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High Risk Surgery

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https://www.readbyqxmd.com/read/29045740/adding-vancomycin-to-perioperative-prophylaxis-decreases-deep-sternal-wound-infections-in-high-risk-cardiac-surgery-patients
#1
Sylvia Reineke, Thierry P Carrel, Verena Eigenmann, Brigitta Gahl, Urs Fuehrer, Christian Seidl, David Reineke, Eva Roost, Magi Bächli, Jonas Marschall, Lars Englberger
OBJECTIVES: Perioperative prophylaxis with cephalosporins reduces sternal wound infections (SWIs) after cardiac surgery. However, more than 50% of coagulase-negative staphylococci, an important pathogen, are cephalosporin resistant. The aim of this study was to determine the impact of adjunctive vancomycin on SWIs in high-risk patients. METHODS: We conducted a pre- and postintervention study in an academic hospital. Preintervention (2010-2011), all patients received prophylaxis with 1...
October 16, 2017: European Journal of Cardio-thoracic Surgery
https://www.readbyqxmd.com/read/29045263/diagnosis-of-axillary-web-syndrome-in-patients-after-breast-cancer-surgery-epidemiology-risk-factors-and-clinical-aspects-a-prospective-study
#2
Patricia V G Figueira, Cinira A S Haddad, Samantha K L de Almeida Rizzi, Gil Facina, Afonso C P Nazario
OBJECTIVES: Axillary web syndrome (AWS) is a complication after breast cancer surgery associated with the axillary approach. We defined a diagnosis tool as well as evaluated cord frequency, characteristics, and risk factors. METHODS: A prospective cohort study of 173 women followed-up at Breast Diseases Division of Universidade Federal de São Paulo between July 2014 and September 2015 was established as an evaluation protocol to diagnose AWS. Sociodemographic status, anthropometric values, range of motion, comorbidities, pain, cord frequency, and characteristics (localization, number, palpable, and/or visible) among other data were collected at different time points before and after surgery...
October 17, 2017: American Journal of Clinical Oncology
https://www.readbyqxmd.com/read/29044795/ahns-series-do-you-know-your-guidelines-perioperative-antithrombotic-management-in-head-and-neck-surgery
#3
Annika Meyer, Neil Gross, Marita Teng
Head and neck surgeons are commonly faced with surgical patients who have underlying medical problems requiring antithrombotic therapy. It is difficult to achieve a balance between minimizing the risk of thromboembolism and hemorrhage in the perioperative period. Data from randomized, controlled trials are limited, and procedure-specific bleed rates are also difficult to pinpoint. The decision is made more difficult when patients with moderate-to-high risk for thromboembolic events undergo procedures that are high risk for bleeding...
October 16, 2017: Head & Neck
https://www.readbyqxmd.com/read/29044598/comparison-of-common-risk-stratification-indices-to-predict-outcomes-among-stage-iv-cancer-patients-with-bowel-obstruction-undergoing-surgery
#4
Sarah B Bateni, Richard J Bold, Frederick J Meyers, Daniel J Canter, Robert J Canter
BACKGROUND AND OBJECTIVES: Among patients with disseminated malignancy (DMa), bowel obstruction is common with high operative morbidity. Since preoperative risk stratification is critical, we sought to compare three standard risk indices, the American Society of Anesthesiology (ASA) classification, Charlson comorbidity index (CCI), and modified frailty index (mFI). METHODS: We identified 1928 DMa patients with bowel obstruction who underwent an abdominal operation from 2007 to 2012 American College of Surgeons National Surgical Quality Improvement Program...
October 16, 2017: Journal of Surgical Oncology
https://www.readbyqxmd.com/read/29044289/preoperative-diagnostics-in-differentiated-thyroid-carcinoma
#5
Philipp Seifert, Martin Freesmeyer
AIM: The preoperative diagnosis of differentiated thyroid carcinomas (DTC) is particularly challenging in view of the high prevalence of thyroid nodules in the general population. Incidental diagnosis of DTC, on the other hand, can lead to reoperations and increased risk of morbidity. This study aimed to assess the prediction value of preoperative DTC dignity assessment and it's impact on surgical approaches. METHODS: We retrospectively reviewed 107 cases of DTC and subdivided them in three groups based on the preoperative dignity assessment: suspected malignancy (SM), unclear dignity (UD), and incidental findings (IF)...
October 18, 2017: Nuklearmedizin. Nuclear Medicine
https://www.readbyqxmd.com/read/29044057/clinicodemographic-profile-and-treatment-outcome-in-patients-of-ocular-surface-squamous-neoplasia
#6
Rachna Meel, Rebika Dhiman, Murugesan Vanathi, Neelam Pushker, Radhika Tandon, Saranya Devi
PURPOSE: The aim is to study the clinicodemographic profile and treatment outcome of ocular surface squamous neoplasia (OSSN). METHODS: This was a retrospective observational study of 57 eyes (56 cases) with clinically diagnosed OSSN, presenting in our center over the past year. RESULTS: The median age of presentation was 55 years with male:female ratio being 4.5:1. Systemic predisposing conditions were xeroderma pigmentosa (1) postkidney transplant immunosuppression (1), and human immunodeficiency virus infection (1)...
October 2017: Indian Journal of Ophthalmology
https://www.readbyqxmd.com/read/29043710/pregnancy-in-non-communicating-rudimentary-horn-of-a-unicornuate-uterus
#7
Mania Kaveh, Abolfazl Mehdizadeh Kashi, Kambiz Sadegi, Forough Forghani
Diagnosis and management of pre-rupture stage of the pregnant horn are difficult and usually missed on a routine ultrasound scan. Also most cases are detected after rupture of pregnant horn. We presented a 28-year-oldG2 L1 woman with diagnosis of rudimentary horn pregnancy (RHP) at 14 weeks of gestation. We diagnosed her with a normal intrauterine pregnancy, whereas a pregnancy in a right-sided non-communicating rudimentary horn with massive hemoperitoneum was later discovered on laparotomy. RHP has a high risk of death for mother, so there must be a strong clinical suspicion for the diagnosis of RHP...
January 2018: International Journal of Fertility & Sterility
https://www.readbyqxmd.com/read/29043692/-appendicitis-versus-nonspecific-acute-abdominal-pain-diagnostic-accuracy-of-ultrasound
#8
M Prada Arias, J L Vázquez, A Salgado Barreira, J Gómez Veiras, S García Saavedra, P Fernández Eire, M Montero Sánchez, J R Fernández Lorenzo
PURPOUSE: The aim of this study is to assess the diagnostic accuracy of ultrasound to differentiate appendicitis from nonspecific acute abdominal pain, that is the most common process requiring differential diagnosis in clinical practice. MATERIAL AND METHODS: Patients admitted for suspicion of appendicitis were prospectively evaluated in our hospital during two years (2013-2014). Cases of nonspecific acute abdominal pain and appendicitis assessed by ultrasound were enrolled in the study...
July 20, 2017: Cirugía Pediátrica: Organo Oficial de la Sociedad Española de Cirugía Pediátrica
https://www.readbyqxmd.com/read/29043245/intentional-partial-odontectomy-a-long-term-follow-up-study
#9
Hyun-Suk Kim, Pil-Young Yun, Young-Kyun Kim
BACKGROUND: The surgical extraction of the third molar is the most frequently encountered procedure in oral and maxillofacial surgery and is related with a variety of complications. This study examined the efficacy of intentional partial odontectomy (IPO) in the third molars which have no periapical lesions and are located near important anatomical structures such as inferior alveolar nerve. METHODS: Seven patients (four males, three females, 39.1 ± 11.6 years), who received IPO to reduce the risk of inferior alveolar nerve injury (IANI), were followed long-term...
December 2017: Maxillofacial Plastic and Reconstructive Surgery
https://www.readbyqxmd.com/read/29042927/novel-type-of-peritoneocentesis-trocar-assisted-distal-ventriculoperitoneal-shunt-placement-with-supervision-via-a-one-port-laparoscope
#10
Guangming Wang, Jinlu Yu, Yongxin Luan, Yanwu Han, Shuanglin Fu
Ventriculoperitoneal shunts (VPS) are the primary treatment for hydrocephalus and are associated with a high risk of complications, specifically in patients who are obese or have abdominal adhesions or shunt revisions. The present study describes the use of a novel type of peritoneal catheter peritoneocentesis trocar insertion with the assistance of a one-port laparoscope. A total of 36 patients with hydrocephalus underwent this novel type of peritoneocentesis trocar-assisted VPS. The distal shunt catheter was placed into the right subdiaphragmatic space and the catheter was traversed through a single hole drilled through the liver falciform ligament...
October 2017: Experimental and Therapeutic Medicine
https://www.readbyqxmd.com/read/29042377/effectiveness-and-meaningful-use-of-paediatric-surgical-safety-checklists-and-their-implementation-strategies-a-systematic-review-with-narrative-synthesis
#11
Janaka Lagoo, Steven R Lopushinsky, Alex B Haynes, Paul Bain, Helene Flageole, Erik D Skarsgard, Mary E Brindle
OBJECTIVE: To examine the effectiveness and meaningful use of paediatric surgical safety checklists (SSCs) and their implementation strategies through a systematic review with narrative synthesis. SUMMARY BACKGROUND DATA: Since the launch of the WHO SSC, checklists have been integrated into surgical systems worldwide. Information is sparse on how SSCs have been integrated into the paediatric surgical environment. METHODS: A broad search strategy was created using Pubmed, Embase, CINAHL, Cochrane Central, Web of Science, Science Citation Index and Conference Proceedings Citation Index...
October 16, 2017: BMJ Open
https://www.readbyqxmd.com/read/29042074/stereotactic-vacuum-assisted-breast-biopsy-comparison-between-11-and-8-gauge-needles
#12
Irene Ruggirello, Jacopo Nori, Isacco Desideri, Calogero Saieva, Elisabetta Giannotti, Giulia Bicchierai, Diego De Benedetto, Giulio Francolini, Simonetta Bianchi, Vania Vezzosi, Luis Sanchez, Tommaso Susini, Lorenzo Orzalesi, Icro Meattini, Lorenzo Livi, Vittorio Miele
PURPOSE: The 11-gauge (11G) stereotactic vacuum-assisted breast biopsy (VABB) showed a better profile than 14G-VABB in terms of feasibility, safety, microcalcification sampling, and accuracy. Underestimation rates were significantly lower with 11G-VABB than with 14G-VABB. Thus, the introduction of an even larger needle at the VABB procedure could reduce this rate further. The purpose of this study was to compare the overall performance of stereotactic VABB with 8G and 11G needles. MATERIALS AND METHODS: Four hundred and three VABBs performed between July 2012 and February 2015 at the Breast Diagnostic Unit of Careggi Hospital in Florence were retrospectively analyzed; 197 were performed with 11G-VABB and 206 with 8G-VABB...
October 6, 2017: European Journal of Surgical Oncology
https://www.readbyqxmd.com/read/29041948/effect-of-levosimendan-on-prognosis-in-adult-patients-undergoing-cardiac-surgery-a-meta-analysis-of-randomized-controlled-trials
#13
Qi-Hong Chen, Rui-Qiang Zheng, Hua Lin, Jun Shao, Jiang-Quan Yu, Hua-Ling Wang
BACKGROUND: Small trials suggest that levosimendan is associated with a favorable outcome in patients undergoing cardiac surgery. However, recently published larger-scale trials did not provide evidence for a similar benefit from levosimendan. We performed a meta-analysis to assess the survival benefits of levosimendan in patients undergoing cardiac surgery and to investigate its effects in subgroups of patients with preoperative low-ejection fraction (EF). METHODS: We identified randomized clinical trials through 20 April 2017 that investigated levosimendan therapy versus control in patients undergoing cardiac surgery...
October 17, 2017: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/29041831/postoperative-complications-after-lower-extremity-arterial-bypass-increase-the-risk-of-new-deep-venous-thrombosis
#14
Faisal Aziz, Erik Lehman, John Blebea, Fedor Lurie
Background Deep venous thrombosis after any surgical operations is considered a preventable complication. Lower extremity bypass surgery is a commonly performed operation to improve blood flow to lower extremities in patients with severe peripheral arterial disease. Despite advances in endovascular surgery, lower extremity arterial bypass remains the gold standard treatment for severe, symptomatic peripheral arterial disease. The purpose of this study is to identify the clinical risk factors associated with development of deep venous thrombosis after lower extremity bypass surgery...
January 1, 2017: Phlebology
https://www.readbyqxmd.com/read/29040800/ocriplasmin-for-symptomatic-vitreomacular-adhesion
#15
REVIEW
James E Neffendorf, Varo Kirthi, Edward Pringle, Timothy L Jackson
BACKGROUND: Symptomatic vitreomacular adhesion (sVMA) is a recognised cause of visual loss and by tradition has been managed by pars plana vitrectomy (PPV). A less invasive alternative to surgery in some people is enzymatic vitreolysis, using an intravitreal injection of ocriplasmin. OBJECTIVES: To assess the efficacy and safety of ocriplasmin compared to no treatment, sham or placebo for the treatment of sVMA. SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (which contains the Cochrane Eyes and Vision Trials Register) (2017, Issue 1), MEDLINE Ovid (1946 to 24 February 2017), Embase Ovid (1947 to 24 February 2017), PubMed (1946 to 24 February 2017), the ISRCTN registry (www...
October 17, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/29040130/volume-outcome-relationship-in-surgical-interventions-for-spinal-metastases
#16
Andrew J Schoenfeld, Marco L Ferrone, Daniel J Sturgeon, Mitchel B Harris
BACKGROUND: Surgery for spinal metastases is challenging and carries a high risk of perioperative morbidity and mortality. Procedures with such characteristics often exhibit a volume-outcome relationship. This has not been previously characterized for spinal metastasis surgery to our knowledge. METHODS: The Florida State Inpatient Database (2011 through 2014) was queried to identify patients who had undergone surgery for spinal metastases. Surgeon and hospital surgical volumes were compared with 90-day complication and readmission rates to develop procedural cut-points used to define high and low-volume providers...
October 18, 2017: Journal of Bone and Joint Surgery. American Volume
https://www.readbyqxmd.com/read/29039999/treatment-and-survival-of-childhood-neuroblastoma-evidence-from-a-population-based-study-in-the-united-states
#17
Dairmuid Coughlan, Matthew Gianferante, Charles F Lynch, Jennifer L Stevens, Linda C Harlan
BACKGROUND: Childhood neuroblastoma describes a heterogeneous group of extracranial solid tumors, that are treated per risk profile. We sought to describe treatment patterns and survival using population-based data from throughout the United States. MATERIALS AND METHODS: Using the National Cancer Institute (NCI)'s Patterns of Care data, we analyzed treatment provided to newly diagnosed, histologically confirmed neuroblastoma patients in 2010 and 2011, registered to one of 14 Surveillance, Epidemiology, and End Results (SEER) cancer registries...
October 17, 2017: Pediatric Hematology and Oncology
https://www.readbyqxmd.com/read/29039829/-factors-for-the-development-of-persistent-postoperative-cognitive-dysfunction-in-patients-undergoing-coronary-artery-bypass-surgery-under-extracorporeal-circulation
#18
O A Trubnikova, I V Tarasova, O V Maleva, E S Kagan, O L Barbarash, L S Barbarash
AIM: To analyze the factors contributing to the increased risk of persistent postoperative cognitive dysfunction (POCD) in patients undergoing coronary artery bypass surgery (CABS) under extracorporeal circulation (EC). SUBJECTS AND METHODS: 257 male patients aged 45 to 69 years with coronary heart disease (CHD) undergoing elective CABS under EC were examined. In addition to conventional clinical examination, all the patients underwent neuropsychological testing 3-5 days before, 7-14 days and 1 year after CABS...
2017: Terapevticheskiĭ Arkhiv
https://www.readbyqxmd.com/read/29039828/-clinical-laboratory-and-instrumental-criteria-for-myocarditis-established-in-comparison-with-myocardial-biopsy-a-non-invasive-diagnostic-algorithm
#19
O V Blagova, Yu V Osipova, A V Nedostup, E A Kogan, V A Sulimov
AIM: To determine the diagnostic value of different clinical, laboratory, and instrumental signs in the diagnosis of myocarditis in patients with the picture of idiopathic arrhythmias, dilated cardiomyopathy (DCM) and in a comparison group when comparing with myocardial morphological examination. SUBJECTS AND METHODS: A study group included 100 patients (35 women; mean age, 44.7±12.5 years) with idiopathic arrhythmias (n=20) and DCM as a syndrome (n=100). All underwent myocardial morphological examination: endomyocardial biopsy (EMB) (n=71), intraoperative biopsy (n=13), study of the explanted heart (n=6), and autopsy (n=11)...
2017: Terapevticheskiĭ Arkhiv
https://www.readbyqxmd.com/read/29039725/high-risk-breast-lesions-a-machine-learning-model-to-predict-pathologic-upgrade-and-reduce-unnecessary-surgical-excision
#20
Manisha Bahl, Regina Barzilay, Adam B Yedidia, Nicholas J Locascio, Lili Yu, Constance D Lehman
Purpose To develop a machine learning model that allows high-risk breast lesions (HRLs) diagnosed with image-guided needle biopsy that require surgical excision to be distinguished from HRLs that are at low risk for upgrade to cancer at surgery and thus could be surveilled. Materials and Methods Consecutive patients with biopsy-proven HRLs who underwent surgery or at least 2 years of imaging follow-up from June 2006 to April 2015 were identified. A random forest machine learning model was developed to identify HRLs at low risk for upgrade to cancer...
October 17, 2017: Radiology
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