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David A Watters, Glenn D Guest, Viliami Tangi, Mark G Shrime, John G Meara
Progress in achieving "universal access to safe, affordable surgery, and anesthesia care when needed" is dependent on consensus not only about the key messages but also on what metrics should be used to set goals and measure progress. The Lancet Commission on Global Surgery not only achieved consensus on key messages but also recommended 6 key metrics to inform national surgical plans and monitor scale-up toward 2030. These metrics measure access to surgery, as well as its timeliness, safety, and affordability: (1) Two-hour access to the 3 Bellwether procedures (cesarean delivery, emergency laparotomy, and management of an open fracture); (2) Surgeon, Anesthetist, and Obstetrician workforce >20/100,000; (3) Surgical volume of 5000 procedures/100,000; (4) Reporting of perioperative mortality rate; and (5 and 6) Risk rates of catastrophic expenditure and impoverishment when requiring surgery...
April 2018: Anesthesia and Analgesia
Hannah M Carl, A Karim Ahmed, Nancy Abu-Bonsrah, Rafael De la Garza Ramos, Eric W Sankey, Zachary Pennington, Ali Bydon, Timothy F Witham, Jean-Paul Wolinsky, Ziya L Gokaslan, Justin M Sacks, C Rory Goodwin, Daniel M Sciubba
OBJECTIVE Resection of metastatic spine tumors can improve patients' quality of life by addressing pain or neurological compromise. However, resections are often complicated by wound dehiscence, infection, instrumentation failures, and the need for reoperation. Moreover, when reoperations are needed, the most common indication is surgical site infection and wound breakdown. In turn, wound reoperations increase morbidity as well as the length and cost of hospitalization. The aim of this study was to examine perioperative risk factors associated with increased rate of wound reoperations after metastatic spine tumor resection...
March 16, 2018: Journal of Neurosurgery. Spine
Deed E Harrison, Paul A Oakley, Joseph W Betz
[Purpose] To present the case of the dramatic reduction in pain, disability, and neurologic symptoms following the reduction of forward head translation and increased cervical curvature in a patient suffering from post-surgical radiculopathy. [Subject and Methods] A 52-year-old male mechanic presented with chronic neck pain, unilateral paresthesia along the C5 and C6 dermatome distributions and diminished unilateral grip strength for 12 years following a C5-C6 cervical discectomy and fusion. Outcome measures included the neck disability index, the numerical pain rating scale, and the Zebris cervical range of motion system...
February 2018: Journal of Physical Therapy Science
Min-Qing Wang, Xu Zhao, Xiao-Fei Wang, Chao Han, De-Guang Xing, Cheng-Wei Wang
BACKGROUND: The purpose of this study was to assess the outcomes in aggressively treated patients with aneurysmal intracerebral hematoma (ICH) and signs of brain herniation, and to investigate possible predictive factors. METHODS: This retrospective study included 43 patients with aneurysmal ICH who presented with brain herniation at emergency department (ED) admission and received aggressive surgical treatment between 2008 and 2016. Emergency surgical clipping, removal of hematoma, and external decompression were combined as an aggressive surgical treatment...
March 12, 2018: World Neurosurgery
Duncan R Morhardt, Miriam Hadj-Moussa, He Chang, J Stuart Wolf, William W Roberts, John T Stoffel, Gary J Faerber, Anne P Cameron
OBJECTIVE: To evaluate the association of clinical factors on outcomes in SCI patients undergoing ureteroscopy. Immobility, recurrent urinary tract infection, and lower urinary tract dysfunction contribute to renal stone formation in spinal cord injury (SCI) patients. Ureteroscopy is a commonly utilized treatment modality, however, surgical complication rates and outcomes have been poorly defined. Evidence guiding safe and effective treatment of stones in this cohort remains scarce. METHODS: Records were retrospectively reviewed for SCI patients who underwent ureteroscopy for kidney stones from 1996-2014 at a single institution...
March 12, 2018: Urology
Khoi Anh Nguyen, Truong Xuan Bui, Hue Van Nguyen, Richard O Wein
OBJECTIVE: The purposes of the study was to evaluate for the functional improvement of outcomes of patients undergoing surgical management for tongue cancer at varying periods after surgery. DESIGN: Case series with intervention. PARTICIPANTS: Thirty consecutive patients, from 2011 to 2015, with carcinoma of the tongue undergoing surgical resection and reconstruction with a radial forearm free flap. MAIN MEASURES: The Speech Intelligibility Test (SIT) is used for objective evaluation of speech function...
March 7, 2018: American Journal of Otolaryngology
Hylke F E van der Toom, Marc P van der Schroeff, Robert Jan Pauw
Importance: The ideal surgical treatment of cholesteatoma has been subject to discussion for years because both traditional surgical techniques (canal wall down [CWD] and canal wall up [CWU] tympanoplasty) have their own advantages and disadvantages. A more recently propagated surgical approach, to combine the CWD or CWU tympanoplasty technique with obliteration of the mastoid and epitympanum, is showing promising results. Objective: To systematically review the literature on recurrent and residual cholesteatoma rates after single-stage CWU and CWD tympanoplasty with mastoid obliteration...
March 15, 2018: JAMA Otolaryngology—Head & Neck Surgery
Kurt P Spindler, Laura J Huston, Kevin M Chagin, Michael W Kattan, Emily K Reinke, Annunziato Amendola, Jack T Andrish, Robert H Brophy, Charles L Cox, Warren R Dunn, David C Flanigan, Morgan H Jones, Christopher C Kaeding, Robert A Magnussen, Robert G Marx, Matthew J Matava, Eric C McCarty, Richard D Parker, Angela D Pedroza, Armando F Vidal, Michelle L Wolcott, Brian R Wolf, Rick W Wright
BACKGROUND: The long-term prognosis and risk factors for quality of life and disability after anterior cruciate ligament (ACL) reconstruction remain unknown. Hypothesis/Purpose: Our objective was to identify patient-reported outcomes and patient-specific risk factors from a large prospective cohort at a minimum 10-year follow-up after ACL reconstruction. We hypothesized that meniscus and articular cartilage injuries, revision ACL reconstruction, subsequent knee surgery, and certain demographic characteristics would be significant risk factors for inferior outcomes at 10 years...
March 2018: American Journal of Sports Medicine
Marius Georg Kaschner, Julian Caspers, Christian Rubbert, Raul Lande, Bastian Kraus, John-Ih Lee, Michael Gliem, Sebastian Jander, Bernd Turowski
Introduction While effectiveness of mechanical thrombectomy (MTE) in M1 segment occlusion is approved for patients with severe impairment, there is a lack of evidence for a potential benefit of MTE in patients with minor to moderate symptoms. The purpose of this study was to evaluate neurological outcome and occurrence of periprocedural complications after MTE in patients with low National Institutes of Health Stroke Scale (NIHSS) scores. Materials and methods A retrospective analysis of 1081 consecutive patients with anterior circulation ischemic stroke due to M1 occlusion detected by computed tomography angiography and treated with MTE at our hospital between February 2012 and November 2017 was performed...
January 1, 2018: Interventional Neuroradiology
Anand Rughani, Jason M Schwalb, Christos Sidiropoulos, Julie Pilitsis, Adolfo Ramirez-Zamora, Jennifer A Sweet, Sandeep Mittal, Alberto J Espay, Jorge Gonzalez Martinez, Aviva Abosch, Emad Eskandar, Robert Gross, Ron Alterman, Clement Hamani
QUESTION 1: Is bilateral subthalamic nucleus deep brain stimulation (STN DBS) more, less, or as effective as bilateral globus pallidus internus deep brain stimulation (GPi DBS) in treating motor symptoms of Parkinson's disease, as measured by improvements in Unified Parkinson's Disease Rating Scale, part III (UPDRS-III) scores? RECOMMENDATION: Given that bilateral STN DBS is at least as effective as bilateral GPi DBS in treating motor symptoms of Parkinson's disease (as measured by improvements in UPDRS-III scores), consideration can be given to the selection of either target in patients undergoing surgery to treat motor symptoms...
March 12, 2018: Neurosurgery
Kwang Hwan Park, Yeokgu Hwang, Seung Hwan Han, Yoo Jung Park, Dong Woo Shim, Woo Jin Choi, Jin Woo Lee
BACKGROUND: Recent studies have reported promising clinical results after osteochondral autograft transplantation (OAT) for the treatment of large osteochondral lesions of the talus (OLT). However, no study has yet compared clinical outcomes between primary and secondary OAT for large OLT. PURPOSE: The purpose is to compare clinical outcomes among patients with large OLT who receive primary OAT versus those who receive secondary OAT after failure of marrow stimulation and to identify factors associated with clinical failure...
March 1, 2018: American Journal of Sports Medicine
Hong-Lei Guo, Ling He, Yan-Cui Zhu, Kun Wu, Feng Yuan
The advent of disease evaluation by means of multi-slice spiral computed tomography (MSCT) and magnetic resonance imaging (MRI) represents a continually emerging role in the evaluation of various diseases; however, its role is yet to be adequately defined. Thus, the aim of the study was to compare the diagnostic value of MSCT and MRI in the diagnosis of peritoneal metastasis in primary ovarian carcinoma. Between January 2013 and December 2015, MSCT or MRI data were collected from 42 patients who had been previously diagnosed with peritoneal metastasis of ovarian carcinoma at the First Affiliated Hospital of Kunming Medical University...
2018: OncoTargets and Therapy
Temitope Adebayo, Michael Abendroth, Gaytri Gupta Elera, Allen Kunselman, Elizabeth Sinz, Amanda Ely, Amr Elkamshoushy, Ajay Soni
PURPOSE: To demonstrate that a nonbiologic strabismus surgery simulator is not inferior to a biologic wet lab for teaching the key steps of strabismus surgery. METHODS: A total of 41 medical students were randomly assigned to one of two groups: biologic wet lab or nonbiologic simulator. The students trained according to the group's protocol then participated in a recorded final assessment using a realistic strabismus surgery model. Two independent reviewers, masked to training method, graded the video recordings using three scoring systems: the International Council of Ophthalmology Approved-Ophthalmology Surgical Competency Assessment Rubric for Strabismus Surgery (ICO-OSCAR), the Global Rating Scale of Objective Structured Assessment of Technical Skills (OSATS), and the Alphabetic Summary Scale (ASS)...
March 10, 2018: Journal of AAPOS: the Official Publication of the American Association for Pediatric Ophthalmology and Strabismus
R J Cong, J F Liu, Y Jiang, Duolikun Dilixiati, X D Hou, L P Zheng
Objective: To explore the influence of the lower extremity abnormal alignment and the joint surface, and to explore the surgical skills. Methods: Twenty-two cases of tibial plateau Schatzker Ⅵ fracture internal fixation failure revision from January 2012 to January 2017 in Department of Orthopedics, Shanghai 10(th) Hospital.One year follow-up after initial surgery to make sure of failure.Three-dimensional CT scan, radiography, infection index, gait analysis, knee joint ROM, femur tibia angle, tibial plateau tibial shaft angle and posterior slope if tibial plateau were observed...
March 1, 2018: Zhonghua Wai Ke za Zhi [Chinese Journal of Surgery]
Justin Ralph Abbatemarco, Mary Alissa Willis, Robert G Wilson, Sean J Nagel, Andre G Machado, Francois A Bethoux
OBJECTIVES: Stiff-person syndrome (SPS) is associated with axial rigidity superimposed on sustained muscle spasms. These symptoms commonly interfere with the performance of activities of daily living including ambulation. This retrospective case series evaluates the outcomes of screening tests and chronic infusion of intrathecal baclofen (ITB) in patients diagnosed with SPS treated in our spasticity clinic. MATERIALS AND METHODS: Patients were identified from an institutional review board-approved clinical registry of ITB therapy...
March 13, 2018: Neuromodulation: Journal of the International Neuromodulation Society
Maria Teresa Trentinaglia, Catherine Van Der Straeten, Ilaria Morelli, Nicola Logoluso, Lorenzo Drago, Carlo L Romanò
BACKGROUND: Antibacterial coatings (ABCs) of implants have proven safe and effective to reduce postsurgical infection, but little is known about their possible economic impact on large-scale use. This study evaluated the point of economic balance, during the first year after surgery, and the potential overall annual healthcare cost savings of 3 different antibacterial technologies applied to joint arthroplasty: a dual-antibiotic-loaded bone cement (COPAL G + C), an antibacterial hydrogel coating (DAC), and a silver coating (Agluna)...
February 10, 2018: Journal of Arthroplasty
Elif Doğan Baki, Şahin Ulu, Ahmet Yüksek, Hüseyin Arıcan, Remziye Sivaci
OBJECTIVE: The aim of this study was to investigate the effect of listening to music on the consumption of an anesthetic agent as well as postoperative recovery and pain in children undergoing elective tonsillectomy. MATERIALS AND METHODS: Fifty patients were randomized into those to whom music was played during surgery (Group M) and a control group to whom music was not played (Group C). The depth of anesthesia was provided by entropy levels of 50 ± 5 in both groups...
March 12, 2018: Medical Principles and Practice: International Journal of the Kuwait University, Health Science Centre
John P Kleimeyer, Ivan Cheng, Todd F Alamin, Serena S Hu, Thomas Cha, Vijay Yanamadala, Kirkham B Wood
STUDY DESIGN: This is a retrospective cohort study. OBJECTIVE: To evaluate the long-term outcomes of selective one- to two-level anterior lumbar interbody fusions (ALIFs) in the lower lumbar spine versus continued nonsurgical management. SUMMARY OF BACKGROUND DATA: Low back pain associated with lumbar intervertebral disc degeneration is common with substantial economic impact, yet treatment remains controversial. Surgical fusion has previously provided mixed results with limited durable improvement of pain and function...
March 9, 2018: Spine
Monique H Vaughan, Shunaha Kim-Fine, Kathie L Hullfish, Tovia M Smith, Nazema Y Siddiqui, Elisa R Trowbridge
STUDY OBJECTIVE: To establish construct validity of the simulated vaginal hysterectomy trainer (SimVaHT). DESIGN: Cross-sectional validation study (Canadian Task Force classification II-2). SETTING: Single academic medical center in the United States. SUBJECTS: Fourteen residents in Obstetrics and Gynecology (four PGY-1, four PGY-2, three PGY-3 and three PGY-4). PGY-1 and PGY-2 residents were grouped to form the "junior level" cohort, while PGY-3 and PGY-4 residents comprised the "senior level" cohort...
March 7, 2018: Journal of Minimally Invasive Gynecology
Jen-Ta Shih, Chun-Lin Kuo, Tsu-Te Yeh, Hsain-Chung Shen, Ru-Yu Pan, Chia-Chun Wu
BACKGROUND: The ideal treatment for comminuted intraarticular calcaneal fractures is still debated. Open reduction and internal fixation (ORIF) is the most popular surgical procedure; however, wound complications, implant choice, and infection remain major concerns. This study aimed to demonstrate the results of an innovative, minimally invasive surgical procedure, namely, a closed reduction technique using large-diameter Steinmann pins and percutaneous calcaneoplasty using injectable calcium sulfate cement (MIIG X3, Wright Medical Technology, Inc...
March 9, 2018: BMC Musculoskeletal Disorders
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