Shear accumulation as a means for evaluating risk of thromboembolic events in novel endovascular stent graft designs

Objective

This study proposes to establish a simulation-based technique for evaluating shear accumulation in stent grafts and to use the technique to assess the performance of a novel branched stent graft system.

Gastric sleeve resection as day-case surgery: what affects the discharge time?

BackgroundSleeve gastrectomy, with its short operating time, is possible to perform as same-day surgery, with the most common reason for requiring overnight hospital stay being postoperative nausea and vomiting.ObjectiveTo demonstrate the feasibility and safety of sleeve gastrectomy as same-day surgery with regard to complication rate. Additionally, the study aimed to evaluate factors determining the duration of hospital stay, such as type of anesthesia, time of procedure, degree of postoperative nausea and pain, American Society of Anesthesiologists score, or previous abdominal surgery.SettingNonacademic primary referral center.MethodsA substudy of a single-center, double-blind, randomized controlled trial. Patients included in this study underwent sleeve gastrectomy and were randomized into 1 of the following 2 types of anesthesia: total intravenous anesthesia with propofol or desflurane. Primary endpoint was the number of patients discharged the same day as surgery. Secondary endpoints were unplanned telephone calls, readmission rate, and complication rate. Time of procedure was registered by the staff at the operation theatre. Visual analog scales score estimating patients’ intensity of pain and nausea were completed at the postoperative unit, surgical ward, and 24 to 48 hours postoperatively.ResultsNinety-three patients were included in the study. Fifty-nine (63%) were discharged the same day as surgery (32 desflurane and 27 total intravenous anesthesia), 30 patients (32%) were discharged 1 day after surgery, and 4 patients (4%) were discharged after >2 days (15 desflurane and 19 total intravenous anesthesia). The most common reasons for prolonged stay were pain, nausea, and fatigue. Statistical analyses showed no association between day of discharge and the type of anesthesia, time of the procedure, degree of postoperative nausea and vomiting, pain intensity, American Society of Anesthesiologists score, or previous abdominal surgery.ConclusionSame-day surgery is feasible and safe in terms of low complication rate. The type of anesthesia, time of procedure, degree of postoperative nausea and vomiting and pain, American Society of Anesthesiologists score and previous abdominal surgery does not appear to affect length of hospital stay.     

High and immeasurable ankle-brachial index as predictor of poor amputation-free survival in critical limb ischemia

Objective

The objective of this study was to assess the prognostic value of a high or immeasurable ankle-brachial index (ABI) at baseline for major amputation and amputation-free survival (AFS) in patients with critical limb ischemia (CLI).

mSTaRT Trauma & Intox

Background

Any kind of mass casualty incident poses a tremendous challenge to emergency medical services regarding both material and human resources. The possible presence of hazardous materials on the scene aggravates such a severe incident significantly. Therefore a triage system should adequately address this problem without needlessly complicating the triage procedure.

Methods

Following a tear gas assault in a shopping arcade in Munich, an expert group has identified and included this relevant aspect as an essential and necessary improvement to the new mSTaRT-Algorithm Trauma & Hazmat. The algorithm has come into effect as new official operational standard for all Munich fire and emergency medical services regarding mass casualty incidents. It covers the aspects of identifying the possible presence of hazardous materials, triage, emergency treatment and transport priorities. The recognition of a possible contamination as well as the appropriate reaction are implemented for each patient category. Moreover, the specific diagnoses of head trauma, inhalation trauma with stridor and possible intoxication have been included as part of the retriage procedure, taking evidence of recent studies into account.

Results

This new algorithm for mass casualty incidents adequately covers any possible contamination with chemical agents.     

Male Patients Above Age 60 have as Good Outcomes as Male Patients 50–59 Years Old at 1-Year Follow-up After Bariatric Surgery

BACKGROUND: It is estimated that 25% of Americans older than 60 years are obese. Male gender and advanced age are indicators of increased risk for bariatric surgery. Good results have been shown in patients older than 50, but nearly all published studies include a large majority of females, and few include patients >60 years old. In this study, we examined the results of males over 60 years old. METHODS: We reviewed a prospective database of 107 consecutive patients who underwent bariatric surgery between April 2002 and June 2007 at the Palo Alto VA. Of these, 60 patients were males older than 50 and available for follow-up 12 months postoperatively. There were 47 males 50-59 years old (group I) and 13 males older than 60 years (group II). Data were analyzed using Student's t test. RESULTS: Mean preoperative body mass index was similar in both groups (49.4 vs. 47.5 kg/m(2); p = 0.468). Length of hospital stay was similar (3.2 vs. 3.5 days; p = 0.678), but early morbidity was higher in group II patients (30.8% vs. 8.5%; p = 0.037). Morbidity included urinary tract infection, cardiac arrhythmias, and early bowel obstruction. Excess weight loss after 1 year was not significantly different (63.6% vs. 60.6%; p = 0.565). Diabetes resolution or improvement was seen in 87% of group I patients and 90% of group II patients. CONCLUSION: Despite a higher early morbidity rate, obese males >/=60 years old perform as well as male patients 50-59 years old with respect to excess weight loss, mortality, length of stay, and improvement of diabetes, at 1 year postoperatively.     

Osteosynthese und Pfannenwechsel bei periprothetischer Azetabulumfraktur über einen Kocher-Langenbeck-Zugang

Objective

Reconstruction/stable fixation of the acetabular columns to create an adequate periacetabular requirement for the implantation of a revision cup.

Indications

Displaced/nondisplaced fractures with involvement of the posterior column. Resulting instability of the cup in an adequate bone stock situation.

Contraindications

Periprosthetic acetabulum fractures with inadequate bone stock. Extended periacetabular defects with loss of anchorage options. Isolated periprosthetic fractures of the anterior column. Septic loosening.

Surgical technique

Dorsal approach. Dislocation of hip. Mechanical testing of inlaying acetabular cup. With unstable cup situation explantation of the cup, fracture fixation of acetabulum with dorsal double plate osteosynthesis along the posterior column. Cup revision. Hip joint reposition.

Postoperative management

Early mobilization; partial weight bearing for 12 weeks. Thrombosis prophylaxis. Clinical and radiological follow-ups.

Results

Periprosthetic acetabular fracture in 17 patients with 9 fractures after primary total hip replacement (THR), 8 after revision THR. Fractures: 12 due to trauma, 5 spontaneously; 7 anterior column fractures, 5 transverse fractures, 4 posterior column fractures, 1 two column fracture after hemiendoprosthesis. 5 type 1 fractures and 12 type 2 fractures. Operatively treated cases (10/17) received 3 reinforcement ring, 2 pedestal cup, 1 standard revision cup, cup-1 cage construct, 1 ventral plate osteosynthesis, 1 dorsal plate osteosynthesis, and 1 dorsal plate osteosynthesis plus cup revision (10-month Harris Hip Score 78 points). Radiological follow-up for 10 patients: consolidation of fractures without dislocation and a fixed acetabular cup. No revision surgeries during follow-up; 2 hip dislocations, 1 transient sciatic nerve palsy.

     

PSA-nadir at 1 year as a sound contemporary prognostic factor for low-dose-rate iodine-125 seeds brachytherapy

Objectives

To identify predictors of outcomes in patients with localized prostate cancer treated with iodine-125 brachytherapy in a longitudinal uncontrolled study.

Methods

Between 2000 and 2011, 560 histologically confirmed patients were treated with brachytherapy of whom 305 with ≥24-month follow-up and localized tumor were evaluated after exclusion of those locally advanced and under androgen ablation.

Results

Patients’ mean age was 63.93 years (44–88), mean pretreatment prostate-specific antigen (PSA) was 6.34 ng/mL (0.67–33.09), overall median follow-up was 75.35 months (24–158.37), biochemical recurrence occurred in 17 patients (5.57 %), cancer-specific survival was 100 %, and overall survival was 98.03 %. At multivariate analyses, only PSA-nadir at 1 year and age were related to disease-free survival: To each unit of PSA-nadir, the risk increases 87.3 %—OR 1.87 (p < 0.001; 95 % CI 1.31–2.67), and risk was 4.7 times higher for those under 50 years (vs. >70)—OR 4.69 (p = 0.04; 95 % CI 1.39–18.47). Best cutoff for PSA-nadir at one year was 0.285 (AUC = 0.78; p < 0.001; 95 % CI 0.68–0.89). Kaplan–Meier analysis confirmed PSA-nadir (p < 0.001) as prognostic, while D’Amico’s classification failed (p = 0.24). No grade 3 or 4 complication was reported, and only 31.4 % of patients had grade 2 urinary or rectal toxicity. PSA bounce ≥0.4 ng/mL occurred in 18.4 % with no impact on biochemical recurrence.

Conclusions

Half (50.49 %) of patients in the scenario of localized prostate cancer treated with iodine-125 brachytherapy reach PSA-nadir at 1 year <0.285, recognized as a key independent prognostic factor.

Graphical Abstract

[Receiver Operating Characteristic curve analysis for PSA-nadir at 1 year]