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Safety in surgery

Gaby Aphram, Laurent De Kerchove, Stefano Mastrobuoni, Emiliano Navarra, Silvia Solari, Saadallah Tamer, Jerome Baert, Alain Poncelet, Jean Rubay, Parla Astarci, Philippe Noirhomme, Gebrine El Khoury
OBJECTIVES: Mitral valve (MV) repair is the gold standard for treatment of degenerative mitral regurgitation. A variety of surgical techniques allow surgeons to achieve a high rate of MV repair even with MV diseases of other aetiologies. However, a certain number of repairs fail over time. The aim of this study was to review our single-centre experience of MV re-repair and analyse the mode of repair failure, re-repair safety and efficiency in relation to the initial aetiology. METHODS: Between 1997 and 2015, 91 patients underwent redo MV re-repair...
March 14, 2018: European Journal of Cardio-thoracic Surgery
David A Watters, Glenn D Guest, Viliami Tangi, Mark G Shrime, John G Meara
Progress in achieving "universal access to safe, affordable surgery, and anesthesia care when needed" is dependent on consensus not only about the key messages but also on what metrics should be used to set goals and measure progress. The Lancet Commission on Global Surgery not only achieved consensus on key messages but also recommended 6 key metrics to inform national surgical plans and monitor scale-up toward 2030. These metrics measure access to surgery, as well as its timeliness, safety, and affordability: (1) Two-hour access to the 3 Bellwether procedures (cesarean delivery, emergency laparotomy, and management of an open fracture); (2) Surgeon, Anesthetist, and Obstetrician workforce >20/100,000; (3) Surgical volume of 5000 procedures/100,000; (4) Reporting of perioperative mortality rate; and (5 and 6) Risk rates of catastrophic expenditure and impoverishment when requiring surgery...
April 2018: Anesthesia and Analgesia
Fauzia A Khan, Alan F Merry
The safety of anesthesia characteristic of high-income countries today is not matched in low-resource settings with poor infrastructure, shortages of anesthesia providers, essential drugs, equipment, and supplies. Health care is delivered through complex systems. Achieving sustainable widespread improvement globally will require an understanding of how to influence such systems. Health outcomes depend not only on a country's income, but also on how resources are allocated, and both vary substantially, between and within countries...
April 2018: Anesthesia and Analgesia
Da Li, Yu-Ming Jiao, Liang Wang, Fu-Xin Lin, Jun Wu, Xian-Zeng Tong, Shuo Wang, Yong Cao
OBJECTIVE Surgical management of brainstem lesions is challenging due to the highly compact, eloquent anatomy of the brainstem. This study aimed to evaluate the safety and efficacy of preoperative diffusion tensor imaging (DTI) and diffusion tensor tractography (DTT) in brainstem cavernous malformations (CMs). METHODS A prospective randomized controlled clinical trial was performed by using stratified blocked randomization. The primary eligibility criterion of the study was being a surgical candidate for brainstem CMs (with informed consent)...
March 16, 2018: Journal of Neurosurgery
Nishant Patel, Jeffrey Forris Beecham Chick, Joseph J Gemmete, Jordan C Castle, Narasimham Dasika, Wael E Saad, Ravi N Srinivasa
OBJECTIVE: The objective of our study was to report the technique, complications, and clinical outcomes of interventional radiology-operated cholecystoscopy with stone removal for the management of symptomatic cholelithiasis. MATERIALS AND METHODS: Ten (77%) men and three (23%) women (mean age, 65 years) with symptomatic cholelithiasis underwent cholecystostomy followed by interventional radiology-operated cholecystoscopy with stone removal. Major comorbidities precluding cholecystectomy included prior cardiac, pulmonary, or abdominal surgery; cirrhosis; sepsis with hyponatremia; seizure disorder; developmental delay; and cholecystoduodenal fistula...
March 16, 2018: AJR. American Journal of Roentgenology
Fernando A Angarita, Sergio A Acuna, Erin Cordeiro, Ahmad Elnahas, Subir Sutradhar, Timothy Jackson, Tulin D Cil
PURPOSE: Postoperative complication rates for elderly women undergoing breast cancer surgery have not been well studied. We describe the postoperative complication rates of elderly (≥ 70 years) women with breast cancer and compare them with young (40-69 years) women. METHODS: Data were extracted from the National Surgical Quality Improvement Program database (2004-2014). We included women with invasive breast cancer who underwent surgery. Outcomes were 30-day postoperative morbidity and mortality (complications), which were compared between young and elderly women...
March 15, 2018: Breast Cancer Research and Treatment
Nan Lan, Bo Shen
Background: Current treatment modalities for anastomotic stricture in Crohn's disease (CD) include endoscopic balloon dilation (EBD) and surgery. We recently published a case series of inflammatory bowel disease patients treated with the novel endoscopic stricturotomy (ES). The aim of this case-control study was to compare the efficacy and safety of ES versus conventional EBD in the treatment of anastomotic strictures in CD patients. Methods: All eligible patients with CD anastomotic stricture who were treated with ES or EBD were included...
March 12, 2018: Inflammatory Bowel Diseases
Tina Streitparth, Denis Schumacher, Robert Damm, Bjoern Friebe, Konrad Mohnike, Ortrud Kosiek, Maciej Pech, Jens Ricke, Florian Streitparth
Purpose: The purpose of this study was to evaluate the efficacy, safety and predictive factors of RFA of primary and secondary lung malignancies. Patients and Methods: 79 patients with 129 primary and secondary lung malignancies were enrolled in a retrospective study. We treated 74 pulmonary metastases of colorectal cancer, 13 malignant melanoma lesions, 13 renal cancer metastases, 5 primary lung malignancies and 24 tumors of other different entities. All patients were considered to be unsuitable candidates for surgery, radiotherapy or chemotherapy...
February 20, 2018: Oncotarget
Lingfu Zhang, Chunsheng Hou, Zhi Xu, Lixin Wang, Xiaofeng Ling, Dianrong Xiu
Objective: Although laparoscopic treatment of gallbladder cancer (GBC) has been explored in the last decade, long-term results are still rare. This study evaluates long-term results of intended laparoscopic treatment for suspected GBC confined to the gallbladder wall, based on our experience over 10 years. Methods: Between August 2006 and December 2015, 164 patients with suspected GBC confined to the wall were enrolled in the protocol for laparoscopic surgery. The process for GBC treatment was analyzed to evaluate the feasibility of computed tomography (CT) and/or magnetic resonance imaging (MRI) combined with frozen-section examination in identifying GBC confined to the wall...
February 2018: Chinese Journal of Cancer Research, Chung-kuo Yen Cheng Yen Chiu
Alessandra Balduini, Hana Raslova, Christian A Di Buduo, Alessandro Donada, Matthias Ballmaier, Manuela Germeshausen, Carlo L Balduini
Inherited thrombocytopenias (ITs) are a heterogeneous group of disorders characterized by low platelet count resulting in impaired hemostasis. Patients can have spontaneous hemorrhages and/or excessive bleedings provoked by hemostatic challenges as trauma or surgery. To date, ITs encompass 32 different rare monogenic disorders caused by mutations of 30 genes. This review will focus on the major discoveries that have been made in the last years on the diagnosis, treatment and molecular mechanisms of ANKRD26-Related Thrombocytopenia and MYH9-Related Diseases...
March 12, 2018: European Journal of Medical Genetics
Bahadir Ege, Merter Gulen
OBJECTIVE: To determine the weight loss, and complications as well as to exemplify the use of vessel sealer and the triple stapler establish the safety and efficacy of vessel sealer for robotic surgery and triple stapler in robotic sleeve gastrectomy. STUDY DESIGN: Observational case series. PLACE AND DURATION OF STUDY: Private Koru Hospital, Ankara, Turkey, from December 2015 till January 2016. METHODOLOGY: Twenty robotic sleeve gastrectomy was performed...
March 2018: Journal of the College of Physicians and Surgeons—Pakistan: JCPSP
Duan Wang, Hui Zhu, Wei-Kun Meng, Hao-Yang Wang, Ze-Yu Luo, Fu-Xing Pei, Qi Li, Zong-Ke Zhou
BACKGROUND: Although randomized controlled trials have confirmed oral tranexamic acid (TXA) can provide similar blood-sparing efficacy compared with intravenous (IV) TXA in total knee arthroplasty (TKA), some concerns do remain about thromboembolic events after such systemic administration. Many studies have confirmed that intra-articular (IA) application of TXA can show similar blood-saving efficacy with minimal levels of systemic absorption compared with IV TXA. However, it remains unclear whether the efficacy and safety of oral TXA administration is equal to or less than that of IA administration in TKA without the use of a tourniquet and drain...
March 15, 2018: BMC Musculoskeletal Disorders
E N Eskina, K K Davtyan
Presently ReLEx Smile as a method of vision correction in refractive surgery is becoming increasingly popular in Russia and abroad. PURPOSE: to develop an algorithm for planning the surgery and choosing its parameters, and to assess the efficacy, safety and predictability of the results in the 6-month follow-up period. MATERIAL AND METHODS: The study involved 80 patients (159 eyes) with myopia of various degrees with a mean age of 33±6 years (25 to 44 years old)...
2018: Vestnik Oftalmologii
S-M Lee, K Gordon, R McMillan, F Crystal, P Acher
Introduction Transurethral resection of the prostate has remained the most common operation for bladder outlet obstruction in the UK, but it is associated with potential morbidity and median two-day length of hospital stay. Holmium laser enucleation of the prostate (HoLEP) provides an alternative procedure. Provision of day-case HoLEP would improve patient care through increased efficiency. We assessed the feasibility and safety of day-case HoLEP and examined predictive factors for increased length of hospital stay...
March 15, 2018: Annals of the Royal College of Surgeons of England
F Mushtaq, C O'Driscoll, Fct Smith, D Wilkins, N Kapur, R Lawton
Background Confidential reporting systems play a key role in capturing information about adverse surgical events. However, the value of these systems is limited if the reports that are generated are not subjected to systematic analysis. The aim of this study was to provide the first systematic analysis of data from a novel surgical confidential reporting system to delineate contributory factors in surgical incidents and document lessons that can be learned. Methods One-hundred and forty-five patient safety incidents submitted to the UK Confidential Reporting System for Surgery over a 10-year period were analysed using an adapted version of the empirically-grounded Yorkshire Contributory Factors Framework...
March 15, 2018: Annals of the Royal College of Surgeons of England
M Brimioulle, A Al-Lami, S Marzouk, H Emerson, A Balfour, V Dhar, I J Nixon
Introduction The aim of this study was to determine whether ultrasound alone is sufficient to safely exclude malignancy in thyroid nodules in a district general hospital setting, to comply with the latest British Thyroid Association guidelines. Methods This retrospective study investigated the quality of ultrasound reporting and the correlation between ultrasound report and histology for individual thyroid nodules. Cases were selected from the thyroid multidisciplinary meeting and included all patients having undergone surgery for a thyroid malignancy in a one-year period...
March 15, 2018: Annals of the Royal College of Surgeons of England
Iwao Sugitani, Naoyoshi Onoda, Ken-Ichi Ito, Shinichi Suzuki
Anaplastic thyroid carcinoma (ATC) accounts for only 1 to 2% of all thyroid carcinomas, but it is one of the most lethal neoplasms in humans. To obtain further insights into this "orphan disease," we have established the ATC Research Consortium of Japan (ATCCJ) in 2009. It represents a multicenter registry for ATC that have been treated in Japan. To date, 67 institutions have taken part in the collaborative research system and over 1,200 cases have been accumulated in its database. Using this big data, several retrospective studies were carried out to evaluate 1) prognostic factors to determine initial treatment policy, 2) significance of extended radical surgery for Stage IVB cases, 3) characteristics of ATC incidentally found on pathological examination and 4) pathological features of ATC with long-term survival...
2018: Journal of Nippon Medical School, Nippon Ika Daigaku Zasshi
Vanessa Trieu, Harlan Pinto, Jonathan W Riess, Ruth Lira, Richard Luciano, Jessie Coty, Derek Boothroyd, A Dimitrios Colevas
LESSONS LEARNED: Chemotherapy for recurrent, metastatic squamous cell carcinoma of the head and neck need not be known for extreme toxicity.The weekly regimen studied here has been demonstrated to be tolerable and effective. BACKGROUND: The objective of this study was to establish the response rate, progression-free survival (PFS) and overall survival (OS), and safety profile of weekly docetaxel, platinum, and cetuximab (TPC) in patients with relapsed or metastatic squamous cell carcinoma of the head and neck (SCCHN)...
March 14, 2018: Oncologist
Valerio Pace, Omar Farooqi, James Kennedy, Chang Park, Joseph Cowan
As a tertiary referral centre of spinal surgery, the Royal National Orthopaedic Hospital (RNOH) handles hundreds of spinal cases a year, often with complex pathology and complex care needs. Despite this, issues were raised at the RNOH following lack of sufficient documentation of preoperative and postoperative clinical findings in spinal patients undergoing major surgery. This is not in keeping with guidelines provided by the Royal College of Surgeons. The authors believe that a standardised clerking pro forma for surgical spinal patients admitted to RNOH would improve the quality of care provided...
March 14, 2018: Postgraduate Medical Journal
Ahilan Sivaganesan, Brandon Hirsch, Frank M Phillips, Matthew J McGirt
Here, we systematically review clinical studies that report morbidity and outcomes data for cervical and lumbar surgeries performed in ambulatory surgery centers (ASCs). We focus on anterior cervical discectomy and fusion (ACDF), posterior cervical foraminotomy, cervical arthroplasty, lumbar microdiscectomy, lumbar laminectomy, and minimally invasive transforaminal interbody fusion (TLIF) and lateral lumbar interbody fusion, as these are prevalent and surgical spine procedures that are becoming more commonly performed in ASC settings...
March 12, 2018: Neurosurgery
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