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https://www.readbyqxmd.com/read/29156482/-how-to-reduce-the-rate-of-postoperative-complications-in-frail-patients
#1
Rudolf Mörgeli, Tobias Wollersheim, Claudia Spies, Felix Balzer, Susanne Koch, Sascha Treskatsch
Frail patients are more prone to develop complications during and after surgery. As the syndrome becomes more common, recognition and special management of frail patients in the perioperative setting is becoming crucial to improve short- and long-term outcomes. Based on current literature and guidelines, we present a compilation of strategies that could be employed to reduce postoperative complication rates in frail patients. Due to their impaired response to stressors, potential perioperative hazards to frail patients are identified and discussed...
November 2017: Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie: AINS
https://www.readbyqxmd.com/read/29154508/primary-gliosarcoma-epidemiology-clinical-presentation-management-and-survival
#2
Ruichong Ma, Delia-Marina Alexe, Davide Boeris, Erlick Pereira
Gliosarcomas are malignant tumours of the central nervous system. As glioblastomas (GBM), they are treated in a similar fashion. However there is growing evidence to suggest that they may be a separate entity. Due to the rarity of primary gliosarcomas (PGS)Here we publish single centre data over a 14-year period, comprising possibly one of the biggest case series in the literature to our knowledge. The mean age at presentation was 59 years with male preponderance (1.75:1). The most common presenting symptoms were balance and mobility issues (61%), followed by headaches (50%) and visual problems (39%)...
November 20, 2017: Journal of Neurosurgical Sciences
https://www.readbyqxmd.com/read/29151688/schockmed-valve-a-novel-surgical-option-for-uncontrolled-glaucoma-in-eyes-with-poor-conjunctiva-and-encircling-bands
#3
David Fleischman, Bryan Kim
Surgical management of elevated intraocular pressure (IOP) in an eye with scarred conjunctiva, an encircling band, and silicone oil has limited options. By combining the flow restrictor of the Ahmed Glaucoma Valve (New World Medical, Rancho Cucamonga, California) and the capsule of the encircling band as a conduit for aqueous flow, immediate pressure reduction could theoretically be achieved in eyes with limited conjunctival mobilization. This is a description of a surgical technique in a case of a patient with multiple ocular surgeries with uncontrolled multimechanism glaucoma despite using all available topical and oral glaucoma medications...
September 2017: Journal of Current Glaucoma Practice
https://www.readbyqxmd.com/read/29150035/thoracic-surgery-considerations-in-obese-patients
#4
REVIEW
Douglas Z Liou, Mark F Berry
The obesity epidemic in the United States has increased greatly over the past several decades, and thoracic surgeons are likely to see obese patients routinely in their practices. Obesity has direct deleterious health effects such as metabolic disorder and cardiovascular disease, and is associated with many cancers. Obese patients who need thoracic surgery pose practical challenges to many of the routine elements in perioperative management. Preoperative assessment of obesity-related comorbid conditions and risk stratification for surgery, thorough intraoperative planning for anesthesia and surgery, and postoperative strategies to optimize pulmonary hygiene and mobility minimize the risk of adverse outcomes...
February 2018: Thoracic Surgery Clinics
https://www.readbyqxmd.com/read/29146507/impact-of-osteoarthritis-and-total-joint-arthroplasty-on-the-kinematics-of-the-trapeziometacarpal-joint-a-pilot-study
#5
Priscilla D'Agostino, Benjamin Dourthe, Faes Kerkhof, Evie E Vereecke, Filip Stockmans
PURPOSE: To quantify the effect of osteoarthritis (OA) and total trapeziometacarpal (TMC) joint replacement on thumb kinematics during the primary physiological motions of the thumb. METHODS: We included 4 female patients with stage III TMC OA. A computed tomography-based markerless method was used to quantify the 3-dimensional thumb kinematics in patients before and after TMC joint replacement surgery with the Arpe implant. RESULTS: Trapeziometacarpal OA led to a marked decrease of internal rotation and abduction of the first metacarpal (MC1) during thumb flexion and a decrease of MC1 adduction during thumb adduction...
November 14, 2017: Journal of Hand Surgery
https://www.readbyqxmd.com/read/29142853/silk-suture-reaction-in-thyroid-surgery
#6
Selen Soylu, Akif Enes Arikan, Serkan Teksoz, Murat Ozcan, Yusuf Bukey
Silk suture reaction (i.e., a benign granulomatous inflammatory foreign body reaction) is a rare complication of thyroid surgery. Here, two cases of post-thyroidectomy suture reaction are presented. Both of the patients were female, one is 48 and the other is 34 years old. The patients were presented with neck swelling and leakage of serous fluid from the Kocher's incision. Both patients had normal free T4, free T3, and TSH values. The 48-year-old female patient had a right subtotal and left near-total thyroidectomy 6 years ago and the other had bilateral total thyroidectomy 6 years ago...
October 2017: Gland Surgery
https://www.readbyqxmd.com/read/29142384/hypercapnic-respiratory-failure-in-case-of-chiari-1-5-malformation-case-report-and-review-of-the-literature
#7
Viralkumar M Vasani, Subhas Kanti Konar, S Satish
Type 2 respiratory failure is defined as hypercapnia associated with hypoxia. Chiari 1.5 is known as herniation of the cerebellar tonsils along with brain stem and fourth ventricle. We report a 35-year-old male who presented with acute hypercapnic respiratory failure (Type 2), without any preexisting neurological or respiratory abnormality. Analysis of blood gases in emergency revealed a pH of 7.12, pCO2 of 132 mmHg, and arterial oxygen tension of 118 mm Hg. He was intubated and ventilated. Magnetic resonance imaging brain revealed herniation of the cerebellar tonsils along with brain stem and fourth ventricle...
October 2017: Indian Journal of Critical Care Medicine
https://www.readbyqxmd.com/read/29135409/double-inlay-plus-ventral-onlay-buccal-mucosa-graft-for-simultaneous-penile-and-bulbar-urethral-stricture
#8
Luciano A Favorito, Paulo P Conte, Ulisses G Sobrinho, Rodrigo G Martins, Tomas Accioly
OBJECTIVES: Buccal mucosa grafts and fascio-cutaneous flaps are frequently used in long anterior urethral strictures (1). The inlay and onlay buccal mucosa grafts are easier to perform, do not need urethral mobilization and generally have good long-term results (2-4). In the present video, we present a case where we used a double buccal mucosa graft technique in a simultaneous penile and bulbar urethral stricture. MATERIALS AND METHODS: A 54 year-old male patient was submitted to appendectomy where a urethral catheter was used for two days in May 2015...
November 17, 2017: International Braz J Urol: Official Journal of the Brazilian Society of Urology
https://www.readbyqxmd.com/read/29134384/totally-robotic-single-docking-low-anterior-resection-for-rectal-cancer-pearls-and-pitfalls
#9
J W T Toh, A Zakaria, I Yang, S H Kim
Total robotic resection of mid- and low rectal cancers confers technical advantages within the confines of the pelvis and allows difficult rectal cancer cases to be performed efficiently with less risk of conversion to open. To maximize the advantage of robotic surgery, we utilize the technique of single docking totally robotic dissection for rectal cancer for both the Da Vinci Si and Xi Surgical Systems. All steps are performed robotically, with the surgery divided into two phases. The first phase consists of inferior mesenteric artery and vein ligation, sigmoid and descending colon mobilization and splenic flexure takedown...
November 13, 2017: Techniques in Coloproctology
https://www.readbyqxmd.com/read/29134042/direct-nerve-sutures-in-extended-upper-obstetric-brachial-plexus-repair
#10
J Bahm, A Gkotsi, S Bouslama, W El-Kazzi, F Schuind
Background  In rare, selected cases of severe (extended) upper obstetric brachial plexus palsy (OBPP), after supraclavicular exposure and distal mobilization of the traumatized trunks and careful neuroma excision, we decided to perform direct nerve coaptation with tolerable tension and immobilized the affected arm positioned in adduction and 90-degree elbow flexion for three weeks. Objectives  We present our surgical technique and preliminary results in a prospective open patient series, including 22 patients (14 right and 8 left side affected) between 2009 and 2016, operated at a mean age of 8...
January 2017: Journal of Brachial Plexus and Peripheral Nerve Injury
https://www.readbyqxmd.com/read/29132982/longitudinal-study-of-bladder-continence-among-people-with-spina-bifida-in-the-national-spina-bifida-patient-registry
#11
Tiebin Liu, Lijing Ouyang, Judy Thibadeau, John S Wiener, Jonathan C Routh, Heidi Castillo, Jonathan Castillo, Kurt A Freeman, Kathleen J Sawin, Kathryn Smith, Alexander Van Speybroeck, Rodolfo Valdez
PURPOSE: Achieving bladder continence among people with Spina bifida is a lifetime management goal. We investigated bladder continence status over time and factors associated with this status among people with SB. MATERIALS AND METHODS: We used National Spina Bifida Patient Registry data collected from 2009 through 2015 and applied generalized estimating equation models to analyze factors associated with bladder continence status. RESULTS: This analysis included 5,250 participants with SB in a large, multi-institutional patient registry who contributed 12,740 annual clinic visit records during the study period...
November 10, 2017: Journal of Urology
https://www.readbyqxmd.com/read/29132797/cloaca-reconstruction-a-new-algorithm-which-considers-the-role-of-urethral-length-in-determining-surgical-planning
#12
Richard J Wood, Carlos A Reck-Burneo, Daniel Dajusta, Christina Ching, Rama Jayanthi, D Gregory Bates, Molly E Fuchs, Katherine McCracken, Geri Hewitt, Marc A Levitt
BACKGROUND: Cloacal malformations represent a uniquely complex challenge for surgeons. The surgical approach to date has been based on the common channel (CC) length with two patient groups considered: less than or greater than 3cm, which we believe is an oversimplification. We reviewed 19 patients, referred after surgery done elsewhere. Eight had postoperative urinary complications, 3 had constant urinary leakage and had been left after surgery with a urethra <1cm, .5 with an original 3 to 5cm common channel, who had undergone total urogenital mobilization (TUM), experienced peri-operative urethral loss needing a vesicostomy, and later, a Mitrofanoff...
October 12, 2017: Journal of Pediatric Surgery
https://www.readbyqxmd.com/read/29132453/code-grey-stained-surgical-instruments-and-their-impact-on-one-canadian-health-authority
#13
Rob Kean, Ron Johnson, Michael Doyle
In 2016, NL's largest RHA was faced with serious challenges stemming from the discovery of stained surgical instruments at its two largest hospitals. This discovery prompted a series of postponed surgeries, an extensive internal mobilization of labour and the purchase of millions of dollars of new equipment. In tackling these challenges, the organization not only acquired a better understanding of its surgical tools, but it also gained renewed appreciation for the resilience of its human resources. By describing this incident and the lessons learned, we hope to offer insight to providers in similar circumstances...
2017: Healthcare Quarterly
https://www.readbyqxmd.com/read/29132347/knee-arthrodesis-versus-above-the-knee-amputation-after-septic-failure-of-revision-total-knee-arthroplasty-comparison-of-functional-outcome-and-complication-rates
#14
Sven Hungerer, Martin Kiechle, Christian von Rüden, Matthias Militz, Knut Beitzel, Mario Morgenstern
BACKGROUND: After septic failure of total knee arthroplasty (TKA) and multiple revision operations resulting in impaired function, bone and/or soft-tissue damage a reconstruction with a revision arthroplasty might be impossible. Salvage procedures to regain mobility and quality of life are an above-the-knee amputation or knee arthrodesis. The decision process for the patient and surgeon is difficult and data comparing arthrodesis versus amputation in terms of function and quality of life are scarce...
November 13, 2017: BMC Musculoskeletal Disorders
https://www.readbyqxmd.com/read/29128183/does-intraoperative-neuromonitoring-of-recurrent-nerves-have-an-impact-on-the-postoperative-palsy-rate-results-of-a-prospective-multicenter-study
#15
Éric Mirallié, Cécile Caillard, François Pattou, Laurent Brunaud, Antoine Hamy, Marcel Dahan, Michel Prades, Muriel Mathonnet, Gérard Landecy, Henri-Pierre Dernis, Jean-Christophe Lifante, Frederic Sebag, Franck Jegoux, Emmanuel Babin, Alain Bizon, Florent Espitalier, Isabelle Durand-Zaleski, Christelle Volteau, Claire Blanchard
BACKGROUND: The impact of intraoperative neuromonitoring on recurrent laryngeal nerve palsy remains debated. Our aim was to evaluate the potential protective effect of intraoperative neuromonitoring on recurrent laryngeal nerve during total thyroidectomy. METHODS: This was a prospective, multicenter French national study. The use of intraoperative neuromonitoring was left at the surgeons' choice. Postoperative laryngoscopy was performed systematically at day 1 to 2 after operation and at 6 months in case of postoperative recurrent laryngeal nerve palsy...
November 8, 2017: Surgery
https://www.readbyqxmd.com/read/29127127/abrikossoff-s-tumour-on-the-upper-limb-a-rare-presentation
#16
Carlos E Costa Almeida, Teresa Caroço, Marta Silva, Miguel Nico Albano
Abrikossoff's tumour or granular cell tumour is a rare entity. Most common locations are the head and neck, with only a few cases reported on the upper limbs. A 55-year-old man with a nodular lesion on the left arm resorted to surgery consultation. Nodule was firm, mobile, painless and non-ulcerated. Total excision using a Limberg flap procedure was performed. Following 3 months of follow-up, the patient is fine. Abrikossoff's tumour is frequently presented in the second to sixth decade of life as an ulcerated nodule with progressive growth...
November 9, 2017: BMJ Case Reports
https://www.readbyqxmd.com/read/29125861/identification-of-hospitalized-elderly-patients-at-risk-for-adverse-in-hospital-outcomes-in-a-university-orthopedics-and-trauma-surgery-environment
#17
Janine Gronewold, Christian Dahlmann, Marcus Jäger, Dirk M Hermann
BACKGROUND: As a consequence of demographic changes, hospitals are confronted with increasing numbers of elderly patients, who are at high risk of adverse events during hospitalization. Geriatric risk screening followed by comprehensive geriatric assessment (CGA) and treatment has been requested by geriatric societies and task forces to identify patients at risk. Since empirical evidence on factors predisposing to adverse hospital events is scarce, we now prospectively evaluated implications of geriatric risk screening followed by CGA in a university hospital department of orthopedics and trauma surgery...
2017: PloS One
https://www.readbyqxmd.com/read/29125521/variation-in-surgical-management-of-neurogenic-bowel-among-centers-participating-in-national-spina-bifida-patient-registry
#18
Jonathan C Routh, David B Joseph, Tiebin Liu, Michael S Schechter, Judy K Thibadeau, M Chad Wallis, Elisabeth A Ward, John S Wiener
PURPOSE: Optimal management of neurogenic bowel in patients with spina bifida (SB) remains controversial. Surgical interventions may be utilized to treat constipation and provide fecal continence, but their use may vary among SB treatment centers. METHODS: We queried the National Spina Bifida Patient Registry (NSBPR) to identify patients who underwent surgical interventions for neurogenic bowel. We abstracted demographic characteristics, SB type, functional level, concurrent bladder surgery, mobility, and NSBPR clinics to determine whether any of these factors were associated with interventions for management of neurogenic bowel...
October 20, 2017: Journal of Pediatric Rehabilitation Medicine
https://www.readbyqxmd.com/read/29117077/vascular-graft-infection-incidence-and-potential-risk-factors
#19
Catherine R Ratliff, David Strider, Tanya Flohr, Danielle Moses, Virginia Rovnyak, Julie Armatas, Jennifer Johnson, Alison Okerlund, Mary Baldwin, Marian Lawson, Suzanne Fuhrmeister, Margaret C Tracci, Gilbert R Upchurch, Kenneth J Cherry
PURPOSE: The purpose of this study was to identify factors that increase the risk of vascular graft infections (VGI) in patients following abdominal or lower extremity revascularization surgery. DESIGN: Retrospective, descriptive study. METHODS: We reviewed the electronic health records of 223 patients who had undergone abdominal or lower extremity revascularization procedures from July 2012 to November 2014, looking for factors associated with VGI...
November 2017: Journal of Wound, Ostomy, and Continence Nursing
https://www.readbyqxmd.com/read/29116047/factors-that-have-an-influence-on-bone-conduction-thresholds-changes-after-otosurgery-in-the-patients-operated-on-due-to-the-perforation-of-the-tympanic-membrane-with-the-preserved-ossicular-chain
#20
Maciej Wiatr, Agnieszka Wiatr, Sebastian Kocoń, Jacek Składzień
INTRODUCTION: The aim of the middle ear surgery is to eliminate abnormalities from the mucous, ensure the due airing of the postoperative cavity and reconstruct the sound-conducting system in the middle ear. Numerous reports can be found in literature on the changes to bone conduction as a consequence of middle ear surgery. STUDY OBJECTIVE: The aim of the work is to define the factors that affect bone conduction in the patients operated on due to the perforation of the tympanic membrane with the preserved and normal mobile ossicular chain...
August 31, 2017: Otolaryngologia Polska
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