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1.
Medicine (Baltimore) ; 100(25): e26334, 2021 Jun 25.
Artigo em Inglês | MEDLINE | ID: mdl-34160398

RESUMO

ABSTRACT: Umbilical hernias constitute some of the most common surgical diseases addressed by surgeons. Endoscopic techniques have become standard of care together with the conventional open techniques for the treatment of umbilical hernias. Several different approaches were described to achieve laparoscopic sublay repair.We prospectively collected and reviewed the medical records of 10 patients with umbilical hernias underwent total endoscopic sublay repair (TES) at our institution from November 2017 to November 2019. All operations were performed by a same surgical team. The demographics, intraoperative details, and postoperative complications were evaluated.All TES procedures were successfully performed without conversion to an open operation. No intraoperative morbidity was encountered. The average operative time was 109.5 minutes (range, 80-140 minutes). All the patients resumed an oral diet within 6 hours after the intervention. The mean time to ambulation was 7.5 hours (range, 4-14 hours), and mean postoperative hospital stay was 2.2 day (range, 1-4 days). One patient developed postoperative seroma. No wound complications, chronic pain, or recurrence were registered during the follow-up.Initial experiences with this technique show that the TES is a safe, and effective procedure for the treatment of umbilical hernias.


Assuntos
Endoscopia/métodos , Hérnia Umbilical/cirurgia , Herniorrafia/métodos , Complicações Pós-Operatórias/epidemiologia , Adulto , Idoso , Endoscopia/efeitos adversos , Endoscopia/instrumentação , Estudos de Viabilidade , Feminino , Seguimentos , Herniorrafia/efeitos adversos , Herniorrafia/instrumentação , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Recidiva , Telas Cirúrgicas , Resultado do Tratamento
2.
Medicine (Baltimore) ; 100(25): e26385, 2021 Jun 25.
Artigo em Inglês | MEDLINE | ID: mdl-34160416

RESUMO

RATIONALE: For isthmic lumbar spondylolisthesis (ILS) associated with the removal of herniation, it remains challenging to perform less invasive and minimally disruptive procedures. Good results could potentially be obtained by further preserving the posterior elements in full-endoscopic lumbar discectomy (FESS), which is less invasive than microenscopic surgery (MES). PATIENT CONCERNS: One patient complained of left leg pain, and another patient complained of right leg pain and low back pain. DIAGNOSES: Two patients with ILS and Meyerding Grade 1 lumbar spondylolisthesis. INTERVENTIONS: We performed a full-endoscopic lumbar discectomy via the interlaminar space (FESS-IL) for L5/S1 lumbar disc herniation (LDH) accompanied by isthmic lumbar spondylolisthesis. FESS-IL was performed in 2 patients with radiculopathy caused by different types of LDH using a full endoscopic system with a 4.1 mm working channel and 6.9 mm outer diameter. A 3.5-mm diameter high-speed drill was used in one patient for an upward-migrated LDH in the inner-rim of the infravertebral border. The other patient underwent minimal resection without bone resection. OUTCOMES: The one-year clinical outcome included confirmation of pain relief and evacuation of migrated LDH on magnetic resonance imaging in all patients. There was no progression of slippage on radiography. The mean operative time was 82 min, and no complication was observed. The one-year clinical outcome demonstrated sufficient pain relief. LESSONS THE Y: ear postoperative outcome showed improvement. We believe that FESS-IL is a viable alternative operative approach for LDH for ILS.


Assuntos
Discotomia/métodos , Endoscopia/métodos , Vértebras Lombares/cirurgia , Espondilolistese/cirurgia , Discotomia/instrumentação , Endoscopia/instrumentação , Feminino , Humanos , Deslocamento do Disco Intervertebral/diagnóstico , Deslocamento do Disco Intervertebral/etiologia , Deslocamento do Disco Intervertebral/cirurgia , Dor Lombar/diagnóstico , Dor Lombar/etiologia , Dor Lombar/cirurgia , Vértebras Lombares/diagnóstico por imagem , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Espondilolistese/complicações , Espondilolistese/diagnóstico , Espondilólise/diagnóstico , Espondilólise/etiologia , Espondilólise/cirurgia , Resultado do Tratamento
3.
Artigo em Inglês | MEDLINE | ID: mdl-34172248

RESUMO

Endocytoscopy provides an in-vivo visualization of nuclei and micro-vessels at the cellular level in real-time, facilitating so-called "optical biopsy" or "virtual histology" of colorectal polyps/neoplasms. This functionality is enabled by 520-fold magnification power with endocytoscopy and recent breakthroughs in artificial intelligence (AI) allowing a great advance in endocytoscopic imaging; interpretation of images is now fully supported by AI tool which outputs predictions of polyp histopathology during colonoscopy. The advantage of the use of AI during optical biopsy can be appreciated especially by non-expert endoscopists who to increase performance. This paper provides an overview of the latest evidence on colorectal polyp characterization with endocytoscopy combined with AI and identify the barriers to its widespread implementation.


Assuntos
Inteligência Artificial/normas , Pólipos do Colo/patologia , Colonoscopia/métodos , Neoplasias Colorretais/patologia , Endoscopia/métodos , Humanos
4.
Artigo em Inglês | MEDLINE | ID: mdl-34172253

RESUMO

The evaluation and assessment of Barrett's esophagus is challenging for both expert and nonexpert endoscopists. However, the early diagnosis of cancer in Barrett's esophagus is crucial for its prognosis, and could save costs. Pre-clinical and clinical studies on the application of Artificial Intelligence (AI) in Barrett's esophagus have shown promising results. In this review, we focus on the current challenges and future perspectives of implementing AI systems in the management of patients with Barrett's esophagus.


Assuntos
Inteligência Artificial/normas , Esôfago de Barrett/diagnóstico , Aprendizado Profundo/normas , Endoscopia/métodos , Humanos , Prognóstico
5.
Artigo em Inglês | MEDLINE | ID: mdl-34172251

RESUMO

Artificial intelligence (AI) research in endoscopy is being translated at rapid pace with a number of approved devices now available for use in luminal endoscopy. However, the published literature for AI in biliopancreatic endoscopy is predominantly limited to early pre-clinical studies including applications for diagnostic EUS and patient risk stratification. Potential future use cases are highlighted in this manuscript including optical characterisation of strictures during cholangioscopy, prediction of post-ERCP acute pancreatitis and selective biliary duct cannulation difficulty, automated report generation and novel AI-based quality key performance metrics. To realise the full potential of AI and accelerate innovation, it is crucial that robust inter-disciplinary collaborations are formed between biliopancreatic endoscopists and AI researchers.


Assuntos
Inteligência Artificial/normas , Colangiopancreatografia Retrógrada Endoscópica/métodos , Endoscopia/métodos , Aprendizado de Máquina/normas , Doença Aguda , Humanos
6.
Artigo em Inglês | MEDLINE | ID: mdl-34172255

RESUMO

The American Society for Gastrointestinal Endoscopy (ASGE) has proposed the "resect-and-discard" and "diagnose-and-leave" strategies for diminutive colorectal polyps to reduce the costs of unnecessary polyp resection and pathology evaluation. However, the diagnostic thresholds set by these guidelines are not always met in community practice. To overcome this sub-optimal performance, artificial intelligence (AI) has been applied to the field of endoscopy. The incorporation of deep learning algorithms with AI models resulted in highly accurate systems that match the expert endoscopists' optical biopsy and exceed the ASGE recommended thresholds. Recent studies have demonstrated that the integration of AI in clinical practice results in significant improvement in endoscopists' diagnostic accuracy while reducing the time to make a diagnosis. Yet, several points need to be addressed before AI models can be successfully implemented in clinical practice. In this review, we summarize the recent literature on the application of AI for characterization of colorectal polyps, and review the current limitation and future directions for this field.


Assuntos
Inteligência Artificial/normas , Pólipos do Colo/diagnóstico , Colonoscopia/métodos , Neoplasias Colorretais/diagnóstico , Endoscopia/métodos , Pólipos do Colo/patologia , Neoplasias Colorretais/patologia , Humanos
7.
Artigo em Inglês | MEDLINE | ID: mdl-34172254

RESUMO

Artificial intelligence is poised to revolutionize the field of medicine, however significant questions must be answered prior to its implementation on a regular basis. Many artificial intelligence algorithms remain limited by isolated datasets which may cause selection bias and truncated learning for the program. While a central database may solve this issue, several barriers such as security, patient consent, and management structure prevent this from being implemented. An additional barrier to daily use is device approval by the Food and Drug Administration. In order for this to occur, clinical studies must address new endpoints, including and beyond the traditional bio- and medical statistics. These must showcase artificial intelligence's benefit and answer key questions, including challenges posed in the field of medical ethics.


Assuntos
Inteligência Artificial/normas , Endoscopia/métodos , Gastroenterologia/métodos , Humanos
8.
Artigo em Inglês | MEDLINE | ID: mdl-34172257

RESUMO

Esophageal cancer is the eight most common cancer in the world and is associated with a poor prognosis. Significant efforts are necessary to improve the detection of early squamous cell cancer such that curative endoscopic therapy can be offered. Studies have shown an overall miss rate of esophageal cancer of up to 6.4%. Human factors including fatigue and lack of attention may be a contributory factor. Computer aided detection and characterisation of early squamous cell cancer can be a second reader which potentially offsets these factors. Recent studies developing artificial intelligence systems show real promise in the detection of early squamous cell cancer and predicting depth of invasion to aid in the management of patients in the same endoscopic session. This has the potential to revolutionise this area of endoscopy.


Assuntos
Inteligência Artificial/normas , Carcinoma de Células Escamosas/diagnóstico , Aprendizado Profundo/normas , Endoscopia/métodos , Neoplasias Esofágicas/diagnóstico , Carcinoma de Células Escamosas/patologia , Neoplasias Esofágicas/patologia , Humanos
9.
Medicine (Baltimore) ; 100(23): e26304, 2021 Jun 11.
Artigo em Inglês | MEDLINE | ID: mdl-34115039

RESUMO

INTRODUCTION: Air embolism has the potential to be serious and fatal. In this paper, we report 3 cases of air embolism associated with endoscopic medical procedures in which the patients were treated with hyperbaric oxygen immediately after diagnosis by transesophageal echocardiography. In addition, we systematically review the risk factors for air embolism, clinical presentation, treatment, and the importance of early hyperbaric oxygen therapy efficacy after recognition of air embolism. PATIENT CONCERNS: We present 3 patients with varying degrees of air embolism during endoscopic procedures, one of which was fatal, with large amounts of gas visible in the right and left heart chambers and pulmonary artery, 1 showing right heart enlargement with increased pulmonary artery pressure and tricuspid regurgitation, and 1 showing only a small amount of gas images in the heart chambers. DIAGNOSES: Based on ETCO2 and transesophageal echocardiography (TEE), diagnoses of air embolism were made. INTERVENTIONS: The patients received symptomatic supportive therapy including CPR, 100% O2 ventilation, cerebral protection, hyperbaric oxygen therapy and rehabilitation. OUTCOMES: Air embolism can causes respiratory, circulatory and neurological dysfunction. After aggressive treatment, one of the 3 patients died, 1 had permanent visual impairment, and 1 recovered completely without comorbidities. CONCLUSIONS: While it is common for small amounts of air/air bubbles to enter the circulatory system during endoscopic procedures, life-threatening air embolism is rare. Air embolism can lead to serious consequences, including respiratory, circulatory, and neurological impairment. Therefore, early recognition of severe air embolism and prompt hyperbaric oxygen therapy are essential to avoid its serious complications.


Assuntos
Ecocardiografia Transesofagiana/métodos , Embolia Aérea , Endoscopia/efeitos adversos , Oxigenação Hiperbárica/métodos , Administração dos Cuidados ao Paciente/métodos , Adulto , Intervenção Médica Precoce/métodos , Embolia Aérea/diagnóstico , Embolia Aérea/etiologia , Embolia Aérea/fisiopatologia , Embolia Aérea/terapia , Endoscopia/métodos , Feminino , Coração/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Artéria Pulmonar/diagnóstico por imagem , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença , Resultado do Tratamento
10.
Medicine (Baltimore) ; 100(23): e26310, 2021 Jun 11.
Artigo em Inglês | MEDLINE | ID: mdl-34115041

RESUMO

ABSTRACT: Cohort study.This study aimed to determine the effectiveness of the universal approach of full endoscopy and percutaneous transpedicular fixation via a medial central approach (ACM) performed to surgically treat patients with lumbar degenerative surgical pathologies.Alternatives to interventionist treatments available to patients with lumbar degenerative surgical pathologies are related to recovery from minimally invasive surgery. Considering this, full endoscopic spinal decompression (full endoscopy) and percutaneous transpedicular fixation via an ACM represent advances in neurosurgical procedures, in particular, spinal surgery. Thus, the introduction of endoscopic and minimally invasive surgeries for the lumbar region has become 1 of the most important advances in modern surgery.A cohort of 79 patients undergoing full endoscopy and percutaneous transpedicular fixation was evaluated 6 times in 1 year. Pain intensity was measured using the visual analog scale (VAS), and lumbar functionality was measured using the Oswestry Disability Index (ODI). Six evaluations were performed: before surgery and on discharge after surgery as well as at 1, 3, 6, and 12 months after surgery.Before the ACM was applied, the VAS pain score was 8.52. At 11 hours post-surgery, the pain score reduced to 2.59 points (a difference of 5.73 points; P = 0.001). Of the 10 ODI domains evaluated, a difference was found between the period prior to surgery and 1 month later (P < 0.01).The universal approach to full endoscopy and lumbar percutaneous transpedicular fixation via an ACM is highly effective for patients with lumbar surgical degenerative pathologies.


Assuntos
Descompressão Cirúrgica , Endoscopia , Degeneração do Disco Intervertebral/cirurgia , Laminectomia , Dor Lombar , Vértebras Lombares , Fusão Vertebral , Descompressão Cirúrgica/efeitos adversos , Descompressão Cirúrgica/métodos , Endoscopia/efeitos adversos , Endoscopia/métodos , Feminino , Humanos , Degeneração do Disco Intervertebral/diagnóstico , Laminectomia/efeitos adversos , Laminectomia/métodos , Dor Lombar/diagnóstico , Dor Lombar/etiologia , Dor Lombar/cirurgia , Vértebras Lombares/patologia , Vértebras Lombares/cirurgia , Masculino , México , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Avaliação de Processos e Resultados em Cuidados de Saúde , Medição da Dor/métodos , Período Perioperatório/métodos , Recuperação de Função Fisiológica , Fusão Vertebral/efeitos adversos , Fusão Vertebral/métodos
12.
Int J Comput Assist Radiol Surg ; 16(5): 849-859, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33982232

RESUMO

PURPOSE: Segmentation of surgical instruments in endoscopic video streams is essential for automated surgical scene understanding and process modeling. However, relying on fully supervised deep learning for this task is challenging because manual annotation occupies valuable time of the clinical experts. METHODS: We introduce a teacher-student learning approach that learns jointly from annotated simulation data and unlabeled real data to tackle the challenges in simulation-to-real unsupervised domain adaptation for endoscopic image segmentation. RESULTS: Empirical results on three datasets highlight the effectiveness of the proposed framework over current approaches for the endoscopic instrument segmentation task. Additionally, we provide analysis of major factors affecting the performance on all datasets to highlight the strengths and failure modes of our approach. CONCLUSIONS: We show that our proposed approach can successfully exploit the unlabeled real endoscopic video frames and improve generalization performance over pure simulation-based training and the previous state-of-the-art. This takes us one step closer to effective segmentation of surgical instrument in the annotation scarce setting.


Assuntos
Simulação por Computador , Curadoria de Dados , Endoscopia/métodos , Processamento de Imagem Assistida por Computador/métodos , Algoritmos , Artefatos , Humanos , Aprendizagem , Software , Estudantes , Gravação em Vídeo
13.
J Clin Neurosci ; 88: 5-9, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33992203

RESUMO

This study aimed to compare the clinical outcomes of endoscopic spinal surgery (ESS) and minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) for degenerative lumbar disease (DLD) through meta-analysis. The Medline (via PubMed), Cochrane, Scopus, and Embase databases were searched for studies that evaluated the outcomes of ESS and MIS-TLIF in DLD, including visual analog scale (VAS) score for low back pain, VAS score for leg pain, Oswestry Disability Index (ODI), and complications published between January 2000 and August 2020. Two authors extracted the data independently. Any discrepancies were resolved by a consensus. Four comparative studies were identified. No significant differences were found between the ESS and MIS-TLIF groups in terms of VAS score for back pain, VAS score for leg pain, and ODI, except for complication rate. The complication rate was higher in the ESS than in the MIS-TLIF group. A literature review identified four comparative studies reporting the clinical outcomes of ESS and MIS-TLIF for DLD. Despite the heterogeneity, a limited number of meta-analyses showed that the clinical outcomes between the two groups were not significantly different except for complication rate. Hence, further large-scale multicenter studies are required to validate our results.


Assuntos
Endoscopia/métodos , Degeneração do Disco Intervertebral/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Fusão Vertebral/métodos , Humanos , Degeneração do Disco Intervertebral/complicações , Dor Lombar/etiologia , Dor Lombar/cirurgia , Vértebras Lombares/cirurgia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
14.
Isr Med Assoc J ; 23(5): 297-301, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-34024046

RESUMO

BACKGROUND: Management of acquired laryngotracheal stenosis (LTS) is challenging and often requires recurrent procedures. OBJECTIVES: To compare the efficacy and safety of balloon dilatation (BD) versus rigid dilatation (RD) in the treatment of LTS. METHODS: A retrospective study of patients undergoing endoscopic intervention for LTS was performed. RESULTS: The study included 69 balloon (BD) and 48 rigid dilations (RD). Most cases were grade 3 Cotton-Meyer stenosis. Mean time interval to recurrence after BD and RD were 27.9 and 19.6 weeks, respectively. Remission of over 8 weeks was achieved in 71% of BD compared to 31.2% of RD (P < 0.05). In the BD group, dilatation of subglottic stenosis showed higher rates of remission of over 8 weeks compared to upper and mid-tracheal stenosis (92% vs. 62% and 20%, respectively, P < 0.05). Complications were encountered in 4.2% of RD and 2.9% of BD. CONCLUSIONS: BD and RD are effective and safe procedures. Overall, BD achieved slightly better long-term results compared to RD.


Assuntos
Dilatação/métodos , Endoscopia/métodos , Laringoestenose/terapia , Estenose Traqueal/terapia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Dilatação/efeitos adversos , Desenho de Equipamento , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva , Indução de Remissão , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
15.
Artigo em Inglês | MEDLINE | ID: mdl-33975677

RESUMO

Early detection of gastric cancer is remaining a challenge. This review summarizes current knowledge on non-invasive methods that could be used for the purpose. The role of traditional cancer markers such as CEA, CA 72-4, CA 19-9, CA 15-3, and CA 12-5 lies mainly in therapy monitoring than early detection. Most extensive studied biomarkers (pepsinogens, ABC method) are aiming at the detection of precancerous lesions with modest sensitivity for cancer. Tests based on the detection of cancer-specific methylation patterns (PanSeer), circulating proteins and mutations in circulating tumour DNA (CancerSEEK), as well as miRNA panels have demonstrated promising results bringing those closer to practice. More extensive research is required before tests based on the detection of circulating tumour cells, extracellular vesicles and cell-free RNA could reach the practice. Detection of volatile organic compounds in the human breath is a promising development; sensor technologies for this purpose could be very attractive in screening settings.


Assuntos
Detecção Precoce de Câncer/métodos , Endoscopia/métodos , Neoplasias Gástricas/diagnóstico por imagem , Humanos , Neoplasias Gástricas/diagnóstico , Neoplasias Gástricas/mortalidade , Análise de Sobrevida
16.
Acta Orthop Traumatol Turc ; 55(2): 166-170, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33847580

RESUMO

OBJECTIVE: This study aimed to investigate the therapeutic effects of full endoscopic spine surgery on clinical and radiological outcomes in elderly patients over 70 years with lumbar spinal stenosis, without any obvious segmental instability. METHODS: A total of 47 patients (27 males, 20 females; the mean age=74.23±5.16) above 70 years who underwent a transforaminal percutaneous endoscopic decompression with the diagnosis of lumbar spinal stenosis, were included in this retrospective study. The mean follow-up was 26±2.97 months. The clinical efficacy of the surgical procedure was assessed by the Oswestry disability index (ODI) and the visual analog scale (VAS) of the leg and lower back at 1 week, 3 months, and 1 year postoperatively, and at the final follow-up examination. Modified MacNab criteria was also performed to assess the clinical efficiency of surgery at the final follow-up. RESULTS: An excellent outcome as per modified MacNab criteria was obtained in 9 patients (19.1%), a good outcome in 33 patients (70.2%), a fair outcome in 3 patients (6.4%), and poor results in 2 patients (4.3%). The mean ODI score significantly improved from 71.29±5.69 preoperatively to 32.05±10.71 at postoperative 1 week, 30.27±9.89 at 3 months, 27.23±8.47 at 1 year, and 23.11±9.97 at the final follow-up (p<0.05 for each evaluation point). The mean VAS score of the leg and lower back significantly decreased from 6.10±0.96 and 5.71±1.13 preoperatively to 1.69±0.96, 2.24±1.01 at postoperative 1 week, 1.69±0.84, 2.45±0.87 at 3 months, 1.71±0.81, 2.38±0.79 at 1 year, and 1.71±0.92, 2.48±0.67 at the final follow-up, respectively (p<0.05 for each evaluation term). Postoperative computed tomography or magnetic resonance imaging showed adequate decompression of the central or lateral recess and removal of combined herniated discs. CONCLUSION: The results of our preliminary study have demonstrated that full endoscopic spine surgery is a safe and efficient technique for the therapy of neurogenic claudication and radiculopathy in elderly patients with lumbar spinal stenosis. LEVEL OF EVIDENCE: Level IV, Therapeutic Study.


Assuntos
Descompressão Cirúrgica , Endoscopia , Vértebras Lombares/diagnóstico por imagem , Complicações Pós-Operatórias , Estenose Espinal , Idoso , Descompressão Cirúrgica/efeitos adversos , Descompressão Cirúrgica/métodos , Avaliação da Deficiência , Endoscopia/efeitos adversos , Endoscopia/métodos , Feminino , Humanos , Masculino , Medição da Dor/métodos , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/fisiopatologia , Estudos Retrospectivos , Estenose Espinal/diagnóstico , Estenose Espinal/cirurgia , Resultado do Tratamento
17.
J Int Med Res ; 49(4): 300060521995273, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33866841

RESUMO

OBJECTIVE: To examine the clinical effects of revision endoscopic frontal sinus surgery (RESS) through modified agger nasi (MAN)-middle turbinate resection on refractory chronic rhinosinusitis (CRS). METHODS: We reviewed 156 patients who were treated for refractory CRS from February 2012 to August 2014. These patients had been diagnosed with refractory CRS by computed tomography and endoscopy and had received several surgical and medical treatments in the past, but their condition had not been cured. They were divided into the observation group (RESS through MAN-middle turbinate resection, n = 78) and the control group (endoscopic sinus surgery, n = 78). Complete or partial control of the patient's symptoms and signs suggested that the treatment was effective, and no improvement in the symptoms and signs indicated that the treatment was ineffective. RESULTS: The 6-month treatment efficacy rate was significantly higher in the observation group (91.03%) than in the control group (71.79%). The observation group had a significantly lower complication rate (7.69%) and recurrence rate (3.85%) than the control group (17.95% and 12.82%, respectively). CONCLUSION: RESS through MAN-middle turbinate resection together with adequate perioperative preparation has a significant effect on the outcome of refractory CRS and is worthy of clinical promotion.


Assuntos
Endoscopia/métodos , Seio Frontal/cirurgia , Sinusite Frontal/cirurgia , Procedimentos Cirúrgicos Nasais/métodos , Rinite/cirurgia , Adolescente , Adulto , Idoso , Doença Crônica , Feminino , Seio Frontal/diagnóstico por imagem , Sinusite Frontal/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva , Reoperação , Estudos Retrospectivos , Rinite/diagnóstico por imagem , Resultado do Tratamento , Conchas Nasais/diagnóstico por imagem , Conchas Nasais/cirurgia
18.
Med Sci Monit ; 27: e929142, 2021 Apr 04.
Artigo em Inglês | MEDLINE | ID: mdl-33813590

RESUMO

BACKGROUND The impaction of an esophageal foreign body is an urgent situation requiring emergency intervention. This retrospective study from a single center in China aimed to compare endoscopy alone with surgery converted from endoscopy for the removal of esophageal foreign bodies in adults. MATERIAL AND METHODS A total of 252 patients with esophageal foreign bodies were divided into 3 groups based on the treatment received: endoscopy, surgery converted from endoscopy, or surgery only. Patients' clinical and demographic data were retrospectively reviewed and analyzed. RESULTS The diameter of the foreign bodies in patients treated by surgery converted from endoscopy was larger than that of those treated by simple endoscopy (5.2 cm vs 2.7 cm, P=0.0003). The cervical or upper thoracic esophagus was the most common site of foreign body impaction treated by surgery converted from endoscopy, while the foreign bodies removed by simple endoscopy were frequently lodged at the middle thoracic esophagus (P=0.021). Bone-related foreign bodies and dentures were most likely impacted in patients treated with surgery converted from endoscopy. The factors influencing the choice of treatment included foreign body maximal diameter and location. CONCLUSIONS Larger foreign bodies that were found in the cervical or upper thoracic esophagus were associated with failed endoscopic removal and required surgical removal. Irregularly shaped or sharp foreign bodies, including dentures and fishbones, required surgical removal. These findings may guide future decisions of first-line approaches for the removal of esophageal foreign bodies.


Assuntos
Endoscopia/métodos , Esôfago/cirurgia , Corpos Estranhos/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , China , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
19.
Lancet Gastroenterol Hepatol ; 6(6): 482-497, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33872568

RESUMO

The majority of patients with Crohn's disease and a proportion of patients with ulcerative colitis will ultimately require surgical treatment despite advances in diagnosis, therapy, and endoscopic interventions. The surgical procedures that are most commonly done include bowel resection with anastomosis, strictureplasty, faecal diversion, and ileal pouch. These surgical treatment modalities result in substantial alterations in bowel anatomy. In patients with inflammatory bowel disease, endoscopy plays a key role in the assessment of disease activity, disease recurrence, treatment response, dysplasia surveillance, and delivery of endoscopic therapy. Endoscopic evaluation and management of surgically altered bowel can be challenging. This consensus guideline delineates anatomical landmarks and endoscopic assessment of these landmarks in diseased and surgically altered bowel.


Assuntos
Procedimentos Cirúrgicos do Sistema Digestório/efeitos adversos , Endoscopia/métodos , Doenças Inflamatórias Intestinais/cirurgia , Intestinos/patologia , Adulto , Anastomose Cirúrgica/métodos , Pontos de Referência Anatômicos/diagnóstico por imagem , Colite Ulcerativa/diagnóstico , Colite Ulcerativa/cirurgia , Bolsas Cólicas/efeitos adversos , Consenso , Constrição Patológica/cirurgia , Doença de Crohn/diagnóstico , Doença de Crohn/cirurgia , Humanos , Intestinos/anatomia & histologia , Intestinos/cirurgia , Pessoa de Meia-Idade , Guias de Prática Clínica como Assunto , Proctocolectomia Restauradora/métodos , Recidiva , Índice de Gravidade de Doença
20.
Rev. cuba. anestesiol. reanim ; 20(1): e701, ene.-abr. 2021.
Artigo em Espanhol | LILACS, CUMED | ID: biblio-1156367

RESUMO

Introducción: La convivencia con la infección por COVID-19 en Cuba supone un reto actual de adaptación a todos los entornos hospitalarios y de salud, creación de protocolos y nuevos modelos de asistencia. La intervención sobre la vía aérea en sus diferentes formas, conlleva un riesgo de contaminación al personal de la salud. Objetivo: Describir las consideraciones anestésicas en los procedimientos laparoscópicos y endoscópicos durante la pandemia COVID-19. Métodos: Se realizó un estudio cualitativo, de investigación-acción, apoyado en el análisis de documentos y la observación participante de las acciones tomadas en el Centro Nacional de Cirugía de Mínimo Acceso en el curso de los cuatro meses transcurridos a partir de que se identificara el primer caso de COVID-19 en Cuba. Resultados: Se establecieron las recomendaciones anestésicas para el procedimiento de actuación durante la COVID-19 en el Centro Nacional de Cirugía de Mínimo Acceso, que dictan las acciones para el tratamiento de los pacientes y la protección de los trabajadores. Esto posibilita mantener la calidad de los servicios médico quirúrgicos en estos escenarios de riesgo. Conclusiones: La evaluación y tratamiento anestésico estandarizado de los pacientes ante el brote de COVID-19 y en la fase poscovid permite optimizar la seguridad del paciente y el personal sanitario. Es importante el cumplimiento de los protocolos dirigidos hacia el control estricto de la parada quirúrgica, uso adecuado de los equipos de protección personal, disminución de los aerosoles con métodos de barrera y la desinfección del salón y equipos al concluir la intervención(AU)


Introduction: Coexistence with COVID-19 infection in Cuba is a current challenge of adaptation to all hospital and health settings, creation of protocols and new models of care. The airway approach in its different forms represents a risk of contamination of the health personnel. Objective: To describe the anesthetic considerations in laparoscopic and endoscopic procedures during the COVID-19 pandemic. Methods: A qualitative, action-research study was carried out, supported by the analysis of documents and participant observation of the actions taken in the National Center for Minimally-Invasive Surgery in the course of four months after the first case of COVID-19 was identified in Cuba. Results: Anesthetic recommendations were established for the action procedure during COVID-19 in the National Center for Minimally-Invasive Surgery, which dictate the actions for the treatment of patients and the protection of workers. This makes it possible to maintain the quality of surgical medical services in these risk settings. Conclusions: Assessment and standardized anesthetic treatment of patients in the face of the COVID-19 outbreak and in the post-COVID phase allows optimizing the safety of the patient and the healthcare personnel. It is important to comply with the protocols aimed at controlling strictly the surgical setting, proper use of personal protective equipment, reduction of aerosols with barrier methods, and disinfection of the room and equipment at the conclusion of the intervention(AU)


Assuntos
Humanos , Infecções por Coronavirus/prevenção & controle , Protocolos , Segurança do Paciente , Laparoscopia/métodos , Endoscopia/métodos , Anestesia/normas
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