共查询到20条相似文献，搜索用时 0 毫秒
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Mustapha El Lakis Andreas Giannakou Pavel J. Nockel Douglas Wiseman Sudheer Kumar Gara Dhaval Patel Zahraa Abdul Sater Yevgeniya Y. Kushchayeva Joanna Klubo-Gwiezdzinska Naris Nilubol Maria J. Merino Electron Kebebew 《Surgery》2019,165(1):50-57
Background
There are conflicting reports on whether familial nonmedullary thyroid cancer is more aggressive than sporadic nonmedullary thyroid cancer. Our aim was to determine if the clinical and pathologic characteristics of familial nonmedullary thyroid cancer are different than nonmedullary thyroid cancer.Methods
We compared patients with familial nonmedullary thyroid cancer to a cohort of 53,571 nonmedullary thyroid cancer patients from the Surveillance, Epidemiology, and End Results database.Results
A total of 78 patients with familial nonmedullary thyroid cancer from 31 kindreds presented at a younger age (P?=?.04) and had a greater rate of T1 disease (P?=?.019), lymph node metastasis (P?=?.002), and the classic variant of papillary thyroid cancer on histology (P < .001) compared with the Surveillance, Epidemiology, and End Results cohort. Patients with ≥3 affected family members presented at a younger age (P?=?.04), had a lesser female-to-male ratio (P?=?.04), and had a greater rate of lymph node metastasis (P?=?.009). Compared with the Surveillance, Epidemiology, and End Results cohort, we found a higher prevalence of lymph node metastasis in familial nonmedullary thyroid cancer index cases (P?=?.003) but not in those diagnosed by screening ultrasonography (P?=?.58).Conclusion
Patients with familial nonmedullary thyroid cancer present at a younger age and have a greater rate of lymph node metastasis. The treatment for familial nonmedullary thyroid cancer should be more aggressive in patients who present clinically and in those who have ≥3 first-degree relatives affected. 相似文献4.
Genia Dubrovsky Nhan Huynh Anne-Laure Thomas Shant Shekherdimian James CY Dunn 《Surgery》2019,165(2):389-392
Background
Short bowel syndrome is a condition with substantial morbidity and mortality, yet definitive therapies are lacking. Distraction enterogenesis uses mechanical force to “grow” new intestine. In this study, we examined whether intestinal plication can be used to safely achieve spring-mediated intestinal lengthening in a functioning segment of jejunum in its native position.Methods
A total of 12 juvenile, miniature Yucatan pigs underwent laparotomy to place either compressed springs or expanded springs within a segment of jejunum (n?=?6 per group). The springs were secured within the jejunum by performing intestinal plication to narrow the intestinal lumen around the spring. After 3 weeks, the jejunum was retrieved and examined for lengthening and for histologic changes.Results
There were no intraoperative or postoperative complications, and the pigs tolerated their diets and gained weight. Segments of jejunum containing expanded springs showed no significant change in length over the 3 weeks. In contrast, jejunum containing compressed springs showed nearly a 3-fold increase in length (P < .001). Histology of the retrieved jejunum showed a significant increase in thickness of the muscularis propria and in crypt depth relative to normal jejunum.Conclusion
Intestinal plication is effective in securing endoluminal springs to lengthen the jejunum. This approach is a clinically relevant model because it allows for normal GI function and growth of animals during intestinal lengthening, which may be useful in lengthening intestine in patients with short bowel syndrome. 相似文献5.
Victor Eng Luis Garcia Habib Khoury John Morton Dan Azagury 《Surgery for obesity and related diseases》2019,15(6):951-957
BackgroundMany insurance companies require patients to undergo supervised weight loss programs lasting several months. However, the association between time to surgery (TTS)—the wait time between the initial consultation visit and the immediate preoperative visit—and weight loss is not well documented.ObjectivesTo investigate whether TTS affects pre- or postoperative weight loss or complication rates.SettingUniversity hospital, United States.MethodsData from 415 patients undergoing laparoscopic Roux-en-Y gastric bypass (n = 263) or sleeve gastrectomy (n = 152) at a single academic institution between 2014 and 2015 were retrospectively reviewed. TTS was compared with the percentage of total weight lost, change in body mass index, and adverse surgical events.ResultsParticipants had an average body mass index of 47.42 kg/m2 at the consultation visit and TTS ranged from 7 to 1813 days with an average wait of 209.23 days. There was a statistically significant negative correlation between TTS and preoperative percentage of total weight lost among gastric bypass patients (b = –.005; P = .0492 2-tailed). A similar inverse relationship was identified among sleeve gastrectomy patients. Extended TTS provided no significant long-term benefits in weight loss by 24 months. No significant difference in rates of complications or readmissions was identified.ConclusionsLonger preoperative wait times do not result in improved weight loss or reduced adverse events. Determination of patient eligibility for bariatric surgery should rest with the health team and delay of treatment should be minimized. 相似文献
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James I. Fann 《The Journal of thoracic and cardiovascular surgery》2018,155(4):1578-1579
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In this case report, we present a successful case of en bloc heart-lung transplant in a patient with advanced cardiopulmonary respiratory failure from amiodarone-associated pulmonary fibrosis that occurred post-left ventricular assist device implantation. 相似文献
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Konstantinos Spaniolas Iliya Goldberg Jie Yang Chencan Zhu Salvatore Docimo Mark A. Talamini Aurora D. Pryor 《Surgery for obesity and related diseases》2019,15(9):1465-1472
BackgroundWhile sleeve gastrectomy (SG) has lower perioperative risk compared with Roux-en-Y gastric bypass (RYGB), long-term data about their differential impact on overall health are unclear. Hospital use after bariatric surgery is an important parameter for improving peri- and postoperative care.ObjectiveThis present study was aimed to compare SG and RYGB in terms of their effect on long-term hospital-based healthcare utilization.SettingMulticenter, statewide database.MethodsA retrospective cohort study of adult patients who underwent SG and RYGB between 2009 and 2011, with follow-up until 2015 and 2-year presurgery information. Propensity score–matched SG and RYGB groups were created using preoperative demographic characteristics, co-morbidities, and presurgery hospital use, measured by cumulative length of stay (LOS) and frequency of emergency department visits. Postsurgery yearly LOS, incidence of hospital visits, and the reason for the visit were compared. Primary outcomes included postoperative hospital visits during years 1 to 4 after bariatric surgery and cumulative LOS. Secondary outcomes included specific reasons for hospital use.ResultsThere were 3540 SG and 13,587 RYGB patients, whose mean (95% confidence interval [CI]) LOS was 1.3 (1.3–1.4), .9 (.8–1), 1 (.9–1.1), and 1.2 (1–1.3) days at years 1 through 4, respectively. Postoperative yearly LOS was similar between the 2 propensity-matched groups. The risk of hospitalizations (odd ratio .73, 95% CI .64–.84, P < .0001) and emergency department visits (odds ratio .84, 95% CI .75–.95, P = .005) was significantly lower for SG, during the first postoperative year. The reverse was seen at the fourth postoperative year, with higher risk of emergency department use after SG (odds ratio 1.16, 95% CI 1.01–1.33, P = .035).ConclusionPostoperative 4-year hospital utilization remains low for both SG and RYGB. The previously established lower early perioperative risk of SG was not appreciated for longer-term hospital use compared with RYGB. 相似文献
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Brant W. Ullery Kenneth Tran Nathan K. Itoga Ronald L. Dalman Jason T. Lee 《Journal of vascular surgery》2017,65(4):981-990
Objective
Alternative endovascular strategies using parallel or snorkel/chimney (chimney endovascular aneurysm repair [ch-EVAR]) techniques have been developed to address the lack of widespread availability and manufacturing limitations with branched/fenestrated aortic devices for the treatment of complex abdominal aortic aneurysms. Despite high technical success and midterm patency of snorkel stent configurations, concerns remain regarding the perceived increased incidence of early gutter-related type Ia endoleaks. We aimed to evaluate the incidence and natural history of gutter-related type Ia endoleaks following ch-EVAR.Methods
Review of medical records and available imaging studies, including completion angiography and serial computed tomographic angiography, was performed for all patients undergoing ch-EVAR at our institution between September 2009 and January 2015. Only procedures involving ≥1 renal artery with or without visceral snorkel stents were included. Primary outcomes of the study were presence and persistence or resolution of early gutter-related type Ia endoleak. Secondary outcomes included aneurysm sac shrinkage and need for secondary intervention related to the presence of type Ia gutter endoleak.Results
Sixty patients (mean age, 75.8 ± 7.6 years; male, 70.0%) underwent ch-EVAR with a total of 111 snorkel stents (97 renal [33 bilateral renal], 12 superior mesenteric artery, 2 celiac). A mean of 1.9 ± 0.6 snorkel stents were placed per patient. Early gutter-related type Ia endoleaks were noted on 30.0% (n = 18) of initial postoperative imaging studies. Follow-up imaging revealed spontaneous resolution of these gutter endoleaks in 44.3%, 65.2%, and 88.4% of patients at 6, 12, and 18 months postprocedure, respectively. Long-term anticoagulation, degree of oversizing, stent type and diameter, and other clinical/anatomic variables were not significantly associated with presence of gutter endoleaks. Two patients (3.3%) required secondary intervention related to persistent gutter endoleak. At a mean radiologic follow-up of 20.9 months, no difference in mean aneurysm sac size change was observed between those with or without early type Ia gutter endoleak (?6.1 ± 10.0 mm vs ?4.9 ± 11.5 mm; P = .23).Conclusions
Gutter-related type Ia endoleaks represent a relatively frequent early occurrence after ch-EVAR, but appears to resolve spontaneously in the majority of cases during early to midterm follow-up. Given that few ch-EVAR patients require reintervention related to gutter endoleaks and the presence of such endoleak did not correlate to increased risk for aneurysm sac growth, its natural history may be more benign than originally expected. 相似文献12.
Western Vascular Society guidelines for transfer of patients with ruptured abdominal aortic aneurysm
Matthew W. Mell Benjamin W. Starnes Larry W. Kraiss Peter A. Schneider William C. Pevec 《Journal of vascular surgery》2017,65(3):603-608
Introduction
When a patient with ruptured abdominal aortic aneurysm (rAAA) presents at a facility ill-equipped to provide care, transfer may provide the best chance for survival. Large distances and long travel times provide challenging barriers to prompt and appropriate care in the western United States.Methods
The Western Vascular Society (WVS) adopted a set of guidelines in considering transfer of a patient with an rAAA using published literature, membership survey and input, and existing recommendations. This article reports the guidelines and describes the process and rationale behind their development.Results
Fifteen guidelines for transfer and care of rAAAs were endorsed by the WVS.Conclusions
When local care cannot be provided, transfer guidelines may standardize care for rAAAs and may be applicable across may practice settings. 相似文献13.
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Objective
We sought to analyze the outcomes of revascularization for aortoiliac-femoral occlusive disease by comparing hybrid repair by endovascular revascularization and open common femoral endarterectomy (ER-CFE) with open aortoiliac reconstruction and CFE (OR-CFE).Methods
Using the national Society for Vascular Surgery Vascular Quality Initiative database from 2009 to 2015, we identified all patients receiving open or endovascular revascularization of the aortoiliac system and who additionally underwent CFE. Patients with concomitant infrainguinal procedures were excluded, as were procedures performed at centers with <50% 9-month or longer follow-up. Main outcome variables were 30-day mortality, length of stay, 1-year mortality and patency, ankle-brachial index (ABI), secondary interventions, major amputations, and ambulatory status.Results
After exclusions, the cohort comprised 879 patients in the OR-CFE group and 1472 in the ER-CFE group with follow-up of at least 9 months. Patients with ER-CFE were older (68 ± 9 years vs 63 ± 9 years; P < .001) and were more likely to have diabetes (37% vs 29%; P < .001) or heart failure (13% vs 9%; P < .01). Those receiving OR-CFE were more likely to have received a previous inflow procedure (27% vs 21%; P < .001). A greater number of arterial segments were treated or bypassed for patients undergoing OR-CFE (5.2 ± 1.6 vs 2.9 ± 1.0; P < .01). ER-CFE was associated with lower 30-day mortality (1.8% vs 3.4%; P = .01), shorter length of stay (median 3 vs 7 days; P < .001), and higher 1-year mortality (8.6% vs 6.3%; P = .04). The two cohorts had equivalent major amputation rate (2.8% vs 2.9%; P = .84). Patients with OR-CFE had greater ABI improvement at long-term follow-up (0.39 ± 0.37 vs 0.26 ± 0.23; P < .001) and were more likely to achieve improved ambulatory status (82% vs 65%; P < .001).Conclusions
For patients with aortoiliac-femoral occlusive disease, endovascular repair with concomitant CFE appeared to have improved short-term outcomes and equivalent freedom from major amputation compared with open surgical repair with CFE. Conversely, open repair with CFE was associated with better long-term improvement in ABI and ambulatory status. Open repair should therefore be considered for patients with aortoiliac-femoral occlusive disease and reasonable surgical risk. 相似文献16.
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