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Non-operative management

Benjamin White, Rachel Rosovsky, Blair Alden Parry, Christopher Kabrhel
Pulmonary embolism (PE) and venous thromboembolism (VTE) are common diagnoses in the emergency department (ED), with significant potential morbidity and mortality. As a result, historically nearly all patients with PE have been admitted to the hospital for observation and treatment. In recent years, the ability to rapidly and accurately risk stratify patients with VTE according to their risk of short-term clinical deterioration has supported outpatient treatment, and non-vitamin K antagonist oral anticoagulants (NOACs) have further facilitated this approach...
October 20, 2016: Seminars in Thrombosis and Hemostasis
Nicholas Arlas, Harry Jergesen
Factors endemic in safety-net hospitals may breed poor outcomes in hip and knee arthroplasty. This review highlights these challenges and discusses strategies to reduce operative risk and promote better surgical outcomes. Sub-optimally managed medical co-morbidities, poverty, and substance abuse are examples of challenges common in safety-net hospital populations and are associated with poor surgical outcomes. Patient management strategies that positively affect surgical outcomes may be nonexistent, underfunded, or underused...
2016: Journal of Health Care for the Poor and Underserved
Aaron J Krych, Patrick J Reardon, Nick R Johnson, Rohith Mohan, Logan Peter, Bruce A Levy, Michael J Stuart
PURPOSE: Medial meniscus posterior root tears (MMPRTs) are a significant source of pain and dysfunction, but little is known about the natural history and outcome and for non-operative management of these lesions. The purpose of this study was to evaluate (1) the mid-term clinical and radiographic outcomes of non-operative treatment of MMPRTs and (2) risk factors for worse outcomes. METHODS: A retrospective review was performed for patients with symptomatic, unrepaired MMPRTs and a minimum 2-year follow-up for IKDC and Tegner outcome scores...
October 19, 2016: Knee Surgery, Sports Traumatology, Arthroscopy: Official Journal of the ESSKA
Daniel W Birch, Jerry T Dang, Noah J Switzer, Namdar Manouchehri, Xinzhe Shi, Ghassan Hadi, Shahzeer Karmali
BACKGROUND: Intraoperative hypothermia during both open and laparoscopic abdominal surgery may be associated with adverse events. For laparoscopic abdominal surgery, the use of heated insufflation systems for establishing pneumoperitoneum has been described to prevent hypothermia. Humidification of the insufflated gas is also possible. Past studies on heated insufflation have shown inconclusive results with regards to maintenance of core temperature and reduction of postoperative pain and recovery times...
October 19, 2016: Cochrane Database of Systematic Reviews
Chun-Yuan Lee, Calvin M Kunin, Chung Chang, Susan Shin-Jung Lee, Yao-Shen Chen, Hung-Chin Tsai
BACKGROUND: Cellulitis is a common infectious disease. Although blood culture is frequently used in the diagnosis and subsequent treatment of cellulitis, it is a contentious diagnostic test. To help clinicians determine which patients should undergo blood culture for the management of cellulitis, a diagnostic scoring system referred to as the Bacteremia Score of Cellulitis was developed. METHODS: Univariable and multivariable logistic regression analyses were performed as part of a retrospective cohort study of all adults diagnosed with cellulitis in a tertiary teaching hospital in Taiwan in 2013...
October 19, 2016: BMC Infectious Diseases
T Ni, X Sun, B Shan, J Wang, Y Liu, S-L Gu, Y-D Wang
OBJECTIVE: To evaluate the role of circulating tumour cells (CTCs) in patients with endometrial cancer (EC). STUDY DESIGN: This study included 40 patients with a pre-operative diagnosis of high-risk EC between April 2015 and May 2016. Patients were further divided into high-risk (grade 3, non-endometrioid, myometrial invasion ≥1/2 and stage III-IV) and high-intermediate-risk (grade 2-3, endometrioid, myometrial invasion <1/2 and stage I-II) groups according to postoperative pathological results...
October 10, 2016: European Journal of Obstetrics, Gynecology, and Reproductive Biology
Shintaro Sukegawa, Takahiro Kanno, Daiki Nagano, Akane Shibata, Yuka Sukegawa-Takahashi, Yoshihiko Furuki
INTRODUCTION: In recent years, bioresorbable plates have undergone remarkable development. However, there has been no attendant improvement in their strength, because strength requires thickness, and complications such as palpability are related to the thickness of bioresorbable plate systems. In this clinical study, we compared the surgical management of zygomatic fractures using newly developed thinner bioresorbable materials or conventional titanium miniplates. METHODS: Twelve patients with zygomatic fractures were randomly divided equally into 2 groups (6 with new bioresorbable osteosynthesis materials and 6 with standard titanium miniplates)...
October 14, 2016: Journal of Craniofacial Surgery
Marcos Espinal, Sylvain Aldighieri, Ronald St John, Francisco Becerra-Posada, Carissa Etienne
The World Health Organization's determination of the Ebola virus disease outbreak as a public health event of international concern prompted non affected countries to implement measures to prevent, detect, and manage the introduction of the virus in their territories. The outbreak provided an opportunity to assess the operational implementation of the International Health Regulations' core capacities and health systems' preparedness to handle a potential or confirmed case of Ebola virus disease. A public health framework implemented in Latin America and Caribbean countries encompassing preparatory self-assessments, in-country visits, and follow-up suggests that the region should increase efforts to consolidate and sustain progress on core capacities and health system preparedness to face public health events with national or international repercussions...
March 2016: Revista Panamericana de Salud Pública, Pan American Journal of Public Health
Chen-Huan Chen
Blood pressure (BP) is conventionally measured with a pressure cuff over an upper arm and a cutoff of 140/90 mmHg in the office is the current criteria for diagnosing hypertension. Recently, out of office BP has been suggested as the reference standard for the management of hypertension, due to its better prognostic value over office BP.However, the above BP parameters are all measured at brachial arteries and may be different from the central blood pressure (CBP) measured in the ascending aorta or carotid arteries...
September 2016: Journal of Hypertension
Steven L Clark, Emily Hamilton, Thomas J Garite, Audra Timmins, Philip A Warrick, Samuel Smith
BACKGROUND: Despite intensive efforts directed at initial training in fetal heart rate interpretation, continuing medical education, board certification/recertification, team training and the development of specific protocols for the management of abnormal fetal heart rate patterns, the goals of consistently preventing hypoxia-induced fetal metabolic acidemia and neurologic injury remain elusive. OBJECTIVE: To validate a recently published algorithm for the management of category II fetal heart rate tracings , examine reasons for the birth of infants with significant metabolic acidemia despite the use of electronic fetal heart rate monitoring and critically examine the limits of EFHRM in the prevention of neonatal metabolic acidemia...
October 14, 2016: American Journal of Obstetrics and Gynecology
E Chapman, A Eastman, A Gilmore-Bykovskyi, B Vogelman, A J Kind
Older adults often face poor outcomes when transitioning from hospital to home. Although physicians play a key role in overseeing transitions, there is a lack of practice-based educational programs that prepare resident physicians to manage care transitions of older adults. An educational intervention to provide residents with real-life transitional care practice was therefore developed-Resident-coordinated Transitional Care (RC-TraC). RC-TraC adapted the evidence-based Coordinated-Transitional Care (C-TraC) nurse role for residents, providing opportunities to follow patients during the peri-hospital period without additional costs to the residency program...
October 17, 2016: Gerontology & Geriatrics Education
K Masmoudi, M Mtaoumi, K Bouattour, M L Ben Ayeche
Congenital constriction of the limbs is usually due to amniotic band syndrome, which often causes damage to the skin and soft tissues. We report an unusual case in which a neonate had recent fractures of both leg bones with an amniotic band encircling the limb. Non-operative treatment was successful. Challenges to the management of neonatal limb constriction include the absence of a consensus about the best treatment and the high frequency of damage to vessels and nerves.
October 10, 2016: Orthopaedics & Traumatology, Surgery & Research: OTSR
Andreas Kiilerich Andresen, Carsten Ernst, Mikkel Ø Andersen
Lumbar spinal stenosis is the most common reason for spinal surgery in Denmark. Lumbar spinal stenosis is a clinical syndrome of pain in the buttocks or lower extremities, with or without back pain. It is associated with reduced space available for the neural and vascular elements of the lumbar spine. The condition is often exacerbated by standing, walking or lumbar extension and relieved by forward flexion. The options for non-surgical management include drugs and physiotherapy. Treatment outcomes seem to be better for surgical neural decompression than for non-operative treatment...
October 10, 2016: Ugeskrift for Laeger
Hafiz Mamoon Rehman, Zahid Hussain Shah, Muhammad Amjad Nawaz, Muhammad Qadir Ahmad, Seung Hwan Yang, Kang Hee Kho, Gyuhwa Chung
This review provides an insight into the beta-cyanoalanine synthase pathway in higher plants for cyanide (CN) detoxification and describes how it contributes to various physiological activities, such as plant growth and development. In higher plants, CN is produced as a natural toxin through the biosynthesis of ethylene and camalexin, the degradation of glucosinolates and cyanogenic glycosides, the oxidation of amino acids, and the metabolism of glyoxylate and hydroxylamine. To maintain cellular homeostasis by maintaining CN at non-toxic levels, plants have evolved four different biochemical pathways: the β-cyanoalanine synthase pathway (beta-CASP), the thiocyanate pathway, the formamide hydrolase pathway, and the natural release of CN through volatilization...
October 15, 2016: Planta
June Yowtak, Suash Sharma, Scott E Forseen, Cargill H Alleyne
BACKGROUND: Mixed tumors of adenomatous and neuronal cells in the sellar region are an uncommon finding. The origins of these heterogeneous tumors are unknown and management of these lesions still debated. We report a very rare case of anterior gray matter pituicytic heterotopia with monomorphic anterior pituitary cells that likely represents a variant of non-secreting pituitary adenoma - neuronal choristoma (PANCH) without any ganglion cells. We also review the current literature for the different clinical presentations of PANCH...
October 12, 2016: World Neurosurgery
Monica Jain, David L Krasne, Frederick R Singer, Armando E Giuliano
Parathyromatosis is a rare condition consisting of multiple nodules of benign hyperfunctioning parathyroid tissue scattered throughout the neck and superior mediastinum. As a potential cause of recurrent or persistent hyperparathyroidism, parathyromatosis is a challenging condition to diagnose and treat. The optimal evaluation and management of patients with parathyromatosis is not well established. The reported case involves a patient who was initially diagnosed with primary hyperparathyroidism. The diagnosis of Type 1 parathyromatosis was made after the patient developed recurrent hyperparathyroidism with hypercalcemia and osteoporosis 17 years after the initial operation and underwent two additional operations...
October 14, 2016: Endocrine
Yusuke Watanabe, Amin Madani, Elif Bilgic, Katherine M McKendy, Gada Enani, Iman Ghaderi, Gerald M Fried, Liane S Feldman, Melina C Vassiliou
BACKGROUND: General surgery residency may not adequately prepare residents for independent practice. It is unclear; however, if non-ACGME-accredited fellowships are better meeting training needs. The purpose of this mixed-method study was to determine perceived preparedness for practice and to identify gaps in fellowship training. METHODS: A survey was developed using an iterative qualitative methodology based on interviews and focus groups of graduated fellows and program directors...
October 14, 2016: Surgical Endoscopy
Rebecca M Rentea, Shawn D St Peter, Charles L Snyder
Appendicitis is a common cause of abdominal pain in children. The diagnosis and treatment of the disease have undergone major changes in the past two decades, primarily as a result of the application of an evidence-based approach. Data from several randomized controlled trials, large database studies, and meta-analyses have fundamentally affected patient care. The best diagnostic approach is a standardized clinical pathway with a scoring system and selective imaging. Non-operative management of simple appendicitis is a reasonable option in selected cases, with the caveat that data in children remain limited...
October 14, 2016: Pediatric Surgery International
Zeinab M Alawadi, Isabel M Leal, Juan R Flores, Julie L Holihan, Blake E Henchcliffe, Thomas O Mitchell, Tien C Ko, Mike K Liang, Lillian S Kao
BACKGROUND: The purpose of this study was to identify issues important to patients in their decision-making, expectations, and satisfaction when seeking treatment for a ventral hernia. STUDY DESIGN: An exploratory qualitative study was conducted of adult patients with ventral hernias seeking care at a safety-net hospital. Two semi-structured interviews were conducted with each patient: prior to and 6 -months following surgical consultation. Interviews were audiotaped, transcribed, and coded using latent content analysis until data saturation was achieved...
October 11, 2016: Journal of the American College of Surgeons
Masakazu Hashimoto, Tsuyoshi Kobayashi, Kohei Ishiyama, Kentaro Ide, Masahiro Ohira, Hiroyuki Tahara, Shintaro Kuroda, Michinori Hamaoka, Hiroshi Iwako, Masashi Okimoto, Hideki Ohdan
BACKGROUND: Despite improvements in surgery and chemotherapy, most patients develop recurrence after initial hepatectomy for colorectal liver metastasis (CRLM). Following initial hepatectomy for CRLM, patterns and surgical management of recurrence have not been widely reported. MATERIALS AND METHODS: We identified 128 patients who underwent hepatic resection for CRLM between January 2000 and December 2012. Demographics, operative data, site of recurrence, and long-term survival data were collected and analyzed...
October 11, 2016: International Journal of Surgery
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