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1.
Radiol Clin North Am ; 58(6): 1147-1159, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33040854

RESUMO

Neuroendocrine tumors are rare solid tumors with an estimated 12,000 people in the United States diagnosed each year. Neuroendocrine tumors can occur in any part of the body. There is a wide spectrum of disease, ranging from slow-growing and indolent tumors found incidentally to highly aggressive malignancies with a poor prognosis. Knowledge of neuroendocrine tumor pathology is essential in the diagnostic workup of these patients. This article focuses on the evaluation, detection, and staging of common neuroendocrine tumors with multiple imaging modalities; the information gained with a multimodality approach is often complementary and leads to image-guided treatment decision making.


Assuntos
Tomada de Decisão Clínica/métodos , Imagem Multimodal/métodos , Tumores Neuroendócrinos/diagnóstico por imagem , Tumores Neuroendócrinos/cirurgia , Cirurgia Assistida por Computador/métodos , Intervalo Livre de Doença , Feminino , Humanos , Imagem por Ressonância Magnética/métodos , Masculino , Invasividade Neoplásica/patologia , Estadiamento de Neoplasias , Tumores Neuroendócrinos/mortalidade , Tumores Neuroendócrinos/patologia , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/métodos , Análise de Sobrevida , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento , Estados Unidos
2.
J Postgrad Med ; 66(4): 215-217, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33109783

RESUMO

Once purely the domain of knee surgery, the use of computer-navigated techniques in total hip arthroplasty (THA) is becoming progressively more commonplace. As with the adoption of any new technology-assisted approach, the uptake of navigated THA utilization has heralded a new suite of technique-specific potential complications. One such example - not usually seen with conventional instrumented THA - pertains to complications related to the insertion and use of fixed pelvic array trackers. This case report describes the unusual circumstance of retained local bony debris generated through application of self-drilling, self-tapping iliac crest pins (for rigid navigation tracker placement) being mis-interpreted on advanced imaging - at a hospital site remote from the index surgery - as an aggressive, early-stage, chondrosarcomatous lesion. This case highlights the critical importance of both a general awareness of common imaging findings after navigated THA surgery (whereby tracker pins have been employed) and the value of 'hands on' clinical assessment of patients to allow correlation with suspicious imaging findings.


Assuntos
Artroplastia de Quadril/efeitos adversos , Pinos Ortopédicos/efeitos adversos , Articulação do Quadril/cirurgia , Pelve/cirurgia , Fraturas Periprotéticas/diagnóstico por imagem , Cirurgia Assistida por Computador/instrumentação , Idoso de 80 Anos ou mais , Artroplastia de Quadril/instrumentação , Feminino , Humanos , Imageamento Tridimensional , Pelve/diagnóstico por imagem , Complicações Pós-Operatórias , Cirurgia Assistida por Computador/métodos , Tomografia Computadorizada por Raios X , Resultado do Tratamento
3.
Am Heart J ; 228: 65-71, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32866927

RESUMO

Intravascular ultrasound (IVUS)-guided percutaneous coronary intervention (PCI) has been shown in clinical trials, registries, and meta-analyses to reduce recurrent major adverse cardiovascular events after PCI. However, IVUS utilization remains low. An increasing number of high-risk or complex coronary artery lesions are treated with PCI, and we hypothesize that the impact of IVUS in guiding treatment of these complex lesions will be of increased importance in reducing major adverse cardiovascular events while remaining cost-effective. The "IMPact on Revascularization Outcomes of intraVascular ultrasound-guided treatment of complex lesions and Economic impact" trial (registered on clinicaltrials.gov: NCT04221815) is a multicenter, international, clinical trial randomizing subjects to IVUS-guided versus angiography-guided PCI in a 1:1 ratio. Patients undergoing PCI involving a complex lesion are eligible for enrollment. Complex lesion is defined as involving at least 1 of the following characteristics: chronic total occlusion, in-stent restenosis, severe coronary artery calcification, long lesion (≥28 mm), or bifurcation lesion. The clinical investigation will be conducted at approximately 120 centers in North America and Europe, enrolling approximately 2,500 to 3,100 randomized subjects with an adaptive design. The primary clinical end point is the rate of target vessel failure at 12 months, defined as the composite of cardiac death, target vessel-related myocardial infarction, and ischemia-driven target vessel revascularization. The co-primary imaging end point is the final post-PCI minimum stent area assessed by IVUS. The primary objective of this study is to assess the impact of IVUS guidance on the PCI treatment of complex lesions.


Assuntos
Doença da Artéria Coronariana , Vasos Coronários/diagnóstico por imagem , Intervenção Coronária Percutânea , Complicações Pós-Operatórias , Risco Ajustado/métodos , Ultrassonografia de Intervenção , Angiografia Coronária/métodos , Doença da Artéria Coronariana/diagnóstico , Doença da Artéria Coronariana/cirurgia , Stents Farmacológicos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Intervenção Coronária Percutânea/efeitos adversos , Intervenção Coronária Percutânea/instrumentação , Intervenção Coronária Percutânea/métodos , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/prevenção & controle , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Risco , Cirurgia Assistida por Computador/métodos , Ultrassonografia de Intervenção/economia , Ultrassonografia de Intervenção/métodos
4.
Am Heart J ; 228: 72-80, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32871327

RESUMO

BACKGROUND: The clinical value of intracoronary imaging for percutaneous coronary intervention (PCI) guidance is well acknowledged. Intravascular ultrasound (IVUS) and optical coherence tomography (OCT) are the most commonly used intravascular imaging to guide and optimize PCI in day-to-day practice. However, the comparative effectiveness of IVUS-guided versus OCT-guided PCI with respect to clinical end points remains unknown. METHODS AND DESIGN: The OCTIVUS study is a prospective, multicenter, open-label, parallel-arm, randomized trial comparing the effectiveness of 2 imaging-guided strategies in patients with stable angina or acute coronary syndromes undergoing PCI in Korea. A total of 2,000 patients are randomly assigned in a 1:1 ratio to either an OCT-guided PCI strategy or an IVUS-guided PCI strategy. The trial uses a pragmatic comparative effectiveness design with inclusion criteria designed to capture a broad range of real-world patients with diverse clinical and anatomical features. PCI optimization criteria are predefined using a common algorithm for online OCT or IVUS. The primary end point, which was tested for both noninferiority (margin, 3.1 percentage points for the risk difference) and superiority, is target-vessel failure (cardiac death, target-vessel myocardial infarction, or ischemia-driven target-vessel revascularization) at 1 year. RESULTS: Up to the end of July 2020, approximately 1,200 "real-world" PCI patients have been randomly enrolled over 2 years. Enrollment is expected to be completed around the midterm of 2021, and primary results will be available by late 2022 or early 2023. CONCLUSION: This large-scale, multicenter, pragmatic-design clinical trial will provide valuable clinical evidence on the relative efficacy and safety of OCT-guided versus IVUS-guided PCI strategies in a broad population of patients undergoing PCI in the daily clinical practice.


Assuntos
Vasos Coronários/diagnóstico por imagem , Intervenção Coronária Percutânea , Complicações Pós-Operatórias/prevenção & controle , Cirurgia Assistida por Computador/métodos , Tomografia de Coerência Óptica/métodos , Ultrassonografia de Intervenção/métodos , Pesquisa Comparativa da Efetividade , Angiografia Coronária/métodos , Doença da Artéria Coronariana/diagnóstico , Doença da Artéria Coronariana/cirurgia , Stents Farmacológicos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Intervenção Coronária Percutânea/efeitos adversos , Intervenção Coronária Percutânea/instrumentação , Intervenção Coronária Percutânea/métodos , Complicações Pós-Operatórias/diagnóstico , Ensaios Clínicos Controlados Aleatórios como Assunto , Risco Ajustado/métodos
5.
PLoS One ; 15(9): e0237229, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32925962

RESUMO

PURPOSE: Placement of one-piece ceramic dental implants requires precision, which can be enhanced by using a computer-guided system. This prospective clinical study examines the accuracy of partially guided implantation in the placement of one-piece ceramic implants in the anterior region. MATERIALS AND METHODS: One-piece ceramic dental implants were placed in 20 patients who were missing a central or lateral incisor. Partially guided dental implant placements were performed in all cases. The deviations in the implant positions were analyzed by superimposing post-operative cone beam computed tomography images over pre-operative treatment planning images. The results were reported as deviations (mean ± standard deviation) for three aspects (3D offset, mesio-distal, labio-lingual, and apico-coronal) and in three dimensions (the angle, coronal, and apical parts). RESULTS: Implants were successfully placed in 20 patients. The mean angular deviation was 4.23±1.84°, whereas the mean coronal 3D offset was 0.98±0.48 mm, and the mean apical 3D offset was 1.57±0.46 mm. CONCLUSIONS: A prospective clinical study involving 20 patients was conducted to measure the accuracy of computer-guided implantation of one-piece ceramic dental implants. Accuracy was determined by comparing the planned implant position to the actual position. Greater accuracy can be expected at the coronal part than at the apical part. The coronal 3D offset was found to be the most accurate.


Assuntos
Implantação Dentária Endo-Óssea , Mandíbula/cirurgia , Maxila/cirurgia , Cirurgia Assistida por Computador/métodos , Adulto , Cerâmica , Tomografia Computadorizada de Feixe Cônico , Implantes Dentários , Feminino , Humanos , Imageamento Tridimensional , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
7.
J Vis Exp ; (162)2020 08 04.
Artigo em Inglês | MEDLINE | ID: mdl-32831300

RESUMO

We are in the midst of the 3D era in most aspects of life, and especially in medicine. The surgical discipline is one of the major players in the medical field using the constantly developing 3D planning and printing capabilities. Computer-assisted design (CAD) and computer assisted manufacturing (CAM) are used to describe the 3D planning and manufacturing of the product. The planning and manufacturing of 3D surgical guides and reconstruction implants is performed almost exclusively by engineers. As technology advances and software interfaces become more user-friendly, it raises a question regarding the possibility of transferring the planning and manufacturing to the clinician. The reasons for such a shift are clear: the surgeon has the idea of what he wants to design, and he also knows what is feasible and could be used in the operating room. It allows him to be prepared for any scenario/unexpected results during the operation and allows the surgeon to be creative and express his new ideas using the CAD software. The purpose of this method is to provide clinicians with the ability to create their own surgical guides and reconstruction implants. In this manuscript, a detailed protocol will provide a simple method for segmentation using segmentation software and implant planning using a 3D design software. Following the segmentation and stl file production using segmentation software, the clinician could create a simple patient specific reconstruction plate or a more complex plate with a cradle for bone graft positioning. Surgical guides can be created for accurate resection, hole preparation for proper reconstruction plate positioning or for bone graft harvesting and re-contouring. A case of lower jaw reconstruction following plate fracture and nonunion healing of a trauma sustained injury is detailed.


Assuntos
Transplante Ósseo/métodos , Desenho Assistido por Computador/instrumentação , Impressão Tridimensional/instrumentação , Próteses e Implantes/normas , Cirurgia Assistida por Computador/métodos , Feminino , Humanos , Masculino
8.
Am J Cardiol ; 132: 93-99, 2020 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-32782067

RESUMO

To compare outcomes of ultrasound guidance (USG) versus fluoroscopy roadmap guidance (FG) angiography for femoral artery access in patients who underwent transfemoral (TF) transcatheter aortic valve implantation (TAVI) to determine whether routine USG use was associated with fewer vascular complications. Vascular complications are the most frequent procedural adverse events associated with TAVI. USG may provide a decreased rate of access site complications during vascular access compared with FG. Patients who underwent TF TAVI between July 2012 and July 2017 were reviewed and outcomes were compared. Vascular complications were categorized by Valve Academic Research Consortium-2 criteria and analyzed by a multivariable logistic regression adjusting for potential confounding risk factors including age, gender, body mass index, peripheral vascular disease, Society of Thoracic Surgeons score and sheath to femoral artery ratio. Of the 612 TAVI patients treated, 380 (63.1%) were performed using USG for access. Routine use of USG began in March 2015 and increased over time. Vascular complications occurred in 63 (10.3%) patients and decreased from 20% to 3.9% during the study period. There were fewer vascular complications with USG versus FG (7.9% vs 14.2%, p = 0.014). After adjusting for potential confounding risk factors that included newer valve systems, smaller sheath sizes and lower risk patients, there was still a 49% reduction in vascular complications with USG (odds ratio 0.51, 95% confidence interval 0.29 to 0.88, p = 0.02). In conclusion, USG for TF TAVI was associated with reduced vascular access site complications compared with FG access even after accounting for potential confounding risk factors and should be considered for routine use for TF TAVI.


Assuntos
Estenose da Valva Aórtica/cirurgia , Valva Aórtica/cirurgia , Fluoroscopia/métodos , Cirurgia Assistida por Computador/métodos , Substituição da Valva Aórtica Transcateter/métodos , Ultrassonografia/métodos , Idoso , Idoso de 80 Anos ou mais , Angiografia , Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/diagnóstico , Feminino , Artéria Femoral , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
10.
Medicine (Baltimore) ; 99(32): e21508, 2020 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-32769888

RESUMO

BACKGROUND: The literature lacks studies that confirm whether the improved radiographic alignment that can be achieved with computer-navigated total knee arthroplasty (TKA) improves patients' activities of daily living or the durability of total knee prostheses. Thus, in this protocol, we designed a randomized controlled trial to compare implant alignment, functional scores, and survival of the implant using computer-assisted surgery versus a conventional surgical technique. METHODS: This prospective, blinded randomized controlled trial was conducted at our single hospital. This study was approved by the ethics committee of Jiaxing Second Hospital. The patient inclusion criteria were age 20 to 80 years' old, a body mass index of ≤35 kg/m, and consented for primary knee arthroplasty performed through a medial parapatellar approach by the senior author. We randomized consented study participants on a 1:1 ratio to 1 of 2 study groups using a computer-generated list of random numbers in varying block sizes. The primary outcome in this study was the Knee Injury and Osteoarthritis Outcome Score. Secondary outcomes were the Knee Society Score, Western Ontario and McMaster Universities Osteoarthritis Index, complications, and range of motion together with alignment and rotational positioning of the implant. Statistical significance was defined as a P value of ≤0.05. CONCLUSIONS: Authors hypothesized that computer-assisted surgery in primary TKA improves implant alignment, functional scores, and survival of the implant compared to the conventional technique.


Assuntos
Artroplastia do Joelho/métodos , Osteoartrite do Joelho/cirurgia , Cirurgia Assistida por Computador/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Artroplastia do Joelho/efeitos adversos , China , Feminino , Humanos , Prótese do Joelho/efeitos adversos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Ensaios Clínicos Controlados Aleatórios como Assunto , Amplitude de Movimento Articular , Recuperação de Função Fisiológica , Método Simples-Cego , Cirurgia Assistida por Computador/efeitos adversos , Resultado do Tratamento , Adulto Jovem
11.
Medicine (Baltimore) ; 99(28): e21064, 2020 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-32664123

RESUMO

BACKGROUND: Computer navigation technology is gradually applied to the placement of pedicle screws, but its security and effectiveness still lack of high-quality evidence-based medical evidence. In this study, we will perform a systematic review of previously published randomized controlled trials to investigate the accuracy and effectiveness of computer navigation vsersus fluoroscopy guidance for pedicle screw placement. METHODS: All study protocols adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed (MEDLINE), The excerpta medica database, Web of Science (science and social science citation index), The Cochrane Library (Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials (CENTRAL), Cochrane Methodology Register), China National Knowledge Infrastructure, Chinese Science and Technology Periodical Database, WanFang, Chinese Biomedical Literature Database will be searched for relevant articles up to 18 April, 2020. We will include randomized controlled trials of computer navigation and fluoroscopy guidance for pedicle screw placement. The Cochrane Handbook (v6) will be used for assessment of study bias and reliability, and a meta-analysis will be performed using STATA 16.0. The main outcome will be the proportion of accurate implanted screws. Additional outcomes including: overall complication rate, radiation dosage, length of surgery, length of stay, estimated blood loss. RESULTS: The quality of the assessments will be assessed through Grading of Recommendations Assessment, Development, and Evaluation. Data will be disseminated through publications in peer-reviewed journals. CONCLUSION: We will evaluate the accuracy and other perioperative parameters between computer navigation and fluoroscopy guidance for pedicle screw placement. TRIAL REGISTRATION NUMBER: PROSPERO 2020 CRD42020172087.


Assuntos
Fluoroscopia/métodos , Parafusos Pediculares , Projetos de Pesquisa , Fusão Vertebral/métodos , Cirurgia Assistida por Computador/métodos , Perda Sanguínea Cirúrgica , Humanos , Tempo de Internação , Complicações Pós-Operatórias/epidemiologia , Estudos Prospectivos , Ensaios Clínicos Controlados Aleatórios como Assunto , Reprodutibilidade dos Testes
13.
Am Surg ; 86(8): 1029-1031, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32721172

RESUMO

BACKGROUND: Breast cancer is the most commonly diagnosed noncutaneous malignancy and remains the second leading cause of cancer deaths in women. The Savi Scout (Cianna Medical, Merit Medical Systems, Inc. South Jordan, UT) is a wireless, nonradioactive, wave reflection implant system that enables surgeons to remove targeted breast lesions. Our study aims to be the largest comparison of wire and Savi Scout localization techniques for positive margin, complication, and reoperation rates. METHODS: Single-institution retrospective review of 512 patients that had Savi Scout Surgical Guidance System breast lesion biopsy or wire localized breast biopsy from May 2017 to December 2018. A RedCaps database was created and reviewed for outcomes. RESULTS: For 320 Savi scout patients, margins were positive or less than 1 mm in 18 cases (5.6%). 17 (5.3%) patients required reoperation. Surgical site occurrence was found in 7 (2.1%) patients, and 2 patients required intervention (0.6%). For 175 wire localization patients, margins were positive or less than 1 mm in 24 patients, and all required reoperation (13.7%). A surgical site occurrence was found in 13 (7.4%) patients and 5 patients required intervention (2.8%). DISCUSSION: In our series, the Savi Scout localization system resulted in a lower rate of positive margins, reoperation, and surgical site occurrence. These data suggest that Savi Scout localization is a reasonable replacement to wire localization for breast lesions and might produce superior results.


Assuntos
Neoplasias da Mama/cirurgia , Mama/patologia , Carcinoma Ductal de Mama/cirurgia , Marcadores Fiduciais , Mastectomia Segmentar/métodos , Radar , Cirurgia Assistida por Computador/instrumentação , Adulto , Idoso , Biópsia , Mama/diagnóstico por imagem , Mama/cirurgia , Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/patologia , Carcinoma Ductal de Mama/diagnóstico por imagem , Carcinoma Ductal de Mama/patologia , Feminino , Humanos , Margens de Excisão , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Cirurgia Assistida por Computador/métodos
14.
Saudi Med J ; 41(7): 698-702, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32601636

RESUMO

OBJECTIVES: To determine the ultrasound guidance for central venous catheter (USG-CVC) placement rate of emergency physicians (EPs) in Kingdom of Saudi Arabia. METHODS: A cross-sectional survey study regarding the respondents' demographic profiles, formal and informal training in USG-CVC placement, experiences, and attitudes towards the procedure was emailed to all EPs registered with the Saudi Commission for Health Specialties (SCFHS) between October and December 2018. RESULTS: In total, 234/350 SCFHS-registered EPs completed the survey; the response rate was 66.9%. Most respondents (70.5%) were board-certified in emergency medicine (EM). Ninety percent indicated that US device for CVC placement assistance was available. Most EPs (78.2%) had performed USG-CVC placement; the US usage rate correlated significantly with recent graduation from residency (p=0.048). In total, 83.3% received formal training during residency. Of the 234 respondents, 53.8% felt extremely comfortable with CVC placement with USG and 19.7% without USG (p less than 0.01). Nevertheless, most respondents desired further USG-CVC training. CONCLUSION: Despite existing evidence and a consensus on its superiority over the landmark technique, USG-CVC placement has not been adopted by a small proportion of EPs into clinical practice. Formal training, education, and institutional provision of permanent onsite US machines may address any barriers.


Assuntos
Cateterismo Venoso Central/métodos , Cateterismo Venoso Central/estatística & dados numéricos , Cateteres Venosos Centrais , Medicina de Emergência , Internato e Residência/estatística & dados numéricos , Médicos , Utilização de Procedimentos e Técnicas/estatística & dados numéricos , Cirurgia Assistida por Computador/métodos , Cirurgia Assistida por Computador/estatística & dados numéricos , Ultrassonografia de Intervenção/métodos , Ultrassonografia de Intervenção/estatística & dados numéricos , Ultrassonografia , Estudos Transversais , Feminino , Humanos , Masculino , Arábia Saudita/epidemiologia , Cirurgia Assistida por Computador/educação , Inquéritos e Questionários
16.
Ann Surg ; 272(2): 199-205, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32675481

RESUMO

OBJECTIVE: The aim of this retrospective study was to compare portal vein embolization (PVE) and radiologica simultaneous portohepatic vein embolization (RASPE) for future liver remnant (FLR) growth in terms of feasibility, safety, and efficacy. SUMMARY OF BACKGROUND DATA: After portal vein embolization (PVE), 15% of patients remain ineligible for hepatic resection due to insufficient hypertrophy of the FLR. RASPE has been proposed to induce FLR growth. MATERIALS AND METHODS: Between 2016 and 2018, 73 patients were included in the study. RASPE was proposed for patients with a ratio of FLR to total liver volume (FLR/TLV) of <25% (RASPE group). This group was compared to patients who underwent PVE for a FLR/TLV <30% (PVE group). Patients in the 2 groups were matched for age, sex, type of tumor, and number of chemotherapy treatments. FLR was assessed by computed tomography before and 4 weeks after the procedure. RESULTS: The technical success rate in both groups was 100%. Morbidity post-embolization, and the time between embolization and surgery were similar between the groups. In the PVE group, the FLR/TLV ratio before embolization was 31.03% (range: 18.33%-38.95%) versus 22.91% (range: 16.55-32.15) in the RASPE group (P < 0.0001). Four weeks after the procedure, the liver volume increased by 28.98% (range: 9.31%-61.23%) in the PVE group and by 61.18% (range: 23.18%-201.56%) in the RASPE group (P < 0.0001). Seven patients in the PVE group, but none in the RASPE group, had postoperative liver failure (P = 0.012). CONCLUSIONS: RASPE can be considered as "radiological associating liver partition and portal vein ligation for staged hepatectomy." RASPE induced safe and profound growth of the FLR and was more efficient than PVE. RASPE also allowed for extended hepatectomy with less risk of post-operative liver failure.


Assuntos
Embolização Terapêutica/métodos , Hepatectomia/métodos , Hepatomegalia/prevenção & controle , Neoplasias Hepáticas/cirurgia , Veia Porta/cirurgia , Cirurgia Assistida por Computador/métodos , Idoso , Distribuição de Qui-Quadrado , Estudos de Coortes , Intervalo Livre de Doença , Feminino , França , Hepatectomia/mortalidade , Humanos , Neoplasias Hepáticas/mortalidade , Neoplasias Hepáticas/patologia , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Cuidados Pré-Operatórios/métodos , Estudos Retrospectivos , Medição de Risco , Estatísticas não Paramétricas , Análise de Sobrevida , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
18.
Updates Surg ; 72(3): 761-772, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32607845

RESUMO

BACKGROUND: Indocyanine green (ICG) has been recently introduced in clinical practice as a fluorescent tracer. Lymphadenectomy is particularly challenging in gastric cancer surgery, owing to the complex anatomical drainage. AIM: The primary outcomes of this study were the feasibility and usefulness of ICG-guided lymphadenectomy in gastric cancer surgery, considering both the success rate and improved understanding of the surgical anatomy of nodal basins. The secondary outcome was the diagnostic ability of ICG to predict the presence of nodal metastases. PATIENTS AND METHODS: We conducted a single-center prospective trial comprising 13 patients with gastric cancer. ICG was injected the afternoon prior to surgery or intraoperatively via the submucosal or subserosal route. Standard lymphadenectomy was performed in all patients, according to patient age and tumor stage, as usual, but after standard lymphadenectomy the residual ICG + nodes were harvested and analyzed. Each nodal station and each dissected node was recorded and classified as ICG + or ICG- (both in vivo and back table evaluation was utilized for classification). After pathological analysis, each nodal station and each dissected node was recorded as metastatic or nonmetastatic (E&E staining). RESULTS: The feasibility rate was 84.6% (11/13). The mean number of dissected lymph nodes per patient was 37.9. Focusing on the 11 patients in whom ICG-guided nodal navigation was successfully performed, 81 lymph node stations were removed, for a total of 417 lymph nodes. Sixty-six stations (81.48%), comprising a total of 336 lymph nodes, exhibited fluorescence. No IC- node was metastatic; all 54 metastatic nodes were ICG + . A total of 282 ICG + nodes were nonmetastatic. In two cases, some nodes outside D2 areas were harvested, being ICG + (1 case of metastatic node). CONCLUSIONS: Fluorescence lymphography-guided lymphadenectomy is a promising new technique that combines a high feasibility rate with considerable ease of use. Regarding its diagnostic value, the key finding from this prospective series is that no metastatic nodes were found outside fluorescent lymph node stations. Further studies are needed to investigate whether this technique can help surgeons performing standard lymphadenectomy and selecting cases for D2 + lymphadenectomy.


Assuntos
Fluorescência , Verde de Indocianina , Excisão de Linfonodo/métodos , Neoplasias Gástricas/cirurgia , Cirurgia Assistida por Computador/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Viabilidade , Feminino , Humanos , Metástase Linfática/diagnóstico , Metástase Linfática/patologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Neoplasias Gástricas/patologia
19.
J Card Surg ; 35(10): 2847-2852, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32683723

RESUMO

BACKGROUND: With the limited number of available suitable donor hearts resulting in plateaued numbers of heart transplantations, short- and long-term mechanical circulatory support devices, including the implantation of total artificial hearts (TAHs) are modalities that are increasingly being used as treatment options for patients with end-stage heart failure. The superior vena cava syndrome has been described in this context in various disease processes. We report successful venoplasty for superior vena cava syndrome in a patient with a TAH. CASE PRESENTATION: A 65-year-old man with a history of nonischemic cardiomyopathy had received a left ventricular assist device, and then 2 years later, underwent orthotopic heart transplantation using the bicaval anastomosis technique. The postprocedural course was complicated by primary graft failure, resulting in the need for implantation of a TAH. About 5 months after TAH implantation, he started to develop complications such as volume retention, swelling of the upper extremities, and was diagnosed to have a superior vena cava syndrome. The patient underwent a successful venoplasty of his superior vena cava by interventional radiology with resolution of upper body edema, normalization of renal, and liver function. CONCLUSION: Potential fatal complications caused by catheter or wire entrapment in the right-sided mechanical valve of a TAH have been reported. We describe a safe method for the treatment of superior vena cava syndrome in patients with TAH.


Assuntos
Transplante de Coração/efeitos adversos , Transplante de Coração/métodos , Coração Artificial/efeitos adversos , Coração Auxiliar/efeitos adversos , Disfunção Primária do Enxerto/etiologia , Síndrome da Veia Cava Superior/etiologia , Síndrome da Veia Cava Superior/cirurgia , Procedimentos Cirúrgicos Vasculares/métodos , Veia Cava Superior/cirurgia , Idoso , Constrição Patológica/cirurgia , Humanos , Masculino , Radiografia Intervencionista , Cirurgia Assistida por Computador/métodos , Resultado do Tratamento , Veia Cava Superior/patologia
20.
J Card Surg ; 35(10): 2785-2793, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32697006

RESUMO

BACKGROUND: Fractional flow reserve (FFR) is a well-established method for the evaluation of coronary artery stenosis before percutaneous coronary intervention. However, whether FFR assessment should be routinely used before coronary artery bypass graft surgery (CABG) remains unclear. A meta-analysis of prospectively randomized controlled trials (PRCTs) was carried out to compare the outcomes of FFR-guided CABG vs coronary angiography (CAG)-guided CABG. METHOD: The meta-analysis adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Two PRCTs (the FARGO and GRAFFITI trials) were found and included reporting data on 269 patients with 6 and 12 month follow-up. Primary endpoints were rates of overall death, MACCE, target vessel revascularization, and spontaneous myocardial infarction (MI). Secondary endpoints were overall graft patency and patency of arterial and venous grafts. RESULTS: There were no significant differences between the FFR-guided and CAG-guided groups in the rates of overall death, MACCE, target vessel revascularization, spontaneous MI and graft patency. Meta-analysis of FARGO and GRAFFITI PRCTs showed that FFR-guided CABG and CAG-guided CABG produced similar clinical outcomes with similar graft patency rates up to a year postoperatively. CONCLUSION: Currently available PRCTs showes no sufficient evidence to support the use FFR in CABG.


Assuntos
Angiografia Coronária/métodos , Ponte de Artéria Coronária/métodos , Estenose Coronária/diagnóstico , Estenose Coronária/cirurgia , Reserva Fracionada de Fluxo Miocárdico , Resultados Negativos , Ensaios Clínicos Controlados Aleatórios como Assunto , Cirurgia Assistida por Computador/métodos , Angiografia Coronária/mortalidade , Ponte de Artéria Coronária/mortalidade , Estenose Coronária/diagnóstico por imagem , Estenose Coronária/mortalidade , Seguimentos , Humanos , Cirurgia Assistida por Computador/mortalidade , Taxa de Sobrevida , Resultado do Tratamento
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