.R., R.S.B.); Yale New Haven Health, Bridgeport Hospital, Bridgeport, CT (H.M., S.M.); and Elizabeth Wende Breast Care, Rochester, NY (S.V.D.)
| | - Reni S Butler
- From the Department of Radiology, Division of Breast Imaging (J.N.T., F.S., S.H.S.C.); and Department of Surgery, Division of Plastic and Reconstructive Surgery (A.S.C., J.M.W.), Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA 02114; Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT (M.V.R., R.S.B.); Yale New Haven Health, Bridgeport Hospital, Bridgeport, CT (H.M., S.M.); and Elizabeth Wende Breast Care, Rochester, NY (S.V.D.)
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Randhawa MK, Sultana S, Stib MT, Nagpal P, Michel E, Hedgire S. Role of Radiology in Assessment of Postoperative Complications of Heart Transplantation. Radiol Clin North Am 2024; 62:453-471. [PMID: 38553180 DOI: 10.1016/j.rcl.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
Heart transplantation is a pivotal treatment of end-stage heart failure, and recent advancements have extended median posttransplant life expectancy. However, despite the progress in surgical techniques and medical treatment, heart transplant patients still face complications such as rejection, infections, and drug toxicity. CT is a reliable tool for detecting most of these complications, whereas MR imaging is particularly adept at identifying pericardial pathologies and signs of rejection. Awareness of these nuances by radiologists, cardiologists, and surgeons is desired to optimize care, reduce morbidities, and enhance survival.
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Affiliation(s)
- Mangun K Randhawa
- Division of Cardiovascular Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Sadia Sultana
- Division of Cardiovascular Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Matthew T Stib
- Division of Cardiothoracic Imaging, Department of Radiology, Mayo Clinic Hospital, Phoenix, AZ, USA
| | - Prashant Nagpal
- Division of Cardiovascular Imaging, Department of Radiology, University of Wisconsin-Madison, Madison, WI, USA
| | - Eriberto Michel
- Division of Cardiac Surgery, Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Sandeep Hedgire
- Division of Cardiovascular Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA.
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Magaldi RJ, Strecker SE, Nissen CW, Witmer DK, Carangelo RJ. Preoperative Bladder Scanning Can Predict Postoperative Urinary Retention Following Total Joint Arthroplasty. J Bone Joint Surg Am 2024; 106:569-574. [PMID: 38377182 DOI: 10.2106/jbjs.23.00841] [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] [Indexed: 02/22/2024]
Abstract
BACKGROUND As total joint arthroplasty (TJA) moves to the outpatient setting, it is becoming clear that postoperative urinary retention (POUR) is a potential impediment to same-day discharge. Although risk factors for POUR have been widely studied, the lack of their clinical utility warrants investigation of specific preoperative factors that can assist in surgical planning and patient optimization. The purpose of the current study was to determine whether preoperative symptom surveys and bladder scanning are useful tools in identifying POUR risk. METHODS We performed a prospective analysis of patients undergoing total hip arthroplasty (THA) and total knee arthroplasty (TKA) at a high-volume orthopaedic hospital between December 1, 2020, and September 30, 2021. A total of 507 patients (324 female and 183 male) undergoing TJA completed the American Urological Association (AUA) symptom index preoperatively and then again at 14 and 64 days postoperatively. Post-void bladder scans were obtained in the immediate preoperative setting. POUR was defined as a bladder volume of >500 mL that required catheterization. Chi-square and quintile analysis were used to compare bladder scanning volumes, and Student t tests were used to compare AUA scores. RESULTS The rate of POUR was 37% (66 female and 34 male) and 23% (37 female and 19 male) in the TKA and THA groups, respectively. Increasing post-void residual volume (PVRV) measured on preoperative bladder scanning was found to be predictive of POUR. Among the TKA cohort, younger age and lower body mass index were also associated with increased catheterization, although age was not statistically significant. The AUA symptom survey was not found to correlate with POUR in either population. CONCLUSIONS There was a predictable and exponential increase in the rate of catheterization as preoperative PVRV increased from 50 to 200 mL. The AUA symptom score showed no utility in predicting POUR in our study population. We propose that preoperative bladder ultrasonography become standard practice in TJA, especially among patients scheduled for same-day discharge. LEVEL OF EVIDENCE Prognostic Level II . See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Robert James Magaldi
- Division of Orthopaedic Surgery, Jefferson Health, Stratford, New Jersey
- Bone and Joint Institute, Hartford Hospital, Hartford, Connecticut
| | | | - Carl W Nissen
- Bone and Joint Institute, Hartford Hospital, Hartford, Connecticut
| | - Dan K Witmer
- Bone and Joint Institute, Hartford Hospital, Hartford, Connecticut
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Ji X, Wei L, Xing Z, Duan Y. Incidence and risk factors of proximal junctional kyphosis in adolescent idiopathic scoliosis after correction surgery: a meta-analysis and systematic review. J Orthop Surg Res 2024; 19:217. [PMID: 38566085 PMCID: PMC10988869 DOI: 10.1186/s13018-024-04638-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Accepted: 02/21/2024] [Indexed: 04/04/2024] Open
Abstract
AIM To analyze the risk factors of proximal junctional kyphosis (PJK) after correction surgery in patients with adolescent idiopathic scoliosis (AIS). METHODS PubMed, Medline, Embase, Cochrane Library, Web of Science, CNKI, and EMCC databases were searched for retrospective studies utilizing all AIS patients with PJK after corrective surgery to collect preoperative, postoperative, and follow-up imaging parameters, including thoracic kyphosis (TK), lumbar lordosis (LL), proximal junctional angle (PJA), the sagittal vertical axis (SVA), pelvic incidence (PI), pelvic tilt (PT), pelvic incidence-lumbar lordosis (PI-LL), sacral slope (SS), rod contour angle (RCA) and upper instrumented vertebra (UIV). RESULTS Nineteen retrospective studies were included in this meta-analysis, including 550 patients in the intervention group and 3456 patients in the control group. Overall, sex (OR 1.40, 95% CI (1.08, 1.83), P = 0.01), larger preoperative TK (WMD 6.82, 95% CI (5.48, 8.16), P < 0.00001), larger follow-up TK (WMD 8.96, 95% CI (5.62, 12.30), P < 0.00001), larger postoperative LL (WMD 2.31, 95% CI (0.91, 3.71), P = 0.001), larger follow-up LL (WMD 2.51, 95% CI (1.19, 3.84), P = 0.0002), great change in LL (WMD - 2.72, 95% CI (- 4.69, - 0.76), P = 0.006), larger postoperative PJA (WMD 4.94, 95% CI (3.62, 6.26), P < 0.00001), larger follow-up PJA (WMD 13.39, 95% CI (11.09, 15.69), P < 0.00001), larger postoperative PI-LL (WMD - 9.57, 95% CI (- 17.42, - 1.71), P = 0.02), larger follow-up PI-LL (WMD - 12.62, 95% CI (- 17.62, - 7.62), P < 0.00001), larger preoperative SVA (WMD 0.73, 95% CI (0.26, 1.19), P = 0.002), larger preoperative SS (WMD - 3.43, 95% CI (- 4.71, - 2.14), P < 0.00001), RCA (WMD 1.66, 95% CI (0.48, 2.84), P = 0.006) were identified as risk factors for PJK in patients with AIS. For patients with Lenke 5 AIS, larger preoperative TK (WMD 7.85, 95% CI (5.69, 10.00), P < 0.00001), larger postoperative TK (WMD 9.66, 95% CI (1.06, 18.26), P = 0.03, larger follow-up TK (WMD 11.92, 95% CI (6.99, 16.86), P < 0.00001, larger preoperative PJA (WMD 0.72, 95% CI (0.03, 1.41), P = 0.04, larger postoperative PJA (WMD 5.54, 95% CI (3.57, 7.52), P < 0.00001), larger follow-up PJA (WMD 12.42, 95% CI 9.24, 15.60), P < 0.00001, larger follow-up SVA (WMD 0.07, 95% CI (- 0.46, 0.60), P = 0.04), larger preoperative PT (WMD - 3.04, 95% CI (- 5.27, - 0.81), P = 0.008, larger follow-up PT (WMD - 3.69, 95% CI (- 6.66, - 0.72), P = 0.02) were identified as risk factors for PJK. CONCLUSION Following corrective surgery, 19% of AIS patients experienced PJK, with Lenke 5 contributing to 25%. Prior and post-op measurements play significant roles in predicting PJK occurrence; thus, meticulous, personalized preoperative planning is crucial. This includes considering individualized treatments based on the Lenke classification as our future evaluation standard.
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Affiliation(s)
- XingHua Ji
- Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences. Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, 030032, China
- Tongji Hospital, Tongji Medical College Huazhong University of Science and Technology, Wuhan, 430030, China
| | - LinDong Wei
- Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences. Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, 030032, China
- Tongji Hospital, Tongji Medical College Huazhong University of Science and Technology, Wuhan, 430030, China
| | - ZeJun Xing
- Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences. Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, 030032, China.
- Tongji Hospital, Tongji Medical College Huazhong University of Science and Technology, Wuhan, 430030, China.
| | - YuChen Duan
- Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences. Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, 030032, China
- Tongji Hospital, Tongji Medical College Huazhong University of Science and Technology, Wuhan, 430030, China
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Thejeel B, Lin J, Queler S, Nimura C, Lin Y, Valle AGD, Sneag DB. Magnetic resonance imaging of femoral nerve injury in the setting of anterior approach total hip arthroplasty. Clin Imaging 2024; 108:110112. [PMID: 38457906 DOI: 10.1016/j.clinimag.2024.110112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 02/01/2024] [Accepted: 02/24/2024] [Indexed: 03/10/2024]
Abstract
PURPOSE To illustrate MRI findings in patients with femoral neuropathy following anterior approach total hip arthroplasty (THA). METHODS This was a retrospective review of patients who underwent MRI for femoral neuropathy following anterior approach THA between January 1, 2010, and July 1, 2022. Included patients had no preexisting neurologic condition. Clinical and diagnostic data were collected. MRIs were reviewed in consensus by 2 musculoskeletal radiologists. RESULTS A total of 115 patient records were reviewed, 17 of which were included in the final analysis (mean age 64 years; 11 females). Study subjects presented with weakness with hip flexion and knee extension and pain and numbness in the femoral nerve distribution. In 7 subjects, the femoral nerve appeared normal. In 5 subjects, the femoral nerve was hyperintense on fluid-sensitive fat-suppressed imaging. In 4 patients, mass effect on the femoral nerve by either ill-defined soft tissue edema (n = 2), seroma (n = 1), or heterotopic ossification (n = 1) was detected. Only 1 patient had a nerve transection. Patients were imaged at a median time of 8 months (range: 1 day to 11 years) following arthroplasty placement. Clinical follow-up was available in 8 patients, of whom half had complete symptomatic resolution and half had partial improvement at a mean follow-up time of 39.3 months (SD 51.1). Of these 8, 1 underwent revision arthroplasty, 1 had removal of hardware, and another had excision of heterotopic ossification. CONCLUSION MRI provides a means to directly evaluate the femoral nerve following anterior approach THA in both the immediate and chronic postoperative periods.
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Affiliation(s)
- Bashiar Thejeel
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 E. 70(th) Street, New York, NY 10021, United States of America.
| | - Ji Lin
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 E. 70(th) Street, New York, NY 10021, United States of America.
| | - Sophie Queler
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 E. 70(th) Street, New York, NY 10021, United States of America.
| | - Clare Nimura
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 E. 70(th) Street, New York, NY 10021, United States of America.
| | - Yenpo Lin
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 E. 70(th) Street, New York, NY 10021, United States of America; Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, No.5, Fuxing Street, Taoyuan 33305, Taiwan.
| | - Alejandro Gonzalez Della Valle
- Department of Orthopedic Surgery, Division of Hip and Knee Replacement, Hospital for Special Surgery, 535 E. 70(th) Street, New York, NY 10021, United States of America.
| | - Darryl B Sneag
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 E. 70(th) Street, New York, NY 10021, United States of America.
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Kloiber R, Lafford H, Koslowsky IL, Tchajkov I, Rabin HR. A practical approach to interpretation of 18F-fluorodeoxyglucose positron emission tomography/computed tomography for postoperative spine infection. Skeletal Radiol 2024; 53:741-752. [PMID: 37867181 DOI: 10.1007/s00256-023-04474-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 08/24/2023] [Accepted: 09/29/2023] [Indexed: 10/24/2023]
Abstract
OBJECTIVE 18F-fluorodeoxyglucose-PET/CT is the imaging modality of choice for the diagnosis of postoperative spine infection. Published interpretation criteria are variable and often incompletely described. The objective was to develop a practical and standardized approach. MATERIALS AND METHODS Two-hundred-twenty-seven FDG-PET/CTs performed on 140 postoperative patients over a 7-year period were reviewed retrospectively. The presence or absence of infection was determined from clinical history, microbiology, other investigations, and clinical outcome during a minimum 6-month follow-up. RESULTS No activity attributable to normal healing was seen in the post-discectomy space or at the bone-hardware interface in the absence of a complication at any stage. Within the incision, activity from normal healing persisted for months. Wound infections were diagnosed clinically, and most had already been treated before FDG-PET/CT was done to assess deep structures. With proven infection, 95% of cases had activity in bone or soft tissue outside the surgical field. The remaining 5% had activity confined to the post-discectomy space. Sterile hardware loosening may cause elevated activity which remains confined to the bone/hardware interface. Pathogens are introduced directly at the time of surgery and may be avirulent resulting in indolent infection with low-grade activity. At the same time, activity from non-infectious causes can be intense. A semi-quantitative method using SUVmax performed poorly compared with assessment of the distribution of activity. CONCLUSION These observations have been incorporated into a checklist which is now being used at the time of interpretation. The potential sensitivity and specificity in the diagnosis of infection are close to 100%.
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Affiliation(s)
- Reinhard Kloiber
- Department of Radiology, Foothills Medical Centre, University of Calgary, 1403 29 Street NW, Calgary, AB, T2N 2T9, Canada
| | - Hans Lafford
- Department of Radiology, Foothills Medical Centre, University of Calgary, 1403 29 Street NW, Calgary, AB, T2N 2T9, Canada.
| | - Ingrid L Koslowsky
- Department of Radiology, Foothills Medical Centre, University of Calgary, 1403 29 Street NW, Calgary, AB, T2N 2T9, Canada
| | - Ilja Tchajkov
- Department of Radiology, Foothills Medical Centre, University of Calgary, 1403 29 Street NW, Calgary, AB, T2N 2T9, Canada
| | - Harvey R Rabin
- Department of Medicine, Foothills Medical Centre, University of Calgary, Calgary, AB, Canada
- Department of Microbiology, Immunology and Infectious Diseases, University of Calgary, Calgary, AB, Canada
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Morino K, Nakano K, Goto T, Tanaka H, Machimoto T. Proposal of the novel predictive model for postoperative pancreatic fistula in distal pancreatectomy for pancreatic tumor based on preoperative imaging parameters and stapler handling. World J Surg 2024; 48:932-942. [PMID: 38375966 DOI: 10.1002/wjs.12113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 02/15/2024] [Indexed: 02/21/2024]
Abstract
BACKGROUND Distal pancreatectomy (DP) using linear staplers is widely performed; however, postoperative pancreatic fistulas (POPF) remain an issue. This study aimed to analyze preoperative risk factors for POPF and assess stapler handling. METHODS We retrospectively analyzed consecutive patients who underwent DP for pancreatic tumors using a linear stapler between 2014 and 2022. Preoperative measurements included pancreas-to-muscle signal intensity ratio (SIR) on fat-suppressed T1-weighted magnetic resonance imaging (MRI). The main outcome was clinically relevant POPF of the 2016 International Study Group of Pancreatic Fistulas definition. The predictive ability of the model was compared with the distal fistula risk score (D-FRS) by using the area under the receiver operating characteristic curve (AUROC). RESULTS Among the 81 patients, POPF occurred in 31 (38.2%). Multivariate analysis identified computed tomography-measured pancreatic thickness (odds ratio [OR] 1.30, 95% confidence interval [CI] 1.05-1.61, p = 0.009) and SIR on T1-weighted MRI (OR 6.85, 95% CI 1.71-27.4, p = 0.002) as preoperative predictors. A novel preoperative model, "Thickness × MRI (TM)"-index, was established by multiplying these two variables. The TM-index exhibited the highest predictability preoperatively (AUROC 0.757, 95% CI 0.649-0.867). In the intraoperative variable analyses, TM-index (p < 0.001), thin cartridge application (p = 0.032), and short pre-firing compression (p = 0.047) were identified as significant risk factors for POPF. The model's AUROC combined with these two stapler handling methods was higher than D-FRS (0.851 vs. 0.660, p = 0.006). CONCLUSIONS The novel preoperative model exhibited excellent predictability. Thick cartridge use and long pre-firing compression were protective factors against POPF. This model may facilitate preventive surgical strategy development to reduce POPF.
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Affiliation(s)
- Koshiro Morino
- Department of Gastroenterological Surgery, Tenri Hospital, Tenri, Japan
| | - Kenzo Nakano
- Department of Gastroenterological Surgery, Tenri Hospital, Tenri, Japan
| | - Toshihiko Goto
- Department of Gastroenterological Surgery, Tenri Hospital, Tenri, Japan
| | - Hirokazu Tanaka
- Department of Gastroenterological Surgery, Tenri Hospital, Tenri, Japan
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Hultcrantz J, Klevebro F, Lindblad M, Brismar TB, Coy DL, Low DE, Andersson M. Improved radiologic diagnosis of delayed gastric conduit emptying (DGCE) after esophagectomy using a functional upper gastrointestinal contrast study. Acta Radiol 2024; 65:329-333. [PMID: 38111253 DOI: 10.1177/02841851231217990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2023]
Abstract
BACKGROUND With increasing incidence of esophageal cancer, a growing number of patients are at risk of developing delayed gastric conduit emptying (DGCE) in the early postoperative phase after esophagectomy. This condition is of great postoperative concern due to its association with adverse outcomes. PURPOSE To give a narrative review of the literature concerning radiological diagnosis of DGCE after esophagectomy and a proposal for an improved, functional protocol with objective measurements. MATERIAL AND METHODS The protocol was designed at Virginia Mason Medical Center in Seattle and is based on the Timed Barium Esophagogram (TBE) concept, which has been adapted to assess the passage of contrast from the gastric conduit into the duodenum. RESULTS The literature review showed a general lack of standardization and scientific evidence behind the use of radiology to assess DGCE. We found that our proposed standardized upper gastrointestinal (UGI) contrast study considers both the time aspect in DGCE and provides morphologic information of the gastric conduit. This radiological protocol was tested on 112 patients in a trial performed at two high-volume centers for esophageal surgery and included an UGI contrast study 2-3 days postoperatively. The study demonstrated that this UGI contrast study can be included in the standardized clinical pathway after esophagectomy. CONCLUSION This new, proposed UGI contrast study has the potential to diagnose early postoperative DGCE in a standardized manner and to improve overall patient outcomes after esophagectomy.
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Affiliation(s)
- Jens Hultcrantz
- Department of Radiology, Karolinska University Hospital, Stockholm, Sweden
| | - Fredrik Klevebro
- Centre for Upper Gastrointestinal Diseases, Division of Surgery, Karolinska University Hospital, Stockholm, Sweden
- Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
| | - Mats Lindblad
- Centre for Upper Gastrointestinal Diseases, Division of Surgery, Karolinska University Hospital, Stockholm, Sweden
- Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
| | - Torkel B Brismar
- Department of Radiology, Karolinska University Hospital, Stockholm, Sweden
- Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
| | - David L Coy
- Department of Radiology, Virginia Mason Medical Center, Seattle, WA, USA
| | - Donald E Low
- Department of Thoracic Surgery, Virginia Mason Medical Center, Seattle, WA, USA
| | - Mats Andersson
- Department of Radiology, Karolinska University Hospital, Stockholm, Sweden
- Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
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Pezzullo F, Comune R, D'Avino R, Mandato Y, Liguori C, Lassandro G, Tamburro F, Galluzzo M, Scaglione M, Tamburrini S. CT prognostic signs of postoperative complications in emergency surgery for acute obstructive colonic cancer. Radiol Med 2024; 129:525-535. [PMID: 38512630 DOI: 10.1007/s11547-024-01778-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 01/04/2024] [Indexed: 03/23/2024]
Abstract
PURPOSE To identify CT prognostic signs of poor outcomes in acute obstructive colonic cancer (AOCC). METHODS Demographic, clinical, laboratory, radiological and surgical data of 65 consecutive patients with AOCC who underwent emergency surgery were analyzed. CT exams were reviewed to assess diameters of cecum, ascending, transverse, descending, and sigmoid proximal to the tumor; colon segments' CD/L1-VD ratios, continence of the ileocecal valve, small bowel overdistension, presence of small bowel feces sign and cecal pneumatosis. Post Operative complications (PO), according to the Clavien-Dindo classification, were analyzed. RESULTS Gender, age and location of the tumor were not predictive factors of complications. Among laboratory exams, CRP was the most important predictive value of PO (OR 8.23). A cecum distension ≥ 9 cm represented the critical diameter beyond which perforation and cecal necrosis were found at surgery. Cecal pneumatosis at CT was correlated with cecal necrosis at surgery in < 50% of patients. Pre-operative transverse colon CD/L1-VD ratio ≥ 1.43 and descending colon CD/L1-VD ratio ≥ 1.31 were associated with the development of PO (grade ≥ III-V). PO (grade ≥ III-V) occurred in 18/65 patients. CONCLUSION Postoperative complications in emergency surgery of AOCC were not related to the age, sex and tumor's location. Preoperative PCR values (≥ 2.17) predict the development of postoperative complications. CT resulted a valid diagnostic tool to identify patients at higher risk of complications: a CD/L1-VD ratios with cut-off values of 1.43 (transverse) and 1.31 (descending) predicted major complications (grade ≥ III-V) and a cecum distension ≥ 9 cm represented the critical diameter beyond which perforation occurred in > 84% of patients.
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Affiliation(s)
- Filomena Pezzullo
- Department of Radiology, Ospedale del Mare, ASL NA1 Centro, Naples, Italy
| | - Rosita Comune
- Division of Radiology, Università Degli Studi Della Campania Luigi Vanvitelli, Naples, Italy
| | - Raffaelle D'Avino
- Department of Surgery, Ospedale del Mare, ASL NA1 Centro, Naples, Italy
| | - Ylenia Mandato
- Department of Radiology, Ospedale del Mare, ASL NA1 Centro, Naples, Italy
| | - Carlo Liguori
- Department of Radiology, Ospedale del Mare, ASL NA1 Centro, Naples, Italy
| | - Giulia Lassandro
- Department of Radiology, Ospedale del Mare, ASL NA1 Centro, Naples, Italy
| | - Fabio Tamburro
- Department of Radiology, Ospedale del Mare, ASL NA1 Centro, Naples, Italy
| | - Michele Galluzzo
- Department of Emergency Radiology, San Camillo Forlanini Hospital, Rome, Italy
| | - Mariano Scaglione
- Department of Medicine, Surgery and Pharmacy, University of Sassari, Piazza Università, Sassari, Italy
- Department of Radiology, James Cook University Hospital, Middlesbrough, UK
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10
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Lindsey MH, Lightsey HM, Xiong GX, Goh B, Simpson AK, Hershman SH. What Happens to Sagittal Alignment Following Laminoplasty Versus Laminectomy and Fusion? World Neurosurg 2024; 184:e211-e218. [PMID: 38266988 DOI: 10.1016/j.wneu.2024.01.087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 01/13/2024] [Accepted: 01/16/2024] [Indexed: 01/26/2024]
Abstract
OBJECTIVE Laminectomy and fusion (LF) and laminoplasty (LP) are 2 sucessful posterior decompression techniques for cervical myelo-radiculopathy. There is also a growing body of evidence describing the importance of cervical sagittal alignment (CSA) and its importance in outcomes. We investigated the difference between pre- and postoperative CSA parameters in and between LF or LP. Furthermore, we studied predictive variables associated with change in cervical mismatch (CM). METHODS This is a retrospective cohort study of adults with cervical myeloradiculopathy in a single healthcare system. The primary outcomes are intra- and inter-cohort comparison of LF versus LP radiographic parameters at pre- and postoperative time points. A secondary multivariable analysis of predictive factors was performed evaluating factors predicting postoperative CM. RESULTS Eighty nine patients were included; 38 (43%) had LF and 51 (57%) underwent LP. Both groups decreased in lordosis (LF 11.4° vs. 4.9°, P = 0.01; LP 15.2° vs. 9.1°, P < 0.001), increased in cSVA (LF 3.4 vs. 4.2 cm, P = 0.01; LP 3.2 vs. 4.2 cm, P < 0.001), and increased in CM (LF 22.0° vs. 28.5°, P = 0.02; LP 16.8° vs. 22.3°, P = 0.002). There were no significant differences in the postoperative CSA between groups. No significant predictors of change in pre- and postoperative CM were found. CONSLUSIONS There were no significant pre-or postoperative differences following the 2 procedures, suggesting radiographic equipoise in well indicated patients. Across all groups, lordosis decreased, cSVA increased, and cervical mismatch increased. There were no predictive factors that led to change in cervical mismatch.
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Affiliation(s)
- Matthew H Lindsey
- Department of Orthopaedic Spine Surgery, Mayo Clinic, Rochester, Minnesota, USA.
| | - Harry M Lightsey
- Department of Spine Surgery, Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, USA
| | - Grace X Xiong
- Department of Spine Surgery, Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, USA
| | - Brian Goh
- Division of Spine Surgery, Emory Orthopaedics & Spine Center, Atlanta, Georgia, USA
| | - Andrew K Simpson
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Stuart H Hershman
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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11
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Nie X, Zhang L, Meng H, Zhong Y, Jiang Y, Chen T, Cheng W. Visceral obesity determined by CT as a predictor of short-term postoperative complications in patients with ovarian cancer. Arch Gynecol Obstet 2024; 309:1491-1498. [PMID: 37698603 DOI: 10.1007/s00404-023-07206-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 08/24/2023] [Indexed: 09/13/2023]
Abstract
OBJECTIVE To explore the association between visceral obesity and short-term postoperative complications in patients with advanced ovarian cancer undergoing cytoreductive surgery. METHODS The medical records of patients with advanced epithelial ovarian cancer were reviewed. The visceral fat area, subcutaneous fat area and total fat area at the L3/4 level were measured on a preoperative single-slice CT scan. The receiver operating characteristic (ROC) curve was used to calculate the optimal cutoff value for the visceral fat area. The relationship between the visceral fat area and the characteristics of ovarian cancer patients were analyzed. Univariable and multivariable logistic regression analyses were performed to investigate relationship between perioperative characteristics and short-term complications. RESULTS According to the ROC curve, the best cutoff value of the VFA was 93 cm2. Of the 130 patients, 53.8% (70/130) had visceral obesity. Patients with visceral obesity were older than those with nonvisceral obesity (58.4 years old vs. 52.1 years old, p < 0.001). The proportion of patients with hypertension was higher (35.7 vs. 13.3%, p = 0.003). The total fat area and subcutaneous fat area were larger in patients with visceral obesity (294.3 ± 75.5 vs. 176.2 ± 68.7, p < 0.001; 158.9 ± 54.7 vs. 121.7 ± 52.6, p < 0.001). Compared with patients in the nonvisceral obese group, patients in the visceral obese group were more likely to have postoperative fever (21/70 30.0% vs. 8/60 1.25%, p = 0.023), leading to a longer length of hospital stay (21 days vs. 17 days, p = 0.009). The time from surgery to adjuvant chemotherapy for patients with visceral obesity was shorter (24 days vs. 19 days, p = 0.037). Multivariate analysis showed that visceral obesity (OR = 6.451, p < 0.001) and operation time (OR = 1.006, p < 0.001) were independent predictors of postoperative complications. CONCLUSION Visceral obesity is an important risk factor for short-term postoperative complications in patients with advanced ovarian cancer undergoing cytoreductive surgery.
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Affiliation(s)
- Xianglin Nie
- Department of Gynecology, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210029, Jiangsu, China
| | - Lin Zhang
- Department of Gynecology, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210029, Jiangsu, China
| | - Huangyang Meng
- Department of Gynecology, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210029, Jiangsu, China
| | - Yi Zhong
- Department of Gynecology, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210029, Jiangsu, China
- Department of gynaecology and obstetrics, Chongqing Maternal and Child Health Care Hospital, Chongqing, China
| | - Yi Jiang
- Department of Gynecology, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210029, Jiangsu, China
| | - Ting Chen
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210029, Jiangsu, China
| | - Wenjun Cheng
- Department of Gynecology, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210029, Jiangsu, China.
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12
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Yang Y, Cheng Y, Wang P, Cai M, Ji X, Zhu H, Zhao X, Sun Y, Zhao P, Yin S. Functional outcome following spontaneous intracerebral hemorrhage between ultrasound guidance endoscopic surgery and conventional craniotomy: A retrospective population-based study. J Stroke Cerebrovasc Dis 2024; 33:107609. [PMID: 38331009 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 01/05/2024] [Accepted: 01/29/2024] [Indexed: 02/10/2024] Open
Abstract
OBJECTIVES Ultrasound guidance endoscopic surgery (ES) has been widely used in the treatment of cerebral hemorrhage in recent years, but relevant research articles are still scarce. Our study aims to investigate the effect of ES compared with conventional craniotomy (CC) on the postoperative complications, and prognosis of patients with intracerebral hemorrhage. MATERIALS AND METHODS The clinical data of 1201 patients with ICH treated in our hospital from January 2017 to January 2020 were collected. The t-test, Chi-squared test and Fisher's exact test were used to analyze the clinical baseline data. Among 1021 spontaneous ICH patients, 193 patients who underwent hematoma evacuation were included in the present analysis. RESULTS The Glasgow Outcome Scale (GOS) score at 6 months had a favorable prognosis in ES group (p = 0.003). ES group had fewer postoperative complications compared with CC group. Operating time and intraoperative blood loss were significantly lower in ES group than CC group (p = 0.001 and p = 0.002). CONCLUSIONS Our study revealed that receiving ES improved the prognosis of ICH patients. Additionally, endoscopic surgery diminishes operative time, and intraoperative blood loss and reduces the incidence of postoperative complications.
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Affiliation(s)
- Yuefan Yang
- Department of Neurosurgery, The Hospital of 81(st) Group Army PLA, PR China.
| | - Yuefei Cheng
- Department of Neurosurgery, The Hospital of 81(st) Group Army PLA, PR China
| | - Peng Wang
- Department of Neurosurgery, The Hospital of 81(st) Group Army PLA, PR China
| | - Ming Cai
- Department of Neurosurgery, The Hospital of 81(st) Group Army PLA, PR China
| | - Xiaojun Ji
- Department of Neurosurgery, The Hospital of 81(st) Group Army PLA, PR China
| | - Hongyu Zhu
- Department of Neurosurgery, The Hospital of 81(st) Group Army PLA, PR China
| | - XiaoYun Zhao
- Department of Ultrasound Diagnosis, The Hospital of 81(st) Group Army PLA, PR China
| | - YinChen Sun
- Department of Neurosurgery, The Hospital of 81(st) Group Army PLA, PR China
| | - Peilin Zhao
- Department of Neurosurgery, The Hospital of 81(st) Group Army PLA, PR China
| | - ShangJiong Yin
- Department of Neurosurgery, The Hospital of 81(st) Group Army PLA, PR China.
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13
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Calinescu AM, Monluc S, Franchi-Abella S, Habes D, Weber G, Almes MF, Waguet J, Jacquemin E, Fouquet V, Miatello J, Hery G, Baujard C, Gonzales E, Branchereau S, Guérin F. Long-term outcome of combined radiologic and surgical strategy for the management of biliary complications after pediatric liver transplantation. BMC Res Notes 2024; 17:86. [PMID: 38509599 PMCID: PMC10953252 DOI: 10.1186/s13104-024-06735-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Accepted: 03/06/2024] [Indexed: 03/22/2024] Open
Abstract
OBJECTIVES We aimed to analyze the risk factors for management failure of BC after pediatric liver transplantation (pLT) by retrospectively analyzing primary pLT performed between 1997 and 2018 (n = 620 patients). RESULTS In all, 117/620 patients (19%) developed BC. The median (range) follow-up was 9 (1.4-21) years. Patient survival at 1, 5 and 10 years was 88.9%, 85.7%, 84.4% and liver graft survival was 82.4%, 77.4%, and 74.3% respectively. Graft not patient survival was impaired by BC (p = 0.01). Multivariate analysis identified the number of dilatation courses > 2 (p = 0.008), prolonged cold ischemia time (p = 0.004), anastomosed multiple biliary ducts (p = 0.019) and hepatic artery thrombosis (p = 0.01) as factors associated with impaired graft survival. The number of dilatation courses > 2 (p < 0.001) and intrahepatic vs anastomotic stricture (p = 0.014) were associated with management failure. Thus, repeated (> 2) radiologic dilatation courses are associated with impaired graft survival and management failure. Overall, graft but not patient survival was impaired by BC.
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Affiliation(s)
- Ana M Calinescu
- Paediatric Surgery Unit, Université Paris-Saclay, Assistance Publique-Hôpitaux de Paris, Bicêtre Hospital, 78 Rue du Général Leclerc, 94270, Le Kremlin-Bicêtre, France.
- University Center of Pediatric Surgery of Western Switzerland, Geneva University Hospitals, Division of Pediatric Surgery, University of Geneva, 6 Rue Willy Donze, 1205, Geneva, Switzerland.
| | - Sébastien Monluc
- Assistance Publique-Hôpitaux de Paris, Bicêtre Hospital, Epidemiology and Public Health Department, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Stephanie Franchi-Abella
- Assistance Publique-Hôpitaux de Paris, Bicêtre Hospital, Pediatric Radiology Unit, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Dalila Habes
- Assistance Publique-Hôpitaux de Paris, Bicêtre Hospital, Pediatric Hepatology and Pediatric Liver Transplantation Unit, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Gabrielle Weber
- Assistance Publique-Hôpitaux de Paris, Bicêtre Hospital, Pediatric Radiology Unit, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Marion F Almes
- Assistance Publique-Hôpitaux de Paris, Bicêtre Hospital, Pediatric Hepatology and Pediatric Liver Transplantation Unit, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Jerome Waguet
- Assistance Publique-Hôpitaux de Paris, Bicêtre Hospital, Pediatric Radiology Unit, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Emmanuel Jacquemin
- Hépatinov, Inserm U 1193, National Reference Centre for Rare Pediatric Liver Diseases, FSMR FILFOIE, ERN RARE LIVER, Assistance Publique-Hôpitaux de Paris, Bicêtre Hospital, Pediatric Hepatology and Pediatric Liver Transplantation Unit, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Virginie Fouquet
- Paediatric Surgery Unit, Université Paris-Saclay, Assistance Publique-Hôpitaux de Paris, Bicêtre Hospital, 78 Rue du Général Leclerc, 94270, Le Kremlin-Bicêtre, France
| | - Jordi Miatello
- Assistance Publique-Hôpitaux de Paris, Bicêtre Hospital, Department of Pediatric and Neonatal Intensive Care, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Geraldine Hery
- Paediatric Surgery Unit, Université Paris-Saclay, Assistance Publique-Hôpitaux de Paris, Bicêtre Hospital, 78 Rue du Général Leclerc, 94270, Le Kremlin-Bicêtre, France
| | - Catherine Baujard
- Assistance Publique-Hôpitaux de Paris, Bicêtre Hospital, Anesthesia Department, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Emmanuel Gonzales
- Hépatinov, Inserm U 1193, National Reference Centre for Rare Pediatric Liver Diseases, FSMR FILFOIE, ERN RARE LIVER, Assistance Publique-Hôpitaux de Paris, Bicêtre Hospital, Pediatric Hepatology and Pediatric Liver Transplantation Unit, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Sophie Branchereau
- Paediatric Surgery Unit, Université Paris-Saclay, Assistance Publique-Hôpitaux de Paris, Bicêtre Hospital, 78 Rue du Général Leclerc, 94270, Le Kremlin-Bicêtre, France
| | - Florent Guérin
- Paediatric Surgery Unit, Université Paris-Saclay, Assistance Publique-Hôpitaux de Paris, Bicêtre Hospital, 78 Rue du Général Leclerc, 94270, Le Kremlin-Bicêtre, France
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14
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Yang F, Windsor JA, Fu DL. Optimizing prediction models for pancreatic fistula after pancreatectomy: Current status and future perspectives. World J Gastroenterol 2024; 30:1329-1345. [PMID: 38596504 PMCID: PMC11000089 DOI: 10.3748/wjg.v30.i10.1329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 01/15/2024] [Accepted: 02/25/2024] [Indexed: 03/14/2024] Open
Abstract
Postoperative pancreatic fistula (POPF) is a frequent complication after pancreatectomy, leading to increased morbidity and mortality. Optimizing prediction models for POPF has emerged as a critical focus in surgical research. Although over sixty models following pancreaticoduodenectomy, predominantly reliant on a variety of clinical, surgical, and radiological parameters, have been documented, their predictive accuracy remains suboptimal in external validation and across diverse populations. As models after distal pancreatectomy continue to be progressively reported, their external validation is eagerly anticipated. Conversely, POPF prediction after central pancreatectomy is in its nascent stage, warranting urgent need for further development and validation. The potential of machine learning and big data analytics offers promising prospects for enhancing the accuracy of prediction models by incorporating an extensive array of variables and optimizing algorithm performance. Moreover, there is potential for the development of personalized prediction models based on patient- or pancreas-specific factors and postoperative serum or drain fluid biomarkers to improve accuracy in identifying individuals at risk of POPF. In the future, prospective multicenter studies and the integration of novel imaging technologies, such as artificial intelligence-based radiomics, may further refine predictive models. Addressing these issues is anticipated to revolutionize risk stratification, clinical decision-making, and postoperative management in patients undergoing pancreatectomy.
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Affiliation(s)
- Feng Yang
- Department of Pancreatic Surgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai 200040, China
| | - John A Windsor
- Surgical and Translational Research Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland 1142, New Zealand
| | - De-Liang Fu
- Department of Pancreatic Surgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai 200040, China
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15
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Yang AE, Shutran MS, Fehnel CR, Yoon J, Das AS. Teaching NeuroImage: Tension Pneumocephalus After Meningioma Resection. Neurology 2024; 102:e209185. [PMID: 38330284 DOI: 10.1212/wnl.0000000000209185] [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: 09/08/2023] [Accepted: 12/11/2023] [Indexed: 02/10/2024] Open
Affiliation(s)
- Ailing E Yang
- From the Division of Neurocritical Care (A.E.Y., C.R.F., J.Y., A.S.D.), Department of Neurology, and Neurosurgical Service (M.S.S.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Max S Shutran
- From the Division of Neurocritical Care (A.E.Y., C.R.F., J.Y., A.S.D.), Department of Neurology, and Neurosurgical Service (M.S.S.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Corey R Fehnel
- From the Division of Neurocritical Care (A.E.Y., C.R.F., J.Y., A.S.D.), Department of Neurology, and Neurosurgical Service (M.S.S.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Jason Yoon
- From the Division of Neurocritical Care (A.E.Y., C.R.F., J.Y., A.S.D.), Department of Neurology, and Neurosurgical Service (M.S.S.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Alvin S Das
- From the Division of Neurocritical Care (A.E.Y., C.R.F., J.Y., A.S.D.), Department of Neurology, and Neurosurgical Service (M.S.S.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
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16
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Nagamoto Y, Okuda S, Matsumoto T, Takahashi Y, Furuya M, Iwasaki M. Mid-Term Results of Single-Level Posterior Lumbar Interbody Fusion in Patients with Pelvic Incidence Minus Lumbar Lordosis Mismatch. World Neurosurg 2024; 183:e796-e800. [PMID: 38218438 DOI: 10.1016/j.wneu.2024.01.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 01/04/2024] [Accepted: 01/05/2024] [Indexed: 01/15/2024]
Abstract
BACKGROUND Recent literature suggests that sagittal imbalance is a risk factor for adjacent segment disease following fusion surgery. This study explored the influence of pelvic incidence minus lumbar lordosis (PI-LL) mismatch on the mid-term results and reoperation rate after single-level posterior lumbar interbody fusion (PLIF). METHODS The participants of this study included 253 patients (80 men and 173 women; mean age 68.2 years) who underwent L4-5 single-segment PLIF. Preoperative PI-LL mismatch was defined as a PI-LL of 30° or greater. The patients were divided into 2 groups according to the presence or absence of PI-LL mismatch (PI-LL mismatch group; group M, Control group; group C), and the clinical outcomes and radiographic parameters were compared. RESULTS Of the 253 cases, 25 were classified in group M and 228 in group C. The Japanese Orthopaedic Association score at 5 years postoperatively was 23.0 ± 3.6 in group M and 23.5 ± 5.1 in group C, and the recovery rate was 66.2 ± 32.6% in group M and 64.6 ± 21.4% in group C and there was no significant difference in the recovery rate between the 2 groups. All radiographic parameters except sacral slope were significantly worse in group M. One patient (4.3%) in Group M and 18 patients (7.8%) in Group C required revision surgery at 2.4 years (range 0.0-5.0) and there was no significant difference in the revision rate between the 2 groups. CONCLUSIONS The mid-term results of L4-5 single-level PLIF were compared with and without PI-LL mismatch, with the threshold defined as 30°; however, there were no significant differences in both the Japanese Orthopaedic Association recovery and reoperation rates between the 2 groups.
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Affiliation(s)
- Yukitaka Nagamoto
- Department of Orthopaedic Surgery, Osaka Rosai Hospital, Sakai, Japan.
| | - Shinya Okuda
- Department of Orthopaedic Surgery, Osaka Rosai Hospital, Sakai, Japan
| | - Tomiya Matsumoto
- Department of Orthopaedic Surgery, Osaka Rosai Hospital, Sakai, Japan
| | | | - Masayuki Furuya
- Department of Orthopaedic Surgery, Osaka Rosai Hospital, Sakai, Japan
| | - Motoki Iwasaki
- Department of Orthopaedic Surgery, Osaka Rosai Hospital, Sakai, Japan
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17
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Ingwersen EW, Rijssenbeek PMW, Marquering HA, Kazemier G, Daams F. Radiomics for the prediction of a postoperative pancreatic fistula following a pancreatoduodenectomy: A systematic review and radiomic score quality assessment. Pancreatology 2024; 24:306-313. [PMID: 38238193 DOI: 10.1016/j.pan.2023.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 12/13/2023] [Accepted: 12/18/2023] [Indexed: 03/02/2024]
Abstract
BACKGROUND Postoperative pancreatic fistula (POPF) is a severe complication following a pancreatoduodenectomy. An accurate prediction of POPF could assist the surgeon in offering tailor-made treatment decisions. The use of radiomic features has been introduced to predict POPF. A systematic review was conducted to evaluate the performance of models predicting POPF using radiomic features and to systematically evaluate the methodological quality. METHODS Studies with patients undergoing a pancreatoduodenectomy and radiomics analysis on computed tomography or magnetic resonance imaging were included. Methodological quality was assessed using the Radiomics Quality Score (RQS) and Transparent Reporting of a Multivariable Prediction Model for Individual Prognosis or Diagnosis (TRIPOD) statement. RESULTS Seven studies were included in this systematic review, comprising 1300 patients, of whom 364 patients (28 %) developed POPF. The area under the curve (AUC) of the included studies ranged from 0.76 to 0.95. Only one study externally validated the model, showing an AUC of 0.89 on this dataset. Overall adherence to the RQS (31 %) and TRIPOD guidelines (54 %) was poor. CONCLUSION This systematic review showed that high predictive power was reported of studies using radiomic features to predict POPF. However, the quality of most studies was poor. Future studies need to standardize the methodology. REGISTRATION not registered.
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Affiliation(s)
- Erik W Ingwersen
- Amsterdam UMC, Location Vrije Universiteit Amsterdam, Department of Surgery, Amsterdam, the Netherlands; Cancer Center Amsterdam, the Netherlands; Amsterdam Gastroenterology Endocrinology and Metabolism, the Netherlands
| | - Pieter M W Rijssenbeek
- Amsterdam UMC, Location Vrije Universiteit Amsterdam, Department of Surgery, Amsterdam, the Netherlands
| | - Henk A Marquering
- Amsterdam UMC, Location University of Amsterdam, Department of Radiology and Nuclear Medicine, Amsterdam, the Netherlands; Amsterdam UMC, Location University of Amsterdam, Department of Biomedical Engineering and Physics Department, the Netherlands
| | - Geert Kazemier
- Amsterdam UMC, Location Vrije Universiteit Amsterdam, Department of Surgery, Amsterdam, the Netherlands; Cancer Center Amsterdam, the Netherlands
| | - Freek Daams
- Amsterdam UMC, Location Vrije Universiteit Amsterdam, Department of Surgery, Amsterdam, the Netherlands; Cancer Center Amsterdam, the Netherlands.
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18
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Boussier J, Lemasle A, Hantala N, Scatton O, Vaillant JC, Paye F, Langeron O, Lescot T, Quesnel C, Verdonk F, Eyraud D, Sitbon A, Delorme L, Monsel A. Lung Ultrasound Score on Postoperative Day 1 Is Predictive of the Occurrence of Pulmonary Complications after Major Abdominal Surgery: A Multicenter Prospective Observational Study. Anesthesiology 2024; 140:417-429. [PMID: 38064713 DOI: 10.1097/aln.0000000000004855] [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: 02/15/2024]
Abstract
BACKGROUND Postoperative pulmonary complications after major abdominal surgery are frequent and carry high morbidity and mortality. Early identification of patients at risk of pulmonary complications by lung ultrasound may allow the implementation of preemptive strategies. The authors hypothesized that lung ultrasound score would be associated with pulmonary postoperative complications. The main objective of the study was to evaluate the performance of lung ultrasound score on postoperative day 1 in predicting pulmonary complications after major abdominal surgery. Secondary objectives included the evaluation of other related measures for their potential prediction accuracy. METHODS A total of 149 patients scheduled for major abdominal surgery were enrolled in a bicenter observational study. Lung ultrasound score was performed before the surgery and on days 1, 4, and 7 after surgery. Pulmonary complications occurring before postoperative day 10 were recorded. RESULTS Lung ultrasound score on postoperative day 1 was higher in patients developing pulmonary complications before day 10 (median, 13; interquartile range, 8.25 to 18; vs. median, 10; interquartile range, 6.5 to 12; Mann-Whitney P = 0.002). The area under the curve for predicting postoperative pulmonary complications before day 10 was 0.65 (95% CI, 0.55 to 0.75; P = 0.003). Lung ultrasound score greater than 12 had a sensitivity of 0.54 (95% CI, 0.40 to 0.67), specificity of 0.77 (95% CI, 0.67 to 0.85), and negative predictive value of 0.74 (95% CI, 0.65 to 0.83). Lung ultrasound score greater than 17 had sensitivity of 0.33 (95% CI, 0.21 to 0.47), specificity of 0.95 (95% CI, 0.88 to 0.98), and positive predictive value of 0.78 (95% CI, 0.56 to 0.93). Anterolateral lung ultrasound score and composite scores using lung ultrasound score and other patient characteristics showed similar predictive accuracies. CONCLUSIONS An elevated lung ultrasound score on postoperative day 1 is associated with the occurrence of pulmonary complications within the first 10 days after major abdominal surgery. EDITOR’S PERSPECTIVE
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Affiliation(s)
- Jeremy Boussier
- Multidisciplinary Intensive Care Unit, Department of Anesthesiology and Critical Care, La Pitié-Salpêtrière Hospital, Greater Paris University Hospitals, Sorbonne University, Paris, France
| | - Aymeric Lemasle
- Multidisciplinary Intensive Care Unit, Department of Anesthesiology and Critical Care, La Pitié-Salpêtrière Hospital, Greater Paris University Hospitals, Sorbonne University, Paris, France
| | - Nicolas Hantala
- Department of Anesthesiology and Critical Care Medicine, Saint-Antoine Hospital, Sorbonne University, GRC 29, DMU DREAM, Greater Paris University Hospitals, Paris, France
| | - Olivier Scatton
- Department of Hepatobiliopancreatic Surgery and Liver Transplantation, La Pitié-Salpêtrière Hospital, Greater Paris University Hospitals, Sorbonne University, Paris, France
| | - Jean-Christophe Vaillant
- Department of Hepatobiliopancreatic Surgery and Liver Transplantation, La Pitié-Salpêtrière Hospital, Greater Paris University Hospitals, Sorbonne University, Paris, France
| | - François Paye
- Department of Surgery, Saint-Antoine Hospital, Sorbonne University, Paris, France
| | - Olivier Langeron
- Department of Anesthesia and Intensive Care, Henri-Mondor University Hospital, Greater Paris University Hospitals, University Paris-Est-Créteil, Paris, France
| | - Thomas Lescot
- Department of Anesthesiology and Critical Care Medicine, Saint-Antoine Hospital, Sorbonne University, GRC 29, DMU DREAM, Greater Paris University Hospitals, Paris, France
| | - Christophe Quesnel
- Department of Anesthesiology and Critical Care Medicine, Saint-Antoine Hospital, Sorbonne University, GRC 29, DMU DREAM, Greater Paris University Hospitals, Paris, France
| | - Franck Verdonk
- Department of Anesthesiology and Critical Care Medicine, Saint-Antoine Hospital, Sorbonne University, GRC 29, DMU DREAM, Greater Paris University Hospitals, Paris, France
| | - Daniel Eyraud
- Multidisciplinary Intensive Care Unit, Department of Anesthesiology and Critical Care, La Pitié-Salpêtrière Hospital, Greater Paris University Hospitals, Sorbonne University, Paris, France
| | - Alexandre Sitbon
- Multidisciplinary Intensive Care Unit, Department of Anesthesiology and Critical Care, La Pitié-Salpêtrière Hospital, Greater Paris University Hospitals, Sorbonne University, Paris, France
| | - Louis Delorme
- Multidisciplinary Intensive Care Unit, Department of Anesthesiology and Critical Care, La Pitié-Salpêtrière Hospital, Greater Paris University Hospitals, Sorbonne University, Paris, France
| | - Antoine Monsel
- Multidisciplinary Intensive Care Unit, Department of Anesthesiology and Critical Care, La Pitié-Salpêtrière Hospital, Greater Paris University Hospitals, Sorbonne University, Paris, France; Sorbonne Université-INSERM UMRS_959, Immunology-Immunopathology-Immunotherapy, Paris, France; Biotherapy (CIC-BTi), La Pitié-Salpêtrière Hospital, Greater Paris University Hospitals, Paris, France
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19
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Sosa Barrios RH, Burguera Vion V, Villa Hurtado D, Viera Ramírez ER, Galeano Álvarez C, Roncal Redín M, Fernández Lucas M, Rivera Gorrín ME. Routine Kidney Graft Ultrasound After Elective Ureteric Stent Removal: Does it Help? Transplant Proc 2024; 56:310-315. [PMID: 38365514 DOI: 10.1016/j.transproceed.2024.01.010] [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] [Received: 12/04/2023] [Accepted: 01/16/2024] [Indexed: 02/18/2024]
Abstract
Transplantation (KTx) is considered to be the best renal replacement therapy, and improving its outcomes remains a primary challenge. KTx ureteral stenting has been used to prevent urological complications, but there is no consensus on the timing of stent removal, and literature regarding routine ultrasonography after ureteric stent removal (RUSUS) to detect complications is lacking. Point-of-care ultrasound has been gaining drive in the medical community in recent years, including nephrologists. We aimed to define the incidence of urological complications diagnosed with RUSUS, if those findings changed patient's management and ultrasound utility. Contrary to previously published data, in our cohort RUSUS allowed a timely diagnosis and early treatment of urological complications, a key factor for successful transplantation. KTx point-of-care ultrasound is a cost-effective and reproducible test that provides relevant information to guide clinical decisions, seeming most efficient when performed approximately 2 weeks post ureteral stent removal. Interventional nephrologists can promptly perform these examinations, reducing waiting times and improving graft and patient's survival.
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Affiliation(s)
- R Haridian Sosa Barrios
- Nephrology Department, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain; Universidad de Alcalá de Henares, UAH, Madrid, Spain; Grupo de Nefrología Diagnóstica e Intervencionista (GNDI) de la Sociedad Española de Nefrología (SEN).
| | - Víctor Burguera Vion
- Nephrology Department, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain; Grupo de Nefrología Diagnóstica e Intervencionista (GNDI) de la Sociedad Española de Nefrología (SEN)
| | - Daniel Villa Hurtado
- Nephrology Department, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain; Grupo de Nefrología Diagnóstica e Intervencionista (GNDI) de la Sociedad Española de Nefrología (SEN)
| | | | - Cristina Galeano Álvarez
- Nephrology Department, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain; Grupo de Nefrología Diagnóstica e Intervencionista (GNDI) de la Sociedad Española de Nefrología (SEN)
| | - Miriam Roncal Redín
- Preventive Medicine and Public Health Department, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
| | - Milagros Fernández Lucas
- Nephrology Department, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain; Universidad de Alcalá de Henares, UAH, Madrid, Spain; Grupo de Nefrología Diagnóstica e Intervencionista (GNDI) de la Sociedad Española de Nefrología (SEN)
| | - Maite E Rivera Gorrín
- Nephrology Department, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain; Universidad de Alcalá de Henares, UAH, Madrid, Spain; Grupo de Nefrología Diagnóstica e Intervencionista (GNDI) de la Sociedad Española de Nefrología (SEN)
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20
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Lv L, Qian L, Xie S, Shen Z. A superior mesenteric venous aneurysm developed after radical pancreaticoduodenectomy: A case report. Asian J Surg 2024; 47:1701-1702. [PMID: 38199883 DOI: 10.1016/j.asjsur.2023.12.046] [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: 11/09/2023] [Accepted: 12/08/2023] [Indexed: 01/12/2024] Open
Affiliation(s)
- Laobo Lv
- School of Medicine, ShaoXing University, Shaoxing, 312000, China; Shaoxing People's Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Shaoxing, 312000, China
| | - Liying Qian
- Shaoxing People's Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Shaoxing, 312000, China
| | - Shisheng Xie
- Shaoxing People's Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Shaoxing, 312000, China; School of Medicine, ShaoXing University, Shaoxing, 312000, China
| | - Zhihong Shen
- Shaoxing People's Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Shaoxing, 312000, China.
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21
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Marquardt MD, Gibbs D, Grossbach A, Keister A, Munjal V, Moranville R, Mallory N, Toop N, Dhaliwal J, Marquardt H, Xu D, Viljoen S. Impact of obesity on adult spinal deformity (ASD) long-segment spinal fusion radiographic and clinical outcomes. Clin Neurol Neurosurg 2024; 238:108187. [PMID: 38402706 DOI: 10.1016/j.clineuro.2024.108187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 02/16/2024] [Accepted: 02/18/2024] [Indexed: 02/27/2024]
Abstract
STUDY DESIGN Retrospective chart review of patients receiving long-segment fusion during a five-year period. OBJECTIVE To determine whether obese patients receive comparable benefits when receiving long-segment fusion compared to non-obese patients and to identify factors that may predict hardware failure and post-surgical complications among obese patients. METHODS Demographic, spinopelvic radiographic, patient-reported outcome measures (PROMs), and complications data was retrospectively collected from 120 patients who underwent long-segment fusion during a five-year period at one tertiary care medical center. Radiographic measurements were pelvic incidence, pelvic tilt (PT), lumbar lordosis, L4-S1 lordosis, thoracic kyphosis, sagittal vertical axis, PI-LL mismatch, and proximal junction cobb angle at upper instrumented vertebrae + 2 (UIV+2). PROMs were Oswestry disability index, numeric rating scale (NRS) Back Pain, NRS Leg Pain, RAND SF-36 pain, and RAND SF-36 physical functioning. Included patients were adults and had at least 2-years of postoperative follow-up. Descriptive and multivariate statistical analysis was performed with α = 0.05. RESULTS Patients with a BMI ≥ 30 (n=63) and patients with a BMI < 30 (n=57) demonstrated comparable improvements (P>0.05) for all spinopelvic radiographic measurements and PROMs. Each cohort demonstrated significant improvements from pre-assessment to post-assessment on nearly all spinopelvic radiographic measurements and PROMs (P<0.05), except PT and L4-S1 lordosis where neither group improved (p=0.95 and 0.58 for PT and P=0.23 and 0.11 for L4-S1 lordosis fornon-obese and obese cohorts respectively) and SF-36 physical functioning where the non-obese cohort not statistically improve (P=0.08). Patients with a BMI ≥ 30 demonstrated an increased incidence of cardiovascular complications (P=0.0293), acute kidney injury (P=0.0241), rod fractures (P=0.0293), and reoperations (P=0.0241) when compared to patients with a BMI < 30. CONCLUSION This study adds to a growing body of evidence linking demographic factors with risks of hardware failure. Further, this data challenges the assumption that obese patients may not receive sufficient benefit to be long-segment surgical candidates. However, given their elevated risk for post-operative and delayed hardware complications, obese patients should be appropriately counseling before undergoing surgery.
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Affiliation(s)
| | - David Gibbs
- The Ohio State University College of Medicine, Columbus, OH, United States
| | - Andrew Grossbach
- Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Alexander Keister
- The Ohio State University College of Medicine, Columbus, OH, United States
| | - Vikas Munjal
- The Ohio State University College of Medicine, Columbus, OH, United States
| | - Robert Moranville
- The Ohio State University College of Medicine, Columbus, OH, United States
| | - Noah Mallory
- The Ohio State University College of Medicine, Columbus, OH, United States
| | - Nathaniel Toop
- Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Joravar Dhaliwal
- Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Henry Marquardt
- The Ohio State University College of Medicine, Columbus, OH, United States; Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - David Xu
- Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Stephanus Viljoen
- Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, United States
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22
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Shaw KA, Anigian K, Sucato DJ. Postoperative CT imaging to characterize fusion in pediatric and adolescent vertebral column resection. Spine Deform 2024; 12:403-410. [PMID: 37889407 DOI: 10.1007/s43390-023-00775-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 10/07/2023] [Indexed: 10/28/2023]
Abstract
BACKGROUND Vertebral column resection (VCR) is a powerful corrective technique for the management severe, rigid spinal deformities but does carry a relatively high complications rate. One of the feared complications is pseudarthrosis which places the patient at risk for implant failure. We present a single-center experience with post-operative computed tomography (CT) imaging at the osteotomy site to screen for impending pseudarthrosis. METHODS A retrospective review of a single surgeon series of posterior-only VCR performed for severe pediatric and adolescent spinal deformities was performed. Demographic, radiographic, and clinical data were collected. Patients underwent postoperative CT imaging at the osteotomy site 6-9 months following VCR with grading of the osteotomy fusion. Patients with impending pseudarthrosis were recommended for prophylactic revision surgery. RESULTS Thirty-three patients were included (mean age 11.6 ± 4.9 years, 54.5% female), undergoing a mean 1.9 level VCR. Kyphoscoliosis accounted for 75.7% (N = 25/33) of cases with 45.5% of all cases being congenital etiology and 60.6% having at least 1 previous surgery. Postoperative CT imaging was performed in 22 patients at a mean of 7.8 months following VCR. Two patients were identified as having impending pseudarthrosis with one undergoing revision surgery to enhance the posterior fusion, with addition of a third rod while one patient refusing surgery who subsequently developed broken hardware requiring revision surgery. No patient with a stable fusion on CT imaging developed a clinically significant pseudarthrosis. DISCUSSION Postoperative CT imaging of the osteotomy is useful in screening for impending pseudarthrosis and can aide in decision making for clearance to return to activity or the need for prophylactic intervention following VCR in pediatric and adolescent patients. We advocate that obtaining routine CT imaging of the osteotomy site at 6-9 months may identify potential complications earlier and allow for prophylactic intervention.
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Affiliation(s)
- K Aaron Shaw
- Department of Pediatric Orthopaedic Surgery, Children's Mercy Hospital, Kansas City, MO, USA.
| | - Kendall Anigian
- Department of Pediatric Orthopaedic Surgery, Cincinnati Children's Hospital, Cincinnati, OH, USA
| | - Daniel J Sucato
- Department of Pediatric Orthopaedic Surgery, Scottish Rite for Children Hospital, Dallas, TX, USA
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23
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Schartz DA, Ismail RF, Rahman AA, Bender MT, Westesson PL, Mesfin A, Kessler A. Management of postoperative cervical pseudomeningocele with percutaneous aspiration and epidural blood patch. Interv Neuroradiol 2024; 30:137-142. [PMID: 35818726 PMCID: PMC10956454 DOI: 10.1177/15910199221113714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 06/27/2022] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION While epidural blood patch can be an effective management option in lumbar pseudomeningoceles in certain clinical settings, its utility in the cervical spine is unclear. The aim of this study was to evaluate the safety and effectiveness of percutaneous aspiration and autologous blood patch for post-operative durotomy related pseudomeningoceles within the cervical spine. METHODS A single institution retrospective review detailing 3 patients with durotomy related pseudomeningocele following posterior cervical spine surgery was completed. RESULTS In all three cases, aspiration with subsequent injection of autologous epidural blood patch successfully treated each pseudomeningocele. One patient required more than one intervention, while the other two were successfully treated after one procedure. All three patients improved clinically without need for additional surgery. CONCLUSION Percutaneous aspiration and epidural blood patch can be used to safely manage post-operative pseudomeningoceles within the posterior cervical spine.
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Affiliation(s)
- Derrek A Schartz
- Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY, USA
| | - Rahim F Ismail
- Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY, USA
| | - Akm A Rahman
- Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY, USA
| | - Matthew T Bender
- Department of Neurosurgery, University of Rochester Medical Center, Rochester, NY, USA
| | - Per-Lennart Westesson
- Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY, USA
| | - Addisu Mesfin
- Department of Orthopedic Surgery, University of Rochester Medical Center, Rochester, NY, USA
| | - Alex Kessler
- Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY, USA
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24
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von Ehrlich-Treuenstätt VH, Guenther M, Ilmer M, Knoblauch MM, Koch D, Clevert DA, Ormanns S, Klauschen F, Niess H, D'Haese J, Angele MK, Werner J, Renz BW. Preoperative ultrasound elastography for postoperative pancreatic fistula prediction after pancreatoduodenectomy: A prospective study. Surgery 2024; 175:491-497. [PMID: 38044240 DOI: 10.1016/j.surg.2023.10.030] [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] [Received: 04/17/2023] [Revised: 07/07/2023] [Accepted: 10/24/2023] [Indexed: 12/05/2023]
Abstract
BACKGROUND Postoperative pancreatic fistulas are the most frequent major complications after pancreatoduodenectomy. The soft pancreatic texture is a critical, independent risk factor for postoperative pancreatic fistulas after pancreatoduodenectomy. The current gold standard for postoperative pancreatic fistula risk evaluation consists of the surgeon's intraoperative palpation of the pancreatic texture and, thus, lacks objectivity. In this prospective study, we used ultrasound-based shear-wave elastography, image data analysis, and a fistula risk score calculator to correlate the stiffness of pancreatic tissue with the occurrence of clinically relevant postoperative pancreatic fistulas. METHODS We included 100 patients with pancreatic pathologies (71% pancreatic ductal adenocarcinoma) and 100 healthy individuals who were preoperatively assessed via real-time tissue ultrasound-based shear-wave elastography on a Philips EPIQ 7 ultrasound device and had pancreatic parenchyma histologically evaluated with manually stained images. RESULTS We found a significant difference in the mean elasticity between the soft (1.22 m/s) and the hard pancreas group (2.10 m/s; P < .0001). The mean elasticity significantly correlated with the pancreatic fibrosis rate and the appearance of a postoperative pancreatic fistula after pancreatoduodenectomy. Low elasticity (≤1.2 m/s, mean) correlated with soft and high elasticity (>2.0 m/s, mean) with hard pancreatic parenchyma, as assessed by pathologic evaluation. Multivariate analysis revealed a mean elasticity of <1.3 m/s as a significant cut-off predictor for clinically relevant postoperative pancreatic fistulas (P = .003; Youden-Index = 0.6945). CONCLUSION Preoperative ultrasound-based shear-wave elastography is a feasible and objective clinical diagnostic modality in evaluating pancreatic tissue stiffness. A mean pancreatic elasticity of <1.3 m/s was a significant independent risk predictor of clinically relevant postoperative pancreatic fistulas after pancreatoduodenectomy.
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Affiliation(s)
| | - Michael Guenther
- Department of Pathology, University Hospital, LMU Munich, Germany; German Cancer Consortium (DKTK), partner site Munich, Munich, Germany
| | - Matthias Ilmer
- Department of General, Visceral, and Transplant Surgery, University Hospital, LMU Munich, Germany
| | - Mathilda M Knoblauch
- Department of General, Visceral, and Transplant Surgery, University Hospital, LMU Munich, Germany; German Cancer Consortium (DKTK), partner site Munich, Munich, Germany
| | - Dominik Koch
- Department of General, Visceral, and Transplant Surgery, University Hospital, LMU Munich, Germany
| | - Dirk-Andre Clevert
- Department of Clinical Radiology, University Hospital, LMU Munich, Germany
| | - Steffen Ormanns
- Department of Pathology, University Hospital, LMU Munich, Germany; German Cancer Consortium (DKTK), partner site Munich, Munich, Germany
| | | | - Hanno Niess
- Department of General, Visceral, and Transplant Surgery, University Hospital, LMU Munich, Germany
| | - Jan D'Haese
- Department of General, Visceral, and Transplant Surgery, University Hospital, LMU Munich, Germany
| | - Martin K Angele
- Department of General, Visceral, and Transplant Surgery, University Hospital, LMU Munich, Germany
| | - Jens Werner
- Department of General, Visceral, and Transplant Surgery, University Hospital, LMU Munich, Germany
| | - Bernhard W Renz
- Department of General, Visceral, and Transplant Surgery, University Hospital, LMU Munich, Germany; German Cancer Consortium (DKTK), partner site Munich, Munich, Germany.
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25
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Herrmann J, Petit P, Franchi-Abella S, Verhagen MV, McGuirk SP, Dammann E, Bokkers RPH, Clapuyt PRM, Deganello A, Tandoi F, de Ville de Goyet J, Hebelka H, de Lange C, Lozach C, Marra P, Mirza D, Kaliciński P, Patsch JM, Perucca G, Tsiflikas I, Renz DM, Schweiger B, Spada M, Toso S, Viremouneix L, Woodley H, Fischer L, Ording-Müller LS, Brinkert F. European Society of Pediatric Radiology survey of perioperative imaging in pediatric liver transplantation: (2) intraoperative imaging. Pediatr Radiol 2024; 54:269-275. [PMID: 38216682 PMCID: PMC10830587 DOI: 10.1007/s00247-023-05840-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 12/19/2023] [Accepted: 12/21/2023] [Indexed: 01/14/2024]
Abstract
BACKGROUND Liver transplantation is the state-of-the-art curative treatment for end-stage liver disease. Imaging is a key element in the detection of intraoperative and postoperative complications. So far, only limited data regarding the best radiological approach to monitor children during liver transplantation is available. OBJECTIVE To harmonize the imaging of pediatric liver transplantation, the European Society of Pediatric Radiology Abdominal Taskforce initiated a survey addressing the current status of imaging including the pre-, intra- and postoperative phase. This paper reports the responses related to intraoperative imaging. MATERIALS AND METHODS An online survey, initiated in 2021, asked European centers performing pediatric liver transplantation 48 questions about their imaging approach. In total, 26 centers were contacted, and 22 institutions from 11 countries returned the survey. RESULTS Intraoperative ultrasound (US) is used by all sites to assess the quality of the vascular anastomosis in order to ensure optimal perfusion of the liver transplant. Vessel depiction is commonly achieved using color Doppler (95.3%). Additional US-based techniques are employed by fewer centers (power angio mode, 28.6%; B-flow, 19%; contrast-enhanced US, 14.3%). Most centers prefer a collaborative approach, with surgeons responsible for probe handling, while radiologists operate the US machine (47.6%). Less commonly, the intraoperative US is performed by the surgeon alone (28.6%) or by the radiologist alone (23.8%). Timing of US, imaging frequency, and documentation practices vary among centers. CONCLUSION Intraoperative US is consistently utilized across all sites during pediatric liver transplantation. However, considerable variations were observed in terms of the US setup, technique preferences, timing of controls, and documentation practices. These differences provide valuable insights for future optimization and harmonization studies.
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Affiliation(s)
- Jochen Herrmann
- Section of Pediatric Radiology, Department of Diagnostic and Interventional Radiology and Nuclear Medicine, Universitätsklinikum Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
| | - Philippe Petit
- Department of Pediatric Radiology, Hôpital de La Timone: Hopital de La Timone, Marseille, France
| | | | - Martijn V Verhagen
- Department of Radiology, University Medical Centre Groningen: Universitair Medisch Centrum Groningen, Groningen, Netherlands
| | - Simon P McGuirk
- Department of Radiology, Birmingham Children's Hospital, Birmingham, UK
| | - Elena Dammann
- Section of Pediatric Radiology, Department of Diagnostic and Interventional Radiology and Nuclear Medicine, Universitätsklinikum Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Reinoud P H Bokkers
- Department of Radiology, University Medical Centre Groningen: Universitair Medisch Centrum Groningen, Groningen, Netherlands
| | | | | | - Francesco Tandoi
- Department of Hepatobiliary and Transplant Surgery, Azienda Ospedaliero-Universitaria Città Della Salute E Della Scienza Di Torino, Turin, Italy
| | | | - Hanna Hebelka
- Department of Radiology, The Institute of Clinical Sciences, Gothenburg, Sweden
| | - Charlotte de Lange
- Department of Radiology, The Institute of Clinical Sciences, Gothenburg, Sweden
- Department of Pediatric Radiology, Queen Silvia Children's Hospital: Sahlgrenska Universitetssjukhuset Drottning Silvias Barn- Och Ungdomssjukhus, Gothenburg, Sweden
| | - Cecile Lozach
- Department of Radiology, Hôpital Universitaire Necker-Enfants-Malades, Paris, France
| | - Paolo Marra
- Department of Radiology, Azienda Ospedaliera Ospedali Riuniti Di Bergamo: Aziende Socio Sanitarie Territoriale Papa Giovanni XXIII, University of Milano-Bicocca, Bergamo, Italy
| | - Darius Mirza
- Department of Hepatobiliary and Transplant Surgery, Birmingham Children's Hospital, Birmingham, UK
| | - Piotr Kaliciński
- Department of Pediatric Surgery and Organ Transplantation, The Children's Memorial Health Institute, Warsaw, Poland
| | - Janina M Patsch
- Department of Radiology, Medical University of Vienna, Vienna, Austria
| | - Giulia Perucca
- Department of Radiology, Great Ormond Street Hospital for Children, London, UK
- Department of Pediatric Radiology, Regina Margherita Children's Hospital, Turin, Italy
| | - Ilias Tsiflikas
- Department of Radiology, University Clinic of Tübingen, Tübingen, Germany
| | - Diane M Renz
- Department of Pediatric Radiology, Hannover Medical School: Medizinische Hochschule Hannover, Hannover, Germany
| | - Bernd Schweiger
- Department of Radiology, Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Clinic of Essen, Essen, Germany
| | - Marco Spada
- Division of Hepatobiliopancreatic Surgery, Liver and Kidney Transplantation, Ospedale Pediatrico Bambino Gesu, Rome, Italy
| | - Seema Toso
- Department of Pediatric Radiology, Geneva University Hospitals: Hopitaux Universitaires Geneve, Geneva, Switzerland
| | - Loïc Viremouneix
- Department of Radiology, Hôpital Femme Mère Enfant - Hospices Civils de Lyon, Bron, France
| | - Helen Woodley
- Department of Pediatric Radiology, Leeds Children's Hospital, Leeds, UK
| | - Lutz Fischer
- Department of Visceral Transplant Surgery, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Lil-Sofie Ording-Müller
- Department of Pediatric Radiology, Rikshospitalet University Hospital: Oslo Universitetssykehus Rikshospitalet, Oslo, Norway
| | - Florian Brinkert
- Department of Pediatric Gastroenterology and Hepatology, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
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Wang JL, Li J, Wang WQ, Lv X, Zhu RH, Yuan T, Zhang ZW, Zhang EL, Huang ZY. Portal vein velocity predicts portal vein system thrombosis after splenectomy with esophagogastric devascularization. Surg Endosc 2024; 38:648-658. [PMID: 38012440 DOI: 10.1007/s00464-023-10566-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 10/23/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND Portal vein system thrombosis (PVST) is a potentially fatal complication after splenectomy with esophagogastric devascularization (SED) in cirrhotic patients with portal hypertension. However, the impact of portal vein velocity (PVV) on PVST after SED remains unclear. Therefore, this study aims to explore this issue. METHODS Consecutive cirrhotic patients with portal hypertension who underwent SED at Tongji Hospital between January 2010 and June 2022 were enrolled. The patients were divided into two groups based on the presence or absence of PVST, which was assessed using ultrasound or computed tomography after the operation. PVV was measured by duplex Doppler ultrasound within one week before surgery. The independent risk factors for PVST were analyzed using univariate and multivariate logistic regression analysis. A nomogram based on these variables was developed and internally validated using 1000 bootstrap resamples. RESULTS A total of 562 cirrhotic patients with portal hypertension who underwent SED were included, and PVST occurred in 185 patients (32.9%). Multivariate logistic regression analysis showed that PVV was the strongest independent risk factor for PVST. The incidence of PVST was significantly higher in patients with PVV ≤ 16.5 cm/s than in those with PVV > 16.5 cm/s (76.2% vs. 8.5%, p < 0.0001). The PVV-based nomogram was internally validated and showed good performance (optimism-corrected c-statistic = 0.907). Decision curve and clinical impact curve analyses indicated that the nomogram provided a high clinical benefit. CONCLUSION A nomogram based on PVV provided an excellent preoperative prediction of PVST after splenectomy with esophagogastric devascularization.
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Affiliation(s)
- Jin-Lin Wang
- Hepatic Surgical Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jie Fang Avenue, Wuhan, 430030, China
| | - Jian Li
- Hepatic Surgical Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jie Fang Avenue, Wuhan, 430030, China
| | - Wen-Qiang Wang
- Hepatic Surgical Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jie Fang Avenue, Wuhan, 430030, China
| | - Xing Lv
- Hepatic Surgical Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jie Fang Avenue, Wuhan, 430030, China
| | - Rong-Hua Zhu
- Hepatic Surgical Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jie Fang Avenue, Wuhan, 430030, China
| | - Tong Yuan
- Hepatic Surgical Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jie Fang Avenue, Wuhan, 430030, China
| | - Zhi-Wei Zhang
- Hepatic Surgical Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jie Fang Avenue, Wuhan, 430030, China.
| | - Er-Lei Zhang
- Hepatic Surgical Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jie Fang Avenue, Wuhan, 430030, China.
| | - Zhi-Yong Huang
- Hepatic Surgical Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jie Fang Avenue, Wuhan, 430030, China.
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Kanaya K, Ichinohe F, Kitamura S, Aonuma T, Kaneko T, Yokota A, Horiuchi T. Contrast-enhanced CT rim sign may predict vestibular schwannoma adhesion and postoperative complications. Clin Radiol 2024; 79:e287-e294. [PMID: 37989668 DOI: 10.1016/j.crad.2023.10.024] [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] [Received: 01/06/2023] [Revised: 10/02/2023] [Accepted: 10/18/2023] [Indexed: 11/23/2023]
Abstract
AIM To investigate the clinical and radiological features to predict adhesion between vestibular schwannoma (VS) and brain tissue which is a critical risk factor for postoperative infarction and residual tumour. MATERIAL AND METHODS One hundred and seven consecutive VS surgeries were analysed. After excluding cases without contrast-enhanced (CE) computed tomography (CT), Koos grades 1 and 2, and cases with incomplete clinical data, 44 patients were finally included in the study. Enhancement of the tumour capsule on the brainstem side on CE-CT was defined as the CE-CT rim sign, which was analysed along with clinical characteristics, including tumour adhesion and postoperative complications. RESULTS Eight patients exhibited CE-CT rim signs; 17 had tumour adhesions. Four patients had postoperative infarction at the ipsilateral middle cerebellar peduncle; 18 exhibited postoperative infarction and/or residual tumour at the middle cerebellar peduncle. The CE-CT rim sign significantly correlated with tumour adhesion, postoperative infarction, and postoperative infarction and/or residual tumour in the cerebellar peduncle. Univariate regression analysis revealed that the CE-CT rim sign significantly correlated with tumour adhesion (odds ratio [OR] 6.81, 95% confidence interval [CI] 1.18-39.25, p=0.032) and postoperative infarction and/or residual tumour at the cerebellar peduncle (OR 6.00, 95% CI 1.04-34.31, p=0.044). CONCLUSION The CE-CT rim sign was identified in 18.2% of patients with VS and significantly correlated with tumour adhesion and postoperative complications, such as postoperative infarction and residual tumour. This study highlights the importance of the preoperative CE-CT rim sign in VS, which is predictive of tumour adhesion and postoperative complications.
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Affiliation(s)
- K Kanaya
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Nagano, Japan.
| | - F Ichinohe
- Department of Radiology, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - S Kitamura
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - T Aonuma
- Department of Radiology, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - T Kaneko
- Department of Radiology, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - A Yokota
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - T Horiuchi
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
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Piazza M, Squizzato F, Forcella E, Bilato MJ, Colacchio EC, Grego F, Antonello M. Effect of narrow paravisceral aorta on target vessel instability after fenestrated and branched endovascular aortic repair. J Vasc Surg 2024; 79:217-227.e1. [PMID: 37852334 DOI: 10.1016/j.jvs.2023.09.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 09/16/2023] [Accepted: 09/22/2023] [Indexed: 10/20/2023]
Abstract
OBJECTIVE To investigate the effect of narrow paravisceral aorta (NPA) on target vessel instability (TVI) after fenestrated-branched endovascular aortic repair. METHODS We conducted a single-center retrospective study (2014-2023) of patients treated by fenestrated-branched endovascular aortic repair for thoracoabdominal aortic aneurysms (TAAA) or pararenal aortic aneurysms. The paravisceral aorta was defined as the aortic segment limited by the diaphragmatic hiatus proximally and the emergence of lower renal artery distally, and was considered "narrow" in case of a minimum inner diameter of <25 mm. The minimum aortic diameter, location, longitudinal extension, angulation, calcification, and thrombus thickness of NPA were evaluated at the preoperative computed tomography angiogram. End points were 30-day technical success and freedom from TVI. RESULTS There were 142 patients with JRAA/pararenal aortic aneurysm (n = 85 [59%]) and extent IV (n = 24 [17%]) or extent I-III (n = 33 [23%]) TAAA, with 513 target arteries successfully incorporated through a fenestration (n = 294 [57%]) or directional branch (n = 219 [43%]). A NPA was present in 95 patients (70%), 73 (86%) treated by fenestrated endovascular aortic repair (FEVAR) and 22 (39%) by branched endovascular aortic repair (BEVAR). The overall 30-day mortality was 2% and technical success was 99%, without differences between NPA and non-NPA (P = .99). Kaplan-Meier estimated freedom from TVI at 4 years was 82%, 81% (95% CI, 75-95) in patients with a NPA and 80% (95% CI, 68-94) and in those without NPA (P = .220). The result was maintained for both FEVAR (NPA: 81% [95% CI, 62-88]; non-NPA: 76% [95% CI, 60-99]; P = .870) and BEVAR (NPA: 77% [95% CI, 69-99]; non-NPA: 80% [95% confidence interval (CI) 66-99]; P = .100). After multivariate analysis, the concomitant presence of a NPA <20 mm and angulation of >30° was significantly associated with TVI in FEVAR (HR, 3.21; 95% CI, 1.03-48.70; P = .036), being the result mostly driven by target vessel occlusion. In BEVAR, a NPA diameter of <25 mm was not associated with TVI (HR, 2.02; 95% CI, 0.59-5.23; P = .948); after multivariate analysis, the use of outer branches in case of a NPA longitudinal extension of >25 mm (hazard ratio [HR], 3.02; 95% CI, 1.01-36.33; P = .040) and NPA severe calcification (HR, 1.70; 95% CI, 1.00-22.42; P = .048) were associated with a higher chance for TVI. CONCLUSIONS FEVAR and BEVAR are both feasible in cases of NPA and provide satisfactory target vessels durability. The use of outer branches should be avoided in cases with an inner aortic diameter of <25 mm with a longitudinal extension of >25 mm or moderate to severe NPA calcifications. In FEVAR, bridging stent patency may be negatively influenced by NPA of <20 mm in association with aortic angulation of >30°.
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Affiliation(s)
- Michele Piazza
- Vascular and Endovascular Surgery Division, Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, Padova University, Padova, Italy.
| | - Francesco Squizzato
- Vascular and Endovascular Surgery Division, Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, Padova University, Padova, Italy
| | - Edoardo Forcella
- Vascular and Endovascular Surgery Division, Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, Padova University, Padova, Italy
| | - Marco James Bilato
- Vascular and Endovascular Surgery Division, Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, Padova University, Padova, Italy
| | - Elda Chiara Colacchio
- Vascular and Endovascular Surgery Division, Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, Padova University, Padova, Italy
| | - Franco Grego
- Vascular and Endovascular Surgery Division, Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, Padova University, Padova, Italy
| | - Michele Antonello
- Vascular and Endovascular Surgery Division, Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, Padova University, Padova, Italy
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Bush S, Klimo P, Onar-Thomas A, Huang J, Boop FA, Gajjar A, Robinson GW, Khan RB. Application of the Rotterdam postoperative cerebellar mutism syndrome prediction model in patients undergoing surgery for medulloblastoma in a single institution. J Neurosurg Pediatr 2024; 33:174-178. [PMID: 38000061 PMCID: PMC10810679 DOI: 10.3171/2023.9.peds23160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 09/25/2023] [Indexed: 11/26/2023]
Abstract
OBJECTIVE Postoperative cerebellar mutism syndrome (CMS) develops in up to 40% of children with medulloblastoma. The Rotterdam model (RM) has been reported to predict a 66% risk of CMS in patients with a score of ≥ 100. The aim of this study was to retrospectively apply the RM to an independent cohort of patients with newly diagnosed medulloblastoma and study the applicability of the RM in predicting postoperative CMS. METHODS Participants had to have their first tumor resection at the authors' institution and be enrolled in the SJMB12 protocol (NCT01878617). All participants underwent structured serial neurological evaluations before and then periodically after completing radiation therapy. Imaging was reviewed by the study neurologist who was blinded to CMS status when reviewing the scans and retrospectively applied RM score to each participant. RESULTS Forty participants were included (14 females and 26 males). Four (10%) patients had CMS. The median age at tumor resection was 11.7 years (range 3.5-17.8 years). Tumor location was midline in 30 (75%), right lateral in 6 (15%), and left lateral in 4 (10%). The median Evans index was 0.3 (range 0.2-0.4), and 34 (85%) patients had an Evans index ≥ 0.3. Five participants required a ventricular shunt. The median tumor volume was 51.97 cm3 (range 20.13-180.58 cm3). Gross-total resection was achieved in 35 (87.5%) patients, near-total resection in 4 (10%), and subtotal in 1. The median RM score was 90 (range 25-145). Eighteen participants had an RM score of ≥ 100, and of these 16.7% (n = 3) had CMS. Of the 22 patients with an RM score < 100, 1 child developed CMS (4.5%, CI 0.1%-22.8%); 3 of the 18 patients with an RM score ≥ 100 developed CMS (16.7%, CI 3.6%-41.4%). The observed rate of CMS in the cohort of children with an RM score ≥ 100 was significantly lower than the observed rate in the original RM cohort (66.7%, CI 51%-80.0%, p < 0.001). A greater risk of CMS in patients with an RM score ≥ 100 could not be confirmed (p = 0.31). CONCLUSIONS At the authors' institution, the incidence of CMS in patients who had an RM ≥ 100 was significantly lower than the RM cohort. These findings raise questions regarding generalizability of RM; however, fewer cases of CMS and a relatively small cohort limit this conclusion.
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Affiliation(s)
- Savannah Bush
- University of Tennessee, School of Medicine, Memphis
| | - Paul Klimo
- Department of Neurosurgery, University of Tennessee, Memphis
| | | | | | | | | | | | - Raja B. Khan
- Division of Neurology, St. Jude Children’s Research Hospital, Memphis, Tennessee
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Dammann E, Ording-Müller LS, Franchi-Abella S, Verhagen MV, McGuirk SP, Bokkers RPH, Clapuyt PRM, Deganello A, Tandoi F, de Ville de Goyet J, Hebelka H, de Lange C, Lozach C, Marra P, Mirza D, Kaliciński P, Patsch JM, Perucca G, Tsiflikas I, Renz DM, Schweiger B, Spada M, Toso S, Viremouneix L, Woodley H, Fischer L, Brinkert F, Petit P, Herrmann J. European Society of Pediatric Radiology survey of perioperative imaging in pediatric liver transplantation: (3) postoperative imaging. Pediatr Radiol 2024; 54:276-284. [PMID: 38285190 PMCID: PMC10830633 DOI: 10.1007/s00247-023-05842-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 12/20/2023] [Accepted: 12/21/2023] [Indexed: 01/30/2024]
Abstract
BACKGROUND Liver transplantation is the state-of-the-art curative treatment for end-stage liver disease. Imaging is a key element in the detection of postoperative complications. So far, limited data is available regarding the best radiologic approach to monitor children after liver transplantation. OBJECTIVE To harmonize the imaging of pediatric liver transplantation, the European Society of Pediatric Radiology Abdominal Taskforce initiated a survey addressing the current status of imaging including the pre-, intra-, and postoperative phases. This paper reports the responses related to postoperative imaging. MATERIALS AND METHODS An online survey, initiated in 2021, asked European centers performing pediatric liver transplantation 48 questions about their imaging approach. In total, 26 centers were contacted, and 22 institutions from 11 countries returned the survey. RESULTS All sites commence ultrasound (US) monitoring within 24 h after liver transplantation. Monitoring frequency varies across sites, ranging from every 8 h to 72 h in early, and from daily to sporadic use in late postoperative phases. Predefined US protocols are used by 73% of sites. This commonly includes gray scale, color Doppler, and quantitative flow assessment. Alternative flow imaging techniques, contrast-enhanced US, and elastography are applied at 31.8%, 18.2%, and 63.6% of sites, respectively. Computed tomography is performed at 86.4% of sites when clarification is needed. Magnetic resonance imaging is used for selected cases at 36.4% of sites, mainly for assessment of biliary abnormalities or when blood tests are abnormal. CONCLUSION Diagnostic imaging is extensively used for postoperative surveillance of children after liver transplantation. While US is generally prioritized, substantial differences were noted in US protocol, timing, and monitoring frequency. The study highlights potential areas for future optimization and standardization of imaging, essential for conducting multicenter studies.
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Affiliation(s)
- Elena Dammann
- Section of Pediatric Radiology, Department of Diagnostic and Interventional Radiology and Nuclear Medicine, Universitätsklinikum Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Lil-Sofie Ording-Müller
- Department of Pediatric Radiology, Rikshospitalet University Hospital: Oslo universitetssykehus Rikshospitalet, Oslo, Norway
| | | | - Martijn V Verhagen
- Department of Radiology, University Medical Centre Groningen: Universitair Medisch Centrum Groningen, Groningen, Netherlands
| | - Simon P McGuirk
- Department of Radiology, Birmingham Children's Hospital, Birmingham, UK
| | - Reinoud P H Bokkers
- Department of Radiology, University Medical Centre Groningen: Universitair Medisch Centrum Groningen, Groningen, Netherlands
| | | | | | - Francesco Tandoi
- Department of Hepatobiliary and Transplant Surgery, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | | | - Hanna Hebelka
- Department of Radiology, The Institute of Clinical Sciences, Gothenburg, Sweden
| | - Charlotte de Lange
- Department of Radiology, The Institute of Clinical Sciences, Gothenburg, Sweden
- Department of Pediatric Radiology, Queen Silvia Children's Hospital, Gothenburg, Sweden
| | - Cecile Lozach
- Department of Radiology, Hôpital Universitaire Necker-Enfants-Malades, Paris, France
| | - Paolo Marra
- Department of Radiology, Azienda Ospedaliera Ospedali Riuniti di Bergamo: Aziende Socio Sanitarie Territoriale Papa Giovanni XXIII, Bergamo, Italy
| | - Darius Mirza
- Department of Hepatobiliary and Transplant Surgery, Birmingham Children's Hospital, Birmingham, UK
| | - Piotr Kaliciński
- Department of Pediatric Surgery and Organ Transplantation, The Children's Memorial Health Institute, Warsaw, Poland
| | - Janina M Patsch
- Department of Radiology, Medical University of Vienna, Vienna, Austria
| | - Giulia Perucca
- Department of Radiology, Great Ormond Street Hospital for Children, London, UK
- Department of Pediatric Radiology, Regina Margherita Children's Hospital, Turin, Italy
| | - Ilias Tsiflikas
- Department of Radiology, University Clinic of Tübingen, Tübingen, Germany
| | - Diane M Renz
- Department of Pediatric Radiology, Hannover Medical School: Medizinische Hochschule Hannover, Hannover, Germany
| | - Bernd Schweiger
- Department of Radiology, Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Clinic of Essen, Essen, Germany
| | - Marco Spada
- Division of Hepatobiliopancreatic Surgery, Liver and Kidney Transplantation, Bambino Gesù Children's Hospital, Rome, Italy
| | - Seema Toso
- Department of Pediatric Radiology, Geneva University Hospitals: Hopitaux Universitaires Geneve, Geneva, Switzerland
| | - Loïc Viremouneix
- Department of Radiology, Hôpital Femme Mère Enfant - Hospices Civils de Lyon, Bron, France
| | - Helen Woodley
- Department of Pediatric Radiology, Leeds Children's Hospital, Leeds, UK
| | - Lutz Fischer
- Department of Visceral Transplant Surgery, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Florian Brinkert
- Department of Pediatric Gastroenterology and Hepatology, Universitätsklinikum Hamburg- Eppendorf, Hamburg, Germany
| | - Philippe Petit
- Department of Pediatric Radiology, Aix Marseille University, Hôpital Timone Enfants, Marseille, France
| | - Jochen Herrmann
- Section of Pediatric Radiology, Department of Diagnostic and Interventional Radiology and Nuclear Medicine, Universitätsklinikum Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
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Wang M, Zhou R, Wang X, Wu J, Shen Y, Qiu Y, Sun X, Zhou D. Validation of age-adjusted pelvic incidence minus lumbar lordosis and lordosis distribution index for assessing adjacent-segment disease after short-level lumbar fusion surgery: minimum 5 years of follow-up. J Neurosurg Spine 2024; 40:143-151. [PMID: 37948690 DOI: 10.3171/2023.8.spine23393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 08/17/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVE The purpose of this study was to investigate the influence of sagittal alignment according to age-adjusted pelvic incidence minus lumbar lordosis (PI-LL) and lordosis distribution index (LDI) on the occurrence of adjacent-segment disease (ASD) after lumbar fusion surgery. METHODS This study retrospectively reviewed 234 consecutive patients with lumbar degenerative diseases who underwent 1- or 2-level lumbar fusion surgery. Demographic and radiographic (preoperative and 3-month postoperative) data were collected and compared between ASD and non-ASD groups. Binary logistic regression analysis was performed to evaluate adjusted associations between potential variables and ASD development. A subanalysis was further conducted to assess their relationships in the range of different PI values. RESULTS With a mean follow-up duration of 70.6 months (range 60-121 months), 118 patients (50.4%) were diagnosed as having cranial radiological ASD. Univariate analyses showed that older age, 2-level fusion, worse preoperative pelvic tilt and LL, lower pre- and postoperative LDI, and more improvement in sagittal vertical axis were significantly correlated with the occurrence of ASD. No significant differences in the PI-LL and age-adjusted PI-LL (offset) were detected between ASD and non-ASD groups. Multivariate analysis identified postoperative LDI (OR 0.971, 95% CI 0.953-0.989, p = 0.002); 2-level fusion (OR 3.477, 95% CI 1.964-6.157, p < 0.001); and improvement of sagittal vertical axis (OR 0.992, 95% CI 0.985-0.998, p = 0.039) as the independent variables for predicting the occurrence of ASD. When stratified by PI, LDI was identified as an independent risk factor in the groups with low and average PI. Lower segmental lordosis (OR 0.841, 95% CI 0.742-0.954, p = 0.007) could significantly increase the incidence of ASD in the patients with high LDI. CONCLUSIONS Age-adjusted PI-LL may have limited ability to predict the development of ASD. LDI could exert an important effect on diagnosing the occurrence of ASD in the cases with low and average PI, but segmental lordosis was a more significant risk factor than LDI in individuals with high PI.
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Affiliation(s)
- Muyi Wang
- 1Department of Orthopedics, The Affiliated Changzhou Second People's Hospital of Nanjing Medical University, Changzhou
- 4Changzhou Medical Center, Nanjing Medical University, Changzhou, Jiangsu Province, China
| | - Ruikai Zhou
- 1Department of Orthopedics, The Affiliated Changzhou Second People's Hospital of Nanjing Medical University, Changzhou
- 4Changzhou Medical Center, Nanjing Medical University, Changzhou, Jiangsu Province, China
| | - Xin Wang
- 1Department of Orthopedics, The Affiliated Changzhou Second People's Hospital of Nanjing Medical University, Changzhou
- 4Changzhou Medical Center, Nanjing Medical University, Changzhou, Jiangsu Province, China
| | - Jingbin Wu
- 1Department of Orthopedics, The Affiliated Changzhou Second People's Hospital of Nanjing Medical University, Changzhou
- 4Changzhou Medical Center, Nanjing Medical University, Changzhou, Jiangsu Province, China
| | - Yifei Shen
- 1Department of Orthopedics, The Affiliated Changzhou Second People's Hospital of Nanjing Medical University, Changzhou
- 4Changzhou Medical Center, Nanjing Medical University, Changzhou, Jiangsu Province, China
| | - Yong Qiu
- 2Department of Orthopedic Surgery, Division of Spine Surgery, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing
| | - Xu Sun
- 2Department of Orthopedic Surgery, Division of Spine Surgery, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing
| | - Dong Zhou
- 1Department of Orthopedics, The Affiliated Changzhou Second People's Hospital of Nanjing Medical University, Changzhou
- 3Department of Orthopedics, Changzhou No. 6 People's Hospital, Changzhou; and
- 4Changzhou Medical Center, Nanjing Medical University, Changzhou, Jiangsu Province, China
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Di Lorenzo S, Carrillo Lizarazo JL, Dionigi G, Kraimps JL, Donatini G. Impact of near-infrared fluorescence imaging plus indocyanine green fluorescence on postoperative hypoparathyroidism rates after total thyroidectomy and central neck lymph node dissection. Br J Surg 2024; 111:znae022. [PMID: 38381933 DOI: 10.1093/bjs/znae022] [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] [Received: 09/14/2023] [Revised: 11/16/2023] [Accepted: 01/06/2024] [Indexed: 02/23/2024]
Abstract
BACKGROUND Patients with thyroid carcinoma often undergo cervical lymph node dissection, which is associated with high rates of both transient and permanent postoperative hypoparathyroidism. The impact of near-infrared fluorescence imaging + indocyanine green (ICG) fluorescence on postoperative hypoparathyroidism rates after total thyroidectomy and central neck lymph node dissection was evaluated. METHODS All patients undergoing surgery between January 2019 and March 2023 were included and divided into three groups: a control group (parathyroid glands identified visually), a near-infrared fluorescence imaging alone group, and a near-infrared fluorescence imaging + ICG fluorescence group. The primary outcome was the transient and permanent postoperative hypoparathyroidism rates. Secondary outcomes were: length of surgery and number of parathyroid glands identified, inadvertently resected, and autotransplanted. RESULTS A total of 131 patients were included in the study (47 in the control group, 45 in the near-infrared fluorescence imaging alone group, and 39 in the near-infrared fluorescence imaging + ICG fluorescence group). The transient hypoparathyroidism rate was 48.9% in the control group, 37.8% in the near-infrared fluorescence imaging alone, and 5.1% in the near-infrared fluorescence imaging + ICG fluorescence group (P < 0.0001), while the permanent hypoparathyroidism rate was 8.5% in the control group, 2.2% in the near-infrared fluorescence imaging alone group, and 0% in the near-infrared fluorescence imaging + ICG fluorescence group (P = 0.096). The number of parathyroid glands identified was 159 of 188 in the control group, 165 of 180 in the near-infrared fluorescence imaging alone group, and 149 of 156 in the near-infrared fluorescence imaging + ICG fluorescence group (P = 0.002). Inadvertent resection of parathyroid glands occurred for 29 of 188 in the control group, 15 of 180 in the near-infrared fluorescence imaging alone group, and 7 of 156 in the near-infrared fluorescence imaging + ICG fluorescence group (P = 0.002), with subsequent parathyroid gland autotransplantation for 2 of 29 in the control group, 2 of 15 in the near-infrared fluorescence imaging alone group, and 3 of 7 in the near-infrared fluorescence imaging + ICG fluorescence group (P = 0.040). There was no difference in the median operating time between groups. CONCLUSION The use of near-infrared fluorescence imaging + ICG fluorescence decreased both transient and permanent hypoparathyroidism rates in patients undergoing total thyroidectomy and central neck lymph node dissection.
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Affiliation(s)
- Sofia Di Lorenzo
- Department of General and Endocrine Surgery, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
- Endocrine and Metabolic Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Jose Luis Carrillo Lizarazo
- Department of General and Endocrine Surgery, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
- Department of Surgery, Oncology and Gastroenterology, University Hospital of Padua, Padua, Italy
| | | | - Jean-Louis Kraimps
- Department of General and Endocrine Surgery, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
| | - Gianluca Donatini
- Department of General and Endocrine Surgery, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
- Unité INSERM 1313-IRMETIST, Université de Poitiers, Poitiers, France
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Asada T, Singh S, Maayan O, Shahi P, Singh N, Subramanian T, Araghi K, Korsun M, Tuma O, Pajak A, Lu A, Mai E, Kim YE, Dowdell J, Sheha ED, Iyer S, Qureshi SA. Impact of Frailty and Cervical Radiographic Parameters on Postoperative Dysphagia Following Anterior Cervical Spine Surgery. Spine (Phila Pa 1976) 2024; 49:81-89. [PMID: 37661809 DOI: 10.1097/brs.0000000000004815] [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: 04/11/2023] [Accepted: 08/19/2023] [Indexed: 09/05/2023]
Abstract
STUDY DESIGN Retrospective review of a prospectively collected registry. OBJECTIVE The purpose of the present study was to investigate the impact of frailty and radiographical parameters on postoperative dysphagia after anterior cervical spine surgery (ACSS). SUMMARY OF BACKGROUND DATA There is a growing body of literature indicating an association between frailty and increased postoperative complications following various surgeries. However, few studies have investigated the relationship between frailty and postoperative dysphagia after anterior cervical spine surgery. MATERIALS AND METHODS Patients who underwent anterior cervical spine surgery for the treatment of degenerative cervical pathology were included. Frailty and dysphagia were assessed by the modified Frailty Index-11 (mFI-11) and Eat Assessment Tool 10 (EAT-10), respectively. We also collected clinical demographics and cervical alignment parameters previously reported as risk factors for postoperative dysphagia. Multivariable logistic regression was performed to identify the odds ratio (OR) of postoperative dysphagia at early (2-6 weeks) and late postoperative time points (1-2 years). RESULTS Ninety-five patients who underwent ACSS were included in the study. Postoperative dysphagia occurred in 31 patients (32.6%) at the early postoperative time point. Multivariable logistic regression identified higher mFI-11 score (OR, 4.03; 95% CI: 1.24-13.16; P =0.021), overcorrection of TS-CL after surgery (TS-CL, T1 slope minus C2-C7 lordosis; OR, 0.86; 95% CI: 0.79-0.95; P =0.003), and surgery at C3/C4 (OR, 12.38; 95% CI: 1.41-108.92; P =0.023) as factors associated with postoperative dysphagia. CONCLUSIONS Frailty, as assessed by the mFI-11, was significantly associated with postoperative dysphagia after ACSS. Additional factors associated with postoperative dysphagia were overcorrection of TS-CL and surgery at C3/C4. These findings emphasize the importance of assessing frailty and cervical alignment in the decision-making process preceding ACSS.
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Affiliation(s)
- Tomoyuki Asada
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY
- Department of Orthopaedic Surgery, Institute of Medicine, University of Tsukuba, Tsukuba, Ibaraki Prefecture, Japan
| | - Sumedha Singh
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY
| | - Omri Maayan
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY
| | - Pratyush Shahi
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY
| | - Nishtha Singh
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY
| | - Tejas Subramanian
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY
| | - Kasra Araghi
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY
| | - Maximilian Korsun
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY
| | - Olivia Tuma
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY
| | - Anthony Pajak
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY
| | - Amy Lu
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY
| | - Eric Mai
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY
| | - Yeo Eun Kim
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY
| | - James Dowdell
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY
| | - Evan D Sheha
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY
| | - Sravisht Iyer
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY
| | - Sheeraz A Qureshi
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY
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Bai J, Liu S, Liu C, Zhao Y, Li M. Proximal junctional kyphosis in Lenke 5C adolescent idiopathic scoliosis after selective posterior thoracolumbar/lumbar fusion: risk factors and predictive index. J Orthop Surg Res 2024; 19:24. [PMID: 38167043 PMCID: PMC10763114 DOI: 10.1186/s13018-023-04470-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 12/13/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Although several studies have reported that selective posterior thoracolumbar/lumbar (TL/L) fusion can yield satisfactory results in Lenke 5C adolescent idiopathic scoliosis (AIS), the proximal junctional kyphosis (PJK) is still a common complication that occurs after surgery. The purpose of this study is to analyse the risk factors for postoperative proximal junctional kyphosis in Lenke 5C patients who underwent selective posterior TL/L fusion and explore whether PJK can be predicted. METHODS A total of 83 AIS patients with Lenke 5C curves who met the inclusion criteria were analysed. All patients were divided into two groups based on the occurrence of postoperative PJK. Univariate and multivariate analyses were used to identify independent factors significantly associated with PJK, and an PJK index was proposed and verified. RESULTS PJK was observed in 27 of 83 (32.5%) patients in the study. Preoperative thoracic kyphosis (TK) and the immediate postoperative proximal junctional angle (PJA) were the primary factors identified by the binary logistic regression analysis. The PJK index was defined as 1.1× preoperative TK + 2.3× immediate postoperative PJA. The receiver operating characteristics curve indicated that the occurrence rate of PJK was 85% and non-occurrence rate was 82% when the PJK index was greater than 42. CONCLUSION Large preoperative TK and a large immediate postoperative PJA play important roles in the development of PJK in Lenke 5C patients treated with selective posterior thoracolumbar/lumbar fusion. The PJK index can be used to predict the occurrence of PJK with high accuracy. To prevent the occurrence of PJK, we should pay attention to the TLK, and preserving more posterior proximal intervertebral elements at the upper instrumented vertebral level would be an important part of corrective surgery; however, moderate correction of the lumbar curve is recommended.
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Affiliation(s)
- Jinyi Bai
- Department of Orthopedics,Changhai Hospital of the Second Military Medical University, Shanghai, China
| | - Shu Liu
- Department of Orthopedics,Changhai Hospital of the Second Military Medical University, Shanghai, China
| | - Chen Liu
- Department of Orthopedics,Changhai Hospital of the Second Military Medical University, Shanghai, China
| | - Yingchuan Zhao
- Department of Orthopedics, Shanghai Tenth People's Hospital, Shanghai, China.
| | - Ming Li
- Department of Orthopedics,Changhai Hospital of the Second Military Medical University, Shanghai, China.
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Siddiqui S, Miller M, Dumont A, Delashaw J, Wang A. Iatrogenic Cerebrospinal Fluid Breast Augmentation: Rare Complication of Ventriculoperitoneal Shunts and Management Strategies. World Neurosurg 2024; 181:e743-e751. [PMID: 37898269 DOI: 10.1016/j.wneu.2023.10.120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 10/24/2023] [Indexed: 10/30/2023]
Abstract
BACKGROUND Ventriculoperitoneal shunt is one of the most common neurosurgical procedures in the treatment of hydrocephalus. There are reports of migration of the distal catheter to the breast pocket where cerebrospinal fluid then collects and can develop into a pseudocyst. There exist case reports in the literature of patients with prior breast augmentation who present with distal catheter migration from the peritoneal space into the breast tissue. We present a case series of 3 patients with preexisting breast augmentation who returned with unilateral breast enlargement after ventriculoperitoneal shunt. In all 3 patients, the distal catheter migrated out of the peritoneal space and was found to be coiled around the breast prosthesis. Additionally, we offer recommendations for managing these complications and a review of the literature. METHODS We performed a systematic review without meta-analysis of studies involving management of shunt migration in the setting of preexisting breast implants. We present a case series of 3 patients whom we treated with breast cerebrospinal pseudocyst after migration of the distal catheter into the breast tissue. RESULTS A total of 17 studies, dating from 2002 to 2022, met our inclusion and exclusion criteria and were selected for full review. Catheter migration occurred between 2 weeks and 9 months of initial shunt placement. All patients presented with unilateral breast enlargement and cerebrospinal fluid pseudocyst formation. All patients underwent revision shunt surgery. Surgical treatment strategies used included reimplantation of the distal catheter into the pleural space or ipsilateral or contralateral peritoneal space or complete removal of the entire shunt system. CONCLUSIONS Breast-related ventriculoperitoneal shunt complication is a rare entity that is increasingly seen as more patients receive breast augmentation. Breast-related shunt complications most commonly present with cerebrospinal fluid pseudocyst formation in the breast. It is important for neurosurgeons to be aware of an underlying breast implant before placing a ventriculoperitoneal shunt. For patients who have migration of the distal catheter into the breast, a protocol for managing these situations should be followed to ensure no shunt infection and avoidance of future catheter migration complications with subsequent shunt revisions.
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Affiliation(s)
- Sarah Siddiqui
- Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Michelle Miller
- Department of Neurological Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Aaron Dumont
- Department of Neurological Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Johnny Delashaw
- Department of Neurological Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Arthur Wang
- Department of Neurological Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA.
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Demirbaglar CC, Cil OC, Ozturk MO, Tezcan E, Guclu O. Evaluation of Periorbital Edema and Ecchymosis After Osteotomy in Septorhinoplasty Cases by Measuring Bone Density and Thickness. J Craniofac Surg 2024; 35:e66-e71. [PMID: 38011627 DOI: 10.1097/scs.0000000000009848] [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] [Received: 02/14/2023] [Accepted: 10/05/2023] [Indexed: 11/29/2023] Open
Abstract
PURPOSE Periorbital edema and ecchymosis that may occur after surgery in septorhinoplasty patients who have undergone lateral osteotomy are common morbidities and are seen as the main limiting factors for the recovery process of the patients. There are many different studies in the literature about the causes of periorbital edema and ecchymosis. In this study, the authors aimed to investigate the possible relationships between the bone density and bone thickness measured in the frontal process of the maxillary bone, and postoperative periorbital edema and ecchymosis, which are suitable for the osteotomy lines that they will detect in computerized tomography. METHODS Between January 1, 2019 and November 11, 2020, 59 patients whose nasal pathologies were determined by paranasal sinus computed tomography examination due to nasal deformity and nasal deformity and who underwent septorhinoplasty operation were included in this study. Bone density and thickness measurements were performed on the frontal process of the maxillary bone in accordance with the lateral osteotomy lines on the lateral nasal wall in each patient, right and left side. According to the bone density values measured at the point determined on the lateral osteotomy line, 2 groups were formed as "very dense" and "less dense." According to the bone thickness values of the patients, 2 groups were determined as "thick" and "thin." Thus, the authors investigated the relationship between periorbital edema and ecchymosis on the postoperative first, third, and seventh days obtained from the examination files of the patients. FINDINGS When bone density subgroups are examined, it has been shown that the degree of periorbital edema of the patients in the "very dense" and "less dense" group categories decreased from the first day to the seventh postoperative day. The degrees of periorbital edema on the third postoperative day were statistically higher in the "less dense" group than in the "very dense" group. In the authors' study, no correlation was found between the degrees of postoperative periorbital edema and ecchymosis and bone density subgroups on other days. While an increase was observed in the periorbital ecchymosis grades of the patients in the "less dense" subgroup category from the first day to the third postoperative day, the periorbital ecchymosis grades of the patients in the "very dense" subgroup category decreased from the first day to the third day. In both subgroups, the lowest periorbital ecchymosis levels were observed on the postoperative seventh day.When bone thickness subgroups are examined, it has been shown that the degree of periorbital edema of the patients in the "thick" and "thin" group categories decreases from the first day to the seventh day postoperatively. When the bone thickness subgroups were examined, the periorbital ecchymosis degrees of the patients in the "thick" and "thin" group categories increased on the third postoperative day, while it reached the lowest level on the postoperative seventh day. There was no significant difference between the first, third, and seventh-day periorbital edema and ecchymosis conditions in the "thick" and "thin" groups. CONCLUSION The authors observed that periorbital edema and ecchymosis that may occur after septorhinoplasty can be affected by the variable features of the lateral nasal wall bone structure. The authors conclude that the changes in the healing process can be affected by different bone density values in particular.
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Churchill LJ, Tronstad O, Mandrusiak AM, Waldmann JY, Thomas PJ. The role of lung ultrasound for detecting atelectasis, consolidation, and/or pneumonia in the adult cardiac surgery population: A scoping review of the literature. Aust Crit Care 2024; 37:193-201. [PMID: 37709655 DOI: 10.1016/j.aucc.2023.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 07/19/2023] [Accepted: 08/10/2023] [Indexed: 09/16/2023] Open
Abstract
OBJECTIVES Postoperative pulmonary complications (PPCs) frequently occur after cardiac surgery and may lead to adverse patient outcomes. Traditional diagnostic tools such as auscultation or chest x-ray have inferior diagnostic accuracy compared to the gold standard (chest computed tomography). Lung ultrasound (LUS) is an emerging area of research combating these issues. However, no review has employed a formal search strategy to examine the role of LUS in identifying the specific PPCs of atelectasis, consolidation, and/or pneumonia or investigated the ability of LUS to predict these complications in this cohort. The objective of this study was to collate and present evidence for the use of LUS in the adult cardiac surgery population to specifically identify atelectasis, consolidation, and/or pneumonia. REVIEW METHOD USED A scoping review of the literature was completed using predefined search terms across six databases which identified 1432 articles. One additional article was included from reviewing reference lists. Six articles met the inclusion criteria, providing sufficient data for the final analysis. DATA SOURCES Six databases were searched: MEDLINE, Embase, CINAHL, Scopus, CENTRAL, and PEDro. This review was not registered. REVIEW METHODS The review followed the PRISMA Extension for Scoping Reviews. RESULTS Several LUS methodologies were reported across studies. Overall, LUS outperformed all other included bedside diagnostic tools, with superior diagnostic accuracy in identifying atelectasis, consolidation, and/or pneumonia. Incidences of PPCs tended to increase with each subsequent timepoint after surgery and were better identified with LUS than all other assessments. A change in diagnosis occurred at a rate of 67% with the inclusion of LUS and transthoracic echocardiography in one study. Pre-established assessment scores were improved by substituting chest x-rays with LUS scans. CONCLUSION The results of this scoping review support the use of LUS as a diagnostic tool after cardiac surgery; however, they also highlighted a lack of consistent methodologies used. Future research is required to determine the optimal methodology for LUS in diagnosing PPCs in this cohort and to determine whether LUS possesses the ability to predict these complications and guide proactive respiratory supports after extubation.
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Affiliation(s)
- Luke J Churchill
- Physiotherapy Department, The Prince Charles Hospital, Chermside, QLD, 4032, Australia; School of Rehabilitation and Health Sciences, The University of Queensland, QLD, 4072, Australia; Critical Care Research Group, The Prince Charles Hospital, Chermside, QLD, 4032, Australia.
| | - Oystein Tronstad
- Physiotherapy Department, The Prince Charles Hospital, Chermside, QLD, 4032, Australia; Critical Care Research Group, The Prince Charles Hospital, Chermside, QLD, 4032, Australia.
| | - Allison M Mandrusiak
- School of Rehabilitation and Health Sciences, The University of Queensland, QLD, 4072, Australia.
| | - Jana Y Waldmann
- Library Services, The Prince Charles Hospital, Chermside, QLD, 4032, Australia.
| | - Peter J Thomas
- Department of Physiotherapy, Royal Brisbane and Women's Hospital, Herston, Australia; Department of Intensive Care, Royal Brisbane and Women's Hospital, Herston, Australia.
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Long B, Cremat DL, Serpa E, Qian S, Blebea J. Applying Artificial Intelligence to Predict Complications After Endovascular Aneurysm Repair. Vasc Endovascular Surg 2024; 58:65-75. [PMID: 37429299 DOI: 10.1177/15385744231189024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/12/2023]
Abstract
Objective: Complications after Endovascular Aneurysm Repair (EVAR) can be fatal. Patient follow-up for surveillance imaging is becoming more challenging as fewer patients are seen, particularly after the first year. The aim of this study was to develop an artificial intelligence model to predict the complication probability of individual patients to better identify those needing more intensive post-operative surveillance. Methods: Pre-operative CTA 3D reconstruction images of AAA from 273 patients who underwent EVAR from 2011-2020 were collected. Of these, 48 patients had post-operative complications including endoleak, AAA rupture, graft limb occlusion, renal artery occlusion, and neck dilation. A deep convolutional neural network model (VascAI©) was developed which utilized pre-operative 3D CT images to predict risk of complications after EVAR. The model was built with TensorFlow software and run on the Google Colab Platform. An initial training subset of 40 randomly selected patients with complications and 189 without were used to train the AI model while the remaining 8 positive and 36 negative cases tested its performance and prediction accuracy. Data down-sampling was used to alleviate data imbalance and data augmentation methodology to further boost model performance. Results: Successful training was completed on the 229 cases in the training set and then applied to predict the complication probability of each individual in the held-out performance testing cases. The model provided a complication sensitivity of 100% and identified all the patients who later developed complications after EVAR. Of 36 patients without complications, 16 (44%) were falsely predicted to develop complications. The results therefore demonstrated excellent sensitivity for identifying patients who would benefit from more stringent surveillance and decrease the frequency of surveillance in 56% of patients unlike to develop complications. Conclusion: AI models can be developed to predict the risk of post-operative complications with high accuracy. Compared to existing methods, the model developed in this study did not require any expert-annotated data but only the AAA CTA images as inputs. This model can play an assistive role in identifying patients at high risk for post-EVAR complications and the need for greater compliance in surveillance.
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Affiliation(s)
- Becky Long
- Department of Surgery, College of Medicine, Central Michigan University, Saginaw, MI, USA
| | - Danielle L Cremat
- Department of Surgery, College of Medicine, Central Michigan University, Saginaw, MI, USA
| | - Eduardo Serpa
- Department of Surgery, College of Medicine, Central Michigan University, Saginaw, MI, USA
| | - Sinong Qian
- Department of Surgery, College of Medicine, Central Michigan University, Saginaw, MI, USA
| | - John Blebea
- Department of Surgery, College of Medicine, Central Michigan University, Saginaw, MI, USA
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Gaballah AH, Kazi IA, Zaheer A, Liu PS, Badawy M, Moshiri M, Ibrahim MK, Soliman M, Kimchi E, Elsayes KM. Imaging after Pancreatic Surgery: Expected Findings and Postoperative Complications. Radiographics 2024; 44:e230061. [PMID: 38060424 DOI: 10.1148/rg.230061] [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: 12/18/2023]
Abstract
Pancreatic surgery is considered one of the most technically challenging surgical procedures, despite the evolution of modern techniques. Neoplasms remain the most common indication for pancreatic surgery, although inflammatory conditions may also prompt surgical evaluation. The choice of surgical procedure depends on the type and location of the pathologic finding because different parts of the pancreas have separate vascular supplies that may be shared by adjacent organs. The surgical approach could be conventional or minimally invasive (laparoscopic, endoscopic, or robotic assisted). Because of the anatomic complexity of the pancreatic bed, perioperative complications may be frequently encountered and commonly involve the pancreatic-biliary, vascular, lymphatic, or bowel systems, irrespective of the surgical technique used. Imaging plays an important role in the assessment of suspected postoperative complications, with CT considered the primary imaging modality, while MRI, digital subtraction angiography, and molecular imaging are considered ancillary diagnostic tools. Accurate diagnosis of postoperative complications requires a solid understanding of pancreatic anatomy, surgical indications, normal postoperative appearance, and expected postsurgical changes. The practicing radiologist should be familiar with the most common perioperative complications, such as anastomotic leak, abscess, and hemorrhage, and be able to differentiate these entities from normal anticipated postoperative changes such as seroma, edema and fat stranding at the surgical site, and perivascular soft-tissue thickening. In addition to evaluation of the primary operative fossa, imaging plays a fundamental role in assessment of the adjacent organ systems secondarily affected after pancreatic surgery, such as vascular, biliary, and enteric complications. Published under a CC BY 4.0 license. Test Your Knowledge questions are available in the supplemental material. See the invited commentary by Winslow in this issue.
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Affiliation(s)
- Ayman H Gaballah
- From the Department of Diagnostic Imaging, The University of Texas Southwestern Medical Center, 201 Inwood Rd, Dallas, TX 75390 (A.H.G.); Departments of Radiology (I.A.K.) and Surgery (E.K.), University of Missouri, Columbia, Mo; Department of Radiology, Johns Hopkins Medical Institutions, Baltimore, Md (A.Z.); Department of Radiology, Cleveland Clinic, Cleveland, Ohio (P.S.L.); Department of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex (M.B., K.M.E.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (M.M.); Department of Radiology, Mayo Clinic, Rochester, Minn (M.K.I.); and Department of Radiology, Northwestern University, Chicago, Ill (M.S.)
| | - Irfan A Kazi
- From the Department of Diagnostic Imaging, The University of Texas Southwestern Medical Center, 201 Inwood Rd, Dallas, TX 75390 (A.H.G.); Departments of Radiology (I.A.K.) and Surgery (E.K.), University of Missouri, Columbia, Mo; Department of Radiology, Johns Hopkins Medical Institutions, Baltimore, Md (A.Z.); Department of Radiology, Cleveland Clinic, Cleveland, Ohio (P.S.L.); Department of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex (M.B., K.M.E.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (M.M.); Department of Radiology, Mayo Clinic, Rochester, Minn (M.K.I.); and Department of Radiology, Northwestern University, Chicago, Ill (M.S.)
| | - Atif Zaheer
- From the Department of Diagnostic Imaging, The University of Texas Southwestern Medical Center, 201 Inwood Rd, Dallas, TX 75390 (A.H.G.); Departments of Radiology (I.A.K.) and Surgery (E.K.), University of Missouri, Columbia, Mo; Department of Radiology, Johns Hopkins Medical Institutions, Baltimore, Md (A.Z.); Department of Radiology, Cleveland Clinic, Cleveland, Ohio (P.S.L.); Department of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex (M.B., K.M.E.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (M.M.); Department of Radiology, Mayo Clinic, Rochester, Minn (M.K.I.); and Department of Radiology, Northwestern University, Chicago, Ill (M.S.)
| | - Peter S Liu
- From the Department of Diagnostic Imaging, The University of Texas Southwestern Medical Center, 201 Inwood Rd, Dallas, TX 75390 (A.H.G.); Departments of Radiology (I.A.K.) and Surgery (E.K.), University of Missouri, Columbia, Mo; Department of Radiology, Johns Hopkins Medical Institutions, Baltimore, Md (A.Z.); Department of Radiology, Cleveland Clinic, Cleveland, Ohio (P.S.L.); Department of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex (M.B., K.M.E.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (M.M.); Department of Radiology, Mayo Clinic, Rochester, Minn (M.K.I.); and Department of Radiology, Northwestern University, Chicago, Ill (M.S.)
| | - Mohamed Badawy
- From the Department of Diagnostic Imaging, The University of Texas Southwestern Medical Center, 201 Inwood Rd, Dallas, TX 75390 (A.H.G.); Departments of Radiology (I.A.K.) and Surgery (E.K.), University of Missouri, Columbia, Mo; Department of Radiology, Johns Hopkins Medical Institutions, Baltimore, Md (A.Z.); Department of Radiology, Cleveland Clinic, Cleveland, Ohio (P.S.L.); Department of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex (M.B., K.M.E.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (M.M.); Department of Radiology, Mayo Clinic, Rochester, Minn (M.K.I.); and Department of Radiology, Northwestern University, Chicago, Ill (M.S.)
| | - Mariam Moshiri
- From the Department of Diagnostic Imaging, The University of Texas Southwestern Medical Center, 201 Inwood Rd, Dallas, TX 75390 (A.H.G.); Departments of Radiology (I.A.K.) and Surgery (E.K.), University of Missouri, Columbia, Mo; Department of Radiology, Johns Hopkins Medical Institutions, Baltimore, Md (A.Z.); Department of Radiology, Cleveland Clinic, Cleveland, Ohio (P.S.L.); Department of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex (M.B., K.M.E.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (M.M.); Department of Radiology, Mayo Clinic, Rochester, Minn (M.K.I.); and Department of Radiology, Northwestern University, Chicago, Ill (M.S.)
| | - Mohamed K Ibrahim
- From the Department of Diagnostic Imaging, The University of Texas Southwestern Medical Center, 201 Inwood Rd, Dallas, TX 75390 (A.H.G.); Departments of Radiology (I.A.K.) and Surgery (E.K.), University of Missouri, Columbia, Mo; Department of Radiology, Johns Hopkins Medical Institutions, Baltimore, Md (A.Z.); Department of Radiology, Cleveland Clinic, Cleveland, Ohio (P.S.L.); Department of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex (M.B., K.M.E.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (M.M.); Department of Radiology, Mayo Clinic, Rochester, Minn (M.K.I.); and Department of Radiology, Northwestern University, Chicago, Ill (M.S.)
| | - Moataz Soliman
- From the Department of Diagnostic Imaging, The University of Texas Southwestern Medical Center, 201 Inwood Rd, Dallas, TX 75390 (A.H.G.); Departments of Radiology (I.A.K.) and Surgery (E.K.), University of Missouri, Columbia, Mo; Department of Radiology, Johns Hopkins Medical Institutions, Baltimore, Md (A.Z.); Department of Radiology, Cleveland Clinic, Cleveland, Ohio (P.S.L.); Department of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex (M.B., K.M.E.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (M.M.); Department of Radiology, Mayo Clinic, Rochester, Minn (M.K.I.); and Department of Radiology, Northwestern University, Chicago, Ill (M.S.)
| | - Eric Kimchi
- From the Department of Diagnostic Imaging, The University of Texas Southwestern Medical Center, 201 Inwood Rd, Dallas, TX 75390 (A.H.G.); Departments of Radiology (I.A.K.) and Surgery (E.K.), University of Missouri, Columbia, Mo; Department of Radiology, Johns Hopkins Medical Institutions, Baltimore, Md (A.Z.); Department of Radiology, Cleveland Clinic, Cleveland, Ohio (P.S.L.); Department of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex (M.B., K.M.E.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (M.M.); Department of Radiology, Mayo Clinic, Rochester, Minn (M.K.I.); and Department of Radiology, Northwestern University, Chicago, Ill (M.S.)
| | - Khaled M Elsayes
- From the Department of Diagnostic Imaging, The University of Texas Southwestern Medical Center, 201 Inwood Rd, Dallas, TX 75390 (A.H.G.); Departments of Radiology (I.A.K.) and Surgery (E.K.), University of Missouri, Columbia, Mo; Department of Radiology, Johns Hopkins Medical Institutions, Baltimore, Md (A.Z.); Department of Radiology, Cleveland Clinic, Cleveland, Ohio (P.S.L.); Department of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex (M.B., K.M.E.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (M.M.); Department of Radiology, Mayo Clinic, Rochester, Minn (M.K.I.); and Department of Radiology, Northwestern University, Chicago, Ill (M.S.)
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Huang YL, Tian XF, Qiu YJ, Lou WH, Jung EM, Dong Y, Wang HZ, Wang WP. Preoperative ultrasound radiomics for predicting clinically relevant postoperative pancreatic fistula after pancreatectomy. Clin Hemorheol Microcirc 2024; 86:313-326. [PMID: 37927251 DOI: 10.3233/ch-231955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Abstract
OBJECTIVES To evaluate the efficacy of the radiomics model based on preoperative B-mode ultrasound (BMUS) and shear wave elastography (SWE) for predicting the occurrence of clinically relevant-postoperative pancreatic fistula (CR-POPF). METHODS Patients who were scheduled to undergo pancreatectomy were prospectively enrolled and received ultrasound assessment within one week before surgery. The risk factors of POPF (grades B and grades C) were analyzed. Preoperative BMUS images, SWE values of pancreatic lesions and surrounding parenchyma were used to build preoperative prediction radiomics models. Radiomic signatures were extracted and constructed using a minimal Redundancy Maximal Relevance (mRMR) algorithm and an L1 penalized logistic regression. A combined model was built using multivariate regression which incorporated radiomics signatures and clinical data. RESULTS From January 2020 to November 2021, a total of 147 patients (85 distal pancreatectomies and 62 pancreaticoduodenectomies) were enrolled. During the three-week follow-up after pancreatectomy, the incidence rates of grade B/C POPF were 28.6% (42/147). Radiomic signatures constructed from BMUS of pancreas parenchymal regions (panRS) achieved an area under the receiver operating characteristic curve (AUC) of 0.75, accuracy of 68.7%, sensitivity of 85.7 %, and specificity of 61.9 % in preoperative noninvasive prediction of CR-POPF. The AUC of the radiomics model increased to 0.81 when panRS was used for the prediction of CR-POPF after pancreaticoduodenectomy. CONCLUSIONS Radiomics model based on ultrasound images was potentially useful for predicting CR-POPF. Patients with high-risk factors should be closely monitored when postoperation.
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Affiliation(s)
- Yun-Lin Huang
- Department of Ultrasound, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiao-Fan Tian
- Department of Ultrasound, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yi-Jie Qiu
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Wen-Hui Lou
- Department of Pancreas Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Ernst-Michael Jung
- Department of Radiology, University Medical Center Regensburg, Regensburg, Germany
| | - Yi Dong
- Department of Ultrasound, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Han-Zhang Wang
- Precision Health Institute, GE Healthcare China, Shanghai, China
| | - Wen-Ping Wang
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
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Young A, Goga U, Aktuerk D, Aziz Z, Cross S, Balan A. A radiologist's guide to median sternotomy. Clin Radiol 2024; 79:33-40. [PMID: 38008662 DOI: 10.1016/j.crad.2023.10.023] [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] [Received: 05/31/2023] [Revised: 10/08/2023] [Accepted: 10/18/2023] [Indexed: 11/28/2023]
Abstract
Median sternotomy is widely recognised as the primary incision technique in cardiac surgery. This surgical procedure involves dividing the sternum to gain access to the heart and lungs, making it invaluable in correcting congenital heart defects. Furthermore, it is frequently employed in adult patients, particularly during coronary artery bypass graft (CABG) procedures. In this imaging review, we present a comprehensive overview of the pre-procedural assessment and various post-sternotomy complications encountered within our clinical experience at a tertiary cardiothoracic centre. The focus of this review is to outline the imaging features associated with mediastinal adhesions and establish the minimal safe distance between the sternum and common mediastinal structures when considering re-sternotomy. By providing visual examples, we aim to facilitate a better understanding of these key concepts. Moreover, we delve into a detailed discussion of a spectrum of postoperative complications that may arise following median sternotomy including those related to metalwork (sternal wire fracture), bone (sternal dehiscence, non-union and osteomyelitis), and soft tissue (abscess, haematoma).
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Affiliation(s)
- A Young
- Department of Radiology, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK.
| | - U Goga
- Department of Radiology, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - D Aktuerk
- Department of Cardiac Surgery, Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Z Aziz
- Department of Radiology, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - S Cross
- Department of Radiology, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - A Balan
- Department of Radiology, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
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Miranda-Lloret P, Simal-Julian JA, de San Román-Mena LP, Ramírez EP, Pancucci G, Asunción CB. CSF leak after pediatric endoscopic endonasal expanded approaches: a series review. Childs Nerv Syst 2024; 40:181-188. [PMID: 37561159 DOI: 10.1007/s00381-023-06103-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 07/23/2023] [Indexed: 08/11/2023]
Abstract
PURPOSE Endoscopic endonasal approaches in the pediatric population pose specific challenges. Management of postoperative cerebrospinal fluid [CSF] leak is probably the major concern. The purpose of the present investigation is to describe and analyze the incidence of postoperative CSF leaks in our pediatric series of endoscopic endonasal approaches. METHODS This is a retrospective analysis, case review of our institutional series. Descriptive statistical parameters and bivariate correlations are analyzed. RESULTS Twenty-one patients have been operated through endoscopic approaches in our series. Four patients showed a postoperative CSF leak needing a revision surgery; these cases are described in further detail. Approaches expanded beyond the sellar area and non-sellar pneumatization of the sphenoid sinus were significantly associated with a higher risk of postoperative CSF leak. CONCLUSIONS CSF leak incidence after endoscopic endonasal approaches is higher in pediatric patients than in adult series. Anatomic and pathologic factors add complexity to these approaches in children. Multilayer closure is advisable to prevent and treat this complication.
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Affiliation(s)
- Pablo Miranda-Lloret
- Pediatric Neurosurgery, Hospital Universitari I Politècnica La Fe, 46010, Valencia, Spain.
| | | | | | - Estela Plaza Ramírez
- Pediatric Neurosurgery, Hospital Universitari I Politècnica La Fe, 46010, Valencia, Spain
| | - Giovanni Pancucci
- Pediatric Neurosurgery, Hospital Universitari I Politècnica La Fe, 46010, Valencia, Spain
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Chen X, Yao S, Peng C, Wu K, Lang H, Chen N. Association between diabetes mellitus and postoperative urinary retention after cerebral angiography. Neurourol Urodyn 2024; 43:105-113. [PMID: 37787526 DOI: 10.1002/nau.25296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 09/20/2023] [Indexed: 10/04/2023]
Abstract
AIMS The aim of this study is to examine the association between diabetes mellitus and postoperative urinary retention on cerebral angiography (including intravascular interventional therapy). METHODS We collected data on the demographic characteristics and comorbidities, imaging and routine laboratory data, surgical information, and medications of patients who underwent cerebral angiography. Multivariate logistic regression was used to explore the correlation between diabetes and the incidence of postoperative urinary retention. RESULTS A total of 932 patients were included, with a mean age of 59.7 years (74.1% men). Postoperative urinary retention occurred in 40.8% of the diabetes mellitus group and 30.3% of the group without diabetes. Compared with the group without diabetes, those with diabetes were more likely to experience postoperative urinary retention. Patients with higher glycosylated hemoglobin A1c levels had a higher risk of developing postoperative urinary retention. CONCLUSIONS Diabetes was independently linked to postoperative urinary retention following cerebral angiography and patients with glycosylated hemoglobin A1c levels > 6% were more likely to experience postoperative urinary retention. Therefore, clinically regulating blood glucose levels may help to reduce the likelihood of postoperative urinary retention after cerebral angiography.
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Affiliation(s)
- Xiwen Chen
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Shaoli Yao
- Department of Neurology, Hospital of Chengdu Office of People's Government of Tibet Autonomous Region, Chengdu, China
| | - Cheng Peng
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Kongyuan Wu
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Hui Lang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Ning Chen
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
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Chen H, Fu N, Zhong J, Wang C, Xu Z, Wang W, Cheng D, Weng Y, Deng X, Shen B. Enhancement pattern of the pancreatic parenchyma predicts postpancreatectomy acute pancreatitis after pancreaticoduodenectomy. Eur Radiol 2024; 34:6-15. [PMID: 37505246 DOI: 10.1007/s00330-023-09927-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 04/18/2023] [Accepted: 05/14/2023] [Indexed: 07/29/2023]
Abstract
OBJECTIVES To assess the association between the enhancement pattern of the pancreatic parenchyma on preoperative multiphasic contrast-enhanced computed tomography (CECT) and the occurrence of postpancreatectomy acute pancreatitis (PPAP) after pancreaticoduodenectomy (PD). METHODS A total of 513 patients who underwent PD were retrospective enrolled. The CT attenuation values of the nonenhanced (N), arterial (A), portal venous (P), and late (L) phases in the pancreatic parenchyma were measured on preoperative multiphasic CECT. The enhancement pattern was quantized by the CT attenuation value ratios in each phase. Receiver operating characteristic (ROC) curve analyses were computed to evaluate predictive performance. Regression analyses were used to identify independent risk factors for PPAP. RESULTS PPAP developed in 102 patients (19.9%) and was associated with increased morbidity and a worse postoperative course. The A/P ratio, P/L ratio, and A/L ratio were significantly higher in the PPAP group. On the ROC analysis, the A/L ratio and A/P ratio both performed well in predicting PPAP (A/L: AUC = 0.7579; A/P: AUC = 0.7497). On multivariate analyses, the A/L ratio > 1.29 (OR 4.30 95% CI: 2.62-7.06, p < 0.001) and A/P ratio > 1.13 (OR 5.02 95% CI: 2.98-8.45, p < 0.001) were both independent risk factors of PPAP in each model. CONCLUSIONS The enhancement pattern of the pancreatic parenchyma on multiphasic preoperative CECT is a good predictor of the occurrence of PPAP after PD, which could help clinicians identify high-risk patients or enable selective enhance recovery protocols. CLINICAL RELEVANCE STATEMENT Preoperative identification of patients at high risk for postpancreatectomy acute pancreatitis by enhancement patterns of the pancreatic parenchyma allows surgeons to tailor their perioperative management and take precautions. KEY POINTS PPAP is associated with increased risk of postoperative complications and a worse postoperative course. A rapid-decrease enhancement pattern of the pancreatic parenchyma is related to the occurrence of PPAP. The A/L and A/P ratios were both independent risk factors of PPAP in each multivariate model.
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Affiliation(s)
- Haoda Chen
- Department of General Surgery, Pancreatic Disease Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin Er Road, Shanghai, 200025, China
| | - Ningzhen Fu
- Department of General Surgery, Pancreatic Disease Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin Er Road, Shanghai, 200025, China
| | - Jingyu Zhong
- Department of Imaging, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chao Wang
- Department of General Surgery, Pancreatic Disease Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin Er Road, Shanghai, 200025, China
| | - Zhiwei Xu
- Department of General Surgery, Pancreatic Disease Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin Er Road, Shanghai, 200025, China
| | - Weishen Wang
- Department of General Surgery, Pancreatic Disease Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin Er Road, Shanghai, 200025, China
| | - Dongfeng Cheng
- Department of General Surgery, Pancreatic Disease Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin Er Road, Shanghai, 200025, China
| | - Yuanchi Weng
- Department of General Surgery, Pancreatic Disease Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin Er Road, Shanghai, 200025, China.
| | - Xiaxing Deng
- Department of General Surgery, Pancreatic Disease Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin Er Road, Shanghai, 200025, China.
| | - Baiyong Shen
- Department of General Surgery, Pancreatic Disease Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin Er Road, Shanghai, 200025, China.
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Turlington R, Rajiah PS, Araoz P. Case of the Season: Gerbode Defect and Left Ventricular Pseudoaneurysm as Complications of Mitral Valve Replacement. Semin Roentgenol 2024; 59:3-6. [PMID: 38388094 DOI: 10.1053/j.ro.2023.10.001] [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: 08/16/2023] [Revised: 09/30/2023] [Accepted: 10/06/2023] [Indexed: 02/24/2024]
Affiliation(s)
| | | | - Philip Araoz
- Department of Radiology, Mayo Clinic, Rochester, MN
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Malta SM, Bilotta F, Nozari A. Is it Safe to Use Ultrasound-Guided Superior Laryngeal Nerve Block for the Prevention of Postoperative Sore Throat After Double Lumen Endotracheal Intubation? Anesth Analg 2024; 138:e1-e2. [PMID: 38100809 DOI: 10.1213/ane.0000000000006732] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2023]
Affiliation(s)
- Stephanie M Malta
- Department of Anesthesiology, Boston Medical Center, Boston, Massachusetts,
| | - Federico Bilotta
- Department of Anesthesiology and Critical Care, Sapienza University of Rome, Rome, Italy
| | - Ala Nozari
- Department of Anesthesiology, Boston Medical Center, Boston, Massachusetts
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Qiu W, Sun Z, Zhou S, Han G, Chen Z, Zeng Y, Yu M, Li W. Association between the upper instrumented vertebra screw angles and proximal junctional complications in patients with de novo degenerative lumbar scoliosis. J Neurosurg Spine 2024; 40:62-69. [PMID: 37856373 DOI: 10.3171/2023.8.spine23554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 08/08/2023] [Indexed: 10/21/2023]
Abstract
OBJECTIVE The aim of this study was to investigate the impact of upper instrumented vertebra (UIV) screw angles on proximal junctional complications in patients with de novo degenerative lumbar scoliosis (DNDLS). METHODS A total of 120 patients with DNDLS who underwent posterior long-segment instrumentation and fusion were included. Patients were divided into a proximal junctional kyphosis/failure (PJK/PJF) group and a non-PJK/PJF group. Radiographic parameters were measured, including UIV screw angle, UIV slope, UIV screw slope, fixed segmental angle (FSA), and spinopelvic parameters. Clinical and radiographic data were compared between the two groups. Multivariate logistic regression was used to analyze the independent risk factors of PJK/PJF. Receiver operating characteristic (ROC) curve analysis was used to determine the threshold value to predict PJK/PJF. RESULTS Thirty-six patients (30.0%) developed PJK or PJF during follow-up. Patients in the PJK/PJF group had a larger postoperative UIV screw angle, a larger postoperative UIV screw slope, and a larger postoperative PJA. A significant increase was observed in UIV screw angle from immediately postoperative assessment to the final follow-up in two groups (p < 0.001). Multivariate logistic analysis indicated that a larger positive postoperative UIV screw angle was an independent risk factor for PJK/PJF (OR 1.546, 95% CI 1.274-1.877). ROC curve analysis indicated that a UIV screw angle ≥ 1° is more likely to develop PJK/PJF. Compared with group A patients (UIV screw angle < 1°), group B patients (UIV screw angle ≥ 1°) had a higher incidence of PJK, PJF, UIV screw loosening, and worse functional scores at the final follow-up. CONCLUSIONS Avoiding insertion of cranially directed UIV pedicle screws may help prevent the development of PJK and PJF in patients with DNDLS.
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Affiliation(s)
- Weipeng Qiu
- 1Department of Orthopaedics, Peking University Third Hospital, Beijing, China
- 2Beijing Key Laboratory of Spinal Disease Research, Beijing, China
- 3Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China; and
- 4Peking University Health Science Center, Beijing, China
| | - Zhuoran Sun
- 1Department of Orthopaedics, Peking University Third Hospital, Beijing, China
- 2Beijing Key Laboratory of Spinal Disease Research, Beijing, China
- 3Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China; and
| | - Siyu Zhou
- 1Department of Orthopaedics, Peking University Third Hospital, Beijing, China
- 2Beijing Key Laboratory of Spinal Disease Research, Beijing, China
- 3Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China; and
| | - Gengyu Han
- 1Department of Orthopaedics, Peking University Third Hospital, Beijing, China
- 2Beijing Key Laboratory of Spinal Disease Research, Beijing, China
- 3Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China; and
| | - Zimu Chen
- 4Peking University Health Science Center, Beijing, China
| | - Yan Zeng
- 1Department of Orthopaedics, Peking University Third Hospital, Beijing, China
- 2Beijing Key Laboratory of Spinal Disease Research, Beijing, China
- 3Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China; and
| | - Miao Yu
- 1Department of Orthopaedics, Peking University Third Hospital, Beijing, China
- 2Beijing Key Laboratory of Spinal Disease Research, Beijing, China
- 3Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China; and
| | - Weishi Li
- 1Department of Orthopaedics, Peking University Third Hospital, Beijing, China
- 2Beijing Key Laboratory of Spinal Disease Research, Beijing, China
- 3Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China; and
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Choffel L, Kleinclauss F, Balssa L, Barkatz J, Lecheneaut M, Guichard G, Frontczak A. Surgical complications and graft survival in kidney transplant recipients according to CT-scans evaluation. Fr J Urol 2024; 34:102543. [PMID: 37858380 DOI: 10.1016/j.purol.2023.09.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 09/24/2023] [Accepted: 09/28/2023] [Indexed: 10/21/2023]
Abstract
INTRODUCTION Obesity is a risk factor for significant surgical complications following kidney transplantation. We examined morphometric parameters other than the body mass index (BMI) that could predict surgical complications and determine their impact on graft survival. MATERIALS Kidney transplantations performed at our center between 2012 and 2019 were retrospectively evaluated. Data for visceral adipose tissue (VAT), subcutaneous adipose tissue, psoas surface, abdominal perimeter (AP), and vessel-to-skin distance (VSK) were collected from pre-transplant computed tomography (CT) scans. The primary outcome was the occurrence of surgical complications within 1 year of transplantation; the secondary outcome was graft survival. RESULTS We included 321 (88%) of 364 kidney transplant recipients, of which 154 (46.5%) patients experienced some form of surgical complication in the 1st year of follow-up. Univariate analysis revealed that higher VAT (P=0.004), VSK (P=0.007), and AP (P=0.01) values were potential risk factors for early postoperative morbidity. However, none of these factors were significant in the multivariate analysis. Concerning the secondary outcome, while the univariate analysis identified higher VAT (P=0.001) value as a risk factor, in the multivariate analysis only delayed graft function demonstrated a significant impact on graft survival (P=0.002). CONCLUSIONS Although morphological parameters showed greater accuracy in predicting surgical complications in univariate analysis, these results were not significant in multivariate analysis. Moreover, these factors were not significantly associated with graft survival. Therefore, routine application of analyses based on these parameters, regardless of BMI, may not be useful. LEVEL OF EVIDENCE: 5
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Affiliation(s)
- L Choffel
- Department of Urology, Andrology and Renal Transplantation, University Hospital of Besançon, 3, boulevard A-Fleming, 25030 Besançon, France.
| | - F Kleinclauss
- Department of Urology, Andrology and Renal Transplantation, University Hospital of Besançon, 3, boulevard A-Fleming, 25030 Besançon, France; University of Franche-Comté, 25000 Besançon, France
| | - L Balssa
- Department of Urology, Andrology and Renal Transplantation, University Hospital of Besançon, 3, boulevard A-Fleming, 25030 Besançon, France
| | - J Barkatz
- Department of Urology, Andrology and Renal Transplantation, University Hospital of Besançon, 3, boulevard A-Fleming, 25030 Besançon, France
| | - M Lecheneaut
- Department of Urology, Andrology and Renal Transplantation, University Hospital of Besançon, 3, boulevard A-Fleming, 25030 Besançon, France
| | - G Guichard
- Department of Urology, Andrology and Renal Transplantation, University Hospital of Besançon, 3, boulevard A-Fleming, 25030 Besançon, France
| | - A Frontczak
- Department of Urology, Andrology and Renal Transplantation, University Hospital of Besançon, 3, boulevard A-Fleming, 25030 Besançon, France; University of Franche-Comté, 25000 Besançon, France
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Pastore MC, Degiovanni A, Grisafi L, Renda G, Sozzani M, Giordano A, Salvatici C, Lorenz V, Pierfelice F, Cappelli C, De Donno F, Focardi M, Ricci F, Benedetto U, Gallina S, Cameli M, Patti G. Left Atrial Strain to Predict Postoperative Atrial Fibrillation in Patients Undergoing Coronary Artery Bypass Grafting. Circ Cardiovasc Imaging 2024; 17:e015969. [PMID: 38227692 DOI: 10.1161/circimaging.123.015969] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 12/06/2023] [Indexed: 01/18/2024]
Abstract
BACKGROUND Postoperative atrial fibrillation (POAF) is a common complication after cardiac surgery being associated with poorer outcomes. Revealing before the operation of left atrial subtle structural/functional abnormalities may help to identify patients at increased risk of POAF. We investigated the role of left atrial strain parameters by preoperative speckle tracking echocardiography as independent predictors of POAF in patients undergoing coronary artery bypass graft. METHODS Consecutive patients undergoing isolated coronary artery bypass graft were prospectively enrolled at three Italian centers. All patients underwent transthoracic echocardiography before the operation. The occurrence of POAF up to discharge was monitored. RESULTS Overall, a total of 310 patients were included. POAF was demonstrated in 103 patients (33%). At receiver operating characteristic curve analysis, lower global peak atrial longitudinal strain (PALS) values significantly predicted the risk of POAF (area under the curve, 0.74; P<0.001). The optimal cutoff value for the arrhythmia prediction was a global PALS value <28%, with a specificity of 86% and a sensitivity of 36%. The incidence of POAF was 51% in patients with global PALS <28% versus 14% in those with PALS ≥28% (P<0.001), with a POAF-free survival at Kaplan-Meier analysis of 45.4% and 85.7%, respectively (P<0.001). At multivariate analysis, a global PALS <28% carried a 3.6-fold higher risk of POAF (hazard ratio, 3.6 [95% CI, 2.2-5.9]; P<0.001). The risk increase was even higher when PALS <28% was associated with age ≥70 years (adjusted hazard ratio, 11.2 [4.7-26.6], P<0.001). CONCLUSIONS A presurgery global PALS <28% is a specific parameter to stratify patients at increased risk of POAF after coronary artery bypass graft. This assessment can be useful to identify patients at higher arrhythmic risk in whom perioperative preventive strategies and stricter monitoring aimed at early diagnosing and treating POAF may be applied.
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Affiliation(s)
- Maria Concetta Pastore
- University of Eastern Piedmont, Novara (M.C.P., L.G., M.S., A.G., G.P.)
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena (M.C.P., C.S., M.F., M.C.)
| | - Anna Degiovanni
- Department of Cardio-Thoracic and Vascular Diseases, Maggiore della Carità Hospital, Novara (A.D., L.G., G.P.)
| | - Leonardo Grisafi
- University of Eastern Piedmont, Novara (M.C.P., L.G., M.S., A.G., G.P.)
- Department of Cardio-Thoracic and Vascular Diseases, Maggiore della Carità Hospital, Novara (A.D., L.G., G.P.)
| | - Giulia Renda
- Department of Neuroscience, Imaging and Clinical Sciences, G. d'Annunzio University of Chieti-Pescara, Chieti (G.R., F.P., C.C., F.D.D., F.R., U.B., S.G.)
- Division of Cardiology, SS. Annunziata Hospital, Chieti (G.R., F.P., C.C., F.D.D., F.R., S.G.)
| | - Martina Sozzani
- University of Eastern Piedmont, Novara (M.C.P., L.G., M.S., A.G., G.P.)
| | - Andrea Giordano
- University of Eastern Piedmont, Novara (M.C.P., L.G., M.S., A.G., G.P.)
| | - Cosimo Salvatici
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena (M.C.P., C.S., M.F., M.C.)
| | - Veronica Lorenz
- Division of Cardio-Thoracic Surgery, Department of Medical Biotechnologies, Azienda Ospedaliera Universitaria Senese, Siena (V.L.)
| | - Francesca Pierfelice
- Department of Neuroscience, Imaging and Clinical Sciences, G. d'Annunzio University of Chieti-Pescara, Chieti (G.R., F.P., C.C., F.D.D., F.R., U.B., S.G.)
- Division of Cardiology, SS. Annunziata Hospital, Chieti (G.R., F.P., C.C., F.D.D., F.R., S.G.)
| | - Clelia Cappelli
- Department of Neuroscience, Imaging and Clinical Sciences, G. d'Annunzio University of Chieti-Pescara, Chieti (G.R., F.P., C.C., F.D.D., F.R., U.B., S.G.)
- Division of Cardiology, SS. Annunziata Hospital, Chieti (G.R., F.P., C.C., F.D.D., F.R., S.G.)
| | - Federica De Donno
- Department of Neuroscience, Imaging and Clinical Sciences, G. d'Annunzio University of Chieti-Pescara, Chieti (G.R., F.P., C.C., F.D.D., F.R., U.B., S.G.)
- Division of Cardiology, SS. Annunziata Hospital, Chieti (G.R., F.P., C.C., F.D.D., F.R., S.G.)
| | - Marta Focardi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena (M.C.P., C.S., M.F., M.C.)
| | - Fabrizio Ricci
- Department of Neuroscience, Imaging and Clinical Sciences, G. d'Annunzio University of Chieti-Pescara, Chieti (G.R., F.P., C.C., F.D.D., F.R., U.B., S.G.)
- Division of Cardiology, SS. Annunziata Hospital, Chieti (G.R., F.P., C.C., F.D.D., F.R., S.G.)
| | - Umberto Benedetto
- Department of Neuroscience, Imaging and Clinical Sciences, G. d'Annunzio University of Chieti-Pescara, Chieti (G.R., F.P., C.C., F.D.D., F.R., U.B., S.G.)
- Division of Cardiac Surgery, SS. Annunziata Hospital, Chieti; Italy (U.B.)
| | - Sabina Gallina
- Department of Neuroscience, Imaging and Clinical Sciences, G. d'Annunzio University of Chieti-Pescara, Chieti (G.R., F.P., C.C., F.D.D., F.R., U.B., S.G.)
- Division of Cardiology, SS. Annunziata Hospital, Chieti (G.R., F.P., C.C., F.D.D., F.R., S.G.)
| | - Matteo Cameli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena (M.C.P., C.S., M.F., M.C.)
| | - Giuseppe Patti
- University of Eastern Piedmont, Novara (M.C.P., L.G., M.S., A.G., G.P.)
- Department of Cardio-Thoracic and Vascular Diseases, Maggiore della Carità Hospital, Novara (A.D., L.G., G.P.)
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50
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Ajlan A, Basindwah S, Hawsawi A, Elmutawi H, Alsaleh S, Alrasheed A, Alroqi A, Alqurashi A. Early Displacement of Reconstruction Material is a Predictor of Cerebrospinal Fluid Leak Post Endoscopic Skull Base Surgery. World Neurosurg 2024; 181:e897-e905. [PMID: 37944857 DOI: 10.1016/j.wneu.2023.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Accepted: 11/03/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND The reconstruction technique and materials used for endoscopic skull base surgery (ESBS) are important factors in preventing cerebrospinal fluid (CSF) leak, a notable complication following this surgery. Visualizing the status of reconstruction early in the postoperative course can help determine the risk of postoperative CSF leak. Here, we aimed to determine if the radiological status of reconstruction post endonasal endoscopic surgery can predict postoperative CSF leak. METHODS This retrospective study included patients who had undergone ESBS between 2015 and 2020. An early computed tomography (CT) scan (obtained within 24 hours of surgery) was utilized to evaluate the reconstruction and postoperative radiological changes, and its findings were correlated with the occurrence of postoperative CSF leaks. RESULTS Our study included 11 (12.7%) out of 86 patients with CSF leaks. The type of reconstruction, construction material, and type of nasal packing were not identified as significant risk factors for CSF leaks. The location of the fat graft (placed properly vs. displaced out of the surgical cavity) was significantly associated with CSF leak (P = 0.001). All patients with a displaced solid reconstruction (n = 5), displaced septal flap (n = 6), signs of air continuation (n = 2), or significantly increased amount of air (n = 5) presented with a CSF leak (P < 0.001). CONCLUSIONS Early postoperative CT scan is predictive of CSF leak. Displacement of the fat graft in early postoperative CT was the most important factor in predicting CSF leak. In this patient group, paying attention to radiological predictors of CSF leaks is important, supported by clinical findings.
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Affiliation(s)
- Abdulrazag Ajlan
- Division of Neurosurgery, Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
| | - Sarah Basindwah
- Division of Neurosurgery, Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Aysha Hawsawi
- Division of Neurosurgery, Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Hend Elmutawi
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Saad Alsaleh
- Department of Otolaryngology- Head and neck surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Abdulaziz Alrasheed
- Department of Otolaryngology- Head and neck surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Ahmad Alroqi
- Department of Otolaryngology- Head and neck surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Ashwag Alqurashi
- Division of Neurosurgery, King Saud University Medical City, Riyadh, Saudi Arabia
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