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Richard Heyes, Krishan Ramdoo, Joseph G Manjaly, Tze Choong Charn, Taran Tatla
Despite a lack of evidence to support drain insertion in thyroid surgery, drain placement, to prevent rapidly expanding haematoma which occurs in around 1% of cases, remains common (1,2,3) . Throughout surgery there has been a drive towards reducing postoperative length of hospital admission. For day-case thyroidectomy to become a widely adopted clinical reality, the use of drains requires abandonment, but beyond this, the cause for surgeons' reticence to practise drain-free surgery, namely haematoma risk, needs to be addressed...
February 24, 2017: Clinical Otolaryngology
Hannah M Carl, Gurjot Walia, Ricardo Bello, Emily Clarke-Pearson, Aladdin H Hassanein, Brian Cho, Rachel Pedreira, Justin M Sacks
Background Although conservative management of lymphedema remains the first-line approach, surgery is effective in select patients. The purpose of this study was to review the literature and develop a treatment algorithm based on the highest quality lymphedema research. Methods A systematic literature review was performed to examine the surgical treatments for lymphedema. Studies were categorized into five groups describing excision, liposuction, lymphovenous anastomosis (LVA), vascularized lymph node transfer (VLNT), and combined/multiple approaches...
February 24, 2017: Journal of Reconstructive Microsurgery
Christoffer Clemmensen, Timo D Müller, Stephen C Woods, Hans-Rudolf Berthoud, Randy J Seeley, Matthias H Tschöp
Because human energy metabolism evolved to favor adiposity over leanness, the availability of palatable, easily attainable, and calorically dense foods has led to unprecedented levels of obesity and its associated metabolic co-morbidities that appear resistant to traditional lifestyle interventions. However, recent progress identifying the molecular signaling pathways through which the brain and the gastrointestinal system communicate to govern energy homeostasis, combined with emerging insights on the molecular mechanisms underlying successful bariatric surgery, gives reason to be optimistic that novel precision medicines that mimic, enhance, and/or modulate gut-brain signaling can have unprecedented potential for stopping the obesity and type 2 diabetes pandemics...
February 23, 2017: Cell
Derrick C Glymph, Tito D Tubog, Mariya Vedenikina
Postpartum hemorrhage (PPH) continues to be a serious complication in both developed and underdeveloped countries. It remains the leading cause of maternal mortality in underdeveloped countries. Implementation of the World Health Organization guidelines of PPH treatment has reduced mortality. In addition, the prophylactic administration of tranexamic acid with uterotonic agents may contribute to the reduction of PPH. This evidence-based literature review of tranexamic acid will examine its mechanism of action as well as its effectiveness in prevention of PPH and blood loss reduction in elective surgery, obstetrics, and trauma...
December 2016: AANA Journal
Pamela Lovett, Rebecca Klingbeil, Ronald Reimer, Timothy Shine
The use of a supraglottic airway, also called laryngeal mask airway (LMA), is gaining in popularity for delivery of general anesthesia in certain situations and is shown to be safe. Use of infraglottic airways (tracheal tubes) allows for positive pressure ventilation and maneuvers, such as holding continuous positive pressure in the airway to check for pleural and dural leaks. We describe the successful use of the LMA (Teleflex Inc) for general anesthesia, in which continuous positive airway pressure of 15 cm H2O held for 20 seconds allowed the neurosurgeon to identify the site of a cerebrospinal fluid (CSF) leak and successfully repair the leak...
December 2016: AANA Journal
Kara F Hedman, Carrie L Mann, Cheryl Spulecki, Jessica Castner
This review assessed the utility of vasopressin and vasopressin analogues for the treatment of refractory hypotension associated with angiotensin-converting enzyme (ACE) inhibitors in the perioperative setting. A systematic review of the literature was conducted using MEDLINE, Embase, and ProQuest. Six randomized controlled trials met eligibility criteria. In the perioperative setting, continued use of ACE inhibitors within 24 hours before surgery remains controversial. Authors of the reviewed studies suggested that the morning dose of the ACE inhibitor be held, and those patients experienced decreased catecholamine use postoperatively and shorter duration of decreased mean arterial pressure...
December 2016: AANA Journal
Oscar Contreras Ortiz, Diaa Ee Rizk, Gabriele Falconi, Lucas Schreiner, Viridiana Gorbea Chávez
AIM: For four decades, the training for fellows in Urogynecology has been defined by taking into account the proposals of the relevant international societies. Primary health care providers and general OB/GYN practitioners could not find validated guidelines for the integration of knowledge in pelvic floor dysfunctions. The FIGO Working Group (FWG) in Pelvic Floor Medicine and Reconstructive Surgery has looked for the consensus of international opinion leaders in order to develop a set of minimal requirements of knowledge and skills in this area...
February 2017: Neurourology and Urodynamics
Uri Alkan, Yotam Shkedy, Aviram Mizrachi, Thomas Shpitzer, Aron Popovtzer, Gideon Bachar
OBJECTIVE: To determine the risk of inflammation associated with fine-needle aspiration during evaluation of Warthin's tumour. DESIGN: Retrospective case series. SETTING: Tertiary medical center. PARTICIPANTS: All patients who underwent fine-needle aspiration followed by parotidectomy between1992-2009 for the diagnosis/evaluation of a parotid gland tumour. MAIN OUTCOME MEASURE: Rate of fine-needle-aspiration-related parotitis in patients with Warthin's tumour or other parotid pathologies...
February 24, 2017: Clinical Otolaryngology
Justin W Griffin, Timothy S Leroux, Anthony A Romeo
Overhead throwing is a common causative factor in disorders of the proximal biceps in athletes. In recent years, arthroscopic repair of unstable superior labral tears or biceps tendonitis involving the long head of the biceps tendon anchor has become the standard of care. However, in some cases, superior labrum anterior-posterior (SLAP) repair requires additional evaluation and even revision surgery, which contributes to patient dissatisfaction. Differentiating overall biceps tendonitis from superior labral tears alone can be a challenge...
January 2017: American Journal of Orthopedics
Eric Swart, Peter Tang
Various authors have documented wrist ligament injuries in patients with distal radius fractures (DRFs). We conducted a study to determine whether scapholunate interosseous ligament (SLIL), triangular fibrocartilage complex (TFCC), or chondral injuries directly assessed with arthroscopy predict DRF outcomes. Forty-two patients who underwent open reduction and internal fixation of DRFs were enrolled in the study. At time of fracture surgery, patients were arthroscopically evaluated for SLIL and TFCC injuries and chondral surface damage...
January 2017: American Journal of Orthopedics
Joseph T O'Neil, Mark L Wang, Nayoung Kim, Mitchell Maltenfort, Asif M Ilyas
Pain management and opioid consumption after distal radius fracture (DRF) open reduction and internal fixation (ORIF) are highly variable and poorly understood. To optimize postoperative opioid dosage and better understand opioid consumption patterns after DRF-ORIF, we conducted a prospective study with the hypothesis that opioid consumption would increase with worsening fracture classification and various patient demographics. All patients who underwent DRF-ORIF were consecutively enrolled over a 6-month period...
January 2017: American Journal of Orthopedics
Brandon J Erickson, Annie Tilton, Rachel M Frank, William Park, Brian J Cole
We conducted a study to determine the rates of symptomatic deep vein thrombosis (DVT) and pulmonary embolism (PE) after high tibial osteotomy (HTO), distal femoral osteotomy (DFO), or tibial tubercle osteotomy (TTO) in patients who did not receive postoperative chemical prophylaxis. All patients who had HTO, DFO, or TTO performed by a single surgeon between 2009 and 2014 were identified. Charts were reviewed to determine presence or absence of DVT or PE. Patient age, smoking status, oral contraceptive (OC) use, and body mass index (BMI) were recorded...
January 2017: American Journal of Orthopedics
John F Mondanaro, Peter Homel, Baron Lonner, Jennifer Shepp, Marcela Lichtensztein, Joanne V Loewy
The treatment of pain continues to gain in saliency as a component of defining best practice in medical care. Music therapy is an integrative treatment modality that impacts patient outcomes in the treatment of spinal pain. At Mount Sinai Beth Israel, we conducted a mixed-methods study addressing the effects of music therapy interventions on the recovery of patients after spine surgery. The study combined standard medical approaches and integrative music therapy. Sixty patients (35 female, 25 male) ranging in age from 40 to 55 years underwent anterior, posterior, or anterior-posterior spinal fusion and were randomly assigned to either music therapy plus standard care (medical and nursing care with scheduled pharmacologic pain intervention) or standard care only...
January 2017: American Journal of Orthopedics
Dean K Matsuda, Nikhil Gupta, Monti Khatod, Nicole A Matsuda, Faith Anthony, Joshua Sampson, Raoul Burchette
PURPOSE: To compare outcomes of mild dysplasia with cam femoroacetabular impingement (FAI) vs mixed FAI with hip arthroscopy without capsular repair. METHODS: A retrospective review of a 2009 to 2010 multicenter prospective outcome study was performed comparing a cohort with mild dysplasia and cam femoroacetabular impingement (cohort D) to a cohort with mixed FAI (cohort M). Outcome measures included Nonarthritic Hip Score (NAHS) and satisfaction with minimum 2-year follow-up...
January 2017: American Journal of Orthopedics
Robert Kollmorgen, Richard Mather
Arthroscopic labral repair and refixation have garnered much attention over the past several years. Restoration of suction seal and native labral function has been an evolving focus for achieving excellent results in hip preservation surgery. Authors have reported using several labral management techniques: débridement, labralization, looped suture fixation, base stitch fixation, inversion-eversion, and reconstruction. The optimal technique is yet to be determined. Absolute indications for labral repair are symptomatic intra-articular pain, joint space >2 mm, and failed conservative management...
January 2017: American Journal of Orthopedics
Benjamin R Kivlan, Shane J Nho, John J Christoforetti, Thomas J Ellis, Dean K Matsuda, John P Salvo, Andrew B Wolff, Geoffrey S Van Thiel, Allston J Stubbs, Dominic S Carreira
As the field of hip arthroscopy continues to grow rapidly, our understanding of the population of patients undergoing hip arthroscopy has led to improved diagnosis and management of hip joint pathologies. The Multicenter Arthroscopic Study of the Hip (MASH) Study Group conducts multicenter clinical studies in arthroscopic hip preservation surgery. Patients undergoing arthroscopic hip preservation surgery are enrolled in a large prospective longitudinal cohort at 10 separate sites nationwide by 10 fellowship-trained hip arthroscopists...
January 2017: American Journal of Orthopedics
Jeffrey J Nepple, John C Clohisy
Our understanding of femoroacetabular impingement (FAI) as a cause of hip pain and secondary osteoarthritis has rapidly evolved since Ganz's description in 2003, which refined concepts described a half century earlier. The concepts of cam and pincer-type impingement continue to be better defined and have evolved from relatively simple concepts to more complex and variable disease patterns that are patient-specific. Ganz and colleagues described open treatment of FAI through the development of the surgical hip dislocation approach...
January 2017: American Journal of Orthopedics
Marc J Philippon, Ioanna Bolia, Renato Locks, Hajime Utsunomiya
Femoroacetabular impingement (FAI) surgery aims to restore the native anatomical relationships between bones and the soft tissues comprising the hip joint. The goal of this approach is to mimic the natural biomechanical function of the hip joint and translate it into a perfect clinical outcome. In this article, we describe the indications and contraindications for our preferred hip arthroscopic techniques for correcting FAI in both primary and revision cases and discuss the role of postoperative rehabilitation and use of biologics in further improving patient outcomes...
January 2017: American Journal of Orthopedics
Luis N Gonzalez Castro, Jaideep H Mehta, Jordan B Brayanov, Gary J Mullen
BACKGROUND: Pre-operative administration of benzodiazepines can cause hypoventilation-a decrease in minute ventilation (MV)-commonly referred to as "respiratory compromise or respiratory depression." Respiratory depression can lead to hypercarbia and / or hypoxemia, and may heighten the risk of other respiratory complications. Current anesthesia practice often places patients at risk for respiratory complications even before surgery, as respiratory monitoring is generally postponed until the patient is in the operating room...
2017: PloS One
Tao Xia, Jia-Yu Zhou, Yi-Ping Mou, Xiao-Wu Xu, Ren-Chao Zhang, Yu-Cheng Zhou, Rong-Gao Chen, Chao Lu, Chao-Jie Huang
Laparoscopic distal pancreatectomy (LDP) is a safe and reliable treatment for tumors in the body and tail of the pancreas. Postoperative pancreatic fistula (POPF) is a common complication of pancreatic surgery. Despite improvement in mortality, the rate of POPF still remains high and unsolved. To identify risk factors for POPF after laparoscopic distal pancreatectomy, clinicopathological variables on 120 patients who underwent LDP with stapler closure were retrospectively analyzed. Univariate and multivariate analyses were performed to identify risk factors for POPF...
2017: PloS One
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