- Surgical Management After Hysteroscopic Sterilization: Minimally Invasive Approach Incorporating Intraoperative Fluoroscopy for Symptomatic Patients with >2 Essure® Devices. [Journal Article]
- STSurg Technol Int 2018 Jun 01; 32:156-161
- CONCLUSIONS: Patients with more than two Essure® devices comprise an unusual group with a complex pelvic foreign body presentation. This is the first report on surgical management for such patients, underscoring the importance of localizing these contraceptive devices with careful imaging before, during, and after surgery. Moreover, hysterectomy is not absolutely mandatory in this setting and intraoperative fluoroscopy/radiography can facilitate complete, safe removal of all implants on an out-patient basis. Creation of ICD-10 modifiers for various post-HS complaints would allow for improved surveillance of the Essure® phenomenon.
- [APPLICATION OF POSTEROLATERAL APPROACH FOR TREATMENT OF BIMALLEOLAR AND TRIMALLEOLAR FRACTURES]. [Journal Article]
- ZXZhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2016 Dec 08; 30(12):1488-1492
- CONCLUSIONS: The single posterolateral approach could simultaneously expose the fragments of lateral malleolus and posterior malleolus, with less complication of the incision, short operation time, and clear exposure of posterior malleolus. The surgery could be performed under direct vision. It especially is suitable for bimalleolar and trimalleolar fractures with lateral malleolus and posterior malleolus.
- Anterior subtemporal approach for severe upper pontine hematomas: A report of 28 surgically treated cases. [Journal Article]
- JCJ Clin Neurosci 2018 May 17
- The efficacy and safety of surgery for patients with primary pontine hemorrhage (PPH) remain debatable. Twenty-eight consecutive patients with huge upper PPH were included in this study. They underwe...
The efficacy and safety of surgery for patients with primary pontine hemorrhage (PPH) remain debatable. Twenty-eight consecutive patients with huge upper PPH were included in this study. They underwent surgical management through a subtemporal approach between January 2009 and October 2013. We analyzed clinical and radiological parameters to assess the patient outcomes. The near-complete (>90%) evacuation rate was 67.9%, and there was no surgery-related death. The overall survival rate at 3 months was 64.3% (17/28), including 28.6% (8/28) with good function, 10.7% (3/28) with disability and 25% (7/28) in a vegetative state. The mortality rate was 35.7% (10/28). Preoperative hemorrhage volume (P = 0.019), preoperative (P = 0.017) and postoperative (P = 0.001) Glasgow coma scale (GCS) score, coma on admission (P = 0.001), ventricular extension (P = 0.001), preoperative mechanical ventilation (P = 0.001) and hydrocephalus (P = 0.007) were found to be statistically significant predictors for mortality on univariate analysis. On multivariate regression analysis, only GCS on admission and coma were found to be significant prognostic predictors. The subtemporal approach was found to be a safe method to treat upper PPH. Microsurgery may be beneficial for the treatment of PPH, but these results need further validation in a more comprehensive and comparative study. GCS on admission and coma were found to be the only significant prognostic predictors for mortality with multivariate regression analysis.
- Microsurgical clipping of ruptured anterosuperior-projecting anterior communicating artery aneurysms: how I do it. [Journal Article]
- WNWorld Neurosurg 2018 May 17
- In anterosuperior-projecting anterior communicating artery (ACoA) aneurysms, the aneurysm dome usually adheres to one or both proximal A2 segment, which may present technical difficulties. This video...
In anterosuperior-projecting anterior communicating artery (ACoA) aneurysms, the aneurysm dome usually adheres to one or both proximal A2 segment, which may present technical difficulties. This video demonstrates microsurgical clipping of a ruptured anterosuperior-projecting AComA aneurysm. A 52-year-old male presented with a Hunt-Hess grade II subarachnoid hemorrhage (SAH). Computed tomography showed SAH in the basal cisterns, sylvian and interhemispheric fissures. Angiography demonstrated a wide-necked AComA aneurysm projecting anterosuperiorly. Considering the risk of recurrence, the patient decided to accept surgical treatment. The patient was positioned supine and the aneurysm was exposed via the lateral supraorbital approach. The carotid cistern and the optic cistern was opened to release cerebrospinal fluid (CSF) and achieve adequate brain relaxation. A subpial resection of a small portion of the gyrus rectus was performed to visualize the ipsilateral A2, the recurrent artery of Heubner and the base of the aneurysm. A plane was dissected between the anterior aspect of both A2 segment and the posterior aspect of the aneurysm. A straight clip was placed to parallel to the ACoA to completely obliterate the aneurysm. Postoperative angiography confirmed complete obliteration of the aneurysm. The patient recovered well without any complications. Successful treatment requires preoperative surgical planning, precise dissection, and preservation of critical structures. With adherence to these general principles, these aneurysms can be treated safely and effectively.
- Right Colon Resection for Colon Cancer: Does Surgical Approach Matter? [Journal Article]
- JLJ Laparoendosc Adv Surg Tech A 2018 May 18
- CONCLUSIONS: The laparoscopic approach to colon resection for colon cancer has lower 30-day morbidity compared to OS. The robotic approach is equivalent to the laparoscopic approach, and its utilization may increase in the future.
- Pure laparoscopic right hemihepatectomy using the caudodorsal side approach (with videos). [Journal Article]
- JHJ Hepatobiliary Pancreat Sci 2018 May 17
- CONCLUSIONS: Our standardized procedure of Lap-RH utilizing the unique laparoscopic caudodorsal view is not only feasible but also confers a true advantage of the laparoscopic approach. This article is protected by copyright. All rights reserved.
- [Practical aspects of anticoagulant therapy in patients with atrial fibrillation and arterial hypertension]. [Journal Article]
- KKardiologiia 2018 SJan; (S1):42-55
- Atrial fibrillation (AF) represents the most frequent sustained cardiac arrhythmia, the prevalence of AF is 1-2 % in the general population and up to 6 % for population over 80 years. Arterial hypert...
Atrial fibrillation (AF) represents the most frequent sustained cardiac arrhythmia, the prevalence of AF is 1-2 % in the general population and up to 6 % for population over 80 years. Arterial hypertension (AH) is the commonest background comorbidity in patients with AF. Patients with AF have 3-6‑fold increased risk of ischemic stroke in comparison to that in general population, additionally the presence of AH leads an 2-3‑fold increase in risk of subsequent stroke. Current clinical guidelines recommend long-time anticoagulant treatment for prevention of stroke and thromboembolic complications in majority of patients with confirmed AF. Not only does uncontrolled high blood pressure contribute to developing new-onset AF or AF progression but also can increase a bleeding risk related to oral anticoagulants. Patients with AF and concomitant AH resulting in target organ damage need for more favorable safety profile of oral anticoagulants. Instruction label dabigatran treatment in two doses can individualize approach to choice of long-term anticoagulation with lower risk of major bleeding in AF patients.
- How we diagnose and treat venous thromboembolism in sickle cell disease. [Journal Article]
- BloodBlood 2018 May 15
- The incidence of venous thromboembolism (VTE) in adult patients with sickle cell disease (SCD) is high. However, overlapping features between the clinical presentation of VTE and SCD complications an...
The incidence of venous thromboembolism (VTE) in adult patients with sickle cell disease (SCD) is high. However, overlapping features between the clinical presentation of VTE and SCD complications and a low index of suspicion for thrombosis can influence patient management decisions. VTE in SCD can therefore present management challenges to the clinical hematologist. Herein, we present three distinct clinical vignettes that are representative of our clinical practice with SCD patients. These vignettes are discussed with specific reference to the hypercoagulable state in SCD patients, recent VTE diagnosis and anticoagulant therapy guidelines from the general population, and evaluation of the risk of bleeding as a result of long term exposure to anticoagulant therapy. We examine current diagnostic and treatment options, highlight limitations of the existing clinical prognostic models that offer personalized guidance regarding the duration of anticoagulation, and propose a clinical approach to guide the decision to extend anticoagulation beyond 3 months.
- Patients receiving chiropractic care in a neurorehabilitation hospital: a descriptive study. [Journal Article]
- JMJ Multidiscip Healthc 2018; 11:223-231
- CONCLUSIONS: Patients suffered significant functional limitations and comorbidity resulting in modifications to the typical delivery of chiropractic care. Chiropractic services focused on relieving musculoskeletal pain and stiffness.
New Search Next
- Gastrointestinal stromal tumors: A multidisciplinary challenge. [Review]
- WJWorld J Gastroenterol 2018 May 14; 24(18):1925-1941
- Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors located in the alimentary tract. Its usual manifestation is gastrointestinal bleeding. However, small asymptomatic lesio...
Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors located in the alimentary tract. Its usual manifestation is gastrointestinal bleeding. However, small asymptomatic lesions are frequently detected as incidental finding. Characteristically, most GISTs (> 95%) are positive for the KIT protein (CD117) by IHC staining and approximately 80%-90% of GISTs carry a mutation in the c-KIT or PDGFRA genes. Mutational analysis should be performed when planning adjuvant and neoadjuvant therapy, due to its possible resistance to conventional treatment. The arise of tyrosine kinase inhibitor has supposed a revolution in GISTs treatment being useful as adjuvant, neoadjuvant or recurrence disease treatment. That is why a multidisciplinary approach to this disease is required. The correct characterization of the tumor at diagnosis (the diagnosis of recurrences and the evaluation of the response to treatment with tyrosine kinase inhibitors) is fundamental for facing these tumors and requires specialized Endoscopist, Radiologists and Nuclear Medicine Physician. Surgery is the only potentially curative treatment for suspected resectable GIST. In the case of high risk GISTs, surgery plus adjuvant Imatinib-Mesylate for 3 years is the standard treatment. Neoadjuvant imatinib-mesylate should be considered to shrink the tumor in case of locally advanced primary or recurrence disease, unresectable or potentially resectable metastasic tumors, and potentially resectable disease in complex anatomic locations to decrease the related morbidity. In the case of Metastatic GIST under Neoadjuvant treatment, when there are complete response, stable disease or limited disease progression, complete cytoreductive surgery could be a therapeutic option if feasible.