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Long-term survival following diverticulectomy for cancer in pharyngoesophageal (Zenker's) diverticulum 总被引：2，自引：0，他引：2
The incidence of cancer in a pharyngoesophageal (Zenker's) diverticulum was 0.4% among 1,249 patients treated for such diverticula at the Mayo Clinic in a 53-year period. Twenty-four patients with squamous cell carcinoma arising in a pharyngoesophageal diverticulum have been reported by others. However, most of the patients died of the malignancy within 2 years of treatment, and there were no long-term survivors. We describe 2 long-term survivors who were without evidence of tumor or diverticulum recurrence 4 1/4 and 8 years after one-stage pharyngoesophageal diverticulectomy. Review of the literature revealed that most patients with cancer in pharyngoesophageal diverticulum should be managed in a manner similar to that for patients with ordinary cervical esophageal malignancy. However, our data suggest that when the tumor is well localized without full-thickness penetration, nodal metastasis, or extension to the line of resection (as in the 2 patients discussed), diverticulectomy alone can provide satisfactory control of cancer with minimal therapeutic risk. 相似文献
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Surgical palliation of respiratory insufficiency secondary to massive exuberant polyostotic fibrous dysplasia of the ribs 总被引：1，自引：0，他引：1
A middle-aged man with long-standing polyostotic fibrous dysplasia had severe progressive restrictive lung disease with hypoxemia and pulmonary hypertension with heart failure because of exuberant intrathoracic, extraosseous proliferation of dysplastic tissue. Subtotal resection of this benign tissue mass ameliorated the respiratory insufficiency and led to sustained improvement in exercise tolerance, increase in pulmonary reserve, and decrease in signs of heart failure and pulmonary hypertension. 相似文献
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Randall R. DeMartino Ying Huang Jay Mandrekar Philip P. Goodney Gustavo S. Oderich Manju Kalra Thomas C. Bower Jack L. Cronenwett Peter Gloviczki 《Journal of vascular surgery》2018,67(1):151-156.e3
Objective
The benefit of prophylactic repair of abdominal aortic aneurysms (AAAs) is based on the risk of rupture exceeding the risk of death from other comorbidities. The purpose of this study was to validate a 5-year survival prediction model for patients undergoing elective repair of asymptomatic AAA <6.5 cm to assist in optimal selection of patients.Methods
All patients undergoing elective repair for asymptomatic AAA <6.5 cm (open or endovascular) from 2002 to 2011 were identified from a single institutional database (validation group). We assessed the ability of a prior published Vascular Study Group of New England (VSGNE) model (derivation group) to predict survival in our cohort. The model was assessed for discrimination (concordance index), calibration (calibration slope and calibration in the large), and goodness of fit (score test).Results
The VSGNE derivation group consisted of 2367 patients (70% endovascular). Major factors associated with survival in the derivation group were age, coronary disease, chronic obstructive pulmonary disease, renal function, and antiplatelet and statin medication use. Our validation group consisted of 1038 patients (59% endovascular). The validation group was slightly older (74 vs 72 years; P < .01) and had a higher proportion of men (76% vs 68%; P < .01). In addition, the derivation group had higher rates of advanced cardiac disease, chronic obstructive pulmonary disease, and baseline creatinine concentration (1.2 vs 1.1 mg/dL; P < .01). Despite slight differences in preoperative patient factors, 5-year survival was similar between validation and derivation groups (75% vs 77%; P = .33). The concordance index of the validation group was identical between derivation and validation groups at 0.659 (95% confidence interval, 0.63-0.69). Our validation calibration in the large value was 1.02 (P = .62, closer to 1 indicating better calibration), calibration slope of 0.84 (95% confidence interval, 0.71-0.97), and score test of P = .57 (>.05 indicating goodness of fit).Conclusions
Across different populations of patients, assessment of age and level of cardiac, pulmonary, and renal disease can accurately predict 5-year survival in patients with AAA <6.5 cm undergoing repair. This risk prediction model is a valid method to assess mortality risk in determining potential overall survival benefit from elective AAA repair. 相似文献5.
Recurrent pharyngoesophageal diverticulum is uncommon after a one-stage diverticulectomy. Among 888 operations at the Mayo Clinic, recurrence has been noted after only 32 (3.6%). The present report outlines our management during a 19-year period of 44 patients operated on previously, including management of various late complications seen in 13 patients after diverticulopexy and diverticulectomy performed at other institutions. The study then focuses on the results in 31 patients in whom reoperation for symptomatic recurrent diverticulum was performed at the Mayo Clinic during the same period. Although reoperation posed a technical challenge, there was only 1 operative death (3.2%). Surviving patients experienced highly satisfactory late results, with only two recurrences. Early surgical morbidity was considerably higher than for primary operations, but this did not interfere with most patients having excellent to good late results. 相似文献
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E L Ceithaml F J Puga G K Danielson D C McGoon D G Ritter 《The Annals of thoracic surgery》1984,38(5):433-437
From 1975 through 1982, the Damus-Stansel-Kaye procedure was performed on 20 patients with complete transposition of the great arteries (TGA) and on 4 with double-outlet right ventricle (DORV) and subpulmonary ventricular septal defect (VSD). The patients ranged from 6 days to 20 years old (median age, 13 months). Associated anomalies included atrial septal defect (24 patients), VSD (14), and others (25). Thirteen patients had had palliative operations previously. Of the 14 hospital deaths (58%), 13 occurred among the 17 patients with one or more risk factors: age less than 18 months, weight less than 10 kg, and left ventricular peak systolic pressure less than 75% of systemic pressure. Follow-up ranged from 12 to 87 months (mean, 51 months). One patient died of cardiac failure two years postoperatively, and 2 required conduit replacement at 40 and 50 months because of stenosis. All 9 survivors are free from major symptoms. The Damus-Stansel-Kaye repair is most suitable for patients with TGA or DORV with subpulmonary VSD who are older than 18 months, weight more than 10 kg, and have a "prepared left ventricle," and whose coronary artery anatomy precludes transplantation. 相似文献
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Naveed Afzal Sunghwan Sohn Sara Abram Christopher G. Scott Rajeev Chaudhry Hongfang Liu Iftikhar J. Kullo Adelaide M. Arruda-Olson 《Journal of vascular surgery》2017,65(6):1753-1761
Objective
Lower extremity peripheral arterial disease (PAD) is highly prevalent and affects millions of individuals worldwide. We developed a natural language processing (NLP) system for automated ascertainment of PAD cases from clinical narrative notes and compared the performance of the NLP algorithm with billing code algorithms, using ankle-brachial index test results as the gold standard.Methods
We compared the performance of the NLP algorithm to (1) results of gold standard ankle-brachial index; (2) previously validated algorithms based on relevant International Classification of Diseases, Ninth Revision diagnostic codes (simple model); and (3) a combination of International Classification of Diseases, Ninth Revision codes with procedural codes (full model). A dataset of 1569 patients with PAD and controls was randomly divided into training (n = 935) and testing (n = 634) subsets.Results
We iteratively refined the NLP algorithm in the training set including narrative note sections, note types, and service types, to maximize its accuracy. In the testing dataset, when compared with both simple and full models, the NLP algorithm had better accuracy (NLP, 91.8%; full model, 81.8%; simple model, 83%; P < .001), positive predictive value (NLP, 92.9%; full model, 74.3%; simple model, 79.9%; P < .001), and specificity (NLP, 92.5%; full model, 64.2%; simple model, 75.9%; P < .001).Conclusions
A knowledge-driven NLP algorithm for automatic ascertainment of PAD cases from clinical notes had greater accuracy than billing code algorithms. Our findings highlight the potential of NLP tools for rapid and efficient ascertainment of PAD cases from electronic health records to facilitate clinical investigation and eventually improve care by clinical decision support. 相似文献12.
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Christopher R. Shubert Michael L. Kendrick Elizabeth B. Habermann Amy E. Glasgow Bijan J. Borah James P. Moriarty Sean P. Cleary Rory L. Smoot Michael B. Farnell David M. Nagorney Mark J. Truty Florencia G. Que 《Surgery》2018,163(3):495-502
Background
Morbidity and costs after pancreatoduodenectomy remain increased, driven by postoperative pancreatic fistula (POPF). A risk-based pathway for pancreatoduodenectomy (RBP-PD) was implemented and the clinical and cost outcomes compared with that of our historic practice.Methods
Prospective clinical and cost outcomes for our RBP-PD cohort treated from September 2014 to September 2015 were compared with a previously published cohort of pancreatoduodenectomies from January 2007 to February 2014.Results
A total of 128 RBP-PD cases were compared with 808 historic controls. Apart from less blood loss, there were no significant clinical differences between the 2 groups. Overall POPF rate did not change. Average duration of stay decreased to 10 days from 12 (P?<?.001) despite similar readmission rates. Postsurgical interventional radiology procedures decreased to 18.0% from 26.4% (P?=?.048). Utilization of and duration of stay in monitored care decreased to 23.4% from 35.6% (P?<?.01) and to 1 day from 3 (P?<?.01). On multivariable analysis RBP-PD was independently associated with decreased odds of higher postoperative pancreatic fistula grade, monitored care, and prolonged duration of stay. Inpatient cost of care decreased $6,387 per patient (–11.1%, P?=?.016), and total 30-day costs decreased $8,565 per patient (–13.7%, P?=?.01), representing a total 30-day cost savings of $1.1 million.Conclusion
RBP-PD significantly improved patient outcomes, decreased costs of care, and likely has applicability for surgical care beyond pancreatoduodenectomy. 相似文献14.
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Feras Zaiem Jehad Almasri Mouaffaa Tello Larry J. Prokop Elliot L. Chaikof Mohammad Hassan Murad 《Journal of vascular surgery》2018,67(1):320-331.e37
Objective
The objective of this systematic review and meta-analysis was to evaluate the optimal modality and frequency of surveillance after endovascular aortic repair (EVAR) in adult patients with abdominal aortic aneurysms.Methods
We searched for studies of post-EVAR surveillance in MEDLINE In-Process & Other Non-Indexed Citations, MEDLINE, Embase, Cochrane Database of Systematic Reviews, and Scopus through May 10, 2016. The outcomes of interest were endoleaks, mortality, limb ischemia, renal complications, late rupture, and aneurysm-related mortality. Outcomes were pooled using a random-effects model and were reported as incidence rate and 95% confidence interval.Results
Of 1099 candidate references, we included 6 meta-analyses and 52 observational studies. Complication rates were common after EVAR, particularly in the first year. Magnetic resonance imaging had a higher detection rate of endoleaks than computed tomography angiography. Doppler ultrasound had lower diagnostic accuracy, whereas contrast-enhanced ultrasound was likely to be as sensitive as computed tomography angiography. The highest endoleak detection rates were in surveillance approaches that used combined tests. There were no studies that compared different surveillance intervals to determine optimal intervals; however, most studies reported detection rates of patient-important outcomes at 1, 6, 12, 24, 36, 48, and 60 months. Data were insufficient to provide comparative inferences about the best strategy to reduce the risk of patient-important outcomes, such as mortality, limb ischemia, rupture, and renal complications.Conclusions
Several tests with reasonable diagnostic accuracy are available for surveillance after EVAR. The available evidence suggests a high complication rate, particularly in the first year, and provides a rationale for surveillance. 相似文献16.
Arterial decannulation from a diseased aorta at high pressure can be hazardous. A technique increasing the safety of this maneuver is described. 相似文献
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A modified continuous suture technique for mitral valve replacement is described which retains desirable features of the less expedient interrupted suture technique. An initial experience with this technique in more than 300 patients has encouraged its continued use. 相似文献
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Aleem K. Mirza Kendall Stauffer Mark D. Fleming Randall De Martino Gustavo Oderich Manju Kalra Peter Gloviczki Thomas Bower 《Journal of vascular surgery》2018,67(4):1199-1206
Objective
Conflicting data exist on outcomes of open vein harvest (OVH) and endoscopic vein harvest (EVH) for infrainguinal bypass. The purpose of this study was to compare outcomes between OVH and EVH in femoral to popliteal artery bypasses.Methods
A retrospective review was performed of all patients undergoing common femoral to popliteal artery bypass with great saphenous vein between January 1997 and June 2014. Bypasses using arm or composite vein were excluded, as were those performed for popliteal artery aneurysms or trauma. Harvest was typically performed by dedicated surgical assistants. Patients were analyzed by either OVH or EVH of vein. The primary outcome was primary patency. Secondary outcomes included assisted primary and secondary patency and major wound complications. Statistical analysis was performed for categorical and continuous variables with life-table and survival statistics for long-term outcomes.Results
In the study time, 505 patients underwent femoral-popliteal bypass; 262 patients and 280 limbs met the inclusion criteria. OVH was performed on 194 (69%) limbs and EVH on 86 (31%). There was no significant difference between the groups in terms of demographics, comorbidities, and preoperative Rutherford classification. Mean follow-up was 34 months. Six of 13 operators (46%) used both harvest techniques. At 5 years, OVH demonstrated higher rates of primary patency compared with EVH (62.8% vs 47%; P = .006) and higher rates of assisted primary patency (81.2% vs 64.3%; P = .003). Secondary patency was not significantly different between groups. The average number of graft interventions was less frequent with EVH, although this trend was not statistically significant (0.1 OVH vs 0.3 EVH; P = .1). EVH also had a lower rate of major wound complications per limb (n = 16; 8% OVH vs 0% EVH; P = .004).Conclusions
OVH was associated with superior primary and assisted primary patencies compared with EVH at 5 years, yet OVH was associated with higher wound complications. Surgeons should weigh the risk of wound complications vs decreased primary and primary assisted patency when deciding which method to use for vein harvest. 相似文献19.
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Muhammad A. Rana Peter Gloviczki Audra A. Duncan Manju Kalra Kevin L. Greason Gustavo S. Oderich Stephen S. Cha Thomas C. Bower 《Journal of vascular surgery》2018,67(3):713-721