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https://www.readbyqxmd.com/read/27923167/long-term-outcomes-for-different-vaginal-cuff-closure-techniques-in-robotic-assisted-laparoscopic-hysterectomy-a-randomized-controlled-trial
#1
Ziv Tsafrir, Matthew Palmer, Marisa Dahlman, A Karim Nawfal, Joelle Aoun, Andrew Taylor, Jay Fisher, Evan Theoharis, David Eisenstein
OBJECTIVE: This randomized controlled trial aimed to evaluate the outcomes of different vaginal cuff closure techniques in robotic-assisted total laparoscopic hysterectomy. STUDY DESIGN: Ninety women undergoing robotic-assisted total laparoscopic hysterectomy for benign disease were randomized to three vaginal cuff closure techniques: running 2.0 V-Lock™ (Arm 1), 0 Vicryl™ figure-of-eight (Arm 2), and running 0 Vicryl™ with Lapra-Ty(®) (Arm 3). Patients' records were reviewed for age, body mass index, smoking status and relevant co-morbidities...
November 16, 2016: European Journal of Obstetrics, Gynecology, and Reproductive Biology
https://www.readbyqxmd.com/read/27922703/robotkirurgi-p%C3%A3-bred-front-%C3%A2-utan-evidensbaserad-grund-tekniken-anv%C3%A3-nds-allt-mer-trots-att-den-%C3%A3-r-dyr-och-att-vetenskapliga-bevis-f%C3%A3-r-patientnytta-saknas
#2
Henrik Sjövall, Josefine Persson
Robot-assisted surgery on a broad front - without evidence for being cost-effective Robot-assisted surgery is currently heavily marketed. The HTA centre in Region Västra Götaland has produced five HTA reports regarding use of robot-assisted surgery in different clinical situations (prostatic cancer, benign gynaecological surgery, pediatric pyeloplasty and fundoplication, and rectal cancer), finding weak evidence for a patient value. The current report by Per Carlsson et al confirms that robot-assisted surgery indeed leads to increased costs that are not balanced by augmented patient value, i...
November 29, 2016: Läkartidningen
https://www.readbyqxmd.com/read/27921992/the-hubble-trial-haemorrhoidal-artery-ligation-hal-versus-rubber-band-ligation-rbl-for-symptomatic-second-and-third-degree-haemorrhoids-a-multicentre-randomised-controlled-trial-and-health-economic-evaluation
#3
Steven Brown, Jim Tiernan, Katie Biggs, Daniel Hind, Neil Shephard, Mike Bradburn, Allan Wailoo, Abualbishr Alshreef, Lizzie Swaby, Angus Watson, Simon Radley, Oliver Jones, Paul Skaife, Anil Agarwal, Pasquale Giordano, Marc Lamah, Mark Cartmell, Justin Davies, Omar Faiz, Karen Nugent, Andrew Clarke, Angus MacDonald, Phillip Conaghan, Paul Ziprin, Rohit Makhija
BACKGROUND: Optimal surgical intervention for low-grade haemorrhoids is unknown. Rubber band ligation (RBL) is probably the most common intervention. Haemorrhoidal artery ligation (HAL) is a novel alternative that may be more efficacious. OBJECTIVE: The comparison of HAL with RBL for the treatment of grade II/III haemorrhoids. DESIGN: A multicentre, parallel-group randomised controlled trial. PERSPECTIVE: UK NHS and Personal Social Services...
November 2016: Health Technology Assessment: HTA
https://www.readbyqxmd.com/read/27921127/pre-authorization-processes-have-no-effect-on-patients-undergoing-knee-mri-in-a-pediatric-setting-when-evaluated-by-specialists
#4
Drew Pierce, J Herman Kan, Megan May, George S Bisset
OBJECTIVE: Pre-authorization processes are often used by medical insurance companies to reduce costs by managing the utilization of advanced diagnostic imaging, and their impact on patient care is unclear. The purpose of our study is to determine if a pre-authorization process increases the rate of surgically significant abnormal knee MRI and surgical referrals compared with patients referred from pediatric orthopedic specialists who do not undergo a pre-authorization process. MATERIALS AND METHODS: A retrospective study was performed; 124 patients were identified who were referred for knee MRI by a pediatric orthopedist...
December 5, 2016: Skeletal Radiology
https://www.readbyqxmd.com/read/27920283/what-can-we-do-for-people-with-drug-resistant-epilepsy-the-2016-wartenberg-lecture
#5
Jerome Engel
Treatment goals for epilepsy are no seizures, no side effects, as soon as possible, but these goals are too often unmet. Approximately 1 million people in the United States continue to have seizures despite adequate treatment with antiseizure drugs, representing 40% of those with epilepsy, and 80% of the cost of epilepsy. Drug-resistant epilepsy (DRE) can be associated with developmental delay in infants and young children, and severe disability and morbidity in older children and adults, as well as a mortality rate 5-10 times that of the general population...
December 6, 2016: Neurology
https://www.readbyqxmd.com/read/27919762/minimally-invasive-transforaminal-lumbar-interbody-fusion-versus-percutaneous-endoscopic-lumbar-discectomy-revision-surgery-for-the-recurrent-herniation-after-microendoscopic-discectomy
#6
Yuan Yao, Huiyu Zhang, Junlong Wu, Huan Liu, Zhengfeng Zhang, Yu Tang, Yue Zhou
BACKGROUND: Most patients suffering from the recurrence of microendoscopic discectomy (MED) need to receive revision surgery. Minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) and percutaneous endoscopic lumbar discectomy (PELD) are common operative methods for MED recurrence, whereas no study has been made to compare the clinical outcomes of these two surgical methods as revision surgery for MED recurrence. METHODS: 105 patients who underwent either MIS-TLIF (58 cases) or PELD (47 cases) for revision of MED recurrence were included in this study...
December 2, 2016: World Neurosurgery
https://www.readbyqxmd.com/read/27919651/computer-assisted-skip-pedicle-screw-fixation-for-adolescent-idiopathic-scoliosis
#7
Masashi Uehara, Jun Takahashi, Shugo Kuraishi, Masayuki Shimizu, Shota Ikegami, Toshimasa Futatsugi, Hiroki Oba, Hiroyuki Kato
STUDY DESIGN: A retrospective single-center and single-surgeon study. OBJECTIVES: This study investigated the clinical and radiological results of skip pedicle screw fixation for adolescent idiopathic scoliosis (AIS). SUMMARY OF BACKGROUND DATA: At present, the generally used technique for pedicle screw fixation for the surgical correction of AIS entails inserting a pedicle screw into every segment on the corrective side and into every or every other segment on the supportive side...
December 2, 2016: Journal of Orthopaedic Science: Official Journal of the Japanese Orthopaedic Association
https://www.readbyqxmd.com/read/27919578/is-the-commercial-antibiotic-loaded-bone-cement-useful-in-prophylactic-and-cost-saving-after-knee-and-hip-joint-arthroplasty-the-transatlantic-paradox
#8
Pablo Sanz-Ruiz, Jose Antonio Matas-Diez, Mar Sanchez-Somolinos, Manuel Villanueva-Martinez, Javier Vaquero-Martín
BACKGROUND: The use of antibiotic-loaded bone cement (ALBC) has proven to be effective in preventing periprosthetic infection (PPI) after total hip (THA) and knee arthroplasty (TKA). However, the economic benefit of using ALBC routinely remains controversial. METHODS: A total of 2518 patients subjected to THA, partial hip arthroplasty, and TKA between 2009 and 2012 were identified in our prospectively collected registry. Two groups were defined: before (2009-2010) and after the introduction of ALBC (2011-2012)...
November 15, 2016: Journal of Arthroplasty
https://www.readbyqxmd.com/read/27919450/development-and-validation-of-a-prediction-model-for-patients-discharged-to-post-acute-care-after-colorectal-cancer-surgery
#9
Elizabeth A Bailey, Rebecca L Hoffman, Christopher Wirtalla, Giorgos Karakousis, Rachel R Kelz
BACKGROUND: As payment shifts toward bundled reimbursement, decreasing unnecessary inpatient care may provide cost savings. This study examines the association between discharge status, hospital duration of stay, and cost for colorectal operation patients without complications and uses risk factors to predict the need for post-acute care. METHODS: We used the New York Statewide Planning and Research Cooperative System and the California Healthcare Cost and Utilization Project State Inpatient Databases to identify all patients who underwent operative resection for colorectal cancer in 2009-2010 and were discharged to home or post-acute care...
December 2, 2016: Surgery
https://www.readbyqxmd.com/read/27919447/case-mix-adjusted-cost-of-colectomy-at-low-middle-and-high-volume-academic-centers
#10
Alex L Chang, Young Kim, Audrey E Ertel, Richard S Hoehn, Koffi Wima, Daniel E Abbott, Shimul A Shah
BACKGROUND: Efforts to regionalize surgery based on thresholds in procedure volume may have consequences on the cost of health care delivery. This study aims to delineate the relationship between hospital volume, case mix, and variability in the cost of operative intervention using colectomy as the model. METHODS: All patients undergoing colectomy (n = 90,583) at 183 academic hospitals from 2009-2012 in The University HealthSystems Consortium Database were studied...
December 2, 2016: Surgery
https://www.readbyqxmd.com/read/27919114/a-low-cost-high-definition-video-system-for-microsurgical-hindlimb-replantation-in-rats
#11
Rui Sergio, Monteiro de Barros, Marcus Vinicius Henriques Brito, Rafael Aquino Leal, Renan Kleber Costa Teixeira, Marcelo Ferreia Sabbá, Vitor Nagai Yamaki, Marcos Vinicius Vieira Lemos
Background The surgical microscope is still essential for microsurgery, but several alternatives that show promising results are currently under development, such as endoscopes and laparoscopes with video systems; however, as yet, these have only been used for arterial anastomoses. The aim of this study was to evaluate the use of a low-cost video-assisted magnification system in replantation of the hindlimbs of rats. Methods Thirty Wistar rats were randomly divided into two matched groups according to the magnification system used: the microscope group, with hindlimb replantation performed under a microscope with an image magnification of 40× and the video group, with the procedures performed under a video system composed of a high-definition camcorder, macrolenses, a 42-in television, and a digital HDMI cable...
December 5, 2016: Journal of Reconstructive Microsurgery
https://www.readbyqxmd.com/read/27917719/prevention-and-treatment-of-postoperative-endophthalmitis-using-povidone-iodine
#12
Hiroyuki Shimada, Hiroyuki Nakashizuka, Andrzej Grzybowski
Postoperative endophthalmitis is typically caused by patient's conjunctival bacterial flora or contaminated solutions and instruments. Visual outcome is often poor in severe cases, and treatment is especially difficult when endophthalmitis is caused by multidrug resistant bacteria. Povidone-iodine is used worldwide due to its wide-spectrum antimicrobial activity, absence of resistant bacteria to povidone-iodine, and low cost. Furthermore, the effective concentration against microorganisms and safe concentration for ocular tissues have been well established...
December 4, 2016: Current Pharmaceutical Design
https://www.readbyqxmd.com/read/27917669/use-of-core-biopsy-in-diagnosing-cervical-lymphadenopathy-a-viable-alternative-to-surgical-excisional-biopsy-of-lymph-nodes
#13
D Allin, S David, A Jacob, N Mir, A Giles, N Gibbins
OBJECTIVES Lymphoma often presents with a neck mass and while fine-needle aspiration cytology may be suggestive, tissue biopsy is required for reliable diagnosis and classification of a lymphoma that is sufficient to deliver the correct treatment for the patient. Traditionally, excisional biopsy of a lymph node has been the standard method of tissue sampling, providing ample tissue for assessment. However, this requires theatre time, and preceding fine-needle aspiration cytology, which may incur a delay. With careful use of tissue, coupled with advances in immunohistochemical and molecular investigative techniques, core biopsy provides a possible alternative to traditional fine-needle aspiration and excisional biopsy...
December 5, 2016: Annals of the Royal College of Surgeons of England
https://www.readbyqxmd.com/read/27916738/a-review-of-the-recent-advances-in-antimicrobial-coatings-for-urinary-catheters
#14
REVIEW
Priyadarshini Singha, Jason Locklin, Hitesh Handa
: More than 75% of hospital-acquired or nosocomial urinary tract infections are initiated by urinary catheters, which are used during the treatment of 15-25% of hospitalized patients. Among other purposes, urinary catheters are primarily used for draining urine after surgeries and for urinary incontinence. During catheter-associated urinary tract infections, bacteria travel up to the bladder and cause infection. A major cause of catheter-associated urinary tract infection is attributed to the use of non-ideal materials in the fabrication of urinary catheters...
December 1, 2016: Acta Biomaterialia
https://www.readbyqxmd.com/read/27916655/allopurinol-as-a-therapeutic-option-in-cardiovascular-disease
#15
REVIEW
Osita N Okafor, K Farrington, Diana A Gorog
Epidemiological studies indicate that hyperuricaemia is an independent risk factor for cardiovascular disease. Alongside uric acid formation, increased xanthine oxidase activity also results in the formation of oxidative free radicals and superoxide particles. Oxidative stress significantly contributes to the development of cardiovascular disease, including endothelial cell dysfunction, atherosclerosis, vascular calcification and impaired myocardial energetics. Allopurinol, a competitive xanthine oxidase inhibitor, in addition to reducing serum uric acid levels, can act as a free radical scavenger...
December 1, 2016: Pharmacology & Therapeutics
https://www.readbyqxmd.com/read/27916365/efficacy-and-safety-of-innoseal-for-air-leak-after-pulmonary-resection-a-case-control-study
#16
Francesco Petrella, Alessandro Borri, Daniela Brambilla, Giorgio Calanca, Nicola Vezzani, Antonio Colantoni, Adolfo Gasparetto, Lorenzo Spaggiari
BACKGROUND: Prolonged air leak is one of the most common complications after lung surgery and the cause of prolonged hospital stay frequently associated with major postoperative morbidity and thus responsible for even higher hospital costs. This case-control study was designed to test the sealing efficacy and safety of Enable-Innoseal TP4 in patients undergoing pulmonary resection for lung cancer. METHODS: This was a case-control trial enrolling patients with primary or single site metastatic lung cancer scheduled for elective anatomic or nonanatomic pulmonary resection presenting intraoperative grade 1 or 2 air leak at water submersion test; the study group population was then matched 1:1 according to surgical procedure, male/female ratio, preoperative FEV1, and age...
November 2016: Journal of Surgical Research
https://www.readbyqxmd.com/read/27916364/the-cost-of-preventable-comorbidities-on-wound-complications-in-open-ventral-hernia-repair
#17
Tiffany C Cox, Laurel J Blair, Ciara R Huntington, Paul D Colavita, Tanushree Prasad, Amy E Lincourt, B Todd Heniford, Vedra A Augenstein
BACKGROUND: Patients with complex ventral hernias may benefit from preoperative optimization. This study evaluates the financial impact of preventable comorbidities (PCM) in elective open ventral hernia repair. METHODS: In this single institution prospectively collected data from 2007-2011, hospital charges (included all hernia-related visits, interventions, or readmissions) and wound-related complications in patients with PCM-diabetes, tobacco use, and obesity-were compared to patients without such risks using standard statistical methods...
November 2016: Journal of Surgical Research
https://www.readbyqxmd.com/read/27916081/-clinical-comparison-of-modified-laparoscopic-and-conventional-placement-of-peritoneal-dialysis-catheters
#18
Q D Tu, Q He, X G Shen, X X Jiang, Y M Liu, Q Q Shen, H J Zhang, W F Chen, L X Yao
Objective: To explore the clinical efficacy of the modified laparoscopic placement of peritoneal dialysis catheters by nephrologists. Methods: A total of 188 patients diagnosed as end-stage renal disease (ESRD) were enrolled, who received catheter and continuous ambulatory peritoneal dialysis (CAPD) therapy from January 2011 to May 2016 in Zhejiang Provincial People's Hospital. They were divided into group A (with modified laparoscopic placement of peritoneal dialysis catheters, n=59) and group B (with conventional placement of peritoneal dialysis catheter, n=129)...
November 29, 2016: Zhonghua Yi Xue za Zhi [Chinese medical journal]
https://www.readbyqxmd.com/read/27914501/levosimendan-in-patients-with-left-ventricular-systolic-dysfunction-undergoing-cardiac-surgery-on-cardiopulmonary-bypass-rationale-and-study-design-of-the-levosimendan-in-patients-with-left-ventricular-systolic-dysfunction-undergoing-cardiac-surgery-requiring
#19
Rajendra H Mehta, Sean Van Diepen, James Meza, Paula Bokesch, Jeffrey D Leimberger, Sandra Tourt-Uhlig, Merri Swartz, Jodi Parrotta, Rachael Jankowich, Douglas Hay, Robert W Harrison, Stephen Fremes, Shaun G Goodman, John Luber, Wolfgang Toller, Matthias Heringlake, Kevin J Anstrom, Jerrold H Levy, Robert A Harrington, John H Alexander
BACKGROUND: Low cardiac output syndrome is associated with increased mortality and occurs in 3% to 14% of patients undergoing cardiac surgery on cardiopulmonary bypass (CPB). Levosimendan, a novel calcium sensitizer and KATP channel activator with inotropic, vasodilatory, and cardioprotective properties, has shown significant promise in reducing the incidence of low cardiac output syndrome and related adverse outcomes in patients undergoing cardiac surgery on CPB. METHODS: LEVO-CTS is a phase 3 randomized, controlled, multicenter study evaluating the efficacy, safety, and cost-effectiveness of levosimendan in reducing morbidity and mortality in high-risk patients with reduced left ventricular ejection fraction (≤35%) undergoing cardiac surgery on CPB...
December 2016: American Heart Journal
https://www.readbyqxmd.com/read/27914123/extending-the-indications-for-autologous-breast-reconstruction-using-a-two-stage-modified-goldilocks-procedure-a-case-report
#20
Jean-Claude D Schwartz, Piotr P Skowronksi
Post-mastectomy reconstruction is performed using implant-based or autologous techniques. Many women refuse or are poor candidates for implant-based reconstruction. We previously described a single-stage autologous technique that was most applicable in obese women with significant ptosis that made use of the mastectomy skin flap and subcutaneous tissue to reconstruct a breast mound. Here, we extend this technique to smaller breasted women by incorporating a second stage of skin tailoring and fat grafting. This technique does not require donor site surgery nor extended operative and recovery times...
December 3, 2016: Breast Journal
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