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1.
Ann Otol Rhinol Laryngol ; 129(1): 12-17, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31394908

RESUMO

OBJECTIVE: To define a new anatomic relationship in pediatric sinus surgery, assessing the maxillary roof as a constant safe landmark to avoid skull base injury in the pediatric population. STUDY DESIGN: Retrospective analysis. SETTING: Tertiary care children hospital. SUBJECTS AND METHODS: A retrospective analysis was performed of all computed tomography scans of the sinuses and facial bones at the emergency department of a tertiary children's hospital over the course of a year. Radiographic measurements included the lowest cribriform plate and planum sphenoidale (PS) heights, or posterior skull base when not yet pneumatized, as well as the highest maxillary roof height. The nasal floor was used for reference. Statistics were performed via Shapiro-Wilks test with a P-value of .05 indicating statistical significance. RESULTS: Three hundred and seven unique scans were reviewed (38.9% female; n = 122; P = .58). Age stratification was based on previously described sinus growth patterns. In all patients, the maximum maxillary height was inferior to the lowest measured cribriform lamella and PS (P < .001; CI, 98.5%-99%). Inter- and intrarater reliability and accuracy were verified through blinded review and re-review (ρ = .99 and .98 respectively, P ≤ .001). The validity of sole coronal measurements due to incomplete sagittal reformatting was also confirmed (ρ = 1.00, P ≤ .001). CONCLUSION: Despite variation in sinus growth and development in children, the current study demonstrated the validity of the maxillary sinus roof as a constant safe landmark in the pediatric population, offering a novel anatomic relationship for teaching safety in performing pediatric sinus surgery. LEVEL OF EVIDENCE: 4.


Assuntos
Pontos de Referência Anatômicos , Endoscopia/métodos , Seio Maxilar/diagnóstico por imagem , Procedimentos Cirúrgicos Otorrinolaringológicos/métodos , Base do Crânio/diagnóstico por imagem , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Seio Maxilar/cirurgia , Reprodutibilidade dos Testes , Estudos Retrospectivos , Base do Crânio/cirurgia , Tomografia Computadorizada por Raios X , Adulto Jovem
2.
Medicine (Baltimore) ; 98(50): e16627, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31852061

RESUMO

BACKGROUND: The purpose of our study is to compare the outcomes and effectiveness of MED vs OLD for lumbar disc herniation. OBJECTIVES: To identify the functional outcomes in terms of ODI score, VAS score complications in terms of intraoperative blood loss, use of general anesthesia, and morbidity in terms of total hospital stay between MED and OLD. METHODS: In our randomized prospective study we analyzed 60 patients with clinical signs and symptoms with 2 weeks of failed conservative treatment plus MRI or CT scan findings of lumbar disc herniation who underwent MED and OLD. The study was undertaken from November 2017 to January 2019 at Guangzhou Medical University of Second Affiliated Hospital, department of orthopedic surgery in spinal Unit, Guangzhou, China. Patients were divided into 2 groups i.e. who underwent MED group and the OLD group then we compared the preoperative and postoperative ODI and VAS score, duration of total hospital stay, intraoperative blood loss, and operation time. RESULTS: We evaluated 60 patients. Among them, 30 underwent MED (15 female and 15 male) and 30 underwent OLD 14 male 16 female. Surgical and anesthesia time was significantly shorter, blood loss and hospital stay were significantly reduced in patients having MED than OLD (<0.005). The improvement in the ODI in both groups was clinically significant and statistically (P < .005) at postoperative 1st day (with greater improvement in the MED group), at 6 weeks (P > .005), month 6 (>0.005) statistically no significant. The clinical improvement was similar in both groups. VAS and ODI scores improved significantly postoperatively in both groups. However, the MED group was superior to the OLD group with less time in bed, shorter operation time, less blood loss which is clinically and statistically significant (P < .05). CONCLUSIONS: The standard surgical treatment of lumbar disc herniation has been open discectomy but there has been a trend towards minimally invasive procedures. MED for lumbar spine disc herniation is a well-known but developing field, which is increasingly spreading in the last few years. The success rate of MED is about approximately 90%. Both methods are equally effective in relieving radicular pain. MED was superior in terms of total hospital stay, morbidity, and earlier return to work and anesthetic exposure, blood loss, intra-op time comparing to OLD. MED is a safe and effective alternative to conventional OLD for patients with lumbar disc herniation.


Assuntos
Discotomia/métodos , Endoscopia/métodos , Deslocamento do Disco Intervertebral/cirurgia , Vértebras Lombares/cirurgia , Microcirurgia/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Deslocamento do Disco Intervertebral/diagnóstico , Vértebras Lombares/diagnóstico por imagem , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Adulto Jovem
3.
Medicine (Baltimore) ; 98(50): e18231, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31852084

RESUMO

Surgical decompression and antibiotic therapy are the treatments of choice for patients with spinal epidural abscess (SEA). Surgical treatment included decompression, evacuation of abscess, and debridement. Recently, minimal invasive surgery has been introduced more widely, and biportal endoscopic spinal surgery have shown satisfactory clinical outcomes compared with traditional open surgery. The purpose of this study was to evaluate the efficacy of biportal endoscopic spinal surgery for the treatment of SEA .From January 2016 to June 2017, 13 patients who underwent biportal endoscopic spinal surgery under the diagnosis of SEA were retrospectively enrolled in this study. The surgical indications of the enrolled patients included SEA with or without early stage spondylodiscitis who had neurological symptoms. Periopertaive data and clinical outcomes were assessed by regular serologic testing, imaging studies, physical examination, visual analog scale, Oswestry Disability Index and modified Macnab criteria.Offending pathogens were identified in seven (54%) of 13 biopsy specimens. Appropriate intravenous antibiotics for the identified pathogens isolated from infected tissue biopsy cultures were administrated to patients for at least 30 days. All patients reported satisfactory relief of pain and neurological symptoms after surgery. No surgery-related complications and recurrences were found after 2 years follow up.Biportal endoscopic spinal surgery may be an effective alternative to traditional open surgical decompression for the treatment of SEA.


Assuntos
Desbridamento/métodos , Descompressão Cirúrgica/métodos , Endoscopia/métodos , Abscesso Epidural/cirurgia , Procedimentos Neurocirúrgicos/métodos , Adulto , Idoso , Biópsia , Abscesso Epidural/diagnóstico , Feminino , Seguimentos , Humanos , Vértebras Lombares , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
4.
Medicine (Baltimore) ; 98(50): e18283, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31852103

RESUMO

RATIONALE: Cochlear implantation (CI) in CHARGE syndrome is technically challenging because of the anatomical anomalies. This case aims to report a successful case of CI in CHARGE syndrome by using the modified transcanal approach with external auditory canal (EAC) obliteration. PATIENT CONCERNS: The 3-year-old girl presented at the outpatient department with bilateral hearing loss and nasal obstruction since birth. DIAGNOSIS: The patient had bilateral profound sensorineural hearing loss, patent ductus arteriosus, atresia of the choanae, middle and inner ear anomalies, and growth retardation, fulfilling the criteria for typical CHARGE syndrome. High resolution temporal bone computed tomography scan revealed a poorly developed mastoid cavity, cochlear dysplasia, hypoplastic semicircular canals, ossicular chain malformation, and sigmoid sinus engorgement. Magnetic resonance imaging revealed a narrow internal auditory canal and a hypoplastic cochlear nerve. INTERVENTIONS: Modified transcanal approach with external auditory canal obliteration OUTCOMES:: CI was successfully done and there are no intraoperative or postoperative complications occurred after 1 year of follow up. LESSONS: The modified transcanal approach is a reasonable and safer option for CI in CHARGE syndrome.


Assuntos
Síndrome CHARGE/cirurgia , Implante Coclear/métodos , Endoscopia/métodos , Síndrome CHARGE/diagnóstico , Pré-Escolar , Meato Acústico Externo , Feminino , Humanos , Tomografia Computadorizada por Raios X
5.
Pan Afr Med J ; 33: 250, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31692793

RESUMO

Sarcoidosis is a non-caseating inflammatory chronic systemic disease of unknown etiology, which may affect one or more organs. Paranasal sinuses involvement occurs sporadic in sarcoidosis. We report a patient with a medical history of sarcoidosis involving her lungs, liver, and lymphatic system for four years who now presented with nasal and sinuses symptoms. The primary treatment with local cortisone showed no improvement. Computed tomography (CT) scan of the paranasal sinuses (PNS) revealed signs of chronic pansinusitis. She was successfully treated with endoscopic sinonasal surgery. Subsequent histological analysis confirmed the involvement of the PNS with sarcoidosis. Her follow-up during the last 6 months was without recurrence.


Assuntos
Doenças dos Seios Paranasais/diagnóstico por imagem , Sarcoidose/diagnóstico por imagem , Sinusite/diagnóstico por imagem , Adulto , Doença Crônica , Endoscopia/métodos , Feminino , Seguimentos , Humanos , Doenças dos Seios Paranasais/cirurgia , Sarcoidose/cirurgia , Tomografia Computadorizada por Raios X
6.
Zhonghua Wai Ke Za Zhi ; 57(11): 829-833, 2019 Nov 01.
Artigo em Chinês | MEDLINE | ID: mdl-31694131

RESUMO

Objective: To examine the clinical effect of all-inside endoscopic treatment of recalcitrant plantar fasciitis through two medial portals. Methods: The recalcitrant plantar fasciitis data of 67 cases (79 feet) that underwent two medial portals all-inside endoscopic treatment at Department of Hand and Foot Microsurgery, Xuzhou Central Hospital from October 2016 to June 2018 were retrospectively analyzed.There were 24 males (30 feet) and 43 females (49 feet) aged 44.3 years old(range:24-76 years).The mean disease duration from the specialist doctor intervention to operation was (23.7±11.0) months (range: 12-60 months). All the patients were treated with the two medial portals all-inside endoscopic procedure when the 6 months conservative treatment had failed.The endoscopic procedure including debridement and partial plantar fasciotomy.The clinical results,including pain,activity,gait and foot health quality,were scored using visual analogue pain scale (VAS),American Orthopaedic Foot & Ankle Society Ankle Hindfoot Scale (AOFAS) and SF-36. Results: All the patients were followed up for (15.2±6.7) months (range: 12-24 months). All cases achieved primarily healing of the wound without postoperative complications of nerve,vessel and tendon.At the last follow-up,the VAS decreased from (5.3±2.0) preoperative to 0 prooperative (t=21.60, P=0.000), AOFAS increased from (72.6±9.4) to (97.3±4.6)(t=19.43,P=0.000),SF-36 increased from (93.6±8.4) to (119.1±7.3) (t=18.78, P=0.000), non-recurrent calcaneal spur, normal foot and ankle activity was recorded. Conclusion: The two medial portals all-inside endoscopic procedure is effective for the treatment of recalcitrant plantar fasciitis.


Assuntos
Endoscopia/métodos , Fasciíte Plantar/cirurgia , Fasciotomia/métodos , Adulto , Idoso , Desbridamento , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
7.
Medicine (Baltimore) ; 98(41): e17497, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31593116

RESUMO

BACKGROUND: This study will systematically evaluate the psychological effects of advanced care (AC) on patients who received endoscopic gastric cancer resection (EGCR). METHODS: This study will search the following databases of Cochrane Library, Pubmed, EMBASE, Web of Science, WANGFANG, Chinese Biomedical Literature Database, and China National Knowledge Infrastructure from inception to the present with no language limitation. All randomized controlled trials on assessing the psychological effects of AC for patients with EGCR will be included. RESULTS: This study will explore the psychological effects of AC on EGCR by assessing depression, anxiety, health-related quality of life, and adverse events. CONCLUSION: This study will summarize recent evidence for the psychological effects of AC on EGCR. PROSPERO REGISTRATION NUMBER: PROSPERO CRD42019139868.


Assuntos
Endoscopia/métodos , Gastrectomia/psicologia , Neoplasias Gástricas/cirurgia , Estômago/cirurgia , Ansiedade/epidemiologia , Ansiedade/psicologia , China/epidemiologia , Depressão/epidemiologia , Depressão/psicologia , Gastrectomia/efeitos adversos , Humanos , Qualidade de Vida/psicologia , Ensaios Clínicos Controlados Aleatórios como Assunto
8.
Medicine (Baltimore) ; 98(41): e17579, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31593145

RESUMO

RATIONALE: Minimally invasive surgeries for thoracic disc herniation (TDH) evolved rapidly in recent years, and multiple approaches have been put forward. Thoracic discectomy via percutaneous spine endoscopy (PSE) is inadequately documented because of the low prevalence of TDH and the high difficulty of thoracic spine endoscopy techniques. Herein, we present a TDH case who underwent percutaneous endoscopic thoracic discectomy. PATIENT CONCERNS: A 28-year-old male suffered backpain and partial paralysis in lower extremities. DIAGNOSES: Magnet resonance imaging demonstrated T11-12 TDH, with cranially migrated disc fragment. INTERVENTIONS: The patient underwent percutaneous endoscopic thoracic discectomy via posterolateral approach with the assistance of endoscopic reamer in the procedure of foramino-laminaplasty. OUTCOMES: The patient's muscle force improved immediately, and the backpain relieved after 5 days post-surgery. In the 6-month follow-up, he had normal muscle force without paresthesia in lower limbs. LESSONS: The innovative design of endoscopic reamer provides effective plasty and access establishment with lower risk and difficulty, which ensures the vision and the operating space of the procedure of decompression. With this technique, the indications of thoracic PSE were broadened to both ventral and dorsal thoracic stenosis.


Assuntos
Discotomia Percutânea/métodos , Endoscopia/métodos , Deslocamento do Disco Intervertebral/cirurgia , Vértebras Torácicas/cirurgia , Adulto , Dor nas Costas/diagnóstico , Dor nas Costas/etiologia , Humanos , Disco Intervertebral/cirurgia , Deslocamento do Disco Intervertebral/diagnóstico por imagem , Deslocamento do Disco Intervertebral/patologia , Imagem por Ressonância Magnética , Masculino , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Paraplegia/diagnóstico , Paraplegia/etiologia , Vértebras Torácicas/diagnóstico por imagem , Vértebras Torácicas/patologia , Resultado do Tratamento
9.
Niger J Clin Pract ; 22(10): 1372-1377, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31607726

RESUMO

Objectives: The aim of the study is to compare the pre- and post-operative symptomatology, endoscopic findings, and nasal patency and to evaluate the postoperative outcomes of conventional compared to endoscopic septoplasty (ES). Materials and Methods: This prospective study was conducted at Rajindra Hospital, Patiala, Punjab, India, on 50 patients aged between 18 and 60 years having symptomatic deviated nasal septum and refractory to medical treatment. The patients were divided into two groups: Group A, which included 25 patients in whom conventional septoplasty (CS) was performed, and Group B, which included 25 patients in whom ES was conducted. The postoperative assessment was carried out at once weekly for 1 month and twice weekly for another 2 months. Results: Nasal obstruction was relieved in 79.1% cases belonging to Group A and 91.3% cases to Group B. Headache was relieved in 62.5% cases belonging to Group A and 93.3% cases to Group B. Postnasal drip was relieved in 73.3% cases in Group A and 94.1% cases in Group B. The results were found to be statistically significant. An improvement in visual analog scale score was observed in both groups, but statistically significant difference was seen at 2nd and 4th week. Postoperative nasal patency improvement was observed in both groups by the Gertner plate, and the results were found to be statistically significant. Postoperative hemorrhage was observed in 24% cases in Group A and 12% cases in Group B. Septal perforation, septal hematoma, and mucosal tear were observed in 4%, 4%, and 8% of cases, respectively, in Group A. No such complication was reported in Group B. Conclusion: ES is more effective in terms of relief of symptoms and improvement of nasal patency. It is best for isolated spur, posterior deviation, and revision surgery, but anterior caudal dislocation is best handled with CS. Both these techniques should be taken as an adjuvant to each other.


Assuntos
Endoscopia/métodos , Obstrução Nasal/cirurgia , Septo Nasal/cirurgia , Rinoplastia/métodos , Adolescente , Adulto , Endoscopia/efeitos adversos , Feminino , Humanos , Índia/epidemiologia , Masculino , Pessoa de Meia-Idade , Obstrução Nasal/etiologia , Septo Nasal/anormalidades , Deformidades Adquiridas Nasais/epidemiologia , Deformidades Adquiridas Nasais/cirurgia , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Hemorragia Pós-Operatória/etiologia , Período Pós-Operatório , Estudos Prospectivos , Rinoplastia/efeitos adversos , Inquéritos e Questionários , Resultado do Tratamento , Escala Visual Analógica , Adulto Jovem
10.
Medicine (Baltimore) ; 98(38): e17254, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31567997

RESUMO

BACKGROUND: Bleeding modifies the surgeon's view of the field during transsphenoidal endoscopic pituitary surgery. Since ventilation can alter venous return, we compared the effect of volume-controlled ventilation (VCV) and pressure-controlled ventilation (PCV) on intraoperative bleeding. METHODS: Eighty-six patients were randomized to VCV or PCV in this single blinded study; comparisons concerned 42 in the PCV group and 43 in the VCV group. RESULTS: Intraoperative bleeding, the primary endpoint, did not differ between groups whether analysis focused on 7 levels of the score, from minimal bleeding to bleeding with significant change in the conduct of surgical procedure (P = .89) or on a stratification into 3 categories, mild, moderate, and major (P = .47). Median [interquartile range] peak airway pressure was lower in the PCV group (13.5 [12.5-15] vs 16.3 [14.4-19.1] cm H2O, P < .001) while mean airway pressures were similar (P = .08). Means ±â€ŠSD of tidal volumes were lower in the VCV group when expressed as absolute values (470.6 ±â€Š84 vs 434.7 ±â€Š71.7 ml, P = .05) or as tidal volume/theoretical ideal weight ratio (6.7 [6.5-7] vs 7.2 [6.9-7.9], P < .001). The 2 groups were similar for postoperative complications and number of patients cured. CONCLUSION: In conclusion, ventilation mode does not influence intraoperative bleeding during transsphenoidal pituitary surgery. TRIAL REGISTRATION: Clinicaltrials.gov identifier: NCT01891838; July 3, 2013.


Assuntos
Hipófise/cirurgia , Respiração Artificial , Adulto , Idoso , Perda Sanguínea Cirúrgica , Endoscopia/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Respiração com Pressão Positiva , Respiração Artificial/efeitos adversos , Respiração Artificial/métodos , Método Simples-Cego , Seio Esfenoidal , Adulto Jovem
11.
Vestn Otorinolaringol ; 84(4): 25-27, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31579053

RESUMO

In the article, a new method of septal perforation closing in children with a flap on the ethmoid artery under endoscopic control is described. Unlike conventional endoscopic procedures described technique allows to close the perforation bilaterally. Using the author's technique, 6 children with septal perforation aged from 13 to 17 years (mean age 15.2±2.1) were operated on. In all patients, the perforation was completely closed. Thus, the method has shown high efficiency and safety, which allows it to be widely used in pediatric practice.


Assuntos
Endoscopia , Perfuração do Septo Nasal , Septo Nasal , Adolescente , Artérias , Criança , Endoscopia/métodos , Humanos , Perfuração do Septo Nasal/cirurgia , Septo Nasal/cirurgia , Retalhos Cirúrgicos , Resultado do Tratamento
12.
Z Gastroenterol ; 57(10): 1226-1229, 2019 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-31610586

RESUMO

INTRODUCTION: Benign colorectal neoplasia are commonly resected using snare resection or endoscopic submucosal dissection (ESD). These methods are safe, but just the piecemeal resection in flat adenomas greater than 20 mm harbor a relevant risk of recurrence. Interventional endoscopic therapy of recurrent lesions can be challenging, even in expert hands due to a high risk of complications. While smaller, scarred recurrent adenomas less than 20 mm are suitable for endoscopic full-thickness resection, hitherto larger ones have had to be removed with more laborious, time-consuming and costly endoscopic methods, or had to undergo surgery. METHOD: The EndoRotor is a novel non-diathermic resection system for benign neoplasia in the gastrointestinal tract. The tissue is aspirated into an opening at the tip of a flexible resection catheter, dissected by means of a rotating blade on the inside of the catheter and finally transported into a tissue trap. CASE REPORT: We present the case of a 79-year-old female patient with a large recurrent adenoma of a lateral-spreading tumor granular type in the rectum. Whereas a part of the adenoma could be resected with ESD, the scarred parts were not amenable to traditional endoscopic methods. By using EndoRotor, the scarred adenoma could be resected completely and without any complication. CONCLUSION: Scarred adenomas pose a challenge for interventional endoscopy. In this case study, EndoRotor proved to be a safe and viable method and a new resection option for complicated scarred rectal adenomas.


Assuntos
Adenoma , Endoscopia , Neoplasias Retais , Adenoma/cirurgia , Idoso , Endoscopia/instrumentação , Endoscopia/métodos , Feminino , Humanos , Neoplasias Retais/cirurgia , Resultado do Tratamento
13.
BMC Surg ; 19(1): 132, 2019 Sep 10.
Artigo em Inglês | MEDLINE | ID: mdl-31500608

RESUMO

BACKGROUND: Foreign body ingestion is a scenario occasionally encountered in the emergency room. Pediatric and psychiatric patients are the two most common populations suffering from accidental or in some cases intentional ingestion of foreign bodies. Commonly, majority of cases require no specific treatment and the swallowed objects pass through the digestive tract spontaneously without causing any significant complications. Less than 1% of the cases complicates with gastrointestinal tract perforation, which are often caused by sharp objects, which warrants surgical intervention. The average time from foreign body ingestion to development of perforation was noted at 10.4 days in previous reports. These cases often present in rapidly progressing peritonitis and are subsequently managed by emergent laparotomy. In this case report, we describe an accidental chopstick ingestion of a patient who initially was misdiagnosed and remained asymptomatic for nine months, then presented with acute abdomen. CASE PRESENTATION: A 27-year-old man accidentally ingested a wooden chopstick and sought consult at a clinic. Negative abdominal plain film misled the physician to believe ingested chopstick was digested into fragments and passed out unnoticed. The patient presented acute abdomen caused by duodenal perforation nine months later and was subsequently treated with emergency laparotomy with primary duodenorrhaphy. CONCLUSIONS: Negative plain films are not sufficient to conclude a conservative treatment in foreign body ingestion. Computed tomography scan or endoscopic examinations should be done to rule out retained foreign body within gastrointestinal tract.


Assuntos
Abdome Agudo/etiologia , Corpos Estranhos/complicações , Perfuração Intestinal/cirurgia , Laparotomia/métodos , Abdome Agudo/cirurgia , Adulto , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Serviço Hospitalar de Emergência , Endoscopia/métodos , Humanos , Masculino , Radiografia , Tomografia Computadorizada por Raios X
16.
Gastroenterol. hepatol. (Ed. impr.) ; 42(7): 423-428, ago.-sept. 2019. graf, tab
Artigo em Inglês | IBECS | ID: ibc-183828

RESUMO

Introducción: Adherence to guidelines on the periendoscopic management of antiplatelet therapy (APT) has not been analyzed in detail. Our aim was to assess adherence to guidelines in patients referred to our Endoscopy Unit on a case-by-case basis, describing in detail the detected deviations and identifying areas of improvement. Patients and methods: Cross-sectional study of outpatients consecutively scheduled for an unsedated upper or lower gastrointestinal endoscopy between January and June 2015. Patients on anticoagulant therapy were excluded. Results: 675 patients were evaluated, including 91 (13.5%) patients on APT [upper GI endoscopy 25 (27.5%), lower GI endoscopy 66 (72.5%)]. Contrary to the clinical guidelines, aspirin was discontinued in 25 of the 77 patients previously prescribed the drug (32.5%) but this modification was patient's own decision in 11 cases. Most of the apparent deviations in the management of clopidogrel and dual antiplatelet therapy (DAPT) were not true non-adherence cases. The Primary Care physician modified an APT prescribed by another physician in 8 of 9 cases (88.9%), always in cases with aspirin. No relationship was found between the endoscopic procedure's predicted risk of bleeding or the patient's thrombotic risk and modification of therapy. Discussion: In many patients, the peri-procedural management of APT goes against current guidelines, but some of these inconsistencies cannot be considered true deviations from practice. Identified areas for improvement are increasing patient awareness about APT, disseminating the guidelines in Primary Care, and underscoring the significance of thrombotic risk related to APT withdrawal


Introducción: El cumplimiento de las guías clínicas sobre el manejo periendoscópico del tratamiento antiagregante plaquetario (TAP) no se ha analizado con detalle. Nuestro objetivo fue analizar caso por caso el cumplimiento de las guías en los pacientes que acuden a nuestra Unidad de Endoscopia, describiendo con detalle las desviaciones detectadas e identificando áreas de mejora. Pacientes y métodos: Estudio transversal sobre pacientes consecutivos programados para gastroscopia o colonoscopia realizadas sin sedación entre enero y junio de 2015. Se excluyeron los pacientes en tratamiento anticoagulante. Resultados: Se evaluaron 675 pacientes de los que se incluyeron 91 (13,5%) por estar en tratamiento con antiagregante plaquetario (gastroscopias 25 [27,5%], colonoscopias 66 [72,5%]). La aspirina se interrumpió contrariamente a las guías clínicas en 25 de los 77 pacientes que la llevaban (32,5%), pero esta modificación fue una decisión del propio paciente en 11 casos. Muchas de las aparentes desviaciones en el manejo del clopidogrel y del tratamiento antiagregante plaquetario doble (TAPD) no eran verdaderos casos de no cumplimiento. El médico de Atención Primaria modificó el TAP prescrito por otro especialista en 8 de 9 casos (88,9%), siempre en casos de aspirina. No se encontró relación entre el riesgo de sangrado del procedimiento endoscópico o el riesgo de trombosis del paciente y la modificación del tratamiento. Discusión: En una proporción significativa de pacientes el manejo periprocedimiento del TAP va en contra de las guías clínicas, pero algunas de estas desviaciones no pueden considerarse verdaderos incumplimientos. Áreas de mejora son aumentar la información al paciente sobre el TAP, extender la diseminación de las guías a atención primaria y resaltar la importancia del riesgo trombótico relacionado con la suspensión del TAP


Assuntos
Humanos , Inibidores da Agregação de Plaquetas/uso terapêutico , Cooperação e Adesão ao Tratamento , Endoscopia/métodos , Gastroscopia , Estudos Prospectivos , Estudos Transversais , Clopidogrel/uso terapêutico , Estatísticas não Paramétricas
17.
Vet Clin North Am Exot Anim Pract ; 22(3): 419-439, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31395323

RESUMO

Even when performed by skilled operators, locating the nerves can be challenging in small exotic pets; in such cases, the use of an electrical nerve stimulator may be useful to confirm the correct identification of the target nerve. Exotic animal anesthesia and analgesia have dramatically progressed over the past decade and continue to do so as more research and technologies develop. Technological advancements such as airway devices, endoscopic intubation techniques, positive intermittent pressure ventilators, and invasive and noninvasive blood pressure monitors have played a significant role in improving patient safety and the anesthetic outcomes of exotic animals.


Assuntos
Analgesia/veterinária , Anestesia/veterinária , Animais Exóticos/fisiologia , Manuseio das Vias Aéreas/instrumentação , Manuseio das Vias Aéreas/métodos , Manuseio das Vias Aéreas/normas , Manuseio das Vias Aéreas/veterinária , Analgesia/tendências , Anestesia/tendências , Anestésicos/administração & dosagem , Animais , Aves/fisiologia , Determinação da Pressão Arterial/métodos , Determinação da Pressão Arterial/normas , Determinação da Pressão Arterial/veterinária , Endoscopia/instrumentação , Endoscopia/métodos , Endoscopia/tendências , Endoscopia/veterinária , Humanos , Mamíferos/fisiologia , Bloqueio Nervoso/instrumentação , Bloqueio Nervoso/métodos , Bloqueio Nervoso/tendências , Bloqueio Nervoso/veterinária , Manejo da Dor , Respiração Artificial/instrumentação , Respiração Artificial/métodos , Respiração Artificial/tendências , Respiração Artificial/veterinária
18.
BMC Surg ; 19(1): 124, 2019 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-31462257

RESUMO

BACKGROUND: Depending on the location of the herniated disc at the shoulder, axilla, or ventral side of the compression nerve root, various puncture sites and channel entrances were selected so that the goal of targeted removal of the herniated disc could be achieved by a full-endoscopic technique. Achieving good clinical therapeutic efficacy through the natural gap of bones can maximally avoid related access complications, and the necessary techniques and relevant anatomical factors were analyzed. METHODS: Between August 2012 and August 2014, 98 patients with L5 - S1 intervertebral disc herniation were treated with posterior percutaneous full-endoscopic discectomy (PPFED) by grafting tubes at various positions via the interlaminar approach. The visual analog scale (VAS) and the Oswestry disability index (ODI) were used to assess the patients' back and leg pain and the improvements in daily function, and the modified Macnab standard was used to evaluate the treatment efficacy. RESULTS: All 98 patients successfully completed the surgery, 84 patients got out of bed and walked on the first postoperative day, and 14 patients got out of bed and walked on the second postoperative day. The preoperative ODI (56.032 ± 3.625) was significantly higher than the ODI score (8.147 ± 1.398) (F = 5343.054, P ≤ 0.001) 48 months after surgery. The preoperative VAS score (7.193 ± 0.875) was significantly higher than the postoperative VAS score (0.914 ± 0.500 points) (F = 1656.173, P ≤ 0.001). The differences in ODI and VAS scores before and after surgery were statistically significant (P < 0.05). Follow-up was conducted 1, 6, 12 and 48 months postoperatively, and the modified Macnab standard was used during the last follow-up to evaluate the efficacy: 67 cases were excellent, 20 cases were good, 7 cases were fair, and 0 cases were poor; the proportion of excellent and good cases was 92.6%. CONCLUSIONS: The treatment of L5 - S1 intervertebral disc herniation with PPFED by grafting tubes at various positions via an interlaminar approach is a safe, effective, and minimally invasive surgical method. Reaching the location of a disc herniation directly through the natural gap in the bones can maximally avoid collateral injury from spine surgery. TRIAL REGISTRATION: The registration number of this clinical study is ChiCTR1800014588; it has been retrospectively registered with a registration date of 05/01/2018.


Assuntos
Discotomia Percutânea/métodos , Endoscopia/métodos , Degeneração do Disco Intervertebral/cirurgia , Deslocamento do Disco Intervertebral/cirurgia , Adulto , Idoso , Feminino , Humanos , Vértebras Lombares/cirurgia , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Período Pós-Operatório , Resultado do Tratamento , Escala Visual Analógica , Adulto Jovem
19.
Medicine (Baltimore) ; 98(35): e16614, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31464897

RESUMO

Accurate tumor response determination remains inconclusive after preoperative chemoradiation therapy (CRT) for rectal cancer. This study aimed to investigate whether clinical assessment, such as endoscopy and magnetic resonance imaging (MRI), can accurately predict ypT stage and select candidates for pelvic organ-preserving surgery in rectal cancer after preoperative CRT. A total of 110 patients who underwent preoperative CRT followed by curative resection for rectal cancer were prospectively enrolled. Magnetic resonance tumor regression grade (mrTRG) using T2-MRI, endoscopic evaluation, and combination modality (combination of endoscopy and mrTRG) were used to analyze tumor response after preoperative CRT. Endoscopic findings were categorized as 3 grades and the mrTRG was assessed into 5 grades. Twenty-nine patients (26.4%) had achieved pathologic complete response. When predicting ypT0, endoscopy showed significantly higher area under the curve (AUC 0.818) than did mrTRG (AUC 0.568) and combination modality (AUC 0.768) in differentiating good response from poor response (P < .001). Both endoscopy and combination modality showed significantly higher diagnostic performance in sensitivity (79.31%), positive predictive value (PPV 67.65%), negative predictive value (NPV 92.11%), and accuracy (84.55%) than those of MR tumor response (sensitivity 37.93%, PPV 36.67%, NPV 77.50%, and accuracy 66.36%) for the prediction of ypT0 (P < .001). Combination modality showed significantly higher diagnostic performance in sensitivity (56.92%), NPV (56.92%), and accuracy (67.27%) compared with those of mrTRG. Neither endoscopy, nor mrTRG, nor the combination modality had adequate diagnostic performances to be clinically acceptable in selecting candidates for nonoperative treatment strategies. However, endoscopy may be incorporated in clinical restaging strategy in planning the extent of surgical resection in patients with rectal cancer.


Assuntos
Quimiorradioterapia/métodos , Endoscopia/métodos , Imagem por Ressonância Magnética/métodos , Neoplasias Retais/diagnóstico por imagem , Neoplasias Retais/terapia , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Imagem Multimodal , Estadiamento de Neoplasias , Tratamentos com Preservação do Órgão , Estudos Prospectivos , Neoplasias Retais/patologia , Resultado do Tratamento
20.
Anticancer Res ; 39(8): 4243-4248, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31366512

RESUMO

BACKGROUND/AIM: This study aimed to clarify the benefits and disadvantages of percutaneous endoscopic gastrostomy (PEG) for patients with esophageal cancer (EC) during preoperative therapy. MATERIALS AND METHODS: We retrospectively reviewed 92 patients who underwent esophagectomy for EC after preoperative therapy. Patients were divided into the PEG group (n=14) and the control group (n=78) and compared regarding patient characteristics, nutritional status, operative variables, and postoperative complications. RESULTS: In the PEG group first nutritional status and tumor stage were significantly worse, but changes of nutritional status from first visit to operation were significantly better. According to the intraoperative thermal imaging, there was no patient with blood flow disturbance in the gastric conduit due to PEG. Short-term surgical outcomes did not significantly differ. CONCLUSION: PEG has less adverse effects on gastric tube production in esophagectomy and may be considered in highly selective patients during preoperative therapy.


Assuntos
Endoscopia/métodos , Neoplasias Esofágicas/cirurgia , Gastrostomia/métodos , Estômago/cirurgia , Adulto , Idoso , Neoplasias Esofágicas/patologia , Esofagectomia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Complicações Pós-Operatórias/patologia , Período Pré-Operatório , Estudos Retrospectivos , Estômago/patologia , Resultado do Tratamento
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