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https://www.readbyqxmd.com/read/28213888/transfusion-in-critical-care-a-uk-regional-audit-of-current-practice
#1
J O M Plumb, M G Taylor, E Clissold, M P W Grocott, R Gill
A consistent message within critical care publications has been that a restrictive transfusion strategy is non-inferior, and possibly superior, to a liberal strategy for stable, non-bleeding critically ill patients. Translation into clinical practice has, however, been slow. Here, we describe the degree of adherence to UK best practice guidelines in a regional network of nine intensive care units within Wessex. All transfusions given during a 2-month period were included (n = 444). Those given for active bleeding or within 24 h of major surgery, trauma or gastrointestinal bleeding were excluded (n = 148)...
February 18, 2017: Anaesthesia
https://www.readbyqxmd.com/read/28213861/peri-operative-allogeneic-blood-transfusion-and-outcomes-after-radical-cystectomy-a-population-based-study
#2
D Robert Siemens, Melanie T Jaeger, Xuejiao Wei, Francisco Vera-Badillo, Christopher M Booth
INTRODUCTION: To describe factors associated with peri-operative blood transfusion (PBT) at radical cystectomy (RC) for patients with bladder cancer and evaluate its association on both early and late outcomes. METHODS: Electronic records of treatment and surgical pathology reports were linked to the population-based Ontario Cancer Registry to identify all patients who underwent RC between 2000 and 2008. Modified Poisson regression model was used to determine the factors associated with PBT...
February 17, 2017: World Journal of Urology
https://www.readbyqxmd.com/read/28208978/a-randomized-controlled-study-of-0-5-bupivacaine-0-5-ropivacaine-and-0-75-ropivacaine-for-supraclavicular-brachial-plexus-block
#3
Ranjan R Venkatesh, Prabhat Kumar, Ramachandran R Trissur, Sagiev Koshy George
INTRODUCTION: For any surgery in the upper extremity that does not involve the shoulder, a supraclavicular block is preferred, as it is a safe procedure associated with rapid onset and reliable anaesthesia. Although ropivacaine has been extensively studied for epidural anaesthesia, very few reports exist on its use in supraclavicular brachial plexus block. AIM: This study was conducted to investigate and compare the effectiveness of supraclavicular brachial plexus anaesthesia with two different concentrations of ropivacaine (0...
December 2016: Journal of Clinical and Diagnostic Research: JCDR
https://www.readbyqxmd.com/read/28208938/institutional-experience-in-the-management-of-hilar-liver-obstruction-a-series-of-13-cases
#4
Adithya Malolan Pathanki, Adithya V Naragund, Basant Mahadevappa
Neoplastic hilar obstruction to the liver outflow presents a unique challenge to the surgeon, wherein, the balance between a curative and possibly larger resection has to be achieved against a more conservative local resection. These are often technically demanding and have thus, far produced equivocal outcomes on both ends. The present case series is on 13 patients who presented with hilar obstruction. They all underwent resections with possible curative intent. The focus of our review is on the technical nuances and the strategies we used, intra- and peri-operatively to make resections possible in these patients, who at first look were deemed inoperable...
December 2016: Journal of Clinical and Diagnostic Research: JCDR
https://www.readbyqxmd.com/read/28208936/supra-hepatic-inferior-vena-cava-thrombosis-surgical-challenges
#5
Senthil Muthuraman, Anand Ramamurthy, Mahesh Gopashetty, Cuddalore Sadasivam Vijayshankar, Anand Khakhar
Autosomal Dominant Polycystic Kidney Disease (ADPKD) is a chronic affliction characterized by numerous liver and kidney cysts. There is a gradual but progressive renal and liver impairment which may require combined liver-kidney transplantation. Compression of the retrohepatic Inferior Vena Cava (IVC) by an enlarged polycystic liver may impede clear visualization on pre-operative imaging and miss an underlying thrombosis or obliteration. This may result in an intra-operative surprise. Management can be challenging requiring modification of conventional surgical approach...
December 2016: Journal of Clinical and Diagnostic Research: JCDR
https://www.readbyqxmd.com/read/28208921/transurethral-cystolithotripsy-of-large-bladder-stones-by-holmium-laser-as-a-day-care-procedure
#6
Shantajit Nameirakpam, Salinita Naorem, M S Faridi, Kaku Singh Akoijam, Rajendra Singh Sinam
INTRODUCTION: Bladder stones constitute around 5% of bladder stones in the developed countries. Holmium laser lithotripsy has revolutionised the treatment of urinary lithiasis. AIM: The aim of this study was to report the outcome of transurethral cystolithotripsy with Holmium Laser under Local Anaesthesia (LA) as a day care procedure in patients with bladder stones. MATERIALS AND METHODS: Patients with bladder stone greater than 1.5cm attending urology Outpatient Department underwent transurethral cystolithotripsy with Holmium Laser under LA as day care procedure...
December 2016: Journal of Clinical and Diagnostic Research: JCDR
https://www.readbyqxmd.com/read/28208571/re-peri-operative-transfusion-risk-in-classic-bladder-exstrophy-closure-results-from-a-national-database-review
#7
Douglas A Canning
No abstract text is available yet for this article.
March 2017: Journal of Urology
https://www.readbyqxmd.com/read/28205284/prognostic-impact-of-complications-after-resection-of-early-stage-hepatocellular-carcinoma
#8
Georgios Antonios Margonis, Kazunari Sasaki, Nikolaos Andreatos, Yujiro Nishioka, Toshitaka Sugawara, Neda Amini, Stefan Buettner, Masaji Hashimoto, Junichi Shindoh, Timothy M Pawlik
BACKGROUND: Resection is the most effective treatment for HCC. However, postoperative morbidity is common and its impact on long-term oncological outcome remains unclear. METHODS: Long-term outcomes of 774 patients who underwent curative resection for early stage HCC at Johns Hopkins Hospital and Toranomon Hospital were investigated after stratifying by the development of postoperative overall and infectious complications. RESULTS: A minor or major postoperative complication developed in 281 and 65 patients, respectively, while postoperative mortality was 1...
February 15, 2017: Journal of Surgical Oncology
https://www.readbyqxmd.com/read/28203409/practice-patterns-in-venous-thromboembolism-vte-prophylaxis-in-thoracic-surgery-a-comprehensive-canadian-delphi-survey
#9
John Agzarian, Lori-Ann Linkins, Laura Schneider, Waël C Hanna, Christian J Finley, Colin Schieman, Marc De Perrot, Mark Crowther, James Douketis, Yaron Shargall
BACKGROUND: The incidence of venous thromboembolic events (VTE) after resection of thoracic malignancies can reach 15%, but prophylaxis guidelines are yet to be established. We aimed to survey Canadian practitioners regarding perioperative risk factors for VTE, impact of those factors on extended prophylaxis selection, type of preferred prophylaxis, and timing of initiation and duration of thromboprophylaxis. METHODS: A modified Delphi survey was undertaken over three rounds with thoracic surgeons, thoracic anesthesiologists and thrombosis experts across Canada...
January 2017: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/28194628/association-between-ck-mb-area-under-the-curve-and-tranexamic-acid-utilization-in-patients-undergoing-coronary-artery-bypass-surgery
#10
Sean van Diepen, Peter D Merrill, Michel Carrier, Jean-Claude Tardif, Mihai Podgoreanu, John H Alexander, Renato D Lopes
Myonecrosis after coronary artery bypass graft (CABG) surgery is associated with excess mortality. Tranexamic acid (TA), an anti-fibrinolytic agent, has been shown to reduce peri-operative blood loss without increasing the risk of myocardial infarction (MI); however, no large study has examined the association between TA treatment and post-CABG myonecrosis. In the MC-1 to Eliminate Necrosis and Damage in Coronary Artery Bypass Graft Surgery II trial, inverse probability weighting of the propensity to receive TA was used to test for differences among the 656 patients receiving and 770 patients not receiving TA...
February 14, 2017: Journal of Thrombosis and Thrombolysis
https://www.readbyqxmd.com/read/28193628/management-of-endocrine-disease-neuroendocrine-surveillance-and-management-of-neurosurgical-patients-non-pituitary
#11
Aoife Garrahy, Mark Sherlock, Chris J Thompson
Advances in the management of traumatic brain injury, subarachnoid haemorrhage and intracranial tumours have led to improved survival rates and an increased focus on quality of life of survivors. Endocrine sequelae of the acute brain insult and subsequent neurosurgery, peri-operative fluid administration and/or cranial irradiation are now well described. Unrecognized acute hypopituitarism, particularly ACTH/cortisol deficiency and diabetes insipidus, can be life-threatening. While hypopituitarism may be transient, up to 30% of survivors of TBI have chronic hypopituitarism, which can diminish quality of life and hamper rehabilitation...
February 13, 2017: European Journal of Endocrinology
https://www.readbyqxmd.com/read/28193572/systematic-review-of-early-and-long-term-outcome-of-liver-resection-for-metastatic-breast-cancer-is-there-a-survival-benefit
#12
REVIEW
Tae Gon Yoo, Isaac Cranshaw, Reuben Broom, Sanjay Pandanaboyana, Adam Bartlett
BACKGROUND: Isolated liver metastases occur rarely in patients with metastatic breast cancer. The success of liver resection (LR) for other metastatic disease has led centres to explore the option of LR for patients with isolated breast cancer liver metastases (BCLM). A number of small series have been published in the literature, however the evidence is conflicting. This study aimed to systematically review the literature to determine the perioperative outcome and survival of patients undergoing LR for BCLM...
February 10, 2017: Breast: Official Journal of the European Society of Mastology
https://www.readbyqxmd.com/read/28192265/microsurgical-outcomes-after-gross-total-resection-on-vestibular-schwannoma-in-the-elderly-a-matched-cohort-study
#13
Nian Jiang, Zaibin Wang, Wen Chen, Yuanyang Xie, Zefeng Peng, Jian Yuan, Siyi Wanggou, Yandong Su, Xuejun Li, Xianrui Yuan
OBJECTIVES: To compare and analyze the differences in clinical manifestations and surgical outcomes after gross total resection (GTR) for vestibular schwannoma (VS) between elderly and younger patients. METHODS: We conducted a retrospective study of 40 elderly (≥65 years) and 40 younger (< 65 years) patients, and matched operation dates and tumor size in the 2 groups were matched. All 80 patients underwent microsurgical resection though the sigmoid approach, by the same surgeon (Professor Xianrui Yuan, M...
February 9, 2017: World Neurosurgery
https://www.readbyqxmd.com/read/28186870/total-hip-arthroplasty-via-the-direct-anterior-approach-with-kerboull-type-acetabular-reinforcement-device-for-an-elderly-female-with-factor-xi-deficiency
#14
Kei Sano, Yasuhiro Homma, Tomonori Baba, Jun Ando, Mikio Matsumoto, Hideo Kobayashi, Takahito Yuasa, Kazuo Kaneko
We present a case of successful and uncomplicated total hip arthroplasty with an acetabular reinforcement device in an elderly patient with hip osteoarthritis already diagnosed with factor XI deficiency, which is a very rare bleeding disorder and at high risk of post-operative haemorrhage, and it poses a substantial challenge to surgeons as a consequence of the specific risks of infection and fixation failure. Moreover, bone fragility in elderly patient increases potential risk of adverse event. Fresh frozen plasma was used to supplement factor XI activity...
2017: SICOT-J
https://www.readbyqxmd.com/read/28181257/limited-synchronous-hepatic-resection-does-not-compromise-peri-operative-outcomes-or-survival-after-cytoreductive-surgery-and-hyperthermic-intraperitoneal-chemotherapy
#15
Akshat Saxena, Sarah J Valle, Winston Liauw, David L Morris
INTRODUCTION: There is uncertainty about whether hepatic resection (HR) combined with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) is effective. METHODS: Nine hundred and thirty-five consecutive CRS/HIPEC procedures were performed between 1996 and 2016 of which 132(14%) involved concomitant HR. Peri-operative complications were graded according to the Clavien-Dindo Classification. The association of concomitant HR with 19 peri-operative outcomes and overall survival (OS) was assessed using univariate and multivariate analyses...
February 9, 2017: Journal of Surgical Oncology
https://www.readbyqxmd.com/read/28165882/role-of-combined-post-operative-venous-lactate-and-48-hours-c-reactive-protein-values-on-the-etiology-and-predictive-capacity-of-organ-space-surgical-site-infection-after-elective-colorectal-operation
#16
Montserrat Juvany, Xavier Guirao, Joan Carles Oliva, Jose M Badía Pérez
BACKGROUND: C-reactive protein (CRP) has been assessed to detect organ-space surgical site infection (OSI). Nevertheless, data about peri-operative oxygen debt and surgical stress-elicited biologic markers to explain and allow for the early detection of OSI are lacking. We analyzed immediate post-operative venous lactate, early CRP levels, and intra-operative hemodynamic values on the capacity to predict OSI after elective colorectal operation. PATIENTS AND METHODS: Patients undergoing an elective colorectal surgical procedure with anastomosis between March 2013 and August 2014 were included and assessed prospectively...
February 6, 2017: Surgical Infections
https://www.readbyqxmd.com/read/28163085/novel-technique-for-proximal-bone-anchoring-of-penile-prosthesis-after-radial-forearm-free-flap-neophallus
#17
Andrew J Cohen, Raj R Bhanvadia, Joseph J Pariser, David M Hatcher, Lawrence J Gottlieb, Gregory T Bales
BACKGROUND: Penile prosthesis insertion allows individuals with a neophallus to achieve erectile function. Lack of corporal bodies to accommodate cylinders makes anchoring of any prosthesis challenging. Anchoring the device to pubic bone is one strategy to achieve proximal stabilization of the prosthesis. PURPOSE: To describe outcomes of bone anchoring of penile implant in a neophallus with an accompanying video focusing on operative technique and salient tips for surgeons performing these procedures...
February 2, 2017: Urology
https://www.readbyqxmd.com/read/28163000/peri-operative-chemotherapy-with-or-without-bevacizumab-in-operable-oesophagogastric-adenocarcinoma-uk-medical-research-council-st03-primary-analysis-results-of-a-multicentre-open-label-randomised-phase-2-3-trial
#18
David Cunningham, Sally P Stenning, Elizabeth C Smyth, Alicia F Okines, William H Allum, Sam Rowley, Laura Stevenson, Heike I Grabsch, Derek Alderson, Thomas Crosby, S Michael Griffin, Wasat Mansoor, Fareeda Y Coxon, Stephen J Falk, Suzanne Darby, Kate A Sumpter, Jane M Blazeby, Ruth E Langley
BACKGROUND: Peri-operative chemotherapy and surgery is a standard of care for patients with resectable oesophagogastric adenocarcinoma. Bevacizumab, a monoclonal antibody against VEGF, improves the proportion of patients responding to treatment in advanced gastric cancer. We aimed to assess the safety and efficacy of adding bevacizumab to peri-operative chemotherapy in patients with resectable gastric, oesophagogastric junction, or lower oesophageal adenocarcinoma. METHODS: In this multicentre, randomised, open-label phase 2-3 trial, we recruited patients aged 18 years and older with histologically proven, resectable oesophagogastric adenocarcinoma from 87 UK hospitals and cancer centres...
February 2, 2017: Lancet Oncology
https://www.readbyqxmd.com/read/28161484/twenty-year-experience-with-aorto-enteric-fistula-repair-gastrointestinal-complications-predict-mortality
#19
Atish Chopra, Lucyna Cieciura, J Gregory Modrall, R James Valentine, Jayer Chung
BACKGROUND: Aorto-enteric fistulae (AEF) represent a lethal subset of aortic graft infections. The optimal management of AEF remains unclear. We aimed to identify predictors of morbidity and mortality. STUDY DESIGN: We performed a single-center retrospective review of consecutive AEF repairs. Demographics, co-morbidities, and peri-operative variables were obtained. Descriptive statistics, Chi-squared, Kruskall-Wallis, and Cox proportional-hazards modeling were utilized where appropriate...
February 1, 2017: Journal of the American College of Surgeons
https://www.readbyqxmd.com/read/28159650/impact-of-the-new-kidney-allocation-system-on-perioperative-outcomes-and-costs-in-kidney-transplantation
#20
David J Taber, Derek DuBay, John W McGillicuddy, Satish Nadig, Charles F Bratton, Kenneth D Chavin, Prabhakar K Baliga
BACKGROUND: In December 2014, a new kidney allocation system (KAS) was implemented nationwide with the goal of improving longevity matching, increasing access to sensitized patients, and improving racial/ethnic disparities. STUDY DESIGN: National cohort study of US kidney transplantation programs, analyzing hospital-level outcomes (October 2012 to June 2016) using University HealthSystem Consortium data. In-hospital outcomes and costs were analyzed for trends over time using interrupted time series analysis with segmented regression...
January 31, 2017: Journal of the American College of Surgeons
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