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1.
Bone Joint J ; 102-B(3): 293-300, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32114805

RESUMEN

AIMS: Vancouver type B periprosthetic femoral fractures (PFF) are challenging complications after total hip arthroplasty (THA), and some treatment controversies remain. The objectives of this study were: to evaluate the short-to-mid-term clinical outcomes after treatment of Vancouver type B PFF and to compare postoperative outcome in subgroups according to classifications and treatments; to report the clinical outcomes after conservative treatment; and to identify risk factors for postoperative complications in Vancouver type B PFF. METHODS: A total of 97 consecutive PPFs (49 males and 48 females) were included with a mean age of 66 years (standard deviation (SD) 14.9). Of these, 86 patients were treated with surgery and 11 were treated conservatively. All living patients had a minimum two-year follow-up. Patient demographics details, fracture healing, functional scores, and complications were assessed. Clinical outcomes between internal fixation and revisions in patients with or without a stable femoral component were compared. Conservatively treated PPFs were evaluated in terms of mortality and healing status. A logistic regression analysis was performed to identify risk factors for complications. RESULTS: In surgically treated patients, all fractures united and nine complications were identified. The mean postoperative Visual Analogue Scale (VAS) for pain was 1.5 (SD 1.3), mean Parker Mobility Score (PMS) was 6.5 (SD 2.4), and mean Harris Hip Score (HHS) was 79.4 (SD 16.2). Among type B2 and type B3 fractures, patients treated with internal fixation had significantly lower PMS (p = 0.032) and required a longer time to heal (p = 0.012). In conservatively treated patients, one-year mortality rate was 36.4% (4/11), and two patients ultimately progressed to surgery. Young age (p = 0.039) was found to be the only risk factor for complications. CONCLUSION: The overall clinical outcome among Vancouver type B PFF was satisfactory. However, treatment with internal fixation in type B2 and B3 fractures had a significantly longer time to heal and lower mobility than revision cases. Conservative treatment was associated with high rates of early mortality and, in survivors, nonunion. This probably reflects our selection bias in undertaking surgical intervention. In our whole cohort, younger patient age was a risk factor for postoperative complications in Vancouver type B PFF. Cite this article: Bone Joint J 2020;102-B(3):293-300.


Asunto(s)
Tratamiento Conservador/métodos , Fracturas del Fémur/terapia , Fijación Interna de Fracturas/métodos , Fracturas Periprotésicas/terapia , Complicaciones Posoperatorias/epidemiología , Adulto , Anciano , Anciano de 80 o más Años , Artroplastia de Reemplazo de Cadera/efectos adversos , China/epidemiología , Femenino , Fracturas del Fémur/diagnóstico , Fracturas del Fémur/etiología , Estudios de Seguimiento , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Fracturas Periprotésicas/diagnóstico , Fracturas Periprotésicas/etiología , Estudios Retrospectivos , Tasa de Supervivencia/tendencias
2.
Bone Joint J ; 102-B(3): 345-351, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32114814

RESUMEN

AIMS: Tibiotalocalcaneal (TTC) fusion is used to treat a variety of conditions affecting the ankle and subtalar joint, including osteoarthritis (OA), Charcot arthropathy, avascular necrosis (AVN) of the talus, failed total ankle arthroplasty, and severe deformity. The prevalence of postoperative complications remains high due to the complexity of hindfoot disease seen in these patients. The aim of this study was to analyze the relationship between preoperative conditions and postoperative complications in order to predict the outcome following primary TTC fusion. METHODS: We retrospectively reviewed the medical records of 101 patients who underwent TTC fusion at the same institution between 2011 and 2019. Risk ratios (RRs) associated with age, sex, diabetes, cardiovascular disease, smoking, preoperative ankle deformity, and the use of bone graft during surgery were related to the postoperative complications. We determined from these data which pre- and perioperative factors significantly affected the outcome. RESULTS: Out of the 101 patients included in the study, 29 (28.7%) had nonunion, five (4.9%) required below-knee amputation (BKA), 40 (39.6%) returned to the operating theatre, 16 (15.8%) had hardware failure, and 22 (21.8%) had a postoperative infection. Patients with a preoperative diagnosis of Charcot arthropathy and non-traumatic OA had significantly higher nonunion rates of 44.4% (12 patients) and 39.1% (18 patients) (p = 0.016) and infection rates of 29.6% (eight patients) and 37% (17 patients) compared to patients with traumatic arthritis, respectively (p = 0.002). There was a significantly increased rate of nonunion in diabetic patients (RR 2.22; p = 0.010). Patients with chronic kidney disease were 2.37-times more likely to have a nonunion (p = 0.006). Patients aged over 60 years had more than a three-fold increase in the rate of postoperative infection (RR 3.60; p = 0.006). The use of bone graft appeared to be significantly protective against postoperative infection (p = 0.019). CONCLUSION: We were able to confirm, in the largest series of TTC ankle fusions currently in the literature, that there remains a high rate of complications following this procedure. We found that patients with a Charcot or non-traumatic arthropathy had an increased risk of nonunion and postoperative infection compared to individuals with traumatic arthritis. Those with diabetes, chronic kidney disease, or aged over 60 years had an increased risk of nonunion. These findings help to confirm those of previous studies. Additionally, our study adds to the literature by showing that autologous bone graft may help in decreasing infection rates. These data can be useful to surgeons and patients when considering, discussing and planning TTC fusion. It helps surgeons further understand which patients are at a higher risk for postoperative complications when undergoing TTC fusion. Cite this article: Bone Joint J. 2020;102-B(3):345-351.


Asunto(s)
Articulación del Tobillo/cirugía , Artrodesis/métodos , Osteoartritis/cirugía , Articulación Talocalcánea/cirugía , Tibia/cirugía , Articulación del Tobillo/diagnóstico por imagen , Femenino , Estudios de Seguimiento , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Osteoartritis/diagnóstico , Complicaciones Posoperatorias/epidemiología , Radiografía , Estudios Retrospectivos , Factores de Riesgo , Articulación Talocalcánea/diagnóstico por imagen , Tibia/diagnóstico por imagen , Resultado del Tratamiento , Estados Unidos/epidemiología
3.
Bone Joint J ; 102-B(3): 285-292, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32114815

RESUMEN

AIMS: The aim of this study is to evaluate the clinical results of operative intervention for femoral metastases which were selected based on expected survival and to discuss appropriate surgical strategies. METHODS: From 2002 to 2017, 148 consecutive patients undergoing surgery for femoral metastasis were included in this study. Prognostic risk assessments were performed according to the Katagiri and revised Katagiri scoring system. In general, the low-risk group underwent resection and reconstruction with endoprosthetic replacement (EPR), while the high-risk group underwent internal fixation (IF) and radiation therapy. For the intermediate-risk group, the operative choice depended on the patient's condition, degree of bone destruction, and radio-sensitivity. Overall survival, local failure, walking ability, and systemic complications were evaluated. RESULTS: A total of 83 patients underwent EPR (low-risk, 23%; intermediate-risk, 60%; high-risk, 17%) and 65 patients underwent IF (low-risk, 0%; intermediate-risk, 32%; high-risk, 68%). The one-year survival rate was 71% for EPR and 15% for IF (p < 0.001). The one-year local failure-free survival was 93% for EPR and 67% for IF, and the two-year and five-year local failure-free survival for EPR were both 88% (p = 0.016). Although the ambulatory rate was 99% for EPR and 60% for IF, the median time to ambulation was shorter in the IF (EPR, 28 days, interquartile range (IQR) 25 to 35; IF, 23 days, IQR 18 to 28; p < 0.001) The cause of non ambulation was mainly due to progression of cancer (89%). The rate of systemic complications was comparable between the two groups (EPR, 18%; IF, 22%; p = 0.598). CONCLUSION: Selective use of EPR where survival is expected to be good offers correspondingly good long-term results. IF is less invasive with shorter treatment period, which is beneficial for patients with short-term expected survival. Prognosis is an important indicator in selecting operative procedures for femoral metastasis. Cite this article: Bone Joint J 2020;102-B(3):285-292.


Asunto(s)
Neoplasias Óseas/cirugía , Fémur , Procedimientos Ortopédicos/métodos , Complicaciones Posoperatorias/epidemiología , Anciano , Neoplasias Óseas/diagnóstico , Neoplasias Óseas/secundario , Femenino , Estudios de Seguimiento , Humanos , Incidencia , Japón/epidemiología , Masculino , Persona de Mediana Edad , Metástasis de la Neoplasia , Pronóstico , Estudios Retrospectivos , Tasa de Supervivencia/tendencias , Factores de Tiempo
4.
Medicine (Baltimore) ; 99(11): e19186, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32176045

RESUMEN

Obese individuals are apt to develop Stanford A acute aortic dissection (AAD) complicated with acute lung injury (ALI), but the mechanism is still not well defined. We aim to investigate whether oxidative stress and inflammatory are involved in the aortic dissection lung injury caused by obesity.Seventy-nine patients were categorized into AAD with obesity group (n = 17) and AAD without obesity group (n = 62) according to body mass index (BMI). Inflammatory reactions including interleukin 1ß (IL-1ß), tumor necrosis factor-α (TNF-α), IL-6, C-reactive protein (CRP) and white blood cell (WBC) count, and oxidative stress including malondialdehyde (MDA), superoxide dismutase were determined using enzyme-linked immunosorbent assays and chemiluminescence. All the patients received ascending aorta replacement combined with total arch replacement and stented elephant trunk. The postoperative complications were recorded.The incidence of preoperative hypoxemia (94.1% vs 35.5%, P < .01) and postoperative ALI (88.2% vs 40.3%, P < .01) in obese patients was significantly higher than that in non-obese patients. Besides, the ICU stay (119.2 ±â€Š59.2 vs 87.8 ±â€Š31.2 h, P < .01) and hospitalization duration (18.8 ±â€Š8.5 vs 14.3 ±â€Š8.1d, P = .048) were increased in the obese patients with AAD. The expression of IL-1ß, TNF-α, IL-6, CRP, and WBC was remarkably increased (P < .01) in obese group compared with non-obese group.Oxidative stress and inflammatory response may be involved in the process of ALI of aortic dissection caused by obesity, which provides new ideas for the treatment of ALI of the aortic dissection.


Asunto(s)
Lesión Pulmonar Aguda/cirugía , Aneurisma Disecante/cirugía , Aneurisma de la Aorta Torácica/cirugía , Implantación de Prótesis Vascular/efectos adversos , Hipoxia/etiología , Obesidad/complicaciones , Lesión Pulmonar Aguda/diagnóstico por imagen , Adulto , Anciano , Aneurisma Disecante/diagnóstico por imagen , Aneurisma de la Aorta Torácica/diagnóstico por imagen , Implantación de Prótesis Vascular/métodos , Índice de Masa Corporal , Estudios de Cohortes , Femenino , Hospitales Universitarios , Humanos , Hipoxia/fisiopatología , Modelos Lineales , Masculino , Persona de Mediana Edad , Obesidad/diagnóstico , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/fisiopatología , Cuidados Preoperatorios , Pronóstico , Valores de Referencia , Estudios Retrospectivos , Medición de Riesgo , Análisis de Supervivencia , Resultado del Tratamiento
5.
JAMA ; 323(11): 1070-1076, 2020 03 17.
Artículo en Inglés | MEDLINE | ID: mdl-32181847

RESUMEN

Importance: Controversy exists about the preferred surgical approach for total hip arthroplasty (THA). Objective: To determine whether an anterior approach is associated with lower risk of complications than either a lateral or posterior approach. Design, Setting, and Participants: Population-based retrospective cohort study of all adults in Ontario, Canada, who had undergone primary THA for osteoarthritis between April 1, 2015, and March 31, 2018. All patients were followed up over a 1-year period (study end date, March 31, 2019). Exposures: Surgical approach (anterior vs lateral/posterior) for THA. Main Outcomes and Measures: Major surgical complications within 1 year (composite of deep infection requiring surgery, dislocation requiring closed or open reduction, or revision surgery). Outcomes were compared among propensity-score matched groups using Cox proportional hazards regression. Results: Of the 30 098 patients (mean [SD] age, 67 years [10.7 years]; 16 079 women [53.4%]) who underwent THA, 2995 (10%) underwent the anterior approach; 21 248 (70%), the lateral approach; and 5855 (20%) the posterior approach performed at 1 of 73 hospitals by 1 of 298 surgeons. All patients were followed up for 1 year. Compared with those undergoing the lateral or posterior approach, patients undergoing an anterior approach were younger (mean age, 65 vs 67 years; standardized difference, 0.17); had lower rates of morbid obesity (4.8% vs 7.6%; standardized difference, 0.12), diabetes (14.2% vs 19.9%; standardized difference, 0.15), and hypertension (53.4% vs 62.9%; standardized difference, 0.19); and were treated by higher-volume surgeons (median range, 111 procedures; interquartile range, 69-172 vs 77 procedures, interquartile range, 50-119 in the prior year; standardized difference, 0.55). Compared with 2993 propensity-score matched patients undergoing a lateral or posterior approach, the 2993 matched patients undergoing anterior approaches had a significantly greater risk of a major surgical complication (61 patients [2%] vs 29 patients [1%]; absolute risk difference, 1.07%; 95% CI, 0.46%-1.69%; hazard ratio, 2.07; 95% CI, 1.48 to 2.88). Conclusions and Relevance: Among patients undergoing total hip arthroplasty, an anterior surgical approach compared with a posterior or lateral surgical approach was associated with a small but statistically significant increased risk of major surgical complications. The findings may help inform decisions about surgical approach for hip arthroplasty, although further research is needed to understand pain and functional outcomes.


Asunto(s)
Artroplastia de Reemplazo de Cadera/efectos adversos , Artroplastia de Reemplazo de Cadera/métodos , Osteoartritis de la Cadera/cirugía , Complicaciones Posoperatorias/epidemiología , Anciano , Femenino , Estudios de Seguimiento , Luxación de la Cadera/epidemiología , Luxación de la Cadera/etiología , Prótesis de Cadera , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Ontario , Tempo Operativo , Complicaciones Posoperatorias/etiología , Puntaje de Propensión , Reoperación/estadística & datos numéricos , Estudios Retrospectivos , Riesgo
6.
JAMA ; 323(11): 1077-1084, 2020 Mar 17.
Artículo en Inglés | MEDLINE | ID: mdl-32181848

RESUMEN

Importance: Consensus guidelines and systematic reviews have suggested that cemented fixation is more effective than uncemented fixation in hemiarthroplasty for displaced femoral neck fractures. Given that these recommendations are based on research performed outside the United States, it is uncertain whether these findings also reflect the US experience. Objective: To compare the outcomes associated with cemented vs uncemented hemiarthroplasty in a large US integrated health care system. Design, Setting, and Participants: Retrospective cohort study of 12 491 patients aged 60 years and older who underwent hemiarthroplasty treatment of a hip fracture between 2009 and 2017 at 1 of the 36 hospitals owned by Kaiser Permanente, a large US health maintenance organization. Patients were followed up until membership termination, death, or the study end date of December 31, 2017. Exposures: Hemiarthroplasty (prosthetic replacement of the femoral head) fixation via bony growth into a porous-coated implant (uncemented) or with cement. Main Outcomes and Measures: The primary outcome measure was aseptic revision, defined as any reoperation performed after the index procedure involving exchange of the existing implant for reasons other than infection. Secondary outcomes were mortality (in-hospital, postdischarge, and overall), 90-day medical complications, 90-day emergency department visits, and 90-day unplanned readmissions. Results: Among 12 491 patients in the study cohort who underwent hemiarthroplasty for hip fracture (median age, 83 years; 8660 women [69.3%]), 6042 (48.4%) had undergone uncemented fixation and 6449 (51.6%) had undergone cemented fixation, and the median length of follow-up was 3.8 years. In the multivariable regression analysis controlling for confounders, uncemented fixation was associated with a significantly higher risk of aseptic revision (cumulative incidence at 1 year after operation, 3.0% vs 1.3%; absolute difference, 1.7% [95% CI, 1.1%-2.2%]; hazard ratio [HR], 1.77 [95% CI, 1.43-2.19]; P < .001). Of the 6 prespecified secondary end points, none showed a statistically significant difference between groups, including in-hospital mortality (1.7% for uncemented fixation vs 2.0% for cemented fixation; HR, 0.94 [95% CI, 0.73-1.21]; P = .61) and overall mortality (cumulative incidence at 1 year after operation: 20.0% for uncemented fixation vs 22.8% for cemented fixation; HR, 0.95 [95% CI, 0.90-1.01]; P = .08). Conclusions and Relevance: Among patients with hip fracture treated with hemiarthroplasty in a large US integrated health care system, uncemented fixation, compared with cemented fixation, was associated with a statistically significantly higher risk of aseptic revision. These findings suggest that US surgeons should consider cemented fixation in the hemiarthroplasty treatment of displaced femoral neck fractures in the absence of contraindications.


Asunto(s)
Artroplastia de Reemplazo de Cadera/métodos , Cementos para Huesos , Fracturas del Cuello Femoral/cirugía , Prótesis de Cadera , Complicaciones Posoperatorias/epidemiología , Reoperación/estadística & datos numéricos , Anciano , Anciano de 80 o más Años , Artroplastia de Reemplazo de Cadera/efectos adversos , Artroplastia de Reemplazo de Cadera/mortalidad , Femenino , Mortalidad Hospitalaria , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Tempo Operativo , Readmisión del Paciente/estadística & datos numéricos , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/cirugía , Diseño de Prótesis , Estudios Retrospectivos , Riesgo , Estados Unidos
7.
Am Surg ; 86(2): 116-120, 2020 Feb 01.
Artículo en Inglés | MEDLINE | ID: mdl-32167042

RESUMEN

Unplanned readmission is often used as a surgical quality metric. A subset of kidney transplant recipients undergos multiple readmissions (MRs), although the incidence and risk factors are not well described. The aim of this study was to evaluate risk factors for MR after deceased donor kidney transplantation. All patients undergoing deceased donor kidney transplantation at a single center over a three-year period were analyzed via retrospective chart review for factors associated with MR. P values <0.05 were considered significant. Of 141 patients, the 30-day readmission rate was 26.2 per cent. MR occurred in 43 (30.5%) patients. Age, race, gender, initial organ function, and dialysis vintage were not associated with MR. Diabetic recipients, those who received basiliximab induction, those with acute rejection, and those with unplanned reoperations were at increased risk for MR. Infection was the most common reason for initial readmission in patients with MR (23.3%). One-year patient survival and death-censored graft survival were reduced for patients with MR. MRs are required for 30 per cent of kidney transplant recipients, primarily because of infection and immunologic causes. Recipients with diabetes and those who have acute rejection are at greatest risk.


Asunto(s)
Trasplante de Riñón/estadística & datos numéricos , Readmisión del Paciente/estadística & datos numéricos , Basiliximab/efectos adversos , Diabetes Mellitus/epidemiología , Femenino , Rechazo de Injerto/epidemiología , Supervivencia de Injerto , Humanos , Inmunosupresores/efectos adversos , Incidencia , Trasplante de Riñón/mortalidad , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/epidemiología , Análisis de Regresión , Reoperación/efectos adversos , Reoperación/estadística & datos numéricos , Estudios Retrospectivos , Factores de Riesgo , Factores de Tiempo
8.
Medicine (Baltimore) ; 99(9): e19361, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32118779

RESUMEN

Successful reconstruction after tumor resection facilitates rapid recovery and retention of good quality of life, and this is important for a successful operation. This study aimed to analyze and compare the application and efficacy of xenogeneic acellular dermal matrix (xeno-ADM) and abdominal skin graft in hypopharynx reconstruction.This is a retrospective cohort study that included 25 patients with posterior hypopharyngeal wall cancer who underwent partial hypopharyngectomy with laryngeal preservation. The patients were divided into 2 groups according to the repair materials used. Eleven patients were treated with xeno-ADM, and 14 patients with abdominal skin grafts for repairing hypopharyngeal mucosal defects. The intraoperative data, postoperative recovery time of eating function, graft contraction, infection and pharyngeal fistula rate, and 1-year survival rate of the 2 groups were analyzed and compared.Compared with skin grafts group (23.1 ±â€Š5.8 days), the recovery time of eating function in xeno-ADM group was shorter (17.3 ±â€Š6.4 days), (P = .026). Also the number of postoperative hospitalization days were less in the xeno-ADM group (18.5 ±â€Š6.7 days) than in the skin grafts group (24.1 ±â€Š5.6 days) (P = .035). Besides, no significant differences were observed in other comparisons between the 2 groups. Also no obvious rejection and severe graft contraction were observed in both the groups. All patients were successfully decannulated.Both xeno-ADM and abdominal skin grafts demonstrated good effects in the reconstruction of hypopharynx, but the recovery time of eating function in patients with xeno-ADM was faster, which may be due to rapid epithelialization. In addition, it avoids trauma of donor sites.


Asunto(s)
Dermis Acelular/normas , Neoplasias Hipofaríngeas/cirugía , Complicaciones Posoperatorias/etiología , Adulto , China , Estudios de Cohortes , Femenino , Humanos , Neoplasias Hipofaríngeas/epidemiología , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/epidemiología , Estudios Retrospectivos , Trasplante de Piel/métodos , Trasplante de Piel/normas
9.
Medicine (Baltimore) ; 99(9): e19376, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32118783

RESUMEN

To introduce the use of a new surgical approach named single-incision bilateral inguinal herniorrhaphy (SBIH) in pediatric surgical population.This was a STROBE-compliant retrospective cohort study using data from 101 patients who had undergone bilateral inguinal herniorrhaphy in our institution. Children with bilateral inguinal hernias without contraindications for surgery, ranging in age from 6 months to 12 years, were included. Fifty-six children with bilateral inguinal hernias underwent SBIH (SBIH group) and 45 patients underwent laparoscopic bilateral inguinal herniorrhaphy (LBIH) (LBIH group). Differences in operative time, postoperative pain, recurrence, and complications between the 2 groups were analyzed. Patient satisfaction with cosmetic result was also investigated using questionnaires.There were no statistically significant differences in operative time (P = .2257), postoperative pain (P = .0607), recurrence (P = .8756), and complications (P = .7467) between the 2 groups. Interestingly, the operation time of girls in SBIH group was significantly shorter than that of the boys in this group (P < .0001), but also shorter than that of girls in LBIH group (P = .0038). Postoperative pain for boys was lower in SBIH group than in the LBIH group (P = .0340). No ascending testis, testicular atrophy, and hydrocele occurred in either group. According to the questionnaire, both procedures had equally high levels of satisfaction for cosmetic results (P = .7531).Initial results show that SBIH for pediatric patients, regardless of gender, is a safe and feasible procedure compared with LBIH with an equally low recurrence rate, few complication, and satisfactory cosmetic outcomes.


Asunto(s)
Hernia Inguinal/cirugía , Herniorrafia/métodos , Herniorrafia/normas , Distribución de Chi-Cuadrado , Niño , Preescolar , Estudios de Cohortes , Femenino , Hernia Inguinal/epidemiología , Herniorrafia/estadística & datos numéricos , Humanos , Masculino , Complicaciones Posoperatorias/epidemiología , Estudios Retrospectivos , Estadísticas no Paramétricas , Resultado del Tratamiento
10.
Zhonghua Fu Chan Ke Za Zhi ; 55(2): 112-119, 2020 Feb 25.
Artículo en Chino | MEDLINE | ID: mdl-32146740

RESUMEN

Objective: To investigate the surgical complications in the treatment of stage Ⅰ endometrial cancer by robotic-assisted laparoscopy, the risk degree of Clavein-Dindo complications and the main risk factors affecting the occurrence of surgical complications. Methods: A retrospective case-control study was conducted in the First Affiliated Hospital of Zhengzhou University from October 2014 to June 2019. The patients were divided into robotic-assisted laparoscopy group and traditional laparoscopy group according to the operation mode, including 131 cases in robot group and 290 cases in traditional laparoscopy group. To compare the complications during and after operation and the risk degree of complications between the two groups by Clavein-Dindo classification standard, the age, body mass index (BMI), comorbidities, past history of pelvic surgery, American Society of Anesthesiologists (ASA) grade, preoperative anemia, number of pelvic lymph node resection, number of abdominal aortic lymph node resection, the total number of lymph node resection, operation time, surgical methods (robot surgery or traditional laparoscopic surgery) and other clinicopathological data were analyzed by logistic regression analysis. Results: (1) Complications of operation: the incidence of operative complications (including intraoperative and postoperative complications) in robot group was significantly lower than that in traditional laparoscopy group [(20.6%, 27/131) vs (34.8%, 101/290); χ(2)=8.620, P=0.003)]. The incidence of intraoperative complications in robot group was lower than that in traditional laparoscopy group [1.5% (2/131) vs 6.2% (18/290); χ(2)=4.368, P=0.037]. The incidence of intraoperative vascular injury in robot group was significantly lower than that in traditional laparoscopy group [0.8% (1/131) vs 5.2% (15/290); χ(2)=4.798, P=0.022]. The incidence of postoperative complications in robot group was also lower than that in traditional laparoscopy group [19.1% (25/131) vs 28.6% (83/290); χ(2)=4.303, P=0.038], but the incidence of postoperative lymphatic leakage in robot group was higher than that in traditional laparoscopy group [10.7% (14/131) vs 5.2% (15/290); χ(2)=4.279, P=0.039]. (2) Clavein-Dindo classification: the incidence of Clavein-Dindo Ⅰ, Ⅲ, Ⅲ, Ⅳ and Ⅴ grade between two groups were respectively 3.8% (5/131) vs 11.0% (32/290), 13.7% (18/131) vs 14.5% (42/290), 3.1% (4/131) vs 8.6% (25/290), 0 (0/131) vs 0.3% (1/290), 0 (0/131) vs 0.3% (1/290), and the incidence of grade Ⅰ (χ(2)=5.684, P=0.015) and Ⅲ (χ(2)=4.361, P=0.037) complications were statistically significant. The incidence of severe complications in robot group (grade Ⅲ and above) was lower than that in traditional laparoscopy group [3.1% (4/131) vs 9.3% (27/290); χ(2)=5.179, P=0.023]. (3) Analysis of influencing factors of surgical complications: univariate analysis showed that BMI (χ(2)=15.801, P=0.000), preoperative anemia (χ(2)=14.299, P=0.000), total number of lymph node resection (χ(2)=10.425, P=0.001), surgical methods (χ(2)=8.620, P=0.003) were related to the occurrence of surgical complications of endometrial carcinoma. Multivariate analysis showed that BMI (OR=0.289, 95%CI: 0.097-0.864, P=0.026), preoperative anemia (OR=0.309, 95%CI: 0.129-0.740, P=0.008), the total number of lymph node resection (OR=0.624, 95%CI: 0.403-0.966, P=0.034) and surgical methods (OR=3.491, 95%CI: 1.030-11.840, P=0.045) were independent risk factors for surgical complications of endometrial carcinoma. Conclusions: Compared with traditional laparoscopic surgery, robot-assisted laparoscopic surgery has fewer complications and lower incidence of severe complications. BMI, preoperative anemia, the total number of lymph node resection and surgical methods are independent risk factors for the occurrence of surgical complications of stage Ⅰ endometrial cancer.


Asunto(s)
Neoplasias Endometriales/cirugía , Laparoscopía , Escisión del Ganglio Linfático/métodos , Complicaciones Posoperatorias/epidemiología , Procedimientos Quirúrgicos Robotizados/efectos adversos , Estudios de Casos y Controles , China/epidemiología , Neoplasias Endometriales/epidemiología , Neoplasias Endometriales/patología , Femenino , Humanos , Incidencia , Estudios Retrospectivos , Factores de Riesgo , Procedimientos Quirúrgicos Robotizados/métodos , Resultado del Tratamiento
11.
Medicine (Baltimore) ; 99(10): e19324, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32150068

RESUMEN

The surgical outcomes of patients with single ureteral stones who had undergone ureteroscopic Holmium laser lithotripsy as outpatients and compare them with those of patients who had received the same procedure as inpatients. Records were obtained from January 2012 to December 2016 for selected patients who had undergone the above mentioned procedure at our institution. Patients were excluded if their ECOG performance status was ≥2, presented with multiple stones or concomitant renal stones, had histories of cancer or congenital urinary system abnormalities, or had undergone urinary system reconstruction surgery. Patients could decide whether to receive the procedure as an outpatient or inpatient. All surgeries were performed by a single surgeon. Patients preoperative, operative, and postoperative data were recorded. The clinical results, such as urinary tract infection, analgesic requirement, rate of returning to the emergency room, stone clearance, surgical complications, and medical expenditure for the treatment courses were analyzed and compared between the 2 cohorts. In total, 303 patients met the inclusion criteria. Among them, 119 patients decided to receive ureteroscopic laser lithotripsy as outpatients, whereas 184 decided to be inpatients. The outpatient cohort was younger (P < .001), had smaller stone diameters (P < .001), and fewer comorbidity factors (P = .038). Patients with a history of stone manipulation favored receiving the procedure under admission (P < .001). After 1:1 propensity score matching, no significant differences were discovered between the cohorts with regard to operative time, rate of lithotripsy failure, and operative complications. Furthermore, rates of stone clearance, post-op urinary tract infection, analgesic requirement, and returning to the emergency room were comparable between the 2 groups. However, the medical expenditure was significantly lower in the outpatient cohort (P < .001). Our data revealed that outpatient ureteroscopic lithotripsy with a Holmium laser was more economical compared with the inpatient group and achieved favorable outcomes for patients with a single ureteral stone.


Asunto(s)
Litotripsia por Láser/tendencias , Pacientes Ambulatorios/estadística & datos numéricos , Cálculos Ureterales/complicaciones , Cálculos Ureterales/terapia , Adulto , Anciano , Femenino , Humanos , Litotripsia por Láser/métodos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Resultado del Tratamiento , Cálculos Ureterales/epidemiología , Ureteroscopía/métodos , Ureteroscopía/tendencias
12.
Medicine (Baltimore) ; 99(10): e19402, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32150087

RESUMEN

In recent years, deep venous thrombosis (DVT) after spine surgery has received extensive attention, but perioperative prevalence of DVT in patients undergoing percutaneous kyphoplasty (PKP) is lacking.To assess the perioperative prevalence of deep vein thrombosis (DVT) in patients undergoing PKP with routinely applied ultrasonography.We reviewed 1113 consecutive patients undergoing PKP from January 2014 to August 2017. The surgical procedure was bilateral PKP. All patients were routinely examined with ultrasonography when admitted to the hospital and on the first post-operative day. Clinical signs of DVT were checked and recorded before examination.Forty (3.6%) out of 1113 patients were diagnosed with DVT by ultrasonography. Of the 40 detected cases of DVT, only six (0.54%) patients presented with clinical signs of DVT, demonstrating that there were 34 (3.05%) asymptomatic cases. No patient presenting with clinically suspected pulmonary embolism (PE) was observed. Gender, body mass index (BMI), operative time, hypertension, diabetes, heart disease, and lower limb fracture were not significant risk factors for DVT (P > .05). In contrast, patient age, oncologic conditions, DVT history, and paraplegia appeared to be significant risk factors for DVT (P < .01). There was no significant difference in the incidence of DVT found between the three PKP surgical levels (P > .05).The total incidence of perioperative DVT diagnosed with ultrasonography in patients undergoing PKP was 3.6%, of which only 0.54% was symptomatic cases. It is necessary to assess DVT using ultrasonography during the perioperative procedure of PKP, especially for high-risk patients.Level of evidence: Level IV.


Asunto(s)
Cifoplastia/efectos adversos , Periodo Perioperatorio , Trombosis de la Vena/etiología , Adulto , Anciano , China , Femenino , Humanos , Cifoplastia/métodos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/fisiopatología , Prevalencia , Estudios Retrospectivos , Factores de Riesgo , Ultrasonografía/estadística & datos numéricos , Trombosis de la Vena/epidemiología , Trombosis de la Vena/fisiopatología
13.
Med Sci Monit ; 26: e921350, 2020 Mar 22.
Artículo en Inglés | MEDLINE | ID: mdl-32200388

RESUMEN

BACKGROUND To facilitate early treatment, we constructed a nomogram to predict risk of postoperative fever before prostate biopsy in patients with high risk of fever. MATERIAL AND METHODS We collected information on patients undergoing prostate biopsy from January 2015 to December 2018 from their medical records, including clinical characteristics and laboratory test results. Finally, after strict screening, the prediction model was established in 440 patients who underwent a transrectal prostate biopsy (TRPB). We divided these patients into a training group and validation group at a ratio of 7: 3, respectively. Univariate analysis and multivariate logistic regression analysis were used to select the predictors and to develop the model. Calibration curve and C-index were used to evaluate the accuracy of the nomogram, while DCA was used to assess the clinical value. RESULTS The individualized predictive nomogram contained 3 clinical features - Biopsy-positive rate (BPR), Hematuria, and Urine WBC - significantly associated with post-biopsy fever. The nomogram had good discriminating ability in both the training group and validation group - the C-index was 0.774 (95% CI=0.717-0.832) in the training group and 0.808 (95% CI=0.706-0.909) in the validation group. Hosmer-Lemeshow test proved a good calibration curve fit. The DCA curve suggested that the nomogram would have good clinical utility. CONCLUSIONS This is the first study to develop a nomogram to predict fever after prostate biopsy via Biopsy-positive rate (BPR), Hematuria, and Urine WBC. Use of this nomogram might help prevent fever and infection, and could facilitate individualized medical treatment after prostate biopsy.


Asunto(s)
Biopsia con Aguja/efectos adversos , Fiebre/epidemiología , Nomogramas , Neoplasias de la Próstata/diagnóstico , Anciano , Anciano de 80 o más Años , Biopsia con Aguja/métodos , Hematuria , Humanos , Recuento de Leucocitos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/prevención & control , Valor Predictivo de las Pruebas , Próstata/patología , Enfermedades de la Próstata/diagnóstico , Enfermedades de la Próstata/patología , Neoplasias de la Próstata/patología , Estudios Retrospectivos , Ultrasonografía Intervencional , Orina/citología
14.
Lancet ; 395(10222): 417-426, 2020 02 08.
Artículo en Inglés | MEDLINE | ID: mdl-32035551

RESUMEN

BACKGROUND: Closure of an abdominal stoma, a common elective operation, is associated with frequent complications; one of the commonest and impactful is incisional hernia formation. We aimed to investigate whether biological mesh (collagen tissue matrix) can safely reduce the incidence of incisional hernias at the stoma closure site. METHODS: In this randomised controlled trial (ROCSS) done in 37 hospitals across three European countries (35 UK, one Denmark, one Netherlands), patients aged 18 years or older undergoing elective ileostomy or colostomy closure were randomly assigned using a computer-based algorithm in a 1:1 ratio to either biological mesh reinforcement or closure with sutures alone (control). Training in the novel technique was standardised across hospitals. Patients and outcome assessors were masked to treatment allocation. The primary outcome measure was occurrence of clinically detectable hernia 2 years after randomisation (intention to treat). A sample size of 790 patients was required to identify a 40% reduction (25% to 15%), with 90% power (15% drop-out rate). This study is registered with ClinicalTrials.gov, NCT02238964. FINDINGS: Between Nov 28, 2012, and Nov 11, 2015, of 1286 screened patients, 790 were randomly assigned. 394 (50%) patients were randomly assigned to mesh closure and 396 (50%) to standard closure. In the mesh group, 373 (95%) of 394 patients successfully received mesh and in the control group, three patients received mesh. The clinically detectable hernia rate, the primary outcome, at 2 years was 12% (39 of 323) in the mesh group and 20% (64 of 327) in the control group (adjusted relative risk [RR] 0·62, 95% CI 0·43-0·90; p=0·012). In 455 patients for whom 1 year postoperative CT scans were available, there was a lower radiologically defined hernia rate in mesh versus control groups (20 [9%] of 229 vs 47 [21%] of 226, adjusted RR 0·42, 95% CI 0·26-0·69; p<0·001). There was also a reduction in symptomatic hernia (16%, 52 of 329 vs 19%, 64 of 331; adjusted relative risk 0·83, 0·60-1·16; p=0·29) and surgical reintervention (12%, 42 of 344 vs 16%, 54 of 346: adjusted relative risk 0·78, 0·54-1·13; p=0·19) at 2 years, but this result did not reach statistical significance. No significant differences were seen in wound infection rate, seroma rate, quality of life, pain scores, or serious adverse events. INTERPRETATION: Reinforcement of the abdominal wall with a biological mesh at the time of stoma closure reduced clinically detectable incisional hernia within 24 months of surgery and with an acceptable safety profile. The results of this study support the use of biological mesh in stoma closure site reinforcement to reduce the early formation of incisional hernias. FUNDING: National Institute for Health Research Research for Patient Benefit and Allergan.


Asunto(s)
Técnicas de Cierre de Herida Abdominal/instrumentación , Hernia/epidemiología , Complicaciones Posoperatorias/epidemiología , Mallas Quirúrgicas , Estomas Quirúrgicos , Adulto , Anciano , Colágeno , Colon/cirugía , Método Doble Ciego , Femenino , Hernia/etiología , Hernia/prevención & control , Humanos , Ileus/cirugía , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/prevención & control , Estudios Prospectivos
15.
Medicine (Baltimore) ; 99(7): e18730, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32049781

RESUMEN

The off-label use of medications is a "right" for pediatricians, owing to lack of enough safety and effectiveness drug trials in pediatric age group. Pediatricians have to rely on their personal judicial use of medications in children.We studied off-label use of ursodeoxycholic acid (UDCA) retrospectively during 2005 to 2015 among those who attended the Pediatic Hepatology Unit, Cairo University.We analyzed data of 779 neonates and infants with cholestasis. 15% dropped out. Males comprised 374 (56.5%). Cholestasis was due to surgical causes in 129 (19.5%), neonatal hepatitis in 445 (67.2%), and paucity of intrahepatic bile ducts in 88 (13.3%). Three hundred sixty (54.4%) received UDCA (15-30 mg/kg/d), and 302 (45.6%) did not. Both groups were matched as regards causes and severity of cholestasis. Those who received UDCA had worse outcome (P < .001), and more complications (P < .001). A total of 73.1% (221) achieved cure without UDCA compared to only 45.8% (165) of those on UDCA (P < .001).UDCA is not effective and not safe in Egyptian neonates and infants with cholestasis. UDCA use compromises chance of cure, and is associated with serious morbidity, progression of disease, and death. UDCA off-label use mortality was absolutely preventable. Off- label use of UDCA in neonates and children should be utterly prohibited. Information of use of off-label medications, effectiveness, and safety, should be recorded, analyzed, and made available within context of Off-label Use Registry Studies with informed consent of parents.


Asunto(s)
Colestasis/mortalidad , Complicaciones Posoperatorias/epidemiología , Ácido Ursodesoxicólico/efectos adversos , Estudios de Casos y Controles , Colestasis/epidemiología , Colestasis/etiología , Egipto/epidemiología , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Uso Fuera de lo Indicado , Complicaciones Posoperatorias/mortalidad , Estudios Retrospectivos , Índice de Severidad de la Enfermedad
16.
Medicine (Baltimore) ; 99(7): e19108, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32049822

RESUMEN

Aspiration pneumonia (AP) has been recognized as one of the most common postoperative complications after hip surgery in elderly. The objective of the present study was to evaluate risk for postoperative complications of AP in elderly patients with femoral neck fractures.We recruited 426 patients (age 84.9 ±â€Š7.4 years) with a history of hip surgery carried out at Toyama Municipal Hospital. AP occurred in 18 out of 426 cases (4.23%). Statistical test has found significant differences in age, gender, serum albumin level, and cognitive impairment, between AP and non-AP groups. Subsequently multiple logistic regression analysis was conducted to investigate the risk factors for AP, including age, gender, serum albumin, cognitive impairment, and activities of daily living (ADL). Adjusted odds ratio showed significant differences in age, gender, and serum albumin, whereas no significant differences were found in cognitive impairment and ADL.This study suggested that serum albumin seemed to be a risk factor for AP but were necessary to assess under adjustment of confounding factors, including age and gender. Monitoring serum albumin level seemed to be important for the postoperative management of AP, especially in elderly patients receiving surgery of femoral neck and trochanteric fractures.


Asunto(s)
Fracturas del Cuello Femoral/complicaciones , Neumonía por Aspiración/etiología , Complicaciones Posoperatorias/etiología , Factores de Edad , Anciano , Anciano de 80 o más Años , Estudios de Casos y Controles , Femenino , Fracturas del Cuello Femoral/cirugía , Humanos , Masculino , Neumonía por Aspiración/epidemiología , Complicaciones Posoperatorias/epidemiología , Estudios Retrospectivos , Factores de Riesgo , Albúmina Sérica , Factores Sexuales
17.
Medicine (Baltimore) ; 99(8): e18572, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32080071

RESUMEN

Stereotactic biopsy (STB) is commonly used in the pathological diagnosis of intracranial lesions. The associated complication and mortality rates are low, but few reports with large sample sizes have assessed the complications of STB for lesions in the brain midline.To evaluate the complications of STB of lesions in the sellar region, pineal region, and brainstem.This was a retrospective analysis of patients who underwent STB of lesions in the sellar region, pineal region, and brainstem at the Neurosurgery Department, Sixth Medical Center, PLA General Hospital, China, between January 2015 and December 2017. The rates of and possible reasons for surgical complications (including bleeding) and mortality were analyzed.A total of 145 patients underwent STB of midline brain lesions, including 16 (11.0%) in the sellar region, 18 (12.4%) in the pineal region, and 111 (76.6%) in the brainstem. Successful biopsy of the sellar region, pineal region, and brainstem was achieved in 16/16 (100%), 18/18 (100%), and 107/111 (96.4%) patients, respectively. There were no complications following STB of lesion in the sellar or pineal regions. Complications occurred in 17/111 patients (15.3%) during/after brainstem biopsy, three of whom died (2.7%). The main clinical manifestations were facioplegia, facial pain, changes in blood pressure and heart rate, and difficulty breathing.STB of lesions in the sellar region, pineal region, and brainstem had a high success rate, but mortality was 2.7%. The occurrence of complications (15.3%) was closely related to the anatomical and functional characteristics of the region biopsied.


Asunto(s)
Neoplasias Encefálicas/patología , Glándula Pineal/patología , Silla Turca/patología , Técnicas Estereotáxicas/efectos adversos , Adolescente , Adulto , Biopsia/efectos adversos , Neoplasias Encefálicas/diagnóstico por imagen , Neoplasias Encefálicas/cirugía , Tronco Encefálico/diagnóstico por imagen , Tronco Encefálico/patología , China/epidemiología , Femenino , Hemorragia/epidemiología , Hemorragia/etiología , Humanos , Masculino , Persona de Mediana Edad , Glándula Pineal/diagnóstico por imagen , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/mortalidad , Estudios Retrospectivos , Silla Turca/diagnóstico por imagen , Técnicas Estereotáxicas/mortalidad , Adulto Joven
18.
Medicine (Baltimore) ; 99(8): e19039, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32080078

RESUMEN

AIM: To compare the efficacy and safety of cemented and uncemented hemiarthroplasty in elderly patients with femoral neck fracture. MATERIALS AND METHODS: We searched PubMed, EMBASE, and Cochrane Library databases for published randomized clinical trials comparing cemented hemiarthroplasty with uncemented hemiarthroplasty in elderly patients with a femoral neck fracture. The search was not limited to language, time, or other factors. The quality of each study was assessed using the revised Jadad scale. Two researchers independently extracted data from all selected studies, including the following base line data: study period, fracture stage, number of patients, male female ratio, average age, and per-protocol (PP) or intent-to-treat (ITT), and the interest outcomes: the mortality at 12 months, operative time, hospital stay, common complications, prosthetic-related complications, blood loss and Harris Hip Score (HHS). Fixed-effects or random-effects models with mean differences and odds ratios were used to pool the continuous and dichotomous variables to determine heterogeneity of the included studies. RESULTS: A total of 8 studies involving 1577 hips (782 uncemented and 795 cemented) were included in this meta-analysis. The meta-analysis is indicated that the operation time of cemented hemiarthroplasty was longer than uncemented hemiarthroplasty and there was statistical significance between two groups (OR = -7.30, 95%CI, -13.13, -1.46; P = .01). However, there was no significant difference between the two methods of fixation in mortality at 12 months (OR = 1.22, 95%CI, 0.94-1.59; P = .14), hospital stay (OR = 0.26, 95%CI, -0.41, 0.93; P = .44), blood loss (OR = -17.94, 95%CI, -65.83, 29.95; P = .46), and HHS score. There were significant differences in the common complications of pulmonary embolism between the two groups, but there were no differences in the other five common complications. The results showed that uncemented hemiarthroplasty could reduce the incidence of pulmonary embolism after operation. Moreover, the outcomes of prosthetic-related complications showed that there were significant differences between the two groups in periprosthetic fracture (OR = 8.32, 95%CI, 3.85-17.98; P < .00001) and prosthetic subsidence and loosening (OR = 5.33, 95%CI, 2.18-13.00; P = .0002). CONCLUSIONS: Our study shows that uncemented prosthesis can shorten the operation time and reduce the incidence of pulmonary embolism, but it does not reduce mortality, blood loss, and hospital stay. Most importantly, the incidence of prosthetic-related complications was higher in uncemented patients.


Asunto(s)
Cementos para Huesos/efectos adversos , Fracturas del Cuello Femoral/cirugía , Hemiartroplastia/tendencias , Complicaciones Posoperatorias/epidemiología , Anciano , Anciano de 80 o más Años , Pérdida de Sangre Quirúrgica , Femenino , Fracturas del Cuello Femoral/mortalidad , Hemiartroplastia/métodos , Hemiartroplastia/mortalidad , Prótesis de Cadera/efectos adversos , Humanos , Incidencia , Tiempo de Internación/estadística & datos numéricos , Masculino , Tempo Operativo , Embolia Pulmonar/epidemiología , Ensayos Clínicos Controlados Aleatorios como Asunto
19.
Medicine (Baltimore) ; 99(3): e18330, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-32011433

RESUMEN

BACKGROUND: To explore the feasibility and safety of coronary angiography (CAG) and percutaneous coronary intervention (PCI) via the distal radial artery in the anatomical snuffbox. METHODS: Ninety two patients who underwent CAG or PCI through distal radial artery access at The Second Affiliated Hospital of Zhejiang Chinese Medical University from September 2017 to March 2018 were included in our study. We collected baseline characteristics, number, and duration of arterial punctures, procedural success rate, postoperative compression time, the numerical rating scale (NRS) scores at 3 hours after procedure, complications, hospitalization duration. RESULTS: The mean age was 69 ±â€Š11years (44-92 years), and there were 57 males (62.0%). The diameter of the right distal radial artery and the more proximal right radial artery were 0.171 ±â€Š0.05 cm, 0.213 ±â€Š0.06 cm, respectively. On average, the number of puncture attempts was 1.52 ±â€Š0.81, access time was 2.3 ±â€Š1.78 minutes (0.33 - 8.72 minutes), access success was 95.7%, the postoperative compression time was 3.41 ±â€Š0.76 hours (2-6 hours), the NRS scores at 3 hours was 1.53 ±â€Š0.72 (1-4), and the mean hospitalization duration was 7.13 ±â€Š4.02 days. Four patients underwent left distal radial artery access and 88 patients underwent right distal radial artery access. There were 3 local hematomas after procedure and 2 patients had vasospasm. There were no cases of major bleeding, arteriovenous fistula, radial artery occlusion, or hand numbness. CONCLUSION: Cardiac catheterization through the distal radial artery in the snuffbox is safe and feasible. The right distal radial artery access can be routinely carried out.


Asunto(s)
Angiografía Coronaria/métodos , Enfermedad Coronaria/cirugía , Intervención Coronaria Percutánea/métodos , Arteria Radial , Adulto , Anciano , Anciano de 80 o más Años , Angiografía Coronaria/efectos adversos , Femenino , Humanos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Intervención Coronaria Percutánea/efectos adversos , Complicaciones Posoperatorias/epidemiología , Estudios Retrospectivos , Factores de Tiempo
20.
Medicine (Baltimore) ; 99(3): e18628, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-32011442

RESUMEN

Post-intubation laryngotracheal stenosis is a complication commonly encountered in patients with central nervous system (CNS) injuries, often preventing decannulation. To date, no data is available in the literature focusing on this issue. Our objective was to describe surgical treatments for laryngotracheal stenosis and discuss factors associated with successful decannulation in this group of patients.Medical records of patients with CNS injury who received tracheal surgeries at our institution between 2009 and 2016 were retrospectively collected and analyzed.Data on 124 surgeries in 62 patients with CNS injury were collected. The total complication rate was 20.9% with no surgical mortality. The decannulation success rate was 85.5%. Argon laser surgeries (48), diode laser surgeries (22), tracheal resection and reconstructions (R&R) (9), and tracheal T-tube placements (67) were performed. The average times from the first bronchoscopy check up to surgery and surgery to decannulation were 0.7 and 8.2 months, accordingly. The mean post-decannulation follow-up time was 13.5 months. A shift from the use of rigid bronchoscopy in the initial surgeries to laryngeal mask in the latter surgeries yielded an average decrease of 3 days in hospital length of stay (LOS). A change from initial rigid bronchoscopic core out procedures and argon laser to interventional flexible bronchoscopic resections with diode laser also decreased LOS significantly.Surgical treatments for patients with CNS injury and laryngotracheal stenosis can be safely performed with low mortality, acceptable complications, and a high decannulation success rate. The majority of patients with laryngotracheal stenosis can be managed with laser endoscopic surgeries, though tracheal R&R might still be required in selected cases. The use of laryngeal mask to secure the airway and diode laser in the intra-luminal resections improved the surgical outcome and was therefore recommended for these patients suffering from post-intubation laryngotracheal stenosis.


Asunto(s)
Sistema Nervioso Central/lesiones , Intubación Intratraqueal/efectos adversos , Laringoestenosis/etiología , Laringoestenosis/cirugía , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Broncoscopía , Niño , Femenino , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/epidemiología , Estudios Retrospectivos , Factores de Tiempo , Adulto Joven
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