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1.
Wiad Lek ; 73(9 cz. 2): 2014-2016, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33148851

RESUMEN

OBJECTIVE: The aim: Is to increase effectiveness of treatment at the children with recurrent inguinal hernias by improving surgical tactics. PATIENTS AND METHODS: Materials and methods: Method of laparoscopic correction of the recurrent inguinal hernias in children. For a period from 2017 to 2020 years in the surgical department of Municipal Establishment «Dnipro specialized clinical center of mother and child named by professor M. F. Rudnev¼ of Dnipro Regional Council¼ situated in the city Dnipro were carried out 48 laparoscopic procedures in a case of recurrent inguinal keel in children at the age of 3 years. RESULTS: Results: We proposed an innovative method of laparoscopic correction the recurrent inguinal hernias, which allows to eliminate a hernial pocket without additional injury structures of the inguinal canal. At the analysis cases of recurrent inguinal hernias was concluded, that recrudescence appeared among young children and more frequently, after surgical interference on the strangulated inguinal hernias, which were operated by traditional ways. CONCLUSION: Conclusions: According to the results of our research, it had been proved, that among numerous measures, focused on a restoration drainage system violation in the testicle, in a case of infringement obliteration of vaginal sprouts of a peritoneum in the boys and to keep safe ovarium vascularization in the girls.


Asunto(s)
Hernia Inguinal , Laparoscopía , Niño , Preescolar , Femenino , Hernia Inguinal/cirugía , Herniorrafia , Humanos , Masculino , Recurrencia , Reoperación
2.
Ther Umsch ; 77(9): 433-440, 2020 Nov.
Artículo en Alemán | MEDLINE | ID: mdl-33146098

RESUMEN

Primary hyperparathyroidism Abstract. Primary hyperparathyroidism is a common endocrine disease that comes along with a disruption of the calcium homeostasis and is accompanied by a variety of downstream disorders. These are often overlooked as patients present with a multitude of unspecific symptoms or may even be asymptomatic. The diagnosis of primary hyperparathyroidism can be made with the determination of calcium and parathyroid hormone levels, including the measurement of calcium in the 24-hours urine. The operation is the only therapy to cure primary hyperparathyroidism. To successfully conduct focused parathyroidectomy an accompanying visual imaging methodology is of great value and improves the operation success rate. Furthermore, an intraoperative parathyroid hormone monitoring is applied. A bilateral neck exploration technique is applicable in selected cases. The endocrine surgical expertise is pivotal in particular for re-operations, hereditary primary hyperparathyroidism and carcinomas. If surgery is not possible, a medication-based therapy is applied. This medical therapy requests a continuous therapy progress monitoring. In conclusion, to treat primary hyperparathyroidism an interdisciplinary team approach with endocrinologists and endocrine surgeons shows the best results.


Asunto(s)
Hiperparatiroidismo Primario , Humanos , Hiperparatiroidismo Primario/diagnóstico , Hiperparatiroidismo Primario/terapia , Monitoreo Intraoperatorio , Hormona Paratiroidea , Paratiroidectomía , Reoperación
3.
Bone Joint J ; 102-B(11): 1457-1466, 2020 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-33135437

RESUMEN

AIMS: To evaluate the rate of dislocation following dual mobility total hip arthroplasty (DM-THA) in patients with displaced femoral neck fractures, and to compare rates of dislocation, surgical-site infection, reoperation, and one-year mortality between DM-THA and bipolar hemiarthroplasty (BHA). METHODS: Studies were selected based on the following criteria: 1) study design (retrospective cohort studies, prospective cohort studies, retrospective comparative studies, prospective comparative studies, and randomized controlled studies (RCTs)); 2) study population (patients with femoral neck fracture); 3) intervention (DM-THA or BHA); and 4) outcomes (complications during postoperative follow-up and clinical results). Pooled meta-analysis was carried out to evaluate the dislocation rate after DM-THA and to compare outcomes between DM-THA and BHA. RESULTS: A total of 17 studies (ten cohort studies on DM-THA and seven comparative studies of DM-THA and BHA) were selected. These studies included 2,793 patients (2,799 hips), made up of 2,263 DM-THA patients (2,269 hips) and 530 BHA patients (530 hips). In all, 16 studies were analyzed to evaluate dislocation rate after DM-THA. The cumulative dislocation rate was 4% (95% confidence interval (CI) 3 to 5). Seven studies were analyzed to compare the rates dislocation and surgical-site infection. The rate of dislocation was significantly lower in the DM-THA group than in the BHA group (risk ratio (RR) 0.3; 95% CI 0.17 to 0.53, p < 0.001, Z -4.11). There was no significant difference in the rate of surgical-site infection between the two groups (p = 0.580). Six studies reported all-cause reoperations. The rate of reoperation was significantly lower in the DM-THA group than in the BHA group (RR 0.5; 95% CI 0.32 to 0.78, p = 0.003, Z -3.01). Five studies reported one-year mortality. The mortality rate was significantly lower in the DM-THA group than in the BHA group (RR 0.58 95% CI 0.45 to 0.75, p < 0.0001, Z -4.2). CONCLUSION: While the evidence available consisted mainly of non-randomized studies, DM-THA appeared to be a viable option for patients with displaced fractures of the femoral neck, with better reported rates of dislocation, reoperation, and mortality than BHA. Cite this article: Bone Joint J 2020;102-B(11):1457-1466.


Asunto(s)
Artroplastia de Reemplazo de Cadera/efectos adversos , Fracturas del Cuello Femoral/cirugía , Hemiartroplastia/efectos adversos , Luxación de la Cadera/etiología , Prótesis de Cadera , Fracturas Intraarticulares/cirugía , Artroplastia de Reemplazo de Cadera/instrumentación , Artroplastia de Reemplazo de Cadera/mortalidad , Hemiartroplastia/métodos , Hemiartroplastia/mortalidad , Prótesis de Cadera/efectos adversos , Humanos , Diseño de Prótesis , Reoperación , Infección de la Herida Quirúrgica/etiología
4.
Acta Ortop Mex ; 34(1): 22-26, 2020.
Artículo en Español | MEDLINE | ID: mdl-33230995

RESUMEN

INTRODUCTION: In primary hip replacement, different materials are used for bearing surfaces. In our medium metal or ceramic heads with highly crossed-linked polyethylene (PA) are the most used. These combinations have good results, but it is not clear which is clinically superior. The objective of this study is to determine whether there is any clinically significant difference based on a systematic review of the literature and national registries of arthroplasty. MATERIAL AND METHODS: We conduct a systematic review of the literature and national registries of arthroplasty and we were looking for studies comparing bearing surfaces: ceramic-highly cross-linked polyethylene (CP) and metal-highly cross-linked polyethylene (MP); describing the revision rate according to the surface type with a minimum 10-year follow-up. The outcome evaluated was: review rate for any cause depending on surface type. RESULTS: Two out of fifteen national registries were included. The Australian registry shows a difference in the 15-year revision rate: CP: 6.3 (IC 5.8, 6.7) vs MP: 5.1 (IC 4.6, 5.7). The New Zealand registry shows no differences in revision rate/100 components/year: CP 0.54 (0.48-0.61) vs MP 0.61 (0.57-0.66). We do not find clinical studies with inclusion criteria that answer the research question. CONCLUSION: The results of this review show a high survival rate with the use of highly cross-linked polyethylene, the results are similar when using ceramic or metal heads.


Asunto(s)
Artroplastia de Reemplazo de Cadera , Prótesis de Cadera , Australia , Cerámica , Humanos , Polietileno , Diseño de Prótesis , Falla de Prótesis , Reoperación
5.
Acta Ortop Mex ; 34(1): 47-52, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33231000

RESUMEN

INTRODUCTION: Anterior dislocation is a rare complication of total hip arthroplasty (THA). There exist only three cases in the literature. None of them report disassembly of the prosthesis components. We present a morbidly obese woman who suffered an irreducible obturator dislocation of an infected total hip arthroplasty (THA), due to uncontrolled adduction during an early debridement surgery. Following unsuccessful closed reduction attempts, a Vancouver B2 periprosthetic fracture and disassembly of the prosthetic components were observed. Two-stage revision THA was necessary to resolve the infection and restore hip functionality. In obturator dislocation, the femoral head prosthetic can be trapped in the obturator foramen, and this may disassemble the prosthesis components during reduction maneuvers; theres also risk of periprosthetic fracture. This mandate an open reduction of the joint. Patient obesity could be a determining factor for this rare type of hip arthroplasty dislocation. Obturator dislocation is an extremely rare complication of the total hip arthroplasty, whose reductions should be handled with caution given the risks of periprosthetic fractures. In most cases, an open reduction of the joint is required. CLINICAL IMPORTANCE: Our work is likely to be of great interest because it offers tips for the management of this rare complication based on our experience.


Asunto(s)
Artroplastia de Reemplazo de Cadera , Fracturas del Fémur , Luxación de la Cadera , Prótesis de Cadera , Obesidad Mórbida , Fracturas Periprotésicas , Artroplastia de Reemplazo de Cadera/efectos adversos , Femenino , Fracturas del Fémur/cirugía , Luxación de la Cadera/etiología , Luxación de la Cadera/cirugía , Prótesis de Cadera/efectos adversos , Humanos , Obesidad Mórbida/complicaciones , Obesidad Mórbida/cirugía , Fracturas Periprotésicas/etiología , Fracturas Periprotésicas/cirugía , Reoperación
6.
J Card Surg ; 35(11): 2927-2933, 2020 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-33111442

RESUMEN

OBJECTIVE: The arterial switch operation (ASO) is the standard treatment for the transposition of the great arteries. The timely variation in the residual pressure gradient across the pulmonary arteries is ill-defined. This study is aimed to study the progressive changes in the pressure gradient across the pulmonary valve and pulmonary arteries after ASO. METHODS: All eligible patients for this study who underwent ASO between 2000 and 2019 were reviewed. Transthoracic echocardiography was used to estimate the peak pressure gradient across the pulmonary artery and its branches. The primary outcome was the total peak pressure gradient (TPG) which is the sum of peak pressure gradients across the main pulmonary artery and pulmonary artery branches. Furthermore, longitudinal data analyses with mixed-effect modeling were used to determine the independent predictors for the changes in the pressure gradient. RESULTS: Three hundred and nine patients were included in the study. Over a 17-year follow-up, the freedom from pulmonary stenosis reintervention was 95% (16 out of the 309 patients underwent reintervention = 5%). The longitudinal data analyses of serial 1844 echocardiographic studies for the included patients revealed that the TPG recorded in the first postoperative echocardiogram across pulmonary valve, right and left pulmonary artery branches was the most significant predictor for reintervention. CONCLUSION: The total peak gradient measured in the first postoperative echocardiogram is the most important predictor for reintervention. We propose that a total peak gradient in the first postoperative echocardiography of 55 mm Hg or more is a predictor for reintervention.


Asunto(s)
Presión Arterial , Operación de Switch Arterial/métodos , Arteria Pulmonar/fisiopatología , Válvula Pulmonar/fisiopatología , Transposición de los Grandes Vasos/fisiopatología , Transposición de los Grandes Vasos/cirugía , Adolescente , Adulto , Niño , Preescolar , Ecocardiografía , Femenino , Estudios de Seguimiento , Humanos , Recién Nacido , Estudios Longitudinales , Masculino , Complicaciones Posoperatorias/diagnóstico por imagen , Complicaciones Posoperatorias/fisiopatología , Valor Predictivo de las Pruebas , Arteria Pulmonar/diagnóstico por imagen , Válvula Pulmonar/diagnóstico por imagen , Estenosis de la Válvula Pulmonar/diagnóstico por imagen , Estenosis de la Válvula Pulmonar/fisiopatología , Reoperación , Transposición de los Grandes Vasos/diagnóstico por imagen , Resultado del Tratamiento , Adulto Joven
7.
Niger J Clin Pract ; 23(10): 1426-1430, 2020 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-33047701

RESUMEN

Background: Osteoarthritis secondary to osteonecrosis of the femoral head is a common presentation in patients with sickle cell disease. Functional limitations with or without deformities from these complications of sickle cell disease often require Total Hip Arthroplasty (THA) to improve outcome. Aim: The aim of this study was to evaluate the postoperative outcome of THA for secondary osteoarthritis from osteonecrosis of the head of the femur in patients with sickle cell disease. Methodology: A retrospective study of outcome of THA in sickle cell disease patients between January 2010 and December 2015 is presented. Primary outcome was measured using the rates of complications and the Harris Hip scores at 6 weeks, 12 weeks, 6 months, and yearly. Results: A total of 68 THA in 56 patients with sickle cell disease was reviewed. The age range was 13-68 years, with a mean of 30.9 years. There were 15 males and 41 females (M: F ratio = 1:3). Approaches to the hip were direct lateral (64.3%), anterolateral (1.8%), and posterior (33.9%). 12 (21.4%) patients had bilateral total hip arthroplasty, and 44 (78.6%) had unilateral total hip arthroplasty. No patient required adductor tenotomy. Superficial surgical site infection was recorded in 7 (12.5%) patients. The postoperative functional outcome, measured by the Harris Hip score, was good or excellent in all patients, except 2 (2.9%) who required revision surgery following unacceptable results after primary hip arthroplasty. Conclusion: THA is a viable and effective treatment modality for sickle cell disease patients with osteonecrosis and secondary hip osteoarthritis. The choice of surgical approach does not affect the outcome.


Asunto(s)
Anemia de Células Falciformes/complicaciones , Artroplastia de Reemplazo de Cadera/métodos , Necrosis de la Cabeza Femoral/cirugía , Osteoartritis de la Cadera/cirugía , Reoperación , Adolescente , Adulto , Anciano , Artroplastia de Reemplazo de Cadera/psicología , Femenino , Fémur , Necrosis de la Cabeza Femoral/etiología , Necrosis de la Cabeza Femoral/psicología , Humanos , Masculino , Persona de Mediana Edad , Osteonecrosis/etiología , Complicaciones Posoperatorias , Periodo Posoperatorio , Calidad de Vida/psicología , Estudios Retrospectivos , Resultado del Tratamiento , Adulto Joven
8.
Khirurgiia (Mosk) ; (10): 68-72, 2020.
Artículo en Ruso | MEDLINE | ID: mdl-33047588

RESUMEN

OBJECTIVE: To evaluate the role of various perioperative risk factors on the incidence of abdominal wound dehiscence. MATERIAL AND METHODS: A retrospective controlled randomized trial of the risk factors of abdominal wound dehiscence was conducted in 62 patients for the period 2013- 2018. The research was performed at the Perm City Clinical Hospital No. 4. All patients were divided into two groups: the main one (n=31) with abdominal wound dehiscence in early postoperative period and the control group (n=31) without this event. Both groups were comparable by gender, age and surgical abdominal diseases. Between-group differences in numerical indicators were analyzed using Mann-Whitney U-test, qualitative variables were analyzed using contingency tables. Differences were significant at p-value <0.05. RESULTS: Incidence of abdominal wound dehiscence was similar in patients who admitted in emergency and elective fashion (p=0.54). Anemia upon admission (p=0.71), diabetes mellitus type 2 (p=1.00), COPD (p=0.13) and obesity (p=0.76) were not significant predictors of abdominal wound dehiscence. There were significant between-group differences in CRP level (p=0.04). Among intraoperative risk factors, duration of surgery (p=0.78), surgical approach (p=1.00), aponeurosis suturing technique (p=0.39) and stoma (p=0.71) did not significantly affect the incidence of abdominal wound dehiscence. In early postoperative period, abdominal wound dehiscence correlated with peritonitis (p=0.04), SSI (p<0.01) and redo laparotomy (p=0.02). CONCLUSION: Despite the variety of pre-, intra- and postoperative risk factors, only infectious postoperative complications (SSI, peritonitis) and redo surgical interventions influenced the development of abdominal wound dehiscence. Thus, the concept of abdominal wound dehiscence prevention should be inextricably associated with the concept of prevention of postoperative infectious complications from the abdominal wall and abdominal cavity.


Asunto(s)
Laparotomía/efectos adversos , Peritonitis/etiología , Reoperación/efectos adversos , Dehiscencia de la Herida Operatoria/etiología , Infección de la Herida Quirúrgica/etiología , Proteína C-Reactiva/análisis , Humanos , Ensayos Clínicos Controlados Aleatorios como Asunto , Estudios Retrospectivos , Factores de Riesgo , Dehiscencia de la Herida Operatoria/sangre
9.
Medicine (Baltimore) ; 99(41): e22529, 2020 Oct 09.
Artículo en Inglés | MEDLINE | ID: mdl-33031295

RESUMEN

BACKGROUND: Reduction malarplasty is a routine clinical procedure among Asian women, but the traditional surgical methods are still associated with serious complications, such as nonunion of the osteotomy sites. Revisional surgery to correct such complications is common, but poor bone healing in the osteotomy area presents a challenge to plastic surgeons. In this report, the authors present a new technique for revision malarplasty that uses the piezosurgery (piezoelectric bone surgery) approach. PATIENT AND DIAGNOSIS: A 30-year-old female patient underwent reduction malarplasty with titanium plate fixation in the zygomatic region at another hospital 4 years ago, but the root of the zygomatic arch was not fixed. The patient was diagnosed with bone nonunion, facial asymmetry, and soft tissue sagging on the right side of the face after malarplasty. INTERVENTION: We used piezosurgery to truncate the displaced healed broken end of the zygomatic bone according to the original osteotomy line. Following this, the malar was re-fixed with micro-titanium mesh, and the zygomatic arch was fixed with a titanium plate. OUTCOME: The patient was followed up for 11 months after the revision procedure. Her facial appearance was satisfactory, and no complications were observed on computed tomography images. LESSONS: This report presents a novel therapeutic option for surgical revision of failed malarplasty. Piezosurgery can help overcome the limitations of traditional surgical methods by reducing bone resorption, preventing resorption of the bone in revision malarplasty, modifying the degree of inward and upward movement of the zygomatic bone by facilitating adjustment of the position of the drill hole in the cortex of the bone stump for stable fixation. Hence piezosurgery can be a simple, accurate, and non-invasive osteotomy method for revision malarplasty.


Asunto(s)
Asimetría Facial/cirugía , Piezocirugía , Complicaciones Posoperatorias/cirugía , Cigoma/cirugía , Adulto , Grupo de Ascendencia Continental Asiática , Placas Óseas , Femenino , Humanos , Osteotomía , Procedimientos Quirúrgicos Reconstructivos , Reoperación
10.
Medicine (Baltimore) ; 99(41): e22584, 2020 Oct 09.
Artículo en Inglés | MEDLINE | ID: mdl-33031309

RESUMEN

NATIONALE: Trichosporon species are widely distributed in nature and are emerging opportunistic human pathogens. Trichosporon infections are associated with superficial cutaneous involvement in immunocompetent individuals to severe systemic disease in immunocompromised patients. Until now, there is no report in infective endocarditis by Trichosporon mucoides confirmed by molecular diagnostics PATIENT CONCERNS:: A 66-year-old man presented with a fever that had occurred for a period of 6 months. He had undergone aortic valve replacement 10 years prior. Transthoracic echocardiography showed vegetations on the prosthetic aortic valve and native mitral valve. T mucoides was detected in the cultures of blood and vegetations. DIAGNOSIS: DNA sequencing using D/D2 region of rRNA and internal transcribed spacer were performed. INTERVENTIONS: Infections were successfully controlled with valve replacement and voriconazole plus liposomal amphotericin B therapy. OUTCOMES: There has been no sign of recurrence for 18-months after treatment completion. LESSONS: This is the first reported case of infective endocarditis due to T mucoides. Clinicians should consider Trichosporon species as causative agents of endocarditis in patients who have undergone cardiac surgery.


Asunto(s)
Endocarditis/microbiología , Implantación de Prótesis de Válvulas Cardíacas , Infecciones Relacionadas con Prótesis/microbiología , Trichosporon/aislamiento & purificación , Tricosporonosis/microbiología , Anciano , Antifúngicos/uso terapéutico , Terapia Combinada , Endocarditis/diagnóstico por imagen , Endocarditis/terapia , Humanos , Masculino , Infecciones Relacionadas con Prótesis/diagnóstico por imagen , Infecciones Relacionadas con Prótesis/terapia , Reoperación , Tricosporonosis/diagnóstico por imagen , Tricosporonosis/terapia
11.
Medicine (Baltimore) ; 99(42): e22466, 2020 Oct 16.
Artículo en Inglés | MEDLINE | ID: mdl-33080682

RESUMEN

Compensatory hyperhidrosis is a debilitating postoperative condition occurring in 30% to 90% of patients with primary hyperhidrosis. The most appropriate treatment for compensatory hyperhidrosis remains controversial.Between January 2018 and December 2019, 44 patients with intractable compensatory hyperhidrosis underwent diffuse sympathicotomy (DS). In the early study periods, DS was performed sparsely (limited DS) to avoid possible adverse effects (right R5/7/9/11, left R5/6/8/10). In the late study periods, levels of surgical interruption were further modified to maximize sympatholytic effects (extended DS; bilateral R5/6/7/8/9/10/11). Patients were followed up for symptom resolution. For objective evidence of improved hyperhidrosis, thermographic images were taken for 7 patients.Immediate resolution of compensatory hyperhidrosis was achieved in 81% of patients, as determined at the 1 to 2 week postoperative visit. With a median follow-up of 22.7 months, compensatory hyperhidrosis continued to be resolved in 46% (n = 20). Logistic regression analysis showed that persistent resolution of compensatory hyperhidrosis was independently predicted by extended DS (odds ratio, 25.67, 95% CI, 1.78-1047.6; P = .036). The presence of gender, BMI, isolated compensatory hyperhidrosis, distribution of sweating, prior operation type, reoperation interval, and same-day lumbar sympathectomy failed to gain statistical significance on maintaining persistent resolution of compensatory hyperhidrosis. No patients experienced surgery-related side effects. Thermographic images obtained before/after surgery in 10 patients showed successful denervation and sweat diminishment.This study shows the safeness and effectiveness of DS for treating compensatory hyperhidrosis, representing a new treatment option. Future research should be directed at confirming a promising result of extended DS with further follow-up.


Asunto(s)
Endoscopía/métodos , Hiperhidrosis/cirugía , Complicaciones Posoperatorias/cirugía , Simpatectomía/métodos , Adulto , Femenino , Humanos , Masculino , Satisfacción del Paciente , Calidad de Vida , Reoperación , Estudios Retrospectivos
12.
Arthroscopy ; 36(10): 2736-2737, 2020 10.
Artículo en Inglés | MEDLINE | ID: mdl-33039044

RESUMEN

The biomechanical and clinical importance of the meniscus is now well-accepted. In accordance with this understanding, recent focus has shifted toward techniques that preserve the meniscus, including repair and meniscal allograft transplantation (MAT). Although MAT is a technically challenging procedure, evidence has suggested that it restores knee kinematics and tibiofemoral contact pressures, which may subsequently delay or prevent cartilage degeneration. Recent literature has reported concerns as to the high rate of reoperations after MAT, bringing into question the clinical utility of this procedure and its place in the realm of knee preservation. However, reoperations do not necessarily equal failure. MAT is a temporizing procedure that, when aligned with patient expectations, is valuable.


Asunto(s)
Meniscos Tibiales , Menisco , Aloinjertos , Humanos , Meniscos Tibiales/cirugía , Reoperación , Trasplante Homólogo
13.
J Card Surg ; 35(10): 2559-2566, 2020 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-33043654

RESUMEN

BACKGROUND: Few data are available on the association between postoperative serum uric acid (SUA) level and poor survival in patients undergoing coronary artery bypass grafting (CABG). We evaluated the relationship between postoperative SUA and major adverse cardiac and cerebrovascular events (MACCE) among patients undergoing CABG. METHODS: This study used data from 1614 consecutive patients undergoing CAGB at Fuwai Hospital (Beijing, China) from 2011 to 2015. Patients were stratified into statistical quartiles of postoperative SUA (between 6 and 18 hours after cardiac surgery): less than 203.7, 203.7 to 254.1, 254.1 to 316.6, and ≥316.6 µmol/L. The association of postoperative SUA with MACCE (ie, death, myocardial infarction [MI], stroke, or repeat revascularization) and the composite endpoint of mortality/MI were assessed. RESULTS: Patients had a mean age of 60.3 ± 8.4 years, and 79.3% were male. During mean follow-up of 2.5 ± 0.7 years, MACCE occurred in 201 (12.5%) patients. In separate multivariable regression models, postoperative SUA level was positively associated with in-hospital MACCE (highest vs lowest SUA quartile: odds ratio [OR]: 2.40; 95% confidence interval [CI]: 1.29, 4.48; P = .006) and in-hospital composite endpoint of mortality/MI (OR: 2.88; 95% CI: 1.45, 5.72; P = .003), respectively. And elevated postoperative SUA level was independently associated with MACCE (Hazard ratio [HR]: 1.70; 95% CI: 1.12, 2.57; P = .01) and the composite endpoint of mortality/MI (HR: 2.42; 95% CI: 1.32, 4.43; P = .004) respectively within 3 years after CABG. CONCLUSIONS: Elevated postoperative SUA level is associated with poor clinical outcomes after CABG. Patients with high postoperative SUA levels after CABG might require to be closely monitored.


Asunto(s)
Puente de Arteria Coronaria , Enfermedad de la Arteria Coronaria/cirugía , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/epidemiología , Ácido Úrico/sangre , Anciano , Biomarcadores/sangre , Enfermedad de la Arteria Coronaria/mortalidad , Femenino , Mortalidad Hospitalaria , Humanos , Masculino , Persona de Mediana Edad , Infarto del Miocardio/diagnóstico , Infarto del Miocardio/epidemiología , Infarto del Miocardio/etiología , Complicaciones Posoperatorias/etiología , Periodo Posoperatorio , Pronóstico , Reoperación/estadística & datos numéricos , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/epidemiología , Accidente Cerebrovascular/etiología , Tasa de Supervivencia
14.
J Surg Orthop Adv ; 29(3): 159-161, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33044156

RESUMEN

Diabetes currently affects over 25 million Americans, with the elderly carrying much of the disease burden. It's well known that diabetes increases the risk of surgical complications, but few studies have analyzed its effects on reoperation rates after single-level lumbar discectomy. Data was obtained using the commercially available Explorys software, which houses de-identified data for several healthcare systems. A database search was conducted to find all patients who'd undergone a lumbar discectomy. Scoliosis, spondylolisthesis, smoking history and obesity were excluded as possible confounding variables, after which 31,210 patients remained. Of them, 950 were found to have undergone a revision discectomy within 2 years. Those with diabetes were found to have a relative risk of 1.29 for revision discectomy compared to those who did not, 95% confidence interval (95% CI) 1.10-1.52, p < 0.002. These findings contribute to the importance of modifiable risk factor assessment preoperatively and their effects on surgical complications. (Journal of Surgical Orthopaedic Advances 29(3):159-161, 2020).


Asunto(s)
Diabetes Mellitus , Fusión Vertebral , Anciano , Diabetes Mellitus/epidemiología , Discectomía , Humanos , Vértebras Lumbares/cirugía , Reoperación , Estudios Retrospectivos , Resultado del Tratamiento
15.
Medicine (Baltimore) ; 99(44): e22896, 2020 Oct 30.
Artículo en Inglés | MEDLINE | ID: mdl-33126342

RESUMEN

Many patients with chronic pancreatitis (CP) undergo a step-up approach with interventional procedures as first-line treatment and resection reserved for later stages. The aim of this study was to identify predictive factors for a significant clinical improvement (SCI) after surgical treatment.All patients operated for CP between September 2012 and June 2017 at our center was retrospectively reviewed. A prospective patient survey was conducted to measure patients postoperative outcome. The primary endpoint SCI was defined as stable health status, positive weight development and complete pain relief without routine pain medication. Additionally, risk factors for relaparotomy were analyzed.A total of 89 patients with a median follow-up of 38 months were included. In most cases, a duodenum-preserving pancreatic head resection (n = 48) or pancreatoduodenectomy (n = 28) was performed. SCI was achieved in 65.3% (n = 47) of the patients after the final medium follow-up of 15.0 months (IQR: 7.0-35.0 months), respectively. Patients with a longer mean delay (7.7 vs 4 years) between diagnosis and surgical resection were less likely to achieve SCI (P = .02; OR .88; 95%CI .80-98). An endocrine insufficiency was a negative prognostic factor for SCI (P = .01; OR .15; 95%CI .04-68). In total, 96.2% of the patients had a complete or major postoperative relief with a mean pain intensity reduction from 8.1 to 1.9 on the visual analogue scale.The results support that surgical resection for CP should be considered at early stages. Resection can effectively reduce postoperative pain intensity and improve long-term success.


Asunto(s)
Pancreatectomía , Pancreatitis Crónica , Complicaciones Posoperatorias , Tiempo de Tratamiento/estadística & datos numéricos , Mantenimiento del Peso Corporal , Tratamiento Conservador/métodos , Insuficiencia Pancreática Exocrina/epidemiología , Insuficiencia Pancreática Exocrina/etiología , Femenino , Alemania/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Dimensión del Dolor/métodos , Pancreatectomía/efectos adversos , Pancreatectomía/métodos , Pancreatitis Crónica/enzimología , Pancreatitis Crónica/epidemiología , Pancreatitis Crónica/fisiopatología , Pancreatitis Crónica/terapia , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/cirugía , Pronóstico , Reoperación/métodos , Reoperación/estadística & datos numéricos , Estudios Retrospectivos , Factores de Riesgo , Resultado del Tratamiento
16.
N Engl J Med ; 383(16): 1535-1543, 2020 10 15.
Artículo en Inglés | MEDLINE | ID: mdl-33053284

RESUMEN

BACKGROUND: Obesity shortens life expectancy. Bariatric surgery is known to reduce the long-term relative risk of death, but its effect on life expectancy is unclear. METHODS: We used the Gompertz proportional hazards regression model to compare mortality and life expectancy among patients treated with either bariatric surgery (surgery group) or usual obesity care (control group) in the prospective, controlled Swedish Obese Subjects (SOS) study and participants in the SOS reference study (reference cohort), a random sample from the general population. RESULTS: In total, 2007 and 2040 patients were included in the surgery group and the control group, respectively, and 1135 participants were included in the reference cohort. At the time of the analysis (December 31, 2018), the median duration of follow-up for mortality was 24 years (interquartile range, 22 to 27) in the surgery group and 22 years (interquartile range, 21 to 27) in the control group; data on mortality were available for 99.9% of patients in the study. In the SOS reference cohort, the median duration of follow-up was 20 years (interquartile range, 19 to 21), and data on mortality were available for 100% of participants. In total, 457 patients (22.8%) in the surgery group and 539 patients (26.4%) in the control group died (hazard ratio, 0.77; 95% confidence interval [CI], 0.68 to 0.87; P<0.001). The corresponding hazard ratio was 0.70 (95% CI, 0.57 to 0.85) for death from cardiovascular disease and 0.77 (95% CI, 0.61 to 0.96) for death from cancer. The adjusted median life expectancy in the surgery group was 3.0 years (95% CI, 1.8 to 4.2) longer than in the control group but 5.5 years shorter than in the general population. The 90-day postoperative mortality was 0.2%, and 2.9% of the patients in the surgery group underwent repeat surgery. CONCLUSIONS: Among patients with obesity, bariatric surgery was associated with longer life expectancy than usual obesity care. Mortality remained higher in both groups than in the general population. (Funded by the Swedish Research Council and others; SOS ClinicalTrials.gov number, NCT01479452.).


Asunto(s)
Cirugía Bariátrica/mortalidad , Esperanza de Vida , Obesidad/mortalidad , Adulto , Estudios de Casos y Controles , Femenino , Humanos , Longevidad , Masculino , Persona de Mediana Edad , Obesidad/cirugía , Obesidad/terapia , Modelos de Riesgos Proporcionales , Estudios Prospectivos , Reoperación , Suecia/epidemiología
17.
J Orthop Surg Res ; 15(1): 474, 2020 Oct 15.
Artículo en Inglés | MEDLINE | ID: mdl-33059739

RESUMEN

BACKGROUND: Coronavirus disease 2019 (COVID-19) has broken out and spread rapidly nationwide at the beginning of 2020, which has brought huge impacts to people and work. The current situation of prevention and control is severe and urges guidance for clinicians, especially for medical systems. In the hope of providing a reference and recommendation for the prevention and control of the COVID-19, we carried out research to improve the quality of patient care and prevention during this epidemic. METHODS: All of the staff were trained rapidly to master personal protection in our department. We reviewed the patients' discharged records who underwent surgery in our department during January 1 to March 1, 2019, and January 1 to March 1, 2020. The management of the surgery patients and flow charts were described and analyzed. Post-operation outcomes of the patients include duration, complications, surgical site infection (SSI), system infection, re-operation, and mortality. Both chi-squared test and Student's t test were performed to determine the relationship between the two periods in terms of post-operation outcomes. RESULTS: Descriptive statistics analysis revealed that demographic of the patients between the two periods is similar. We had benefited from the strict flowcharts, smart robot, and protection equipment during the perioperative managements for orthopedic patients. With the help of the strict flow charts and smart equipment, post-operation outcomes of the patients revealed that the rates of the complications and re-operation had been reduced significantly (p < 0.05), while duration of operation, SSI, and system infection had no significant difference between two periods (p > 0.05). No patient and staff caught COVID-19 infection or mortality during the epidemic. CONCLUSIONS: Our study indicated that medical quality and efficiency were affected little with the help of strategies described above during the epidemic, which could be a reference tool for medical staff in routine clinical practice for admission of patients around the world. What is more, the provided strategies, which may evolve over time, could be used as empirical guidance and reference for orthopedic peers to get through the pandemic and ensure the normal operation of the hospital.


Asunto(s)
Infecciones por Coronavirus/epidemiología , Eficiencia Organizacional , Procedimientos Ortopédicos , Atención Perioperativa , Neumonía Viral/epidemiología , Garantía de la Calidad de Atención de Salud , Betacoronavirus , China/epidemiología , Femenino , Unidades Hospitalarias , Humanos , Control de Infecciones , Masculino , Persona de Mediana Edad , Tempo Operativo , Pandemias , Equipo de Protección Personal , Complicaciones Posoperatorias , Reoperación , Estudios Retrospectivos , Robótica , Flujo de Trabajo
18.
Anesth Analg ; 131(5): 1551-1556, 2020 11.
Artículo en Inglés | MEDLINE | ID: mdl-33079878

RESUMEN

BACKGROUND: Recently, there has been significant focus on the effects of anesthesia on the developing brain. Concern is heightened in children <3 years of age requiring lengthy and/or multiple anesthetics. Hypospadias correction is common in otherwise healthy children and may require both lengthy and repeated anesthetics. At academic centers, many of these cases are performed with the assistance of anesthesia and surgical trainees. We sought to identify both the incidence of these children undergoing additional anesthetics before age 3 as well as to understand the effect of trainees on duration of surgery and anesthesia and thus anesthetic exposure (AE), specifically focusing on those cases >3 hours. METHODS: We analyzed all cases of hypospadias repair from December 2011 through December 2018 at Texas Children's Hospital. In all, 1326 patients undergoing isolated hypospadias repair were analyzed for anesthesia time, surgical time, provider types involved, AE, caudal block, and additional AE related/unrelated to hypospadias. RESULTS: For the primary aim, a total of 1573 anesthetics were performed in children <3 years of age, including 1241 hypospadias repairs of which 1104 (89%) were completed with <3 hours of AE. For patients with <3 hours of AE, 86.1% had a single surgical intervention for hypospadias. Of patients <3 years of age, 17.3% required additional nonrelated surgeries. There was no difference in anesthesia time in cases performed solely by anesthesia attendings versus those performed with trainees/assistance (16.8 vs 16.8 minutes; P = .98). With regard to surgery, cases performed with surgical trainees were of longer duration than those performed solely by surgical attendings (83.5 vs 98.3 minutes; P < .001). Performance of surgery solely by attending surgeon resulted in a reduced total AE in minimal alveolar concentration (MAC) hours when compared to procedures done with trainees (1.92 vs 2.18; P < .001). Finally, comparison of patients undergoing initial correction of hypospadias with subsequent revisions revealed a longer time (117.7 vs 132.2 minutes; P < .001) and AE during the primary stage. CONCLUSIONS: The majority of children with hypospadias were repaired within a single AE. In general, most children did not require repeated AE before age 3. While presence of nonattending surgeons was associated with an increase in AE, this might at least partially be due to differences in case complexity. Moreover, the increase is likely not clinically significant. While it is critical to maintain a training environment, attempts to minimize AE are crucial. This information facilitates parental consent, particularly with regard to anesthesia duration and the need for additional anesthetics in hypospadias and nonhypospadias surgeries.


Asunto(s)
Anestesia/métodos , Anestésicos/administración & dosificación , Hipospadias/cirugía , Anestesia/efectos adversos , Anestesia Caudal , Anestesiólogos , Anestésicos/efectos adversos , Preescolar , Humanos , Incidencia , Lactante , Internado y Residencia , Masculino , Enfermeras Anestesistas , Tempo Operativo , Alveolos Pulmonares/metabolismo , Reoperación/estadística & datos numéricos , Cirujanos , Apoyo a la Formación Profesional , Resultado del Tratamiento
19.
Kyobu Geka ; 73(9): 683-685, 2020 Sep.
Artículo en Japonés | MEDLINE | ID: mdl-32879272

RESUMEN

A 67-year-old woman was admitted with exertional dyspnea. She had undergone mitral valve replacement with Björk-Shiley prosthetic valve (convexo-concave type) 36 years previously for stenosis and regurgitation in another institute. An echocardiography showed a severe degree of aortic stenosis, and the implanted mitral valve function is normal. We performed aortic valve replacement with a bioprosthetic valve and no prophylactic reoperation for the implanted mitral valve. The postoperative courses were uneventful. The patient was discharged from the hospital in good clinical condition. Postoperative echocardiography showed the prosthetic valves were normal. The close follow-up should be needed to prevent fatal valve dysfunction.


Asunto(s)
Válvula Aórtica , Prótesis Valvulares Cardíacas , Anciano , Femenino , Humanos , Válvula Mitral , Falla de Prótesis , Reoperación
20.
Kyobu Geka ; 73(8): 619-622, 2020 Aug.
Artículo en Japonés | MEDLINE | ID: mdl-32879293

RESUMEN

A 66-year-old woman with primary antiphospholipid antibody syndrome (APS) was admitted due to severe dyspnea. Eight months prior to admission, she underwent bioprosthetic mitral valve replacement for mitral valve stenosis and regurgitation. Transthoracic echocardiogram showed thickening bioprosthetic valve leaflets and severe valve stenosis. Emergency reoperation for artificial valve failure was performed. The explanted bioprosthetic valve showed massive thrombus formation. After the operation, she started strict anticoagulant and antiplatelet therapies and was discharged without recurrence of valve thrombosis.


Asunto(s)
Síndrome Antifosfolípido , Bioprótesis , Prótesis Valvulares Cardíacas , Trombosis , Anciano , Femenino , Humanos , Válvula Mitral , Falla de Prótesis , Reoperación
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