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Surgical patient safety

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https://www.readbyqxmd.com/read/28351116/management-of-people-with-early-or-very-early-stage-hepatocellular-carcinoma-an-attempted-network-meta-analysis
#1
REVIEW
Avik Majumdar, Davide Roccarina, Douglas Thorburn, Brian R Davidson, Emmanuel Tsochatzis, Kurinchi Selvan Gurusamy
BACKGROUND: Hepatocellular carcinoma (primary liver cancer) is classified in many ways. The Barcelona Clinic Liver Cancer (BCLC) group staging classifies the cancer based on patient's life expectancy. People with very early- or early-stage hepatocellular carcinoma have single tumour or three tumours of maximum diameter of 3 cm or less, Child-Pugh status A to B, and performance status 0 (fully functional). Management of hepatocellular carcinoma is uncertain. OBJECTIVES: To assess the comparative benefits and harms of different interventions used in the treatment of early or very early hepatocellular carcinoma through a network meta-analysis and to generate rankings of the available interventions according to their safety and efficacy...
March 28, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28350942/prevention-of-surgical-site-infection-in-spine-surgery
#2
Paul A Anderson, Jason W Savage, Alexander R Vaccaro, Kristen Radcliff, Paul M Arnold, Brandon D Lawrence, Mohammed F Shamji
BACKGROUND: Spine surgery is complicated by an incidence of 1% to 9% of surgical site infection (SSI). The most common organisms are gram-positive bacteria and are endogenous, that is are brought to the hospital by the patient. Efforts to improve safety have been focused on reducing SSI using a bundle approach. The bundle approach applies many quality improvement efforts and has been shown to reduce SSI in other surgical procedures. OBJECTIVE: To provide a narrative review of practical solutions to reduce SSI in spine surgery...
March 1, 2017: Neurosurgery
https://www.readbyqxmd.com/read/28350685/inadequate-enoxaparin-dosing-predicts-90-day-venous-thromboembolism-risk-among-plastic-surgery-inpatients-an-examination-of-enoxaparin-pharmacodynamics
#3
Christopher J Pannucci, W Bradford Rockwell, Maureen Ghanem, Kory I Fleming, Arash Momeni, Jayant Agarwal
BACKGROUND: Evidence-based plastic surgery guidelines support the effectiveness of once-daily enoxaparin prophylaxis. Despite prophylaxis, one in 25 highest risk patients has a venous thromboembolism event. The authors examined the pharmacodynamics of standard enoxaparin doses in plastic surgery patients to examine whether patient-level factors predict enoxaparin metabolism, whether inadequate enoxaparin dose predicts downstream venous thromboembolism events, and whether a pharmacist-driven dose-adjustment protocol was effective...
April 2017: Plastic and Reconstructive Surgery
https://www.readbyqxmd.com/read/28346915/safety-and-efficacy-of-flexible-ureteroscopy-in-combination-with-holmium-laser-lithotripsy-for-the-treatment-of-bilateral-upper-urinary-tract-calculi
#4
Bing Yang, Hao Ning, Zheng Liu, Yi Zhang, Chengfan Yu, Xianghua Zhang, Dongliang Pan, Kejia Ding
OBJECTIVE: To retrospectively evaluate the safety and efficacy of flexible ureteroscopy (FURS) in combination with holmium laser lithotripsy for the treatment of bilateral upper urinary calculi. MATERIALS AND METHODS: The stone-free status was defined as the absence of any stones or asymptomatic status, or the presence of clinically insignificant residual fragments <4 mm, and was assessed by plain kidney, ureter, and bladder X-ray. The operative time, stone-free rates (SFRs), serum creatinine (SCr), and complications were recorded...
March 28, 2017: Urologia Internationalis
https://www.readbyqxmd.com/read/28345371/ewma-document-negative-pressure-wound-therapy
#5
Jan Apelqvist, Christian Willy, Ann-Mari Fagerdahl, Marco Fraccalvieri, Malin Malmsjö, Alberto Piaggesi, Astrid Probst, Peter Vowden
1. Introduction Since its introduction in clinical practice in the early 1990's negative pressure wounds therapy (NPWT) has become widely used in the management of complex wounds in both inpatient and outpatient care.(1) NPWT has been described as a effective treatment for wounds of many different aetiologies(2,3) and suggested as a gold standard for treatment of wounds such as open abdominal wounds,(4-6) dehisced sternal wounds following cardiac surgery(7,8) and as a valuable agent in complex non-healing wounds...
March 1, 2017: Journal of Wound Care
https://www.readbyqxmd.com/read/28344618/patient-and-lesion-tailored-algorithm-of-endovascular-treatment-for-arterial-occlusive-disease-of-extracranial-arteries-supplying-the-brain-safety-of-the-treatment-at-30-day-follow-up
#6
Paweł Latacz, Marian Simka, Paweł Brzegowy, Piotr Janas, Marek Kazibudzki, Piotr Pieniążek, Andrzej Ochała, Tadeusz Popiela, Tomasz Mrowiecki
INTRODUCTION: Although surgical endarterectomy remains the treatment of choice for carotid artery stenosis, stenting plays an important role as an alternative treatment modality, especially in high-risk patients. The actual safety profile associated with stenting procedures is probably better than that reported by randomized controlled trials. AIM: To assess the safety of stent implantations in extracranial arteries supplying the brain, and also to identify risk factors associated with this procedure...
2017: Postępy W Kardiologii Interwencyjnej, Advances in Interventional Cardiology
https://www.readbyqxmd.com/read/28342650/subtotal-cholecystectomy-for-the-hostile-gallbladder-failure-to-control-the-cystic-duct-results-in-significant-morbidity
#7
Michael E Lidsky, Paul J Speicher, Brian Ezekian, Edwin W Holt, Daniel P Nussbaum, Anthony W Castleberry, Alexander Perez, Theodore N Pappas
BACKGROUND: Outcomes following the inability to control the cystic duct due to a hostile triangle of Calot during cholecystectomy remain unknown. The purpose of this study was to analyze the safety and efficacy of subtotal cholecystectomy, with attention to the necessity for secondary interventions. METHODS: Sixteen thousand five hundred ninety six cholecystectomies from January 2002 to August 2014 were reviewed, identifying patients managed with subtotal cholecystectomy, defined as the inability to isolate/transect the cystic duct...
March 22, 2017: HPB: the Official Journal of the International Hepato Pancreato Biliary Association
https://www.readbyqxmd.com/read/28342263/surgical-pitfalls-of-jejunal-vein-anatomy-in-pancreaticoduodenectomy
#8
Yoshiya Ishikawa, Daisuke Ban, Satoshi Matsumura, Yusuke Mitsunori, Takanori Ochiai, Atsushi Kudo, Shinji Tanaka, Minoru Tanabe
BACKGROUND: Pancreaticoduodenectomy (PD) is the standard surgical procedure for treating pancreatic head cancers. Considerable knowledge of proximal jejunal and pancreatic vein anatomy is a prerequisite for performing PD surgery safely, yet there appear to be no detailed descriptions of first and second jejunal vein (J1V, J2V) anatomy available in the literature. STUDY DESIGN: Adults with hepatobiliary-pancreatic disease underwent multidetector-row computed tomography with intravenous contrast (n=155), and SYNAPSE 3D(®) (Fujifilm Medical, Tokyo, Japan) was used to generate 3D-CT images...
March 24, 2017: Journal of Hepato-biliary-pancreatic Sciences
https://www.readbyqxmd.com/read/28342127/robotic-single-site-plus-one-port-distal-pancreatectomy
#9
Sung Hyun Kim, Chang Moo Kang, Woo Jung Lee
Laparoscopic distal pancreatectomy is regarded as safe and effective surgical approach in benign and low-grade malignant tumor of the pancreas. With the advances of laparoscopic techniques and instruments, many efforts to reduce the number of the trocar site has been made. There are a few available surgical techniques of laparoscopic single-site (single port or reduced port) distal pancreatectomy, suggesting its safety and feasibility. However, it is true that laparoscopic single-site distal pancreatectomy is difficult and technically quite demanding...
March 24, 2017: Surgical Endoscopy
https://www.readbyqxmd.com/read/28341919/intraoperative-hydroxyethyl-starch-70-0-5-administration-may-increase-postoperative-bleeding-a-retrospective-cohort-study
#10
Toko Fukushima, Shigehiko Uchino, Tomoko Fujii, Masanori Takinami, Shoichi Uezono
PURPOSE: Studies evaluating the safety of hydroxyethyl starch with a molecular weight of 70 kDa and a molar substitution ratio of 0.5 (HES 70/0.5) are scarce in the literature. In this study, we investigated the relationship between intraoperative HES 70/0.5 administration and postoperative bleeding. METHODS: This is a single-center, retrospective cohort study. Subjects were postoperative adult patients who stayed in the intensive care unit (ICU) for more than 24 h during the period from January 1, 2010 to December 31, 2012...
March 24, 2017: Journal of Anesthesia
https://www.readbyqxmd.com/read/28341916/long-term-results-following-antibiotic-treatment-of-acute-appendicitis-in-adults
#11
K Lundholm, J Hansson-Assarsson, C Engström, B-M Iresjö
BACKGROUND: Antibiotic treatment of acute appendicitis has gained interest and inquiries. Reports have demonstrated both safety and high resolution of symptoms and inflammation following antibiotic treatment of appendicitis, but information on long-term results is required. Our present aim was therefore to evaluate long-term recurrence rate of initial antibiotics-alone treatment for suspected acute appendicitis. METHODS: Patients with favourable response to antibiotics in earlier randomized (RCT, n = 97) and population-based (PBT, n = 342) studies as well as subsequently treated non-randomized (Non-R, n = 271) patients are evaluated for long-term risk to relapse demanding surgical appendectomy; altogether 710 patients...
March 24, 2017: World Journal of Surgery
https://www.readbyqxmd.com/read/28341868/risk-factors-of-reoperation-after-pancreatic-resection
#12
Heather G Lyu, Gaurav Sharma, Ethan Brovman, Julius Ejiofor, Aparna Repaka, Richard D Urman, Jason S Gold, Edward E Whang
BACKGROUND: Pancreatic resection is associated with a high incidence of postoperative complications, some of which require reoperation. AIMS: To analyze the incidence of and risk factors for reoperation following pancreatectomy. METHODS: Pre- and postoperative information and procedure characteristics of 15,549 patients having undergone pancreatectomy in 435 hospitals participating in the American College of Surgeons National Surgical Quality Improvement Program from 2011 to 2014 were analyzed...
March 24, 2017: Digestive Diseases and Sciences
https://www.readbyqxmd.com/read/28340837/complications-in-donors-using-right-liver-graft-analysis-of-280-consecutive-cases
#13
M Özbilgin, T Ünek, T Egeli, C Ağalar, S Ozkardesler, E Karadeniz, H Ellidokuz, F Obuz, I Astarcıoğlu
INTRODUCTION: Living donor liver transplantation (LDLT) is performed with increasing frequency worldwide due to the shortage of donated organs. It is a life-saving procedure for the recipient, but, on the other hand, a major surgical procedure for healthy donors and it may cause morbidity and even mortality. PATIENTS AND METHODS: This research was completed at Dokuz Eylül University Faculty of Medicine Hospital General Surgery Department Liver Transplant Unit and included 280 cases (4 with simultaneous liver and kidney transplants from living donors) who underwent donor right hepatectomy for LDLT from June 2000 to June 2016...
April 2017: Transplantation Proceedings
https://www.readbyqxmd.com/read/28340827/end-to-side-versus-end-to-end-uretero-ureteral-anastomosis-in-kidney-transplant-recipients-with-disused-atrophic-bladder
#14
V Turunç, A Eroğlu, B Tabandeh
BACKGROUND: Extravesical Lich-Gregoir ureteroneocystostomy (UC) is the most widely used method for urinary reconstruction during kidney transplantation. Sometimes it is difficult to perform UC in cases with disused atrophic bladder. Pyelo-ureteral anastomosis (PUA) and uretero-ureteral anastomosis (UUA) may be preferred to UC for these patients. METHODS: We retrospectively reviewed the charts of 833 kidney transplant recipients operated on by our transplantation team between July 2010 and November 2014...
April 2017: Transplantation Proceedings
https://www.readbyqxmd.com/read/28340825/should-interventional-radiology-or-open-surgery-be-the-first-choice-for-the-management-of-ureteric-stenosis-after-transplantation-dual-center-study
#15
C Simsek, S M Dogan, T Piskin, G Okut, K Cayhan, A Aykas, E Tatar, A Uslu
BACKGROUND: Ureteric stenosis (US) is the most common urologic complication after kidney transplantation. In this dual-center retrospective study we compared the efficacy and safety of open surgery versus interventional radiology for the management of US. METHODS: From 2009 to January 2016, US was treated by surgical revision in 22 (7.8%) out of 281 recipients at one center (group 1) and managed by percutaneous nephrostomy with antegrade nephroureteral stenting (PNAS) in 22 (14...
April 2017: Transplantation Proceedings
https://www.readbyqxmd.com/read/28340242/insertion-of-miniaturized-cardiac-monitors-outside-the-catheter-operating-room-experience-and-practical-advice
#16
Jan Steffel, David Jay Wright, Harald Schäfer, Tabinda Rashid-Fadel, Thorsten Lewalter
Minor surgical procedures are increasingly being performed as outpatient procedures in settings outside hospital operating rooms (ORs). In electrophysiology, the recent miniaturization of insertable cardiac monitors (ICMs) has enabled the routine insertion of the device as a minimally invasive procedure without the need of a catheter OR. However, a shift to office-based environments for minor surgical procedures is associated with some concerns, particularly with respect to patient- and procedure-related safety in the new setting...
March 17, 2017: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
https://www.readbyqxmd.com/read/28340054/outcomes-of-atrial-arrhythmia-radiofrequency-catheter-ablation-in-patients-with-ebstein-s-anomaly
#17
Abdallah Hassan, Nicholas Y Tan, Htin Aung, Heidi M Connolly, David O Hodge, Emily R Vargas, Bryan C Cannon, Douglas L Packer, Samuel J Asirvatham, Christopher J McLeod
Aims: Atrial arrhythmias are common in patients with Ebstein's anomaly (EA) despite cardiac surgical repair and concomitant Maze procedures. We aimed to evaluate the outcome of radiofrequency catheter ablation in this group of patients. Methods and results: All patients with EA and atrial arrhythmias who underwent catheter ablation for atrial arrhythmias between 1/1999 and 1/2016 were included. Atrial arrhythmia recurrence was identified as the primary outcome; secondary outcomes included repeat ablation, need for antiarrhythmic medications after ablation, and death...
February 27, 2017: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
https://www.readbyqxmd.com/read/28340017/patient-reporting-of-undesirable-events-a-pilot-study-in-china
#18
Jia Yan, Ke Liu, Lifeng Zhang, Ting Chu, Xuehua Wang
Objective: To identify the frequency of undesirable events reported by patients during hospitalization and explore the relationship between undesirable events and perception of safety and satisfaction with care in China. Design: Cross-sectional survey. Setting: Chinese university hospital. Participants: Adult patients (N = 341) discharged from medical and surgical departments. Interventions: Patients were interviewed post-discharge using a survey instrument to ask whether they had experienced specific undesirable events during hospitalization...
March 10, 2017: International Journal for Quality in Health Care
https://www.readbyqxmd.com/read/28338437/contralateral-peripheral-neurotization-for-a-hemiplegic-hindlimb-after-central-neurological-injury
#19
Mou-Xiong Zheng, Xu-Yun Hua, Su Jiang, Yan-Qun Qiu, Yun-Dong Shen, Wen-Dong Xu
OBJECTIVE Contralateral peripheral neurotization surgery has been successfully applied to rescue motor function of the hemiplegic upper extremity in patients with central neurological injury (CNI). It may contribute to strengthened neural pathways between the contralesional cortex and paretic limbs. However, the effect of this surgery in the lower extremities remains unknown. In the present study the authors explored the effectiveness and safety of contralateral peripheral neurotization in treating a hemiplegic lower extremity following CNI in adult rats...
March 24, 2017: Journal of Neurosurgery
https://www.readbyqxmd.com/read/28338117/endovascular-treatment-for-acute-mesenteric-ischaemia-in-a-young-woman-with-polyarterial-disease
#20
Mihai C Ober, Calin Homorodean, Dan A Tataru, Antonia E Macarie, Camelia D Ober, Dan M Olinic
BACKGROUND: Acute mesenteric ischaemia is a condition with a grim prognosis on conservative treatment. Endovascular revascularisation is a promising approach for some of these patients. CASE REPORT: We present the case of a 44-year-old woman with a history of severe arterial hypertension, left leg claudication, and overlooked symptoms of chronic mesenteric ischaemia for one year, who was admitted for severe abdominal pain for one week. Computed tomographic angiography (CTA) showed acute mesenteric ischaemia by occlusion of the coeliac trunk and the superior mesenteric artery (SMA), without bowel perforation...
March 2017: Journal of Gastrointestinal and Liver Diseases: JGLD
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