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https://www.readbyqxmd.com/read/29161397/abdominal-aortic-aneurysm-repair-in-the-united-kingdom-an-exemplar-for-the-role-of-anaesthetists-in-perioperative-medicine
#1
S J Howell
The past two decades have seen an increasing recognition that the delivery of safe surgery with low complication rates and good long-term outcomes is a team endeavour embracing the whole patient care pathway. The key role of the anaesthetist in managing the patient through the surgical process is widely understood and has driven the emergence of perioperative medicine. In parallel with these developments there has been a sea change in the organisation of the care of patients presenting for elective abdominal aortic aneurysm (AAA) repair...
December 1, 2017: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/29161390/thiopental-to-desflurane-an-anaesthetic-journey-where-are-we-going-next
#2
J R Sneyd
Development targets in anaesthetic pharmacology have evolved from minimizing harm caused by unwanted effects through an era in which rapid onset and offset of drug effect were prioritised. Today's anaesthetists have access to a library of effective drugs whose characteristics offer controllable hypnosis, analgesia and paralysis with manageable off-target effects. The availability of these agents at generic prices inhibits commercial interest and this is reflected in the limited number of current anaesthetic drug development projects...
December 1, 2017: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/29160777/motion-compensation-with-skin-contact-control-for-high-intensity-focused-ultrasound-surgery-in-moving-organs
#3
Alessandro Diodato, Andrea Cafarelli, Andrea Schiappacasse, Selene Tognarelli, Gastone C Ciuti, Arianna Menciassi
High Intensity Focused Ultrasound (HIFU) is an emerging therapeutic solution that enables non-invasive treatment of several pathologies, mainly in oncology. On the other hand, accurate targeting of moving abdominal organs (e.g., liver, kidney, pancreas) is still an open challenge. This paper proposes a novel method to compensate the physiological respiratory motion of organs during HIFU procedures, by exploiting a robotic platform for ultrasound-guided HIFU surgery provided with a therapeutic annular phased array transducer...
November 21, 2017: Physics in Medicine and Biology
https://www.readbyqxmd.com/read/29160136/utility-of-bulging-technique-for-endovascular-treatment-of-small-and-wide-necked-aneurysms-with-a-low-profile-visualized-intraluminal-support-lvis-jr-device-a-case-report-and-review-of-the-literature
#4
Akihiro Inoue, Masahiko Tagawa, Shirabe Matsumoto, Masahiro Nishikawa, Kosuke Kusakabe, Hideaki Watanabe, Takeharu Kunieda
Small and broad-necked aneurysms are generally very difficult to treat using endovascular therapy. The arrival of the low-profile stent (e.g., Low-profile Visualized Intraluminal Support; LVIS) has enabled reconstructive treatment for these aneurysms. In addition, the bulging technique using LVIS is an effective and attractive technique for performing stent-assisted coiling to preserve parent arteries and achieve neck coverage. We report here a patient with a small and wide-necked ruptured basilar artery (BA) top aneurysm, in whom successful treatment was achieved by stent-assisted coiling with LVIS Jr...
January 1, 2017: Interventional Neuroradiology
https://www.readbyqxmd.com/read/29159605/outcomes-of-emergency-laparotomy-el-care-protocol-at-tertiary-care-center-from-low-middle-income-country-lmic
#5
Nitin Vashistha, Dinesh Singhal, Sandeep Budhiraja, Bharat Aggarwal, Raj Tobin, Kamal Fotedar
BACKGROUND: Emergency laparotomy mortality ranges between 10 and 20% in best of Western healthcare systems and is currently a major focus for quality improvement programs. In contrast, emergency surgery scenario in LMIC is largely undefined, often neglected and complex (large burden of diseases but only limited capacity for adequate treatment). We evaluated the efficacy of 'EL care protocol' aimed at cost-effective optimal utilization of best available local expertise and infrastructure...
November 20, 2017: World Journal of Surgery
https://www.readbyqxmd.com/read/29158923/diffuse-subcutaneous-emphysema-pneumomediastinum-and-pneumothorax-following-robotic-assisted-laparoscopic-hysterectomy
#6
Laryssa Patti, William Haussner, Grant Wei
Robotic assisted laparoscopic surgery is becoming more widely available, but despite its multiple benefits, it is not without risk. This case is of a 62-year-old female who presented to the emergency department for dyspnea two days after robotic assisted laparoscopic hysterectomy. Physical exam revealed diffuse facial, neck, upper extremity, torso, and lower extremity crepitus, which was diagnosed as diffuse subcutaneous air on computed tomography (CT). Imaging also revealed right apical pneumothorax and pneumomediastinum...
2017: Case Reports in Emergency Medicine
https://www.readbyqxmd.com/read/29157798/euglycemic-diabetic-ketoacidosis-secondary-to-dapagliflozin-use-a-case-report
#7
Felicity Brown, Tamara McColl
BACKGROUND: Sodium-glucose co-transporter-2 (SGLT2) inhibitors are a novel class of oral antihyperglycemic agents. They are associated with rare cases of euglycemic diabetic ketoacidosis (DKA), which presents a diagnostic challenge in the emergency department (ED) and potentially severe consequences if missed. CASE REPORT: A 53-year-old man with type 2 diabetes mellitus and a recent Roux-en-Y gastric bypass surgery presented to the ED with nausea, vomiting, and generalized abdominal pain...
November 17, 2017: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29157787/a-consultation-phone-service-for-patients-with-total-joint-arthroplasty-may-reduce-unnecessary-emergency-department-visits
#8
Eerik Hällfors, Sami A Saku, Tatu J Mäkinen, Rami Madanat
BACKGROUND: Different measures for reducing costs after total joint arthroplasty (TJA) have gained attention lately. At our institution, a free-of-charge consultation phone service was initiated that targeted patients with TJA. This service aimed at reducing unnecessary emergency department (ED) visits and, thus, potentially improving the cost-effectiveness of TJAs. To our knowledge, a similar consultation service had not been described previously. We aimed at examining the rates and reasons for early postdischarge phone calls and evaluating the efficacy of this consultation service...
October 31, 2017: Journal of Arthroplasty
https://www.readbyqxmd.com/read/29156629/reconstruction-of-craniomaxillofacial-bone-defects-using-tissue-engineering-strategies-with-injectable-and-non-injectable-scaffolds
#9
REVIEW
Bipin Gaihre, Suren Uswatta, Ambalangodage C Jayasuriya
Engineering craniofacial bone tissues is challenging due to their complex structures. Current standard autografts and allografts have many drawbacks for craniofacial bone tissue reconstruction; including donor site morbidity and the ability to reinstate the aesthetic characteristics of the host tissue. To overcome these problems; tissue engineering and regenerative medicine strategies have been developed as a potential way to reconstruct damaged bone tissue. Different types of new biomaterials; including natural polymers; synthetic polymers and bioceramics; have emerged to treat these damaged craniofacial bone tissues in the form of injectable and non-injectable scaffolds; which are examined in this review...
November 20, 2017: Journal of Functional Biomaterials
https://www.readbyqxmd.com/read/29156016/pectus-excavatum-repair-after-sternotomy-the-chest-wall-international-group-experience-with-substernal-nuss-bars
#10
Dawn E Jaroszewski, Paul J Gustin, Frank-Martin Haecker, Hans Pilegaard, Hyung Joo Park, Shao-Tao Tang, Shuai Li, Li Yang, Sadashige Uemura, Jose Ribas Milanez De Campos, Robert Obermeyer, Frazier W Frantz, Michele Torre, Lisa McMahon, Andre Hebra, Chih-Chun Chu, J Duncan Phillips, David M Notrica, Antonio Messineo, Robert Kelly, Mustafa Yüksel
OBJECTIVES: Patients with pectus excavatum (PE) after prior sternotomy for cardiac surgery present unique challenges for repair of PE. Open repairs have been recommended because of concerns about sternal adhesions and cardiac injury. We report a multi-institutional experience with repair utilizing substernal Nuss bars in this patient population. METHODS: Surgeons from the Chest Wall International Group were queried for experience and retrospective data on PE repair using sub-sternal Nuss bars in patients with a history of median sternotomy for cardiac surgery (November 2000 to August 2015)...
October 1, 2017: European Journal of Cardio-thoracic Surgery
https://www.readbyqxmd.com/read/29155541/a-festive-case-series-of-emergencies-admissions-and-friendship-at-a-busy-oral-and-maxillofacial-unit
#11
Ross Keat, Paul Leavy, Mathew Thomas
The festive season presents oral and maxillofacial surgery (OMFS) dental core trainees (DCTs) with the challenges of managing an eclectic mix of emergencies. We present three such patients in this case series. First, Patient A, a 39-year-old homeless male who presented with a maxillary extra-oral draining sinus. Secondly, Patient B, a 38-year-old intra-venous (IV) drug user who suffered pan-facial fractures following an alcohol-fuelled assault. Finally, Patient C, a 38-year-old male who sustained a left zygomatic complex fracture a week previously, in attendance for corrective surgery...
December 2016: Dental Update
https://www.readbyqxmd.com/read/29155448/influence-of-national-centralization-of-oesophagogastric-cancer-on-management-and-clinical-outcome-from-emergency-upper-gastrointestinal-conditions
#12
S R Markar, H Mackenzie, T Wiggins, A Askari, A Karthikesalingam, O Faiz, S M Griffin, J D Birkmeyer, G B Hanna
BACKGROUND: In England in 2001 oesophagogastric cancer surgery was centralized. The aim of this study was to evaluate whether centralization of oesophagogastric cancer to high-volume centres has had an effect on mortality from different emergency upper gastrointestinal conditions. METHODS: The Hospital Episode Statistics database was used to identify patients admitted to hospitals in England (1997-2012). The influence of oesophagogastric high-volume cancer centre status (20 or more resections per year) on 30- and 90-day mortality from oesophageal perforation, paraoesophageal hernia and perforated peptic ulcer was analysed...
November 20, 2017: British Journal of Surgery
https://www.readbyqxmd.com/read/29154517/a-proposal-for-a-tailored-approach-to-diverting-ostomy-for-colorectal-anastomosis
#13
Lisa Manzenreiter, Georg Spaun, Michael Weitzendorfer, Rosalia Luketina, Stavros A Antoniou, Helwig Wundsam, Oliver O Koch, Klaus Emmanuel
BACKGROUND: The use of a protective stoma represents an important issue in colorectal surgery. Although evidence suggests that loop ileostomy may be superior, the optimal method for temporary decompression of colorectal anastomosis still remains controversial. Aim of this study was to make an evidence-based proposal for a tailored approach to the use of diverting colostomy or ileostomy. METHODS: A retrospective analysis of all patients subjected to creation and closure of a diverting loop colostomy or loop ileostomy between May 2007 and November 2014 in our institution was performed...
November 20, 2017: Minerva Chirurgica
https://www.readbyqxmd.com/read/29153898/the-significance-of-the-pd-l1-expression-in-non-small-cell-lung-cancer-trenchant-double-swords-as-predictive-and-prognostic-markers
#14
REVIEW
Kazuki Takada, Gouji Toyokawa, Fumihiro Shoji, Tatsuro Okamoto, Yoshihiko Maehara
Lung cancer is the leading cause of death due to cancer worldwide. Surgery, chemotherapy, and radiotherapy have been the standard treatment for lung cancer, and targeted molecular therapy has greatly improved the clinical course of patients with non-small-cell lung cancer (NSCLC) harboring driver mutations, such as in epidermal growth factor receptor and anaplastic lymphoma kinase genes. Despite advances in such therapies, the prognosis of patients with NSCLC without driver oncogene mutations remains poor. Immunotherapy targeting programmed cell death-1 (PD-1) and programmed cell death-ligand 1 (PD-L1) has recently been shown to improve the survival in advanced NSCLC...
October 28, 2017: Clinical Lung Cancer
https://www.readbyqxmd.com/read/29153848/-maternal-death-by-stroke-results-from-the-french-enquiry-into-maternal-deaths-2010-2012
#15
H Cohen, M Rossignol
Stroke is a rare event during pregnancy (10/100,000) and can be ischemic (24%), hemorrhagic (74%) or both (2%). Pregnancy probably increases the risk even if it is discussed for arteriovenous malformation (AVM), aneurismal subarachnoid hemorrhage (SAH) and cavernomas. Between 2010 and 2012, 31 maternal deaths were associated with stroke. In 22 cases, stroke was the direct cause of death giving a maternal mortality ratio of 0,9/100,000 witch is not different from the former report (2007-2009). There were 2 cerebral thrombophlebitis, 2 ischemic strokes and 18 hemorrhagic strokes (4 SAH, 2 AVM)...
November 15, 2017: Gynecologie, Obstetrique, Fertilite & Senologie
https://www.readbyqxmd.com/read/29153247/early-versus-delayed-appendectomy-a-comparison-of-outcomes
#16
Kyle Seudeal, Hira Abidi, Saad Shebrain
BACKGROUND: The optimal timing for performing appendectomy in adults remains controversial. METHOD: A one-year retrospective review of adult patients with acute appendicitis who underwent appendectomy. The cohort was divided by time-to-intervention into two groups: patients who underwent appendectomy within 8 h (group 1), and those who had surgery after 8 h (group 2). Outcome measures including perioperative morbidity and mortality, post-operative length of stay, and the 30-day readmission rate were compared between the two groups...
November 11, 2017: American Journal of Surgery
https://www.readbyqxmd.com/read/29152500/application-of-3d-technology-and-printing-for-femoral-derotation-osteotomy-case-and-technical-report
#17
Nicolás Fiz, Diego Delgado, Xabier Sánchez, Pello Sánchez, Ane Miren Bilbao, Jaime Oraa, Mikel Sánchez
In some surgical techniques like femoral derotation osteotomy, accuracy is a key factor that often is not optimal because of the lack of appropriate technology. 3D printing is emerging in many professional areas and its use in the medical field may enhance the results of certain surgeries. This case describes a patient who underwent an intramedullary nail fixation to treat a femoral shaft fracture. After nine months, the patient presented hip pain and "in toe" walking caused by a malrotation produced during the surgery...
October 2017: Annals of Translational Medicine
https://www.readbyqxmd.com/read/29152076/profiling-tumour-heterogeneity-through-circulating-tumour-dna-in-patients-with-pancreatic-cancer
#18
Patricia Adamo, Caroline M Cowley, Christopher P Neal, Vilas Mistry, Karen Page, Ashley R Dennison, John Isherwood, Robert Hastings, JinLi Luo, David A Moore, Pringle J Howard, Martins L Miguel, Catrin Pritchard, Margaret Manson, Jacqui A Shaw
The majority of pancreatic ductal adenocarcinomas (PDAC) are diagnosed late so that surgery is rarely curative. Earlier detection could significantly increase the likelihood of successful treatment and improve survival. The aim of the study was to provide proof of principle that point mutations in key cancer genes can be identified by sequencing circulating free DNA (cfDNA) and that this could be used to detect early PDACs and potentially, premalignant lesions, to help target early effective treatment. Targeted next generation sequencing (tNGS) analysis of mutation hotspots in 50 cancer genes was conducted in 26 patients with PDAC, 14 patients with chronic pancreatitis (CP) and 12 healthy controls with KRAS status validated by digital droplet PCR...
October 20, 2017: Oncotarget
https://www.readbyqxmd.com/read/29151242/a-qualitative-examination-of-increased-alcohol-use-after-bariatric-surgery-among-racially-ethnically-diverse-young-adults
#19
Christine E Spadola, Eric F Wagner, Leah M Varga, Jennifer L Syvertsen, Nestor F De La Cruz Munoz, Sarah E Messiah
INTRODUCTION: Mounting evidence suggests that bariatric surgery, or weight loss surgery (WLS), patients might be vulnerable to developing post-operative alcohol use problems. While the majority of published research offers information concerning the prevalence of problematic alcohol use post-WLS, the literature lacks comprehensive, qualitative explorations examining why alcohol misuse might emerge after WLS. Such data-driven hypotheses are needed to effectively target this emerging concern...
November 19, 2017: Obesity Surgery
https://www.readbyqxmd.com/read/29150999/focus-on-focus-lack-of-coherence-between-systemic-and-microvascular-indices-of-edema-formation
#20
Birkitt Ten Tusscher, Corien Gudden, Suus van Vliet, Bob Smit, Can Ince, E Christiaan Boerma, Harm-Jan S de Grooth, Paul W G Elbers
BACKGROUND: Fluid therapy remains a cornerstone of therapy in shock states. However, fluid overloading ultimately results in edema formation which is related to excess morbidity and mortality. Handheld microscopes are now frequently used to study the sublingual microcirculation. As a corollary, these devices measure focal distance, or surface to capillary distance. Physiologically, this could represent a microvascular index of edema formation and could have the potential to guide fluid therapy...
November 18, 2017: Anaesthesiology Intensive Therapy
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