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Surgical outcomes research

Rodrigo Antonio Rocha da Cruz Adry, Lucas Crociati Meguins, Sebastião Carlos da Silva Júnior, Carlos Umberto Pereira, Gerardo Maria de Araújo Filho, Lúcia Helena Neves Marques
BACKGROUND: Mesial temporal sclerosis (MTS) is the most common disease found in an epilepsy surgery series. Early age of onset, a history of febrile convulsions, epileptiform discharges on EEG, duration of epilepsy, number of generalized seizures and severity of psychiatric disorders are possible prognostic factors in patients with MTS. OBJECTIVE: The aim of this study is to review the clinical, semiotic, psychological, electrophysiological and neuroradiological researches and relate their findings to the prognosis of patients with MTS who underwent anteromedial temporal lobectomy (ATL)...
October 21, 2016: Acta Neurochirurgica
Christos Karagiannopoulos, Michael Sitler, Susan Michlovitz, Carole Tucker, Ryan Tierney
STUDY DESIGN: Prospective cohort study. INTRODUCTION: The active wrist joint position sense (JPS) test has been determined to be a clinically useful test for assessing wrist sensorimotor (SM) status after distal radius fracture (DRF). Its responsiveness is yet to be determined. PURPOSE OF THE STUDY: Primary study aim was to determine the active wrist JPS test responsiveness to detect change in wrist SM status at 8 and 12 weeks after DRF treatment intervention...
October 18, 2016: Journal of Hand Therapy: Official Journal of the American Society of Hand Therapists
Philip Tack, Jan Victor, Paul Gemmel, Lieven Annemans
BACKGROUND: Three-dimensional (3D) printing has numerous applications and has gained much interest in the medical world. The constantly improving quality of 3D-printing applications has contributed to their increased use on patients. This paper summarizes the literature on surgical 3D-printing applications used on patients, with a focus on reported clinical and economic outcomes. METHODS: Three major literature databases were screened for case series (more than three cases described in the same study) and trials of surgical applications of 3D printing in humans...
October 21, 2016: Biomedical Engineering Online
Matthew T Wilson, Sung-Kiang Chuang, Vincent B Ziccardi
PURPOSE: This study compared a type 1 collagen conduit (NeuraGen) with a porcine small intestinal submucosa conduit (AxoGuard) when used in lingual nerve microsurgery and any differences in achieving functional sensory recovery (FSR). PATIENTS AND METHODS: All patients who underwent lingual nerve microsurgery performed by 1 surgeon (V.B.Z.) from 2007 to 2014 had their surgical information obtained by a retrospective review of hospital records and office charts after institutional review board approval...
September 22, 2016: Journal of Oral and Maxillofacial Surgery
Rupert M Pearse, Tom E Abbott, Richard Haslop, Tahania Ahmad, Brennan C Kahan, Claudia Filipini, Andrew Rhodes, Marco Ranieri
BACKGROUND: Over 300 million patients undergo surgery worldwide each year. Postoperative morbidity - particularly respiratory complications - are most frequent and severe among high-risk patients undergoing major abdominal surgery. However, standard treatments, like physiotherapy or supplemental oxygen, often fail to prevent these. Preliminary research suggests that prophylactic continuous positive airways pressure (CPAP) can reduce the risk of postoperative respiratory complications...
October 20, 2016: Minerva Anestesiologica
Colleen Tewksbury, Noel N Williams, Kristoffel R Dumon, David B Sarwer
Bariatric surgery is the most robust treatment for extreme obesity. The impact of preoperative medical weight management sessions designed, in theory, with the primary goal of promoting preoperative weight loss, is unclear. This paper reviews studies that have investigated the relationship between preoperative weight loss and bariatric surgical outcomes, both with respect to postoperative weight loss and complications. We conclude that the most robust of preoperative interventions has not been implemented or evaluated in a manner which would conclusively assess the value of this element of care...
October 20, 2016: Obesity Surgery
Emily B Devine, Rafael Alfonso-Cristancho, N David Yanez, Todd C Edwards, Donald L Patrick, Cheryl A L Armstrong, Allison Devlin, Rebecca G Symons, Mark H Meissner, Ellen L T Derrick, Danielle C Lavallee, Larry G Kessler, David R Flum
Importance: Intermittent claudication (IC) is the most common presentation of infrainguinal peripheral artery disease. Both medical and revascularization interventions for IC aim to increase walking comfort and distance, but there is inconclusive evidence of the comparative benefit of revascularization given the possible risk of limb loss. Objective: To compare the effectiveness of a medical (walking program, smoking cessation counseling, and medications) vs revascularization (endovascular or surgical) intervention for IC in the community, focusing on outcomes of greatest importance to patients...
October 19, 2016: JAMA Surgery
Massimo Del Fabbro, Stefano Corbella, Patrick Sequeira-Byron, Igor Tsesis, Eyal Rosen, Alessandra Lolato, Silvio Taschieri
BACKGROUND: When primary root canal therapy fails, periapical lesions can be retreated with or without surgery. Root canal retreatment is a non-surgical procedure that involves removal of root canal filling materials from the tooth, followed by cleaning, shaping and obturating of the canals. Root-end resection is a surgical procedure that involves exposure of the periapical lesion through an osteotomy, surgical removal of the lesion, removal of part of the root-end tip, disinfection and, commonly, retrograde sealing or filling of the apical portion of the remaining root canal...
October 19, 2016: Cochrane Database of Systematic Reviews
Nebras M Warsi, Oliver Lasry, Adel Farah, Christine Saint-Martin, Jose L Montes, Jeffrey Atkinson, Jean-Pierre Farmer, Roy W R Dudley
PURPOSE: Three-tesla intraoperative MRI (iMRI) is a promising tool that could help confirm complete resections and disconnections in pediatric epilepsy surgery, leading to improved outcomes. However, a large proportion of epileptogenic pathologies in children are poorly defined on imaging, which brings into question the utility of iMRI for these cases. Our aim was to compare postoperative seizure outcomes between iMRI- and non-iMRI-based epilepsy surgeries. METHODS: We performed a comparative retrospective analysis of non-iMRI- versus iMRI-based epilepsy surgeries with 2-year follow-up...
October 18, 2016: Child's Nervous System: ChNS: Official Journal of the International Society for Pediatric Neurosurgery
Milan V Stevanovic, Vanessa G Cuéllar, Alidad Ghiassi, Frances Sharpe
: In the upper extremity, the latissimus dorsi muscle can be used as an ipsilateral rotational muscle flap for soft-tissue coverage or functional reconstruction of arm and elbow. Patients who have both major soft-tissue loss and functional deficits can be successfully treated with a single-stage functional latissimus dorsi rotational muscle transfer that provides simultaneous soft-tissue coverage and functional reconstruction. METHODS: Our data base was queried for all patients undergoing a rotational latissimus dorsi muscle transfer for simultaneous soft-tissue coverage and functional reconstruction of elbow flexion...
September 2016: Plastic and Reconstructive Surgery. Global Open
Michael S Crowell, Erik A Dedekam, Michael R Johnson, Scott C Dembowski, Richard B Westrick, Donald L Goss
BACKGROUND: While advanced diagnostic imaging is a large contributor to the growth in health care costs, direct-access to physical therapy is associated with decreased rates of diagnostic imaging. No study has systematically evaluated with evidence-based criteria the appropriateness of advanced diagnostic imaging, including magnetic resonance imaging (MRI), when ordered by physical therapists. The primary purpose of this study was to describe the appropriateness of magnetic resonance imaging (MRI) or magnetic resonance arthrogram (MRA) exams ordered by physical therapists in a direct-access sports physical therapy clinic...
October 2016: International Journal of Sports Physical Therapy
Marco Ranucci, Ekaterina Baryshnikova, Valeria Pistuddi, Lorenzo Menicanti, Alessandro Frigiola
OBJECTIVES: Postoperative bleeding in cardiac surgery remains an important complication, leading to increased morbidity and mortality. Different interventions are possible to prevent/treat postoperative bleeding. The present study aims to investigate the effectiveness of these interventions in a real-world scenario. METHODS: This is a retrospective study based on 19 670 consecutive adult cardiac surgery patients operated from 2000 to 2015. During the study period, the following interventions have been applied and tested for effectiveness with a before versus after analysis: thromboelastography (TEG)-based diagnosis and treatment in actively bleeding patients; platelet function tests (PFTs); timing of surgery based on PFTs; fresh frozen plasma (FFP)-free strategy using prothrombin complex concentrate and fibrinogen concentrate...
October 17, 2016: Interactive Cardiovascular and Thoracic Surgery
H H G Handoll, S D Brealey, L Jefferson, A Keding, A J Brooksbank, A J Johnstone, J J Candal-Couto, A Rangan
OBJECTIVES: Accurate characterisation of fractures is essential in fracture management trials. However, this is often hampered by poor inter-observer agreement. This article describes the practicalities of defining the fracture population, based on the Neer classification, within a pragmatic multicentre randomised controlled trial in which surgical treatment was compared with non-surgical treatment in adults with displaced fractures of the proximal humerus involving the surgical neck...
October 2016: Bone & Joint Research
S J van Rooijen, D Huisman, M Stuijvenberg, J Stens, R M H Roumen, F Daams, G D Slooter
BACKGROUND: Colorectal anastomotic leakage (CAL) is a major surgical complication in intestinal surgery. Despite many optimizations in patient care, the incidence of CAL is stable (3-19%) [1]. Previous research mainly focused on determining patient and surgery related risk factors. Intraoperative non-surgery related risk factors for anastomotic healing also contribute to surgical outcome. This review offers an overview of potential modifiable risk factors that may play a role during the operation...
October 15, 2016: International Journal of Surgery
Zaheed Damani, Gail MacKean, Eric Bohm, Brie DeMone, Brock Wright, Tom Noseworthy, Jayna Holroyd-Leduc, Deborah A Marshall
BACKGROUND: Policy dialogues are critical for developing responsive, effective, sustainable, evidence-informed policy. Our multidisciplinary team, including researchers, physicians and senior decision-makers, comprehensively evaluated The Winnipeg Central Intake Service, a single-entry model in Winnipeg, Manitoba, to improve patient access to hip/knee replacement surgery. We used the evaluation findings to develop five evidence-informed policy directions to help improve access to scheduled clinical services across Manitoba...
October 18, 2016: Health Research Policy and Systems
Chih-Cheng Luo, Kuang-Fu Cheng, Chen-Sheng Huang, Hung-Chieh Lo, Sheng-Mao Wu, Hung-Chang Huang, Wen-Kuei Chien, Ray-Jade Chen
BACKGROUND: In this study, we studied the therapeutic effectiveness of percutaneous drainage with antibiotics and the need for an interval appendectomy for treating appendiceal abscess in children with a research-oriented dataset released by the Bureau of National Health Insurance in Taiwan through the Collaboration Center for Health Information Application (CCHIA). METHODS: We identified 1225 patients under 18 years of age who had non-surgical treatment for an appendiceal abscess between 2007 and 2012 in a Taiwan CCHIA dataset...
October 18, 2016: BMC Surgery
James Lee Pace
Pediatric and adolescent forearm fractures continue to present treatment challenges. Despite high-level evidence to the contrary, traditional guidelines for nonsurgical treatment have been challenged in favor of surgical intervention, but it is unclear if this results in improved outcomes. Recent evidence suggests that certain open fractures in children may be successfully treated nonsurgically. Good results have been achieved with closed reduction and appropriate casting and clinical follow-up. Further research investigating functional outcomes into adulthood is needed...
November 2016: Journal of the American Academy of Orthopaedic Surgeons
Ahmad Alenezi, Giacomo Novara, Alexander Mottrie, Salah Al-Buheissi, Omer Karim
Nephron-sparing surgery for the removal of small renal masses delivers equivalent oncological outcomes and better functional outcomes compared with those associated with radical nephrectomy. All contemporary partial nephrectomy techniques including open, laparoscopic and robotic approaches involve the use of hilar clamping in order to facilitate haemostasis, and to enable accurate tumour excision and parenchymal reconstruction. Zero ischaemia was subsequently introduced as a technique to eliminate the renal ischaemia induced by hilar clamping...
October 18, 2016: Nature Reviews. Urology
Scott L Zuckerman, Ilya Laufer, Arjun Sahgal, Yoshiya J Yamada, Meic H Schmidt, Dean Chou, John H Shin, Naresh Kumar, Daniel M Sciubba
STUDY DESIGN: Systematic review. OBJECTIVE: The aim of this study was to review the techniques, indications, and outcomes of minimally invasive surgery (MIS) and separation surgery with subsequent radiosurgery in the treatment of patients with metastatic spine disease. SUMMARY OF BACKGROUND DATA: The utilization of MIS techniques in patients with spine metastases is a growing area within spinal oncology. Separation surgery represents a novel paradigm where radiosurgery provides long-term control after tumor is surgically separated from the neural elements...
October 15, 2016: Spine
Tamir Ailon, Radmehr Torabi, Charles G Fisher, Laurence D Rhines, Michelle J Clarke, Chetan Bettegowda, Stefano Boriani, Yoshiya J Yamada, Norio Kawahara, Peter P Varga, John H Shin, Arjun Saghal, Ziya L Gokaslan
STUDY DESIGN: Systematic review. OBJECTIVE: To determine evidence-based guidelines for the management of locally recurrent spinal chordoma. SUMMARY OF BACKGROUND DATA: Chordoma of the spine is a low-grade malignant tumor with a strong propensity for local recurrence. Salvage therapy is challenging due to its relentless nature and refractoriness to adjuvant therapies. There are currently no guidelines regarding the best management of recurrent chordoma...
October 15, 2016: Spine
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