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1.
World Neurosurg ; 161: e417-e426, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-35149250

RESUMO

BACKGROUND: Standalone single and multilevel lateral lumbar interbody fusion (LLIF) have been increasingly applied to treat degenerative spinal conditions in a less invasive fashion. Graft subsidence following LLIF is a known complication and has been associated with poor bone mineral density (BMD). Previous research has demonstrated the utility of computed tomography (CT) Hounsfield units (HUs) as a surrogate for BMD. In the present study, we investigated the relationship between the CT HUs and subsidence and reoperation after standalone and multilevel LLIF. METHODS: A prospectively maintained single-institution database was retrospectively reviewed for LLIF patients from 2017 to 2020, including single and multilevel standalone cases with and without supplemental posterior fixation. Data on demographics, graft parameters, BMD determined by dual-energy x-ray absorptiometry, preoperative mean segmental CT HUs, and postoperative subsidence and reoperation were collected. We used 36-in. standing radiographs to measure the preoperative global sagittal alignment and disc height and subsidence at last follow-up. Subsidence was classified using the Marchi grading system corresponding to disc height loss: grade 0, 0%-24%; grade I, 25%-49%; grade II, 50%-74%; and grade III, 75%-100%. RESULTS: A total of 89 LLIF patients had met the study criteria, with a mean follow-up of 19.9 ± 13.9 months. Of the 54 patients who had undergone single-level LLIF, the mean segmental HUs were 152.0 ± 8.7 for 39 patients with grade 0 subsidence, 136.7 ± 10.4 for 9 with grade I subsidence, 133.9 ± 23.1 for 3 with grade II subsidence, and 119.9 ± 30.9 for 3 with grade III subsidence (P = 0.032). Of the 96 instrumented levels in the 35 patients who had undergone multilevel LLIF, 85, 9, 1, and 1 level had had grade 0, grade I, grade II, and grade III subsidence, with no differences in the HU levels. On multivariate logistic regression, increased CT HU levels were independently associated with a decreased risk of reoperation after both single-level and multilevel LLIF (odds ratio, 0.98; 95% confidence interval, 0.97-0.99; P = 0.044; and odds ratio, 0.97; 95% confidence interval, 0.94-0.99; P = 0.017, respectively). Overall, the BMD determined using dual-energy x-ray absorptiometry was not associated with graft subsidence or reoperation. Using a receiver operating characteristic curve to separate the patients who had and had not required reoperation, the threshold HU level determined for single-level and multilevel LLIF was 131.4 (sensitivity, 0.62; specificity 0.65) and 131.0 (sensitivity, 0.67; specificity, 0.63), respectively. CONCLUSIONS: Lower CT HUs were independently associated with an increased risk of graft subsidence after single-level LLIF. In addition, lower CT HUs significantly increased the risk of reoperation after both single and multilevel LLIF with a critical threshold of 131 HUs. The determination of the preoperative CT HUs might provide a more robust gauge of local bone quality and the likelihood of graft subsidence requiring reoperation following LLIF than overall BMD.


Assuntos
Linfoma Folicular , Fusão Vertebral , Humanos , Reoperação , Estudos Retrospectivos , Cirurgia de Second-Look , Tomografia Computadorizada por Raios X
3.
Anticancer Res ; 42(2): 1001-1006, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-35093900

RESUMO

BACKGROUND/AIM: Formation of stoma during cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) for peritoneal carcinomatosis (PC) is often performed to reduce the risk of anastomotic leak. Subsequent stoma reversal provides a unique opportunity for second-look surgery to detect early peritoneal recurrence. Current surveillance methods often fail to detect disease early, including imaging and biochemical markers. In our study, we examined the safety and efficacy of second-look surgery for detection and treatment of disease recurrence. PATIENTS AND METHODS: We performed a retrospective analysis of prospectively collected data from 35 patients undergoing stoma reversal from 2015 to 2019 with negative pre-operative imaging. RESULTS: A total of 37% of cases had disease recurrence, with a median peritoneal cancer index of 4. Complete cytoreduction was achieved in all patients. The majority of patients (77%) suffered minor complications only. Median length of hospital stay was 12 days. CONCLUSION: Second-look surgery detects early disease recurrence and is a safe alternative to conventional screening methods post primary CRS/HIPEC for PC. Long-term, routine second-look surgery can improve survival.


Assuntos
Carcinoma/cirurgia , Procedimentos Cirúrgicos de Citorredução , Recidiva Local de Neoplasia/diagnóstico , Neoplasias Peritoneais/cirurgia , Cirurgia de Second-Look , Adulto , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Carcinoma/epidemiologia , Carcinoma/patologia , Carcinoma/terapia , Quimioterapia Adjuvante , Procedimentos Cirúrgicos de Citorredução/efeitos adversos , Procedimentos Cirúrgicos de Citorredução/estatística & dados numéricos , Feminino , História do Século XXI , Humanos , Quimioterapia Intraperitoneal Hipertérmica , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/epidemiologia , Recidiva Local de Neoplasia/cirurgia , Neoplasias Peritoneais/epidemiologia , Neoplasias Peritoneais/patologia , Neoplasias Peritoneais/terapia , Estudos Retrospectivos , Cirurgia de Second-Look/estatística & dados numéricos , Taxa de Sobrevida , Carga Tumoral
4.
Knee Surg Sports Traumatol Arthrosc ; 30(1): 208-218, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33492407

RESUMO

PURPOSE: The aim of this study was to compare clinical and second-look arthroscopic outcomes between bone marrow aspirate concentrate (BMAC) augmentation and human umbilical cord blood-derived mesenchymal stromal cell (hUCB-MSC) implantation in high tibial osteotomy (HTO) for medial compartmental knee osteoarthritis and identify the relationship between articular cartilage regeneration and HTO outcomes. METHODS: A total of 176 patients who underwent HTO combined with a BMAC or hUCB-MSC procedure for medial compartment osteoarthritis (Kellgren-Lawrence grade 3) between June 2014 and September 2018 with a minimum follow-up of 2 years were reviewed. After HTO, multiple holes were drilled at cartilage defect sites of the medial femoral condyle (MFC), and then prepared BMAC or hUCB-MSCs in combination with scaffolds were implanted in the MFC lesions. After propensity score matching based on sex, age, body mass index, and lesion size, 55 patients in each of the BMAC and hUCB-MSC groups were successfully matched. Second-look arthroscopic findings were assessed according to the International Cartilage Repair Society (ICRS) Cartilage Repair Assessment (CRA) grading system and Koshino staging system. Clinical outcomes were evaluated using the International Knee Documentation Committee (IKDC), Knee Injury and Osteoarthritis Outcome Score (KOOS), Short-Form 36 (SF-36), and Tegner activity scores. RESULTS: At a mean follow-up of 33 months, clinical outcomes including IKDC, KOOS, SF-36, and Tegner activity scores were significantly improved in both groups (p < 0.001); however, there were no differences between the two groups. Second-look arthroscopy showed better healing of regenerated cartilage in the hUCB-MSC group (Grade I [4 cases, 9.1%]; Grade II [30 cases, 68.2%]; Grade III [11 cases, 22.7%]) than in the BMAC group (Grade I [1 case, 2.7%]; Grade II [20 cases, 54.1%]; Grade III [11 cases, 29.7%]; Grade IV [5 cases, 13.5%]) according to the ICRS CRA grading system (p = 0.040). There was no significant intergroup difference in terms of defect coverage based on the Koshino staging system (p = 0.057). Moreover, ICRS CRA grades at second-look arthroscopy were significantly correlated with clinical outcomes (r = - 0.337; p = 0.002). CONCLUSION: There were no significant differences in the clinical outcomes between the two groups. Both treatments provided similar, reliable outcomes in terms of pain relief, functional scores, and quality of life at a mean follow-up of 33 months. However, hUCB-MSC implantation was more effective than BMAC augmentation for articular cartilage regeneration.


Assuntos
Cartilagem Articular , Células-Tronco Mesenquimais , Osteoartrite do Joelho , Artroscopia , Medula Óssea , Cartilagem Articular/cirurgia , Sangue Fetal , Humanos , Articulação do Joelho , Qualidade de Vida , Cirurgia de Second-Look , Resultado do Tratamento
5.
Knee Surg Sports Traumatol Arthrosc ; 30(5): 1605-1610, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-34279703

RESUMO

PURPOSE: Although there has been substantial improvement in ACL reconstructive surgery, graft failure remains a devastating complication for some patients. Revision procedures are inherently more complex and technically challenging. The purpose of this study is to determine the incidence of short-term complications after these procedures and to compare trends in operative length, relative valuation, and reimbursement after primary versus revision ACL reconstruction. METHODS: Primary and revision arthroscopic ACL reconstruction cases were identified on the American College of Surgeons' NSQIP database using Current Procedural Terminology (CPT) and International Classification of Diseases (ICD) codes between January 1, 2012 and December 31, 2017. Demographics, patient variables, and surgical variables were compared between primary and revision groups using Chi-squared tests. Logistic regression was used to identify independent risk factors for revision ACL reconstruction. Various 30-day outcome measures were compared between the primary and revision ACL reconstruction groups. Various measures of valuation-including total relative value units (RVU) and reimbursement per minute-were calculated and compared between the two groups. RESULTS: A total of 8292 patients-8135 primary and 157 revision procedures-were included in the final cohort. Higher ASA scores were associated with revision ACL reconstructions. Patients undergoing revision procedures were less likely to have an ASA score of 1 (p < 0.001) and more likely to have an ASA score of 2 (p = 0.004) or 3 (p = 0.020). Revision ACL reconstruction was associated with higher rates of poor 30-day outcome measures, including unplanned readmission (p = 0.029), reoperation (p = 0.012), return to the OR (p = 0.012), and surgical complications (p = 0.021). The total RVUs and reimbursement for revision procedures were significantly greater than those for primary procedures (p < 0.001). However, when accounting for operative time, the RVU/minute and reimbursement/minute were similar between the two groups (n.s.). CONCLUSIONS: Relative to primary ACL reconstruction, revision ACL procedures are associated with worse short-term outcomes-including unplanned readmission, reoperation, return to the OR, and surgical complications. A greater ASA score was independently predictive of revision ACL surgery. The current RVU system undervalues revision ACL procedures, considering the increased operative time and complexity of such procedures. LEVEL OF EVIDENCE: Level III.


Assuntos
Lesões do Ligamento Cruzado Anterior , Readmissão do Paciente , Lesões do Ligamento Cruzado Anterior/cirurgia , Humanos , Incidência , Duração da Cirurgia , Reoperação/métodos , Cirurgia de Second-Look
7.
Bone Joint J ; 103-B(11): 1686-1694, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34719267

RESUMO

AIMS: To determine the relationship between articular cartilage status and clinical outcomes after medial opening-wedge high tibial osteotomy (MOHTO) for medial compartmental knee osteoarthritis at intermediate follow-up. METHODS: We reviewed 155 patients (155 knees) who underwent MOHTO from January 2008 to December 2016 followed by second-look arthroscopy with a mean 5.3-year follow-up (2.0 to 11.7). Arthroscopic findings were assessed according to the International Cartilage Repair Society (ICRS) Cartilage Repair Assessment (CRA) grading system. Patients were divided into two groups based on the presence of normal or nearly normal quality cartilage in the medial femoral condyle: good (second-look arthroscopic) status (ICRS grade I or II; n = 70), and poor (second-look arthroscopic) status (ICRS grade III or IV; n = 85) groups at the time of second-look arthroscopy. Clinical outcomes were assessed using the International Knee Documentation Committee (IKDC) score, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and 36-Item Short Form survey. RESULTS: Significant improvements in all clinical outcome categories were found between the preoperative and second-look arthroscopic assessments in both groups (p < 0.001). At the latest follow-up, the mean IKDC and WOMAC scores in the good status group further improved compared with those at the time of second-look arthroscopic surgery (p < 0.001), which was not shown in the poor status group. The mean IKDC (good status, 72.8 (SD 12.5); poor status, 64.7 (SD 12.1); p = 0.002) and mean WOMAC scores (good status, 15.7 (SD 10.8); poor status, 21.8 (SD 13.6); p = 0.004) significantly differed between both groups at the latest follow-up. Moreover, significant correlations were observed between ICRS CRA grades and IKDC scores (negative correlation; p < 0.001) and WOMAC scores (positive correlation; p < 0.001) at the latest follow-up. Good cartilage status was found more frequently in knees with the desired range of 2° to 6° valgus correction than in those with corrections outside this range (p = 0.019). CONCLUSION: Second-look arthroscopic cartilage status correlated with clinical outcomes after MOHTO at intermediate-term follow-up, despite the relatively small clinical differences between groups. Cite this article: Bone Joint J 2021;103-B(11):1686-1694.


Assuntos
Artroscopia , Cartilagem Articular/patologia , Osteoartrite do Joelho/cirurgia , Osteotomia/métodos , Cirurgia de Second-Look/métodos , Tíbia/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento
8.
PLoS One ; 16(9): e0257315, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34520482

RESUMO

PURPOSE: The present study evaluated changes in bone tracer uptake (BTU) after medial open-wedge high tibial osteotomy (MOWHTO) and determined whether postoperative BTU correlates with clinical symptoms, radiologic parameters, or cartilage regeneration following MOWHTO. METHODS: A total of 210 knees underwent MOWHTO for medial compartmental osteoarthritis (OA) were enrolled in this study. Mean follow-up period was 42.7 months. We assessed BTU for the medial compartment of the knee before MOWHTO and at the time of plate removal. Radiologic parameters included Kellgren-Lawrence (K-L) grade and Hip-Knee-Ankle angle (HKAA). Clinical evaluation included American Knee Society (AKS) score and cartilage status was graded at the time of MOWHTO and second-look arthroscopy according to the International Cartilage Repair Society (ICRS) grading system and articular cartilage regeneration stage. Statistical analysis performed to assess the relationships among postoperative BTU of the medial compartment, radiologic parameters, arthroscopic changes and clinical outcomes. RESULTS: BTU of medial femoral condyle and tibial plateau were significantly decreased at 2 years after MOWHTO (p<0.001). AKS scores and arthroscopic cartilage status were also significantly improved following MOWHTO. BMI and postoperative HKAA showed significant correlations with postoperative changes of BTU in uni- and multi-variable analysis. Meanwhile, postoperative changes of BTU did not show significant correlation with clinical outcomes or cartilage regeneration following MOWHTO. CONCLUSION: Lower BMI and postoperative valgus alignment were significant predictor for postoperative BTU decrease of the medial compartment following MOWHTO. However, postoperative changes of BTU did not reflect cartilage regeneration or clinical outcomes until the midterm follow-up.


Assuntos
Osteotomia/métodos , Cintilografia/métodos , Tíbia/cirurgia , Artroscopia , Cartilagem Articular , Feminino , Fêmur , Seguimentos , Humanos , Articulação do Joelho , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Cirurgia de Second-Look , Resultado do Tratamento
9.
Acta Med Okayama ; 75(4): 423-430, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34511608

RESUMO

The treatment of medial meniscus posterior root tears (MMPRTs) has evolved to include a variety of repair strategies. This study investigated the location of the articular cartilage degeneration during second-look arthroscopy after transtibial pullout repair with a modified Mason-Allen suture using FasT-Fix (F-MMA) in 22 patients with MMPRTs. Second-look arthroscopy was performed approximately 1 year postoperatively to eval-uate the healing status of the medial meniscus (MM). Articular cartilage degeneration was assessed using the International Cartilage Repair Society grade at primary surgery and again at second-look arthroscopy. Articular surfaces of the medial/lateral femoral condyles, the medial/lateral tibial plateaus, the patella and the trochlea were divided into several subcompartments (MF 1-9, LF 1-9, MT 1-5, LT 1-5, P 1-9, T 1-3). Clinical evaluations used the Japanese Knee Injury and Osteoarthritis Outcome, Lysholm, and International Knee Documentation Committee scores. Second-look arthroscopic findings showed complete healing of the MM posterior root in all patients. Significant differences between pullout repair and second-look arthroscopy were observed for MF 2 and 4, LF 7, and P 7. All clinical outcomes were improved. Our results indicate that this technique improves clinical outcomes postoperatively and may prevent the progression of cartilage degenera-tion on the loading surface of the medial knee compartment.


Assuntos
Artroscopia/métodos , Cirurgia de Second-Look/métodos , Técnicas de Sutura , Lesões do Menisco Tibial/cirurgia , Idoso , Cartilagem Articular/cirurgia , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Lesões do Menisco Tibial/diagnóstico por imagem
10.
BMC Cancer ; 21(1): 946, 2021 Aug 23.
Artigo em Inglês | MEDLINE | ID: mdl-34425774

RESUMO

BACKGROUND: In patients with average risk of bleeding, second-look endoscopy does not reportedly reduce bleeding after gastric endoscopic submucosal dissection. However, effectiveness of second-look endoscopy for patients with a high risk of bleeding, such as those who are taking antithrombotic agents, is unclear. Hence, this study aims to clarify the effectiveness of second-look endoscopy for patients with antithrombotic therapy. METHODS: We studied 142 consecutive patients with 173 gastric epithelial neoplasms who were routinely taking antithrombotic agents and were treated by endoscopic submucosal dissection at Tonan Hospital between November 2013 and December 2019. They were classified into two groups: those with second-look endoscopy (SLE group, 69 patients with 85 lesions) and those without second-look endoscopy (non-SLE group, 73 patients with 88 lesions). The incidence of post-endoscopic submucosal dissection bleeding was compared between the SLE and non-SLE groups. RESULTS: There were no statistical differences in the rate of patients undergoing single antiplatelet therapy, single anticoagulant therapy, and multiple therapy between the SLE and non-SLE groups (SLE group vs. non-SLE group; 32 [46.4%], 16 [23.2%], and 21 [30.4%] patients vs. 37 [50.7%], 20 [27.4%], and 16 [21.9%] patients, respectively; p = 0.50). Post-endoscopic submucosal dissection bleeding incidence was 21.7% (15/69) and 21.9% (16/73) in the SLE and non-SLE groups, respectively, and did not significantly differ between the two groups (p = 0.98). CONCLUSIONS: For patients taking antithrombotic agents, the incidence of post-endoscopic submucosal dissection bleeding was not reduced by second-look endoscopy.


Assuntos
Ressecção Endoscópica de Mucosa/efeitos adversos , Fibrinolíticos/efeitos adversos , Gastroscopia/efeitos adversos , Neoplasias Epiteliais e Glandulares/terapia , Hemorragia Pós-Operatória/prevenção & controle , Cirurgia de Second-Look/métodos , Neoplasias Gástricas/terapia , Idoso , Estudos de Casos e Controles , Terapia Combinada , Feminino , Seguimentos , Humanos , Masculino , Neoplasias Epiteliais e Glandulares/patologia , Hemorragia Pós-Operatória/diagnóstico , Hemorragia Pós-Operatória/etiologia , Prognóstico , Neoplasias Gástricas/patologia
12.
BMC Musculoskelet Disord ; 22(1): 623, 2021 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-34266424

RESUMO

BACKGROUND: Medial meniscal posterior root tears (MMPRTs) are frequently associated with medial compartment osteoarthritis, leading to loss of meniscal hoop tension. This study aimed to evaluate the efficacy of concurrent MMPRT repair during high tibial osteotomy (HTO) compared to HTO alone in patients with medial osteoarthritis and MMPRTs. METHODS: The MEDLINE/PubMed, EMBASE, and Cochrane Library databases were searched for studies reporting on concurrent MMPRT repair during HTO. Pre- and postoperative data were pooled to investigate the treatment effects of concurrent MMPRT repair during HTO, and compare postoperative clinical, radiological, and arthroscopic outcomes including cartilage status and healing event rates according to the arthroscopic classification of MMPRT healing (complete, partial [lax or scar tissue], or failed healing) between HTO patients with and without concurrent MMPRT repair. The random-effect model was used to pool the standardized mean differences, odds ratios (ORs), 95% confidence intervals (CIs), and event rates. RESULTS: Seven patient subgroups in six articles divided according to meniscal repair techniques were included in the final analysis. Concurrent MMPRT repair during HTO significantly improved the Lysholm score, while no intergroup differences were observed in the postoperative Lysholm and WOMAC scores, as well as radiological and arthroscopic outcomes. Those who underwent concurrent MMPRT repair showed a higher rate of complete meniscal healing (OR: 4.792, 95% CI, 1.95-11.79), with a pooled rate of complete meniscal healing of 0.327 (95% CI, 0.19-0.46). CONCLUSION: Concurrent MMPRT repair during HTO for medial osteoarthritis with MMPRTs has little benefits on the clinical, radiological, and arthroscopic outcomes during short-term follow-up. Further accumulation of evidence is needed for long-term effects.


Assuntos
Osteoartrite do Joelho , Lesões do Menisco Tibial , Artroscopia/efeitos adversos , Humanos , Meniscos Tibiais , Osteoartrite do Joelho/diagnóstico por imagem , Osteoartrite do Joelho/cirurgia , Osteotomia , Cirurgia de Second-Look , Lesões do Menisco Tibial/diagnóstico por imagem , Lesões do Menisco Tibial/cirurgia
14.
BMC Cardiovasc Disord ; 21(1): 348, 2021 07 22.
Artigo em Inglês | MEDLINE | ID: mdl-34294038

RESUMO

BACKGROUND: There is a paucity of published literature describing electrical storm after the correction of uncomplicated atrial septal defect (ASD) in an adult. CASE PRESENTATION: We present a 49-year-old woman with a congenital ASD combined with mild tricuspid regurgitation who denied any history of arrhythmia or other medical history. She suffered from electrical storm (≥ 3 episodes of ventricular tachycardias or ventricular fibrillations) in the early stage after ASD repair with combined tricuspid valvuloplasty. During electrical storm, her electrolytes were within normal ranges and no ischemic electrocardiographic changes were detected, which suggested that retained air embolism or acute coronary thrombosis were unlikely. Additionally, echocardiographic findings and her central venous pressure (5-8 mmHg during the interval between attacks) failed to support the diagnosis of pericardial tamponade. After a thorough discussion, the surgeons conducted an emergent re-exploration and repeated closure of the ASD with combined DeVega's annuloplasty. Eventually, the patient recovered uneventfully, without reoccurring arrhythmias during follow-up. Although we fail to determine the definite cause, we speculate that the causes probably are iatrogenic injury of the conduction system due to a rare anatomic variation, poor intraoperative protection, latent coronary distortion during tricuspid valvuloplasty, or idiopathic or secondary abnormalities of the conduction system. CONCLUSIONS: For most surgeons, performing re-exploration without a known etiology is a difficult decision to make. This case illustrates that re-exploration could be an option when electrical storm occurs in the early stage postoperatively. Nevertheless, surgeons should assess the benefit-risk ratio when taking this unconventional measure.


Assuntos
Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Frequência Cardíaca , Comunicação Interatrial/cirurgia , Taquicardia Ventricular/etiologia , Fibrilação Ventricular/etiologia , Feminino , Comunicação Interatrial/diagnóstico por imagem , Comunicação Interatrial/fisiopatologia , Humanos , Pessoa de Meia-Idade , Recidiva , Reoperação , Fatores de Risco , Cirurgia de Second-Look , Taquicardia Ventricular/diagnóstico , Taquicardia Ventricular/fisiopatologia , Taquicardia Ventricular/prevenção & controle , Resultado do Tratamento , Fibrilação Ventricular/diagnóstico , Fibrilação Ventricular/fisiopatologia , Fibrilação Ventricular/prevenção & controle
15.
World J Emerg Surg ; 16(1): 32, 2021 06 10.
Artigo em Inglês | MEDLINE | ID: mdl-34112205

RESUMO

BACKGROUND: Selection of patients for open abdomen (OA) treatment in severe acute pancreatitis (SAP) is challenging. Treatment related morbidity and risk of adverse events are high; however, refractory abdominal compartment syndrome (ACS) is potentially lethal. Factors influencing the decision to initiate OA treatment are clinically important. We aimed to study these factors to help understand what influences the selection of patients for OA treatment in SAP. METHODS: A single center study of patients with SAP that underwent OA treatment compared with conservatively treated matched controls. RESULTS: Within study period, 47 patients treated with OA were matched in a 1:1 fashion with conservatively treated control patients. Urinary output under 20 ml/h (OR 5.0 95% CI 1.8-13.7) and ACS (OR 4.6 95% CI 1.4-15.2) independently associated with OA treatment. Patients with OA treatment had significantly more often visceral ischemia (34%) than controls (6%), P = 0.002. Mortality among patients with visceral ischemia was 63%. Clinically meaningful parameters predicting developing ischemia were not found. OA treatment associated with higher overall 90-day mortality rate (43% vs 17%, P = 0.012) and increased need for necrosectomy (55% vs 21%, P = 0.001). Delayed primary fascial closure was achieved in 33 (97%) patients that survived past OA treatment. CONCLUSION: Decreased urine output and ACS were independently associated with the choice of OA treatment in patients with SAP. Underlying visceral ischemia was strikingly common in patients undergoing OA treatment, but predicting ischemia in these patients seems difficult.


Assuntos
Técnicas de Fechamento de Ferimentos Abdominais , Pancreatite/cirurgia , Seleção de Pacientes , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Tratamento Conservador , Fasciotomia , Feminino , Humanos , Unidades de Terapia Intensiva/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Tratamento de Ferimentos com Pressão Negativa , Complicações Pós-Operatórias , Fatores de Risco , Cirurgia de Second-Look , Transplante de Pele , Telas Cirúrgicas
16.
J Bone Joint Surg Am ; 103(19): 1844-1851, 2021 10 06.
Artigo em Inglês | MEDLINE | ID: mdl-34138774

RESUMO

BACKGROUND: The effect of supramalleolar osteotomy without a bone marrow-stimulating procedure for articular cartilage regeneration in the ankle joint remains unknown. We investigated whether supramalleolar osteotomy yielded favorable clinical and radiographic outcomes. We also evaluated the joint tissue appearance after supramalleolar osteotomy without a bone marrow-stimulating procedure with use of second-look arthroscopy and its correlation with the outcome. METHODS: Twenty-nine ankles were retrospectively reviewed at a mean of 2.9 years after supramalleolar osteotomy without a bone marrow-stimulating procedure. All 29 ankles had had second-look arthroscopy to evaluate tibiotalar joint tissue regeneration at a minimum of 1 year postoperatively. A visual analog scale (VAS) pain score, the American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score, and patient satisfaction were used for functional evaluations. Ankle osteoarthritis was classified with the Takakura staging system, and the tibial anterior surface (TAS) angle and tibial lateral surface (TLS) angle were measured on radiographs. RESULTS: The mean VAS and AOFAS scores improved from 6.2 (95% confidence interval [CI], 5.7 to 6.8) preoperatively to 1.5 (95% CI, 0.9 to 2.1) postoperatively and from 60.5 (95% CI, 54.9 to 66.1) preoperatively to 88.3 (95% CI, 84.3 to 92.3) postoperatively, respectively. Patient satisfaction with the outcome of the procedure was classified as very satisfied or satisfied for 27 ankles (93.1%). Sixteen of 21 ankles that were classified as Takakura stage-IIIa and 2 of 3 ankles that were classified as stage-IIIb preoperatively improved to stage II postoperatively. The mean TAS and TLS angles significantly improved from 83.5° (95% CI, 82.2° to 84.7°) and 77.0° (95% CI, 75.4° to 78.7°) preoperatively to 94.2° (95% CI, 92.7° to 95.7°) and 80.4° (95% CI, 78.3° to 82.5°) postoperatively, respectively. On second-look arthroscopy, 26 ankles (89.7%) showed tissue regeneration of the medial compartment of the ankle joint and no patient showed cartilage deterioration. CONCLUSIONS: Medial tibiotalar tissue regeneration was identified in most patients with medial compartment ankle osteoarthritis following supramalleolar osteotomy without a bone marrow-stimulating procedure. The procedure results in satisfactory clinical and radiographic outcomes with high patient satisfaction. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.


Assuntos
Articulação do Tornozelo/cirurgia , Artroscopia , Cartilagem Articular/cirurgia , Osteoartrite/cirurgia , Osteotomia/métodos , Adulto , Idoso , Medula Óssea/efeitos dos fármacos , Cartilagem Articular/fisiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Regeneração , Estudos Retrospectivos , Cirurgia de Second-Look , Resultado do Tratamento
17.
Knee ; 29: 411-417, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33714928

RESUMO

BACKGROUND: The purpose of this study was to examine the status of cartilage repair by second-look arthroscopy following double-level osteotomy (DLO) performed for osteoarthritic knees with severe varus deformity. METHODS: Forty-seven consecutive knees in 33 patients who underwent DLO were included in the study. The surgical technique used was a minimally invasive DLO procedure combining lateral closed-wedge distal femoral and medial open-wedge high tibial osteotomies. In the second-look arthroscopic evaluation, the following grading system proposed by Koshino was adopted: Stage A, no repair; stage B, pink fibrous tissue with or without partial coverage with white fibrocartilage; and stage C, total coverage with cartilage. The findings corresponding to stage B or C were considered as repaired. Arthroscopic assessment was performed for each compartment. Clinical outcomes were evaluated using the validated outcome measures. RESULTS: The mean age at surgery was 62.8 ± 6.2 years (range: 45-75 years), and the mean time period from DLO to second-look arthroscopy was 17.1 ± 5.0 months (range: 12-33 months). Cartilage repair to some extent was identified in over 90% of the medial femoral and tibial condyles, and 12.8% of the patellar facet. As for clinical scores, both Knee Injury and Osteoarthritis Outcome Score (KOOS) and the International Knee Documentation Committee Subjective Knee Form (IKDC) subjective scores significantly improved after surgery (P < 0.01). CONCLUSIONS: Evaluation of the present study subjects showed that DLO could induce cartilage repair in the majority of the affected femoral and tibial articular surfaces with significant clinical improvement. In the patellar facet, however, cartilage repair could be identified in only 12.8% of cases.


Assuntos
Artroscopia , Cartilagem Articular/patologia , Cartilagem Articular/cirurgia , Osteoartrite do Joelho/cirurgia , Cirurgia de Second-Look , Idoso , Feminino , Humanos , Deformidades Articulares Adquiridas/cirurgia , Articulação do Joelho/cirurgia , Masculino , Pessoa de Meia-Idade , Osteotomia/métodos
18.
Scand J Urol ; 55(2): 108-115, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33678124

RESUMO

OBJECTIVE: To assess the value of second-look resection (SLR) in stage T1 bladder cancer (BCa) with respect to progression-free survival (PFS), and also the secondary outcomes recurrence-free survival (RFS), bladder-cancer-specific survival (CSS), and cystectomy-free survival (CFS). PATIENTS AND METHODS: The study included 2456 patients diagnosed with stage T1 BCa 2004-2009 with 5-yr follow-up registration in the nationwide Bladder Cancer Data Base Sweden (BladderBaSe). PFS, RFS, CSS, and CFS were evaluated in stage T1 BCa patients with or without routine SLR, using univariate and multivariable Cox regression with adjustment for multiple confounders (age, gender, tumour grade, intravesical treatment, hospital volume, comorbidity, and educational level). RESULTS: SLR was performed in 642 (26%) individuals, and more frequently on patients who were aged < 75 yr, had grade 3 tumours, and had less comorbidity. There was no association between SLR and PFS (hazard ratio [HR] 1.1, confidence interval [CI] 0.85-1.3), RFS (HR 1.0, CI 0.90-1.2), CFS (HR 1.2, CI 0.95-1.5) or CSS (HR 1.1, CI 0.89-1.4). CONCLUSIONS: We found similar survival outcomes in patients with and patients without SLR, but our study is likely affected by selection mechanisms. A randomised study defining the role of SLR in stage T1 BCa would be highly relevant to guide current praxis.


Assuntos
Cirurgia de Second-Look , Neoplasias da Bexiga Urinária , Administração Intravesical , Idoso , Idoso de 80 Anos ou mais , Cistectomia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Vigilância da População , Cirurgia de Second-Look/estatística & dados numéricos , Análise de Sobrevida , Neoplasias da Bexiga Urinária/epidemiologia , Neoplasias da Bexiga Urinária/mortalidade , Neoplasias da Bexiga Urinária/patologia , Neoplasias da Bexiga Urinária/cirurgia
19.
Arthroscopy ; 37(8): 2521-2530, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-33621649

RESUMO

PURPOSE: The purpose of this study was to compare the outcome of cartilage regeneration between bone marrow aspirate concentrate (BMAC) augmentation and allogeneic human umbilical cord blood-derived mesenchymal stem cell (hUCB-MSCs) transplantation in high tibial osteotomy (HTO) with microfracture (MFX) for medial unicompartmental osteoarthritis (OA) of the knee in the young and active patient. METHODS: Between January 2015 and December 2019, the patients who underwent HTO and arthroscopy with MFX combined with BMAC or allogeneic hUCB-MSCs procedure for medial unicompartmental OA with kissing lesion, which was shown full-thickness cartilage defect (≥ International Cartilage Repair Society [ICRS] grade 3B) in medial femoral cartilage and medial tibial cartilage, were include in this study. Retrospectively we compared clinical outcomes, including Hospital for Special Surgery score, Knee Society Score (KSS) pain and function, and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score between BMAC and hUCB-MSCs group at minimum of 1-year follow-up. Also, second-look arthroscopy was performed simultaneously with removal of the plate after complete bone union. Cartilage regeneration was graded by the ICRS grading system at second-look arthroscopy. Radiological measurement including hip-knee-ankle (HKA) angle, posterior tibial slope angle, and correction angle were assessed. RESULTS: Of 150 cases that underwent HTO with MFX combined with BMAC or allogeneic hUCB-MSCs procedure for medial unicompartmental OA, 123 cases underwent plate removal and second-look arthroscopy after a minimum of 1 year after the HTO surgery. Seventy-four cases were kissing lesion in medial femoral cartilage and medial tibial cartilage during initial HTO surgery. Finally, the BMAC group composed of 42 cases and hUCB-MSCs group composed of 32 cases were retrospectively identified in patients who had kissing lesions and second-look arthroscopies with a minimum of 1 year of follow-up. At the final follow-up of mean 18.7 months (standard deviation = 4.6 months), clinical outcomes in both groups had improved. However, there were no significant differences between the IKDC, WOMAC, or KSS pain and function scores in the 2 groups (P > .05). At second-look arthroscopy, the ICRS grade was significantly better in the hUCB-MSC group than in the BMAC group in both medial femoral and medial tibial cartilage (P = .001 for both). The average ICRS grade of the BMAC group improved from 3.9 before surgery to 2.8 after surgery. The average ICRS grade of the hUBC-MSC group improved from 3.9 before surgery to 2.0 after surgery. Radiological findings comparing postoperative HKA angle, posterior tibial slope angle, and correction angle showed no significant differences between the groups (P > .05). Therefore it was found that the postoperative correction amount did not affect the postoperative cartilage regeneration results. CONCLUSIONS: We found that the hUCB-MSC procedure was more effective than the BMAC procedure for cartilage regeneration in medial unicompartmental knee OA even though the clinical outcomes improved regardless of which treatment was administered. LEVEL OF EVIDENCE: Level III, retrospective comparative study.


Assuntos
Cartilagem Articular , Células-Tronco Mesenquimais , Osteoartrite do Joelho , Artroscopia , Medula Óssea , Cartilagem Articular/cirurgia , Sangue Fetal , Humanos , Articulação do Joelho , Osteoartrite do Joelho/cirurgia , Osteotomia , Estudos Retrospectivos , Cirurgia de Second-Look , Resultado do Tratamento
20.
Neurosurgery ; 88(6): 1088-1094, 2021 05 13.
Artigo em Inglês | MEDLINE | ID: mdl-33575788

RESUMO

BACKGROUND: Posterior cervical decompression and fusion (PCF) is a common procedure used to treat various cervical spine pathologies, but the 90-d outcomes following PCF surgery continue to be incompletely defined. OBJECTIVE: To identify risk factors associated with 90-d readmission and reoperation following PCF surgery. METHODS: Adults undergoing PCF from 2012 to 2020 were identified. Demographic and radiographic data, surgical characteristics, and 90-d outcomes were collected. Univariate analysis was performed using Student's t-test, chi square, and Fisher exact tests as appropriate. Multivariable logistic regression models with lasso penalty were used to analyze various risk factors. RESULTS: A total of 259 patients were included. The 90-d readmission and reoperation rates were 9.3% and 4.6%, respectively. The most common reason for readmission was surgical site infection (SSI) (33.3%) followed by new neurological deficits (16.7%). Patients who smoked tobacco had 3-fold greater odds of readmission compared to nonsmokers (odds ratio [OR]: 3.48; 95% CI 1.87-6.67; P = .0001). Likewise, the most common reason for reoperation was SSI (33.3%) followed by seroma and implant failure (25.0% each). Smoking was also an independent risk factor for reoperation, associated with nearly 4-fold greater odds of return to the operating room (OR: 3.53; 95% CI 1.53-8.57; P = .003). CONCLUSION: Smoking is a significant predictor of 90-d readmission and reoperation in patients undergoing PCF surgery. Smoking cessation should be strongly considered preoperatively in elective PCF cases to minimize the risk of 90-d readmission and reoperation.


Assuntos
Vértebras Cervicais/cirurgia , Descompressão Cirúrgica/estatística & dados numéricos , Readmissão do Paciente/estatística & dados numéricos , Reoperação/estatística & dados numéricos , Fumar/epidemiologia , Fusão Vertebral/estatística & dados numéricos , Adulto , Idoso , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Cirurgia de Second-Look , Infecção da Ferida Cirúrgica/etiologia
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