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guidelines for postoperative

Joseph A Ricci, Kayva Crawford, Olivia A Ho, Bernard T Lee, Ketan M Patel, Matthew L Iorio
BACKGROUND: Venous thromboembolism encompasses a spectrum of disease, ranging from asymptomatic deep vein thrombosis to fatal pulmonary embolism. As microsurgical techniques increase in complexity, the overriding benefit from a microsurgical versus a venous thromboembolism prophylactic regimen remains unclear. This study evaluated the current recommendations and procedure-specific strategies for venous thromboembolism prophylaxis with a focus on the utility of prophylaxis in microsurgical procedures...
November 2016: Plastic and Reconstructive Surgery
Mirjana Cihoric, Line Toft Tengberg, Morten Bay-Nielsen, Nicolai Bang Foss
BACKGROUND: With current literature quoting mortality rates up to 45%, emergency high-risk abdominal surgery has, compared with elective surgery, a significantly greater risk of death and major complications. The Surgical Apgar Score (SAS) is predictive of outcome in elective surgery, but has never been validated exclusively in an emergency setting. METHODS: A consecutive prospective single-center cohort study of 355 adults undergoing emergency high-risk abdominal surgery between June 2013 and May 2014 is presented...
October 24, 2016: Anesthesia and Analgesia
Pan Chi
The efficacy of laparoscopic total mesorectum excision (TME) has been confirmed by many clinical trials and guidelines. But two issues on laparoscopic TME are still questioned, including the integrity of specimen membrane of TME and the incidence of postoperative sexual dysfunction. According to my experiences and the primary results of the multicenter clinical trial (LASRE, identifier: NCT01899547) conducted by me, the integrity of the specimen membrane of laparoscopic TME is not inferior to the open TME...
October 25, 2016: Zhonghua Wei Chang Wai Ke za Zhi, Chinese Journal of Gastrointestinal Surgery
Joshua Park, Ethan Frank, Alfred Simental, Sara Yang, Christopher Vuong, Steve Lee, Pedro Andrade Filho
After thyroid surgery, protocols based on postoperative parathyroid hormone (PTH) levels may prevent symptoms of hypocalcemia, while avoiding unnecessary prophylactic calcium and/or vitamin D supplementation. We examined the value of an initial management protocol based solely on a single PTH level measured one hour after completion or total thyroidectomy to prevent symptomatic hypocalcemia by conducting a retrospective review of 697 consecutive patients treated from July 2003 to April 2015. The proportion of patients who developed symptomatic hypocalcemia was similar between those treated before (n = 155) and after (n = 542) implementation of this 1-hour PTH protocol (16...
October 2016: American Surgeon
Owain Thomas, Hampus Rein, Karin Strandberg, Ulf Schött
BACKGROUND: The risk of spinal haematoma in patients receiving epidural catheters is estimated using routine coagulation tests, but guidelines are inconsistent in their recommendations on what to do when results indicate slight hypocoagulation. Postoperative patients are prone to thrombosis, and thromboelastometry has previously shown hypercoagulation in this setting. We aimed to better understand perioperative haemostasis by comparing results from routine and advanced tests, hypothesizing that patients undergoing major upper gastrointestinal surgery would be deficient in vitamin K-dependent coagulation factors because of malnutrition, or hypocoagulative because of accumulation of low molecular weight heparin (LMWH)...
2016: Perioperative Medicine
Dénes Lukács, Nóra Stáczer, László Vajta, Lajos Olasz, Árpád Joób-Fancsaly, József Szalma
INTRODUCTION: In 2015 a new Hungarian guideline was published regarding dental treatment and management of anticoagulated patients in agreement of the Hungarian Association of Oral and Maxillofacial Surgeons and the Dental Implantology Association of Hungarian Dentists. AIM: The aim of the authors was to evaluate the efficiency and safety of local hemostatic measures recommended by the guideline in anticoagulated patients. METHOD: In these patients, postoperative bleeding episodes were examined after dental and oral surgical treatments, retrospectively...
October 2016: Orvosi Hetilap
Tommaso Cai, Paolo Verze, Alessandro Palmieri, Mauro Gacci, Paolo Lanzafame, Gianni Malossini, Gabriella Nesi, Gernot Bonkat, Florian M E Wagenlehner, Vincenzo Mirone, Riccardo Bartoletti, Truls E Bjerklund Johansen
OBJECTIVES: To evaluate whether it is always necessary to test for the presence of asymptomatic bacteriuria (AB) in patients undergoing urological surgical procedures and if present, to treat AB with antimicrobial prophylaxis. METHODS: All patients who underwent urological surgical procedures from December 2008 to October 2013 in a tertiary referral urological center were considered for this study. All patients received antimicrobial prophylaxis in line with European Association of Urology (EAU) guidelines on urological infections...
October 20, 2016: Urology
Samer G Zammar, Barbara A Pockaj, Chee Chee Stucky, Nabil Wasif, Richard J Gray
BACKGROUND: Cancer patients have a 4 to 7 fold increased risk of venous thromboembolism (VTE) vs the normal population. Chest guidelines recommend no chemical VTE prophylaxis for women with a <1.5% risk for VTE. Although the risk of VTE among women undergoing breast-conserving therapy is reported to be low overall, the rate without chemical prophylaxis has not been defined. The objective of the study was to establish the VTE risk among women undergoing breast-conserving surgery (BCS) who did not receive chemical VTE prophylaxis...
October 3, 2016: American Journal of Surgery
Ming-Jie Kuang, Chao Han, Jian-Xiong Ma, Fei Li, Jie Zhao, Lin Fu, Xin-Long Ma
PURPOSE: Autologous platelet gel, developed from fresh autologous blood, is a breakthrough in the promotion and acceleration of soft tissue and bone repair. The application of autologous platelet gel has been reported to improve haemostasis and promote function recovery. We screened the randomized controlled trials and controlled clinical trials of high quality to investigate whether autologous platelet gel makes a better performance for postoperative bleeding and functional recovery in patients after total knee arthroplasty...
October 19, 2016: International Journal of Surgery
Michael G White, Marc A Ward, Megan K Applewhite, Harry Wong, Vivek Prachand, Peter Angelos, Edwin L Kaplan, Raymon H Grogan
BACKGROUND: With over 110,000 bariatric operations performed in the United States annually, it is important to understand the biochemical abnormalities causing endocrine dysfunction associated with these procedures. Here we compare 2 malabsorptive procedures, duodenal switch and Roux-en-Y gastric bypass, to determine the role malabsorption plays in secondary hyperparathyroidism in this population. METHODS: Data from all super-obese patients undergoing duodenal switch or Roux-en-Y gastric bypass between August 2002 and October 2005 were prospectively collected...
October 18, 2016: Surgery
Ruchi Goel, Smriti Nagpal, Sushil Kumar, Ravi Meher, Saurabh Kamal, Sonam Garg
PURPOSE: To evaluate and compare the success rate of transcanalicular laser-assisted dacryocystorhinostomy with endonasal augmentation, with and without intubation, in patients suffering from primary acquired nasolacrimal duct obstruction, at 1 year of follow up. METHODS: A prospective, randomized interventional pilot study was conducted at a tertiary care center, in accordance with the guidelines of Declaration of Helsinki. Sixty eyes of 60 adult patients with primary acquired nasolacrimal duct obstruction were included...
October 20, 2016: Ophthalmic Plastic and Reconstructive Surgery
Christian Voigt, Andreas Schaller, Carsten Klöhn, Roger Scholz
PURPOSE: In revision total hip arthroplasty, until today, orthopaedic surgeons are missing evidence-based guidelines on cementless acetabular cup fixation. METHODS: 5 finite element models were generated featuring the following anchorage strategies: 1 short peg, 1 long peg, 2 long screws, 3 short screws and zero anchoring components for reference. The micromotions at the implant-bone interface were analyzed for 3 different loadcases, "Seated leg-crossing" (joint force 940 N, impingement force 750 N), "Normal gait" (joint force 1820 N), and "Stumbling" (joint force 4520 N)...
October 15, 2016: Hip International: the Journal of Clinical and Experimental Research on Hip Pathology and Therapy
Kathryn L Kreicher, Jeremy S Bordeaux
Importance: Cutaneous surgery is performed by otolaryngologists, plastic surgeons, oculoplastic surgeons, dermatologic surgeons, and some primary care physicians. Practice gaps exist among cutaneous surgeons, as do differences in how different physicians approach preoperative, intraoperative, and postoperative decision-making. Objective: To present the newest and best evidence to close common practice gaps in cutaneous surgery. Evidence Review: We performed a detailed search of peer-reviewed publications that were identified through a search of PubMed/MEDLINE (January 1, 2000, through June 30, 2016) using the literature search terms "cutaneous surgery," "Mohs micrographic surgery," "plastic surgery," in combination with "safety," "cost," "anesthesia," "anti-coagulation," "bleeding," "pain," "analgesia," "anxiety," or "infection," among others...
October 20, 2016: JAMA Facial Plastic Surgery
Giovanni Milito, Giorgio Lisi, Elena Aronadio, Michela Campanelli, Dario Venditti, Simona Grande, Michele Grande
BACKGROUNDS: Hemorrhoidectomy is considered the gold standard and the most effective and definitive treatment for grades 3 or 4 haemorrhoids, and Milligan-Morgan's and Ferguson's procedures are the most widely used techniques throughout the world. The aim of the study is to present our surgical technique using LigasureTM vessel sealing, focus on technical aspects and surgical tricks showing our results with a huge number of patients and a long-term follow-up. METHODS: Between June 2001 and June 2014 at the University Hospital of Tor Vergata, Rome, Italy, 1000 patients were selected to underwent LigaSureTM hemorrhoidectomy for III and IV degree haemorrhoids...
October 21, 2016: Minerva Gastroenterologica e Dietologica
T Apaydin, H M Ozkaya, F E Keskin, O A Haliloglu, K Karababa, S Erdem, P Kadioglu
PURPOSE: To determine the differences in acromegaly diagnosis, treatment, and follow-up among Turkish endocrinologists, and to investigate how the published guidelines are applied in clinical practice. METHODS: The questionnaire was formatted as an electronic survey, conducted between November and December 2015, and sent weekly for 6 weeks via e-mail to 528 endocrinologists in Turkey. RESULTS: The questionnaire was answered by 37.4 % of endocrinologists...
October 20, 2016: Journal of Endocrinological Investigation
Sarav S Shah, Alexander M Satin, James R Mullen, Sara Merwin, Mark Goldin, Nicholas A Sgaglione
BACKGROUND: Prior to 2012, the American Academy of Orthopaedic Surgeons (AAOS) and American College of Chest Physicians (ACCP) differed in their recommendations for postoperative pharmacologic venous thromboembolism prophylaxis (VTEP) after total joint arthroplasty. More specifically, aspirin (ASA) monotherapy was not endorsed by the ACCP as an acceptable prophylaxis. In 2012, the ACCP supported ASA monotherapy compared with no prophylaxis. Our aim was to investigate the impact of the convergence of ACCP and AAOS recommendations on surgeon prescribing patterns after knee arthroplasty (KA)...
October 20, 2016: Journal of Orthopaedic Surgery and Research
Sven Reuter, Andreas B Imhoff, Frank Martetschläger
BACKGROUND: The aim of this study was to systematically review the literature for the impact of rotator cuff tear (RCT) surgery on postoperative sporting activity in professional and recreational athletes. METHODS: To identify any published clinical study on return to sports data for athletes following rotator cuff surgery a systematic search in literature was conducted. Inclusion criteria were partial- and full-thickness rotator cuff tears and any open or arthroscopic RCT surgery in sports participating people...
October 20, 2016: Journal of Sports Medicine and Physical Fitness
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
Wei Yu, Wei Hu, Yongjie Shui, Xiaoyang Zhu, Chao Li, Xiaoqiu Ren, Xueli Bai, Risheng Yu, Li Shen, Tingbo Liang, Lei Zheng, Qichun Wei
OBJECTIVES: To explore the areas at highest risk for postoperative pancreatic cancer local recurrence according to the spatial location of local failures, with the aim to provide a precise target volume for pancreatic cancer adjuvant radiotherapy. METHODS: Patients with pancreatic cancer who had undergone surgery for the primary tumor in pancreas at our institution from January 2010 to August 2015 were retrospectively analyzed. All local recurrences were plotted on the computed tomography (CT) image of a representative patient according to their relative coordinates to superior mesenteric artery (SMA) or celiac axis (CA)...
October 19, 2016: Radiation Oncology
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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