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Advances in general surgery

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https://www.readbyqxmd.com/read/28108823/which-clinical-and-patient-factors-influence-the-national-economic-burden-of-hospital-readmissions-after-total-joint-arthroplasty
#1
Steven M Kurtz, Edmund C Lau, Kevin L Ong, Edward M Adler, Frank R Kolisek, Michael T Manley
BACKGROUND: The Affordable Care Act of 2010 advanced the economic model of bundled payments for total joint arthroplasty (TJA), in which hospitals will be financially responsible for readmissions, typically at 90 days after surgery. However, little is known about the financial burden of readmissions and what patient, clinical, and hospital factors drive readmission costs. QUESTIONS/PURPOSES: (1) What is the incidence, payer mix, and demographics of THA and TKA readmissions in the United States? (2) What patient, clinical, and hospital factors are associated with the cost of 30- and 90-day readmissions after primary THA and TKA? (3) Are there any differences in the economic burden of THA and TKA readmissions between payers? (4) What types of THA and TKA readmissions are most costly to the US hospital system? METHODS: The recently developed Nationwide Readmissions Database from the Healthcare Cost and Utilization Project (2006 hospitals from 21 states) was used to identify 719,394 primary TJAs and 62,493 90-day readmissions in the first 9 months of 2013 based on International Classification of Diseases, 9th Revision, Clinical Modification codes...
January 20, 2017: Clinical Orthopaedics and related Research
https://www.readbyqxmd.com/read/28104012/-simultaneous-triple-semicircular-canal-plugging-and-cochlear-implantation-in-advanced-meniere-s-disease
#2
D G Zhang, L Xu, Y C Han, Y F Lyu, J F Luo, Y W Li, R J Wang, Z M Fan, H B Wang
Objective: To evaluate the feasibility of combining simultaneous triple semicircular canal plugging (TSCP) and cochlear implantation (CI) to treat vertigo and hearing loss in advanced Meniere's disease(MD) patients, so as to provide an alternative surgical procedure for treating this disorder. Methods: Data from seven patients, who were referred to our hospital and diagnosed with unilateral MD strictly meeting the criteria issued by Chinese Academy of Otolaryngology-Head and Neck Surgery Committee (2006), from Jan...
January 7, 2017: Zhonghua Er Bi Yan Hou Tou Jing Wai Ke za Zhi, Chinese Journal of Otorhinolaryngology Head and Neck Surgery
https://www.readbyqxmd.com/read/28098564/male-breast-cancer-originating-in-an-ectopic-breast-tissue-in-the-umbilicus-a-case-report
#3
Nikolaos Kopanakis, Olympia Tzaida, Georgios Nikolaou, Dimitrios Ermidis, Vassiliki Manou, Elias Efstathiou, John Spiliotis
INTRODUCTION: Accessory breast tissue is a rare finding in the general population with an incidence of 1-2%. Carcinomas of accessory breast tissue account for ∼0.3% of breast cancers, 5% of which are arising within a supernumerary breast. They are usually diagnosed at a later stage compared with breast cancer, due to their rarity and low clinical suspicion. CASE PRESENTATION: We present the case of a 58 years old male who was admitted to our hospital for an umbilical hernia, surgical repair...
November 4, 2016: Annali Italiani di Chirurgia
https://www.readbyqxmd.com/read/28096041/advance-care-planning-in-adults-with-congenital-heart-disease-a-patient-priority
#4
Lisa X Deng, Lacey P Gleason, Abigail M Khan, David Drajpuch, Stephanie Fuller, Leah A Goldberg, Christopher E Mascio, Sara L Partington, Lynda Tobin, Yuli Y Kim, Adrienne H Kovacs
BACKGROUND: Adult congenital heart disease (ACHD) patients with moderate or great defect complexity are at risk for premature death. Although early engagement in advance care planning (ACP) is recommended, previous research suggests that it seldom occurs. METHODS: This study investigated ACHD patient preferences for ACP and factors that impact preferences. ACHD patients completed an ACP preferences questionnaire, the Hospital Anxiety and Depression Scale and a measure of attachment styles...
January 4, 2017: International Journal of Cardiology
https://www.readbyqxmd.com/read/28089285/thick-keratoconic-cornea-associated-with-posterior-polymorphous-corneal-dystrophy
#5
K Zaarour, E Slim, J Antoun, N Waked
INTRODUCTION: We herein report a case of bilateral unusually thick non-edematous keratoconic corneas with associated endothelial features of posterior polymorphous corneal dystrophy (PPCD). CASE REPORT: We report the case of a 27-year-old myopic woman who presented for refractive surgery. Slit lamp exam showed bilateral corneal protrusion with diffuse deep stromal and endothelial vesicular opacities and small paracentral bands. Topography showed generalized advanced corneal steepening in both eyes with increased anterior and posterior central corneal elevations in comparison to the best fit sphere...
January 12, 2017: Journal Français D'ophtalmologie
https://www.readbyqxmd.com/read/28061541/a-prospective-multicenter-phase-ii-trial-of-low-dose-erlotinib-as-maintenance-treatment-after-platinum-doublet-chemotherapy-for-advanced-non-small-cell-lung-cancer-harboring-egfr-mutation
#6
Satoshi Hirano, Go Naka, Yuichiro Takeda, Motoyasu Iikura, Noriko Hayama, Asako Yanagisawa, Hiroyuki Amano, Makoto Nakamura, Sukeyuki Nakamura, Hiroshi Tabeta, Haruhito Sugiyama
BACKGROUND: Maintenance therapy with full-dose erlotinib for patients with advanced non-small cell lung cancer (NSCLC) has demonstrated a significant overall survival (OS) benefit. However, 150 mg/day of erlotinib seems too toxic as maintenance therapy. This study aimed to evaluate the efficacy and safety of low-dose erlotinib (25 mg/day) as maintenance treatment after platinum doublet chemotherapy in NSCLC harboring epidermal growth factor receptor (EGFR) mutation. METHODS: Activated EGFR-mutation-positive NSCLC patients who did not progress after first-line platinum-doublet chemotherapy, ≥20 and ≤85 years old, with performance status (PS) 0-3 were included in this study...
December 2016: Chinese Clinical Oncology
https://www.readbyqxmd.com/read/28059648/validation-of-effectiveness-of-keyhole-clipping-in-nonfrail-elderly-patients-with-unruptured-intracranial-aneurysms
#7
Kentaro Mori, Kojiro Wada, Naoki Otani, Arata Tomiyama, Terushige Toyooka, Kazuya Fujii, Kosuke Kumagai, Satoru Takeuchi, Satoshi Tomura, Takuji Yamamoto, Yasuaki Nakao, Hajime Arai
OBJECTIVE Advanced age is known to be associated with a poor prognosis after surgical clipping of unruptured intracranial aneurysms (UIAs). Keyhole clipping techniques have been introduced for less invasive treatment of UIAs. In this study, the authors compared the complications and clinical and radiological outcomes after keyhole clipping between nonfrail elderly patients (≥ 70 years) and nonelderly patients. METHODS Keyhole clipping (either supraorbital or pterional) was performed to treat 260 cases of relatively small (≤ 10 mm) anterior circulation UIAs...
January 6, 2017: Journal of Neurosurgery
https://www.readbyqxmd.com/read/28056476/-advanced-systemic-sclerosis-endovascular-reconstruction-of-the-aortic-bifurcation-for-limb-salvage
#8
Florian Stein, Lars Kamper, Konstantinos Meletiadis, Ulrich Kusenack, Patrick Haage
History and admission findings A 69-year-old patient was initially hospitalized because of a 1.5 cm ulceration at the back of the right foot which had existed for the last year and become increasingly swollen and painful. Medical history revealed PmScl-positive systemic sclerosis presenting with a massive calcinosis cutis, advanced pulmonary fibrosis and peripheral artery disease. Examinations Inflammatory markers were normal. MR-Angiography of the lower extremities revealed a multi-segmental high-grade stenosis of the aortic bifurcation due to extensively calcified plaques...
January 2017: Deutsche Medizinische Wochenschrift
https://www.readbyqxmd.com/read/28056246/-the-present-status-and-future-prospects-of-application-of-digital-medical-technology-in-general-surgery-in-china
#9
C H Fang, Y Y LauWan, W Cai
It has been almost 10 years since digital medical technology has started to becommonly used in general surgery in China.Led by advances in three dimensional(3D) visualization technology, virtual reality, simulation surgery, and 3D printing, digital medical technology have played important roles in changing the current practice of general surgery in China to become more effective by improving diagnostic accuracy and a better choice of therapeutic procedure with a resultant increased surgical success rate and a decreased surgical risks...
January 1, 2017: Zhonghua Wai Ke za Zhi [Chinese Journal of Surgery]
https://www.readbyqxmd.com/read/28056121/comparing-patient-casual-observer-and-expert-perception-of-permanent-unilateral-facial-paralysis
#10
Jacob K Dey, Lisa E Ishii, Jason C Nellis, Kofi D O Boahene, Patrick J Byrne, Masaru Ishii
Importance: Differences in perception of facial paralysis among patients, casual observers, and experts may have implications for outcomes research and patient care. Objective: To compare multiple domains of casual observer and expert perception with the actual experience of patients with permanent unilateral facial paralysis. Design, Setting, and Participants: This investigation was a prospective cohort study conducted at an academic tertiary referral center...
January 5, 2017: JAMA Facial Plastic Surgery
https://www.readbyqxmd.com/read/28053815/the-rare-and-challenging-presentation-of-gastric-cancer-during-pregnancy-a-report-of-three-cases
#11
Sergio Pacheco, Enrique Norero, Claudio Canales, José Miguel Martínez, María Elisa Herrera, Carolina Muñoz, Nicolás Jarufe
Pregnancy-associated gastric cancer is extremely rare. In many cases, it is diagnosed at an advanced stage because the symptoms during pregnancy are generally overlooked. We report three cases of gastric cancer during pregnancy with various outcomes. The first case included a patient with stage IV gastric cancer who received palliative chemotherapy. This patient had a preterm birth and died 7 months after diagnosis. The second case received neoadjuvant chemotherapy during pregnancy and a total gastrectomy was performed after delivery...
December 2016: Journal of Gastric Cancer
https://www.readbyqxmd.com/read/28047377/mo-fg-202-02-automated-plan-quality-assurance-integrated-with-eclipse-using-varian-s-esapi-interface
#12
E Schreibmann, I Crocker, A Dhabaan, E Elder
PURPOSE: Treatment plan compliance to physician's intent is still assessed by hand in clinical practice by visually comparing prescription details against corresponding plan values. We report on a script that uses the Varian's programming interface to automate the scoring of treatment plan dose values to the physician's prescribed constraints. METHODS: The Eclipse Scripting Advance Programming Interface (ESAPI) is a FDA-approved scripting environment written in C# that allows programming access to a patient's record in Aria and Eclipse...
June 2016: Medical Physics
https://www.readbyqxmd.com/read/28045741/is-your-graduating-general-surgery-resident-qualified-to-take-trauma-call-a-15-year-appraisal-of-the-changes-in-general-surgery-education-for-trauma
#13
Aaron Strumwasser, Daniel Grabo, Kenji Inaba, Kazuhide Matsushima, Damon Clark, Elizabeth Benjamin, Lydia Lam, Demetrios Demetriades
BACKGROUND: Trauma training in general surgery residency is undergoing an evolution. Hour restrictions, the growth of subspecialty care and the trend towards non-operative management have altered resident exposure to operative trauma. We sought to identify trends in resident trauma training since the inception of the 80-hour workweek. METHODS: The Accreditation Council for General Medical Education (ACGME) Case Log Statistical Reports for Surgery was abstracted for general surgery resident trauma operative volume for the years 1999-2014...
December 31, 2016: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28045115/skeletal-related-events-significantly-impact-health-related-quality-of-life-in-metastatic-castration-resistant-prostate-cancer-data-from-prevail-and-affirm-trials
#14
F Saad, C Ivanescu, D Phung, Y Loriot, S Abhyankar, T M Beer, B Tombal, S Holmstrom
BACKGROUND: We investigated the impact of skeletal-related events (SREs) on health-related quality of life (HRQoL) in patients with metastatic castration-resistant prostate cancer (mCRPC) in phase III trials of enzalutamide versus placebo. METHODS: Patients with mCRPC experiencing at least one SRE during AFFIRM and PREVAIL were assessed for trajectory-adjusted mean change in HRQoL by first SRE using Functional Assessment of Cancer Therapy-Prostate (FACT-P; AFFIRM, three domains, and PREVAIL, nine domains) and EQ-5D (PREVAIL) instruments...
January 3, 2017: Prostate Cancer and Prostatic Diseases
https://www.readbyqxmd.com/read/28041996/utilization-of-perioperative-systemic-chemotherapy-in-upper-tract-urothelial-carcinoma
#15
Greg E Gin, Nora H Ruel, Steven V Kardos, John P Sfakianos, Edward Uchio, Clayton S Lau, Bertram E Yuh
INTRODUCTION: Evidence for the use of perioperative chemotherapy (PC) in upper tract urothelial carcinoma (UTUC) is largely derived from level I evidence for invasive urothelial carcinoma of the bladder (UCB). There has been an increase in PC for urothelial carcinoma of the bladder, as it has disseminated into clinical practice. Therefore, we sought to not only analyze trends in the utilization of PC in UTUC, but also assess factors associated with its use in a large cancer registry database...
December 29, 2016: Urologic Oncology
https://www.readbyqxmd.com/read/28034287/the-ignored-role-of-intraoperative-hypotension-in-producing-postoperative-acute-kidney-injury-an-obligatory-appeal-for-more-preventative-nephrology
#16
Macaulay Amechi Chukwukadibia Onuigbo, Nneoma Agbasi
Intraoperative hypotension (IOH) invariably follows the induction of general anesthesia. There is this general consensus that IOH is beneficial - less bleeding, less blood transfusions, shorter surgery times - and absent adverse consequences on renal, hepatic and neurological functions. Nevertheless, a critical review of the literature revealed that past research studied younger patients with normal kidney function, short surgery times while excluding patients with advanced CKD and uncontrolled hypertension...
December 29, 2016: Current Hypertension Reviews
https://www.readbyqxmd.com/read/28030435/feasibility-and-technique-for-transvaginal-natural-orifice-transluminal-endoscopic-surgery-liver-resection-a-porcine-model
#17
Toshio Katagiri, Yuichiro Otsuka, Santiago Horgan, Bryan J Sandler, Garth R Jacobsen, Alisa M Coker, Masaru Tsuchiya, Tetsuya Maeda, Hironori Kaneko
INTRODUCTION: Natural orifice transluminal endoscopic surgery (NOTES) is a challenging minimally invasive procedure. Although laparoscopic techniques for liver resection are gaining acceptance worldwide, few studies have investigated NOTES liver resection. We used a porcine model to assess the feasibility and safety of transvaginal NOTES liver resection (TV NOTES LR). MATERIALS AND METHODS: Nine female pigs underwent TV NOTES LR. A nonsurvival acute porcine model with general anesthesia was used in all cases...
December 26, 2016: Surgical Laparoscopy, Endoscopy & Percutaneous Techniques
https://www.readbyqxmd.com/read/28028994/an-open-label-multicenter-phase-i-trial-of-a-cremophor-free-polymeric-micelle-formulation-of-paclitaxel-combined-with-carboplatin-as-a-first-line-treatment-for-advanced-ovarian-cancer-a-korean-gynecologic-oncology-group-study-kgog-3016
#18
Shin Wha Lee, Yong Man Kim, Young Tae Kim, Soon Beom Kang
OBJECTIVE: This phase I study aimed to determine the maximum tolerated dose (MTD) of Genexol-PM, when combined with carboplatin, as a first-line treatment in patients with advanced ovarian cancer. METHODS: This open-label, multicenter, phase I, dose-escalation study included 18 patients (median age: 59.0 years, range: 40-75 years) diagnosed with advanced epithelial ovarian cancer. All patients had measurable residual disease after debulking surgery. Patients were assigned to groups (n=6 each group) that received different doses of Genexol-PM (220, 260, and 300 mg/m², once every 3 weeks) and 5 area under the curve (AUC) carboplatin...
December 19, 2016: Journal of Gynecologic Oncology
https://www.readbyqxmd.com/read/28011470/advances-in-experimental-targeted-therapy-and-immunotherapy-for-patients-with-glioblastoma-multiforme
#19
REVIEW
Jiri Polivka, Jiri Polivka, Lubos Holubec, Tereza Kubikova, Vladimir Priban, Ondrej Hes, Kristyna Pivovarcikova, Inka Treskova
Glioblastoma multiforme (GBM) represents the most malignant primary brain tumor in adults with generally dismal prognosis, early clinical deterioration and high mortality. GBM is extremely invasive, characterized by intense and aberrant vascularization and high resistance to multimodal treatment. Standard therapy (surgery, radiotherapy and chemotherapy with temozolomide) has very limited effectiveness, with median overall survival of patients no longer than 15 months. Progress in genetics and epigenetics of GBM over the past decade has revealed various aberrations in cellular signaling pathways, the tumor microenvironment, and pathological angiogenesis...
2017: Anticancer Research
https://www.readbyqxmd.com/read/28009732/patient-reported-limitations-to-surgical-buy-in-a-qualitative-study-of-patients-facing-high-risk-surgery
#20
Michael J Nabozny, Jacqueline M Kruser, Nicole M Steffens, Kristen E Pecanac, Karen J Brasel, Eva H Chittenden, Zara Cooper, Martin F McKneally, Margaret L Schwarze
OBJECTIVE: To characterize how patients buy-in to treatments beyond the operating room and what limits they would place on additional life-supporting treatments. BACKGROUND: During a high-risk operation, surgeons generally assume that patients buy-in to life-supporting interventions that might be necessary postoperatively. How patients understand this agreement and their willingness to participate in additional treatment is unknown. METHODS: We purposively sampled surgeons in Toronto, Ontario, Boston, Massachusetts, and Madison, Wisconsin, who are good communicators and routinely perform high-risk operations...
January 2017: Annals of Surgery
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