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1.
M. Kavousanaki Μ. Tzagournissakis I. Zaganas K.G. Stylianou A.P. Patrianakos M.K. Tsilimbaris A. Mantaka D.N. Samonakis 《Transplantation proceedings》2019,51(2):429-432
Background
Familial amyloidosis polyneuropathy (FAP) is a rare, progressive, and life-threatening disease inherited in the autosomal dominant pattern. Liver transplantation is the only proven disease-modifying treatment to date.Aim
To study the long-term outcomes of patients transplanted for FAP under a multidisciplinary team care.Methods
We included adult patients who were transplanted for FAP indication and were followed up in a relevant clinic or admitted in our department.Results
Twelve patients (6 male) with a mean age of 43 years and mean follow-up post-transplant of 100 months were included. Three patients died in this period, 1 due to a disease-related cause. All patients had peripheral neuropathy (25% severe). Eighty-three percent had autonomic nervous system dysfunction; all men, except one, erectile dysfunction; and half of the patients several genitourinary manifestations. Gastrointestinal involvement was present in 75% of the patients. The severity of several complications related to FAP was found to be associated with waiting on the transplant list for more than 12 months.Conclusions
Patients transplanted for FAP have a long survival. Prolonged stay on the transplant waiting list is associated with frequency and severity of disease complications. These patients are best managed in the context of multidisciplinary team care. 相似文献2.
3.
A. Hawasli L. Camero T. Williams G. Ambrosi M. Sahly D. Demos S. Harrington 《American journal of surgery》2019,217(3):454-457
Background
Esophagectomy has high cardiac and pulmonary complication rates that can reach 43% and 58% respectively. The original Ivor Lewis esophagectomy was a two-stage procedure. We revisited this procedure using a hybrid minimally-invasive approach.Methods
Thirty-five consecutive patients with esophageal cancer were operated on over an eight-year period. The first stage used laparoscopic mobilization of the stomach, while the second stage used open thoracotomy. Six patients were aborted due to unresectable disease.Results
Twenty-nine patients were studied. The mean operative times for stage-one and stage-two were 108?±?18 and 226?±?63?min respectively. All patients were extubated in the operating room. One (3.4%) patients had cardiac complication and one (3.4%) patient had pulmonary complication.Conclusion
Metachronous hybrid two-stage esophagectomy was associated with a low rate of cardio-pulmonary complications. It may be considered as an alternative to the one-stage esophagectomy, especially in low-volume centers, to decrease these high-risk cardio-pulmonary complications. 相似文献4.
R. Valero A. Sanchez-Fructuoso E. Rodrigo L. Belmar M.A. Cos I. Perez-Flores J. Delgado J.C.R. San Millan 《Transplantation proceedings》2019,51(2):341-343
Background
Many studies demonstrate the relationship between the high intrapatient variability of calcineurin inhibitor (CNI) levels and poor long-term renal graft outcome. Our objective is to analyze the intrapatient variability observed in the mammalian target of rapamycin inhibitors (mTOR-i) blood levels, to compare the variability of sirolimus (SRL) with that of everolimus (EVL) in kidney transplant patients converted to an mTOR-i, and to analyze whether the coefficient of variation (CV) was correlated with long-term graft survival.Methods
We analyzed 279 adult renal transplant patients converted to an mTOR-i. CV was calculated using at least 3 blood trough levels between 3 and 18 months postconversion.Results
The mean and median CV of the entire group was 25.54% and 23.7%, respectively. SRL and EVL mean CV was 23.8% and 27.1% (P = .03), respectively. The group of patients into the last tertile with CV> 28.52% presented a lower death-censored graft survival (75.26% vs. 93.01%, P < .0001) with a mean follow-up of 66.5 months.Conclusion
The CV of mTOR-i is correlated with long-term renal graft survival, so it should be considered a prognostic factor. SRL has a lower CV than EVL in renal transplant patients converted to mTOR-i in the stable posttransplant phase. 相似文献5.
Ramon O. Minjares-Granillo Bertha A. Dimas Jean-Paul J. LeFave Eric M. Haas 《American journal of surgery》2019,217(4):670-676
Background
Despite numerous benefits, only a small fraction of laparoscopic left-sided colectomy is accomplished without the need for an abdominal incision to retrieve the specimen and prepare for anastomosis. We report our early experience with a robotic approach using Natural orifice IntraCorporeal anastomosis with Extraction of specimen (NICE) to help overcome the technical limitations and challenges of this approach.Methods
Twenty consecutive patients presented for elective sigmoid or rectosigmoid resection for benign and malignant disease and underwent the NICE procedure. Safety, feasibility and post-operative outcomes were analyzed.Results
Intracorporeal anastomosis was accomplished in all patients. One patient required an abdominal incision to extract a bulky tumor. Mean operative time was 222?min (146–344). Mean time to first flatus and length of stay was 23 and 49?h, respectively. All but 4 patients were discharged home on post-operative day 2. One patient was readmitted with a pelvic fluid collection.Conclusion
Robotic left-sided colorectal resection with NICE procedure is a safe and feasible minimally invasive approach and may facilitate greater adoption rates of this technique. 相似文献6.
Study Design
Prospective cohort.Introduction
Clinical studies that evaluate the correlation between associated lesions of the triangular fibrocartilage complex (TFCC) and outcome of distal radial fractures expressed with the patient-rated disability are missing.Purpose of the Study
To evaluate the outcomes of distal radius fractures associated with or without an injury of the TFCC.Methods
Patients undergoing operative treatment for distal radial fracture were prospectively enrolled (n = 70). The TFCC was examined by wrist arthroscopy, and injuries were classified according to Palmer. Comparative analyses were performed on data from 45 patients with TFCC injury (the injured group) and 25 patients with an intact TFCC (the intact group). The outcome measures included The Patient-Rated Wrist Evaluation (PRWE) and the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaires, 3 and 12 months after injury.Results
The TFCC was injured in 45 patients (64%). In patients with an intact TFCC, the mean total PRWE score was 27 (at 3 months) and 16 (at 12 months), whereas in patients with TFCC injury, it was 40 (at 3 months) and 24 (at 12 months). Mean DASH scores were 26 and 13 for the intact group and 39 and 27 for the injured group at 3 and 12 months, respectively. PRWE and DASH results showed significant difference at 3 and 12 months when compared using the Mann-Whitney test.Conclusions
Disability outcomes were worse in patients with distal radial fracture where TFCC was injured. TFCC injuries are an important cofactor affecting the outcome of distal radial fractures. 相似文献7.
Study Design
Case series.Introduction
A salvaged limb is one that has undergone a major traumatic injury, followed by repeated surgical attempts in order to avoid amputation. Psychological recovery for individuals with lower extremity limb salvage has been examined in a number of studies. However, psychosocial reactions for individuals with upper extremity (UE) limb salvage are understudied in the literature.Purpose of the Study
The purpose of this study was to explore the process of psychosocial adaptation for 3 trauma cases after UE limb salvage.Methods
The Reactions to Impairment and Disability Inventory was used to assess psychosocial adaptation. Physical function outcomes (pain, range of motion, edema, sensation, and dexterity) are presented. The Disabilities of the Arm, Shoulder, and Hand measure was used to assess perceived disability. Medical and rehabilitation history are discussed for each case, in order to provide in-depth understanding of the impact of these injuries.Results
Reactions to injury varied across the cases; however, outcomes suggest that psychosocial adaptation may be influenced by the experience of pain, the ability to participate in valued roles and activities, and having a supportive social network.Discussion
For this population, therapists may consider emphasizing pain management, focusing on client-centered goals and interventions, and facilitating peer support. Providers should closely monitor patients for signs of poor adaptation, such as hand-hiding behaviors.Conclusions
This study is among the first to examine psychological outcomes for the UE limb salvage population. Future research would be beneficial to provide deeper understanding of the psychosocial challenges for these individuals. 相似文献8.
Vikas Satyananda Junko Ozao-Choy Christine Dauphine Kathryn T. Chen 《American journal of surgery》2019,217(4):764-766
Introduction
The Affordable Care Act (ACA) mandated the expansion of Medicaid in order to increase access to health care services. We examined the effect of the ACA on breast cancer screening and diagnosis at a Los Angeles safety net hospital.Methods
We performed a retrospective review of breast cancer patients treated at our institution. We compared two cohorts: patients diagnosed with breast cancer in the years 2011–2012 (pre-ACA) vs. 2015–2016 (post-ACA).Results
There were no differences in number of screening mammograms performed, age at diagnosis, mammography-detected cancers, or clinical stage at diagnosis. There was a significant decrease in the number of patients who reported as self-pay (34% vs. 6%, p?<?0.0001).Conclusion
In the 2-year period following ACA implementation, there was limited impact on breast cancer presentation at a safety-net hospital. Long-term follow-up across different healthcare systems is necessary to fully evaluate the global impact of the ACA on breast cancer care. 相似文献9.
N. Machairas P. Stamopoulos I.D. Kostakis Z. Garoufalia A. Paspala P. Tsaparas G.C. Sotiropoulos 《Transplantation proceedings》2019,51(2):437-439
Introduction
Mixed hepatocellular cholangiocarcinoma (HCC-CC) represents a rare hepatic tumor, which demonstrates histological features of both hepatocellular carcinoma (HCC) and cholangiocarcinoma (CC). HCC-CC can be an unexpected finding in patients undergoing liver transplantation (LT) for HCC. The objective of our review was to review and evaluate long-term outcomes in patients undergoing LT for mixed HCC-CC.Methods
A meticulous MEDLINE search was performed for articles referring to long-term results in patients who underwent LT and whose final pathology revealed HCC-CC.Results
A total of 7 studies, which comprised 93 patients who underwent LT and whose resected specimen revealed mixed HCC-CC, were included in our review. One-year overall survival (OS) rates ranged from 64% to 93%, 3-year OS ranged from 38% to 78%, and 5-year OS rates range from 14% to 78%. Disease-free-survival (DFS) rates at 1-year from LT ranged from 60-% to 64%, whereas both 3- and 5-year DFS rates ranged from 30% to 53.3%.Conclusions
Long-term results of LT in the setting of mixed HCC-CC are associated with fairly unfavorable overall outcomes compared to LT for other indications including HCC yet are improved compared to others such as intrahepatic CC. A stricter preoperative evaluation could potentially help identify the patients with mixed HCC-CC who are at high-risk after LT, reduce the risks of recurrence, and improve OS. 相似文献10.
Seung Bo Shim Jeung Yeol Jeong Dong Ho Keum Jae Chul Yoo 《Journal of orthopaedic science》2019,24(2):250-257
Purpose
Creating a trough on the anterior glenoid rim is one of the methods used for arthroscopic Bankart repair with suture anchors. The purpose of this study was to analyze clinical and radiological outcomes of arthroscopic Bankart repair with suture anchors; to compare between the outcomes of surgical procedures with and without trough.Methods
Clinical and radiological outcomes were evaluated for 116 patients who underwent arthroscopic Bankart repair at our institute from 2005 to 2011. The mean follow-up was 5.2 years (range, 2–8.8 years). All data were divided into trough group (n = 62) and non-trough group (n = 71). Clinical and functional outcomes were assessed pre- and postoperatively as range of motion (ROM), pain on the visual analog scale (p-VAS), function on the visual analog scale (f-VAS), and Rowe score. Radiological outcomes were also evaluated.Results
The overall postoperative clinical and functional outcomes improved significantly (P < .001). A total of 8 patients (6.8%) showed recurrent instability. Radiologic findings showed mild arthritis in 27 cases (23.1%), moderate arthritis in 6 cases (5.1%), and no severe arthritis. 32 patients showed anterior apprehension after surgery, and 22 out of those 32 patients were from non-trough group. However, no significant difference between the trough and non-trough groups was found with respect to clinical and functional outcomes (P > .05).Conclusion
The additional procedure of creating a trough did not improve clinical outcomes in terms of frank dislocation; however, at the final follow-up, patients with the trough showed less anterior apprehension. Overall, arthroscopic Bankart repair using suture anchors had relatively good clinical outcome, with a redislocation rate of 6.8%.Level of evidence
Level III, Case series. 相似文献11.
Joseph A. Gil Kerry Ebert Keri Blanchard Avi D. Goodman Joseph J. Crisco Julia A. Katarincic 《Journal of hand therapy》2019,32(1):80-85
Study Design
Basic research (biomechanics).Introduction
The high degree of motion that occurs at the thumb metacarpophalangeal (MCP) joint must be taken into account when immobilizing a partially torn or repaired thumb ulnar collateral ligament.Purpose of the Study
To determine the efficacy of a radial-based thumb MCP-stabilizing orthosis in resisting abduction across the thumb ulnar collateral ligament.Methods
Ten fresh cadaveric hands were mounted to a custom board. An anteroposterior radiograph of the thumb was obtained with a 2 N preload valgus force applied to the thumb, and the angle between the Kirschner wires was measured as a baseline. Subsequently, 20, 40, 60, 80, and 100 N valgus forces were applied 15 mm distal to the MCP joint. Anteroposterior radiographs of the thumb were obtained after each force was applied. The angle of displacement between the wires was measured and compared with the baseline angle. The angles were measured with an imaging processing tool. A custom radial-based thumb MCP-stabilizing orthosis was fashioned for each cadaveric thumb by a certified hand therapist. The aforementioned loading protocol was then repeated.Results
The radial-based thumb MCP-stabilizing orthosis significantly reduced mean abduction angles at each applied load.Discussion
We found that our orthosis, despite being hand-based and leaving the thumb IP and CMC joints free, significantly reduced mean abduction angles at each applied load.Conclusions
This investigation provides objective evidence that our radial-based thumb MCP-stabilizing orthosis effectively reduces the degree of abduction that occurs at the thumb MCP joint up to at least 100 N.Level of Evidence
n/a (cadaveric). 相似文献12.
Background
Small bowel obstruction (SBO) is a common condition leading to numerous hospital admissions and operations. Standardized care of adhesive SBO patients has not been widely implemented in hospital systems.Methods
A prospective cohort of SBO patients was compared to a historical cohort of SBO patients after implementation of a SBO protocol using evidence-based guidelines and Omnipaque, a low-osmolar water soluble contrast. Patients without a history of abdominal surgery were excluded and data was collected through chart review.Results
Univariate analyses demonstrated a decrease in both LOS by 1.35 days and in the proportion of patients receiving surgery (37% vs 25%; p?<?0.05). There was a decrease in time to surgery, rate of SBR, and rate of complications, yet an increase in readmission, although these findings were not statistically significant.Conclusions
Utilizing an evidence-based SBO protocol can lead to shorter LOS and may result in fewer operations for adhesive SBO patients. 相似文献13.
Byron D. Hughes Eric Sieloff Hemalkumar B. Mehta Anthony J. Senagore 《American journal of surgery》2019,217(3):534-538
Background
In 2008, 2005–2006 National Surgical Quality Improvement Program (NSQIP) data were used to identify surgical operations contributing disproportionately to morbidity and mortality. Since then, numerous enhanced recovery programs have been utilized to augment quality improvement efforts. This study reassesses procedural complication incidence after a decade of quality improvement efforts.Methods
Data from the 2015 NSQIP were used. The same original 36 general surgery procedure groups were created using Current Procedural Terminology codes. Ninety percent of our 409,230 patients matched into a procedure group and adverse event rates were analyzed for each.Results
Ten procedure groups accounted for 80% of adverse events. Colectomy ranked the highest for adverse events (34%), readmissions (27%) and mortality rates (45.8%). For outpatient cholecystectomy, the relative percent point difference for adverse events has increased by 224% since 2005.Conclusion
Refocusing on colectomy and outpatient cholecystectomy represent current priorities in general surgery. 相似文献14.
Stephanie A. Valente Yitian Liu Siddhi Upadhyaya Chao Tu Debra A. Pratt 《American journal of surgery》2019,217(3):514-518
Introduction
The aim of this study was to determine whether complications following mastectomy with immediate breast reconstruction (IBR) were associated with breast cancer recurrence.Methods
A retrospective review was performed of women diagnosed with stage I-III breast cancer who underwent mastectomy with IBR between 2005 and 2010. Patient demographics, tumor data, surgical wound complications, treatment details and timing were recorded and analyzed.Results
We identified 458 women with a median follow up time of 7.6 years. A total of 22% of patients experienced IBR complications. There was a delay in initiation of adjuvant therapy in patients who had a complication (52 vs 41 days, p?<?0.001). There was no significant difference in recurrences between groups with and without complications (p?=?0.65).Conclusions
In breast cancer patients who undergo mastectomy with IBR, wound complications delayed initiation of adjuvant systemic therapy, but were not associated with an increased risk of cancer recurrence. 相似文献15.
Joseph R. Esparaz Greg C. McGovern Alyssa R. Mowrer Ryan T. Nierstedt Elise A. Biesboer Breanna M. Elger Richard H. Pearl Charles J. Aprahamian 《American journal of surgery》2019,217(3):469-472
Background
With similar effectiveness of ultrasonography, our institution replaced CT imaging with ultrasound for diagnosing appendicitis in children. An unexpected consequence was the overutilization of ultrasound. Our objective was to establish measures that could help prevent this overuse.Methods
A retrospective chart review of 327 consecutive pediatric patients evaluated for appendicitis between October 2014 and September 2015?at our institution was performed. Data on clinical, radiographic, and histopathologic findings were reviewed. Diagnostic accuracy of US and white blood cell (WBC) values was determined. An algorithm was created.Results
327 (100%) patients received an ultrasound for suspected appendicitis. WBC of 10,000/μl was determined to be the primary discriminant for management and ultrasound utilization. If a WBC ≥10,000/μL had been utilized as criteria for imaging, 49.5% fewer patients would have received an ultrasound.Conclusions
Clinical exam, WBC count, and surgery consultation prior to ultrasonography can lessen then need for ultrasound utilization in children with suspected appendicitis. 相似文献16.
Study Design
Case series.Introduction
Upper extremity (UE) trauma and subsequent immobilization affects functional performance.Purpose of the Study
Determine the usefulness and feasibility of unilateral hand training (UHT) on improving functional performance in patients with UE trauma.Methods
Nine participants received UHT within 10 days of immobilization. Functional performance, dexterity, grip, and pinch strength were measured at initial and 4-week visits. Qualitative interviews were coded to develop themes.Results
All Jebsen-Taylor hand function test subtests improved from pretest to post-test. Disabilities of the Arm, Shoulder and Hand scores of all 9 participants improved. Functional performance was more impaired for participants with dominant UE injury. Four themes emerged: participants were forced to alter or avoid most daily activities, had an increased dependency on others, took longer to perform activities, and felt UHT decreased the impact of UE trauma on function.Discussion
Functional performance was impaired for all participants. Participants believed that UHT was useful and contributed to improved function.Conclusion
This case series tracked a comprehensive intervention based on a holistic activities of daily living framework that considered the nuances of individual complexities of immobilization following hand trauma. Knowledge from this study supports an early intervention like UHT to educate clients on effective strategies to improve immediate activities of daily living functioning and potentially prevent longer term impairments. 相似文献17.
Thomas Sénage Florence Gillaizeau Thierry Le Tourneau Basile Marie Jean-Christian Roussel Yohann Foucher 《The Journal of thoracic and cardiovascular surgery》2019,157(4):1383-1390.e5
Objectives
Structural valve deterioration (SVD) remains a major bioprosthesis-related complication, as recently described for the Mitroflow valve (models LX and 12A) (LivaNova, London, United Kingdom). The real incidence of the SVD risk remains unclear, often due to methodologic pitfalls by systematically using the Kaplan-Meier estimator and/or the Cox model. In this report, we propose for the first time a precise statistical modeling of this issue.Methods
Five hundred sixty-one patients who underwent aortic valve replacement with the aortic Mitroflow valve between 2002 and 2007 were included. We used an illness–death model for interval-censored data. Median follow-up was 6.6 years; 103 cases of SVD were diagnosed.Results
The 4-year and 7-year SVD cumulative incidences after the first anniversary of surgery were 15.2% (95% confidence interval, 11.9-19.1) and 31.0% (95% confidence interval, 25.8-37.2), respectively. Female gender, dyslipidemia, chronic obstructive pulmonary disease, and severe patient-prosthesis mismatch were significant risk factors of SVD. The occurrence of SVD was associated with a 2-fold increase in the risk of death.Conclusions
Appropriate statistical models should be used to avoid underestimating the SVD complication associated with worse long-term survival. 相似文献18.
Kidney Transplantation in Patients With Chronic Kidney Disease After a Previous Lung Transplantation
M. Serrano-Salazar L. Medina-Zahonero D. Janeiro-Marín C. Contreras-Lorenzo M. Aguilar-Pérez B. Sánchez-Sobrino P. López-Sánchez P. Ussetti-Gil J. Portoles-Perez 《Transplantation proceedings》2019,51(2):324-327
Background
The development of chronic kidney disease is a common complication after a lung transplantation, especially since the introduction of immunosuppressive treatments based on calcineurin inhibitors. Many of these patients reach end-stage renal disease and even need renal replacement therapy. Among the different options of renal replacement therapy, we consider kidney transplantation as a feasible option for these patients.Methods
A single center, observational retrospective study including 8 lung transplanted patients who have received a kidney transplant in the period between 2013 and 2017 with at least 1 year of follow-up was used.Results
Seven patients maintained an adequate function of the graft 1 year after kidney transplantation, and 1 patient died because of a pulmonary condition in spite of a previous kidney transplant. Two patients presented delayed graft function in the first days after surgery.Conclusions
The kidney transplantation is a technique of renal replacement therapy that should be considered in patients with previous lung transplantation. Experienced centers in double sequential lung and kidney transplantation should be established to assess and treat these types of patients. 相似文献19.
Background
Medical malpractice is a source of stress and cost to physicians. Little is known about how it impacts resident physicians.Methods
We analyzed data from the Comparative Benchmarking System between 2007 and 2016. We also surveyed surgery residents at our institution regarding malpractice in training.Results
4% of cases identified a resident physician and 32% involved a surgical specialty. Common allegations were “improper performance of surgery” and “improper management of surgical patient”. 1 case attributed supervision as the major allegation but supervision was a contributing factor in 26% of cases. 18% of cases named a resident as a defendant. Most residents correctly answered that they can be defendants, agreed that a medico-legal curriculum is at least “moderately important”, but had “poor” to “terrible” malpractice knowledge.Conclusions
A significant number of medical malpractice claims involve resident physicians as a responsible party. Though universally recognized as important, medico-legal training in surgical residency is often lacking. 相似文献20.