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971.
Mohamed H. Kamel Jun Tao Joseph Su Mahmoud I. Khalil Nabil K. Bissada Benjamin Schurhamer Philippe E. Spiess Rodney Davis 《Urologic oncology》2018,36(2):82.e7-82.e15
Purpose
To describe the survival outcomes of organ sparing surgery (OSS), partial penectomy (PP), and total penectomy (TP) in pathological stage pT1/pT2 penile cancer (PC) as reported in the United States National Cancer Data Base.Methods
Patients with pT1/pT2 PC, treated with surgery as their primary treatment modality were classified into 3 groups according to the type of surgery into OSS, PP, and TP. Patient and tumor characteristics of the groups were compared using bivariate analysis, and Cox- proportional hazard model was used for survival analysis.Results
A total of 4,238 patients were examined. There were 1,211, 2,360, and 584 patients in the OSS, PP, and TP groups, respectively. In 83 patients, the type of surgery was missing. The 5- and 10-year overall survival rates for OSS, PP, and TP were 88% and 74% vs. 85% and 72% vs. 79% and 63%, respectively (P ≤ 0.001). In addition, in a multivariable model for predictors of patient survival, OSS did not predict poor patient survival (hazard ratio = 0.88, CI: 0.64–1.21).Conclusions
Our results demonstrate, at national level, OSS in early stage PC provided comparable outcomes in selected patients compared to PP and TP. Also, organ preservation was not associated with any significant reduction in patient survival in early stage PC. Our results help with early stage PC patient informed treatment decisions and anticipated outcomes. 相似文献972.
Raisa S. Pompe Sami-Ramzi Leyh-Bannurah Felix Preisser Georg Salomon Markus Graefen Hartwig Huland Pierre I. Karakiewicz Derya Tilki 《Urologic oncology》2018,36(12):527.e21-527.e28
Objectives
To examine oncological, surgical, and functional outcomes of radical prostatectomy (RP) in patients with history of transurethral resection of the prostate (TUR-P).Materials and methods
Retrospective analysis of 18,681 RP-patients including 470 patients with previous TUR-P at a single institution (2002–2015). Kaplan-Meier as well as multivariable Cox and logistic regression analyses compared surgical, oncological, and functional outcomes between TUR-P and non-TUR-P patients after propensity score matching (nearest neighbor in a 1:3 fashion).Results
After propensity score adjustment, pathological and surgical results were similar between both groups. Specifically, rates of positive surgical margins and nerve-sparing (NS) procedure did not differ between groups (positive surgical margins: 18.5% vs. 17.2%, P = 0.7; nerve-sparing: 89.4% vs. 91.6%, P = 0.5). In addition, there was no difference in mean operating room time (185 vs. 184 minutes, P = 0.6), blood loss (710 vs. 666 ml, P = 0.1), and catheterization time (12 days, P = 0.3). In multivariable analyses, TUR-P patients did not exhibit higher risk of biochemical recurrence, metastatic progression, or mortality (all P > 0.05). However, TUR-P patients exhibited higher risk for urinary incontinence at third month (OR: 1.47; 95% confidence interval [CI] 1.01–2.12, P?=?0.04) and first year (OR: 2.06; 95% CI 1.23–3.42, P?=?0.006) and worse 1-year erectile function recovery (OR: 0.48; 95% CI 0.27–0.86, P?=?0.02).Conclusions
This large series of TUR-P RP patients demonstrated that RP could be safely performed in patients with history of TUR-P without compromising oncological results. However, functional outcomes were worse for patients with previous TUR-P. 相似文献973.
Long‐term outcome and quality of life in patients with total colonic aganglionosis in the Netherlands 
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S.H. Howitt M. Herring I. Malagon C.N. McCollum S.W. Grant 《British journal of anaesthesia》2018,120(3):509-516
Background
The Sepsis-3 guidelines diagnose sepsis based on organ dysfunction in patients with either proven or suspected infection. The objective of this study was to assess the incidence and outcomes of sepsis diagnosed using these guidelines in patients in a cardiac intensive care unit (CICU) after cardiac surgery.Methods
Daily sequential organ failure assessment (SOFA) scores were calculated for 2230 consecutive adult cardiac surgery patients between January 2013 and May 2015. Patients with an increase in SOFA score of ≥2 and suspected or proven infection were identified. The length of CICU stay, 30-day mortality and 2-yr survival were compared between groups. Multivariable linear regression, multivariable logistic regression, and Cox proportional hazards regression were used to adjust for possible confounders.Results
Sepsis with suspected or proven infection was diagnosed in 104 (4.7%) and 107 (4.8%) patients, respectively. After adjustment for confounding variables, sepsis with suspected infection was associated with an increased length of CICU stay of 134.1h (95% confidence interval (CI) 99.0–168.2, P<0.01) and increased 30-day mortality risk (odds ratio 3.7, 95% CI 1.1–10.2, P=0.02). Sepsis with proven infection was associated with an increased length of CICU stay of 266.1h (95% CI 231.6–300.7, P<0.01) and increased 30-day mortality risk (odds ratio 6.6, 95% CI 2.6–15.7, P<0.01).Conclusions
Approximately half of sepsis diagnoses were based on proven infection and half on suspected infection. Patients diagnosed with sepsis using the Sepsis-3 guidelines have significantly worse outcomes after cardiac surgery. The Sepsis-3 guidelines are a potentially useful tool in the management of sepsis following cardiac surgery. 相似文献975.
Background
The QoR-15 is a patient-reported outcome questionnaire that measures the quality of recovery after surgery and anaesthesia. We aimed to perform a systematic review and meta-analysis of the measurement properties of the QoR-15.Methods
Studies reporting measurement properties or interpretability of the QoR-15 after surgery were eligible for inclusion. All languages were included in the PubMed and Embase search. The COSMIN guidelines for systematic reviews of patient-reported outcome measurements were followed. Criteria for good measurement properties outlined in the consensus-based guidelines for selecting outcome measurement instruments for clinical trials were applied. A metaanalysis and synthesis of data across studies was performed.Results
Nine hundred and thirty-three titles were identified, and six articles were included in the study. The study population comprised 1548 patients undergoing a variety of surgical elective procedures. The QoR-15 was validated in English, Danish, Chinese, and Portuguese. High-quality evidence for good content validity, good internal consistency (Cronbach's α of 0.836), and essential unidimensionality of the QoR-15 as a measurement of postoperative quality of recovery was found. There was at least moderate-quality evidence of good reliability of the QoR-15 (intraclass correlation of 0.989) and good error of measurement (standard error of measurement of 1.85). The upper 95% confidence limit of the smallest detectable change was 3.63, and the minimal clinical important difference was 8.0.Conclusions
The QoR-15 fulfils requirements for outcome measurement instruments in clinical trials and is the first measurement instrument of postoperative quality of recovery to undergo a systematic review according to the COSMIN checklist. 相似文献976.
F. van Lier F.H.I.M. Wesdorp V.G.B. Liem J.W. Potters F. Grüne H. Boersma R.J. Stolker S.E. Hoeks 《British journal of anaesthesia》2018,120(1):77-83
Background
Myocardial injury after noncardiac surgery is common, although the exact pathophysiology is unknown. It is plausible that hypotension after surgery is relevant for the development of myocardial injury. The authors evaluated whether low mean arterial pressures (MAPs) after surgery are related to an increased incidence in postoperative cardiac-troponin elevation.Methods
A prospective cohort of 2211 patients aged ≥60 yr, undergoing major or moderate noncardiac surgery in The Netherlands, was retrospectively analysed for the occurrence of postoperative cardiac-troponin elevation [high-sensitive troponin T (hsTnT) >14 ng L?1]. Blood pressures after surgery were recorded and divided into quartiles based on the lowest MAP prior to peak troponin recording. The association between MAP and extent of postoperative cardiac-troponin elevation was analysed.Results
The patients were divided into quartiles based on their lowest MAP in the period preceding the peak hsTnT, ranging from a median of 62 in the lowest quartile to 94 in the highest quartile. Postoperative hsTnT elevation was present in 53.2% of the population. An association between MAP quartile and postoperative peak hsTnT was predominantly observed in the lowest quartile (P<0.001): median hsTnT 17.6 (10.3–37.3), 14.9 (9.4–24.6), 13.8 (9.1–22.5), and 14.0 (9.2–22.4). The multivariable logistic-regression analysis showed an increased risk for postoperative cardiac-troponin elevation with decreasing MAP thresholds.Conclusions
Lower postoperative blood pressure is associated with an increased incidence of postoperative cardiac hsTnT elevation, irrespective of pre- and intraoperative variables. 相似文献977.
978.
B.I. Valk A.R. Absalom P. Meyer S. Meier I. den Daas K. van Amsterdam J.A. Campagna S.P. Sweeney M.M.R.F. Struys 《British journal of anaesthesia》2018,120(6):1401-1411
Background
Cyclopropyl-methoxycarbonyl metomidate, or ABP-700, is a second generation analogue of etomidate, developed to retain etomidate's beneficial haemodynamic and respiratory profile but diminishing its suppression of the adrenocortical axis. The objective of this study was to characterise the safety and efficacy of 30-min continuous infusions of ABP-700, and to assess its effect on haemodynamics and the adrenocortical response in healthy human volunteers.Methods
Five cohorts involving 40 subjects received increasing infusion doses of ABP-700, propofol 60 μg kg?1 min?1 or placebo. Safety was evaluated through adverse event (AE) monitoring, safety laboratory tests, and arterial blood gasses. Haemodynamic and respiratory stability were assessed by continuous monitoring. Adrenocortical function was analysed by adrenocorticotropic hormone (ACTH) stimulation tests. Clinical effect was measured using the modified observer's assessment of alertness/sedation (MOAA/S) and continuous bispectral index monitoring.Results
No serious AEs were reported. Haemodynamic and respiratory effects included mild dose-dependent tachycardia, slightly elevated blood pressure, and no centrally mediated apnoea. Upon stimulation with ACTH, no adrenocortical depression was observed in any subject. Involuntary muscle movements (IMM) were reported, which were more extensive with higher dosing regimens. Higher dosages of ABP-700 were associated with deeper sedation and increased likelihood of sedation. Time to onset of clinical effect was variable throughout the cohorts and recovery was swift.Conclusions
Infusions of ABP-700 showed a dose-dependent hypnotic effect, and did not cause severe hypotension, severe respiratory depression, or adrenocortical suppression. The presentation and nature of IMM is a matter of concern.Clinical trial registration
NTR4735. 相似文献979.
T. Becher M. Bußmeyer I. Lautenschläger D. Schädler N. Weiler I. Frerichs 《British journal of anaesthesia》2018,120(6):1219-1228
Background
Electrical impedance tomography (EIT) is increasingly used for continuous monitoring of ventilation in intensive care patients. Clinical observations in patients with pleural effusion show an increase in out-of-phase impedance changes. We hypothesised that out-of-phase impedance changes are a typical EIT finding in patients with pleural effusion and could be useful in its detection.Methods
We conducted a prospective observational study in intensive care unit patients with and without pleural effusion. In patients with pleural effusion, EIT data were recorded before, during, and after unilateral drainage of pleural effusion. In patients with no pleural effusion, EIT data were recorded without any intervention. EIT images were separated into four quadrants of equal size. We analysed the sum of out-of-phase impedance changes in the affected quadrant in patients with pleural effusion before, during, and after drainage and compared it with the sum of out-of-phase impedance changes in the dorsal quadrants of patients without pleural effusion.Results
We included 20 patients with pleural effusion and 10 patients without pleural effusion. The median sum of out-of-phase impedance changes was 70 (interquartile range 49–119) arbitrary units (a.u.) in patients with pleural effusion before drainage, 25 (12–46) a.u. after drainage (P<0.0001) and 11 (6–17) a.u. in patients without pleural effusion (P<0.0001 vs pleural effusion before drainage). The area under the receiver operating characteristics curve was 0.96 (95% limits of agreement 0.91–1.01) between patients with pleural effusion before drainage and those without pleural effusion.Conclusions
In patients monitored with EIT, the presence of out-of-phase impedance changes is highly suspicious of pleural effusion and should trigger further examination. 相似文献980.