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1.
Background
Limb lengthening and deformity correction with motorized intramedullary lengthening nails is a more comfortable and equally safe procedure than the use of external fixators. While this treatment is a well-established method in adults, intramedullary nailing for skeletally immature patients remains a challenge and is the focus of current clinical investigations.Objective
Elucidation of the indications for the application of femoral and tibial lengthening nails in skeletally immature patients, presentation of essential characteristics and limitations of the treatment.Material and methods
Treatment of skeletally immature patients up to 16 years old who had a lengthening nail inserted was retrospectively clinically and radiologically evaluated (2016–2018).Results
A total of 60 procedures were performed on 54 patients. Mean age at the time of surgery was 13.6 years and the mean follow-up time was 10 months. Different nailing approaches were used: antegrade femoral (n?=?42), retrograde femoral (n?=?10) and antegrade tibial (n?=?8). The average amount of lengthening was 45?mm. In 58 of the 60 cases (96.7%) the desired amount of lengthening was achieved, while 2 patients experienced complications that required interruption of the treatment. None of the patients developed growth disorders associated with the nailing approach.Conclusion
Different approaches for intramedullary lengthening nails can be used in children and adolescents to correct leg length discrepancy with or without concomitant deformities. The treatment is limited by the size of the available nails, the residual growth and extent of the deformity. Larger trials will be needed to further validate the application of lengthening nails in skeletally immature patients.2.
Wostrack M Shiban E Harmening K Obermueller T Ringel F Ryang YM Meyer B Stoffel M 《Acta neurochirurgica》2012,154(8):1419-1430
Background
Despite the increased risk of hemorrhage and deteriorating neurological function of once-bled cerebral cavernous malformations (CM), the management of eloquently located CMs remains controversial.Methods
All eloquently located CMs (n?=?45) surgically treated between 03/2006 and 04/2011 in our department were consecutively evaluated. Eloquence was characterized according to Spetzler and Martin's definition. The following locations were approached: brainstem, n?=?16; sensorimotor, n?=?8; visual pathway, n?=?7; cerebellum (deep nuclei and peduncles), n?=?7; basal ganglia, n?=?4, and language, n?=?3. Follow-up data was available for 41 patients (91 %) with a median interval of 14 months. Outcomes were evaluated according to the Glasgow outcome and the modified Rankin scale.Results
Immediately after surgery, 47 % (n?=?21) had a new deficit. At follow-up, 80 % (n?=?36) recovered to at least preoperative status or were better than before surgery, 9 % (n?=?4) exhibited a slight, and 7 % (n?=?3) had a moderate neurological impairment. Only two cases (4 %) with a new permanent severe deficit were observed, both related to dorsal brainstem surgery. The outcome after the surgery of otherwise located brainstem CMs was as beneficial as that for non-brainstem CMs. Patients with initially poor neurological performance fared worse than oligosymptomatic patients.Conclusions
Despite the high postoperative transient morbidity, the majority improved profoundly during follow-ups. Compared with natural history, surgical treatment should be considered for all eloquent symptomatic CMs. Dorsal brainstem location and poor preoperative neurological status are associated with an increased postoperative morbidity.3.
Farrell E. Cooke Jon D. Samuels Alfons Pomp Farida Gadalla Xian Wu Cheguevara Afaneh Gregory F. Dakin Peter A. Goldstein 《Obesity surgery》2018,28(10):2998-3006
Background
Retrospective studies indicate that acetaminophen iv administration reduces hospital length of stay (LoS) and opiate consumption in patients undergoing bariatric surgery.Objective
This study sought to determine whether using acetaminophen iv in morbidly obese subjects undergoing sleeve gastrectomy decreased LoS and total hospital charges as compared to patients receiving saline placebo.Setting
Single-center university hospitalMethods
Using a randomized, double-blind, placebo-controlled design, subjects were assigned to receive either acetaminophen iv (group A) or saline placebo iv (group P). Data were collected between Jan 1 and Dec 31, 2016. Group A received acetaminophen every 6 h for a total of four doses. The first dose was administered following the induction of general anesthesia; group P received saline iv on the same schedule. Anesthetic management and prophylactic antiemetic regimen were standardized in all subjects. Postoperative pain management consisted of hydromorphone via patient-controlled infusion pump. Primary outcomes include hospital LoS and associated hospital costs. Secondary outcomes include patient satisfaction and postoperative nausea and pain scores.Results
Subject demographics (n?=?127) and intraoperative management were similar in the two groups. Across all subjects, median hospital LoS in group A (n?=?63) was 1.87 vs. 1.97 days in group P (n?=?64) (p?=?0.03, Wilcoxon rank-sum test). Postoperatively, daily quality-of-recovery (QoR-15) scores, narcotic consumption, and the use of rescue antiemetics were not significantly different between groups. Median hospital costs were as follows: group A, $12,885 vs. group P, $12,977 (n?=?64).Conclusions
Acetaminophen iv may reduce hospital LoS in subjects undergoing sleeve gastrectomy.4.
Zubaidah Nor Hanipah Suriya Punchai Arthur McCullough Srinivasan Dasarathy Stacy A. Brethauer Ali Aminian Philip R. Schauer 《Obesity surgery》2018,28(11):3431-3438
Introduction
Studies on bariatric patients with cirrhosis and portal hypertension are limited. The aim of this study was to review our experience in cirrhotic patients with portal hypertension who had bariatric surgery.Method
All cirrhotic patients with portal hypertension who underwent laparoscopic bariatric surgery, from 2007 to 2017, were retrospectively reviewed.Results
Thirteen patients were included; eight (62%) were female. The median age was 54 years (interquartile range, IQR 49–60) and median BMI was 48 kg/m2 (IQR 43–55). Portal hypertension was diagnosed based on endoscopy (n?=?5), imaging studies (n?=?3), intraoperative increased collateral circulation (n?=?2), and endoscopy and imaging studies (n?=?3). The bariatric procedures included sleeve gastrectomy (n?=?10, 77%) and Roux-en-Y gastric bypass (n?=?3, 23%). The median length of hospital stay was 3 days (IQR 2–4). Three 30-day complications occurred including wound infection (n?=?1), intra-abdominal hematoma (n?=?1), and subcutaneous hematoma (n?=?1). No intraoperative or 30-day mortalities. There were 11 patients (85%) at 1-year follow-up and 9 patients (69%) at 2-year follow-up. At 2 years, the median percentage of excess weight loss (EWL) and total weight loss (TWL) were 49 and 25%, respectively. There was significant improvement in diabetes (100%), dyslipidemia (100%), and hypertension (50%) at 2 years after surgery.Conclusion
Bariatric surgery in selected cirrhotic patients with portal hypertension is relatively safe and effective.5.
Objectives
Over the past decade, minimal invasive surgery for correction of pectus carinatum has gained worldwide acceptance. This study reviews our clinical experience with minimally invasive repair of pectus carinatum (MIRPC) since 2008.Methods
Between 2008 and 2018, 101 patients (77 male, 24 female) underwent correction of pectus carinatum with the MIRPC technique. The mean age of the patients was 14.7?±?4.8 (3–38) years. Over an 8 years’ experience we slightly modified the original Abramson technique. All patients presented with cosmetic complaints and all had a flexible chest wall on “compression test”. Early follow-up was on postoperative day 15 and 30.Results
The mean operative time was 42.1?±?16.9 min. The mean hospital stay was 4.2?±?0.9 days. Postoperative complications included pneumothorax (n?=?2, 1.9%), wound infection (n?=?2, 1.9%), skin perforation (n?=?2, 1.9%), intolerable pain (n?=?1, 0.9%), skin hyperpigmentation (n?=?1, 0.9%), and overcorrection (n?=?1, 0.9%). Initial postoperative results were excellent in all patients. The bars were removed at a median of 24.8?±?4.5 months in 44 of 101 patients. 43 of 44 (97.7%) patients whose bar were removed reported excellent results.Conclusions
MIRPC is a feasible procedure with low morbidity and excellent cosmetic results in the treatment of pectus carinatum deformities in selected patients.6.
Takeshi Takamoto Keiji Sano Takuya Hashimoto Akihiko Ichida Kei Shimada Yoshikazu Maruyama Masatoshi Makuuchi 《Journal of gastrointestinal surgery》2018,22(12):2037-2044
Background
Recent improvements in imaging technologies have enabled surgeons to perform precise planning using virtual hepatectomy (VH). However, the practical and clinical benefits of VH remain unclear. This study sought to assess how three-dimensional analysis using a VH contributed to preoperative planning and postoperative outcome in patients undergoing liver surgery for the treatment of colorectal liver metastases (CRLM).Methods
From 2007 to 2017, a total of 473 CRLM patients who received curative hepatectomy were retrospectively assessed. A 1:1 matched propensity analysis was performed between patients who did not receive a VH (without 3D group: n?=?188) and received a VH (3D(+) group: n?=?285).Result
The rate of VH increased over the study period (P?<?0.001). After propensity score matching (n?=?150 for each group), no significant differences were observed in the intraoperative and postoperative outcome, including liver transection time, blood loss, or morbidity between the groups. More patients received a small anatomical resection (plus limited resections) in the 3D(+) group (25 vs 11%, [P?=?0.03]). A submillimeter margin was less frequent in the 3D(+) group. No significant differences in the 5-year overall survival and disease-free survival rates were seen between the without 3D group and the 3D(+) group (38.0 vs. 45.9% [P?=?0.99], 11.1 vs. 21.7%, respectively [P?=?0.109]).Conclusion
Although VH did not significantly influenced on the long-term outcome after hepatectomy, a more parenchymal-sparing operative procedure (anatomical resections, plus limited resections) was selected and the risk of a submillimeter surgical margin was reduced after introduction of VH.7.
Purposes
The purpose of this study was to evaluate the influence of comorbidities on the surgical outcomes of early cholecystectomy for acute cholecystitis.Methods
Data were retrospectively collected for patients with acute cholecystitis who underwent early cholecystectomy. Patients were separated into three groups based on the cholecystitis severity grade, and the surgical outcomes of early cholecystectomy were analyzed. Patients with mild and moderate cholecystitis were subdivided into a comorbidity group (n?=?10) and a non-comorbidity group (n?=?83).Results
There were 57 (55.3%) patients with mild cholecystitis, 36 (35.0%) with moderate cholecystitis, and 10 (9.7%) with severe cholecystitis. The surgical outcomes were significantly worse for patients with severe cholecystitis than for patients with mild or moderate cholecystitis. There were no postoperative deaths after cholecystectomy. There were no significant differences in the complication rate (P?=?0.629), conversion rate (P?=?0.114), or intraoperative blood loss (P?=?0.147) between the comorbidity and non-comorbidity groups.Conclusion
Our findings suggest that early cholecystectomy can be performed safely for patients with mild and moderate cholecystitis even if comorbidities are present. Early cholecystectomy may be an alternative treatment strategy for patients with severe cholecystitis who are candidates for anesthesia and surgery.8.
Yoshihiro Sakamoto Shutaro Hori Seiji Oguro Junichi Arita Yoji Kishi Satoshi Nara Minoru Esaki Akio Saiura Kazuaki Shimada Takeharu Yamanaka Tomoo Kosuge 《Journal of gastrointestinal surgery》2016,20(3):595-603
Background
A retrospective analysis indicated that the incidence of delayed gastric emptying (DGE) was less after using a circular stapler (CS) for duodenojejunostomy than that after hand-sewn (HS) anastomosis in pylorus-preserving pancreaticoduodenectomy (PpPD). This randomized clinical trial compared the incidence of DGE postoperative after CS duodenojejunostomy with that of conventional HS anastomosis in PpPD.Methods
We randomly assigned 101 patients (age 20–80) undergoing PpPD to receive CS duodenojejunostomy (group CS, n?=?50) or HS duodenojejunostomy (group HS, n?=?51) in two Japanese cancer center hospitals between 2011 and 2013. The patients were stratified by institution and size of the main pancreatic duct (<3 or ≥3 mm). The primary endpoint was the incidence of grade B or C DGE according to the international definition with a non-inferiority margin of 5 %. This trial is registered with University hospital Medical Information Network (UMIN) Center: UMIN000005463.Results
Per-protocol analysis of data on 95 patients showed that grade B or C DGE was found in 4 (8.9 %) of 45 patients who underwent CS anastomosis and in 8 (16 %) of 50 patients who underwent HS anastomosis (P?=?0.015). There were no differences in the overall incidence of DGE (P?=?0.98), passage of the contrast medium through the anastomosis (P?=?0.55), or hospital stays (P?=?0.22).Conclusions
CS duodenojejunostomy is not inferior to HS anastomosis with respect to the incidence of clinically significant DGE, justifying its use as treatment option.9.
Kamal K. Mahawar Abdelrahman Nimeri Marco Adamo Cynthia-Michelle Borg Rishi Singhal Omar Khan Peter K. Small 《Obesity surgery》2018,28(9):2650-2660
Background
There is currently little evidence available on various aspects of Revisional Bariatric Surgery (RBS) and no published consensus amongst experts. The purpose of this study was to understand variation in practices concerning RBS.Methods
Bariatric surgeons from around the world who perform RBS were invited to participate in a questionnaire-based survey on SurveyMonkey®.Results
A total of 460 respondents from 62 countries took the survey. For revision after gastric banding, Roux-en-Y gastric bypass (RYGB) (75.5%, n?=?345) emerged as the commonest choice followed by sleeve gastrectomy (SG) (56.9%, n?=?260) and one anastomosis gastric bypass (OAGB) (37.2%, n?=?170). For revision after SG, RYGB (77.7%, n?=?355) was the commonest option followed by OAGB (42.45%, n?=?194) and re-sleeve (22.32%, n?=?102). For revision after RYGB, surgical pouch reduction (49.1%, n?=?223), prolongation of bilio-pancreatic limb (30.0%, n?=?136), and surgical stoma size reduction (26.43%, n?=?120) were the most preferred options. Approximately 90.0% of respondents (n?=?406/454) routinely perform an upper gastrointestinal endoscopy before an RBS, and 85.6% (n?=?388/453) routinely perform a contrast study. Ninety percent (n?=?403/445) reported that the demand for RBS was usually patient-driven, and there was wide variation in criteria used to define successful response, non-responders, and significant weight regain.Conclusions
This survey is the first attempt to understand various aspects of RBS. The findings will help in identifying areas for research and allow consensus building amongst experts.10.
Purpose
To investigate the clinical characteristics of acute type A aortic dissection (ATAAD) occurring during a sporting activity.Methods
The subjects of this study were 615 patients who underwent surgery for ATAAD between 1990 and 2015. The patients were divided into two groups according to whether the ATAAD was associated with a sporting activity (sports group: n?=?25, mean age 62.3 years; non-sports group: n?=?590, mean age 63.7 years). Specific activity was assessed in the sports group, and the characteristics and outcomes were compared between the groups.Results
The sports group accounted for 5% of the patients with daytime onset ATAAD (25/479). The most common sport was golf (n?=?8), followed by swimming (n?=?4), cycling (n?=?4), and weight lifting (n?=?3). The average diameter of the ascending aorta on preoperative computed tomography was 4.8 cm. The dissection characteristics of the sports group included DeBakey type I (n?=?23, 92%) and malperfusion (n?=?9, 36%), which were similar to those of the non-sports group. The 30-day mortality rates were 16% (4/25) for the sports group and 8% (49/590) for the non-sports group (P?=?0.33).Conclusions
The most common sport associated with ATAAD was golf, followed by swimming cycling, and weight lifting. The findings of this study reinforce that sports-related aortic dissection is not a unique clinical condition of young syndromic patients, but can occur in all age groups.11.
12.
Purpose
To compare the complication rates associated with hepatic arterial infusion chemotherapy (HAIC) for unresectable hepatocellular carcinoma (HCC) using two different catheter tip locations, the right/left hepatic artery (group 1) and the gastroduodenal artery (group 2).Methods
Between April 2001 and March 2015, 88 patients (group 1, n?=?36; group 2, n?=?52) with unresectable HCC, underwent HAIC via a transfemorally placed infusion catheter. The incidence of complications related to catheter placement (including hepatic arterial occlusion, catheter dislocation, non-target embolization and port-catheter system infection) as well as catheter patency and patient survival were evaluated.Results
The technical success rate was 100%. The overall complication rate was 17% (15/88 patients). The specific complications were as follows: hepatic artery occlusion, n?=?1 (group 2, n?=?1), gastroduodenal ulcer, n?=?6 (group 1, n?=?2; group 2, n?=?4); catheter dislocation, n?=?1 (group 2, n?=?1); port-catheter system infection, n?=?3 (group 2, n?=?3); and bleeding at the puncture site, n?=?4 (group 1, n?=?1; group 2, n?=?3).Conclusions
The complication rates in groups 1 and 2 did not differ to a statistically significant extent.13.
Jiheum Paek Maria Lee Bo Wook Kim Yongil Kwon 《International urogynecology journal》2016,27(4):593-599
Introduction and hypothesis
The aim of this study was to compare robotic or laparoscopic sacrohysteropexy (RLSH) and open sacrohysteropexy (OSH) as a surgical treatment for pelvic organ prolapse (POP).Methods
Among 111 consecutive patients who had undergone sacrohysteropexy for POP, surgical outcomes and postoperative symptoms were compared between the RLSH (n?=?54; robotic 14 cases and laparoscopic 40 cases) and OSH (n?=?57). groups The medical records of enrolled patients were reviewed retrospectively.Results
Compared with the OSH group, the RLSH group had shorter operating time (120.2 vs 187.5 min, p?<?0.0001), less operative bleeding (median estimated blood loss 50 vs 150 ml; p?<?0.0001; mean hemoglobin drop 1.4 vs 2.0 g/dl; p?<?0.0001), and fewer postoperative symptoms (13 vs 45.6 %; p?<?0.0001). Patients’ overall satisfaction (94.4 vs 91.2 %; p?=?0.717) and required reoperation due to postoperative complications (3.7 vs 1.8 %; p?=?0.611) did not differ between groups.Conclusions
RLSH could be a feasible and safe procedure in patients with POP and should be considered as a surgical option that allows preservation of the uterus. Prospective randomized trials will permit the evaluation of potential benefits of RLSH as a minimally invasive surgical approach.14.
Background
Bibliometric and Altmetric analyses highlight key publications, which have been considered to be the most influential in their field. The hypothesis was that highly cited articles would correlate positively with levels of evidence and Altmetric scores (AS) and rank.Methods
Surgery as a search term was entered into Thomson Reuter’s Web of Science database to identify all English-language full articles. The 100 most cited articles were analysed by topic, journal, author, year, institution, and AS.Results
By bibliometric criteria, eligible articles numbered 286,122 and the median (range) citation number was 574 (446–5746). The most cited article (Dindo et al.) classified surgical complications by severity score (5746 citations). Annals of Surgery published most articles and received most citations (26,457). The country and year with most publications were the USA (n?=?50) and 1999 (n?=?11). By Altmetric criteria, the article with the highest AS was by Bigelow et al. (AS?=?53, hypothermia’s role in cardiac surgery); Annals of Surgery published most articles, and the country and year with most publications were USA (n?=?4) and 2007 (n?=?3). Level-1-evidence articles numbered 13, but no correlation was found between evidence level and citation number (SCC 0.094, p?=?0.352) or AS (SCC?=?0.149, p?=?0.244). Median AS was 0 (0–53), and in articles published after the year 2000, AS was associated with citation number (r?=?0.461, p?=?0.001) and citation rate index (r?=?0.455, p?=?0.002). AS was not associated with journal impact factor (r?=?0.160, p?=?0.118).Conclusion
Bibliometric and Altmetric analyses provide important but different perspectives regarding article impact, which are unrelated to evidence level.15.
Yannik?Kalbas Zhi?Qiao Klemens?Horst Michel?Teuben René?H.?Tolba Frank?Hildebrand Hans-Christoph?Pape Roman?Pfeifer
Introduction
The local circulatory changes induced by intramedullary reaming are not fully understood. This study aimed to analyse the short-term local microcirculation associated with different surgical strategies in a porcine model with a mid-shaft fracture.Methods
German landrace pigs were subjected to a standardised femoral fracture under standard anaesthesia and intensive care monitoring. One group was subjected to intramedullary reaming and nailing (nail group), while a second group was stabilised with external fixation (fix ex group). Microcirculation [e.g. relative blood flow (flow), oxygen saturation and relative haemoglobin concentration] was measured in the vastus lateralis muscle adjacent to the fracture using an O2C (oxygen to see, LEA Medizintechnik GMBH) device at 0 (before fracture, baseline), 6 (90-min posttreatment), 24, 48 and 72 h.Results
A total of 24 male pigs were used (nail group, n?=?12; fix ex group, n?=?12). During the observation period, a significant increase of flow was found at 6 (P?=?0.048), 48 (P?=?0.023) and 72 h (P?=?0.042) in comparison with baseline levels. Local oxygen delivery was significantly higher at 48 (P?=?0.017) and 72 h (P?=?0.021) in animals in the nail group compared to animals in the external fixation group.Conclusion
This study used a standardised porcine femoral fracture model and determined a significant increase in local blood microcirculation (e.g. flow and oxygen delivery) in animals treated with intramedullary reaming compared to external fixation. These changes may be of importance for fracture healing and local and systemic inflammatory responses. Further studies in this area are justified.16.
J. Paccou M. H. Edwards J. M. Patsch K. A. Jameson K. A. Ward C. Moss E. M. Dennison C. Cooper 《Osteoporosis international》2016,27(11):3279-3287
Summary
In older women, the presence of lower leg arterial calcification assessed by high-resolution peripheral quantitative computed tomography is associated with relevant bone microstructure abnormalities at the distal tibia and distal radius.Introduction
Here, we report the relationships of bone geometry, volumetric bone mineral density (BMD) and bone microarchitecture with lower leg arterial calcification (LLAC) as assessed by high-resolution peripheral quantitative computed tomography (HR-pQCT).Methods
We utilized the Hertfordshire Cohort Study (HCS), where we were able to study associations between measures obtained from HR-pQCT of the distal radius and distal tibia in 341 participants with or without LLAC. Statistical analyses were performed separately for women and men. We used linear regression models to investigate the cross-sectional relationships between LLAC and bone parameters.Results
The mean (SD) age of participants was 76.4 (2.6) and 76.1 (2.5)?years in women and men, respectively. One hundred and eleven of 341 participants (32.6 %) had LLAC that were visible and quantifiable by HR-pQCT. The prevalence of LLAC was higher in men than in women (46.4 % (n?=?83) vs. 17.3 % (n?=?28), p?<?0.001). After adjustment for confounding factors, we found that women with LLAC had substantially lower Ct.area (β?=??0.33, p?=?0.016), lower Tb.N (β?=??0.54, p?=?0.013) and higher Tb.Sp (β?=?0.54, p?=?0.012) at the distal tibia and lower Tb.Th (β?=??0.49, p?=?0.027) at the distal radius compared with participants without LLAC. Distal radial or tibial bone parameter analyses in men according to their LLAC status revealed no significant differences with the exception of Tb.N (β?=?0.27, p?=?0.035) at the distal tibia.Conclusion
In the HCS, the presence of LLAC assessed by HR-pQCT was associated with relevant bone microstructure abnormalities in women. These findings need to be replicated and further research should study possible pathophysiological links between vascular calcification and osteoporosis.17.
Erol Oksuz Fatih Ersay Deniz Ozgur Gunal Ozgur Demir Sener Barut Fatma Markoc Unal Erkorkmaz 《European spine journal》2016,25(4):1006-1011
Background
Several methods have been used to reduce the infection rate in spinal surgeries with instrumentation.Purpose
Which method is the most effective for preventing postoperative infection?Study design
Basic science, animal model.Objective
In the present study, the efficiency of antibiotic prophylaxis, silver-plated screws, and local rifamycin application to the surgical site was investigated in an experimental animal model. Staphylococcus aureus was used as the pathogen.Methods
Fifty 6-month-old female Wistar albino rats were used. The animals were randomly numbered and divided into five groups of ten rats each (Group 1, control group; Group 2, titanium screw and S. aureus inoculation; Group 3, titanium screw, 0.1 ml rifamycin application to the surgical area, and bacterial inoculation; Group 4, titanium screw, single preoperative dose of IM cefazolin, and bacterial inoculation; Group 5, silver-plated screw and bacterial inoculation). Titanium micro-screws were placed into the pedicles. The control group received a sterile isotonic solution, and the other four groups received bacterial suspensions containing S. aureus. The animals were killed 15 days later.Results
Intensive S. aureus growth was observed in all tissue and screw samples from Group 2. The results for Group 3 were similar to those for Group 1, no growth was observed in the screw cultures. Intensive growth was observed in the five screw samples in Group 4 and in the eight samples in Group 5.Conclusion
Our study suggests that rifamycin application to the surgical area in spinal operations with instrumentation is an effective method to prevent S. aureus infections.18.
Roos E. Pouw Joep J. Gondrie Carine M. Sondermeijer Fiebo J. ten Kate Thomas M. van Gulik Kausilia K. Krishnadath Paul Fockens Bas L. Weusten Jacques J. Bergman 《Journal of gastrointestinal surgery》2008,12(10):1627-1637
Background
Radiofrequency ablation is safe and effective for complete eradication of nondysplastic Barrett esophagus (BE). The aim was to report the combined results of two published and two ongoing studies on radiofrequency ablation of BE with early neoplasia, as presented at SSAT presidential plenary session DDW 2008.Methods
Enrolled patients had BE ≤12 cm with early neoplasia. Visible lesions were endoscopically resected. A balloon-based catheter was used for circumferential ablation and an endoscope-based catheter for focal ablation. Ablation was repeated every 2 months until the entire Barrett epithelium was endoscopically and histologically eradicated.Results
Forty-four patients were included (35 men, median age 68 years, median BE 7 cm). Thirty-one patients first underwent endoscopic resection [early cancer (n?=?16), high-grade dysplasia (n?=?12), low-grade dysplasia (n?=?3)]. Worst histology remaining after resection was high-grade (n?=?32), low-grade (n?=?10), or no (n?=?2) dysplasia. After ablation, complete histological eradication of all dysplasia and intestinal metaplasia was achieved in 43 patients (98%). Complications following ablation were mucosal laceration at resection site (n?=?3) and transient dysphagia (n?=?4). After 21 months of follow-up (interquartile range 10–27), no dysplasia had recurred.Conclusions
Radiofrequency ablation, with or without prior endoscopic resection for visible abnormalities, is effective and safe in eradicating BE and associated neoplasia.19.
Purpose
Dorsal spinal instrumentation with pedicle screw constructs is considered the gold standard for numerous spinal pathologies. Screw misplacement is biomechanically disadvantageous and may create severe complications. The aim of this study was to assess the accuracy of patient-specific template-guided pedicle screw placement in the thoracic and lumbar spine compared to the free-hand technique with fluoroscopy.Methods
Patient-specific targeting guides were used for pedicle screw placement from Th2–L5 in three cadaveric specimens by three surgeons with different experience levels. Instrumentation for each side and level was randomized (template-guided vs. free-hand). Accuracy was assessed by computed tomography (CT), considering perforations of <2 mm as acceptable (safe zone). Time efficiency, radiation exposure and dependencies on surgical experience were compared between the two techniques.Results
96 screws were inserted with an equal distribution of 48 screws (50 %) in each group. 58 % (n = 28) of template-guided (without fluoroscopy) vs. 44 % (n = 21) of free-hand screws (with fluoroscopy) were fully contained within the pedicle (p = 0.153). 97.9 % (n = 47) of template-guided vs. 81.3 % (n = 39) of free-hand screws were within the 2 mm safe zone (p = 0.008). The mean time for instrumentation per level was 01:14 ± 00:37 for the template-guided vs. 01:40 ± 00:59 min for the free-hand technique (p = 0.013), respectively. Increased radiation exposure was highly associated with lesser experience of the surgeon with the free-hand technique.Conclusions
In a cadaver model, template-guided pedicle screw placement is faster considering intraoperative instrumentation time, has a higher accuracy particularly in the thoracic spine and creates less intraoperative radiation exposure compared to the free-hand technique.20.
Hong-xiang Lu Jian-hui Sun Da-lin Wen Juan Du Ling Zeng An-qiang Zhang Jian-xin Jiang 《World journal of emergency surgery : WJES》2018,13(1):52