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urgent surgery

Durga S Borkar, Ines Lains, Emily A Eton, Nicole Koulisis, Giannis A Moustafa, Tavé van Zyl, Carolyn E Kloek
PURPOSE: To ascertain the incidence of unexpected management changes at the postoperative week one visit in asymptomatic patients who have had an uncomplicated cataract surgery and a routine postoperative day one examination. DESIGN: Retrospective observational study METHODS: Retrospective chart review was conducted of all cases of cataract extraction by phacoemulsification with intraocular lens insertion performed by the Comprehensive Ophthalmology Service at Massachusetts Eye and Ear between January 1, 2014 and December 31, 2014...
October 16, 2018: American Journal of Ophthalmology
Sarah Maki, Joshua H Hou
SIGNIFICANCE: As the prevalence of post-laser-assisted in situ keratomileusis (LASIK) patients rises, recognition of possible traumatic complications and their management in this population becomes increasingly relevant. Penetrating injuries and intraocular foreign bodies are possible in post-LASIK corneas despite an intact anterior corneal surface. However, with prompt recognition and treatment, excellent visual recovery can be achieved. PURPOSE: The purpose of this study was to report an interesting case of a penetrating foreign body through an intact LASIK flap...
October 18, 2018: Optometry and Vision Science: Official Publication of the American Academy of Optometry
Mark Crowther, Adam Cuker
The direct oral anticoagulants (DOACs), or non-vitamin K antagonist oral anticoagulants (NOACs), including dabigatran, which inhibits thrombin, and rivaroxaban, apixaban, edoxaban, and betrixaban, which inhibit coagulation factor Xa, are associated with similar or lower risk of bleeding compared with warfarin. The need for reversal of their anticoagulant effect may occur in patients with life-threatening bleeding or those requiring urgent surgery. Currently, the only specific reversal agent for dabigatran, idarucizumab is widely available, while andexanet alfa, which reverses factor Xa inhibitors, was approved in the US in May 2018...
October 19, 2018: Kardiologia Polska
Q Xiu, X Chen, T Liu, M X Chen, P Yao, W H Xin
Post-intubation tracheal stenosis was a late time complication after tracheotomy but the happening of dyspnea was unusual. Diagnosing tracheal stenosis after incubation, and figuring out the location and causes of the stenosis were important. Treatment of post-incubation tracheal stenosis relied on accurate diagnosis of the type of tracheal stenosis. Computed tomography (CT) and laryngoscope could be used for detecting the stenosis but not enough. Two patients who were already under the urgent tracheotomy over 1 year were reported...
October 18, 2018: Beijing da Xue Xue Bao. Yi Xue Ban, Journal of Peking University. Health Sciences
Justyna Swol, Jan Belohlávek, Daniel Brodie, Joseph Bellezzo, Scott D Weingart, Zachary Shinar, Andreas Schober, Matthew Bachetta, Jonathan W Haft, Shingo Ichiba, Tetsuya Sakamoto, Giles J Peek, Roberto Lorusso, Steven A Conrad
BACKGROUND: Extracorporeal life support (ECLS) describes the use of blood perfusion devices to provide advanced cardiac or respiratory support. Advances in percutaneous vascular cannula insertion, centrifugal pump technologies, and the miniaturization of extracorporeal devices have simplified ECLS. The intention of this discussion is to review the role of ECLS as a potential rescue method for emergency department (ED) clinicians in critical clinical scenarios and to focus on the prerequisites for managing an ECLS program in an ED setting...
October 15, 2018: Resuscitation
Davide La Regina, Matteo Di Giuseppe, Stefano Cafarotti, Andrea Saporito, Marcello Ceppi, Francesco Mongelli, Florian Bihl, Ruben Carlo Balzarotti Canger, Antonjacopo Ferrario di Tor Vajana
INTRODUCTION: Acute cholecystitis is a common disease and a frequent cause of emergency admission to surgical wards. Evidence regarding antibiotic administration in urgent procedures is limited and remains a contentious issue. According to the Tokyo guidelines, the antibiotic administration should be guided by the severity of cholecystitis, but internationally accepted guidelines are lacking. In particular, the need to perform antibiotic therapy after laparoscopic cholecystectomy is controversial for mild and moderate acute calculous cholecystitis (Tokio I and II)...
October 16, 2018: Surgical Endoscopy
P Jaulent, E Vignot, R Chapurlat
Fibrous dysplasia of bone is a stem cell bone disease due to a somatic GNAS mutation which can affect craniofacial bones. Although craniofacial fibrous dysplasia is a benign and progressive disorder, it can cause mass effect on the cranial structures. We describe an 18-year-old man, without past medical history, came at the emergency department with progressively worsening headache, associated with vomiting. Cranial bone CT and then brain MRI revealed fibrous dysplasia of occipital bone with intraosseous cyst, compression of right sigmoid vein...
October 16, 2018: Osteoporosis International
Cindy Canivet, Sophie Gourgou-Bourgade, Bertrand Napoléon, Laurent Palazzo, Nicolas Flori, Pierre Guibert, Guillaume Piessen, Dominique Farges-Bancel, Jean-François Seitz, Eric Assenat, Véronique Vendrely, Stéphanie Truant, Geoffroy Vanbiervliet, Philippe Berthelémy, Stéphane Garcia, Anne Gomez-Brouchet, Louis Buscail, Barbara Bournet
BACKGROUND: The prognosis for pancreatic cancer remains poor despite diagnostic advances and treatments with new chemotherapeutic regimens. The five year survival rate remains below 3%. Consequently, there is an urgent need for new treatments to significantly improve the prognosis. In addition, there is a big gap in terms of the screening, early diagnosis and prevention of pancreatic cancer the incidence of which is increasing dramatically. METHODS: Design: the BACAP cohort is a prospective multicenter pancreatic cancer cohort (pancreatic ductal carcinoma) with clinical and multiple biological samples; Participating centers: 15 French academic and private hospitals; Study Population: any cytologically and/or histologically proven pancreatic carcinoma regardless of the stage (resectable, borderline, locally advanced or metastatic) or treatment (surgery, palliative chemotherapy, best supportive care)...
October 16, 2018: BMC Cancer
Amir K Bigdeli, Emre Gazyakan, Volker J Schmidt, Christoph Bauer, Günter Germann, Christian A Radu, Ulrich Kneser, Christoph Hirche
BACKGROUND:  Vascular occlusion after free flap surgery has become a rare complication but still poses a major challenge. It necessitates urgent re-exploration, but the logistic challenge to provide sufficient resources for the emergency intervention remains. The aim of this study was to analyze the long-term outcome after successful lower extremity free flap salvage. METHODS:  A single-center retrospective study including long-term follow-up was approved by the local ethics committee...
October 16, 2018: Journal of Reconstructive Microsurgery
Kelvin Robertson, Laurence A G Marshman, David Plummer, Elena Downs
Importance: Optimal pharmacologic treatment for chronic sciatica (CS) is currently unclear. While gabapentin (GBP) and pregabalin (PGB) are both used to treat CS, equipoise exists. Nevertheless, pharmaceutical regulation authorities typically subsidize one drug over the other. This hinders interchange wherever the favored drug is either ineffective or ill-tolerated. Objective: To assess GBP vs PGB head to head for the treatment of CS. Design, Setting, and Participants: A preplanned interim analysis of a randomized, double-blind, double-dummy crossover trial of PGB vs GBP for management of CS at half the estimated final sample size was performed in a single-center, tertiary referral public hospital...
October 15, 2018: JAMA Neurology
Christopher W Bunt, Christopher E Jonas, Jennifer G Chang
Knee pain affects approximately 25% of adults, and its prevalence has increased almost 65% over the past 20 years, accounting for nearly 4 million primary care visits annually. Initial evaluation should emphasize excluding urgent causes while considering the need for referral. Key aspects of the patient history include age; location, onset, duration, and quality of pain; associated mechanical or systemic symptoms; history of swelling; description of precipitating trauma; and pertinent medical or surgical history...
November 1, 2018: American Family Physician
Michele Carlo Schiavi, Ottavia D'Oria, Natalia Aleksa, Flaminia Vena, Giovanni Prata, Chiara Di Tucci, Delia Savone, Valentina Sciuga, Andrea Giannini, Maria Letizia Meggiorini, Marco Monti, Marzio Angelo Zullo, Ludovico Muzii, Pierluigi Benedetti Panici
The aim of this study was to assess the effectiveness and safety of Ospemifene in the improvement of urgency component in women affected by mixed urinary incontinence (MUI) who underwent surgery with mid-urethral sling (MUS). Eighty-one patients with MUI underwent surgical intervention with MUS were enrolled. After surgical intervention 38 patients received Ospemifene 60 mg one tablet daily per os for 12 weeks. Physical examination, 3-day voiding diary, urodynamic testing were performed at the start and the follow-up after 12 weeks in the Trans-Obturator-Tape (TOT)-Alone group and TOT-Ospemifene...
October 16, 2018: Gynecological Endocrinology
Nasser Sakran, Doron Kopelman, Ron Dar, Nael Abaya, Shams-Eldin Mokary, Chovav Handler, Dan D Hershko
BACKGROUND: Recent studies have suggested that urgent cholecystectomy is the preferred treatment for acute cholecystitis. However, initial conservative treatment followed by delayed elective surgery is still common practice in many medical centers. OBJECTIVES: To determine the effect of percutaneous cholecystostomy on surgical outcome in patients undergoing delayed elective cholecystectomy. METHODS: We conducted a retrospective analysis of all patients admitted to our medical center with acute cholecystitis who were treated by conservative treatment followed by delayed cholecystectomy between 2004 and 2013...
October 2018: Israel Medical Association Journal: IMAJ
Sami Gendler, Hila Shmilovich, David Aranovich, Roy Nadler, Hanoch Kashtan, Michael Stein
BACKGROUND: Unlike the elective treatment of metastatic colorectal cancer (MCRC), sufficient data and consensual guidelines on acute care are lacking. OBJECTIVES: To analyze a cohort of MCRC patients who required urgent surgery due to acute abdomen and to identify risk factors contributing to the patient's perioperative mortality and morbidity. METHODS: A retrospective analysis was conducted of patients diagnosed with stage IV colorectal cancer who required urgent laparotomy at the Rabin Medical Center...
October 2018: Israel Medical Association Journal: IMAJ
Aristotelis Kechagias, Anastasios Sofianidis, Georgios Zografos, Emmanouel Leandros, Nicholas Alexakis, Christos Dervenis
Purpose: Conservative management is successful in unperforated (Hinchey Ia) acute diverticulitis (AD) and also generally in local perforation or small abscesses (Hinchey Ib). A higher degree of radiological severity (Hinchey >Ib), ie, a larger abscess (>3-4 cm) or peritonitis, commonly requires percutaneous drainage or surgery. Retrospective studies show that high levels of C-reactive protein (CRP) distinguish Hinchey Ia from all cases of minor and major perforations (Hinchey >Ia)...
2018: Therapeutics and Clinical Risk Management
Dilyara S Ismailova, Irina M Belovalova, Yaroslav O Grusha, Natalya Y Sviridenko
Orbital decompression is a surgical procedure aimed at increasing the orbital volume and/or decreasing the volume of the orbital fat. The indications for orbital decompression are determined in the course of thorough eye examination. An important objective of examination of a patient with thyroid eye disease (TED) is determination of inflammation activity and severity. Orbital decompression is a surgical procedure that can be performed in both the active and nonactive stages of the disease. However, the indications for the surgery in these cases are different...
2018: International Medical Case Reports Journal
João Rocha Neves, Marta Casal Moura, André Ferreira, Joel Sousa, Luís Gamas, Mário Vieira, Alcídia Pereira, Hélio Alves, José Teixeira
INTRODUCTION: Minimally invasive revascularization of the left anterior descending coronary artery has gained popularity. Recently, the emergence of new surgical instruments and the improvement of the technique, allowed its use by routine. Its use in Heart Team allows excellent results. Our aim is to present the results of patients undergoing this technique in our center. METHODS: Retrospective study of patients submitted to minimally invasive revascularization of the left anterior descending coronary artery at our center...
January 2018: Revista Portuguesa de Cirurgia Cardio-torácica e Vascular
Jan Willem Cohen Tervaert
In the present review, recent findings regarding autoimmune/inflammatory syndrome by adjuvants (ASIA) are described. Patients with ASIA present with complaints such as fatigue, cognitive impairment, arthralgias, myalgias, pyrexia, dry eyes and dry mouth. During the last few years, it has been postulated that these symptoms in patients with foreign body implants are due to a chronic inflammatory process and an adjuvant effect of the implanted biomaterial. Ultimately, these inflammatory reactions result in (an increase of) allergies, autoimmune diseases, immune deficiency and/or lymphomas...
October 11, 2018: Autoimmunity Reviews
Lan B Hoang-Minh, Duane A Mitchell
Despite aggressive surgery, radiation, and systemic chemotherapy, the prognosis for patients diagnosed with malignant brain tumors remains extremely poor, and standard treatments carry significant risks for long-term neurocognitive deficits. There is a clear and urgent need for the development of more effective treatments that will add minimal toxicity to standard therapies for invasive brain cancers. Cancer immunotherapy is a treatment modality that holds promise for the delivery of tumor-specific cytotoxicity, with the potential to eliminate brain tumor cells without harming the eloquent brain...
October 11, 2018: Current Treatment Options in Oncology
Xinhua Bu, Ji Zhang, Fangzheng Tian, Xiulan Wang, Linyun Wu, Weizhong Tian
BACKGROUND Radioresistance during radiotherapy of cervical cancer often leads to treatment failure; therefore, there is an urgent need to develop effective predictive indicators of radiosensitivity for cervical cancer patients. MATERIAL AND METHODS Cervical cancer cells were collected from 40 patients who received surgical resections. The relationships between apparent diffusion coefficient (ADC) values of masses before surgery and different micro-RNAs (miRNA) levels (miR-18a, miR-132, and miR-145) of these cells were investigated...
October 11, 2018: Medical Science Monitor: International Medical Journal of Experimental and Clinical Research
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